This document provides information about a continuing education activity on anabolic-androgenic steroids for physicians, physician assistants, and nurse practitioners. The activity is intended to last 1 hour and provide the latest information on detecting steroid use, educating patients, and public awareness efforts. The faculty includes experts from A.T. Still University and adjunct instructors. Physicians can earn 0.75 AMA PRA Category 1 credits for completing a post-test with a score of 70% or higher. The activity discusses the prevalence of steroid use, associated health risks and benefits, and the importance of prevention efforts.
This document summarizes evidence from randomized controlled trials on the use of complementary health approaches for pain management in the United States. It examines trials of acupuncture, massage therapy, osteopathic manipulative therapy, relaxation techniques, natural supplements, tai chi, and yoga for managing chronic low back pain, osteoarthritis, neck pain, and headaches. The trials generally found modest benefits of these approaches for pain relief and functional improvement compared to usual care or placebo, with few reported adverse effects. Larger and longer trials are still needed to provide more definitive evidence.
Defining What is Value-Based Care for Patients with Relapsed/Refractory Chro...Carevive
The target audiences for these activities are hematologists, medical oncologists, pulmonologists, pathologists, physician assistants, nurse practitioners, registered nurses, oncology nurses, nurse navigators, palliative/symptom management teams who care for patients with chronic lymphocytic leukemia (CLL) and quality administrators responsible for their cancer center’s adherence to value-based care delivery models.
This practice parameter from the American Academy of Child and Adolescent Psychiatry provides guidelines for the appropriate use of psychotropic medications in children and adolescents. It outlines best practice principles for conducting psychiatric and medical evaluations, developing treatment and monitoring plans, obtaining consent, implementing medication trials, managing nonresponse, and discontinuing medications. The goal is to promote the safe and effective use of psychotropic medications for psychiatric disorders in children while reducing inappropriate or ineffective prescriptions.
Outcomes research examines the end results of healthcare provided to patients and uses this information to provide scientific evidence to help clinicians and patients make informed healthcare decisions. It aims to include subjective patient-reported outcomes like quality of life that were previously excluded from traditional clinical research. Two key organizations that conduct outcomes research are the Patient-Centered Outcomes Research Institute (PCORI), which funds research to help patients make healthcare choices based on desired outcomes, and the Agency for Healthcare Research and Quality (AHRQ), which develops knowledge and measures to improve patient safety and healthcare quality. While outcomes research provides important patient-centered data, limitations include potential reluctance to share private information and variability in how patients perceive symptoms and treatment impact.
A Catalyst For Transforming Health Systems And Person-Centred Care Canadian ...Becky Gilbert
This document presents a Canadian national position statement on patient-reported outcomes (PROs) from a steering committee of PRO experts.
The key points are:
1. PROs capture the patient perspective on health and quality of life and can improve care, but their use is not consistent in Canada. This position statement aims to support greater PRO implementation.
2. The position statement was developed through an expert consensus process and stakeholder feedback. It contains recommendations in 4 areas: patients and families, health policy, clinical implementation, and research.
3. The overarching recommendations are that resources should be invested to integrate PROs into care, a national PRO body is needed for guidance, and PRO tools must
Web only rx16 pdmp-tues_330_1_kreiner_2ringwalt-schiroOPUNITE
This document discusses three projects in North Carolina aimed at reducing harm from prescription drug abuse: 1) Identifying prescribers who prescribe very high levels of controlled substances using PDMP data and algorithms, in partnership with state agencies and the medical board. 2) Identifying prescribers with multiple patients who died from opioid-related overdoses. 3) Providing immediate feedback to prescribers on high-risk patients through electronic health records integrated with PDMP data, in partnership with health systems. The goals are to develop valid methods to identify problematic prescribing patterns using multiple data sources and address technical and policy hurdles to information sharing.
This document summarizes evidence from randomized controlled trials on the use of complementary health approaches for pain management in the United States. It examines trials of acupuncture, massage therapy, osteopathic manipulative therapy, relaxation techniques, natural supplements, tai chi, and yoga for managing chronic low back pain, osteoarthritis, neck pain, and headaches. The trials generally found modest benefits of these approaches for pain relief and functional improvement compared to usual care or placebo, with few reported adverse effects. Larger and longer trials are still needed to provide more definitive evidence.
Defining What is Value-Based Care for Patients with Relapsed/Refractory Chro...Carevive
The target audiences for these activities are hematologists, medical oncologists, pulmonologists, pathologists, physician assistants, nurse practitioners, registered nurses, oncology nurses, nurse navigators, palliative/symptom management teams who care for patients with chronic lymphocytic leukemia (CLL) and quality administrators responsible for their cancer center’s adherence to value-based care delivery models.
This practice parameter from the American Academy of Child and Adolescent Psychiatry provides guidelines for the appropriate use of psychotropic medications in children and adolescents. It outlines best practice principles for conducting psychiatric and medical evaluations, developing treatment and monitoring plans, obtaining consent, implementing medication trials, managing nonresponse, and discontinuing medications. The goal is to promote the safe and effective use of psychotropic medications for psychiatric disorders in children while reducing inappropriate or ineffective prescriptions.
Outcomes research examines the end results of healthcare provided to patients and uses this information to provide scientific evidence to help clinicians and patients make informed healthcare decisions. It aims to include subjective patient-reported outcomes like quality of life that were previously excluded from traditional clinical research. Two key organizations that conduct outcomes research are the Patient-Centered Outcomes Research Institute (PCORI), which funds research to help patients make healthcare choices based on desired outcomes, and the Agency for Healthcare Research and Quality (AHRQ), which develops knowledge and measures to improve patient safety and healthcare quality. While outcomes research provides important patient-centered data, limitations include potential reluctance to share private information and variability in how patients perceive symptoms and treatment impact.
A Catalyst For Transforming Health Systems And Person-Centred Care Canadian ...Becky Gilbert
This document presents a Canadian national position statement on patient-reported outcomes (PROs) from a steering committee of PRO experts.
The key points are:
1. PROs capture the patient perspective on health and quality of life and can improve care, but their use is not consistent in Canada. This position statement aims to support greater PRO implementation.
2. The position statement was developed through an expert consensus process and stakeholder feedback. It contains recommendations in 4 areas: patients and families, health policy, clinical implementation, and research.
3. The overarching recommendations are that resources should be invested to integrate PROs into care, a national PRO body is needed for guidance, and PRO tools must
Web only rx16 pdmp-tues_330_1_kreiner_2ringwalt-schiroOPUNITE
This document discusses three projects in North Carolina aimed at reducing harm from prescription drug abuse: 1) Identifying prescribers who prescribe very high levels of controlled substances using PDMP data and algorithms, in partnership with state agencies and the medical board. 2) Identifying prescribers with multiple patients who died from opioid-related overdoses. 3) Providing immediate feedback to prescribers on high-risk patients through electronic health records integrated with PDMP data, in partnership with health systems. The goals are to develop valid methods to identify problematic prescribing patterns using multiple data sources and address technical and policy hurdles to information sharing.
The document discusses medication errors and the need for a comprehensive approach to reduce preventable errors. It reports that at least 1.5 million preventable adverse drug events occur each year in the US, costing $3.5 billion annually. The National Centers for Education and Research on Therapeutics (CERTS) were established to conduct research and provide education to optimize drug use, reduce errors and adverse events, and improve patient outcomes and health. CERTS focuses on research and web-based education for professionals and consumers around safe medication use.
The survey of over 2,800 undergraduate students at UC Irvine found:
1) 35% had used some form of CAM in the past 12 months, and over 90% believed CAM can be effective. However, only 31% had received prior education on CAM.
2) The most common CAM therapies used were supplements, massage, body movement like yoga, herbal medicine, and traditional Chinese medicine.
3) Factors associated with higher CAM use included being female, Asian ethnicity, and having prior CAM education. Most students said they would be interested in CAM courses if they fulfilled graduation requirements or were in their major.
4) The study supports that education is a key factor in CAM use decisions
ChiropracticAndManualTherapies.ArticleDr. Zara Ali
This survey of chiropractors in Saskatchewan found that:
1) All respondents provide nutritional advice to patients and nearly all (99%) provide dietary supplement recommendations.
2) The most commonly recommended supplements were glucosamine sulfate, multivitamins, vitamin C, vitamin D, calcium, omega-3 fatty acids, and probiotics.
3) Respondents generally recommend supplements for conditions related to bone, joint, and muscle health like arthritis, as well as for general health and wellness.
Outcomes research examines the end results of health services on individuals and is intended to provide scientific evidence relating to decisions made by all who participate in health care. This presentation examines two leading organizations in outcomes research: the Agency for Healthcare Research and Quality (AHRQ) and the Patient Centered Outcomes Research Institute (PCORI). AHRQ funds research to improve quality and safety, focusing on priority populations like children and the elderly. PCORI funds research allowing patients and providers to make informed decisions, with mental/behavioral health being the most studied condition. While outcomes research considers patient preferences, it is difficult to satisfy all patients regardless of efforts to provide evidence-based care.
Presentation of our curricular integration, Interprofessional approaches and Student Leader Training strategies in the second year of our 3 year SBIRT Training Grant.
The document discusses various topics related to physical therapy (PT) practice. It notes that in 2014, PTs can avoid PQRS penalties by reporting 3 quality measures for 50% of patients, and the number of measures required to receive bonuses will increase from 3 to 9. It also eliminates reporting via measures groups through claims. The document discusses focusing on developing quality measures for PT, payment models that promote value, and public policy initiatives to advance the role of PT in areas like disease management. It also discusses improving access, eliminating self-referral profits, and ensuring an adequate PT workforce.
systematic approach in answering Drug queries.pptxDrpradeepthi
1) The document outlines the steps in a systematic approach to answering drug information queries. This involves gathering background information on the requestor and patient, categorizing the question, developing a search strategy, evaluating the data found, and formulating a response.
2) Key steps include determining the requestor's profession and patient details if applicable, selecting relevant references based on the question category, prioritizing sources by likelihood of containing the answer, and critically analyzing findings in the context of the inquiry.
3) The goal is to efficiently provide an accurate, unbiased response by following a standardized process for clarifying the request, searching appropriately for the answer, and synthesizing the data.
The document provides information about Drug Information Centres (DIC). It defines a DIC as a service that provides advice and refers queries about drugs to appropriate resources. DICs aim to promote evidence-based practice and improve patient care. They classify DICs as hospital-based, industry-based, or community-based. Clinical pharmacists working in DICs provide written or verbal drug information to healthcare professionals and patients. They respond to queries about various drug attributes like indications, dosages, interactions and side effects. When answering drug information questions, pharmacists gather background details, clarify the question, search multiple sources for relevant data, interpret the findings and formulate an appropriate response to address the query.
Rheumatoid arthritis is a chronic inflammatory disease that causes pain, swelling, and loss of function in the joints. It affects around 1-3% of the population worldwide and is three times more common in women than men. The disease involves inflammation of the synovium and destruction of articular cartilage and bone over time. Clinical features include symmetric polyarthritis of small joints in hands and feet, morning stiffness lasting over 30 minutes, and systemic symptoms like fever. Diagnosis is based on clinical features and confirmation with serological tests for rheumatoid factor or imaging tests showing erosions. Long-term treatment aims to reduce inflammation and prevent joint damage.
Article critique assignment course drugs and health (hlth 3honey690131
This document outlines an assignment for critiquing a research article on alcohol use among college students and their non-college peers. Students are asked to write a critique following a provided sample format, which includes summarizing the research problem, methods, conclusions, and overall critique. The assignment aims to help students evaluate research in health psychology. It will be graded based on several criteria such as application of course concepts, organization, and original analysis.
The document summarizes key topics covered in a Professional Capstone and Practicum course, as reflected in a student's journal. The journal addresses new practice approaches learned, including evidence-based practice and intraprofessional collaboration. It also discusses healthcare delivery systems, ethics, population health, the role of technology, health policy, leadership models, and health disparities. The student reflects on strengthening their cultural competence and how the course helped them meet competencies.
Outcomes research tests evidence-based interventions to see how they impact individuals, groups, and populations. It examines the effects on both patients and healthcare providers. The Patient Protection and Affordable Care Act, Accountable Care Organizations, Center for Medicare and Medicaid Services, Agency for Healthcare Research and Quality, and Patient Centered Outcomes Research Institute all play roles in outcomes research. Outcomes research can help improve patient care by identifying effective interventions and understanding different treatment outcomes. However, outcomes may differ based on patient demographics and reported data could be skewed.
Name olubunmi salako date 1262021identification of scenariojack60216
This document provides an annotated bibliography by Olubunmi Salako for a leadership and management in nursing course. It summarizes four sources that discuss various aspects of patient education, nursing standards, and healthcare policy. The sources examine how competency-based nursing curriculum and educational interventions can improve compliance with nursing standards. They also discuss how health policies and addressing social determinants can help reduce public health problems and disparities. The annotations provide details on the authors and relevance of each source to topics like patient education, nursing practice standards, and using policy to influence health outcomes.
1Copyright 2016 American Medical Association. All rights reser.docxfelicidaddinwoodie
1Copyright 2016 American Medical Association. All rights reserved.
Listening with
empathy
Save time, communicate more effectively and improve patient
and provider satisfaction
CME
CREDITS:
0.5
How will this module help me listen with empathy?
Eight STEPS to listening with empathy
Answers to frequently asked questions about empathetic listening
Tools and resources to help you and your team
1
2
3
Neeraj H. Tayal, MD, FACP
The Ohio State University Wexner
Medical Center
2Copyright 2016 American Medical Association. All rights reserved.
Increasing administrative responsibilities—due to regulatory pressures
and evolving payment and care delivery models—reduce the amount of
time physicians spend delivering direct patient care. When empathetic
listening is used in health care, patients and families are more satisfied
and more open to hearing their physician’s advice. Practicing empathy
can save time and effectively defuse difficult situations. By forging deeper
connections with patients, physicians can experience greater professional
satisfaction and joy in work.
Listening with empathy
Release Date: August 31, 2016
End Date: August 31, 2019
Objectives
At the end of this activity, participants will be able to:
Identify the benefits of listening with empathy.
Demonstrate techniques on how best to listen for underlying feelings,
needs or values.
Reflect on conversations and refine techniques as necessary.
Target Audience
This activity is designed to meet the educational needs of practicing
physicians.
Statement of Need
Studies have shown that physician empathy is an essential attribute of
the patient-physician relationship and is associated with better outcomes,
greater patient safety and fewer malpractice claims. However, due to the
rigorous amount of education physicians already need to go through,
communication skills training has traditionally received less attention. This
module provides physicians the training on how to demonstrate empathy
to patients in their practice.
Statement of Competency
This activity is designed to address the following ABMS/ACGME
competencies: practice-based learning and improvement, interpersonal
and communications skills, professionalism, systems-based practice and
also address interdisciplinary teamwork and quality improvement.
Accreditation Statement
The American Medical Association is accredited by the Accreditation
Council for Continuing Medical Education to provide continuing medical
education for physicians.
Credit Designation Statement
The American Medical Association designates this enduring material for
a maximum of 0.5 AMA PRA Category 1 Credit™. Physicians should claim
only the credit commensurate with the extent of their participation in the
activity.
Claiming Your CME Credit
To claim AMA PRA Category 1 Credit™, you must 1) view the module
content in its entirety, 2) successfully complete the quiz answering 4 out
of 5 questions c ...
How To Get Your Research Published in the BMJbmjslides
The document provides guidance for researchers on publishing their work, including choosing an appropriate journal, writing different sections of a research paper, and dealing with peer review and editorial processes. It discusses what editors look for in submissions and emphasizes the importance of transparency, ethics, and properly attributing contributions and conflicts of interest.
Assessing Benefits and Harms of Opioid Therapy for Chr.docxfestockton
Assessing Benefits and
Harms of Opioid Therapy
for Chronic Pain
Clinician Outreach and
Communication Activity
(COCA) Call
August 3, 2016
Office of Public Health Preparedness and Response
Division of Emergency Operations
Accreditation Statements
CME: The Centers for Disease Control and Prevention is accredited by the Accreditation Council for Continuing Medical
Education (ACCME®) to provide continuing medical education for physicians. The Centers for Disease Control and Prevention
designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should only claim credit
commensurate with the extent of their participation in the activity.
CNE: The Centers for Disease Control and Prevention is accredited as a provider of Continuing Nursing Education by the
American Nurses Credentialing Center's Commission on Accreditation. This activity provides 1.0 contact hour.
IACET CEU: The Centers for Disease Control and Prevention is authorized by IACET to offer 1.0 CEU's for this program.
CECH: Sponsored by the Centers for Disease Control and Prevention, a designated provider of continuing education contact
hours (CECH) in health education by the National Commission for Health Education Credentialing, Inc. This program is
designed for Certified Health Education Specialists (CHES) and/or Master Certified Health Education Specialists (MCHES) to
receive up to 1.0 total Category I continuing education contact hours. Maximum advanced level continuing education contact
hours available are 0. CDC provider number 98614.
CPE: The Centers for Disease Control and Prevention is accredited by the Accreditation Council for Pharmacy Education as
a provider of continuing pharmacy education. This program is a designated event for pharmacists to receive 0.1 CEUs in
pharmacy education. The Universal Activity Number is 0387-0000-16-150-L04-P and enduring 0387-0000-16-150-H04-P course
category. Course Category: This activity has been designated as knowledge-based. Once credit is claimed, an unofficial
statement of credit is immediately available on TCEOnline. Official credit will be uploaded within 60 days on the NABP/CPE
Monitor
AAVSB/RACE: This program was reviewed and approved by the AAVSB RACE program for 1.0 hours of continuing education
in the jurisdictions which recognize AAVSB RACE approval. Please contact the AAVSB RACE Program at [email protected] if
you have any comments/concerns regarding this program’s validity or relevancy to the veterinary profession.
CPH: The Centers for Disease Control and Prevention is a pre-approved provider of Certified in Public Health (CPH)
recertification credits and is authorized to offer 1 CPH recertification credit for this program.
Continuing Education Disclaimer
CDC, our planners, presenters, and their spouses/partners wish to
disclose they have no financial interests or other relationships with
the manufacturers of commercial products, suppli ...
A New Perspective On Survival Outcomes In Multiple SclerosisJustin Knight
This document discusses new findings on survival outcomes in multiple sclerosis (MS) from international registries and databases. It summarizes that MS patients have a mean decrease in survival time of 6 to 12 years compared to the general population. A 21-year follow-up study of interferon beta-1b treatment showed that early treatment may positively impact long-term mortality rates in MS patients compared to delayed treatment. The findings suggest that early and continued disease-modifying treatment may improve long-term survival outcomes for individuals with MS.
Transforming Medicine Through Personalized Health Care at Ohio State Universi...Ryan Squire
The document describes Ohio State University Medical Center's vision to transform medicine through personalized health care. Their goal is to move from today's reactive, disease-based system to a proactive, wellness-based system using systems biology tools. They plan to create predictive, personalized, precise and preventive (P4) medicine through discovery platforms using omics data, modeling, and imaging. These platforms will be translated through diagnostics, devices, and targeted therapeutics. Applications include pilot programs, a personalized medicine collaborative, and accountable care organizations. The overall vision is to improve quality and lower costs through disruptive innovation and personalized strategic health plans.
Dr Dev Kambhampati | NCCAM- Exploring the Science of Complementary and Altern...Dr Dev Kambhampati
The National Center for Complementary and Alternative Medicine (NCCAM) 2011-2015 Strategic Plan outlines goals to advance research on CAM interventions over the next decade. NCCAM's goals are to: 1) Advance the science and practice of symptom management for conditions like pain that CAM is often used to treat; 2) Develop effective strategies for promoting health and well-being using CAM approaches; and 3) Provide objective evidence to enable better decision-making about CAM use and integration into healthcare. NCCAM's first decade of research investment has grown the evidence base on CAM safety and efficacy through clinical trials and basic research, influencing public use of certain CAM products and practices.
Writing Paper Background - Crumpled Writing Paper BAmber Ford
Writing Paper Background - Crumpled Writing Paper B
The document provides instructions for creating an account and submitting a request for writing assistance on the HelpWriting.net site. It outlines a 5 step process: 1) Create an account with email and password; 2) Complete a 10 minute order form with instructions, sources, and deadline; 3) Review bids from writers and choose one based on qualifications; 4) Review the completed paper and authorize payment if satisfied; 5) Request revisions until fully satisfied, with a refund option for plagiarized content. The document encourages choosing the site for original, high-quality writing assistance.
022 Essay Example Page 4 Narrative ThatsnotusAmber Ford
The document discusses Baron Montesquieu and his idea of separating government powers. It states that Montesquieu established the separation of the executive, legislative, and judicial branches in his work "De l'Esprit des Lois" in 1748. The separation of powers has been an integral part of constitutions. However, the separation of powers was never formally part of the framework of Britain's unwritten constitution.
The document discusses medication errors and the need for a comprehensive approach to reduce preventable errors. It reports that at least 1.5 million preventable adverse drug events occur each year in the US, costing $3.5 billion annually. The National Centers for Education and Research on Therapeutics (CERTS) were established to conduct research and provide education to optimize drug use, reduce errors and adverse events, and improve patient outcomes and health. CERTS focuses on research and web-based education for professionals and consumers around safe medication use.
The survey of over 2,800 undergraduate students at UC Irvine found:
1) 35% had used some form of CAM in the past 12 months, and over 90% believed CAM can be effective. However, only 31% had received prior education on CAM.
2) The most common CAM therapies used were supplements, massage, body movement like yoga, herbal medicine, and traditional Chinese medicine.
3) Factors associated with higher CAM use included being female, Asian ethnicity, and having prior CAM education. Most students said they would be interested in CAM courses if they fulfilled graduation requirements or were in their major.
4) The study supports that education is a key factor in CAM use decisions
ChiropracticAndManualTherapies.ArticleDr. Zara Ali
This survey of chiropractors in Saskatchewan found that:
1) All respondents provide nutritional advice to patients and nearly all (99%) provide dietary supplement recommendations.
2) The most commonly recommended supplements were glucosamine sulfate, multivitamins, vitamin C, vitamin D, calcium, omega-3 fatty acids, and probiotics.
3) Respondents generally recommend supplements for conditions related to bone, joint, and muscle health like arthritis, as well as for general health and wellness.
Outcomes research examines the end results of health services on individuals and is intended to provide scientific evidence relating to decisions made by all who participate in health care. This presentation examines two leading organizations in outcomes research: the Agency for Healthcare Research and Quality (AHRQ) and the Patient Centered Outcomes Research Institute (PCORI). AHRQ funds research to improve quality and safety, focusing on priority populations like children and the elderly. PCORI funds research allowing patients and providers to make informed decisions, with mental/behavioral health being the most studied condition. While outcomes research considers patient preferences, it is difficult to satisfy all patients regardless of efforts to provide evidence-based care.
Presentation of our curricular integration, Interprofessional approaches and Student Leader Training strategies in the second year of our 3 year SBIRT Training Grant.
The document discusses various topics related to physical therapy (PT) practice. It notes that in 2014, PTs can avoid PQRS penalties by reporting 3 quality measures for 50% of patients, and the number of measures required to receive bonuses will increase from 3 to 9. It also eliminates reporting via measures groups through claims. The document discusses focusing on developing quality measures for PT, payment models that promote value, and public policy initiatives to advance the role of PT in areas like disease management. It also discusses improving access, eliminating self-referral profits, and ensuring an adequate PT workforce.
systematic approach in answering Drug queries.pptxDrpradeepthi
1) The document outlines the steps in a systematic approach to answering drug information queries. This involves gathering background information on the requestor and patient, categorizing the question, developing a search strategy, evaluating the data found, and formulating a response.
2) Key steps include determining the requestor's profession and patient details if applicable, selecting relevant references based on the question category, prioritizing sources by likelihood of containing the answer, and critically analyzing findings in the context of the inquiry.
3) The goal is to efficiently provide an accurate, unbiased response by following a standardized process for clarifying the request, searching appropriately for the answer, and synthesizing the data.
The document provides information about Drug Information Centres (DIC). It defines a DIC as a service that provides advice and refers queries about drugs to appropriate resources. DICs aim to promote evidence-based practice and improve patient care. They classify DICs as hospital-based, industry-based, or community-based. Clinical pharmacists working in DICs provide written or verbal drug information to healthcare professionals and patients. They respond to queries about various drug attributes like indications, dosages, interactions and side effects. When answering drug information questions, pharmacists gather background details, clarify the question, search multiple sources for relevant data, interpret the findings and formulate an appropriate response to address the query.
Rheumatoid arthritis is a chronic inflammatory disease that causes pain, swelling, and loss of function in the joints. It affects around 1-3% of the population worldwide and is three times more common in women than men. The disease involves inflammation of the synovium and destruction of articular cartilage and bone over time. Clinical features include symmetric polyarthritis of small joints in hands and feet, morning stiffness lasting over 30 minutes, and systemic symptoms like fever. Diagnosis is based on clinical features and confirmation with serological tests for rheumatoid factor or imaging tests showing erosions. Long-term treatment aims to reduce inflammation and prevent joint damage.
Article critique assignment course drugs and health (hlth 3honey690131
This document outlines an assignment for critiquing a research article on alcohol use among college students and their non-college peers. Students are asked to write a critique following a provided sample format, which includes summarizing the research problem, methods, conclusions, and overall critique. The assignment aims to help students evaluate research in health psychology. It will be graded based on several criteria such as application of course concepts, organization, and original analysis.
The document summarizes key topics covered in a Professional Capstone and Practicum course, as reflected in a student's journal. The journal addresses new practice approaches learned, including evidence-based practice and intraprofessional collaboration. It also discusses healthcare delivery systems, ethics, population health, the role of technology, health policy, leadership models, and health disparities. The student reflects on strengthening their cultural competence and how the course helped them meet competencies.
Outcomes research tests evidence-based interventions to see how they impact individuals, groups, and populations. It examines the effects on both patients and healthcare providers. The Patient Protection and Affordable Care Act, Accountable Care Organizations, Center for Medicare and Medicaid Services, Agency for Healthcare Research and Quality, and Patient Centered Outcomes Research Institute all play roles in outcomes research. Outcomes research can help improve patient care by identifying effective interventions and understanding different treatment outcomes. However, outcomes may differ based on patient demographics and reported data could be skewed.
Name olubunmi salako date 1262021identification of scenariojack60216
This document provides an annotated bibliography by Olubunmi Salako for a leadership and management in nursing course. It summarizes four sources that discuss various aspects of patient education, nursing standards, and healthcare policy. The sources examine how competency-based nursing curriculum and educational interventions can improve compliance with nursing standards. They also discuss how health policies and addressing social determinants can help reduce public health problems and disparities. The annotations provide details on the authors and relevance of each source to topics like patient education, nursing practice standards, and using policy to influence health outcomes.
1Copyright 2016 American Medical Association. All rights reser.docxfelicidaddinwoodie
1Copyright 2016 American Medical Association. All rights reserved.
Listening with
empathy
Save time, communicate more effectively and improve patient
and provider satisfaction
CME
CREDITS:
0.5
How will this module help me listen with empathy?
Eight STEPS to listening with empathy
Answers to frequently asked questions about empathetic listening
Tools and resources to help you and your team
1
2
3
Neeraj H. Tayal, MD, FACP
The Ohio State University Wexner
Medical Center
2Copyright 2016 American Medical Association. All rights reserved.
Increasing administrative responsibilities—due to regulatory pressures
and evolving payment and care delivery models—reduce the amount of
time physicians spend delivering direct patient care. When empathetic
listening is used in health care, patients and families are more satisfied
and more open to hearing their physician’s advice. Practicing empathy
can save time and effectively defuse difficult situations. By forging deeper
connections with patients, physicians can experience greater professional
satisfaction and joy in work.
Listening with empathy
Release Date: August 31, 2016
End Date: August 31, 2019
Objectives
At the end of this activity, participants will be able to:
Identify the benefits of listening with empathy.
Demonstrate techniques on how best to listen for underlying feelings,
needs or values.
Reflect on conversations and refine techniques as necessary.
Target Audience
This activity is designed to meet the educational needs of practicing
physicians.
Statement of Need
Studies have shown that physician empathy is an essential attribute of
the patient-physician relationship and is associated with better outcomes,
greater patient safety and fewer malpractice claims. However, due to the
rigorous amount of education physicians already need to go through,
communication skills training has traditionally received less attention. This
module provides physicians the training on how to demonstrate empathy
to patients in their practice.
Statement of Competency
This activity is designed to address the following ABMS/ACGME
competencies: practice-based learning and improvement, interpersonal
and communications skills, professionalism, systems-based practice and
also address interdisciplinary teamwork and quality improvement.
Accreditation Statement
The American Medical Association is accredited by the Accreditation
Council for Continuing Medical Education to provide continuing medical
education for physicians.
Credit Designation Statement
The American Medical Association designates this enduring material for
a maximum of 0.5 AMA PRA Category 1 Credit™. Physicians should claim
only the credit commensurate with the extent of their participation in the
activity.
Claiming Your CME Credit
To claim AMA PRA Category 1 Credit™, you must 1) view the module
content in its entirety, 2) successfully complete the quiz answering 4 out
of 5 questions c ...
How To Get Your Research Published in the BMJbmjslides
The document provides guidance for researchers on publishing their work, including choosing an appropriate journal, writing different sections of a research paper, and dealing with peer review and editorial processes. It discusses what editors look for in submissions and emphasizes the importance of transparency, ethics, and properly attributing contributions and conflicts of interest.
Assessing Benefits and Harms of Opioid Therapy for Chr.docxfestockton
Assessing Benefits and
Harms of Opioid Therapy
for Chronic Pain
Clinician Outreach and
Communication Activity
(COCA) Call
August 3, 2016
Office of Public Health Preparedness and Response
Division of Emergency Operations
Accreditation Statements
CME: The Centers for Disease Control and Prevention is accredited by the Accreditation Council for Continuing Medical
Education (ACCME®) to provide continuing medical education for physicians. The Centers for Disease Control and Prevention
designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should only claim credit
commensurate with the extent of their participation in the activity.
CNE: The Centers for Disease Control and Prevention is accredited as a provider of Continuing Nursing Education by the
American Nurses Credentialing Center's Commission on Accreditation. This activity provides 1.0 contact hour.
IACET CEU: The Centers for Disease Control and Prevention is authorized by IACET to offer 1.0 CEU's for this program.
CECH: Sponsored by the Centers for Disease Control and Prevention, a designated provider of continuing education contact
hours (CECH) in health education by the National Commission for Health Education Credentialing, Inc. This program is
designed for Certified Health Education Specialists (CHES) and/or Master Certified Health Education Specialists (MCHES) to
receive up to 1.0 total Category I continuing education contact hours. Maximum advanced level continuing education contact
hours available are 0. CDC provider number 98614.
CPE: The Centers for Disease Control and Prevention is accredited by the Accreditation Council for Pharmacy Education as
a provider of continuing pharmacy education. This program is a designated event for pharmacists to receive 0.1 CEUs in
pharmacy education. The Universal Activity Number is 0387-0000-16-150-L04-P and enduring 0387-0000-16-150-H04-P course
category. Course Category: This activity has been designated as knowledge-based. Once credit is claimed, an unofficial
statement of credit is immediately available on TCEOnline. Official credit will be uploaded within 60 days on the NABP/CPE
Monitor
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in the jurisdictions which recognize AAVSB RACE approval. Please contact the AAVSB RACE Program at [email protected] if
you have any comments/concerns regarding this program’s validity or relevancy to the veterinary profession.
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recertification credits and is authorized to offer 1 CPH recertification credit for this program.
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A New Perspective On Survival Outcomes In Multiple SclerosisJustin Knight
This document discusses new findings on survival outcomes in multiple sclerosis (MS) from international registries and databases. It summarizes that MS patients have a mean decrease in survival time of 6 to 12 years compared to the general population. A 21-year follow-up study of interferon beta-1b treatment showed that early treatment may positively impact long-term mortality rates in MS patients compared to delayed treatment. The findings suggest that early and continued disease-modifying treatment may improve long-term survival outcomes for individuals with MS.
Transforming Medicine Through Personalized Health Care at Ohio State Universi...Ryan Squire
The document describes Ohio State University Medical Center's vision to transform medicine through personalized health care. Their goal is to move from today's reactive, disease-based system to a proactive, wellness-based system using systems biology tools. They plan to create predictive, personalized, precise and preventive (P4) medicine through discovery platforms using omics data, modeling, and imaging. These platforms will be translated through diagnostics, devices, and targeted therapeutics. Applications include pilot programs, a personalized medicine collaborative, and accountable care organizations. The overall vision is to improve quality and lower costs through disruptive innovation and personalized strategic health plans.
Dr Dev Kambhampati | NCCAM- Exploring the Science of Complementary and Altern...Dr Dev Kambhampati
The National Center for Complementary and Alternative Medicine (NCCAM) 2011-2015 Strategic Plan outlines goals to advance research on CAM interventions over the next decade. NCCAM's goals are to: 1) Advance the science and practice of symptom management for conditions like pain that CAM is often used to treat; 2) Develop effective strategies for promoting health and well-being using CAM approaches; and 3) Provide objective evidence to enable better decision-making about CAM use and integration into healthcare. NCCAM's first decade of research investment has grown the evidence base on CAM safety and efficacy through clinical trials and basic research, influencing public use of certain CAM products and practices.
Writing Paper Background - Crumpled Writing Paper BAmber Ford
Writing Paper Background - Crumpled Writing Paper B
The document provides instructions for creating an account and submitting a request for writing assistance on the HelpWriting.net site. It outlines a 5 step process: 1) Create an account with email and password; 2) Complete a 10 minute order form with instructions, sources, and deadline; 3) Review bids from writers and choose one based on qualifications; 4) Review the completed paper and authorize payment if satisfied; 5) Request revisions until fully satisfied, with a refund option for plagiarized content. The document encourages choosing the site for original, high-quality writing assistance.
022 Essay Example Page 4 Narrative ThatsnotusAmber Ford
The document discusses Baron Montesquieu and his idea of separating government powers. It states that Montesquieu established the separation of the executive, legislative, and judicial branches in his work "De l'Esprit des Lois" in 1748. The separation of powers has been an integral part of constitutions. However, the separation of powers was never formally part of the framework of Britain's unwritten constitution.
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The document provides instructions for using the writing assistance service HelpWriting.net in 5 steps:
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Essay Title - Center For Student SuccessAmber Ford
The document provides instructions for students seeking writing help from the HelpWriting.net website. It outlines a 5-step process: 1) Create an account and provide contact details. 2) Complete a form with assignment details and attach samples. 3) Review bids from writers and choose one based on qualifications. 4) Review and approve the completed paper, then authorize payment. 5) Request revisions until fully satisfied, with the option of a refund for plagiarized work. The process aims to match students with qualified writers and ensure high-quality, original assignment help.
Begin Your Essay With A. Online assignment writing service.Amber Ford
The document discusses two different perspectives on piety from Plato's dialogues and the Book of Job. In Plato's Apology, Socrates searches for a definition of piety to understand why he has been accused of impiety, but finds the explanations ambiguous. Meanwhile, the Book of Job presents Job as one of the most pious men, who remains faithful to God despite suffering many punishments, setting an example of piety through his actions.
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The document discusses the multipolar system that existed in ancient China. It was characterized by multiple powerful states that exercised control over surrounding weaker states. This created a balance of power between the major states, resulting in a stable multipolar system. In contrast, ancient Greece experienced a shift from a multipolar system to Athenian domination, creating a brief unipolar system before being overtaken by another power.
002 Essay Example Rogerian Thatsnotus. Online assignment writing service.Amber Ford
The summary compares the rhetorical devices used in marriage proposals in passages from Jane Austen's Pride and Prejudice and Charles Dickens' work. In Austen's passage, Mr. Collins uses a tone of overconfidence and argues that marriage would add to his happiness, not considering his cousin's feelings. In Dickens' passage, the speaker passionately argues why the woman should marry him instead of others, expressing his dedication to her needs over his own wants.
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The document provides instructions for creating an account and submitting requests on the website HelpWriting.net. It outlines a 5-step process: 1) Create an account with an email and password. 2) Complete a request form providing instructions, sources, and deadline. 3) Review bids from writers and choose one based on qualifications. 4) Review the completed paper and authorize payment. 5) Request revisions to ensure satisfaction, with a full refund option for plagiarized work. The website offers writing assistance and stands by providing original, high-quality content.
Be Your Ghost Writer, Paper Back Writer, Non Fiction Writer And EditorAmber Ford
The document provides instructions for using a writing service called HelpWriting.net. It outlines a 5-step process: 1) Create an account with an email and password. 2) Complete a 10-minute order form with instructions, sources, and deadline. 3) Review bids from writers and choose one. 4) Review the completed paper and authorize payment if satisfied. 5) Request revisions until fully satisfied, with a refund option for plagiarized work.
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The document discusses the process for requesting writing assistance on the HelpWriting.net website. It outlines 5 steps: 1) Create an account with a password and email. 2) Complete an order form providing instructions, sources, and deadline. 3) Review bids from writers and choose one. 4) Review the completed paper and authorize payment. 5) Request revisions to ensure satisfaction, with refund available for plagiarized work.
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The document discusses how to request writing assistance from HelpWriting.net. It involves a 5-step process:
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This document provides instructions for requesting writing assistance from HelpWriting.net. It outlines a 5-step process: 1) Create an account with a password and email. 2) Complete an order form with instructions, sources, and deadline. 3) Review bids from writers and choose one. 4) Review the completed paper and authorize payment. 5) Request revisions until satisfied with the work. The service aims to provide original, high-quality content and offers refunds for plagiarized work.
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Magic Essay Typer Plagiarism EssayTyper,Amber Ford
Moving charged particles in a magnetic field will experience a force perpendicular to both their velocity and the magnetic field. This causes the particle's path to curve. By observing how much a particle's path curves in a known magnetic field, its mass and charge can be determined. J.J. Thomson discovered the electron using this principle, observing cathode rays curving in electric and magnetic fields. He measured the amount of curvature to calculate the electron's charge to mass ratio, identifying it as a subatomic particle.
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The document provides instructions for requesting writing assistance from HelpWriting.net. It outlines a 5-step process: 1) Create an account with a password and email. 2) Complete an order form with instructions, sources, and deadline. 3) Review bids from writers and select one. 4) Review the completed paper and authorize payment. 5) Request revisions until satisfied, with a refund option for plagiarized work. The service aims to fully meet customer needs through original, high-quality content.
Best Free Essay Sites. Online assignment writing service.Amber Ford
This document provides information about Lashkar e Taiba (LET), a Pakistani-based Islamic terrorist organization. It details that LET is a Sunni group that aims to create an Islamic caliphate by removing India's security forces from Jammu and Kashmir. The group receives funding and instructions from Pakistan's intelligence agency, ISI, and maintains close ties with al-Qaeda, the Taliban, and other extremist groups. Key decisions are made by LET's shura council, which oversees all military and missionary operations.
College Essay Review Service 48-Hour Essay RAmber Ford
1. The stability or instability of funding for international organizations shapes the nature of activities they engage in. Stable funding allows for better planning and execution of core mandates, while unstable funding can force organizations to rely on short-term projects.
2. The rise of extra-budgetary or voluntary funding has increased competition among organizations and led to overlapping mandates. Organizations must now often pursue contract-based work to remain viable.
3. Contract-based funding affects organizational culture, institutional memory, and staffing. It can disrupt long-term planning and reduce expertise as staff turnover increases due to temporary project-based work.
Descriptive Essay Political Science Quantitative ResearAmber Ford
1. The document describes the steps to get writing help from HelpWriting.net, including creating an account, submitting a request, reviewing writer bids, authorizing payment, and requesting revisions.
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StudentS Guide To Writing College Papers Fourth EdAmber Ford
The document discusses the common cold, noting that it is a viral infection of the nose and throat that affects over 3 million people in the US each year. It explains that the cold spreads easily, can be self-treated without medical tests or imaging, and usually clears up within a few days. The summary briefly outlines some of the main characteristics and impacts of the common cold according to the provided text.
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
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How to Build a Module in Odoo 17 Using the Scaffold MethodCeline George
Odoo provides an option for creating a module by using a single line command. By using this command the user can make a whole structure of a module. It is very easy for a beginner to make a module. There is no need to make each file manually. This slide will show how to create a module using the scaffold method.
বাংলাদেশের অর্থনৈতিক সমীক্ষা ২০২৪ [Bangladesh Economic Review 2024 Bangla.pdf] কম্পিউটার , ট্যাব ও স্মার্ট ফোন ভার্সন সহ সম্পূর্ণ বাংলা ই-বুক বা pdf বই " সুচিপত্র ...বুকমার্ক মেনু 🔖 ও হাইপার লিংক মেনু 📝👆 যুক্ত ..
আমাদের সবার জন্য খুব খুব গুরুত্বপূর্ণ একটি বই ..বিসিএস, ব্যাংক, ইউনিভার্সিটি ভর্তি ও যে কোন প্রতিযোগিতা মূলক পরীক্ষার জন্য এর খুব ইম্পরট্যান্ট একটি বিষয় ...তাছাড়া বাংলাদেশের সাম্প্রতিক যে কোন ডাটা বা তথ্য এই বইতে পাবেন ...
তাই একজন নাগরিক হিসাবে এই তথ্য গুলো আপনার জানা প্রয়োজন ...।
বিসিএস ও ব্যাংক এর লিখিত পরীক্ষা ...+এছাড়া মাধ্যমিক ও উচ্চমাধ্যমিকের স্টুডেন্টদের জন্য অনেক কাজে আসবে ...
How to Make a Field Mandatory in Odoo 17Celine George
In Odoo, making a field required can be done through both Python code and XML views. When you set the required attribute to True in Python code, it makes the field required across all views where it's used. Conversely, when you set the required attribute in XML views, it makes the field required only in the context of that particular view.
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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Walmart Business+ and Spark Good for Nonprofits.pdfTechSoup
"Learn about all the ways Walmart supports nonprofit organizations.
You will hear from Liz Willett, the Head of Nonprofits, and hear about what Walmart is doing to help nonprofits, including Walmart Business and Spark Good. Walmart Business+ is a new offer for nonprofits that offers discounts and also streamlines nonprofits order and expense tracking, saving time and money.
The webinar may also give some examples on how nonprofits can best leverage Walmart Business+.
The event will cover the following::
Walmart Business + (https://business.walmart.com/plus) is a new shopping experience for nonprofits, schools, and local business customers that connects an exclusive online shopping experience to stores. Benefits include free delivery and shipping, a 'Spend Analytics” feature, special discounts, deals and tax-exempt shopping.
Special TechSoup offer for a free 180 days membership, and up to $150 in discounts on eligible orders.
Spark Good (walmart.com/sparkgood) is a charitable platform that enables nonprofits to receive donations directly from customers and associates.
Answers about how you can do more with Walmart!"
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
Your Skill Boost Masterclass: Strategies for Effective Upskilling
Anabolic Steroids
1. Image T/K
CE CONTINUING EDUCATION
CONTINUING EDUCATION INFORMATION
TARGET AUDIENCE: This activity has been designed to meet the educational needs of phy-
sicians, physician assistants, and nurse practitioners involved in the management of patients who
may use or abuse anabolic-androgenic steroids.
• Original Release Date: November 2008
• Expiration Date: November 30, 2009
• Estimated Time to Complete This Activity: 1 hour
• Medium: Printed journal and online CME
• Sponsored by Postgraduate Institute for Medicine
PROGRAM OVERVIEW: The primary objective of this educational initiative is to provide
clinicians in primary care with the most up-to-date information regarding detecting steroid use,
educating patients who might be using steroids, and contributing to public efforts to raise aware-
ness and reduce illegal steroid use.
EDUCATIONAL OBJECTIVES: After completing this activity, the participant should be
better able to:
• Identify the “typical” user of anabolic-androgenic steroids, including the motivation be-
hind use.
• Trace the progression from the original 1970 Controlled Substances Act to the 2004 Anabolic
Steroid Control Act and the intended impact of the legislation.
• Describe the physiological mechanisms and effects of anabolic steroid use that may be perceived
as beneicial.
• Explain the elevated risks associated with supraphysiologic doses of anabolic steroids.
• List the signs of anabolic steroid abuse in men and women.
FACULTY: Matthew Rhea, PhD, is an Assistant Professor and Director of the Human Move-
ment Master of Science Program in the Department of Interdisciplinary Health Sciences at the
Arizona School of Health Sciences, A. T. Still University, in Mesa, Arizona. Pedro J. Marín
Cabezuelo, PhD(c), an instructor at the European University of Madrid, is a doctoral candidate
at A. T. Still University. Mark Peterson, PhD, ABD, and Derek Bunker, MS, CSCS, NASM-PES,
are members of the adjunct faculty in the Human Movement Program at A. T. Still University
and at Mesa Community College. Jeffrey L. Alexander, PhD, ACSM-CES, NASM-CPT, CES,
is an Assistant Professor in the Department of Interdisciplinary Health Sciences at A. T. Still
University, where Eric L. Sauers, MS, PhD, ATC, CSCS, is Academic Administrator and Randy
D. Danielsen, PhD, PA-C, is Professor and Dean of the Arizona School of Health Sciences. Ben
Potenziano, MEd, LATC, CES, is a member of the adjunct faculty at A. T. Still University and
an Assistant Athletic Trainer and Strength and Conditioning Coordinator for the San Francisco
Giants of Major League Baseball.
PHYSICIANS
Accreditation Statement: This activity has been planned and implemented in accordance with
the Essential Areas and Policies of the Accreditation Council for Continuing Medical Educa-
tion (ACCME) through the joint sponsorship of Postgraduate Institute for Medicine (PIM) and
Quadrant HealthCom Inc. PIM is accredited by the ACCME to provide continuing medical
education for physicians.
Credit Designation: Postgraduate Institute for Medicine designates this educational activity for
a maximum of .75 AMA PRA Category 1 CreditTM
. Physicians should only claim credit commen-
surate with the extent of their participation in the activity.
PHYSICIAN ASSISTANTS
The American Academy of Physician Assistants accepts AMA category 1 credit for the PRA from
organizations accredited by ACCME.
NURSE PRACTITIONERS
This program has been approved by the Nurse Practitioner Association New York State (The
NPA) for 1.0 contact hour.
DISCLOSURE OF CONFLICTS OF INTEREST: Postgraduate Institute for Medicine
(PIM) assesses conlict of interest with its instructors, planners, and managers, and other indi-
viduals who are in a position to control the content of CME activities. All relevant conlicts of
interest that are identiied are thoroughly vetted by PIM for fair balance, scientiic objectivity of
studies utilized in this activity, and patient care recommendations. PIM is committed to providing
its learners with high-quality CME activities and related materials that promote improvements or
quality in health care and not a speciic proprietary business interest of a commercial interest.
The faculty reported the following inancial relationships or relationships to products or de-
vices they or their spouse/life partner have with commercial interests related to the content of this
CME activity: Matthew Rhea, PhD, Pedro J. Marín Cabezuelo, PhD(c), Mark Peterson, PhD,
ABD, Jeffrey L. Alexander, PhD, ACSM-CES, NASM-CPT, CES, Ben Potenziano, MEd, LATC,
CES, Derek Bunker, MS, CSCS, NASM-PES, Eric L. Sauers, MS, PhD, ATC, CSCS, and Randy
D. Danielsen, PhD, PA-C, reported no signiicant inancial relationship with any commercial
entity related to this activity.
The planners and managers reported the following inancial relationships or relationships to
products or devices they or their spouse/life partner have with commercial interests related to
the content of this CME activity: Jan Hixon, RN, BSN, MA, Linda Graham, RN, BSN, BA, and
Trace Hutchison, PharmD, reported no signiicant inancial relationship with any commercial
entity related to this activity.
METHOD OF PARTICIPATION: The fee for participating and receiving CME credit for
this activity is $10.00. During the period November 2008 through November 30, 2009, par-
ticipants must 1) read the learning objectives and faculty disclosures; 2) study the educational
activity; 3) complete the posttest by recording the best answer to each question in the answer key
on the evaluation form on page 30; 4) complete the evaluation form; and 5) mail or fax the evalu-
ation form with answer key and payment or payment information to: Postgraduate Institute for
Medicine, 367 Inverness Parkway, Suite 215, Englewood, CO 80112; fax: (303) 790-4876.
This test can also be taken online at www.CliniciansCME.com. If you have any questions, call
(800) 423-3576 or e-mail evaluations@pimed.com.
A statement of credit will be issued only upon receipt of a completed activity evaluation form
and a completed posttest with a score of 70% or better. Your statement of credit will be mailed
to you within three weeks.
DISCLOSURE OF UNLABELED USE: This educational activity may contain discussion of
published and/or investigational uses of agents that are not indicated by the FDA. Postgraduate
Institute for Medicine (PIM), The NPA, and Quadrant HealthCom Inc. do not recommend the
use of any agent outside of the labeled indications.
The opinions expressed in this educational activity are those of the faculty and do not neces-
sarily represent the views of PIM, The NPA, or Quadrant HealthCom Inc. Please refer to the
oficial prescribing information for each product for discussion of approved indications, contra-
indications, and warnings.
DISCLAIMER: Participants have an implied responsibility to use the newly acquired infor-
mation to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any pro-
cedures, medications, or other courses of diagnosis or treatment discussed or suggested in this
activity should not be used by clinicians without evaluation of their patient’s conditions and the
possible contraindications or dangers in use, review of any applicable manufacturer’s product in-
formation, and comparison with recommendations of other authorities.
Anabolic Steroids
Matthew Rhea, PhD, Pedro J. Marín Cabezuelo, PhD(c),
Mark Peterson, PhD, ABD, Jeffrey L. Alexander, PhD, ACSM-CES, NASM-CPT, CES,
Ben Potenziano, MEd, LATC, CES, Derek J. Bunker, MS, CSCS, NASM-PES,
Eric L. Sauers, MS, PhD, ATC, CSCS, Randy D. Danielsen, PhD, PA-C
Illicit use of anabolic steroids, a signiicant issue in the United States,
is by no means restricted to elite athletes or adolescent sport participants.
While steroids can stimulate and enhance muscle tissue development,
long-term or excessive use can increase the risk of heart attack, cancer,
and/or psychologic impairments. This review examines the prevalence of
steroid use, associated beneits and risks, and the importance of
accelerating effective education and prevention efforts.
There is often more to anabolic steroid
use than enhanced sport performance.
Clinician Reviews
November 2008 • Vol 18, No 11
26
2. T
hrough time, pharma-
cotherapeutic develop-
ments have had a pro-
found impact on health
and quality of life. Unfortunately,
the illicit and incorrect use of some
substances can turn a positive in-
luence into an inappropriate and
even dangerous scenario.
The use of anabolic steroids,
not for legitimate medical pur-
poses but for their ergogenic ef-
fects—increased strength, power,
speed, and endurance—and/or to
alter body weight or composition,1
is one such example. To the gen-
eral public, steroids are most com-
monly used or abused for the en-
hancement of sport performance
and among bodybuilders and par-
ticipants in recreational exercise.
In recent years, anabolic steroid
use and abuse have received signif-
icant media attention, but as early
as 1993, the National Strength and
Conditioning Association2
issued
a position statement reviewing the
risks and beneits of using anabolic
substances.
Exercise physiologists have de-
ined anabolic steroids as “pre-
scription drugs with the anabolic
(growth-stimulating) characteris-
tics of testosterone, taken by some
athletes to increase body size,
muscle mass, and strength.”3
While this deinition satisies the
physiologic foundation of these
substances, restricting our atten-
tion to the use of anabolic steroids
by athletes, as will be shown, may
be too narrow a focus. The pur-
pose of this article is to examine
the existing evidence regarding
the risks and beneits of steroid
use, data indicating the prevalence
of use, and efforts to reduce illicit
steroid consumption.
WHO IS USING STEROIDS?
Over the past several decades, use
of dietary supplements and ex-
perimentation with illegal drugs
have become increasingly preva-
lent among certain segments of
the US population. Of the nearly
three million Americans reported
to have experimented with ana-
bolic steroids (see Table 1), profes-
sional athletes and youth have re-
ceived the majority of attention.1,4
A national ixation has developed
on “cheating” in elite and profes-
sional sports, justifying a public
health concern for the well-being
of preadolescent and teenage po-
tential drug users, both male and
female. Children and adolescents
often model their behavior after
that of professional athletes, and
rising numbers of youths consider
it acceptable for their sport heroes
to “get an edge on the competition”
by using steroids or other banned
substances.1,4
The use of illegal performance-
enhancing substances among mi-
nors has been followed through the
NIH’s ongoing “Monitoring the
Future” study,5,6
which provides
insight into the problem behav-
iors of illicit drug, alcohol, and to-
bacco use among eighth, 10th, and
12th graders, college students, and
young adults (ages 19 through 24).
Though nearly nonexistent before
the 1990s, steroid abuse in youth
populations soon began to increase
steadily, reaching a peak between
2000 and 2003.5
In 2003, accord-
ing to Grunbaum et al,7
6.1% of
US ninth to 12th graders (6.8% of
boys, 5.3% of girls) had used non-
prescribed steroid shots or pills at
least once.
As tracked in a number of large
epidemiologic surveys, the inci-
dence of overall illegal drug use
among youth populations has fol-
lowed similar trends.7
It is gener-
ally agreed that the increase of
steroid use among high school stu-
dents from the 1990s to the early
2000s can be explained in part by
an accompanying decline in the
perception of drug use as danger-
ous.6
Nonathletes and female high
school students as well as young
male sport participants account
for increased experimentation.8,9
Since the reported peak of steroid
abuse in the early 2000s, a gradual
decline has been observed, with
2006 seeing the lowest reported
prevalence since the early 1990s.6
Nevertheless, among current US
high school students, it is reported
that more than one million have
tried illegal performance-enhanc-
ing drugs at least once. However,
little research has been conducted
to investigate these substances’
ergogenic beneits or health risks
in this patient population.1,8
Edu-
cation and prevention efforts to
ensure the continued decline in
steroid use are essential, although
a policy statement from the Ameri-
can Academy of Pediatrics1
cau-
tions against using “scare tactics”
or minimizing these substances’
potential ergogenic effects.
Negative media attention to the
nonmedical use of anabolic steroids
among professional and elite ath-
continued on next page >>
Clinician Reviews
November 2008 • Vol 18, No 11
27
Matthew Rhea is an Assistant Professor and Director of the Human Movement Master of Science Program in the Department of Interdisciplinary Health Sciences at the Arizona
School of Health Sciences, A. T. Still University, in Mesa, Arizona. Pedro J. Marín Cabezuelo, an instructor at the European University of Madrid, is a doctoral candidate at A. T.
Still University. Mark Peterson and Derek Bunker are members of the adjunct faculty in the Human Movement Program at A. T. Still University and at Mesa Community College.
Jeffrey L. Alexander is an Assistant Professor in the Department of Interdisciplinary Health Sciences at A. T. Still University, where Eric L. Sauers is Academic Administrator and
Randy D. Danielsen is Professor and Dean of the Arizona School of Health Sciences. Ben Potenziano is a member of the adjunct faculty at A. T. Still University and an Assistant
Athletic Trainer and Strength and Conditioning Coordinator for the San Francisco Giants of Major League Baseball.
TABLE 1
Common Anabolic Steroids
Generic name Trade name Stated indication/comments
Oxymetholone Anadrol®
Treatment of anemias caused by deficient
red cell production
Oxandrolone Oxandrin®
Promotion of weight gain after weight
loss following extensive surgery, chronic
infection, or severe trauma
Methandrostenolone Dianabol N/A
Stanozolol Winstrol®
Prevention of hereditary angioedema,
treatment of nonregenerative anemias
Nandrolone decanoate Deca-Durabolin®
Treatment of anemia associated with
renal insufficiency
Nandrolone phenpropionate Durabolin Treatment of refractory deficient red cell
production anemias, breast carcinoma,
others
Testosterone cypionate Depo®
-Testosterone
Cypionax
Testosterone replacement therapy;
female sexual dysfunction
Boldenone undecylenate Equipoise Veterinary (equine) steroid
Tetrahydrogestrinone THG N/A (banned by the World Anti-Doping
Agency)
Data extracted from: US Food and Drug Administration. MedWatch. www.fda.gov/medwatch; www.fda.gov/cder/drugSafety.htm;
www.steroidology.com; www.steroid.com; www.flexyx.com.
3. letes is likely to blame for young-
er athletes’ receiving “the wrong
message” that winning is the only
important goal in sport participa-
tion.1,10
By most accounts, reports
of steroid use by professional play-
ers are exaggerated; these athletes
may actually represent a mere frac-
tion of the population that uses il-
legal performance-enhancing sub-
stances.11
Who Is the Typical User?
According to current epidemiologic
data, a large constituency of non-
medical anabolic-androgenic steroid
users or abusers do not it either pa-
tient category previously mentioned.
In fact, recent evidence suggests that
the typical anabolic steroid user is a
well-educated, gainfully employed
professional earning an above-aver-
age income, who is about 30 years old
and not active in organized sports or
athletic competition (although most
are committed to a regular workout
regimen and strict diet).10
Steroid use
is initiated, on average, during the
mid-20s. Cycling (alternating peri-
ods of use and endocrine recovery
through abstinence) is a common
practice.
These steroid users, speculate
Cohen et al,10
may see themselves
as using directed drug technol-
ogy responsibly, “as one part of a
strategy for physical self-improve-
ment.” Their use of steroids is not
motivated by a desire to enhance
athletic performance, but in the
pursuit of increased skeletal mus-
cle mass, strength, and physical
attractiveness.
This trend may be explained by
an escalating dissatisfaction with
body weight and musculature, even
body dysmorphia, among males of
all ages—perhaps paralleling the
common concern with overweight
in adolescent girls.12,13
A large pro-
portion of adolescents who use per-
formance-enhancing substances do
not compete in sports and may share
the “typical” user’s motivation.1,14
Understanding the reasons for ste-
roid use is an important component
in prevention.1
LEGISLATIVE RESPONSE
Historic concerns about the grow-
ing illicit market, potential abuse
within youth populations, and the
escalating reports of use among
professional athletes led Congress
to include anabolic steroids as a
Schedule III controlled substance
under the Controlled Substances
Act.15
The act was originally cre-
ated in 1970, with ive schedules
based on potential for abuse, ac-
cepted medical utility, and safety
of use under medical supervision
(including the potential for depen-
dence as a consideration).
In 1990, the act was amended
to impose more stringent controls
with more severe criminal penal-
ties on those who commit offenses
involving the illegal distribution
of anabolic steroids.16
It was in this
amendment that anabolic steroids
were irst classiied as Schedule III
controlled substances, with penal-
ties comparable to those associated
with narcotics distribution.
Next, Congress passed the Ana-
bolic Steroid Control Act of 2004,
which further amended the deini-
tion of anabolic steroid under the
Controlled Substances Act to in-
clude a number of supplements that
are considered steroid hormone
precursors (eg, androstenedione,
tetrahydrogestrinone [THG]). It
also granted authority to the Drug
Enforcement Administration to
add other steroid precursors to the
deinition in the future (eg, dehy-
droepiandrosterone [DHEA]17
; in
March 2007, a bill was introduced
in the US Senate to so reclassify
DHEA, and referred to the Sen-
ate Judiciary Committee18
). The
Anabolic Steroid Control Act,
which took effect on January 20,
2005, also provided $15 million
for educational programs for chil-
dren about the dangers of anabolic
steroids.17
PHYSIOLOGIC MECHANISMS
AND EFFECTS OF ANABOLIC
DRUGS
Anabolic steroids function in a
manner similar to testosterone,
the principal male reproductive
hormone. Testosterone binds with
special receptor sites on muscle
and other tissues that contribute
to male secondary sex character-
istics. Levels of endogenous ana-
bolic hormones, such as testoster-
one and growth hormone (GH),
have been shown to rise during
the 15 to 30 minutes following
resistance exercise that provides
suficient stimulus to the body.19
These levels decline when exoge-
nous steroids are taken and remain
lowered even after exogenously
administered steroids are no lon-
ger detectable in the urine.20
Steroids and other anabolic
hormones, such as insulin and in-
sulin-like growth factor 1 (IGF-1),
are critical to the growth of skel-
etal muscle. The combination of
steroids and strategic hypertro-
phic exercises tends to produce the
greatest acute hormonal elevations
(eg, testosterone, GH, and the
catabolic hormone cortisol)19
; pre-
suming adequate protein intake,
steroids combined with exercise
stimulate protein synthesis and
increase muscle protein content
(myosin, myoibril, and sarcoplas-
mic factor),21
muscle RNA, body
mass, fat-free mass, and muscle
size.3,22
Steroids also increase water
retention, which leads to increased
interstitial and extracellular vol-
ume.22
Steroid use has no apparent
positive effects on aerobic endur-
ance performance.3
The physiologic beneits of ex-
ogenous anabolic steroid use re-
main somewhat unclear, although
steroids’ impact on both ani-
mals and humans has been stud-
ied extensively. In the late 1970s,
Rogozkin23
demonstrated that
when rats consumed adequate pro-
tein and performed exercise, they
experienced an increase in skeletal
muscle protein—accompanied by
increased relative enzyme activ-
ity when anabolic steroids were
injected. In a study of hamsters
some 20 years later, Melloni et al24
found no change in body weight
between anabolic steroid users and
nonusers, suggesting no change in
skeletal muscle protein; the inves-
tigators did observe increased ag-
gression in animals undergoing
steroid administration.
In human research, conlicting
results have been reported, even
in well-controlled double-blind
studies.25
However, recent trials
in which supraphysiologic doses of
anabolic steroids were administered
to normal and eugonadal men have
consistently demonstrated increas-
es in fat-free mass and muscular
strength, with accompanying re-
ductions in adipose tissue.26-30
Nev-
ertheless, with these supraphysi-
ologic doses comes an increased
likelihood that the user will expe-
rience the potential adverse effects
of anabolic steroid use.
Potential Risks
In contrast to the conlicting re-
ports regarding the physiologic
beneits of anabolic steroid use,
there appears to be no question as
to the adverse effects associated
with their use. These range from
unpleasant changes in appearance
Anabolic Steroids
CE
Clinician Reviews
November 2008 • Vol 18, No 11
28
>> continued from previous page
TABLE 2
Risks Associated With Supraphysiologic
Steroid Use26,30,31,33
Increased risk of heart attack
High blood pressure
Liver cancer
Tumors
Infertility
Shrinking of the testicles
Male-pattern baldness (both men and women)
Breast development (men)
Shrinking of the breasts and enlargement of clitoris (women)
Deepening of the voice and increased facial hair (women)
Premature growth halting (adolescents)
Severe acne and cysts
Rage/aggression
Mania
Delusions
Data extracted from: Woodhouse et al. J Clin Endocrinol Metab. 200426
; Bhasin et al. N Engl J
Med. 199630
; Kam and Yarrow. Anaesthesia. 200531
; Pope et al. Arch Gen Psychiatry. 2000.33
4. (eg, acne, unwanted hair growth,
masculinization in women) to long-
term, potentially life-threatening
alterations in physiology and overall
health, including cardiomyopathy,
dyslipidemia, atherosclerosis, hy-
percoagulopathy, and hepatic dis-
ease or dysfunction1,31,32
(see Table
2,26,30,31,33
page 28). Cancers in vari-
ous organs, including the kidneys
and the liver, have been reported.34
Additional long- or short-term ef-
fects of anabolic steroid abuse may
include reduced fertility, tendon
damage, and luid retention.12,35
A comprehensive 2002 research
review by Pärssinen and Seppälä36
examined steroids’ adverse impact
on former athletes and reported an
elevated risk of premature mortal-
ity in powerlifters who had used
steroids. In research examining the
mental/psychosocial health of ana-
bolic steroid users, patients have
reported increased aggression,
hostility, insomnia, mood swings,
impaired judgment, and feelings
of invincibility.33,36-39
Competitive
bodybuilders have reported that
steroids elicit an antidepressant
feeling.38
Use of steroids at supra-
physiologic levels has been associ-
ated with manic episodes involv-
ing violent behavior (“roid rage”),
hypomania, hallucinations, or
delusions.33,38,39
Drug withdrawal
(sometimes associated with suicid-
ality) and dependence are not un-
common.33,39
In studies of mood and aggres-
sion among men who self-admin-
ister steroids, symptoms were un-
common among those who took
the equivalent of no more than 300
mg per week of testosterone, but
weekly regimens of 1,000 mg or
more yielded frequent symptoms,
particularly in users who engaged
in simultaneous “stacking” of oral
and injectable steroids.33,40
In men, the outward signs of
performance-enhancing drug use
may include testicular atrophy,
breast enlargement, severe acne,
baldness, painful erections, and
loss of testicular function.32
Wom-
en may experience virilization:
growth of facial and body hair,
deepened voice, breast reduction,
enlarged clitorises, and menstrual
irregularities.1,41
Growth Hormone
The reported beneicial effects
of GH have led to its expanded
therapeutic use in both children
and adults. But over the past de-
cade, improper or excessive use of
GH has become one of the most
common drug abuses in sporting
competition—particularly among
elite athletes—in part, perhaps,
because its use cannot easily be
detected.42,43
The effectiveness and long-term
health effects of GH use among
adolescents are unclear.12
In adults,
its use has been associated with
colon, breast, and prostate can-
cers—although GH is often used
with other licit or illicit substances
that may account in part for these
developments.34
EDUCATION, INTERVENTION
The irst challenge in implement-
ing intervention efforts is to iden-
tify the warning signs of steroid
abuse. Among adolescents in par-
ticular, it may not be easy to detect
use of performance-enhancing
drugs through outward signs.1
In
adults, however, some noticeable
signs (see Table 31,41
) may include
rapid muscle growth, growth of fa-
cial and body hair, deepened voice,
breast reduction (in females),
dermatologic oily hair, oily skin,
alopecia, and sebaceous cysts.1,41
Worsening acne is common. Other
signs are depression, nervousness,
extreme irritability, delusions,
hostility, and aggression.33,38,39
Although identifying persons
who may be abusing steroids can
make intervention possible, pre-
venting uninitiated teens and pre-
teens from beginning to use them
is a more urgent priority. This re-
quires accelerated education and
prevention efforts, with steroids
included among the illicit drugs
addressed and an emphasis on the
long-term risks of steroid abuse.
Drug bans and drug testing (see
below) are the most commonly
used strategies to deter youth from
abusing, but they fail to address
the conlict between “doing the
right thing” and winning at any
cost.1
Few interventions have been
appropriately tested, although
one reportedly effective program
offered adolescent athletes drug
education combined with drug re-
fusal skills training.1,44
Limiting use by reducing access
to anabolic steroids is an added
challenge, considering their wide
accessibility through the Internet12
and the availability of substances
(some of questionable origin) on
the black market. These sources
hinder tracking and prevention.
Perhaps the most effective con-
tribution clinicians can make is to
resist requests to prescribe steroids
for athletes, bodybuilders, or other
patients without a genuine medi-
cal need. Programs, education,
controls, and checks should be
implemented by the medical com-
munity to uphold a legal and ethi-
cal approach to anabolic steroids
and help prevent inappropriate
disbursement through registered
clinicians.
A considerable challenge that
cannot be overlooked is the need
to reach the large hidden segment
of the steroid-abusing population.
Users who self-administer these
substances justify their practices
based on anecdotal data and their
own experiences as self-appointed
study subjects. Without the per-
sonal intervention of a respected
clinician, they are likely to dismiss
common warnings that steroids are
ineffective and/or dangerous.40
Drug Testing Among Athletes
Although a considerable majority
of anabolic steroid users are likely
to remain untouched by strate-
gies to reduce these substances’
nonmedical use, drug testing is an
important component of address-
ing the problem in youth and elite
athletes. Olympic athletes have
been required to undergo testing
since the 1968 games, and recom-
mendations from the Internation-
al Olympic Committee have led to
a system of accreditation for labo-
ratories to perform national and
international sport drug testing.45
Despite mounting social pres-
sures to detect and punish for use
of illicit or performance-enhanc-
ing substances, testing among
professional athletes has been less
well coordinated. While most
major professional sports orga-
nizations now have drug-testing
programs, these vary in degree of
quality, coordination, thorough-
ness, and effectiveness.
One challenge is the avail-
ability of tests to identify certain
substances. New techniques have
Clinician Reviews
November 2008 • Vol 18, No 11
29
continued on next page >>
TABLE 3
Potential Warning
Signs of Steroid Use1,41
Rapid muscle growth
and development
Aggressive behavior
Extreme mood swings
Delusions
Jaundice
Severe acne
Data extracted from: Gomez. Pediatrics.
20051
; Strauss et al. JAMA. 1985.41
TABLE 4
Anabolic Agents Banned by the NCAA46
Androstenediol
Androstenedione
Boldenone
Clostebol
Dehydrochlormethyltestosterone
Dehydroepiandrosterone (DHEA)
Dihydrotestosterone (DHT)
Dromostanolone
Epitrenbolone
Fluoxymesterone
Gestrinone
Mesterolone
Methandienone
Methyltestosterone
Nandrolone
Norandrostenediol
Norandrostenedione
Norethandrolone
Oxandrolone
Oxymesterone
Oxymetholone
Stanozolol
Testosterone
Tetrahydrogestrinone (THG)
Trenbolone
Abbreviation: NCAA, National Collegiate Athletic Association.
Data extracted from: NCAA Banned-Drug Classes, 2007-08.46
5. become available in which carbon-
13 levels of urinary steroids are
analyzed to detect both exogenous
steroids and urine-manipulating
agents.27
Testing for the “designer
steroid” THG has also been devel-
oped. However, a quality test for
human growth hormone has yet to
be developed and validated.
On the college level, the Nation-
al Collegiate Athletic Association
(NCAA; www.ncaa.org) imple-
mented a drug-testing program for
Divisions 1, 2, and 3 in 1990. The
program involves random urine
collection for laboratory analysis
for substances on a list of banned
drugs—principally, stimulants and
anabolic steroids46
(see Table 4,46
page 29). Failing a drug test results
in loss of eligibility to participate in
NCAA athletics, generally for one
year. This program offers a solid
standard for drug testing, educa-
tion, and prevention among stu-
dent athletes—including resources
for both athletes and coaches to
improve awareness and prevention.
Secondary schools have been
much less organized in their ef-
forts to test for and prevent drug
use among their athletes and/or
participants in extracurricular ac-
tivities—in part because available
resources and inancial support for
testing programs are lacking. Cur-
rently, the National Federation of
State High School Associations
provides materials for its member
state organizations and their associ-
ated schools47
regarding drug test-
ing (www.nfhs.org), but it neither
mandates nor regulates it. Legal is-
sues have been raised in opposition
to such testing48
; however, a 1995
Supreme Court ruling declared
random student athlete drug tests
constitutional.49
While immunoassay is used to
perform initial screening for am-
phetamines, marijuana, cocaine,
opiates, phencyclidine, and other
substances, the more costly gas
chromatography–mass spectrome-
try is considered the standard test-
ing procedure to detect steroids
Anabolic Steroids
CE
Clinician Reviews
November 2008 • Vol 18, No 11
30
>> continued from previous page
1. According to results of large epidemiologic studies, illicit use of
anabolic steroids among high school students:
a. Was unheard of before 1990
b. Has increased steadily since the late 1960s
c. Peaked between 2000 and 2003 and has declined since
d. Declined in the late 1990s and has increased sharply since
2. Which of the following best describes the “typical” steroid user?
a. A professional football or baseball player
b. A recreational weightlifter or bodybuilder
c. An underweight adolescent boy with low self-esteem
d. A gainfully employed professional in his 30s
3. Of the following, which best explains the motivation for nonmedical
use of steroids?
a. Greater speed in sports that involve running
b. Dissatisfaction with body weight and musculature
c. Increased endurance for powerlifting
d. Faster recovery after an exercise workout
4. Which of the following substances has been proposed for addition to the
list of deined anabolic steroids under the Controlled Substances Act?
a. Androstenedione
b. Dehydroepiandrosterone (DHEA)
c. Dihydrotestosterone (DHT)
d. Tetrahydrogestrinone (THG)
5. Anabolic steroid use has no apparent beneicial impact on:
a. Muscle protein content
b. Endurance in resistance training
c. Cortisol levels
d. Endurance in aerobic exercise
6. Which of the following substances cannot yet be detected through
a reliable, validated test?
a. DHEA c. Testosterone cypionate
b. Growth hormone d. THG
7. Illicit use of growth hormone has been associated with:
a. Colon, breast, and prostate cancers
b. Cancers of the kidneys and the liver
c. Hypercoagulopathy
d. Premature mortality
8. Steroid withdrawal is sometimes associated with:
a. Suicidality c. Hypomania
b. Insomnia d. Testicular dysfunction
9. Men are more likely to experience symptoms of aggression
and hostility when they:
a. Periodically abstain from use (“cycling”)
b. Take oral and injectable steroids together (“stacking”)
c. Follow weekly regimens of 200- to 300-mg equivalent of testosterone
d. Are prevented from exercising
10. Women who take performance-enhancing drugs may experience any
of the following except:
a. Menstrual irregularities
b. Growth of facial hair
c. Breast enlargement
d. Enlargement of the clitoris
Posttest Questions
Directions: Select one answer for each question in the exam and evaluation by completely darkening the appropriate circle. An identifier is
required to process your exam.
The primary objective of this educational initiative is to provide clinicians in primary care with the most up-to-date information
regarding detecting steroid use, educating patients who might be using steroids, and contributing to public efforts to raise awareness
and reduce illegal steroid use.
Mail to: Postgraduate Institute for Medicine, 367 Inverness Parkway, Suite 215, Englewood, CO 80112
or fax to: (303) 790-4876 or participate online at: www.CliniciansCME.com
Examination Answer Sheet
Issue Date: November 2008 Expiration Date: November 30, 2009
This exam can be taken online at www.CliniciansCME.com. Upon passing the exam, you can print out your certificate
immediately. You can also view your test history at any time and print out duplicate certificates from the Web site.
Anabolic Steroids
Examination
1. A B C D
2. A B C D
3. A B C D
4. A B C D
5. A B C D
6. A B C D
7. A B C D
8. A B C D
9. A B C D
10. A B C D
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How well was each course objective met?
11. Identify the “typical” user of anabolic-androgenic steroids, including the motivation behind use. 1 2 3 4 5
12. Trace the progression from the original 1970 Controlled Substances Act to the 2004 Anabolic
Steroid Control Act and the intended impact of the legislation. 1 2 3 4 5
13. Describe the physiological mechanisms and effects of anabolic steroid use that may be
perceived as beneficial. 1 2 3 4 5
14. Explain the elevated risks associated with supraphysiologic doses of anabolic steroids. 1 2 3 4 5
15. List the signs of anabolic steroid abuse in men and women. 1 2 3 4 5
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Lesson 105924 6036-ES-34 CLR0811
6. (and to conirm other positive test
results).47
Collecting samples for
testing on short notice appears to
be the most effective way to dis-
courage young athletes from using
anabolic steroids.45
CONCLUSION
Steroid abuse education and pre-
vention efforts, including drug
testing among athletes at several
levels, are vital. Although some
progress has been made in reduc-
ing the reported prevalence of such
illicit drug use, we must further
this trend through more focused
prevention efforts. Clinicians can
play a vital role by sharing up-to-
date information with patients and
parents regarding the risks of ste-
roid use. See Table 5 for sources of
information on drug abuse preven-
tion that can beneit health care
providers, patients, parents, and
teachers alike. CR
REFERENCES
1. Gomez J; American Academy of Pediatrics Committee
on Sports Medicine and Fitness. Use of performance-
enhancing substances. Pediatrics. 2005;115(4):1103-
1106.
2. Wright JE, Stone MH; National Strength and Condi-
tioning Association. Position statement: anabolic-andro-
genic steroid use by athletes. Natl Strength Conditioning
Assoc J. 1993;15(2):9-28.
3. Wilmore JH, Costill DL. Physiology of Sport and Exer-
cise. 3rd ed. Champaign, IL: Human Kinetics Publishers;
2004:487-491.
4. Mitchell GJ. Report to the Commissioner of Baseball
of an independent investigation into the illegal use of
steroids and other performance enhancing substances
by players in Major League Baseball (2007). http://
i.l.cnn.net/cnn/2007/images/12/13/mitchell.report.pdf.
Accessed October 27, 2008.
5. Johnston LD, O’Malley PM, Bachman JG, Schulen-
berg JE. Monitoring the Future: National Survey Results
on Drug Use, 1975-2006: Volume I, Secondary School
Students (NIH Publication No. 07-6205). Bethesda, MD:
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Clinician Reviews
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TABLE 5
Internet Resources
for Steroid Abuse
Information
National Institute on
Drug Abuse (NIDA)
www.drugabuse.gov
Anabolic Steroid Abuse, NIDA
www.steroidabuse.gov
ClubDrugs.gov, NIDA
www.clubdrugs.gov
US Drug Enforcement Agency
www.justthinktwice.com
Alcohol and Drug Information,
US Department of Health
and Human Services
www.health.org