Poetry Analysis Essay Example for Free

Poetry Analysis Essay The poetry of Judith Wright conveys a strong sense of ? Australian Identity. This is evident though Wrights strong connection to the sea, using descriptions and personifications of the sea. Wrights ? Australian Identity is firmly established through poetry with her use of ideas that have become synonymous with the Australian stereotype: what people recognise as being uniquely ? Australian. This includes the description of the stereotypical Australian beach scene and the attitudes shown by the surfer and even the surf in the poem: characteristics recognised as ? typically Australian. These features of her poetry have established Wright as a truly ? Australian poet. The surf, grey-wolf sea sitting on the whitened pebbles and shells are images that are recognised as Australian and part of the Australian identity. The surfer too is instantly recognisable as typical Aussie character. He is described as brown and he has muscle ? he is the stereotype of the bronzed, muscular surfer. The use of these ideas that have become typically Australian show Judith Wright as an Australian poet which in turn reflects the Australian identity. Judith Wright has a strong connection to the Australian beach, and the ideas she conveys through her poetry are very much steeped in nature. This link to the Australian sea immediately distinguishes Wright as an Australian poet. The Australian connection to the sea and surf is reflected in the repetition of muscle to describe both the surfer and the wave expresses the surfers connection to the wave and to nature. This connection is further emphasised by the personification of the wave through long muscle of water. The bond of both the surfer and Wright to the sea defines Wright as Australian and reflects Australians strong links to the sea. ?Australian traits are not shown only by Wright herself, but by characters in her poems. In The Surfer, Wright uses assonance (those and foam) to describe the wave. This has the effect of creating a long and lazy piece of sound imagery for the reader. The laconic nature of the wave is the same as the typical Australian ? laid back spirit giving Wrights poetry an Australian flavour and such contribute greatly to Wrights recognition as being an Australian poet.

Customer Relationship Management In Hospitality Industries Tourism Essay

Customer Relationship Management In Hospitality Industries Tourism Essay Customer Relationship Management, or CRM, has many perspectives and definitions that illustrate its fundamental thrust, that of trying to present a holistic strategy for managing customer relationships by getting to know the customers and their needs better, communicating with them more effectively and trying to fulfil these needs (Payne, 2005, Pp. 1 2). Because CRM is about getting to know customers and their needs better, it is about implementing specific Information and Communication technology projects within an organisation to process organisational data to deliver knowledge about customers and their needs. It is now possible for organisations to implement more effective and sophisticated technology solutions for processing customer related data because computers are now far more powerful and cheaper compared to what they used to be, with a vastly increased storage capacity. In addition, businesses and organisations can now store vast amounts of data about their customers on co mputerised systems that can communicate more effectively with individuals and other computer systems using technologies for the Internet. Companies in all sectors, including the hospitality and tourism sector, now routinely engage their customers on the World Wide Web and process customer data to deliver more useful products and services at competitive rates (Gretzel, 2010, Pp. 1 48 63 72). Thus, CRM presents opportunities leading to higher profitability and superior competitive advantage (Roberts, 2005, Pp. 315 316). It is important for modern hospitality organisations to try to increase customer occupancy rates and customer experience in a tough and rapidly changing business environment that presents intense competition (Minghetti, 2003, Pp. 141 143). Thus, managers associated with the hospitality sector, including the hotels and tourism sector must have a deep knowledge of customers needs, behaviours, and preferences to offer services that deliver value to create customer retention, value and loyalty. In addition, it is important to try to communicate effectively with customers in a timely manner and to encourage them to engage in a dialogue with an organisation that can benefit everyone. Thus, customer-centric information systems are important for the hospitality industry, which must use these systems to develop effective relationships with customers to serve them better, encourage them to use more offerings from an organisation and to get to know about their needs in order to satisfy them an d to retain them. It is important to understand that customers are the lifeblood of an organisation and without customers, there will be no revenues and no organisation. Customers who are not satisfied or fulfilled leave to benefit from others who can offer more and this means that efforts directed towards trying to maintain effective customer relationships are now essential for all organisations, including those operating within the hospitality and tourism sectors. It is far more expensive to try to get a new customer than it is to retain and to earn from an existing customer (Buttle, 1996, Pp. 155). The collection and use of customer information, its effective analysis and use for delivering to customers are now more important than ever before (Minghetti, 2003, Pp. 1 2). To understand better the importance of CRM in hospitality industries, it makes sense to try to carry out an in-depth investigation into the topic of discussion from the perspectives of customers, managers and other stakeholders, including employees, from within the context of a place with established hospitality industry that has achieved a reputation for excellence around the world. Edinburgh, in Scotland is a suitable location for such an investigation, not only because the author of this dissertation studies nearby, but also because in addition to being the United Kingdoms favourite domestic holiday destination, Edinburgh is now a world renowned destination for its festivals, events and conferences (Susan, 2008, Scotland A World Class Product). Susan (2008, Scotland A World Class Product) goes further to state that Edinburgh is the most favourite city in the United Kingdom to hold a conference and the demand for rooms for guests is fast outstripping supply. Edinburgh is at the forefront of hospitality and tourism in terms of innovation and quality and the hospitality sector in this city employs 31,000 people, which is nine percent of the workforce (Edinburgh Tourism Action Group, 2010, Edinburgh Tourism Framework for Growth 2007-15). According to the previously mentioned publication, Edinburgh won the Guardian / Observer Travel Award as the UK best city for seven consecutive years and tourism generates more than  £ 1.7 billion expenditure in this city. Efforts are ongoing to maintain Edinburgh as a competitive tourism destination of world class and to try to expand on its potential. Thus, it makes sense to try to examine how the hospitality industry in Edinburgh uses CRM to attract customers and to deliver more to Edinbu rgh and its tourists. The research presented in this dissertation attempts to examine the importance of CRM for the hospitality industry in Edinburgh by presenting a review of selected literature, a customer survey, insights from senior managers and executives from the hospitality and tourism industry in Edinburgh and opinions from those who have the real ground-level knowledge, the employees working within the hospitality sector. 1.1 A Discussion of the Problem for Research Marketing is important for the hospitality industry and for marketing for a successful hospitality organisation should touch the customer (Buttle, 1996, Pp. 155 157). The hospitality product is highly personalised with a substantial intangible content judged on experience. Relationship marketing is important for hospitality because the hospitality market with its ongoing and periodic demand in the face of competition presents a greater need for relational efforts and an understanding of the needs of customers. A need for the personal touch exists in hospitality and information technology provides opportunities for using information about customers to deliver the personal touch in novel ways. However, it is important to deliver correctly the CRM effort, based on the right information analytics and using the right channels to make a positive impact for the customer and the hospitality organisation. Despite the fact, that CRM has continued to present a promise of effecting improvements in corporate profitability, performance, customer retention and customer satisfaction, the proper implementation of CRM in an organisation is essential for success (Van Bentum, 2005, Pp. 28). CRM literature not only reports successes, it also reports a large number of failures in situations when well thought ought CRM solutions were not implemented correctly to impact the customer and to benefit an organisation. Thus, it is important to try to find out how the hospitality industry in Edinburgh is effectively making use of CRM in its efforts to compete with destinations from the rest of the United Kingdom, Europe and the world. It is far easier to articulate CRM than it is to implement it (Dickinson, 1999, Pp. 11 12). Today, the hospitality industry needs exceptional marketing that has the capacity for delivering the long-term customer who profits the business over time to emerge as a business partner. Thus, it is important to know the right way for CRM in hospitality and to get to know how the winners are making use of this new marketing reality for hospitality. For the small business operator in the hospitality sector, a customer information database that has evolved over time is likely to serve well using personal computers and internet connectivity if business continuity persists. However, for a large luxury hotel chain, resort or hotels involved with hosting and arranging conferences, the equation becomes more complex. In the present day and age, the design of CRM system emphasises linking knowledge management in organisations with CRM to try to enhance operational and strategic efficiencies (Xu, 2005 , Pp. 955 956). Thus, hospitality organisations and businesses must not only try to use CRM implementations effectively, but it must also be ensured that the right CRM implementation is serving an organisation by capturing the right data to perform the right analysis to present the most useful of results. With the passage of time, the lifestyles and preferences of customers change, customers become more demanding, new customers become involved with organisations and the business environment places new demands on businesses. Thus, it is not possible to say that knowledge acquisition for CRM in hospitality will be a once only exercise that will not be required on a continuous basis. A requirement exists for understanding CRM implementations, processes, practices and techniques with a view for making projections for the future to benefit most from this essential and important component of hospitality marketing. 1.2 Rationale for the Study It is important to consider the fundamental reason or reasons serving to account for something, or a statement of reasons when contemplating a research study because such an approach serves to elucidate, the aims of a research project or that which is required to be researched. For this dissertation, rationale for undertaking research into CRM in hospitality industries in Edinburgh is important because this influences the thrust of research into the topic of discussion. Clearly, an understanding of CRM and its implementation is not only of importance to the researcher who intends to make a career in the hospitality management, but it is also important for Edinburgh, Scotland and all destinations with an interest in enlarging and enhancing hospitality and tourism industries. Thus, a research project involving CRM in hospitality will benefit the industry and the place where the research is carried out to present new insights into what hospitality management should aim for in the future. Many of the more successful and ambitious hospitality establishments from around the world have practices in place to manage customer relationships (Lo, 2010, Pp. 139 156) and (Pechruttanamunee, 2008, Pp. 134 142). Not only is it likely that the more traditional forms of CRM will continue to play an important role in the evolution and success of hospitality organizations, but it is also likely that eCRM, which is made possible by advances in computer and communicatio n technologies, will present a new global meaning to marketing for hospitality at a destination. Thus, the right way to deliver, manage and to drive the CRM effort in hospitality will make the difference and is worth researching in depth. 1.3 Significance of the Study An examination of literature available in learned journals and books on the subject suggests that a very large body of published literature is available for CRM in organisations and the number of published research studies on CRM in hospitality is increasing. However, although a keen interest exists in Edinburgh and Scotland for promoting and further enhancing the hard won competitive advantage in hospitality and tourism for this city, little is available in terms of what role CRM plays in hospitality industries in Scotland and how better, more effective CRM strategies may be implemented for greater success. Thus, it is likely that this study will not only serve to add to the knowledge about CRM in hospitality, but it will also serve to highlight and to emphasise the importance of CRM in the hospitality industries of Edinburgh and Scotland. It is very likely that an effort to examine CRM practices and implementations in the hospitality industry in Edinburgh will present new insights and ideas that will be use to all with an interest in the management of hospitality and tourism. 1.4 Purpose and Research Questions The following research questions are of interest in the research presented for this dissertation: What is the thrust of CRM strategies in the hospitality industries of Edinburgh? What impact has CRM made on the hospitality industries in Edinburgh and is it possible to improve or to innovate further? What are the critical factors that influence deployment, development, planning and implementation of CRM in the hospitality industry in Edinburgh? What role does technology play in the delivery and implementation of CRM in the hospitality sector in Edinburgh? How has CRM shaped the corporate culture and vision for the hospitality sector in Edinburgh? What rewards has CRM presented to the hospitality sector in Edinburgh? How has CRM influenced the design and delivery of competitive and superior services for the hospitality sector in Edinburgh? What essential framework for the implementation of CRM has emerged in the hospitality sector for Edinburgh? What is the alignment that characterises CRM success for hospitality industries and businesses in Edinburgh? A literature review that attempts to examine and to present relevant perspectives on the importance of CRM in hospitality industries is in the next chapter. Chapter 2 Review of Relevant Literature and Research In the tourism and hospitality industries in general and the hotel industry in particular, Customer Relationship Management (CRM) becomes important as travellers become more price sensitive, less brand loyal and more sophisticated (Sigala, 2005, Pp. 391 392). In the present day and age, information technologies have made it possible for shoppers to make instant comparisons between hospitality and tourism offerings on websites and this means that it is important to implement CRM efforts to ret to retain customers and to provide them with better than what the competitors offer. The hotel industry around the world in particular is experiencing increased globalisation, competition, higher customer turnover, growing customer acquisition costs and rising customer expectations not only because the financial recession and competition but also because prospective customers can quickly make comparisons. Depending on the nature of hospitality business in which an organisation is involved, proc esses for automated data collection and analysis for influencing engagement with the customers are possible. Ryals (2001, Pp. 531 535) states that CRM in hospitality and service industries is important because efforts directed towards trying to enhance customer relationships pay in terms of offsetting high customer acquisition costs for those customers that use certain types of service offerings frequently. After covering acquisition costs, a stream of profit flows emerges for the previously mentioned customer and the longer a customer stays with a hospitality firm, the higher the profit. Thus, CRM helps to offset acquisition costs and to generate higher profits. In addition, the return from CRM increases even further when satisfied customers refer other potential customers who add to the bottom line for an organisation. Because efforts to develop a relationship with customers have generally positive effects on customers, a relationship with a hospitality organisation has a value for customers who associate with a brand to become price insensitive. The impact of efforts to enhance CRM in hospitality organisations are likely to result in the following (Ryals, 2001, Pp. 535): Long-term retention of selected customers Gathering and integrating information on customers An emphasis on data mining and analysis of customer data An emphasis on customer segmentation in terms of lifetime value Identification and micro-segmentation of markets for types of offerings Efforts towards enhanced customer value creation An emphasis on the delivery of customer value through channels optimised for serving various market segments A shift in emphasis from management of product portfolios to the management of portfolios of customers, resulting in efforts directed towards optimising an organisation to serve better customer segments Sigala (2005, Pp. 409 410) goes further to suggest that profound change in service marketing, including marketing for hospitality and tourism, demands that an emphasis exist for customer retention, customisation of products and customer focused processes that incorporate Information and Communication Technologies (ICT) for collecting and processing customer data. Processed data is required to deliver customer insights, superior customer relationships and design of superior products and services. The previously mentioned author suggests an integration of ICT, knowledge management and CRM for hotels and the hospitality industry. However, CRM can and does exist in small hospitality and tourism establishments without the implementation of elaborate ICT applications, and it is important to try to have a good fit between the CRM implementation and the business. It is important to understand that with a good fit, the integrated CRM system will present opportunities for improving staff skil ls, competencies, the working environment and services in addition to enhancing customer relationships. The advent of e-commerce has meant that online intermediaries on the web present a threat to hospitality operators because although such intermediaries do present opportunities to customers to select after comparing a number of offerings, they do not always correctly depict the true value of offerings (OConner, 2004, Pp. 474 476). By implementing CRM efforts, hospitality establishments are in direct contact with customers and they can try to sell the value of their offerings to customers with a personal touch that is missing with online intermediaries. To illustrate the point, it is possible to suggest that by mailing a hotel magazine to selected customers who qualify, it will be possible for a hotel to keep customers informed about developments and at the same time to offer new or discounted products to try to maintain and enhance customer interest. In the age of Internet and the World Wide Web, post visit presentations, including magazines or other advertising literature from hosp itality establishments will neither be expensive to deliver nor late in a fast changing world full of new developments. CRM in the hospitality industry has the potential for reducing marketing expenditure and for increasing sales, but it is important to ensure that potential data-ownership dilemmas are in control so that CRM can work optimally at the brand level (OConner, 2004, Pp. 480 481). Effective data mining using artificial intelligence and sophisticated statistical techniques for data analysis on warehoused data is important for CRM, especially for the large hospitality organisations. However, the previously mentioned author suggests that the regional proliferation of Internet and interest in web-based interactions determines how effective eCRM will be when focusing on a region. The developed world with a more prolific proliferation of the Internet is far more suited to eCRM compared to regions in the developing world with limited access to ICT. In addition, large multinatio nal hotel chains must practice and present effective knowledge sharing for international hotel joint ventures (Magnini, 2008, Pp. 249 252). Hence, clearly CRM implementations in hospitality present both risks and opportunities. OConner (2004, Pp. 482) states that the hospitality industry spends millions of dollars on information technology acquisitions every year, but not much published material exists about the management of acquired information technology resources. According to Ozgener (2006, Pp. 1356 1358), senior management commitment and adequate budgets are important for CRM implementations in the hospitality industries. CRM implementations in the small and medium hospitality firms are likely to feel the effects of innovation quality, customer relations, communication-distribution infrastructure and business dynamics. Business dynamics, which refers to change imposed on businesses due to economic, social, technological and environmental change, is important for CRM because it is such change that demands new offerings from businesses to retain customers in the face of competition. Although the smaller hospitality firms will have less to spend on CRM, they are likely to be more interested in having CRM systems because existing customers are far more important to the smaller businesses compared to the larger ones. Thus, within the context of the hospitality industries existing in a city or a region, CRM implementation within small and large h ospitality businesses may vary, depending on the peculiarities of the place. The previously mentioned, together with barriers for the implementation of CRM in hospitality, is likely to be something that will be worth investigating in the small-scale research project for the importance of CRM in Edinburgh. In addition, the more important goals for implementing CRM in hospitality are also worth investigating because the relative reasons for an interest in CRM are likely to differ. It is possible to use CRM systems in hospitality firms for decreasing costs, sustaining competitive advantage, improving customer services, improving customer retention, acquiring new customers or for increasing profits. However, the relative priority reasons for CRM implementation may vary from firm to firm. Oronsky (2007, Pp. 944) suggests that CRM implementations in hospitality industries are not just limited to hotels, resorts, airlines or travel agencies because it is possible for restaurants to benefit from such implementations and a strategic thrust for CRM. The previously mentioned author suggests that chain restaurants and independent full-service restaurants may benefit from information technology and CRM implementations that effectively use IT for engaging customers and better understanding their needs. Within the restaurant sector, information technology has made an impact on the dining experience of customers and the way in which meals are prepared, even though according to the previously mentioned authors, some researchers suggest that the hospitality industry is not technology oriented. However, it is clear that if information technology for implementing CRM systems can benefit large hotel chains, then there is no reason why the same technology cannot benefit chain restaura nts. Oronsky (2007, Pp. 942) states that within the restaurant industry, information technology has the potential for minimising costs, providing support for superior employee and revenue management, enabling analysis of customer preferences and optimising menus for target costs that will appeal more to customers. Thus, despite reservations expressed by some researchers about hospitality not being a technology industry, other researchers suggest that it is likely that more than 50% of the change that will have an impact food service within the hospitality sector will involve technology influences. Thus, it is clear that a potential exists for using information technology and CRM systems within the food service sector in hospitality organisations. According to Oronsky (2007, Pp. 944), customer feedback and analysis of customer needs is as important for restaurants as it is for any other hospitality operation. Like hotels, airlines and tour operators, restaurants too can engage customers using websites and receive comments, feedback, suggestions or survey results presented on the web. For large restaurant chains, it is possible to implement systems for deciding about how well menu items are doing across the entire chain, and it is possible to enhance customer relationships by using imaginative ways, including deal offerings, special promotions, joint offerings with other businesses or offerings related to food events, etc. Thus, clearly technology facilitates information management, knowledge management and engagement with the customer even in the food service sector. In the business environment that prevails today, CRM is as important for airlines as it is for other hospitality industries because serving and having the customer counts and influences the bottom line (Cheng, 2008, Pp. 487 490). CRM is likely to make a difference for airlines in their effort to retain and attract the frequent flyers because relationship marketing emphasises maintaining long-lasting relationships with customers and a significant proportion of airline customers, even during the tough economic times, are business travellers who fly more frequently than tourists do. Thus, it is clear that the character of airline service offers many opportunities for practicing the relationship marketing approach and many airlines do maintain frequent flyer databases that are useful for deciding about customer requirements and for engaging the customer. Because airline operations present a substantial dependence on computers and information technology for reservation systems, schedulin g and maintenance activities, it is quite possible to incorporate effectively CRM implementations as an addition to existing information technology support systems. For airline CRM that delivers results, it is important to ascertain what keeps customers loyal to airlines and how airlines can respond better to offerings presented by competitors (Cheng, 2008, Pp. 488 489). Loyal customers do appreciate rewards for patronage by loyal customers if airlines present competitively priced offerings that are comparable in quality to offerings from competitors. Although, it is very likely that the touch, the thoughtfulness, benefits and the effort will count in CRM for airlines, customers must be satisfied with the price for quality and type of service offerings. Thus, enrolling customers in frequent flyer programs is not a guarantee of customer loyalty because service quality and service recovery policies in case of service disruption are important for frequent flyers. Clearly, a frequent flyer is likely to prefer an airline that checks them into a decent hotel and presents meals instead of leaving them to wait it out in a departure lounge if a substant ial flight delay persists. A balance must exist between rewards for frequent flyers with the care that airlines can offer to such customers who must constantly be on the move to attend to important business matters. In the present day and age, the digital market on the World Wide Web made possible by the Internet is important for airlines, and it is important that airlines lean closer to their customers to try to cut off agents and other intermediaries. In addition, the previously mentioned author suggests that airlines need to emphasise customer orientation, domain expertise, interpersonal relationships, service recovery performance and the judicious use of information technology to make an impact with customers that will result in superior relationship quality. From a customer perspective, domain orientation or the quality of offerings made by an airline and the quality of its employees are of the greatest importance to customers and this means that it is important to tune the CRM system for presenting superior offerings that benefit customers most. 2.1 2.2 2.3 2.4 2.5 2.6 The chapter, which follows, presents a discussion about the methodology for this dissertation. Chapter 3 Methodology / Methods Used 3.1 Research Approach for the Thesis 3.2 Preparation of a Literature Review Chapter 4 Chapter 5 Discussion A discussion about the conclusions derived from the results of the literature review and the interviews are in the next chapter. Chapter 6 Conclusion, Recommendations and Suggestions for Further Work Appendix A (This page intentionally left blank)

Potentially Inappropriate Medication at a Private Hospital

Potentially Inappropriate Medication at a Private Hospital Abstract The use of certain medications in geriatrics when potential risks outweigh the potential benefit and an effective alternative is available is called as Potentially Inappropriate medication. Because geriatrics are more sensitive towards adverse effects of medications. Beers criteria which is updated and reviewed by American Geriatric society list out 53 medications/therapeutic classes of drugs to be avoided in geriatrics. Methodology: A prospective observational study was conducted for 9 months in a 650 bed private corporate hospital, South India. All geriatric patients admitted in the hospital during the study period was included. Beers Criteria 2013 were used to identify potentially inappropriate medications. Result: The prevalence of PIM use (52%) was significantly higher in study population. An avg of 10 drugs were taken by the study population. A total of 215 medications were identified as PIMs. Among them 195(90%) medications should be avoided by the geriatrics independent of th eir condition (category I). 66(60%) of the study population had used more than one PIMs. 91(83%) of the PIM users had atleast one DRPs and the mean DRPs value of the PIM users were 1.59à ¯Ã¢â‚¬Å¡Ã‚ ±1.3. Conclusion: High prevalence of PIMs in the study population signifies the need of monitoring geriatric prescriptions. Key words: PIMs, Beers Criteria, Geriatrics Introduction In recent years proportion of geriatric hospital admission with comorbidity and polypharmacy has been increasing continuously (1, 2). Adverse drug events (ADRs) are the most common reason for hospital admission, but sometimes it’s not identified. Medication errors (MEs) or conventional adverse drug reactions (ADRs) are the common reason for adverse drug events which ends in clinical symptoms. Overall, elderly patients need greater attention to drug therapy and safety parameters (1, 3-5). Greater attention is needed for geriatric population due to age related pharmacodynamics and pharmacokinetic changes. But appropriate pharmaceutical care for elderly are determined on the basis of clinical trial conducted with adult population.(6) The burden of harm resulting due to the use of multiple drugs in geriatric populations is a major health related problem in developed countries. A research study reveals that around one in four geriatrics admitted to hospitals are prescribed with at least one inappropriate medication and potentially preventable adverse drug reactions accounts for nearly 20% of all inpatient deaths (7). The assessment of potentially inappropriate medication (PIM) in geriatric is a challenging work and there is a need for considering many factors which influences the prescribing as well as outcome. Eight well known tools are available to identify the PIMs and studies reports that Beers criteria is the best and easy one to assess the PIMs. Beers criteria also has the advantage over others because it is periodically updated (8).This study therefore aimed to investigate the prevalence of PIM use on geriatric population using Beers criteria 2012 and its association with Drug Related Problems (DRPs) . Methodology Study Site: The work entitled â€Å"A study on prevalence and impact of Potentially Inappropriate Medication use in geriatrics at a private corporate hospital† was carried out in a 640 bedded private corporate hospital, South India. Study Design: Prospective –Observational study. Study Period: Nine months. Inclusion criteria: Patients above age of 65 yrs. Exclusion criteria: The patients who are unwilling to participate in the study and out patients METHOD: A regular ward rounds was carried out in all the wards of General medicine. Each patient’s medication profile was reviewed. Patients who met the inclusion criteria were briefed on the project with the help of patient information form and if they are willing to participate in the study their consent was obtained. The data from medical chart were recorded in customized data entry form. The prescribed drugs were evaluated and PIMs use were identified with the help of Beer’s criteria. The drugs which are identified as PIM are categorized into following: Potentially inappropriate medications /classes to avoid in geriatrics, Potentially inappropriate medications /classes to avoid in geriatrics with certain pathological condition that the listed PIM use can exacerbate Medications to be used with caution in geriatrics. ADRs associated with PIMs use were assessed. Drug interaction and ADR was monitored and reported. DRPs and Drug Risk Ratio (DRR) were calculated for PIMs. DRPs were the sum of ADR, drug interaction and drug allergy.DRR was calculated as the number of DRPs in relation to how often the drug was used (DRPS/number of times used). Results and Discussion In the study period, 212 patients were included in the study as per inclusion criteria and exclusion criteria. 110 (52%) patients were found to be prescribed with PIMs listed in Beers criteria (fig no: 01). A similar study conducted by Birader K et al (2013) (9) reported that PIM prevalence were 38% in their study population. Increased anxiolytics use as a prophylaxis for hospital related anxiety might be the reason for high prevalence of PIM than the later study. The total number of patients in study population were 110. Among them 62(56%) were males and 48(44%) were females.The study result reveals that PIMs user are mostly males. A similar study conducted by Birader K et al (2012) (9) reported that prevalence of PIM use is more among males than females. The age categorization of PIM users was done. The maximum age of PIM users was 93 years and mean age of PIM users was found to be 70.2 ±5.77. The median age for PIM users was 68.5 years. The result indicated that age group of (65-69) were commonly prescribed by PIMs. This results compared with a previous study carried out by Birader K et al (2012) (9) which also reports that PIMs were frequently prescribed in the age group of 65-69 years. The social habit of the PIM users shows that 8(7%) patients were smokers and alcoholics, 14(13%) patients were alcoholics, 21(19%) patients were smokers and 67(61%) patients were teetotalers in PIM users. The comorbidities of the PIM users was analyzed. There were 52 (47%) suffering from hypertension and 32(29%) were suffering from DM. The results shows that most of the study group had comorbidities of hypertension followed by DM and CVDs. A similar study conducted by Fouquet A (11) also reported that most common diagnosis among their study population was hypertension and diabetes. The number of drugs prescribed for the PIM users were calculated (fig no: 2). The mean number of drugs per prescription was 9.9 ±2 with the maximum of 16 drugs and minimum of 5 drugs prescribed. The above results signifies that all prescriptions were in polypharmacy category. A similar study conducted by Blozik E (12) concluded that one of the main factor for PIM use is â€Å"polypharmacy†. The number of PIM drugs per prescription in the study population was calculated (Fig no: 3). The result reveals that 44(40%) were using one PIM drug, 50(45%) were using two PIMs, 14(13) were using three PIMs, 1(1%) were using 4 PIMs and the maximum of 5 PIMs use were found in 1(1%) of the study population. 66(60%) of the study population consumed more than one PIM. The mean was found to be 1.8 ±0.78 and an avg of 2 PIM was used by the study population. A similar study conducted by Dormann H (2013) (13) were reported that 87% of the study population consumed at least one PIM. Among the PIM users the total number of PIM drugs was calculated and it was found to be 215 drugs. PIM users were categorized into three groups according to Beers criteria. (Table no: 2) There were 195(90%) belongs to category I, 12(6%) were in category II and 8(4%) were in category III. The individual categories of PIM was analyzed. It was found that alprazolam 57(52%), clonazepam 17(15%), hyocyamine 10(9%), Lorazepam 10(9%), hydroxyzine 10(9%), zolpidem 10(9%), ketorolac 10(8%) were prescribed in category I (table no: 3). A similar study conducted by Birader K et al (2013) (16) reported that alprazolam and cimetidine were frequently used PIM among their study population. Use of hyocyamine in constipation 3(25%) accounts for the most frequent inappropriate drug use in category II (table no: 4). Hydroxyzine in constipation 2(17%), cyproheptidine in constipation 2(17%), ketorolac in PUD 2(17%), clonazepam in frequent fall 1(8%), ketorolac in CHF 1(8%) and theophylline in insomnia 1(8%) were other category II inappropriate medication use. Use of escitalapram 3(40%), mirtazapine 2(30%), fluoxetine 1(10%), sertraline 1(10%) and Duloxetine 1(10%) were the category III PIMs (table no:5). The DRP among the PIM users were analyzed (fig no: . It was found that 19(17%) of the PIM users were free from DRPs. Majority of the study population had at least one drug related problems. The mean value of DRP in the study population was found to be 1.59 ±1.3. The minimum observed number of DRP per patient was one and maximum observed number of DRP per patient was six. The ADR use was monitored in the study population. A total number of 40 ADR associated with PIM use (Fig no:5) and 14 ADR associated with nonPIM use were identified. The study result reveals that one among three PIM users were found to have at least one ADR. A similar study conducted by N. Nixdorff et al (2008) were also reported that PIM users were found to experience ADR most frequently than nonPIM users. As a part of our study, screening of drug interactions were done. A total number of 131 major drug interactions were identified, in that 111 were unique. Among the drug interactions found 16(12%) were PIM-PIM drug interactions, 39(30%) were PIM-other drugs drug interactions and 76(58%) were caused by non PIM drugs (table no: 6). Drug risk ratio were calculated for the study population (table no:7). It was observed that prochlorperazine had the highest DRR (4) followed by phenobarbitone (2), digoxine (2), pentazocine (2) and duloxetine (2). The statistical analysis of obtained results has been done using statistical tools. The association of different variables are analyzed using à ¯Ã‚ Ã‚ £2 test. On assessment of association between â€Å"number of comorbidities† with â€Å"number of drugs† and â€Å"number of PIMs† (table no:8), the result proved that â€Å"number of comorbidies† are statistically associated with â€Å"the number of drugs† at 0.001 level of significance and â€Å"number of PIMs† at 0.05 level of significance. It means that as number of comorbidity increases polypharmac and PIM use also increases. On assessment of association between â€Å"number of drugs† and â€Å"number of PIMs† (table no: 9), the result proved that â€Å"number of drugs† are statistically associated with â€Å"number of PIMs† at 0.05 level of significance. This result proves that polypharmacy is one of the reason for PIMs. On assessment of association between â€Å"number of DRPs† with â€Å"number of drugs† and â€Å"number of PIMs† (table no:10), the result proved that â€Å"DRPs† are statistically associated with â€Å"number of PIMs† at 0.01 level of significance but not associated with â€Å"number of drugs† at 0.05 level of significance. This result proves that DRPs is more associated with PIMs than polypharmacy which means it not the number of drugs contributing to DRPs but the use of PIMs. Conclusion Our study identified a high prevalence of PIMs use and associated DRPs in the study population. DRPs due to PIMs is preventable. Development and implementation of new criteria or modification of already existing criteria such as Beers criteria, START STOPP criteria which will helps in safe prescribing practice can reduce the PIMs use. References Budnitz DS, Lovegrove MC, Shehab N, Richards CL. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med 2011; 365: 2002–12. Budnitz DS, Shehab N, Kegler SR, Richards CL: Medication use leading to emergency department visits for adverse drug events in older adults. Ann Intern Med 2007; 147: 755–65. Lau DT, Kasper JD, Potter DE, Lyles A, Bennett RG: Hospitalization and death associated with potentially inappropriate medication prescriptions among elderly nursing home residents. Arch Intern Med 2005; 165: 68–74. Pirmohamed M, James S, Meakin S. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ 2004; 329: 15–9. Chrischilles EA, VanGilder R, Wright K, Kelly M, Wallace RB. Inappropriate medication use as a risk factor for self-reported adverse drug effects in older adults. J Am Geriatr Soc 2009; 57: 000–6 Avorn J, Shrank WH. Adverse drug reactions in elderly people: A substantial cause of preventable illness. BMJ. 2008;336:956–7 Minimizing Inappropriate Medications in Older Populations: A 10-step Conceptual Framework. Ian A. Scott, MBBS, MHA, MEd,a Leonard C. Gray, MBBS, MMed, PhD,b Jennifer H. Martin, MBChB, MA (Oxon), PhD,c Charles A. Mitchell, MBBSd Opondo D. Inappropriateness of Medicationth Prescriptions to Elderly Patients in the Primary Care Setting: A Systematic Review, plos one, aug 2012, volume 7, issue 8 Biradar K; assessment of potentially inappropriate medication in elderly patients at Basavehwar teaching hospital;IJPP 2012dec, vol 5,issue 4, 73-5 Denys TL (2011) Functional Decline Associated With Polypharmacy and Potentially Inappropriate Medications in Community-Dwelling Older Adults With Dementia, Am J Alzheimers Dis Other Demen. 2011 December ; 26(8): 606–15. doi:10.1177/1533317511432734 Fouquet A, Zegbeh H, Krolak-Salmon P, Mouchoux C. Detection of potentially inappropriate medication in a French geriatric teaching hospital: A comparison study of the French Beers criteria and the improved prescribing in the elderly tool. J Eurger 2012 3: 326-29 Blozik E, Rapold R, von Overbeck J, Reich O. Polypharmacy and potentially inappropriate medication in the adult, community-dwelling population in Switzerland. Drugs aging. 2013;30:561-8 Dormann H, Sonst A, Mà ¼ller F, Vogler R, Patapovas A, Pfistermeister B, Plank-Kiegele B, Kirchner M, Hartmann N, Bà ¼rkle T, Maas R. Adverse drug events in older patients admitted as an emergency the role of potentially inappropriate medication in elderly people (PRISCUS). Dtsch Arztebl Int 2013; 110(13): 213–9. DOI: 10.3238/arztebl.2013.0213 N. Nixdorff et al. Potentially inappropriate medications and adverse drug effects in elders in the ED. AJEM 2008 26: 697–700 Tables and figures NO. of PIM/prescription Number of patients N=110 Percentage 1 44 40 2 50 45 3 14 13 4 1 1 5 1 1 Table no:1 Number of PIM per Prescription sl no category no. of PIMs percentage 1 PIM drugs/classes to be avoid in geriatrics (category I) 195 90 2 PIM to be avoided in certain pathological condition (category II) 12 6 3 PIMs to be used with caution (category III) 8 4 Table no:2 Categories of PIM sl no Drugs No. of Patients sl no Drug No. of Patients 1 Alprazolam 57 (29%) 16 Nitrofurentoin 3(1.5%) 2 Clonazepam 17(9%) 17 Mirtazapine 2(1%) 3 Hyocyamine 10(5%) 18 Cyproheptidine 2(1%) 4 Lorazepam 10(5%) 19 Diazepam 2(1%) 5 Hydroxyzine 10(5%) 20 Piroxicam 2(1%) 6 Zolpidem 10(5%) 21 Prochloperazine 2(1%) 7 Ketorolac 10(5%) 22 Chlorphemiramine 2(1%) 8 Aceclofenac 9(4.5%) 23 Trihexylphenedine 2(1%) 9 Propoxyphene 8(4%) 24 Digoxin 2(1%) 10 Diclofenac 7(3.5%) 25 Phenobarbitone 1(0.5%) 11 Spironolactone 6(3%) 26 Naproxen 1(0.5%) 12 Prazosin 5(3%) 27 Clinidium-chlordiazepoxide 1(0.5%) 13 Clonidine 5(3%) 28 Indomethacin 1(0.5%) 14 Chlordiazepoxide 3(1.5%) 29 Metachlopramide 1(0.5%) 15 Amitriptyline 3(1.5%) 30 Pheniramine 1(0.5%) 31 Pentazocine 1(0.5%) Table no: 3 Category 1(PIM drugs/classes to be avoid in geriatrics) Sl no Drug Disease No. Patients Percentage 1 Ketorolac CHF 1 8 2 Hydroxyzine Constipation 2 17 3 Hyocyamine Constipation 3 25 4 Ketorolac PUD 2 17 5 Cyproheptidine Constipation 2 17 6 Clonazepam Frequent Fall 1 8 7 Insomnia Theophyllin 1 8 Table no: 4 Category II (PIM to be avoided in certain pathological condition) sl no Drug No of Patients percentage 1 Mirtazapine 2 30 2 Fluoxetine 1 10 3 Sertraline 1 10 4 Duloxetine 1 10 5 Escitalapram 3 40 Table no: 5 Cateegory III (PIMs to be used with caution) NO OF INTERACTION PERCENTAGE PIM-PIM 16 12 PIM- OTHER DRUGS 39 30 OTHER DRUGS 76 58 Table no:6 Categories of Drug Interactions Sl No Drug DRPs Total Drug Risk Ratio 1 PROCLORPERAZINE 8 2 4.00 2 PHENOBARBITONE 2 1 2.00 3 DIGOXIN 4 2 2.00 4 PENTAZOCINE 2 1 2.00 5 DULOXETINE 2 1 2.00 6 NAPROXEN 2 1 2.00 Table no.7 Drug Risk Ratio Sl no Varience No. of comorbidities Chi squire value P value 1 2 ≠¥ 3 1 No. of PIMs 1 5 21 13 12.76* 0.05 2 10 12 15 ≠¥ 3 7 15 12 2 No. of drugs 6-8 13 16 4 26.77* 0.001 9-11 8 25 17 ≠¥ 12 1 7 19 Table no:8 Association of no. of comorbidities with no. of drugs and PIMs . varience No. of Drugs Chi squire value P value 6-8 9-11 12-14 ≠¥15 No. of PIMs 1 16 21 4 3 21.76* 0.001 2 14 24 8 4 ≠¥ 3 2 5 5 4 Table no: 9 Association of no. drugs and no. PIMs Sl no Varience No. of DRPs Chi squire value P value 0 1 2 ≠¥3 1 No. of PIMs 1 11 21 10 2 21.76* 0.001 2 7 23 8 12 ≠¥ 3 1 4 2 9 2 No. of drugs 6-8 9 15 11 1 11.77 0.05 9-11 4 25 6 12 ≠¥ 12 6 8 3 10 Table no:10 Association of DRPs with no. of drugs and PIMs Fig no:1 Prevalence of PIMs Fig no:2 Number of Drugs Prescribed per Patient Fig no:3 Number of PIM per Prescription Fig no: 4 Adverse Drug Events and Its frequency Fig no:5 Adverse Drug Events and Its Frequency

Kurt Vonneguts Who Am I This T Essay -- essays research papers

Growing up we learn the importance of many different things. Of all these things, we have learned that being accepted into society, forming friendships, and loving someone are very important to us. In Kurt Vonnegut’s short story, “Who Am I This Time?';, we see through the experiences of Helene Shaw that by shutting ourselves off from others around us we can miss out on some of the most important things in life. Many things are important to us, one of these is being accepted by our society. We all hate to be the outsider or the new kid, because we feel alone and secluded . In “Who Am I This Time?';, Helene Shaw’s job kept her moving to a different town every eight weeks. She became very cold to her surroundings in order to ease the transition from ...

Sir Isaac Newton Essays -- Biographies

Isaac Newton Isaac Newton was one of the greatest scientists of all time. He is best-known for his discovery of the law of universal gravitation and the laws of motion. Much of modern science is based on the understanding and use of his laws. Isaac Newton was born on Christmas Day, 1642, in the small English town of Woolsthorpe. His father, a farmer, died shortly before Isaac was born. When the boy was three years old, his mother remarried and moved to another town. Isaac stayed on at the farm in Woolsthorpe with his grandmother. After attending small country school, he was sent at the age of twelve to the Kings School in the near by town of Grantham. At first Isaac was a poor student. He cared little for school work, perferring to paint, make kites, write in notebooks, or invent toys. He made no friends. Silent and dreamy, he was at the bottom of his class. Oddly, it was a savage kick by a school bully that caused Newton's great mind to awaken. The mild, dreamy boy flew into a rage and beat the other boy thoroughly. Isaac determined to beat the bully in school work as well. Soon Isaac was at the head of his class. In 1656 Newton's stepfather died. His mother returned to Woolsthorpe to take care of the farm left by Newton's father. But she could not manage the farm by herself. Isaac was taken out of school and brought home to help her. As a farmer, Newton proved to be a dismal failure. He neglected the necessary chores and thought only of books to study and mechanical things to make. There are many stories about him at that time that show how absent minded he was becoming. One day while he was leading a horse, the animal slipped its bridle and ran away. ... ...ly called the Principia, after its Latin title. Many scientists think its the most important scientific book ever written. It contains Newton's famous three laws of motion. It also contained his law of universal gravitation. This law applies not only to heavenly bodies. It also explains why a baseball drops from your hand to the ground and why a particle of dust settles on a bookshelf. During later years Newton served his country in Parliament, as well as in other ways. In 1703 he was elected president of the Royal Society, and in 1705 he was knighted by Queen Anne. Isaac Newton died in 1727. He was burried in Westminster Abbey, among the great men of England. His statue stands today in the hall of Trinity College, Cambridge University. Bibliography: David C. knight. "isaac Newtons, Mastermind of modern Science" Groiler inc. Canada, 1969.

Company strategic plan Essay

According to company strategic plans, the company aims to achieve a net profit before tax of $1,000,000. The chief risks to this goal are: ââ€" poor sales due to economic downturn ââ€" increases in expenses such as wage expenses. In addition to Australian operations, the company is considering manufacturing overseas to take advantage of reduced costs. The company is also considering diversifying its product range to reduce exposure to poor sales of one product. Role You are the manager of Sales Centre A, based in Adelaide. The centre has achieved great success over the last year and consistently outsells other sales centres. In fact, due to the large number of accounts managed by your sales team and larger staff, your centre is expected to sell as much volume as the other two sales centres put together. Naturally, you expect cost allocations to reflect the both the needs and importance to the business of Cost Centre A. Task A The Sales General Manager, Sam Gellar has asked you to review the master budget and cost centre budgets prepared by the Senior Accountant. She would like you to meet with her to discuss the whether the budget projections are achievable, accurate, understandable and fair. She would like you to look at the budget for your cost centre closely, note any changes you think are necessary, develop an argument for the changes and negotiate those changes with her. Information you are aware of includes: ââ€" Sales in the first quarter (Q1), second quarter (Q2), and the fourth quarter (Q4) are generally 30% less than Q2. ââ€" Sales in Q2 depend on completion of 90% of repair and maintenance. ââ€" Commission negotiated with members of the sales team is now at 2.5%.

Limitations of interviews Essay

Despite the advantages associated with interviews, a number of limitations must also be acknowledged. For example they are time-consuming; one of the biggest weaknesses could be the ability to interview only a sample population, raising concerns with the generalization of findings. As a consequence, in this investigation, the use of multiple sources of data has been conceived to validate qualitative data, as the degree to which archival data, interviews, and document analysis converge makes the conclusions about the phenomenon more convincing. The Method in which Conclusions will be derived The most important issue in research is that the process of arriving at conclusions is not a sequential one. No conclusion can be drawn until there is a clear data display. The process of arriving at conclusions will be as shown in Figure 6 below (Miles. Huberman, 1994). Consequently, after having administered the questionnaires and collated the responses, the findings will be compared with review of literature to analyze the banking system in China and UK. Figure 6 Chapter 3 – Literature Review Literature on Banking in China. Banking China – General. Modern banking in China commenced with the establishment of the first Chinese bank based on western pattern of banking in 1897. (Cheng, 2003). The Chinese banking system however has undergone turbulence over the years due to historical upheavals in the country such as the invasion by the Japanese in 1937, the Second World War, the Communist Revolution, communist party rule and there after opening of the economy in the 1980’s and 1990’s. The era of 1927 to 1937 is regarded as the golden era of Chinese banking under the government of Sun Yat Sen. There after there have been many changes until the emergence of the present banking system. (Cheng, 2003). Chow (1994) has indicated that the principal player in the Chinese banking industry is the People’s Bank which has played an important role in the Chinese economy even after liberalization though its role has been relatively passive. The Chinese banking reforms were undertaken after the landmark decision during the Third Plenary Session of the Fourteenth Congress of the Chinese Communist Party on 11 and 14 November. (Chow). These reforms reversed the processes undertaken almost five decades earlier in December 1948 when the People’s Bank was established after consolidating a number of local banks such as the Huabei Bank, Beihai Bank and Xibei Farmer Bank. The China Banking Regulatory Commission was established to supervise the financial industry in March 2003, thus diluting the hold of the People’s Bank as a central bank established in 1983. The People’s Bank is supported by four principal state controlled banks of which Bank of China (BOC) is one of the largest entities. The OECD Economic Survey on China 2005 indicates that the government policy has provided adequate space for the growth of market forces to influence the economy and is now determining the prices, trade, and investment by foreign companies as well as the overall financial system. (OECD, 2005). These reforms have impacted the level of savings in the Chinese economy while at the same time providing for greater foreign investment. The report has called for greater reforms in the banking sector to ensure that the process of growth is carried forward. (OECD, 2005). Thus broadly it would be seen that Chinese banking industry is on a threshold of transformation. Literature on Bank of China Bank of China – General The Bank of China is one of China’s oldest banks which has had a significant role to play in China’s financial history. The Bank was established in 1912 under the Sun Yat Sen regime. It had an important part to play in the turbulent period of China’s history to include a constant flux in the economy, political change and revolutionary periods including wars. (About Bank of China,. 2006). In the beginning of the Communist era, in1949, it was nominated as the primary bank specializing in foreign exchange. Thus it was at the fore front of development of foreign trade, providing currency and credit facilities to a large variety of individuals and firms. (About Bank of China, 2006). In 1994, the Bank was converted to a state owned commercial bank thus in 2003, when the Chinese banking sector assumed velocity it greatly benefited Bank of China. In 2003 another initiative to convert it into a joint holding bank was undertaken, a process which was finalized in 2004 when it was incorporated as a joint stock commercial bank, thereby providing it the ability and the regulatory authority to provide a wide spectrum of services across a vast geographic area to include 27 countries and regions. It is stated to have 10000 domestic and 600 overseas operations. (About Bank of China, 2006).