...an underdeveloped topic of research, it was difficult to pull conclusions from a scarce amount of resources available. Almost every article used in this systematic review claimed that there was no dominant...
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...Telemonitoring in CHF patients Evidence Based Practice Project Sacred Heart University The Effect of Telemonitoring in CHF Patients Evidence Based Practice Project Question (PICOT) Question: In elderly individuals over the age of 65, does the use of a mobile phone-based medication adherence application, compared to a mobile phone texting reminder, increase medication compliance by 25%, within 12 weeks of implementing the program? Evidence Appraisal Matrix Source (APA) | Type of Study design (RCT, phenomenology, etc.)/Purpose | Level of Evidence(According toMelnyk & Fineout-Overholt) | Sample, settingInclusion/ExclusionCriteria | Methods, instruments, data analysis | Findings/Implications | Inglis, S. C. (2011). Structured telephone support or telemonitoring programmes for patients with chronic heart failure. Cochrane Database Of Systematic Reviews, (6), doi:10.1002/14651858.CD007228.pub2 | Systematic Review | Level I | Twenty-five studies and five published abstracts were included. 16 evaluated structured telephone support, 11 evaluated telemonitoring, and two tested both interventions. Inclusion criteria:only peer reviewed, published RCTs comparing structured telephone support or telemonitoring to usual care of CHF patients were included. | Various search engines such as: MEDLINE, EMBASE, CINAHL, and AMED were searched from 2006 to November 2008.Relevant studies and systematic reviews and abstract conference proceedings were hand searched. No language limits...
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...Annotated Bibliographies Lisa Stevens Kaplan University Annotated Bibliographies Au, A., McAlister, F., Bakal, J., Ezekowitz, J., Kaul, P., & vanWalraven, C. (2012). Predicting the risk of unplanned readmission or death within 30 days of discharge after a heart failure hospitalization. American Heart Journal, 164(3). 365-372. Retrieved from: http://www.medscape.com/viewarticle/771215_print This article sought to find an appropriate model to predict the risk of unplanned heart failure readmissions. The primary outcome from chart reviews also included death of heart failure patients within 30 days of discharge. The study looked at Centers for Medicaid and Medicare Services (CMS) models and the LACE+ index, to mention two of many that looked at prediction ability. The LACE+ index is a model that looks at length of stay, acuity, the Charlson comorbidity score and age, to predict readmissions. They found that no one model was appropriate in predicting the 30-day readmission rates, although using a combination of the models was an improvement to that predictor. The authors are all physicians, PhDs, or have a Master’s degree- helping to establish credibility. The authors also make a statement as to the funding of the project and that they (the authors) were solely responsible for all data collection, design and submission approval writing for the project, also lending credibility to the study. The references used for this study were appropriate in age, of the 28; 13 were...
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...Definition Heart failure occurs when abnormal cardiac function causes failure of the heart to pump blood at a rate sufficient for metabolic requirements under normal filling pressure. It is characterised clinically by breathlessness, effort intolerance, fluid retention, and poor survival. Fluid retention and the congestion related to this can often be relieved with diuretic therapy. However, diuretic therapy should generally not be used alone and, if required, should be combined with the pharmacological therapies outlined in this review. Heart failure can be caused by systolic or diastolic dysfunction, and is associated with neurohormonal changes. [1] Left ventricular systolic dysfunction (LVSD) is defined as a left ventricular ejection fraction (LVEF) below 0.40. It may be symptomatic or asymptomatic. Defining and diagnosing diastolic heart failure can be difficult. Recently proposed criteria include: (1) clinical evidence of heart failure; (2) normal or mildly abnormal left ventricular systolic function; (3) evidence of abnormal left ventricular relaxation, filling, diastolic distensibility, or diastolic stiffness; and (4) evidence of elevated N-terminal-probrain natriuretic peptide. [2] However, assessment of some of these criteria is not standardised Top of Form Search the BMJ[pic][pic] Bottom of Form • BMJ • BMJ Journals • BMJ Careers • BMJ Learning • Evidence Centre • BMJ Group [pic] [pic] [pic] [pic] [pic] [pic] Home | Log in | Athens...
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...THE CASE FOR A MODEL OF CARE Contemporary health care systems are constantly challenged to revise traditional methods of health care delivery. These challenges are multifaceted and stem from: 1. novel pharmacological and non-pharmacological treatments; 2. changes in consumer demands and expectations; 3. fiscal and resource constraints; 4. changes in societal demographics in particular the ageing of society; 5. an increasing burden of chronic disease; 6. documentation of limitations in traditional health care delivery; 7. an increasing emphasis on transparency and accountability, 8. evidence based practice (EBP) and clinical governance structures; and 9. the increasing cultural diversity of the community. These challenges provoke discussion of the necessity of developing services around a model of care. What do we mean by a model of care? Ambiguity exists in the literature, with the terms, model of care, nursing model, philosophy, paradigm, framework and theory often used interchangeably, despite referring to diverse, yet parallel concepts (Tierney 1998). In their recent review of the literature, the Queensland Government (Australia) reported that they found no consistent definition of ‘model of care’ (Queensland Health 2000). They concluded that a model of care is a multidimensional concept that defines the way in which health care services are delivered (Queensland Health 2000). More specifically, Davidson and Elliott...
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...DIRECTORATE STRATEGY TO CHANGE CULTURE SCHOOL PARTNERSHIPS FOUNDATION LEARNING TIER ADDITIONAL LEARNING SUPPORT Contents Page College Vision, Mission and Values 3 Existing Cultures 4 Overarching College Priorities 4 Bringing about culture change 5 The 5 step journey 6 Roles & Responsibilities 8 Communication & embedding the values 9 Benchmarking 9 Training & Development needs 9 Significant barriers and overcoming them 10 Priorities 11 College Vision, Mission and Values The Strategic Vision For The Merged College Is: “An inspirational organisation that delivers excellence” Mission Statement: “To provide high-quality education and training that is inclusive, and which matches and supports the needs of our diverse learners and the local and regional economy” Corporate Values: ▪ Place learners at the heart of everything we do ▪ Promote a progressive, inspirational and dynamic approach to teaching and learning which responds to learners ▪ Create an environment and ethos which encourages learning and skills development ▪ Promote and provide opportunities for successful participation in education for people from all backgrounds and abilities ▪ Strive for excellence in all aspects of college business ▪ Encourage staff to embrace challenging professional standards and raise...
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...ADAL Tamara Zgadzaj Tutor: Thomas Torley This plan will examine three main long term problems affecting people with diabetes: • eyes • kidneys • heart and brain People with diabetes should visit an eye doctor regularly, every year for an eye exam. Eye problems that can occur with diabetes include : cataracts ( a clouding of the lens ), glaucoma (increased pressure in the eyes ), retinopathy ( eye changes with the retina in the back of the eye ). Symtoms of eye problems are : blurred vision, spots or lines in your vision, watery eyes, eye discomfort, and loss of vision. Diabetics should check for urine problems at least once a year. Proteins in the urine are a sign of kidney disease. Also, blood pressure should be checked regularly. Symtoms of kidney problems can include, swelling of the hands, feet, and face. Weight gain from edema, itching and drowsiness. If they will get promt treatment, there is a chance to slow down the changes in the kidneys. All people with diabetes have increased chance of heart disease and even stroke. Heart disease is the major cause of death for diabetics. It's important to control other risks such as high blood pressure and high fats ( cholesterol ), as well as blood sugar. Symtoms of heart attack are, shortness of breath, feeling faint, feeling dizzy,sweating, nausea, chest pain or pressure, pain in the shoulders, jaw and left arm. Warning signs of stroke are, sudden numbness or weakness in the face,arm, or leg, usually on...
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...60% of cancers have causes other than lifestyle factors; these include environmental exposures. A WHO European Region conference in Asturias, Spain in March 2011 unanimously adopted a declaration which stated: "A substantial percentage of all cancer is caused by environmental and occupational exposures". (3) Expert scientific reviews have linked endocrine-disrupting chemicals to breast and prostate cancer. (4) A European Commission assessment of REACH prior to its introduction stated that if this legislation succeeds in reducing chemical-related diseases by only 10%, the health benefits are estimated at 50 billion Euros over 30 years. This corresponds with 2,200 to 4,300 fewer cancer cases in the workplace annually. (5) Children are especially vulnerable The Asturias declaration says: "Pregnant women, fetuses, infants, children and workers are especially vulnerable." (3) Childhood cancer is increasing at a rate of more than 1% per year in Europe. (6) Cancer is diagnosed in one child in every 500 before the age of 15 years. (7) In the US, the growing burden from environment-related ill-health in children is reflected in health care costs. A recent review in the US estimated health costs of children's environmental illness at 3.5% of the nation's total budget, up from 2.8% in a similar study in 1997. (8) Chemicals causing...
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...Review The benefits of physical activity for health and well-being C3 Collaborating for Health* June 2011 Director: Christine Hancock First Floor, 28 Margaret Street, London W1W 8RZ, United Kingdom; Tel +44 (0) 20 7637 4330; Fax +44 (0) 20 7637 4336 C3 Collaborating for Health is a registered charity (no. 1135930) and a company limited by guarantee (no. 6941278), registered in England and Wales. Contents Overview Part I: Evidence supporting the benefits of physical activity on health and well-being 1. The impact of physical activity on health 2. Literature review of the evidence i) Major chronic diseases ii) Mental health iii) Whole-life benefits of physical activity iv) Recommended levels of physical activity v) Socioeconomic disparities Part II: Evidence supporting interventions to encourage physical activity 1. The scale of the problem 2. An active environment? 3. Behaviour change 4. Selected interventions Part III: Case studies 1. Introduction 2. What makes for best practice? 3. Case studies Appendix 1: Selected literature on the health benefits of physical activity Appendix 2: Physical activity interventions Appendix 3: Evidence for the benefits of specific activities Endnotes 3 4 4 5 5 6 7 7 9 10 10 10 11 12 15 15 15 16 21 24 27 28 2 Review: The benefits of physical activity on health and well-being www.c3health.org Overview The purpose of this review is to provide a snapshot of the scientific evidence of the benefits of physical activity on health...
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...streamlining, integrating, and transforming a process to eliminate waste, delays, and slow response time (Ivancevich, p. 518). These processes allow for individual commanders to adjust unit approach to still meet the objectives and intent without endangering the Marine Corps strategic message and vision. Over the next seven pages, I have taken Kotter’s eight step process and incorporated them into my experience to how The Heart of Change theme and reasoning influenced my expected behavior as a manager in the Marine Corps. Increase Urgency While working as a staff officer in a higher level command the sense of urgency is slow and unwilling to change. The typical expression you hear in the office spaces at a higher level headquarters, “is if you want change throw money at it to continue research”. The expression only proves the lack of change that occurs within the organization. Though the expression does provide humor, however, it really does not accomplish the task at hand for change. The idea for change is to focus on maximizing worker output. Conducting change in a higher level headquarters does not necessarily correspond with institutional laziness or unmotivated workers, though the constraints imposed and lack of empowerment are overwhelming, it only simply faulted to the fact of changing the organization’s environment. The Hawthorne Effect provoked many mangers and academics to focus on employees’ needs, attitudes, and behaviors which...
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...1 PATHOPHARMACOLOGICAL FOUNDATIONS FOR ADVANCED NURSING PRACTICE OBESITY WESTERN GOVERNORS UNIVERSITY SANDRA ROGERS 2 A. Obesity is an epidemic disease which is increasing in frequency in frequency. It is one of the most common disorders in medical practice and among the most frustrating and difficult to manage. Little progress has been made in prevention or treatment, yet major changes have occurred in our understanding of its causes and implications for health. It is associated with changes in many body systems. The definition of obesity is: a condition of excess body fat. Obesity is measured using Body Mass Index (BMI). BMI is calculated by dividing body mass in kilograms by the square of height in meters, (ie. Kg/M2). In adults a person with a BMI greater than 30 kg/m2 is considered obese. (www.anzca.edu) A1. Over time obesity can cause a number of pathophysiological changes to body systems. Obesity affects the cardiovascular system and can cause hypertension, ischemic heart disease, cardiomyopathy, hyperlipidemia, cardiovascular and peripheral vascular disease, varicose veins, venous thrombosis, pulmonary embolism, and even sudden death. It can affect the respiratory system by causing obstructive sleep apnea syndrome (OSAS), obesity hyperventilation syndrome (OHS), restrictive lung disease; the Endocrine system causing diabetes, Cushing’s disease, hypothyroidism; the gastrointestinal system causing gastro-esophageal reflux disease (GERD),...
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...that can be caused when a person does not control the level of stress they have in their life. An unhealthy lifestyle consists of stress, depression, eating high fat foods, and not exercising enough. The more a person knows about how to control their stress levels will help them to deal with some of the diseases that they might get and will also help them to live healthy to control the risk of getting any unhealthy diseases. In this paper I will strive to describe what the multifactorial model is and how it relates to the diagnosis of illnesses. I have also selected two health problems which I will explain what role psychology has played in understanding and managing these problems. The health problems that I have selected are coronary heart disease and menstrual problems. The multifactorial model is described as the belief that health and illnesses are a function of several factors that involve biological, psychological, and cultural domains, and how they interact with each other (Nevid & Rathus, 2005). People might wonder how some people become ill easily and some don’t, or maybe why some people are affected by health problems while others are not. According to the multifactorial model there isn’t one answer to why this happens. There are many factors that include genetics and lifestyle choices. Genes play a role in a person having a chance of getting certain diseases, but they do not guarantee that the disease will be passed down from generation to generation. If cancer runs...
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...P6 review physiological data collected, describing the effects of exercise on the musculoskeletal, cardiovascular, respiratory and energy systems. For P6, learners need to examine the data collected and review the results by describing how the body responds to each type of exercise during the acute phases and also the long-term effects of the selected exercises. Learners need to review physiological data collected before, during and post-exercise. Consideration should also be given to the practicality of the exercise activities selected, and any advantages or disadvantages encountered during data collection. Learners should be able to describe the strengths and areas for improvement of their investigation. Session1 …Aerobic…………………….. In each box explain what happens WHILST exercising and what happens to each one after completing a 6 week training programme. (RPE won’t be affected by 6 week programme). Data Collected | Before exercise | During exercise | After exercise | Resting Heart Rate | Throughout the six week training programme your heart rate will be improved as the amount of exercise you do, will decrease the amount of beats per minute. You started off with 68 and it will improve during the training plan. | | | Working heart rate | | Whilst doing the training plan your heart rate during exercise will decrease a lot as the fitter you become, your heart rate will be much lower than it started. Your heart rate was 144 during the training and will improve throughout...
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...ca/ph-sp/determinants/index-eng.php. Scott Murray, Data Angel Policy Research, Incorporated, Rima Rudd, Harvard School of Public Health, Irwin Kirsch, Educational Testing, Service, Kentaro Yamamoto, Educational Testing Service and, Sylvie Grenier, Statistics Canada. Health literacy in Canada: initial results from the International Adult Literacy and Skills Survey 2007 [monograph on Internet]. Ottawa, ON: Canadian Council on Learning; 2007 [cited 2011 Nov 26]. Available from: www.ccl-cca.ca/pdfs/HealthLiteracy/HealthLiteracyinCanada.pdf Rao JK, Anderson LA, Inui TS, Frankel RM. Communication interventions make a difference in conversation between physician and patients: a systemic review of the evidence. Med Care. 2007;45(4):340-9. Stewart MA. Effective physician–patient communication and health outcomes: a review. CMAJ. 1995;152(9):1423-33. Rootman I, Gordon-El-Bihbety D, Frankish J, Hemming H, Kaszap M, Langille L, et al. National Literacy and Health Research Program: needs assessment and environmental scan [monograph on the Internet]. Ottawa, ON: Canadian Public Health Association; 2002 [cited 2011 Nov 25]. Available from: www.cpha.ca/uploads/portals/h-l/needs_e.pdf 6. 7. 8. 4. 5. Multi-Disciplinary Health...
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...questions and was able to recall information from recent and distant past events that were needed to complete the health history. T.J. recalled childhood illnesses and immunizations, and patient’s family history was obtained. The review of systems was discussed and documented, as well as the functional assessment. Nursing diagnoses deemed appropriate were applied for the client. A blended format of the traditional systems approach and the functional health patterns were used. Comprehensive Health History Interview Biographical Data Name: Karen Carlisle Address: 205 nottingham lane Red Springs nc 28377 Phone Number: 910-734-6143 Date of Birth: 06-15-72 Current Age: 43 Gender: f Race: c Ethnic Origin: Baptist Marital Status: Single Occupation: RN Education: BSN Contact Person: Frances Carlisle Source of History T.J. was the source of history. Client was reliable and oriented x3. She was able to verbalize information needed to obtain the health history. Reason for Seeking Healthcare “To help with final check-off.” (T.J., personal communication, April 29th, 2014). Present History States she is in a good state of health. Denies any health concerns. Denies any current medical conditions such as anemia, arthritis, depression, heart problems, thyroid disease, seizures, or diabetes. Past Health Childhood Illnesses: States she had chicken pox between the ages of 5 and 6. Accidents/Injuries: Face busted playing softball 2002 Hospitalizations: States routine 48-hour...
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