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Discussion Question 1, Discussion Question 2
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Week 5 Discussion Question 1
Discuss and analyze the world health situation. What is the greatest
problem facing the world population? What strategies (at least three)
would you utilize to alleviate this problem?
Week 5 Discussion Question 2
Explain health, poverty, and Millennium Development Goals (MDG). Briefly discuss each concept on this list from the World Health Organization (WHO).

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Virtues and Values and two Discussion Question
Virtues and Values and two Discussion Question
Discussion Question 1Explain why caregivers are considered patient advocates. When and how
does one become a patient advocate? Discuss the legal implications of
being a patient advocate. What resources can patient advocates access to
help them perform their roles/responsibilities? Identify a minimum of
three resources.Discussion Question 2Discuss the correct way of charting in a patient’s record. Analyze the
impact of poor documentation in patient care? Give one or two examples.
Explain possible legal concerns for poor documentation. This is the AssignmentVirtues and Values
For this assignment differentiate virtues from values. Discuss the characteristics of both.How do they affect one’s character? How are they acquired? How
can they be helpful in resolving health care ethical dilemmas? (content
criteria #2)Identify and discuss a health-related case in which virtues and
values played a part. Discuss application/and interpretation of these
virtues and values in your selected case. (content criteria #3)Make sure you have an Introduction and Conclusion (content criteria #1).
Your paper must be three to five double-spaced pages (excluding title
and reference pages) and formatted according to APA style as outlined in
the Ashford Writing Center. Utilize a minimum of three scholarly
and/or peer-reviewed sources (not including the course textbook) that
were published within the last five years.

Two Discussion Question
Two Discussion Question
Discussion Question 1Differentiate between allowing a patient to die and physician-assisted
suicide. What are the legal implications of the two concepts? What moral
implications do they have? Why are doctors reluctant to abide by
patient or family wishes to stop life support machines?Discussion Question 2After viewing the OSHA Strategic Plan Slideshow,
examine OSHA’s goals and strategies in measuring results. How can
employers comply with OSHA standards? How can employees conform to the
rules, regulations, and orders of OSHA? What happens when OSHA standards
are violated? Do you feel the violation penalties/consequences are
fair? Why or why not? Include a minimum of one APA cited reference to
support your response.

Health Final Paper
Health Final Paper
For this project, you are to complete the following case study. This project needs to be completed in a Microsoft Word document answering each question individually. The document should be set up in a numbered format. For example:Type your answer hereType your answer hereInclude references in APA format for each pertinent question and include a Reference page as well.This assignment should follow the conventions of Standard American English (correct grammar, punctuation, etc.). Your writing should be well ordered, logical and unified, as well as original and insightful. Your work should display superior content, organization, style, and mechanics.Case StudyDB is a 50 YO African American woman. She has been diagnosed with type 2 Diabetes Mellitus and hypertension. DB takes the following medications: Novolin 70/30 insulin breakfast and supper, Lasix and Cymbalta. DB lives with her husband and 3 children, ages 13, 15 and 17. Her height is 5’6”.Weight: 185 pounds.Activity level: sedentaryDB reports the following 24-hour food intake:Wakes up at 6am: Skips breakfast because needs to be at work at 6:45am. Will have coffee with 2 sugars and cream at work.11am lunch: usually eats out. Yesterday - ate at a popular fast food restaurant. Ate: 2 pieces of fried chicken, 1 biscuit, 1 cup cole slaw, 1 large sweet tea, 1 cup mashed potatoes with gravy, 1 slice of fruit pie.3pm snack: regular size candy bar from vending machine at work6pm dinner: 1 large plate of spaghetti with meat sauce. 1 slice of garlic toast with parmesan cheese. 1 large glass of diet soda.9 pm bedtime snack: 1 bowl of chocolate ice creamGoes to bed at 10pm.DB reports that she will walk 1 mile on Saturday and Sunday at a local mall. DB will eat some vegetables, such as corn and potatoes. DB reports that she rarely eats green vegetables. DB’s favorite ways to prepare foods are to grill them or fry them. DB’s family eats at least three meals a week together as a family.Questions:Assess DB’s food intake for calories, fat, saturated fat, carbohydrate, dietary fiber, protein, and sodium. Please indicate how you assessed the diet and include your work.Analyze the 24-hour recall using example fitday.com orwww.choosemyplate.gov. Provide an in text citation for the source of your nutrient analysis.Show the results of your food intake analysis in a table or cut and past your data table from the web site. Sample data table to present the results of you intake analysis[img height="85" width="431" border="0" src="http://content-hsc.kaplan.edu/NS270_1005B/images/product/table1.jpg" align="center">24 hour recall nutrient analysis on _____________.comEquation to calculate percentage CHO, PRO, FATCalculate DB’s BMI and identify weight classification.Calculate DB’s energy needs using Mifflin St. Jeor equationMifflin St Jeor Energy EquationIdentify your calorie goal to achieve a healthy weight. Support your answer.Identify the dietary guidelines you are choosing (Joslin, American Diabetes Association, DASH) to address DB’s diabetes, and hypertension. Provide an in text citation. Updated Dietary RecommendationsBased on DB’s calorie goal calculate the grams CHO, PRO, FAT, Saturated Fat goals based on a nutrient standard you select.Equation to calculate grams CHO, PRO, FAT, Saturated fat, dietary fiberIdentify the nutrient goals for dietary fiber, sodium, potassium, calcium, magnesiumCompare DB’s intake to the recommended intake. Present this data in a table and discussion format. Your discussion should include your assessment DB’s intake of Calories, CHO, PRO, FAT, saturated fat, sodium, dietary fiber highlighting any shortage or excess of these nutrients. [img height="239" width="325" border="0" src="http://content-hsc.kaplan.edu/NS270_1005B/images/product/table2.jpg" align="center">Identify current nutrient deficiency as you find it on the nutrient analysis. You can cut and paste your data table from your nutrient analysis software or create your own data table to show which nutrients are below 100% RDA/AI. Your answer should also include a short written description of DB’s actual nutrient deficiency. [img height="460" width="796" border="0" src="http://content-hsc.kaplan.edu/NS270_1005B/images/product/table3.jpg" align="center">Sample shown is from fitday.comSample comparison of intake by food groupDietary exchange calculator:http://diabeteslibrary.org/View.aspx?url=DiabeticExchangeListUsing the DRI tables for vitamins and elements identify additional nutrients DB would potentially be deficient in based on identified missing foods/food groups. http://iom.edu/Activities/Nutrition/SummaryDRIs/~/media/Files/Activity%20Files/Nutrition/DRIs/DRI_Vitamins.ashxDRI: Vitamins http://iom.edu/Activities/Nutrition/SummaryDRIs/~/media/Files/Activity%20Files/Nutrition/DRIs/DRI_Elements.ashxDRI ElementsWrite a summary of the potential nutrient deficiency you identify in b and c.Identify potential pharmacotherapy issues related to DB’s drug prescriptions. For each medication identify:Why the medication is prescribed?Important facts about this medication.How do you take this medication?Identify considerations for timing, and missed doses.Special warnings about this medication.How do these drugs affect nutrients?Suggested websites:http://www.pdrhealth.com/drugs/rx/rx-a-z.aspx http://www.drugs.com/drug_information.html (food & drug information under “What should I avoid)Create a 1-day meal plan for DB and explain how the menu meets the some of the guidelines you set in question 1c. You may use the 1 day sample meal plan link below to help the process.Address these aspects:Identify calorie and % CHO, PRO, FAT goalsIdentify timing for meals and snacksIdentify CHO goals for meals and snacksCreate a sample menu to match your goalsComplete a nutrient analysis on your menuDay 1 SampleDescribe how you would educate DB on the meal plan you created and your health maintenance recommendations.During your counseling session, DB confesses to not taking as much of her prescribed medicines so that she can sell it to people at her church that she thinks need it more than she does. She assures you that she charges less than her friends would have to pay for it at the pharmacy. How would you counsel her regarding this new information?ID: NS270-09-09-P

DISCUSSION QUESTION and Commonwealth Fund
DISCUSSION QUESTION and Commonwealth Fund
DISCUSSION QUESTION 1How should the federal government participate in supporting health care
for all when the constitution does not include health care as a federal
responsibility?ASSIGNMENTView the article, Why Not the Best? Results from the National Scorecard on U.S. Health System Performance, 2008.
Click on 'Download Fund Report (PDF)' and read Exhibits 1, 2, 3, 4, 5,
6, 13, 14, 15, and 21. Of these Exhibits, select the three you believe
are the most important in terms of current health policy in the U.S.
Analyze why you selected your three choices, and provide some data to
back up your choices. Prepare a four- to five-page paper expounding on
your choices, and provide justification for the importance over the
other topics covered in the Exhibits.
Your paper must be four to five double-spaced pages (excluding title and
reference pages) and formatted according to APA style as outlined in
the Ashford Writing Center. Utilize a minimum of five to seven
scholarly and/or peer-reviewed sources that were published within the
last five years. All sources must be documented in APA style, as
outlined in the Ashford Writing Center.

Two Discussion Question
Two Discussion Question
Discussion Question 1In the course text, read case 4 -1 on pages 98 (bottom) to 101. On page
102, what is your response to question #4? Justify your response.Case 4–1 NATIONAL STANDARDS ON CULTURALLY AND LINGUISTICALLY APPROPRIATE SERVICES (CLAS)In 1997, the Office of Minority Health (OMH) in the U.S. Department of Health and Human Services began work on national standards for culturally and linguistically competent health care. The stated goal was to help reduce health disparities. OMH published draft standards in December 1999 and solicited public comment through a variety of channels over a 4-month period. On December 22, 2000, it published the final standards. Although the standards are primarily directed at health care organizations, OMH encourages their use by individual providers as well as by policy makers, accreditation and credentialing agencies, purchasers, patients, advocates, educators, and the health care community in general (OMH, 2001).CULTURALLY COMPETENT CARE (GUIDELINES FOR ACTIVITIES RECOMMENDED BY OFFICE OF MINORITY HEALTH FOR ADOPTION AS MANDATES BY FEDERAL, STATE, AND NATIONAL ACCREDITING AGENCIES)Standard 1Health care organizations (HCOs) should ensure that patients/consumers receive effective, understandable, and respectful care from all staff members that is provided in a manner compatible with their cultural health beliefs and practices and preferred language.Standard 2HCOs should implement strategies to recruit, retain, and promote at all levels of the organization a diverse staff and leadership that are representative of the demographic characteristics of the service area.Standard 3HCOs should ensure that staff members at all levels and across all disciplines receive ongoing education and training in culturally and linguistically appropriate service delivery.LANGUAGE ACCESS SERVICES (MANDATED REQUIREMENTS FOR ALL RECIPIENTS OF FEDERAL FUNDS)Standard 4HCOs must offer and provide language assistance services, including bilingual staff and interpreter services, at no cost to each patient/consumer with limited English proficiency at all points of contact in a timely manner during all hours of operation.Standard 5HCOs must provide to patients/consumers in their preferred language both verbal offers and written notices informing them of their right to received language assistance services.Standard 6HCOs must assure the competence of language assistance provided to limited English-proficient patients/consumers by interpreters and bilingual staff. Family and friends should not be used to provide interpretation services (except on request by the patient/consumer).Standard 7HCOs must make available easily understood patientrelated materials and post signage in the languages of the commonly encountered groups and/or groups represented in the service area.ORGANIZATIONAL SUPPORTS FOR CULTURAL COMPETENCEStandards 8–13 are guidelines for activities recommended by the Office of Minority Health for adoption as mandated by federal, state, and national accrediting agencies. Standard 14 is suggested for voluntary adoption by HCOs.Standard 8HCOs should develop, implement, and promote a written strategic plan that outlines clear goals, policies, operational plans, and management accountability/oversight mechanisms to provide culturally and linguistically appropriate services.Standard 9HCOs should conduct initial and ongoing organizational self-assessments of CLAS-related activities and are encouraged to integrate cultural and linguistic competence-related measures into their internal audits, performance improvement programs, patient satisfaction assessments, and outcomes-based evaluations.Standard 10HCOs should ensure that data on individual patient’s/consumer’s race, ethnicity, and spoken and written language are collected in health records, integrated into the organization’s management information systems, and periodically updated.Standard 11HCOs should maintain a current demographic, cultural, and epidemiological profile of the community as well as a needs assessment to accurately plan for and implement services that respond to the cultural and linguistic characteristics of the service area.Standard 12HCOs should develop participatory, collaborative partnerships with communities and use a variety of formal and informal mechanisms to facilitate community and patient/consumer involvement in designing and implementing CLAS-related activities.Standard 13HCOs should ensure that conflict and grievance resolution processes are culturally and linguistically sensitive and capable of identifying, preventing, and resolving cross-cultural conflicts or complaints by patients/consumers.Standard 14HCOs are encouraged to regularly make available to the public information about their progress and successful innovations in implementing the CLAS standards and to provide public notice in their communities about the availability of this information (OMH, 2001). From page 102What would you change about these regulations if you were in charge at the U.S. Department of Health and Human Services? Discussion Question 2In the course text, read case 6-1, pages 171 through 175. What is your response to question #5 on page 176? Case 6–1 GLOBAL MEDICAL COVERAGEBACKGROUNDBlue Ridge Paper Products, Inc. (BRPP) in Canton, NC is a paper company making predominantly food and beverage packaging. It was the largest employer left in Western North Carolina in 2006, with 1,300 covered employees in the state and 800 elsewhere. Started as a Champion Paper plant in 1908, it was purchased by the employees and their union (a United Steelworkers local) in May 1999 with the assistance of a venture capital firm and operates with an Employee Stock Ownership Plan (ESOP). To purchase it, the employees agreed to a 15% wage cut and frozen wages and benefits for seven years. From the buyout through the end of 2005, the company lost $92 million and paid out $107 million in health care claims. It became profitable in 2006. Maintaining health benefits for members and retirees is a very high priority item with the employees and the union, although retiree medical benefits have been eliminated for salaried employees hired after March 1, 2005.BRPP employees are “predominantly male, over 48, with decades of services and several health risk factors. They work 12-hour, rotating shifts, making it extremely difficult to manage health conditions or improve lifestyle” (Blackley, 2006). The ESOP has worked hard to reduce its self-insured health care costs. Health insurance claims for 2006 had been estimated at $36 million, but appeared likely to hold near $24 million, which is still 75% above the 2000 experience. A volunteer Benefits Task Force of union and nonunion employees worked to redesign a complex benefit system. After two years of 18% health care cost increases, the rate of growth dropped to 2% in 2003. It was 5% in 2004 and a negative 3% in 2005.Programs initiated in 2001 included a plan offering free diabetic medications and supplies in return for compliance and a tobacco cessation plan with cash rewards. In 2004, the company opened a full-service pharmacy and medical center with a pharmacist, internist, and nurses. In 2005, it began a Population Health Management program. Covered employees and spouses who completed a health risk assessment were rewarded with $100 and assigned a “personal nurse coach.” The nurse coach assists those who are ready to change to set individual health goals and choose from among one or more of 14 available health programs, which may include “cash rewards, waived or reduced co-pays on over 100 medications, free self-help medical aids/equipment, educational materials, etc.”Where BRPP could not seem to make headway was with the prices paid to local providers. Community physicians refused deeper discounts. Even banding together in a buying cooperative with other companies could not move the local tertiary hospital to match discounts offered to regionally dominant insurers. This hospital was not distressed and had above-average operating margins.Articles on “medical tourism” in the press and on television attracted the attention of benefits management. Reports were of high quality care at 80% or less of U.S. prices with good outcomes. BRPP contacted a company offering services at hospitals in India, IndUShealth in Raleigh, NC, and began working on a plan to make its services available to BRPP employees.IndUShealthIndUShealth provides a complete package to its U.S. and Canadian clients, including access to Indian superspecialty hospitals that are Joint Commission International accredited and to specialists and supporting physicians with U.S. or U.K. board certification. It arranges for postoperative care in India and for travel, lodging, and meals for the patient and an accompanying family member—all for a single package price. For example, it represents the Wockhardt hospitals in India, which are Joint Commission International accredited and affiliated with Harvard Medical International. Other Indian hospitals boast affiliations with the Johns Hopkins Medical Center and the Cleveland Clinics.Mitral Valve ReplacementOne of the first cases considered was a mitral valve replacement. IndUShealth and BRPP sought package quotes from a number of domestic medical centers and could get only one estimate. That quote, from the University of Iowa academic medical center, was in the $68,000 to $98,000 range. The quote from India was for $18,000 including travel, food, and lodging for the patient and one companion. Testifying before the U.S. Senate Special Committee on Aging, Mr. Rajesh Rao, IndUShealth CEO, (2006) cited the following costs.ProcedureTypical U.S. CostIndia CostHeart bypass Surgery$55,000 to $86,000$6,000Angioplasty$33,000 to $49,000$6,000Hip replacement$31,000 to $44,000$5,000Spinal fusion$42,000 to $76,000$8,000EMPLOYEE PARTICIPATIONTo encourage employee participation, BRPP prepared a DVD on its medical tourism initiative, which it called Global Health Coverage. It outlined the opportunities and described the Indian facilities and credentials. The next step was to be a trip by an employee “due diligence” committee to India to inspect facilities and talk with doctors. Then they would discuss how to handle the option in the next set of union negotiations.SENATE HEARINGSOn June 27, 2006, the U.S. Senate Special Committee on Aging held hearings entitled “The Globalization of Health Care: Can Medical Tourism Reduce Health Care Costs?” Both BRPP and IndUShealth presented together with others.When testifying to the Senate subcommittee, Bonnie Grissom Blackley, benefits director for BRPP, concluded:Should I need a surgical procedure, provide me and my spouse with an all expense-paid trip to a Joint Commission International-approved hospital, that compares to a 5-star hotel, a surgeon educated and credentialed in the U.S., no hospital staph infections, a registered nurse around the clock, no one pushing me out of the hospital after 2 or 3 days, a several-day recovery period at a beach resort, email access, cell phone, great food, touring, etc., etc. for 25% of the savings up to $10,000 and I won’t be able to get out my passport fast enough.BLUE RIDGE PAPER PRODUCT’S TEST CASEThe test case under the new arrangement was a volunteer, Carl Garrett, a 60-year-old BRPP paper-making technician who needed a gall bladder removal and a shoulder repair. He reportedly was looking forward to the trip in September 2006, accompanied by his fiancée. A 40-year employee approaching retirement, he would be the first company-sponsored U.S. worker to receive health care in India. The two operations would have cost $100,000 in the United States but only $20,000 in India. The arrangement was that the company would pay for the entire thing, waive the 20% co-payment, give Garrett about a $10,000 incentive, and still save $50,000.The United Steel Workers Union national office objected strongly to the whole idea, however, and threatened to file for an injunction. The local district representative commented, “We made it clear that if healthcare was going to be resolved, it would be resolved by modifying the system in the U.S., not by offshoring or exporting our own people.” USW President Leo Gerard said, “No U.S. citizen should be exposed to the risk involved in travel internationally for health care services” and sent a letter to members of Congress that included the following (Parks 2006):Our members, along with thousands of unrepresented workers, are now being confronted with proposals to literally export themselves to have certain “expensive” medical procedures provided in India.With companies now proposing to send their own American employees abroad for less expensive health care services, there can be no doubt that the U.S. health care system is in immediate need of massive reformThe right to safe, secure, and dependable health care in one’s own country should not be surrendered for any reason, certainly not to fatten the profit margins of corporate investors.The union also cited the lack of comparable malpractice coverage in other countries. The company agreed to find a domestic source of care for Mr. Garrett, but may continue the experiment with its salaried, nonunion employees. Carl Garrett responded unhappily, “The company dropped the ball …. people have given me so much encouragement,” he said, “so much positive response, and they’re devastated. A lot of people were waiting for me to report back on how it went and perhaps go themselves. This leaves them in limbo too” (Jonsson, 2006, p. 2). This is the Question from 176How might state and national governments respond to this expanding phenomenon?
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