FAST FOOD

Part 1

KEEP OFF FAST FOOD

1. This article addresses the issue of the youthful generation and their great zeal for consuming fast food. The demand has been on an increasing trend making fast food businesses growth at a very high speed. In Jammu culture, they have never been inclined to such food but that did not stop the fast food business from growing in their area. There have been factors that have led to their growth that includes cheap prices and they are easily available as most of these businesses are located in areas where there are a large number falls. The article has also focused on the fast food culture as the food joints are found in major joints of colleges, schools and tuition centers in the old cities like Pacca Danga or the Rani Park. The article gracefully talks about the emergence and the acceptance of the fast food business and the health impacts it has on the youths and the general population.
2. The article is useful as it shed some light on the acceptance of the fast food despite the challenges and the health impacts it has on the people and especially the youths. The information is reliable as most of the people are usually away from the health impacts of the foods but they demand them more in order to quench their desires. The source is objective as it is able to achieve its mission by explaining the rapid growth of the fast foods and why its demand increases with time.
3. The sources is a perfect fit for my research as it is able to tackle the reason as to why the fast food business are increasing and why many malls have eating facilities that are specializing in fast foods. It is insightful as I can be able to defend my argument that despite the health implication fast food business will continue to increase as they are readily available and assessable. It is useful in the project due to the fact that information is relevant and in that my perspective about fast food has also changed as there is a negative side to it that should dealt with.

Part 2

FUTURE WATCH: IS FAST FOOD SLOWING DOWN

1. The article is based on the argument of the future direction of the fast food and their likelihood to slow down. The article takes a look at why most people who are poor want to eat the good food despite the health challenges. The article also addresses the future direction and the new business openings that are as a result of the fast foods. It would be true to say that the article uniqueness of the fast foods, how it is technologically driven, the posh parties and the appetite for the fast food apps.
2. The source is useful as it has a new context of the food provenance, safety the changing demography and the whole concerns in both socio-economic and age profile status. The information is reliable compared to other bibliographies as it is more detailed in the fast foods business, their challenges and why they are increasingly becoming a dominating factor in the food world by portraying a clear picture of the Chinese consumers. It is objective as it has been able to explain and support its arguments thus achieving its goal of being educative in the fast food business.
3. The source of the article is a perfect fit for my research as it is reliable and objective which has helped me by facilitating my knowledge about fast food. My arguments have become more directional due to the insightful information about the technology is driven business and its rapid growth. The data and the figure obtained in the research are useful in my result as I can be able to support my argument with facts that are proven. I have been able to understand that it is not all about the taste of the people that has created demand but also the acceptance and embracement of technology in fast food.

            The Analysis of Food in Japan

            Abstract

            This report aims at analyzing and attempting to break how Japanese food, mainly with the view of rice in Japan has made a type of character in the nation.  Rice in Japan is a form of food which is regarded as the major source of nourishment or strength. The ways of rice consumption are practices, customs ceremonies as well as convictions which surround food nourishment in particular social living and social gatherings. The thing of consuming calorie-free food in Japan is slowly taking over.  The nutrition system in Japan has achieved a dichotomy that is more in regard to getting less.  The strategy of no food consumption and zero take-ups off drinks is taking over the economy slowly. An individual is thus bound to consume fewer calories as they are packed with gyudon forms. This is thus associated with fewer prices and zero intakes of calories. Rice, forms the personality basis for strength Japanese cultural strength. However, the rate of consumption in the recent years has thus decreased due to lifestyle changes.  Rice is chosen as the important motivation in discussing the personality of Japan since it highly connects itself with history, territories as well as social ceremonies in distinct ways which most foods cannot achieve.  To the Japanese individuals, the importance of rice to the existence ways is additionally represented by practices such as rice planting.  The plantation of rice and its development is highly viewed as a symbol of the southeast and eastern parts of Asia where watering of the plants is achieved from rainfall.  In Japan, rice significantly stands out amidst all the focal culinary items in the state in regard to typical and pragmatic nature.  This paper will, therefore, seek to investigate nourishments well as locations into the association with the society of Japan and distinct strategies which are identified with nourishments that are shared by the use of rice as the main point of exchange premium.

            Introduction

In regard to food preparation and the general food consumption, Japan stands as the most passionate and enthusiastic nation in comparison to all other nations and race towards their cuisines (Bestor and Theodore, 2011).  If one happens to question a Japanese individual regarding any recent travel or trip that they were involved in, the answers will generally involve talks about their local meals.  This shows the fact that for the Japanese even a travel beyond their home is mainly motivated by foods.  Food is therefore highly valued in Japan as the individuals adore their cuisines. Food to the Japanese is a form of cultural practice that is beyond just consumption.  For this rationale, most of the towns, cities, as well as restaurants in Japan, are well appreciated and they are ranked at the foremost positions for their domestic specialty whether it is a kind of fish, sweet, sewed, noodle or even tofu. This is crucial in illustrating the food passion in Japan when one can switch on the radio or television at any moment and hold the assurance of catching a food show directly (Bestor and Theodore, 2011). In Japan, careful meticulous and preparation are important Japanese cuisines elements. In Japan, food is termed as a form of art where even the most simple dishes are mainly prepared by individuals who are well trained and holds long-term working experience in food preparation. Rice food in the Japanese culture remains as the major source of nourishment despite the transformation of lifestyle.

            In Japan, rice was at one time traded as a currency in the state. Ice has remained as a staple food in the nation for more than two thousand years. Additionally, rice forms the basis and still accompanies other meals in the nation even in the current existence in Japan.  The Japanese individuals are reminded of the fact that harvesting rice is a form of intensive labor. This shows that they value rice as a nation as it is their basic meal in all years (Bestor and Theodore, 2011).  This is the major reason as to why rice is not wasted in Japan and the remains of rice which are the leftovers are utilized in good ways.  In exemption of sushi other popular foods in Japan include Onigiri which are rice small parcels that are covered in a seaweed that is dried, Donburi which involves meat, simmered meat or vegetables that are served together with rice, rice porridge which is known as Kayu, rice cakes that are pounded known as mocha, rice that is cooked with tea that is green known as Chazuke in the mention of only a few meals.  All these meals have something in common which is rice. This, therefore, supports the fact that rice in japan forms the nourishment basis as it is a kind of cultural practice.  The acknowledgment runs to the various regional expertises of Japanese means that are referred as Meibutsu (Bestor and Theodore, 2011). With their presence, the restaurant shortage in Japan does not even exist as most restaurants are comfortably dedicated to serving local cuisines.

The significance of rice in the state of Japan cannot be evaluated and emphasized adequately. This is mainly because rice is the kind of stable food for the Japanese individuals.  As the stable and nourishment source rice is the traditional spirit source as it is used in the offering sake to their gods as well as the forefathers. Rice, therefore, acts as a form of the cultural element as it connects individuals with the living dead as well as the gods (Bestor and Theodore, 2011). It can thus be termed as a form of cultural practice as it offers both physical and spiritual strength. There is a famous saying that holds that the Japanese individuals can be termed as a rice bowl which is characterized by homogeneity, uniformity as well as their ever growing desire to always stick to one another.  In those old days primarily white rice was preserved and only eaten by individuals who were living in towns and cities.  Japan militarization however exposed conscripts before the occurrence of the world war two from the rural areas to the consumption of white rice which was well appreciated.  However, the white rice shift resulted in the deficiencies of vitamins because the rice is normally polished and is usually free from nutrition.

To the Japanese, the meaning of rice cannot be described with mere love because they believe that it holds more than just love.  This is supported by the fact that they believe that those that farms rice are hardworking individuals who utilize much of their energy in the production and therefore wasting should not be witnessed.  Rice in Japan forms the basis of their social structure and civilization (Bestor and Theodore, 2011). The consumption of rice in Japan rates with more than nine million tons as about more than three quarter individuals in the state consumes rice for lunch, dinner and breakfast. A day that has not involved the cooking of rice cannot be called a day by the Japanese people. In the recent world due to the emergence of different cuisines rice is being consumed in fewer amounts as compared to before. This is mainly because it is normally served with other meals. The rice consumption decrease has thus been motivated by the higher generation of income, a much wider foods kind’s availability and the emerging of fast foods.  Currently, rice consumption as partly is replaced with noodles and bread. Additionally, due to health knowledge increase in diabetes most individuals have substituted rice to other meals.  According to a recent study, a woman who consumes three or even more bowls of rice every day increases the probability of diabetes development by 50% (Bestor and Theodore, 2011).

            Rice significance in Japan is excellent as rice has thus established the Japan society’s embodiment. The evaluation of the food culture in Japan unveils puzzled association that is held by rice which takes major parts of the Japanese expressions as well as social structures based on contemporary and verifiable setting (Hendry, 2008).  This, therefore, sets a conclusion that all the sections of the Japanese conduct begin with the development of rice.  These activities cannot be achieved solemnly without the cooperation of the society.

With this fact family and individual’s worked with togetherness in watering the development.  Since the development of rice was done in almost similar period’s individual were thus forced to work and relies on the efforts of one another. Cultural language in Japan provides important values as well as concepts which are additionally true within the culture of Japan.  The lead of rice as a staple diet is well illustrated within the language of the Japanese nation.  This is depicted with words such as Gohan which is used in reference to cooked rice as well as in regard to a general meal (Hendry, 2008).  The term Gohan utilization within the Japanese language helps in generation of distinct terms which suggests to meals in languages that are comprehensive (Hendry, 2008).

This is thus crucial in portraying a clear demonstration of the challenge experienced by the Japanese individuals as they had to hold the goal at the end of involving a feast without the involvement of rice. In general, rice holds numerous links to distinct sections of the great society of the Japanese for example the sovereign happening before the occurrence of schedule head into a lord’s minister in the history of Japan (Hendry, 2008). Under the religion of Shinto, a heavy part of his growing and famous religion moved around rice items as well as the development of rice like rice cakes as well as rice wines.

            Shifting intersection, as well as separation with distinct societies, has influenced the way of living for the Japanese based on examinations.  Segregation influenced the aggregate self-individuality fortification towards the fact that the presence of impact in the consideration of everything. Between the juncture times with china in 18th AD and in 19th AD westerns incomes the strengthening of identity as especially rice was used as an element of viewing the character.  The excellence state of rice remained high despite the more in which it lost it financial qualities during those periods. Rice s kept as cash by Ohnuki-Tierney as well as virtue fortification via selectiveness. The utilization of rice as a form of trade was crucial in signifying its unimportance to others well it strengthened its connection with the Japanese nation.  To the Japanese, they show the help that was being brought by the rice rather than being just an element of the state as viewed by the rest (Ohnuki-Tierney and Emiko, 1993).

Rice is basically a food that holds different and recorded and social qualities that are merged deeply into the Japanese colossal society and the current pattern of the Japan history.  This, therefore, shows that Japan cannot be termed as a nation whose prior involvements utilized more than 90% of the entire population in the product of rice (Ohnuki-Tierney and Emiko, 1993).  Several measurements which entail family portions rice use also shows that there is a decrease of rice utilization per every family in Japan.  Rice has continuously remained dominant as period’s moves by in the present life.

Based on deals figures it is thus clear that the rice stores still outstands the bread stores as most individuals tend to rise towards rice consumption in comparison to bread.  Between the periods of post, wars rice was dominantly linked to problems of the government and thus provoked a state force that is abnormal.  The ranchers of rice have used the energy of voting to illustrate dismay over the decreases in appropriations in value as well as the transformations proposed in the import of rice. In the state of Japan rice is still a product that is controlled with direction administration through area measure (Ohnuki-Tierney and Emiko, 1993).

            Japan today is the biggest consumer of rural items as well as imports which end to a combined of about thirty billion.  Japan is slightly worried in regard to food reliance in around fifty-three percent of the caloric admission Japanese that is generated from food stuff that is imported. Basically, in Japan rice serves as a cognitive if not actual Japanese staple eating procedure. Rice offers enough in its own development which holds a passion that is critical as well as implications of distinct materials (Ohnuki-Tierney and Emiko, 1993). An additional element that is imperative is the impact of the Japanese main residence which primarily involves a link to an individual’s familial rice which had been formed.  Recent surveys show that actual sympathy towards the lessening number of Japan’s rice ranchers (Ohnuki-Tierney and Emiko, 1993).

From the prior mentioning rice assessment and estimation in the connection of Japanese contemporary is a challenge one (Hendry, 2008).  The impacts of liberation on the rice market turn out to be mutually changing some to evaluate.  The consumers in Japan tend to be trustful and loyal towards their grain and have the tendency of lining in the direction of the stick scraps of rice. This is mainly because their major objective is to ensure that the grains suit their sushi making requests and additional Japanese cooking options.  Japan is currently in the procedure of encountering external weight from multilateral plans but the quality of their grains seems as a sacred thing (Hendry, 2008).

In summary, in consideration of food analysis in Japan, which is nourishments in Japan rice, has emerged to be a major character. Rice holds a personality segment which comprises of thoughts that are self-sustained. Through the general food history in Japan, rice has emerged to be of less financial importance lately.  With the above mentioning, it is thus clear that although rice held a great significance in the history of Japan it still holds great potential and importance in the current Japanese times with slight changes due to lifestyle changes.  Rice is dearly held by the Japanese culture as a cultural practice as well as their way of showing togetherness strength. To the Japanese rice is the major source of strength. The significance of rice as well as the manner in which the Japanese values rice cannot be underrated. Noodles and bread consumption may be on the rise but this may not imply that rice consumption will drop gradually.  This is mainly because rice in the Japanese society is a form of custom practice that cannot be ignored.

            References

Bestor, Theodore C. 2011. “Cuisine and Identity in Contemporary ,” in Victoria Lyon Bestor and Theodore C. Bestor with Akiko Yamagata (eds.), Routledge Handbook of ese Culture and Society, NY: Routledge, pp. 273-85. [posted to Blackboard]

Hendry, Joy. 2008.  Sharing Our Worlds: An Introduction to Cultural and Social   Anthropology.  2nd edition. NY: New York University Press. [E.g., have a look             in her index under “food” to find ideas relevant to your paper; Hendry, after all, is an expert on .]

Ohnuki-Tierney, Emiko. 1993.  Rice as Self: ese Identities Through Time.  Princeton, NJ: Princeton  Univ. Press.

Health Care Nursing

I find the Risk-Factor theory to be the most effective and helpful. The risk factors of a family can be incidental from the lifestyle factors, the environmental factors, spiritual and cultural dimension, social psychological and the biological factors together with the health care system (Edelman, Mandle &  Kudzma, 2014). Patients from all walks of life have distinguishing features as some of them appear to tougher than the others as they are subjected to a lifestyle that makes them have a different story to tell. When assessing a patient I usually find out that there are various reasons for their behaviors that assist me in understanding the patient and establishing a powerful bond with them. Nurses always encounter a number of patients in their line of duty whereby these patients are of different personality (Edelman, Mandle &  Kudzma, 2014). The environment around us has a lot to do due to the fact that patients have different health discrepancies due to how they are raised. For instance, a person raised in a radius of a radiation plant they have high chances of incurring cancer.

The risk factor theory is more appealing as it is more diverse in family nursing as it is able to provide primary health care to all patients through a better understanding of the patient’s background of all ages.  It entails the identification of the health problem and the risk factor that revolves around it that help in developing of various interventions that address the health concerns in a better way and implement them to improve the health of an individual and the family at large (Edelman,  Mandle &  Kudzma, 2014). The theory identifies how the nurses’ works with the patients throughout their whole life cycle that help them foster a strong relationship between the patient and the health care providers.

Reference

Edelman, C.,  Mandle, C. L., &  Kudzma, E. C. (2014). Health promotion throughout the life span. St. Louis, Missouri : Elsevier

Healthcare Management

            Virtua organization is primarily a nonprofit generation organization for healthcare system USA New Jersey which operates a series of hospitals, physical practices, surgery centers, fitness centers and so more that regard to healthcare (Vitua, 2016).  The hospital branches for Virtua Health Centre are situated in mount holly, Marlton, Berlin as well as Voorhees.  In South Jersey, virtua hospital is the largest healthcare provider which is associated with quality and affordable healthcare services.  The major headquarter of virtua hospital is situated on the campus of Marlton. The organization interests me because despite it being a nonprofit generation company it provides primary as well as secondary healthcare services.  The hospitals cater for both in patients and out patients   that providing an expended range of medical services to the New Jersey communities. In addition, the operations of the organization are interesting because its major philosophy is centered on the well-being of the patients.  This, therefore, makes the organization a patient-centered corporation which is essential in illustrating its social responsibility nature (Vitua, 2016).  The corporation’s philosophy is also focused on the employees as the organization recognizes their contributions and importance towards achieving its goals.

The organization began in 1885 in New Jersey as the West jersey healthcare in Camden location. The organization was involved in a merger with alliance memorial health in 19998 which created virtua healthcare as the largest provider of healthcare in south jersey.  Richard miller who is the present CEO and present of the organization was involved in leading the merger. He instituted the concepts and the currently utilized values by the organization (Vitua, 2016).  In addition, he also led the adoption of their business strategy known as Six Sigma. This made Virtua Health as one of the initial healthcare structures to utilize this strategy as its main technique for solving issues.  Virtue’s stated philosophy is aimed at providing the best experience to its patients via its own developed star initiative.  Through this initiative, the organization tries to exercise healthcare that is quality as well as medical services that are outstanding (Vitua, 2016).

Star initiative was launched in the year 20 two years after virtua health and provide the employees of the organization conception. The purpose that was behind the star Initiative was to generate and provide its employees with a stable framework in order to carry out the philosophy of the corporation (Vitua, 2016).  The philosophy holds that the company is responsible for the provision of outstanding healthcare experience to its patients. The philosophy is supported by five ideas as each of the ideas is represented by a single star (Vitua, 2016). The five elements of the philosophy include caring culture, excellent services, best individual, highest clinical safety and quality as well as resource stewardship (Vitua, 2016).

The hospital branches are divided based on different roles which make their services more advanced and characterized with quality. The use of the differentiation strategy is effective in ensuring that the corporation’s objectives are achieved efficiently.  For example, the Camden healthcare center provides outpatient services and through these services the patients have the opportunity to access other services like podiatry, dentistry, cardiology, wound care and others (Vitua, 2016). This, therefore, acts as a healthcare emergency center where the corporation permits the patients to visit them as soon as they are experiencing any medical issues. However, since the institution is not a general hospital complex   attention patients are transported to a different facility of the same organization for care. The hospital is also well known for expertise surgery services, rehabilitations as well as physical practices.  The operations of the organization are thus based on a wide range of services which helps in serving the patients better.   The corporation employees highly experienced and specialized profession as they believe in safe and quality care for everyone.

Virtua hospital is a multiple-care system for healthcare services where driven and talented professionals are responsible for delivering the highest and quality care to all the patients. The virtual healthcare organization experience stands as Virtua’s journey to becoming the leading healthcare in loyalty as well as customer satisfaction.  The company’s mission that virtua is involved in helping individuals to get well when they need the medical attention, get well as soon as they receive the services as well as staying well after the treatment (Vitua, 2016).  The organization’s mission is crucial in showing the concern of the organization at depth as it is based on providing quality health and ensuring that the good-being of individuals is observed at all times. The corporation’s vision stands as virtua being the premier option in wellness and in health (Vitua, 2016).  This has thus been effective in illustrating the company’s direction for both short and long term goals.  Virtua’s credo is providing genuine as well as caring healthcare services all the time (Vitua, 2016). The corporation believes that each interaction is a chance of building better relationships as well as loyalty via anticipating needs, listening, engagement as well as collaboration.  This is facilitated by the five stars intuitive which provide direction and guidance for the corporation. Through this, a well developed working structure helps the employees is delivering quality healthcare experience to the patients.

Virtual main physicians act as healthcare coaches by listening to the needs of the patients and their concern and helping them in developing the best decisions in regard to healthcare.  Virtua care ensures that their patients are able to access to ranges of specialists as well as services. This, therefore, involves the provision of educational programs with management topics as well as the best management options.  With healthcare access at the hospitals, the physicians ensure that the progress and lifestyle changes are observed regularly (Mervio, 2013).

The employees are opted for based on their qualifications and not based any form of discrimination. The company structure is a flat structure. In this form of structure there is one individual at the top and everyone is expected to report directly to them.  This form of structure ensures that there is developed communication, improved staff organization, low costs of operation, simple decision making and well-defined functions for every organization (Mervio, 2013).  However in virtua there are different managers where the staff’s reports to as the management form is the matrix management structure (Friedman, Savage, & Goes, 2012).

Virtua health is additional effective in medical care provision due to the utilization of technological advances in its treatment.  In 2004 the organization announced its alliance with medical imaging global provider known as GE healthcare. The alliance was purposed at ensuring that virtua health provides medical imaging, and information technology healthcare services. The alliance helped in providing Virtua with fresh technologies and equipment which are essential for diagnoses process as well as treatment.  The stated purpose of GE is that via the sample provided by Virtua their fresh technologies and designs will adequately set healthcare industry benchmark. The organization additional announced its developed partnership with the children hospital that is located in Philadelphia which is aimed at providing pediatric services to all the facilities of Virtua in Voorhees and Mount holly. The employed physicians at the children’s hospital according to the partnership are responsible for providing inpatients pediatric services at virtua facility, intensive care for pediatrics as well as pediatric emergency services provision.  The corporation is well equipped with resources that are generated through merging as well as partnership which helps in ensuring that the organization attains its social responsibility of providing healthcare services (Friedman, Savage, & Goes, 2012). 

            In conclusion, my opinion is that Virtua healthcare organization is effective.  This is because healthcare should be based on general care as well as the improvement of health services which should be emphasized.  The organization observes the following major process that is crucial in the provision of quality and safe healthcare.  This includes the ability to detect health issues, maintain healthy, diagnosing illnesses, treating the diagnosed illness and the provision of good end of existence. In this processes the patient should always be viewed as a value co-creator and the processes improvement.  The organization is effective due to its general willingness to provide safe and quality care. This is accomplished through the employment of specialists in all the hospital locations.  The professionals help in ensuring that the concerns of the patients are observed through the provision of better treatment. In addition the specialists are additionally responsible for ensuring that illnesses are diagnosed and treated accordingly.  The health of patients is the major concern of the organization in general as it aims at ensuring that the fitness of individuals is maintained.  With the provision of adequate services and a favorable working condition and relationships between the patient and the physicians the capability of achieving the organization vision is boosted.

References

            Friedman, L. H., Savage, G. T., & Goes, J. (2012). Annual review of health care management: Strategy and policy perspectives on reforming health systems. Bingley, U.K: Emerald.

Mervio, M. M. (2013). Healthcare management and economics: Perspectives on public and private administration. Hershey, Pa: IGI Global (701 E. Chocolate Avenue, Hershey, Pennsylvania, 17033, USA.

Vitua. (2016). Virtua Careers. Retrieved From https://www.virtua.org/about/careers

Vitua. (2016). Virtua Voorhees Hospital. Retrieved from https://www.virtua.org/locations/voorhees-hospital

            Vitua. (2016). Virtual Memorial Hospital. Retrieved from https://www.virtua.org/locations/memorial-hospital

Vitua. (2016). Virtua Health for Life.  Retrieved from https://www.virtua.org/

Leadership at Advocate Good Samaritan Hospital

Q1.

He believed in the aspect of continuous improvement and this made him be a role model to others in the company as he encouraged them to continue improving their operations. He made crucial decisions on behalf of the company which led the company into doing great. He encouraged unity among the employees and the management which enabled the team to work in unison thus providing quality services.

Q2.

 Kearn’s approach is broadly applicable in almost all sectors in the organization. Though there are so many competitors in the market, Kearn believes that if all the employees in the company continued to work together. According to his approach, there is no end to the provision of quality products and services. Hence there is room for more and more improvement and hence all stakeholders should work towards continually improving all their operations. Therefore the approach is quite applicable in all settings of the organization. With the use of this approach, the company is likely to be competent in the increased competition and the high expectations from the customers (Evans 2014).

Q3.

Kearn’s allowed the senior managers to be taking the calls of the customers with problems. This was a nice practice to start with as it enhanced customers to be satisfied. Most of the customers have a belief that their problems can only be solved by the senior managers in any company. Hence the implementation of this practice in the company allowed the customer's cases to be solved more efficiently as the senior managers are able to talk to the customers apologizing for the mistakes and offering to rectify the problem for the customers (Evans 2014).

Part B

Q1.

Leaders have the knowledge of the patients’ requirement thus they are in a position to ensure that the customers’ needs are met. They have an organized way of managing the operations within the hospital (Evans 2014).

Q2.

The leadership appears to be more transformational as they use strategies and styles that focus more on team-building, the motivation of workers and collaboration of laborers at different levels in the organization.

Q3.

References

Evans, J. R. (2014). Quality and performance excellence: Management, organization, and strategy. Mason, OH: South-Western/Cengage Learning.

Ventilator Associated pneumonia

 Pneumonia is known to be the second nosocomial disease in U.S.A the first one being Urinary Tract Infection. VAP is a pathologic condition and it has been noted that it is increasing the cost of care as it increases the length of stay.  VAP is a serious infection and a life threatening disease at it increases the mortality in a higher rate.  A high clinical knowledge is needed to examine the patients who develop VAP as well as factor which leads to VAP (Saravu et al, 2013, p. 337).  VAP is brought by pathogenic microorganism which enters in the lower respiratory track and weakens the immune response. People who are infected develop some typical symptoms such as unable to communicate, hypoxemia and fever. A diagnosis is made through clinical sign, radiograph and laboratory test.  For examples, patient with VAP have a high temperature than normal or lower temperature than normal.    White blood cells go beyond or below the normal kevel and some patients develop respirtaoiry distress among other symptoms (Saravu et al, 2013, p.337).  VAP increases the risk of death as it causes neurologic disease and contributes to factors which cause modifiable risk.   A comprehensive research on VAP has been done and there are preventions for reducing the resistance bacteria and infection.  To have an effective control, it is advisable to wash hands properly, use sterile   techniques while conducting invasive procedures and separate the patients whom have resistance organisms.  There are treatments for VAP which includes the   ciprofloxacin, gentamicin and other antibiotics which match with the causative bacteria (Saravu et al, 2013, p.338).

That leads to the PICOT question;   to those patients who develop VAT while they are admitted in ICU,

1. Factors which lead to VAP in patients who are admitted in ICU and how the factors impact the disease.
2. How long does the patient stay in ICU to recover from VAP or does VPA lead to death.

References

Saravu, Kavitha, V. Preethi, Rishikesh Kumar, Vasudev Guddattu, Ananthakrishna Barkur Shastry, and Chiranjay Mukhopadhyay. 2013. "Determinants of ventilator associated pneumonia and its impact on prognosis: A tertiary care experience." Indian Journal Of Critical Care Medicine 17, no. 6: 337-342. Academic Search Premier, EBSCOhost (accessed August 14, 2016).

            Public Perceptions of Pharmacists and Pharmacy Services

            Abstract

            Background: One of the essential and ultimate aspects that will help in pharmacy advancement in the nation in the future as well as in the current living is a concise public understanding which is also represented as consumer satisfaction.  This systematic review is therefore purposed for the exploration of satisfaction and perception of patients and the public with services and functions that are provided by pharmacies and pharmacists.

Objectives: The primary goal of the systematic review is to investigate and examine the notions, viewpoints, perspectives, and beliefs of the public concerning pharmacy as a field and pharmacists as having medical roles

            Methods: All relevant articles examining and identified published from January 2000 until December 2015 were searched using various search engine, bibliography searches and authors’ libraries. Studies were included if they: 1) quantitative and qualitative primary research papers, 2) any papers looking at the public perception of pharmacy or pharmacists or pharmacy services.

Results and Discussion: Forty percent (10 out of 25) of studies conducted in developed countries while sixty percent (15 out of 25) of studies conducted in developing countries. In both developed and developing countries, 60% (15 out of 25) of studies demonstrated the satisfaction of public perception towered pharmacists’ activities and pharmaceutical services while 40% (10 out of 25) of studies illustrated the dissatisfied of public expectation overlooked pharmacists’ role and pharmacy services. The satisfaction of public perception towered  pharmacists’ role and pharmaceutical services in developed countries was 40% (4 out of 10) of studies while 73% (11 out of 15) of studies in developing revealed the public fulfilled.

Conclusion:

Based on the review’s results majority of individuals held a perception that was positive in regard to pharmacist’s services as well as positive results at professional pharmacists.  This therefore generates a good suggestion on that there is a great requirement to provide training to the public about the functions, their responsibilities and the services that they offer.  This will therefore help in developing the relationship between pharmacists and the patients thus developing the role of the pharmacist’s thus enhancing patient’s fulfillments.

Word count 315

• INTRODUCTION

            Health and life disciplines are a precarious area, mostly given its connection with the daily lives of people. In that line, Pharmacists have been much about connecting with the individuals in matters relating to their well-being. In a more general perspective, the role of the pharmacists is the role of being as health enhancers. However, the use of pharmaceutical services has been on the rise in the last few decades. The shift experienced has been from a typical view of a pharmacist being mere medication vender to a position where the public now a visions them as doctors. Revisiting the case of the changes of roles in the pharmaceutical environment, it is clear that the public perceives their services in a different point of view.

            The pharmacy services in most cases are the diagnosis of treatment, administration of care and disease prevention. Revisiting the case of the changes of roles in the pharmaceutical environment, it is clear that the public perceives their services in a different point of view. The National Health Service (NHS) England currently has a strategy, the Five Year Forward View, of improving the state of the pharmacy services in the case of pharmacists oversupply, shortage of general practitioners and improved cost effectiveness formulated that much cause of action had to be undertaken in line with better health care service provision. In line with studying the experience of patients and their perceptions towards the pharmacy services, it is critical to conduct an intensive review using the baseline data. Then baseline data should give the experiences of people, attitude, and expectation before the implementation of the NHS strategy and later check the differences arising there from the implementation of the plan ("The National Health Service Five Year Forward View ", 2014).

Guirguis et al., (2005) postulates that further studies support the increasing involvement of pharmacists in the broader healthcare setting will demand transitions in behaviour by pharmacists and the general public as a whole. Other researchers continue to show and support that attitudes, beliefs and views made a dominant part of practice as postulated by Jose et al., (2015).  In that case, there was a need to look at the attitudes of consumers on the healthcare setting mostly pharmacists and pharmacy in addressing persons medical needs.

1. Objectives

The main objective of the review was to scrutinize and observe the ideas, viewpoints, perspectives, and beliefs of the public concerning pharmacy as a field and pharmacists as having medical roles. This systematic review identified that consumers and the pharmacists do have significant roles and specific responsibilities in their relationship, also depicted as a patient pharmacist professional relationship. It is at this point that the satisfaction of the consumer has been an essential component healthcare service. Sightseeing the public awareness helps both in decision making among the pharmacists and pharmacy services as well as assists in improving the patient’s pharmacologist’s relationship. This will therefore ensure that a direct relationship is developed among the patients and pharmacists services and roles. It is important to develop adequate understanding of the perception held by the public in regard to pharmacists and their roles.  With this reason the systematic review is highly necessary because it is a section that not only provides investigations insights but also detailed analysis which will help in developing healthcare experience.

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2. Methods

            A systematic evaluation of the existing research evidence will discourse the question ‘What are the public perceptions of pharmacy, pharmacists and pharmacy services?’ through the utilization of a descriptive examination method. Three electronic databases used in this review MEDLINE (PubMed), Scopus and the Cochrane Library. They identified all relevant articles published in English from January 2000 until December 2015. Furthermore, the search engine Google Scholar, which provides a broad search of academic articles from sources including theses, books and abstracts used to identify the papers published online that are not identified by the databases. In addition, a hand-search done using the bibliographies of the articles found from the electronic database searches. Also as part of the methods, there were two techniques in selection and extraction studies used to assess all articles that were found then applied the Critical Appraisal Skills Program (CASP) tools to examine the quality appraisal for the studies included in this review.

2.1.   SEARCH STRATEGY

The following combination of search terms used in the search strategy with each database: (“public” OR “consumers” OR “patients” OR “clients” OR “customers” OR “users”) AND (“perception” OR “belief” OR “attitude” OR “view” OR “satisfaction” OR “expectation” OR “opinion”) AND (“pharmacy” OR “pharmacist” OR “pharmaceutical service”) AND (“pharmacist” OR “pharmacists”) AND (“hospital” OR “community).

2.2.   Inclusion Criteria

            The inclusion criteria for this review are: 1) quantitative and qualitative primary research papers, 2) any papers looking at the public perception of pharmacy or pharmacists or pharmacy services, 3) papers written in the English language, 4) full text available, 5) papers related to studies in humans aged 19 and above.

2.3.   Study Selection and Data Extraction

There are two different techniques used to examine the articles that were found. First, the author identified, screened articles that retrieved from searching database, and scanning the title and abstract: The titles and abstracts screened against the inclusion criteria. Studies excluded based on titles, abstracts and removal of duplicates that did not related to the public perception of pharmacists and pharmacy services. Second, reading and assessing the full text articles if the abstract provide insufficient details then potential relevant papers identified and screened for eligibility. Studies excluded based on full text screening and that did not related to the public perception of pharmacists and pharmacy services. Finally, the number of articles used and include in the systematic review was 25 articles in total (figure 1).

Figure 1: Study selection process.

2.4.   Assessing Quality

To assess the quality of selected articles in this review, papers screened against the appropriate Critical Appraisal Skills Program (CASP) checklist and tools that have been validated, to ensure that studies are assessed and critically appraised in a standardized way. Relevant studies included in the review and analysed to form conclusions on the cumulated results. There were 10 studies in developed countries assessed and critically appraised based on Critical Appraisal Skills Programme (figure 2) while 15 studies in developing countries assessed and critically appraised based on CASP tools (figure 3). The Consolidated Standards of Reporting Trials (CONSORT) is a method of assuring proper reporting of Randomised Controlled Trials (RCTs). However, the CASP tools used for assessing the quality of selected articles because it assess the quality of various type of studies such as RCTs, qualitative and quantitative, so the CASP consider as a comprehensive quality appraisal tools for this review.

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Figure 2: Quality appraisal of 10 studies in developed countries based on Critical Appraisal Skills Programme (CASP).

Y= “Yes available” ; N= “Not available” ; V= “Valuable” ; NV= “Not valuable

Figure 3: Quality appraisal of 15 studies in developing countries based on Critical Appraisal Skills Programme (CASP).

Y= “Yes available” ; N= “Not available” ; V= “Valuable” ; NV= “Not valuable”

3. Result

            The results of the systematic review about Public perception of pharmacists and pharmacy services are developed through quantitative and qualitative research methods in both developed and developing countries. There were a total of twenty five studies met the inclusion criteria with a pharmacists’ role and pharmacy services outcome measure that was reported as final outcome. There were a total of 37 studies which evaluate the pharmacists’ role and pharmacy services and met the design criterion; however, 12 articles that equivalent (35%) of these did not report any public perception of pharmacists’ role and pharmacy services thus were not included in the review (figure 1). The outcomes of the research on the attitude of the public on pharmacy attendants and pharmaceutical service in developed and developing counties are obtained through structured, semi-structured or across sectional study techniques.  Forty percent (10 out of 25) of studies conducted in developed countries while sixty percent (15 out of 25) of studies conducted in developing countries.

3.1.   Study Design

            In the study design of the twenty five studies, 32% (8 out of 25) of studies used to derive the outcomes through qualitative approach while 68 % (17 out of 25) of studies used to derive the outcomes through quantitative approach. In developed countries, the study design used to derive the outcomes was through 50% (5 out of 10) of studies quantitative approach, 40% (4 out of 10) of studies qualitative approach and 10% (1 out of 10) of studies mixed method (quantitative and qualitative). In the developing countries, the study design used to derive the outcomes was through eighty percent (12 out of 15) of studies quantitative and twenty percent (3 out of 15) of studies qualitative approach (figure 4).

3.2.   Study Aim

In the study aim of the twenty five studies, six studies (24%) assess pharmacists’ role and pharmaceutical services, eight studies (32%) evaluate pharmaceutical services as health care provider and eleven studies (44%) evaluate pharmacists as having medical roles. According to the study aim used to assessing pharmacy services and pharmacists’ role, there were 40% (4 out of 10) of studies conducted in developed countries while 13% (2 out of 15) of studies in developing countries (figure 4).

3.3.   Public Satisfaction

            Table 1 illustrate the twenty five studies used in the systematic review. The outcome expressed based on the satisfaction, expectation and perception of the customers and patient towered pharmacists’ role and pharmacy services in developed and developing countries. In both developed and developing countries, 60% (15 out of 25) of studies demonstrated the satisfaction of public perception towered pharmacists’ activities and pharmaceutical services while 40% (10 out of 25) of studies illustrated the dissatisfied of public expectation overlooked pharmacists’ role and pharmacy services. However, the fulfilment of public expectation towered  pharmacists’ role and pharmacy services in developed countries was 40% (4 out of 10)  of studies while 73% (11 out of 15) of studies in developing showed the public fulfilled. On the other hand, the dissatisfaction of public perception overlooked  pharmacists’ role and pharmaceutical services in developed countries was 60% (6 out of 10)  of studies whereas 27% (4 out of 15) of studies in developing revealed the public dissatisfied (figure 4).

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Figure 4: study design, aim and finding of 25 studies included in the systematic review

Table 1: Summarize of 25 studies for developed and developing countries in the systematic review

4. Discussion

            The level of relevance attached to pharmacy and pharmacists seems unexpectedly not in tandem with the global acceptance and usage of health services when an evaluation is made to determine the perception people in developed and developing nations have regarding pharmacists’ role and pharmacy services. A key objectives of this paper are to help improving the pharmacists’ role and pharmacy services, the patients-pharmacists relationship, and the overall healthcare systems. The question is what are the public perceptions of pharmacy, pharmacists and pharmacy services?

In the developed countries the percentages of qualitative and quantitative studies were almost equal.  They assessed public perception by statistical and psychological methods to cover their whole perception. However, 80% of the studies were quantitative and 20% qualitative in terms of the developing countries. This shows a need of improvement for the qualitative methods in developing countries because the qualitative technique gives emphasis on the issues and subjects covered can be evaluated in depth and in detail. In addition, the data in qualitative approach depends on human experience and this is more compelling and powerful than the data collected through only a quantitative technique. There is a possibility that the quantitative methods are higher in developing countries due to illiteracy and the rapid rhythm of life for the population (Al-Arifi, 2012). Moreover, the population in these countries do not value the technique of qualitative and psychological method, so if they were to have more qualitative studies then we can assess this percentage of satisfaction carefully.

In the developed countries 40% of studies assessed both pharmacists’ roles and pharmacy services while only 13% assessed the pharmacists’ activities and pharmaceutical services in the developing countries. This shows a lack of studies that evaluate both pharmacists’ roles and pharmacy services together in developing countries which means a lot of studies needs to be done to measure the public perception precisely. For instance, in Saudi Arabia there are four studies conducted to assess the public perception towered pharmacist and pharmacy services. 3 out of 4 evaluate pharmacists’ role while only one study assess the pharmacy services. Two-third studies that assessing the pharmacists’ activity showed the satisfaction of public perception while the studied evaluate pharmacy services revealed the unfulfilled of consumers perception (Al-Arifi, 2012; Al-Hassan, 2009; Alotaibi & Abdelkarim, 2015; Bawazir, 2004). This is verify the importance of doing both pharmacists’ roles and pharmacy services together when evaluate the public perception in developing countries.

In the developed countries, the satisfaction of public perception was low (40%) while 60% of public in developed countries were not satisfied. It is important to understand that some developed countries may have proper health care system but may have lack proper channels to administer the services (Latif, Boardman, & Pollock, 2013; Saramunee et al., 2015). For example, United Kingdom has very advanced medicine field but one of the setback arising is shortage of general practitioners which translates into poor services. Also, public know what the pharmacists’ role and responsibility should offer and the pharmacy services that should be delivered. This kind of limitation in services and high level of public education creates a negative perception of the people towards the health care system in general and pharmacists’ role and pharmacies’ services in specific (Latif et al., 2013). Therefore, it is important to improve the patients-pharmacists relationship, and develop community pharmacists as primary care practitioners.

In the developing countries, the satisfaction levels were high (73%) due to the pharmacists did not only give the base features of a “vendor” by giving dosage only, but they go an upper hand by formulating a positive interaction with the patients. Interaction created leads to the build-up of the new opinions which in the long run is crucial in promoting the quality of the service provision. These goes further and create a positive perception of the consumers to their facilities, so the public in this case were not know exactly what the pharmacists’ role and the services they should offer (Al-Arifi, 2012; Jin et al., 2014). Therefore, no wonder in developing countries the satisfaction derived from the pharmacies’ use and services provided goes to an extent of (73%) acceptability, so there is need to educate the public about the role of pharmacists in health care systems and the services that should be delivered. On the other hand, (27%) of public in developing countries were unfulfilled. This is because some studies indicated that pharmacists have had a history of confidentiality problems when handling health information from the public (Al-Hassan, 2009; Bawazir, 2004). In addition, some developing countries, for example Moldova, has number of pharmacists very small, so this inhibits their operation and limit number of people can access their services (Bezverhni, 2010). This can be solved by increasing the number of pharmacists to a suitable ration with the statistical figure of the people and develop consultation area with more confidential and high privacy to patient.

4.1.   Strength and Limitation

            The main strength of this systematic review is the first review conducted in field of public perception of pharmacists and pharmacy services nationwide. However, the differentiation from country to others in health care system, education level of resident, public culture and status of life may consider as limitation.

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5. Conclusion

            The systematic review demonstrates public perception on pharmacists and pharmacy services across the globe. It has reveals the majority of public had positives perception regarding the services offered to them by the pharmacists as well as perception towered their profession although suggests that steps and initiatives to improve clinical skills and social relationships. Satisfaction, on the other hand, comes to the act pharmacies embracing new actions which make the services better such as the counselling. When such proactive measures are integrated into the healthcare provision, there is a likelihood of consumer getting the highest level of satisfaction. The result of this improved satisfaction is translated into a positive perception towards the pharmaceutical services. Lastly, the case on the expectation as highlighted on the paper is connected with a factor of attitude. It is noted that educated persons in the society have the belief of being more cautious in matters concerning their health care and the level of services should received. Therefore, there is dire need for public awareness that seek to educate populations on different aspects of pharmacist roles and functions. The above analysis surmises the review creating insight and adding knowledge on public attitudes and perceptions of pharmacy as a medical practice. Steps must be taken to enhance the administration's gave, relationship kept up and in this manner enhance the fulfillment of clients. Using the three forms outline on matters of expectations, satisfactions, and expectation, then a realization is understood on how various opinions are reached upon leading to either creation of a positive or a negative perception. This type of research would provide a solid foundation for future research in professional or stockholder perception of pharmacists and pharmacy services.

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            Acknowledgement

            Following, an intensive research period, writing my note of thanks is the completing touch of my thesis. This has been an intense learning period for me both in the research arena and at an individual level. Writing this research has thus made a huge effect on me.  I would therefore, wish to mirror on the individuals who assisted and supported me throughout the whole period.

            First, I would wish to thank all my colleagues from school for their great and lovely collaboration. It would be an ungrateful act to assume thank you supported me because you had too. Your support is well appreciated and it was of great help to me as you were all willing to help me at all times. In particular I would wish  to single out my research professor and supervisor, I want to thank you so much for your reliable  cooperation, support and for the general opportunities that you provided for me to perform my research and also to further my research project.

            Additionally, I would wish to thank my tutors, for offering their valuable knowledge as well as guidance.  Definitely you were great to me because you provided me with the necessary tools which I mostly needed in selecting an accurate direction.  This gave me the power to complete my research thesis without worry as the knowledge and power of working everything out was well exposed.

            Moreover, I wish to thank my parents for their general wise support, counsel as well as the sympathetic ear that they always landed to me. I would not have made it without your support as this is all that I needed during this period.  Finally, I cannot be done without thanking my friends. We did not only offer deliberate support to each other over the issued that we shared as well as findings but we were additionally involved in happy talks in regard to general things in exemption of the papers which made a huge impact based on the generated happiness.

To everyone, I say thank you.

            Funding

            This research did not receive any particular funding grants from agencies in commercial, public or from the profit generating sectors.

Nursing leadership skills

Option 1

            Senior nurses are necessitated to engage in a variety of leadership activities throughout their daily work routines (Clark, 2009).   Some nurses are therefore bound to adopt effective styles of leadership while others will find the leadership concept to be challenging to understand.  Effective nursing leadership is essential in the delivery of quality healthcare, enhancing the safety of the patient and assisting the positive development of all the staffs. Leadership can be described as a process of establishing, motivation other individuals to act, provision of assistance and the motivation of achieving goals that are mutually negotiated (Clark, 2009).  At Walden, I expect to acquire coordination, planning, communication and operation and management skills.  This is mainly because as a nurse coordinating operations is essential in ensuring that the daily goals are well defined and that all the staffs are clearly aware of the things that they are expected to do this, therefore, requires a well-developed strategy to ensure that cooperation is achieved. This cannot be achieved without good skills of communication. I hope to achieve better communication skills so that my activities will be impacted positively. Good communication skills help in developing understanding thus ensuring that conflict is not developed.  Operations success solely depends on the effectiveness of communication in stating duty directions to the employees (Clark, 2009).  Nursing operations are characterized by complex situations which require creative skills.  At Walden, I expect that my skills in developing solutions when faced with challenging situations will be developed.  Since leadership and management are two distinct roles management skills would be crucial in ensuring that things are accomplished in the right way.

In order to be successful in my professional role, I am necessitated to hold expanded knowledge as well as skills.  Self-awareness is essential for an effective leader which must start with having a good look at self.  This, therefore, means the ability to understand emotions and how they may impact other individuals.  Time management is also essential in ensuring that all the responsibilities are met accordingly.  These skills will help in ensuring that my organizing, planning, scheduling and prioritizing abilities are developed (Rigolosi, 2013). This will additionally help in establishing the most important responsibilities as well as how and when they should be accomplished.   Social awareness and relation management skills are crucial in ensuring that I am fully able to motivate and inspire others in order to influence their behaviors. This is required from a leader in order to be able to develop the potential of staffs while managing initiatives, conflicts as well as emergencies.  A leader should be a diverse individual in order to develop a better relationship at the workplace and enhance effectiveness (Rigolosi, 2013). In future I will apply research expertise through assembling clinical data in order to advance nursing practices and develop the outcome of a patient in my work setting.

Leaders are individuals with equipped approaches, visions, plans and the desire to offer directions to their teams (Rigolosi, 2013).  It is, therefore, a necessity for a nurse leader to utilize problem-solving skills to ensure that work effectiveness is achieved. In my professional nursing practice, the major skills that are necessary include communication skills, strategic knowledge, creation skills and organization management skills. I must, therefore, apply these skills in order to become an effective leader so that I can win teams trust and respect in order to develop my clinical setting.  These skills will be essential in influencing others and also in ensuring that all the nursing professional standards are met which will help in permitting competent growth (Rigolosi, 2013).  The dynamic nature of a nurse helps to respond to the growing healthcare environment changes (Rigolosi, 2013).

            References

            Clark, C. C. (2009). Creative nursing leadership & management. Sudbury, Mass: Jones and Bartlett Publishers.

            Rigolosi, E. L. M. (2013). Management and leadership in nursing and health care: An experiential approach. New York: Springer.

An Overview of Breast Cancer

Introduction

Breast cancer still remains one of the major problems in public health, and regardless of contemporary efforts to avoid or prevent the cancer malady; the rate is increasing in several nations and is anticipated to go up further over the next 20 years. In most countries, there has been an increase in cases of women with elevated risk factors associated with breast cancer, and the increased rate is not even surprising.  The major breast cancer risks factors include late first pregnancy age, lower menarche age, fewer pregnancies, later menopause, and shorter or no  breastfeeding periods. Additionally, hormone replacement therapy (HRT), inactivity, obesity increase, and consumption of alcohol are the other possible risk factors which may possibly lead to breast cancer burden while the hereditary breast cancer impact is also on the rise. This paper provides an overview of breast cancer and how it is currently impacting public health today.

History and an overview Breast Cancer

Breast Cancer together with the uterus cancer and skin cancer were mentioned as early as before the fourth century which was during the Hippocratic writings. Despite having been studied for about twenty five centuries, breast cancer defied all those efforts and in fact went on to increase at around the middle of the 19^th century and to date its cause is still a mystery to most scientists with its frequency still increasing. With female breast being the femininity, fertility and beauty symbol of all times, it has however challenged physicians in disease since antiquity and when the knife was applied due to surgery’s rule of roost for cancer therapy, breast disfigurement was inevitable.

Thus, attempts by physicians to overcome it by destructing the cell or chemo-radiotherapy, cell receptors targeted therapy or bio modulation and physical removal or surgery and to understand the this cancer crafty nature which is hormone-responsive has become a complex maze which is the history of breast cancer. Finding the right tools that can enable this disease diagnosis early enough has also become an intense exploration saga. Over two millennia of surgery domination story and evolution from fatal choices to minimum damage has also been told including the narrative of the change to finesse from crudity due to chirurgical practice change on path biological breast cancer basis (Homer, 1966).

In addition, a surgical papyrus discovered by Edwin Smith that date back to 2,500 B.C has provided breast cancer accounts that are authentic and is attributed to the Egyptian physician-architect known as the Imhotep. According to Breasted (1984), if the disease was spread all over the breast, bulging and cool to touch the case was deemed incurable. The ancient Greeks also offered relief from breast maladies in order to exhort divinity according to evidences in Greek temples which was the dwelling place of the medicine god or Asclepius which was votive offerings shaped like breasts (Lyons & Petrucelli, 1978). Homer (1966) implies that the theory of Hippocrates in 400 B.C on blood, phlegm, and yellow and black bile or humours imbalance and the breast cancer classic descriptions progressive stages represent the early suppositions on cancer causes.

Moreover, in preserving the Greek traditions in the 1^st century A.D, Leonides of Alexandria skilfully and boldly detailed his approach of cautery and incision. He stipulated leaving wide margins of excision and removing limited extent tumours only which foreshadowed contemporary surgical practice’s oncological principles whereas in 200 A.D, Galen, concluded that it was a systemic disease after attributing breast cancer to accumulation of black bile in the blood (De Moulin , 1983). According to these ancient physicians, menstruation cessation was somehow linked to cancer and they postulated that in fact there was probability that old age was somehow associated to cancer. This theory led Galen who had coined the word crab to represent cancer to exemplify the enlarged veins glowing from the cancer after having neglected the use of ligatures in order to get rid of black bile through allowing the surgical wounds to bleed freely.

Currently, breast cancer remains the most common of all cancers in women in United States as well as the second leading cancer death cause. Nearly three million women were estimated to be breast cancer survivors as of January 1, 2012 in the United States. Estimates predict this number to rise to about four million before 2022. However, overall survivor rate recently increased to 90% for 2001 to 2007 from 75% between 1975 and 1977 which is good news for women with breast cancer. This has greatly been enabled by the fact that there is early detection through the use of hormone therapy treatments, better chemotherapy and increased use of mammography as well as widespread knowledge of early signs and symptoms by the affected females (NCCN, 2012).

Moreover, there are usually no symptoms caused during the early stages of breast cancer although later on there are changes on how the breast feels and looks as tumours grow. The indication of a breast problem may be the changes in the breast tissue and generally, breast cancer does not cause pain in the early stages. This calls for regular screenings which are actually the exams and tests used to find diseases like cancer in those individuals who fails to show or have any symptoms with a goal of finding the cancer before it begins to show up the symptoms. If breast cancers are discovered since they can be felt, generally, they are more likely to have spread elsewhere which is why it is advisable for women to go for regular checkups so that they can be found when still confined to the breast and still small and in case of any breast pain or breast cancer symptoms that do not go away the woman should see her health care provider (Colditz & Bohlke, 2014).

Normally, there are common changes like underarm area thickening or a lump, breast shape or size change, bloody discharge from the nipple and retraction of the nipple. In other cases the breast skin dimples or ridges. As for the very aggressive breast cancer which is somehow rare and whose symptoms develop fast over a period of months or weeks, lymph nodes swell Albrand and Terret (2008). They may be located at the collarbone or under the arm and even on both places. This breast cancer is known as the “inflammatory breast cancer”. It is more common among women of African-American origin and usually attacks the younger generation. Moreover, the woman experiences breast size increase, tenderness, burning and aching in addition to    heaviness. It is called inflammatory due to its nature of inflaming the breast such that it looks red and swollen.

However, breast cancer’s most cases of occurrence are by chance. Probably, factors combination that includes hormonal, lifestyle and environmental factors are the mostly suspected contributors although the actual causes are still largely unknown. Mutations or changes in certain genes are also thought to be linked with breast cancer at a percentage of between 5 and 10% with BRCA 2 and BRCA 1 genes being the most common of them. During their lifetimes, women with “BRCA 1” or “BRCA 2” mutations are at an elevated risk that may develop several other types of cancer in the course of their existence in addition to ovarian cancer and breast cancer.

Additionally, women whom families have a breast cancer history must gather as much details as possible about those family members that include cancer type and onset age. Diagnosis age, affected relatives number and specific lineage also increase the breast cancer development risk in line with the history of the family. Genetic component is more likely to be involved when one is diagnosed at a younger age. Other causes and risk factors may include, Cancer from the other breast, Diet with saturated fat due to high intake, Oral contraceptives, Age at menopause after 54 years, Exposure to ionising radiation, Hormone replacement therapy, Body mass index, being Elderly (Albrand &Terret, 2008).

Furthermore, a significant impact on public health in the United State is caused by cancer and many problems which are associated with it. This issues which take a toll at a population level includes the economic burden driven by the lost of productivity and the costs linked to illness and therapy, years of life, cancer long time effects and treatment on the survivors. In addition, as some cancer incidence and population ages rates rise in United States, the impact of cancer on public health will keep on rising (Colditz & Bohlke, 2014).

On the other hand, since cancer usually affects individual patients and their families in different ways, the cost of studying its impact on large populations is very expensive in United States. Moreover, while interpreting the results from population-based research into policies and practices that can improve public health, carrying out research that involves assessing very large groups of people is associated with intrinsic challenges. According to National Cancer institute (2015), cancer therapies are approximately $30,000 per month while the newly cancer drugs cost amount to an average of $10,000 per month. Hence, due to the side effects of chemotherapy involved, patients are also required to pay for drugs that are found to alleviate these side effects. The pay provider and facility fees are also a major problem associated with cancer treatments.  Only 24 percent of direct cancer costs are accounted from drugs.  But 54 percent of costs are accounted from hospital and outpatient facilities and 22 percent is accounted from physicians fees.

Patients with breast cancer can be diagnosed or treated using different types of treatment available in heath care.  However, some treatments of breast cancer are clinical trials while others are standard. A clinical trial treatment involves a research study that is apparent intended to get hold of the necessary information on latest treatments or assist on improving modern treatments on patients suffering from cancer. The new treatment may possibly turn out to be the standard treatment, once clinical trials provide evidence that a new treatment is well improved than the existing standard treatment. The standards treatment includes surgery, targeted therapy, chemotherapy, hormone therapy, and radiation therapy (Komen, 2012). However, there is no confident way to prevent breast cancer.

Therefore, public health professionals should create awareness and educate people about the options that will help prevent or treat the breast cancer. It is always reported that early detection of cancer usually helps to control the breast cancer. Public health cares should therefore educate people on how to conduct Breast Cancer Early Detection Plan that involves Breast Self-Exam (BSE) in order to save some people lives. In addition, public awareness that is associated with developing breast cancer risk factors        should be made to the public by the health professionals.

Conclusion

This paper has provided an overview of breast cancer and how it is currently impacting public health today. Appreciable reductions in breast cancer risk can result from the application of measures that are already available that include lifestyle prevention and chemoprevention. Furthermore, new avenues for prevention in the future can be gained through the breast cancer risk and development understanding and awareness biology. However, measures that will enable to assess risk while explaining the pros and cons associated with treatment and appropriate therapies prescription will be needed.

References

Albrand, G. & Terret, C. (2008). Elderly assessment and management considerations on early      reast cancer. Drugs Aging 32, 46-51.

Breasted, J. (1984). The Edwin Smith Surgical papyrus. Chicago, Illinois: The University             Chicago Press.

Colditz, G. & Bohlke, K. (2014). Priorities for the primary prevention of breast cancer. CA           Cancer J Clin, 54:177–186.

De Moulin, D. (1983). A short history of breast cancer. Boston, pp. 1–107.

            Homer, I. (1966).A Signet Classic. New American Library, New York, p. 36

Komen, G. (2012). Understanding Breast Cancer Guide. Retrieved from             http://ww5.komen.org/understandingbreastcancerguide.html.

Lyons, A. & Petrucelli, R. (1978). An illustrated history.  Harry Abrams Publishers, New             York..

National Cancer Institute (2015). Targeted Therapies for Breast Cancer Tutorial. Retrieved         from             http://www.cancer.gov/cancertopics/understandingcancer/targetedtherapies/breastcanc      er

National Comprehensive Cancer Network (NCCN) (2012). Breast Cancer Screening and

            Diagnosis, Version 5.

            Colorado State Regulations Regarding Clinical Supervision

            In order to become a clinical supervisor in Colorado, one is necessitated to obtain a master’s degree in social work termed as MSW.  The master's degree should therefore from a university that is regionally accredited, fulfill the requirements of social worker examinations which are managed by the ASWB which referred to the association of work boards.  The boards administer and review the licensing applications (Social Work, 2016).  One must have worked in a clinical setting that is well supervised for at least three thousand three hundred and sixty hours in a minimum of at least twenty-four months.

Clinical social worker licenses in the state of Colorado are given based the graduates qualifications where one must be a master’s degree holder in social work.  Those that have a bachelor degree are not provided with licensing.  In order for an individual to get a license for clinical supervision, they must attain a social worker license first.  Once one obtains an LSW license they can begin to count the supervision hours as well as experience.  In order for one to qualify for one must have worked at least 3360 hours in 24months (Social Work, 2016).  This must, therefore, involve at least nine six concurrent hours under the strict supervision of a clinical supervisor whose LCSW must have been obtained in Colorado. 

The first step of becoming a clinical worker in Colorado is a four-year bachelor’s degree.  This, therefore, requires one to attend university or college which is accredited by CSWE following which one becomes licensure eligible. The bachelor program consists of the clinical supervisor course work which equips one with the whole knowledge of social work ethics, practices, and laws.  This additionally provides an individual with the chance to attain field experience. The bachelor’s degree qualification allows one to obtain jobs in settings that are direct which involves program management and case but holds limited privileges (Social Work, 2016). If one wishes to become a clinical specialist a social work master’s degree is required.  The study involves advanced training and basics as it expands from the basic social work concepts into distinct areas that are specialists such as social policy, family law, children’s right and misuse and use policies.  This allows an individual to specialize in specific concepts such as child welfare, mental health substance abuse and more (Social Work, 2016).

Additionally, an individual who has passed the clinical level examination or the advanced generalist is qualified to apply for LCSW (Groshong, & Clinical Social Work Association, 2009).  If one took the master's examinations level in order to attain an LSW they are necessitated to undertake and also pass the advanced generalist examinations or clinical examinations level. There are two distinct educational paths of becoming a clinical supervisor in Colorado. Being a holder of a social work bachelor degree from accredited program by the CSWE allows one to work in a non-clinical environment without the requirement of licensing but if one wishes to apply for a license a social work master’s degree is required.

There are three steps to becoming a licensed social order in Colorado State. This involves LSW, LCSW, and SWP.  The LSW is an option that is reserved for individuals who have accredited MSW program. This requires one to undertake the mental health examinations and pass, complete the application packet of LWS, complete the professional healthcare profile, pass the master's examinations and check licensing status (Groshong, & Clinical Social Work Association, 2009).  LCSW is the most advanced level of licensing in Colorado State and it enables an individual to practice medical at a more sovereign level. This requires MSW from accredited program by CSWE.

Reference

Groshong, L. W., & Clinical Social Work Association. (2009). Clinical social work practice and regulation: An overview. Lanham, Md: University Press Of America.

Social Work. (2016). Colorado Social Work Licensing Requirements. Social Work Guide. Copyright. Retrieved From http://www.socialworkguide.org/licensure/colorado/

Rhetorical analysis of Centers for Disease Control’s (CDC) website on Attention Deficit/Hyperactivity Disorder (ADHD)

It is factual that ADHD is a prevalent childhood disorder in the contemporary society. According to the website, ADHD is one of the psychiatric disorders which makes a child endure problems while paying attention or controlling their conduct when alone or with friends (Sistino et al, 2015). The parent can know the child is suffering from ADHD by symptoms such as daydreaming frequently, restless behavior, talking too much, extreme forgetting and child loneliness. These symptoms derive the three types of ADHD which include predominantly inattentive presentation, predominantly hyperactive-impulse presentation and combined presentation. Precisely, the possible risks that cause ADHD according to the scientists include premature birth, consumption of alcohol and smoking cigarettes during pregnancy, and brain injury among others. According to the CDC site, diagnosis of ADHD takes several steps which start with medical exam and check up for ADHD signs and symptoms (CDC, 2016). The treatment of the disorder involves both pharmacological treatment and behavior therapy at the childhood age (Derakhshanpoor et al, 2016). However, behavior therapy should come first prior to commencing medication. Therefore, citing from this article by CDC, this paper will focus on assessing the rhetorical tools used by the site to convey the intended information to the reader.

To start with, it is perceptible that CDC lays out the information regarding ADHD very clearly on the website making it easy for the general public to access information on the disorder. Being online, the information is accessible anytime from anywhere with an internet connection, which can help parents or other concerned parties gain valuable information on what steps to peruse next. The arrangement of the information on the page is systematic which promotes easy understanding of the topic. The webpage starts with introducing the disorder briefly, and then goes to signs and symptoms, types, causes, diagnosis, and treatment of ADHD. Therefore, brief and exact points on the disorder promote easy reading and understanding the points made by the author.

On the webpage the CDC uses pathos to appeal to people when listing different types of symptoms and sigs of the disorder. Anyone in the general public near a child may have some emotions regarding the child exhibiting some symptoms of ADHD. It can also give emotions to individuals living with the disorder exhibiting the highlighted symptoms. There are pictures of children playing and talking with a doctor on the website which gives the reader the perception that CDC would like to help your child get into good health. There are also videos of actual families talking about the journey of treating the disorder in their children which shows how effectively proper treatment can work.

CDC as the author of the article uses ethos by expressing the belief that ADHD is a very common disorder in the contemporary society that is resulted by some of the things that people do such as drinking alcohol and smoking cigarettes during pregnancy (CDC, 2016). The helps the author convey the stake of the information which is based on the seriousness of the disorder to the life of a child.

On the other hand, as a way of persuading the reader, CDC uses facts such as 2 million out of 10 million children were diagnosed with ADHD at the age of 2- 5 years, as logos for the article. Additionally, the site uses pictures of the healthy children undergoing different types of therapies in order to persuade the reader that ADHD cannot be noticed through the general appearance of the child but rather through signs and symptoms. Additionally, these pictures are used to emphasize the importance of seeking treatment for the child.

There is solid logic behind the CDC creating this informative webpage on ADHD. You can get all the information you really need on this disorder in one place online that has the credibility of being published on a United Stated government website. It is to navigate the site to find treatments, get more education about ADHD and other recommendations. Professional concerns and perspectives are transparent this site. The webmaster of this webpage published this information in order to be available at all times for such disorders and help increase the quality of life to anyone suffering from them. The author is utilizing his professional perspective to convince the general public to be aware of ADHD.

In conclusion it is exhibited that the stake of the author is to exhibit the seriousness of ADHD on the life of the child through facts and verifications from scientists’ results on the disorder. In order to convey this stake effectively, CDC uses brief and precise points regarding ADHD in order to make it easy for the visitor of the site to read. Additionally, the site uses pictures that carry the intended information on ADHD. Thus, citing from the fact that the information is published online, CDC is guaranteed that it will reach the target audience effortlessly.

References   

Sistino, J. J., Atz, A. M., Simpson, K. N., Ellis, C., Ikonomidis, J. S., & Bradley, S. M. (2015). The prevalence of attention-deficit/hyperactivity disorder following neonatal aortic arch repair. Cardiology In The Young, 25(4), 663-669. doi:10.1017/S1047951114000547

Derakhshanpoor, F., Khaki, S., Vakili, M. A., Shahini, N., & Saghebi, S. A. (2016). A survey of the relationship between mental health with parenting styles in mothers of children with attention deficit hyperactivity disorder. Journal of Fundamentals of Mental Health, 18(3), 151-155.

CDC, (2016). Facts about ADHD. Retrieved from http://www.cdc.gov/ncbddd/adhd/facts.html

Disability

            The Tourette syndrome happens where there are other connected diseases.  These diseases are such as deficit of concentration, disorder in hyperactivity, obsessive disorder and other manners related problems. People with this disorder are at a high risk of learning, manners and social predicaments. The signs of the disorder can cause complications of the treatment of the disease and can cause led to more challenges to the people with the disease and their families and the clinicians.  The ADHD or the lack of attention and the Hyperactivity disorder is a common disease that happens among the children with TS.  These children have problems in concentration and the control of impetuous manners. These children may do something without looking forward to the consequences but in some conditions they become more active (Waterhouse, 2013). 

            It is quite normal for children to have this kind of disorder at a time or another but these manners happens beyond early childhoods and to those kids with ADHD. The symptoms of the disorder may cause problems at school, home or with friends.  Autism disorders include developmental disorders that start in the early childhood and increase during adulthood.  The disorder affects developmental areas such as communication, social interaction and some manners.  Epilepsy and fragile condition are some conditions of the Autism disorder.  The difference between ADS and other disorders can be more challenging as the traits of the disease link with symptoms of other disorders and the features of ADS which make diagnostic procedures hard. Intellectual disability happens on the individuals with autistic disorder and these individuals have been diagnosed with hardship of spotting the autistic cleverness. For instance, many children are found to be clever in their normal range which is above 70% and can also be found with intellectual disability at a range of 50% (Waterhouse, 2013). 

            Persons with ASD have a wide range of having intellectual disability where females are more likely to have the disorder.  The research conducted in 2006 revealed that many children with intellectual disability have intellectual disability.  There is a probability in that the connection between intellectual disability and autism is low in that there causes are the same but the occurrence of them is likely for them to be diagnosed. Tourette disorder happens mostly to persons with autism and can be caused by having common hereditary factors and serotonin irregularities. Mental disorders can be caused by phobia, depression.  Children or adults who suffer from mental disorders may qualify from the benefits based on disability.  If the harm of the child is limiting, whether it is the case of developmental disability such as ADHD and autism,  there can be a delay in areas of the child’s development such has learning disability or difficulty in emotions such as depression are fear (Waterhouse, 2013)

            For the scientist to reveal out what is happening with these disabilities, they must understand what is common among them and the difference.  Instead of having different evaluation on each disorder, well learned scientists can diagnose the disorders of OCD, ADHD and autism by looking at the eyes of the individuals.  Although the autism has the symptoms of inability to read feelings, it is clear that it is also diagnosed with children with ADHD.  ADHD and ASD disorders can be called impaired social functions in that a child with ADHD disorder has the ability to read emotions as well as a kid with ASD.  So these disabilities are based on disorders. Many parents wish to have clever and able children who will be under the societal expectations of the society in which the society value intelligence more.  Thus people with intellectual disability and their parents are at a high risk of being undervalued by the society (Myers & Gardner, 2014). 

            Young people with intellectual disability should be supported by their parents as they grow up with self esteem and contribute to the society.  Thus the professions who deal with these disabilities should recognize these issues and acknowledge their personal values and attitudes to make sure that they respond well to the people with certain disorders. The impacts that these disorders will have on me as a future counselor who deal with persons with disabilities is that I have to spot these disorders in children although it is a difficult task and needs more skills.  As a future counselor, I have to be under special training and have education and the social services which will involve the disabled person’s family and the disabled.  These may include the diagnosis of the disorder, counseling of the parents, regular connections with the family and other networks, conduction of the disabled therapies such as art therapies and cognitive manner therapy (Myers & Gardner, 2014). 

            The quality of care that is under these disabled persons with the disorders can be affected by the attitudes and the values of the counselors that are dealing with them.  So as a counselor, I should have quality services which can also be influenced by the approach and the principles of the commissioners. Mental health problems in the children and adults with the disabilities can be comprehensive and need more assessment from the qualified that have a good training and the experience of this kind of work (Myers & Gardner, 2014).    

Reference

In Myers, G., & In Gardner, M. (2014). Psychiatry.                   

Waterhouse, L. H. (2013). Rethinking autism: Variation and complexity. London: Academic Press.