Patient Psychological disorder and Alternative Drug Treatments

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who selected a different interactive media piece on  Patient psychological disorder, and provide recommendations for alternative drug treatments to address the patient’s pathophysiology.

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Depression Scenario

The interactive depression scenario described a 70-year-old male who presented with complaints of depression (Laureate Education, 2019). He also reported shoulder pain related to warehouse labor, experiencing the death of his mother at a young age, being an outsider at school, anhedonia, recent weight gain, insomnia, and poor concentration (Laureate Education, 2019). On exam, he had poor eye contact, soft speech, constricted effect without evidence of psychosis or suicidal/homicidal ideation (Laureate Education, 2019). For the first decision, I chose to start the patient on Zoloft 25 mg oral daily. When the patient returned four weeks later with a 25 percent improvement of depressive symptoms and a new onset of erectile dysfunction, I chose to add Wellbutrin IR 150 mg in the morning. When the patient came in four weeks later with the continued decrease of depressive symptoms, no erectile dysfunction, and feelings of increased nervousness, I chose to change the Wellbutrin order to Wellbutrin XL 150 mg oral in the morning to address the Patient psychological disorder and provide recommendations for alternative drug treatments.

Pharmacotherapeutic Impact on Pathophysiology

When choosing initial treatment options for depression, the classes of medications have similar efficacy, so it is best to focus on safety and medication tolerance (Rosenthal & Burchum, 2018). Therefore, I chose to start with a Selective Serotonin Reuptake Inhibitor (SSRI), recognized as the safest and most tolerated medication for treating major depression (Rosenthal & Burchum, 2018). The pathophysiology of these medications is unclear; however, the theory suggests that these medications compensate for serotonin deficiency in the synapse (Holck, Wolkowitz, Mellon, Reus, Nelson, Westrin, & Lindqvist, 2019). Serotonin is needed to regulate sleep, mood, and cognition (Holck et al., 2019). By increasing the amount of Serotonin in the synapse, this patient’s depressive symptoms decreased.  In the second decision, I chose to add Wellbutrin IR to the patient’s medication regimen to help treat his erectile dysfunction symptoms. Wellbutrin is an atypical antidepressant where the mechanism of action is also not understood (Rosenthal & Burchum, 2018). However, the effects may be related to blocking the reuptake of dopamine, which regulates behavior and influences learning, and norepinephrine, which plays a role in getting the brain and body ready for action (Berke, 2018; Rosenthal & Burchum, 2018). While Wellbutrin helps depression, it also seems to help with sexual desire (Rosenthal & Burchum, 2018). Fortunately, this additional medication helped the patient in the scenario. After four weeks of taking both drugs, he had a continued decrease in depressive symptoms and no longer struggled with sexual dysfunction.           In my third decision, I chose to change the Wellbutrin order to extended-release since the patient was experiencing restlessness symptoms. The immediate release may have been too much, too fast for the patient as it reaches its peak two hours after administration (Rosenthal & Burchum, 2018). Extended-release Wellbutrin reaches its peak at five hours with a half-life of approximately 21 hours (Food and Drug Administration, n.d.). This change will help to settle the experienced side effects of the medication.

Treatment Plan The effect of Zoloft and Wellbutrin on the patient’s pathophysiology will impact the patient’s treatment plan. Common side effects of SSRIs include weight gain, insomnia, sexual dysfunction, and increased risk of suicide (Rosenthal & Burchum, 2018). I already addressed sexual dysfunction by adding Wellbutrin, but the monitoring for the other side effects is also essential for safety and compliance purposes. The patient already has had a significant amount of weight gain and complains about insomnia. Therefore, follow-up appointments are necessary for close monitoring of these possible side effects. Treatment should include education about proper diet and activity to regulate weight. The provider should also assess the patient’s sleep to ensure the medication is helping rather than worsening the amount and quality of sleep. It is also crucial for the provider to educate the patient on the increased risk of suicide and encourage the patient to seek help immediately if he starts having these thoughts. The provider should assess the patient for suicidal ideation frequently.

Wellbutrin is usually well tolerated; however, it carries a risk for seizures and psychotic symptoms. Therefore, the provider should assess for any seizure risk factors such as a history of seizures, a head injury, an eating disorder, or a CNS tumor (Rosenthal & Burchum, 2018). The provider should also assess the patient for psychotic symptoms at each follow-up visit, such as hallucinations or delusional thoughts (Rosenthal & Burchum, 2018).

References

Berke, J.D. (2018). What does dopamine mean? Nature Neuroscience, 21(6), 787-793. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29760524Food and Drug Administration. (n.d.). Wellbutrin XL. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/021515s026s027lbl.pdfHolck, A., Wolkowitz, O. M., Mellon, S. H., Reus, V. I., Nelson, J. C., Westrin, Å., & Lindqvist, D. (2019). Plasma serotonin levels are associated with antidepressant response to SSRIs. Journal of Affective Disorders, 250, 65–70. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jad.2019.02.063Laureate Education (Producer). (2019). Adult geriatric depression [Interactive media file]. Baltimore, MD: Author.Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

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 Patient Psychological disorder and Alternative Drug Treatments

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Three Examples in a Healthcare organization for both quality and cost.

Question Three world examples in a healthcare organization of under-use, overuse, and misuse for both quality and cost.

What are the implications for effectiveness, efficiency, and the patient for each of your examples? Basically, provide an example of underuse, overuse, and misuse.

Your response should be a minimum of 1000 words and include a minimum of  Provide three scholarly real-world examples in an organization of under-use, overuse, and misuse for both quality and cost.

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Three World Examples in a Healthcare organization for both quality and cost.

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Assessing community health issues on Specific population groups

When assessing community health issues of specific population groups, it is important to identify what may be involved and ensure they are captured in the overall assessment. What is a targeted or high-risk population group? How would you identify this population group in a community? Why is it necessary to focus on these groups? Provide 2-3 examples of this type of population.

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Assessing community health issues on Specific population groups

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Hospital Implementation of New EHR and Implications

You are the Director of a Health Information Management department, and your hospital will soon be the Hospital implementation of New EHR and Implications. The doctors in your hospital are concerned about using a new EHR. They are afraid that it will take away from their ability to care for their patients and that it will cause extra work for them. The Chief Medical Officer (CMO) has approached you because you are on the EHR implementation and design team. You are asked to negotiate and persuade the physicians – to onboard them with the upcoming transition to an Electronic Health Record. To do this, you will create a presentation for the Medical Staff Meeting and it will include:

  1. Specifics on how the EHR will benefit them. These will be used to negotiate with them in an open forum at the meeting. The CMO provides some physician issues:
  • They have fears about their typing skills.
  • They want to use their own order sets – not pre-set orders.
  • They fear that the system won’t be secure.
  • They like to review the old paper records to see the patient’s treatment history.
  • Some of them use an EHR at a nearby facility and don’t want to learn a different system.
  1. Steps that will be taken to ensure a successful transition to the Hospital Implementation of New EHR and Implications. Create a persuasive presentation for the doctors, sharing at least four benefits the doctors will realize from a new EHR, and recording at least two ideas that can be negotiated during implementation to meet their personal preferences and ensure a successful transition. Your presentation should be 2-3 pages long or if you prefer, it may be completed using PowerPoint which would likely be longer to accommodate for the larger fonts used in PowerPoint. Correct spelling, grammar, Reference in APA format with in-text citations

Submit your completed assignment by following the directions linked below. Please check the Course Calendar for specific due dates.

 

Hospital Implementation of New EHR and Implications

Hospital Implementation of New EHR and Implications

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Quality Multidimensions and its Perspectives in an organisation

Quality multidimensions and its perspectives in an organisation of various stakeholders, including patients and families. As noted in this week’s Learning Resources, defining quality is not a simple, straightforward task. Yet, it provides an essential foundation for being able to measure and assess quality, and, ultimately, to improve it.

In this Discussion, you consider definitions and measurements of

. As you proceed, think about why it is important for organizations to be able to quantify quality and compare current performance to previous performance, to a set of standards, and/or to performance in other organizations.

To prepare:

  • Review the information in the Learning Resources, especially the chapters in the Sadeghi, Brazi, Mikhail, and Shabot course text, focusing on how quality is or could be defined and measured.
  • Think about a health care organization with which you are familiar. It may be the same organization you are focusing on for your Course Project or a different one. How do you think various stakeholders in this organization would define quality? How would you define quality as it relates to this organization?
  • Review the information on quality standards and/or aims in the Learning Resources, and consider the following:
    • Which outcomes related to quality are currently being monitored in the organization that you have selected?
    • How is related data collected and evaluated?
    • Does the organization use health information technology in this regard? If so, how?
    • How is quality-related information (e.g., data, needs for improvement) communicated throughout the organization?
    • What do you consider to be the strengths and weaknesses of the current approach to quality in this organization?

By Day 3

Post a definition of quality, Quality Multidimensions and its Perspectives in an organisation. Describe at least one quality-related measure that is currently being monitored within the organization and summarize the data collection process for this measure, and explain how this information is communicated to or among the staff. Identify at least one strength and one weakness related to how quality is defined, measured, and/or monitored within the organization.

only needs to be around 300 words

optional resources

Epstein, J. N., Langberg, J. M., Lichtenstein, P. K., Kolb, R. C., & Stark, L. J. (2010). Sustained improvement in pediatricians’ ADHD practice behaviors in the context of a community-based quality improvement initiative. Children’s Health Care, 39(4), 296–311.

Gardner, K., Bailie, R., Si, D., O’Donoghue, L., Kennedy, C., Liddle, H., . . . Beaver, C. (2011). Reorienting primary health care for addressing chronic conditions in remote Australia and the South Pacific: Review of evidence and lessons from an innovative quality improvement process. The Australian Journal of Rural Health, 19(3), 111–117.

Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.

Knox, L. M., & Aspy, C. B. (2011). Quality improvement as a tool for translating evidence-based interventions into practice: What the youth violence prevention community can learn from healthcare. American Journal of Community Psychology, 48(1-2), 56–64.

http://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementEstablishingMeasures.aspx

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Quality Multidimensions and its Perspectives in an organisation

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Aromatherapy for sleep disorder Powerpoint presentation

Aromatherapy for sleep disorder Powerpoint presentation. The presentation must follow Instructions.

When you do the presentation,  note the following six points :

  1. What the Complementary alternative Medicine practice actually is
  2. Who are its practitioners?
  3. How it is typically used.
  4. Why people use this type of practice
  5. Its current status in the Medical world.
  6. What evidence is there that supports its use ( must be APA STYLE and you must do research )
  7. PowerPoint presentation must have a reference page with all the sources used
  8. If you use graphics in your presentation, please be sure that they are small in size and suitable for the PowerPoint format.

Please make sure you cite all the sources used and must be APA style, no plagiarism, and must have valid information. This is a nursing PowerPoint based on a complementary and alternative medication class.

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Aromatherapy for sleep disorder Powerpoint presentation

Aromatherapy for sleep disorder Powerpoint presentation

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Articles that are supporting your PICOT question in type-2 diabetic patients

Research Articles that are supporting your PICOT question in type-2 diabetic patients. There are 4 articles provided only 2  needed and it only has to be one paragraph. And it also has to go through to turn it in. So please no plagiarism.

On the discussion board, using a minimum of two articles that are supporting your PICOT question, submit one paragraph synthesizing the research into clear, concise statements without separately reviewing each of the studies in the paragraph—but by paraphrasing and synthesizing the work that was done.

PICOT: In type-2 diabetic patients, how does the ketogenic diet compare to a low-calorie diet in the maintenance of weight loss in a one-year time frame?

Comments from the teacher:

Wow!  This week’s assignment was evidently one that no one understood.  May I suggest you go back and at least read the lectures posted on week 6!  This lecture stated:

To synthesize is to combine two or more elements to form a new whole. In the literature review, the “elements” are the findings of the literature you gather and read; the “new whole” is the conclusion you draw from those findings.

“Rigorous methods of quantitative assessment are necessary to establish interventions that are both effective and cost-effective. Usually, a single study will not fully address these issues and it is desirable to synthesize evidence from multiple sources.

At this point in the process, you should aim for the synthesis of the material. Synthesizing means comparing different materials and highlighting similarities, differences, and connections. When a writer synthesizes successfully, he or she presents new ideas based on interpretations of other evidence or arguments. Critical reading and critical thinking are key components of successful synthesizing.’

Please look at your paragraph and see if you did this (hint:  most of you did not!)

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  • Articles that are supporting your PICOT question in type-2 diabetic patients

    Articles that are supporting your PICOT question in type-2 diabetic patients

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Individual rights in the delivery of health care and public health

Whereas the protection and promotion of human rights stand out among the major purposes of the law, sometimes the law is viewed as a restriction to individual rights in the delivery of health care and public health.

Individuals are deeply impacted by law on a daily basis, and this fact is no less true when they navigate the healthcare system, or when an individual’s actions are measured against the broader interests of the public’s health. Over many decades, legal principles have been rejected, developed, and refined as the law continually struggles to define the appropriate relationship between individuals and the physicians, hospitals, managed care companies, and others they encounter in the healthcare delivery system, and between individuals and government agencies charged with protecting public health and welfare. (Teitelbaum& Wilensky, 2017, p.102)

By completing this assignment, you will gain insight into the individual’s legal rights to health care and individual rights in the context of government/policy-initiated public health efforts.

Imagine you are a chief ethics and compliance officer for a local public health department, and prepare a 15- to 17-slide PowerPoint presentation (title and reference slides do not count towards the total slide requirement) for presenting at a national health ethics conference organized by the National Association of County and City Health Officials (NACCHO).

In this presentation, you should:

  • assess the conflicts of interest between individual rights and health care delivery and public health policies in the United States, focusing on a complex ethical issue of choice pertaining to public health policy; and
  • compare the United States’ approach to health rights and that of other high-income countries.

Your assignment must be supported with evidence from a minimum of three published resources with one from the CSU Online Library. All sources used in this assignment, including your textbook, must be cited and referenced according to APA standards found in the APA Style Guide located in your Student Portal. Please ensure the presentation includes visuals such as images and graphics. These images or graphics must be cited according to APA standards as well.

As part of the presentation, you are encouraged to use the speaker notes section for the content slides to reinforce your presentation.

Course Textbook: Teitelbaum, J. B., & Wilensky, S. E. (2017). Essentials of health policy and law (3rd ed.). Burlington, MA: Jones & Bartlett Learning

Please follow the directives to the letter

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Individual rights in the delivery of health care and public health

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Discussion of the epidemiology of allergies and treatment options

Discussion of the epidemiology of allergies and treatment options

A 35-year-old comes to the clinic. He states, “It’s getting close to allergy season and I need something to keep me from getting sick. Last year the doc gave me a shot, a spray, some pills, and an inhaler. They worked really well but I don’t remember what they were. Can I have those things again? I just can’t afford to miss work.”

Please answer the following questions in a narrative format:

  1. Discuss the epidemiology of allergies.
  2. What are your treatment options (consider pharmacoeconomic)? Compare first and second-generation antihistamines.
  3. What education will you provide to the patient?

1 initial post, 2 replies using APA 6th format. 300 words, 2 references not older than 5 years.

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Discussion of the epidemiology of allergies and treatment options

Discussion of the epidemiology of allergies and treatment options

 

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Research on relationship between Exercise and Depression

The project Research on the relationship between Exercise and Depression must be typewritten, double spaced, and very limited in length (maximum 12 pages).

Part I (25%)

An NP researcher conducted Research  on the relationship between Exercise and Depressionexercise and depression relationship and randomly sampled 100 women aged 50-65 years and measured their minutes of exercise in the past week, BMI, and depression. Depression was measured using a Likert-type scale consisting of 20 items. The summation score ranged from 20 to 100 and the higher the score, the higher the level of depression. The Pearson correlation coefficients (r’s) are summarized in the following table. For the analyses, the statistical significance level was set at α=0.05.

Table 1: correlation among minutes of exercise, BMI, and depression

Exercise in the past week (minutes)

BMI

BMI

-0.15

Depression score

-0.30*

0.20

*p < 0.05

1. Write the research and null hypotheses regarding the relationship between exercise and depression.

2. Based on the test statistics in table 1, what is your conclusion regarding your research hypothesis? (Hint: discuss both the magnitude and direction of the relationship).

3. What proportion of variance is shared by minutes of exercise and depression among women 50-65 years of age?

4. For the relationship between minutes of exercise and BMI, Depression

a. what was the estimated power of the statistical test? (Using the power table on page 202, table 9.1, Polit 2010).

b. What was the risk that a type II error was committed?

5. If -0.20 is a good estimation of population correlation, what sample size would be needed to achieve power of 0.80 at a significance α=0.05?

PART II. (25%)

Using the “N6208 Final Project Data”,

a). select two variables with nominal or ordinal level measurements, and perform the descriptive statistics (frequency and percentage). [Please select only dichotomous variables from the following list: poverty, smoker, PoorHealth].

b). perform the bi-variate descriptive statistics using crosstabulation.

c). Hand calculate the ARs, ARR, RR, and OR. Show all your calculations.

d). Perform a chi-square analysis.

e). Using APA format, write a full report with the following sections:

1. Introduction: Describe your research question and hypothesis. Include the variables, measurement levels, the bivariate research question, and the hypothesis [for example, the event of adverse risk (using your variable name here, for instance, alcohol usage) will be higher/or lower in the risk exposed group (i.e., marijuana use) compare to the non-exposed group (non-users of marijuana)].

2. Method: Include the sample description (sample size, eligibility criteria) and statistical methods used for data analysis. (The sample information can be found in “Polit Dataset Description” in the SPSS Data Sets folder).

3. Results: Include frequencies and percentages for the two variables, crosstabulation results, risk indexes (ARs, ARR, RR, and OR), and chi-square test results. Include a summary table for the results and write your interpretation.  (Attach SPSS outputs).

4. Discussion: Write a report including a summary and interpretation of the findings reported in the previous sections relative to the research questions you posed in your introduction.

Part III. (50%)

Run a one-way ANOVA using the dataset “N6208 Final Project Data”. The Dataset contains 462 cases from the original PolitDatasetA. Two variables will be used for this analysis: Satisfaction and House problem.

The variable Houseproblem is created using the variable housprob, a summary index of eight variables about current housing problems for the women in this sample—for example, whether or not they had their utilities cut off, had vermin in the household, had unreliable hear, and so forth. The variable housprob is a count of the total number of times the women said “yes” to these eight questions. The variable housprob is recoded into Houseproblem based on a number of housing problems. The coding for Houseproblem is: 1=no housing problems, 2=one housing problem, and 3= two or more housing problems.

Satisfaction measures the overall satisfaction with material sell-being. This variable is a summated rating scale variable for women’s responses to their degree of satisfaction with four aspects of their material sell-being—their housing, food, furniture, and clothing for themselves and their children. Each item was coded from 1 (very dissatisfied) to 4 (very satisfied), so the overall score for the four items could range from a low of 4 (4 X 1) to 16 (4 X 4). A higher score indicates greater satisfaction. This scale has an internal consistency Cronbach’s alpha of 0.90. The content validity and construct validity have been established in previous research.

For this analysis, use the variable Houseproblem as the independent (group) variable and variable Satisfaction as the outcome variable. To run the one-way ANOVA, click Analyze Compare Means Oneway. In the opening dialogue box, move Satisfaction into the Dependent List and Houseproblem into the slot for Factor. Click the Options push button, and click Descriptives and Homogeneity of Variance, then continue. Next, click the Post Hoc push button and select LSD. Click continue, then OK, and answer the following questions using compete sentences:

  1. What are the mean levels of satisfaction in the three groups? Report the mean, SD, minimum, maximum       and sample size in a table.
  2. Write a research question.
  3. Write the research hypothesis (Ha)       and the null hypothesis (Ho).
  4. What was the value of the F statistic and its p-value?
  5. Can the null hypothesis be rejected?
  6. What were the degrees of freedom?
  7. According to the LSD test, where any group means significantly different from any others? If yes,       which ones?
  8. Write a paragraph summarizing all the results.
  9. Attach the relevant SPSS       printouts.

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