Category: Health & Medicine

There are significant inconsistencies across cortical thickness and volume studies regarding the localization and extent of age effects. This is despite the revelation of use of effects on large areas of the mind by cross-sectional magnetic resonance imaging (MRI) system. These dissimilarities impede research on effects of aging on brain, and reduce the probable worth of MR in studies on age-related brain alterations.

The authors used six independent samples comprising of 883 participants to examine consistency of age effects on the thickness of cortical. Surface-based method of segmentation helped in computation of cortical thickness across the surface of the brain. Consistent age effects were revealed in various cortices across samples (Fjell, Westlye, Amlien, Espeseth, Reinvang, Raz,& & Walhovd, 2009).

Introduction

Many studies in MRI agree that as one ages, there is a reduction of brain volumes as well as enlargement of the ventricular system. However, there is growing proof that brain aging is significantly heterogeneous rather than homogeneous across brain regions. Regrettably, this heterogeneity is hard to analyse because of discrepancies between results.

Fjell et al. (2009) in their study endeavoured to tackle this predicament by testing the consistency of age effects on cortical thickness across six samples drawn from four research centers, with 883 participants. Fjell et al. (2009) argues that recent semiautomated and automated dissection methods have allowed studies of age effects continuously across the cortical mantle without manually defining ROIs. The study objective was to examine the consistency of age effects on regional cortical thickness across samples.

Method

The study involved 883 participants with an age range of 75 years. Scanning of all study subjects was by use of 1.5T magnets from two different manufacturers. The researchers used four different models of scanners. A single scanner generated data for both sample 4 and 5. For the Siemens scanners, T1-weighted sequences were acquired while GE used pulse sequences known as 3D spoiled gradient recalled (SPGR).

Slice thickness were between 1.25 mm (samples 4 and 5) and 1.5 mm (sample 1), with acquisition matrices of 256 3 192 (samples 1, 3, and 6) or 256 3 256 (samples 2, 4, and 5). The need to increase the strength of the signal-to-noise ratio (SNR) resulted in development of several scans within equal scanning time and then averaging for all samples.

General linear models (GLMs) were the statistical tools used to analyse the correlation between age and cortical thickness at each vertex across the entire cortical mantle in each independent sample. The foundation of the computation for the level of overlap between results from the different samples was the number of samples in which each of the P value thresholds was attained for each surface vertex. This information was color coded and projected onto a template brain. Next, all samples were included simultaneously in one GLM.

Results

The authors observed widespread age differences in cortical thickness across samples. However, the magnitude of effects varied among samples and brain regions. Results of using FDR < 0.05 as threshold revealed that there was a relationship between age and thinning of the cortex across nearly the whole brain surface.

However, bilateral thickening in the medial frontal cortex including anterior cingulate gyrus emerged in samples 46. Sample 3 had smaller age effects than in the other samples, but even in that sample, thinning was more noticeable in the prefrontal regions. Using a P value scale from 103 to 109 permitted assessment of regionally differential effects. The most strongly affected areas by age across all samples were the frontal cortices.

While some thinning was evident in four of the samples, age generally had more moderate effects on the medial-temporal cortices. Thickening in the medial frontal cortex emerged in the left hemisphere of samples 4 and 5 after using higher P value threshold. An area was a region of consistent age effects when effects emerged in five or all six of the samples.

Conversely, an area was an area of preservation when effects emerged in none or one of the samples. When FDR < 0.05 was used, large areas showed consistent age effects across studies, especially frontal cortices, where effects were seen in superior, middle, and inferior frontal cortices in all 6 samples.

MRI parameters

Note: FOV, field of view; FA, flip angle; TR, repetition time; TE, echo time; TI, inversion time

Source: Fjell et al. (2009)

Limitations

An important limitation of MRI studies of aging is the achievement of highest CNR possible. Lower CNR decreases the accuracy of the thickness estimation, and may cause variation across the cortical surface. Besides, the thin gap between hippocampus and the neighbouring cortical GM may make it difficult to locate the GM/WM surface around the insular and entorhinal cortical regions thus intensifying the inconsistency of the thickness estimates.

Data smoothing is a problem despite its role in reducing noise and thus improving reliability of the thickness estimates. As smoothing level increases, thickness measurement variability becomes smaller. Manual methods cannot reliably measure thickness because for proper measurements to be obtained, both the localization and the orientation of the white and pial surfaces must be known.

Discussion

The study investigated age effects on the cerebral cortex across multiple large samples enabling assessment of consistency. A considerable component of interstudy variability reduced because of using similar pre-processing procedures for all brains. One may conclude there is a relationship between progression in age and widespread thinning of the cerebral cortex.

Additionally, there was discrepancy of the size of age differences in thickness across cortical regions. Age effects were strongest in the prefrontal cortex, especially in superior, lateral, and medial regions. The other area that recorded heavy effects is the superior temporal gyri at the lower bank of the Sylvian fissure. Although there was generally good agreement among the different samples, some discrepancies cropped up.

For instance, in sample 3, the effects of age were weaker than in other samples. Across all or five of the six samples, large areas had consistent affects. The sensitivity to age effects may increase by using data from different studies and scanners, even in regions where consistency across samples is not impressive (Fjell et al., 2009).

Reference

Fjell, M.A, Westlye, T.L, Amlien, I, Espeseth, T., Reinvang, I., Raz, N,.& &Walhovd, B.K. (2009). High Consistency of Regional Cortical Thinning in Aging across Multiple Samples. Cerebral Cortex September, 19 (9), 20012012. doi:10.1093/cercor/bhn232

The Multi-Axial System of DSM-IV

Axis I: Major depressive episode

This axis points out the clinical syndromes that cause significant impairment to the patient (Warelow & Holmes, 2011). Therefore, Joan had a clinical disorder which required immediate attention. Since she had refused to take her anti-depressant medication, the possibility that she would fall in a major depressive episode was inevitable (Warelow & Holmes, 2011).

Axis II: Anti-Social personality disorder

According to Warelow & Holmes, this axis assesses permanent problems that are often overlooked in the presence of Axis I disorders and it entails disorders such personality disorders (Warelow & Holmes, 2011, par. 23). Joans personality disorder is explained by her social isolation and magical thinking which borders unconventional beliefs.

She sits alone most of the day and never speaks in community meetings. She is also unable to maintain close relationships e.g. divorcing the husband and breaking up with her boyfriend. Joan has a difficult and conflicted relationship with her mother (Warelow & Holmes, 2011).

Axis III: Salysilism (Aspirin Poisoning)

This axis depicts physical and medical that may manipulate or aggravate Axis 1 and Axis II disorders which are noted in the patient (Warelow & Holmes, 2011). Joan had already taken an overdose of aspirin tablets and before she passed out, she called her husband informing him that she was committing suicide (Warelow & Holmes, 2011).

Axis IV: Psycho-social and environmental problems

In this axis, the non-clinical, albeit medically significant, stressors that have the capacity to impact Axis 1 or Axis II disorders are explored. Joans husband left her for another woman almost five years ago and they divorced a year later. In addition, her ex-husband is sporadic about child support and visitation. Joan also broke up with her boyfriend recently and her relationship with her mother is one which is difficult and conflicted.

Other environmental problems include the sight of her elder brother diagnosed with schizophrenia and the thought of the death of her father seven years ago. Joan is from a poor back ground and as such, she must attend workfare assignments in order to get public assistance. She also worked as a book keeper. Such psycho-social and environmental problems predispose her to a depressive episode characterized by feelings of wanting to be alone and a tendency towards self destruction (Warelow & Holmes, 2011).

Axis V: Global Assessment of Functioning Scale: 30 (moderately profound symptoms)

This axis serves as a hint of the evaluating psychiatrists judgment of the patients capacity to function. The scale calibrated on a 100 point and evaluates functioning in psychological, social and occupational spheres (American Psychiatric Association, 2000).

Joans score is justified by the fact that she used to work as a book keeper and has one year of college. She also misses work fair assignments which are a must for her to get public assistance, and moves slowly while walking. The presence of stressors predisposes her to her condition. Therefore, she is hospitalized in a psychiatric ward with a suicidal tendency (Warelow & Holmes, 2011).

Reasons for Joans Depression From Two Theoretical Perspectives

Psycho-Dynamic Theory

This theory depicts a similarity between the kind of grieving which occurs through the death of a loved one and symptoms of depression (Gray, 2011; Castillo, 1997). Depression is perceived as an excessive and irrational grief as a result of and as a reaction to loss, thus resulting in feelings associated with loss of affection (real or imagined) (American Psychiatric Association, 2000).

In addition, grief is perceived to be caused by a person to whom an individual was most dependent as a child. Actual losses (such as loss of a loved one or death) and symbolic losses (e.g. loss of social prestige or job) leads to parts of an individuals childhood being re-experienced. Therefore, individuals with depression are over-dependent and may revert to childhood states (American Psychiatric Association, 2000; Gray, 2011).

According to psychoanalysts, the more an individual experiences loss in childhood, the greater he is predisposed to depression. Unresolved and existing hostility towards an individuals parents (which has been repressed to unconscious levels) is a crucial explanation for depression.

This is due to the belief that anger (outwardly expressed) cannot be accepted by the superego, and as a result, it is masked. Therefore, hostility directed at oneself results to feelings of despair, unworthiness and guilt. This kind of inward directed aggression is thought to be so severe that it can motivate suicidal tendencies (Gray, 2011; Castillo, 1997).

In addition, grief is complicated by mixed feelings which are inevitable. For instance, psychoanalytic accounts by Freud have pointed out that mourners have had (occasionally) feelings of anger towards the deceased. Because such feelings cannot be accepted by the super ego, they end up being self-directed causing low self esteem and feelings of guilt (American Psychiatric Association, 2000).

Cognitive Behavioral Theory

Cognitive behavioral theorists such as Seligan pointed out (through experiments carried out in animals) that an expression of helplessness in individuals is usually generalized to new incidences. This was evident through experiments where dogs were given electric shocks at uncontrollable levels and they failed to have learnt responses either to stop the shock or initiate escape attempts.

The findings of these animal experiments have been thought to depict sound explanations on development of depression. For instance, theorist such as Seligan termed reactive depression in human beings as a state of learned helplessness (American Psychiatric Association, 2000, par. 23).

This implies that a person depicts learned expectations of untenable external events rather than events which are crucial. Therefore, the behavioral features of this state can produce the likely features of depression. This can be evident in aspects such as cognitive deficits and difficulties in motivation e.g. retardation in psychomotor dynamics (Gray, 2011; Castillo, 1997).

Impact of Gender, Race, and Class on the Possible Diagnoses

In investigations of correlates of depression where gender was included, interesting differences in the clinical picture of depression has been noted.

For instance, a greater incidence of psychiatric morbidity has been reported to exist in African American females and males compared to their white counterparts. This is coupled with other societal perspectives such as increased severity of somatic symptoms, higher incidences of stress and differences in perception in terms of health beliefs and physical functioning (American Psychiatric Association, 2000; Castillo, 1997).

In this regard, African Americans have less suicidal ideation compared to the whites, and they depict less melancholia compared to the Latinos and the whites. However, research studies have depicted a rising trend of poorer health-related quality of life among the African Americans, which are due to stressful events that emanate from socio-economic challenges (American Psychiatric Association, 2000).

In other studies, African American women have been thought to experience higher incidences of mood irritability (unlike melancholia), increased appetite and hypersomnia (American Psychiatric Association, 2000, p. 12). In addition, research findings have pointed out prevalence of depressive symptoms from childhood to adolescence among girls.

However, in the pre-adolescent stage, boys have been found to have higher incidences of depressive symptoms. The depressive symptoms in girls were found to increase rapidly through the early adolescent period, but on their male counterparts, the increase was either insignificant or stable.

In addition, researchers have predicted depressive symptoms and pointed out that low socio-economic status, which is a major causal factor of depression in the african Americans (especially women), is mediated by several other factors such as marital status, internalized racism, physical heath challenges and religious orientation (American Psychiatric Association, 2000 Gray, 2011).

Research has also explored race related stress as an important correlate of mental health, and pointed out that race related at self-reported and perceived discrimination attempts including both lifetime and day-to-day events is common among African Americans (American Psychiatric Association, 2000, par. 12). In addition, racism acts as a correlate of poor psychological heath, including depression and this relationship is thought to be mediated by racial identity.

Other studies on mental illnesses and depression have pointed out that the features which are specific to racial identity show existing correlations with other features like low levels of depression. This was depicted in a longitudinal study where self reported levels of depression among male and female American students of African origin were analyzed (American Psychiatric Association, 2000).

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, fourth edition: DSM-IV-TR. Washington, DC: American Psychiatric Association.

Castillo, R. J. (1997). Culture and mental illness: A client-centered approach. Pacific Grove, Calif., Brooks/Cole Pub. ISBN 13: 978-0-534-34558-7

Gray, S.W. (2011). Competency-based assessments in mental health practice: Cases and practical applications. Hoboken, NJ: Wiley.

Warelow, P., & Holmes, C.A. (2011). Deconstructing the DSM-IV-TR: A critical perspective. International Journal of Mental Health Nursing, 20(6), 383-391.

The rising complexity in health care has compelled practitioners to learn, as well as understand ways to improve the patients care based on the medical terminology. In this respect, this paper considers the system-based practice/program. This is one of the key competencies where medics should be proficient in order to deliver quality and safe patient care.

Systems-based practice is seen as a way through which society can be examined. The system is linked with the metaphor village, which implies that the practitioners are supposed to work with a community of care provider in delivering optimal care to patients.

To begin with, the systems-based practice competence requires practitioners to be well versed with the relationship between patient care and health care systems. This is crucial in determining how the system guarantees safety and quality of patient care. The system current effort is based on medical education (Croskerry, 277). This focuses on mastering of medical terminology, as well as treatment. This results in preoccupation with the system elements.

For this reason, the system all together plus its impact on a patients care remains visible. The systems-based practice is necessary in providing broad awareness about the health care system (Abrams and American Medical Association, 32). This is achieved using the aspect of systems thinking. System thinking is regarded as the foundation of how organizations such as a health care organization perceive their environment.

The safety of the patient is used as a main entry point into this system-based practice/program. In this case, its concepts regarding safety, errors, and harms identified, all have an effect on the patient or provider within this framework. Additionally, this program fosters the ability of identifying the input of this system, which is significant to medical physicians and patients in the delivery of safe and quality care.

The systems-based program best targets the community residents. Its main focus is to make the residents aware of and responsive in the larger context of health care systems about patient care. This is enabled through their participation in establishing faults and executing probable resolutions to the health care systems. In addition, the system is meant to test the residents ability to call on the other resources of health care systems in the provision of optimal patient care successfully.

Based on the system-based practice, the residents are entitled to work effectively in assisting and coordinating delivery of patient care. In addition, they should consider certain aspects related to the patients. One of the aspects is the cost awareness. The other is a risk-benefit analysis. Moreover, the residents should champion for enhanced and ideal patient care. Finally, this program encourages residents to embrace inter-professional teamwork in order to improve the safety and quality of patient care.

The community residents are also the biggest beneficiaries besides being the targets of such a program. This program enlightens residents on how to enhance patient care within the community. In turn, this keeps them in a better place whenever they may be the victims. The residents are kept knowledgeable about diseases, diagnostic skills, as well as their treatments by understanding the medical terminologies.

Overall, effective ways of improving patient care within the community should be created. The way should enhance the teaching of medical terminology. Many people are not acquainted with medical terminologies. The systems-based practice/program as described above is one of the effective ways.

Works Cited

Abrams, Mary, Ann and American Medical Association. Health Literacy and Patient Safety: Help Patients Understand: Removing Barriers to Better, Sare Care: Reducing the Risk by Designing a Safer, Shame-Free Health Care Environment. New York: American Medical Association Press, 2007. Print.

Croskerry, Pat. Patient Safety in Emergency Medicine. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2009. Print.

Reasons why People Continue to Overeat, Smoke, Take Illegal Drugs, Practice Unsafe Sex and Fail to Sleep

People continue with the listed habits for several reasons. Drugs, smoking, and sex are highly addictive and, most likely, extremely challenging behaviors to avoid. Depending on the geographical location, smoking may socially be accepted and even encouraged. Additionally, it may result from an environmental behavior in which children may be raised as it is known that they are used to imitate from their parents, while growing up.

Majority of teenagers spend time on coaches watching television and playing video games, as opposed to playing outside. This behavior aggravates intake of unhealthy fast foods and fatty snacks and leads to detrimental health.

People continue engaging in using illegal drugs as the single way to run away from their reality, and interfere with their mind states. People fail to get adequate sleep since they have adopted the notion that one lives once. Therefore, time should not be wasted for sleep when one can spend it partying and enjoying his/her life.

Mostly, people practice unsafe sex since they are usually too intoxicated to remember about safety. Others dislike the feel of condoms, and consider the feelings more significant as compared to long-term health. In other cases, people unconsciously engage in unsafe sex.

Steps to Maintaining Good Health

Developing as well as maintaining an unimpeachable health is hard for every person. However, it is not impossible if the person has determination. There are five basic guidelines which can help maintain good health, while fulfilling the fitness goals. The steps offer accountability and motivation so that achieving a satisfactory health becomes easier. These steps may be considered undemanding and vital for maintaining better well-being and energy.

Keep the Goal of Embracing Good Health Visible

The goal of achieving good health should always be kept in mind. Therefore, pictures of vegetables and fruits may be placed on the refrigerator, and pictures of healthy bodies taped on the mirror. Moreover, the desired new habits can be written on sticky notes and placed in the purse, by the clock, on the billfold, by the side of the computer screen, or any other place where they catch your attention. This is extremely motivational and helps the person keep focused.

Learn the Facts which will Inspire Change

Reading new articles, magazines and books, which offer the scientific data to prove the importance of new habits and health claims, impacts on the efforts made to seem worthy.

Establish Accountability

Establishing accountability is the most vital step towards achieving good health. When a person is striving to maintain health habits, a partner should help him/her remain focused on the set goals. Support of a partner makes it easier for a person to adhere to his/her aim to quit smoking, exercise more, or eat better as opposed to when an individual is working alone. Hence, various diet and exercise groups are more successful in achieving the end result as compared to individual effort.

Allow for Failures

Since failure may be inevitable, it should be allowed. Giving up a new habit because of pressing issues should be excused though a person should try again. In such a case, the principle goal is to develop the appropriate health habit throughout lifetime.

Rewarding the Achievements

The person should come up with small goals and identify how to reward him/herself after meeting the aim. However, the reward should not disrupt the goal, for instance, allowing smoking a cigarette for a smoker. On the contrary, the goal should motivate one to keep moving forward.

Introduction

A placebo is an inert substance that is administered to medical patients as a form of disease management. Some patients may experience positive changes in their ailment owing to administration of the placebo. It is presumed that because disease is a combination of mental and physical factors, then the placebo plays into the psyche of the patient and causes positive results.

Placebo effect

Medical practitioners and researchers usually create the placebo effect by making the patients believe that they may be receiving treatment for their disease, yet this is not true. Thereafter, the practitioners will reinforce the effects by reassuring the subjects that they are already seeing positive improvements in the patients conditions. Expectancy and false feedback combine to create improved outcomes in the patients health (Colagiuri & Boakes, 2009)

Price et. al. (2008) explain that the placebo effect is not just a response bias. It emanates from emotional changes in the patient. These, eventually, affect the patients neurological system and thus lead to noted changes in the patients body. Therefore, emotions play an important role.

Psychological factors may also be used to explain how body functions change. Sometimes classical conditioning occurs, thus affecting the bodys immunity, respiratory or even hormonal systems. These alterations are manifested as improvements in symptoms of the disease.

In medical research, placebos are used to demonstrate the effect of an intervention. These studies are often called randomised controlled trails. Andrews (2001) explains that placebos illustrate the usefulness of a new drug by comparing its effects with those that belong to randomized groups. If a drug has results that are weaker than the placebo, then the drug is labelled ineffective. Scholars argue that such drugs may have a mild effect on patients, but the result is not strong enough to overpower those that emanate from the placebo effect.

Consequently, the failed drug should not be made available to the public because a non-interventionist effect is more powerful. A lot of psychologists have carried out research on antidepressants and found that their effects are less effective than placebos. This has reduced use of the drugs in treatment of depression.

However, some ethical concerns exist concerning the use of placebos for drug-treatment research. By its very definition, placebos are inert, so they should create no psychological or biological change in the concerned individuals.

Therefore, medical practitioners who endorse such a strategy are using a non scientific, hence an objectionable approach in medicine. Andrews (2001) explains that placebos should be used only when no other proven alternative exists in the market. Starting with the placebo when there are other options is unethical to this author and several others.

Additionally, problems also arise for researchers who carry out placebo-controlled trials. All scholars must get informed consent from subjects as long as they are human. This is an ethical prerogative that every one must abide by. However, telling participants about the consumption of a placebo could minimise its effects because they will already know that they are taking an inert substance.

Therefore, in order to meet this ethical standard while maintaining research blindness of the participants, most scholars tell all participants about the existence of a placebo (Colagiuri & Boakes, 2009). They also add that the participants have a 50-50 chance of belonging to a placebo group (control) or to the test group. As a result, the placebo effect will still arise as patients would peg on the hope of belonging to the test group.

Conclusion

The placebo effect is useful in medicine because it leads to positive outcomes; it eliminates ineffective drugs in the market and also creates positive outcomes in patients. However, researchers must address ethical concerns such as informed consent and availability of other alternatives when dealing with placebos.

References

Andrews, G. (2001). Placebo response in depression: Bane of research, boon to therapy. British Journal of Psychiatry, 178, 192-194. Web.

Colagiuri, B. & Boakes, R. (2010). Perceived, treatment, feedback, and placebo effects in double blind RCTs: An experimental analysis. Psychopharmacology, 208(3), 433-441. Web.

Price, D., Finiss, D. & Benedetti, F. (2008). A comprehensive review of the placebo effect: Recent advances and current thought. The Annual Review of Psychology, 59, 565-590. Web.

Methods of assessing medical terminology

The medical staff can be assessed using the Occupational English Test. In this case, the likely performance of the medical professionals can be determined (McNamara 21). In addition, there is the International English Language Testing System (IELTS) test, which can be used in the assessment of the medical terminologies. This test is known to examine the use of medical English (ONeill, Buckendahl, Plake and Taylor, 297).

It can be observed that most of the tests developed to assess proficiency in medical language focus on the use of the English language. Thus, it should be noted that, the tests suggested are not sufficient. In this case, development of specific tests that can be used for the sole purpose of determining medical language proficiency is needed (Fulcher and Davidson, 125).

Exam Report transcription

Jane D was admitted for pain in her right arm. She had been involved in a motorcycle accident. She had problems moving her right arm. The arm had sustained some injuries during the accident. To determine the extent of her condition, it was necessary to take her to the X-ray. The X-ray indicated that there was a blood clot in her acromioclavicular joint. This indicated that she might have suffered from a shoulder sprain during the accident.

She was lucky that she did not suffer a shoulder fracture or a dislocation. Apart from the shoulder injury, Jane had suffered a deep cut on her left part of the mandible. She was bleeding profusely from the injury. During the accident, Jane had also suffered a nasal fracture. In addition, she had suffered fractures on her coccyx. Apart from the fractures and cuts, Jane had soft tissue injuries that caused her excruciating pain. She was given morphine that had been prescribed to ease her pain.

Upon further examination, it was revealed that Jane had suffered a knee injury. In this case, she had suffered a patella fracture and dislocation. An examination on her blood count indicated a deficiency in the erythrocytes. She was injected with an intravenous of lactated ringers to assist her regarding insufficient blood. This also was to prepare her for the surgery in the operating room.

Determining whether one has learned the language of medicine

The medical profession uses a unique language, which can only make sense to those in this profession. In this case, the various medical professionals have to be efficient in using this language in order to carry out their duties in an effective manner. Therefore, all individuals in the medical profession have to be tested for their comprehension of the medical language.

Lack of proficiency in the medical language can lead to various errors by the medical professional. In this case, such errors include mis-diagnosis and mistreatment. In the extreme case, fatalities may occur due to lack of proficiency in the medical language. Therefore, a medical professional can be assessed through the various tests to determine his or her proficiency.

Those who score highly will be deemed to be proficient in the language of medicine. In addition, it is easy to tell of ones proficiency in medical language by observing the amount of errors related to the language of medicine. In this case, few or lack of errors emanating from the language of medicine can indicate that one has learned the language of medicine. On the contrary, numerous errors related to the medical language will indicate that one has not grasped the language effectively.

Works Cited

Fulcher, Glenn and Fred Davidson. Test Architecture, Test Retrofit. Language Testing 26. 1 (2009): 123  144. Print.

McNamara, Tim. Problematising content validity: the Occupational English Test (OET) as a measure of medical communication. Melbourne Papers in Language Testing 6. 1 (1997): 19  43. Print.

ONeill, Thomas, R., Chad W. Buckendahl, Barbara S. Plake and Lynda Taylor. Recommending a Nursing-Specific Passing Standard for the IELTS Examination. Language Assessment Quarterly 4. 4 (2007): 295  317. Print.

Statement of the purpose

There is a significant difference in the proportion of cholesterol values greater than the mean of the control group between the 2-day, 4-day and 14-day heart attack patients.

Background

Heart attack cases have been associated with the level of cholesterol in a patient. Low-density-lipoprotein cholesterol concentration is factor that contributes to development of atherosclerosis, which causes cardiovascular diseases (Brown & Goldstein 1984). This implies that with a reduction in the level of HDL cholesterol in a patients blood, the higher the chance of atherosclerosis.

Conversely, an increase in the concentration of this cholesterol reduces the risk of a heart attack. Conducting of a heart disease therapy can be done by increasing the level of HDL-cholesterol. Therefore, some studies have correlated cholesterol with cardiovascular diseases.

Currently, heart attack therapy is associated with the understanding of cholesterol levels in a patient. Studies have demonstrated the significant differences relating to cholesterol levels in patients. The High Density Lipoprotein (HDL) has been found to be significantly low than the control groups (Valappil, Chaudhary, Praveenkumar, Gopalakrishnan & Girija, 2012).

Conversely, heart attack patients have been found to have a high level concentration of LDL cholesterol. This has led to some conclusions that these two kinds of cholesterol can be associated with the development of cardiovascular diseases. However, with varying results, no studies have put it confident that the level of cholesterol is significantly different in the heart attack patients and the control groups.

Study significance

The study will be vital in determining the significant difference between the level of cholesterol in heart attack patients and the control group. Last, the study will determine the significant difference basing on 2-day, 4-day and 14-day patients compared to the control group.

Description

A comparison study conducted by Valappil et al. (2012) revealed that reduced cholesterol in intracerebral hemorrhage patients was significantly higher than that of the control group, see table 1. Averagely, the total cholesterol was significantly different between the ICH patients and the control group. The results also showed that LDH cholesterol was low in ICH patients than the control group. This difference was significant, unlike, the difference in the level of HDL, which was proved insignificant.

Table 1: mean cholesterol level in ICH patients and the Control group

A study by Carroll et al. (2005) indicated that the level of cholesterol continues to decline. The study was conducted in the United States by comparing the data from the National Health and Nutrition Examination Surveys from 1988 to 2000. The average cholesterol decline was high in older people than younger people. The decline in HDL levels was insignificant, while that in LDL was significant. See fig. 1 and table 2.

Fig. 1. A reduction in cholesterol level for old and young people in the United States with time

Table 2: cholesterol reduction in older people (20 and older)

Methodology

The study will be conducted in the United States. The research design to be used will be a comparative study, which compares cholesterol levels in 30 heart attack patients and 30 patients without heart attacks. Patient used will be of the white race. Purposive sampling will be used to select the sample because with use of other sampling, it will be hard to get a heart attack patient. Data will be analyzed through graphs and tables, using percentages and mean.

Limitations

The study is limited to the white race in the United States. This will make it hard using the conclusions on the black race.

References

Brown, M., & Goldstein, J. L. (1984). How LDL receptors influence cholesterol and atherosclerosis. Sci Am, 251, 5866.

Carroll, M.D., Lacher, D.A., Sorlie, P. D., Cleeman, J.I., Gordon, D.J., Wolz, M., Grundy, S. M., & Johnson, C.L. (2005). Trends in Serum Lipids and Lipoproteins of Adults, 1960-2002. JAMA, 294(14), 1773-81.

Valappil, A.A., Chaudhary, N.V., Praveenkumar, R., & Girija, S. A. (2012). Low Cholesterol as a Risk Factor for Primary Intracerebral Hemorrhahage: A case Control Study. Ann Indian Acad Neurol., 15(1), 19-22.

Center for Medicare and Medicaid Services (CMS) is an agency of the US federal government that governs Medicare. In addition, CMS collaborates with state governments in governing Medicaid, State Childrens Health Insurance Program (SCHIP), and Health Insurance Portability and Accountability Act (HIPAA).

The HITECH Act tasks CMS with the responsibility of advancing the implementation of IT in the healthcare industry. In addition, the act gives CMS the responsibility of implementing the electronic health record (EHR) and formulation of standards for certification of EHR technology. Implementation of IT in healthcare is one of the major activities of CMS. Therefore, CMS collaborates with the Office of the National Coordinator for Health IT (ONC) to improve the efficiency and relevance of its activities.

Tens of thousands of patients die annually due to preventable medical errors in various American hospitals. According to a report by the Institute of Medicine, avoidable medical errors lead to the death of between 44,000 and 98,000 patients annually (Kohn, Corrigan, & Donaldson, 2008).

In 2002, the Center for Disease Control and Prevention (CDC) estimated that 99,000 patients die due to hospital-acquired diseases (Klevens, et al., 2007). Medical errors lead to approximately 2.3 million extra hospital days and loss of $9.3 billion in excess hospital charges (Zhan & Miller, 2003). These statistics highlight the need for significant improvement in the quality of healthcare delivery in American hospitals.

National Quality Forum (NQF) is one of the first organizations that developed a system that helped in improving healthcare delivery. In 2002, NQF compiled a list of 28 preventable medical conditions. These conditions  never events  were due to the mistakes of medical practitioners.

Therefore, medical practitioners could prevent these events easily. Never events lead to a significant increase in the costs of healthcare provision. CMS has its own list of never events. Treatment of preventable conditions makes hospitals receive additional Medicare reimbursements. In response to the Deficit Reduction Act (DRA), CMS formulated a strategy that would prevent hospitals from receiving additional Medicare reimbursements due to the treatment of infections that patients acquire due to hospital stay.

Retention of a foreign object in the patients body after surgery is the first never event of CMS. Since this is a preventable event, CMS ensures that hospitals do not receive Medicare reimbursements due to this event. Air embolism is the second never event of CMS. Air embolism is generally non-fatal.

However, it may cause death in some instances. Air embolism may occur if medical practitioners insert air into the patients bloodstream. The average cost of air embolism is $67,000 per event (Rowland, 2009). Blood incompatibility is the third never event of CMS. Blood incompatibility occurs when medical practitioners give patients the wrong blood type. The cost of treatment of blood incompatibility is $46,492 per event (Rowland, 2009).

Pressure ulcers are the fourth never event of CMS. Pressure ulcers due to failure of an individual to move and change the area of the skin where the body exerts pressure. The severity of the symptoms of pressure ulcers depends on the duration that an individual exerts pressure on the skin. The symptoms range from reddened skin to loss of skin loss in the area under pressure. The average cost of pressure ulcer is $40,318 per event (Rowland, 2009).

The CMS also classifies falls and trauma related injuries within the hospital setting as a never event. Falls from the hospital bed are the most common event in this category. Catheter-associated urinary tract infections are the sixth never event of CMS. Preventable infections of the urinary tract are some of the most common never events. The average cost of treating catheter-associated urinary tract infections is $40,000 (Rowland, 2009).

References

Klevens, R.M, Edwards, J.R., Richards, C.L., Horan, T.C., Gaynes, R.P., Pollock, D.A. & Cardo, D.M. (2007). Estimating health care-associated infections and deaths in U.S. hospitals 2002. Public Health Report, 122(2), 160-166.

Kohn, L.T., Corrigan, J.M. & Donaldson, M.S. (2008). To err is human: Building a safer health system. Washington, DC: National Academy Press.

Rowland, H.T. (2009). When never happens: Implications of Medicares never-event policy. Marquette Elders Advisor, 10(2), 341-382.

Zhan, C. & Miller, M.R. (2003). Excess length of stay, charges, and mortality attributable to medical injuries during hospitalization. JAMA, 290(14), 1868-1874.

This site is dedicated to helping dummies understand the terminologies used in medicine. It is suitable for anyone new to the field of medicine, as well as anyone with an interest of the medical language and or medical education.

The authors explain that knowledge of medical terminologies will only start by knowing the system of the body and recognizing the medical words that are commonly used. They also give an explanation of the influence of Greek in medical terminologies. In addition, they give a list of the medical words that always seem hard to spell.

In explaining the bodys system, the authors explain that the body is a complex system with components that work together. They give a list of terms that represent different parts that make up the body system. These include the skeletal, which represents the bones, joints, axial skeleton and the appendicular skeleton.

The other term is muscular, which represents the tendons and muscle. The other term is sensory organs, which represents the eyes, mouth, ears, nose and the skin receptors. Furthermore, there is the lymphatic system, which includes the spleen, lymph nodes, tonsils, thymus, lymph fluid and the lymphatic vessels among other systems (Henderson and Dorsey 2).

A list of the common root words used in medicine is given. The site seeks to give the meaning of certain body parts. Examples of the words listed include the abdomino, which means abdomen; Adeno meaning glad; anterio meaning front; arterio meaning artery; bio, which means life; cardio, which means the heart; cyto meaning a cell, and a list of many other words.

The other section gives an explanation of the medical terms that are derived from the Greek language. The website explains that the founders of modern medicine are the Greeks hence the origin of most medical words.

Examples of such words listed on the site include Semantics. This word is derived from the Greek word semantikos that refers to significant. The coccyx is a term derived from the Greek terminology cuckoo. In essence, this is similar to a cuckoos beak. Cardium meaning the heart is derived from the Greek word kardia. The authors also give a list of medical words that are commonly misspelled such as adolescence, alopecia, inoculate eczema, and gonorrhea among others. (Henderson and Dorsey 3).

This site is specifically directed to people who are completely new to the medical field and would like to understand the different terms used in medicine. Medicine is considered one of the most crucial necessities to everyone. It is an area of knowledge, and a science concerning the body system, the diseases, and ways of treatment.

Individuals have at some time in their lives visited a hospital or has seen a doctor for one reason or the other. There are advertisements in the media like in magazines, radios, televisions and the internet. All these mediums try to explain about health and how to deal with it.

They use different terminologies that are at times hard for the layman to understand. Therefore, it is important to be conversant with the different terminologies used in medicine in order to understand the human bodies and the issues that affect them. This site gives an explanation of the basic terms used in the field of medicine. In this case, I will readily introduce it to my community and my work place as a reference guide to different terms used in medicine.

Works Cited

Henderson, Beverley and Jennifer Dorsey. Medical terminology for dummies. 2013. Web.

Introduction

Under the foster care system, many children and teenagers in the United States have been adopted and have been successful in gaining a permanent home. However, this process is not as smooth as it might sound since there are children who live with several families before finally getting a permanent home. Consequently, due to different backgrounds, lifestyles, and culture, some of these children find it difficult to cope with their new families.

As a result, they experience physical and psychological stress that might result in the development of adverse behaviors that affect them and the individuals around them. To overcome this problem, psychiatrists have been using psychiatric drugs to suppress and cure disorders such as attention deficit hyperactivity disorder (ADHD), schizophrenia, and bipolar disorder. This has greatly increased the use of psychiatric drugs on children and adolescents since the 1990s (Vitielo and Jensen, 1997).

Safety of Psychiatric Drugs

According to Eig (2012), medication is an effective measure of treating psychiatric problems in children and teenagers. However, there are parents who are worried about the long-term effects that psychiatric drugs have on their. Under normal circumstances, only qualified physicians have the mandate to of prescribing antipsychotic.

Moreover, such physicians should have the experience of dealing with mental illness in children and adolescents. Administration of these drugs should only be done after precise diagnosis have been made. This enables psychiatrists to determine the type of treatment that a patient might require.

As a result, a psychiatrist will be in a position of developing a comprehensive treatment plan for the patient. At this point, a psychiatrist might decide to administer antipsychotic drugs to control and cure the condition that a patient is suffering from. It is the duty of psychiatrists to explain why they have administered antipsychotic drugs to their patients. Consequently, psychiatrists should inform their patients about the possible effects that the drugs might have on them.

Different medications have different side effects. Some of these side effects are mild while others are severe. Therefore, to ensure that the administration of antipsychotic drugs achieves the desired goals, psychiatrists should always be in close contact with their patients.

Consequently, parents should avoid switching from one psychiatrist to another. If antipsychotic drugs are administered in this manner, there are high chances that their effects will be beneficial to patients. However, if unqualified physicians administer these drugs without proper diagnosis, their effects might be detrimental to the health of the patients. Most importantly, it is advised that the administration of antipsychotic drugs should be supplemented by alternative modes of treatment such as psychological therapy.

Over Prescription of Antipsychotic Drugs

Prior to the 1990s, a small proportion of children and teenagers were under the prescription of antipsychotic drugs (Szalavitz, 2012). However, this trend has changed since the numbers of children under prescribed antipsychotic drugs keeps on increasing.

Despite this trend, many psychiatrists have admitted that there are physicians who overprescribe these drugs to children. All the children who were featured in the video were under more than one antipsychotic drug at any given time. For instance, when Mark met his father, he was using over five different antipsychotic drugs. His father later learned that he had been prescribed with over 26 different antipsychotic drugs in his life.

These drugs had adverse effects on his physical and mental health since most of these drugs are administered without proper diagnosis. For instance, after being diagnosed with bipolar disorder, Mark was administered with five different antipsychotic drugs. However, it was later found that he was suffering from ADHD, a condition that only required one drug for treatment. It is through such negligence that antipsychotic drugs are prescribed to children when they might actually not need them.

Who is Responsible?

Due to negligence, physicians tend to prescribe antipsychotic drugs without proper diagnosis. Most physicians view the alternatives to antipsychotic drugs as energy and time consuming. Therefore, prescribing antipsychotic drugs not only eases their work but also ensures that they have more time to attend to other patients hence earning more money.

Pharmaceutical companies on the other hand have launched marketing campaigns that have led to the successful introduction of second-generation drugs called atypical antipsychotics that are sold off the label in the market (PBS Video, n.d.). Once in the market, physicians can use these drugs to treat various mental illnesses such as bipolar disorder, schizophrenia, and ADHD. In 2009, the sale of these drugs earned pharmaceutical companies over $2 billion in revenue. Thus, over prescription on this ground is profit driven.

Alternative Treatments

Other than drugs, there are alternative treatments that can be used to control and cure mental illness in children and adolescents. Cognitive mental therapy, psychotherapy, and parent training are some of the alternatives that can be used to treat mental illness in children and adolescents (Vitielo and Jensen, 1997).

Physicians are aware of these alternatives but because they are time consuming and do not earn physicians a lot of money, they are always avoided. This trend explains the increased consumption of antipsychotic drugs by children and teenagers in the United States.

References

Eig, A. (2012). Psychiatric Medication and Young Children: Is There too Much Pill Popping? Web.

PBS Video (Executive Producers). (n.d.). The Medication for Foster Children. Need to Know, PBS Video.org. Web.

Szalavitz, M. (2012). Antipsychotic Prescriptions in Children Have Skyrocketed: Study. Web.

Vitielo, B. and Jensen, P. (1997). Medication Development and Testing in Children and Adolescents Current Problems, Future Directions. Arch Gen Psychiatry, 54(1), 871-876.