Decoding the past the secrets of kabbalah Movie Review

Decoding the past the secrets of kabbalah - Movie Review Example The literal meaning of Kabbalah is â€Å"receiving.† It relates to mystical features of Rabbinic Judaism. Creator is the All-pervading power that controls everything in the world. The quality of helping others and charitable disposition paves the way for the Creator for the well-being of the individual. The movie brings to the reach of the common viewers the exclusive philosophy and religious practices of Judaism that is reserved for study by ultra-religious scholars. The scene has undergone total transformation. It is a multi-million dollars industry now, and celebrity-endorsed venture. The secrets for thousands of years have been demystified. To grasp the original teachings is still a far cry for the commoner, and one has some idea as to what Kabbalah is all about, after viewing the movie. The problem with the movie is that it presumes that the viewer has the backgrounder information about Judaism. So if you are going with the hope of watching the secrets of the mystical history of Judaism, the way the rituals are conducted and their importance, you will be disappointed. The script of the movie is based on many texts whose authenticity is doubtful. They are unable to provide tangible information and reveal the secret alphanumeric code in the Torah. Unless the viewers have the cultural knowledge of Judaism, watching the movie will not be a rewarding experience. A movie of 50 minutes duration will certainly not be able to provide complete information about the secrets of mysticisms of Judaism. The message through the movie is clear and straightforward but it is incomplete. When you are dealing with the intricacies of a profound philosophy, to learn which the rabbis take a lifetime, how justice can be made to the subject with a capsule of 50 minutes? There are many hidden meanings in the revelations of Judaism, unless the producer or the director is well- versed in them, the dialogues will not carry the intended import. It

An audit on the appropriate completion of the venous thromboembolism Dissertation

An audit on the appropriate completion of the venous thromboembolism (VTE) risk assessment and adequate thromboprophylaxis durin - Dissertation Example Certain patient subsets display VTE pathologies of idiopathic causes, with no apparent identifiable risk factors. Therapeutic anticoagulation is the cornerstone of management in all patients with VTE, in many cases, standard anticoagulants such as heparin are included as therapeutic options in normal practice. (Schulman et al 2009) Adjunctive treatments, such as thrombolysis and the use of vena cava filters, are prescribed in certain cases. Pregnancy is among several risk factors for deep venous thrombosis, in addition to minor injuries and surgery. (Van Stralen et al. 2008) But those with a familial history of thrombophilia-related blood conditions are at an increased risk. (American College of Obstetricians 2000) Most physicians do not recommend general screening for the patient population at large, and several studies attest to the need for a regimen of targeted testing for VTE conditions only when a battery of predisposing factors is extant. ( Robertson et al. 2006) (Osinbowale e t al. 2010) Of particular instance in this case is the degree to which proper screening is conducted for pregnant women, both upon admittance to Maternity, and postpartum. SCREENING Diagnostic testing for inherited or acquired thrombophilic conditions is advisable in the presence of personal or family history indicating heightened risk factors. The Factor V Leiden and prothrombin G20210A mutations are the most common genetic thrombophilic disorders, and antiphospholipid antibody syndrome is the most clinically significant acquired defect. Venous thromboembolism often results from the interplay between a series of risk factors. 50% of pregnant women with also exhibit thrombophilia. (Nelson-Piercey 2004) (Zotz et al. 2003) Understanding these VTE risks increases the probability of timely prevention and diagnosis. Virchow’s triad refers to 3 abnormalities that promote thrombogenesis: hypercoagulability, stasis, and endothelial dysfunction or injury. (Van Stralen et al. 2008) (Os inbowale et al. 2010) Several predisposing factors alter ? 1 components of Virchow’s triad. In a systematic analysis of 1231 consecutive patients treated for VTE, 96% exhibited > 1 recognized risk factor. Venous thromboembolism risk factors as may be hereditary or acquired. (Osinbowale et al. 2010) (Dresang et al. 2008) Osinbowale et al. 2010 Provides a ranking of predisposing risks from to lowest to highest in terms of probability: 1.) Obesity LOW 2.) Elderly 3.) Varicose veins (Varicosity) 4.) Laparoscopy 5.) Stasis (Immobility, due to long-term bed rest) 6.) CV catheterization 7.) Any other medical condition requiring hospitalization 8.) Previous VTE states 9.) Paralytic stroke 10.) Hormone Replacement Therapy 11.) Oral contraceptives, and pregnancy itself 12.) Arthroscopic knee surgery 13.) Malignancy and chemotherapy 14.) Spinal Cord injury 15.) Multiple traumas 16.) Major general surgery 17.) Major orthopedic surgery 18.) Long bone fractures, or fractures of hips and pe lvis. HIGH Clinical examinations may prove unreliable, therefore decisions in terms of treatment and/or screening tests must be based upon signs, symptoms, and preexisting risk factors. In this manner, patients are grouped into low, moderate, or high clinical probability of risk. (Sandler et al. 1984) Clinical symptoms of VTE disorders may be subtle and difficult to distinguish from gestational edema, though pain, warmth,

School Funding Essay Example for Free

School Funding Essay Youre a ninth grader at a school in Philadelphia. The neighborhood is poor, even if not all of the students are. Your school has very little money for things like computers or technology. You walk into second period one day, sit down, and discover that the floor next to your desk is damp. The teacher explains that there is a leak in the roof, and that the school cant afford to fix it. The school cant afford to fix the leak or buy computers because it is inadequately funded. So the government kindly lends your school the money to not only fix the leak, but buy computers. But does that necessarily motivate you to improve your grades? Do you suddenly decide to do your homework because the leak is fixed? Probably not. The government sees that your grades remained the same, and two years later, when our school needs to hire more teachers and make the classes smaller, the government denies the school that money. They say that since money didnt help your grades last time, why should it help you now? But the truth is that smaller classes and better teachers do improve student achievement. Members of our government claim that giving more money to schools will not make a difference, but the government funding for schools needs to be used effectively to see a change in student performance. (Connell) The reason that some schools cant do things like buy computers and maintain their buildings to begin with is because the school funding system is so ineffective. The US government pays only 7% of all school money, and the rest is up to the states and the tax payers. Whatever money the states wont pay is paid as school tax, part of your property taxes, which are higher or lower depending on how much your home is worth. But this means that schools in poor neighborhoods get little money while wealthy schools, like ours, get nearly all they need. You dont see any leaky roofs in our school. Even if the state pays a lot of money, that still doesnt mean that the schools are well funded. In Hawaii, there is only one school district, and the state pays for nearly all of that districts funding. Only 2% comes from property tax, and the rest comes out of income tax. But think about the industry in Hawaii- farming and tourism, two low income industries. 73% of Hawaiis schools report a need for expensive building repair that they cant afford on their own, and there is only one computer for every sixteen students. Even funded evenly by the state, Hawaiis schools are still under funded, and it has been predicted that by 2010, Hawaii will need 760 new classrooms. (National Education Association. ) Where will this money come from? It is up to the national government to make the difference in school funding. Take Pennsylvania for example. The Philadelphia school district is near bankruptcy. The debate goes on over whether to privatize the schools or not. If the schools are privatized, it means that a wealthy company will take over the district and fund it. The only problem with this is that the company now has the power to control everything in the district, including teacher salary, equipment, and even curriculum. Now if you were a business owner looking to make money, and not looking to educate children, you would most likely chose to change the curriculum to fit your own financial ambitions. It would be completely within the limits of the law for the company that owned these schools to dumb down the curriculum in order to save money, thus lowering the level of education received by students in Philadelphia. And what would be the first to go? Sports, Art, music, drama, and any other subject that isnt included on the standardized tests or SATs. How would you like to go to a school where there is no football team, no marching band, no cheerleading, no chorus, no trips to the State Drama Conference? Thats where schools in Philadelphia are headed. (Snyder) Compare that to my school district, just a short drive away. Every teacher has a laptop and every student has Internet access. Were looking at new classrooms of the future, where every kid gets a personal computer and all board work is done on a high tech projector. We have a Frisbee team, for heavens sake. And some schools dont even have money for textbooks. Inequality in school funding is so widespread that fixing it would mean a lot of work for government officials. But while they ponder how to fix it, the least they could do is help out the already failing schools. Nearly one fifth of all schools are considered high poverty, which means that three quarters of the students in these school qualify for free or reduced lunch. A study of 40,000 students by the US Department of Education showed that students in poor school districts, even if they came from wealthy to middle class families, scored two grade levels lower than the national average in math, and four levels lower in reading. (Overview) The government needs to be willing to help these schools with things like staff training and building maintenance. They should not hold it against the school if revamping the building doesnt improve student grades. What the government is doing, in essence, in punishing the victims of its own inept system. The assumption that money doesnt help kids in school is just that- an assumption. Money can make a huge difference, but a lot of the time it is wasted or used inappropriately. One school district began a highly expensive program to help kids doing poorly in school. The aides helping with the program did exactly what they were told, and reported all the progress made by kids in the program, which was little. It was a long time before the teachers participating in the program realized that it was useless, and that the money had been wasted. (Connell) If the National government is going to help fund failing schools, those schools do need to be held, to a certain extent, accountable for that money. In Philadelphia, so much money was wasted that the sate and national government now refuse to help fund it any longer. What is needed is a system to make sure that money given to the school is used effectively, so a tragedy like Philadelphia doesnt repeat itself. It is also important to remember that computers do not heal all wounds- they are not a magic pill to improve grades. But teachers are. The important thing in school is teaching. A recent study showed the link between class size and grades by placing a random selection of children into three groups- a large group with one teacher, a medium group with two teachers, and a small group with one teacher. It was shown that kids in smaller classes with well trained teachers did much better than those in larger classes, even if the teacher had an aide to help. And the students who benefited the most, believe it or not, were those who came from families with less income. (Connell) Why? Possibly because they dont receive that kind of one on one attention at home, or possibly just because a smaller class is easier for a teacher to handle. Either way, the goal is achieved. Kids who live in the city and poorer neighborhoods deserve the same education as the rest of us, and if their schools cant pay for it, the government should. Helping the country is the governments job, but how are they able to help anyone if they cant start with Americas children? Our constitution states that All men are created equal, but these day that means kids too. Our education sets the tone for the rest of our lives-from getting a job to providing for a family and having knowledge of the real world. Giving some students a better education than others, just because of the value of their home, is unconstitutional. If the present system doesnt provide the resources for schools to provide an equal education for all, then the government needs to pick up the slack of their own system. The money given to the schools by the government must be used effectively if a change is desired, and the way to do that is by hiring better teachers and making class size smaller. If the school itself cannot afford to educate its students, then the government needs to provide the school with the money to do so. Theyre Americas children too. Works Cited Overview. School Funding Inequity.  ©2000. Noreen Connell. Under Funded Schools-Why Money Matters. School funding Inequity. March/April 1998.  ©2000. NEA Government Relations. School Modernization Facts- Hawaii. National Education Association Website. May 23, 2001. Susan Snyder. PA to study school district finances The Philadelphia Inquirer. December 4, 2001. Julie green and Erica Lepping. Education Report- Shows Poverty Linked to Student Achievement. School Funding Inequity. Sptember 8, 1998.  ©2000. Funding Schools Appropriately Youre a ninth grader at a school in Philadelphia. The neighborhood is poor, even if not all of the students are. Your school has very little money for things like computers or technology. You walk into second period one day, sit down, and discover that the floor next to your desk is damp. The teacher explains that there is a leak in the roof, and that the school cant afford to fix it. The school cant afford to fix the leak or buy computers because it is inadequately funded. So the government kindly lends your school the money to not only fix the leak, but buy computers. But does that necessarily motivate you to improve your grades? Do you suddenly decide to do your homework because the leak is fixed? Probably not. The government sees that your grades remained the same, and two years later, when our school needs to hire more teachers and make the classes smaller, the government denies the school that money. They say that since money didnt help your grades last time, why should it help you now? But the truth is that smaller classes and better teachers do improve student achievement. Members of our government claim that giving more money to schools will not make a difference, but the government funding for schools needs to be used effectively to see a change in student performance. (Connell) The reason that some schools cant do things like buy computers and maintain their buildings to begin with is because the school funding system is so ineffective. The US government pays only 7% of all school money, and the rest is up to the states and the tax payers. Whatever money the states wont pay is paid as school tax, part of your property taxes, which are higher or lower depending on how much your home is worth. But this means that schools in poor neighborhoods get little money while wealthy schools, like ours, get nearly all they need. You dont see any leaky roofs in our school. Even if the state pays a lot of money, that still doesnt mean that the schools are well funded. In Hawaii, there is only one school district, and  the state pays for nearly all of that districts funding. Only 2% comes from property tax, and the rest comes out of income tax. But think about the industry in Hawaii- farming and tourism, two low income industries. 73% of Hawaiis schools report a need for expensive building repair that they cant afford on their own, and there is only one computer for every sixteen students. Even funded evenly by the state, Hawaiis schools are still under funded, and it has been predicted that by 2010, Hawaii will need 760 new classrooms. (National Education Association. ) Where will this money come from? It is up to the national government to make the difference in school funding. Take Pennsylvania for example. The Philadelphia school district is near bankruptcy. The debate goes on over whether to privatize the schools or not. If the schools are privatized, it means that a wealthy company will take over the district and fund it. The only problem with this is that the company now has the power to control everything in the district, including teacher salary, equipment, and even curriculum. Now if you were a business owner looking to make money, and not looking to educate children, you would most likely chose to change the curriculum to fit your own financial ambitions. It would be completely within the limits of the law for the company that owned these schools to dumb down the curriculum in order to save money, thus lowering the level of education received by students in Philadelphia. And what would be the first to go? Sports, Art, music, drama, and any other subject that isnt included on the standardized tests or SATs. How would you like to go to a school where there is no football team, no marching band, no cheerleading, no chorus, no trips to the State Drama Conference? Thats where schools in Philadelphia are headed. (Snyder) Compare that to my school district, just a short drive away. Every teacher has a laptop and every student has Internet access. Were looking at new classrooms of the future, where every kid gets a personal computer and all board work is done on a high tech projector. We have a Frisbee team, for heavens sake. And some schools dont even have money for textbooks. Inequality in school funding is so widespread that fixing it would mean a lot of work for government officials. But while they ponder how to fix it, the least they could do is help out the already failing schools. Nearly one fifth of all schools are considered high poverty, which means that three quarters of the students in these school qualify for free or reduced lunch. A study of 40,000 students by the US Department of Education showed that students in poor school districts, even if they came from wealthy to middle class families, scored two grade levels lower than the national average in math, and four levels lower in reading. (Overview) The government needs to be willing to help these schools with things like staff training and building maintenance. They should not hold it against the school if revamping the building doesnt improve student grades. What the government is doing, in essence, in punishing the victims of its own inept system. The assumption that money doesnt help kids in school is just that- an assumption. Money can make a huge difference, but a lot of the time it is wasted or used inappropriately. One school district began a highly expensive program to help kids doing poorly in school. The aides helping with the program did exactly what they were told, and reported all the progress made by kids in the program, which was little. It was a long time before the teachers participating in the program realized that it was useless, and that the money had been wasted. (Connell) If the National government is going to help fund failing schools, those schools do need to be held, to a certain extent, accountable for that money. In Philadelphia, so much money was wasted that the sate and national government now refuse to help fund it any longer. What is needed is a system to make sure that money given to the school is used effectively, so a tragedy like Philadelphia doesnt repeat itself. It is also important to remember that computers do not heal all wounds- they are not a magic pill to improve grades. But teachers are. The important thing in school is teaching. A recent study showed the link between class size and grades by placing a random selection of children into three groups- a large group with one teacher, a medium group with two teachers, and a small group with one teacher. It was shown that kids in smaller classes with well trained teachers did much better than those in larger classes, even if the teacher had an aide to help. And the students who benefited the most, believe it or not, were those who came from families with less income. (Connell) Why? Possibly because they dont receive that kind of one on one attention at home, or possibly just because a smaller class is easier for a teacher to handle. Either way, the goal is achieved. Kids who live in the city and poorer neighborhoods deserve the same education as the rest of us, and if their schools cant pay for it, the government should. Helping the country is the governments job, but how are they able to help anyone if they cant start with Americas children? Our constitution states that All men are created equal, but these day that means kids too. Our education sets the tone for the rest of our lives-from getting a job to providing for a family and having knowledge of the real world. Giving some students a better education than others, just because of the value of their home, is unconstitutional. If the present system doesnt provide the resources for schools to provide an equal education for all, then the government needs to pick up the slack of their own system. The money given to the schools by the government must be used effectively if a change is desired, and the way to do that is by hiring better teachers and making class size smaller. If the school itself cannot afford to educate its students, then the government needs to provide the school with the money to do so. Theyre Americas children too. Works Cited Overview. School Funding Inequity.  ©2000. Noreen Connell. Under Funded Schools-Why Money Matters. School funding Inequity. March/April 1998.  ©2000. NEA Government Relations. School Modernization Facts- Hawaii. National Education Association Website. May 23, 2001. Susan Snyder. PA to study school district finances The Philadelphia Inquirer. December 4, 2001. Julie green and Erica Lepping. Education Report- Shows Poverty Linked to Student Achievement. School Funding Inequity. Sptember 8, 1998.  ©2000.

Effectiveness Of Electronic Medication Administration Record System Information Technology Essay

Effectiveness Of Electronic Medication Administration Record System Information Technology Essay The report will highlight that to enhance technology in clinical setting is not easy. It required lot of support and resources. In-addition technology cannot be successful without well organized plan. It requires long term planning. This report will provide the overview of pilot implementation of electronic medication administration record (eMAR) system. Health care providers need to understand the importance of eMAR its role in improving patient care safety. This system will help to increase patient safety and have extremely positive impact on hospital reputation. It also helps to decrease medication errors and adverse drug reaction via safe medication administration. It also helps to save printing cost. Pilot implementation of the system assist in identifying issues related to medication administration error in hospital setting. Thus, help to understand how IT processes help to enhance safety. It further helps to understand analyze benefits of the system and how IT facilitates can reduce the chances of error by having robust computerized system. This paper helps to identify users anxiety to accept the IT systems and little modification in programming helps to get positive outcome. This paper investigates why IT systems are unsuccessful and suggest computer literacy and simple modification and technical support to users will help to expedite the process to achieve everlasting solutions to provide quality and safe care to the patients Introduction: The quality of patient care and safety is one of the most significant aspects of health care sector. Nursing and medical professionals face increased need of using information technology in day to day operations with an overall aim of improving the quality of care by increasing patients safety. Currently, hospitals facing patient safety issue related to medication administration. Numerous studies conducted to identify number of medication administration error. Stoppler (2006) pointed it as Approximately 1.3 million people are injured annually in the United States following so-called medication errors. Chiang (2008) supported this issue as Medication errors have been a major concern of patient safety initiatives for all health care systems of the world. Internationally health care facilities are struggling hard to increase patient safety via safe medication administration, because existing paper base medication administration record process is not safe and presented with large number of errors. Russo, (2007) stated that, current paper based medication administration record (MAR) is an inefficient process with no decisive workflow, that places needless stress on nursing staff and lead to illegible entries can resulted in medication administration errors. Therefore, to maintain the quality of drug dose administration and to prevent medication administration errors, electronic medication administration record (eMAR) system, is found to be significant. Few studies suggested that eMAR is a bedside medication administration recording tool providing new levels of recording medication administration activities by dropping error rates and making the administration of medications safer for patients. This report aims to outline the background to implement eMAR system, process of implementation, strength weakness of newly developed system and potential benefits on complete implementation to develop insights about newly developed electronic system for medication administrat ion record. Background: At my institution in 2006 during Joint Commission International Accreditation (JCIA) survey, auditors were not able to find out the administration record of one of the drug of a patient. This generated a thought to have electronic records for all the care provides to the patients. Malloch (2007) highlighted the need of electronic record as: Three specific applications within the electronic record-computerized physician order entry (CPOE), electronic medication administration records (eMAR), and clinical documentation-are impacting patient safety in numerous ways by decreasing incorrect and unnecessary treatments and medications, as well as improving the timeliness of careà ¢Ã¢â€š ¬Ã‚ ¦.The benefits from these 3 applications vary, depending on the implementation sequence; some organizations implement each application as separate initiatives, while other organizations have implemented all 3 applications simultaneously. (p. 159) Consequently our organization decided to initiate each application separately. CPOE for medication prescription, dispensation and medication order review had already been implemented in July 2005. Therefore higher management decided to design and develop in-house system of eMAR for safe medication administration as an initial step towards electronic patient record. The purpose was to eradicate manual MAR and replace with eMAR since current paper based MAR sheets had following subsequent issues: Manual administration record are more prone to error Prone to being lost as difficult to manage paper Utilizes large amount of paper Not meeting the JCIA requirement Administration record not available after discharge Data retrieval is difficult from paper based MAR Sheet Paper records are frequently lost unorganized Sloppily written record lead to legibility issues Mekhjian et al (2002) found that manual medication administration charting resulted in a transcription error rate of 11.3 percent whereas transcription errors were completely eliminated via eMAR. Further literature supports that the most common errors reported were administering drugs at the wrong time or neglecting to administer drugs at all. eMAR provided the framework for improvements in patient safety and in the timeliness of care. (Mekhjian, 2002). Bates Cullen (1995) suggested that 78% of errors leading to drug errors are due to inadequate information management system of eMAR. Furthermore, eMAR has gained a foothold in inpatient settings to support medication administration safety. It prevents paper records prone to being lost, incomplete, or misread. California Institute for Health Systems Performance report highlighted that upto 38% of inpatient medication errors occur at the administration stage (Miller et.al, 2001) Solution: Electronic Medication Administration Record System Safe medication administration is one of the most important elements of care. During hospitalization nurses are responsible to administered medication safely to the patients. This activity is performed multiple times in a day for an individual patient. It is a complex process therefore accurate documentation of the medication administration is extremely important. Jylha Saranto (2008) cited: The complexity of the medication management process exposes it to errors, and medication errors can occur at any point in the medication management process. A survey recently conducted in a Finnish hospital showed that more than half of reported adverse events (66%) were medication errors, most of them relating to documentation (33.6%) However, manual MAR had lot of issues related to patient safety and could lead to adverse drug events. Thus, organization decided implement for eMAR because it allows nurses to manage medication administration efficiently as it has the potential to make the administration of medication safer for the patients by reducing error rates (Westbrook, 2007). Therefore following steps were taken: eMAR task force developed to explore the need of technology including hardware software Group reviewed current medication administration process and developed flow diagram for expected system Visited different hospitals in USA to develop understanding of the system and its flow Conducted regular meeting with ISD for system design and development After having vigorous exercise team identified that eMAR could not be implemented completely without right patient identification and right drug identification. This system is heavily dependent on admission and pharmacy system. Therefore bar-coded wrist band bar-coding unit dose system would be pre- requisite. Consequently sub-group was developed to explore bar-coding system for different applications. The purpose to incorporating bar-coding in health care setting is to improve the quality of care by reducing medical error and by decreasing the cost of care for the patient. Thus, admission and pharmacy departments had been involved for bar-coding implementation. After multiple sitting and cost analysis, group decided to break eMAR implementation in 3 different phases Phase 1) Implementation of Barcodes: Patients Armbands for right patient identification for all the inpatients on arrival from admission department Bar-coded medication labels for identification of 5 rights include right patient, right drug, right time, right dose right route. Further pharmacy system generates medication administration schedule; this schedule will be foundation stone for eMAR. Phase 2) Medication Trolley Purchase new medication trolleys with Laptop having wireless connectivity barcode reader to view active drug list due at specific time, to follow 5 rights Phase 3) Online MAR Develop software of eMAR to eliminate manual MAR and initiate online entry after administration in computer to eradicate paper How this will work Nurse will identify the patient by scanning wrist band Nurse will then scan the Medication Cassette Bin of respective patient First RIGHT will be identified at this point Right Patient Nurse will then scan the Medication Labels Remaining four RIGHTS will be identified at this point Right Drug Right Dose Right Time Right Route Nurse Administer the Dose to the Patient After Administration, Nurse will put her Signature electronically into the system Thus above requirements were communicated to the senior management. Consequently due to lack of resources implementation of all above requirement were not possible at once because huge amount of money is required for barcode implantation in admission and pharmacy department and sophisticated medication trolley with laptop barcode reader. Therefore, team determined to implement eMAR successfully, with good outcome and within the resources provided, all above phases need to be implemented step by step. Thats why 3 sub-groups have been developed to initiate the work for each activity. Group 1 will work on Bar-coding planning and implementation. Group 2 will be responsible for purchasing of sophisticated medication trolley and group 3 will work on software development for electronic administration entry for medication. However, phase 3 of aforementioned plan was to be implemented first as it only required in-house software developments with no extra cost involvement and further built on existing CPOE system. Therefore, group 3 comprises of nursing and information system department (ISD) team work together to design and develop the system. ISD developed first template of eMAR in December 2006 and presented to nursing management team for feedback, they suggested few modifications. Modified version presented to them again for re-evaluation in February 2007. Afterward, pilot implementation was done in 5 beded cardiac step down unit in April 2007. Same was replicated in other cardiac stopdown units. Subsequently it was replicated in other units depending upon the availability of computers. Therefore, 06 desktop computers, 20 wall mounted computers in intensive care units, 2 mobile trolleys without medication bins 2 laptop mounted medication trolleys were provided in nursing units to cover 153 beds out of 520 beds. This covers 30% of total admitting patients. This phase will help to overcome issues of legibility, decrease chances of data lost as not need to manage paper since no paper is required. It helps to meet the JCIA requirement as data retrieval is easy and able to find out administration record. In-addition this will help to have ontime administration record and nurse need to sign the medication after administration and system will capture administration time which will further help to indentify wrong time administration, delayed administration and miss dose administration. Through this phase patient safety issue is still not resolved as identification of 5 rights is achieved manually because bar-coding is yet to be implemented. However, further implementation discontinued after July 2008 due to resource limitation for computerized laptop based eMAR trolley barcode implementation. In-addition few reservation for further implementation related to multiple frequent system breakdown and users resistance for further implementation was also highlighted. Therefore, eMAR task force re-collected to discuss and resolve above concerns to promote further. They identified following issues: Issues related to system functionality System performance/ shutdown issue. Issues related to limited hardware availability Training issue and computer literacy issues Users resistance as system force them for ontime documentation whereas paper base MAR have provision to sign the administration record as per their own accord On other hand group 1, barcode team implemented bar-coded armbands for all the inpatient. Now only medication label to be bar-coded is pending, for that label has been designed and approval has been taken from nursing users and pharmacy. Bar-coded label printer is to be purchased and pilot testing of barcode label needs to be carried out. Group 2 representatives explored different eMAR trolleys available in the market to identify the most suitable for our working environment. Our requirement is light weighted small trolley with 10 medication bin as 1 nurse is assign to 10 patients. Finally it was decided to purchase Atromick Medication Trolley. Purchase order was generated to have sample trolley to pilot. Trolley has been piloted successfully and received positive feedback from nursing users. Therefore, it was decided to purchase 72 more trolleys as required by nursing units. 46 trolleys will be purchase by October 2010 and remaining will be purchased in 2011. System feedback after pilot implementation Information technology seems to be more proficient and provide transparent alternative to manage issues/concerns smoothly. After pilot implementation of in-house developed eMAR software and Atromick medication trolley few strength and weaknesses were identified. We identified that most of the users in our hospital are not well computer literate. This lead to increase resistance and they prefer to use manual system. Another most important issue is lack of interest from some of the nursing managers. They even not agreed to initiate the pilot project and the main reasons were lack of staff, lack of computer literacy, lack of hardware availability on nursing floor and they felt it would increase staff workload. Their concerns were well taken and computer training had been provided to nursing staff before initiation and on regular basis as well. Moreover, extra computers have been provided on nursing floor before pilot implementation. Nursing director is working hard to increase number of staff but its difficult as currently nurses turnover rate in our organization is 17%. Lastly management group was explained that it definitely increase some workload initially but it save nurses time currently utilize on maintaining paper record and data retrieval as it will be more transparent. It also increases safety of the patient and their record and have ontime documentation of drug administration. Thus, pilot project has been put into practice for 30% of hospital beds. The pilot project helped us to be acquainted with the weaknesses of the system which includes: Lack of material resources human resources Gaps in software programming i.e. initially all the stat orders and single dose order automatically disappeared from the screen with drug stop time. This created frustration among users as they were not able to mark administration for pre post transfusion drugs, chemo therapy drug, pre post operative drugs. Another gap is related to infusion screen as nurses have to sign infusion record every hourly which increase their workload. Multiple time system got stuck/ slowdown/ non functional endorse resentence of users as they feel whole process is very slow Users highlighted that system is not user friendly On multiple occasion users identified that same drug appears twice on the screen. On investigation it was find out that its because physician enter new order for same drug without discontinuing the previous one. Therefore, modification is required in CPOE system. Unsatisfactory technical support Lack of training System usually found to be slow which lead to increase administration recording time Beside, this one of the most important issues is resistance from users side as it increases their workload as well as their accountability, because paper base system has provision to sign the administration record as per their own accord. Whereas, electronic system increase obligation for ontime documentation. Another most important weakness is related to patient safety issue as bar-coding system has not been initiated yet and users relays on manual identification of 5 rights. However, in conjunction with above resistance, users satisfaction survey conducted in July 2008 showed 79.9% satisfaction of users with the system. The results appear with positive feedback but they highlighted area for improvement. Their feedback enclosed request for multiple modification, for instance separate screen for cyctotoxic drug administration as this required to mark start and stop administration time with comments as these drugs administration time last for hour. Demand to generate multiple reports to view administration record, miss dose administration record, administration record of discharge patient, administration report of particular drug etc. Primarily system starts with single screen for all type of administration i.e. intravenous infusion, PRN and routine medication which overcrowd administration screen and create confusion. Therefore, requested to develop separate option for each. In-addition modification was requested for infusion screen as current option requi res to sign infusion every hourly. Survey also highlighted some of the strength of the system pointed out by users which include: System helps users to easily identify numbers of doses administered to particular patient for specific drug as data retrial is extremely easy, though sometimes it takes time due to slowness of the system but its faster than manual process as data retrieval is difficult with paper base system. In addition it helps users to identify miss doses, delayed administration and skipped administration. It decreases utilization of paper and save printing cost. It helps to identify reason for delayed miss dose administration Administration screen appears with current drug only i.e. due for administration for next dose time. System frequently update with changes in CPOE system and has good interface with pharmacy and admission system System is easy to operate and output (Administration reports) data from system is reliable and accessible System appears with detail information regarding drug including drug name, ID, required dose, dose time, route, frequency, star time and stop time, drug comments if any for safe administration. System is provided with dictionary based comments column for nurses to enter administration comments if any, in case of delayed, missed early administration. Paper base system utilizes nurses time to print medication label on drug review and then need to paste them in MAR sheet. This system omits all above and reviewed order in CPOE system automatically appears on eMAR screen for administration. Thus, many nurses found this system very effective the only concern is related to more time required at entry level. We identified that nurses with good computer skills are more positive towards IT systems. Chiang (2008) cited that Studies have shown that, for instance, nurses found that the IT system was good in aiding prevention of medication errorsà ¢Ã¢â€š ¬Ã‚ ¦.but required a lot of time in operating the system. Potential benefits of the system after complete implementation eMAR system can improve the administration record and will able to provide accurate administration time of the drug. It advances patient safety by right patient and right drug identification via bar-coding system. To elevate further safety option has been developed in a manner to mark administration after actual drug administration to the patient as system is not provided with any go back to your old ways option, which will help to increase reliability. System has been provided with mandatory option to enter comments for delayed administration or miss administration which will help later to identify causes and corrective action can be taken to improve business. Besides the safety of patient and its data, other supplementary benefits are cost and saving of storage space. Currently our hospital utilize huge amount ($15857/annum) of money for storage space. Although, these potential benefits are currently not very visible but it will be apparent with complete computerization of patients record. In addition an electronic system gathers all at one wave length and has standardized practice. This will provide opportunity to have good interface with national and international systems later. To get most out of it nurses suggested to provide medication order review screen drug formulary on eMAR system to save nurses time for multiple login. Kuperman Gibson (2003) cited This technology can yield many significant benefits and is an important platform for future changes to the health care system. Conclusions Patient safety is our main objective while working in clinical setting. Therefore, technology needs to be adopted to enhance safety. This will help to progress further. We all need to work continue to enhance computerization and involve information communication technology in hospital setting. Our organization actually works hard to achieve eMAR to increase patient safety and by 2011 we will certainly achieve our target to reduce medication administration error. Above report shows that eMAR system helps to increase safety, decrease medication administration error and safe printing cost. On top of it system will avoid wrong time error and have ontime documentation.

War of 1812 Essay -- essays research papers

The War of 1812   Ã‚  Ã‚  Ã‚  Ã‚  The United States of America began to see the effects of Anglo-French War by the early 1800's. This European quarrel began affecting the United States shipping industry. Britain and France were violating neutral shipping rights of American merchants. They thought of America as weak due to inadequate time the nation had to develop. These violations were the first and primary provoking factors that led to war with Britain. There was reason that Britain became the target of US military rather that France. Britain has influenced Indians around Lake Michigan to resist white settlement. This was one of the primary reasons the English were chosen as our foe. Britain had the Indians do this as an attempt to keep the U.S. border as low as possible - not exceeding the Canadian border. France had made no such attempts to interfere with America; they in fact only had the simple desire to obtain our goods. They did with hopes of gaining this territory for their new colony late r. Consequently, Britain became the target, and it led to a continuation of the American Revolution. The primary cause of the war with Britain was the fact the neutral shipping rights were violated by Britain, and though France had also violated these rights, there were other issues that the British were responsible for. Britain blockaded the United States in such a manner it was no longer possible to export goods by ship. The British were not doing this to harm America's economy, however it was extremely harmful to the economy of this young country. Britain was doing this so that France could not import as many goods that would behoove them in the war. France desperately needed various goods that could be imported from the United States and they were willing to pay where America's economy could have benefited tremendously. Though the fact of the matter is Britain's enormous, notorious navy would not allow the exporting of America's goods. The desire for Canadian colonies to join the United States, and the accusations of the British supplying Indians with weapons to be used against the U.S. are also causes of the War of 1812. The battles of this war were primarily fought on US soil. The British military was surprised by the United States military. They had underestimated of the young country that was blossoming and flourishing on freedom. The battl... ...e was gained by either of the opposing forces of the war. The British suffer tremendous casualties. The U.S. gained nothing in terms of land. This war was indeed pointless: it is amazing how one leader's feelings can kill thousands. President Madison got involved in this war because he felt that the country's pride had been stepped on. The opportunity to challenge Britain came up, and Madison jumped into it readily. The War of 1812 was definitely a war this nation could have gone without taking part in. It was ridiculous to lose so many valuable American lives for such worthless reasons - pride. Pride should be swallowed in certain occasions: this was definitely a time in which our leaders of America could easily have swallowed their pride at much less of a cost. American merchants and greed can be held at fault for this costly American war. Had merchants not pushed so hard this war may had been avoided, but they fact is it did. The War of 1812 did, however, strengthen America's ability to be self-reliant. This is valuable, but not worth the thousands of lives that were spent obtaining this minor wartime convenience. (american History - a survey by alan brinkley) and encarta 95 cd

Graduation Speech -- Graduation Speech, Commencement Address

I stand before you tonight because of love — love that was given to me and displayed in its purest, sacrificial form. This evening, I would like to share with you how that love has changed my life. When my parents enrolled me at Milkins Academy 13 years ago, they recognized the fact that the value of a Christian education is far greater than a new house or car. The material possessions that they have forfeited through the years have allowed me to remain in an environment in which I can see Christ lived out every day. For the sacrificial love that my parents have displayed, together with the parents of all my class members, I am exceedingly grateful. The teachers here at Milkins display love to us students as well. Whether in getting a little extra math help before a test or receiving a needed hug after English class, we experience the love our teachers have for us. Thank you, teachers — all of you. We know that you constantly pray for us, encourage us and reprimand us when we need it. Your love, humility and desire to know Christ have been a brilliant example of what you long to see demonstrated in our lives. God is at work in you, and we pray that everyone here is able to see Christ in us as well. However, although the love of our parents and teachers has greatly influenced our lives, their love is insignificant compared to the love of the One who first loved us. He is the source of all true love and is the ultimate example of sacrifice. One of my favorite passages of Scripture is Romans 5:1-8, which states, "Therefore, since we have been justified through faith, we have peace with God through our Lord Jesus Christ, through whom we have gained access by faith into this grace in which we now stand. And we rejoice in th... ...blameless died, And through it all was tested, shunned, and tried. His life on earth, as all, was but a breath, Yet lived he true until his awful death And after, for although he was but man, He was held in God’s almighty plan, And was truly God in human form; By his death the temple veil was torn. And he calls us all to follow him, Turning from a life of vile sin To perfection by a God all pure; His grace is that of which we can be sure. Blameless Jesus lived and blameless died, And he can be forevermore our Guide. "For I am convinced that neither death nor life, neither angels nor demons, neither the present nor the future, nor any powers, neither height nor depth, nor anything else in all creation, will be able to separate us from the love of God that is in Christ Jesus our Lord." Thank you all for coming tonight, and have a lovely evening.

Compare Contrast Greek and Roman Art

Compare Contrast Greek And Roman Art And Architecture Compare/Contrast Greek and Roman Art and Architecture Since the onset of Greek and Roman civilizations centuries ago we have seen the art and architectural worlds evolve into what we know them as today. In fact, many of the ancient Greek styles were duplicated by the Romans and modified to suit their needs. We can still see a lot of Greek and Roman influences in the present day, especially in the architectural world. Below I will cite some examples of Greek and Roman pieces of art and a structure from each culture and detail some similarities as well as some contrasting values.I’d like to begin by comparing some pieces of art. In The Fallen Warrior (Greece) and The Dying Gaul (Roman copy) both clearly represent a tragic event. Both subjects are leaning on the ground and seem to be dying but the reality of the event is more evident in the Gaul sculpture. The wound is clearly visible and the anguish of the subject is captured in his poise. Conversely the subject of the Warrior piece looks rather content and shows no visible injury. Both works are roughly the same size and represent a relatively perfect human structure with attention to muscular detail as well as an idealization of the human body.However, the Warrior sculpture shows less optical fact and more stylization as far as the eyes, mouth and beard are concerned when compared to the almost true to nature elements of the Gaul piece. This shows how some of the Greek foundation was carried along but modified by the Romans. In The Three Goddesses (Greece) and Marcus Aurelius on Horseback (Rome) there are many similarities. Each shows fine attention to the cloaks worn by the subjects as well as weight distribution and, if all limbs were present on the Three Goddesses, implied motion.But in the Aurelius sculpture there is a shift from strictly human subjects to the addition of a horse. The Romans did this as part of their love of realism along with the ir later concern for psychologically penetrating portraits. Moving along to architecture I’d like to compare the Parthenon (Greece) and the Pantheon (Rome). Upon looking at each structure you would immediately notice the use of columns. Albeit the Parthenon’s main weight-bearing elements are the columns whereas the columns used on the Pantheon are more aesthetic than functional. Each of these structures also makes use of a portico that originated in the Greek culture.Both structures are immense places of worship to the gods. The Parthenon was created for the goddess Athena but over the centuries it changed through a series of hands finally ending up as an ammunition dump for the Turks during a seventeenth century war with the Venetians. The Venetians bombed the building leaving most of it in ruins. The Pantheon was created as a house for sculptures of Roman gods. Enough care was taken throughout the centuries that this structure is still being used for religious functi ons today. The Parthenon was a more simplistic and ancient looking design where the Pantheon took on a whole new era.The dome came into play along with the many ornamental features seen on the inside as well as the outside of the Pantheon. The interior contains marble slabs and granite columns. These are accentuated when the sun shifts locations through the oculus in the center of the dome. These features reaffirm the fact that the Greek culture was to the point as far as balance of mind and body. They created their work meticulously but didn’t overdo it. Their buildings were functional but not overworked. The Roman culture took it to the next level with their architectural innovations as well as their emphasis on beauty.