Motivational Interviewing for Smoking Cessation

Motivational Interviewing for Smoking Cessation Maria (titanium number: 47144) is a retired, 65-year-old lady who visited the clinic, for the replacement of her teeth in quadrant 4 (#33-36) after the removal of the old bridge and the abutments by a private dentist due to weakened abutments. According to the patient, her last visit to the dentist was 2 weeks before her first appointment with me. It was for the removal of the residual root of 44 which served as one of the abutments for the previous bridge. Maria brushes her teeth twice a day, using a soft bristle toothbrush and fluoridated toothpaste. She also flosses and rinses her mouth with Listerine mouthwash twice a day. The patient has underlying cardiac arrhythmia, chronic bronchitis, fracture on vertebrae T5 and T7, depression, fibrocystic breast, hypertension, sciatica leg, scoliosis, type 2 diabetes and osteoarthritis on her rotator cuffs as well as her knees. She is allergic to resedronate sodium. Socially, Maria is a smoker and she smokes 15 cigarettes a day since she was 17 and she is not thinking of quitting. She drinks occasionally. Upon oral examination, her oral hygiene is generally good with some mild plaque and calculus deposition. Her PSR score was 0 for all sextants, suggesting no active periodontal disease but generalized gingival recession was present. Her #24-27 as well as #34-36 was replaced by bridges. There were restorations on almost all of the dentitions with only 4 sound teeth. However, no active carious lesion was found. Tobacco smoking can cause damage to almost every system of the human’s body, contributing to a variety of diseases thus increasing the mortality rate.1 Moreover, studies have shown that smoking can affect oral health in diverse manners such as increasing occurrence of oral cancer, periodontitis as well as causing teeth discolouration.2 Therefore, it is the responsibility of a dental practitioner to address this issue. In Maria’s case, the habit of smoking is rather alarming because it not only can affect the oral health but her general wellness. From her medical history, it has been shown that she is suffering from multiple diseases that can be modified by tobacco smoking. Most significantly, smoking is the major cause of chronic bronchitis and can further exacerbate the symptoms.3 Hence, motivational interviewing was attempted to help Maria in quitting smoking. I started the motivational interviewing session by exploring the stage of change Maria was at. According to Maria, she has thought of quitting but it was very difficult because smoking provide her a means to relieve anxiety and depression. She also expressed that she was not ready to quit. From here, it can be deduced the she is at pre-contemplation stage. Subsequently, I asked for her permission to discuss about this issue, emphasizing that the decision of quitting is up to her. She agreed and in return, I give affirmation by thanking for her willingness to talk about quitting. To elicit the ‘change talk’, I started by further exploring the source of her barrier. She told me that her medical conditions and the need for surgery were making her depressed. From here, I presumed that her concern about health could be a good motivator. Then, I asked her the reason as to why she has thought of quitting. In response, she said that she wanted to be healthier and that she was aware of the disadvantages of smoking as her GP had always advised her to quit. Furthermore, smoking had also become a financial burden for her. At this point, I summarized that her goal was to improve her health. Hoping to develop a discrepancy between smoking and her goal, I asked her to think about the advantages of quitting smoking. She replied that by quitting smoking, she might be able to become healthier and save some money. When I asked her about her ability to make the change, she replied with ‘I really don’t know.’ As I was facing resistance, I tried t o find an alternative question. When she was asked about what she would do to make the change, I got a similar reply ‘I am not sure.’ With her permission, I introduced her to the quit line. Finally, I concluded with reiteration of the discrepancy between smoking and her goal to become healthier. A brief evaluative session was done before a restorative procedure when I updated her medical history. She told me that she just had a biopsy done, suspected with breast cancer and still using cigarette to relieve stress. Due to time pressure, the session stopped here. Judging from Maria’s response during the conversation, it can be seen that although I have successfully encouraged her to think and talk about the issue, the intention of quitting is low. The response ‘I really don’t know’ and ‘I am not sure’ suggest that she is highly in doubt of her ability to quit. In addition, it is clear that cigarette as a stress reliever is a strong ambivalence that stops her from quitting. I feel that the session was a good start for both Maria and I but there is still a lot of improvement needed. To illustrate, I lack the experience in giving appropriate affirmations. There were a few instances where my affirmations were rather awkward. Besides, I need to improve my skill in complex reflection. For instance, when she talked about the source of depression which was her health, I could have leaded her to a new thought whereby smoking cessation can improve health and hence, reducing the source of depression. I could have also asked Maria to compare the advantages and disadvantages of smoking. This might help her to recognize her goal and ambivalence better. As she has low confidence in quitting, there should be more discussion as to how help could make a difference.4 In conclusion, motivational interviewing can be a good approach to induce behavioural change in patients however practice is needed to develop the skills and to execute it effectively. References Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years’observations on male British doctors. BMJ 2004; 328:1519-1528. Sham AS, Cheung LK, Jin LJ, Corbet EF. The effects of tobacco use on oral health. Hong Kong Med J 2003; 9:271–277. Rebecca JT, Frank ES, Bernard R, Dimitrios T, Walter CW. Cigarette Smoking and Incidence of Chronic Bronchitis and Asthma in Women. Chest 1995; 108(6):1557-1561. David B. Rosegren. Building Motivational Interviewing Skills: A Practitioner Workbook. 1 edn. Washington: The Guilford Press, 2009.

Claudio Monteverdi :: Composers Renaissance Biographies Essays

Claudio Monteverdi Claudio Monteverdi was born on May 15, 1567, in Cremona Italy, Monteverdi was an Italian composer of the late Renaissance and the Early Baroque, and is known as the first great composer of the operas. Monteverdi is often view as a composer of the Renaissance and of the Baroque, there is a similar pattern in that is continuous that is often viewed through his work in both styles. Monteverdi often was known as a dramatic composer, while bringing a tremendous meaning from the text he set that often turned each of his pieces into a believable musical and also produced a dramatic statement. It was an early age when Monteverdi’s career began, he then published his first pieces, and this was based on as a collection of three-voice motets, at the age of fifteen. It was by 1591, when he went to Mantua as a musician for the Gonzaga court, by then he had already published books of â€Å"spiritual madrigals† in 1583, then another canzonettas in 1584, by 1587 and 1590 he published his first two books of â€Å"madrigals.† It was in Mantua he continued writing madrigals, and then in 1607 he produced his first work in the new genre of opera, the setting was of Orfeo. 1613, he was then appointed maestro di cappella at ST. Mark’s Cathedral which was held in Venice. Monteverdi had remained in Venice for the rest of his life, writing music in all different kinds of genres, including his final opera, â€Å"incoronaszione di Poppea in 1642. The style that Monteverdi intended to write in was called seconda prattica, this was a description that he used to separate himself for what was known as the more conservative tradition of Palestrina and his â€Å"Contemporaries.† The main starting point for Monteverdi was the always the words. Whatever his mood was at the time and what the words might suggest, and or whatever a one word needed to express, was mainly reflected on his music. Throughout the century, this was the basic idea of word content; this painting was used in madrigals through out the century. Due to the fact that his music expressed different moods of styles, for Monteverdi it was however isolated effect, and a guiding force. â€Å"This ideal permeated his madrigals and found new expression in the dramatic language or opera.† All Monteverdi’s techniques of work altogether made Monteverdi one of the expertise in the field of Western music.

Botulism Is A Rare Gastrointestinal Infection Biology Essay

Botulism is a rare GI infection, it is a serious status caused by toxins from bacteriums called Clostridium Botulinum. Clostridium Botulinum are a species of anaerobiotic, Gram-positive, rod shaped bacteriums in the household Clostridiaceae that produces proteins with features neurotoxicity. The botulinus toxin is a powerful neurolysin that impairs nerve map, including those of the stop, taking to palsy. It is the etiologic agent of botulism in worlds, wild poultry, Equus caballuss and cowss. There are seven subtypes of these bacteriums, each bring forthing a different Botulinum Toxin. The being and its spores are widely distributed in nature. They can be found in dirt, deposits of watercourses and lakes, and in the enteric piece of lands of fish and mammals. Clostridium botulinus interferes with the presynaptic release of acetylcholine at the neuromuscular junction. Acetylcholine is a neurotransmitter found at neuromuscular junctions, autonomic ganglia, parasympathetic effecter junctions, and at many other sites in the CNS. Acetylcholine enables musculus contraction hence without it musculuss will non contract. The stop enables take a breathing hence without acetylcholine the infected animate being will decease of respiratory failure and asphyxia. Clinical characteristics include abdominal hurting, emesis, acute palsy, blurred vision, and double vision. There are eight types of botulism. They are: A, B, CI ± , CI? , D, E, F, and G. Out of the eight merely three of them are associated with human disease. They are A, B, E and F. A, and B are foodborne related potent strains. It was foremost recorded in Europe in 1735 and it was suspected of being associated with a German sausage, hence being named after the Latin word for sausage, â€Å" botulus † . Several states produced botulism toxins in the WWII as a possible bacteriological arm. They were said to hold trial sprayed over a subdivision of Canadian wilderness killing all animate beings within 6 hours but they were ne'er used in combat. The bacterium itself is non toxic when ingested and are normally consumed on fruits, veggies and seafood. The German doctor and poet Justinus Kerner foremost developed the thought of a possible curative usage of botulinus toxin. In 1870, another German doctor, Muller, coined the name botulism. In 1895, Professor Emile Van Ermengem, of Belgium, was the first to insulate the bacteria. In 1928, Dr Herman Sommer, at the University of California, was the first to insulate in purified signifier the toxin type A ( BoNT-A ) as a stable acid precipitate. Dr Edward J Schan tz succeeded in sublimating BoNT-A in crystalline form-cultured C blotulinum and isolated the toxin in 1946. In the 1950 ‘s, Dr Burgen ‘s ASV group discovered that blotulinum toxins blocks neuromuscular transmittal in 1949. Dr Vermon Brooks discovered that when BoNT-A is injected into a overactive musculus, it blocks the release of acetycholine from motor nervus terminations. Dr Alan B Scott, of Smith-Kettlewell Eye Research Institute used BoNT-A in monkey experiments in 1973, and in 1980 he used if for the first clip in worlds to handle squint. The incubation period of botulism is 12-80 hours. It can be obtained through inspiration of toxin, ingestion of toxin or C botulinus spores, and taint of a tissue with toxin or C botulinus spores. Signs and symptoms have six presentations. The central marks include afebrile ( holding no febrility ) ; symmetrical neurological manisfestations ; normal mental position, though may look lethargic and have trouble with communicating ; normal to decelerate bosom rate without presence of hypotension ; and normal centripetal nervus map, other than vision. The early presentations include: cranial abnormalcies, weariness and dizziness, dual and bleary vision, and trouble get downing nutrient. The ulterior presentation include ; falling palsy, trouble traveling eyes and mild pupillary dilation, lingua failing, lessening joke physiological reaction, indistinct address, symmetrical falling progressive muscular failing particularly on weaponries and legs, utmost failing on postural cervix musculuss and occasional oral cavity external respiration, and irregularity. Ingestional presentation include: dry oral cavity and dysarthria, and sickness and emesis. Inhalational presentation include: mucous secretion in pharynx, and serous nasal discharge, salivation. Last the infant presentation include: inability to suck and get down, irregularity, weakened voice and floppy cervix. There are five chief sorts of botulism. They are foodborne botulism, wound botulism, infant botulism, adult enteric toxemia of pregnancy botulism, and iatrogenic botulism. Even though botulism bacteriums are common in nature, they can be killed by O. Thereof, the bacteriums signifier spores that protect them from the O. Once on an oxygen-free environment the spores activate. The most common manner to acquire botulism is from improperly canned nutrient. When the can is sealed it creates an oxygen-free environment suitable for the bacterium. If heated decently the spores dies but if non heated decently, the spores activate and the can is filled with toxin, botulismotoxin. Since botulismotoxin is a protein it can be denatured by heat, nevertheless canned nutrient is largely eaten cold botulism occurs. Affected persons have trouble swallowing or speech production, dry oral cavity, facial failing on both sides of the face, blurred or dual vision, saging palpebras, problem external respira tion, sickness, purging and abdominal spasms, and palsy. Babies usually obtain botulism from honey in a assortment of ways. When roll uping nectar from flowers, bees collect botulism spores and blend them into the honey. Most grownups can eat these spores without trouble since the bacteriums within the organic structure robust the immune system which eliminates the spores. Since babies still do non hold these bacterial defense mechanisms the spores come to life when they reach the intestine oxygen-free environment. While inside of the babe they produce toxin. This typically occurs between the ages of 2 and 6 months. Complications arise usually within 18 to 36 hours after the toxin enters the babe ‘s organic structure. Signs and symptoms include: irregularity, floppy motions due to muscle failing and problem commanding caput, weak call, crossness, salivating, saging palpebras, fatigue, trouble suction or eating, and palsy. Wound botulism is the consequence of lesions contaminated with C botulinus spores. It develops traumatic hurt that involves soil taint among injection drug users ( those who use black-tar diacetylmorphine ) and after a cesarean bringing. The lesion may look benign. The involved tissues which are traumatized and devitalized provide a perfect anaerobiotic medium for the C botulinus spores to shoot into vegetive beings and produce neurolysins. The symptoms normally appear 4 to 18 hours after an hurt occurs and are similar to food-borne botulism although GI symptoms may be absent. They include: trouble get downing or speech production, facial failing on both sides of the face, blurred or dual vision, saging palpebras, problem external respiration, and palsy. Adult enteric toxemia of pregnancy ( big enteric colonisation ) botulism is a really rare sort of botulism that occurs among grownups by the same path as infant botulism. The exact prevalence of AITB is unknown. To day of the month, about 20 instances have been reported. The disease affects grownups and older kids. Features include unknown beginning of toxin, presence of toxin in stool, and unnatural GI pathology ( e.g. , Billroth surgery, Crohn ‘s disease, and peptic ulcer disease ) or antimicrobic drug usage. Last, iatrogenic botulism can happen from inadvertent overdose of botulinus toxin. It has been noted really seldom after medical usage or abuse of the botulinus toxin. Injectable toxins are used to handle a scope of spastic and autonomic muscular upsets. These toxins are purified and extremely diluted. Toxin type A ( Botox ) is used in highly infinitesimal doses for the intervention of facial furrows and blepharospasm ( an unnatural contraction or vellication of the palpebra ) , cervical dystonia squint ( an chronic painful neurological upset characterized by loss of control over one or more parts of the organic structure ) , glabellar lines ( are the perpendicular lines on the human face and are seeable when a individual scowl ) , and primary alar hyperidrosis ( inordinate perspiration ) . Toxin type B ( Myobloc, Neurobloc ) is used to handle cervical dystonia. The diagnosing of this infection can be slippery because symptoms mimic those presented by other diseases. Sepsis ( whole organic structure redness ) is the most common initial diagnosing for infant botulism. Lab trials are used for unequivocal diagnosing. Analysis of blood, stool or puke for grounds of the toxin may assist in the verification of the infection. Treatment includes the usage of drugs, respiratory support, surgery, and stomachic lavage. Adults with botulism are treated with an antitoxin. The antitoxin is effectual against toxins types A, B and E and inactivates merely the toxin that is unattached to steel terminations. For babies, BIG ( botulism immune globulin ) is available neutralizing A, B, C, D, and E before they can even adhere to nervousnesss. Infant intervention normally involves respiratory support and tubing eating for hebdomads even months. Physical therapy is initiated one time the babe can take a breath unaided. A inhalator is frequently required to assist grownup patients breathe, and a tracheotomy may besides be necessary. Surgery may be necessary to clean an septic lesion and take the beginning of the bacteriums. Antimicrobial therapy may be necessary. In stomachic lavage, psychotherapeutic agents or clysters are used. Vaccines against botulism do non be nevertheless scientist have successfully vaccinated mice and ducks against type C and D, which may assist in the creative activity for human inoculation. The toxin can non be seen, smelled or tasted so the wisest thing to make is to fling any nutrient that seems spoiled without savoring it.

Assisted Suicide Should Be Legal - 909 Words

The Suicide Debate Does a suffering person have the right to end their own life? That is the main debate behind assisted suicide. Assisted suicide is a very secretive, but surprisingly available option for people who are suffering. The documentary The Suicide Plan is largely presented from the point of view of the people who believe assisted suicide should be legal. The documentary takes us inside the hidden world of assisted suicide, as seen through the eyes of the people considering it. Assisted suicide is only legal for terminally ill patients in the states Oregon and Washington. Individuals in other states who consider assisted suicide are generally suffering terminally ill patients who want the same equal opportunity. There are many organizations that people can reach out to for information about the requirements, the step-by-step process, and what to expect. The organizations have very specific guidelines for their client and patients have to understand that they will be killing themselves. Organ izations are not physically involved in the suicide, they do not provide any drugs or materials, and very carefully confirm the individual’s understanding. The organizations help people decide if suicide is the right option for them and are there through out the whole process to support the individual and their families. One of the many issues for debate is whether these organizations are aiding the suicides. But the laws banning assisted suicide are so vague that â€Å"assisting†Show MoreRelatedAssisted Suicide Should Be Legal986 Words   |  4 Pagesphysician assisted suicide should be legal I all fifty states because people should be able to determine when they are ready to end their life, but only in certain limited circumstances. Physician assisted suicide, also known as PAS, is suicide committed with the help of a physician. Another name for assisted suicide is euthanasia, which is the painless killing of a patient suffering from an incurable and painful disease or in an irreversible coma. Euthanasia is different from assisted suicide becauseRead MoreAssisted Suicide Should Be Legal Essay1490 Words   |  6 PagesThe process of assisted suicide, or physician-assisted death, is a hotly debated topic that still remains at the forefront of many national discussions today. Assisted suicide can be described as the suicide of patient by a physician-prescribed dose of legal drugs. The reason that this topic is so widely debated is that it infringes on several moral and religious values that many people in the United States have. But, regardless of the way that people feel, a person’s right to live is guaranteedRead MoreAssisted Suicide Should Be Legal2265 Words   |  10 PagesAssisted Suicide should be made legal, as many people suffer from diseases that aren’t always curable, and it doesn t make sense to let them go through all that pain, and also for some families that have financial struggles paying for their medical bill. This controversial debate is whether or not assisted suicide or mercy killing should be legal and whether or not doctors should be allowed to help patients kill themselves or give guidance on how to. People argue that assisted suicide should beRead MoreAssisted Suicide Should Be Legal1130 Words   |  5 Pagesdebate behind assiste d suicide. Assisted suicide is a very secret, but surprisingly available option for suffering people. The documentary The Suicide Plan focuses on the people who believe assisted suicide should be legal. The documentary takes us inside the hidden world of assisted suicide, as seen through the eyes of the people considering it. Assisted suicide is only legal for terminally ill patients in Oregon and Washington. Individuals in other states who consider assisted suicide are generallyRead MoreAssisted Suicide Should Be Legal2253 Words   |  10 PagesAssisted Suicide should be made legal because many people suffer from diseases that aren’t always curable, it doesn t make sense to let them go through all that pain and some families have financial struggles paying for their medical bill. This controversial debate is whether or not assisted suicide or mercy killing should be legal, whether or not doctors should be allowed to help patients kill themselves or give guidance on how to. People argue that assisted suicide should be considered legal,Read MoreAssisted Suicide Should Be Legal1761 Words   |  8 Pagesdying a slow and painful death, but assisted suicide could be best option for these patients. Assisted suicide is â€Å"any case in which a doctor gives a patient (usually someone with a terminal illness) the means to carry out their own suicide by using a lethal dose of medication† (Lee and Stingl 1). Some feel that assisted suicide is unnecessary because it is too great of a controversy and will only cause problems in society. However, assisted suicide should be legal in the United States as long as thereRead MoreAssisted Suicide Should Be Legal2030 Words   |  9 Pagesis whether or not assisted suicide should be legalized. In order for people to truly argue and decide whether assisted suicide should be legal they must know the definition. Many people mix up the definition of assisted suicide with euthanasia. There are both arguments for assist ed suicide and against it. When arguing for and against assisted suicide the big argument seems to be whether it is morally right or morally wrong. The question of whether assisted suicide should be legal question what isRead MoreAssisted Suicide Should Be Legal2300 Words   |  10 Pages What is assisted suicide? By definition, assisted suicide is suicide committed with the assistance of another person, usually a physician. This definition has changed slightly from the past. Assisted suicide used to be defined more as when a terminally ill patient would be assisted in their death by a doctor or physician. To some, it is a way to end the pain and suffering of a terminally ill loved one. To others, assisted suicide is considered killing people without giving them a chance. PeopleRead MoreAssisted Suicide Should Be Legal Essay1870 Words   |  8 Pagesyour dog having been through a horrible accident. An accident that should of killed the dog but yet it didn’t. The only opt ions for the dog are to let it suffer or put it down. Now, imagine this happening to a loved one or a family member. What if the loved one wanted their suffering to end? Assisted suicide is the intentional termination of life by a doctor at the request of the person who wishes to die. Assisted suicide should be legal because there are times when the terminally ill can be found inRead MoreAssisted Suicide Should Be Legal1936 Words   |  8 Pagespatients suffer from cancer and tumors, and they endure a lot of pain that they would kill for something to stop the pain. Death is no crime and does no harm to other people. They might feel mental pain, but no physical pain is inflicted. Assisted Suicide should be legal because it is a Civil Right, it can be for terminally ill patients, and it does not harm others. The people of the United States of America have Civil Rights and stated in the Civil Rights the people have the right to die. They mostly