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Yesmath Islam
English 3010-010
Fall 2012
Reflection on Learning Objectives
12990_ef1360_3010F2012
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Table of Contents
1. Reflective Letter …………………………………………………………………..…3-17
2. Appendix A- Project 1: Discourse Community: Physician Assistant Perspective…..18-23
3. Appendix B- Project 2: Annotated Bibliography/ Historical Overview: Diabetes
effects and medication effects ……………………………………………………………... 24 -30
4. Appendix C- Project 3: Psychology: Substance Abuse ……………………………31-36
5. Appendix D – Project 4: Research Proposal: Diabetes …………………………….37-48
6. Appendix E : Interview email, questions and answers ……………………………………. 49 -53
7. Appendix G : Rough Draft of Annotated Bibliography/ Historical Overview: Diabetes
effects and medication effects …………………………………………………………….....54-56
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Introduction:
As a Wayne State University undergraduate student, studying psychology and soon to
apply to become to pre-physician assistant, I would have never have guessed how much I could
learn from an English class. English 3010, which is Intermediate English, highlights discourse
communities, how our discourse community affects our everyday life, the importance of
research, and how we will conduct research with our majors. This class consisted of 4 essays.
The first project was about discourse communities and required an interview with someone in
our major. The second project consisted of an annotated bibliography (finding scholarly articles)
and writing a historical overview about a related topic. The third project was a field presentation
(relating to our majors) and a short paper about our roles in the presentation. That last project
consisted of a research question and proposal (relating to our majors) containing a background,
literature review, research questions, proposed research method, hypothesis and concluding
remarks. Each project helped us prepare for the next project, for example in project 2 we had to
have a research question and, based on a research question, we had to write an annotated
bibliography with 15 sources and an historical overview. Though it was a lot of work, it helped
me in my project 4 (research proposal) having done the annotated bibliography, and it also
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helped me with the literature review. Throughout the projects, we came across 4 learning
objections that taught us the importance of this course. The 4 learning objectives are:
1. Produce writing that demonstrates their ability to identify, describe, and
analyze various occasions for writing, genres, conventions, and audiences in
their discipline or profession from a rhetorical perspective.
2. Produce an extended writing project that uses research methods and research
genres to explore a topic applicable to the course and that draws substantively
on concepts from primary AND/OR secondary sources
3. Produce writing that shows use of a flexible writing process (generating ideas,
drafting, substantive revision, and editing) and shows their ability to adapt this
process for different writing situations and tasks.
4. Produce writing that shows how they used reflection to make choices and
changes in their writing and that explains how they would use reflection and
the other skills taught in this course to approach a completely new writing task.
For learning objective one, I will use passages from project one, to demonstrate how I
identify, describe, and analyze a discourse community and also how this discourse community
would be used in my future profession. The concept of a discourse community was a bit
confusing to me when it was first introduced, but when we were given homework to do, to draw
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4 different pictures of different settings we are in, in our everyday lives, this helped me
understand the meaning of discourse communities. It did not come across to me how important
our discourse community is, until writing this paper. Here is a passage from project 1, entitled
“Discourse Community: Physician Assistant Perspective” showing what I learned about my
discourse community:
“A discourse community is a group of different people with the same knowledge of
communication and shared interest of a specific area. It uses the same concept of writing, elaborating on
specific issues and communicating with different groups around you.
We are all a part of discourse communities in our everyday lives. For example, how we act and
talk with our parents to our teachers to when we are in a work setting, it is all in a different
communication. As an employed student at Wayne State University, I have come across my teachers, my
co-workers, my boss and my friends with whom I share the different discourse communities with. A few
ways that I communicate people are with are texting, Facebook, Pinterest and other social medias. One of
the six ways John Swales described discourse communities as, “A discourse community
uses its participatory mechanisms primarily to provide information and feedback” ( Swales 472). This
is important since not only are you communicating, you are also communicating with different parties.
When communicating with others you should also give an appropriate feedback for the conversation to go
smoothly. “A discourse community is a group of people who “speak the same language”( Deanna Mascle,
2008). This is a great example because we are talking in detailed way where people in other professional
fields won’t understand because they have not been educated in this subject. Speaking the same language
does not necessarily refer to a language (from foreign culture), but to a particular group of people that
work in the same field.
As a physician assistant there are many places for discourse communities. For example in the
hospital setting, nursing home, clinic, etc. Physician Assistant communicates with doctors, pharmacist,
physical therapist, radiology technicians and most importantly patients. Being a physician assistant alone
teaches you a lot about the discourse community in an everyday life. It is essential for having a discourse
community in a PA setting since there are many people around you in a day to day basis and there is also
many kinds of communication for every professional.” ( Appendix 1)
This passage demonstrates my ability to identify discourse communities and also
describes how I use this discourse community throughout my daily life, and also how it plays a
role in my profession. Some examples are, in paragraph 1, how I described what a discourse
community is, this was by reading “The concept of discourse community” by John Swales. In
paragraph 2, I described how I apply discourse community in my everyday life. I did this by
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analyzing my daily routine by differentiating the different people that I meet in different settings
and that fact that with each setting I communicate with them in a different way. For example,
talking to my mom (acting myself), to talking to my boss (acting professionally) to hanging out
with my friends (acting goofy). The 3rd paragraph describes how discourse community plays a
role in my profession. Interviewing Sarah, ( a future PA, currently attending Wayne State
University Eugene Applebaum) and also by attending informational meetings, I have learned
many times of the discourse community a PA comes across. For example, a PA communicates
with different professionals in a hospital setting, professionals such as physical therapists,
doctors, radiology technicians and pharmacists. A PA would talk to a pharmacist about the
medications the patient is taking, whereas when talking to a radiology technician they would talk
about an imaging of the patient’s body.
For learning objective one, there are a lot of genres that we have come across, for
example emails, interviews, interview questions, etc. For the email interview, I practiced a few
times along with my teacher reviewing it before we sent them out. Another PA that I
interviewed by email was Janell Wilcox and here are some questions I asked her:
“What is it like to work as a Physician Assistant?
What is your favorite part of being a Physician Assistant?
What type of writing do you do?
How often do you do writing as a Physician Assistant?.
Do you do any research ? If so, what kind?
Are you interested in a particular type of research?
How is the research of PAs different from that of MDs?
What is the format of writing you use as a Physician Assistant?
What type of research have you participated in?” ( Appendix E)
After the interview, I learned few of the types of writing genres that a PA does ( by her
answering my questions), she mentioned writing daily progress notes, discharge summaries,
history and physical exams. All of these writings are performed on computer, so it is easier to
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bring up, read and organize the writings. I achieved this learning objective by describing and
analyzing different discourse communities and genres in my profession.
Understanding my audience occurred best in project 3. Project 3 was a field project
(group project with similar majors) presenting a multimedia presentation about a key concept in
our majors. This presentation also included different types of discourse communities in particular
aspect. Substance abuse was the topic of our project and the different perspectives we focused on
were behavioral perspective, biological perspective, cognitive perspective and the prospective
that I focused on, sociocultural perspective.
“We also wrapped up the presentation by talking about the different types of discourse communities and
how each professional would approach the treatments and communication. Group members also talked
about discourse communities and how psychiatrist, doctor, pharmacist, and social worker would take part
to help a person going through substance abuse. This shows how the different professionals come
together to work on the same situation” (Appendix 3)
We used different discourse communities in our presentation, for example each person in
the group (pretended) to be a doctor, a social worker, a psychologist and a pharmacist. We
described and analyzed the different types of discourse communities to the audience. This helped
the audience (because the audience had different backgrounds) understand how different
professionals come together to discuss one topic.
Learning objective 2 requires a research methods and research genres to explore a topic
relating to the course and that draws substantively on concepts from primary/ secondary sources.
Project 2 and 4 accomplished these learning objectives. Both project include research questions,
research methods, research genres such as annotated bibliographies and historical overviews, and
project 4 was a research proposal.
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Research project 2 was the start of our research process. This process consisted of several
genres that leads us to the research proposal (project 4). For project 2, it was my first time
writing both an annotated bibliography and an historical overview. For an annotated
bibliography we summarized and assessed scholarly articles and for the historical overview, we
wrote a paper of the articles in chronological order. It was hard to find scholarly articles that
related to my topic (diabetes), to understand the writing, and also hard to summarize and analyze
the articles. The annotated bibliography consisted of 15 sources from scholarly articles, which
were my secondary resources. In my project 3, entitled “ Diabetes cure and medication effects”
here are some examples of my annotated bibliography:
Robbins, J.M., Webb, D.A. (2006). Diagnosing diabetes and preventing Rehospitalizations:
The Urban Diabetes Study. Medical Care, 44(3), 292-296. Retrieved
fromhttp://www.jstor.org/stable/3768165/
Hospitalized as a diabetic can get very dangerous. Patients who are hospitalized n is
seen more after hospital discharge with patients who have diabetes. Philadelphia residents
ages 25-84 with diabetes had their hospital information tracked compared to non elective
rehospitalization within 30 days of discharged. The rehospitalized portion was 9.4% where as
nonelective rehospitalized witth in 30 days of hosipital discharge was 20%. There was a
failure to record diabetes diagnoses after discharges and also to check if the patients are
treated for any other diseases. This results in the lack of attention for diabetes
patients.
This article was helpful, but the lack of attention for the patients was poor and if this
was different the results may have differ.
Yawn, B., Zyanski, S.J., Goodwin, M.A, Gotler, R.S., Stange, K.C., Olmsted Medical Center. (2001). Is
diabetes treated as an acute or chronic illness in community family practice? Diabetes Care,
24(8), 1390-1396.doi:10.2337/diacare.24.8.1390
There is poor quality of care in hospital settings for diabetes patients. For two seperate days the
nurses observed consecutive outpatients in 138 family physician offices. The patients were 40 years of
age and more and there were about 1,867 patient visits. Davis Observation Code was used for time.
Patients with diabetes were compared with people who have chronic diseases to see if there is more
attention to one another. It compared time used during the visits of diabetes patients and other chronic and
acute illnesses. This has showed that diabetes has greater proportion of the time. This has help to show
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other that they should all be treated
equality.
This article was very useful. It showed that giving just a little more time with talking to the
patient can change a lot. There were many questions and problems that were addressed during the times
that were spent longer with the physician.” (Appendix 3)
This research was a research topic then evolved in to a research question. The research
question at first was too broad, it was: “Which is more effectiveness for diabetes, medication or
non-medication?” This is very broad question, so I decided to narrow down the question to
more specific questions dealing with diabetes: to “Is the treatment of medication for diabetes
more effective than non-medication treatments? What is the risk of taking these medications?
How does this affect other illnesses (when taking medications for diabetes?)?” I finally reached
the final research question: “How does diabetes medication affect and interact with other illness
and medications such as cholesterol?” My first 2 questions were very broad and also have been
answered so I decided to narrow it down. Also, by reading different scholarly articles, my
research question began to build on a question that was left unanswered.
After choosing a research question, we started on project 4 (research proposal) and
started off with a background, which was easy because we have already done so much research
for this topic. The literature review was a combination of annotated bibliography and historical
overview ( from project 2). This was a great amount of help because I had already done the main
research. The primary source used was the interview and the research articles and scholarly
articles were our secondary resources. Here is an example of the literature review showing
secondary sources:
In 2001, there was a research done which showed all types of people having diabetes and
this was due to the lack of income in the family and also unhealthy life style (Khan, 2001). It also showed
that people with low income bought cheaper foods and this resulted in unhealthy eating habits. Another
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research that was done showed that computerized information has helped physicians organize the
database with more information about the patient since before this it was randomized and now electronic
literature searches has made it easier on the physicians (Balas, 2004). The significance of this was to see
and compare the prevalence of type 2 diabetes in white Europeans and individuals of African-Caribbean
and Pakistani descent. This was helpful for many people to see the different kinds of people who are
effect type 2 diabetes in Manchester.
Research has shown that there is direct effect of cholesterol on insulin secretion (Hao, 2007). This
is because the medication taken for cholesterol and the insulin are taken together. It is also shown that
women who take insulin more like have hyperlipidemia and while taking insulin for diabetes,
hyperlipidemia is more likely to occur at age 40 -60 ("Could insulin cause," 2012).
Research has shown that Statins, a drug that treats high cholesterol may increase risk of diabetes.
This is a major problem for those who do not have diabetes (because they will be at risk of having it), and
also a problem for those who have diabetes, because there blood sugar may rise and worsen (Rocco,
2012). This is an important matter for many people who are taking this drug, because are in a risk for a
life threating disease.
In those 3 paragraphs I have done research to find scholarly articles relating to the
research question. In the second writing objective, I have learned to formally conduct a research
proposal, by learning how to do an annotated bibliography and an historical overview.
Finding primary and secondary resources has also helped me
For learning objective 3, I have done a lot drafting and editing throughout the course to
better my writing. This was done in project 2 and 4. I choose 15 sources for my annotated
bibliography, but only incorporated 3-5 sources to my research proposal because I changed my
research question. This led me to find a few more sources while writing my research proposal.
When starting on the summarize and assessment on scholarly articles for annotated bibliography,
I found a bit difficult because it was my first time writing in this format along with the historical
overview. After completing project 2, project 4 was easy to do. This was because I adapted to the
writing and carried it on to project 4, and that is how I meet the learning objective 3.
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In project 2, I did a lot editing on my annotated bibliography because the writing of the
scholarly articles was very hard to understand because of the lexis. Here is piece of an scholarly
article I choose and found hard to understand this example is from the Journal of Lipid Research,
“An appropriate amount of both a 14C-labeled and unlabeled probe molecule was dissolved in an
exact volume of chloroform-methanol 2:l (v:v) in an incubation beaker, and the chloroformmethanol phase was then evaporated to ensure complete re- moval of the organic solvents. Seventyfive ml of a 40 mM taurodeoxycholate solution in Krebs-bicarbonate buffer (with calcium omitted) was
added to the beaker and the solution was stirred with a magnetic bar for 2 hr”
Using a dictionary and thesaurus helped me with words, but what I realized was, that some of
these scholarly articles are for advanced students who are in the medical field, because a random
person ( like me) would not understand it. Here is an example of 2 draft sources from my
annotated bibliography from project 2, entitled “ Historical Overview : Diabetes cure and
medication effects” :
“Balas, E.A. , Krishna, S., Kretschmer, R.A., Cheek, T.R., Lobach, D.F., Boren, S.A. (2004).
Computerized knowledge management in diabetes care. Medical Care, 42(6) , 610-621. Retrieved
from http://www.jstor.org/stable/4640793/
Automated information interventions on diabetes care and patient care plays a huge role in
diabetes care patient. Systematic electronic and manual searches were conducted and studies
were grouped. Glycated hemoglobin and blood glucose level improved expressively. The computerized
educational programs enhanced the metabolic and diet. The computerized management has greatly
impacted the quality of diabetes care.
Redmon, J.B., Bertoni, A.G., Connelly, A., Feeney, P.A., Glasser, S.P., Glick, H., Greenway, F., Hesson,
L.A., … Montgomery,B. ( 2010). Effect of the look ahead study intervention on medication use
and related cost to treat Cardiovascular Disease risk factors in individuals With Type 2 Diabetes.
Diabetes Care, 33(6), 1153-1158. doi:10.2337/dc09-2090
This article is about weight loss and how physical fitness vs. the cost of medication for treating
cardiovascular disease which is a risk factor for people who have type 2 diabetes. The 2 groups were
intensive lifestyle intervention (ILI) and diabetes support and education (DSE) condition This article was
important, it proved that losing weight does help prevent type 2 diabetes. ” ( Appendix G)
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After going through the articles and reading it again, I rewrote my annotated bibliography to
make it more clear and understandable. I did this by rereading it, focusing on the words that I am
not familiar with and using a dictionary and thesaurus, and rereading it again, this took a lot of
time.
“Balas, E.A. , Krishna, S., Kretschmer, R.A., Cheek, T.R., Lobach, D.F., Boren, S.A. (2004).
Computerized knowledge management in diabetes care. Medical Care, 42(6) , 610-621.
Retrieved from http://www.jstor.org/stable/4640793/
Automated information interventions on diabetes care and patient care plays a huge role in
diabetes. Systematic electronic and manual searches were conducted and studies were grouped in to 3
categories. The computerized prompting of diabetes care, utilization of home glucose records and
computer assisted diabetes patient education. The results have shown that the glycated hemoglobin and
blood glucose level improved expressively. This was due to the wide-ranging of electronic literature
searches that was randomized for the clinical trials. Computerized knowledge is becoming a vitual
component for diabetes care and has documented to show improved diabetes related outcomes.
This article proved that computerized data of diabetes has helped organize information on
the clinical trials. It was helpful to see that there was randomized databases used and that now it is much
clear for physicians to see the information in the database.
Redmon, J.B., Bertoni, A.G., Connelly, A., Feeney, P.A., Glasser, S.P., Glick, H., Greenway, F., Hesson,
L.A., … Montgomery,B. ( 2010). Effect of the look ahead study intervention on medication use
and related cost to treat Cardiovascular Disease risk factors in individuals With Type 2
Diabetes. Diabetes Care, 33(6), 1153-1158. doi:10.2337/dc09-2090
This article is about weight loss and how physical fitness vs. the cost of medication for treating
cardiovascular disease which is a risk factor for people who have type 2 diabetes. There was a
randomized group, of about 5,145 who were overweight or obese that has type 2 diabetes, they were the
ages of 45 – 76. The 2 groups were intensive lifestyle intervention (ILI) and diabetes support and
education (DSE) condition.n The results shown that the ILI had a greater result for CVD and this also
helped them to lower cost of medication. This article was important, it proved that losing weight does
help prevent type 2 diabetes and also can get rid of it and it can save a lot of money for not buying
medications any more. ” ( Appendix 2)
Here I am showing my writing process of how I edit, draft and revise. Above is shown 2
sources of how I first wrote my annotated bibliography, and how I revised it. I will also show
how I use these two sources into my historical overview (project 2) and how I related it to my
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literature review (project 4) in my research proposal. By showing this, it will prove that I have
learned how to conduct a research, how I shift my sources by editing and revising and using it
my final research proposal and finally showing how adapt this process for different writing
situations (by writing the source in annotated bibliography, then using it in historical overview,
and lastly in a literature review) . This will also cover learning objective 2 because I am using
research genres to explore my topic (diabetes) by using concepts from primary and/ or secondary
source.
Here is a piece of my historical overview using the 2 same sources, this will show how I
transformed my summary and assessment into a historical overview. Here is an example from
project 2,
“In 2001, there was a research done which showed all types of people having diabetes and this was due to
the lack of imcome in the family and also unhealthy life style (Khan, 2001). It also showed that people
with low income bought cheaper foods and these results in unhealthy foods. Another research that was
done showed that computerized information has helped physicians organize the database with more
information about the patient because it was randomized and now electronic literature searches has had it
easier on the doctors. ( Balas, 2004).
In 2012, we stil are facing many problems with the cure of diabetes and also the effects of long
term and also effects of taking medication while having other illness. A study done in 2011, may lead us
to the path of a cure for diabetes. It proved that it reduces diabetes due to the loss of body fat, but is
lacked the fact that the surgical group was much younger and also much heavier than lifestyle group. In
2010 there was a research done about risk for Cardiovascular Disease for people who have diabetes. .
There was a randomized group, of about 5,145 who were overweight or obese that has type 2 diabetes,
they were the ages of 45 – 76. The 2 groups were intensive lifestyle intervention (ILI) and diabetes
support and education (DSE) condition.n The results shown that the ILI had a greater result for CVD and
this also helped them to lower cost of medication. ( Redmon,2010)” ( Appendix 2)
Finally, showing how I incorporated my annotated bibliography and historical overview
into a literature review for my research proposal. A literature review shows what we do know
about the research topic/question and what we don’t know. This will know show the gap that is
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unknown. These two sources (same from above) will be used in “what we do know” part. Here is
an example from project 4, entitled “ Research Proposal: Diabetes”,
“In 2001, there was a research done which showed all types of people having diabetes and this
was due to the lack of income in the family and also unhealthy life style (Khan, 2001). It also showed that
people with low income bought cheaper foods and this resulted in unhealthy eating habits. Another
research that was done showed that computerized information has helped physicians organize the
database with more information about the patient since before this it was randomized and now electronic
literature searches has made it easier on the physicians (Balas, 2004). The significance of this was to see
and compare the prevalence of type 2 diabetes in white Europeans and individuals of African-Caribbean
and Pakistani descent. This was helpful for many people to see the different kinds of people who are
effect type 2 diabetes in Manchester.
A study done in 2011, may lead us to the path of a cure for diabetes. It proved that it reduces
diabetes due to the loss of body fat, but this lacked the fact that the surgical group was much younger and
also much heavier than lifestyle group. In 2010, there was a research done about risk for Cardiovascular
disease for people who have diabetes. There was a randomized group of about 5,145, who were
overweight or obese that has type 2 diabetes, they were all the ages of 45-76. The 2 groups were intensive
lifestyle intervention( ILI) and diabetes support and education (DSE) condition. The results shown that
the ILI had greater results for CVD and also might them to lower cost of medication ( Redmon, 2012)”
(Appendix 4)
Writing literature review was very similar to writing my historical overview. This is
because after summarize and assessment, I combined the two ( summary and assessment) into
my historical overview and just by showing how it relates to my research question and showing
it’s “what we do know”, it can be added into the literature review. By showing how I use
secondary sources from project 2 to project 4, shows my ability to adapt to different types of
gerens, and by this I have completed and accomplished learning objective 3.
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For learning objective 4, I have learned so much in this semester than I probably have
lerned in any other semester. Starting with genres, I have learned how to write and professional
email, annotated bibliography, research proposal and how professionally present and conduct a
speech in an audience. I have understood and mastered these concepts due to taking English
3010 and with great help my teacher, Abigail Heiniger.
I have changed how I write an professional email. I learned that when receiving an email
with a rejection, to always reply back. Though at first this I was confused to why there is even a
reason to email them back, but then I realized, in a professional setting everyone is always busy,
and for them to even consider us, that they should receive an email back from us. Stating and
thanking them to even consider us.
By having one on one conference, in class discussions and emails, I was able to reflect
my paper on key concepts I was told about my paper. During conferences, I would make sure I
have questions down to ask so it can help me on my paper. Also during class, we have
discussions involving everyone in the class, we also get into groups and grade each other’s rough
draft, and this has helped me revise because it is views in another person perspective. After doing
this in class, I started to print out my paper and by using a red pen (pretending to be a teacher)
to grade my own paper, this has helped me realize my mistake because I am reading it out loud
and because it is printed out.
This is has greatly changed how I will began to write from emails, to professional emails,
to even writing my own research proposal in my future job. As a psychology, I will be doing a
lot of research, and having done a lot of it in this class will also me greatly in the future for
graduate school or even a future job. I understand that this may give me the edge in my field for
example, getting the job I want. Giving an oral presentation in class has helped me prepare
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myself in the future for one as well. I learned that while giving and oral presentation to focus
your eyes on the audience, always stay on topic, and when asked a question, and you don’t know
the answer, let them know that’s a great question and possibly get back at them.
After taking this class, I will definitely start to reread many of my writings. This is
something that I have not done before. Many errors that I face because of this are fragment
sentences, run on, and also I tend to talk as I write and I say the sentence correctly but will forget
to add the word in as I am talking. I also realized that I will jump from topic to topic but I do not
use explaination. Here is an example showing from project 2,
“A decade later, there are still many more treatments and cures to be found dealing with diabetes. One of
the main options people may have is weight loss or even surgery, because many people with type 2
diabetes have seen a drastic change. It has also been said that when many people that are overweight,
there is a risk of having diabetes. This can lead to hypertension which can lead to cardiovascular disease.
Choosing a medication when having diabetes depends a lot on your weight, this is because some
medication promotes weight gain or even weight loss because of glucose control. ” (Appendix 2)
As you can see, in the second sentence, I forgot to mention what changed they seen, good or
bad? Also I did not make it clear in the 3rd sentence about who said when overweight, there is
risk factor for diabetes. This problem has come up many times, and now I reread my papers
thoroughly before turning them in.
Before taking this class, I did not think much writing; I would think that it comes up here
and there, for example I would not think I need it in a biology class, and after taking an English
class, wouldn’t apply in my everyday life. What I did not realize is that writing never leaves, it is
with us every day and with everything we do, from writing emails, to answering short questions,
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to even writing protocols. This course has designed to help me realize different types of genres,
what a discourse community is and how it plays a role in my profession, using research methods
that draws attention the primary and secondary sources, how to conduct a research proposal and
most importantly using all these concepts the real world. There is a tremendous amount of
writing techniques (drafting, revising, editing, rereading etc.) and skills that I have learned and
will carry on through my daily life. Taking this course has brought me to understand a new
meaning of writing that writing never leaves.
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Appendix A: Discourse Community: Physician Assistant Prospective
A discourse community is a group of different people with the same knowledge of
communication and shared interest of a specific area. It uses the same concept of writing,
elaborating on specific issues and communicating with different groups around you. The word
discourse means a formal discussion of a subject in speech or writing (Douglas Harper , 2012)
and the word community means the surrounding around you. We are all a part of discourse
communities in our everyday lives. For example, how we act and talk with our parents to our
teachers to when we are in a work setting, it is all in a different communication. As an employed
student at Wayne State University, I have come across my teachers, my co-workers, my boss and
my friends with whom I share the different discourse communities with. A few ways that I
communicate people are with are texting, Facebook, Pinterest and other social medias. One of
the six ways John Swales described discourse communities as, “A discourse community
uses its participatory mechanisms primarily to provide information and feedback” ( Swales
472). This is important since not only are you communicating, you are also communicating with
different parties. When communicating with others you should also give an appropriate feedback
for the conversation to go smoothly. “A discourse community is a group of people who “speak
the same language”( Deanna Mascle, 2008). This is a great example because we are talking in
detailed way where people in other professional fields won’t understand because they have not
been educated in this subject. Speaking the same language does not necessarily refer to a
language ( from foreign culture), but to a particular group of people that work in the same field.
My studies at Wayne State University lead me to my goal in life as a physician assistant
also known as a PA. This is also my research topic that I am pursuing for this course. A
physician assistant practices medicine under the supervision of physicians and surgeons.( Bureau
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of Labor Statistics, U.S. Department of Labor, 2012). As a physician assistant there are many
places for discourse communities. For example in the hospital setting, nursing home, clinic, etc.
Physician Assistant communicates with doctors, pharmacist, physical therapist, radiology
technicians and most importantly patients. Being a physician assistant alone teaches you a lot
about the discourse community in an everyday life. It is essential for having a discourse
community in a PA setting since there are many people around you in a day to day basis and
there is also many kinds of communication for every professional.
To learn more about research, writing and the discourse community of physician assistant, I had
the pleasure of interviewing a student ,Sarah Lekity , via email who attends Wayne State
University Graduate School, Eugene Applebaum. I met her at the general information meetings
which are held every Tuesday for students who are interested in pharmacy and health science
programs. I have emailed her a few times about my interest in PA a few months back and she
was helpful, so I decided she would be a great person to interview for my paper.
In the email, one of the questions I asked was, “What is it like to work as a Physician
Assistant?” She replied, “It can be overwhelming at times but as far as I have experienced, it is
very rewarding.”( S. Lekity, personal communication, September 19th 2012 ). This shows that it
is a lot to handle but at the end it is worth it. PA’s deal with patient care and this deals with a lot
of responsibility. They let their patients know what is going on, and what is going to happen so
they are not left clueless. Lekity also mentioned, “ My favorite part is being able to take the time
and explain everything to the patient. You can tell that they really do appreciate it.” Doctors
don’t really talk to patient one on one on a daily basis and take care of the patients a PA
does. The PA’s are here to take care of the patient every step of the way. This is a great
Islam 20
discourse community that they have with the patients. While in the hospital setting, PA’s
communicate with others by a pager, computers and writing on the boards for others to see.
The discourse community for a PA is very broad. A PA communicates with everyone in the
hospital setting especially with patients. For example a PA to PA discourse community should be
similar but PA to a biomedical equipment technician, the physician assistant should understand
what the biomedical equipment technician is saying and to give an appropriate feedback. This
also should be done with others (nurses, pharmacist, doctors etc.). It is both of the sides
responsibility to know this and to communicate with each other. The discourse communities that
I have encountered relating to PA, are visiting patients at the nursing homes and volunteering at
hospitals. Before Lekity was admitted to PA school, she had many types of discourse
communities in her life. “I worked at a free clinic and organized a breast cancer walk, along with
many other events”( S. Lekity, personal communication, September 19th 2012).Not only did she
gained volunteer experience, she also explored many types of discourse communities throughout
her college years to prepare and familiarize herself with the discourse communities she will face
as a PA.
The discourse community between a PA and a nurse is the communication of how the
patient is doing and what the patient needs. The nurse works with the PA’s and the PA’s works
with the physicians. You can say that a PA are the engine of the team. The communication
between PA and nurse is extremely important because the PA diagnose and treats the patient and
anything else they need the nurse must do, for example bedside care or nursing the patient. If
there is a lack of communication this will be a problem because the nurse might do something
that shouldn’t be done or vice versa, so communication is important. There is also a different
discourse community between PA and doctors. PA’s work with physicians and does as they say
Islam 21
and also works with them. The PA should know what the physicians are talking about, and if
they have any questions they should ask. If there is nonexistence of communication, something
serious can happy this can even mean death. Both PA( in some states) and physicians are
allowed to write prescriptions is this a discourse community to the pharmacist because you are
sending a message in the form of writing to communicate what type of drugs are needed for the
patient. Nurses, PA’s and physicians also share important documents together, which are called
medical records. This is a type of chart that can be written but most are electronic.
Written or Electronic charts are important ways for communication in hospitals, clinics,
nursing homes ect. These charts are health information filled out by nurses and PA’s when there
is a new patient, when patient visits and also updates on the patient. Few of the things that are
asked on the chart are physical assessments, asthma control, there medical history, allergies,
shots that they have taken, prescriptions they are taking of course the patients personal
information. When I asked Lekity, “What type of writing do you do?”, she replied, “Writing is
very limited as a PA, we mostly do a lot of electronic charting”.This is a great example of
discourse community between all the workers in the hospital. Whenever a nurse or physician
may need a patients file, they can just look him/her up in the program where all the patients file
are. Though years ago this was used on paper and was hand written but technology has
introduced its self to the medical field and now electronic charts are used because they are easy
access.
Though PA’s don’t do much research (S. Lekity, personal communication, September 19th
2012), there is an important type of writing in the medical field that physicians encounter. AMA
(American Medical Association) is a type of writing for research and journals. This is helpful for
researchers and also helpful for people searching for journals. AMA journals/research requires
Islam 22
introduction, method, results and conclusion. This great way to communicate with others who
want to learn about a research since anyone anywhere can read them.
There are many types of discourse communities that I have learned and many that I am
gradually learning every day. As a PA in the near future, I want to be able to communicate with
the different types of co- workers and also outside of the hospital setting. Other than doing prerequisites to become a pre- physician assistant, which are microbiology, anatomy & physiology,
general chemistry, statistics etc. ,there is also an exam called GRE which stands for Graduate
Records Examination. This class will help me prepare for examination because there is an essay
portion and I believe this class will help me achieve a high score. There are also 500 hours of
direct hands-on patient care experience; this is a great opportunity to learn different types of
discourse communities with different people. Not only do I love meeting people, I also have a
passion for helping others and this will help me gain my hours and help me get into a PA
program. I have learned this information about attending the monthly informational meetings
held the first Tuesday of every month at the Eugene Applebaum.
Over all this research paper was a great experience for me to communicate with someone
who is perusing a degree in my field. Though it was via email and we could not talk one on one,
it was a great chance for me to get to know a student in a PA program. The feeling of
interviewing a person who you can learn so much from, and who has the same passion as you (
to become a PA), makes me feel as if I can also do this. When interviewing Lekity, I felt very
important and skilled because I was in a professional setting. This research has helped me write a
professional email, to talking to a professional in my field, to becoming a wise person with
greatly amount of knowledge about PA’s. It has also helped me communicate with people in a
professional field. Having experience on doing this gives me the courage to branch out to others
Islam 23
for help and to seek knowledge about things I want to know. Not only have I familiarized myself
with the many types of discourse communities are as PA, I have also increased my knowledge
of writing a professional email.
Word Cited
Discourse. (n.d.). Online Etymology Dictionary. Retrieved September 19, 2012, from
Dictionary.comwebsite: http://dictionary.reference.com/browse/discourse
Lekity, S. (2012, September 19). Interview by Y Islam [Personal Interview]., Detroit,MI.
Mascle, D. (2008, May 4). Understanding discourse community and its importance.
Retrieved
from http://ezinearticles.com/?Understanding-Discourse-Community-And-Its
Importance&id=1153237
Scribe, A. (2009, November 22). Ama style stat! for reseach papers. Retrieved from
http://www.docstyles.com/library/amastat.pdf
Swales, John. ''The Concept of Discourse Community." Genre Analysis: English in
Academic and Research Settings. Boston: Cambridge UP, 1990.21-32. Print.
Islam 24
Appendix B: Annotated Bibligraphy/ Historical Overview: Diabetes effects and medication
effects
Annotated bibliography:
Balas, E.A. , Krishna, S., Kretschmer, R.A., Cheek, T.R., Lobach, D.F., Boren, S.A. (2004).
Computerized knowledge management in diabetes care. Medical Care, 42(6) , 610-621.
Retrieved from http://www.jstor.org/stable/4640793/
Automated information interventions on diabetes care and patient care plays a huge role
in diabetes. Systematic electronic and manual searches were conducted and studies were grouped
in to 3 categories. The computerized prompting of diabetes care, utilization of home glucose
records and computer assisted diabetes patient education. The results have shown that the
glycated hemoglobin and blood glucose level improved expressively. This was due to the wideranging of electronic literature searches that was randomized for the clinical trials. Computerized
knowledge is becoming a vitual component for diabetes care and has documented to show
improved diabetes related
outcomes.
This article
proved that computerized data of diabetes has helped organize information on the clinical trials.
It was helpful to see that there was randomized databases used and that now it is much clear for
physicians to see the information in the database.
Cramer, J.A. (2004). A systematic review of adherence with medications for diabetes. Diabetes
Care, 27(5), 1218 1224.
http://www.haifamed.org.il/pictures/files/Adherence2004DiabCare_Cramer.pdf
Medications for diabetes have troubled many people. This article talks about how people
go out of their way to omit prescriptions for diabetes. It was used to see if the patients would use
oral hypoglycemic agents, insulin or electronic monitoring. Results has showed that patients with
diabetes were poor compliers for treatment , but electronic monitoring was useful because it
improving for patients.
This article was interesting because there are many things that are unknown about
medication for diabetes and this can help find support for the patients.
Fujita, Y., Cheung, A. T. and Kieffer, T. J. (2004), Harnessing the gut to treat diabetes. Pediatric
Diabetes, 5: 57–69. doi: 10.1111/j.1399-543X.2004.00080.x
The gut is a very important part of the body, it is the largest stem cell population. The
cells are almost same pathway of different and both intestinal and pancreatic endocrine cells to
help the gut, to treat diabetes. Insulin injection has been used for type 1 diabetes for a long time.
To harness the gut by reprogramming the stem cells to develop β-cells would help to co-secrete
insulin. This article was also hard in understand. There was trouble familazing the words to there
meanings.The information was usefull because it showed us a new way to harness the gut.
Islam 25
Gruesser, M., Hoffstadt, K., & Joergens, V. (2003). Structured outpatient education and
treatment programs for patients with diabetes mellitus and/or hypertension: the German
experience. Disease Management & Health Outcomes, 11(4), 217-223
In the German system, it is said that a recent legislation should include a treamment and
also teaching patients for diabetes. They found ways to teach others about diabetes and
hypertension. A few they did was inpatient and outpatient were separated so that way there two
different people they would talk to. they also did routine for daily basis this was called patient
education. This was a nice to interact with the patients, and the physicians will learn more about
their patients while working with them.
Hao,M., Head, W.S., Gunawardana, S.C., Hasty, A.H., Piston, D.W. (2007). Direct effect of
cholesterol on insulin secretion. Diabetes, 56(9), 2328-2338. doi:10.2337/db07-0056
Cholesterol and insulin secretion are important when it comes to β-cells. Mouse model
was used for the article and itexhibits cholesterol butl FFA levels normal. It was found that
cholesterol and reduced insulin had a link together. Cholesterol for to β-cells breakdown may
add to the β-cell
dysfunction.
This was
useful to see what a person with cholesterol may be in effect if he/she also is taking insulin.
Kashyap, S.R., Louis, E.S., Kirwan, J.P. (2011). Weight loss as a cure for Type 2 Diabetes? fact
or fantasy. National Institute of Health, 6(4), 557–561. Retrieved
from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3145356/
Surgery may be a way to help cure type 2 diabetes. By losing body fat, you can reduce
insulin resistant. This also reduces diabetes due to the body fat loss. There were two groups,
one was much younger and more over weight, this was the surgical group and then there was
lifestyle group . There was also lack of glucose tolerance after the test. Also there should be
randomized people, it would have helped the
research.
This is because the surgical group was younger and also heavier than the lifestyle group. This
article helped me prove that surgery is an option for a cure for diabetes but where was a lack of
control group and also choosing the randomized surgical group.
Redmon, J.B., Bertoni, A.G., Connelly, A., Feeney, P.A., Glasser, S.P., Glick, H., Greenway, F.,
Hesson, L.A., … Montgomery,B. ( 2010). Effect of the look ahead study intervention on
medication use and related cost to treat Cardiovascular Disease risk factors in individuals
With Type 2 Diabetes. Diabetes Care, 33(6), 1153-1158. doi:10.2337/dc09-2090
This article is about weight loss and how physical fitness vs. the cost of medication for
treating cardiovascular disease which is a risk factor for people who have type 2 diabetes. There
was a randomized group, of about 5,145 who were overweight or obese that has type 2 diabetes,
Islam 26
they were the ages of 45 – 76. The 2 groups were intensive lifestyle intervention (ILI) and
diabetes support and education (DSE) condition.n The results shown that the ILI had a greater
result for CVD and this also helped them to lower cost of medication. This article was important,
it proved that losing weight does help prevent type 2 diabetes and also can get rid of it and it can
save a lot of money for not buying medications any more.
Riste, L., Khan, F., Cruickshank, K., Clinical Epidemiology Group. (2001). High prevalence of
Type 2 Diabetes in all Ethnic Groups, including Europeans, in a British Inner
City. Diabetes Care, 24(8), 1377-1383. doi:10.2337/diacare.24.8.1377
There is a high prevalence in type 2 diabetes in many ethnic groups. There was a random
sampling in Manchester. About 1,318 people participated. Physical activity was rare and obesity
was common. There was a great number of Europeans who had diabetes and also AfricanCaribbeans and Pakistanis. Some reasons of this was physical inactivity and also poverty which
maybe lead them to eat unhealthy since unhealthy foods are cheap and some
sugary.
This article was helpful to see that many different kinds of people who
are affected with diabetes and then different reasons why. The goal of this article was see
examine different cultures in Manchester that have type 2 diabetes and how it affected them to
get type 2 diabetes in the first place.
Robbins, J.M., Webb, D.A. (2006). Diagnosing diabetes and preventing Rehospitalizations: The
Urban Diabetes Study. Medical Care, 44(3), 292-296. Retrieved
fromhttp://www.jstor.org/stable/3768165/
Hospitalized as a diabetic can get very dangerous. Patients who are hospitalized n is seen
more after hospital discharge with patients who have diabetes. Philadelphia residents ages 25-84
with diabetes had their hospital information tracked compared to non elective rehospitalization
within 30 days of discharged. The rehospitalized portion was 9.4% where as nonelective
rehospitalized witth in 30 days of hosipital discharge was 20%. There was a failure to record
diabetes diagnoses after discharges and also to check if the patients are treated for any other
diseases. This results in the lack of attention for diabetes
patients.
This article was helpful, but the lack of attention for
the patients was poor and if this was different the results may have differ.
Roep, B. (2003). The role of t-cells in the pathogenesis of type 1 diabetes: from cause
to cure. Diabetologia, 46(3), 305-321. doi: 10.1007/s00125-003-1089-5
This articles addresses the challenge of t-cells and how it provides information to
determine the key for islet allografts transplanted to Type 1 diabetic patients. There was a lack
technology to determine the T-cell autoreactivity, there for the process was very slow. There was
also a try for mouse models for human disease but did not work out because mouse models
cannot be used to determine the effectiveness of immunointervention in
humans.
The title of the article was misleading. It was not helpful
because it failed to discuss a cure.
Islam 27
Seifter, E., Ruttura, G., Padawer, J,. ( 1981). Impaired wound healing in streptozotocin diabetes.
Prevention by supplemental vitamin A. Ann Surg,193(1), 42-50
Wound healing is complicated in Virginia espeaically people who have wound infections
for non diabetic patients. There were 2 experiments that happened. The first was sectioned into
3groups, The first group of rats is enjected with isotonic saline. The 2nd and 3rd were injected
with Sz. A few weeks later group 3 started tp take vitamin. A supplement, and group 1 and 2
were continued in the basal chow. For all the experiments rats that were injected streptozotocin
and also became hyperglycemic. This article was useful since it was about rats and how they
would diabetes and how last the can get it.
Selvin, E., Coresh, J.,Brancati, F.L. (2006). The burden and treatment of diabetes in elderly
individuals in the U.S. Diabetes Care, 29(11), 2415-2419. doi: 10.2337/dc06-1058
How diabetes distinguishes between the old and the middle aged. 2,809 diabetes patients
of the elderly were used in the survey. The elderly have more burden on them because they have
diabetes so late in their age this can effect there microvascular disease and glycemic control.
This has been shown that middle aged adults who have diabetes until they are old have risks of
having diseases. This article is also unique in which is it comparing the middle age to the elderly
and also people who have had diabetes there middle age to their old age.
Thornson, A.B., Division of Gastroenterology. ( 1980). Unidirectional flux rate of
cholesterol and fatty acids into the intestine of rats with drug-induced
diabetes mellitus: Effect of variations in the effective resistance of
the unstirred water layer and the bile acid micelle. Journal of Lipid Research, 21(6),
687-698. Retreived from http://www.jlr.org/content/21/6/687.long
The context used for this article was hard to comphremend, the words were unfamiliar
from my other articles. The method they used were the measure od adherent mucosal fluid
volume, there would be unlabeled and labled short chain of fatty acid , The results shown that the
mean of the groups were determined by students t-Test. The slopes were for fatty acid 6:0 to
12:0.
This article was not useful to me at all, there many words I was unfamiliar with and also words I
had to look up. For something picking up this artile and reading it, it would be very hard on
them.
Wikblad, K., Wibell, L., & Montin, K. (1990). The patient's experience of diabetes and its
treatment: construction of an attitude scale by a semantic differential technique. Journal
Of Advanced Nursing, 15(9), 1083-1091. doi:10.1111/j.1365-2648.1990.tb01990.x
This article talk about building scale of diabetes and what kinds of people are most likely
to get it. About 50 diabetic patients were tested and this showed that men had more positive
additude than females. Also showed that patients having diabetes for less than 10 years were
happier. This was reliable because it showed that how you can compare people with diabetes for
Islam 28
how long they have been having the illness, also not many research has been done like this it is
very interesting.
Yawn, B., Zyanski, S.J., Goodwin, M.A, Gotler, R.S., Stange, K.C., Olmsted Medical Center.
(2001). Is diabetes treated as an acute or chronic illness in community family
practice? Diabetes Care, 24(8), 1390-1396.doi:10.2337/diacare.24.8.1390
There is poor quality of care in hospital settings for diabetes patients. For two seperate
days the nurses observed consecutive outpatients in 138 family physician offices. The patients
were 40 years of age and more and there were about 1,867 patient visits. Davis Observation
Code was used for time. Patients with diabetes were compared with people who have chronic
diseases to see if there is more attention to one another. It compared time used during the visits
of diabetes patients and other chronic and acute illnesses. This has showed that diabetes
has greater proportion of the time. This has help to show other that they should all be treated
equality.
This article was very useful. It showed that giving just a little more time with talking to the
patient can change a lot. There were many questions and problems that were addressed during
the times that were spent longer with the physician.
Historical Overview: Diabetes cure and medication effects
This annotated bibliography examines the evolution of diabetes and also the risk of taking
medication for diabetes and how it may affect other illnesses. Scholarship on this topic has
evolved from how diabetes have advanced throughout the years till now, where we have many
treatments to find a cure.
The first blood sugar meters and insulin pumps came out the 1970’s. These meters were
huge and needed a lot of blood for the results to be clear, and even then it would not be as
accurate as now. As the years have progressed, in the 1980s, UCSF coordinated the first multicenter clinical trial of human insulin and the first human insulin was made. This insulin was
much safer, more accurate, and also were less allergic. At this time, Stem cells were believed to
play a good role for diabetes and also for other diseases. In the late 1980’s 6.7 million people
reported to have diabetes, and many who had it were unaware. This is due the lack the checks
and also unawareness.
Islam 29
In the early 1990’s, one of the major cauases of blindness was because of diabetes. Not
only was blindness a problem, but in the 1990’s kidney disease nerve damage, foot
complications were also a major problem of having diabetes. Around this time there was also a
research for measuring attitudes towards diabetes, this proved that men who had diabetes were
much happier than women, it also showed that a person who has a higher degree of education
and also was self-monitoring of their blood glucose had more negative attitude for diabetes (
Wikbald, 1990).
A decade later, there are still many more treatments and cures to be found dealing with
diabetes. One of the main options people may have is weight loss or even surgery, because many
people with type 2 diabetes have seen a drastic change. It has also been said that when many
people that are overweight, there is a risk of having diabetes. This can lead to hypertension
which can lead to cardiovascular disease. Choosing a medication when having diabetes depends
alot on your weight, this is because some medication promotes weight gain or even weight loss
because of glucose control. In 2001, there was a research done which showed all types of people
having diabetes and this was due to the lack of imcome in the family and also unhealthy life style
(Khan, 2001). It also showed that people with low income bought cheaper foods and these results
in unhealthy foods. Another research that was done showed that computerized information has
helped physicians organize the database with more information about the patient because it was
randomized and now electronic literature searches has had it easier on the doctors. ( Balas,
2004).
People with many other illness may take medications for diabetes and this can cause
many side effects. In 2004, a study was done about diabetes patients who top taking there
Islam 30
medications. In the study they used many other methods, for example if they lost weight, or if the
used electronic monitoring.(Cramer 2004)
In 2012, we stil are facing many problems with the cure of diabetes and also the effects
of long term and also effects of taking medication while having other illness. A study done in
2011, may lead us to the path of a cure for diabetes. It proved that it reduces diabetes due to the
loss of body fat, but is lacked the fact that the surgical group was much younger and also much
heavier than lifestyle group. In 2010 there was a research done about risk for Cardiovascular
Disease for people who have diabetes. . There was a randomized group, of about 5,145 who were
overweight or obese that has type 2 diabetes, they were the ages of 45 – 76. The 2 groups were
intensive lifestyle intervention (ILI) and diabetes support and education (DSE) condition.n The
results shown that the ILI had a greater result for CVD and this also helped them to lower cost of
medication. ( Redmon,2010)
Work Cited
Balas, E.A. , Krishna, S., Kretschmer, R.A., Cheek, T.R., Lobach, D.F., Boren, S.A. (2004).
Computerized knowledge management in diabetes care. Medical Care, 42(6) , 610-621.
Retrieved from http://www.jstor.org/stable/4640793/
Redmon, J.B., Bertoni, A.G., Connelly, A., Feeney, P.A., Glasser, S.P., Glick, H., Greenway, F.,
Hesson, L.A., … Montgomery,B. ( 2010). Effect of the look ahead study intervention on
medication use and related cost to treat Cardiovascular Disease risk factors in individuals
With Type 2 Diabetes. Diabetes Care, 33(6), 1153-1158. doi:10.2337/dc09-2090
Riste, L., Khan, F., Cruickshank, K., Clinical Epidemiology Group. (2001). High prevalence of
Type 2 Diabetes in all Ethnic Groups, including Europeans, in a British Inner
City. Diabetes Care, 24(8), 1377-1383. doi:10.2337/diacare.24.8.1377
Seifter, E., Ruttura, G., Padawer, J,. ( 1981). Impaired wound healing in streptozotocin diabetes.
Prevention by supplemental vitamin A. Ann Surg,193(1), 42-50
Wikblad, K., Wibell, L., & Montin, K. (1990). The patient's experience of diabetes and its
treatment: construction of an attitude scale by a semantic differential technique. Journal
Of Advanced Nursing, 15(9), 1083-1091. doi:10.1111/j.1365-2648.1990.tb01990.x
Islam 31
Appendix C: Psychology: Substance Abuse Disorder
Substance abuse can be abused by the repetition of the drug/alcohol, this leads to
addiction. The purpose of this study was to present substance abuse in a way many people do not
see: the psychological aspects of this disorder. The effects of this disorder are very apparent in
society today but the underlying psychological causes are often missed. Substance abuse is
caused by psychological issues , with that said, each of the members of the group talked about a
psychological approach and how it effects substance abuse. The group project aimed to
demonstrated four parts psychological perspective of substance abuse; sociocultural perspective,
behavioral perspective, biological perspective and cognitive perspective. Each group member
explained there parts and elaborated on their psychological perspective and how it is a major
factor for substance abuse. We also wrapped up the presentation by talking about the different
types of discourse communities and how each professional would approach the treatments and
communication. Group members also talked about discourse communities and how psychiatrist,
doctor, pharmacist, and social worker would take part to help a person going through substance
abuse. This shows how the different professionals come together to work on the same situation.
Some of the challenges that we overcame was how to bring discourse community into substance
abuse. With all of our thoughts and ideas together we thought about if each of us play a
professional in a field working together a substance abuser. My role in this presentation was
primarily to discuss the sociocultural aspect.
The sociocultural aspects of substance abuse are friends and family, environment,
community/culture, and economic conditions. Every person is affected by a sociocultural aspect
at one point in their lives especially when dealing with substance abuse. Though these four
aspects are different in terms of living conditions, they are also similar in many ways. These four
Islam 32
aspects can all relate to each other because they are all reasons that influence others for substance
abuse.
Friends and family play a huge role in this, since you are most likely to be around them,
they can influence you very easily. Evidence has shown that children born of an alcoholic parent,
even though they are raised by non-alcoholic foster parents, have much higher rates of
alcoholism than those with non- alcoholic origins (Differences in Susceptibility, 1999). This
shows that the origin is more important than the non-alcoholic foster parents, even though they
grew up with the non- alcoholic foster parents. Friends and family are one of the most important
aspects of why and how people are influence by substance abuse. Having an alcoholic family
member, will double the risk of a male child ( later in life) to become accessible to alchol or
drugs (Differences in Susceptibility, 1999). It is also because pervasive daily influence and
adapting to their friends and family life style. Another aspect of substance abuse is your
environment.
Your environment plays a huge role on how substance abuse enters your life. When
he/she is not near their family members or friends, their environment becomes a more important
factor. For every place, for example, the mall, school, a party or even someone’s home, there is a
different environment. Your environment influences you to do things that others are doing
around you. If the environment you are in consist of people drinking on a daily basis, you would
most likely to drink. Peer pressure also plays a role in your environment, you may not want to
drink or use drugs but many would, for others to stop asking them. Physical and sexual abuse can
also play a role in your environment. If you were physically or sexually abused you may think
drinking or taking excess amount of drugs might hide or relieve the pain. The environment
aspect of substance abuse is different from friends and family aspect because, family and
Islam 33
friends2 may count as your environments but your environments do not count as friends or
family (Drug Abuse and Addiction, 2011). Your environment on a Saturday night can simply be
at the bar with others that you don’t know. This leads the community you live in and everyone
around can influence you into substance abuse.
Your community/culture around you is everyone that influences you as a whole. Growing
up in the same community you were born, shapes who you are today. If you grew up in a
community surrounded by substance abuse and alcohol, you would most likely to come across it
at one point of your life. You would be more likely to be involved in substance abuse if it is
accepted in your community. You wouldn’t think twice because since it is acceptable and if
everyone else does, then why wouldn’t I? Community along with culture also plays a huge
impact into substance abuse. In India, substance abuse has become a major problem for people
living there. Since India has many heath issues, there is a reason to give out medications as
young as 15 to treat their health ( Comer, 2005). Because many people have access to these
medications do to their health, substance abuse has easily grown. Reasons for them to
excessively take the drugs are maybe to feel better, because of hunger, or maybe the lack of
educations (that they don’t realize how bad it is to overdose). Compared to the US and why
many people become involved in substance abuse, many take them to feel cool to be in a popular
crowd. This is the way of thinking called cognitive aspect. Alcohol that is found used by Jews
and Protestants, which shows that drinking is acceptable with limits. Whereas Eastern European
and some Irish people, substance abuse has no limits. Your community/ culture is different from
your environment because your culture is how your parents grew up and how most likely you
would grow up, no matter what environment you live in and your environment changes every
Islam 34
day. This leads to economic changes and how substance abuse has influence us due to economic
changes.
Economic conditions play a part of your financial life. Going through a loss of a job,
losing a home, of even being in bankruptcy are some examples why many get themselves into
substance abuse. These all can influence you to drink, washing your problems away, when in
reality they are not gone. Most people are likely to enter substance abuse when they are under
stressful socioeconomic problems. Studies have shown that high levels of unemployment have
higher rates of alcoholism (Comer, 2005). Economic conditions in a positive way, such as
winning the lottery can let them feel as if they have everything in life, wasting money on drinks,
getting wasted and not really thinking about reality, can lead to substance abuse because they can
get addicted to alcohol. Economic conditions is different from your community/culture because
during economic conditions, you are facing financial problems, poverty, and stressful problems
that can lead you to taking drugs and leading you to substance abuse, where as your
community/culture, it is your surroundings and how others influence you.
As a pharmacist, the discourse community along with other professionals come together
and also work together at times to help the patient for better communication and treatment. There
is not one specific treatment to treat/cure substance abuse, there are many. Treatment for opioids
are methadone, buprenorphine and naltrexone. For the treatment of Methadone, you should visit
a license clinic daily this medication and offset cravings. Naltrexone blocks the effects of opiate
drug and reduced behavioral response to alcohol. (Smith 2007) Some types of medication that
are over the counter are patch, spray, gum, and lozenges for the treatment
of Tobacco. Naltrexone, acamprosate, and disulfiram are medication for alcohol, all with
different aspects. Naltrexone blocks opioid receptors that are involved in the rewarding effects of
Islam 35
drinking and in the craving for alcohol. Acamprosat reduces symptoms of protracted withdrawal,
such as insomnia, anxiety, restlessness, and dysphoria. Disulfiram interferes with the degradation
of alcohol, resulting in the accumulation of acetaldehyde, which, in turn, produces a very
unpleasant reaction that includes flushing, nausea, and palpitations if the patient drinks alcohol. (
DrugFacts, 2009). Non-therapeutic drug and screening are done by pharmacist for therapeutic
goals (Tommasello, 2004). For every person there will most likely be a different medication, this
is because they may be polydrug users, people who are addicted to more than one drug, you will
need more than of medication to treat there addiction.
In conclusion, sociocultural plays a major role in substance abuse for every person who is
effective. These 4 aspects come into play on everyday basis. Everyone at one point of their lives
are influenced by others or sociocultural has come in. Though the 4 aspects are similar, they are
also different in many ways.Discourse communities for substance abuse users play a important
role for the pharmacist. Without the right prescription or drug there ino treatments.
Work Cited
Butler, A. (08, 2010 24). Environmental influences on drug abuse. Retrieved
from http://www.livestrong.com/article/218355-environmental-influences-on-drug-abuse/
Children affected by substance abuse. (n.d.). Retrieved
from http://www.childlineindia.org.in/children-affected-by-substance-abuse.htm
Comer , R. (2005). Substance abuse : From a social and cultural view . Retrieved
from http://www.psychtreatment.com/substance_abuse_social_cultural_view.htm
Drugfacts: Treatment approaches for drug addiction . (2009, 09). Retrieved
from http://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction
Islam 36
Drugfacts: Understanding drug abuse and addiction . (03, 2011). Retrieved
fromhttp://www.drugabuse.gov/publications/drugfacts/understanding-drug-abuseaddiction
Miller, W. R. (2005). Are alcoholism treatments effective? the project match data:
Response. 5(76), doi: 10.1186/1471-2458-5-76
Tommasello, A.C.(2004). Substance abuse and pharmacy practice: what the community
pharmacist needs to know about drug abuse and dependence. Harm Reduction Journal.
1(3), 1-15. doi: 10.1186/1477-7517-1-3
For more information check the Substance Abuse Project:
http://wsuengpsych.pbworks.com
Islam 37
Appendix D: Research Proposal: Diabetes
Background on Topic:
Diabetes is a growing health concern in the world today. Nearly one million people are
affected by diabetes annually and there are about 2.8 million people suffering from diabetes
today (Diabetes statistics, 2011). This rapid spread of disease is frightening because there is no
cure for this disease, only treatments to manage it. Diabetes starts off when a person does not
have enough insulin in the body, or the lack of response to insulin (Shaw, 2009). This will lead
us to two types of diabetes, type 1 and type 2.
Type I diabetes is also called insulin- dependent diabetes; this is because the body does not
produce insulin (Nordqvist , 2010). Insulin is a hormone that converts food ( starch, sugar ect.)
into energy for everyday life. If this process cannot occur a person must take insulin ("Type 1,"
2011). Type 1 diabetes develops in childhood, teenage years and even adulthood.
Treatments/medications for type 1 diabetes include taking insulin, eating healthy, watching
blood sugar, and exercising. There are many types of insulin, for example fine needle, insulin
pen, and insulin pumps. A fine needle is a syringe. An insulin pen holds insulin inside and looks
like a pen. An insulin pump is a device that is portable and also battery operated that is worn on
the arm, leg or abdomen, and it can be set so it gives doses of insulin during the
day ("Treatments and drugs ," 2012). Insulin side effects are rare but can arise such an allergic
reactions ("Insulin side effects," 2012 ).
Type II diabetes is when the body does not produce enough insulin. This is less serious than type
I, but still needs attention. Obese or overweight people are at a greater risk of type II diabetes. It
can be treated early be exercising and eating healthy or it will get worse. (Nordqvist ,
Islam 38
2010). Drugs and injections are both used for medications for type II diabetes. Some examples
are metformin, glipizide, glyburide etc. There is also insulin for those people who choose not to
take medication. People who choose to take either, may have bariatric surgery. This surgery can
help obese people greatly (by losing fat), but there are risk and complications such as risk of
death. ("Treatments and drugs ," 2012).
The first blood sugar meters and insulin pumps came out the 1970’s. These meters were huge
and needed a lot of blood for the results to be clear, and even then it would not be as accurate as
now. As the years have progressed, in the 1980s, UCSF ( University of California, San
Francisco) coordinated the first multi-center clinical trial of human insulin and the first human
insulin was made. This insulin was much safer, more accurate, and also were less allergic. At this
time, Stem cells were believed to play a good role for diabetes and also for other diseases. In the
late 1980’s 6.7 million people reported to have diabetes, and many who had it were unaware.
This was due the lack the check ups and also unawareness. (Defeat Diabetes Foundation, 2011).
There was also a research for measuring attitudes towards diabetes, this proved that men who
had diabetes were much happier than women, it also showed that a person who has a higher
degree of education and also was self-monitoring of their blood glucose had more negative
attitude for diabetes ( Wikbald, 1990). This article talk about building scale of diabetes and what
kinds of people are most likely to get it. It showed that patients having diabetes for less than 10
years were happier. This was reliable because it showed that how people are compared with
diabetes and for how long they have been having the illness, also not many research has been
done like this.
People with other illnesses may take medication for diabetes and this can cause many side
effects. For example, when a person takes medication for diabetes and medication for steroids
Islam 39
(this could be taken for inflammation in the body). The two medications would not be a good
combination because steroids can cause blood glucose level to rise. There are also medications
that decrease your blood glucose level, for example high blood pressure medication. ("Diabetes
and taking," 2003).
Diabetes is a common illness that affects and interacts cholesterol medication, it has many side
effects when the medications are taken together. Cholesterol is a lipid which is produced by the
liver (Nordqvist, 2004). Cholesterol is in everyone’s body, knowing how much cholesterol we
have in our body identifies if we have good or bad cholesterol. It is carried throughout the blood
by lipoproteins. Bad cholesterol also known as LDL ( Low density lipoprotein), carries the from
the liver to the cells. When too much cholesterol is carried to the cells, this becomes a buildup
of plaque throughout the arteries and eventually lead to hyperlipidemia also known as high
cholesterol or high LDL("High cholesterol -," 2010). Good cholesterol also known as HDL (high
density lipoprotein), is the opposite of LDL. It carries the cells to the liver and also removes LDL
or bad cholesterol by transferring into the liver (instead of the cells). Below is a chart showing
the different types of screenings and the target ranges for cholesterol.
Islam 40
There are many medications for cholesterol, along with many side effects. Some
medications including Statins, which is a medication that helps lower cholesterol levels, have
side effects such as rash, difficulty sleeping and has warnings such memory loss. ("Side effects
of,"2012). A major side effect includes increasing blood glucose level. This may lead to
developing type 2 diabetes ("Statin side effects:," 2012). Another medication to treat cholesterol
is Lipitor. Lipitor is also used to treat high blood pressure, heart attack, lower risk of stroke etc.
("Lipitor," 2012). This medication also risks, due to diabetes. Research has shown that Lipitor
may lead to slightly risk of developing blood sugar level ("Lipitor tied to," 2011).
Literature Review/Scholarship Review:
The evolution of the topic, how diabetes affect and interact with medications topic has
expanded for decades, of course there is always new and more improvement throughout the
years. Some improvements include new medication for diabetes and finding side effect for some
Islam 41
of the medications. Research has shown that one of the top risk factors for type 2 diabetes is high
blood pressure and high cholesterol (Manzella, 2010). The reason for this is because it damages
heart vessels and is a main factor for metabolic syndrome. Both type 1 &2 diabetes have
different side effects to cholesterol since one is far more complication than the other ( Manzella,
2010)
In 2001, there was a research done which showed all types of people having diabetes and this
was due to the lack of income in the family and also unhealthy life style (Khan, 2001). It also
showed that people with low income bought cheaper foods and this resulted in unhealthy eating
habits. Another research that was done showed that computerized information has helped
physicians organize the database with more information about the patient since before this it was
randomized and now electronic literature searches has made it easier on the physicians (Balas,
2004). The significance of this was to see and compare the prevalence of type 2 diabetes in white
Europeans and individuals of African-Caribbean and Pakistani descent. This was helpful for
many people to see the different kinds of people who are effect type 2 diabetes in Manchester.
A study done in 2011, may lead us to the path of a cure for diabetes. It proved that it reduces
diabetes due to the loss of body fat, but this lacked the fact that the surgical group was much
younger and also much heavier than lifestyle group. In 2010, there was a research done about
risk for Cardiovascular disease for people who have diabetes. There was a randomized group of
about 5,145, who were overweight or obese that has type 2 diabetes, they were all the ages of 4576. The 2 groups were intensive lifestyle intervention( ILI) and diabetes support and education
(DSE) condition. The results shown that the ILI had greater results for CVD and also might them
to lower cost of medication ( Redmon, 2012)
Islam 42
Though there are many improvements throughout the decades of diabetes, there also have been
many downfalls. For example, incidents where a few medications for type 2 diabetes are being
recalled; Avandia, Avandamet, and Avandaryl. This is because of an active ingredient,
rosiglitazone, which lead to heart risks. Though there are only a few people who can take this
medication, those who have used this drug effectively and did not have any problems, or if they
are not able to take other medications for diabetes (Hitti, 2011). Another diabetes
medication, Actos is banned in the European Union, because it may lead to bladder cancer and
heart failure, it is yet to be banded here in the US. ("Diabetes drug recall," 2012 ).
Research has shown that there is direct effect of cholesterol on insulin secretion (Hao,
2007). This is because the medication taken for cholesterol and the insulin are taken together. It
is also shown that women who take insulin more like have hyperlipidemia and while taking
insulin for diabetes, hyperlipidemia is more likely to occur at age 40 -60 ("Could insulin cause,"
2012).
Research has shown that Statins, a drug that treats high cholesterol may increase risk of
diabetes. This is a major problem for those who do not have diabetes (because they will be at risk
of having it), and also a problem for those who have diabetes, because there blood sugar may rise
and worsen (Rocco, 2012). This is an important matter for many people who are taking this drug,
because are in a risk for a life threating disease.
Though there are many improvements throughout the decades of diabetes, there also have been
many downfalls. For example, incidents where a few medications for type 2 diabetes are being
recalled; Avandia, Avandamet, and Avandaryl. This is because of an active ingredient,
rosiglitazone, which lead to heart risks. Though there are only a few people who can take this
medication, those who have used this drug effectively and did not have any problems, or if they
Islam 43
are not able to take other medications for diabetes (Hitti, 2011). Another diabetes
medication, Actos is banned in the European Union, because it may lead to bladder cancer and
heart failure, it is yet to be banded here in the US. ("Diabetes drug recall," 2012 ).
Research has been done for a few diabetes medications; find out side effects dealing with
cholesterol. Also recalling drugs of diabetes which helped take off medications with major side
effects . There is not much research dealing with diabetes and its complications with cholesterol.
A huge gap that takes place in this research is how diabetes effects and interacts with high
cholesterol. How to know which diabetes medication effects which cholesterol medication. Also
a few limitations according to “Weight Loss as a Cure for Type 2 Diabetes? Fact or Fantasy” is
for the patients to be random, so this way there are many possible conclusions.
Research Question:
How does diabetes medication affect and interact with other illness and medications such
as cholesterol?
Proposed Research Method:
Definition of related key terms:
According to Legal Rights of Students with Diabetes, here are some definitions
that may help with some key terms.
Blood Glucose level: Amount of glucose in the blood. 80 to 120 should be the amount
before eating. Lower than 180 when after eating and during bed time it should be 100 t
140 ("What are key," ).
Blood glucose monitoring: The act of checking the amount of glucose in the
blood
("What are key," ).
Islam 44
Glucose: Sugar that is found in the blood, body’s main source of energy. ("What are
key,").
Insulin: A hormone produced by the pancreas that supports the body uses of glucose for
growth and energy ("What are key," ).
Pancreas: Located in power part of abdomen that makes insulin ("What are key," ).
Type 1 diabetes: insulin-dependent diabetes that requires life-long insulin treatment; This
occurs when the pancreas doesn't make enough insulin (Yoffee, 2009).
Type 2 diabetes: non-insulin-dependent diabetes, when a person body doesn't make
enough insulin or is not used properly (Yoffee, 2009).
Cholesterol: substance that occurs naturally in all parts of the body (Beckerman, 2012)
LDL (low density lipoprotein) cholesterol:can build up on the walls of the arteries.
(Beckerman, 2012)
HDL (high density lipoprotein) cholesterol: This takes the bad cholesterol out of the blood
and keeps it from piling up in the arteries. (Beckerman, 2012)
Hyperlipidemia: High blood cholesterol ("High blood cholesterol," 2012)
Triglycerides: Chemical form that exists in the body and food (Beckerman, 2012)
Lipitor: is a cholesterol medication used to lowers bad cholesterol and good
cholesterol ("Cholesterol medications: Consider," 2012)
Zetia: is a cholesterol medication that lowers bad cholesterol and
triglycerides ("Cholesterol medications: Consider," 2012)
The design of the experiment will demonstrate the risk of taking these diabetes medications and
how it affects other illnesses, such as cholesterol. The experiment aims to show how both illness
and medication interacts with each other. For the experiment, the tools used glucose meter, a
Islam 45
computer to store data, medications for diabetes and cholesterol, exercise machine etc. There are
will be 5 groups in this experiment, all ages 25- 60. The lifestyle group, diabetes group, diabetes
with type 1 and cholesterol group, and diabetes with type 2 and cholesterol group and the
cholesterol group. The life style group people who may be at risk of diabetes and cholesterol but
workout and eat healthy every day. The diabetes group are diabetics who take medication for
diabetes. Type 1 diabetes and cholesterol group of people who has both of the conditions and are
taking medication for both. Type 2 diabetes and cholesterol group are people also in the same
position and taking both medications, and lastly the cholesterol group with people taking
medications for cholesterol. Each group will have 50 people. The group will later be divided by
age, male or female and different races. This method is similar to the scholarly article experiment
“High Prevalence of Type 2 Diabetes in All Ethnic Groups, Including Europeans, in a British
Inner City”, because it is divided by race and lot there will be questions ask to the participants.
Diabetes patients and cholesterol patients will be taking drug medication while type 2
diabetes patients will be taking insulin. This experiment will go on 6 months to a year depending
on what side effects occur. Their blood sugar and cholesterol will be checked very often, along
with the life style groups.
Hypothesis/Expectations:
Expectations for the experiment is that the complications and interactions will occur
for the cholesterol group and diabetes type 2 with cholesterol group. This is because in the
literature review the article, "Could insulin cause," showed that women who took insulin where
more likely to have hyperlipidemia. Also in the literature review, there was a risk for those
who took cholesterol medication could be in risk for diabetes. The life style group may have
done well because they worked out and eat healthy, so there shouldn’t be any complications. The
Islam 46
expectations shows the purpose of the study, and how other can be aware of many side effects
and illness that comes with taking medications together.
Concluding Remarks:
The importance of this research is to be aware of how medications affect and interact
with other illness such as high cholesterol. This research has shaped how medications are used.
Taking the right medication and being on a healthy diet will and can lead you to a healthy
lifestyle. Some limitations of this research is mentioning where the participants are from, maybe
if the groups of individuals lived in different parts of the state, this can affect how their living
conditions were and possibly effect the results. Another limitation that occurred was to measure
and weight the lifestyle group ( before and after) and to see of their blood sugar or cholesterol
lowered along with their weight. This could possible show a healthy life style while taking either
of the medication.
Work Cited
Beckerman, J. (2012, June 12). Cholesterol & triglycerides health center . Retrieved
from http://www.webmd.com/cholesterol-management/glossary-terms-cholesterol
Cholesterol medications: Consider the options . (2012, November 13). Retrieved
from http://www.mayoclinic.com/health/cholesterol-medications/HB00042
Could insulin cause hyperlipidemia? a study of 27 users. (2012). Retrieved
from http://www.ehealthme.com/ds/insulin/hyperlipidemia
Diabetes drug recall . (2012). Retrieved from http://www.weitzlux.com/Actos-diabetesdrug-recall_1962938.html
Diabetes statistics. (2011, January 26). Retrieved from http://www.diabetes.org/diabetesbasics/diabetes-statistics/
Diabetes - type 2 - complications. (2011). Retrieved
fromhttp://www.umm.edu/patiented/articles/what_emergency_conditions_associated_with
_type_2_diabetes_000060_5.htm
Islam 47
Hao, M. (2007). Direct effect of cholesterol on insulin secretion. American Diabetes
Aaaociation, 56(9), 2328-2338. doi: 10.2337/db07-0056
Herman, W. (1983). An approach to the prevention of blindness in diabetes. 6(6), 606-613.
Retrieved fromhttp://care.diabetesjournals.org/content/6/6/608.full.pdf
High cholesterol - what happens . (2010, July 2). Retrieved
from http://www.webmd.com/cholesterol-management/tc/high-cholesterol-what-happens
History of diabetes in timeline . (2011, August 22). Retrieved
from http://www.defeatdiabetes.org/about_diabetes/text.asp?id=Diabetes_Timeline
Hitti, M. (2011, May 19). Diabetes drugs avandia, avandamet, and avandaryl to exit retail
pharmacies . Retrieved fromhttp://blogs.webmd.com/breaking-news/2011/05/diabetesdrugs-avandia-avandamet-and-avandaryl-to-exit-retail-pharmacies.html
Insulin side effects. (2012). Retrieved from http://www.diabetes.co.uk/insulin/insulin-sideeffects.html
Lipitor. (2012). Retrieved from http://www.drugs.com/lipitor.html
Lipitor tied to diabetes risk, more evidence shows. (2011, March 8). Retrieved
from http://www.huffingtonpost.com/2011/03/29/lipitor-tied-to-diabetes_n_842064.html
Manzella, D. (2010, November 09). Top 7 risk factors for type 2 diabetes. Retrieved
fromhttp://diabetes.about.com/od/symptomsdiagnosis/tp/riskfactors.htm
Martinez, A. (2011, May 4). Drug-free treatment for type 2 diabetes. Retrieved
from http://newcurefordiabetes.blogspot.com/2011/05/drug-ffree-treatment-for-type2.html
Nordqvist , C. (2009, May 15). What is the difference between diabetes 1 and diabetes 2?.
Retrieved fromhttp://www.medicalnewstoday.com/articles/7504.php
Rocco, M. B. (2012). Statins and diabetes risk: Fact, fiction, and clinical
implications. Cleveland Clinic, 29(12), 883-893. doi: 10.3949/ccjm.79a.12091
Shaw, J. (2009, November 11). How does diabetes occur?. Retrieved
from http://www.livestrong.com/article/32042-diabetes-occur/
Islam 48
Side effects of cholesterol-lowering statin drugs . (2012, June 21). Retrieved
from http://www.webmd.com/cholesterol-management/side-effects-of-statin-drugs
Statin side effects: Weigh the benefits and risks. (2012, March 12). Retrieved
from http://www.mayoclinic.com/health/statin-side-effects/MY00205
Treatments and drugs. (2012, January 25). Retrieved
from http://www.mayoclinic.com/health/diabetes/DS01121/DSECTION=treatments-and-drugs
What are key terms and concepts for diabetes advocates?. (n.d.). Retrieved
from http://web.diabetes.org/Advocacy/legalmaterials/LegalRights/LR-Chap3.pdf
What is type 1 diabetes?. (2011, December 16). Retrieved
from http://www.eurostemcell.org/factsheet/type-1-diabetes-how-could-stem-cells-help
What is type 1 diabetes (t1d)?. (2012). Retrieved from http://donate.jdrf.org/what-istype1diabetes.php?mkwid=s6w1Vnq0m&pcrid=19732673030
Yoffee, L. (2009, November 3). A glossary of key diabetes terms. Retrieved
from http://www.everydayhealth.com/diabetes/glossary-of-diabetes-terms.aspx
Islam 49
Appendix E : Interview email, questions and answers
Email to boss:
Hello Ms. Bower,
This is Yesmath Islam from Wayne State University. I am currently enrolled in my intermediate
writing class and we are requiredto research the writing practice of our intended majors in efforts to enter
the field or job we wish to enter after graduation. In order to research more thoroughly, I am looking to
find a professional in my field that would be willing to answer a few questions about the writing in
Physician Assistant. If possible if you can give me there email address, if possibily the PA that worked
on the same floor and you have told me about or any PA that you have encountered with, I would greatly
appreciate it.
Thank you
Yesmath Islam
Email to interviewer:
Dear ___________
My name is Yesmath Islam and I am a student at Wayne State University. I am currently enrolled in
my intermediate writing class and we are required to research the writing practice of our intended majors
in efforts to enter the field or job we wish to enter after graduation. In order to research more thoroughly,
I am looking to find a professional in my field that would be willing to answer a few questions about the
writing in Physician Assistant. The interview would take up a small portion of your time and I would
greatly appreciate the opportunity. Please email me back at your earliest convenience and I will send you
a list of interview questions to help you prepare.
If you have any questions feel to email me at ef1360@wayne.edu or my instructor
Abigail Heiniger, at ed1911@wayne.edu.
Thank you for your consideration and your time
Yesmath Islam
Islam 50
Questions to Lekity:
1. What is it like to work as a Physician Assistant?
2. What is your favorite part of being a Physician Assistant?
3. What type of writing do you do?
4. How often do you do writing as a Physician Assistant?.
5. Do you do any research ? If so, what kind?
6. Are you interested in a particular type of research?
7. How is the research of PAs different from that of MDs?
8. What do you do that a MD does not?
9. What is the format of writing you use as a Physician Assistant?
10. What is the format for citing you use?
12.What are the top/hot topics for research in the field of Physician Assistant?
13.Are you currently taking part in any research?
14.What type of research have you participated in?
15.What type of journals do you read as a Physician Assistant?
16. What have you come across as PA that you did not think you would?
17. What would you say are main factors of getting into PA school?
Answers:
What is it like to work as a Physician Assistant? It can be overwhelming at times but as far as I
have experienced, it is very rewarding.
> What is your favorite part of being a Physician Assistant? My favorite part is being able to take
the time and explaining everything to the patient. You can tell that they really do appreciate it.
> What type of writing do you do? Writing is very limited as a PA, we mostly do a lot of
electronic charting.
> How often do you do writing as a Physician Assistant?.
> Do you do any research ? If so, what kind? I have not personally done any research.
> Are you interested in a particular type of research?
> How is the research of PAs different from that of MDs?
> What do you do that a MD does not? PAs tend to be more involved in patient care.
> What is the format of writing you use as a Physician Assistant?
> What is the format for citing you use?
> What are the top/hot topics for research in the field of Physician Assistant?
> Are you currently taking part in any research?
> What type of research have you participated in?
> What type of journals do you read as a Physician Assistant?
> What have you come across as PA that you did not think you would?
Islam 51
> What would you say are main factors of getting into PA school?
> Personality is crucial. You have to be confident that this is the career you want.
Questions ask to Janell Wilcox:
What is it like to work as a Physician Assistant?
What is your favorite part of being a Physician Assistant?
What type of writing do you do?
How often do you do writing as a Physician Assistant?.
Do you do any research ? If so, what kind?
Are you interested in a particular type of research?
How is the research of PAs different from that of MDs?
What do you do that a MD does not?
What is the format of writing you use as a Physician Assistant?
What is the format for citing you use?
What are the top/hot topics for research in the field of Physician Assistant?
Are you currently taking part in any research?
What type of research have you participated in?
What type of journals do you read as a Physician Assistant?
What have you come across as PA that you did not think you would?
What would you say are main factors of getting into PA school?
What is the discourse community between you and patients, doctors and nurses?
Janell Wilcox Answers:
1. I enjoy a PA position due to the responsiblity and the flexiblity of the job. You are able to
have a autonomy to care for patients with minimal physician supervision. You are able to have a
lot of face to face time with patients. You all write perscriptions, order tests, interpuret tests, do
history and physical exams, and participate in desicion making for the patients.
2. I enjoy that extra time I am able to spend with patients that a physician is unable to
provide. Working in BMT, our patients need a lot of extra time for explanations and psychiatric
support that I am able to provide.
Islam 52
3. As for writing, I have not write any journal articals. I work only inpatient, which is unique
for a PA, most work outpatient or a combination. I type my daily progress notes, discharge
summaries, and history and physical exams. As for outpatient PA they would also write letters to
referring physicians.
4. I write everyday. All on the computer. From orders to daily notes as above.
5. I do participate in research for Karmanos BMT. As a PA, many are published in journals.
6. I am interested in research related to BMT patients.
7. I am not sure how research differs between PA and MD. The MD is usually the PI, and the
PA would work under him/her. I have not participated in research at this level.
8. I have not writen a research paper since college.
9. Again, I have not did citing since college.
10. I work in the sub-specialty of BMT so I do not think my interests would be the same
interests as the majority of PA. Cardiology is always a hot topic of interest. I the cancer world,
targeted treatment is big.
11. I skipped a question - What do you do that a MD does not? Our roles can be very
similar. On a whole, PAs are able to spend more time with the patients. This is a difficult
question because there is a lot of similarities in the day to day job.
12. I participate in the BMT clinical research protocols by helping to get get data collected and
make sure the protocol is being followed at the bedside level.
13. I read JAAPA, UpToDate ( not a journal), Blood, CIBMTR.
14. I did not expect to be working BMT with such sick patients including ICU care. I would
have never guessed that I would work only inpatient.
15. The main things to help get into PA is a good GPA, good interview skills. Know the history
Islam 53
of the profession. Know why you what to be a PA over anyother medical profession.
16. I not sure I understand this question. We work well as a team (PA, physicians, nurses and
staff) to give the best patient care possible.
Islam 54
Appendix G: Rough Draft of Annotated Bibliography/ Historical Overview: Diabetes
effects and medication effects
There are many treatments out there for diabetes, many of those treatments have risk
involving other illnesses or medication. Non medication maybe important then taking
medication at all. Diabetes also have affects with the body when you take other medications or
even just side effects. In the 1980s, UCSF coordinated the first multi-center clinical trial of
human insulin.( diabetes center). They also found that stem cells are believed to play a good role
for diabetes and also for other diseases. 1989 about 6.7 million people reported to have diabetes,
this may leave many with questions for cure.
In the early 1990’s , the major causes of blindness was because of diabetes. This was huge
news because till this day many people struggle from this. There are many effects from having
diabetes, example: kindey diease. nerve damage, foot complications etc. Around this time it was
said that hyperglycemia was one of the major cause of problems for diabetes. Cardiovascular
disease was had been also increased , this was also associated with hyperlipidemia. When serum
lipids are controlled it results in decrease occurrence of coronary heart disease and those with
the coronary heart disease, there rate of progression would be reduced. At result there good out
comes for treatments used in diabetes of serum lipids and lipoproteins.
In 1991, an article showed that many people with diabetes have increased there
hypertension.Though finding a drug that will both treat diabetes and hypertension would be very
Islam 55
difficult, there still is a good chance it can be reduced. Antihypertesnsive therapy may be a
possible treatment to prevent the progress of diabetes Nephropathy.
A decade later, there are still many more treatments and cures to be found dealing with
diabetes. One of the main options people may have is weight loss or even surgery, because many
people with type 2 diabetes have seen a drastic change. It has also been said that when many
people that are overweight, there is a risk of having diabetes. This can heard to hypertension
which can lead to cardiovascular disease. Choosing a medication when having diabetes depends
a lot on your weight, this is because some medication promotes weight gain or even weight loss
because of glucose control.
In 2012, we stil are facing many problems with the cure of diabetes and also the effects of
long term and also effects of taking medication wile having other illness. As for type 2 diabetes
weight loss has been a great result of reducing diabetes, but for those who struggle, surgery is the
answer.
Balas, E.A. , Krishna, S., Kretschmer, R.A., Cheek, T.R., Lobach, D.F., Boren, S.A. (2004).
Computerized knowledge management in diabetes care. Medical Care, 42(6) , 610-621.
Retrieved
from http://www.jstor.org/stable/4640793/
Automated information interventions on diabetes care and patient care
plays a huge role in diabetes care patient. Systematic electronic and manual searches were
conducted and studies were grouped. Glycated hemoglobin and blood glucose level improved
Islam 56
expressively. The computerized educational programs enhanced the metabolic and diet. The
computerized management has greatly impacted the quality of diabetes care.
Robbins, J.M., Webb, D.A. (2006). Diagnosing diabetes and preventing Rehospitalizations: The
Urban Diabetes Study. Medical Care, 44(3), 292-296. Retrieved
fromhttp://www.jstor.org/stable/3768165/
Diabetes is a very dangerous disease especially if you are hospitalized.
Rehospitalization is seen more after hospital discharge with patients who have diabetes.
Philadelphia residents ages 25-84 with diabetes had their hospital information tracked compared
to non elective rehospitalization within 30 days of discharged. The rehospitalized portion was
9.4% where as nonelective rehospitalized witth in 30 days of hosipital discharge was
20%. There was a failure to record diabetes diagnoses after discharges. This results in the lack
of attention for diabetes patents.
Yawn, B., Zyanski, S.J., Goodwin, M.A, Gotler, R.S., Stange, K.C., Olmsted Medical Center. (
2001). Is diabetes treated as an acute or chronic illness in community family practice? Diabetes
Care, 24(8), 1390-1396. doi:10.2337/diacare.24.8.1390
Diabetes is very important illnesss but it seems as if there is poor quality of care
in hospital settings. For two seperate days the nurses observed consecutive outpatients. Davis
Observation Code was used for time. Patients with diabetes were compared with people who
have chronic diseases to see if there is more attenetion to one another. This has showed that
diabetes has greater proportion if the time. This has help to show other that they should all be
treated equality.
8. Kashyap, S.R., Louis, E.S., Kirwan, J.P. (2011). Weight loss as a cure for Type 2 Diabetes?
fact or fantasy. National Institute of Health, 6(4), 557–561. Retrieved
fromhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3145356/
Surgery may be a way to help cure type 2 diabetes. By losing body fat, you
can reduce insiline resistant. This also reduces diabetes due to the body fat loss. Having two
groups, one was much younger and more over weight, this was the surgical group and then
there was . There was also lack of glucose tolerance test. Also there should be randomized
people, it will help the research.