Controversial Treatments and Legislative ChangeCourse Outcomes addressed in this assignmentMN506-3: Evaluate the implications of the effects of contemporary health policy on providers and consumers.MN

Controversial Treatments and Legislative Change

Course Outcomes addressed in this assignment

MN506-3: Evaluate the implications of the effects of contemporary health policy on providers and consumers.

MN506-4: Assess the legislative and policy-making strategies specific to scope of practice and nursing roles that influence health care services and practice.

The group will choose a health care treatment option that is controversial and maybe costly. Describe the positive and negative benefits from the treatment, evidence of effectiveness, and the potential harm of a different treatment option. What strategies would you use to advocate for a legislative change in your state to influence insurance coverage for this treatment.

1. Choose a controversial health care treatment option. Describe the treatment.
2. Describe the social and legal controversy associated with your controversial treatment.
3. Describe the evidence that supports the effectiveness of the controversial treatment.
4. Describe the evidence that does not support the effectiveness of the controversial treatment.
5. Compare and contrast the positive and negative benefits or harm of the controversial treatment.
6. Compare and contrast positive and negative aspects of available traditional treatments.
7. Compare and contrast the costs of the controversial treatment with the costs associated with traditional treatments
8. Describe the required process for legislative change to occur in your state.
9. Describe a strategies that you would you use at the local and state level to advocate for a legislative change in your state that would influence insurance coverage for this treatment.
10. Provide an estimated timeline for your legislative change to occur. Use the steps describe in required process for legislative change for your state.

Note:

• This is a fact-based Assignment that will not include your opinion.
• This will require research and support for what is written.
• The Assignment should be in your words after reading the scholarly and fact-based publications and have proper citations. There should be no quotations. The professor wants to hear your voice as a masters trained nurse.
• The paper should have a minimum of seven citations and some of these should be case law or applicable statutes.
• Due: Day 7 by 11:59 p.m. (ET)

To view the Grading Rubric for this Assignment, please visit the Grading Rubrics section of the Course Resources.

Assignment Requirements:

Before finalizing your work, you should:

• Be sure to read the Assignment description carefully (as displayed above);
• Consult the Grading Rubric (under the Course Resources) to make sure you have included everything necessary; and
• Utilize spelling and grammar check to minimize errors.

Your writing Assignment should:

• Follow the conventions of Standard American English (correct grammar, punctuation, etc.;
• Be well ordered, logical, and unified, as well as original and insightful;
• Display superior content, organization, style, and mechanics; and
• Use APA 6th Edition format as outlined in the APA Progression Ladder.

How to Submit

Submit your Assignment to the unit Dropbox before midnight on the last day of the unit.

Each student was assigned to a team in Unit 4 and the Assignment was discussed at length in the Unit 4 Seminar.

When you are ready to submit your Assignment, click the Dropbox tab and select this unit’s basket from the dropdown menu, then attach your file. Make sure to save a copy of your work and be sure to confirm that your file uploaded correctly.

********Our topic is on bariatric surgery and I have questions number 9 & 10 to discuss and the c

The Case Study Approach and Problem ScopingNow that you know a little more about creative problem solving and the importance of health literacy, you will take the next step to approaching a problem by

The Case Study Approach and Problem Scoping

Now that you know a little more about creative problem solving and the importance of health literacy, you will take the next step to approaching a problem by completing the initial phase of Creative Problem Solving: Problem Scoping. This process establishes clear requirements for creating a viable final solution. It often is initiated by the identification of a need or issue. This part of the problem-solving process focuses on the issue/need by gathering and analyzing information. In other words, you will clearly define what needs to be done prior to creating an effective solution.

This SLP will help you practice your problem-scoping skills by completing a clear, focused Problem Scoping Document. This will provide a clear problem definition and target for solution development.

Problem Scoping Assignment Instructions:

As you complete the problem-scoping phase, your proposed document will include the following information:

• Develop a problem statement.
• Determine any potential constraints.
• Determine the criteria.
• Identify the stakeholders.
• Develop a procedure for gathering data prior to decision making.

Be sure to thoroughly complete and submit the Problem Scoping Document Template.

Select a public health issue from the CDC website that you reviewed for Module 3 at http://www.cdc.gov/features/datastatistics.html and incorporate the information found there into a Problem Scoping document by following these steps:

1. Determine what questions you would ask yourself:
   1. Scope of the problem—Part of the Problem Statement.
   2. When and where the problem occurs—Part of the Problem Statement.
   3. Impact—Part of the Problem Statement.
   4. Identify two criteria related to the problem statement that you created.
   5. Who is directly involved with the problem? Stakeholders?
2. Determine how you would gather data important to educating the public on this issue.

SLP Assignment Expectations

Address each step above in the Problem Scoping Word document template.

I would like to do my project on Fall Prevention in the Medical Surgical Setting The purpose of this assignment is to draft an appropriate and effective PICOT question that can be related to your DNP

I would like to do my project on Fall Prevention in the Medical Surgical Setting

The purpose of this assignment is to draft an appropriate and effective PICOT question that can be related to your DNP project. Keep in mind your project will continue to evolve and take more specific shape as you move through your program. That is expected. It is important to begin with a workable PICOT question in mind so that you start off on the right track and can continue to refine your area in subsequent courses.

Consider an advanced practice nursing care problem or issue related to your intended DPI Project. Conduct a search in the GCU Library using CINAHL, The Cochrane Library, the Joanna Briggs Institute (JBI), OVID, or Sage Research Methods databases to find appropriate empirical resources regarding applicable nursing intervention research.

General Requirements:

• Doctoral learners are required to use Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
• This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
• You are not required to submit this assignment to Turnitin.
• Review the “PICOT Decision Pathway” and “PICOT Selection Guidelines” resources.

Directions:

1. Utilizing your feedback you have received on your draft PICOT question from Topic 2 DQ1, create a draft PICOT question specifically related to your project. This PICOT will be revised and in Topic 8 will be submitted for approval by the college.
2. Use the “PICOT Decision Pathway” to determine if your PICOT question is appropriate and can be supported with substantial research.
3. Using the “PICOT Question Template”, formulate an evidence-based practice (EBP) question that pertains to your project focus.
4. In addition to your evidence-based practice PICOT question, prepare a brief abstract about your topic. Include a rationale for why you have selected this topic and why you believe it is in line with the PICOT selection guidelines. If you have selected a route that advises caution on the “PICOT Decision Pathway” explain how you think you might mitigate complications that could occur to ensure you are able to successfully accomplish your project in a timely manner.

Assignment 3 Worth a total of 50 points. Read each abstract or excerpt carefully. These are all from published reports/papers. Please type your answers for your final submitted version and use compl

Assignment 3   

These are all from published reports/papers. Please type your answers for your final submitted version and use complete and clear sentences. No bullets and no one word answers except for the “1 pt.” questions, where appropriate. In some cases the selections have been edited to remove obvious answers J.

1.       Since marijuana legalization, pediatric exposures to cannabis have increased.1 To date, pediatric deaths from cannabis exposure have not been reported. The authors report an 11-month-old male who, following cannabis exposure, presented with central nervous system depression after seizure, and progressed to cardiac arrest and died. Myocarditis was diagnosed post-mortem and cannabis exposure was confirmed. Given the temporal relationship of these two rare occurrences – cannabis exposure and sudden death secondary to myocarditis in an 11-month-old – as well as histological consistency with drug-induced myocarditis without confirmed alternate causes, and prior reported cases of cannabis-associated myocarditis, a possible relationship exists between cannabis exposure in this child and myocarditis leading to death. In areas where marijuana is commercially available or decriminalized, the authors urge clinicians to preventively counsel parents and to include cannabis exposure in the differential diagnosis of patients presenting with myocarditis.

A.      What kind of study is this and why is it used here? (2pts)

B.      What is the comparison group? (2pts)

C.      What is the measure of effect (if any)? (1pt)

2.       Background: The aim was to study whether number of visits to emergency department (ED) is associated with suicide, taking into consideration known risk factors. Methods: This is a population-based study nested in a cohort. Computerized database on attendees to ED (during 2002-2008) was record linked to nation-wide death registry to identify 152 [suicides], and randomly selected 1520 [non-suicides]. The study was confined to patients attending the ED, who were subsequently discharged, and not admitted to hospital ward. Odds ratio (OR) and 95% confidence intervals (CI) of suicide risk according to number of visits (logistic regression) adjusted for age, gender, mental and behavioral disorders, non-causative diagnosis, and drug poisonings. Results: Suicides had on average attended the ED four times, while [non-suicides] attended twice. The OR for attendance due to mental and behavioral disorders was 3.08 (95% CI 1.61-5.88), 1.60 (95% CI 1.06-2.43) for non-causative diagnosis, and 5.08 (95% CI 1.69-15.25) for poisoning. The ORs increased gradually with increasing number of visits. Adjusted for age, gender, and the above mentioned diagnoses, the OR for three attendances was 2.17, for five attendances 2.60, for seven attendances 5.97, and for nine attendances 12.18 compared with those who had one visit. Conclusions: Number of visits to the ED is an independent risk factor for suicideadjusted for other known and important risk factors. The prevalence of four or more visits was 40% among [suicides] compared with 10% among [non-suicides]  . This new risk factor may open new venues for suicide prevention. [ABSTRACT FROM AUTHOR]

A.      What type of study is this and why might they have used this design? (2pts)

B.      Describe the comparison groups. (2pts)

C.      Summarize and describe the results in “lay” terms – but still quantitatively. (4pts)

3.       There has been no worldwide XXXXXXXXXXXXX study on suicide as a global major public health problem. This study aimed to identify the variations in suicide specific rates using the Human Development Index (HDI) and some health related variables among countries around the world. In this XXXXXXXXXX study, we obtained the data from the World Bank Report 2013. The analysis was restricted to 91 countries for which both the epidemiologic data from the suicide rates and HDI were available. Overall, the global prevalence of suicide rate was 10.5 (95% confidence intervals: 8.8, 12.2) per 100,000 individuals, which significantly varied according to gender (16.3 in males vs. 4.6 in females, p < 0.001) and different levels of human development (11.64/100,000 individuals in very high development countries, 7.93/100,000 individuals in medium development countries, and 13.94/100,000 individuals in high development countries, p = 0.004). In conclusion, the suicide rate varies greatly between countries with different development levels. Our findings also suggest that male gender and HDI components are associated with an increased risk of suicide behaviors. Hence, detecting population subgroups with a high suicide risk and reducing the inequality of socioeconomic determinants are necessary to prevent this disorder around the world.

A.      What type of study is this and why might they have used this design? (2pts)

B.      Describe the study population. (2pts)

C.      Should suicide rates have been standardized and why or why not? (2pts)

D.      What is the best interpretation of these results and why? (2pts)

4.       Background and Aims Although they often co-occur, the longitudinal relationship between depression and substance use disorders during adolescence remains unclear. This study estimated the effects of cumulative depression during early adolescence (ages 13-15 years) on the likelihood of cannabis use disorder (CUD) and alcohol use disorder (AUD) at age 18. Design XXXXXXXXXX study of youth assessed at least annually between 6th and 9th grades (~ age 12-15) and again at age 18. Marginal structural models based on a counterfactual framework that accounted for both potential fixed and time-varying confounders were used to estimate cumulative effects of depressive symptoms over early adolescence. Setting The sample originated from four public middle schools in Seattle, Washington, USA. Participants The sample consisted of 521 youth (48.4% female; 44.5% were non-Hispanic White). Measurements Structured in-person interviews with youth and their parents were conducted to assess diagnostic symptom counts of depression during early adolescence; diagnoses of CUD and AUD at age 18 was based the Voice-Diagnostic Interview Schedule for Children. Cumulative depression was defined as the sum of depression symptom counts from grades 7-9. Findings The past-year prevalence of cannabis and alcohol use disorder at the age 18 study wave was 20.9 and 19.8%, respectively. A 1 standard deviation increase in cumulative depression during early adolescence was associated with a 50% higher likelihood of CUD [prevalence ratio (PR) = 1.50; 95% confidence interval (CI) = 1.07, 2.10]. Although similar in direction, there was no statistically significant association between depression and AUD (PR = 1.41; 95% CI = 0.94, 2.11). Further, there were no differences in associations according to gender. Conclusions Youth with more chronic or severe forms of depression during early adolescence may be at elevated risk for developing cannabis use disorder compared with otherwise similar youth who experience fewer depressive symptoms during early adolescence.

A.      What type of study is this and how can you tell? (2pts)

B.      What was the exposure? (2pts)

C.      How does the prevalence ratio reported here differ from the risk or prevalence ratios we have seen thus far in this class? (2pts)

D.      What is the best interpretation of these results and why? (2pts)

5.       Study Description: Tapentadol has already been studied in adults. This study is needed to find out if tapentadol works and is safe to use in children and adolescents with long-term pain. During the first 2 weeks of the study (Part 1), participants will be given either tapentadol or morphine prolonged-release tablets. Assignment will be done randomly (like tossing a coin). The participant and the caregiver will know which medication they are taking. The primary endpoint is based on data collected in Part 1 of this XXXXXXXXX. If eligible and willing, participants from Part 1 can enter a 12 month follow-up period (Part 2). In Part 2 of this XXXXXXXparticipants will be treated with tapentadol prolonged release tablets or with the standard of care (observation arm).Outcomes: Binary variable “responder”. [ Time frame: up to Day 14 (End of Part 1) ] A participant is defined as responder if both of the following criteria are met: Completion of the 14-day TreatmentPeriod (Part 1). One of the following calculated from the scheduled pain assessments (“pain right now”) documented during the last 3 days of the Treatment Period: Average pain less than 50 on a visual analog scale (VAS) for subjects aged 12 years to less than 18 years; or less than 5 on the Faces Pain Scale-revised (FPS-R) for subjects aged 6 years to less than 12 years. Average reduction from baseline of pain greater than and equal to 20 on a VAS for subjects aged 12 years to less than 18 years; or greater and equal to 2 on the FPS-R for subjects aged 6 years to less than 12 years. The proportion of participants classified as responders will be assessed and compared between the treatment groups NOTE this is an ongoing study so no results are reported yet.

A.      What type of study is this and why might they have used this design? (2pts)

B.      Why is the comparison group given morphine instead of a placebo?. (2pts)

C.      What is the outcome of this study and who will be counted? (1pt)

D.      What effect measure will most likely be used and why? (1pt)

E.       If (for example) patients on tapentadol are found to be 16% more likely to be “responders” than those on the standard morphine treatment what would the value of the effect measure be? (2pts)

6.       Background: Supervised injection facilities (SIFs) are legally sanctioned environments for people to inject drugs under medical supervision. SIFs currently operate in ten countries, but to date, no SIF has been opened in the USA. In light of increasing overdose mortality in the USA, this study evaluated willingness to use a SIF among youth who report non-medical prescription opioid (NMPO) use. Methods: Between January 2015 and February 2016, youth with recent NMPO use were recruited to participate in the Rhode Island Young Adult Prescription Drug Study (RAPiDS). We explored factors associated with willingness to use a SIF among participants who had injected drugs or were at risk of initiating injection drug use (defined as having a sex partner who injects drugs or having a close friend who injects). Results: Among 54 eligible participants, the median age was 26 (IQR = 24-28), 70.4% were male, and 74.1% were white. Among all participants, when asked if they would use a SIF, 63.0% answered “Yes”, 31.5% answered “No”, and 5. 6% were unsure. Among the 31 participants reporting injection drug use in the last six months, 27 (87.1%) reported willingness to use a SIF; 15 of the 19 (78.9%) who injected less than daily reported willingness, while all 12 (100.0%) of the participants who injected daily reported willingness. Compared to participants who were unwilling or were unsure, participants willing to use a SIF were also more likely to have been homeless in the last six months, have accidentally overdosed, have used heroin, have used fentanyl non-medically, and typically use prescription opioids alone. Conclusions: Among young adults who use prescription opioids non-medically and inject drugs or are at risk of initiating injection drug use, more than six in ten reported willingness to use a SIF. Established risk factors for overdose, including homelessness, history of overdose, daily injection drug use, heroin use, and fentanyl misuse, were associated with higher SIF acceptability, indicating that young people at the highest risk of overdose might ultimately be the same individuals to use the facility. Supervised injection facilities merit consideration to reduce overdose mortality in the USA.

A.      What type of study is this and why might they have used this design? (2pts)

B.      Describe the study population and the comparison group. (2pts)

C.      Should any of these results be standardized and why or why not? (2pts)

D.      What are some concerns (as an epidemiologist) you might have about these results and why? (2pts)

7.       Objective. To evaluate the time of onset, overall efficacy, and safety of fentanyl buccal tablet (FBT) for noncancer-related breakthrough pain (BTP) in opioid-tolerant adults over 12 weeks. Design. A novel 12-week study that mimicked clinical practice with dose titration to effective dose, open-label treatment, and three randomized, double–blind, placebo-controlled, multiple-crossover periods at weeks 4, 8, and 12. For each double–blind period, study patients received nine doses (FBT = 6, placebo = 3) in a randomized sequence. Setting. Twenty-one study centers in the United States. Population. Opioid-tolerant adults with noncancer-related chronic pain and BTP. Outcome Measures. The primary outcome was the sum of the pain intensity differences (PID) 5–60 minutes post dose (SPID60) during the final double–blind period. Secondary outcomes included pain relief (PR), meaningful PR, and proportion of episodes with a PID of ≥33% and ≥50%. Results. Of 148 patients who entered the titration phase, 105 (71%) achieved a successful dose and 81 (55%) participated in all three assessment periods in the study. The final RCT assessment period results demonstrated continued efficacy of FBT vs placebo ( P < 0.05) for SPID60 (mean [SD]: 7.7 [6.2] vs 4.6 [4.7]). The average onset of PR began at 5 minutes, with meaningful PR by ≤10 minutes. The proportion of episodes with ≥33% improvement in PI was 7% with FBT vs 3% with placebo at 5 minutes and with ≥50% was 17% vs 10% at 15 minutes. All periods showed similar results. Adverse events and patient discontinuations were generally typical of clinical opioid use. Conclusions. FBT showed continued clinically important analgesic effects and was generally well tolerated over 12 weeks of treatment.

A.      Why is a placebo being used?(2pts)

B.      Who is being treated and who is being given a placebo? (2pts)

C.      What is the RR of an episode ending with pain relief of ≥33% comparing one treated with FBT to a placebo? (1pt)

D.      By 10 minutes how many episodes of breakthrough pain result in ≥50% improvement in pain intensity and how does that compare to those who are treated? (1pt)

E.       Overall what is your impression of this as a solution to break through pain and why? (2pts)

DiscussionA special focus of this course is executive communications that are succinct, strategic, and supported. Accordingly, your initial post should not exceed 500 words in the Discussion Area. Fol

Discussion

A special focus of this course is executive communications that are succinct, strategic, and supported. Accordingly, your initial post should not exceed 500 words in the Discussion Area. Follow-up posts should not exceed 300 words.

 Select any one of the following starter bullet point sections. Review the important themes within the sub questions of each bullet point. The sub questions are designed to get you thinking about some of the important issues. Your response should provide a succinct synthesis of the key themes in a way that articulates a clear point, position, or conclusion supported by research. Select a different bullet point section than what your classmates have already posted so that we can engage several discussions on relevant topics. If all of the bullet points have been addressed, then you may begin to re-use the bullet points with the expectation that varied responses continue.

• Power is an important tool. Getting the power equation right is tricky; it is the toughest with a leader’s immediate team. Leaders have difficulty exercising power within their team due to the close interpersonal dynamics and face-to-face encounters with other emotional human beings. From your experience with or observation of leaders, identify a leader who demonstrated effective use of power within the team. Why do you believe the leader demonstrated effective use of power? Identify a leader who did not demonstrate effective use of power within the team. Why do you believe the leader did not demonstrate effective use of power? Analyze the characteristics of each leader’s behavior. What were the behaviors that were effective or ineffective? Make sure to analyze how developmentally minded the leader appeared to be as he or she interacted with and led the team. What leadership lessons can you learn?
• It is important for a leader to use power clearly and appropriately to gather cooperation for and commitment to any decision, building cohesiveness within the team. There are three fundamental sources of power: coercive, utilitarian, and normative. Coercive power uses punishment to force cooperation and commitment. Utilitarian power uses incentives. Normative power uses value alignment. Which source of power is most frequently utilized in your organization? How would you rank the three sources of power in terms of their frequency of use within your organization? Which source of power is most appealing to you from the perspectives of both a leader and a follower? What leadership lessons can you learn?
• Teamwork requires trust among team members so that (a) all members can depend on each other, (b) all members contribute their share of the work, (c) the team distributes resources fairly, and (d) the team includes and informs everyone through open and honest communication. High-performing teams consciously establish and maintain an environment of trust. Trust becomes a felt presence, an accepted norm, and a foundation for all that the team does. Think about all the teams you have been in. Select the team that was characterized by an environment of trust. Describe the team and what it did. How was the environment of trust established? How did you know an environment of trust was present? What did you see, hear, and experience? What were the benefits of the environment of trust for the team members, their work, and the organization? What did you learn from this team that might help your current or future teams build a stronger environment of trust?
• Among the most important skills of good coaches are listening and the use of powerful questions. Think about the best leaders that you have experienced. Were they good coaches? Describe their listening and interaction skills. How did they use questions? How did their listening and questioning activities make you feel? How did they affect your performance? Your development? Conversely, how have some of the worst leaders that you experienced used listening and questioning? How would you rate them as a coach-leader? How did their practices impact you and your performance? How might we evaluate coaching as an effective or ineffective approach to leadership?