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The Introduction Of Clozapine Nursing Essay

Clozapine is the only drug specifically indicated for treatment-resistant schizophrenia and also for treatment of patients with high risk o suicide and aggressive behavior. A meta-analysis of randomized clinical trials confirmed its superiority in this patient population compared with other antipsychotics, both first- and second-generation. A growing number of reports suggest that clozapine may also have a role in other psychiatric conditions such as manic episode. Some patients, however, do not have an adequate response to clozapine. As with other medications, adherence and pharmacokinetic matters must be addressed. This project was a 24-months noninterventional and observational study from January 2009 to December 2010, conducted in Clinical Department for acute patients belonging to the Psychiatry and Neurology Hospital, the most important in the region. Patients with age above 18 years were considered for entry into the study if they were eligible according to criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) as having schizophrenia in acute exacerbation. Our study was designed to investigate the treatment management of a really heterogeneous patients with schizophrenia hospitalized for acute exacerbation in a naturalistic setting of acute psychiatric departments and to identify the patterns of treatment used by the psychiatrist when they decided to use clozapine. Investigators recorded all the data about the patients (gender, age, age of onset of schizophrenia, marital status, education, type of assurance, number of days of hospitalization) and data regarding pharmacotherapy that had been prescribed during hospitalization. Patient’s demographics and illness characteristics were analyzed using descriptive statistics. We used Analysis of variance (ANOVA) including post-hoc comparisons to test the difference between means in first generation antipsychotics (FGA) and second generation antipsychotics (SGA) groups. Categorical data were analyzed using Chi-square test. All calculations were made by Stat Soft Statistics v.4.5. Statistical significance was set at P value less than 0.05. A total of 273 patients hospitalized for an acute exacerbation of schizophrenia entered into the study. The vast majority of patients met the criteria for paranoid schizophrenia (74.8%), followed by undifferentiated schizophrenia (21.3%), disorganized schizophrenia (1.2%) and catatonic type (0.08%). The mean age across the group was 42.67 years (SD=11.2) with significant difference between female and male (female mean age was 44.25 and male mean age was 41.1, p<0.001). It was also a difference between female and male regarding the age of onset schizophrenia; the mean age of onset of schizophrenia in male was with 2.9 years earlier than in female cases (25.63 vs.28.52, p<0.001). The mean schizophrenia duration was 15.72 years (SD=9.4), being higher in women than men (16.91 vs.14.54). The level of education of the group was relatively high, with mean years of education above 10 years of studies, greater in male cases. The results of hospitalization indicated a mean of 22.25 days (SD=10.50), almost equal for female and male. The mean age of onset of schizophrenia was statistically significant lower in male patients treated with SGAs compared with those treated with FGAs (24.62 vs. 26.84, p<0.001). An important aspect of our study was to evaluate the combinations used in treatment of schizophrenia indicated at discharge after an acute episode. All patients with schizophrenia under study were treated with first or second generation antipsychotics in different proportions. Of 273 patients treated with ,,atypical” received amisulpride (25.27%), aripiprazole (0.7%), clozapine (26.37%), olanzapine (27.73%), quetiapine (7.32%) and risperidone (13.55%). There were only 14 patients who received FGAs alone at discharge (6.70%) compared with 93 patients who received mono-therapy with SGAs (34.06%, p<0.0001). Combination between FGAs and benzodiazepine was indicated in 11.00% of cases being lower than in SGAs and benzodiazepine with was prescribed in 19.41% of cases (p = 0.01). The number of patients who received antiparkinsonian compounds in combination with antipsychotics was significantly higher for FGA (p=0.0004). The combination antipsychoticbenzodiazepine-mood stabilizer triple combination was found in approximately equal proportions for the two types of antipsychotics (p = 0.69). The number of patients who have had their treatment regimen at discharge with a combination included antipsychoticbenzodiazepine-mood stabilizer and antiparkinsonian was significantly greater in FGAs cases (16.27%) compared with SGAs (2.93%), p<0.0006. Analysis of variance between the type of treatment chosen at discharge and the average length of hospitalization revealed no statistically significant differences between the group treated with FGAs and SGAs, the values obtained were approximately equal. It was a significant difference between atypical antipsychotics in terms of psychotropic added; amisulpride was prescribed alone in 4.35% cases and was associated most frequently with benzodiazepine, mood stabilizers or both of them compared with olanzapine and clozapine (p<0.005). The treatment with clozapine alone was recorded in 50%. We observed many similarities between treatment with clozapine and olanzapine (the almost same percentage regarding number of patients treated with those antipsychotics and the number of patients who needed benzodiazepine and mood stabilizers). There were no significant differences regarding hospitalization, gender and type of antipsychotic treatment between the two groups. The mean duration of illness was greater in group treated with FGAs compared with SGAs group and it was significant for male (p<0.001). Our observational study was the first study in Romania who intended to explore the patterns in antipsychotic treatment with clozapine in patients with schizophrenia in terms of demographics, hospitalization duration and necessity of other psychotropic compounds. Despite treatment guidelines and consensus of experts in psychiatry, the severity of schizophrenia frequently required adaptation of treatment and therapeutic combinations that often exceed imposed boundaries. In our study we noted the high percentage of patients who received treatment with clozapine, often in attempting to resolve psychotic symptoms or extreme agitation. Although all antipsychotics have been used in therapeutic doses, most times the maximum recommended dose, lack of therapeutic response in many cases required a combination of a benzodiazepine or mood stabilizer even in a clozapine case. The challenge of treatment-resistant schizophrenia with agitation or high risk of aggressive behavior continues despite the advent of a second-generation class of antipsychotics. Further research in treatment of schizophrenia is clearly needed to address the needs of patients who remain substantially symptomatic and disabled even with the use of currently available antipsychotic agents. In Romania, psychiatrists exhibited different approach of clinical concepts and on prescription guidelines of antipsychotics and they are influenced by patient’s age and personal experience. It is necessary to reach a consensus to establish and standardize the treatment of schizophrenia, based on the information reported in naturalistic trials to avoid inadequate treatments in schizophrenia. 1062 words
University of San Francisco Mother Created by Author Lewin Funke Museum Report.

For this assignment, you will visit a virtual art museum and write an analysis of one artwork. Download and read the instructions in their entirety before proceeding with this assignment.For the Museum Report, you are asked to visit a virtual museum and choose one artwork to analyze. Please choose from any of the following venues.Remember to take a screenshot of your artwork within the museum of choice and include it at the end of your paper.Virtual ToursDali Museum (Links to an external site.)The Frick, Pittsburgh (Links to an external site.)The Louvre (Links to an external site.)São Paolo Museum of Art (Links to an external site.)Vatican Museums (Links to an external site.)British Museum (Links to an external site.)Getty Museum (Links to an external site.)Uffizi Gallery (Links to an external site.)National Gallery of Art, London (Links to an external site.)Van Gogh Museum (Links to an external site.)Musée D’Orsay, Paris (Links to an external site.)Digital CollectionsGetty (Links to an external site.)Guggenheim (Links to an external site.)The Metropolitan Museum of Art (Links to an external site.)Rijksmuseum (Links to an external site.)Whitney Museum of American Art (Links to an external site.)Art Institute of ChicagoRequirements: Essay | 3 pages, Single spaced
University of San Francisco Mother Created by Author Lewin Funke Museum Report

watch two videos and answer the following questions.

Watch both of the videos on the Arctic National Wildlife Refuge. As you learned in the lecture slides there are 3 types of Federally protected lands. The Arctic National Wildlife Refuge (ANWR) is a classic case study in land that can be used for multiple purposes. Sometime those purposes conflict with each other. This is the case with ANWR.Since the OPEC Oil Embargo in the late 1970’s ANWR has been a subject of debate regarding oil drilling. Should we drill for oil or not? In my live classes, we debate this issue as a class. That will be difficult to do for an online education class like this one.I want you to look at the issues associated with drilling for oil in this wildlife refuge and analyze them from the perspectives of the stakeholders.I REPEAT- WATCH THE 2 VIDEOS I POSTED TO ANSWER THIS QUESTION WITH SPECIFIC DETAIL YOU HAVE GAINED FROM WATCHING THE VIDEOS. i WILL BE LOOKING FOR SPECIFIC THINGS ONLY FOUND IN THE VIDEOSOIL ON ICE TRAILER (Links to an external site.)Links to an external site.The risks of Drilling for oil in the Arctic National Wildlife Refuge) (Links to an external site.)Links to an external site.In addition to watching the videos, do some light research on ANWR. Research it from the perspectives of the major stakeholders:1) The Gwitch’In, the indigenous people of Alaska2) The Oil Companies3) Scientists and Environmentalists4) Alaskan PoliticiansASSIGNMENT : Answer each of the following question-1) Are EACH the stakeholder groups above for or against drilling for oil? Why?2) List the overall benefits of drilling for oil?3) List the negative factors associated with drilling for oil?4) What type of Federally protected land is ANWR?5) Personally, What do you think? Should we open ANWR for drilling or not? Why or why not? Be specific and state your reasons clearly.
watch two videos and answer the following questions

ABC Liabilities and Owners Equity Discussion

ABC Liabilities and Owners Equity Discussion.

Liabilities and Owners’ EquityPart of a business liabilities is the payroll. What are employment taxes? What are Social Security taxes and how do these taxes work? Does it make a difference if you are self-employed, or employed by a business? If you are a lender, do you think you may rely on any payroll data to assess business solvency? How about the rest of liabilities a business may have recorded? Does it make a difference if it is short-term or long-term liability? Would you please, provide us with links to some real financial statements of a business of your and provide your analysis of the business’s liabilities. Don’t forget to read the and share with us “Notes to Financial Statements” where the liabilities may be discussedHow do you judge a business’s well-being from examining its capital structure? Does it make a difference who you are (investor, lender, government, labor union, etc..)? Show us part of a balance sheet that represents stockholders’ equity section of a company of your choice. Did you notice any notes attached to the financial statements relating to Stockholders’ equity section? Please share with us your findings and provide your resources as well.
ABC Liabilities and Owners Equity Discussion

Strategic Plan Part II: SWOTT Analysis, business and finance homework help

essay help online Strategic Plan Part II: SWOTT Analysis, business and finance homework help.

Purpose of Assignment Students gain experience conducting an internal and external environmental analysis for their proposed new division and its business model. They will also gain valuable experience in conducting a SWOTT analysis for their proposed division. Assignment Steps Resources: Strategic Planning Outline and Week 3 textbook readingsConduct an internal and external environmental analysis for your proposed new division and its business model.Develop a SWOTT table summarizing your findings. Your environmental analysis should consider, at a minimum, the factors below.For each factor, identify the one primary strength, weakness, opportunity, threat, and trend, and include it in your table. Include the SWOTT table in your submission.External forces and trends considerations:Industry ChangesLegal and regulatoryGlobalEconomicTechnologicalInnovationSocialEnvironmentalCompetitive analysisInternal forces and trends considerations:StrategyStructuresProcesses and systemsResourcesGoalsStrategic capabilitiesCultureTechnologiesInnovationsIntellectual propertyLeadershipCompose a maximum of 1,400-word synopsis in which you analyze relevant forces and trends from the list above. Your analysis must include the following:Identify economic, legal, and regulatory forces and trends.Critique how well the organization adapts to change.Analyze and explain the supply chain of the new division of the existing business. Share your plans to develop and leverage core competencies and resources within the supply chain in an effort to make a positive impact on the business model and the various stakeholders.Discuss the primary internal organizational considerations for the development of a strategic plan.Identify the major issues and/or opportunities the company faces based on your analysis. Format your assignment consistent with APA guidelines.
Strategic Plan Part II: SWOTT Analysis, business and finance homework help

I need a reply to the discussion below. the reply must be at least 200 words. Do not just say “good job” or “I learned something from your post.” Replies are not a cheering exercise. Instead, your rep

the reply must be at least 200 words. Do not just say “good job” or “I learned something from your post.” Replies are not a cheering exercise. Instead, your replies must be substantial, reflecting what you learned from reading the post, offering an extension, or correcting a mistake. Use what you learned in researching for your post (or knowledge gained from other classes or personal experience) to either supplement or critique the post you are writing about. Inventory Situation Case Study                  Financial accounting reporting and statement preparation are not based on a day entry nor transaction, these are entries that span throughout at least six to twelve months period. The case study under review is that of a poorly managed system. For effective management of an organization and implementing a strong internal control system, an accounting information system is a top priority. An accounting information system (AIS) is a computer-based system that is used to process financial information which helps in strategic decision-making tasks and other organizational activities more accountable (Fatriati

Business homework help

Business homework help. You will be participating in five online discussions in INFM 208. The dates are given in the Course Schedule. The first discussion will include the entire class. Discussions #2-5 will be in a small group of 7 or 8 other classmates.,You will be participating in five online discussions in INFM 208,INFM 208 Guide to Online Discussions,What will you be doing?,You will be participating in five online discussions in INFM 208. The dates are given in the Course Schedule.,The first discussion will include the entire class. Discussions #2-5 will be in a small group of 7 or 8 other classmates. The groups will remain the same for the term. This allows you to build relationships and trust with each other – it is called a community of practice.,In these five discussions, you will be doing one initial post, and responding to at least five of your classmates’ posts. This does not mean you have to respond to five different classmates. You can respond a couple of times to one person, a few times to someone else and not be involved in others’ posts. The reason for this is simple. These discussions should be as authentic as possible. Respond to those posts which interest you and to which you have something to contribute. Not everyone’s posts will necessarily inspire you to contribute. But try to respond to at least two others – don’t spend all of your time with just one person, and try to engage with everyone by the end of the five discussions during the term.,Why are we doing discussion posts in this class?,Asynchronous discussion enhances learning as you share your ideas, perspectives, and experiences with others.  You develop and refine your thoughts through the writing process, plus broaden your classmates’ understanding of the course content.,Because we are lacking in-person, class discussions, an online discussion forum can allow us to share our perspectives, questions, and contribute to new insights.,How will you be evaluated?,Use the following feedback to improve the quality of your discussion contributions.,This is not a giveaway grade. I will keep the grading very simple however, and assign grades from 0-5.  In order to achieve a full five marks (5% per discussion), the following must be achieved (see table below). A mark of 4/5 is a very good mark for a discussion post. 5/5 are reserved for exceptional contributions.,What are the qualities of an exceptional response to others’ posts? Use this as a guide:,Effectively contributes to the learning community. Frequently initiates dialogue and motivates group discussion by providing feedback to students’ postings, asking follow-up questions, and through thoughtful, reflective comments. Respectfully encourages a variety of viewpoints and invites contributions from others.,How long should your post be?,Your initial post should be around 200-250 words. This is a guide only. Sometimes, you can articulate your thoughts very clearly in less than 200 (but that would be rare). If you are beyond 300 words, your post may require some editing. Be cognizant of your colleagues’ time and keep your posts succinct and interesting.,Your responses should be in the area of 100-200 words but those are evaluated more on content/substance than length.,Further advice: a must read,Check out this great site for important advice on writing discussion posts:,Writing A+ Discussion Board Posts in Online Courses, In particular, read the ,Discussion Board Etiquette and Tips for Success.,Points,Performance Criteria,5 points,Your initial post is original, relevant, demonstrates that you read and reflected on the assigned material (or your classmate’s point of view in the case of a response), and also is well written. For five points, you have added substantial discussion and also stimulated additional thought about the issue. You have provided at least one additional source outside the assigned readings/powerpoint. APA formatting is used.,You have responded to at least 5 other posts. Your responses show the same level of depth as your original post.,4 points,The post (and responses) lack at least one of the above qualities and is above average in quality. Your post and responses still make a significant contribution to our understanding of the issue in the discussion.,You have responded to at least 5 other posts. Further, your responses show the same level of depth as your original post.,3 points,The post/responses lack two or three of the required qualities. Initial posts which are based solely upon personal opinion or personal experience without reference to assigned readings and also other authoritative sources often fall within this category. Your post may still have some depth to it.,You have responded to at least 5 other posts. Your responses lack some depth.,2 points,The post/responses lack two or three of the required qualities. Initial posts which are based solely upon personal opinion or personal experience without reference to assigned readings and also other authoritative sources often fall within this category. What distinguishes a 2 from a 3 is that your post and/or responses are very brief and lacks significant depth.,You have responded to at least 5 other posts.,1 points,One point is assign ed if you have responded to others but have failed to submit your own initial post.,0 points,No participation this week (no initial post, no responses)., ,Attachments,Click Here To Download,Business homework help