This document summarizes a presentation on screening for depression in medical settings. The presenter expresses skepticism about screening and notes controversies should be resolved by evidence. Screening is meant to detect untreated depressed patients but success requires identifying many such patients and engaging them in effective treatment. However, evidence shows recognition alone does not improve outcomes and benefits of screening depend on the quality of routine care available. Overall, the presenter argues the evidence does not clearly support widespread screening and identifies potential harms such as high false positive rates and risks of overdiagnosis.
Where’s the evidence that screening for distress benefits cancer patients?James Coyne
“The case against screening for distress.” A presentation delivered as part of an invited debate with Alex Mitchell at the International Psycho Oncology Conference, Rotterdam, November 7, 2013
Rethinking, rebuilding psychosocial care for cancer patientsJames Coyne
Presented as the 8th Trevor Anderson Psycho-Oncology Lecture, September 8, 2014, Melbourne, Australia.
Discusses how psychosocial care for cancer patients needs to be reorganized so that a broader range of cancer patients are served. Routine screening for distress is unlikely to be an efficient means of countering tendencies of cancer care more generally becoming more organized around time efficiency and billable procedures. Psychosocial care for many cancer patients involves discussions, negotiations, and care coordination they cannot be well fit into the idea of a counseling session. The unsung heroes of providing such care are underappreciated social workers and oncology nurses.
Why screeing cancer patients for distress will increase disparities in psycho...James Coyne
Keynote address
Implementing screening of cancer patients for distress will not improve patient outcomes and may aggravate existing biases in who get psychosocial services.
SHARE Presentation: Integrative Medicine and Cancer with Dr. Heather Greenleebkling
Oncology doctors are considering new ways in addition to conventional care to improve cancer outcomes. Examples of integrative medicine include acupuncture, mind-body approaches, and botanicals. Dr. Heather Greenlee of Columbia University Mailman School of Public Health will discuss new guidelines developed within the Society for Integrative Oncology.
Exploring the transition to secondary progressive MS (SPMS): patient, carer a...MS Trust
This presentation by Professor Adrian Edwards and Dr Freya Davies from the Institute of Primary Care and Public Health at Cardiff University looks at the experiences of patients, carers and clinicians at the stage of transition to SPMS.
It was presented at the MS Trust Annual Conference in November 2014.
SHARE Presentation: Palliative Care for Womenbkling
Dr. Michael Pearl discusses supportive palliative care for women with cancer, how it differs from hospice care, and the New York Palliative Care Information Act. Dr. Michael Pearl is Professor and Director of the Division of Gynecologic Oncology in the Department of Obstetrics, Gynecology and Reproductive Medicine at Stony Brook University Hospital.
Where’s the evidence that screening for distress benefits cancer patients?James Coyne
“The case against screening for distress.” A presentation delivered as part of an invited debate with Alex Mitchell at the International Psycho Oncology Conference, Rotterdam, November 7, 2013
Rethinking, rebuilding psychosocial care for cancer patientsJames Coyne
Presented as the 8th Trevor Anderson Psycho-Oncology Lecture, September 8, 2014, Melbourne, Australia.
Discusses how psychosocial care for cancer patients needs to be reorganized so that a broader range of cancer patients are served. Routine screening for distress is unlikely to be an efficient means of countering tendencies of cancer care more generally becoming more organized around time efficiency and billable procedures. Psychosocial care for many cancer patients involves discussions, negotiations, and care coordination they cannot be well fit into the idea of a counseling session. The unsung heroes of providing such care are underappreciated social workers and oncology nurses.
Why screeing cancer patients for distress will increase disparities in psycho...James Coyne
Keynote address
Implementing screening of cancer patients for distress will not improve patient outcomes and may aggravate existing biases in who get psychosocial services.
SHARE Presentation: Integrative Medicine and Cancer with Dr. Heather Greenleebkling
Oncology doctors are considering new ways in addition to conventional care to improve cancer outcomes. Examples of integrative medicine include acupuncture, mind-body approaches, and botanicals. Dr. Heather Greenlee of Columbia University Mailman School of Public Health will discuss new guidelines developed within the Society for Integrative Oncology.
Exploring the transition to secondary progressive MS (SPMS): patient, carer a...MS Trust
This presentation by Professor Adrian Edwards and Dr Freya Davies from the Institute of Primary Care and Public Health at Cardiff University looks at the experiences of patients, carers and clinicians at the stage of transition to SPMS.
It was presented at the MS Trust Annual Conference in November 2014.
SHARE Presentation: Palliative Care for Womenbkling
Dr. Michael Pearl discusses supportive palliative care for women with cancer, how it differs from hospice care, and the New York Palliative Care Information Act. Dr. Michael Pearl is Professor and Director of the Division of Gynecologic Oncology in the Department of Obstetrics, Gynecology and Reproductive Medicine at Stony Brook University Hospital.
This slideshow is a tour of Cancer Awakens - www.cancerawakens.com - showcasing how our site, newsletter and social media channels support the cancer community.
Provider Based Patient Engagement - An Essential Strategy for Population HealthPhytel
As the healthcare industry starts to re-engineer care delivery to accommodate new reimbursement models, providers on the front lines of change recognize the need for population health management and for increasing patients’ engagement in their own care. These two approaches are inextricably bound together, because it is impossible to manage the health of a population without getting patients more involved in self-management and the modification of their own risk factors. This paper discusses the fundamentals of patient engagement and shows how automation tools and web-based care management can facilitate this key process.
Scoring Suffering to Address Patient Needs in Palliative Care: The "Maslow Sc...Mike Aref
Introduction
Palliative care patients have been scored by their symptom burden and performance but there is little standardization of their multidimensional suffering, needs, and wants. Maslow’s Hierarchy of Needs is a model for describing these needs as physiological, safety, love/ belonging, esteem, and self-actualization. The functional pain score is a validated method of scoring pain based on patient report and provider assessment. Using these two frameworks, the “Maslow Score” seeks to use Maslow’s Hierarchy to score the current patient situation based on symptom burden, plan, network, and meaning.
Methods
The scores are four-digit codes describing the patient situation at a given time base on team consensus. Each digit is a score from most secure, 0, to most vulnerable, 5. Both written examples and an algorithmic approach have been provided to obtain each score.
Results
Morning huddle has been expedited by utilizing scores recorded the previous day. Also if sudden changes have been reported they can be compared rapidly against a team standard. This triaging helps direct team resources as to whether patients should be reassessed by the entire team or specific members. The discussion has improved assessment of patients from an interdisciplinary perspective. In general, patients cannot improve their network and meaning scores until symptom and planning scores have been optimized.
Discussion
The “Maslow Score” appears to have improved the quality of care that our service delivers by improving efficiency. Further development and study is needed to standardize and validate our method.
Depression is a state of feeling sad, miserable and down in the dumps with loss of self-confidence. Depression despite being a serious condition in all age groups is more common and significant in the
geriatric population as it is associated with morbidity and mortality. The cause of depression is multifactorial. Various scales have been developed to assess depression of which the Geriatric Depression
Scale is most suited for elderly population and those with dementia. In our study, we aim to analyse the prevalence of depression among elderly patients visiting the outpatient departments of a tertiary care hospital and determine the factors influencing depression in them. The study was an Observational study carried out on 51 elderly patients over the age of 60 years attending the outpatient departments of PSG Hospital. The Geriatric Depression Scale Short form was used to determine the prevalence of depression. A
self-designed questionnaire considering various factors causing depression was administered to determine
the factors influencing depression. It was found that among 51 elders in the age group of 60 to 80 years,
58.8% were depressed of which 54% were males and 68% were females. Financial fears regarding future
and income insufficiency were the most important factors contributing to depression. This shows that
monetary fear is a major factor resulting in depression. The government and other organizations must
ensure that better support both financial and other services like healthcare are provided to the elderly in
order to prevent depressive illnesses.
Out-patient Primary and Specialty Palliative CareMike Aref
Presentation on primary and specialty palliative care, covering what is palliative care, basics of primary palliative care including pain and symptom management, and referral criteria for out-patient specialty palliative care.
Three hour slide deck for basics of palliative care including what is palliative care, symptom management (pain, dyspnea, nausea, constipation), goals-of-care, family meetings, comfort care, and issues around artificial nutrition.
We will cover the topic of Palliative Care – specialized medical care for people with serious illnesses. It focuses on providing patients with relief from the symptoms and stress of a serious illness. The goal is to improve quality of life for both the patient and the family.
Presented by Dr. Jean S. Kutner, MD, MSPH a tenured Professor of Medicine in the Divisions of General Internal Medicine (GIM), Geriatric Medicine, and Health Care Policy and Research at the University of Colorado School of Medicine (UC SOM)
Psychosocial aspects (Cancer patients has to cope with a variety of stressors)kalyan kumar
A diagnosis of cancer begins a long journey that can affect physical health, mental well-being, and relationships with loved ones. While getting treatment for the physical aspects of cancer, patients should not neglect the emotional issues associated with cancer. One of the best things patients can do to improve their quality of life is to learn more about their cancer. This can make the disease seem less mysterious and frightening. Information from your doctor and other credible sources can be very helpful in this respect.
Consolidating, Improving, and Novel Palliative Care: Order SetsMike Aref
A selection of slides, taken from a series of presentations, showing the evolution of consolidating and developing order sets for delivery of primary palliative care in our healthcare system.
A lecture given at a Primary Care Conference in Massachusetts - on the important role primary care physicians could play in ensuring good palliative care for patients, communication, hospice, myths & realities
Hospice care and palliative care: Is there a difference between the two, and if so, what?
Many people still think that palliative care means hospice care. But today, hospice is only a small part of palliative care.
The goal of palliative care is to prevent or treat the symptoms and side effects of a disease; and it should be part of the picture from the first day a serious illness is diagnosed.
Dr. Jim Meadows, Director of Hospice and Palliative Care at Tennessee Oncology, will discuss this important topic. How does a family and a health care team best work together to guide a patient through a terminal illness? How does everyone continue to support quality, patient-centered, end-of-life care?
Overview of international challenges faced by psychiatrists through their practice
Collaborative work of:
1-Dr Yomna Gaber Senior Registrar Psychiatrist
2- Dr Hosam Kasseb Senior Registrar Psychiatrist
3-Dr Wasem Marey Consultant Psychiatrist
This slideshow is a tour of Cancer Awakens - www.cancerawakens.com - showcasing how our site, newsletter and social media channels support the cancer community.
Provider Based Patient Engagement - An Essential Strategy for Population HealthPhytel
As the healthcare industry starts to re-engineer care delivery to accommodate new reimbursement models, providers on the front lines of change recognize the need for population health management and for increasing patients’ engagement in their own care. These two approaches are inextricably bound together, because it is impossible to manage the health of a population without getting patients more involved in self-management and the modification of their own risk factors. This paper discusses the fundamentals of patient engagement and shows how automation tools and web-based care management can facilitate this key process.
Scoring Suffering to Address Patient Needs in Palliative Care: The "Maslow Sc...Mike Aref
Introduction
Palliative care patients have been scored by their symptom burden and performance but there is little standardization of their multidimensional suffering, needs, and wants. Maslow’s Hierarchy of Needs is a model for describing these needs as physiological, safety, love/ belonging, esteem, and self-actualization. The functional pain score is a validated method of scoring pain based on patient report and provider assessment. Using these two frameworks, the “Maslow Score” seeks to use Maslow’s Hierarchy to score the current patient situation based on symptom burden, plan, network, and meaning.
Methods
The scores are four-digit codes describing the patient situation at a given time base on team consensus. Each digit is a score from most secure, 0, to most vulnerable, 5. Both written examples and an algorithmic approach have been provided to obtain each score.
Results
Morning huddle has been expedited by utilizing scores recorded the previous day. Also if sudden changes have been reported they can be compared rapidly against a team standard. This triaging helps direct team resources as to whether patients should be reassessed by the entire team or specific members. The discussion has improved assessment of patients from an interdisciplinary perspective. In general, patients cannot improve their network and meaning scores until symptom and planning scores have been optimized.
Discussion
The “Maslow Score” appears to have improved the quality of care that our service delivers by improving efficiency. Further development and study is needed to standardize and validate our method.
Depression is a state of feeling sad, miserable and down in the dumps with loss of self-confidence. Depression despite being a serious condition in all age groups is more common and significant in the
geriatric population as it is associated with morbidity and mortality. The cause of depression is multifactorial. Various scales have been developed to assess depression of which the Geriatric Depression
Scale is most suited for elderly population and those with dementia. In our study, we aim to analyse the prevalence of depression among elderly patients visiting the outpatient departments of a tertiary care hospital and determine the factors influencing depression in them. The study was an Observational study carried out on 51 elderly patients over the age of 60 years attending the outpatient departments of PSG Hospital. The Geriatric Depression Scale Short form was used to determine the prevalence of depression. A
self-designed questionnaire considering various factors causing depression was administered to determine
the factors influencing depression. It was found that among 51 elders in the age group of 60 to 80 years,
58.8% were depressed of which 54% were males and 68% were females. Financial fears regarding future
and income insufficiency were the most important factors contributing to depression. This shows that
monetary fear is a major factor resulting in depression. The government and other organizations must
ensure that better support both financial and other services like healthcare are provided to the elderly in
order to prevent depressive illnesses.
Out-patient Primary and Specialty Palliative CareMike Aref
Presentation on primary and specialty palliative care, covering what is palliative care, basics of primary palliative care including pain and symptom management, and referral criteria for out-patient specialty palliative care.
Three hour slide deck for basics of palliative care including what is palliative care, symptom management (pain, dyspnea, nausea, constipation), goals-of-care, family meetings, comfort care, and issues around artificial nutrition.
We will cover the topic of Palliative Care – specialized medical care for people with serious illnesses. It focuses on providing patients with relief from the symptoms and stress of a serious illness. The goal is to improve quality of life for both the patient and the family.
Presented by Dr. Jean S. Kutner, MD, MSPH a tenured Professor of Medicine in the Divisions of General Internal Medicine (GIM), Geriatric Medicine, and Health Care Policy and Research at the University of Colorado School of Medicine (UC SOM)
Psychosocial aspects (Cancer patients has to cope with a variety of stressors)kalyan kumar
A diagnosis of cancer begins a long journey that can affect physical health, mental well-being, and relationships with loved ones. While getting treatment for the physical aspects of cancer, patients should not neglect the emotional issues associated with cancer. One of the best things patients can do to improve their quality of life is to learn more about their cancer. This can make the disease seem less mysterious and frightening. Information from your doctor and other credible sources can be very helpful in this respect.
Consolidating, Improving, and Novel Palliative Care: Order SetsMike Aref
A selection of slides, taken from a series of presentations, showing the evolution of consolidating and developing order sets for delivery of primary palliative care in our healthcare system.
A lecture given at a Primary Care Conference in Massachusetts - on the important role primary care physicians could play in ensuring good palliative care for patients, communication, hospice, myths & realities
Hospice care and palliative care: Is there a difference between the two, and if so, what?
Many people still think that palliative care means hospice care. But today, hospice is only a small part of palliative care.
The goal of palliative care is to prevent or treat the symptoms and side effects of a disease; and it should be part of the picture from the first day a serious illness is diagnosed.
Dr. Jim Meadows, Director of Hospice and Palliative Care at Tennessee Oncology, will discuss this important topic. How does a family and a health care team best work together to guide a patient through a terminal illness? How does everyone continue to support quality, patient-centered, end-of-life care?
Overview of international challenges faced by psychiatrists through their practice
Collaborative work of:
1-Dr Yomna Gaber Senior Registrar Psychiatrist
2- Dr Hosam Kasseb Senior Registrar Psychiatrist
3-Dr Wasem Marey Consultant Psychiatrist
Psychological depression prevention programs for 5-10 year olds: What’s the e...Health Evidence™
Health Evidence hosted a 90 minute webinar on psychological depression prevention programs for children and adolescents. This work received support from KT Canada funding from the Canadian Institutes of Health Research (CIHR). Key messages and implications for practice were presented.
This webinar focused on interpreting the evidence in the following review:
Merry, S., Hetrick, S.E., Cox, G.R., Brudevold-Iversen, T., Bir, J.J., & McDowell, H. (2011).Psychological and/or educational interventions for the prevention of depression in children and adolescents. Cochrane Database of Systematic Reviews, 2011(12), Art. No.: CD003380.
Kara DeCorby, Managing Director & Knowledge Broker with Health Evidence, lead the webinar.
Depression, OCD, Psychopathy, and Schizophrenia are the four most commonly misrepresented mental disorders represented in the media. Here, we talk about the difference between the Myths surrounding them, and the Realities that compose them.
(This slideshow was made for COM-201 at Spalding University. All pictures and music are being used for educational purposes only -- that purpose being to educate viewers on the realities of various mental illnesses.)
This a project for a high school AP Psychology course. This is a fictionalized account of having a psychological ailment. For questions about this blog project or its content please email the teacher, Laura Astorian: laura.astorian@cobbk12.org
Depression: What Is It and What Are My Treatment Options? (Community Lecture)Summit Health
In this community lecture, Summit Medical Group practitioners share insights regarding the warning signs of depression and offer options for treatment, including therapy and medication.
Discussion post reply APA Format2 references for each discussiLyndonPelletier761
Discussion post reply
APA Format
2 references for each discussion post with intext citation.
Make it short and simple.
Post # one
Misty B
I have chosen to become a Psychiatric Mental Health Nurse Practitioner. I chose this path because I feel God is calling me to help guide and mentor people through this age of transition. With the increase of the digital age, social media specifically, and the COVID Pandemic, peoples’ mental health needs need to be cared for in a better manner than how they are currently being managed. “The role of the PMHNP is to assess, diagnose and treat the mental health needs of patients. Many PMHNPs provide therapy and prescribe medication for patients who have mental health disorders or substance abuse problems.” (American Association of Nurse Practitioners, n.d.) I believe your overall health begins with a healthy mind. When your mental health is not healthy you can spiral out of control and turn to substances (illicit drugs, alcohol, food, etc.) or self-harm. This can lead to other health problems such as obesity, diabetes, cardiovascular disorders, liver disorders, kidney disorders, etc. I feel as a PMHNP I will be able to start with the root cause of a patient’s overall health. I waxed and waned with my decision between a PMHNP and FNP. I feel starting with PMHNP is the best option for me at the moment and continuing afterward to have a dual certification as an FNP.
Professional Organization
“Another factor essential to a nurse’s professional development is active membership in 1 or more professional organization. Memberships provide exposure and access to education resources (eg, websites, webinars, publications, and conferences) and rewarding networking opportunities with peers and colleagues.” (Cherry et all, 2019)
Having been a member of the Emergency Nurses Association (ENA) for 8 years, I too feel it is important to become a member of your of an association for your nursing specialty. I have chosen to become a member of the American Psychiatric Nurses Association. Their mission statement and beliefs are parallel to my own.
APNA is committed to the practice of psychiatric-mental health nursing, health and wellness promotion through identification of mental health issues, prevention of mental health problems, and the care and treatment of persons with mental health disorders. APNA champions psychiatric-mental health nursing and mental health care through the development of positions on key issues, the dissemination of current knowledge and developments in PMH nursing, and collaboration with stakeholders to promote advances in recovery-focused assessment, diagnosis, treatment, and evaluation of persons with mental health disorders. (American Psychiatric Nurses Association, n.d.)
Becoming a member was as easy as going to their website www.apna.org and selecting your membership type, fill in the required information, and pay the fee. Being a member will give me access to educational oppo ...
ADVANCED NURSING RESEARCH
1
ADVANCED NURSING RESEARCH 2
Evidence Based Practice Grant Proposal
Table of Contents
3
4
5
6
6
7
8
8
9
9
9
11
11
11
11
12
12
13
14
14
19
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Grant Proposal-Assessing the role of stigma towards mental health patients in help seeking
Study problem
There are several studies that have shown that stigmatization towards mental health patients have been present throughout history and even despite the evolution in modern medicine and advanced treatment. For example, Verhaeghe et al., (2014), captures in a publication in reference to a study that he conducted that stigmatization towards mental health patients has been there even as early is in the 18th Century. People were hesitant to interact with people termed or perceived to have mental health conditions.
Stigmatization has resulted from the belief that those with mental problem are aggressive and dangerous creating a social distance (Szeto et al., 2017). Also, mental health-related stigma has become of major concern as it creates crucial barriers to access treatment and quality care since it not only influences the behaviour of the patients but also the attitude of the providers hence impacting help-seeking. Timmermann, Uhrenfeldt and Birkelund (2014), have identified stigma as a barrier that is of significance to care or help seeking while the extent to which it still remains a barrier have not been reviewed deeply. Therefore, this study will assess the role contributed by stigma in help seeking in depth. 1. Purpose
The intention of the research study is to review the association between stigma, mental illness and help seeking in order to formulate ways in which the stigma that is around mental health is done away with to enable as many people suffering from mental health complications to seek medical help.2. Background
Mental health is crucial in every stage of life. It is defined as the state of psychological well-being whereby the individual realizes a satisfactory integration instinctual drive acceptable to both oneself and his or her social setting (Ritchie & Roser, 2018). The status of mental health influences physical health, relationships, and most importantly day-to-day life. Mental health problems arise when there is a disruption in mental well-being.
The risk factors to mental health problems are not limited and therefore everyone is entitled to the problem irrespective of gender, economic status, and ethnic group. For example, data shows that in America one out of five individuals experience mental health problems annually; with mental disorders being recognized as the leading cause of disability not only in the United States but also globally (Ritchie & Roser, 2018). Mental health disorders are seen to be complex and of many forms such as anxiety, mood, and schizophren.
2Reducing Stroke Readmissions in the Acute.docxlorainedeserre
2
Reducing Stroke Readmissions in the Acute Care Setting
Michelle L Wallace
NUR 430
Professor Roberts
Introduction:
Cardiovascular diseases, obesity, cancer, and stroke are some of the leading diseases in the world, and they are the most frequent causes of death in recent past years. Stroke is the condition when there is a blockage of blood supply, and oxygen to any part of the brain. Unfortunately, his will cause the death of brain cells. This capstone project is about stroke readmissions that are increasing with passing time. There are efforts being made to reduce stroke readmissions to hospitals, and there are a lot of factors involved. Patients should be given proper awareness, and nurses should be educated so they may treat the patients with the appropriate care necessary. According to the American Heart Association, 389 deaths occur each day due to a stroke in 2016 (Sunil, 2013). This proposal will discuss the different ways to reduce the stroke causes and readmissions in the hospital.
Purpose:
The purpose of the project is to discuss the different causes of stroke and other cardiovascular diseases and further, it will discuss the ways of prevention and treatment as well. It is a common observation that stroke readmissions are increasing day by day, and patients are not getting enough care and treatment in hospitals. It is observed that may stroke patients are admitted to the hospital, go home after treatment; and unfortunately, have to re visit hospitals again and again. The awareness level has to be increased and the education level has to be enhanced as well. The community should be engaged in the different training sessions and proper guidance should be given to them (Stephanie Rennke, 2015). There are different strategies for reducing stroke readmissions in the hospitals. First, it should be noticed that the immune system and nervous system of the patients are weak, and they have to build immunity and the concept of self-care should be introduced. The families and peer groups should be supportive enough and diet recommendations should be given to them. Subsequently, it would be the duty of the nurses to provide education to patients hopefully resulting in the reduction of stroke readmissions.
Personal Reflections:
There are different significant issues regarding ailments and medical experts are presenting their strategies to control these issues; however, I have selected stroke for the proposal. Stroke and its incidence are increasing day by day, and the western countries are most at risk. Sedentary lifestyles are increasing, and the junk food prevalence is enhanced in western countries as well. We as a people are so busy with jobs and business, there is very little time to incorporate a healthy lifestyle. Unfortunately, there is a lack of routine exercise as a nation. On the other hand, the ratio of smokers is also increasing, in which is ...
2Reducing Stroke Readmissions in the Acute.docxBHANU281672
2
Reducing Stroke Readmissions in the Acute Care Setting
Michelle L Wallace
NUR 430
Professor Roberts
Introduction:
Cardiovascular diseases, obesity, cancer, and stroke are some of the leading diseases in the world, and they are the most frequent causes of death in recent past years. Stroke is the condition when there is a blockage of blood supply, and oxygen to any part of the brain. Unfortunately, his will cause the death of brain cells. This capstone project is about stroke readmissions that are increasing with passing time. There are efforts being made to reduce stroke readmissions to hospitals, and there are a lot of factors involved. Patients should be given proper awareness, and nurses should be educated so they may treat the patients with the appropriate care necessary. According to the American Heart Association, 389 deaths occur each day due to a stroke in 2016 (Sunil, 2013). This proposal will discuss the different ways to reduce the stroke causes and readmissions in the hospital.
Purpose:
The purpose of the project is to discuss the different causes of stroke and other cardiovascular diseases and further, it will discuss the ways of prevention and treatment as well. It is a common observation that stroke readmissions are increasing day by day, and patients are not getting enough care and treatment in hospitals. It is observed that may stroke patients are admitted to the hospital, go home after treatment; and unfortunately, have to re visit hospitals again and again. The awareness level has to be increased and the education level has to be enhanced as well. The community should be engaged in the different training sessions and proper guidance should be given to them (Stephanie Rennke, 2015). There are different strategies for reducing stroke readmissions in the hospitals. First, it should be noticed that the immune system and nervous system of the patients are weak, and they have to build immunity and the concept of self-care should be introduced. The families and peer groups should be supportive enough and diet recommendations should be given to them. Subsequently, it would be the duty of the nurses to provide education to patients hopefully resulting in the reduction of stroke readmissions.
Personal Reflections:
There are different significant issues regarding ailments and medical experts are presenting their strategies to control these issues; however, I have selected stroke for the proposal. Stroke and its incidence are increasing day by day, and the western countries are most at risk. Sedentary lifestyles are increasing, and the junk food prevalence is enhanced in western countries as well. We as a people are so busy with jobs and business, there is very little time to incorporate a healthy lifestyle. Unfortunately, there is a lack of routine exercise as a nation. On the other hand, the ratio of smokers is also increasing, in which is .
ADVANCED NURSING RESEARCH
1
ADVANCED NURSING RESEARCH 2
Evidence Based Practice Grant Proposal
Table of Contents
31.Purpose
42.Background
5Research objectives
6Theoretical framework
63.EBP Model
74.Proposed Change
85.Outcomes
86.Evaluation Plan
97.Dissemination Plan
9Tools to be Used
9Peer review tools for the proposal
11Grant Request
11Proposed Tasks
11Task 1: Case study- Reviewing existing literature on stigma around mental health complications
11Task 2: Interviewing clinicians that have dealt with the study topic
12Task 3: Interviewing patients of mental health
12Schedule
13Budget
148.Appendices
14a.Informed Consent
19Certificate of Consent
19Signature or Date
21b.Literature Matrix
32c.Tools and equipment to be used
34References
Grant Proposal-Assessing the role of stigma towards mental health patients in help seeking
Study problem
There are several studies that have shown that stigmatization towards mental health patients have been present throughout history and even despite the evolution in modern medicine and advanced treatment. For example, Verhaeghe et al., (2014), captures in a publication in reference to a study that he conducted that stigmatization towards mental health patients has been there even as early is in the 18th Century. People were hesitant to interact with people termed or perceived to have mental health conditions.
Stigmatization has resulted from the belief that those with mental problem are aggressive and dangerous creating a social distance (Szeto et al., 2017). Also, mental health-related stigma has become of major concern as it creates crucial barriers to access treatment and quality care since it not only influences the behaviour of the patients but also the attitude of the providers hence impacting help-seeking. Timmermann, Uhrenfeldt and Birkelund (2014), have identified stigma as a barrier that is of significance to care or help seeking while the extent to which it still remains a barrier have not been reviewed deeply. Therefore, this study will assess the role contributed by stigma in help seeking in depth. 1. Purpose
The intention of the research study is to review the association between stigma, mental illness and help seeking in order to formulate ways in which the stigma that is around mental health is done away with to enable as many people suffering from mental health complications to seek medical help.2. Background
Mental health is crucial in every stage of life. It is defined as the state of psychological well-being whereby the individual realizes a satisfactory integration instinctual drive acceptable to both oneself and his or her social setting (Ritchie & Roser, 2018). The status of mental health influences physical health, relationships, and most importantly day-to-day life. Mental health problems arise when there is a ...
Evidence-Based Practices & Nursing
Introduction
Normally, PICOT format is helpful in formulation of questions in an evidenced based clinical practice. PICOT generated questions generally fall under for main categories of clinical practices. These include; therapy, prevention, diagnosis, etiology as well as Prognosis. The essential elements in PICOT questions. The PICOT format is valuable in addressing research questions comprehensively. Five elements are normally addressed including; population, intervention, comparison, outcome and time as well (Riva, Malik, Burnie, Endicott, & Busse, 2012).
Summary of Case Study
The ever increasingly high incidence of breast cancer conditions has posed serious challenges in the nursing profession. Provision of appropriate healthcare to the cancer patients has been lacking leading to adverse effects of the proliferation of cancerous cells which further worsen the conditions of the patients. As primary care, clinicians have the responsibility to stressing providing healthcare services within healthcare facilities as well as monitoring treatment in home based facilities to help manage cancer condition. Most cancer patient need clinicians who practice evidence-based clinical practices (Riva, Malik, Burnie, Endicott, & Busse, 2012).
Research Question
In cancer patients receiving chemotherapy, will they have better white blood cell count monitoring with a follow-up at home versus follow-up at a health care facility during their treatment?
PICOT Format
1) P-Population: Patients aged 18-60 years-old, breast cancer who have not received chemotherapy in the past six months are subjected to the treatment. Patients with other serious health conditions such as heart diseases were excluded in the study. 30 patients, with 15patients stationed at the healthcare facility while the other 15 patients receiving home-based care, are expected to take part in the study.
2) I -Intervention: The patients will receive dosage based on the age, sex and health general body health as well as the stage of cancer cells proliferation in the body. The patients are required take the prescribed drugs at regular intervals. The subjects will be subjected to treatment under the same during the research study.
3) C-Comparison: All the subject regardless of variations in their level of dose requirement will be subjected to the same treatment for the same duration, 3months. Standardized treatment will be given to subjects with no extreme variations in their level of dose requirement and would be used as an active control group. Using this strategy, it will be possible to minimize the non-specific effects due to a group of the patient receiving treatment within the healthcare.
4) O-Outcome: The response in chemotherapy treatments will be check by examining the numbers of defective cancerous cells in the body tissues. The patients will report to the theatre in order to be examined by an oncologist. The results will be recorded i ...
Running Head PICOT STATEMENT1PICOT STATEMENT4.docxglendar3
Running Head: PICOT STATEMENT 1
PICOT STATEMENT 4
PICOT statement
Name of the student:
Good start on your PICO question this week. However, I am not clear on what the PICOT question is. What is the specific intervention, comparison, and outcomes you are evaluating? I noted a few corrections and comments in your paper. Be sure to make corrections before including this in the final capstone paper in week 9. Thanks. – Mrs. Guzman
PICOT Sstatement
Patient/Ppopulation
The population that is mostly affected with hypertension are male adults between the ages of 40 and 70 with hypertension, and with different diseases, that shows alteration in lifestyle (attracting routinely in practice and taking in more advantageous and sufficient dinners), appeared differently in relation to patients who use solution to treat/manage their high blood pressure, assist to manage their heartbeat and lessen the threat of making cardiovascular sicknesses in their recovery time inside a half year. The period will be adequately long to make a sick be able not to encounter the evil impacts of high blood pressure and to in like manner diminish the threats that the general population will customarily experience (Dua, et.al, 2014). Comment by Melanie Guzman: Meaning is not clear Comment by Melanie Guzman: This is vague Comment by Melanie Guzman: 5 authors: Put all last names inn first citation, then et al. in subsequent citations
Intervention Comment by Melanie Guzman: Headings bolded
The essential strategy for mediation for sick with high blood pressure it is with no vulnerability to place them under medicine so that they can be restored. That is the most secure way as it will impact the patient to have the ability to manage themselves to the extent how they to think, what they eat and even the activities that they endeavor to take an interest in. The age of the patients will in like manner suggest that the sick are given arrangement that can oversee them in the most useful means and which they can recognize with everything taken into account. The medicine that can be provided for this circumstance is one that can diminish the brutality of a prescription. The nursing intercession for sick with high blood pressure is evaluating the migraine torments that sick is encountering and checking the obscured vision in like clockwork until the point when it leaves. Another nursing mediation is for an attendant to teach a sick on how they counsel with their specialist before the medicine is ceased (Dua, et.al, 2014). Comment by Melanie Guzman: This is not clear. What is the identified problem? PICOT statement? What evidenced-based interventions related to that problem are you proposing? Comment by Melanie Guzman: What interventions are being doing to prevent high blood pressure? Is evaluation of migraine a major issue with HTN? Comment by Melanie Guzman:
Comparison Comment by Melanie Guzman: What are you specifically comparing in your PICOT statement?
The first c.
Running Head PICOT STATEMENT1PICOT STATEMENT4.docxtodd581
Running Head: PICOT STATEMENT 1
PICOT STATEMENT 4
PICOT statement
Name of the student:
Good start on your PICO question this week. However, I am not clear on what the PICOT question is. What is the specific intervention, comparison, and outcomes you are evaluating? I noted a few corrections and comments in your paper. Be sure to make corrections before including this in the final capstone paper in week 9. Thanks. – Mrs. Guzman
PICOT Sstatement
Patient/Ppopulation
The population that is mostly affected with hypertension are male adults between the ages of 40 and 70 with hypertension, and with different diseases, that shows alteration in lifestyle (attracting routinely in practice and taking in more advantageous and sufficient dinners), appeared differently in relation to patients who use solution to treat/manage their high blood pressure, assist to manage their heartbeat and lessen the threat of making cardiovascular sicknesses in their recovery time inside a half year. The period will be adequately long to make a sick be able not to encounter the evil impacts of high blood pressure and to in like manner diminish the threats that the general population will customarily experience (Dua, et.al, 2014). Comment by Melanie Guzman: Meaning is not clear Comment by Melanie Guzman: This is vague Comment by Melanie Guzman: 5 authors: Put all last names inn first citation, then et al. in subsequent citations
Intervention Comment by Melanie Guzman: Headings bolded
The essential strategy for mediation for sick with high blood pressure it is with no vulnerability to place them under medicine so that they can be restored. That is the most secure way as it will impact the patient to have the ability to manage themselves to the extent how they to think, what they eat and even the activities that they endeavor to take an interest in. The age of the patients will in like manner suggest that the sick are given arrangement that can oversee them in the most useful means and which they can recognize with everything taken into account. The medicine that can be provided for this circumstance is one that can diminish the brutality of a prescription. The nursing intercession for sick with high blood pressure is evaluating the migraine torments that sick is encountering and checking the obscured vision in like clockwork until the point when it leaves. Another nursing mediation is for an attendant to teach a sick on how they counsel with their specialist before the medicine is ceased (Dua, et.al, 2014). Comment by Melanie Guzman: This is not clear. What is the identified problem? PICOT statement? What evidenced-based interventions related to that problem are you proposing? Comment by Melanie Guzman: What interventions are being doing to prevent high blood pressure? Is evaluation of migraine a major issue with HTN? Comment by Melanie Guzman:
Comparison Comment by Melanie Guzman: What are you specifically comparing in your PICOT statement?
The first c.
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
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Primitive, less old, and new olfactory systems with different path
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Screening for depression in medical settings 2015 update
1. Screening for depression in
medical settings: A 2015 Update
Public Health Research Centre Seminar
University of Hong Kong
9th December 2014
James C. Coyne, Ph.D.
Department of Health Psychology
University of Groningen, University Medical
Center Groningen (UMCG), Groningen, the
Netherlands
jcoynester@gmail.com
2. Screening for Depression
How do we evaluate a medical intervention?
How do we evaluate recommendations for a
medial procedure?
How do we challenge recommendations?
3. I'm a skeptic.
Controversies are to be resolved by looking
at the available evidence.
I’m skeptical about the quality of that
evidence.
I believe that individuals and professional
organizations are not skeptical enough, often
have conflicts of interest that are worth
attention.
I believe that you should be skeptical about
me and what I say and demand evidence.
4. Recognized in 1990’s
Depression is a serious
source of suffering,
personal and social
impairment.
Treatments such as
psychotherapy and
medication are effective.
Most people who were
depressed were not
getting treatment.
5. The solution?
Detect untreated
depressed persons,
diagnose them, and get
them into appropriate
treatment.
The model: detect –>
diagnose –> initiate
treatment –> watch the
recovery.
How to accomplish this?
Introduce routine
screening for depression.
7. SSccrreeeenniinngg ffoorr ddeepprreessssiioonn
Involves using depression questionnaires or small
sets of questions to identify patients who may be
depressed, but who have not sought treatment
and whose depression has not already been
recognized by healthcare providers.
Patients identified as possible cases need to be
further assessed and, if appropriate, offered
treatment.
8. SSccrreeeenniinngg ffoorr ddeepprreessssiioonn
Screening is potentially useful only if it improves
patient outcomes beyond any detection and
treatment provided as part of existing standard
care.
To be successful, a screening program must
identify a significant number of depressed patients
who are not already diagnosed with depression,
engage those patients in treatment, and obtain
sufficiently positive treatment results to justify
costs and potential harms from screening.
9. Those who propose screening assume a
burden to demonstrate that it improves patient
outcomes more than simply allowing the
patients and their healthcare providers access
to the same resources without screening.
12. A Digression: Screening for
Thyroid Cancer in Korea
Screening patients without symptoms has led
to 1500% increase in diagnosis since 1999.
No perceptible decrease in deaths due to
thyroid cancer.
Surgery leaves 10% with problems
metabolizing calcium, 2% vocal cord
paralysis, .2% deaths.
13. Why withdrawn?
The World Health
Organization recently
withdraw its
recommendation that
primary-care physicians
routinely screen women
for domestic violence.
14. I was skeptical about screening
for depression from the start,
but didn't think I would find
many people to agree with me.
15. Community physicians missed over 2/3 of the
depression in patients coming for a visit.
Most of the depression missed was mild and patients
were highly functioning.
Most patients with missed depression had only the
minimum number of symptoms needed for diagnoses or
one more.
16.
17. United States Preventive
Services Task Force (USPSTF)
“An independent panel of experts in primary
care and prevention that systematically reviews
the evidence of effectiveness and develops
recommendations for clinical preventive
services.“
The task force is a panel of primary care
physicians and epidemiologists. is funded,
staffed, and appointed by the U.S. Department
of Health and Human Services.”
18. U 2002 USSPPSSTTFF RReeccoommmmeennddaattiioonn
SSttaatteemmeenntt
Recommended in primary care settings ‘that
have systems in place to assure accurate
diagnosis, effective treatment, and follow-up’’
19. Screening for depression in medical care
Pitfalls, alternatives, and revised priorities
Steven C Palmer & James C Coyne
Change in recommendations based on 1 decisive
collaborative care study (Wells et al)
Personnel to administer and score screening instruments,
Training materials and academic detailing.
Depression management specialists.
Initiatives to ensure scheduling of follow up appointments,
Consultations & training with mental health professionals.
Ready access to antidepressants and psychotherapy.
20. Screening for depression in medical care
Pitfalls, alternatives, and revised priorities
Steven C Palmer & James C Coyne
Accumulating evidence from diverse
sources that recognition alone does not
translate into improved outcome for
depressed patients.
Difficulties sustaining screening programs in
routine care.
22. AAnnttiiddeepprreessssaanntt pprreessccrriippttiioonn rraatteess
wweerree aallrreeaaddyy hhiigghh aanndd ttrreennddiinngg
uuppwwaarrdd
Among adults 35 years of age and older in the United
States, antidepressant use increased from 8.3% to
14.1% from 1996 to 2005 with a third to a half of
prescriptions specifically for psychiatric problems.
In a 2005 study from Canada, 7% of a general
population sample reported current antidepressant use,
a figure higher than the estimated prevalence of major
depression (4%).
23.
24. One size fits some: the impact of patient treatment
attitudes on the cost-effectiveness of a depression
primary-care intervention
JEFFREY M. PYNE a1c1, KATHRYN M. ROST a2,
FARAH FARAHATI a1, SHANTI P. TRIPATHI a1,
JEFFREY SMITH a3, D. KEITH WILLIAMS a4,
JOHN FORTNEY a1 and JAMES C. COYNE a5
25. Interpretation?
Detecting cases of depression and having a
collaborative care system (care manager) are
cost effective for the 50% of patients
interested in a particular treatment,
antidepressants.
Such a system of care is not cost-effective for
the other half of patients who don't want an
antidepressant.
26. Screening ffoorr DDeepprreessssiioonn iinn CClliinniiccaall
PPrraaccttiiccee AAnn EEvviiddeennccee--BBaasseedd GGuuiiddee
ISBN 0195380193
Paperback, 416 pages
Nov 2009 US
Feb 2010 UK
28. SSuummmmaarryy
“The high prevalence of depression in patients with
CVD, the adverse health care outcomes associated
with depression, and the availability of easy-to-use
case-finding instruments make it tempting to
endorse widespread depression screening in
cardiovascular care. However, the adaptation of
depression screening in cardiovascular care settings
would likely be unduly resource intensive and would
not be likely to benefit patients in the absence of
significant changes in current models of care.”
31. Whoops!
How dare we disagree with the American Heart
Association and the American Psychiatric
Association?
There are rules for making policy
recommendations and they didn't follow them.
33. Guidelines for Screening for
Depression Deficient in
Systematic review of the literature.
Transparency.
Composition of guidelines committee
including formal involvement of patients,
frontline clinicians, and other key
stakeholders.
Articulation of guidelines in terms of strength
of evidence.
External review.
34. A difference
USPSTF guidelines have orderly process of
gathering, grading, and integrating evidence.
Room for disagreement, but transparent
enough so you could see process and
challenge results.
Professional organizations consensus-based,
room for bias.
35. WWhhaatt iiss tthhee qquuaalliittyy ooff rroouuttiinnee ccaarree
iinnttoo wwhhiicchh ssccrreeeenneedd ppaattiieennttss wwoouulldd
bbee sseenntt??
Only 20-30% of depressed persons being
treated exclusively in general medical settings
receive adequate care and follow up.
About 40% of all depressed patients are
administered treatment with little benefit over
what would be obtained by remaining on a wait
list, representing 20% of the total cost of treating
depression.
36. U 2009 USSPPSSTTFF RReeccoommmmeennddaattiioonn
SSttaatteemmeenntt
Recommends screening adults for depression when
staff-assisted depression care supports are in place to
assure accurate diagnosis, effective treatment, and
follow-up. (Grade B recommendation)
Recommends against routinely screening adults for
depression when staff-assisted depression care supports
are not in place.
Fair evidence that screening and feedback alone without
staff-assisted care supports does not improve clinical
outcomes in adults and older adults.
37. 22000099 UUSSPPSSTTFF RReeccoommmmeennddaattiioonn
SSttaatteemmeenntt
Evidence from meta-analysis of 11 trials in primary
care settings supported recommendation.
Several of the trials found that screening increased
identification or treatment of depression.
None found that screening reduced diagnoses of
depression or improved depressive symptoms.
Overall effect estimate was virtually zero (standardized
mean difference [SMD] = -0.02, 95% confidence
interval [CI] -0.25 to 0.20).
38. 22000099 UUSSPPSSTTFF RReeccoommmmeennddaattiioonn
SSttaatteemmeenntt
Patients with depression in the intervention groups
received a collaborative care intervention for
depression, whereas depressed patients in the control
groups received only standard primary care.
Whereas the results of the trials suggest that providing
collaborative depression care is better than not
providing such care to patients with depression, they do
not address the issue of whether screening would
benefit patients with previously unrecognized
depression.
39. AA cclloosseerr llooookk aatt tthhee eevviiddeennccee cciitteedd ffoorr
22000099 UUSSPPSSTTFF RReeccoommmmeennddaattiioonn
Among the 3 largest studies cited by the USPSTF
(those with > 100 patients), in one, 44% of patients in
the trial were treated for depression prior to trial
enrollment.
In another, 44% were receiving appropriate depression
care, defined as specialized counseling or
antidepressant medication, prior to trial enrollment.
In the third, data on pre-trial treatment rates were not
provided, but already treated patients were not
excluded.
40. Collaborative Care for Depression
American studies consistently find moderate
(.30) effect size of enhancements of
depression care involving depression care
manager.
Studies do not consistently replicate in
Europe.
Reason?: Poorer routine care in US gives
more room to show efficacy of enhancement.
41. 2010 National Institute for Health
and Clinical Excellence (NICE)
Depression Management
Guidelines
United Kingdom
42. IInnsstteeaadd ooff ssccrreeeenniinngg,, NNIICCEE
rreeccoommmmeennddeedd……
Physicians be alert to possible depression,
particularly when there is a past history or when
patients have a chronic physical health problem with
functional impairment, and that physicians inquire
about symptoms of depression when there is a
specific concern.
43. PPootteennttiiaall hhaarrmmss
2010 NICE Depression Management Guidelines
identified number of serious concerns about routine
depression screening.
High false-positive rates of screening tools, which are
often well over 50%.
Likelihood that most individuals identified only by
screening would have relatively mild symptoms of
depression and often recover without formal
intervention.
48. OOuurr sskkeeppttiicciissmm
Whether screening for depression is effective is a different
question from there is evidence that collaborative care
depression management interventions improve depression
outcomes over routine care.
Of the 4 trials cited by the USPSTF as evidence supporting
depression screening, none actually evaluated depression
screening. In each of the 4 studies, patients were required
to have depressive symptoms or a diagnosis of depression
to be eligible for the trial.
49. CCoonncclluussiioonnss ooff RReevviieeww
No trials have found that patients who undergo
screening have better outcomes than patients who do
not when the same treatments are available to both
groups.
Existing rates of treatment, high rates of false-positive
results, small treatment effects, and the poor quality
of routine care may explain the lack of effect seen
with screening.
Developers of future guidelines should require
evidence of benefit from randomized controlled trials
of screening, in excess of harms and costs, before
recommending screening.
50. CCaann wwee aassssuummee tthhaatt ssccrreeeenniinngg
wwiillll bbeenneeffiitt ppaattiieennttss??
We know of no clinical trial in which patients screened
for depression had better depression outcomes than
patients who were not screened when the same
depression treatment resources were available to both
screened and non-screened patients, as would be the
case in actual primary care settings.
51.
52. Raffle, AA aanndd GGrraayy,, MM.. ((22000077)).. SSccrreeeenniinngg::
EEvviiddeennccee aanndd PPrraaccttiiccee.. OOxxffoorrdd PPrreessss..
Screening must be delivered in a well functioning
total system if it is to achieve the best chance of
maximum benefit and minimum harm. The system
needs to include everything from the identification of
those to be invited right through to follow-up after
intervention for those found to have a problem.
53. Recommendations for adults
For adults at average risk of depression, we
recommend not routinely screening for
depression. (Weak recommendation; very-low-quality
evidence)
For adults in subgroups of the population who
may be at increased risk of depression, we
recommend not routinely screening for
depression (Weak recommendation; very-low-quality
evidence)
54.
55.
56. The politics of publishing on
screening, depression, and
antidepressants
Why JAMA (Journal of the American Medical
Association) refused to even consider this
article, without seeing it.
59. More patients are now prescribed an
antidepressant at some point in their adult life.
More patients in the waiting room where
screening is done are already on an
antidepressant or have them at home but are
not taking them.
More antidepressants are being given out to
patients who cannot possibly benefit from them.
Rates of medication were going up, but rates of
psychotherapy tend to be going down.
60. Many depressed patients
do not renew prescriptions.
About half would benefit
from dosage adjustment,
medication changes, or
education about adherence
at five weeks to achieve
benefits, but don’t get
followed up.
61. Differences between countries
American practice guidelines recommend either
antidepressants or psychotherapy to all patients
with a diagnosis of depression.
Other countries such as Canada, the UK, and
the Netherlands do not recommend
antidepressants as first-line treatment for
patients with mild, but diagnosable depression.
Emergence of stepped care whereby patients
with mild depression encouraged to try self-help
strategies, then psychotherapy or counseling,
before going on to antidepressants.
62. Drug company supports monitoring
screening with quality indicators:
Pfizer gives $10 million
grant to American
psychologist to develop
quality indicators to monitor
oncologists’ screening for
distress.
64. An American woman Susan Krantz, received
national news attention when she complained
about her physician charging her $50 for her
having asked questions during her annual physical.
Her insurance company
paid her physician for the
physical, but not for
answering her questions.
She had not been warned
of the extra charge ahead
of time.
65. Talking to patients is a (billable) procedure.
Conversations occur with the meter running
“We’re not paid to solve
patients’ problems, we are
paid to do procedures.”
66. Screening contributes to
bureaucratizing talking to patients
Quality indicators.
Rationing.
Requires mental health backup and
further screening.
Requires patients to have repeat
discussions in order to get their needs
met.
67. Rather than routinely screening patients
for depression and placing them in
inadequate routine care without follow-up:
•Concentrate on ensuring better follow-up
care for known cases of
depression.
•Concentrate on patients
at high risk for depression.