Why Are Systematic Reviews Important Health And Social Care Essay

A systematic reappraisal is â€Å" [ a ] reappraisal of a clearly formulated inquiry that uses systematic and expressed methods to place, choose, and critically measure relevant research, and to roll up and analyze informations from the surveies that are included in the reappraisal. Statistical methods ( meta-analysis ) may or may non be used to analyze and summarize the consequences of the included surveies † ( Greens & A ; Higgins, 2005 ) . SRs are claimed to be the best beginning of grounds in clinical pattern and decision-making ( Cook et al, 1997 ) . They provide sum-ups of grounds from a myriad of primary surveies which focus on the same inquiries ( Cook et al, 1997, Sanchez-Meca & A ; Botello, 2010 ) by efficaciously pull offing and incorporating well big sum of bing information ( Mulrow, 1994 ) . An overview of available scientific grounds which addresses a specific job brand clip devouring procedure of reading single surveies unneeded and therefore, aid wellness atten tion professionals save their cherished clip ( Sanchez-Meca & A ; Botello, 2010 ) . By summarizing consequences of included research surveies into a individual statement, SRs provide greater advantage to clinicians in measuring grounds ( Stevens, 2001 ) . Furthermore, SRs resolve incompatibilities of surveies that discuss the same job but output confusing and conflicting consequences ( Stevens, 2001, Sanchez-Meca & A ; Botello, 2010 ) . Besides, SRs set up generalisability by measuring whether clinical findings are consistent across populations and scenes or vary harmonizing to peculiar subsets ( Mulrow, 1994, Stevens, 2001 ) . SRs have become progressively critical to a wide scope of stakeholders ( Moher et al, 2007 ) , peculiarly wellness attention suppliers, research workers and determination shapers ( Mulrow, 1994 ) . Health attention suppliers particularly clinicians read SRs to maintain abreast with their forte ( Swingler et al, 2003, Moher et Al, 2007 ) and to stay educated in wider facets of medical specialty ( Mulrow, 1994 ) . Health policy shapers and clinical guideline developers use SRs as get downing point in explicating clinical guidelines and statute laws ( Mulrow, 1994, Moher et Al, 2007 ) . As for some medical diaries, SRs are important as they serve as prerequisite grounds base tools to warrant the demand to carry on farther research ( Young & A ; Houltan, 2005 ) .2.2 Overall coverage quality of SRsOver the past few decennaries, SRs are being published yearly in progressively big Numberss ( Shea et al, 2002 ) . A survey conducted by Moher et Al ( 2007 ) showed that there are about 2500 SRs indexed yearly on Medline. However, there is relatively small bing informations on the coverage quality of SRs despite figure of SRs published is tremendous ( Shea et al, 2002 ) . Several earlier surveies concluded that quality of coverage of SRs was by and large hapless ( Sacks et Al, 1987. Mulrow et Al, 1987, Silagy, 1993, Mc. Alister et Al, 1999 ) . Sacks et Al ( 1987 ) evaluated the coverage quality of 86 meta-analyses of studies of randomised controlled tests published in English linguistic communication by taking into consideration 23 points covering six indispensable spheres, i.e. â€Å" survey design, combinability, control of prejudice, statistical analysis, sensitiveness analysis and application of consequences † . The consequences of the survey showed that coverage was by and large hapless, where merely 24 of 86 meta-analyses ( 28 % ) addressed all six spheres and of the 23 points, between 1 and 14 were satisfactorily reported ( average = 7.7, standard divergence = 2.7 ) ( Sacks et Al, 1987 ) . Another earlier rating of SRs by Mulrow et Al ( 1987 ) examined 50 reappraisals published between June 1985 and June 1986 in 4 major medical diaries and found that no individual reappraisal met all eight explicit standards of which the appraisal was based on, i.e. â€Å" purpose, informations designation, informations choice, cogency appraisal, quantitative synthesis, quality synthesis, drumhead and future directives † ( Mulrow et al, 1987 ) . An update of this survey affecting 158 reappraisals published in six general medical diaries in 1996 noted small betterment with merely 2 reappraisals met all 10 methodological standards and the average figure of standards fulfilled was one ( Mc. Alister et Al, 1999 ) . Silagy ( 1993 ) evaluated 28 reappraisals covering a broad scope of capable countries which were published in seven chief primary attention diaries in 1991 based on eight standards. The consequences of the survey showed that merely one one-fourth of the reappraisals scored 8 points out of 16 points ( 2 points allocated for each clearly reported standard, 1 point for each non clearly reported standard and 0 point for unreported standard ) ( Silagy et al, 1993 ) . More late, a survey by Jadad et Al ( 1998 ) concluded that Cochrane reappraisals have superior â€Å" methodological asperity † and are more on a regular basis updated compared with SRs or meta-analyses published in paper-based diaries. Oslen et Al ( 2001 ) assessed the quality of Cochrane reappraisals and noted that in general, there were no jobs or merely fiddling jobs found in most of the reappraisals. They studied 53 reappraisals published in issue 4 of the Cochrane Library in 1998 and found that major jobs were identified in 15 reappraisals ( 29 % ) , which correspond to the decision non to the full supported by the grounds in 9 reappraisals ( 17 % ) , unequal coverage in 12 reappraisals ( 23 % ) and â€Å" stylistic jobs † were recognized in 12 reappraisals ( 23 % ) ( Oslen et al, 2001 ) . Moher et Al ( 2007 ) examined the epidemiology and describing features of 300 SRs indexed in Medline during November 2004 and found that great differences exist between Cochrane reappraisals and non-Cochrane reappraisals in the coverage quality of several features. Main facets of SR methodological analysis were non reported in many non-Cochrane reappraisals, for case, merely 11 % of the reappraisals mentioned working from a protocol in the procedure of finishing the reappraisal. Besides, informations obtained from the survey suggested that the quality of coverage is inconsistent.2.3 SRs on herbal medical specialties for mental and behavioral upsets2.3.1 St John ‘s wort ( Hypericum perforatum ) for depressionHypericum infusions have been studied and included in clinical tests since the 1980s ( Linde et al, 2009 ) . Several systematic reappraisals published from 1995 to 2008 concluded that Hypericum infusions are more effectual compared with placebo and comparable to ( likewise e ffectual as ) criterion antidepressants in handling depressive upsets ( Linde et al, 1996, Kim et Al, 1999, Gaster & A ; Holroyd, 2000, Williams et Al, 2000, Whiskey et Al, 2001, Linde et Al, 2005, Clement et Al, 2006, Linde et Al, 2008 ) . However, some of the tests included in a few reappraisals ( Linde et al, 1996, Kim et Al, 1999, Gaster & A ; Holroyd, 2000, Williams et Al, 2000 ) were being criticised because they incorporated patients with really few and/or mild symptoms who did non run into the inclusion standards of major depression, were carried out by primary attention doctors who were deficiency of experience in depression research, and/or used low doses of comparator drugs ( Shelton et al, 2001 ) . Linde et Al ( 2005 ) conducted an update of antecedently completed reappraisal ( Linde et al, 1996 ) by including several new well-designed placebo-controlled tests where negative findings were found in some of the tests ( Shelton et al, 2001 ) . The consequences obtained aggravated new arguments on the efficaciousness of Hypericum infusions for intervention of depression and the analyses showed that effects of Hypericum infusions over placebo were less pronounced in surveies restricted to patients with major depression ( Linde et al, 2005 ) . In order to understate clinical heterogeneousness every bit good as to uncover the fact that about all new high-quality tests of Hypericum infusions are restricted to patients with major depression, another update of reappraisal ( Linde et al, 2008 ) was conducted by including several new well-designed tests restricted to patients with major depression. 29 tests were included in the survey. In nine larger tests and nine smaller tests affecting comparing of hypericum infusion with placebo, the combined response rate ratio ( RR ) obtained was 1.28 ( 95 % assurance interval ( CI ) , 1.10-1.49 ) and 1.87 ( 95 % CI, 1.22-2.87 ) severally. As for comparing with standard antidepressants, RRs were 1.02 ( 95 % CI, 0.90-1.15 ; 5 tests ) for tri- or tetracyclic antidepressants and 1.00 ( 95 % CI, 0.90-1.11 ; 12 tests ) for selective 5-hydroxytryptamines reuptake inhibitors ( SSRIs ) . Hence, it can be concluded that Hypericum infusions tested in the included test are more effectual than placebo and are likewise effectual as standard antidepressants in patients with major depression ( Linde et al, 2008 ) .2.3.2 AnxietyThere are SRs on three herbal medical specialties, i.e. kava infusion, valerian and Passiflora for anxiousness ( Pittler & A ; Ernst, 2003, Miyasaka et Al, 2006, Miyasaka et Al, 2007 ) . Merely survey conducted by Pittler & A ; Ernst ( 2003 ) found that kava infusion is more effectual than placebo in diagnostic interven tion of anxiousness despite the size of the consequence is little. Finding of SR carried by Miyasaka et Al ( 2006 ) comparing the effectivity of valerian with placebo and Valium for anxiousness showed that there is no important differences between valerian and placebo and between valerian and Valium in Hamilton Anxiety ( HAM-A ) entire tonss. Besides, a definite decision was unable to be drawn as there was merely a individual little survey with 36 patients available ( Miyasaka et al, 2006 ) . Miyasaka et Al ( 2007 ) conducted a SR by including 2 surveies to compare the effectivity of Passiflora with benzodiazepines, i.e. mexazolam and oxazolam severally in handling anxiousness. None of the survey was able to separate Passiflora from benzodiazepines in any of the result steps. Two possible grounds for this deficiency of statistical difference identified were the medicines were every bit effectual and deficient figure of surveies were included ( sample size was non big plenty ) ( Miya saka et al, 2007 ) .2.3.3 DementiaStrontium on three herbal medical specialties, i.e. Zhiling decoction, Yizhi capsule and Huperzine A for vascular dementedness found no converting grounds to back up the usage or effectivity of these herbs ( Jirong et al, 2004, Wu et Al, 2007, Hao et Al, 2009 ) . Jirong et Al ( 2004 ) found no suited randomised placebo-controlled tests and concluded that the available grounds was unequal to back up the usage of Zhiling decoction in the direction of vascular dementedness. Wu et Al ( 2007 ) conducted a SR of Yizhi capsule for vascular dementedness found no survey that met the inclusion standards and no grounds from randomised controlled tests to measure the potency of Yizhi capsule in handling vascular dementedness. SR conducted by Birks & A ; Grimley Evans ( 2009 ) to measure the efficaciousness of Gingko biloba for dementedness included 36 tests but most were little and the continuance was less than 3 months. More recent tests with longer continuance showed inconsistent consequences for knowledge and activities of day-to-day life when comparing Gingko biloba with placebo and 1 of the tests reported big intervention effects in favor of Gingko biloba ( Birks & A ; Grimley Evans, 2009 ) . Another SR conducted by Weinmann et Al ( 2010 ) which included 9 tests with 2372 patients found that Gingko biloba appeared to be more effectual than placebo for dementedness. Datas obtained showed statistical important advantage of Gingko biloba compared with placebo in bettering knowledge every bit good as statistical important advantage of Gingko biloba compared with placebo in bettering activities of day-to-day life in subgroup of patients with Alzheimer ‘s disease. Consequences for quality of life and neuropsychiatric marks and symptoms were inconsistent ( Weinmann et al, 2010 ) .2.3.4 SchizophreniaA SR conducted by Rathbone et Al ( 2005 ) to reexamine Chinese herbal medical specialty, either being used entirely or as a portion of Traditional Chinese Medicine ( TCM ) attack for people with schizophrenic disorder found that Chinese herbal medical specialties, given in a Western biomedical context, may be good for people with schizophrenic disorder when combined with major tranquilizers.2.3.5 Insomnia/Sleep upsets2 of the SRs and/or meta-analyses of valerian for insomnia output inconclusive grounds of the benefit of valerian as a slumber assistance ( Stevinson & A ; Ernst, 2000, Bent et Al, 2006, Taibi et Al, 2007 ) . This was because the included surveies of these reappraisals presented great incompatibility across patients, experimental designs, processs and methodological quality ( Stevinson & A ; Ernst, 2000 ) . As for reappraisal conducted by Bent et Al ( 2006 ) , the surveie s included showed great heterogeneousness in footings of doses, readyings and length of intervention. Taibi et Al ( 2007 ) conducted a SR to analyze the grounds of valerian for insomnia and found that overall grounds did non back up the clinical efficaciousness of valerian as a slumber assistance. A meta-analysis including 18 randomised controlled tests was conducted by Fernandez-San-Martin et Al ( 2010 ) and the qualitative dichotomous consequences showed that valerian was effectual for subjective betterment of insomnia. However, the effectivity of valerian was non demonstrated with quantitative measurings ( Fernandez-San-Martin et Al, 2010 ) .2.4 Characteristics and Quality of SRs of herbal medical specialtiesHarmonizing to Linde et Al ( 2003 ) , â€Å" descriptive empirical surveies † on SRs are comparatively uncommon. Linde et Al ( 2003 ) conducted a research to analyze the features and quality of SRs on stylostixis, herbal medical specialties and homeopathy by including 115 SRs with 58 SRs on herbal medical specialties. The features and quality of the included SRs examined are summarised in the tabular arraies below ( Table 2.1 & A ; 2.2 ) . Table 2.1 Characteristics of included SRs ( Linde et al, 2003 ) Characteristic E.g. ( s ) Bibliographic features Year of publication Question Narrow intercession focal point Condition reviewed Psychiatric Information on inclusion standards Explicit inclusion standards sing patients/condition ; of import inclusion standards, e.g. merely placebo-controlled tests Literature hunt Explicitly in Medline Others Methods ; consequences and decision Table 2.2 Quality of included SRs ( Linde et al, 2003 ) Items reviewed Search methods reported Comprehensive hunt Inclusion standards reported Choice prejudice avoided Cogency standards reported Methods for uniting reported Findingss combined suitably Decisions supported by informations Some restrictions encountered in the survey were discussed, for illustration, restrictions in resources doing half of the reappraisals were extracted and assessed by merely 1 referee and there was great heterogeneousness across some of the included reappraisals. Therefore, it was suggested that the analysis of the informations merely served to give an overall position of the descriptive epidemiology of available SRs on herbal medical specialties and there is still plenty room for betterment in future SRs conducted on herbal medical specialties ( Linde et al, 2003 ) .2.5 Guidance/appraisal tools to measure coverage quality of SRsThe increasing popularity and utility of SRs urged the studies of SRs to be â€Å" clear, accurate and crystalline † ( Moher, 2008 ) . Despite there are some betterment in the coverage of SRs, the quality of coverage is still inconsistent ( Moher et al, 2007 ) . Therefore, it is of paramount importance to follow describing criterion or coverage checklis t ( Wiesler & A ; McGauran, 2010 ) . QUOROM ( QUality Of Reporting Of Meta-analyses ) statement, which serves as a criterion to heighten the coverage quality of â€Å" meta-analyses of randomised controlled tests ( RCTs ) † was developed in 1996. QUOROM checklist consists of a sum of 20 headers and subheadings and describes the preferable ways of coverage of meta-analyses in footings of abstract, debut, methods, consequences and treatment ( Moher et al, 1999 ) . Table 2.3 Quality of coverage of meta-analyses Heading Subheading Descriptor* Reported? ( Y/N ) Page figure Title Abstraction There are 6 points, i.e. aims, informations beginnings, reappraisal methods, consequences and decision Introduction Methods There are 6 points, i.e. searching, choice, cogency appraisal, informations abstraction, survey features and quantitative informations synthesis. Consequences There are 3 points, i.e. test flow, survey features and quantitative informations synthesis Discussion *Detailed form please refers to Moher et Al ( 1999 ) . Beginning: Moher et Al, 1999 QUOROM statement was revised and renamed PRISMA ( Preferred Reporting Items for Systematic reappraisals and Meta-Analyses ) statement ( Moher et al, 2009 ) . PRISMA checklist consists of 27 points ( see Appendix 5 for elaborate checklist points ) . PRISMA checklist differs from QUOROM checklist in a few facets as shown by the tabular array below ( Table 2.4 ) . Table 2.4 Substantive specific alterations between the QUOROM checklist and the PRISMA checklist ( a tick indicates the presence of the subject in QUOROM or PRISMA ) Section/topic and point QUOROM PRISMA Comment* Abstraction Introduction: Aim Methods: Protocol Search Appraisal of hazard of prejudice in included surveies Appraisal of hazard of prejudice across surveies Discussion Funding *Detailed remark please refers to Moher et Al ( 2009 ) . Beginning: Moher et Al, 2009

Clinic management system Essay

Introduction A system is a collection of elements that are organized for a common purpose. The word sometimes describes the organization or plan itself (and is similar in meaning to method, as in â€Å"I have my own little system†) and sometimes describes the parts in the system (as in â€Å"computer system†). A computer system consists of hardware components that have been carefully chosen so that they work well together and software components or programs that run in the computer. This concept includes Information System. Information system can be defined as any means of communicating knowledge from one source to another, and/or from one person to another. On the other hand, an information system is designed to provide the best possible information to its users. Information systems typically refer to computerized methods of searching, storing and retrieving information. An information system is all about providing the most usable information needed, and is there to empower users and equip them with the tools to do their jobs most effectively. An information system offers a litany of benefits that help to make the process of managing information easier. Central access, easy back up, central distribution of information, easy record keeping, as well as easy customer trait identification, are just a few of the benefits offered by an information system. Central access means all organization members have one point to access all organizationally public information and increases efficiency. Having information in a variety of locations can be cumbersome and cause information to be overlooked. With easy back up, the chances of lost data are decreased and organizational staff will tend to back up more regularly as the system is easy to navigate. To receive the greatest benefit overall, it is important to understand that it is an adaptable tool that should progress as your business progresses. Information systems are rarely innovative business solutions. They are designed to grow with you and enhance your organization’s information delivery in the process. In Computer System, It includes database for storing data and information. Not-for-profit organizations must track information about people including volunteers, clients, potential donors, current donors, event attendees, who support or who might support their programs and services. Managing this information is crucial. A database allows you to manage and use an incredible variety of information easily. Databases are easy to set-up, easy to manipulate and easy to use. A database allows you to maintain order in what could be a very chaotic environment. Employees and volunteers of not-for-profit organizations have to manage existing resources very carefully. There may not be the resources to hire a full-time database manager or a short-term consultant. Initial data base structure can be very basic, easy to use and to maintain. Databases can be expanded and manipulated as your organization grows and your resources increase. Background of the Study A Clinic in Dr. Arcadio Santos National High School provides health care for the students thru regular physical and nutritional assessment, operational instructions and by giving emphasis on the ideals of a safe, healthy and drug free environment. Dr. Arcadio Santos National High School was conceived merely todecongest the big enrollment of then Paraà ±aque Municipal High School that was in 1991. This was in under the supervision of Mrs. Rosa V. Sioson, the principal of PMHS. The school was named then PMHS Annex San Martin de Porres. It has a total number of 804 freshmen and 422 sophomore enrollees with 38 teachers. A two-storey building with 16 rooms situated along Km. 15 East Service Road, South Super Highway, San Martin de Porres, Paraà ±aque City under the stewardship of Mr. Urbano E. Agustin as Officer-in-charge, was the only building in use that time. Steady growth of enrollment occurred. 1993, because Dr. Filemon S. Salas, then Schools Division Superintendent of Pasay City Division, advocated and recommended the establishments of more autonimous municipal high school in Paraà ±aque, school independence is worked out. Through the collaborative effort of the school administration, the Parents Teachers Association, the municipal officials and the community itself, Audience and hearings were made. Resolution was passed. And with the authorship of Atty. Manuel de Guia, municipal councilor an chairperson of committee of Education, a Municipal Ordinance No. 93-10 Series of 1993 was approved making PMHS-Annex-San Martin de Porres an independent secondary school. The name Dr. Arcadio Santos, a native son of Paraà ±aque with exemplary reputation was adopted. Its immediate autonomy benefited much the youth and community of District II specifically Brgy. San Martin de Porres. By 1994, enrollment tripled. From 1301 in 1993, it rose to 3033. An influx of teachers also occured to meet the teaching demands of students. This was also the year that Department of Education Culture and Sports in accordance with the guidelines in DECS Order NO., s. of 1989, approved and recognized Dr. Arcadio Santos High School as an independent secondary school. This year on September 1, a mass appointment of teachers, 72 items, were given by the local government under the mayoral ship of Dr. Pablo Olivarez. September 1 also became the basis of the celebration of the school’s foundation day. School Year 1994-1995 sprouted another school in the name of DASHS Masville Annex. Mrs. Virginia B. Vecino was designated officer-in-charge with 167 teachers and almost 300 students. Due to an unavoidable circumstances however, it was closed in the same year. In 1995, another four-storey building with 24 rooms was constructed to meet the increasing classroom needs of the stud entry under the local fund chaired by then Mayor Olivarez. A year after, a two-storey building was erected through the country wide Development Fund of Cong. Roilo Golez. The building is now utilized as the school library in the second floor and three classrooms for THE-I.A. in the ground floor. In 1996, DASHS Annex was reopened. This time it found its haven at Don Galo in juxtaposition with the Don Galo Elementary School. Mrs. Concepcion Bernaldez, the assistant school principal, was designated officer-in-charge. It had 330 students; First and Second year level with 16 teachers. In 1997, DASHS annex found its way back again to Masville with a total population of 994. This was upon the completion of a four-storey building with 16 rooms sponsored by Mayor Joey P. Marquez. In 1998, a complete secondary annex came to existence. Now it has a total population of 1443 and 34 teachers administering the needs of the student body under the supervision of Dr. Teodulo N. Timtiman, II as Officer-in-charge. The fourth building named Golez Building sponsored by Cong. Roilo S. Golez, himself, has found its way. This is a three-storey edifice with six classrooms and the ground floor is an open space used for programs and some other special occasions of the school. August 22, 2000, a major event happened. Dr. Arcadio Santos High was converted into Dr. Arcadio Santos National High School in the City of Paraà ±aque through a Republic Act No. 8844. Thios was made possible through the effort of no other than the Lone Representative of Paraà ±aque Congressman Roilo Golez. Truly, Dr. Arcadio Santos National High School after a decade of existence has reached its speak of excellence be it academic or structure wise. Its aim to serve par excellence and produce a productive and competitive citizen is needed a fruition of existence. Statement of the Problem General Problem The general problem of the study is the manual operations in generating treatment report and monitoring the patient’s ailments. Specific Problem How to easily manage the school clinic treatment record? Using manual system, the assigned clinic staff is hard for them to manage, organize and generate all reports in the clinic especially in the Treatment Report. How could they monitor the total number of ailments and how do they generate a report every month? All information of ailments collected will be store in the log book and then they just make a report before the end of the month. How could they give an update to the DEPED (Department of education) division of Paraà ±aque for the medical supplies needed by the clinic? The Treatment Report will be submitted to the head office to review all the types of ailments and to produce a needs of the clinic especially the medicines. Objectives of the Study General Objectives The general objectives of the study are to design and develop software that will enhance the existing Treatment Report System for a better one. Specific Objectives They can easily manage their record process using the computerized treatment report with monitoring patient’s ailments. Managing the records daily would be easier with the help of the proposed system without having difficulties in which the nurse and the dentist can supervise all the needs of medications for each patient. The proposed system will automatically count the total number of ailments every week. Instead of Monthly Report, the nurse and the dentist will generate the report weekly by the use of the proposed system. They can easily update the DEPED (Division of Paranaque) regarding the medical supplies of the school clinic. By the use of a proposed system, they can send request to the main office for the medical supply weekly. Scope and the Delimitation Scope The scope of the study can record the students and school personnel information who admitted inside the school clinic. It can automatically optimize in managing all the records together with the medication needs of the patients. The information including the name, age, grade/year level, address, contact number and etc., can modify and update the data by using control selection of the proposed system. The study is only for Dr. Arcadio Santos National High School (clinic). It has a security that the School Nurse, School Dentist, students or other school personnel who can only access the system. Also, using their own account in the propoed system the Nurse and the Dentist can generate the reports and can update the information stored in the database. Delimitation The proposed system has an account security for the users so that all unauthorized person outside the school premises are not allowed to use. Also, the students and principal are cannot generate the Treatment Reports and the proposed system does not support for the online services. Significance of the study The proposed Computerized Treatment Report with Monitoring Patient’s ailment system has the ability to perform with different features such as fast, accurate and user-friendly. For this reason, the proposed system benefits not just its primary user but also the proponents, future researchers, and the country’s I.T industry. For the Users The prime beneficiary of the proposed system is the User. This system will help them easily to process their transactions. Because of this is a friendly user, the problem can be easily solve and the transactions done well. Also the transaction will be enhanced from manual to computerized one. For the Proponents The proposed system also benefits the proponent’s method of thinking. While creating the system, each proponent will enhance his knowledge and express his thoughts or ideas in order to create and implement a new design and the system performance as well. The proposed system will also help them to analyze the flow of transactions and trace every problems encountered. For the Future Researchers This proposed system will help the future researchers because it will serve as their reference. It will serve as their basis in analyzing the current status of Monitoring System. Because of this, other proponents will be able to improve the said system as they create a new design. For the IT Industry The IT Industry will benefit this study because they create programmers that can help them to improve and develop more in terms of enhancing the latest computerized systems. Conceptual Framework Figure 1.0 shows the existing system for generating a Treatment Report every month. First, the Medical staff will ask question to the patient which includes Name, Address and Contact Number together with the ailments. All the information gathered are manually Record in the Log Book that serves as a database. After recording all information, the medical staff will now check if there is an available first aid medication for the particular ailment. If no, the patient will be transfer to the other clinics and the medical staff will now record the medical needs inside the school clinic. After a month, the Medical staff will now count all the total number of ailments and generate a Treatment Report by using a bar chart. It is conflict for the staff to generate a report because of too many record stored in Log book. The report will be submitted to the main office of the Department of Education (DEPED) Division of Paraà ±aque and after reviewing the chart, it is the time to send a supply of medicines into the school. Conceptual Framework Figure 1.1 shows the Computerized System for generating a Treatment Report every week instead of monthly report. First, the Medical staff will ask question to the patient which includes Name, Address and Contact Number together with the ailments. All the information gathered will type in the proposed system with SQL database. After recording all information, the medical staff will now search to the database for the available medicines. Every week, the Medical Staff generate the Treatment Report by using the proposed system. It is easy for them to accomplish the report because it is automatically tally all the ailments records counted saved on the database. Operational Terms: Analysis – the process of breaking down a something into its parts to learn what they do and how they relate to one another. Ailments – a physical disorder or illness, especially of a minor or chronic nature. Clinic – a class of medical instruction in which patients are examined and discussed Data – factual information (as measurements or statistics) used as a basis for reasoning, discussion, or calculation. Database – a comprehensive collection of related data organized for convenient access, generally in a computer. Design – to prepare the preliminary sketch or the plans for (a work to be executed) especially to plan the form and structure . Input – data to be entered into a computer for processing, the process of introducing data into the internal storage ofa computer. Medication – the use or application of medicine,a medicinal substance. Monitoring –Supervising activities in progress to ensure they are on-course and on-schedule in meeting the objectives and performance targets. Output – information in a form suitable for transmission from internal to external units of a computer, or to an outside medium. Process – a systematic series of actions directed to some end. a continuous action, operation, or series of changes taking placein a definite manner: Programmer – a person who writes computer software. Programming – is the comprehensive process that leads from an original formulation of a computing problem to executable programs. It involves activities such as analysis, understanding, and generically solving such problems resulting in an algorithm. Report – is any informational work (usually of writing, speech , television, or film) made with the specific intention in relaying information or recounting certain events in a widely presentable form. School personnel –a body of persons usually employed in a school. Software – is a collection of computer programs and related data that provides the instructions for telling a computer what to do and how to do it. SQL – Structured Query Language is a standard computer language for relational database management and data manipulation. is used to query, insert, update and modify data. System Design – is the process of defining the architecture, components, modules, interfaces and data for a system to satisfy specified requirements. Transaction – information processing that is divided into individual, indivisible operations, a unit of work performed within a database management system Treatment – The process or manner of treating someone or something. C H A P T E R II Review of Related Studies and Literature This Chapter consists of review related literature and a study that includes the local and foreign study to make relevance our study. It also discusses the different references and text that are relevant to the studies. Related Literature the researchers cited some of the related literature made by different researchers which are quite similar to the present study. These related literatures can help the researchers in analyzing the problems that the present study will encounter in the future. Foreign Literature 1. Universiti Teknikal Malaysia Melaka Clinic Management System. â€Å"Clinic management is introduced to optimize clinic’s operation. Because of huge changes in management nowadays, management for clinic is important due to the widely spread of technology.† According to the internet the Universiti Teknikal Malaysia Melaka Clinic . This system is proposed for clinic in UniversitiTeknikal Malaysia Melaka (UTeM) to manage the clinic’s operation efficiently. The process in developing the system include patient’s clinic in UTeM. The area consists of the user in clinic which is doctor and clinic assistant. Basically there are no such systems in the clinic. The system use before has caused a lot of problems to the user. Due to that, using manual system seems to be the only solutions in managing the daily works. The system will help out the user in the clinic in managing the work. 2. On-line Constructions of Metrosexuality and Masculinities. â€Å"A metrosexual can be defined as a man who is narcissistic in nature, loves his urban lifestyle and is a straight man who is in touch with his feminine side.† According to Matthew Hall on his Cultural Studies On-line Constructions of Metrosexuality and Masculinities. A British journalist named Mark Simpson devised this word. It can be said that any urban male of any sexual orientation who spends a lot of time and money on his appearance and lifestyle is known as a metrosexual. There are a large number of celebrities out there who are famous icons such as David Beckham, Brad Pitt, Robbie Williams, P. Diddy and George Clooney. 3. Mediwise Clinic Management Software â€Å"Mediwise Clinic Management Software is a fully integrated solution for the business and clinical needs of medical medicine clinics.† According to the internet Cynthia Anderson tells that the Mediwise addresses of all the facility’s data processing needs: Patient Accounting, EMR, Referral Management, Scheduling, Case and Encounters Management and Financials. It provides physicians, clinicians, and health care executives with the necessary information to make critical decisions about the patient and the enterprise. Local Literature 1. According to Dean Francis Alfair, Filipino men are spending millions to look and feel good. As was stated in his article, â€Å"Machos in the Mirror†, a metrosexual like himself doesn’t generally think of himself as vain, but then there’s this incident where Mr. Alfair remember from high school: some of his friends were assembled at his house so that they could all ride together to a party. As they were getting dressed in their Spandau Ballet-inspired finery (then the height of fashion), one of the barkada produced, from out of the depths of his bag, a can of mousse, which none of them hapless males had ever seen or even heard of before. Naturally, they all had to squirt some into their hands and smear it on their hair. Not knowing that they were then supposed to blow-dry or otherwise style it, they left the house feeling snazzy, while looking pretty much the same as they had prior to applying the mousse at most, their hair was a little damper, vaguely crispy in texture, and certainly stickier than before. But they felt utterly transformed. 2. According to Noel Manucom, head of planning and strategy at Splash cosmetics, the quest for beauty may also be perceived as a quest for social equality. â€Å"Filipinos, especially those in the C and D (classes), are still influenced by their colonial mentality that white skin and a tall nose are what those in high society have,† Manucom says. â€Å"They may not be able to afford to have their nose done, but the desire to have a fairer skin can be met by buying products.† In fact, the double-digit growth in skin care popularity among Filipino males over the last six years is largely attributable to skin-whitening formulas. Pinoys are still devoted to hair care products and fragrance above anything else — with growing interest in bath washes, oral hygiene, and weight loss or gain — yet skin care is acknowledged to be the main fuel of the Philippine beauty industry. 3. According to Fairview Physician Associates -Medical student-run health clinics have become popular programs among medical schools for fostering education and community service among students. The proliferation of these clinics has not, however, coincided with a better understanding of these programs’ impact on medical education or public health. There are no data of how many student-run clinics exist or how many schools have one. Foreign Studies 1. Clinics Management System (CMS) based on Patient Centered Process Ontology â€Å"A major problem faced by today’s healthcare is the increasing diversity and differentiation. New medical specialties are constantly created: there exist a large number of roles in patient care and many different public and private organizations† According to Prasad M. Jayaweera (University of Ruhuna, Sri Lanka) the process oriented business ontologies are developed in customer centered manner in order to develop business systems applications to provide more and more value added services to target consumers. This trend is also valid in healthcare sector although there are some restrictions and limitations that can be noticed in Sri Lankan. 2. Patient Management System by Terrence Adam, BS Pharmacy MD PhD â€Å"Any tool used to assists in the delivery of clinical care from the point of care initiation to completion† According to Terrence Adam, interest in Patient Management Systems with prior experience as clinical user in pharmacy and medicine development and evaluation of a patient monitoring system use of secondary data for surveillance applications evaluation. It is for one stop source of information. 3. Computerized Health Records Management System for Kitagata Hospital â€Å"Health records management is such an important area in health care delivery because without proper records, planning is rendered difficult† According to Charles Namibara , the aim of his study was to build a computerized records management system that would be more effective and efficient than the existing manual system in Kitagata Hospital. This was done by looking at the existing health records management system , analysing its strong and weak points design and implementation of a new system. Interviews, observation and document reviews were tools used in data collection. MySQL database management system, Apache server, PHP scripting language embaded in HTML were used for design. Related Studies The review of related studies is an essential part of any investigation. The survey of the related studies is a crucial aspect of the planning of the study. The identification of a problem, tire development of a Research design and determination of the size and scope of the care and intensity with which a researcher has examined the literature related to the intended research. Local Studies 1. Clinical Information Management for Divine’s Clinic Malolos City â€Å"Our Journey towards the implementation of a Clinical information system to the Critical Care Environment† According to the above statement, there have been a significant advances in medical technology used in patient treatment and care. The Intensive Care Unit (ICU) in an acute hospital is designed to treat the most complex and unstable medical and surgical patient. 2. A Comprehensive Online Clinic Management System â€Å"Online clinic management system are designed to immediately record the patients’ information† According to the Rosa Sta. Maria the main problem of Villa-Santarromana Dental Clinic is that they have the manual way on recording, tracking, and managing patients request which sometimes lead to slower transaction within the clients. This study was aimed to designed and develop an online clinic management solution that will serve as proposal to help the dentist and staff to save time and resources with the automation of its daily clinic operations. 3. Patient Profiling System WEST VISAYAS STATE UNIVERSITY DENTAL CLINIC â€Å"Health is metabolic efficiency, sickness is metabolic deficiency† According to Ms. Venus Papilota Diaz, information technology student , that health is important. One place that we can rely on is the so called â€Å"Clinic† that provides primary aid and care that will eliminate or at least lessen up our difficulties when in pain. When the transaction of recording the patient’s information is more quickly it will help rapidly the medical staffs in their leverages to assist the Dentist to care for their patients. Synthesis The Computerized Treatment Report with Monitoring of Patient’s Ailment will help the school to enhance efficiency and will generate accurate report for the clinic. This system provides an authorization for the user to access the transaction like generating reports and monitoring the patients. View as multi-pages

Jainism vs. Sikhism Essay

Read the assigned chapters for the week and complete the following table. Be as specific as possible when identifying practices, beliefs, rituals, and historical elements. Cite sources in APA formatting. Core Beliefs Jainism Sikhism 1. Jainism, believing that reality and existence are eternal, does not believe in a Creator force or entity (Molloy, 2013). 1. Sikhism believes in a strict Monotheism, and that all names and titles that humans apply to God are limited because God is beyond all human conception (Molloy, 2013). 2. Jainism believes in the existence of Karma and its influence on the cycle of Rebirth. Unlike other religions that share this belief, Jains believe that more than just animals and insects possess a spirit that is subject to karma and rebirth (Molloy, 2013). 2. Sikhs believe in reincarnation, and that karma influences the cycle of rebirth, with the goal being to accumulate enough karma to obtain freedom from the cycle of reincarnation and be absorbed by God (Molloy, 2013). 3. Jainism believes in five ethical positions that are required for monks and nuns (to varying degrees) and recommended to laypersons. The First is Nonviolence, also known as Ahimsa, which requires the believer to bring no harm to any life-form. The second is Nonlying, as the Jains believe the lying or exaggeration may bring harm to the parties involved. The third is Nonstealing, the desire to steal comes from being attached, to the object or the world, and can cause pain to others. The forth is Chastity, among the monks and nuns it is taken as full celibacy, and among the laypeople, as  fidelity to the believers marital partner. Finally, the fifth is nonattachment, that to progress spiritually, the believer must limit their attachment to worldly objects and people, taken to the extreme among some monks to mean detachment from all including family, and clothes (Molloy, 2013). 3. Sikhs believe in the five sacred components of attire by those initiated into the Khalsa. The first is the Kesh, or uncut hair and beard, with a turban worn by the males. The second is the Khanga, or wooden hair comb, to be worn with the hair at all times. The third is the Kach, a pair of special cotton undergarments. The fourth is the Kirpan, a sword or dagger that is worn at all time. And lastly the Kara, a bracelet of steel worn to symbolize strength (Molloy, 2013). 4. The Jains believe that in the current cycle of the universe, 24 people have reached perfection and have escaped the cycle of rebirth, they are known as Tirthankara, and that they should be role-model and emulated, but not worshiped (Molloy, 2013). 4. Sikhs believe that the scriptures, known as Adi Granth, to contain the spirit of all the past Gurus of Sikhism and revere it as the last, and final guru. When faced with difficult and troubling questions, Sikhs believe that consulting the Adi Granth, or Guru Granth Sahib, by opening the book at random will provide answers (Molloy, 2013). 5. The Jains do believe in the presence of gods, but believe they are also subject to the karma and the cycle of rebirth, and that after they use their positive karma as gods, they are reborn as lesser beings again. Also that, while gods, they are not the Creators (Molloy, 2013). 5. Sikhs believe the use of Military Self-defense to protect themselves and the faith is morally correct. Such a position is unusual in the religious environment of India where nonviolence is common. (Molloy, 2013). Part 2 Respond to the following questions in 150 to 200 words: 1. What do you think is the most important similarity and which is the most  important difference? Use specifics to support your answer. The most significant similarity between Jainism and Sikhism is their continued belief in karma and the cycle of rebirth. This similarity shows that while Sikhism may have been influenced by Islamic teachings, that both faiths have retained a non-linear idea of the progression of time that is integral to Hinduism. The most important difference is each of the religion’s views of violence. The Jains believe in ahimsa, a requirement to bring no harm to anything that bear a living soul, monk and nuns going so far as to brush aside insects before walking so they are not stepped on, and the laypersons avoiding farming because plowing may cause harm to small animals and insects. The Sikhs, however, believe in the use of violence to defend them self’s and their faith, possessing within their faith a military order, the Khalsa, who wear a dagger or sword known as a kirpan at all times. This belief is also evident in the followers of Sikhism to join and participate in the militaries of the country they reside. (Molloy, 2013) 2. Consider the following statement: Sallekhana (â€Å"holy death†) violates the Jain principle of ahimsa because it is an act of violence against oneself. Using examples from Ch. 5 of your text, what points might a follower of Jainism make to argue against this statement? Ahimsa is the prohibition of causing harm. Ahimsa requires that all care must be taken so that one does not bring harm to another living soul, whether it is physical, mental, spiritual or emotional. To remain attached to the material, and the objects of this life will also bring spiritual harm to oneself. Sallekhana is an extension of the practice of fasting. The participant prepares himself for the next life by detaching from the current life, taking in only water and spiritual guidance. This practice is not a violent act against one’s body, but a natural progression at the end of one’s life. This extended fasting is only Sallekhana when willfully taken at the end of a full like as a culmination of one’s detachment from the material and as a sign of one’s virtue. Sallakhana is not an escape from one’s troubles in this life through suicide, but a releasing of this life in order to proceed to the next life in a proper fashion. (Molloy, 2013) References: Molloy, M. V. (2013). Experiencing the world’s religions: Tradition, challenge, and change (6th ed.). New York, NY: McGraw-Nill Companies, Inc.

Urban Sociology Essay Example | Topics and Well Written Essays - 500 words

Urban Sociology - Essay Example n Factor: Is Afghanistan Next in Line for an Ethnic Civil War?’; the religious implications of the Iraq war will be thoroughly examined and discussed. Since the September 2001 terrorist attack, the United States had been very active in extending its support by sending some of its troops and its allies to Iraq. Aiming to provide justice to American individuals who had lost their lives during the terrorist attack, President Bush declared the launching of a campaign against terrorism. In reality, Bush’s statement and strong declaration to go against the terrorism was not only focused on political and social dimension of the case scenario. It also suggests a long-term war between Christianity against the Arab and Islamic world. (Fawzy, 2003) When President Bush made his statement to go into war with the Iraqi people, he has violated the real concept of Christianity in the sense that we should spread love and peace around us – not war. The only people who can be considered a victim of the situation are the U.S. solidiers who were sent to Iraq with the risk of losing their lives and fight against individuals who were merely protecting themselves from being attacked by the U.S. troop members. Eventhough the war in Iraq was not literally known to be a war between two religious sectors, it remains a fact that there is a strong political and religious aspect behind the war in Iraq. One political reason why U.S. is very much determined to attack Iraq is the fact that the country is rich in natural resources especially with oil which is very important to the U.S. future economic growth. (Escobar, 2007) On the other hand, war in Iraq is also considered a religious civil war. Since Islam is widely used as a transnational faith which unites its community (Toft, 2008), attacking the Islamic religion could weaken the unity of its community which could easily make the U.S. and its allies take over Iraq. The oil reserve of Iraq is second biggest in the world.

What is Akrasia (incontinence) according to Aristotle in Book 7 of Essay

What is Akrasia (incontinence) according to Aristotle in Book 7 of Nicomachean Ethics - Essay Example According to Aristotle, the feelings of an incontinent person are not usually more powerful than their reason as people have been made to believe (Aristotle 106). Thus, an incontinent person could also be driven by reason as well as by their feelings and emotions. Other philosophers like Socrates believed that incontinence presents a scenario where individuals have let their emotions control their lives and they have found it difficult to control their emotions. â€Å"It would be strange... if knowledge was in a man, something else could master it and drag it about like a slave† (Aristotle 107). This was an anomaly that Aristotle sought to correct. Aristotle believes that it is on the basis of akrasia that people are influenced or propelled to act irrationally and this is not to say that these people are not logical in nature. Aristotle also opined that the incontinent people have not totally lost their sense of reasoning and even in cases that there seems to be no appreciable amount of reasoning in them, these people could still decide to behave logically, but they prefer to use the pleasures of their emotions (Aristotle 108). Aristotle uses these arguments to explain the uncontrolled and unrestrained nature of the incontinent people that it is not due to the fact that they are incapable of keeping their emotions at bay and this is really not the reason that they behave in an irrational manner. Aristotle believed that the fact that incontinent people have knowledge of their actions goes a long way to show that they also make logical calculations and people should not see them as irrational human beings that are only driven by their feelings. Aristotle believed that akrasia does not imply irrationality or ignorance as he was of the opinion that akrasia is not a total neglect of reason and that people should not assume that incontinence results only from pleasurable feelings. Aristotle agrees that the incontinent person is

Summary of an article Essay Example | Topics and Well Written Essays - 250 words - 1

Summary of an article - Essay Example Students use their computer systems to copy music files and download movies and similarly they think that copying and pasting other writers’ work is the same non-serious task. Gabriel mentions a survey which shows that 40% of students admit plagiarizing, and the number of students who consider plagiarism as a serious act is declining with every passing year. Students going to libraries for research work are very few today and since everything is virtual online, thus they do not think that there is any harm in using words that do not belong to them. Students get motivated to use other works through TV shows that copy other shows and music that contains others’ lyrics. They just need a grade to pass the exam and do not mind plagiarizing for this purpose which makes their work unoriginal and unauthentic. Students mix their work with others which keeps them from bringing up new and innovative ideas. However, Gabriel quotes Ms. Wilensky who states that still there are many s cholars who are producing original pieces of work. She asserts that students should be taught to reproduce ideas in their own words right from the start so that they do not plagiarize when they go to

CASE 5 Information Security and Ethics Essay Example | Topics and Well Written Essays - 1000 words

CASE 5 Information Security and Ethics - Essay Example Because it is unfortunate that a leakage of information committed by an internal employee who accesses almost every details of the valuable information daily. This issue no doubt harms the ethical bonding between the employees and the organizations. But in the case of external trespassing into the organization’s confidential information zone, the blame would directly go to its security system which basically shows the loopholes of its security protocols. But, this is another issue. The organization should make the employees of all levels signed into the document where policies have been stated transparently after distributing and describing the issues about information security. Definitely, an organization containing three employees would differ from the organization with manpower of thousand people in the sense of organizational information policy. The implementation of the e-business framework has led many organizations into serious threat about information security. From the very commencement of the internet, rather say the from the beginning the internet has came with complications and vulnerabilities that is- its basic communications as well as the nodes, norms about its protocols, authentication of its network and host frameworks etc. Dissatisfied employees, hackers, opponents and other stakeholders destroyed the internet’s vulnerabilities which caused damages of privacy, financial damages, loosing of customers, interruption in the activities and unpredictability. Many employees were allowed to access internet for authentic business purpose but actually the result went to misuse of information either from lack of compassion for uncertainty, or lack of consciousness of authentic usage of internet in the organization or exactly by the wicked intension. For these reasons, some protocols are generally set inside an org anization to make the information security system more

Unit III Assessment #2 Systemic Effects Essay Example | Topics and Well Written Essays - 250 words

Unit III Assessment #2 Systemic Effects - Essay Example Delhi recorded hypertension in 36.1% lifetime nonsmokers living in the city compared to the 9.5% of rural controls. The dominance of hypertension increased with increase in age. Despite the great prevalence, severity of hypertension was higher in the urban subjects. There was a record of 15.4% less severe stage 1 hypertension having systolic blood pressure of 140 to 159 mm Hg and more severe stage 2 hypertension in comparison with 6.1% and 0.9% of the rural controls having stage 1 and stage 2 systolic hypertension respectively. Stage 1 and stage 2 90 to 99 and greater than 100 mm Hg hypertension prevailed in 23.4% and 10.0% of Delhi citizens in contrast with 4.4% and 0.8% of control subjects correspondingly. An important and positive association transpired between the PM levels in Delhi’s air, the systolic blood pressure and diastolic blood pressure in Spearman’s correlation experiment. Particulate air toxins along with lifestyle are great contributors of the prevalence of hypertension in Delhi. The elderly and those with pre-existing cardiovascular diseases are at high risks of death due to air pollution. Surprisingly, air pollution causes more deaths through cardiovascular diseases compared to the respiratory diseases, which are more associated with pollution of air. Hypertension prevailed in a high percentage among the lifetime nonsmokers, which increased with increase in age. Those in urban areas had less severe stage 1 hypertension and more severe stage 2 hypertension compared to those in rural stage 1 and stage 2 systolic hypertension (Gurjar, Molina, & Ojha,

Is Boxing just a sport Essay Example | Topics and Well Written Essays - 2000 words

Is Boxing just a sport - Essay Example The paper shows that boxing does not just involve getting into shape and knowing the tools of the sweet science. An element that is equally vital of the fight match is posing a mental determination of succeeding. Boxing is unique from other sports, as a participant has to stand alone in the ring. Even well-known trainers like Angelo Dundee and Eddie Futch would get out of the ring during rounds. In spite of the ability of a boxer, there comes a time when he has to fight fatigue. One has to hurt or be injured, yet forced to go on. Boxing is different from other sports where a participant can look to the referee to call timeout. Instead, a boxer has to fight until the bell rings. He has the option to resign. They fight in spite of the hardship faced in the ring. Having a strong mind is important in these hardships, as the mind is a strong tool that some have not learned to control. This paper makes a conclusion that boxing is a sport that involves a lot more than what sport may require. This is from both the participants and the fans. Both the participants have to observe the rules and the requirements of the sport so as to enjoy it. Boxing also takes more than the physical participation. The mind of a boxer is also involved in so many ways. Boxing as a sport also involves a lot of risks. Every time risks happen, there is a call to abolish boxing or at least reform the institution. However, due to the money involved and the on going interest of the fans, boxing still has many participants who are willing to take the risks.

A Synopsis of the Movie I, Robot Essay Example for Free

A Synopsis of the Movie I, Robot Essay I always asked myself if those stories about robots overcoming humankind will become real. Sci-Fi books are being my favorites since I was a kid and I watched every major movie about this subject. My favorites is â€Å"I, robot† that tells the story of a society in the future that relies on robots for all its domestic activities, but somehow one of those robots became aware of his own self and started to develop a mind, but most important, a soul. The robot started to develop a sense of what is right and wrong, and not because some program installed in its memory or an algorithm protocol of orders, it begun making decisions not based on instructions or learning by mistake process, but by searching deep on its â€Å"heart† what was the right thing to do. The robot’s name is Calvin and the movie, starred by Will Smith, is based on a set of short stories by Isaac Asimov, prolific writer considered a master in hard science fiction. On his â€Å"I, robot† short stories, one of them titled â€Å"Three Law of Robotic†, and which he considered his maximum contribution to human kind of the future (Asimov wrote the book on 1950), he came up with three laws that he thought a future society must input on robots in order to coexist with them as part of their day by day living. Those laws are: 1. A robot may not injure a human being or, through inaction, allow a human being to come to harm. 2. A robot must obey the orders given to it by human beings, except where such orders would conflict with the First Law. 3. A robot must protect its own existence as long as such protection does not conflict with the First or Second Laws. These laws seem to be really basic, but their logic really doesn’t have any gaps, at least at first impression. When Calvin (the robot) encounters a conflict with those commands, he started to develop its artificial intelligence and becoming more human. When Calvin is in a situation that its deactivation will be harmful for his two human friends, he decided to fight for his existence, and a new era of robots was born. Like Asimov there are several authors and scientists that predicted a future where robots and artificial intelligence are a big part of society. And they have reasons to believe on this. After the Industrial Revolution took place, we have being searching for more productive ways to increase manufacture. Industrialization and mass production levels demand better, faster and smarter ideas to satisfy the greater demand of consume based societies. To achieve those exigent goals, technology and specially robotics is used more and more often. Some factories are made only on robots that build equipment parts or process food in a way no human can do. Major companies know where we are heading and invest more and more in robotic technology and artificial intelligence, like we read in the following citation of the article of Nicholas Carr â€Å"Is Google Making us Stupid?†: â€Å"Where does it end? Sergey Brin and Larry Page, the gifted young men who founded Google while pursuing doctoral degrees in computer science at Stanford, speak frequently of their desire to turn their search engine into an artificial intelligence, a HAL-like machine that might be connected direct ly to our brains. â€Å"The ultimate search engine is something as smart as people—or smarter,† Page said in a speech a few years back. â€Å"For us, working on search is a way to work on artificial intelligence.† In a 2004 interview with Newsweek, Brin said, â€Å"Certainly if you had all the world’s information directly attached to your brain, or an artificial brain that was smarter than your brain, you’d be better off.† Last year, Page told a convention of scientists that Google is â€Å"really trying to build artificial intelligence and to do it on a large scale.†Ã¢â‚¬  There is no doubt for me that there is a future where robots will be everywhere: Some robots might be performing precise heart surgeries, controlling traffic and overseen proper transit on the streets, cleaning our houses as domestic service or maybe even teaching English Composition at the local Community College (no offense to Ms. Patrice Fleck), but let’s be ready if some day they become aware of their own existence, giving the next step on their evolution as metallic beings. Let’s hope that their intentions towards us are attached to the Three Laws of Robotic stipulated by Asimov, they could be the difference between our survival and coexistence, or our total annihilation.

Effect of Globalisation on Chinas Economy

Effect of Globalisation on Chinas Economy Globalisation has had a dramatic affect on the Chinese economy. Discuss. Introduction In this essay I will be looking at the effect the growing globalisation has had on the Chinese economy. I will look at both the positive and negative effects globalisation has had on China and in general. I will start by briefly describing the term globalisation. Globalisation Globalisation is the term used to describe the continuing integration of economies from different countries. Globalisation has been brought about by the reduction in cost of transportation and communication from country to country. Also, artificial barriers of flows of goods and services have also been lowered. These lowering of barriers have, in turn, brought about increased market liberalisation. Globalisation has also brought about the need for international organisations to govern and offer advice for globalisation. These organisations include the World Trade Organisation (WTO) and the International Monetary Fund (IMF). Affects of Globalisation Globalisation and liberalisation has caused a few problems to countries. These problems occur due to the way the liberalisation is pushed on developing countries by the IMF. Indeed, many authors state that the fundamental ideas of liberalisation are sound it is just the pace the measures are taken onboard by the developing countries that needs to be carefully considered. The argument was voiced by Stiglitz (2002) who stated that the ‘IMF vigorously pursued privatisation and liberalisation, at a pace and in a manner that often imposed very real costs on countries ill-equipped to incur them’. Authors do state that liberalisation can only benefit a country if the pace of liberalisation is right. Liberalising too quickly can do more harm than good in the long term. Lichtenstein (2000) reported that China, through gradual liberalisation, has grown into one of the world’s biggest economies. Indeed, it has been forecasted that in 20 years time China will be the world leader in terms of the size of economy. Probably the best argument for liberalisation through sequencing is that of India. This was argued by Tripathi (2003). In 1991 India plunged into financial crisis. Their political leaders decided the best cause of action was to liberalise their market. However, this was only done gradually as the population would never have agreed to complete liberalisation from the beginning. Now 12 years later India is one of the strongest economies in the world and is lending money to the IMF. The Indian economy is expected to grow at between 5 and 8 percent a year. Also, India was in the position to write off  £12.5 million worth of debt owed to them by heavily indebted countries as an act of generosity. Other authors argue for liberalisation but also say that the underlying policies and financial structures of individual countries need improving if liberalisation is to be beneficial. Improved policies and financial structures will mean that market failure is less likely. Authors that argued this point include Ortiz (2003) and Gibson and Tsarkalotos (1994) who argue that ‘market failures hamper the liberalisation process’. Liberalisation used properly can have huge benefits for individual countries. Increased inward investment will, in theory, stimulate growth and strengthen the economy. This inward investment will create new jobs and new projects that will benefit the local population. This initial investment will create initial growth and over time, through the improved education of the local population, domestic companies will start up that will be more efficient and competitive compared to the old domestic companies before liberalisation began. However, there is a potential problem with this theory. This comes about in the terms of what kind of inward investment there is. If some company invests into a country with a long-term strategy in place then this will be beneficial to the economy. However, if someone invests into a country as a speculator then this could cause problems. These problems will come about if the investor decides to remove they money. Long-term projects might be dependent on this investment and therefore run the risk of having to be downscaled or stopped altogether. This could lead to the economy collapsing. Solomon (1999) who stated that funding long-term projects with short-term funding can not be a good idea argued this. This point is supported by the arguments of Krugman (1995) who stated that increased liberalisation has led to ‘excessive speculation for which Mexico was not ready’. Also, Cypher (1998) argues about so-called ‘hot money’. Other authors have also argued against liberalisation. Taylor (2000) argues that liberalisation does not have any positive affect on a countries economy. He argued that liberalisation in the countries he looked at ‘at best generated modest improvement and at worst was associated with increasing income inequality and slower growth’. Clift (2003) argued that liberalisation was to blame for the growing number of world crisis’ and, in turn, to the growing level of contagion, such as the Asian crisis in 1997. Affects on the Chinese Economy In this section I will look at some of the effects that globalisation has had on the Chinese economy. Many countries have tried to take advantage of the increasing globalisation, some with better success than others. No developing countries have taken advantage of globalisation better than those countries in East Asia. Indeed, countries from this region have been the most successful economies over the last 20 years or so. Good examples of this success come from India and, indeed, China. As I mentioned in the previous section, Lichtenstein (2000) reported that China, through gradual liberalisation, has grown into one of the world’s biggest economies. Indeed, it has been forecasted that in 20 years time China will be the world leader in terms of the size of economy. China has grown into one of the most successful economies in the world and avoided going into crisis, especially avoiding the Asian crisis of 1997, by not completely following the guidelines stated by the IMF about liberalisation. China, along with India, has gradually opened up its market over the last 20 – 30 years. This slow transition has meant that the economy could adjust to a new system over time. Many other countries that follow IMF guidelines find themselves in economic crisis. Another effect that globalisation has had on China is that it has experienced reduced unemployment and reduced poverty. Indeed, China has experienced the largest reduction in poverty in the shortest amount of time in history. The figure fell from 358 million in 1990 to 208 million in 1997. China has also experienced an increase in the foreign direct investment it receives through increased globalisation. Foreign direct investment rose from $8 billion in 1990 to $41 billion in 1999. This increased foreign direct investment has also meant that China has more access to other markets and also has increased access to new technology. This access to new technology can be emphasized by looking at the mobile phone industry. Today, China is one of the top markets when it comes to the production and selling of mobile phones. Through globalisation, China has gradually increased its economy and is now in a very strong position. Because of this China has been accepted as a new member to the World Trade Organisation (WTO). This has huge implications, because China is looked at as a developing country. Now that China has a seat on the WTO, the developing world now has a major voice to express its concerns on a global audience. Some of the major western powers on the WTO, such as the USA and the UK, have expressed concerns over this as they feel it weakens their own power. Conclusion To conclude, I can say that globalisation can be described as the coming together of individual countries economies. Trade barriers that existed before are becoming less and less. Globalisation has been found to have both advantages and disadvantages. Some advantages include the fact that it makes the economy more efficient and also the economy will become stronger. This is true with the examples of China and India. Some disadvantages include the fact that if the liberalisation is enforced too quickly then the economy could collapse and cause crisis, both in the country and in the local region. This was true with regards of the Asian crisis of 1997. China has been able to take advantage of globalisation by undertaking liberalisation at a slow pace. This has meant that poverty has reduced, foreign direct investment has increased and they have been accepted into the WTO. Because of all this it has been forecasted that China will be the world’s biggest economy in 20 years time. References Salil Tripathi. (2003) The right way and the Indian way: who has written off poor-country debts and now lends to the IMF? Salil Tripathi on an economic miracle. New Statesman (ISSN: 1364-7431) July 21, 2003 v132 i4647 p29(1) Jeremy Clift (2003) Beyond the Washington Consensus. Finance Development (ISSN: 0015-1947) v40 i3 p9(1) Guillermo Ortiz (2003)Overcoming reform fatigue: Latin America and the Washington Consensus. Finance Development, v40 i3 p14(4) Paul Krugman (1995) Dutch tulips and emerging markets. (global capitalism) Foreign Affairs, v74 n4 p28(17) Heather D. Gibson; Euclid Tsakalotos. (1994) The scope and limits of financial liberalization in developing countries: a critical survey. Journal of Development Studies, v30 n3 p578(51) James M. Cypher (1998) The slow death of the Washington Consensus on Latin America. (Celebrating 25 Years) Latin American Perspectives, v25 n6 p47(5) Taylor (2000) The consequences of capital liberalistion, Challenge November 2000, Volume 43 Issue 6 Lichtenstein (2000) Competing perspectives on the liberalisation of Chinas foreign trade and investment regime, Journal of Economic Issues, Vol 34 Issue 4 Solomon (1999) Money on the move, The Revolution in International Finance since 1980 Stiglitz (2002) Globalization and its discontents

Assisting In Endotracheal Intubation Nursing Essay

Assisting In Endotracheal Intubation Nursing Essay An ETT is an advanced measure of airway management, where a catheter is inserted in the trachea generally through the mouth. This creates a direct passage between mechanical ventilator, which simulates breathing, and the lungs, where gaseous exchange occurs. ETT is most commonly used in unconscious or sedated patients, where the patient may lose spontaneous breathing, also bringing about benefits like protection from aspiration of gastric contents into the lungs, which lead to infection and complications. Considerable amount of attention is given to the intubation procedure, avoiding trauma and infection. Preparing a patient for intubation requires the patient to be positioned in the sniff in the morning, that being body straight with head slightly tilted to the front to obtain a straight airway. An anaesthetist will perform this procedure and the nurse prepares the necessary: an intubation set including an Ambu with face mask and other connectors and a laryngoscope with different blade sizes and muscle relaxant (Atracurium) and sedation (Propofol) medication are prepared. Once everything is checked that is in perfect working order, the anaesthetist, positioned behind the patients head, starts by giving the first IV bolus of Propofol later followed by the Atracurium. From this point onwards sedation will be administered by the nurse, and the anaesthetist will keep the head in position to maintain an open airway and bag the patient for 1-minute using the soft Ambu attached to the mask with 100% oxygen at 10-15l/min to hyper-oxygenate. After this 1-minute the first try for intubation is began and this should be no longer than 30secoonds. A laryngoscope is then inserted from the right side pushing the tongue to the side and lower, this will create physical space to see the epiglottis and the laryngoscope will be advanced slightly more to see the larynx. Once identified, the ETT is carefully advanced from the right side over the laryngoscope and straight between the larynxes. Then the tube is advanced up to 21-24cm from its markings, laryngoscope withdrawn and the soft Ambu is now connected with a specific connector to attach to the ETT. The anaesthetist will now bag and auscultate over the chest to check position of ETT, and to check that air is going into both sides of lung, or only a single side or worse the stomach. During the process the nurse may be requested to give more boluses of sedation, depending on what the anaesthetist encounters. Once the position is confirmed, the ETT is secured using a tie or a facial adhesive. The patient is then connected to the ventilator, where the anaesthetist gives the initial setting and liaises with the nurse on the aims and guidelines needed to safeguard the patients health and especially avoid unnecessary complications. Continuous sedation is as well started as now the patient is preferably left unconscious to stabilise, as a patient may extubated once semi-conscious and agitated. Parameters post-intubation are checked and charted, blood gases are taken and analysed. Shortly after insertion a chest X-ray is performed to verify positioning thanks to the radio-opaque strip incorporated in the ETT. Indications for intubation may vary from hypoxemia, loss of consciousness, airway obstruction or manipulation of the airway. In one of the cases I had the opportunity to observe clearly, the patient was suffering from pneumonia and was losing consciousness as she could not maintain a decent pO2 via a non-rebreather mask and started to get agitated and therefore continue lowering her oxygen saturation level. I took a blood gases sample and it resulted in a low enough result that the nurse decided to advise the anaesthetist to try intubation, apart from the fact that she was definitely in need to be sedated to reduce her agitation. In a pneumonia case a sedated patient may benefit more from care and obtain a healthier outcome as consciousness is then resumed when infection has started to clear. Intubation as like all the other invasive procedures carries numerous risks for the patient. To start with is the high risk of infection, which may come from lack of attention to asepsis during the procedure, and there can even be trauma to the lungs if the anaesthetist goes in too far with the ETT, or can even cause trauma to the buccal cavity, where with the use of the laryngoscope, leverage over the teeth may be exerted leading to the breaking of teeth. Moreover, if the patient takes too long to be intubated hypoxia may result, since the patient is not breathing at all. Single-sided or stomach intubation may occur as well. In the intubation procedure, precautions to prevent complications include patient sedation and muscle relaxation at the start of the procedure to avoid movements of any muscles. The patient is positioned to help the anaesthetist have an improved visualization of the larynx while using the laryngoscope. A measurement of the length of the airway is taken, to avoid inserting the ETT too much further down into the lungs. A patient is bagged for 1-minute prior to trial of intubation and no try takes longer than 30seconds, and ultimately a chest X-ray is performed to confirm ETT position. Blood sampling through an arterial catheter An arterial catheter is one of the most common lines required in ITU, indispensable for continuous intra-arterial blood pressure which is essential in a critically ill patient supported by vasoactive drugs. Moreover it aids in arterial blood sampling, being routines or ABG of an intubated patient, where if a patient doesnt have an arterial line would be pricked countless times during a single day, therefore is a benefit for the patient as well. Taking a blood sample through an arterial line requires following step by step instructions, while always keeping in mind asepsis, as although it is not actual invasive procedure, we are dealing with arterial blood and colonising a cannula imposes great risks of infection. To start with, perform hand hygiene and prepare essentials within easy reach, including alcoholic 2%chlorohexidine wipes (clinell), a packet of sterile non-woven swabs, pair of non-sterile gloves, luer lock stopper, 5ml syringe, ABG syringe, appropriate vacutainers and luer lock adaptor. Once everything is prepared and patency of line is checked by using the flushing device, perform hand hygiene once again and wear gloves. Place the open packet of sterile swabs under the area you will be working around, i.e. the 3-way tap on the arterial line. Wipe the stopper locked port at the 3-way tap for 15seconds using a clinell wipe. Now the 3-way tap OFF position should be facing the port that has just been disinfected, remove the stopper and attach 5ml syringe using a non-touch technique, turn the 3-way tap to OFF from flushing device and aspirate the first 3-5ml which will contain mostly heparinised saline. Turn the tap back to OFF from the port being used. Now, remove the 5ml syringe and start from collecting blood sample for ABG, using the same non-touch technique attach the syringe to the port, turn the stopper OFF from the flushing device. Withdraw small sample of blood (up to half of ABG syringe, approximately 1ml), if you require more blood samples turn the tap OFF to port again and remove ABG syringe while attaching its stopper at its end, connect luer lock adaptor for vacutainer use. Now turn the tap OFF to flushing device and start pressing each vacutainer until it stops filling, always changing the vacutainers using non-touch technique. It is suggested to leave for last any blood test sample that its result is affected by the amount of heparin in the sample, eg. APTT/INR. Once finished from taking the necessary blood samples, turn tap OFF to patient and flush using flushing device onto the packet of swabs. Once clear from blood, close with luer lock stopper using non-touch technique. Now turn the tap OFF to port and flush the remaining part of the arterial line. Avoiding leaving blood traces in the lines will ensure longer lifetime and patency of the arterial line itself. Patients in a critical care setting most often need several blood sampling every day, one indication may be ABG monitoring due to the patient being supported by a mechanical ventilator. ABG sampling is also needed in the weaning off process, but can also be used to monitor any acidosis or alkalosis the patient may be suffering from, due to his admitting condition. Other blood samples are mostly taken routinely in the morning and more investigations may be required throughout the day. The withdrawal of blood via an arterial line is not an invasive procedure, though it is still a manipulation of a catheter leading to the bloodstream, therefore it exposes the patient to a high risk of acquiring a nosocomial infection through the line if asepsis is not maintained throughout the procedure. The colonisation of the line without adequate disinfection may eventually lead to life-threatening septicaemia. Prevention of infection was applied using universal precautions like hand hygiene, disinfection using alcoholic 2%chlorohexidine wipes (clinell) and non-touch technique. This minimised drastically the chances of nosocomial infections. Section B INTERPROFESSIONAL COLLABORATION IN THE CRITICAL CARE SETTING Describe the role of the nurse in each of the following units: Intensive Therapy Unit (ITU) Neonatal and Paediatric Intensive Care Unit (NPICU) Burns and Plastic Surgery Unit Renal Unit Intensive Therapy Unit (ITU) An Intensive Therapy Unit (ITU) nurse is required to work in a setting where patients are experiencing or at-risk of experiencing life-threatening conditions, thus require complex assessment, high-intensity therapies and interventions, continuous nursing care and high-tech monitoring. Critical care nurses trust upon a particular organization of knowledge, skills and experience to provide care to patients and families and create healing, humane and caring environments. Patient advocacy is a major role in ITU nursing, as usually the conditions of a patient may be poor to the extent that the patient is unconscious or else is induced into unconsciousness. Therefore the nurse has to act on behalf of and in the patients best interest as the patients advocate and ensuring that the patients family are well informed about the care that the patient is receiving. The necessary information needs to be given to help make highly personal decisions about the patients care, and that the patient and familys decisions are respected in the development of any treatment plan for the patient. Advanced and continuous assessment needs to be carried out to verify patients health status; physical assessment may include Glasgow Coma Scale, eye sensitivity test, cardiac auscultation, abdominal palpation and more. Leading then to high-tech monitoring from highly specialised bedside monitors, requires critical nurses to be trained in telemetry. Telemetry is a computerized monitoring system that transmits essential information about the condition of the patient (heart and lung activity), and the nurse using this information can make healthcare judgements. Therefore with the help of telemetry in conjunction with the extensive knowledge of pathophysiology of illnesses, nurses assess the need to perform any intensive interventions that the patient might need. For instance, take arterial blood gases of a patient if oxygen saturation are getting lower, or perform suctioning if certain breathing sounds are noticed. More assessment may be done after certain interventions and therefore prevention of degrading in the patients condition is another main responsibility of the ITU nurse. This requires the nurse to be able to interpret any result and respond with an appropriate intervention, these may include; titration with inotropic substances to maintain a pre-determined arterial pressure, increase oxygen supply through the mechanical ventilator or change the mode it is set to wean off from extra support. ITU nursing in certain large-scale hospitals may be split in specialized sectors, like for instance the Cardiac Intensive Care Unit (CICU) in Mater Dei Hospital is a post-surgery intensive unit mostly dedicated to open heart surgery, leaving the ITU to take care of mostly post-laparotomy patients, serious trauma and other life-threating cases, including severe infections. Neonatal and Paediatrics Intensive Care Unit (NPICU) Nurses working in Neonatal and Paediatrics Intensive Care Unit (NPICU) require being extremely careful and vigilant, as this field requires working with neonates which may have some sort of complication from birth (or even before) to kids up to four years. As with all patients of this age group, symptoms and conditions change drastically, due to the frailty of the neonates, therefore continuous assessment is of extreme importance. As cases can differ from premature babies to post major operation neonates, the care is split into three: Intensive, High-Dependency, and Special Care. Caring for this type of population, care is adopted to support the patient medically and physically, assess and monitor but a great input in supporting psychologically the parents is a major requirement in these cases as they will be going through a really rough period, especially in the most serious cases like complications. Necessary time and information is given to the parents to understand what is going on with their child, involvement in the babys needs in special care. In intensive and high dependency cases, the patients will be connected to high tech bedside monitors; monitoring vital signs like arterial blood pressure, ECG traces, respirations, oxygen saturation and pulse. Most often patient with such frailty will be in a temperature controlled and humidified incubator to keep a stable environment, promoting recovery. The need of certain accesses may be essential as well, an umbilical line (usually arterial) is needed in cases of drug and fluid therapy, intubation may be needed in some of the cases as well. Inputs and outputs are strictly monitored throughout all levels of care provided in the unit, but as blood gases and other blood investigations may also be essential in certain intensive cases, keeping the blood volume withdrew as low as possible is of extreme importance as too much blood withdrawal in neonate may lead to serious complications. For special care there is more the usual care of a baby, therefore involving basic feeding, bathing and nappy changes, but need some extra care especially in calculation and handling due to the their small structures. Naso-gastric or oro-gastric tubes may be necessary in patients premature enough not to have a fully developed swallowing reflex or those too frail to suckle all the milk they need to maintain themselves. In this type of care, parents (especially the mother) are encouraged to handle and take care of the baby themselves as this has positive effects on both the mother and babys health. The nurse is responsible to liaise with the mother to set appointment regarding washing her baby or nappy changes which the mother may wish to do herself. Monitoring of daily weight, measurement of Occipitofrontal Circumference (OFC) and nappy weighting are some of the documentation taken by the nurse apart from the regular vital sign like temperature and heart rate. Plastic Surgery and Burns Unit Nurses working on the Plastic Surgery and Burns Unit (PSBU) may encounter the extremes of wounds through skin layers, since those present in burns cases could involve from only skin to muscles, nerves, blood vessels and even bones. On the other hand, plastic surgery is more related to the surgical grafts done post-recovery from a burns accident, or superficial level surgery like the removal of melanomas and other skin disorders. Burns nurses are responsible in fluid resuscitation given through wide-bore IV lines in severe cases of burns. In conjunction with fluid resuscitation, is a strict input and output charting to assess renal perfusion due to large volume loss from interstitial spaces due to loss of skin. Haemodynamic monitoring is another essential role, as the fluid loss from wounds may lead to hypotension, inotropic substances may be needed to support the heart muscle in extreme cases. Furthermore, the importance to keep sterility over wound and to aseptically cover using a special type of dressing containing paraffin oil, which does not allow water to transpire, is stressed in burns cases, as once the skin layer is lost, all the infection and water loss prevention which the integumentary system was responsible for, are now absent. In the plastic surgery cases, nurses are mostly responsible in post-op wound reviews and change of dressings. The nurse also advises the patients to protect fresh wounds and prevent infections. Renal Unit Dialysis Nurses on the Renal Unit work with a patient population of solely End Stage Renal Disease (ESRD), therefore their insight into the illness and its treatment needs to be well-defined. Dialysis treatment, which is the process of removing waste from the blood of a patient whose kidneys lost this function, is available in two modalities, namely; Haemodialysis (HD) and Peritoneal Dialysis (PD). Nurses in charge of PD patients conduct periodical reviews to collect blood, peritoneal fluid and swabs for investigations. Their main responsibility though, is to check progress from the personal log that the patient is encouraged to keep from the start of the treatment, this includes daily weight, oral intake, dialysate input (type and amount), dialysate output (colour/consistency and amount). Since PD is a self-care treatment at home, a high-quality nurse-patient relationship is required to assess for adherence to treatment. The nurse is responsible to liaise with patient and relatives if they are encountering any challenges during treatment. Advices about the necessity of any treatment changes and the importance of asepsis during treatment, to avoid unnecessary exposure to infection, i.e. peritonitis, are one of the key responsibilities of a PD nurse. On the other hand, nurses responsible of HD patients, unlike PD, have a more direct responsibility with the patients infection prevention. The nurse first responsibility is to inspect equipment, ensuring it is in perfect working order before use and all lines are new and sterile to minimize chance of infection. Review of the patients previous session handover and preparation of any treatment needed during the dialysis is carried out by the nurse. A typical dialysis treatment starts with morning weighting and then, the nurse, using strict aseptic technique, inserts two wide bore cannulas into the patients AV access. Finally the patient is connected to an HD machine for 4 hours, set to target weight calculated by the physician, to remove excess water and waste products from the bloodstream. Before, during and after these 4 hours, vital signs are checked and charted. Routine blood investigations are also taken and any indicated medications from previous investigations are administered and documented. The patient is advised of the possible complications and suggested to notify as soon as any abnormal feelings set on. Any pain complaint reported by the patient during the dialysis is reported in the documentation for hand over and physicians are contacted in view of treatment changes requirements. Moreover, as HD patients have to attend these sessions 3-4 times weekly, the need of a quality nurse-patient relationship is essential. The dialysis nurse spends time with the patient assessing any psychological or physical ill effects of the illness and documents an adequate handover to obtain successful treatment of this condition. Compile a list of the different types of health care workers whom you encountered during this entire placement. Physiotherapists Anaesthetists Midwives Nurses Nursing Aides Care workers Radiographers Speech Language Pathologists Occupational Therapists Audiologists Electrocardiogram (ECG) Technicians Describe the role of THREE other (non-nursing) members of the ITU team. Include key responsibilities of these persons for the patient. From your observation, what is the nature of their interaction, if any, with the critical care nurse? Physiotherapists Physiotherapists in an intensive care setting are mainly responsible for clearing secretion from chest walls using positioning, percussion, manual hyperinflation and vibration. These methods clear the peripheries of the lungs and mobilize secretions to the central airways to be easily suctioned and therefore re-establish a larger lung capacity. Apart from chest-physio, they also work with conscious patients on the early movement of limbs to resume physical function and avoid muscle waste due to being sedated and bed-bound. Whilst encouraging the patient to do these exercises on his/her own initiative as needed, the physiotherapist reports to the nurse any result of his/her actions and reminds the nurse to encourage and observe the patient doing the exercise needed for further improvement in recovery. Radiographers Radiographers in the ITU setting are not mainly responsible for diagnosis, as in critically ill patients usually the underlying conditions of illness are discovered prior to admission. Though, with the use of portable X-ray machines, their help is essential in confirming the positions of any tubes or lines inserted in the unit or theatre, whilst minimizing discomfort of unnecessary transport to the Medical Imaging. Moreover through radiography any degradation of the ITU admission health insults may be identified, for example comparisons of previous chest x-ray to analyse if consolidations increased or decreased. The radiographer-nurse relationship is usually more concerned in helping to position the patient well to get a clear shot, giving the possibility to take the most out of the X-ray taken. Once published, X-ray are seen by medical staff to verify placement of any newly inserted central venous line or endotracheal tube, and the progression of the condition is also assessed. Electrocardiogram (ECG) Technicians ECG Technicians are indispensable in cardiac related admissions in ITU, this usually would be a post-MI patient with recurrent arrests. Their main responsibilities are into attaching leads at specific sites on the patients body to the ECG machine, which in turn prints the signal it receives onto an ECG strip. Although patient in an ITU setting are generally attached to a continuous ECG monitor, this type of ECG gives a better picture of any arrhythmias and axis deviations of the pulse. The technician then analyses the result, identifies any emergencies and liaises with nursing staff and medical staff. Most often this involves cardiology staff as well, since decisions regarding treatment are usually deducted from these types of ECGs. Section C DOCUMENTATION Why is documentation important in a critical care area? Documentation in critical care, as in the all nursing field, is an essential role which enables a better continuation of care and assessment of progression or regression of the patients condition. That said, the importance of precise information in the critical area is exponential to the fragility of the critically-ill patient, therefore this gives a valid reason for the necessity of hourly vital signs, urine output, continuous IV pump rate and more. Along the various types of documentation, comes in the rationale for certain actions taken leaving a pattern to be followed and leave good ground for recommendations to be given during handover. For instance, low oxygen saturation is monitored and the nurse decides to perform suctioning and an improvement is visible in the forthcoming readings, therefore one can suggest the following nurse to try this method as it has shown good results. Moreover, importance of documentation increases as the risks for the patient increase leading to a more responsible practice. This helps to improve quality of care provided and safeguard the patient from malpractice. Documentation is critical not only for nurses in this setting, but plays quite an enormous part in any of the doctors actions, as strong and consistent rationale is needed to back up certain decisions taken in critical life-threatening moments to improve care given and obtain healthier outcomes. List all forms of documentation which nurses perform in each of these units: Intensive Therapy Unit (ITU) Neonatal and Paediatric Intensive Care Unit (NPICU) Burns and Plastic Surgery Unit Renal Unit Intensive Therapy Unit Chart (incl. Hourly Parameters, Investigation Results, I.V./Oral Intake, Ventilation (via type of Mask or Ventilator Mode (SIMV, CPaP, BiPaP) FiO2), Continuous I.V. Treatment, Output via N.G./Drains/Urinary Catheter), Handover Sheet Neonatal Abstinence Scoring System, Investigation Flow Chart, Parameters + Intake/Output Chart, Fluid Prescription Chart, Apnoea Chart Parameters + Intake/Output Chart, Chart for Estimating Severity of Burn Wound, PSBU 24hrs. Drain Output Chart Haemodialysis Chart (incl. Parameters, Actual + Target Body Weight, Blood Test Results, Handover for next session) Section D ITU PROCEDURES During your ITU placement, select one of the following procedures which you have observed and in which you have taken part: Admission of a patient to ITU Transport of a patient to the operating theatre or the medical imaging department Discharge of a patient to another ward/unit (a) DESCRIBE the nursing observations, actions and documentation during the procedure. Include a rationale for these activities. (b) How did YOU participate in this event? (c) REFLECT on what was done properly and what could have been done better. Transport of a patient to the operating theatre or the medical imaging department The transport of a critically ill patient is one of the most challenging and requires a lot of preparation, but thanks to the portable X-ray and Ultrasound (US) technology this occurs in only a few cases like Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) scan, or else an essential need to transfer back to the operation theatres in case of complications. In a case I had the opportunity to take part in; we had to take a patient to MRI for a brain and C-spine scan. The nurses I was with started from contacting an anaesthetist as the patient was intubated, contacted a radiographer to take girth measurements, since the patient was obese, to check if the patient would go through the scanner and contacted the family that their relative will go for a scan and may not be there when they come. Afterwards the nurse extended IV tubing to obtain enough length during the scan, while I started to collect all the portables needed for the transport including; oxygen cylinder, portable ventilator, crash pack, Ambu bag and monitor stand. Preparation of extra sedation, other IV treatments and necessary flushing solutions was done to prevent running out of medications during this transportation. The nurse checked that the patient was stable enough on the current inotropic support and sedation. The nurse also checked the oxygen tank pressure, ventilator function and just before we left connected to portable machinery and evaluated condition of the patient again and charted the parameters. The anaesthetist gave a dose of muscle relaxant to avoid any unexpected movements from the patient while doing the transportation, which could lead to lose the airway if the patient would extubate. Extra muscle relaxant was prepared as well. Leaving off from the ITU, we continuously monitored the patients parameters on the monitor, arrived securely at the medical imaging and started discussing what needs to be removed or replaced from the patient before we enter the MRI room. Certain machinery is not MRI-compatible, therefore the exposure to that magnetic field would damage it or cause malfunction. Following advises given by the radiographer, anything that needed to be removed was removed, leaving only essential monitoring to be removed and re-attached to appropriate machinery once in the MRI room. Patient was then transferred from the bed to the MRI table going straight into the MRI room, back on essential monitoring assessment of condition was done and we aligned MRI table to the scanner to start the procedure. During all this time the nurse and anaesthetist gave necessary amount of sedation and muscle relaxation bolus to prevent accidental alertness of the patient and unexpected extubation. The moment when we were getting the patient inside the scanner, we realized he wouldnt get in because of his hands had to pass over his already enormous girth and he simply wouldnt fit. At that point we realized we made a lot of effort, but unfortunately we were still unsuccessful. Therefore all the process had to be reversed, and once out from the MRI room, settled the patient with adequate monitoring for transportation back to ITU. Once back in ITU, we removed any unnecessary tubing, placed all transport equipment back in place and documented parameters post-transportation. A note was added in the documentation regarding the failed MRI; the family was let in to see the patient and was given an explanation of what was done during the day. Looking back and reflecting on the event, I realise the amount of things that are taken in consideration prior to leaving the ITU. The importance given to sedation and muscle relaxation to avoid extubation, Ambu bag for manual ventilation in case portable ventilator stops working or needs to be disconnected. The extension of the IV tubings was something, that actually didnt even cross my mind and though so important. Preparation of extra medication, not too run without during transport. These are all things that require effective thought as if omitted, the repercussions can be terrible. I dont consider the unsuccessful try of getting the patient into the MRI has anything to do with being unprepared or unaware of something, as this fact was taken in consideration from the beginning. I do consider it as an unfortunate event, which left us all with another important lesson learned. I believe it is imprinted enough that, from now onwards when I hear that a patient is for MRI will be the first I will consider. Section E PATIENT CARE IN A CRITICAL CARE SETTING In this account I will be focusing on a case I followed during my placement on the Renal Unit at Mater Dei Hospital. The case study involves an interview with a 27-year old male patient suffering from End Stage Renal Disease (ESRD). This gentleman is to date known to have lost renal function due to Focal Segmental Glomerulosclerosis (FSGS) with onset of illness symptoms started at 17 years of age. Due to ethical reasons the patient involved in this account will have the pseudonym Mr. Frank Abdilla. Mr. Abdilla has been treating this illness for slightly more than 10 years now and is currently following haemodialysis (HD) 3 times a week. I started this interview with getting to his medical history, and to tell me more about the onset of the illness and its treatment to date. Frank expressed that he suffered from nothing prior to the onset symptoms, which he referred to them as a silent killer symptoms. I only know that I started to feel less the urge to urinate and my breath had a foul smell, then after a couple of days I had an episode of loss of consciousness,