Swallowing and Prediction of Dysphagia Severity Essay Example for Free

Swallowing and Prediction of Dysphagia Severity Essay Introduction: Daniels, McAdam, Brailey, and Foundas (1997) reviewed literature from Linden, Kuhlemeier, and Patterson (1993) and examined signs of aspiration, but specifically six risk factors, including dysphonia, dysarthria, abnormal gag reflex, abnormal volitional cough, voice change after swallow, and cough after swallow. They then designed their study in an attempt to link the six signs of aspiration to the diagnosis and severity of dysphagia. The purpose of the study was to determine whether the six risk factors approximated the VSS in identification of dysphagia severity (Daniels et al. , 1997). It was hypothesized that the presence of any one factor could predict at least mild dysphagia or normal swallowing on a video fluoroscopic swallow study (VSS) and that two factors could predict moderate dysphagia. Methods (Procedures): Fifty-nine male veterans, ages 41-88, with recent neurological deficits were recruited for the study and had one of the following issues: unilateral left hemispheric damage (22 men), bilateral hemispheric damage (18 men), and bilateral hemispheric damage (13 men), or brainstem lesions (6 men). The men were assessed by a neurologist using CT or MRI scans upon admission to view and localize lesions. They were then rescanned 2 weeks later if the initial scans yielded negative results. Excluded from the study were agitated patients and patients with a history of disorders and diseases other than stroke that would cause dysphagia. Within 5 days of admission, the men were given an oropharyngeal exam of gag reflex, volitional cough, speech, and voice. A video fluoroscopic assessment was also given that consisted of 3,5,10, and 20 ml, and  ½ tsp of barium paste along with half of a cookie to be swallowed. A swallow study was also performed by administering 5 ml of liquid, and then giving 10 and 20 ml volumes, which were administered twice each, unless the patients immediately had a negative reaction such as a cough. After each swallow, the men phonated â€Å"ah† to see if there was a change in vocal quality. Results: The VSS served as the outcome variable in determining dysphagia severity, which ranged from mild dysphagia to normal swallowing (scores 0-1; 1 if two or more of the six risk factors were present and 0 if one or less were present) to moderate to severe dysphagia (scores 2-4). The reliability for the scores was 92%. 74% of the 59 patients had varying dysphagia severity, while 5.1% had severe dysphagia. 13.6% had moderate to severe dysphagia along with aspiration, while 25.4% had moderate dysphagia, and 25.4% had normal swallowing. 47% had dysphonia, 63% had dysarthria, 27% had abnormal volitional cough, 42% had abnormal gag reflex, 41% had a cough after swallow, and 19% had voice change after swallow (Daniels et al., 1997). Discussion/Conclusion: The results of this study demonstrated that this clinical assessment has utility in the evaluation of acute stroke patients with probable dysphagia who may be at risk for the development of aspiration (Daniels et al., 1997). Also discussed was the fact that this assessment does not account for silent aspiration. In conclusion, early detection of aspiration by using this short assessment can reduce aspiration and pneumonia in patients if addressed early in their hospital stay. Commentary: This article provides helpful information for clinicians practicing in a medical setting. The article includes a flow chart to help determine which patients require further evaluation. Ill and physically challenged patients can avoid the physical distress of unnecessary testing with a proper bedside evaluation, and moderate to severe respiration can be caught early to prevent pneumonia. This study was performed in 1997, and clinicians are still using this method today, proving its reliability in early detection of aspiration.

Love in Poems Essay -- Robert Browning Poetry Literature Essays

Love in Poems Robert Browning’s poem â€Å"My Last Duchess† is based on a real story about the fifth Duke of Ferrera in the Renaissance period. He married a 14-year-old named Lucrezia and then left her for a two-year period. She died at the age of 17. In this poem, the Duke is now looking for a second wife-to-be. Robert Browning is one of the greatest poets in the Victorian age. He writes romantic poems and he expresses love in this poem as obsessive. The poem’s rhyme scheme is a, a, b, b. This is a dramatic monologue. This is the kind of poem where there is only one speaker. In this poem it is the duke. At the very start of the poem, we are already given the idea that the Duke is a proud man especially with his art collections. â€Å"That’s my last duchess painted on the wall†, this quote tells us that he includes his last wife in his collection. The â€Å"my† emphasizes the duke owning his last duchess. By doing this, Robert Browning emphasizes the Duke wanting power especially over his last wife. Her painting is behind the wall now and the Duke shows it to a very few chosen strangers, â€Å"since none puts the curtain I have drawn for you but I†. The painting was made by Fra Pandolf. The Duke is jealous by the fact that the Duchess can blush by receiving any compliments from just anyone. â€Å"Sir, ‘twas not her husband’s presence only†¦into the Duchess’ cheek.† In this quote, the Duke never treated his wife as an equal. But he considered himself higher than her and he wouldn’t lower himself to tell the duchess what she did that annoyed him. He thinks the duchess has no pride at all because she treats everybody equally, â€Å"as if she ranked my gift of a nine-hundred-years-old name with anybody’s gift†. He wants the duchess for h... ...n wants the mistress to understand that it will never be a good idea if she will die a virgin. He is now desperate to get her in bed. If she dies a virgin, the man’s â€Å"lust† will just turn to ashes. The last part of the poem uses a more passionate language and basically gives the mistress a more appealing idea if the man makes love to the mistress. The whole of the third part is describing how the man feels about making love to the mistress. Andrew uses similes â€Å"like morning dew† to compare the â€Å"youthful hue† of his mistress and â€Å"like amorous birds of prey† to describe the way in which they should do the act of making love. Basically, this part has more persuasion than the other parts. It is similar to â€Å"The Beggar Woman† because it represents physical love. However, we will never know if the woman agrees with the man. We are left to decide for ourselves.

Culture and Care Value Base Essay

In this assignment I am going to examine and explain my own personal values and principles influence my own work in professional practice. I will compare my principles and values with the Northern Ireland Social Care Council codes of practice and the Care Value Base. The NISCC and the Care Value Base have many similar codes of practice which all health and social care practitioners should adhere by and work with. The values I feel that are relevant within my experience of healthcare and within my current placement are confidentiality, dignity and respect, effective communication, anti-discriminatory practice and culture and beliefs. In researching NISCC codes of practice and the Care Value Base, I have found that their values are also similar to my own values within my care practice. The first value I am going to discuss is confidentiality. According to the Care Value Base maintaining confidentiality of information is an important part of caring. Any information clients give is private and confidential. Individuals need to be aware of what they say to other carers and clients and also who have access to client files. Previously undergoing work experience in the stroke ward I found that all patients’ medical information is on a clipboard on the front of their bed, anyone could read this information, I feel the patient’s confidentiality is  being breached. During my work placement at Ceara School, I observed that each pupil has individual care folders within school; these are kept in a secure filling cabinet and only the members of staff who are looking after a particular pupil is allowed access, I feel this is very good practice to uphold confidentiality. Within my placement I feel my values would be similar to the Care Value base, if a service user informed me of private information I would keep it to myself to build trust and confidence unless the individual or others were at harm. The second value that I feel is most important and relevant to my experience and work placement is effective communication. According to NISCC, one of their codes of practice is to communication in an appropriate, open, accurate and straightforward way. Within my work placement you have to have recognition and respect of the pupil’s opinions and ideas so they gain confidence within you and be more comfortable to talk. You also have to talk respectfully and use a lot of humor and creativity to keep them interested. On a regular basis there are group conversations and also one to one conversations, simple language is used that is easily understood and additionally open questions are applied to develop the conversation. With having previous work experience in Craigavon Area Hospital I have learnt the importance of communication. Many doctors used jargonistic terms, which can be very hard for patients to understand, I consider this to be ineffective communication. I feel my values are comparable to those of the Northern Ireland Social Care Council. I think that my value of communication within my work placement will come across positively. While in placement I make the speaker feel heard and understood, I make sure to create an environment where pupils feel safe to express ideas opinions and feelings. I keep suitable eye contact and show interest in what is being said and sure my posture is open and inviting. The Care Value Base deems that it is important to acknowledge an individuals personal beliefs and identity. The NISCC feel that respective diversity and different cultures and values are very significant and can have extensive affects on a persons care. I went to an integrated secondary school with many cultures and religions. I took part in a multi-cultural day in school, I got to see other communities and cultures and what they believed in, this widened my views and changed my opinions of different religions. While in Craigavon Area Hospital completing work experience I learned that meals and meal times were very important in some religions and culture. Some individuals were vegetarian; I had to be very respectable of their culture and identity. They were supplied with a different menu with different foods that they could choose this promotes the right of choice and independence. Before my work placement commenced I hoped that the employees and pupils had the same value as myself in consideration of different cultures and are open to express their beliefs and identity and be proud of who they are. My next value is extremely important in my care practice and that is upheld by NISCC and the Care Value Base is anti-discriminatory practice. Anti-discriminatory practice is action to prevent discrimination against people on the grounds of race, class, gender and disability. Anti-discriminatory practice promotes equality by introducing anti-discriminatory policies in different situations of work. http://uk.ask.com/question/what-is-the-definition-of-anti-discriminatory-practice The Care Value Base describes one of their values by promoting anti-discriminatory practice and to protect the individual from abuse. There are many pieces of legislation that are in place to protect individuals from discrimination including the Disability Act 1995, Human Rights Act,  Equality Act 2010 and the Children (Northern Ireland) Order 1995. In my work placement I will work in an anti-discriminatory way, I will not discriminate or judge the service users on their gender, race, class or disability. I believe everyone is different and we all have rights set in place to prevent us from being discriminated against. While undertaking work experience in Craigavon Area Hospital, disabled individuals were protected from discriminatory practice, there were lifts and ramps so all wheel chairs could access the building. There were wide and automatic doors so wheel chairs could get through them with no difficulty, although I feel this is very good practice there was also bad practice within the hospital. I consider individuals with different religions and languages were discriminated against. There were no interpreters for different languages therefore the patients didn’t know what had happened or what was about to happen. I feel my values hinder those of the Care Value Base and I imagine my values will come across positively within my work placement. I feel my personal culture and experience has influenced me in many different ways in supporting users of services and others in health and social care settings. My parents have taught me from a young age to say please and thank you and to be respectful to others. I have grown up knowing these simple values and therefore it has influenced me to show dignity and respect to all service users. Although I am of a Catholic background and practice the Catholic faith, I went to an integrated primary school and secondary school with many different religions and cultures. I now have an understanding of other cultures within health and socials care settings and I am able to accept other religions and their beliefs. I believe this have had a positive influence on my personal culture and experience. When I was in primary school, I met my best friend, he was homosexual. My parents were quite weary of this as they didn’t like the way he dressed and  acted. They came to the terms of his sexual orientation and accepted him; because I have had the privilege of meeting him it has allowed me to open my eyes to all sexual ordinations. When working and supporting users of health and social care service I wouldn’t mind what sexual ordination the service user was, I would not discriminate against them. I would promote and uphold my values to protect them from harm. From experience I know many people have been discriminated on because of their gender. Some individuals will not be chosen for a particular job because they are male/female. Service users are also judged on their sexual ordinations, recently in the news according to Poots, Northern Irelands Health Minister he said that all gay men are not allowed to give blood. I feel this sexual ordination is being discriminated against, it is very bad practice and defeats the purpose of legislation created to protect individuals from this happening. I will promote and uphold my values to protect individuals from being discriminated against. http://www.bbc.co.uk/news/uk-northern-ireland-15014823 I think a pedophile and a murder would cause a barrier in the care setting I am working in. I have grown up knowing that they are bad from family, friends and the media. This may affect and hinder my work but as I am now aware of this negative point I need to work on this barrier. I can not make an assumption until I work and understand them, until then, I will try not to judge this group. New developments and changes to personal values can have a major impact on working in the Health and Social Care sector. Firstly a new development of mine is starting a new course; I have met new people and got to know them. Working in different practices can impact work in a care setting, partnership can be developed and new skills can be gained. I have started a new placement in Ceara School, I am very excited to see if it is the right area of health and social care I want to do further studying in. I feel this experience can be very education and rewarding. This experience will help me in my future and will give me a good start. I can now see that it is the first time I have looking at my values thoroughly and reflected on them, I  will challenge my values to become a better professional. I feel guest speakers were a new development of mine, they give me an insight into their organisation, and they also give me information on how I could get work experience. New developments and changes to my personal values can benefit the service user. I could reflect more in action rather than later, use communication more effectively and user my initiative in different situations. To conclude I believe that personal values is very significant in influencing my own work in the health and social care sector. I have found that my values are similar to the values of the Care Value Base and the Northern Ireland Social Care Council. I have found that there is legislation to protect individuals from unconfidentiality and anti-discriminatory practice also to promote dignity and respect, effective communication and culture and beliefs. I have also explored my new developments and what changes I could make to my personal values to create more effective and efficient care.

Essay about Neptune The Planet - 1615 Words

Roughly, 30.1 AU (astronomical units) from the Sun (Chaisson McMillan, 2011 p. 316) there is a cold, dark, lifeless planet. We call this planet Neptune, after the Roman god of the sea. The planet Neptune is a very complex one with many different facets. The following will discuss nearly every aspect of the planet from its history, to the general composition of the planet, and everything in between. Neptune began just as all the other planets in our solar system did and the condensation theory describes the process of how they formed (Chaisson McMillan, 2011 p. 147). The basic thought process behind the condensation theory is that when a star is born a dust and gas cloud forms and begins rotating around the parent star, planets are†¦show more content†¦315). This means that Neptune did not complete one full orbit around the Sun until July of this year. This full orbit marked Neptune’s first birthday since its discovery. The discovery and creation of the planet are very interesting. However, how do we study and learn more about Neptune? Neptune is the only planet in our solar system that cannot be studied without the aid of an optical tool such as binoculars or a small telescope (â€Å"Neptune Celebrates†, 2011). Neptune cannot be seen without the aid of an optical device because it has an apparent magnitude of +7.8 (Carina, 1990-2008) and our naked eyes c an only see objects with a magnitude of +6 (Chaisson McMillan, 2011, Fig. 17.7, p. 423). The distance of the planet from the Earth, 29.1 AU (Chaisson McMillan, 2011 p. 316), also makes the planet very difficult to study. However, we have visited the planet, or Voyager 2 has. This spacecraft visited the planet in 1989 (NASA, 2010). As of now, no other spacecraft have visited the planet. Voyager 2 also passed very close to one of Neptune’s moons before leaving the solar system (NASA, 2010). Currently there are no plans to visit, or land on the planet. We only observe Neptune with the aid of our telescopes and binoculars. We are able to tell quite a bit about the atmosphere and other characteristics about Neptune, and the rest of this essay will discuss these factors and several others, which help to make this planet very interesting. Neptune’sShow MoreRelatedPlanet Neptune2008 Words   |  9 PagesNeptune  is the eighth and farthest  planet  from the  Sun  in the  Solar System. It is the fourth-largest planet by diameter and the third-largest by mass. Neptune is 17 times the mass of  Earth  and is somewhat more massive than its near-twin  Uranus, which is 15 times the mass of Earth but not as dense.[12]  On average, Neptune orbits the Sun at a distance of 30.1  AU, approximately 30 times the Earth–Sun distance. Named for the  Roman god of the sea, its  astronomical symbol  is ♆, a stylised version of theRead MoreEssay on Terrestrial and Jovian Planets1318 Words   |  6 Pages Terrestrial and Jovian Planets Our solar system contains nine planets, which are broken down into 2 classifications known as terrestrial planets and jovian planets. The terrestrial planets are composed primarily of rock and metal. They also generally have high densities, slow rotation, solid surfaces, no rings, and few satellites. These planets include Mercury, Venus, Earth, and Mars. On the other hand, the jovian planets are composed primarily of hydrogen and helium. They generally haveRead MoreEssay about Solar System1580 Words   |  7 PagesSolar System Humans live on a small planet in a tiny part of a vast universe. This part of the universe is called the solar system, and is dominated by a single brilliant star-the sun. 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Being the farthest planet has made it difficult to study Pluto, Adding to the obscurity of this strange planet is that the capability to send spacecraftRead MoreThe Discovery Of Neptune, By Le Verrier1444 Words   |  6 Pagesrivalry, which, as leading to the benefit of science, so far from hindering, does but cement, the frank and brotherly friendship of those who cultivate it.† (Le Verrier, 1846a). To this, Herschel had responded saying that, â€Å"The prize (the discovery of Neptune) was by a ll rules accredited to Le Verrier since his research was documented and brought to light before Adams discovery†. Almost seeming to assure the people of France that Le Verrier was sure to be given credit to the discovery, however HerschelRead MoreMercury And Its Effects On The Earth1138 Words   |  5 Pageshuman population is also constantly increasing and we need more space to survive. What can we do to survive? Where can we go? This film Deadliest Planets on YouTube will help us to explore our options. This video looks at 6 other Planets that may or may not be possibilities of sustaining life. The first planet was Mercury. Mercury is the closest planet to the sun and one day on mercury lasts up to 58 days on Earth due to its slow rotation. There is one positive aspect of Mercury, which is that thereRead MoreThe Earth s Planetary Group1104 Words   |  5 Pagescomprises of eight planets. The IAU is right now perceiving five midget planets, however of the five there are perhaps a few hundred more to be named. At this point there are 431 common satellites, and of those 173 of them are planetary and 258 of them are named minor. There are 659,212 referred to lunar planets and 3296 comets as of September 25, 2014. Our earth s planetary group just has nineteen round satellites in it starting now. In the event that I were to rundown the planets by separation fromRead More Pluto Essay1507 Words   |  7 Pageslimits of our solar system there is a planet unlike any other, Pluto. Pluto was discovered in February of 1930 by an American astronomer, Clyde Tombaugh. It is the only planet to have been discovered by an American. All though we have known of the existence of Pluto for over thirty years now, there are still many mysteries surrounding this celestial body. Being the farthest planet has made it difficult to study Pluto, Adding to the obscurity of this strange planet is that the capability to send spacecraftRead MoreThe Planets And The Celestial Bodies Of Astrology802 Words   |  4 PagesThe Planets (Grammar Check) Ascertaining the defining characteristics associated with the celestial bodies of astrology will establish the novice in the fundamentals of astrology, and enhance the comprehension of adept astrologers. After all, as planets orbit established positions, the axis of astrology encompasses the idiosyncrasies of the planets. Additionally, a familiarization of Greek and Roman deities benefits the comprehension of the various planetary personalities. The Inner Planets TheRead MorePluto s Planet X : Discovery And Naming1266 Words   |  6 Pages Abstract Pluto is a Plutoid in the solar system located beyond the orbit of Neptune in the Kuiper belt. It is distant more than 6 billion miles from the sun. Pluto’s history will be examined from its discovery and naming to its recent classification. The planetoid’s orbit will be surveyed as it passes inside and out of Neptune’s orbit. Charon, Pluto’s largest satellite, will be discussed as a possible binary planetoid and the four smaller satellites. Pluto’s composition will be studied from its