Write a ten page research paper on "Alzheimer's Disease". Please use APA format for the references that will be at the end of the research paper.

Outline is included as a guideline but you can change it if you decided, you that you have a better approach to writing a more superior research paper.


Research Outline- Alzheimer?s Disease

Question:
1.) What age do people start to get Alzheimer?s?
2.) What are the causes of Alzheimer?s?
3.) Can medication prevent Alzheimer?s?

1.) Introduction- Why I picked this topic?
A.) Family member ? Grandfather

2.) Definition- How it happens? What is it?

3.) Cause-What causes Alzheimer?s disease?
A.) Health issues
B.) Symptoms
C.) Early warning signs
1.) Hereditary

4.) The Stages of Alzheimer?s Disease

5.) Drugs for Alzheimer?s Disease
A.) Name of Drugs
B.) Side Effects ? Pills

6.) Alternative Treatment
A.) Diets
B.) Medication
C.) Behaviors

7.) Alternative Living Choices - Alzheimer?s
A.) Living at home
1.) Family?s responsible
2.) Home safety
3.) Caregivers role
B.) Adult Daycare
1.) Assisted living
C.) Nursing home
1.) Levels of nursing home
2.) Sleep disorders
3.) Planning an outing
4.) Financial, insurance, and legal issues

8.) Living with Alzheimer?s
A.)Lifestyle changes
1.) Support organization and coping
2.) Future Issues

9.) Conclusion- What did I learn about Alzheimer?s?

The student will select a specific health care policy issue and propose nursing strategies to address the problem.

Read chapters 7 and 8 in Mason, Leavitt & Chaffee (2012) and review Sample Paper on pages 58-64, and matrix scorecard example on page 54. The student can use resources from the text, legislative bills, web-based materials, and current nursing journals.

Suggested websites:

http://www.nursingworld.org and read Nursing Code of Ethics

http://www.who.int/ethics and read Ethics and Health

http://www.healthcare_ethics.org

The sample paper in text is a guide. It will look different from yours as you have different grading criteria.

From the sample paper, you cannot use the "do nothing or incremental change" options.

Paper is worth 20/100 points possible for the course.


Details:

8-10 pages (maximum) -(does not include title page, references, appendix)

Strict APA (6th edition)
Requires introduction and conclusion
Must submit the matrix scorecard of Evaluation of Options as an Appendix.
Plagerism will result in a zero (0) for the assignment and a failing grade for the course.


Grading Rubric: Issue Paper

1/1 Problem Identification: Purpose statement

4/4 Background (local, state, regional and national perspectives with statistics, facts, figures, monetary issues)

*Social Factors (how impacted, who are those involved, why is this a problem)

*Economic Factors (how much does it cost? Use specific $, %. #, etc.)

*Ethical Factors (be sure to address ethical principles being violated - Cardinal bioethical principles are autonomy, distributive justice, nonmaleficence, and Code of Nursing information)

*Political and Legal Factors (what legislative action has already happened either at the state or national level, what was the impact? What do the different parties have to say about the issue? What is the impact of issue for both the legal and political arenas?)

1/1 Issue Statement (one sentence/question). Focus on issue, rather than a specific policy proposal.

1/1 Stakeholders (do not merely list. Must clearly address what stake each stakeholder has in the issue)

2/2 Policy Goals and Objectives (Identify at least 2). You will describe what kind of policy would most benefit the issue you have identified. Think globally for this section.

2/2 Policy Options and Alternatives (only 2 can be presented). Provide the actual name and number of the 2 bills ??" and must include the reference for each bill in the Reference section of the paper. These are two bills currently in Congress that could benefit the issue you have identified. They can be two different ways to accomplish your policy goals ??" but might not be the exact answer to your question. You are looking to see what might be available already, or what changes you might need to ask your legislator to include in the bill the best meet your policy goals.



2/2 Evaluation of Options. Identify at least 2 options or evaluative criteria and provide rationale for why these criteria are important. Each bill must be evaluated on all evaluative criteria utilizing pro and con statements. Rationales must be provided for each of your statements and there must have references for each pro and con statement for each bill.

2/2 Results of Analysis & Summary: Discuss the analysis and comparison of the two bills based on the policy goals you identified earlier in the paper. Not based just on the evaluation criteria (which is included in your matrix), but how closely does the recommended bill fit your policy objectives. State which policy alternative would be recommended based on the analysis.

1/1 Matrix/Scorecard in the same format as example in Mason text and put into an appendix.

2/2 1 point for title page and 1 point for reference page

2/2 Correct APA format, Grammar, Punctuation, Turn It In

peer reviewed journal articles within 5 years should be used (2006-2011). essay should be written according to the grading rubric. all references should be cited in text. chapters from text book can be faxed,


There are faxes for this order.

Format and requirements
a) 10 pages minimum, not counting the title page, table of contents, diagrams, photos, non-text material, or references.
b) Typed, double-spaced, with 1" margins on all sides. Use clear, legible font such as Arial or Times New Roman in 12 point. Do not insert additional spaces between paragraphs.
c) Include a bibliography, follow APA format. If you are unfamiliar with this format there is a useful web site on the syllabus page under Web Links. Use a variety of sources (at least five) from the internet and/or scientific journals, most of which should be less than two years old. Citing "personal sources" or "personal experience" can be used, but cannot be counted as one of the five.
d) Papers not meeting the format and/or content requirements will not be read and considered for extra credit.

(3) Content areas
a) Pathological problem, definition & cause
b) Complications (additional clinical manifestations and/or side effects)
c) Treatment (drug regime, surgery, life-style change, etc.)
d) Side effects of the treatment
e) Prognosis: expectations for the individual with the pathological problem and expectations for the future treatment & prevention of this pathology.

No certain format is required. Just answer the following 4 questions in terms of using marketing concepts.

1.Why is GlaxoWellcome introducing a second migraine medication?

2.How should GlaxoWellcome position Naramig in the U.K.?

3.Was the chosen strategy (Option 4) the best decision?

4.How should GlaxoWellcome position Amerge in the United States?

(the material below is to answer the 4 questions)

Migraine medicine is a key growth area for Glaxo Wellcome Inc. (Glaxo), a Britain-based pharmaceutical company with global operations. Glaxo's primary business is to market prescription products to physicians and health care providers. Glaxo was the first pharmaceutical company to manufacture and market a revolutionary new class of prescription migraine medications, called triptans. Triptans, which Glaxo launched in 1993, are a class of medications that work specifically on the 5HT-1 receptor sites, which doctors believe to be the primary cause of migraine headaches.

In mid-May 1997, Sir Benjamin Palmer, the general manager of Glaxo's CNS/GI Metabolic division, sat at the head of the conference table in Room G-1 of the Glaxo Wellcome global headquarters in Stockley Park West, England. A group of six marketers (three from the Professional team and three from the Commercial team) were staged in front of Palmer and two vice presidents of sales (east and west). The three officers listened attentively to the final marketing presentation that more than 60 marketing-team members had worked on for the preceding 19 months. The issue: how to launch Naramig, Glaxo's new (second-generation) prescription migraine medicine, in the U.K. In the back of Palmer's mind were the following considerations:

How would U.K. hospitals and doctors react to Glaxo's promotion of Naramig?
What was the best product positioning of Naramig with respect to Imigran?


Although Naramig was considered by Glaxo to be a better triptan than Imigran, some attributes of Naramig were in reality, inferior to those of Imigran.


It was not as though Imigran had not been successful: Glaxo had captured 91 percent of the prescription-medication market share (in pounds sterling, or ?s) for migraines in the U.K.


Glaxo expected the approval and launch of its competitor, Zeneca's first triptan medication (Zomig), before the launch of Naramig; likewise, Glaxo expected Zeneca to market Zomig as a second-generation triptan.


Early in February 1998, a similar scene to that of eight and a half months ago, in Room G-1 of the U.K. headquarters, was taking place in a conference room at the U.S. home office in Research Triangle Park, North Carolina. Mark Glackin, U.S. general manager of Glaxo's CNS/GI Metabolic Division, considered several marketing options presented by the team for the U.S. launch of Amerge, Glaxo's second-generation triptan, which had been marketed in the U.K. as Naramig. Although Glackin had several considerations to keep in mind, various factors and events gave Glackin a much different perspective from the one Palmer had eight and a half months earlier:

Glaxo was apprised of the marketing strategy chosen by the U.K. for Naramig and its short-term results.
Zeneca's Zomig had in fact been approved and launched in the U.K. before the approval of Naramig. The effects of Zomig on the success of Naramig and Imigran were therefore available for analysis by Glackin.
Just as in the U.K., Glaxo U.S. expected the approval and launch of Zomig in the United States before the FDA approval of Amerge.
Glaxo U.S. had launched the marketing promotion of Imitrex (the U.S. brand name of U.K.'s Imigran) nasal spray five months earlier.
Unlike in the U.K., which has stricter government regulations on pharmaceutical marketing, Glaxo U.S. could use direct-to-the-consumer (DTC) advertising to promote Amerge.

Glaxo Wellcome Inc. was formed in 1995 when U.K.-based Glaxo Pharmaceuticals, a relatively young company, acquired U.K. pharmaceutical company Burroughs Wellcome in a corporate takeover. The acquisition made Glaxo Wellcome Inc. one of the top three pharmaceutical firms in the world, with approximately 4 percent of the worldwide prescription pharmaceutical market.
Glaxo Wellcome Inc. is based in the U.K., with its worldwide headquarters in Stockley Park West. As of 1997, Glaxo Wellcome Inc. had 22 local operating companies (LOCs) in nine countries, of which Glaxo U.S. was one. Although Glaxo is based in the U.K., the U.S. market made up approximately 40 percent of worldwide sales, and the U.K. accounted for only 7 percent. Because of the rigid guidelines of the Food and Drug Administration (FDA), Glaxo's products are generally introduced first in one of the other eight LOCs before gaining approval in the U.S. The majority of (R&D) and production for Glaxo takes place in the U.S., U.K., France, and Italy, each having both an R&D unit and manufacturing plants.


The organizational structure of Glaxo Wellcome in both the U.K. and the U.S. is based around its three divisions and the product lines within each of those divisions (see Figure C11-1):

Product Lines: Product Lines: Product Lines:
Migraine Allergy/Immunology/ HIV
Depression Respiratory Division Cancer
Gastrointestinal Allergy/Immunology
Asthma
COPD
HIV/Oncology Division




Glaxo sells prescription medications that are in one of these three product lines. As of 1998, the migraine product line made up just over 9 percent of total Glaxo sales worldwide. The CNS/GI Metabolic Division, of which migraine makes up 60 percent, grew 31 percent from 1997 to 1998.

Pharmaceuticals are generally classified into two categories: over-the-counter (OTC) and prescription medications. As of 1998, no OTC drugs were specifically formulated for migraines. After a pharmaceutical medication has been developed, it undergoes two stages:

1.Approval
2.Marketing

For a pharmaceutical company to market and sell any medication it has developed, the product must first be approved by the respective regulatory body of each country (FDA in the U.S., MCA in the U.K.). It takes 12 years, on average, for an experimental drug to travel from the lab to the medicine chest. Only 5 in 5,000 compounds that enter preclinical testing make it to human testing. One of these five tested in humans is approved. Although each country has its own particular set of guidelines and specific procedures for approval, new medicines are generally developed and approved as follows:

Preclinical testing?In this exploratory process, a pharmaceutical company identifies compounds through in vitro (test tube) testing. The deliverables at the end of this process are compounds that can enter Phase One of clinical testing.
Clinical trials, phases? Clinical trials have three mandatory phases. These clinical trials study the medicine's safety profile, its absorption and distribution, the duration of its action, and its efficacy and side effects.
Application?Following the completion of all three phases of clinical trials, the company analyzes all the data and applies for approval in the respective country if the data successfully demonstrates safety and effectiveness. The application contains all the scientific information the company has gathered. At this point, the regulatory body may request further information.
Approval/refusal?After the regulatory body completes the professional assessment of all relevant information, it either approves the application and the new medicine becomes available for physicians to prescribe, or, if it is not satisfied, refuses to grant approval.


One important distinction exists between the United States and the U.K. in the approval stage of pharmaceuticals. In the United States, every medication must be approved by the FDA before it can be marketed and sold. However, because of the existence of the European Union (EU), a medication may be approved in member nations without being professionally assessed and analyzed by each country's respective regulatory body. If one member nation's (for example, Sweden's) regulatory body approves a medication, the applying pharmaceutical company can either ask the other EU member nations to "recognize" Sweden's approval or apply to each member nation separately. If one member nation approves a medication, all countries in the mutual-recognition procedure have the same prescribing information. However, if a medication receives independent approvals, the prescribing information will be unique in each country. The difference can have an effect if applying in each country separately produces slightly different results in the trial phases. (For example, the trials might show that a medication is more effective for its desired indication during trials in the U.K. as compared to similar trials performed in Sweden.)

Products are generally marketed and advertised solely toward the final consumer. This targeting makes sense because the final consumer ordinarily has the final say about whether he or she will purchase the product. However, pharmaceuticals are marketed to physicians and hospitals that in turn decide whether they will prescribe the medication to their patients.
Although pharmaceutical companies cannot legally advertise their products directly to patients and consumers in the U.K., in the United States (as of 1997) direct-to-consumer (DTC) advertising is permitted. Research has shown that DTC advertising in the United States has a large impact on sales. The research shows that patients' requests for specific medications marketed by specific pharmaceutical companies affects the companies' sales to physicians and hospitals.


The other major difference in the pharmaceutical industry between the United States and the U.K. is the extent of governmental coverage. In the U.K., the health care system is socialized. Doctors are paid by the government with an additional payment per patient. Everyone is entitled to free medical care under the plan, which is funded by the national treasury and the health insurance tax.


The United States, on the other hand, has not employed socialized medicine, although Medicare and Medicaid cover a significant part of the population. Instead, the U.S. health care system follows an insurance-based coverage scheme whereby individuals buy insurance from a company that in turn pays for their medical costs

Doctors classify headaches into three main types:

Cluster
Tension
Migraine



Although cluster headaches are the most painful type, they are also quite rare and, hence, have not offered pharmaceutical companies a sufficient market potential to profitably develop and market a medication specifically focused on curing this type of headache. Tension headaches, although the most prevalent type, can generally be treated with over-the-counter medications, such as aspirin and ibuprofen; they also do not offer Glaxo a profitable market for which to develop a prescription product. Migraines, on the other hand, afflict an estimated 26.3 million people in the United States, 5 million people in the U.K., and, at the time of Glaxo's launch of Imigran/Imitrex, were not effectively treatable with over-the-counter medications.


Migraine headaches are complicated combinations of intense pain (usually on one side of the head) and neurological symptoms?like visual problems, nausea, vomiting, and sensitivity to light and sound?which often reduce sufferers' productivity and concentration and in some cases render the them bedridden. In the U.K., about 18 million working days are lost to migraine sufferers per year. In the United States, approximately 10 million migraine sufferers were bedridden for more than 3 million days per month and experienced 74.2 million restricted-activity days per year (as of 1989). Such statistics translate to lost workplace productivity ranging from $5.6 billion to $17 billion annually in the United States and sick pay and replacement-personnel costs of ?750 million annually in the U.K.. Hence, in the early 1990s, Glaxo took advantage of the market potential for migraine-specific prescription drugs.
In 1993, Glaxo Pharmaceuticals introduced Imitrex/Imigran in the U.K. and the United States, the first medication (triptan) specifically formulated for the acute treatment of migraines. Imitrex/Imigran, when initially launched in March 1993, was produced in injection form. In 1995 and 1997, Glaxo followed up the marketing of Imitrex/Imigran by introducing line extensions in the forms of tablets and nasal spray, respectively (see Table C11-1).

Table C11-1: Line Extenson of Imitrex/Imigran Injections
Line Extension U.K. U.S.
Injection 3/1993 3/1993
Tablet 5/1995 7/1995
Nasal spray 5/1997 8/1997




These line extensions were spurred by the fact that only a small percentage of the total 26.3 million migraine sufferers had ever tried Imitrex/Imigran in injection form. Hence, Glaxo, even two years after its introduction of Imitrex/Imigran injections, viewed the potential market as wide open.


The injection formulation of the product provides the fastest relief?as early as 10 minutes; the nasal spray?as early as 15 minutes; and the tablet?as early as 30 minutes. Hence, Glaxo has been successful in marketing the injection form of Imitrex/Imigran by using a strategy of quick relief (an important aspect to severe-migraine sufferers) and successfully marketing the tablet and nasal spray forms of the drug using a strategy of "easy and painless administration" (an important aspect to migraine sufferers who are uncomfortable injecting themselves). Sales of Imitrex/Imigran worldwide grew from less than $350 million in the year of its introduction to more than $1 billion in 1997.

Glaxo considered the strengths, weaknesses, opportunities, and threats (SWOT) of Imigran/ Imitrex to be the following:

Strengths?Imigran/Imitrex was the first medication marketed toward specific migraine relief. Hence, Imigran/Imitrex had a strong brand image as the market leader, and in fact played a significant role in the development of the migraine market. Imigran/Imitrex was also a potent medication with a proven efficacy; it was in fact very successful in relieving the pain of migraine headaches. Although some side effects were associated with the medication, Imigran/Imitrex has a proven safety profile. The fact that Imigran/Imitrex is offered in three different line extensions offers Glaxo a "portfolio" of relief to offer to various patients.
Weaknesses?That Imigran/Imitrex is a potent medication has its downside as well. The medication proves to be too powerful for some patients, which therefore limits its use. Moreover, Imigran/Imitrex is expensive relative to OTC products that are used to fight headaches. This weakness of being expensive is exacerbated by the medication's high rate of recurrence (a patient may need to take the drug more than once during a migraine). Although Imigran/Imitrex is proven to be safe, because of its side effects (tightening of the chest, for example), some people have the perception that the medication is not safe.
Opportunities?Glaxo felt that having three product-line extensions opened up the opportunity to perhaps exploit Imigran/Imitrex as a medication that is right for every kind of migraine sufferer. The biggest opportunity for Glaxo and Imigran/Imitrex lies in the fact that the migraine market was completely underdeveloped.
Threats?The two main threats to Imigran/Imitrex are competition and cannibalization. Glaxo was aware that Zeneca was close to marketing a competitor triptan, named Zomig. Because Imigran/Imitrex had been on the market for more than four years, Glaxo felt that Zomig would be marketed as a second-generation triptan (an improved version of Glaxo's first-generation Imigran/Imitrex). Imigran/Imitrex had also experienced some cannibalization effects between its three line extensions.

As of 1997, approximately 90 percent of migraine sufferers were not being medicated with a triptan. Many people were therefore still taking ineffective OTC drugs to combat their migraine pain. Accordingly, Glaxo considered the market for triptan drugs to have great potential.

Since the introduction of Imitrex/Imigran in 1993, it had clearly played a role in defining patient expectations. Glaxo, however, combined its awareness that Zeneca was in the process of developing Zomig with its own enthusiasm for bringing new medications and improvements to the forefront to work on developing a second-generation triptan of its own. Company research revealed that for a new triptan product to be successful, patients and doctors would require it to be as effective as Imitrex/Imigran, but with a longer duration of pain relief and a lower side-effect profile.
Naramig/Amerge, Glaxo's second-generation triptan, was being developed before the launch of Imigran/Imitrex. Testing of Amerge/Naramig, available only in tablet form, showed that it has both a longer duration and a lower side-effect profile than Imigran/ Imitrex. Although Naramig/Amerge was considered by Glaxo to be a better triptan than Imigran/Imitrex, some attributes of Naramig/Imigran were, in reality, inferior to those of Imigran/ Imitrex.


Table C11-2 shows how Naramig/Amerge specifically compared to Imigran/Imitrex as a migraine medication.

Table C11-2: Imigran Versus Naramig
Measure Order (Best First)
Speed of onset Imigran > Naramig
Peak efficacy Imigran > Naramig
Consistency of response Imigran > Naramig
Tolerability Naramig > Imigran
Incidence of chest pain Naramig < Imigran
Incidence of recurrence Naramig < Imigran




Glaxo considered the strengths, weaknesses, opportunities, and threats of Naramig/Amerge to be the following:

Strengths?Although Naramig/Amerge was not as powerful as Imigran/Imitrex, Naramig/Amerge was effective in relieving migraine pain. Its biggest strength, relative to Imigran/Imitrex, was its mildness; the side effects caused by Naramig/Amerge were substantially less compared to Imigran/Imitrex, which gave it a "user friendly" image. Its long duration of pain relief gave Naramig/Amerge a low rate of recurrence; 67 percent of patients require only one dose of Naramig/Amerge over a 24-hour period. Naramig/Amerge was able to be marketed as a true second-generation triptan, (an improvement over the first) because Glaxo was the company that had introduced the first triptan medication.
Weaknesses?The major weaknesses of Naramig/Amerge were twofold. First, it had a slow onset of action. This characteristic, of course, would turn off patients looking for fast relief. Second, Naramig/Amerge had been developed only in tablet form and therefore lacked marketability in terms of line extensions.
Opportunities?The market opportunity for Naramig/Amerge was quite obvious. At the time of Naramig/Amerge's approval, only 10 percent of all migraine attacks were being treated with triptan drugs. Ninety percent of migraine sufferers were therefore either not being treated or were being treated with relatively ineffective medications.
Threats?As with Glaxo's first-generation triptan, the biggest threat to Naramig/Amerge came from Zeneca's Zomig. Although it was unclear how successful Zomig would be in stealing Glaxo's market share and expanding the market through sales to the untapped 90 percent, what was clear was that Zomig was likely to be approved in both the U.K. and the United States before Glaxo obtained approval for Naramig/Amerge.

When Glaxo Pharmaceuticals acquired Burroughs Wellcome in 1995, it had already launched Imigran/Imitrex (1993). However, Burroughs Wellcome was also developing a triptan of its own. When the takeover took place, the Federal Trade Commission (FTC) forced Glaxo Wellcome to divest one of its triptan formulations because of antitrust implications (monopolization). Having already successfully marketed Imigran/Imitrex, Glaxo Wellcome chose, of course, to divest the triptan that Burroughs Wellcome had developed. (Burroughs completed only about 55 percent of the clinical trials.)


Zeneca purchased the rights to this incomplete triptan and finished the further development and application process of what came to be Zomig. Glaxo made the following assumptions about Zomig:

Like Naramig/Amerge, Zomig had a lower recurrence rate than Imigran/Imitrex.

Zeneca would be successful in marketing Zomig as a second-generation triptan, even though it was the company's first triptan. This issue was simply one of timing.

Zomig's efficacy was comparable to Imigran/Imitrex.

Zomig would be launched in both the U.K. and the United States before Naramig/Amerge gained approval in both markets.

Sir Benjamin Palmer sat in his office weighing all the information he had just learned in the marketing meeting. Only one question had to be considered. The considerations were complex, the answer to that question was crucial, and the success of a major product line of Glaxo Wellcome hung in the balance: How should Glaxo Wellcome U.K. position its new triptan, Naramig?


Palmer wondered how U.K. hospitals and doctors would react to Glaxo's promotion of Naramig when Imigran had been the "gold standard" for the preceding four years and had captured 91 percent of the prescription migraine medication market share. Palmer's bigger concern was how to position Naramig with respect to Imigran to capture the 90 percent of the market that was untapped. Although Naramig was considered to be a better triptan than Imigran, perhaps new patients would be partial to the characteristics of Imigran. Just as important, what positioning strategy would be the most effective in fighting off the attack of Zeneca's Zomig that Palmer expected to be launched in the U.K. before Naramig was launched?


Palmer had been presented by the marketing team with five positioning strategies for Naramig:

Clinical-/patient-based segment?Glaxo would target its marketing efforts toward different patient types (for example, adolescent; elderly; chronic migraine; Imigran/ Imitrex nonresponder; and Imigran-intolerant) Using such a strategy would allow Glaxo to promote Naramig where Imigran was weak to increase market share. At the same time, though, it was not clear how the market should be segmented or how able physicians would be able to identify such segments. If, in fact, physicians had trouble identifying the different patient types, the effect may be to confuse the prescribing process.
Distribution-based segment?Glaxo would segment the market based on distribution channels (for example, hospitals only; clinics only; private channels; and less wealthy areas). Although Glaxo considered this option to be a powerful means of maximizing market share, Palmer was unsure of the logistics of such an approach and worried about the ethical considerations of focusing the promotion of his company's product in areas based on factors such as socioeconomic status. Also, Palmer considered the possibility that such a strategy may overlook patient needs.
An alternative?Glaxo would market Naramig as an alternative to Imigran/Imitrex (for example, superior; different; or similar). The positive aspects of the alternative strategy were that it could detract from competitor noise and could in fact devalue the image of the second-generation triptan. This latter aspect could be an effective way to combat Zomig. The biggest drawback of this strategy was the idea that having no clear message (in terms of the medication that was best for migraines) could lead to confusion and hurt Glaxo's image.
Replacement?Glaxo would discontinue the marketing of Imigran and focus solely on Naramig. This option fit well with the overall concept that Naramig was an overall superior drug to Imigran. It would also allow Naramig to gain all the benefits of a new compound: second-generation, safety, and low recurrence. However, Palmer worried about the confusion that would accompany such an approach and whether a replacement strategy would devalue Glaxo Wellcome in the eyes of physicians and hospitals.
Don't launch?Glaxo would continue to market only Imigran and never launch Naramig. Although this strategy might classify all triptans as the same, negating Zomig as a second-generation triptan, Palmer had already made up his mind that not launching Naramig was a waste of an opportunity and of resources that had gone into developing the medication. He would also have to consider that Zeneca would still be able to accomplish the marketing of Zomig as a second-generation triptan and leave Zeneca with an open field.


Palmer and his team chose a replacement strategy for Naramig. This plan involved ceasing all promotion of Imigran (except to the extent of sales for patients who were already using Imigran) and positioning Naramig as the recommended starting place for migraine patients. Palmer felt that replacement was the best way to attract triptan-na?ve patients and capture the untapped market. Glaxo focused the promotion around Naramig as a "patient-friendly" medication providing patients with the best relief on the market.


The results showed that the replacement strategy met Glaxo U.K. expectations. Naramig proved to be effective for migraine headaches in the majority of patients. In terms of the 90 percent untapped market, Naramig was preferred by 67 percent of previous non-triptan users. Figure C11-4 shows worldwide sales of Glaxo Wellcome's two triptan drugs. The replacement strategy clearly thwarted the growth of Imigran, and Zomig and Naramig were both successful in expanding the market.

Mark Glackin was now faced with the same decision that Palmer had been faced with eight and a half months earlier. What was the best strategy to market Amerge with respect to Imitrex in the United States market? Glackin had several considerations to keep in mind, including the results of the replacement strategy chosen in the U.K., and the effect of Zomig as a competitor. As was the case in the U.K., Imitrex had largely defined the market for migraine medication and had been quite successful in capturing customers. Glackin also expected that Zomig would be launched in the United States before Amerge was approved. The United States had recently legalized DTC advertising, and Glackin would have to consider this difference along with the differences in the respective health care systems. Would Glaxo United States be successful in using DTC advertising to offer a portfolio of migraine medication to various types of migraine patients, or should the United States follow a replacement strategy similar to the one used in the U.K. and position Amerge as the best migraine medication available? Glackin considered the same five options for Amerge positioning as Palmer had considered eight and a half months earlier for Naramig:

Clinical-/patient-based segmentation
Distribution-based segment
An alternative to Imitrex
A replacement for Imitrex
Don't launch Amerge

An annotated Outline
Problem statement
Provide a one to two paragraph statement that is the result of a review of research findings and current practice and that it contains the following information:
1. A logical argument for the need to address an identified gap in the research literature that has relevance to the discipline and area of practice.
2. Preliminary evidence that provides justification that this problem is meaningful to the discipline or professional field. Provide three to five key citations that highlight the relevance and currency of the problem.
3. The over all purpose or intention of the study.
In quantitative studies, state what need be studied by describing two or more factors (variables) and a conjectured relationship among them related to the indentified gap or problem.
In qualitative studies describe the need for increased understanding about the issue to be studied based on the identified gap.
In mixed methods studies with both quantitative and qualitative aspects clarify how the two approaches will be used together to inform the study.
For other approaches, clarify why an alternative approach is needed and useful for this project.
Significance
Provide one to two paragraphs informed by the topic in the problem statement which describes;
1. How the study will contribute to filling the gap identified in the problem statement ? What original contribution wills this study make?
2. How this research will support professional practice or allow practical application-Answer the So what? Question.
3. How the claim aligns with the problem statement to reflect the potential relevance of this study to society - how might the potential findings lead to positive change?
Background
Provide a representative lit of scholarship and findings that support the main assertions in the problem statement, highlighting their relationship to the topic (e.g., ?This variable was studied with a similar sample by Smith (2010) and Johnson (2008),? or Jones?s (2011) examination of industry leaders showed similar trends in the same key segment.?).
Framework
In one paragraph, describe the theoretical base and conceptual framework in the scholarly literature that will ground the study. This theory or framework informs, and is informed by, the research question (s) and helps top identify research design decisions, such as the method of inquiry and data collection and analysis.
Research question (s)
Lit the question or a series of related questions that are informed by the study purpose, which will lead to the development of what needs to be done in this study and how it will be accomplished. A research question informs the research design by providing a foundation for:
? Generation of hypothesis in quantitative studies
? Questions necessary to build the design structure for qualitative studies and a
? Process by which different methods will work together in mixed studies.
Nature of the Study
Using one of the following terms as a subheading, provide a concise paragraph that discusses the approach that will be use to address the research question(s) and how this approach aligns with the problem statement. The subheadings and examples of study design are:
? Quantitative ? for experimental, quasiexperimental, or nonexperimental designs; treatment control; repeated measures; causal-comparative; single-subject; or predictive studies.
? Qualitative ? for ethnography, case study, grounded theory, narrative inquiry, phenomenological research, or policy analysis.
? Mixed methods, primarily quantitative ? for sequential, concurrent, or transformative studies, with the main focus on quantitative methods.
? Others ? for the designs, to be specified with a justification provided for its use


Possible Types and Sources of Information or Data
Provide a list of possible types and sources of information or data for this study, such as test scores from college students, employee surveys, observation of children, interviews with practitioners, historical documents from state records, deidentified medical records, or information from a federal database.
Possible Analytical strategies
Provide some possible ways to organize and analyze the results obtained by the research strategies detailed previously. A few examples of possible analytical strategies include multiple regression, content analysis and meta-analysis.
Other Information
Provide any other relevant information, such a challenges or barriers that may need to be addressed when conducting this study.
References
Include references formatted in the corrected style (APA sixth edition, mod3led at the end of this guide) for all citations within the Dissertation Prospectus.
Quality Indicators
Nice key indicators have been identified to assure the overall quality of the dissertation project at this point in its development. Supervisory committee members will use these indicators to give ongoing feedback and as a means to document their final approval of the Dissertation Prospectus. Students should use these rubric items to guide development of prospectus.
1. Complete?
Does the prospectus contain all the required elements? Refer to the annotated outline to see the required parts of the Dissertation Prospectus document.
2. Meaningful?
Has a meaningful problem or gap in the research literature been identified? In other words, is addressing this problem the logical next step, given the previous exploratory and confirmatory research (or lack thereof) on this topic? It is not acceptable to simply replicate previous research for a PhD degree.
3. Justified?
Is the evidence presented that this problem is significant to the discipline and/or professional field? The prospectus should provide relevant statistics and evidence, documentable discrepancies, and other scholarly facts that point to the significance and urgency of the problem. The problem must be an authentic ?puzzle? that needs solving, not merely a topic that the researcher find interesting.

4. Grounded?
Is the problem framed to enable the researcher to either build on or counter the previously published findings on the topic? For most fields, grounding involves articulating the problem within the context of a theoretical base or conceptual framework. Although many approaches can ground a study in the scientific literature, the essential requirement is that the problem is framed such that the new findings will have implication for the previous findings.
5. Original?
Does this project have potential to make an original contribution? Addressing the problem should result in an original contribution to the field or discipline.
6. Impact?
Does this project have potential to affect positive social change? As described in the Significance section (see annotated outline), the anticipated findings should have potential to support the mission of the University to promote positive social change.
7. Feasible?
Can a systematic method of inquiry be used to adder the problem? The tentative methodology demonstrated that the researcher ha considered the options for inquiry and has selected an approach that has potential to address the problem.
8. Aligned?
Do the various aspect of the prospectus align overall? The nature of the study should align with the problem, research questions and tentative approaches to inquiry.
9. Objective?
Is the topic approached in an objective manner? The framing of the problem should not reveal bias or present a foregone conclusion. Even if the researcher has a strong opinion on the expected findings, the researcher must maximize scholarly objectivity by framing the problem in the context of a systematic inquiry that permits multiple possible conclusions.

Please use the following as an outline as this is what I used in my rough draft

Background
Pathophysiology
Etiology
Epidemiology
Diagnosis
Treatment
Prognosis



This is paper guidelines we were given...I will send my rough draft that I submitted with what the professor gave me for feedback.


As you review the course outline for Applied Pathophysiology, you will note that there are several units which are not covered in the core content. This paper will give you the opportunity for in depth exploration of a topic of your choice and interest from a unit not covered in this course.

Paper Topic and Length: This paper will be 7-10 pages in length (excluding title page and reference page). It should describe a specific disease process with emphasis on pathophysiology and evidence based interventions for that disease.

Sources for Your Paper: The information for your paper should come from pathophysiology (not medical surgical nursing) textbooks or professionally based reliable internet resources. Websites designed specifically for lay persons should not be included including Wikipedia and Answers.com. You must also include a minimum of three (3) evidence based research studies. The research must be current (within the past 5-10 years) and from peer reviewed journals. The references must also be primary sources unless the source is a systematic review. Access the document Writing Your Paper on the D2L content page for assistance in meeting these expectations.

Elements of Paper

The final paper will include the following elements. Please note weight of each element in percentages for grading emphasis.
1. A description of the disease process that includes in depth pathophysiology at the cellular and tissue level as appropriate. 25%
2. Epidemiology of the disease 5%
3. Diagnostic criteria for the disease. 5%
4. Clinical manifestations (signs and symptoms) of patients with this disease including the pathophysiology of those symptoms. 20%
For example: Dyspnea in heart failure occurs when cardiac output decreases leading to an increase in pulmonary capillary filtration pressure. That causes fluid to move from the pulmonary capillary bed to the interstitium of the lung. The presence of fluid in the lung interferes with gas exchange and results in dyspnea and hypoxia. (Porth & Matfin, 2009, p. 611-617).
5. Evidence based interventions for the disease and how they alter pathophysiology and course of the disease. 25%
6. Suggestions for safe, quality implementation of those interventions in the healthcare environment. 10%
7. APA format (cover page, introduction, body, summary, headings, grammar, spelling, citations, reference page, etc) 10%

Rough Draft: (This has already been completed and does not need to be done)
1. Develop the format of the paper and the outline (headings).
2. Using your APA manual as a resource, the rough draft will contain the following elements:
Basic paper setup (font, margins, spacing) - Section 8.03 (Pages 228 ??" 230)
Title page including running head - See page 41-42 example for format, Sections 2.01, 2.02, 8.03 (Pages 23-25 and -228-231)
Headings, seriation - Sections 3.02, 3.03, 3.04 (Pages 62-65)
Reference page established with textbook source included. Crediting Sources Chapter 6 (Page 59 for format example)
The reference page should include a minimum of three (3) evidenced based articles that you will be using for your paper along with the sources that you will be using for disease pathophysiology, epidemiology, diagnostic criteria and clinical manifestations.
Do not hesitate to review this site for assistance with APA. http://library.nmu.edu/guides/userguides/style_apa.htm

3. Submit your rough draft to the course dropbox by midnight on February 10, 2012.

There are faxes for this order.

The format should include:
Chapter 1-Introduction
Chapter 2-Case presentation of OCD client (*I will fax in a psychological eval on client but u will need to elaborate and embellish- this chapter should be about 15 pgs.)
a-Presenting problem
b-Developmental history
c- Diagnosis
Chapter 3-Treatment History to date (*Once again must embellish on psyeval info)
Chapter 4-Key Theoretical Concepts of this Clinician(* i will fax paper on my theoretical beliefs)
a. Cognitive theory related to OCD (Donald/Miller, Michelbaum, Berne,Piaget)
b. Psycholanalysis theory related to OCD (mainly Jungian, Adler, Freud, Fromm, Murray)
C. Developmental theory related to ocd (mainly eriksonian)
Chapter 5- Countertransference and transference issues (include my own history about obsessive neatness and perfectionism)
Chapter 6-Therapeutic relationship
Chapter 7-conclusion
Chapter 8- Bibliography

There are faxes for this order.

This is not to be a dissertation. It is an all
inclusive literature review of the following topic : Prevention and
treatment of hypotension with spinal and epidural anesthesia in the
parturient (Again, Masters degree Literature Review) I do not wish to
have you send me anything but the body of the paper. By this I mean I do
not want an outline, title pages, abstracts, tables, graphs, charts,
introductions, conclusions, implications, etc. No running head or footers
on the pages, and quotes are not necessary unless you wish to include some.
Please do not include any references on the reference pages that are not
cited in the body of the paper. Please keep internet
references to a minimum if any at all - none are required. Below I will
place an outline to follow that I have constructed, this is the sequence I
would like you to follow. If a word document of this outline would be more
helpful please let me know and I will email it to you as quickly as I get
the message. I have also done a PubMed search and located the references I
would like to see in this work. These will be attached below. The journal,
author, title, and Pubmed ID #'s are available for each source so they
should be very easy to locate. Again they can be found on PubMed or any other online resource centers.

The title of the dissertation is: Examining the potential use of beta secretase enzymes in the treatment of Alzheimer's Disease.
I would like the literature review to be mainly focused on the beta secretases that have been successful in trials on mice and comparing them and I would also like a conclusion.

1. Introduction ?
Brief introduction to your topic: definition, population, prevalence, etc. ? The introduction should be no more than 1-2 paragraphs, and definitely no longer than 1 page

2. Name of the first treatment/prevention modality to be discussed?
Example: if the topic were alcohol addiction, the title of this section might be 12-Step Treatment ? Description of treatment or prevention modality ? Discussion of effectiveness

3. Name of the second treatment/prevention modality to be discussed ?
Example: Inpatient Treatment ? Description of treatment or prevention modality ? Discussion of effectiveness

4. Name of third treatment/prevention modality to be discussed
Example: School-Based Drug and Alcohol Prevention Education ? Description of treatment or prevention modality ? Discussion of effectiveness

5. Conclusion ?
Summary of treatment/prevention modalities. Identify ?best? treatment and explain why

This paper is a combination of 3 projects and then an additional page for the summary of the whole project.

You will combine Parts 1, 2, and 3 of your Course Project (assigned in Weeks 2, 4, and 8 respectively) into one cohesive and cogent paper.

Note: In addition, include a 1-page summary of your project.

For this final iteration you will need to:

Reminder: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The School of Nursing Sample Paper provided at the Walden Writing Center provides an example of those required elements (available from the Walden University website found in this week?s Learning Resources). All papers submitted must use this formatting.
Note: The Course Project will be your Portfolio Assignment for this course.


Week 2
Suicide in psychiatric patients
Suicide rates are remarkably high worldwide and nationally, making suicide one of the leading causes of death (Schwartz-Lifshitz, Zalsman, Giner et al, 2012; Tillman, 2014). Although most suicides do not occur in the hospital setting, psychiatric disorders?especially mood disorders and psychotic disorders?are risk factors that increase the likelihood of a suicidal event (Appleby, 1992; Sarzetto, Delmonte, Seghi, et al, 2017). Suicide not only affects the patient, but reverberates throughout the patient?s family and social circle, also causing distress and potential performance issues among clinical staff (Tillman, 2014). Therefore, it is important that psychiatric nurses understand how to recognize risk factors, and establish a clinical practice environment that prevents suicide. Minimizing suicidal tendencies requires different types of treatment interventions individually tailored for at-risk patients, as well as implementing best practices for creating a clinical environment that reduces risk. Best practices may also include preparing, teaching, and training nursing staff, especially when working with at risk populations.
Both psychiatric patients and psychiatric nursing staff can be considered target populations for an intervention designed to prevent suicide in the clinical setting. Preliminary research questions using the PICO (patient/population, intervention/issue, comparison, and outcome) model include the following:
1. Among psychiatric patients (P), do mandatory intake assessments specifically for suicide risk (I) reduce rates of suicide (O) versus institutions without such policies (C)? This is a reasonable PICO question, but one that would require a large-scale assessment of different psychiatric institutions. Therefore, it might be too difficult to find sufficient evidence to make an informed decision for evidence-based practice.
2. Among psychiatric patients with mood disorders and other high-risk populations (P), do pharmacological interventions (I) reduce rates of suicide (O) versus patients who only receive talk or group therapies (C)? This is a commonly posed question related to suicide in the population group. The problem with this PICO question is there are too many different pharmacological interventions and individual differences among patients to come up with a clear, definitive guide for evidence-based practice.
3. Among psychiatric patients with suicidal ideations or a history of suicidal behavior (P), does family and group therapy (I) reduce risk (O) versus patients who do not receive any family or group therapy (C)? This is one of the most feasible PICO questions to use because family and group therapy options might offer some sound solutions for preventing suicide and reducing long-term risks.
4. Do community awareness, public service announcements, and other means of education and communication (I) help reduce rates of suicide (O) among discharged psychiatric patients (P) versus communities that do not receive such public relations services (C)? This is an important avenue of research for evidence-based practice in the community, helpful from a public health perspective. However, methodologically such interventions are less feasible.
5. Does mindfulness meditation (I) reduce long-term risk factors and suicidal behaviors (O) among high risk psychiatric patients (P) versus those who do not participate in the meditation programs (C)? As with question three, this is a suitable line of inquiry, which could actually lead to evidence-based practice guidelines for psychiatric institutions. Therefore, I will select this PICO question for the remainder of my research.
PICO Question: Does mindfulness meditation (I) reduce long-term risk factors and suicidal behaviors (O) among psychiatric patients (P) versus those who do not participate in the meditation programs (C)?
The patient population (P) can include all psychiatric patients on any given unit or within any given institution. Alternatively, the patient population can include psychiatric patients who have been diagnosed with one or more conditions known to increase risk of suicide: those conditions being mood disorders, psychotic disorders, substance use disorders, and personality disorders (Schwartz-Lifshitz, Zalsman, Giner, et al, 2012). This would allow the researcher to compile evidence from multiple studies.
The intervention (I) in this PICO question is mindfulness meditation. It is important to clarify exactly what this would mean, such as how many hours per day or per week of meditation, and which specific meditation instructions were given. The addition of the time (T) variable to the PICOT analysis might also be helpful. For example, does the meditation intervention yield results after three months, six months, or one year?
The comparison (C) is like a control group in this case, consisting of psychiatric patients who are not meditating formally within the designated intervention. Finally, the outcome (O) can be measured in different ways such as overall rates of suicide or surveys of patients regarding their subjective assessments of suicidal ideation.
The following keywords that can be used for conducting a literature search include: major depressive disorder, mood disorders, psychotic disorders, DSM-V, suicidal behavior, suicide, suicidal ideation, mindfulness, mindfulness meditation, meditation, suicide risk, and psychiatric patients.
References

Appleby, L. (1992). Suicide in psychiatric patients. British Journal of Psychiatry 1992(161): 749-758.
Jacobs, D.G., Baldessarini, R.J., Conwell, Y., et al (2010). Practice guideline for the assessment and treatment of patients with suicidal behaviors. https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/suicide.pdf
Sakinofsky, I. (2014). Preventing suicide among inpatients. Canadian Journal of Psychiatry 59(3): 131-140.
Sarzetto, A., Delmonte, D., Seghi, F. et al (2017). Suicide in depressed patients. European Psychiatry 41(April 2017 Supplement): S891-S892.
Schwartz-Lifshitz, M., Zalsman, G., Giner, L., et al (2012). Can we really prevent suicide? Current Psychiatry Reports 14(6): 624-633.
Tillman, J.G. (2014). Patient suicide: impact on clinicians. Psychiatric Times. Dec 31, 2014. http://www.psychiatrictimes.com/special-reports/patient-suicide-impact-clinicians



Week 4 : Literature review of week 2 project

A synthesis of what the studies reveal about the current state of knowledge on the question developed

The mindfulness meditation theory appears to have the potential to treat addictive disorder patients. Zgierska and coworkers (2009) state that such models seem to be safe if implemented within the context of clinical studies. One can find considerable methodological shortcomings in a majority of existing works on the subject. Further, which addiction-diagnosed individuals may derive maximum benefits out of mindfulness meditation isn?t clear. But, of late, related initiatives and practices in the role of complementary clinical aids for treating multiple physical and psychological ailments have grown in popularity. MBCT (mindfulness-based cognitive therapy) and MBSR (mindfulness-based stress reduction) as clinical initiatives have specifically been analyzed, with a sound evidential pool recording their efficacy. Integration of the latter initiative?s aspects and cognitive behavioral therapy and cognitive psychology strategies resulted in the former?s creation. At first, MBCT was labeled Attentional Control Training, concentrating chiefly on psychiatric disorder treatment. Xie and colleagues (2014) claim that the general psychological health improvements depicted by individuals undergoing MBCT may stem from various training-related advantages. Thus, anxiety and depression diagnosed individuals may profit from MBCT during rehab, for facilitating long-run maintenance of improved QOL (quality of life).
Being deployed to the battlefield is linked to an appreciable growth in fresh onset substance use disorder, PTSD (post-traumatic stress disorder), chronic pain and MDD (major depressive disorder). Vythilingam and Khusid (2016) note that a growing number of ex-servicemen have been increasingly recognizing mindfulness as being easily understandable, safe, inexpensive, and substantiated by an increasing pool of evidence. The absence of adequate quality patient-focused proofs hints at adjunctive MBCT?s benefits for patients experiencing a depressive spell, and in the form of a maintenance or continuation treatment among individuals who have recovered from MDD. Moreover, existing proofs support the adoption of adjunctive MBSR in managing PTSD.
MBC therapy is targeted at individuals undergoing remission from MDD. The goal is allowing them a chance at practicing the cultivation of non-judgmental awareness connected with harmless feelings, bodily sensations and thoughts, prior to trying to use similar processing in case of negative feelings, bodily sensations and thoughts. But in case of individuals who might mull over or attempt at long-term suppression of such negative emotions, embracing this sort of drastically different strategy might prove intimidating. In fact, certain individuals whose negative emotions are extremely near the surface might have to instantly face challenging emotions upon commencement of meditation (Crane & Williams, 2010).
In the last few decades, a considerable growth in interest has been witnessed in the area of scrutinizing mindfulness as both a clinical initiative and psychological construct. Villatte and Luoma (2012) assert that it is possible to readily arrive at the conclusion that mindfulness has numerous positive psychological impacts such as enhanced perceived well-being and conduct regulation and a decrease in emotional reactivity and psychological symptoms.
Inconsistencies and contradictions in the literature, and possible explanations for inconsistencies
Zgierska and coworkers (2009) reveals a lack of conclusive information linked to mindfulness meditation as addiction therapy. But the preliminary proofs suggest mindfulness meditation?s effectiveness. Clinical trials in the future need to have a sufficiently large sample size for successfully answering a given clinical issue. Furthermore, they need to encompass thoroughly-designed comparison clusters for allowing evaluation of mindfulness meditation?s means of action as well as impact size. Williams and Crane (2010) indicate that people exhibiting superior cognitive reactivity, depressive rumination and brooding levels might struggle a lot with MBCT engagement. However, puzzlingly, they depict the likelihood of profiting most from mindfulness skill acquisition if they continue to attend class. Dealing with how best to equip these individuals for therapy and support them in continuing therapy in the event of difficulties constitutes a major challenge.
As the mindfulness construct has its roots in Buddhist religious teachings, and lacks a sufficiently long history in the psychological science of the West, the fact that appreciable challenges exist in its definition, quantification and operationalization is not surprising. While numerous self-report repertoires for mindfulness evaluation have been created, they differ considerably in their factor and content structure, revealing inconsistencies in its nature and meaning. To date, scant information exists with regard to the conditions under which, and the individuals for whom, mindfulness training proves most effectual; however, one can find certain preliminary proofs indicating that its efficacy differs based on individual variances (Keng, Smoski & Robins, 2011).

Preliminary conclusions on whether the evidence provides strong support for a change in practice or whether further research is needed to adequately address your inquiry
While the need for further studies on the topic has been identified, the mindfulness approach seems to have the potential to aid individuals considering ending their lives and thus ending their suffering. Positive preliminary proofs indicate therapists may promote mindfulness within a fairly short duration; additionally, it may influence various processes apparently contributing to suicide (Luoma and Villatte, 2012). On the basis of an assessment of empirical studies over numerous methodologies, the review reaches the conclusion that mindfulness meditation and its adoption aids adaptive psychological operation. In spite of extant methodological inadequacies in individual literature works, one may find an explicit convergence of results of correlational researches, experimental, lab-based mindfulness researches and clinical intervention researches which all indicate a positive link between psychological health and mindfulness. Furthermore, mindfulness training can lead to positive psychological impacts which extend from enhanced behavioral regulation to enhanced subjective wellbeing and decreased emotional reactivity and psychological symptoms (Keng, Smoski & Robins, 2011). Lastly, enhanced behavioral self-regulation and values clarification might prove to be additional means by which this strategy betters psychological health.




References
Crane, C., & Williams, J. M. G. (2010). Factors Associated with Attrition from Mindfulness-Based Cognitive Therapy in Patients with a History of Suicidal Depression. Mindfulness, 1(1), 10?20. http://doi.org/10.1007/s12671-010-0003-8
Keng, S. L., Smoski, M. J., & Robins, C. J. (2011). Effects of mindfulness on psychological health: A review of empirical studies. Clinical psychology review, 31(6), 1041-1056.
Khusid, M. A., & Vythilingam, M. (2016). The emerging role of mindfulness meditation as effective self-management strategy, part 1: clinical implications for depression, post-traumatic stress disorder, and anxiety. Military medicine, 181(9), 961-968.
Luoma, J. B., & Villatte, J. L. (2012). Mindfulness in the Treatment of Suicidal Individuals. Cognitive and Behavioral Practice, 19(2), 265?276. http://doi.org/10.1016/j.cbpra.2010.12.003
Xie, J. F., Zhou, J. D., Gong, L. N., Iennaco, J. D., & Ding, S. Q. (2014). Mindfulness-based cognitive therapy in the intervention of psychiatric disorders: A review. International Journal of Nursing Sciences, 1(2), 232-239.
Zgierska, A., Rabago, D., Chawla, N., Kushner, K., Koehler, R., & Marlatt, A. (2009). Mindfulness Meditation for Substance Use Disorders: A Systematic Review. Substance Abuse?: Official Publication of the Association for Medical Education and Research in Substance Abuse, 30(4), 266?294. http://doi.org/10.1080/08897070903250019


Week 8: Translating Evidence from week 2 project to Practice
Suicide in psychiatric patients
Suicide rates are remarkably high worldwide and nationally, making suicide one of the leading causes of death (Schwartz-Lifshitz, Zalsman, Giner et al, 2012; Tillman, 2014). Although most suicides do not occur in the hospital setting, psychiatric disorders?especially mood disorders and psychotic disorders?are risk factors that increase the likelihood of a suicidal event (Appleby, 1992; Sarzetto, Delmonte, Seghi, et al, 2017). Suicide not only affects the patient, but reverberates throughout the patient?s family and social circle, also causing distress and potential performance issues among clinical staff (Tillman, 2014). Therefore, it is important that psychiatric nurses understand how to recognize risk factors, and establish a clinical practice environment that prevents suicide. Minimizing suicidal tendencies requires different types of treatment interventions individually tailored for at-risk patients, as well as implementing best practices for creating a clinical environment that reduces risk. Best practices may also include preparing, teaching, and training nursing staff, especially when working with at risk populations.
Both psychiatric patients and psychiatric nursing staff can be considered target populations for an intervention designed to prevent suicide in the clinical setting. Preliminary research questions using the PICO (patient/population, intervention/issue, comparison, and outcome) model include the following:
1. Among psychiatric patients (P), do mandatory intake assessments specifically for suicide risk (I) reduce rates of suicide (O) versus institutions without such policies (C)? This is a reasonable PICO question, but one that would require a large-scale assessment of different psychiatric institutions. Therefore, it might be too difficult to find sufficient evidence to make an informed decision for evidence-based practice.
2. Among psychiatric patients with mood disorders and other high-risk populations (P), do pharmacological interventions (I) reduce rates of suicide (O) versus patients who only receive talk or group therapies (C)? This is a commonly posed question related to suicide in the population group. The problem with this PICO question is there are too many different pharmacological interventions and individual differences among patients to come up with a clear, definitive guide for evidence-based practice.
3. Among psychiatric patients with suicidal ideations or a history of suicidal behavior (P), does family and group therapy (I) reduce risk (O) versus patients who do not receive any family or group therapy (C)? This is one of the most feasible PICO questions to use because family and group therapy options might offer some sound solutions for preventing suicide and reducing long-term risks.
4. Do community awareness, public service announcements, and other means of education and communication (I) help reduce rates of suicide (O) among discharged psychiatric patients (P) versus communities that do not receive such public relations services (C)? This is an important avenue of research for evidence-based practice in the community, helpful from a public health perspective. However, methodologically such interventions are less feasible.
5. Does mindfulness meditation (I) reduce long-term risk factors and suicidal behaviors (O) among high risk psychiatric patients (P) versus those who do not participate in the meditation programs (C)? As with question three, this is a suitable line of inquiry, which could actually lead to evidence-based practice guidelines for psychiatric institutions. Therefore, I will select this PICO question for the remainder of my research.
PICO Question: Does mindfulness meditation (I) reduce long-term risk factors and suicidal behaviors (O) among psychiatric patients (P) versus those who do not participate in the meditation programs (C)?
The patient population (P) can include all psychiatric patients on any given unit or within any given institution. Alternatively, the patient population can include psychiatric patients who have been diagnosed with one or more conditions known to increase risk of suicide: those conditions being mood disorders, psychotic disorders, substance use disorders, and personality disorders (Schwartz-Lifshitz, Zalsman, Giner, et al, 2012). This would allow the researcher to compile evidence from multiple studies.
The intervention (I) in this PICO question is mindfulness meditation. It is important to clarify exactly what this would mean, such as how many hours per day or per week of meditation, and which specific meditation instructions were given. The addition of the time (T) variable to the PICOT analysis might also be helpful. For example, does the meditation intervention yield results after three months, six months, or one year?
The comparison (C) is like a control group in this case, consisting of psychiatric patients who are not meditating formally within the designated intervention. Finally, the outcome (O) can be measured in different ways such as overall rates of suicide or surveys of patients regarding their subjective assessments of suicidal ideation.
The following keywords that can be used for conducting a literature search include: major depressive disorder, mood disorders, psychotic disorders, DSM-V, suicidal behavior, suicide, suicidal ideation, mindfulness, mindfulness meditation, meditation, suicide risk, and psychiatric patients.
References

Appleby, L. (1992). Suicide in psychiatric patients. British Journal of Psychiatry 1992(161): 749-758.
Jacobs, D.G., Baldessarini, R.J., Conwell, Y., et al (2010). Practice guideline for the assessment and treatment of patients with suicidal behaviors. https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/suicide.pdf
Sakinofsky, I. (2014). Preventing suicide among inpatients. Canadian Journal of Psychiatry 59(3): 131-140.
Sarzetto, A., Delmonte, D., Seghi, F. et al (2017). Suicide in depressed patients. European Psychiatry 41(April 2017 Supplement): S891-S892.
Schwartz-Lifshitz, M., Zalsman, G., Giner, L., et al (2012). Can we really prevent suicide? Current Psychiatry Reports 14(6): 624-633.
Tillman, J.G. (2014). Patient suicide: impact on clinicians. Psychiatric Times. Dec 31, 2014. http://www.psychiatrictimes.com/special-reports/patient-suicide-impact-clinicians

Rubric
Excellent
Quality of Work Submitted:
The extent of which work meets the assigned criteria and work reflects graduate level critical and analytic thinking.
27 (27%) - 30 (30%)
Assignment exceeds expectations. All topics are addressed with a minimum of 75% containing exceptional breadth and depth about each of the assignment topics.
24 (24%) - 26 (26%)
Assignment meets expectations. All topics are addressed with a minimum of 50% containing good breadth and depth about each of the assignment topics.

---Quality of Work Submitted:
The purpose of the paper is clear.
5 (5%) - 5 (5%)
A clear and comprehensive purpose statement is provided which delineates all required criteria.


----Assimilation and Synthesis of Ideas:
The extend to which the work reflects the student\'s ability to:

Understand and interpret the assignment\'s key concepts.
9 (9%) - 10 (10%)
Demonstrates the ability to critically appraise and intellectually explore key concepts.

---Assimilation and Synthesis of Ideas:
The extend to which the work reflects the student\'s ability to:


Apply and integrate material in course resources (i.e. video, required readings, and textbook) and credible outside resources.
18 (18%) - 20 (20%)
Demonstrates and applies exceptional support of major points and integrates 2 or more credible outside sources, in addition to 2-3 course resources to suppport point of view.

---Assimilation and Synthesis of Ideas:
The extend to which the work reflects the student\'s ability to:

Synthesize (combines various components or different ideas into a new whole) material in course resources (i.e. video, required readings, textbook) and outside, credible resources by comparing different points of view and highlighting similarities, differences, and connections.
18 (18%) - 20 (20%)
Synthesizes and justifies (defends, explains, validates, confirms) information gleaned from sources to support major points presented. Applies meaning to the field of advanced nursing practice.

---Written Expression and Formatting

Paragraph and Sentence Structure: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are clearly structured and carefully focused--neither long and rambling nor short and lacking substance.
5 (5%) - 5 (5%)
Paragraphs and sentences follow writing standards for structure, flow, continuity and clarity
---Written Expression and Formatting

English writing standards: Correct grammar, mechanics, and proper punctuation
5 (5%) - 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors.

Contains many (? 5) grammar, spelling, and punctuation errors that interfere with the reader?s understanding.

---Written Expression and Formatting

The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.
5 (5%) - 5 (5%)
Uses correct APA format with no errors.


Plagiarism should be less than 8%

Major Paper

Instead of a final exam we will have a final paper.


Logistics: Papers should be 5 to 8 pages double spaced, 12 point font, with 1 inch margins.

Paper Options



Over the course of the past few years, gas drilling in Pennsylvania's Marcellus
Shale region has raised concerns over the amount of water used in the drilling process, the disposal of wastewater from the drilling process into state rivers, and the contamination of groundwater aquifers. It will be your task to analyze at least one of these water resource issues using the ideas you have learned throughout the semester. You are asked to take a holistic approach in your assessment by identifying some of the multiple stakeholders involved (e.g., landowners, neighbor landowners, government agencies, natural gas industry, industry workers, members of aquatic ecosystems - e.g., fish), the multiple scales (i.e., individual, local, state, national, global, etc.) or spatial distribution (across the US) of the potential impacts, and the solutions offered to remedy these impacts.


What I DO and DO NOT Want:

I do not want this paper to turn into a general list of stakeholders, impacts, and solutions. Rather I would like this to be a well crafted, sharp analysis, starting with the thesis you have come to after researching the stakeholders, impacts, and solutions. This means I want you to come to a personal option about the issue that is founded in thoughtful, well-rounded research and analyses of the water resource issue. I want you to support your thesis with evidence, but also identify the assumptions and weakness in your own argument.

I would suggest that this might mean that 90% of your time will be spend reading and thinking (i.e., bubble bath time) and 10% of your time will be spent writing. However, flow and grammar will be a portion of your grade. This will be imperative because while a good thesis is important, being able to follow it without interruptions is equally important in getting your thoughts across to the reader.


Grading

Therefore, your paper will be graded using the following criteria (including examples ??" not all inclusive ??" of questions I will ask myself when reading your paper):

100 Points:
A. The Thesis Statement:
Does this paper have a thesis statement? Is it appropriate for the water resource issue chosen by the student? Is the thesis statement clear (i.e., Do I understand it?)?
B. Supporting Evidence:

Is the thesis supported by evidence? What are the sources of the evidence used (i.e., peer-reviewed literature, other reputable sources, ambiguous websites, etc.)? Are multiple sources used?

C. Assumptions and Weaknesses:

Are the assumptions and weaknesses of the thesis recognized? Are further justifications for ignoring the assumptions or discounting the weaknesses established? (i.e., Ask yourself: If your thesis is weak, then how can you justify your argument?) Are solutions to the weaknesses in the argument offered?
100 Points:
D. Flow

Does this paper have a beginning (introduction), a middle (body), and an end (conclusion)? Is there a topic sentence for each paragraph? Does each paragraph contain just one idea or concept (i.e., please, only one idea or concept per paragraph)? Is the rest of the paragraph used to present evidence that supports the topic sentence?

E. Grammar

Does the paper have proper punctuation? Are words spelled correctly? Are there full and complete sentences (please, no sentence fragments or run-on sentences)? Does this paper have consistent verb tense and voice?

F. Citations

Is their evidence of plagiarism? Be careful, plagiarism is not just copying text word for word. It also includes using someone elses idea without proper citation. Are there proper citations (and quotes) within the text? If there is one author: Authors Last Name Date. If there are two authors: First Authors Last Name & Second Authors Last Name Date. If there are three or more authors: First Authors Last Name et al. Date. Are references documented at the end of the paper? Is the format used consistent (preferred: APA or MLA)? Is the author citing secondary sources (i.e., citing someone that citing someone else ??" e.g., Wikipedia) or primary sources?

must follow the academic review checklist which will be emailed soon. There is a research study to do... I need the first 3 chapters completed so I can do the research. Is it possible to do the first 3 chapters and then finish the rest after the research is finished? Another possibility is to do it with blank formulas I can just plug in when the research is done? I would like to discuss the options with the writers. Page numbers and references are negotiable, there are suggested page requirements in the review list.
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In the project to be created, introduce the reader to the older adult that was examined. Explain the meaning of the results of all five areas of the test. From the interpretation of the test, do you have any concerns about this individual and what would you recommend?
Suppose this individual demonstrated some degree of cognitive impairment and that the co-morbid condition of mental illness or delirium was also present in this individual. How would one recognize delirium and mental illness in the patient who demonstrated cognitive impairment? Would the findings in the MMSE be different? In what ways? How do the goals of treatment differ in the elderly patient with CI, delirium and mental illness superimposed on other chronic conditions?

Rader, J., Barrick, A. L., Boeffer, B., Sloane, P.D., McKenzie, D., Talerico, K. A., & Glover, J. U. (2006). The bathing of older adults with dementia. American Journal of Nursing, 106(4), 40-49.


Puentes, W. J. (2004). Cognitive therapy integrated with life review techniques: An eclectic treatment approach for affective symptoms in older adults. Journal of Clinical Nursing, 13, 84-89.
Rader, J., Barrick, A. L., Boeffer, B


Bates, J., Boote, J., & Beverley, C. (2004). Psychosocial interventions for people with a milder dementing illness: A systematic review. Journal of Advanced Nursing, 45(6), 644-658.
Lai, C. K. Y., & Arthur, D. C. (2003). Wandering behavior in people with dementia. Journal of Advanced Nursing, 44(2), 173-182

Writing: The Primary Source Analysis

You will write one four page essay (double spaced, 12 pt. font, Times New Roman, one inch margins, with page numbers and footnotes or endnotes) addressing the options listed below. Four pages is a minimum. You may write slightly more if necessary. Use a formal, clear writing style, and proofread your essays for errors in grammar or spelling. Your paper must have a thesis statement. If necessary, refer to Rampolla?s guide, the thesis statement handout and the primary source handout document for tips on writing an effective paper. Use Chicago Manual of Style citation format (See Rampolla or consult handout on Angel). Your essay must be properly cited or it will be returned to you for revision. Please see me at office hours, by appointment, or send an email with questions about the paper well in advance of the due date.

Our job is to ?get inside the authors? heads? in order to understand what larger historical themes the sources reflect. Read your chosen sources carefully. Can you place the sources in a specific place, specific time, and within a specific group? Your job is to understand what larger historical themes the sources reflect. Do not concern yourself with whether or not you personally agree with the sources, but with the reasons the authors had for believing in what they were writing. Do not judge them by present day standards, but consider the time and conditions in which the sources were written. This is an historical analysis; this means that regardless of which option you choose, you must be conscious of the author?s position, his/her audience, and what this information tells us about the society in which the source was created.

Explanation of Essay Grades:
An"A" paper will make comprehensive use of the material and offer a sophisticated analysis. A "B" paper usually is weak in one area. A strong argument may have used just a few pieces of evidence, or a paper may use much evidence but only in a descriptive way. A "C" paper usually has some significant flaw. It is likely to offer a conclusion that is contradicted by the evidence or misses a key point. ?D? and ?F? papers fail to meet the standards and requirements of the assignment, or have serious deficiencies in grammar and style.

Each Essay Must Have the Following Components:
1. Introduction
-Identify key terms, concepts, and the historical context necessary to understand argument. These may be dates, figures or important events that contributed to the production of the documents you are analyzing. You may find this information in the textbook or your lecture notes. It must be concise, and it must be pertinent. Try not to be too grand or vague (?Since the beginning of time, humans fought wars.?) Ask yourself, what does my reader need to know before s/he can understand my paper? This information should be expressed in no more than one paragraph.

2. Thesis Statement
-This should be one to two sentences at the end of the first paragraph. A thesis is a clear claim supported by the evidence. Take a stand on a debatable issue or make another assertion based on the document you have read. The point is to convince someone else that the position you take is worth taking seriously. The evidence you select for your paper will support this claim. Each paragraph of your analysis will refer to the argument you are making here. You are telling the reader what you intend to argue, and how you will do it. For our purposes, you may craft a statement such as, ?In this paper I will show that??, or ?I will argue that?.? This is the only time in the paper in which you are permitted to use first person.

3. Document Summary
-Briefly introduce works under discussion and key information about authors and texts. This should be a short paragraph introducing the documents you analyze. Explain who wrote it, what it is, when it was written, where and why it was written. This must be done in just a few sentences and should not exceed one paragraph.

4. Body
-After the thesis statement, this is the most important section of the essay. The bulk of the essay (2-3 pps.) will contain paragraphs with clear topic sentences and supporting evidence directly related to the thesis statement. This is the portion of the paper where you will select the evidence from the sources that you believe supports your claim. This is your opportunity to add your own historical interpretation. Supply the evidence, and offer an interpretation. Question the document. What does it, or doesn?t it, tell us about the society that produced it? What evidence contradicts or challenges my claim? In addition, you might want to save space for evidence that refutes your argument. Do not ignore it. Rather, incorporate it into the paper and supply evidence that explains why the evidence is not so important. Ask yourself, is there evidence that contradicts or challenges my claim? How do I explain the contradiction?

5. Conclusion (one paragraph)
-Here you will restate thesis, summarize your ideas, explain the historical significance, and connect the essay to wider course themes. Do not simply cut and paste the introduction. Tie your paper together by explaining what you did and why it was important for broadening our historical understanding. This paragraph should be in your own words. In other words do not quote evidence, the textbook, myself, or your favorite singer. You might begin this paragraph by writing, ?In this paper I have shown?.?

6. Grammar and Style
-The most important aspect of your essay is the analysis you provide in the body of your paper. However, you will be graded on grammar and style. For example, an ?A? paper will not contain grammar and spelling errors. Be sure to proofread your essay for errors. Check for spelling mistakes, incomplete sentences, and verb tense. Historians write in the past tense. Write your paper in the same tense throughout. Write your paper in active voice, not passive.
Active voice: Homer wrote The Iliad.
Passive voice: The Iliad was written by Homer.
Use a clear, formal writing style. Avoid using slang or colloquialisms. With the exception of the Thesis Statement, do not write in the first (?I?) or second (?you?) person. Finally, the paper should be properly formatted: stapled, double-spaced, typed, 1? margins on all sides, and be paginated. Your name, title, and course should appear at the top left of the first page.

Options and Due Dates: CHOOSE ONE
Using documents 16.1, 16.3 and 16.4, what problems did prevailing cultural ideas of the time, Catholicism, Confucianism, and Islam, face? How was each doctrine challenged and what solutions did they offer?



Essay Grading Sheet
History 102
Fall 2011

Name:

See notes in the margin of the essay for additional comments.

Grading scale: 5=excellent, 4=good, 3, 2=Needs Work, 1=Unacceptable

1. Introduction. Did you ?set the stage? by introducing specific background information necessary for understanding the historical context of the primary sources (from Strayer, lectures)? Did you define all key terms carefully? (one paragraph)

2. Thesis. Is there a clear thesis that can be proven in the limits of the paper? Does the thesis link the primary sources? (one or two lines, at end of the intro paragraph.)

3. Summary. Did you briefly describe the contents of each of the primary sources? (one paragraph)

4. Analysis. Did you follow through on the thesis statement? Did you compare sources to one another? Is your logic clear, specific and sound? Did you provide evidence (quotations or specific examples) from the primary sources in support of your thesis and cite them appropriately? Did you include analysis of each primary source in the assigned group? (approximately 2 pages)

5.Conclusion. Did you restate the thesis and indicate the historical impact or outcome of themes introduced by the primary sources, beyond their specific context? Did you link the sources to wider historical themes we?ve already studied in class? (one paragraph)

6.Grammar and Style. Did you proofread carefully for errors in spelling, grammar and punctuation? Does each paragraph contain a topical sentence? Does your writing style flow clearly and easily from point to point? Did you avoid run-on sentences, sentence fragments, and passive constructions?

Hello,
for our graduate assignment we have to submit a marketing plan for an entrepreneurial project, my part in the group consist in writing the '''Strategies/Goals'' part within 3 pages (APA Style).

I will try to give you as much informations as I can.

Here is the entrepreneurial idea :
""""""""I've realized since I moved to DC that, as a women, having access to some basics beauty services as waxing, facials and body treatments usually is associated with high prices!
I thought about opening a beauty center that is 100% for womens that is fast, effective and inexpensive. It will work based on monthly fees membership allowing to have access to quality beauty services at the lowest rate possible in the market, student will be allowed even more discount.
No appointment required, fast and effective service without spending long hours inside a SPA.Very practical for busy womens, for example, who can make their treatment at any moment of the day without having to schedule, like at lunch time break, etc.
The profit will be obviously determined by the volume of members attracted thanks to this new concept.""""""

I will attach herewith :
- some documentations that I have been able to collect on the internet
- an estimation of charges and revenues for the next 5 years (that you're free to amend if necessary).
- brochure including list of services together with prices.
- Structure of the marketing plan that we have to follow (student book), and my part is Strategy/Goals
- Marketing Strategy Chapter copy from the student book.

The Web has become a vital aspect of health care. It has become a place to research diseases and medications, as well as components of the health care continuum. These sites are used to provide information about their services, physician referrals, and community outreach information. Select a health care delivery system provider from around thhe Whicita Kansas area (hospital, nursing home, medical laboratory, school health, public health, and so forth.) and research the information available on this site.

? Prepare a 1,050- to 1,400-word APA formatted paper describing the following about your selected provider:

o Name of agency and Web site information
o Based on the information, summarize the delivery services that are provided.
o How does this agency and its services fit in the continuum of care?
o Identify resource options provided by the Web site.
o Does the site provide community information? (Describe the programs offered or information that they have available as general health care.)
o Was this site helpful in providing a better understanding of the services available in your community? Explain.
o How would you use this site for your own health care needs?

Assign this paper to an American writer only. This paper should be based on the readings I sent. When writing, make sure you think about what the authors are saying (do not rely solely on someones findings or what they say someone else found). If you use a direct quote from a reading, you must provide me with the name of the author and the page number where the quote was taken from. If you borrow or use materials that are not sent for this paper, you need to provide me with full citations (author, date, location of article, etc.) for these works. Please make the paper respond to the question being asked and you MUST use the readings sent. Do not just summarize each of the sent readings. Integrate the readings while developing your answers. You do not need to use materials that are not provided. Your answer must be in your own words. DO NOT use lengthy quotes from the materials sent. I would expect that the paper be in propper APA format. All work should be saved in RTF format. Opinions are okay. But ONLY IF YOU SUPPORT YOUR OPINIONS with materials sent or elsewhere. This does not mean you may forget about the readings. You should first use the readings and then you may want to add your opinions/experiences to say whether you agree or do not agree with the readings. Paragraphs should be a minimum of 3 sentences and no more than 8. In the first paragraph of any paper you should state what the paper is about, briefly, and then use the following paragraphs to make your points. You should end you papers with a concluding paragraph in which you review what you stated in the previous paragraphs and why it is relevant. Flow is important. You must always use citations to develop and defend your arguments in the empirical findings of the assigned readings. You should base your arguments on the evidence you find in as many of the empirical readings as you can. Please remember, failure to use appropriate citation constitutes plagiarism. Work from an outline. If you use an outline (no matter how basic), your thoughts will be better
organized and your arguments will be more coherent. Also, make sure to include all of the readings in the paper that I send. Use subheadings in your papers where appropriate ??" it will keep you organized.

Here are a few examples of what your citations should look like:

Citing 1 author - (Smith, 2002).
Citing 2 authors - (Smith & Smith, 2002).
Citing 3 or more authors - (Smith et al., 2002).

Please use APA style in your papers. A great resource if youre not familiar with this citation style is:(http://owl.english.purdue.edu/owl/resource/560/01)

With all that said, here is the question you must answer in the paper:
1. A recurring problem in juvenile justice is determining how to balance individualized sanctions and offender-based treatment versus proportionate and consistent sanctions. (a) Is this possible? (b) Why or why not? (c) Do sentencing guidelines that account for the various goals of the system in dealing with youthful offenders offer a plausible solution? (d) What about a system of graduate sanctions coupled with targeted treatment like that highlighted by some of your readings? (e) What are the relevant trade-offs in each of these approaches?
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Hi, The assignment is about pain management and how due to some misconceptions about opioids (morphine etc), pain is mismanaged in general and in clinical situations. I am a physiotherapist, not a nurse, so any practical implications need to be written from a similar perspective in private practice. Although if any valuable references from the readings i supply after submitting this request, are specific to nursing or hospital situations thats fine.

Writing style can be reasonably casual, as thats my style anyway. And length can be about 2100 words

The lecturer has stipulated that I leave 3cm margins and double line space the assignment, so that there is ample space for her to comment.

Font must be 12pt. All pages must be numbered etc

I have included all relevant assessment criteria below, please email me if you have any questions

Ryan.


Assignment 1
Value: 40%
Length: 2000-2500 words

Topic:
For over 30 years the research literature has reinforced that the global under-treatment of pain is due to barriers inherent to both patients/clients and clinicians. In particular, misconceptions pertaining to the use of opioids perpetuate their under-use in situations where they are the most efficacious form of pain relief.
You are to write an essay that:
1) Identifies and describes common opioid misconceptions and the reasons why they exist
,
2) Critically discusses their specific impact on both the accuracy of pain assessment, decisions regarding the use of analgesics (including opioids) and the timely and necessary involvement of other members of the multidisciplinary team;

3) Provides factual evidence from both your readings and wider research to dispel each misconception, and

4) Outlines a plan, strategies and resources for education that you personally could use in your day to day dealings with both clients and colleagues in order to change attitudes and help minimize the impact of these misconceptions

Rationale

The rationale for this assignment is for you to critically examine common misconceptions pertaining to opioids (as introduced in Modules 1-2) and the ways in which they impact on pain management practice, in order to facilitate changes that result in more positive pain management outcomes.



Marking criteria

Criteria for Assessment of Assignment 1 - NRS235 - Each of the below criteria is marked with the below grades and is weighted as follows

Student Name:______________________ Value: 40% of final grade
Criteria grade
E = excellent work = criterion met to an exceptionally high standard.
W = well done = criterion met to a high standard.
S = satisfactory = criterion met but depth and/or breadth somewhat limited.
N = needs improvement = criterion met to an acceptable standard just, but there is much room for further development.
P = poor = criterion not met; either not addressed or treated very superficially.

Presentation

No marks awarded but up to 10% will be deducted from total mark for work poorly presented.

Legibility
Grammar/use of English
Format (page no's, title page with essay topic in full, small footers on each page,spacing, etc.)
Essay structure/development
No marks awarded but up to 10% will be deducted from total mark for work poorly developed.
Paragraphing
Linking ideas/signposting
Clear/fully developed introduction
Body - discussion follows clear plan
Conclusion


Content and critical analysis incorporating use of research evidence - 90%
Introduces issue/misconception and discusses reasons why it exists -10%
Critically analyses how issue/misconception can affect pain assessment
20%
Critically analyses how issue/misconception can affect choice of interventions (including analgesics)
20%
Provides effective use of current evidence to reduce negative impact or change practice
20%
Outlines specific plan, strategies and resources for intended education
20%
Evidence of additional research - 10%
Additional research by student to creatively support discussion: At least 10 references are used for each 2000 words 10%
Referencing
No marks awarded but up to 20% will be deducted from total mark according to the guidelines within this Subject Outline
APA referencing system correct in paper
APA referencing system correct in reference list


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Essay
Describe the theory/s that you feel represented the tenets of career development in helping the following client develop their career goals and objectives:

? 1st generation immigrant with a college degree

? 28-year-old female

? Bachelor?s degree in teaching-special education

? Bilingual (English and Spanish)

? Currently employed as a paraprofessional in the Department of education

? Divorced from abusive spouse with two children ages five and fourteen

? Enjoys bowling with friends periodically

? Father deceased

? Has applied for the teaching fellows program

? Has bouts with depression because of divorce which causes her to drink occasionally

? Has two siblings-poor relationship

? Immigrated to USA six years ago

? Mother lives with older siblings

? Would like to become a psychologist or psychiatrist

? Youth worker at local community center once a week so her children can attend program for free.


a. Outline the possible problems that she could encounter
b. Develop a treatment plan to assess her current and future needs
c. State the theory and assumptions that clarify your views
d. How can you utilize this theory or theories to help a client research and develop their options?
? Be sure to clearly outline goals and objectives that this client may explore and how those goals and objectives can be met
? Describe any obstacles that could interfere with this client?s successes

British Psychology BSc dissertation, 10,000 words on "Gender differences in attitude towards alcohol consumption"
Needs abstract,introduction, methods, results and discussion. (raw data /questionnaires) results analysed using SPSS.
Questionnaires will need to be used. Results section will need relevant graphs and charts.
IF THIS IS A PROBLEM THEN PLEASE SUGGEST VIABLE OPTIONS AND CONTACT ME ASAP

Hello Writer!
I am enrolled in Developmental Psychology course and take it as a pre-requisite to my program, which is not that much related to this course.
In this course they discuss 50% of the time Piaget?s Cognitive-Developmental theory, as well as some other theories (behaviorism, psychosocial, information processing, etc..)
This work is considered to be a major assignment for this course, but I am running out of time.
I am a full-time working mom and in my age most of my friends have children (mostly second children) in pre-school age.
I understand that creating a hypothetical child observation is not that straight-forward task, but I believe that you have access to many observation reports like this and can compile something.
Please do not worry about:
?Setting: Describe the background and the setting of each of your observation sessions. Include how you made the arrangements and with whom. Detail your own behavior during the sessions, including where you were in relation to the child and how your presence seemed to affect the child?. .. Informed Consent and so on.
Just write something what is natural and logical, I will adjust your text if needed later to any of suitable family with young kids (I have a lot of options ? and a huge experience of observing kids as mom, aunty, friend ). My problem is writing. I am running out of time and English is not my first language. Using your writing as a template I will be able to adjust and ?customize? your version.

I have attached the Article, an extract of Piaget?s theory from text book, the same for Vygotsky theory (for just in case).
I?ve also attached that part of text book where they are talking about various research designs, so that you know in which terms those designs are described in this course.
The Text Book they use is : Seventh Edition ?Infants, Children and Adolescents? Laura E. Berk
The assignment manual with all details and marking matrix is attached as well.
Please let me know if any questions or concerns asap.
If writing about some hypothetical child observation is a bit too challenging, in this course they suggest Option 2, which is a comparison and contrasting of 2 theories and discussion of 6 research articles supporting those theories (3 per theory). My Tutor believes that Option 2 involves much more serious literature observation and she has given a sort of hint that Option 1 is easier. But if you really prefer Option 2 as more ?theoretical? task, please let me know asap. I will send to you all the information.
Please note, that in Assignment Option 1 (child observation) they are asking for 4-7 references other than the text book.
Those should be articles and researches from PsycINFO. Please include them, I trust your professionalism.
I have come across one article where they are discussing play therapy for 3y-old children in the context of Piagetian developmental stages. I have included it for just in case you would find it suitable for citation.
Thank you so much! Please do not hesitate to contact me. I can discuss all your concerns and questions with the tutor (from myself, of course) to make sure that the work is done in accordance with tutor?s understanding of what should be done.
Thank you once again!

I will attach the case study separately

A. Write an essay (suggested length of 5??"7 pages) in which you analyze the case study information by doing the following:
1. Identify three to five appropriate members for an interdisciplinary team from whom
you can obtain information for the Trosacks initial visit.
a. Explain why you chose each member of the team.
b. Explain the type of information you expect to obtain from each member
(suggested length of 1??"2 pages).
2. Create a teaching plan (suggested length of 2??"3 pages) for the Trosacks initial visit
that includes information on each of the following areas: Genetic diagnosis
Treatment
Prognosis as it applies to Tay-Sachs
Support groups and appropriate referrals
Pregnancy information
3. Discuss three ethical implications regarding the availability of personal genetic
information (suggested length of 1??"2 pages).
B. Write a short reflection paper (suggested length of 1??"2 pages) in which you do the following:
1. Discuss your thoughts and feelings about the Trosacks choice.
2. Discuss how you would handle advocating for the couples decision whether you
agree with it or not.
3. Discuss how ethical and legal considerations affect the couples decision about
continuing the pregnancy. (You should include at least one of each type.)
C. If you use sources, include all in-text citations and references in APA format.
Note: Please save word-processing documents as *.rtf (Rich Text Format) files.
Note: For definitions of terms commonly used in the rubric, see the Rubric Terms Web link below.
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Here is the assignment task.

Using your organisation, choose a particular process from your specific functional area (purchasing, supply chain management) and critically discuss that process in the context of appropriate and relevant management theories and philosophies. For example is your process operated classically, scientifically, through a HR approach or a hybrid of these philosophies..
In conducting this critique, critically reflect upon the current management responses adopted by your organisation and also the options available to suggest alternatives or improvements for managing that process in the future.

The basis for my assignment is that I want to show the change from a classical/scientific approach to supply chain management to a hybrid of scientific/HR one. The books that have been recommended are.

Boyett, J and Boyett, J. The guru guide
Drainer, S. the management century
Cole, G.A. And Kelly, P management theory and practice
Saunders, M strategic purchasing and supply chain management.
Mintzberg, lampel and Ahistrand strategy safari the Oxford handbook of business history.

The company I work for I manufactures equipment for the mining industry and has done so since 1929. We are privately owned by an American corporate organisation. I will send over some details that I've pulled together.

You plan is to open a gourmet coffee shop next to a college campus in Washington, DC. The hours of
operation will be from 6:00 a.m. until 10:00 p.m. Monday ? Friday and 7:00 a.m. until 3:00 p.m. on
weekends. Initially, the coffee shop will have three (3) store managers and ten (10) coffee servers. Your
local bank has preapproved your business loan based on your forecasted profit and loss statement and
collateral. Before the bank will give final approval for the loan, the bank has requested that you provide
them with two documents (Staffing Organizations Part 1 and Staffing Organizations Part 2) that explain
how you plan to staff and manage the business for the next three years. Note: Staffing Organizations?
Part 2 will be due in Week 8.
Write a 4-5 page paper in which you:
1. Identify the type of employment relationship you would establish between the coffee shop and
employees from a legal perspective. Explain your reasoning.
2. Suggest ways that you could avoid claims of disparate treatment.
3. Identify the type of external influences that could hinder staffing and how you would address
them.
4. Create a plan that you can use to deal with employee shortages and surpluses.
5. Outline a strategy for workforce diversity.
6. Conduct a job requirements job analysis for the store managers and coffee servers in order to
identify tasks, KSAOs, and context for those positions.
7. Use at least three (3) quality resources in this assignment.
Your assignment must follow these formatting requirements:
? Be typed, double spaced, using Times New Roman font (size 12), with one-inch margins on all
sides; citations and references must follow APA or school-specific format. Check with your
professor for any additional instructions.
? Include a cover page containing the title of the assignment, the student?s name, the professor?s
name, the course title, and the date. The cover page and the reference page are not included in
the required assignment page length.
The specific course learning outcomes associated with this assignment are:
? Develop a model for staffing an organization that supports the firm?s Human Resources
Management strategy and sustains productive operations.
? Summarize the key legal compliance issues associated with staffing organizations.
? Explain the planning considerations for staffing organizations, the use of job analysis, and the
components of a staffing plan.
? Use technology and information resources to research issues in staffing organizations.
? Write clearly and concisely about staffing organizations using proper writing mechanics.
Grading for this assignment will be based on answer quality, logic/organization of the paper, and
language and writing skills, using the following rubric.