Please provide  a rebuttal in an AMA format. Please write 200 words.

please use one reference. Thank you.

Please respond to this-

Ethics is a system of standards applied to medical research to ensure the study is well-designed, has integrity, and protects the individuals involved. Ethical research is critical when human subjects are included. The safety of research subjects should be as important as the significance of the study. Ethics ensure that researchers do not compromise the health and well-being of their subjects while completing their study. Throughout history, several examples of research did not meet ethical guidelines for human subjects. As a result, the individuals involved were manipulated and inevitably harmed by the conducted research.

The Tuskegee Syphilis study was an example of a gross ethics violation in medical research.1 In this study, disadvantaged African American men were studied for the effects of long-term syphilis. Even when treatment was developed and readily available, it was withheld from the research participants. Ethically speaking, their involvement in the study was financially driven to some degree. The subjects were incentivized to participate, and informed consent was not obtained. Syphilis treatment could have drastically changed the course of these participants’ lives. Instead, the researchers in this study withheld curative therapy for these individuals, thus causing direct harm.

Another example of a severe ethical violation is the Willowbrook Hepatitis study.2 In this study, disabled children were exposed to hepatitis to study the effects of the illness. This study lasted more than 10 years, and given that the infection rate was high at the school anyway due to poor conditions, intentional exposure was deemed appropriate. This, again, is another example of how medical research failed its subjects. As with all research, there are possible risks; however, knowingly infecting mentally disabled individuals with a devastating disease is unacceptable.

Informed consent is a fundamental component of research. Participants must be aware of a research study’s potential risks and benefits. Informed consent is not met just by explaining to a subject what the research entails; the individual must understand their involvement and possible complications in-depth. Consent is necessary to ensure a research subject fully comprehends the intended study. Informed consent allows participants to agree to or deny the proposed treatment and empowers them to accept the associated risks with the planned research.

Over the years, there has been significant improvement in the ethics of medical research. Today, research must be a minimal risk to patients, and subjects must be made aware of all possible complications associated. Over the years, the change in ethical guidelines was necessary to uphold research integrity and protect involved individuals. In addition, informed consent has been developed to ensure that subjects genuinely understand the why, how, and what of their participation.

References

1. The syphilis study at Tuskegee timeline. CDC. December 5, 2022. Accessed March 4, 2023. https://www.cdc.gov/tuskegee/timeline.htm

PLEASE WRITE A 200 WORD REBUTTAL ADDRESING THIS DISCUSSION BOARD POST.

AMA FORMAT, 2 REFRENCES, 200 WORDS, KEEP REFRENCES IN ORDER PLEASE.

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INTRODUCTION

The topic of my graduation project is to write a clinical review article discussing the physiological effects of aeromedical transport. 

DISCUSSION

The first database being utilized is PubMed. A search using the term “aeromedical transport” was performed with a filter that selected articles published within the last 5 years. Utilizing these parameters, 250 articles were listed. The first article listed is a literature review by Ariaza et al discussing the aeromedical transport of critically ill patients.1 After clicking on the link to open the abstract, several related articles are listed in PubMed. A useful article by Loyd et al discusses background information regarding aeromedical evacuation.2 Utilizing this technique of looking at the articles related to the articles found in the database search will increase the number of relevant sources.

          When a PubMed MeSH heading search was performed using the term “aeromedical”, no results could be found. When searching for “aeromedical transport”, a few unrelated topics were listed that were not useful. Finally, after searching for “air ambulance”, it was found to be located in the search tree under emergency medical services and transportation of patients. It also lists emergency helicopters and helicopter ambulances as related search terms. Using “air ambulance” in a PubMed search filtering articles within the past 5 years returned 1,314 publications. Changing the search to “air ambulance AND physiology” returned 125 articles with a relevant article by Nakajima et al discussing body temperature changes and outcomes of patients undergoing long-distance air medical transport.3

          Another search using Google Scholar was performed using the term “aeromedical transport”. After filtering for articles in the past 5 years, over 5,000 articles were populated. Several of the first articles listed were found in the previous PubMed search with the same search terms. The 5,000 articles were further filtered to include only review articles. After using this filter, 556 articles were listed, one of which was an article by Fouts and Mortimer reviewing the stresses of flight during aeromedical transport.4

CONCLUSION

Utilizing the search techniques found in this week’s lesson, several articles relevant to the topic of my doctorate article were found. Besides the articles already listed above, other relevant references include publications by Proctor et al, Butler et al, Fang et al, and Singer et al.5678 These articles and others will greatly help in the writing of my clinical review article discussing the physiological effects patients experience during aeromedical transportation.

REFERENCES

1. Araiza A, Duran M, Surani S, Varon J. Aeromedical transport of critically ill patients: A literature review. Cureus. 2021;13(5):e14889. doi:10.7759/cureus.14889

PLEASE WRITE A 200 WORD REBUTTAL ADDRESING THIS DISCUSSION BOARD POST.

AMA FORMAT, 2 REFRENCES, 200 WORDS, KEEP REFRENCES IN ORDER PLEASE.

////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////

INTRODUCTION

The topic of my graduation project is to write a clinical review article discussing the physiological effects of aeromedical transport. 

DISCUSSION

The first database being utilized is PubMed. A search using the term “aeromedical transport” was performed with a filter that selected articles published within the last 5 years. Utilizing these parameters, 250 articles were listed. The first article listed is a literature review by Ariaza et al discussing the aeromedical transport of critically ill patients.1 After clicking on the link to open the abstract, several related articles are listed in PubMed. A useful article by Loyd et al discusses background information regarding aeromedical evacuation.2 Utilizing this technique of looking at the articles related to the articles found in the database search will increase the number of relevant sources.

          When a PubMed MeSH heading search was performed using the term “aeromedical”, no results could be found. When searching for “aeromedical transport”, a few unrelated topics were listed that were not useful. Finally, after searching for “air ambulance”, it was found to be located in the search tree under emergency medical services and transportation of patients. It also lists emergency helicopters and helicopter ambulances as related search terms. Using “air ambulance” in a PubMed search filtering articles within the past 5 years returned 1,314 publications. Changing the search to “air ambulance AND physiology” returned 125 articles with a relevant article by Nakajima et al discussing body temperature changes and outcomes of patients undergoing long-distance air medical transport.3

          Another search using Google Scholar was performed using the term “aeromedical transport”. After filtering for articles in the past 5 years, over 5,000 articles were populated. Several of the first articles listed were found in the previous PubMed search with the same search terms. The 5,000 articles were further filtered to include only review articles. After using this filter, 556 articles were listed, one of which was an article by Fouts and Mortimer reviewing the stresses of flight during aeromedical transport.4

CONCLUSION

Utilizing the search techniques found in this week’s lesson, several articles relevant to the topic of my doctorate article were found. Besides the articles already listed above, other relevant references include publications by Proctor et al, Butler et al, Fang et al, and Singer et al.5678 These articles and others will greatly help in the writing of my clinical review article discussing the physiological effects patients experience during aeromedical transportation.

REFERENCES

1. Araiza A, Duran M, Surani S, Varon J. Aeromedical transport of critically ill patients: A literature review. Cureus. 2021;13(5):e14889. doi:10.7759/cureus.14889

Please provide a discussion board rebuttal that is 200 words, AMA format, one reference.

Rebuttal to this statement below.

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The majority of my career has been working in an urgent care setting. This setting often required the providers to resolve onsite conflicts, only including upper-level management, if necessary. The freedom to make decisions within reason can often seem alluring. However, many times the providers at this clinic would face difficult choices to ensure the productivity and sustainability of the clinic.

One of the most challenging decisions I faced as a provider in this clinic was the need for disciplinary action against one of the team members. While I technically had no disciplinary authority, I was responsible for reporting concerns to upper-level management if they could not be resolved internally. Unfortunately, one of the team members employed at this clinic developed an undesirable and pessimistic attitude toward her position. As a result, the atmosphere at the clinic became hostile, unproductive, and destructive. As the onsite leader, I attempted to talk with her to understand her displeasure. Unfortunately, her attitude only worsened. The clinic started to receive complaints from her coworkers and patients regarding her attitude. At this point, I decided to involve upper-level management to determine a resolution to her disruptive behavior. 

Upper-level management applied a heuristic approach to the decision and ultimately decided to terminate her employment. A heuristic approach applies assumptions to a problem to determine a rapid solution without much research into the cause.1 No one at the clinic realized that this team member had a previous disciplinary action on file; this led her manager to assume she was a continued problem. As a result, her employment was terminated, and she was placed on the dreaded “illegible for rehire” list. This decision devastated me. I felt overwhelming guilt as I had initiated the investigation with management.

Reflecting on this event in my career, I would have attempted to speak to the team member again to understand her position. Her frustration stemmed from a high-volume, demanding clinic, and she struggled to keep pace. She likely could have been beneficial elsewhere in the system if given a chance. I regret that I did not employ some of the critical topics I have learned throughout this course to understand better my teammate’s concerns and how to troubleshoot and resolve the issue without the involvement of upper-level management. As Chang states, we cannot expect decisions to be easy as those are not challenging and hard choices provide opportunities.2 The easy choice for me was to report her behavior to management to avoid conflict.  My advice would be to accept the challenge of a hard choice. In reflection, facing the hard choice of resolving the conflict myself could have resulted in her continued employment.

Discussion board rebuttal.

Please use AMA format, 200 words, one reference.

Please provide a rebuttal to this post from our discussion board.

Thank you

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Please reply to the following regarding ntended doctoral project will be a case report of a 60-year-old uncontrolled diabetic woman admitted with septic shock secondary to emphysematous pyelonephritis. Unenhanced CT of the abdomen and pelvis revealed severe right emphysematous pyelonephritis with gas tracking into the retroperitoneum and mediastinum. Urine and blood cultures grew pansensitive Escherichia Coli. She underwent resuscitation and was started on empiric antibiotics followed by urgent open right radical nephrectomy and retroperitoneal washout. Operative findings revealed severe necrotizing emphysematous pyelonephritis involving the right kidney, right retroperitoneum with extension into the left retroperitoneum, and mediastinum.

One of the journals I am considering submitting my article to is the Journal of the American Academy of Physician Assistants (JAAPA). Physician Assistants (PAs) can be first authors for this journal. JAAPA covers many topics and publishes multiple types of articles, including case reports. Case reports must be between 1,500-2,000 words.1 A benefit of publishing with JAAPA is that there are infrequent urologic articles published, with the most recent being published in 2020. No articles about emphysematous pyelonephritis were found in my search of prior published articles in JAAPA. A concern I have about publishing in JAAPA is that my topic may be too specialized for the journal. However, this topic would also be of interest to emergency medicine, hospitalist, and infectious disease PAs.

I also looked into publishing in the Journal of Urology which is the official journal of the American Urologic Association (AUA) of which I am a member. They, unfortunately, do not accept case reviews. The AUA’s newest publication, the JU Open Plus, which is an open-access online journal does accept case reviews. PAs are able to be first authors in this journal. The word limit for a case report is 1,500 words. Regrettably, it does have a fee of $750 to publish a case review even as an AUA member.2

Another journal I am considering is Sutureline which is the American Association of Surgical Physician Assistants (AASPA) journal. PAs can be first authors in this journal. It accepts multiple types of articles, however, the instructions for authors do not specify if case reviews are accepted. I have reached out to the journal, but have yet to hear back. The word limit is listed at 3,000.3 It is a good choice to consider since my topic involves surgical management, though this will be dependent on whether case reports are accepted or not.

paring for the day’s challenges, reflecting on the effectiveness of the previous work day, and envisioning the ideal leadership model are important.1 Such reflection improves a leader’s compassion towards others in the workplace.1

In addition, self-regulation of a leader’s personal reaction to conflicts and challenges, ensures initial supervision of oneself, prior to leading others.1 This task involves rating the value of an event’s life importance on a scale of 1-10.1 A rating of 1 would be low-level importance, while a 10 would represent a critical life event. This provider found this tool, exceptionally helpful in the workplace. Many challenges seem important; however, credibility as a leader improves if there is a level of discernment first.

Finally, in the words of Marcus Aurelius, emperor, and philosopher, “So act virtuously, use your free will, and be cheerful. Then, when you drop from life’s tree, you will drop like a ripe fruit.”1

Discussion board rebuttal.

Please use AMA format, 200 words, one reference.

Please reply to the following regarding TEDx talk by Lars Sudman, “Leadership Utopia.”1

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Much leadership advice is available in books, audio podcasts, and videos. Managers obtain formal training in university and graduate programs on leadership as well. However, managers are human and prone to mistakes, judgments, and ineffective leadership styles, based on their own experiences, values, and culture. It is imperative that a tool of self-reflection be utilized regularly to enhance and improve managerial abilities.

One effective way for a manager to engage this tool is presented in the TEDx talk by Lars Sudman, “Leadership Utopia.”1 Mr. Sudman touts the belief that excellent leadership starts with self-leadership.1 The premise of this theory starts with identifying the greatest leader from past experience. Using this model to identify admirable traits is important. Sudman uses the example of the Roman emperor, Marcus Aurelius.1 The leader proclaimed, “The happiness of your life depends on the quality of your thoughts.”1

The content of Mr. Sudman’s talk offers a helpful, daily, mental exercise plan for leaders to implement. The 3 tools are 1) self-awareness, 2) self-reflection, and 3) self-regulation.1

Before the work day starts, identifying traits of a poor leader also reveals similar tendencies in ourselves. This provider experienced a former manager that withheld important information, was vague with leadership instructions and offered no definitive plan to manage provider-nurse conflict in the office. Sudman theorizes that characteristics we find at fault in others often reflect similar traits in ourselves.1 Using the self-awareness tool, this provider recognized that conflict is avoided by being direct in certain situations and avoiding vagueness regarding patient safety concerns. The attempt to avoid hurting others’ feelings in this situation, was not fulfilling the organization’s mission of providing good healthcare. As Schwartzer illuminates, mistakes eventually occur in the workplace, if proactive leadership regarding office stressors is not implemented.2

Self-reflection is the second step in effective leadership. Preparing for the day’s challenges, reflecting on the effectiveness of the previous work day, and envisioning the ideal leadership model are important.1 Such reflection improves a leader’s compassion towards others in the workplace.1

In addition, self-regulation of a leader’s personal reaction to conflicts and challenges, ensures initial supervision of oneself, prior to leading others.1 This task involves rating the value of an event’s life importance on a scale of 1-10.1 A rating of 1 would be low-level importance, while a 10 would represent a critical life event. This provider found this tool, exceptionally helpful in the workplace. Many challenges seem important; however, credibility as a leader improves if there is a level of discernment first.

Finally, in the words of Marcus Aurelius, emperor, and philosopher, “So act virtuously, use your free will, and be cheerful. Then, when you drop from life’s tree, you will drop like a ripe fruit.”

Please provide a short 200 word rebuttal to the below pasted discussion board on power.

Please write in Ama format with one refrence.

This is the discussion board essay to write the rebuttal to

Its is based off of French and Raven’s five bases or sources of power are

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“Borkowski and Meese1 discuss the five sources of social power first detailed in a 1959 study.  The five sources of social power are reward power, coercive power, referent power, legitimate power, and expert power.1  A manager can show reward power when they have the ability to reward a subordinate’s behavior with something of value to that subordinate.1  Coercive power is just that, a manager that has the ability to punish subordinates by doling out actual punishment or by removing something of value.1  Legitimate power comes in three different types cultural, social, and delegating.1  The cultural type is power resting with those whom a particular culture has deemed to be the decision maker and can be based on age, sex, etc.1  The delegating and social types are close in nature where the delegation type is bestowed by the legitimizing power and social are granted to those in certain positions within a formal organization’s hierarchy.1  Referent power comes with attraction to or identification with somebody else whereas expert power is awarded to those who demonstrate a certain level of knowledge in a particular area.1

In the given scenario, by virtue of his position as the department manager Joe has reward power, coercive power, and legitimate social power.  Betty in the given scenario has expert power.  Joe’s managerial position as department head likely gives him a great amount of latitude to hire, motivate, counsel, as well as terminate subordinates under him.  The position within the organization inherently gives Joe legitimate social power within the formal organization.  As department head, he would likely be within his authority to reward subordinates with time off, choice of projects, and preference to temporarily step into Joe’s position when he’s out of the office.  Most managers tend to have a motivational preference for carrots or sticks and coercive power in the form of ultimatums and direct orders also have their place within a manager’s motivational repertoire. 

Betty, by Joe labeling her the “answer to my problems” has expert power.  She’s an expert in the computer software the department uses, and frankly, it is likely this expertise that blinds her to the reason Joe was promoted over her.  de Waal and coleagues2  detailed Betty’s attitude toward Joe and the new trainees aptly when she puts her agenda ahead of the organization’s.  She’s focused on putting her work first without a care about the department when she appears unaware that her work will be viewed as a component of the whole and the whole is more than the sum of its parts.  By withholding pertinent information from the new team members, de Waal et al2 indicate the organization’s performance will be negatively affected she’s inhibiting any shared learning and innovation that is possible within the department.

Please provide a short 200 word rebuttal to the below pasted discussion board on power.

Please write in Ama format with one refrence.

This is the discussion board essay to write the rebuttal to

Its is based off of French and Raven’s five bases or sources of power are

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“Borkowski and Meese1 discuss the five sources of social power first detailed in a 1959 study.  The five sources of social power are reward power, coercive power, referent power, legitimate power, and expert power.1  A manager can show reward power when they have the ability to reward a subordinate’s behavior with something of value to that subordinate.1  Coercive power is just that, a manager that has the ability to punish subordinates by doling out actual punishment or by removing something of value.1  Legitimate power comes in three different types cultural, social, and delegating.1  The cultural type is power resting with those whom a particular culture has deemed to be the decision maker and can be based on age, sex, etc.1  The delegating and social types are close in nature where the delegation type is bestowed by the legitimizing power and social are granted to those in certain positions within a formal organization’s hierarchy.1  Referent power comes with attraction to or identification with somebody else whereas expert power is awarded to those who demonstrate a certain level of knowledge in a particular area.1

In the given scenario, by virtue of his position as the department manager Joe has reward power, coercive power, and legitimate social power.  Betty in the given scenario has expert power.  Joe’s managerial position as department head likely gives him a great amount of latitude to hire, motivate, counsel, as well as terminate subordinates under him.  The position within the organization inherently gives Joe legitimate social power within the formal organization.  As department head, he would likely be within his authority to reward subordinates with time off, choice of projects, and preference to temporarily step into Joe’s position when he’s out of the office.  Most managers tend to have a motivational preference for carrots or sticks and coercive power in the form of ultimatums and direct orders also have their place within a manager’s motivational repertoire. 

Betty, by Joe labeling her the “answer to my problems” has expert power.  She’s an expert in the computer software the department uses, and frankly, it is likely this expertise that blinds her to the reason Joe was promoted over her.  de Waal and coleagues2  detailed Betty’s attitude toward Joe and the new trainees aptly when she puts her agenda ahead of the organization’s.  She’s focused on putting her work first without a care about the department when she appears unaware that her work will be viewed as a component of the whole and the whole is more than the sum of its parts.  By withholding pertinent information from the new team members, de Waal et al2 indicate the organization’s performance will be negatively affected she’s inhibiting any shared learning and innovation that is possible within the department.

Please provide a 200 word rebuttal to the discussion board Medical Appraisal article. Please use 1 refrence.

Please write in AMA format-

Thanks-

This is the appraisal I have to provide a rebuttal-

“The study is of good quality and valid based on a critical appraisal of the article. It had a well-formulated clinical question using the PICO approach.1 In the NEJM article provided, the clinical question asked was if the use of remdesivir in symptomatic, high-risk, Covid-19 positive, nonhospitalized patients prevents hospitalization or death within 28 days. It also addressed whether it had an acceptable side effect profile.2 It was published in a well-known high-quality journal and had multiple clinician authors which increase the reader’s trust. It was determined to be a valid study after looking at randomization, blinding or masking, and interventions.1 The article clearly stated that the study was a double-blind randomized controlled trial (RCT) and that this was maintained until the data was finalized, supporting the study’s validity. The article described the treatment as receiving 200 mg of IV remdesivir on day 1 followed by 100 mg on days 2 and 3 versus the control group who received a placebo.2 The study did not specify whether patients were allowed to or did use any over-the-counter (OTC) therapy which could have affected the results and therefore the study’s validity.1 It also specified inclusion and exclusion criteria, supporting its validity.3

The data was then analyzed to determine whether the results were statistically significant. Hazard ratios, confidence intervals, and P values were provided in a table. The text reported the relative risk reduction (RRR) stating that the risk of hospitalization related to Covid-19 or death for any reason by day 28 was 87% lower in the treatment group versus the control group.2 They do not provide the absolute risk reduction (ARR), however, this was calculated to be 4.6%. They did not provide the number needed to treat. This was calculated to be 21.7, which means that approximately 22 patients need to be treated with remdesivir to prevent 1 Covid-19-related hospitalization or death. Adverse events were almost equal in both groups, however serious adverse events were less likely to occur in those treated with remdesivir based on the odds ratio which was calculated to be 0.25.

After appraising the article and determining the validity of the study, providers should then use their clinical judgment in deciding whether this study applies to their particular patient. This entails comparing patient characteristics and comorbidities to the subjects of the study and deciding whether they are similar enough to apply this new information. Providers should also take into consideration their patient’s preferences and values, such as whether the side effects and cost are acceptable.4 The results of this study would be clinically significant should the provider determine that their patient is similar enough to the study subjects and that their preferences and values align with the treatment.”

Please provide a 200 word rebuttal to the discussion board Medical Appraisal article. Please use 1 refrence.

Please write in AMA format-

Thanks-

This is the appraisal I have to provide a rebuttal-

“The study is of good quality and valid based on a critical appraisal of the article. It had a well-formulated clinical question using the PICO approach.1 In the NEJM article provided, the clinical question asked was if the use of remdesivir in symptomatic, high-risk, Covid-19 positive, nonhospitalized patients prevents hospitalization or death within 28 days. It also addressed whether it had an acceptable side effect profile.2 It was published in a well-known high-quality journal and had multiple clinician authors which increase the reader’s trust. It was determined to be a valid study after looking at randomization, blinding or masking, and interventions.1 The article clearly stated that the study was a double-blind randomized controlled trial (RCT) and that this was maintained until the data was finalized, supporting the study’s validity. The article described the treatment as receiving 200 mg of IV remdesivir on day 1 followed by 100 mg on days 2 and 3 versus the control group who received a placebo.2 The study did not specify whether patients were allowed to or did use any over-the-counter (OTC) therapy which could have affected the results and therefore the study’s validity.1 It also specified inclusion and exclusion criteria, supporting its validity.3

The data was then analyzed to determine whether the results were statistically significant. Hazard ratios, confidence intervals, and P values were provided in a table. The text reported the relative risk reduction (RRR) stating that the risk of hospitalization related to Covid-19 or death for any reason by day 28 was 87% lower in the treatment group versus the control group.2 They do not provide the absolute risk reduction (ARR), however, this was calculated to be 4.6%. They did not provide the number needed to treat. This was calculated to be 21.7, which means that approximately 22 patients need to be treated with remdesivir to prevent 1 Covid-19-related hospitalization or death. Adverse events were almost equal in both groups, however serious adverse events were less likely to occur in those treated with remdesivir based on the odds ratio which was calculated to be 0.25.

After appraising the article and determining the validity of the study, providers should then use their clinical judgment in deciding whether this study applies to their particular patient. This entails comparing patient characteristics and comorbidities to the subjects of the study and deciding whether they are similar enough to apply this new information. Providers should also take into consideration their patient’s preferences and values, such as whether the side effects and cost are acceptable.4 The results of this study would be clinically significant should the provider determine that their patient is similar enough to the study subjects and that their preferences and values align with the treatment.”