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Abnormal Psychology Questions and Answers ap world history homework help: ap world history homework help

Distinguish Between Cyclothymic Disorder, Bipolar I Disorder And Bipolar II Disorder

Cyclothymic disorder is considered to be a relatively mild mood disorder whereby the body moods usually fluctuate between short sessions of less severe depression and elevated body moods. In cyclothymic disorder, the high and low mood swings usually do not attain the severity of major depressive episodes (Butcher, Mineka, & Hooley, 2017). Bipolar I disorder which is also referred to as the manic depressive disorder is usually a  form of mental diseases whereby the affected individual usual experience one or more manic episodes in his or her life. bipolar ii disorder also tends to be a mental disease whereby the general body moods usually recycle between low and high over a certain period of time. However, the  up moods usually  do not   reach or attain the full-blown mania

How the Disorders are Similar and Different

All these disorders tend to be similar in that they all involve the fluctuation of the body moods. The types of fluctuations of body mood usually play a key role in determining the kind of disorder that the body will develop.

On the other hand, the main difference between the three conditions is that the mood fluctuation tends to differ from one disorder to the other. For instance, cyclothymic involves the fluctuation of moods between hypomania and short sessions of depression. In Bipolar ii disorder, people experience abnormally increased mood while in bipolar I disorder the body moods usually cycle between low and high over a specific period of time. Also, the three disorders tend to differ in that,  bipolar I and ii are mental health conditions while cyclothymic disorder is usually a mood disorder.

Reference

Butcher, J. N., Mineka, S., & Hooley, J. M. (2017). Abnormal psychology. Pearson Education India. ISBN-13: 9780205944286

Critical and Ethical Insights on Voting ap history essay help

One should be concerned about unthinkingly following political patterns and voting tradition because times change and what might have been relevant a few years ago could be completely irrelevant today. Blindly following your family’s political pattern would mean that your own conscience is without value. One’s family might have supported a specific political party in the previous years because they had relevant policies on issues such as healthcare and education (Boaduo 361). Always listening to what others (in this case, your family) say and following it to the latter should really bother one’s conscience. What if the opinion of others violates your own moral beliefs? I believe it is more important to follow one’s own conscience especially in circumstances that demand a moral choice. It would be myopic to blindly follow your family’s voting tradition even when it violates your moral beliefs.

By consulting my conscience in voting, I recognize and respect the fact that I am first of all a person who perceives issues from a certain perspective. Making a decision based on your conscience basically means consulting the truth of the nature of things (Ojakangas 76).  However, this does not mean that we completely ignore the ideologies of others. There is a very thin line between being open to other people’s views and respecting them, and blindly following these views. An American who has attained voting age should be in a position to make reasoned moral choices guided by their own conscience. Conscience views things from a very broad perspective (Ruggiero 15). The opinions of other people including your family should never overrule your principles. When you follow your own conscience, you will at least accept the consequences and will not have to blame others for influencing you.

Works Cited

Ruggiero, Vincent R. Thinking Critically About Ethical Issues, 2019.

Ojakangas, Mika. Voice of Conscience: A Political Genealogy of Western Ethical Experience. New York: Bloomsbury, 2013.

Boaduo, Nana A.-P. “Assessing the Role of Conscience and Self Adjudication in Enhancing Development, Social Justice and Governance: The Case of South Africa.” East African Journal of Peace & Human Rights, vol. 15, no. 2, 2009, pp. 361-369.

How to treat or manage venous leg ulcers history homework: history homework

A critical literature review on the interventions (dressing) used by nurses to treat or manage venous leg ulcers

Abstract

Venous Leg Ulcers has become a significant health concern over the years globally. The maintenance and treatment of the health condition are very critical to the determination of the lives lived by the patients. The disease has led to increased social and economic burden to the patients as well as the people around them and the health care system in general. This study has therefore provided an analysis of the VLUs to enhance the understanding of the problem, how it is caused or the risk factors contributing to the prevalence of the disease, the diagnosis as well as the treatment and management of the condition. Much more focus has however been placed on reviewing the existing literature sources to build an understanding of the interventions used by nurses to treat or manage Venous Leg Ulcers. A critical review of references has been done to provide more understanding of the research topic. These sources have also been supported by other secondary literature source materials which also provide more information on the treatment and management of the disease or healthcare condition.

Introduction

Venous Leg Ulcers (VLUs) is one of the most common health or clinical problems affecting the health systems globally as well as affecting the lives of many people. Chronic Venous leg ulceration (VLU) according to global statistics by world health organization occurs up to 5% of the population over 65 years of age whereas only 1.5% of the general population is affected by the condition (NHS)  For instance in the United States, approximately 0.5 to 1 million people are affected by the condition. The cost of treating the health condition is relatively very high as it is approximated that the United States spends an estimate of $ 3 billion per year in the treatment of Venous Leg Ulcers. Such statistics, therefore, reveal that the health condition has an overall huge economic and social burden worldwide. The treatment and maintenance of VLUs are critical and hence it requires the nurses to have a certain level of competency and skills (Van Leen, Rondas, Neyens, Cutting, Schols, 2014). This is predominantly because the several issues of pain, compression, banding as well as smelling exudate which arise during the treatment and maintenance process. As a result, the patients experience a variety of different problems that can impact their lives as well as the lives of those around them. It is, however, critical to note that sometimes it is not the ulcer that comes out from the wound that causes the major treatment or maintenance health problem but the type of form of treatment and maintenance administered to the patient that is able to cause both physical and psychological problems (Wicks, 2015). Therefore, different scholars have developed various studies to help in understanding the different intervention strategies that are used by nurses to treat or manage the condition. The purpose of this study is therefore to develop a critical literature review on the interventions used by nurses in the management and treatment of Venous Leg Ulcers. The review will predominantly focus on 10 primary literature sources to develop our understanding on various issues of concern in the treatment and maintenance of VLUs and most importantly the interventions aimed at improving the quality of healthcare provided to the patients with Venous Leg Ulcers. The review will also focus on the various treatment options such as bandaging and dressing as well as pain relief and management interventions as used by nurses to improve the healing process.

Literature Search Strategy

The development of the critical literature review will comprise the use of population data which enhances the study by analyzing the experiences of the patients or people affected by VLUs. The keywords guiding the research will be; Venous, Leg Ulcers (VLUs), Nurses intervention, pain relief, and management, dressing, bandaging, compression as well as hoister socks. The literature review will not be limited to any specific country but will focus on the global nursing interventions on the treatment and maintenance of VLUs. However, to enhance the validity and the reliability of the literature review findings the sources to be included in the literature review must be published within the last five years and must be related to the topic under review as well as must be journals which have been peer reviewed. Any literature source that does not support the topic or was published in more than five years ago will not be included. This is because the information may be outdated and we desire to provide up to date information on the current intervention strategies used by nurses in the treatment and maintenance of Venous Leg Ulcers. The review will comprise of 10 reference journal articles through the use of systemic review research design.

Critical Literature Review

Nurses play a critical role in the treatment and management of Venous Leg Ulcers as in most case they are the one responsible for the care provided to the patients suffering from the condition. The management and treatment of the disease are therefore very essential because it contributes significantly to the healing process as well as to improve the quality of lives for the patients. It, therefore, requires the nurses to have high competency levels as well as skills towards effective management and treatment for VLUs. Alavi et al. (2016) denote that VLUs have increasingly grown to become a burden not only to the patients but also to the people around them and the overall healthcare systems. The prevalence of the condition to occur in up to 5% among the elderly population as well as 1.5% among the general population. The cost of treatment and maintenance of the disease or condition is very high for many governments and is expected to even increase with the growing population of elderly people who are most vulnerable population groups (Ulrich et al., 2015). There are a number of issues which arise with the growth of the condition including pain, compression, bandaging and smelling exudate, however, in most cases it is not the ulcer that causes a major problem but the form of treatment and maintenance that is provided to the patients that are able to cause major physical and psychological problems. This has therefore created the need for appropriate intervention strategies for dressing or for the treatment and maintenance of the condition.

Factors Leading to Venous Leg Ulcers

According to National Health Service (NHS), Venous Leg Ulcers is defined as a chronic sore that takes more than 2 weeks to heal and that in most cases develop on the inside of the leg, just above the ankle. The most common symptoms for the disease include pain, itching, and swelling of the affected area. The disease may also cause discoloring or hardening of the skin around the ulcer whereas the sore may also produce foul-smelling discharge (Melikian, O’Donnell, Suarez & Iafrati, 2019). The most common type of leg ulcer is the venous leg ulcer which accounts for more than 90% of the cases reported in healthcare centers. The condition develops after a minor injury where there is persistent pressure on the veins of the leg leading to the damaging of the skin. Therefore constant pressure which is likely to damage the blood vessels is the primary cause of the VLUs because an individual skin can easily break and form an ulcer after a knock or a scratch (Tickle, 2015). There are however other predisposing factors that can also contribute to the development of leg ulcers. Obesity increases the pressure on the leg veins. Previous leg surgery such as hip replacement or a knee replacement may also contribute to the development of the condition as well as previous deep vein thrombosis (DVT). Increased age is also a risk factor because people find it had to move about and especially if they suffer from arthritis.

How and Why the Leg Ulcers Occur

An individual symptom for the basis for diagnosis for the health condition and therefore it is advisable that whenever an individual experiences symptoms such as pain, itching and swelling in their legs they should consult a specialist who will examine the condition as well as to conduct some additional tests (Dowsett et al., 2015). The nurses will, therefore, ask for these symptoms as well as other predisposing risk factors about underlying conditions and or previous injuries such as diabetes, deep vein thrombosis, injury or surgery in the affected area as well as a previous leg ulcer (Hampton, 2019). In any case, the conditions affect the blood vessels then the nurses are able to refer the patients to a specialist for specialist care or treatment.

Treatment and management options for Venous Leg Ulcers

There are different intervention strategies that have been developed by nurses and other healthcare researchers to aid in successful treatment and management of VLUs. In their journal or American Academy of Dermatology Alavi et al. (2016) were able to investigate the optimal management for patients with venous leg ulcers as well as highlight the role of the multidisciplinary team in delivering high-quality care. The rationale for their research was the need for quality healthcare services for patients with VLUs. One of the critical findings in their research was that Venous disease management can be optimized by treating pain and infection as well as by reducing the bio-burden through the use of routine compression therapy.` compression therapy is the most widely used form of treatment for VLUs. According to research by Raffetto, Eberhard, Dean, Ligi & Mannell, (2016) that the application of external pressure to the leg and calf is able to increase the interstitial pressure as well as decreases the hydrostatic venous pressure in both the superficial and deep venous systems. It also improves the venous return and causes a reduction in venous hypertension, which in this case allows healing to occur in the affected area. They have also been able to provide two main compression therapies which include compression bandaging and compression hosiery as the most commonly used intervention strategies used by nurses in the treatment and maintenance of VLUs in patients. Besides the compression therapies which have been effective in the treatment and the maintenance of VLUs, wound dressing is also imperative to the care plan (Guest, Gerrish, Ayoub, Vowden& Vowden, 2015). Compression is done by the nurse through the application of a firm bandage over the affected area. The compression bandages are designed in a way to squeeze the patient’s legs and encourage blood to flow upwards to their heart. There are however different bandages or even elastic stockings which are used for compression and can be either in two, three or four layers. The application of the bandages, however, is a delicate and skilled procedure which should be carried out by a skilled or trained healthcare specialist. This is because most of the damage or harm is caused during this process of treatment and maintenance.

Guest, Gerrish, Ayoub, Vowden& Vowden, (2015) in their research were able to assess clinical outcomes and cost-effectiveness of  different compression bandage forms of treatment which included; a two-layer cohesive compression bandage ( Coban 2) compared with a two-layer compression system ( Ktwo) and a four-layer compression system ( Profore) in treating venous leg ulcers (VLUs).  Their research was able to establish that initiating treatment with a two-layer compression bandage, compared with the other two compression systems is a more cost-effective use of NHS-funded resources in any given clinical practice. This is because it resulted in an increased healing rate and better HRQoL as well as a reduction in National Health Service management cost. Therefore based on their findings it is more cost effective to the NHS to use the two-layer compression bandage in the treatment and management of VLUs. It is also more effective in term s of healing as it has a higher healing rate. On the other hand, Raju, Lurie & O’Donne (2016) were able to provide a review of compression used in the context of emergent endovenous therapies as it caused concerns among nurses and another healthcare specialist during the treatment and management process of VLUs. Based on their research they were able to establish that compression therapy as an intervention strategy used by nurses should be initiated in the majority of patients presenting with CVD, and compression failure identified promptly (Simon, 2016).  This is because a delay in intervention leads to increased costs and the chance of recurrence. To improve cost efficiency and also improved patient response behavior there is, therefore, a need for immediate compression treatment upon diagnosis with the condition.

Purcell et al., (2017) in their research were able to evaluate the effect of EMLA 5% dressing and treatment cream applied to painful chronic leg ulcers as a primary dressing on wound healing and health-related quality of life. Based on the research, they were able to establish that daily applications of EMLA as a primary dressing do not inhibit wound healing but rather play a critical role in improving patient well-being. Therefore as an intervention strategy, nurses can effectively apply the EMLA cream to help in improving the health outcomes of patients with VLUs. However, this should be done at the required proportion of percentage to avoid any further complications to the healing process. The silver poly absorbent is also another new intervention strategy in the treatment and management of the condition. Dalac et al., 2016 were able to conduct as a qualitative study aimed at assessing the efficacy, safety, and acceptability of a new silver poly absorbent dressing in the treatment and management of chronic wounds at risk of infection with VLUs. Their research finds were able to establish that the tested dressing is a credible therapeutic alternative for the management and treatment of chronic wounds at risk of infection with inflammatory signs suggesting heavy bacterial load. Therefore this shows that nurses can employ the use of the Silver poly absorbent as an intervention strategy to improve the quality of health and the healing process for the patients with VLUs.

Franks et al., 2016 in their journal of wound care have been able to identify barriers and facilitators in the implementation of best practice in the management of a VLU. They were also able to provide clinical practice statements addressing key aspects to consider by the nurses and another healthcare specialist when developing an evidence-based leg ulcer service that improves the patient healing process. The rationale of their research was due to increased challenges resulting from the treatment and management of the VLUs. Therefore based on their research they were able to establish that there are variations in practice and barriers preventing the implementation of best practice from the patient, HCP, NHS, and organization perspective. Therefore there was a need to develop an effective framework for handling the challenges resulting from the various intervention strategies in order to achieve. Lagerin,  Hylande& Törnkvis (2017), in their journal of qualitative studies on health and well-being, they were able to investigate the different nurses’ experiences of caring for leg ulcers in accordance with clinical guidelines at seven primary district health care centers in Stockholm and Sweden. In their research, they were able to establish that that, for effective nurses intervention in treatment and management of VLUs, it would be wise to include leg ulcer treatment as a routine component of specialist education for DNS. For efficiency in the policy-making process, they were able to suggest that policymakers should engage in a discussion about the distribution of responsibilities between professions. This is because care for patients might be enhanced if DNS were given the right or were responsible to take care or to refer patients to specialist care for leg ulcers further treatment and maintenance.

Summary of the critical Literature review

Based on the above literature review, it is evident that Venous Leg Ulcers has increasingly become a concern in the healthcare systems based on the report and statistics provided by the National Health Service. The prevalence rate of the disease is high among the aged population as compared to the general population. However, the management and treatment of the disease or condition are critical to the quality of life of the patients suffering from the condition (Downc, 2014). The treatment and management process, therefore, requires a lot of skills and competency among the healthcare specialists and especially the DNS in the given healthcare systems. Over the years different intervention strategies according to the research have been developed to enhance or improve the quality of life for the affected people both the patients and those around them (Chan et al., 2017). Once an individual is able to experience the signs and symptoms of pain, swelling, and itching, he or she is advised to seek consultancy services from any healthcare specialist for an examination. Based on the review, compression has been the widest form of intervention and treatment as well as a management option for the Venous Leg Ulcers. Based on the review the most cost-effective compression method is the two layers compression bandaging as it is less costly to the National Health Service and has also be found to have higher healing rates as compared to the other two compression methods (Ashby, Gabe &  Ali 2014). The use of other antibiotics intervention strategies were also found to be effective in enhancing the healing process for the patients and as well as in reducing the cost of treatment and maintenance for the condition. However, the best intervention strategy according to the review was the one that is readily available, easy to use or administer to the patients as well as cost effective and is able to improve the quality of care and outcomes for the patients.

Conclusion

The literature review has been able to effectively provide an understanding of the Venous Leg Ulcers health condition, causes, diagnosis as well as the intervention strategies which have been developed to enhance the treatment and the maintenance process. However, there is a need for research into how the various intervention strategies for the treatment and maintenance can be included under the nursing curriculum to provide an opportunity for further research and assessment of the challenges resulting from the treatment of VLUs. However, the evidence provided in this critical review on the various nursing intervention strategies to manage and treat VLUs is critical for the development of my career and practice as a nurse towards the development of a patient-centered healthcare approach. It provides critical insights and developments on how I can improve the quality of healthcare provided to the patients suffering from the Venous Leg Ulcers. The evidence or the deeper understanding of the intervention strategies, therefore, changes my perspective on the treatment and management of the VLUs positively in that I would love to study more in order to acquire more skills on pain relief and in the treatment and maintenance of the healthcare condition.

References

Alavi, A., Sibbald, R. G., Phillips, T. J., Miller, O. F., Margolis, D. J., Marston, W., … & Kirsner, R. S. (2016). What’s new: Management of venous leg ulcers: Treating venous leg ulcers. Journal of the American Academy of Dermatology, 74(4), 643-664.

Melikian, R., O’Donnell Jr, T. F., Suarez, L., & Iafrati, M. D. (2019). Risk factors associated with the venous leg ulcer that fails to heal after 1 year of treatment. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 7(1), 98-105.

Raffetto, J. D., Eberhardt, R. T., Dean, S. M., Ligi, D., & Mannello, F. (2016). Pharmacologic treatment to improve venous leg ulcer healing. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 4(3), 371-374.

Guest, J. F., Gerrish, A., Ayoub, N., Vowden, K., & Vowden, P. (2015). Clinical outcomes and cost-effectiveness of three alternative compression systems used in the management of venous leg ulcers. Journal of wound care, 24(7), 300-310.

Raju, S., Lurie, F., & O’Donnell Jr, T. F. (2016). Compression use in the era of endovenous interventions and wound care centers. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 4(3), 346-354.

Franks, P. J., Barker, J., Collier, M., Gethin, G., Haesler, E., Jawien, A., … & Weller, C. (2016). Management of patients with venous leg ulcers: challenges and current best practice. Journal of wound care, 25(Sup6), S1-S67.

Guest, J. F., Ayoub, N., & Greaves, T. (2015). Clinical outcomes and cost-effectiveness of an externally applied electroceutical device in managing venous leg ulcers in clinical practice in the UK. Journal of wound care, 24(12), 572-580.

Purcell, A., Buckley, T., Fethney, J., King, J., Moyle, W., & Marshall, A. P. (2017). The Effectiveness of EMLA as a Primary Dressing on Painful Chronic Leg Ulcers: Effects on Wound Healing and Health-Related Quality of Life. The international journal of lower extremity wounds, 16(3), 163-172.

Dalac, S., Sigal, L., Addala, A., Chahim, M., Faivre-Carrere, C., Lemdjadi, Z., & Bohbot, S. (2016). Clinical evaluation of dressing with poly absorbent fibers and a silver matrix for managing chronic wounds at risk of infection: a non-comparative trial. Journal of wound care, 25(9), 531-538.

Lagerin, A., Hylander, I., & Törnkvist, L. (2017). District nurses’ experiences of caring for leg ulcers in accordance with clinical guidelines: a grounded theory study. International journal of qualitative studies on health and well-being, 12(1), 1355213.

Wicks, G. (2015). An alternative to compression bandaging in venous leg ulcers. Journal of Community Nursing. 29 (4), p40-46

Van Leen, M., Rondas, A., Neyens, J., Cutting, K., Schols, J. M. G. A. (2014). Influence of superabsorbent dressings on non-healing ulcers: a multicentre case series from the Netherlands and the UK. Journal of Wound Care. 23 (11), p543-550.

Tickle, J. (2015). How can I improve leg ulcer care when faced with increasing service demands?. Journal of Community Nursing. 29 (1), p20-21.

Ulrich, C., Kluschke, F., Patzelt, A., Vandersee, S., Czaika, V, A., Richter, H., Bob, A., Von-Hutten, J., Painsi, C., Hüge, R., Kramer, A., Assadian, O., Lademann, J. , Lange-Asschenfeldt, B. (2015). Clinical use of cold atmospheric pressure argon plasma in chronic leg ulcers: A pilot study. Journal of Wound Care. 24 (5), p20-21.

Dowsett, C., Grothier, L., Henderson, V., Leak, K., Milne, J., Davis, L., Bielby, A., Timmons, J. (2015). Venous leg ulcer management: single-use negative pressure wound therapy. Journal of Wound Care. 2 (1), p6-15.

  Hampton, S. (2019). Turning black or yellow wounds red using a hyporesponsive dressing. British Journal of Community Nursing. 3 (5), p20-24.

Simon, D. (2016). How to improve the community care of leg ulcer patients. Journal of Community Nursing. 29 (6), p24-28.

Ashby, R., Gabe, R., and Ali S. (2014). VenUS IV (Venous leg Ulcer Study IV) – compression hosiery compared with compression bandaging in the treatment of venous leg ulcers: a randomized controlled trial, mixed-treatment comparison, and decision-analytic model. Health Technol Assess. 57 (1), p1-293

 Chan, B., Cadarette, S., Wodchis, W., Wong, J., Mittmann, N., Krahn, M. (2017). Cost-of-illness studies in chronic ulcers: a systematic review.Journal of Wound Care. 26 (8), p4-14.

Downc, A. (2014). How wound cleansing and debriding aids management and healing. Journal of Community Nursing. 28 (4), p33-37

 

 

Appendices

The following table provides a detailed analysis of the 10 references used in the literature review to advance our understanding of the interventions used by nurses in the treatment and management of Venous Leg Ulcers.

Author and Year
Journal Name
Type of study
Purpose
Sample no and design
Data collection
Key Findings

Key themes

 Alavi et al., 2016
Journal of the American Academy of Dermatology
Qualitative
To outline optimal management for patients with venous leg ulcers, highlighting the role of a multidisciplinary team in delivering high-quality care
Design: Descriptive
Observation
VLUs are a growing healthcare burden.

Venous disease management can be optimized by treating pain and infection, by reducing the bioburden and through the use of routine compression therapy.

 

Melikian, O’Donnell , Suarez & Iafrati (2019).
Journal of Vascular Surgery
Retrospective cohort study
To identify influential risk factors associated with the failure of a VLU to heal for a minimum of 52 weeks at a vascular surgeon-staffed wound center within an academic medical center
Experimental

Sample No. 65 Patients

 
Experiment
 The risk factors known to be associated with the failure of a VLU to heal deep venous disease were found to be significant at 52 weeks while depression and race were also found to be rare risk factors.

Raffetto, Eberhard, Dean,  Ligi & Mannell, (2016)
Journal of Vascular Surgery
Quantitative
To determine the effectiveness of venotonic towards promoting VLUs healing
Evidence-based review

Sample No. 723 patients
Observation
Suggested that several pharmacological drugs can be used in combination with compression therapy in the healing of VLUs.

The use of Pharmacological venotonic drugs in VLUs healing was found to be effective for VLUs that have a duration between 6 to 12 months

Guest, Gerrish, Ayoub, Vowden& Vowden, (2015).
Journal of wound care
Qualitative
To assess clinical outcomes and cost-effectiveness of using a two-layer cohesive compression bandage (TLCCB; Coban 2) compared with a two-layer compression system (TLCS; Ktwo) and a four-layer compression system (FLCS; Profore) in treating venous leg ulcers (VLUs)
Retrospective analysis of the case records of VLU patients

Sample Number;

TLCCB (n=250), TLCS (n=250) or FLCS (n=175)
Case Records Review
Evidence demonstrates that initiating treatment with TLCCB, compared with the other two compression systems, affords a more cost-effective use of NHS-funded resources in clinical practice, since it resulted in an increased healing rate, better HRQoL and a reduction in NHS management cost

Raju, Lurie & O’Donne (2016).
Journal of Vascular Surgery
Qualitative
 To provide a review of compression used in the context of emergent endovenous therapies
Correlational
Randomized trial tests and Literature review
Compression therapy should be the treatment initiated in the majority of patients presenting with CVD, and compression failure identified promptly. Delay in intervention leads to increased costs and the chance of recurrence

Franks et al., 2016
Journal of wound care,
Qualitative
To identify barriers and facilitators in the implementation of best practice in the management of a VLU.

To provide clinical practice statements addressing key aspects to consider when developing an evidence-based leg ulcer service that enhances the patient journey
Descriptive
Literature review
 The authors were able to identify that there are variations in practice and barriers preventing the implementation of best practice from the HCP, patient and organization perspective.

Guest, Ayoub & Greaves, (2015).
Journal of wound care,
Qualitative
To estimate the cost-effectiveness of treating patients with a venous leg ulcer (VLU) with an externally applied electroceutical (EAE) device, plus dressings and compression bandaging
descriptive
Observation
The use of the EAE device potentially affords the NHS a cost-effective treatment for managing VLUs when compared with patients remaining on their previous care plan.

The cost-effectiveness of treating VLUs with EAE therapy relative to continuing with patients’ prior care is dependent on healing rates, wound duration and size of the wound.

Purcell et al., 2017
The international journal of lower extremity wounds
Quantitative
To evaluate the effect of EMLA 5% cream applied to painful chronic leg ulcers (CLUs) as a primary dressing on wound healing and health-related quality of life
Experimental

Sample Number; 60 participants with painful CLUs
randomized controlled trial
The authors were able to establish that daily applications of EMLA as a primary dressing do not inhibit wound healing and may improve patient well-being

Dalac et al., 2016
Journal of wound care
Qualitative
To assess the efficacy, safety, and acceptability of a new silver poly absorbent dressing (UrgoCleanAg) in the local management of exudative chronic wounds at risk of infection, with inflammatory signs suggesting heavy bacterial load
Experimental research design

Sample size; 37 patients with chronic wounds
Observation
They were able to establish that the tested dressing is a credible therapeutic alternative for the management of chronic wounds at risk of infection with inflammatory signs suggesting heavy bacterial load.

Lagerin,  Hylande& Törnkvis (2017)
International journal of qualitative studies on health and well-being
Qualitative research study through the use of grounded theory
To investigate district nurses’ experiences of caring for leg ulcers in accordance with clinical guidelines at seven primary health care centers in Stockholm, Sweden
Descriptive research design

Sample Number; 30 nurses
Group Interviews
The findings indicate that it would be wise to include leg ulcer treatment as a routine component of specialist education for DNs.

The findings also established that policymakers should engage in a discussion about the distribution of responsibilities between professions; care for patients might be enhanced if DNs were given the right to refer patients to specialist care for leg ulcers

 

History of Japanese Samurai Sample Essay a level history essay help

Few nations have a warrior custom as exciting and long as Japan. It is a custom existing within the Samurai, the self-sacrificing and loyal knight of antique Japan. The Samurai is a heroic warrior who is able to equally appreciate the exquisiteness of flora in that of a rose bloom but will likewise die for or kill his master instantaneously. This well-rounded soldier was the ruling class of Japan for approximately seven centuries. He fought for control of his nation and to maintain the freedom of Japan from external influences.

The noble warrior class rose in the course of the 12th-century wars amid the Minamoto and Taira clans and was associated with the Tokugawa era. Samurai were lucky to carry dual swords, and once had the privileged to destroy any commoner who upset them. They nurtured the martial qualities, triviality to death or pain, and persistent loyalty to their masters. Samurai were the prevailing cluster in Japan. The Samurai were eliminated from direct governing of the villages and moved into the territory castle cities, and granted government remunerations under the Tokugawa shogunate. They were motivated to adopt governmental positions.

Fleming (2018) denotes that the way of the Samurai is founded in mortality. In respect to either, there exists just the prompt alternative of death. It is not mostly hard. Be resolute and progress. To state that dying minus achieving one’s motive is to die the death of a dog is the perky way of connoisseurs. When pressure with the alternative of death or life, it not mandatory to acquire one’s motive. Everyone desires to be alive. And in big part, everyone makes their logic based on what they like. But failing to achieve one’s motive and still living is a weakness. This is a narrow risky line. To die without achieving one’s motive being like the death of a dog is extremism. There is no disgrace to this. This is the element of the Way of the Samurai. If by putting one’s heart right each evening and morning, one is capable of living like their body were dead already, one attains autonomy in the Way. Their entire life will be minus blame, and he will succeed in their mission.

The warriors of antique Japan just had a passing similarity to the later Samurai. Armor and weaponry were of exceptionally Chinese taste, and the earliest soldiers carried shields, a tool obviously out of trend even prior to the Heian era. Some of the knowledge of the protection and weapons the early Japanese carried emanates from artifacts exhumed from the graves built in the 5th and 4th centuries to house deceased royalty.

The Japanese Samurais have been exceedingly powerful numbers in the course of the history of Japan. Their effect has been perceived in every aspect of Japanese life from the tutelage of young boys in mind and body to controlling of the Emperors, to the study of the military arts (Joshua, 2016). Their cipher of loyalty and honor are customs that are respected by every Japanese and they try to adhere to even today. The self-sacrifice of one’s life for a mutual cause was even observed in the Second World War when Japanese pilots intentionally crashed their airplanes into the U.S. ships moored at Pearl Harbor. This was overwhelming violence and may show the dismay caused by vengeance and their confidence in honor and sacrifice. They were even referred to as kamikaze pilots after the well-known Samurai scuffle of long ago. The influence of the Samurai is still observed in modern Japan in an affirmative way with the legends and stories of valiant Samurai and the Bushido and their leader.

References

Fleming, W. D. (2018). A History of Japanese Theatre/Edo Kabuki in Transition: From the Worlds of the Samurai to the Vengeful Female Ghost/Onnagata: A Labyrinth of Gendering in Kabuki Theater. TDR: The Drama Review, 62(2), 163–167. https://doi.org/10.1162/DRAM_r_00760

Joshua, R. (2016). Uncle Samurai: America’s military alliance with Japan. Policy Review, (58), 24–31. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=eft&AN=503027213&site=ehost-live