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The 30-Second Trick for Nyu Essay Samples

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College Papers in Paris - Preparing Yourself For A Challenge

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Nursing Dissertations - Diabetes Mellitus Affects About 2% Of The UK Population - Nursing Dissertations - Free Essay Example

A holistic nurse prescribing: a case study Introduction 1 the patient and their presenting symptoms. Mr Pickles presents an interesting, complex and therapeutically challenging problem. In essence he is a gentleman with multisystem pathology who presents with an almost incidental finding which he was clearly reluctant to discuss. It is a common finding amongst experienced healthcare professionals that in any consultation it is the last 30 seconds which is the most important. As the patient stands up to go, there is the just while Im here moment when they can bring up an issue that really troubles them and may not be the real presented reason for the consultation. In this essay we shall discuss the various aspects of this situation and the measures we can take to try to help him. (Parker and Lawton 2003) 2.a holistic assessment of the pt, including any relevant medical social and psychological issues. If we start with the initial presenting symptom under discussion the impotence it is easier to work backwards from that to discuss the possible pathophysiology that can be relevant. Impotence is said to occur whenever the male fails to get an erection when it is required. This, in itself is neither unusual nor necessarily pathological. It becomes a significant symptom when the male repeatedly fails to get an erection that is sufficient for intercourse. It is quite possible to get full spontaneous erections and yet still be impotent. This is one of the major diagnostic features that distinguishes the psychogenic impotence from the purely physical. (Ackerman MD, Carey MP. 1995) There are a number of obvious physical causes of erectile dysfunction that are relevant to Mr Pickles (see on), but equally there are a number of possible psychogenic causes that may be either primary factors or possibly secondary contributory factors in the aetiology of his problems. The fact that he has recently undergone major cardiac surgery is a very relevant factor. Patients will frequently suffer from a major change in body perception when they have come to a close realisation of their own mortality. If we add to this the fact that, as the major breadwinner in the family, it is likely that Mr Pickles would have felt a major blow to his self-esteem when he was made redundant from a responsible high esteem job and forced to become a taxi driver with long working hours. This is quite apart from the anxiety and fatigue that such a job would engender.(Beck J. 1995) It is possible that the medication that Mr Pickles is taking may have a bearing on his erectile dysfunction as the male erection is dependent on the hydrostatic pressure of the blood for its maintenance. Any medication that reduces the average blood pressure, will effectively reduce the capacity to acquire and maintain an erection. In addition to this the adrenergic beta-blocker group will also selectively block the sympathetic pathways that are vital to the neurovascular control of the mechanisms of erection. Pathophysiology of diabetes and impotence Both of these topics are huge subjects, so in this essay we will restrict out considerations to those aspects which are relevant to Mr Pickles and his problems. We know that Diabetes Mellitus affects about 2% of the UK population with a specifically higher incidence in both the Asian and Afro-Caribbean communities(Nathan 1998). There is also a marked genetic component in the development of Diabetes Mellitus. Mr Pickles has Type II diabetes mellitus which is associated with a number of factors including a high BMI and increasing age. At 56 yrs. old he is currently at the peak incidence age for Type II diabetes mellitus (Gregg et al. 2003). Diabetes Mellitus is known to be associated with a number of complications. The prevalence and incidence of the complications, in general, tends to increase with the length of time that the patient has been diabetic. There is also an independent variable for complications that is directly proportional to the degree of control (as measured by the HbA1 levels). In general terms, the better the control the lower the incidence of complications (Kissebah et al. 1999) As far as Mr Pickles is concerned, there are two major complications of Type II diabetes mellitus that are directly linked with impotence and they are cardio-(macro)vascular disease and neuropathy. (Wagner et al. 1998) We can deduce that Mr Pickles has macrovascular disease by virtue of the fact that he his recovering from a CABG. And this may well be a very relevant factor in his erectile dysfunction but also there is the question of neuropathy which typically occurs in about 2.4% of the general population, but this figure rises to above 8% in the diabetic patient over the age of 60 yrs. ( Hughes 2002) Impotence tends to occur, in varying degrees, in about 10-15% of men under 40 yrs. Its incidence increases with age to the extent that 40% of men at the age of 40 yrs report a degree of impotence and this prevalence rises to 70% at the age of 70 yrs. (Gregoire 1999). If we add to this basic clinical picture the fact that there are other factors such as hypertension, smoking, cardiac neurosis, loss of self-confidence, depression and iatrogenic causes (medication etc.) all of which may well be relevant to Mr Pickles, then it can be seen that there are a plethora of potential causes of his erectile dysfunction. (Barnes, DE. 2004) Both of the first two causes (hypertension and smoking) are independent risk factors for impotence, quite apart for the fact that they are also risk factors for the development of the macrovascular complications of Diabetes Mellitus (Bowering 2001) Mr Pickles diabetic state has been recently well controlled (HbA1 of 6.5%). This is important as the incidence of development of diabetic complications is reduced by between 34-76% (depending on the particular study) for every 10% reduction in the average HbA1 reading. (Bowering 2001). In addition to all of these considerations, atherosclerosis is also a major complication of Type II diabetes mellitus, which, presumably is relevant to Mr Pickles because of his CABG, and this may be a major factor in the development of his erectile dysfunction. Management plan 3.a plan/strategy based on critical understanding of physiological and pharmaceutical issues. Any management plan must firstly be based on an accurate diagnosis. At this point in time we do not have this luxury. As we have discussed, there are anyone of a huge number of possibilities in the aetiology of Mr Pickles erectile dysfunction problem. When confronted with a problem such as this, any experienced healthcare professional may reasonably chose to manage the problem by making a rational judgement of the probabilities of any one particular cause being relevant. Implicit in such a management strategy is the fact that there are some causes that my be correctable (iatrogenic, psychological, and life style related) and there are some that may not (macrovascular damage, neuropathy and atherosclerosis). It is reasonable, in such circumstances, to discuss the situation openly with Mr Pickles and discuss with him the various treatment options. Patient empowerment and education is a vital strategy to adopt in circumstances such as this as Mr Pickles is far more likely to comply and respond if he understands the rationale behind the treatment plan.(Howe and Anderson 2003) We would suggest that an appropriate strategy would be to initially tackle the situation on two fronts. The psychological aspects of the erectile dysfunction are probably best discussed with an experienced psychologist or councillor who has expertise in this particular area. This is important because there is a considerable skill in eliciting the relevant factors from the patient. Many patients are reticent about talking openly about their imitate sexual details and there has to be a careful build up of trust and empathy on both sides. Factors such as good eye contact and a non-judgemental body stance are essential on the part of the healthcare professional if the optimal result is to be obtained Not only can the issues that are relevant be explored, but also any one of a number of psychological treatment techniques can be employed. This is a matter of considerable clinical judgement and skill and therefore probably best done by an experienced healthcare professional in that area. The pharmaceutical area can also be addressed as Atenolol is clearly not the best anti hypertensive to use as, not only will it reduce the blood pressure (which it clearly is important to do) but it also produces a counter productive beta-blockade which will not help the erectile dysfunction problem. The difficulty is that, after the CABG, Atenolol does have a degree of action on the suppression of ectopic electrophysiological foci in the myocardium which is a recognised complication of the procedure. It also is thought to have a cardioprotective effect post-myocardial infarction. It is probably a good idea to change his anti-hypertensive medication, but in the circumstances, it is probably better to seek the advice of the surgical team who performed the CABG. before making the transition. The question of Viagra has been raised by Mr Pickles. This is not as straight forward as it might initially appear. Viagra has been shown to work well in these circumstances. It has the downside that it allows sexual intercourse which is associated with increased peaks of blood pressure. As Mr Pickles is still in the postoperative recovery phase (16 weeks) it would again be sensible to consult with the surgical team as to their advice on the issue. The other problem with Viagra is that if it transpires that the long term aetiology is actually psychological rather than purely physical, then the prescription of Viagra will often breed a feeling of psychological dependence which may firstly be both inappropriate and unnecessary and secondly, very hard to break. It is probably therefore inappropriate to consider such options at this stage in the management. 4.legal and professional accountability should be discussed. The legal and professional issues are largely covered in the making of a management plan. In any area of professional competence, the best defence against criticism or censure, is the fact that a healthcare professional works from a rational evidence-based plan. It is for this reason that we have set out the rational and reasoning for the plan that we have chosen to adopt. It is actually quite permissible (legally) for a healthcare professional to be wrong on any given issue, as long as they have come to a reasoned and rational decision based on the facts that were placed before them. And behaved in a way that the majority of their professional colleagues believe is reasonable in the circumstances. It is, of course, central to these considerations, that all actions are carefully and fully recorded in the patients notes Prescribing decisions 5.a critical discussion of influences on prescribing decisions. The area of prescribing for Mr Pickles is clearly important. To some extent, we have covered the reasoning behind the change of prescription earlier in this essay. There is a common misconception amongst many members of the public (and indeed many of the less experienced healthcare professionals) that the solution to every problem comes in the form of tablets on a prescription. The whole area of patient empowerment and education is often filled with issues of lifestyle change, healthy living, self care and positive thinking which can frequently be more effective that simply giving the patient a prescription. (Boule NG et al. 2001) In the context of the NHS, it is a common observation that sometimes a prescription is given because it is the most expedient short-term measure in a given situation, (Dawes RM et al. 1974), however, time invested in an explanation to a patient as to why other measures might be equally as important is rarely time wasted., (Corrigan B. 1974) Future management 6.consider your future prescribing activity based on experience gained from this case study. In any professional area of activity, the author likes to use the mechanism of reflective practice to allow a critical assessment of a past course of action to modify future actions when faced with a similar situation. (Gibbs, G 1988) On careful reflection of this case, I believe that I may have acted rather rashly in stopping the Atenolol as a first choice. On reflection, I believe that the Atenolol did need to be changed for any one of a number of other anti-hypertensive agents but I feel that, in retrospect, I would have been wiser to take advice from the surgical team before I made that decision. Further reflection and discussion with other healthcare professionals (Marks-Moran Rose 1996), suggested that another appropriate course of action would have been to stop the antihypertensive medication altogether for a short period. This is on the grounds that his hypertension was not severe and was hitherto well controlled. If the erectile dysfunction was simply a reflection of the fact that the medication was holding his blood pressure down to a level where erection could not easily occur, a few days off the medication may allow a transient increase in his blood pressure to the point that erection could occur. As long as one was careful to monitor his blood pressure to ensure that it did not rise too far, I have been advised that this would represent a reasonable therapeutic trial to establish whether the underlying causes were mainly physical or physiological.(Wagner G et al 1998). On the face of it, this does seem reasonable but I believe that I would have to take further advice before I was fully comfortable with that decision. It follows from what has already been discussed, that I also feel that I may have been too quick to consider the pharmacological interventions before making a complete holistic assessment of the patient. There are clearly a number of lifestyle adjustments that may be relevant here such as weight loss and increasing exercise and looking for a new focus in life (to minimise any element of depression) which would be comparatively easy to achieve with appropriate empowerment and education of the patient. (Funnell R et al 2004) All in all, this is not a straight forward case. There are many elements which require careful and considered assessment. I believe that it is one of those cases that helps to point out that although there is a huge emphasis to be placed on modern scientific understanding and application of medical principles, there is also a very large element of human understanding and caring that is so very important to the successful management of patients such as Mr Pickles (Waterlow J. 1998) References Ackerman MD, Carey MP. 1995 Psychologys role in the assessment of erectile dysfunction: historical precedents, current knowledge and methods. J Consult Clin Psychol 1995; 63: 862-87 Barnes, Darryl E. 2004 Action Plan for Diabetes Copyright 2004 ISBN: 0736054596 Pub. Human Kinetics Illinois USA Beck J. 1995 Hypoactive sexual desire disorder: an overview. J Consult Clin Psychol 1995; 63: 915-927. Boule NG, Haddad E, Kenny GP, et al. 2001 Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. JAMA 2001;286:1218-27 Bowering (2001) Diabetic foot ulcers. Pathophysiology, assessment, and therapy. Can Fam Physician. 2001 May;47:1007-16. Dawes RM, Corrigan B. 1974 Linear models in decision making. Psychol Bull 1974;81:95-106. Funnell, and Robert M. Anderson, (2004) Empowerment and Self-Management of Diabetes Clinical Diabetes 22:123-127, 2004 Gibbs, G (1988) Learning by doing: A guide to Teaching and Learning methods EMU Oxford Brookes University, Oxford. 1988 Gregg, R. B. Gerzoff, C. J. Caspersen, D. F. Williamson, and K. M. V. Narayan (2003) Relationship of Walking to Mortality Among US Adults With Diabetes Archives of Internal Medicine, June 23, 2003; 163(12): 1440 1447. Gregoire 1999 ABC of sexual health: Assessing and managing male sexual problems BMJ, January 30, 1999; 318(7179): 315 317. Howe and Anderson 2003 Involving patients in medical education BMJ, Aug 2003; 327: 326 328. Hughes RAC. 2002 Regular review: Peripheral neuropathy BMJ, Feb 2002; 324: 466 469. Kissebah AH, Freedman DS, Peiris AN. 1999 Health risks of obesity. Med Clin North Am 1999; 73: 111-138 Marks-Moran Rose 1996 Reconstructing Nursing: Beyond Art and Science London: Balliere Tindall October, 1996 Nathan D. (1998) Some answers, more controversy, from UKPDS. Lancet 1998; 352: 832-833. Parker and Lawton 2003 Psychological contribution to the understanding of adverse events in health care Qual. Saf. Health Care, Dec 2003; 12: 453 457. Wagner G, Seanz de Tejada I. 1998 Update on male erectile dysfunction. BMJ 1998; 316: 678-682 Waterlow J. (1998) Prevention is better than cure. Nurs Times 1988; 84: 69-70 Appendix

How to Use CBest Test Essay Samples to Write Your Homework

<h1>How to Use CBest Test Essay Samples to Write Your Homework</h1><p>Having to compose a best test exposition isn't excessively simple. It ought to be intense and testing however not all that hard that the understudies can't deal with it. The greater part of the educators have taught their understudies to focus on the substance instead of the style.</p><p></p><p>The best test article test ought to be made dependent on the investigation control that you are understanding at this point. Concentrate on the subject as opposed to attempting to remember lines from a book. Bring notes or record the content and scribble down your notes to ensure that you are composing the exposition as indicated by the framework that you have read.</p><p></p><p>Always ensure that the substance and structure of the article is clear before you begin composing. You will discover the blueprint that you are utilizing to write in the book on the wa y toward making an exposition. There are focuses that you ought to consider while composing and ensure that they fit your subject and theme.</p><p></p><p>If you have contemplated the principle thought of the article, at that point you can make a starting blueprint. You should simply begin from the earliest starting point and finish toward the end. The finish of the paper may should be transformed into an end with the goal that you can without much of a stretch haul it out after you have completed your essay.</p><p></p><p>The most normal inquiry that understudies have about example articles is the manner by which to make them not quite the same as the others. What improves one paper than another? There are a wide range of elements that go into this inquiry, however there are a few things that understudies should search for while picking the correct exposition theme for their homework.</p><p></p><p>One thing that you ought to consider is the means by which simple it is for the author's regard for meander. You should ensure that the topic has been secured by different articles that you have perused. This is a decent method to have a new point of view about the subject that you need to compose about.</p><p></p><p>A great structure is likewise significant while picking the theme. There ought to be a progression of inquiries that the understudy should reply. Likewise the length of the paper ought to be deliberately considered on the grounds that the shorter the article is, the more troublesome it will be for the understudy to make it interesting.</p><p></p><p>There are different CBest test exposition tests that you can utilize when you are planning for your test. Huge numbers of these example expositions are made in view of a particular reason. Ensure that you utilize these example expositions when you are making your own essay.</p>

Writing a Good Length for a College Essay

<h1>Writing a Good Length for a College Essay</h1><p>A great length for a school paper, is one that would feature all the data in a brief way. It ought to likewise be a short enough with the goal that you could fit in your whole idea or thought into a couple of sentences. A decent length for a school exposition will assist you with picking up accomplishment in finishing it.</p><p></p><p>One of the principal things that you will need to remember when you are picking a decent length for a school article is that your paper is special and should stand apart from the entirety of the others in the class. Recollect that your paper is a piece of your resume, and it should be composed for you by you.</p><p></p><p>It is likewise a smart thought to perceive what different understudies in the class are composing their school articles. These understudies are your opposition for the article part of the class. It is a smart thought t o differentiate the two expositions, so you can pick the best one for your kind of composing style.</p><p></p><p>One of the most significant factors in picking a decent length for a school article is to ensure that you have the correct data to compose it with. You need to have the option to give you full musings, which are what your article is comprised of. Attempt to pick themes that you are proficient about and afterward compose an exposition that identifies with those topics.</p><p></p><p>If you are composing a book, attempt to compose it in a similar way as how an essayist would compose the book. Try not to attempt to think of your paper in various organizations. It's the best way to give quality outcomes. Select a couple of basic organizations to assist you with composing the paper, and afterward return and utilize these layouts when you compose your essay.</p><p></p><p>Another thing that you need to rememb er when you are composing a school article is to ensure that you are utilizing the entirety of the best possible sentence structure, accentuation, and spelling. It's critical to keep these things all together with the goal that your article streams well. This will assist you with having the option to make more progress when you are composing your paper. You will be significantly more powerful in finishing it.</p><p></p><p>Writing a school article is significant, and is one of the most significant pieces of composing a school continue. In the event that you can't compose a decent length article, you won't get the most extreme outcomes. It is suggested that you not compose such a large number of articles on the off chance that you are attempting to find a full line of work in college.</p>

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<h1>Essay Help For Your College Essay</h1><p>When it comes to composing an article for school, it is anything but difficult to get befuddled and begin looking for the best exposition help accessible on the web. It is ideal on the off chance that you pick a decent author who will compose your exposition and assist you with understanding the correct organization of sentence structure. Great article help would give you back the most effortless and straightest approach to compose an examination paper.</p><p></p><p>Most understudies at school will in general race through their expositions and to ensure that they get the entirety of their assignments completed, they will in general commit errors in their papers. An exposition composed with care would go far according to the educator, instructor and even your future business. There are a few journalists who offer online assistance for papers. A portion of these scholars are on a basic agreement prem ise and they charge by the word and you have to pay by the piece.</p><p></p><p>The paper should be perfect and expert. It is significant that you guarantee that the language utilized in the paper is exact and all around characterized. Likewise, ensure that you look into online exposition help articles to become familiar with paper help and to see instances of papers that have been composed with the assistance of these articles. All things considered, your article needs to reflect what your identity is and how you see yourself in the future.</p><p></p><p>You additionally need to ensure that your paper does exclude any slang or idioms that can either make you look terrible or will just make the individuals perusing your exposition think you are inept. This is on the grounds that most understudies nowadays originate from families which are not used to tuning in to the English language. At the point when they experience issues with the man ner in which you talk in your exposition, it is far-fetched that they will locate your thinking persuading and persuasive.</p><p></p><p>When you utilize online article help, it is significant that you cause a rundown of inquiries regarding your paper and afterward to inquire as to whether you need help or not. You ought not stop for a second to request help and on the off chance that you feel that you are not getting the sort of help you need, at that point you have to reconsider your arrangement. There are acceptable papers which can be composed by the understudies alone however there are likewise those which require the assistance of a specialist exposition author who realizes how to compose a thesis in a particular way.</p><p></p><p>As soon as you understand that you have no clue about how to continue with your article, you should quit everything and go online to discover exposition help. You should peruse online expositions and dis cover what style you like best. At the point when you find what you need, you ought to plunk down and compose your article utilizing the assistance and direction of the online exposition writer.</p><p></p><p>You need to ensure that you select an author who comprehends the standards of language and composing and can compose a paper without mistake. As the topic is significant in school, there is no motivation behind why you can't pull off an erroneous paper. At the point when you have discovered an article author who is directly for your exposition, you should then wrap up of the work.</p>