Souldice Hospital Marketing Strategy Essay Example

Souldice Hospital Marketing Strategy Paper Unlike physical products, a service cannot be seen, tasted or felt before it is bought. There is always an element of uncertainty and the service seeker looks for evidence of quality. People will draw conclusions from the place, the people, key influencers, communication material and most importantly from people who have already gone through the experience. Therefore the service providers task is to supply this evidence, to tangibilize the intangible [Kotler] Shouldice marketing strategy is one of a kind, in the sense that it is different, which is the secret behind every successful strategy. Its ? thinking out of the box. Its sensing a need and fulfilling it in a remarkable manner. Everything we have studied in the past classes seems to be embodied in the strategy of Shouldice hospital from experiential marketing, brand loyalty, providing a memorable experience, the importance of good word of mouth advertising, to focus and using ones competitive advantage to such an extent that although people might try to copy it, there are slim chances of them getting it right. Shouldice hospital is marketing a well-developed, focused service delivery system, it is providing an experience. Core Competency Dr. Earle Shouldice who founded the hospital started this operation from an idea and then developed the idea further by dedication and passion, he operated on men who wanted to be soldiers but were denied because they needed hernia treatment, during the war in 1940, hospital space and doctors were scarce, especially for this non-emergency surgery that normally took three weeks of hospitalization. Dr. We will write a custom essay sample on Souldice Hospital Marketing Strategy specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Souldice Hospital Marketing Strategy specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Souldice Hospital Marketing Strategy specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Shouldice stepped in and operated without taking any fee, he performed an innovative method of surgery on seventy of these men, hastening their induction into the army, and thus the idea developed into a surgical technique which survived him and is still thriving. As Bruce Lee once said I fear not the man who has practiced 10,000 kicks once, but I fear the man who has practiced one kick 10,000 times. The focus on doing what you are best in, and developing it to such an extent that people are trying to copy it, it makes sense to just stick to that and thats what Shouldice did. A Strategic Service Concept- Focused Service Factory Shouldice defined the one thing they do to perfection and built a whole integrated system around it. Removal of external hernia were their forte and they stuck to it. The patients at the Shouldice center take some of care of themselves. Before the operation a questionnaire is sent to them which is simple to understand and the purpose is to determine the type of hernia and other risks associated with surgery. In Shouldice, all the patients were encouraged to walk up and down the halls and to get in dialog with the other patients and the surgeons. In thought of encouraging the patients, the steps between the floors are constructed with a smooth inclination, there are not TVs at the bedrooms and the rooms were designed as if it were a home instead of a hospital. Every square foot of facility is carpeted to reduce the hospital feeling and the possibility of a fall. ?Market Segment: Shouldice hospital is staying focused because it has not changed its target market and the methods that made it a success; the target market for Shouldice Hospital remains the people who were detected with a primary inguinal, which was the most common kind of hernia. They treated only external hernias. More complicated cases, especially those involving patients with other health problems, were not undertaken. The primary advantage of admitting only healthy people was that the duration of the patient in the hospital was drastically cut down. Thus new patients could be admitted with a higher frequency. Great Word of mouth advertising Part of the success of the Hospital from a psychological point of view is the opportunity for the patients to meet one another. I certainly enjoyed the other patients and I did not hear a single one express any negative attitude toward the hospital and I heard many glowing words about it. RON KENYON-THORNHILL, ONTARIO Other qualities that help it stay focused in short are ?A Flat Organizational structure Top Management Commitment to Quality Dr. Shouldice and his sister Mrs. Uquhart each owned 50% of each, i. e. , the hospital and the clinic. ODell as the administrator was responsible for all the five departments ? surgery, nursing, administration, maintenance and housekeeping. T ? Customer Value Satisfaction As is evident by the questionnaire and response and the fact that most of its customers are referrals. Which according to most is the one number you need to be concerned about. ?Focused Differentiation Stayed focus on treating external hernias ?Self Service Technologies Patients self screen Self Serve Walk about Dont need bed pans Q2. Is Shouldice hospital a good place to work and why? Excellent service providers know that positive employee attitudes will promote stronger customer loyalty, so the best employees must be found to do the job and then they must be retained. At Shouldice the turnover rate is minimal, only four nurses a year, which for hospitals is quite remarkable. Shouldice hospital is great place to work pretty much for the same reason that it is a great place to be operated on. There is an atmosphere of warmth of family rather than a workplace. The nurses work more as psychologists. And a lot of the dirty jobs so to say are avoided since the patient is healthy enough to walk around the place, his linen need not be washed regularly and can be changed only after he leaves the hospital after four days plus patients do not need bed pans. This also reduces the amount of time that the nurses need to devote to each patient in terms of individual care. Nurses could better utilize this time by conducting orientation programs for the patients and also counseling them. This kind of work keeps the work force motivated and they do not have to deal with the drudgery of day-to-day work. There s a profit sharing plan for both doctors and nurses. As far as the doctors are concerned they get a chance to see ? their children grow up, meaning that the hospital does not take over their entire lives as this profession normally does. The doctor on call is rarely called to the office and has regular hours. A surgeon day ends at 4 p. m.  which in medical terms is quite a ? miracle. And although hernia repairs are traditionally seen as mundane the Shouldice technique is a trick anatomical procedure and thus it gives a doctor a new skill. Salary and bonuses are good too. Since the patient base is healthy post-operative care required is lesser. There is an ? open door policy that was in place for the staff. Employees can go to ODell could come in and discuss their problems ranging right from their personal problems to their official problems. This kind of close staff and management interaction helped in keeping the staff. Nobody gets fired; the pay scale is higher than comparable jobs in other areas. There is a feeling of family as people often pitch in to do work. Alan ODell went on to further elaborate the happy and feeling involved. Yet another policy prevalent is that of job rotation, which removes the monotony from the job, also helps in keeping the staff prepared to face crisis situations, which could possibly arise due to some staff member remaining absent or suddenly taking ill. The staff functioned more as autonomous units loosely controlled by the administration. This freedom served as a motivating factor and propelled them to achieve higher efficiency results. Q3. How is Shouldice providing a unique and memorable experience to its patients? The Provision of an Experience rather than a service! The first thing that struck me while reading the case that its not like a hospital at all its more like a home where people for retired people or even in fact a hostel. Shouldice has been remarkably successful in its ability to not only provide its patients with a quick, quality and low cost surgery but also providing an unforgettable experience and comfortable environment to all of its patients. Shouldice Hospital success is due to a number of factors ? Warm and friendly environment [carpets to dispel the hospital feeling and disinfectant smell] ? Communal Dining; which is psychologically appealing to patients receiving surgery, they are able to associate with other patients as well as doctors receiving the procedure to compare notes and discuss concerns and ultimately alleviate any anxieties with other patients. ?Patients encouraged to exercise and walk around meeting other people making friends. 58% appreciated friendship with other patients as ? very important and 34. 57% rated exercise as ? very important ? Shouldice Hospital has a high success rate; only 0. 8%. Dr. Shouldice technique is far superior to others. 72% rated that as ? very important ? Building of partnerships and sharing of medical notes. Patients are given rooms that they share with a roommate who is generally from a similar professional background or shares similar hobbies. ?Post-operative treatment that they get. No television or telephone is kept in the room. Thus the patient compulsorily has to walk down the specially constructed stairs and come to the common room to avail of these facilities. This helps the patient recovers mentally and considers himself fit and healthy. Patients in fact want to stay longer; they can explore the premises make new friends, You are not alone and isolated feeling scared for children their parents are allowed to stay with them without charge. At every customer touch point the feeling of intimacy and caring putting yourself in the patients shoes is available Q4 Should Shouldice hospital expand? Why? Group 13 Shouldice should expand but be very cautious not lose out on its uniqueness, because bigness and the cost associated with it often can lead to undifferentiating. Q5. If it were to expand, what are the options available to expand what are the options available to expand and which option do you recommend? What is going on presently? 1. Alan ODell wants to increase capacity he doesnt want to lose control over quality. He thinks himself as a doctor first then as an entrepreneur. 2. They cant market their services as they dont know if they will be able to fulfill the demand. 3. Other doctors are using the Shouldice technique without results. 4. Saturday operations, if they expand further there is danger of change in attitude. 5. Dr. Obney is resisting change and opposes operations on Saturdays. 6. Even when hey expand capacity backlog declines but climbs once again 7. The selection of the next chief surgeon So what should they do? The were established as a focused service factory and that hs led to their success so they should definitely not move away from that into other areas, stick to external hernia operations. Since patients are attracted to the hospital in part by rates, any expansion plan has to ensure that the cost des not have to be borne by the patient. They should definitely copyright the Shouldice technique. Teach it to other surgeons and make sure that people check if the surgeon who says he is using the Shouldice technique has a certification much like the board certification needed. This is to protect their intellectual property. Or have a campaign that makes people aware that others are copying their technique and its not endorsed. Since you cant stop them from copying you can train them yourselves. There is a demand for the same operation from other hospitals. Besides, some of the other hospitals are imitating the same method wrongly. So, they should develop a self-contained branch in northern part of US. And by the help of their good image in medical care, they can brass to offer new specialty medical service first in Toronto. If the demand is enough, they can expand their new specialty medical care service area. Brochures saying that Shouldice Hospital is the only hospital having the technical expertise to practice the Shouldice method and warning the people against fraudulent practices will ensure that the failures of such fraud operations are not blamed on the Shouldice method. They can videoconference now that technology permits. This technique can be done over the world. They can hire new surgeons and nurses to deal with the expanded capacity, especially for Saturdays. If Saturday surgery is causing a rift a compromise can be reached by limiting the number of operations that would be actually performed on Saturday. Although addition of Saturday operations will result in increased workload. Since the patients stay at Shouldice for average of 5 days, an increment in capacity will be inevitable. There should be a lot of talks and Saturdays should definitely be utilized since patients whos  operations are scheduled late in the weekend stayed in the hospital over the weekend Adding another floor of beds which could increase MON-FRI surgeries by 50%. In my opinion adding a half day Saturday is the best option. Although 42% of their patients come from the U. S. Im not sure whether opening a hospital in the U. S. would allow them to stick to their strategy or the differentiation they have created. An organization like this is very characteristic of the place it belongs ? Canada. America is a different ball game and it could cause them to lose its distinctive edge and ? soul.

The Safavid Empire of Persia

The Safavid Empire of Persia The Safavid Empire, based in Persia (Iran), ruled over much of southwestern Asia from 1501 to 1736. Members of the Safavid Dynasty likely were of Kurdish Persian descent and belonged to a unique order of Sufi -infused Shia Islam called Safaviyya. In fact, it was the founder of the Safavid Empire, Shah Ismail I, who forcibly converted Iran from Sunni to Shia Islam and established Shiism as the state religion. Its Massive Reach At its height, the Safavid Dynasty controlled not only the entirety of what is now Iran, Armenia, and Azerbaijan, but also most of Afghanistan, Iraq, Georgia, and the Caucasus, and parts of Turkey, Turkmenistan, Pakistan, and Tajikistan. As one of the powerful gunpowder empires of the age, the Safavids re-established Persias place as a key player in economics and geopolitics at the intersection of the eastern and western worlds. It ruled over the western reaches of the late Silk Road, although the overland trade routes were quickly being supplanted by ocean-going trading vessels. Sovereignty The greatest Safavid ruler was Shah Abbas I (r. 1587 - 1629), who modernized the Persian military, adding musketeers and artillery-men; moved the capital city deeper into the Persian heartland; and established a policy of tolerance towards Christians in the empire. However, Shah Abbas was fearful to the point of paranoia about the assassination and executed or blinded all of his sons to prevent them from replacing him. As a result, the empire began a long, slow slide into obscurity after his death in 1629.

Human nature vs. Human condition Essay Example | Topics and Well Written Essays - 1250 words

Human nature vs. Human condition - Essay Example But it needs to be noted here that everything that relates to us is inbuilt. Some features that build up our personality are depending on our past rather than having a scientific background. Things that build up the human condition are marriages, deaths, terrorism, physical activities like sports etc. which are not applicable to any scientific reasoning need to be studied in a more humanly manner. "Thinking about humans and the rest of nature has focused on shared biological properties and environmental attitudes." (Levin, 9) The reason why people confuse these very different branches of anthropology is that these branches despite being quite different share certain features which are quite similar when it comes to human development and growth. It needs to be discriminated here the difference between those features that symbolize the human way of living as we take it to be and the reasonable claim that it has taken origin from the human nature.at times it is easy to discriminate. For instance, cooking is part of one's everyday activity and despite how essential it is to us humans we can still not consider to be part of our nature although it has a past but still the utensils, material etc. required to produce food is not innate but a creation. Likewise sports is not something we were naturally interested in or has an evolutionary history but it is more of a requirement of one's prevailing conditions and desires. But the problem arises with certain issue that is quite intriguing for even researchers because of their dominating biological nature. The philosopher I would like to mention here are Thomas Hobbes and Plato who both in their distinct manner have contributed to propagate this theory. Although "The interpersonal structures of humanity, the genesis of social order cannot be conveyed from a philosophical perspective" (Klein and Sitling, 191) In Hobbes book Leviathan he provides a very detailed analysis about the human condition. In this book he tells that our internal desires, motives and behavior are all because of the biological processes that are taking place inside us. The choice between good and bad, right and wrong is merely the choice of the individual and his/her personal preferences. When one is not bounded by society and is only answerable to him then the objective of living fades. In a natural atmosphere one does not need to abide by justice or injustice but can choose what he prefers and neglect what is not a part of his conscious choice o0r ill for his existence. Apparently the picture Thomas Hobbes tried to draw was fairly vague with no practicality in itself. He believed that the humans did not require moral or ethical values to survive. There was no room for justice, fairness, trust, equality etc. which are such virtues without which a society can never prosper. For instance if the people constituting a society have only desires of basic necessities like food etc. then the one in power and dominance on the basis of hi s position would oppress the one underneath depriving the oppressed one of his basic necessities. The reason behind such representation was not to portray a scary sort of a depiction but was consciously based on the ethics of society. For instance if today we are bound to morality, value and principles it is merely because we have a sense of responsibility and certain infused respect for others which we have learnt from our surroundings. If these values vanish and humans are not liable to others then an environment will be created that would be free from justice with bloodshed and injustice everywhere. Furthermore an environment would be created that w

Refund Anticipation Loans Research Paper Example | Topics and Well Written Essays - 2500 words - 1

Refund Anticipation Loans - Research Paper Example In spite of the high fees associated with RAL’s, most of those coming from the poor families are the ones who usually apply for it. There is an on-going battle between the government, the consumer advocates and tax preparation companies on the continued offering of Refund Anticipation Loans. A refund anticipation loan is a type of short-term loan that is applied by a taxpayer, who wants an early claim on his tax refund. The amount that is acquired through the loan will be repaid by the taxpayer’s anticipated tax refund. It may also be called â€Å"Rapid Refund† or â€Å"Instant Money.† A contract is provided by the financial institution to be signed by the taxpayer that serves as an assurance that the loan will be paid back through the taxpayer’s tax refund (â€Å"Refund Anticipation Loan Fraud†). Common interest rates for RAL’s start from 50% up to over 500%, the basis of which is the length of the time that is needed to process tax forms at the Internal Revenue Services (IRS), that is According to the Center for Responsible Lending. Although this type of loan has been claimed as a way for taxpayers to have their tax refunds earlier in their pockets, more often than not it is advanced only for just a few days or less as compared to the actual date that the IRS releases the tax refund (â€Å"Tax Refund Resources for Consumers†). RAL’s give taxpayers the opportunity to get their tax refund at a sooner date and be able to use the money earlier rather than wait for a couple more days. Even so, problems occur when someone opts to use a refund anticipation loan. Basically the lender knows that the money borrowed will be paid no matter what since the guarantee is the taxpayer’s tax refund; therefore, it is considered as a safer type of loan compared to the other types, but then risking everything just to get the money sooner seems to not sound good at all (Pritchard).

Assignment Example | Topics and Well Written Essays - 2500 words - 5

Assignment Example This means that when a company makes an agreement, they must honor this agreement even if the terms are beyond the constitution. In this case, the cat contract with Feline Fertility Pty Ltd is enforceable since company willing entered the contract while understanding that the their constitution did not allow them to trade in cats. Lassie Ltd argues that since the company constitution does not allow the company to trade cats, the contract was invalid and unenforceable. However, going by the law, the fact that the company entered the agreement with Feline Fertility Pty Limited, it remains valid even if this goes beyond the constitution. Therefore, Feline Fertility can move to the court to have the contract enforced and to avoid termination. Alternatively, Lessie Ltd should finance any losses that the other company may incur as a result of this termination. The Company act of 2001 states that a director of the company must act within the constitution while conducting business on behalf of the company. Since the director of the company conducts the business on behalf of the stakeholders, the constitution limits their actions.5 However, this must be in tandem with the requirements of the constitution. In this case, Willy Woof has the power to make decisions regarding the business process, as long as these decisions do not infringe the constitution. The company current constitution allows the director to enter the lease with Hot Ltd.6 However, the other company directors intends to include a new clause that requires that â€Å"the establishment of any store outside the state of Western Australia requires the approval of all the directors.† If the amendment is successfully integrated in the constitution, Lessie will not be able to enter into the agreement with Hot Ltd since the constitution will empower other directors to object suc h a move7. Therefore, changes in the constitution will help

Intrathecal Chemical Neurolysis With Phenol

Intrathecal Chemical Neurolysis With Phenol CANCER PAIN Intrathecal neurolysis with 6% phenol for intractable and opiate resistant perineal pain secondary to terminal bladder cancer . Name : Dr R Srivastava Department: Heart of England NHS Trust, Solihull. E-mail: [emailprotected] Abstract Background: Intrathecal chemical neurolysis with Phenol is a neurodestructive technique to provide saddle anaesthesia for perineal pain, in patients unresponsive to pharmacological therapy or not ameneable to surgical treatment. Its use has been advocated in patients with terminal illness with a short life expentancy of less than a year. Phenol’s neurodestructive mechanism relies on precipitation of proteins in the nerves with myelin sheath separation and axonal oedema, resulting in fibrosis. Neurolysis can be induced with chemicals like phenol or alcohol or by physical methods of radiofrquency or cryoablation Neurolytic saddl block is a high risk procedure leading to almost irreversible neuro-destruction with significant risks including failure, paralysis and incontinence.Careful patient selection and psychological evaluation is mandatory and comprehensive risks and benefits assessment should be carried out before embarking on this technique. Communication with patient is vital due to the resultant side effects of the block. Results: Patient was extensively evaluated for the procedure with all co-morbidities and life expectancy considered and underwent subarachnoid chemical neurolysis with hyperbaric 5% phenol leading to drastic pain relief and significant reduction in opiate consumption. Case Report: Mr JJ ,a 73 year old gentleman was referred form a hospice with complaints of severe abdominal and anal pain due to a surgically inoperable bladder tumor with extensive pelvic involvement and distant metastases . He was referred to our clinic from hospice with severe opiate resistant pain. Mr JJ was diagnosed with the Transitional Cell Carcinoma: T2a N0 MX(Pulmonary nodules) G3,TCC Bladder, eight months ago when he initially presented with back and pelvic pain. He had pulmonary metastases and bladder biopsy and cystoscopy revealed a large tumor on the back wall of the bladder. Mr JJ underwent a radical course of radiotherapy. Subsequently he was admitted to the hospital with rectal pain . Examination under anaesthetic revealed a large mass extending from the bladder in to the prostrate. MRI scan confirmed the tumor with invasion of seminal vesicles and of the prostrate.He underwent ureteric stenting for his right hydronephrosis and hydroureter. His background included history of chronic obstructive airway disease, hypertension, diabetes, Ischaemic heart disease(Coronary stenting 5 years ago) and hypothyroidism. His pain at the time remained unsettled with associated symptoms of tenesmus, nausea and vomiting and profound weakness. Mr JJ lived alone and was unable to cope on his own and was referred to hospice for further palliative care. He was initially treated with Zomorph 30mg twice a day and with Oromorph as a PRN dose for breakthrough pain. Pain worsened over a period of six weeks when it was decided to start him on a syringe driver of diamorphine 30 mgs and metoclopramide30 mgs. Inspite of some relief, he remained extremely confused and constipated. His syringe driver was changed to alfentanil 5mgs and haloperidol 3 mgs to reduce the confusion and drowsiness. Subsequent increment of alfentanil dose via the syringe driver did not resolve his rectal pain. In view of his worsening symptoms and prognosis ,saddle block with phenol for rectal pain remained the only viable option. After a careful assessment and explanation of the risks ( double incontinence and possible paralysis) and benefits of the procedure explained, patient was transferred to our centre as a day case and underwent intrathecal neurolysis with phenol. 1 ml of 5% phenol in glycerol was injected intrathecally and flushed with 0.2 mls of 0.5% hyperbaric bupivacaine. Patient was sat up for 30 minutes to achieve a saddle block. In recovery he seemed to be pain free with no loss of motor power. Mr JJ was transferred back to the hospice the same day. During follow up it was noted that within a few days Mr JJ’s alfentanil infusion was stopped and he was more awake and was managing on small doses of oral morphine of up to 40 mgs a day. His tenesmus completely disappeared but he still complained of some dull aching and deep visceral pain. Case discussion: There are more than 5000 deaths/year related to bladder cancer in the UK and it is the seventh commonest cause of cancer related deaths. Our patient had an extensive spread of his bladder tumor resulting in a combination of background visceral pain involving the rectum causing intractable tenesmus Prevalence of cancer pain in patients with incurable or advanced disease ranges from 43 -63%. More than one third of the patients complain of significant pain during the terminal stages of the disease.[1] Pathophysiological Mechanisms: The mechanisms involving cancer pain are complex and can not be solely attributed to either nociceptive ,musculoskeletal , visceral or neuropathic pain . Pain presents itself as a combination of various mechanisms, which would be dependent on the characteristics of disease progression. Visceral pain as was the case with our patient has both spinal and vagal innervation with feature of dull and diffuse pain with poor localization. Cancer cells in combination with the stromal cells will result in release of inflammatory markers like endothelin, bradykinin , tyrosine kinase and proteases which would lead to sensitization of the nerve fibres. Tyrosine kinase seems to play an important role in the sensitization of the afferent nociceptors.[2] Growth of the tumor may cause direct compression of the nerve fibres resulting in ischemia related neuropathic pain. Cancer induced bone pain is a result of proliferating osteoclasts which lead to bone resorption. This also leads to stimulation of TRPV1 and acid sensing channels expressed on the nerve fibres resulting in cancer associated bone pain. Periosteal sensitization of afferent fibres in an acidic melieu contributes to the persistence of cancer pain.[3] Assessment of cancer pain remains complex and is influenced by patient population, variability in assessment tool ,scoring systems and under reporting of severity of pain by patients.[4] Assessment of patients with cancer requires a multidimensional approach in order to evaluate the physiological, psychological and social impact on life. A careful assessment of history, symptoms, signs and disease progression is crucial. Patient’s expectations with regards to treatment should be discussed and the impact of pain on patients functional activity should be assessed. Patients with cancer complain of background pain and exacerbation of pain (Breakthrough Pain), which might be related to movement or due to progression of tumor resulting in compression of underling tissues and organs . Metastases to the bone can be the primary cause of pain in up to 75% of the patients. Assessment of localization, severity, duration, exacerbating and relieving factors is a must. Cancer pain patients are often on high dose of opiates for their pain control, which may have a detrimental effect on their daily living due to side effects of tolerance to opiates, opioid induced hyperalgesia, leading to inadequate pain control. Management of cancer pain: Cancer pain management in a palliative patient is challenging and requires consideration of all aspects of pain in the terminally ill. Optimum control can only be achieved if pharmacological and bio-psycho-social element of treatment are carefully reviewed. Most patients understandably are depressed and more than 75% suffer from moderate to severe pain. Surgical management is rarely appropriate in patients with distant metastases but may be indicated in some circumstances like internal fixation for pathological long bone fracture. Chest drainage may be required for patients with mesothelioma for recurrent pleural effusion. Radiotherapy which can be localized or wide field and may be useful in patients with metastatic bone disease with proven efficacy of up to 60%. and 25% respectively. Radioisotopes like strontium are also used to treat metastatic bone disease but may not be cost effective in all healthcare systems. Chemotherapy may be helpful in some types of cancer,provided that the tumor remains chemo-sensitive. Assessing the benefits of chemotherapy with regards to prognosis and life expectancy is crucial as the side effects of chemotherapy may be more detrimental to the patient than the pain itself. Hormonal therapy has been useful in prostrate and breast cancer with anti-androgen and anti-oestrogens as both types of cancer are hormone sensitive. Pelvic pain may result from the tumor invasion to organs and The World Health Organisation (WHO) 3 step analgesic ladder of 1986 recommends a staged approach from non-opiods like paracetamol and non-steroidal anti-inflammatory drugs to weak opioids and if necessary ,strong opioids for moderate to severe pain. However, the role of adjuvants like tricyclic anti-depressants, selective serotonin reuptake inhibitors and anticonvulsants like gabapentin and pregabalin should be considered and individualized depending on the symptomatology of the patient. NMDA antagonist like ketamine may help reduce central sensitization[6] Heavy reliance on strong opioids can lead to troublesome side –effects which should be appropriately managed with laxatives and anti-emetics. Opioid rotation should be considered for opioid induced hyperalgesia as in the case of Mr JJ where diamorphine was substituted for alfentanil infusion. Evaluation of psychological factor of perception of pain and the behavioural responses has a significant impact on patient’s lifestyle. Cognitive behavioral therapy may help elicit these perception and help individuals with chronic pain ,forming coping strategies. Pain management programme is helpful for the patient in identifying all aspects of pain and are aimed at improving the quality of life. Physical therapy for pain is aimed at improving functionality and reducing the physiological deconditioning. Lifestyle adjustment in terms of daily routines ,tasks and adapting to new envoirement should be planned for facilitating any coping strategies. Intervention techniques are aimed at targeting the source of pain involving destructive and non-destructive techniques which could involve local anesthetics and steroids for nerve blocks .Continuous infusions of local anaesthetics and opioids via a catheter placed intrathecally, can be used for spinal cord modulation and pain control. Catheter is connected to a programmable pump to administer the desired dose. Nerve destructive techniques should be only considered in a multidisciplinary framework . Patient selection and progonostication of the illness is paramount. It is important that the patient has a full understanding of the procedure and the benefits at the expense of the undesired consequences of such a block like incontinence or motor paralysis. Trial of local anaesthetic is desirable in most cases to predict efficacy of further neurolysis. Neurolytic blocks necessiate the need for close monitoring and evaluation of patient’s pain scores in order to titrate the strong opioids accordingly. Indications and contraindications to Intrathecal neurolysis: Although there has been a decreasing trend in the use of intrathecal neurolysis following advancement in the techniques of spinal blocks with infusions of local anaesthetics and opioids; intrathecal neurolysis has its place in a select subset of patients in whom the pain remains refractory inspite of conventional therapies and treatment with strong opioids . The distinct advantage with neurolysis is of reduction in the opiate consumption and the associated side effects. Complications of subarachanoid block include bladder and bowel dysfuction along with motor weakness .[5]. Pain relief associated with neurolytic blocks is short lived(less than 6 months), and disease progression may lead to refractory pain .In view of our patient’s limited life expectancy of less than two months with pre- exsisting bowel and bladder dysfunction ,intrathecal neurolysis was the quickest and the most cost effective way to provide pain relief. Neurodestructive techniques used in clinical practice range from cryoablation, radiofrequency lesioning to chemical neurolysis with Alcohol (50-100%),Phenol (7-12%) , Hypertonic saline and glycerol. Intrathecal neurolysis: It involves the destruction of nociceptive afferent fibres ,both myelinated and unmyelinated leading to almost instant pain relief. It is effective in well localized pain. The effect of neurolysis is short lived but it involves a short period of hospitalization in comparision to neurosurgical procedures like cordotomy. Phenol(7-12%) causes nerve destruction by coagulating protein in both small and large fibres which leads to degeneration of the nerves within the nerve roots involving more of the posterior than anterior columns. Nerves tend to regenerate faster with phenol than alcohol . Phenol is hyperbaric and when mixed with glycerol, it tends to diffuse more slowly out of the solution causing a more targeted destruction compared to alcohol. It can be mixed with water but the nerve destruction will be more extensive. Phenol compared to alcohol is not painful on injection and for this reason alcohol injections are administered with a local anaesthetic. In concentrations of lower than 5%, phenol tends to exert local anaesthetic action rather than neurodestructive. Phenol when mixed with glycerol or radiopaque dye can provide a higher concentration of up to 15%. Neurolysis with phenol in comparision to alcohol is milder and short lived. Due to the hyberbaric nature of phenol in comparision with alcohol, the patient is positioned with the affected side down to target the dorsal roots. Phenol being highly viscous requires a wider bore spinal needle for injection. Phenol can cause skin and tissue necrosis along with neuritis if the nerve destruction is incomplete. For patients undergoing neurolysis with alcohol the targeted side is positioned up due to the hypobaric nature of the solution. Patients are initially in the lateral position followed by proning to 45 degrees to target the dorsal roots. Alcohol may cause mild burning on injection. Hypertonic saline(10-15%) for intrathecal neurolysis can provide a significant relief of more than 50% but has significant side effects. Conclusion: Management of cancer pain is very complex and challenging and requires considerable expertise in providing appropriate care to terminally ill patients. Significant reliance on strong opioids is not without it’s side effects and a multifaceted approach towards pain control is warranted. Our patient was treated with chemical neurolysis as a last resort since all other measures had failed. Although it helped in reduction of opiate requirement and drowsiness, it still remains difficult to judge the correct dosage and concentration of phenol and balance it against the duration of pain free interval with minimum side effects for the patient before leading to death. Intrathecal neurolysis is not a routine procedure and outcomes of this type of intervention are variable. The extreme complications of this procedure and availability of other techniques makes clinicians reluctant to use in their regular clinical practice. However, cancer pain treatment needs to be tailored in accordance with the patients condition and chemical neurolysis may perhaps be the only option to relieve pain in specific patients. References: [1]M. H. J. van den Beuken-van Everdingen, J. M. de Rijke, A. G. Kessels, H. C. Schouten, M. van Kleef, and J. Patijn, â€Å"Prevalence of pain in patients with cancer: a systematic review of the past 40 years,† Ann. Oncol. Off. J. Eur. Soc. Med. Oncol. ESMO, vol. 18, no. 9, pp. 1437–1449, Sep. 2007. [2]S. Pezet and S. B. McMahon, â€Å"NEUROTROPHINS: Mediators and Modulators of Pain,† Annu. Rev. Neurosci., vol. 29, no. 1, pp. 507–538, 2006. [3]â€Å"Review of Cellular Mechanisms of Tumor Osteolysis.à ¢Ã¢â€š ¬Ã‚ ¯: Clinical Orthopaedics and Related Research,† LWW. [Online]. Available: http://journals.lww.com/corr/Fulltext/2000/04000/Review_of_Cellular_Mechanisms_of_Tumor_Osteolysis_.13.aspx. [Accessed: 23-Nov-2014]. [4]C. Shute, â€Å"The Challenges of Cancer Pain Assessment and Management,† Ulster Med. J., vol. 82, no. 1, pp. 40–42, Jan. 2013. [5]A. Watanabe and M. Yamakage, â€Å"Intrathecal neurolytic block in a patient with refractory cancer pain,† J. Anesth., vol. 25, no. 4, pp. 603–605, Aug. 2011. [6]Cancer Pain Management. The British Pain Society 2010

The Canadian Governing System is not Fair or Democratic Essay -- essay

There are Canadian citizens who thought that the Canadian government we have is perfect, citizens who believed that every aspect of the government was truly democratic, and citizens who believe that government could do no wrong. Truly this group of believers has been living a lie. In our Canadian system of government, large aspects within are far from democratic and need to be changed. Liberal-minded people will cry out for a change in order for government to serve the people better, and on the other hand the more conservative thinkers will argue that no change is needed because our government is efficient and considerate. However, our voting system, our Senate, and the power vested to the Prime Minister are far from democratic, do not meet the actual needs of the people and definitely need to be addressed. Canada itself claims to be democratic, yet the Canadian Senate is appointed to office by the current Prime Minister rather than elected by the citizens. The original purpose of the Senate was to give fair representation between provinces and to the citizens. Having failed its purpose, clearly there are issues within the Senate that need to be addressed. Because of the Prime Minister appointing the Senators, they will now serve the Prime Ministers needs rather than the people who they should have been listening to. As if this were not enough of a show of power for the Prime Minister, the Senators cannot be lawfully kicked out of office until the age of seventy-five. An example of Senate idiosyncrasy in Canadian government is Ross Fitzpatrick, who was appointed to office by former Prime Minister Jean Chretien of the Liberals in June 1990. His official opponent, Preston Manning, rightfully questioned the circumstances regardin... ...e a lot of parties are going to be running for office. However, for the fringe parties this creates a major advantage for them. With the load of political parties in the House of Commons, there would be a wider range of interests for people but there would be a lot of indecision and coalitions. It is cold hard fact that Canadian government is not entirely democratic. The question remains of how to deal with this. Canadian government, as effective as it currently is, has major factors in their system that have a negative effect on Canadians. Our current voting system favors the higher-populated provinces and creates a tyranny of the majority. Our Senate is distinctly undemocratic as it is an assigned position. Our head of State, the Prime Minister, holds too much power. Unless we resolve these issues, our government will remain far from a perfect governing system.

Balancing Penn Foster Studies Essay

Balancing Penn foster studies with work and family Being a full time working father of one, I have the responsibility of taking caring of my mother, wife and son. However this doesn’t hinder me to continue my studies, though it has some difficulties on adjusting the life in between my studies and family life. The hardest part for me in balancing my studies, work and family demands is just how to set up the time so everything is balanced out. I guess that we all must have to make personal sacrifices in order to be successful and have a fulfilling life. With proper planning however the balance between work, family, and collage studies is possible to obtain. Everyday I must make choices on how I will manage my time so I can keep the balance of my studies, work, and family demands. Maintaining the balance between everything is an everyday process. This is where the real task of balance takes place. While attending the Penn foster online courses and sitting time back for my studies, I also have a family to take care of, which requires most of my time. I also have    a full time job that requires me to work on the grave yard shift. Despite the fact that each of the responsibilities need more time on their own I have to set specific times up in a daily planner and discuss these set of specific times with my family and friends so that they can help me keep the balance between work, family demands, and my collage studies. I know that people struggle everyday to balance their studies, work, and family demands. However, I also believe that each person must come up with their own way of balancing things out in their life, so they are happy and successful. Keeping the balance between work, family demands, and college can be a very difficult process to do, but with the support from family and friends it can be done. Generally speaking, nothing is in possible in this world. Many people think that once they have their own family they ignore their studies and focus on their work. This is all because they think they will not get enough time to concentrate on their studies while looking after their work and family. I was also of such kind of people for long time until I got the advice from friends and families and got the courage to continue my studies. The difficulties of adjusting time cannot be denied however, managing ones time will solve all the difficulties. The idea of online studies has also contributed a lot in encouraging many working people who have family as well to continue their studies at their convenience time and place. Besides, going through the difficulties of attending your studies while taking care of your family and work is also worth as it will lead you to a better and successful life in the future.

Every Day Use essays

Every Day Use essays In Alice Walkers story Everyday Use the two sisters, Maggie and Dee are foils or opposites. They have nothing in common except that they have the same mother. They have many opposite characteristics through out the story and one major opposing viewpoint that contributes to the meaning of this story and its theme. The central theme of the story concerns the way in which an individual understands his present life in relation to the traditions of his people and culture. Dee tells her mother and Maggie that they do not understand their "heritage," because they plan to put "priceless" heirloom quilts to "everyday use." The story makes clear that Dee is equally confused about the nature of her inheritance both from her immediate family and from the larger black tradition. The two opposite beliefs of the sisters teach a valuable lesson about family and heritage and how it should be considered. There are many factors leading to Maggie and Dee being foils. One way they are opposite is that Maggie is younger than Dee and is shy and timid whereas Dee can look anyone in the eye and talk to them, meaning she is very outgoing and not quiet. For example, when Dee arrives at the house, Maggie tries to hide behind her mother and does not speak because she is scared of even her own sister. It also says that Maggie is not very articulate, whereas Dee is very bright. In the story where Mrs. Johnson says She used to read to us without pity; forcing words, lies, other folks habits, whole lives upon us two sitting trapped and ignorant underneath her voice (1556). Also, Maggie only has a high school education compared to Dees college education. When Mrs. Johnson says, Maggie sometimes reads to me. She stumbles along good-naturedly but cant see well. She knows she is not bright. Like good looks and money, quickness passed her by (1557). She knows that Maggie and Dee are nothing alike, but tends to love th...

Founder of the Black Panther Party Huey P Newton A Forgotten Legacy essays

Founder of the Black Panther Party Huey P Newton A Forgotten Legacy essays In the late 1960's and early '70's posters of the Black Panther Party's co-founder, Huey P. Newton were plastered on walls of college dorm rooms across the country. Wearing a black beret and a leather jacket, sitting on a wicker chair, a spear in one hand and a rifle in the other, the poster depicted Huey Newton as a symbol of his generation's anger and courage in the face of racism and classism. He is the man whose intellectual capacity and community leadership abilities helped to found the Black Panther Party (BPP). Newton played an instrumental role in refocusing civil rights activists to the problems of urban Black communities. He also tapped the rage and frustration of urban Blacks in order to address social injustice. However, the FBI's significant fear of the Party's aggressive actions would not only drive the party apart but also perpetuated false information regarding the Panther's programs and accomplishments. In recent years, historians have devoted much attention of the e arly 1960's, to Malcolm X and Martin Luther King and have ignored the Black Panthers. The Panthers and Huey P. Newton's leadership of the Party are as significant to the Black freedom struggle as more widely known leaders of the Civil Rights Movement. A typical American history high school textbook not only neglects to mention Huey Newton but also disregards the existence of the Black Panthers altogether . Therefore, we must open this new chapter in American history and discover the legacy and story of Huey P. Newton's Black Panthers, which has been hidden for far too long. Huey's experiences growing up were central in his conception of the Black Panthers. Unlike King and many other civil rights leaders who were religious Southerners, from middle class and well-educated families, Huey P. Newton was a working class man from a poor urban black neighborhood. Born February 17, 1942, in Oak Grove Louisiana, Huey moved to Oakland, California shortly after his ...

Ethics In The Workplace Essay Example | Topics and Well Written Essays - 500 words

Ethics In The Workplace - Essay Example The worst thing about Bob’s act in cheating the old man is lowering the belief in the basic nature of a fellow human being. Part C: Yes, it is very important to keep a word of promise, irrespective of whether the promisee is known or not or whether we see that person again or not. Failure to keep a promise is an act of cheating that is violating the other person’s right not to be abused. For the person indulging in cheating, it also involves living with that guilt feeling forever and consequently suffering a loss of self-esteem. While deciding on the policy with its ethical implications, I would be guided by not sentimental or political considerations but by the consequential results of my action. The larger question would then be: Will doing business in China, albeit with censored version of services, lead to opening a window of opportunity, however small an opening it may be, for the people of China? Most certainly it does. According to Google’s policy, politically unacceptable information would be blocked out and the viewer informed of the same. This act by itself and the frequency with which such blockades take place are most likely to be a source of embarrassment to the authorities who can be expected to slacken the controls – in other words, open the window a little more. Thus, Google’s policy, while being Utilitarian morally, also has the desirable objective of contributing to the common good of the customers in the longer run. iii). ‘Ends do not always justify means’ is my new perception, after the lessons. In personal life or professional life, even when difficult decisions are to be taken, I would act in as transparent a manner as possible to make my objective clear and ethically

Ethics and the college Student Essay Example | Topics and Well Written Essays - 750 words

Ethics and the college Student - Essay Example These resources are used to enhance and promote conversations and curricula on issues relating to ethics designed for college students, staff, and even the administration. Among the code of ethics include integrity which is to be present in any manner of relationship. Moreover, must treat others in respect, fairness and honesty. Competence is paramount any college for it to realize its educational objectives. Students in any college are to ensure equality and acceptance so as to prevent harassment, discrimination, and intimidation. Finally, it is honor and trust in all academic assignments thus avoiding plagiarism in any given assignment. Discussion A code of ethics must be there in colleges so as to curb cheating and related vices. Cheating is an epidemic in most of the colleges as it affects almost fifty percent of the total student population. The code of ethics is affected by the social characteristics and demographics of students like sex, age, levels of test anxiety, academic s tanding, and internal social control. Thee factors have been found to contribute to cheating in colleges which is unethical (Loveland & Rayna, 2000). This is because many students have rationalized their behavior in cheating and they do so without having to challenge the norm of honesty that is required. Most of the commonly cited technique they use is the denial of responsibility. In addition they use the neutralization technique of appealing to the higher loyalties. Here, they have been arguing that it is more vital to aide a friend than to avoid cheating which quite unethical. By the students recognizing and accepting cheating as a very undesirable behavior but nonetheless they see it as an excuse under certain circumstances thus the presence of situational ethics. To some students cheating is planned, expected and their opinion it is rewarded by good grades. This leaves the ethics and internalized control of the student as a barrier to cheating (Corll, 2007). However, the neutra lizing attitude gives the students the green light to side step issues of guilt and ethics and going ahead to place the blame for their behavior on another front. This concept of neutralization in relation to the ethics of college students permits them to state that cheating is wrong but to some extent in special circumstances it is acceptable, and even necessary. David Matza and Gresham Sykes (1957) are the first who developed the concept of neutralization so as to explain the concept of delinquent behavior. They explained the expression of delinquent behavior through the process of situationally defining deviant behavior in this case the college students through naturalization justify the violation of accepted behavior (Labeff et al, 2010). Plagiarism is considered as an act of dishonesty in academic spheres whereby a person takes the work of others and presents them as his or her own without proper attribution. Plagiarism can have numerous effects on both the student and the educ ational sector as a whole. Plagiarism leads to the student failing to develop sharp critical thinking skills which are paramount in any learning process. Also, it damages the relationship between the students and teachers by eroding their mutual trust and the students who legitimately earn their grades. Plagiarism can lead to loss of a degree or a job. This includes the college students, the college faculty members who may plagiarize the work of other scholars, and finally professors who face