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A review of conceptual and methodological issues order viagra 50 mg fast delivery, Psychology and Health buy cheap viagra 75 mg on-line, 12: 417–31 viagra 75mg sale. This paper explores the complex and ever-growing area of coping and focuses on the issues surrounding the questions ‘What is coping? This paper outlines the concept of illness cognitions and discusses the implica- tions of how people make sense of their illness for their physical and psycho- logical well-being cheap viagra 100 mg otc. This is an edited collection of projects using the self-regulatory model as their theoretical framework. It describes and analyses the cognitive adaptation theory of coping with illness and emphasizes the central role of illusions in making sense of the imbalance created by the absence of health. This educational perspective explains communication in terms of the transfer of knowledge from medical expert to layperson. Such models of the transfer of expert knowledge assume that the health professionals behave according to their education and training, not their subjective beliefs. Next, the chapter focuses on the problem of variability and suggests that variability in health professionals’ behaviour is not only related to levels of knowledge but also to the processes involved in clinical decision making and the health beliefs of the health professional. This suggests that many of the health beliefs described in Chapter 2 are also relevant to health professionals. Finally, the chapter examines doctor– patient communication as an interaction and the role of agreement and shared models. Compliance has excited an enormous amount of clinical and academic interest over the past few decades and it has been calculated that 3200 articles on compliance in English were listed between 1979 and 1985 (Trostle 1988). Compliance is regarded as important primarily because following the recommendations of health professionals is considered essential to patient recovery. However, studies estimate that about half of the patients with chronic illnesses, such as diabetes and hypertension, are non-compliant with their medication regimens and that even com- pliance for a behaviour as apparently simple as using an inhaler for asthma is poor (e. Further, compliance also has financial implications as money is wasted when drugs are prescribed, prescriptions are cashed, but the drugs not taken. This claimed that compliance can be predicted by a combination of patient satisfaction with the process of the consultation, understanding of the information given and recall of this information. Several studies have been done to examine each element of the cognitive hypothesis model. Patient satisfaction Ley (1988) examined the extent of patient satisfaction with the consultation. He reviewed 21 studies of hospital patients and found that 41 per cent of patients were dissatisfied with their treatment and that 28 per cent of general practice patients were dissatisfied. Ley (1989) also reported that satisfaction is determined by the content of the consultation and that patients want to know as much information as possible, even if this is bad news. For example, in studies looking at cancer diagnosis, patients showed improved satisfaction if they were given a diagnosis of cancer rather than if they were protected from this information. Participants were asked to read some information about medica- tion and then to rate their satisfaction. Some were given personalized information such as, ‘If you take this medicine, there is a substantial chance of you getting one or more of its side effects’ whereas some were given non personalized information, ‘A substantial proportion of people who take this medication get one or more of its side effects’. The results showed that a more personalized style was related to greater satisfaction, lower ratings of the risks of side effects and lower ratings of the risk to health. The authors coded recorded consultations for their humour content and for the type of humour used. They then looked for differences between high and low satisfaction rated consultations. The results showed that high satisfaction was related to the use of more light humour, more humour that relieved tension, more self-effacing humour and more positive-function humour. Patient satisfaction is increasingly used in health care assessment as an indirect measure of health outcome based on the assump- tion that a satisfied patient will be a more healthy patient. This has resulted in the development of a multitude of patient satisfaction measures and a lack of agreement as to what patient satisfaction actually is (see Fitzpatrick 1993). However, even though there are problems with patient satisfaction, some studies suggest that aspects of patient satisfaction may correlate with compliance with the advice given during the consultation. Patient understanding Several studies have also examined the extent to which patients understand the content of the consultation. Boyle (1970) examined patients’ definitions of different illnesses and reported that when given a checklist only 85 per cent correctly defined arthritis, 77 per cent correctly defined jaundice, 52 per cent correctly defined palpitations and 80 per cent correctly defined bronchitis. Boyle further examined patients’ perceptions of the location of organs and found that only 42 per cent correctly located the heart, 20 per cent located the stomach and 49 per cent located the liver. This suggests that understanding of the content of the consultation may well be low. Further studies have examined the understanding of illness in terms of causality and seriousness. Roth (1979) asked patients what they thought peptic ulcers were caused by and found a variety of responses, such as problems with teeth and gums, food, digestive problems or excessive stomach acid. Roth also reported that 30 per cent of patients believed that hypertension could be cured by treatment. If the doctor gives advice to the patient or suggests that they follow a particular treatment programme and the patient does not understand the causes of their illness, the correct location of the relevant organ or the processes involved in the treatment, then this lack of understanding is likely to affect their compliance with this advice. This study examined the effect of an expert, directive consulting style and a sharing patient-centred consulting style on patient satisfaction. This means that it is possible to compare the effects of the two types of consulting style without the problem of identifying individual differences (these are controlled for by the design) and without the problem of an artificial experi- ment (the study took place in a natural environment). Theoretically, the study examines the prediction that the educational model of doctor–patient communication is problem- atic (i. Background A traditional model of doctor–patient communication regards the doctor as an expert who communicates their ‘knowledge’ to the naïve patient. Within this framework, the doctor is regarded as an authority figure who instructs and directs the patient. However, recent research has suggested that the communication process may be improved if a sharing, patient-centred consulting style is adopted. This approach emphasizes an inter- action between the doctor and the patient and suggests this style may result in greater patient commitment to any advice given, potentially higher levels of compliance and greater patient satisfaction. Savage and Armstrong (1990) aimed to examine patients’ responses to receiving either a ‘directive/doctor-centred consulting style’ or a ‘sharing/ patient-centred consulting style’. Methodology Subjects The study was undertaken in a group practice in an inner city area of London. Overall, 359 patient were invited to take part in the study and a total of 200 patients completed all assessments and were included in the data analysis. Design The study involved a randomized controlled design with two conditions: (1) sharing consulting style and (2) directive consulting style. Procedure A set of cards was designed to randomly allocate each patient to a condi- tion. When a patient entered the consulting room they were greeted and asked to describe their problem. For example, the doctor’s judgment on the consultation could have been either, ‘This is a serious problem/I don’t think this is a serious problem’ (a directive style) or, ‘Why do you think this has happened?

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These changes suggest that most anxiety disorders stem from perceived 25mg viagra free shipping, rather than actual buy viagra 50mg low price, threats to our well-being cheap viagra 50mg without prescription. A single dog bite can lead to generalized fear of all dogs; a panic attack that follows an embarrassing moment in one place may be generalized to a fear of all public places viagra 50mg mastercard. Behaviors become compulsive because they provide relief from the torment of anxious thoughts. Similarly, leaving or avoiding fear-inducing stimuli leads to feelings of calmness or relief, which reinforces phobic behavior. In contrast to the anxiety disorders, the causes of the dissociative orders are less clear, which is part of the reason that there is disagreement about their existence. Unlike most psychological orders, there is little evidence of a genetic predisposition; they seem to be almost entirely environmentally determined. Severe emotional trauma during childhood, such as physical or sexual abuse, coupled with a strong stressor, is typically cited as the underlying cause (Alpher, [33] [34] 1992; Cardeña & Gleaves, 2007). Kihlstrom, Glisky, and Angiulo (1994) suggest that people with personalities that lead them to fantasize and become intensely absorbed in their own personal experiences are more susceptible to developing dissociative disorders under stress. Does the anxiety keep you from doing some things that you would like to be able to do? Selective attention and emotional vulnerability: Assessing the causal basis of their association through the experimental manipulation of attentional bias. The epidemiology and cross-national presentation of obsessive-compulsive disorder. Meta-analysis of risk factors for posttraumatic stress disorder in trauma- exposed adults. An unbalanced balancing act: Blocked, recovered, and false memories in the laboratory and clinic. Dissociative disorders among psychiatric patients: Comparison with a nonclinical sample. Unmasking Sybil: A reexamination of the most famous psychiatric patient in history. Smaller hippocampal volume predicts pathologic vulnerability to psychological trauma. Gene-by-environment (serotonin transporter and childhood maltreatment) interaction for anxiety sensitivity, an intermediate phenotype for anxiety disorders. Introject and identity: Structural-interpersonal analysis and psychological assessment of multiple personality disorder. Summarize and differentiate the various forms of mood disorders, in particular dysthymia, major depressive disorder, and bipolar disorder. Explain the genetic and environmental factors that increase the likelihood that a person will develop a mood disorder. The everyday variations in our feelings of happiness and sadness reflect ourmood, which can be defined as the positive or negative feelings that are in the background of our everyday experiences. In most cases we are in a relatively good mood, and this positive mood has some positive consequences—it encourages us to do what needs to be done and to make the most of [1] the situations we are in (Isen, 2003). When we are in a good mood our thought processes open up, and we are more likely to approach others. We are more friendly and helpful to others when we are in a good mood than we are when we are in a bad mood, and we may think more [2] creatively (De Dreu, Baas, & Nijstad, 2008). On the other hand, when we are in a bad mood we are more likely to prefer to be alone rather than interact with others, we focus on the negative things around us, and our creativity suffers. It is not unusual to feel “down‖ or “low‖ at times, particularly after a painful event such as the death of someone close to us, a disappointment at work, or an argument with a partner. We often get depressed when we are tired, and many people report being particularly sad during the winter when the days are shorter. Mood (or affective) disorders are psychological disorders in which the Attributed to Charles Stangor Saylor. People who suffer from mood disorders tend to experience more intense—and particularly more intense negative—moods. The most common symptom of mood disorders is negative mood, also known as sadness or depression. Consider the feelings of this person, who was struggling with depression and was diagnosed with major depressive disorder: I didn’t want to face anyone; I didn’t want to talk to anyone. I didn’t really want to do anything for myself…I couldn’t sit down for a minute really to do anything that took deep concentration…It was like I had big huge weights on my legs and I was trying to swim and just kept sinking. And I’d get a little bit of air, just enough to survive and then I’d go back down again. It was just constantly, constantly just fighting, fighting, fighting, fighting, fighting. Recurrence of depressive episodes is fairly common and is greatest for those who first experience depression before the age of 15 years. About twice as [5] many women suffer from depression than do men (Culbertson, 1997). This gender difference is consistent across many countries and cannot be explained entirely by the fact that women are more likely to seek treatment for their depression. Rates of depression have been increasing over [6] the past years, although the reasons for this increase are not known (Kessler et al. As you can see below, the experience of depression has a variety of negative effects on our behaviors. In addition to the loss of interest, productivity, and social contact that accompanies depression, the person‘s sense of hopelessness and sadness may become so severe that he or she considers or even succeeds in committing suicide. Suicide is the 11th leading cause of death in the United States, and a suicide occurs approximately every 16 minutes. Almost all the people who commit suicide have a diagnosable psychiatric disorder at the time of their death (American Attributed to Charles Stangor Saylor. Behaviors Associated with Depression  Changes in appetite; weight loss or gain  Difficulty concentrating, remembering details, and making decisions  Fatigue and decreased energy  Feelings of hopelessness, helplessness, and pessimism  Increased use of alcohol or drugs  Irritability, restlessness  Loss of interest in activities or hobbies once pleasurable, including sex  Loss of interest in personal appearance  Persistent aches or pains, headaches, cramps, or digestive problems that do not improve with treatment  Sleep disorders, either trouble sleeping or excessive sleeping  Thoughts of suicide or attempts at suicide Dysthymia and Major Depressive Disorder The level of depression observed in people with mood disorders varies widely. People who experience depression for many years, such that it becomes to seem normal and part of their everyday life, and who feel that they are rarely or never happy, will likely be diagnosed with a mood disorder. If the depression is mild but long-lasting, they will be diagnosed with dysthymia, a condition characterized by mild, but chronic, depressive symptoms that last for at least 2 years. If the depression continues and becomes even more severe, the diagnosis may become that of major depressive disorder. Major depressive disorder (clinical depression) is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem and by loss of interest or pleasure in normally enjoyable activities. Those who suffer from major depressive disorder feel an intense sadness, despair, and loss of interest in pursuits that once gave them Attributed to Charles Stangor Saylor. These negative feelings profoundly limit the individual‘s day-to-day functioning and [8] ability to maintain and develop interests in life (Fairchild & Scogin, 2008). About 21 million American adults suffer from a major depressive disorder in any given year; this is approximately 7% of the American population.

In the past it was found that simple grid sys- tems worked well with fat scenes buy viagra 100 mg fast delivery, similar to an airplane crash on land generic 25 mg viagra overnight delivery. It has been found in recent incidents that when dealing with collapsed buildings and water settings buy viagra 75mg overnight delivery, simple grids fail to give adequate information about elevation and return points of reference order viagra 75 mg with mastercard. A control system needs to be established early in the incident to allow access to the crime scene to only authorized personnel. Badge systems, periodic changes of codes, and photo identifcation have all been used to prevent unauthorized access. A security ofcer and an established security protocol should be the focus areas for all security-related questions. Te protocol should be required reading for all workers, who should avow that they have read and understood the policies in a signed document as a part of their indoctrination into the operation of the incident. Safety should be among the most important aspects in the management of a mass disaster site. Tere may be a large number of injured and dead individuals as a result of the disaster. Tere is no justifcation for adding to those numbers with responders who do not follow safe practices. A safety ofce should be created, and as in the security section, there should be a safety protocol developed, understood, and adhered to by the workers to prevent more injuries and loss of life. Te debris feld of an airplane crash or the resulting devastation of a detonation of a bomb in an urban setting yields situations and materials that are physically dangerous and potentially contaminated with dangerous substances. Te safety ofcer and the person responsible for hazardous materials (hazmat) should coordinate and estab- lish the safety of the site before responders enter the area. Te safety ofce dental identifcation in multiple Fatality incidents 251 should address the problem of proper decontamination of materials being sent to the morgue area. Tere are, in most cases, emergency plans of action in place by the local emergency response ofce to activate police, fre protection, and medical services. Tese local agencies should be in close communication and would be best organized if one person is assigned to supervise the operation. Tere should also be con- tingency plans for contacting outside resources for assistance if the situation becomes too complex for the local responders to handle. In times of natural disaster the state agencies work with their state governor to seek this aid through a presidential declaration. In the early and middle 1990s several complaints were lodged by family members of victims killed in airplane crashes. Te complaints revolved around poor treatment and lack of communication with the families. Congress felt strong enough about these complaints that they enacted the Family Assistance Act of 1996. Most of these units act as a resource for each country but work together in an inter- national response when needed. Trough training and establishment of response manuals this person is usu- ally defned for most local jurisdictions. Te problem arises when many state and federal agencies come together in a response role and then try to work as independent agencies. Any assignments within the command framework not delegated to others revert to the incident commander. In more complicated situations with many agencies involved, a modifed system can be implemented with a unifed command replacing a single incident commander. Te unifed command is composed of agency representatives who have full authority to make policy decisions for their respective agencies. Tere is an agreement made before the unifed command is activated that it will work as a democratic body, with each agency repre- sented committed to follow the decisions of the entire group. Although deciding on a victim and missing person numbering system may seem uncomplicated, in the past there have been almost as many diferent number- ing systems as operations done. With the use of computers so prevalent, numbering systems need only be tailored for estimated numbers and some obvious diferentiation between antemortem and postmortem records. Always begin the antemortem or postmortem records with a variation of the number 1. For purposes of electronic database storage and order, zeros can be added before the 1 to approximate the total number of records expected. For example, if there are three hundred expected fatalities, the frst number would be 001. Tis would not only accommodate the 300 expected fatalities, but also could be used if the incident increased up to 999 victims. Antemortem records can easily be numbered in the same way, with the addition of A to appear before the number to make an obvious dif- ference between antemortem (A001) and postmortem (P001). As far as using the numbering system to show recovery areas, operation names, or any other bits of information, digital databases replace this function with record-specifc data cells that can be ordered or searched as necessary. If numbering systems are changed for any reason in the middle of an operation, many problems will dental identifcation in multiple Fatality incidents 253 ensue. Some computer systems use the numbering system for unique identi- fcation within a particular sofware application, and in addition might use the number to connect or bridge to another sofware program to accomplish a diferent task. Tese types of systems do not allow quick and easy updates of initial numbering systems. In fact, it could require many hours of work and coordination to establish a new numbering system. Terefore, establish the exact numbering system before operations begin and stick with it. Forensic anthropologists who have a doctorate degree and are board certifed by the American Board of Forensic Anthropology should be used if available. Te dental section is responsible for antemortem and postmortem dental records, the dental postmortem examination, and the comparison of dental records for identifcation. Tis section is also charged with obtaining latent prints from missing persons’ premises that may lead to identifcation of missing persons with no antemortem fngerprint records. Tis section is stafed with experienced fngerprint experts from local, state, or federal agencies. Te personal efects section is usually the frst physical station in the morgue area. Personal efects collects those items associated with each victim, docu- ments and stores those items, and prepares them for return to the families of the victims. Tis section usually confrms proper numbering of victims and begins the sequential processing of the morgue operation. Te forensic pathology section is usually headed by the medical examiner in charge of the morgue. Te radiology section provides medical radiographic docu- mentation for each unidentifed victim. Tey may then compare antemortem radiographs from missing persons to those of unknown victims for identif- cation. Other sections may be added or any of the sections listed above can be modifed, expanded, combined, or deleted to ft the needs of the operation.

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As a general rule order viagra 100 mg amex, every effort is made to encourage the patient to take the medica- tion viagra 25mg low cost. Healthcare providers should avoid speaking in medical terminology and proven viagra 100 mg, instead cheap 50 mg viagra visa, use common words and expressions that are familiar to the patient—and always in the language that the patient speaks. The patient provides feedback that he or she understands everything about the medication. It is common for the healthcare provider to ask the patient to tell in his or her own words what was told to them about the medication. The list should have the name of the medication, dose, time the medication is to be taken and the name and phone number of the prescriber who ordered the medication. Summary Pharmacology is the study of drug effects on living tissue and how drugs cure, prevent, or manage diseases. Drugs are derived from plants, animals, miner- als, and are synthesized in the laboratory. These are the chemical name, the generic name that is considered the official name for the drug, and the brand name, which is used by the manufacturer to market the drug. There are two general classifications of drugs: prescription and over-the- counter drugs. Prescription drugs are also known as legend drugs and must be prescribed by an authorized healthcare provider. Drugs have three effects: these are the therapeutic effect to fight or prevent a disease; a side effect that isn’t harmful; and an adverse effect that is harmful to a varying degree. Healthcare providers must know about these effects before administering the med- ication to the patient. Clinical studies determine the therapeutic effect, adverse effect, and side effects the drug has on humans. A drug is prescribed to a patient by writing a drug order or medical prescrip- tion. A drug order specifies, among other things, the name of the drug, the dose, route of administration, and frequency. These are to give the right patient the right drug, in the right dose, at the right time, by the right route. Patients also have the right to refuse medication and the right to education about the medication. With this overview of pharmacology under your belt, let’s take a closer look at how drugs work by exploring the principles of drug action and drug inter- actions in the next chapter. A brand name of a drug is (a) the non-trademarked name given by the original drug manufacturer. A drug order that requires the drug to be given immediately is called a (a) one-time order. The number of times a drug is given to a patient can be determined by the half-life of the drug. You might have even reached the point when you’d welcome an injection of a miracle drug if it would get you back on your feet quickly. Drugs aren’t miracles and have nothing to do with magic although you might think differently when your nose is running, eyes watering, and you feel rotten all over. In this chapter, you’ll be introduced to the scientific principles that describe how drugs interact with cells in your body to bring about a pharmaceutical response that either directly attacks the pathogen that is causing your sniffles or stimulates your body’s own defense mechanism to stamp them out. This occurs when an antihypertensive (high blood pressure) drug interferes with the process that constricts blood vessels and may cause blood pressure to rise. A drug action begins when the drug enters the body and is absorbed into the bloodstream where the drug is transported to receptor sites throughout the body (see Pharmacokinetics, in this chapter). Once the drug hooks onto a receptor site, the drug’s pharmacological response initiates. The pharmacological response is the therapeutic effect that makes the patient well. The desirable effect is what makes the patient well or prevents the disease or disorder. Some side effects are desirable and others are undesirable (see Side Effects, in this chapter). The strength of a drug action is determined by how much of the drug is given, (the dose) and how often the drug is given (the frequency). For example, a patient who has a sore throat can be given a large dose of an antibiotic—a loading dose— on the first day of treatment and a normal or maintenance dose for the next five days. These are: • Pharmaceutic Phase: This phase occurs after the drug is given and involves disintegration and dissolution of the dosage form. The inactive ingredient, called excipient, is the substance that has no pharmaceutical response but helps in the delivery of the drug. The coating around tiny particles of a capsule that causes a timed-release action of the drug is an inactive ingredient. The time necessary for the drug to disintegrate and dissolve so it can be absorbed is called the rate limiting time. A drug has a higher rate limiting time (Table 2-1) if it is absorbed in acidic fluids rather than alkaline fluids. Some drugs are more effective if absorbed in the small intestine rather than the stomach. Therefore, pharmaceutical manufacturers place an enteric coating around the drug that resists disintegration in the stomach. Enteric coating is also used to delay the onset of the pharmaceutical response and to prevent food in the stomach from interfering with the dissolution and absorption of the drug. Tip: Never crush a capsule that contains enteric release beads or is coated for timed-release. Drug molecules move to the intended site of action in the plasma but sometimes this journey can be limited because they have to get into the interior of a cell or body compartment through cell membranes. These membranes could be in the skin, the intestinal tract, or the intended site of action. Drug particles then attach themselves to receptor sites resulting in its therapeutic effect. These are: Passive Diffusion Passive diffusion is the flow of drug particles from a high concentration to a low concentration—similar to how water flows downstream. There is no energy expended in passive diffusion because drug particles are moving along the natural flow. Active Diffusion Active diffusion is how drug particles swim upstream against the natural flow when there is a higher concentration of plasma than there is of drug particles. Drug particles don’t have enough energy to go against the natural flow without help. Help comes from an enzyme or protein carrier that transports drug parti- cles upstream across the membrane and into the plasma. Pinocytosis Pinocytosis is the process of engulfing the drug particle and pulling it across the membrane. This is similar to how you eat an ice pop by engulfing a piece of it in with your mouth and swallowing it.

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