The Management of Restraint and Seclusion for Aggression in Essay

The Management of Restraint and Seclusion for Aggression in Psychiatric Patients in Inpatient Units - Essay Example Although initially nonviolent, Jane turned aggressive during normal sampling for tests and punched the nurse who was collecting samples for the tests. On becoming excessively aggressive, the patient was secluded and further restraint to minimize harm to her, her loved ones and the facilities’ staffs and other clients. However, these interventions are rather controversial and the family members opposed their use just as health care and legal professionals and the public continue to question their therapeutic capacities. Consequently, their use is questioned and opposed in equal measures. Instead, aggression management strategies such as individualized safety plans, patient-specific and focused restraint management and prevention, staff notification of restraint and seclusion phenomena, official briefing and debriefing about restraint and nursing staff mentoring are encouraged. In applying these interventions, a nurse leaders and managers should work with all other stakeholders, especially other medical and nursing staff and the families or caretakers of the patient. Consultative approach to leadership would have been quite appropriate for dealing with Jane’s situation. Transformational leadership theory, which postulates that great leadership emerges in cases of problems and encourages collaboration and teamwork, could also apply in this situation. In addition, the contingency theory, which expects leaders to different behaviours and contexts or circumstances are and react accordingly is also appropriate for handling Jane’s aggression. This paper proposes strategies likely to help eliminate or reduce the use of restraint and seclusion as the first choice measures whenever a psychiatric patient turns aggressive on self or others. Introduction For many nurses working in psychiatric inpatient units, violence and aggression are common phenomena. Aggression continues to pose serious challenges to psychiatric inpatient unit nurses despite the many modern and universal methods and strategies of restraint (Schacht, 2006). The two most commonly used interventions applied in the treatment and management of violent and disruptive conducts in psychiatric patients are seclusion and intervention (Anderson & West, 2011). Notably, the application and management of these nursing interventions vary from one country and institution to another. The central role played by these interventions have been largely highlighted in quite a number of nursing and health care studies and literatures, with most of the authors citing numerous recommendations for managing and reducing mental patient aggression (Peterson, 2004). In most of the studies and literatures, the effects of seclusion and restraint on mental illness patients and the prevention of seclusion and restraint or the reduction of their use are among the most highlighted aspects of seclusion management (The Joint Commission, 2008). Whereas seclusion refers to retaining and placing a ment ally ill inpatient in a room so that the immediate aggressive clinical situation is contained, restraint entails the use of different techniques that are custom-made to confine a mentally person to specific body motions (Cruzan, 1992). Despite the difference in meaning, both seclusion and restraint are measures generally used with the aim of preventing further injuries to patients, harm to nurses and to reduce violence and agitation (Centers for Medicare & Medicaid Services, 2006). This paper explores the appropriate management and leadership strategies for handling restraint of mentally ill inpatients by nurses. The following case study of an aggressive patient will form the basis of the proposed aggression management strategies outlined in the paper. Sample Case Jane (name changed for confidentiality)

SCCT Coursework Example | Topics and Well Written Essays - 250 words

SCCT - Coursework Example The theories usually ensure that the reputation of the company is not dented resulting from a problem or difficulty found in an organization. A company has to communicate with its stakeholders so that they can be well aware of the things that are happening in the company. The theories to show that communication in times of a crisis should be able to maintain and construct perceptions of reality among the stakeholders involved. The response approaches that are found in SCCT include impression of management, synthesis of work, and image repair. Coombs gave four approaches for communication. The approaches include bolstering, rebuilding, denial, and diminishment. In any business, there may be a number of crises that may arise; the way the crisis is tackled will depend on the way the manager perceives and reacts to the given situation. The field of sociology usually provides a number of theories that show how a person can conduct himself in case of a crisis (Weick & Sutcliffe 2007, 42). The business field usually examines sense making ways and processes that can be used in leadership to ensure smooth flow of operations in an organization (Ramo 2009, 52). A business should be perfectly organized to ensure that any difficult situations that may arise are tackled in a perfect manner that will not interrupt with the smooth flow of business. A leader should be creative and innovative in the way he or she solves any crisis or problem that exist in the company (Sellnow, et al 2002, 201). The theories also provide a way in which an organization can cope up with the learning theory. The theory will involve the recruitment and training of new employees in a company (Martin 2009, 123). In conclusion, situational crisis communication theories should be studied to ensure that all problems arising are tackled in the appropriate manner (Ware & Linkugel 1973,

Impact of internet social and political Essay Example for Free

Impact of internet social and political Essay The internet is less than two decades old but its impact has been felt by almost everyone in the global village. It has not only revolutionized our personal interaction habits but has also impacted greatly on other spheres of our life, most notably the economy. In many societies, the digital technology has not only influenced the political communication but also the whole political systems. Shapiro (1999) suggests that the digital technology has captured the attention of everyone from the media, government and the general public. Although the invention of the internet has brought with it some negative aspects, the digital technology has been hailed as the man’s new road to the better world. This paper will try to discuss some of the aspects of the internet that have continuously impacted on our social and political behaviours as citizens. Computers and the internet have greatly facilitated and expanded the individuals’ capacities in every sector of the society. Gurstein (2000) contends that the new ICTs have impacted almost everyone from institutions to business to organizations to the political arena. The impact has been so great that every sector of our society feels obliged to embrace the information communication technology in order to either improve the running of the government, community networking or to improve the citizen participation in the new information society. Terms such as â€Å"citizen networks†, â€Å"digital cities† or â€Å"e-governments† have become common expressions these days. They simply imply the new ways of interactions that exist between the governed and the government and new ideas regarding the metropolitan policies, through the use of electronic media (Sclove, 1995). The urban settings, built landscape as well as the social setting in our society, has undergone tremendous transformation from the last decade into the new millennium. The citizens have also not been left behind in this era of transformation. What we consider space, time, and our perception of politics as well as what we consider public or private and local or global has greatly changed. The advancement in the information communication technology has largely contributed to the changes in our cities and contemporary societies (Tsagarousianou, Tambini, Bryan, 1998). There is a new concept that has caught on with most people in our society concerning governance. The term â€Å"electronic democracy† though has been in use since 1960s when most activists introduced a number of communication medias like free radio stations, to make the governments more accountable and responsive to its citizens, has found its way back in the advent of the internet (Sclove, 1995). Internet is currently being used to marshal grassroots groups to support a certain cause by most civil activists. There is also a growing mass of citizen initiatives that help to shape public opinion and thus influencing policies both at the national and local level. The internet therefore has greatly challenged the hitherto monopolies of the most political classes through better communication networks that have empowered the citizens to create a form of democracy in the society (Schuler, 1998). Today, many cities around the globe have created home pages in the internet and forums for interaction with their city residents. Governments around the world both at the local and national level in developed and developing nations alike, have invested in e-government projects through networks that enable citizens access to government structures, engage in online transactions or to get information on government policies. Some of these networks and sites have enable citizens to participate in most decision making regarding the management of urban habitats (Underwood, 2002). The internet has great potential to amass groups of people persuasive to certain ideologies. Many organizations now have websites which they use not only to communicate with their members but to recruit more like-minded individuals into their groups. Indeed the internet has become one of the major tools for lobbying citizens to a particular cause. Such organizations as the Internet Society and Voters Frontier Foundation have been very active in recruiting and educating the public on political issues in America (Tsagarousianou, Tambini, Bryan, 1998). These groups have greatly contributed to the policy making processes through intensive lobbying. The internet has therefore provided a better platform for the citizens to actively participate in the political arena. This development has actually dealt a big blow to the interest group politics that have gone on over the years (Davis, 1999). The internet has impacted greatly on how we interact these days. Due to its widespread and accessibility, the information communication technology has completely changed the forms of social engagements. Today, there are numerous social networking sites that have increased the speed at which we do interact and organize our social activities. The most notable ones are MySpace and Facebook, which have simply taken the social interactions to the next level. These sites not only make it easier to keep in touch with friends and family members but enable subscribers to find other friends online. The era of information communication has ushered in a new way of keeping contacts with others no matter the distance between us. In a nutshell, the internet has reduced the world to a global village where everyone can be reached simply by a few clicks of the mouse (Subrahmanyam Greenfield, 2008). The social networking sites have also been very important in educating the public on social and political problems afflicting the society. There are groups of people who have formed social forums and recruited individuals with like-minded views on the social and political events in the country. Members would be easily reached through the internet and topics as well as current affairs discussed. These forums have been quite helpful in bringing change in the political and social arenas in our country. It is the emergence of the internet as a political tool that some countries like the Myanmar, Iran and China have censored its usage among their citizens. These countries have restricted contents of political and religious materials that are accessible to their citizens (Shapiro, 1999). Again, a new internet phenomenon has emerged reshaping the politics and political activities in many countries around the global. What has been referred to as the internet activism has caught on in many countries and political players and citizens alike have embraced internet to win masses into their camps and political groupings (Tolbert, McNeal, 2003). The current United States president Barrack Obama owes much of his political success to the internet. He amassed overwhelming campaign funds that enabled him outmuscle his opponents in the 2008 elections simply by recruiting a greater mass of followers through the internet. The citizens who were eager for change contributed wholeheartedly to this cause through internet donation. What was most remarkable was the overwhelming following Obama was able to attract over a short period of time in politics. Those who contributed included even non-Americans, who found it easier because of the internet. The internet has also provided leisure activities to its users through social entertainment sites. Currently, there are a number of forums that provide games, videos, and cartoons to entertain internet users. The internet has also enabled easy access to news and information. People these days are able to watch and listen to news, book for vacations, get information on weather and many other things of their interest. There are also thousands of blog sites that have not only provided a platform of communication but have enabled most people to interact by sharing views on various happenings around them. The blog sites have also become political tools most citizens use to lobby people onto their way of thinking (Rodgers, 2003). During the early stages of its development, in the early 1990s, the digital technology led to what many considered internet-euphoria. Many optimists believe it was the new dawn to mankind’s participation in social, political as well as economic spheres in his society. These euphoric evaluation has somewhat changed over the years as more people are now becoming more aware of the dangers technological advancement may pose to the society (Engel, Keller, 2000). There is the issue of lack of internet safety as the social networking sites have proved to be. The critics of internet claim that it may increase cyber thefts or deceits because one may be able to steal one’s identity especially from the social networking sites. The challenges posed by the internet to the political activities have been cited as some propaganda wars between nations which may spill over into real battles (Tolbert, McNeal, 2003). Conclusion The internet has profound altered our societal operation both in political and social spheres. The citizens will continue to access vital information that would eventually empower them which in turn will reshape the politics and political class that have long governed with their interest-based policies. Again, the internet has proved to be a better social tool in our society because it has made interaction easier than before. However, there are a few challenges that must be overcome to make it safer for every user.

The Autonomic Nervous System

The Autonomic Nervous System The Autonomic Nervous System is a widespread system of nerves that innervates, with the exception of skeletal muscle, nearly every process in the body. This Autonomic Nervous System (ANS) is a completely unconscious process which is responsible for maintaining homeostasis, as well as having many other functions such as control of digestion. The Autonomic Nervous System was first discovered, and studied by Walter Gaskell (Purves, Augustine, Fitzpatrick and Hall, 2001) who had his work on the ANS first published in 1916, two years after his death. He discovered that certain physiological effects, such as an increase in heart-rate, could be achieved by stimulating certain nerves branching off from the first few thoracic spinal cord segments. Using this, and other similar studies, he then theorized that each system in the body was innervated with two sets of nerves that had opposing functions (Purves, Augustine et al., 2001). These two sets of nerves we now know to be the Sympathetic and Parasympathetic branches of the Autonomic Nervous System; though recently a third branch has been separated from the others and called the Enteric Nervous System, which is found solely in the gut and the supporting features such as the Pancreas (Barker and Barasi, 1999). Although the ANS plays an unconscious process, it can sometimes be over-ridden by conscious thought; one example of this is in breathing, although breathing happens automatically without any need for purposeful thought, it is possible to take control of your breathing, such as holding your breath, or exhaling forcefully (to inflate a balloon for example). As the Autonomic Nervous System is such an important part of the nervous system, studying it and knowing how it works, and how it is controlled, is also very important; in this essay I am going to talk about the three different branches of the Autonomic Nervous System and their functions and differences, and then explain how they are regulated in the brain. The Sympathetic Nervous System When we are faced with what our bodies consider to be a threat we have to be prepared to, either stand and face the danger (fight), or get ourselves out the situation as quickly as possible (flight); this is the job of the Sympathetic Nervous System. These Fight or Flight responses are designed to give us as much of a physical advantage as possible, such as: making sure enough oxygen is reaching our muscles as possible by increasing heart-rate and dilating blood vessels, saving energy by slowing down lesser-needed processes such as digestion, dilating our pupils so we take in as much light as possible thus improving our vision, and makes our hairs stand on end so we look as big and ferocious as possible; all of these would have given us an edge over any predators we faced. The main nerve-trunks of the Sympathetic Nervous System leave the Central Nervous System from the Thoracic and Lumbar segments of the spinal cord, this is also known as the thoraco-lumbar outflow (Bakewell,1995). The cell bodies of the Sympathetic pre-ganglionic neurones are found in the lateral horn of the spinal cord between segments T1 and L2. Some of these pre-ganglionic fibres of the Sympathetic Nervous System synapse with the post-ganglionic fibres in a long chain, known as the Sympathetic Chain, that runs the length of the spinal cord, although some have a separate ganglion outside this sympathetic chain; from the ganglion, the post-ganglionic neurones then synapse with their target-organ. Post-ganglionic Sympathetic neurones have a very extensive network of dendrites that are innervated by many pre-ganglionic neurones; but there are roughly 10 times as many post-ganglionic sympathetic neurones than pre-ganglionic neurones, this divergence is thought to aid with coordination o f activity between neurones projecting from different segments of the spinal cord (Kandel, Schwartz, and Jessell, 2000). The Parasympathetic Nervous System The Parasympathetic Nervous System works in opposition to the Sympathetic Nervous System and therefore gives rise to Rest and Digest responses, which act to rebuild the energy stores that were depleted in the previous period of Sympathetic activity. These responses include: slowing down the heart-rate, stimulating digestion, and constricting the pupils. The cell bodies of Parasympathetic Pre-ganglionic neurones are found mostly in the brainstem, with some in the sacral segments of the spinal cord. In the brainstem, these cell bodies are found in the EdingerWestphal nucleus in the midbrain, which is related to the Oculomotor nerve, the Superior and Inferior Salivary nuclei found in the Pons, and related to the Facial nerve and Glossopharyngeal nerve, and in the Dorsal motor Nucleus of the Vagus nerve, in the medulla and the Nucleus Ambiguus. Because of the location of the cell-bodies of the Parasympathetic Nervous System, the it can also be called the Cranio-Sacral outflow (Bakewell, 1995). There are a few contrasts between the Sympathetic Nervous System and the Parasympathetic, apart from their opposing actions; the first and most obvious of these is that, in the sympathetic nervous system, all the preganglionic neurones are very short, most making synapses in a chain that runs very close to the spinal cord, meaning they have much longer post-synaptic neurones (as the pathway is disynaptic), whereas in the parasympathetic nervous system, the pre-ganglionic neurones are much longer and almost reach their target organ before making a synapse with a post-ganglionic neurone. This is an important difference as pre-ganglionic neurones are myelinated and therefore conduct action potentials a lot faster than the unmyelinated post-ganglionic neurones, suggesting the the parasympathetic nervous system works slightly quicker than the sympathetic (Kandel et al. 2000). Another difference is that there is a lot of divergence in the Sympathetic Nervous System, as previously discussed , whereas in the Parasympathetic Nervous System there is a lot less, with the ratio of Pre-Ganglionic Neurones to Postganglionic Neurones being 1:3, although this is highly dependant on the tissue as in some it is nearly a 1:1 ratio. Thirdly, both Pre-Gnaglionic and post-Ganglionic neurones in the Parasympathetic Nervous System use Acetyl Choline (ACh) as their Neurotransmitter, whereas Post-ganglionic neurones in the Sympathetic Nervous System use Noradrenaline; this is important as it has lots of clinical applications for drugs that target specifically the Sympathetic or Parasympathetic Nervous System. The Enteric Nervous System The Enteric Nervous System is a unique branch of the Autonomic Nervous System that is found lining the sides of the digestive system, specifically the oesophagus, stomach, intestines and secretory glands such as the pancreas (Bear, Connors, and Paradiso, 2007). The Enteric Nervous System is responsible for the control of the tension of the walls of the gut and monitoring the ever-chaning chemical balance within the digestive system, these are highly important functions in digestion. The special property of the Enteric Nervous System is that it can act reasonably independently from the rest of the Central Nervous System, leading to it sometimes being referred to as The Little Brain. The cell bodies of the Enteric Nervous System are connected together in two major structures known as plexuses; these are the myenteric plexus and the submucous plexus, these plexuses line the walls of the gut in two separate layers and control peristalsis, internal mucous levels and every other important aspect of the digestive system, including a role in secretion from the pancreas and gall bladder. Though the Enteric Nervous System is a separate function of the Autonomic Nervous System that deals almost solely with the digestive process, it contains as many neurones as the entire spinal cord does, meaning it has a very. Unlike the Sympathetic and Parasympathetic branches of the Autonomic Nervous System which are limited to either 1 or 2 Neurotransmitters, the Enteric Nervous System has been shown to have as many as 20 possible Neurotransmitters, though they have yet to all be proven to act as Neurotransmitters in this system (Gershon, Kirchgessner and Wade, 1994). The Enteric Nervous System has also been shown to play a role in Immune Responses (Hansen, 2003). Higher Control of the Autonomic Nervous System As the Sympathetic and Parasympathetic Branches of the Autonomic Nervous System work, for the most part, in opposition to each other, there must be some higher control coordinating them to work in harmony, and the first step of this is in the Nucleus of the Solitary tract (Kandel et al. 2000); here, the nucleus receives afferent input from the Facial, Glossopharyngeal and Vagal nerve, and firstly sends this information to both the brainstem and the spinal cord, where basic functions of the Autonomic Nervous System are carried out, but more cleverly, the Nucleus of the Solitary Tract also takes in other information and combines it, the Nuclei of the Solitary tract also project to the Periaqueductal grey, which also receives information from the hypothalamus, the periaqueductal grey takes all this information and then projects to the Reticular Formation of the Medulla, where it controls the co-ordination between behavioural activity and the autonomic nervous system, and example of this is that when doing heavy exercise (behavioural), its important your heart-rate increase so your muscles can get a greater oxygen supply from the blood (autonomic). Another important control of the Autonomic Nervous System is in homeostasis, there needs to be cooperation between the baroreceptors or chemoreceptors for example, and the most useful branch of the autonomic nervous system, so hair can stand on end on cold days to preserve heat, for example; this is the job of the hypothalamus (Kandel et al. 2000) as the hypothalamus receives input from pretty much every sensory pathway in the body; a dated study from Swanson and Sawchenko (1983) proved that the Paraventricular Nucleus of the Hypothalamus had descending pathways to the Autonomic Nervous System. As well as direct control over the Autonomic Nervous System, the Hypothalamus also has an indirect influence over it through the use of relays in other parts of the brain (Squire, Berg, Bloom, du Lac, Ghosh and Spitzer, 2008). In conclusion, the Autonomic Nervous System is a diverse and widespread system that innervates nearly every aspect of the body, meaning that a threatening stimulus can elicit a whole range of responses throughout the body, from increasing heart rate to diverting blood from the gut and widening blood vessels, this means that the whole body is very quickly and efficiently prepared to face the danger, and then the entire body can quickly calm down again to replenish resources; and not only this, but because of its connections with the hypothalamus and other higher centres, the Autonomic Nervous System isnt limited to reacting to physical changes, such as body temperature, but it can react to even mental stimuli such as emotions or the anticipation of something. This is important in evolutionary terms, there is little point in reacting to a danger once it has already causes damage so the heightened physical performance needs to come in anticipation of a danger, so that when the danger p resents itself, the fight or flight response is at its strongest. As this is such an important process in the body, many studies have been carried out into it, and continue to be carried out, and much work is being done on diseases of the Autonomic Nervous System, as, obviously, they have such a dramatic effect on the sufferer. References Bakewell, S., (1995) The Autonomic Nervous System. Practical Procedures 5(5) Barker, R., A. and Barasi, S. (1999) Neuroscience at a Glance, Blackwell Publishing Bear, M. F., Connor B. W. and Paradiso, M. A. (2007) Neuroscience: Exploring the Brain, Lippincott Williams Wilkins: a Wolters Kluwer business Gershon M. D., Kirchgessner A.L. and Wade P.R., (1994) Functional anatomy of the enteric nervous system, Springer Berlin Heidelberg Hansen, M. B., (2003) The Enteric Nervous System II : Gastrointestinal functions. Pharmacology Toxicology, 92(6) 249-257 Kandel, E. R., Schwartz, J. H. and Jessell, T. M., (2000) Principles of Neural Science, McGraw-Hill Medical Purves, D., Augustine, G. J., Fitzpatrick, D. and Hall, W. C., (2008) Neuroscience 4th Edition, Sinauer Raj K. Goyal, M.D., and Ikuo Hirano, M.D., (1996) Mechanisms of disease: the enteric nervous system. The New England Journal of Medicine, 334(17) 1106-1115 Squire, L.R., Berg, D., Bloom, F.E., Du Lac, S., Ghosh, A. and Spitzer, N.C., (2008) Fundamental Neuroscience 3rd Edition, Elsevier Swanson, L. W. and Sawchenko, P.E, (1983) Hypothalamic integration: organisation of the paraventricular and supraoptic nuclei. Ann. Rev. Neuroscience 6 269-324

Discovery Of Losartan Potassium Health And Social Care Essay

Discovery Of Losartan Potassium Health And Social Care Essay Losartan is the first angiotensin II receptor antagonist drug to be marketed for use mainly to treat high blood pressure (hypertension). Losartan was first discovered in March 1986 by scientists on their first assignments at a corporate research laboratory, in Du Pont, as DuP 753(Merck 954), a highly potent and orally active non-peptide Ang II receptor antagonist. At the time, DuPont as a company was rather new to pharmaceutical business. The company had previously been dealing in chemicals, but the in the 1970s when the demand for Petroleum and its related products natural gas drove prices high, management attempted to diversify the business by seeking other business avenues to reduce their dependency on chemicals in a hope of also increasing their profit. As a result of creating new business, DuPont had ventured into pharmaceuticals and other life sciences businesses by the 1980s. Losartan work was one of the compounds DuPont research labs worked on. The company being inexperience in this area of business, hired Robert I. Taber, a scientist with two decades of research experience with Schering, to head pharmaceutical research at DuPont.It was Taber who recognized the areas of potentials and encouraged the research team to delve further. However, DuPont being a fairly young company in these areas would lead to other weighty problems, and these issues were quickly settled by a collaboration with the more experienced Merck, who also recognised the Potential of Losartan and convinced DuPont that there was more to be gained by working on Losartan. Development of Losartan was done after a series of efforts. The final market product was Co-Developed with Scientists from both Merck DuPont. [BHARDWAJ, G., 2006] Losartan was approved by the FDA in April 1995, and it was then launched that month as the first non-peptide anti-hypertensive drug in the new class of Ang II receptor antagonists. Merck started selling losartan under the trade names CozaarT and HyzaarT with annual sales in excess of $3 Billion Dollars by 2005. Chemical Structure (IUPAC) nomenclature (2-butyl-4-chloro-1-{[2-(1H-tetrazol-5-yl) biphenyl-4-yl] methyl}-1H-imidazol-5-yl) methanol Chemical data Formula C22H23ClN6O Mol. mass 422.91 Action of Losartan Losartan selectively inhibits all Ang II responses that have been studied and lowered blood pressure in several animal models of renin-dependent hypertension. In animals, the antihypertensive efficacy of losartan has been found to be similar to that of the ACE Inhibitors (Angiotensin Converting Enzyme inhibitors) but, unlike ACE inhibitors, losartan is a more selective inhibitor of the renin-angiotensin system since it does not affect the metabolism of kinins. Compared with peptide Ang II antagonists (e.g. saralasin), losartan has significant advantages, including a long duration of action, effective oral absorption and no Ang II agonist activity. [SIEGL, P.K., 1993] Indications Hypertension Losartan tablets is indicated for the treatment of hypertension. Losartan can be used alone or used in combination with other antihypertensive agents, including diuretics. [Rx LIST THE INTERNET DRUG INDEX., 2009] Hypertensive Patients with Left Ventricular Hypertrophy Losartan is also indicated in patients with hypertension and left ventricular hypertrophy to reduce the risk of stroke, but there has been a study to suggest that Losartan is not beneficial with Black patients in reducing the risk of stroke. [Rx LIST THE INTERNET DRUG INDEX.,2009] In the LIFE study, it was found out that Black patients with conditions of hypertension and left ventricular hypertrophy had a lower risk of stroke on atenolol than on Losartan. However, there was some shortcomings of the LIFE study, as it did not provide evidence that the benefits of Losartan in hypertensive patients with left ventricular hypertrophy by reducing the risk of cardiovascular events applied to Black patients. [Rx LIST THE INTERNET DRUG INDEX.,2009] Nephropathy in Type 2 Diabetic Patients Losartan is also very useful in the treatment of patients with diabetic nephropathy, where there is an elevation of serum creatinine and proteinuria (urinary albumin to creatinine ratio à ¢Ã¢â‚¬ °Ã‚ ¥ 300 mg/g) in patients that have type 2 diabetes and a history of hypertension. In this group, Losartan has been shown to reduce the rate of progression of the nephropathy. This is measured by the occurrence of doubling of serum creatinine or end stage renal disease where there is need for dialysis or renal transplantation. [Rx LIST THE INTERNET DRUG INDEX.,2009] SPECIFIC PRODUCTS ( CONTAINING THIS DRUG) AVAILABLE FOR USE IN GIVEN CONDITION Combination therapy: A combination therapy is used if losartan monotherapy alone is not sufficient to control hypertension. Hence, losartan is available in combination with hydrochlorothiazide in different strengths as follows:[BRITISH NATIONAL FORMULARY., 2009] Losartan 50mg + Hydrochlorothiazide 12.5mg Losartan 100mg + Hydrochlorothiazide 12.5mg Losartan 100mg + Hydrochlorothiazide 25mg. The above combination is used for treatment of high blood pressure and stroke in patients with heart disease. It is a prescription only medicine. [MEDICINES AND HEALTH CARE PRODUCTS REGULATORY AGENCY., 2009] EVIDENCE FOR EFFICACY FOR THIS TREATMENT. Clinical trials have shown a better efficiency of losartan as an antihypertensive by itself and a further higher efficiency in a combined state with hydrochlorothiazide. For example : a double-blind, multicenter, randomized, parallel group study performed on African Americans (who are generally less responsive to monotherapy from any hypertensive class), with severe hypertension have shown a significant reduction in sitting diastolic and systolic blood pressure with losartan monotherapy (45.8%) when compared with placebo (27.2%) . In the same study, the combination losartan/ hydrochlorothiazide regimen showed significant higher reductions (62.7%) in blood pressure compared with losartan monotherapy or placebo. More over, both the regimens i.e losartan monotherapy and the losartan/hydrochlorothiazide were as well tolerated as the placebo[FLACK, et al., 2001]. Other studies were performed on hypertensive patients who had discontinued treatment with calcium channel blockers and angiote nsin converting enzyme inhibitors due to side effects like peripheral edema or dry cough respectively. These patients when treated with losartan have shown as much reduction and control over blood pressure as they use to with previous therapies.[GIOVANNETTI, et al., 1997]. And quite interestingly it has also been observed that the clinical side effects were minimal with losartan treatment and the haematologic and biochemical profiles were also not disturbed. [GIOVANNETTI, et al., 1997] Studies performed on the pharmacokinetics and pharmacodynamic parameters of losartan on healthy male volunteers and also on special patient groups like elderly patients with renal impairment and those having liver disease, suggest that losartan is orally active and its effect lasts for over 24 hours. None of the patient groups showed any significant pharmacokinetic interactions[McINTYRE, et al., 1997]. Losartan 50mg appears to be a safe starting and maintenance dose in most patient populations. However, when an additive effect is required, it can be easily combined with thiazide diuretics to achieve the target blood pressure. Losartan has low discontinuation rate and it has also been observed that it was not associated with cough even in patients who experience this side effect with to ACE inhibitors [McINTYRE, et al., 1997]. A BRIEF COMPARISON WITH OTHER MEDICINAL PRODUCT USED TO TREAT THE SAME AILMENT Losartan potassium, is an angiotensin receptor antagonist (AT1) used in the treatment of hypertension and other cardiovascular diseases. However, a comparison with other ARB(e.g. valsartan and candesartan) shows that, these drugs have the same mechanism of action, though, their differences in pharmacokinetic profile may be responsible for their differences in efficacy in the treatment of hypertension. Losartan and valsartan when compared, exhibited a similar reduction in blood pressure at a lower concentration ,however, valsartan has a higher response rate and more effective 24hours blood pressure control rate at the dose of 160mg and 80mg respectively than losartan at 100mg and 50mg respectively.[BURNIER BRUNNER 2000]. Candesartan 8mg and 16mg has also demonstrated a more lasting antihypertensive effect than losartan 50mg and 100mg in ambulatory BP monitoring.[LACOURCIERE ASMAR 1999] A brief comparison with other medicinal products from the other class like B- adrenergic blocker(e.g. atenolol), ACEI(e.g. enerlapril), calcium channel blocker(e.g. felodipine) and diuretics were based on the efficacy, tolerability and safety in the treatment of essential hypertension. Losartan , when compared with amilodipine has been shown to exhibit a similar clinically relevant reduction in patients with systolic blood pressure, however, losartan was better tolerated as evidenced by fewer clinically adverse effect(CAE)and discontinuation compare with amlodipine [VOLPE, et al., 2003]. Meanwhile, in the contrasting effect of losartan, nifedipine GIT, and fosinopril on the ambulatory blood pressure, cardiac structure and function, and protective function of the endothelium in patients with essential hypertension, nifedipine GIT is superior to others in plate- granule membrane protein (GMP), while fosinopril and losartan had a preffered action to nifedipine GIT in reversing ventricul ar hypertrophy, however, losartan was better tolerated than the other drugs [QI XIURONG 2001]. Losartan potassium has been known to exhibit a fewer drug related adverse effect in contrast to other medicinal products in the other classes used in the treatment of hypertension. [GOLDBERG, et al., 1995] In summary, losartan potassium has an excellent tolerability profile in patient with essential hypertension and, in a demographic sub group of elderly versus young, women versus men and black versus non black; it has been shown to have an excellent safety profile. ADVANTAGES OF LOSARTAN POTASSIUM. Side effect; In the treatment of hypertension, losartan has exhibited fewer drug related side effect when it was compared with other class of antihypertensive agents .[GOLDBERG, et al., 1995] Tolerance; when compared in patients with essential hypertension, losartan was better tolerated than other agents from the other class and hence an excellent tolerability profile. Safety profile; It has a good safety profile in a demographic sub groups. It doesnt produce rebound high blood pressure when it is withdrawn. DISADVANTAGES OF LOSARTAN POTASSIUM. 1 Losartan has been associated with some damaging effect on the foetus which may include reduced body weight, death and kidney injuries hence it is contraindicated in pregnancy. [GOLDBERG, et al., 1995] Analysis of the market potential for the development of new drug candidates to treat the given condition Development of new drug products has always been a challenging task. Growth in technology resulted in an evolution in pharmaceutical world and has paved way for research and development to meet demands for more efficient products. About one billion people have been affected by hypertension world wide and reports also says that in US alone 65 millions people are affected by high blood pressure.[SMITH ASHIYA 2007]. This indicates the level of demand of antihypertensives world wide. Efforts have been made and many potential drugs have been developed till date. However the expiry of patents of angiotensin receptor blockers (ARB) opened doors for arrival of cheap generic products which resulted in a threat to the global pharmaceutical market. Data monitoring of the sales of antihypertensives in seven major global markets (i.e UK, France, US, Italy, Spain, Germany and Japan ) predicted sales of upto $ 29.5 billions by 2018, which would be a drop of $6 billion when compared to that of 2008. Considering above threats, the big pharmaceutical companies are under an impression that it is not worth to spend on research and development of novel therapies and they appear to be moving away from investing in research and development to develop more efficient antihypertensive therapies. [THE MEDICAL NEWS., 2009] Product Name Patent Number Patent Expiration Mercks COZAAR (losartan potassium) 5,138,069*PED  Ã‚   11 Feb,2010 Mercks COZAAR (losartan potassium) 5,153,197*PED   06 Apr, 2010 Mercks COZAAR (losartan potassium) 5,210,079*PED  Ã‚   11 Nov,2010 Table showing the expiry of patent of COZAAR (losartan potassium) Angiotensin receptor blocker. [DRUG PATENT WATCH., 2010] Short comings of the existing treatment to justify new drug development Though antihypertensive agents were able to achieve significant control over hypertension induced morbidity and mortality, still there is much to be done. For example: disappointments associated with coronary artery disease, risk of cardiovascular events even after treatment with antiphyertensive agents and comparatively higher possibility of cardiovascular events in hypertensive patients compared to normotensive patients. These effects are thought to be due to inability of existing antihypertensives to reverse other associated factors like left ventricular hypertrophy, negative metabolic effects and risk associated with overtreatment.[HANSSON, L., 1991]. Hence there is a need for an ideal hypertensive agent which may be able to control blood pressure to normotensive levels whilst being free of negative metabolic effects. Moreover, it should also be able to reverss cardiovascular changes like cardiac hypertrophy and control tissue damage in case of possible vascular complications. [H ANSSON, L., 1991]. Analysis of data available on search engines indicates the promising role of upcoming gene therapy and nano-technology to produce new drug candidates. For example: Exploring areas like gene transcripton, molecular genetic regulation of blood pressure ( targeting genetic risk factors as in cases of essential hypertension) appears to be a new hope for future developments of antihypertensives.[KURTZ GARDNER 1998] Possible potential for new therapy. Research is currently being carried out to explore the potential of upcoming gene therapy and nano-technology to produce new drug candidates. For example: Areas like gene transcripton, molecular genetic regulation of blood pressure ( targeting genetic risk factors as in case of essential hypertension) appears to be a new hope for future developments of antihypertensives.[KURTZ GARDNER 1998]. However alternatively, combination products containing antihypertensives and statins could be a new hope for future developments. à ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦

Old Messages Brought To Life Essay -- essays research papers

Old Messages Brought to Life Today's world needs to be taught the old messages of life. We have so many different religions that preach the same things. All are of one or more supreme beings and their teachings. Across this world it is the same messages and yet we fight one another, because my god of love is better then your god of love. The basic human problems are even the same we all call these situations sin. Is it possible to change the world and it beliefs? One must start with their self and realize that the basic rules for life. Laws condition the manifest universe and life on earth. There are inviolable laws of life that govern all aspects of earthly life and determine the destiny of each individual. Understanding the first three or four help you to understand the rest. They cannot be ignored without inviting negative consequences. It is therefore important that one understands these laws and observes them. The whole universe is permeated with divine presence. Therefore one should deal with every object in it as if one is dealing with oneself or with "God". Everyone's god is omnipresent and omniscient in each religious person's eyes. Everything in this universe is sacred because it is filled with the presence of this Supreme Being. Everything in this universe is therefore a divine entity and should be treated as such. Those who seek harmony and peace in life understand this principle very well and treat every thing in the worl...

Creation and Science Essay -- Religion Creationism Papers

Creation and Science We have all heard about the evolution vs. creation debate. Two sides opposing each other in fits of heated passion. One group believes that humans developed from monkeys, and the other group is a bunch of religious fanatics. Does this sound somewhat familiar? This is one of the most stereotypical views of the dispute, but is, unfortunately, how many people believe it to be. So what is it all about? What makes these groups (there are actually quite a few more than two) so determined to fight and try to win others over to their belief? In the answers to these questions lie the truth about why humans take this aspect of science so personally. There must be some fairly significant reasons that cause individuals to become so committed to arguing their point of view in the evolution/creation debate. Many creationists feel that without a supernatural creation by an intelligent being there is no purpose to the universe and no reason to live (Wager, 1997). Many Christian creationists hope that by convincing others of Godà ­s role in the origins of life, they can more effectively lead others to salvation. Still others believe that it is the duty of Christians to "defend against the godless dogma of evolutionary humanism" (Tyler, 1995). It is easy to see why this topic is so important to people. If one believes that evolution and Christianity are mutually exclusive, as many people do, then it is natural for Christians to want to disprove evolution and eliminate what they perceive as a threat (Wright, 1989). However, the debate is also meaningful to evolutionists. Many evolutionists feel that to try and discredit evolution is to ignore facts and scientific reasoning (Tyler, 1995). Some evolutionists who are dominant i... .../Biol410/Biol410SrSemPapers97/millerl.html Myers, Jesse. (1996). Biology Senior Seminar Student Papers: "A Look At Scientific Creationism." http://www.goshen.edu/bio/Biol410/Biol410SrSemPapers/myers.html Nelkin, Dorothy. (1982). The Creation Controversy. Boston, Massachusetts: Beacon Press. Scott, Eugenie C. (1996). "Dealing With Anti-evolutionism." (10/25/98) http://www.natcensied.org/deal174.htm Tyler, David J. (1995). Review of: "Creation Based Science By Phillip Johnson." (10/22/98) http://www.pages.org/bcs/Bcs057.html Wager, Michael. (1997) "Evolution: The Lie." (10/25/98) http://www.student.uwa.edu.au/~mlwager/evovscrt.htm Wright, Richard T. (1989). Biology: Through the Eyes of Faith. New York, New York. HarperSanFrancisco. Zook, Marc E. (1987). Biology Senior Seminar Student Papers: "Origins: A Collection Of Thoughts."