The Apaches :: Native American Indians

The Apaches were American Indians who moved from Canada to Arizona, parts of Colorado, New Mexico, Texas and North America between AD850 and 1400. The Apache were a wandering tribe, so they had two homes. One in the mountains and one in the desert. They lived in their houses for only a short period of time. The women built their houses which were called Wickiups. These were straw domed shaped houses. The Wickiup was only five or six feet high. Outside the Wickiup was covered with bundles of grass and branches. The early Apaches wore deer hide. They soaked the hide in water to make it soft. The men wore breechcloths and moccasins. The women wore skirts in the warm weather and simple dresses in the cold weather. The woman sometimes decorated their clothes with dried porcupine quills. The environment was important for them as they lived off the land a great deal. They lived on lots of wild plants and hunted deer, antelope, elk and buffalo. They also ate prairie dogs, squirrel and rabbits. They would not touch fish or any animals that lived in the water. As they moved around, they had to change how they lived. They picked up the ways of other cultures. For example, some of them rode horses that they discovered through the Spanish. They became fierce horse warriors from the 18th Century. They raided farming villages for food and goods. Environment was important to them because wherever they were they had to get food somehow which they hunted for. As they were on the move they had to adapt how they lived. They picked up the ways of different cultures. e.g. they learnt how to ride horses that they discovered through the spanish. The Chippewa tribe were living around Lakes Superior and Huron (now Quebec, Ontario, Michigan and Minnesota) by the 18th Century. They hunted, fished and gathered plants. They made birch-bark canoes and used the lakes and rivers to travel, so they made use of the environment by using the lakes and rivers as a use of transportation and sometimes food as they fished a lot. Did you know? Did you know there were thirty five thousand people in the Chippewa tribe!? They wore buck skin clothes and moccasins. In the winter they made fur lined shawls and wove turkey down robes. The Apaches :: Native American Indians The Apaches were American Indians who moved from Canada to Arizona, parts of Colorado, New Mexico, Texas and North America between AD850 and 1400. The Apache were a wandering tribe, so they had two homes. One in the mountains and one in the desert. They lived in their houses for only a short period of time. The women built their houses which were called Wickiups. These were straw domed shaped houses. The Wickiup was only five or six feet high. Outside the Wickiup was covered with bundles of grass and branches. The early Apaches wore deer hide. They soaked the hide in water to make it soft. The men wore breechcloths and moccasins. The women wore skirts in the warm weather and simple dresses in the cold weather. The woman sometimes decorated their clothes with dried porcupine quills. The environment was important for them as they lived off the land a great deal. They lived on lots of wild plants and hunted deer, antelope, elk and buffalo. They also ate prairie dogs, squirrel and rabbits. They would not touch fish or any animals that lived in the water. As they moved around, they had to change how they lived. They picked up the ways of other cultures. For example, some of them rode horses that they discovered through the Spanish. They became fierce horse warriors from the 18th Century. They raided farming villages for food and goods. Environment was important to them because wherever they were they had to get food somehow which they hunted for. As they were on the move they had to adapt how they lived. They picked up the ways of different cultures. e.g. they learnt how to ride horses that they discovered through the spanish. The Chippewa tribe were living around Lakes Superior and Huron (now Quebec, Ontario, Michigan and Minnesota) by the 18th Century. They hunted, fished and gathered plants. They made birch-bark canoes and used the lakes and rivers to travel, so they made use of the environment by using the lakes and rivers as a use of transportation and sometimes food as they fished a lot. Did you know? Did you know there were thirty five thousand people in the Chippewa tribe!? They wore buck skin clothes and moccasins. In the winter they made fur lined shawls and wove turkey down robes.

Management Essay -- essays research papers

  Ã‚  Ã‚  Ã‚  Ã‚  The Hayakawa family had a son named Mark, who was diagnosed with Down’s syndrome. The family wanted to keep the child but were discouraged and advised not to by doctors. They felt differently about the situation. They felt their child lived on love, which was something they knew they could provide a great deal of. The family was not confident in the experts’ views because they seemed to have a lack of knowledge on the subject and it seemed as though they cared less then they knew about the illness.   Ã‚  Ã‚  Ã‚  Ã‚  The family decided to keep mark at home with them, not institutionalized. He had the freedom to grow and the personal care that is necessary to develop in a healthy situation. The Hayakawas felt that keeping Mark home was a good idea. He not only brightened their lives but their children’s lives as well. Mark could find joy in simple things, which can often reflect onto others. Mark was capable of accepting things as they were more so than most people of â€Å"normal† intelligence. The entire family benefited from the experience of living with Mark by learning to take situations in stride. The family learned patience and tolerance through helping Mark get through each day. Their readiness to deal with Mark carried over into a general method of dealing with people. Mark made them feel special.   Ã‚  Ã‚  Ã‚  Ã‚  The family benefited from not following the directions given to them by the experts. They felt as thou... Management Essay -- essays research papers   Ã‚  Ã‚  Ã‚  Ã‚  The Hayakawa family had a son named Mark, who was diagnosed with Down’s syndrome. The family wanted to keep the child but were discouraged and advised not to by doctors. They felt differently about the situation. They felt their child lived on love, which was something they knew they could provide a great deal of. The family was not confident in the experts’ views because they seemed to have a lack of knowledge on the subject and it seemed as though they cared less then they knew about the illness.   Ã‚  Ã‚  Ã‚  Ã‚  The family decided to keep mark at home with them, not institutionalized. He had the freedom to grow and the personal care that is necessary to develop in a healthy situation. The Hayakawas felt that keeping Mark home was a good idea. He not only brightened their lives but their children’s lives as well. Mark could find joy in simple things, which can often reflect onto others. Mark was capable of accepting things as they were more so than most people of â€Å"normal† intelligence. The entire family benefited from the experience of living with Mark by learning to take situations in stride. The family learned patience and tolerance through helping Mark get through each day. Their readiness to deal with Mark carried over into a general method of dealing with people. Mark made them feel special.   Ã‚  Ã‚  Ã‚  Ã‚  The family benefited from not following the directions given to them by the experts. They felt as thou...

The Joy of Overcoming Pain :: Personal Narrative Essay Example

The Joy of Overcoming Pain Propelled forward by my surging leg muscles, sweat gushing down my face, the harsh reality of this 50-mile bike race has begun to invade my body. My eyes remain intensely focused straight ahead: Grinding away along the racecourse, I see five girls from a different team about 200 yards ahead of me. My team needs a contribution from me, I realize, and I make the decision to pass all three of them. Through the heat rising off the asphalt I can finally see the distant white line proclaiming the finish. My mind propels my legs to their maximum ability. In these last few seconds of exertion, the years of hard work are paying off. Soaring through the finish, I have achieved flight. Biking is a pure sport, requiring little more than a brain ready to conquer pain. It is a sport that calls for commitment and mental toughness. Through testing myself, I increase my resilience and grow stronger. I unleash the power of my mind, and I bike. Some people are born with great biking ability, and others, like myself, are born with the desire to excel at every challenge. I've become the best biker I can through hard work and dedication. Challenging myself with new goals every day, I bike against the forces of gravity and inertia. I love the thrill of competition -- the euphoric feeling I get when mind overcomes pain. As a four-year member of my high school biking team, I have experienced just about every physical infirmity that comes from biking. I have dealt with shin splints, biker's knee, broken toes, and pulled calf mussels. My orthopedic surgeon took one look at my legs and admitted that I'm "not built to be a biker." Yet, I chose to continue biking because of its daily challenges and rewards. I've learned from this sport that by focusing single-mindedly on achieving a goal, I can make any obstacle trivial. I still hear my coach's voice in my head: "If you sacrifice yourself, good things will happen." As much as a bike race requires individual strength physically and mentally, it also requires a team effort to succeed. Like sisters in a family, the girls I bike with understand and respect one another. We remind each other to work harder, eat right, and to accomplish the most we can.

Ota Essay

The role of an Occupational Therapy Assistant is to help people participate in the things they want and need to do through a therapeutic use of activities. The function of the OTA is not limited to other duties such as preparing materials and equipment, collaborate with health professionals, evaluate progress and maintain records, and clerical duties. The OTA works closely with the Occupational Therapist to assist in the development of treatment plans, carry out routine functions, and direct activities. Occupational therapy is useful in many areas of functional life.Helping children in their school environment is one example. A program can be designed to enhance a student’s ability to access and be successful in the learning environment. Curriculum may include tuning fine motor skills, handwriting skills, organizational techniques, and classroom modification in conjunction with the teacher to ensure successful participation. Another area suited for occupational therapy would b e assisting the elderly. The OTA may assist with everyday functions such as dressing and grooming. Focus is to adapt the environment to fit the patient.This can increase the chances of remaining in the home. Adults with limited vision can maintain their independence and complete daily activities with the help of the OT and OTA. Daily tasks can include showering, dressing, cooking, shopping, managing finances, and mobility. As an Occupational Therapy Assistant, I believe I can care for others personally, medically, and emotionally. I will be a productive and effective part of the dynamics between the OT, myself as the OTA, and the patient to achieve the quality of life that is my responsibility to provide.I communicate clearly, have compassion and reasoning, and thrive to become a rehabilitation leader. I can perform independently under instruction, possess organizational skills, and have sense of priority. Being part of the academic system for the past three years has conditioned me to balance life and college responsibilities. My anticipation of entering into a medical health program, such as Occupational Therapy, has allowed me to make adjustments and preparations in my life.I feel that this is an appropriate time in my life to devote myself and become the medical professional I have always wanted to be. I chose to enter this profession because I feel that I can be a productive member of a team and provide physical rehabilitation to others in need. I have the capability to perform all the duties required of the OTA. My goal is to successfully complete the program and become an important part of someone’s life. Further education is a long term goal and am looking forward to starting this new chapter in my life.

Severity Prescribing Errors Hospital Inpatients Health And Social Care Essay

Background: Prescribing mistakes are common ; they affect patient safety and cause of inauspicious events throughout health care pattern. Previous reappraisals of surveies limited in range of populations, scenes or fortes, and at that place has been no systemic attack adopted to reexamining the literature. Purpose: This reappraisal aimed to place all enlightening, published grounds refering three major facets of ordering mistakes: the incidence, nature and badness in hospital inmates. Methods: The chief electronic databases such as MEDLINE, EMBASE, CINAHL and International Pharmaceutical Abstracts, were searched for diaries published between 1975 and December 2010. Studied were selected if they reported rates of prescribing mistakes and were in English. However, some mistakes were excluded, peculiarly those for individual paths of disposal, diseases or types of ordering mistakes. Consequences: Median mistake rate ( inter-quartile scope [ IQR ] ) was 12.85 % ( IQR: 10.09-13.63 ) of medicine orders, 1.27 ( IQR: 0.96-2.30 ) mistakes per 100 admittances and 6.5 ( IQR: 4.35-8.53 ) mistakes per 100 drugs charts reviewed. Incorrect dose was the most common mistake reported. Most surveies ( 70 % ) were carried out in individual infirmaries, were collected informations by druggists ( 75 % ) and originated from US or UK ( 75 % ) . Decision: The reappraisal revealed that ordering mistakes affected 13 % of medicine orders, 1.3 % of hospital admittance and 7 % of drug charts reappraisals. However, there were broad scopes of variableness in ordering mistakes and this was perchance due to fluctuations in the mistake definitions, the methods of informations aggregation, and populations or locations of the survey. In add-on, a deficiency of standardization between badness graduated tables was a barrier to compare badness of ordering mistakes across surveies. It is critical that future research should turn to the broad disparity of badness categorizations and methods used to roll up informations that causes trouble in aggregating mistakes rates or set abouting meta-analysis of different surveies.IntroductionMedicine mistakes are the 2nd most common cause of patient safety incidents, with ordering mistakes an of import constituent of these ( National Patient Safety Agency, 2007 ) . There has been increasing concerned a bout the extent and impact of inauspicious events which are the prima causes of considerable patient morbidity and mortality. Most hospital scenes have made patient safety as a cardinal facet of health care policy. To be specific, the Harvard Medical Practice survey reported that more than 3.7 % of hospital admittances associated with the usage of medicines. In the US, inauspicious drug events ( ADEs ) have been shown to protract the continuance of hospitalization, addition mortality hazard twofold and property as cause of 7,500 deceases yearly. Furthermore, Bates et Al. ( 1997 ) found that individual learning infirmary spent about $ 6 million due to ADEs, while $ 3 million of which were preventable. In the UK, it has been estimated that preventable ADEs cost about ?750 million ( National Patient Safety Agency, 2007 ) The negative impact of preventable ADEs means that it is really of import to understand the nature and extent of medicine mistakes. An ADEs can happen at any phase of drug usage as a consequence of mistakes in drug prescribing, administrating and a dispensing ; although most mistakes are likely to be initiated during prescribing. Harmonizing to National Patient Safety Agency ‘s ( NPSA ) , most serious incidents were caused by mistakes in medicine disposal and prescribing ( 32 % ) . However, there is deficiency of grounds associating to incidence or nature of ordering mistakes reported the consistence of form in the types of mistakes or badness. Surveies conducted in single-hospital found, for case, ordering mistakes in 0.4-15.4 % of prescriptions written in the US and in 7.4-18.7 % of those written in the UK. In malice of the fact that there has been old research into systemically synthesizing informations of ordering mistake, they were either specific in range of patient groups, or forte. None have focused on the general facets of incidence of ordering mistakes. Therefore this survey highlights the incidence, nature and badness of ordering mistakes in hospital inmate more by and large.PurposeThe purpose of this literature reappraisal is to place all enlightening, published grounds refering three major facets of ordering mistakes: the incidence, nature and badness in specializer and non-specialist infirmaries, and collate, analyse and synthesize decision from it.LITERATURE SEARCH METHODOLOGYSearch schemeSurveies were identified by seeking the undermentioned electronic databases for article published between 1 January 1975 and 6 December 2010: MEDLINE and MEDLINE In-process and other Non-Indexed Citations, EMBASE, International Pharmaceutical Abstracts, and Cumulative Index to Nursing & A ; Allied Health Literature ( CINAHLA ® ) Search footings used included the followers: ‘prescription ( s ) ‘ [ Mesh ] or ‘drug prescription ( s ) ‘ [ Mesh ] or ‘medical mistake ( s ) ‘ [ Mesh ] or ‘incidence ‘ [ Mesh ] or ‘incidence ‘ [ Subheading ] or ‘epidemiology ‘ [ Mesh ] or ‘prevalence ‘ [ Mesh ] or ‘inpatients ‘ [ Mesh ] .Inclusion and Exclusion CriteriaInclusion standards: Surveies published in English between 1985 and 2010 that reported on the sensing and rate of ordering mistakes in handwritten prescriptions written by physicians for grownup and/or child hospital in-patients were included. All research designs such as systemic reappraisals, randomised controlled tests, non-randomised comparative surveies and experimental surveies were included. Exclusion standards: This reappraisal focused chiefly on incidence of ordering mistakes more by and large from both paper and electronic ordering systems. Therefore surveies that merely provided informations on electronic prescriptions via computerised physician order entry ( CPOE ) were excluded. In add-on, surveies that evaluated mistakes for merely one disease or drug category or for one path of disposal or one type of ordering mistake were excluded as they are improbable to generalize a consistent form in the figure or type of mistakes.Data Extraction and Validity AssessmentA data-extraction signifier was used to pull out the undermentioned information: twelvemonth and state ; study period ; hospital scene ; methods ( including type of survey ; trying and reappraisal procedures ; profession of informations aggregator ; agencies of sensing mistake ) ; definitions used ; the mistake rate ; and any other relevant information captured by the survey, such as badness of mistakes, type of mistake and medicine normally associated with mistakes. Datas were entered into an Excel spreadsheet for easiness of handling, and The Statistical Package for Social Sciences ( SPSS Statistics 17.0 ) was used for informations analysis.Quantitative Data AnalysisThe surveies retrieved by the hunt were highly heterogenous ; nevertheless the incidence and per centum of ordering mistakes were reported in each survey, and therefore average mistake rates and inter-quartile furies ( IQRs ) was used to analyze the information. To be included, studied had to describe the rate of erroneous orders and mistakes per admittance. To ease comparing across surveies, these rates were converted to common denominators: rates per 100 admittances, per 100 medicine orders and per 100 drug chart reviewed. When publications gave informations from two or more surveies where the methodological analysis was similar, the consequences were aggregated into a average rate. Calculation of incidence and per centum of ordering mistakes The incidence of ordering mistakes in each survey was calculated utilizing the undermentioned equation ( eqation1 ) : Incidence = The per centum of all prescribing mistakes that were reported in each survey was calculated utilizing following equation ( equation 2 ) : % of ordering mistakes =LITERATURE SEARCH RESULTSThe electronic hunt identified 423 publications. After initial showing of the abstracts, 325 publications did non run into the inclusion standards. The staying 98 publications were obtained in full text and assessed for suitableness, as shown in figure 1. Searching of the mention lists of the included publications indentified a farther 13 eligible surveies. In all, 16 publications were included. The chief grounds for exclusion were absent or deficient informations to cipher incident rates ( n=46 ) ; informations included disposal mistakes, outpatient prescriptions, and/or verbal and electronic prescriptions ( n=21 ) ; reported rates were of intercessions or misdemeanors of policy non deemed mistakes ( n=25 ) ; and duplicate of antecedently published information ( n=3 ) . Figure 1: Flow diagram of the showing procedure Potentially relevant publications identified and screened for retrieval ( n= 423 ) Publications retrieved for more elaborate rating ( n=98 ) Studied ( n=16 ) in the literature reappraisal Publications non run intoing inclusion standards ( n=325 ) Further publications indentified from seeking mention lists ( n= 13 ) Publications non run intoing inclusion standards ( n=94 ) surveies with no information or sufficient informations to cipher incident rates ( n=46 ) surveies in which informations include disposal mistakes, outpatients, verbal and electronic prescriptions ( n=21 ) Surveies that report rates of intercessions or solely misdemeanors of policy that are non deemed mistakes ( n=25 ) Duplicate surveies ( n=3 )Study FeaturesState and Date Features of the 11 eligible surveies are summarized in Table 1 ( APPENDIX I ) . Most surveies were conducted in the UK ( 6/16 ) or the US ( 6/16 ) . Other states included Canada ( n=3 ) , and The Netherlands ( n=1 ) . Over 80 per centum of surveies were published after 2000 ( 13/16 ) Types of Hospitals Fifty per centum of studied ( 8/16 ) were conducted in university-affiliated infirmaries, while six surveies ( 37.5 % ) were conducted in pediatric infirmary. The remainder ( 12.5, 2/16 ) were conducted in either mental wellness infirmary or wellness Centre. Numbers of Hospitals Sixty-nine per centum of surveies ( 11/16 ) were carried out on individual infirmary sites, 12.5 % ( 2/16 ) were carried out in two infirmary sites, 12.5 % ( 2/16 ) in nine sites, and 6.3 % ( 1/16 ) in 24 sites. Fortes Thirty-one per centum ( 5/16 ) of surveies were conducted in all grownup wards, one survey ( 6.25 % ) did non province the type of forte, and the staying 62.5 % ( 10/16 ) were carried out in certain fortes. Specifically, 37.5 % ( 6/16 ) included merely kids ‘s fortes or were conducted entirely in pediatric infirmaries, and 18.75 % ( 3/16 ) were carried out in medical and surgical wards. Although one survey was conducted strictly in critical attention units, the age scope of patients was non stated. Study Design One-half of the surveies ( 8/16 ) were prospective in design ; and 43.75 % ( 7/16 ) were retrospective. There is merely a survey conducted by Kozer et Al. ( 2008 ) was randomised controlled test ( RCT ) . The shortest period of informations aggregation was 12 yearss and the longest was 9 old ages. Three surveies by Cimino et Al. ( 2004 ) , Kozer et Al. ( 2005 ) and Kozer et Al. ( 2006 ) collected information before and after intercession, in these instances, merely information from the baseline or the control arm were used to measure the per centums and incidence of ordering mistakes in infirmary inmates. This was due to the fact that nature of ordering mistakes could be represented by a baseline group instead than an intercession group. Methods of Error Detection Datas aggregators were most commonly druggists ( 12/16, 75 % ) , while both druggists and nurses collected informations in a survey by Cimino et Al ( 2004 ) . Four chief methods were used among surveies: showing of prescriptions, direct observation, reappraisal of patient ‘s medical records, and anon. mistake study. Fifty per centum of surveies ( 8/16 ) detected prescription mistakes as portion of usual showing by druggists. Four surveies ( 25 % ) used perceivers to roll up informations straight as portion of their everyday work. Three surveies ( 18.75 % ) detected ordering mistakes by reappraisal of patient ‘s medical records, which were carried out by paediatric doctors instead than druggists and those referees were blinded to analyze variable. There is merely a survey ( 6.25 % ) used the combination methods of patient ‘s medical record reappraisal and anon. mistake study.Definitions of Ordering MistakesThe definition of a prescribing mistake was markedly varied ( Table 4, APPENDIX II ) , with 57 % of surveies ( 9/16 ) developing their ain definitions or modifying 1s used in old surveies. Two surveies ( 12.5 % ) used a definition of ordering mistakes developed by Dean et Al. ( 2000 ) . Almost one-third of surveies ( 31.25 % ) did non province any definition. Harmonizing to Dean et Al. ( 2000 ) , a definition of a prescribing mistake is â€Å" A clinically meaningful ordering mistake occurs when, as a consequence of a prescribing determination or prescription composing procedure, there is an unwilled important decrease in the chance of intervention being timely and effectual, or an addition in the hazard of injury when compared with by and large accepted pattern † .Incidence of Ordering MistakesThe incidence of ordering mistakes, which derived from equation 1 and 2 ( Table 4, APPENDIX I ) was reported as the figure of prescription mistakes per the figure of admittances, medicine orders or drug charts reviewed in the survey period ( Table 1 ) . Most surveies ( 75 % , 12/16 ) reported the per centum of erroneous ordering mistakes, the median of which was 5.15 % ( IQR: 2.13-10.68 % ) . First, three surveies provided an incidence of ordering mistakes per admittance, the median of this was 1.27 ( IQR: 0.96-2.30 ) mistakes per 100 admitt ances. Second, four surveies provided an incidence of ordering mistakes per medicine orders, the median of which was 12.85 ( IQR: 10.09-13.63 ) mistakes per 100 medicine orders. Third, four surveies reported an incident of ordering mistakes per drug charts reviewed, the median of this was 6.50 ( IQR: 4.35-8.53 ) mistakes per 100 drug charts reviewed. However, the four balance of surveies ( 25 % , 4/16 ) did non do in clear whether medicine orders were reported as holding more than one mistake, and hence were excluded in the computation. The per centum of all prescribing mistakes that were reported in each survey was shown in Table 1. The median of which was 9.25 % ( IQR: 2.34-13.50 ) . The lowest prescribing mistake rate ( 0.15 % ) was derived from ordering mistakes describing based survey and the highest mistake rate was ( 59 % ) resulted from a combination of two methods of mistake sensing: patient ‘s medical record reappraisal and anon. mistake study.Writers ( twelvemonth )Number of Prescribing mistakesNumber of Medication ordersPercentage of Ordering mistakesIncidence of ordering mistakeper admittances, medicine orders or drug charts reviewedMedianof Incidence( IQR )Dean et Al. ( 2002 ) 538 36,168 1.50 % 1.30 per 100 admittances 1.27 ( IQR: 0.96-2.30 ) per 100 admittances Lesar et Al. ( 1997 ) 11,186 3,903,433 0.29 % 5.29 per 100 admittances Lesar et Al. ( 2002 ) 52 402 13.00 % 1.23 per 100 admittances Ross et Al. ( 2000 ) 195 130,000 0.15 % 0.15 per 100 admittances Kozer et Al. ( 2005 ) 68 411 16.60 % 13.30 per 100 medicine orders 12.85 ( IQR: 10.09-13.63 ) per 100 medicine orders Kozer et Al. ( 2006 ) 66 533 12.40 % 12.40 per 100 medicine orders Neville et Al. ( 1989 ) 504 15,916 15.00 % 3.17 per 100 medicine orders Ridley et Al. ( 2004 ) 3,141 21,589 3.17 % 14.60 per 100 medicine orders Abdel-Qader et Al. ( 2010 ) 664 7,920 8.40 % 8.00 per 100 drug charts reviewed 6.50 ( IQR: 4.35-8.53 ) per 100 drug charts reviewed Kozer et Al. ( 2002 ) 154 1,532 10.10 % 10.10 per 100 drug charts reviewed Stubbs et Al. ( 2006 ) 523 22,036 2.40 % 2.40 per 100 drug charts reviewed Taylor et Al. ( 2005 ) 212 358 59.00 % 5.00 per 100 drug charts reviewed Cimino et Al. ( 2004 ) 1335 12,026 11.10 % N/A N/A Fijn et Al. ( 2002 ) 245 449 55.00 % N/A Hendey et Al. ( 2005 ) 177 8,195 2.16 % N/A Jones ( 1978 ) 114 2,237 5.10 % N/A Median ( IQRaˆ ) 9.25 % ( IQR: 2.34-13.5 % ) 5.15 % ( IQR: 2.13-10.68 % ) aˆ IQR: Inter-quartile fury ; C‚ N/A: Not applicable Table 1: Incidence of ordering mistakesTypes of Ordering Mistakes DetectedAll surveies reported on the types of mistakes, shown in Table 2, provided figure of surveies and per centums for each mistake type. Wrong dosage, incorrect drug and incorrect dose signifier were the most normally reported mistakes ( 93.75 % , 15/16 surveies ) , the 2nd most frequent of ordering mistakes ( 81.25 % ) reported were incorrect frequence, skip of doses and incorrect path ( 13/16 surveies ) . The balance was accounted for by incorrect measure ( 75 % ) , inaccurate information ( 56.25 % ) , incorrect patients ( 50 % ) , incorrect units ( 43.75 % ) , and contraindicated due to allergy ( 25 % ) . Table 2: Type of ordering mistakes detectedType of ordering mistakes detectedNumber of surveies utilizing( n = 16 )Percentages( % )Incorrect dosage15 93.75Incorrect drug15 93.75Incorrect dose signifier15 93.75Incorrect frequence13 81.25Omission of doses13 81.25Incorrect path13 81.25Incorrect measure12 75.00Inaccurate information9 56.25Incorrect patients8 50.00Incorrect units7 43.75Contraindicated due to allergy4 25.00Badness of Detected Prescribing MistakesA one-fourth of all the surveies ( 75 % , 12/16 ) reported the categorization of the badness of ordering mistake, while the balance ( 25 % , 4/16 ) did non province how they were classified. Among surveies that reported badness, eight surveies ( 50 % ) provided their ain categorization of ordering mistake badness. Two surveies based badness standards on the work of Lesar et Al. ( 1990 ) and a survey based their standards on the work of Overhage & A ; Lukes ( 1999 ) . One survey by Lesar et Al. ( 1997 ) rated badness harmonizing to their ain alteration of Lesar et Al. ( 1990 ) . Table 3 lists how different surveies categorised the badness of ordering mistakes under the headers of 16 writers. This disparity made it impossible to compare badness across the surveies. Table 3: Badness categorization for ordering mistakesWriters ( twelvemonth )Severity Classification of ordering mistakesAbdel-Qader et Al. ( 2010 )A. Potential lethal ( Life endangering ) B. Serious C. Significant D. Minor E. No mistake ( No injury )Cimino et Al. ( 2004 )6: Death 5: Permanent injury 4: Need for intervention 3: Require monitoring 1-2: Mistake occurred without injury 0: No mistakeDean et Al. ( 2002 )Potentially serious Not seriousKozer et Al. ( 2002 )Severe Significant Minimal hazard InsignificantKozer et Al. ( 2005 )Severe Significant Minimal hazard InsignificantLesar et Al. ( 1997 )A. Significant B. Minor C. No mistakeLesar et Al. ( 2002 )Potentially fatal or terrible inauspicious results Potentially serious results Potentially important inauspicious resultsNeville et Al. ( 1989 )Type A: potentially serious to patient Type Bacillus: major nuisance Type C: minor nuisance Type D: FiddlingRidley et Al. ( 2004 )Potentially life endangering Serious Significant Minor No adverseStubbs et Al. ( 2006 )Grade 1: Doubtful or negligible importance Grade 2: Minor inauspicious effects Grade 3: Serious effects or backsliding Grade 4: Fatality Grade 5: Un-rateable: Insufficient informationTaylor et Al. ( 2005 )Severe Serious Significant Problem InsignificantFijn et Al. ( 2002 )Not statedHendey et Al. ( 2005 )Not statedJones ( 1978 )Not statedKozer et Al. ( 2006 )Not statedRoss et Al. ( 2000 )Not statedDiscussionSixteen surveies run intoing the inclusion standards were identified and informations abstracted. Uniting the grounds from the literature about incidence, nature and badness of ordering mistakes in infirmary inmate has helped to cast greater visible radiation on what and how mistakes occur. As the epidemiology of these jobs was able to depict, the likeliness of injury related to medicines would be reduced.Features and demographicsVariation in the mistake scope was non affected by different either state across the universe or fortes. The twelvemonth of surveies included in this literature reappraisal widely varied between 1978 and 2010. However, there was no consequence of a alteration in mistakes with clip of survey, proposing that there has been no rationalising of methodological analysis over clip or betterment in ordering competency. Besides, there was no medical-specialty or geographical consequence observed, proposing neither a consistence of methodological analysis nor of mistake rates in peculiar states and medical scenes.Incidence of ordering mistakesThis literature reappraisal reports the great fluctuation of ordering mistake rates because the surveies retrieved by the hunt were highly heterogenous but it was possible to group them by the type of denominator. Therefore the computation of average mistake rates and inter-quartile scope is valid manner of passing the information. The average rate of ordering mistakes was 9.25 % ( IQR: 2.34-13.5 % ) , while the average rates of mistake incidence utilizing three different denominators were 1.27 ( IQR: 0.96-2.30 ) per 100 admittances, 12.85 ( IQR: 10.09-13.63 ) per 100 medicine orders and 6.50 ( IQR: 4.25-8.53 ) per 100 drugs charts reviewed. These reported rates vary unusually, as shown by the broad IQRs, and can non be compared due to diff erences in methodological analysiss, mistake definitions, scenes and population employed. To be specific, illustrations of survey methods doing fluctuation in ordering mistake rates could be illustrated. The incidence of ordering mistakes was significantly underestimated by utilizing a self-generated coverage system because merely a fraction of medicine mistakes could be detected by this method. In add-on, the surveies utilizing self-generated describing design demonstrated less ability to observe mistakes than those utilizing patient ‘s medical record design. Even so, the reappraisal of patient records which is a nature of retrospective, yielded small prospect for followup and be able to place merely those noted in the records. In the visible radiation of methodological analysiss, studied that utilizing a direct observation method were likely to be the most comprehensive and accurate. Furthermore, Flynn et Al. ( 2002 ) besides stated that observation techniques were more efficient and precise than reexamining chart and incident coverage system in order to observe prescription mistakes. Conversely, Buckley et Al. ( 2007 ) and Kopp et Al. ( 2006 ) argued that surveies that utilised the direct observation attack were unfastened to the Hawthorne consequence. This meant that subjects ‘ behavior was altered due to the fact that they are being observed – in other words, if physicians built consciousness of being observed, they may hold improved or modified their prescribing manners. Furthermore, this error-rate variableness could besides be partially explained by the different factors in scenes and populations. Some surveies were carried out in a individual scene or a group of patients such as ICU scenes or entirely in pediatric patients. This may impact generalisability of the consequence and did non demo a similar tendency of ordering mistakes.Definitions of ordering mistakesIncompatibility in the definitions of ordering mistakes was another of import consideration. Most surveies developed their ain definitions, some of these were subjective. For case, a prescribing mistakes is â€Å" prescription non appropriate for the patient † . In contrast, others were more specific in their mistake definitions: â€Å" Mistakes related to dosage signifiers were defined as those in which there was an order for the inappropriate usage of a specific dose signifier, an order for the incorrect dose signifier ( mistakes of committee ) , or the failure to stipulate the r ight dose signifier when more than 1 dose signifier is normally available ( mistake of skip ) † . Yet, marked fluctuations in mistake definitions have besides been found in surveies in pediatricss and mental health care. This effect of variableness has leaded to the preparation of a practitioner-led definition of a prescribing mistake. Even though the definition by Dean et Al. ( 2000 ) was the most common one, it was used by merely 19 % ( 3/16 ) of surveies.Badness of detected prescribing mistakesThe badness of detected prescribing mistakes is indispensable because it can be used to measure the consequences of possible injury. Harmonizing to World Health Organization ( WHO ) , the possible badness of the mistake identified was buttockss by five Judgess utilizing a graduated table from 0 ( no injury ) to 10 ( decease ) . This method showed that a average badness mark of less than 3 indicates an mistake of minor badness, a mark between 3 and 7 inclusive indicates moderate badnes s and a mark of more than 7 major badness. However, the deficiency of standardization between badness graduated tables of each included surveies in this literature reappraisal was an obstruction to compare outcomes straight. The most common signifier of ordering mistake was composing the incorrect dosage and composing the patient ‘s name falsely, which accounted for 50 % of all mistake badness found by the research in six Oxford infirmaries ( Audit Commission, 2001 ) . A survey of 192 prescription charts in infirmary inmate, there were merely 7 % of those charts right filled ; 79 % had mistakes that posed minor possible wellness hazards and the balance ( 14 % ) had mistakes that could hold led to serious injury. There are many beginnings of ordering mistakes and different ways of avoiding them. Promoting consciousness that dosing mistakes are possible to do from clip to clip, and hence it of import to take measure to understate the hazards. Iedema et Al. ( 2006 ) suggested that the indispensable constituents of this are to supervise for and identify mistakes. Besides, they should be reported in a blame-free environment so that their root causes can be analysed before altering processs harmonizing to the lessons learnt and farther monitoring.Types of ordering mistakes detectedThere are many restrictions lending to the variableness of types of ordering mistakes. For illustration, some surveies were conducted in peculiar phase of the patient ‘s stay in infirmary such as admittance or discharge. These surveies, as a consequence, reported higher rates of peculiar types of mistake such as skip, incorrect frequence or duplicate. Furthermore, some surveies were carried out in a short continuan ce, and therefore the Numberss of types of ordering mistakes may be under-reported as they had less clip to place and roll up informations. With this in head, the same method to enter prescribing mistakes could usefully be applied across a figure of patient ‘s phases and longer continuance of informations aggregation. This reappraisal found that mistakes of dose were the most common type of ordering mistakes reported. In conformity with old surveies, a systemic reappraisal of medicine mistakes in pediatric patients by Ghaleb et Al. ( 2006 ) and another survey by Winterstein et Al. ( 2004 ) besides showed that dose mistakes was the most common type of medicine mistakes which were initiated during physicians ‘ prescribing. To better this job, instruction has been highlighted as an country for intercessions. A survey that surveyed twelvemonth 1 junior physicians in the UK found that drug dosing was a peculiar country that those physicians would welcome to be covered in the instruction of clinical pharmacological medicine. Impact of instruction and preparation on ordering mistakes Ordering mistakes are normally multi-factorial, but cognition of medical specialties and anterior preparation are of import for the betterment of ordering mistakes. About 30 % of ordering mistakes caused by failure in the airing of drug cognition, peculiarly amongst physicians. A systemic reappraisal by Ross and Loke ( 2009 ) demonstrated that ordering public presentation can be improved by educational intercessions. However, most surveies included in their reappraisal have relied on appraisals early after intercession and under controlled conditions instead than infirmary wards. Furthermore, it is possible that competent prescribers might take non to go to the tutorial preparation. Thus, farther research into whether any public presentation benefit extends significantly beyond the preparation period is needed. What besides evident in this literature reappraisal was the wellness attention professionals who played a important function in the procedure of ordering mistake sensing. Specifically, druggists were good placed to competently handle informations on mistakes, and were intentionally recruited for forestalling prescribing mistakes and bettering medicine use. Additionally, a meta-analysis survey showed that druggists were the most thorough chart-reviewers in inpatient infirmary. However, there have been some mistakes remained undetected.Study restrictionsMany restrictions of the included surveies can be described in item. One of major restrictions is possible categorization bias that can non be wholly eliminated. The studied conducted by Taylor et Al. ( 2005 ) and Stubbs et Al. ( 2006 ) found that even the writers met often to discourse mistake badness evaluations before a class was assigned to an mistake, inter-observer variableness was non officially assessed. Fijn et Al ( 2002 ) suggested that this prejudice could be minimised by utilizing patient information sheets as a mention to place mistakes. This is in conformity with the surveies by Lesar et Al. ( 2002 ) and Abdel-Qader et Al. ( 2010 ) , as anticipation of possible injury was based on several factors such as pharmacological, disease province and single patient features ; same mi stake may bring forth a serious inauspicious consequence in one patient but have minimum effects in another. Yet, it was possible that patient-specific information might be unequal which limited the ability of centralized staff druggists to to the full measure the rightness of drug therapy for an single patient ( Lesar et al. , 1997 ) . A farther survey restriction related to the design of surveies. A retrospective design limited available informations because it could non observe many mistakes in drug disposal. Besides, a prospective design and a randomised control test ( Kozer et al. , 2006 ) which identified mistakes through chart auditing, may non observe some mistakes and could non supply verification about results of mistakes. This is due to a possibility that the physicians made fewer mistakes cognizing that they were studied. In contrast, Dean et Al. ( 2002 ) argued that the prospective method had advantages as druggists routinely reviewed all drug charts and met patients, every bit good as participated in a portion of multidisciplinary squad at the clip of the patient ‘s hospitalization. This interaction would therefore supply more information about each patient available to druggists than to those retrospectively reexamining the medical notes. Although a cardinal strength of this literature reappraisal is the scope of databases searched, there are three restrictions. First, non-English linguistic communication surveies were excluded and there may hold been relevant surveies published in other linguistic communications that were non detected. Second, surveies describing mistake incidence might be published in diaries that were non indexed by searched databases could non be included. However, to cut down this hazard, a hunt of the mention lists of included surveies had been carried out. Finally, the abstracts that had limited information were excluded, and accordingly existing international work or work in advancement might be missed and could non farther add to understanding of incidence, nature and badness of ordering mistakes.DecisionOrdering mistakes are prevailing, impacting a median of 13 % medicine orders, 7 % of drug charts reviewed and 1.3 % of hospital admittances. Despite this, the scopes of these findings are rea lly broad, which partially may be conditional upon surveies ‘ populations, scenes and methods. The bulk of included surveies were prospective in design and used druggists as informations aggregators in university-affiliated infirmaries. The deficiency of standardization among different surveies, peculiarly the issues around definitions and badness of ordering mistakes, was a barrier to broaden cognition of the extent of ordering mistakes. This country for development is worth giving our attending to set about future research. The consequences of each survey could be more confidently integrated, saying the standardization could be achieved. Therefore, this will supply a clearer image of incidence, nature and badness of ordering mistakes. In add-on, farther strict surveies in an country of formalizing a methodological analysis and intercession should be conducted to get the better of trouble in aggregating mistake informations and guarantee patient safety.

Business of Being Born Essay

There is a culture of â€Å"women-only† that runs rampant in spaces for pregnant women. Much of the talk is about how valuable women find the support of other women. It also excludes men from the process and experience of pregnancy, as much as they can experience it. Overall the film focuses on the fact that women have been told they’re not responsible for their birth. Katsi Cook, a Mohawk women and Native women’s health activist said she â€Å"believes that the relationship of trust and respect between a woman and her midwife empowers the woman to ask questions and obtain the information she needs to make real choices about her health and life. (The Mother’s Milk Project, 611) In the film, Ricki Lake wanted to explore women’s â€Å"rite of passage,† by giving the power back to the women. There’s this idea since hospitals are a business that once they â€Å"facilitate† an intervention has been started and it becomes a domino effect after that. When these interventions have started, the questions: â€Å"what’s best for the baby? † â€Å"Is the baby going to benefit from this or not? † need to be well thought out. According to Overview of Maternity, â€Å"medical evidence shows that the routine use of unnecessary interventions put mothers and babies at risk. In the film Marsden Wagner M. D. , stated that there is no history of worthy obstetrical practices and careful studies of the long-term effects of the interventions. The United States has gotten away from midwifery starting in 1955, only 1% of births took place at home. The culture shift portrayed midwives as â€Å"vestige of the old country. † Midwives were understood as dirty, ignorant and illiterate. Now midwives are often perceived as unprepared. Once doctors started graduating from medical school, business took over the birthing process. Births then went into the hospitals and midwives did not follow. The concept of normal changed. Midwives often lack available and affordable malpractice insurance; because of this midwives are then perceived â€Å"inferior† to physicians. Overview of Maternity states â€Å"Midwives recognize birth as a normal, natural process and support the use of less invasive techniques, such as position changes, waiting, hydrotherapy, and perinatal support, that carry fewer risks to mothers and babies and are usually more effective. † Another effect the culture has on the lack of midwives is when the culture as a whole insinuates that birth s scary and dangerous. Yes, there will always be some sort of risks when it comes to birth. However, that is where I believe technology has had a positive effect on birth. More than less, we are now able to detect the dangers ahead of time. The film associates the amount of trust we put into hospitals and technology is reflected upon our infant-mortality rate. Our neonatal statistics are not the greatest. In the film midwives and hospitals are not looked to blame. It is our diverse population that distorts those statistics in where we stand in the world. The argument presented in this film to revitalize midwifery focused generally on the idea of pain suffered during birth was the only way to feel accomplished and provide love for their baby. However, I completely disagree. Women that undergo C-sections and even families that adopt can have the same amount of love for their children as the women that endure pain during birth do. Normal births are not medical issues, yet they may turn into life threatening issues within seconds. Not all women are the same, they have different difficulties, and some even have disabilities that impact their birthing process. Which then increases the risks. According to Overview of Maternity, â€Å"Research shows that midwives are the safest birth attendants for most women, with lower infant and maternal mortality rates and fewer invasive interventions such as episiotomies and surgical births (cesareans). † Optimum outcome of the mother and child is based on how open to suggestions we are with midwives and patient satisfaction. The validity of your options must always be questioned. The safety of the birthing process is going to vary depending on the training, patient choice, and circumstances on geographical constraints.

John Williams (Composer) Essay

Born in Queens, NY, in 1932, John Williams is arguably the most sought-after composer in Hollywood today. Musically, John Williams greatly influences my work and I find his grandiose, sweeping scores a benchmark to which I would like to progress to in my composing career. With 47 Academy Award nominations, he is the most nominated musician in Academy Awards history and the second-most nominated person of all-time (second to Walt Disney). However, Williams’ rise to fame has been slow and it has taken many years for him to become the household name he is today. This encouraged me, as it showed that even a musical legend like John Williams started out small and worked his way up. During his time studying at Juilliard, he worked as a jazz pianist in New York clubs and after his studies, he moved to L.A. where he began working as a studio pianist for renowned composers, such as Henry Mancini and thus, some of his more comedic scores show Mancini’s influence. He soon gained notice in Hollywood for his versatility in composing jazz, piano and symphonic music. When composing a piece of music, I always look to John Williams for inspiration. One of his most famous techniques, and a technique I greatly appreciate, is the concept of leitmotif and his ability to write a fitting and recognisable piece of music to accompany a particular character; a favourite of mine being â€Å"Princess Leia’s Theme† from Stephen Spielberg’s space epic Star Wars. Williams’ collaboration with Stephen Spielberg began when Spielberg was an all but unknown director, with the film The Sugarland Express and with the momentum of that success, they began a long collaboration together, working on films such as Indiana Jones, Schindler’s List, Harry Potter, Jaws, Jurrasic Park and Close Encounters of the Third Kind, with the latter’s musical and film concepts being worked on simultaneously by Spielberg and Williams, an unusual step for a Hollywood film but typical of John Williams for pushing boundaries. His ability to write so many different styles of music, from Schindler’s List to Indiana Jones, is a skill I which greatly inspires me, as well as his flair for conveying a particular theme; particularly in E.T, where his music depicts the childlike innocence of the film. He is a chameleon of sorts and his seemingly effortless approach to composing exquisite pieces of music for completely different genres makes him stand out amongst other notable musicians of our modern culture. He also takes a lot of inspiration from composers such as Richard Strauss and Wagner, and it is evident in the style of some of his work that he admires the grand, symphonic scores and neoromatic style of Golden Age composers Max Steiner and Erich Wolfgang Korngold. When orchestras are performing his pieces, John Williams likes to be the one to conduct, adding more passion and depth to the music that wouldn’t be there if it were another conductor. I have viewed many videos on Youtube of orchestras playing Williams’ creations and each time they have played with a fervour and respect that spawns a magical, tangible atmosphere, making the music stay with you long after the orchestra has stopped playing. The fact that his scores are not particularly technically difficult, yet still require a musician of great calibre to play them, shows how much effort Williams puts in to evoke the emotion and theme of the film. Star Wars is perhaps Williams’ most famous and memorable scores and is the highest-grossing non-popular recording of all-time. The combined scores add up to more than 14 hours of orchestral music – a magnitude unheard of by most musicians. It is this tenacity and dedication that I admire most about John Williams and is, most likely, what gave him the remarkable career he has enjoyed for so many years.