Research Topics: Health Management Essay

Physical Activity

Health Benefits of Increased Physical Activity Regular physical activity that is performed on most days of the week reduces the risk of developing or dying from some of the leading causes of illness and death in the world. Regular physical activity improves health in many ways than one—from reducing the risk of dying prematurely to promoting psychological well-being.   <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Physical activity and health go hand in hand, greater health benefits can be achieved by increasing the amount (regularity, duration, or intensity) of physical activity.</li> <li class="MsoNormal" style="color: black; line-height: 200%"> People who are most of the time inactive can improve their health and well-being by becoming active even in moderation on a regular basis. </li> <li class="MsoNormal" style="line-height: 200%"> Physical activity need not be strenuous and vigorous to achieve significant health benefits and it can be achieved in a variety of ways.</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Individuals contemplating an increase in physical activity to jumpstart their system should start slowly and gradually build up to the desired amount to give the body time to adjust.</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> The benefits of exercise extend far beyond weight management. Regular physical activity reduces the morbidity and mortality from many chronic diseases and can help improve the overall quality of life. </li> Credit:ivythesis.typepad.com

Physical Activity

Health Benefits of Increased Physical Activity Regular physical activity that is performed on most days of the week reduces the risk of d...

Health journal

Feb 22- Experiencing symptoms of Sinus congestion because of the weather here in Canada, dry unlike in Korea. I have been experiencing sinus congestion that is typically causes symptoms of pressure, tenderness, or pain in the area above the eyebrows (frontal sinus) and above the upper, side teeth (maxillary sinus). Other symptoms include nasal stuffiness sometimes accompanied by a thick yellow or green discharge, postnasal drip, bad breath, and an irritating dry cough  (1999)   Feb 23- Since I am always having sinus congestion especially when I started living in Canada, sinus congestion may be a result of the sudden change of my lifestyle. The most common cause of nasal congestion is allergy to inhalants, such as pollen, molds, dust mites, trees, or animal dander (:1997). Exposure to various chemicals in the home or workplace may also contribute to allergic rhinitis. Indoor and outdoor air pollution may also be a factor in susceptible people. Smoking and secondhand exposure to tobacco smoke have been implicated in chronic nasal congestion and the prevalence of chronic rhinitis among men has been shown to increase with increasing cigarette consumption. People exposed to chlorine, such as lifeguards and swimmers, may also be at risk of developing nasal congestion. Feb 24-This day, I am starting to look for cure and relief, “Tension… pressure… pain?” With these words and pictures of a twisting coil, a tightening vise, and a lightning bolt imposed on a sufferer’s skull, television commercials for over-the-counter (OTC) pain relievers once sought to capture the miseries of sinus trouble. Feb 26-I found out from some studies on sinus congestion that the common complaint that “I have  sinus” shows that  sinus illness is widely misunderstood. Everybody has sinuses, cavities hollowed in the bone structure of the skull. The problem is sinusitis, inflammation of these cavities due to viral, bacterial and fungal infections or allergic reactions, or sometimes rhinitis, irritation of the lining inside the nose. Inflammation may invite infection, which aggravates the problem. Any bone cavity is a sinus, but the culprits in sinusitis are the eight facial cavities grouped around the nose, the paranasal sinuses (1997). Some anatomists theorize that these enhance the resonance of the voice, warm and moisten inhaled air, and relieve the skull of the excessive weight solid bone would impose. Others believe that the sinuses form simply because the facial bones of the skull of a newborn must grow faster than the cranium above to help the infant breathe and eat better. Feb 27- I took stronger medicine for my sinus congestion, because sinusitis that interferes with routine daily activities, forcing naps or cancellation of plans, may signal serious chronic trouble. Rebound congestion may mean it’s time to look beyond OTC stopgap remedies to more comprehensive doctor-prescribed courses of treatment (1999). Repeated absence from work or school is another likely sign. Frequent colds, stubborn earaches, or other infections may be harbingers of sinus infection. Since many people get so used to sinus pain that they take it for granted, it’s important to note any serious impact on health and lifestyle. Allergies are common triggers of nose and sinus inflammation, so one way to fight sinusitis is by targeting the causes of allergy. Feb 28- I took Antibiotics to control infection may be necessary in both acute and chronic sinusitis. Clogged nasal passages and filled sinuses readily become infected. Because of their proximity to such sensitive areas as the eye muscles and the brain, infected sinuses can have serious consequences, including meningitis (inflammation of brain membranes). Complications of untreated sinus infection can be fatal (1999). Antibiotics are used to kill the bacteria that cause infection. Analysis Most persons think of themselves as being well when they are not sick. Well-being fluctuates and at times so-called healthy people do not function or feel as well as they do at other times. A person considered healthy may have headache and colds and might perform poorly. High level of wellness is the ultimate goal of every person. It requires services that are broad in scope and achieving it requires team work with representation from all groups of society. The well-being of the neighborhood can be assessed and it can be offered comprehensive health services. While personal and environmental health services cannot be separated in practice, some type of distinction can be made in describing them.   Credit:ivythesis.typepad.com

Health journal

Feb 22- Experiencing symptoms of Sinus congestion because of the weather here in Canada, dry unlike in Korea. I have been experiencing s ...

Health Care Management

Health Care Organization And Delivery Mt371 Unit 9   Final Project     By             QUALITY HEALTHCARE MANAGEMENT   Introduction Quality as a means of creating and sustaining a competitive advantage has been widely adopted by both public and private sector organizations ( 1999). In the healthcare system recent decades have observed a remarkable changes even an evolution in the quality management in the healthcare system, (, 1997).   Before such revolution, the quality assurance of care had been assessed by professional evaluation, most often this is done in a subjective manner on individual patients (1996). However, the accountability for quality in healthcare is no longer in the exclusive reality of physicians.  The national health authorities, governmental agencies as well as accrediting bodies and other institutions are staking a claim to improve the quality of the healthcare system.  The main goal of this paper is to discuss different factors or driving forces that influence the quality improvement of healthcare management.  The factors include the emergence of information technologies and information systems, customer or patient satisfaction, increasing healthcare costs, demand for quality form purchasers of healthcare, variations in patterns of care, the existence of managed care, the emergence and growth of healthcare industries devoted to healthcare quality, ensuring quality service, gaining competitive advantage and, having effective management system .    Driving Forces for Quality Healthcare Management The current preoccupation with quality assurance is symptomatic of a far wider concern with modern management methods and contemporary management speaks and their application to the health care field. This has, in part, been driven by the relatively new competitive and contractual climate in health care delivery and in part by the need to provide effective and efficient services and programmes.   The factors that have been mentioned above are not independent from each other. These factors are integrated to establish a powerful force   Emergence of Information Technologies and Information System The complexities of achieving management success through increased efficiency, effectiveness and competitiveness, combined with innovative applications of modern technology, has heightened the awareness of both Technology and organizational managers towards more strategically oriented approaches for planning and management of any industry (  1993). The existence of information technologies can e considered as an important aspects that cuts across all other elements that have influenced changes into the quality management of healthcare. In this manner, the advancement of information technologies and information systems, as well as communications systems and computer technologies made it easier, cheaper and faster for those people involved in healthcare to accumulate and assess multiple types of information (1997). Furthermore, the emergence of the internet has been able to allow patients to become perceptive customers of healthcare.  In this manner, patients who have become well informed or probably misinformed thru the internet medical sources have become a major influence to change the physician-patient relationship.  Since, patients are more informed of different facts about healthcare, they are able to question the decisions of the attending physicians based upon the details on their diseases which was previously unavailable to the average patient. In addition, thru this, the patient is able to gather data on the performance of healthcare givers, efficiently handling one aspect of healthcare quality responsibility to the patients.   Customer or Patient Satisfaction             With the occurrences of changes in both methods and modalities of healthcare management, patients nowadays perceive a number of plausible medical options beyond conventional medicine.  Progressively, insurance organizations are willing to take the expenses of non-traditional healthcare system.  With this, patients are given the chance to choose medical practices in healthcare environment.  Hence, it is important that satisfactions are given to these patients.  Patients’ satisfaction is similar to any form of customer satisfaction.  (1992) stated that customer satisfaction has been deemed directly to affect customer retention and companies’ market share. In addition, there are researchers who discuss the links between satisfaction, loyalty, and profitability ( 1994;   1994). They are proponents of the theory called service management, which argues that “customer satisfaction is the result of a customer’s perception of the value received in a transaction or relationship relative to the value expected from transactions or relationships with competing providers. Pertaining to this theory,  (2004) stated: “Loyalty behaviors, including relationship continuance, increased scale or scope of relationship, and recommendation (word of mouth advertising) result from customers’ beliefs that the quantity of value received from one service is greater than that available from other service providers”  They continued: “Loyalty, in one or more of the forms noted above, creates increased profit through enhanced revenues, reduced costs to acquire customers, lower customer-price sensitivity, and decreased costs to serve customers familiar with a firm’s service delivery system” ( 2004,). Accordingly, patient satisfaction is the cognitive assessment or judgment of an emotional reaction to the provided healthcare service ( 1993). Furthermore, satisfied patients represent the notion to which a patient has received quality service.  If patients are not satisfied with the service, they decide to seek the services of another healthcare provider. Hence, the healthcare community has a vested interest in increasing the satisfaction of patients thru the use of the quality healthcare management.   Increasing healthcare costs             Just like information technologies, the healthcare cost is also a common interconnected theme among the driving forces which led to the change of healthcare management in terms of improving the quality of the service.  The demand for controlling cost ahs come from the major payers of healthcare which compose of government and the employers.  In the phase of aging customers which will avail a larger proportion of the federal budget as beneficiaries of Medicare benefits, the national government has an interest in cost control. In addition, the evolution of global market competitions, more employers’ desire cost control as an effective way to reduce the cost of products and services that they give. From this notion, the variability of the healthcare services delegates’ suboptimal quality and the likelihood of overuse or sometimes misuse of such services, hence, improving quality of the healthcare management can reduce cost (1999).    Demand for Quality from Purchasers of healthcare,             The government and national authorities, with the existence of medical insurances became actively involved in analyzing the details of medical and healthcare practices ( 1997).  Due to the concept of cost-containment and quality assurance, national health authorities have formed different types of agencies to address healthcare management quality ( 2000). Similarly, other established purchasers of healthcare services like unions and employers, have paid more attention with population-based measures of quality and measuring performance of the healthcare system. In this manner, purchases are utilizing such measures to examine the performance of healthcare plans and the also the providers ( 1996). Responsibility for quality of the purchasers in line with the healthcare management is now a certainty.             With the existence of industries which adheres to the notion of quality management, other healthcare providers are trying to adapt such concept to ensure that their management system will be effective.   Variations in Patterns of Care             In the emergence pf the quality management techniques were flourishing in other economic sectors, the healthcare organization has shown patterns of variability of patient care showing the medical decisions made by physicians or healthcare workers depends more on the resources which came from local institutions and on existing local styles than on the context of science (, 1998). In lieu with the increasing healthcare costs, such variability was not only regarded to be a sign of varying quality, but also an indicator of insignificant practices. This influence the realization of the healthcare authorities to imposed a quality healthcare management system.   Existence of Managed Care             The notion of managed care has increased in large part due to increasing demands to contain costs.  The managed care industries use several approaches to contain costs and many of these mechanisms give emphasis on the reduction of overused resources of healthcare (, 2004).  The consequence of the style has been concern that the uses of healthcare services can be lessen to the point that the quality of care is reduced.  Since the existence of managed care has become well-known, there also exist some public concerns regarding the idea of whether the managed care is delivering care that is expected by individuals ( 1998). The existence of the notion of managed care had pushed healthcare organizations to streamline their management system and adhere to the needs of having quality healthcare management.   Emergence and Growth of Accrediting Bodies Devoted to Healthcare Quality             Another factor that influences healthcare providers to implement quality management is the emergence and growth of accrediting bodies in healthcare.  In response of healthcare management to the public concern about quality of care provided in managed care organization and to the assumption that the government and national health authorities might soon develop another institution that would monitor healthcare providers, different nations have developed accrediting agencies.  These agencies are responsible for inspecting a certain healthcare providers to determine if such provider executes quality management. Realizing that the assessment of accrediting agencies is important for the organization, many healthcare providers adhere to the needs of imposing quality management in healthcare.   Ensuring Quality Service             According to (1994), implementing a quality management system has become the preferred approach for improving quality and productivity in different organizations including the healthcare organizations. The concept of quality management, which has been adopted by different healthcare organizations, is a participative system empowering all employees to take responsibility for improving quality within the organization (1994). Instead of using traditional bureaucratic rule enforcement, quality management calls for a change in the corporate culture, where the new work climate has the following characteristics: an open, problem-solving atmosphere; participatory design making; trust among all employees (healthcare workers, managers); A sense of responsibility for goal achievement and problems solving; and, self-motivation and self-control by all healthcare workers and providers (1994). The quality management approach involves more than simply meeting traditional rejection rate standards. The end result of quality management within healthcare system is the efficient and effective use of all organizational processes in providing consistent quality to make the patients and consumers satisfied.   Gaining Competitive Advantage             Winning s strategies such as the utilization of quality management approach are grounded in sustainable competitive advantage.  It is said that a healthcare organization has competitive advantage whenever it has an edge over its competitors in attracting customers and defending against competitive forces. Competitive advantage is derived from external factors or positional advantage and internal factors or resources and assets used. The latter is the effect of the competencies of the firm (1991). Thus, a definition of competitive advantage might be: competitive advantage is a measure of the ability of the company to deliver value to the customer or patients divided with the resources used relative to the competitors.  This measure of competitive advantage is not an operational measure and should not be taken as such. However, it does focus attention on two different issues that must be seen in connection in quality management: the position enjoyed by the healthcare organization and the internal competencies of the firm, which together form the basis for judging the competitive advantage of the firm. Evidently, both measures must be taken relative to the competitors of the company (1985). Any firm is interested in competitive advantage; actually it may be said to be the very purpose of quality management, especially if the advantage proves to be sustainable. (1995, ) defines this as, “…companies have sustainable competitive advantage when they consistently produce service systems with attributes which correspond to the key buying criteria for the majority of customers in their targeted market…” Thus, if a company has sustainable competitive advantage, customers will prefer its product offerings to those of the competition; that is, external and internal productivity will be greater than that of other firms in the targeted market.   Having effective management system             Lastly, it is said that healthcare organizations tries to utilize a quality management healthcare system because they want to initiate an effective management system which will be helpful in adhering to quality assurance.  The implementation of the concept of quality assurance enables the health care system determine the focus of work, directions and content of healthcare activities and the cost effectiveness priorities of the person involved.  The need of the healthcare system may be determined in a variety of ways but typically through the judicious use of focus groups using rapid appraisal techniques or through standard questionnaires as assessment instruments. QA can be built into the needs assessment strategy by developing post-intervention methods that rely on, for example, critical incident techniques. This allows members of the community to assess explicitly whether a health care programme has met and satisfied the identified need. This application of QA to the process of an interventions life has to have standards in order to measure the quality. These standards, which should be quantifiable, need to provide a precise indication of consistency. They should initially be based on best existing practice with the cooperation of practitioners, and have a temporal dimension which allows them to improve over time. Standards can be sub-divided into criteria and indicators, depending on how precise the QA process is to be.   Conclusion             The factors or driving forces mentioned above are just some of the influencing factors that influence healthcare industries to apply and implement the concept of quality healthcare management system.  Whatever the techniques employed by the healthcare organization does not matter as long as such technique adheres to the needs of quality assurance.    Credit:ivythesis.typepad.com

Health Care Management

Health Care Organization And Delivery Mt371 Unit 9 Final Project By QUALITY HEALTHCARE MANAGEMENT ...

MANAGEMENT OF ANEMIA

MANAGEMENT OF ANEMIA IN RENAL PATIENTS   Introduction               Anemia is a serious medical condition which manifests in renal patients. Management of anemia in these patients is a collaborative effort which involves the general practitioner, the nephrologists, the specialist and the nurse. This paper will look into the roles these healthcare professionals play in the management of anemia.   Body   Renal failure can either be acute or chronic. Acute renal failure is the clinical condition associated with rapid, steadily increasing azotemia, with or without oliguria. The causes of renal failure can be grouped into three diagnostic categories: prerenal (inadequate renal perfusion), postrenal (obstruction), and renal. Prerenal and postrenal are potentially reversible if diagnosed and treated early, and some of the causes of primary renal injury which result in acute tubulointerstitial nephropathy are also treatable, such as bacterial infections, drug reactions, and metabolic disorders.             Initial evaluation of acute renal failure should seek reversible or specifically treatable causes of acute renal failure. Bladder neck obstruction is probably the most common cause of sudden, and often total, cessation of urinary output, especially in older men. A preceding history of difficulty in voiding is frequently given.             Chronic renal failure on the other hand is the clinical condition resulting from a multitude of pathologic processes which lead to derangement and insufficiency of renal excretory and regulatory functions (uremia). Chronic renal failure may result from any cause of renal dysfunction of sufficient magnitude.             When disease causes kidney failure or otherwise compromises the ability of the kidneys to remove toxic materials from the blood and maintain fluid, electrolyte, and acid-base balance, therapeutic dialysis by diffusion across a semipermeable membrane may be used. The patient’s own peritoneum or a machine using a synthetic semipermeable membrane such as cellophane may be used – peritoneal dialysis and hemodialysis, respectively.             Anemia is a frequent problem in patients with renal failure especially those in end stage and in chronic kidney disease (CKD) who are not yet receiving dialysis and can lead to major health complications if left untreated. The successful management of these patients entails repletion of iron stores, often through use of intravenous iron, particularly in patients receiving erythropoietin therapy. To encourage patient compliance with anemia management protocols, the nephrology nurse can play a key role in patient education in reducing barriers to proper management and in raising the awareness of the benefits of treating this condition (, 2001).             Nurses play a key role in helping to maintain Hb levels in the range recommended to mitigate anemia-related risk factors in both predialysis patients and those with end stage renal disease (ESRD). This is actually a situation which calls for a team approach comprising of the nephrologist, general practitioner, specialist and the nurse. Additional progress in anemia management can be obtained by understanding, the importance of early diagnosis and treatment of iron deficiency. Several factors contribute to iron deficiency in renal failure patients. First, observations with patients in the predialysis period, on hemodialysis, and on peritoneal dialysis suggest that intestinal iron absorption is reduced during ESRD. Poor absorption of iron can lead to the depletion of both circulating iron and iron stores, which is referred to as absolute iron deficiency. It has been suggested that low iron absorption in these patients may be explained by the intestinal mucosal changes that develop with uremia, including changes in activity of certain digestive enzymes–decreased activity of dipeptidases and increased activity of disaccharidases. Intestinal inflammation with associated histologic alterations may also be related to low iron absorption. Erosions and ulcers are additional gastrointestinal complications that often develop during ESRD. These are associated with gastrointestinal bleeding, which may also contribute to the development of iron deficiency. In hemodialysis patients, significant blood loss may also be caused by blood remaining in the dialyzers and dialysis lines postdialysis (, 2002). All patients returning to the dialysis facility following hospitalization should be immediately assessed to determine their clinical status. This process should include both a complete review of hematologic parameters and an individualized assessment for the presence of comorbid conditions that could affect hemoglobin (Hb) levels either acutely or chronically (, 2004).             Anemia may be aggravated during hospitalization, and patients returning to the dialysis facility may present with Hb levels that are significantly lower than baseline. Clinical data indicate that anemia can persist after hospitalization, with some patients requiring up to 6 months to regain preadmission Hb levels. To optimize anemia-related outcomes, a special approach to minimize post-hospitalization anemia may be warranted. Nursing interventions to proactively manage comorbid conditions, modify the anemia management prescription before hospitalization, and/or initiate a Rapid Ramping approach afterward can often minimize the severity of any decrease in Hb while shortening the time required to reaehieve targeted Hb levels (2004).             Proactive nursing interventions, including appropriate patient assessment, timely initiation of therapy, and individualized dose calculations, can help ensure that patients attain and maintain targeted Hb levels. The anemia manager should monitor the trends in Hb levels and note the increase after weeks of therapy; iron parameters should remain within the targeted range. Assessment should be negative for other conditions that may contribute to a low Hb, and if the Hb levels rose, the Epoetin alia dose should be gradually decreased to the prehospitalization level of 80 Units/kg TIW. The Hb should be restabilized weeks after discharge (, 2004).             The iron status of patients with renal failures should be evaluated on a regular basis during both the predialysis and dialysis periods, since these patients are at risk for developing iron deficiency (, 2002).             The role of the nephrology nurse in the anemia management of ESRD patients has been reviewed previously. Nephrology nurses often play a key role in managing patients with CKD. Because of recognition of the importance of active management of CKD patients at earlier stages in the disease practice, more CKD patients are likely to be referred to nephrologists before they need dialysis (, 2001). The advanced practice nurse, who is functioning as a physician extender, is more likely to work with patients in the predialysis setting than the nephrology nurse in standard practice who is usually involved with dialysis management. The advanced practice nurse may fulfill essential roles in identifying CKD patients at risk for developing anemia and managing the iron and EPO requirements of these patients (e.g., laboratory assessments of iron and hematology indices, prescriptions of therapies, etc.) (, 2001).             However, as more patients are being cared for by nephrologists at the predialysis phase, the nephrology nurse in the standard setting is likely to have increased contact with CKD patients. Nephrology nurses who do not oversee the direct medical management of CKD patients may still play vital roles in identifying anemic patients, promoting compliance, educating patients and health care personnel, and administering therapies. These functions are essential because several barriers exist to optimal anemia management in the CKD patient. For instance, patients and care providers may not understand the importance of anemia management and may question whether it is worth bringing CKD patients into the office weekly for injections. Nephrology nurses can communicate the importance of anemia management over the long term and assure patients about the safety and efficacy of the available therapies. Reimbursement for EPO may involve a great deal of red tape, even though it is an important therapy. The health care team must be unified in its commitment to overcoming the barriers to these interventions (, 2001).             Early identification and aggressive treatment of anemia in CKD patients may improve patient outcomes such as cardiovascular function, quality of life, and morbidity/mortality. There is a need for greater awareness of the importance of early intervention. Nephrology nurses have assumed increased clinical responsibilities within today’s practice setting, and their role in managing CKD patients may increase in the future. Nephrology nurses can have a major impact on the clinical outcomes of CKD patients, primarily through patient education and improved patient compliance (, 2001).  (, 2002).             Documentation of anemia-related assessments, interventions, and outcomes is an integral component of proper anemia management for patients with ESRD. In addition to promoting vital communication among medical professionals, documentation helps fulfill regulatory, legal, and payer reimbursement requirements, thereby ensuring that nursing contributions to patient well-being are recognized and that access to care is preserved (2003).             It is important for nephrology nurses to understand the relationship that exists between renal disease, cardiac disease, and anemia. Even mild cases of chronic kidney disease (CKD) have been associated with an increase in adverse cardiovascular outcomes. And anemia, which can result from both CKD and congestive heart failure, has been shown to exacerbate the adverse consequences of these conditions. An early, aggressive correction of anemia in patients with CKD can be implemented to break this cycle and stop disease progression. Studies have shown that anemia correction improves both cardiac and renal function and can result in increased hemoglobin levels, decreased number of hospital days, and improved quality of life. An effective strategy for managing anemia in patients with renal disease and comorbid cardiovascular disease includes the administration of both recombinant human erythropoietin and intravenous iron. In addition, the nephrology nurse plays an integral role in managing anemia and improving outcomes in these patients. Therefore, the nephrology nurse should have an increased awareness of the link between anemia and renal/cardiac disease as well as available treatment options (, 2005).   Recommendation and Conclusion               Anemia has long been recognized as a serious health problem in patients who have renal failures, especially those requiring dialysis. Successful treatment of anemia (i.e., increasing the hematocrit [hct] towards normal) in such patients is associated with reduced morbidity/mortality and significant improvements in cardiovascular and brain function as well as quality of life.             Although recent data indicate that the current anemia management protocols are resulting in good patient outcome, health care providers can still improve patient health by more aggressively addressing the problem of iron deficiency. A good starting point would be to establish a simple iron deficiency management protocol that involves early detection and treatment during both the predialysis and dialysis periods. Clinicians can also improve the outcome of iron deficiency by optimizing iron therapy. The administration of safe and effective IV iron supplements, close monitoring of iron and hematologic parameters, and maintenance IV iron therapy will help clinicians achieve good patient outcome. Taken together, improvements in anemia and iron deficiency management will ultimately improve patient health and quality of life and may also reduce financial burden.           REFERENCES   Credit:ivythesis.typepad.com

MANAGEMENT OF ANEMIA

MANAGEMENT OF ANEMIA IN RENAL PATIENTS Introduction Anemia is a serious medical condition which manifests in renal pat...

Occupational Therapy

INTRODUCTION Just living is an occupation people everywhere participate in daily activities that are the occupations of life. Growing, playing, learning, exercising, caring for the family and working make lives full and enjoyable but when unexpected things happen to change that level of participation, what can be done? Occupational therapy is there to restore the joys of living without pain or suffering. Occupational therapists are increasingly taking on supervisory roles due to rising health care costs that are beginning to encourage occupational therapy assistants and aides to take more hands-on responsibility, the cost of therapy should be more manageable for those needing service. Occupational therapy provides the bridge that allows the health client to cross the gap between decreased ability and living a full life and represents the best of applied science in health care practice and its needed assessment tools. The goal of occupational therapy (OT) assessment tools as well as services is to provide educationally related services that will assist in benefiting from therapy which is designed to enhance the development of skills necessary for academic learning and vocational training within the child’s current and future educational settings. Several highly trained professionals work closely with teachers, parents and other service providers to enable students with exceptional needs to realize their potential both in and outside of the classroom.     DISCUSSIONS The paper will critically evaluate a certain occupational therapy assessment tool – the Canadian Occupational Performance Measure (COPM) being used to facilitate useful process such as children affected by autism as it can involve this intervention program and goals related to the domains of communication, behavior and social interaction. The COPM was found to be a useful tool for enabling parents to identify goals for their children, when used and understood from a strong client and family-centered philosophical perspective. Pre- and post-intervention parent ratings of goal performance and satisfaction are presented to demonstrate the use of the COPM as an outcome measure. Implications for practitioners in early childhood and special education settings and areas for further research are also discussed ( 1998). Fundamental to a family-centered approach is the importance of matching early intervention support with the unique characteristics of each child and family (1990). As stated by  (1994), ‘the greatest impact on child, parent, and family functioning is most likely to occur when interventions are based upon the needs, aspirations, and desires a family considers important’ .         The Canadian Occupational Performance Measure (COPM) (1998) is used to identify priorities for therapy and to document the client’s self-rating of occupational performance and satisfaction. It is embedded in an understanding of client- and family-centered practice (2002;  1995) and the Canadian Model of Occupational Performance, which highlights the importance of the transaction between the client, occupation, and the environment (1990). (1998) and  (1993) reported good utility of the COPM across a wide range of occupational performance dysfunctions such as orthopaedics, pain, traumatic brain injury). The scoring of the COPM has been found to be responsive to changes in perceived occupational performance over time (1999; 1994; 1999). When used as an outcome measure, pre- and post-performance and satisfaction ratings and change scores can be determined. A change score of two to three points is considered indicative of clinically significant change (1998). To date, there has been some use of the COPM with children (aged over seven years) (2001; 2001). However, limited use with families has been reported in the literature. A modified version of the COPM (2003) was used with parents to facilitate the identification of priorities and goals for intervention.       Certain study aimed to: Ø      Consider the utility of the Modified COPM (M-COPM) in assisting parents to identify and prioritize their goals Ø      Demonstrate the utility of the M-COPM as a self-report outcome measure, pre- and post-intervention. Modified Canadian Occupational Performance Measure (M-COPM) Two modifications were made to the COPM to create the M-COPM. First, when working with children, it was important to reframe occupations as the things children need to do, want co do and are expected to do in their daily lives. For young children with compromised language and communication abilities, parents are in the best position to identify their child’s occupational performance issues, prioritize these and in collaboration with professionals, identify realistic intervention goals. The modified version of the Canadian Occupational Performance Measure (M-COPM) (2003) which can be obtained from the corresponding author–was administered during the first visit following the two-day workshop. This visit was scheduled, where possible, at a time convenient to both parents. In the majority of cases, both parents were involved in the administration of the M-COPM. The second, post-intervention, administration occurred within two weeks of the completion of the home visits.     Administration of the M-COPM: Ø      Parents were asked to identify occupations that were difficult for their son/daughter in regard to self-care, play and relaxation Ø      Parents then rated the difficulties using a 10-point scale to identify priorities for intervention Ø      Parents then rated current performance and satisfaction of their son/daughter on three to five of the priority areas using a 10-point scale and rated performance and satisfaction post-intervention. In addition to describing their goals, the M-COPM enabled parents to prioritize these goals, using the rating scale format for importance. Second, the M-COPM was clinically useful, enabling facilitators to help parents reflect upon their children’s occupations and consider the difficulties they experience. The modifications that enabled this reflection appear to have been successful in assisting this process. Specifically, the structure of the M-COPM interview helped parents consider communication, behavior, play, self-care, routines and transitions, as well as family socialization. Important prerequisites in utilizing the M-COPM include the establishment of rapport with parents and ensuring that the interviewer embodies the underpinning philosophies of family-centered practice and have developed excellent listening skills.     Professionals need to be sensitive to language use and ensure that other practices involved in goal setting are parent friendly such as keeping goal-setting meetings small in size by minimizing the number of professionals’ present and holding meetings at convenient times and in a family-friendly location (1994;2001). The M-COPM provides a clear yet flexible structure for both parental goal identification and prioritization. Measurement tools that provide information regarding how the child performs in the educational setting have become the focus of attention in recent years in support of the client-centered approach to measuring performance (2001). Developmental and diagnostic assessments may be beneficial in providing more in-depth information for a particular deficit area, but these assessments do not provide information about performance in context. Recommendations regarding interpretation of test results from the Developmental Test of Visual Perception-Second Edition (1993) indicate that diagnosis regarding a child’s visual perceptual skills cannot be made by test data alone. Thus, these test authors, along with others (1998), have stressed the need to validate findings with objective measures of the student’s performance of daily life activities (1998) and provides information about the barriers that may be interfering with the child’s performance in the educational setting. The unique tool affords the therapist working with adolescents in a school-based practice the opportunity to receive first-hand information from the adolescent regarding performance issues in daily life.   Thus, examinations of the student’s performance in context, such as assessment techniques, yield valuable information in the evaluation process when the OT is required to provide input regarding the need for assistive technology. Using the information from relevant assessment tools facilitates the development of outcome measures that enable children to be active participants in the school day. It is believed that occupational therapists are taking on supervisory roles. Due to rising health care costs, to encourage occupational therapy assistants and aides to take more hands-on responsibility under the guidance of a therapist, the cost of therapy should be more manageable for those needing service. The emergence of more opportunities where occupational therapy is needed guarantees the future of the profession and creates a better job process. The focus is to assist the person in achieving maximum independence through individualized adaptation to health care challenges and that practitioners in the field must have these strengths: high level critical thinking, the ability to creatively adopt tools, make observation of daily life skills and the ability to recognize the unique needs of work therapy as it provides the bridge that allows the health client to cross the gap between decreased ability and living a full life and represents the best of applied science in health care.       Implications Parent-identified goals in the domains of communication, behavior, play and social interaction frequently pervade all environmental contexts in which the child with ASD functions. Knowledge of these goals can assist early childhood educators in both special education and inclusive settings to discuss with parents how they envisage these goals being supported with specific interventions ( 1998), This enables a consistent approach across home, early childhood and community settings. Awareness of the parents’ goals for a child in a child care setting can also assist early childhood professionals to make the most of their time in this environment, which is frequently highly sought after and valued by parents (1994) and offering frequent requesting opportunities. The involvement of family and professionals in all of the contexts in which the child engages is recognised as one of the key components of effective programs for young children with autism ( 1997).           The COPM is a useful method for identifying parents’ priorities in both inclusive and special educational settings. It also provides a structure for discussing parents’ expectations of what they wish their child to achieve in inclusive settings. This can assist educators to clarify expectations of how they will support the child in various settings to achieve priority goals, as well as to determine realistic expectations of each educational setting. The COPM could also be used for such discussions in transdisciplinary team settings, where one team member as primary case manager may undertake the COPM with parents to assist with goal identification, and report back to the team who can then identify the necessary. It would seem that the tool provides a useful means for identifying and prioritizing goals in home-based programs, early special education and regular early childhood settings. In addition, it provides a means of documenting outcome of intervention by way of addressing parental perception of change, in both the child’s performance in relation to specific goals as well as their satisfaction with that performance as used within a framework of family centered practice, the COPM appears to have potential in assisting parents to identify and prioritize early intervention goals for their children with Autism Disorders.               A patient may express more than one desired outcome of treatment. In such cases, we contend it is important for the therapist to have the patient rank which outcomes are most important. The Canadian Occupational Performance Measure (COPM) was designed for use by occupational therapists, but it can be useful for physical therapists to help patients to identify and rank goals of intervention. The COPM provides a standardized format for assisting patients to identify goals that are most important to them in the areas of self-care, productivity (work, household management, play/school), and leisure. Following intervention, the tool is again used to rate patients’ perceived change in their performance and change in satisfaction with performance. Assessment that describes studies designed to investigate the reliability of data obtained with the Physiotherapy Evidence Database (PEDro) scale developed to rate the quality of RCTs evaluating physical therapist interventions randomly selected from the PEDro database generated a set of individual and consensus ratings of individual and consensus ratings repeated the process.           In such a situation, both sides of the base rate problem debate would agree that the estimates of reliability provided by the kappa statistic are misleading. In both studies, we randomly selected a sample of trials from the population of trials on the PEDro database. Not surprisingly, the base rates in the 2 samples were very similar to the base rate for the population was justified and did not produce misleading inferences about reliability of ratings for items on the PEDro scale. An understanding of the error associated with the PEDro scale can be used to guide the conduct of a systematic review that uses a minimum PEDro score as an inclusion criterion. In our studies, we noted that repeated PEDro consensus scores were within one point on 85% of occasions and within 2 points on 99% of occasions. We believe it is sensible to conduct a sensitivity analysis to see how the conclusions of a systematic review are affected by varying the PEDro cutoff. For example, in Maher’s review of workplace interventions to prevent low back pain, reducing the PEDro cutoff from the original strict PEDro cutoff of 6 to a less strict cutoff of 5 (or even 4) did not change the conclusion that there was strong evidence that braces are ineffective in preventing low back pain. Readers should have more confidence in the conclusion of a review that is unaffected by changing the quality cutoff.       CONCLUSION The precision of the PEDro scale also should be considered by users of the PEDro database. None of the scale items had perfect reliability for the consensus ratings displayed on the PEDro database; users need to understand that the PEDro scores contain some error. Readers who use the total score to distinguish between low- and high-quality RCTs need to recall that the standard error of the measurement for total scores is 0.70 units and consider the standard error of the measurement, a difference of 1 unit in the PEDro scores provides confidence that truly had different PEDro scores (1998;1996; 2004). M-COPM was clinically useful, enabling facilitators to help parents reflect upon their children’s occupations and consider the difficulties they experience. The modifications that enabled this reflection appear to have been successful in assisting this process. Specifically, the structure of the M-COPM interview helped parents consider communication, behavior, play, self-care, routines and transitions, as well as family socialization. Important prerequisites in utilizing the M-COPM include the establishment of rapport with parents prior to the underpinning philosophies of family-centered practice and have developed listening skills and expertise in perspective, aiming all the time to understand the parents’ perspectives (1994;2001). The M-COPM provides a clear yet flexible structure for both parental goal identification and prioritization.   Credit:ivythesis.typepad.com

Occupational Therapy

INTRODUCTION Just living is an occupation people everywhere participate in daily activities that are the occupations of life. Growing,...

DIABETES

DIABETES   To keep well and healthy, every person who has diabetes needs good and regular healthcare. The early detection, treatment and continued control of diabetes is very important as this will reduce a person’s chances of developing the serious health problems and complications linked to diabetes. In England and Wales there are new national service frameworks for diabetes (National Service Framework for Diabetes) and in Scotland there is the Scottish Diabetes Framework. Similar decisions for a diabetes framework are being taken in Northern Ireland.             To achieve the best possible diabetes care, the diabetic patient needs to work together with healthcare professionals as equal members of his or her diabetes care team. It is essential that he or she must understand their condition as well as possible so that the diabetic patient can be an effective member of this team.   Effective diabetes care is normally achieved by team work, between the diabetic patient and his or her diabetes care team. Looking after their diabetes and changing their lifestyle to fit in with the demands of diabetes is hard work, but it is worth it.             When the patient is in the hospital, he or she must receive a full explanation of their treatment during their stay in hospital and have the opportunity to discuss any particular worries. It is a right of the patient to receive information and if they do not receive an explanation, they should ask for it. The patient should inform the ward team of their usual diet, tablets or insulin treatment.             The patient should have access to the hospital diabetes care team — doctor, nurse, state registered dietitian and chiropodist. The patient should also be allowed to discuss their diabetes so they can manage some aspects of it themselves, such as blood/urine monitoring and injections at the desire of the patient. However, the staff may need to check the patient’s technique and results and they may need to do additional tests of their own.             The objectives of symptom control in diabetes are to avoid episodes of ketoacidosis and to control symptoms resulting from hyperglycemia and glucosuria. Symptom control begins with the measurement of urine glucose as an index of plasma glucose levels. In starting therapy for diabetic patients, it is best to analyze the urine prior to each meal and at bedtime. The timing of the collections and the method of testing must be understood. Collecting “double-void” urine specimens immediately prior to meals helps avoid testing urine stored in the bladder since the preceding meal.             The patient should be instructed to void about 30 minutes before the meal, drink 2 or 3 glasses of water, and then void again immediately prior to the meal; the latter specimen will then be tested for glucose. The method for testing urine glucose is chosen on the basis of whether the patient normally spills glucose in the urine or not.             Occasional plasma glucose determinations can be timed on the basis of urine test and hypoglycemic symptom reports. The lowest plasma glucose values, usually before meals and at bedtime when the urine is negative for glucose, are generally most useful in regulating the drug and dietary regimens. They help to determine renal glucose threshold and guide interpretation of urine tests.             The cornerstones of ketoacidosis therapy, required in all patients, are insulin and IV fluids. Insulin is given immediately. The choice of insulin regimen should be based on the experience of the therapeutic team; the objective in all approaches is to achieve optimally effective levels of circulating insulin and maintain them until there is evidence of biochemical recovery.             If the patient is treated by insulin, he or she should expect that it may be given via a glucose/insulin drip into a vein if for some reason they are not allowed to eat or drink. If the patient is having anaesthetic, then an anaesthetist will arrange care of the patient’s diabetes during and immediately following the operation. If the patient is treated by tablets, he or she should be prepared that their treatment may need to be changed while they are in hospital, which may involve being transferred from tablets to insulin during their stay. For continuing treatment, hourly blood glucose determinations and semiquantitation of serum ketones by serum serial dilution will reflect patient improvement. Patients without an appreciable response after four hours should have the insulin dose doubled each hour until a response occurs. After the blood glucose begins to fall, an infusion containing glucose helps to avoid late hypoglycemia.             Potassium loss is estimated from the serum potassium level interpreted in light of the degree of acidosis. As soon as urine flow is known to be adequate, potassium can be added to the infusion. Marked improvement should occur within a few hours.             Plasma potassium levels should be monitored every hour initially. Continual monitoring of potassium levels is extremely important in the management of diabetes because inadequate management of potassium balance is the main cause of death. Bicarbonate is not needed routinely but may be required if acidosis is very severe. Reevaluation of areas of physiologic abnormalities should direct therapy to any significant remaining imbalances. Treatment should be continued until the patient is able to take fluid freely by mouth. As soon as food is tolerated, a regular diabetic diet and insulin therapy should be resumed.             Diets for diabetic patients should be neither insufficiently detailed nor unnecessarily complex and should be tailored to fit the propensities and lifestyle of the patient. Sociologic, cultural, and economic barriers to patient adherence to a prescribed diet should be considered and avoided.             There is no need to disproportionately restrict the intake of carbohydrates in the diet of most diabetic patients. Flexibility in diet design helps many patients to adhere to an effective program. Lowering of fat consumption may reduce risk factors of coronary heart disease, the most important cause of death and debility in the diabetic.             It is a good idea to take up some form of regular physical activity, such as walking, swimming, dancing or cycling. The patient should consult their doctor or diabetes nurse before taking up any regular exercise, particularly if they are overweight.             The patient should expect to be able to use their own emergency supplies of biscuits, sugary drinks, fruit or glucose tablets to treat hypoglycemia if they are on insulin or sulphonylurea tablets. If the patient does experience a hypoglycemia, he or she should inform the nurse or doctor. The patient should also expect to be informed and consulted about any changes in their treatment or diet which may be necessary during their stay in hospital — for example, if the patient has Type 2 diabetes, he or she will sometimes be temporarily treated with injections of insulin while in hospital. This will be because their illness or operation has upset their diabetes control.             Whether treatment of asymptomatic hyperglycemia decreases morbidity and mortality is unknown, and there is significant risk of hypoglycemia in elderly patients given oral hypoglycemic agents or insulin therapy. Therefore, it appears best not to use drug treatment for glucose intolerance in elderly patients with normal fasting plasma glucose levels or asymptomatic fasting hyperglycemia. Blood glucose monitoring is a useful tool for controlling diabetes. It can help to maintain day to day control, detect hypoglycemia, assess control during any illness, and helps to provide information that can be used in the prevention of long term complications. It is very important that the diabetic patient should follow the treatment that their doctor or diabetes nurse has advised. Diabetic patients will feel much better if they keep their blood glucose levels as near normal as possible. The doctor or diabetes nurse will advise the patient on what are the best blood glucose levels for that specific patient. They can also advise the patient on the many gadgets available that can help them to monitor their blood glucose levels in order to safely say out of diabetes. A person with diabetes will have to make some changes to his or her way of life. However, by sticking to their respective treatments, monitoring their health condition and following a generally healthy lifestyle, diabetic patients should be able to continue their normal, day-to-day life and take part in the activities that they have always enjoyed. Attaining good health after being affected with diabetes is the purpose of being in rehabilitation. For program planning, emphasizing the proximal, attainable benefits of just feeling better today and framing those efforts as part of improving health might have more powerful appeal than avoiding more serious complications of diabetes in the future years. Identifying outcomes valued by each person is a key strategy in promoting change in behavior. Focusing on smaller, attainable goals can help develop self-efficacy for diabetic patients.     Credit:ivythesis.typepad.com

DIABETES

DIABETES To keep well and healthy, every person who has diabetes needs good and regular healthcare. The early detection, treatment and...