Assess the extent to which it would be beneficial for Norway to join Essay

Assess the extent to which it would be beneficial for Norway to join the European Union - Essay Example In fact, Norway has close political and economic ties with the EU (regjeringen, 2011). For instance, according to regjeringen (2011), Norway and the EU are members of the European Economic Area (EEA, signed in 1994). Moreover, the EEA agreement regulates the relationship between Norway and EU (regjeringen, 2011). In addition, Norway and the European Union signed Schengen agreement and they are partners in the Iceland and Liechtenstein (regjeringen, 2011). The foundations of Norway-EU trade relations were led by the EFTA (European Free Trade Association), which was established in 1960 (regjeringen, 2011). The EU in collaboration with Norway participate in the fields of justice and home affairs, climatic changes, foreign policies, research policies and in regulation of energy consumption (regjeringen, 2011). Increase in cooperation of Norway with European Union dramatically affects more aspects of both Norwegian and the EU community and economy (regjeringen, 2011). Norway is a major su pplier of natural gas supplying up to 24% of the total gas imports, (regjeringen, 2011). Norway has contributed to the EU budget â‚ ¬ 230 million in 2010 (regjeringen, 2011). In addition, according to regjeringen (2011), the overall amount of Norway’s export to the EU is 80.7%. In order to understand the importance of the EU for Norway, one should not only look at the EEA Agreement, but analyze the entire structure of agreements. For example, the Schengen Agreement or the many other agreements between Norway and the EU that concern Justice, Security policy, fisheries and agriculture (regjeringen, 2012). On the other hand, Norway persistent refrains from joining the EU for various reasons, even though accession to the EU would bring new insights and new opportunities for Norway across diverse areas. Ladegaard (2012) states that, accordingly to

Global Marketing Term Paper Essay Example | Topics and Well Written Essays - 2500 words

Global Marketing Term Paper - Essay Example Therefore, they more or less stuck to their pricing levels in US and tried to bring in quality and technology to ensure that the product tasted better and was more nutritional. The re-entry in case of Kellogg was in terms of price. The war in the middle class consumer products is over the price. Kellogg had to compete with Mohun which has been in the market prior to Kellogg's entry. Mohun and another of the competitors, Champion were both pricing their products at a much lesser price compared to the one Kellogg did. Kellogg however, was sure of the strategy and continued with the same pricing strategy of being the premium brand among corn flakes. Though of course, the other two offered by Kellogg, the wheat and the rice flakes did not do well in the market and had to be slashed down. On analysis of the first two to three years of Kellogg business in India, it is seen that the company has not spent enough efforts in understanding the consumer preference in the market. A large percent of the upper and middle class consumers will not be having their breakfast. In addition to this, most of the people who do take breakfast would like to have something that 'fil ls' the stomach. More likely Indian alternatives like idli and vada dominated the breakfast scene in most houses rather than any other. The cereal breakfast concept did not just pick up and was viewed mostly as a health issue. Only those people who were either sick or otherwise not healthy would go for cereal food. Therefore, number of people who would be continuous or regular buyers of corn flakes was becoming lesser. As their study shows only 2% of the buyers were regular buyer which is not what Kellogg wanted to have. Kellogg had launched during its re-entry, the chocos which is corn flakes coated with chocolate. This was a roaring success and the market immediately picked up. Kellogg could corner nearly 57% of the market share in the Indian market. In addition to this, Kellogg had other products in the pipe line to suit the taste of the Indian consumer. Indian consumers want their breakfast to be filling, nutritious and less costly. It was not expected to be fun. But when the Chocos was introduced with a fun element to it, it immediately appealed to the kids and it took over the morning breakfast from the noodles and idlis for the children. Kellogg therefore had to ensure that the fun factor in the breakfast cereals continued. In line with this, Kellogg further went ahead and released the biscuits with the same brand, the Chocos and another line of special corn flakes primarily aimed at the growing Indian breakfast eaters. It had the mazaa in it; special flavours exclusively developed for the Ind ian market. On analysing further the status of the corn flakes market, it could be seen that the company was aiming at improving their continued domination of the market and might better their share. But the market itself if small and has to be increased to ensure that there is adequate growth for the company in real terms. This was taken care of in the third approach that Kellogg had. They planned to educate the people and distributed free samples to the students and the target customers so that they might get converted. In the course of time, the effect could be felt. Kellogg was intent on weaning the people who starved away the morning and then slowly

Research Paper for Othello Example | Topics and Well Written Essays - 1000 words

For Othello - Research Paper Example Jealousy, that is roused by suspicion and wounded pride, which could be reactions to prejudice, makes Othello the most celebrated text that explores the powers of these debilitating factors even over someone who is considered a hero (Collie 88-9). Shakespeare’s Othello is one of the earliest texts that depict racism against blacks (Iyasere, Iyasere, and Little 326). Normally, especially during Shakespearian days, the whites are the natural protagonists while the blacks are usually portrayed as antagonists. This depiction of a hero is unusual because Othello is shown as troubled with bitterness, delusions, and self-importance (Vaughn 180). He is a dignified, brilliant, heroic, and important figure in the Venetian army, yet despite this prominent status, his own insecurities make him prey to the selfish motives of Iago, the play’s villain (Jacobsen 502). The tragic part here is that no matter how great his status is, and no matter how admired he is by the people of Venice , the war strategies that make him win several battles do not win for him his battle at home, which ultimately resulted in the tragic end of Othello and his beloved Desdemona. Iago sees Othello’s jealousy for his wife Desdemona and decides to use it to his own advantage. He is able to manipulate Othello easily, even when Iago never once presented strong evidence about Desdemona’s infidelity. In fairness to Othello, the ideas that Iago convinces him of are very likely to happen, therefore, easy to believe (Jacobsen 503-4). However, if he knows his wife Desdemona well, it is also easy to see that these accusations are not only improbable, but ridiculous as well. In a scene in the play, Iago exclaims â€Å"Ha! I like not that.† (3.3.33) and â€Å"Cassio, my lord? No, sure, I cannot think it, That he would steal away so guilty-like, Seeing you coming.† (3.3.37-9). Here, it is obvious that Iago, lacking any solid proof, tries to plant ideas in Othello’s mind through manipulation. Iago acts like he is unwilling to confess the sordid details of the scene between Desdemona and Cassio, yet all the while uses a suggestive tone and drops hints that Desdemona is having an illicit affair with Cassio. This causes Othello to demand for more details, making it appear that he is dragging information out of Iago, while the truth is that Iago leads him into that trap of suspicion. This skillful manipulation ignites jealousy in Othello that is roused by the suspicion that Iago successfully implants in his head. These suspicions that rouse his jealousy cause constant speculations by different critics. Othello’s self-loathing is one popular idea. For example, making their marriage private instead of public could mean that he does not believe he is good enough for Desdemona (Vaughn 180). Othello is also portrayed as filled with contradicting characteristics. He promotes Cassio (1.1.18-21) but shows more trust to Iago; he kills his wife Desde mona (5.2.137-8) despite professing his overwhelming love and passion for her; he also kills himself (5.2.376-7) instead of facing the consequences of his crime despite being noted for his courage and dignity. His insecurity makes him gullible to Iago’s manipulations. It can be said that even without Iago’s exploitations of his insecurities, Othello would still be susceptible to suspicions one way or another (Vaughn 181). Despites his great accomplishments and elevated status in the society,

The Old proof of Human Craving to Preserve Heritage Essay Example for Free

The Old proof of Human Craving to Preserve Heritage Essay Humans love their routes and even more love to bask in the glory of the accomplishment of their ancestors, and such attitude towards heritage has only manifested in modern times with the advent of museums. However, the level of wonder rises to an unbelievable degree when one discovers a piece of architecture as old as 421 BCE too clearly consolidates the above belief. That is the reason why this essay has chosen to describe Erechtheion, the building that was decidedly built to accommodate all possible nuances of ancient Greek heritage and culture. Background Right after they completed Parthenon and the Propylaia, the city-states of Athens and Sparta and their respective allies got involved in the Peloponnesian Wars between 431 and 404 BCE, between which they had a peaceful period of six years under the regime of Nikias, and the Athenians didnt miss that chance to fulfil the dream of their dead hero Perikles (died in 429 BCE), who wanted to restore the glory of Acropolis, and accordingly started constructing Athena Polias, which later became known as the Erechtheion (Syrigos, 1995), the work of which commenced on 421 BCE and finished around 406 BCE. Erechtheion contains six larger than life maidens columns known as the Caryatids. According to mythology, it was here that Poseidon struck the ground with his trident and that Athena produced the Olive tree. Overall, the building proves to be a brilliant solution of both spiritual confluence and practical problems (Sanctuary, 2006). Architectural Details The Erechtheion had two main entrances, on the north and east sides, where some columns from the east porch, comprising an ornamental pedestal supporting a fluted shaft of white marble and topped by a separately made capital, carried the flavour of neo-classical architecture, especially with their floral ornament of the necking and the delicate mouldings of the pedestal and capital (Cook, 1997). The uniqueness of this building lies in the fact that it contains more original features than any of its counterparts in Acropolis. It can be classified by three separate independent sections like the central temple, the porch of the Caryatides and the north extension, all having separate roofs. Apart from that, it is built at four different levels and accordingly, Ionic columns of three different dimensions and proportions are used, besides Korai as supports for the entablature the famous Caryatides (Erechtheion, 2008). Otherwise the temple has two main parts, where once Athena reigned at the east and Poseidon-Erechtheus found their places at the west. In all, it reflected the compactness of classical Attic architecture. The frieze was created out of Eleusinian stone of a deep grey colour, and metal connecting pins set in the slabs were used to hold the relief figures. Once a gold lamp adorned inside, reportedly made by Kallimakhos, the artist accredited with the invention of the Corinthian capital (Syrigos, 1995). There is no authentic document regarding the architect of this building, yet its Ionic structure would remind the genius of Mnesikles, who is regarded as one of the stalwarts of Greek architecture and who was known for his originality and his ability to provide functional adaptation to accommodate the multiple religious needs of so many cults, even amid the irregular basement (Syrigos, 1995). Another researcher Williamson (2008) too supports this idea, who opines, The Erechtheion, built on the site of ancient sanctuaries on the Athenian Acropolis, is so unlike every other Greek temple that some have dismissed it as an aberration. Rather, it is the result of its architect, probably Mnesikles, applying inventive skill to accommodate a complex web of religious relationships. The Erechtheion provides evidence that the craft tradition of architecture, hobbled by convention, was giving place to a new creative approach to design. Proof of Craving to Preserve Heritage It is this meticulous projection of religious confluence of Greece separates Erechtheion in dignity, as it comprehensively covered the spiritual milieu of ancient Greece within its chambers and its temenos (sacred courtyard). Though the structure primarily facilitated worship of Athena Polias and Poseidon, it meticulously accommodated a host of other important characters/elements of Greek Mythology, like the graves of Erechtheus with the sacred snake, and of Kekrops, the ancestors of the Athenians, as well as the signs from Poseidons trident which produced water, the Erechtheis Sea, a well that contained salt water, and the marks from the thunderbolt of Zeus. The altars of Zeus Hypatos, of Peseidon and Erechtheus, of Hephaistos, of the hero Boutes, of the Thyechoos, and the very ancient xoanon of Hermes, all were placed together there. And there was more the sacred olive and the sanctuary of Pandrosos, which included the altar of Zeus Herkeios too found their places (Sanctuary, 2006). According Syrigos (1995), the architect succeeded by subtle and ingenious use of the differences in level to produce an astonishing temple, which satisfied the requirements of all these cults. He respected the traditions and at the same time introduced striking innovations. Present Situation The unique temple was converted into a church during the Middle Ages, and later it was used as a harem for the ruler of Athens during the Turkish occupation. In 1801 the British ambassador, Thomas Bruce, Earl of Elgin, took a caryatid (which he later sold to the British Museum), replacing it with a plaster cast. The Erechtheion was partly rebuilt by the American School of Classical Studies. Now it again suffers depredations, this time from atmospheric pollution and the increasing pressure of tourism (Williamson, 2008). Conclusion The evidences and discussion clearly points at the innate desire of the Greeks to preserve their heritage at one place, and the intensity of such desire brought the issue completing their mammoth task of creating Acropolis even after the war, which normally could be a period of general consolidation. Thus, apart from skill, innovativeness and beauty, which are tangible in Erechtheion, one intangible proof is right there, which proves human craving fore preserving their heritage and gather inspiration from it. References Cook, B. F. (1997). Ionic column from the ErechtheionThe Acropolis, Athens, Greece, about 420-415 BC in The Elgin Marbles. 2nd Edition: London, The British Museum Press. Retrieved 8 December 2008, from http://www. britishmuseum. org/explore/highlights/highlight_objects/gr/i/ionic_col umn_-_the_erechtheion. aspx Erechtheion (2008). Retrieved 8 December 2008, from http://www. erechtheion. org/Docs/Lesk%20Erechtheion%20with%20figs%20sm. p df http://www. ne. jp/asahi/daikannw/network/webacropol/erechtheio. html Sanctuary of Erechtheion. (2006). Retrieved 8 December 2008, from http://www. travelpod. com/travel- photo/rcl0906/turkey_greece06/1158590880/dscn03. jpg/tpod. html Syrigos, A. B. (1995). The Erechtheion. Retrieved 8 December 2008, from Williamson, M. (2008). The Erechtheion, Athens, Greece; Mnesikles(? ), architect, 421- ca. 406 b. c. Retrieved 8 December 2008, from http://warandgame. blogspot. com/2008/08/erechtheion. html

Reflective Summary On Prescribing Practice Learning Nursing Essay

Reflective Summary On Prescribing Practice Learning Nursing Essay The author, a nurse practitioner based in an Emergency Department (ED), from here on in will be referred to as the practitioner. The practitioner is currently employed in a development role with the view, following training, of becoming an acute care practitioner. This will entail working autonomously: taking accurate clinical histories, physical examination, gain differential and working diagnosis and organise a plan of care. This plan of care could well include a number of prescribed medications. Hence it is in the practitioners job description (as it is increasingly in many specialist/autonomous nursing roles) to become a Nurse Independent and Supplementary Prescriber (NISP). The Cumberlege Report (1986) suggested that nurses should be able to prescribe independently and highlighted that patient care could be improved and resources used more effectively by doing so. It identified that nurses were wasting their time requesting prescriptions from Doctors. Since the publication of this seminal piece of work, non-medical prescribing has been analysed, reflected upon, researched at great lengths and changes in practice made (DoH 1989, 1999, 2006 2008; Luker et al 1994; Latter et al 2011) and is still under constant review. The aim of this portfolio is to: Reflect on practice as a means of on-going personal and professional development. Demonstrate a capability of integrating learning into practice. Submit a range of material mapped against the module learning outcomes, NMC 2006 prescribing standards, domains of practice and core competencies. Establish an evidence-based approach to practice competence as a safe independent supplementary prescriber. This prescribing practice portfolio will be a reflective portfolio using Rolfe et al (2001) model of reflection to aid learning from experience and close the gap between theory and practice. This model has been chosen as it is something the practitioner is familiar with and has used before. The portfolio will conclude with a reflective summary on prescribing practice learning which will draw together the evidence used to support achievement of the competences identified. After discussing with colleagues who have already completed the NISP course, the practitioner is aware of the complex nature and volume of work that is required over the duration of it. There is a feeling of nervousness due to this but also a feeling excitement over what will be learnt. If successful the practitioner believes her practice will be enhanced significantly as she will have the ability to give patients seamless care. References Department of Health. (1986) Neighbourhood Nursing: A Focus for Care. (Cumberlege Report). London: HMSO Department of Health. (1989) Report of the Advisory Group on Nurse Prescribing. The Crown Report). London: HMSO Department of Health. (1999) Review Of Prescribing, Supply And Administration Of Medicines. (The Crown Report Two) London: HMSO. Department of Health. (2006) Medicines Matters. London: HMSO Department of Health. (2008) Making Connections: Using Healthcare Professionals to Deliver Organisational Improvements. London: HMSO Latter, S. Blenkinsopp, A. Smith, A. Chapman, S. Tinelli, M. Gerard, K. Little, P. Celino, N. Granby, T. Nicholls, P. Dorer, G. (2011) Evaluation of nurse and pharmacist independent prescribing. Faculty of Health Sciences, University of Southampton; School of Pharmacy, Keele University on behalf of Department of Health [Online] Available at http://eprints.soton.ac.uk/184777/ [Accessed 15th Sept 2012] Luker, K. Austin, L. Hogg, C. Ferguson, B. Smith, K. (1998) Nurse-Patient Relationships: The context of Nurse Prescribing. Journal of Advanced Nursing. (28) 2: 235-242 Rolfe, G. Freshwater, D. Jasper, M. (2001) Critical Reflection in Nursing and the Helping Professions: a Users Guide. Basingstoke: Palgrave Macmillan. Consultation Holistic Assessment Case Study In this case study the consultation, diagnosis, prescribing options and decisions of a 35 year old female seen in the ED will be discussed. This case study will aim to improve the practitioners knowledge of conducting a consultation and its relationship with making a diagnosis and treatment options. To maintain confidentiality, in line with the code of professional conduct, the patient will be referred to as Mrs A (Nursing and Midwifery Council (NMC), 2008). Consultation Examining the holistic needs of the patient is the first of seven principles of good prescribing (National Prescribing Centre (NPC), 1999) and must be undertaken before making a decision to prescribe (NMC Practice Standard 3, 2006). Holistic assessment takes into consideration the mind, body and spirit of the patient (Jarvis, 2008). Traditionally consultation and making a diagnosis has been completed by Doctors. However, nurse diagnosis would appear to have been formally acknowledged since The Crown Two Report (DoH, 1999) as part of the independent prescriber role. Horrocks et al, (2002), found greater patient satisfaction with nurse consultations than with GP consultations. Jennings et al, (2009) and Wilson Shifaza, (2008) also found this to be true of nurse practitioners working in emergency departments. Importantly, they also found no significant variation in other health outcomes. Most of these studies found that consultations with nurses were to some extent longer, they offered more advice on self-care and self-management and that nurses gave more information to patients. Although there are various consultation models that have been described (Byrne Long, 1976; Pendleton et al, 1984; Neighbour, 2005; Kurtz et al, 2003; Stott Davis, 1979), these are based upon observation of doctor, not nurse consultations. Nevertheless, the consultation models and skills described in the medical literature are relevant to all practitioners (Baird, 2004). Consultation models help the practitioner centre the consultation around successful information exchange and try to provide a theoretical structure. Consultation models can also be used to help make maximum use of the time available at each consultation (Simon, 2009). Traditionally the medical model is used to assess patients however; it does not take into account the social, psychological, and other external factors of the patient. The model also overlooks that the diagnosis (that will affect treatment of the patient) is a result of negotiation between doctor and patient (Frankel et al, 2003) In this case study, the practitioner has used Roger Neighbours model of consultation. This was found by the practitioner to be simple and easy to remember, whilst covering all areas needed to make an effective consultation and assessment. He describes a 5 stage model which he refers to as a journey with checkpoints along the way: Connecting establishing a relationship and rapport with the patient. Summarising taking a history from the patient including their ideas, expectations, concerns and summarising back to the patient to ensure there are no misunderstandings. Handing over negotiating between the practitioners and patients agenda and agreeing on a management plan. Safety netting the consideration of what if? and what the practitioner might do in each case. Housekeeping reflecting on the consultation. (Neighbour, 2005) Connecting Mrs A was called through to the Rapid Assessment and Treatment area in the ED. It was apparent from Mrs As facial expression and limp that walking caused her pain. Silverman Kinnersley, (2010) state that non-verbal communication is extremely important and can often provide clues to underlying concerns or emotions. The practitioner had never met the patient before so had no previous relationship with her but was aware that she may have pre-conceived ideas about the ED which may have caused her anxiety. The practitioner introduced herself to Mrs A, explained her job role, the process that was about to be undertook and consent obtained. During this time eye contact was maintained and the practitioner also asked Mrs A how she would like to be addressed. This was done to try and build up a rapport with Mrs A, to help her feel at ease and reassure her. Simon, (2009) and Moulton, (2007) agree and state that rapport is essential to effective communication and consultation. Mrs A was also of fered a trolley to sit on to make herself comfortable and the curtains pulled around for privacy and dignity. On reflection the practitioner was aware that the environment was a busy and noisy assessment area and this can have a negative impact on the consultation (Silverman et al, 2005). Identifying this with Mrs A and apologising may have re-assured her further and gained trust and respect. Summarising The practitioner began with an open ended question and did not interrupt the patients response. Neighbour, (2005) and Moulton, (2007) advise this to open the consultation. Gask Usherwood, (2002) found that if a practitioner interrupts, patients then rarely disclose new information, which could lead to not finding out the real reason for the consultation. Mrs A revealed that she received an insect bite to her right lower leg 5 days ago, since then the surrounding skin had become swollen, increasingly red, painful and hot to touch. She explained that the redness was spreading up her leg and the pain was getting worse. Mrs A explained that she was concerned that it was not going to get better and was very worried that it had got worse during the last 3 days. Upon questioning Mrs A also complained of malaise and that she had been feeling very hot and cold and at times. She had been managing to eat and drink as normal. Mrs A lived with her husband, was a non smoker and drank alcohol occasionally. She had no past medical history and took no prescribed or over the counter (otc) medications. It was also elicited that she was allergic to Penicillin which she had an anaphylaxis reaction to. Taking a medical, social, medication and allergy history is important as it can be relevant to the presenting complaint, makes sure key information has not been overlooked and is essential in preventing prescribing errors (Bickley, 2008; Young et al, 2009). The practitioner actively listened to what Mrs A was saying by maintaining eye contact, using open questions and by summarising the history back to clarify points and to make sure nothing was missed. On reflection the practitioner feels this also gave the opportunity for Mrs A to add any further information not disclosed so far. Closed questions were then used to gain specific information related to the initial information given, this is advised by Young et al, (2009) and Moulton, (2007). Effective communication is important as Epstein et al, (2008) explains that a precise history can supply at least 80% of the information necessary for a diagnosis. Upon examination there was obvious erythema. Light palpation revealed that the area was very warm and tender. Neurovascular assessment was performed and was unremarkable. Mrs As chest was clear, heart sounds normal and her abdomen was soft, non tender. Physical examination is important as it is used to detect physical signs that the patient may not be aware of and can be used to confirm or disprove a possible diagnosis. It also suggests to the patient that their illness is being taken seriously. (Bickley, 2008, Charlton, 2006). Observations were taken including blood pressure, heart rate, temperature, respiratory rate and oxygen saturations. All were within normal parameters except her temperature which was 38.2 degrees Celsius. Venous blood was taken to check haematological, biochemical and coagulation status. Mrs A white cell count (WCC) and C-reactive protein (CRP) levels were raised, all other blood results were normal. Handing Over Before making a final diagnosis, it is important that differential diagnoses are excluded (Nazarko, 2012). The practitioners differential diagnoses were deep vein thrombosis (DVT) or venous eczema. However, Mrs A had a straightforward history (insect bite) that together with her observations (raised temperature), examination findings (redness, heat, swelling and pain) and blood results (raised WCC and CRP) indicated an alternative diagnosis, so DVT and venous eczema were ruled out. The practitioners working diagnosis was cellulitis. This was discussed with Mrs A and she appeared reassured that a diagnosis had been made. The practitioner explained that she would like to discuss this with a senior Doctor to help decide on a treatment plan. The practitioner presented the patient to an ED Registrar who agreed with the diagnosis. Diagnosis, treatment and prescribing options were then discussed to aid the practitioners learning. Cellulitis is a bacterial infection of the skin and subcutaneous tissue which is potentially serious (Epstein et al, 2008). It is caused by one or more types of bacteria, most commonly streptococci and staphylococcus aureus (Nazarko, 2012). Cellulitis usually occurs on the lower legs, arms and face but can arise anywhere on the body (Bickley, 2008). Patients with cellulitis present with signs of inflammation, distinctively heat, redness, swelling and pain (Nazarko, 2012). Inflammation is localised initially but increases as the infection progresses. Patients can be systemically unwell (pyrexial, tachycardic, hypotensive) and white cell count and C-reactive protein levels will be markedly raised (Beldon, 2011, Wingfield, 2009, Nazarko, 2012). It appears there is a general lack of evidence based literature surrounding the treatment of patients with cellulitis. The practitioner could only find one national guideline on the management of cellulitis in adults, which was published in 2005 by the Clinical Resource Efficiency Support Team (CREST, 2005). However, to the practitioners knowledge, these have not been validated by a clinical study. Morris, (2008) found in his systematic review that antibiotics cure 50-100% of cases of cellulitis but did not find out which antibiotic regime was most successful. Kilburn et al, (2010) also could not find any definitive conclusions in their Cochrane review on the optimal antibiotics, duration or route of administration. Eron, (2000) devised a classification system for cellulitis and its treatment which CREST used in their guidelines. This system divides people with cellulitis into four classes and can serve as a useful guide to admission and treatment decisions. However Koerner Johnson, (2011) found in their retrospective study, comparing the treatment received with the CREST guidelines, that patients at the mildest end of the spectrum were over treated and at the more severe end undertreated. They also found a significant variation in antibiotic regimes prescribed for patients with cellulitis. Marwick et al, (2011) questioned whether classes I and II could actually be merged to improve treatment. The practitioners trust has antibiotic guidelines (updated yearly) which also include a classification system. This aids the prescriber in choosing the correct antibiotic, dose, route and duration for certain conditions, cellulitis being one of them. After discussion with the Registrar it was determined that Mrs A was in Class I or non-severe which meant she could be managed with oral antibiotics on an outpatient basis. The practitioners trust and CREST, (2005) guidelines advise first line treatment for non-severe or class I cellulitis as oral Flucloxacillin 500mg, three times a day. Flucloxacillin is a moderately narrow-spectrum antibiotic licensed for the treatment of cellulitis. However, Flucloxacillin was contra-indicated for Mrs A as she had a severe penicillin allergy (British National Formulary, (BNF) 2012). Clarithromycin is a macrolide which has an antibacterial spectrum that is similar but not identical to that of penicillin; they are thus an alternative in penicillin-allergic patients (BNF, 2012). Clarithromycin is licensed and recommended by CREST, (2005), and by the practitioners trust, as an alternative to Flucloxacillin in cellulitis for patients with a Penicillin allergy. It is indicated in the BNF, (2012) for the treatment of mild to moderate skin and soft-tissue infections. It demonstrates suitable pharmacokinetics, with good distribution into skin and soft tissues, and is effective against the large majority of staphylococcal and streptococcal bacteria that cause cellulitis (Accord Healthcare Limited, 2012), (See drug monologue page 21-28). There were no contraindications in prescribing Clarithromycin for Mrs A. The option of not having any medication was discussed with Mrs A however, she wanted treatment so the benefits and side effects of Clarithromycin was explained, and consent obtained from Mrs A to prescribe the antibiotics and to be discharged, (NMC Practice Standard 5, 2006). Dose and duration were then also clarified and the importance of taking the antibiotics as prescribed and to complete the full course. On reflection, by discussing and deciding on the best treatment together this would hopefully promote concordance. Negotiating with patients and agreeing on a management plan is very important aspect of reaching patient centred care (Neighbour, 2005). Using an FP10 Clarithromycin tablets 500mg twice a day was prescribed by the Registrar (as the practitioner was not a licensed prescriber, NMC Practice Standard 1, 2006), as per trust guidelines, for 7 days. Paracetamol tablets 1g four times a day was also prescribed for its analgesic and anti-pyretic properties (BNF, 2012). A stat dose of both were prescribed and the practitioner asked the nurse to administer the first dose (NMC Practice Standard 9 14, 2006), and was aware that by delegating this task the prescriber remained accountable. The FP10 was given to the patient to take to the pharmacy of her choice for them to dispense (NMC Practice Standard 10, 2006), (See mock prescription page 29). The practitioner did not initially contemplate cost effectiveness but on reflection it has been recognised that this needs to be taken into consideration when prescribing (NPC, 1999). Intravenous antibiotics may have been prescribed, which may have meant an admission into hospital or administration by nurses on an outpatient basis; thus would have increased the cost of treatment significantly. Admission to hospital can also be overwhelming and can put the patient at risk of hospital acquired infections and increased risk of antibiotic resistance (Wingfield, 2008). Safety Netting The erythematous border was marked, with the patients consent, with permanent pen to monitor for any improvement or additional spread of infection (CREST, 2005, Beldon, 2011). The practitioner advised Mrs A that she should return or see her GP if she had worsening symptoms or if by the completion of the course of antibiotics symptoms had failed to resolve. Mrs A was also advised that, if a similar incident occurred, she should seek medical assistance early so that treatment could begin as soon as possible to reduce the risk of severe and long-term complications. In addition it was recommended that she should drink plenty of fluids to prevent dehydration, elevate the leg for comfort and to help reduce the swelling (CREST, 2005, Beldon, 2011). Mrs A was warned that there could be an increase in erythema in the first 24-48 hours of treatment (CREST, 2005). This advice and information empowered Mrs A and made sure that her discharge was as safe as possible. The practitioner brought the consultation to a close by asking Mrs A if she had any questions or if there was anything else she would like to discuss. This gave Mrs A the opportunity of clarifying any information given by the practitioner and the opportunity to divulge any information or concerns not previously mentioned. This re-assured the practitioner that she had addressed her problem appropriately. Housekeeping The practitioner made sure there was clear concise documentation of the consultation and choice of prescription in Mrs A notes (NMC Practice Standard 7, 2006). A discharge letter was also produced to send to her GP NMC Practice Standard 6, 2006). Once the prescription was ready, Mrs A was discharged. This case study has shown the practitioner the importance of effective communication in consultation. By following Neighbours consultation checkpoints it gave structure to the consultation and will be used by the practitioner in future practice. It has also helped the practitioner to gain an understanding of different prescribing options and how to explore these further. For example, the practitioner did find when reading around the subject that there has been some research on the use of corticosteroids in cellulitis to increase resolution, however, to the practitioners knowledge, this is not currently advised in any guidelines and further research is needed. The practitioner would also like to be involved in the development of a cellulitis pathway at her place of work. This could include an algorithm to aid practitioners to differential diagnosis so patients can receive appropriate treatment and reduce the incorrect prescribing of antibiotics. As there are no National Institute for Health and Clinical Excellence (NICE) guidelines on the treatment and management of cellulitis, treatment of patients is not standardised and consequently quality of care could be affected. The optimal choice for antimicrobial therapy requires review and definitive study in clinical trials. References Accord Healthcare Limited (2012) Summary of Product Characteristics for Clarithromycin Capsules 500mg. [online]. Electronic Medicines Compendium. Datapharm Communications Ltd. Available from: http://www.medicines.org.uk/EMC/medicine/25914/SPC/Clarithromycin+500mg+Tablets/ [Accessed 21ST September 2012] Byrne, P. Long, B. (1976) Doctors Talking to Patients. London, HMSO. Baird, A. (2004) The Consultation. Nurse Prescriber. (1) 3: 1-4 British National Formulary: No. 64 (2012) London: BMJ Group and Pharmaceutical Press. Bickley, L. (2008) Bates Guide to Physical Examination and History Taking. 6th Ed. London: Lippincott, Williams and Wilkins. Beldon, P. (2011) The Assessment, Diagnosis and Treatment of Cellulitis. Wound Essentials. (6): 60-68. Clinical Research Efficiency Support Team (2005) Guidelines on the Management of Cellulitis in Adults. Belfast: Clinical Research Efficiency Support Team. Charlton, R. (2006) Learning to Consult. Abingdon: Radcliffe. Department of Health (1999) Review Of Prescribing, Supply And Administration Of Medicines. (The Crown Report) London: HMSO. Epstein, O. Perkin, G. Cookson, J. De Bono, D. (2008) Clinical Examination. 4th Ed. London: Mosby. Eron, L. (2000) Infections of Skin and Soft Tissues: Outcome of A Classification Scheme. Clinical Infectious Diseases. (31) 287 Frankel, R. Quill, T. McDaniel, S. (2003) The Biopsychosocial Approach: Past, Present, and Future. Rochester: University Of Rochester Press. Gask L, Usherwood, T. (2002) ABC of Psychological Medicine: The Consultation. British Medical Journal (324) 7353: 1567-1569. Horrocks, S. Anderson, E. Salisbury, C. (2002) Systematic Review of Whether Nurse Practitioners Working in Primary Care Can Provide Equivalent Care to Doctors. British Medical Journal. (324) 7341: 819-823. Jarvis, C. (2008) Physical Examination and Health Assessment. 5th Ed. Missouri: Saunders Elsevier. Jennings, N., Lee, G., Chao, K., Keating, S. (2009) A Survey of Patient Satisfaction in a Metropolitan Emergency Department: Comparing Nurse Practitioners to Emergency Physicians. International Journal of Nursing Practice (15) 213-218. Kilburn, S., Featherstone, P., Higgins, B., Brindle, R. Interventions for Cellulitis and Erysipelas. Cochrane Database Systematic Reviews. 2010 Issue 6, Art. No. CD004299. DOI:  10.1002/14651858. Koerner, R. Johnson, A. (2011) Changes in the classification and management of Skin and Soft Tissue Infections. Journal of Antimicrobial Chemotherapy. (66) 232-234. Kurtz S, Silverman J, Benson J, Draper J. (2003) Marrying Content and Process in Clinical Method Teaching; Enhancing the Calgary-Cambridge Guides. Academic Medicine (78) 8: 802-809. Marwick, C. Broomhall, J. McCoowan, C. Phillips, G. Gonzalez-McQuire, S. Akhras, K. Merchant, S. Nathwani. Davey, P. (2011) Severity Assessment of Skin and Soft Tissue Infections: Cohort Study of Management and Outcomes for Hospitalised patients. Journal of Antimicrobial Chemotherapy. (66): 387-397 Morris, A. (2008) Cellulitis and Erysipelas. Clinical Evidence. [online] BMJ Publishing Group Ltd. Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907977/ [Accessed 10th September 2012] Moulton L. (2007) The Naked Consultation: A practical Guide to Primary Care Consultation skills. Abingdon: Radcliffe. National Prescribing Centre. (1999) Signposts for Prescribing Nurses General Principles of Good Prescribing. Prescribing Nurse Bulletin. (1): 1-4. Nazarko, L. (2012) An Evidence-Based Approach to Diagnosis and Management of Cellulitis. British Journal of Community Nursing. (17) 1: 6-12. Neighbour, R. (2005) The Inner Consultation. How to Develop an Effective and Intuitive Consulting Style. 2nd Ed. Oxford: Oxford-Radcliffe. Nursing and Midwifery Council (2006) Standards of Proficiency for Nurse and Midwife prescribers. London: Nursing and Midwifery Council. Nursing and Midwifery Council (2008) The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives. London: Nursing and Midwifery Council. Pendleton, D. Schofield, T. Tate, P. Havelock, P. (1984) The Consultation: An Approach to Learning and Teaching. Oxford: Oxford University Press. Silverman, J. Kurtz, S. Draper, J. (2005) Skills for Communicating with Patients. 2ND Ed. Oxford: Radcliffe. Silverman, J. Kinnersley, P. (2010) Doctors Non-Verbal Behaviour in Consultations: Look at the Patient Before You Look at The Computer. British Journal of General Practice. (60): 76-8. Simon, C. (2009) The Consultation. InnovAiT (2) 2: 113-121. [online] Available at http://rcgp-innovait.oxfordjournals.org/content/2/2/113.full. [Accessed 13th September 2012] Stott, N. Davis, R. (1979) The Exceptional Potential in Each Primary Care Consultation. Journal of the Royal College of General Practitioners. (29): 201-5. Wingfield, C. (2009) Lower Limb Cellulitis: A Dermatological Perspective. Wounds UK. (5) 2: 26-36. Wingfield, C. (2008) Cellulitis: Reduction of Associated Hospital Admissions. Dermatological Nurse 7(2): 44-50. Wilson, A. Shifaza, F. (2008) An Evaluation of the Effectiveness and Acceptability of Nurse Practitioners in an Adult Emergency Department. International Journal of Nursing Practice. (14): 149-156. Young, K. Duggan, L. Franklin, P. (2009) Effective Consulting and History-Taking Skills for Prescribing Practice. British Journal of Nursing. (18) 17: 1056-1061. Drug Monologue. Name of Drug Clarithromycin Drug Classification Macrolide Therapeutic Uses(s) Clarithromycin film-coated tablets are indicated in adults and adolescents 12 years and older for the treatment of the following bacterial infections, when caused by clarithromycin-susceptible bacteria. à ¢Ã¢â€š ¬Ã‚ ¢ Acute bacterial exacerbation of chronic bronchitis à ¢Ã¢â€š ¬Ã‚ ¢ Mild to moderate community acquired pneumonia. à ¢Ã¢â€š ¬Ã‚ ¢ Acute bacterial sinusitis à ¢Ã¢â€š ¬Ã‚ ¢ Bacterial pharyngitis. à ¢Ã¢â€š ¬Ã‚ ¢ Skin infections and soft tissue infections of mild to moderate severity, such as folliculitis, cellulitis and erysipelas Clarithromycin film-coated tablets can also be used in appropriate combination with antibacterial therapeutic regimens and an appropriate ulcer healing agent for the eradication of Helicobacter pylori in patients with Helicobacter pylori associated ulcers Dose range and route(s) of administration Adults and adolescents (12 years and older) à ¢Ã¢â€š ¬Ã‚ ¢ Standard dosage: The usual dose is 250 mg twice daily. à ¢Ã¢â€š ¬Ã‚ ¢ High dosage treatment (severe infections): The usual dose may be increased to 500 mg twice daily in severe infections. Children younger than 12 years: Use of Clarithromycin film-coated tablets is not recommended for children younger than 12 years. Use Clarithromycin paediatric suspensions. Clinical trials have been conducted using clarithromycin pediatric suspension in children 6 months to 12 years of age. Elderly: As for adults Dosage in renal functional impairment: The maximum recommended dosages should be reduced proportionately to renal impairment. In patients with renal impairment with creatinine clearance less than 30 mL/min, the dosage of clarithromycin should be reduced by one-half, i.e. 250 mg once daily, or 250 mg twice daily in more severe infections. Treatment should not be continued beyond 14 days in these patients. Patients with hepatic impairment: Caution should be exercised when administrating clarithromycin in patients with hepatic impairment Administered orally. Pharmacodynamics Mode of Action Clarithromycin is a semi-synthetic derivative of erythromycin A. It exerts its antibacterial action by binding to the 50s ribosomal sub-unit of susceptible bacteria and suppresses protein synthesis. It is highly potent against a wide variety of aerobic and anaerobic gram-positive and gram-negative organisms. The 14-hydroxy metabolite of clarithromycin also has antimicrobial activity. The MICs of this metabolite are equal or two-fold higher than the MICs of the parent compound, except for H. influenzae where the 14-hydroxy metabolite is two-fold more active than the parent compound. Side Effects Dyspepsia, tooth and tongue discoloration, smell and taste disturbances, stomatitis, glossitis, and headache; less commonly: arthralgia and myalgia; rarely: tinnitus; very rarely: dizziness, insomnia, nightmares, anxiety, confusion, psychosis, paraesthesia, convulsions, hypoglycemia, renal failure, interstitial nephritis, leucopenia, and thrombocytopenia Interactions Aprepitant Clarithromycin possibly increases plasma concentration of aprepitant Atazanavir Plasma concentration of both drugs increased when Clarithromycin given with atazanavir. Atorvastatin Clarithromycin increases plasma concentration of atorvastatin. Cabazitaxel Avoidance of clarithromycin advised by manufacturer of cabazitaxel. Calcium-channel Blockers Clarithromycin possibly inhibits metabolism of calcium-channel blockers (increased risk of side-effects). Carbamazepine Clarithromycin increases plasma concentration of carbamazepine. Ciclosporin Clarithromycin inhibits metabolism of ciclosporin (increased plasma concentration). Colchicine Clarithromycin possibly increases risk of colchicine toxicity-suspend or reduce dose of colchicine (avoid concomitant use in hepatic or renal impairment). Coumarins Clarithromycin enhances anticoagulant effect of coumarins. Disopyramide Clarithromycin possibly increases plasma concentration of disopyramide (increased risk of toxicity). Dronedarone Avoidance of clarithromycin advised by manufacturer of dronedarone (risk of ventricular arrhythmias). Efavirenz Increased risk

Essay --

Electronic health records or electronic medical records depending on where you are reading are becoming a growing trend in the health care field. When we go to the doctor’s office, we are familiar with a folder containing all of our medical visits, immunizations we have received, and medical treatments we may have also received. All of this information is kept in a folder and either stored on site or it is sent off to a storage facility. The new trend of electronic health records are suppose to simplify and make things a lot easier for both the patient and the health care workers. Imagine going to a doctor’s appointment for a physical and your medical records were not present. There is no way for the doctor’s office and staff to know what shots you have received and needed to renew. This had actually happened to me. I went for a physical that is needed for the nursing program in November and my doctor’s office did not have my charts on hand and need ed to request them from Iron Mountain. Why they didn’t have it ready before my appointment, nobody knows and to this day are unable to answer. If they had transitioned to the electronic health recording, they would have been able to pull up my records right there and then. Instead, they had inconvenienced me (by having me come back) and set their schedules back because another appointment was needed to be rescheduled. Electronic health records are an electronic/digital version of a patient’s medical records. It is recorded in real-time and is readily available as soon as it is updated. It is a secured digital way of keeping track of a patient’s medical records and only authorized medical personnel are able to have access to them. Electronic health records was developed in ... ...t has also opened up other options for physicians like Filipiuk who can’t adapt to the new system and have another way of getting their job completed. In conclusion, electronic health records are a new trend that will affect patients, health care providers and physicians in a positive way. It will allow a universal database for all health care providers to access and to have everyone on the same page. Patients and physicians will see improvement in quality and convenience of patient care, increased patient participation in their care, improved accuracy of diagnosis and health outcomes, improved care coordination, and increased practice efficiencies and cost savings. In order to increase awareness of electronic health records, education is the central focus. Like with anything new, it will take time for patients, physicians, and health care providers to adjust.

A Guard on Religious Freedom Essay examples -- essays research papers

Persuasive Essay #1   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  A Guard on Religious Freedom In the eyes of our founding fathers, few things seemed as important as the separation of church and state. The first amendment grants all Americans the freedom to subscribe to any religion they wish and promises that the government will not promote any religion above any other. Although the separation of church and state and the freedom of religion are firmly and concretely secured in the Constitution of the United States, events in the recent past bring to question whether this ideal is under threat of losing its place as an American standard. A recent controversy that brings to light the threat of the separation of church and state is the debate over the words â€Å"one nation under God† in the pledge of allegiance. A review of current event programs when the offense first unfolded showed few other stories as important as an attack on our separation of church and state. Although maintaining a critical eye on our rights and assuring that no true threats develop on one of the cornerstones of the country, it is important to also keep in perspective whether a true infraction has taken place. On several American artifacts you can find a reference to God. However, taking offense to these references is counterproductive and overly sensitive. First, the God mentioned on these American artifacts is a generic God and only means that the collective A...