The document summarizes a randomized clinical trial that tested the effectiveness of a Drug Adherence Enhancement Program (DAEP) on drug adherence behaviors in patients with major depressive disorder (MDD) in Thailand. The experimental group received the DAEP plus usual care, while the control group received only usual care. The DAEP consisted of four individual counseling sessions over 4 weeks focusing on motivation, problem-solving, and cognitive techniques. The results showed that patients who received the DAEP had significantly higher drug adherence behaviors than those receiving only usual care. The DAEP is an effective nursing intervention to promote medication adherence in patients with MDD.
Outcomes of Online Mindfulness-Based Cognitive Therapy for Patients With Residual Depressive SymptomsA Randomized Clinical Trial
Zindel V. Segal, PhD1; Sona Dimidjian, PhD2; Arne Beck, PhD3; et alJennifer M. Boggs, PhD3; Rachel Vanderkruik, MA2; Christina A. Metcalf, MA2; Robert Gallop, PhD4; Jennifer N. Felder, PhD5; Joseph Levy, BA2
Author Affiliations
JAMA Psychiatry. Published online January 29, 2020. doi:10.1001/jamapsychiatry.2019.4693
Significance for fasd
Title. Does Giving the Doctor a Document Template with the Patient's Own Values and Preferences When Making Decisions about Starting Medication Improves Shared Decision Making?
Presented by BITO, Seiji
@ SMDM2019 postersession
PCOMS and an Acute Care Inpatient Unit: Quality Improvement and Reduced Readm...Barry Duncan
High psychiatric readmission rates continue while evidence suggests that care is not perceived by patients as “patient centered.” Research has focused on aftercare strategies with little attention to the inpatient treatment itself as an intervention to reduce readmission rates. Quality improvement strategies based on patient-centered care may offer an alternative. We evaluated outcomes and readmission rates using a benchmarking methodology with a naturalistic data set from an inpatient psychiatric facility (N 2,247) that used a quality-improvement strategy called systematic patient feedback. A systematic patient feedback system, the Partners for Change Outcome Management System (PCOMS), was used. Overall pre-post effect sizes were d 1.33 and d 1.38 for patients diagnosed with a mood
disorder. These effect sizes were statistically equivalent to RCT benchmarks for feedback and depression.
Readmission rates were 6.1% (30 days), 9.5% (60 days), and 16.4% (180 days), all lower than national benchmarks. We also found that patients who achieved clinically significant treatment outcomes were less likely to be readmitted. We tentatively suggest that a focus on real-time patient outcomes as well as care that is “patient centered” may provide lower readmission rates.
An Interprofessional Approach to Substance Abuse in Primary CareASAMPUBS
An integrated model of treatment improves care by recognizing that patients need clear and consistent care from their primary care provider “in a way that thoroughly considers biological, social, behavioral, and psychological components of their presenting complaint” by integrating psychological, addiction, and other treatments into a cohesive whole.
Outcomes of Online Mindfulness-Based Cognitive Therapy for Patients With Residual Depressive SymptomsA Randomized Clinical Trial
Zindel V. Segal, PhD1; Sona Dimidjian, PhD2; Arne Beck, PhD3; et alJennifer M. Boggs, PhD3; Rachel Vanderkruik, MA2; Christina A. Metcalf, MA2; Robert Gallop, PhD4; Jennifer N. Felder, PhD5; Joseph Levy, BA2
Author Affiliations
JAMA Psychiatry. Published online January 29, 2020. doi:10.1001/jamapsychiatry.2019.4693
Significance for fasd
Title. Does Giving the Doctor a Document Template with the Patient's Own Values and Preferences When Making Decisions about Starting Medication Improves Shared Decision Making?
Presented by BITO, Seiji
@ SMDM2019 postersession
PCOMS and an Acute Care Inpatient Unit: Quality Improvement and Reduced Readm...Barry Duncan
High psychiatric readmission rates continue while evidence suggests that care is not perceived by patients as “patient centered.” Research has focused on aftercare strategies with little attention to the inpatient treatment itself as an intervention to reduce readmission rates. Quality improvement strategies based on patient-centered care may offer an alternative. We evaluated outcomes and readmission rates using a benchmarking methodology with a naturalistic data set from an inpatient psychiatric facility (N 2,247) that used a quality-improvement strategy called systematic patient feedback. A systematic patient feedback system, the Partners for Change Outcome Management System (PCOMS), was used. Overall pre-post effect sizes were d 1.33 and d 1.38 for patients diagnosed with a mood
disorder. These effect sizes were statistically equivalent to RCT benchmarks for feedback and depression.
Readmission rates were 6.1% (30 days), 9.5% (60 days), and 16.4% (180 days), all lower than national benchmarks. We also found that patients who achieved clinically significant treatment outcomes were less likely to be readmitted. We tentatively suggest that a focus on real-time patient outcomes as well as care that is “patient centered” may provide lower readmission rates.
An Interprofessional Approach to Substance Abuse in Primary CareASAMPUBS
An integrated model of treatment improves care by recognizing that patients need clear and consistent care from their primary care provider “in a way that thoroughly considers biological, social, behavioral, and psychological components of their presenting complaint” by integrating psychological, addiction, and other treatments into a cohesive whole.
This presentation is designed to assist those working in the Youth Work and AOD sector in identifying and assessing at risk young people within Australia. Whilst exploring contemporary theories relating to drug use, prevention and harm reduction, drug use types and drugs in a cultural and social construct within Australia.
The pharmaceutical industry has made it very difficult to know what the clinical trial evidence is regarding psychotropics. As a consequence, primary care physicians and other front-line practitioners are at a disadvantage when attempting to adhere to the ethical and scientific mandates of evidence-based prescriptive practice. BARRY DUNCAN and DAVID ANTONUCCIO call for a higher standard of prescriptive care derived from a risk/benefit analysis of clinical trial evidence. The authors assert that current prescribing practices are often empirically unsound and unduly influenced by pharmaceutical company interests, resulting in unnecessary risks to patients. In the spirit of evidenced-based medicine’s inclusion of patient values as well as the movement toward health home and integrated care, a patient bill of rights for psychotropic prescription is presented. Guidelines are offered to raise the bar of care equal to the available science for all prescribers of psychiatric medications. This is a Psychotherapy in Australia reprint of an earlier article.
Click here for a video of the presentation http://heartandsoulofchange.com/content/resources/viewer.php?resource=video&id=97
Click here for a pdf of the slides: http://heartandsoulofchange.com/content/resources/viewer.php?resource=handout&id=127
What is the correlation between CNS active medication and fall risk for the geriatric community and how should one best prevent fall injuries from occurring for those taking such medication?
PROFESSOR JONATHAN CHICK - ANTIPATHY OR NAIVETY: 12-STEP FACILITATION IN UK H...iCAADEvents
When 300 English addiction treatment workers were surveyed, 9% said they used the 12-Step model and only a third felt that their clients were suited to AA or NA. Less than half would recommend trying a meeting. The NHS survey of the UK population found that of people who reported serious concern about their drinking some had had counselling, but very few had ever attended a mutual aid group This presentation traces some myths and barriers and proposes changes for colleagues and su erers.
Treating Insomnia in Depression Insomnia Related Factors Pred.docxturveycharlyn
Treating Insomnia in Depression: Insomnia Related Factors Predict
Long-Term Depression Trajectories
Bei Bei
Monash University and Royal Women’s Hospital, University of
Melbourne
Lauren D. Asarnow
Stanford University
Andrew Krystal
University of California, San Francisco
Jack D. Edinger
National Jewish Health, Denver, Colorado, and Duke University
Medical Center
Daniel J. Buysse
University of Pittsburgh
Rachel Manber
Stanford University
Objective: Insomnia and major depressive disorders (MDD) often co-occur, and such comorbidity has
been associated with poorer outcomes for both conditions. However, individual differences in depressive
symptom trajectories during and after treatment are poorly understood in comorbid insomnia and
depression. This study explored the heterogeneity in long-term depression change trajectories, and
examined their correlates, particularly insomnia-related characteristics. Method: Participants were 148
adults (age M � SD � 46.6 � 12.6, 73.0% female) with insomnia and MDD who received antidepressant
pharmacotherapy, and were randomized to 7-session Cognitive Behavioral Therapy for Insomnia or
control conditions over 16 weeks with 2-year follow-ups. Depression and insomnia severity were
assessed at baseline, biweekly during treatment, and every 4 months thereafter. Sleep effort and beliefs
about sleep were also assessed. Results: Growth mixture modeling revealed three trajectories: (a)
Partial-Responders (68.9%) had moderate symptom reduction during early treatment (p value � .001)
and maintained mild depression during follow-ups. (b) Initial-Responders (17.6%) had marked symptom
reduction during treatment (p values � .001) and low depression severity at posttreatment, but increased
severity over follow-up (p value � .001). (c) Optimal-Responders (13.5%) achieved most gains during
early treatment (p value � .001), continued to improve (p value � .01) and maintained minimal
depression during follow-ups. The classes did not differ significantly on baseline measures or treatment
received, but differed on insomnia-related measures after treatment began (p values � .05): Optimal-
Responders consistently endorsed the lowest insomnia severity, sleep effort, and unhelpful beliefs about
sleep. Conclusions: Three depression symptom trajectories were observed among patients with comorbid
insomnia and MDD. These trajectories were associated with insomnia-related constructs after commenc-
ing treatment. Early changes in insomnia characteristics may predict long-term depression outcomes.
What is the public health significance of this article?
This study identified three distinct depression trajectories in patients with comorbid major depression
and insomnia disorders during treatment and 2-year follow-up. Those with the largest and most
sustained improvements in depression consistently scored the lowest on postbaseline insomnia and
insomnia-related cognitions. Early changes in insomnia symptoms and insomnia-related character ...
This presentation is designed to assist those working in the Youth Work and AOD sector in identifying and assessing at risk young people within Australia. Whilst exploring contemporary theories relating to drug use, prevention and harm reduction, drug use types and drugs in a cultural and social construct within Australia.
The pharmaceutical industry has made it very difficult to know what the clinical trial evidence is regarding psychotropics. As a consequence, primary care physicians and other front-line practitioners are at a disadvantage when attempting to adhere to the ethical and scientific mandates of evidence-based prescriptive practice. BARRY DUNCAN and DAVID ANTONUCCIO call for a higher standard of prescriptive care derived from a risk/benefit analysis of clinical trial evidence. The authors assert that current prescribing practices are often empirically unsound and unduly influenced by pharmaceutical company interests, resulting in unnecessary risks to patients. In the spirit of evidenced-based medicine’s inclusion of patient values as well as the movement toward health home and integrated care, a patient bill of rights for psychotropic prescription is presented. Guidelines are offered to raise the bar of care equal to the available science for all prescribers of psychiatric medications. This is a Psychotherapy in Australia reprint of an earlier article.
Click here for a video of the presentation http://heartandsoulofchange.com/content/resources/viewer.php?resource=video&id=97
Click here for a pdf of the slides: http://heartandsoulofchange.com/content/resources/viewer.php?resource=handout&id=127
What is the correlation between CNS active medication and fall risk for the geriatric community and how should one best prevent fall injuries from occurring for those taking such medication?
PROFESSOR JONATHAN CHICK - ANTIPATHY OR NAIVETY: 12-STEP FACILITATION IN UK H...iCAADEvents
When 300 English addiction treatment workers were surveyed, 9% said they used the 12-Step model and only a third felt that their clients were suited to AA or NA. Less than half would recommend trying a meeting. The NHS survey of the UK population found that of people who reported serious concern about their drinking some had had counselling, but very few had ever attended a mutual aid group This presentation traces some myths and barriers and proposes changes for colleagues and su erers.
Treating Insomnia in Depression Insomnia Related Factors Pred.docxturveycharlyn
Treating Insomnia in Depression: Insomnia Related Factors Predict
Long-Term Depression Trajectories
Bei Bei
Monash University and Royal Women’s Hospital, University of
Melbourne
Lauren D. Asarnow
Stanford University
Andrew Krystal
University of California, San Francisco
Jack D. Edinger
National Jewish Health, Denver, Colorado, and Duke University
Medical Center
Daniel J. Buysse
University of Pittsburgh
Rachel Manber
Stanford University
Objective: Insomnia and major depressive disorders (MDD) often co-occur, and such comorbidity has
been associated with poorer outcomes for both conditions. However, individual differences in depressive
symptom trajectories during and after treatment are poorly understood in comorbid insomnia and
depression. This study explored the heterogeneity in long-term depression change trajectories, and
examined their correlates, particularly insomnia-related characteristics. Method: Participants were 148
adults (age M � SD � 46.6 � 12.6, 73.0% female) with insomnia and MDD who received antidepressant
pharmacotherapy, and were randomized to 7-session Cognitive Behavioral Therapy for Insomnia or
control conditions over 16 weeks with 2-year follow-ups. Depression and insomnia severity were
assessed at baseline, biweekly during treatment, and every 4 months thereafter. Sleep effort and beliefs
about sleep were also assessed. Results: Growth mixture modeling revealed three trajectories: (a)
Partial-Responders (68.9%) had moderate symptom reduction during early treatment (p value � .001)
and maintained mild depression during follow-ups. (b) Initial-Responders (17.6%) had marked symptom
reduction during treatment (p values � .001) and low depression severity at posttreatment, but increased
severity over follow-up (p value � .001). (c) Optimal-Responders (13.5%) achieved most gains during
early treatment (p value � .001), continued to improve (p value � .01) and maintained minimal
depression during follow-ups. The classes did not differ significantly on baseline measures or treatment
received, but differed on insomnia-related measures after treatment began (p values � .05): Optimal-
Responders consistently endorsed the lowest insomnia severity, sleep effort, and unhelpful beliefs about
sleep. Conclusions: Three depression symptom trajectories were observed among patients with comorbid
insomnia and MDD. These trajectories were associated with insomnia-related constructs after commenc-
ing treatment. Early changes in insomnia characteristics may predict long-term depression outcomes.
What is the public health significance of this article?
This study identified three distinct depression trajectories in patients with comorbid major depression
and insomnia disorders during treatment and 2-year follow-up. Those with the largest and most
sustained improvements in depression consistently scored the lowest on postbaseline insomnia and
insomnia-related cognitions. Early changes in insomnia symptoms and insomnia-related character ...
AssignmentWrite a Respond to two of these #1&2 case studies.docxnormanibarber20063
Assignment:
Write a Respond to two of these #1&2 case studies using one or more of the following approaches:
Share additional interview and communication techniques that could be effective with your colleague’s selected patient.
Suggest additional health-related risks that might be considered.
Validate an idea with your own experience and additional research.
Each must have at least 2 references no more than 5 years old using APA Format
Response # 1
“The case of physician do not heal thyself”
Three questions I will ask the patient on a visit to my office and rationale thereof.
Major depressive disorder (MDD) is defined as “feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and at home” and it is one of the most common reasons patients present for medical care worldwide (McConnell, Carter & Patterson, 2019). Childhood traumatic experiences, including physical, sexual, and emotional abuse, neglect, and separation from caregivers, they posit significantly increase the risk of developing mental and physical illnesses later in life.
NO .1
Have you had any thoughts of death or suicide before? Are you having them now? And do you have a current plan to harm or kill yourself? What are the details of that plan?
McConnell,et .al, (2019) posit that clients with MDD often presents with feeling sad or depressed; lack of interest or pleasure in previously enjoyed activities; appetite changes (unintentional weight loss or gain); sleep difficulty (too much or little); lack of energy (fatigue); feeling of guiltiness or worthlessness; moving more slowly or pacing (others observe); difficulty with decision-making, concentration, and thinking; and/or suicidal thoughts.
Patient safety remains a central concern in every healthcare setting (Smith,2018). This patient did report several feelings of Suicide Ideation and Homicidal ideation so patients’ safety should be priority. Although the welfare of patients encompasses a broad range of concerns, the increasing prevalence of suicide in our society compels health care workers to ensure a safe healthcare environment for patients with suicidal ideation. These efforts include the elimination or, at least, the mitigation of physical setting characteristics that enable suicide attempts.
No 2.
Are you depressed? How does this problem make you feel? What makes the problem better?
According to DSM-5 (2013) diagnostic criteria, MDD requires five or more of the following symptoms during the same two-week period and represent a change from previous functioning; at least one symptom is either 1) depressed mood or 2) loss of interest or pleasure (American Psychiatric Association [APA], 2013).
According to the patient’s file, he has experienced five or more of the symptoms of MDD during the same two-week period, on more than one occasion, incl.
My Role Salesforce DeveloperMy Working Client Truck Rental Com.docxroushhsiu
My Role: Salesforce Developer
My Working Client: Truck Rental Company
Purpose:
This assignment is a written assignment where students will demonstrate how this course research has connected and put into practice within their own career.
Description:
Provide a reflection of at least 500 words (2 pages double spaced) of how the knowledge, skills, or theories of this course have been applied, or could be applied, in a practical manner to your current work environment.
Deliverable:Prepare a 2 page (excluding title and reference page) APA styled Microsoft Word document that shares a personal connection that identifies specific knowledge and theories from this course as well as demonstrates a connection to your current work environment.
Critique the decision making of two of your peers in your response posts.
1. Do you agree/disagree with their medication choice? Why?
2. Is there anything else you recommend including?
3. Compare peer's decision making to yours—what are the advantages and disadvantages of each?
Your response should include evidence of review of the course material through proper citations using APA format.
Reply one:
1)Psychosis: Again, the diagnosis of schizophrenia is best made over time because repeated observations increase the reliability of the diagnosis. A diagnosis of schizophrenia is reached through an assessment of patient-specific signs and symptoms, as described in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Schizophrenia presents with four symptom clusters: positive, negative, cognitive, and affective disturbances. Positive symptoms can include hallucinations, delusions, thought disorders/behaviors, and movement disorders. Negative symptoms include a flat affect, alogia, anhedonia, lack of self-motivation, social withdrawal. Cognitive symptoms include poor executive function, difficulty focusing, memory deficits. And finally, affective disturbances include odd expressions or actions, poor self-esteem, depression with an increased risk of suicide (Dunphy, Winland-Brown, Porter, & Thomas, 2011).
The diagnostic criteria for schizophrenia include the persistence of two or more of the following active-phase symptoms, each lasting for a significant portion of at least a one-month period: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms. At least one of the qualifying symptoms must be delusions, hallucinations, or disorganized speech (DSM-5, 2013). Patient Andy presents with delusions, auditory/cenesthetic hallucinations, and increasing social withdrawal extending upon two months. As well, an estimated 80% of clients affected by a psychotic disorder experience their first episode between the ages of 16-30. In men, the symptoms tend to present between 18 and 25 years of age. In women, the onset of symptoms has two peaks, the first between 25 years of age and the mid-30s, and the second after 40 years of age (Hol ...
Integrated Care Model: Interventions and Strategies for Addressing Co-Morbidities in Early Recovery by Dr. Alkesh Patel, M.D., M.R.O. Addiction Psychiatrist and Assistant Clinical Professor Icahn School of Medicine at Mount Sinai, NYC.
Background: Behavioral health conditions are prevalent among patients in inpatient medical settings and when not adequately treated contribute to diminished treatment outcomes and quality of life. Substantial evidence has demonstrated the effectiveness of psychological interventions in addressing behavioral health conditions in a range of settings but, to a lesser extent with psychologically-based interventions delivered in inpatient medical settings. Purpose: The purpose of this paper is to increase attention on psychological interventions being delivered to patients across a broad spectrum of medical specialties in inpatient medical settings to support the implementation of interventions to address increasing patient needs. Methods: This selected, brief review of the literature sought to describe published psychologically-based interventions delivered in inpatient medical settings. A search for studies catalogued on PubMed from 2007 to 2016 was examined and studies were included in the review if they were delivered within inpatient medical settings. Two reviewers independently assessed relevant studies for criteria. Results: A total of ten articles met the inclusion criteria with interventions targeting outcomes across four primary domains: 1) pain and fatigue; 2) cognition; 3) affective/emotional and; 4) self-harm. Several articles support interventions grounded in Cognitive-Behavioral Therapy and brief psychological interventions. Most studies reported favorable outcomes for the interventions relative to controls. Conclusions: Psychologically-based interventions, especially those that integrate components of cognitive-behavioral therapy and a multidisciplinary approach, can be implemented in inpatient medical settings and may promote improved patient outcomes. However, the quality of this evidence requires formal assessment, requiring more comprehensive reviews are needed to replicate findings and clarify effectiveness of interventions.
Original ArticleDesign and implementation of a randomized.docxgerardkortney
Original Article
Design and implementation of a randomized
trial evaluating systematic care for bipolar
disorder
Abundant evidence demonstrates that treatments
for bipolar disorder can reduce the severity of
mood symptoms and improve daily functioning.
Specific pharmacotherapies have been proven effi-
cacious in the acute management of mania and
depression (1, 2) as well as in the prevention of
recurrence (1). For lithium, more intensive treat-
ment has been shown to improve both long-term
clinical outcomes and psychosocial functioning.
Promising evidence also supports the efficacy of
several disease-specific psychosocial interventions
for bipolar disorder (3, 4).
Unfortunately, treatments provided in everyday
practice fall far short of those proven in clinical
Simon GE, Ludman E, Unützer J, Bauer MS. Design and implementation
of a randomized trial evaluating systematic care for bipolar disorder.
Bipolar Disord 2002: 4: 226–236. ª Blackwell Munksgaard, 2002
Objectives: Everyday care of bipolar disorder typically falls short of
evidence-based practice. This report describes the design and
implementation of a randomized trial evaluating a systematic program to
improve quality and continuity of care for bipolar disorder.
Methods: Computerized records of a large health plan were used to
identify all patients treated for bipolar disorder. Following a baseline
diagnostic assessment, eligible and consenting patients were randomly
assigned to either continued usual care or a multifaceted intervention
program including: development of a collaborative treatment plan,
monthly telephone monitoring by a dedicated nurse care manager,
feedback of monitoring results and algorithm-based medication
recommendations to treating mental health providers, as-needed outreach
and care coordination, and a structured psychoeducational group
program (the Life Goals Program by Bauer and McBride) delivered by the
nurse care manager. Blinded assessments of clinical outcomes, functional
outcomes, and treatment process were conducted every 3 months for
24 months.
Results: A total of 441 patients (64% of those eligible) consented to
participate and 43% of enrolled patients met criteria for current major
depressive episode, manic episode, or hypomanic episode. An additional
39% reported significant subthreshold symptoms, and 18% reported
minimal or no current mood symptoms. Of patients assigned to the
intervention program, 94% participated in telephone monitoring and 70%
attended at least one group session.
Conclusions: In a population-based sample of patients treated for bipolar
disorder, approximately two-thirds agreed to participate in a randomized
trial comparing alternative treatment strategies. Nearly all patients
accepted regular telephone monitoring and over two-thirds joined a
structured group program. Future reports will describe clinical
effectiveness and cost-effectiveness of the intervention program compared
with usual care.
Gregory E Simona, Evette
Lud.
Responsed to colleagues posting that addressed different trends tha.docxzmark3
Responsed to colleague's posting that addressed different trends than those you described. Agree or disagree with the colleague's position on the current and future trends in the treatment of addiction.
Colleague #1
Current trends:
There are a number of trends within the addiction recovery and treatment field. One of the most utilized modalities within the field of addiction recovery may be cognitive behavioral therapy (CBT). CBT seeks to teach those recovering from addiction and other mental illness to find connections between their thoughts, feelings and even their actions or behaviors (Kiluk & Carroll, 2013). The cognitive behavioral approach often encourages those participating in the treatment to identify, and challenge potential thinking errors that may be contributing to their current addiction, or even mental illness.
Another widely used treatment trend is the 12-step program. This program is one that is based on peer support groups that meet together regularly to provide support, guidance and care as each individual works the program as a whole (AAWS, 2012). The basic assumption of the intervention model is that people can help one another achieve and maintain abstinence from substances, and healing cannot come about until one surrenders to a higher power (AAWS, 2012). This is a widely spread program that is estimated to be used by the majority of treatment centers throughout the country (Doweiko, 2019).
Future trends:
There have been a number of developments and shifts within the field of addiction recovery therapy. It seems that societal trends, to a certain extent, may have some sort of impact on the trends as they develop as well. For example, there has been more of an emphasis placed on holistic health, and holistic treatment in a number of fields. This trend may be seen being implemented into the field of substance abuse treatment, and recovery as well.
Drake (2020) suggests that holistic care should be integrated into a multidisciplinary approach within the substance abuse field. The concept of incorporating a registered dietician to the multidisciplinary approach supports the “moniker” of providing a holistic approach to those in substance abuse disorder treatment. Implementing this style of holistic care is said to improve the overall quality of treatment and recovery. It has been reported that those with substance use disorders have become well quicker, fewer symptoms, and sustain recovery longer when they follow principles of quality nutrition (Drake, 2020).
Similarly, there have been various studies implementing the Integrative Body Mind Spirit (I-BMS) intervention among those with substance use disorders. This intervention utilizes Western practices in congruence with Eastern philosophies, as well as techniques (Rentala et al., 2020) There are a number of specific interventions utilized within this particular program that all seek to foster a deeper connection between body, mind and spirit. One of the most com.
For this Discussion, review the case Learning Resources and the DustiBuckner14
For this Discussion, review the case Learning Resources and the case study excerpt presented. Reflect on the case study excerpt and consider the therapy approaches you might take to assess, diagnose, and treat the patient’s health needs.
Case: An elderly widow who just lost her spouse.
Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications:
•
Metformin 500mg BID
•
Januvia 100mg daily
•
Losartan 100mg daily
•
HCTZ 25mg daily
•
Sertraline 100mg daily
Current weight: 88 kg
Current height: 64 inches
Temp: 98.6 degrees F
BP: 132/86
By Day 3 of Week 7
Post
a response to each of the following:
• List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.
• Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.
• Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.
• List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.
• List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.
• For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on the client’s ethnicity. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals of other ethnicities?
• Include any “check points” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen.
Respond to the these discussions. All questions need to be addressed.
Discussion 1 En
Three questions to ask the patient and a rationale for asking these questions.
How may I be of assistance today? This question creates a rapport between you and the patients, and it makes her know that the doctor is ready to listen and help her.
What are you doing to cope with grief after losing your husband? This question will help the care ...
Running head PSYCHOTHERAPY APPROACHES .docxtodd581
Running head: PSYCHOTHERAPY APPROACHES 1
PSYCHOTHERAPY APPROACHES 2
Supportive and interpersonal psychotherapy approaches
Name
Institutions
Supportive and interpersonal psychotherapy approaches
With the prevalence of mental disorders, researchers and healthcare providers have studied the efficacy of different psychotherapy approaches to determine the most efficient strategies that can be used in assisting patients with particular psychiatric disorders. Supportive psychotherapy along with interpersonal psychotherapy are prevalently used in the treatment of mental disorders. These two approaches have various similarities as well as differences. Herein, I will discuss the two psychotherapy approaches, their similarities, differences, and situations in which each of the approaches would be effective in the treatment of patients with psychiatric disorders.
Similarities and Differences of Supportive and Interpersonal Psychotherapy Approaches
Supportive psychotherapy approach refers to a form of psychotherapeutic strategy that combines psychodynamic, cognitive-behavioral as well as interpersonal conceptual approaches of psychotherapy and techniques (Wheeler, 2014). With this psychotherapy approach, the major aim of the therapist is to improve the adaptive along with healthy patterns of the patient with the major objective being to reduce the prevailing intrapsychic conflicts contributing to the patient’s condition. On the other hand, the interpersonal approach refers to a brief, interpersonal focused strategy, which concentrates on identifying and resolving the prevailing interpersonal problems to alleviate the presenting symptoms (Wheeler, 2014). The therapist is essentially concerned with the interpersonal context and the associated factors that may predispose, propagate or precipitate the symptom of psychiatric disorders.
Both approaches are mainly aimed at bringing a therapeutic impact to patients presenting with the symptoms of psychiatric conditions. However, the two approaches have differences. Firstly, the interpersonal approach is an emphatically supported treatment model that mainly adheres to a highly structured and time-limited approach that often takes between 12 to 16 weeks (Cuijpers et al., 2016). Conversely, the supportive approach is not structured and utilizes a combination or either the psychodynamic, cognitive-behavioral and/or interpersonal conceptual approach. What is more, as highlighted in the above paragraph, the main aim of the supportive approach is to enhance the patient’s healthy as well as adaptive patterns in order lessen the prevailing intrapsychic conflicts contributing to the development of mental disorders. Conversely, the main aim of using the interpersonal approach is to ide.
Plan of WorkGloria is employed at Jones University, through .docxJUST36
Plan of Work
Gloria is employed at Jones University, through Higher Learning Systems in Connecticut as a data entry specialist. She originally worked for Higher Learning Systems in Canada; but, she transferred with her husband to the United States through his military career. Gloria has been employed with Higher Learning Systems for 6 years. She worked 5 years in Canada and has been in Connecticut for one year. She was on medical leave for 6 months due to her pregnancy with her first child. She had complications and was absent from work for 3 months before the birth of her child.
There are 12 data entry specialists at Jones University in Connecticut. When Gloria took leave unexpectedly, the other 11 specialists had to split up her work duties. After the birth of Gloria’s child, her co-workers were upset that she decided to take off 12 weeks after the birth, despite the fact she was out 12 weeks before the delivery. When Gloria returned to work, she took frequent breaks, more than the policy allowed, to pump and securely store breast milk for her infant. Since these breaks interfered with her workload, the 11 employees were required to carry a percent of Gloria’s workload until she decided to stop pumping and storing breast milk at work. Employees were extremely frustrated at Gloria and felt as though the university was giving her special treatment.
Gloria felt the frustration immediately when returning to work, despite the fact that the university had indicated that it supported mothers on parental leave and mothers who needed extra time to pump breast milk after maternity leave. She felt disrespected by her co-workers due to her cultural beliefs about the importance of breast feeding. The discomfort she felt affected her work, and she began to fall further behind in her daily responsibilities. Soon, she dreaded going to work, cried often, and felt unappreciated by her supervisor. She also felt her supervisor did not approve of her decision to take 12 weeks off after her infant was born and she didn’t approve of her frequent breaks. Gloria often overheard other employees making jokes about her. Gloria has worked for the company for 6 years and does not want to quit. She decides to visit Human Resources for assistance. Human Resources works with Gloria and her supervisor to create a plan of work to assist with the areas of concern.
For this assignment, there are three main parts: first summarize the scenario, second outline Human Resources response to Gloria, and third prepare a plan of work for Gloria and her supervisor. The plan of work is prepared by Human Resources, so it should include goals for Gloria, the supervisor, and/or the department. Include a timeline with the goals. Ensure the goals are measurable and attainable.
Length: 6 pages, not including title and reference pages " 1 title, 6 body, 1 reference "
References: Include a minimum of five scholarly resources.
Your paper should demonstrate thoughtf.
Planning, Implementation, and Evaluation Evaluate the importa.docxJUST36
Planning, Implementation, and Evaluation"
Evaluate the importance of each major step in policy analysis as it relates to political choice. Next, debate if one would consider any of these steps more important than another. Provide a rationale to support your answer.
From the e-Activity, Next, suggest one (1) method that a policy analyst could use in order to implement the strategic plan overall. Provide a rationale to support yo
.
Planet of the Apes (1974) (Race relations and slavery—turnabout is .docxJUST36
Planet of the Apes (1974): (Race relations and slavery—turnabout is fair play?)
Romeo and Juliet, Shakespeare 1996 (film)
Les Miserables, Victor Hugo 1998 (film)
The Crucible, Arthur Miller 1996 (film)
Death of a Salesman, Arthur Miller 2001 (film)
The Great Gatsby T.S. Elliot 2000 (film)
The Count of Monte Cristo, Alexander Dumas 2002 (film)
Saving Private Ryan: (Saving the last family to survive WWII combat)
Avatar: (The displacement of native populations)
Jurassic Park (1993): (Science and Ethics)
A Few Good Men: (Following illegal orders in the military service)
Pick 5, each should have a separate paper.
Write a short written report on the
ethical issues
expressed in 5 of these films.
Limit the length to one and a half pages, double spaced. Try to pick out the most important ethical issues and explain how they are handled in the film. (Do not give simple plot conditions and character types—get to the heart of the ethical issues and how they are treated, that is, talk about the morality play that is being presented.)
.
Planning effective English language arts lessons many times incl.docxJUST36
Planning effective English language arts lessons many times includes focusing on multiple literacy skills, aligned to state or national standards, while incorporating interesting, student-centered materials. When focusing on reading, it is essential to model metacognitive strategies, before, during, and after reading, including relevant vocabulary. A book walk is a powerful pre-reading strategy that can be used at all elementary grade levels. This strategy exposes students to a new piece of literary or informative text, while predicting text content and exploring vocabulary.
Throughout this course you will be creating a literature unit based on one piece of grade-appropriate literature (fiction or non-fiction) that includes all areas of reading development. Select a piece of literature suitable for the students in the “Class Profile.”
For this assignment, use the “COE Lesson Plan Template” to create a lesson plan that incorporates a book walk,
Incorporate the following into your lesson plan:
Objectives aligned to state or national grade-appropriate vocabulary and reading standards
Content-specific vocabulary development
Technology or multimedia that supports developmentally appropriate, engaging instruction
Pre-reading strategies and activities
During reading strategies and activities
Post-reading activities and strategies
Assessment aligned to learning objectives, that is engaging for student and provides meaningful feedback
Differentiation to meet particular learning differences or needs
In addition, rationalize your instructional choices in a 250-500 word reflection, including how you will apply your findings to personal professional practices related to instruction and differentiation in the English language arts classroom
.
PKI Submission RequirementsFormat Microsoft WordFon.docxJUST36
PKI
Submission Requirements
Format: Microsoft Word
Font: Arial, 12-Point, Double-Space
Citation Style: APA
Length: 1–2 pages
Self-Assessment Checklist
Use the following checklist to support your work on the assignment:
I have identified specific data types related to the specific compliance regulatory requirements.
I have indicated a solution for sharing data beyond the borders of the organization.
I have appropriately selected and developed a PKI solution for content control.
I have followed the submission requirements.
.
PLAGIARISM SCAN REPORT
Date 2020-04-12
Words 161
Characters 991
Content Checked For Plagiarism
Stereolithography (SLA) is one method of many used for 3D printing. There are roughly 30 different processes for additive manufacturing
(commonly called 3D printing) used for different materials from plastics, metals, ceramics, clay, concrete, chocolate, pancake batter and other
foodstuffs, paper, and sand (silica) to living tissue and cells. SLA was one of the earlier 3D methods first developed around 1984. Commercial
SLA printers originally cost hundreds of thousands of dollars, but can now be purchased for a few hundred or a few thousand dollars or even
built at home for less [1]. In the SLA process a liquid material called a photo-polymer is exposed to light from a laser, from a digital projector,
or from another focused optical source. The radiation causes the material to solidify (or cure) where the light hits it. When the full object has
been “drawn”, it is removed from the tank holding the liquid polymer. And there you have your “heart’s desire” in your hand.
Matched Source
Similarity 89%
Title: What is stereolithography used for? - Quora | How it works: SLA
stereolithography (sla) is one method of many used for 3d printing. there are roughly 30 different processes for additive manufacturing
(commonly called 3d printing) used for different materials from plastics, metals, ceramics, clay, concrete, chocolate, pancake batter and
other...
https://www.quora.com/What-is-stereolithography-used-for
Similarity 12%
Title: 1 John commentary - Scripture Verse By Verse
... and a coke and unwraps it for you and puts it in your hand don't blame him if ... A hatred for sin; a desire to please God and confession
when we fail are ... If you hate someone you have murdered them in your heart as far as God is concerned. ... fact that Jesus is God and
savior and there you have your three witnesses. 9.
https://www.thebibleversebyverse.com/1-john-commentary.html
100%
Plagiarised
0%
Unique
https://www.quora.com/What-is-stereolithography-used-for
https://www.quora.com/What-is-stereolithography-used-for
https://www.quora.com/What-is-stereolithography-used-for
https://www.thebibleversebyverse.com/1-john-commentary.html
https://www.thebibleversebyverse.com/1-john-commentary.html
https://www.thebibleversebyverse.com/1-john-commentary.html
Motivation and Emotion:
Driving Consumer Behavior
Chapter 5
Motivation
Types:
Homeostasis
Maintain yourself in a current acceptable state
Self improvement
Desire to change yourself to a more ideal state
Exercise
Think of something of something you have purchased because you wanted something thing to remain the same (homeostasis)
Think of something you have purchased because you wanted something to change (self improvement)
Other ways to look at motivations
Utilitarian
Desire to acquire products that can be used to accomplish things
Hedonic
Desire to experience something personally grat.
Plato’s Apology The Trial of SocratesSocrates in the trial .docxJUST36
Plato’s Apology: The Trial of Socrates
Socrates in the trial – speaking plainly, daily converse. He is a speaker of the truth, not an accomplished speaker.
Socrates’ accusers:
1. Meletus
2. Anytus
3. Lycon
Why does he fear the early accusers more than the recent ones?
They’re anonymous, they are shadows, rumours brainwashed children of that period are now jurors who will decide his fate, they’re nameless, cannot bring evidence forward. They corrupted mind of jurors.
• Children grew hearing that Socrates is a trouble maker, their minds have been infected since they could not ask any acquisitions.
• They accepted this truth and now deciding his fate with prejudice against him they developed when they were kids. He cannot do anything about the prejudices.
• You cannot argue with phantom, ghosts, cannot address them in a straightforward manner.
He fears them the most, they are formidable, because he exposes them for having a reputation of wisdom while they know little, he broke their façade, exposed their flaws hence they may go to any lengths to take vengeance. He exposed people’s ignorance = made himself a lot of enemies.
They accused him of being a Sophist, bad reputation during his time, teaching people weak arguments, weak ideas for money. Socrates was not a sophist. This is what the early accusers made them believe. Sophists were doubtful of God. The 500 jurors never got to hear Socrates speak, they’re just brainwashed.
Socrates’ Attitude during the trial:
• Kind of saying take it easy on me, old man in court for the first time. “I’m a stranger to the court room, treat me kindly”
• Tries to appeal to their humanness, the jurors.
The story of the oracle (Delphi) – temple of Apollo
Oracle is like a messenger, knowledge she has is provided by the gods. The wisdom was unnatural. One of Socrates followers asked the Oracle who is the wisest, is there wiser than Socrates? The God answered no. Socrates was in disbelief, he knew he was unwise.
So he questioned people and learns that people have a reputation to be wise, yet they know nothing and pretend to know. They continue this charade of wisdom because they’re reputation is built on it. He questioned craftsmen, politicians, poets
In the sight of god: wisdom means nothing, like Socrates, we should not pretend more than we are. True wisdom = not knowing.
“Socrates, the gadfly of Athen”
He was proud of the fact that he was like a fly, an irritant. Gadfly = horse fly. He believes this type of insect is necessary. He compares himself to the gadfly and the horse that the gadfly bites is Athens. Gods put Socrates as a gadfly to wake Athens up. Rousing, reproaching, scolding is a good thing. People do not want to be questioned, be shammed, have their knowledge punctured. He compares this to as though the person who wakes you up, you’d naturally be mad.
Philosophy is dangerous but necessary. Living well is more important than living. Die well is better than to live.
W3 C2 – Plato’s Apology
A.
Pine tree tops” by Gary SnyderIn the blue night frost haze,.docxJUST36
“Pine tree tops” by Gary Snyder
In the blue night
frost haze, the sky glows
with the moon
pine tree tops
bend snow-blue, fade
into sky, frost, starlight.
The creak of boots. Rabbit tracks, deer tracks,
what do we know.
writing thesis statement for this poem,
for example: Snyder builds his poem on nouns to give power to the “thing” in his scene.
.
Platform as a Service (PaaS) and Infrastructure as a Service (I.docxJUST36
"Platform as a Service (PaaS) and Infrastructure as a Service (IaaS)" Please respond to the following:
Examine how IaaS and PaaS trends in cloud computing will impact enterprise security policies in the short and long term. Support your findings with an example of each service in the cloud computing stack.
Differentiate between physical, dedicated virtual, and shared virtual servers
.
plan for your client Eliza. Since the initial treatment plan, severa.docxJUST36
plan for your client Eliza. Since the initial treatment plan, several changes have taken place within Eliza’s case. Since the mandatory assessment two weeks ago, you have discovered that Eliza is again on your client listing for the day due to a mandatory evaluation, with the incident report indicating that campus public safety, due to a tip from a concerned resident, found the client passed out and alone in her dorm, smelling of alcohol.
Part 1: Review the initial Treatment Plan submitted in Topic 5.
Reassess your treatment plan diagnoses, goals, and objectives based on the new information provided.
.
Plan a geographic inquiry to investigate the question. In the pl.docxJUST36
Plan a geographic inquiry to investigate the question. In the plan students will explain how they will complete the following aspects of the investigation
a. Investigating cultural perceptions of land and land use
b. Collecting primary and secondary data c. Analysing data
d. Mapping the study area, data and results
e. Communicate results
.
PLAGIARISMWhat is it Whose Responsibility is It Wha.docxJUST36
PLAGIARISM:
What is it?
Whose Responsibility is It?
What Are the Consequences?
A Brief Guide
Department of Management
CBPA, CSUSB
This presentation meets ADA compliance criteria for posting to CSUSB websites
Plagiarism is a Serious Problem
in Academia
“A study of almost 4,500 students at 25 schools,
suggests cheating is . . . a significant problem in
high school - 74% of the respondents admitted to
one or more instances of serious test cheating
and 72% admitted to serious cheating on written
assignments. Over half of the students admitted
they have engaged in some level of plagiarism
on written assignments using the Internet.”
Based on the research of Donald L. McCabe, Rutgers University.
Source: “CIA Research.” Center for Academic Integrity, Duke University, 2003
<http://academicintegrity.org/cai_research.asp>.
http://academicintegrity.org/cai_research.asp
The Student’s Responsibility
• A student should be clear that work submitted for
a grade in the class must be original work.
• It is the responsibility of the student to become
fully acquainted with what constitutes
plagiarism.
• A student can check his/her writing in
Turnitin.com to see whether material shows us
that he/she may have advertently or unknowingly
used that is not their own. (However, it is up to
the instructor to determine plagiarized material )
• The student must correct the error with an
appropriate citation.
Instructor’s Responsibility
The Instructor is responsible for drawing a
conclusion regarding whether the amount of
improperly attributed or unattributed material
is so significant that intent may be presumed.
Excuses Won’t Work
The
teacher
treated me
unfairly,
so I feel
O.K. doing
it!
My job takes up too
much time, plus I am a
caregiver to my younger siblings
My classmates
Are going to
Berkeley
& I want to go
Too!
Students sometimes claim
“Accidental” or “Unintentional Plagiarism”--
What is This?
• Not knowing how/when to cite sources
• Plagiarism vs. paraphrasing
• Careless paraphrasing
• Uncertainty over what is a fact or common
knowledge
• Not knowing what constitutes research
• Quoting excessively
• Different view of plagiarism based on cultural
background
• NOTE: It is the responsibility of the student to become
fully acquainted with what constitutes plagiarism
Disciplinary Consequences
• See pages 53-54, “Plagiarism and Cheating”
CSUSB University Catalog/Bulletin for
violations and consequences.
Pay Attention to Avoiding Even the
Appearance of Plagiarism
WHAT IS PLAGIARISM?: It is use of the following
without giving credit to:
another person’s idea, opinion, or theory;
any facts, statistics, graphs, drawings, and audio
extractions from another’s work;
Any information that is not in the realm of common
knowledge;
quotations of another person’s actual spoken or
written words;
paraphrasing another person’s spoken or written words
without givin.
PKI and Encryption at WorkLearning Objectives and Outcomes· De.docxJUST36
PKI and Encryption at Work
Learning Objectives and Outcomes
· Develop a plan to deploy public key infrastructure (PKI) and encryption solutions to protect data and information.
Assignment Requirements
In this assignment, you play the role of chief information technology (IT) security officer for the Quality Medical Company (QMC). QMC is a publicly traded company operating in the pharmaceutical industry.
QMC is expanding its arena of work through an increase in the number of clients and products. The senior management of the company is highly concerned about complying with the multitude of legislative and regulatory laws and issues in place. The company has an internal compliance and risk management team to take care of all the compliance-related issues. The company needs to make important decisions about the bulk of resources they will need to meet the voluminous compliance requirements arising from the multidimensional challenge of expansion.
QMC will be required to conform to the following compliance issues:
· Public-company regulations, such as the Sarbanes-Oxley (SOX) Act
· Regulations affecting financial companies, companies that make loans and charge interest, such as the U.S. Securities and Exchange Commission (SEC) rules and Gramm-Leach-Bliley Act (GLBA)
· Regulations affecting healthcare privacy information, such as Health Insurance Portability and Accountability Act (HIPAA)
· Intellectual Property Law that is important for information asset protection particularly for organizations in the pharmaceutical and technology industry
· Regulations affecting the privacy of information, including personal identification information, such as personally identifiable information (PII) regularly collected from employees, customers, and end users
· Corporate governance policies including disclosures to the board of directors and the auditors and the policies related to human resources, governance, harassment, code of conduct, and ethics
Compliance with regulatory requirements implies encrypting sensitive data at rest (DAR) and allowing access to role-holders in the enterprise who require the access. It also implies that sensitive data in motion (DIM) or data that is being communicated via e-mail, instant message (IM), or even Web e-mail must be suitably protected and sent only to the individuals who have a right to view it. The company is conscious about the loss they may face in terms of penalty and brand damage if they fail to abide by the compliance laws, especially in the online information transfer phase. Therefore, as a dedicated employee, your task is to develop a content monitoring strategy using PKI as a potential solution. You will need to determine a process or method to identify multiple data types, processes, and organizational policies. Incorporate them into a plan, and select a PKI solution that will effectively address the content management needs of your company.
You need to present your PKI solution in the form of a profes.
Pine Valley Furniture wants to use Internet systems to provide value.docxJUST36
Pine Valley Furniture wants to use Internet systems to provide value to its customers and staff. There are many software technologies available to internet systems development teams, including SOAP, HTML, JSON, XML, CSS, ASP.NET, Objective C, php, JAVA™, Python, Ruby, AJAX, Swift™, AngularJS, Bootstrap, jQuery, R, and many more.
Create
a 3- to 4-page comparison table or tabbed spreadsheet and supporting narrative that addresses the items listed below. Analyze and compare at least three internet systems development software technologies for use at PVF.
Analyze
how the selected internet systems development software technologies support PVF’s core business processes.
Compare
the selected technologies and then the reasons why, as an internet systems developer, you might choose one technology over another technology for PVF.
Explain
how these technologies can bring value to PVF.
Incorporate
additional research to support your comparison.
Cite
any references according to APA guidelines.
.
Pick the form of cultural expression most important to you. It could.docxJUST36
Pick the form of cultural expression most important to you. It could be music, theater, dance, visual arts—whatever excites and/or inspires you most. Describe:
Its most significant characteristics (e.g., visual, audio, etc.)
Your favorite artists in this art, and why.
The one example of this art that inspires you most.
500 words
.
Pick two diseases from each of the following systems HEENT .docxJUST36
Pick two diseases from each of the following systems:
HEENT :
1.
Glaucoma 2. Conjunctivitis
Pulmonary:
1.
Asthma 2. Pneumonia
Hematology:
1.
Anemia. 2. Sickle Cell Anemia
Neurology:
1.
Epilepsy 2. Migraines
Gastroenterology:
1.
Gastroesophageal reflux 2. irritable bowel disease
Cardiovascular:
1.
Coronary artery disease 2. Atrial Fibrillation
Orthopedics:
1.
Carpal Tunnel Syndrome 2. Arthritis
Endocrinology:
1.
Hypothyroidism 2. Hyperthyroidism
Dermatology:
1.
Eczema 2.Rosacea
Urology and STD’s:
1.
Hematuria 2. prostatitis
Pregnancy:
1.
Gestational diabetes 2.preeclampsia
men’s health:
1.
Erectile dysfunction 2. Low testosterone
psychiatry:
1.
Anxiety 2.depression
and pediatric growth and development topics are required:
1.
Giantism 2. pubertal delay
……………………………………………………………………………………………………..
From each of the diseases listed above include:
· Information on the disease/Condition
· What causes it
· Signs and symptoms
· How it is diagnosed
· Common treatment
Each disease is individual, this is NOT a compare between the diseases under the body systems.
………………………………………………………………………………………………
REQUIREMENTS
APA format
15-18 pages
Scholarly articles for sources ONLY!! From years 2015 -2020 only.
.
Pick only one topic!!!!!!!!!!You will need to choose one topic f.docxJUST36
Pick only one topic!!!!!!!!!!
You will need to choose one topic from the following list, explore online resources, and write a report about the topic of your choosing from the following list of topics:
• Disposal of hazardous San Francisco Bay dredging materials
• Earthquake liquefaction hazards around the Bay Area
• Planning for sea level rise around the Bay Area
• Bay Area wetlands restoration projects: past, present and future
• Impacts of filling historical wetlands around the Bay Area
• Stormwater pollution prevention around the Bay Area
• Oil spill hazard mitigation in the San Francisco Bay
• Wastewater pollution prevention around the Bay Area
• Upstream dam construction effects on the estuary health
Lab 3 is asking you to investigate one of the many topics, or issues, related to the San Francisco Bay Estuary and it's restoration. Your deliverable for this assignment is a 1,000 word (at minimum) essay that has AT LEAST five references. The format of your essay should follow the structure outlined in the grading rubric at the end of the assignment sheet (i.e. it should have an Introduction section, Discussion section, and Conclusion section).Please make sure that your paper follows this format, contains at least FIVE references, and has a word count of at least 1,000.
You are required to reference a minimum of five (5) credible sources and include a references section. In addition to a references section, be sure you use intext citations to these sources as their information comes up in your paper.
AND MOST IMPORTANT THING IS NO PLAGIRISM.
Here are some useful information.
https://www.kcet.org/redefine/a-look-at-the-deltas-tastiest-invasive-species
https://www.nationalgeographic.com/news/2016/12/estuaries-california/
http://www.resilientbayarea.org/
https://youtu.be/clZz2OjE5n0
https://youtu.be/dAul4-vE5TM
https://youtu.be/SsxQMgKnClY
Practicum Experience Time Log and Journal Template
Student Name:
E-mail Address:
Practicum Placement Agency's Name:
Preceptor’s Name:
Preceptor’s Telephone:
Preceptor’s E-mail Address:
(Continued next page)
Time Log
Learning Objective
Psychotherapy with Trauma
List AND COMPLETE the 5 objective(s) met and Briefly Describe 8 the Activities you completed during each time period. If you are not on-site for a specific week, enter “Not on site” for that week in the Total Hours for This Time Frame column. Journal entries are due in Weeks 4, 8, and 11; include your Time Log with all hours logged (for current and previous weeks) each time you submit a journal entry.
You are encouraged to complete your practicum hours on a regular schedule, so you will complete the required hours by the END of WEEK 11.
Time Log
Week
Dates
Times
Total Hours for This
Time Frame
Activities/Comments
Learning Objective(s) Addressed
Assess clients presenting with posttraumatic stress disorder
Analyze therapeutic approaches for treating clients presenting with posttraumatic stress disorder
Ev.
Pick one organized religion to research. First, describe the religio.docxJUST36
Pick one organized religion to research. First, describe the religion’s prevalence in the U.S. and membership patterns. Then, apply the symbolic interactionist perspective to this system, describing the symbols, rituals, beliefs, and religious experiences members share. You are required to source your content on this topic.
.
Pick one of the 2 (Buddhist Syllogism or Meditation)...The B.docxJUST36
Pick one of the 2 (Buddhist Syllogism or Meditation)...
The Buddhist Syllogism:
1. “Good” is a judgment.
2. Judgments are a form of attachment.
3. Attachments are the source of all misery and pain.
4. Nirvana is release from all misery and pain through the practice of non-attachment.
5. So
Nirvana is bliss.
6. But if "good" is a judgement and judgements are a form of attachment, and attachments are the source of all misery then
those who say Nirvana (or bliss)
is good
thereby prevent themselves from attaining it
7. So
you must not believe that nirvana is not good....OR you must not want to be in a state of enlightenment.... OR you must not prefer bliss to pain....
Attainment of Nirvana is impeded by desire to attain it. If you want to be without suffering, you will suffer. How, then, does one attain Nirvana?
Above is a traditional discussion on the nature of Nirvana (the ultimate goal of Buddhism.) For this discussion board state why you agree or disagree with the above assessment of the Nature of Nirvana.
Meditation
Meditation is one means of practicing non-attachment, leading to enlightenment.
In some traditions a first step in learning meditation is learning to distinguish the receptive mind from the reactive mind. In meditation, primacy is given to the receptive mind. Reactive states are not to be reacted to, but received. The habitual awareness and non-attachment that result from this practice is called “mindfulness”.
In the meditation drama below, which response is the best example of mindfulness? Why?
Breathe in. Breathe out. Breathe in. Breathe out. Breathe in. Breathe out. I’d kill for a Big Mac. Breathe in.
Responses:
(a) Damn! My mind is so unruly. I’ll never get it under control.
(b) What kind of Buddhist gets distracted by McDonald’s? How embarrassing.
(c) Ah, wishing. It is so hard to stay focused.
(d) Impermanence is the nature of all things. The satisfaction from a Big Mac is fleeting. Your goal is eternal bliss.
(e) None of the above is mindful. A better response would be:
taken from
Spot PCC.edu (Links to an external site.)
Your initial response should be clear and support your view. Write about in your initial post with a minimum length of 175 words.
No References
.
Pick one of the following terms for your research Moral philosophy,.docxJUST36
Pick one of the following terms for your research: Moral philosophy, justice, white-collar crime, differential association, or power.
( DEFINITION: a brief definition of the key term followed by the APA reference for the term; this does not count in the word requirement. SUMMARY: Summarize the article in your own words- this should be in the 150-200 word range. Be sure to note the article's author, note their credentials and why we should put any weight behind his/her opinions, research or findings regarding the key term.
DISCUSSION: Using 300-350 words, write a brief discussion, in your own words of how the article relates to the selected chapter Key Term. A discussion is not rehashing what was already stated in the article, but the opportunity for you to add value by sharing your experiences, thoughts and opinions. This is the most important part of the assignment.
REFERENCES: All references must be listed at the bottom of the submission--in APA format. )
.
Safalta Digital marketing institute in Noida, provide complete applications that encompass a huge range of virtual advertising and marketing additives, which includes search engine optimization, virtual communication advertising, pay-per-click on marketing, content material advertising, internet analytics, and greater. These university courses are designed for students who possess a comprehensive understanding of virtual marketing strategies and attributes.Safalta Digital Marketing Institute in Noida is a first choice for young individuals or students who are looking to start their careers in the field of digital advertising. The institute gives specialized courses designed and certification.
for beginners, providing thorough training in areas such as SEO, digital communication marketing, and PPC training in Noida. After finishing the program, students receive the certifications recognised by top different universitie, setting a strong foundation for a successful career in digital marketing.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
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Archives of Psychiatric Nursing 30 (2016) 322–328
Contents lists available at ScienceDirect
Archives of Psychiatric Nursing
journal homepage: www.elsevier.com/locate/apnu
The Effect of a Drug Adherence Enhancement Program on the
Drug
Adherence Behaviors of Patients With Major Depressive
4. Association,
2010). However, patients with MDD tend to be uncooperative
regarding
medication intake when antidepressant drugs are first
prescribed. Study
findings have revealed that the lack of cooperation of patients
with
MDD is commonly found within the first three months of
treatment
(Nemeroff, 2003), and about 70% of patients with MDD
discontinue
their medications by themselves during the course of treatment
(Demyttenaere et al., 2008; Haynes, Ackloo, Sahota, McDonald,
& Yao,
2008; Pampallona, Bollini, Tibaldi, Kupelnick, & Munizza,
2002). Of
Thai patients with MDD who sought treatment at a medical
school
hospital as many as 64% did not follow up on treatment within
the
first month (Vannachavee, Pakdeejit, & Seeherunwong, 2008).
On
the other hand, approximately four out of 10 US patients
(42.4%) who
initiated antidepressant treatment for depression discontinued
their
antidepressant medication during the first 30 days of treatment.
⁎ Corresponding Author: Acharaporn Seeherunwong, DNS, RN,
Associate Professor, Faculty
of Nursing, Mahidol University, 2 Phannok road, Bangkoknoi,
Bangkok, Thailand 10700.
E-mail addresses: [email protected] (U. Vannachavee),
[email protected] (A. Seeherunwong), [email protected] (P.
Yuttatri),
[email protected] (S. Chulakadabba).
6. taken only
when they have the symptoms (Chakraborty et al., 2008).
Regarding
drug adverse reactions, patients were unable to tolerate the
undesirable
reactions of the drugs such as dizziness and drowsiness, which
are most
likely to occur in the early course of treatment (Lin, Korff, &
Katon,
1995; Maddox, Levi, & Thompson, 1994). Furthermore, during
delivery
services in an outpatient clinic, health care providers did not
have enough
time to create a relationship and provide individualized
information to
the patients, which led to the patients' continued
misunderstanding and
erroneous beliefs. All of these reasons cause patients to
terminate their
medication in the early days of treatment.
http://crossmark.crossref.org/dialog/?doi=10.1016/j.apnu.2015.1
2.001&domain=pdf
http://dx.doi.org/10.1016/j.apnu.2015.12.001
mailto:[email protected]
mailto:[email protected]
mailto:[email protected]
mailto:[email protected]
http://dx.doi.org/10.1016/j.apnu.2015.12.001
http://www.sciencedirect.com/science/journal/
Table 1
Topic and Implementation of Each Session of the DAEP.
Session Implementation
7. #1 Motivation to comply with
the treatment plans
Build the nurse–patient relationship and conduct comprehensive
assessment for understanding the patient's problems and care
needs
Find out the participant's goal for visiting psychiatry clinic
Explore patient's attitude, perceptions, and feelings toward
depressive disorder and its impact
Find out the patient's erroneous attitudes toward becoming a
patient with depressive disorder and its treatment
Provide information about MDD and its treatment
Encourage participants to present their concerns and intention
to adhere to the regime
Use trigger questioning to make the patients aware of their
problems, provide information or useful options for making
decisions regarding
self-care and to perceive the situation as manageable, leading
them to have hope, set goals, and make plans for their mental
health
Assign homework to record drug taking on worksheet every day
#2 Enhancement of confidence and
strengthening the commitment
to take medication
Explore the experience of medication taking, its benefit, and
barriers to adhering to drug taking
Search for feelings of ambivalence toward drug use
Elicit attitudes, perceptions, and feelings about drug taking that
made the patients have ambivalence concerning adherence
Modify erroneous automatic thought toward drug taking,
symptoms of adverse effects, and their illness
Provide information tailored to the patient regarding the illness,
reasons for using antidepressant drugs, and how to manage
8. adverse effects
Modify their behaviors that did not facilitate drug taking or
recovery
Record a plan to change specific behavior
Assign homework to make them have a sense of success
#3 Monitoring and evaluation
of the actual situation
Help the patients manage problems related to adverse effects of
drugs and other problems
Anchor drug adherence
Assign homework to record change in perceptions and feelings
in the worksheet
#4 Planning for continuing
adherence
Prepare for solutions to drug taking problems for a long time
Rehearse alternative options when forgetting to take drugs
Provide information related to problems in discontinuing the
regimen
Encourage continuous medication intake after the end of the
program
Revision and summarization
323U. Vannachavee et al. / Archives of Psychiatric Nursing 30
(2016) 322–328
A program that can enhance patients' cooperation in the
treatment
of MDD, increase their medication adherence, and reduce their
depres-
sive symptoms has been developed based on the concept of
motivational
interviewing of Miller and Rollnick (2002), together with the
strategies of the cognitive therapy of Beck, Rush, Shaw, and
9. Emery
(1979). It has been reported that such a program is effective in
adjusting
patients' attitudes toward medication intake (Tay, 2007) and
their
motivation to continue drug taking to 12 weeks is 2.7 times that
of
those who received the usual care (OR 2.7, 95% CI 1.6–4.8),
resulting
in significantly improvement in depressive symptoms during the
follow-ups at 12 weeks (Peveler, George, Kinmonth, Campbell,
&
Thompson, 1999) and six months after the medication treatment
(Sirey et al., 2001). In Thai psychiatric clinics, there is no
nursing inter-
vention to improve the drug adherence of patients with MDD.
There-
fore, the researcher developed the Drug Adherence
Enhancement
Program (DAEP) based on the concept of motivational
interviewing
(MI) proposed by Miller and Rollnick (2002), implemented
together
with the concept of cognitive therapy of Beck et al. (1979). The
DAEP
was utilized for patients with first episodes of MDD who were
still
receiving pharmacological treatment for the first time.
According to
MI, the program provides counseling which emphasizes to the
patients
the problems caused to them by non-adherence and manages
their hes-
itation in becoming motivated to take antidepressant drugs.
Regarding
the cognitive approach, the program placed its emphasis on
10. negative
automatic thinking and erroneous beliefs associated with the
disease
and its treatment, which directly affected patients' motivation
and
hesitation in appropriately adhering to the treatment plan and
taking
antidepressant drugs. In addition, the DAEP emphasized the
establishment of a good relationship between nurses and
patients,
encouraged patients to accept their illness and treatment with
medica-
tions, reduced their anxiety and concern about the undesirable
side
effects of the prescribed antidepressant drugs, and provided
informa-
tion regarding the benefits of antidepressant drugs. Therefore,
the
specific aim of the current study was to determine the effect of
the
DAEP on the drug adherence behaviors of patients with MDD.
The secondary aim was to explore the lessons learned from the
clinical
implementation. We hypothesized that patients with MDD who
received the DAEP together with usual care would exhibit better
drug
adherence behaviors during the sixth week after the initial
treatment
than those who received only the usual care.
METHODS
Design
A randomized controlled trial with two parallel-group posttest-
only
designs was used in this study. As a result of the patients
11. visiting the
clinic for the first time, there was no pre-test score for drug
adherence
behavior. The study was carried out from October 2009 to
January
2010. The experimental group received the DAEP for four
weeks plus
the usual care, while the control group only received the usual
care.
Sample and Setting
The target population was outpatients first diagnosed with MDD
at
the psychiatric unit of a medical school hospital, in Bangkok,
Thailand.
The patients were recruited based on the inclusion criteria as
follows:
1) male or female patients aged 18 or over, 2) receiving a first
diagnosis
of MDD based on the DSM-IV TR criteria by psychiatrist, 3)
starting
treatment with antidepressant drugs, 4) Thai language ability
and
5) no psychosis. The participants who met the inclusion criteria
and
who were willing to participate in the study were randomly
assigned
into the experimental group and the control group, with 30
participants
in each group, using block randomization performed using a
statistical
computer program. Participants were excluded if they had any
addi-
tional psychotic symptoms and/or had attempted suicide.
Sample sizes were calculated on the basis of medium effect size
12. (ES = 0.5) of the intervention on the outcome of the drug
adherence
(Cohen, 1988), using a one-sided 5% significance level. The
sample
sizes are sufficient to have about 90% power to detect a
difference
between experimental and control groups of 30 in t-test
analysis.
The hospital where this study took place is a leading medical
school.
The hospital provides general tertiary health care services
having 1200
beds for inpatients. Bangkok is the capital of Thailand, and a
major
commercial city, with a population of 10,000,000 and an
estimated
MDD prevalence of 3.2% in males and 4.8 in females aged over
15
(data from national survey of Department of Mental Health,
Ministry
of Public Health, Thailand 2008). From the monthly record of
the
psychiatric unit, the number of new patients with first episode
MDD
averages 29 per month.
324 U. Vannachavee et al. / Archives of Psychiatric Nursing 30
(2016) 322–328
Drug Adherence Enhancement Program
The DAEP was developed by the researchers and comprises four
individual face-to-face sessions that take place over a 4-week
period.
13. The program integrated three main components: an educational
component imparting information about depressive disorders
and their
treatment; (2) a motivational component; and (3) a cognitive
compo-
nent. The contents of the program covered the initiation of
motivation
to adhere to the treatment plan, solving the patients' problems,
negative
automatic thoughts, and erroneous beliefs, and overcoming
obstacles
during medication intake to strengthen the patients' motivation
to adhere
continuously to medication intake. The topics and
implementation of the
four sessions are shown in Table 1. The first session took 1
hour, and the
second through fourth sessions were approximately 30–45
minutes
in length.
During the implementation of the program, worksheets designed
by
the researchers were used to record the participants'
information,
which was provided in response to trigger questions for the
creation
of motivation, such as the reasons for coming to see the doctor,
the
levels of motivation regarding medication intake, problems and
obstacles with medication intake, the reasons for medication
intake,
etc. The level of motivation was arranged on a ruler scale,
which is a
simple form of measurement. The participants were asked to
evaluate
14. their motivation and encouraged to talk about drug taking “How
strong
do you feel about wanting to take drugs?” on a scale from 1 to
10, where
1 was “not at all” and 10 was “very much.” The patient was
asked,
“Where would you place yourself now?” For instance, the
patient was
asked why he or she gave a particular number, say 5, and not a
lower
number. This conversation was explored in some detail. During
sessions
1–4 the researcher provided written tasks for that session, and
in the
follow-up session the researcher kept a record of all of the
patient contacts.
In addition to the worksheets, the participants received a
booklet
comprising knowledge on dealing with the adverse effects of
medication and a self-reported medication intake form created
by
the researchers.
A candidate master degree researcher conducted the
intervention
using a comprehensive program manual developed by the
researchers.
The program manual was examined by a panel of five experts,
including
two psychiatrists, two psychiatric nursing instructors, and one
highly-
experienced professional nurse, to ensure content validity and
language
appropriateness.
15. Measurement
The General Information Questionnaire was designed to collect
the demographic data and clinical information, including
gender, age,
marital status, educational background, occupation, and
antidepressant
drugs prescribed.
Montgomery–Asberg Depression Rating Scale (MADRS)
The MADRS is a ten-item observer-rated scale (1979) and was
translated into Thai by Thitakawee Kaewpornsawan (Sathapisit,
Posya-anuwat, Sasalaksananon, Kaewpornsawan, & Singhakan,
2007).
The MADRS was used to assess the severity of depressive
symptoms
on a 0–6 severity scale, resulting in a total score range of 0–60.
The va-
lidity and reliability of the MADRS Thai-version were at a high
level,
with the inter-rater reliability and intra-rater reliability equal to
.99
and .99, respectively (Sathapisit et al., 2007). MADRS provides
informa-
tion on depression, internal tension, reduced sleeping, reduced
appetite,
difficulty concentrating, fatigue, inability to have feelings,
negative
thinking, and suicidal thoughts. Scores equal to or higher than
21 points
meant that the patients were depressed.
Self-Medication Intake Record Form (SMIR)
Drug adherence behaviors were measured using the SMIR
devel-
16. oped by the researchers based on the concept that drug
adherence
behaviors can be assessed according to the number of days that
the
patients correctly take medication, with the right dose and at the
right
time (Demyttenaere, 1997). This should be followed up
continuously
for more than one month. In this study, a self-report daily
medication
intake form was designed with three response choices: complete
as pre-
scribed by the doctor, score = 1; incomplete medication intake,
score = 0; and no medication intake at all, score = 0. The total
scores
were calculated from the patients' self-report lasting six weeks
(42 days) to determine their drug adherence behaviors. The
record
form was determined to be valid in previous research, and it
yields sim-
ilar results to the medication event monitor system (MEMS)
(Ludman
et al., 2003; Peveler et al., 1999). The self-reported number of
days
that the patients took medication in one month was highly
correlated
with the data from the MEMS with 86.7% agreement and K =
0.66
(Ludman et al., 2003). The record form was submitted to a panel
of ex-
perts to ensure its content validity and was revised based on
their sug-
gestions. The record form was tried out with five participants
whose
demographic characteristics were similar to those of the
17. participants
in the main study to ensure clarity and ease of understanding.
Ethical Considerations
This study was approved by the Medical School's Ethical
Committee
for the protection of human subjects, code number Si476/2009.
A com-
plete description of the study was provided to the patients and
written
informed consent was obtained from each one. The participants
were
informed that they could withdraw at any time without effect on
their
health service from the clinic. They were also informed that all
of the in-
formation gathered in the study would be treated as
confidential.
Data Collection
The evaluation of the program took place two weeks after the
last
session. The program was used with newly-diagnosed patients
when
they were first admitted to treatment. The participants of the
control
group received the usual care from the nurses. When the
participants
finished their first visit to a psychiatrist in the outpatient clinic,
nurses
provided them with health education on MDD, offered advice on
keep-
ing up with their follow-up appointments, and made telephone
follow-
18. ups if the participants did not show up on the appointment day.
In gen-
eral, the psychiatrist made an appointment for a follow-up
examination
every one or two weeks, for a total of four appointments. When
the pa-
tients' symptoms had improved, the intervals between the
follow-ups
were extended. In this study, one of the researchers met each
partici-
pant in the control group twice, at six-week intervals. During
the first
session, the researcher collected information on patients'
demographic
characteristics and severity of depressive symptoms from their
first di-
agnosis with MDD and pharmacological treatment via
interviewing.
The researcher also gave them a manual for patients with MDD
which
included the SMIR for keeping a daily record of their
medication intake
at home for a period of six weeks. During the second session, at
the sixth
week of treatment, the researcher assessed their depressive
symptoms
and collected the SMIR during the follow-up appointment. At
the end
of the research procedure, it was found that there were four
participants
who did not show up on the appointment days and these
participants
could not be reached. Therefore, they were excluded from the
study,
and the total number of participants in the control group was
then re-
19. duced to 26.
The participants in the experimental group received routine
nursing
care similar to that of the participants in the control group.
However,
they also received the DAEP for a total of four sessions, each
lasting
30–60 minutes. The first session was conducted when the
participants
first attended the clinic with the initial received antidepressant
treatment, and the second to fourth sessions were conducted
when
the participants came to visit the psychiatrist on the days of the
appointment. The researcher conducted the intervention after
the
Randomly assigned
approached
60 participants received
baseline assessment
Experimental group:
n=30
Control group: n=30
7 re-arranged their
appointment
20. 2 re-arranged their
appointment
4 lost to follow-up
30 participants
completed the study
Post-test Post-test
2 wks
2 wks
DAEP
4 wks
4 wks
26 participants completed
the study
60 potential participants were
Fig. 1. Recruitment and retention patterns of participants.
325U. Vannachavee et al. / Archives of Psychiatric Nursing 30
(2016) 322–328
psychiatrists had finished the examination of the participants.
The
researcher asked the participants if it was convenient for them
to
participate in the rest of the sessions on the day that was
planned or if
they would rather choose the days on which they were available,
which
21. could be the days of the follow-up appointment. The researcher
offered
the participants 200 baht (35 THB = 1 $US) for their traveling
expenses.
After the research ended, it was found that all of the
experiment's
participants cooperated with the research procedure and all 30
participants remained in the program until the end (Fig. 1).
Data Analysis
Chi-square or Fisher's exact test was used to compare the
character-
istics of the experimental and control groups and an
independent t-test
was utilized to compare age and depressive symptoms. The
indepen-
dent t-test was employed to examine the mean difference in
drug
adherence behaviors after the intervention with both groups.
The
significance level was set at 0.05. Data analysis was carried out
using
IBM SPSS Statistics, version 17. Moreover, the written
statements on
the experimental group worksheets from the second and third
sessions
of the intervention were analyzed using content analysis.
RESULTS
Participants
The participants in the experimental and control groups were
not different in terms of statistical significance, except for
occupation.
A further analysis revealed that most of the participants in the
control
22. group were unemployed, while the largest group of participants
in the
experimental group consisted of government officials. The mean
scores
on the depressive symptoms at baseline were not different but a
difference was found between both groups at two weeks after
the intervention (Table 2).
Effect of Intervention on Drug Adherence Behaviors
The participants in the experimental group who received the
usual
care together with the DAEP had a higher mean score on drug
adher-
ence behaviors during the sixth week than that of the
participants in
the control group, who received only the usual care, with
statistical sig-
nificance (Table 3). In addition, the three highest barriers to
taking anti-
depressant drugs during the second week of participations in the
experimental group included drug adverse effects (33%), the
beliefs
that drugs cannot relieve mental distress (21%), and concern
about
the danger of taking drugs (10%) (Table 4). After participating
in the sec-
ond session of the intervention, during the third week they
reported their
reasons for continuing to take drugs, including getting better
after taking
them (40%), no longer suffering from the side effects of the
drugs (20%),
and making the decision to complete the treatment plan (20%)
(Table 5).
DISCUSSION
23. The participants in the experimental group had more correct
drug
adherence behaviors in terms of the dosage and timing when
compared
to those in the control group with statistical significance. Thus,
the study
hypothesis was accepted. This evidenced that a multi-facetted
compo-
nents program based on the integration of the strategies of
motivational
interviewing and cognitive therapy tailored to meet the needs of
Thai
patients with MDD can improve drug adherence behaviors. It
reinforced
a finding from a recent systematic review (Nieuwlaat et al.,
2014). As a
result, patients' needs were met as soon as they first came to
seek treat-
ment, which continued all through the subsequent follow-ups at
the
outpatient-clinic. The finding was consistent with previous
studies
that reported that collaborative intervention between health care
providers and patients tailoring the information and the methods
of
communication, in response to the problems reported by the
patient
at the initial time of treatment could enhance drug adherence
and
attendance at subsequent appointments. A study of Olfson,
Marcus,
Tedeschi, and Wan (2006) found that patients who received
24. Table 2
Group Differences on Demographic Characteristics and Clinical
Symptoms of Participants.
Variables Experimental
(n = 30)
Control
(n = 26)
p-value
n (%) n (%)
Gendera .815ns
Male 4 13 5 19
Female 26 87 21 81
Agea .619ns
b25 years 3 10 4 15
25–44 years 12 40 7 27
45–59 years 11 37 9 35
N60 years 4 13 6 23
Ageb 44.07 14.15 45.92 17.47 .439ns
Marital statusa .062ns
Single 9 30 10 39
Married 17 57 13 50
Separated/divorced/widowed 4 13 3 11
Education levela .637ns
25. No formal education 1 3 2 8
Primary education 8 27 5 19
Secondary education 2 7 5 19
Certificate of vocational Education 3 10 1 4
Under graduate education 13 43 11 42
Graduate education 3 10 2 8
Occupationa .035
Housework/unemployed 7 23 16 62
Government official 10 33 1 4
Agriculture 2 7 2 8
Own business 2 7 2 8
Employed 8 27 4 14
Student 1 3 1 4
Antidepressant drugs receiveda .904ns
MAOI – – – –
TCA 3 10 2 8
SSRI 24 80 22 84
Others 3 10 2 8
Depressive symptoms [Mean (SD)]b
Pre-test 28.01 6.82 25.73 6.83 1.29ns
Post-test 11.53 6.59 19.90 11.07 .004⁎
ns = no statistical significance, p N .05
⁎ p-value ≤0.05 level was considered statistically significant.
a Chi-square or Fisher's exact test was used.
b Independent sample t-test was used.
326 U. Vannachavee et al. / Archives of Psychiatric Nursing 30
(2016) 322–328
psychotherapy or mental health counseling during the initial
26. period
of antidepressant treatment were significantly more likely to
continue
antidepressants beyond 30 days than those who did not receive
psycho-
therapy (64.8% versus 43.7%). A study by Peveler et al. (1999)
revealed
that drug counseling by a nurse at weeks 2 and 8 according to a
written
protocol had a significant effect on adherence self-reported at 6
weeks
and 12 weeks than receiving a leaflet. Regarding the counseling,
the nurses assessed the patients' attitudes toward treatment,
under-
standing of medication intake and provided knowledge about
depressive illness and related problems, the importance of
medication
intake, and side effects and their management. Similarly,
Hunkeler,
Mersman, Hargreaves, and Fireman (2000) found that when
nurses
showed compassion and understanding and offered to help solve
the
patients' problems with medication intake and psychosocial
problems
through consistent telephone calls during the first six weeks of
the
Table 3
Effect of the DAEP on Drug Adherence Behaviors During the
Sixth Week.
Drug adherence behaviors Experimental
group (n = 30)
Con
(n =
27. Mean SD Mea
Total drug adherence scores at six weeks (42 days) 41.17 2.87
22.5
⁎ Significance at p b .05
† Significance at p b .05
treatment, the patients with MDD had more satisfaction with the
treatment. Also, 10 minutes of drug-related counseling by a
pharmacist
for the patients increased attendance at scheduled follow up
clinics
6 weeks after initial treatment (66%) more than the group
receiving
leaflets (58%) and the 34% of the control group, which is a
statistically
significant difference (p = 0.004). After adjusting for age, sex
and
education, counseling was significa ntly associated with a much
higher
incidence of using medication correctly (OR 31.3, p = 0.009),
leaflet
use was less strongly associated (OR 8.4, p = 0.009) (Nabeel,
2008).
On the other hand, it was supported by previous studies that
found
that information alone provided by leaflet (Peveler et al., 1999)
or
repeated mailings (Mundt, Clarke, Burroughs, Brenneman, &
Griest,
2001) were not enough to enhance medication adherence.
Regarding clinical benefits, the findings showed that the
patients
who received the DAEP had better depression scores after the
28. interven-
tion than those who received only the usual care at a significant
level, as
shown in Table 1. This information supported the finding that
the DAEP
could enhance patients' drug adherence behaviors. As the
antidepres-
sant drugs adjusted the balance of the biochemical substances in
the
brain, patients' depressive symptoms improved. However, the
depres-
sion scores of the participants in the control group also reduced
during
the sixth week of the intervention, but to a lesser extent when
com-
pared to the scores of the participants in the intervention group.
One
plausible explanation is that the participants in the control
group did
not have correct or consistent medication intake. According to
the
interviews, some participants indicated that they took only
sleeping
pills but did not take the …
Ethical Considerations in Mental Health Research Paper
Each student will be assigned one of three faculty selected
articles and will write a three to four page paper addressing
ethical issues related to protection of a vulnerable
3. Vannachavee, U., Seeherunwong, A, Yuttatri, P., &
Chulakadabba, S. (2016). The effect of a
drug adherence enhancement program on the drug
adherence behaviors of patients
with major depressive disorder in Thailand: A
29. randomized clinical trial. Archives of
Psychiatric Nursing, 30, 322-328.
*Keep in mind that you will need to include at least two other
references to support your opinion. These references must be
from a reliable and professional source.
Imagine that you are a member of a human subjects review
committee or the institutional review board and are considering
whether to approve this study. You job is to evaluate whether
the ethical rights of the potential subjects were protected.
While the study has already been completed and published, and
results are available, do not consider the results as you analyze
the ethics of the study. Focus your evaluation on the plans to
protect the vulnerable population. You will need to support
your argument with other published scholarly work.
Questions you may want to consider are as follows:
· Consider if the subjects or their proxy gave voluntary and
informed consent. Many studies are not specific about this, but
you should decide what the researchers should have done based
upon the diagnosis, mental health issues, cultural, and other
considerations of the group of patients being studied and the
research (medication, psychotherapy, diagnostic testing,
personality testing, etc.). If a proxy was used, was their
sufficient reason for using a proxy, and did the subject give his
or her own view or assent?
· Evaluate if the study was worthwhile doing.
· Evaluate the risk/ benefit ratio. Were the possible benefits of
the study sufficient to justify the risks to the subjects? Were the
risks so great that the subjects should not have been asked to
participate, or should have said no to participating?
Were there adequate protections in place for the subjects? If
there was a wash out phase, or placebos, were the subjects
protected? Did the subjects have psychiatric and medical
evaluations sufficiently frequently and in enough depth for the
researchers to protect them from harm?
30. - All of the above topics may not be specifically addressed in
the article, and it is the student’s assignment to think about this
study and read relevant articles that discuss the above issues
and come to your own conclusions.
- Sources must be cited for any ideas taken from authors; even
if they are stated in your own words. The paper should be no
more than 4 pages of text in length (not counting title page and
references) and should be written in A.P.A. format.
Students should only write one paragraph to summarize the
study and assume that the reader has read the study.
- The purpose is not to evaluate the results of the study, but the
ethical aspects of doing the study.
-The paper must be succinct and well written. This includes
being well organized, having clear expression of ideas and
opinions as well as proper mechanics (spelling, punctuation,
references, grammar, etc.).
-The ethical issues selected must be explored in depth and
should address the topics listed above that are relevant for that
study.
31. Ethics Paper Rubric
Criteria
Ratings
Points Points
Brief summary of the study a. Logical and clear writing
10.0 pts
Exceeds Standard/Very Good/Outstanding 9-10 points
8.0 pts
Meets Standard/Good 7-8 points
6.0 pts
Below Standard 0-6 points
10.0 pts
Student's discussion with development of argument to address
the following if applicable (weighting change applied if not
applicable) a. Discussion of voluntary and informed consent
including IRB approval, written consent, and written assent
10.0 pts
Exceeds Standard/Very Good/Outstanding 9-10 points
8.0 pts
Meets Standard/Good 7-8 points
32. 6.0 pts
Below Standard 0-6 points
10.0 pts
Student’s discussion with development of argument to address
the following if applicable (weighting change applied if not
applicable) b. Evaluation of inherent worth of the study
including contribution to body of knowledge and additional
adherent benefits
10.0 pts
Exceeds Standard/Very Good/Outstanding 9-10 points
8.0 pts
Meets Standard/Good 7-8 points
6.0 pts
Below Standard 0-6 points
10.0 pts
Student’s discussion with development of argument to address
the following if applicable (weighting change applied if not
applicable)
Student's own opinion with rational development of argument
with
discussion of the following if applicable (weighting change
applied if not applicable)
c. Evaluation of the risk/benefit ratio including risks and
benefits of study and comparison of risks versus benefits.
10.0 pts
Exceeds Standard/Very Good/Outstanding 9-10 points
33. 8.0 pts
Meets Standard/Good 7-8 points
6.0 pts
Below Standard 0-6 points
10.0 pts
Student’s discussion with development of argument to address
the following if applicable (weighting change applied if not
applicable) d. Evaluation of adequate protections for subjects
including protections
10.0 pts
Exceeds Standard/Very Good/Outstanding 9-10 points
8.0 pts
Meets Standard/Good 7-8 points
6.0 pts
Below Standard 0-6 points
10.0 pts
Student’s discussion with development of argument to address
the following if applicable (weighting change applied if not
applicable) e. Evaluation of inclusion and exclusion criteria,
evaluation of overall sample selection, and additional concerns
for protections for subjects based upon diagnosis or other
criteria (age, gender, culture, etc.)
10.0 pts
Exceeds Standard/Very Good/Outstanding 9-10 points
8.0 pts
34. Meets Standard/Good 7-8 points
6.0 pts
Below Standard 0-6 points
10.0 pts
Student’s discussion with development of argument to address
the following if applicable (weighting change applied if not
applicable) f. Logical and clear writing
10.0 pts
Exceeds Standard/Very Good/Outstanding 9-10 points
8.0 pts
Meets Standard/Good 7-8 points
6.0 pts
Below Standard 0-6 points
10.0 pts
Student’s argument supported with literature
20.0 pts
Exceeds Standard/Very Good/Outstanding 17-20 points
16.0 pts
Meets Standard/Good 14-16 points
13.0 pts
Below Standard 0-13 points
20.0 pts
Format of Paper a. APA Style b. Spelling, grammar, and
35. punctuation c. In-text citations and reference list (at least 2
references)
10.0 pts
Exceeds Standard/Very Good/Outstanding 9-10 points
8.0 pts
Meets Standard/Good 7-8 points
6.0 pts
Below Standard 0-6 points
10.0 pts
10.0 pts
Exceeds Standard/Very Good/Outstanding 9-10 points
8.0 pts
Meets Standard/Good 7-8 points
6.0 pts
Below Standard 0-6 points
10.0 pts
Total Points: 100.0
Order #214565173 Ethical Considerations in Mental Health
Research Paper (3 pages, 0 slides)
Type of service:
Writing from scratch
Work type:
36. Research paper
Deadline:
(15h)
Academic level:
College (3-4 years: Junior, Senior)
Subject or Discipline:
Health Care
Title:
Ethical Considerations in Mental Health Research Paper
Number of sources:
3
Provide digital sources used:
No
Paper format:
APA
# of pages:
3
Spacing:
Double spaced
# of words:
825
# of slides:
ppt icon 0
# of charts:
0
Paper details:
Kindly see attached document for instruction, article and
grading criteria
Comments:
37. Customer local details
01:02 AM, United States of America
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