: Value Proposition in Patient Care

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HSA 501 ASSIGNMENT 1

Assignment 1: Value Proposition in Patient Care

Paradise Hospital, Inc. is a for-profit hospital. As the facility’s new hospital administrator, you have been tasked with improving the service value of the hospital. The administration has not done this process since the hospital began operating in the year 1995. The investors are not familiar with the value proposition strategies of hospitals in the current-day America.

Note: You may create and / or make all necessary assumptions needed for the completion of this assignment.

Write a four to six pages paper in which you:

1. Articulate the meaning of value-added service as it pertains to patient care services, and argue the major reasons why it matters to add value to patient services. Justify your response.

2. Outline a system for identifying the functional areas in which changes might be necessary in order to improve the hospital’s service value. Recommend the key methods that you would use to acquire the information necessary to identify the specified functional areas.

3. Specify four (4) specific areas where you believe the administration can add value in Paradise Hospital, and argue the most significant reasons why such value proposition would improve the value of services to the patients.

4. Use five (5) recent (within the last five [5] years) quality academic resources in this assignment. Note: Wikipedia and other websites do not qualify as quality academic resources.

NOTE: PLEASE USE AS A GUIDE OR REWRITE TO MAKE IT YOURS

 
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Cycle Ergometer and Step Submaximal Graded Exercise Tests

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LAB 2​​

Demonstration of Cycle Ergometer and Step Submaximal Graded Exercise Tests

Purpose

This laboratory experience is designed to illustrate the pretesting, testing, and posttesting procedures for conducting a submaximal graded exercise test (GXT) on the cycle ergometer and step and to develop your skill in administering these tests.

Equipment

· Stationary cycle ergometer

· Step with risers

· HR monitor

· Sphygmomanometer

· Metronome

Student Assignments

1. Select one apparently healthy student to serve as the client.

2. Select one or two students to prep the client for the test.

3. Assign one student to monitor and collect HR data from HR monitor.

4. Select one student to measure palpated HRs.

5. Select one student to measure BPs.

6. Select one student to set and monitor work rates on cycle ergometer.

7. Select one student to monitor client throughout test and to obtain client’s RPE.

Testing Procedures

1. Select an appropriate cycle ergometer protocol for the client.

2. Prepare the client for the test, explain purpose and nature of the GXT, measure height and body weight, position electrodes, and calculate target HR for test termination if required by the GXT protocol.

3. Collect resting data. Measure resting HR using palpation and HR monitor. Measure resting BP using auscultatory method.

4. Collect exercise data. Measure exercise HR every minute using palpation and HR monitor. Measure exercise BP during last 2 min of each stage of test. Ask client for RPE during last minute of each stage of test. Closely monitor client throughout test, checking for signs and symptoms that indicate the test should be terminated. Make certain that client achieves a steady-state HR during the last 2 min of each stage (HR values within ±5 to 6 bpm) before increasing the work rate.

5. Continue GXT until test protocol is completed or target exercise HR is achieved, or HR, BP data indicate test should be stopped, or client voluntarily terminates the test.

6. Collect recovery data for 3 to 5 min. Measure recovery HR every minute using palpation and HR monitor. Measure recovery BP every 2 to 3 min.

Data Analysis

1. Use the HR and work rate data from the last two exercise stages to estimate the client’s VO2max using the multistage method. Hint: Use the ACSM cycle ergometry equation (see table 4.3) to calculate the metabolic cost for the last two exercise stages. Note: Use ACSM equation only if client obtained steady state (i.e., HRs during last 2 min of each stage are within ±5 to 6 bpm) for the last two stages of the GXT.

2. Graph the HR versus energy cost (ml · kg-1 · min-1) data for the last two stages. Estimate the client’s VO2max using the graphing method.

3. Determine the client’s cardiorespiratory fitness level by classifying the estimated VO2max (see table 4.1).

4. Graph the client’s HR response during each minute of exercise and recovery. Plot HR on the y-axis and time on the x-axis.

5. Extra credit: Correlate the client’s exercise HRs obtained from palpation and the HR monitor using the Pearson product-moment correlation technique (rx,y).

Data Collection Form for Cycle Ergometer and Step Submaximal Graded Exercise Test

Client’s Demographics

Name ____________________ Date _________
Age ___32__ yr Body weight _80___ kg
Height __174___ cm  

Resting Data

HR ____86__ bpm

BP ____125/80__ mmHg

GXT Test 1 Data: Astrand-Rhyming Cycle Ergometer Test

Protocol __________________

Target HR for test termination (if needed) ________ bpm

Minute Work rate HR palpated HR monitored RPE Systolic BP Diastolic BP
  kgm · min-1 Watt          
1       140   140 80
2       148   160 85
        152   165 80
4       156   160 80
5       160   160 75
6       160   140 80

Recovery Data HR Sys Dys

1         139 120 80
2         120 120 80
3         115 110 70
4              
5              

Reasons for stopping the test:

GXT Test 2 Data: Harvard Step Test

Protocol __________________

Target HR for test termination (if needed) ___188_____ bpm

Minute Work rate HR palpated HR monitored RPE Systolic BP Diastolic BP
  kgm · min-1 Watt          
1       162      
2       180      
3       189      
4       189      
5       191      
6              

Recovery Data

1              
2              
3              
4              
5              

Reasons for stopping the test:

Converting predicted VO2 max values from absolute (L/min) to relative (ml/kg/min).

mL/min = L/min *1000

mL/kg/min = mL/ body weight in kg

Ex. An 80 kg man achieved a peak VO2 of 4.7 L/min

4700 mL/min = 4.7 L/min *1000

58.75 mL/kg/min = 4700 mL/min/ 80kg

Lab report: Due October 15

This lab is a comparison between the submaximal step test and submaximal bike test. You will be comparing your data and evaluating results from each test.

5 From V. Heyward and A. Gibson. 2014, Advanced Fitness Assessment and Exercise Prescription instructor guide, 7th ed. (Champaign, IL: Human Kinetics).
 
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“The Cell, Lokiarcharum, And RRNA”

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“The Cell, Lokiarcharum, and rRNA”

For your primary post, please respond to one of the following three topics with a post of at least 125 words that addresses each point given in the instructions. Also, please reply to at least one fellow student on any topic.

Topic 1

: Introduction to the Cell. Watch the Khan Academy video “Introduction to the cell” (1)* and then address the following issues.

  • (a) In the video, the narrator says that we might think that since cells are so small, that they must be simple, but “nothing could be further from the truth.” What did he mean by that?
  • (b) Describe features that are only found in eukaryotic (but not prokaryotic) cells.
  • (c) Did anything in this video surprise you, or was it mainly a recap of material you already knew?

Topic 2 [article]: Lokiarchaeum. Read about Lokiarcheum in the article by Yong (2)* and/or the article by Zimmer (3)*. Both articles describe recently discovered evidence about a previously unknown organism. Then, address the following issues:

  • (a) Lokiarchaeum may be a “transitional form” between archaea and eukarya. What evidence suggests this?
  • (b) Describe one way that this relates to this week’s lesson.
  • (c) Cite whichever article you use. If you use both, cite them both. There’s no particular reason why you should need any other source, but if you do use any other source, you must cite it, too.

Topic 3 [research]: Carl Woese. Carl Woese (b. 1928, d. 2012) worked out a new method for classifying organisms based on RNA from their ribosomes. This is called ribosomal RNA (rRNA). Research Carl Woese’s research on the Internet, and then address the following issues:

  • (a) Describe the basic logic of this Woese’s approach. In other words, how can you tell if two organisms are closely-related or distantly-related from their rRNA?
  • (b) Name one of Woese’s most important findings.
  • (c) Describe one way that this relates to this week’s lesson.
  • (d) Don’t forget to cite your source or sources!

References (in Strayer Writing Standards format).

  1. Khan Academy, November 29, 2017. Introduction to the cell,  https://www.youtube.com/watch?v=5KfHxF6Vhps
  2. Ed Yong, May 6, 2015. New Loki microbe is closest relative to all complex life,  http://phenomena.nationalgeographic.com/2015/05/06/new-loki-microbe-is-closest-relative-to-all-complex-life/
  3. Carl Zimmer, May 6, 2015, Under the sea, a missing link in the evolution of complex cells, http://www.nytimes.com/2015/05/07/science/under-the-sea-a-missing-link-in-the-evolution-of-complex-cells.html?_r=0
 
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Anatomy & Physiology Homework

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Dangerously Thin: A Case Study on the Genetic Code

At 65 years old, Henry Blake was in excellent health and enjoying his first year of retirement. Upon returning from his dream trip to the Great Barrier Reef in Australia, he noticed that his left leg was swollen just inferior to the knee. He already had scheduled an appointment for a complete physical, so he knew that in a few days he would be able to have his physician look at his leg.

Dr. Strickland had been the Blake family doctor for more than 40 years. Knowing that Henry had planned to do some traveling, Dr. Strickland opened with a question that Henry initially found to be a bit out of the ordinary.

“Any chance this swelling showed up after a long flight?”

“As a matter of fact it did,” Henry replied.

“My gut tells me that you may have a clot in that leg, but we’ll have to have a look at it before we’ll know for sure.”

Dr. Strickland knew that Henry’s family had a history of clotting disorders, and he had recently treated Henry’s brother for a deep vein thrombosis (DVT), a disorder that gets its name from the blood clots that form in a vein deep within the leg. A DVT was confirmed by the Doppler ultrasonography results (a test that uses sound to create images of blood flow). Dr. Strickland placed Henry on a “blood thinning” drug called warfarin, which works by preventing clots from forming.

Henry returned to his retirement plans but quickly found himself back in Dr. Strickland’s office after suffering from frequent nose bleeds. A laboratory test called an INR (International Normalized Ratio) was performed. This test measures the time it takes for blood to clot and compares it to an average. The test revealed that the time it took for Henry’s blood to clot was well above what would be expected for the dose of warfarin that he had been placed on. Dr. Strickland immediately took Henry off of his warfarin treatments and asked that he come in every three days for blood tests. Dr. Strickland became concerned when Henry’s abnormal INR results continued long after he had stopped taking warfarin.

Through genetic testing, Henry was found to carry a mutation in a gene for an enzyme called CYP2C9. While the strange name of the gene does not really fully appear to capture the importance of its function, it has a role in breaking down more than 15% of the drugs currently in use, and as many as 35% of people carry a slower acting form of this enzyme. The portion of Henry’s DNA that codes for the CYP2C9 enzyme contains more than 1,400 nucleotides. Henry carries two copies of the CYP2C9 gene, and the tests showed that both of them contain a mutation. On one of these genes, the 1075th nucleotide has been changed from an adenine (A) to a cytosine (C). This mutation converts an ATT triplet code in the coding strand of the DNA molecule to CTT. In Henry’s other CYP2C9 gene, the 430th nucleotide has been changed from a cytosine (C) to a thymine (T). The DNA triplet code CGT in the coding strand becomes TGT as a result of this mutation. Henry was considered a poor metabolizer (PM) because both of his CYP2C9 genes contained a mutation, and therefore he was not making any fully functional enzyme. People who carry two normal copies of the gene are referred to as extensive metabolizers (EM) for their ability to quickly break down drug molecules.

Short Answer Questions

1. Why would someone with this type of mutation be at a much higher risk for overdosing on a prescribed drug?

2. The underlying problem in this case resides in Henry’s “genes.” From what you know about the function of a gene, explain how this problem led to a malfunction in one of Henry’s proteins (the CYP2C9 enzyme).

3. The DNA changes that are described in Henry’s story are changes to the coding strands of the CYP2C9 genes. What is the function of the coding strand and how does it differ from the function of the template strand of Henry’s CYP2C9 gene?

4. Consider the following DNA sequence found on a different portion the coding strand of Henry’s CYP2C9 gene: TTACCGAGA

a. What would be the sequence of the template strand on this portion of the gene?

b. How many triplet codes does this DNA sequence contain?

c. What would be the sequence of the mRNA after this sequence is transcribed?

d. How many amino acids does this portion of Henry’s coding stand actually code for?

5. In the first mutation of the CYP2C9 gene described in Henry’s story, the 1075th nucleotide had changed from an adenine (A) to a cytosine (C). This mutation converts an ATT triplet code in the coding strand of the DNA molecule to CTT. Beginning with this triplet code on the DNA, describe the effect that this change would have on the following:

a. The nucleotide sequence on the template strand of the gene.

b. The mRNA codon that results after this triplet code is transcribed.

c. The anticodon on the tRNA molecule that is complementary to the mRNA codon described above.

d. The amino acid that would be carried by the tRNA molecule described above.

6. In Henry’s other CYP2C9 gene, the 430th nucleotide had changed from a cytosine (C) to a thymine (T). This mutation converts a CGT triplet code in the coding strand of the DNA molecule to TGT. Beginning with this triplet code on the DNA, describe the effect that this change would have on the following:

a. The nucleotide sequence on the template strand of the gene.

b. The mRNA codon that results after this triplet code is transcribed.

c. The anticodon on the tRNA molecule that is complementary to the mRNA codon described above.

d. The amino acid that would be carried by the tRNA molecule described above.

7. From what you understand about enzymes, explain why a change in an amino acid would cause Harry’s enzyme to lose its function.

8. In both of Henry’s mutations, it is the first nucleotide in the DNA triplet code that has been changed.

a. Using the genetic code chart below, create a list of single nucleotide changes in the two affected triplet codes described for Henry’s genes that could occur WITHOUT resulting in a change in the amino acid in the enzyme.

NOTE: The code chart below contains mRNA codons and the amino acids associated with those codons. Your list should contain DNA triplet codes.

image1.png

b. How many triplet code changes did you find that could occur WITHOUT resulting in an amino acid change in the enzyme?

c. Which position (first, second, or third) did the changes occur within the DNA triplet codes you listed above?

d. What would you conclude from the pattern that emerged?

 
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