Obesity and Gastric Bypass Surgery Essay Example for Free

Obesity and Gastric Bypass Surgery Essay In this paper I will discuss an article from the Seattle Press written by Associated Press Medical Writer Lindsay Tanner. I will discuss the statistical procedures used in the study and provide an analysis of the conclusions both the researchers and the reporter drew from the study results to consider the statistical significance of the data presented. The article explains the research of Dr. Sayeed Ikramuddin of the department of surgery, University of Minnesota, Minneapolis and his colleagues relating to bariatric surgery its potential role in glycemic control in type two diabetics. Irkamuddin states that at 12 months, â€Å"the primary goal was considered successful if patients achieved the composite of the triple endpoint: HbA1c of less than 7. 0%, an LDL cholesterol level of less than 100 mg/dL, and systolic blood pressure of less than 130 mmHg at the 12-month visit† (2013, p. 2242). The study was conducted at four sites, including New York, Minnesota, and two hospitals in Taiwan and lasted 12 months. Patients with mild to moderate obesity and adult-onset diabetes mellitus were offered a free intensive intervention and recruited using mass media advertisements, practice-based databases and contact with professional groups, leading to an unblinded randomized group after screening 2648 candidates. Body mass index in participants ranged from 30. 0 to 39. 9, with a mean of 34. 6. The study participants had been diagnosed with diabetes for a mean of 9. 0 years. The intensive intervention included lifestyle modification with daily caloric intake counts, increased physical activity, daily weights and counseling sessions, and intensive medical management including close monitoring and treatment from doctors with medications for cholesterol, blood pressure, and glycemic control. Sixty of these participants were randomly selected to receive Roux-en-Y gastric bypass surgery. Two of the participants selected declined to have the surgery, and two others were randomly selected to undergo the procedure. These patients continued to receive the same intensive intervention during the entire 12 months. The frequency of sessions and monitoring decreased for both groups during the study period as planned, going from weekly to monthly over the course of the study. The author of the newspaper article summarizes the study’s results by stating, â€Å"The surgery group lost on average nearly 60 pounds and 75% lowered blood glucose levels to normal or near-normal levels. The non-surgery group lost on average 17 pounds and just 30% reached the blood-sugar goal. The surgery group also needed less medication after the operation† (Tanner, 2013, p. 2). The last portion of this statement is misleading as the study evaluates and considers only medications to manage blood glucose levels, dyslipidemia, and hypertension (Ikramuddin, 2013, p. 2245). The study reports, â€Å"Patients who underwent gastric bypass surgery experienced 50% more serious and 55% more nonserious adverse events than did those in the lifestyle-medical management group† (Ikramuddin et al. , 2013, p. 2248). It is important to consider the frequency and rate of adverse events, in addition to classification of such data. Researchers also state that the surgical group took 66% fewer medications than the nonsurgical group. The most common adverse event in the surgical group that was not considered peri- or late post-operative was nutritional deficiencies, especially iron and vitamin B levels, requiring treatment with medications and supplements. Nutritional deficiencies are often long-term and require frequent monitoring and dose adjustment. Because of the time limitations of the study and the relatively small sample size, long-term cardiovascular and nutritional effects of bariatric surgery in the mild to moderately obese population for glycemic control remains to be determined. Both the study and the newspaper article assert that there is no conclusive evidence on long-term effects when bariatric surgery is used in conjunction with lifestyle and medical management for glycemic control on mild to moderately obese patients. Other serious adverse events documented and considered by the authors of the study included motor vehicle accidents and pancreatic cancer, both of which occurred in the medical management group, decreasing the difference between the medical management group and the Roux-en-Y gastric bypass group. Pregnancy was considered as well. The total number of serious adverse events was 15 for the medical management group and 22 for the surgical group. The study does not discuss or measure in any way the adherence of participants to the intensive intervention in either group. Patients’ adherence to recommended regimen including decreased caloric intake, recommended physical activity, and medication compliance is a variable that was not assessed by Ikramuddin and his colleagues during the study, limiting its scope. In general, the newspaper article correctly interprets the statistics and draws conclusions from this study appropriately. The surgical group tended to have less hypertension and elevated LDL cholesterol levels, but this data lacks statistical significance. Tanner stated in the newspaper article â€Å"those between-group differences could have been due to chance† (2013, p. ). The study states a confidence interval of 95%, which correlates with a 0. 05 significance level. Many of the values representing these measures were marginally different. Many other studies have reported effects on these values as individual variables. There are many other factors involved in cholesterol and blood pressure management that must be identified an d considered before drawing conclusions on such data. This study was very detailed and presented a large amount of data. Despite this, the overall conclusions of the newspaper article were accurate in relation to the data. The newspaper article summarized the conclusions of the researchers appropriately. The statistics representing HbA1c as part of the composite endpoint are reliant on weight loss and can be primarily attributed to this factor (Ikramuddin et al. , 2013, p. 2240). The newspaper article states, â€Å"The researchers say the diabetes changes were likely due to the weight loss but that hormonal changes affecting blood sugar may have contributed† (Tanner, 2013, p 2). This was determined by using regressive analyses of the available data. The study suggests that altered gastrointestinal hormone secretion as well as differences in individual medication use during the study may have attributed to the results, but acknowledges that the study lacks the data to determine this. By going to the source of news-reported statistical studies, the reader can evaluate the statistical significance of the data and determine if the data were presented accurately and if the conclusions drawn are reliable. Research and comprehension of data and statistical significance is essential to best evidence-based practice in the field of nursing and beyond.

Pessimism in Thomas Hardy’s The Darkling Thrush Essay -- Darkling Thru

Pessimism in Thomas Hardy’s The Darkling Thrush Thomas Hardy’s writings are often imbued with pessimism, and his poem â€Å"The Darkling Thrush† is not an exception. Through the bleakness of the landscape, the narrator’s musings on the century’s finale, and the narrator’s reaction to the songbird, â€Å"The Darkling Thrush† reveals Hardy’s preoccupation with time, change, and remorse. Written in four octaves, â€Å"A Darkling Thrush† opens with a view of a desolate winter landscape. With â€Å"spectre-grey† frost covering everything in sight (line 2), all joyful colours and sounds are smothered with an intangible film of bleakness. This gloominess is not to be dispersed, for the imagery of â€Å"Winter’s dregs† suggests that there exists a residue of the year’s melancholy (3). The burden of the word â€Å"dregs† creates a caesura, and the heaviness of the poem is reinforced with alternating lines of iambic tetrameters and iambic trimeters. The tangled bine-stems that scored the sky (5) and â€Å"the land’s sharp features† (9) move the miasmal pessimism to a more sharply defined pain that is intensified with the alliteration in â€Å"his crypt the cloudy canopy† (11). The â€Å"bleak twigs overhead† (18) cast a sharp image of bars stretching across the sky, embracing the gloominess in Hardy†™s world. Reflecting the narrator’s sense of perceptions, the dreary landscape mirrors the narrator’s depression and projects his emotions into solid images. An occasional poem, â€Å"A Darkling Thrush† depicts the setting of one century and the birth of another through the narrator’s eyes. Leaning perhaps wearily on the coppice gate, the narrator observes how even the people that haunt the land like soulless wanderers (7) return to their homes where brightly shine their fires, a ... ...llest cause for hope. The thrush’s exuberance seeps into the narrator’s life for a brief moment, revealing to him a life lived to the fullest, yet the narrator remains unconvinced and melancholy. Submerging â€Å"The Darkling Thrush† in a dreary landscape devoid of life and colour, Thomas Hardy is able to weave pessimism into his work, providing a core of bleak emotions for his narrator, who sees no hope for the empty society he lives in. Even when he catches a glimpse of cheerfulness from an old thrush, the narrator declares his personal plight excluded from the possible causes of joy. With all signs of hope criticized as being absurd, Thomas Hardy’s â€Å"The Darkling Thrush† conveys a purely pessimistic view. Work Cited Hardy, Thomas, â€Å"The Darkling Thrush.† 1900. The Norton Anthology of English Literature. 7th ed. 2 vols. New York: Norton, 2000. 2: 1935-1936.

Health Care Utilization Essay

Health care reform is not a recently devised concept. The government and health professionals have studied and tried to establish legislation that would assist the general population with a means of accessing adequate health care for decades. The task has proven itself as a daunting one although studied the world over. Individuals struggle with disease and illness that they cannot afford medical attention and treatment. Insurance companies price gouge or drop individuals from their insurance coverage. Reform has to be implemented to protect the public and provide across the board health care for every situation. Ronald Andersen wrote in the Journal of Health and Social Behavior there is a model of behavior that determines the seeking out of health services (Anderson, 1995). Anderson collaborated with Odin Anderson and wrote The Initial Behavioral Model in 1968 to assist in the analysis of national survey data collected by the Center for Health Administration Studies and the National Opinion Research Center at the University of Chicago (Andersen & Anderson, 1967). The model explains that there are elements that may determine if an individual will access health services. Anderson explained, â€Å"I want to stress that the model was initially designed to explain the use of formal personal health services rather than to focus on the important interactions that take place as people receive care, or on health outcomes†(Andersen, 1968, p. 1). The Initial Behavioral Model (1960s) PREDISPOSING ENABLING USE OF CHARACTERISTICS RESOURCES NEED HEALTH SERVICES Demographic Personal/Family Perceived Social Structure Community  (Evaluated) Health Beliefs (Revisiting The Behavioral Model and Access to Medical Care: Does it Matter?, 1995) The president had legislation passed in 2010 to implement the Affordable Care Act. Today, more than 45 million Americans lack access to affordable health insurance. Additionally, many individuals who do have health insurance have incomplete coverage that may include exclusions for pre-existing conditions, or they may be one-step away from losing coverage because of a change in employment. Individuals with health insurance face increasingly high premiums and medical costs that drive some to bankruptcy or force choices between maintaining health insurance coverage and paying for other household essentials (HHS, 2013). These new regulations will provide consumer protections and the developing of a competitive market. Insurance companies will be required to spend a specific percentage on health care and not excessive administrative costs. There have been major changes to the accessibility of insurance coverage for individuals which have been diagnosed with a pre-existing medical condition. Insurance companies will no longer be allowed to deny insurance coverage for individuals, such as children born with life-threatening illnesses. This will also address lifetime limits on medical care. There has been a health insurance exchange in an effort to pool millions of people and allow them to examine various insurance coverage policies to determine the best policy for them and their families. Health and Human Services has implemented a website for the comparison of the insurance coverage options (HHS, 2013). There have been conversations for decades about the implementation of universal health coverage. The World Health Organization defines it as a goal to ensure that people obtain the health services they need without suffering financial hardship when paying for them. It goes on explaining, access to health services enables people to be more productive and active contributors to their families and communities†¦.financial risk protection prevents people from being pushed into poverty when they have to pay for health services out of their own pockets (WHO, 2012). There is a definite similarity with the concepts of universal health care and the Affordable  Care Act now in place in this country. Attempts are being made to ensure that all citizens can access health care and increase their wellbeing in the process. The expansion of Medicaid will benefit multiple low-income citizens who, through no fault of their own, are working at a minimum wage job. They are barely earning too much money to be eligible for assistance and are not making enough of a salary to afford health insurance coverage. It turns into a viscous cycle. The individual has to decide whether it is better to quit work and get assistance for medical care or to continue struggling and still not make the grade. There have been no major issues personally with the implementation of the health care expansion. The insurances that I carry are both the Medicare and Medicaid. Medicaid has changed in that they are requiring that there is a primary care physician (PCP) established to oversee medical services provided. The initial visit would be to the PCP where any examination and testing would be performed for the determination of the necessity of a referral. The PCP’s office would organize all medical records and coordinate with the specialist’s staff to establish a consultation. I consider myself an extremely fortunate individual because I have been able to have multiple medical issues addressed and corrected because of the medical coverage. The Medicare coverage is not as restrictive as Medicaid. Medicare allows the individual to access any physician or facility that the patient desires for treatment as long as their insurance is accepted. There has not been any specific positive or negative effect with this coverage. Medicare has provided successfully for preventive measures in my health services such as yearly mammograms, colonoscopy testing every two years (if deemed necessary through findings during prior examination), and comprehensive yearly physical examinations. Unfortunately, there is minimal dental coverage and no eye examinations available. There has been major skepticism with the Affordable Care Act being voted on and implemented in the governmental realm. It is exhibiting a number of positive actions implemented with the creation of this act. It is time that this country gives thought to the individuals which are suffering because of no fault of their own other than being on the lower end of the income scale. Also citizens are pleased with the inclusion of the poor souls battling daily with an affliction that requires more attention and treatment than they could ever afford. It is in this new light that people are viewing the creation of the Affordable Care Act and see that this should prove to be beneficial to every citizen within the national borders. Reference Andersen, R. M. (1995). Revisiting The Behavioral Model and Access to Medical Care: Does it Matter? Journal of Health and Social Behavior, 36, 1-10, retrieved from: http://www.jstor.org/stable/2137284 Andersen, R.M., Anderson, O.W. (1967), A Decade of Health Services, retrieved from: http://www.jstor.org/stable/1815595 Health and Human Services (2013), Strengthen Health Care, retrieved from: http://www.hhs.gov/secretary/about/goal1.html World Health Organization (2012), What is Universal Health Coverage, retrieved from: http://www.who.int/features/qa/universal_health_coverage/en/index.html

Ideas In The Necklace Tale - Free Essay Example

Sample details Pages: 2 Words: 521 Downloads: 9 Date added: 2019/08/02 Category Literature Essay Level High school Tags: The Necklace Essay Did you like this example? The tale The Necklace through man DE man de Maupassant takes location in France many hundred years beyond. Mathilde Loisel lives in a very flat along aspect her husband, WHO works as a clerk for the Minister of class. Their lives do not appear to be highly-priced, but theyre no longer pinched, actually sincere. Don’t waste time! Our writers will create an original "Ideas In The Necklace Tale" essay for you Create order Mathilde, but, longs to be sumptuous. She envies her buddy Jeanne WHO talents a sizably voluminous house and plenty of jewelry.at some point her husband brings domestic letter of invitation to a ball. He cerebrates his mate are going to be gladdened to wait the sort of difficult birthday celebration, however rather she is upset. She repines that she has not some thing opportune to put on to such AN extravagant event. Her kind husband is of the same opinion to relinquish her the four hundred francs that he have been conserving to buy AN inchoate rifle to prompt herself a robe.She and her husband attend the gala and function a splendid time. She dotes tremendous and dances all night time. Determinately, they circulate home inside the wee hours of the morning. as soon as they arrive domestic, Mathilde realizes that the jewellery is missing. They wonder if it fell off inside the carriage that they took home, however neither of them descried the amount. Her husband goes resolute probe the streets however returns empty bimanual. To stall for time, Mathilde indites to her friend that she negative the clasp and has it restored. within the in the meantime, they phrase every other rings that suits the missing one, however it charges cardinal thousand francs. Her husband propitiously genetic eighteen thousand francs from his father, however they are going to want to borrow the remainder of the mazuma. Determinately, they want enough to get the replacing rings and Mathilde offers it to Jeanne WHO does not even visually take a look at it.the subsequent 10 years Mathildes life changes dramatically. They pergrinate to a a whole lot of minuscule dormitory anywhere she should cook dinner and easy for herself. She in addition will paintings at the factor while her husband works a couple of jobs to pay back all of the mazuma they borrowed. at the same time as the 10 years, the mazuma is all paid returned, but Mathilde has aged an first rate deal. one day she visually perceives Jeanne Forestier on the street. She makes a decision to tell her the reality concerning the jewelry. Jeanne is surprised by means of Mathildes tough look. Mathilde explicates that its miles indirectly because of Jeanne due to the fact that she misplaced the jewellery she borrowed from her and needed to benefit a changing. bowled over, Jeanne confesses that the jewellery Mathilde borrowed have become AN unauthentically spurious, composed of paste, price no quite five hundred francs.truely, the sophistication of the tale is that truthfulness is that the first-rate insurance. If Mathilde have been veracious toget her with her friend from the commencement, she could have found out that the jewellery wasnt composed of actual diamonds and could not have wasted 10 years purchasing a replacing.