What is the selection of a treatment approach largely determined by?
Which one of the following is an effect of the recent trend toward standardized treatment? A) People have medical examinations regularly. B) Hospital policies and prices are more flexible. C) People are enjoying better health care service. D) Medical care is viewed in terms of "products." ...
What are the recent trends in testing?
Prevalence and Consequences of CSA. A recent meta-analysis of the international literature found that approximately 20% of women and 8% of men experience sexual abuse as children (Pereda, Guilera, Forns, & Gomez-Benito, 2009).Although an encouraging trend indicates that sexual abuse in the U.S. appears to have declined in recent years (Jones, Finkelhor, & Halter, 2006), the …
What is the pattern of the patient's performance indicated?
The trend toward deinstitutionalization in recent years means that _____ A: inpatient hospitalization in public institutions has increased. B: people with psychological problems more often receive inpatient treatment than outpatient treatment. C: people are hospitalized more briefly and then treated on an outpatient basis.
Does effective drug therapy serve to selectively increase metabolic activity?
in the preparation of this report. A more extensive treatment of these data is planned in the following monographs which are currently in preparation, to be published by Russell Sage Foundation: Goslin, David A., Teachers and Testing; Brim, Orville G., Jr., et al., American Attitudes toward Intelligence; and Goslin, David A., Testing and
What is standard care quizlet?
The standard of care is the conduct that is demanded of a person as to avoid liability for negligence. In other words, it is the measure of the duty owed by the defendant to the plaintiff.
Which of the following aspects of patient care is the most vital factor to the issue of informed consent?
Which of the following aspects of patient care is the most vital factor in the issue of informed consent? The doctrine of informed consent is the legal basis for advising patients regarding certain aspects of care.
Which of the following are among challenges to hospice and palliative care?
3 Big Challenges in Hospice and Palliative CareCombatting Misconceptions. Common misconceptions and the resulting negative public perception surrounding hospice and palliative care can often present a tremendous roadblock in delivering the right level of care at the right time. ... Late Referrals. ... Managing Expectations.Dec 6, 2018
In which of the following situations is it most likely that expert testimony about the standard of care would not be required?
In which of the following situations is it most likely that expert testimony about the standard of care would not be required? Health maintenance organizations and similar health plans cannot be held liable for adverse treatment outcomes because they only make decisions about insurance coverage.
What are the 4 types of consent in healthcare?
There are 4 components of informed consent including decision capacity, documentation of consent, disclosure, and competency. Doctors will give you information about a particular treatment or test in order for you to decide whether or not you wish to undergo a treatment or test.
Which of the following is a disadvantage of EHR?
The disadvantages of EHRs relate primarily to a range of factors include user-related issues, financial issues and design flaws that create barriers to using them as an effective tool to deliver healthcare services.Aug 15, 2019
What is the problem with hospice care?
Among the most commonly cited patient-related barriers are denial of health status, desire to exhaust all treatment options, a negative perception of hospice, and patient demographics.Sep 21, 2016
What are the barriers to palliative care?
Ahmed and colleagues9 also found other barriers pertaining to some healthcare providers, which included lack of traditional training around palliative and end of life training, personal opinions toward hospice care, and managing patients' and families' fears and other feelings related to end of life.
What may be some of the challenges for palliative care in rural and remote communities?
There is a reliance on generalists to provide palliative care, particularly in rural and remote regions where there is a shortage of specialists and providing quality healthcare faces well-recognised challenges of a limited workforce, poor access, and vast geography.Mar 10, 2020
Which of the following is an example of respondeat superior?
An example of Respondeat Superior For example, if there is a personal injury case that involves a situation where a truck driver's negligence results in a truck accident, the injured individual can also try to bring the driver's employer-often the trucking company itself- into the case and hold them liable as well.Oct 12, 2018
What are factors of care patients can expect?
Medical Law VocabABPatients' RightsThe factors of care that patients can expect to receivePatients' Bill of RightsA bill recognized and honored by health care facilities stating the level of care patients can expect to receive27 more rows
What are the methods to ensure quality patient care and decrease risks?
2) Set goalsSafe: Avoid injuries to patients from the care that is intended to help them.Effective: Match care to science; avoid overuse of ineffective care and underuse of effective care.Patient-Centered: Honor the individual and respect choice.Timely: Reduce waiting for both patients and those who give care.More items...•Feb 18, 2016
What is the importance of opioids in chronic pain?
Opioids are useful in treating chronic pain but have accompanying complications. It is important for clinicians to understand the basics of opioid pharmacology, the benefits and adverse effects of opioids, and related problematic issues of tolerance, dependence, and opioid-induced hyperalgesia. In this article, the role of psychiatric comorbidity and the use of validated assessment tools to identify individuals who are at the greatest risk for opioid misuse are discussed. Additionally, interventional treatment strategies for patients with chronic pain who are at risk for opioid misuse are presented. Specific behavioral interventions designed to improve adherence with prescription opioids among persons treated for chronic pain, such as frequent monitoring, periodic urine screens, opioid therapy agreements, opioid checklists, and motivational counseling, are also reviewed. Use of state-sponsored prescription drug monitoring programs is also encouraged. Areas requiring additional investigation are identified, and the future role of abuse-deterrent opioids and innovative technology in addressing issues of opioid therapy and pain are presented. Copyright © 2015 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
How does neuroadaptation affect opioids?
Opioids are still the most potent drugs to control severe pain. However, neuroadaptation prevents opioids’ability to provide long-term analgesia and produces opposite effects i.e. enhancement of existent pain and facilitation of chronic pain development. Neuroadaptation to opioids use yields to the development of two interrelated phenomenons: tolerance and “opioid-induced hyperalgesia” (OIH). Tolerance, a pharmacologic concept, and OIH, a clinical syndrome, have been mostly observed under experimental conditions in animals and in human volunteers. In contrast, their occurrence and relevance in clinical practice remains debated. In perioperative setting, intraoperative administration of high doses of opioids increases postoperative opioid requirements and worsens pain scores (acute tolerance or perioperative OIH). Further, preoperative chronic opioid intake as well as postoperative longterm use of opioid analgesics beyond the normal healing period have a negative effect on surgical outcome. Conversely, observations of improved patient’s recovery after opioid-sparing anesthesia techniques stand as an indirect evidence that perioperative opioid administration deserves caution. To date, perioperative OIH has rarely been objectived by psychophysics tests in patients. A direct relationship between the presence of perioperative OIH and patient’s outcome is missing and certainly deserves further studies.
Why is opioid tapering difficult?
Introduction: Primary care practitioners (PCPs) are concerned about adverse effects and poor outcomes of opioid use but may find opioid tapering difficult because of a lack of pain management training or time constraints limiting patient counseling . In 2010, Kaiser Permanente Northwest implemented a pharmacist-led opioid tapering program-Support Team Onsite Resource for Management of Pain (STORM)-to address high rates of opioid use, alleviate PCPs' workload demands, and improve patient outcomes. Objective: To describe the rationale, structure, and delivery of this unique pharmacist-led program, which partners with PCPs and provides individualized care to help patients reduce opioid use, and the Facilitating Lower Opioid Amounts through Tapering study, which examines the program's effectiveness, cost-effectiveness, and implementation. Results: The STORM program includes a pain medicine physician, a social worker or nurse, and pharmacists who have received specialized clinical and communications training. The program has a 2-fold role: 1) to provide PCP education about pain management and opioid use and 2) to offer clinician and patient support with opioid tapering and pain management. After program training, PCPs are equipped to discuss the need for tapering with a patient and to refer to the program. Program pharmacists provide a range of services, including opioid taper plans, nonopioid pain management recommendations, and taper-support outreach to patients. Discussion: The STORM program provides individualized care to assist patients with opioid tapering while reducing the burden on PCPs. Conclusion: The STORM program may be a valuable addition to health care systems and settings seeking options to address their patients' opioid tapering needs.
What is OIH in cancer?
Background: Evidence for opioid-induced hyperalgesia (OIH) has been shown in animal and human studies, but the clinical implications of this phenomenon remain unclear. Objectives: We examined whether cancer patients taking opioids differ in their sensitivity to a clinical pain stimulus using a local anesthetic injection compared to those not taking opioids. We also evaluated the effect of the opioid dose, duration of opioid therapy, and patients' pain severity and functional status on this clinical pain stimulus. Study design: Prospective observational study. Setting: University outpatient department for interventional pain management, Republic of Korea. Methods: Eighty-two cancer patients including 20 patients not taking opioids (non-opioid group) and 62 taking opioids (opioid group) who were scheduled for an interventional procedure were enrolled in this study. Patients received a standardized subcutaneous injection of lidocaine prior to a full dose of local anesthetic (LA). Before the injection, patients completed the Brief Pain Inventory (BPI) questionnaire and were asked to rate their current pain using numeric rating scales. Immediately following the injection, LA injection-specific pain was evaluated using pain intensity, unpleasantness, and behavior pain scores. Results: LA injection-specific pain intensity, unpleasantness, and behavior pain score were significantly higher in the opioid group compared with the non-opioid group (P < 0.001). In the opioid group, these post-injection pain scores were higher in patients taking high-dose opioids than those taking low doses (P < 0.05). In addition, we observed a strong correlation between the baseline BPI pain interference score and the LA injection-specific pain score (r = 0.695, P < 0.001). Limitations: This study is limited by its sample size and observational design. Various opioid medications, which were not standardized, may have inadvertently biased our results. Finally, the pain assessed by a brief stimulus does not fully reflect disturbances in endogenous pain inhibitory processes. Conclusion: The results of this study suggest that opioid medication is an important contributing factor to pain perception accompanying LA injection, and cancer patients using high-dose opioids may be highly susceptible to hyperalgesic responses to this clinical stimulus. We also suggest that the possible presence of OIH may be intensified among cancer patients with poor physical and psychosocial functional status.
What is the role of the PPT gene in opioids?
Unlabelled: The preprotachykinin A gene (ppt-A) codes for Substance P (SP), supports nociceptive sensitization, and modulates inflammatory responses after incision. Repeated opioid use produces paradoxical pain sensitization-termed opioid-induced hyperalgesia (OIH) -which can exacerbate pain after incision. Here the contribution of SP to peri-incisional nociceptive sensitization and nociceptive mediator production after opioid treatment was examined utilizing ppt-A knockout (-/-) mice and the neurokinin (NK1) receptor antagonist LY303870. Less mechanical allodynia was observed in ppt-A (-/-) mice compared to wild types (wt) after morphine treatment both before and after incision. Moreover, LY303870 administered with morphine reduced incisional hyperalgesia in wt mice. Incision after saline or escalating morphine treatment upregulated skin IL-1β, IL-6, G-CSF and MIP-1α levels in ppt-A (-/-) and wt mice similarly. However, chronic morphine treatment greatly exacerbated increases in skin nerve growth factor levels after incision, an effect entirely dependent upon intact SP signaling. Additionally, SP dependent upregulation of prodynorphin, NMDA1 and NK1 receptor expression in spinal cord was seen after morphine treatment and incision. A similar pattern was seen for 5-HT3 receptor expression in tissue from dorsal root ganglia. Therefore, SP may work at both central and peripheral sites to enhance nociceptive sensitization after morphine treatment and incision. Perspective: These studies show that SP signaling modulates enhanced nerve growth factor production and changes in neuronal gene expression seen after incision in mice previously exposed to morphine.
How does opioid induced hyperalgesia work?
Opioid-induced hyperalgesia is characterized by increased pain intensity over time, spreading of pain to other locations, and increased pain sensation to external stimuli. To characterize opioid-induced hyperalgesia, laboratory methods to measure hyperalgesia have been developed. To determine the performance of these methods, the authors conducted a systematic review of clinical studies that incorporate measures of hyperalgesia in chronic pain patients on long-term opioids. PubMed and Cochrane databases were searched (terms: opioid induced hyperalgesia, study or trial, and long-term or chronic). Studies published in English were selected if they were conducted in chronic pain patients on long-term opioids and incorporated measures of hyperalgesia; acute/single-dose studies and/or conducted in healthy volunteers were excluded. Fourteen articles made the final selection (11 were selected from the search and 3 others were found from additional sources); there was one randomized controlled trial, one prospective controlled study, three prospective uncontrolled studies, and nine cross-sectional observation studies. Hyperalgesia measurement paradigms used included cold pain, heat pain, pressure pain, electrical pain, ischemic pain, and injection pain. Although none of the stimuli were capable of detecting patients' hyperalgesia, heat pain sensitivity showed some promising results. None of the measures reviewed herein met the criteria of a definitive standard for the measurement of hyperalgesia. Additional studies that use improved study design should be conducted.
Is opioid therapy effective for sickle cell disease?
Chronic opioid therapy (COT) for chronic non-cancer pain is frequently debated, and its effectiveness is unproven in sickle cell disease (SCD). The authors conducted a descriptive study among 83 adult SCD patients and compared the severity of disease and pain symptoms among those who were prescribed COT (_n_=29) with those who were not using COT. All patients completed baseline laboratory pain assessment and questionnaires between January 2010 and June 2014. Thereafter, participants recorded daily pain, crises, function, and healthcare utilization for 90 days using electronic diaries. Analyses were conducted shortly after the final diary data collection period. Patients on COT did not differ on age, sex, or measures of disease severity. However, patients on COT exhibited greater levels of clinical pain (particularly non-crisis); central sensitization; and depression and increased diary measures of pain severity, function, and healthcare utilization on crisis and non-crisis diary days, as well as a greater proportion of days in crisis. Including depressive symptoms in multivariate models did not change the associations between COT and pain, interference, central sensitization, or utilization. Additionally, participants not on COT displayed the expected positive relationship between central sensitization and clinical pain, whereas those on COT demonstrated no such relationship, despite having both higher central sensitization and higher clinical pain. Overall, the results point out a high symptom burden in SCD patients on COT, including those on high-dose COT, and suggest that nociceptive processing in SCD patients on COT differs from those who are not.
What is the 4/5 rule?
One of the most interesting issues with the four-fifths rule is that. specifically prohibits discriminatory use of test scores. Section 9 of the 1991 Civil Rights Act.
Is neuropsychology a multidisciplinary field?
Clinical neuropsychology is multidisciplinary and overlaps with the fields of. more in the left than the right side of the brain. Receptive and expressive language abilities seem to be localized. any one center in the brain can be involved in several different functional systems.
What is precision in research?
precision. If a researcher asks a participant in a study to envision himself or herself as an unemployed autoworker living in Detroit, Michigan, with a partner and two children , who is struggling to afford food and housing , the researcher is using a. vignette.
How is educational performance measured?
Educational performance is measured by the students' grade point average and by scores on standardized tests. In this study, "feeling part of the school community" and "educational performance" are examples of. concrete definitions. Reliability and validity are both central to the goal of.
What is qualitative research?
Qualitative research, often using an inductive approach, typically starts with data collection, which means that conceptualization and operationalization. often come later than they do in a quantitative study. Valeria plans to study the influence of students' attachment to school on their educational outcomes.
Why is education important for society?
Increasing the population's educational attainment helps society because a more educated population is more economically productive. Those who access higher education gain more of society's social rewards. Higher education results in credentialism, stratification of people based on degree rather than skill.
