Pressure Sores Essay Example for Free

Pressure Sores Essay The basic philosophy of palliative care is to achieve the best quality of life for patients even when their illness cannot be cured. Palliative care is provided through comprehensive management of the physical, psychological, social, and spiritual needs of patients, while remaining sensitive to their personal, cultural, and religious values and beliefs. Hospital palliative care services are often provided through an interdisciplinary team of health care professionals including, but not limited to: Doctors, Nurses, Healthcare Assistants, Psychologists, Social Workers, and Priests. FATIGUE Fatigue is a common, distressing and debilitating symptom experienced by people with cancer. In those receiving palliative care it is probably the most frequently reported symptom and is experienced by more than 90 per cent of these patient. However, it represents the most commonly unrelieved cancer symptom. Cancer related fatigue can have a number of factors that can be difficult to establish, however despite these problems advancing research will help to promote the problem as a palliative care symptom that can be assessed and managed. In patients with advanced cancer, the prevalence rates of various symptoms are approximately as follows Pain 89% Fatigue 69% Weakness 66% Anorexia 66% Lack of energy 61% Nausea 60% Dry mouth 57% Constipation 52% Dyspnoea 50% Vomiting 30%. (Donnelly 1995) Defining Cancer-Related Fatigue Cancer-related fatigue is a complex phenomenon with physical, cognitive and affective methods of expression. A clear understanding of what it means is essential before it can be assessed and managed, or healthcare Assistants are able to discuss it with patients and colleagues. After exploring fatigue from the perspective of patients, Ream (1996) derived the following definition: a subjective, unpleasant symptom which incorporates feelings ranging from tiredness to exhaustion, creating an unrelenting overall condition which interferes with individual’s ability to function to their normal Causes and effects. The causes of cancer-related fatigue is still unknown, and lack of success in treating it at the end of life stage is in part due to this lack of knowledge. Quality of life is related to symptoms, functioning, and psychological and social well-being, while during end-of-life care, spirituality is a major issue, patients become too tired to participate fully in their roles an d activities that make life meaningful, fatigue therefore significantly affects their quality of life. Patients/Family Perceptions One of the barriers to treating fatigue at the end of life may be patients, families and Doctors perception of it as an unavoidable, untreatable symptom (Johnson, 2004).Many people experience fatigue, but studies have shown that fatigue experienced by patients with cancer is more rapid in onset, more energy-draining, more intense, longer-lasting, more severe and more unrelenting when compared with typical fatigue. Advance care planning and establishing goals of care are essential because they enhance the control patients have over their care and assure autonomy if the patient is unable to communicate their wishes or make decisions at later stages of illness. Patients want a voice in their healthcare, they want to know what to expect and how to plan for their treatment and their future. Establishing goals early on for current and future healthcare helps to avoid future unnecessary harm and inappropriate prolongation of dying. It is well recognized that interventions focused on curing dying patients result in increased suffering, with little or no benefit for the patient. This suffering may even extend beyond the patient. Nurses also struggle ethically and emotionally when care for dying patients is focused on technology rather than on comfort and quality of life. In addition, twenty-per cent of patients relatives develop a physical illness in response to the stress of coping with their loved on es poor health. Treating Underlying Causes Before a patients fatigue is simply attributed to the cancer it is important to identify and treat easily reversible underlying physiological and psychological causes of fatigue. For example, this may involve reducing non-essential medications, treating infections, correcting hypercalcaemia and electrolyte disorders or treating pain, depression, sleep disorders or anaemia .A link between fatigue, sleep and anxiety can be readily identified, and the approach to management is a general one. In palliative care, efforts are directed at alleviating symptoms, as well as toward preventing or treating the underlying cause when that is possible interventions should begin with the promotion of sensitive communication, giving patients the opportunity to discuss their fatigue in the context of living with a terminal illness and its impact on their lives , found that enabling patients to talk about their fatigue both facilitated professional assessment and helped them to explore the meaning of th e cancer and fatigue experience for themselves, and for their family and friends. This can help patients regain a sense of control and freedom to focus on other important aspects of their lives, so restoring their self-esteem .Patient and family education can be of great value in understanding cancer-related fatigue. Family members may interpret fatigue as a sign that the patient is giving up, when it is actually beyond her or his control. Complementary medicine embodies the principles of palliative care by helping to ease the physical, psychosocial, and spiritual effects of illness. It aims to control symptoms and to enhance quality of life for patients and their families. Relaxation, visualisation, massage and aromatherapy are currently being evaluated as part of a global intervention known as Beating Fatigue. There is already evidence of the beneficial effect of massage and aromatherapy on depression and other symptoms including fatigue. CONCLUSIONS/EVALUATIONS Whilst undertaking this assignment certain words keep coming to mind. Words like empathy, caring, stress, burnout, teamwork many more but I have learned to respect all patients, promote dignity, to be a better team player be confident in my abilities, but mostly I have realised that to further a career in any area of palliative care will require more training, more understanding of different patients conditions and there requirements on a daily basis and to be more conscience of the responsibilities of healthcare assistants when caring for all patients. As said previously I will seek further training in this area not only to be of greater benefit to the patients but also to seek training in some form of grief counselling to be of greater assistance to relatives and friends of patients, to empathise more and to just be able to listen when needed. Despite the high prevalence of cancer-related fatigue among patients in palliative care, its treatment is less successful than treatment for other symptoms at the end of life. The causes of fatigue in patients with advanced cancer are often unclear, multiple factors may be responsible and little is known about its causes. The specific goals of palliative care are to improve the quality of the last stages of patient’s lives, control symptoms, and provide support to family members and to pay attention to patient’s perceptions of purpose and meaning of life. The experience of cancer-related fatigue has a major impact on patient’s motivation as it means they are unable to undertake physical activities and that they lose interest in activities and life in general. Although it is difficult to conduct research on patients who are highly distressed, have severe symptoms or who are dying, there is the potential for such research to have a therapeutic benefit for those taking part. Providing patients with cancer an opportunity to discuss their feelings associated with symptoms such as fatigue provides information necessary to develop professional understanding and can also help patients to make sense or come to terms with their condition. Future research should focus on determining effective solutions including alternative and complementary therapies rather than on reassessing need. More focused fatigue assessment tools and targeted fatigue interventions for patients at the end of life are required, as is training in fatigue management so that healthcare assistants are more knowledgeable and skilled in assessing and managing fatigue. By understanding the physical, psychosocial and emotional needs of an individuals experience of advanced cancer, palliative care research demonstrates that health professionals can help patients to adapt to living with cancer-related fatigue. Such intervention can empower patients to maintain control over decisions relating to their care and can assist them to understand and find meaning in their fatigue. REFERENCES Donnelly S, Walsh D.(1995) The symptoms of advanced cancer. Semin Oncol 1995; 22(2 suppl 3):67–72. Johnson, C. (1992). Coping with compassion fatigue. Nursing, 22(4), 116, 118-120. Ream E. (2007) Fatigue in patients Nursing Stand.2007: 21(28)49-56

Deletion Essay -- Biology, DNA

Deletion is a mutation in which a part of the chromosome or the DNA is absent or lost. It may be inherent, or it may be due to improper chromosomal crossing-over during meiosis. This deletion is responsible for the abnormalities in the patient. One of the known disorders seen due to deletion is the Wolf-Hirschhorn syndrome. Wolf-Hirschhorn syndrome (WHS), first described by Wolf et al[1] and Hirschhorn et al[2], results from the hemizygous deletion of the distal short arm of chromosome 4. Due to the complex and unmarked expression of this disorder, the WHS syndrome is presumed to be a contiguous gene syndrome with an indeterminate number of genes responsible for the phenotype i.e. a multigenic etiology. [3][4] The size of the terminal deletion may vary from a subtle 1.4Mb to a classic 30Mb [5]. Earlier genotype-phenotype correlation studies reveal that the main characteristic feature of WHS - the ‘Greek warrior helmet face’, is caused due to the hemizygosity of the WHSC1 gene located in the WHS critical region (WHSCR).[5] Various other genes are also located in the WHSCR which are responsible for most other phenotypic features. More precisely, the Wolf-Hirschhorn syndrome critical region (WHSCR) is located at 4p16.3 region. Approximately 25% of the patients with WHS deletion in this region are not detectable by cytogenetic karyotyping [6]. Hence, FISH has to be performed. The prevalence of this syndrome is estimated to be 1 in 50,000 births [7] with a female to male ratio of 2:1[8]. Case report: A baby was born with low birth weight of 1.8 kg to a 36 yr old father and 32 yr old mother. The proposita is the 6th girl child of the non-consanguineous parents. As can be seen from the pedigree chart shown in figure 2, the mothe... ...infant with Wolf-Hirschhorn syndrome: a dilemma in determination of the optimal timing of delivery. Clinical Medicine: Case reports. 8. Society for the Study of Behavioral Phenotypes (SSBP) Information sheet: Wolf-Hirschhorn syndrome. Registered Charity number 1013849. 9. Altherr, M.R., Bengtsson, U., Elder, F. F. B., Ledbetter, D. H., Wasmuth, J. J., McDonald, M.E., Gusella, J. F., Greenberg, F. Molecular confirmation of Wolf-Hirschhorn syndrome with a subtle translocation of chromosome 4. Am. J. Hum. Genet. 49: 1235-1242, 1991. [PubMed: 1746553] 10. Althea T. Impact of chromosome 4p-syndrome on communication and expressive language skills: A preliminary investigation. Language, Speech and Hearing Services in Schools. Vol 41 265-276 July 2010. 11. Harold Chen. EMedicine Specialties> Pediatrics: Genetics and Metabolism Disease> Genetics. Updated Jun 16, 2009.

L. E. Fouraker & J. M. Stopford †Organizational Structure and the Multinational Strategy Essay

Organizations constitute an important part of society. Parsons (1960) said that with organizations it is possible to â€Å"get things done†, and â€Å"achieve goals beyond the reach of the individual†. However, organizations may face continuous structural change, as A. D. Chandler’s â€Å"Strategy and Structure† (1966) suggest. Lawrence E. Fouraker, a Business Administration lecturer, and John M. Stopford, a research associate at the Harvard Graduate School of Business Administration analyze this work in their paper titled â€Å"Organizational Structure and the Multinational Strategy†. The following is a brief synopsis of the same. To begin with, a historical outline is given of how company resources were acquired and used. According to Chandler, there was an â€Å"initial expansion and accumulation of resources† (qtd. in Fouraker and Stopford 1968: 48), then followed by a reduction of these utilized resources, an opening out into new markets, and eventually the development of an entirely new structure. These four stages in time, according to Fouraker and Stopford lead to distinctive organizational structures. The so called Type I – organization is a basic organization that is seen to be the extension of the head of the company, and hence reflects the same â€Å"interests, abilities, and limitations† (qtd. in Fouraker and Stopford 1968: 48) of the chief and/or founder. It is characterized by its focus on the production of a single product only, and furthermore, stresses a single task, leaving little or no flexibility in terms of adaptation to new market developments. The problem solving or decision-making always leads to one individual who carries all burdens. This might also be explained by the philosophy or mind-set of the management (â€Å"command and control†). Having a very basic organizational design, the marketing orientation (as per Kotler and Armstrong 2006) that describes the Type I – organization best, may be the product concept. Although no actual product innovations are implemented, it does apply to a certain extent since this model assumes that the organization’s core business is to target a high sale in volumes of the product that is marked by its quality, and that is manufactured by the smaller-sized company. A simple example for such an organizational type may be a company that produces plain mousetraps. Since a Type I – organization would believe in its single product most intensively, it is important that the organization does not get trapped in marketing myopia, i.e. by thinking that their product (the mousetrap) is the only and best built product, ignoring better solutions (for instance chemical spray or exterminating services) (Kotler and Armstrong 2006: 10). The Type II – organization on the other hand is defined by efficiency and the â€Å"rational use of resources† (qtd. in Fouraker and Stopford 1968: 49). Being based on the structure of a Type I – organization, one still stays within a single functional activity (qtd. in Fouraker and Stopford 1968: 49), but simultaneously expands to a few more related products, or diversified product-lines. This development mainly took place, according to Fouraker and Stopford, in order to avoid risks, ensure that the organization continues to function once the core product has reached its expiration, and to make an efficient use of the equipment and plant (i.e. to use it to its full capacity). One now also has a vertically integrated style of management, which, however, still excludes research and development. It is further highlighted by Fouraker and Stopford, that although various products are being produced efficiently, so far no actual management or professional administratio n is applied. On the contrary, the same type of management philosophy predominates. However, the better co-ordination in functions allows for the move within the marketing framework; One shifted to the production concept. This becomes obvious since, according to Kotler and Armstrong (2006: 9), consumers are in need of affordable and available products, which on the other hand makes more efficiency in the production-process necessary. An historical example is given by Henry Ford and his development of the Model T car. It had been his aim that every family could afford such a car, hence he efficiently reduced the production time from 12 hours to 96 minutes by means of the moving assembly line (Ali and Gomez 2006: 14). The subsequently developing organization, Type III, builds up in its complexity, which also brings about the need for professional management and a general change in management’s approach towards the components within the value chain. It allows for general managers to be trained and tested and also to be instituted in unrelated divisions (which are separated on the basis of the nature of the products). Specifically, one now has a multi-divisional product structure (i.e. the divisions are separated on the product basis) with more functional responsibility being delegated to the division general managers. For the first time, organizations now also carry out research and development to a large degree. Product innovation hence plays a role, and the need for better marketing arises, that means the marketing concept (as per Kotler and Armstrong 2006) is practiced. By focusing on consumer needs, one uses integrated marketing perfectly on both, the external and the internal level, and achieves profits through customer satisfaction (Kotler and Armstrong 2006: 10). Ericsson and Sony might be examples for companies who follow this organizational and marketing design. The authors then go into the fact that from research and development, product innovation, and the new organizational structure, a development of investments into foreign markets emerges. Among others, that is the case because the products produced locally, are unique and will not be found abroad. There are different types however, of how the set-up may look like (i.e. there might be a separate international division, world-wide production divisions, a geographic division, or a mixed form). Lastly, there is an illustration of the modern organization, or â€Å"matrix organization†, where there are many more products and product departments, along with different managers and different geographical registrations. In terms of a three-dimensional design it typically would see the managers on an x-axis, the product range on the y-axis, and the locations on the z-axis (although this may vary). It is also very likely that a manager in such a structure carries responsibility for more th an one product, attached to different regional focuses. This clearly suggests more flexibility (managers are automatically more skilled and can adopt different tasks), but also brings about the problem of a divided responsibility or a weak accountability (for instance difficulties when questioning which manager would be liable for the success or failure of a particular product launch in any region). Both the product as well as the marketing concept can be implemented by a company that has this structure. The product concept may be applicable since product differentiation takes place, and it is the organization’s aim to create higher value added by exploring different product ranges (most likely by the use of R&D). At the same time, relationship marketing might be applied (i.e. satisfying customers for the long-term), when considering that managers will opt for recurring purchases. All in all, the above has been an outline of Chandler’s â€Å"Strategy and Structure† (1966), re-studied by Lawrence E. Fouraker and John M. Stopford. Although the evolution of different organizational designs is illustrated to a great extent, it is evident that virtually all of these are still having importance today as they are wittingly or unwittingly implemented by corporations.

Marketing Analysis Shania s Business - 1350 Words

Abstract Shania s business idea is viable, but it requires some adjustments to fit into the modern market requirements. It is important to realize that different business forms have their benefits and drawbacks; thus, their selection is not only important for registration processes but also their long-term survival. Each business form has regulatory, market, and customer complexities that it must handle to navigate in the currently volatile and dynamic working environment. Therefore, the choice of name demands reconsideration so as to establish a unique brand that is identifiable with her business. In addition, she should have an elaborate process of sourcing for workers, and it should avoid violating biblical rules, family expectations,†¦show more content†¦A coffee business targeting the Christian market segment does not need such complex organizations because of its functional simplicity and scope. In other words, only large-scale organizations can opt for these choices. This leaves sole proprietorship and partnership business models because they fit into Shania s strategic needs. Partnerships require drawing an agreement between entities on roles, responsibilities, and revenue sharing rations even in times of losses. Every partner is required to have some form of legal liability relative to the business functions in accordance with state laws. On the other hand, sole proprietorship requires registration and its registered owner is liable, at the same time, enjoys all profits from the business. Both business forms are easy to register even though their management, working, and regulatory procedures differ (Blais, 2011). Shania s goal is to open a coffeehouse that targets her Christian community. Even though she has found some franchise offers with complimentary training, the recommendable option is to become a sole proprietor. Franchises will force her business to conform to business practices that may violate certain Christian norms making her lose customers she had targeted in the first place. Such oversight is not needed when targeting niche markets that areShow MoreRelatedCase Study : Open For Business1694 Words   |  7 PagesOpen for Business Shania is a Christian who is considering opening a new business. She is contemplating who she will potential involve in the business as well as the manner in which she will establish the new business. The following is an analysis of the options in which Shania might choose, given the perceived goals and legal implications that will assist her in achieving those goals. Reviewing the Facts Shania Jackson is a married woman, living in Denver, Colorado, who has aspirations of openingRead MoreIntroduction to Fmcg Industry8866 Words   |  36 Pageshtm FMCG industry, alternatively called as CPG (Consumer packaged goods) industry primarily deals with the production, distribution and marketing of consumer packaged goods. The Fast Moving Consumer Goods (FMCG) are those consumables which are normally consumed by the consumers at a regular interval. Some of the prime activities of FMCG industry are selling, marketing, financing, purchasing, etc. The industry also engaged in operations, supply chain, production and general management. Leading FMCG companiesRead MoreAnalysis of the Music Industry30024 Words   |  121 Pagesintellectual or minority types of music (classical, jazz and world music). In mainstream music, recording and marketing are now dominated by just four `majors worldwide, one of which is the UK s own giant record company, EMI Group PLC. The other majors are Universal Music Group and Warner Music Group, based in the US, and Sony BMG, a Japanese/German joint venture only created in 2004. One of EMI s major strengths is its historic catalogue of recordings — and copyrights — which includes The Beatles andRead MoreEMI Corporate Finance Essay7263 Words   |  30 Pagesmust certainly continue to fight piracy in all its forms. But there can be no doubt that with even greater commitment to innovation and a true focus on the consumer, digital distribution is becoming the best thing that ever happened to the music business and the music fan. —Eric Nicoli, CEO, EMI Group1 In early spring of 2007, Martin Stewart drove through the darkened streets of Kensington in West London. As chief financial officer (CFO) for global music giant EMI, Stewart already knew most of the