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By U. Mirzo. Westwood College Colorado. 2019.

After seeing firsthand the waste in health due to the lack of health care in my community and family and the health disparities that exist among minorities and those of the lower economic rungs of society generic 10 mg toradol otc natural pain treatment for dogs, I am aware of the need for physicians in medically underserved areas order toradol 10 mg mastercard pain treatment hypnosis. As a potential physician buy generic toradol 10 mg on line pain treatment in cancer patients, I wish to eliminate health disparities that exist among minorities and lower income individuals by making health care available to those who would not otherwise have access to it. Medical school would provide me with the skills needed to counter the health disparities that exist domestically and globally by providing experience in such areas. The struggle continues as a black mother mourns the loss of her infant daughter because the infant mortality rate amongst the African- American community is twice that of any other ethnic group in America. With the world becoming increasingly more connected, we cannot continue to detach ourselves from these issues. I have always felt attached to and compelled by the problems of the world, therefore these stories of disparities and inequalities have always distressed me. Focusing on international social change, I have learned many of the extreme social issues affecting the world today. These issues have inspired me to want to be in the forefront of combating these problems with the best of my capabilities. I have wanted to be a doctor from the time I was a child and as I excelled in the sciences throughout my education, that interest developed even more. The University of Michigan provided many outlets for students to gain medical experience and I took advantage of many opportunities there, two of them being my job as a nurse assistant and my Distraction Osteogenesis research. Working as a nurse assistant in the hemodialysis unit for over a year, allowed me to develop health care professional- to- patient relationships and it allowed me to see the doctors and nurses in their working environment. Whereas my research, which investigates the effects of radiation on bone healing, involves surgical procedures in which I assist in and require me to do post-operative rounds. This experience gives me a glimpse of how medical student 16 rotations are conducted on the wards. Opportunities like these and many others continue to nurture the spark for medicine that was ignited when I was young. Growing up, my idea of medicine was confined to dealing with patients in a doctors office. However, majoring in sociology has allowed me to see that I want to practice a kind of medicine that extends beyond the walls of an office and into the community where disparities in infant mortality have to be addressed through research and education. Furthermore, my travels to Nigeria in December 2004 and my recent trip to China in May 2007, have shown me that medicine can transcends the borders of the United States to places like Nicaragua where I can organize mission trips to provide free, quality health care for those that would never be able to afford it. Achieving quality health is a product of both good physiological maintenance and a healthy living environment. My sociology background has taught me that people not only require their health needs to be addressed but also other life issues as well. As health committee chair, I partnered with several professional health school organizations to put together a health fair. What I can do as a doctor in the future is build upon the efforts I demonstrated in college by merging the principles I will learn in medicine with those that I have learned in sociology. I am not a superhero, I am but one person who believes that the needs of the less fortunate should not be overlooked. As long as I am equipped with the armor of medicine, I can help see to the improvement of some of the disparities that prevent people from receiving optimum health care in the United States and abroad. So I hope that I will be given the opportunity to affect the life of that little boy in Mozambique, as well as many medically disadvantaged across the globe. Executive Summary Non-adherence can threaten patients health individually as well as add vast costs to the health care systeman 1 estimated $290 billion annually. Non-adherence can threaten patients health individually as well as add vast costs to the health care systeman estimated $290 billion annually. This population represents 30 percent of all adults, with a 1 Thinking Outside The Pillbox: A System-wide Approach to Improving Patient Adherence for Chronic Disease. The National Report Card on Adherence is based on an average of answers to questions on nine non-adherent behaviors. National Medication Adherence Report Card Average Grade: C+ A B 24% 24% F 15% C 20% D 16% 3 The score can range from 0 (non-adherence on all nine behaviors) to 100 (perfect adherence). Grouping adherence levels [see chart on previous page], just 24 percent earn an A grade for being completely adherent. An additional 24 percent are largely adherent, reporting one non-adherent behavior out of nine (a grade of B). Twenty percent earn a grade of C and 16 percent a D for being somewhat non-adherent, with two or three such behaviors in the past year, respectively. The remaining 15 percentone in seven adults with chronic conditionsare largely non-adherent, with four or more such behaviors, an F grade. Survey results on a subject such as medication adherence can be influenced by potential reluctance among some respondents to admit to undesirable behaviors. Thus the grades in this survey, if anything, may understate non- adherenceunderscoring cause for concern about the extent to which patients are following their medication instructions. Regression modeling, a statistical technique that assesses the independent strength of the relationship between two variables while holding other factors constant, identified the six key predictors of medication adherence. The survey also found demographic as well as attitudinal and informational differences in adherence: older Americans indicate greater adherence than younger respondents, for example, and those with lung problems report lower adherence than those without this chronic condition. When non-adherent respondents are asked their reasons for failing to comply with doctors orders, the most commonly mentioned reason is simply forgetting, cited by more than four in 10 as being a major reason. Other top reasons include running out of medication, being away from home, trying to save money and experiencing side effects. These, as well as further details about the drivers of medication adherence, are outlined in the full report. The full report, including its appendices on methodology, statistical analyses and the full questionnaire and topline results, is available for download at www. Millions of adults age 40 and older with chronic conditions are departing from doctors instructions in taking their medications skipping, missing or forgetting whether theyve taken doses, failing to fll or refll prescriptions, under- or over-dosing or taking medication prescribed for a different condition or to a different person. An overall C+ grade underscores the problem; the F grades earned by one in seven of these medication usersthe equivalent of more than 10 million adultsshould heighten alarm. This survey not only establishes the breadth of the problem but evaluates factors that infuence medication non-adherence, suggesting paths to attempt to address the problem. Pharmacists have a role at the forefront of addressing prescription medication non- Pharmacists have a role at the forefront of addressing prescription medication non-adherence. The results of this survey indicate that much depends on the extent to which pharmacists and pharmacy staff establish a personal connection with their patients and caregivers and engage with them to encourage fuller understanding of the importance of taking medications as prescribed. Independent pharmacists may be particularly well-placed to boost adherence, given their greater personal connection with patients. Health care providers have a vital role to play in stressing the importance of taking medications as prescribed, in monitoring and helping patients avoid or reduce unpleasant side effects that may compromise adherence and in helping to keep patients more generally well-informed about their health conditions.

The need to incorporate the development and maintenance of a guidelines website patient preferences is also discussed throughout the document discount toradol 10mg amex treatment pain ball of foot. The projection of prevalence and cost of stantly expanding literature on new therapies and technologies that diabetes in Canada: 2000 to 2016 cheap 10mg toradol otc back pain treatment youtube. Overweight and obesity in children and adolescents: Results from the 2009 to 2011 Canadian Health Measures Survey purchase toradol 10 mg otc gosy pain treatment center. Diabetes prevalence and able evidence into clinical practice as well as for people with dia- income: Results of the Canadian Community Health Survey. The dynamics of the relationship between diabetes incidence and low income: Longitudinal results government with the evidence they need when rationalizing access from Canadas National Population Health Survey. Maturitas 2012;72:229 to health care so that the potentially benecial health outcomes 35. Geneva, Switzerlan: Department of Chronic Diseases and Health Promotion, World Health Organization; 2005. Time for action: A Canadian proposal for primary prevention of have much to celebrate. Characteristics and effective- ness of diabetes self-management educational programs targeted to racial/ Appendix 1. Diabetes Canada Diabetes Charter ethnic minority groups: A systematic review, meta-analysis and meta-regression. Culturally appropriate health educa- tion for people in ethnic minority groups with type 2 diabetes mellitus. Houlden reports grants from Boehringer Ingelheim, Novo eng/news/2015/11/26/diversity-canadas-strength. Global health risks: mortality and burden of disease attributable to selected major 93. Glycemic control of type 2 diabetes and severe peri- -essential/diabetes-statistics-in-canada. Can J Diabetes 42 (2018) S6S9 Contents lists available at ScienceDirect Canadian Journal of Diabetes journal homepage: www. Identifying and Appraising the Evidence To further support the principles previously adopted to develop evidence-based recommendations, the current iteration of the guide- The trials we have comprise islands of evidence, linked by shorter lines engaged the McMaster Evidence Review and Synthesis Centre and longer bridges of extrapolation spanning oceans of uncertainty. At the outset of the process, committee nosis, prevention or management of diabetes and its sequelae. Patient prefer- to ensure a consistent approach to the development of recommen- ences and values were sought from expert panel members living dations. Committee members identied clinically important ques- with diabetes and the literature (where available). Two health sciences librarians with Methods Review member and had to be approved by the expertise in evidence-based practice constructed and peer-reviewed comprehensive searches of the relevant English-language, pub- lished, peer-reviewed literature using validated search strategies of Conict of interest statements can be found on page S9. For Table 1 topics that were covered in the 2013 Clinical Practice Guidelines, Criteria for assigning levels of evidence to the published studies the literature searches focused on new evidence published since Level Criteria those guidelines, including literature published in September 2013 Studies of diagnosis or later. For new topics, the search time frame included the litera- Level 1 a) Independent interpretation of test results (without ture published since 1990 or earlier where relevant. Updated lit- knowledge of the result of the diagnostic or gold erature searches were performed at two other intervals throughout standard) b) Independent interpretation of the diagnostic the development process. Using a priori have the disorder dened criteria of inclusion and exclusion, all citations were screened d) Reproducible description of both the test and at the title and abstract level in duplicate by team members from diagnostic standard e) At least 50 patients with and 50 patients without the evidence centre; full-text screening was completed by a dia- the disorder betes clinician and methodologist for relevance. All full-text cita- Level 2 Meets 4 of the Level 1 criteria tions and supporting documents were then made available to the Level 3 Meets 3 of the Level 1 criteria chapter authors for review. Authors were asked to review all remain- Level 4 Meets 1 or 2 of the Level 1 criteria ing citations and systematically determine whether the citation Studies of treatment and prevention would be used for background material, discarded (with justica- Level 1A Systematic overview or meta-analysis of high-quality tion) or used to support a new or existing recommendation. Because they answer the question posed by the investigators could not be critically appraised, meeting abstracts, narrative review a) Patients were randomly allocated to treatment articles, news reports and other sources could not be used to support groups b) Follow up at least 80% complete recommendations. Papers evaluating the cost effectiveness of thera- c) Patients and investigators were blinded to the pies or diagnostic tests also were not included. Level 1B Non-randomized clinical trial or cohort study with A number of considerations were made when evaluating the evi- indisputable results dence within a given area. As such, some evidence relating to these problems was iden- studies tied that either excluded, did not report on or did not focus on Level 4 Other people with diabetes. Whenever such evidence was identied, a level Studies of prognosis was assigned using the approach described above. Higher levels were Level 1 a) Inception cohort of patients with the condition of assigned if: a) people with diabetes comprised a predened sub- interest, but free of the outcome of interest group; b) the results in the diabetes subgroup were unlikely to have b) Reproducible inclusion/exclusion criteria c) Follow up of at least 80% of subjects occurred by chance; and c) the evidence was generated in response d) Statistical adjustment for extraneous prognostic to questions that were formulated prior to the analysis of the results. Level 2 Meets criterion a) above, plus 3 of the other 4 criteria Level 3 Meets criterion a) above, plus 2 of the other criteria Level 4 Meets criterion a) above, plus 1 of the other criteria * In cases where such blinding was not possible or was impractical (e. In the absence of new evidence since the publication cited in the nal recommendation and were assigned a grade to of the 2013 Clinical Practice Guidelines, recommendations from the reect the uncertainty signalled by conicting ndings. The studies used to develop and support each recommenda- Finally, several treatment recommendations were based on evi- tion are cited beside the level of evidence. In some cases, key cita- dence generated from the use of 1 therapeutic agent from a given tions that inuenced the nal recommendation were not assigned class (e. Whenever evidence relating to 1 or the same level of evidence, but rather were of varying levels of evi- more agents from a recognized class of agents was available, the dence. In those circumstances, all relevant studies were cited, regard- recommendation was written so as to be relevant to the class, but less of the grading assigned to the recommendation. The nal grading specically studied therapeutic agents were identied within the depended on the totality of evidence, including the relative strengths recommendation and/or cited reference(s). Only medications with of the studies from a methodological perspective and the studies Health Canada Notice of Compliance granted by September 15, 2017 ndings. Studies with conicting outcomes were considered and were included in the recommendations. Varying grades of recommendations, Grade A The best evidence was at Level 1 therefore, reect varying degrees of certainty regarding the strength Grade B The best evidence was at Level 2 of inference that can be drawn from the evidence in support of the Grade C The best evidence was at Level 3 recommendation. Therefore, these evidence-based guidelines and Grade D The best evidence was at Level 4 or consensus their graded recommendations are designed to satisfy 2 impor- tant needs: 1) the explicit identication of the best research upon which the recommendation is based, and an assessment of its sci- entic relevance and quality (captured by the assignment of a level Grading the Recommendations of evidence to each citation); and 2) the explicit assignment of strength of the recommendation based on this evidence (cap- After formulating new recommendations or modifying exist- tured by the grade). In this way, they provide a convenient summary ing ones based on new evidence, each recommendation was assigned of the evidence to facilitate clinicians in the task of weighting and a grade from A through D (Table 2). The highest possible grade that incorporating ever-increasing evidence into their daily clinical a recommendation could have was based on the strength of evi- decision-making. They also facilitate the ability of clinicians, health- dence that supported the recommendation (i. However, the assigned grading was lowered in some cases; conclusions regarding its appropriateness. Thus, these guidelines for example, if the evidence was found not to be applicable to the facilitate their own scrutiny by others according to the same prin- Canadian population or, if based on the consensus of the Steering ciples that they use to scrutinize the literature. In some situations, the grading also was ommendations differs from the approach used in some other guide- lowered for subgroups that were not well represented in the study, line documents in which a treatment or procedure that is not useful/ or in whom the benecial effect of an intervention was less clear. In this Diabetes Canada guidelines document, recom- rigorous) studies on the topic were conicting. Thus, a recommen- mendation to avoid any harmful practices would be graded in the dation based on Level 1 evidence, deemed to be very applicable to same manner as all other recommendations.

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While there I worked buy generic toradol 10mg pain medication for uti infection, studied their religions trusted toradol 10mg pain treatment center hattiesburg ms, ate their food buy cheap toradol 10mg line pain medication for dogs arthritis, traveled and contracted malaria. Despite all of Ghanas economic hardships, the blending of Christianity, Islam, and traditional religion did not affect the health of the country. When I reached the front of the line, the customs officer glanced at my backpack and with authoritative curiosity asked me, What are you studying? In my quest to understand where I fit into society, I used service to provide a link between science and my faith. Science and religion are fundamentally different; science is governed by the ability to provide evidence to prove the truth while religions truth is grounded on the concept of faith. Physicians are constantly balancing the reality of a persons humanity and the illness in which they are caring for. The physicians I have found to be most memorable and effective were those who were equally as sensitive and perceptive of my spirits as they were of my symptoms. Therefore, my desire to become a physician has always been validated, not contradicted by my belief system. Being a servant is characterized by leading by 2 example and striving to be an advocate for equity. As a seventh grade math and science teacher in the Philadelphia public school system, everyday is about sacrifice and service. I sacrifice my time before, during and after-school; tutoring, mentoring and coaching my students. I serve with vigor and purpose so that my students can have opportunities that many students from similar backgrounds do not have. Although I had been diagnosed with asthma, I had not had an attack since I was in middle school. Consequently, the physicians attributed my attacks to high stress, lack of sleep, and poor eating habits. It had become clear to me that my unrelenting drive to provide my students with a sound math and science education without properly balancing teaching and my personal life negatively impacted my ability to serve my students. I believe this experience taught me a lesson that will prove to be invaluable as a physician. Establishing an equilibrium between my service and my personal life as a physician will allow me to remain connected to the human experience; thus enabling me to serve my patients with more compassion and effectiveness. Throughout my travels and experiences I have seen the unfortunate consequences of not having equitable, quality health care both domestically and abroad. Illness marks a point in many peoples lives where they are most vulnerable, thus making a patients faith and health care providers vital to their healing process. My pursuit to blend the roles of science and religion formulate my firm belief that health care providers are caretakers of Gods children and have a responsibility to all of humanity. Nevertheless, I realize my effectiveness and success as a physician will be predicated mostly on my ability to harmonize my ambition with my purpose. Therefore, I will always answer bewildered looks with the assurance that my faith and my abilities will allow me to serve my patients and achieve what I have always strived for and firmly believe in, balance. We never made it to see a horror movie; but our night was nothing close to mundane, when we became innocent victims to gang crossfire. As we descended my front door stairs two gunshots were fired and one person fell to the floor. I vividly recall holding him in my arms, and while he lost blood I almost lost my mind. While this event started me on my quest to become a medical doctor, at that moment all I could envision was a life of despondency. According to author Jennifer Holloway, tragedy is a substance which can ignite the soul. As fast as despondency had filled my heart, it was now gone; I was consumed by anger, frustration and motivation to change my lifes direction. By the end of the year I excelled as the top student in biology, received the Inorganic Chemistry Achievement Award and was encouraged to become a tutor in general biology and chemistry. Questions raised by students challenged my understanding of scientific concepts and their application in patient care. While shadowing doctors, I was introduced to triaging, patient diet monitoring and transitioning from diagnosis to treatment. This exposed me to some of the immense responsibilities of a doctor, but my 4 experience helping in the cancer ward was where I learned the necessity of humanity in a physician and how it can be used to treat patients. Peering through a window I saw Cynthia, a seven-year-old girl diagnosed with terminal cancer, laughing uncontrollably after watching her doctor make funny faces. For a moment not only did Cynthia forget that she was dying, but her smile expressed joy and the beauty of being alive. This taught me that a physician, in addition to being knowledgeable and courageous, should show compassion to patients. It also became clear to me that a patients emotional comfort is as important as their physical health, and are both factors that a physician considers while providing patient care. Although focused on medicine, I was introduced to research through the Louis Stokes Alliance for Minority Participation in Science. Here, I learned organic synthesis techniques, while working on a project to elucidate the chemical mechanisms of oxygen- protein binding and its relationships to anemia. I also received the United Negro College Fund/Merck Science Initiative Research Scholarship that allowed me to experience cutting edge research in Medicinal Chemistry, with a number of world-class scientists. At Merck Research Labs, I learned the fundamentals of synthesizing novel compounds for drug discovery, and we focused on treatments for cardiac atrial fibrillation. This internship changed my view of medication and their origins, and left me with a deep appreciation of the challenges of medicinal research. I also now understand that medical doctors and research scientists have similar responsibilities: to solve current and future health issues that we face. Today as I move forward on the journey to become a physician I never lose sight of the ultimate goal; to turn the dying face of a best friend into the smiling glow of a patient, just like Cynthias. But with the right medications, a physicians compassion and some luck, sickness can be overcome, and the patient helped. In time and with hard work it will be my privilege to possess the responsibilities of a physician in caring for life. Over several weeks I witnessed his losing battle, not only with a terminal illness but also with cultural incongruence and a continual feeling of unease, thousands of miles away from home. Jorge was a victim of health care inequality, a subject that has been at the forefront of my mind since enrolling in Race and Medicine in America during my sophomore year. The course revealed to me the historically poor distribution of quality medical attention and how treatment continually evades socio-economically disadvantaged communities. This unfortunate reality inspired me to take an interest in treating these populations, in hopes of helping to improve the care for our countrys poor and underserved. Jorges story broadened my perspective, as I further realized that this need is exponentially worse in developing nations.

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