...nausea and vomiting, restlessness, confusion and drying secretions in the throat. Abstract T he use of syringe drivers as a method of drug delivery to control symptoms in palliative care is a common and accepted practice, but one which has evolved rather than been subject to close multiprofessional scrutiny and guideline formation. There is evidence that adverse incidents may arise as a result of syringe driver use (Medical Devices Agency (MDA), 1998), for example, errors in drug calculations, drug stability, equipment failure (including disconnection) and the wrong rate of infusion. Inadequate user training, poor servicing of equipment and inadequate documentation and record keeping are all thought to be contributing factors (MDA, 1998). In the hospital where this audit was carried out, syringe drivers are used to administer drugs to patients with cancer during the palliative phase of illness. The purpose of this clinical audit was to establish the standard of current practice in wards where syringe drivers were being used. A retrospective study of 13 cases of syringe driver use is presented. The results highlight many areas of unregulated practice with regard to setting up, monitoring and maintenance of syringe drivers. The choice of drugs and doses prescribed, evaluation of treatment responses and review of treatment regimens were also areas of concern. Guidelines for the use of syringe drivers in non-specialist hospitals are put forward. Therapeutic regimens Diamorphine...
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...1 Introduction to Clinical Applications Objectives In this chapter we will study • various approaches to the study of disease; • the role of the Centers for Disease Control and Prevention; • common causes of disease; • the distinction between signs and symptoms of disease; • terms used to describe the time course of a disease; and • common abbreviations for medical specialists and specialties. Homeostasis and Disease The body’s tendency to maintain internal stability is called homeostasis. Examples include the body’s relatively stable temperature, blood glucose concentration, hormone levels, acid-base balance, and electrolyte balance. When physiological variables deviate too much from their set point, the body activates negative feedback loops that tend to restore stability and maintain health. In some cases, such as the stoppage of bleeding, positive feedback loops are activated to bring about rapid change. If the attempt to regain homeostasis fails, disease results. There is a strong emphasis in medicine today on promoting wellness through prevention. However, this manual focuses on what happens when prevention fails, homeostasis is disrupted, and disease occurs. The Study of Disease Disease (illness) is any deviation from normal that interferes with correct, life-sustaining bodily function. Literally, the word means dis-ease, the opposite of ease (comfort and normal function). Disease may have underlying structural foundations, such as a broken bone, and its...
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...Mechanical Heart Valves in the Development of Infective Endocarditis? Prosthetic heart valves are, undoubtedly, one of the most profound innovations to be introduced into the medical community. In 1961 the Starr-Edwards ball and cage mitral valve became the first commercially available mechanical heart valve. In 1969, the Bjork-Shiley tilting disk valve emerged, which was then followed by the St. Jude Medical bi-leaflet valve in 1977. In addition to the creation of mechanical valves, bioprosthetic valves were also being developed; and in1968 the Hancock and Carpentier-Edwards porcine mitral valve became a popular alternative to the mechanical valve (Wheatley and Will, 2005, p.1). Over the...
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...Ethics Case Study Jennifer Edwards HCS/335 February 20, 2014 Dr. Lena Watson University of Phoenix Ethics Case Study: Background and Medical Training In the case study Jerry is an office assistant for Dr. William’s office. Jerry’s professional skill and training is in medical assistance and licensed practical nurse (LPN). At the time of day, the receptionist in Dr. Williams’s office was at lunch. In Jerry’s satisfaction he was in the position where he could be used the most, answering phones. A patient calls asking for a refill on the prescription drug Valium an antidepressant medication. The patient is asking for this prescription called in right away before leaving for the airport in thirty minutes. The patient states he is a personal friend of Dr. Williams and the doctor has always given him a small supply of Valium when he has to fly. Jerry’s training does not qualify him to make refilled medication request for patients. Because Jerry is not trained to look at the last clinical from the doctor, the dosage Jerry may or may not give the patient will cause an adverse effect. Prescription management based on the patients’ needs will be based on the recommendation of the physician. One must take in to account the age of the patient, disorder and other important information (not mentioned), Jerry may find it hard to give the correct dosage to the pharmacists. Valium and Controlled medications The issue of calling...
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...Question 1 Question : An investigator obtains consent from subjects to review their medical records and HIV status. He plans to go back to the medical record, so the HIV status information is stored along with patient identifiers in a database that he keeps on his laptop computer. His laptop is stolen. This incident constitutes: Your answer : An invasion of privacy. Correct Answer : A breach of confidentiality. Comment : Privacy is about people and their expectations. Privacy risk pertains primarily to the methods used to obtain information about subjects. Confidentiality pertains to the actual treatment of the personal information once it is obtained. In other words, now that the researcher has obtained private information, how will it be used, stored, and reported. Clearly, this event represents a breach of confidentiality. Points Earned : 0 Question 2 Question : A researcher wants to conduct a secondary analysis using a Centers for Disease Control and Prevention (CDC) database that was collected by the agency solely for surveillance purposes from 1996-2006. The researcher did not participate in the initial collection of the data. The database is publicly available. The database does not include any identifiers. The IRB makes a determination that the individuals whose records will be reviewed do not meet the federal definition of human subjects. Which of the following considerations was relevant to the IRB's determination that this activity does not constitute...
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...PAWAR Roll No. 35 In Partial Fulfilment For The Award Of The Diploma Of PGDM IN PHARMACEUTICAL MANAGEMENT PROJECT GUIDE: INTERNAL GUIDE : MR .KAPIL.MUDLIAR MRS.SUMANA BOSE (PRODUCT MANAGER) (FACULTY) DUPEN LABORITIES PVT. SIESCOMS. S.I.E.S COLLEGE OF MANAGEMENT STUDIES MAY 2010 - JUNE2010 DECLARATION I hereby declare that the project work entitled “MARKET ANALYSIS AND PERCEPTION ON PRE-PROBIOTICS” –PROJECT 1 MARKET ANALYSIS AND PERCEPTION ON LATEST HEMATINIC (FERROUS ASCORBATE+ FOLIC ACID)- PROJECT 2 submitted to SIES COLEGE OF MANAGEMENT STUDIES, NERUL NAVI MUMBAI is a record of an original work done by me under the guidance of Mrs.SUMANA BOSE, Faculty Member,and Dr. Suhas Tambe ,HOD. this project work has not performed the basis for the award of any Degree or diploma/ associate ship/fellowship and similar project if any. GAYATRI PAWAR ABSTRACT The main goal of the report was to investigate about the PRE-PROBIOTICS molecule, its market perception, prescription pattern and the most prescribed and selling brands in Navi Mumbai. This report begins by examining the current prescription rates of Pre-Probiotics...
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...“Conflicted Medical Journals and the Failure of Trust” the issue of pharmaceutical businesses and their research, and how it is presented is outlined. The article covers one of the largest controversies with business research conducted by GlaxoSmithKline (GSK) and how the results were skewed and then reported by many medical journals as fact, even though the research did not support what was reported. The study was GSK 329, which showed a particular drug to be effective in adolescents with depression, even though the testing showed otherwise. (Jureidini & McHenry, 2011) The biggest unethical behavior that was demonstrated by GSK, and medical journals was the skewing of results of a study. Medical journals published articles that misrepresented the findings of GSK’s research. Internal reports by the company showed that their trials of the drug had failed to benefit adolescents with depression, and positively showed that there were negative results. (Jureidini & McHenry, 2011) The internal report states that “it would be commercially unacceptable to include a statement that efficacy had not been demonstrated, as this would undermine the profile of paroxetine,” and that “to effectively manage the dissemination of data in order to minimize any potential negative commercial impact.” (Jureidini &McHenry, 2011) This indicates that they skewed the results of the study so that only selective data would be published. The authors also place blame on the medical journals...
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...stirring image of a life in utero has changed the way health professionals comprehend the prenatal world. Besides making the fetus visible to practitioners, technology has heightened the range of diagnostic possibilities of fetal anomalies. The end result is the complex field of fetal intervention and surgery, and along with it, the corresponding complicated moral and ethical dilemmas. Consider the case of Maria (real name withheld), who, at 30 years old, became pregnant for the first time and underwent a routine prenatal ultrasound. The initial ultrasound at 14 weeks showed Maria was carrying twins, baby A and baby B. At 26 weeks gestation, baby A seemed normal, however, baby B showed evidence of congenital hydronephrosis secondary to unilateral ureteral obstruction. Harrison and Adzick (1991) described possible devastating and fatal consequences for the developing fetus with a severe bilateral obstruction due to renal failure from hydronephrosis, as well as pulmonary failure related to lung hypoplasia. Because Baby B has a unilateral obstruction, the physicians in the case recommended surgical treatment after delivery. Against her physicians’ recommendations, Maria requests fetal surgery be done immediately, after learning about fetal surgery on the internet. Brief history of fetal surgery Fetal surgery began in the United States over three decades ago after extensive animal experiments and innovative technological advances. Led by Dr. Michael Harrison, the “father...
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...The study analysed is a prospective, nonrandomized clinical trial investigating the outcome of Standardbred racehorses diagnosed with midbody suspensory ligament desmitis (MSD) and treated with platelet-rich plasma (PRP) followed by a program of gradually increasing exercise. A clear hypothesis is not evident, with the objective being to determine the outcome of the treatment in case horses. The abstract does not explain that the ‘outcome’ investigated in the study is the racing performance of the horses post treatment, evaluated by comparison of number of starts, total earnings, and earnings per start against a control group of horses. The advantage of a prospective trial is that it allows the researcher the ability to analyse currently available...
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...Chronic Obstructive Pulmonary Disease | INTRODUCTION We are doing a case study on medical, nursing, pharmacological management of COPD (Chronic Obstructive Pulmonary Disease). We took a COPD patient and assessed the patient for clinical manifestation, the medical, nursing, pharmacological care given to the patient. In our case study we will include the care Hawwa is receiving now and the care we can add to daily routine to help her recover faster. Hawwa Ismail is admitted to Medical ward with diagnosis of COPD. She is 145cm tall, slim, with dark complexion. She is 79 years old. She said that she has difficulty in breathing, she cannot sleep in night time ,she do not feel like eating food and she was having cough. Physical assessment revealed BP 138/47mmHg right arm in lying position, pulse 84 regular and strong, and breathing pattern was irregular labored, tachypnic at 40 breathes per minute,SpO2 99% in room air and temperature 360C (96.80F).Her facial color and lips are ruddy, but nails are clean ,pale and clubbed. She has a little barrel chest, uses accessory muscle to breathe. She has prolonged expiration. While auscultating lungs, diminished breath sound in most of the lower lobes and a small wheezing sound in right lower lobe was noted. PERSONAL DETAILS PATIENT NAME: Hawwa Ismail ADDRESS:Iruvaige/R.Inguraidhoo GUARDIAN: NAME: Abdul HameedHussain CONTACT NO: 7772099 AGE: 79yrs SEX: female NATIONALITY: Maldivian LANGUAGE: Dhivehi RACE: Asian ...
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...regarding the future course of action of its next generation anti-depressant drug. In this case analysis, the company faces three critical decisions before NDA submission: 1) establish Cymbalta as efficacious for treating major depressive disorders (MDD) using once-a-day (QD) dosing, 2) pursue a separate pain indication in addition to submitting for an MDD using twice-daily (BID) dosing, and 3) delay submission until both issues were established. All of these options are complex and not without difficult trade-offs but based on market research of its customer segments and market potential, the best strategic option is to prove efficacy for treating MDD using QD and only after launch get FDA approval for treating pain. 1. FDA approval for once-a-day dosing for Cymbalta is more important to have at launch. First, Cymbalta is the successor to Prozac and with it carries the brand that creates this resonance in the mind of consumers (patients/physicians). This is a successful brand that patients trust, value and can identify with. With this brand, Lilly has established a perceptual positioning and differentiation from its competitors, and so as to introduce this next generation product for the first time for a different indication, Lilly could run the risk of losing their large customer base. Second, establishing efficacy for treating MDD using QD dosing is more promising than pursuing an indication for efficacy in treating pain for which the company has limited experience in, and since...
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...Karen Kaye | | | | | Santos,Maricar | | | | | Taradel,Dexter | | | | | Valdez,Rafael Mark | | | | | TABLE OF CONTENTS LESSON IV: THE STUDY OF HEALTH CARE DELIVERY SYSTEM (Summary) I. An Indication on the Financial and Operational Presentation of Health Maintenance Organization i. Mishandled Care ii. Paying Low and Late II. Health Transformation III. Varying Functions of Allied Medical Professionals IV. Philippine Health Insurance Corporation I. An Indication on the Financial and Operational Presentation of Health Maintenance Organization i. Mishandled Care 1965 was the earliest Health maintenance organization(HMO) in our country and there are more or less 30 HMO who pay thousands of physicians who will going to serve the people/community. But, according to Homobono Calleja, who is renounced cardiologist and a four-term president of Philippines Medical Association also concede that many doctors prefer not to help disseminate the medical gospel and among to them are coming from Western Visayas and parts of Southern Tagalog and Bicol who realized that all are not well in the HMO business. Even the Philippine College of Surgeons(PCS) in Panay refused to work in HMO and they don’t want to have anything to do with the merchants and brokers of medical...
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...Developing & Marketing A Blockbuster Drug: Eli Lilly’s Experience with Prozac BME-6 B. HBS CASE: “Developing and Marketing a Blockbuster Drug: Lessons from Eli Lilly’s experience with Prozac” 1. What factors contributed to Prozac becoming a blockbuster drug? Explain how each factor contributed and what management decisions helped the drug’s success. The following factors contributed to Prozac’s success: • Prozac’s low side effects and toxicity: The many drugs that were available before Prozac, such as tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) for treating depression, were too toxic or tricky to use except by trained psychiatrists. In the early 1970s, Ray Fuller, a senior Lilly pharmacologist, had been following new European research showing that a low concentration of serotonin in the brain was linked to depression. A Lilly chemist Bryan Malloy had synthesized some compounds intended to boost serotonin without the side effects of the TCAs. Human research data produced consistent and positive data. The new lower dose human studies revealed that 20 mg once a day was better than placebo and just as effective as TCAs taken multiple times a day. Prozac also produced fewer side effects, and was not lethal in overdose. Dropout rates on Prozac were comparable to the other TCAs and lower than for placebo that contributed to its success. • Thoughtful Marketing Launch Plan: When Prozac was launched in January 1988, Ken Cohen, the Marketing...
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...MIDW113 – Jodie Sparke S00163149_assess2 b). Postnatal case study – Gina is a 34 year old G2 P2 woman, day 2 post caesarean section. You enter her room to find her teary and upset; she tells you she had planned on having a natural birth in a midwifery led model of care. However, she experienced an emergency caesarean section after her baby showed signs of fetal distress. Describe and discuss the role and responsibilities of the midwife in providing pre and post-operative care to a woman in Gina’s position. You are expected to demonstrate, plan and evaluate safe, holistic, woman centred evidence-based midwifery care. This paper considers a postnatal case study of Gina, a day two post-operative, 34 year old Gravida 2 Para 2 woman. She experienced an Emergency Caesarean Section (ECS) resulting from fetal distress. This essay will investigate why birth can become an emergency and the evidence-based indications involved in decision making. It will explore the roles and responsibilities of a midwife in both the pre and post-operative support of a woman; based on a safe, woman centred and holistic approach to maternal care. It will discuss the emotional effects an ECS can have on a woman and her family as a crucial aspect in this case. An integral part of the preparation for birth is a birth plan. This allows the woman to detail how she would like her labour/birth to progress. It often includes the expectation of a natural vaginal birth. However, due to a variety of physiological...
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... | |Course Project | |Flaws in Advance Directives, Living Wills, and Power of Attorney | Introduction A Living Will is a form of an advance directive that is a “legal document that describes those treatments an individual wishes or does not wish to receive should he or she becomes incapacitated and unable to make medical decisions” (Pazgar, 2007, p. 378). Normally in a Living Will an individual would also indicate another individual as his or her power of attorney in the legal document; however, it is not necessary for a living will to be created with a power of attorney or a power of attorney to be created with a living will though it is highly recommended to do so. This is due to the fact that each has its flaws and each could compensate for one another though in reality it could create more conflicts too. For a physician or any other healthcare provider to go against a patient’s autonomy means that there are many legal problems these physicians may face because they went against the patient’s desires, especially because of such allegations as criminal...
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