Management Of Resistant Hypertension An Advance Approach...

Management of Resistant Hypertension: An advance approach with new vision Sandeep Banga MD, Jeffrey Heslop, MD, Dr. Sparrow MD, Sudhir Mungee MD, FACC, FSCAI Definition Resistant hypertension is defined as blood pressure measurement that exceeds 140/90 mmHg (130/80 in patients diagnosed with Diabetes Mellitus/renal insufficiency) despite regular use of three or more antihypertensive drugs of different classes that should include one diuretic at maximum(or maximum tolerated) dose unchanged for at least one month without interruption. {1} Renal insufficiency is defined as creatinine levels above 1.5mg % or protienuria of more than 300mg in 24 hours. Prevalence and Prognosis The reliable estimates of prevalence of resistant hypertension†¦show more content†¦Renovascular Disease c. Cons Syndrome d. Obstructive Sleep Apnea e. Pheochromocytoma f. Thyroid Diseases g. Cushing Syndrome h. Coarctation of Aorta i. Intracranial tumors Pseudo-Resistant Hypertension This term refers to lack of control of blood pressure with appropriate treatment in a patient who does not have resistant hypertension. The following factors may result in this situations{12-16} as given in table below- Causes of Pseudo-Resistant Hypertension 1. Blood pressure measurement not done by proper guidelines. 2. White-Coat Hypertension. 3. Calcified or atherosclerotic arteries as seen in elderly. 4. Poor patient adherence to medications. 5. Inadequate dosing or inappropriate combinations of anti-hypertensives. 6. Physicians’ inertia to increase dose/number of drugs even if targets are not reached. Step Approach by Physician for evaluation and management of Resistant Hypertension. 1. Knowledge and adherence of hypertension treatment according to latest guidelines 2. Identify and reverse the causes of pseudo-resistance 3. Identify and reverse the causes of true-resistance a. know pharmacological agents like NSAIDS which increase BP and discontinue or minimize its use . b. Evaluate amount of alcohol intake and try to cease its use. c. Decrease salt intake to less than 2-3 grams per

Health and Social Care Essay - 659 Words

Health and Social Care Assignment UNIT 2 - PRINCIPLES OF PERSONAL DEVELOPMENT ASSIGNMENT OVERVIEW In this assignment, you will investigate standards that influence adult social care practice. You will look at examples of these standards and how they affect the role of social care workers. Personal development and reflective practice are important for social care workers, and you will be completing tasks that cover these concepts. You will look at the different ways that this is done, how you can benefit from it and who will support you. TASKS There are three task to this assignment. TASK 1 2 3 EVIDENCE Short answer questions Case study Reflective account OUTCOMES 1.1, 3.1, 3.2, 3.3, 3.4 1.2, 1.3 2.1, 2.2, 2.3 TASK 1 Social workers†¦show more content†¦Jenna tells Fatima that she disapproves of some of his ways, which are against her beliefs, but had not realised that this showed in her attitude. 1. Describe how Jenna should ensure that her personal attitudes and beliefs do not affect her work. 3 Health and Social Care Assignment 2. Explain why it is important to reflect on your work activities. TASK 3 1. Think of a learning activity you have taken part in that has improved your knowledge, skills and understanding. The activity may have been a training session, a demonstration of practice, learning a new skill or a research activity. Description of experience How did this experience improve your knowledge, skills and understanding? 4 Health and Social Care Assignment 2. Think of an example of a time you have received feedback from others than has improved your knowledge, skills and understanding. This may have been from your assessor, tutor, a supervisor or line manager, or individuals using the service. Description of experience How did this experience improve your knowledge, skills and understanding? 5 Health and Social Care Assignment I can confirm that the evidence listed for this unit is my own work and was carried out under the conditions and context specified in the assessment specification, through discussion with my VLA and recorded on DVR. 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This is done by creating an environment that promotes the personal worth, uniqueness, and social confidence of the individual, as well as respect, independence and hope. I.e. Person centr ed values covers the total care of the person. There is no doubt that person-centred care values must influence all aspects of health and social care work, and shouldRead MoreHealth Social Care3065 Words   |  13 Pages| BTEC HIGHER NATIONAL HEALTH AND SOCIAL CARE: LEVEL-5 | Unit 16: Understanding specific needs in health amp; social care | Student name Student ID | Assessor name | | Margaret Amankwah | Date issued | Completion date | Submitted on | | | | | | Assignment title | Understanding specific needs in health and social care | Assignment Overview: Individuals have a wide amp; diverse range of demands amp; care needs. 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By learning about each person with dementia as an individual, with his or her own history and background, care and support can be designed to be more appropriate toRead MoreEssay on Health and Social Care960 Words   |  4 Pageshow health and safety legislation is implemented in the health and social care workplace 1.1 Review systems, policies and procedures for communicating information on health and social care workplace in accordance with legislative requirements. 1.2 Assess the responsibilities in a specific health and social care work place for the management of health and safety in relation to organizational structure. 1.3 Analyse health and safety priorities appropriate for a specific health and social care

Actings in my blood Essay Example For Students

Actings in my blood Essay The playbill for a show presented at Arizona State Universitys Institute for Studies in the Arts reads: Two One-Act Plays performed as part of the Performance Induced Personality Transformation Immunity Project. Further along, the program contains this eye-opener: Because we need to draw blood and have it shipped by 5 p.m. each day, we have had to schedule the plays at the unothodox hour of 1:40 p.m. The plays and the research connected to them are components of a biology of performance study conceived by two University of South Florida professors Nicholas Hall, head of the schools psychoimmunology division, and Denis Calandra of the theatre department aimed at exploring the links between the brain and the immune system. Hall was cued into the immunity-performance connection when he discovered significant changes in the immune system of a multiple personality disorder patient as she switched between characters. After conducting the first part of their pilot study in Tampa in 1990, Hall and Calandra carried out a more complex second stage at Arizona State, where the two one-acts were performed in March. This collaboration between the medical world and the artistic world is about breaking down barriers, Calandra says. What exactly is the link between actors and immunology? The team is working on the assumption that through the use of learned acting techniques, which often incorporate guided imagery and meditation exercises to enter character, an actor is able to induce changes in his or her physiology that in turn may cause positive or negative changes in the immune system. What if patients could use the same methods to induce personalities in themselves, thereby making positive changes in the immune system changes that may even prove healing? The theory dates back to the 4th century B.C., when Hippocrates asserted that virtually all bodily functions could be influenced by ones emotions. Positive imaging techniques have been explored for years in the medical establishment, particularly in rehabilitative work with cancer patients. Calandra thinks incorporating theatre arts into the study is a wise decision: Theatre has always been a lab for emotions and imaging of various kinds. Hall and Calandras pilot study recruited the services of two brave Equity actors who for two weeks performed back-to-back performances of Peter Barness Its Cold, Wanderer, Its Cold and an episode from I Love Lucy (both directed by Calandra). Before and after each double-bill, assistants drew blood samples from the actors, who, in turn, kept elaborate logs on elements that may have caused stress and also wore heart monitors during performances. The samples were immediately sent off to the lab for hormonal and immune tests. The researchers are now in the process of evaluating the data. In the studys next phase, Calandra is interested in eliminating movement by doing radio dramas, and would in the future like to work with distinctively different acting techniques and types of scripts.

What Every Woman Knows monologue Essay Example For Students

What Every Woman Knows monologue Essay A monologue from the play by J. M. Barrie NOTE: This monologue is reprinted from What Every Woman Knows. J.M. Barrie. New York: Scribners, 1921. CHARLES: Your husband has been writing the speech here, and by his own wish he read it to me three days ago. The occasion is to be an important one; and, well, there are a dozen young men in the party at present, all capable of filling a certain small ministerial post. And as he is one of them I was anxious that he should show in this speech of what he is capable. It is a powerful, well-thought-out piece of work, such as only a very able man could produce. But it has no special quality of its own none of the little touches that used to make an old stager like myself want to pat Shand on the shoulder. He pounds on manfully enough, but, if I may say so, with a wooden leg. It is as good, I dare say, as the rest of them could have done; but they start with such inherited advantages, Mrs. Shand, that he had to do better. I am sorry, Mrs. Shand, for he interested me. His career has set me wondering whether if I had begun as a railway porter I might not still be calling out, By your leave. We will write a custom essay on What Every Woman Knows monologue specifically for you for only $16.38 $13.9/page Order now

Israel and Palestine essays

Israel and Palestine essays The war between Israelis and Palestine can date back to years and years ago. For decades these two cultures have fought with each other and neither have ever come across peace. Instead of using peaceful protesting the Pales tines tends to use violence, thinking that is the key. The way I think the Palestinians act is like how a child acts when crying hysterical wanting a cookie. My mother always said you will never get the cookie unless you calm down peacefully and act normal. The cookie represents the issues the Palestinians are fighting for, and they will never get their cookie acting in violence. The Jewish people claimed Israel their independent state on May 14th 1948, Therefore pushing the Palestinians out of their holy land. The Palestinians have tried to establish their own country however most of their land or all of it has been occupied by Israel. Sources say the Palestinians lived in the region long before Jews began moving there in large numbers in the late 1800's. The United Kingdom gained control of Palestine after World War I and after the horrible tragedy that had taken place in World War II The British created a national homeland for the Jews, but pushed the Palestinians to the side. The after math of these decisions have caused chaos between both worlds. Innocent people have died in shootings, suicide bombers, and battles between both armies. Till this day no peace has been established and everyday you hear on the news about a new suicide bomber or attack on innocent Israelis. What has been done about this situation? What can be done? How many more lives have to suffer because of these issues? I am sick of hearing about innocent lives being taken away. This war has been going on for decades and it has to stop. I feel that the Palestinians deserve their own state. I first learned about this war when I was very young and my opinion has never changed . It is not right what has happened to the Palestinians b ...

Adventist Music Guidelines Essays

Adventist Music Guidelines Essays Adventist Music Guidelines Essay Adventist Music Guidelines Essay however, implies that the dead go through that bright shining celestial door to Heaven. Therefore, that song is theologically unsound in the context of the Seventh-day Adventist Church, no matter how poetic the text, or how lovely the melody. As mentioned earlier, the text is indeed more equal than the musical element. However, without the tune, the text could never have the impact that comes from being coupled with good music that adds a new dimension.25 Even though the musical part plays an important role in church music as a whole, the message of the text which should not be overpowered by accompanying elements must take precedence.26 This means that when the congregation sings they should not be excessively caught up with that catchy melody and/or rhythm; the singers should strive to sing out as clearly as possible, so that the text of the hymns or songs is very audible. Therefore, the hymns and songs should be sung in a clear, natural voice. It is not loud singing that is needed, but clear intonation, correct pronunciation, and distinct utterance, so that Gods praise can be sung in clear, soft tones, not with harshness and shrillness that offend the ear.27 Mrs. White mentions that The long drawn-out notes and peculiar soundsare not pleasing to the angel.The songs in which every word is uttered clearly, in a musical tone are the songs that [the angels] join us in singing.28 Singing clearly is not enough, though. The singing should also be done with conviction and understandingthe singers should know and believe what they are singing. God is glorified by songs of praise from a pure heart filled with love and devotion to Him.29 In other words, the singers must not sing for the sake of singing, but they should sing from the heart. Only then will the hymns and songs become worthy of glorifying God. And the nearer the people of God can approach to correct, harmonious singing, the more He is glorified.30 The vocal treatment of the songs and hymns is just as important as the performance of the music. This applies mostly to the special music part of the worship service, when the congregation listens to the music being performed up front. The music itself might glorify God, but so must the singers and/or instrumentalists in their performance. In fact, The nuance which the performer brings to the presentation of a particular piece is a most important contributor to its power as a communicative medium.31 The performers of music in the worship music must be careful not to let themselves be the stars, or get all the limelight. They should keep one thing straight: they are singing (or playing whatever instruments) for the Lord, not performing just to get the attention, praise, and admiration of the congregation. Therefore, they must bring across the right message that they are praising God in their music. It is very important that the right Person is exalted in the church: God, not man himse lf. Since God is the One being glorified, He deserves the attention. Therefore, anything which calls for undue attention to the performer(s) such as excessive, affected bodily movement or inappropriate dress, should find no place in witnessing.32 Also, there should be no theatricality and prideful display when the singers and/or instrumentalists perform. If they perform with the objective of impressing the congregation with their refined abilities, then they are in the wrong place33they should not be playing music in church. Most, if not all, the music guidelines in worship service also apply towards music in evangelism. The songs should contain texts which are compatible with the Biblical teachings and beliefs of the church; the songs should be sung clearly. One point has to be stressed in this context: the performersthe music evangelistsshould bear witness for Christ, not bring glory to themselves. However, one aspect unique to evangelism is the audience. In evangelism, the audience can be considered as the target group; after all, the audience in this case are the people to whom the gospel message is directed. Therefore, it is vitally important to consider the audience as a whole in the choice of music. Factors like the general age-groups and religious backgrounds should be examined. The point is to identify the audience. Evangelism is like a bridge in some ways. The Christians are reaching out to the believers with the gospel message. Therefore, in evangelism the appropriate music is like an effective bridge, because the music then becomes a proper evangelistic tool. However, no matter who the audience is, the music must be honest and sincere. It must bemusic which rings true to itself. There must be no falseness and pretense about it.34 Simply said, the music must tell of the gospel message in a clear, unambiguous way. In this section about evangelism, the focus will be on youth as the audience. In youth evangelism, evangelists have chosen certain musical idioms which the youth can relate to. One of these musical idioms is rhythm, or better known as the beat. Most musical scholars agree that music is a combination of three things: melody, harmony, and rhythm. To be complete, the music needs to keep in equilibrium all the three components; for example, the beat should not dominate to the extent of overpowering the tune and the lyrics of the song.35 Therefore, in the use of youth-related musical idioms like the strong sense of beat, there must be a balance between the main tune of the song and its other componentsrhythm and harmony. It is not wrong to use carefully selected contemporary music in evangelism, agrees Mr. Staples, a missionary, as long as the music does not bear too much resemblance to secular musiccomplete with the overtones of violence, drugs, and sex.36 However, whatever the music chosen for evangelism, the guidelines must still apply, because The desire to reachyouth where they are with the gospel of Christ leads to the use of certain questionable musical idioms.37 These questionable musical idioms should be carefully examined with the music guidelines to church music as the standards. As a matter of fact, Mrs. White had something prophetic to say back in l900 when she heard certain kinds of music to which she was against. She wrote: Every uncouth thing will be demonstrated. There will be shouting, with drums, music, and dancing. The sense of rational beings will become so confused that they cannot be trusted to make right decisions. And this is called the moving of the Holy Spirit. The Holy Spirit never reveals itself in such methods, in such a bedlam of noise.38 Even though it is fine to use selected contemporary music elements, the music evangelists must be careful not be overly occupied in the music as to the extent of breaking the rules (i.e. guidelines) in the effort to evangelize. In youth evangelism, there should be no compromise of standards, in particular, the standards of church music. Never compromise high principles of dignity and excellence in efforts to reach people where they are.39 In their evangelistic efforts the evangelists are not follow the ways of the world.40 Mrs. White said that instead of bringing the truth to a low level in order to obtain converts, they should seek to bring the sinful corrupted up to the high standard of the law of God.41 Music has been around for ages. It has also been used in the church for a good period of time; and in more ways than one, it has been (and no doubt will be) an important part of the church. However, times have been (and still are) changing, therefore the context and circumstances of church music have not remained stagnant. But the important thing to remember is that the guidelines must be kept in sight so that the ultimate goal of the Christian of glorifying and praising God is not blurred through the years. Since music is a medium in which the blending of the best and the worst can be done more subtly than through any other media form,42 the christians will have to be extra careful in the selection of music for church use. In conclusion, Dr. Lickey, a church musician, has this to say about judging the music for church use: Responsible Christians would not seek to see how close to the edge of purity they could get but would rather turn their backs to the world.43

A Cultural Breakaway Essay Example | Topics and Well Written Essays - 1250 words

A Cultural Breakaway - Essay Example Scott does not only present Kiowa traditional myths, but helps us to create and relate Kiowa culture. Through a well examined process of mentally forming a clear picture of traditional stories, Scott’s view on contemporary cultural life, the reader is placed at a point of being able to offer a personal appreciation of the fluctuating experience of Kiowa as a culture. Momaday fit into the historic times of the Indian society coming at a time of American imagination, not as the end of the long trail, but coming into full view as an Indian contemporary society. Momaday puts into context and relates to the audience his views. In his description he talks about how his ancestors are buried in that land so that he puts a claim on the land through his memory. The wild animals knew this very well, the weather was fast changing and winter was vividly fast approaching, it was during that time of the year that even the bravest of all animals had to seek warmth and comfort in order to shie ld itself from the adverse winter time. The cold is sharp and straight reaching even up to the bones chilling throughout the body. The branches of the tree turn bare and their beauty gone, as Scott puts it â€Å"that winter brings blizzards, hot tornadic winds.† ... Best captured in Hoffman’s own ideas â€Å"It is indeed a feeling whose shades and degrees am destined to know quite intimately, but at this hovering moment, it comes upon me like a visitation from a whole new geography of emotions, an annunciation of how much an absence can hurt.† We had moved into this new area some six months ago, when my family had to flee due to the great tsunami that made everybody move out of my former city to this new environment. Reflecting back at my childhood, I come across darkened imagination of the place where we had come from. Deep within me there is a feeling that I don’t want to be separated from my childhood memories, the sweet moments and the little jokes and games that we used to play with my friends at our countryside home. Every situation around me seems bleak offering no meaning, losing my childhood memories, my thoughts are stuck in a moody situation refused to move and think on. This kind of winter weather is indeed pure beauty, it surrounds trees and bushes. It’s a whole new form of world; the getaway. Several years have passed, it is now indeed a new culture and life for me, things are different now, at a friend’s party I meet a lady in her early twenties; who had also been separated from her childhood. They must also have apparently left China during that time, we talk issues of how a part of her has since then been missing ever since that time. Her journey as she vividly describes that â€Å"It was a long journey toward the dawn, and it led to the golden age† (Momaday 2), and along the way they have interacted with a different type of people that have in a much deeper sense influenced their culture and religion. That aspect of cultural