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One assignment, a psychiatric evaluation, is worth 10% of this course grade. Students will be expected to select one of the patients in the clinical site without using any identifiable demographics and write a psychiatric evaluation of the client and case formulation following the criteria below.  Assessment: Documents all required assessment findings of a psychiatric evaluation following standardized criteria Diagnosis: Determines DSM5 diagnosis based on criteria and supported by symptomatology presented Treatment Plan: Recommend a plan of care following a standardized format, fully documented Case Formulation: Documents comprehensive review of biopsychosocial aspects of the client, including expected outcomes example :  Thomas Deliver, a 36-year-old male, presents with complaints of difficulties with concentration, completing tasks, and maintaining attention in various settings, including work and home. He reports significant impairment in his ability to organize tasks, meet commitments, and manage his responsibilities as a father. Mr. Deliver describes longstanding challenges with attention and focus, which have intensified following his recent divorce. He attributes these difficulties to problems with communication and organization that contributed to the breakdown of his marriage. He reports symptoms such as chronic lateness, trouble initiating and completing tasks, and forgetfulness. Mr. Deliver's medical history includes hypertension, for which he takes hydrochlorothiazide (HCTZ), and hyperlipidemia managed with fish oil supplementation. He has a history of asthma but has not required the use of a rescue inhaler for several years. He takes a daily men’s multivitamin. There is no reported history of psychiatric diagnoses or treatment. Mr. Deliver has expressed concerns about the stigma associated with psychiatric diagnoses and hesitancy regarding the use of psychotropic medications. Family history is notable for possible ADHD symptoms in Mr. Deliver’s immediate family members, including a sibling who was diagnosed with ADHD during childhood. Mr. Deliver is a computer programmer by profession. He recently finalized his divorce and has joint custody of his two daughters, ages 6 and 10. He reports challenges in maintaining a regular schedule and managing his children’s extracurricular activities. He expresses worry that his difficulties with attention and organization may impact his custody arrangement and job stability. There is no reported history of substance use or abuse. The patient’s appearance is casual, appropriate for the setting. His behavior is cooperative during the interview, maintains eye contact. Normal rate and tone, coherent speech. He is anxious regarding the impact of his symptoms on his life. His affect is full range and appropriate. Logical and goal-directed thought process is observed. No delusions or hallucinations. His cognition is intact, oriented to time, place, and person. No evidence of cognitive impairment. Limited insight into the impact of ADHD symptoms on his life; judgment appears intact. Based on the assessment findings and symptomatology described, Mr. Thomas Deliver meets the criteria for Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Presentation (314.00). Symptoms include persistent difficulties with attention to details, organization, and completing tasks, consistent with the DSM-5 criteria for ADHD. Initiate treatment with stimulant medication, specifically methylphenidate (e.g., Ritalin), to target ADHD symptoms. Start with a low dose and titrate based on response and tolerability. Provide Mr. Deliver and his family with education about ADHD, including its symptoms, course, and treatment options. Address concerns about stigma and the benefits of treatment. Refer Mr. Deliver for cognitive-behavioral therapy (CBT) to develop strategies for improving organization, time management, and coping skills. Schedule regular follow-up appointments to monitor medication response, assess for side effects, and adjust treatment as needed. Collaborate with Mr. Deliver’s employer and family to evaluate improvements in functioning. Mr. Thomas Deliver presents with significant impairment in attention and organizational skills, impacting his professional and personal life. Biopsychosocial factors contributing to his presentation include genetic predisposition (family history of ADHD), recent life stressors (divorce), and medical comorbidities (hypertension). Psychosocial stressors include challenges in parenting and maintaining daily routines. With comprehensive treatment addressing pharmacological, psychoeducational, and behavioral interventions, expected outcomes for Mr. Deliver include improved attention, organization, and time management skills. Enhanced coping strategies and reduced functional impairment should contribute to improved job performance, better familial relationships, and increased overall quality of life. In conclusion, this psychiatric evaluation and case formulation provide a structured approach to understanding Mr. Deliver's ADHD symptoms, integrating clinical findings, diagnosis, treatment plan, and expected outcomes. Adjustments may be made based on ongoing assessment and collaboration with Mr. Deliver and his support network.

please respond to the following discussion post as a peer making an comment on the current discussion. Cleo and Joshua did a great job explaining the nature of our group’s plan. As they stated, our group's chosen CLC Business Plan involves the development of an Ambulatory Surgery Center (ASC) attached to a 300-bed community hospital with a 100-physician medical group. This project aims to leverage the hospital's existing resources and reputation, especially the well-known orthopedic surgeons, to enhance surgical capacity and efficiency through an outpatient surgery center. We anticipate challenges in coordinating efficient patient flow to avoid bottlenecks and ensure smooth transitions between preoperative, operative, and postoperative stages. Determining the optimal number of rooms and necessary equipment is crucial. Construction challenges include selecting a reliable contractor, adhering to timelines, and obtaining permits. Additionally, managing physician needs and potential conflicts among surgical specialists is essential. Hopefully, the group can work out any time management or scheduling conflicts to make this a successful project. To succeed, we need detailed data on current and projected patient volumes to determine the ASC's capacity (Badlani, 2019). Best practices for patient flow and OR efficiency from established ASCs will be invaluable. We also need staffing models and job descriptions to recruit and train the right personnel. Additionally, understanding financial impacts is crucial. Trend analysis on ASCs' growth or decline will inform strategic planning (Badlani, 2019). Competitive analysis will help position the ASC effectively, and a comprehensive marketing strategy will ensure we attract the right patient demographics. To create a business plan that's both realistic and fosters learning, we'll immerse ourselves in a simulated environment reflecting real-world ASC operations. We'll achieve this by integrating data and case studies from existing ASCs.

please respond to the following discussion post as a peer making a comment. he group chose the Ambulatory Surgery Center (ASC) for the CLC Business Plan. ASCs provide cost-effective services and a convenient environment that is less stressful than what many hospitals offer. Patients have the convenience of having surgeries and procedures performed safely outside of hospital outpatient departments (HOPDs) (Hollenbeck et Al. 2015). The business plan involves the development of an Ambulatory Surgery Center (ASC) attached to a 300-bed community hospital with a 100-physician medical group. This project aims to leverage the hospital's existing resources and reputation, especially the well-known orthopedic surgeons, to enhance surgical capacity and efficiency through an outpatient surgery center. We will need scholarly, peer-reviewed sources, however, if we find ourselves stuck on getting more information for the plan we can reach out to other groups members.. The challenges that I see are the time zones. This as always been an issue with getting together a time for everyone together and collaborate on the project. To create a realistic document that maximizes learning in a simulated context, we will integrate real-world data and case studies from existing ASCs. Using simulation software to model patient flow and financial impacts will provide practical insights. By leveraging detailed data, expert consultations, and simulation tools, we can create a comprehensive and realistic business plan for the ASC, ensuring it is both practical and educational.

Assessment Description To successfully complete the Individual Project Plan assignment later in this course, you will need to understand what a project plan is, how it functions, how to structure a project to achieve maximum efficiency and success.. Considering those goals, this assignment will allow you to interact with explanatory media and software-specific tutorials to gain foundational information about the working and structure of a project and to develop rudimentary skill in using project management software. Use the media tool "Business Planning," provided in the Student Success Center via the topic Resources, to complete the assignment. Select the "Business Plan Videos" button to view the "Introduction Video" and the Business Plan Video: "Elements Video." Read the section titled "Business Plan Overview" and then complete the "Business Plan Element Self-Assessment." Once you have completed the self-assessment," select "Microsoft Project or Merlin" and click the appropriate link to learn more about Microsoft Project if you are operating on a PC or Merlin if you are operating on a Mac. You will need to develop basic proficiency in these applications to successfully complete the Individual Project Plan in Topic 7.

Case Discussion on ADHD Thomas Deliver, a 36-year-old male patient, enters your office for his initial appointment. According to the intake paperwork, Mr. Deliver is a computer programmer who is complaining of problems with concentration, completing tasks, and being terrible at listening during company meetings and even at home. He explains that he has difficulty starting and completing work projects and trouble being on time or keeping appointments and commitments. He has divorced 3 months ago and has joint custody of two daughters ages 6 and 10 years old. On most days, he sleeps late and he has trouble keeping a regular schedule and getting his children to their lessons and extracurricular appointments on time. Mr. Deliver believes the lack of concentration and poor communication with his wife led to the divorce, and Mr. Deliver worries that his trouble with organization and attention may affect his custody agreement and prevent him from keeping his job. Mr. Deliver’s employer and his family and friends have suggested to him that he should get evaluated for ADHD, but he has resisted because of concerns about the stigma of a psychiatric diagnosis and the risks of taking a psychotropic medication. Mr. Deliver is 5'11" and his weight is 165 lb. He takes a men’s multivitamin daily, HCTZ at 25 mg for hypertension, fish oil 1,000 mg at bedtime for hyperlipidemia, and a rescue inhaler that he keeps with him although he hasn’t had to use it for many years. What screening tools can be used to affirm your initial diagnosis that Mr. Deliver meets the criteria for ADHD? Further assessment determines that Mr. Deliver does meet the criteria for ADHD, inattentive type. What is the current recommendation for pharmacological treatment for Mr. Deliver? Assume that instead of Mr. Deliver being 36-years-old, Thomas is a 13-year-old male that also meets the diagnostic criteria for ADHD, hyperactive type (Thomas is not on any medications at this age). How will your pharmacological treatment change?

Analyze the components of a value added service delivery system and explain why this type of system is critical for long term system sustainability.

What is the importance of de-prescribing? How might you assist a patient to taper from a medication safely or transition to a new medication? In this Assignment, you will use the following patient examples to write a 5- to 6-page paper on considerations you have for how you might de-prescribe. Support your answers with five (5) evidence-based, peer-reviewed scholarly literature resources outside of Required Learning Resources in this course. Note: APA style format guidelines will apply. Patient Examples: Patient 1: A 36-year-old male presents to your office being prescribed by his primary care physician (PCP) for the past 3 years an opioid analgesic medication for a work accident. He has chronic pain and is attending a pain clinic. It is determined the best course of treatment for pain is to remain on opioid medication. The patient is also being prescribed clonazepam 1mg BID for “relaxation” and panic attacks. Patient 2: A 42-year-old female on alprazolam 1mg BID for panic attacks. Panic attacks have been in remission and the patient wants to taper off the medication. But, every time she has attempted to do so in the past, she experienced withdrawal effects. She is wondering how to safely taper off the benzodiazepine medication without having withdrawal effects. Patient 3: A 24-year-old female prescribed lorazepam 1mg TID for generalized anxiety disorder. She recently found out she is pregnant (9 weeks gestation). She was referred to you by her OB-GYN to discuss this medication for her current situation. The patient is wondering if she can stay on the lorazepam through her pregnancy and postpartum, as it is an effective medication for anxiety symptoms. She plans to exclusively breastfeed for the first 6 months postpartum. She has not had any other trials of medication to treat anxiety as lorazepam has been effective. Patient 4: A 71-year-old-male who comes to see you at the insistence of his daughter. His daughter expresses concern of memory loss and is wondering if he has the beginning stages of dementia. He is forgetful and seems to be tripping on things or walking into walls, although he has lived in the same home for the past 35 years. The patient does not agree with his daughter but does admit he has had a “few stumbles and falls” lately. Medication reconciliation shows the following medications: metoprolol ER 50mg q day, omeprazole 20mg q day, clonazepam 1mg TID, levothyroxine 75mcg q am. His daughter is wondering if he should be started on a “dementia medication.” RESOURCES Answer the following questions using the patient examples described above. Patient 1 What are the concerns of the patient remaining on the opioid medication and clonazepam? How might you educate the patient about these risks and concerns? The patient agrees that he should not continue both medications in combination. He would like to “get off” the clonazepam but worries about “bad withdrawals” that he’s heard about from stopping clonazepam “cold turkey” and is concerned about re-occurring panic attacks. How might you respond to the following: How would you instruct the patient to taper off clonazepam? What other medication would you recommend for the patient for the treatment of his panic attacks? Keep in mind, he will continue the opioid medication for pain relief. How would you start the new recommended psychotropic medication for the patient? Discuss one legal, ethical, or social consideration with the treatment plan. Patient 2 The patient reports withdrawal symptoms when previously tapering off the alprazolam. What symptoms are common withdrawal symptoms from this medication? Provide the patient education of withdrawal symptoms that range from common and less serious to withdrawal symptoms that are a cause for concern and that should prompt patient should seek medical attention. Given the patient’s history of having withdrawal effects from attempting to taper off alprazolam, what longer-acting benzodiazepine would you choose to convert the patient to? What is the dose you would prescribe and how would you taper off the medication? Patient 3 Review the potential risks, benefits, and side effects of continuing lorazepam throughout the pregnancy and postpartum for both the patient and fetus. Review other alternative medications to treat generalized anxiety disorder. Include risks, benefits, and potential side effects to both the patient and the developing fetus. Keep in mind, the patient is looking to breast feed for 6 months postpartum. The patient agrees that it would be safest for her pregnancy and fetus to discontinue the lorazepam. How would you recommend she discontinue lorazepam? Provide education on potential side effects from tapering off the medication, including common side effects to more serious side effects and when to seek medical attention. The patient would like to forgo medications at this time, given she is early in her pregnancy and is concerned about “damage” to the fetus if she were to continue medications. Provide education to the patient about the risks of untreated anxiety symptoms during pregnancy for both the patient and the fetus. Patient 4 Review potential side effects for elderly on benzodiazepines providing education to both the patient and the patient’s daughter. What are the risks of continuing the benzodiazepine for this patient? How would you evaluate the patient for these side effects? The patient and daughter agree he will need to taper off the clonazepam given the risks of continuing this medication. How would you recommend tapering off this medication? Review with the patient and daughter potential side effects of tapering off the medication. Review with them common side effects to more serious side effects and when to seek medical attention.

Task summary: Your chosen sport is Football. You will decide the age and experience of the athlete and based on a sport and athlete analysis create a tailored program. You will also select four appropriate performance tests to administer to the athlete. Please include charts in the paper. Use at least five sources from 2017 onwards. Use the attached template for the tables that will need to be included inside the paper. The size of the paper should be 1800 words. Full order description: ? MAIN DETAILS: The program design project provides experience in administering athletic performance tests and designing a resistance training program to meet the goals and needs of an athlete. Throughout this course, you must decide on a specific sport (powerlifting, basketball, football, soccer, volleyball, etc.) you will do a short explanation of the sport, the rules, and the number of competitions available in an academic year (4 meets for powerlifting, 15 football games, etc.). -You will create a 12-week weightlifting program (at a weight room and plyometric training) for an athlete. -You will decide the age and experience of the athlete and based on a sport and athlete analysis create a tailored program. -You will also select four appropriate performance tests to administer to the athlete. After administering the performance tests to the athlete and evaluating the results from the tests, you must design an off-season, pre-season, in-season, and post-season resistance training program for the athlete. (Following Chapter 21 guidelines and the literature) Areas of emphasis for the evaluation of the program will include: (a) Selection of appropriate performance tests based on a sports analysis, (b) Selection of appropriate program design variables for resistance training (exercise selection, training frequency, exercise order, training load and repetitions, volume, and rest periods), and (c) Appropriate rationale for each selection. Importantly, proper references and review of literature style/format will be used. (Minimum 5 2017-to-date academic publication articles) 

1. jwilde  Evidence-based practice requires the healthcare worker to be open to change.  They must avoid doing things a certain way because that’s how it’s always been done, and transition to utilizing research and studies to guide their actions.  However, our text discusses that organizational factors are often the most significant barriers to developing evidence-based models.  Lack of interest, motivation, leadership, vision, strategy, and direction among leadership were all cited as barriers frontline staff members face (Melnyk & Fineout-Overholt, 2019).  In my practice, I have worked for university hospitals that conduct research showing the best way to do something or a new treatment, the organization would drag its feet implementing these changes at a policy level.  These facilities would be policy-driven and speak against implementing the new research until the policies would be updated.  Policy reviews were not conducted regularly and some policies are these facilities were a decade or more since the last revision.  These policies are necessary, but regular reviews to follow evidence-based practice models are a daunting task, within Banner Health we have thousands of policies that require regular updates.  But with the ease of access to new information, the speed of new studies being produced, and the rapid change within healthcare, we must become active participants in our health systems to ensure these policies are updated regularly. As we learn about evidence-based practice, EBP, and its importance, we should be mindful ensure we utilize it.  We don’t want to be like the ones that were warned of in Revelation “I know your works; you are neither cold nor hot. I wish that you were either cold or hot.  So, because you are lukewarm and neither cold nor hot, I am about to spit you out of my mouth” (NRSVUE Bible, 2021, Revelation 3:15-16).  As we learn of its importance, we should ensure we incorporate EBP into our practice and into our workplaces. In a study of nurse practitioners and their use of EBP, the authors found the nurse practitioners reported EBP as very important but they did not utilize it. The authors cited several reasons, such as lack of EBP competence, lack of support, inadequate resources.  But they also cited physician-driven practice and the need to maintain professional/political boundaries (Clarke et al., 2021). In a separate study the authors found that a stronger emphasis on evidence-based implementation must be utilized.  The authors discuss the success or failure of EBP initiatives depend on the leadership, with nurses in the unique position of both frontline staff and leaders.  Nursing formal and informal leaders are key stakeholders in the implementation efforts.  As nurses become active leaders in the implementation of EBP these initiatives will the authors suggest more initiatives will be successful (McNett et al., 2021). Within my own practice, I manage several procedural areas, an hybrid Cardiac Cath and Interventional Radiology Lab, Endoscopy department, and the Medical Imaging nurses that perform procedures in MRI, Nuclear Medicine, CT, and Ultrasound.  There are several opportunities to identify new research and developing procedures.  As we expand our services and bring new procedures onboard, the staff have opportunities for training, as well as new approaches, e.g., cardiac baths through ulnar arteries instead of traditional femoral or radial approaches.  On several occasions new procedures have required I become an expert before the staff begin so that they can rely on me as a resource.  We recently launched our structural heart program performing transcatheter aortic valve replacement, TAVR, in the lab instead of a hybrid OR suite.  This was an effort that required collaboration with myself and my boss maintaining the progress forward and overall vision.  As OR would meet with us and discuss the research of best practices, I was required to be able to speak to our procedures and policies at a high level and bring other leaders onboard ensuring proper context of the research.  When procedures began, I have to be able to give answers to not only my direct reports but the staff of other leaders and ensure we followed EBP that many were not familiar with. References Bible Gateway. (2021). Bible gateway passage: Revelation 3 - new revised standard version updated edition https://www.biblegateway.com/passage/?search=Revel... Clarke, V., Lehane, E., Mulcahy, H., & Cotter, P. (2021). Nurse practitioners’ implementation of evidence?based practice into routine care: A scoping review. Worldviews on Evidence-Based Nursing, 18(3), 180–189. https://doi.org/10.1111/wvn.12510Links to an external site. McNett, M., Tucker, S., & Melnyk, B. M. (2021). Evidence?based practice requires evidence?based implementation. Worldviews on Evidence-Based Nursing, 18(2), 74–75. https://doi.org/10.1111/wvn.12494Links to an external site. Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in Nursing & Healthcare: A guide to best practice (4th edition). Wolters Kluwer Health.  2. tayc  I hope you are all having a great week so far! Before we begin, we must remember what exactly is meant by evidence based practice or EBP. According to a recent article, evidence based practice is "a holistic, individualized approach to health care delivery. Health care professionals who use this approach apply patient values, relevant and proven evidence, and clinical expertise to every aspect of care delivery, with the goal of providing optimal care and improving patient outcomes" (Duquesne University, 2022). This type of care is important as it works to provide patients with the best care based on scientific findings. EBP works to improve quality care for patients while working to help a facility efficiently run. As an office manager of a Gastroenterology practice, evidence based practice is important in working to improve our patient outcomes and help our facility improve our care. The GI field is always improving and finding new ways to diagnose and treat conditions related to the GI tract. For instance, a lot of our patients suffer from a condition known as celiac disease. Years ago, it would of been hard to treat this condition and detect it, but now we have the ability to utilize lab serum testing and ways of diagnosing through endoscopes. With my profession, I plan to maintain my relevance by continuing to work to provide treatment options for patients and finding ways to make testing measures affordable. One thing I have mentioned in the past is how our practice has opened affordable plan services for procedure options to locate GI conditions. One article found evidence based practice "prevents unsafe/inefficient practices and improves healthcare quality, but its implementation is challenging due to research and practice gaps" (Cardoso et al, 2021).  In the next three years I hope to still be in the Gastroenterology field. I really enjoy the management position I am in with being an office manager, but I want to do more. My practice is a small practice with one doctor. While sometimes this feels like a good thing, I feel as though I am limited on the amount of patients we can help. I hope int he next three years to move into a management position for a GI surgical facility or even at a hospital setting. My plan is to continue to implement ways to make screenings and care affordable. But also having access to treatment options that we can provide to patients for further protection. Scientific findings are so important to me, especially in the GI field. Years ago, the recommended age for colonoscopy screenings was over 50. My grandfather died at 51 due to having colon cancer that went undetected. Now the recommended age is 45 and there are so many patients that we have found it much much sooner and the outcome is not just to remain comfortable. We are able to treat it in many different ways. The Bible verse I have selected for this week is Proverbs 3:5-6, "Trust in the Lord with all your heart and lean not on your own understanding; in all your ways submit to him, and he will make your paths straight" (Bible Gateway Passage, n.d). To me this relates to the topic as I do not know where my mind will be in the next three years, but the Lord will get me to where I am going. He will ensure my path leads me to hopefully continue to improve the field and help those around me. I wish you all the best this week !

Complete the self-scoring “Followership Questionnaire” in Ch. 13 (p. 387) of Leadership: Theory and Practice. Due Thursday Write a response to the following: Based on your results from the “Followership Questionnaire,” describe your high-scoring and low-scoring followership styles. What might you consider working on as you strive to become the leader you envision?