New paradigms for health care delivery

Changes occurring in Health care delivery and Medicine are the result of social, economical, technological, scientific forces that have evolved in the 21st century. Among the most significant changes are shift in disease patterns, advanced technology, increased consumer expectations and high costs of health care. These factors have redefined medical practices to fit into the changing health delivery system. Many health care professionals have come to the conclusion and belief that they will be compelled to explore new paradigms for health care delivery in the future like electronic medical record keeping, telemedicine, computer-based diagnostics and health monitoring to keep pace with the changing scenario. This is due to the accountability of the medical profession today and changing disease patterns. Doctors are under increasing pressure to keep up to date and to base their decisions more firmly on evidences as opposed to anecdotal information of the past. Patients are much more informed than they were 10 years ago. No doctor can tell a patient what to do without being questioned today. Further, with the advent of concepts like informed consent and advance directives, such scientific changes gain relevance. ELEMENTS OF THE NEW PARADIGM The use of electronic documentation is becoming increasingly prevalent in terms of convenience. The National Academy of Sciences report states that the US health care industry spent between $10 and $15 billion on information technology in 1996. Much of this expenditure is attributed to creating electronic records systems and converting conventionally stored data to electronic formats.   There are many software programs specially developed for electronic record keeping. This includes ‘Doctors partner’, an advanced Electronic Medical Records (EMR) System with Integrated Appointment Scheduling Billing, Prescription Writer, Transcription Module, Document Management and Workflow Management built to meet HIPAA standards. ‘Practice Partner Patient Records’ is an award winning electronic medical records (EMR) system, allowing practices to store and retrieve patient charts electronically. There are innumerable such branded medical record softwares available today. The standards in practice for EMR include ASTM International Continuity of Care Record , ANSI X12 (EDI) CEN , EN13606, HISA, DICOM , HL7 ,ISO   and openEHR . (Ringold et.al.,2000). The American Medical Association and 13 other medical groups representing 500,000 physicians have signaled their intention to go electronic with the AMA formed   Physicians' â€Å"Electronic Health Record Coalition† to recommend affordable, standards-based technology to their constituents. President Bush has also promoted a nationwide computerized medical records system in a recent visit to a children's hospital at Vanderbilt University. Scientific innovations have found a niche in complicated medical procedures as well. A recent study successfully has evaluated a bar code patient identification system, which involves a hand-held computer for sample collection and for compatibility testing administration of blood. (Turner et.al, 2003). A recent research article (Sandler et.al, 2000) reports of a solid phase and micro titer plate hemagglutination method for pretransfusion compatibility tests. This I-TRAC is an automated process of blood matching with improved serological sensitivity and standardized compatibility testing supporting electronic record keeping and linking to a bar code identification system. San Raffale Hospital in Milan, Italy, has recently collaborated with Intel and CISCO systems to use wireless-enabled infrastructures and Radio frequency identification (RFID) technologies. The system uses RFID-radio frequency identification technology to address the sources of   human and systems error in blood transfusion supply chain. This pilot programme has been   implemented at the 1,100 bed San Raffale hospital where more than 15000 blood transfusions are done every year. The CAT (Computer Aided Tomography) is yet another revolution in medicine which combines the X-ray technology with computer signal processing to generate images of tissues of the body obscured by other organs. Magnetic Resonance Imaging (MRI) is a common technique used to scan pathological or physiological status of living tissues. Much is known about the computer aided continuous ECG monitoring with a play back facility for assessing the cardiac status of the patient. Today we are in a wonderful situation where we will be able to develop a drug based on computer analysis skipping a few phases of clinical testing. PERSPECTIVES ON THE PARADIGM SHIFT Thus, scientific innovations are part of the evolutionary process of the medical science. The basic instrument of a physician, the Stethoscope, the Sphygmomanometer used for monitoring the patient blood pressure, the Catheter, Radiotherapy, Chemotherapy, the EEG, ECG, EMG, Echocardiogram, Ultrasonic scan, to name a few were nothing but such scientific innovations integrated into the field of medicine in the nineteenth and twentieth century. Thus, Computer based telemedicine, medical record system, and diagnostic procedures are scientific innovations of the twenty-first century. Hence, it is nothing but a natural and moral obligation of the health care sector to integrate them into the field of medicine. Changes in financial incentives and health care delivery structures are producing new threats to health care quality (A.Brennan, 1991). The retributive measures are cumbersome and expensive. Hence, there is a need for more accountable health delivery system, which will enable application of modern scientific approaches to quality health care system. In this context, quality of the medical care depends on promotion of quality medical care by managed care organizations. REFERENCE Brennan, T, et.al, â€Å"Incidence of adverse events and negligence in hospitalized patients: the results of the Harvard Medical Practice Study†, New England Journal of Medicine 324: 370-76, 1991. Là ¦rum Hallvard, MD, Tom H. Karlsen, MD, and Arild Faxvaag, MD, PhD . â€Å"Effects of Scanning and Eliminating Paper-based Medical Records on Hospital Physicians' Clinical Work Practice†. Journal of the American Medical Informatics Association 10: 588-595.2003. Ringold DJ , JP Santell, and PJ Schneider , â€Å"ASHP national survey of pharmacy practice in acute care settings: dispensing and administration–1999†. American Journal of Health-System Pharmacy 57 (19): 1759-75. 2000. Sauer et.al, â€Å"Errors in transfusion medicine† Lab Med. 32(4): 205-207, 2001. Turner et.al, â€Å"Bar code technology: its role in increasing the safety of blood transfusion†, Transfusion, 43(9): 1200:2003.

Stephen Kings All That You Love Will Be Carried Away

Stephen Kings All That You Love Will Be Carried Away Free Online Research Papers Stephen King’s â€Å"All That You Love Will Be Carried Away† is about a frozen food salesman Alfie Zimmer, who has to decide to either change his life and write a book or end his life by his own hand. He wants to write about his collection of sayings he has written down during his traveling. King’s ending of the story is obscure, and I want to prove that Alfie has too much to live for and that he is too committed to his notebook to end his own life. Alfie Zimmer makes money for his family by selling gourmet foods from the trunk of his car. However he is intrigued by the graffiti that litters the walls of rest stops and truck stops that he has encountered on his monotonous sales route. Alfie feels that writing a book about the sayings would be too hard of a change in his life and decides to commit suicide instead. Alfie chooses Room 190 at the Motel 6 in Lincoln, Nebraska to end his life. When he enters the room and sits on the bed â€Å"he reached for the telephone then remembered his notebook† (83). Alfie is intrigued by the old spiral notebook; it was more than a hobby now â€Å"(he) had been carrying this notebook, for almost seven years†¦Ã¢â‚¬  (83), it now was his work, his life. Alfie eats, drinks, and lives for the graffiti on the walls. He even analyzes it to make sure it is fit for his book, â€Å"â€Å"Poopie Doopie you so loopy (Papillion Neb)† Something about the â€Å"-ie –ie† and then, boom you got â€Å"y†Ã¢â‚¬  (84). Alfie thinks about the English Classes he wants to take to learn about the rules of writing. Although Alfie has decided to end his life that day, he says â€Å"Time to record today’s finds† (84) because it is his routine and his fun in life. As Alfie flips to an open page he thinks â€Å"Now two in one day. Two on the last day. Like some sort of omen† (84) it’s like he is searching for an excuse or answer not to take his life. Alfie also thinks of his family and calls them twice to remind them about errands and appointments tells them, he loves them for the first time in five years, hangs up the phone and inserts the fully loaded gun into his mouth. He pauses to think of his own graffiti about his death, â€Å"Here I sit, about to cool it, my plan to eat a fuckin’ bool it’. He grinned around the barrel. That was terrible. He never would have written that down in his book† (86). I also believe he knows that suicide is not written in his book of life. Alfie knows that by writing the book, it would change his life, he may be reje cted or accepted and he is not sure it is worth it. Alfie â€Å"had thought of writing a book, just a little one† (85) he just felt that society would not get the humor that he did out of the poetry. While sitting on the bed writing his daily finds â€Å"he put the pen back in his pocket wondering why he or anyone would continue anything this close to ending everything† (84). He cannot control his intrigue with the notebook, he compares it to â€Å"just†¦well†¦breathing he said, and smiled.† (84). When Alfie had called his family and recorded his notebook entries, he thought he was ready to do the â€Å"end† deed but then â€Å"he frowned and put the gun down. The book was open to the last four entries† (86) the notebook once again stopped him from shooting his brains out. He thought of what the police would think. Finding a dead man with a notebook of crazy sayings â€Å"he was not crazy, and the things he had written here over the years weren’t crazy, either† (86). So Alfie thinks of ways to destroy or hide the notebook He decides to flush it down the toilet, but makes the excuse that it would clog the toilet but he also thinks â€Å"besides, the notebook had been with him so long†¦He hated the idea of flushing it away† (87). He keeps thinking of the notebook, he is very compulsive about his findings â€Å"he loved the stuff in the notebook† (87). Alfie realizes that without him â€Å"the notebook might be a real embarrassment once he was dead† (87) and he just can’t come to destroy the notebook. Alfie still feels the need to commit suicide but â€Å"there was no need to destroy it (notebook) after all† (89). So he goes out into the blustery January day and throw the notebook into the farmer’s field â€Å"Alfie drew the book back to throw it, then lowered his arm. He hated to let it go, that was the truth of it† (89). He was not ready for the future, but with his book in hand, he felt alive. With notebook in hand he made himself a deal, â€Å"if the spark lights of the farmhouse reappeared at anytime during the count, he would try to write the book† (89). Alfie once more intrigued by his collections, he thinks about the book, what it should contain, the des criptions, noises, and smells of the rest stop restrooms and truck stops. Alfie had already thought of a title for the book, he was just scared that the book would be rejected by society and he would be laughed at. As â€Å"Alfie stood there counting inside his head waiting to see if the wind would drop† (89) however I believe that Alfies own spark lights came on because he realized the book is his life, his life that would be filled with fun and enjoyment. I also think he knows he can’t kill â€Å"Alfie the Salesman† because it would kill â€Å"Alfie the Writer† and â€Å"Alfie the Dad†. The notebook is Alfie’s life if he cannot destroy the notebook, he cannot destroy himself. Research Papers on Stephen King’s â€Å"All That You Love Will Be Carried Away"Book Review on The Autobiography of Malcolm XHarry Potter and the Deathly Hallows EssayThe Masque of the Red Death Room meaningsComparison: Letter from Birmingham and CritoArguments for Physician-Assisted Suicide (PAS)Trailblazing by Eric AndersonEffects of Television Violence on Children19 Century Society: A Deeply Divided EraCapital PunishmentMind Travel

Bunker Hill Essays - Charlestown, Boston, Battle Of Bunker Hill

Bunker Hill Essays - Charlestown, Boston, Battle Of Bunker Hill Bunker Hill The battle on Breeds Hill, wrongly named the Battle of Bunker Hill, changed the course of the American Revolution. This battle was the first large-scale engagement and also one of the bloodiest battles of the American Revolution. It was held on June 17, 1775 in Charlestown (now part of Boston), Massachusetts. The prior battle to this one would be the at Lexington and Concorde which sort of started it all. This battle took place April 19, 1775. After the battle at Concorde British troops decided to give up and stop fighting and marched back. Meanwhile the Americans continuously made hit and run attacks on the retreating forces. This heightened the heat between the rebels and the British. Later, 5 days before the battle at Breeds Hill, General Thomas Gage would declare martial law. Stating to give pardon to anyone who would lay down their arms and pledge himself to King George. He did this to avoid further uprisings and armed conflict. Unfortunately, this had the opposite effect and upset many of the colonists. Thus, adding to the flame and making the battle almost imminent. On June 16, 1775 the Americans became aware of the British plan to take control of Bunker and Breeds Hills. So the rebels decided to invade the area before the British in a hope to fortify it and be prepared for the Redcoats. Colonel William Prescott and 1,200 men, mostly from Massachusetts, moved in to the peninsula with the mission to fortify Bunker Hill. Two ours upon arriving they realized that they needed to fortify Breeds Hill and fall back on Bunker Hill if necessary. During the night of the sixteenth Colonel Prescott gave them the orders to Dig, and dig hard. Trying to get the soldiers to fortify Breeds Hill as best as possible. If they learned anything from that night they learned that a Yankee soldier, at this stage of war, was a great digger. The nights work turned out to be tactically genius. Between those ours of midnight and first light the troops dug up a square frame on the hill. Each side being about 45 yards. They also fortified an area running northeast from the hill about halfway to the water. A quarter of a mile behind that, they continued the barricade along a stone wall and rail fence that went the rest of the way down the shore. Breeds Hill was now tactically secure and was ready for battle. The next day when the British discovered this fortification they became infuriated. The boat Lively opened fire upon the hill. Joined in by the Glasgow and Somerset these three ships made much noise and did minimal to no damage. The British finally realized that the American position was not as completely stupid as it looked some eight hours later. Sir William Howe received tactical information from Gage on commands of operation. With this and 1,200 men Howe landed on the peninsula. Throughout that day the American forces had been reinforced to about 1,500 troops. The British grew to about 2,500 that would actually partake in the battle. The stage was now set for one of the bloodiest battles of the Revolutionary War. The British could have easily taken over the hills by surrounding them but they wanted to show them who was boss so they decided on a head on battle. They realized faults in their plan where the rebels fortified the areas well, however the British paid no attention to it. They had no reason to stop and think twice from their past experiences with the rebel forces. So far they had shown no great ability to shoot and these men behind low stone walls or rails surely would be nothing to think twice about. British brought some light cannons for some direct artillery support but foolishly brought the wrong size ammunition, but no one expected to use them anyway so they remained there useless. This type of thinking was part of why the British had such seve re casualties. When it was obvious the battle was going to begin the officers were extremely nervous on the American side. Many of the officers paced back and forth in the trenches behind their men. They had

ONE FOOT IN FRONT OF THE OTHER

ONE FOOT IN FRONT OF THE OTHER Finding time to write is hard, but you do it. Improving your writing is time consuming, but you manage. Its hard to find critiquers for your work, but you keep searching until you do. You never think youll find a publisher, but its doable. Then you hold a book in your hand, and you beam with happiness. Youve done it, and you want to whoop your achievement to the world. Friends pat you on the back and others email you with congrats. And the hard part hasnt started. Promotion is harder than all that combined. Surely she jests, I hear you say. Nope. Im serious as a heart attack. In all my years of writing, editing, researching, and building a platform, Ive never run into anything as frustrating as promoting a book. Ive been tossed Ive had my magical moments of selling 20 books in one night. Ive had my down evenings where I doubted what I was doing trying to establish myself as an author. Then I always tell myself that each and every author was a nobody before he became somebody. He sold one book at a time, hoping whoever bought it would spread the word until books sold he wasnt even aware of, the number adding up until he realized the hellacious journey he traveled over the years was finally beginning to show results. You dont see success coming. It just shows up one day, asking you to let it in . . . unless you quit along the way. Then it goes and knocks on somebody elses door.

COMS 445 Portfolio Paper Essay Example | Topics and Well Written Essays - 1750 words

COMS 445 Portfolio Paper - Essay Example The theme song and opening sequence set the sequel of the show. Why was the show viewed negatively? In this paper I will recommend that The Fresh Prince of Bel-Air, the African American sitcom broadcast in the 1990s, might be recognized a vehicle through which the accepted representation of dark characters in the last part of the twentieth century has been undermined, addressing the old stereotypes about African Americans, consistent with which a character must be poor, ghettoized or a criminal. One of the points of this paper is to highlight and to analyze why the show was seen contrarily in connection to the everlasting social crash between blacks and whites and, most importantly, as Brooks and Marsh uphold, "the troubles confronted by blacks in a white social order" (Brooks & Mash, p368). Moreover, having investigated the first season of the arrangement, I will offer a few perceptions identified with the part of the primary character, featured by the performer Will Smith, and his connection with alternate parts of the family, highlighting that the hero's assignment to think about his relatives' societal position and conduct as absence of Blackness is a methodology that permits the other dark characters to subvert the universal picture of African Americans offered by American broad communications everywhere throughout the planet. The point of this approach could be recognized an approach to decipher the new dark socio-social environment of the most recent decades of the previous century in the USA, permitting viewers of the nations where the sitcom was publicized to meet and comprehend key parts of the American dark group of that period (Brooks & Mash, p367). Judging by a confounding African American circumstance parody by Means Coleman for its unique approach to delineate additionally undermine conventional pictures of dark stereotypes, The Fresh sovereign of Bel-Air is frequently looked into (Coleman, p144). It is conceivable to look after that all around t he entire first season, that incorporates 24 scenes, two propensities are unmistakable: the first is undoubtedly the representation of the everlasting crash between the primary character of the story and his relatives, addressing the accepted part of dark characters in the handling on TV in the twentieth century, and the second one is identified with the challenges of living in a white rich neighborhood being part of the Black group. These two focal issues are addressed and confronted through two coordinating techniques. The clearer of the two is portrayed by the incessant verbal battles between the principle characters, and the other one uses amusing and evidently say-nothing circumstances to highlight the issues this rich dark family needs to face as a result of a white-focused social order (Coleman, p168). How does Zook re-interpret the show? How does Zook re-translate the Fresh Prince of Bel-Air? According to zook, when Fox's urban system was started in 1986, the system tight th rew or focused on a particular back viewership and counter-customizing against different shows to suite that group of onlookers' taste (Zook, p90). As per Zook, a normal for dark Tv is socially particular feel. While rap music and graffiti-like representation were regular on white shows of this period also, Afrocentric Clothing, haircuts, and antiquities performed particular capacities in dark shows, for example the new ruler of bel-air with continuous references to Malcom X,

The Performance Appraisal Meeting and Performance Diagnosis PowerPoint Presentation

The Performance Appraisal Meeting and Performance Diagnosis - PowerPoint Presentation Example tly by checking whether they have accomplished their goals but only after a year.  Effective performance management in ACME is illustrated under the leadership of managers who apply various techniques in dealing with performance management. If performance management is treated as a complete system not leave any parts, and if there is success with performance planning and ongoing performance communication, there can almost be guaranteed success during the performance meetings. There are two reasons for this: First, the employee will understand appraisal process is a partnership. Second, there will be no surprises in the appraisal meeting (Bacal, pg.102). During the appraisal meeting the most crucial tasks for the managers is to evaluate and relate the output of the employee with their targets. The managers carry out a regular overview of the progress of each employee in relation to the tasks assigned to the employee. In return, the management expects each employee to meet the set goals in their working area, and this ends up being a collective objective that can enhance an organizations success. During the appraisal meeting, the manager should take on role of helper, problem solver, rather than evaluator, employee is in partnership and is a self-evaluator, employee should understand what to expect, in terms of content and process, manager should treat meeting as important, and most importantly, both manager and employee should understand why of the apprai sal. At ACME Healthcare Inc. there seems to be a need to integrate the need to prepare the employee for the appraisal meeting without a conversation of what is expected. Managers should let the employee understand purpose of meeting. Performance Diagnosis is the process that should be used with an employee to determine the causes of his or her success and/or difficulties. Performance is affected by the interaction of the work environment and the individual, and not by one or the other alone. ACME Healthcare Inc.

BMW Automobiles. BMW Demand and Supply Coursework

BMW Automobiles. BMW Demand and Supply - Coursework Example Microeconomic Analysis Demand is the willingness and the ability of consumers to buy a certain product for a certain price at a particular period. While other factors are held constant, the prices of goods and services increase as its demand increases and vice versa. Supply is the willingness of the manufacturer or the company producing then goods or services to sell the products at a given price at a given period. While other factors are held constant, the supply of goods and services will increase at an increase in price. Various demand and supply factors affect the production and sale of BMW 3 series vehicles (Flaschel, 2010, p.1). The first factor is affecting BMW’s demand and supply is consumer taste and preference. Different consumers have a varied taste and preference for the product. BMW 3 series is a mid-level luxury performance sedan. The car is also a bench marker in the market. It has played a great role in influencing the competitor’s in trying to achieve i ts class. The consumers also have their taste, which varies with the individual. The taste and preference of this car by some individual consumers is predominantly affected by its price in the market, the performance both on road and on off roads modes, the cars ability to perform, and the fuel consumption. The BMW 3 series has a relatively high fuel consumption capacity as compared to its competitors and it is better in performance than its competitors are. Secondly, consumer income affects the demand of the BMW 3 series. Consumer income is the amount that the consumer has which they are willing to invest on that commodity. The BMW 3 series retail price varies depending with the model. The lowest price for the BMW 3 series is $32,400. This price may not be affordable to many consumers. The consumer income is the greatest determiner of the demand for this product both in America and outside the American market (Flaschel, 2010, p.1). Additionally, price of substitutes and other compl ementary vehicles affects the demand of the BMW 3series cars. BMW, being a luxury mid-level vehicle, has many substitutes and complementary vehicles. An example of these substitutes is the Audi A3, Infiniti G35, Cadillac CTS, and the Acura TL. These substitutes have a relatively low price and perform equally with the BMW 3 series. The availability of these substitutes has greatly affected the consumers’ decision in determining the best car available for them. The availability of these substitutes also influences the ability of the consumer to save in comparison to what they would have used if they purchased the BMW 3series. Additionally, the BMW 3 series has been affected by the complementary goods. Complementary goods are the goods that are used alongside the product. The BMW 3 series is a relatively high consumer if gasoline in comparison to its competitors. This has hugely influenced the demand of this car (Hortacs, et al, 2010, p.1). The forth factor that has influenced t he demand of this car is the consumer expectations. The BMW 3 series car has largely met the consumers’ expectations. BMW is actually an envy of many people, which has also increased the demand of this vehicle. The BMW 3 series is a great performer both on road and on off road modes. This has enabled it to have an innovative over the others in the market. The BMW also produces high quality vehicles that are not prone to damages as compared to it