Develop Procedures And Practice Essay Example

Develop Procedures And Practice Essay Identify the regulatory requirements, codes of practice and relevant guide once for managing concerns and complaints in own area of work The complaints procedure for my organization outlines the following aims: To ensure that its complaint procedure is properly and effectively implement d and that Irvine users feel confident that their complaints and worries are listened to a ND acted upon promptly and fairly. If a service users wishes to make a complaint or register a concern they should d find it easy to do so. It is the organization policy to welcome complaints and look upon the m as an opportunity to learn, adapt, improve and provide better service. The policy is I intended to ensure that complaints are dealt with properly and that all complaints or com meets by service users and their relatives and careers are taken seriously. The policy is not designed to apportion blame, to consider the possibility of n gelignite or to provide compensation. The Legal considerations followed are Regulation 19 0 f the Health and Social Care Act (2008) regulated activities Regulations 2009. . 2 Analyses how regulatory requirements, codes of practice and relevant GUID once for managing concerns and complaints affect service provision within own area o f work By ensuring that we have a robust and efficient complaints procedure in the o organization, we are giving the service users and their relatives the confidence that we try and do everything correct the first time and follow codes of practice. If we shou ld not achieve HTH s there are venues in which relatives or visitors to the home can raise an issue or comply main. We will write a custom essay sample on Develop Procedures And Practice specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Develop Procedures And Practice specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Develop Procedures And Practice specifically for you FOR ONLY $16.38 $13.9/page Hire Writer The guidance this is in place is in line with national guidelines and the local council regarding complaints. The fact that there are regulatory requirements also means that e ACH complaint is dealt with in the same way, but is treated individually, and there are standard s for the investigators of a complaint to abide by. A complaint can feel secure in the an ledge that in line with guidance, they will not be unnecessarily discriminated against for the e fact they have complained and they have clear rights which protect them from any stigma. Having clear set guidelines also enables the investigators and those implicate d in the complaint to understand their expectations of the process and feel more com portable that things are being carried out it a procedural manner. When I myself have had to respond to a complaint, I am able to structure my work following the policy Of the organization, and work the time striations set out in the poll icy. I have organized my work and setting meetings, gathering information and data and time to writer response of the complaint. The outcome of the complaint or concern may directly benefit the organization and a lesson may be learnt from an issue or complaint, this may lead to change in the police sis and procedures and working practices, for an individual or a team of workers. It m ay also identify an additional training that is needed for team members. Be able to develop procedures to address concerns and complaints 2. 1 Explain why individuals might be reluctant to raise concerns and make co implant In a care home setting a relative may feel like they are putting their relative (t he service user) at risk of maltreatment if they complain. They might fear that they will be Eden defied as being he one whom complained and then as a result the service user could be at TA regret of rebellious staff members emotional response. A lot Of relatives and residents may see how hard the staff work and feel they dont want to complain because they sympathy hiss with the difficult job that careers do, and the tasks they have to carry out, so they may s meme and feel as if they are being ungrateful for the care the relative (the service user) may be getting. A relative may not be aware that they can complain or might not know what the expectations are for the care of the service user. They may assume that what has given them c use for concern is the norm and that in complaining they will be told that is the way I t is. A relative might not think their concern or complaint will be taken seriously or be dealt with professionally, they might not have faith in the management of the organist on or think that they will be alienated as a result of complaining. Staff who are involved in the complaints or concerns may experience anxiety or Stress. The line manager is expected to support staff through traumatic and stressful situ actions by offering immediate support following a stressful event. The line manager needs to pro did a supportive style of management and be fully aware of the action to take if on e of the team members is experiencing difficulties. They need to be confident of seeking ad vice from other managers in the organization and the proprietors and to know if they can refer r a team member to occupational health and confidential staff counseling service whew n greater levels of support are needed. . 2 Outline steps that can be taken to encourage individuals to raise concerns or complaints Providing easily accessible standards of care in the form of leaflets or within t he welcome book/ Taft handbook will help relatives, residents and others to identify the standard ads to be expected and then they can identify whether they feel that these standards AR e not being met. An open door policy should be adopted by th e management. I always ensure I am available on a drop in basis to relatives and visitors to the home, I feel they can approach chi me with one off questions, I give give the best of my ability and knowledge to answer paper proprietary. La meeting is required I arrange a more formal meeting by arranging an appoint meet. I encourage all team members to actively seek feedback in the form of checking with the service user and relatives if everything is k and do they require anything dada action, to ensure the resident is comfortable and happy. Correctly handling complaints and showing that we respond to feedback by a advertising our feedback and demonstrating the actions in the workplace, this builds confide once in other residents and relatives. 2. 3 Work with others in development Of procedures to address concerns and complaints It is easy to overlook certain areas of the organization where things may be slip ping below expected standards or team members have become too compliant to their w Ark routines. Through regular staff meetings, I can receive feedback and team members pop onions on what their observations are of the way the organization is running and any areas the at needs extra care and attention. I encourage team members to come and speak with me w tit their concerns and complaints. They may see any in the organization before I do. By going to management meetings I am able to share and discuss the types of concerns that are being raised in other homes and explore why these have come up. It may be that I can take information back from the meetings and apply them in to my working en reorient. Encourage feedback from other professionals and will seek feedback through h a telephone call or in person, if a professional has visited whilst I was absent, I may contact them to see how they found the visit and the team members on duty, were they able to AC cues information they required and is there anything they could recommend, and anything that could be put in place to improve the service. 2. Ensure information on how to raise a concern and make a complaint is VA liable in accessible formats In my organization all set-vice users, relatives and others are made aware that hey are welcome and encouraged to provide feedback whenever they think it IS necks Sara. They do not have to wait until a review is due of the residents care, until the residents key worker is on shift or I am absent. They can leave a message, write a letter or fill in a comply nits form, or speak to the se nior member of staff on duty. In the service user welcome pack there is a section on complaint and the prop sees which is followed should the need arise. Once an individual makes a complaint a Reese ones is written and send immediately, acknowledging receipt Of the complaint and a time far e for the deal of the complaint or any further information required. There is the telephone number for the manager, the regional manager and the e ICQ, so that if the complaint is about the manager or they feel the manager cannot deal wit h the complaint, they can seek support from higher management. There is a copy of the stand awards of care expectations, which this gives the resident and relatives a reference for what should be expected in the organization. In my experience, most relatives choose to speak to the senior on duty to Clara FYI and informally discuss their concerns. Also, the staff team find and are confident t deal with small problems as it occurs, meaning there is not need for it to be taken further. There has been more serious complaints, which has involved the safeguarding g team, and meetings have taken place and investigations to outcomes of it the setting WA s appropriate for the resident. In staff meetings it is encouraged that team members think of new ways of en occurring feedback and information provided from annual surveys. In team members s provisions, it is NV Develop procedures and Practice to Respond to Concerns and Complain asked if they know the expectations of them and what is expected of the organ sensation as a whole, examples are given of what they are doing that is inline with the expect tattoos in place. Staff training needs to be up to date and frequent monitoring of staff. If a co implant pertains to a certain member of staff conduct and it is found they have made a mistake o r behaved in a certain way because they have not been trained otherwise questions will be a asked about why was training up to date and ensure it is a developmental point that is mimed tell addressed. 2. 5 Review the procedures that have been developed against regulatory require rents, codes of practice and relevant guidance Below are the regulatory requirements and what has been implemented into my organizations policy in line with the requirements. If you are unhappy with the care or treatment you receive you have the right to make a complaint, have that complaint investigated and be given a full and promptly y reply. The response is, In the residents contract there is a section which explains co implants, and demonstrates that we do care about complaints and feedback that reside ants and relatives to the home have, be we are required and regulated to respond to t hem in a corre ct way. By law, all health and social care services must have a procedure for dealing efficiently with complaint. The response is, The procedure for verbal and writ ten complaints is set out in the organizations policy on complaints procedure. A c poppy of this is sent out with a complaint with a holding letter and posted to the comply anoint immediately after the complaint is received. Be able to lead the implementation of procedure and practice for addressing concerns and complaints 3. 1 Promote a person centered approach to addressing concerns and complain ants As every residents care needs are different, so should be the delivery Of the c re. One persons standards and opinions will be different from others. We cannot expo etc everyone to adjust to an institutionalized way of living. It is important that the organization n adapts and is flexible in its approaches to each service user. Whilst standards in care are set at a certain level, some residents and relatives will expect more and some will expect less. Therefore a complaint may be received for people who are used to doing things in a certain n way that we are perhaps not used to doing, this will rarely be raised in the form of a comply mint, but more as concern regarding adapting an element of care to suit that persons needs. When a complaint is received with regards to the resident care, the first area of interest will be that the resident care needs and the care plan that was established and review wed is being an accurate representation of the type Of care that the resident should be receive Eng. The complaint will than be analyses in light of the agreed expectations to see how far the complaint has merit. Information will be gathered from the relatives and the r students about how the complaint has come about and take any dates, names or details which will assist in generating a picture of how the residents needs have not been met. . 2 Ensure that others are informed about the procedure for raising concerns or making complaints Not only are residents and relatives aware of how to raise a concern or comply mint and are encouraged to complain by promoting the complaints procedure and encounter aging feedback, the staff are also made aware of how to complain themselves, either about o en another or about the organization. They have a copy of the weightlessness policy as well as general complaints procedure in the staff handbook and they are made aware of the disciplinary reoccurred that they will be subject to should a complaint be received which in evolves them and serious misconduct. There is a box for comments and feedback in the porch a rear of the home. This provides relatives and others the opportunity to provide feedback anonymously if they wish to. . 3 Use supervision to support workers to recognize and address concerns an d complaints In team members supervisions and meetings we are able to discuss and Pratt ice the ways in which we seek our feedback and what to do when the information is received. For example, I encourage team members to openly discuss comments they have received, w list on shift. They can discuss how they responded and seek opinions from other team me members. In individual supervision sessions I will ensure that the team members training g is up to date, having fully trained staff is the key to ensuring that standards are met and the staff feel confident and knowledgeable about the care they are providing to resident. Can also explore any areas that a team member might feel they need to address. 3. 4 Implement systems and procedures which address concerns and complain ants and fully inform the complainant of the outcome within agreed time frames Any concerns or complaint should be dealt with efficiently and be investigate d properly and appropriately. Verbal concerns or complaints should be responded to mimed tell if at all possible and an apology offered at the time, if appropriate. Mrs. smiths daughter came to me concerning an incident which had happen d over the weekend whilst I had not been at work. She was concerned that her mother h ad been taken to the hospital and had fractured her pelvis. Mrs. Smiths daughter was concern d that she had managed this injury and it had not been recognized by any of the team member errs.

Diet and Primate Evolution essays

Diet and Primate Evolution essays Variation in the choices of food on a daily, seasonal, and yearly basis is one of the greatest differences between primate species. Primate diets have generally been divided into three main food categories-fruit, leaves and fauna (including insects, spiders, and bird's eggs for the most part). The different diets also are referred to as Frugivores, Folivores, and Insectivores (fruits, leaves and insects respectively). These gross dietary categories are correlated with aspects of primate activity patterns such as home range and group size. There are different problems that have to be overcome in order to obtain a balanced diet on a day-to-day basis. New leaves and mature leaves, for example, may have different nutritional bases or availabilities. Some fruits appear in large clumps while others are spread thinly over a larger area. Aside from diet, primates have tended to either adapt through specialized dentition and digestive systems or rely on a variety of different foods. T hose that chose this second route have tended to have larger brain sizes relative to their overall body size. This may be due to the need to know where different types of food can be found at different times throughout the year. Have you ever looked at a picture of a gorilla or money that has what appears to be a "beer belly" look? Those primates that specialize on eating large amounts of vegetation have difficulty digesting their meals. Different solutions have been found including double stomachs or multichewes, but the problem usually requires an individual to sit back and let the digestive system work-and on the die expel gas. It hasn't been until recently that it was realized that primates, who evolved in the canopy, actually had a quite difficult time finding adequate nutrition. Due to natural selection, which strongly favors those traits enhancing foraging efficiency, and this difficulty finding sustenance, the characteristics regarded ...

Emotional Intelligence Essay Example | Topics and Well Written Essays - 2500 words - 1

Emotional Intelligence - Essay Example Emotional intelligence basically means to control our emotions and expressions and thus maintain the interpersonal relationships. This art of emotional intelligence is very important in a person’s life. If anyone can control his or her facial expressions then he can be successful in his life just because of this emotional intelligence. The importance of emotions and feelings is vital but same is the case with the emotions and feelings of others. At certain times we have to take care of their emotions also just to save our relationships. In this situation emotional intelligence plays important role. With the help of this art we can control what we are felling at that particular time. When we talk about team work, leadership and management, then the importance of emotional intelligence is vital. Because all of these are totally dependent on relationships or we can say interpersonal relationships. These relationships can be managed only by controlling the emotions so that people may not feel any disrespect or harm form the management. The sentimental capacity of human mind can also be referred as the emotional intelligence. Some authors are of the opinion that emotional intelligence of any human being can be developed as the time and age passes and thus we can say a mature person would be more mentally stable as compare to an individual who is younger than him. But this theory does not fit in most of the cases. We may find many young individuals who are more stable emotionally as compare to their elders. Therefore the other group of authors which are against the development of emotional stability give their view point as that emotional intelligence is only inborn and it cannot be developed with the passing time. The presence of emotional intelligence is important in order to survive in the community or we can say that it helps us to manage our social lives also. Suppose we are unable to

Commercialization Plan Essay Example | Topics and Well Written Essays - 1250 words

Commercialization Plan - Essay Example The Sweet Cat center provides safe and secure daycare for children aged up to 7 years. Market research helps in gathering valuable information from the customers (Klopper, 2000). The Sweet Cat center will carry out market research to gauge the level of customer satisfaction. Improvements and modifications in its services will be carried out accordingly. The center also plans to gather information on the unmet needs of the customers and devise appropriate strategies to satisfy those needs. The Sweet Cat centre will strive to provide top-notch day care services. Since the company operates in the services sector, it will pay due attention to all the 7 Ps of services; product, place, price, promotion, physical evidence, processes and people (Khan, 2014). Sweet Cat will provide close personal attention to each child. The centre will provide a combination of educational and recreational services to ensure holistic development of the children. Sweet Cat has a vast repertoire of toys and games for children. The company will continue to add on to its existing collection of toys and books. At the same time, we will dispose of old worn out and out-dated material. The walls of the Sweet Cat center will have pictures of various cartoon characters. This will ensure that the overall ambience of the centre remains lively and vibrant where children can relax and enjoy. The appropriate physical evidence is bound to attract the target market (Buttle, 1994). Our center recognizes the fact that infants require special care. Therefore we will have a dedicated team of employees to cater to this segment. The center will offer some water-based activities to add to the fun quotient. It will also have kitchen facility to prepare food for the children. We, at Sweet Cat center are committed to providing top notch services to our clients. It will be mandatory for all employees of the center to undergo periodic training programs. This training will be arranged by the

Finance Essay Example | Topics and Well Written Essays - 2250 words - 6

Finance - Essay Example Therefore, for those organizations, the cost of capital can be measured through a weighted average method that can be termed as weighted average cost capital. In specific, the execution of cost of capital is due to figure out the hurdle rate that the companies come across with and are supposed to overcome in order to generate earnings. This method is widely exploited during the process of capital budgeting to identify the risk or favorable scenario for the company to proceed with a concerned project (Droms and Wright, 2010, pp. 31-34). From the financer’s standpoint, the investors are looking for respective profit over the company’s existing securities portfolio, which is used to assess a companys new project, because it is expected return that the investor is anticipated for providing funds, with the lowest rate of return, thereby establishing a benchmark that should be adhered by the new project (Pedell, 2006, pp. 26-31). The main perspective of this assignment is to analyze the cost of capital, which often known as Weighted Average Cost of Capital (WACC) of the chosen organization. The company that has been chosen for the same analysis is Tesco Plc. Tesco Plc is a British based multinational grocery and general merchandise retailer with its headquartering located in England, United Kingdom (UK). Tesco Plc is known as the second largest retailer in the world after the Wall-Mart. The company earned net revenue amounting to  £70.894 billion in the year 2013 with net income amounting to  £124.0 million in the same year. The method which has been used for computing the WACC of the selected company comprises on two different aspects, which are cost of debt and cost of equity. The formula of WACC institutionalized to cumulate cost of debt and cost of equity by applying relevant amount of weights with these elements. The justification of this particular method lies in the fact that this method has the tendency to analyze the cost of capital of the

Potentially Inappropriate Medication at a Private Hospital

Potentially Inappropriate Medication at a Private Hospital Abstract The use of certain medications in geriatrics when potential risks outweigh the potential benefit and an effective alternative is available is called as Potentially Inappropriate medication. Because geriatrics are more sensitive towards adverse effects of medications. Beers criteria which is updated and reviewed by American Geriatric society list out 53 medications/therapeutic classes of drugs to be avoided in geriatrics. Methodology: A prospective observational study was conducted for 9 months in a 650 bed private corporate hospital, South India. All geriatric patients admitted in the hospital during the study period was included. Beers Criteria 2013 were used to identify potentially inappropriate medications. Result: The prevalence of PIM use (52%) was significantly higher in study population. An avg of 10 drugs were taken by the study population. A total of 215 medications were identified as PIMs. Among them 195(90%) medications should be avoided by the geriatrics independent of th eir condition (category I). 66(60%) of the study population had used more than one PIMs. 91(83%) of the PIM users had atleast one DRPs and the mean DRPs value of the PIM users were 1.59à ¯Ã¢â‚¬Å¡Ã‚ ±1.3. Conclusion: High prevalence of PIMs in the study population signifies the need of monitoring geriatric prescriptions. Key words: PIMs, Beers Criteria, Geriatrics Introduction In recent years proportion of geriatric hospital admission with comorbidity and polypharmacy has been increasing continuously (1, 2). Adverse drug events (ADRs) are the most common reason for hospital admission, but sometimes it’s not identified. Medication errors (MEs) or conventional adverse drug reactions (ADRs) are the common reason for adverse drug events which ends in clinical symptoms. Overall, elderly patients need greater attention to drug therapy and safety parameters (1, 3-5). Greater attention is needed for geriatric population due to age related pharmacodynamics and pharmacokinetic changes. But appropriate pharmaceutical care for elderly are determined on the basis of clinical trial conducted with adult population.(6) The burden of harm resulting due to the use of multiple drugs in geriatric populations is a major health related problem in developed countries. A research study reveals that around one in four geriatrics admitted to hospitals are prescribed with at least one inappropriate medication and potentially preventable adverse drug reactions accounts for nearly 20% of all inpatient deaths (7). The assessment of potentially inappropriate medication (PIM) in geriatric is a challenging work and there is a need for considering many factors which influences the prescribing as well as outcome. Eight well known tools are available to identify the PIMs and studies reports that Beers criteria is the best and easy one to assess the PIMs. Beers criteria also has the advantage over others because it is periodically updated (8).This study therefore aimed to investigate the prevalence of PIM use on geriatric population using Beers criteria 2012 and its association with Drug Related Problems (DRPs) . Methodology Study Site: The work entitled â€Å"A study on prevalence and impact of Potentially Inappropriate Medication use in geriatrics at a private corporate hospital† was carried out in a 640 bedded private corporate hospital, South India. Study Design: Prospective –Observational study. Study Period: Nine months. Inclusion criteria: Patients above age of 65 yrs. Exclusion criteria: The patients who are unwilling to participate in the study and out patients METHOD: A regular ward rounds was carried out in all the wards of General medicine. Each patient’s medication profile was reviewed. Patients who met the inclusion criteria were briefed on the project with the help of patient information form and if they are willing to participate in the study their consent was obtained. The data from medical chart were recorded in customized data entry form. The prescribed drugs were evaluated and PIMs use were identified with the help of Beer’s criteria. The drugs which are identified as PIM are categorized into following: Potentially inappropriate medications /classes to avoid in geriatrics, Potentially inappropriate medications /classes to avoid in geriatrics with certain pathological condition that the listed PIM use can exacerbate Medications to be used with caution in geriatrics. ADRs associated with PIMs use were assessed. Drug interaction and ADR was monitored and reported. DRPs and Drug Risk Ratio (DRR) were calculated for PIMs. DRPs were the sum of ADR, drug interaction and drug allergy.DRR was calculated as the number of DRPs in relation to how often the drug was used (DRPS/number of times used). Results and Discussion In the study period, 212 patients were included in the study as per inclusion criteria and exclusion criteria. 110 (52%) patients were found to be prescribed with PIMs listed in Beers criteria (fig no: 01). A similar study conducted by Birader K et al (2013) (9) reported that PIM prevalence were 38% in their study population. Increased anxiolytics use as a prophylaxis for hospital related anxiety might be the reason for high prevalence of PIM than the later study. The total number of patients in study population were 110. Among them 62(56%) were males and 48(44%) were females.The study result reveals that PIMs user are mostly males. A similar study conducted by Birader K et al (2012) (9) reported that prevalence of PIM use is more among males than females. The age categorization of PIM users was done. The maximum age of PIM users was 93 years and mean age of PIM users was found to be 70.2 ±5.77. The median age for PIM users was 68.5 years. The result indicated that age group of (65-69) were commonly prescribed by PIMs. This results compared with a previous study carried out by Birader K et al (2012) (9) which also reports that PIMs were frequently prescribed in the age group of 65-69 years. The social habit of the PIM users shows that 8(7%) patients were smokers and alcoholics, 14(13%) patients were alcoholics, 21(19%) patients were smokers and 67(61%) patients were teetotalers in PIM users. The comorbidities of the PIM users was analyzed. There were 52 (47%) suffering from hypertension and 32(29%) were suffering from DM. The results shows that most of the study group had comorbidities of hypertension followed by DM and CVDs. A similar study conducted by Fouquet A (11) also reported that most common diagnosis among their study population was hypertension and diabetes. The number of drugs prescribed for the PIM users were calculated (fig no: 2). The mean number of drugs per prescription was 9.9 ±2 with the maximum of 16 drugs and minimum of 5 drugs prescribed. The above results signifies that all prescriptions were in polypharmacy category. A similar study conducted by Blozik E (12) concluded that one of the main factor for PIM use is â€Å"polypharmacy†. The number of PIM drugs per prescription in the study population was calculated (Fig no: 3). The result reveals that 44(40%) were using one PIM drug, 50(45%) were using two PIMs, 14(13) were using three PIMs, 1(1%) were using 4 PIMs and the maximum of 5 PIMs use were found in 1(1%) of the study population. 66(60%) of the study population consumed more than one PIM. The mean was found to be 1.8 ±0.78 and an avg of 2 PIM was used by the study population. A similar study conducted by Dormann H (2013) (13) were reported that 87% of the study population consumed at least one PIM. Among the PIM users the total number of PIM drugs was calculated and it was found to be 215 drugs. PIM users were categorized into three groups according to Beers criteria. (Table no: 2) There were 195(90%) belongs to category I, 12(6%) were in category II and 8(4%) were in category III. The individual categories of PIM was analyzed. It was found that alprazolam 57(52%), clonazepam 17(15%), hyocyamine 10(9%), Lorazepam 10(9%), hydroxyzine 10(9%), zolpidem 10(9%), ketorolac 10(8%) were prescribed in category I (table no: 3). A similar study conducted by Birader K et al (2013) (16) reported that alprazolam and cimetidine were frequently used PIM among their study population. Use of hyocyamine in constipation 3(25%) accounts for the most frequent inappropriate drug use in category II (table no: 4). Hydroxyzine in constipation 2(17%), cyproheptidine in constipation 2(17%), ketorolac in PUD 2(17%), clonazepam in frequent fall 1(8%), ketorolac in CHF 1(8%) and theophylline in insomnia 1(8%) were other category II inappropriate medication use. Use of escitalapram 3(40%), mirtazapine 2(30%), fluoxetine 1(10%), sertraline 1(10%) and Duloxetine 1(10%) were the category III PIMs (table no:5). The DRP among the PIM users were analyzed (fig no: . It was found that 19(17%) of the PIM users were free from DRPs. Majority of the study population had at least one drug related problems. The mean value of DRP in the study population was found to be 1.59 ±1.3. The minimum observed number of DRP per patient was one and maximum observed number of DRP per patient was six. The ADR use was monitored in the study population. A total number of 40 ADR associated with PIM use (Fig no:5) and 14 ADR associated with nonPIM use were identified. The study result reveals that one among three PIM users were found to have at least one ADR. A similar study conducted by N. Nixdorff et al (2008) were also reported that PIM users were found to experience ADR most frequently than nonPIM users. As a part of our study, screening of drug interactions were done. A total number of 131 major drug interactions were identified, in that 111 were unique. Among the drug interactions found 16(12%) were PIM-PIM drug interactions, 39(30%) were PIM-other drugs drug interactions and 76(58%) were caused by non PIM drugs (table no: 6). Drug risk ratio were calculated for the study population (table no:7). It was observed that prochlorperazine had the highest DRR (4) followed by phenobarbitone (2), digoxine (2), pentazocine (2) and duloxetine (2). The statistical analysis of obtained results has been done using statistical tools. The association of different variables are analyzed using à ¯Ã‚ Ã‚ £2 test. On assessment of association between â€Å"number of comorbidities† with â€Å"number of drugs† and â€Å"number of PIMs† (table no:8), the result proved that â€Å"number of comorbidies† are statistically associated with â€Å"the number of drugs† at 0.001 level of significance and â€Å"number of PIMs† at 0.05 level of significance. It means that as number of comorbidity increases polypharmac and PIM use also increases. On assessment of association between â€Å"number of drugs† and â€Å"number of PIMs† (table no: 9), the result proved that â€Å"number of drugs† are statistically associated with â€Å"number of PIMs† at 0.05 level of significance. This result proves that polypharmacy is one of the reason for PIMs. On assessment of association between â€Å"number of DRPs† with â€Å"number of drugs† and â€Å"number of PIMs† (table no:10), the result proved that â€Å"DRPs† are statistically associated with â€Å"number of PIMs† at 0.01 level of significance but not associated with â€Å"number of drugs† at 0.05 level of significance. This result proves that DRPs is more associated with PIMs than polypharmacy which means it not the number of drugs contributing to DRPs but the use of PIMs. Conclusion Our study identified a high prevalence of PIMs use and associated DRPs in the study population. DRPs due to PIMs is preventable. Development and implementation of new criteria or modification of already existing criteria such as Beers criteria, START STOPP criteria which will helps in safe prescribing practice can reduce the PIMs use. References Budnitz DS, Lovegrove MC, Shehab N, Richards CL. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med 2011; 365: 2002–12. Budnitz DS, Shehab N, Kegler SR, Richards CL: Medication use leading to emergency department visits for adverse drug events in older adults. Ann Intern Med 2007; 147: 755–65. Lau DT, Kasper JD, Potter DE, Lyles A, Bennett RG: Hospitalization and death associated with potentially inappropriate medication prescriptions among elderly nursing home residents. Arch Intern Med 2005; 165: 68–74. Pirmohamed M, James S, Meakin S. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ 2004; 329: 15–9. Chrischilles EA, VanGilder R, Wright K, Kelly M, Wallace RB. Inappropriate medication use as a risk factor for self-reported adverse drug effects in older adults. J Am Geriatr Soc 2009; 57: 000–6 Avorn J, Shrank WH. Adverse drug reactions in elderly people: A substantial cause of preventable illness. BMJ. 2008;336:956–7 Minimizing Inappropriate Medications in Older Populations: A 10-step Conceptual Framework. Ian A. Scott, MBBS, MHA, MEd,a Leonard C. Gray, MBBS, MMed, PhD,b Jennifer H. Martin, MBChB, MA (Oxon), PhD,c Charles A. Mitchell, MBBSd Opondo D. Inappropriateness of Medicationth Prescriptions to Elderly Patients in the Primary Care Setting: A Systematic Review, plos one, aug 2012, volume 7, issue 8 Biradar K; assessment of potentially inappropriate medication in elderly patients at Basavehwar teaching hospital;IJPP 2012dec, vol 5,issue 4, 73-5 Denys TL (2011) Functional Decline Associated With Polypharmacy and Potentially Inappropriate Medications in Community-Dwelling Older Adults With Dementia, Am J Alzheimers Dis Other Demen. 2011 December ; 26(8): 606–15. doi:10.1177/1533317511432734 Fouquet A, Zegbeh H, Krolak-Salmon P, Mouchoux C. Detection of potentially inappropriate medication in a French geriatric teaching hospital: A comparison study of the French Beers criteria and the improved prescribing in the elderly tool. J Eurger 2012 3: 326-29 Blozik E, Rapold R, von Overbeck J, Reich O. Polypharmacy and potentially inappropriate medication in the adult, community-dwelling population in Switzerland. Drugs aging. 2013;30:561-8 Dormann H, Sonst A, Mà ¼ller F, Vogler R, Patapovas A, Pfistermeister B, Plank-Kiegele B, Kirchner M, Hartmann N, Bà ¼rkle T, Maas R. Adverse drug events in older patients admitted as an emergency the role of potentially inappropriate medication in elderly people (PRISCUS). Dtsch Arztebl Int 2013; 110(13): 213–9. DOI: 10.3238/arztebl.2013.0213 N. Nixdorff et al. Potentially inappropriate medications and adverse drug effects in elders in the ED. AJEM 2008 26: 697–700 Tables and figures NO. of PIM/prescription Number of patients N=110 Percentage 1 44 40 2 50 45 3 14 13 4 1 1 5 1 1 Table no:1 Number of PIM per Prescription sl no category no. of PIMs percentage 1 PIM drugs/classes to be avoid in geriatrics (category I) 195 90 2 PIM to be avoided in certain pathological condition (category II) 12 6 3 PIMs to be used with caution (category III) 8 4 Table no:2 Categories of PIM sl no Drugs No. of Patients sl no Drug No. of Patients 1 Alprazolam 57 (29%) 16 Nitrofurentoin 3(1.5%) 2 Clonazepam 17(9%) 17 Mirtazapine 2(1%) 3 Hyocyamine 10(5%) 18 Cyproheptidine 2(1%) 4 Lorazepam 10(5%) 19 Diazepam 2(1%) 5 Hydroxyzine 10(5%) 20 Piroxicam 2(1%) 6 Zolpidem 10(5%) 21 Prochloperazine 2(1%) 7 Ketorolac 10(5%) 22 Chlorphemiramine 2(1%) 8 Aceclofenac 9(4.5%) 23 Trihexylphenedine 2(1%) 9 Propoxyphene 8(4%) 24 Digoxin 2(1%) 10 Diclofenac 7(3.5%) 25 Phenobarbitone 1(0.5%) 11 Spironolactone 6(3%) 26 Naproxen 1(0.5%) 12 Prazosin 5(3%) 27 Clinidium-chlordiazepoxide 1(0.5%) 13 Clonidine 5(3%) 28 Indomethacin 1(0.5%) 14 Chlordiazepoxide 3(1.5%) 29 Metachlopramide 1(0.5%) 15 Amitriptyline 3(1.5%) 30 Pheniramine 1(0.5%) 31 Pentazocine 1(0.5%) Table no: 3 Category 1(PIM drugs/classes to be avoid in geriatrics) Sl no Drug Disease No. Patients Percentage 1 Ketorolac CHF 1 8 2 Hydroxyzine Constipation 2 17 3 Hyocyamine Constipation 3 25 4 Ketorolac PUD 2 17 5 Cyproheptidine Constipation 2 17 6 Clonazepam Frequent Fall 1 8 7 Insomnia Theophyllin 1 8 Table no: 4 Category II (PIM to be avoided in certain pathological condition) sl no Drug No of Patients percentage 1 Mirtazapine 2 30 2 Fluoxetine 1 10 3 Sertraline 1 10 4 Duloxetine 1 10 5 Escitalapram 3 40 Table no: 5 Cateegory III (PIMs to be used with caution) NO OF INTERACTION PERCENTAGE PIM-PIM 16 12 PIM- OTHER DRUGS 39 30 OTHER DRUGS 76 58 Table no:6 Categories of Drug Interactions Sl No Drug DRPs Total Drug Risk Ratio 1 PROCLORPERAZINE 8 2 4.00 2 PHENOBARBITONE 2 1 2.00 3 DIGOXIN 4 2 2.00 4 PENTAZOCINE 2 1 2.00 5 DULOXETINE 2 1 2.00 6 NAPROXEN 2 1 2.00 Table no.7 Drug Risk Ratio Sl no Varience No. of comorbidities Chi squire value P value 1 2 ≠¥ 3 1 No. of PIMs 1 5 21 13 12.76* 0.05 2 10 12 15 ≠¥ 3 7 15 12 2 No. of drugs 6-8 13 16 4 26.77* 0.001 9-11 8 25 17 ≠¥ 12 1 7 19 Table no:8 Association of no. of comorbidities with no. of drugs and PIMs . varience No. of Drugs Chi squire value P value 6-8 9-11 12-14 ≠¥15 No. of PIMs 1 16 21 4 3 21.76* 0.001 2 14 24 8 4 ≠¥ 3 2 5 5 4 Table no: 9 Association of no. drugs and no. PIMs Sl no Varience No. of DRPs Chi squire value P value 0 1 2 ≠¥3 1 No. of PIMs 1 11 21 10 2 21.76* 0.001 2 7 23 8 12 ≠¥ 3 1 4 2 9 2 No. of drugs 6-8 9 15 11 1 11.77 0.05 9-11 4 25 6 12 ≠¥ 12 6 8 3 10 Table no:10 Association of DRPs with no. of drugs and PIMs Fig no:1 Prevalence of PIMs Fig no:2 Number of Drugs Prescribed per Patient Fig no:3 Number of PIM per Prescription Fig no: 4 Adverse Drug Events and Its frequency Fig no:5 Adverse Drug Events and Its Frequency

Jeannine :: Personal Narrative Papers

Jeannine She had seen things and experienced a life that I only knew about through the movies. She acted as though she knew I would not be able to understand her, but I could see in her eyes that she hoped I could. e stood in the driveway, physically closer than we had been to each other in two weeks. Jeannine, my sister, did not stay at home too much anymore. She had dedicated her existence to her boyfriend Steven and chose to live with his family so that the two of them could be closer. My parents were supportive and open, but they would never have let their seventeen year old daughter sleep in the same bed under their roof with her nineteen-year-old boyfriend. So after countless years of tension and arguments, my sister had achieved what she had sought for years, independence from her family, but most of all from her older brother. Now standing in that driveway, our childhood playground, as I prepared for the long journey to James Madison University, we realized that the past five years of our lives had been wasted. Her constant struggles to get out of the house coupled with my harsh attempts to see that she met that goal consumed our adolescent years, the period where we needed each other the most. My parents told me that they were ready to leave, and I gave Jeannine a long hug. It was the first time in half a decade that I gave her a meaningful show of affection. I met her with the love that I had suppressed for so long, rather than the hate and loathing that was quick to my aid in the many years of confrontation that we shared. It was then, as her head rested on my chest and her arms wrapped around me, that I realized the wrongs I had done to her. All of a sudden, I did not want to leave. I had my sister back, how could I abandon her again? No one can really claim to have a perfect childhood sibling relationship, but we were still very close. At times, we could even be proud of one another. Yet, as in all sibling bonds, these good tidings never lasted. Our games of tic-tac-toe or kickball with our friends would go from friendly backyard, Little- House-on-the-Prairie type moments to screaming matches in a matter of days. Jeannine :: Personal Narrative Papers Jeannine She had seen things and experienced a life that I only knew about through the movies. She acted as though she knew I would not be able to understand her, but I could see in her eyes that she hoped I could. e stood in the driveway, physically closer than we had been to each other in two weeks. Jeannine, my sister, did not stay at home too much anymore. She had dedicated her existence to her boyfriend Steven and chose to live with his family so that the two of them could be closer. My parents were supportive and open, but they would never have let their seventeen year old daughter sleep in the same bed under their roof with her nineteen-year-old boyfriend. So after countless years of tension and arguments, my sister had achieved what she had sought for years, independence from her family, but most of all from her older brother. Now standing in that driveway, our childhood playground, as I prepared for the long journey to James Madison University, we realized that the past five years of our lives had been wasted. Her constant struggles to get out of the house coupled with my harsh attempts to see that she met that goal consumed our adolescent years, the period where we needed each other the most. My parents told me that they were ready to leave, and I gave Jeannine a long hug. It was the first time in half a decade that I gave her a meaningful show of affection. I met her with the love that I had suppressed for so long, rather than the hate and loathing that was quick to my aid in the many years of confrontation that we shared. It was then, as her head rested on my chest and her arms wrapped around me, that I realized the wrongs I had done to her. All of a sudden, I did not want to leave. I had my sister back, how could I abandon her again? No one can really claim to have a perfect childhood sibling relationship, but we were still very close. At times, we could even be proud of one another. Yet, as in all sibling bonds, these good tidings never lasted. Our games of tic-tac-toe or kickball with our friends would go from friendly backyard, Little- House-on-the-Prairie type moments to screaming matches in a matter of days.

Carribean Adventures

I am Sandra Gaskins, born in California. I have completed MBA from Anderson School of Management in 2008, did graduation in commerce streams from University of American inter Continental and schooling from Belmont Senior high school. During my MBA course, I did summer internship in American express as a Management Trainee, where my job profile was to work with the travel counselor and prepare the project report on delivery of quality services to the customers. During this program I realized my strengths, which are better communication skill, handling the queries of customers and working in teams. About my family background – my father is running a privately owned business of textiles and mother is a home maker. I have one sibling pursuing BBA. I am keen to work with the Carribean Adventures, since the profile of Travel Counselor requires the skill of customer service and ability to work under pressure and I am familiar with the workings and dealings of travel counselors as I worked in the same field during internship. I had a great learning during internship. There I learnt about the customer values, needs and what quality means to them. Along with this, I had a selling experience and learnt how to coordinate in teams, which ultimately enhanced my problem solving capabilities and all these qualities form the core in order to become the travel counselor. Apart from this, I possess a sound knowledge of geographical locations, as it was one of my hobbies to gather the information related to the diversities in the places and study the human psychology. Therefore, based on the above mentioned qualities and my sheer determination towards the work that is assigned to me, I can say that I will be the suitable candidate for this post. Â   Â  

Tasseled Wobbegong Shark Facts

Tasseled Wobbegong Shark Facts The tasseled wobbegong shark is one of the most extraordinary-looking shark species.   These animals have distinctive, branched lobes extending from their head and a flattened appearance. Although these sharks were first described over 100 years ago (1867), they are not well-known.   Tasseled Wobbegong Shark Identification Like other wobbegong sharks, tasseled wobbegongs have large heads and mouths, flattened bodies and a spotted appearance.   These sharks have 24 to 26 pairs of highly branched dermal lobes that extend from the front of the sharks head to its pectoral fins. It also has branched nasal barbels on its head.  This shark has patterns of dark lines over lighter skin, with dark spots and saddle patches.   Tasseled wobbegongs are usually thought to grow to a maximum size of about 4 feet in length, although a questionable report estimated one tasseled wobbegong shark at 12 feet. These sharks have three rows of sharp, fang-like teeth in their upper jaw and two rows of teeth in their lower jaw.   Classification: Kingdom: AnimaliaPhylum: ChordataClass: ChondrichthyesSubclass: Elasmobranchii Order: Orectolobiformes Family: Orectolobidae Genus: EucrossorhinusSpecies: dasypogon   The genus Eucrossorhinus comes from the Greek words eu (good), krossoi (tassel) and rhinos (nose). Where Do Tasseled Wobbegong Sharks Live? Tasseled wobbegong sharks live in tropical waters in the southwest Pacific Ocean off Indonesia, Australia and New Guinea. They prefer shallow waters near coral reefs, in water depths of about 6-131 feet.   Feeding: This species feeds at night upon benthic (bottom) fish and invertebrates. During the day, tasseled wobbegong sharks rest in sheltered areas, such as in caves and under ledges. Their mouths are so large, the tassseled wobbegong sharks have even been seen swallowing other sharks whole. This shark can feed on other fish that share its caves. Reproduction: The tasseled wobbegong shark is ovoviviparous, which means that the females eggs develop within her body. During this process, the young get their nourishment in the womb from the egg yolk. Pups are about 7-8 inches long when born.   Shark Attacks: Wobbegong sharks are not generally considered threatening to humans, but their ability to camouflage with their environment, combined with sharp teeth, can result in a painful bite if you come across one of these sharks.   Conservation: These sharks are listed as near threatened on the IUCN Red List, Threats include damage to and loss of their coral reef habitat and overfishing.   Not much is known about this species, but populations appear to be declining, which is another reason for their near threatened listing.   Because of their beautiful coloration and interesting appearance, these sharks are sometimes kept in aquariums. References and Further Information: Bester, C.  Tasseled Wobbegong. Florida Museum of Natural History. Accessed July 31, 2015.Campagno, L., Dando, M. and S. Fowler. 2005. Sharks of the World. Princeton University Press. 368pp.Compagno, L.J.V., 1984. Eucrossorhinus  dasypogon   (Bleeker, 1867).  FAO Species Catalogue. Vol. 4. Sharks of the world. An annotated and illustrated catalogue of shark species known to date. Part 1 - Hexanchiformes to Lamniformes. FAO Fish. Synop. 125(4/1):1-249. Rome: FAO.  In  FishBase. Accessed July 31, 2015. International Shark Attack File. 2015.  Florida Museum of Natural History. Accessed July 31, 2015. Pillans, R. (SSG Australia Oceania Regional Workshop, March 2003) 2003.  Eucrossorhinus dasypogon. The IUCN Red List of Threatened Species. Version 2015.2.   Scales, H. Pictures: Shark Swallows Another Shark Whole. National Geographic. Accessed July 31, 2015.

Free Essays on The First Native Americans

The First Americans Throughout time our ancestors have always been the race that we have descended from. To this day scientists and philosophers still don’t grasp the true revelation, of who owns the past. The controversies of the Kennewick man very well define some of our many questions about the actual origin of the 9300 year old skeleton. The remains are an ongoing battle with the American anthropologists and the NAGPRA. And archeologists may never know the biological evidence of linkage between us and the Kennewick man. The origin of the human remains is still not known to this day, although archeologists believe to be of a Caucasoid descent. Originally the Kennewick man was thought to be a fur –trader or pioneer. Obtained though a CAT scan and was thought to be dated from 9000 to 4500 years ago. The NAGPRA claims that these remains are from a Paleo-Indian tribe and believes that they should preserve and keep the remains. The only problem with this claim is that this tribe is a fairly new tribe and with radiocarbon dating the facts just don’t match. Controversy surrounds the whole situation of the Kennewick man, the remains, the origin, and the possessions is all being fought over. Since this skeleton was found on land that the Native American Graves Protection and Repatriation Act. The Committee also believes that the remains are closely related or are one of a Paleo-Indian Tribe. For many archaeologist the find of these remains are huge, mainly because a huge portion of the skeleton was found. This piece could very well tell us the many things we still have to learn about our early ancestors. Native Americans believe that there is a close ancestral relationship between the Kennewick man and a modern tribe. The tribe has been around for many years, but not more that 4500 years ago. The radio carbon dating on the fossil dated back to about 9300 years ago this would throw this theory in the water. T... Free Essays on The First Native Americans Free Essays on The First Native Americans The First Americans Throughout time our ancestors have always been the race that we have descended from. To this day scientists and philosophers still don’t grasp the true revelation, of who owns the past. The controversies of the Kennewick man very well define some of our many questions about the actual origin of the 9300 year old skeleton. The remains are an ongoing battle with the American anthropologists and the NAGPRA. And archeologists may never know the biological evidence of linkage between us and the Kennewick man. The origin of the human remains is still not known to this day, although archeologists believe to be of a Caucasoid descent. Originally the Kennewick man was thought to be a fur –trader or pioneer. Obtained though a CAT scan and was thought to be dated from 9000 to 4500 years ago. The NAGPRA claims that these remains are from a Paleo-Indian tribe and believes that they should preserve and keep the remains. The only problem with this claim is that this tribe is a fairly new tribe and with radiocarbon dating the facts just don’t match. Controversy surrounds the whole situation of the Kennewick man, the remains, the origin, and the possessions is all being fought over. Since this skeleton was found on land that the Native American Graves Protection and Repatriation Act. The Committee also believes that the remains are closely related or are one of a Paleo-Indian Tribe. For many archaeologist the find of these remains are huge, mainly because a huge portion of the skeleton was found. This piece could very well tell us the many things we still have to learn about our early ancestors. Native Americans believe that there is a close ancestral relationship between the Kennewick man and a modern tribe. The tribe has been around for many years, but not more that 4500 years ago. The radio carbon dating on the fossil dated back to about 9300 years ago this would throw this theory in the water. T...

MEDIA TECHNOLOGIES Essay Example | Topics and Well Written Essays - 2000 words

MEDIA TECHNOLOGIES - Essay Example As per Carlyle (1830), development of printing press was the first step towards the modern era of media. McLuhan has introduced the term â€Å"Media† along with other terms like â€Å"The Global Village† and the â€Å"Age of Information† which gained high popularity. In 1965 his famous book â€Å"Understanding Media: The Extension of Man† was published. Soon he was called the most important thinker after Newton, Darwin, Pavlov and few more. With the further development in technology, media has made constant evolution and has improved itself to fit best into the society. McLuhan has called media as an extension of man. (Griscom, n.d. â€Å"McLuhan’s message†). The chart given above indicates that with passage of time, some vital changes took place in the media industry. These changes are more influenced by the changes that are taking place in the field of technology and also in the society. One of such revolutionary change was brought by the development of the internet. Internet introduced speed in media. The present era of media is known as digital media due to influence of internet in each and every aspect. In the year 1964, Rand Corporation, created a communication network which had several nodes and each node was capable of originating, passing and receiving message. In 1967 Britains National Physical Laboratory succeeded in developing the first test network. This was just the beginning of a new era. With passage of time, more and more such networks came into existence. Many agencies came forward and actively participated in developing their own network. By the end of the 20th century, six basic internet domains developed. These domains got segregated by separate abbreviations for representing their address such as â€Å"gov†, which was for government; â€Å"mil†, which was for military; â€Å"edu†, which was for education; â€Å"com†, which was for commercial; â€Å"org†, which was for organisation and

Econometrics Essay Example | Topics and Well Written Essays - 2000 words - 2

Econometrics - Essay Example velopment to fulfill international expectations, high excellent of job and items, up-to-date engineering, consumer as well as environmental responsibility and robust networks in conducting company operations. More importantly, the competition of Thai market, particularly SMEs, has usually relied in low-cost job and normal resource advantages as opposed to technological capability or qualified human investment capital. Many models of growth along with development suppose that end result is generated with a two component, CobbDouglas specification for your aggregate production function using physical capital and work or Man capital adjusted labor helping as inputs. The CobbDouglas specification could be the only linearly homogenous production function that has a constant elasticity of substitution in which each factor’s Share of income is constant over time. Since this latter implication with the CobbDouglas specs is considered consistent with among stylized information of development, that this shares involving income accruing to help capital along with labor are relatively constant over time most researchers have not questioned the application of a CobbDouglas production function to check questions involving growth along with development. The linear homogeneity along with constant elasticity of alternative properties with the CobbDouglas specification also can explain this popularity with this functional style (Duffy & Papageorgiou 2000, p. 1). In all forms of production of one good with multiple factors, the formulation is presented as. Y represents the total production, L represents labor input, K represents the capital input, and A represents the total output by the factory. Regression evaluation generates the equation to spell it out the statistical relationship between more than one predictor variables along with the response varying. The p-value for every term checks the null hypothesis, which the coefficient is equal to zero (no effect). A low p-value