Clinical Decision Making Process Research Paper - 550 Words

Clinical Decision Making Process (Research Paper Sample) Content: CLINICAL DECISION MAKING PROCESSName:Subject:Professor:University:City/State:Date:Issue DescriptionWorking jointly with my mentor, we were alerted to attend to a fifty year old patient who called for an ambulance complaining of severe chest pain. We found the patient seated eschew across the couch, drenched in sweat and in great distress. Drawing from the medical history of the patient, we learned that he had picked a hard-hitting row with his wife as he moved furniture from one location in the house to another, and then collapsed. Moreover, the client had been under medication for Stable Angina and hypertension. Upon examination of his blood pressure it was 170/100, his heart rate was 120 whilst his respiration recorded 24, his chest was clear on both sides and his GCS was at 15.We carried out a pulse Oximetry, with an ECG monitoring level at SaO2 92% and an ECG of Sinus tachycardia with St Depressants. The patient complained of intense pain on his middle chest. In a scale of 10, his pain rated at seven before we arrived at the scene, but after a while the pain abated to rate at 4 in a scale of ten. After carrying out the resting 12-lead electrocardiogram (ECG) the patient did not show St ElevationThinking Process AnalysisDuring the onset of the various assessments carried out on the patient we deduced that he was suffering form unstable angina. He complained of chest pain and certain tightness on which gave him a heavy crushing feeling on the chest making his breathing difficult. The patient was diagnosed with unstable angina given that he presented stable chest pain. Unlike unstable angina, stable angina can be diagnosed through clinical assessment alone or clinical assessment in addition to diagnostic testing (NICE, 2010 p.7). Thus the diagnosis of stable angina would have required two tests namely anatomical testing for obstructive coronary artery disease (CAD) and functional testing for myocardial ischaema. Moreover, other features that m ade the diagnosis of stable angina unlikely include very prolonged or continuous chest pain and chest pain that is unrelated to the activity the patient was doing (NICE, 2010 p.8).We managed the patient's cardiac pain by administering the anti-platelet therapy; we administered 300 mg of aspirin orally. To cater for the oxygen deficiency, we administered oxygen 10later per pint using the Non re-breather mask. To relieve pain, we administered GTN 5gm S/L decreased heat preload and vasodilator to coronary artery, hence easing the chest heaviness and pain (NICE, 2010 p.15). We transferred the patient to the hospital from where he had been receiving medication for stable angina and hypertension for further specialized medical examination. This is because the patient's lod ECG needed to be compared with the current ECG (Dekker and Crow, 2001 p.67).EvaluationAfter carrying out the diagnosis and managing the patient's cardiac complication the tests revealed that the patient was gradually f eeling better. The chest pain had drastically reduced so that the client said that in the scale of ten the pain was now at two. Moreover, the blood pressure was minimized to a manageable level of 150/90, RR 18, pales 100 and SaO2 96%.The patient was stable and breathed normally, there were no more excessive perspirations and he was able to sit down with ease. We were definitely carrying out the right management.RecommendationsIn future, I would recommend adherence to the following clinical procedure as an improvement in the decision making process. First and foremost I recommend the recording of 12-lead electrocardiogram (ECG) immediately and sending the results to the hospital before the arriv...

The GRE PowerPrep II Scoring Algorithm, Demystified.

The GRE PowerPrep II Scoring Algorithm, Demystified. Many years ago, I was doing some professional research on the GMAT scoring algorithm. I found several webpages on the topic, several of which were extremely informative. The authors would take the official GMAT Prep Software and run a variety of simulations with it, to see what types of strategies yield the best scores. The results were surprisingthey showed that the total number of questions correct and incorrect is far from the only factor in determining ones GMAT score.Well, the GRE is also a computer adaptive test (CAT), so I decided to do some research on the GRE PowerPrep II algorithm as well (new GRE scoring scale: 130 to 170). To my surprise, I have discovered that this information is nowhere to be found on the internet. So I decided to roll up my sleeves and do the research myself. First, some disclaimers:1) I cannot guarantee that the algorithm on the actual GRE is exactly the same as the algorithm on the GRE PowerPrep tests, likely as that may be.2) Doing these simulations took me forever. OK, not literally forever. But a lot of research (working through the software to double-check the answer keys) and a TON of mouse clicks (the PowerPrep tests dont have keyboard shortcuts, and you have to start every test with 15 clicks). Every question requires two clicks, and there are 80 questions per test. Thus, there may have been a human error or two mixed in there, because I didnt have time to double-check all of my simulations. If anyone wants to double-check my work, or to run additional simulations, then please, be my guestthe software is free to use and downloadbut running all the simulations myself took up too many hours of my life, and I am never doing that again.3) I only ran simulations on PowerPrep test #1. I would assume that test #2 is the same scoring algorithm, but I cannot guarantee that. 4) Dont forget that the real GRE (but not the PowerPrep practice tests) includes an experimental section in either Verbal or Quant, and it can be any of the s ections. So you wont necessarily know which sections are your first and second sections on the actual test. 5) If you are among the 2% of GRE test-takers taking the paper-based test, then you don't need to worry about PowerPrep. Instead, you should download the current paper-based GRE as well as the old one. These questions overlap with the PowerPrep II questions.BRIAN'S GRE POWERPREP 2 TEST SIMULATIONS AND SCORE ANALYSES:The first sections (Quantitative and Verbal) of the Powerprep CATs have only one version, which is of average difficulty.The second section has one of three possible versions (Easy, Medium, Hard), depending on your overall performance on the first section.Quant:0-7 correct: Easy8-14 correct: Medium15-20 correct: Hard Verbal:0-6 correct: Easy7-14 correct: Medium15-20 correct: HardThe first section is weighted more strongly than the second section. To get an idea of how you can earn the score you want, take a look at the table below, which lists a myriad of different score scenarios on the GRE PowerPrep CATs.As you can see, the total number correct is not always an accurate predictor of your score, because a heavier emphasis is put on the first section than the second.The key to a solid GRE score is to "qualify" for the medium or hard sections on your first scored section--doing so automatically improves your score. Of course, there is one major caveat to all of this: when you are taking the GRE, you are trying to get every question right, and you don't know which questions you are getting right and wrong. So in many ways, you are operating in the dark. However, this table should at least give you a better idea of precisely how you need to perform on the test in order to achieve your desired score. In order to easily access the easy, medium and hard second sections of the software, it helps to have an answer key. Here are the answer keys to PowerPrep Tests 1 and 2, with percent correct listed when possible (this information is only available for the PDF tests, not the PowerPrep only questions): PowerPrep Test 1 Answer Key With Percentiles / PowerPrep Test 2 Answer Key With PercentilesHaving now done this research, I am also qualified to address some unverified rumors I had heard about the GRE. Rumor #1: The GRE only scores your second sectionthe first section simply determines whether you get an Easy, Medium, or Hard second section. Verdict: FALSE. When controlling for scores on the second section, first section performance still has an effect on the final score (see table).Rumor #2: There is a penalty for leaving questions blank and/or not finishing the test.Verdict: FALSE. I ran some simulations on this (finishing the sections, but not getting any extra questions right vs. leaving half the questions blank) and did not find this to be true. However, you would have to be crazy to leave anything blank, because the GRE scoring algorithm does not care how many questions you get wrongit only cares how many questions you get right. Which means that you should make sure to give yourself enough time to answer any remaining questions, even if its a complete guess, because probability dictates that some of those guesses will be correct and thus lead to a higher score. Rumor #3: You can get a perfect score even with one question wrong.Verdict: TRUE. In order to get a perfect score o n math, you need to get all 40 questions right, but as you can see from the table, you can get one verbal question wrong (on either section) and still earn a perfect 170. A perfect combined score is 340, but any combined score 330 or above is an extremely elite score and should help earn you admission to nearly any graduate studies program. I hope this information helps you in your quest for a great score on the GRE computer adaptive exam. Please email me directly with any questions, comments, suggestions, suggested revisions, etc. at mcelroy@post.harvard.edu. And for more information about GRE prep, please check out my GRE Action Plan.