2. Methods:
Study: To determine the effects of particular antibiotics on C. difficile infection, we will use a case-control study, which is the most appropriate design because we will begin by looking at those who have the CDI (health outcome) and determine from there which antibiotics (exposure) lead to the highest risk of infection. Furthermore, case-control studies are more efficient with rarer health outcomes, and CDI has a low prevalence of around 15 cases per 10,000 Americans.9 We will aim to study around 2,200 cases and 8,800 controls in the Twin Cities metro area. This number of cases will help ensure we have a significant number of patients taking each of the 12 classes of antibiotics we are measuring.
Population source: i. Inclusion
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We understand that since we are essentially testing for 12 different groups, the chances of calculating false positives are high, which is why the tests for antibiotics other than the 3 antibiotics in our hypothesis are purely explanatory. Furthermore, we are comparing the relative effects of certain antibiotics, rather than testing the absolute effect of individual classes of antibiotics. iii. Accounting for potential confounders:
Age: We will match each case to four controls in the same hospital on the basis of age in order to account for age as a potential confounder. Age will be classified into two categories, 65 years old and above, and under 65 years old, due to strong evidence indicating that CDI is much more common in those older than 65.
Duration of antibiotic use: We will use conditional logistic regression models (1 per antibiotic class) to account for the effects of how longer or shorter durations of antibiotic use affect CDI infection while also taking into account age, with duration of antibiotic use on the x-axis and probability of CDI on the y-axis.
Comorbidity: We will account for the possible effects of comorbidities on CDI in our discussion
T. Paulette Sutton is one of the world’s leading experts in bloodstains and is the former Assistant Director of Forensic Services and Director of Investigations at the University of Tennessee, Memphis. She has been involved in nationally known murder cases and has worked hard during her long career to make a position contribution to the legal system. Sutton says, “Its best for my fellow man that we get the killers off the street.” Since 2006 Sutton has been officially retired but continues to teach, consult, and testify about her area of expertise.
Clostridium difficile, otherwise known as C. diff, is a species of spore-forming, anaerobic, gram-positive bacteria that is known to cause watery diarrhea. 1 The genus name, Clostridium refers to the spindle shape of the organism while Difficile means difficult in Latin due to the fact that this organism thrives in unfavorable conditions and is very difficult to isolate.4 The incidence of getting CDI has increased over the years due to new strains of increased toxin production of the bacteria and increased resistance to antibiotics.2 It is a gastrointestinal infection, and the most common cause of infectious diarrhea.1 C. difficile was first identified in the feces of healthy newborns back in the 1930’s and by 1935, it was considered normal flora. 2 During 1974, researchers conducted that about 21% of patients that were treated with an antibiotic called clindamyacin reported diarrhea and about 10% of them reported to have conducted pseudomembranous colitis as a side effect of this treatment. 2 It was in 1978 where C. diff had been known to cause anti-biotic associated diarrhea and pseudomembranous colitis. 2 It is known to form spores that resist many disinfectants; it also survives for several months on different surfaces.1 It is a common form of a nosocomial infection and the prevalence of becoming infected with C. diff is about 0-15% in a health care setting. 3 The spores survive well in environments such as soil, water and animals and is distributed worldwide. 4 CDI produces two toxins (Toxin A and B), which are cytotoxic and cause tissue necrosis.4
A common hospital acquired condition that nurses see now days is clostridium difficile. This bacterium usually invades patients who have been on long-term antibiotics that have killed off bacteria that protect them from infection. C. diff is passed from host to host by both direct and indirect contact making it readily moved from patient to patient in hospital settings (Mayo, 2013, 1). Nurses can use the QSEN competencies and KSAs to help treat and prevent hospital acquired conditions such as C.diff.
Overall adverse effects (AE) and AE-related discontinuation rates were generally similar across groups, but higher with canagliflozin100 mg (5.2%). Genital mycotic infection and osmotic diuresis-related AE rates were higher with canagliflozin vs sitagliptin and sitagliptin/placebo. Hypoglycemia incidence was higher with canagliflozin over the 52 weeks (6.8%) clinical study. Urinary tract infections (UTIs) were similar across groups over 52 weeks. One death was reported in all treatment arms except for canagliflozin 100mg.5
Case conceptualization explains the nature of a client’s problem and how they develop such problem ( Hersen, & Porzelius, p.3, 2002) In counseling, assessment is viewed as a systematic gathering of information to address a client’s presenting concerns effectively. The assessment practice provides diagnostic formulation and counseling plans, and aids to identify assets that could help the client cope better with concern that they are current. Assessment is present as a guide for treatment and support in the “evaluation process. Although many methods can be employed to promote a thorough assessment, no one method should be used by itself” (Erford, 2010, p.269-270). Eventually, it is the counselor's job to gain adequate information concerning the client and the client's presenting concerns to establish an effective treatment strategy. Using a combination of assessment techniques increases the likelihood of positive interventions and promotes successful treatment (Erford, 2010, p.271). A case conceptualization reflects how the professional counselor understands the nature of the presenting problems and includes a diagnostic formulation. Case conceptualization organizes assessment data into meaningful outline, applying research, and theory to make sense of client’s current problem.
The occupations that I have chosen to analyze using the three elements for this assignment are paraprofessional, what I am currently, and a teacher, what I am going to college to become. Teachers and paraprofessionals work side by side, collaborate, plan, and share many of the same experiences. However, paraprofessionals are often not treated as equals and has created some ethical judgement regarding treatment of the paraprofessionals from other teachers and administrators in the business of education. I want to use this assignment as an opportunity to distinguish the true professional using the elements designed for this course.
It is also suggested that those of ‘high risk’ cases should be subjected to a longer treatment period
The eight-step module is a framework tool used to help analyze and assist you in thinking through an ethical dilemma. After Koch Industries acquired Georgia-Pacific, they immediately took steps to transfer its unique and highly ethical culture to their new “family member.” Tom Butz along with a few other Koch employees and Georgia-Pacific employees were in charge of getting the transition started immediately. Butz says “The key, was the commitment from leadership across the company to our vision for compliance and to building the desired culture.”(Travion & Nelson, 2011, p.247) There were some breakdowns in communication at the beginning that may have possibly led to the firing of some employees but I do not believe this can completely be the blame. They have to take responsibility for their own actions, when you deliberately go against something you have to be prepared for the consequences. Letting the employees go will benefit the company and other employees in the long run. I will begin my analysis by gathering facts and defining the ethical issues. Once the ethical issues are defined I will identify who these issues affect and think about the potential consequences. Then I will identify the obligations and reason for each one depending on the people involved. I will then ask myself what a person of integrity would do in this specific situation. And before making any decisions I will think creatively about any potential actions and check my gut feelings about the situation.
D1: I have decided to look at a 6 year old going through bereavement. Bereavement means to lose an individual very close to you. When children go through bereavement they are most likely to feel sad and upset about the person’s death. Children at a young age may not understand when a family member dies. Children may not understand bereavement. For example a 6 year old’s father been in a car crash and has died from that incident. Death is unpredictable and children can’t be prepared for a death of a family member as no one knows when someone is going to die or not. Unfortunately every child can experience bereavement even when a pet dies. It is important that we are aware that effects on the child so we can support them in the aftermath.
Some of reason that have been suggested that the that United States mortality rates are higher because of higher risk of iatrogenic drugs, drug toxicity, hospital-acquired infections, and that patients have the “do more” attitude but are not explained all the risks (Moses et al., 2013).
What does ‘care’ mean? Care is the provision of what is necessary for your health, welfare and protection of someone or something. However when you talk about ‘care’ in a care practice the term changes and becomes more about enabling people to meet all their needs which would refer to their social, physical, emotional, cognitive and cultural needs. The individual is central to the meaning of care in this context.
This manuscript details the alarming increase in disability in the oldest old. With the rapid growth of this age group, issues associated with functional loss with have a tremendous financial impact throughout the world. The study has identified several risk factors associated with increased disability incidence, several of which may be modifiable. This is especially critical, as CHF is the most expensive medical illness in the United States and represents over 5% of the total health care budget48. With the prevalence and incidence of CHF rapidly rising in the United States49, it will be critical to prepare for the dramatic increase in disability as a result. Reduction of risk factors for CHF, such as hypertension and high cholesterol, would likely be beneficial in reducing incident disability in the oldest old.
In the last decade, the number of prescriptions for antibiotics has increases. Even though, antibiotics are helpful, an excess amount of antibiotics can be dangerous. Quite often antibiotics are wrongly prescribed to cure viruses when they are meant to target bacteria. Antibiotics are a type of medicine that is prone to kill microorganisms, or bacteria. By examining the PBS documentary Hunting the Nightmare Bacteria and the article “U.S. government taps GlaxoSmithKline for New Antibiotics” by Ben Hirschler as well as a few other articles can help depict the problem that is of doctors prescribing antibiotics wrongly or excessively, which can led to becoming harmful to the body.
The uncertain nature of chronic illness takes many forms, but all are long-term and cannot be cured. The nature of chronic illness raises hesitation. It can disturb anyone, irrespective of demographics or traditions. It fluctuates lives and generates various inquiries for the patient. Chronic illness few clear features involve: long-lasting; can be managed but not cured; impacts quality of life; and contribute to stress. Chronic illnesses can be enigmatic. They often take considerable time to identify, they are imperceptible and often carry a stigma because there is little sympathetic or social support. Many patients receive inconsistent diagnoses at first and treatments deviate on an individual level. Nevertheless, some circumstances require
The infection control plays an important role for the prevention from bacteria and other microorganism that may affect the condition of the patient.