By P. Bozep. National University.
It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks order cheap toradol on-line. Walden University College of Social and Behavioral Sciences This is to certify that the doctoral dissertation by Laura McCormick has been found to be complete and satisfactory in all respects order toradol cheap, and that any and all revisions required by the review committee have been made generic 10mg toradol otc. Chet Lesniak, University Reviewer, Psychology Faculty Chief Academic Officer Eric Riedel, Ph. Walden University 2015 Abstract Women and Thyroid Disease: Treatment Experiences and the Doctor-Patient Relationship by Laura J. Numerous factors make diagnosing and treating thyroid disease in women challenging. The standard blood test for diagnosing thyroid disease and determining treatment effectiveness is inconsistent in its accuracy. Many women with thyroid disease are misdiagnosed or struggle with symptoms even once receiving treatment. Although thyroid disease is highly prevalent among women and the doctor-patient relationship is known to influence treatment outcomes, there is a gap in the literature regarding the treatment experiences of women with thyroid disease and the doctor-patient relationship. The purpose of this phenomenological study was to explore female thyroid patients’ experiences of treatment and the doctor-patient relationship. Sixteen female thyroid patients, ages 18 and older and members of an international online support group, were individually interviewed via online chat. Data interpretation was guided by social constructionism and feminist theory and was accomplished via Moustakas’s analytic method. Themes related to the doctor-patient relationship were identified, including the culture of the medical profession, diagnostic bias, and gender differences in communication. Emergent themes included patient education level, patient self-advocacy behaviors, and the use of natural thyroid medication. The results of this study may contribute to positive social change by enhancing doctors’ understanding of thyroid disease in women and the influence of the doctor-patient relationship in determining positive treatment outcomes, thus equipping doctors with enriched knowledge for providing their female thyroid patients with the highest quality of care. Women and Thyroid Disease: Treatment Experiences and the Doctor-Patient Relationship by Laura J. Ruth Crocker—Thank you so much for sharing your wisdom with me during this long journey. We will overcome the debilitating effects of thyroid disease and help to ensure better outcomes for individuals yet to be diagnosed. Across cultures, the prevalence of thyroid disease is much higher among women than among men (Canaris, Manowitz, Mayor, & Ridgway, 2000; Cassidy, Ahearn, & Carroll, 2002). In fact, women have an estimated 1 in 7 chance of developing thyroid disease (Godfrey, 2007). A number of factors make proper diagnosis and treatment of thyroid disease challenging. In addition, as thyroid dysfunction produces symptoms similar to those of other disorders (e. In the face of such challenges, a doctor-patient relationship based on mutual trust and collaboration helps to ensure positive treatment outcomes (Houle, Harwood, Watkins, & Baum, 2007; Munch, 2004). In addition, effective communication between doctors and patients is critical in both the diagnosis and management of thyroid disease (Shimabukuro, 2008; Simmons, 2010). However, the culture of the medical profession, diagnostic bias, and gender differences in communication may interfere with doctor-patient discourse (Cheney & Ashcraft, 2007; Hamberg, Risberg, & Johansson, 2004; Hoffmann & Tarzian, 2001; Kaiser, 2002; Munch, 2004). An exploration of women’s experiences in the treatment of thyroid disease, especially relative to these three points, may contribute to better understanding on the part of doctors and thus more effective doctor-patient communication and relationships. Despite the pervasiveness of thyroid disease in women and the importance of the doctor-patient relationship in positive treatment outcomes, there is a gap in the literature regarding the treatment experiences of women diagnosed with thyroid disease, particularly regarding the doctor-patient relationship. Therefore, the purpose of this phenomenological study was to explore female thyroid patients’ experiences of treatment and the doctor-patient relationship. The phenomenological research approach was used, as it is designed to examine the meaning of experiences about a particular phenomenon (e. The theoretical perspectives used to guide data interpretation included feminism and social 3 constructivism. More specifically, the following issues were addressed in regard to their relationship with women’s treatment experiences: (a) the culture of the medical profession (see Kaiser, 2002; Thomas, 2001), (b) diagnostic bias (see Hamberg et al. The following paragraphs provide a review of the literature relevant to the study, followed by the problem statement, the purpose and nature of the study, research questions, conceptual framework, definition of terms, assumptions and limitations, and the significance of the study. Background of the Study The incidence of thyroid disease is higher than previously thought (Canaris et al. Across cultures, the prevalence of thyroid disease is much higher in women than men (Canaris et al. Approximately 1 out of every 7 women develops thyroid disease, and its prevalence increases with age (about 20% in women over age 60; Godfrey, 2007). The two predominant conditions resulting from thyroid disease are hyperthyroidism and hypothyroidism, with Grave’s disease and Hashimoto’s disease, respectively, as the most common causes (Zeitlin et al. In the United States, the most common cause of hyperthyroidism is Grave’s disease, an autoimmune form of thyroid disease (Bunevicius & Prange, 2006). Individuals with hyperthyroidism experience heat intolerance, hot flashes, absent menses, insomnia, decreased libido (Godfrey, 2007), rapid heartbeat, sweating, and tremors (Aslan et al. In the United States, the most common cause of hypothyroidism is Hashimoto’s disease, an autoimmune form of thyroid disease (Erdal et al. Individuals with hypothyroidism experience fatigue (Bono, Fancellu, Blandini, Santoro, & Mauri, 2004), lethargy, apathy, difficulty concentrating (Aslan et al. In extreme cases, the individual may experience slowing of thought processes, progressive cognitive impairment, hallucinations, and delusions (Bono et al. Furthermore, abnormalities in thyroid function present with symptoms similar to those of other disorders and can be mistaken for other conditions (Canaris et al. For example, hyperthyroidism and hypothyroidism are frequently misdiagnosed as anxiety and depressive disorders, respectively (Aslan et al. Postpartum thyroiditis, which affects more than 8% of women, is sometimes mistaken for depression (Fassier et al. In older patients, symptoms of hyperthyroidism and hypothyroidism often lead to inaccurate diagnoses of menopause or dementia (Godfrey, 2007; Shimabukuro, 2008). Thus, it is vital that physicians conduct a thorough assessment of their patients, including an ongoing discussion of symptoms, to ensure proper diagnosis and treatment. Although antithyroid drugs have been used for over 60 years, remission rates are variable, and relapses are frequent. However, some experts recommend the addition of T3 (liothyronine; name brand Cytomel) due to its antidepressant effects (Dayan, 2001; Joffe, 2006). As previously mentioned, proper treatment of thyroid disease is dependent upon accurate diagnosis. Misdiagnosis of thyroid disease delays treatment and can result in progressive psychological and physiological problems (Heinrich & Grahm, 2003; McDermott & Ridgway, 2001) including psychosis (Gaitonde, Rowley, & Sweeney, 2012; Heinrich & Grahm, 2003) and potential heart failure (Hak et al. These risks highlight the importance of an effective doctor-patient relationship in ensuring proper diagnosis and positive treatment outcomes. The treatment experiences of women with thyroid disease might be best examined from social constructionist and feminist viewpoints, as both worldviews emphasize individuals’ experiences in social contexts (Docherty & McColl, 2003; Fernandes, Papaikonomou, & Nieuwoudt, 2006; Hearn, 2009).
Another limiting factor is lyse purchase toradol 10mg free shipping, especially considering that the owners of the data are the capacity to analyse and integrate big data (see Challen- the patients purchase toradol paypal. There are initiatives paving the way by establishing tronic data storage and data-sharing; this is relevant when supercomputing centres in order to solve this problem of there is a need to combine clinical data with other data storage buy genuine toradol, integration and analysis (Merelli, 2014). Promote engagement and close collaboration platforms, coordination at the semantic level and, fnally, between patients, stakeholders and healthcare education mechanisms and awareness raising. Therefore a collaborative partnership between he- eHealth services (Commission Recommendation of 2 July althcare professionals and patients should be sought. Pati- 2008 on cross-border interoperability of electronic health ents should be helped to become active managers of their record systems notifed under document number C(2008) own health, and healthcare professionals should learn how 3282). Better solution is the primary vehicle for delivery of [cross-bor- collaboration between primary care, secondary care and der] care, for example a second opinion delivered by vi- hospital care and the coordination of health and social care deo conferencing with simultaneous capture and transfer services should be encouraged (Godman et al. The legal and regulatory issues include also adminis- status – and is sustainable for health systems. These layers will now be populated with In the case of reimbursement, the main problem centres standards, specifcations, case studies, workfows, subsets on budget constraints and single technologies analyses; in of terminologies, interoperability agreements, guidelines many cases the prices of reference limit the improvement developed by specialised organisations, fora, consortia of methods to defne prices and gain reimbursement. This is in logies analysis and pricing, and budget impact analysis of principle positive because of its promise to reduce uncer- these single technologies (Leopold et al. Develop an optimised overall healthcare fnancing and determination of added value and the difculties in strategy. For example, a shared risk-and-beneft mechanism could be There is also a lack of knowledge among professionals and elaborated. Additionally a ‘full cost of the patient’ view should citizens about the signifcance and consequences of these be established and adopted. The most innovative approaches with capacities could ensure faster patient access to innovative their strong intellectual property protection are especially technologies and cost-efective translation, which could re- complicating for shared decision-making processes. Therefore, public–private healthcare systems (Goldman, 2012; Said & Zerhouni, 2014). Thus, managed entry-agree- number of patients involved, for example in the case of rare ments, coverage with evidence schemes and new ways of diseases and stratifcation. Gaps of evidence and uncertainty innovative public procurement processes are good candi- management: When uncertainties regarding outcomes are dates for addressing most of the issues that are currently still in the pipeline and added value from existing eviden- under debate. Mechanisms exist that can be valuable in the case of new evidence generation while ensuring access to a. Practice Guidelines for Quality Assurance, Provision and Use of Genome-based Information and Thechno- logies’). The implementation of the concept of public Key Enablers for Challenge 5 health genomics, being the responsible and efective Europe: e. Ministries of health, regulatory au- logies for the beneft of population health, requires thorities’ (e. In this concept, genome-based 37 information is highly holistic and includes not only all the adoption of technologies with proven value in ‚omics‘ data but also environmental, socioeconomic hospitals. Decision-makers in hospitals are thereby of the projects in health sector that are already in pla- informed of the likely value of a health technology for ce can be viewed at http://www. It is a clear example of well-presented in- labelling and the defning of functional and other cri- formation for patients and professionals and provides teria. EuroRec is organised as a permanent network of a comprehensive health information service to help national centres and provides services to industry (de- put individuals in control of their healthcare. The web- velopers and vendors), healthcare providers (buyers), site helps people make choices about health, from de- policy makers and patients. There are also hundreds of thousands of and Certifcation of Electronic Health Record systems entries in more than 50 directories. The forum has published vari- archiving and distribution of personally identifiable ous papers that address value-based pricing and ad- genetic and phenotypic data resulting from biome- aptive licensing (http://www. To this end, stakeholders representing all pies, for example by the validation of biomarkers. But too relevant perspectives were included, such as research po- many current approaches result in failure at some point licy and funding, healthcare provision, and citizens’/pati- along the development pipeline or do not demonstrate ents’ needs and interests. For these reasons, additional participation, a very broad spectrum of recommendations funding for clinical implementation and ‘real-world’ as- and potential felds of action has been identifed. Research projects that are carri- it has been a signifcant challenge to pinpoint reasonable ed out in close collaboration with, for example, regulatory concrete actions. This will confront rese- ges as well as the 35 recommendations several enablers archers with hitherto unfamiliar communication and co- have to join forces on either European or national level. Several recommendations relate to more than one of the As a result, the challenge for research funders and decisi- defned fve challenges or cut across more than one of the on-makers will be to fund research beyond the classical three broad areas of activity which have been identifed funding schemes. In these cases, the recommendations communication and training modules, more outreach have been ascribed to the challenge or activity area to activities, and more non-research cross-sectoral projects which they mainly relate, in the interest of producing a to complement ‘classical’ basic and translational research clearer picture. Funding also needs to provide incentives to in- linked package of measures will provide sufcient impact clude specialists from a wide range of areas such as: on the wellbeing of citizens, the sustainability of health- care systems and the competitiveness of relevant indus- • Big data and information and communication techno- tries in Europe and beyond. Some of these recom- mendations are also related to other challenges, therefore they are shown again within the circle. Furthermore, there are manifold interrelations between the fve challenges; these have not been indicated in order to keep the clearness of the fgure. Research to investigate diferent trial designs and their Such an investigation would inform the regulatory pro- results; whether they have been successful in addressing cess and the drug development process. Research on tools for more personalised healthcare and Paving the way for providers to implement standardised, rehabilitation. Already existing software applications and tools have to be integrated into a security framework. The challenge is to bring together multiple applications and multiple data standards to allow a datafow in a meaningful and secure way. Reclassifcation of diseases at the molecular level for Development of new and more efective diagnostic and optimisation of therapeutic strategies. Modelling of health and diseases by interdisciplinary The aim is the representation of health and disease research projects, for example via systems medicine and based on the simultaneous consideration of clinical, in silico modelling/simulation approaches. Support clinical validation of pharmacogenomics appro- The fndings will accelerate the translation from basic aches that integrate age and gender considerations into research biomarker development to their efcient genetically divergent populations. Research on phenotype–genotype correlations on exis- Optimal use of national resources for established co- ting data and specifcally established cohorts. Correlation studies of phenotypic evolution of diseases Evidence on the impact of the environment on the in subgroups or individuals within longitudinal cohorts, evolution of diseases. Support for decision makers and for example in terms of poly-pathologies, socio-econo- providers to set up public health measures for disease mic inequalities and access to care. Develop inexpensive and rapid test systems to produce A better understanding of disease mechanisms related a short development cycle for diagnosis and therapy, to genetic variants and the design of biopharmaceutical e. Earlier diagnostic markers would support the assessment of prognosis, monitoring and identifcation of the most efective treat- ment for a given group of patients. Optimise individual drug therapies and poly-pharmacy More specifc and efective drug therapies particularly especially in the case of multi-morbidity.
When bacteria are antibiotic resistant it means that an antibiotic will not kill the bacteria purchase toradol 10 mg on-line. These infections Thell your childcare commonly occur where children have cuts and scrapes cheap toradol 10 mg amex. This means that the bacteria are Childcare and School: there without causing any infection or any harm order genuine toradol online. Yes, if draining sores If your child is infected, the time it will take for symptoms are present and cannot to start will vary by type of infection. Contagious Period Activities: Avoid participating in As long as the bacteria are present. A child who has activities where skin-to- draining infections has more bacteria and is more skin contact is likely to contagious than a child who is only colonized. Wash clothes, bed sheets, and blankets in hot water with detergent and dry in a hot dryer. The bumps are usually painless, but, on rare occasions, can be itchy, red, swollen, and/or sore. It may last longer and cover more of the body in people with eczema (skin disease) or those who have a weakened immune system. It can also be spread by contact with contaminated objects such as shared clothes, towels, washcloths, gym or pool equipment, and wrestling mats. Persons with this skin disease can accidentally spread the virus to other parts of their body. Spread can occur by touching or scratching the bumps and then touching another part of the body (autoinoculation). Researchers who have investigated this idea think it is more likely that the virus is spread by sharing towels and other items around a pool or sauna than through water. After that, the bumps will begin to heal and the risk of spreading the infections will be very low. Encourage parents/guardians to cover bumps with clothing when there is a possibility that others will come in contact with the skin. Activities: Exclude any child with bumps that cannot be covered with a watertight bandage from participating in swimming or other contact sports. Wash hands thoroughly with soap and warm running water after touching the bumps or discarding bandages. Contagiosum If you think your child Symptoms has Molluscum Contagiosum: Your child may have bumps on the face, body, arms, or legs. Avoid participating in - By touching or scratching your bumps and then swimming or contact touching another part of your body. After the bumps begin to heal, the risk of spreading the infection will be very low. Contact sports or using shared equipment: Avoid sharing towels, wash cloths, uniforms, clothing, or other personal items. It may take weeks to months to regain energy; however, this will vary from person to person. Less common problems include jaundice (yellowing of the skin or eyes) and/or enlarged spleen or liver. Since this virus does not live long on surfaces and objects, you need to be exposed to fresh saliva to become infected. Because students/adults can have the virus without any symptoms and can be contagious for such a long time, exclusion will not prevent spread. Sports: Contact sports should be avoided until the student is recovered fully and the spleen is no longer palpable. Wash hands thoroughly with soap and warm running water after any contact with saliva or items contaminated with saliva. If you think your child Symptoms has Mono: Your child may have a sore throat, swollen glands, Thell your childcare headache, fever, and sometimes a rash. Childcare and School: Less common problems include jaundice (yellowing of the No, as long as the child skin or eyes) and/or enlarged spleen or liver. Sports: Children with an Spread enlarged spleen should avoid contact sports - By kissing or sharing items contaminated with saliva. Call your Healthcare Provider ♦ If anyone in your home has symptoms of mononucleosis. Your child may need bed rest, to drink plenty of water, and to avoid some physical activities. Prevention Wash hands after touching anything that could be contaminated with secretions from the nose or mouth. Mosquito-borne diseases are viral diseases that are spread by infected mosquitoes. The many viruses have the potential of causing serious disease affecting the brain and central nervous system. Removal of potential breeding sites is important in preventing the spread of mosquitoes. Birdbaths, wading pools, dog bowls, and other artificial containers of water should be emptied weekly to eliminate mosquito-breeding areas. Mosquitoes breed in water and artificial containers, especially flower pots, birdbaths, cans, children’s toys, wading pools, tire swings, old tires, or anything that will hold a small pool of water should be emptied or discarded. Rarely, swelling of the spinal cord and brain (encephalitis), inflammation of the ovaries (oophoritis) or breasts (mastitis), and deafness may occur. Other examples of how the virus can be spread is through sharing toys, beverage containers, eating utensils, and smoking materials (cigarettes), and kissing. Exclusion will last through at least 26 days after the onset of parotid gland swelling in the last person who developed mumps. A blood test specific for mumps antibody should be done as soon as possible after symptoms begin. Sometimes, healthcare providers will obtain a second blood test 2 to 3 weeks later. Encourage parents/guardians to keep their child home if they develop symptoms of mumps. Wash hands thoroughly with soap and warm running water after contact with secretions from the nose or mouth. If you think your child Symptoms has Mumps: Your child may have swollen glands in front of and below the ear. Childcare and School: Contagious Period Yes, until 5 days after For 2 days before until 5 days after swelling begins. Call your Healthcare Provider If two or more cases of If anyone in your home: mumps occur in your ♦ was exposed to mumps and has not had mumps or childcare or school, public mumps vaccine in the past.