Effect Of Pharmacist and Nurse on Improving Blood Pressure

Effect Of Pharmacist and Nurse on Improving Blood Pressure Afzal Hussain Problem and Purpose In this paper, I will be critically analyzing the article â€Å"A Randomized Trial of the Effect  Of Community Pharmacist and Nurse Care on Improving Blood Pressure Management  in Patients With Diabetes Mellitus- Study of Cardiovascular Risk Intervention by Pharmacists–Hypertension (SCRIP-HTN) by Donna L. Maclean ; Finlay A. McAlister; Jeffery A. Johnson, Kathryn M. King; Mark J. Makowsky ; Charlotte A. Jones and Ross T. Tsuyuki. This article outlines a quantitative experimental design involving two sample groups (experimental and Control). According to Sullivan-Bolyai, Bova, Singh (2013), experimental designs are particularly suitable for testing cause and effect relationships because they help eliminate potential alternative explanation (threats to validity) for the findings (p. 217). The authors articulate their recognition of the fact that interventions are key markers to identify and observe blood pressure (BP) control in diabetic patients. The authors also recognize the fact that there is a need for a new model of care to improve BP control, particularly with significant challenges in accessing primary care physicians attributing to labor shortages in the health scare system. In addition, the authors used manipulation by introducing the intervention, then by comparing the standard and usual care among the control group and experimental groups. This resulted in the manipulation variable being the difference of care among patients with blood pressure and diabetes. One intervention delivered to the group based on the manipulated variable of difference of care is evident through the interventions made by the pharmacist-nurse teams at various pharmacy sites, which included cardiovascular risk reduction counselling, education brochure on hypertension, lifestyle strategies, effect of diabetes on high BP, and referral to the patient’s primary care physician for further BP and cardiovascular assessment (McLean, McAlister , Johnson, King, Makowsky, Jones, and Tsuyuki, 2008, p. 2356). The control group received the standard and usual treatment compared to the experimental intervention group. Furthermore, blood pressure wallet card, educational pamphlet on diabetes and physician care were received by the control group. (McLean et al., 2008, p. 2355).The authors used randomization to categorize the research participants into two groups- experimental intervention and control which is set to receive the standard treatment of care. Mclean et al (2008) states, â€Å" Randomization was at the level of the patient ( stratified by pharmacy and using a variable block design), it was performed centrally to preserve allocation concealment using a computer generated sequence over a secure internet service at the Epidemiology Coordinating and Research (EPICORE) centre,(p. 2356). The authors propose a practical necessity for this research problem to be explored and be further researched. The purpose of the research was to explore whether pharmacist or nurses can professionally contribute to improving the BP control of patients with diabetes and implement preventative care measures due to ongoing lack of physicians, pharmacist and nurses, it is clear that the research is also significant. It is based on changing the attitude of health care professionals to meet current outcomes, outcomes which seem to be on par with those of the current health care system in Canada. Sample Size, Design and Collection Methods The sample for this study was appropriately assembled for a quantitative study. The study sample is easily identified when reading the article, included a description of the demographic characteristics and the size of the sample. Also included were any sampling bias, drop outs or loss of patients to follow up. In doing so, an adjustment of 85 to 110 per group were added. (McLean et al., 2008, p. 2357). Its purpose was to test the efficacy of community-based interventions through a pharmacist and nurse team approach on reduction of cardiovascular events in diabetes mellitus patients. This was achieved by measuring the BP which has been linked to comorbidities such as cardiovascular disease, and to BP measurement changes used as an indicator of health. This sampling was appropriate to the study as the sample were to represent diabetic patients. Mclean et al (2013) states, â€Å" All adult diabetic patients with BP higher than 130/80 mm Hg on 2 screening visits separated by 2 weeks wer e identified in participating pharmacies. Diabetes was identified by community pharmacists through the use of diabetes indicator medications in each pharmacy’s prescription database. (p. 2356). In this study, Mclean et al (2008) used a randomized controlled trial (RCT) in 14 community Pharmacies in Edmonton, Alberta as a method of data collection (McLean et al., 2008, p. 2355). Participants were identified and manipulated by pharmacists and nurses who were trained using a combination of an online learning program and a case-based learning session – both based on the Canadian Hypertension Education Program (CHEP) guidelines†. Also the use of a commercial BP monitor set at an average of 5 measurements of BP taken 1 minute was used to measure participants BP (McLean et al., 2008, p. 2356). Data analysis procedures were appropriate to the research study because â€Å"all analyses were conducted using a commercially available software program† (McLean et al., 2008, p. 2357). Threats to Internal and External Validity specifically the authors use of instrumentation and selection could possibly have introduced problems of internal validity in the research. This threat was discussed by ensuring that both groups (control and experimental) BP were measured with the same BP device, which has 6 readings, discard the first test and further takes an additional 5 measures . Mclean et al (2008) found that, â€Å"It is possible that the more frequent contact with the pharmacist –nurse team reduced the anxiety of patients and any â€Å"white coat effect† on their BP measurement†. (p.2359). Furthermore, the screening modules used by the researchers to collect the data were conducted by pharmacists and nurses well versed in their profession. Selection bias was another threat predisposing the sampling design to internal validity. The authors in their findings found that patients eligible for selection presented with lower BP, this can be caused by the researchers utilizing a convenience sample instead of a random sample. Also, selection bias may have been an essential part of the end results due to the fact that patients who are eager to monitor and control their BP are more likely to agree to participate in the trial, also that more than 80% of trial participants were aware that hypertension is a risk factor for cardiovascular disease (McLean et al., 2008, p. 2358). The external validity of the study was weakened by the sampling design. The authors failed to take into consideration non English speaking people, whose cultural differences and beliefs could influence the study, and who may lack health literacy to read and identify medical abbreviations and symbols. Maclean et al (2008) states, â€Å"pharmacists and nurses who participated may be different from those who did not participate, an investigator vol unteer bias that may limit generalizability of the program† (McLean et al., 2008, p. 2359). Limitations of the Design One major limitation of the design identified by the authors is regarding the interventions implemented in regards to the in person contact time between patients and the pharmacist-nurse team, which can be further be evaluated by future studies on whether less intensive interventions are The researchers identified a potential limitation regarding that the intervention involved substantial in-person contact time between patients and study personnel, and that future studies will need to determine whether less intensive interventions are productive in controlling BP in diabetic patients (McLean et al., 2008, p. 2359 Generalization of Findings The research findings can be generally be applied to larger populations, the authors acknowledge the fact that their research intervention was extremely efficacious, resulting in a 24.1 mm Hg greater reduction in systolic BP (McLean et al., 2008, p. 2358) They recommend a new model of care to improve BP control. In addition, by utilizing an experimental research design in which a cause and effect relationship can be analyzed and measured, the researchers were able to provide coherent evidence and correlation that community pharmacists and nurses through a collaborative effort with primary care physicians could have a huge impact on hypertension management in patients with diabetes mellitus and BP control within the community (McLean et al., 2008, p. 2360) References LoBiondo-Wood, G., Singh, M.D., (2013). Introduction to quantitative research. In C. Cameron, M. D. Singh (Eds.), Nursing research in Canada: Methods and critical appraisal for evidence-based practice (3rd ed.) (pp. 198-215). Toronto: Elsevier Canada McLean, D. L., McAlister, F. A., Johnson, J.A., King, K.M., Makowsky, M.J., Jones, C.A., Tsuyuki, R.T. (2008). A randomized trial of the effect of community pharmacist and nurse care on improving blood pressure management in patients with diabetes mellitus. Archives of Internal Medicine, 168(21), 2355-2361 Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/19029501 Sullivan-Bolyai, S., Bova, C., Singh, M.D. (2013). Experimental and quasiexperimental designs. In C. Cameron, M. D. Singh (Eds.), Nursing research in Canada: Methods and critical appraisal for evidence-based practice (3rd ed.) (pp. 216-233). Toronto: Elsevier Canada

Dulce et Decorum est †Anthem for Doomed Youth Essay

â€Å"Dulce et Decorum est† and â€Å"Anthem for Doomed Youth† are two poems written by Wilfred Owen during the First World War. Owen, like most soldiers, joined up after being convinced that war was fun by propagandistic posters, poems and stories, and once he had realised that the truth was quite the opposite of this, he decided that it was his responsibility to oppose and protest against poets like Jessie Pope through poetry itself. People were not prepared for the sheer scale and manner of death and the mechanised nature of trench warfare, and had false expectations of the heroic endeavour, but little awareness of the realities. However, compared to â€Å"Dulce†, the anger portrayed is dramatically understated. â€Å"Dulce† is an outrageous protest, displaying the â€Å"haunting† and â€Å"bitter† effects of war, and after describing in great detail the horrific story of a soldier â€Å"drowning† and â€Å"choking† in gas, Owen reveals his passionate hatred for the false and misleading idealisms of heroism in war using particularly emphatic imagery in â€Å"cancer† and â€Å"froth corrupted lungs†. The fact that â€Å"Anthem† is a sonnet, is ironic in that they are usually about love, and because it is actually about grief, it somewhat lulls the reader into a false sense of security, therefore making the poem more effective. Both poems seem to talk about the vile and painful conditions in war, â€Å"Dulce† using onomatopoeia in â€Å"trudge†, giving the impression that war is truly appalling, immediately going against the common belief that it is a game from poems like â€Å"Who’s for the game?†. Also, true to both poems is the idea of undignified and casual death, rather than the heroic, glorious death promised by governmental propaganda. For example, in â€Å"Dulce†, Owen talks about the way they â€Å"flung [the dead soldier] in a wagon† with such brutal nonchalance. Furthermore, â€Å"Anthem† introduces a typical Victorian funeral with singing â€Å"choirs†, and juxtaposes it with the â€Å"shrill, demented choirs of wailing shells† on the battlefield, and with the constant end-stopped lines, this conveys a sense of solemn grief rather than the vicious anger in â€Å"Dulce†, which tends to use enjambment more frequently. Also, â€Å"Anthem† discusses the lack of ceremony and dignity in which people are â€Å"honoured† after their death on the battlefield, and Owen reveals his anger for this using the powerful, hyperbolic alliteration in â€Å"rifles’ rapid rattle†. In addition, the fact that the sound of machine gun fire is reflected in the phrase â€Å"rifles’ rapid rattle† presents to the reader that the harsh realities of war are indeed more than just frightening. In addition, a sense of urgency and immediacy is portrayed in the second stanza of â€Å"Dulce†, when Owen uses direct speech and exclamations in â€Å"Gas! Gas!†, while the epizeuxis and use of the present continuous tense gives further emphasis to this desperate urgency .On the other hand, â€Å"Anthem† has a strong sense of sympathy and general tranquillity throughout the second stanza, which is juxtaposed by something quite the opposite in the first. As well as this, the light lexis used in words such as â€Å"glimmers† and â€Å"tenderness† in the second stanza, give the impression that it is a poem of mourning and respect rather than anger and hate. In general, â€Å"Dulce† uses fairly vulgar and crude language, conveying his disrespect for propagandistic poets, as well as his anger at the unawareness of the dangers of war of the British public: â€Å"He plunges at me, guttering, choking, drowning.† Owen’s use of the words â€Å"guttering, choking [and] drowning†, has numerous implications and effects. Firstly, a â€Å"gutter†¦Ã¢â‚¬  represents the bottom of society, and therefore shows how soldiers dying is in fact not a respectable act, but rather an act that is hardly noticed by society. Also, the onomatopoeic sounds of â€Å"guttering† and â€Å"choking†, give an even more emphatic image of death on the battlefield, portraying Owen’s desire for the awareness of the harsh realities of war in youth culture as well as in everyday men. Finally, the fact that Owen uses three separate adjectives to describe the horrific scene, in addition to the tri-conic feel it gives, the phrase implies that Owen could not put what he was seeing into words, and therefore persuading the reader that war is simply a catastrophic, desperate excuse for a fight, sacrificing millions of men in the process. Unlike â€Å"Dulce†, â€Å"Anthem† brings out the mournful, respectful side of Wilfred Owen through the melancholy atmosphere he creates through the modulation of harsh imagery to a more resigned tone: â€Å"The monstrous anger of the guns†¦ †¦but in their eyes Shall shine the holy glimmers of goodbyes.† This dramatic contrast between coarse and frightening imagery in â€Å"monstrous anger of the guns† and the solemn melancholy in â€Å"the holy glimmers of goodbyes† is a very moving one. This is not only because the phrase refers to tears in young men’s eyes, which in itself is a saddening image, but also because it refers to â€Å"goodbyes†, forcing a more personal image of saying â€Å"goodbye† to close friends or relatives as they go to war upon the mind of the reader, again, creating a sombre mood. In addition, the end-stopped line following â€Å"goodbyes† is very effective in that it makes the â€Å"goodbye† seem all the more sudden, harsh, and hurtful. In conclusion, â€Å"Dulce† and â€Å"Anthem†, although they are both written in protest against the deceiving propaganda made by various people, they go about it in different ways. â€Å"Dulce† is an outright outrage at individuals, which we know from Owen’s draft that it was targeted at Jessie Pope, using coarse and harsh language to do so. â€Å"Anthem† on the other hand is a more solemn and moving poem, although it starts as if it were to be an outrage, before we learn that in fact, it is only grieving for the dead and their lack of ceremony, and it becomes literally, an anthem for doomed youth.

Martial Arts An Effective Tool Against Violence And...

*Thesis Statement: Research shows that training in martial arts has many mental and physical health benefits; this essay, therefore, will argue that offering martial arts in public schools offers a successful tool against violence and bullying, is an effective way to recover mental health without use of pharmaceuticals, and can improve academic outcomes. I. Introduction A. Start with compelling story of Phoebe Prince who committed suicide in 2010 after relentless bullying. B. General introduction to the benefits of martial arts C. *Thesis statement II. The addition of martial arts training into schools can be used as an effective tool against violence and bullying. A. Bullying is either physical or social and can be controlled through†¦show more content†¦12). B. According to Zivin, et al., students participating in school based martial arts program showed significant improvements in attention and a reduction in impulsive and inappropriate behaviors (Zivin, Hassan, DePaula, Monti, et al, 2001, p. 3). C. Statistics on use of anti-psychotics amongst children and adolescents (Harris, Sorbero, Kogan, Schuster, Stein, 2012, p.1). D. In summary, martial arts are shown to improve many mental health disorders, such as impulsivity, ADHD, and inappropriate behaviors; therefore, required training in these arts would be an effective tool to reduce the number of students using mental health related drugs. IV. Infusing martial arts training in schools will have a positive influence on academics because it results in less delinquency, increased attention span and improved physical activity. A. Research shows that martial arts practice leads to less delinquency and lowered number of expulsions (Zivin et al., 2001) B. Increase in math skills and decrease in aggressive behaviors from martial arts (Vertonghen,Jikkemien, Theeboom, Marc, 2010, p. 531) C. Physical activity is shown to increase academic outcomes when activities include areas of judgment, communication, and memory.(Intrator Siegel, 2008, p. 4) D. Given these points, martial arts impacts several important

Relation of Conforming to Self-Esteem and Conforming to...

A lot is known about self-esteem and conforming peer pressure separately. There is not much known about the effects of one on the other. Peer pressure, the feelings of pressure to engage in something that those you associate with are doing, when it works negatively is a large problem and can cause conflicts throughout life. Conforming to peer pressure can have both positive and negative effects. The pressure can cause a person who conforms to make themselves better or worse. Many factors influence a person’s susceptibility to succumb to peer pressure. A person’s likelihood to be influenced can be affected by their level of self-esteem or their positive/ negative view of themselves. If a person conforms to peer pressure easily and has a†¦show more content†¦The relationship between a person and their family is usually considered important. Studies have recently show that they are more important than would be noticed at first glance. Having strong family ties has been shown to provide resistance to peer pressure and that having factors in a person’s life such as maternal warmth and positive psychological connections with family members causes a greater resistance to peer pressure (Chan Chan, 2013). Other factors in family life influence the levels of resistance to peer pressures. It was noticed that in immigrants, those who had a low generational status, meaning their families recently immigrated and had a good relationship w ith their parents were less likely to be susceptible to peer pressure (Bà ¡maca Umana-Taylor, 1997). When children have a high regard for their parents they are also shown to have a higher self-esteem and a higher level of resistance to peer pressure (Sim, 2000). 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