Literature Review Partitioned Bayesian Analyses

Question: Discuss about the Literature Review for Partitioned Bayesian Analyses. Answer: Introduction In the paper by Ciccarelli, the problems associated with the construction of the phylogenetic tree of life are presented. Although the evolutionary relationships of many organisms have been successfully placed in the tree of life, there have been numerous debates on this issue (Brandley et al., 2005). The author indicates that even after the advent of generation of genomic data through molecular biology techniques, there are increasing debates on the tree of life. These debates are as a result of lack of proper theoretical and practical limits that are set out during the construction of a phylogenetic tree. In other cases, there are concerns on the lack of sufficient characters (Kremp et al., 2014). In the computing resources so as to be able to cope up with increasing number of species. In essence, there can a rise in biasness in terms of sampling of species as well as the dilution of the horizontal gene transfer in bacteria. In figure one, of this article, the process of developing a phylogenetic tree by use of bootstrap is presented. In this figure, the major steps are presented alongside the parts that can be automated (Chao et al., 2014). As a result of evolution which takes place, the construction of a phylogenetic tree involves the collection of data which is representative of the ancestral relationship (Ciccarelli et al., 2006). Then the universal families are identified, followed by the removal of the families that may contain several gene transfers. The next step is to construct the tree by use of concatenated alignment. This step involves the removal of pseudo genes, paralogs and copies of the organelles. The remaining genetic materials are aligned in a way that they cover all the three domains of life. The next step is to perform the detection of any horizontal gene transfers and removing them. In this case, the randomly chosen samples consisting of eight families are subjected to jack knife te sts (Yilmaz et al., 2014). The final step involves the reconstruction of the phylogenetic tree by use maximum likelihood approaches which is aided by use of bootstraps, gamma 4 and the phyml protocols. Bootstrap is the use of the already obtained data to make inferences of uncertain data. This method improves statistics because it pulls on its bootstraps by sampling the input data. In this case, bootstrapping gives an indication on the number of times, out of 100, a certain branch of the phylogenetic tree is observed when the construction of a phylogenetic tree is repeated on a set of resampled data (Schreiber et al., 2014). From the caption, the official title for figure2 is on the global phylogeny of fully sequenced organisms showing the alignment of 31 universal proteins in bacteria, archaea and eukaryote. However, the decoded title from this figure is the representation of the evolutionary relationship of bacteria, archaea and eukaryotes on the basis of 31 proteins alignment. The specific questions being answered in the experiment which yielded figure 2 is, how are evolutionary trends determined in bacteria by the use of protein families? The data which was used for the reconstruction of the phylogenetic tree presented in Figure 2 was derived from 31 concarnated genes that occur universally and had undisputable orthologs. From around 91 species whose genomes were already annotated. The 31 genes used are important in transduction and hence were based on the non-translational genes which are domain-specific. In general, from figure 2, it is evident that the proteins used to construct an evolutionary tr ee should be based on protein families that are universally expressed by all species. As the branching of the tree continues, more specific proteins are put into consideration in order to determine the length of the branches which corresponds with the level of relatedness (Ciccarelli et al., 2006).. Moreover, from this figure, it can be noted that when constructing the phylogenetic tree, it is important to ensure that all the three domains of life are considered. Although much information has been presented in these articles, there are some concerns which can be raised. For instance, the accuracy of the phylogenetic tree, the recommended tools for use in bootstrapping and the ways to choose the closely related family problems. These questions can be structured in this manner; how can the accuracy of a phylogenetic tree be determined? What are the recommended tools to be used to generate a phylogenetic tree? What are the recommended methods of choosing the family proteins for use in the construction of a phylogenetic tree? Dagon and Martin calls the tree which was generated by Ciccarelli et al., as the tree of one percent because its construction was based on the assumption that all genes are linked by a single bifurcating tree in terms of evolutionary relatedness (Dagan and Martin, 2006). For instance, since the genome of prokaryotes have about 3,000 genes that code for proteins use of 31 proteins by Ciccarelli et al., indicates that these proteins were representative of only 1 % of the prokaryotic genome, which is not fully representative. Based on the comparison between the prokaryotic proteome and the proteins used, the Ciccarelli et al., tree is thus an insufficient model. The origin of these genes is very important because it offers a clear indication of the nature of the evolutionary relatedness between organisms. The authors of this article argue that the origin of the genes used to construct this tree was based on endosymbiosis. In this case, it is argued that the eukaryotes acquired many gene s from the endosymbionts (Baum and Smith, 2013). The process that Dagan and Martin argue that was neglected by Ciccarelli et al., is the lack of consideration of whether the genes could make a phylogenetic tree. This analysis is important because it gives a biologist an opportunity to study he patterns and level of genetic relatedness of various species. From figure 2 in the article by Ciccarelli et al., it is evident that within each of the levels of taxonomy between the eukaryotes, archaea and bacteria the length of the branches is different. On the other hand, there is a strong discrepancy between the divisions in prokaryotes and eukaryotes (Winter et al., 2013). For instance, there are some animals which have been assigned to make a separation in a certain phylain eukaryotes is able to be classified in the same phyla as in the prokaryotes too. In figure 2 by Dagon and Martin, the symbiotic tree model is similar to Ciccarelli et al., model of evolutionary relationship is the symbiotic tree which proposes that the common ancestor in eukaryotes was from the endosymbiotic process of one prokaryote, say X, in another prokaryote host, say Y (Dagan and Martin, 2006).. this process led to the development of a nucleated eukaryote which gave rise to several other eukaryotes from a common lineage. Although the work by Ciccareli et al was published in a prestigious journal, Science, the immediate criticism by Dogon and Martins, despite the comments given by the reviewers and editors indicate that through intensive research, other researchers determined a gap in construction of a phylogenetic tree. It is the paper by Ciccareli et al which supports the fact that some computer programs assume that the history of life is best depicted by use of a tree. This is true because some of these computer programs use the bootstrap method so as to determine the relatedness of unknown proteins based on the known proteins from various species. The article by Koonin ends the controversy in the initial two articles by indicating that there are numerous gene exchange processes which take place in organisms. In this case, the reliability of phylogenetics becomes an issue of concern because viruses and plasmids re the major agents of horizontal gene transfer. The arguments of Koonin as presented in this article are convincing because when there is increased cases of gene transfers and recombination, then the evolutionary tree of life might not be relevant (Koonin, 2016). However, Koonin advices that endosymbiosis blocks the horizontal gene transfers and thus phylogenies should be used with caution. Reference List Ciccarelli, F.D., Doerks, T., Von Mering, C., Creevey, C.J., Snel, B. and Bork, P., 2006. Toward automatic reconstruction of a highly resolved tree of life. science, 311(5765), pp.1283-1287. Koonin, E.V., 2016. Horizontal gene transfer: essentiality and evolvability in prokaryotes, and roles in evolutionary transitions. F1000Research, 5. Dagan, T. and Martin, W., 2006. The tree of one percent. Genome biology, 7(10), p.118. Brandley, M.C., Schmitz, A. and Reeder, T.W., 2005. Partitioned Bayesian analyses, partition choice, and the phylogenetic relationships of scincid lizards. Systematic biology, 54(3), pp.373-390. Kremp, A., Tahvanainen, P., Litaker, W., Krock, B., Suikkanen, S., Leaw, C.P. and Tomas, C., 2014. Phylogenetic relationships, morphological variation, and toxin patterns in the Alexandrium ostenfeldii (Dinophyceae) complex: implications for species boundaries and identities. Journal of phycology, 50(1), pp.81-100. Baum, D.A. and Smith, S.D., 2013. Tree thinking: an introduction to phylogenetic biology. Roberts. Yilmaz, P., Parfrey, L.W., Yarza, P., Gerken, J., Pruesse, E., Quast, C., Schweer, T., Peplies, J., Ludwig, W. and Glckner, F.O., 2014. The SILVA and all-species living tree project (LTP) taxonomic frameworks. Nucleic acids research, 42(D1), pp.D643-D648. Winter, M., Devictor, V. and Schweiger, O., 2013. Phylogenetic diversity and nature conservation: where are we?. Trends in Ecology Evolution, 28(4), pp.199-204. Schreiber, F., Patricio, M., Muffato, M., Pignatelli, M. and Bateman, A., 2014. TreeFam v9: a new website, more species and orthology-on-the-fly. Nucleic acids research, 42(D1), pp.D922-D925. Chao, A., Chiu, C.H. and Jost, L., 2014. Unifying species diversity, phylogenetic diversity, functional diversity, and related similarity and differentiation measures through Hill numbers. Annual Review of Ecology, Evolution, and Systematics, 45, pp.297-324.

Discussion on Medication Management-Free-Samples for Students

Question: Discuss about the Medication Management. Answer: Importance of the topic: Medication Management Medication error is a kind of error that causes inappropriate application of medication over the patient, causing potential harm (Fatemah et al. 2013). The medication error is preventable but when it occurs in an emergency department of a hospital, the situation becomes fatal. The medication management lies solely in the hand of the health care professionals and generally deals with the norms, process and the mode of administration of the medicines. The importance of the topic lies in the fact that such management directed towards the medication will cut-short the occurrence of the manual error occurring in the emergency department and thereby reducing the rate of mortality and unwanted deterioration of the patients health condition. The medication management system will promote the development of the proper medication plan, or the routine protocol that needs to be undertaken while providing medication to any patient admitted in an emergency unit and will also encourage proper intera ction between the nurses and the doctors (Patanwala et al. 2012; Moorhead et al. 2014). Audit Standards Maintained The number of nurses with respect to doctors is high along with the increase in the number of non-veterans doctors; amount of medication error is increasing vigorously. The latest data obtained from the Kings Hospital, Singapore states that, majority of the casualties in the emergency unit of the hospitals have occurred because of the medication errors. The medication error statistics shows drastic increase of medication error incidence. 3 cases are reported in 2016 and 10 cases in 2017. Moreover, there are 2 unfortunate Serious Reportable Events (SREs) that have occurred within one-month in year of 2017. Here SRE is defined as adverse event that causes negative effect leading to an unintended harmful impact on the patient, which may or may not have been prevented (MOH 2014). Emergency Department (ED) has a stressful environment with high turnover rate of patient and unpredictable critical events. Such sudden events and work pressure make ED to suffer from high frequency of medicatio n error. The statement holds true across the nation (Vazin, Zamani and Hatam 2014). In promotion of patient safety level, medication safety had long been recognized to be important in the field of healthcare provision (MOH 2006) Based on the escalating medication error incidence in the beginning of 2017; it was predicted the same scenario will prevail for the rest of the year. Given the significance of the current report of MEs in ED, it is very important to develop an audit on the medication administration on all Registered Nurses (RN) in this ED in order to find out their performance and identify the area of improvement. This will help to combat further ME incidence and will enhance the level of patient safety. The nursing audit is an exercise to elucidate whether good nursing practices are followed in a particular health care unit where the nursing audit is being carried out. In Singapore, according to Medication Safety Practice Guide, all healthcare professionals have equal shar e of responsibility to ensure medication safety especially for the nurses. Nurses hold a important position which acts as a last barrier to prevent any medication error happening at the bedside. (MOH 2006) All nurses must abide by the authorized guidelines, standards and evidence based best practices (MOH 2006). Figure: Medication Error Statistics (Kings Hospital, Singapore for the year of 2016-2017) Each medical nurse or midwifery specialist is relied upon to create and keep up skill with respect to all parts of medicine administration, guaranteeing that her/his insight, aptitudes and clinical practice are breakthrough. The pharmaceutical administration requires the nurse/midwife to be responsible in managing the medicinal management for the patient/benefit client, the general population. The nurses must adopt the administration of the best medicine after the authorized standards are being made. The audit standards that the nurses/midwives can adopt are the The nurses should be aware of the legal and professional responsibilities The nurses must have access to the medicines in need of the patient need and there will be support of the local systems The nurses must be aware of the actions and omissions of the role of the nurses in administering a prescribed medicine They must actively follow the transcription as mentioned by the visiting doctor They will have to follow the administration and frequently monitor the desired effect of the drug and make review The nurses should have an understanding for the drug prescription and the potential side effects. They must be efficient enough to identify, intervene and report the adverse conditions They should understand the purpose of the medicines that is been registered. The nurses must seek all the information in a written form prior to the audit study The audit can be done if the nurses know the potential benefits and the misuse of the drugs which is being administered to the patient The nurses must adhere with the requirements of the Misuse of Drugs act and regulations to follow a strict regime in the audit They must be well aware of the factors that are involved in the medicinal errors like right of the patient, mode of administration of the prescribed drug, the time of cyclic administration of the medicine in a routine base and route of administration Nurses must be aware of the special care regime need to be undertaken during the intravenous administration of the drugs and these include the duration of administration, the ratio of dilution, the drug compatibility and the speed to administration or transfusion through the veins (Gardner, Gardner and O'connell 2014) Audit Questions The 5 specific audit questions, solely directed towards the concept of the medication management which the nurses are requirement to fill at the time of medicine administration are Does the hospital have a medicines policy that is practiced in the hospital? Are the medicines kept safe in the hospital? Are medicines requiring refrigeration stored in a separate refrigerator? Are refrigerated medicines properly labeled to indicate storage requirements? Are dosage instructions clear and is the medication administration record completed correctly? Audit Setup The audit was done at emergency department of the Kings hospital Singapore. It is a multidisciplinary hospital. Population and Sampling All the nurses of the emergency unit of the Kings hospital in Singapore will be involved in the audit. The exact population who will be examined are the 150 registered nurses. The number of samples who are actually being audited are 150 veteran nurses of the emergency unit Introduction Medication management can be regarded as the principal responsibility of a nurse in any health care setting (Health Information and Quality Authority (HIQA) 2009). It is a complex process, which involves several steps like prescribing proper medicines, ordering the medicines, dispensing the used vials and syringes, supplying the medicines to the wards, then finally administering the drug, and storing via proper refrigeration (Dilles et al. 2012). Research suggests that error in any phase of the medication cycle, adversely effects the patients physical safety, which is comes under the highest priority in the nursing practice (Weaver et al. 20013). Moreover, adverse drug events are common in the emergency unit of the hospitals and hospital residents are more susceptible to such threats because of high occurrence of polypharmacy and change in pharmacokinetics and pharmacodynamics. The pharmacokinetic and pharmacodynamics varies with age and have a huge influence over the durg interactio ns and associated side-effects (Dilles et al. 2012, p.172). In the nursing practice, the nurses are religiously trained to preach the five basic rights of medication administration. The 5 rights are include, the right of medication, right dose, right route, right time and right patient. However, evidence indicates that majority of the nurse fail to preach these five basic rights. Therefore, additional strategies are required to be implemented in order to negate the chances of the medication errors. This additional strategy comes in the form of nursing audit. The objectives of this audit were: The aim of this project is to implement best practices prevalent in medication management in the emergency unit of the hospital. The principal objectives are to reduce the overall rate of occurrence of the medication errors or the chances of adverse drug events through incident reporting and adherence to the medication administration via following safety guidelines. The additional objectives of this dissertation are to promote the overall safety quotient of the residents via complying the professional and national standards of nursing on the medication management. Rationale Medical Audits Technology Systems have designed an audit system to promote the improvement of the operation of the medication safety in the clinical areas. It also ensures compliance with legislation and thereby improves medication management to prevent patient harm (McBane et al. 2015). The importance of the medication management lies in the fact that it promotes proper monitoring of the medicines that are going to be administered to the patients. It also evade the chances of the unsafe medication communications with over-the-counter medications or different cross-reactivity of the pharmaceuticals. This is particularly imperative for those taking extensive quantities of drugs to address interminable ailments and different maladies, which is more predominant among seniors (Wager, Lee and Glaser 2017). The Health (Nursing Homes) (Amendment) Act (Health Act) (2007) states that all the suppliers and the social care administrations (private and government hospitals), need to enlist with HIQA and need to claim that they attempt to observe controlled exercises as characterized in the Act. Numerous proposals were made to guarantee that the supplier/individual in control (nurture director/pioneer) conform to the Health Act 2007 and National Quality Standards for Residential Care Settings for Older People before they get officially enrolled. These suggestions can only be implemented by the change in structure and frameworks of the association (Smith, Bates and Bodenheimer 2013). Background Drug administration in nursing is extensively characterized. It deals with the protected and successful utilization of the remedy and over-the-counter restorative items. The nurses and midwives are the most important members in solution administration and add to persistent/benefit client mind. Pharmaceutical administration is a complete mediation, which includes the learning of trained nurses and the exercises that are performed to help the patient/benefit client in accomplishing the best advantage and best results including drugs. The duties of pharmaceutical administration fuse the appraisal, arranging, execution and assessment of the nurses (Sousa et al. 2017). The Medication Management Plan (MMP) of Singapore furnishes wellbeing specialist co-ops with a standard frame that can be utilized by nurses and the associated wellbeing staff to enhance the exactness of data recorded on confirmation and accessible to the clinician in charge of restorative basic leadership (Westbrook et al. 2015). Standard recording of the prescriptions taken preceding introduction at the hospital and accommodating of patients' pharmaceuticals on affirmation, intra-doctor's facility exchange and at release is viewed as fundamental for the medicine compromise process. The MMP gives an appropriate paper frame to this reason. The MMP shape was intended for use in minor and grown-up patients (Walker and Colledge 2013). Audit purpose Assessing and monitoring the quality of service provisions To provide the evidence of competence Preventing and reducing errors Demonstrating accountability Developing and training staffs Methods Standards The audit standards will be created on the basis of the emergency department of the organization. The audit survey will be conducted at the emergency department of the multidisciplinary hospital in Singapore, Kings Hospital. Setting The audit will be done in the emergency ward of the department of multidisciplinary hospital, Kings hospital Singapore. Population The population required in this will be 150 registered nurses in the emergency unit out of 150 total nurses. Data collection The data was collected by distributing the questionnaire among the nurses who are attending patients in the emergency unit. The nurses only after having the proper knowledge about the patient and the medicines are asked to fill the questionnaire in Yes or No format while administering the medicine to the patient. A planned investigation includes the accumulation of the information related to pharmaceutical information. Audit examination is finished utilizing graph audits or other information sources to survey pharmaceutical use as indicated by pointers and criteria arranged ahead of time (Billingham, Whitehead and Julious 2013). The benefit of a forthcoming survey is that the drug specialist (or other commentator) can mediate at the time the solution is apportioned to counteract blunders in, for instance, dose, signs, or cooperation. Audit assessment, may include a greater amount of the analyst's opportunity or expect access to medicinal records, is best expert when the commentator has time far from the patient care zones and diversions. Commonly, solution related criteria that are explored in these sorts of assessments are as per the following Prospective studies (obtained from prescription records) (Herrett et al. 2015) Indication of the dosage Dose of the drug per body mass and age Duration of therapy and degree of toxicity Dosage form and route of administration Potential medicine interactions or drug cross-reactivity Appropriate therapy and medicine selection Therapeutic duplication Contraindications in medication with drug allergy and age Quantity dispensed Retrospective studies (obtained from prescription, medical records, and laboratory records) (Aiken et al. 2014) Proper Laboratory monitoring Monitoring of the therapeutic use of high-cost medicines ADRs to medications Correct use of generic or therapeutic equivalents Patient outcomes from pharmaceutical therapy Collection of the information is performed by auditing an appropriate example of outlines or solution records from the human services office, for the most part by chose drug store faculty. At any rate, 50 to 75 records ought to be explored at every human services office. The bigger the office and the more experts, who are accessible, the bigger the level of records that would should be looked into and broke down (Bronzino 2014). Data collection Table Response Res Res Res Res Res Res Res Res Res Res Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N Y/N 1. Is the patients name in the medication chart legible? 2. Has the Date of Birth of the patient been enlisted in the medication chart? 3. Is the Allergy status clearly marked on the medication chart? 4. Is the authorised doctors signature present on all medication orders? 5. Is the date of order written by the nurses on all medications orders provided the doctor? 6. Are all the medication orders clear and legible? 7. Are the medication orders has the clear indication of the patient name? 8. Are the medications orders clearly stating the route of administration of the drug? 9. Are the medications orders clearly stating the tenure or the time of medicine administration 9in case of intravenous or intramuscular or subcutaneous? 10. Are there any medicines for which the administrations have been ceased in the last 7 days? If yes has the chart been signed and dated to indicate the cessation date? Are the unused medicines returned to the pharmacy for repacking? Are the bottles or the packs of the ceased medicines removed from the patients drug trolley? 11. Are the required authorised signatures present on all the medication charts? 12. If medication refused or withheld has been recorded appropriately with proper reasons? 13. Have all the refused or withheld medicines (more than 7 consecutive doses) been referred back to the doctors for proper audit? 14. Has the pharmacy dispensed adequate stock of medicines prescribed in order to ensure that the doses are never missed under any circumstances? 15. Is the patients current photo attached at the front of the medication chart for instant identification? 16. Is the temperature of the drug storage refrigerator been strictly monitored or maintained? 17. Have all the opened eye drops or nose drops been marked with the date of seal opening date? Key Elements Standards Audit questions Patient Information Easily accessible and readily available demographics and clinical data (age, diagnosis, allergies status) via electronic system. This will ensure that the correct drug is administered to the correct patient Demographic data and medication profile such as patient identity and allergy status must be updated regularly 1. Do nurses apply barcode name bracelets and coloured allergy bracelets to every patient? (YES/NO) 1. Do nurses identify the correct patient and IC number before serving medication? (YES/NO) Drug Information To maintain an up-to-date drug knowledge among the nurses through readily accessible online references, protocols, and computerized drug information systems. All nurses must know where to look for the online up-to-date drug information resources 1. Do nurses know where to access online drug information resources? (YES/NO) Drug labeling, packing, and nomenclature To facilitate proper identification of drugs and to prevent medication error from sound alike or look alike drugs name All post filled syringes medication must be labeled with the name and strength of the medication 1. Do nurses label all post-filled syringes medication with the name and strength? (YES/NO) Staff competency and Education Staff education plays a vital role in the medication error prevention such as baseline competencies and knowledge about medications, non-formulary medication and High Alert Medication (HAM). All nurses must know the safe use and proper storage of the medications within the hospital. 1. Do nurses know the safe use and storage of medications within the hospital? (YES/NO) Table: The table represents the basis of the audit question framed (Source: Created by author) Ethical consideration In case of conducting a research, the researcher is required to strictly follow the ethical guidelines that comes under the Data Protection Act. The ethical principles along with the guidance help the researcher to conduct the research successfully. In order to carry forward the research, the researcher is required to take consent from the participants. The participants who are not interested in survey shall never be forced or compelled. Apart from taking the consent, the research needs to be quite aware about the biased factor, which is quite common in survey. Proper screening of the biasness will help in generation of the standard data, minus the false positive results. However, manipulation is not the way out for standard results and must be avoided on highest priority. Moreover, the collected data must be protected as per the privacy guidelines. The data collected was primary data and hence again privacy comes into consideration and should not be used or cited in other related wo rks. While designing the survey questionnaire, it was kept in mind that the it does not contain any personal questions that can hurt the emotion and feelings of the participants. Furthermore, for successful completion of the survey, the researcher needs to collect information from some of the most authentic resources while conveying the purpose of the survey to the participants. Now this will subsequently will make the participants more cautious and to deliver their views properly. In order to conduct this nursing audit, the researcher obtained an ethical approval. It was collected from the Institutional Review Committee along with a signed consent collected from the hospitals higher authority before data collection. The completed audit questionnaires were retrieved only after their completion in the emergency ward of the Kings hospital References Aiken, L.H., Sloane, D.M., Bruyneel, L., Van den Heede, K., Griffiths, P., Busse, R., Diomidous, M., Kinnunen, J., Kzka, M., Lesaffre, E. and McHugh, M.D., 2014. Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study.The Lancet,383(9931), pp.1824-1830. Billingham, S.A., Whitehead, A.L. and Julious, S.A., 2013. An audit of sample sizes for pilot and feasibility trials being undertaken in the United Kingdom registered in the United Kingdom Clinical Research Network database.BMC medical research methodology,13(1), p.104. Bronzino, J.D. ed., 2014.Management of medical technology: a primer for clinical engineers. Butterworth-Heinemann. Carayon, P., Wetterneck, T.B., Rivera-Rodriguez, A.J., Hundt, A.S., Hoonakker, P., Holden, R. and Gurses, A.P., 2014. Human factors systems approach to healthcare quality and patient safety.Applied ergonomics,45(1), pp.14-25. Dilles, T., Elseviers, M. M., Van Rompaey, B., Van Bortel, L. M., Stichele, R. R. V. Fatemah, D, Arash, R, Hassan, T, Sara, A, Somayaeh, H, Shadi, F and Mohammadreza, J 2013, Medication Errors in an Emergency Department in a Large Teaching Hospital in Tehran, Iranian Journal of Pharmaceutical Research, Vol 12, no. 4, pp. Gardner, G., Gardner, A. and O'connell, J., 2014. Using the Donabedian framework to examine the quality and safety of nursing service innovation.Journal of clinical nursing,23(1-2), pp.145-155. Graffigna, G., Barello, S., Libreri, C. and Bosio, C.A., 2014. How to engage type-2 diabetic patients in their own health management: implications for clinical practice.BMC public health,14(1), p.648. Hamer, S. and Collinson, G., 2014.Achieving Evidence-Based Practice E-Book: A Handbook for Practitioners. Elsevier Health Sciences. Herrett, E., Gallagher, A.M., Bhaskaran, K., Forbes, H., Mathur, R., van Staa, T. and Smeeth, L., 2015. Data resource profile: clinical practice research datalink (CPRD).International journal of epidemiology,44(3), pp.827-836. Jokanovic, N., Tan, E.C., van den Bosch, D., Kirkpatrick, C.M., Dooley, M.J. and Bell, J.S., 2016. Clinical medication review in Australia: a systematic review.Research in Social and Administrative Pharmacy,12(3), pp.384-418. McBane, S.E., Dopp, A.L., Abe, A., Benavides, S., Chester, E.A., Dixon, D.L., Dunn, M., Johnson, M.D., Nigro, S.J., Rothrock?Christian, T. and Schwartz, A.H., 2015. Collaborative drug therapy management and comprehensive medication management?2015.Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy,35(4). MOH, 2006, Medication Safety, Accessed 19 August 2017 https://www.moh.gov.sg/content/dam/moh_web/HPP/all_healthcare_professionals/Medication%20Safety.pdf MOH, 2014, Directives for Review of Serious Reportable Events for Prescribed Healthcare Institution: Regulation 12A (1)(b) of the private Hospitals and Medical Clinics Regulations (CAP 248, RG 1), Accessed 19 August 2017, https://www.moh.gov.sg/content/dam/moh_web/Publications/Guidelines/Private%20healthcare%20institutions/2010/DIRECTIVES%20FOR%20REVIEW%20OF%20SERIOUS%20REPORTABLE%20EVENTS%20v02012011.pdf Moorhead, S., Johnson, M., Maas, M.L. and Swanson, E., 2014.Nursing Outcomes Classification (NOC)-E-Book: Measurement of Health Outcomes. Elsevier Health Sciences. nursing scholarship?: an official publication of Sigma Theta Tau International Honor Society of Nursing / Sigma Theta Tau, 43(2): 171-180 Patanwala, A.E., Sanders, A.B., Thomas, M.C., Acquisto, N.M., Weant, K.A., Baker, S.N., Merritt, E.M. and Erstad, B.L., 2012. A prospective, multicenter study of pharmacist activities resulting in medication error interception in the emergency department.Annals of emergency medicine,59(5), pp.369-373. Shaw, S., Ng, Y.S., Whittaker, R., McFarland, R., Turnbull, D., Gorman, G. and Schaefer, A., 2015. A Clinical Audit Of Acute Management Of Stroke-like Episodes From A National Mitochondrial Disease Centre. Smith, M., Bates, D.W. and Bodenheimer, T.S., 2013. Pharmacists belong in accountable care organizations and integrated care teams.Health Affairs,32(11), pp.1963-1970. Sousa, S.R., Shoemaker, S.J., Nascimento, M.M., Costa, M.S. and Ramalho de Oliveira, D., 2017. Development and validation of a logic model for comprehensive medication management services.International Journal of Pharmacy Practice. Sultan, N., 2014. Making use of cloud computing for healthcare provision: Opportunities and challenges.International Journal of Information Management,34(2), pp.177-184. Tse, B., Augustine, J. and Boesen, K., 2015. Impact of a Nationwide Medication Therapy Management Program on Drug-Related Problems at the Medication Management Center in 2012. Vazin, A, Zamani, Z and Hatam, N. 2014, Frequency of medication errors in an emergency department of a large teaching hospital in southern Iran, Drug, Healthcare and Patient Safety, vol. 6, pp.179-184. Wager, K.A., Lee, F.W. and Glaser, J.P., 2017.Health care information systems: a practical approach for health care management. John Wiley Sons. Walker, B.R. and Colledge, N.R., 2013.Davidson's Principles and Practice of Medicine E-Book. Elsevier Health Sciences. Weaver, S.J., Lubomksi, L.H., Wilson, R.F., Pfoh, E.R., Martinez, K.A. and Dy, S.M., 2013. Promoting a Culture of Safety as a Patient Safety StrategyA Systematic Review.Annals of internal medicine,158(5_Part_2), pp.369-374. Westbrook, J.I., Li, L., Lehnbom, E.C., Baysari, M.T., Braithwaite, J., Burke, R., Conn, C. and Day, R.O., 2015. What are incident reports telling us? A comparative study at two Australian hospitals of medication errors identified at audit, detected by staff and reported to an incident system.International Journal for Quality in Health Care,27(1), pp.1-9.

Lincoln And The Civil War Essays - , Term Papers

Lincoln and the Civil War President Abraham Lincoln said in 1858, I am not, nor ever have been, in favor of bringing about in anyway the social and political equality of the white and black races. President Lincoln is widely believed to be the fabled liberator of the slaves. However, Lincoln showed time and time again that he only cared about the fate of blacks as it served him and the interests of his administration. The major objective of President Lincolns administration was to preserve and sustain the Union. The southern states insurgence started as a result of disputes over states rights and representation in Congress; it was coincidence that most of the disputes in congress revolved around slavery. The Civil War actually had little to do with slavery. During the Civil War President Lincoln wrote and delivered the Emancipation Proclamation. It is true that this document freed slaves, however, it did not free all of the slaves. It left the slaves of the boarder states in bondage. The Emancipation Proclamation order only the slaves released that were in areas still in rebellion. These two instances show that while Lincoln had no intention of changing relations between the races, circumstances dictated that he needed to change them to a certain extent. This supports the original statement made by President Lincoln in 1858.

Sample of a Second Grade Persuasive Writing Essay

Sample of a Second Grade Persuasive Writing EssayIn this article I'm going to give you a sample of a second grade persuasive writing essay. Although this was not written by a professor, this is an example of how a teacher can use persuasive writing to get a better grade.This second grade persuasive essay follows an article about the subject of the article and is based on a typical situation where the author discussed the subject. This article tells us that we all want to go to college because we want to go to a different place and experience a different culture. This writer goes over why it would be great to go to college and whether or not he wants to go to college.The writer tells us that he is happy that he is doing his own thing and not staying in the same school that he has been in since first grade. He likes the different opportunities that come with going to school and loves the thought of going to a new school and new friends.College is a big commitment and that is why the wr iter tells us that it is important to go for a college education that is going to be worth it. We all need to have a good set of skills in order to make a successful career. The writer tells us that he is willing to do whatever it takes to be successful in his field of interest. The writer goes over why it would be a good idea to go to college.Writing a persuasive essay is about making your point and convincing the reader to agree with you. The writer does a good job of getting the point across and makes his readers want to support him.Another way to make sure that you are doing a persuasive writing is to read the entire article before you write your second grade persuasive essay. Don't write any part of it based on what you learned from the article. All the information should be derived from the article.In this case, the paragraph begins with a beginning sentence, the opening paragraph and the conclusion. Then we have the first paragraph, the argument section and the conclusion. Yo u can then go back and work on the next paragraphs based on the information you learned from the article.

Persuasive Essay Topics

Persuasive Essay Topics Persuasive Essay Topics Persuasive Essay Topics The purpose of persuasive essay writing is to persuade the reader to accept an idea or agree with an opinion. While writing an essay, you should strive to convince the reader that your point of view is a reasonable one. The persuasive essay should be written in a style that grabs and holds the reader's attention.   In addition, your opinion should be supported with details and evidence from secondary sources. Persuasive writing involves persuading the reader to perform an action, or it may consist of an argument convincing the reader of the writer's point of view. Persuasive writers employ many techniques to present their argument and show support for their claim. There may be several different ways of choosing persuasive essay topics. Your teacher may give you some prompts or requirements on topic selection. Sometimes, you may have an opportunity to make your own choice. If you have some choice in the topic selection, it will be helpful if you select the topic of interest to you. Essay Help It isn't an easy task to persuade someone to change his point of view.   You should read and analyze a lot of information, make notes, arrange ideas in an outline, and ensure proper referencing of all cited articles, books, and internet resources. Before writing an essay, make sure that your points are well-organized, and that supporting arguments are understandable and relevant. Create a list of supporting points as well as counterarguments.   It is very important not to forget about examples illustrating your ideas and thoughts. The introductory paragraph should introduce the argument of your persuasive essay. A well-constructed introductory paragraph immediately captures the interest of your reader and gives appropriate background information about the essay topic. Include a brief summary of the ideas to be discussed in the essay body as well as other information relevant to persuasive essay argument. Make sure to include thesis statement!   It is impossible to write a good persuasive essay without clear and effective thesis statement.   Custom essay writing is about logical development of your arguments and ideas.   Each body paragraph must present a single idea supporting the main argument.   Persuasive essay conclusion should summarize the main points and stress the strongest idea. Persuasive Essay Writing Help If you are not sure in your ability to write an attention-getting persuasive essay, if you cannot find enough supporting information, you are welcome to ask our writers for assistance.   We provide only custom written persuasive essays and guarantee originality of every custom paper we deliver.   In addition to final draft, you will receive free plagiarism report.   Returning customers are offered wide range of discounts on .com  services.

MANAGING PEOPLE AND PRODUCTIVITY Essay Example | Topics and Well Written Essays - 4750 words

MANAGING PEOPLE AND PRODUCTIVITY - Essay Example This has given rise to the need for companies to pay a great deal of attention to employee performances on the job and motivate them effectively, in order to improve the productivity of an organization. The recent credit crunch has hit the banking industry particularly hard, turning the spotlight on the manner of functioning of these institutions. The need for quality and accountability in these organizations has become even more evident, especially in a recessionary environment where productivity has become even tougher to attain. The management of human resources has come to play an even more important role in achieving that productivity and motivating employees has become vital, especially for the banking industry. This study therefore proposes to apply a case study approach to examine issues surrounding the motivation of employees in Barclays Bank. The true origins of the crisis can be traced back several years to the late 1990s when, concomitant with financial deregulation in the United States that commenced during the Reagan administration, banks began to change their traditional mortgage arrangements. Earlier, mortgages issued were few and far between, because banks provided them to customers only after intense verification checks on credit and customer income. The customer was then obliged to make regular monthly payments to the bank. Earlier, banks had to finance their mortgages largely from their existing deposits from other customers; as a result this restricted the scope of their lending. With the rise in the mortgage bond market, this situation changed because banks were able to find additional sources of funding for loans through investors in mortgage bonds. Banks began to lump their mortgages together with other kinds of loan assets and sell them off to investors in the bond market, through the process of securitization of loans. In recent years, many of the regulatory measures that were instituted as a part of the New Deal after the Great depression of 1929 have been overturned, including the Steagall Glass Act, which imposed restrictions on speculative activity. (Chossudusky, 2008). Inflation in most developed countries was held down in developed countries such as the U.S. and the U.K. using the cheap imports available from countries such as China. Since inflation rates were low, this also helped to keep interest rates low, pushing up the value of property prices.(Blythe, 2008). Such an atmosphere, where property values appeared to be stable and keep rising, only encouraged banks further to branch into more speculative activity related to mortgage lending, and to lend out more than what they had on deposit from customers.(Blythe, 2008). The model presented below graphically depicts the traditional model of mortgage lending as compared to the current, existing system which involves third party bond investors, with deregulation encouraging speculative activity by banking institutions. Fig 1: The new model of mortgage lending (Source: http://news.bbc.co.uk/2/hi/business/7073131.stm) THE NEW MODEL OF MORTGAGE LENDING Top of Form How it went wrong Bottom of Form As per the new model, the banks rely on additional source

Integrated Case Study Analysis Example | Topics and Well Written Essays - 6000 words

Integrated Analysis - Case Study Example ee thirds’, of having the company’s revenue equally generated from goods made in China and sold overseas, and goods that are produced and sold overseas. As the company approached the third decade in its business operations, the CEO was aiming at even higher targets. The goal of the company was to attain deeper penetration of the market in both rural China and overseas. The goal was to be achieved by increasing the share of the market and adding the product categories. The fast growing Chinese economy as well as shifts in production facilities to China may have played a role in driving the company to globalize. The impact of the WTO on China after entry in 2001 added pressure on the company to solidify its brand and products globally and to also have a dominant position in the local Chinese market. However, Zhang experienced the challenge of maintaining the company’s industry leadership in home (Archer & Cameron, 2013). The task of going global required Zhang to decide what lessons learnt from the international operations needed to be implemented at home and which lessons learnt from the domestic operations of the company needed to be applied in the international markets (Bonaglia & Goldstein, 2007). With the rapid growth of the economy in China, inflation peaked at 17 percent in 1995 forcing central banks to curtail lending by banks. As such, the Chinese government denied the company a loan of RMB 1.6 billion to curb speculation in the real estate. Zhang, faced with no other option of raising funds to expand the company decided to sell 43.7 percent of Qingdao Haier refrigerator division to the Shanghai Stock Exchange. The company was also faced by the challenge of penetrating global markets as its approach was to start with the difficult markets of the U.S and U.K whic h were already well established in consumer electronics and home appliances there by providing stiff completion for the Chinese company. This study has several objectives that it seeks to