Patient Outcomes for Fibromyalgia Treatments

Patient Outcomes for Fibromyalgia Treatments Busch et al. (2011) describes fibromyalgia as chronic condition that exhibits symptoms that include widespread pain, non-recuperative sleep and fatigue. Fibromyalgia can affect anyone of any age but is most prevalent in women aged 50 or older (Traska, Rutledge, Mouttapa, Weiss, Aquino, 2010). Currently, the etiology of fibromyalgia is not understood. Fibromyalgia also has no specific diagnostic tests or cures (Becker, Stuifbergen, Taxis, Beal, Pierini, 2009). Diagnosis is established with guidelines set by the American College of Rheumatology (Gore, Sadosky, Zlateva, Clauw, 2009). Gore, et al. (2009) states that the guidelines stress the incidence of pain and tenderness at least 11 of the 18 defined tender points. Treatment for fibromyalgia, according to Zhao, Sun, Watson, Mitchell, and Swindle (2011), is palliative measures that include pharmacological treatment, behavioral modifications, physical and exercise therapy, and alternative medicines. This literature review is an examination of both pharmacologic and non-pharmacologic treatments for fibromyalgia and the effectiveness of the treatments. The following text will review and analyze several pieces of literature that provide information and statistics regarding the different methods of controlling the symptoms of fibromyalgia. The conclusion of this review will present suggestions and recommendations for enhancing and expanding the current body of research. Literature Review Pharmacologic Treatment Pharmacologic treatment for fibromyalgia includes many classes of medications. Medications include analgesics, antidepressants, anticonvulsants, opioids, and dopamine agonists (Zhao, Sun, Watson, Mitchell, Swindle, 2011). The pathophysiology of fibromyalgia is not well understood, but is believed to be the result of an increase in pain signal transmission of the central nervous system (Gore, et al. 2009). Gore, et al. (2009) focused attention on the medications gabapentin and pregabalin. A commercial database was used to study identifying traits among patients newly prescribed gabapentin and pregabalin that included clinical characteristics, healthcare resource use, and pharmacologic therapy (Gore, et al. 2009). Statistics were limited to those with at least one healthcare encounter during 2006 and 2007 with a diagnosis of fibromyalgia and naive to both gabapentin and pregabalin. The sample was majority female (85%) and greater than 70% over the age of 45 (Gore, et al. 2009). Results indicated that pregabalin users in the cohort study saw statistically significant reduction (p values A systematic literature review of 14 studies revealed a decrease in healthcare access among Latinos in the US as compared to Caucasian Americans (Timmins, 2002). Fifty-five percent of these studies indicated significant negative effects to healthcare access for Latino individuals with LEP (Timmins, 2002). Cancer screenings, mental health evaluations, and reproductive care among Latino populations were substantially lower (Timmins, 2002). The reason for this decline was primarily linked to poor health education and promotion as a result of linguistic barriers (Timmins, 2002). Communication barriers also hindered therapeutic rapport that potentially contributed to decreased access to care (Timmins, 2002). Shi, Lebrun, and Tsai (2009) conducted descriptive and comparative research on a national health survey that involved 29,868 participants. The purpose of this research was to determine the influence of LEP on healthcare access (Shi et al., 2009). Analysis showed that respondents with LEP were more inclined to waive needed medical care and less inclined to have healthcare visits (Shi et al., 2009). In particular, unadjusted analysis showed 58% of respondents with LEP and adjusted analysis revealed 34% of those respondents were more likely to have reduced healthcare visits (Shi et al., 2009). This study revealed multivariable impacts upon healthcare access; however, strategic analysis allowed for variable isolation in order to fully assess the effect of language barriers alone upon healthcare access. In a descriptive study, DuBard and Gizlice (2008) examined responses from 45,076 Hispanics in a randomized national health survey. The study indicated that healthcare access was substantially limited for Hispanics with LEP than Hispanics with English proficiency. The results showed 55% of Hispanics with LEP had no health insurance; whereas, 23% of Hispanics who spoke English were uninsured (DuBard Gizlice, 2008). An additional comparison revealed that 58% of Hispanics with LEP had not obtained a primary doctor, while 29% of English-speaking Hispanics were under primary physician care (DuBard Gizlice, 2008). Hispanics with LEP were also less likely to have annual health visits and preventative services, such as immunization, dental, and screening care (DuBard Gizlice, 2008). These results have implied a prominent influence of language barriers upon access to healthcare. Multivariate analysis disclosed limitations to healthcare access for all Hispanics, but a substantial decrease in access to health services was observed for Hispanics with LEP (DuBard Gizlice, 2008). Safety and Quality of Care In his systematic review, Timmins (2002) reported that 86% of studies indicated a definite negative effect of linguistic barriers upon the quality of care for Hispanics with LEP. In comparison to Hispanics that were proficient in English, one study revealed Hispanics with LEP were significantly (P Masland, Kang, and Ma (2011) conducted a study that assessed medication prescription comprehension in the following five ethnic minority groups: (a) Mexican, (b) Central American, (c) Chinese, (d) Korean, and (e) Vietnamese. Limited English proficiency inhibited communication and understanding of prescriptions in all ethnicities except Vietnamese (Masland et al., 2011). In particular, limited English proficiency in the Mexican, Central American, and Korean groups tripled the chance of misinterpretation and quadrupled the chance for the Chinese group (Masland et al., 2011). Poor communication and unavailability of prescription labels in native languages were associative reasons that inhibited prescription understanding and ultimately compromised client safety (Masland et al., 2011). However, most all ethnicities greatly benefitted from having language concordant physicians (Masland et al., 2011). As a result of physician/patient communication barriers, patients with LEP had an increased probability of undergoing more diagnostic testing (Pares-Avila et al., 2011). Studies reported physicians unnecessarily ordering an array of tests to determine or rule out health problems (Pares-Avila et al., 2011). This action not only potentially contributed to poor patient satisfaction but also promoted delays in care services (Pares-Avila et al., 2011). Health Status and Management According to DuBard and Gizlice (2008), 39% of Hispanics with LEP reported fair or poor health status; whereas, 17% of Hispanics who were English proficient conveyed fair or poor health condition. Timmins (2002) added that negative health status and outcomes could be attributed to language barriers. Misdiagnosing and prescription errors were found in one study to have contributed to negative health outcomes, yet limited English proficiency was not clearly isolated as a specific cause (Timmins 2002). Another study alluded to a casual association between language barriers and negative health outcomes, which potentially promoted declines in health status (Timmins, 2002). Wisnivesky et al. (2009) conducted a cohort study to analyze asthma control and quality of life. Upon comparing English proficiency levels, Wisnivesky et al. (2009) discovered major language barrier impacts. Latinos with LEP had statistically significant (P Fernandez et al. (2010) examined data from the 2005-2006 Diabetes Study of Northern California, a well-designed cohort of insured clients, to determine diabetes management of Hispanic individuals with LEP. Although this study’s multivariate analysis examined other variables that could have contributed to ineffective glycemic control, limited English proficiency was identified as the primary â€Å"independent predictor† (Fernandez et al., 2010, p. 170) of poor glycemic management among US Hispanics. Analysis further revealed statistically significant improvement (P Future Research and Practice Recommendations Literature has confirmed the existence of multivariable elements that compound, exacerbate, and/or lead to healthcare disparities among minority populations. Ongoing research is needed to explore all potential variables, to analyze the impact each variable has upon healthcare, and to discover best methods to improve healthcare for minority groups. A substantial amount of literature has corroborated language barriers as a major source contributing to negative healthcare management; therefore, this appraiser has considered this evidence indicative of poor professional practice that insufficiently bridges language barrier divisions and compromises patient healthcare. Nurses should be proactive in employing interpreter services and finding best practice measures to effectively communicate with patients. Pares-Avila et al. (2011) reported that patients with LEP are often not informed of their legal rights to have interpreters; hence, nurses must be client advocates and inform patients of this entitlement. Furthermore, quality improvement measures and future research should be implemented to continually evaluate interpreter service use and effectiveness. In the US, rapid expansion in language diversity has not mirrored the available diversity among healthcare workers (Pares-Avila et al., 2011). Literature has reflected improvements in healthcare directly related to having language concordant physicians, yet accessibility of language concordant providers has not adequately complemented the increasing number of patients with linguistic diversities. This literature review lacked studies that addressed or assessed the impact of nurse language concordance. However, this appraiser values language agreement between nurse and patient, perceiving it a powerful measure to ensure affective communication and promote health. More research is needed to analyze the effect of language unity between nurses and clients. With a growing diverse nation and competitive work arena, nurses should envision secondary language acquisition as the â€Å"edge† toward professional success and patient satisfaction. References Becker, H., Stuifbergen, A., Taxis, C., Beal, C. C., Pierini, D. M. (2009). The use of goal attainment scaling to facilitate and assess individualized change in a wellness intervention for women with fibromyalgia syndrome.Journal of Holistic Nursing,27, 232-240. doi: 10.1111/j.1365-2702.2010.03501 Busch, A. J., Webber, S. C., Brachaniec, M., Bidonde, J., Bello-Haas, V. D., Danyliw, A. D., . . . Schacter, C.L. (2011).Exercise therapy for fibromyalgia.Current Pain Headache Reports, 15, 358-367. Gore, M., Sadosky, A. B., Zlateva, G., Clauw, D. J. (2009).Clinical Characteristics, Pharmacotherapy and Healthcare Resource Use among Patients with Fibromyalgia Newly Prescribed Gabapentin or Pregabalin.Pain Practice,9, 363-374. doi: 10.1111/j.1533-2500.2009.00292 Traska, T. K., Rutledge, D. N., Mouttapa, M., Weiss, J., Aquino, J. (2010). Strategies used for managing symptoms by women with fibromyalgia.Journal of Clinical Nursing,21, 626-635. doi: 10.1177/0898010109339525 Zhao, Y., Sun, P., Watson, P., Mitchell, B., Swindle, R.(2010). Comparison of medication adherence and healthcare costs between duloxetine and pregabalin initiators among patients with fibromyalgia.Pain Practice,11, 204-216.

the stand :: essays research papers

  Ã‚  Ã‚  Ã‚  Ã‚  King, Stephen. The Stand. New York: New York, 1978   Ã‚  Ã‚  Ã‚  Ã‚  tephen Edwin King was born on September 21, 1947 in Portland, Maine He was a surprise to the family because his mother was told that she would never have children. His parents, Donald and Nellie King, were having trouble in their marriage, and when Stephen King was only 2, his father, a door to door salesman for a company, left the house to buy a pack of cigarettes, but never returned. Stephen King hasn't seen his father since.   Ã‚  Ã‚  Ã‚  Ã‚  Stephen and his adopted older brother, David King, lived with their mother back and forth between Massachusetts and Maine. And his passion for writing came about in 1959 when he wrote articles in his brothers local newspaper titled Daves Rag. Copied on a mimeograph machine, and with a circulation of only 20 or so Stephen wrote articles. Inspired by the relative success, Stephen copied some of his short stories and sold them to local people for a whole thirty cents. Stephen actually sold some of his work at school until teachers stopped it. And that’s how he started his carrier in writing.   Ã‚  Ã‚  Ã‚  Ã‚  The setting of the story takes place in 1991 in America. A plague struck the U.S. only leaving a few thousand survivors.   Ã‚  Ã‚  Ã‚  Ã‚  In the year 1991, a plague strikes America, leaving only a few thousand people alive who are immune to the epidemic. Of the survivors, those who serve G-d instinctively join in Boulder, Colorado, while those who worship the Dark Man are drawn to Las Vegas, Nevada. The two groups separately rebuild society, until one must destroy the other. Franni Goldsmith comes very close to killing herself. She thinks she can not deal with her parents' deaths, being unwed and pregnant, and having the only other survivor in her hometown of Ogunquit, Main be her recently deceased best friend's weird brother Harold Lauder. On their way, they meet up with six people from various states in the United States who joined them on their journey. Fran is disturbed by her dreams, as all of them are by their own. She dreams of an old lady named Abigail, in Colorado. This lady is kind and loving and promises to protect them from the evil. In the dreams there is also a Dark Man. He is always t here lurking, waiting to attack. Harold admits to himself that he is in love with Fran and goes crazy when he realizes how serious Fran has become with Stuart Redman, one of the newcomers to their traveling group.

The Shawnee Tribe

The Shawnee Tribe Did you know that the Shawnee Indian tribe is a fascinating tribe? I recently have learned that they are nomads. Nomads are people who travel instead of settling in one place. Southern Ohio, West Virginia, and western Pennsylvania were a couple of states they once lived in. Until around 1660 Iroquois drove out the tribe to southern Carolina, Tennessee’s Cumberland basin, eastern Pennsylvania, and southern Illinois. They had tried to return, but again they were forced to leave by American settlers.The settlers pushed them first to Missouri and then to Kansas, but the Shawnee people settled in Oklahoma after the Civil War. The Shawnee survived using various methods of hunting and gathering. Both men and women had responsibilities in providing food. They hunted many animals including deer, squirrel, turkey, raccoon, bear, muskrat, rabbit, and ducks/geese. They set traps for the animals, and they disguised themselves to blend in with their surroundings to get clo se enough to club or shoot them. People never wasted anything; they used all the different parts for different things.In January and February they hunted beaver for their pelts and meat to trade with the settlers. In the summer time they, and during fall, groups of men and women would leave the village and hunt. Small temporary lodges were used. Another way to get food was to plant or gather it. They planted beans, squash, corn, pumpkins, and melons but corn was their main food. They gathered wild berries, nuts, maple, roots, and wild honey. In the springtime women planted crops and summer through fall they gathered wild plants and fruits.Tapping maple trees for sap was another thing they did. Raiding beehives was also popular to get honey. The women were mostly responsible for planting, harvesting, and taking care of crops. Roles for people are very important because the people would know what their job was and what other’s jobs were. Men were very important because they mos tly hunted, carved wood into ladles, bowls, and spoons, were in charge of politics and war, and were warriors. Women had many roles, but some were harder than others. They built homes and fires, dressed the game, cooked, lanted crops, scraped skins and tanned hides, made clothing, wove blankets, and made vessels of clay. They also served as advisors of peace and war. They managed all farming activities and ceremonies in the village. Both men and women took part in storytelling, artwork, music, and traditional medicine. Young girls learned from their mothers how to gather wild foods, plant crops, care for children and perform household duties. Boys were taught to hunt and fight from their fathers. At age nine, boys began special training and self-discipline. Parents were strict, and the children were seldom punished.They were expected to be the judge of their own behavior. However, the parents expected high standards of behavior and responsibility. Special jobs of the Shawnee tribe i ncluded being a chief. Chiefs would handle problems and activities, good or bad and also dealt with problems that could not be resolved by individuals or families. War chiefs protected the tribe from enemy attack and decided when to go to war. They had to prove themselves in battle as leaders and warriors. Chiefs inherited their positions as peace, clan, or war chiefs. Peace chiefs could also call-off a war.The Thawikila and Chalaakaatha divisions were in charge of governing the people and chiefs came from one of the two divisions. Membership for one of the five divisions was inherited by the father’s side. Clothing of the Shawnee was homemade and you had to make your own clothes in order to stay warm. Deerskin clothing was what most Shawnee people wore. During the winter, men and women added loose shirts and leggings and would also wrap themselves in buffalo robes or fur cloaks made of bear or moose skins. Decorations were important to the tribe. They dyed clothing, porcupin e quills; and feathers and points were also used.Men wore headdresses made of animal fur and decorated them with feathers from a bird of prey such as an eagle, hawk, or owl. Men mostly wore shirts and leggings and women wore shirts with leggings or dresses. After contact with the European traders, the Shawnee began to own glass beads which they used on their clothing. Jewelry included silver pins, necklaces, and bracelets for women. Men liked to wear silver nose rings and earrings. Dances, music, and ceremonies were all important to the Shawnee tribe. Spring held a dance named â€Å"Spring Bread Dance† in which they prayed for plentiful crops.In the summer they held the â€Å"Green Corn Dance† in celebration for the growing of corn. Fall held the â€Å"Fall Bread Dance† where they prayed that game would be plentiful also and gave thanks for the harvest. Musical instruments included skin drums, gourd rattles, deer-hoofed rattles and sometimes reed flutes. Many di fferent tools were used by the Shawnee and they needed them to survive. They used hammers made of stone or other hard substance, some had handles and some did not. Knives and saws were made of shells, stone, or other materials. Borers were natural tools used for making holes in soft or hard objects.An axe was another tool made of shells, iron, or copper. The blade could easily turn at a right angle. It was held with your hands or attached in various ways to a handle by a rawhide. Some other weapons are bows and arrows, stone tomahawks, spears, and chipped flint arrow points. Homes and shelters were another item that was needed by the Shawnee. The home they lived in was called a wegiwa which were tree poles covered by bark or animal skin. The frame of the house was made of sapling tied together and covered with bark from elm or birch trees.When bark was not available animal skin was used. There were no windows and there was only one opening in one end for a door and a hole in the mid dle of the roof for the smoke from the cooking fire. In a pit in the middle of the floor is where they burned the fire. Inside walls were lined with raised wooden platforms that were used as beds. Homes were sometimes furnished with shelves, benches, and tables. The Shawnee’s way of life came to an end by splitting into small bands and moving away from others. The Shawnee had many wars with American settlers over land rights.One Native American named Tecumseh, who was an excellent communicator and military strategist, was admired greatly by the Shawnee. They followed his every command. During the Battle of Thames in 1813, Tecumseh was shot and killed. With his death the Shawnee people lost their spirit to fight. They then scattered and drifted in small bands into Missouri, Kansas, Arkansas, Oklahoma, and Texas. Some remained in Ohio. Between 1825 and 1900 the United States Government took more land rights away through various treaties. This led to more movement and most Shawn ee became part of a non-native society.The Shawnee tribe is so interesting and amazing. Shawnee people believe in one female God, Our Grandmother, and she created the earth and made people. When people grew old she scooped them up in nets and brought them to the sky. Also, the most sacred spirits to the Shawnee were Tobacco, Fire, Water, and Eagle. Daniel Boone was one of the most famous prisoners taken in war and was held for several months. During that time he made friends with them and participated in their games. When he went back to the settlers he realized that the Shawnee tribe was a friendly tribe.Another interesting fact about the Shawnee is that parents would plunge their babies into snow or freezing cold water every day for several months because they wanted to make their children tougher. The Shawnee tribe was fun to study and I learned a lot about their way of life and history. BIBLIOGRAPHY Bial, Raymond. The Shawnee. Tarrytown, New York. Benchmark Books, 2004. Flanagan , Alice K. The Shawnee. Canada. Children’s Press, 1998. Mattern, Joanne. The Shawnee Indians. Manakato, Minnesota. Bridgestone Books, 2001. Yacowitz, Caryn. Shawnee Indians. Chicago, Illinois. Heinemann Library, 2003. Additional research includes many websites

Terrorist Attacks On The United States - 1453 Words

September 11th, 2001, alleged Al-Qaeda members attacked the United States of America with four passenger planes, Boeing 757s. Two planes flew into the North and South Towers of the World Trade Center in New York, one plane flew into the Pentagon, and the remaining plane was possibly targeting the White House but was unsuccessful. People all over America felt an utter shock and disbelief after this tragic event as people demanded answers. After the terrorist attacks, a portion of Americans started to believe in conspiracies proving the government was behind it all. To add, Americans also believed that the U.S. government knew in advance of the terrorist attacks on September 11th due to the time between the attacks and the Bush administration’s attempt to investigate, the National Security Association’s lack of investigation of suspicious phone calls, and the odd â€Å"collapse† of World Trade Center Seven. However, the government tried to counter attack with the p oints that Al Qaeda was behind the attacks on September 11th, Khalid Mohammed was the mastermind behind September 11th, and that debris hit World Trade Center Seven. After the tragedy, the U.S. government believed that Al-Qaeda hijacked the planes used in the attacks. During investigations after the attacks, the FBI found a copy of the Koran-the holy book of Islam-and pilot manuals in a hijacker’s car at the Logan International Airport in Boston prior to the attacks. The FBI then traced down the hijackers toShow MoreRelatedThe Terrorist Attacks Of The United States1409 Words   |  6 PagesThe 2001 terrorist attack in the United States had negative social and economic effects in the country and generally stirred the peace of the citizens. Terrorism is a major threat to any sovereign country in the world including the United States where. There are other threats that influence the comfort and the interests of the residents of the United States in varying measures (Decker, 200 1). The Department of Homeland Security is tasked with the protection of the people from any activity that influencesRead MoreThe Terrorist Attacks Of The United States2247 Words   |  9 Pagesâ€Å"9/11†-the terrorist attacks that took place on September 11, 2001- many Americans, officials such as the local Police Departments, Fire Fighters, the government and the President of the United States all shared one main priority and thought. That thought, concern and priority was to combat terrorism in the United States and avoid something this immense from happening ever again. 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Life changing events such as 9/11 terrorist attacks on the United States has set the tone in how our government responds to such horror. It has put the entire nation on an edge and citizens feel the insecurity of their gover nment and fear for their safety. Every individual was scrutinized, but some were looked at more closely than others due to their sex, race, and religious background. Government has