Emergency Medical Services & Pharmacies
Long Term Health Care
Physicians? Offices
Hospitals
This paper needs to be written using all of these organizations.
? Discuss the influence of regulatory and accreditation standards on performance-management systems.-
? Discuss how the performance-management systems affect risk management and quality management in each type of organization
? Identify key areas in the organization that will have direct responsibility for carrying out the day-to-day responsibilities associated with the regulations or standards.---
? Identify other areas in the organization that will be indirectly affected by the regulations or standards.
? Outline what oversight activities you could put in place to ensure that the regulatory and accreditation requirements are being implemented and are achieving the desired results.
? Collaborate to complete the University of Phoenix Material: Organizational Performance Management Table located on the student website.
? Propose how each organization will monitor performance, achieve regulatory and accreditation compliance, and improve overall organizational performance.
Describe ways each organization will communicate with leadership to ensure alignment of organizational goals and gain buy-in from staff to achieve compliance with the standards and requirements issued by regulatory and accreditation bodies.
Determine how compliance with the regulations and development of risk-management and quality-management systems for each type of organization contribute to the organization system
Conclusion:
? Address the similarities and differences among the types of organizations.

There are 4 questions all together please limit each to a page

1). Evaluate this statement this statement: Medical care is never free, although the individual may pay nothing?
2). What factors determine demand? How do they relate to price?
3). What is the role of physicians in the demand for care? Why is there a conflict? How can the conflict be addressed?
4). How has the elasticity of supply of medical services affected the government's cost of expanding healthcare to the poor and uninsured?

Please make sure it meets these standards
Consistently, concisely and clearly stated new ideas to discuss; contributes solutions to the questions with APA citations from current, peer-reviewed journals; analyzes and evaluates from many positions; consistently uses case studies/examples from interviews or experiences; graduate-level composition; contribute valuable insight based on recent related research.
Concisely summarizing and moving on with new issues based on the discussion and current literature; takes leadership role in individual discussion

NIMS Medical/Public Health Components and Disaster Responses


Assignment Overview

National Incident Management System (NIMS) (2008). Department of Homeland Security. FEMA: http://www.fema.gov/pdf/emergency/nims/NIMS_core.pdf

Review Appendix B?Incident Command System, specifically references to the Medical Unit and medical services.

Discuss the medical components in terms of:
?Logistics
?Inventory
?Personnel Credentialing
?Emergency Operations Center
?ICS 206, Medical Plan

Read pp 11-12, Foster integrated, scalable health care delivery system, of the National health security strategy for the United States of America (2009).

://www.phe.gov/Preparedness/planning/authority/nhss/strategy/Documents/nhss-final.pdf

What are the implications in conjunction to the NIMS?

Assignment Expectations

Length: This Case Assignment should be at least 3-4 pages not counting the title page and references.

References: At least two references should be included from academic sources (e.g. peer-reviewed journal articles). Required readings are included. Quoted material should not exceed 10% of the total paper (since the focus of these assignments is critical thinking). Use your own words and build on the ideas of others. When material is copied verbatim from external sources, it MUST be enclosed in quotes. The references should be cited within the text and also listed at the end of the assignment in the References section (preferably in APA format).

Organization: Subheadings should be used to organize your paper according to question.

Grammar and Spelling: While no points are deducted, assignments are expected to adhere to standards guidelines of grammar, spelling, punctuation, and sentence syntax. Points may be deducted if grammar and spelling impact clarity.

The following items will be assessed in particular:
?Relevance (e.g. all content is connected to the question)
?Precision (e.g. specific question is addressed. Statements, facts, and statistics are specific and accurate).
?Depth of discussion (e.g. present and integrate points that lead to deeper issues)
?Breadth (e.g. multiple perspectives and references, multiple issues and factors considered)
?Evidence (e.g. points are well-supported with facts, statistics and references)
?Logic (e.g. presented discussion makes sense, conclusions are logically supported by premises, statements, or factual information)
?Clarity (e.g. writing is concise, understandable, and contains sufficient detail or examples)
?Objectivity (e.g. avoid use of first person and subjective bias)

TUIU
MKT301 Module 2 CASE

Write a paper of no more than FIVE pages in length addressing the following questions:
Following is a list of product categories:
? AUTO REPAIR.
? TINNED TOMATOES
? MEDICAL SERVICE PROVIDER, (DENTIST, OPTOMETRIST, FAMILY PHYSICIAN ETC).
? JEWELRY.

Additional information included in file attached

You are the newly appointed Management Services Officer for a medium-sized (50,000 calls per year) EMS system (the system handles 911 calls only, not inter-facility medical transportation). Part of your job is to prepare periodic reports for the CEO and governing board concerning the performance of the organization. You were astounded (and disappointed) to learn that the only performance measure consistently reported by this organization has been the average response time for all calls.

Develop, using what you have learned thus far, (including week #5), develop a comprehensive set of recommended performance measures for a medium-sized (50,000 call per year) emergency medical service organization. Present your recommendations to me as though you were a staff officer in my organization, in written format.

You should present recommended performance measures in each of the following areas:

Operational performance measures

Clinical performance measures (must include and justify at least 3 measures beyond those set forth in the Myers-Slovis paper)
S System Design and Structure
HR Human Resources (culture, training, safety, credentialing, etc.)
CC Clinical Care and Outcome
R Response
F Finance/Funding
Q Quality Management
CD Community Demographics

Financial performance measures

Customer and Employee Satisfaction/Engagement performance measures


Submitted documents should meet the following criteria:


Student name should appear in file name

EHS 6210 - Memo - Your last name
Example: EHS6210 Memo ?

Business memo header
Single-spaced
Number the pages
12 point font (Time New Roman)
1? margins
APA Style (6th edition)
Use quotations if you are providing the information verbatim
No lists or outlining
No use of Wikipedia
Citations of all material used (including textbook)
Provide a reference list, including the textbook
The length of the paper does not include the title page, table of contents, reference page(s), or any appendixes; use of pictures, tables or other figures should appear in the appendix with a reference to them in the body of the paper.

Essay Question
Please choose two of following questions to answer.


1. Did managed care succeed in reducing medical expenditures?
2. What steps can be taken to limit increases in medical expenditures?
3. Who should decide how much is to be spent on health care?
4. What are the key issues that public policy debates on medical services have been concerned with, and how does health policy need to be more clearly defined?
5. What are the arguments for and against having one government program instead of both Medicare and Medicaid?
6. Why will contracting with HMOs to provide care to Medicaid patients increase access to care for Medicaid enrollees?
7. Why do price controls require hospitals to make a trade-off between quality of medical services and number of patients served?
8. Why has there been an increase in government regulation of managed care?
9. How can the Internet help improve patient care?
10. Evaluate the following statement: Rising Medicare and Medicaid expenditures contribute to the growing federal deficit. To finance this larger deficit, the government must borrow more, which in turn increases interest rates, raises the value of the dollar, and consequently makes U.S. goods more expensive than foreign-produced goods.
11. How did firms like General Motors pay off huge unfunded medical liabilities for current and future retirees?
12. Currently, the public is protected from incompetent and unethical physicians by requiring graduation from an approved medical school, passing a one-time licensing examination, and continuing education. What are alternative, lower-cost approaches for protecting the publics interest?
13. Why do drug manufacturers charge different purchasers different prices for
the same prescription drug?
14. What methods have managed care plans used to limit their enrollees drug costs?
15. How do drug companies determine who gets price discounts?
16. What are orphan drugs, and why are drug firms less likely to develop such drugs today?
17. What is the consequence of the FDA providing the public with greater assurance that a new drug is safe?
There are faxes for this order.

This paper is a System of Inquiry based on the existing Code of Ethics for EMTs.

The paper should cover and evaluate the following:
1. Decision-making,
2. Problem solving
3. Behavior in the business and public environment
4. The model should discuss the why, how, when and whom it is used
5. The implementation of this code
6. Reactions from the EMTs within the working environment
7. Overall effect that this code has on EMTs

I can paste this code below for your review.


EMT Code of Ethics
As adopted by the National Association of EMTs
Professional status as an Emergency Medical Technician and Emergency Medical Technician-Paramedic is maintained and enriched by the willingness of the individual practitioner to accept and fulfill obligations to society, other medical professionals, and the profession of Emergency Medical Technician. As an Emergency Medical Technician-Paramedic, I solemnly pledge myself to the following code of professional ethics:
A fundamental responsibility of the Emergency Medical Technician is to conserve life, to alleviate suffering, to promote health, to do no harm, and to encourage the quality and equal availability of emergency medical care.
The Emergency Medical Technician provides services based on human need, with respect for human dignity, unrestricted by consideration of nationality, race creed, color, or status.
The Emergency Medical Technician does not use professional knowledge and skills in any enterprise detrimental to the public well being.
The Emergency Medical Technician respects and holds in confidence all information of a confidential nature obtained in the course of professional work unless required by law to divulge such information.
The Emergency Medical Technician, as a citizen, understands and upholds the law and performs the duties of citizenship; as a professional, the Emergency Medical Technician has the never-ending responsibility to work with concerned citizens and other health care professionals in promoting a high standard of emergency medical care to all people.
The Emergency Medical Technician shall maintain professional competence and demonstrate concern for the competence of other members of the Emergency Medical Services health care team.
An Emergency Medical Technician assumes responsibility in defining and upholding standards of professional practice and education.
The Emergency Medical Technician assumes responsibility for individual professional actions and judgment, both in dependent and independent emergency functions, and knows and upholds the laws which affect the practice of the Emergency Medical Technician.
An Emergency Medical Technician has the responsibility to be aware of and participate in matters of legislation affecting the Emergency Medical Service System.
The Emergency Medical Technician, or groups of Emergency Medical Technicians, who advertise professional service, do so in conformity with the dignity of the profession.
The Emergency Medical Technician has an obligation to protect the public by not delegating to a person less qualified, any service which requires the professional competence of an Emergency Medical Technician
The Emergency Medical Technician will work harmoniously with and sustain confidence in Emergency Medical Technician associates, the nurses, the physicians, and other members of the Emergency Medical Services health care team.
The Emergency Medical Technician refuses to participate in unethical procedures, and assumes the responsibility to expose incompetence or unethical conduct of others to the appropriate authority in a proper and professional manner.

________________________________________
Written by: Charles Gillespie M.D.
Adopted by: The National Association of Emergency Medical Technicians, 1978.
http://www.naemt.org/aboutNAEMT/EMTCodeOfEthics.htm, October 9, 2005

Short answers (1 paragraph or more)

Typed, single spaced (line spacing 1.15), using Times New Roman font (size 12), with one-inch margins on all sides; citations and references must follow APA format.

"Simkins v. Moses H. Cone Memorial Hospital"
Categorize the sources of law and each corresponding branch of government that apply to this case. Assess the role that each played.
Compare how the concepts of due process and stare decisis may affect judicial decisions. In this case, state the ramifications, if any, of these two legal concepts.

"Case Study: Woodyard, Insurance Commissioner v. Arkansas Diversified Insurance Co."
Devise an explanation as to how the Blue Cross health plan can fall under the definition of ?hospital and medical service corporation.?
Examine how this type of corporation fits into the health care system overall and explain how its unique characteristics serves its members and the doctors who subscribe to it. Discuss if this type of plan is ideal for you and your loved ones. Provide a rationale.

?Describe at least three efforts at health reform in the 20th century, the outcome of each, and what factors led to the outcomes.

?Study the Affordable Health Care Act and determine what reforms have been successful according to 50% or more of the public. As a health care administrator, discuss what your findings mean to you.

?During a hospital in-patient stay, explain how and when a contract is legally terminated between the physician and the patient. Determine what the physician?s duties will be following the termination of the relationship with the patient. As an administrator, identify what steps you would take to ensure the patients are aware of the legal aspect of the relationship.

?Explain when a physician may become susceptible to legal action due to strict liability versus negligence.

?A patient was given a medication by an unfamiliar physician that caused a severe reaction. This physician was covering for the physician who normally treated the patient. Analyze why a case alleging a breach of contract might be easier to prove than a standard case alleging negligence in a hospital setting.

?Justify why a physician who uses a procedure that is different from one he or she promised to use may be liable for breach of contract. Assess how such an action places a medical facility at risk and what the facility can do to protect itself.

?Determine the importance of a thorough understanding of the legal liability of health care institutions from the Chief Medical Officer?s viewpoint. When you come across a legal issue that you do not understand, describe what your action steps might be.

?Differentiate between corporate liability and liability under respondent superior, and how expert testimony might be needed in each instance.

?Explain who has the authority to admit a patient to the hospital. In most cases, patients do not have the right to be admitted. Assume you were part of a training team responsible for assimilating patient registration teams to the policies of a facility. Develop a policy that educates them on patient administration and discuss what you deemed significant to point out.

?Evaluate the types of issues a hospital and physician may confront when discharging a patient. Develop a policy for staff to implement based on the issues identified.

?Should you observe a member of a medical staff conducting illegal or unethical practices, describe the steps that you would take to bring this conduct to the proper authorities. Then, assume you were the chief administrator of a medical firm. Determine who would be the proper authority. Provide your rationale.

?Peer review is generally the way that medical facilities assess medical staff performance. Create an alternative method for performance reviews that would not rely upon peer involvement.

?If you were a medical professional and came across an individual needing immediate aid, determine how the Good Samaritan Law might affect your willingness to assist. Then discuss an actual case where the law did not apply to the ?hero.?

?You just received a patient in the emergency room for a broken leg which requires immediate surgery. Your hospital is able to provide the surgical services required. However, the patient is refusing care and requesting to be transferred to another hospital for the same services. Explain the course of action that the hospital should take to meet the standards of the Emergency Medical Treatment and Active Labor Act (EMTALA).

University of Phoenix Material
Let It Pour: My First Assignment as Executive Assistant
Who says rainy days and Mondays can get you down? It?s Monday and raining, and I?m on top of the world! On Saturday I got engaged, on Sunday we found a house that we?re going to bid on this coming weekend, today is the first day of my promotion to executive assistant to the chief executive officer (CEO), and this coming Saturday I?m graduating, having completed my bachelors at the University of Phoenix. Oh yeah! ?Let it pour,? I yell to myself as I pull into the hospital?s parking lot.
In fact, rain is good! Why do they always call anything but sunshine ?bad weather?? After such a long dry spell, we need the moisture. It helps the crops grow, cleans the air, and fills the lakes. So, all the eaters, breathers, and water drinkers--that should cover us all--can?t live without it. Bad weather? What kind of thinking is that? Uh, oh! My thinking is bouncing around like the waves of the puddle I just stepped in.
Greetings and best wishes surround me as I make my way to the executive offices--my new place of employment. I discover my office to be a single desk in space shared with the CEO?s administrative assistant (AA). No problem! The AA is a great person, with a positive attitude, a good thinker, and very efficient. We?ll work well together.
?Good morning. Your new business cards are on your desk; here?s a writing pad, and the boss wants to see you in the executive meeting room ASAP,? shoots out of the AA?s mouth as if from an automatic weapon. I throw my attach? case ?on? my office--the desk--grab one of my new business cards, and hustle to the meeting room. I take a quick look at my card. There it is: Chris Smith, Executive Assistant, Faith Community Hospital.
As I reach for the door handle, it seems unusually low. I must be walking above the clouds. My moment of pride is cut short by the incredible panoramic view of our beautiful valley--that view, the clouds with their infinite variety of geometric patterns and shades of white and gray, rolling through the sky.
?Good morning, Chris,? my new boss greets me. ?Welcome aboard,? Pat offers, more as an obligatory greeting than a real welcome. ?These rainy days and Mondays really get me down. Have a seat.? As I sit down, Pat continues by commenting, ?I understand you?re about to get your degree.?
?I am almost done! This Saturday is graduation,? I answer, with a sense of pride and relief and somewhat nostalgically.
?Far from done; you?ve only just begun,? the CEO clarifies. ?But, before we go on with the task at hand, tell me: which courses did you enjoy the most?? Just as I begin to answer, Pat quickly adds, ?Let me change that question: in which courses did you learn the most??
I think, ?Which ones do you want to hear?? but I answer, ?Management, Public Speaking, Organizational Behavior, Ethics, and, of course, Critical Thinking.?
?Great,? answers the CEO, ?because you?re going to need every one of those and more with the first assignment I?m about to give you. Are you ready to apply your newly developed skills??
?Let the rain fall down on me,? I respond, hoping Pat has a sense of humor.
?Oh it will, and I hope it doesn?t dissolve you.? Yes, Pat does have sense of humor.
?I see you have your business card. Turn it over, please. Just in case you don?t have the mission statement memorized, you can always read it, right there on the back of the card.
?With the foundation and commitment of our spiritual heritage and values, our mission is to promote the health and well-being of the people in the communities we serve through a comprehensive continuum of services provided in collaboration with the partners who share the same vision and values.?
?What do you think?? asks Pat.
?I do believe it and I?ll certainly try hard to live by it. Plus, by having it on the back of our cards, we?re doing a great job at keeping it in front of everybody, so to speak,? I chuckle.
?Nice play on words, Chris. Unfortunately, few Faith Community members and partners seem to be flipping for it lately,? responds the CEO. We?ve got some interesting interpretations of the mission statement being made in all of our stakeholder groups. Very patchy, I must say. Chris, do you have any idea what?s going on out there??
?It?s pouring,? I respond bluntly.
?Yes it is!? Pat confirms. ?It?s falling from every direction, and coming in all over the place. Here?s some of what I?m thinking about.
?Let?s start with this morning?s news headline that medical errors cause tens of thousands of deaths each year, close to 100,000 in hospitals alone. With that as the external panoramic view, let me paint the picture for you, from the inside out.
?I report directly to the Board of Directors of the Faith Foundation. Its diversity alone represents a kaleidoscope of thinking and decision-making. The grand point of commonality among the Board members is their support of the purpose, values, and survival of Faith Hospital. The entire community knows of our religious heritage and our commitment to the public. That openness attracts a wide variety of believers--Board of Directors, staff, patients and their families, as well as others--each with infinite influences on his or her own thinking. I?m not sure how many of our stakeholders realize or understand the differences between ethics, laws, beliefs, oaths, etc. If they do understand, how many accept the fact that we draw our value lines at diverse junctures when it comes to applying these ground rules?
?On one hand, we have particular patients who refuse to take certain medical services, and on the other hand, particular staff members who refuse to provide certain services. In both cases, they feel that medical intervention can go too far into conflict with their religious beliefs or personal moral convictions. We have a case in our Neo-Natal Ward, where Child Protective Services is in the process of taking custody of the baby and threatening to file charges against us because of the way we provided services or, as they allege, failed to provide services. All this trouble, despite our actions being in agreement with the parents? wishes. Last week, three staff members in the ICU initiated Do Not Resuscitate (DNR) directives. The only problem was that no written orders to that effect existed. At the same time, I have some sincere, qualified staff that are driven by a personal directive that says ?we have to do all that we can.? In another recent incident, staff members did not follow DNR directives even though these were in place. Moreover, all three events had the support of the patients? families.
?And how are our doctors responding? Well, they?re putting patients first, I guess! From various interpretations of the Hippocratic oath, to assorted compassions and passions regarding the ?right to die,? they are all over the place. From managed care to capitation, health care givers are experiencing a tremendous loss of power.
?Nonetheless, we have wonderful people who care very much about the well-being of their patients; so much so, in fact, that one of our hospital pharmacists is filling uninsured prescriptions by accepting payment in installments. Two of our counselors are treating some of their clients pro bono--unauthorized! At the other end of the spectrum, some staff members care so much about Faith?s survival that they refuse to serve patients unless they confirm insurance coverage first. You can imagine how popular that is with patients and the media alike. All we need is for someone to die because we didn?t service him or her! One of our residents is ordering fruitless exams for the terminally ill.
?Those who request our services (i.e., our clients, the public) come to us from all points of the compass?.?
??Or spectrums of the rainbow,? I interject.
?O.K.,? the CEO responds slowly. ?From all spectrums of the rainbow. But I?m not talking as much about ethnicity, culture, or physical stuff--stuff, one of those biomed-tech terms, you know--as I am about the range of responsibility. Between their needs and wants, our patients bring a massive flood of service demands through our doors. Sure, we all want to live healthier and longer, but who has the greatest responsibility for health maintenance? And when someone?s well being is in distress, we at Faith had better provide the perfect remedy. Heck, it?s like blaming the rain for getting wet, or the umbrella if you?re not totally dry.
?If we had more time and stamina, I could also tell you about so-called especially wonderful collaborations with insurance companies and the regulators--HMOs, PPOs, and other TLAs--you know, three letter acronyms such as AMA, AHA, HHS, etc. Who gets covered, how much and when we get paid, seem to be totally out of our hands at times. At the same time, we get so-called supportive intervention that goes something like, ?I?m from Medicare and Medicaid, and I?m here to save you.? And, if they don?t, we, of course, have our own insurance coverage. I bet you wouldn?t believe me if I told you that our premium costs are decreasing. Good, because they?re not!
?Look at how much our costs have increased compared to last year. A year ago, our costs were $217.00 per patient per day. On the last report that I received from accounting, that figure had risen to $240.00. Two questions came immediately to mind when I saw this number: Are we running a less efficient operation? Can we reduce costs without impacting quality?
?I asked the financial analyst for an evaluation, and he indicated that we?ve had a 7% decrease in patient population. Roughly 28% of our costs are fixed costs--costs that do not vary with the fluctuating patient population. This tells me that our costs do not change proportionally with the number of patients that we treat. If we can?t do something to increase the patient count, then we will have to make some tough cost-reduction decisions. Assuming that we are not able to increase our patient count, we will have to reduce our fixed cost to break even.?
As I listen to Pat, I try not to let my mounting stress show in my face. At this point, I wish I had paid more attention in those accounting and finance courses I took?.
Pat picks up a paper from the desk. ?Here is some data that you might find interesting, Chris. If we hold steady at 7,863 patients and 39,866 patient days, we will be forced to reduce our fixed costs by 15% just to break even. That assumes that our average reimbursement rate does not change. That is one heck of a big reduction!?
?I?m sorry, it?s just that I?m getting showered with chaos. I really don?t believe everyone is against us. We may have a written unifying mission statement, but everyone thinks about it differently. We may all be in the same boat during the same storm, but no two people are rowing in the same way or in the same direction. In fact, some don?t even have their oars in the water! Harsh as it may sound, I?ve got a business to run here. We may be a not-for-profit, but we have people to serve, bills to pay, a mission to live by--as if I need the Board to remind me--and it is pouring.
?I?m not sure of my role any more. I mean, where should I be spending most of my time and energy, not to mention other resources? Should I fight for healthcare reform or reform the healthcare fight? I?m not trying to play word games here, but are the answers from the outside in, or vice versa??
Pat takes a slow and deliberate pause, and then turns to me appearing ready and eager to solve the problems before us.
?Here, then, is your first assignment,? says Pat. ?I want you to put together a preliminary report that will form the basis for my presentation at that meeting. Two weeks from today, we will hold the first all-member staff meeting I?ve attempted during my ten years at Faith.?
Pat is ready and eager to solve the problems before us by first delegating them to me.
?We will also tape the meeting for those who can?t be there in person or who need to review the message a few times. And, guess what added bonus we?ll have? Members of the media are requesting permission to attend.
?I?m not asking you to write a speech. I can create my own message. But I do want you to give me some ideas about what to say. If I talk about all the stuff going on, I?ll have everyone running for a storm shelter; therefore, capture the essential components. Just as importantly, though, I want some specifics on how to say it. What I?d like you to do is to give me a strategic overview that offers a look from three angles: what?s going on right now, what we can do about it, and what we should do about it.?
?These are the three main elements of a case study,? I proclaim.
?Great! Our investment in your schooling is paying off already,? adds Pat, somewhat sarcastically.
?I want you to use your critical-thinking skills in addressing the main topics that I need to cover in this presentation. To me, these appear to be organizational processes, ethics issues, and communication systems. I also want you to address--to paraphrase what it says at the end of a job description--any other particulars not identified at this time.
?Oh, by the way, Chris, I hate to rain on your parade, but I want to go over that report with you next Monday. Good luck on your first week.?
As I leave the executive office my legs move as if I have 20-pound ankles weights on each foot. I quietly whisper to myself, ?Rainy days and Mondays still don?t get me down. Let it pour.?
Here?s what I came up with?.
1. Define the problems that appear in this case study.
2. Propose the appropriate solution(s).
3. Describe your rationale for the proposed solution(s).
Use the appropriate format for your paper.


There are faxes for this order.

As you can see below, this is my approved proposal. There are some required references and a decision matrix listed in the description of how the student will address the Program Outcomes. If you have any questions, please don't hesitate to email me. I will be send the links to the resources, the syllabus, and the Capstone Exam instructions.

-Comprehensive Question 1

Statement of the question. How does an accident investigator analyze the human factors and decipher what role they played in an accident? How will the safety manager effectively utilize this data in order to make recommendations or changes to the Safety Management System (SMS)?

-Program outcomes addressed by this question.

Program Outcome #3 - Information Literacy. The student will use multiple valid and reliable resources to provide accurate information relating to the percentage of aviation accidents resulting from human factors. These resources will be utilized in order of precedence as they apply to aviation safety and their application to human factors, accident investigators, and the applicable safety regulations. The FAA website will be the primary resource, while blogs, journals, research papers, and other websites will be secondary.

Program Outcome #10 - Aviation Safety. The student will describe how an accident investigator evaluates the safety program procedures and draws a conclusion on the results of an incident. This will include the impact of human factors and human error on the incident and how to prevent it from happening again. The student will also discuss how safety personnel evaluate and analyze prior aviation accidents to make changes to the SMS. This will include an explanation of the functions of an SMS and its role to prevent accidents, as outlined on the FAA website.


-Comprehensive Question 2

Statement of the question. What were some the major changes in aircraft design between the Wright Flyer of 1903 and the Boeing 707? How did the aviation community utilize emerging aeronautical technology and contribute to the advancement of aviation concepts? More specifically, which aircraft were used and what was learned from each one? How did these aircraft contribute to the advancement of aviation?

-Program outcomes addressed by this question.

Program Outcome #6 - Cultural Literacy. The student will analyze the historical events and describe the impact that they had on the aviation community, which heightened the interest in aviation and air travel. This project will include how the manufacturers took what they had learned from their predecessors and applied it to their emerging design ideas. The student will examine the evolution of the Wright Flyer, the Ryan Monoplane, the DC-3, the Stratoliner, and the Boeing 707. This will include how each one of these shaped the face of aviation. The primary references on the history and science of these aircraft will be derived from a book written by the National Aeronautics and Space Administration called Progress in Aircraft Design since 1903 and The Airplane: A History of its Technology.

Program Outcome #8 - Aeronautical Science. The student will discuss the advancement in aeronautical knowledge made by the designers of these five aircraft. These will include key aeronautical innovations like 3-axis control, propellers, the liquid-cooled aero engine, retractable landing gear, wing flaps, jet engines, and many more. The student will also analyze how the designers utilized what they learned from these increasingly sophisticated flying machines to produce a better, more efficient, and safer aircraft. The two books mentioned in Program Outcome #6 will also be utilized to assess these advancements in aeronautical science, to include the pros and cons of each.


-Comprehensive Question 3

Statement of the question. What would a helicopter pilot need to consider when opening a helicopter scenic tour business? Specifically, what type of helicopter, certificates required, initial and ongoing costs, and location or locations that best fits the needs of the business. Will this business be able to operate year round based on weather, maintenance, and customers?

-Program outcomes addressed by this question.

Program Outcome #2 - Quantitative Reasoning. The student will develop a decision matrix, as outlined in the Commander and Staff Officer guide, to help the business determine which helicopter is best for their operation. The primary consideration for the matrix will be the capabilities of the helicopter, but will also take into consideration things like burn rate, maintenance, and required certificates. The values for the matrix will be selected by the student based on his analysis of the selection criteria. The helicopter with the greatest value will be selected for the business.
Program Outcome #5 - Scientific Literacy. The student will utilize scientific literacy to evaluate what type of aircraft would best suit a helicopter scenic tour business. This will include performance capabilities of the helicopter, environmental considerations, and intended use. This data will be retrieved from the Bell Helicopter and Eurocopter websites. The student will also analyze the weather patterns, which will be obtained through The National Weather Service, to determine the location or locations that will best fit a year round operational business.

Program Outcome # 11 - Aviation Management and Operations. The student will demonstrate knowledge and competence in aviation operations and management by explaining the considerations involved with starting up and running a scenic helicopter business. These considerations will cover heliport operations, safety program implementation, maintenance management, and staffing requirements. The management guide that will be utilized is from the National Business Aviation Association (NBAA). The student will also discuss Title 14 CFR Part 135, Operating Requirements: Commuter and On Demand Operations and Rules, as per the 2014 Federal Aviation Regulations (FAR) Aeronautical Information Manual (AIM).


-Comprehensive Question 4

Statement of the question. How is the Federal Aviation Administration (FAA) going to integrate the safe use of Unmanned Aircraft Systems (UAS) in the National Airspace System (NAS) without reducing current operations?
Program outcomes addressed by this question.

Program Outcome #4 - Communication. The student will demonstrate competence in communication skills by the use of written word and word-processing software to explain the integration of the UAS, use of PowerPoint to provide visual aids and timelines during the presentation, insertion of appropriate figures and tables to support the data and describe complex ideas as they relate to the implementation of the UAS into the National Airspace System.

Program Outcome #9 - Aviation Legislation and Law. The student will demonstrate knowledge of aviation legislation and law during the analysis of regulations governing the establishment and operation of UAS in the National Airspace System. The regulations that will be discussed and apply to the UAS integration are the FAA, International Civil Aviation Organization (ICAO), and National Security. The student will also analyze the plans for safely integrating UAS operation in the NAS by 2015, which is outlined in the FAA Modernization and Reform Act of 2012.


-Comprehensive Question 5

Statement of the question. How does an Army helicopter pilot make the transition to an Emergency Medical Services (EMS) helicopter pilot? What additional certificates, training, and skills are necessary to enter the industry?

-Program outcomes addressed by this question.

Program Outcome #1 ??" Critical Thinking. The student will evaluate the pros and cons of the additional training, flight time, and certificates required in order to successfully obtain a job as an EMS pilot. The student will then use that data to analyze the resume and decide what steps need to be taken and establish the priorities of each one. The decision making process, as outline in the Commander and Staff Officer Guide, will be used to determine what should be taken into consideration and the final outcome. Some examples of these considerations are; prerequisites, cost benefit, and career advancement. The final course of action will be determined based on the students knowledge and understanding of the job requirements outlined by Air Evac Lifeteam website.

Program Outcome #7 ??" Life Long Personal Growth. The student will assess what an Army helicopter pilot can do throughout his career, based on his training and experience, to better prepare himself for a successful career in the EMS community. This will include topics such as; gaining civil ratings and certificates, flight time and experience, and joining aviation organizations outside of the military. The student will also evaluate the benefits of the related topics as they apply to the hiring process, job security, and career advancement. One of the topics that should be considered is the resultant insurance cost based on the pilots resume.

There are faxes for this order.

Sources have been uploaded (3 files uploaded:
-DOHMS: 21 pages
- Strategic plan: 26 pages
- Checklist example: 1 page)


Assume that you have been appointed to the Executive Committee of Rashid Hospital within the departement of health & Medical Service(brief describtion of organization details is emailed). You have been asked to develop a strategic plan for the Rashid Hospital.

Kindly note that an initiative strategic plan for Rashid hospital is emailed including:
a. brief description of the organization
b. Statements of vision, mission, and values for the organization in the context of the future.
c. Realistic strategic goals for the organization
d. For those goals, detailed action plan to achieve the desired outcomes.

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So with relation to the above mentioned points and in addition to it, please prepare a report consisting of the following strategic planning components:

1)an assessment of the external environment of the organization, including discussion of payers for care, population served, and competitors.
2)a description of the internal environment of the organization.
3)Use either Porters five forces model and/or a TOWS model to assess the organization.
4)A checklist linking strategic alternatives with the situational analysis. (example is emailed)
5)Discussion of the specific methods to evaluate strategies. (Examples include product life cycle, portfolio analysis, the "Space" Matrix, and contingency planning. The key is that you cannot conduct dozens of analyses; based upon the organization and its environment select a small number of tools to further your planning activity.)


The following text book can be of great help and can be used as a reference- if available- " Strategic Managment of Health Care Organizations" ( Linda E. Swayne, W. Jack Duncan, Peter M. Ginter)


There are faxes for this order.

This essay is a personal statement for medical school and needs to be about myself and why i am a good candidate for medical school and would succeed.

1. I volunteer on an emergency medical service Hatzalah and responded to over 300 emergency calls in my local community in New York City. I take calls at all hours of the day from morning to night. I have gained tremendous medical skills and learned how to communicate with patients appropriately. I also took time to be certified as a CPR and first aid instructor to teach the community to be able to respond to emergencies appropriately.
2.I volunteered in Kings County Hopspital Center, which is level 1 trauma center, i was able to observe critical care and critical trauma patients. I have seen 18 year olds die from gunshot wounds and the elder die from strokes and heart attacks and i beleive it has allowed me to mature and be able to handle these critical situations. At the same time, i have seen people hanging on to their last breath and be brought back to life. Shadowing the various ER doctors and trauma surgeons allowed them to teach me many skills that cannot be learned via textbook.
3. I spent one semester in research in the cancer of biology. I surgically removed tumors and stitched them back. The research was an attempt to treat circulating breast cancer cells. Besides being in the medical field, this allowed me to be in the laboratory research setting.
4. I volunteered in old age home Isabella specifically on the alzhiemers and dementia ward and spent a few hours a week making them smile and playing games to provide a brightspot in their week.
5. Besides actally working in the medical field, the undergraduate classes i attended in my biology major were focused on medicine. The more i learn, the more i am interested in the subject. I usually end up spending most of my time talking medicine with my EMS partners or father who is a doctor.

These are my voluteerships listed as very straightforward but the key is making it UNIQUE interpretation of how these experiences shaped me into a great candidate for medical school.

ARNOLD PALMER HOSPITAL Arnold Palmer Hospital was founded in 1989. It is one of the largest hospitals for women and children in the U.S., with 431 beds in two facilities totalling 676,000 square feet. Located in downtown Orlando, Florida, and named after its famed golf benefactor, the hospital with more than 2000 employees serves an 18-county area in central Florida and is the only Level 1 trauma centre for children in that region. Arnold Palmer Hospital provides a broad range of medical services including neonatal and paediatric intensive care, paediatric oncology and cardiology, care for high-risk pregnancies, and maternal intensive care.
The Issues of Assessing Quality Health Care Quality health care is a goal all hospitals profess, but Arnold Palmer Hospital has actually developed comprehensive and scientific means of asking customers to judge the quality of care they receive. Participating in a national benchmark comparison against other hospitals, Arnold Palmer hospital consistently scores in the top 10% in overall patient satisfaction. Executive Director Kathy Swanson states, Hospitals in this area will be distinguished largely on the basis of their customer satisfaction. We must have accurate information about how our patients and their families judge quality of our care, so I follow the questionnaire results daily. The in-depth survey helps me and others on my team to gain quick knowledge from patient feedback. Arnold Palmer Hospital
employees are empowered to provide gifts in value up to 0 to patients who find reason to complain about any hospital service such as food, courtesy, responsiveness, or cleanliness.
Swanson doesnt focus just on the customer surveys, which are mailed to patients one week after discharge, but also on a variety of internal measures. These measures usually start at the grassroots level, where the staff sees a problem and develops ways to track performance. The hospitals longstanding philosophy supports the concept that each patient is important and respected as a person. That patient has the right to
comprehensive, compassionate family - centered health care provided by a knowledgeable physician-directed team.
Some of the measures Swanson carefully monitors for continuous improvement are morbidity, infection rates, readmission rates, costs per case, and length of stays. The tools she uses daily include Pareto charts, flowcharts, and process charts, in addition to benchmarking against hospitals both nationally and in the southeast region.
Arnold Palmer Hospitals Supply Chain Arnold Palmer Hospital had been a long-time member of a large buying group, one servicing 900 members. But the group did have a few limitations. For example, it might change suppliers for a particular product every year (based 0n a new lower-cost bidder) or stock only a product that was not familiar to the physicians at Arnold Palmer Hospital. The buying group was also not able to negotiate contracts with local manufacturers to secure the best pricing.
Effective supply chain management in manufacturing often focuses on development of new product innovations and efficiency through buyer-vendor collaboration. However, the approach in a service industry has a slightly different emphasis. At Arnold palmer Hospital, supply chain opportunities often manifest themselves through the Medical Economic Outcomes Committee. This Committee (and its subcommittees) consists of users (including the medical and nursing staff) who evaluate purchase options with a goal of better medicine while achieving economic targets.
(Source: HEIZER, J. & RENDER, B. (2008). Principles of Operations Management. 7th ed. New Jersey, Pearson Prentice Hall.)

Requirement You are required to critically evaluate Arnold Palmer Hospitals approach in managing their quality of services, processes and supply chain from both a strategic and tactical viewpoint. Develop and justify a new approach towards enhancing the quality of services, processes and supply chain at Arnold Palmer Hospital. In doing these, evaluate the transformations required to enhance Arnold Palmer Hospitals philosophy of 100% patient satisfaction.
Can consider tools for Arnold palmer hospital: JIT( Just in Time tools), TQM( Total Quality Management),Taguchi concept,
Ways of improving quality service in food, cleanliness, staff responsiveness, hospital facilities. How to improve?
Ways of improving supply chain
Please add in text citation in assignments and give references
At 15 references required

Critique 2 or more sections of company's code of ethics. Are those sections of the code working well or should be revised? Be specific in your recommendations. Also discuss ways you could "incentivize" the code.
here's code of ethics for hospital:

OUR PRINCPLES OF ETHICAL CONDUCT INCLUDE:
LEGAL & ETHICAL REQUIREMENTS
???? Compliance with applicable laws, rules and regulations governing Lenox Hill Hospital and
its Affiliates.
???? Adherence to high ethical standards and use of good judgment.
PATIENT RELATIONS
???? Provision of patient care that is medically necessary and appropriate in a respectful and
dignified manner, without regard to race, color, creed, sex, ethnic origin, age, disability,
sexual orientation, source of payment, or other classification prohibited by law.
???? Recognition of the patients right to make informed decisions about medical treatment and
advanced directives and respect for patient choice.
???? Responsibility to protect patient privacy and confidentiality.
???? Compliance with laws and regulations relating to the provision of emergency care to patients.
PHYSICIAN AND PROVIDER RELATIONSHIPS
???? Acceptance of patient referrals and referrals of patients without regard to the direct or
indirect payment or receipt of remuneration, based on each patients medical need and the
providers ability to render the service.
???? Adherence to legal requirements of contractual arrangements or joint ventures with
physicians .
???? Proper supervision of allied health care professionals and residents and other house staff.
ii
MANAGED CARE RELATIONSHIPS
???? Avoidance of improper financial incentives under managed care contracts that would result
in underutilization of medically necessary services.
RECORD KEEPING
???? Truthful, accurate, and legible completion of medical records, billing records, business
records and regulatory and financial reports.
???? Retention, storage and disposal of patient and business records and information in
accordance with legal and business requirements.
PRIVACY AND CONFIDENTIAL INFORMATION
???? Protection and safeguarding of information created in the conduct of Lenox Hill Hospital and
its affiliates business including patient information, staff data, financial data, research data,
strategic plans, statistical information, purchasing agreements and contracts.
???? Protecting and enhancing the rights of patients by providing them access to their information
and controlling the inappropriate use of that information pursuant to the Health Insurance
Portability and Accountability Act of 1996 (HIPAA).
BILLING FOR SERVICES
???? Accurate coding and billing for medical services rendered in accordance with legal
requirements and agreements with third party payors.
???? Compliance with applicable legal, regulatory and program requirements in the preparation
and submission of claims for reimbursement and reports concerning the costs of the hospital
and its affiliates operations.
???? Avoidance of improper waivers and write-offs of patient costs.
BUSINESS PRACTICES
???? Selection of supplies, vendors, contractors and consultants based upon fair, competitive
practices and objective factors including quality, price, service and delivery.
???? Avoidance of transactions that excessively benefit private individuals in contravention of
laws and regulations applicable to tax-exempt organizations.
???? Adherence to Lenox Hill Hospital policies on solicitation and acceptance of charitable
contributions.
???? Compliance with laws respecting the use of intellectual property.
INTERNAL CONTROLS
???? Safeguarding of proper internal financial controls in compliance with established accounting
control standards and procedures.
???? Maintain the integrity of the Hospitals financial statements and its financial reporting
process.
iii
CONFLICTS OF INTEREST
???? Avoidance of situations or conduct that may involve a conflict between personal interests and
the interests of Lenox Hill Hospital and its Affiliates.
CLINICAL RESEARCH
???? Observance of laws and regulations relating to reporting, use of grant and private research
funds, audits, informed consent and reimbursement in clinical research.
???? Compliance with IRB policies, procedures and directives.
???? Integrity in the research process, avoidance of conflicts of interest, improper inducements,
and other forms of scientific misconduct.
???? Protection of the privacy of health information of research subjects.
???? Conduct of research in compliance with approved protocols.
WORKPLACE PRACTICES
???? Fair and respectful treatment of employees, staff and co-workers.
???? Prohibiting discrimination based on race, color, religion, gender, national origin, age,
citizenship status, disability or sexual orientation and prohibiting sexual harassment.
???? Compliance with environmental laws and regulations including the proper storage, handling
and disposal of hazardous material and infectious waste.
???? Proper handling and dispensation of controlled substances in accordance with applicable law.
???? Avoidance of the use of Lenox Hill Hospital and its Affiliates resources to influence the
political process.
MARKETING AND ADVERTISING
???? Truthful and accurate marketing and advertising of medical services for educating the public,
reporting to the community and increasing awareness of the Hospitals mission of the
Hospital and its Affiliates.
???? Compliance with rules applicable to marketing to Medicare and Medicaid beneficiaries.
HOW TO USE THE COMPLIANCE PROGRAM
All employees and staff have a part to play in ensuring that the business of the Hospital and its
affiliates is conducted legally and ethically. All employees and staff are responsible for
performing their assigned duties in accordance with the principles of ethical and legal conduct
and are obligated to report suspected violations of laws, regulations or the Code of Ethics to their
immediate supervisors or the Compliance Officer. The Compliance Officer is responsible for
coordinating the dissemination of information on new laws or regulations that govern the
activities of the Hospital and its affiliates or information related to changes in existing laws or
regulations. All communications will reinforce the employees responsibility to comply with
applicable laws and policies and to report a suspected violation to the Compliance Office.
iv
The Compliance Office may be reached 24 hours a day, seven days a week by calling: (212)
434 - 2126. The Hospital and its Affiliates prohibit any retaliation against an employee who, in
good faith, reports a question or concern about a compliance matter.

Create a report and executive summary to be delivered to the "Mayor".
APA would not apply. Develop strategy(s) for providing fire and EMS services to Collinsville Township. This magical mystical township exists only in our minds, but represents many facets of real life situations. The town has about 12,000 population, three schools (elementary, middle and high), a small hospital, a strong downtown commerce section, and other typical governmental facilities. Fire service is provided by a department located near the center of town that responds with 2 engines, 1 ALS ambulance, 1 BLS ambulance 1 ladder, a tanker and a brush truck. Additionally they have two staff vehicles and a supply truck. Staffing comes from the chief and a fire code inspector who work M-F day schedules, two fire fighters are on each 24-48 hour shift, and 20 paid on call staff members. The closest mutual aid is more than 12 miles away from the closes point and 23 miles at the most remote point. Collinsville is essentially a peninsula formed by rivers on two sides and large rock outcropping type mountains on the third. Call volume is provided in the database format with the GIS map.

The primary issue facing Collinsville Fire and Rescue is that citizens in the rural area are complaining about service levels. Data provides fire and ems call volume and times, but the chief indicates the real problem is getting paid-on-call staff in the remote area. Driving time is long for apparatus but population is not sufficient to staff a fire station even if it were built and equipped. Change is occurring in the rural area, developers are dividing large ranches in the eastern region along the river and mountains into 75-125 acre tracts, and building $1 - $5 million dollar second homes. This development is being marketed as ranch living.

For the Collinsville project, you will review data for a community that is experiencing significant change, along with associated challenges for providing fire and emergency medical services. Strategies will be developed for this community with the Diamond-E Framework in mind. A change management model will be described for each emerging strategy. The change management model as discussed in Strategic Analysis and Action by Mary. M. Crossan.

Assignment:
As evidence of progress on your project provide a paper that identifies and discusses the administrative/managerial, legal, ethical, financial implications of the problem listed below in the background information.



Using this background information/problems discussed in here to answer the question above (include introduction and conclusion, 12 Font Times Roman):
My occupation in the military is a field medical assistant which is a general term used for all medical service officers. My specialty is a health care manager. The occupation of a health care manager can include many different responsibilities in a military hospital. Health care managers are necessary in many organizations, from hospitals to HMOs and other insurance programs. A health care manager in a small clinic may have very different responsibilities than a health care manager at a huge hospital, and both deal with very different issues than a health care manager that works for an HMO. However, the qualifications are very similar. To be a health care manager one must have a degree in health care management (or be a doctor with experience and training in management) and be able to organize and oversee aspects of management and patient care. The responsibilities also have one thing in common: a health care manager is someone other than a patient?s personal physician who has the difficult task of deciding what kind of care is appropriate and arranging circumstances so that can be provided. ?Health care managers play essential roles in keeping the business of health care running smoothly. They plan, direct, coordinate, and supervise the delivery of health care.
Within the military hospital setting, a health care manager has a number of roles. The primary health care manager is responsible only to the hospital commander, though indirectly one could say that they also answer to Tricare and insurance companies because they have to juggle their demands and conditions in order to be financially reasonable. The health care manager is the one to whom doctors and nurses must go for direction, and to whom they are answerable regarding the financial aspects and some of the organizational aspects of their job. Daily duties in a large military hospital are primarily delegatory so that subordinate health care managers do more of the paperwork, but in a small clinic, the health care manager is actively responsible for the record keeping involved with filing medical charts and organizing patient records. They also must answer patient questions about insurance, process insurance claims and take charge of the billing, collections, and other financial concerns such as taxes. Health care managers also oversee personnel development, such as hiring of civilians and organizing employees and soldiers, evaluating the performance and financial intake of civilian doctors, enforcing work schedules, and making general goals for the hospital. The health care manager may also be in charge of expenditures on equipment, and upgrading or maintaining the facility.
As can be imagined, there are a nearly infinite number of things that can go wrong for a health care manager. Two common problems are worth some attention. The first deals with the ubiquitous staff problems that arise in any managerial position. Doctors and nurses may have interpersonal conflicts. Certain doctors may not feel comfortable with the appropriate profit-consciousness and resent the interference of a manager. Budget concerns may mean that everyone has to work long hours, and complaints may arise regarding lack of flexibility or inhospitable working conditions. Poor relations within the staff and resentment between levels (like nurses who resent the doctors, or doctors who resent the interference of management) can represent a real problem with a huge scope. This problem may seem like it represents insurmountable difficulties, however, it is possible that such tensions can be reduced not by making significant changes that would threaten the hospital?s basic profit margin and management, but by implementing more personal attention would make everyone comfortable with the status quo.
On the other side of the problem that arises when staff resent the pressures placed on them from above is the problems that arise when the hospital commander or staff decide that the profit margin is not high enough. The health care manager may be asked to find a way to reduce costs, or to be more efficient, or even to reduce the number of patients. Figuring out how to balance the neat for a trim budget with the doctors need to feel that they have freedom in their treatment options can pose difficulties. Raising the profit margin, balancing the books, and assuring that the hospital is a viable business first and foremost is the biggest problem faced by health care managers in the army. Possible solutions may lie in a variety of fund-raising techniques, cutting waste, reducing unnecessary procedures on the under-insured, and trimming personnel expenses while attempting to assure quality so that the hospital can best attract patients with the willingness and ability to pay for high quality treatment. This is the problem I would prefer to investigate further, since it seems to be the most pressing for most health care managers. ?A 1988 survey of 1,400 general acute-care community hospitals found that the administrators of 700 of the hospitals feared that their institutions would be forced to close in the next five years because of financial problems.

Research Proposal ? Thesis, Major Points, and Plan

Select a topic on which your persuasive writing paper will be focused.

My topic - Should taxes on alcohol and tobacco be increased to help pay for rising medical costs? (My position is that taxes should not be raised)

Write a two (2) page research proposal in which you:

1. Identify the topic you selected and explain two (2) reasons for using it.
2. Include a defensible, relevant thesis statement in the first paragraph.
3. Describe three (3) major characteristics of your audience (official position, decision-making power, current view on topic, other important characteristic).
4. Describe the paper?s scope and outline the major sections.
5. Identify and explain the questions to be answered.
6. Explain your research plan, including the methods of researching and organizing research.
7. Develop a coherently structured paper with an introduction, body, and conclusion.
8. Document at least three (3) primary sources and three (3) secondary sources. Use credible, academic sources available through Strayer University?s Resource Center.


If possible, I would like the following paragraph be incorporated within the paper.
I chose this topic because I feel strongly against the idea that increasing these taxes solves the problem of rising medical costs. This issue is of interest to everyone that uses alcohol or tobacco products as well as anyone that pays for medical services. My argument is that the federal and state governments should find new opportunities to combat rising medical costs other than increasing taxes on alcohol and tobacco products. Furthermore, there is no reason for us to believe these taxes are designed to discourage alcohol and tobacco consumption because that would decrease sources for revenue

The Essay should be written in a professional way for an application for a leadership developmnet program ( a program that is assigned only for leaders & Directors and limited numbers will be accepted depnding on their responces in the application essay)

you'll write a 3 pages. The first one should include:

1. my mission
2. my vision
3. my strategies & Objectives

The second page should include:

discussion of my career objectives and how the leadership development program will contribute to the attainmenet of my objectives

The third page must include:

an example of a situation or an action that describes my potentials for success in a professinal environment (e.g. communication skills,leadership ability, entrepreneurial interests,...etc)
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you can have a look at my CV ( attached) as well as the program websites www.leaders.ae to have an insight about what must be included in the essay.
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for my mission, vision & objectives you may consider the following:
being a female who would like to act as a catalyst for organizational change, be a lead examples for other women in the community and empowering women to lead for success and reach their full potintial.
and being a leader who can influences others to translate vision into action; creates a compelling and inspirational picture of the future.

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for the other parts of the essay you may consider that i'm currently working in the departement of health & Medical Services as a head of standard & criteria development office ( details included in the Cv attached).

i have been working through different areas in my career path because of my enthuasism to learn and make differences in where ever i work. till i get my master degree in healthcare administation where i decided to lead from the top and make difference in quality of healthcare services delivary. i have many accomplichments that i'm proud of dusring my career path and i belive i'm still in the learning process where i still can acomplish more.

for the example part, just imagine any situation or action related to my professional environment.
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Kindly be consice in a professional way covering all aspects as requested above in details in 3 pages.

Please consider the above details as well as my CV and the objectives of the leadership program.
make it as inspiral as you can to increase my opportunity to be accepted in the program.


There are faxes for this order.

Risk Management Assessment Summary


Leaders in a health care organization have identified risk management as an opportunity for improvement for the upcoming year. The organization has hired you as a consultant to help assess the organization?s current status and define the future plan for addressing risks.


? Select an organization type in the health care industry as the basis for this assignment. The organization may be your employer or a health care organization of particular interest to you. Types of health care organizations include, but are not limited to, the following:


o Hospital, nursing facility, physician office, emergency medical services, managed care organization, home health care, community health department or provider, pharmacy, laboratory, drug manufacturer, medical device manufacturer, durable medical equipment supplier, and electronic medical records software suppliers

? Research the key concepts of risk management in health care and the factors that influence risk management for your chosen type of organization.
? Write a 1,050- to 1,400-word paper in which you complete the following:
o Describe the purpose of risk management in health care organizations in general and in your chosen organization in particular.

o Explain key steps this organization may take to identify and manage their risks.

o Identify three typical or actual risks in your chosen organization. Describe how each risk might negatively affect your organization and its stakeholders.

o Summarize the types of education, training, or policies that would help this type of organization mitigate these risks.


? Include at least four sources, two from the University Library and two from either the course textbooks or this week?s Electronic Reserve Readings. Prepare a reference list of all resources and websites used in your research.

1). What are the two basic tools of economics? Give an example of each with respect to health, medical services, and hospitals?

2). What are the various purposes that prices serve? Can you provide an example of how a particular purpose of price has affected an organization you are familiar with?

4). Show how an increase in the quantity of medical care consumed can be achieved through either a demand or supply subsidy. What are the advantages and disadvantages of general versus targeted demand and supply subsidies


PLEASE LIMIT EACH TO A PAGE
REQUIREMENTS
Consistently, concisely and clearly stated new ideas to discuss; contributes solutions to the questions with APA citations from current, peer-reviewed journals; analyzes and evaluates from many positions; consistently uses case studies/examples from interviews or experiences; graduate-level composition; contribute valuable insight based on recent related research.
Concisely summarizing and moving on with new issues based on the discussion and current literature; takes leadership role in individual discussion

The main target of the essay to focus in the important of the leadership and strategy for the head of clinical Auditing unit within the departement of Health and Medical Services.

Clinical Audit Unit responsibility is over all the private healthcare sectors in the area, which include more than 1800 facilities (hospitals, healthcare centers, clinics, etc..). their main activities includes:
1. setting standard of practice for private sector and mesuring the effectivness of it.
2. Assess whether or not standards are being met / improve standards
3. Indicate level of compliance / improve compliance if possible
4. Improve clinical effectiveness.


The responsibility of the head of clinical audit includes:
1. Creating the strategy for embedding clinical audit and standard of practice within private healthcare facilities.
2. Setting audit priorities, agreeing the audit program, implementing the strategy and implementing the audit program. moreover ensuring that these tasks are delivered and completed within the desired time-frame.

So being as a Head of Clinical Audit, how do you think that a course of leadership and strategy can be important for your current work and future career development.

Various leadership outlines, topics and modules can be considered: including- but not limited to-:

Attributes of effective leadership including leadership qualities, laws of leadership, principles of leadership and leadership ethics
Trait approach to leadership including intelligence, self-confidence, determination, integrity and sociability
Organizational leadership including leadership and power, leadership and coercion, leadership and management, change management, time management, decision making, conflict management and shared leadership
Strategic planning/Participatory planning including using the planning network as a strategy
Strategy including principles of personal vision and leadership, principles of win/win, principles of emphatic communication, principles of creative cooperation and principles of balanced self renewal.
Surveillance and related strategies

Identify those modules which can be of assistance to your current functions as a head of clinical audit uniit.

The following text book can be of great help:
1. Kouzes, JM and B. Z. Posner (2002): The leadership challenge. San Francisco, Jossey Bass Publishing

2. Watkins, M. (2003): The first 90 days: Critical success strategies for new leaders at all levels. Boston, Harvard Business School Publishing (will be emailed as a resource).

Please be concise and focus in the main target of the essay.

Thank you.
There are faxes for this order.

Nursing practicum learning agreement
Practicum goals:To analyze, develop, implement, and evaluate an evidence-based seizure disorder nursing assessment skills educational program for nursing staff at the Los Angeles Sheriff's Department Medical Services Bureau (LASDMSB).

Objective and Evidence of Accomplishment #(All Journal Entries Must Relate to a Practicum Objective or Evidence of Accomplishment)Reflective Learning.

1. Submit at least three or four pages of annotated bibliography.
2. Summary of evidence based on nursing seizure disorder assessment skills.
3. Summary of learning needs assessment developed.
4. The outline of education program for the nursing staff
5. Objectives.
6. Content outline.
7. Written copy of two different scenarios.

Singapore's total fertility rate has fallen to a record low; from 1.28 in 2008 to 1.22 in
2009 and 1.16 in 2010. This problem is evident across all three major ethnic groups
in Singapore. It could be traced to people postponing marriage or not getting
married at all. Those who are married also do not have many children.
To solve the problem, the Singapore government is considering new measures to
encourage marriage and procreation. The government may provide incentives for
marriage such as a 50% subsidy for the purchase of HDB flats and a 50% income tax
reduction. To encourage procreation, it may provide free medical services at
government hospitals for child birth, S$10,000 for every child born to a married
couple in Singapore to help with the cost of raising a child, and a 100% subsidy for
the basic education (primary and secondary schools) of the children. The
government may also use sanctions to increase the income tax among the
unmarried working adults as well as increase the restrictions on the purchase of a
HDB flat.

Reference
Ramesh, S. (Jan 18, 2011). ?MM Lee weighs in on Singapore?s record?low fertility rate?.

Retrieved from:
http://www.channelnewsasia.com/stories/singaporelocalnews/view/1105496/.html


a. Draw from the theory of psychological reactance and overjustification effect to
explain how the above approaches to change behaviour among Singaporeans
are unlikely to have the resulting effect on attitude change.
(400 words)

b. Apply the theory of cognitive dissonance to show how attitude change may
occur. Discuss the effects of insufficient justification and a large incentive, and
effort justification.
(700 words)

ASSIGNMENT 2 ??" LITERATURE REVIEW
2,500 word graded paper
This assignment will require you to prepare a literature review which encapsulates the findings of the literature and other information you have gathered. The literature review to be conducted is a narrative review. This is different to a systematic review which is usually undertaken in order to perform a statistical analysis of the findings of previous research. A narrative review involves performing thorough literature searches, describing how these were done, grouping findings according to themes and showing how the articles relate to those themes. It is important to accurately reference all material used.
Specific assessment criteria
In this assignment you should: Succinctly state your aim for the literature review. Succinctly your search strategy (this is to include databases, search engines, key words, time frame of search, inclusion and exclusion criteria, people who you will contact to discuss their work on this particular issue and any other strategies you have used to conduct a systematic search). State the range of literature you obtained (number of articles and main focus). Group findings according to themes and describe the process you used to identify the themes.




I will put lecture and study guide read from page 45 to 47 that are very important

my resources and my proposal you must the same my health issue ( obesity ) you don't change my topic

I will put my friend's answer that help you

the some web that are very important

http://flinders.libguides.com/content.php?pid=178886&sid=1505232

you can see the databes



I found this :

Search for: 9 and 10 and 11 Results: 2 Database: Ovid MEDLINE(R) <1948 to August Week 4 2011>Search Strategy:--------------------------------------------------------------------------------1 Obesity/ or Obesity, Abdominal/ (102944)2 *Overweight/ or *Body Weight/ (24438)3 *Weight Gain/ (5535)4 *Women/ (9661)5 Female/ (5800290)6 *Adolescent/ (19211)7 exp Saudi Arabia/ (6587)8 exp Arabs/ (2343)9 1 or 2 or 3 (125690)10 4 or 5 or 6 (5819694)11 7 or 8 (8825)12 9 and 10 and 11 (148) ***************************2. Obesity among Saudi Female University Students: Dietary Habits and Health Behaviors. Al Qauhiz NM. Journal of the Egyptian Public Health Association. 85(1-2):45-59, 2010. [Journal Article] UI: 21073847 BACKGROUND: The remarkable economic growth in Saudi Arabia has affected the population life style negatively. Theincreasing problem of obesity has been reported from different regions in the kingdom. The rate of overweight andobesity reached 65.4% in the eastern region among females aged 18-74 years old. Although there is considerable amount ofdata on prevalence of obesity, yet, data on dietary habits and food consumption pattern are limited.OBJECTIVES: The present study is a cross- sectional descriptive study aimed at exploring the BMI distribution amonguniversity female students. Food consumption pattern and health related behaviors were also assessed.MATERIAL AND METHODS: 799 students participated in the study; data were collected using self administered questionnaire.Body weight and height were measured to calculate the BMI.RESULTS: Among the study participants, overweight and obesity reached 47.9%. Marriage, presence of obesity among familymembers, frequency of drinking aerated beverages increased the risk of obesity significantly. Misperception of bodyimage was reported by 17.4% and 54.2% of obese and overweight students respectively. Analysis of dietary habits and lifestyles indicated the predominance of unhealthy behaviors.CONCLUSION AND RECOMMENDATIONS: The study results mandate the need for a national strategy to adopt healthy dietaryhabits and life styles.StatusMEDLINEAuthors Full NameAl Qauhiz, Norah M.InstitutionHome Economics (Nutrition and Food Sciences) Department, Princess Nora Bint Abdul Rahman University, Riyadh, SaudiArabia. [email protected] Created20101115 Link to the Ovid Full Text or citation: https://ezproxy.flinders.edu.au/login?url=http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=21073847 Link to the External Link Resolver: http://linkit.flinders.edu.au/flinders?sid=OVID:medline&id=pmid:21073847&id=doi:&issn=0013-2446&isbn=&volume=85&issue=1&spage=45&pages=45-59&date=2010&title=Journal+of+the+Egyptian+Public+Health+Association&atitle=Obesity+among+Saudi+Female+University+Students%3A+Dietary+Habits+and+Health+Behaviors.&aulast=Al+Qauhiz&pid=%3Cauthor%3EAl+Qauhiz+NM%3C%2Fauthor%3E%3CAN%3E21073847%3C%2FAN%3E%3CDT%3EJournal+Article%3C%2FDT%3E 4. Body mass index and obstetric outcomes in pregnant in Saudi Arabia: a prospective cohort study. El-Gilany AH. Hammad S. Annals of Saudi Medicine. 30(5):376-80, 2010 Sep-Oct. [Journal Article] UI: 20697173 BACKGROUND AND OBJECTIVES: We examined the effect of body mass index in early pregnancy on pregnancy outcome since nostudy in Saudi Arabia has addressed this question.METHODS: This prospective cohort study involved women registered for antenatal care during the first month of pregnancyat primary health care centers in Al-Hassa, Saudi Arabia. Data was collected from records and by direct interview.RESULTS: The study included 787 women. Compared to normal weight women (n=307), overweight (n=187) and obese (n=226)women were at increased risk for pregnancy-induced hypertension (RR=4.9 [95% CI 1.6-11.1] and 6.1 [95% CI 2.1-17.8],respectively), gestational diabetes (RR=4.4 [95% CI 1.2-16.3] and 8.6 [95% CI 2.6-28.8]), preeclamptic toxemia (RR=3.8[95% CI 1.1-14.6] and 5.9 [95% CI 1.7-20.4]), urinary tract infections (RR=1.4 [95% CI 0.5-3.9] and 3.7 [95% CI1.7-6.2]), and cesarean delivery (RR=2.0 [95% CI 1.3-3.0] in obese women). Neonates born to obese women had an increasedrisk for postdate pregnancy (RR=3.7 [95% CI 1.2-11.6]), macrosomia (RR=6.8 [95% CI 1.5-30.7]), low 1-minute Apgar score(RR=1.9 [95% CI 1.1-3.6]), and admission to neonatal care units (RR=2.1 [95% CI 1.2-2.7]). On the other hand, low birthweight was less frequent among obese women (RR=0.5 [95% CI 0.3-0.9]) while the risk was high among underweight women(RR=2.3 [95% CI 1.4-3.8]).CONCLUSION: Even with adequate prenatal care, overweight and obesity can adversely affect pregnancy outcomes.StatusMEDLINEAuthors Full NameEl-Gilany, Abdel-Hady. Hammad, Sabry.InstitutionCollege of Medicine, King Faisal University, Al-Hassa, Saudi Arabia.Other IDSource: NLM. PMC2941250Date Created20100913 Link to the Ovid Full Text or citation: https://ezproxy.flinders.edu.au/login?url=http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=20697173 Link to the External Link Resolver: http://linkit.flinders.edu.au/flinders?sid=OVID:medline&id=pmid:20697173&id=doi:&issn=0256-4947&isbn=&volume=30&issue=5&spage=376&pages=376-80&date=2010&title=Annals+of+Saudi+Medicine&atitle=Body+mass+index+and+obstetric+outcomes+in+pregnant+in+Saudi+Arabia%3A+a+prospective+cohort+study.&aulast=El-Gilany&pid=%3Cauthor%3EEl-Gilany+AH%3BHammad+S%3C%2Fauthor%3E%3CAN%3E20697173%3C%2FAN%3E%3CDT%3EJournal+Article%3C%2FDT%3E


Thomson Reuters Web of Knowledge
VR 1.0

PT J
AU Farghaly, NE
Ghazali, BM
Al-Wabel, HM
Sadek, AA
Abbag, FI
AF Farghaly, Nadia E.
Ghazali, Bothaina M.
Al-Wabel, Huda M.
Sadek, Ali A.
Abbag, Fuad I.
TI Life style and nutrition and their impact on health of Saudi school students in Abha, Southwestern region of Saudi Arabia
SO SAUDI MEDICAL JOURNAL
LA English
DT Article
ID CHILDREN; GROWTH; SCHOOLCHILDREN; ADOLESCENTS; ADULTHOOD; PATTERN
AB Objectives: To evaluate the life style and dietary habits of school students and the prevalence of some nutritional problems.
Methods: We conducted this study in Abha city during the scholastic year 2000. A two-stage random sample was used to select the students. The sample consisted of 767 male and female students in different grades of education. A designed questionnaire was used to collect data regarding life style practices and dietary habits. Weight, height, and body mass index were obtained.
Results: Diets were rich in carbohydrates, and deficient in fiber. Breakfast was a regular meal for 72% of primary school students compared to 49% of secondary school students. Milk was consumed daily by 51.5% of the sample; fast food consumption was low (2.0 +/- 1.7 times/month). Physical exercise was practiced significantly longer by males than by females; 8.6% and 5.8% of males in intermediate and secondary grades were smokers. Sleeping hours during school days were adequate (7.4 +/- 1.7 hours/day), but relatively higher (9.5 +/- 2.3) during vacation. Underweight (18.9%), obesity (15.9%), and overweight (11%) were prevalent. Overweight and obesity were significantly more prevailing among females of primary and secondary grades.
Conclusion: Health education and physical education programs in the schools are recommended to promote healthy life styles and dietary habits. School feeding programs may be required to achieve some of these goals.
C1 King Khalid Univ, Coll Med, Dept Child Hlth, Abha, Saudi Arabia
King Khalid Univ, Male Coll Hlth Sci, Abha, Saudi Arabia
King Khalid Univ, Female Coll Hlth Sci, Abha, Saudi Arabia
RP Abbag, FI (reprint author), King Khalid Univ, Coll Med, Dept Child Hlth, POB 641, Abha, Saudi Arabia
EM [email protected]
NR 18
TC 3
Z9 3
PU SAUDI MED J
PI RIYADH
PA ARMED FORCES HOSPITAL, PO BOX 7897,, RIYADH 11159, SAUDI ARABIA
SN 0379-5284
J9 SAUDI MED J
JI Saudi Med. J.
PD MAR
PY 2007
VL 28
IS 3
BP 415
EP 421
PG 7
WC Medicine, General & Internal
SC General & Internal Medicine
GA 165NL
UT WOS:000246312100020
ER




Source: Scopus

Abalkhail, B.A.a b , Shawky, S.a , Soliman, N.K.a
Validity of self-reported weight and height among Saudi school children and adolescents
(2002) Saudi Medical Journal, 23 (7), pp. 831-837. Cited 14 times.


a Department of Community Medicine and Primary Health Care, College of Medicine and Allied Health Sciences, King Abdul-Aziz University, Jeddah, Saudi Arabia
b Department of Community Medicine and Primary Health Care, Faculty of Medicine and Allied Health Sciences, King Abdul-Aziz University, PO Box 80205, Jeddah 21589, Saudi Arabia


Abstract
Objectives: To explore the relationship between self-reported weight and height to actual weight and height in a cross-sectional representative sample of school students in Jeddah City, Kingdom of Saudi Arabia and its relation to selected socio-economic and socio-demographic factors. Also to evaluate the validity of self-reported weight and height measurements. Methods: Data was collected from a sample of Saudi school students in Jeddah City, KSA from 42 boys' schools and 42 girls' schools during the month of April 2000. Data collection was carried out by an in-person interview to collect sociodemographic and self-reported weight and height, as well as, actual measurement of weight and height. Body mass index was classified according to age and genders into underweight (<15th percentile), normal weight (?15th percentile to <85th percentile), overweight (?85th percentile to <95th percentile) and obesity (?95th percentile). Validity of self-reported obesity, as compared to measured body mass index, was assessed. Results: A total of 2,860 Saudi school students were enrolled in the study with an age range from 9 to 21 years (mean=13.9, standard deviation=2.8). Overweight was reported in 13.4% and obesity in 13.5% of school students. Overweight and obesity were more marked among those of at least 13 years of age, male of high social class and students with highly educated mothers. Slightly above half of the school children were unaware of their weight and height giving an unknown body mass index in approximately 60% of cases. Among the remaining 40% who reported their weight and height, underestimation of weight was around 2.7 kg and was mainly among girls, in 16-21 year old group, high socio-economic class and born from educated mothers. Overestimation of height by 4cm was reported mainly among the overweight, obese, girls, those with at least 16 years of age. Sensitivity of determining obesity by reported weight and height was low especially among girls and those of at least 16-years of age while specificity was more among boys than girls and improved by increase in age. Conclusion: Our results display the inaccuracy of self-reported weight and height in tracking obesity in our youth population. These results also emphasize the need for community and school based programs for preventing and reducing obesity in school age through improving the nutritional status awareness, diet habits and life style in order to ensure health and longevity.


Author Keywords
Adolescence; Children; Obesity; Self-reported weight and height; Validity


Index Keywords
accuracy, adolescent, adult, age, anthropometry, article, awareness, body height, body mass, body weight, child, community, controlled study, data analysis, demography, education, feeding behavior, female, health program, human, interview, juvenile, lifestyle, longevity, male, mother, nutritional status, obesity, population research, Saudi Arabia, school, self report, sensitivity and specificity, sex difference, social class, socioeconomics, student, validation process; Adolescent, Adult, Body Height, Body Mass Index, Body Weight, Child, Cross-Sectional Studies, Female, Humans, Male, Obesity, Reproducibility of Results, Sensitivity and Specificity



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Correspondence Address
Abalkhail B.A.; Dept. Comm. Med./Primary Health Care, Faculty Med./Allied Health Sciences, King Abdul-Aziz University, PO Box 80205, Jeddah 21589, Saudi Arabia; email: [email protected]




ISSN: 03795284
CODEN: SAMJD
PubMed ID: 12174236
Language of Original Document: English
Abbreviated Source Title: Saudi Med. J.
Document Type: Article
Source: Scopus


Herzallah, H.K., Bubshait, S.A., Antony, A.K., Al-Otaibi, S.T.
Incidence of influenza A H1N1 2009 infection in Eastern Saudi Arabian hospitals
(2011) Saudi Medical Journal, 32 (6), pp. 598-602.


Preventive Medicine Services Division, Dhahran Health Center, PO Box 09384, Dhahran 31311, Saudi Arabia


Abstract
Objectives: To describe the clinical and epidemiologic features of pandemic influenza A (H1N1) cases. Methods: This study was conducted in Saudi Aramco Medical Services Organization (SAMSO) facilities in the Eastern province of the Kingdom of Saudi Arabia (KSA). Electronic medical records for H1N1 infected patients who visited SAMSO between June and October 2009 were reviewed retrospectively. Nasopharyngeal and oropharyngeal swabs were collected from suspected patients, and sent to the Ministry of Health (MOH) Regional Laboratory in Dammam, KSA to confirm the diagnosis. Results: A total of 587 cases were diagnosed with H1N1 given an incidence rate of 3.5 per 1000. Most of the infected cases were outpatients. The study showed that H1N1 was more common in the younger age group (median age; 22 years), and in female dependents at all ages, which differs from that reported by other researchers. Conclusion: Influenza A H1N1 was more common in the younger age group and in female dependents, and it was more severe among pregnant women. In addition, obesity did not affect the frequency of H1N1 infection.


Document Type: Article
Source: Scopus




Ng, S.W.a , Zaghloul, S.b , Ali, H.I.c , Harrison, G.d , Popkin, B.M.e
The prevalence and trends of overweight, obesity and nutrition-related non-communicable diseases in the Arabian Gulf States
(2011) Obesity Reviews, 12 (1), pp. 1-13. Cited 1 time.


a Department of Nutrition, University of North Carolina, Chapel Hill, United States
b Kuwait Institute for Scientific Research, Department of Human Nutrition, Food and Animal Sciences, University of Hawaii, Manoa, United States
c Department of Nutrition and Health, UAE University, Al-Ain, United Arab Emirates
d Department of Community Health Services and Nutrition, University of California, Los Angeles, United States
e Department of Nutrition, University of North Carolina, Chapel Hill, NC, United States


Abstract
This paper reviews studies on the prevalence of overweight, obesity and related nutrition-related non-communicable diseases in Bahrain, Kuwait, Qatar, Oman, Saudi Arabia and the UAE. Obesity is common among women; while men have an equal or higher overweight prevalence. Among adults, overweight plus obesity rates are especially high in Kuwait, Qatar and Saudi Arabia, and especially among 30-60 year olds (70-85% among men; 75-88% among women), with lower levels among younger and elderly adults. The rate of increase in obesity was pronounced in Saudi Arabia and Kuwait. Prevalence of obesity is high among Kuwaiti and Saudi pre-schoolers (8-9%), while adolescent overweight and obesity are among the highest in the world, with Kuwait having the worst estimates (40-46%); however, comparison of child data is difficult because of differing standards. Among nutrition-related non-communicable diseases, hypertension and diabetes levels are very high and increase with age, with the UAE performing the worst because of a rapid rate of increase between 1995 and 2000. Additional monitoring of the prevalence of metabolic syndrome and cancers is necessary. Nationally representative longitudinal surveys with individual, household and community-level information are needed to determine the importance of various factors that contribute to these troubling trends. 2010 The Authors. obesity reviews 2010 International Association for the Study of Obesity.


Author Keywords
Gulf; Obesity; Overweight; Prevalence


Document Type: Review
Source: Scopus




Alghamdi, K.M.
The use of topical bleaching agents among women: A cross-sectional study of knowledge, attitude and practices
(2010) Journal of the European Academy of Dermatology and Venereology, 24 (10), pp. 1214-1219.


Dermatology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia


Abstract
Background Although the practice of bleaching is common worldwide, there are few studies that discuss knowledge, attitudes and practices towards bleaching. Objective The aim of this study was to explore the knowledge, attitudes and practices towards the usage of topical bleaching agents among women. Methods A self-administered questionnaire on the use of bleaching creams was distributed randomly to women attending the outpatient clinics at a university hospital in Saudi Arabia during 2008. Results Five hundred ad nine of 620 women responded (82% response rate). All the participants had dark skin (skin type 4-5). The mean age was 29.22 9 years. Of the participants, 38.9% (197/506) were current users of bleaching agents. Only 26.7% (106/397) of the respondents used bleaching agents for medical purposes to treat localized abnormal skin hyper-pigmentation; 20.8% (101/485) were ready to use any bleaching cream that gives fast results, even if the components were unknown. Of the respondents, 30% (152/509) used more than 100 g of bleaching creams monthly. These products were applied to the whole body in 7.3% of the cases. While 10.3% (28/271) continued applying the bleaching products during pregnancy, 20.8% (54/260) did so during lactation. No associations could be found between the various sociodemographic variables and differences in the attitude towards and practice of using bleaching creams. Conclusion A major proportion of our sample respondents have overused and/or misused bleaching agents. This was regardless of age, income, education or marital status. There is a need to educate women about the possible risks. 2010 European Academy of Dermatology and Venereology.


Author Keywords
attitudes; bleaching agents; de-pigmentation; knowledge; misuse; overuse; practices


Document Type: Article
Source: Scopus




El-Gilany, A.-H.a , Hammad, S.b
Body mass index and obstetric outcomes in pregnant in Saudi Arabia: A prospective cohort study
(2010) Annals of Saudi Medicine, 30 (5), pp. 376-380+421. Cited 1 time.


a College of Medicine, King Faisal University, Al-Hassa, Saudi Arabia
b From the Ministry of Health, Riyadh, Saudi Arabia


Abstract
Background and Objectives: We examined the effect of body mass index in early pregnancy on pregnancy outcome since no study in Saudi Arabia has addressed this question. Methods: This prospective cohort study involved women registered for antenatal care during the first month of pregnancy at primary health care centers in Al-Hassa, Saudi Arabia. Data was collected from records and by direct interview. Results: The study included 787 women. Compared to normal weight women (n=307), overweight (n=187) and obese (n=226) women were at increased risk for pregnancy-induced hypertension (RR=4.9 [95% CI 1.6-11.1] and 6.1 [95% CI 2.1-17.8], respectively), gestational diabetes (RR=4.4 [95% CI 1.2-16.3] and 8.6 [95% CI 2.6-28.8]), preeclamptic toxemia (RR=3.8 [95% CI 1.1-14.6] and 5.9 [95% CI 1.7-20.4]), urinary tract infections (RR=1.4 [95% CI 0.5-3.9] and 3.7 [95% CI 1.7-6.2]), and cesarean delivery (RR=2.0 [95% CI 1.3-3.0] in obese women). Neonates born to obese women had an increased risk for postdate pregnancy (RR=3.7 [95% CI 1.2-11.6]), macrosomia (RR=6.8 [95% CI 1.5-30.7]), low 1-minute Apgar score (RR=1.9 [95% CI 1.1-3.6]), and admission to neonatal care units (RR=2.1 [95% CI 1.2-2.7]). On the other hand, low birth weight was less frequent among obese women (RR=0.5 [95% CI 0.3-0.9]) while the risk was high among underweight women (RR=2.3 [95% CI 1.4-3.8]). Conclusion: Even with adequate prenatal care, overweight and obesity can adversely affect pregnancy outcomes.


Document Type: Article
Source: Scopus




Trainer, S.S.
Body image, health, and modernity: Women's perspectives and experiences in the United Arab Emirates
(2010) Asia-Pacific Journal of Public Health, 22 (3), pp. 60S-67S.


Zayed University, PO Box 19282, Dubai, United Arab Emirates


Abstract
The countries of the Arab Gulf have experienced accelerated development and urbanization over the last 50 years. Changes in health have likewise been dramatic: Kuwait, Saudi Arabia, Bahrain, and the UAE now have some of the highest proportions of obese/overweight people in the world, with correspondingly high rates of chronic disease. In the UAE, particularly high rates of obesity/overweight have been reported among middle-aged Emirati women, but other problems relating to health and nutrition are starting to be identified in younger age groups as well. This article describes preliminary data from a project among young Emirati women in the UAE. This study examines how these women cope with the increased availability of fast food, changing work patterns, and evolving ideas about body image, "risk," and health within a larger context of increasing chronic disease and weight gain throughout the UAE. 2010 APJPH.


Author Keywords
body image; development; nutrition transition; obesity/overweight; underweight; United Arab Emirates; women


Document Type: Conference Paper
Source: Scopus




Mabry, R.M.a b , Reeves, M.M.b , Eakin, E.G.b , Owen, N.b
Gender differences in prevalence of the metabolic syndrome in Gulf Cooperation Council Countries: A systematic review
(2010) Diabetic Medicine, 27 (5), pp. 593-597. Cited 4 times.


a Office of the WHO Representative, Muscat, Oman
b Cancer Prevention Research Centre, School of Population Health, University of Queensland, Herston, QLD, Australia


Abstract
Aims To systematically review studies documenting the prevalence of the metabolic syndrome among men and women in Member States of the Gulf Cooperative Council (GCC; Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates) - countries in which obesity, Type 2 diabetes and related metabolic and cardiovascular diseases are highly prevalent. Methods A search was conducted on PubMed and CINAHL using the term 'metabolic syndrome' and the country name of each GCC Member State. The search was limited to studies published in the English language. The metabolic syndrome was defined according to the Third Adult Treatment Panel (ATPIII) of the National Cholesterol Education Program (NCEP) and/or International Diabetes Federation (IDF) definitions. The methodological quality of each study was evaluated based on four criteria: a national-level population sample; equal gender representation; robustness of the sample size; an explicit sampling methodology. Results PubMed, CINAHL and reference list searches identified nine relevant studies. Only four were considered high quality and found that, for men, the prevalence of the metabolic syndrome ranged from 20.7% to 37.2% (ATPIII definition) and from 29.6% to 36.2% (IDF definition); and, for women, from 32.1% to 42.7% (ATPIII definition) and from 36.1% to 45.9% (IDF definition). Conclusions Overall, the prevalence of the metabolic syndrome in the GCC states is some 10-15% higher than in most developed countries, with generally higher prevalence rates for women. Preventive strategies will require identifying socio-demographic and environmental correlates (particularly those influencing women) and addressing modifiable risk behaviours, including lack of physical activity, prolonged sitting time and dietary intake. 2010 Diabetes UK.


Author Keywords
Gulf Cooperative Council; Metabolic syndrome; Obesity; Prevalence


Document Type: Article
Source: Scopus




El-Gilany, A.-H.a , El-Wehady, A.b
Prevalence of obesity in a saudi obstetric population
(2009) Obesity Facts, 2 (4), pp. 217-220. Cited 1 time.


a Community Medicine Department, College of Medicine, Mansoura University, Mansoura 35516, Egypt
b Al-Hassa Directorate of Health, Saudi Arabia


Abstract
Objective: To estimate the prevalence of obesity and its determinants during the first month of gestation in Saudi women. Methods: Retrospective chart review of measured BMI in Al-Hassa, the largest province in Saudi Arabia, in 2007. Data were collected from records of 791 (72.6% of 1,089) pregnant women registered for prenatal care. Results: Height shows a normal Gaussian distribution, whereas weight is skewed positively (skewness of 0.77). The prevalence of underweight, normal weight, overweight, obesity, and extreme obesity (BMI > 40 kg/m2) were 8.5, 39.3, 23.6, 23.9, and 4.7%, respectively. Logistic regression revealed that the most important significant independent predictors of obesity are parity of 4 and more (odds ratio (OR) = 5.8) and urban residence (OR = 4.9). Conclusion: Overweight, obesity, and extreme obesity are commo (>52%) among pregnant women in Saudi Arabia. Health education to control body weight before pregnancy is warranted. Copyright 2009 S. Karger AG, Basel.


Author Keywords
BMI; Body mass index; Obesity; Obstetric population; Overweight; Saudi Arabia


Document Type: Article
Source: Scopus




Al-Ruhaily, A.D., Malabu, U.H., Sulimani, R.A.
Hirsutism in Saudi females of reproductive age: A hospital-based study
(2008) Annals of Saudi Medicine, 28 (1), pp. 28-32.


Department of Medicine, King Khalid University Hospital, PO Box 7805, Riyadh 11472, Saudi Arabia


Abstract
Background: Hirsutism among women of fertile age is commonly seen in clinical practice, but the pattern of the disease in Saudi Arabs has not been studied. The aim of the study was to determine the clinical, biochemical and etiologic features of hirsutism in Saudi females. Methods: 101 Saudi Arab Women presenting with hirsutism at King Khalid University Hospital, Riyadh, Saudi Arabia, from 1 January 2000 to 31 December 2005 were prospectively assessed using the recently approved diagnostic guidelines for hyperandrogenic women with hirsutism. Results: Polycystic ovary syndrome (PCOS) was the cause of hirsutism in 83 patients (82%) followed by idiopathic hirsutism (IH) in 11 patients (11%). Others causes of hirsutism included late onset congenital adrenal hyperplasia in 4 patients (4%), microprolactinoma in 2 (2%) and Cushing's syndrome in 1 (1 %) patient. Age at presentation of PCOS was 24.56.6 years (meanSD) and 51% of the subjects were obese. Furthermore, 74 (89%) of patients with PCOS had an oligo/ anovulatory cycle while the remaining 9 patients (11 %) maintained normal regular menstrual cycle. Luteinizing hormone and total testosterone were significantly higher in patients with PCOS than in those with lH (P<.05). Conclusions: The present data show PCOS to be the commonest cause of hirsutism in our clinical practice and PCOS is prominent amongst young obese females. However, further studies on a larger scale are needed to verify our findings.


Document Type: Article
Source: Scopus




Al-Qahtani, D.A., Imtiaz, M.L., Saad, O.S., Hussein, N.M.
A comparison of the prevalence of metabolic syndrome in Saudi adult females using two definitions
(2006) Metabolic Syndrome and Related Disorders, 4 (3), pp. 204-214. Cited 5 times.


Department of Primary Health Care, Northern Area Armed Forces Hospital, Post Box 10018, KKMC, Hafr Al-Batin 31991, Saudi Arabia


Abstract
The aim of this study was to estimate the prevalence of metabolic syndrome in Saudi adult women aged 18 years and above using the criteria of International Diabetes Federation (IDF) and modified National Cholesterol Education Program Adult Treatment Panel III (mNCEP-ATPIII). A cross-sectional survey was performed involving a group of 2577 non-pregnant Saudi women subjects aged 18-59 years residing in a military city in northern Saudi Arabia recruited from a primary care setting. Anthropometric data, together with a brief medical history, were obtained at initial contact, and laboratory investigations were performed on the following day after fasting for 12 h. Data on all variables required to define the metabolic syndrome according to IDF and mNCEP-ATPIII criteria were available for only 1922 subjects who attended the laboratory for investigations (response rate of 74.6%). Non-respondents were excluded from data analysis. Prevalence rates were estimated according to both definitions. Age-adjusted prevalence of metabolic syndrome was found to be 16.1% and 13.6% by IDF and mNCEP-ATPIII definitions, respectively. Abdominal obesity was the most common component in the study population (44.1% by mNCEP-ATPIII and 67.9% by IDF cut-off points). It was followed by low serum high-density lipoprotein cholesterol (36.0%). About two-thirds of the subjects (66.4% by mNCEP-ATPIII and 67.9% by IDF definitions) exhibited at least one criterion for metabolic syndrome by both definitions. Mean values and prevalence of individual components of the syndrome showed a steady rise with increase in age, general and abdominal obesity, and the presence of diabetes. Since the cut-off values for waist circumference by IDF definition were lower, prevalence rates by this definition were higher than those defined by mNCEP-ATPIII. High prevalence rates in this young sample predict a sharp rise in the prevalence rates of this syndrome among Saudi women over the next few years. Mary Ann Liebert, Inc.


Document Type: Article
Source: Scopus




Al-Harithy, R.N., Al-Doghaither, H., Abualnaja, K.
Correlation of leptin and sex hormones with endocrine changes in healthy Saudi women of different body weights
(2006) Annals of Saudi Medicine, 26 (2), pp. 110-115. Cited 2 times.


Department of Biochemistry, King Abdulaziz University, P.O. Box 40288, Jeddah 21499, Saudi Arabia


Abstract
Background: A relationship between estrogen and leptin has been described during the follicular phase of both spontaneous menstrual cycles and cycles stimulated with exogenous follicle-stimulating hormone (FSH), which suggest that leptin has either a direct effect on or is regulated by gonadal steroids in the human ovary. To examine the changes in plasma leptin levels during the menstrual cycle, we studied the association between plasma leptin and reproductive hormones in young, healthy Saudi women. Subjects and methods: Sixty-five young women between 19 to 39 years of age, with a normal menstrual cycle, were grouped into 33 overweight and obese females of BMI >25 kg/m2, and 32 lean females of BMI <25 kg/m2. Anthropometrics measurements were made at the time of the collection. Samples were analyzed for leptin, progesterone, estradiol (E2), FSH, luteinizing hormone (LH), cortisol, and testosterone concentrations. Results: Overweight and obese women, compared with lean, tended to have a significantly higher plasma leptin levels (11.384.06 vs. 6.222.87 ng/mL; P=0.05). In overweight and obese subjects, circulating leptin concentrations showed a direct correlation with BMI (r=0.53; P=0.002), hip circumference (r=0.32; P=0.005), waist-hip ratio (r=0.37; P=0.042), weight (r=0.41; P=0.021), and E2 on day 3 (r=0.35; P=0.048). In all correlation analyses, leptin levels did not correlate with cortisol or testosterone. In lean subjects, a bivariate correlation analysis showed that plasma leptin concentrations were directly correlated to hip circumference (r=0.43; P=0.012). Moreover, a direct correlation was found with progesterone on day 10 (r=0.43; P=0.014) and E2 on day 24 (r=0.47; P=0.007). Conclusion: There is a link between plasma leptin and progesterone concentrations during the menstrual cycle, and the variation in circulating estradiol concentrations may have an influence on circulating leptin in female subjects.


Document Type: Article
Source: Scopus




Al-Harithy, R.N.
Dehydroepiandrosterone sulfate levels in women. Relationships with body mass index, insulin and glucose levels
(2003) Saudi Medical Journal, 24 (8), pp. 837-841. Cited 5 times.


Department of Biochemistry, Faculty of Science, King Abdul-Aziz University, PO Box 40288, Jeddah 21499, Saudi Arabia


Abstract
Objectives: Dehydroepiandrosterone (DHEA) and DHEA-sulfate (DHEA-S) are the most abundant steroids in human plasma. Previous studies have shown that administration of DHEA-S is more effective than DHEA in reducing adipose tissue mass and cellularity in rats. Another study suggested that maintaining high levels of DHEA-S might prevent the development of obesity. Therefore, this study aims to determine the relationship of plasma dehydroepiandrosterone sulfate (DHEA-S) levels with respect to obesity, fasting insulin and glucose levels in a cohort of obese and normal weight healthy Saudi women. Methods: This study was carried out at King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia during the year 2001. A total of 65 healthy volunteers between 19-30 years of age with body mass index (BMI) of 15.35-38.30 kg/m2 were grouped into 26 young obese females of BMI >27 kg/2 and 39 young lean females of BMI <27 kg/m2. Weight, height, waist and hip circumference, fasting blood glucose, insulin and DHEA-S levels were measured. Results: Dehydroepiandrosterone-S levels were found lower in the obese group than in the lean women. In all subjects, DHEA-S levels were related negatively with BMI (p=0.02, correlation co-efficient [r]=-0.25) and hip circumference (p=0.03, r=-0.27). In the obese group, DHEA-S levels showed a significant positive relationship with insulin (p=0.03, r=0.43). No significant relationship was found between DHEA-S and glucose levels in considering either the whole group or the obese women. Conclusion: Hip circumference, as a corollary for peripheral obesity, was better associated with DHEA-S than the waist circumference or waist-to-hip ratio. The data indicated that BMI and hip circumference are important factors in explaining DHEA-S variability. Insulin could have an independent regulatory effect on DHEA-S secretion, but glucose metabolism is not related.


Document Type: Article
Source: Scopus

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Herzallah, H.K., Bubshait, S.A., Antony, A.K., Al-Otaibi, S.T.
Incidence of influenza A H1N1 2009 infection in Eastern Saudi Arabian hospitals
(2011) Saudi Medical Journal, 32 (6), pp. 598-602.


Preventive Medicine Services Division, Dhahran Health Center, PO Box 09384, Dhahran 31311, Saudi Arabia


Abstract
Objectives: To describe the clinical and epidemiologic features of pandemic influenza A (H1N1) cases. Methods: This study was conducted in Saudi Aramco Medical Services Organization (SAMSO) facilities in the Eastern province of the Kingdom of Saudi Arabia (KSA). Electronic medical records for H1N1 infected patients who visited SAMSO between June and October 2009 were reviewed retrospectively. Nasopharyngeal and oropharyngeal swabs were collected from suspected patients, and sent to the Ministry of Health (MOH) Regional Laboratory in Dammam, KSA to confirm the diagnosis. Results: A total of 587 cases were diagnosed with H1N1 given an incidence rate of 3.5 per 1000. Most of the infected cases were outpatients. The study showed that H1N1 was more common in the younger age group (median age; 22 years), and in female dependents at all ages, which differs from that reported by other researchers. Conclusion: Influenza A H1N1 was more common in the younger age group and in female dependents, and it was more severe among pregnant women. In addition, obesity did not affect the frequency of H1N1 infection.


Document Type: Article
Source: Scopus




Ng, S.W.a , Zaghloul, S.b , Ali, H.I.c , Harrison, G.d , Popkin, B.M.e
The prevalence and trends of overweight, obesity and nutrition-related non-communicable diseases in the Arabian Gulf States
(2011) Obesity Reviews, 12 (1), pp. 1-13. Cited 1 time.


a Department of Nutrition, University of North Carolina, Chapel Hill, United States
b Kuwait Institute for Scientific Research, Department of Human Nutrition, Food and Animal Sciences, University of Hawaii, Manoa, United States
c Department of Nutrition and Health, UAE University, Al-Ain, United Arab Emirates
d Department of Community Health Services and Nutrition, University of California, Los Angeles, United States
e Department of Nutrition, University of North Carolina, Chapel Hill, NC, United States


Abstract
This paper reviews studies on the prevalence of overweight, obesity and related nutrition-related non-communicable diseases in Bahrain, Kuwait, Qatar, Oman, Saudi Arabia and the UAE. Obesity is common among women; while men have an equal or higher overweight prevalence. Among adults, overweight plus obesity rates are especially high in Kuwait, Qatar and Saudi Arabia, and especially among 30-60 year olds (70-85% among men; 75-88% among women), with lower levels among younger and elderly adults. The rate of increase in obesity was pronounced in Saudi Arabia and Kuwait. Prevalence of obesity is high among Kuwaiti and Saudi pre-schoolers (8-9%), while adolescent overweight and obesity are among the highest in the world, with Kuwait having the worst estimates (40-46%); however, comparison of child data is difficult because of differing standards. Among nutrition-related non-communicable diseases, hypertension and diabetes levels are very high and increase with age, with the UAE performing the worst because of a rapid rate of increase between 1995 and 2000. Additional monitoring of the prevalence of metabolic syndrome and cancers is necessary. Nationally representative longitudinal surveys with individual, household and community-level information are needed to determine the importance of various factors that contribute to these troubling trends. 2010 The Authors. obesity reviews 2010 International Association for the Study of Obesity.


Author Keywords
Gulf; Obesity; Overweight; Prevalence


Document Type: Review
Source: Scopus




Alghamdi, K.M.
The use of topical bleaching agents among women: A cross-sectional study of knowledge, attitude and practices
(2010) Journal of the European Academy of Dermatology and Venereology, 24 (10), pp. 1214-1219.


Dermatology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia


Abstract
Background Although the practice of bleaching is common worldwide, there are few studies that discuss knowledge, attitudes and practices towards bleaching. Objective The aim of this study was to explore the knowledge, attitudes and practices towards the usage of topical bleaching agents among women. Methods A self-administered questionnaire on the use of bleaching creams was distributed randomly to women attending the outpatient clinics at a university hospital in Saudi Arabia during 2008. Results Five hundred and nine of 620 women responded (82% response rate). All the participants had dark skin (skin type 4-5). The mean age was 29.22 9 years. Of the participants, 38.9% (197/506) were current users of bleaching agents. Only 26.7% (106/397) of the respondents used bleaching agents for medical purposes to treat localized abnormal skin hyper-pigmentation; 20.8% (101/485) were ready to use any bleaching cream that gives fast results, even if the components were unknown. Of the respondents, 30% (152/509) used more than 100 g of bleaching creams monthly. These products were applied to the whole body in 7.3% of the cases. While 10.3% (28/271) continued applying the bleaching products during pregnancy, 20.8% (54/260) did so during lactation. No associations could be found between the various sociodemographic variables and differences in the attitude towards and practice of using bleaching creams. Conclusion A major proportion of our sample respondents have overused and/or misused bleaching agents. This was regardless of age, income, education or marital status. There is a need to educate women about the possible risks. 2010 European Academy of Dermatology and Venereology.


Author Keywords
attitudes; bleaching agents; de-pigmentation; knowledge; misuse; overuse; practices


Document Type: Article
Source: Scopus




El-Gilany, A.-H.a , Hammad, S.b
Body mass index and obstetric outcomes in pregnant in Saudi Arabia: A prospective cohort study
(2010) Annals of Saudi Medicine, 30 (5), pp. 376-380+421. Cited 1 time.


a College of Medicine, King Faisal University, Al-Hassa, Saudi Arabia
b From the Ministry of Health, Riyadh, Saudi Arabia


Abstract
Background and Objectives: We examined the effect of body mass index in early pregnancy on pregnancy outcome since no study in Saudi Arabia has addressed this question. Methods: This prospective cohort study involved women registered for antenatal care during the first month of pregnancy at primary health care centers in Al-Hassa, Saudi Arabia. Data was collected from records and by direct interview. Results: The study included 787 women. Compared to normal weight women (n=307), overweight (n=187) and obese (n=226) women were at increased risk for pregnancy-induced hypertension (RR=4.9 [95% CI 1.6-11.1] and 6. [95% CI 2.1-17.8], respectively), gestational diabetes (RR=4.4 [95% CI 1.2-16.3] and 8.6 [95% CI 2.6-28.8]), preeclamptic toxemia (RR=3.8 [95% CI 1.1-14.6] and 5.9 [95% CI 1.7-20.4]), urinary tract infections (RR=1.4 [95% CI 0.5-3.9] and 3.7 [95% CI 1.7-6.2]), and cesarean delivery (RR=2.0 [95% CI 1.3-3.0] in obese women). Neonates born to obese women had an increased risk for postdate pregnancy (RR=3.7 [95% CI 1.2-11.6]), macrosomia (RR=6.8 [95% CI 1.5-30.7]), low 1-minute Apgar score (RR=1.9 [95% CI 1.1-3.6]), and admission to neonatal care units (RR=2.1 [95% CI 1.2-2.7]). On the other hand, low birth weight was less frequent among obese women (RR=0.5 [95% CI 0.3-0.9]) while the risk was high among underweight women (RR=2.3 [95% CI 1.4-3.8]). Conclusion: Even with adequate prenatal care, overweight and obesity can adversely affect pregnancy outcomes.


Document Type: Article
Source: Scopus




Trainer, S.S.
Body image, health, and modernity: Women's perspectives and experiences in the United Arab Emirates
(2010) Asia-Pacific Journal of Public Health, 22 (3), pp. 60S-67S.


Zayed University, PO Box 19282, Dubai, United Arab Emirates


Abstract
The countries of the Arab Gulf have experienced accelerated development and urbanization over the last 50 years. Changes in health have likewise been dramatic: Kuwait, Saudi Arabia, Bahrain, and the UAE now have some of the highest proportions of obese/overweight people in the world, with correspondingly high rates of chronic disease. In the UAE, particularly high rates of obesity/overweight have been reported among middle-aged Emirati women, but other problems relating to health and nutrition are starting to be identified in younger age groups as well. This article describes preliminary data from a project among young Emirati women in the UAE. This study examines how these women cope with the increased availability of fast food, changing work patterns, and evolving ideas about body image, "risk," and health within a larger context of increasing chronic disease and weight gain throughout the UAE. 2010 APJPH.


Author Keywords
body image; development; nutrition transition; obesity/overweight; underweight; United Arab Emirates; women


Document Type: Conference Paper
Source: Scopus




Mabry, R.M.a b , Reeves, M.M.b , Eakin, E.G.b , Owen, N.b
Gender differences in prevalence of the metabolic syndrome in Gulf Cooperation Council Countries: A systematic review
(2010) Diabetic Medicine, 27 (5), pp. 593-597. Cited 4 times.


a Office of the WHO Representative, Muscat, Oman
b Cancer Prevention Research Centre, School of Population Health, University of Queensland, Herston, QLD, Australia


Abstract
Aims To systematically review studies documenting the prevalence of the metabolic syndrome among men and women in Member States of the Gulf Cooperative Council (GCC; Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates) - countries in which obesity, Type 2 diabetes and related metabolic and cardiovascular diseases are highly prevalent. Methods A search was conducted on PubMed and CINAHL using the term 'metabolic syndrome' and the country name of each GCC Member State. The search was limited to studies published in the English language. The metabolic syndrome was defined according to the Third Adult Treatment Panel (ATPIII) of the National Cholesterol Education Program (NCEP) and/or International Diabetes Federation (IDF) definitions. The methodological quality of each study was evaluated based on four criteria: a national-level population sample; equal gender representation; robustness of the sample size; an explicit sampling methodology. Results PubMed, CINAHL and reference list searches identified nine relevant studies. Only four were considered high quality and found that, for men, the prevalence of the metabolic syndrome ranged from 20.7% to 37.2% (ATPIII definition) and from 29.6% to 36.2% (IDF definition); and, for women, from 32.1% to 42.7% (ATPIII definition) and from 36.1% to 45.9% (IDF definition). Conclusions Overall, the prevalence of the metabolic syndrome in the GCC states is some 10-15% higher than in most developed countries, with generally higher prevalence rates for women. Preventive strategies will require identifying socio-demographic and environmental correlates (particularly those influencing women) and addressing modifiable risk behaviours, including lack of physical activity, prolonged sitting time and dietary intake. 2010 Diabetes UK.


Author Keywords
Gulf Cooperative Council; Metabolic syndrome; Obesity; Prevalence


Document Type: Article
Source: Scopus




El-Gilany, A.-H.a , El-Wehady, A.b
Prevalence of obesity in a saudi obstetric population
(2009) Obesity Facts, 2 (4), pp. 217-220. Cited 1 time.


a Community Medicine Department, College of Medicine, Mansoura University, Mansoura 35516, Egypt
b Al-Hassa Directorate of Health, Saudi Arabia


Abstract
Objective: To estimate the prevalence of obesity and its determinants during the first month of gestation in Saudi women. Methods: Retrospective chart review of measured BMI in Al-Hassa, the largest province in Saudi Arabia, in 2007. Data were collected from records of 791 (72.6% of 1,089) pregnant women registered for prenatal care. Results: Height shows a normal Gaussian distribution, whereas weight is skewed positively (skewness of 0.77). The prevalence of underweight, normal weight, overweight, obesity, and extreme obesity (BMI > 40 kg/m2) were 8.5, 39.3, 23.6, 23.9, and 4.7%, respectively. Logistic regression revealed that the most important significant independent predictors of obesity are parity of 4 and more (odds ratio (OR) = 5.8) and urban residence (OR = 4.9). Conclusion: Overweight, obesity, and extreme obesity are common (>52%) among pregnant women in Saudi Arabia. Health education to control body weight before pregnancy is warranted. Copyright 2009 S. Karger AG, Basel.


Author Keywords
BMI; Body mass index; Obesity; Obstetric population; Overweight; Saudi Arabia


Document Type: Article
Source: Scopus




Al-Ruhaily, A.D., Malabu, U.H., Sulimani, R.A.
Hirsutism in Saudi females of reproductive age: A hospital-based study
(2008) Annals of Saudi Medicine, 28 (1), pp. 28-32.


Department of Medicine, King Khalid University Hospital, PO Box 7805, Riyadh 11472, Saudi Arabia


Abstract
Background: Hirsutism among women of fertile age is commonly seen in clinical practice, but the pattern of the disease in Saudi Arabs has not been studied. The aim of the study was to determine the clinical, biochemical and etiologic features of hirsutism in Saudi females. Methods: 101 Saudi Arab Women presenting with hirsutism at King Khalid University Hospital, Riyadh, Saudi Arabia, from 1 January 2000 to 31 December 2005 were prospectively assessed using the recently approved diagnostic guidelines for hyperandrogenic women with hirsutism. Results: Polycystic ovary syndrome (PCOS) was the cause of hirsutism in 83 patients (82%) followed by idiopathic hirsutism (IH) in 11 patients (11%). Others causes of hirsutism included late onset congenital adrenal hyperplasia in 4 patients (4%), microprolactinoma in 2 (2%) and Cushing's syndrome in 1 (1 %) patient. Age at presentation of PCOS was 24.56.6 years (meanSD) and 51% of the subjects were obese. Furthermore, 74 (89%) of patients with PCOS had an oligo/ anovulatory cycle while the remaining 9 patients (11 %) maintained normal regular menstrual cycle. Luteinizing hormone and total testosterone were significantly higher in patients with PCOS than in those with lH (P<.05). Conclusions: The present data show PCOS to be the commonest cause of hirsutism in our clinical practice and PCOS is prominent amongst young obese females. However, further studies on a larger scale are needed to verify our findings.


Document Type: Article
Source: Scopus




Al-Qahtani, D.A., Imtiaz, M.L., Saad, O.S., Hussein, N.M.
A comparison of the prevalence of metabolic syndrome in Saudi adult females using two definitions
(2006) Metabolic yndrome and Related Disorders, 4 (3), pp. 204-214. Cited 5 times.


Department of Primary Health Care, Northern Area Armed Forces Hospital, Post Box 10018, KKMC, Hafr Al-Batin 31991, Saudi Arabia


Abstract
The aim of this study was to estimate the prevalence of metabolic syndrome in Saudi adult women aged 18 years and above using the criteria of International Diabetes Federation (IDF) and modified National Cholesterol Education Program Adult Treatment Panel III (mNCEP-ATPIII). A cross-sectional survey was performed involving a group of 2577 non-pregnant Saudi women subjects aged 18-59 years residing in a military city in northern Saudi Arabia recruited from a primary care setting. Anthropometric data, together with a brief medical history, were obtained at initial contact, and laboratory investigations were performed on the following day after fasting for 12 h. Data on all variables required to define the metabolic syndrome according to IDF and mNCEP-ATPIII criteria were available for only 1922 subjects who attended the laboratory for investigations (response rate of 74.6%). Non-respondents were excluded from data analysis. Prevalence rates were estimated according to both definitions. Age-adjusted prevalence of metabolic syndrome was found to be 16.1% and 13.6% by IDF and mNCEP-ATPIII definitions, respectively. Abdominal obesity was the most common component in the study population (44.1% by mNCEP-ATPIII and 67.9% by IDF cut-off points). It was followed by low serum high-density lipoprotein cholesterol (36.0%). About two-thirds of the subjects (66.4% by mNCEP-ATPIII and 67.9% by IDF definitions) exhibited at least one criterion for metabolic syndrome by both definitions. Mean values and prevalence of individual components of the syndrome showed a steady rise with increase in age, general and abdominal obesity, and the presence of diabetes. Since the cut-off values for waist circumference by IDF definition were lower, prevalence rates by this definition were higher than those defined by mNCEP-ATPIII. High prevalence rates in this young sample predict a sharp rise in the prevalence rates of this syndrome among Saudi women over the next few years. Mary Ann Liebert, Inc.


Document Type: Article
Source: Scopus




Al-Harithy, R.N., Al-Doghaither, H., Abualnaja, K.
Correlation of leptin and sex hormones with endocrine changes in healthy Saudi women of different body weights
(2006) Annals of Saudi Medicine, 26 (2), pp. 110-115. Cited 2 times.


Department of Biochemistry, King Abdulaziz University, P.O. Box 40288, Jeddah 21499, Saudi Arabia


Abstract
Background: A relationship between estrogen and leptin has been described during the follicular phase of both spontaneous menstrual cycles and cycles stimulated with exogenous follicle-stimulating hormone (FSH), which suggest that leptin has either a direct effect on or is regulated by gonadal steroids in the human ovary. To examine the changes in plasma leptin levels during the menstrual cycle, we studied the association between plasma leptin and reproductive hormones in young, healthy Saudi women. Subjects and methods: Sixty-five young women between 19 to 39 years of age, with a normal menstrual cycle, were grouped into 33 overweight and obese females of BMI >25 kg/m2, and 32 lean females of BMI <25 kg/m2. Anthropometrics measurements were made at the time of the collection. Samples were analyzed for leptin, progesterone, estradiol (E2), FSH, luteinizing hormone (LH), cortisol, and testosterone concentrations. Results: Overweight and obese women, compared with lean, tended to have a significantly higher plasma leptin levels (11.384.06 vs. 6.222.87 ng/mL; P=0.05). In overweight and obese subjects, circulating leptin concentrations showed a direct correlation with BMI (r=0.53; P=0.002), hip circumference (r=0.32; P=0.005), waist-hip ratio (r=0.37; P=0.042), weight (r=0.41; P=0.021), and E2 on day 3 (r=0.35; P=0.048). In all correlation analyses, leptin levels did not correlate with cortisol or testosterone. In lean subjects, a bivariate correlation analysis showed that plasma leptin concentrations were directly correlated to hip circumference (r=0.43; P=0.012). Moreover, a direct correlation was found with progesterone on day 10 (r=0.43; P=0.014) and E2 on day 24 (r=0.47; P=0.007). Conclusion: There is a link between plasma leptin and progesterone concentrations during the menstrual cycle, and the variation in circulating estradiol concentrations may have an influence on circulating leptin in female subjects.


Document Type: Article
Source: Scopus




Al-Harithy, R.N.
Dehydroepiandrosterone sulfate levels in women. Relationships with body mass index, insulin and glucose levels
(2003) Saudi Medical Journal, 24 (8), pp. 837-841. Cited 5 times.


Department of Biochemistry, Faculty of Science, King Abdul-Aziz University, PO Box 40288, Jeddah 21499, Saudi Arabia


Abstract
Objectives: Dehydroepiandrosterone (DHEA) and DHEA-sulfate (DHEA-S) are the most abundant steroids in human plasma. Previous studies have shown that administration of DHEA-S is more effective than DHEA in reducing adipose tissue mass and cellularity in rats. Another study suggested that maintaining high levels of DHEA-S might prevent the development of obesity. Therefore, this study aims to determine the relationship of plasma dehydroepiandrosterone sulfate (DHEA-S) levels with respect to obesity, fasting insulin and glucose levels in a cohort of obese and normal weight healthy Saudi women. Methods: This study was carried out at King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia during the year 2001. A total of 65 healthy volunteers between 19-30 years of age with body mass index (BMI) of 15.35-38.30 kg/m2 were grouped into 26 young obese females of BMI >27 kg/m2 and 39 young lean females of BMI <27 kg/m2. Weight, height, waist and hip circumference, fasting blood glucose, insulin and DHEA-S levels were measured. Results: Dehydroepiandrosterone-S levels were found lower in the obese group than in the lean women. In all subjects, DHEA-S levels were related negatively with BMI (p=0.02, correlation co-efficient [r]=-0.25) and hip circumference (p=0.03, r=-0.27). In the obese group, DHEA-S levels showed a significant positive relationship with insulin (p=0.03, r=0.43). No significant relationship was found between DHEA-S and glucose levels in considering either the whole group or the obese women. Conclusion: Hip circumference, as a corollary for peripheral obesity, was better associated with DHEA-S than the waist circumference or waist-to-hip ratio. The data indicated that BMI and hip circumference are important factors in explaining DHEA-S variability. Insulin could have an independent regulatory effect on DHEA-S secretion, but glucose metabolism is not related.


Document Type: Article
Source: Scopus



database such as, BMJ, Google Scholar, Informit Health databases, Medline, Proquest Central, Scopus, Science Direct?, World Health Organisation, World Bank and Web of knowledge ??"ISI.




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Assignment:
In this paper, begin to put the final project together. Be sure that your paper includes discussion of not only the information from earlier 3 papers listed below but also the following:

A. The obstacles, barriers or pitfalls (legal, ethical, personal, etc...) to success in resolving the earlier identified problem

B. Describe the factors that may influence those obstacles, barriers or pitfalls

Assignment#1:
My occupation in the military is a field medical assistant which is a general term used for all medical service officers. My specialty is a health care manager. The occupation of a health care manager can include many different responsibilities in a military hospital. Health care managers are necessary in many organizations, from hospitals to HMOs and other insurance programs. A health care manager in a small clinic may have very different responsibilities than a health care manager at a huge hospital, and both deal with very different issues than a health care manager that works for an HMO. However, the qualifications are very similar. To be a health care manager one must have a degree in health care management (or be a doctor with experience and training in management) and be able to organize and oversee aspects of management and patient care. The responsibilities also have one thing in common: a health care manager is someone other than a patient?s personal physician who has the difficult task of deciding what kind of care is appropriate and arranging circumstances so that can be provided. ?Health care managers play essential roles in keeping the business of health care running smoothly. They plan, direct, coordinate, and supervise the delivery of health care.
Within the military hospital setting, a health care manager has a number of roles. The primary health care manager is responsible only to the hospital commander, though indirectly one could say that they also answer to Tricare and insurance companies because they have to juggle their demands and conditions in order to be financially reasonable. The health care manager is the one to whom doctors and nurses must go for direction, and to whom they are answerable regarding the financial aspects and some of the organizational aspects of their job. Daily duties in a large military hospital are primarily delegatory so that subordinate health care managers do more of the paperwork, but in a small clinic, the health care manager is actively responsible for the record keeping involved with filing medical charts and organizing patient records. They also must answer patient questions about insurance, process insurance claims and take charge of the billing, collections, and other financial concerns such as taxes. Health care managers also oversee personnel development, such as hiring of civilians and organizing employees and soldiers, evaluating the performance and financial intake of civilian doctors, enforcing work schedules, and making general goals for the hospital. The health care manager may also be in charge of expenditures on equipment, and upgrading or maintaining the facility.
As can be imagined, there are a nearly infinite number of things that can go wrong for a health care manager. Two common problems are worth some attention. The first deals with the ubiquitous staff problems that arise in any managerial position. Doctors and nurses may have interpersonal conflicts. Certain doctors may not feel comfortable with the appropriate profit-consciousness and resent the interference of a manager. Budget concerns may mean that everyone has to work long hours, and complaints may arise regarding lack of flexibility or inhospitable working conditions. Poor relations within the staff and resentment between levels (like nurses who resent the doctors, or doctors who resent the interference of management) can represent a real problem with a huge scope. This problem may seem like it represents insurmountable difficulties, however, it is possible that such tensions can be reduced not by making significant changes that would threaten the hospital?s basic profit margin and management, but by implementing more personal attention would make everyone comfortable with the status quo.
On the other side of the problem that arises when staff resent the pressures placed on them from above is the problems that arise when the hospital commander or staff decide that the profit margin is not high enough. The health care manager may be asked to find a way to reduce costs, or to be more efficient, or even to reduce the number of patients. Figuring out how to balance the neat for a trim budget with the doctors need to feel that they have freedom in their treatment options can pose difficulties. Raising the profit margin, balancing the books, and assuring that the hospital is a viable business first and foremost is the biggest problem faced by health care managers in the army. Possible solutions may lie in a variety of fund-raising techniques, cutting waste, reducing unnecessary procedures on the under-insured, and trimming personnel expenses while attempting to assure quality so that the hospital can best attract patients with the willingness and ability to pay for high quality treatment. This is the problem I would prefer to investigate further, since it seems to be the most pressing for most health care managers. ?A 1988 survey of 1,400 general acute-care community hospitals found that the administrators of 700 of the hospitals feared that their institutions would be forced to close in the next five years because of financial problems.

Assignment #2:
As a health care manager, the reason for choosing this profession and the day-to-day activities, which fill my schedule, are often vary different. As a health care professional, I entered this profession to make a contribution to the health and well being of my fellow soldiers. I chose to become a part of the support system, which keeps the military functioning, and able to freely commit themselves to the defense of our country. As a health care manager, my time is filled with responsibilities, which revolve around 4 categories that have little to do with the daily care of the soldiers and civilians who use our facilities. My job responsibilities focus on the Administrative, financial, legal, ethical, and financial aspects of keeping the medical care facilities operational (so that the other health care staff, such as doctors and nurses, can tend to the medical well being of the patients.
Administratively, I am responsible to keep the diverse staff functioning as a team. A multicultural mindset has taken hold in most professional environments, including the armed services. This has created a diverse set of attitudes, and talents within the team operating in the medical facilities. While the military chain of command remains strong, as a health care administrator I am continually challenged to creatively assist my staff to work together. We see changes in demographics of staff and those we serve, and changes in technology, which create a flood of, increased demand on our resources. The multicultural mindset may be a positive paradigm to assist staff to accept the difference between us, but the increased number of differences demands increased management and problem solving time. These changes are occurring at a time when changes in financing and care management create an earthquake of system instability. (Kirkman-Liff, 2002)
Driving the financial changes in the health delivery system is raising health care costs in the public and private care sectors. The military health care systems cannot remain unaffected to the rising costs because we are interrelated. We purchase medicines form the same sources, and we purchase the same diagnostic machinery. While military wages are not as volatile as in the civilian world, the cost of health care is rising due to other factors, such as those mentioned above. In order for the health care facilities to stay in operation, I am responsible to balance needed care options with the most economical methods for delivering those health care services. In the civilian world, nearly one third of health care expenditures are spent on hospital care. When patients, employers, insurers, and the government worry about rising health care costs, they put pressure on hospitals to provide more efficient care. This pressure lands on the shoulders of the health care administrator. (Shah, Reed, Francis, Ridley, and Schulman, 2003) Unfortunately, these choices can lead to legal issues, and further to ethical considerations. Health care premium rose 13.9 percent this year, according to a recently released survey of more than 2,800 companies by the Kaiser Family Foundation and the Health Research and Educational Trust. (Knight-Ridder, 2003) This reflects the rising costs of health care. When faced with the daily decisions of operating the hospital or field medical office within budget, and providing the best medical care for my patients, I am often faced with a decision with no good options. If the treatment cost exceeds the likelihood of successful treatment of illness of injury, then my responsibility to the patient is opposed by my responsibility to the hospital. These ethical issues can lead to legal ramifications if a hospital unit is operating with it?s eye only in the bottom line, and chooses to limit care for financial reasons. These choices are not representative of the reasons I became a health care professional.
Keeping a military unit operational in the highest level of readiness is a combined effort that requires dedication from many disciplines. Medical services are one of those areas, which must serve the needs of the patient, and the overall military. We must balance the needs of today with those of tomorrow within a changing world.


References


Kirkman-Liff, Brad. Keeping an eye on a moving target: quality changes and challenges for

nurses. Nursing Economics. 11/01/2002;

South Florida Employees Face Higher Health-Care Premiums, Fewer Benefits. Knight

Ridder/Tribune Business News. 10/12/2003

Shah, Bimal R Reed, Shelby D Francis, Jennifer Ridley, David B Schulman, Kevin A

The cost of inefficiency in US hospitals, 1985-1997. Journal of Health Care Finance.

10/01/2003

www.netlibrary.com



Assignment #3:
Today, health care management for the Department of Defense is handled by TRICARE, which is a regionally managed health care program, for all active duty and retired members of the armed forces, their families and survivors. TRICARE meshes the health care resources of the Army, Air Force and navy plus the abilities of civilian health care professionals. This network has been established to provide the utmost quality care plus access to a wide variety of professionals to meet the needs of the military.
Health care management in a military setting differs from the professional who serves in a small clinic or large hospital. Although the rigors of the job can be the same because the responsibilities, i.e., to help determine and administer the appropriate care, the role of a military medical assistant is under further stringent guidance from TRICARE.
Within the confines of a military environment, the healthcare manager must also handle insurance and financial aspects of patient care. They play an evolving role in the patient?s well being that goes beyond the daily care routine.
Any number of problems can arise from a healthcare management perspective, but the majority of problem concern interpersonal conflicts and the pressures associated with healthcare profit margins. Both of these problems are compounded by the fact that health care management in any setting is under a high degree of scrutiny.
Personality conflicts abound in an environment where volatility and pressures are part of the every day routine. The key is to reduce the tensions between the staff by ensuring that there is awareness on everyone?s part of the role that each member plays and the nee for teamwork. Long hours and tension about profit margins can create a highly charged atmosphere. It is up to the delegating staff members to remove potential threats and implement a system that acknowledges individuals, their achievements and their needs. The business of caring for people has to begin with the staff.
As for profit margins, healthcare has become a business. Reducing costs and saving money are part of the health care managers responsibilities, particularly in the armed force. The objective is to cut costs but not at the expense of quality care. The solution may be to implement a variety of procedures that can substantially reduce costs while not negatively impacting healthcare. Evaluating budgets and trimming excess costs, reducing unnecessary costs, eliminating unnecessary procedures, and cutting personal expenses can provide a way to increase profit and continue to provide quality healthcare.
A revolution is taking place in the healthcare industry with the emphasis on profit. Rising healthcare costs in the private and public sector is changing the health care delivery system. Even the military health care system is being affected by the rising cost of pharmaceuticals, diagnostic systems and hospital costs.
As a health care manager it is my responsibility to insure that military personnel and their families receive the best health care options while minimizing the financial burden on the system. Ethical issues arise on both ends, as my duty is to implement the best possible solution for the patient and the system.
It is imperative that improvements continue to be made in health care to strengthen the existing system and improve the infrastructure. Healthcare services globally need to benefit from the talented resources available as demand for services increase. Medicine cannot continue to be commercialized by malpractice, misconduct and negligence.
In order to satisfy the growing needs associated with the healthcare system, initiatives need to be put into place to focus on the critical issues the industry is facing:
? In some instances, existing hospitals need to be upgraded to provide the expected level of care
? Teaching medical ethics is imperative and there needs to be a comprehensive revision based on the standards now provided through the healthcare management system
? Healthcare managers must be aware of their obligation to ?serve? to masters---the patient and the hospital. In the case of the military, that also needs to be taken into account.
? Laws regarding healthcare services need to be basic knowledge for all healthcare personnel
These recommendations still require the healthcare manager to keep the objectives of their job in view. Careful consideration needs to be given to each case and the best possible solution implemented that would satisfy all.
Amid the turmoil of constant change that surrounds the healthcare manager, rarely is there a simple solution to meeting both the patient?s needs and needs of the business. In the book, The Tracks We Leave Behind, Ethics in Healthcare Management, the author provides some expert advice on dealing with competing values and the moral issues that are part of healthcare.
With the cost of healthcare premiums rising (13.9 percent in 2003), healthcare managers are faced with the daily decisions of cost effectively running a hospital or field medical office. As a healthcare professional in the military, I realize the importance of keeping a military unit in operational readiness through the administration of quality medical services. My duty is to make sure these men and women are receiving the proper care?providing quality care in an efficient and effective manner. The business of healthcare is to cure and care and healthcare managers are the first line of defense in insuring that happens.

Bibliography
Kirkman-Liff, Brad. ?Keeping an eye on a moving target: quality changes and challenges for
Nurses.? Nursing Economics. November, 2002.
Shah, Bimal R Reed, Shelby, D. Francis, Ridley, Jennifer, Schulman, David B. ?The cost of
inefficiency in US hospitals 1985-1997. Journal of Healthcare Finance.
Perry, Frankie. The Tracks We Leave: Ethics in Healthcare Management. Healthcare
Administration Press. Chicago: 2001.
?South Florida employees face higher healthcare premiums, fewer benefits?. Knight
Ridder/Tribune Business News. October 10,2003.