An in-depth study of the treatment of older patients who are suffering from chronic obstructive pulmonary disease (COPD) and the success of medication adherence.
Abstract This paper examines the critical success factors for medication adherence in older men and women with chronic obstructive pulmonary disease (COPD). Specifically, the paper attempts to identify what critical factors improve medication adherence among the elderly diagnosed with COPD. The results of this study help to fill the gap in literature that currently exists related to medication adherence among the elderly. The paper further discusses the ample evidence lending support for studies that specifically target the elderly, as empirical data suggests their compliance to procedures and practice guidelines varies significantly from that of younger populations.
Contents:
Chapter 1
Introduction to the Study
Overview
Problem Statement
Purpose
Significance
Chapter 2
Literature Overview
Conceptual & Theoretical Framework
Medication Adherence and COPD
Operational Definitions
Hypothesis Research Questions
Chapter 3
Method
Research Design
Sample Characteristics
Instruments and Interventions
Ethical Issues Protection Human Subjects
Chronology of Events
Chapter 4
Plan for Data Analysis
Data Analysis
Results and Discussions
Chapter 5
Evaluation of Proposal
Abstract
Strengths and Limitations
Publication
Appendix I - Survey Questionnaire
References
From the Paper "In any study involving human subjects it is vital the researcher take precautions to ensure the confidentiality, safety and support of all participants involved in the study. It is also vital the researcher fully inform study participants of the intent of the study, and provide ample guidance for completing each aspect of the study. For this reason the researcher will provide comprehensive instructions at the beginning of each survey mailed to participants, and provide participants a contact number to ensure they have a resource for discussing questions related to the study if necessary.
To ensure the ethical nature of this study, all study participants will be fully informed of the intent of this study and the potential uses for the information provided by this study. Study participants will be asked to sign an agreement stating they understand the focus and implications of this study. All study participants will be afforded the opportunity to provide information confidentiality for purposes of this study. Further, participants will all receive the results of this study in a separate mailing at the end of study. In cases where participants are unable to complete the questionnaires mailed to them, they may appoint a proxy to complete the questionnaire for them."
Tags: health, conditions, risk, treatment, administration, general, practitioners, care, chemical
Abstract This paper critically analyses the factors that may contribute to the chronically ill person maintaining or not maintaing adherence to treatment. Five related areas of concern associated with compliance metatheory are briefly reviewed. It is asserted that theory building, assessment, research, and clinical application have been needlessly constrained as a result of the tendency of compliance investigations to be: (a) unidimensional, (b) practitioner centered, (c) reductionist, (d) stability (consistency) oriented, and (e) a motivational. The problem listing is then followed by a discussion of potential conceptual alternatives, and by the presentation of a tentative family of terms to replace the current overextended usage of the compliance label.
From the Paper "Compliance is usually defined as a technical problem that is a theoretical in nature; that is to say, compliance is a problem associated with getting the patient to behave in accord with medical advice. Karoly finds this definition to be somewhat sterile and urges that compliance should be thought of as a construct not unlike intelligence. Karoly argues that control theory offers a useful meta-analytic framework for conceptualizing the construct. The power of this approach is that it offers the possibility of combining cause-effect models and those that attempt to analyze "properties of people and/or systems (e.g., families) that are capable of yielding consistencies in health maintaining behavior." Karoly offers a triarchic model of compliance that is analogous to Sternberg's model of the construct of intelligence."
Abstract The research paper examines different strategies that are being used within communities in order to determine the most successful ones in increasing the amount of patients who adhere and complete the treatment plan and therefore decrease the level of tuberculosis (TB) infection. The paper explores the reasons behind non-compliance with treatment and shows how successful strategies attempted to take a multi-faceted approach, addressing issues such as supervision,
economic factors, social support, drug availability, healthcare set-up and others. The paper includes a literature review as an appendix to the paper.
Outline:
Introduction
Results
Conclusions
Appendix: Literature Review
From the Paper "Tuberculosis remains a significant cause of mortality in sub-Saharan Africa, a situation which is exacerbated due to the association of TB as an opportunistic infection of HIV. Despite there having been treatment programmes in place in many areas of Africa for a number of years there remain a large number of deaths from the disease partially due to poor adherence rates to the treatment programmes available. There has been a large amount of literature published which discusses the factors which may impact on adherence to these treatment programmes, and some which evaluates strategies to improve adherence."
Abstract This paper offers a review of the factors that may contribute to the chronically ill person maintaining or not maintaining adherence to prescibed treatment. Chronic mentally ill clients exert considerable energy avoiding loss of control. Both the therapeutic environment and the nurse-patient relationship are contextual factors furthering this goal. The paper looks at the important role played by the nurse in building a strong and reliable relationship with the mentally ill patient, in order to better adminster treatment.
From the Paper "In the last several years, there has been a growing concern for the plight of family caregivers of persons with chronic disease and disability. This focus arose primarily from recognition that chronic disease is becoming a greater problem in our society. In part, this problem is due to the advances in medical science and technology that have prolonged the lives of many chronically ill persons."
This paper analyzes two radio commercials for prescription medications for their adherence to FDA guidelines, marketing techniques, failings and overall message of the advertisement.
Abstract This paper explains that direct-to-consumer advertising is considered to be a powerful marketing tool and to be a helpful service for patients who wish to be informed about their options and be active in their own treatment; however, direct-to-consumer advertisements for prescription medications may hinder effective health care in several ways including reducing doctor-patient communication. The author concludes that the analyzed commercials for Allegra D to treat allergy symptoms and an unnamed cholesterol-fighting drug did adhere to the FDA guidelines. The paper states that these gimmicky commercials are not actually informative to the general public; they are simply a tool used by the medication companies to benefit from the consumerist impulses of the population.
From the Paper "Direct-to-consumer advertising is a phenomenon of the past couple of decades. The FDA has set guidelines for drug companies to follow that are intended to prevent consumers from being taken advantage of by misleading advertisements. All commercials must use words that common people can understand, without using advanced or complicated vocabulary that would require higher education or specialized training to decipher. Most of these commercials have to state a great deal of information about the product, including intended uses and common side-effects, as well as providing means for consumers to get more information about the product that would include all of the labelling that the FDA requires for the drug. However, the commercials that were observed were exempt from these guidelines because they were brief "reminder" or "help-seeking" ads."
This paper reviews the qualitative research method used by K.K. Baird and L.L. Pierce as reported in their article 'Adherence to Cardiac Therapy for Men with Coronary Artery Disease' in "Rehabilitation Nursing".
Abstract This paper explains that the purpose of the reviewed study was to find out why these men with coronary artery disease were not taking care of themselves so that new and better ways can be found for these people. The author reports that the qualitative method consisted of one hour interviews with five informants that were involved in a cardiac therapy program. The paper states that the qualitative method is far more appropriate for this type of study than the quantitative method would have been and the researchers used bracketing to shield the data that they collected and analyzed from their own preconceived ideas, which could have greatly affected the results of the study; however, one possible limitations is that the study sample was not large enough.
From the Paper "The way that the subjects for this study were obtained was very appropriate, since they were all older men between 60 and 70 years old that were involved in a cardiac therapy program as a result of CAD. They had all been diagnosed within the past two years, and they were willing participants. The sample size was also adequate. Although the study could have certainly been conducted with more individuals, the fact that there were only five patients interviewed allowed the researchers to have a lot of time with each person. This helped the patients feel that they could actually talk about what they needed and wanted, as well as what they had difficulty with."
Abstract This paper discusses the code of conduct as set by the American Nurses Association. The writer relates this code of conduct to her own personal code of ethics and how they can work together in a work setting. The paper presents a case example of confidentiality that must be maintained when dealing with patients and their relatives or guardians and the importance of adhering to a code of conduct in this regard.
From the Paper "Accordingly the website espoused the fact that special care was to be implemented in this case. The key, according to the website, was not what should or should not be the end result, but the steps taken in order to culminate in a fair and just decision for all involved. Justice, in this particular case would have to pertain to more than just what actions should be taken to punish the nurse for her choices. Other items to consider would be how other employees would feel and act if the nurse were to be hired back after her rehabilitation, as well as the fact that patients were affected, and a primary concern of how such a individual can affect those with who she works and interacts within the health care facility."
Abstract Gaugin's "Ia Orana Maria" and Reni's "The Immaculate Conception" are two very different representations of the Virgin Mary. The paper explains that by utilizing more classical composition techniques, smooth, curving lines and rich, strong colors, Reni portrays Mary as an idealized version of Baroque femininity in a heavenly setting. It shows, in contrast, how Gauguin adheres to the primitive tradition, illustrating Mary as a native woman, a naked Christ child set on her shoulders. His use of asymmetrical composition in a cluttered, unplanned scene provides a feeling of energy and naturalism, a striking contrast to the serenity of Reni's work. The paper shows therefore that in illustrating the Virgin Mary in their works, each painter adheres to the very different sensibilities of their time periods.
From the Paper "Paul Gaugin's "Ia Orana Maria," translated as "Hail Mary," treats a similar subject matter, in that it illustrates the Virgin Mary with adoring attendants. However, this is not the Mary of the Immaculate Conception, but with Christ who is perched upon her shoulders. Painted in the post-impressionist genre known as Arcadia, which exemplifies scenes of blissful simplicity and retreat from the complex, this work was completed in 1891 and hangs in the Metropolitan Museum in New York. It is not a large work, only 44 inches by about 36 inches. In keeping with its primitive tradition, and in stark contrast to "The Immaculate Conception," the composition is highly asymmetrical, with the central Mary figure set off to the right of the picture. The poses are unstudied, casual and almost accidental, with Mary and the Christ child looking at the viewer, and the two prayerful, adoring native women gazing at them. This casual approach may be an attempt of Gauguin to emphasize the "naturalness" of the scene, despite the obviously supernatural halos."
This study investigates the effects of programs dealing with risk-based pricing and increased mortgage loan limits on mortgage approval rates for low- and moderate-income households.
Abstract The in-depth research performed for the study finds that risk-based pricing policies had a positive impact on the extension of residential mortgages to low- and moderate-income applicants making less than $35,000 annually, in that rejection rates associated with risk-based factors declined. The research also finds that higher mortgage limit policies had a positive impact on the extension of residential mortgages to low- and moderate-income applicants making less than $35,000 annually, in that rejection rates associated with risk-based factors declined. Lastly, the research results indicate that higher mortgage limit policies had a greater positive impact than did risk-based pricing policies.
The findings that both risk-based pricing policies and higher mortgage limit policies have positive impacts on the extension of residential mortgages to low- and moderate-income applicants making less than $35,000 annually, also showed that mortgage approval rates for this group actually declined over the period of analysis. The implication of these findings considered together is that other problems exist that have led to the rejection of low- and moderate-income applicants making less than $35,000 annually, for residential mortgages.
The major conclusion drawn from the findings of this study is that adherence to risk-based pricing policies and increased mortgage loan limit policies by conventional lenders is more show than real, as the aggregate approval rate among conventional lenders actually declined from 1990 to 1999. Thus, it appears that conventional lenders have found new reasons to reject low- and moderate-income applicants making less than $35,000 annually, while publicly adhering to the new policies intended to broaden access to mortgage lending for these applicants.
TABLE OF CONTENTS
1 - Introduction
Problem Statement
Study Purpose
Research Questions & Hypotheses
Significance of the Study
Definitions of Terms
Delimitations of the Study
Overview of the Remainder of the Study
2 ? Review of the Literature
Systems Theory
Systems Theory and the Mortgage Lending Model
Mortgage Lending Markets
Past Discrimination in Mortgage Lending
Summary
3 ?Methodology
Research Design
Research Hypotheses
Variables and Operational Definitions
Data Collection
Data Analysis
Methodological Limitations
Summary
4 ?Results
Restatement of the Research Questions
Restatement of the Hypotheses
Research Results
5 ? Summary, Discussion and Conclusions
Discussion
Conclusions
Appendix: Data Tables
Bibliography
From the Paper "The effort to improve accessibility to residential mortgage finance for low- and moderate-income individuals and families making less than $35,000 annually, tends to be impeded by a system that has become entrenched. This existing system is an interlocking structure of public and private sector players that has developed rules and processes with which they are comfortable and which they are reluctant to change. The existing system for the extension of residential mortgages also involves both the primary and the secondary mortgage markets, as well as credit review and reporting agencies. The system in place was never intended to provide access to residential mortgages to low- and moderate-income persons making less than $35,000 annually, except within the framework of specific governmental programs targeting such individuals. These specific programs involved direct public funding, government guaranteed repayment of loans extended by private sector lenders, or subsidies to developers and builders."
A look at the reconciliation of the indignant words of Socrates to the jurors of the city's court at his trial and his loyal obedience to the laws of Athens in Plato's "Crito".
Abstract This paper explains that the apparent inconsistencies in the willingness of Socrates to disobey the government of Athens and its laws are merely the result of his love for Athens and distrust of the common people (hoi polloi) as rulers of the city. It shows that, to Socrates, the people of Athens collectively formed a force destructive to the ethical and philosophical ideals to which he adhered. These adherents to the tradition of concessive belief, according to Socrates, were of no use to themselves or to the city because they failed to make any significant contributions and merely provided one additional voice in the chorus that was Athenian democracy.
From the Paper "Socrates maintains a consistent loyalty to Athens and its laws throughout his trial in the Apology and his discussion with a student in Crito. Both works portray Socrates as a patriotic individual who regarded his city and its population as separate entities and who intended wholeheartedly to improve the former while preventing ruin at the hands of the latter."
Abstract This paper examines the "Monroe Doctrine" and the principles that were established by this statement of policy. "The Monroe Doctrine? set as policy certain principles that have been adhered to by U.S. administration in regards to events in other countries. This paper explores the original intents of "The Monroe Doctrine" and to what extent that adherence is given in the present and what implications that has in regards to future foreign relations.
From the Paper "James Monroe was the United States President during the period of the creation of ?The Monroe Doctrine". Monroe, served two terms during the period that has been labeled the "Era of Good Feelings". The 19th Century witnessed significant changes and adjustments in view of global relationships and added a new dimension to the nation as well as the world at large. During this time Monroe made his famous speech, written by John Quincy Adams, which came to be known as "The Monroe Doctrine". "
Abstract This paper examines the "Monroe Doctrine" and the principles that were established by this statement of policy. The paper explores the original intents of "The Monroe Doctrine" and to what extent adherence is given to the Doctrine in the present and what implications that adherence has in regards to future foreign relations.
From the Paper "South America and the United States, having very little in common in aspects of government, religion, or race did little trading or traveling between during the time of the 18th Century. This period was witness to war in South America between Napoleonic forces, King Ferdinand and revolutionaries within the South American countries. Spain and France were speaking of joining together in a war on the new Latin American republics that were Chile, Peru, Argentina, Colombia and Mexico. This prompted Britain to request that the U.S. join with them against Spain and France."
Tags: assisting, revolutionaries, maintenance, independence, americans, president, south, america
Abstract This paper examines whether the French architect, Le Corbusier, was modernist or post-modernist in his style. The writer explains and analyzes the definition of these styles and concludes that Le Corbusier's style of architecture in essentially modern in that it adheres to the foundational concepts of modernism. It explains that his emphasis on functionality is particularly modernist in that it subverts and reshapes the past, but still adheres to the principles of form, functionality, and order.
From the Paper "Basically, the design of the ground floor is quite similar to the Villa Savoye. This can be seen in that the design uses massive pilotis to make the whole building distanced from the ground as well as creating a free place for other uses such as a car park. The free area underneath the house was used for circulation and parking, as well as the entrance, elevators, and janitor's closet. (Alexander Tzonis, 2001) Also, no historical precedents and ornaments were used. The building was constructed mainly out of reinforced concrete, ...the Unite revealed its cellular structure through the use of concrete sun-baffle balconies and canopies projecting from the main body of the building. (Kenneth Frampton, 1992) large windows were installed in every apartment, giving a full view of the landscape. "Unspoiled views of the unfolding grounds, light breezes blowing freely over the soil without being blocked and sustained ecological conditions were also required." (Alexander Tzonis, 2001)"
This paper discusses three Christian moral issues and their related ethics: Euthanasia, abortion and the saving a child's life by producing a healthy baby in order to assist a dieing older sibling.
Abstract This paper stresses that it is impossible to determine precisely what Christian ethics or morals are on any given issue without a plausible definition of what constitutes a Christian. The author points out that, from this review of the history of Christianity, the religion is practiced in varying formats and with various degrees of adherence to the moral and ethical dictates of the religion; furthermore, one observes that more than likely the "root-cause" for failures to adhere to Christian morals and ethics is a product of the slow-paced evolution of the Christian religion. The paper relates that, as an example of these other ethical issues, most scholars from both sides of the abortion issue feel that the resolution will come in the form of pre-natal research and development because advancements made within this science have already dropped the abortion rates appreciably nationwide.
Table of Contents
Thesis Statement
Why Christianity is in Turmoil
An Important Turning Point in Establishment
The Bible and the Establishment of Morals and Ethics
The Christian Ethics of Euthanasia
A Brave New Set of Ethics
Conclusions
From the Paper "The Christian ethic concerning physician-assisted suicide is of course spelled out within the "Ten Commandments," of the Old Testament. Quite simply, "Thou shall not kill." On the other hand, down through the decades since the inventions of or development of "pain-relieving," drugs, physicians have been quietly going about the process of Euthanasia where there is no hope for continued productive life - usually labeled "end-stage relief," and their work although secretive in nature has not conjured much debate until the past two decades. Indeed, with the passage of a new "politically correct," law in the Netherlands recently the ethical reaction into the nature of this act has been minimal at best with discussions cropping up from time to time brought on primarily by the Religious Right. For example, the Reverend Billie Graham is one, along with his son Franklin that is quite out-spoken on the issue."
Abstract The paper explains that Emmett Till lived an unassuming life in the north. The paper explains that Emmett went to visit his great-uncle, Mose Wright, who lived in Mississippi. The writer shows that Emmett would not adhere to the notion of inferiority that most blacks in the south adhered to. The paper describes how Emmett flirted with a white clerk in a shop, in order to show his friends that this was allowed in the north. The writer describes how Emmett is accused of physically accosting the clerk, while his friends claim that he only flirted with her verbally. The paper explains that Emmett was murdered by a relative of the store clerk for this alleged crime and that the murderer, Roy Bryant, was acquitted of the murder by a jury within one hour. The writer explains that the outcome of the trial was considered a triumph by white people for the southern way of life and as a major setback by the black community. The writer posits that Rosa Parks, the black woman who refused to give up her seat for a white woman on a bus, was given the strength to do so because of Emmett Till's example. In conclusion, the writer states that the result of the court case resulted in a major triumph for the black community.
From the Paper "Some would argue that this event gave Rosa Parks the audacity to do what she did. This was the straw that broke the camel's back as it were. Professor Weems published a book asserting that this was the catalyst of the civil rights movement. Mamie Till Bradley, Emmett's mother, has spoken out in support of such sentiment, "The murder of my son has shown me that what happens to any of us, anywhere in the world, had better be the business of us all." This spoke to national importance of the entire issue. Till's death continues to have an effect on society. There are streets named in his honor, books about his short life, and a society that has gained much through his loss."
