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Evidence-Based Practice and the Procedural Education of Nurses
Medication reconciliation is a critical issue in healthcare reform. Today, improvement in this area of treatment could have a transformative effect on the current practices of nursing and medicine administration. The discussion, literature review and research tests that are conducted hereafter will outline the implications of medication reconciliation; justify the call for improvement in this treatment area; and offer support for the resultant recommendations using the Quality and Safety Education for Nurses (QSEN) template as a guide. The discussion will provide a background discussion on the three primary procedural steps by which medication reconciliation is defined: Verifying Medications by Collecting an Accurate Medication History; Clarifying Information by Ensuring Medications and Doses Are Appropriate, and; econciling and Documenting Change. Additionally, the discussion will offer a literature review as a means of providing some comprehensive knowledge of current practices in the field.…
Agency for Healthcare Research and Quality (AHRQ). Medication Reconciliation. U.S.
Department of Health and Human Services.
Alabama Universal Medication Form, Retrieved April 28, 2012 from: http://alaha.org/uploadedFiles/Resources/UniversalMedicationForm.pdf
American Association of Colleges of Nursing (AACN). (2008). The Essentials of Baccalaureate Education for Professional Nursing Practice. Quality and Safety
It is interesting to note that Tambour and Quertemont studied the effects of the same two drugs plus Disulfiram, an alcohol-deterrent drug. Their findings, in reviewing other studies, indicated slightly different results from Richardson. Since different drugs target different neuro-inhibitors, the drugs were used both separately and together. Quertemont discovered, in reviewing the results of previous and current studies, that none of the drugs worked particularly well, and that the combination of two of the drugs didn't seem to help. Her review of these studies contradicted the Richardson trial in which acamprosate was found to be ineffective.
Quertemont and Tambour ultimately concluded that the future of curing alcoholism lie in both discovery of new drugs and the refinement of the use of current drugs either singly or in combination.
In Willenbring and Gitlow's debate over the value of drugs to treat alcohol dependence, Dr. Gitlow concludes that until it is…
Gitlow, S., & Willenbring, M. (2008). Are medications that reduce risk of drinking, or heavy drinking, or that promote abstinence, of value in the treatment of alcohol dependence? American Journal on Addictions (peer-reviewed), 17(1), 1-5, doi:10.1080/10550490701756047.
Kranzler, H. (2006). Medications to treat heavy drinking. Are we there yet? Addiction (peer-reviewed), 101(2), 153-154, doi:10.1111/j.1360-0443.2006.01324.x.
Richardson, K., Reid, S., Baillie, A., Morley, K., Teesson, M., Sannibale, C., et al. (2008). Do acamprosate or naltrexone have an effect on daily drinking by reducing craving for alcohol? Addiction, (peer-reviewed), 103(6), 953-959, doi:10.1111/j.1360-0443.2008.02215.x.
Tambour, S., & Quertemont, E. (2007). Preclinical and clinical pharmacology of alcohol dependence. Fundamental & Clinical Pharmacology (peer reviewed), 21(1), 9-28, doi:10.1111/j.1472-8206.2006.00459.x.
Medication Compliance in Psychotic isorders
Janssen, Birgit., Gaebel, Wolfgang., Haerter, Martin, Komaharadi, F., Lindel, Birgit., & Weinmann, Stefan. (2006 April). "Evaluation of factors influencing medication compliance in inpatient treatment of psychotic disorders. Psychopharmacology 187:229-236.
The authors and researchers examine short- and long-term compliance to prescribed antipsychotic drugs. Their objective is to evaluate patient-related and treatment-related factors associated with medication compliance in inpatients with the following diagnoses: schizophrenia, schizoaffective disorder, and other psychotic disorders. The study is a "naturalistic study," based in seven hospitals with patients assessed weekly. The following characteristics were studied: social function, side-effects of medication, mental status, and compliance to medication requests. The researchers in this study attempted to determine whether medication is the basis for compliance or whether multiple factors including innate factors such as social influence and individual characteristics, environmental characteristics, genetic and personality characteristics were more likely to influence medication compliance in psychotic patients because…
Dolder, Christian R., Pharm.D., Jonathan P. Lacro, Pharm.D., Laura B. Dunn, M.D., and Dilip
V. Jeste., M.D (2002 Jan). Antipsychotic medication adherence: Is there a difference between typical and atypical agents? Am J. Psychiatry, 159:103-108.
The researchers and authors of this study had a primary objective of comparing medication adherence in outpatient veterans using typical vs. atypical antipsychotic agents. To accomplish this goal the researchers used pharmacy refill records; the patient selection criteria including patients using medications haloperidol, perphenazine, risperidone, olanzapine and quetiapine. Patients used medications for a 3-month period before using an atypical agent, and refill records were reviewed for a period of 12 months. The results of this study suggested that adherence rates were higher in patients receiving atypical agents, suggesting that medication compliance is more likely in patients receiving these agents compared to typical antipsychotic agents. Patient personality traits were not examined in this study, as in previous studies, so it is uncertain whether characteristics including aggression, addiction or other factors may have influenced compliance, as was the case in some previous studies. Patients were likely to miss medications seven times per month on typical antipsychotics vs. four times per month on atypical antipsychotics in this particular study. At the end of the study refill rates showed a four percent difference between typical and atypical agents, with approximately 54% of patients on atypical agents likely to refill their medications vs. roughly 50% of patients likely to comply with necessary refills on traditional or typical antipsychotics.
Cliff, Barbara (2012). "Excellence in Patient Satisfaction within a Patient-Centered Culture." Academic journal article from Journal of Healthcare Management, Vol. 57, No. 3.
his article can be used to explain how the scores of HCAHPS has become an important consideration among the healthcare leaders. Furthermore, this resource is also important because it explains the Value-Based Purchasing program that would be implemented nationwide in the fiscal year 2013 for better reimbursement. his article also explains the breakdown of the payment in this particular system; 70% would be the cost of the clinical care and medication of the patient, meanwhile 30% would be based on patient's satisfaction. In this paper, it has also been explained how HCAHPS surveys forms the basis for the patient's domain.
Bernhofer, E., (October 25, 2011) "Ethics and Pain Management in Hospitalized Patients" OJIN: he Online Journal of Issues in Nursing Vol. 17 No. 1.
This article provides with all the statistics that are required for the findings of HCAHPS scores nationwide. It explains the approach that was adopted to collect all the required information. Basically, this resource can be used to obtain all the required data and statistics on the surveys of HCAHPS. The limitations of this research are also explained in this article and therefore, they can be kept in mind when doing any further research on the topic.
15. D' Amore, John' Murray, John; Powers, Helen; Johnson, Craig (2011). "Does Telephone Follow-up Predict Patient Satisfaction and Readmission?" Population Health Management.
This article explains the importance of communication with respect to the increase in quality of the healthcare services and their delivery at the hospitals. The introduction of HCAHPS has highlighted the fact that it has increased the engagement of the employees of the healthcare systems. When patients are followed up through telephone, email or other ways of communication, it also adds to their satisfaction. In this study a comparison has been made between the satisfaction levels of the patients who were followed up through telephone and those who were not.
medication errors by nurses. There are six references for this paper.
Health care professionals are responsible for the welfare and safety of their patients. One of the most dangerous and preventable mistakes a nurse can make is a medication error. It is important to understand how errors occur, their repercussions and ways to prevent a medication error.
In order to prevent a medication error, a nurse must first understand how it is defined. A medication error is "any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. Such events may be related to professional practice, health care products, procedures, and systems, including prescribing; order communication; product labeling, packaging, and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use (http://www.fda.gov/cder/present/DIA62002/gross/sld014.htm)."
There are a number of factors which can contribute to…
Cohen, Hedy. (01 July, 2004). "Pediatric medical errors part 3: safety strategies: medication use system to analyze errors." Pediatric Nursing, pg 33.
Meadows, Ginny. (01 July, 2002). "Safeguarding patients against medication errors." Nursing
(Medication errors defined. (accessed 04 September, 2005).
Population and Global Health: Medication Adherence in Seniors
Assess the preventive and protective healthcare needs of a community of individuals, including emergency preparedness. Develop a plan for using behavioral change techniques to promote optimum health of a community, include culturally and spiritually sensitive care.
Describe the population/community you have chosen
The elderly are an incredibly high needs population when it comes to the field of professional medicine: they are consistently under-served and struggle very often to get even their most basic health needs met. One of the particular issues that prevents this population from staying healthy is the issue of medication adherence. A lack of proper medication adherence can cause a range of complicated issues and all of these issues are highly preventable: the individual just needs to stay on their medication. Medication adherence in seniors greater than 60 years of age is a primary factor for preventing serious complications…
Coughlin, T.A. (2006). The health care experiences of rural Medicaid beneficiaries. Journal of Health
Care for the Poor and Underserved, 17(3), 575-91.
Griffiths, R., Johnson, M., Piper, M., & Langdon, R. (2004). A nursing intervention for the quality use of medicines by the elderly clients. International Journal of Nursing Practice,
Griffiths, R., Johnson, M., Piper, M., & Langdon, R. (2004). A nursing intervention for the quality use of medicines by the elderly clients. International Journal of Nursing Practice,
There is a common saying that nobody is perfect. No human being is immune to errors and mistakes from time to time. Not even trained professionals in the course of discharging their duties and roles. In a medical setting, the cost of even the simplest of errors could be immense. For this reason, it would be prudent to assess/examine the legal and ethical implications of disclosure and non-disclosure of a personal error and the course of action that would be most appropriate when medication errors are detected. Further, it would also be prudent to evaluate strategies and approaches to minimize education errors.
One of the most important considerations, from an ethical perspective, that health practitioners ought to make with reference to the disclosure of medication errors is whether or not they (or their loved ones) would like to be notified if they were to find themselves in a similar scenario.…
Medication changes with technology: A description and detailed review of five clinical electronic systems that correlate with the process of medication administration technology.
Computerized physician / prescribed order entry (CPOE)
In 2000, following the huge spate of accidental death (approximately 2 million) that occurred nationwide, the Department of Health Services (DHS) surveyed hospitals in California regarding the nexus of patient safety and technology and which technological system they had it in mind to procure by 2005.
46% of the hospitals surveyed rated the computerized physician / prescribed order entry (CPOE) as their preferred technological system since it helps the prescribing clinician enter the medication order directly into the system (Spurlock, et al., 2003). The CPOE, moreover, can instantly detect any error in the prescription as well as employing various levels of decisions support to detect errors to situations that could have led to an error in the prescription (such as…
Spurlock, B. et al. (2003) Legislating Medication Safety: The California Experience. Convergence Health Consulting.
Health Information Technology (2009) Electronic medication administration records improved communication and decision-making in nursing homes http://www.ahrq.gov/research/jul09/0709RA29.htm
Institute of Medicine (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. The National Academies Press. http://www.nap.edu/books/0309072808/html .
Medication Practice Improvement Episode
An intravenous antibiotic Benzylpenicillin (Benpen) course was prescribed for a child to treat acute osteomyelitis. The 30mg/kg dose calculation was duly followed. The child weighed 28kg and so 840mg Benpen dose was to be given every six hours and this was charted accordingly. The chart showed these times: 06:00, 12:00, 18:00 and 24:00. Dose number two was to be taken at 14:00 and two Ns -registered nurses - that administered the dose signed on the column of 12:00 and indicated 14:00 above the signatures. At the time of the handover, no communication was made to the fresh team that the antibiotics had been administered late. When it reached 18:00, me and my colleague went to ready the patient for the next Benpen dose; since it is a requirement that two nurses check an intravenous medication. I discovered that the last dose had been administered…
Evans, J. (2009). The prevalence, risk factors, consequences and strategies for reducing medication errors in Australian hospitals: A literature review. Contemporary Nurse: A Journal for the Australian Nursing Profession, 31(2), 176-189.
Teunissen, R., Bos, J., Pot, H., Pluim, M., & Kramers, C. (2013). Clinical relevance of and risk factors associated with medication administration time errors. American Journal of Health-System Pharmacy, 70(12), 1052-1056. Doi:10.2146/ajhp120247
Jones, S.W. (2009). Reducing medication administration errors in nursing practice. Nursing Standard, 23(50), 40-46.
Volpe, C.R.G., Pinho, D.L.M., Stival, M.M., & de Oliveira Karnikowski, M.G. (2014). Medication errors in a public hospital in Brazil. British Journal of Nursing, 23(11), 552-559.
Medication adherence is delineated as the magnitude to which patients take medications as recommended by their health-care providers. Correct and accurate adherence to a treatment plan, particularly taking medication on a regular basis and as recommended in the prescriptions is a shared clinical challenge not only for clinicians but patients as well. The population growth of older adults continues to magnify and increase with the baby boomer age group almost coming to their age of retiring. The inference of this is that there is an increasing necessity for enhancing healthcare results amongst patients suffering from heart failure. Self-care discrepancies have been established to be considerably linked with deleterious healthcare results amongst heart failure patients. It has been conveyed that patients with heart failure who show diminished self-care capabilities in undertakings like medication compliance have recurrent hospitalizations and dwindled quality of life (Britz and Dunn, 2010).
Medication adherence is a multi-faceted…
According to the BWH study, in some cases an increase of potential adverse drug events was possible, especially when every dose of medications was not scanned. For barcode scanning technology to work as designed, every medication dose would have to be scanned before it reached the patient (BWH, 2002). Given the current shortage of nurses available to perform routine tasks in hospital care settings, it is likely that multiple errors might occur from a nurse not having time to or forgetting to scan every dose a patient would take before medicating the patient.
Some reports acknowledge that technological systems as barcode scanning are "cumbersome" and may "cause an unreasonable increase in time needed to administer medications" with some hospitals reporting an 8-second delay in medication recognition when nurses used a database instead of manual methods (Cipriano, 2002).
The use of barcode scanning for medication processing and administration is not…
Bayley, C. & Berlinger, N. Who is responsible? The Hastings Center Report, 36(3): 11.
BWH. (2005). BWH study finds using bar code technology in a hospital pharmacy dramatically reduces dispensing errors and potential adverse drug events." Brigham and Women's Hospital. February, 2005. Accessed 7, May 2007: http://www.hms.harvard.edu/news/pressreleases/bwh/1006barcodes.html
Cipriano, P.F. "Statement of the American Academy of Nursing and the American
Organization of Nurse Executives regarding barcode labeling." July 26, 2002. Accessed 7, May, 2007:
esearch questions related to psychotropic medications might include ow can a clinician determine whether a psychotherapeutic treatment is enough or when a psychotropic medication should be prescribed? In what ways can different types of psychotropic medications be abused? In what cases should a clinician avoid giving a medication due to a theory of substance abuse? How often should a clinician run an assessment for substance abuse when he or she has a patient with a psychotropic prescription? Among the most interesting findings in regards to psychotropic medications and dependence are the findings or Lazaratou et al. (2007)., who found that most parents were afraid to give their children psychotropic medications and feared a long time drug use based on the use of the medication, although this is unsubstantiated by research.
Lazaratou, Helen et al. (2007). Parental attitudes and opinions on the medication in mental disorders of children. Ann…
Lazaratou, Helen et al. (2007). Parental attitudes and opinions on the medication in mental disorders of children. Ann Gen Psychiatry. 6(32)
Electroconvulsive therapy (ECT) can be an effective alternative intervention to psychotropic medications. The therapy is mainly used for persons experiencing acute episodes of melancholy but may also be recommended for other disorders that include symptoms like catatonia, mania, or schizophrenia. Antipsychotic drugs are more commonly used to treat psychotic episodes (NIMH). ECT may also be helpful for persons who cannot take psychotropic drugs such as pregnant women or seniors.
Research questions related to the use of psychotropic medications"
. What are the long-term effects of taking psychotropic medications? Since they are new to the pharmacopia, what are some of the potential long-term risks of taking psychotropic drugs and might they affect human beings on the level of DNA?
2. Do psychotropic drugs become addictive, or are clients able to wean themselves off them without experiencing recurring symptoms of the clinical disorder? Do they have to be taken long-term?
1. What are the long-term effects of taking psychotropic medications? Since they are new to the pharmacopia, what are some of the potential long-term risks of taking psychotropic drugs and might they affect human beings on the level of DNA?
2. Do psychotropic drugs become addictive, or are clients able to wean themselves off them without experiencing recurring symptoms of the clinical disorder? Do they have to be taken long-term?
National Institute of Mental Health (NIMH). "Medications." Retrieved Oct 18, 2008 at http://www.nimh.nih.gov/health/publications/medications/complete-publication.shtml
This process primarily involves the provision of drugs in solid dose forms like tablets and capsules with high degree of drug stability. The main advantage of oral administration of medication is that doses are normally required to be taken once or twice every day. However, this method is associated with the disadvantage of problematic and unpredictable nature of gastro-intenstinal absorption of drugs. Sublingual administration is a method involving the use of sublingual mucosa that provides a rich supply of blood vessels for drug absorption. An example of sublingual administration is the treatment of acute angina through glyceryl trinitrate. While this route offers rapid absorption into the systemic circulation, it's suitable in specific markets where taking tablets may be problematic.
Parenteral administration is a process where the drug is administered through a needle or syringe that passes the skin and mucous membranes. In addition to being considered as non-oral means of…
"Administration of Medication." (n.d.). E-Notes: Study Smarter. Retrieved June 22, 2013, from http://www.enotes.com/administration-medication-reference/administration-medication "The Administration of Medicines." (2007, November 19). Nursing Times. Retrieved June 22,
2013, from http://www.nursingtimes.net/nursing-practice/clinical-zones/prescribing/the-administration-of-medicines/288560.article
Bar code medication administration (BCMA) is one of the keys to minimizing medical errors in a manner consistent with evidence-based practice (Poon et al., 2010). However, universal embrace and utilization of BCMA remains stagnant. easons for resisting the transition to BCMA include nurse perceptions. Holden, Brown, Scanlon, & Tzion-Karsh (2012), for instance, found nurses reporting low perceived usefulness of BCMA in spite of the wealth of evidence supporting the technology. Perceived ease of use of BCMA was moderate, suggesting that it is mainly attitude factors preventing nurses from implementing BCMA in their institutions. When perceptions of the usefulness of BCMA increase, then compliance with BCMA standards can become more widespread. Any program that attempts to increase the utilization of BCMA must focus first on human factors including attitudes. This requires that all nurse leaders, as well as nurse educators, prepare advance practice nurses for using BCMA as a matter…
Duffield, C.M., Roche, M.A., Blay, N., & Stasa, H. (2011). Nursing unit managers, staff retention and the work environment. Journal of Clinical Nursing, 20(1-2), 23-33.
Roberts, B.R. (2013). Doctor of nursing practice: Integrating theory, research, and evidence-based practice. Clinical Scholars Review, 6(1), 4-8. doi: http://dx.doi.org/10.1891/1939-2095.6.1.4
Ethical Dilemmas in esponding to Nursing Medication ErrorsIt is well documented that medication errors made by nurses are among the most prevalent but also the most preventable types of adverse patient incidents that occur in health care settings today. The impact of these medication errors is also severe and even life-threatening, and the potential for an increase in the numbers and frequencies of medication errors has been compounded in recent months as the ongoing Covid-19 pandemic continues to stretch medical resources and health care personnel to their limits. When medication errors are discovered, though, some type of patient incident report is typically required to be made to appropriate authorities and the consequences of these adverse drug events can also be severe for the nursing personnel who are responsible (Escriva et al., 2021). Against this backdrop, it is clear that there are some profound ethical dilemmas involved in responding to nursing…
ReferencesBrady, A.-M., Malone, A.-M., & Fleming, S. (2009). A literature review of the individual and systems factors that contribute to medication errors in nursing practice. Journal of Nursing Management, 17(6), 679697.da Silva, B. A. & Krishnamurthy, M. (2018). The alarming reality of medication error: a patient case and review of Pennsylvania and National data. Journal of Community Hospital Internal Medicine Perspectives, 6(4), 10-15.Erlen, J. A. (2011). Medication errors: ethical implications. Orthopedic Nursing, 20(4), 8285.Escriv Gracia, J., Brage Serrano, R., & Fernndez Garrido, J. (2019). Medication errors and drug knowledge gaps among critical-care nurses: a mixed multi-method study. BMC Health Services Research, 19(1), 640.Medication safety. (2021). U.S. Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/medicationsafety/basics.html .Pedley, L. (2002). Medication errors and ethical nursing practice. Perspectives, 26(2), 1013.Perm, J. (2018). Evidence-Based Medicine and Bioethics: Implications for Health Care Organizations, Clinicians, and Patients. The Permanente Journal, 22, 1-10.Sorrell, J.M. (2017, March 7). Ethics: Ethical Issues with Medical Errors: Shaping a Culture of Safety in Healthcare. OJIN: The Online Journal of Issues in Nursing, 22(2), 1-7.
EXPEIENCE OF NUSES WITH MEDICATIONS
The Lived Experiences of Nurses with Medication
Nurses are tasked with the proper distribution of medications. Unfortunately, they sometimes are unable to perform that task properly due to various factors. This paper presents five separate studies, two qualitative and three quantitative or mixed, which researched how nurses commit medication error, what the antecedents are, and how they can be avoided. The studies are examined according to research design, sample size and whether the study could be extrapolated to the broader population.
The Lived Experiences of Nurses with Medication
This is a literature review which focuses on nurses who make medication errors and what importance is placed on those errors in relation to patient safety. Five studies were examined with the express purpose of determining what types of studies are being conducted to alleviate this issue, what research designs they are using, and whether…
Hofmann, D.A., & Mark, B. (2006). An investigation of the relationship between safety climate and medication errors as well as other nurse and patient outcomes. Personnel Psychology, 59(4). 238-249.
Kim, J., An, K., Kim, M.K., & Yoon, S.H. (2007). Nurses' perception of error reporting and patient safety culture in Korea. Western Journal of Nursing Research, 29(7). 827-844.
Jones, J.H., & Treiber, L. (2010). When the 5 rights go wrong: Medication errors from the nursing perspective. Journal of Nursing Care Quality, 25(3). 240-247.
Schelbred, A.-B., & Nord, R. (2007). Nurses experiences of drug administration errors. Journal of Advanced Nursing, 60(3). 317-324.
Poor medical safety practices result in over 40,000 deaths per year, of that 7,000 deaths are attributed to medication-related medical errors. There is no excuse for negligence when it comes to human lives. It is imperative that the medical community introduce sound medication safety best practices to eliminate adverse outcomes related to medication prescriptions. Best practices include the implementation of standardization and protocols in addition to the use of technology to reduce errors.
Medical Safety Practices
Medical practitioners are relied upon to provide solutions, acting as the first and many times, last hope of those in dire need. But despite this great responsibility to patients whose lives are entrusted in medical staff studies show that out of every 100 patients admitted to a medical facility 2 patients will experience a medical error due to incorrectly prescribed or administered medication. The results can be mild but can also be…
Bates, David W.; Spell, Nathan; Cullen, David J., et al. (1997).The Costs of Adverse Drug Events in Hospitalized Patients. JAMA. 277:307 -- 311.
Centers for Disease Control and Prevention (National Center for Health Statistics). (1999). Births and deaths: Preliminary data for 1997. National Vital Statistics Reports.
Grissinger, M., Globus, N.J. (2004). How Technology Affects Your Risk of Medication Errors. Nursing2004. 34(1), 36-41.
Institute of Medicine. (2000). To Err Is Human: Building A Safer Healthcare System.
Today, diagnosis has improved for the condition known as AD/HD, or Attention Deficit Disorder. However, many parents are dismayed after getting the diagnosis to find that the only thing their insurance company will pay for is medication. Parents aren't always comfortable using medication at first, and some would like to try behavioral strategies before going to medications. Insurance companies, however, often will pay for medication, but not pay for behavioralists or psychologists, or only pay part of the bill. Unless the parent can afford to make up the difference, their choices are then limited.
For instance, an insurance Web site on AD/HTD devotes 1450 very specific words about medication, including specific information on establishing doses and when to try a different med, but only about 450 words with no real specific suggestions and less compelling arguments for its use. The message insurance companies get is that medication works and…
American Academy of Pediatrics (AAP). 2001. "Practice Guideline." Pediatrics 108:4, pp. 1033-1044, Oct. accessed via the Internet 2/19/03. http://www.aap.org/policy/s0120.html
Ellwood, Leslie C. 2003. "Parental perceptions and satisfaction with stimulant medication for attention deficit hyperactivity disorder." Journal of Developmental & Behavioral Pediatrics, June.
Kaplanek, Beth. 2002. "Household Havoc: One Mother's Quest for Quiet on the Home Front." Psychology Today, Vol. 35, Sept-Oct.
Sappell, Joel, and Welkos, Robert W. 1990. "The Scientology Story." Los Angeles Times, June 29, p. A48:1.
Psychiatric medications have been taking the place of emotional bonding, effective socialization, and conscious parenting. The number of children taking medications for ADHD alone is now "well over three million," according to Wedge (2013). About five percent of all American children are also taking antidepressants (Wedge, 2013). Older students might be prescribed anti-anxiety medications too. Overreliance on medications in early childhood could cause any number of problems ranging from medication side effects, drug addiction, and even in some cases death. As Wedge (2013) points out, children whose emotions and cognitions are altered through medications also run the risk of growing up emotionally illiterate. This grounded theory research seeks a new non-pharmacological approach to working with children. The proposed theory seeks to promote emotional and spiritual growth in young children.
The goal of this exploratory research will be to discover ways children's emotions can become integrated into their education, learning, and…
Baer, R.A. (2015). Mindfulness-Based Treatment Approaches. Academic Press.
Semple, R.J. & et al. (2005). Treating anxiety with mindfulness. Journal of Cognitive Psychotherapy 19(4).
Wedge, M. (2013). The drawbacks to medicating children. The Mother Company. Retrieved online: http://www.themotherco.com/2013/02/choice-medicate-child/
And Li, (2006). These researchers took previous findings regarding the efficacy of ACE inhibitors (Fosinopril, in particular) and applied them to children of different racial populations. Moreover, Menon et al. (2006) investigated whether the evidenced differences in effectiveness of ACE inhibitors among adults of different racial groups transferred to children of different racial groups. The results of the study indicated that Fosinopril was effective in treating hypertension in all racial groups, but Black children in the study required a higher dosage of the anti-hypertensive medication in order to experience the beneficial results. Furthermore, the differences in ACE inhibitor efficacy observed among adults of different races exist also in children of various races (Menon et al., 2006).
The demonstrated fact that African-Americans with hypertension are not as responsive to certain anti-hypertensive medications than non-African-Americans has opened the door for further research. Papademetriou, Narayan, and Kokkinos (2004) studied the effectiveness of ACE…
Brewster, L.M., van Montfrans, G.A., Kleijnen, J. (2004). Systematic Review: antihypertensive drug therapy in black patients. Annals of Internal Medicine, 141(8), 614-27.
Ferdinand, K.C., Saunders, E. (2006). Hypertension-related morbidity and mortality in African-Americans - why we need to do better. Journal of Clinical Hypertension, 8 (Suppl. 1), 21-30.
Flack, J.M., and Hamaty, M. (1999). Difficult to treat hypertensive populations: focus on African- Americans and people with type 2 diabetes. Journal of Hypertension. Supplement, 17(1), S19-24.
McDowell, S.E., Coleman, J.J., Ferner, R.E. (2006). Systematic review and meta-analysis of ethnic differences in risks of adverse reactions to drugs used in cardiovascular medicine. British Medical Journal, 332, 1177-81.
Prescribing Psychotropic Medications to Minors
It is every parent's worst nightmare: the drugs intended to cure a child kill him or her instead. Since the development of drugs like Prozac and Paxil, drugs classified as SSIs (selective serotonin reuptake inhibitors) have been increasingly used to address depression in patients that otherwise would have been treated with talk therapy alone. This is true of adolescents as well as adults, given that SSIs were once thought to have fewer side effects when compared with older types of antidepressants (Antidepressant medications for children and adolescents: Information for parents and caregivers, 2013, NIMH). Since the development of SSIs, the increase in psychotropic drug prescriptions has increased so rapidly that it is estimated that 1 in 5 of all Americans are on some form of psychotropic medication at any one time (Smith 2012:36). However, SSI use in adolescents and young adults has become specifically linked…
Antidepressant medications for children and adolescents: Information for parents and caregivers.
(2013). NIMH. Retrieved from http://www.nimh.nih.gov/health/topics/child-and-adolescent-mental-health/antidepressant-medications-for-children-and-adolescents-information-for-parents-and-caregivers.shtml
Boodman, S, (2012). Off-label use of risky antipsychotic drugs raises concerns. Kaiser Health News. Retrieved from:
Identifying Effective Strategies to Reduce Medication Errors
Nurses are responsible for the largest percentage of medication errors. Medication errors adversely affect more than 7 million patients, cost almost $21 billion and result in excess of one million emergency room visits and 3.5 million additional visits to doctors’ offices each year (Stoppler & Marks, 2018).
Problem: Medication errors remain the leading cause of adverse incidents for inpatients in the United States.
Intervention: Develop and disseminate an attractive and informative poster that underscores the severity of the problem and its causes, and provides nursing staff with the mnemonic five “rights” of medication administration (i.e., right patient, the right drug, the right dose, the right route and the right time). Nursing supervisors were requested to hang The posters in a prominent location at all nursing stations (see below).
Comparison: A comparison of medication error rates following the dissemination of the…
This literature review revealed that this practice had begun in the 1950s, and was an outgrowth of less-than-reliable studies that were accepted at the time but that are questionable now in terms of their methodologies and scope. The fact that no substantive studies conducted in more recent years have been able to substantiate the findings of these half-century-old studies is a strong indicator that the practices recommended by the earlier studies are not necessarily effective and could potentially be harmful.
Armed with this information, it was possible to engage in the design and implementation of an evidence-based change to practice. Using a well-established model for this process, the specific needs for change were identified and a plan for educating relevant personnel regarding the practice was deigned. Specifically, it was determined that head medical nad nursing staff should be made aware of the inefficacies of the current practices, and that the…
Phenoxodiol, a Medication for Cancer
Clinical studies have predominantly focused on a couple of standard benzopyrans, namely flavopiridol and phenoxodiol (by Novogen, via MEI Pharma, the company's subsidiary at the time). Although a benzopyran, the former's method of action apparently differs from phenoxodiol's action neither of the two aforementioned benzopyrans has gained FDA (Food and Drug Administration) or EMA (European Medicines Agency) approval. The height of research on phenoxodiol was one 'Phase III' research on resistant cancer cells in the ovaries. Although slow recruitment led the trial at this phase to formally close down, results clearly displayed that oral consumption of phenoxodiol would most probably not have benefited patients, if the trial phase had been completed. Phenoxodiol results (in combination with others) led to the following hypothesis by Novogen: the problem with phenoxodiol pertained to bioavailability (in other words, the ingested drug wasn't reaching the site of cancer in adequate…
Marc Sinatra. (2015). Novogen Limited. Lodge Partners Research.
Marshall Edwards Inc.2003Investigational New Drug Status Cleared By FDA for Phenoxodiol in Oral Formpr Newswire
Paul Howard. (2015, November 1). Why The FDA Rejected A Drug That Helps Cure Lung Cancer -- And What We Can Do To Fix It. Forbes.
U.S. Department of Health and Human Services1998Guidance for Industryrockvillefood and Drug Administration
Valli G., et.al. (2002). Benefits, Adverse Effects and Drug Interactions of Herbal Therapies With Cardiovascular Effects. Journal of the American College of Cardiology. Vol. 29, No. 7. Reprieved April 30, 2017 from http://www.unifra.br/pos/aafarm/downloads/_intera%C3%A7_%20cardiovascular.pdf
The article is a culmination of research and extensive literature reviews done by three researchers and specialists in the herbal medicine field of medical therapies. It is an academic and professional article widely informed by the ever rising use and need to use the herbal medicine in the USA. The FDA has weighed in especially in terms of the safety concerns of these various herbs hence this article objectively looks at the issues concerning the benefits, the adverse effects and the therapeutic value of various herbal therapies particularly among patients with cardiovascular diseases.
The article highlights the challenges that the herbal medicine faces in terms of the regulations and standards setting is concerned. Many manufacturers are seen…
Communication & Price
The target market will be composed of major retailers like Walmart, Target, CVS, Walgreens, as well as, regional and national grocery chain pharmacies. Each of these retailers already contains a product mix for these products that is diverse and cost competitive. Thus the company will have to work to differentiate itself in every way possible. One strategy for differentiation could be the product packaging and the container.
The products should be packaged in a way that separates them from the rest of the crowd. One idea would be to offer a more portable bottle that would fit into someone's pants or purse much easier. Usually products in this niche are packaged in a child proof bottle or in an individually wrapped sheet in which you have to peel back some kind of plastic to be able to access a single dosage. There are many versions…
Evidence-Based Project Proposal
Graduate Project in Nursing
The incidence of sexually transmitted diseases has been increasing among adolescents in countries around the world, but there remains a dearth of timely and relevant studies concerning salient differences in knowledge level and attitudes between different cultures and ethnic populations. One common factor that has been consistently demonstrated in improving the effectiveness of treatments for sexually transmitted diseases is promoting adherence to treatment regimens, most especially for medications since these are used in all treatments for sexually transmitted diseases. While there have been some studies concerning various strategies for promoting adherence levels to treatment regimens, there remains a lack of studies concerning evidence-based practices that incorporate technological solutions. To this end, the proposed study intends to conduct an experiment using innovative face recognition and motion detection smartphone app to evaluate its effectiveness in promoting adherence to medication regimens among a population of adolescents…
Roberts et al. (1998) deals with medications in connection with nursing home residents where the mean number of drugs prescribed per patient range from 6 to 8 medications in the U..A., but identification of factors that result in prescribing and administration patterns of drugs are not well understood. The object of this research accordingly was to identify the factors that influence the pattern of medication use in nursing homes.
Medication data of 998 residents in 15 nursing homes in Australia were collected from the various hospitals and assessed. tatistics used included the multiple linear regressions that since many components were involved were multiple and was used to test whether there was an association between age, gender, nursing home size, and instrument rating.
ince there were various factors involved, a one-way ANOVA (going in only oen direction) had to be used where the five different influences of age, gender, the results…
Banks, MR et al. (2008). Animal-Assisted Therapy and Loneliness in Nursing Homes: Use of Robotic vs. Living Dogs American Medical Directors Association, Origianl Studies, 173-178
Robert MS et al. (1998) Medication prescribing and administration in nursing homes Age and Ageing 1998; 27: 385-392
legislation on PA SB 1299
The General Assembly of Pennsylvania
Senate Bill No. 1299
Session of 2014
Introduced by: Ward, Pileggi, Erickson, Schwank, Washington, White and Baker.
The significance of PA SB 1299 Bill
The deaths from overdose on opioids have been a common occurrence across the nation with many of the people falling victims to either ignorance or intentional negligence by the people around then when they suffer the overdose symptoms to death. Initially, there were rampant incidences of the arrest and prosecution of the volunteers who called the law enforcement and the first responders to the scene since they too were often found to have used the drugs. The first responders were also not allowed to administer opioid antagonist at the scene to the person suffering obvious signs of overdose on the opioids hence the death rates from the overdose kept increasing even amidst the knowledge that…
Incorvaia M., (2015). Lawmaker: Allow more first responders to give antidote to opiate overdoses. Retrieved February 20, 2014 from http://cronkitenewsonline.com/2015/01/lawmaker-wants-more-first-responders-allows-to-deliver-antidote-to-opiate-overdoses/
Wenner D., (2014). Pa. expands use of heroin overdose antidote, provides 'good Samaritan' protection in overdose cases. Retrieved February 20, 2014 from http://www.pennlive.com/midstate/index.ssf/2014/09/pennsylvania_heroin_good_samar.html
EMS1, (2015). 85,000 Emergency Responders Reduce Response Time with IamResponding.com. Retrieved February 20, 2014 from http://www.ems1.com/ems-products/communications/press-releases/1033418-85-000-Emergency-Responders-Reduce-Response-Time-with-IamResponding-com/
Heightman A.J., (2014). Should Naloxone Be Available to All First Responders? Retrieved February 20, 2014 from http://www.jems.com/article/administration-and-leadership/should-naloxone-be-available-all-first-r
Sickness Can be Good for You," raises the question of whether treating the symptoms of common illnesses with medication is good for the body. He argues that many diseases are actually defenses that have been developed over time to prevent susceptibility to worse malady; that coughing and vomiting are simply the impact of Darwinism. Nesse points out that coughing clears bacteria from lungs, those with Shigella infections are more likely to suffer longer if medicine for diarrhea is taken, that rats and rabbits deprived of a fever response will likely die from an infection, and that the chance of birth defects are higher with a mother who had less morning sickness.
Based on the information presented in web investigation 3, it may not be beneficial to our survival to always treat the symptom. Sometimes the miserable conditions suffered turn out to be beneficial in the long run. If a child…
Medication Administration Tech
Policy and Procedure Change Bar Code eader System for Medication Administration
Though the Utah State Hospital has an integrated electronic prescription system there is no evidence that the institution utilizes bar code reading technology either on the unit or in the pharmacy itself. This is evidenced by the lack of such information in the institutions policies and procedures manual, and specifically in their policies and procedures associated with controlled drugs, which is an area where inventory controls, accountability and patient safety are particularly important. Such a system would serve the patient population well, helping to ensure that fewer errors were made and more observation of possible conflicts between medications as well as other issues could be more closely monitored. This work will describe in detail from the literature both the types of systems available, their use and the research effects associated with them to aide in the…
"ASHP statement on bar-code verification during inventory, preparation, and dispensing of medications: developed through the ASHP Section of Pharmacy Informatics and Technology and approved by the ASHP Board of Directors on April 15, 2010, and by the ASHP House of Delegates on June 6, 2010." (2011) American Journal of Health-System Pharmacy 68(5), 442. Gale Power Search. Web. 24 Oct. 2011.
Agrawal, A. (2009). Medication errors: prevention using information technology systems. British Journal Of Clinical Pharmacology, 67(6), 681-686. doi:10.1111/j.1365-2125.2009.03427.x
Fowler, S.B., Sohler, P., & Zarillo, D.F. (2009). Bar-Code Technology for Medication Administration: Medication Errors and Nurse Satisfaction. MEDSURG Nursing, 18(2), 103-109.
Prusch, A.E., Suess, T.M., Paoletti, R.D., Olin, S.T., & Watts, S.D. (2011). Integrating technology to improve medication administration. American Journal Of Health-System Pharmacy, 68(9), 835-842. doi:10.2146/ajhp100211
One of the major challenges impact healthcare providers is medical errors. These issues are challenging, as they will have an adverse impact on quality and safety. In the case of the ICU, these challenges are becoming more pronounced. This is because of the different conditions and large number of patients they are working with. A good example of this can be seen with insights from Orgeas (2010) who said, "Although intensive care units (ICUs) were created for patients with life-threatening illnesses, the ICU environment generates a high risk of iatrogenic events. Identifying medical errors (MEs) that serve as indicators for iatrogenic risk is crucial for purposes of reporting and prevention. We describe the selection of indicator MEs, the incidence of such MEs, and their relationship with mortality. We selected indicator MEs using Delphi techniques. An observational prospective multicenter cohort study of these MEs was conducted from March 27…
Data and Statistics. (2014). CDC. Retrieved from: http://www.cdc.gov/hai/surveillance/
Marcucci, L. (2012). Avoiding Common ICU Errors. Hoboken, NJ: Wiley.
Marino, P. (2012). ICU Book. Thousand Oaks, CA: Sage.
McClean, S. (2011). Intelligent Patient Management. New York, NY: Springer.
True that the existence of both which is intended for a similar use, operation or treatment might cause confusion and a question on which is a better product. In this case the replacement of Imigran with the new medication Naramig was the best choice among the other 4 options. With this decision it only proves to its customers, hospitals and patients that the new drug is an improved medication for migraines. As it was noted in this article:
The results showed that the replacement strategy met Glaxo U.K. expectations.
Naramig proved to be effective for migraine headaches in the majority of patients.
4. How should GlaxoWellcome position Amerge in the United States?
Considering several factors which are primarily different from UK, the U.S. market is broader in terms of population and territory. Difference in health care system is also a factor to be considered. In my opinion, the alternative positioning…
Net doctor Co.UK
Article on Imigran
Tiscali Lifestyle Naramig
voluntary, collaborative and active involvement of the patient in a course of behaviour that is mutually accepted in order to gain therapeutic result (Michael, H. et al., 2009). According to this definition it can be clearly observed that the patient has a clear choice to follow the goal and that the patient and well as the providers agree to make a medical regimen and treatment goals (Delamater, 2006).
There are two basic factors involved in the medical adherence, these are:
Whether the patients takes the medicine that has been prescribed to him/her.
Whether the patient keeps on taking the prescribed medicine or not.
Therefore, the adherence behaviour is divided into 2 main concepts which are: adherence and persistence. Although the concept of adherence and persistence is similar however, adherence means the intensity with which the drug was taken during the duration of the therapy while, persistence means the overall duration…
Urquhart J. The electronic medication event monitor: lessons for pharmacotherapy. Clin Pharmacokinet. 1997; 32: 345 -- 356.
Vrijens B, Vincze G, Kristanto P, Urquhart J, Burnier M. Adherence to prescribed antihypertensive drug treatments: longitudinal study of electronically compiled dosing histories. BMJ. 2008; 336: 1114 -- 1117.
World Health Organization. 2003. Adherence to Long-Term Therapy: Evidence for Action. Available at: http://www.who.int/chp/knowledge/publications/adherence_introduction.pdf .
The second purpose was to explore the association of demographic variables and nurses' perceptions of pump implementation to ratings of the management team and job satisfaction. Data was collected via a survey given to 1056 nurses at a tertiary Magnet hospital. The first section of the questionnaire pertained to demographic characteristics, while the second section consisted of thirty questions on a 5-point Likert scale based on both STS Theory and the Life Patterns Model conceptual framework.
The researchers conclude that generalizations cannot be made based on just one study. They did state however that the findings of this study give credence to the importance of technological changes in clinical nursing practice. ecommendations were made for future studies in that there is a need to analyze the degree to which technology affects the environment, patient acuity as well as overall nursing satisfaction. Carrying out this study in more that one hospital…
Advantages and Disadvantages of the Survey Method. (2011). Retrieved from http://writing.colostate.edu/guides/research/survey/com2d1.cfm
Bowcutt, Marilyn, Rosenkoetter, Marlene M., Chernecky, Cynthia C., Wall, Jane, Wynn, Donald
and Serrano, Christina. (2008). Journal of Nursing Management, 16(2), p.188-197.
The right medication stimulates these under-operating chemicals to make added neurotransmitters, thereby enhancing the child's potential to concentrate, have a check on the impulses, and lessen hyperactivity. Medication required to attain this usually needs a number of doses in the course of the day, since a single dose of medication remains effective for a short interval up to 4 hours. but, slow or timed-release types of medication for instance, Concerta would let a child having ADHD to go on to take the advantage of medication in an extended stretch of period. (Identifying and Treating Attention Deficit Hyperactivity Disorder: A esource for School and Home)
Psycho-stimulant medications like MPH are considered to trigger auto-regulatory or control procedures, thus improving the basic restraint shortfall in children having ADHD. Documented experiments on stimulants have exhibited experimental favor for this hypothesis. For instance, the influences of MPH on reaction restraint employing the fundamental stop-signal…
Arcus, Doreen. Attention Deficit Hyperactivity Disorder (ADHD). Gale Encyclopedia of Psychology. 2002. pp: 14-23
Attention Deficit Hyperactivity Disorder. December 2001. Retrieved at http://www.reutershealth.com/wellconnected/doc30.html. Accessed on 8 December, 2004
Barabasz, Arreed; Barabasz, Marianne. Attention Deficit Hyperactivity, Disorder: Neurological Basis and Treatment Alternatives. Journal of Neurotherapy. Volume: 1; No: 1; p: 1. Retrieved at ( http://www.snr-jnt.org/JournalNT/JNT (1-1)1.html. Accessed on 8 December, 2004
Bedard, Anne-Claude; Ickowicz, Abel; Logan, Gordon D; Hogg-Johnson, Sheilah; Schachar, Russell; Tannock, Rosemary. Selective Inhibition in Children with Attention Deficit Hyperactivity Disorder Off and on Stimulant Medication. Journal of Abnormal Child Psychology. June, 2003. Volume: 12; No: 1; pp: 90-93
Migraine headaches typically cause an intense, throbbing, headache in a specific area of the head (most often one side of the head) and are commonly accompanied by nausea and sensitivity to either light or sound. For many people these headaches are so debilitating that it can take hours or days before the person can return to their normal level of functioning. The etiology of migraine headaches is not well understood; however, genetic factors are thought to play a significant role (Burton, Landy, Downs, & unken, 2009). Is it estimated that in the United States more than 30 million people have at least one migraine headache per year. Migraine headaches occur more commonly in females, who are diagnosed with approximately 75% of all migraine headaches (Bigal & Lipton, 2009). Generally a treatment program for migraine headache begins with a diagnosis, an assessment of the effects of the headaches on…
Bigal, M.E., & Lipton, R.B. (2009). The epidemiology, burden, and comorbidities of migraine.
Neurologic Clinics, 27(2), 321-334.
Burton, W.N., Landy, S.H., Downs, K.E., & Runken, M.C. (2009). The impact of migraine and the effect of migraine treatment on workplace productivity in the United States and suggestions for future research. Mayo Clinic Proceedings, 84(5), 436-445.
Martin, P.R. (2010). Behavioral management of migraine headache triggers: learning to cope with triggers. Current Pain and Headache Reports, 14(3), 221-227.
Current practices in the Blood Marrow Transplant Unit (BMTU) are to administer Tylenol and/or Benadryl as pre-medications prior to the administration of blood products before a transplant takes place. This paper will study whether such pre-medicating actions are detrimental to the patient due to the masking effects of the medicines and the occurrence(s) of mostly mild reactions to the blood transfusions that are normal occurrences before BMTU surgery. The paper will seek to discern whether the practice of pre-medicating patients is a viable practice or one that needs to be changed or terminated.
The purpose of the study is to determine whether a change can be made to improve the care of patients undergoing bone marrow transplants. The improvement could take a number of different forms; two of those forms include; first a fewer number of reactions to the blood transfusions that take place before and during the transplant,…
Bringman, H.; Giesecke, K.; Thorne, A.; Bringman, S.; (2009) Relaxing music as pre-medication before surgery: a randomized controlled trial, Acta Anaesthesiologica Scandinavica, Vol. 53, Issue 6, pp. 759 -- 764
Horng, H.C.; Wong, C.S.; Hsiao, K.N.; Huh, B.K.; Kuo, C.P.; Cherng, C.H.; Wu, C.T.; (2007) Pre-medication with intravenous clonidine suppresses fentanyl-induced cough, Acta Anaesthesiologica Scandinavica, Vol. 51, Issue 7, pp. 862 -- 865
Kennedy, L.D.; Case, L.D.; Hurd, D.D.; Cruz, J.M.; Pomper, G.J.; (2008) Transfusion: A prospective, randomized, double-blind controlled trial of acetaminophen and diphenhydramine pretransfusion medication vs. placebo for the prevention of transfusion reactions, Tranfusion, Vol. 48, pp. 2285-2291
In addition, the recall constitutes an expectation of substantial change before products actually reached consumers, placing it in compliance with 402A. obins & obins lived up to its legal and its ethical responsibilities.
The Blanchard and Peale method of determining ethicality consists of three checks, which can be applied to both the decision to avoid the $0.35 per-package charge to automate recalls and to the "fake" recall process of the company (Lankard, 1991). First, the models asks if the action is legal, both in terms of governmental laws and company policy; the answer for both dilemmas in this case is "yes." The second test is whether the action is balanced and fair, promoting "win-win" solutions; here, the answer in both cases is more ambiguous. The additional costs of medications from the UPC rule would have been passed on to consumers, which is a "lose" to some extent even…
Adminsitrative Procedure Act. (n.d.). Accessed 18 April 2012. http://www.archives.gov/federal-register/laws/administrative-procedure/553.html
402A. (n.d.). Accessed 18 a / http://biotech.law.lsu.edu/cases/products/402a-b.htm
Lankard, B. (1991). Resolving Ethical Dilemmas in the Workplace. Accessed 18 April 2012. http://www.ericdigests.org/pre-9220/focus.htm
Radcliffe, M. & Brinson, D. (1999). Contracts Law. Accessed 18 April 2012. http://library.findlaw.com/1999/Jan/1/241463.html
Nursing Case Study
The first concern is that Mrs. Baker is taking a new drug that has side effects such as she is experiencing. Although the other high blood pressure medication has similar side effects (Drugs.com, 2012), she has been taking it for a long period of time and should not be experiencing as much difficulty. It seems germane to ask her how long she has been taking the hydrochlorothiazide though. One of the first thoughts is how well do the two medications work together, which is something her doctor understands, and if she can have an increase in side effects because of the increase in medication. The second question the symptoms, especially the fact that she seemed "confused and beside herself" on the phone, is to determine if there are other symptoms of stroke. Her breathing difficulties could be a symptom of the medication, and so could the confusion,…
Drugs.Com. (2012). The side effect of Lisinopril. Retrieved from http://www.drugs.com/sfx/lisinopril-side-effects.html
Robins & Robins
THE RIGHT THING TO DO
Robbins & Robbins
Possible Defenses by Casings, Inc.
It was the primary responsibility of Robbins & Robbins to have foreknown the risk of explosives getting into its medication before it entered into any formal agreement with Casings, Inc. Although both companies share the ethical responsibility, Robbins & Robbins should have had the greater interest in avoiding the risk. Second, the accounting firm, which worded the clause, was selected by Robbins & Robbins and was necessarily partial towards the company. And the clause was written in small 9-point font and on page 285, signifying the minimal significance given by the framer of the contract and agreed to by Robbins & Robbins. And lastly, Robbins & Robbins had known about the contamination two months before making the recall.
lanchard and Peale Analysis
Their first of three ethics checks to determine whether a decision is…
Evers, S. (2009). Business ethics and social responsibility. Chapter 4. Reindance
Productions LLC: University of Carolina Wilmington. Retrieved on February 25,
2014 from http://www.csb.uncw.edu/people/eversp/classes/BLA361/Powerpoint/361-4a.Ethics.pdf
Lankard, B. (1991). Resolving ethical dilemmas in the workdplace: a new focus on adult career. ERIC Digests: ERIC Clearinghouse and Vocational Education. Retrieved on February 25, 2014 from http://www.ericdigests.org/pre_9220/focus.htm
Pitocin Induction and Postpartum Hemorrhage
THE SEARCH CONTINUES
Is Pitocin Induction a Factor in Postpartum Hemorrhage?
The induction of oxytocin injection has been a bane of contention in the medical community not only because it has been listed as a high-alert medication, which incurs serious risks to the patient, the fetus and the institution. It is also used frequently to manage postpartum hemorrhage. This quantitative correlational study analyzes and presents the findings of five updated and authoritative sources on the subject and answers the questions surrounding the induction of oxytocin in postpartum hemorrhage and its appropriateness, efficacy and safety.
Postpartum hemorrhage occurs when there is blood loss greater than 500 ml during spontaneous vaginal delivery or 1,000 ml during a cesarean section delivery (Yiadom, 2010). Fortunately, in most cases, healthy females can tolerate much blood loss of more than 500 ml without incurring adverse conditions. The two types are early…
Balci, O. et al. (2011). Comparison of induction of labor with vaginal misoprostol plus
Oxytocin vs. oxytocin alone in term primigravidae. Vol. 2 # 9, Journal of Maternal
and Neonatal Medicine: Informa Healthcare Publishing Technology. Retrieved on January 12, 2014 from http://www.ingenta.connect.com/content/apl/mfn/2011/00000024/00000009/art00002
Clayworth, S. (2000). The nurse's role during Oxytocin administration. Vol. 25 # 2, The
Health Information & QR Codes
asic medical information and medical history is critical in case of medical emergencies. If first responders do not have that information patients can be put at risk for medication reactions, medical complications, and treatment processes can take longer as healthcare providers are left to explore the patient's condition in the dark. When the medical information is non-attainable, patients can also be put at risk for death in cases of coronary and heart health issues. QR codes are scanned by smartphone or mobile phones containing camera software that link to a website URL to retrieve basic medical information that is used to get the patient help.
ERMedStat (Harrington, 2012) is a company that uses QR codes and smartphones to provide first responders with basic medical history. The information contains blood type, emergency contacts, allergic reactions, medical complications, and a list of medications. The company does not…
Harrington, C. (2012, Mar 7). Maryville company uses QR codes to share medical histories in emergencies. Retrieved from knoxvillebiz.com: http://www.knoxnews.com/news/2012/mar/07/marville-company-uses-qr-codes-to-share-medical/
How it Works. (n.d.). Retrieved from Lifesquare: https://www.lifesquare.com/how
Staff, T.N. (2012, Sep 26). New QR Codes Tell Paramedics Your Medical Info. Retrieved from Tech News Daily: http://www.technewsdaily.com/6264-new-qr-codes-tell-paramedics-your-medical-info.html
The health of the person usually starts declining with every passing day after 65 years of age and as Mrs. Smith is 82 years old, she is also suffering from some problems. She is in mid stage of dementia because of which she suffers from recent memory impairment, hypertension and mental confusion. Due to dementia, she has already been in problems several times. Like, once she left the pan over the stove and also fallen number of times due to syncope. Moreover, she forgets to take her medicines on time. So, she needs an attended that takes care of her medication, diet and exercises and must not be left alone or unattended at home.
In an old age, a person is in need of company more than any medication. Healthy routine and happiness is the best treatment for various diseases. However, Mrs. Smith lives alone at home during…
AHRQ. (n.d.). Choosing Long-term Care. Retrieved from Agency of Healthcare Research and Quality: http://archive.ahrq.gov/consumer/qnt/qntltc.htm
Brodaty, H. (1988). 'Minimal brain damage in the Adult II: Early dementia'. Patient Management, August, 127-150.
Better Health Channel. (2011). Dementia -- Support Services are available. Retrieved from Better Health Channel: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Dementia_support_services_are_available-open
Shea, D.E. & Reilly, M.S. (1999). An Action Plan for Dementia. Dublin 2: National Council on Ageing and Older People.
The objective of this study is to examine the condition of Fibromyalgia. Toward this end, this study will conduct a review of current literature in this area of inquiry.
Fibromyalgia is a syndrome reported as common and one in which the individual has pain throughout their body as well as joint, muscle, tendon and soft tissue tenderness on a long-term basis.
Causes of Fibromyalgia
While the cause of Fibromyalgia is uncertain it has been linked to such as fatigue, problems sleeping, headaches, anxiety, and depression. Factors that are believed to be potential triggers of fibromyalgia include: (1) physical or emotional trauma; (2) abnormal responses to pain in areas of the brain; (3) disturbances in sleep; and (4) infection although no specific virus has been identified as being responsible for causing Fibromyalgia.
Occurrence of Fibromyalgia
Fibromyalgia is known to occur most in women ages 20 to 50 years of age.…
Demirbad, B. And Erci, B. (2012) The Effects of Sleep and Touch Therapy on Symptoms of Fibromyalgia and Depression. Iran J. Public Health. 2012;41(11):44-53. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed
Fibromyalgia - Fibromyositis; Fibrositis (2012) Summary of Cochrane Review. PubMed Health. Retrieved from:
Alcoholic Liver Disease
CAUSES AND IMPACT
Causes, Incidence, Risk Factors, Impact
Alcohol use has been linked with liver disease mortality and increased social and economic costs (NCI, 2014; ruha et al., 2009). Most recent statistics say that disorders in alcohol consumption afflict millions of people worldwide. The incidence has been increasing along with increasing alcohol consumption. Alcohol liver disease takes the form of acute alcoholic hepatitis and chronic liver disease, such as steatosis, steatohepatitis, fibrosis and cirrhosis. Seriousness and prognosis depend on the amount consumed, the pattern of drinking and the length of time of consumption, the presence of liver inflammation, diet and nutritional and genetic disposition. While steatosis is virtually benign, morbidity and mortality are both high in liver cirrhosis. Survival rate for advanced cirrhosis is 1 to 2 years and 50% mortality risk for those with severe acute alcoholic hepatitis have as much as 50% mortality (NCI, 2014).…
Bruha, R., et al. (2009). Alcoholic liver disease. Vol. 110 # 3m Prague Medical Report:
PubMed Central. Retrieved on April 6, 2014 from http://www.ncbi.nlm.nih.gov/pubmed /19655694
EASL (2012). EASL clinical practical guidelines: management of alcoholic liver disease. Vol. 51 # 1, Journal of Hepatology: European Association for the Study of the liver. Retrieved on April 6, 2014 from http://www.easl.eu/assets/application/files/5e1b5512fb2cabb_file.pdf
Frazier, T.H. (2011). Treatment of alcoholic liver disease. Vol. 4 # 1, Therapeutic
Chang Proposal - Milestone #4
[Type text] [Type text] [Type text]
N 451- Capstone Project Milestone #4: Design for Change Proposal
N 451 Capstone Course
Quality of patient care is a paramount concern of healthcare professionals. When nurses experience interruptions while they are working, the quality of care patients receive can be negatively impacted. Interruptions have been shown to disrupt working memory, disrupt on-duty focus, induce frustration and stress, contribute to accidents, and lead to patient care errors (Bennet, et al., 2010). Interruptions that occur when nurses administer medication to patients are a particular concern. The incidence of interruptions is higher than might be surmised; according to Day (2010), 19.8% of all procedures did not have any disruptions or clinical errors. Biron, et al. (2009) reviewed 14 observational studies of nurses providing patient care, in which they found that 6.7 interruptions occurred each hour during mediation administration. This…
Bennett, J. (2006). Effects of interruptions to nurses during medication administration.
Nursing Management (Harrow), 16(9), 22-3.
PMID: 20222227 [PubMed - indexed for MEDLINE]
Biron, A., Lavoie-Tremblay, N., and Loiselle, C.G. (2009). Characteristics of work interruptions during medication administration. Journal of Nursing Scholarship, 41(4), 330-336. doi: 10.1111/j.1547-5069.20009.01300.x
Bipolar disorder, originally called manic depressive disorder, is a severe mood disorder that vacillates between extreme "ups" (mania, hypomania) and "downs" (depression). The effects of having bipolar disorder can be observed across the patients social and occupational functioning. Often the patient is left isolated from work, friends, and family. Medications have become the first-line treatments for bipolar disorder; however, psychotherapy can offer additional benefits in the ongoing treatment of patients with bipolar disorder. This paper discusses the symptoms and treatment of bipolar disorder focusing on cognitive behavioral therapy and emotion focused therapy.
Description and differentiation
According to the Diagnostic and Statistical Manual of Mental Disorders -- Fourth Edition -- Text evision (DSM-IV-T) one's mood is an all-encompassing and sustained feeling tone experienced internally by the person and influences the person's behavior and perception of the world. Affect is the external or outward expression of this inner…
Alloy, L.B., Abramson, L.Y., Walshaw, P.D., Keyser, J., & Gerstein, R.K. (2006). A cognitive vulnerability-stress perspective on bipolar spectrum disorders in a normative adolescence brain, cognitive, and emotional development context. Developmental Psychopathology, 18(4), 1057-1103.
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders-IV-Text Revision. Washington, DC: Author.
Beck, J.S. (1995). Cognitive therapy: Basics and beyond. New York: Guilford Press.
Butler, A.C., Chapman, J.E., Forman, E.M., & Beck, A.T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26, 17-31
B. This study used cross-sectional design and may tend to under-select individuals who have been exposed. This is known as "late-look bias." The possibility of nurses recalling MAEs over their careers may result in reporting of, or remembering information that is not accurate.
C. The instrument developed by authors used expert validity, but more research is needed to determine the construction validity and use the appropriate interventions to decrease MAEs (Lin & Ma).
ather than a hypothesis, the Lin and Ma (2009) study was guided by the following research questions:
A. What is the self-reported incidence of MAEs throughout a nurse's career in Taiwan?
B. What is the willingness of nurses to report MAEs?
C. What factors are related to nurses' willingness to report MAEs?
The first research question, though, differs from the authors' stated purpose which was to "explore the prevalence of MAEs and the willingness…
Gebhart, F. (2008, May 12). N.C. hospital loses CMS certification over drug and other errors.
Drug Topics, 152(6), 12.
Lin, Y-H & Ma, S-n. (2009). Willingness of nurses to report medication administration errors in southern Taiwan: A cross-sectional survey.
Wakefield, B.J., Uden-Holman, T. & Wakefield, D.S. (2005). Development and validation of the medication administration error reporting survey. In Advances in patient safety: From research to implementation. Henriksen, K., Battles, J.B., Marks E.S., et al. (eds).
VIII. Preliminary Literature Review
The work of Martin, Scahill, Klin and Volkmar (1999) entitled: "Higher-Functioning Pervasive Developmental Disorders: Rates and Patterns of Psychotropic Drugs Use" reports a study in which the frequency, characteristics and associated target symptoms of psychotropic drug use among individuals with developmental disorders and specifically those with "higher functioning pervasive developmental disorders. (HFPDDs) in a total of 109 children, adolescents and adults results show that 55% of these were taking psychotropic drugs and 29.3% were taking two or more of these medications simultaneously. Conclusions of the study report as follows: "Psychotropic medication use appears to be common among subjects with HFPDDs, yet not generally based on the results of empirical research. Clinical heterogeneity among treated subjects suggests that psychiatric comorbidity may be overlooked in this population." (Martin, Scahill, Klin and Volkmar, 1999) the work of Reynolds and Dombeck (2006) relates that individuals with autism spectrum disorders are…
Martin, Andres; Scahill, Lawrence, Klin, Ami, and Volkmar (1999) Higher-Functioning Pervasive Developmental Disorders: Rates and Patterns of Psychotropic Drug Use. Child and Adolescent Psychiatry. Vol. 38 Issue 7. Online available at: http://www.journals.elsevierhealth.com/periodicals/jaac/article/PIIS0890856709665436/abstract
Reynolds, Tammi; Dombeck, Mark (2006) Autism: Medication. MentalHelp.net. Online available at: http://www.mentalhelp.net/poc/view_doc.php?type=doc&id=8792&cn=20
De Bildt, Annelies, et al. (2006) Pervasive Developmental Disorder, Behavior Problems, and Psychotropic Drug Use in Children and Adolescents With Mental Retardation. Pediatrics Journal Vol. 118 No. 6 December 2006. Online available at: http://pediatrics.aappublications.org/cgi/content/abstract/118/6/e1860
Mikkelsen, Edwin J. (nd) the Rational Use of Psychotropic Medication for Individuals with Intellectual Disabilities. NADD. Online available at: http://www.thenadd.org/pages/products/bookdetails/dt07-038b.shtml
Nusing poblem 1: May's pain must be contained so she does not injue heself.
Because childen cannot always expess thei sensations of pain, thei pain may go unnoticed until it becomes sevee and fightening.
Nusing poblem 2: Vomiting and the possibility of choking.
Anxiety and pain can cause childen to vomit, making teatment of pain and administeing pope nutition difficult.
Nusing poblem 3: May is attempting to emove he oxygen mask.
A lack of knowledge on the pat of the child as to why cetain teatments ae administeed can esult in noncompliance.
Nusing poblem 4: The need fo social suppot when May's mothe is not pesent.
The unfamiliaity of the hospital envionment is exacebated by May's lack of paental cae.
Diagnosis 1: Pain management
Outcome: The FLACC: a behavioual scale fo scoing postopeative pain in young childen that can be helpful in detemining how to teat…
Almond, C. (1998). Children are not little adults. Australian Nursing Journal, 6(3), 27 -- 30.
Bruce, E., & Franck, L. (2000). Self-administered nitrous oxide (Entonox () for the management of procedural pain. Paediatric Nursing, 12(7), 15 -- 19.
Manworren R. & Hynan L.S (2003) Clinical validation of FLACC: preverbal patient pain scale. Paediatric Nursing 29(2):140-146.
McInerney, M. (2000). Paediatric pain. Pulse Information Sheet of Royal College of Nursing,
Woods up with an exercise group close to her house, or a support group
who could help her with adjusting to her new diagnosis and give her
support. The social worker and the nursing staff would also be able to
educate Mrs. Woods' family on the condition and what needs to be done to
maximize her bone health.
5. Should Mrs. Woods have a history of renal calculi; care will be
taken for the administration of calcium supplements. Any supplement she
would take would need co-administration of Vitamin D for proper absorption.
Hormone replacement therapy is no longer considered to be a stable of
treatment due to concerns about heart disease. Additionally, there was no
significant evidence of fracture reduction of the HES study, so the risk
of thrombosis and breast cancer probably outweighs the need for HT.
Selective estrogen receptor modifiers are other alternatives which preserve
bone density but…
1. Libanati CR, Baylink DJ. (1997) Prevention and treatment of
glucocorticoid-induced osteoporosis. A pathogenetic
perspective. Chest. 102:1426-35.
. 2. Sambrook P, Birmingham J, Kelly P, et al. Prevention of
corticosteroid osteoporosis: A comparison of calcium,
calcitriol and calcitonin. N Engl J Med. 1993;328:1747-1752
2. Heaney RP. (1998) Pathophysiology of osteoporosis. Endocrin
Metabol Clin North Am.;27:255-65.
Stated to be barriers in the current environment and responsible for the reporting that is inadequate in relation to medical errors are:
Lack of a common understanding about errors among health care professionals
Physicians generally think of errors as individual that resulted from patient morbidity or mortality.
Physicians report errors in medical records that have in turn been ignored by researchers.
Interestingly errors in medication occur in almost 1 of every 5 doses provided to patients in hospitals. It was stated by Kaushal, et al., (2001) that "the rate of medication errors per 100 admission was 55 in pediatric inpatients. Using their figure, we estimated that the sensitivity of using a keyword search on explicit error reports to detect medication errors in inpatients is about 0.7%. They also reported the 37.4% of medication errors were caused by wrong dose or frequency, which is not far away from our result of…
Discussion Paper on Adverse Event and Error Reporting In Healthcare: Institute for Safe Medication Practices Jan 24, 2000
Patient Safety/Medical Errors Online at the Premiere Inc. page located at: http://www.premierinc.com/all/safety/resources/patient_safety/downloads/patient_safety_policy_position_2001.doc
Medstat / Shortell, S. Assessing the Impact of Continuous Quality Improvement on Clinical Practice: What It Will Take to Accelerate Progress.
Health Policy Monitor (2001) A Publication of the Council of State Governments Vol. 6, No. 1 Winter/Spring 2001 PO18-0101
Specifically, Singleton's case was denied review by the U.S. Supreme Court in 2003, and he was executed in Arkansas on January 6, 2004. As noted in the lower court's dissent: "Treating the prisoner may provide short-term relief but ultimately result in his execution, whereas leaving him untreated will condemn him to a world such as Singleton's, filled with disturbing delusions and hallucinations." Simply put: The Court found it in the state of Arkansas' best interest for Singleton to be forcibly treated and executed rather than left untreated but alive."
The U.S. Supreme Court has been consistently clear since the decision in Gregg v. Georgia that the Constitution does not prohibit execution as long as procedural safeguards are established, but the Court's jurisprudence concerning the mentally ill as opposed to the mentally retarded has been less clear. In 2002, the Court ruled that it is unconstitutional to execute the mentally retarded…
RIGHTS-U.S.: DEATH PENALTY for MENTALLY ILL CALLED a RIGHTS ABUSE
Inter-Press Service English News Wire; 11/7/2003; Katherine Stapp
Inter-Press Service English News Wire
Killer's case stirs debate about death penalty for the mentally ill.
Smart Card Health Role in Rational Use of Medicines
The objective of this study is to examine the role of smart cared in health and their role in the rational use of medicines. Smart cards are very small and very secure and serve to protect patient privacy. Smart cards contain digital logs with location, date, time, and the individual's stamp to record every transaction. Smart cards also may contain digital prescriptions therefore mistakes made with prescriptions that are handwritten are eliminated and specifically as to the "quantity or quality of medications." (HealthOne, 2011)
How the Smart Card Works
The smart card uses technology that stores a patient's personal health information on a microprocessor chip embedded in the card that is the size of a credit card but that has a "small metal contact plate on the front which is how the reader accesses the medical information stored on the chip"…
Benjamin, DM (2003) Reducing Medication Errors and Increasing Patient Safety: Case Studies in Clinical Pharmacology. J Clin Pharmacol 2003 Jul;43(7):768-83.
Hsu, MH (2011) Online detection of potential duplicate medications and changes of physician behavior for outpatients visiting multiple hospitals using national health insurance smart cards in Taiwan. Int J. Med Inform. 2011 Mar;80(3):181-9. Epub 2010 Dec 22.
Hsu, MH, Li, YC, and Liu, CT (2006) ADRs and Smart Health Cards. CMAJ Aug 15, 2006 Vol. 175 No. 4. Retrieved from: http://www.cmaj.ca/content/175/4/385.1.full
Runciman, WB et al. (2003) Adverse Drug Events and Medication Errors in Australia. Int J. Qual Health Care 2003, Dec;15 Suppl 1:i49-59.
448). However, due to the recent introduction of the CPOE system (Computerized Physician Order Entry), the authors surmise that this system will help to eliminate up to 80% of all medication errors (Tang, Sheu, Yu, Wei and Chen, 2007, p. 448).
Third, the authors make it abundantly clear that nurses themselves must accept the bulk of the responsibility when it comes to transcribing, dispensing and administering medications to patients. Of course, if the prescription itself, almost always filled out by a physician, is inaccurate, then the responsibility falls upon the prescribing physician, a situation which then leads to nurses dispensing and administering the wrong medication. In addition, the authors provide an analysis related to nurses failing to report their medication mistakes to the proper hospital/clinic authorities, due perhaps to "shame, guilt and the fear of punishment" from their superiors when informed of medication errors on the part of nurses (Tang,…
Tang, Fu-in, Sheu, Shuh-Jen, Yu, Shu, Wei, Ien-Lan, and Ching-Huey Chen. (2007).
Nurses relate the contributing factors involved in medication errors. Journal of Clinical Nursing, 16, 447-457.
Direct-Consumer Drug Advertising
Direct-to-Consumer Drug Advertising
Direct-to-consumer drug advertising of pharmaceutical drugs is a hot-button issue. Is it ethical, or does it lead to self-diagnosis and take advantage of people who have hope for a cure? Currently, New Zealand and the United States are the only two countries that allow this kind of direct-to-consumer advertising to take place, which calls into question why other countries do not allow the same, if the practice is ethical. From a deontological point-of-view, using Kant's categorical imperative, this paper will address whether the direct-to-consumer advertising of pharmaceutical drugs is ethical or unethical. According to the deontological approach, one's duty is to do what is morally right and avoid what is morally wrong, regardless of what the consequences of those actions may be (Beauchamp, 1991; Waller, 2005). Because that is the case, there are moral questions raised that have to be considered with something as…
Beauchamp, T.L. (1991). Philosophical Ethics: An Introduction to Moral Philosophy, 2nd Ed. New York: McGraw Hill.
Kamm, F.M. (1996). Morality, Mortality Vol. II: Rights, Duties, and Status. New York: Oxford University Press.
Kamm, F.M. (2007). Intricate Ethics: Rights, Responsibilities, and Permissible Harm. New York: Oxford University Press.
Kant, I. (1964). Groundwork of the Metaphysics of Morals. New York: Harper and Row Publishers, Inc.
The majority of nurse practitioners commit themselves daily to help provide compassionate and comprehensive healthcare that focuses on disease prevention and health promotion within a cost effective format. Our elders deserve the respect of appropriate and successful treatment and preventative measures to help reduce the risk of complications associated with polypharmacy. As such, the goal of policy aimed at reducing this practice tries to formulate a more active plan for keeping track of patient records and keeping costs of medications down in order to prevent patients from skipping doses (Lorenz, 2012). In order to provide effective policies and practices to reduce risks associated with polypharmacy, many organizations have turned to using computer-based recording as a way to help keep track of medications prescribed across specialist and doctors (Bushardt et al., 2008). Additionally, federal health care programs, like Medicare and Medicaid are working continuously to help improve policies and help make…
Bushardt, Reamer, Massey, Emily B., Simpson, Temple W., Airial, Jane C., & Simpson, K.T. (2008). Polypharmacy: Misleading, but manageable. Clinical Interventions in Aging, 3(2), 383-389. Web. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2546482/
Lorenz, Joan M. (2012). Polypharmacy and the elderly. Advance for Nurses. Web. http://nursing.advanceweb.com/Continuing-Education/CE-Articles/polypharmacy-in-the-elderly.aspx
WHAT WORKS EST
Adherence Intervention for Afro-Caribbeans
Recent improvements on prescription medications are beneficial only if patients adhere to them faithfully. Non-adherence is common and results in adverse conditions (Ho et al., 2009). This is a problem both to patients and heir care providers as well as the healthcare system itself. The solution consists of identifying the causes and motivations of non-adherence and the design and implementation of better interventions to improve adherence (Ho et al.). The following studies present and suggest more effective interventions for a variety of health conditions among Afro-Caribbean people who have been reported to have a high level of non-adherence to therapy.
Many health providers contend that more effective interventions in reducing risks for diseases, especially HIV / AIDS, through greater adherence need to culturally conform to the specific culture of the subject population (Archibald, 2011). This study used a…
Adams, O.P. And Carter, A.O. (2010). Diabetes and hypertension guidelines and the primary health care practitioners in Barbados: knowledge, attitudes, practices and barriers -- a focus group study. Vol 11 # 96, BMC Family Practice: BioMed Central.
Retrieved on February 1, 2013 from http://www.biomedcentral.com/1471-2296/11/96
Archibald, C. (2011). Cultural tailoring for an Afro-Caribbean community: a naturalistic approach. Vol 18 # 4, Journal of Cultural Divers: Pubmed. Retrieved on January 27,
2013 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3408883