Interprofessional Collaboration In Practice Social Work Essay Essay Example

Interprofessional Collaboration In Practice Social Work Essay Essay Interprofessional instruction ( IPE ) is an juncture where two or more professionals learn with, from and about each other to ease coaction in pattern ( CAIPE, in Freeth et al 2002:11 ) . Barr ( 2005 ) noted that the degree of attention given to service users was adversely affected by the bias and ignorance some professionals brought with them when working together. IPE seeks to turn to this. Carpenter ( 1995 ) writes how IPE was hence devised to better the dislocation in trust and communicating between professions. Service users have demands that can non be covered by one profession entirely ( Means, 2010 ) hence the demand for effectual coaction. The two twenty-four hours conference provided an chance for coaction between a scope of wellness attention professionals There were a big figure of nurses on my group tabular array and I decided to do this experience a positive one and develop my larning to profit my hereafter pattern. It appeared as though all members of the group were confident talkers and I briefly wondered if we would let each other the chance to be heard or give each other clip to speak. However, we all had infinite to speak, were listened to and valued for our parts. I felt this was a positive start to the group work. We will write a custom essay sample on Interprofessional Collaboration In Practice Social Work Essay specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Interprofessional Collaboration In Practice Social Work Essay specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Interprofessional Collaboration In Practice Social Work Essay specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We discussed the stereotypes attached to our professions, there were more for societal work than there were for other professions, although I heard nurse s described as rough and loud . Unfortunately one of the nurses in our group acted as judged when she had an statement on the 2nd twenty-four hours with another nurse, in position of all go toing the conference. Sellman, cited in Pollard, et Al ( 2000:156:171 ) writes Peoples have fixed ways of behaving and act consistent with their characters. He besides voices how influences from a personal, professional and structural position can impact whether practicians seek to be willing, swearing or leaders in interprofessional working. The behavior of this pupil allowed others to see an unprofessional side of her and may hold re-inforced bias. Mandy et Al ( 2004 ) compose about how the bringing of health care is affected by interprofessional stereotypes, competition and tribalism. It was reviewing to hear of the positive experiences some of the nurses had with societal workers. Some nurses thought that societal workers had a unsmooth trade ; a remark from one of them was It s so unjust ; you are dammed if you do and dammed if you do nt, but I think you people are to be admired for all you do . It made me gain that non all professions have a negative feeling of societal work. Whilst working on our group sentences ( See Appendix ) , linguistic communication differences were discussed. I felt confident to dispute the word of the usage patient since societal workers are employed in a figure of scenes, hence the usage of the word patient would non ever be appropriate. Dalrymple and Burke ( 2006 ) and Martin and Henderson ( 2001 ) illustrate the footings used to depict those in reception of services will ever be a beginning of treatment and alteration, but it could be argued that the footings that professionals use can hold negative intensions for the individual. Bruce and Borg ( 2002 ) discourse the term patient reenforcing the ill function and making the thought that the single demands to be taken attention of. The group agreed jointly to utilize the term service user , nevertheless Heffernan ( 2005 ) draws us to recognize that this term can be damaging to the ethical patterns of societal work. Heffernan proposes that labelling persons with this term cou ld circulate their sense of dependance on services. Upon contemplation I realised that as professionals we need to be sensitive to the penchants of the person. Communication and service user involvement were issues discussed at great length within the group. The usage of slang between professions and illegible script meant it was hard to entree information associating to care and made it debatable for service users to lend. Reeves et Al ( 2010:65 ) provides a annihilating illustration of hapless communication- a patient holding incorrect site surgery . We discussed state of affairss that had hapless results for service users and its links to uneffective communicating. On contemplation, the absence of effectual communicating and constructive relationships within the interprofessional squad impacted on the ability to work collaboratively. Hirokawa cited in Royeen et Al ( 2009:49 ) high spots communicating is the cardinal constituent to interprofessional working and Tomlinson et Al ( 2008:108 ) puts communication cardinal in order to supply a non-discriminatory service that is advancing lingual competency . Knowledge and lucidity of functions is an element key to successful interprofessional squads. Reeves et Al ( 2010:62 ) considers how Clear functions help specify the nature of each squad members undertakings, duties and range of pattern . She clarifies that where each member s function is seen as indispensable and there are clear squad ends teamwork is effectual. Sargent et Al ( 2008 ) adds to Reeve treatment, by doing professionals cognizant that in larning about the functions of other subjects, you need to be cognizant of how they complement your ain pattern, in order for effectual teamwork to go on. The drama by the Dramatic Voices drama group Up to here , allowed an penetration into the positions of service users, carers and professionals and the tensenesss and struggles within those functions ( e.g. necessitating a interruption from caring, force per unit areas of marks ) whilst foregrounding the defeats when one feels unsupported. The DVD Alison Ryan s Story by Patient Voices ( 2010 ) emphasised the importance of carers and their expertness of a status, so should be listened to and more to the full involved. Cooper and Spencer ( 2006 ) explain in their article the of import part service users can do to IPE for pupils at the beginning of their preparation. Service users provided the pupils with existent life illustrations of how they had learnt through experience, enabling them to go experts , and as such stakeholders within the interprofessional squad . Interprofessional working has many benefits for all involved. It can eliminate barriers between professionals, whilst foregrounding the value each profession has to offer. Uniting the demands, accomplishment and expertness from all professionals means that demands are identified Oklahoman, taking to earlier and more effectual intercession. A bundle of attention that is focussed around the person and is more coordinated with a faster deliver clip should ensue in better results. Tirrito et Al ( 1996:31 ) examines the benefits ; The client benefits from the corporate wisdom, professionals benefit from the support of co-workers and society benefits from the riddance of extra services . Decisions from enquiries and current policies have summarised that interprofessional instruction and working are indispensable to good pattern. The National Service Framework for Mental Health ( DH, 1999 ) , The National Service Framework for Older Peoples ( DH, 2001 ) and The National Service Framework for Children ( DH, 2004 ) , Partnership in Action: New Opportunities for Joint Working Between Health and Social Services ( DH, 1998 ) and the Laming Report ( 2003 ) have insisted practicians to embrace an interprofessional attitude to their work. Despite the counsel sing interprofessional working, there are unfortunately instances where this has non occurred ensuing in preventable deceases of kids. Victoria Climbie s decease led to Lord Lamings study ( 2003 ) , placing the failures of professionals to protect her. Irrespective of this, Baby Peter in 2007 and Khyra Ishaq in 2008, die whilst under the attention of several professionals. Serious instance reviews from Haringey and Birmingham ( 2009 and 2010 severally ) sing their deceases underscore unequal communicating ( amongst other failures ) between professionals every bit good as missed chances for intercession. The Government green paper Every Child Matters ( 2004 ) recommended alterations to policy sing information sharing to guarantee all bureaus obtain a full image of a kid s life. Following from this the authorities has released a new guideline Working Together to Safeguard Children ( 2010 ) which provides a national model for persons and professions. It sets out wa ys of working together to safeguard and advance the public assistance of kids. This includes working together with an in agreement program of action, information sharing and recording and guaranting that their work is child-centred, that the focal point is ever on the kid. This should guarantee that farther calamities are avoided at all costs. 1332 words Section 2 DISCUSS HOW YOU WOULD Take AWAY WHAT YOU HAVE LEARNT ABOUT IP WORKING INTO PRACTICE The interprofessional conference was an huge acquisition chance for me. The importance of service user engagement, person-centred planning and communicating within interprofessional squads highlighted in the conference gave me a batch to see for future pattern. Upon contemplation of the conference, I was cognizant that I could be working with people who have non had IPE, so considered how I could join forces with those that are non willing to embrace interprofessional working. This led me to contemplate old experience, my old arrangement experience, my following pattern arrangement and where IPW suit into this. Every Child Matters ( 2004 ) require that all practicians will be involved in information sharing that welcomes all positions as every bit valid ; nevertheless I witnessed a state of affairs that had the opposite consequence. In my old experience as a babys room nurse, I had raised concerns following a revelation from a kid. To summarize, the societal worker dismissed my sentiment, stating that I was unqualified to do any remark as I was merely a nursery nurse . The world that I had a batch of contact with this kid was disregarded. Nurse ( 2007 ) discusses the troubles in interprofessional working where one professional believes that merely they have the expertness and cognition to do a opinion sing concerns. In the hereafter as a SW in an interprofessional squad I may be outnumbered by other professions, but I will show assurance in my profession and my function in order to be heard and will esteem the position of other professionals irrespective of occupation rubric or making. My old pattern arrangement allowed me to see an interprofessional squad in action. I was able to detect a squad meeting for a mental wellness squad. There were professionals represented from wellness and societal attention backgrounds. All professionals were given clip to turn to any concerns they had sing a service user and were able to seek/offer advice from others. Medical and societal positions were taken into history, leting all professionals to work from their ain theoretical base but working in partnership to supply continuity of attention. Martin et Al ( 2001 ) recognize how the sharing of background and experience while placing people s functions within the multidisciplinary squad allows the members positions to be explored. This becomes a beginning of strength, with this integrated pattern holding benefits for service users and patients. I was grateful of the chance to witness the results of effectual interprofessional working. I am trusting for my following arrangement to be in a infirmary scene. In order for my experience of IPE to be extended I will try to invent an action program to maximize my acquisition chances and experience of interprofessional working. I would inquire about the chances where professions interact and inquire to be an perceiver to this ( e.g. discharge be aftering meeting ) . I would inquire for the chance to run into other pupils from other professions at the arrangement in order to portion our acquisition experiences, professional policies and processs in order to recognize similarities. I would set up clip shadowing other professions, in order to acquire a fuller image of their function. I would besides bespeak clip with my arrangement supervisor in order to reflect on IPW and its challenges, troubles and benefits. This pattern could advance relationship edifice for the hereafter, every bit good as stressing how other professionals can back up my function as a societal worker. It would let me to place and develop appropriate accomplishments in my pattern. Hostility between professions could be reduced and coaction and squad kineticss could be increased and improved as those who are non familiar to IPE can see it demonstrated in their pupils. The importance of service user engagement was highlighted in the conference. The Children Act 1989, National Health Service and Community Care Act 1990, and the Community Care ( Direct Payments ) Act 1996 were among the first pieces of statute law related to service user engagement. Policy counsel, pattern counsel and service criterions have developed from this. For illustration, the GSCC ( 2002 ) and Skills for Care ( 2002 ) provide counsel for societal workers related to serve user engagement. I had witnessed illustrations of hapless pattern in the yesteryear where the service user had no determination sing their attention ( e.g. a adult female who speaks Bengali holding her intervention discussed about her with no transcriber sought to explicate it to her ) . Service users now have more power to dispute determinations and garbage attention should they wish, as they are now experts by virtuousness of their experience ( Tanner et al ( 2008:6 ) . Lishman ( 2007:270 ) reminds practicians that keeping meetings with single service users, instance conferences, consultative commissions ( to call a few illustrations ) are power sharing constructions in relation to determinations but the degree of active hearing by societal workers and other professionals guarantee the service users voice is heard and valuable to the determination devising procedure. Wallace and Cooper ( 2009 ) highlight the importance of seting the service user at the Centre and the administrations of services w ith and around them in order to interrupt down the barriers of the administration we work in. I recall on my old arrangement a state of affairs that provides an illustration of person-centred attention. I was at a twenty-four hours Centre of grownups with dementedness and was a detecting a group of gentleman playing dominoes. Upon recognizing a gentleman detecting non playing, I discovered he could nt retrieve how to play. Through joint reminiscing of our seniors playing dominoes and leting the gentleman to remember himself playing when he was in Jamaica, triggered his memory so he was able to play once more. Brooker cited in Innes et Al ( 2006:6 ) signpost four elements indispensable to supplying individual centred attention, one of which is a positive societal environment to enable the individual with dementedness to see comparative wellbeing. Supplying culturally appropriate conversation, every bit good as clip for this gentleman to reminisce allowed him to retrieve a portion of his cultural individuality that was of importance to him and through retrieving how to play dominoes, was able to socially interact with other members of the Centre. The function of a SW is really much dependent on the setting- appraisal, crisis intercession, patient well-being and protagonism are merely a few of the myriad of functions I could set about. Holoskom et Al ( 1992 ) show the multiple roles a SW could be portion of in wellness attention scenes. It highlighted the deficiency of clearly defined function competencies specific to societal work. Wilson et Al ( 2008 ) suggest aˆÂ ¦social workers are less able to specify what their specific part to an inter-professional squad might be aˆÂ ¦ .It could be argued nevertheless that SW are indispensable to how attention is delivered. As a SW I could be assisting patient s job solve and header with state of affairs or unwellness, link persons with resources and services and advance effectual and human-centered service systems. Carlton, cited in Holoskom et Al ( 1992: 8 ) emphasis the significance of the societal workers as being the lone professional who has the cardinal foundation tha t a holistic position of the service user is of extreme importance I have realised that it is of import for me to heighten cognition of medical issues so that I can be knowing when speaking to patients and can take part to the full in interprofessional squads. The squad will besides derive cognition about my function as a societal worker with positions, values and positions being shared in order for my presence to be ocular and effectual to the bringing and construction of wellness attention. I left the conference with a positive attitude to interprofessional working. As one of the following coevals of wellness and societal attention workers I will guarantee that what I have learnt will be used in pattern to guarantee interprofessional working is at the heart of patient centred attention . I would wish to stop with a quotation mark that I feel expresses the procedure of interprofessional working: Coming together is a beginning ; maintaining together is advancement ; working together is success ( Henry Ford 1863-1947 ) 1310 words Appendix -Agreed Group Sentences Communication Issues between Health and Social Care Professionals Effective communicating between the multi-disciplinary squad including the service user and their household is overriding to client centred attention. All communicating should be clear and concise without the usage of slang or abbreviation to ease collaborative working. Contrasting professional positions / values within squads By sing the positions of the service user s and other professionals, practicians are able to broaden their apprehension in order to better bringing of attention. There are contrasting positions and values between professionals but it is our duty and responsibility of attention to compromise for the service user s best involvement. Pigeonholing, power instabilities and squad procedures Although there may be perceived hierarchy s within wellness and societal attention professionals, everybody s different accomplishments, cognition and input is variable to the demands of the service user at that peculiar clip and hence should non be translated into power instabilities and struggles with the Interprofessional team.A It is human nature to organize stereotypes of others but we must notA let this to impact the attention we provide to service users.

Reservoir Dogs Essays (680 words) - Concept Albums, Feces

Reservoir Dogs Essays (680 words) - Concept Albums, Feces Reservoir Dogs Gangsters, violence, murder and corruption !!!!! If these are some of the things that you're into, then this is your kind of movie. Be ready to watch it more than once to be sure to get all the movie has to offer because it jumps from subject to subject and can be a little confusing. The movie on the whole was really great. It was filled with some pretty gory scenes and extreme violent content, Tarantinos' trademark. The way he portrays the real life aspects of crime and violence are unbelievable. I wonder if he experienced some of these things himself and that's why he has a realistic view of them. Then again, I can't really gauge how realistic any of these themes are because after watching this kind of movie it makes me feel like I lead a really sheltered lifestyle. Why does all the violence in Tarantinos' movies become so attractive to us normal people? I think it's because most of his material is underworld stuff. He deals with things we can barely relate to. Topics that are so far fetched to a "normal" person that they kind of hypnotize us into watching. Things happen in his movies that are so bizarre, we can't begin to imagine them happening to us in real life. The weird part is, many of these things DO happen every day. We all know there really are gangsters, mobsters and really low-life people that involve themselves in what we think of as underworld crime. Drug deals.... on a level so great... amounts we can't begin to comprehend. Murders, for whatever reason. Even the thought of hiring someone to kill someone else gives us a goose bump or three. In his movies it's almost like borrowing a cup of sugar from your next door neighbor. Chopping off someone's ear would repulse me and probably make me want to spew my lunch. Tarantinos' characters chop off ears then talk into them as if they were using ma bell. His characters attitudes are totally ruthless. They could give a shit if you were the cousin of the president or a nanny. They have a job to do and they do it. No holes barred, no questions asked, no thought given to actions or consequences. They are almost like robots, zombies of the underworld that have no emotions or respect for the value of life. You would think these characters are drugged or brainwashed, but they're not. It amazes me that people do this kind of shit as if it were just another day. It's as second nature to them as brushing our teeth every morning is to us. Belonging. Everyone likes to feel like they fit in. There is a certain comfort level in belonging to something, anything. Even if it is to a gang of criminal types. I think that's another reason we all relate or get captured by viewing these kinds of movies. I can only compare it to a fraternity; fraternity brothers all belong to an organized group. They have similar interests, goals and acquaintances. All Tarantinos' characters have these things in common. Although they aren't exactly what we would consider acceptable, they all still feel this common bond. It's a sick kind of thing though. When you think of all the things life has to offer, why would you want to involve yourself in all this complicated criminal shit? They jeopardize their own existence because even though they are considered members of the organization, they would snuff each other out in the blink of an eye if the right person told them to do it. !!!! I have to admit I was totally awed by his movie. I couldn't wait for the next scene to start. As a movie maker, his ideas and the way he presents them are phenomenal. He definitely captures his viewers. You don't even want to blink for fear of missing something. I would like to see him do a movie about topics that aren't so bizarre just to see if the movies would be as good.

Write about play Essay Example | Topics and Well Written Essays - 750 words

Write about play - Essay Example Mama is scheduled to get the pension amount, and every member of the family has their own dreams, of what to make of it. As the play progresses, Ruth discovers she is pregnant, but decides upon aborting the baby, because of their financial condition. Beneatha is inclined towards Joseph Asagai, her African friend and rejects the proposal of George Murchison. Walter loses $6,500 that he gave his friend to start the liquor shop business. Mama zeroes in on the house to buy and pays the down payment. However, the family receives a threat from the all-white neighbours, as they do not want them to move in. The end of the play sees the family all set to move in and Beneatha accepting Asagai's proposal. 2. Structure, using Remembrance. Page 157 (bottom) Follow the exercise as written for A Raisin in the Sun.Reread at least one of the scenes we have presented, noting moments when the characters are engaged basically in remembrance. Then write a paragraph in which you make and support a claim about the extent to which the scene is concerned with the past rather than with the present or future. When Mama talks about her dream, she slips into the past, wherein she painfully recounts the dream her husband and she shared---to move into a beautiful house of their dreams. This is one instance where she moves to the past. She describes her husband's dream of owning a house, and asserts that it is her dream now----to fulfill her husband's. This dream of hers is more concerned with the past than of the present and the future, because of the sheer feasibility factor. Towards the end of the play, we do see the family sticking to their decision to move into the new house, however, amid threat and scathing hatred and hear. 3. Character Development. Page 159 Follow the exercise as written except choose a scene from A Raisin in the Sun. This paragraph will probably be longer than others, but you do not have to write an informal essay as indicated by the writing prompt. Choose one of the scenes we have excerpted, and write a brief, informal essay in which you examine the scene for signs that either or both of the characters will eventually change. In my opinion, the scene that involves Walter Lee talking about investing money in business and convincing his family about giving him a part of the pension money t get into liquor business with his friend is one that shows some signs that the character of Walter Lee is a round character. His character is one that exhibits signs of change, though the play does not go on into the future, to prove that part. In the beginning, Walter is shown as a person who is a defiant husband and a belittling brother. He is someone who harbours dreams of making it as a businessman, though he is presently not too productive. He takes the step and invests part of the pension money in the liquor business his friend and he propose to begin. However his friend runs off with the money and Walter loses the amount. Towards the end of the play, Walter transforms in a man, by refusing to quit moving into the all-white neighbourhood and thereby, shattering his Mama's dreams. He stands up for what the family believes in and refuses to give in. This reveals his strong mind-set and

Can parents who abuse drugs and alcohol be good enough parents Essay

Can parents who abuse drugs and alcohol be good enough parents - Essay Example In 2006, a study revealed that about 5% of all adults in the UK are alcohol-dependent with one out of 24 parents drinking heavily; these figures put about one million children living with alcoholic parents (In the news, 2006). The Institute of Alcohol Studies (2009) also revealed in their latest statistics that 22.1% of children in the UK are living with alcoholic parents; and about 8% of children in the UK are living with parents who are drug abusers. Moreover, 3.6% of children live with parents who are both alcohol and drug abusers (Institute of Alcohol Studies, 2009). In other words, these children are put at risk of being exposed to neglectful and abusive parents. Alcohol abuse and substance abuse potentially affect entire families and these are also habits which, if not stopped, are often passed on from generation to generation (In the News, 2006). With the above considerations, this paper shall now answer the question: can parents who abuse drugs and alcohol be good enough pare nts? This discussion shall use relevant literature, theoretical frameworks and research findings in order to come up with a thorough and critical understanding of the subject matter. Various studies and researches shall be evaluated in relation to this subject matter, analysing them for validity and credibility. Drugs and alcohol have different effects on different people. Shaw points out succinctly that â€Å"the good and bad effects of alcohol lie in complex psychological and sociological continua...Concepts of use and abuse have therefore been open to equally wide interpretations† (Shaw, 1978, p. 41). The effects of drugs and alcohol largely depend on a person’s physiology and sociology. Indeed, the adage, â€Å"being able to handle one’s drink† is appropriate in determining the effect of alcohol on a person. Some people may be able to handle their drink well, and others, not at all. Nevertheless,

New business proposal Essay Example | Topics and Well Written Essays - 4000 words

New business proposal - Essay Example This paper also contains the market analysis of the product, describing the industry, size of the market, and the description of the product. It is very difficult for the company to achieve success in penetrating the American market without ban elaborate and effective marketing strategy. This paper contains the marketing strategy that the organization should use, and the estimated financial flow that the project intends to attract. The company intends to start making some profits during its third year of operations. The product of the company under review is ASOS.com. This is a British online company that is responsible for selling beauty and fashion products. The target markets of the company are young adults. Furthermore, the company manages to sale over 850 clothing brands, and it also has its own brand of accessories and clothing materials. As of the year 2013, the company was able to make a sale of 753.8 million pounds. The products that the company manages to sale are menswear, womenswear, beauty products, jewellery, accessories, footwear. On each and every week, the ware house of the company normally comes up with new products, aimed at replacing the already sold out products. The major disadvantage is that these products removed from the warehouse are not unique (Sachdev, 2004). This is a major disadvantage to the company, and it ought to invest heavily in research and development for purposes of developing unique products aimed at catering for the needs of its target market. ASOS.com has various websites that target markets in USA, UK, Australia, Germany, China, Italy, Spain, Russia, etc. These are not the only countries that the company operates in, and this is because it normally ships its products to over 237 countries of the world. It has two distribution centres in the United Kingdom, which is responsible for undertaking this job. The company has approximately 21 million unique customers per month, and 7 million active or permanent

Case Study: Pre Eclampsia | Essay

Case Study: Pre Eclampsia | Essay This essay is based on a case study and will discuss the underlying pathophysiology, management and psychosocial aspects a patient faces when diagnosed with pre-eclampsia. Information was obtained through the patient and from their medical notes. Section A: Case History JB is a 38-year-old, gravida 4, para 0, Caucasian female who presented in hospital at 36 weeks plus 5 days gestation with sudden development of oedema in the face and upper and lower extremities along with a severe headache. On examination her blood pressure (BP) was elevated at 171/107 mmHg. Her pulse 81 beats per minute (bpm), respiratory rate 15 breaths per minutes, and temperature was 36.4  °C. Her urine sample showed ++ 2 proteinuria. There was evidence of oedema in her face and upper and lower extremities and her lower deep tendon reflexes were brisk but without any clonus. JB denied any visual disturbances and epigastric pain. On palpitation of the abdomen, the symphysio-fundal height was 38cm. The fetal lie was longitudinal and the back appeared to be on the right. The presentation appeared to be cephalic and the head was 3/5 engaged. Electronic fetal monitoring showed fetal heart rate at 135 bpm, with reassuring variability. There was no deceleration and acceleration was normal. It was also noted that contractions were absent. Her antenatal care had been shared between the hospital and her general practitioner and was uneventful until she was admitted to hospital on this occasion. On briefly reviewing JBs past medical history she has seasonal allergies as well as long standing asthma in which she uses salbutamol inhaler to relieve her symptoms. JB also has a history of depression. In her family history her father suffers from hypertension as well as cirrhosis and her mother has a remarkable medical history of extensive medical conditions such as hypertension, angina, and transient ischemic accidents. Both her maternal grandparents had a history of type 2 diabetes. With regards to her social history, JB works as a customer assistant and lives with her partner. JB has never smoked, and has not taken alcohol since finding out she was pregnant. Her past obstetric history is remarkable for recurrent miscarriages. She had two miscarriages at 6-8 weeks and one ectopic pregnancy a year and a half ago which miscarried naturally at 10 weeks. The initial investigations showed; a normal full blood count, liver enzymes and creatinine. However urate (0.37 mmol/l) and the protein: creatinine ratio (44 mg/mmol) levels were elevated. JB is demonstrating key cardinal symptoms of pre-eclampsia including hypertension, proteinuria, oedema, and increased reflexes.1 A diagnosis of severe pre-eclamptic toxaemia was made, JB was admitted and treatment was commenced with 10mg nifedipine. With JB being admitted onto the ward, there was continuous monitoring of BP and fetal monitoring using cardiotocography (CTG). The next morning JBs BP stabilised to 128/74 mm Hg and she reported feeling better. With the BP stable and a reassuring CTG a decision to induce delivery was made and she was given Prostaglandin E2 (PGE2) over three days. However there was poor response and the cervix remained obstinately unchanged and so it was decided the baby would need to be delivered via caesarean section. Section B: Pathophysiology Pre-eclampsia is part of a range of conditions known as the hypertensive disorders of pregnancy.2 It is defined as a multisystem disorder characterised by the new onset of raised BP (≠¥140/90 mm Hg) and proteinuria (at least 1 + on dipstick or ≠¥0.3 g/24 hours) after 20 weeks of gestation.3-5 Although the triggering event initiating the syndrome is unknown, a two stage model of pre-eclampsia has been proposed (figure 1).1,6-9 The primary asymptomatic stage, characterised by inadequate remodelling of the placental vasculature during the first trimester results in reduced placental perfusion leading to placental ischemia and release of placental products into the maternal circulation.1,6,7 Consequently this initiates the second symptomatic stage, the maternal syndrome in which endothelial dysfunction precedes the clinical manifestations of the disease including characteristic hypertension, proteinuria, and glomerular endotheliosis.1,6,7 There is also risk for developing the H ELLP syndrome (haemolysis, elevated liver enzymes and low platelets), progression to eclampsia, and end-organ damage.1,6,7 Stage 1 In normal pregnancy, following implantation, the surface trophoblast cells of the adhering blastocyst differentiate into an inner cellular layer, the cytotrophoblast, and an outer syncytiotrophoblast.10,11 The undifferentiated cytotrophoblasts found in the inner layer can develop into hormonally active villous syncytiotrophoblasts, extravillous anchoring trophoblastic cell columns, and invasive intermediate trophoblasts.10 The extravillous trophoblastic cells proliferate from the tips of anchoring chorionic villi to form the cytotrophoblast shell which line the uterine cavity.10,11 Cytotrophoblasts continue to migrate through the uterine endometrium until they reach the spiral arteries, by which time they have differentiated into an endothelial-like cell type.10,11 Endovascular trophoblast cells begin to remodel the spiral arteries by replacing the endothelium and smooth muscle cells resulting in the destruction of medial elastic, muscular and neural tissue.10-12 These physiological changes result in an increased vessel diameter leading to the creation of a low-resistance arteriolar system with the absence of maternal vasomotor control, and therefore allowing a notable increase in blood supply to the developing fetus.7,10 In pre-eclampsia this physiological dilatation does not occur adequately thus resulting in placental hypoperfusion and ischemia.1,8,10 The ischemic placenta may lead to the production of cytokines and growth factors as well as simulate placental apoptosis or necrosis, resulting in release of humoral or particulate materials into maternal systemic circulation that promote generalised maternal vascular endothelium dysfunction, culminating in the clinical manifestations of pre-eclampsia.1,8,10 The invasion of trophoblast cells is regulated by factors expressed by the decidual barrier.7,10 These factors include cell adhesion molecules, extracellular matrix, proteinases, growth factors and cytokines.7,10 Malfunctions in any these factors may lead to poor trophoblast invasion and subsequently pre-eclampsia.7,10 Immunological factors play a main factor in pre-eclampsia.7,10,11 Abnormal placentation may be the result of maternal immune rejection of paternal antigens expressed by the fetus. Normally HLA-G, a class 1B MHC antigen, expressed by the extravillous trophoblasts protects from natural killer cell lysis.11-13 Women who develop pre-eclampsia do not appear to express this HLA-G and therefore are not protected.7,10 Stage 2 The clinical manifestations of pre-eclampsia can be linked to the pathophysiological changes that occur including vasoconstriction, activation of coagulation cascade and reduced plasma volume.14 Development of hypertension is a key feature of pre-eclampsia.1,8,14 During normal pregnancy, although through maternal physiological adaptations there is a 30-50 % increase in cardiac output, the decrease in peripheral vascular resistance results in decreased arterial BP.14 However, those who develop pre-eclampsia experience widespread vasoconstriction, increased peripheral vascular resistance, and decreased cardiac output.1,13 Evidence shows there to be an exaggerated sensitivity of the vasculature of women with pre-eclampsia to all vasopressors hormones, best known is the increased responsiveness to angiotensin II.1,13 This increase in vascular reactivity is thought to be due to an alteration in the balance of prostaglandins as a result to the damage to vascular endothelial damage.1 JBs BP when she presented was 171/107 mm Hg. This is a considerably elevated and can be defined as severe pre-eclampsia (≠¥160 / ≠¥110 mm Hg).2-4 Although fluid retention and oedema occurs in patients with pre-eclampsia they are also a feature of normal pregnancy.1 Plasma volume increases by approximately 50% in uncomplicated gestations and normal gravidas sometimes experience oedema.1 However in pre-eclampsia plasma volume is decreased by 15-20% and in these cases women experience rapid weight gain and generalised oedema as a result of an abnormal shift of extracellular fluid (ECF) from the vascular to the extravascular compartment hence maintaining a low plasma volume and an increased interstitial fluid volume.1,14,17 With excessive accumulation of interstitial ECF, the presence of peripheral oedema particularly in the face and hands is seen. JB haemoglobulin was 130g/l, reflecting the haemoconcentration seen in pre-eclampsia as a consequence of the reduced intravascular volume.1 Women with pre-eclampsia also have noticeably reduced renal plasma flow (RPF) and glomerular filtration rate (GFR).1 The decline in RPF is attributed to vasoconstriction, whereas the fall in GFR is related both to the decline in RPF as well as to the morphological changes in the kidney.1 These characteristic pathological changes of pre-eclampsia are known as glomerular endotheliosis and comprise mainly of diffuse glomerular endothelial cell swelling, enough to obstruct the capillary lumen.1,7,8,13,15 The morphologic lesion is accompanied by functional changes in renal hemodynamics which correlates best with the magnitude of hyperuricemia and proteinuria.1,5 Early to middle pregnancy serum uric acid usually falls well below 0.24 mmol/l, in patients with pre-eclampsia levels often rise >0.27 mmol/l as seen in the case of JB (0.37 mmol/l).14 A number of studies have correlated the rise in serum uric acid with the severity of pre-eclampsia and with the extent of glomerular injury.5,8 JBs PCR levels was also measured to estimate the extent of proteinuria. The result recorded 44 mg/mmol predicts significant proteinuria, the threshold being >30mg/mmol.17 Left untreated, pre-eclampsia can proceed to life threatening convulsions termed eclampsia.18 Another specific complication that can arise from pre-eclampsia is the HELLP syndrome, which is illustrated by the sudden appearance of a microangiopathic haemolytic anaemia, elevation of liver enzymes and a rapidly falling platelet count.18 In these cases rapid interruption of pregnancy is required to avoid hepatic or renal failure, sepsis, or even death.1,6,7,15,18 Section C: Management Treatment for hypertension in pregnancy raises a series of challenges to the healthcare team.17 An in-depth knowledge of the adaptive physiological, psychological and social processes is required in order to choose the optimal management for the mother and her fetus.17,19 Incomplete understanding of the aetiology in pre-eclampsia has hindered attempts at prevention.12,17 However effective and adequate prenatal care management of pre-eclampsia has led to the reduced mortality related to this disorder.15,16 This includes early detection and referral of women at high risk, careful monitoring with prevention and treatment of complications, and a decision regarding timely delivery.15,16 Delivery remains the definitive treatment for pre-eclampsia even though the disease progression may not resolve immediately.8 Following diagnosis of pre-eclampsia, management relies on the initial observations recorded of both mother and fetus.4,16 The central goal of management of pre-eclampsia is ultimately to protect the wellbeing of the mother and prevent progression to eclampsia and then the delivery of a healthy newborn.4,16 While delivery is always suitable for the mother, it might not be appropriate for a premature fetus.4,16 Therefore the decision to deliver is influenced by the mothers condition, gestational age and status of fetus at the time of assessment.4,16 JBs management was given in accordance to guidelines from Royal College of Obstetricians and Gynaecologists.5,17 Based on JB diagnosis at 36.5 weeks she was admitted to hospital with the decision to induce labour and allow a vaginal delivery. Observations of vital signs including BP, heart rate, oxygen saturations, and respiratory rate were recorded every 15 minutes along with continuous CTG monitoring.5,15 A 10 mg dose of oral anti-hypertensive nifedipine was given to stabilize her BP before she could be induced. The sole need to treat is to prevent the hemorrhagic squeal of hypertension, in particular cerebral haemorrhage, rather than alter the progression of the disease process.2 Antihypertensive drug therapy is advised for pregnant women with systolic BP of ≠¥ 160 or diastolic BP ≠¥ 110 mm Hg.2,5,17 The goal of treatment is to lower systolic pressure to 130-150 mmHg and diastolic pressure to 80-100 mmHg.5,17 It is also important that BP is lowered gradually to prevent hypotension as placental perfusion can be adversely affected and compromise the fetus15. With a conservative management plan in place and JB stable, the BP was measured every four hours during the day. Full blood count, renal and liver function tests, were all carried out daily.5,17 There are many possible choices of antihypertensives that are appropriate in pregnancy.8 Methyldopa and labetalol are first line antihypertensive drugs used in treatment of pre-eclampsia.4,5 Methyldopa is a centrally acting alpha2 agonist that reduces sympathetic outflow activity.15,20 Although it has a long track safety record, due to the common drug side effects of depression, in the case of JB with a history of depression it was agreed an alternative should be used.14,15 The use of labetalol was also contraindicated in JB case as she is asthmatic.5 Labetalol is a non selective beta blocker and a selective alpha blocker.15,21 As both of these were contraindicated in JB case, nifedipine was prescribed instead. Nifedipine is a type 2 calcium channel blocker which is usually used as a second line agent in cases where BP is noncompliant to treatment with methyldopa and beta blockers.15,20,21 It acts by inhibiting the inward transfer of calcium ions from extracellular space and by the inhibition of uptake by smooth muscle cells.15,20,21 Its primary effect is to cause smooth muscles relaxation.15,20,21 Nifedipine has become a widely used antihypertensive, owing to its ability to vasodilate the vasculature with rapid onset and its full reversibility on discontinuing the drug.15,20,21 With respect to use of drugs in pregnancy, nifedipine has been rated as a Category C drug.21 This means that its use is recommended only when likely maternal benefits are seen to outweigh possible fetal effects, as the teratogenic effect of the drug on the fetus is uncertain.21 Once the BP was stabilized, induction of labour commenced. It is recommended that women in presence of severe pre-eclampsia at or beyond 34 weeks gestation to be induced to prevent the progression of the disease to eclampsia.5 Induction of labour was stimulated via PGE2, which contains dinoprostone. Its mechanisms of action are similar to the natural cervical ripening process.22,23 It is administered intravaginally to induce cervical ripening by directly softening the cervix, relaxing the cervical smooth muscle, and producing uterine contractions.22,23 There has been some debate of the use of dinoprostone in women with a history of asthma; however PGE2 is a bronchodilator, thus not contraindicated to use, in JB case. 23 For women whom there is a concern about the risk of eclampsia, it is recommended they receive magnesium sulphate as a prophylactic to protect against seizures, however in JBs case it was held off. The MAGPIE study demonstrates that the risk of eclampsia is more than halved in these women.5,8,24 However, it is also worth noting that only 1-2 % of pre-eclamptic women in the UK had fitted in the absence of anticonvulsant treatment.24 After magnesium sulphate is administered, extra caution is needed due to the potency of the drug which can lead to respiratory depression especially where nifedipine has previously been taken.21 When magnesium sulphate has been prescribed, it should be continued at least 24 hours post partum, as the risk of eclampsia does not resolve immediately after delivery. 5,14,15,24 The majority of women following deliver with severe pre-eclampsia will require inpatient care for four days or more.5 JB was discharged on the forth day after careful review of her clinical signs. She was continued on her anti hypertensive treatment, and was to be reviewed as an outpatient. JB was also offered a postnatal follow up to discuss the events of the pregnancy as well as preconception counselling.5 Section D: Psychological and Social Aspects Epidemiology Pre-eclampsia complicates about 2-8 % of pregnancies and may have serious effects on the mother and child, which makes it important threat to pubic health in both developed and developing countries. 2,24,25 Worldwide maternal mortality and morbidity from pre-eclampsia and eclampsia remains high, it is estimated to be responsible for approximately 12 % of maternal deaths per year. 24 It is estimated that pre-eclampsia is accountable for 67% of the referrals to day care assessment units, 20% of antenatal admission and 25% of obstetric admissions to intensive care units in the UK .26 The cost of treating pre-eclampsia varies between  £500- £10000 including the sum of hospital stay, induction costs, mode of birth, and pre-admission costs.17 Due to improvements in antenatal care in the UK, syndrome of eclampsia and development of HELLP syndrome is now rare.17 Eclampsia is reported in 1 in 2000 pregnancies.8,15,25 Also perinatal mortality rates are gradually improving, due to advances in antenatal care, early detection, improved anaesthesia, early delivery and expert neonatal paediatric care.15 Factors associated with an increase risk of pre-eclampsia include nullparity, African-American ethnic background, multiple gestations, obesity, chronic hypertension, molar pregnancy, family history of pre-eclampsia and a previous history of pre-eclampsia.4,8 Psychosocial Women who experience pre-eclampsia are exposed to significant amount of psychological and social stress.27 These stress disturbances in turn may have a significant impact on the mother and baby during the important early months following delivery.27,28 Pre-eclampsia is a disease which develops without warning therefore as JB reported, she found herself having to deal with the unexpected and dramatic changes in fetal health risk as well as her own all of a sudden. The diagnosis of pre-eclampsia initiates feelings of fear, shock, and sometimes even disbelief particularly to those experiencing it well before term. Shock comes from the fact that they were being hospitalised and felt unprepared for delivery.27,28 JB was very nervous after being admitted to hospital as she and her baby were regularly monitored and the realisation of the serious consequences the disease possess.28,29 There was also a sense of frustration as well as disempowerment as JB felt she had no control over the situation, and it was no longer just a personal responsibility. These feelings were amplified through the lack of sufficient information given on the disease, not completely informed about her actual situation, and on the medical decisions being made.27,28 JB was very emotional as she felt responsible for developing pre-eclampsia and worried about the risks she may have propelled on her child. Other psychological stresses were requirement of bed rest, boredom and being separated from her partner during hospitalisation.28 For those women who are diagnosed well before term, there is a greater risk of prematurity.28 These women being unprepared for the experience of delivering a premature baby can be a major component of shock and fear experienced. When progression of disease leads to complications, an emergency caesarean section which is usually performed can be very traumatic experience and life can suddenly be thrown into chaos. 27,28 These women usually have less early contact with there baby and are less likely to breast feed as they are recovering from surgery.27,28 For those who unfortunately loose their baby, they will be faced with the complex and traumatic events of grieving. This grieving process can be coupled to relationship problems as partners usually grieve differently.28 Women with pre-eclampsia are at increased risk of reoccurrence with subsequent pregnancies; therefore it is important they are advised of this if they wish to conceive again.28,30 The experience of severe pre-eclampsia may be overwhelmingly stressful. There is little time to adjust to new realities. Women may blame themselves adding the burden of guilt to the acute emotional chaos that follows diagnosis. Conclusion In conclusion, pre-eclampsia remains a global problem and a clinical challenge. It is a significant cause of maternal and perinatal mortality and morbidity. As the triggering factors remain unknown, prevention of the disease becomes difficult. At present, the only treatment option for pre-eclampsia is delivery, but this is not always simple and usually involves a risk-benefit balance between health of mother and the maturity of the fetus.

Modems :: essays research papers

Modems Modems are used to connect two computers over a phone line. Modem is short for Modulator Demodulator. It's a device that converts data from digital computer signals to analog signals that can be sent over a phone line. This is called modulation. The analog signals are then converted back into digital data by the receiving modem. This is called demodulation. A modem is fed digital information, in the form of ones and zeros, from the CPU. The modem then analyzes this information and converts it to analog signals, that can be sent over a phone line. Another modem then receives these signals, converts them back into digital data, and sends the data to the receiving CPU. At connection time, modems send tones to each other to negotiate the fastest mutually supported modulation method that will work over whatever quality line has been established for that call. There are two main differences in the types of modems for PC, internal and external modems. Evolution of Modems In the last 10 years, modem users have gone from data transfer rates of 300bps to 1,200 bps to 2,400 bps to 9,600 bps to 14.4Kbps to 28.8Kbps to, and to 33.6Kbps. Now new modem standards are emerging, reaching speeds of up to 56Kbps. Unlike the 33.6Kbps modems being sold today, 56Kbps is a significant improvement over 28.8Kbps modems. Viewing complex graphics or downloading sound files improves significantly with 56Kbps. The modem experts keep telling us that we are about maxed out. For instance when the 28.8 modems where first introduced they said that we've reached our maximum speed, and the same thing was said about the 33.6 and now again for the 56K, but how true is this? The experts say that the next major improvement will have to come from the telephone companies, when they start laying down fibber-optic cables so we can have integrated services digital network (ISDN) . The thing that makes digital modems better than analog is because with analog modem transmission errors are very frequent which results in your modem freezing or just freaking out. These errors are caused mainly by some kind of noise on the line due to lightning storms, sunspots, and other fascinating electromagnetic phenomena, noise occurs anywhere on the line between your PC and the computer you're communicating with 2,000 miles away. Even if line noise is minimal, most modems will automatically reduce it's speed to avoid introducing data errors. Baud vs bps While taking about modems, the transmission speed is the source of a lot of confusion. The root of the problem is the fact that the terms "baud" and