It does not rely exclusively on established views or the researcher’s own perspective buy 5mg prochlorperazine with mastercard, as is typical of quantitative research (Maxwell buy cheap prochlorperazine 5 mg online, 2005) purchase 5 mg prochlorperazine with amex. Nonetheless, it is acknowledged that the researcher enters into the process with their own, personal preconceptions and inevitably influences the data obtained through the data gathering process (i. Grounded theory draws attention to the perspectives of research participants, including their subjective accounts of social and psychological events and of associated phenomenal and social worlds (Maxwell, 2005; Pidgeon, 1996; Rubin & Rubin, 1995). The ultimate purpose of grounded theory is to develop a theory that remains close to, and illuminates, the phenomenon under investigation by studying the experience from the standpoint of those who live it (Jones, Torres & Arminio, 2006). Grounded theory was deemed a suitable approach for the current study due to its commitment to communicating the participant perspective. I believe that the consumer perspective on medication adherence provides a valuable contribution to knowledge in the area, particularly because of the complexity of medication adherence and the failure of health services to address medication adherence effectively amongst people with schizophrenia on a large scale despite the extensive research in the area. With its openness to generating theory which has not necessarily been pre-established in research, I perceived a grounded theory approach to the topic of medication adherence as potentially groundbreaking as well as valuable both in academic and practical terms, with potential clinical implications (Rubin & Rubin, 69 1995). Although the research presented was influenced by a grounded theory approach, however, the analysis did not ultimately involve theory generation as this was beyond the scope of the thesis. Grounded theory methods have become a topic of debate from both proponents and opponents of the approach. Post-modernists and post- structuralists dispute the positivistic premises assumed by grounded theory’s major supporters and within the logic of the method itself (Charmaz, 2003). The positivistic assumptions of grounded theory stem from the reliance on a realist ontology, which posits that there is a “real”, objective reality that researchers are able to directly and, therefore, objectively and accurately capture and represent (Willig, 2001). There has also been divergence in the grounded theory methodology between Glaser and Strauss (in collaboration with his more recent co-author, Juliet Corbin), who have developed the grounded theory method into conflicting directions, leading to a split between Glaserian and Straussian grounded theory. Glaser’s position is close to traditional positivism, as it assumes an objective, external reality. Furthermore, the researcher is positioned as a neutral observer who discovers data, reduces inquiry to a set of manageable research questions and objectively renders data (Charmaz, 2003). Strauss and Corbin’s position assumes an objective external reality, aims toward unbiased data collection, proposes a set of technical procedures and supports verification (Charmaz, 2003). Strauss and Corbin’s stance is aligned more with post-positivism, however, as it additionally advocates giving voice to participants, representing them as accurately as possible, discovering and acknowledging how participants’ views of reality may conflict with researchers’ and recognizing creativity as well as science in the analytic product and process (Charmaz, 2003). As the primary researcher, I aimed to be reflexive throughout the conduction of the research presented. As acknowledged earlier, whilst the research presented was influenced by a grounded theory approach, a process model of medication adherence as part of the analysis was not produced as this was beyond the scope of the thesis. Participation was completely voluntary and participants were free to withdraw from the study at any time prior to the completion of interviews. As the primary investigator, I distributed information sheets to potential participants for their perusal. Potential participants were encouraged to discuss the study and share all documents with other members of the public, such as family members, peers, case managers or health workers prior to deciding whether to participate or not. Upon agreeing to participate, prospective interviewees were given a consent form to sign and were then screened to ensure they met the requirements for the study. Transcriptions were transferred into a study database to allow the results of this study to be 71 analysed and reported. Respondents were assured that their identities (and the identities of other people discussed in interviews) would remain confidential as no identifying information would be included in the write-up. Pseudonyms were created for participants (and other people discussed, such as prescribers) to help to preserve their anonymity and other identifying information was changed or excluded from transcriptions. Information provided by participants in interviews was only used for the purpose of the study. The initial recruitment strategy involved distributing flyers to various outpatient services, which was ineffective in attracting participants (see Appendix A for example flyer). Approaching potential participants was much more effective in the early stages of recruitment, with the assistance of a research nurse. Presenting my research to outpatient groups and asking for expressions of interest in participating also proved an effective means of recruitment. The research nurse was of great assistance as she had contact details of several consumers who were willing to participate in research as they had done so in the past. The research nurse facilitated this process significantly, through identifying relevant contacts or by recognizing potential candidates in settings (such as the medication clinic) where I was unable to. Snowball sampling then occurred naturally as many interviewees stated that they enjoyed interviews and, thus, agreed to distribute information sheets to peers who met the study requirements. As my details were listed on the information sheet (see Appendix C), I was then contacted by consumers and interviews were arranged. Recruitment ceased following theoretical saturation, when I noticed consistent repetition of codes and no new conceptual insights were generated (Bloor & Wood, 2006). I decided that I had reached theoretical saturation in consultation with my supervisors. Two more interviews were conducted after this to ensure that saturation had been achieved. Of note, the grounded theory principle of theoretical sampling was not adhered to. Theoretical sampling refers to the purposive selection of research participants to compare with prior cases in order to gain a deeper understanding of analysed cases (Glaser & Strauss, 1967). Sampling is, thus, based on emerging codes and categories until a full and varied category is developed and tested against incoming cases. All participants in the research presented were outpatients with schizophrenia and exclusion criteria were minimal. As interviewees’ experiences were so varied and they were asked to reflect on their experiences at different stages of their illnesses, theoretical sampling was deemed unnecessary. Although it could be argued that 73 inclusion of service providers views, for example, may have broadened the theory, this would have been inconsistent with the focus of this research; the consumer perspective. Of note, it was found during screening for entry into the study, that some people who had been given formal diagnoses of schizoaffective disorder also matched the criteria for schizophrenia and were, therefore, included in the study. Participants were also required to sign a consent form prior to taking part (see Appendix D). The exclusion criteria for this study were intellectual disability and severe co-morbid conditions (such as drug dependence which could hinder capacity to interview). Furthermore, the original exclusion criterion of people being prescribed typical antipsychotic medication was also removed as it was decided that this could potentially render irrelevant interesting discussions about past experiences with medications amongst interviewees who were previously prescribed typical antipsychotic medications. Furthermore, the 74 views of consumers who continue to be prescribed typical medications are considered just as important as those who are prescribed atypical medications, particularly considering that there are adherence difficulties associated with both types of medication. The screening process was tested on two pilot interviewees and on some peers who did not have a previous diagnosis of schizophrenia and it proved effective. The same approach had previously also been used effectively by a fellow student examining cognition amongst people with schizophrenia. This helped to establish rapport and to ease interviewees into the interview process. A sampling frame was not devised prior to interviewing, however when it became noticeable that certain groups (i. In the end, males were represented more than females in the sample (M=15, F=10) however this could also be a reflection of higher incidence of schizophrenia amongst males (i. Ideally more young participants would have been involved (the youngest participant 75 included was 19 and the second youngest was 25). Additional demographic information was obtained, including participants’ age of illness onset, which ranged from 16-57 years of age. A few participants had relatively late illness onsets (45, 47 and 57 years), however, which may have skewed the average calculation. Notably, four participants indicated that they had been hospitalised too many times to recall the exact number. Ten participants resided alone whereas the remaining 15 lived either with family, a partner or in a share-house situation. The majority of participants were prescribed medication by their psychiatrist (21) and the remainder were prescribed medication by General Practitioners.
Characteristic symptoms - tongue full and coated from base to tip with a yellowish order prochlorperazine 5 mg, pasty fur; bowels tumid buy 5 mg prochlorperazine with visa. Prescribe - Podophyllin thoroughly triturated buy discount prochlorperazine 5mg online, adding a small portion of Capsicum or Ginger, to free purgation. Late in the Fall I was applied to by a Southerner, who told me he had had ague for over a year; he had tried everything, and could get no relief. He had taken Quinine, Fowler’s Solution, Salicine, and indeed all the common drugs. Prescribed - Filled an ounce bottle one-fourth full of Homœopathic pellets, and dropped on them Fowler’s Solution, gtts. The gentleman came to my office in about ten days, and after telling me that he thought he was well, and was going home, said, “Now, Doctor, I wont ask you what your bill is. In 1864 I had to treat three students who, coming from Missouri and Illinois, brought ague with them. During October and the first two weeks of November, they kept the disease partly in check by the use of Quinine and Podophyllin pills. But finally these failed, and the disease commenced to present typhoid symptoms, one of them being confined to his bed. There was no seeming loss of flesh, but the tissues seemed sodden, and expressionless. The tongue and other mucous tissues were tumid and bluish; a brownish fur gathered on the tongue, and sordes about the teeth; the bowels were loose, stools papescent; the chills not very severe, but the fever intense; pulse in intermissions, soft and fluent, during fever small and thready. They had taken the usual remedies, Quinine in full doses, as well as Strychnine; what should I give them? But they will cure some cases, and those are usually inveterate ones that Quinine won’t reach. Clark had suffered with ague for some five years - broken at times - but never free from its effects. Can not take a grain of Quinine without cerebral symptoms; can not take the ordinary medicines in use, because they nauseate and are rejected by the stomach. Evidently a very bad case, and the young Doctor is at his wits’ end to know what to do. Had just been studying the action of remedies, and was at that time especially interested in cutaneous absorption, and concluded I would ask the skin to do the work of the stomach. I have used Quinine inunction in scores of cases since - not always with such positive results, but nearly always with benefit. In children it is a favorite remedy, especially in cases of slow infantile remittent. Kemp, tells me he has employed it in a large number of cases this year and last, and with the most flattering results. Used Ether Spray to chill a surface three inches in diameter over the epigastrium, and applied a Solution of Quinine. I have used Quinine in this way in a few cases, and in part of them with excellent results. Either applied with a sponge, and evaporated by fanning, answers quite the same purpose as the spray apparatus. The Quinine is absorbed when reaction occurs, and it makes little difference to what part of the body it is applied, so the skin is thin. Quinine breaks the chill, but it returns within a week - and then for a time the drug has no influence. I would be glad to have reports from physicians using Boletus, to show the special condition, if any, in which it is curative. Quinine will break it for a few days, but makes him feel so badly, that he dislikes to take it. His skin is sallow, looks full and waxy, and has lost its natural elasticity; extremities are cold most of the time; urine in usual quantity, but of light specific gravity, 110 to 116; pulse is full, but shows want of power; bowels torpid; spleen much enlarged and tender; slight cough; tongue broad and furred white; appetite poor. Recovery was slow, but at the end of the month every vestige of ague had disappeared, and the patient was gaining flesh rapidly. The treatment of ague with Acetate of Potash was strongly recommended by Golding Bird in his work on Urinary Deposits, and will be found an excellent plan in some cases. Ague the second year was treated for some time without success, and was finally broken with Fowler’s Solution in large doses - leaving him with the peculiar puffy condition of face and œdema of lower extremities, that so frequently follows this use of Arsenic. The third year the ague came on, and nothing would reach it, and he came here in September. Skin is sallow, but looks like parchment and is tightly drawn to the tissues; pulse is small and frequent; urine is scant and high colored; bowels irregular, with occasional mucous diarrhœa; tongue looks lifeless, and is covered with a milky looking coat; appetite is poor; greasy eructations, and occasional vomiting of mucoid matter. Gained from the first day, and ceased taking medicine before the end of the third week. I would report these cases as well if I could see how a report of my want of care or want of skill could benefit the reader. I doubt not every one of my readers has a sufficient amount of that experience in his own practice, and need not go abroad for it. What we want to know here, as in every other disease is - the exact condition of disease, and when we know this we can prescribe with certainty. Very certainly it requires something more than to say - “this is ague and I’ll give Quinine;” that is further than I can go in Specific Medication. It has been treated with Quinine, and he is now suffering from quinism, and at times the nervous symptoms are almost unbearable. The special symptoms are - a full blue tongue, and a cutaneous trouble showing the peculiar red glistening surface we see in some cases of erysipelas. Made a good recovery, improving from the first, and has had nothing like ague for the six months past. Now Quinine irritates the nervous system, and the remedy is worse than the disease. The headaches recurred for three days, decreasing in severity, and there was complete and permanent recovery. I have prescribed Nitric Acid in various forms of Chronic disease, when this peculiar symptom presented, with most satisfactory results, and would advise its trial. What we want to learn in regard to this disease might be divided into three parts. That, though the disease is called bilious fever, the liver has nothing to do with it. That, though classified as arising from vegetable malaria, for which Quinine is the specific, it is always best to treat the disease as if it were not so, until the fever, commencing to pass away, leaves the system in good condition for the kindly action of Quinine. And, lastly, there are cases, and seasons, where Quinine must be avoided, if we wish to have success, and not injure our patients. These points are pretty clearly set forth in the “revised edition” of my practice, to which the reader is referred. The patient has a well marked chill, followed by febrile action, and then a very decided remission, together occupying a period of twenty-four hours, and repeating the febrile exacerbation and remission in the same way, each succeeding day. You examine the patient carefully, and you find nothing but fever - no particular lesion of one part or function, more than another. Jones - Give a sufficient amount of Quinine during the decline of the exacerbation and remission to stop the disease. But if it fails the first time, it is safer to prepare the system for its kindly action. An Eclectic was called, and commenced the treatment by the administration of Podophyllin pills to violent catharsis; then Quinine in divided doses; then Podophyllin in alterative (? Had furious delirium, requiring to be held on the bed; skin dry and harsh, pungent heat; mouth and tongue dry, tongue furred, bleeding, almost black sordes upon teeth; pulse 140, small and hard; eyes injected, pupils contracted, had not slept for three days. Probably not so grossly, though it was rather from skepticism than good teaching that I escaped. If I had followed instructions closely, I should probably have ended some of my patients in the same way. Quinine was given in broken doses alternated with Dover’s Powder, Spiritus Mindereri, and Veratrum.
If only this wonderful man could afford his dental work: what a blessing to society he could be for a long time to come buy cheap prochlorperazine 5mg online. Scalp Pain Infection anywhere in the head can cause sensitive scalp and scalp pain order prochlorperazine 5mg with amex. See Recipes for dishwasher liquid purchase prochlorperazine 5 mg fast delivery, dishwasher detergent, and laundry detergent replacements. Diabetes All diabetics have a common fluke parasite, Eurytrema pan- creaticum, the pancreatic fluke of cattle, in their own pancreas. It seems likely that we get it from cattle, repeatedly, by eating their meat or dairy products in a raw state. It is not hard to kill with a zapper but because of its infective stages in our food supply we can immediately be reinfected. Eurytrema will not settle and multiply in our pancreas with- out the presence of wood alcohol (methanol). Methanol pollution pervades our food supply—it is found in processed food including bottled water, artificial sweetener, soda pop, baby formula and powdered drinks of all kinds including health food varieties. If your child has diabetes, use nothing out of a can, package or bottle except regular milk, and no processed foods. By killing this parasite and removing wood alcohol from the diet, the need for insulin can be cut in half in three weeks (or sooner! The insulin shot itself may be polluted with wood alcohol (this is an especially cruel irony—the treatment itself is wors- ening the condition). Test it yourself, using the wood alcohol in automotive fluids (windshield washer) or from a paint store, as a test substance. Drugs that stimulate your pancreas to make more insulin may also carry solvent pollution; test them for wood alcohol and switch brands and bottles until you find a pure one. They do not have a food mold, Kojic acid, built up in their bodies as diabetics do. Being able to detoxify a poisonous substance like wood alcohol should not give us the justification for consuming it. This virus grows in the skin as a wart but is spread quite widely in the body such as in the spleen or liver besides pan- creas. It is not necessary to kill this virus since it disappears when the pancreatic fluke is gone. There might even be a bacterium, so far missed in our observations, that is the real perpetrator. There are additional aspects to diabetes that have been studied by alternative physicians. Perhaps the pan- creas and its islets would heal much faster if grains were out of the diet for a while. Perhaps the 50% improvement that is con- sistently possible just by killing parasites and stopping wood alcohol consumption could be improved further by a month of grain-free diet. Eating fenugreek seeds has been reported to greatly benefit (actually cure) diabetes cases. Wood alcohol also accumulates in the eyes, and there is a connection between dia- betes and eye disease. Heavy metals should be removed from dentalware including all gold crowns and no metal should be worn next to the skin as jewelry, including all gold items. She had pancreatic flukes and sheep liver flukes in her pancreas, vanadium (a gas leak) in her home and cadmium in her water (old pipes). After kill- ing parasites and cleaning kidneys her morning blood sugar was down to 148. This encouraged her so much she did the rest of her body cleanup and could go off her medicine completely. Robert Greene, age 65, had been on insulin five years already, getting two shots a day (25 u each), and even this was not controlling his blood sugar which was 288 in the morning. This was possible because he had wood alcohol accumulated there, from drinking various beverages and using artificial sweetener. As soon as he stopped this practice and killed everything with a frequency gen- erator his blood sugar fell below 100 in the morning and he had to reduce his insulin to 20 units. Ralph Dixon, age 72, had been switched to 30 units of insulin, once a day, after six years on pills for his diabetes. After killing the pathogens and cleaning his kidneys, his blood sugar dropped so he cut his insulin to 25 units (blood sugar was at 111) Soon he had to cut it to 20 units. But if he went off the maintenance parasite program he would promptly get a spike in his blood sugar, showing how easy it was for him to reinfect and how new parasites would immediately find his pancreas. Melissa Bird, 54, had major illnesses including heart disease (2 an- gioplasties), numerous other surgeries and diabetes. Her parasites were instantly eliminated with a fre- quency generator and she was started on kidney herbs for her other problems. Seven weeks later she stated she had to cut down her insulin because her morning blood sugar had dropped to 90. Then she eliminated the decafs and artificial sweetener that were giving her wood alcohol, started the parasite herbs and did a liver cleanse. The day after the liver cleanse her blood sugar went up to 164 but was completely normal after that (under 100) and she did not dare take any more insulin or pills. We advised her to keep monitoring her blood sugar and be very, very vigilant and to please stop smoking. After doing some dental work and parasite killing his fasting blood sugar dropped to a normal 98. Only after changing his diet to include milk did the phosphate crystals stay away and eliminate his cramps. Cornelius Edens, age 33, came for his diabetes, although he also had fatigue, digestion problems, and headaches. He had numerous other minor symptoms like chest pain over the heart, soreness in testicles, etc. His aflatoxin level was very high; he was told to stop eating grocery store bread, eat bakery bread only. He had silver, nickel and very high levels of gold–probably all three coming from his gold crowns– he was to have them all replaced with composite. He was to stop drinking all store bought beverages, whether frozen, powdered, or ready to drink. He did not test positive to benzene, propyl alcohol, Salmonellas, Shigellas, or E. He was to start the Kidney Cleanse recipe for his testicle problem, and after 6 weeks do a Liver Cleanse. Four months later we received a phone call he was too embarrassed to make himself. Prediabetic Alyce Dold, 64, came because she was worried about her blood sugar and chest pain. Indeed, a blood test showed her fasting blood sugar to be 136, just beginning to show insufficient insulin produc- tion by her pancreas. She had six more solvents accumulated due to eating raisin bran and other cold cereals each day. She was glad to be forced off this routine: she switched to 2 eggs every other day with biscuits or bread (not toast) and cooked cereal in between. Her chest pain was due to dog heartworm and Staphylococcus aureus bacteria that originated at teeth #16, 17, 1, 32. Two weeks later, there was still a little residual heart pain due to Staph; dental work was not yet done. Diabetes Of Childhood The problem is the same for diabetes of childhood as for diabetes of later onset, but much easier to clear up, provided the whole family cooperates. He had pancreatic flukes and their reproductive stages in his pancreas as well as wood al- cohol. Adults who get repeated attacks also have low immunity (this is obvious from a blood test where the white blood cell count is less than 5,000 per cu mm). It is often blamed on promiscuous sex but I believe it has quite dif- ferent origins. I have some evidence that it is released from dog tapeworm stages when these are being killed by your immune system. Herpes lives in your nerve centers (ganglia) and it is from here that you can be attacked after the initial infection. But a meal of aflatoxin or other moldy food suddenly “gags” your white blood cells and lets a viral attack happen.
Access to medication history was more frequently used for patients with low socioeconomic 650 status and a greater number of medications cheap prochlorperazine 5mg free shipping. Wang 653 and colleagues found that a positive performance measure based on ease cheap 5 mg prochlorperazine amex, efficiency discount prochlorperazine 5mg amex, and care was correlated with nonuse of an e-Prescribing system incorporating standards for medication history, benefits, and formulary. A study assessing the frequency of use of three common pediatric order sets found differential use rates, with asthma order sets used significantly more often than both appendectomy and community-acquired pneumonia order 649 sets. Three studies looked at usability and also included data on comparison 638,647,652 638 groups. Rosenbloom and colleagues found that highly visible hyperlinks significantly 647 increased the use of educational material and patient information. Satisfaction with various 644,645,656-658 systems used by various health care providers tended to be positive. Differences in satisfaction and perceptions of the systems were found between nurses and 656,657 654,657 654 physicians; medical and surgical staff; and residents compared with physicians. Perceptions of the system impact on work were also found to be different among health care 656,658 providers. Other factors correlated with satisfaction included computer sophistication, 654-657 experience, training, system characteristics, and perceived improvements in care. The new system led to problems in the synchronization and feedback aspects of the joint medication care, leading to the recognition that new systems do not always directly replace 666 the work entailed in old systems and that care processes can be negatively impacted. Of the four studies assessing the communication phase, outcomes 645 540,668,669 assessed included only satisfaction and attitudes. They further produced 11 best practice recommendations to improve e-Prescribing in a community pharmacy setting. Benefits revolved around improved repeat prescription processes, convenience, and a greater role for pharmacists in medication management. The potential for pharmacy systems to assist pharmacists in detecting adverse drug interactions by having greater access to patient information in the form of patient medication 669 profiles was assessed by Kirking in a survey study asking pharmacists using two systems and a third group using no system how often they detected potential drug interactions and how often they contacted prescribers. Computer users reported an average of twice as many detected interactions per week (16. The majority of the differences were the result of users of one of the unnamed computer systems, while the other groups had use rates similar to the noncomputer group. Rupp and Warholak presented best practice recommendations for community pharmacies using e-Prescribing based on surveys showing satisfaction with e-Prescribing in community chain pharmacies. Hurley and 671 colleagues, on the other hand, found significant improvements on a satisfaction scale of 1,087 nurses after implementation of a similar system for efficacy, safety, care, and access factors. Perception of effects did depend on which previous paper system they were used to, and workflow support was perceived as worse by both groups. Most monitoring phase interventions were geared toward patients and showed positive effects on the intermediate outcomes of use, knowledge (self-efficacy), and satisfaction. Ross and 639 colleagues found that online records for heart failure patients improved self-efficacy (91 percent vs. Chemotherapy patients using a mobile phone symptom system reported a number of benefits: better communication, better symptom 633 management, and reassurance of physician access. A study of satisfaction with a reconciliation system found that patients reported satisfaction for self-reported perceptions of clear instructions on what medications to take, how much and how often the medications were to be taken, other instructions on taking the medication, potential side effects, and general understanding of the medications. Health care provider perceptions of satisfaction with reconciliation and instructions did not differ for five factors except for three factors reported by physician assistants and nurse practitioners. Physician assistants and nurse practitioners reported that patients had clearer instructions on discharge (p = 0. Use of an integrated pharmaceutical system to provide information to patients to understand the pharmacological properties of their medications resulted in significantly 648 improved patient knowledge after use of the system. However, even if these technologies are effective, they are expensive to implement and maintain and thus a review of the economic literature to determine cost-effectiveness and value for money for such interventions is warranted. All studies passing the inclusion criteria that were considered to be cost or economics studies were reviewed and categorized into two groups based on the type of economic evaluation used in the analysis: (1) full economic evaluations; and (2) partial economic evaluations. A full economic evaluation is the comparative analysis of alternative courses of action in terms of both costs and consequences. Therefore, the economic evaluations which identify, measure, value, and compare the costs and consequences of the alternative being considered were further classified into one of the three categories: (1) cost-effectiveness analysis; (2) cost-utility analysis; 679 and 3) cost-benefit analysis. The label, partial economic evaluation, indicates that the studies do not entirely fulfill both of the necessary conditions for a full economic evaluation (i. However, cost analyses can provide useful information on ‘upfront’ costs 679 compared with ‘downstream’ cost avoidance. For this reason, both full economic evaluations and cost analyses were included in this review. In each of these classifications, articles were further categorized by setting (i. Descriptive information on the populations, interventions evaluated, the study year, perspective, and country of study were abstracted for each study. Data specific to the costs and effectiveness of each comparison were also abstracted and summarized in Appendix C, Evidence Tables 8a and 8b. The objective of the evaluation was to compare the costs and effects of a multifaceted intervention, including computerized reminders to physicians, aimed at improving prescribing of antihypertensive and cholesterol-lowering drugs compared with the passive dissemination of guidelines. The cost per additional patient started on a thiazide rather than another antihypertensive agent in the intervention group was compared with usual care. It was found that reduced drug expenditures based on increased use of thiazides did not outweigh the costs of the intervention. The authors commented that if the effect was sustained for a second year, the intervention would have been expected to lead to savings. Over the 1-year study period, the authors found that from a societal perspective, the intervention dominated standard care (i. From the health care payer perspective, the incremental cost-effectiveness ratio was €61 per percentage point reduction in the St. Using information obtained from a systematic review of the literature, 681 Karnon et al. It was noted that the monetary value of lost health needed to be included for the interventions to have a high probability of producing positive net benefits. Partial Economic Evaluations Most of the economic literature reported the results of partial evaluations (26 of 31 studies, 84 percent). In other words, the costs of the alternatives were examined separately and the effectiveness, efficacy, or both measures were not used in the analyses, which results in an inability to answer efficiency questions about an intervention. The study compared patients whose microbiologic data were processed in the normal manual manner in the pharmacy to patients whose microbiological data were processed using the computer software. The study patients were matched by diagnosis related groups to patients in the control group. Additionally, the control group patients were adjusted for severity to make the groups more comparable. Antimicrobial utilization was managed by an existing antimicrobial management team using the system in the intervention arm and without the system in the control arm. Direct antibiotic costs, as well as costs incurred by observed adverse events, were similar. A Canadian study in an orthopedic institution assessed the safety and potential cost savings of a computerized, laboratory-based program (i. It is important to note that the cost estimates and potential cost savings are speculative and are meant to be illustrative and not conclusive in nature. A before-after study of the system found no significant difference in the total inpatient costs among the groups before and after intervention. The authors stated that it took over 5 years to realize a net benefit and over 7 years to realize an operating budget benefit. Based on total costs per admission, no significant difference was seen in any of the U. Based on the data from 6 months before and 6 months after the intervention, a 47 redistribution of workload was found. The authors claim that if these effects were extrapolated to all medicine service admissions at that hospital, the projected savings in charges per year would be $3 million in 1993 U. In both studies, care recommendations were displayed electronically to either physicians, pharmacists, or both physicians and pharmacists, compared with no care recommendations. In the asthma and chronic obstructive lung disease study, the authors found no difference in total costs (i. It was noted that these savings coincided with only modest quality improvements in projected mortality rates and length of stay. The impact on total costs was markedly different in the two groups: €264,658 in the usual care group and €170,061 in the intervention group.
Clark: Removing all metal means removing all root ca- nals generic prochlorperazine 5 mg with amex, metal fillings and crowns cheap prochlorperazine 5mg line. But you may feel quite attached to the gold buy 5mg prochlorperazine overnight delivery, so ask the dentist to give you everything she or he removes. The top surfaces of tooth fillings are kept glossy by brushing (you swallow some of what is removed). Bad breath in the morning is due to such hidden tooth infections, not a deficiency of mouthwash! Jerome: If your dentist tells you that mercury and other metals will not cause any problems, you will not be able to change his or her mind. Ask for the panoramic X-ray rather than the usual series of 14 to 16 small X-rays (called full mouth series). This lets the dentist see impacted teeth, root frag- ments, bits of mercury buried in the bone and deep infections. Cavitations are visible in a panoramic X-ray that may not be seen in a full mouth series. Unfortunately, many people are in a tight financial position because of the cost of years of ineffective treatment, trying to get well. Jerome: It is quite all right to have temporary crowns placed on all teeth that need them in the first visit. It is common to find a crowned tooth to be very weak and not worth replacing the crown, particularly if you are already having a partial made and could include this tooth in it. The metal is ground up very finely and added to the plastic in order to make it harder, give it sheen, color, etc. Jerome: Dentists are not commonly given information on these metals used in plastics. Their effects on the body from dentalware 21 Call the American Dental Association at (800) 621-8099 (Illinois (800) 572-8309, Alaska or Hawaii (800) 621-3291). Members can ask for the Bureau of Library Services, non-members ask for Public Infor- mation. Jerome: These are the acceptable plastics; they can be procured at any dental lab. The new ones are very much superior to those used 10 years ago and they will continue to improve. They do, however, contain enough barium or zirconium to make them visible on X-rays. Hopefully, a barium-free va- riety will become available soon to remove this health risk. Jerome: Many people (and dentists too) believe that porcelain is a good substitute for plastic. Porcelain is aluminum oxide with other metals added to get different colors (shades). Jerome for his contributions to this section, and his pioneering work in metal- free dentistry. Horrors Of Metal Dentistry Why are highly toxic metals put in materials for our mouths? Just decades ago lead was commonly found in paint, and until recently in gasoline. The government sets standards of toxicity, but those “standards” change as more research is done (and more people speak out). You can do better than the government by dropping your standard for toxic metals to zero! Opponents cite scientific studies that implicate mercury amalgams as disease causing. Cad- mium is five times as toxic as lead, and is strongly linked to high blood pressure. Occasionally, thallium and germanium are found together in mercury amalgam tooth fillings. If you are in a wheelchair without a very reliable diagnosis, have all the metal removed from your mouth. Try to have them analyzed for thallium using the most sensitive methods available, possibly at a research institute or university. Effects are cumulative and with continuous exposure toxicity occurs at much lower levels. The periph- eral nervous system can be severely affected with dying-back of the longest sensory and motor fibers. Acute poisoning has followed the ingestion of toxic quantities of a thallium-bearing depilatory and accidental or suicidal ingestion of rat poison. Acute poisoning results in swelling of the feet and legs, arthralgia, vomiting, insomnia, hyperesthesia and paresthesia [numbness] of the hands and feet, mental confusion, polyneuritis with severe pains in the legs and loins, partial paralysis of the legs with reaction of degeneration, angina-like pains, nephritis, wasting and weakness, and lymphocytosis and eosinophilia. Thallium pollution frightens me more than lead, cadmium and mercury combined, because it is completely unsuspected. For instance chromium is an essential element of glucose tolerance 24 Dangerous Properties of Industrial Materials, 7th ed. It is volume 10 of a series called Metal Ions in Biological Systems, edited by Helmut Sigel. Their brilliant work and discussion was largely responsible for my pursuit of the whole subject of cancer. Dental Rewards After your mouth is metal and infection- free, notice whether your sinus condition, ear-ringing, enlarged neck glands, headache, enlarged spleen, bloated condition, knee pain, foot pain, hip pain, dizziness, aching bones Fig. So go back to your dentist, to search for a hidden infection under one or more of your teeth, or where your teeth once were! You may be keeping them glossy by the constant polishing action of your toothpaste. In breast cancer, es- pecially, you find that metals from dentalware have dissolved and ac- cumulated in the breast. They will leave the breast if you clear them out of your mouth (and diet, body, home). Buy hot cereals that say “no salt added,” like cream of wheat, steel cut oats or old fashioned 26 oats, millet, corn meal, cream of rice, or Wheatena. Cook it 26 Rolled oats have 235 mcg nickel per serving of 4 ounces, picked up from the rollers, according to Food Values 14th ed. I have only found nickel in the "one-minute" or "instant" variety of oats, however. Could the researchers have accidentally transferred the bacteria from the shell to the inside while they were testing? Eating fish can give you a lot of calcium, but it is in the tiny bones hidden in the fish. Just cook two or three vegetables for lunch and eat them with butter and salt or homemade sauces. Thyme and fenugreek, together, make a flavorful combination you can purchase in capsules. If all this is too much work, make fresh vegetable juice once a week and freeze enough so that you can have a daily nutritious meal just by pouring a glass of it, together with bread and yogurt or milk. I found aflatoxin in commercial bread after just four days in my bread box, but none in homemade bread even after two weeks! Aflatoxin is the toxin in your diet that keeps you from clearing propyl alcohol from your body (see 382)! Aflatoxin is a substance made by mold; bread starts to mold on the grocery store shelf. Make your own salad and salad dressing out of olive oil, fresh lemon juice or white distilled vinegar (apple cider vinegar has aflatoxins), honey, salt and herbs to flavor. Get a sturdy juicer and make your juice about half carrot juice and half from vegetables like celery, squash, lettuce, and broccoli. Make your own tomato sauce with pure herb seasoning, not from ajar or can (home canned foods are fine, of course, as long as they are not made in a big aluminum pot with aluminum-containing salt). Make mashed potatoes from scratch, with milk, not box potatoes, nor chips nor French fries. Other animals are as parasitized as we, full of flukes and worms and Schistosomes in every imaginable stage, and if the blood carries these, would we not be eating live parasites if we eat animals in the raw state?
After all questions were addressed purchase 5 mg prochlorperazine overnight delivery, the consent form was signed indicating voluntary participation prior to collecting data buy prochlorperazine 5mg otc. Study participants received a copy of the consent form with a verbal and written statement of their right to withdraw from the study at any time without negative consequences buy 5mg prochlorperazine visa. Precautions were taken to eliminate risks to confidentiality on all data collection forms and computer files by using non-identifiable or random number codes to identify participants instead of names or other identifiable information. The tool included information such as socioeconomic status (education, income, and occupation), medical history, health care coverage, housing/living arrangements, and transportation. Because adherence reflects the conceptual basis for this study, the term adherence was interchanged with the term compliance throughout this study. Responses are scored on a 4-point Likert scale (1=none of the time, 2=some of the time; 3=most of the time, and 4=all the time). For this study, the medication taking subscale was chosen to assess medication taking behavior plus one item that addressed prescription refills. Adding this one question is consistent with the use of this tool in the literature (Hill et al. Lower 94 scores reflect medication adherence behaviors and higher scores reflect nonadherence. The sample in the original study was 91% Black, 70% female, with a median age of 54 years th and a median 8 grade educational level (Morisky et al. Responses are scored on a 4-point Likert scale (1=strongly disagree, 2=disagree, 3=agree, and 4=strongly agree). In the initial study conducted by Dowd (1991), a sample of 130 undergraduate college students in their early 20s and composed of mostly women 95 (75%) were participants in a test-retest design using 112 items in each session. A total of 28-items out of 112 remained after item-total correlations and factor analysis. A two factor solution (labeled verbal and behavioral) accounted for 26% of the total variance with a correlation of 0. The minimum score is 28 and the maximum score is 112 with higher scores reflecting greater reactance. In a study conducted by Martins, Gor, Teklehaimanot, and Norris (2001), 397 Blacks and over half female (63%), aged 18 to 73 years, were surveyed. To evaluate this test, validity (face and content) and reliability (Cronbach‘s alpha) methods were employed. Therefore, no total score exists and each subscale is standardized to a score of 100 for comparability purposes. Responses are scored on a 4-point Likert scale (never or rarely=1, sometimes=2, frequently=3, and always or daily=4). Although confidence influences self-care, it is not part of the self-care process (Riegel et al. Responses are scored on a 5-point Likert scale (1=strongly disagree, 2=disagree, 3=neutral, 4=agree, and 5=strongly agree). The minimal score is 11 and the maximal score is 55 with higher scores reflecting greater trust. A second study followed with 106 veterans, 62% White, with a mean age of 61 years. The scale has demonstrated construct validity as evidenced by positive correlations with the Multidimensional Health Locus of Control indicating the client‘s desire of control and satisfaction in clinical interactions (Anderson & Dedrick, 1990). Responses are scored on a 5-point Likert scale (1=completely false, 2=somewhat false, 3=don‘t know, 4=somewhat true, and 5=completely true). Scores are recorded as high (above the median) or low (below the median) to reflect coping characteristics of the 98 study group (James, 1996; James et al. However, by age 60 active coping begins to taper as employment and career goals decrease in intensity. Because this tool is important in answering the research questions, the age group of 18 to 60 was included in this study. Responses are scored on a 5-point Likert scale (0=this has never happened to me, 1=event happened but did not bother me, 2=event happened and I was slightly upset, 3=event happened and I was upset, and 4=event happened and I was extremely upset). Scores of global racism or total scale result by converting each subscale score to z scores before summing the scores of each subscale. In a study conducted by Utsey (1999), the 22-item questionnaire was tested on a sample of 239 Black male (n=78) and female (n=138) college students, substance abuse program clients, and an area community along with a subsample of Whites (n=25). Responses are scored on a 4-point Likert scale (not at all=0, several days=1, more than half the days=2, and nearly every day=3). A score of 0-4 represents no depressive symptoms, 5-9 represents minimal depressive symptoms, 10-14 represents minor depressive symptoms, 15-19 represents moderately severe depressive symptoms, and 20-27 represents severe 100 depression symptoms. Any person scoring 5 to 9 were classified as having minimal symptoms of depression, while scores of 10 to 14 were classified as possibly clinically significant, and scores of 15 to 19 and 20 to 27 were classified as warranting active treatment (Spitzer, Williams, & Kroenke, n. An additional item at the end of the tool addressed problem areas checked on the questionnaire: ―How difficult have these problems made it for you to do your work, take care of things at home, or get along with other people‖ (Kroenke et al. Study participants in the medicine clinics had a mean age of 46 (±17), and the majority were White (79%) women (66%), while the obstetrical-gynecology participants were all women (100%) with a mean age of 31 (±11), and the majority were White (39%) and Hispanic (39%). This scale uses true-false questions whereby higher scores reveal the tendency to provide socially desirable answers. According to Crowne (1960), the initial study revealed a Kuder-Richardson formula 20 (K-R 20) reliability coefficient of 0. In a study conducted by Strahan and Gerbasi (1972) to form a new scale with fewer items, a sample of 176 non-college and college males and 185 college and university females were tested. Of the shorter scales, the M-C 1(10) was deemed slightly superior because reliability coefficients were similar across 102 diverse samples when compared to the M-C 2(10), thus, the M-C 1(10) was used for this study. Procedures All potential participants were informed of the study through one or more mechanisms that included flyers, announcements, or social nomination. All questions regarding the study were answered, and if the individual met the inclusion criteria and agreed to participate in the study, an appointment was made to conduct an interview for data collection. Reading the consent form prevented any issues of illiteracy that may affect participation and cause embarrassment (Waltz, Strickland, & Lenz, 2005). After the informed consent was obtained, each participant was assigned an identification number with a designated folder for their data tools. Height was measured using a portable Seca 217 stadiometer with measurements to the nearest 0. With a Gulick tape measure (which included a mechanism to ensure consistent tension when measuring), waist circumference was measured to the nearest 0. The participant stood in an upright position without sucking in the abdomen while the tape was pulled taut without squeezing into the skin. Waist circumference body fat of more than 35 inches (89 cm) for women and more than 40 inches (102 cm) for men increases the risk of heart disease (Heaner, n. Direct visualization of all medications allowed for accurate documentation of medication names, dosages, and time frequencies for administration. In addition, direct 105 visualization minimized embarrassment if names of medications were not known or pronounced correctly. Depression is often unrecognized and therefore not treated, especially in Black women (Artinian, Washington, Flack, Hockman, & Jen, 2006). There was a strong possibility that some study participants may not be able to read because of illiteracy or low literacy skills (Flack et al. This process helped to prevent embarrassment and ensure clarity and understanding of the questions. When instruments had Likert scale responses, the scale was provided to participants as a visual aid during the interview. Respondent fatigue was addressed by alternating the various types of scales, keeping the participant‘s interest by rotating between dull and interesting questions, and controlling the number of questions. In addition, participants were offered a break to prevent fatigue during data collection. Overall results of the research study will be shared with participants upon request while ensuring confidentiality of individual responses. Data Analyses Descriptive statistics were used to describe the demographic characteristics of the sample population. The Shapiro-Wilk test was used to assess normality of all independent variables (Norusis, 2008). In addition, all continuous data had calculated means, ranges, standard deviations, frequencies, skewness, kurtosis, and graphic plots to examine the 107 distribution and cause of nonnormal data.
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