Health Care Reform Essay Example | Topics and Well Written Essays - 3000 words

Human services Reform - Essay Example Some the advantages incorporate permitting kids to buy protection, toward the beginning of 2014 ladies will never again be charged more than men. Protection firms will likewise be directed so they can't climb protection rates when an individual becomes sick will be good for all the residents. This control of the protection will enormously help in guaranteeing that the wellbeing of any individual isn't risk a direct result of their societal position and age The capacity of state-based trades will likewise permit people who are jobless to buy protection. Sponsorships will likewise be given to those families that are beneath the government neediness level. These changes will be an incredible lift to the greater part of the residents who don't win a better than average salary (Jill, 2012). Human services in the United States is a major piece of living. This is because of the numerous medical problems that Americans face in an everyday schedule. In any case, the social insurance structure in the America is looked by a major issue of costly administrations, which isn't reasonable to the greater part of the individuals. A major level of American populace isn't restoratively safeguarded and this prompts the doctor visits being unreasonably costly for a conventional resident. Roughly 44million Americans are not guaranteed and an extra 38 million have inadequate medical coverages. This populace experience every day not certain what might occur in the event that they fell debilitated or needed clinical consideration. The nonattendance of a clinical protection hence implies that they can't visit the doctor for ordinary check ups and will consistently delay ailments or excursions to the specialist since they basically can't manage the cost of it. Deferred clinical consideration because of a paranoid fear of costs is a catastrophe considering the quantity of individuals in the nation and the sicknesses that could be dealt with early turning lethal. Individuals without health care coverage are at the most serious danger of not getting diseases sufficiently early and not gaining clinical

England :: essays research papers

History of England The Ice Age finished around 8000 BC, during which the Neanderthals and Cro-Magnons lived in Great Britain. In light of the dissolving ice the water level rose and the English Channel was made, making Great Britain an island. The Middle Stone Age went in this new backwoods and bog, trailed by the New Stone Age when the act of cultivating started. During this period a ton of new individuals came to Britain. By 2500 BC the Beaker individuals had moved there. They were named after their earthenware, and noted for their bronze devices and tremendous stone landmarks, similar to Stonehenge. These Monuments demonstrate they had a superb monetary association just as their specialized aptitude and capacity. Around 1000 BC the Celts assumed control over the British Isles, they additionally took over the greater part of western Europe. In light of their iron furrows, iron weapons, and pony drawn chariots, they had the option to assume control over the occupants of the islands. Their clerics ruled their general public. Lord Alfred became ruler of Wessex in probably the breaking point. The Danes, viking powers that had assaulted the English drifts in the eighth century, wanted to assume control over England. All that held them up were Wessex and Alfred. After Alfred's triumph at Edington in 878 AD he made the Danish ruler Guthrum acknowledge absolution and a division of England occurred. The two sections were Wessex and Danelaw. By making a naval force, redesigning the volunteer army, permitting warriors to switch among cultivating and battling, and fabricating posts, Alfred had the option to assume control over London and start to take over tthe Danish. The battel to assume control over the Danish was finished by Alfred's child, Edward the Elder, and by his grandson Athelstan. Athelstan won a fight at Brunanburth in 937 AD and the vast majority of the remainder of the century was quiet. Holy person Dunstan, Archbishop of Canterbury had the option to reestablish the Church. The victory of the Danelaw implied the production of brought together government for the entirety of England. In spite of this the Danish intrusions returned again during Ethelred II's rule. In 1154 Henry II took the seat. During his rule he fortified the administration, built up the precedent-based law, made the fantastic jury, and endeavored to decrease the purview of chapel courts. He was contradicted by Thomas Becket, his previous chancellor, who King Henry had made ecclesiastical overseer. His resentment at Becket prompted his homicide. His realm included portion of France and lordship over Ireland and Scotland.

Guest Blog Music and Mayhem by Jess 12

Guest Blog Music and Mayhem by Jess ‘12 Hi, Im Jess L. 12. I met Yan during our freshman year (she even unwittingly snapped a picture of me in Diff Eq. around Valentine’s Day http://www.mitadmissions.org/topics/life/student_life_culture/valentines_day_special_1.shtml) and continued to run into her with increasing frequency until we were living under the same roof this summer at pika*. You might recall we journeyed to New York City at the end of July and survived a gastronomical bildungsroman**. *In all prepositional honesty, at least half of the living at pika happens on the roof instead of under it. Pikas homemade, impeccably sanded (by Yan Co.) roofdeck is a full-service pit stop on the road to cozy summer skylines, breezy sunsets, and barely-interpolated constellations swimming in celestial gutters cluttered with light pollution. As I shiver in the dregs of December and qwertily exercise fingers unwarmed by penurious radiators, I cant help but rhapsodize my midsummer memories of coarse-grained films splattered onto a makeshift screen on the roofdeck, froth-tipped banana-sweet smoothies on the roofdeck, impromptu rope-climbing on the roofdeck, reading books in eye-frazzling noon sunlight on the roofdeck, listening to Jess discover the 2934829th normal mode of her violin on the roofdeck, absorbing plenty of delightful UV radiation on the roofdeck . . . anyway, I digress. **Way to steal my polysyllabic descriptors, Jess. For kicks, I asked to borrow five minutes of her fame, and she gave me a guest blog entry. Yans pretty generous.* *Jess, I could use a little more specificity here. Remember the time you gave me two entire packs of gum because I mentioned that the kind you had in your backpack was the most delicious thing I have ever eaten instead of breakfast while trying to catch a bus? And remember how I was so Oprah-gasmically grateful that I gave you one of my granola bars from Trader Joes? Anyway, I think that would have made a fine anecdote about the value of friendship and generosity, etc. Im Course 6-2 (Electrical Engineering and Computer Science) and live on Conner 4 of Burton-Conner. Basically, Ive got a run-of-the-mill major and live in a dorm populated by a glut of bloggers, past and present. There are a few unusual things I can share about my experience at MIT, though. For one, I have a UROP (a research job) that’s in a field totally outside my major and so non-technical that it’s slightly blasphemousâ€"it’s in Course 21W: Writing and Humanistic Studies.* *What in the world is a writing UROP, Jess? “What in the world is a writing UROP?” you ask.* *Way ahead of you, Jess. I’m working as an editorial assistant for Angles (http://web.mit.edu/angles/), a magazine of exemplary work written by students in MIT’s introductory writing classes. The authors here aren’t the most polished, professional writersâ€"these are the voices of regular MIT students who take the introductory classes to improve their writing, or out of interest in a particular class’s topic, or even because they are required to by the results of the Freshman Essay Evaluation. Regardless, the essays students produce in these classes are thought-provoking and even intensely personal at times. In the course titled “Writing and Experience,” people have written on topics ranging from coming to terms with their racial identity, to the death of a brother, to ethical vacillations about vegetarianism.* *Jess, alliteration with the letter V is so passe. Ever since that movie came out that began with the letter V and ended with the letters “for Vendetta,” you cant say phrases like “vacillations about vegetarianism” anymore unless you wear a plastic halloween mask. So, there you go, UROPs don’t have to be in your major, or even technical. I also do quite a bit of music in what time I can squeeze out of my life during the school year. And here’s a not-so-big-secretâ€"the music department at MIT is a gem.* *Mohs def, Jess. (Mineralogy puns are hard.) I started piano in kindergarten, violin in third grade, and played in the Boston Youth Symphony Orchestras from middle through high school. When it came time to choose a college, music was an important factor in my decision. What initially drew me in about the MIT Music Department was the Emerson Scholarship Program, which funds half to all of students’ private instrumental or voice lessons if they pass an audition. MIT has a variety of musical ensembles, from the standard to the exotic: the MIT Symphony Orchestra; Chamber Music Society; Wind Ensemble; Concert Choir; Festival Jazz Ensemble; Rambax, a Senegalese drumming ensemble; and Galak Tika, a Balinese gamelan. There are many fine musicians* here (especially pianists). Some people here go to Aspen Music Festival and other competitive music programs over the summer. *Did you know that Feynman played the bongos? This term I took two and a half music classesâ€"Musical Improvisation, Harmony and Counterpoint I, and Chamber Musicâ€"which combined with last year’s classes finished up my humanities concentration in music. My favorite class was Musical Improvisation, which was taught by a visiting professor, Donal Fox. As a classically-trained musician, I had always played the notes on the page. The professor asked us to keep a journal through the class, so I started a blog for it. The last entry pretty much sums up what I want to tell you about that class. I would just copy/paste. Although HASS classes are considered by some to be exercises in irritation*, there’s a benefit people don’t talk about muchâ€"you make friends through these classes. At least in freshman and sophomore years, when the courses you take tend to be large lectures in which you’re one in a relatively faceless crowd, HASS classes are a good way to meet new people. By virtue of being HASS, they tend to involve more discussion and interaction. All the ones I’ve taken have had fewer than twenty people, and I’ve met a range of students from different backgrounds**â€"from different majors, living groups, and graduating classes. *No kidding. Nothing quite jerks your stomach into your lungs like spending two hours fleshing out the harmonic nuances of a Bach chorale in Harmony and Counterpoint II only to discover that you missed the key signature that Bach intended by an angle of pi/2 on the Circle of Fifths. Trignometry hurts. **Speaking of diversity, I met someone in one of my HASSes who didnt like any sauces with tomatoes. And hey, chances are I’ll meet none of you reading this, unless we take the same HASS*. *Jess is being humble here. Other ways of meeting Jess include but are not limited to: living at pika over the summer, working for the Tech, playing in MITSO, joining the Sport Taekwondo team, spending all your time in Course 6-2 classes, letting me have your gum, writing a guest blog for MITadmissions, spending a happy new year (hopefully) with your family in Massachusetts, and visiting me over IAP because we didnt spend nearly enough time together this term, right, Jess?

Why Joe Biden Quit His 1988 Campaign

Long before Joe Biden was tapped to be Barack Obamas vice president, and long before he began testing the waters for the 2016 Democratic presidential nomination, the lawmaker from Delaware got caught up in a plagiarism scandal that derailed his first campaign for the White House in 1987. Later in his political career, Biden described his 1987 campaign as an embarrassing train wreck and put the plagiarism case behind him, but his use of others work without attribution became an issue in the 2016 presidential election. Joe Biden Acknowledges Plagiarism in Law School Biden first publicly acknowledged plagiarizing another authors work during his bid for the 1988 Democratic presidential nomination. Biden used five pages from a published law review article without quotation or attribution in a paper he claimed to have written as a first-year student at the  Syracuse University College of Law, according to a faculty report on the incident issued at the time. The article Biden plagiarized, Tortious Acts as a Basis for Jurisdiction in Products Liability Cases,  was initially published in the  Fordham Law Review in May 1965. Among the sentences Biden used without appropriate attribution, according to a New York Times report, was: The trend of judicial opinion in various jurisdictions has been that the breach of an implied warranty of fitness is actionable without privity, because it is a tortious wrong upon which suit may be brought by a non-contracting party. Biden apologized to his law school when he was a student and said his actions were unintentional. On the campaign trail 22 years later, he told the press before abandoning his campaign:  I was wrong, but I was not malevolent in any way. I did not intentionally move to mislead anybody. And I didnt. To this day I didnt. Joe Biden Accused of Plagiarizing Campaign Speeches Biden was also said to have used without attribution substantial portions of speeches by  Robert Kennedy and Hubert Humphrey, as well as  British Labor Party leader Neil Kinnock, in his own stump speeches in 1987. Biden said those claims were much ado about nothing but eventually  quit his campaign for the 1988 Democratic presidential nomination on  Sept. 23, 1987, amid scrutiny of his record. Among  the  similarities with Kinnock that came under scrutiny, according to The Telegraph newspaper, was this Biden turn of phrase: Why is it that Joe Biden is the first in his family ever to go a university? Why is it that my wife ... is the first in her family to ever go to college? Is it because our fathers and mothers were not bright? ... Is it because they didnt work hard? My ancestors who worked in the coal mines of northeast Pennsylvania and would come after 12 hours and play football for four hours? Its because they didnt have a platform on which to stand. The Kinnock speech reads: Why am I the first Kinnock in a thousand generations to be able to get to university? Was it because our predecessors were thick? Does anybody really think that they didnt get what we had because they didnt have the talent or the strength or the endurance or the commitment? Of course not. It was because there was no platform upon which they could stand. Plagiarism Cases an Issue in 2016 Campaign The plagiarism cases were long forgotten until Biden, who was vice president at the time, began testing the waters for the Democratic presidential nomination in 2015. Republican presidential hopeful Donald Trump  asked how hed fare against Biden in a general election in August 2015, brought up Bidens plagiarism. Trump said: I think Id matchup great. Im a job producer. Ive had a great record, I havent been involved in plagiarism. I think I would match up very well against him. Neither Biden nor his campaign commented on Trumps statement.

History of the Domestication of Donkeys

The modern domestic donkey (Equus asinus) was bred from the wild African ass (E. africanus) in northeastern Africa during the predynastic period of Egypt, about 6,000 years ago. Two wild ass subspecies are thought to have had a role in the development of the modern donkey: the Nubian ass (Equus africanus africanus) and the Somali ass (E. africanus somaliensis), although recent mtDNA analysis suggests that only the Nubian ass contributed genetically to the domestic donkey. Both of these asses are still alive today, but both are listed as critically endangered on the IUCN Red List. The donkeys relationship with the Egyptian civilization is well-documented. For example, murals in the tomb of the New Kingdom pharaoh Tutankhamun illustrate nobles participating in a wild ass hunt. However, the real importance of the donkey relates to its use as a pack animal. Donkeys are desert-adapted and can carry heavy loads through arid lands allowing pastoralists to move their households with their herds. In addition, donkeys proved ideal for the transport of food and trade goods throughout Africa and Asia. Domestic Donkeys and Archaeology Archaeological evidence used to identify domesticated donkeys includes changes in body morphology. Domestic donkeys are smaller than wild ones, and, in particular, they have smaller and less robust metacarpals (foot bones). In addition, donkey burials have been noted at some sites; such burials likely reflect the value of trusted domestic animals. Pathological evidence of damage to spinal columns resulting from donkeys use (maybe overuse) as pack animals is also seen on domestic donkeys, a situation not thought likely on their wild progenitors. The earliest domesticated donkey bones identified archaeologically date to 4600-4000 BC, at the site of El-Omari, a predynastic Maadi site in Upper Egypt near Cairo. Articulated donkey skeletons have been found buried in special tombs within the cemeteries of several predynastic sites, including Abydos (ca. 3000 BC) and Tarkhan (ca. 2850 BC). Donkey bones also have been discovered at sites in Syria, Iran, and Iraq between 2800-2500 BC. The site of Uan Muhuggiag in Libya has domestic donkey bones dated to ~3000 years ago. Domestic Donkeys at Abydos A 2008 study (Rossel et al.) examined 10 donkey skeletons buried at the Predynastic site of Abydos (about ca 3000 BC). The burials were in three purposefully constructed brick tombs adjacent to the cult enclosure of an early (so far unnamed) Egyptian king. The donkey tombs lacked grave goods and in fact, only contained articulated donkey skeletons. An analysis of the skeletons and comparison with modern and ancient animals revealed that the donkeys had been used as beasts of burden, evidenced by signs of strain on their vertebral bones. In addition, the body morphology of the donkeys was midway between wild asses and modern donkeys, leading researchers to argue that the domestication process was not complete by the end of the predynastic period, but instead continued as a slow process over periods of several centuries. Donkey DNA DNA sequencing of ancient, historic and modern samples of donkeys throughout northeastern Africa was reported (Kimura et al) in 2010, including data from the site of Uan Muhuggiag in Libya. This study suggests that domestic donkeys are derived solely from the Nubian wild ass. Results of the testing demonstrate that Nubian and Somali wild asses have distinct mitochondrial DNA sequences. Historic domestic donkeys appear to be genetically identical to Nubian wild asses, suggesting that modern Nubian wild asses are actually survivors of previously domesticated animals. Further, it seems likely that wild asses were domesticated several times, by cattle herders perhaps beginning as long ago as 8900-8400 calibrated years ago cal BP. Interbreeding between wild and domestic asses (called introgression) is likely to have continued throughout the domestication process. However, Bronze Age Egyptian asses (ca 3000 BC at Abydos) were morphologically wild, suggesting either that the process was a long slow one, or that wild asses had characteristics that were favored over domestic ones for some activities. Sources Beja-Pereira, Albano, et al. 2004 African origins of the domestic donkey. Science 304:1781. Kimura, Birgitta. Donkey Domestication. African Archaeological Review, Fiona Marshall, Albano Beja-Pereira, et al., ResearchGate, March 2013. Kimura B, Marshall FB, Chen S, Rosenbom S, Moehlman PD, Tuross N, Sabin RC, Peters J, Barich B, Yohannes H et al. 2010. Ancient DNA from Nubian and Somali wild ass provides insights into donkey ancestry and domestication. Proceedings of the Royal Society B: Biological Sciences: (online pre-publish). Rossel, Stine. Domestication of the donkey: Timing, processes, and indicators. Fiona Marshall, Joris Peters, et al., PNAS, March 11, 2008.

Palliative care is an approach that improves the quality of life Free Essays

string(54) " of the patient and the advice for out-of-hours care\." 1Introduction 1.1 Definition of Palliative care According to the WHO, Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychological and spiritual. Palliative care provides relief from pain and other distressing symptoms, affirms life and regards dying as a normal process, and intends neither to hasten nor to prolong death. We will write a custom essay sample on Palliative care is an approach that improves the quality of life or any similar topic only for you Order Now 2 Palliative care integrates the psychological and spiritual aspects of patients care, and offers a support system to help patients live as actively as possible until death. It also offers a support system to help the family cope during the patient’s illness and in their own bereavements. In many countries, the terms hospice and palliative care are used interchangeably to refer to the support provided to people with little or no prospect of cure.3 In the United States, a distinction is made between general palliative care and hospice care, which delivers palliative care to those at the end of life; the two aspects of care share a similar philosophy but differ in their payment systems and location of services. Whereas in the United Kingdom, this distinction is not operative; in addition to specialized hospices, non hospice-based palliative care teams provide care to those with life-limiting illness at any stage of the disease. According to the Scottish Partnership for palliative care, palliative care is the term used to describe the care that is given when cure is not possible. The word comes from the Latin â€Å"palliatus†(covered or hidden with a cloak) and is used to mean â€Å"relieving without curing†.4 Although palliative care is historically associated with later stages of cancer, it is now established that palliative care should be a routine part of care for those living with and dying from a wide variety of non-malignant conditions, such as dementia, heart failure, Huntington’s disease, motor neurone disease, multiple sclerosis, muscular dystrophy, Parkinson’s disease, renal failure and respiratory failure among others. General palliative care is an integral part of the routine care delivered by all health and social care professionals to those living with a progressive and incurable disease, whether at home, in a care home, or in hospital.4 Specialist palliative care is based on the same principles of palliative care, but can help people with more complex palliative care needs. Specialist palliative care is provided by specially trained multi-professional specialist palliative care teams and can be accessed in any care setting. 1.2 Public health context of palliative care Public health approaches to palliative care have a valuable contribution to make in understanding and developing community capacity related to , dying, loss and care acknowledging that carers of the dying and bereaved are an important group who have their own significant needs in end -of-life care.5 Primary care has a vital role in delivering palliative care. 6,7 In most developed countries more people die in hospital than at home 8,although substantially more people would prefer to die at home.9 Primary care professionals play a central role in optimising available care, but they often lack the processes and resources to do this effectively.6,10 The Gold Standards Framework (GSF) for community palliative care 11 is a primary care led programme in the United Kingdom that is attracting international interest.7 The framework enables general practitioners and community nurses to optimise practice by providing guidance through workshops and locally based facilitation on how to implement processes needed for good primary palliative care. It is supported by a plethora of practical tools, guidance documents, and examples of good practice.12 It is regarded by many as â€Å"the bedrock of generalist palliative care†. GSF is recommended as best practice by the Department of health End of life care strategy, NICE, Royal College of General Practitioners, Royal College of Nurses and other major policy groups. 1.3 Care pathways in palliative care A care pathway is a plan of how someone should be cared for when they have a particular medical condition or set of symptoms. There is increasing evidence that using an integrated care pathway to manage care at the end of life is good way to implement and monitor best practice, and to standardise care in a variety of care settings. The use of pathways to manage the care of dying patients has gained considerable support from the clinical teams who have used them, as there is evidence that use of such pathways improves the quality of care in the last days and hours of life. A number of end of life care pathways have been developed but the first and most well known is the Liverpool Care Pathway for the Dying Patients (known as the LCP).13 A number of other pathways are available in relation to supporting the care of dying patients: – Pathway for Improving the Care of the Dying (PICD) (Australia) – Palliative Care for Advanced Disease (PCAD) pathway (USA) – Department of Veteran’s Affairs (DVA) Palliative Care Clinical Pathway (Australia) – Gold Standards Framework (GSF) for community Palliative Care (UK) – Preferred Priorities for Care Plan (PPC) (UK) The Liverpool Care Pathway (LCP) is aimed at improving care and communication in the dying phase. In the UK, the LCP was developed to improve care for dying patients.14 The LCP was developed to take the best of hospice care into hospitals and other settings. It is used to care for patients in the last days or hours of life once it has been confirmed that they are dying. The LCP is designed to enable all healthcare workers to provide optimal care to dying patients, whether they are specialists in palliative care or not, by guiding clinical decision making. The LCP is a legal document which replaces the usual medical record at the end of life, and is structured to facilitate audit and outcome measurement.15 It promotes clear communication around the dying and death of the patient, and it supports psychosocial and spiritual care to the patients and their relatives, for example, by promoting adequate communication and support and giving relatives a brochure for bereavement after the deat h of the patient.15 The UK and 13 other countries are registered with the LCP Continuous Quality Programme. 16 In Scotland the LCP is applied by 12 of the 13 voluntary hospices; but only a quarter of district nurses reported in 2008 that they are currently using the LCP.17 In NHS Greater Glasgow and Clyde 37% of the GP practices, 33% of the nursing homes and 47% of the wards in the acute operating division are in the process of implementing the LCP.18 1.4 Pharmaceutical care context of palliative care It is estimated that one in three people in the UK will develop cancer and one in four will die from it.19The survival rate for cancer is increasing with more patients being treated as day-case patients. The length of stay for in patients is also decreasing, therefore it is essential to ensure appropriate care continues in the community setting.20 Hepler and Strand defined pharmaceutical care as improves a patient’s quality of life.21 For pharmaceutical care to be successful, a quality system should be implemented to ensure appropriate patient outcomes. It is important that all pharmacy members of the healthcare team in different settings are included in the delivery of pharmaceutical care.22To ensure continuity of care, pharmaceutical care plans require to be updated when the patient’s needs change. Seamless care helps patients to move across healthcare boundaries without experiencing a gap in the standard of healthcare delivery, but this requires effective communicati on between primary and secondary care.23 In providing pharmaceutical care, pharmacists co-operate with doctors, patients and/or carers in designing, implementing and monitoring a â€Å"pharmaceutical care plan†. The pharmaceutical care provided aims to optimize drug treatment and achieve specified therapeutic outcomes. This has the potential to reduce drug-related problems and improve patient’s quality of life To support the local delivery of chemotherapy, models of care need to be developed and remote models of care need to be developed and remote patient monitoring performed which is linked to an electronic health record.24 The use of an electronic record would undoubtedly improve seamless care. It is therefore essential that improvements are made in the transfer of pharmaceutical care. Over the past decade, there has been a large increase in the number of patients receiving cancer treatments and symptom relief treatments at day-case chemotherapy clinics25. With the increase in the prescribing of oral chemotherapy and the use of ambulatory intravenous pumps which allow patients to receive continuous chemotherapy at home, there is increasing need for hospital pharmacists to liaise more closely with general practitioners (GPs) and community pharmacists to explain unusual indications for a drug or unconventional dosage regimens. This liaison is needed to avoid incidents reported through the in-house reporting system such as inadvertent continuation of intended short courses of medication, for example, dexamethasone prescribed for three days as an anti-emetic after chemotherapy. There is a need for the required clinical monitoring to be undertaken in primary care to minimise risks associated with these medicines. It is essential that detailed information on monitoring requirements is conveyed from the day-case clinic to the patient’s GP and community pharmacist, so that both are aware of the therapeutic plan for the patient and management of potential toxicities and possible drug interactions. Methods of transferring care require exploration and hence Julie Fisher et al,in their study examined and designed a documentation system to monitor pharmaceutical care between cycles of chemotherapy for patients who attended an oncology care unit.24 Their study confirmed a recognised need for continuity of pharmaceutical care between hospital and community pharmacists. The Gold Standards Framework Scotland (GSFS) was introduced in 2003 and is an adapted version of the GSF for implementation within NHS Scotland. The Gold Standards Framework Scotland provides a means of improving the quality of care provided by primary care teams in the final year of a patient’s life. The main differences to the core GSF are : addressing the needs of patients from diagnosis onwards; maintaining a GSF palliative care register, and ; advanced care planning, defined as a process of discussion between an individual and their care providers about individual’s concerns, their preferences for types of care and their understanding of their illness and prognosis.26 Across Scotland, 75% of GP practices are registered as using the GSFS.17 As of 2009, 80%of GP practices in NHS Greater Glasgow and Clyde are signed up for the GSFS.18 The most recent development in 2009 has been the electronic Palliative Care Summary (ePCS). The ePCS allows, with patient or carer consent, the access to daily updated summary information from GP records for Out of Hours services and NHS 24. This facilitates structured and accurate information to be available in hours and out of hours to support palliative care patients and their families. The ePCS includes: prescribed medication, medication diagnosis, patients’ and carers understanding of prognosis, patient wishes about place of care and resuscitation.26, 18. The UK department of Health has proposed that Primary Care Trusts across England should invest in pharmaceutical care services giving patients access to more help from pharmacists in using their medicines.27 Evaluation of pharmacists’ interventions has shown that they can make a valuable contribution in secondary care settings such as hospices and hospitals.28 Lucas et al found that more than 60% of pharmacists’ interventions in an inpatient palliative care unit could significantly improve patient care.29 The pharmacist advised on the appropriateness of medication regimens, side effects and contraindication of medication and provided drug and prescribing information to patients and staff. Despite being perhaps the most accessible healthcare professional, there is limited research into the possible contribution of community pharmacists to community-based palliative care in the UK. A recent review showed that the delivery of palliative care to patients in the community is far from ideal.30 Inadequacies in knowledge and training of professional currently providing palliative care to patients at home may prevent the patient receiving optimum pain and symptom control.31, 32 Fragmentation and poor organisation of current palliative care services may result in a loss of continuity of care for such patients or hinder the timely availability of appropriate medication.33,34 Poor communication within existing teams and across organizational boundaries also limits the provision of effective palliative care to patients in the community.35,36 If community pharmacists were included in the local network of healthcare professionals, this would benefit all parties, especially patients and carers, and it would help to share the over-increasing work load in palliative care, due in part to an aging population. Needman et al, 37 assessed the effectiveness of community pharmacists’ clinical intervention in supporting palliative care patients in primary care using an independent multi-professional panel review. In their study, they suggested that when trained community pharmacists are included as integral members of the multi-professional team, they can intervene effectively to improve pharmaceutical care for palliative care patients in the community, providing additional support for them to remain at home; because majority of palliative care patients spend most of their last year at home under the care of their GP and the primary care team.38 It is only when the community pharmacist knows and have the details of the patient’s medical condition and prognosis , that she is able to suggest new therapies or to titrate existing ones. Unfortunately in the present UK community pharmaceutical services system, the community pharmacists are unlikely to know the medical diagnosis of the patients or other essential clinical details.39, 40 As a result, community pharmacists in general are unable to make full use of their knowledge and expertise o r to anticipate problems and advice on them. The recent NHS pharmacy plan advocates that personal medicine management services should be provided by community pharmacists in the future.27 The study of Needman et al showed that the personal palliative pharmaceutical care services are feasible in everyday practise when community pharmacist is included in the multidisciplinary palliative care team.37 In 2002, the Scottish Government through its publication â€Å"The Right Medicine: A strategy for pharmaceutical care in Scotland†, proposed a better use of pharmacists’ professional competence in planning and delivering services, especially in priority areas such as cancer, heart disease and mental health.41This policy document placed emphasis on the continued development of Pharmaceutical Care Model Schemes including palliative care, initiated in 1999 in collaboration with the Royal Pharmaceutical Society in Scotland. This work has developed and now all NHS Boards have developed Community Pharmacy Palliative Care Networks. Access to specific palliative care medicines within and out with working hours via this network is quality standards in all NHS Board areas.42 Within the NHS Greater Glasgow and Clyde area 71 of the current 312 pharmacies are involved in the Community Pharmacy Palliative Care Network. This network was established in 2001 and is funded by NHS Greater Glasgow and Clyde18, 43, 44. The purpose of the project is to increase awareness of the community pharmacist’s role, their capacity to manage patients requiring cancer and palliative care support, reduce risks and effectively manage anticipatory care needs to minimise out of hours issues. The services of the network pharmacies includes: retailing a stock of more specialized medication which may be required for palliative care; a courier service for transport of urgent prescriptions and medicines, and ; provision of advice and support to other pharmacies, GPs and district nurses. In 2006, a new community pharmacy contract was agreed with the Scottish Government to modernise community pharmacy practice and to support the delivery of pharmaceutical care. The contract is based on four core services, namely the acute medication service, the minor ailment service, the public health service and chronic medication service (CMS) 45 of which palliative care is one. The Chronic Medication Service (CMS) will also require patients to register with a pharmacy. It will enable a pharmacist to manage a patient’s long-term medication for up to 12 months. Under this service, a patient can have his or her medicines provided, monitored, reviewed and, in some cases, adjusted as part of a shared care agreement between the patient, the GP and the community pharmacist. It is in this service that an emphasis on the systematic approach to pharmaceutical care is particularly apparent; it will incorporate the pharmaceutical care model schemes, serial dispensing and supplementary prescribing. In October 2008, the Scottish Government published â€Å"Living and Dying Well in Scotland. ‘Living and Dying Well’ is the first plan for the development of a single, cohesive and nationwide approach to ensure the consistent, appropriate and equitable delivery of high quality and person centred palliative care based on neither diagnosis nor prognosis but on patient and carer needs. The concepts of assessment and review, planning, coordination and delivery of care, of communication and information sharing and of appropriate education and training are addressed in this Action Plan. The Action Plan states that NHS Boards and Community Health Partnerships (CHPs) should take steps to ensure that patient with palliative care needs are included in a palliative care register and are supported by a multidisciplinary team. The Action Plan also emphasises the importance of proactive care planning and anticipatory prescribing to aid the prevention of unnecessary crisis and unschedu led hospital admissions, particularly out of hours. This also includes the planning for stages of illness trajectories that are likely to produce changing patient needs in the future. Key to the progress of â€Å"Living and Dying Well† is its emphasis on a person centred approach to care and care planning and on the importance of communication, collaboration and continuity of care across all sectors and all stages of the patient journey. In order to fully realise the necessary improvements in palliative and end of life care, NHS Boards should review their projects the â€Å"Living and Dying Well† actions and the actions set out in Living and Dying Well: Building on Progress – with particular priority on the following areas. – Early identification of patients who may need palliative care – Advance / Anticipatory Care Planning (ACP) – Palliative and end of life care in acute hospitals – Electronic Palliative Care Summary (ePCS) – Do not Attempt Cardiopulmonary Resuscitation (DNACPR) 1.5 Transfer of information in Palliative Care Access to specialist palliative care services must be more consistent across Scotland, according to a report published by Audit Scotland.17 Audit Scotland investigated the provision of specialist and general palliative care in all NHS board areas. It found a significant variation in the availability of specialist palliative care services and in the ease with which patients can access services.46 Although community pharmacists’ provision of palliative care medicines was not specifically reviewed by the audit, the report notes: â€Å"NHS boards reported that provision was well organised through the national community pharmacy scheme† Many people, who are terminally ill, do prefer to spend their last days in their own homes. It is therefore, essential that these patients have easy access to care and medicines that can help them if their condition were to change rapidly or deteriorate suddenly at night or during the weekend (as is common in terminal illness). However, the provision of out-of-hours specialist palliative care and the availability of palliative care medicines in the community can present major problems. Communication between professionals and patients/carers is an important aspect of palliative care in any setting. However, effective communication and co-ordination between professionals, especially across organisational boundaries, systems and structures, can play an even more crucial role in ensuring the quality of care and enhancing patient and carer experience. According to â€Å"Living and Dying well† in Scotland the aim of communication and co-ordination is – to ensure that all patients and carers with palliative and end of life care needs are supported to participate fully in developing care plans and making decisions about their care – to ensure that their needs are communicated clearly across care settings and systems to all professionals involved – to ensure that the care of all patients and carers with palliative and end of life care needs is co-ordinated effectively between specialists and across care settings and sectors. The transfer of appropriate information between care settings, including out of hours services and NHS 24, could be improved, and is known to have particular significance for those with palliative and end of life care needs. The Scottish Government is therefore facilitating development of an electronic Palliative Care Summary (ePCS) which is developed from the Gold Standards Framework Scotland Project 47 and is based on the Emergency Care Summary. The ePCS will, with patient and carer consent, allow automatic daily updates of information from GP records to a central store, from where they will available to out of hours services, NHS 24 and Accident and Emergency service. The ePCS is currently being piloted in NHS Grampian, and subject to successful evaluation, will be rolled out nationally from 2009. NHS Quality Improvement Scotland is currently developing National Key Performance Indicators for palliative care which address out of hours issues. The timely sharing of information betw een primary and secondary care, especially at times of admission and discharge and including transfer between home, care homes and hospitals remains a challenge to be addressed.46 The ePCS now provides a helpful framework for identifying the type of information from assessments and care pans which should be shared. NHS Boards will be expected to ensure, by whatever means are locally available, the availability over 24 hours of such information to all relevant professionals. 1.6 Electronic Palliative Care Summary The ePCS builds on the Gold Standards Framework Scotland project and the Emergency Care Summary (ECS). The ePCS will, with patient /carer consent, allow automatic daily updates of information from GP records to a central store, from where they are available to Out Of Hours (OOH) services, NHS 24, Acute Receiving Units, Accident Emergency Departments and shortly to the Scottish Ambulance service. The ePCS is now in use in over 23% of practices across 11 Health Board in Scotland.48 The electronic Palliative Care Summary (ePCS) allows practices to: replace the fax form used to send patient information to out of hours services, clearly see essential information on patient with palliative care needs, view or print lists of patients on the practice Palliative Care Register, set review dates to ensure regular review of patients. The information allows practises to build up Anticipatory Care Plans which may include: – medical diagnoses as agreed between GP and patient – patient and carer understanding of diagnosis and prognosis – patient wishes on preferred place of care and resuscitation (DNAR) – information on medication and equipment left in the patient’s home â€Å"just in case† – current prescribed medication and allergies, as per the Emergency Care Summary (ECS). ePCS needs to be developed to meet the needs of palliative care patients. This will require electronic transfer of appropriate information across care settings and to be accessible by recognised healthcare workers supporting patient care. This project will review the development to date of relevant electronic transfer systems. 2. Aim and Objectives Aim Describe current pharmaceutical care provision and make recommendations for electronic transfer of information through evolving palliative care summaries. Objectives 2.1 To conduct an extensive literature review to establish current published work as a baseline for describing information summaries to support pharmaceutical care of palliative care patients. 2.2 To describe relevant information summaries in current practice. 2.3 To describe current information transfer across care settings. 2.4 To identify developments in electronic transfer of care summaries and make recommendations on data fields to support information transfer based on evidence. 2.5 To make recommendations to support an electronic palliative care summary (ePCS) for use by pharmacists in different settings providing pharmaceutical care to palliative care patients. 3.Methods 3.1 Description of literature searching A literature search was conducted in order to identify relevant previous work and experiences in the transfer of information in palliative care to support pharmaceutical care of such patients. The findings are presented in the introduction. For the outline literature review the biomedical database MEDLINE was accessed and browsed via University of Strathclyde library services. The search was carried out using both MeSH (Medical Subject Headings) vocabulary and plain search terms, either individually or in different combinations. The inclusion criteria comprised articles published between 2010 and around 2000 and publications in English Language. The following search terms were mainly considered. Palliative careEnd of life careCancerChronic disease management Pharmaceutical care provisions Scotland United Kingdom Qualitative research Out-of-hoursPharmaceutical carePharmaceutical serviceCommunity pharmacyPharmacist Patient care Electronic palliative care summaries In addition, the Google search engine, PubMed, the Google scholar database indexing full texts of scientific literature and the search engine Bing from Microsoft were used and the web pager of several journals like the Pharmaceutical Journal, Palliative Care Journals, Palliative Medicine Journal, British Journal of General Practise, and the British Medical Journal were reviewed applying the same key words. In addition, the websites of a number of professional organisations such as NHS Scotland, NHS 24, and NHS Boards across Scotland, Scottish Government, Community Health and Care Partnerships, Audit Scotland, the Scottish Partnership for Palliative Care and the World Health Organisation were searched for government policy documents relating to palliative care. 3.2 Identification of current practice Face to face interviews and group meetings and telephone discussions were also deployed in this research work. Group meetings were held with the University team of the Macmillan Pharmacist Facilitator Project, head of pharmacy of NHS 24, a district nurse as well as a palliative care link nurse. The meetings helped as appropriate tools of information due to the fact that they enabled the participants to describe and talk freely about their experiences while retaining a focus on the subjects of interest. A method that facilitates the expression of criticism and the suggestion of different types of solutions is invaluable when the aim is to improve services.49 3.3 Current information transfer to support practice The head of pharmacy of NHS 24 advised making contact with district nurses or palliative care nurses and the need for them to participate in face to face interviews. The actual recruitment of one district nurse was co-ordinated by a Macmillan Pharmacist Facilitator and the palliative care link nurse agreed to a telephone conversation to capture clinical care issues arising as part of their daily practice. 4.Results The services provided to patients out-of- hours (OOH) are an essential part of palliative and end of life care, and the issues relating to OOH service provision were of paramount relevance in this research work. The recent changes to the General Medical Services (GMS) contract shifted the responsibility for OOH service provision from GP practices to NHS Boards. This has changed the way in which patients access care outside normal working hours. The establishment of NHS 24 has introduced a new model where 24-hour telephone advice is the single point of access to all OOH services. Patients are now unlikely to receive OOH care from a doctor who knows them and the importance of continuity to palliative care patients means that they are likely to be particularly affected by these changes.50More recently, the establishment of centralized services (NHS Direct in England and Wales, NHS 24 in Scotland) present a new model 24-hour telephone advice that will be the single point of access to all OOH services, even in rural areas. The intention is to benefit patients and carers by offering simple and convenient access to advice and effective triage, so that appropriate care can be delivered quickly and efficiently.51 Responsibility for healthcare is been transferred from GPS to local primary care organisations, which are currently setting up new unscheduled care services. There has been a progressive shift in the locus of care from the home and local general practices to more distant emergency clinics or telephone advice.52 An understanding of the needs and experiences of palliative care patients and their carers is essential to ensure that OOH care is effect as well as efficient. Alison Worth et al, in their qualitative study of OOH palliative care, explored the experiences and perceptions of OOH care of patients with advanced cancer, and with their informal and professional carers.50 this study made explicit the barriers experienced by palliative care patients and their carers when accessing care. The importance of good anticipatory care particularly provision of information to patients and carers along with regularly updated handover forms sent to OOH services, was identified as key by both patients and professionals. Professionals described the barriers to achieving individualised patient care and the problem posed by competing priorities, but saw potential for improvements through an expansion of OOH resources, particularly nursing and supportive care. Worth et al, compared their study to previous studies which suggested that good anticipatory care, particularly provision of information to patients and carers about sources of help OOH, and what to expect from services, helps maintain care at home and manage patients’ and carers’ expectations of services.53,54According to Worth et al, GPs and district nurses wanted 24-hour access to specialist palliative care advice on symptom management and medication use.55Access to palliative care drugs and advice via a community palliative care pharmacy network is a quality standard in Scotland.42 Many people who are terminally ill want to spend their last days in their homes. For this reason therefore, these patients should have easy access to care and medicines that can help them if their condition change rapidly or deteriorate suddenly at night or during the weekend. However, the provision of out-of-hours specialist palliative care and the availability of palliative care medicines in the community can present major problems. Palliative care medicines are only readily available during normal working hours, Monday to Friday. Feelings of uncertainty and anxiety can be heightened in patients and carers, particularly OOH, if there is no easy access to familiar sources of professional help and advice or to the medicines needed to control symptoms that commonly occur in the terminal phase of a disease.11 The â€Å"just-in-case† six-month pilot study which was set up in three areas of the Mount Vernon Cancer Network was aimed to avoid distress caused by inadequate access to medicines OOH by anticipating pharmaceutical needs stemming from new or worsening symptoms; and prescribing medicines to be used on a â€Å"just-in-case† basis. The initiative was intended to support the â€Å"Gold Standards Framework†, a programme that aims top develop a practice-based system to improve the organisation and quality of care for patients in their last 12 months of life.56 the â€Å"just-in-case† box (blue plastic hobby box-27x20x10cm) where medicines were stored at the patient’s home. The prescriptions reflected the individual needs of each parient and were written up in the patient’s notes and on an administration sheet used only for anticipatory or when required medicines. An approved list of medicines for symptom control in patients in the terminal phase of an illness was made available through the Liverpool Care Pathway for the dying patient15, 57 and this was adopted for the pilot. As a result, the medicines usually supplied on a â€Å"just-in-case† basis were diamorphine (for pain), midazolam (for agitation), cyclizine, haloperidol or levomepromazine (for nausea or vomiting), glycopyrronium or hyoscine hydrobromide (for respiratory secretions). Information transfer in palliative care is currently underdeveloped because most of the information is within the decision of the GP. Presently NHS 24 does not have access to patients’ medical records. Anytime a call is made to NHS 24, a record is made, a previous contact is seen and all reports are documented as well as the resources and advices used in the past. However, from May 2007, all NHS 24 centres are now able to access a patient’s Emergency Care Summary (ECS) provided patient’s consent is first obtained. The Emergency Care Summary (ECS) is a relatively new system which allows information on a patient’s medication and allergies to be automatically extracted from their GPs records. The security around accessing ECS is very strict and any time an access is made, it is logged so as to know who has been seeing it and this is especially doctors. The NHS 24 has access to ePCS but there is nothing on the ePCS that mentions medicines and that element of pharmaceutical care is missing in the ePCS. Legislation was introduced throughout the UK in 2000, which provided the framework for the supply and administration of medicines without the need for an individual prescription. This framework was Patient Group Directions (PGDs). According to NHS Education for Scotland (NES), a Patient Group Direction (PGD) is a written instruction for the sale, supply and /or administration of named medicines in an identified clinical situation.58 It applies to groups of patients who may not be individually identified before presenting for treatment. Before now, out-of-hours GP care in England, Denmark and the Netherlands has been reorganised and the Netherlands has been reorganised and is now provided by large scale GP co-operatives. Adequate transfer of information is necessary in order to assure continuity of care, which is of major importance in palliative care. Schweitzer et al, conducted a study to assess and investigate the availability, content and effect of information transferred to the GP co-operatives.59 According to their study, GPs in the UK were satisfied with the palliative care provided by their out-of-hours co-operatives, but satisfaction was less for inner city GPs who had concerns about the continuity of care.60 District nurses reported less satisfaction, especially with the quality of the advice, the reluctance to visit, and difficulties in obtaining medication.61 In their study , the total number of palliative care phone calls was 0.75% of all calls to the GP co-operative. Information was transferred and the content consisted mainly of clinical data. It was also found that half of the calls regarding palliative care resulted in a home visit by the locum, and that medication was prescribed in 57%of all palliative care calls. According to this study, a report from the UK stated that a lack of information can lead to problems in symptom control and an increase in unnecessary hospital admissions.62 This study recommended that GP co-operatives needed to develop and implement an effective system of patient information management. The potentials for improvement in the end-of-life care that is provided by the GP co-operatives was a factor of information transfer especially if an electronic patient file is accessible during the out-of-hours period, and this should contain information that is of relevance to locums. The two nurses who took part in the interviews suggested that the service provided for palliative care patients has improved a great deal over the past few years especially with the introduction of the Gold Standards Framework Scotland. An integral part of this improvement was said to be the anticipation of patients’ possible future needs [by the development of Anticipatory Care Plan (ACP)], so that the essential equipment and drugs are either already in place when they become necessary or else can be obtained without delay. This act was identified as reducing the need to call the local out-of-hours GP services over the weekend or in the evenings. The district nurse explained that patients and their carers/family were given details of how to contact the evening or night nursing service who was on call and when one action/plan was carried out the next nurse who is giving care to the patient is able to see what the previous nurse had done. This was done with the use of a â€Å" mobile computer†. The palliative care link nurse explained that the ePCS was not accessible by nurses yet but this is being looked into by GPs but nurses who needed access were allowed by their GPs. During out-of-hours, GP practices cannot provide essential services and general management to patients who are terminally ill. Following an independent review of GP out-of-hours services, Primary Care Trusts (PCTs) are also responsible for developing a more integrated out-of-hours system. (Carson Review). The Carson review envisaged that the needs of palliative care patients will be identified in advance noted on the NHS Direct database and passed directly without triage to the service they needed.63This followed from recommendations that transfer of information between GPs and their out-of-hours provider is essential to ensure continuity of care 62, thus forming one of the current GP co-operative accreditation standards.64 Burt J et al, conducted an audit across four co-operatives to assess progress of continuity of care within primary palliative care in England.61Across these four co-operatives, there were 279 palliative care-related calls (2.1% of all calls), form 185 patients du ring the audit month. The co-operatives held handover information for between 1 (12%) and 13 (32.5%) of these patients. Co-operative doctors had information about previous co-operative contacts for 7.5-58.1% of repeat calls. Three co-operatives faxed details of every palliative care contact to the patient’s GP the following morning, one did so for only 50% of calls. This system of alerting the co-operatives to the needs of palliative care patients was under-utilized. Even within the most frequently used systems, the diagnosis, prognosis and care preferences of two thirds of patients with palliative care were not made known to the co-operatives. 5. Discussion Information that encourages appropriate use of out-of-hours services needs to be made accessible for all patients and carers. Primary care professionals and community palliative care specialists share responsibility for advising patients and carers on how to seek help out-of-hours. Practices and primary care organisations need to develop and audit effective systems of patient information management and transfer. These could be included in quality standards. Reviewing the way calls are handled by NHS 24, in addition to their factual content, offers opportunities for communication difficulties to be highlighted and included in staff development. Effective out-of-hours community palliative care requires an integrated, multidisciplinary service that is able to respond to planned and acute needs. Continuity of care may be personal, informational or managerial, the latter implying a consistent and coherent approach responsive to the patient’s changing needs.63 In the context of curr ent primary care provision, personal continuity of care is increasingly unlikely to be provided out-of-hours, but informational and management continuity, supplemented by good communication, may suffice. There is a relative lack of communication and joint working between all health care professionals involved in the care of patients with palliative care needs and this is a major issue affecting the effective delivery of services. Since the district nurses are the professional seeing the patients more regularly, they are an important resource and a vital link person and pharmacists could consult them for information about a patient’s clinical condition or for clarification of problems caused by incorrect or incomplete prescriptions. As at January 2011, the ePCS is now in use in over 32% of practices across 11 Health Boards in Scotland. All three GP IT systems have software for recording ePCS information which is updated automatically to ECS when any changes are made. ePCS is the available to all out-of-hours-and unscheduled care users who already have access to ECS. The information in the ePCS is recorded in the GP system to form an Anticipatory Care Plan which will be availab le out-of-hours and includes medical diagnoses (as agreed between the GP and patient), patients and carers’ understanding of diagnosis and prognosis, patient wishes {preferred place of care and resuscitation (DNACPR)}, information on medication/equipment left in patients’ home â€Å"Just in Case and prescribed medication (this includes all repeat and last 30 days acute and allergies as per ECS. Though the patients’ medicines are not described in detail, that element of pharmaceutical care is not present on this current ePCS. (Appendix 1). The reason for this may be because of a skills gap for instance, independent prescribers might be few in this clinical area. The way pharmacists can adjust medicines as part of an agreement in the delivery of care to palliative care patients should be included in the ePCS. Boards across Scotland are aligning the rollout of ePCS with their plans for moving GP IT systems from GPASS to either InPs Vision o EMIS and local champions in Greater Glasgow and Clyde and Dumfries and Galloway have encouraged uptake of ePCS. Work is at early stages in Ayrshire Aran, Fife, Orkney and Western Isles. Shetland is planning to start the rollout shortly. Grampian has completed connection for all EMIS and Vision practices and further rollouts will start shortly. Lothian has been using ePCS for a year, and is now planning how to maintain usage and encourage the remaining practices. Lanarkshire have a good uptake in Gpass practices and are awaiting the completion of the Gpass to InPs Vision migrations before wider rollout is commenced. Scottish Ambulance Services (SAS) is now piloting the use of ECS and ePCS in Lothian.48 According to Burt et al, co-operative doctors were required to provide care in a range of complex and time-consuming cases, including during the last days and hours of a patient’s life, with little or no information. Continuity of care within co-operatives was frequently threatened by a lack of information about previous contacts to the service by a patient.61 Within the present and new integrated out-of-hours systems, the effective transfer of patient information between all providers will be critical if palliative care patients and other vulnerable groups are to receive the care they need, especially where GPs opt out of providing out-of-hours care. Electronic patient records may provide a solution, although concise, up-to-date information will be needed and as services move to a more integrated approach (ePCS), a careful scrutiny of information transfer systems and encouragement of providers such as GPs and district nurses to update information, may help to ensure better co ntinuity of care. The current ePCS (see Appendix I) describes the patient’s medical conditions (current drugs and doses, and additional drugs available at home); the current care arrangements (syringe driver at home); the extent to which patients and carers understands the present condition of the patient and the advice for out-of-hours care. You read "Palliative care is an approach that improves the quality of life" in category "Essay examples" According to â€Å"Living and Dying Well 46, there is a need for communication and co-ordination between all professional who are involved in providing care to palliative care patients. This will help ensure that all patients and carers with palliative and end of life care needs are supported to participate fully in developing care plans and making decisions about their care. To ensure that their needs are communicated clearly across care settings and systems to all professional involved. To also ensure that the care of all patients and carers with pal liative and end of life care needs is co-ordinated effectively between specialities and across care settings and sectors. The introduction of more joint out-patient clinics for example the joint respiratory/palliative care out-patient clinic at Victoria Infirmary in Glasgow should be encouraged. 6. Conclusion Although the electronic Palliative Care summary (ePCS) is being rolled out in almost all Health Boards across Scotland, there are still some areas of care delivery that needs to be improved in palliative care especially during out-of-hours. A model needs to be fashioned out to enhance what the next step in the delivery of palliative care should be. If anything is done by one member of the palliative care team, other members need to know within the shortest time possible. The pharmacist who is an important member of the team, at the moment do not have access to the ePCS, this area needs to addressed. There is also need to use the new and emerging technology in the delivery of unscheduled healthcare, for instance strategic frontline application, which means upgrading the current IT and telephoning capability as well the potential for video conferencing in pharmacies. In current practice special notes (a flag facility that can be attached to a patient’s CHI number by GPs) used by GPs can be replaced by special texts in palliative care practice. Calls to out-of-hours through NHS 24 can also be by video calls and texts as this enhances telephone assessments especially in palliative care. Development of specialized care plans should also be encouraged. There should be equitable access to a range of health care professionals and support staff across the UK and this may well demand additional resources, particularly for district nurses. Partnership working with non-statutory palliative care providers should also be enhanced. Specialist palliative care telephone advice to unscheduled care services, including access to a consultant in palliative medicine, may need to be delivered through extended rotas in areas where there is a shortage of specialists. The ePCS should be able to provide more pharmaceutical care provision to patients. How to cite Palliative care is an approach that improves the quality of life, Essay examples

Reflective Report

Question: Write a reflective essay that aims to introduce certain attributes that can improve the marketing mix policy of the new product Acne Blemish Solution. Answer: Introduction The current study is a reflective essay that aims to introduce certain attributes that can improve the marketing mix policy of the new product Acne Blemish Solution. While conducting the study, it had been determined that the longevity of the FMCG (Fast Moving Consumer Goods) products in the Malaysian market is highly fluctuating. Therefore, I have generated the idea that, since, the brand MP Beauty Care has chosen to launch the Acne Blemish Solution products need to make a persistent product recall activities to withstand its sustenance. The existing study would scrutinise on the previous marketing mix methods applied to position the product in the market and provide the effacing solutions for its further improvement. Body According to Ali et al. (2016), the customers generally look for the familiar ingredients in the acne product. I have understood that the teenagers generally believe that the common ingredients like clay, mud packs, cucumber and green tea to be a useful ingredient to remove the acne issues. Therefore, as per my opinion MP Beauty Care needs to highlight the presence of cucumber and green tea along with the benzoyl peroxide acid. Although the product consists of the common acne removing ingredients, yet, it failed to highly the elements in the package. This might enact to be a constraint to receive the depicted reactions of the customers. Hence, the presence of the familiar ingredients needs to be mentioned in the product package to convince the customers. The pricing strategy initiated by the management of MP Beauty Care is highly effacing and lucrative. The concept behind the pricing strategy thoroughly gets aligned with the current purchasing attitudes of the target customers. I have acknowledged the fact that the teenagers definitely have the tendency of switching towards the products that offer a premium price range. Especially, placing the Acne Blemish Solution at RM 14 would be adequate for the enterprise to pursue the teenage segment. Conversely and Rajendran (2014) determined that placing the product on the premium level of the initial phase might be a risky approach for the brand. The teenagers rely heavily on the pocket money. Thus, the high price margin of the new acne solution product might not be a sufficient measure to receive the effective purchasing action of the teenagers. The idea I have generated after conducting the research work, the teenagers are highly aware regarding the difference between a pimple and acne issue. Therefore, especially the female segment prefers to visit the acne clinics to receive the corrective treatment (Grubor and Milicevic, 2015). The marketing activities of the acne clinics are highly convincing to convert the target prospects. Therefore, it would be a smart initiative to place the product in the acne clinics and convince the experts with the formula to apply the product to the patients. The promotional strategy of the particular brand for the specific products had been highly effective. Prakash and Pathak (2014) denoted that apart from the website, traditional and the blog promotion, Acne Blemish Solution needs to be promoted on the Facebook pages. Facebook is highly popular amongst the teenagers. Therefore, it can be the exclusive platform for the reaching and interact directly with the target audience. Conclusion The particular study had facilitated me to enhance my knowledge in the FMCG segment. I have generated the idea regarding the marketing activities that needs to be undertaken while launching a personal care product in the Malaysian market that basically targets the teenage segment. My idea regarding the particular subject had become transparent to a possible extent, the knowledge I would be implementing in my upcoming professional career. References: Ali, M., Ilyas, M. and Abdul Rehman, C. (2016) Impact of consumer centric marketing mix elements on consumer buying behavior: An empirical investigation in context of FMCG industry of Pakistan, Kuwait Chapter of Arabian Journal of Business and Management Review, 5(5), pp. 3042. Grubor, A. and Milicevic, N. (2015) Measuring on-shelf availability of FMCG products, Industrija, 43(1), pp. 5371. K, J. and Rajendran, G. (2014) Examining variety seeking BehaviorA study with reference to fast moving consumer goods (FMCG), Journal of Food Products Marketing, 20(3), pp. 283307. Prakash, G. and Pathak, P. (2014) Understanding rural buying behaviour: A study with special reference to FMCG products, Indian Journal of Marketing, 44(8), p. 43.

Acquisition and Merging

Introduction In today’s competitive global business environment, in order to survive companies are required to devise ways to grow (Donald 2008.). The two companies in this case are considered equals. The involved companies in this case are regarded to be of the same size.Advertising We will write a custom critical writing sample on Acquisition and Merging specifically for you for only $16.05 $11/page Learn More In principle the stocks of the two companies are usually surrendered rather than issuing. Such instances can be recalled of the case of Glaxo Welcome merging in 1999 with SmithKline Beecham that gave birth to GlaxoSmithKline. Advantages of Acquisition Acquisition enables to penetrate a specific market niche that could otherwise not have been penetrated due to many barriers. Acquiring encourages specialization in that a company is able to enter into other markets which could not have been penetrated before (Jarrod , 2005). Acquiring a compa ny means acquiring its customers as well. The company expands its operations through producing a wide variety of products (Jarrod, 2005). In acquiring another company, the acquiring company increases its economy of scale. The acquisitions may result in the reduction in the fixed costs and thus increasing the resultant profit margin. Acquisition also leads to increased financial leverage- the power gained by a company when more financial assets are acquired of the acquiring company. Earnings per share and the overall profitability of the acquiring company are improved. The improved productivity and increased stock generates more (Jarrod, 2005). Disadvantages of Acquisitions Acquiring of another company may involve high financial implications. These include buying costs legal costs and other associated costs. This may cause the company to take loans which may take long to (Jarrod, 2005). The anticipated profits of acquisition may take long to be realized. It will take the company quit e some time before it penetrates the new market. (Jarrod, 2005). Acquisition may not go down well with the customers and shareholders. Acquired company may be placed under management of a new team. The new employees may not be familiar with the company’s operations. This may have negative effects on the clients.Advertising Looking for critical writing on business economics? Let's see if we can help you! Get your first paper with 15% OFF Learn More Advantages of merging Merging of companies is aimed at improving the financial performance of the companies in question. Merged companies enjoy the same advantages as those acquired company. Merging companies also enjoy Vertical integration. This occurs when an upstream and downstream firm merges. Disadvantages of merging While diversification may hedge a company against a downturn in an individual industry it fails to deliver value (Harwood, 2006). Merging may also lead to Manager’s hubris. This is managerâ₠¬â„¢s overconfidence about expected synergies from merging. Merging requires empire-building. Conclusion Even though acquisitions are found to be advantageous to a company, there face numerous challenges, thus the need for planning that is acceptable. Merging and Acquisitions bring benefits to all stakeholders of a company by generating more profits, expanding the market share, and other benefits. However the two are costly to operate, there is high opportunity costs involved in the short run and other drawbacks which may hinder a company from adopting involved strategies. That notwithstanding, merging and acquisitions are of great benefit to a company and managers should consider taking this as a growth strategy. Reference Donald, DePamphilis (2008). Mergers, Acquisitions, and Other Restructuring Activities. New York: Elsevier, Academic Press. pp.740. Harwood, I. A. (2006). â€Å"Confidentiality constraints within mergers and acquisitions: gaining insights through a ‘bubbleà ¢â‚¬â„¢ metaphor†. British Journal of Management 17 (4): 347–359. Jarrod M., Coulhard, M., and Lange, P. (2005). Planning for a successful merger: A lesson form an Australian case study.’ Journal of Global Business and Technology, 1(2).Advertising We will write a custom critical writing sample on Acquisition and Merging specifically for you for only $16.05 $11/page Learn More This critical writing on Acquisition and Merging was written and submitted by user Miranda Delaney to help you with your own studies. You are free to use it for research and reference purposes in order to write your own paper; however, you must cite it accordingly. You can donate your paper here.

Gladiaotrs essays

Gladiaotrs essays The Gladiators of ancient Rome are interesting and important in many ways. This paper will touch on four subjects that have to do with the Gladiators. The first subject is the history of first and earliest gladiators and how Gladiatorial fights came to be a part of Roman civilization. The second area is the type of gladiator, which includes the type of armor, weapons, and a little history of each type. The third is the way the gladiator lived and participated in the Roman civilization. The fourth and final is the arenas they fought in, and what types of enemies they had to face. The very first recorded gladiatorial fight was at a burial of Junius Brutus in 264 B.C. His two sons Marcus and Decimus brought back an ancient custom of having slaves fight at the funeral. In which this sacrifice would please the Gods. Three slaves were ordered to fig to the death as many spectators watched. This led to become a large spectator event. As the years rolled on more and more slave fights at the funerals of Romes great leaders appeared. The number of fighters also increased, as well as the number of viewers. This was thought to be a family name inhancer when large fights were held at the mans funeral. By the time of the Great Julius Caesar, all the direct ties to funerals and or religion were gone. These gladiators as they were now called fought to entertain. This was the idea of Caesar to keep the Roman citizens pleased. With much entertainment and suspense the people were living happily, brining the hole family to watch such gruesome events. This was the start of the great gladiatorial battles that Ancient Rome was so popular for. Caesar knew this and took control of all such events held for the public. This made him very powerful and wealthy. The ancient ritual that was for the gods was now for the entertainment of thousands of excited Romans who...

Case Study Example | Topics and Well Written Essays - 500 words - 10

Case Study Example ular profession and these conducts stems from ethical point of view since some of the professional code of conducts are inefficient without the ethical inclination. Thus profession and religious ethics are intertwined and anybody dealing with professional life problem will in most cases be influenced by the religious ethical views. (Kultgen, H pg 4 & 5) In the case scenarios given, Mayor Bazelon, governor Schreiner and Alya are concerned as to what is the appropriate dress code for students, the issue of female genital mutilation and submission to husband respectively, with restorationists opposing the view of school uniforms as not being modest and against their religious teachings and FGM is grounded on their religious practices, feminists argue that restrictive robes are degrading to women and FGM is inhumane, conservatives holds that their shall be segregation of Muslims and loss of American culture if they are allowed to wear religious robes. The Jews also express concerns of totally outlawing circumcision including male. It can be viewed that we should respect the religious teachings for they are what shape our daily lives and makes us righteous with the creator, thus Muslims who are the dominant group should be allowed to exercise their obedience to Allah through their daughters wearing restrictive robes (Utilitarian approach). (Markkula Center for Applied Ethics, pg 5) Given that ethical actions should be that which allows all to choose freely what they desire, in this regard therefore Muslims, feminists, conservatives and Jews should choose freely whatever they want. However, since social order is fundamental for societal prosperity, the end of this is disorder, therefore in my view it should not be followed (Rights approach). (Markkula Center for Applied Ethics, pg 6) Since all are Americans bound by the federal and State constitution with the obligation to respect them, thus if it’s a matter of law then all ought to adhere as this is fair and just

Persuasion Essay Example | Topics and Well Written Essays - 500 words

Persuasion - Essay Example This is a great advantage for the Mac computers because many users like to install and use multiple operating systems for different uses (Stoncypher, 2010). Therefore, with apple computers, you can run multiple operating systems on a single machine. Secondly, apple computers software has advantage over windows computers. This is because apple’s software is compatible with many others as compared to windows (Martin, 2008). Apples software is very different from that of Microsoft in that Microsoft’s software is not compatible with apples software. For example, the type of files, file extensions and complex codes in the operating system are different, and apple can handle most of them, unlike windows computers (Emigh, 2007). The other advantage of apple computers over windows computers lies in their design (Martin, 2008). Macs are cosmetically designed to appeal to the user’s requirements. Apples designs are light and thin, and powerful than windows. The design itself is engineered to meet high performance standards than other computers. Apple computers have an appealing design to the eyes of the user, with an apple logo that is lit at the back, a backlit keyboard and keys. Apples design eliminates bulkiness and uses spinning hard drive technology and not the optical drive to enhance high performance (Martin, 2008). This hard drive technology makes apple’s drive faster than windows computer drives, and this saves the designs space hence making apple lighter and slim as compared to windows computers. The design of apples cooling system has been engineered to draw air from the sides, to ensure that they remain cool for a long period. Apple’s speakers have been custom designed to utili ze every space available and provides good sound response and high quality performance. The other advantage of apple computers over windows is the security of their system. Windows PCs are considered more insecure than apples

Developing A Five Star Hotel In Maldives Construction Essay

Developing A Five Star Hotel In Maldives Construction Essay Expedition Maldives Pvt. Ltd, this is leading construction company in Maldives, A Company is a expand hard with the ability to meet its clients building needs through wide range of contracting and company with a staffs of professionals skilled in architectural design and construction management, In every movement, the companys priority is helping its clients achieve their construction and developmental objectives. Our goal is to build the most expertly designed structure as economically as possible. During the past 07 years, Expedition Maldives Pvt. Ltd, a company, has successfully completed a wide range of construction projects for the private sector, hotels building, and government projects. Background Developing a five star hotel in Maldives. The project environment Mendhoo island is located in (BAA-Atoll) and this is an individual stand alone island. This is an investment of Blue line corporation, Netherland. The project commenced on 2011 February. The island is plan and design for 200 bed rooms with other necessary building in a five hotel. The first phase of the project is going to complete 100 bed rooms and required other buildings, such as restaurants, bars, sport centers and etc. The total investment of first phase is Eight million US$ (Eight million dollars), and the duration of the this phase is three years, after finishing the first phase the resort will be opened and connect the tourism industry. The remaining project phase of 100 bed room will start after analysis of performance. Project goals 1- To complete the project within the agreed timeframe of three years from January 2011 to January 2014, and handover to the owner of Mendhoo International 2- To complete the all the project works within agreed budget of US$ Eight Million (United State Dollars), that includes goods, materials, food, accommodation, transportation and labor cost. 3- To maintain the project quality according to the plan, without omitting any single part of project work and hand over the project after revising entire the project work, to make ensure the owner are satisfied with the project work. 4- To make sure the customer is satisfy, by finishing the project with the specification the customer provided and exactly the customer want. 5- To use the best methods and ways, to complete the project in a difficult situation such as strong weather it normally faced in the country like Maldives. Project objectives 1- To monitor the project works day-by-day and how the project team performance to avoid the problems that are facing on the project activities to complete project on time. 2- Adopt an effect monitoring system to handle goods, materials and other services which are used in the project to control the budget. 3- Supervise the all the project works, to ensure that the works are carryout according to the plan provided, to maintain the quality of the work. 4- Get the continuous feedback from owner or consultant that the owner has selected, to provide the product the customer actually wants. 5- Continuous monitoring of weather forecast, to organize the work schedules, suppliers transportation, to mitigate the obstacle facing on the project performance. Stakeholders Stakeholders of this project defined as all internal and external stakeholders. Internal stakeholders who involved in this project are Investors, investing for the project, Board of Directors, Managing director, Organizational staffs, Project manager, Project team members, Contractor and Suppliers. External stakeholders are government agencies, Architectures, Consultants, Competitors, Tourists and banks. Project Scope and Time Management Scope is building a five star hotel in Maldives, to provide higher quality accommodation for the customers and to deliver owners acceptable quality works within given budget and time frame and project time is managed buy according to the work breakdown structure (WBS) attached in this plan. Human resources management This looks on the process which required and how these people effectively involved in the project. This will includes all the stakeholders. In the organizational planning it was mentioned roles and responsibility of each member, whom they should report and provide the best resources to the staffs, that will include provide the best training which required for the project and good standard of food, accommodation, health and safety. Financial Management Required funding is provided by the investors for part payments from Blue Line Corporation, Netherland. They are paying in many different phases, according to the ongoing project works. Internally project will be audit; according to the audit management system will monitor and order the required good and materials for the project and made the payment for contractors and suppliers. Stakeholders Roles and responsibilities 1- The project investors will oversee the research of the business and finalized the budget for the project and investing on project. 2- Project board of directors will establishing the organization mission and vision, establish the plan and provide resources required for the project. 3- Managing director will develop the organization strategic plan in an effective manner and accountable for overall performance of organization. Managing day-to-day activities of the business, authority delegated from board and implementing board policies and strategy, allocating resources required to achieved the objectives. 4- Project Manager responsibility is completing the project on time, within the provided or given budget, and maintain the quality criteria provide training for the project staffs, maintain the project quality, identify the project procurement, develop and approve project charter, define the goals and objectives. 5- Project Teams members responsible are performing the project activities. They also help obtaining commitments to complete the project within schedule and limited budget. 6- Contractors will carry out the task handover according to the design and plan and contract they may be a construction or electrical. 7- A Supplier will supply good and material according to the contract, which are required for the project and should maintain the quality standard of the according to the contract. Project Management Information System PMIS Project Management Information System adopts for this project, collect, combine and distributes the information through electronically and manually. This used for upper management to communicate with lower management. It will provide the resources for planning, evaluating, monitoring, and controlling to a project through both formal and informal channels. Risks management In the risk identification of this project, all identified risks will be stored in a risk register and this list will be determine which risk is most danger to the project and will give more priority to attend the high risks first likewise resolving one after another. Tools and Techniques consider are Documentation Reviews, Information Gathering Techniques, Checklist, Assumption Analysis and Diagramming Techniques such as Cause and effect, and fishbone Ishikawa diagrams, Process flow charts, Influence diagram Risk treatment plan is a part of risk and also it is a part of risk management plan. This plan will show how the risk will be managed either that is high, medium or low. According to this project the first create risk management plan that will guide the team members and stakeholders, how they react on the risk. Communication Plan Maintain the communication among the stakeholders, according to the communication matrix given below. Communication type Project Objectives Medium Used Frequency Project Audience Project Owner Deliverable Methods Project Kick-off Introducing the project team and review objectives and management approach Face-to-Face Once Investor Board of Directors Stakeholders Project Team Project Manager Agenda Meeting Minutes Project Team Meetings Review project status within project team. Face-to-Face Call Conferencing Weekly Project Team Project Manager Agenda Meeting Minutes Technical Design Meetings Develop a technical design and solution for the project. Face-to-Face As needed Technical staff Technical Leader Agenda Meeting Minutes Status Meetings of Project Project status report to management Face-to-Face Call Conferencing Monthly PMO Project Manager Status Reports of Project Project status report of the activities, progress, costs and issues Email Monthly Investor Board of directors Project Team Stakeholders PMO Project Manager Status Report of Project Quality management To manage the quality of the project, the firm will adopt ISO 14000 for Environmental issues and ISO 12006 for Building construction issues. Both of these two families have many other series of standards that are included in this project. This is a five star hotel, so the quality management system of the project conduct according to the ISO approved standard. The firm staffs will be trained the standard of ISO approved level. The project is running with international standard, than these agencies provide required knowledge for particular issues, so adopting ISO standard is very important for this full project. The main reason of adopt ISO standard is to meet or exceed stakeholders needs and expectation. The project team will develop a good relationship with key stakeholders, specially the supporter and the recipient of the project, to understand what quality means to them. The project team will need to make adjustment to scope, schedule and budget to satisfy the recipient s needs and expectation. Procurement Management Procurement planning of this project, the firm will use annual procurement planning. This planning encourages the firm management to handle the available resources as well as deliveries according plans and strategies. 1- To identify the quantity of good and materials required for the project, according to the plan other requirements. 2- Always materials should be available for the project works. 3- Giving special attention to good, material and resources prices. 4- Minimize the procurement time, cost and increase the production. 5- Mitigating the level of risk associate with the project. 6- Equally perform the production and procurement plan. 7- A trusted understanding between business partners and suppliers. The firm management will consider on following stages of annual procurement planning. 1- Supporting service of delivering the products 2- Assessing company expenses on goods, materials and services 3- Improving the project procurement process 4- Improving the project performance of goals and events

Effects of Television on Children: A Chain Indicating Their Behavior Es

Kate Moody, author of Growing Up On Television: The TV Effect, explains that a nine-year-old’s effort to slip his teacher a box of poisoned chocolates, a seven-year-old’s use of ground glass in the family stew, a seventeen-year-old’s re-enactment of a televised rape and murder by bludgeoning the victim’s head and slashing her throat, and a fifteen-year-old’s real-life rerun of a rape with a broomstick televised in the movie Born Innocent are all examples of crimes copied from TV (86). Many children are introduced to the world of television before they enter school and grow up committing crimes because they were under the influence of television. In Mary L. Gavin’s article, â€Å"How TV Affects Your Child,† found on KidsHealth.org, which is the most visited website for information about health, behavior, and development from before birth through the teen years, Mary reported that two-thirds of infants and toddlers watch television an a verage of two hours a day, kids under the age of six watch an average of about two hours of television a day, and children between the ages of eight and eighteen years old spend nearly four hours a day in front of a television screen (Gavin). The article found on the Media Awareness Network website, â€Å"Television’s Impact on Kids,† reports that television is one of the most prevalent media influences in kids’ lives (Media Awareness Network). Lately, reality shows like Bad Girls’ Club and Jersey Shore are being aired because they are full of drama that catches the viewers’ attention. Children are more receptive of what they see on TV than adults are and are more likely to mimic those actions. The negative influence of television causes children to absorb and retaliate what they see on TV, which in part cause... ...use. And often, there's no discussion about the consequences of drinking alcohol, doing drugs, smoking cigarettes, and having premarital sex (Gavin). Children who view TV become involved in three processes: (1) they are exposed to new behaviors and characters, (2) they learn to do or acquire those behaviors, and (3) they eventually accept them as their own (Moody 86-87). Children are attracted to violence, and violence on TV is portrayed as tolerable. As a result, kids show aggressive behavior and learn to handle their problems with violence, which leads to an increase in crime. Also, children that watch shows that contain sexual content are more likely to become involved in sexual activities. Children assimilate everything they see on TV, and they assume behaviors like violence and sex are appropriate, which guides them to actually undertake in such activities.

Importance Of English Language Essay

The importance of English language is spreading geographically. In the world there are many languages being spoken. English is one of them which become international language. Language is used to defining the characteristics of every nation. Every country has its own language culture. People in USA, Canada and Europe speak English. Different Stages of Languages in Subcontinent: In subcontinent history of language is takes a great amount of time. When Muslims governed in subcontinent then they brought their language. At that time Urdu became the official language and language of common people. Muslims also learned Arabic language to improve their social condition but they can’t brought prominent change in their set-up. After that, When English came in the place of Muslim. They brought their culture and language. English became the master language. Everyone tried to learned English language quickly. They change their social , economical and education system. Which people learned English they got good jobs and able to got success. Read more: Importance of English language essay Realisation of its importance: Almost Asians were felt hesitation to learn English. Leaders of Muslims convinced then to learn or write English for their progress. They helped them to make acceptable place for themselves in new system. Because of English, We are able to get success in every profession. English as medium of success: In developed countries almost everyone speaks English and they lead all over the world. Unfortunately in our society our people feel shy & they are too much confuse and nervous to speak English. People fear to bring change in educational and government level. They are unwilling to introduced English at the place of Urdu. Government should to take action to make English common. In start this step from government departments. They try to conduct their business in English not in Urdu. Urdu is our mother tongue everyone can speak Urdu easily. But we try to make English common in offices, schools,  business etc. English as a medium of information: English use ass a medium of information and instruction in schools, at higher education level, in offices. We should change our system Urdu to English. Make English compulsory from primary level, conduct exams in English. Students, who feel English difficult, they can’t get good jobs in higher education to get good jobs in high standard institutions and multinational companies. It is necessary that, We have command in English. Private English medium schools play an important role in rapid growth of English. They prepare their in good way but no one can afford the expense of English medium schools. English is a Language of Science & Technology: English is not important for educational system it is also became the language of science and technology. It is an international language as well as, it is a language of technological research. Every field based on English. Now people of our society know the importance of English, they learn English with great speed. Pakistan also develop English in scientific research. Pakistan gets idea from developed countries. English is also important of our success. Increase in Foreign Income: As we know, English is an international language. To conduct business with other countries, We must be able to deal them in English. Income from export of goods is a major part of our national income. We have known, How the basics of English language then we can easily deals with foreign traders, Which increase our foreign income. Knowledge of English keeps people of our society to get good jobs in other countries. Important of English in Strong Future: Our government should improve set-up of educational system. Makes our society social English-speaking. Advantage of this great step is, We can lead other developed countries. We also can influence in world situation. Our government try to reduce the difference between Urdu and English. Medium institutions makes English as a compulsory subject and other subject conduct in English. Urdu also is an important language, it shows the good manners  and attractive culture to others but for the country progress or stand with other countries, We should have strong grip on English. English play very important role in our political, economical and social progress. We need English for our better present and for better future. Conclusion: We should focused on English language. Because it is an international language also a living language, and it is also important for our success. We surely can’t ignore the importance of English Language. Disraeli.Disraeli saying about success.