Ch2 Health care administration in AT

• Establishing a system for AT health care
  • Developing a strategic plan
    • Strategic planning
    • Vision statement
      • a concise statement that describes the ideal state to which an organization aspires
      • the provide of the service
      • the actual service
      • target clients
    • Mission statement
      • organization’s philosophy, purposes & characteristics
      • help the AT direct resources
      • insipire AT
      • should stimulate a change in behavior
    • Accreditation
      • JCAHO
        • Joint Commission on Accreditated Healthcare Organization
        • Joint commision on Accreditated healthcare organiztion
      • CARF
        • Commission on Accreditation of Rehabilitation Facilities
    • WOTS UP analysis
      • UP – underlying planning
  • Developing a policies and procedures manual
    • Operational planning
      • no longer than 2 years
    • Policies
      • intended behavior relative to a specific program subfunction
      • not intended to answer detailed questions
      • basic rules and principles
    • Processes
      • a collection of steps designed to direct the most important tasks of an organization
      • ex) injury prevention
    • Procedures
      • provides specific directions for members
      • procedure for discharge from rehabilitation
    • Practices
      • the action that takes place in response to administerative problems
    • PERT
      • Program evaluation and review technique
    • Gannt charts
      •  a graphic planning and control technique that maps discrete taks on a calender
    • Agreement – trust matrix
      • bedfellows
      • allies
      • opponents
      • adversaries
• AT program operations
  • The scope of the AT program
  • Providing coverage
    • Facility personnel coverage
      • time of coverage depends on number of staff
  • Hygiene and sanitation
    • OSHA
      • Occupational safety and healthcare administration
  • The Gymnasium
    • Facilities cleanliness
  • Budgetary concerns
    • Spending ceiling model
      • requires justification only for those expenses that exceed those of the previous budget cyle
      • incremental model
    • Spending reduction model
      • financial crisis model
      • requires reallocation of institutional funds
    • Zero based budgeting
      • requires justification for every budget line
      • requires documentation of actual program needs
      • rank each item
    • Fixed budgeting
      • revenues are progected on a monthly basis
      • providing an estimate of cash flow
    • Varibale budgeting
      • requires adjustment of monthly expenditures so that they do not exceed revenues
      • rarely used by school based programs because it’s difficult to estimate costs in advance
    • Lump-sum budgeting
      • allocates a fixed amount of money for an entire program without specifying how the money will be spent
      • gives freedom to spend
    • Lump item budgeting
      • allocates a fixed amount of money for each subfunction of a program
      • limited flexibility
    • Performance budgeting
      • allocates funds for discrete activities
      • not comonly used due to expense and difficulty of analyzing specific activity costs
  • Planning the budget
    • Needs assessment
      • exploration
      • information gathering
      • decision making
        • integrate solutions into the pgoram budget
    • Capital improvements
  • Supplies / equipment
    • expendable
    • nonexpendable – scissors, neoprene sleeves
    • non consumable capital – usually not removed from AT facility
      • ice machine
      • tx table
      • modality unit
    • consumable capital
      • crutches, coolers, and kits
  • Purchasing process
    • Request for quotation
      • bidding
    • negotiations
      • the process of bargaining
        • Price
        • Supply
        • Quality
          • implied warranty
          • express warranty
        • shipping
          • freight on board point
            • point at which the title for shipped goods passes from vendor to purchaser
        • support
    • Requisition
      • communication used for requesting authorization to purchase
    • Purchase order
      • only do for purchase orders over 200 — minimum order policy
    • Receiving
    • Accounts payable
      • submit invoice to business office
    • alternative purchasing strategies
      • buy or lease capital equipment
        • purchasing
          • cost
          • program owns equipment
        • leasing
          • possible tax advantages
          • lower initial cost
          • use capital on other things
  • Purchasing services
    • Try to get service free of charge
    • try to employ cost sharing whenever possible
  • Developing a risk management plan
    • Security issues
    • Fire safety
    • Electrical and equipment safety
      • Ground fault interrupters
        • especially in areas of water
        • interrupts electricity if a surge of 5 ma
      • Three prolonged hospital grade plugs and electrical outlets – green dot

アルギニン Arginine

• 今後調べておきたいquestionsを添えて。
• non EAA
• 子供のうちは体内で生成できないそう。
  • 具体的になん歳ぐらいまで？
  • なぜ起こる？　子供の間は生成できないアルギニン分解酵素の生なの
• 必要量
  • 6-7g/day
• 食品
  • ナッツ類
  • 豆類
  • 凍り豆腐　凍り限定。。。？
  • しらす干し
• 作用
  • NO 生成
    • —– アルギニンからNOが生成される過程を分子構造レベルで確認。他のアミノ酸では起こらないのか確認。
    • 血管拡張
      • 単純にアルギニンを取るだけで血管拡張するのか？
      • アルギニン摂取+運動etcによってNOの効果を高めるのか？
      • 冷え性 しもやけ
      • ーーーー
      • ということは血圧の上昇を抑える効果も期待できるのか
      • 持久力向上にも役立つそうな。
    • 前駆体 collagen
      • 創傷治癒
      • hydroxyproline
    •  骨を強くする
      • NOと骨芽細胞の関係。。。？
    • Immune system
      • NK cell
      • LAK cel
      • Macrophage ]
      • ———-
      • NOは活性酸素としても働く。
        • 3g 8 weeks
    • Increase the number of muscle cells
      • NO activates Satellate cells
    • Increase the muscle mass
      • Activation of AMPK?
      • Activation of PPAR – gamma
      • Potentiate insulin effect?
      • cGMP
      • Activation of androgen receptor?
    • Improve memory / cognitive function
      • これはNOによって血管拡張、as a result increase cerebral blood flow?
  • Growth hormone
  • Glycogenを早く貯める
    •  work on the liver?
  • Remove ammonia
  • きゅーとるふぃん？
    • 痛みを抑えるらしい。
  • 脂肪を燃やす酵素の働きを高める。
    • 白色脂肪細胞の増加が抑えられる
    • 褐色脂肪組織も増える。
    • 白色と褐色を分ける要因はなんなんだろう。
  • Creatine
• オルニチン回路　尿素回路
  • アミノ基 + alfa ketoぐるたるさん = alfa keto acid & glutamate
  • 運動時のエネルギーを取り出すため glutamine acid はグルタミン酸脱水素酵素の働きにより　ammnonia とalda ケトグルタル酸になる
    • alfa ケトぐるたるさんはエネルギー源になるのか？
  • 組織で発生したアンモニアはアラニンやグルタミンに変換されたのちにグルタミンさんになり、　アンモニアに戻ってから尿素になる
  • 肝細胞ミトコンドリア
  • オルニチン
  • シトルリン
  • アンモニア —- 尿素 + オルニチン
  • ———–
  • オルニチン回路をスムーズに回すために
    • アルギニン
    • オルニチン
    • シトルリン
    • アスパラギン酸 を十分に摂取すること
• 弱点
  • アルカリ性
• 代替
  • シトルリン
    • 6g /day —- increase high intensity performance
    • 2.4 g/day —– 7 days —- 4km bike time
  • オルニチン
    • to enhance growth hormone production
      • 170mg / kg bw
• 摂取方法
  • 30分でアルギニンの血中濃度最大
    • これはカプセル単独摂取？
    • 他の食事と合わせても大丈夫？
    • ーーーー
  • 90分でNO生成活性化 血流最大
  • —-
• タイミング
  • トレーニング１時間前に5-9gのアルギニンを摂取することが望ましい。
  • 起床直後
  • —-
  • アルカリ性なので 食事と共に取るとpHがアルカリ性に振り込みすぎる

L-Carnitine —- L-カルニチン

• so called —疲労回復に役立つアミノ酸
•  牛赤身肉に多く含まれる
  • 「多く」とはどれぐらいのことを言っているのか？
  • 体重あたりどの程度摂取することが望ましのか？
  • 適切な摂取タイミングはいつか？
    • 朝昼夜、どのタイミング？
    • トレーニング後？
  • どの食材 (栄養素)と一緒に摂取すれば synergistic 的な効果はあるか？
    • アリシン
      • ニンニクに含まれる

Neurology | Sympathetic Nervous System

• Thoarcolumbar outflow
  • Preganglionic motor neuron
  • Intermedial lateral column
  • T1-L2
  • Ganglia — cell bodies
  • collateral ganglia
• Superior cervical ganglia
• Middle cervical ganglia
• Inferior cervical ganglia
• ——————

• T1-T3

  • SCG
  • Internal carotid artery
  • The eye
    • Norepinephrine
      • dilate pupilae
        • Far vision
        • more light come in
      • Celiary muscle
        • helps lens more become flatten
        • Accomodation
        • Far vision
        • 脳震盪後に起こる症状と照らし合わせて考えたい。
  • Salivary gland
    • NE
    • blood vessels
      • constrict tunica media?
      • thick viscous
      • mucous production
  • lacrimal glands
    • NE
    • decrease lacrimation
• Carotid plexus 内頸動脈を囲む神経叢
  • Cardiac plexus
    • heart
      • nodal cells
        • increase the heart rate
        • positive chronotropic action
      • myocardium
        • increase the contraction power
        • increase cardiac output
  • Pulmonary plexus
    • lungs
      • esophagus
      • decrease peristalsis
      • dilation of the bronchial smooth muscle
      • ——————-
      • decrease secretion
      • vasoconstriction of bronchial arteries
        • NOT TALKING ABOUT PULMONARY ARTERIES
        • they are completely different
  • Esophageal plexus
    • esophagus

• T5-T9

  • Greater splanchnic nerve 大内臓神経
  • aorta
  • celiac ganglia
    • prevertebral
    • collateral
  • celiac trunk
    • stomach
      • inhibit peristalsis
      • decrease absorption
    • Liver
      • Glycogenolysis
      • Decrease biliary tree flow
    • Pancreas
      • inhibit beta cell
        • decrease insulin production
        • to prevent blood glucose decreasing
      • stimulate alfa cell
        • increase glucagon production
        • increase blood glucose
    • Splenic contraction
    • Chrommafin cells
      • Intramural ganglion
      • release chemicals
      • NE
      • Epi
      • ————
    • Superior mesenteric ganglia
      • cecum
      • transverse colon
      • duodedum
      • jujenum
      • ilieum

• T10-T11 

  • Lesser splenchnic nerve
  • Aortico Renal ganglion
  • Renin release