Type 2 diabeties Case Study Example | Topics and Well Written Essays - 1500 words

Type 2 diabeties - Case Study Example In 1910, physicians were able to make progress on determining the cause of diabetes. Edward Sharpey Shafer stated that a patient showed signs of diabetes when the pancreas failed to produce a chemical, named â€Å"insulin†, which was responsible for breaking down sugar. He explained that that was why the urine contained excess sugar. In an effort to fight the disorder, doctors encouraged a fasting diet and urged patients to exercise regularly. This was in vain, as patients continued to die prematurely (Porter, 2013). In 1921, Charles Herbert and Frederick Grant made an important discovery when experimenting with dogs. They noticed that the conditioned improvement when they injected diabetic dogs with insulin extracted from healthy dogs. This also worked with diabetic people. However, doctors noticed that some people did not respond to this treatment. In 1936, Harold Himsworth classified the two types of diabetes as â€Å"insulin-sensitive† and â€Å"insulin-insensitive † with the latter being Type 2 diabetes (Porter, 2013). The 1950s brought in oral medication for patients with Type 2 diabetes, which would help stimulate the pancreas to secrete insulin. ... They previously referred to it as adult onset diabetes but as children and teenagers cases increased, they changed it to Type 2 diabetes (Porter, 2013). Differential Diagnoses It is important for a physician to determine correctly whether a patient has Type 1 diabetes or Type 2 diabetes. This is because these two types of diabetes need different treatments. Results obtained from physical examination, laboratory tests and the patient’s history can be used to make the right diagnosis that will help clinicians differentiate Type 1 diabetes from Type 2 diabetes (Colvin, & Lane, 2011). Through physical examinations, a clinician can identify Type 2 diabetes’ patients, as they may be obese; body may show manifestation of acanthosis nigricans, have chubby cheeks, and thick necks. The patients’ history can indicate whether they have Type 1 or Type 2 diabetes, for example, patients controlling their diabetes with oral antidiabetic agent or diet for long periods can be diag nosed with type 2 diabetes. Thin patients, who have had diabetic ketoacidosis for a long period and have always depended on insulin since childhood, can be diagnosed with Type 1 diabetes (Laine, 2007). Patients who show no signs of diabetes need two abnormal test results for a clinician to make a diagnosis of Type 2 diabetes. The abnormal tests can be done on different days, or different tests can be done on the same day. If the two results are abnormal, the patient is diagnosed with Type 2 diabetes but if only one result turns out to be abnormal, the test is repeated on a different day. If it turns out to be abnormal the second time, the patient is diagnosed with Type 2 diabetes. Diagnosis of patients showing polyuria, weight loss or polydipsia, which are all

My Victory Essay Example for Free

My Victory Essay Whats happening? I heard the soldiers crying. I didnt understand how everything went wrong. First we were happy Then we were sad. It was like a blossoming flower caught in a storm. The knocking in my head wouldnt end. Were we so stupid all along? This is what happened We are going to win this war! my regiment sang happily. This was exactly what my mum always wanted me to be independent, have a family of my own and fight for my country! She would be so proud of me. Even though shed passed away a while back, she could still see me from heaven which she used to call a special place. Time flew past as we were on our way to win the war. We began digging up the damp mud to build our trenches. Our feet were sinking into the soft surface of the mud. The time had slowed down. Throughout the day, the clock ticked slower as if it has completely stopped. Our brightness had faded away. Even the smiles on our faces were forgotten. What happened? We had thought that we would win, that this war would be a war to end all wars. We thought this would be the Great War. So what was going to happen? Nobody knew. I had that feeling, which felt like the END! That feeling is fear. I was frightened that I was going to die. I was frightened that we were going to lose. I was frightened that it would get worse. And it did get worse. The Germans began to fire. My fear came back. The captain ordered us to cross no mans land; he said we had no choice. This was it. My heart was pounding like the footsteps of a running horse. We started to cross no mans land. My feet were hurting from standing in the muddy trenches. The land was so empty and lonely. I was so stiff from the coldness of the wind, trying to walk on the mud and scared to death. At if I got shot? I thought. The Germans were firing all around us and I could hear the fast beat of my blood drumming through my ears. I was motionless, trying to think of what to do. But it was too hard. At once all I could think about was my mum. Her words went through my head one day, youll find your victory! Its inside you from then on I knew exactly what to do. I knew that I would find my victory. I didnt care if my body was in pain. My mind was strong and thats what mattered. I dodged the bullets and fought so hard, running and shooting the Germans. But suddenly I felt a pain, a bigger sharper pain than Ive had before. It was just above my stomach, in the middle. It hurt so much. The ripping feeling was an agony. I looked down and saw blood everywhere. Id been shot! As I through my feet forward to walk, I couldnt take any more of the tearing pain. Slowly, I dropped to the muddy ground. Blood was running down my hands. The incapable agony of the burning bullet got worse and worse but I was still alive. And then Flash! through my eyes! Something wonderful had happened. The pain flew away, along with my fear. Flash! again, but this time I saw my whole life in a flashback right before my own eyes! It felt incredible. Everything went dark. And suddenly I saw my mum. She was standing in a bright light like an angel. This wasnt a memory this was a real fantasy. Her eyes filled with happiness. Her tears rolled down her cheeks and dripped of her lips. She was happy, and so was I. I knew that I would never lose her. I knew I found my victory.

Web Based Technology and Continuing Medical Education

Web Based Technology and Continuing Medical Education This dissertation explores the use of Web based technology to enhance and maintain procedural skills in the context of continuing medical education. The research was initiated by the perceived need for novel and alternative methods of providing procedural skills training to health practitioners. This observation, supported by learning needs analysis, led to the design and implementation of a Web based educational resource aimed at doctors and other healthcare practitioners. The assessment part of the research focused on an empirical evaluation of the effectiveness of this Web based educational resource. This dissertation draws on a number of strands of Health Informatics: Principals of Heath Informatics Research Methods Clinical Information Systems Creating Online Educational Resources Whilst on a small scale, the results are relevant to medical educators involved in developing and evaluating web based educational resources. BACKGROUND Medical practitioners receive comprehensive procedural skills training and it is expected that this is maintained and regularly updated to limit skills decay and ensure clinical competency. Skills decay is defined as the loss of a trained or an acquired skill after a period of nonuse. Skills decay rapidly as the period of nonuse lengthens; and the extent of the decay is influenced by the characteristics of the skill and how and when these skills were learnt. Arthur et al., (1998) Skills are classified either as closed loop or open loop tasks. Arthur et al., (1998). Closed loop tasks are fixed sequence tasks with a defined beginning and end, for example, the preoperative anaesthetic machine check. Open loop tasks are tracking and problem solving tasks, for example, managing patients hypoxia. Arthur et al., (1998) in their review on the rate of skills decay and its influencing factors concluded that closed loop tasks decay more slowly than opened loop tasks. Arthur et al., (1998) also mentions that mental tasks decay more quickly than physical tasks and after 28 to 90 days of nonuse of the trained skills, task performance declines by 23% and by 40% after a year of nonuse. Clinical practice alone may be insufficient to prevent skills decay as indicated in a simulated airway management training study Kovacs et al., (2000). Skills decay quickly without practice; and procedural skills are only optimally retained when trainees regularly practiced the procedure on their own, in their own time and received periodic feedback. Training on simulation modalities, mannequins, fresh cadavers and live patients have the potential to successfully teach the procedural skill with significantly less skills decay over time as compared to didactic teaching alone. TI L et al., (2006). The traditional one to one apprenticeship model of medical procedural skills training and the in-hospital continuous medical education and maintenance of a skills base are often inefficient, expensive, and labour intensive. Patients, who are often used as practice tests subjects during skills training, safety is reliant on the medical practitioner skills retention and task competency. Maintaining procedural skills competency may prove to be increasingly more challenging as expense, time constraints, available manpower, lack of resources and patients reluctance to be used as experimental models make this endeavor increasingly impossible to set up. The resultant worldwide move towards competency based training programs and self directed problem oriented based learning has made necessary the search for alternative valid and reliable educational methods for skills training and its maintenance. Fortunately, the last decade has seen an explosion in the use of technology to enhance medical education. Web-based educational programs, computer aided virtual reality situations, and high fidelity simulation has played an increasingly important role in medical education owning to its efficiency, ability to provide flexible learning experiences, multimedia capabilities, and economies of scale and power to distribute instructional content internationally. Vozenilik et al., (2004) In the last 5 to 10 years extensive empirical research has been conducted on the use of computer aided and web-based instruction in medical education where there has been overwhelming support for these mediums of instruction. Unfortunately the literature is strikingly sparse on the use of Web based instruction for procedural skills training and in the few studies where empirical research has been carried out; study designs were not robust enough to withstand interrogation or had inconclusive results. LITERATURE REVIEW A review of the literature was conducted to ascertain what work had been done in the field of Web based learning, medical education and procedural skills training. A CINAHL and Medline search was carried out exploring all citations up to June 2010. The search using Medical Subjects Headings (MeSH) Computer Aided Instruction, Internet, CME returned 322 publications. Adding the MeSH term Review returned 21 reviews of which four were relevant. Replacing CME with Procedural Skills Training produced only one noteworthy empirical research paper and 2 publications worthy of discussion. Relevant systematic reviews of the literature are summarized in the table below: 3 Title Author / Date Findings Review Conclusions Assessment of the Review Internet-Based Learning in Health Professionals: A Meta-analysis Cook et al., 2008 201 eligible studies with qualitative or comparative studies of Internet based learning accounting for 56 publications Internet formats were equivalent to non-Internet formats in terms of learner satisfaction and changes in knowledge, skills and behavior. Internet based learning is educationally beneficial. Comprehensive work with a robust study design. Skills outcomes included communication with patients, critical appraisal, medication dosing, cardiopulmonary resuscitation, and lumbar puncture. Unfortunately the study had many limitations as many publications were poorly designed with low methodological quality, without validity and reliability evidence for assessment scores and with widely varying interventions What the meta analysis did suggest was that no further studies comparing Internet based interventions with traditional methods or no intervention were merited as these types of studies would almost invariably be in favour of Internet Based interventions. The author of the review suggested that the questions that warranted further research would be when and should Internet based learning be used and how could it be effectively implemented giving impetus to the exploration of Internet based skills training and maintenance. Title Author / Date Findings Review Conclusions Assessment of the Review The Effectiveness of Computer-Aided (CAL) Self-Instructional Programs in Dental Education: Rosenberg et al. 2003 1024 articles systematically reviewed. 12 publications included in the final review. Five studies significantly favored CAL. CAL is as effective as other methods of teaching and can be used as an adjunct to traditional education or as a means of self-instruction. This study is a comprehensive review of controlled randomized studies with clear and relevant inclusion criteria assessed with good inter and intra rated reliability. The reviewer limited the study to dental students. Forms of Computer Aided Instruction was not clearly defined or specified in the inclusion criteria. It is unclear whether web based studies were included. The skills referred to in the studies were dental diagnostic not procedural skills. The apparent dearth of studies assessing procedural skills justified the investigation undertaken by this dissertation. Title Author / Date Findings Review Conclusions Assessment of the Review Internet-based medical education: a realist review of what works, for whom and in what circumstances. Wong et al. 2010 249 papers met their inclusion criteria. Learners were more likely to accept a course if it offered a perceived advantage over available internet alternatives, if it was easy to use technically, had elements of interactivity and gave formative feedback. This study is a realist review and the methodology used answered the question of the study which aimed to provide a theory driven criteria to guide development and evaluation of Internet based tools. The findings and guidelines suggested in this review would later be incorporated in the design of the resource to be investigated in this dissertation. Title Author / Date Findings Review Conclusions Assessment of the Review eLearning: a review of Internet-based continuing medical education (CME). Wuton et al. 2004 16 studies met their eligibility criteria Internet based CME programs were as effective as traditional formats of CME A comprehensive and appropriate search of databases. Randomized controlled trials of Internet based education in practicing health care professionals. These results showed that Internet based interventions do have a place in CME and that these effects on skills behavior warrants further investigation. Title Author / Date Review Conclusions Assessment of the publication Procedures can be learned on the Web: a randomized study of ultrasound-guided vascular access training. Chenkin et al. 2008 Web based tutorial may be an useful alternative to didactic teaching for learning of procedural skills A randomized control trial with non inferiority data analysis. The non inferiority margin was specified at a 10% margin however the actual amount of improvement was not specified. Blinding bias was not assured and the trial relied on the reputation of the investigator. No mention of inter rated reliability was made. Despite its inherent weaknesses, the trial suggested that web based intervention is as good as the alternatives; however, the study incorporated the use of simulation and live models to teach the actual procedural skill. David Cook is a prolific writer of many reviews and publications investigating Internet based formats in medical education. His noteworthy publications Web based learning: pros, cons and controversies Cook, (2007) and Where are we with Web based education Cook,( 2006) extolled the benefits overcoming barriers of distance and time with novel instructional methods, and extenuated the disadvantages which included social isolation, upfront costs and technical difficulties of Web based education. He concluded that Web based instruction can be a potentially powerful tool and strongly recommended that the focus of future studies should concentrate on the timing and application of Web based learning tools. Summary of literature survey The review of the literature has outlined the use of Web based procedural skills training as an area that requires further research. Empirical research and systematic reviews that has been carried out thus far has been limited. The literature research conducted for this dissertation (though in its self may have been limited) was unable to find publications exploring the whole use of the Internet as a means of procedural skills training and skills maintenance. Justification and Learning needs analysis To assess the effectiveness of an Internet based learning resource in the context of procedural skills training, a skill had to be chosen that was relevant, involved both a physical and mental task, and had the potential of decaying. A procedural skill is defined as the mental (knowledge) and motor activities (behaviour) required to execute a manual task and usually involves patient contact. Kovacs (1997). Furthermore, a learning needs analysis was undertaken to assess the value of this topic choice. Justification Intubation with a Laryngeal Airway Device (LAD) was chosen as the representative procedural skill. When a patient collapses from a cardiac or respiratory cause, timely control of the patients breathing and airway with prompt delivery of cardiopulmonary resuscitation (CPR) and defibrillation have resulted in life saving survival and neurological recovery. The LAD is a breathing maintenance device that can, with minimal training, be inserted effortlessly into the mouth of the patient allowing for breathing and oxygenation. It is increasingly being used in the repertoire of techniques available to frontline practitioners (practitioners first on call to resuscitation events) in emergencies where the technique has proven to be easy to use and life saving in the management of an airway crisis. Kette, (2005). In a survey of family medicine practitioners, all practitioners surveyed agreed that insertion of an LAD during a resuscitation procedure was a core procedural skill that most practiti oners were required to perform in any setting; 86% admitting that they had been called upon at some point to perform the procedure. Wetmore et al., (2005). Insertion of a LAD with knowledge of the patients anatomy, indication and contraindication for use and technique of use both under a controlled setting and in an emergency is representative of a procedural skill a frontline practitioners is expected to perform. Learning needs analysis A key step in developing an effective educational website is performing a learning needs analysis to determine what the learning needs the resource hopes to address are and why these needs were not met by existing learning or teaching arrangements. Cook Dupras, ( 2004). A questionnaire not previously validated, making use of closed type questions, were used to assess three broad areas; knowledge and training, skills application and Internet accessibility. Eleven frontline practitioners were asked to provide an indication of how often they were called to attend resuscitation or airway management situations in the last two years. They were surveyed regarding training received in LAD usage and insertion, their desire to obtain more information or skills updating, and whether there was a perceived need for Internet-based continuing medical education courses on LAD usage and intubation. Their attendances at CME workshops in the last year were surveyed and the barriers to CME workshop attendance were assessed. The respondents were surveyed regarding access to the Internet and previous exposure to e-learning modules. This was done to assess whether the uptake of the resource would be biased towards participants with Internet access, frequent Internet uses or previous e-learning experiences. The results of the learning needs analysis showed that most respondents (90%) received exposure to the device. It is a requirement of their post as frontline practitioners, to be Acute Life Support (ALS) trained where usage of the device in resuscitation is taught. Half the respondents indicated that they were not comfortable with their level of knowledge; and 63% felt unconfident about inserting the device as they were on average, only exposed to two resuscitation scenarios per year. All had Internet access at work and at home; and half had previous experience of online learning. Only one percent of the respondents were able to attend a CME session in the last year, citing lack of time and convenience as the main reasons. 80% of respondents were interested in taking courses through the Internet, as continuous education credits are a requirement of a license to practice in medicine. Interest in the topic was high and given the above self-appraisal, it was felt that the course was nee ded and should appeal to this population. METHODS The method section is dealt with in two parts. The first will focus on the development and design of a Web based educational resource and the second on the evaluation of the resource. 1. Development and design The idea was to develop an educational resource that could be used to train, reinforce knowledge and maintain a procedural skill by employing and integrating principles of effective adult learning with the unique features of the web. The development was driven by educational needs and outcomes of learning needs analysis completed by participants in a previous part of this study. 1.1 Development Theories The course design reflected Adult Learning Principles and the aim of the course was to improve knowledge (cognition), integration of attitude changes (confidence) and in so doing result in a change in behaviour (competency). Gale (1986). With accessibility of the Web based educational resource, it was hoped that the resource would be accessed frequently until the task becomes automatic or accessed as a refresher when required or at regular intervals. The resource incorporated principals that were shown to be effective. It was centered on the learners needs, was focused on a specific task and recognised past experiences of the learner (Gale 1986). The theories used in the development of the resource included; Experiential Learning Theory, which concluded that experiential learning should have personal relevance, should be self-initiated and lead to pervasive effects on the learner. Rodgers (1969) Constructivist Theory where learning is an active process with learners constructing new ideas and concepts based upon past and current knowledge. Bruner (1966) Information Processing Theory where knowledge is presentation in sequences or chunking to accommodate short attention spans (Miller 1956). The educational resource strived to be pedagogically sound uniquely applying these principles online. Information was presented in small chunks in a sequential fashion, was self-contained, had interactive components and contained assessments with instant feedback. Online communication did not occur in real time as which happens with video conferencing and online chat rooms, instead the resource used communication that was asynchronous where participants logged on, viewed and downloaded course material, read postings and submitted interactive tasks. The advantage of using an asynchronous format was that learners and/or the instructor did not need to be online at the same time allowing the participant to work at his or her own pace. The asynchronous nature of this web based learning environment allowed for barriers of time, location and expense to be overcome. Sanoff (2005) 1.2 Moodle Description University College Londons (UCL) Moodle was the platform used to develop the educational resource. There are many applications offering free alternatives to the commercial software WebCTTM and BlackboardTM, however the UCL Moodle was chosen as a matter of convenience because it was accessible, independent of specific operating systems, fit for purpose and easy to use without much technical computer knowledge thereby potentially removing barriers to any future course design and development.. Moodle (Modular Object Oriented Dynamic Learning Environment) is software freely available to use and was developed by Dougiamas. Moodle. org (1999). The Moodle software was designed on pedagogical principles that encourage learner interaction in a virtual learning environment. Moodle is a course management system used to support Web-based courses and has a number of innovative tools that could be used to create courses that promoted collaborative learning. Moodle is able to run without modification on Unix, Linux, FreeBSD, Windows, Mac OS and Netware. (Moodle. Org). After an initial learning curve, the program was easy to use with simple but comprehensive online instructions. Moodle It did not require pre-existing computer programming knowledge, and in fact the author of this dissertation considered herself a novice computer user. Moodle is written in hypertext pre-processor (PHP) which is HTML embedded scripting language used to create dynamic Web pages.  PHP allows for connecting to remote servers, checking email, URL encoding and setting cookies. It offers good connectivity to many databases including MySQL, and PostgreSQL,  which Moodle uses as a single database. MySQL is a  relational database management system  that runs as a server providing multi-user access to a number of databases. (www.php.net). Moodle had the support for easily displaying multimedia aspects of the educational resource and the interface could be used in over 70 native language translations. The Web based educational resource was easily built up using multimedia activity modules and design elements, which included with easy navigation; Authentication and enrollment, Syndication with a chat forum made available to others as newsfeeds, Current evidence based didactic teaching, Interactive quizzes allowing import/export in a number of methods Hyperlinked resources to provide for branched learning, The use of a Wikipedia, A glossary of commonly used terms, Instructional video presentations. All the attributes of the Moodle made for an international transportable tool ideal for knowledge presentation, learner interaction, comments and reflection, dynamic and interactive assessments, flexibility, extendibility, and most importantly, support for autonomous learning and continued educational development around the world. The only noteworthy disadvantage of using the UCL Moodle was an imposed instructional design. 1.3 Resource Description The educational resource was named; VIRTUAL [emailprotected]: Onà ¢Ã¢â€š ¬Ã¢â‚¬Å"line Laryngeal Airway Device training. à ¢Ã¢â€š ¬Ã¢â‚¬Å" Virtual suggesting both the virtual reality of an Internet based generated environment and the adjective, meaning practically or almost Collins English Dictionary ( 2008). The Web based educational resource was developed for distance learning and contained all the elements of a totally Internet delivered educational resource. The content of the course was drawn from the authors personal experience using the Laryngeal device; peer reviewed journal articles, manufactures product information and videos downloaded from the Internet. Permission for the use of copywriter-restricted material was sought and obtained where appropriate. 1.3.1 Screen Design The screen design refers to how the information was arranged and presented on the display screen. The guidelines used followed those (amongst others) suggested by DoD HCI Style Guide (1992). The screen was kept simple, orderly, clutter free and consistent with a limited, non-dominating colour palate of four colours à ¢Ã¢â€š ¬Ã¢â‚¬Å" blue, black, white and blue à ¢Ã¢â€š ¬Ã¢â‚¬Å" green, a combination that has been shown to cause little fatigue and distraction. Kelley (1988). The content of each lesson was presented on a plain white background with black text in a non-jarring informal style font that made the lessons easy to read. Clark (1997). One template was used and the navigation bar, top bar and individual lesson heading bars kept the same with only the content of each lesson changing. All the content was displayed statically on one screen with individual lessons accessed by scrolling vertically down to the individual lesson. Unnecessary menus and long selection lists were avoid ed. This allowed for an overall view of the content, minimized pointer and eye movements and caused less distraction with easy navigation. (Gruneberg 1978). A discussion forum, interactive quizzes and an end of resource examination were included to allow engagement and self-assessment. The quizzes and examination included a range of question types à ¢Ã¢â€š ¬Ã¢â‚¬Å" multiple choice questions, true/ false, photo matching and random short answer matching type questions. These varieties of questions were shown to improve the learning experiences of adult learners. (Mackway-Jones, 1998). Information was provided in chunks and the writing style kept informal, with plain, simple language and in conversational tone with some elements of humour. There were fewer than 60 à ¢Ã¢â€š ¬Ã¢â‚¬Å" character positions on a standard 80 à ¢Ã¢â€š ¬Ã¢â‚¬Å" character line, spacing between characters were 25 à ¢Ã¢â€š ¬Ã¢â‚¬Å" 50% of character height and spacing between lines were equal to the character h eight, this to increase reading efficiency. 1.3.2 Course Content The course material was presented as text, graphics, power point presentations, hyperlinks and video demonstrations of the procedural skill presented in animation and on an actual patient. Knowledge was provided in five short lessons that followed the natural sequence of usage and intubation with a Laryngeal device. Aims of the resource and objectives of each lesson were stated at the beginning of the course. Here too a glossary of commonly used terms and a baseline knowledge assessment quiz were included. Each lesson was kept succinct with hyperlinks to websites and folders for those seeking extra information. This was to limit download times. Each lesson was concluded with an interactive quiz used to reinforce and test the knowledge learnt. Instant responses were provided to the quizzes after submission with suggestions to either revisit the lesson or to continue depending on the results obtained in the quizzes. The resource was concluded with an end of course examination and the c ourse was predicted to take 1 to 2 hours to complete. The resource content was accessed with a secured password with all content downloadable by way of an Internet connection. All the participants were supplied with a secure company email address and all the ISTCs had Internet access. Permission was requested for the use of company time and resources e.g. airway device training mannequin and time during the working day for those who chose to access the resource at work. Participants were supplied with instructions on how to use Microsoft Word and how to log on to and navigate the Moodle site. The course material was available online for two weeks with access monitored. 1.4 Pilot Study The aim of the pilot study was to assess the ease of navigation, gauge the time it took to complete the course, the integrity of the hyperlinks and the validity and reliability of the content and examination questions. Font preferences, layout and download speeds were also assessed. A prototype of the resource was tested on a selected sample of five participants of similar profile to the participants used in the study. The participants of the pilot study were excluded from participating in the actual study. An external panel of three Consultant Anaesthetists and two trainee Registrar Anaesthetists where used to provided expert advice. The Consultant Anaesthetists were selected based on their special interest in emergency medicine or difficult intubation scenario teaching. A few typographic errors were corrected, aims and objectives were clarified, difficult navigational issues were corrected and some content deemed repetitive and lengthy by the pilot participants were excluded before rolling out the resource. These changes however, were minor and further usability studies were deemed unnecessary. 1.5 Content Validation The content presented was current, evidence based and peer reviewed for content validity by the panel of experts (made up of three Consultant Anaesthetists and two trainee Registrar Anaesthetists), who deemed the content to be relevant and appropriate. The panel of experts and the pilot participants also judged good face validity. 2. Evaluation of the Resource The study evaluates effectiveness and acceptance of a Web based educational resource used to train and maintain a learnt procedural skill in the context of continuous medical Education (CME). The evaluation of the resource was undertaken in two parts. First the effectiveness of the resource was evaluated and the endpoints measured were changes in knowledge, confidence and technical ability. This evaluation made use of a summative framework redefined by Saettler (1990); which takes place after interaction with the resource. A before and after interventional ipsative assessment was undertaken where participants performance was compared to their own over a period of time. The second part of the evaluation was undertaken to assess the acceptability of the Web based educational resource as a medium for procedural skills training and this was done by way of an evaluation questionnaire completed by the participants after course completion. 2.1 Participants and Setting The participants and settings were specifically targeted, as they would ultimately be interested stakeholders and end users of this type of resource. The research was conducted at five Care UK TM Independent Centers (ISTCs) on practitioners employed at these facilities. The ISTCs are part of the governments initiative to reduce long NHS waiting times for elective surgery by adding increased capacity and alternative treatment venues for patients. There are approximately 25 ISTCs in the United Kingdom with Care UK TM represents 20% of this market. The ISTCs were chosen as a setting because: They are not part of the UK NHS medical training scheme and therefore have no formal programs of medical training or teaching that similar grades of staff in the NHS would receive. Contractual obligations of the ISTC contract decreed that the ISTCs could not employ medical practitioners from the NHS; therefore, most of the medical staff employed at the ISTCs have trained abroad and are waiting either to enter a formal career path within the NHS or wanting UK work experience. This situation has resulted in a mixture of nationalities, non-uniform medical training and medical staff with differing levels of post qualification experience and more importantly, a high staff turnover. (ref) These resulting factors were conducive to a system of competency-based appraisals and continuous medical education, which could be addressed with Web, based educational resources. Participants in the study were all frontline practitioners employed at Care UK TM ISTCs, which employs 48 practitioners of this grade. This represents 50% of all frontline practitioners employed in ISTCs throughout the UK. This intended sample size of 48 adequately represented the wider population in this type of analysis. frontline practitioners are the first practitioners on call to the resuscitation of a collapsed patient where they would be called upon to secure the patients airway and ensure oxygenation until the Anaesthetists or the resuscitation team arrives. It is expected that frontline practitioners are trained and certified with acute cardiac and life support skills and confident in dealing with clinical emergencies. In reality, analysis has shown that frontline practitioners in these ISTCs, though some trained and certified, rarely use these skills due to the infrequent nature of resuscitation clinical emergencies, making these scenarios potentially high-risk events when they do occur. Frontline practitioners are made up of Resident Medical Officers (RMOs), Anaesthetic Assistants (ODAs) and Recovery Room Practitioners (RNs). RMOs are doctors who have completed their medical training and have at least two years post graduate work experience as qualified doctors. They are employed to provide 24 hours on site medical management of patients at the ISTCs and like general practitioners (RACGP 2006) and doctors outside NHS academic hospitals, are usually first on call for emergencies and the sole source of medical advice on the premises on which they work. Anaesthetic assistants and recovery room practitioners are nursing practitioners

The Poisoning of Our Ozone Layer :: essays research papers

The Poisoning of Our Ozone Layer The poisoning of the Earth’s ozone layer is increasingly attracting worldwide concern for the global environment and the health effects of life on the Planet Earth. There is not just one particular cause for the ozone’s depletion; the accumulation of different pollutants into our ozone layer has all added up and equaled a worldwide problem. There is not just one effect from the poisoning of the ozone, but instead multiple ramifications from diseases to death. The damage to the ozone is increasing with every second; moreover, there are many ways we can help reduce the problem and preserve the ozone layer. Ozone is a pale blue gaseous form of oxygen, in chemical form it is also known as O3. Ozone can be beneficial or harmful depending on its location in the Earth’s atmosphere. If the ozone is located in the troposphere (which extends from the surface of the Earth up to approxiametly10 miles) it is a harmful pollutant and a major component in smog and other environmental health problems. Such tropospheric ozone can damage plastic, rubber, plant and animal tissue. Ozone located approximately 10-25 miles above the Earth’s surface, in a part of the Earth’s atmosphere called the stratosphere is very beneficial. The ozone is a major factor that makes life possible on Earth. About 90% of the planet’s ozone is in the ozone layer. Ozone in this layer shields and filters out the Earth from 95-99 percent the sun’s ultraviolet radiation. A low level of ozone does not protect or prevent the sun’s ultraviolet rays from reaching the surface of the Earth, therefore, overexposing life on Earth causing many diseases. The depletion of the ozone is caused by many factors, but the one cause that will be elaborated on in the next paragraph is the main reason our ozone is continuously being poisoned. The major cause in the depletion of the Earth’s ozone layer is because of the release of chlorofluorocarbons into the atmosphere. Chlorofluorocarbons also known as CFCs, are industrially produced chemical compounds that contain the elements chlorine, fluorine, carbon, and sometimes hydrogen that will break down the protective ozone in the atmosphere. Since CFCs are heavier than air, the process of CFCs reaching the ozone will generally take from two to five years to get into the stratosphere. When CFCs reach the stratosphere, the sun’s ultraviolet radiation cause them to break apart.

To what extent and why would you agree or disagree with the view that the New Right proceeded by assertion approach to welfare provision?

(3) ‘Our judgement would be that, essentially, the New Right proceed by assertion' [George and Wilding]. To what extent and why would you agree or disagree with the view that the New Right proceeded by assertion approach to welfare provision? Professors George and Wilding made the statement in their study of welfare and ideology that the New Right ‘proceed by assertion' – that is to say that they make over generalised and unbalanced rhetoric about the state provision of welfare. The New Right emerged as an ideology in critical response to the post 1945 government attempts to provide a comprehensive system of welfare in Britain. They argue that state provision is not only inefficient and ineffective, but that collective enterprise is actually impossible as they have no belief in a common purpose in society. New Right ideas can be separated into two major strands of thought. The Neo- Liberal philosophy that is concerned with economic factors; and the Neo-Conservative strand which is interested with social, moral and political implications. However, they can be grouped together to define a philosophy which favours more market and less state involvement in peoples lives. They equate that more government means less personal reedom which, for the New Right, undercuts the principles of democracy. It is widely argued that the New Right present an ideology of Welfare that while being rational and efficient in theory; in practice is simply too idealistic and is neither sensitive nor flexible enough to the social needs of contemporary society. This essay intends to show that the ideologies of welfare presented by the New Right lack legitimate evidence to support and justify their proposals; this will be shown in two ways. First, the inadequacies of the New Right philosophical basis will be highlighted o show that at the most primary footing of their perspectives on social policy are unsound. Secondly, I will look at their argument for the supremacy of the free market system over state provision. This will be examined in both the economic and social spheres. The key and most basic reason why the New Right has a tendency to make statements with little substance or legitimacy is that their fundamental philosophical basis appears to be flawed. New Right thinkers emphasise individualism; Friedman asserts that ‘. The individual (is) the ultimate entity in society ‘. Clearly, there is little room for collective conscious in their philosophy. This egotistical individualism stresses that the welfare state, a collectivist policy, cannot work due to ‘human nature' e. g. self-seeking and greedy. The New Right ideology claims that the nature of human kind is unchangeable which thus makes the Welfare State an impossibility. However, many critics of this theory argue that classifying human nature as fixed ignores all culture and history surrounding the development of society. They centre their ideology on agency and completely fail to recognise the role of structure. Thatcher, a leading figure of the New Right ideology, said there is no such thing as society -just ndividuals. However, George and Wilding dismiss this assertion by highlighting that as human beings, we are all linked together in patterns and cycles of dependency. Williams also points out that surely ‘. We are not just individuals or families, but members of one another. ‘ The New Right also asserts that the Welfare State policies view people as social beings who can be motivated by social concerns and social goals. Naturally, the New Right reject this view of humans, again this can be rooted back to the importance of the individual and their assumption that humankind will very rarely act for the collective good. However, this argument ignores the cyclical nature of human relationships, any moral or collective consciousness is disregarded which is highly unrealistic for as humans we are social beings, we are graggrarious . New Right supporters also declare that the Welfare State is essentially inefficient due to its need for rational planning. They reason that due to the complexity of modern society, it is impossible to structure and implement plans that would be beneficial both economically and socially. As Willets points out ‘. It is precisely the increasing complexity of modern life which makes centralised organisation mpossible.. ‘ They dismiss constructive rationalism as unrealistic and call for less government intervention. Friedman views much government activity as undesirable. He believes it should have a limited role restricted to areas such as foreign policy and overseeing economic policies. However, it seems unreasonable to dismiss some degree of planning in modern society, people need valid motives and goals that are justified. The New Right principles on the role of the Welfare State assert that: we must first help those in need. Socialists believe that the State should provide an average standard. We believe that it should provide a minimum standard, above which people should be free to rise as far as their industry, their thrift, their ability or their genius may take them†¦. This highlights the New Right emphasis on individual freedom and choice. They say that the state provision of welfare is an encroachment on basic human freedoms as it restricts choice. However, if one considers services such as water, housing or health care, these are such fundamental needs that there is no real choice whether or not these needs are fulfilled. As a result of this, consumers in markets for these services are in a weak osition. Because of this vunerablilty, state provision of these services ensures a comprehensive service which is regulated. Market systems in such essential areas of provision leave the consumer susceptible to exploitation and it also undermines the principles of a free democracy As a result of the need for planning in the functioning of the Welfare State, many New Right thinkers dismiss it as it ignores the concept of spontaneous order- the market system. Or, at a more tangible level, they favour monetarism over Keynesianism. – The New Right view the market as the most efficient system as it generates ompetition which,in turn, spurs innovation and a consumer led market. It also means that a monopoly cannot be created and consequently, prices are kept reasonable and quality of services are kept high. They argue that the Welfare State violates the spirit of capitalism and basic human nature . For the New Right, the market is the most efficient and rational way to operate economically and socially – The New Right also argue that the State presents a series of destructive economic consequences. Mead contends that the government projects a view to society that work is merely an option, not a nessecity. In other words, that social security creates a ‘nanny state', causing idleness. He views the Welfare state as a victim of it's own success by feeding and sustaining the type of behaviour it is trying to minimise. Another problem with this, according to the New Right, is because the welfare state is centralised it is therefore seen as ‘government money', it is depersonalised and as a result becomes vulnerable to abuse and manipulation . Again, this leads back to the view that man is individualistic and self seeking, rejecting the concept of the ‘common good' or collective social conscious. In the defence of the State, it is obvious that in any socio-political arena there will be negative and positive outcomes of any kind of social policy. However they must be weighed up against each other. It is impractical and unrealistic to assess the welfare state in the abstract, as the New Right tends to. Their philosophies also ignore the complex and diverse nature of modern society, and are simply not sensitive enough to the various needs. Holman explains that in reality, the New Right regard ‘.. personal gain and material selfishness.. as virtues while compassion for the disadvantaged and a readiness to share oods and power are sneered at as weakness.. ‘ Thus far we have seen that the New Right philosophy celebrates private enterprise as it promotes democracy, however there is much substantial evidence to prove otherwise. Friedman, for example, claims in his writings NAME OF BOOK AND QUOTE DIRECTLY.. that it is the free market which made it possible for black people to overcome racial discrimination in the United States. This completely disregards the role of state legislation in this matter, and further presents an unbalanced and misleading view of the social policy process which seems to be a consistent motif hat runs through the New Right philosophies. XPAND ECONOMIC POINT Another major factor in the inadequacy of the market provision of Welfare State services is that it cannot supply needs regardless of ability to pay or according to need. As a result, it is easy to deduce that the market solutions are distinctly less equitable than the state provision of public services. Therefore, it can be argued that, the New Right fail to consider the social consequences of the market system. The problem of the New Right is that their opinions of the supremacy of the free market are formed from their own view point which is invariably secure, affluent and rofessional. They fail to recognise that the freedom the market offers is conditional. Holman argues that it ‘†¦ depends upon the prior advantage of having jobs, opportunities, savings. The market provides freedom for the privileged. ‘ The World Bank, long regarded as supporters for the free market, issued a report in 1997 emphasising that an effective state is ‘†¦ vital to the provision of goods and services and the rules and institutions that allow markets to flourish and people to lead healthier, happier lives. Without it, sustainable development, both economic and social is impossible.. This shows that while the New Right ideology is not wholly disregarded, it is seen as not looking at the whole picture, which gives an unbalanced and bias view of state provision. The New Right can be thought of as ‘leading by assertion' due to the fact that they often make statements without backing it up with legitimate evidence. According to the New Right ideology, the Welfare State has many negative social implications. Firstly, it undermines any sense of responsibility and self-reliance by providing, not so much a ‘safety net', more an altogether too comfortable cushion to those who get state provision. This, in turn, fosters what Keith Joseph coined in the 1970's a ‘dependency culture'. This anti-collectivist theory claimed that poor families in poverty transmitted this culture of difficult relationships, unskilled work or unemployment. However, this is an generalised statement that when examined, becomes totally inadequate. Willams argues that ‘such an explanation .. fails to account for the effect of social circumstances†¦ ‘ Charles Murray, whose work has been widely published in Britain by the Institute of Economic Affairs, assets that the Welfare State infact sustains an ‘underclass' by emoving any element of real risk or danger-factors which, according to the New Right, are essential to the consistent function of an innovative and motivated market. This theory is best represented by a quote from the 1992 Conservative Party Conference where the Social Security minister, Peter Lillley, categorised single mothers as having dominant membership of this supposed underclass and described them as ‘young ladies who get pregnant just to jump the housing list. ‘ This assertion by Peter Lilley is an example of how the New Right thinkers tend to make broad statements, often considering them in the abstract without using much vidence and dispensing normative prescriptions for the social ills. Clearly, however, a broader agenda is required when evaluating social policies. Also this approach fails to consider the supportive and cohesive functions that the Welfare State provides. Holman shows effectively the inadequacy of the New Rights theory of the emergence of an underclass in his study of the effect of the implementation of New Right policies in Easterhouse during the early nineties. He presents quantitative evidence to show that it is not the ‘feather-bedding' approach of the Welfare State that is ccountable for social problems and ‘wrong' values. Rather Holman argues that, . the deprivations are imposed upon people by government policies and economic factors beyond their control. The underclass thesis should be seen less as an explanation of the state of places like Easterhouse and more as a New Right excuse which diverts blame away from the dire results of New Right practices.. The New Right maintain that the free market promotes democracy by offering choice to the consumer. They argue that the Welfare state creates a monopoly, therefore there is no competition, which is bad for the consumer. asically the state is answerable to no-one because people are not directly paying for their health care or schooling (for example). Williamson summarises that the Welfare State from a New Right perspective is ‘significantly inefficient as it is an effective monopoly, bureaucratic in character and dominated by producers, not consumers. ‘ Williams also highlights the problem of the concentration of power in the market or oligopoly , which is fundamentally undemocratic. She asserts that business people rarely practice free competition whenever they are in a position to control the market hemselves. This is further reinforced by Richard Titmuss in his 1959 lecture ‘The Irresponsible Society' where he stressed that major monetary decisions of building societies, insurance and pension companies were being made by a small minority of people. Such decisions affect millions of people, and their views are not taken into account, which is fundamentally undemocratic. It must be noted, however, The New Right philosophy does not altogether reject the role of state in Welfare. Gray accepts the idea of quasi-markets within the welfare state, perhaps in the form of a voucher system. This way competition is still strong because people have the freedom to choose which hospital or school they want. Seldon reinforces this by suggesting that ‘ National economic expansion can best be helped by putting welfare by stages into the market where the consumer will rule instead of the politician'. The effectiveness of the market system is not completely convincing. The New Right tends to present a distorted and partial view of the efficiency of the free market. -more explanation of efficiency of market see george nad wildiing chapter on democratic socialism. conclusion

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buy custom Falls essay Hospitalized patients may require bedside help depending on their health conditions. The bedside help is referred to as 1:1sitter ratio and it involves having a person to continually take care of the patient. Research shows that many hospitalized patients who lack the 1:1sitter ratio suffers more injuries from falls than those with such care. The care includes assistance in cleaning the patients body, turning them occasionally as well as feeding. The increase in the hospitalization period may necessitate a permanent care taker assigned to help the patient. The caretaker may be a nurse as well as other family members. The only requirement for the care taker is to understand the cause of illness plus the type of special care needed. Without the 1:1sitter ratio, the hospitalized patients may occasionally fall out of their beds and therefore suffer more injuries. The injuries include the head, hands, knees, forehead and mouth. The most affected patients are normally aged above 60 years. Most fall results when the patients attempts to turn on the beds (Gluck, Wientjes, Rai, 1996, pp. 105). They may as well fall while they try to pick something from either side of the bed. Essentially, it is necessary to implement change in the hospitals in ordr to alleviate falls amongst hospitalized patients. The care takers should identify the fall risks especially among the most prone patients. Consequentially, nurses and health personnel ought to introduce and implement individualized approaches). These strategies include assigning every fall prone patient an individualized care taker. Additionally, these strategies ought to be resourced adequately with appropriate equipment in order to allow for effectiveness. Additionally, all the hospital health care providers have to be more involved in a multifactor falls prevention program for more effectiveness. This program is necessary to allow all staff members to exercise the 1:1 sitter care to hospitalized patients. In addition, intensive training ought to be done to the mature people in the family. This acts as an essential part in the prevention and curtailing of harm from falls thereof. Most important in the fall prevention and management is the need to maximally adhere to the strategies laid down. This is primarily important in ensuring that all patient receive due attention so that deaths due to injuries are alleviated. The care taker should help the patient reduce the fear of being injured this can be achieved by involving them in constructive activities. Additionally, some time should be providded to practice all the strategies agreed upon by staff. Thereafter, intensive assessment ought to be done to monitor for improvements. As mentioned earlier, the preventive measures as well as the training program requires a lot of money and other kinds of investments. Therefore there is need for the government to allocate adequate resources in the hospitals. The resources may be needed to purchase the hip supports, necessary vitamins supplements as well as constructing appropriate walk areas. The hospital may also need to add the number of beds for the fall related hospitalization cases. This may be necessary since falls are caused by dizziness, drunkenness, old age and epilepsy. Thus appropriate care should be taken to reduce the falls incidences. The hospitals should use the cost-effectiveness analysis to compare between cost and outcomes of health care alternatives taken. The political contribution towards prevention of falls is by introducing anti drug campaign. This is necessary especially for men who get overly drunk and on falling suffer head injuries as well as body fractures. It is also necessary to put up special programs to train all people in the remote areas on the need for a healthy living (Lane, 1999, pp 43). Generally, prevention of falls is better than curing. Buy custom Falls essay