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Further cheap 75mg clopidogrel overnight delivery, the client-health care provider relationship should foster trust order 75 mg clopidogrel, actively involve the client in decision-making, and support the client in the adherence process. Paper presented at the meeting of Southern Nursing Research Society, Jacksonville, Florida. Development of the trust in physician scale: A measure to assess interpersonal trust in patient-physician relationships. Relationship of racial stressors to blood pressure responses and anger expression in Black college students. Racial differences in hypertension knowledge: Effects of differential item functioning. Racial discrimination and blood pressure: Perceptions, emotions, and behaviors of Black American adults. Compliance, adherence and therapeutic alliance: Steps in the development of self-care. The interrelationship between hypertension and blood pressure, attendance at religious services, and race/ethnicity. Discovering the full spectrum of cardiovascular disease: Minority health summit 2003: Report of the outcomes writing group. Trust, mistrust, racial identity and patient satisfaction in urban African American primary care patients of nurse practitioners. Effects of perceived racism, cultlural mistrust and trust in providers on satisfaction with care. Stress, coping, and health outcomes among African-Americans: A review of the John Henryism hypothesis. The institute of medicine report "unequal treatment" ten years later: The Disparities Solutions Center. Swimming upstream: Access, health outcomes, and the social determinants of health. The relationship between spirituality and compliance in patients with heart failure. Predictors of medication adherence for African American patients diagnosed with hypertension. The relation between perceived unfair treatment and blood pressure in a racially/ethnically diverse sample of women. Exploring the role of religiosity in hypertension management among African Americans. Thinking upstream: Nurturing a conceptual understanding of the societal context of health behavior. An American health dilemma: Race, medicine, and health care in the United States: 1900-2000. Evaluation of the interaction model of client health behavior through the first decade of research. Perceived racism, medication adherence, and hospital admission in African-Caribbean patients with psychosis in the United Kingdom. Seventh Report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Validation of patient reports, automated pharmacy records, and pill counts with electronic monitoring of adherence to antihypertensive therapy. A cohort study of possible risk factors for over-reporting of antihypertensive adherence. Effects of John Henryism and anger- coping on mean arterial pressure changes in African American women. Preventing stroke: A narrative review of community interventions for improving hypertension control in Black adults. The acceptability of treatment for depression among African-American, Hispanic, and White primary care patients. Disparities in patient experiences, health care processes, and outcomes: The role of patient-provider racial, ethnic, and language concordance. An interaction model of client health behavior: theoretical prescriptions for nursing. The interaction model of client health behavior: Application to the study of community-based elders. A conceptual explanation of risk- reduction behavior and intervention development. Differences in coronary heart disease risk markers among apparently healthy individuals of African ancestry. Stress-related racial discrimination and hypertension likelihood in a population-based sample of African Americans: The metro Atlanta heart disease study. Underserved urban African American men: Hypertension trial outcomes and mortality during 5 years.

Utilizing a point of care documentation system for increased medication administration accuracy discount 75mg clopidogrel fast delivery. Evaluation of pharmaceutical interventions due to drug-related problems in hospitalized patients order clopidogrel 75mg visa. Influence of simple computerized feedback on prescription charges in an ambulatory care: A randomized clinical trial. The effect of computerized feedback coupled with a newsletter upon outpatient prescribing charges: A randomized controlled trial. Online--an Internet-based decision tool for adjuvant chemotherapy in early breast cancer. A prospective randomised trial comparing individualised pharmacokinetic dosage prediction for aminoglycosides with prediction based on estimated cratinine clearance in critically ill patients. Implementing technology to improve medication safety in healthcare facilities: a literature review. Estimation of the supporting functions for prescription making in an order entry system. Contribution to medical risk management of computerized prescription order entry systems - Improvement of master maintenance system using a commercially available order entry program. Electronic prescribing influence on calcium supplementation: a randomized controlled trial. Implementation and evaluation of a comprehensive system to deliver pediatric continuous infusion medications with standardized concentrations. Electronic medical record use by office-based physicians and their practices: United States, 2006. Electronic medical record use by office-based physicians and their practices: United States, 2006. Computerized physician order entry in a pediatric teaching institution: Design process, implementation and benefits. Simple computer program for guiding management of cardiovascular risk factors and prescribing. Patient request for pharmacist counseling and satisfaction: Automated prescription delivery system versus regular pick-up counter. A prospective controlled trial of computerized decision support for lipid management in primary care. Countrywide computer alerts to community physicians improve potassium testing in patients receiving diuretics. Practical consideration for implementation of new technology within a large health-system market. Health technology assessment review: Computerized glucose regulation in the intensive care unit--how to create artificial control. Implementation of an electronic medication administration record system for Point-of-Care Scanning: using bar coding and automated medication distribution technologies. Wireless, hand held device used by physicians to prescribe medication in an outpatient setting. Potential use of bar codes to implement automated dispensing quality assurance programs. Key role of software in implementing computerbased information systems for the hospital pharmacy. Influence of decision aids on patient preferences for anticoagulant therapy: A randomized trial. A comprehensive appropriateness of prescribing questionnaire was validated by nominal consensus group. A review of medical error reporting system design considerations and a proposed cross-level systems research framework. Operating room controlled drug accountability incorporating pharmacy witnessed waste and electronic documentation. Systematic review on quality control for drug management programs: Is quality reported in the literature? Dispensed drug information services for outpatients at Kumamoto University Hospital. A tiered approach is more cost effective than traditional pharmacist-based review for classifying computer-detected signals as adverse drug events. Clinical decision support systems: Customization of a drug interaction database to avoid alert fatigue. Characteristics and consequences of drug allergy alert overrides in a computerized physician order entry system. Predicting adequacy of vancomycin regimens: A learning- based classification approach to improving clinical decision making. The pharmacy as part of an integrated hospital information system: a focus on benefits.

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In patients with a positive overnight of cases are caused by a deficiency of 21-hydroxylase dexamethasone suppression test blocking conversion of 17-α hydroxyprogesterone C discount 75mg clopidogrel with visa. Precursors of cortisol discount 75mg clopidogrel, usually either 17-α hydroxyprogesterone Chemistry/Apply knowledge to recognize inconsistent or 11-deoxycortisol are increased. This results in results/Adrenal/2 low serum cortisol levels, but high levels of these intermediates (mainly 17-ketogenic steroids). Which test is used to distinguish Cushing’s disease Answers to Questions 27–29 (pituitary Cushing’s) from Cushing’s syndrome caused by adrenal tumors? Which is the most widely used screening test for dexamethasone suppression test is also used. Overnight low-dose dexamethasone 50% suppression of cortisol release after receiving an suppression test 8-mg dose of dexamethasone, but patients with B. A Dexamethasone is a synthetic corticosteroid that diagnosis of Cushing’s disease (pituitary exhibits 30-fold greater negative feedback on the Cushing’s)? Low-dose dexamethasone suppression 1 mg of the drug is given to a patient at 11 p. Therefore, a normal corticotropin-releasing hormone stimulation response to dexamethasone excludes Cushing’s syndrome with a sensitivity of about 98%. D Although dexamethasone suppression tests have a high sensitivity, some patients without Cushing’s syndrome have indeterminate results (e. Samples are drawn from the sinuses draining the pituitary gland and from the peripheral blood. Which of the following statements about the Answers to Questions 30–33 diagnosis of Addison’s disease is true? Twenty-four–hour urinary free cortisol is normal response occurs in both primary and secondary in Addison’s disease Addison’s disease. Which of the following statements regarding the and dopamine—are produced from the amino acid catecholamines is true? Tey are produced by the zona glomerulosa of measured in order to diagnose pheochromocytoma. Plasma levels show both diurnal and pulsed sweating, and other endocrine involvement. The zona glomerulosa is Chemistry/Apply knowledge of fundamental biological the outermost portion of the adrenal cortex, where characteristics/Catecholamines/2 aldosterone is mainly produced. D Catecholamines are metabolized to metanephrines best single screening test for pheochromocytoma? Some carcinoid tumors produce mainly 5-hydroxytryptophan because they lack an enzyme needed to convert it to serotonin. The 5-hydroxytryptophan is converted by the kidneys to serotonin resulting in high urinary serotonin. Which statement regarding the measurement of Answers to Questions 34–36 urinary catecholamines is true? B Measurement of total urinary catecholamines is not catecholamines is specific for pheochromocytoma a specific test for pheochromocytoma. Twenty-four–hour urinary catecholamine assay may be increased by exercise and in muscular avoids pulse variations associated with diseases. Catecholamines in urine may also be measurement of plasma catecholamines derived from dietary sources rather than endogenous C. Most catecholamines are excreted as the provides greater specificity than measurement of glucuronide, and the urinary free catecholamines urinary free catecholamines increase only when there is increased secretion. Total urinary catecholamines are not affected by Measurement of free hormone in urine is equal in exercise clinical sensitivity and specificity to measurement of metanephrines. Twenty-four–hour urine is the sample Chemistry/Apply knowledge to identify sources of of choice because plasma levels are subject to pulse error/Catecholamines/2 variation and affected by the patient’s psychological 35. Which method is most often used to measure and metabolic condition at the time of sampling. Fluorescent methods detection employing ferricyanide (trihydroxyindole method) or C. Which statement about sample collection for results in formation of radiolabeled metanephrines catecholamines and metabolites is true? Electrospray manner following a 12-hour fast ionization tandem-mass spectroscopy is an B. Twenty-four–hour urine creatinine should be catecholamine elevation, and therefore, patients measured with vanillylmandelic acid, must be resting supine for at least 30 minutes prior to homovanillic acid, or metanephrines blood collection. Tere is no need to discontinue medications if a is catheterization, so that the anxiety of venipuncture 24-hour urine collection is used is not a factor.

Cronbach‘s alpha values are an indication of scale reliability cheap clopidogrel 75 mg visa, whereby values of generic 75 mg clopidogrel otc. Both the Hill-Bone sodium intake and appointment-keeping subscales had low Cronbach‘s alphas, but neither was used in data analysis. Only the outcome variable, represented by the Hill-Bone medication subscale was used in data analysis, and the Cronbach‘s alpha was good (. The Self-Care of Hypertension Index management subscale also had a low Cronbach‘s alpha of. This subscale was applicable to 34 of the 80 participants who reported trouble controlling their blood pressure in the past month. Again, the response pattern was inconsistent as participants did not answer similarly in how they managed their blood pressure. Lastly, the Therapeutic Reactance total scale and behavioral subscale had acceptable Cronbach‘s alphas, while the verbal subscale had low Cronbach‘s alpha related to a variance in participants‘ response pattern consistency. Frequencies were run on all variables to check for missing data and extreme values. There were no missing data, however, outliers were consistently found in most of the variables of study. To limit outlier influence, variables not previously categorized were divided into quartiles prior to statistical analysis (Mertler & Vannatta, 2010; Vogt, 2005). Because outliers do not follow the normal distribution, statistical models that do not require distribution assumptions, such as nonparametric and semiparametric models, were used for data analyses. Although nonparametric models avoid restrictive assumptions of normality, they may yield difficult interpretations and inaccurate estimates for a large number of regressors. However, semiparametric models combine components of both parametric and nonparametric models while retaining the flexibility of nonparametric models and providing the easy 115 interpretation of parametric models (Hardle, Muller, Sperlich, & Werwatz, 2004). Thus, nonparametric and semiparametric models were ideal statistical models for data analyses. Over half of the participants were not married (56%) and had a single, divorced, or widowed status. The majority of the sample was employed (67%), physically inactive (89%), overweight/obese (88%), and had a history of smoking (54%). Descriptive statistics in the form of percentages or means and standard deviations are displayed for the background variables (see Table 3), dynamic variables (see Table 4), and the health outcome, medication adherence (see Table 5). Medication subscale scores were used to determine adherent and nonadherent groups. The adherent group consisted of 20 (25%) participants (score of 9) and the nonadherent group consisted of 60 (75%) participants (score 10-36). Both groups were analyzed in relation to antihypertensive medication adherence or nonadherence and background variables associated with adherence. The Shapiro-Wilk test was used to assess normality (Norusis, 2008) of independent variables. In addition, calculated means, ranges, standard deviations, frequencies, skewness, kurtosis, and graphic plots were analyzed on all continuous data to assess distributions. This was suggestive of a normal distribution allowing use of the independent sample t-test (Gliner & Morgan, 2000; Polit, 1996) to determine if there was a significant difference between the adherent and nonadherent antihypertensive medication groups. Because there was evidence of nonnormality, a two-tailed Mann-Whitney U-test (Gliner & Morgan, 2000) was used to investigate differences between the adherent and nonadherent groups. The Fisher‘s exact test was used to examine the significance of association (contingency) between background and dynamic variables on medication adherence. The procedure follows a hypergeometric distribution under the null hypothesis of independence with fixed margins and is frequently used in place of a phi correlation coefficient when data are sparse (Bower, 2003; Huck, 2008). Fisher‘s exact test does not rely on normality assumptions and uses the exact distribution instead of a normal approximation (Polit, 1996). Variables not previously categorized were divided into quartiles (Q) prior to statistical analysis. Quartile derivations is advantageous because it limits outlier influence (Mertler & Vannatta, 2010; Vogt, 2005). In addition, Fisher‘s exact test could test the significance of the difference in proportions of background and dynamic variables on medication adherence when some of the expected cell frequencies fell below 5 (Polit, 1996). The results displayed in Table 7 show counts and frequencies of all variables as related to the outcome variable medication adherence and provide results of the Fisher‘s exact test. However, the lack of a statistically significant association in a simple contingency table analysis does not rule out ordinal effects or trends that may predict outcome. Influence of Background and Dynamic Variables on Medication Adherence Compliant Compliant Compliant Compliant None of Some of Most of All of Characteristics the time the time the time the time (>14) (13-14) (10-12) (9) Fisher‘s n(%) n(%) n(%) n(%) Exact Test Income Q1 <20,000 7 (37) 7 (33) 7 (35) 8 (40) Q2 ≥20,000- <35,000 1 (5) 7 (33) 7 (35) 3 (15) Q3 ≥35,000- <55,000 6 (32) 4 (19) 2 (10) 6 (30) Q4 ≥55,000 5 (26) 3 (14) 4 (20) 3 (15) 0.

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These data suggest that safety should not be different between the new dosing regimen and current clinical practice discount clopidogrel 75mg on-line, but further prospective studies are warranted to verify this finding generic clopidogrel 75 mg line. This finding may be due to higher doses (more frequent administration) prescribed per routine medical care when compared with published regimens and suggests that prescribing 5,6 practices in the neonatal intensive care unit are not driven by these sources. In adults, metronidazole undergoes extensive hepatic metabolism with subsequent 16 17 renal elimination ; the elimination half-life is 8 hours, 20% is protein-bound, and the 17 apparent V ranges between 0. The bias introduced by scavenged sampling was quantified in this study and resulted in an underestimation of metronidazole concentrations by ~30%. To more precisely estimate the amount of bias introduced by scavenged samples, a higher number of timed samples should be obtained. This finding could be due to higher documentation errors associated with sampling or dosing times extracted from the medical record after a scavenged sample was collected. Future efforts evaluating this methodology should consider the physicochemical properties of the drug (i. Individualised dosing of amikacin in neonates: a pharmacokinetic/pharmacodynamic analysis. Population pharmacokinetics of meropenem in plasma and cerebrospinal fluid of infants with suspected or complicated intra-abdominal infections. Development of a liquid chromatography-tandem mass spectrometry assay of six antimicrobials in plasma for pharmacokinetic studies in premature infants. Methods for Antimicrobial Susceptibility Testing of Anaerobic Bacteria; Approved Standard. Pediatric drug labeling: improving the safety and efficacy of pediatric therapies. Developmental pharmacokinetics of morphine and its metabolites in neonates, infants and young children. Metronidazole population pharmacokinetics in preterm neonates using dried blood-spot sampling. Simultaneous quantification of amoxycillin and metronidazole in plasma using high-performance liquid chromatography with photodiode array detection. Clinical data by gestational age group Gestational age at birth Characteristic <26 weeks 26–29 weeks 30–32 weeks N 13 14 5 Gestational age, weeks 24 (22, 25) 28 (26, 29) 31 (30, 32) Postnatal age, days 29 (2, 71) 32 (2, 78) 29 (10, 73) Postmenstrual age, weeks 32 (24, 39) 32 (28, 43) 36 (32, 40) Weight, g 1410 (678, 2537) 1510 (850, 3611) 1658 (1230, 3850) Female sex 6 (46) 9 (64) 2 (40) White race 4 (31) 10 (71) 2 (40) Hispanic 1 (8) 2 (14) 0 (0) Serum creatinine (mg/dL) 0. Solid and dashed black lines represent observed and predicted median concentrations, respectively. Weight-normalized metronidazole clearance versus postmenstrual age (A) and serum creatinine (B). Shaded gray area represents the 90% prediction interval around the loading dose simulations. However, this approach underestimates the complicated physiology of preterm infants, which differs greatly from other populations. Preterm infants have a larger extracellular fluid volume, immature renal and hepatic function, underdevelopment of metabolic enzymatic systems, and a unique blood-brain barrier—all of 1 which can substantially alter drug disposition. Preparation of standards Individual clear stock solutions of piperacillin and tazobactam were prepared at a concentration of 15 mg/mL. This master stock standard was used to prepare 7 intermediate composite stock solutions: piperacillin (1,500,000, 750,000, 300,000, 150,000, 30,000, 15,000, and 3,000 ng/mL) and tazobactam (750,000, 300,000, 150,000, 30,000, 15,000, 3,000, and 1,500 ng/mL). Whole blood working calibration solutions at 150,000, 75,000, 30,000, 15,000, 3,000, 1,500, and 300 ng/mL for piperacillin and 75,000, 30,000, 15,000, 3,000, 1,500, 300, and 150 ng/mL for tazobactam were prepared by diluting the intermediate solutions in human drug- free fresh whole blood in a ratio of 1:9. Samples and pre-treatment This method was used to measure antimicrobial concentrations in clinical samples collected from preterm infants. Sample collection (~1 drop onto card) occurred under an investigational protocol approved by the institutional review board at participating sites and after informed consent was obtained from caregivers of study participants. Samples were obtained at the same time as plasma samples and could be obtained after single or multiple dosing. Criteria for a non-valid samples included appearance of multiple drops of blood per each spot on the card, asymmetry of spot, and cross-contamination between spots on the same card. Hematocrit (Hct) values were recorded for each participant if collected during routine medical care. The solutions were gently vortex-mixed for 10 minutes and o centrifuged at 15,600 g at 4 C for 5 minutes. Dicloxicillin was used as internal standard for both positive and negative analyses. The chromatographic separation of analytes was performed with gradient elution of increasing mobile phase B (0% hold until 0. Ionspray voltage and turbo heater temperature o were kept at 2500 V (-2000 V for tazobactam) and 500 C, respectively. Compound-specific instrument parameters were optimized for each transition (Table 4.

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Samples are drawn from the sinuses draining the pituitary gland and from the peripheral blood clopidogrel 75mg with amex. Which of the following statements about the Answers to Questions 30–33 diagnosis of Addison’s disease is true? Twenty-four–hour urinary free cortisol is normal response occurs in both primary and secondary in Addison’s disease Addison’s disease purchase 75 mg clopidogrel visa. Which of the following statements regarding the and dopamine—are produced from the amino acid catecholamines is true? Tey are produced by the zona glomerulosa of measured in order to diagnose pheochromocytoma. Plasma levels show both diurnal and pulsed sweating, and other endocrine involvement. The zona glomerulosa is Chemistry/Apply knowledge of fundamental biological the outermost portion of the adrenal cortex, where characteristics/Catecholamines/2 aldosterone is mainly produced. D Catecholamines are metabolized to metanephrines best single screening test for pheochromocytoma? Some carcinoid tumors produce mainly 5-hydroxytryptophan because they lack an enzyme needed to convert it to serotonin. The 5-hydroxytryptophan is converted by the kidneys to serotonin resulting in high urinary serotonin. Which statement regarding the measurement of Answers to Questions 34–36 urinary catecholamines is true? B Measurement of total urinary catecholamines is not catecholamines is specific for pheochromocytoma a specific test for pheochromocytoma. Twenty-four–hour urinary catecholamine assay may be increased by exercise and in muscular avoids pulse variations associated with diseases. Catecholamines in urine may also be measurement of plasma catecholamines derived from dietary sources rather than endogenous C. Most catecholamines are excreted as the provides greater specificity than measurement of glucuronide, and the urinary free catecholamines urinary free catecholamines increase only when there is increased secretion. Total urinary catecholamines are not affected by Measurement of free hormone in urine is equal in exercise clinical sensitivity and specificity to measurement of metanephrines. Twenty-four–hour urine is the sample Chemistry/Apply knowledge to identify sources of of choice because plasma levels are subject to pulse error/Catecholamines/2 variation and affected by the patient’s psychological 35. Which method is most often used to measure and metabolic condition at the time of sampling. Fluorescent methods detection employing ferricyanide (trihydroxyindole method) or C. Which statement about sample collection for results in formation of radiolabeled metanephrines catecholamines and metabolites is true? Electrospray manner following a 12-hour fast ionization tandem-mass spectroscopy is an B. Twenty-four–hour urine creatinine should be catecholamine elevation, and therefore, patients measured with vanillylmandelic acid, must be resting supine for at least 30 minutes prior to homovanillic acid, or metanephrines blood collection. Tere is no need to discontinue medications if a is catheterization, so that the anxiety of venipuncture 24-hour urine collection is used is not a factor. Chemistry/Apply principles of special Many drugs contain epinephrine, which may falsely procedures/Specimen collection and handling/2 elevate catecholamine measurements. Both can be measured immunochemically after Chemistry/Correlate clinical and laboratory data/ hydrolysis and derivatization Tyroid/2 C. However, these Catecholamines/2 methods are affected by dietary sources of vanillin; coffee, chocolate, bananas, and vanilla must be 38. Psychiatric disorders such as manic depression is elevated in more than 75% of neuroblastoma patients. Enzymatic coupling of these Chemistry/Apply knowledge of fundamental biological residues form T (3,5,3´-triiodothyronine) and T 3 4 characteristics/Tyroid/1 (3,5,3´,5´-tetraiodothyronine). Which statement regarding thyroid hormones from thyroglobulin, forming active hormones. Circulating levels of T3 and T4 are about equal the rate of coupling favors formation of T. T3 is about 10-fold more active than T4 of T are about 50 times those of T, but T is 4 3 3 C. Te rate of formation of monoiodotyrosine and approximately 10 times more active physiologically. Most of the T3 present in plasma is from its enzymatic conversion of T by T 5´-deiodinase. Which of the following statements regarding Total T4 or T3 may be abnormal in a patient with thyroid hormones is true?

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In other words generic 75 mg clopidogrel fast delivery, the caregivers stress hormones and lower levels of anxiety provided nutrients but not contact cheap clopidogrel 75mg on-line. Other benefits that were identified include pain reduction, increased This early finding has been supported by attentiveness, and enhanced immune function. Just give them a moment to play with an idea, and they’re off on another anxiety trip. But the good news is that you can backtrack and rewind your mind to a calmer place. Guided imagery creates a calm place by using your imagination to put yourself into a state of relaxation and peace. For example, you might imagine hearing birds, smelling flowers, feeling a slight breeze, and enjoying the taste of chocolate in the middle of a beautiful meadow. Some people find that breathing exercises or progressive relaxation don’t get them sufficiently relaxed. From the time that she springs out of bed in the morning to the last gripping thought before restless sleep mercifully overtakes her, Shauna thinks. She replays every anxious moment at her job and dwells on each imagined error that she’s made during the day, turning it over and over in her mind. To reduce the stress and anxiety that saturate the scenes in her mind, she decides to seek the services of a counselor. The counselor teaches her several breathing techniques, but Shauna can’t hold back the ava- lanche of anxious images. She tries progressive muscle relaxation, massage, and then music and aromatherapy to no avail. When she tried other relaxation techniques, they failed because anx- ious images still filled her mind. With guided imagery, however, the richness of the peaceful experience pushed aside all other concerns. Letting Your Imagination Roam Some people, thinking of themselves as rather unimaginative, struggle to create pictures in their minds. These people generally feel uncomfortable with their drawing skills and have a hard time recalling the details of events they’ve witnessed. If so, using your imagination to relax and reduce your anxiety may not be the approach for you. Guided imagery encompasses more than the visual sense; it includes smell, taste, touch, and sound. We encourage you to give these exercises a shot, but all people have different strengths and weaknesses, and you may find that one or more of these exer- cises just don’t work for you. For example, some folks have problems with hearing, sight, or smell that could impede their ability to use certain techniques based on those senses. We don’t want to make you more anxious by telling you these exercises must be done in a certain order or frequency. Our editor found herself surprisingly relaxed at work after reading about these tech- niques! Just before doing each series of numbered steps for the guided imagery exer- cises in this chapter, do the following: 1. Chapter 12: Creating Calm in Your Imagination 195 Imagining touch Imagery exercises work best if they incorporate more than one sense. Imagining bodily sensations enhances the overall experience of relaxing, guided imagery. The tub fills, and you mentally see yourself pouring bath oil in and mixing it around. The water feels just a bit too hot at first, but you find that the warm tem- perature soothes you after lowering your body into the bathtub. You can improve your awareness by spending just five minutes a day actively participating in a real experience and then committing that experience to your memory. The following day, do the exercise, wait five minutes, and then recall the sensations. Each day, make the length of time between the actual experience and your recol- lection of the experience a little longer. Recalling sounds You don’t have to be a musician to appreciate music or to re-create it in your mind. Guided imagery often asks you to create the sounds of nature in your mind to enhance relaxation. In your mind, you hear each wave rolling in and coming to a cre- scendo as it breaks gently onto the beach. You can improve your abil- ity to re-create sounds in your mind by actively experiencing the real McCoy beforehand. You may think of some other ways to practice listening to sounds with your mind’s eye, too.