Progesterone For Maintenance Tocolytic Therapy after Threatened Preterm Labour Essay Example for Free

Progesterone For Maintenance Tocolytic Therapy after Threatened Preterm Labour Essay What was the sampling technique used and what are the advantages and disadvantages of using that technique? The researchers used a two-stage sampling method that was non-random in the first stage and randomized in the second stage. The total population was made up of 137 patients who were admitted for preterm labour. Selection from this initial population was non-random because there were exclusion criteria. The seventy women included were randomised to their treatment groups by assigning randomly generated numbers. The main advantage of using the technique was its simplicity and straightforwardness. Every individual who fit the inclusion criteria had equal chance of being selected. The disadvantage of the technique was that there was bias in the initial selection. Such bias could have affected the accuracy of the experiment. Was there randomisation? There was randomisation in the second stage of sampling, where all those women who fit the inclusion criteria were part of the sampling population. Randomisation was done by generating random numbers and assigning numbers to the women included in the study. Was it biased? There were several sources of bias in the study. The fact that the patients were all from the same clinic is already in itself introducing bias. The study was not double blind, which could also be a source of bias. The use of exclusion criteria in the first stage of sampling lessened the bias. In the second stage of sampling, efforts were done to further remove bias by assigning treatment to all included patients. No patient also left the study, thus further reducing bias. Describe the validity and power of the study Based on the researchers’ desired results, the statistical power of the study for improving latency was initially calculated be 80% with an assumption of getting standard deviation (SD) of 12 days at 5% level of significance. However, when their results came out, the power was calculated to be lower (value for this was not presented in the paper). By checking the means and SD for latency, and assuming a two-tailed analysis, power was calculated to be 51% only. This could be attributed to the high standard deviation that could in turn be due to the relatively small number of samples tested. In other similar studies, the sample population is much higher. For example, another study testing the effect of vaginal progesterone on preterm birth used 413 women (Eduardo B. Da Fonseca, et al. , 2007). Despite the low statistical power, the results presented here are valid as preliminary data on the supplementation of tocolytic therapy with vaginal progesterone to control preterm labour. The study was able to show that progesterone treatment had an effect on the other outcomes that were measured (please refer to Table 2 in the text). Background information of the hypothesis Progesterone is a steroid hormone that is widely used in hormone replacement therapy in menopausal women. It is also used to induce menstruation in women who suddenly stop menstruating. Its capacity to control preterm labour was first reported in the 1980s. Oral administration of progesterone induces side effects like migraine, dizziness, vomiting and blurred vision. This was the usual mode of administration of progesterone, which was proven effective to reduce preterm labour (Meis, et al. , 2003). Since 2003, studies have reported on the use of progesterone vaginal suppository to treat preterm labour (E. B. Da Fonseca, Bittar, Carvalho, Zugaib, 2003) and even in high risk women (Eduardo B. Da Fonseca, et al. , 2007). Until this current study, there were no previous reports on the use of progesterone to supplement tocolytic therapy, using magnesium sulphate and intravenous ampicillin, on women who actually had preterm labour. Hypothesis of the study Null hypothesis: The use of vaginal progesterone after inhibition of preterm labour will not change latency period and recurrence of preterm labour. Alternate hypothesis (what the study really wants to prove): After the inhibition of preterm labour, treatment with vaginal progesterone will result in increased latency period and decreased recurrence of preterm labour. Methodology The study was conducted on 70 women who were had arrested uterine activity after they were treated for premature labour. The women were randomized to two groups; one was administered vaginal progesterone and the other, a placebo, until delivery. Subjects were monitored for days to latency until delivery, recurring preterm labour and other primary and secondary outcomes. Different statistical tests were used to determine if the treatments resulted in significantly different outcomes. Comparisons were done using Student’s t-test for quantitative data; chi-square and Fisher exact tests, among others, were used for categorical data. Conclusion of the study The study concluded that the use of vaginal progesterone after tocolytic therapy was effective in increasing latency to delivery but not in decreasing the incidence of recurrence of preterm labour. Is it a valid assumption based on the data of the study? Describe the applicability and relevance of the paper to clinical practice. The conclusion is valid based on the data of the study. The paper and the results presented are applicable and relevant to clinical practice because it proposes a new means of treating preterm labour for increased latency. Although the recurrence of preterm labour appeared not to be reduced with the treatment, this could be due to the advanced stage of the pregnancy when the preterm labour occurred or due to the small sampling population. It is significant to note that this is the first to report on the supplementation of tocolytic therapy with vaginal progesterone. Further studies can also be done to validate the results.

Our War Against Terrorism is Justified Essay -- September 11 Terrorism

Our War Against Terrorism is Justified    This essay will address the question whether the war against terrorism declared by President George W. Bush is a just war.    According to the September 22nd edition of Star-Ledger, Professor Richard Falk, of Princeton University said   Ã¢â‚¬Å"the mainstream media have turned into a 'war-mobilizing mechanism' leading to intense indoctrination of the public in support of a military response." "We are living in a society that is so convinced of its own innocence that it is ready to embark on its own 'holy war,'" Falk said. He said that if and when the United States decides to use force, it should do so only in conformance with international law and according to the principles of a "just" war. "These would include making it illegal to target non-military sites or people, making sure the response is proportionate and ensuring that no unnecessary pain is inflicted. "In Bush's address (Thursday night) I saw no signs of sensitivity to any of these limits, no deference to the authority of the United Nations," Falk said.    Contrary to what Prof. Falk suggested, our country does consider before undertaking such actions whether it complies with the description of a "just war." We had such a discussion, for example, before moving to turn back Iraq's invasion of Kuwait in 1990. There was a good interview on the CNN website on the topic of a just war.    I don't believe there is any disagreement that non-violent methods of resolving conflicts must always be used when they are possible. But this is not always possible. Therefore the first thing to note is that there is such a thing as a "just war." The tradition goes back to St. Augustine and has been highly developed over the cent... ... While moving against bin Laden and the ruling Taliban which protects him, Pres. Bush and his advisers have clearly stated that we have no quarrel with the Afghan people. Instead of dropping bombs on them, our government has started to airlift food to alleviate the acute distress caused by more than twenty years of uninterrupted war. There has not been any military action merely for the sake of taking action or assuaging any supposed public desire for revenge.    Thus I conclude that the war against terrorism meets all four criteria of a "just war."   Sanity, virtue, and a sense of humor all depend, though in different ways, on having a proper sense of proportion. I suggest that early critics of the war on terrorism lack the necessary sense of proportion. They take themselves too seriously, and the situation and the ideas it contains not seriously enough.

Govern safeguarding adults work Essay

Legislations The Safeguarding Vulnerable Groups Act 2006 The Safeguarding Vulnerable Groups Act 2006 aims to prevent unsuitable people from working (either paid or unpaid) with children or vulnerable adult. Employers who work with these people have to be registered according to the act and The Independent Safeguarding Authority decides if people should be barred from working with any vulnerable person. Everyone gets checked before they are able to work with all vulnerable people for instance, a DBS check will be carried out to see if the person has carried out any criminal offences. The Rehabilitation of Offenders Act 1974 The Rehabilitation of Offenders Act 1974 supports the rehabilitation into employment of reformed offenders who have stayed on the right side of the law. All employers require full disclosure of pervious offences. The Police Act 1997 A CRB check is done under a Part V of the Police Act 1997, this protects vulnerable people from harm because employers will then know of any criminal convictions that have been done by particular people. http://www.dhsspsni.gov.uk/gmgr-annexe-c29 The Sexual Offenders Act 1976 The Sexual Offences Act 1976 is an Act of the Parliament of the United Kingdom. It made provision in relation to rape and related offences. This Act put the Sex Offenders Register in action for identification and tracking  purposes. This Act protects vulnerable people from danger, by tracking sex offenders. Care Standards Act 2000 This Act set the national minimum standards to protect the vulnerable, the standards include accommodation, services and good working practice. This Act established the Protection Of Vulnerable Adults (POVA) scheme, this scheme helps protect vulnerable adults from abuse. People who are working with vulnerable adults have to go through POVA training, I have done so myself through volunteering. The training makes you more aware of different types of abuse, people that are abused and the abuser, and how this is identified. Care Homes for Older People- National Minimum Standards and Care Homes Regulations 2003 This regulation identifies the levels of care that vulnerable adults need in care homes. There are points in this regulation that all older people in care homes should always receive the standards that are set for example, having a choice of what they would like to eat for dinner. Mental Health Act 1983 This Act is to protect those vulnerable people who suffer with a mental illness and others that are caring for them. There are procedures to ensure that there rights are protected and not being abused. The Act also allows compulsory treatment for those with a mental illness. Mental Capacity Act 2005 This Act allows to help vulnerable people who cant make decisions for themselves because they lack the mental capacity, this is done by them having an advocate. It is established by The Independent Mental Capacity Advocates Service. Disability Discrimination Act 1995 People who have a disability are treated equally to those without, this should be done in any work place. This act not only covers physical disabilities but mental as well. The Act has an aim which is, ending discrimination that individuals face with a disability. People who have a disability now have the rights to many things including, employment, education access to goods, facilities and services and buying or renting land or property. http://www.nidirect.gov.uk/the-disability-discrimination-act-dda Race Relations Act 1976 The Race Relations Act is to protect people from discrimination, this includes a persons race, colour, nationality, ethnic origin. People should be treated equally and fairly no matter what race or colour they are. Human Rights Act 1998 Vulnerable people have the right to be treated correctly and cared for effectively due to the Human Rights Act 1998. This act gives every person the power to challenge perceived discrimination by any public body. Data Protection Act 1998 The Data protection Act is essential to follow in a health and social care setting, all personal details from an individual are to be kept safe and only seen by the people who care for them. Information will only be disclosed if there is a potential that a person is in danger. It is very important that every health care setting for vulnerable adults has strategies and procedures that reduce the risk of abuse, if this was not done effectively then individuals may be in danger. Recruitment of staff- The health care system is always recruiting new staff due to more and more people using the system every day, more elderly are getting ill and leaving their homes to go into a residential care home. Every person who employs a new member of staff has to make sure that they are save to work with the elderly as they are very vulnerable. The adults who are barred from working with the vulnerable are identified on the Adults Barred List. The list subdivides these people into two different categories which are, people who are automatically barred because they are a ‘risk of threat’ and people who offer a ‘very probable risk of harm’. The process of the Adults Barred list gathers information for many places including, the Criminal Records Bureau (CRB) , Health and Social services and employers. A CRB check is done before someone is employed, personal information is written down about a person and  then it is sent off to be checked by the police to see if they have any criminal convictions. Staff who work with the vulnerable have to register under the Vetting and Barring Scheme since July 2010. Sector guidance- Guidance is given to employers to reduce the risk of abuse in the environment they are working in. Two acts are included in this guidance and they are Dignity in Care Initiative 2006 and Human Rights in Healthcare. The Human Rights has a framework which assists local NHS Trusts to apply human rights approaches for the people using the services. FREDA values are focused on, Fairness, Respect, Equality, Dignity and Autonomy. Dignity and Care Initiative campaigns to end toleration of indignity in health care. Organisational policies- Every organisation must have policies and guidelines on expected behaviour from staff, this is done when an organisation develops there own policies from the guidelines that they have been provided with. Policies enable people who are using the services to know what is acceptable and unacceptable with their own care. Codes of practice- Codes of practice enables professionals to work effectively at high standards, respect and minimise risk to people that are in their care. Many care systems produce codes of conduct including The Nursing and Midwifery Council, nurses and midwives have to abide by these codes and put them into their practice to be able to care after individuals at the right standard. Multi-agency working and Closer working between professionals within organisations – Multi-agency working is when all different teams come together to care and meet needs for a person as a whole, an example of professional bodies working together would be, doctors, care workers, nurses, social workers etc. The support planning and single assessment has encouraged greater inter-agency cooperation. Working like this encourages sharing of an individuals information and together they can all look after that person very effectively. This has not been put into place with some agencies and in this situation an individual would not be taking care of  properly because of this, this could lead to harm with elderly people. The government has guidance on multi-agency working and this is a paper called ‘No Secrets’. Beryl Strecth (2010). Health and Social Care . Essex: Pearson Education. Close working between professionals and organisations enables better communication about the people involved. This could be done in staff meetings, team meetings etc. In care homes they have daily logs about individuals who they care for, this ensures that when a new member of staff is working they know for instance what they have ate that day and what sort of care they have provided for them. This can also detect a residents behaviour for example, if they act differently when certain members of staff are on shift. Working in partnership with adults using services- When agencies work in partnership with the adults, families or informal carers it makes them more confident about the situation, when confident they will be more likely to talk about there worries and people can then help them build their self-esteem back up. Decision-making processes and forums- Decision making is essential when looking after a vulnerable adult, when it is kept transparent and clear then everyone knows what is happening. Monthly meeting of residents in a care home encourages ideas that can be shared between one another, this will make people more confident at speaking out. Organisational policies and staff training- The role of the Care Quality Commission- Whistle blowing- Whistle blowing is when someone who is working in a care setting reports suspected wrongdoing in the work place. This is called ‘making a disclosure in the public interest’. Some things that may be reported include, someone’s health and safety is in danger, damage to the environment, a criminal offence, the company isn’t obeying the law (like not having the right insurance) and covering up wrongdoing. https://www.gov.uk/whistleblowing/overview There is a chance that any individual will have to ‘whistle blow’ while working in a care setting, if the person thinks that what they have witnessed is ‘wrong’. A form has to be filled out by the person who has allegedly seen wrong doing and then it is sent off to get assessed and monitored for rooms of improvement. Complaint procedures- Complaint procedures will be in every care setting, this is important to protect vulnerable adults from harm or abuse and for them to have the best care possible. People are encouraged to use complaint procedures. Complaint services are there to improve the quality and life of the individuals in there care, but it is important that elderly people feel safe if there are going to complain about the care they are being given and not victimised.

Healthcare Professionals Understanding Barriers And...

This booklet will be supporting healthcare professionals in understanding barriers to communication and how to overcome them. In this booklet, we will have a number of examples (or scenarios) of barriers and easy to use strategies of how we can support patients in different circumstances. In addition to this booklet, the strategies to overcome different barriers will also be evaluated. A barrier blocks things and stops them ‘getting through’. Scenario 1 A manager confronting an employee in front of colleagues in a staff room. Confronting an employee in front of colleagues is an abuse of power. An abuse of power is where a care worker or a manager deliberately controls and manipulates others. According to ‘The General Social Care†¦show more content†¦For example: â€Å"Michael, I want to talk with you about your behavior towards the service user and the effect it’s having on the reputation of yourself and this team. I noticed you were ignoring the needs of the service user by not responding appropriately and also saying sentences that were not in conjunction to her needs.’’ Furthermore, It is crucial not to use words such as â€Å"you’re unprofessional, ridiculous, etc’’ when a manager is stating an issue. The more objective the manager can make it, the less likely the employee can become defensive and ashamed in front of his/her colleague. Secondly, It is important for the manager to maintain a good posture between himself and the employee. The way in which we face other people can also communicate emotional messages. Standing or sitting face-to-face with the employee may send a message that he is being formal or angry. A slight angle can create a more relaxed and friendly feeling. Review of the Strategies With consideration to the first strategy of showing respect to the employee, this can be evidenced to be working through, one-to-one sessions with employees. In these sessions, the manager could practically provide constructive criticism. Additionally, an organisation would implement specific policies regarding respect and equality in the workplace. These can be improved through quarterly or annual reviews of how disciplinary procedures are being followed, but most