Research Topics: Laboratory Report

Health Care Organization

Introduction Quality as a means of creating and sustaining a competitive advantage has been widely adopted by both public and private sector organizations. In the healthcare system recent decades have observed a remarkable changes even an evolution in the quality management in the healthcare system,    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 . 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. 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. 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. 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. 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, stated: “Loyalty behaviours, 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. Accordingly, patient satisfaction is the cognitive assessment or judgment of an emotional reaction to the provided healthcare service. 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.    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.  Due to the concept of cost-containment and quality assurance, national health authorities have formed different types of agencies to address healthcare management quality. 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. 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. 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.  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. 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             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. 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. 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. 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. 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. “…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 utilise 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 Organization

Introduction Quality as a means of creating and sustaining a competitive advantage has been widely adopted by both public and priva...

DNA and RNA

Question 1 Viruses are not living things though they have some characteristics of living things such as mutation and replication. One of the major characteristics of all living things is being made up of cells, the basic structure of all living things, which viruses are not; viruses are made up of core of nucleic acid, either DNA or RNA, surrounded by protein coat. Viruses should have both the DNA and RNA to be considered as living things. These nucleic acids are the genetic components of life; to be able to reproduce, an organism should have both DNA and RNA and through the process of mitosis which viruses can not perform. But how do viruses reproduce? Once a virus has found a host, it will infect its cells, using the cell’s enzyme that is required to copy the viral genome, virus now replicates itself thousands of times. Without living cells, viruses can not exist, grow and reproduce; they are simply parasites but they are not living things. Also, viruses do not eat unlike living things. Viruses are not living things but we eradicate or kill them because they have the capability to reproduce, infecting the host and making the host ill. Question 2             Protists are unicellular eukaryotes; complex because of its cellular organization and because they have a nucleus to house their genetic material and membrane-bound organelles. This composition of protists makes them functionally complex despite of their small size. Protists have mitochondria for metabolic functions, and vacuoles for digestion and excretion; they have the organelles necessary to survive. Single-celled organisms like protists, unlike multi-cellular organisms, can not do complex tasks like reproduction through meiosis. They rely on hosts to replicate and complete their complex life or perform mitosis for reproduction. Because of their unicellularity, they can just do simple tasks.     Credit:ivythesis.typepad.com

DNA and RNA

Question 1 Viruses are not living things though they have some characteristics of living things such as mutation and replication. On...

Lab Report on Lactate Threshold

Introduction             The lactate threshold is a field in exercise physiology where several studies have already been conducted. A lactate threshold test is useful as it will lead to the discovery of specific applications for a person’s racing, training, and other exercise activities. The workload corresponding to the lactate threshold and onset of blood lactate accumulation has previously been quantified using lactate tests incorporating stage increments.             The anaerobic threshold is a submaximal index related to endurance exercise performance, which is usually determined by the measurement of blood lactate concentration during an incremental exercise test (lactate threshold). The lactate threshold, and thus the anaerobic threshold, can also be detected noninvasively in normal subjects by means of the gas exchange threshold (GET).             The concept that muscle contraction can occur for extended periods of time without sufficient oxygen supply may have been first suggested as early as 1871. As early as 1909, investigators surmised that lactate stimulated respiration during high-intensity exercise, other investigators suggested that lactate was the “signal” that initiated muscle contraction, and the role of oxygen was to remove lactate once it was formed (it is now known, of course, that lactate is the product of, not the cause of, muscle contraction). Shortly thereafter, several other laboratories in the United States and Europe independently reported that exercise intensity, lactate production, metabolic acidosis, and bicarbonate buffering appeared to be linked. The accumulation of lactate in the blood was thought to reflect a point during exercise in which oxygen supply was inadequate to meet the energy requirements of the working muscle. In the early 1960s, investigators linked lactate production in the blood to endurance performance among German athletes. In 1964, other investigators explicitly developed the concept that a critical threshold exists in which (1) the metabolic needs for oxygen in the muscle exceed the capacity of the cardiopulmonary system to supply them, (2) there is a sudden increase in anaerobic metabolism, and (3) lactate is formed in the muscle.             There are limited data on the reproducibility of blood lactate variables, heart rates and ratings of perceived exertion (RPE) during sub-maximal exercise. The aim of this study was to determine the lactate threshold, at different blood lactate concentrations, heart rate (beats per minute) and RPE during a continuous, incremental training cycle.   Methods               The lactate threshold in this experiment was obtained by a progressive exercise test and taking a blood sample at the end of each stage. The lactate content of each blood sample is then analyzed. Lactate profile is a form of testing that is very useful for monitoring changes in fitness and should be performed several times throughout the course of the training cycle.             In one study, a cycle ergometer was also used to determine lactate threshold. The tests for this particular study included (1) an incremental ramp test for peak workload; two lactate tests consisting of six stages of either 3 min or 8 min duration to determine the lactate threshold and onset of blood lactate accumulation; and (4) a 90 rain time-trial for determination of average power output. Pearson correlation coefficients were calculated between the lactate threshold and onset of blood lactate accumulation obtained from the 3 min and 8 min lactate tests as well as the 90 min time-trial. A two-way (test x variable) analysis of variance (ANOVA) was used to compare the lactate threshold and onset of blood lactate accumulation obtained from the 3 min and 8 min lactate tests. The test consists of successive stages of exercise on a treadmill, bicycle ergometer, swimming flume, rowing machine etc. Initially the exercise intensity is about 50- 60% of the VO2 max. Each stage generally lasts about 5 minutes. Near the end of each stage, heart rate is recorded, oxygen consumption is measured, and a sample of blood is withdrawn, using a needle prick of the finger or earlobe. Using special instrumentation, blood lactate concentration can be determined during the test.             Before starting the experiment, the conditions of the testing facility such as the room temperature, barometric pressure, and relative humidity are recorded on data sheets.             Informed consent is given to every participant of the study and each of them is also asked to complete the health questionnaire given to them.             The heart rate transmitter was attached to the chest of the subject. RPE measurements were recorded every minute throughout the test. The appropriate lab safety and subject care protocol for obtaining a small blood sample were followed.             As is the same with some other studies that were conducted in the past, the sample blood is taken from the earlobe of the subject at rest and at the end of each stage. The Lactate Pro handheld lactate analyser was used to determine the blood lactate concentrations for the subject.              In this study conducted, the test started with 100 watts of power. This is increased steadily until exhaustion is reached by the subject. Every 4 minutes, the resistance of the cycle ergometer is increased by 25 watts. The concentration of blood lactate, the ratings of perceived exertion, and the heart rate are all measured at the end of each 4 minute stage. The blood sample is taken during the last 30 seconds of each stage.             Based on the above table and graph, the following interpretations can be made. At the start of the experiment, when the power is still at 0, the subject’s heart rate is 93 beats per minute, the lactate 1.3 mmol/l, and the RPE is not stated or lacking since this is measured at the start. At 100 watts, when the subject has a maximal heart rate of 121 beats per minute, the lactate is 3 mmol/l and the RPE is 7. At 130 watts, with a heart rate of 132 beats per minute, the lactate is 3.2 mmol/l and the RPE is still 7. At 160 watts, the heart rate is 149 beats per minute, the lactate 3.7 mmol/l and the RPE is 8. At 190 watts, the heart rate is 161 beats per minute, the lactate is 4.8 mmol/l, and the RPE is 10. At 220 watts with a heart rate of 173 beats per minute, the lactate is 7.6 mmol/l, and the RPE is 13. At 250 watts with a heart rate of 184 beats per minute, the lactate is 12.6 mmol/l, and the RPE is 15. Lastly, at 280 watts, the heart rate is 188 beats per minute, the lactate is 16.7 mmol/l, and the RPE is 19.             There is also a 2-minute post-exercise lactate which is 16.2 mmol/l and a 5-minute post-exercise lactate which is 15.2 mmol/l.   Critical Discussion    During exercise, such as sprinting type activities, when the rate of demand for energy is high, lactate is produced faster than the ability of the tissues to remove it and lactate concentration begins to rise. This is a beneficial process since the regeneration of NAD+ ensures that energy production is maintained and exercise can continue. During exercise, the amount of oxygen entering the blood in the lungs is increased because the amount of oxygen to be added to each unit of blood and the pulmonary blood flow per minute are increased. The PO2 of blood flowing into the pulmonary capillaries falls from 40 to 25 mm Hg or less, so that the alveolar-capillary PO2 gradient is increased and more oxygen enters the blood. Blood flow per minute is increased from 5.5 L/min to as much as 20-35 L/min. The total amount of oxygen entering the blood therefore increases from 250 mL/min at rest to values as high as 4000 mL/min. The amount of carbon dioxide removed from each unit of blood is increased, and carbon dioxide excretion increases from 200 mL/min to as much as 8000 mL/min. The law of mass action states that as the end products of a chemical reaction build up in a reacting medium, the rate of the reaction approaches zero. The two end products of the glycolytic reactions are (1) pyruvic acid and (2) hydrogen atoms combined with NAD+ to form NADH and H+. the buildup of either or both of these would stop the glycolytic process and prevent further fromation of adenosine triphosphate (ATP). When their qualities begin to be excessive, these two end products react with each other to form lactic acid. Thus, under anaerobic conditions, by far the major portion of the pyruvic acid is converted into lactic acid, which diffuses readily out of the cells into the extracellular fluids and even into the intracellular fluids of other less active cells. The increase in oxygen uptake is proportionate to work load up to a maximum. Above this maximum, oxygen consumption levels off and the blood lactate level continues to rise. The lactate comes from muscles in which aerobic resynthesis of energy stores cannot keep pace with their utilization and an oxygen debt is being incurred. Contrary to popular belief, this increased concentration of lactate does not directly cause acidosis, nor is it responsible for muscle pain or “burning”. This is because lactate itself is not capable of releasing a proton, and secondly, the acidic form of lactate (lactic acid) cannot be formed under normal circumstances in human tissues. Analysis of the glycolytic pathway in humans indicates that there are not enough hydrogen ions present in the glycolytic intermediates to produce lactic or any other acid.             The relationship between the increase in blood lactate and oxygen supply to the muscle has a long history. Studies performed early in this century closely linked exercise intensity, lactate appearance, metabolic acidosis, and bicarbonate buffering. These associations provided a convenient and logical explanation for lactate production during exercise. Numerous studies have supported the link between oxygen supply and the magnitude of the increase in blood lactate, albeit without direct evidence of cause and effect. For example, the extent to which lactate increases in the blood during exercise is reduced as fitness increases or with training, and is increased in the presence of reduced cardiac output states or disease of the electron transport chain. When oxygen supply is experimentally altered, blood lactate is profoundly affected. With an increase in inspired oxygen tension, either by increasing the oxygen content of the inspired air or by increasing the barometric pressure, the exercise-induced increase in lactate level is attenuated. Decreasing the fraction of inspired oxygen either experimentally or by exposure to altitude increases blood lactate. In normal subjects, reducing blood volume causes an increase in blood lactate level during exercise. In patients with chronic heart failure, increasing cardiac output with inotropic therapy attenuates the increase in blood lactate during exercise.             The concept that a “threshold” exists, in which there is a sudden onset of anaerobic metabolism resulting in the accumulation of lactate in the blood has been challenged. Recently, this issue has generated some rather lively debate. Studies by some investigators raised questions about the subjective intraobserver and interobserver reliability and reproducibility of ventilatory and lactate thresholds. Concerns over the presence or absence of a discrete threshold point led investigators the use of a log-log transformation (ie, plotting oxygen uptake, lactate, or [CO.sub.2] production on logarithmic axes). These investigators reported that lactate exhibited an abrupt transition from a slowly increasing phase to a rapidly accelerating phase, findings consistent with the historic interpretation of the anaerobic threshold. Despite its wide adoption, however, such an idea was unacceptable to many since among other things, a log transformation could “create” a visually apparent breakpoint where none existed before, by spreading out the early data points over the X-axis relative to the later on.             The lag in blood lactate concentration observed during the test is possibly related to vasoconstriction of the active muscle mass stemming from isometric contraction of the body during the exercise effort. More specifically, if a measurement of peak blood lactate concentration is required after an ergometry test, it is recommended that a capillary blood sample should be obtained 3-5 min after exercise.             The fixed blood lactate concentration of 4.0 mmol * [l.sup.-1] has been used extensively to monitor and prescribe endurance exercise training programmes with adults in many studies. It is well recognized that the blood lactate response to exercise is different in young people than in adults. Therefore, a lower fixed blood lactate concentration has been proposed for use with children. The rationale for these single concentrations was that they represent the maximum exercise intensity at which an equilibrium between blood lactate accumulation and elimination occurs. This physiological parameter is believed to represent the highest intensity of exercise that can be supported almost exclusively by oxidative energy metabolism.   Conclusion   The lactate threshold provides a clear picture of the subject’s current fitness level. The lactate threshold, along with the power output, can determine a person’s specific heart-rate training zones. Knowing these zones and how to intersperse them enables everyone to ultimately improve performance. At the start, concentrations of lactate rise slowly, but then suddenly increase sharply at a clearly-defined point, which is termed as the lactate threshold. The lactate threshold corresponds to the shift in metabolism to anaerobic within the muscle cells after exercise has begun in the experiment. At this point, lactate is being produced faster than it can be metabolized and it accumulates, passing into the blood. Obtaining blood samples can determine the amount of lactate present in the blood. The way to improve Lactate Threshold is to incorporate one or two Lactate Threshold training runs into the weekly plan. These are run at a comfortably hard, near race pace, with a steady, unvarying effort. After about five to 10 minutes of easy running, run for at least 20 minutes at Lactate Threshold pace. An individual should work hard but not have to slow down over the course. If they do, they are going too fast and it won’t be as beneficial as maintaining a steady Lactate Threshold effort. A person can measure their training zone by heart rate, pace, or perceived effort. But it is best if their course can be level and smooth so that they are able to maintain a regular tempo (hence the term tempo runs) rather than having to speed up or slow down to accommodate hills and rough terrain.   Credit:ivythesis.typepad.com

Lab Report on Lactate Threshold

Introduction The lactate threshold is a field in exercise physiology where several studies have already been conducted. A lac...

Treatment of Allergies

y> Introduction Allergies or allergic reactions are abnormal responses to normally harmless foreign substances in our body that would sometimes even lead to life threatening situation.  Our body has developed a sophisticated system in screening, identifying, and destroying foreign microorganisms before they cause rigorous damage to the human body.  This system acts as a biological warfare protecting our body from harsh invasion of harmful microorganisms.  It acts as our body shield from potential diseases caused from these destructive and damaging microorganisms within our body.  This is our Immune System.              There is a close relevance and direct link connecting our immune system and allergy.  For the fact of the matter that immune system protects us from harmful microorganisms’ invasion, it wouldn’t bring fort only to fight those harmful and dangerous ones.  Once it detects foreign cells or molecules, the system automatically reacts to that specific invader, harmful or not.  Such natural immune system reaction to foreign microorganisms doesn’t have control on whether the invading foreign cells are harmful or not.  Consequently, this would instead develop into an allergy.  Allergies are undesirable effects of an aggressive immune system response against harmless organisms.  It would be nice to hear that medical science then developed allergens (allergy medicines) for this unwanted effects of aggressive immune response.  How does treatment of allergies works?             Science has produced an allergy medicine called Allegra and is widely prescribed by doctors nowadays.  Allegra is believed to relieve seasonal allergy symptoms like sneezing, runny nose, and itchy, watery eyes.              Allegra is a powerful and non-sedating antihistamine.  Histamine is a chemical in our body that causes allergy symptoms.  To relieve allergy symptoms such as those stated above, Allegra works by blocking the effect of histamine.              In cases like nasal congestion, a specialized kind of Allegra, the Allegra-D 12 Hour, combines a powerful antihistamine with a nasal decongestant.  It would be very important to follow the specified prescription of the doctor with regards to the regularity of taking Allegra even though your body starts to feel better.  Skipping the suggested time between doses might give a chance for the symptoms to get worse.  Allegra is a powerful allergy medicine to common colds and offers a quick 60-minute relief of allergy symptoms after taking a dose.              There are actually four allergy medicines developed by far.  The Allegra, Claritin, Clarinex, and Zyrtec.  Not surprisingly, these allergy medicines are of the same use and function in relieving allergy symptoms.  It would be the doctor’s discretion as to what to prescribe taking into consideration the patient’s bodily reaction to each of the four allergy medicines.    Credit:ivythesis.typepad.com

Treatment of Allergies

y> Introduction Allergies or allergic reactions are abnormal responses to normally harmless foreign substances in our body that woul...

Fluorescent in Situ Hybridisation TEchniques Assignment

What is the difference between DNA and RNA that is critical for In Situ Hybridisation?    DNA or Deoxyribonucleic acid is defined as the long polymer of nucleotides and encodes the sequence of the amino acid residues in proteins using the genetic code, a triplet code of nucleotides. DNA is responsible for the genetic propagation of most inherited traits. On the other hand, PNA or Peptide Nucleic ps Acids are DNA mimics with a pseudopeptide backbone. The difference between the two molecules however is that PNA are stable under acidic conditions and resistant to nucleases as well as proteases compared to DNA. PNA oligomers can be shorter than oligonucleotides when used as hybridisation probes. Another advantage of PNA to DNA is that it permits the hybridisation of DNA samples under low or no salt conditions, since no interstrand repulsion, as occurs between two negatively charged DNA strands, needs to be counteracted. PNA shows a greater specifity of interaction to DNA or RNA than DNA or RNA itself. Furthermore, it also shows a stronger binding. Binding to DNA or RNA is essentially independent of salt concentration. Also, PNA is resistant to nucleases and proteases What is the purpose of washing slides in the formamide solution after FISH? Slides should be washed after a formamide solution. It is one of the causing factors in an effective FISH application. Not performing a post-hybridisation washing of slides may result in nonuniform cell permeability, variable target site accessibility, poor sensitivity, which are basically common disadvantages of the FISH process. Post hybridization washing is one of the methods that should be used to ensure FISH effectiveness. Why is it necessary to incubate the “paint” probe with a highly repetitive fraction of the human DNA? This is necessary because the paint probe without incubation can     Credit:ivythesis.typepad.com

Fluorescent in Situ Hybridisation TEchniques Assignment

What is the difference between DNA and RNA that is critical for In Situ Hybridisation? DNA or Deoxyribonucleic acid is defined ...

LAB REPORT ON LACTATE THRESHOLD

Introduction             The lactate threshold is a field in exercise physiology where several studies have already been conducted. A lactate threshold test is useful as it will lead to the discovery of specific applications for a person’s racing, training, and other exercise activities. The workload corresponding to the lactate threshold and onset of blood lactate accumulation has previously been quantified using lactate tests incorporating stage increments.             The anaerobic threshold is a submaximal index related to endurance exercise performance, which is usually determined by the measurement of blood lactate concentration during an incremental exercise test (lactate threshold). The lactate threshold, and thus the anaerobic threshold, can also be detected noninvasively in normal subjects by means of the gas exchange threshold (GET).             The concept that muscle contraction can occur for extended periods of time without sufficient oxygen supply may have been first suggested as early as 1871. As early as 1909, investigators surmised that lactate stimulated respiration during high-intensity exercise. Between 1910 and 1915, other investigators suggested that lactate was the “signal” that initiated muscle contraction, and the role of oxygen was to remove lactate once it was formed (it is now known, of course, that lactate is the product of, not the cause of, muscle contraction). Shortly thereafter, several other laboratories in the United States and Europe independently reported that exercise intensity, lactate production, metabolic acidosis, and bicarbonate buffering appeared to be linked. The accumulation of lactate in the blood was thought to reflect a point during exercise in which oxygen supply was inadequate to meet the energyenergy, requirements of the working muscle. In the early 1960s, investigators linked lactate production in the blood to endurance performance among German athletes. In 1964, other investigators explicitly developed the concept that a critical threshold exists in which (1) the metabolic needs for oxygen in the muscle exceed the capacity of the cardiopulmonary system to supply them, (2) there is a sudden increase in anaerobic metabolism, and (3) lactate is formed in the muscle.             There are limited data on the reproducibility of blood lactate variables, heart rates and ratings of perceived exertion (RPE) during sub-maximal exercise. The aim of this study was to determine the lactate threshold, at different blood lactate concentrations, heart rate (beats per minute) and RPE during a continuous, incremental training cycle. The hypothesis of this study is that there is a directly proportional relationship between heart rate and rate of perceived exertion to measures of blood lactate threshold.   Methods             The lactate threshold in this experiment was obtained by a progressive exercise test and taking a blood sample at the end of each stage. The lactate content of each blood sample is then analyzed. Lactate profile is a form of testing that is very useful for monitoring changes in fitness and should be performed several times throughout the course of the training cycle.             Before starting the experiment, the conditions of the testing facility such as the room temperature, barometric pressure, and relative humidity are recorded on data sheets.             Informed consent is given to every participant of the study and each of them is also asked to complete the health questionnaire given to them. The body mass of the subject is then measured in terms of kgs.             The heart rate transmitter was attached to the chest of the subject. RPE measurements were recorded every minute throughout the test. The appropriate lab safety and subject care protocol for obtaining a small blood sample were followed.             As is the same with some other studies that were conducted in the past, the sample blood is taken from the earlobe of the subject at rest and at the end of each stage. The Lactate Pro handheld lactate analyser was used to determine the blood lactate concentrations for the subject.              In this study conducted, the test started with 100 watts of power. This is increased steadily until exhaustion is reached by the subject. The duration of each stage is 4 minutes. Every 4 minutes, the resistance of the cycle ergometer is increased by 25 watts. During the last 30 seconds of each stage, the physiological resistance of each stage is taken and recorded and the resistance is increased by 50 W. The concentration of blood lactate, the ratings of perceived exertion, and the heart rate are all measured at the end of each 4 minute stage. The blood sample is taken during the last 30 seconds of each stage.             Based on the above table and graph, the following interpretations can be made. At the start of the experiment, when the power is still at 0, the subject’s heart rate is 93 beats per minute, the lactate 1.3 mmol/l, and the RPE is not stated or lacking since this is measured at the start. At 100 watts, when the subject has a maximal heart rate of 121 beats per minute, the lactate is 3 mmol/l and the RPE is 7. At 130 watts, with a heart rate of 132 beats per minute, the lactate is 3.2 mmol/l and the RPE is still 7. At 160 watts, the heart rate is 149 beats per minute, the lactate 3.7 mmol/l and the RPE is 8. At 190 watts, the heart rate is 161 beats per minute, the lactate is 4.8 mmol/l, and the RPE is 10. At 220 watts with a heart rate of 173 beats per minute, the lactate is 7.6 mmol/l, and the RPE is 13. At 250 watts with a heart rate of 184 beats per minute, the lactate is 12.6 mmol/l, and the RPE is 15. Lastly, at 280 watts, the heart rate is 188 beats per minute, the lactate is 16.7 mmol/l, and the RPE is 19.             There is also a 2-minute post-exercise lactate which is 16.2 mmol/l and a 5-minute post-exercise lactate which is 15.2 mmol/l.   Critical Discussion    During exercise, such as sprinting type activities, when the rate of demand for energy is high, lactate is produced faster than the ability of the tissues to remove it and lactate concentration begins to rise. This is a beneficial process since the regeneration of NAD+ ensures that energy production is maintained and exercise can continue. During exercise, the amount of oxygen entering the blood in the lungs is increased because the amount of oxygen to be added to each unit of blood and the pulmonary blood flow per minute are increased. The PO2 of blood flowing into the pulmonary capillaries falls from 40 to 25 mm Hg or less, so that the alveolar-capillary PO2 gradient is increased and more oxygen enters the blood. Blood flow per minute is increased from 5.5 L/min to as much as 20-35 L/min. The total amount of oxygen entering the blood therefore increases from 250 mL/min at rest to values as high as 4000 mL/min. The amount of carbon dioxide removed from each unit of blood is increased, and carbon dioxide excretion increases from 200 mL/min to as much as 8000 mL/min . The law of mass action states that as the end products of a chemical reaction build up in a reacting medium, the rate of the reaction approaches zero. The two end products of the glycolytic reactions are (1) pyruvic acid and (2) hydrogen atoms combined with NAD+ to form NADH and H+. the buildup of either or both of these would stop the glycolytic process and prevent further fromation of adenosine triphosphate (ATP). When their qualities begin to be excessive, these two end products react with each other to form lactic acid. Thus, under anaerobic conditions, by far the major portion of the pyruvic acid is converted into lactic acid, which diffuses readily out of the cells into the extracellular fluids and even into the intracellular fluids of other less active cells. The increase in oxygen uptake is proportionate to work load up to a maximum. Above this maximum, oxygen consumption levels off and the blood lactate level continues to rise. The lactate comes from muscles in which aerobic resynthesis of energy stores cannot keep pace with their utilization and an oxygen debt is being incurred. Contrary to popular belief, this increased concentration of lactate does not directly cause acidosis, nor is it responsible for muscle pain or “burning”. This is because lactate itself is not capable of releasing a proton, and secondly, the acidic form of lactate (lactic acid) cannot be formed under normal circumstances in human tissues. Analysis of the glycolytic pathway in humans indicates that there are not enough hydrogen ions present in the glycolytic intermediates to produce lactic or any other acid.             The relationship between the increase in blood lactate and oxygen supply to the muscle has a long history. Studies performed early in this century closely linked exercise intensity, lactate appearance, metabolic acidosis, and bicarbonate buffering. These associations provided a convenient and logical explanation for lactate production during exercise. Numerous studies have supported the link between oxygen supply and the magnitude of the increase in blood lactate, albeit without direct evidence of cause and effect. For example, the extent to which lactate increases in the blood during exercise is reduced as fitness increases or with training, and is increased in the presence of reduced cardiac output states or disease of the electron transport chain. When oxygen supply is experimentally altered, blood lactate is profoundly affected. With an increase in inspired oxygen tension, either by increasing the oxygen content of the inspired air or by increasing the barometric pressure, the exercise-induced increase in lactate level is attenuated. Decreasing the fraction of inspired oxygen either experimentally or by exposure to altitude increases blood lactate. In normal subjects, reducing blood volume causes an increase in blood lactate level during exercise. In patients with chronic heart failure, increasing cardiac output with inotropic therapy attenuates the increase in blood lactate during exercise.             The concept that a “threshold” exists, in which there is a sudden onset of anaerobic metabolism resulting in the accumulation of lactate in the blood has been challenged. Recently, this issue has generated some rather lively debate. Studies by some investigators raised questions about the subjective intraobserver and interobserver reliability and reproducibility of ventilatory and lactate thresholds. Concerns over the presence or absence of a discrete threshold point led investigators the use of a log-log transformation (ie, plotting oxygen uptake, lactate, or [CO.sub.2] production on logarithmic axes). These investigators reported that lactate exhibited an abrupt transition from a slowly increasing phase to a rapidly accelerating phase, findings consistent with the historic interpretation of the anaerobic threshold. Despite its wide adoption, however, such an idea was unacceptable to many since among other things, a log transformation could “create” a visually apparent breakpoint where none existed before, by spreading out the early data points over the X-axis relative to the later on.             The lag in blood lactate concentration observed during the test is possibly related to vasoconstriction of the active muscle mass stemming from isometric contraction of the body during the exercise effort. More specifically, if a measurement of peak blood lactate concentration is required after an ergometry test, it is recommended that a capillary blood sample should be obtained 3-5 min after exercise.             The fixed blood lactate concentration of 4.0 mmol * [l.sup.-1] has been used extensively to monitor and prescribe endurance exercise training programmes with adults in many studies. It is well recognized that the blood lactate response to exercise is different in young people than in adults. Therefore, a lower fixed blood lactate concentration has been proposed for use with children. The rationale for these single concentrations was that they represent the maximum exercise intensity at which an equilibrium between blood lactate accumulation and elimination occurs. This physiological parameter is believed to represent the highest intensity of exercise that can be supported almost exclusively by oxidative energy metabolism.   Conclusion   The lactate threshold provides a clear picture of the subject’s current fitness level. The lactate threshold, along with the power output, can determine a person’s specific heart-rate training zones. Knowing these zones and how to intersperse them enables everyone to ultimately improve performance. At the start, concentrations of lactate rise slowly, but then suddenly increase sharply at a clearly-defined point, which is termed as the lactate threshold. The lactate threshold corresponds to the shift in metabolism to anaerobic within the muscle cells after exercise has begun in the experiment. At this point, lactate is being produced faster than it can be metabolized and it accumulates, passing into the blood. Obtaining blood samples can determine the amount of lactate present in the blood. The way to improve Lactate Threshold is to incorporate one or two Lactate Threshold training runs into the weekly plan. These are run at a comfortably hard, near race pace, with a steady, unvarying effort. After about five to 10 minutes of easy running, run for at least 20 minutes at Lactate Threshold pace. An individual should work hard but not have to slow down over the course. If they do, they are going too fast and it won’t be as beneficial as maintaining a steady Lactate Threshold effort. A person can measure their training zone by heart rate, pace, or perceived effort. But it is best if their course can be level and smooth so that they are able to maintain a regular tempo (hence the term tempo runs) rather than having to speed up or slow down to accommodate hills and rough terrain.   Advertising Online Credit:ivythesis.typepad.com

LAB REPORT ON LACTATE THRESHOLD

Introduction The lactate threshold is a field in exercise physiology where several studies have already been conducted. A lac...

Clinical Healthcare and The challenges that Lie Ahead

Introduction             Medicine is not all, or even mostly, about money. Science, caring, professionalism, and even religious concerns regarding birth and death can be more important than dollars.             Around the world, healthcare institutions are encountering growing pressures from governments, investors and the general public. These institutions must simultaneously improve the health and well being of the public, cut costs and remain competitive. To achieve these goals, many healthcare institutions have implemented total quality management (TQM). Evidence from hospital-based studies, however, suggests that the success of TQM is constrained by inadequate information systems and poor application of information technology. Change appears to be a driving force in society today and the American healthcare system is no exception. In addition to the need for change in today’s society, the importance of creativity in bringing about needed change must also be considered. An organization will quickly lose strategic advantages that it has worked hard to gain unless it invests in innovation and creativity, and consequently, change. According to some experts, the American Healthcare system is on the brink of failure. To support this assertion, experts point out signs of failure in the healthcare system. For one, Americans spend more than twice as much as Canadians on healthcare. And, there is a similar disparity between American and British spending. The Americans certainly don’t get their money’s worth, according to some experts. The US has roughly 43 million people with no insurance whatsoever, and among the rest, many are underinsured. That is, they have shrinking packages. This might be covered, but that won’t be covered. What’s more, experts argued that Americans are unhealthy. The life expectancy is shorter and infant mortality is higher. Childhood immunization rate is lower. The United States is considered to have the highest healthcare costs per capita in the world. The healthcare industry faces a lot of challenges at present and which can be reflective of what lies ahead. These includes health care costs, the growing diversity of health populations and their expectations, government support for healthcare, the increasing use of technology and yet its poor application, the decreasing quality of healthcare education and the growing shortage of healthcare professionals especially the nurses among many others. There is also a challenge on the kind of leadership and management that is present in the healthcare profession. Hospitals will be forced to shell out more on bioterrorism preparedness. Insurers will face rising demand for costly behavioral healthcare services. Vendors will have to scramble to supply new antibiotics. And physicians’ pleas for better Medicare payments may fall on deaf ears as Congress remains focused on homeland security. Add to that the economic slowdown-which is leaving more Americans without health insurance and compelling states to squeeze their Medicaid budgets-and you have a perilous outlook for the coming year. The American healthcare system is facing reform, which demands collaboration instead of competition, employment of a more diverse work force, and service to a larger number of uninsured individuals. This paper aims to look into the American healthcare system and the challenges that lie ahead by using the qualitative method of research.   Review of Related Literature             A number of external and internal forces cause health care systems to consider the need for change. The process in changing governance and management had three critical elements: establishment of a vision and guiding principles for the change, development of support, and implementation of change in governance and management. For the initial step in the change process, a clear and simple vision to focus the change was determined to be most important. The healthcare professions all involve life and death situations. In these situations, quality is crucial and quantity is irrelevant. Clinical governance provides a framework for a coherent, local program of quality improvement and an opportunity to share best practice. For the healthcare professionals, clinical governance will be about building upon and linking together many of the activities that they are already involved in, which help to promote and improve standards of patient care. In the succeeding paragraphs, the various challenges that the American healthcare system faces will be discussed.   Cost Healthcare costs are skyrocketing. Most people are frustrated and angry about the state of affairs, and they want something done to rectify the problem. Added to the cacophony of complaints are claims by medical “experts” that the United States’ healthcare is sub-par and controlled by greedy doctors and pharmaceutical companies and that Americans definitely don’t get the healthcare that they pay for. If one asks most people what should be done about the problem, the answer usually involves government intervention as a solution–something along the lines of “the government ought to put a stop to runaway costs. While the U.S. healthcare system is costly and does face challenges, the costs were largely brought on by government actions and agencies, not helped by them, and many problems attributed to our healthcare system–such as high infant mortality and short longevity–aren’t a reflection of bad healthcare. Those things have other causes. In fact, the United States has the best healthcare system in the world, despite its being hamstrung by government rules and regulations. The assortment of components of health care cost increases are not independent but interact. But a main cause of the increased cost of medical care is clearly the growth of third-party payments, including private health insurance and various government programs, of which Medicare and Medicaid are the most important. Third-party payments affect all the other causes of health care cost increases. In majority of cases, payment for healthcare services and products are provided by a third-party. Many of working-age persons have their healthcare services and products paid for by their employer.   Health Insurance Of the 285 million people in the United States, most have some form of private health insurance, usually through an employer. Government programs, mostly Medicare and Medicaid, cover 24 percent of the population, and about 25 million people, 9 percent of the population, purchase private insurance individually. That leaves about 44 million people, or 15 percent of the population, uninsured. Payments from third-party increase the amount of medical services demanded by consumers by making them insensitive to the prices. This increased demand in turn allows the physicians to increase the supply of services rendered and to also increase their fees and earnings, attracting malpractice lawyers and tempting dissatisfied customers. Pharmaceutical companies and suppliers of medical technical equipment are encouraged to increase their research spending, their advertising, prices, and sales also at the same time. Even if pharmaceutical drugs are not covered in many insurance contracts, the fact that other medical costs are covered makes the consumer more willing to pay high prices for the medicines. These effects are made worse by tax subsidies for health insurance obtained through employers that lead to the purchase of insurance that is excessive in quantity and inaccurate in coverage. Health insurance coverage is currently the primary means for access to medical services when unexpected medical crises arise and for everyday health concerns. The high costs of health insurance and medical services has led to reliance on (1) employer-provided health insurance coverage, and (2) federal- and state-funded Medicare and Medicaid programs.   Technological Advancements Rapid advancements in science and technology, along with investor dollars, have created major advances in medical care. These emerging technologies in medicine, which were increasingly housed in hospitals and physicians’ offices, not only laid the groundwork for the coming shift in the way health care was delivered, but also increased healthcare costs. Technology standards like electronic information and other tools have significantly increased healthcare costs. Strongly associated with technological advances is also the issue of how quickly new treatments are made available to the general public. Although of course this is beneficial for the consumer, this would mean increased healthcare cost on their parts. Indeed all these advances have helped improve health care services for the consumers, but it also added extra payment or cost on their part. The choice should be the optimal combination of inputs to produce a specified level of output at the lowest cost. Organizational innovation was complemented by an intellectual innovation, statistics. Clinic doctors began to count how many people were treated and how many got well. Numerical comparisons of outcomes began to replace doctors’ personal assessments. Determining which treatment was best previously depended mostly on the reputation and experience of the physicians who vouched for it, but now experiments and statistical observation were used. Information systems and access to capital gave hospitals economies of scale and made them necessary adjuncts to medical practice. Although medicine has been actively practiced since ancient times, only fragmentary technological advances were made until the end of the industrial era. Medical progress resulted more from planned effort and massive public investment than serendipitous discovery or any preordained mass of ideas. Rising incomes, falling mortality, and commercial organization were more than just contributing factors; they were central forces driving the demand that created medical technology. Information technology can contribute significantly to quality improvements in healthcare institutions. There are difficulties associated with implementing information technologies, but they are not insurmountable. Suggestions are offered as to how managers can adopt information technology systems to improve the delivery of service to the consumer/patient. Advances in medical care also made way for the provision of healthcare services to the financially less privileged. Hospitals began generating capital funds from paying patients who in the past had been treated at home. The importance of admitting privileges rose along with the criteria for receiving these privileges. Many physicians began making deals with the hospitals to admit their private patients. The hospitals in effect became the workshop for physicians where their private patients would pay the hospital charges and physician fees. In turn, this arrangement enabled both the physician and hospital to provide free care for the poor in the hospital dispensaries. Seriously ill poor patients were generally admitted to both municipal and private hospitals as “service cases,” where they were supervised by attending and cared for by students and house officers. Implementing information systems in healthcare organizations poses a series of challenges. These include complexity, human acceptance of IT, data security, and data quality and standards. In light of these challenges, some argue that no other industry invests as little in IT as the healthcare industry. Most hospitals and physicians still rely on outmoded paper records organized by visual color codes, alphabet and number. On the other hand, the increasing use of IT in the healthcare systems also has drawbacks. Ensuring the integrity and confidentiality of patient-related data is a major requirement of healthcare information networking strategies. The availability of easy and rapid electronic transmission of patient information to various organizations at different locations increases the risk of violating confidentiality. Because of convenience and efficiency, staff may forget to consider the privacy implications. Rather than improving healthcare quality, IT could reduce patient satisfaction and the quality of care. Confidentiality is especially problematic in the management of suspected child abuse cases, psychiatric cases and for patients with AIDS. Quality improvement data must be reliable and valid in order to measure performance and change within a healthcare system or to make comparisons with other organizations. The electronic transfer of health-related information inter-departmentally and, in particular, interorganizationally has been hampered by the slow development of standard clinical guide, lines and nomenclature. Even between different Blue Cross/Blue Shield health insurance groups organized at the state level in the U.S., there is little standardization of data elements. Electronic sharing of information is difficult. In some hospitals a 24-hour stay is classified as an inpatient episode while other hospitals classify it as outpatient care.   Diverse Population The growing elderly population is largely the outcome of new technology, public health as well as medical technology, saving lives and postponing death. The introduction of Medicare and Medicaid in 1965 improved access to medical care for the poor and many of the elderly, contributing to life extension past age sixty-five. This age group uses an uneven share of medical resources. In the elderly group, the social and personal requirements of residents who need some assistance with daily activities and health care are emphasized. Its an important distinction, in that the design of housing, services, activities, employee training, and such is truly customer-centered, or in other words, suited to their age group/population. At present there are many institutions or organizations that are specifically for the elder populations in the United States. For Americans aged over 65 years and certain disabled persons, the federal government program Medicare pays for the majority of hospital and physician services consumed. The growth in the number of elderly, coupled with the previously-mentioned large increases in the cost of health care, are making long-term care for the elderly populations very expensive. Although many of the most promising medical innovations will result in better health and longer life for the elderly populations, they will also increase–not decrease—healthcare costs and spending. Health systems of different countries are struggling to improve the quality of care for an increasingly diverse population. This is very much true for the United States. For those with limited English proficiency and some who even do not know how to speak English, language barriers often result in reduced access to health care services, misdiagnoses, poor quality of care, and compromised medical treatment. The lack of an interpreter could lead to misdiagnosis and negative health outcomes. The lack of an interpreter could also result in patients not complying with a prescribed treatment regimen. When a health care professional and a patient don’t share the same language, medical treatment can be compromised not to mention frustrating.   Government   Local government is a large portion of the overall health care safety net in the United States, providing direct-care services and funding such items as public hospitals, transportation, educational outreach, and housing subsidies. As stated at the start of the paper, various government programs have contributed to the rising cost of health care in the US. The social awakening of the 1960s brought the introduction of Medicare and Medicaid as a means to give adequate healthcare to the poor. Its effect on the overall health care system in America was overwhelming. Americans belonging to the low-income brackets can enroll in a state-administered Medicaid program that pays for select healthcare services. The role of the government in regulating health care providers will be limited to ensuring that providers and payers do not engage in anticompetitive practices and that the safety of consumers and patients is protected. This means that the government tries its best to reduce the healthcare costs at all levels for the consumer’s benefits. As people go about their daily activities, trying to stay happy and healthy and save a few dollars, they are usually not aware of government intrusion. Suppose that a man gets a headache and goes to the drugstore for some aspirin. The man is making that choice individually, as a private citizen, and buying from a private company. It seems so simple. Yet this simple transaction could not take place unless a government had already done many things to prepare for the welfare the man and the company. To begin with, government provides a medium of exchange (money) and maintains its value. Not only is the value of money determined by the government, so are the measurements of what the people would buy. Another thing is that through government policing, a person can depend on the government to keep the local stores from selling to the public anything that could harm or even kill a person when ingested.   Consumer expectations Almost all healthcare consumers would want to go to the “best” hospital in town, see their own doctor, and have access to the same new medicines. When one falls ill, gets a certain level of medical care, and tells the neighbor about it, the other’s expectations are raised accordingly. Each individual consumer shares a common need for health and a desire for the absence of illness through the demand for health care services and products. This in return affects the healthcare costs. Since consumers expect so much of healthcare, the healthcare providers are pushed to offering consumers a range of choices. Consumer expectations are fueling demand for health information that they can understand and services that they want. Consumers would want to know what their care options are and what health plans are available to them. By offering consumers a choice of healthcare services and plans, various healthcare organizations encourage the development of price competition among competitors. Price competition among healthcare providers could generate in a cost reduction of a range of healthcare services. The empowerment of the consumer is perhaps the most exciting and potentially the most threatening of all the developments in healthcare. In a consumer-empowered marketplace, once dominant, name-brand players compete on a level playing field with those with a fresh approach and a strong customer focus. In a consumer-empowered marketplace, information flows freely, facilitating comparisons of quality, value, and price. In a consumer-empowered marketplace, there is less reliance on “experts” to make decisions because consumers have the information to participate actively in those decisions.   Deterioration of Healthcare Work Environments             The deterioration of healthcare work environments is a major problem of concern to the healthcare leaders or managers. It presents a challenge to the American healthcare system. A healthy work environment is necessary to bring about quality healthcare service to the population. An unhealthy work environment would create a devastating impact not only to the healthcare professionals and the clients but most importantly on the effectiveness of the entire healthcare system.             The possible root causes for this apparent deterioration of healthcare work environments are outlined in the succeeding sentences. (1) Healthcare professionals are placed in leadership positions even if they are not adequately prepared and without adequate support for their roles. (2) Healthcare professionals, especially in the case of nurses are assigned to handle many clients than they can handle. (3) Decision-making within the work environment is done only by one department, without consultation of all the other parties that are involved.             The resulting environment created by these situations brings about many negative results in the working environment. When inadequate leaders are placed in positions, there will be dissatisfaction and high turnover for healthcare leaders and the staff as well. For example, when each nurse is assigned to handle many clients, this would result in confusion and the clients are placed at risk for errors and injury. The nurses are also frustrated, angry and stressed out. Decisions that are made without consulting all the parties involved places everyone involved – doctors, clients, nurses, managers and other staff – at risk. The overall quality of care offered by the healthcare service would be diminished. State, federal, and local government accounted for almost half of all health spending in 2002. However, most “government” health care is actually third-party insurance payment to the highly regulated private health care industry composed of independent physicians, hospitals, nursing homes, and so on. Since health care is one of the primary concerns of people, policies pertaining to healthcare were made to safeguard people from health problems. There are many different health care structures in different countries, like the employer based coverage or the universal coverage. There are more economic concerns when it comes to the universal coverage. In a universal coverage structure, the government gives health care to all the citizens.   Healthcare Education and Training Skill acquisition is increasingly becoming the responsibility of the worker, although for healthcare professionals it is generally their professional body that determines the appropriateness of education and training. There is a growing acknowledgement of the importance of continuing professional development (CPD) in order that the individual can continue to refine skills and keep up to date with current evidence for practice. CPD must encompass, among many other things, technical skills and attitudes towards patients, staff and the general population. The healthcare workforce is ageing, particularly in community nursing staff, and there is an increasing proportion of women in the workforce. The differing needs in terms of how training is delivered must be taken into account. Whereas in the past training has needed to cater for people in full-time employment, women frequently require more flexible arrangements, such as career breaks in which to raise a family. While it is acknowledged that the education and training provided for the development of healthcare professionals is the responsibility of the individual and of the professional body, all education providers must share in the responsibility. That is, issues such as those relating to discrimination, stigma and social exclusion should have been raised within primary and secondary education and this should be clearly defined as part of the national curriculum. One might even suggest that these issues should be raised in pre-school education, and certainly all appropriate opportunities to include such discussions within adult learning environments should be taken.   Management             Management is necessary to make labor and capital productive and requires converting economic principles into rules of behavior that can be clearly communicated to employees, bosses, clients, and other partners. Management is not simple. In management it is people, not things, that have to be managed, and because decisions must be made under uncertainty, based on expectations, without ever really knowing the entire facts one would like to have, it makes it all the more complicated.   Methodology   For this proposal, the authors will employ a combination of qualitative methods. The qualitative methodology that was employed in this research is appropriate since it seeks to interpret or illuminate the actions and/or subjective experiences of the healthcare professionals regarding their experiences in the American healthcare system. This kind of research can utilize the qualitative method.             For the particular study, the participants will be various healthcare professionals from different parts of the country. Basically, how the participants will be selected is only a matter of random. Before the study will be conducted, an approval to perform the study will be obtained from the ethics committee. The researchers will employ an interview method of data collection in two forms: (1) a questionnaire which will be sent by mail or email (2) a narrative interview through the telephone. Every participant in the study will be interviewed in the same manner and the data will all be collected in the same way. The timing of when the interviews will take place will also be within one timeframe – e.g. within a span of two weeks. The reason for this is because discrepancies in time could significantly affect the data collected.   Data Analysis             Data analysis employed in the study will be carried out in steps. Every data form (audiotape-recorded or written and transcribed) will be carefully read in order to have an idea of the whole results concept. The text will then be read again and divided into meaningful units as the researchers see fit. Data will be condensed and formed into four syntheses which will be integrated to form the structure of the challenges of the American healthcare system.   Summary, Conclusion and Recommendations Most early leaders in healthcare management had a vision that stressed the primacy of patient care. The aim of management is to put the interest of the patient first, regardless of race, creed, or ability to pay, and to seek complete health rather than just to cure the ailment at hand. This is a critical moral commitment to the same core value as the caring professions. Any philosophy that puts management values contrary to the caring professions will be corrosively destructive. Management must establish organizational goals or standards for both the administrative and clinical processes. Managers must begin with a focus on outcomes. The decision of what outcomes to measure determines the type of data that need to be collected and maintained. For example, outcomes related to administrative activities suggest that the degree of cost efficiency obtained is an important outcome. This means that data on expenditures and revenues by appropriate subcategories need to be available. The development of clinical standards for quality patient care and patient satisfaction outcomes also determine the type of data that should be maintained in the clinical information system. Managers should plan, coordinate and implement information technologies that can improve quality and efficiency in all processes. For example, an organization should provide on-line medical records and other clinical information at multiple sites, such as laboratory results and imaging. Measures to evaluate the outcomes of the various processes must be developed. These have implications for the type of data that need to be collected and the design of databases and records. The issue of data quality is particularly crucial because the resulting information is used to make vital decisions. Data entry of patient information must be free of transcription errors. Data must be maintained in order to provide longitudinal performance measures for the various clinical and administrative processes and develop a clear track record against the quality standards that have been set. If a quality improvement team uses poor data to report outcomes, this provides an excuse for some personnel in the organization to criticize and remain peripheral to the quality improvement process. This is another reason why involvement of all parties is crucial. Clinicians must be involved in establishing the standards of practice, performance levels and types of data required in their particular areas of expertise. The system can then be instructed to build an appropriate database that can be used to compare actual outcomes with the standards.             Health care settings utilize different management theories. Group theories exist where groups seem effective in the management process. No single team member has any statutory authority over the others, but in the event of irreconcilable disagreements, issues should be referred to an authority. There is a collaborative process in managing health care concerns.             Management needs strong leadership. Effective leadership style is an integral part of creating an environment that nurtures the development of a well managed health care setting. Leadership is defined as a process of social influence in which one person is able to enlist the aid and support of others in the accomplishment of a common task.             Employees sometimes feel bored and disinterested in their work which calls for the need to motivate them. One big factor in motivating employees is through cash incentives. But, contrary to popular perception, motivation is more internal. The management is responsible for creating an environment in which people can motivate themselves. And this can be done without relying on merit increases, incentives and bonuses.             That is an important concept to understand because few health care setting have had opportunities to promote people internally; many have withheld equity adjustments and even annual merit pool increases because the bottom line has been squeezed so tightly. In this climate, it is important for managers to focus on the top non-monetary motivating factors: open communication, recognition, career development plan and the ability to make a difference at work.             More companies adhere to the philosophy of minimal communication rather than “open book” management. In other words, senior management often assumes that the less the employees know, the better. Even if the senior management adheres to this closed communication style, it is important to practice open book management with the staff. Knowledge is power, and the Internet and library make for free resources of invaluable information.             Sometimes, situations call for a time to shift the responsibility for leadership away from management and toward the employees. One way to do this is to allow each of the employees to run a weekly staff meeting–its structure, delineation of responsibilities to others and follow-up. Placing future leaders into management development roles is probably the most important benefit that management has to offer the people. In addition, management should keep an eye out for other ways to give the employees more responsibility to test their leadership skills. Respect and recognition are two proven ways to retain employees.             The key in retaining employees is to allow all of them a chance to reach their career goals at the health care organization. People are much more inclined to feel like they’re making a positive contribution to the organization if they’re in a learning curve. The health care organization could do this by providing seminars for further learning. The employees should also be given time and allowed to reflect on their careers as well as to reinvent themselves in light of your organization’s changing needs. There are three main routes to improve performance in the health care setting: (1) prevention, (2) appropriateness of services, and (3) coordination of services. Formal organization and trained management will be essential to all three. Improving the skills of healthcare managers depends on how six problems are solved. First is to achieve the vision of healthcare as a commitment to the worth of individuals and communities. This goal of providing healthcare that is “safe, effective, patient-centered, timely, efficient, and equitable” demands a new level of management performance. To reach it, management must expand use of quantitative comparison to “best in class” and benchmarking on access, satisfaction, quality, and cost. The transition requires financial support for the development of managerial technology. The second is to strengthen the recognition of managers’ contribution to the health enterprise. The funding system must reward responsive provider organizations and individuals and encourage others to follow that success . The third is to attract a fair share of the leading intellectual talent in each cohort, and promote healthcare management as a rewarding professional endeavor. A program to promote healthcare management, expand scholarships, support mentoring and encouragement for young managers, and expand opportunities for under-represented minorities and women will attract talented young people to the field.  The fourth is to develop a formal education program that recognizes both the unique needs of healthcare and the learned skills of management. Organizations should begin specifying learning outcomes, prioritize them in terms of practice needs, and measure learning. The fifth is to expand and improve continuing professional education. Education beyond the entry degree must be systematically improved by an alliance of large healthcare buyers, provider associations, consulting houses, professional organizations, and universities. An accreditation mechanism should insist on outcomes learning assessment and should coordinate learning opportunities with entry education. Health care organizations should help the management with specific learning goals that are reviewed yearly and a subsidized plan for fulfillment. Lastly, there is a need to identify health care managers of exceptional potential. There is also a need to develop their skills for the most-senior leadership roles. Few will rise to the most-demanding posts in the largest healthcare organizations. They need a training facility that rivals the best of the large public companies. To attain this, there needs to be collaboration among organizations affecting the health care sector. This would include the government, educational institutions, private insurance companies and the people among others.             Healthcare management can be realistically described as an arena where the need is pressing, the risks are high, the complexity is great, and the monetary rewards are relatively low. A series of conditions are necessary to stimulate change in healthcare and to support managers leading that change. The critical requirements are (1) broader understanding of goals and the potential. Quantitative comparison, comparison to “best in class,” and benchmarking on the dimensions of success–access, quality, and cost–will improve the governance ability to set goals and the management ability to translate these to achievable targets. (2) Support for the development of information systems, communication devices, and training systems. (3) Revisions to the funding system that reward responsive provider organizations and individuals and encourage others to follow that success. As in the for-profit sector, capital should flow to organizations that meet social goals. The uniformity of funding hampers innovation, reinforces the status quo, promotes individualism rather than teamwork among caregivers, and, in recent years, has left even the best-performing organizations short of capital.             A number of actions should be taken to engender support for change. First, a facilitator should be retained to work within the setting for the analysis and modification of the governance. As part of that process the facilitator will have meetings with all the corporate and institutional boards to discuss changes in the health care organization and to obtain input on the process. Additional feedback from the facilitator will be obtained through a written survey and selective one-on-one interviews with key board members, management, and medical staff leaders. Questions should be designed to solicit views on the need for a change and the issues and concerns that had to be dealt with in effecting governance or management modifications. The feedback from the survey as well as input obtained from a board retreat will allow the top officials to make better plans for communications and other change management interventions. Data from the surveys will be used as illustrations to validate the problems and the overall need for change within the healthcare setting.             Second, change agents or champions will then be identified. This would provide core support to bring about the change needed by the health care organization. Managers often fail because they lack skills, which they might have learned under more systematic dissemination of management practice. Major concepts, such as total quality management, are subject to widespread distortion; it is little wonder that many implementations fail. Less-publicized improvements simply are not widely recognized. The innovations of the twenty-first century are likely to be sophisticated structures and processes, which managers must study before they can implement.             The tools of health care management includes continuous quality improvement, “balanced scorecard” measures of performance throughout the organization, empowerment of workers, new approaches to collaboration across traditional lines, improved use of outsourcing, supply chain management, and strategic partnerships with outside organizations – all these constitute a revolution in management practice. Willingness to accept change, focus on customers, and reliance on data have replaced old attitudes of inflexibility, introspection, and personal authority. This is the transition that supported the 1990s’ economic boom, and this is the transition that the healthcare industry is struggling to make. Faced with a rapidly changing healthcare environment, there is often a need to change how health care providers practice medicine. Yet change is difficult, and the process needs strong management. The lack of leadership skills is one major factor. In order to solve this problem, focus should be given to the nursing leaders and managers. Leadership training programs should be offered and nursing managers and leaders should be required to attend. These managers and leaders in turn should perform their responsibilities of teaching and guiding the rest of the staff in promoting a healthy work environment. With the particular problem concerning the deterioration of the work environment, a change is needed. This change would include on a large scale the leadership and management styles within the work environment. Aside from that, there should also be empowerment for all the parties involved in the work environment. Healthcare organizations must empower their staff to deliver patient-focused care. Empowerment is defined as “moving decision making down to the lowest level where competent decisions can be made”.  This kind of empowerment requires an environment of autonomy where mutual trust and respect are encouraged. The empowerment process requires that healthcare staff be prepared to accept and effectively use expanded decision-making responsibilities. To start changing the work environment into a healthy one, there should first be mutual trust and encouragement in all the parties involved. Each and every opinion should be respected and given consideration in the decision-making process. There should also be an all-out support for this desire for change.             Effective leadership style is an integral part of creating an environment that nurtures the development of an empowered healthcare staff,  defines leadership as “a process of social influence in which one person is able to enlist the aid and support of others in the accomplishment of a common task.”       The major points of this definition are that leadership is a group activity, is based on social influence, and revolves around a common task. Although this specification seems relatively simple, the reality of leadership is very complex. Intrapersonal factors (i.e., thoughts and emotions) interact with interpersonal processes (i.e., attraction, communication, influence) to have effects on a dynamic external environment . The professional accountabilities of the empowered healthcare professional includes having a sense of value about their work and willingness to provide the full scope of practice as well as ability to work as equal members of a comprehensive interdisciplinary team. In order to move into a fully empowered position, healthcare professionals need mentoring, education, awareness of political activism opportunities, and networking skills. In order to achieve all these, shared leadership should be employed. In the field of nursing, shared leadership supports staff nurses in extending their influence about decisions that affect their practice, work environment, professional development, and self-fulfillment. As previously mentioned, leadership is a group activity. In shared leadership, every voice is heard and given consideration. Shared leadership is a collaborative team process in which team members share key leadership roles. Shared leadership is empowering employees to act autonomously, be decisive at the point-of-service, and create a shared vision aligned with organizational goals. Shared leadership development and autonomously practicing nurses appear to be the equation for success in delivering quality patient outcomes in today’s organized health care delivery systems. Employees must develop or refine new behaviors and skills in empowerment, facilitation, negotiation, systems thinking, and accountability on behalf of patients. Shared leadership is a way to strengthen continuous learning and enhance relationships between leaders/managers, staff and clients, which are the foundation upon which the nurses can develop a new type of relationship with management and with each other. This in turn could significantly improve the work environment. There is an emphasis on ‘relationships’ since these relationships can be tenuous at times as both managers and staff members adopt attitudes of contention and competition with each other. Aside from shared leadership, the transformational leadership theory can be employed to help face the challenges ahead. The transformational healthcare leader typically inspires followers to do more than originally expected. Transformational leadership theories predict followers’ emotional attachment to the leader and emotional and motivational arousal of followers as a consequence of the leader’s behavior. Transformational leaders broaden and elevate the interests of followers, generate awareness and acceptance among the followers of the purposes and mission of the group and motivate followers to go beyond their self-interests for the good of the group. The demands of the health care environment have brought about changes that have not always contributed to positive work environments, and healthcare professionals have been concerned about the impact this has had on patient care and the entire healthcare quality in general. Managers have had to develop ways to achieve expected outcomes and meet targets required by their organizations. To address all these issues, healthcare professionals need to focus on developing relationships that facilitate working with each other from strengths and not just criticizing weaknesses. Developing an empowering culture in which positive relationships are nurtured, leadership capabilities are developed, and professional practice is supported can improve the work environment and satisfaction of healthcare workers. Simply put, collaborative work relationships should be actively enhanced and promoted in order to create a positive work environment. In an increasingly technological healthcare world, it is therefore apparent that in order to respond to the ever-changing and increasing diversity of skills required to participate effectively in a highly technological healthcare system, mechanisms for continuing skills acquisition are a necessity. Yet it is not solely technical skills that are required. It is becoming increasingly important for healthcare staff to provide more holistic care which requires staff from differing professions to work effectively within a multidisciplinary team. These teams may be ward, acute care or primary care based, and may also require working across areas and with other voluntary and statutory organizations. It is increasingly recognized that formal preparation is necessary for healthcare staff so as to ensure true teamwork. We are moving away from the traditional, didactic teaching methods (e.g. lectures) to more student-centered enquiry or problem-based learning methods. These alternative approaches not only develop problem-solving skills and enhance critical thinking, but they may also provide a forum for the frank discussion of issues relating to deviance, difference and dilemmas in healthcare. Advertising Online Credit:ivythesis.typepad.com

Clinical Healthcare and The challenges that Lie Ahead

Introduction Medicine is not all, or even mostly, about money. Science, caring, professionalism, and even religious concerns ...