Pediatric Recommended Core Measures Health And Social Care Essay

After run intoing Stage 1 for the two old ages, Fletcher Allen Partners will necessitate to run into meaningful usage Phase 2 standards get downing in 2014 ( Figure 1 ) . With this following phase, EHRs will farther salvage Fletcher Allen Partners money, save clip for physicians and infirmaries, and salvage lives.The Stage 2 standards includes new aims to better patient attention through better clinical determination support, attention coordination and patient battle ( cms.com ) . The phase 2 ends would spread out the Phase 1 standards and concentrate on the meaningful usage of electronic wellness records ( EHRs ) to back up the purposes and precedences of the National Quality Strategy ( NQS ) . The Phase 2 standards encourages the usage of wellness IT for uninterrupted attention and information quality betterment. The proposed Phase 2 meaningful usage demands include strict outlooks for wellness information exchange and include: more demanding demands for eprescribing ; integrating structured laboratory consequences ; and the outlook that suppliers will electronically convey patient attention sum-ups with each other and with the patient to back up passages in attention. Phase 2 focal points on existent usage instances of electronic information exchange and requires that a supplier direct a sum-up of attention record for more than 50 % of passages of attention and referrals. The regulation besides requires that a supplier electronically transmit a sum-up of attention for more than 10 % of passages of attention and referrals. Increasingly robust outlooks for wellness information exchange in Stage 2 and Stage 3 would back up the end that information follows the patient ( Federal Register, 2012 ) . To let suppliers clip to follow 2014 certified EHR engineering and fix for Stage 2, all participants will hold a three-month coverage period in 2014. Figure 1: Phases of Meaningful Use Beginning: NeHC University ( 2012 )REQUIREMENTS FOR STAGE 2 IMPLEMENTATIONCore Aims and Menu Aims Fletcher Allen Partners must run into certain demands for a successful Phase 2 execution. The figure of Stage 1 and Stage 2 entire aims remains the same, EPs are must run into the the step of 20 entire aims and CAHs must run into the step of 19 entire aims. However, the combination of aims has changed. Under Phase 2, eligible professionals ( EPs ) must run into the step or measure up for an exclusion to 17 nucleus aims and 3 of 6 bill of fare aims and eligible infirmaries ( EHs ) and CAHs must run into the step or measure up for an exclusion to 16 nucleus aims and 3 of 6 bill of fare aims ( Figure 2 ) . This is a alteration from EP ‘s holding to run into 15 nucleus aims and EHs holding 14 nucleus aims and 5 bill of fare aims severally. About all of the Stage 1 nucleus and bill of fare aims are retained for Stage 2. Figure 2: Changes from Phase 1 to Stage 2 Phase 1 Phase 2 Eligible Professionals 15 nucleus aims 17 nucleus aims 5 of 10 bill of fare aims 3 of 6 bill of fare aims 20 entire aims 20 entire aims Eligible Hospitals & A ; CAHs 14 nucleus aims 16 nucleus aims 5 of 10 bill of fare aims 3 of 6 bill of fare aims 19 entire aims 19 entire aims Clinical Quality Measures needed to be captured by FAP In add-on to run intoing the nucleus and bill of fare aims, eligible professionals, eligible infirmaries and CAHs are besides required to describe clinical quality measures.The clinical quality steps ( CQMs ) are tools used to mensurate and track the quality of health care services by eligible professionals ( EPs ) , eligible infirmaries ( EHs ) and critical entree infirmaries ( CAHs ) within the health care system. The CQMs step many facets of patient attention to include wellness results, clinical procedures, patient safety, efficient usage of healthcare resources, attention coordination, patient battles, population and public wellness, and clinical guidelines.The measuring and coverage of the CQMs guarantee that Fletcher Allen Partners deliver efficient, patient-centered, and safe quality care.A Eligible professionals must describe on 6 entire clinical quality steps: 3 required nucleus steps ( or 3 surrogate nucleus steps ) and 3 extra steps ( selected from a set of 38 clinical qu ality steps ) . Eligible infirmaries and CAHs must describe on all 15 of their clinical quality steps ( CQMS, cms.gov ) . Centers for Medicare & A ; Medicaid Services ( CMS ) selected the recommended nucleus set of CQMs for EPs based on analysis of several factors: Conditionss that contribute to the morbidity and mortality of the most Medicare and Medicaid donees Conditionss that represent national public wellness precedences Conditionss that are common to wellness disparities Conditionss that disproportionately drive health care costs and could better with better quality measuring Measures that would enable CMS, States, and the supplier community to mensurate quality of attention in new dimensions, with a stronger focal point on penurious measuring Measures that include patient and/or health professional battle Get downing in 2014, all Medicare-eligible suppliers in their 2nd twelvemonth and beyond of showing meaningful usage must electronically describe their CQM information to CMS. Medicaid suppliers will electronically describe their CQM information to their province. As Figure 3 shows, EPs must describe on 9 of the 64 approved CQMs. Selected CQMs must cover at least 3 of the National Quality Strategy domains Eligible Hospitals and CAHs must describe on 16 of 29 approved CQMs Selected CQMs must cover at least 3 of the National Quality Strategy domains. Get downing in 2014, all Medicare-eligible suppliers beyond their first twelvemonth of showing meaningful usage must electronically describe their CQM information to CMS informations to CMS. Figure 3: Clinical Quality Measures ( CQMs )SupplierPrior to 20142014 and Beyond*EPs Complete 6 out of 44 Complete 9 out of 64 aˆ?3 nucleus or 3 elevation. nucleus Choose at least 1 step in 3 NQS spheres aˆ?3 bill of fare Recommended nucleus CQMs include:Aaˆ?9 CQMs for the grownup population aˆ?9 CQMs for the paediatric population aˆ?Prioritize NQS spheresAEligible Hospitals and CAHs Complete 15 out of 15 Complete 16 out of 29 aˆ?Choose at least 1 step in 3 NQS spheresAFor 2014, CMS is non necessitating the entry of a nucleus set of CQMs. A Alternatively we identify two recommended nucleus sets of CQMs, one for grownups and one for kids. A We encourage eligible professionals to describe from the recommended nucleus set to the extent those CQMs are applicable to your range of pattern and patient population. Figure 4 shows the recommended nucleus steps: Figure 4: Recommended Core MeasuresAdult Recommended Core MeasuresPediatric Recommended Core MeasuresControling High Blood Pressure Appropriate Testing for Children with Pharyngitis Use of High-Risk Medications in the Aged Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents Preventive Care and Screening: A Tobacco Use: A Screening and Cessation Intervention Chlamydia Screening for Women Use of Imaging Studies for Low Back Pain Use of Appropriate Medications for Asthma Preventive Care and Screening: A Screening for Clinical Depression and Follow-Up Plan Childhood Immunization Status Documentation of Current Medications in the Medical Record Appropriate Treatment for Children with Upper Respiratory Infection ( URI ) Preventive Care and Screening: A Body Mass Index ( BMI ) Screening and Follow-Up Attention deficit disorder: A Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder ( ADHD ) Medicine Closing the referral cringle: reception of specialist study Preventive Care and Screening: A Screening for Clinical Depression and Follow-Up PlanAAChilds who have dental decay or pits Patient Care Improvements Patient entree to their wellness information is an of import facet of patient attention and battle, and the capablenesss of CEHRT in 2014 and beyond will enable suppliers to do this information available online in a manner that does non enforce a important load on suppliers. Patient engagement – battle is an of import focal point of Stage 2. There are 26 Requirements for Patient Action: More than 5 % of patients must direct secure messages to their EP. More than 5 % of patients must entree their wellness information online. Loss of future gross through authorities inducements Changes to Medicare EHR Incentive Programs The Medicare and Medicaid EHR Incentive Programs provide incentive payments to eligible professionals, eligible infirmaries and critical entree infirmaries ( CAHs ) as they adopt, implement, upgrade or show meaningful usage of certified EHR engineering. Eligible professionals can have up to $ 44,000 through the Medicare EHR Incentive Program and up to $ 63,750 through the Medicaid EHR Incentive Program. The Medicare and Medicaid EHR Incentive Programs provide fiscal inducements for the â€Å" meaningful usage † of certified EHR engineering to better patient attention. To have an EHR incentive payment, suppliers have to demo that they are â€Å" meaningfully utilizing † their EHRs by run intoing thresholds for a figure of aims. CMS has established the aims for â€Å" meaningful usage † that eligible professionals, eligible infirmaries, and critical entree infirmaries ( CAHs ) must run into in order to have an incentive payment. A The Medicare and Medicaid EHR Ince ntive Programs are staged in three stairss with increasing demands for engagement. All suppliers begin take parting by run intoing the Phase 1 demands for a 90-day period in their first twelvemonth of meaningful usage and a full twelvemonth in their 2nd twelvemonth of meaningful usage. After run intoing the Phase 1 demands, suppliers will so hold to run into Stage 2 demands for two full old ages. Eligible professionals participate in the plan on the calendar old ages, while eligible infirmaries and CAHs take part harmonizing to the federal financial twelvemonth beginnning on October 1st. ( EHR Incentive Program, cms.gov ) In order to successfully take part in the plan, EPs, EHs, and CAHs are required to subject CQMs to in order to have an incentive payment in the EHR Incentive Program.Beginning in 2014, the coverage of clinical quality steps ( CQMs ) will alter for all suppliers. EHR engineering that has been certified to the 2014 Edition criterions and enfranchisement standards will hold been tested for enhanced CQM-related capabilities.ELECTRONIC Coverage: In order to let participants to successfully describe CQMs electronically for 2014, CMS is supplying a set of electronic specifications for clinical quality steps ( eCQMs ) for eligible professionals and eligible infirmaries for usage in the EHR Incentive plan for electronic coverage. A These electronic specifications contain multiple parts which allow certified EHR engineering systems to be plan to accurately capture, calculate, and describe clinical quality steps electronically for the 2014 CQMs. A Each eCQM can be described in 3 different ways depending on the intended usage: HTML A – A This is a human clear format so that the user can understand both how the elements are defined and the implicit in logic used to cipher the step. XML – This is a computing machine clear format which enables the machine-controlled creative activity of questions against an EHR or other operational informations shop for quality coverage. Value Sets – Value sets are the specific codifications used by developers to plan the system to accurately capture patient informations in the EHR system. A ATo have the maximal EHR inducement payment, Medicare eligible professionals must get down engagement by 2012.Eligible professionals who demonstrate meaningful usage of certified EHR engineering can have up to $ 44,000 over 5 uninterrupted old ages under the Medicare EHR Incentive Program Incentive payments for eligible professionals are higher under the Medicaid EHR Incentive Payments- up to $ 63,750 over 6 old ages under the Medicaid EHR inducement plan Get downing in 2015, Medicare eligible professionals who do non successfully show meaningful usage will be capable to a payment accommodation. The payment decrease starts at 1 % and increases each twelvemonth that a Medicare eligible professional does non show meaningful usage, to a upper limit of 5 % . The eligibility for the EHR inducement plan is determined by the HITECH Act. The lone eligibility alterations under Phase 2 are under the Medicaid EHR incentive plan. The Phase 2 eligibility. Meaningful usage way for Medicare eligible doctors ( EPs ) : Meaningful usage way for Medicare infirmaries: *Payments will diminish for infirmaries that start having payments in 2014 and subsequently. The alterations from Phase 1 to Stage 2 are as follow: Reporting Period Reduced to Three Months – to let suppliers clip to follow 2014 certified EHR engineering and fix for Stage 2, all participants will hold a three-month coverage period in 2014. â€Å" Phase 2 ends, consistent with other commissariats of Medicare and Medicaid jurisprudence, would spread out upon the Phase 1 standards with a focal point on guaranting that the meaningful usage of EHRs supports the purposes and precedences of the National Quality Strategy. Specifically, Stage 2 meaningful usage standards would promote the usage of wellness IT for uninterrupted quality betterment at the point of attention and the exchange of information in the most structured format possible. Our proposed Phase 2 meaningful usage demands included strict outlooks for wellness information exchange including: more demanding demands for eprescribing ; integrating structured laboratory consequences ; and the outlook that suppliers will electronically convey patient attention sum-ups with each other and with the patient to back up passages in attention. Increasingly robust outlooks for wellness information exchange in Stage 2 and Stage 3 would back up the end that information follows the patient. † Hospitals- FY14 ) Providers-Jan 2014

Why Farts Are Awesome

People are too uptight. Or maybe people just don't realize how funny farting actually is. And by people, I mean the feminine half of the population. The difference in opinion between the sexes on the humorous value of a good fart is one of the most telling signs that men are far more evolved than women. Or at least have a better sense of humor. Dammit, farts are funny. So what brought this on, you ask? Well today at work, I had to fart. So naturally I ran over to where one of my coworkers was standing, lifted my leg, scrunched my face up, and let ‘er rip. Apparently, that was rude. Well, excuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuu uuuuuuuuuuuse me. After I farted on my coworker, every single male working starting laughing their asses off, and the females looked at me as if I'd just committed the most heinous crime one can commit. The manager tried to keep the peace by politely asking me to not fart on people, but it was one of those times where you're trying to tell somebody not to do something, yet you just can't stop laughing. I was forced to admit that farting on someone is rude. Yeah, so? It's also very freakin hilarious. We do it to each other all the time, well, the guys anyway. We'll run over to each other's workstations, rip one off, then run away laughing as the other person covers their nose. Then an hour later they'll get us back. And you know what? It's damn funny too. So of course when I farted on my coworker people asked me if I would think it's funny if someone farted on me. Not especially, but it would be damn funny to them, and if they did it to me and didn't laugh, I'd kick their ass. Of course it isn't funny if you're on the receiving end, but it's comedic gold if you deliver a well-timed stinker to a friend. The humor value of a fart is judged by the level of humor in the eyes of the farter and the third-party audience, if applicable. The fartee's perspective doesn't count. That's the whole point of getting a good laugh at the expense of others. I don't mind if people get a laugh at my expense. It's the rules of the game, you live by the sword and die by the sword. I can take a fart from someone else, but you can bet your ass I'll be delivering one with your name on it. You see, if God didn't want people to fart on each other, he wouldn't have made it so funny. God wants us to fart in the funniest manner possible. Usually that involves assaulting the nasal passages of your fellow man. Farting is just funny. I mean think about it, it stinks, it makes a funny noise, and it comes out of your ass, how could it possibly get any funnier than that? As a matter of fact, I challenge you to name five things in life that are funnier than nailing somebody else with a big stinky fart. I don't think it's possible. To help all of you appreciate the art of farting a little more, I have taken the liberty of coming up with a few farting tips from a farting pro. If possible, make certain someone else gets the pleasure of smelling your fart. A fart nobody else smells or hears is an opportunity wasted and lost forever. If you have to fart and you're standing next to someone, bend your ass and â€Å"aim† toward them. This doesn't really make it any smellier for them, but it adds dramatic effect and makes the experience funnier. If you have to fart, and nobody is standing right next to you, hunt someone down, then lift your leg, scrunch up your face, and let it go. For bonus points, try to corner someone and then fart on them. Also for bonus, get down on your knees as though you're looking for something on the ground. Ask for help. As soon as the good samaritan gets on their knees to help you, quickly move your ass right up next to their face and let go. When someone is giving their opinion and you have to fart, say â€Å"You know what I think about that? † and then scrunch up your face and fart. When you have to fart and someone is walking in your direction, hold the fart until the are directly behind you, then release. If you're sitting down when you fart, lift the ass cheek facing the person nearest to you, that way they get the full effect. Upon completion of the fart, say â€Å"aaaaaaaaaaaaahhhhhhhhhhhhhhhhhhhhhhhhh†, as though you've just taken an eleven-pound shit. Quickly claim the fart as your own handiwork, especially to those who didn't hear it. If you don't tell them, they may never know you just farted. Raise your arms over your head as though you've just won the World Heavyweight Title in front of thousands of people. Announce what it was that made you fart. Make sure to use lots of description. Rather than say â€Å"I need to stop eating so much Mexican food†, say â€Å"God damn, those three bean burritos went right through me, I'll be lucky if I don't get diarrhea. † Describe to all around you how the fart felt as it came out. For example, was it a wet one? A cheek burner? Did you feel like a giant gas bubble in your stomach popped with the fart's release? Do you need to go to the restroom just to make sure a little feces didn't escape as well? Rate the fart. Unless it was a dud, in which case you shouldn't have done all the buildup. But if it was a good one, talk about what a great fart it was and how you wish you'd had a video camera.

Zombies Rogerian Argument

Zombies have taken over. They dominate television shows, movies and anything else related to pop culture and have become increasingly more popular as the years progress. Whether it’s a mob of zombies sucking the brains out of a helpless victim on the big screen or zombies terrorizing families on television shows, it is hard to ignore the gory entourage. Fans of zombie lore generally fall into two categories: those who are attracted to the popularity of zombies and see them as purely amusement and those who not only are amused by zombies, but can also see the possibility of fiction becoming reality. The possibility of a zombie apocalypse is very real and terrifying; and most of the population simply wouldn’t survive. No one is safe. Now is the time to prepare and learn about the potential threat and to ensure–above all else– survival. For hundreds of years zombies have conjured images of the reanimated dead, mindlessly searching for the next meal of human brains. While this may be true in Hollywood, zombies actually started out as mindless servants who worked on farms in Haiti, where voodoo was the main religion in practice. Voodoo priests of priestesses are believed to use medicinal concoctions which can bring the dead back to life as zombie slaves, who were then worked out in the fields. This became such a problem in Haiti that family members would guard the graves of loved ones until they were certain the body had begun to decompose, as voodoo only works on the freshly dead. (Real Zombies, 1) At any rate, many people simply do not believe in the possibility of a single zombie, let alone a zombie apocalypse. The notion of a human being brought back to life as a blood thirsty creature does sound far-fetched, and as of yet there have been no documented cases of the typical Hollywood zombie. It is human nature to resist ideas that are so outlandish and terrifying, especially given the seeming lack of proof surrounding a zombie invasion. Normally, such things can be chalked up to a simple fad taking hold of the nation’s youth as a result of cinematic glamour and the growth of social networking. Normally, most people would agree that the zombie craze will be short lived and would certainly not amount to the apocalyptic infatuation that seems to have taken hold of the populace. We always seek the rational, the explainable, the safe. Unfortunately, like history has proven time and again, inexplicable events can often change our views of what is rational and real. There is a very real and poignant possibility that we could be faced with a zombie infestation, and it could occur at any time. The conditions are right. From a scientific standpoint, the ingredients for a devastating zombie outbreak are primed and ready, with some needing only a slight evolution of a bacteria, virus, or even parasites. Toxoplasmosa Gondii is a rather terrifying parasite that can only breed in the intestines of a cat. While that may not seem unusual, the parasite actually lives and grows on rats. In order to be ingested by felines, the parasites take over the rats brain and make it scurry towards where cats habitate. What makes this even more horrifying is that over half of the human population are already infected with Toxoplasmosa and it has been scientifically proven to alter the personality of those who are infected. It would only take a few changes in the parasites to occur either naturally or in a lab before we become slaves to a parasite. Neurotoxins are second on the list. Neurotoxins are poisons(naturally occurring or man-made) that can be used to slow bodily functions to the point of being legally declared dead. They can also be used to bring those people back in a trance-like state with no memory; essentially leaving them as a shuffling, mindless husk. One case in Haiti tells of a Clairvius Narcisse, who was legally declared dead by two doctors but was found 18 years later wandering around a village. A voodoo preist had been using neurotoxins to make Clairvius into a zombie to work his fields. Next is the virus that causes Mad Cow disease. The virus turns cows into enraged attack animals, and when ingested by humans it manifests as Creutzfeldt-Jakob disease. This disease causes hallucinations, lack of coordination, muscle twitching and rapidly-developing dementia that an turn intensely violent. Neurogenesis is also capable of creating zombies. Neurogenesis is the act regrowing brain cells, or entire brains. This sounds great, but a lab who expiraments in neurogenesis has proven that is can cause the brain to die from the inside out; destroying parts of the rain that make us human first. It destroys the cerebral cortex and leaves only basic motor functions and instincts behind. Lastly are nanobots, which are microscopic, self-replicating robots that scientists have used to attach to viruses. These nanobots can survive even after the host dies. Now there are studies that aim to use nanobots to replace damages neural connections in the human brain. They can rewire your thoughts and survive after host death–what could possibly go wrong? (Wong,5) In lieu of the overwhelming scientific evidence that supports the possibility of a zombie apocalypse, it is imperative that the human race be prepared for such an event. It is essential that we strive to get in shape and remain healthy not only for longevity, but also for survival. The reality of the situation is that, quite simply, one cannot possibly deny that science is constantly evolving. There are weapons of warfare, both biological and chemical, that can cause mass dementia, insanity, and eventually death. Wiki,1) Is it so hard to imagine a weapon being forged that could enslave humans by destroying their minds and making them a mindless horde? Suddenly, the concept of a zombie apocalypse doesn’t seem so far fetched. While the vast majority may, thanks to the exaggerations made by Hollywood, not believe in the possibility of a zombie take-over, it is important to remember that anything is possible with the amount of technology that continues to constantly evolve. By keeping in shape, memorizing escape routes at home and being constantly aware, human-kind may stand a chance against a plague of undead. The presence of parasites able to take over brain functions, neurotoxins able to control the body, miniscule robots poised to take over the brain and viruses able to reduce humans into demented, tortured shadows of a creature, it is essential that preparations are taken in the event one of those things should evolve. The reasoning is simple and appeals to human nature: it is better to be safe, than sorry.

Business Ehics Assignment (6questions) Essay Example | Topics and Well Written Essays - 750 words

Business Ehics Assignment (6questions) - Essay Example In school, facial discrimination is also a problem. Students tend to pay more attention to teachers who are good looking than to teachers who are not good looking. In effect, students are more inclined to give higher instructional rankings to attractive professors simply because they learned more from these people because they paid more attention to what these professors say in class. Yes, the whole idea that the degree of learning of students may be affected by their personal likes or dislikes of the facial features of their teachers but the fact still remains that this situation is true. 2. The argument that there is nothing wrong with â€Å"facial discrimination† is to some extent valid. The physical appearance of the person is the first thing that we notice. People are generally attracted to a beautiful face which is why some companies that are engaged is customer relations prefer to employ good-looking people. You see, it is generally easier for people to warm up to people who are good looking than towards people who have sour expressions. Moreover, people are generally more forgiving towards people who look good than to those who are ugly. On the other hand, the idea of hiring people based on their looks may not be acceptable when the job in question does not require face to face dealings with customers. Most companies are not really particular as to how their technical employees look like. You see, most technical employees work in cubicles and they seldom have to come face to face with customers. In this case, the ability of the person is what counts and his or her looks. 3. Physical attractiveness becomes a job-related criterion when the job requires the employee deal directly with customers on a daily basis. For instance, people who work in the sales department need to look the part to be able to attract customers. We all know that people at the sales department or at the

Literature Review Assignment Example | Topics and Well Written Essays - 2250 words

Literature Review - Assignment Example Clinical symptoms of CHF include: breathing problems, fatigue, exercise intolerance and peripheral oedema, and frequent thirst. According to Donner et al. (2012, p. 442), some of the causes of heart failures include high sodium consumption, consumption of foods that are poor in vitamins, mineral and fiber, high intake of saturated fat, cholesterol, and simple carbohydrate. Among adults with over 65 years, CHF is the leading cause of hospitalization. Doris et al. (2007) argue that effective management of heart failure requires pharmacological management combined with non-pharmacological interventions. This position is significant in this literature review because of the need to evaluate the best option between pharmacological and non pharmacological management interventions. It will be vital to evaluate which option will provide the best management that will ensure no reoccurrence of hear failure in elderly patients. In this literature review, three themes stand out in the management of congestive heart failure namely; pharmacological treatment therapies, non pharmacological treatment therapies, and a combination of the two management therapies. PHARMACOLOGICAL MANAGEMENT THERAPIES Pharmacological management therapies involve administration of a drug to alleviate the symptoms of CHF. Diuretics such as furosemide, torsemide, bumetanide and thiazide are important drugs in the management of CHF. Administration of these drugs can either be through intravenous bolus every 12 hours or by continuous intravenous infusion. Debates still exist on the most effective way of administrating these drugs. Similarity Some studies have shown that administration by continuous intravenous infusion is more effective in the management of CHF. Differences However, these studies have received a fair share of criticism. Similarly it is not clear as to whether administration of high dose of diuretics is more effective in management of CHF than administration of low doses of diuretics. Th is means that current guidelines on administration of diuretics are based on expert opinion. This has resulted in variation in the mode of administration and the dosing. The integration/synthesis of the evidence There is still some controversy on the administration of pharmacological management therapies. This may have some negative impact on the treatment of CHF among elderly patients. For example, in a study done by Felker et al. (2011), it was observed that among patients with acute decompensated heart failure (HF), there no significant differences in â€Å"patients’ global assessment of symptoms† or in the change in renal function on administering diuretic therapy by bolus when compared with continuous infusion or at a high dose as compared with a low dose (p.797). These findings do not agree with findings of previous study, which recommended that continuous intravenous infusion is more effective than intravenous bolus. Critique of the evidence This leaves the medi cal doctor at a dilemma and thereby, no agreement on the best way to administer pharmacological treatment to patients. Unless this is done, varying expert opinion will still be used in the administration of diuretics by clinicians, and this poses a danger to the patients because such treatment will be based on try and error. NON PHARMACOLOGICAL CHF MANAGEMENT THERAPIES Non pharmacological CHF management therapies involve the use of non drug approaches to alleviate the symptoms (Kostis, et al., 1994).

Dennetts Arguement Essay Example | Topics and Well Written Essays - 500 words

Dennetts Arguement - Essay Example People have been trying to shake the world’s confidence in quantum physics through different scientific theories but they have been unsuccessful because the world can see something tangible and Einstein’s theory of relativity is well established beyond doubt. These are the people who argue that intelligent causes can explain the complex, information-rich structures of science and biology but people have never really been able to get the their heads around the concepts involved. Dennett is however convinced that any creation must have a creator and supernatural things cannot be explained through intelligent causes. He believes there is plenty of motivation to resist the assurance of the biologists and that ID is a hoax but people find ingenious ways to fool themselves. In support of his argument that natural selection is the process which has the power to generate ingenious designs, Dennett discuses the evolution of the eye. The intelligent design proponents feel that a fully evolved eye is evidence of intelligent design process but evolutionary biology has proved that this is wrong. Dennett also argues on the history of genes involved in the evolution process. He argues that if evolution did not occur through the process of natural selection, species would have found it difficult to adapt to their environment. The proponents of intelligent design have not been able to come up with any theory that challenges the theory of evolution. Dennett convincingly states that no intelligent design hypothesis till date has been able to give a rival explanation of any biological phenomenon. Intelligent design cannot even explain why human beings differ from their relatives. Dennett recounts that there are plenty of scientific controversies that are not yet in public knowledge as the scientists and biologists are first trying to get acceptance from their peers. Dennett’s

Organisational change management Essay Example | Topics and Well Written Essays - 3000 words

Organisational change management - Essay Example Such moves, however, may not be successful in ensuring the company’s progress. The Case Study D2, the auto components producer, introduced change due to external pressures such as competition from other auto parts manufacturers, and the financial recession that resulted in fewer customers. In response to these external pressures, D2 made some immediate changes to counter the down turn in revenue. To cut costs, the company stopped manufacturing some of its components while increasing the production of others in specific sites. The company also made the decision to close down its UK Plant because it contained archaic manufacturing technical gadgets. Moreover, the company’s management is yet to divulge the new changes of the impending closure of the UK Plant to its employees. It is a fact that the workers based at the UK plant in Didcot will be shocked by their discharges because they are expecting continued business operations with even more investment or capital being di rected into the operations there. It also has not deigned to share the new strategies with the firms remaining employees. Only the higher ranking managers are aware of the strategies. Most researchers tend to first evaluate organisational change through the input of Kurt Lewin’s Field theory. The field theory asserts that all businesses exist in an active though constant state. To sustain this balance, businesses are compelled to make changes in reaction to forces that affect or influence the business’s field (Burnes 2004). Lewin’s model seeks to prove that most of the time, any kind of organisational change will be gradually realised. Moreover, when a company is experiencing a crisis, any organisational changes it decides on are quickly implemented. The field’s theory states that when an organisation ahs to realise changes on a fast pace, it has to ensure that there are corresponding powerful forces working to see the needed changes become an accepted pa rt of the organisation’s functions (Burnes 2004). The theory also asserts that there is a need to ensure that there is a dissuasion of any efforts that encourage the organisation’s status quo to remain. Lewin’s model asserts that, when there is gradual change in an organisation, the necessary steps will take place in three stages: (i) The old, archaic and ‘accepted’ business operations or ways of doing things must be ‘unfrozen’ or removes altogether so that the coming changes can be allowed to take hold without any competing functions making the process difficult. In the ‘unfreezing process’, an organisation’s management will examine why the change is necessary while also looking into facts that exists and which might impair or assist the changes that will be suggested. The management will also encourage workers to think as they do about the necessity of incorporating changes in the organisation in order to improve i t. (ii) In the second stage, movement, the organisation starts to change its behaviour. These shifts in behaviour usually occur after the organisation’s personnel understand the how different options of change will work and have selected their preferred method of change (Cameron and Green 2004). In most organisations, the process of change is supervised or overseen by a specialist such as an organisational development practitioner. (iii) In the third stage of the field model, refreezing, the organisation generates structures and functions to