1. Maria is a 35 y/o female who is complaining of frequent vaginal yeast infections. She has had 4 in the last 6 months, and they have been treated with topical and oral antifungal medications which have initially worked, but the infections recur within 1-2 weeks. Maria reports increased thirst and urination for the last two to three months. Maria is an office manager in a bookstore who works full-time and has 4 children aged 5, 7, 10, and 12, who live with her 80% of the time. She has been divorced x 3 years and is struggling to make ends meet and reports she and her children frequently eat fast food because of the low cost and time constraints. Maria’s vital signs are 136/88, 98.8, 16, 80, Ht 5’3”, Wt 187 lbs,  
    
2. Tim is a 22 y/o male who is complaining of lethargy, cold sensitivity, weight gain of 10 lbs over the last 3 months with an unnoticeable change in appetite, brain fog, constipation, and muscle weakness that he feels has become progressively more noticeable over the last several months. Tim is a heterosexual, single, full-time college student and works part-time at a coffee shop. His last annual physical examination was 2 years ago and was WNL. His current vital signs are 110/70, 62, 98.6, 12, Ht 5’9” Wt 190 lbs.  

NOTE: Cite at least 2 scholarly references published within the last 2-3 years.   

Deliverable Length: 5-7 pgs  not including the title, abstract, and reference pgs

Description

Since the enactment of the Affordable Care Act, there have been several lawsuits in the federal courts, and some have made their way to the Supreme Court. Not all of these cases are accepted for appeal by the Supreme Court and thus are settled at the appellate court. Analyze a recent appellant court case related to a healthcare legal case. If possible, find a case in your own federal appellate court. Discuss your answers to the following questions:

• In what court did this case originate? What is the law at issue in this case?
• What are the arguments supporting the law, and what are the arguments to overturn the law?
• Discuss the effect of this court case on healthcare delivery or operations. For example, will patient care be changed?
• How will the operations of a healthcare organization or health insurance company be changed?

Assignment Objectives:

For this assignment, you will appraise a clinical practice guideline (CPG).  The purpose of this assignment is to acquaint you with a clinical practice guideline as well as the appraisal process to determine the feasibility of the CPG.

Assignment Instructions: 

Read/Review the clinical practice guideline provided below:

• Practice Guidelines for Psychiatric Evaluation of Adults Download Practice Guidelines for Psychiatric Evaluation of AdultsOpen this document with ReadSpeaker docReader This guideline may also be helpful to you as you move through the program as you will have many opportunities to evaluate adults with psychiatric needs.  

You will appraise the clinical practice guideline using the AGREE II Tool Download AGREE II Tool for evaluating Clinical Practice Guidelines.  You must download the document to your computer, save it, and then open the document.  You should then be able to type in the comment section for each of the items to provide your responses.  You will not be able to type in the document if you just download it here without saving it first.  Here is the user’s guide for the AGREE II Tool Download user’s guide for the AGREE II Tool  Beginning on page 11 of the guide, you will find a detailed explanation of the purpose for each section of the tool, an overview of how to score that section, as well as where to locate this information in your CPG.  

A rationale and “answer” must be provided for each item in the comment section so that we can “see” how you formulated your response to that section.

How to Read the Guideline to Complete the Critique Assignment

The guideline that you are being asked to review contains many sections within the overall document.  Pages 1-3 and 145-148 decribe the process for developing the entire document.  Pages 3-7 provide a list of key recommendations found within the individual sections of the document for immediate access. This is followed by the references for the document (a complete reference list is on pages 150-162).  Beginning on page 9, you will find an indepth discussion of each of the different components of the guideline.  Each section is laid out in the same manner:  

• Guideline Statements:  This is where you will find a summary of the recommendations made based on the review of hte literature
• Rationale:  This section provides a rationale for the development of that specific guideline as well as a discussion of the strength of the evidence identified for this guideline.  
• Potential Benefits and Harms:  This section provides a discussion of the benefits and harms associated with using or not using these recommendations.  There may also be a discussion of the need for future research in this area.
• Implementation:  This section provides a discussion of how to use these recommendations in practice.  Other resources that can be used to enhace the assessment of this section are also provided.  Barriers to implementation of the guideline are also discussed.

Typically, a clinical practice guideline will be one document that contains recommendations for practice for one particular subject.  Since the psychiatric evaluation contains many components, the guideline you are asked to review contains several “mini” guidelines which make up the overall guideline for the “Psychiatric Evaluation of Adults.”  You will use the information on pages 1-9 and 145-148 to answer the majority of the critique items in Domains 1-3 of the AGREE II tool. 

To answer items 11 and 12 in Domain 3 and the items in Domains 4-5, you will choose ONE of the guidelines to follow through the Guidelines and Implementation section, the Review of Available Evidence section. and the Quality Measurement Considerations section of the CPG.  For example, if you choose to do an indepth review of Guideline III:  Assessment of Suicide Risk, you will look on pages 18-23, 57-65, and 139-140 to answer the specific questions about that guideline.