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  • Archive for the ‘Essays’ Category

    acquired goodwill is capitalized and not amortized.

    acquired goodwill is capitalized and not amortized.
    Accounting for acquired goodwill has been a controversial issue for many years. In the United States, the amount of acquired goodwill is capitalized and not amortized. Globally, the treatment of goodwill varies significantly, with some countries not recognizing goodwill as an asset. Professors Johnson and Petrone, in “Is Goodwill an Asset?” discuss this issue.
    Required:
    1. In your library or from some other source, locate the indicated article in Accounting Horizons, September 1998.
    2. Does goodwill meet the FASB’s definition of an asset?
    3. What are the key concerns of those that believe goodwill is not an asset?
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    classroom accommodation children with learning disabilities

    View the attached video and respond to the prompt with a minimum of 250 words.

    Describe three ways that you might modify instruction in the general classroom to accommodate children with learning disabilities ?

    Video: http://www.youtube.com/watch?v=jZhRf2fxlyw

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    Religion and Theology

    Religion and Theology
    The Beast in Revelation Chapter 13
    Project description
    After reading the articles on Persecution (pg 907-914), Emperor Worship (pg 321-326), and Apocalypticism (pg 55-68) from “Dictionary of the Later New Testament & Its Developments”, Intervarsity Press, 1997, write 1,000 words describing how this material can shed light on the book of Revelation – specifically focusing in the Beast in Revelation 13. Please have this to me for review by 7:00am. Only quote from the source given and the Bible NIV.
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    Case Study: Prescribed Drugs with CAMs

    A 35 year old male presents to your clinic today with complaints of back pain and “just not feeling good.” Regarding his back, he states that his back pain is a chronic condition that he has suffered with for about the last 10 years. He has not suffered any specific injury to his back. He denies weakness of the lower extremities, denies bowel or bladder changes or dysfunction, and denies radiation of pain to the lower extremities and no numbness or tingling of the lower extremities. He describes the pain as a constant dull ache and tightness across the low back.
    He states he started a workout program about 3 weeks. He states he is working out with a friend that is a body builder. He states his friend suggested taking Creatine to help build muscle and Coenzyme Q10 as an antioxidant so he started those medications at the same time he began working out. He states he also takes Kava Kava for his anxiety and garlic to help lower his blood pressure.
    His past medical history includes:
    Type II diabetes since age 27
    High blood pressure
    Recurrent DVT’s
    He states his other medications include:
    Glyburide 3 mg daily with breakfast
    Lisinopril 20 mg daily
    Coumadin 5 mg daily
    Questions:
    •    What are your recommendations for managing this patient’s medications?
    •    What are the components for educating the patient?
    •    When will you follow up with him on the efficacy of medications and education, and specifically what will you assess then?

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    motivational theories and factors

    motivational theories and factors
    Paper instructions:
    Motivational Theories and Factors

    To be effective, a company must learn to motivate its employees to efficiently meet the goals of the organization. Using what you know about motivation and the field of I/O psychology, respond to the following:

    Propose at least three ways to motivate others in the workplace.
    Create a strategy for enhancing your own motivation in the workplace.
    Compare and contrast two motivational theories (found in Chapter 7 of your course text) of your choice.
    Finally, discuss the pros and cons of using financial incentives in the workplace.

    Your assignment must be two to three double-spaced pages in length (excluding title and reference pages) and formatted according to APA guidelines as outlined in the Ashford Writing Center. Include a cover page and reference page formatted in APA style. In addition to the textbook, utilize at least one scholarly peer-reviewed source that was published within the past five years. Your sources must be cited according to APA format as outlined in the Ashford Writing Center.

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    scientific misconduct

    You do your own research into a reported case of scientific misconduct and summarize what happened. In the essay, you should point out who was involved? What were they working on? What did they do that was unethical? What happened to them ( fired? , fined?, nothing?,)….things like that. The amount of information available will vary with each case probably, but you should be able to come up with 2 double-spaced pages. If you google search “scientific misconduct cases” that should give you a start.

    Below is an detailed illustration of the general GEOS170C format. Note the punctuation and placement of initials after the authors’ names, etc. Every comma, colon and capitalization has to be right. Note the use of italics.
    The basic format is
    Author(s)        in the order shown on the publication, Last name, First initial…
    Date        original publication’s year, followed by a period
    Title        italics if a book, not-italics otherwise
    Publisher    replaced by journal title if a scientific article

    Encyclopedias (including Wikipedia) are not acceptable as references.
    Book (italics for book title) –

    McGarity, T. O. and Wagner, W. 2008. Bending science : how special interests corrupt public health research. Harvard University Press, Cambridge, Mass.

    Spece, R. G. and Bernstein, C. 2007. Scientific misconduct and liability for the acts of others : investigating scientific misconduct. International Center for Health, Law and Ethics, University of Haifa, Haifa, Israel.

    Journal article (italics for journal name) –

    Cyranoski, D. 2009. Retracted paper rattles Korean science. Nature 458: 561-561.

    Marris, E. 2010. Statistics spark dismissal suit. Nature 467: 260-260.

    Moore, J. W. 2002. Scientific misconduct. Journal of Chemical Education 79: 1391.

    Article published online –
    Follow the “journal article” format, above, and also include the URL, because journals may correct mistakes in the online article and they do not always make that obvious.

    (Nature Editorial Staff). 2010 Collateral damage: An investigation at Harvard University highlights the human cost of scientific misconduct. Nature: 466: 1023. Available from http://www.nature.com/nature/journal/v466/n7310/full/4661023a.html. Accessed  October 1, 2010.

    Wade, N. 2010. Harvard finds scientist guilty of misconduct. The New York Times August 20, 2010. Available from http://www.nytimes.com/2010/08/21/education/21harvard.html. Accessed September 23, 2010.

    Web site –
    Web pages typically don’t include all the information found in books and journal articles, making them potentially a less reliable source of information. Furthermore, web pages are frequently taken offline making their content impossible to check. Web references that are not electronic copies of published (paper) journal articles should contain the same information (if included!)
    Author(s)        in the order shown on the web page, Last name, First initial…
    Date        moved to the end of the reference as “last updated”
    Title        the largest font at the top of the page, usually; not-italics
    Publisher    replaced by URL, followed by: last updated, date viewed

    Akst, J. 2010. When is self-plagiarism ok? The Scientist. http://www.the-scientist.com/blog/display/57676/#ixzz0z3MbZ6QV. Last updated September 9, 2010; date viewed October 1, 2000.

    Grant, B. 2008. UK psychiatrist suspended for plagiarism. The Scientist. http://www.the-scientist.com/blog/display/54763/#ixzz11aqSgDP0. Last updated June 23, 2008; date viewed October 1, 2000.

    Additional reference examples (for example: dissertations, chapters in book) are listed under “Bibliography” at the bottom of the class schedule.

    SCIENCE IS BASED ON WRITING
    Publication of research in scholarly, peer-reviewed publications is the basis for scientific advancement and professional success. (“publish or perish”)

    A “jury of peers” — established scientists in the same field — reads each manuscript and recommends its acceptance or rejection for publication, to the editor of the journal. (The same procedure is used for competitive grant proposals.)

    Nonetheless, published research is sometimes false. When this is discovered, the scientist responsible is subject to professional sanctions (firing) and civil judgments (jail). Scientific Misconduct primarily results from falsifying data and plagiarism.
    •    biased reviews of papers or grant proposals
    •    bias created by business funding A
    •    changing collected data Ntr Ntr UA
    •    making-up data, without any research UA A
    •    stealing someone else’s data *cuny
    •    submitting someone else’s text plag
    •    re-publishing one’s own text. A B C
    You do your own research into a reported case of scientific misconduct and summarize what happened. In the essay, you should point out who was involved? What were they working on? What did they do that was unethical? What happened to them ( fired? , fined?, nothing?,)….things like that. The amount of information available will vary with each case probably, but you should be able to come up with 2 double-spaced pages. If you google search “scientific misconduct cases” that should give you a start.

    Below is an detailed illustration of the general GEOS170C format. Note the punctuation and placement of initials after the authors’ names, etc. Every comma, colon and capitalization has to be right. Note the use of italics.
    The basic format is
    Author(s)        in the order shown on the publication, Last name, First initial…
    Date        original publication’s year, followed by a period
    Title        italics if a book, not-italics otherwise
    Publisher    replaced by journal title if a scientific article

    Encyclopedias (including Wikipedia) are not acceptable as references.
    Book (italics for book title) –

    McGarity, T. O. and Wagner, W. 2008. Bending science : how special interests corrupt public health research. Harvard University Press, Cambridge, Mass.

    Spece, R. G. and Bernstein, C. 2007. Scientific misconduct and liability for the acts of others : investigating scientific misconduct. International Center for Health, Law and Ethics, University of Haifa, Haifa, Israel.

    Journal article (italics for journal name) –

    Cyranoski, D. 2009. Retracted paper rattles Korean science. Nature 458: 561-561.

    Marris, E. 2010. Statistics spark dismissal suit. Nature 467: 260-260.

    Moore, J. W. 2002. Scientific misconduct. Journal of Chemical Education 79: 1391.

    Article published online –
    Follow the “journal article” format, above, and also include the URL, because journals may correct mistakes in the online article and they do not always make that obvious.

    (Nature Editorial Staff). 2010 Collateral damage: An investigation at Harvard University highlights the human cost of scientific misconduct. Nature: 466: 1023. Available from http://www.nature.com/nature/journal/v466/n7310/full/4661023a.html. Accessed  October 1, 2010.

    Wade, N. 2010. Harvard finds scientist guilty of misconduct. The New York Times August 20, 2010. Available from http://www.nytimes.com/2010/08/21/education/21harvard.html. Accessed September 23, 2010.

    Web site –
    Web pages typically don’t include all the information found in books and journal articles, making them potentially a less reliable source of information. Furthermore, web pages are frequently taken offline making their content impossible to check. Web references that are not electronic copies of published (paper) journal articles should contain the same information (if included!)
    Author(s)        in the order shown on the web page, Last name, First initial…
    Date        moved to the end of the reference as “last updated”
    Title        the largest font at the top of the page, usually; not-italics
    Publisher    replaced by URL, followed by: last updated, date viewed

    Akst, J. 2010. When is self-plagiarism ok? The Scientist. http://www.the-scientist.com/blog/display/57676/#ixzz0z3MbZ6QV. Last updated September 9, 2010; date viewed October 1, 2000.

    Grant, B. 2008. UK psychiatrist suspended for plagiarism. The Scientist. http://www.the-scientist.com/blog/display/54763/#ixzz11aqSgDP0. Last updated June 23, 2008; date viewed October 1, 2000.

    Additional reference examples (for example: dissertations, chapters in book) are listed under “Bibliography” at the bottom of the class schedule.

    SCIENCE IS BASED ON WRITING
    Publication of research in scholarly, peer-reviewed publications is the basis for scientific advancement and professional success. (“publish or perish”)

    A “jury of peers” — established scientists in the same field — reads each manuscript and recommends its acceptance or rejection for publication, to the editor of the journal. (The same procedure is used for competitive grant proposals.)

    Nonetheless, published research is sometimes false. When this is discovered, the scientist responsible is subject to professional sanctions (firing) and civil judgments (jail). Scientific Misconduct primarily results from falsifying data and plagiarism.
    •    biased reviews of papers or grant proposals
    •    bias created by business funding A
    •    changing collected data Ntr Ntr UA
    •    making-up data, without any research UA A
    •    stealing someone else’s data *cuny
    •    submitting someone else’s text plag
    •    re-publishing one’s own text. A B C

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    Marketing Planning and Strategy (Ethical Challenge)

    Marketing Planning and Strategy (Ethical Challenge)
    Project description
    Is segmenting and targeting a market based on physical disabilities or health problems a violation of sound ethical practices? Support your response with real-life examples.

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    Case Study—Cerebrovascular Accident

    Quality in Healthcare at the National Level

    Quality is a serious initiative in healthcare at the national level. Hospitals, providers, insurance companies, and government-sponsored agencies are now faced with meeting quality initiatives. Compliance with these initiatives means more revenue and better patient quality and provider care.
    Select any area in your city (Phenix City, Alabama), and assume the patient in this week’s case study is in this area. Using the case study and the Internet, research and answer the following:

    •Does your community have the required medical resources to handle the patient’s problem?
    •How would the patient’s care be handled in your community? Identify the nearest hospital to the area you have chosen that treats the problem. Trace the patient’s course to this hospital.
    •List the healthcare professionals and facilities that would be encountered on the way.
    •Compare any two insurance plans and choose the one that would offer the most to the patient.
    •Discuss the essential quality-of-care issues involved in this case. What is the role of Telemedicine in your community and how do you access it? How does it affect the quality of care?

    Read the case study and answer all questions above.

    Case Study—Cerebrovascular Accident

    It is Saturday, March 26 at the Quinn residence. Robert Quinn is a sixty-six-year-old retired school district superintendent living in Sarasota, Florida. He and his wife Carol celebrated their thirty-fifth wedding anniversary earlier this month, and they have just returned from traveling to Louisiana and Texas visiting friends and sightseeing.

    Robert retired last June, and so far retirement is just fine by him. He plays golf, cooks, travels with Carol, and generally enjoys life a lot. Carol was a teacher and retired a few years before Robert. Since the couple was unable to have children, they decided to devote themselves to the children of their school. They both feel that they deserve their retirement and are making the most of the time after retirement.
    At 9:10 p.m., Robert has a headache, which he attributes to change of weather, sinuses, or a bug that he picked up while traveling. He is also dizzy, which he thinks is due to an inner ear infection. He has no fever.

    Over the next few minutes, the headache worsens, and now Robert starts experiencing some numbness in his right arm and leg and his vision is blurred. As he tries to tell Carol about his discomfort, his speech slurs. Carol is very concerned, and she calls 911.

    Emergency Medical Services

    The Sarasota Emergency Medical Services (EMS) is one of the best in the country. On duty with a staff of Emergency Medical Technician-Basic (EMT-Basic) is paramedic Trish Nevil, EMT-P. Notes the squad is toned out at 9:22 p.m., rolls at 9:24 p.m., and reaches the Quinn residence at 9:35 p.m. They immediately administer oxygen by partial rebreather mask at 90% oxygen. Trish recognizes the signs of a likely stroke, and wants to get as much oxygen to Robert’s brain as possible during transport. She also starts an IV. Notes
    The Quinn’s live very near St. Catherine’s Hospital. Trish and her team transport Robert to St. Catherine’s emergency room (ER), arriving at 9:47 p.m.
    As Robert is wheeled into the ER, Trish says to ER physician David Palmer, "Doctor, this is a stroke until proven otherwise. Severe headache, right-sided weakness, so left-sided stroke; all the physical findings"

    Dr. Palmer smiles, "I love it when you make these diagnoses for me before the patient even hits the door. Mind if I do a CT scan just to confirm?" Trish smiles. Over several years of working together, Trish has earned Dr. Palmer’s respect and also friendship. She makes sure that Robert is well attended to by the ER nurses and then leaves the ER to complete her EMS run sheet.

    Payer Issues

    One real advantage of being retired and on Medicare is that some of the managed care payer issues that affect the care of younger patients become simpler. Robert is on Medicare, and he has the AARP Medicare supplement. With those two payers, he can receive care at just about any Sarasota healthcare facility. Notes

    Diagnostic Tests

    It is 10:19 p.m. Following completion of vital signs and some very quick chart documentation, Robert is transported to the computerized tomography (CT) scanner. This is the only way to confirm or rule out what certainly appears to be a cerebrovascular accident (CVA), and to determine whether this is an ischemic or hemorrhagic stroke. A quick determination will greatly influence Robert’s treatment.
    Carol is permitted to go with Robert to the scanner. Robert is unconscious and is having difficulty maintaining his airway, so both a nurse and respiratory therapist accompany him to the CT scanner. Registered Respiratory Therapist (RRT), Kathy Haynes, is on duty. Notes Kathy is keeping Robert’s airway open with a jaw thrust maneuver while continuing to administer high concentration oxygen. The registered radiographer on duty is Mike Johnson, RT. He has a degree in radiological technology Notes and has taken additional specialty training in CT. He receives the order for a head CT scan.

    The hospital has a state-of-the-art CT scanner. The scanning procedure is completed in just over five minutes. The scan appears normal. Mike calls Dr. Palmer in the ER and says, "Doctor, this CT scan appears normal. There is definitely no intracranial bleed, but I really think this gentleman is having a stroke down here. Can I go ahead and get an image with our new Xenon-enhanced CT process?" Notes
    "Do it Mike, and thanks for speaking up," responds Dr. Palmer.

    While Mike is completing computer reconstruction of the exams, Kathy notices that Robert has stopped breathing. "Mike, you’d better call a code blue here. Notes This gentleman is not moving any air!" Kathy inserts an oral airway and begins to manually ventilate. Mike dials the overhead page number and calls, "Code Blue in CT . . . Code Blue in CT." Within a minute, more than a dozen staff members descend on the CT scanner, rolling a crash cart with them. Notes

    Dr. Palmer arrives at the CT area. "What happened," he shouts.
    "He just stopped breathing," says Kathy. "I’ve got an oral airway in place and I’m bagging him with 100% oxygen."
    "Can you intubate him Kathy, or do you want me to do it," says Dr. Palmer.
    "I can do it," says Kathy, "Give me a laryngoscope with a #4 curved blade and a size 8 endotracheal tube."
    Another respiratory therapist arrives at the code, hands Kathy the equipment and assists her as she intubates Mr. Quinn. Notes Kathy secures the endotracheal tube, checks for proper position, and attaches the manual bag-valve-mask to the tube. She begins to ventilate Robert in this manner. A cardiac monitor on the crash cart indicates tachycardia with a heart rate of 140.

    Dr. Palmer calls out, "Let’s move folks, we need to be in ICU for this." The team moves Robert back to the ER gurney, which brought him to CT, and begins to roll him to the ICU. Notes Kathy continues to bag him, breathing for him during the transport.

    Diagnostic Review

    Telemedicine and CT Interpretation

    Dr. David Watts is the radiologist on call. He is at home watching television. He has a complete telemedicine reading station at home.
    Following medical school, Dr. Watts completed a residency in internal medicine. Then he went back to school for a second residency in radiology. His bedside clinical experience has made him an outstanding radiologist.

    Dr. Palmer calls Dr. Watts’ home, and says, "Dave, could you prioritize the CT scan on Mr. Robert Quinn. I’m resuscitating this fellow and I really need to know what I’m dealing with here."
    Dr. Watts calls up the CT images on his monitor. The reading station is a blessing to him beyond anything he could have imagined during his training days. With it he can manipulate the images—make them lighter or darker, change the contrast, zoom in or out, and so on.

    What he sees on the CT images for Mr. Quinn is a classic example of why hospitals need to keep up with the advancements in medical technology. The regular CT image of Mr. Quinn is normal. It rules out hemorrhagic stroke, but shows no evidence at all of ischemia. The Xenon CT image shows the characteristic blood flow reduction of an ischemic stroke. The left side of Robert’s brain is getting very little blood supply. It is dying for lack of blood and oxygen. Notes

    Dr. Watts says to Dr. Palmer, "Okay, Dave, this is a CVA; it is occlusive, and likely an embolus in a good-sized vessel leading to the left hemisphere. Hit him with your tPA, pal. You can really change the outcome for this man if the tPA happens soon enough." Notes

    ICU Course

    tPA is tissue plasminogen activator, the "clot buster" medication, which has been saving heart attack victims for some years now. An ischemic stroke patient will benefit from tPA if the symptoms came on "all of a sudden" and then got worse. An indication of sudden onset is that the patient is "normal" before the symptoms show—talking, walking, eating, driving, and the like.

    Cindy Stempien, RN, CCRN Notes is attending Mr. Quinn. At Dr. Watt’s instruction, she quickly assembles the tPA kit and administers the dose at 10:37 p.m., well within the recommended three-hour interval from onset of symptoms. Notes

    After the tPA administration, Kathy places Robert on a Puritan Bennett 840 ventilator to breathe for him. He is making some very limited respiratory efforts, but not adequate to sustain himself.
    "Dr. V" or Dr. Vijay Venkataramana, the staff neurologist, takes over the case. Notes
    He reviews the CT images, concurs with Dr. Watts, and plots the course of care for Robert’s recovery. Dr. Vijay has worked with many such patients and knows some methods for improving the chances of recovery, assuming that Robert survives the next few days.
    Physical therapist Bill Morris, Licensed Physical Therapist (LPT), looks in. All that he can realistically do right now is a range of motion exercises, so he does a complete set of those with Robert.

    Intensive Care Experience

    Ventilator Weaning

    For three days Robert is unconscious, he cannot be aroused. His neurological signs are consistent with significant stroke. Then on the afternoon of the fourth day in Intensive Care, he begins to stir. Carol sees him making a fist with his left hand. Again and again he makes the fist, and then reaches up and grabs the endotracheal tube, trying to pull it out of his throat. Carol grabs the hand and calls for a nurse. Several nurses come to the bedside and get Robert’s hand down to the bed and hold it there. Right now Robert’s very existence is dependent upon that endotracheal tube staying in place.

    Nurse Penny Hampton speaks to Robert, "You are in Intensive Care at St. Catherine’s Hospital, Mr. Quinn. You’ve had a stroke and we are helping you to get better. That tube in your mouth is to help you breathe, and you really need it. Please don’t try to pull it out." She places a soft restraint on the hand and ties it to the bed. Penny hates restraining patients, but there are times when it must be done for the patient’s own benefit.

    A pulmonary consult from Dr. Frank Henizman indicates that Robert’s lungs are in good condition for his age, especially since he never smoked and had no occupational lung exposures. He should be weaned from the ventilator, but only when his central nervous system function is adequate. Notes

    Kathy Haynes from respiratory therapy is called to see Mr. Quinn and takes the following measurements to see if Mr. Quinn is ready to come off the ventilator:
    •Negative inspiratory force = 35 mmHg
    •Spontaneous tidal volume = 450 ml
    •Spontaneous vital capacity = 1,200 ml
    •Spontaneous respiratory rate = 22
    These measurements are encouraging. What is even more encouraging is that Robert is looking at the staff with attention and nodding or shaking his head in answer to their questions.

    Kathy adjusts the ventilator to allow Robert to breathe on his own for a while and he does well. Over the remainder of the day, Kathy works with Robert, gradually allowing him to take over more and more of his breathing. The following morning Kathy extubates, that is, removes the breathing tube, from Robert, and he does well breathing on his own. Kathy will keep him on oxygen therapy for several days, just to help him recover and ease his work of breathing.

    Robert speaks for the first time after extubation, and Donna, Kathy, Penny, and the rest of the team are thrilled to hear it.
    Carol goes home to get some rest. She has been sleeping in a chair in the ICU waiting room since the first night.

    Post hospitalization Rehabilitation

    Rehabilitation

    Physical therapist Bill Morris, LPT, and Scott Underwood, occupational therapist registered (OTR), visit Robert the following day, and they write a plan of care for his rehabilitation. Part of the plan is to transfer Robert to the main inpatient floor, out of ICU, where physical therapy (PT) and occupational therapy (OT) procedures can be accomplished more easily. Dr. V approves the transfer to the floor later the same day. Over the next several days, Bill and Scott begin working with Mr. Quinn on some basics, getting out of bed into a chair, learning how to eat with less help, and swallowing without choking. Robert starts learning a lot of things over again, things that he has done easily throughout his adult life.

    Transfer to Rehabilitation

    On the morning of day five on the inpatient floor, Bill and Scott approach Dr. V, "Doctor, if Mr. Quinn is clinically stable from your standpoint, we really could help him more effectively in the Thorpe Rehabilitation Center now." Dr. V agrees. An order is written, and the transfer by wheelchair takes place the same afternoon. Notes

    About ten years ago, St. Catherine’s made the decision to build its own rehabilitation center on-site instead of transferring patients to outside facilities. The decision has paid off both clinically and financially. Notes

    Occupational Therapy Evaluation
    On Friday, April 8, Robert is transferred to rehabilitation. He progresses to using a walker with assistance. He can make it back and forth to the bathroom. He is also able to speak. So, his challenges become those of OT more than PT or speech therapy, though physical therapist Bill Morris will be in daily to work with Robert and push him to extend his ambulation.

    On Monday, April 11, occupational therapist Scott Underwood comes in to see Robert in the morning. Now he begins the real work of OT, and he has Robert in an environment, which is very well suited for rehabilitation. The rehabilitation center has a model apartment in which patients can practice the activities of daily living, from doing laundry, to cooking, to eating, to washing dishes, and bathing.
    Scott reports the following regarding Mr. Quinn:

    The patient:
    •Is right-hand dominant
    •Has approximately ½ normal range of motion in right shoulder
    •Has grip strength in right hand, which is about one-third of left hand
    •Has very poor fine-motor coordination
    •Can oppose the right thumb only to the first digit
    •Has some edema in the right hand

    All of this is making it very difficult for Robert to manage his daily activities such as dressing himself and eating.
    Scott designs a program for Robert, which involves a diversity of exercises to improve both strength and coordination. Robert finds himself doing activities such as cutting pictures out of newspapers, shuffling and dealing cards, and practicing the activities which had become so routine that they were almost unconscious. At first he finds the exercises silly, but he notices that he is improving. PT also continues as the weeks go by.

    On the twenty-third day at Thorpe Rehabilitation Center, Robert dresses himself without help, feeds himself, albeit with difficulty, and walks the entire main corridor of the patient unit. Dr. V reads the occupation therapy evaluation and says to Robert, "Mr. Robert, you are now taking up a bed here which we need for sick people. I must kick you out today." They both laugh. Carol is thrilled.

    Healthcare at Home

    Home Healthcare

    For another twelve weeks, OT continues at Robert’s home. Robert was hopeful that Scott Underwood could "follow him home," but it is a new therapist Cindy Montgomery, who visits him each Monday and Thursday. He continues to progress. Eventually, Cindy advises Robert that she has done what she can for him, and discharges him from the service. Notes

    Lifestyle Changes

    When the smoke clears in the hospital, one thing that Robert learns is that his bad cholesterol LDL is very high, and this is certainly a contributing factor in his stroke. Narrowing of a particular artery leading to the left side of his brain, caused by lipid plaque, this means that a tiny blood clot could easily block that artery. Meanwhile, Robert’s blood work indicates that he could benefit from thinner blood, which Dr. V decides could be accomplished with daily aspirin therapy and clopidogrel bisulfate (Plavix).

    Robert had always considered himself to be in pretty good shape, but Dr. V advises him that he would be much better off at 160 pounds versus 180 pounds, and he now has dietary instructions in hand to help make that happen. Dr. V also advises Robert to walk for thirty minutes three times a week. He and Carol have always enjoyed taking exercise walks together, but now they schedule them and actually keep track on a calendar. Notes

    Life Goes On

    It is Saturday morning, July 23. Robert and Carol are sitting together at the breakfast table. Carol remarks on just how much better Robert is doing now, and he agrees, "Almost back to 100 percent I would say. I’m going to write out some ‘thank you’ notes this morning to the people who helped me, and you will have to help, Carol, because I don’t remember a lot of those early days in the hospital." Carol responds, "I’d love to. They were wonderful people, and Dr. V says that it was their quick actions that made all the difference in your recovery."

    Carol has been thinking for several days, and now speaks, "You know, you always said you’d like to see the Grand Canyon, Robert. Do you think that you’d be up to that this year?" Robert smiles, "I thought you’d never ask. I left the motor home in a mess after that last trip and I think today would be a fine day to clean it up. While I do that, why don’t you go online and get some dates and prices for that airplane ride through the Canyon and that restaurant that you saw on the Food Network. You know the one that looks out over the North Rim of the Canyon. I’ve always wanted to do that." Life goes on.

    NQII

    There are currently three major NQIIs underway in America. These are for the diseases of pneumonia, congestive heart failure, and acute myocardial infarction. The initiatives were taken by the CMS, the federal agency, which administers the Medicare program.

    We shall explore the quality initiatives, for acute myocardial infarction, as an example in practice, and see what is expected of doctors and hospitals. It is important to note that hospitals are, for the first time ever, being judged by Medicare on their compliance with published standards of practice.
    Hospitals are now required by law to electronically submit their own data on certain quality indicators to the organization in their own state, which is responsible for medical quality. For example, the Oklahoma Foundation for Medical Quality is one such organization. Click the link on the right to learn more about this organization.

    Initially, Medicare is reducing payments only to hospitals, which fail to submit the data, but eventually they will actually base payments to hospitals on how well they comply with the standards. This compliance is very controversial in the healthcare community.
    The newly published quality indicators for acute myocardial infarction, stated as questions for the hospital to answer as follows:

    •Aspirin administered within 24 hours of arrival?
    •Beta-blocker administered within 24 hours of arrival?
    •Did patient receive initial reperfusion? Thrombolytic door-to-drug within 30 minutes? Primary angioplasty door-to-balloon within 60 minutes?
    •Aspirin ordered as a discharge medication?
    •Beta-blocker ordered as a discharge medication?
    •ACE inhibitor medication ordered as a discharge medication?
    •Smoking cessation counseling provided?

    This process is rather controversial among doctors. Many doctors, especially older doctors see this as a clear case of "somebody trying to tell us how to practice medicine."
    Irrespective of the controversy, hospitals and doctors are now being judged on their compliance with the standards, and their payments from Medicare in the years ahead will be based upon this. There will even be a website at which individual hospital’s "performance scores" will be posted for public viewing. This process is very new, and it will be interesting to see how doctors and hospitals respond to this type of oversight and monitoring

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    The attempt merger of at&t and t-mobile

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