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
The Role of Collaborative Arrangements on Quality Perception in Ambulatory CareBruno Agnetti
Il pronto intervento italiano aveva posto un accento particolare sulla promozione di nuove modalità organizzative. Alcuni studi hanno analizzato il loro impatto sulla percezione della qualità. Con l'obiettivo di esaminare i clienti 'e medici' in cura ambulatoriale all'interno dei diversi modelli organizzativi, abbiamo studiato 96 pazienti (di età compresa tra i 18-80 anni) e 22 medici (M = 50,33 anni).
In the present days of increasing consumer awareness and distrust among the public towards the medical profession its time to introspect & rectify ....
Patient satisfaction and side effects in primary care: An observational study...home
1) The study compared patient satisfaction and perception of side effects between homeopathic and conventional primary care in Switzerland. It found that patients receiving homeopathic treatment reported significantly higher satisfaction and fewer side effects than those receiving conventional treatment.
2) Specifically, 53% of homeopathic patients reported being completely satisfied with treatment compared to 43% of conventional patients. Homeopathic treatments were also perceived as having 2-3 times fewer side effects.
3) While symptom resolution was slightly higher for conventional patients, homeopathic patients generally had more chronic conditions and reported their health status as better.
Social workers currently do not have the authority to prescribe or administer medication, though they play an important role in medication management and adherence. Some other non-physician professions, like psychologists, have begun gaining limited prescribing privileges. This document discusses the expanding roles of social workers in medication management, reviews new laws allowing prescribing by psychologists in New Mexico and Louisiana, and raises questions about whether social work should also pursue prescribing privileges.
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.
bioethical considerations for preventative enhancementsLuke Brennan
This document discusses medically relevant enhancements and proposes a framework to distinguish them from medical treatments. It begins by defining enhancements as interventions that improve human functioning beyond what is necessary for health. However, it notes issues with this definition. The document then proposes an "expected functioning account" to better distinguish enhancements and treatments. Under this framework, a treatment returns a patient to their previous level of functioning, while an enhancement improves functioning beyond that level. The document focuses on "medically relevant enhancements" - those that make people less susceptible to disease without significantly altering other traits. It argues these types of enhancements can permissibly be used in medicine to fight disease.
Teaching issues acc and neurotechnology lessons drug preventionJacob Stotler
Teaching Technique: Functional connectivity of the Anterior Cingulate Cortex, error awareness and the effects of inhibition on the ACC from drug use / Nuerofeedback approaches to Bio-technologies and bio-engineering.
The Role of Collaborative Arrangements on Quality Perception in Ambulatory CareBruno Agnetti
Il pronto intervento italiano aveva posto un accento particolare sulla promozione di nuove modalità organizzative. Alcuni studi hanno analizzato il loro impatto sulla percezione della qualità. Con l'obiettivo di esaminare i clienti 'e medici' in cura ambulatoriale all'interno dei diversi modelli organizzativi, abbiamo studiato 96 pazienti (di età compresa tra i 18-80 anni) e 22 medici (M = 50,33 anni).
In the present days of increasing consumer awareness and distrust among the public towards the medical profession its time to introspect & rectify ....
Patient satisfaction and side effects in primary care: An observational study...home
1) The study compared patient satisfaction and perception of side effects between homeopathic and conventional primary care in Switzerland. It found that patients receiving homeopathic treatment reported significantly higher satisfaction and fewer side effects than those receiving conventional treatment.
2) Specifically, 53% of homeopathic patients reported being completely satisfied with treatment compared to 43% of conventional patients. Homeopathic treatments were also perceived as having 2-3 times fewer side effects.
3) While symptom resolution was slightly higher for conventional patients, homeopathic patients generally had more chronic conditions and reported their health status as better.
Social workers currently do not have the authority to prescribe or administer medication, though they play an important role in medication management and adherence. Some other non-physician professions, like psychologists, have begun gaining limited prescribing privileges. This document discusses the expanding roles of social workers in medication management, reviews new laws allowing prescribing by psychologists in New Mexico and Louisiana, and raises questions about whether social work should also pursue prescribing privileges.
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.
bioethical considerations for preventative enhancementsLuke Brennan
This document discusses medically relevant enhancements and proposes a framework to distinguish them from medical treatments. It begins by defining enhancements as interventions that improve human functioning beyond what is necessary for health. However, it notes issues with this definition. The document then proposes an "expected functioning account" to better distinguish enhancements and treatments. Under this framework, a treatment returns a patient to their previous level of functioning, while an enhancement improves functioning beyond that level. The document focuses on "medically relevant enhancements" - those that make people less susceptible to disease without significantly altering other traits. It argues these types of enhancements can permissibly be used in medicine to fight disease.
Teaching issues acc and neurotechnology lessons drug preventionJacob Stotler
Teaching Technique: Functional connectivity of the Anterior Cingulate Cortex, error awareness and the effects of inhibition on the ACC from drug use / Nuerofeedback approaches to Bio-technologies and bio-engineering.
The document summarizes the key points from a panel discussion on solving America's workers' compensation crisis. The panel identified four main changes needed: 1) Eliminate unproven therapies in favor of accurate diagnosis and evidence-based treatment; 2) Identify at-risk workers early and invest in wellness programs; 3) Embrace innovative treatment solutions currently not covered by insurance; and 4) Advocate for changes to public policy to alleviate financial motivations that drive up costs. The panel agreed comprehensive reform is needed across the entire workers' compensation system to improve outcomes and reduce costs.
This document discusses creating a market for personalized whole genome sequencing to develop patient-centric healthcare. It begins by outlining how genome sequencing costs have dropped significantly since 2003, enabling more widespread genomic data collection. However, genome sequencing has provided little direct economic benefit due to a lack of defined markets or networks to deliver personalized care. The document then discusses how whole genome sequencing could shift healthcare towards a preventative, personalized, participatory model focused on wellness rather than disease. However, information asymmetries and technical limitations have prevented this vision. The document argues that creating a patient-centric model where individuals own their genomic data could help address these issues and promote innovative healthcare solutions through disruptive approaches like whole genome sequencing.
The document discusses the history and principles of evidence-based medicine (EBM). It describes EBM as the conscientious and judicious use of current best evidence from clinical research in medical decision making. The five essential steps of EBM are outlined as formulating a question, finding evidence, appraising the evidence, applying the evidence, and evaluating performance. Examples are provided of applying EBM concepts to manage panic disorder and assess delirium.
This document discusses substance abuse and polypharmacy among older adults. It begins by defining polypharmacy as the use of multiple medications concurrently. It then identifies several risk factors for substance abuse and polypharmacy in older adults, such as taking 5 or more medications, cognitive impairment, and lack of social support. The document outlines holistic interventions that can address issues like physical limitations, psychological well-being, social support and cultural practices. It concludes by stating that polypharmacy is a major quality-of-care concern for older adults and that early interventions can help older adults avoid health problems from misusing drugs or medications.
Direct To Consumer Genomics and the Future of HealthcareRyan Squire
Richard Sharp, Ph.D., Director of Bioethics Research at the Cleveland Clinic presents on direct-to-consumer genomics and the future of health care.
Dr. Sharp received his training in philosophy and medical ethics at Michigan State University.
Prior to joining the Cleveland Clinic in 2007, Dr. Sharp taught bioethics at Baylor College of Medicine and the National Institute of Environmental Health Sciences, one of the National Institutes of Health (NIH), where he directed the Program in Environmental Health Policy and Ethics.
His research examines the promotion of informed patient decision-making in clinical research, particularly research that involves genetic analyses.
The document discusses the mission and goals of the Patient-Centered Outcomes Research Institute (PCORI). PCORI was established through the Affordable Care Act to help patients make informed healthcare decisions through comparative clinical effectiveness research. The organization aims to produce high-quality evidence by involving patients and caregivers throughout the research process, from developing research questions to disseminating results. PCORI also seeks to address treatment heterogeneity and improve outcomes for various patient subgroups through its research.
This document discusses the formation of Behavioral Emergency Response Teams (BERT) in hospitals to quickly de-escalate potentially violent situations involving patients exhibiting dangerous behaviors. The objectives of BERT are to promote safety for patients and staff. A literature review found that BERT reduced injuries and increased staff satisfaction by providing psychiatric expertise. The author recommends that BERT teams have clear communication structures, availability, and properly trained members to effectively handle behavioral emergencies.
This document outlines Dan Hausman's critique of economic evaluations of health that rely on eliciting and aggregating individual preferences. Hausman argues that preferences are an unreliable guide to the value of health states for several reasons. People's preferences can be distorted by cognitive flaws and irrelevant factors. They are also often uninformed since health states are unfamiliar alternatives. Rather than relying on preferences, Hausman believes health economists should directly evaluate health states based on their effects on well-being, opportunities, autonomy, and other considerations.
- A study compared rates of preventable adverse drug events (ADEs) in intensive care units (ICUs) vs. non-ICUs at two hospitals over 6 months.
- The unadjusted ADE rate was twice as high in ICUs, but when adjusted for number of drugs, there was no difference between ICUs and non-ICUs.
- Preventable ADEs occurred due to normal systems failures like poor communication rather than overworked individuals, showing the need for systems solutions over blaming individuals.
Steve Shortell: Integrated care: Policy and evidenceNuffield Trust
This document discusses integrated care and provides evidence in support of more integrated models of care delivery. It makes three key points:
1) Current healthcare systems often fail to provide integrated care for patients with chronic conditions who require care from both primary physicians and hospitals. Effective coordination of this care can result in better outcomes and lower costs.
2) Integrated delivery systems (IDS) that provide coordinated, team-based care show promise in improving quality of care and health outcomes, especially for patients with chronic conditions. The Veterans Health Administration and Kaiser Permanente are cited as examples of high performing IDS models.
3) Evidence suggests that use of elements of the Chronic Care Model, such as patient registries, self
Towards an evidence informed adventure therapy implementing feedback informed...Will Dobud
ABSTRACT
As an intervention for adolescents, adventure therapy has evolved considerably over the last three decades with support from multiple meta- analyses and research input from both residential and outpatient services. Tainted by a history of unethical practice and issues of accountability, this article explores the question of how adventure therapy can meet a standard of evidence preferred by policymakers and funding bodies on the international stage. In this case, feedback-informed treatment (FIT) is presented as a means for routine outcome management, creating a framework for adventure therapy which aims to improve the quality of participant engagement while maintaining and operationalizing today’s definitions for evidence-based practice. A case vignette illustrates the use of FIT with an adolescent participant engaged on a 14-day adventure therapy program.
The Empower Veterans Program provides intensive, integrated self-care coaching through group and individual sessions for veterans suffering from chronic pain. Over 10 weeks, veterans receive training in whole health and well-being, acceptance and commitment therapy, and mindful movement. Preliminary results show improvements in pain, functioning, mental health, and quality of life for veterans, as well as decreased healthcare utilization and costs. The program aims to safely empower veterans with chronic pain through a multidisciplinary approach that promotes self-management over passive treatments.
2 why did you decide to pursue a baccalaureate degree in nursinAASTHA76
This survey asked 65 nurses about their reasons for pursuing a baccalaureate degree in nursing. It identified six main themes in their responses: desire to help others, lifelong dream of being a nurse, ability to advance their career, availability of jobs, earning potential, and loss of a previous job. However, the summary does not provide details about the level of measurement used in the study or how frequently each theme was reported. This information is important for determining what descriptive statistics are most appropriate.
Apa format…450 words each. please include biblical integration. a AASTHA76
The document discusses the roles and functions of health informatics (HI) professionals. It covers several key points:
1. HI professionals are responsible for collecting, storing, organizing, and managing health data to improve healthcare services. Their roles require technical skills with health information systems, clinical knowledge of medical processes, and administrative skills.
2. Proper education and training are needed to build the clinical competence required for various HI roles. Experience and graduate-level education are important for advancing to higher positions.
3. HI professionals play critical roles on healthcare teams by ensuring standardized data, analyzing collected information, and supporting quality patient care through the use of technology.
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.
BM THESIS HTA LIT BM THESIS De Kinderen et al (2013)Roel Rinkens
The document discusses the economic burden of side effects from antiepileptic drugs (AEDs). It estimates the annual healthcare costs, patient and family costs, and other costs associated with common side effects experienced by 203 epilepsy patients in the Netherlands. The total estimated societal cost per patient per year is €20,751 (US$26,675), including healthcare costs (€4,458), patient and family costs like informal care (€10,526), and other costs like lost productivity (€5,761). When examined separately, the most to least expensive side effect categories were: other (€13,228), behavioral (€9,689), general health (€7,454), cognitive (€7,
This document summarizes the results of a study examining factors that influence multiple sclerosis (MS) patients' willingness to participate in clinical trials. The study involved questionnaires assessing patients' knowledge of and attitudes towards clinical trials. The results showed that about half of MS patients were willing to consider participating in a trial. The strongest positive predictors of willingness were older age, not having children, progressive MS, and previous trial participation. Risk of side effects was the top negative factor influencing participation. Providing comprehensive information to patients was the most important solution to increase participation.
This document discusses challenges around obtaining informed consent from vulnerable populations in medical research. It explores two case studies: research in emergency settings where patients may be temporarily incompetent, and research with cancer patients where illness can impact competency. For both cases, it examines difficulties around ensuring understanding while obtaining consent, and proposes alternatives like deferred consent or waiving consent with additional protections. Throughout, it emphasizes finding the right balance between individual autonomy, beneficence, and justice when conducting research with vulnerable groups.
When children and teens present with behaviour and emotional problems the lure of a quick fix is
understandable and drugs present a ready-made solution. Therapists are often hesitant to talk about
medication and defer to medical professionals. In this paper DUNCAN, SPARKS, MURPHY and MILLER
highlight the explosion in the use of psychotropic medications for children and teens. This trend flies in the
face of the American Psychological Association’s recommendation of the use of psychosocial interventions
as the first intervention of choice with children and teens. The reliability and validity of psychiatric diagnoses is
questioned, in particular against a background of fluctuations in child development and social adaptations,
and a compelling critique is provided of the current research findings on the effectiveness of psychotropic
medications including antidepressants and ADHD medications. Therapists are urged to shed their timidity
and discuss openly the risks and benefits of medication with the knowledge that there is empirical support
for psychosocial interventions as a first line approach. Recommendations are offered to engage clients as
central partners in developing solutions—medical or non-medical—that fit each child and each situation.
The pharmaceutical industry has made it very difficult to know what the clinical trial evidence actually is regarding psychotropics. Consequently, 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. This article calls 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 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, we present a patient bill of rights for psychotropic prescription. We then offer guidelines to raise the bar of care equal to the available science for all prescribers of psychiatric medications.
The first quasiexperiemental study of the ORS/SRS in a telephonic EAP company. Doubled outcomes and improved retension. Set the stage for the RCTs that followed
The Norway Couple Project: Lessons LearnedBarry Duncan
The document discusses lessons learned from studies on using client feedback to improve outcomes in couple therapy. A large randomized clinical trial in Norway found that routinely collecting and discussing client feedback on progress and the therapeutic alliance using brief measures led to better outcomes compared to treatment as usual. Specifically, couples receiving feedback showed greater improvement in their relationships and were less likely to deteriorate over time. The findings suggest incorporating systematic client feedback into routine practice can help therapists improve outcomes for couples across different therapy approaches.
The document summarizes the key points from a panel discussion on solving America's workers' compensation crisis. The panel identified four main changes needed: 1) Eliminate unproven therapies in favor of accurate diagnosis and evidence-based treatment; 2) Identify at-risk workers early and invest in wellness programs; 3) Embrace innovative treatment solutions currently not covered by insurance; and 4) Advocate for changes to public policy to alleviate financial motivations that drive up costs. The panel agreed comprehensive reform is needed across the entire workers' compensation system to improve outcomes and reduce costs.
This document discusses creating a market for personalized whole genome sequencing to develop patient-centric healthcare. It begins by outlining how genome sequencing costs have dropped significantly since 2003, enabling more widespread genomic data collection. However, genome sequencing has provided little direct economic benefit due to a lack of defined markets or networks to deliver personalized care. The document then discusses how whole genome sequencing could shift healthcare towards a preventative, personalized, participatory model focused on wellness rather than disease. However, information asymmetries and technical limitations have prevented this vision. The document argues that creating a patient-centric model where individuals own their genomic data could help address these issues and promote innovative healthcare solutions through disruptive approaches like whole genome sequencing.
The document discusses the history and principles of evidence-based medicine (EBM). It describes EBM as the conscientious and judicious use of current best evidence from clinical research in medical decision making. The five essential steps of EBM are outlined as formulating a question, finding evidence, appraising the evidence, applying the evidence, and evaluating performance. Examples are provided of applying EBM concepts to manage panic disorder and assess delirium.
This document discusses substance abuse and polypharmacy among older adults. It begins by defining polypharmacy as the use of multiple medications concurrently. It then identifies several risk factors for substance abuse and polypharmacy in older adults, such as taking 5 or more medications, cognitive impairment, and lack of social support. The document outlines holistic interventions that can address issues like physical limitations, psychological well-being, social support and cultural practices. It concludes by stating that polypharmacy is a major quality-of-care concern for older adults and that early interventions can help older adults avoid health problems from misusing drugs or medications.
Direct To Consumer Genomics and the Future of HealthcareRyan Squire
Richard Sharp, Ph.D., Director of Bioethics Research at the Cleveland Clinic presents on direct-to-consumer genomics and the future of health care.
Dr. Sharp received his training in philosophy and medical ethics at Michigan State University.
Prior to joining the Cleveland Clinic in 2007, Dr. Sharp taught bioethics at Baylor College of Medicine and the National Institute of Environmental Health Sciences, one of the National Institutes of Health (NIH), where he directed the Program in Environmental Health Policy and Ethics.
His research examines the promotion of informed patient decision-making in clinical research, particularly research that involves genetic analyses.
The document discusses the mission and goals of the Patient-Centered Outcomes Research Institute (PCORI). PCORI was established through the Affordable Care Act to help patients make informed healthcare decisions through comparative clinical effectiveness research. The organization aims to produce high-quality evidence by involving patients and caregivers throughout the research process, from developing research questions to disseminating results. PCORI also seeks to address treatment heterogeneity and improve outcomes for various patient subgroups through its research.
This document discusses the formation of Behavioral Emergency Response Teams (BERT) in hospitals to quickly de-escalate potentially violent situations involving patients exhibiting dangerous behaviors. The objectives of BERT are to promote safety for patients and staff. A literature review found that BERT reduced injuries and increased staff satisfaction by providing psychiatric expertise. The author recommends that BERT teams have clear communication structures, availability, and properly trained members to effectively handle behavioral emergencies.
This document outlines Dan Hausman's critique of economic evaluations of health that rely on eliciting and aggregating individual preferences. Hausman argues that preferences are an unreliable guide to the value of health states for several reasons. People's preferences can be distorted by cognitive flaws and irrelevant factors. They are also often uninformed since health states are unfamiliar alternatives. Rather than relying on preferences, Hausman believes health economists should directly evaluate health states based on their effects on well-being, opportunities, autonomy, and other considerations.
- A study compared rates of preventable adverse drug events (ADEs) in intensive care units (ICUs) vs. non-ICUs at two hospitals over 6 months.
- The unadjusted ADE rate was twice as high in ICUs, but when adjusted for number of drugs, there was no difference between ICUs and non-ICUs.
- Preventable ADEs occurred due to normal systems failures like poor communication rather than overworked individuals, showing the need for systems solutions over blaming individuals.
Steve Shortell: Integrated care: Policy and evidenceNuffield Trust
This document discusses integrated care and provides evidence in support of more integrated models of care delivery. It makes three key points:
1) Current healthcare systems often fail to provide integrated care for patients with chronic conditions who require care from both primary physicians and hospitals. Effective coordination of this care can result in better outcomes and lower costs.
2) Integrated delivery systems (IDS) that provide coordinated, team-based care show promise in improving quality of care and health outcomes, especially for patients with chronic conditions. The Veterans Health Administration and Kaiser Permanente are cited as examples of high performing IDS models.
3) Evidence suggests that use of elements of the Chronic Care Model, such as patient registries, self
Towards an evidence informed adventure therapy implementing feedback informed...Will Dobud
ABSTRACT
As an intervention for adolescents, adventure therapy has evolved considerably over the last three decades with support from multiple meta- analyses and research input from both residential and outpatient services. Tainted by a history of unethical practice and issues of accountability, this article explores the question of how adventure therapy can meet a standard of evidence preferred by policymakers and funding bodies on the international stage. In this case, feedback-informed treatment (FIT) is presented as a means for routine outcome management, creating a framework for adventure therapy which aims to improve the quality of participant engagement while maintaining and operationalizing today’s definitions for evidence-based practice. A case vignette illustrates the use of FIT with an adolescent participant engaged on a 14-day adventure therapy program.
The Empower Veterans Program provides intensive, integrated self-care coaching through group and individual sessions for veterans suffering from chronic pain. Over 10 weeks, veterans receive training in whole health and well-being, acceptance and commitment therapy, and mindful movement. Preliminary results show improvements in pain, functioning, mental health, and quality of life for veterans, as well as decreased healthcare utilization and costs. The program aims to safely empower veterans with chronic pain through a multidisciplinary approach that promotes self-management over passive treatments.
2 why did you decide to pursue a baccalaureate degree in nursinAASTHA76
This survey asked 65 nurses about their reasons for pursuing a baccalaureate degree in nursing. It identified six main themes in their responses: desire to help others, lifelong dream of being a nurse, ability to advance their career, availability of jobs, earning potential, and loss of a previous job. However, the summary does not provide details about the level of measurement used in the study or how frequently each theme was reported. This information is important for determining what descriptive statistics are most appropriate.
Apa format…450 words each. please include biblical integration. a AASTHA76
The document discusses the roles and functions of health informatics (HI) professionals. It covers several key points:
1. HI professionals are responsible for collecting, storing, organizing, and managing health data to improve healthcare services. Their roles require technical skills with health information systems, clinical knowledge of medical processes, and administrative skills.
2. Proper education and training are needed to build the clinical competence required for various HI roles. Experience and graduate-level education are important for advancing to higher positions.
3. HI professionals play critical roles on healthcare teams by ensuring standardized data, analyzing collected information, and supporting quality patient care through the use of technology.
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.
BM THESIS HTA LIT BM THESIS De Kinderen et al (2013)Roel Rinkens
The document discusses the economic burden of side effects from antiepileptic drugs (AEDs). It estimates the annual healthcare costs, patient and family costs, and other costs associated with common side effects experienced by 203 epilepsy patients in the Netherlands. The total estimated societal cost per patient per year is €20,751 (US$26,675), including healthcare costs (€4,458), patient and family costs like informal care (€10,526), and other costs like lost productivity (€5,761). When examined separately, the most to least expensive side effect categories were: other (€13,228), behavioral (€9,689), general health (€7,454), cognitive (€7,
This document summarizes the results of a study examining factors that influence multiple sclerosis (MS) patients' willingness to participate in clinical trials. The study involved questionnaires assessing patients' knowledge of and attitudes towards clinical trials. The results showed that about half of MS patients were willing to consider participating in a trial. The strongest positive predictors of willingness were older age, not having children, progressive MS, and previous trial participation. Risk of side effects was the top negative factor influencing participation. Providing comprehensive information to patients was the most important solution to increase participation.
This document discusses challenges around obtaining informed consent from vulnerable populations in medical research. It explores two case studies: research in emergency settings where patients may be temporarily incompetent, and research with cancer patients where illness can impact competency. For both cases, it examines difficulties around ensuring understanding while obtaining consent, and proposes alternatives like deferred consent or waiving consent with additional protections. Throughout, it emphasizes finding the right balance between individual autonomy, beneficence, and justice when conducting research with vulnerable groups.
When children and teens present with behaviour and emotional problems the lure of a quick fix is
understandable and drugs present a ready-made solution. Therapists are often hesitant to talk about
medication and defer to medical professionals. In this paper DUNCAN, SPARKS, MURPHY and MILLER
highlight the explosion in the use of psychotropic medications for children and teens. This trend flies in the
face of the American Psychological Association’s recommendation of the use of psychosocial interventions
as the first intervention of choice with children and teens. The reliability and validity of psychiatric diagnoses is
questioned, in particular against a background of fluctuations in child development and social adaptations,
and a compelling critique is provided of the current research findings on the effectiveness of psychotropic
medications including antidepressants and ADHD medications. Therapists are urged to shed their timidity
and discuss openly the risks and benefits of medication with the knowledge that there is empirical support
for psychosocial interventions as a first line approach. Recommendations are offered to engage clients as
central partners in developing solutions—medical or non-medical—that fit each child and each situation.
The pharmaceutical industry has made it very difficult to know what the clinical trial evidence actually is regarding psychotropics. Consequently, 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. This article calls 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 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, we present a patient bill of rights for psychotropic prescription. We then offer guidelines to raise the bar of care equal to the available science for all prescribers of psychiatric medications.
The first quasiexperiemental study of the ORS/SRS in a telephonic EAP company. Doubled outcomes and improved retension. Set the stage for the RCTs that followed
The Norway Couple Project: Lessons LearnedBarry Duncan
The document discusses lessons learned from studies on using client feedback to improve outcomes in couple therapy. A large randomized clinical trial in Norway found that routinely collecting and discussing client feedback on progress and the therapeutic alliance using brief measures led to better outcomes compared to treatment as usual. Specifically, couples receiving feedback showed greater improvement in their relationships and were less likely to deteriorate over time. The findings suggest incorporating systematic client feedback into routine practice can help therapists improve outcomes for couples across different therapy approaches.
The article discusses the development and research supporting the Partners for Change Outcome Management System (PCOMS). PCOMS uses two brief measures - the Outcome Rating Scale (ORS) and Session Rating Scale (SRS) - to collect feedback from clients at each session on their progress and the therapeutic alliance. The ORS and SRS were developed to be brief and feasible for routine use. Research shows providing therapists feedback based on these measures improves client outcomes compared to treatment as usual. The article outlines how PCOMS was developed and refined, presents supporting research on the measures' psychometrics and clinical usefulness, and discusses examples of implementing PCOMS in behavioral health settings.
Our recent article about therapist effects in couple therapy. So what distinguished one therapist from another? Demographics didn’t matter but 2 other things did. First, that tried and true but neglected old friend, the alliance accounted for 50% of the differences among therapists. Those who formed better alliances across clients got better outcomes. And therapist specific experience with couples accounted for 25% of the differences. So, experienced therapists can take some solace that getting older does have its advantages—as long as it is specific to task at hand.
THIS CHAPTER DISCUSSES
•The empirical evidence supporting a strengths-based approach
•Specific practice guidelines for recruiting client resources to promote change
•The link between pluralistic counselling and a focus on client strengths
This document summarizes a study on implementing a systematic client feedback protocol into a marriage and family therapy training program to improve trainee competence and accountability. The study describes how the program integrated continuous client feedback into coursework, clinical training, and supervision using an Outcome Management system. Research shows that incorporating client feedback improves client outcomes and therapist effectiveness. The program believes this approach will train therapists to be more accountable to clients and enhance services provided at their family therapy clinic.
The document discusses research on whether using a continuous feedback system called the Partners for Change Outcome Management System (PCOMS) can improve psychotherapy outcomes. PCOMS involves clients completing brief measures after each session to assess treatment progress and the therapeutic relationship. Studies found that clients who used PCOMS with their therapists demonstrated statistically significant treatment gains compared to those receiving usual treatment and were more likely to experience reliable change in fewer sessions.
Duncan & Sparks Ch 5 of Cooper & DrydenBarry Duncan
THIS CHAPTER DISCUSSES
•
Systematic feedback and the Partners for Change Outcome Management System (PCOMS)
•
PCOMS as a way to truly privilege clients, include them as full partners in decision-making and operationalize social justice and a pluralistic approach
This paper examines the relationship between socioeconomic factors and prescription drug abuse. It reviews 7 studies that found higher rates of opioid misuse among low-income populations, including Medicaid patients and those with mental health or substance abuse disorders. While doctors often perceive younger and non-white patients to be at higher risk of abuse, studies have found no evidence to support these assumptions. The paper calls for reducing reliance on opioids for chronic pain and improving clinician training on cultural competence and implicit biases.
The document discusses issues around the marketing of pharmaceutical drugs. It notes that pharmaceutical marketing can influence doctors' prescribing decisions and priorities. Several studies cited found that doctors view drug sales representatives as an important source of information. The document then outlines a proposed research agenda to further examine the extent and impact of pharmaceutical marketing, including potential costs and benefits to health systems and policies around transparency. It concludes by noting concerns that extensive marketing practices could undermine affordable medical care.
A systematic review_on_the_use_of_psychosocial.4Paul Coelho, MD
This document summarizes a systematic review of 27 empirical studies on the use of psychosocial interventions in conjunction with medications for the treatment of opioid addiction. The most widely studied interventions were contingency management and cognitive behavioral therapy, primarily in the context of methadone treatment. The results generally support providing psychosocial interventions along with medications to improve outcomes like reducing opioid use and increasing treatment retention and completion rates, though benefits varied across studies. However, significant gaps remain in understanding the most effective combination and delivery of psychosocial treatments with different medications. More research is needed to optimize treatment of the opioid epidemic.
Recovery from Addictions in Healthcare workers - by Ann Sparks (research synt...Ann Hinnen Sparks
This document provides background information for a proposed qualitative study examining the experiences and perceptions of healthcare practitioners in long-term recovery from addiction. The study aims to understand how perceptions of stigma, social support, and spirituality change throughout the recovery process. 18 participants who entered non-punitive recovery programs at least 5 years prior will be interviewed. Modeling and Role Modeling theory guides the study by taking a holistic, client-centered approach. Key concepts of stigma, social support, and spirituality are defined. The proposed method is a phenomenological analysis of interviews to identify themes in practitioners' recovery journeys and how their views have changed over time.
Vowles et al (2015) opioid misuse, abuse, and addictionPaul Coelho, MD
This systematic review analyzed 38 studies on rates of problematic opioid use among chronic pain patients. The review sought to provide precise prevalence estimates for misuse, abuse, and addiction by applying explicit definitions and weighting studies by sample size and quality. Rates of misuse averaged between 21-29%, while rates of addiction averaged between 8-12%. Only one study reported rates of abuse. Significant variability remained between studies. Higher quality studies and those where prevalence was a primary objective tended to report lower addiction rates. The review provides guidance on possible average rates but also indicates need for further clarification.
1. The document discusses the influence of pharmaceutical companies on patients through disease awareness campaigns and direct-to-consumer information. It argues that such information is often promotional rather than objective.
2. Recommendations are made to ensure information provided to the public is unbiased and meets consumer rights to high-quality, non-promotional health information. More independent research is also needed to study the impact and costs of disease awareness campaigns.
3. The European Commission's proposal on information to patients aims to distinguish information from promotion but could still allow promotion; it needs stricter rules to avoid unethical practices.
The dilemma to use drugs for treatment as the standard for care creates problems for drug side effects that cause harm and death of patients.
The problem of the drug side effects and prescription errors kill more patients, according to Lazarus et al (1998), an "estimated of 106,000 deaths occur annually due to adverse drug side effects" for standard of care for "practicing medicine".
In the case of prescription drug, the ethical issue is standard of care for treatment, and is complicated because of adverse drug effect.
The dilemma for standard of care by drugs is the problem for unexpected adverse reaction to drug that harms patients for medical law, ethics, and bioethics.
The standard of care for practicing medicine is a drug for a treatment can never be about ethics between a doctor and a patient.
To think health care coverage for vaccination and immunization is standard of care for introducing virus, bacteria and toxin cause sickness for practicing medicine (use of drugs) for treatment.
There are no medical ethics that said 'to treat patients right by giving advice' instead, the standard of care is prescribing drugs with side effect is practicing medicine "drug" for compliance with treatment that cannot apply to the doctrine "to do no harm".
According "to the ethical guidance in the Era of managed Care" by Higgins & Hackett (2000), an analysis of the American College of Healthcare Executives' (ACHE) Code of ethics suggests, "the managed care revolution undermining the medical ethics and that it does not adequately address several ethical concerns." Bioethics is the study of life, moral and ethical issues for debate as it relates to medical policy and practice that were appropriate for legal standard and standard of care, which can arise from the relationship between biology, technology, medicine, politics, law and philosophy, especially in the application for life and reproduction such as the recent event about plan parenthood.
Without a change to the current system for standard of care of practicing medicine by diagnose diseases to prescribe drugs for treatment for health care coverage, the answer is no.
The document discusses the ethical dilemma around using prescription drugs as the standard of care for treating patients. While the Hippocratic Oath states that doctors should first do no harm, prescription drugs can cause harmful side effects and even death for some patients. Studies have found that adverse drug reactions and medical errors kill over 100,000 patients annually in the US. Some doctors have also been found to unethically prescribe unnecessary treatments, like yearly flu shots that introduce viruses and bacteria, just to generate revenue from prescribing antibiotics. The current healthcare system prioritizes treating illnesses with drugs over preventing them, but changing to a preventative model and using telemedicine could help solve the healthcare crisis and better uphold medical ethics of first doing no harm.
This systematic review analyzed data from 38 studies on rates of problematic opioid use among chronic pain patients prescribed opioids. The key findings were:
1. Rates of problematic use varied widely across studies, from 1% to 81%.
2. When weighted averages were calculated, rates of misuse averaged between 21-29% and rates of addiction averaged between 8-12%.
3. Only one study directly reported rates of abuse.
4. Few differences emerged when analyzing rates based on study characteristics, though rates of addiction may be lower in studies where assessing prevalence was the primary aim.
5. Significant variability remains in the literature, but this review provides guidance on possible average rates of different types of problematic
Outcomes research seeks to understand the end results of health care practices and interventions, including effects on quality of life and mortality. It links the care received to outcomes experienced to improve quality. Outcomes can be grouped as care-related, patient-related, or performance-related and are measured over short, intermediate, and long terms. Agencies like AHRQ and PCORI fund outcomes research to establish evidence-based practices and evaluate care quality. PCORI's mission includes increasing research quality and speeding evidence implementation to influence funded research.
Behavioral Health Integration PowerPointT L Dunlop
The document discusses behavioral health integration and its benefits. It defines behavioral health integration as the systematic coordination of mental health, substance abuse, and primary care services through a team approach using evidence-based practices. Integrating behavioral health services into primary care settings provides a one-stop shop for patients, benefits patients and providers by improving quality of care, and lowers overall healthcare costs by 20-40%. The document recommends integrating behavioral health practitioners into primary care clinics to assist patients with lifestyle changes, medication compliance, and management of chronic conditions, mental health issues, and substance abuse.
Running head WEEK THREE ASSIGNMENT .docxtoltonkendal
Running head: WEEK THREE ASSIGNMENT
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WEEK THREE ASSIGNMENT
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Week Three Assignment
PHI445: Personal & Organizational Ethics
Week Three Assignment
The case that I chose was Pharmaceuticals (Merck). The pharmaceutical industry is a multi-billion dollar industry that has evolved over decades developing, producing, and marketing various medications to the masses. They deal with increasing criticism in this industry due to the multiple side effects and drug interactions that occur. “In fact, research has shown that more than 100,000 deaths are caused by drug reactions each year in the United States (Null, 2010)” (Fieser, 2015). An ethical and moral dilemma for the pharmaceutical industry is that many drug companies are caught deceiving the public. The pharmaceutical industry continues to face controversy due to their advertising techniques. Pharmaceutical companies began to bypass the healthcare professionals and advertise directly to the patients. This tactic is called direct-to-consumer advertising which began in 1982. In our text is says, “Such advertising, it argued, is problematic “because of the inability of patients to understand medical information and make a rational, informed choice of medication from an array of drugs making similar claims.” The DEA was further concerned about “the messages conveyed to our youth” through such advertising” (Fieser, 2015).
The Food and Drug Administration (FDA) which is the government agency that ensures the safety and effectiveness of medicines available to Americans. The FDA pushes guidance, compliance, and regulatory information onto the pharmaceutical industry. The FDA publishes regulations in the federal government’s official publication for notifying the public in accordance with the U.S. law, Executive Orders (EO) and memoranda issued by the President. The Center for Drug Evaluation and Research (CDER) has been tasked from the FDA with evaluating new drugs before they could be sold to consumers. They also oversee the type of advertising that the pharmaceutical companies use to market their products to consumers to ensure that false or misleading information is not presented.
Utilitarianism is the theory that focuses on the cost-benefit analysis which believes that and action is morally right as long as the consequences of some do not out weight the benefits of the majority. They also emphasize goodness and badness in decision making by focusing on how our actions affect human happiness. “An action is morally right if the consequences of that action are more favorable than unfavorable to everyone” (Fieser, 2015). The pharmaceutical companies contend that the drugs they create save thousands of lives worldwide on a daily basis. They live and work under a Pharmacist Code. The Pharmacist Code of Ethics and Oath ...
This document discusses the rise of evidence-based health care over the last decade. Key points:
- Evidence-based health care aims to minimize problems like overuse, underuse and misuse of treatments by basing clinical practice closely on scientific research evidence.
- During the 1990s, the concepts of evidence-based health care spread widely and began influencing health policymakers, providers and researchers.
- Advances have been made in managing and disseminating research findings through initiatives like the Cochrane Collaboration and clinical practice guidelines.
- However, integrating research evidence into everyday clinical practice remains a challenge and some critics argue evidence-based practice could stifle innovation.
Over the counter drugs and drug abuse among healthcare professionals is discussed. The document examines the prevalence of substance use among healthcare workers, citing studies that found 65.1% of males and 34.9% of females reporting abuse of over-the-counter drugs. Reasons for abuse included easy accessibility, saving time and money, and treating minor ailments. Intervention and prevention measures are recommended, including anonymous physician health programs for evaluation and treatment, medical interventions like rehabilitation programs, and conditions for licensure to help prevent relapse. Education on substance use and effects should begin in high school and continue during university and professional training.
12Week IV, Discussion Post Care for the Client with a Substlauvicuna8dw
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Week IV, Discussion Post: Care for the Client with a Substance Abuse Diagnosis
Opioids are substances extracted from opium poppy, they are a sophisticated group of prescribed drugs that are used in pain management, especially after significant surgeries. Unfortunately, when these medications are used in an uncontrolled manner, they have adverse addictive effects. These drugs are specifically designed to treat severe pain and are often prescribed following surgery or injury or for health conditions that cause extensive chronic illness such as cancer. At times, when taken in a way other than prescribed by a licensed practitioner, they can cause euphoric and pleasurable effects, making them a high demand on the streets. The death statistics resulting from opioid overdose in the United States between 1999 and 2010 increased exponentially, and it was recorded that in 2010 alone, the number of deaths recorded from opioid overdose was 16,651 deaths (Volkow, Frieden, Hyde, P. & Cha, S., 2014).
In the last 20 years, both therapeutic and illicit opioid use has escalated in the United States (Volkow et al., 2014). The total number of opioid prescriptions dispensed from the United States outpatient retail pharmacies increased from 174.1 million in 2000 to 256.9 million in 2009 (Brown, A.R., 2018). The over-prescription of opioid medications widely contributes to an increase in opioid overdose, and this has had a massive impact on the states. The United States has used more than 1 trillion dollars since the year 2001 to try and contain the pandemic.
The Centers for Disease Control and Prevention estimates that the total "economic burden" of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement. The increase in drugs used by injection has also contributed to the spread of diseases including HIV and hepatitis C. As we have seen throughout the history of medicine, science can be a major part of the solution in such a public health crisis. Expanding access to effective, evidence-based treatments for those with addiction and also less severe substance use disorders is critical, but broader prevention programs and policies are also essential to reduce substance misuse and the pervasive health and social problems caused by it.
Time and again, studies have found that there are high levels of correlation between mental and emotional disorders and addiction. This means that those who suffer from addiction have a higher-than-average likelihood of also suffering from a psychiatric disorder (Coon, Mitterer, & Martini, 2019). That said, it is extremely important for the Psychiatric Mental Health Nurse Practitioner (PMHNP) to recognize both physical and mental exam findings consistent with substance abuse disorder. The earlier a diagnosis is made, the better the prognosis. However, use over periods of years produces physical and psy ...
12Week IV, Discussion Post Care for the Client with a Substdrennanmicah
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Week IV, Discussion Post: Care for the Client with a Substance Abuse Diagnosis
Opioids are substances extracted from opium poppy, they are a sophisticated group of prescribed drugs that are used in pain management, especially after significant surgeries. Unfortunately, when these medications are used in an uncontrolled manner, they have adverse addictive effects. These drugs are specifically designed to treat severe pain and are often prescribed following surgery or injury or for health conditions that cause extensive chronic illness such as cancer. At times, when taken in a way other than prescribed by a licensed practitioner, they can cause euphoric and pleasurable effects, making them a high demand on the streets. The death statistics resulting from opioid overdose in the United States between 1999 and 2010 increased exponentially, and it was recorded that in 2010 alone, the number of deaths recorded from opioid overdose was 16,651 deaths (Volkow, Frieden, Hyde, P. & Cha, S., 2014).
In the last 20 years, both therapeutic and illicit opioid use has escalated in the United States (Volkow et al., 2014). The total number of opioid prescriptions dispensed from the United States outpatient retail pharmacies increased from 174.1 million in 2000 to 256.9 million in 2009 (Brown, A.R., 2018). The over-prescription of opioid medications widely contributes to an increase in opioid overdose, and this has had a massive impact on the states. The United States has used more than 1 trillion dollars since the year 2001 to try and contain the pandemic.
The Centers for Disease Control and Prevention estimates that the total "economic burden" of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement. The increase in drugs used by injection has also contributed to the spread of diseases including HIV and hepatitis C. As we have seen throughout the history of medicine, science can be a major part of the solution in such a public health crisis. Expanding access to effective, evidence-based treatments for those with addiction and also less severe substance use disorders is critical, but broader prevention programs and policies are also essential to reduce substance misuse and the pervasive health and social problems caused by it.
Time and again, studies have found that there are high levels of correlation between mental and emotional disorders and addiction. This means that those who suffer from addiction have a higher-than-average likelihood of also suffering from a psychiatric disorder (Coon, Mitterer, & Martini, 2019). That said, it is extremely important for the Psychiatric Mental Health Nurse Practitioner (PMHNP) to recognize both physical and mental exam findings consistent with substance abuse disorder. The earlier a diagnosis is made, the better the prognosis. However, use over periods of years produces physical and psy ...
This document discusses integrative medicine and its principles. It defines integrative medicine as patient-centered care that uses both conventional and alternative therapies. The document outlines the history of complementary and alternative medicine in the US healthcare system. It was largely pushed out after the Flexner Report in 1910 but continued growing. The document discusses the principles of integrative medicine, which include treating the whole person, using natural therapies when possible, and emphasizing prevention and health promotion. It provides a case study of how integrative medicine helped an 18-year-old with persistent headaches by addressing physical and lifestyle factors. The document advocates for a healthcare system grounded in these integrative principles.
This document discusses integrative medicine and its principles. It defines integrative medicine as patient-centered care that uses both conventional and alternative therapies. The document outlines the history of complementary and alternative medicine in the US healthcare system. It was largely pushed out after the Flexner Report in 1910 but continued growing. The document discusses the principles of integrative medicine, which include treating the whole person, using natural therapies when possible, and emphasizing prevention and health promotion. It provides a case study of how integrative medicine helped an 18-year-old with persistent headaches by using osteopathic manipulation rather than just medications. The document recommends a patient-centered model with a primary practitioner coordinating a team to meet all patient needs.
12Week IV, Discussion Post Care for the Client with a Subst.docxherminaprocter
The document discusses substance abuse in the United States, focusing on opioids. It describes how opioid prescriptions and overdoses have increased dramatically in recent decades. The economic and social costs of the opioid epidemic are immense. The document then discusses factors that contribute to substance use disorders, common physical and mental health findings in patients with substance abuse issues, the neurobiological mechanisms underlying addiction, and recommended pharmacological and psychotherapeutic treatments for alcohol and opioid abuse.
12Week IV, Discussion Post Care for the Client with a Subst.docxRAJU852744
The document discusses substance abuse in the United States, focusing on opioids. It describes how opioid prescriptions and overdoses have increased dramatically in recent decades. The economic and social costs of the opioid epidemic are immense. The document then discusses how substance abuse is often correlated with mental health disorders. It provides examples of physical findings that may indicate substance abuse, such as malnutrition, infections, withdrawal symptoms, and organ damage from long-term use. The neurobiological mechanisms of addiction and tolerance are explained. First-line treatments for opioid and alcohol abuse, including medication-assisted therapies and psychotherapy, are outlined.
This document provides an overview of wound healing, its functions, stages, mechanisms, factors affecting it, and complications.
A wound is a break in the integrity of the skin or tissues, which may be associated with disruption of the structure and function.
Healing is the body’s response to injury in an attempt to restore normal structure and functions.
Healing can occur in two ways: Regeneration and Repair
There are 4 phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This document also describes the mechanism of wound healing. Factors that affect healing include infection, uncontrolled diabetes, poor nutrition, age, anemia, the presence of foreign bodies, etc.
Complications of wound healing like infection, hyperpigmentation of scar, contractures, and keloid formation.
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إضغ بين إيديكم من أقوى الملازم التي صممتها
ملزمة تشريح الجهاز الهيكلي (نظري 3)
💀💀💀💀💀💀💀💀💀💀
تتميز هذهِ الملزمة بعِدة مُميزات :
1- مُترجمة ترجمة تُناسب جميع المستويات
2- تحتوي على 78 رسم توضيحي لكل كلمة موجودة بالملزمة (لكل كلمة !!!!)
#فهم_ماكو_درخ
3- دقة الكتابة والصور عالية جداً جداً جداً
4- هُنالك بعض المعلومات تم توضيحها بشكل تفصيلي جداً (تُعتبر لدى الطالب أو الطالبة بإنها معلومات مُبهمة ومع ذلك تم توضيح هذهِ المعلومات المُبهمة بشكل تفصيلي جداً
5- الملزمة تشرح نفسها ب نفسها بس تكلك تعال اقراني
6- تحتوي الملزمة في اول سلايد على خارطة تتضمن جميع تفرُعات معلومات الجهاز الهيكلي المذكورة في هذهِ الملزمة
واخيراً هذهِ الملزمة حلالٌ عليكم وإتمنى منكم إن تدعولي بالخير والصحة والعافية فقط
كل التوفيق زملائي وزميلاتي ، زميلكم محمد الذهبي 💊💊
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This presentation was provided by Racquel Jemison, Ph.D., Christina MacLaughlin, Ph.D., and Paulomi Majumder. Ph.D., all of the American Chemical Society, for the second session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session Two: 'Expanding Pathways to Publishing Careers,' was held June 13, 2024.
A Visual Guide to 1 Samuel | A Tale of Two HeartsSteve Thomason
These slides walk through the story of 1 Samuel. Samuel is the last judge of Israel. The people reject God and want a king. Saul is anointed as the first king, but he is not a good king. David, the shepherd boy is anointed and Saul is envious of him. David shows honor while Saul continues to self destruct.
Andreas Schleicher presents PISA 2022 Volume III - Creative Thinking - 18 Jun...EduSkills OECD
Andreas Schleicher, Director of Education and Skills at the OECD presents at the launch of PISA 2022 Volume III - Creative Minds, Creative Schools on 18 June 2024.
How to Manage Reception Report in Odoo 17Celine George
A business may deal with both sales and purchases occasionally. They buy things from vendors and then sell them to their customers. Such dealings can be confusing at times. Because multiple clients may inquire about the same product at the same time, after purchasing those products, customers must be assigned to them. Odoo has a tool called Reception Report that can be used to complete this assignment. By enabling this, a reception report comes automatically after confirming a receipt, from which we can assign products to orders.
THE SACRIFICE HOW PRO-PALESTINE PROTESTS STUDENTS ARE SACRIFICING TO CHANGE T...indexPub
The recent surge in pro-Palestine student activism has prompted significant responses from universities, ranging from negotiations and divestment commitments to increased transparency about investments in companies supporting the war on Gaza. This activism has led to the cessation of student encampments but also highlighted the substantial sacrifices made by students, including academic disruptions and personal risks. The primary drivers of these protests are poor university administration, lack of transparency, and inadequate communication between officials and students. This study examines the profound emotional, psychological, and professional impacts on students engaged in pro-Palestine protests, focusing on Generation Z's (Gen-Z) activism dynamics. This paper explores the significant sacrifices made by these students and even the professors supporting the pro-Palestine movement, with a focus on recent global movements. Through an in-depth analysis of printed and electronic media, the study examines the impacts of these sacrifices on the academic and personal lives of those involved. The paper highlights examples from various universities, demonstrating student activism's long-term and short-term effects, including disciplinary actions, social backlash, and career implications. The researchers also explore the broader implications of student sacrifices. The findings reveal that these sacrifices are driven by a profound commitment to justice and human rights, and are influenced by the increasing availability of information, peer interactions, and personal convictions. The study also discusses the broader implications of this activism, comparing it to historical precedents and assessing its potential to influence policy and public opinion. The emotional and psychological toll on student activists is significant, but their sense of purpose and community support mitigates some of these challenges. However, the researchers call for acknowledging the broader Impact of these sacrifices on the future global movement of FreePalestine.
Philippine Edukasyong Pantahanan at Pangkabuhayan (EPP) CurriculumMJDuyan
(𝐓𝐋𝐄 𝟏𝟎𝟎) (𝐋𝐞𝐬𝐬𝐨𝐧 𝟏)-𝐏𝐫𝐞𝐥𝐢𝐦𝐬
𝐃𝐢𝐬𝐜𝐮𝐬𝐬 𝐭𝐡𝐞 𝐄𝐏𝐏 𝐂𝐮𝐫𝐫𝐢𝐜𝐮𝐥𝐮𝐦 𝐢𝐧 𝐭𝐡𝐞 𝐏𝐡𝐢𝐥𝐢𝐩𝐩𝐢𝐧𝐞𝐬:
- Understand the goals and objectives of the Edukasyong Pantahanan at Pangkabuhayan (EPP) curriculum, recognizing its importance in fostering practical life skills and values among students. Students will also be able to identify the key components and subjects covered, such as agriculture, home economics, industrial arts, and information and communication technology.
𝐄𝐱𝐩𝐥𝐚𝐢𝐧 𝐭𝐡𝐞 𝐍𝐚𝐭𝐮𝐫𝐞 𝐚𝐧𝐝 𝐒𝐜𝐨𝐩𝐞 𝐨𝐟 𝐚𝐧 𝐄𝐧𝐭𝐫𝐞𝐩𝐫𝐞𝐧𝐞𝐮𝐫:
-Define entrepreneurship, distinguishing it from general business activities by emphasizing its focus on innovation, risk-taking, and value creation. Students will describe the characteristics and traits of successful entrepreneurs, including their roles and responsibilities, and discuss the broader economic and social impacts of entrepreneurial activities on both local and global scales.