EVIDENCE-BASED PRACTICE PAPER Essay Example | Topics and Well Written Essays - 1500 words

Proof BASED PRACTICE PAPER - Essay Example As indicated by Cleary (143), a few people who don't experience the ill effects of any psychological instability hurt themselves as well as other people; nonetheless, experiencing mental conditions improves the probability of an individual doing self-hurt. People with character issue of any sort are at high danger of harming themselves; including double character issue and marginal character issue. What's more, fears to different regular marvels cause individuals to hurt themselves in one manner or the other, as is melancholy brought about by numerous weights of every day living. Schizophrenia decreases a person’s capacity to recognize genuine and envisioned things, subsequently making an individual mischief self or others. Likewise, schizophrenic patients will in general be self-destructive particularly if the patients are youthful and realize what the malady will do to their lives. Last in the rundown of mental issue is Munchausen Syndrome, however it brings about self-damag e less significantly. Late examinations have indicated that in critical condition patients are additionally in danger of submitting self-mischief or self destruction in outrageous cases, for example, HIV/AIDS patients. Mentally, self-hurt is brought about by any type of injury including youth misuse, mourning, and oppressive connections. Mental imbalance may make patients hurt themselves, while different factors in life in may likewise contribute, including neediness and joblessness. Lesch-Nyhan disorder is simply the main hereditary conditions that bring about self-hurt; nonetheless, hereditary qualities inclines an individual to conditions like pressure and misery that may make a patient self-hurt. Heavy drinkers are simply the most inclined medication clients hurt, representing more than 60 percent of medication clients who do as such. Hurting oneself because of medication impact may happen when an individual is mishandling the medications, because of the enslavement, or in view of withdrawal indications coming about because of endeavoring to stop the propensity (Laye-Gindhu and

DuPont Case Analysis Essay Example for Free

DuPont Case Analysis Essay Presentation: DuPont was built up in the year 1802 by French Chemist, E.I DuPont de Nemours in USA. DuPont got fruitful before third year's over and it began sending out back to its landmass, Europe. In the range of these 200 years, it had formed into a worldwide organization with assortment of ventures like Chemical, Energy, Science Based and High Technology. It amplified its assembling or preparing tasks in 40 nations and its items were sold in 150 places before the finish of 1990. The company’s 33% income originates from the European market from 1960. There are 50 organizations, which utilized in excess of 19,000 individuals in 14 nations of Europe. The researchers of DuPont built up the engineered strands industry by presenting nylon. They were the main maker of artificial filaments on the planet. The most significant result of DuPont is â€Å"Carpet Fibre†. This division was arrangement in Geneva, Switzerland which holds the RD, advertising and creation regions. Items were created in the UK and the business workplaces are in Germany, the UK, France, Belgium, Spain, Scandinavia, and Holland. CASE CONTEXT: DuPont’s item nylon cover fiber isn't unique in relation to different filaments accessible in the market; anyway they were the top players in fiber industry. The parameters like shading and surface are the variables that vary in the rugs. The fiber business has nothing to do with these things. The rug business is worried about these straightforwardly and they thusly prompted the wholesalers, retailers and thus to the clients. From the buyers perspective the rug ought to be bright, its surface is significant and it ought to be effectively kept up. DuPont has done broad research on the clients third intrigue for example upkeep and established the â€Å"Stain Master† that would permit to expel the stains forever. With this innovation, DuPont’s piece of the pie expanded by 5%. This was first presented in USA, later on with minor changes it has been propelled in Europe. It gave blended outcomes for the organization. DuPont’s choice is that the plants ought to have certain quality to utilize the procedure of stain ace. In Germany, numerous plants felt that they don’t have these principles set by them; thus they didn’t show enthusiasm for the item. The UK market and France advertise responded emphatically. Many companied executed similar formulae by giving low quality material at lower costs. This prompted the stake of DuPont’s position in the market by 1980. Realities: DuPont led explore in the European Industry after the decrease of its situation in the market. They came to know some significant realities: Stream of DuPont’s Fibers: DuPont’s Fibers Carpet Mills Wholesalers Retailers End Users The rug plants are amassed in just three nations the UK, France and Belgium. 80-20 guideline is applied in European market; 80% of the business is conveyed yet top 20% producers. To animate the market, they utilized the assistance of Style Books to the wholesalers and retailers. They were not steadfast clients to the fiber business. They concentrated on the organization that gives material at the best cost. Retail and Wholesale activities are altogether different in these nations. In Germanyâ wholesalers ruled in the UK and Belgium retailers ruled the gracefully chain. Issue: DuPont focused uniquely on the floor covering factories and they didn’t put forth any attempt in knowing the end clients. They put cash in RD for making developments in strands that will be provided to the rug factories. They are least tried to think about the clients. Options: DuPont need to focus on the procedures that esteem the clients without influencing the gracefully chain. As floor covering factories are the significant clients to DuPont, they have to hold them. â€Å"Creating faithful clients is at the core of each business†-Don Peppers and Martha Rogers. Distinguish the â€Å"Customer Benefit† and â€Å"Customer Cost† of the clients and give the item at â€Å"Customer-saw value† (CPV). Screen the fulfillment of the client by directing reviews. Investigation OF ALTERNATIVES: In Europe, there are 60 floor covering factories that can level DuPont’s norms; anyway just half of them are utilizing their strands. Rest of them meandering around for best cost. The factories utilizing DuPont’s filaments ought to be held and they have to examine the CPV worth and set the â€Å"price† in like manner. The â€Å"place† is additionally significant for setting the cost as European market is divided not normal for USA advertise which is having just four players. The clients give least inclination to floor coverings when they are purchasing house-hold types of gear. They are abhorring or respecting to look for covering as it is only a cover to secure the floor. Clients go through at any rate 10 weeks in purchasing the carpets.52% Customers purchase floor coverings if the current one is exhausted. Repurchase cycle for rugs is 12 years. Clients are not happy with the item data. The retailers and wholesalers are not giving full data. They are not giving data on value, shading, fitting rooms and quality. On the off chance that â€Å"product† and â€Å"service† quality is kept up, clients would hold with them as it were. They didn’t â€Å"promote† their items. Suggestions: Hold the clients by giving them offers that pulls in them without any problem. Give test strands to half floor covering plants that are not utilizing DuPont’s material and offer a value that fulfill their requirements. Give a gateway to the clients to pick their own shading and configuration as indicated by their decisions by teaming up with factories. Give better client care benefits via preparing the retailers and wholesalers. Give inventories to the clients to better attention to the item, regardless of whether it is retailer, distributer or last end client. Strategy: Distinguish the clients who are faithful to the organization, give them impetuses and advance the item brand. Select the area where deals of the organization are not sufficient and apply the options in contrast to them for example setting cost and offering offers to the rug factories. Later on work together with the plants in that area and train the wholesalers and retailers about the item and give them the full data alongside the lists. Offer better types of assistance to the clients by setting an entrance where they can pick their own plans and spot request to the floor covering factories. Execute the previously mentioned ventures for a quarter of a year and discover the business development. Spread the arrangement in the event that it worked in the chose area, by rolling out moment improvements to it as per the area. Alternate course of action: Since DuPont is a specialist and driving maker in the artificial strands, it can go for â€Å"VERTICAL INTEGRATION†. Rather than providing strands to cover factories, it can set up a factory and production floor coverings. It can straightforwardly manage the clients. The previously mentioned arrangement can be executed without the mediation of the plants. The Customer Satisfaction can be checked and it can become acquainted with the escape clauses all the while and in this manner prompting adjustment of the missteps and expanding the business development of the organization.

The Opioid Epidemic and Medicare Part D

The Opioid Epidemic and Medicare Part D Addiction Drug Use Opioids Print Opioid Abuse Is on the Rise in the Medicare Population American seniors struggle with opioid abuse By Tanya Feke, MD facebook twitter linkedin Tanya Feke, MD, is a board-certified family physician, patient advocate and best-selling author of Medicare Essentials: A Physician Insider Explains the Fine Print. Learn about our editorial policy Tanya Feke, MD Medically reviewed by a board-certified physician Updated on December 08, 2017 Roel Smart / E / Getty Images More in Addiction Drug Use Opioids Cocaine Heroin Marijuana Meth Ecstasy/MDMA Hallucinogens Prescription Medications Alcohol Use Addictive Behaviors Nicotine Use Coping and Recovery From 2000 to 2014, nearly a half million people died from an opioid overdose, 165,000 of those being from prescription  narcotics. In 2016, it was estimated that 78 Americans die from opioid abuse every day. Half of these opioid-related deaths are attributed to prescription drugs. It doesnt matter if you are young or old, rich or poor, opioid abuse is a problem that needs to be addressed by the United States at large. How the U.S. Government Defines Addictive Drugs The Centers for Disease Control and Prevention (CDC) report that overdose deaths from opioids have increased four-fold since 1999. Interestingly, the use of prescription opioids also quadrupled during this time. Is the American health care system to blame? The Drug Enforcement Administration (DEA) assigns drugs to one of five different categories, referred to as Schedules. Schedules I through V describe whether a drug is appropriate for medical use in certain conditions and whether or not it has addictive potential. Schedule I: No medical use, high addictive potentialSchedule II: Medical use, high addictive potentialSchedule III: Medical use, moderate to low addictive potentialSchedule IV: Medical use, low addictive potentialSchedule V: Medical use, lowest addictive potential It should be no surprise that heroin falls under Schedule I (interestingly, so does marijuana). Common prescription opioids that fall into Schedule II are codeine, fentanyl (Sublimaze, Duragesic), hydromorphone (Dilaudid), methadone, meperidine (Demerol), morphine, and oxycodone (OxyContin, Percocet). Schedule III narcotics include combination products containing less than 15 milligrams of hydrocodone per dose (Vicodin), products containing less than 90 milligrams of codeine per dose (Tylenol with Codeine), and buprenorphine (Suboxone). Have you ever been prescribed one of these medications? Pharmaceutical Companies Minimize the Risk for Addiction In 2001, The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) released its first statement on pain management. Intending to bring awareness to under-treated pain and to improve quality of care, JCAHO made recommendations that affected how hospitals monitored, addressed and treated pain. As a result, the pain scale came into existence, and there was an increased public awareness around pain control. That, in and of itself, is a great thing. No one should be in pain. The trouble, however, was that many people misunderstood what pain control was all about. It meant improving pain, not necessarily bringing pain levels down to 0 on a 0-10 scale. Elimination of pain is not always possible. With that came pressure on the health care system to live up to unrealistic expectations. While JCAHO did not tell healthcare providers how to treat pain, concern was raised over materials the Commission distributed that were sponsored by Purdue Pharma, the pharmaceutical company that makes OxyContin. The materials minimized the link between opioid medications and addiction. Pharmaceutical representatives for the company went so far as to say that the risk for addiction was  less than one percent when it was long known that the risk for abuse in non-cancer patients could reach as high as 50 percent. In fact, Purdue Pharma was later found guilty of misleading marketing practices and fined $634 million. It is important to note that the Joint Commission no longer distributes those materials to healthcare professionals but had the damage already been done? JCAHO states that prescription opioid use was on the rise before they released their statement but it is important to note that it continued to rise in the aftermath of the pain scale. Government Policies May Have Affected Opioid Prescribing In 2006, the Centers for Medicare and Medicaid Services (CMS) initiated the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). The survey was used as a way to assess hospital performance and was completed by patients based on their experience during their hospital stay. HCAHPS includes questions about pain control: How often was your pain well controlled? and How often did the hospital staff do everything they could to help with your pain? The responses are subjective and do not necessarily represent what the patient actually received for pain control or if the care was the most medically appropriate. A patient who expected 0 on the pain scale could rate a hospital with a low score even if his pain was much improved over his stay. Still, it was a step in the right direction to hear how patients perceived their care. The problem? HCAHPS scores were linked to hospital reimbursement rates. CMS would pay hospitals more if they had higher scores. While CMS claims the pain control questions contributed little to payment, the fact is that they were included. The concern is that some healthcare professionals may have felt pressured to prescribe opioids to achieve higher scores. Aware that HCAHPS could have contributed indirectly to increased prescription opioid use, CMS has since removed the pain control survey questions from their reimbursement model. The data continues to be collected, however, to help hospitals improve quality of care and pain control. Medicares Increased Use of Opioid Drugs A 2016 study in JAMA Internal Medicine raised eyebrows when it revealed that Medicare beneficiaries were being prescribed a disproportionate amount of opioid medications after hospital stays. Specifically, researchers reviewed hospitalizations for approximately 623,000 Medicare beneficiaries in 2011. These beneficiaries were not previously on opioid medications, at least not for the 60 days preceding their hospital stay. Nearly 15 percent of them filled a new opioid prescription within one week of hospital discharge and 42.5 percent of them continued on those medications for longer than 90 days. For anyone who questioned whether HCAHPS affected prescription patterns, the study showed a modest correlation between inpatient satisfaction scores and new opioid prescriptions. Another study, this time in JAMA Psychiatry, also showed a concerning trend. Data from Medicare Part D was assessed and it was found that 6 in 1,000 Medicare beneficiaries have an opioid abuse disorder. This is a six-fold increase compared to people on other insurance plans. Why are Medicare beneficiaries more prone to opioid abuse? Do they truly have more chronic pain? Are they more likely to be put on opioids because, as seniors, they tend to have more hospitalizations? In that regard, is HCAHPS to blame? More investigation is needed so that we can get at the heart of the problem. We need to not only prevent opioid abuse but also the complications that surround it. What Can We Do to Stop Opioid Abuse? The opioid epidemic does not belong to any one group. Multiple factors led to this state of affairs, and collaboration between the government, pharmaceutical companies, insurance companies, healthcare systems and healthcare providers will be needed to make effective changes. These steps may help to move us in the right direction. Policies and regulations should not allow reimbursements to healthcare systems based on patient satisfaction scores that may relate to prescription drug use. This could shift prescription patterns in a way that favors higher payments to hospitals.Research needs to be done to develop newer less addictive pain treatments. Pharmaceutical companies and others need to invest money to increase available options.Insurers need to expand coverage of alternative pain therapies. Acupuncture, biofeedback, massage therapy, and physical therapy, for example, have shown benefit in improving pain levels but insurance does not always cover them.Healthcare providers may need additional training when it comes to pain management strategies and use of prescription opioids.Other pain therapies should be considered before opioid medications whenever possible. Using opioid therapies first-line is more likely to lead to continued use of those medications.Access to rehabilitation programs (counseling, medicat ions, etc.) that promote recovery from opioid abuse needs to be improved. People need help but limited resources are available to address the magnitude of the problem at the present time.