Pharmacy calculations are very important for prescribing, especially in regards to renal function and pediatric dosing

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Getting Started

Pharmacy calculations are very important for prescribing, especially in regards to renal function and pediatric dosing. This assignment will focus on calculating renal function and medication doses for pediatric patients. Review the information below and then follow the subsequent instructions.

Upon successful completion of the course material, you will be able to:

  • Successfully calculate dosing for renal functions

Background Information

Renal function

Renal function can be calculated different ways but the most common ways are using the Cockcroft-Gault and CKD-EPI equations (see below). If adjustments to dosing are required due to decreased renal function, it is important to know which equation should be used. This can be found in a drug reference or the package insert for a particular medication. In general, if renal cutoffs are expressed as mL/min the Cockcroft-Gault equation should be used but if renal cutoffs are expressed in mL/min/1.73m2 then the CKD-EPI equation should be used. Different equations are necessary to calculate renal function in the pediatric population.

The Cockcroft-Gault equation is as follows:

  • CrCl = [(140-age) (ideal body weight)]/[(72) (SCr)] x 0.85 (if female)
    • age is expressed in years
    • weight is expressed in kg [ideal body weight (IBW) should be used except for obese patients, in which case adjusted body weight is typically used]
    • SCr is serum creatinine expressed in mg/dL
    • IBW (male) = 50kg + 2.3 kg for each inch of height over 5 feet
    • IBW (female) = 45.5kg + 2.3 kg for each inch of height over 5 feet
    • Adjusted body weight = IBW + [0.4 x (actual body weight – IBW)]

The CKD-EPI equation is as follows:

  • eGFR = 141 x min(SCr/κ, 1)α x max(SCr /κ, 1)-1.209 x 0.993Age x 1.018 [if female] x 1.159 [if Black]
    • eGFR (estimated glomerular filtration rate) = mL/min/1.73 m2
    • SCr is serum creatinine expressed in mg/dL
    • κ = 0.7 (females) or 0.9 (males)
    • α = -0.329 (females) or -0.411 (males)
    • min = indicates the minimum of SCr/κ or 1
    • max = indicates the maximum of SCr/κ or 1
    • age = years

Pediatric Dosing

In general, medication dosing for pediatric patients is based on weight. This makes it particularly important to be able to calculate doses appropriately. The most basic calculation is dose (ie. mg/kg) times weight (in kg).

Example

  • Cefdinir (Omnicef®) for acute otitis media is 14 mg/kg/day in 1-2 divided doses
    • What would the recommended dose be for a 22 lb patient?
    • First, lbs must be converted to kg.
      • 22 lb x (1 kg/2.2 lb) = 10 kg
    • Now, the dose can be calculated.
      • 14 mg/kg x 10 kg = 140 mg
    • Based on the dosing recommendation above, this could be given 2 different ways:
      • 140 mg once daily
      • 70 mg two times daily

For liquids or suspensions, medication doses are often given as the volume to be given to the patient. One must be aware of the available concentrations for a particular medication.

Example

  • Cefdinir (Omnicef®) is available in the following concentrations:
    • 125 mg/5 mL
    • 250 mg/5 mL
  • Using the example above, how many mL would be needed for 140 mg daily?
    • [140 mg / 125 mg] x 5 mL = 5.6 mL
    • [140 mg / 250 mg] x 5 mL = 2.8 mL
    • Often, we have to round to the nearest 0.5 mL to make it easier to administer using an oral syringe. Rounding the first option to 5.5 mL would give the patient 137.5 mg (5.5 mL x 125 mg/ 5 mL)

Instructions

  1. Print out the Calculations Quiz.
  2. Complete each question by hand and show your work.
  3. Scan the completed quiz and submit via the Assignment.

This assignment is worth 50 Points

Access the Assignment submission page

  • attachment

    Calculation.pdf

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There has been an increase of interest in the role of spirituality in health care, as well as in the workplace and other fields in general.

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PHI-413V Lecture 1

Worldview Foundations of Spirituality and Ethics

Introduction

There has been an increase of interest in the role of spirituality in health care, as well as in the workplace and other fields in general. This interest has been met with a variety of responses, including an uneasiness that has historical roots. There is generally a perceived tension between science and religion/spirituality. This estrangement between the worlds of science and religion is in some ways not truly reflective of some inherent incompatibility between science and religion per se, but rather a reflection of underlying worldview tensions. The rediscovery of spirituality and its implications for health care provides recognition that the estrangement between the two worlds has not served patients’ best interests. If this is the case, then part of the task of serving patients well will require some basic worldview training in order to not only understand patients’ own backgrounds more clearly, but to also promote the fruitful interaction of science and religion in the health care setting more generally.

Spirituality and Worldview

The theoretical and practical foundations of any discipline or field take place within the wider framework of what is known as a worldview. A “worldview” is a term that describes a complete way of viewing the world around you. For example, consider religion and/or culture. For many people, their religion or culture colors the way in which they view their entire reality; nothing is untouched by it and everything is within its scope. Yet one need not be religious to have a worldview; atheism or agnosticism are also worldviews. Thus, all of one’s fundamental beliefs, practices, and relationships are seen through the lens of a worldview. The foundations of medicine and health care in general bring with it a myriad of assumptions about the very sorts of questions answered in a person’s worldview. Consider carefully the seven questions in the Called to Care textbook in order to begin grasping more clearly the concept of a worldview.

A Challenging Ethos

A fundamental thesis of this course is that two sorts of underlying philosophies or beliefs about the nature of knowledge, namely, scientism and relativism, are at the heart of this perceived tension between science and religion. Moreover, scientism and relativism help explain to some degree why this tension has not served the best interests of patients, and is even at odds with the fundamental goals of medicine and care.

Scientism is the belief that the best or only way to have any knowledge of reality is by means of the sciences (Moreland and Craig, 2003, pp. 346-350). At first glance this might sound like a noncontroversial or even commonsensical claim. However, think about this carefully. One way to state this is to say that if something is not known scientifically then it is not known at all. In other words, the only way to hold true beliefs about anything is to know them scientifically. Relativism on the other hand is the view that there is no such thing as truth in the commonsensical sense of that concept. Every claim about the nature of reality is simply relative to either an individual or a society/culture. Thus, according to this way of thinking, it might be true here in the United States that equality is a good thing, but in some Middle Eastern countries it is simply not a concern. Yet there is no ultimate truth of the matter, it is simply a matter of individual or popular opinion. In some way, truth is just what an individual or a culture decides that it is, and therefore not truly discovered, but invented.

The current context of health care and medicine in the West is defined by an ethos (the prevailing attitudes and beliefs of a culture) of scientism and relativism. This ethos has exacerbated the perceived philosophical and cultural tension between science and religion. The result has been a general relativizing and caricaturing of religion, and the elevation of science as the default epistemology for all things rational or even true.

While scientism may seem commonsensical or rational at first glance, a closer examination reveals glaring weaknesses. It should be noted right from the outset that scientism is not equivalent to science. This is because scientism is a philosophy about the nature and limits of science as well as the extent of human knowledge. Scientism is a philosophical thesis that claims that science is the only methodology to gain knowledge; every other claim to knowledge is either mere opinion or false.

One of the most pressing dilemmas for scientism is science’s inability to make moral or ethical judgments. To understand why, consider the nature of scientific claims and their distinction from moral or ethical judgments. General scientific claims can be described simply as the attempt to make descriptions of fact. But when people make moral or ethical judgments, they do not simply make statements of fact (though that is part of it), but are evaluating those fact claims. Thus when making a moral judgment people are evaluating whether some fact is good or bad. Thus consider the distinction between the following statements:

(1) 90% of Americans believe that racism is wrong.

(2) Racism is wrong.

Statement (1) is a statement of fact in the sense that it is meant to describe the way things actually are, or what is the case. Statement (2) however, makes a judgment; it makes a normative claim in the sense that it is making a claim about what ought to be the case. Statement (2) is not simply reporting or describing the facts. It is saying that it is not the way it is supposed to be. In recognizing these differences, a crucial distinction has surfaced between (1) scientific claims and (2) moral and ethical claims. Scientific claims are limited to statements of description; they are solely claims about what is the case. Moral and ethical statements are prescriptive and are evaluative claims about what ought to be the case. This has been described as the fact-value distinction to designate the difference between facts and values, values being a prescription of the way things ought to be, the moral evaluation of facts. This distinction has also been described as the “is” (fact) versus “ought” (value) distinction.

Thus, because science deals with mere facts, it is not in a position to say anything about what ought to be the case. Science is relevant to moral and ethical claims in interesting ways, but prescriptive statements about what morally ought to be the case are simply beyond the bounds of science. To try to derive what ought to be the case only from what is the case is a logical fallacy. If one were to look at the world and the way things are, and then claim that it simply follows that it is the way it ought to be does not match the experience of morality. There are many events that are the case and describe what is (genocide, war, hatred, murder), but whether or not they ought to be that way is a further question that science is not in a position to answer. Thus to try to derive an ought from an is refers to what is called the fallacy of deriving of ought from an is.  Much more could be said of the inadequacy of scientism, but it should be noted that moral, ethical, and religious claims all involve normative claims about the way the world ought to be. One practical effect within health care has been the subtle but pervasive view that religion is a harmless tangent to medicine and health care at best, and a superstitious and destructive distraction at worst.

Recently there has been a resurgence and appreciation of spirituality within medicine in more holistic approaches to health care. For example, the Center for Spirituality, Theology and Health at Duke University was established in 1998 for the purpose of

conducting research, training others to conduct research, and promoting scholarly field-building activities related to religion, spirituality, and health. The Center serves as a clearinghouse for information on this topic, and seeks to support and encourage dialogue between researchers, clinicians, theologians, clergy, and others interested in the intersection.

(Center for Spirituality, 2014, para. 1)

While a welcome corrective, it is easy to inadvertently buy into weaker forms of scientism and fail to appreciate the particularity of each religion by reducing all religion to a generic spirituality. For example, Burkhardt (1999) attempts to defend a generic definition of the term “spirituality” (p. 71), but Shelly and Miller (2006) point out the inadequacy of such a strategy. It is not fair or respectful to paint all religions or worldviews with the same brush under the heading of spirituality and ignore the differences.

Thus, in the interest of philosophical clarity, religious sensitivity, and genuine care, this section will introduce fundamental concepts and challenge the contemporary ethos to make room for genuine religious dialogue.

The Foundations of Christian Spirituality in Healthcare

In stark contrast to this ethos is the Christian tradition and the resources it provides for a rich conception of care. Contra scientism and relativism, the foundations of Christian spirituality in health care, includes two attitudes/theses: (1) an acknowledgement of science as a subset of knowledge in general, and a deep appreciation for science as a collective human enterprise that reflects the knowability and order of creation; and (2) the goodness and worth of this creation (in so far as it reflects God’s creative intention) with human beings bearing special dignity and intrinsic worth, reflected in the well-known bioethical principle of “respect for persons” (National Commission, 1979).

The foundations of Christian spirituality in health care assume genuine knowledge of God and his purposes. Central to this foundation are the biblical Christian narrative and the person of Jesus Christ. In order to appreciate and do justice to this center, the ethos of scientism and postmodernism must be first challenged and dispelled.

This first topic of this course is devoted to understanding the concept of worldview in detail and to begin to challenge the philosophies of relativism and scientism. It will also begin to lay the foundations of a broadly holistic understanding of the relationship between spirituality and health care in general, and a Christian worldview for health care in general.

References

Burkhardt, M. (1989). Spirituality: An analysis of the concept holistic nursing practice. New York, NY: Aspen Publishers, Inc.

Center for Spirituality, Theology and Health. (2014). Retrieved from http://www.spiritualityandhealth.duke.edu/

Moreland, J.P., & Craig, W.L. (2003). Philosophial foundations for a Christian worldview. Downers Grove, IL: IVP Academic.

National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. (1979). The Belmont report: Ethical principles and guidelines for the protection of human subjects of research. Retrieved from http://www.hhs.gov/ohrp/humansubjects/guidance/belmont.html

Shelly, J. A., & Miller, A. B. (2006). Called to care: A Christian worldview for nursing (2nd ed.). Downers Grove, IL: IVP Academic.

 

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Marsha and Clement are both carriers of sickle cell disease, a disease that is autosomal recessive

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Case Study 1  Marsha and Clement are both carriers of sickle cell disease, a disease that is autosomal recessive. Their first child, Amelia, does not have the disease. Marsha and Clement are planning another pregnancy, but they are concerned about their second child having the condition. Clement’s dad died from complications of sickle cell disease shortly before Amelia was born.  1.Draw a Punnett square to determine the likelihood of Marsha and Clement having a baby with sickle cell disease. What is the chance the baby will be a carrier of the disease, just like the parents? 2.Marsha suggested to the nurse at the local family planning clinic that if the baby were a boy he might have a higher risk for developing the disease, just like his grandfather. If you were this Practitioner, how would you respond? 3.When Amelia, who does not have sickle cell disease, grows up and marries someone who does have the disease, how likely is it that her children will have the disease?

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Singapore Airlines Case Study

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NRS-451V Singapore Airlines Case Study

(Student paper)

Singapore Airlines was created in 1972 following a separation from Malaysian Airlines. In the wake of reorganization, Singapore Airlines undertook aggressive growth, investing and trading to maximize profitability and expand market share. Through this change, a new company philosophy emerged, “Success or failure is largely dictated by the quality of service it provides” (Wyckoff, 1989). By reinventing the company infrastructure and introducing new initiatives focused on excellence in customer service, Singapore Airlines became a global leader in the service industry, elevating existing standards among competitors.
Evaluation of Workforce Management Program
The strategy widely utilized by Singapore Airlines to ensure differentiation in an increasingly competitive market was its attention to in-flight service. “Good flight service [was] important in its own right and is a reflection of attention to detail throughout the airline” (Wyckoff, 1989). This statement perpetuated the belief that excellence in service was directly tied to the careful selection and individual performance of in-flight crews charged with the responsibility of fulfilling the needs of individual passengers and exuding the levels of service demanded by the organization. Applicants destined to work as flight stewards were drawn from a very young population, typically spanning the ages of 18-25 years of age with high school equivalency against the English system of education. Selection of applications was competitive largely due to the degree of skill, poise, and experience required of its candidates. These policies led to the on-boarding of a highly skilled and youthful workforce with positive attitudes and a willingness to be trained. Critique of this approach revealed several disadvantages. The most significant being the potential for greater turnover when hiring a younger population as opposed to an older, more experienced crew. Experience alone would play some role in the development of new employees, as greater experience would bring greater poise and confidence. However, in light of the predominant population Singapore Airlines catered to, a younger in-flight crew would remedy the awkwardness likely to be encountered by older clients being served by older crew members. In addition, a younger crew would likely be more accepting of new procedures and less cynical of the requirements of employment.

In light of the young demographic most desired in this role, recruitment, training and “conversion” processes were both stringent and comprehensive. All aspects of in-flight service, including training related to terminology, amenities and food preparation were provided in great detail, as were training for emergency preparedness and response to every potential scenario encountered in the air and on the ground. Formalized on-boarding, training and continued development were the hallmarks of the comprehensive workforce program. Even well into a crew member’s employment, on-going training and cyclical evaluation provided a mechanism for employees to be aware of individual performance and gain exposure to methods of continuous improvement. With an on-going plan of evaluation, communication, and development, the workforce was well-positioned for high levels of performance and quality improvements.

Though it would seem that Singapore Airlines’ work management program suited the organization well, it greatly narrowed the pool of applicants and kept many, well-qualified and experienced candidates from positions that would create diversity among the largely homogeneous workforce and place the organization in a better position to serve populations whose ethnic origins were not of Asian descent. If the organization aims to be the leader in an increasingly global marketplace, the workforce must mirror the diverse needs and perceptions of the greater population.

Advertising Campaign

Singapore Airlines is known in the airline industry for its quality of service. This emphasis on customer service and customer satisfaction is largely reflective of the Asian culture for which the company embodies. Attention to detail, impeccable presentation, and care for others are traits synonymous with countries of Asian heritage. Similarly, Asian countries revere conservatism, organization and hierarchy (Allik, n.d.) so, it would follow that young Asian individuals demonstrate the same gracious, caring behaviors to others. The expectation of “gentle, courteous service” is consistent with these norms and with the approaches taken by the organization. So much are these standards and stereotypes linked to Asian culture and the epitome of service, that the symbol applied to the airline is that of a young Asian woman. This image is resoundingly more beguiling and traditional, recognized by nearly 50% of consumers over typical marketing imparted by competitors, with a marginal recognition of 9.6%. In light of the positive impact and recognition of the existing marketing campaign, it was considered advisable to retain the current marketing strategy.

Systems for Measuring Service Quality

Singapore Airlines has two primary components involved in measuring service quality. The first is a system to measure customer complaints and compliments for every 10,000 passengers. The second measurement is a comparative rating of airline services prepared by the International Research Associates (INRA).

The first component, customers’ complaints and compliments, stayed relatively the same despite rapid organizational expansion. This type of analysis has shown a generally high satisfaction level, but could be skewed due to the vast areas the complaints and compliments could cover; from ticket sales and baggage areas to in-flight crews. To address this concern the complaints were split between the areas. However, to get an accurate barometer of customer satisfaction, it was recommended that the airline conduct routine surveys of customers. Often, customers submitting comments fell into one of two categories; those having complaints or those having compliments.

The second component to gauge customer satisfaction involved the INRA surveys. The airline executives paid particular attention to these scores as they indicated levels of satisfaction among the general consumer population and identified areas requiring continuous improvement. In 1973 Singapore Airlines scored 68, in 1974 the company scored 74 and in 1979 they scored 78. The scores of 39 other airlines demonstrated that two other competitors, Cathy Pacific and Thai International, were improving rapidly. This provided one indicator of competitive advantage. In order for Singapore Airlines to stay ahead of their competitors they would need to evaluate their position against industry leaders and determine if changes would be needed to stay competitive, particularly with respect to customer service and customer satisfaction (Wyckoff, 1989).

Plan to Introduce Slot Machines

Singapore Airlines has responded to many changes in order to differentiate itself within an increasingly competitive market place. One responsive action was to remove sleepers, replacing them with a business class section. Reactions from consumers were less than favorable. The move strayed from what consumers came to expect of elite levels of customer service, which were in large part, due to the attention paid to the personal needs of its elite customers. Although intended to be innovative and distinctive, the inclusion of slot machines on transatlantic flights was another idea met with considerable consumer dissatisfaction. While potentially generating a new stream of revenue, the idea only worked to incite passengers with a new category of charges. In addition to generating cost for the consumer, the machines took valuable space away from seats and posed problems in light of weight restrictions (Time, 1981). These changes only compounded issues and introduced new problems such as the potential for in-flight injury, rather than improving in-flight services. While there was some opportunity for revenue, initially, the gains would last for a season and were not expected to extend out into the long-term.

Conclusion

The Singapore Airlines Case Study highlights both effective as well as ineffective management approaches within the company. The subsequent analysis and evaluation of company operations and strategies offer a compelling glimpse of organizational design and leadership amid change, as well as provide a platform for future discussions of organizational development and change management. Group evaluation of organizational design, organizational decision-making, and organizational process at Singapore Airlines yielded some recommendations for new approaches to address complaints, become more mainstream in an increasingly diverse market space, and become more innovative without losing sight of the customer service focus that has made Singapore Airlines so successful.
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