Thursday, November 28, 2019

Structured Individual

Discussion Patients need a structured group education program when they are newly diagnosed with type 2 diabetes. Evidence from research showed that such structured programs are able to limit the patients’ weight loss and smoking incidences, which are helpful in managing the diabetes conditions.Advertising We will write a custom research paper sample on Structured Individual-based Lifestyle Programs specifically for you for only $16.05 $11/page Learn More At the same time, the structured education program is beneficial because it is effective in improving the patients’ beliefs about diabetes such that they become more responsive to treatment and other intervention programs (American Diabetes Association, 2013). It is also useful to note that while the education program achieves its intended purpose of changing attitudes, it does not make any significant impact on actual incidences of diabetes as measured by haemoglobin A levels in research findings by Davies et al. (2008) and Adolfsson, Walker-Engstrà ¶m, Smide, and Wikblad (2007). Although quality of life may not improve, the structured group education program that relies on experts is influential in improving patient satisfaction with treatment as they become more knowledgeable about diabetes and improve their physical activity levels. On the other hand, structured individual-based lifestyle education (SILE) programs show remarkable improvements in haemoglobin A levels (Adachi et al., 2013; Tan, Magarey, Chee, Lee, Tan, 2011). Education targeted on community, culture and cultural events, such as the Ramadan focused education in diabetes, are effective as they are contextually relevant to patients’ situations. Not only do patients learn about their need to embrace dietary flexibility and insulin adjustment, but they also learn about hypoglycaemia, which then acts as a motivating factor for lifestyle change. It is also instrumental in overcoming cultural bias es (Bravis et al., 2010). Indeed, the culturally tailored diabetes educational interventions (CTDEI) improve glycaemic control among ethnic minorities as influenced by the settings of the intervention.Advertising Looking for research paper on health medicine? Let's see if we can help you! Get your first paper with 15% OFF Learn More When using the CTDEI, care givers must also consider the influences of baseline haemoglobin A level and time of haemoglobin A measured as these also impact on the measured value (Nam, Janson, Stotts, Chesla, Kroon, 2012; Moher, Liberati, Tetzlaff, Altman, 2009). Increase in knowledge appears as the only guaranteed result of single education and self-management, structured programme, with biomedical and lifestyle outcomes being circumstantial (Khunti et al., 2012). In fact, as Cooper, Booth, and Gill (2008) concluded, diabetes education does not guarantee lasting benefits of glycaemic control, but it is very effective in changing patient attitudes such that they develop a positive outcome of the disease. The fact holds for education interventions carried out for different lengths between six months and two years. The reinforcement of the education programme is essential to achieve lasting behavioural changes as Sperl-Hillen et al. (2013) concluded. This happens because conventional individual education leads to sustained improvements in self-efficiency and reduces diabetes related stress more than usual care does, but then the effects only last within the period of education (Moriyama et al., 2009; Wu et al., 2011) In addition, the complexities of the education program do not have significant influences on the outcome, but they have a salient effect on the cost of education. The UK X-PERT programme performs as well as the UK DAFNE and the Italian BASICs, despite the other two being expensive and labour intensive (Cooper et al., 2008). Moreover, group based diabetes self-management education (DSME) allows patients to meet and discuss with each other, which significantly contributes to better outcomes on clinical, lifestyle, and psychosocial aspects (Steinsbekk, Rygg, Lisulo, Rise, Fretheim, 2012). The consideration here is that the effects of the DSME are affected by ethnicity, sex, and other socioeconomic characteristics of the patients (Gucciardi, Chan, Manuel, Sidani, 2013). Meanwhile, locally developed education programs could be less effective than programs specifically developed for studies mainly due to the lack of appropriate control features (Rygg, Rise, Gà ¸nning, Steinsbekk, 2012; Whittemore Knafl, 2005).Advertising We will write a custom research paper sample on Structured Individual-based Lifestyle Programs specifically for you for only $16.05 $11/page Learn More All education programs must focus on the patient because patients control behaviour choices and activities that influence their experience of diabetes. However, patients must have the nec essary knowledge to properly self-manage their diabetes. In this regard, intervention programs that focus on the patient empowerment and incorporate a means of collaborative learning to improve patient’s knowledge will be the ones that succeed as shown by Heinrich, Schaper, and de Vries (2010). When there is adequate knowledge of diabetes, patients are able to change their dietary behaviour, irrespective of the type of diabetes they have or their present treatment method. In this regard, knowledge becomes a universal requirement for successful self-management of the disease and would be important in any education program targeting diabetes patients. As an isolated intervention, education improves self-care and metabolic control variables (IKarakurt KaÅŸÄ ±kà §Ã„ ±, 2012). In resource constrained and pressured environments, the same educational interventions used in other settings may not work appropriately. Therefore, they should be modified to take care of the possibili ties of task shifting for the experts tasked with the job of educating patients. Group motivational interviewing for the health experts and their patients helps in this case (Mash, Levitt, Steyn, Zwarestein, Rollnick, 2012). Implication The effectiveness of self-care education depends on the components of self-care available in the education program and their ease of monitoring. The combination of DSME and patient-centred care should offer care providers enough options to influence both broad and specific impacts on their diabetes patients. Working within the DSME program features to suit the context of application along parameters such as socioeconomic and cultural backgrounds, resource availability and intended outcomes can potentially make the program more effective. The development of self-management diabetes education in Singapore will benefit from the findings that show the effectiveness of structured diabetes education. Practitioners should be aware of the potential differen ces in outcome between locally prepared programs and study-specific programs in terms of their effectiveness (Im Chang, 2012).Advertising Looking for research paper on health medicine? Let's see if we can help you! Get your first paper with 15% OFF Learn More Limitation Despite the extensive consultation on the subject of diabetes education, there is still limited knowledge of the intervention features of DSME that actually promote behaviour change and then go on to improve clinical outcomes. Much of what is presented in the paper covers the DSME as a whole and would, therefore, need additional research to obtain a measurable result for the five intervention features associated with DSME, together with other related features that researchers see as having positive effects on patient outcomes. Recommendation Future studies on self-care activities of diabetes patients should look into the efficacy aspect, in addition to the overall difference in pre- and post-intervention periods. Evidence from the research and the subsequent discussion calls for planners of the education for diabetes patients to take care of environmental variables, patient specific challenges, when obtaining standardized results. This would then make it easier for evalua tors to compare different interventions and eliminate comparison errors that may arise due to contextual differences. Education programs need to cover a larger period of time to capture a varied number of changes in patients. In addition, there should be more divergent sample groups to provide extensive case coverage. Conclusion Structured individual-based lifestyle programs (SILE) are the way forward because they lead to great improvement in haemoglobin A1c as compared to usual care. Moreover, a culturally tailored diabetes educational intervention (CTDEI) is a better approach to use when targeting ethnic minorities. This would go well with the Singaporean context, where there are ethnic majority and minority groups that may not have similar care opportunities. In addition, as a cost-intervention measure group, intervention would be a preferred mode of delivery for Singapore Diabetes Centres that are mostly running a busy schedule with a high patient volume. However, this should on ly happen due to budget constraints. References American Diabetes Organization. (2013). A1C and eAG. Retrieved from http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/a1c/ Adachi, M., Yamaoka, K., Watanabe, M., Nishikawa, M., Kobayashi, I., Hida, E, Tango, T. (2013). Effects of lifestyle education program for type 2 diabetes patients in clinics: a cluster randomized controlled trial. BMC Public Health, 13(1), 467. doi: 10.1186/1471-2458-13-467. Adolfsson, E. T., Walker-Engstrà ¶m, M-L., Smide, B., Wikblad, K. (2007). Patient education in type 2 diabetes—A randomized controlled 1-year follow-up study. Diabetes Research and Clinical Practice, 76(3), 341-350. Bravis, V., Hui, E., Salih, S., Mehar, S., Hassanein, M., Devendra, D. (2010). Ramadan Education and Awareness in Diabetes (READ) programme for Muslims with Type 2 diabetes who fast during Ramadan. Diabetic Medicine, 27(3), 327-331. Cooper, H., Booth, K., Gill, G. (2008). A trial of e mpowerment-based education in type 2 diabetes—Global rather than glycaemic benefits. Diabetes Research and Clinical Practice, 82(2), 165-171. Davies, M. J., Heller, S., Skinner, T. C., Campbell, M. J., Carey, M. E., Cradock, S., Dallosso, H. M., Daly, H., Doherty, Y., Eaton, S., Fox, C., Oliver, L., Rantell, K., Rayman, G., Khunti, K. (2008). Effectiveness of the diabetes education and self management for ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomised controlled trial. BMJ, 336(7642), 491-495. Gucciardi, E., Chan, V. W., Manuel, L., Sidani, S. (2013). A systematic literature review of diabetes self-management education features to improve diabetes education in women of Black African/Caribbean and Hispanic/Latin American ethnicity. Patient Education And Counseling, 92(2), 235-245. Heinrich, E., Schaper, N. C., de Vries, N. K. (2010). Self-management interventions for type 2 diabetes: a systematic review. E uropean Diabetes Nursing, 7(2), 71-76. Im, E.-O., Chang, S. J. (2012). A systematic integrated literature review of systematic integrated literature reviews in nursing. Journal of Nursing Education, 51(11), 636-640. Karakurt, P., KaÅŸÄ ±kà §Ã„ ±, M. K. (2012). The effect of education given to patients with type 2 diabetes mellitus on self-care. International Journal of Nursing Practice, 18(2), 170-179. Khunti, K., Gray, L. J., Skinner, T., Carey, M. E., Realf, K., Dallosso, H., Fisher, H., Campbell, M., Heller, S., Davies, M. J. (2012). Effectiveness of a diabetes education and self management programme (DESMOND) for people with newly diagnosed type 2 diabetes mellitus: three year follow-up of a cluster randomised controlled trial in primary care. BMJ: British Medical Journal, 344, e2333. doi: https://www.bmj.com/content/344/bmj.e2333 Mash, B., Levitt, N., Steyn, K., Zwarestein, M., Rollnick, S. (2012). Effectiveness of a group diabetes education programme in underserved com munities in South Africa: pragmatic cluster randomized control trial. BMC Fam Pract, 13, 126. doi:10.1186/1471-2296-13-126. Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Annals of Internal Medicine, 151(4), 264-269. Moriyama, M., Nakano, M., Kuroe, Y., Nin, K., Niitani, M., Nakaya, T. (2009). Efficacy of a self-management education program for people with type 2 diabetes: results of a 12 month trial. Japan Journal of Nursing Science, 6(1), 51-63. Nam, S., Janson, S. L., Stotts, N. A., Chesla, C., Kroon, L. (2012). Effect of culturally tailored diabetes education in ethnic minorities with type 2 diabetes: A meta-analysis. Journal of Cardiovascular Nursing, 27(6), 505-518. DOI: 510.1097/JCN.1090b1013e31822375a31822375. Rygg, L. Ø., Rise, M. B., Grà ¸nning, K., Steinsbekk, A. (2012). Efficacy of ongoing group based diabetes self-management education for patients with type 2 diabetes mellitus. A randomised controlled trial. Patient Education and Counseling, 86(1), 98-105. Sperl-Hillen, J., Beaton, S., Fernandes, O., Von Worley, A., Vazquez-Benitez, G., Hanson, A., Lavin-Tompkins, J., Parsons, W., Adams, K., Spain, C. V. (2013). Are benefits from diabetes self-management education sustained? American Journal of Managed Care, 19(2), 104-112. Steinsbekk, A., Rygg, L. Ø., Lisulo, M., Rise, M. B., Fretheim, A. (2012). Group based diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus. A systematic review with meta-analysis. BMC Health Serv Res, 12, 213. doi: 10.1186/1472-6963-12-213. Tan, M. Y., Magarey, J. M., Chee, S. S., Lee, L. F., Tan, M. H. (2011). A brief structured education programme enhances self-care practices and improves glycaemic control in Malaysians with poorly controlled diabetes. Health Education Research, 26(5), 896-907. Whittemore, R., Knafl, K. (2005). The integrative review: Upda ted methodology. Journal of Advanced Nursing, 52(5), 546-553. Wu, S.-F. V., Lee, M. C., Liang, S. Y., Lu, Y. Y., Wang, T. J., Tung, H. H. (2011). Effectiveness of a self-efficacy program for persons with diabetes: A randomized controlled trial. Nursing Health Sciences, 13(3), 335-343. This research paper on Structured Individual-based Lifestyle Programs was written and submitted by user Brooklynn K. to help you with your own studies. 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Sunday, November 24, 2019

Darwin, Charles essays

Darwin, Charles essays In his 23rd year of life, Charles Robert Darwin set sail from England for an around the world journey that proved to be the biggest turning point in biology and genetics ever. The surveying ship H.M.S Beagles voyage would last five years, mainly concerning the South American coast. This trip would come across thousands of species and see animals yet discovered at the time. The expedition would provide the science community with the startling theories of evolution. Darwin was born in Shrewsbury England and grew up hearing his grandfathers theories of evolution. This being often confused, Darwin was not the first to propose that organisms evolve or change through time. He was the first, though, to come up with strong supporting evidence and an explanation unto how it worked. He studied medicine and theology before joining the Beagle, which both helped him on this tremendous journey. The expedition began in England in 1831 and arrived in Brazil three months later and then spent three and half years up and down the South American coast. The crew would stop at an island to survey the land and make inland expeditions. He was amazed at the variations among animals all along the vast coast. The birds and animals on one side of South America were completely different then those of the other. On these coasts, Darwin found fossils of extinct animals that seemed to resemble modern species. These small trips to the coast were informative, but almost all his theories were formed on the Galapagos Islands. It is hard to mention Darwin and his discoveries without bringing up the Galapagos Islands. These small barren islands off the coast of Ecuador fascinated Darwin to no end. These islands, named after the large tortoises (Galapagos in Spanish), had a unique affect on Darwin and all of biology for that matter. He took notes on the variations of the tortoises from island to island; all have a slightly different kind of tortoise. ...

Thursday, November 21, 2019

Audit Independence Case Study Example | Topics and Well Written Essays - 1500 words

Audit Independence - Case Study Example This paper provides an insightful study into the role played by lack of competition in the audit marketplace in affecting auditor independence and the ways through which it can affect the audit quality. It also sheds light on the solutions actually implemented to resolve this problem as well the ones that have been proposed and yet to be implemented. Lack of competition in the audit marketplace is one of the most significant concerns among the regulators these days. Lack of competition in the audit marketplace refers to the fact that there are big four auditing firms predominantly involved in the provision of accounting services around the world encompassing approximately 78% of the total US publicly trading companies. There is a serious lack of accounting services firms in several markets and usually companies are left with no or few choices as to the selection of company auditor because of domination of these big four firms in their respective markets. For example, KMPG has a dominating position in providing auditing services to financial institutions whereas PricewaterhouseCoopers is dominant in the coal and petroleum industry (Bloom and Schirm, 2005). The events such as Enron and WorldCom led to the widespread notion of audit failure or audit incapacity to act as shareholders representatives and report any problems prevailing in the company. This lack of competition became a concern of crucial importance soon after the incidence of Enron and the termination of Arthur Andersen (Bloom and Schirm, 2005). There have been several causes behind the occurrence of such events that seriously shattered the image of auditing and accountancy service profession and directed the attention of regulators towards the notion of lack of competition in the audit marketplaces. Simunic and Stein (1995) elaborate that the market for professional accountancy services highly lacks competitiveness because of several rigid restrictions imposed by the government such as code of ethics, limit on fees and prohibition of advertisement etc. Such restrictions as well as the dominance of big four firms in the industry has been hampering the advent and success of new firms in the market leading to lack of competition. Apart from that, these firms are also involved in the provision of non-audit professional services to their client companies. Because of that fact that there happen to be a very few number of firms in the market, companies turn towards these four firms for both audit and non-audit professional services. Such involvement also contributes to concentration of a major part of these audit firms' income in the client company. This has been the major factor affecting the independence of auditors in providing an opinion on a client company's financial statements. Hence, lack of competition in the audit marketplace is considered to be acting as a threat to audit independence. Audit independence refers to the notion of complete freedom on the part of an auditor while presenting an audit opinion. Hemraj elaborate that "the function of 'public watchdog' demands that the auditor subordinates