Three policies that led to the outbreak of War in Europe in 1914. What Essay

Three policies that led to the outbreak of War in Europe in 1914. What nation is primary responisble - Essay Example For instance, Germany established aggressive foreign policies that created unhealthy relationship with other nations. The policies deteriorated the existing peaceful trading partnerships and eventually led to the poor performance of the international market. The three policies that fuelled the war were; the Germany’s expansionist policy, the emergence of two opposing sides (the triple alliance and the triple alliance) and the isolation policy. Germany had a great urge to dominate the world economy. The only means to achieve this was by acquiring more territories and colonies. By this time, the world was portioned among the major powers such as the Britain. In this regard, Germany had to use military conquest to acquire territories that were already possessed by other European nations. The use of force to acquire new territories strained the already poor relation between Germany and some European powers such as Britain. These nations responded furiously to defend their interest and to maintain their political and economic power. This eventually led to the sprouting of a massive war that spread to almost all parts of the world. Some countries in Europe started forming defense alliances and promised to protect each other in case any of them was attacked by their rivals. For instance, Germany and Austria-Hungary joined and formed the dual alliance. Italy joined the alliance, and the three formed the triple alliance. On the other hand, Britain, France and Russian joined to form the triple entente. These two coalitions heightened the tension among the rival European nations leading to the sparking of the World War 1. The isolation policy adopted USA also contributed to the sprouting of the war. The US kept off from engaging in European affairs and thereby cold not assist in reconciling the European nations. However, it offered financial support to warring nations. The responsibility of the war can be blamed on Germany’s ultimate support for

Three most significant events in american history between 1877 and Essay

Three most significant events in american history between 1877 and 2014 - Essay Example The shortchanging of the minority groups by judicial misinterpretations of the Declaration of Independence in the 1800s, the Watergate scandal in the 1970s, and the assassination of John Kennedy in the 1960s are some of the most significant events that have shaped American history. Despite the promises heralded by the new laws after the dawn of independence, it is plausible that the former slaves, their descendants and all other ethnic and racial minority populations were not accorded equal regard and treatment under the law. As if to seal the fate of the Native Americans and African Americans who continued to be subjected to oppression, the highest court in the land delivered a landmark ruling in 1886 with the assertion that State authorities had the power to separate people into different races. The major caveat here was that the separation was justified provided that the separation facilities remained equal. The apparent â€Å"separate but equal† doctrine was a clear demonstration that even though independence had arrived in the United States, people of color had to wait a bit longer to reap the fruits of this freedom. The contradiction that persisted between the existence of slavery in America and the claim that all men are equal became a subject of debate when the Declaration was first published. As one media commentator wrote, the most truly ridiculous object in nature around that time was the country’s decision to sign independent declarations with one hand â€Å"and the other brandishing whip over its affrighted slaves â€Å"(Armitage 77). Even to this day, the idea of equality and freedom remains as paramount as ever to American politics and culture. One thing remains clear; the story of equality and freedom in America remains forever unfinished. The colored populations in America can only remain hopeful that as new definitions of freedom continue to emerge in the twenty-first-century, the true meaning and intentions of the Declaration will become clear

Computerized Payroll System for GTZ Printing Press Essay Example for Free

Computerized Payroll System for GTZ Printing Press Essay I am find no words at my command to express our deepest sense of gratitude to the almighty GOD, the most Gracious, the most Merciful and the most Beneficent, who gives us the talent to complete this task successfully. He is the one who gave us the courage to do this. I am are much obliged to our beloved parents whose prayers have enabled us to reach this stage. At this occasion we can’t forget our parents for their guidance at the crucial moments of our life. I am are very thankful to Marmolejo Naryvic T. whose guidance is always with us. Who always encouraged us and his guidance us to complete this project. We are greatly thankful to our adviser Ms. Cecilia Abaricia who helped us in proposal writing and gave us a lot of helping material and suggestion. Her specific comments, corrections, critiques and criticisms were the most helpful. Acknowledgement The researcher would like to acknowledge the following persons in making this research work successful: Almighty God, for the gift of wisdom and strength in creating this kind of research work; Ms. Cecilia Abaricia thesis adviser, for her time, patience, and effort in sharing her knowledge in correcting this research work; Naryvic T. Marmolejo for his instructions and tips in the development of the system that was developed by the researchers. Mr. Alex Hipolito, Finance Officer, for sharing his expertise in payroll procedures of their company And above all to the Great Almighty God who give us strength, courage presence of mind, guidance and inspiration to finish my study.

The Kawasaki disease

The Kawasaki disease Kawasaki disease is an intense systemic paediatric vasculitis disease that is seen commonly in childhood. Kawasaki disease is one of the most common heart diseases. It is the inflammatory disorder but the aetiology of Kawasasaki disease is unknown. It first appeared in 1967 by report of Tomisaku Kawasaki who was a Japanese paediatrician. He also called Kawasaki disease as mucocutaneous lymph node syndrome. There is no diagnostic test; therefore, doctors are using the clinical criteria that were proposed by Dr. Kawasaki 45 years ago to diagnose the Kawasaki disease. There are many different diagnosis of Kawasaki disease such as viral infections, genetic predisposition or environmental factors. Many research proposed that Kawasaki disease is an infectious disease that may be caused by Epstein-Barr virus, measles, adenovirus, enterovirus. However, there is no confirmed evidence. Usually, KD can found more in Japanese society but it keep spread to western countries and the incidence of K D in western countries are increase dramatically. There are typical symptoms that can be seen in KD such as rash, edema, and mucosal membrane changes. But there are more symptoms that are involved which are not typically found from every KD patients. Therefore, it is hard to diagnosis patients if they have KD or not. The treatment of KD is different depends on if patients are complete or incomplete KD and also, the susceptibility of IVIG will make treatment different along patients. The etiology is not certain but there are several researches shown that KD is caused by infectious agents, genetic factors, or immune system disorder. Current knowledge on the subject   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  There are several symptoms that can be found in patients with Kawasaki disease. When patients have more than 5 days of fever for more than 38C and have more than 4 symptoms such as bilateral nonexudative conjunctival injection, polymorphous exanthem, nonvesicular rash, strawberry tongue, edema of hands and feet, bilateral non-suppurative cervical lymphadenopathy, and mucosal membrane changes, patients will diagnosis as KD. Kawasaki disease can be divided into complete Kawasaki disease and incomplete or atypical Kawasaki disease depending on the number of symptom that are present in the patient. When patients have more than four symptoms or have developed coronary artery abnormality, patients will be diagnosed as complete Kawasaki disease. In contrast, patients who have less than four of the diagnostic criteria and still develop coronary artery abnormality is diagnosed as atypical or incomplete KD. Because of the cause of Kawasaki disease is unknown, di agnosis of Kawasaki disease in infants are very challenging. Kawasaki disease can be divided into three phases. First, from one week to two weeks from onset is called acute phase. Typical symptoms are highly febrile, irritable and the fever approaches more than 39 Celsius. Oral changes occurs and also rash can be found in perineal area. Secondly, from two to eight weeks from onset is called subacute phase. In this phase, fever start to decrease slowly and the perineal area, soles, and periungual areas start to peel off. Lastly, from months to years from onset, it is called convalescent phase. In this phase, laboratory value gets normal but there may be severe consequences. For example, patients who had aneurysms may continuously have, for rest of their life, persistent cardiac dysfunction, or myocardial infarction.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Coronary artery aneurysm can be highly found in incomplete Kawasaki disease patients. It is defined as coronary dilatation that the diameter of coronary vessel gets enlarged 1.5 folds. It can be diagnosed by angiographically and it is similar to patients with coronary artery disease. The end-diastolic pressure, end-diastolic volume, and ejection fraction levels are not normal and the left ventricular contraction is not normal. The coronary artery aneurysms are mostly caused by atherosclerosis.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  There are several associated symptoms that can be seen in Kawasaki patients. Diarrhea and abdominal pain and patients may develop arthritis. Also, myocardial dysfunction can be found in early phase of Kawasaki disease such as pancarditis which is the inflammation of all three layers of heart. Another symptom is periarteritis nodosa which is disease in connective tissue that is blocked by nodules in arteries thereby causing blood to not circulate properly. When Kawasaki disease shows periarteritis nodosa, other symptoms cannot be found.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Kawasaki disease can be diagnosis by physical exam but also it can be diagnose by laboratory exam and imaging technique. First, complete blood count test should be performed to look at the amount of white blood cell in blood. Complete blood count is the calculation of white blood cells, red blood cells, and platelet. The number of white blood cell increased to more than 15,000. Also, the erythrocyte sedimentation rate and C-reactive protein increase. After 2 weeks from onset of disease, the platelets level dramatically increases up to 1 to 2*106. There are other abnormalities such as sterile pyuria, increases of hepatic transaminases, hypoalbuminemia. In patients who have KD will have higher level of transaminase than normal person. Also, they will have higher level of ALAT and GGT than other patients who have other febrile diseases. When ALAT level increases, it will lead to coronary artery disease. Research proposed that almost 50% of incomplete KD p atients had pyuria in bladder urine. Pyuria can cause different diseases depends on where it is. When pyuria is in bladder, it can cause tubulointerstitial nephritis but when it is in voided urine, it will cause urethral inflammation. Another symptom to diagnosis incomplete KD is to look at acute anterior uveitis after the onset. Patients who have anterior uveitis do not have pain, photophobia, nor visual impairment. By using ophthalmological evaluation, it can detect if patients have different disease which have similar symptoms with anterior uveitis. One of the research in 2006 showed that there were 40% of KD patients had hyponatromia. It is caused by incorrect hormone secretion by cerebral vasculitis, dehydration, or tubular dysfuction. It is hard to diagnosis KD since there is no diagnosis test. To treat incomplete KD, the principle clinical criteria should be renewed in order not to miss out some patients who did not have principle symptoms. By missing out patients will develo p severe other diseases and will not be able to give proper treatments.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  KD also can be found out by using imaging technique. At acute phase, chest x-ray or echocardiography (ECG) are used to look at heart problem. Patients may develop coronary artery abnormalities in acute phase and this can be showed by ECG. When patients are very severe, heart specialists sometimes use single photon emission computed tomography to look into bloodstream of patients. SPECT will provide an image in 3D by using gamma rays. Epidemiology Kawasaki disease is new disease that is predominantly found among Asian children1,2,3. It was first found in Japan by Dr.Kawasaki in 1961. In early 1970s, Pathologist Eunice Larson and Benjamin Landing at Los Angeles recognized it as a new disease. Still today, there is no evidence of how Kawasaki disease emerged but some researchers proposed that Kawasaki disease emerged from Japan and spread to Western countries through Hawaii after World War II. Kawasaki disease was nationwide epidemics but now it is more likely a regional outbreak. The mean annual incidence rate is different in variety of countries and districts3. There are 90 to 112 per 100,000 in Japan, 8.0 to 47.7 per 100000 in US, and 3.6 to 3.7 per 100000 in the United Kingdom and Australia for children who are less than 5 years old. Research in China indicates that the incidence rate is 18.2 to 18.6 per 1000003. The statistics shows that Japan predominantly has highest incidence rate among Asian. Kawasaki disease can be fou nd commonly in males than females and the reoccurrence rate is less than 1%3. The incidence of Kawasaki disease has been increasing annually. In 2000, the incidence rate was 73.7 per 100000 but in 2002, the number of occurrence increased to 95.5 per 1000003. There are relationships between season and occurrence of Kawasaki disease3. But there are variations among different countries. From Japanese reports, there were more patients in winter but in American data shows that patients will develop KD more in the spring and winter. For female the occurrence appeared to be high in March, and highest in July. For boys, the highest occurrence rate was in May and the lowest occurrence rate was in February. As the research indicated, the season and climates have relationship with the susceptibility to Kawasaki disease3. Genetics   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Patients with Kawasaki disease may develop coronary artery abnormalities (CAAs) if patients are not treated early. Usually patients are treated with high amounts of intravenous gamma-globulin (IVGG) as well as aspirin which are used to reduce the possibility of developing CAAs2. However, 10-20% of Kawasaki patients do not response to induced intravenous gamma-globulin. Coronary artery abnormality will develop more frequently to patients who are not responding well to IVGG than patients who respond well to IVGG. Recent research reported that matrix metalloproteinase-9 (MMP-9) is involved in formation of CAA in acute phase of Kawasaki disease patients2. From research, the level of MMP-9 in serum who have Kawasaki disease have much higher than serum from children who does not have KD and patients who have other kinds of febrile diseases2. Using MMP-9 inhibitors might prevent the formation of CAA. However, MMP-9 inhibitors are not used clinically. MMP-9 is endopeptidase that depends on zinc that has zinc at the active site. MMP-9 have major role in tissue remodelling of extracellular membrane (ECM) 2. It can be seen in cardiac remodelling after myocardial infarction, plaque destabilization of atherosclerotic lesion. The mechanism of angiotensin-converting enzyme (ACE) inhibitors is involve with the bind zinc to the active site and stabilize by hydrogen bonds and hydrophobic interactions in the active site. The ACE inhibitor can inhibit the activity of MMP-9 and MMP-2, which have major role in neointimal formation and angiogenesis. The effect of the ACE inhibitor on MMP-9 can be measure by using captopril to the enzyme2. Involvement of the immune system From the studies by Satoshi Sato, Kawasaki disease is commonly found from patients who are younger than 5 years old1. The average age of occurrence of this disease is 2 years. Kawasaki disease does not occur frequently from children who is less than 6 months and can hardly find patients who are less than 3 months1. Kawasaki disease usually does not occur for adults who have immunity to common infectious disease. This result explains that children are more susceptible to Kawasaki disease because they might not produced antibodies to common infectious viruses, and bacteria1. Mannose bind lectin (MBL) is an important component of the innate immunity and is a reactant for hepatic origin which can bind to multiple lectin domains1. MBL has very important role in complement activation and opsonization. Complement activation refers to as the biochemical activity that helps to get rid of pathogen from animal and opsonization have similar activity to complement activation that plays role of pa thogens to get rid of the organism by ingestion and destruction by phagocyte1. It is usually found in bacterial cells, fungus cells, and viruses. It has repeating pattern of mannose and N-acetylglucosamine sugar. There are three single polymorphisms in chromosome 10 for MBL gene at codon 52 (CGT to TCT), codon 54 (GGC to GAC), and codon 57 (GGA to GAA). This mutation will lead to reduction of the level of MBL concentration but polymorphism of the promoter region of MBL will lead to increase the level of MBL concentration in the serum1. When the base changes from glycine to aspartic acid in codon 54, it will distract the interaction between MBL and MBL-associated serine protease. The interaction between MBL and MBL-associated serine protease defend against infection when patients are young. But when patients become older, the interaction of these two molecules will not have impact on the innate immunity1. Because, the patients will develop the mature lymphocytes and immunoglobulins a nd they will engulf the invaded pathogen. Therefore, this research proposes the susceptibility of the Kawasaki disease will be influenced by the MBL polymorphism1. Children who have Kawasaki disease develop endothelial dysfuntion in early phase after onset of disease and this will caused by the production of nitric oxide (NO)5. As described earlier, the primary innate immune system is very important feature for Kawasaki disease. Tumour necrosis factor alpha, IL-1, 6, 8, monocyte, chemoattractant protein-1 (MCP-1), and vascular endothelial growth factor (VEGF) will be activated to produce cytokine storm5. After cytokines are produced, it will release iNOS (inducible nitric oxide synthase) in neutrophils, endothelial cells, and smooth muscle cells. Nitric oxide is produced by two enzymes which are endothelial NOS and iNOS5. Recent research found out that patients who developed Kawasaki disease have higher level of iNOS concentration in neutrophils in acute phase. Also, children have high level of nitric oxide metabolites such as NOx, NO3-, and NO2-. After production of Nitric Oxide, it will react with Reactive Oxygen Species (ROS) to give more bi ochemical reactions. This will be measured by new device called fluorescent indicators5. There are new devices used to measure the concentration of NO and ROS. First, Hydroxyphenyl fluorescence (HPF) was used to measure the concentration of ROS. Another device is called Diaminofluorescin-Flu Diacetate (DAF-FM DA) which is used to measure the concentration of intracellular Nitric Oxide5.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  There are significant evidences that the production of ROS and NO by neutrophils were much higher in Kawasaki disease patients in compare to people who have non-KD febrile children or non-febrile children5. By treating with IVIG, NO level will decrease. But, the production of NO can be beneficial or harmful. Usually, NO is cytotoxic but sometimes, it can protect cells from toxic materials. NO may react with hydroxyl radicals to produce much higher toxicity. To control the influence of NO, the duration, the amount of NO synthesis should be controlled. Therefore, in acute phase of Kawasaki disease, NO and ROS is highly produced and will cause damage to endothelial cells5. Treatment and future research   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  When patients are diagnosis as complete or incomplete KD, treatment should be induced right away. Because when patients have more than 10 days of fever will develop CAA. Major treatment that doctors use to treat KD is intravenous immunoglobulin (IVIG). Intravenous immuglobulin induced into bloodstream which contains immunoglobulin antibody G that is brought from other control blood donors. IVIG is still a major recommended treatment but some patients do not response to this treatment. The effects of IVIG last for 2 weeks up to 3 months. The typical amount of IVIG is a dose of 1000mg per kg of patients bodyweight. High amount of IVIG with aspirin will reduce the rate of coronary artery abnormalities (CAA) which includes coronary artery dilatation or aneurysms from 20% to 3 to 5%. Also, depends of patients, IVIG can also used with acetylsalicylic acid to treat KD.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  There is one example about the incorrect treatment will cause severe disease. When IVIG was induced, patients could not cure coronary artery lesion. When patients induced with corticosteroid, they developed more coronary artery lesion3. There are two therapies which are antiinflammatory and antithrombotic therapy which are to treat Kawasaki disease instead of using IVIG. In antiinflammatory therapy, methylprenisolone, prednisone, prednisolone, and infliximab are used to treat Kawasaki disease. For antithrombotic therapy, Aspirin, heparin, warfarin, exoxaparin, tissue plasminogen activator, clopidogrel, and abciximab are used. Recently, infliximab proved by US Food and Drug administration to cure not only Crohn disease but also used to treat Kawasaki disease patients. It was not used at all in 2001 but today, the administration of infliximab usage increased up to 2.3% of total number of therapies used. It became favourable because of two reasons. First, it only administer to patients only one time. Secondly, by not using infliximab more than once, it reduce the complication as seen in other therapies which are used more than once. Infliximab is an antibody to tumour necrosis factor alpha, and cytokine in inflammatory response. It binds to tumour necrosis factor alpha and blocks the T-cell receptors to block the biochemical cascade. It will decrease the coronary artery abnormalities in patients who developed Kawasaki disease in early acute phase. To treat KD much better way, there should be more research. First, there should be more laboratory and echocardiographic data. Second, more development of clinical criteria and symptoms should be proposed. Even today, there is no perfect evidence that can explain the cause of KD; therefore, there should be more research on genetic factors by looking at KD patients family. Lastly, after treatment of KD in childhood, complication may be developed after several decades and there is not much information about complication. Therefore, by monitoring and keep in touch with KD patients are good way to find out more about complication after initial treatment. References Sato, S., H. Kawashima, Y. Kashiwagi, T. Fujioka, K Takekuma, and A. Hoshika. 2009. Association of mannose-binding lectin gene polymorphisms with Kawasaki disease in the Japanese. I. Jour. R. Dis. 12:307-310. Inoue, N., S. Takai, D. Jin, K. Okumura, N. Okamura, M. Kajiura, S. Yoshikawa, N. Kawamura, H. Tamai, M. Miyazaki. 2010. Effect of angiotensin-converting enzyme inhibitor on matrix metalloproteinase-9 activity in patients with Kawasaki disease. Clinica Chimica Acta. 411:267-269. Huang, G.Y., Ma, X.J., Huang, M., Chen, S.B., Huang, M.R., Gui, Y.H., Ning, S.B., Zhang, T.H., Du, Z.D., Yanagawa H., and Kawasaki T. 2006. Epidemiologic Pictures of Kawasaki disease in Shanghai from 1998 through 2002. Journal of Epidemiology. 16:No. 1. Yeo, Y.K., Kim, T.Y., Ha, K.S., Jang, G.Y., Lee, J.H., Lee, K.C., Son, C.S., and Lee, J.W. 2009. Incomplete Kawasaki disease in patients younger than 1 year of age: a possible inherent risk factor. Eur J Pediatr. 168:157-162. Yoshimura, K., Tatsumi, K., Iharada, A., Tsuji, S., Tateiwa, A., Teraguchi, T., Ogino, H., Kaneko, K. 2009. Increased nitric oxide production by neutrophils in early stage of Kawasaki disease. Eur J Pediatr. 168:1037-1041 Perrin, L., Letierce, A., Guitton, C., Tran, T.A., Lambert, V., Kone-Paut, I. 2009. Comparative study of complete versus incomplete Kawasaki disease in 59 pediatric patients. Joint Bone Spine. 76:481-485. Son, M.B.F., Gauvreau, K., Ma, L., Baker, A.L., Sundel, R.P., Fulton, D.R., Newburger, J.W. 2009. Treatment of Kawasaki Disease: Anlaysis of 27 US Pediatric Hospitals From 2001 to 2006. Pediatrics. 124:1-8. Ugi, J., Lepper, P.M., Witschi, M., Maier, V., Geiser, T., Ott, S.R. Nonresolving pneumonia and rash in an adult: pulmonary involvements in Kwasakis disease. EUROPEAN RESPIRATORY JOURNAL. 35:452-454. Climaz, R., Sundel R. 2009. Atypical and incomplete Kawasaki disease. Best Practice Research Clinical Rheumatology. 23 (5):689-697.

The Plastic Pink Flamingo :: Literary Analysis, Jennifer Price

Since the 1930's, plastic pink flamingos have been a trendy statement piece at hotels and in yards across the country. Jennifer Price, the author of "The Plastic Pink Flamingo: A Natural History", uses tone, satire, and diction to show her view on United States culture. Price's view is that United States culture is flashy, cocky, and that Americans tend to try and stand out to get attention. "The pink flamingo splashed into the fifties market, it staked" (Price lines 1-2). Plastic flamingos are unable to splash like real flamingos, therefore Price is demonstrating satire. Also, the plastic flamingos are staked into the ground. "Americans had been flocking to Florida" (Price line 4) is humorous because the Americans flocking to the southern east coast like flamingos. The plastic pink flamingo became "synonymous with wealth and pizzazz"(Price line7-8). After the Great depression and the war, Americans had a lot of pride for their country, and this was one way of showing it. "This was a little ironic, since Americans had hunted flamingos to extinction in Florida" (Price lines 13-14). Price may be putting down American because Americans tend to follow the crowd and copy what everyone else is doing. The flamingo could be a metaphor of how Americans are followers and do not come up with their own ideas. The plastic pink flamingo gave an "extra fillip of boldness" (Price line 20). The flamingo was a way for Americans to stand out in the crowd and be noticed. Americans were flashy, cocky, and maybe even a little bit conceited. "And the Flamingo was pink- a second and commensurate claim to boldness" (Price lines 30-31). American culture is very flashy and bold. By being bold and flashy, it makes Americans stand out from the crowd and be noticed. Pink was the thing to have, it showed wealth and status. "The hues were forward-looking rather than old-fashioned" (Price lines 36-37). The pink flamingos were a way for the Americans to show pride after World War II. The plastic flamingos were the Americans' way of coming back out after the Depression and the war. They are the symbol that marks the beginning of a new era. "Even a real flamingo is brighter that anything else around it" (Price lines 48-49). The Americans wanted to be recognized after the war and show their pride for their country. The flamingo was a symbol of status and power.

Essay examples --

Introduction As the number of Americans covered by managed care plans grows, it becomes more important to understand how managed care organizations (MCOs) control costs and how these controls affect access, quality, and health outcomes. This paper will examine patterns in referrals from primary care physicians (PCPs) to specialists in order to evaluate physicians’ satisfaction with this inter-physician communication and to identify problems in the referral process. Prior authorizations will also be studied in order to learn the criteria considered when deciding if a treatment or medication is medically necessary and appropriate. The reasons prior authorization systems are utilized and their effectiveness in controlling costs and constraining access will also be examined. Case management as a function of utilization management and methods for measuring quality and patient satisfaction will be discussed. Historical patterns of case management will be studied in order to evaluate the effecti veness of case management in managing costs. The implications of referral and prior authorizations systems for all stakeholders, MCOs, purchasers, providers, and consumers will be considered. Background/Understanding In MCOs, there are a variety of processes that are used to influence the practice style of a PCP. The method that causes one of the most controversial and frustrating aspects of managed care for the members and their PCP is the use of referral systems (Grumbach et al, 1998). A referral system is the process in which PCPs determine whether services that are performed outside of their office are medically necessary and appropriate. These referrals are used to send members to other physicians in order to gain the excess amount of care t... ...spects of care including, rehabilitation, home care, and health education. MCOs can also utilize disease management, which is a specialized form of case management to monitor and control certain individuals with specialized needs. Like case management, disease management is targeted at specific high risk and high cost medical cases but with a focus on diseases. Disease management is unique because it offers patients access to not only physicians but also other types of health care professionals including pharmacists and dieticians. The idea behind this is to provide each patient with all available resources to help control or eliminate their disease. Pharmacists can provide specialized knowledge on medication techniques and types while dietitians can provide information on healthy eating habits that can help ease symptoms of particular diseases (Kongstvedt, 2009).

Nurse: Health Care Field Essay

The health care field has numerous amounts of individuals that care for patients or assist with their care. All persons that assists with a patients care must be able to communicate effectively amongst each other and this includes the nurse. Nursing is a communicative intervention and is founded on effective communication. Nurses have to communicate with various people such as: patients, families, physicians, and or consultants to provide the best care for his or her patients. So communication is the most important aspect when it comes to caring properly for patients. Communication is the simple element of human relations that allows people to establish, maintain and improve interactions with others. â€Å"Communication is essential when reporting a patient’s status, change in condition, or developing and revising the plan of care† (Fernandez, Johnson, & Jones, 2010, pg. 266). Furthermore, the importance of effective communication includes an interdisciplinary team approach which in turn promotes safe and effective health care for the patient. All health care professionals share a mutual commitment to serve the patient and work towards optimal health care for the patient. This is carried out by using the interdisciplinary approach of health care. Interdisciplinary team is defined, â€Å"as a group of health care professionals from diverse fields work in a coordinated fashion toward a common goal for the patient† (Saunders, 2013, pg. 60). This makes each team member valuable, and when each team member’s expertise and perspective is brought together patient care is improved and delivered in a more complete and effective manner. The facility at work at uses the interdisciplinary care approach when we receive trauma patients. These trauma patients can range from motor vehicle collision, shooting victims, or any incidents involving life threatening injuries. Each member of the trauma team has a title or a role within the team such as: team leader, manager, or facilitator. For example, the emergency room resident is in charge of the neurology assessment and airway, the trauma resident and trauma attending are responsible for the rest of the assessment. We also have a primary nurse that records all events that take place in the trauma room. Another member is the intensive care nurse, she delivers all the meds and any other skill that are needed for the patient. We also have a phlebotomist, chaplin, and respiratory therapist on the team. Other doctors are also available if other injuries such as: broken bones, neurologic conditions, or cardiac conditions arise. All the members of this team, brings valuable professional safe care to the trauma patient promoting optimal outcomes. â€Å"Ineffective communication is a leading cause of preventable patient injuries and deaths† (Fernandez, Johnson, & Jones, 2010, pg. 265). If all the members of the health care team are not communicating effectively it can jeopardize the care of the patient and also exhaust the interdisciplinary team. This is why communication is very important when providing care for patients. Another approach to health care is the intradisciplinary approach. The intradisciplinary approach is an individual that works alone to promote health in patients. An example of this is a home healthcare nurse. The home health care nurse provides care for a patient in his or her home. This nurse works alone when caring for patients. This professional nurse has to be organized and able to make decision on his or her own regarding the patients care. I feel the home health care nurse must be very knowledgeable is his or her field and have keen assessment skills. This nurse should have experience within the hospital before deciding to care for others at their home. This difference with interdisciplinary care is that the nurse has multiple resources at the time of care for the patient. caring for Finally, working as a team in the health care field helps empower not only the nurse, but also the patient. â€Å"Empowerment is a transactional process involving relationship with others. This relationship includes mutually beneficial sharing through mutual sharing of knowledge, resources, and opportunities; and respect for self and others† (Burkhardt & Nathaniel, 2008, pg. 72). This develops the professional nurse to provide successful, safe care for his or her patients. When patients witness nurses and physicians working together to assist with his or her health care. This in turn enables and may motivate the patient to â€Å"develop awareness of area that need change, foster a desire to take action, and share resources, skills, and opportunities that support change† (Burkhardt & Nathaniel, 2008, pg. 471) in his or her health . The nurses and patients experience and perspective regarding healthcare empowers them to make change patient to become advocates in their health.