Another group demonstrated that when insulin infusion was initiated in patients in the operating room before sternotomy and continued until the third postoperative day that there was improved glucose control. There was a 57% decrease in mortality rate, compared with control groups who were treated with subcutaneous insulin. Patients with diabetes have been shown to have worse outcomes compared to patients without diabetes. There have been no relationship was found between the presence of diabetes and the influence of hyperglycemia on outcomes. Patients who have diabetes, even though they are at increased risk for adverse outcomes because of having diabetes, have been found to have the same risk as patients without diabetes. Based upon these findings it would seem reasonable to say that that Perioperative serum glucose control for patients undergoing Coronary Artery Bypass surgery would be an encouraged best practice.
It has been found that strict glucose control is…...

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References

1. Gandhi, Gunjan Y., Nuttall, Gregory A., Abel, Martin D., Mullany, Charles J., Schaff, Hartzell

V., O'Brien, Peter C., Johnson, Matthew G., Williams, Arthur R., Cutshall, Susanne M.,

Munday, Lisa M., Rizza, Robert A., and McMahon, M. Molly. Intensive Intraoperative

Insulin Therapy vs. Conventional Glucose Management during Cardiac Surgery.

d.).
Limited information about oral hygiene and difficulty accessing preventive dental care are thought to add to the racial and income difference in the incidence of caries. Underprivileged and minority kids are more probable to have untreated dental decay, compared with more wealthy white children. In a recent examination of national survey data, the General Accounting Office found that underprivileged children had five times more untreated decay than did children from higher earnings families. Untreated decay can result in troubles with eating and drinking, talking, and education. Children who are underprivileged experience twelve times the number of limited activity days caused by dental troubles, compared with more wealthy children (Lewis, Grossman, Domoto and Deyo, 2000).

The baby teeth start to come through at varying ages throughout a child's first year of life. A child is vulnerable to tooth rot as almost immediately as their first teeth come in if they have an…...

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References

Bright Futures in Practice: Oral Health Pocket Guide (2004). Retrieved October 27, 2010, from Web site:  http://brightfutures.aap.org/pdfs/Guidelines_PDF/8 -

Promoting_Oral_Health.pdf

Lewis, Charlotte W., Grossman, David C., Domoto, Peter K. And Deyo, Richard A. (2000). The

Role of the Pediatrician in the Oral Health of Children: A National Survey. Pediatrics,

Generally, the level of evidence for most of the studies is low. Ten studies are classified as level 2c which represents 'outcomes research' (evidence is obtained from uncontrolled trials without randomization) and two studies are classified as level 5 meaning 'expert opinion without explicit critical appraisal'.
#5 Were the results similar from study to study?

What is best?

When the compiled studies are homogenous, statistical applications can be useful, and meta-analysis is achievable (Stevens, 2009).

This paper: Yes ( No ( xx Unclear (

Comment:

The studies were heterogeneous; therefore, meta-analysis could not be performed. Most of the included studies describe integrated processes but there is a variety in the described outcomes and processes within the models. At this moment standardized outcome measures in pain management are not available, so it is not always possible to make a proper comparison between the outcomes. Therefore, generalization of the results can be problematic.

What were the results?

The paper…...

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References

Brink-Huis, A., van Achterberg, T., & Schoonhoven, L. (2008). Pain management: A review of organisation models with integrated processes for the management of pain in adult cancer patients. Journal of Clinical Nursing, 17(15), 1986-2000. doi:10.1111/j.1365-

Stevens, K.R. (2009). Systematic reviews. In M.A. Mateo, & K.T. Kirchoff (Eds.), Research for advanced practice nurses: From evidence to practice. (pp.249-265). New York: Springer.

Medical Dilemma
The Dilemma

The dilemma associated with this case study suggests that little is known or can be done with serious illness with any great confidence. At the heart of the issue is who is responsible for the sick child as it appears, but may not be true, that he cannot take care of himself and that his immune system needs to be guided by someone else.

The lack of a formal family and the unnatural formation of this family also contributes to the confusion of this ethical problem. The Christian Scientist mother of the child holds no biological claim to the child and is demanding a unique spiritual procedure to be used to the heal the child. Although this method is controversial and not based in traditional science, the laws allowing for this type of treatment are allowed in reasonable circumstance in many areas of the world.

The situation is also complicated…...

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References

Dean, M. (2010). Comparative evaluation of homeopathy and allopathy within the Parisian hospital system, 1849 -- 1851. Journal of the Royal Society of Medicine, 103(1), 34-36.

Flamm, B.L. (2004). Faith healing confronts modern medicine. Scientific Review of Alternative Medicine, 8, 9-14.

Starfield, B. (2000, July 26). Is U.S. health really the best in the world? Journal of the American Medical Association, 284(4), 483-485

Medical Abbreviations
How can eliminating abbreviations reduce errors?

In the medical profession, time is everything. To make documentation as expeditious as possible, a series of abbreviations have been accepted in records. This has been considered an acceptable practice as much as calling a registered nurse an "RN." The problems occur when people are unclear about the abbreviations mean or if a set of letters can have more than one meaning. For example, there is the abbreviation "CA" which means cancer and then "Ca" which is calcium. Another example is "a" which can mean both "artery" and "before" (Medical 2011-page 1). It is very easy to misread abbreviations when medical staff is in a hurry. Imagine the problem if a "q.w." which is take weekly was confused for a "q.v." which is take as one wishes. If the terms were written out rather than abbreviated, these potentially dangerous situations could be completely avoided.

Should…...

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Works Cited:

Berman, Jules. (2008). "Specified Life." Biomedical Informatics.

Greenall, Julie (2006). "Safe Medication Practices." Hospital News.

"Medical Abbreviations Glossary." (2011). JD-MD.

Medical Use of Marijuana
Increasing use of medical marijuana

Having looked at the various areas that medical marijuana has been brought into use and the various forms in which marijuana is administered, it is also important to take note of the various challenges that come with it. There have been various researches that have been conducted that covers the medical as well as the ethical side of the medicinal marijuana, and there have been a dilemma in the balance of the two sides on whether to institutionalize the drug or to stop it, and even on whether the medicinal use can be made to work without the proneness to abuse as is the case at the moment.

Medicinal marijuana has neither medical nor ethical standing within the contemporary society where drug abuse is one of the biggest worries of governments across the world and the alternative medicines that medical research can appropriately come…...

In this case, that power dynamic was only exacerbated by the fact that the entire MSICU nursing team had never received training in management of the type of clinical issues presented and by the fact that they were excluded from any consultation in connection with a post-operative management plan.
Therefore, it is recommended that the institution immediately implement a policy of "see something, say something" according to which all members of healthcare teams are encouraged to speak up irrespective of power differentials. Furthermore, that protocol must include a statement of policy insulating any member of a healthcare team who does voice a legitimate concern in good faith from any retaliation or other negative response that could conceivably deter such diligence. Finally, the record of this case also indicates the immediate need for protocols requiring all members of the healthcare team to identify themselves to other members of the team, especially…...

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References

Bosk, Charles L. (2003). Forgive and Remember: Managing Medical Failure.

Gawande, Atul. (2008). Better: A Surgeon's Notes on Performance.

Groopman, Jerome. (2008). How Doctors Think.

Timmermans, Stefan. (2003). The Gold Standard: The Challenge of Evidence-Based

These examples highlight that technology is always a tool, a way of enhancing human judgment -- we must not mistake it as a replacement for good nursing practice.
After all, the use of a computer is no substitute for a medical education. Anyone who works in a hospital can see this -- the increased accessibility of information through the Internet also means that patients often come in, convinced that they are suffering from a serious illness, allergy, or condition, based more upon a diagnosis Googled on WebMD, rather than upon the fact that they saw a doctor! If a computer alone was required to diagnose, everyone would have a degree!

Don't get me wrong -- I use technology every day in my life, and thank my lucky stars, and my patient's lucky stars, that it is so ubiquitous. When health care providers wish to communicate, the use of cell phones is…...

According to the work of Fulford (1994) in an Oxford Practice Skills Project eport "Three elements of practice (ethics, law and communication skills) are approached in an integrated teaching programme which aims to address everyday clinical practice. The role of a central value of patient-centered health care in guiding the teaching is described. Although the final aim of the teaching is to improve the actual practice, we have found three 'sub-aims' helpful in the development of the programme. These sub-aims are: increasing students' awareness of ethical issues; enhancing their analytical thinking skills, and teaching specific knowledge. (Hope, 1994)

In the work of Miles, et al. (1989) entitled "Medical Ethics Education: Coming of Age it is stated that "medical ethics education is instruction that endeavors to teach the examination of the role of values in the doctor's relationship with patients, colleagues and society. It is one form of a broad curricular effort…...

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References

Fryer-Edwards, PhD (2005) Tough Talk: Helping Doctors Approach Difficult Conversations - Resources for Teaching- Domains for Small Group Teaching Prelude 3 Department of Medical History and Ethics University of Washington School of Medicine.

Siegler, Mark MD (2001) Lessons from 30 Years of Teaching Clinical Ethics AMA Journal 2001 October.

St. Onge, Joye (1997) Medical Education Must Make Room for Student-Specific Ethical Dilemmas" Canadian Medical Association Journal 15 Apr 1987, 156(8).

Hicks, L. et al. (2001) Understanding the Clinical Dilemmas that Shape Medical Students' Ethical Development: Questionnaire Survey and Focus Group study. BMJ Journal 2001;322-709-71- 24 march 2001.

My predilection for working under stress prepares me psychologically for the unique and demanding profession. The college professor who advised that my disposition and talents lend themselves to a career in osteopathy told me that osteopaths need to be creative as well as analytical: to assess situations and make decisions that synthesize years of prior knowledge and experience. I believe I possess the qualities that would prepare me for a successful and rewarding career as an osteopathic physician.
As I seek entry into your esteemed medical school program with a focus in osteopathy, I can assure you of my capacity to meet challenges with poise and calm. My business experience has prepared me for the demands of medical school: owning a business while attending school full-time has not deterred nor tired me physically. I look forward to participating in your program; I assure you that I will represent your school…...

The facts that you have provided indicate extremely troubling circumstances that could seriously jeopardize the welfare of your organization. It is well-settled law that entities contracting for the services of subsidiaries are legally responsible for legal and ethical improprieties committed by those subsidiaries irrespective of whether or not the contracting organization had any specific involvement in or knowledge of those actions. Accordingly, we would strongly advise that you take immediate action to rectify the situations described in the manner outlined in our recommendations below.

ecommendations

To avoid the potentially serious criminal, civil, and financial consequences arising under MWHC's respondeat superior responsibility to prevent fraud and abuse in connection with its association with subsidiaries, it is hereby recommended that MWHC immediately:

1. Instruct the subsidiary to cease and desist from offering its contracted home health agency employees compensation of any kind in connection with client durable medical equipment (DME) orders from the subsidiary.

2. Instruct…...

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References

Reid, T. (2009). The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care. New York: Penguin Group.

USDHHS. (2004). U.S. Department of Health and Human Services-Office of Inspector

General-Statement of Organization, Functions -- and Delegations of Authority.

Federal Register. Vol. 69, No. 127; July 2, 2004. Retrieved November 14, 2010,

As mentioned earlier, the desired outcome of nursing care is comfort and there are many articles in which the researchers have talked about the needs of the patients and the things that alter the comfort of the patients. Kolcaba suggested that the cancer patients who are terminally ill can benefit from comfort care as it pays attention to the perspective and needs of the patients. Through such kind of care, the patient is not only provided with pain relief, but the depression of the patient is also addressed adequately. As she said that patients who are not in pain but are depressed seek comfort in the transcendental sense as well as in the psycho-spiritual sense (Kolcaba, 1992 p 4). In some of her works, she has explained the use of the instruments and their application by the nurses. Kolcaba reckons that the instruments presented by her to evaluate the…...

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Bibliography:

Kolcaba K. (1994). A theory of holistic comfort for nursing. Journal of Advanced Nursing, 19(10): 1178-1184.

Kolkaba, K. (1992). Holistic comfort: Operationalizing the construct as a nurse-sensitive outcome..Advances in Nursing Science, 15 (1), pp. 1-10.

Kolkaba, K. (1997). The primary holisms in nursing..Journal of Advanced Nursing, 25 pp. 290-296.

Kolkaba, K. And Fisher, E. (1996). A holistic perspective on comfort care as an advance directive..Critical Care Nursing Quarterly, 18 pp. 66-76.

Case Involving a Medical Dilemma Nurses usually experience ethical dilemmas while carrying out their work of providing care to different patient populations. Ethical dilemmas arising during nursing practice are largely attributable to the complex processes involved in healthcare delivery. An example of a landmark case involving a medical dilemma is the case of a 17-year-old girl in Connecticut, Cassandra C, who refused to continue receiving chemotherapy. Cassandra was diagnosed with Hodgkin lymphoma at Connecticut Children’s Medical Center in September 2014. Following her diagnosis, doctors recommended chemotherapy as a suitable treatment approach that would help save her life. However, with her mother’s support, Cassandra refused this treatment approach for her potentially curable cancer resulting in a medical dilemma that ended up at the Connecticut Supreme Court. In a unanimous decision, the Connecticut Supreme Court ruled that the teenager cannot refuse chemotherapy on the premise that she is not mature (Viale, 2015).
Cassandra’s case…...

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References

Hevia, M. & Schnidrig, D. (2016, December). Terminal Patients and the Right to Refuse Medical Treatment in Argentina. Health and Human Rights Journal, 18(2), 247-250.

Viale, P.H. (2015, March-April). Refusal of Therapy: When Is It Appropriate? Journal of the Advanced Practitioner in Oncology, 6(2), 96-97.

medical home concept and describe the principles (operational characteristics mentioned above) of the PC-MH as defined by these organizations. How does this concept differ from the gatekeeper concept of Managed Care Organizations?
According to the 'gatekeeper' philosophy of health management organizations (HMOs), physicians are intentionally given incentives to reduce access to care. This is based upon the assumption that patients will want to obtain as much care as they can receive and physicians will want to bestow that care to please patients and incur more revenue. HMOs encourage physicians to do the opposite and often financially reward physicians for cost reductions and limiting access of patients to specialists or heroic treatments. In the HMO model, physicians try to restrict access to specialists when they do not deem it necessary.

In contrast, the medical home concept is viewed as a partnership between "individual patients, and their personal physicians, and when appropriate, the…...

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References

Case for change to the PC-MH Model (2011). American Dietetic Association.

Retrieved October 19, 2011 at  http://www.eatright.org/HealthProfessionals/content.aspx?id=7059 

Joint Principles of the Patient-Centered Medical Home. (2007). American Academy of Family

Physicians (AAFP). American Academy of Pediatrics (AAP). American College of Physicians (ACP). American Osteopathic Association (AOA)

Introduction
Medical marijuana has increasingly been in the news as a growing number of states throughout the U.S. have passed measures or at least put on the ballot an initiative to legalize either medicinal or recreational marijuana usage.  The history of marijuana in the U.S. is one that goes back as far as the country itself:  hemp (a type of marijuana plant) was used for rope, paper and a number of other purposes because of its strong fibrous tissue.1  It was not until the Prohibition Era of the 1920s that marijuana began to be prohibited by law in the U.S.—and within a decade, it was regulated among most states under the Uniform State Narcotic Act.2  Thus, from its very first days as a crop grown by the Virginia Company for exporting to England by decree of James I—and in fact from the days of the first President of the U.S. George…...