Bp Oil Spill Analysis Essay - 6383 Words

I. INTRODUCTION 1. Scope of Research The spectrums of oil spill issues are diverse and large. They range from environmental issue to economic, ecological, ethical, politics and policies. Among many other oil spills, the BP oil spill in the Gulf of Mexico, occurred on April 20, 2010 was recorded as the greatest environmental disaster in our history (BP leak the worlds worst accidental oil spill, 2010). The goal of our research is to seek possible solutions to reduce the risks of offshore oil spills. To attain this goal, we gathered information from over twenty sources, including â€Å"Deepwater Horizon oil† from Wikipedia research and an article from the LA Times. Our research focused mainly on four aspects of the BP oil spill,†¦show more content†¦In 1999, BP was fined $1.7 million for burning polluted gases at its Ohio refinery. In the following year, the company was charged $10 million by the EPA for the air pollution from its U.S. refineries (Beder, 2002). BP has also been accused of violating human rights. In 2005, one of BP’s refineries in Texas exploded, caused 15 deaths and 180 injuries. The explosion was largely a result of safety cuts to reduce costs (Baker et al., 2007). From 2006 to 2008, three workers were killed at BP’s Texas refinery due to equipment failure (Collette, 2008). II. PROBLEM ANALYSIS 1. Environmental Problems Environmental Impact On April 20, 2010, one of BP’s drilling wells below the Gulf of Mexico exploded and caused a disastrous oil spill. Thousands of barrels of crude oil flowed into the gulf every day, causing widespread pollution in the Gulf of Mexico (Law Brain, n.d). The habitats of many bird species are threatened by this oil spill. The American Bird Conservancy (ABC) listed the top ten most polluted areas from the oil spill: 1. Gulf Coast Least Tern Colony, 2. Lower Pascagoula River, 3. Gulf Islands National Seashore, 4. Breton National Wildlife Refuge, 5. Dauphin Island, 6. Fort Morgan Historical Park, 7. Bon Secour National Wildlife Refuge, 8. Eglin Air Force Base, 9. Delta National Wildlife Refuge, and 10. BaptisteShow MoreRelatedA Neo Aristotelian Analysis Of President Obama s Oval Office Address On Bp Oil Spill Energy 1613 Words   |  7 PagesEleanor A. Lockhart Rhetorical Criticism 2 October 2015 A Neo-Aristotelian Analysis of President Obama’s: Oval Office Address on BP Oil Spill Energy On June 15, 2010, President Barack Obama formally addresses the Deepwater Horizon oil spill to inform people of his plans to contain the oil spill and the nation s need for clean energy. The purpose of this paper is to analyze President Obama’s speech on the BP oil spill using Foss’ neo-Aristotelian method of rhetorical criticism, by which I willRead MoreBritish Petroleum and Its Corporate Strategy1595 Words   |  7 PagesBritish Petroleum and its Corporate Strategy Introduction The organisation environment is always changing and therefore it is essential that a structured, detailed and continuous analysis of the principal dimensions of the environment is made. In order to profitably satisfy customer needs, an organisation must understand its external and internal situation including the customer, the market and its own capabilities. Furthermore, it needs to understand and adapt to the dynamic and uncontrollableRead MoreBp Oil Spill1094 Words   |  5 Pagescompetitive) segments do you think BP considered or didn’t consider prior to their drilling of the Gulf Coast? What should the wedding business owners now consider in their external environment? BP decided to drill in the Gulf Coast mostly because of the oil availability and competition. Opportunity was definitely considered by BP. The North Sea was saturated with other oil companies and BP saw an opportunity in the Gulf of Mexico (Pour, 2011). The segment that BP did not do well is the environmentalRead MoreArgumentative Essay : Bp Oil Spill1558 Words   |  7 PagesArgumentative Essay: The BP Oil Spill Phillip Staton PHI 445 Personal Organizational Ethics Prof. Gloria Zuniga y Postigo February 29, 2016 Argumentative Essay: The BP Oil Spill Introduction In 2010, BP’s Deepwater Horizon rig exploded, causing millions of barrels of crude oil to be leaked out into the Gulf of Mexico. The extensive oil spill created a lot of pollution and far-reaching effects on the tourism industry. The resultant damage to marine wildlife such as fish will continue to be feltRead MoreThe Hurricane Katrina Disaster And The Bp Oil Spill Tragedy941 Words   |  4 Pagesethical behavior in high-profile events, as well as examining various regulatory and sustainability market approaches to business environmental responsibilities. The paper focuses on two major occurrences; the Hurricane Katrina disaster and the BP oil spill tragedy. Hurricane Katrina entered into records as one of the worst disasters ever to hit the US, the storm is considered as the most disastrous and damaging in the US history in 2005. Well over 1800 peopleRead MoreBp Deepwater Horizon Case Analysis Essay1392 Words   |  6 Pagesthe Deep Horizon blowout Background: The Deepwater Horizon oil spill or the BP oil spill refers to the oil spill in the Gulf of Mexico which flowed for three months in 2010. The spill was a result of the explosion of Deepwater Horizon, which drilled on the BP-operated Macondo Prospect. The explosion killed 11 men working on the platform and injured 17 others (Summarized from Wikipedia article on: â€Å"Deepwater Horizon oil spill† http://en.wikipedia.org/wiki/Deepwater_Horizon_oil_spill ) InRead MoreEssay about Stakeholder Analysis on Bp689 Words   |  3 PagesAssignment # 1 Stakeholder analysis on the British Petroleum oil spill disaster Stakeholder: UK and USA Government The British Petroleum (BP) oil spill in the Gulf of Mexico flowed unabated for three months in 2010. It is the largest accidental marine oil spill in the history of the petroleum industry. This event affected individuals and groups, know as stakeholders, in different ways according to the impact that the catastrophe meant to their situation. The stakeholders treated in this case areRead MoreBp Plc And Civil Society1189 Words   |  5 Pages BP PLC and Civil Society BP p.l.c understands that society continues to have a high expectation from companies, specifically coming from media and political figures. BP p.l.c published their 2013 annual report that reads, â€Å"We are also seeing that society has ever higher expectations of business. This is reflected in the increasing scrutiny placed on the commercial sector, particularly by politicians and the media. Companies must work hard to maintain people’s trust and respect† (BP p.l.c, 2013Read MoreThe Spill Of The Bp Oil Spill1464 Words   |  6 PagesThe BP oil spill was one of the worst oil spills to ever happen in the US. There are many factors that caused this horrible spill to happen; to be exact there were eight failures of the oilrig that caused this disaster. The first failure was the cement at the bottom of the borehole was not sealed properly. This caused the oil and gas to start leaking into the pipe leading to the surface of the rig. The second failure was that the valve l eading to the surface was sealed improperly with cement. InRead MoreEthical Issues Of Offshore Drilling1008 Words   |  5 Pagestoday, and have known for many years, BP is not just a local gas station that we go to sometimes to fill up our tanks. BP is a HUGE Multi-Billion dollar company! Many people believe they get there oil mostly from the mid-east but they’re also a company (or industry) that does offshore drilling for oil that is refined into a much more stable state that doesn’t blow up cars as soon as ignition occurs. Off shore drilling by definition on BP’s main site is drilling oil â€Å"35,000 feet (10,660 meters) below

A Report on Blackwattle Bay Career Education Program Free Essays

The most important goal of secondary education is to prepare students for their future, whether it is for higher education or for the world of work. It is a reality that not all high school graduates can proceed to tertiary education, some would have to forgo college and enter the world of work. Secondary education should be able to provide the right amount of training and education that would help the graduate become successful in his/her chosen life path (Hamilton Hamilton, 1994). We will write a custom essay sample on A Report on Blackwattle Bay Career Education Program or any similar topic only for you Order Now Secondary education does not also limit itself to providing academic and skills training but also in developing the personality of the student and by teaching life skills which they will use in their daily lives. In doing so, students are no only equipped academically with skills and knowledge but also become responsible young adults. Education’s ultimate goal is to teach and transform the minds of the young in the hope that they will become productive citizens of the country. With the many issues and controversies that the educational sectors are facing, it is no wonder that more and more schools are trying to address the issues of providing quality education that would result to student success in and out of school (Myrick, 2002). For some, innovation and the use of technology had helped in motivating students and in enhancing instruction, others focus more on providing excellent support for the needs of students that would aid in decision making in terms of their future and life goals. This support programs include career guidance, counseling, social action, volunteerism and spiritual guidance. Other schools emphasize academic preparation and excellence by providing programs such as remedial classes, enrichment classes, advanced courses in science and math, tutorials and the like (Cobia Henderson, 2007). As most educators agree, a school which provides holistic education and personal development are the best kind of schools whether it is public or private, and rural or urban. In recent years, the general public had been averse to sending their children to public schools owing to the negative reputation that it has been given for not providing quality education, for not having excellent teachers and for the lack of funding given to such schools. More and more parents had sent their children to private schools for secondary education, in an attempt to reverse the negative perception towards public schools especially in the inner cities; the Sydney Secondary College was created in 2002 in order to revitalize public education. The Sydney Secondary College system is composed of three campuses located at Balmain, Leichhardt, and Blackwattle Bay. Students attend either Balmain or Leichhardt for their grade 7 to 10 education then move to Blackwattle Bay for their 11th and 12th years. Although Blackwattle Bay accepts applicants from different schools, students from Balmain and Leichhardt are given priority. The college system is unique in the sense that the learning environment of the Blackwattle Bay campus is very similar to a true college or university wherein students take courses that are geared towards enhancing the students’ chances of being accepted in tertiary education. Moreover, the college concept also posits that juniors and seniors would benefit more from a more mature and challenging learning environment than a regular high school. How to cite A Report on Blackwattle Bay Career Education Program, Papers

Ancient Romes Animal Cruelty For Entertainment In The Amphi

Ancient Romes Animal Cruelty For Entertainment In The Amphi-Theatre Essay The Romans are often characterized as loving violent and cruel entertainment in the amphitheatre. It has been suggested that the games served the dual purpose of providing entertainment for the people and maintaining the political status quo. In todays society, the killing of humans and animals usually means a jail term, and seeing someone die is not something people go and see for fun. Violence was glorified in Rome hundreds of years ago. All the crimes they committed were condoned, accepted and glorified. There were four different genres of such entertainment in the games held in amphitheatres (Amphi-theatres are outdoor arenas. theatres in the round: Amphi- meaning round in Greek.) : Gladiatorial combat, the theatrical execution of foreigners, beast shows, as well as chariot racing. Watching someone or a beast kill another was applauded for the method, skill, or artistry used in the slaughter. The games themselves provided ways for Rome to demonstrate the power of their empire, as huge investments of wealth, time, and emotion was put into the games. Death became a spectator sport with the viewers and the viewed both contributing to a wild and gory performance. Already by the late Republic magistrates were spending huge amounts of money on these games. The Latin word for gladiatorial games is Munus which means obligatory offering. This reflects the origin of these games as funerary offerings to the dead. While magistrates in the Republic may well have put on games to gain popular favo ur, this was in their private capacity and not as magistrates. Only gradually did the gladiatorial shows come to be assimilated with the games put on by magistrates. While the most popular games were chariot racing and simulated naval battles, fights in the amphitheatres, shown in these mosaics include gladiator V gladiator, gladiator V animal (pic 2) and animal V animal, were a common feature. Less common, but not infrequent was the release of wild beasts from the pits into the arena where hundreds of criminals had earlier been positioned. These spectacles all deeming to be very entertaining to spectators. Throughout the history of the Republic, there was a difference between the gladiatorial contests and other forms of spectacular entertainment. The Romans did not invent the concept of gladiatorial fighting; there is some uncertainty as to the exact source. One ancient source says it was the Etruscans, a non-Indo-European people who lived directly north of the Romans. Games that the state sponsored were called Ludi and held quite frequently. They never involved armed single combat, were associated with the worship of a god and were paid for (in part) by the public treasury. The Gladiatorial contests (Munera Gladiatorial) were sponsored and paid for privately, held very infrequently and were associated with funeral rituals. In A.D 70, the emperor Vespasian began construction on the site of a drained lake, of the largest amphitheatre in Rome, the Colosseum. The word Colosseum comes from a colossal statue of Nero that once stood near the stadium. The Colosseum could seat up to 50, 000 spectators, including the dignitaries, their guests, their slaves, a select number of common people, and foreigners (people who did not hold Roman citizenship). Commoners, slaves and foreigners were seated in the hottest place right under the canvas roof. After nine years of building by slave labour, the Colosseums opening ceremonies, including the Inaugural games, in A.D. 80 involved spectacles held for 100 days in which 9, 000 animals and 2,000 gladiators were killed, all for the delight of the crowd. In such a cultural climate, gladiatorial games were immensely popular and a characteristic symbol of Roman culture for almost seven centuries. Adopted from the earlier Etruscans, perhaps by way of Campania, Gladiatorial Games / Munera were introduced to Rome in 264 BC, and originated in the rites of sacrifice due the spirits of the dead and the need to propitiate them with offerings of blood. The were the obligatory funerary offerings owed to important men at their death, the first time being when the sons of Junius Brutus honoured their father by matching three pairs of gladiators. Traditionally, Munera among ancient Romans, gladiators (usually slaves or captives trained for the purpose), fought, usually to the death with swords or other weapons at public shows. The more harm the gladiators inflicted the bigger hero he was, and the more respect he gained. A vessel too fragile EssayCircus Maximus was also used because the Empire had trouble conveying information to an ignorant public without mass media at its disposal. The Circus Maximus allowed emperors an opportunity to announce new laws, taxes and inform the public on some of Romes à hot gossip. These bloody forms of entertainment served an important political function, helping maintain the political status quo. The administration saw it as important, as it assisted in teaching the local Romans how to fight in preparation for visits outside their empire, and to display the strength and courage of the Roman citizen to unemployed visitors to the city of Rome. In the growth of Munera, political competition among aristocrats was an important factor. Elections continued, and members of the ruling class continued to compete for the peoples affection through the offering of magnificent shows. The terms of competition were somewhat different. It was expected that everyone give games upon taking up office, and public funds were offered to help defray the cost both of purchasing gladiators from professional trainers and acquiring splendid beasts. But the magistrate was expected to add to this sum, and inscriptions were set up commemorating particularly splendid shows. There was great pressure to make your Munus more impressive than the last. During the Republic, gladiatorial combats brought great popularity to the giver of the games, their aim to increase their votes at election time. Julius Caesar in 65 BC, the year of his Aedileship, planned to give a gladiatorial exhibition consisting of 320 pairs of fighters. Although this exhibition was a Munus in memory of his father, Caesar was seeking to win political favour for his candidacy for the praetor ship. Although we know it was expensive to stage a gladiatorial show, no one has so far noted how expensive. Money had to be spent on prize money for the winners of these games (Gladiatorial Contests, Chariot Racing), or buying the animals for the shows. The endless blood lust of the spectators, populus and emperors alike, the brutality of the combat, and the painful deaths of men and animals are seen as cruel today, but the administration had these games to show the public of their cities the culture of war, discipline, and death. The gladiator demonstrated the power to overcome death and instilled in those who witnessed it the Roman virtues of courage and discipline. Gladiatorial games in the amphitheatres and entertainment in Circus Maximus have major significance to the way the Romans ordered their lives. Like any other form of ritual, these contests were implicitly understood by the Romans to express a message important to their social order and that message involved violence, death, and power.

The Great Depression Essay Example For Students

The Great Depression Essay Outline1 Introduction2 Popular topics3 Depression essay example4 Conclusion Introduction At college or at university, students are often required to complete essays and other writing assignments on particular topics or issues. The topic and the methods usually depend on the field of studies. In the psychological field, one of the most complex and controversial issues is depression. The number of people experiencing depression is only growing over time, and thus, it is important to investigate the issue and all the related aspects from different perspectives. This article will be helpful for college students studying Psychology, Medicine, Health Care, or other related disciplines. It provides a hook for writing essays about depression by offering necessary information on a good essay about depression structure and the most popular topics concerning depression. Popular topics We will write a custom essay on The Great Depression specifically for you for only $16.38 $13.9/page Order now The study of depression involves numerous controversial and relevant topics, which can become themes for your essay about depression. For example, the essay can be focused on exploring the nature of depression and related disorders or on measuring how common and serious depression is. Besides, among the popular topics, one can choose to write a paper on The Depression Signs, The Causes and Effects of Depression, Treatment Successfully Used to Overcome Depression and other topics. Choosing the right topic is the key to success in writing an essay. Besides that, you have to develop a strong and arguable thesis in your paper. Finally, you should show your awareness of the topic at both theoretical and practical levels. Your essay can be descriptive. At the same time, like the majority of essays, it can be argumentative providing strong arguments supporting the thesis. Depression essay example Depression is a complex and multi-sided phenomenon. It is not just a feeling of sadness  that every person can have. As compared to sadness, depression can be characterized by a longer duration and higher intensity, and it strongly influences people’s everyday lives. A person with depression usually loses the ability to feel pleasure and interest to everyday activities and instead, suffers from the feelings of hopelessness. Consequently, depression can often lead to the development of thoughts about suicide. Besides, the primary symptoms of depression include a considerable increase or decrease in appetite, fatigue, and sleeping disorder. As a result, a person’s body also suffers because of the mental state. Researchers differentiate between major depression and dysthymic disorder. Patients with a major disorder are those who have experienced the mentioned disease indication for some period. At the same time, these signs are rather severe and can be experienced in an intense form. People with dysthymia disorder experience the mentioned symptoms in a less severe form typically for two years or more on the majority of days. Even though the term â€Å"depression† has been used in the scientific field only for less than a hundred years, the notions of sadness, melancholy, and depression have been long known in society. Nowadays, as more and more people are experiencing depression, the study of this disorder has significantly improved. In addition, researchers state that today, antidepressants are the most frequently prescribed medications in the United States. One of the most popular ways of treatment for patients with depression is the use of St. John’s Wort herb. Other ways of treatment that can be recommended for use are exercise, Omega-3 oils, SAMe, and 5-HTP. They can be used either as stand-alone alternatives of therapy or as complementary medicines. At the same time, the success in the use of these therapies strongly depends on individual characteristics, such as the person’s reactions to different remedies and the severity of his/her symptoms. .u1720ae3b5c0439de6a7344d124c6feac , .u1720ae3b5c0439de6a7344d124c6feac .postImageUrl , .u1720ae3b5c0439de6a7344d124c6feac .centered-text-area { min-height: 80px; position: relative; } .u1720ae3b5c0439de6a7344d124c6feac , .u1720ae3b5c0439de6a7344d124c6feac:hover , .u1720ae3b5c0439de6a7344d124c6feac:visited , .u1720ae3b5c0439de6a7344d124c6feac:active { border:0!important; } .u1720ae3b5c0439de6a7344d124c6feac .clearfix:after { content: ""; display: table; clear: both; } .u1720ae3b5c0439de6a7344d124c6feac { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .u1720ae3b5c0439de6a7344d124c6feac:active , .u1720ae3b5c0439de6a7344d124c6feac:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .u1720ae3b5c0439de6a7344d124c6feac .centered-text-area { width: 100%; position: relative ; } .u1720ae3b5c0439de6a7344d124c6feac .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .u1720ae3b5c0439de6a7344d124c6feac .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .u1720ae3b5c0439de6a7344d124c6feac .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .u1720ae3b5c0439de6a7344d124c6feac:hover .ctaButton { background-color: #34495E!important; } .u1720ae3b5c0439de6a7344d124c6feac .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .u1720ae3b5c0439de6a7344d124c6feac .u1720ae3b5c0439de6a7344d124c6feac-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .u1720ae3b5c0439de6a7344d124c6feac:after { content: ""; display: block; clear: both; } READ: The Kite Runner By John Kite EssayTypically, depressed people use a combination of different therapies as it is supposed to produce better results. It is apparent that a person should use professional help for defining the best combination of remedies that can be recommended for use regarding a particular situation. For instance, the use of complementary medicines for depressed people is combined with psychotherapy. In the majority of cases, psychotherapy is viewed as a strongly beneficial way of treating depression. The matter is that the opportunity to talk to someone about your problems can not just lead to the symptoms relief but can help to reveal the main ground of d epression and the best ways of overcoming it. What is more, in most cases psychotherapy help patients find ways for dealing with their everyday problems. Conclusion Depression as a complex and multi-sided psychological phenomenon is a popular issue discussed in student essays. These writings usually discuss the indications of the illness as well as the effect of depression on everyday life and the severity of this illness. Researchers prove that depression can be treated if a person asks for professional help and uses a combination of therapies to fight the symptoms. With regard to that, papers about depression can also be focused on the exploration of the existing ways of medical care and their effectiveness for people with depression.

Catherin the great essays

Catherin the great essays History 120, Section 4 Russell Smith One of the most interesting, hard-working and powerful people to grace the pages of history during the eighteenth century was Catherine II, Empress of Russia. Historians have not always been so kind to her memory, and all too often one reads accounts of her private life, ignoring her many achievements. The stories of her love affairs have been overly misinterpreted and can be traced to a handful of French writers in the years immediately after Catherine's death, when Republican France was fighting for its life against a coalition that included Russia. Catherine was born Sophia Augusta Frederika of Anhalt-Zerbst on April 21, 1729 in Stettin, then Germany, now Poland. Her father, Prince Christian Augustus of Anhalt-Zerbst, was a high-ranking officer in the Prussian Army and a minor prince among the principalities in Germany. He married the much younger Princess Johanna of Holstein-Gottorp. Years before, Johanna's brother Karl August of Holstein-Gottorp had gone to Russia to marry the Princess Elizabeth Petrovna. However the Prince died of small pox, leaving Elizabeth heart-broken. Elizabeth's sister, Anna gave birth to a son named Peter Ulrich, however tragedy once again struck as Anna's died of tuberculosis three months after giving birth to Peter. Peter, who eventually became Tsar Peter III, was the only surviving male descendent and the potentially heir to the throne of Russia after his father died. In November 1741, Elizabeth seized the throne with the help of the Imperial Guards, and formally declared her nephew Peter heir to the throne. Peter was now 14 years old, and it was time for him to find a bride. Elizabeth had always remembered the family of her dead fiance with fondness, and chose Sophie as the bride to be. The Empress Elizabeth seemed to have taken an instant liking to Sophie at an early age. Sophie began to learn the Russian language and ...

How to Construct an Index for Research

How to Construct an Index for Research An index is a composite measure of variables, or a way of measuring a constructlike religiosity or racismusing more than one data item. An index is an accumulation of scores from a variety of individual items. To create one, you must select possible items, examine their empirical relationships, score the index, and validate it. Item Selection The first step in creating an index is selecting the items you wish to include in the index to measure the variable of interest. There are several things to consider when selecting the items. First, you should select items that have face validity. That is, the item should measure what it is intended to measure. If you are constructing an index of religiosity, items such as church attendance and frequency of prayer would have face validity because they appear to offer some indication of religiosity. A second criterion for choosing which items to include in your index is unidimensionality. That is, each item should represent only one dimension of the concept you are measuring. For example, items reflecting depression should not be included in items measuring anxiety, even though the two might be related to one another. Third, you need to decide how general or specific your variable will be. For example, if you only wish to measure a specific aspect of religiosity, such as ritual participation, then you would only want to include items that measure ritual participation, such as church attendance, confession, communion, etc. If you are measuring religiosity in a more general way, however, you would want to also include a more balanced set of items that touch on other areas of religion (such as beliefs, knowledge, etc.). Lastly, when choosing which items to include in your index, you should pay attention to the amount of variance that each item provides. For example, if an item is intended to measure religious conservatism, you need to pay attention to what proportion of respondents would be identified as religiously conservative by that measure. If the item identifies nobody as religiously conservative or everyone as a religiously conservative, then the item has no variance and it is not a useful item for your index. Examining Empirical Relationships The second step in index construction is to examine the empirical relationships among the items you wish to include in the index. An empirical relationship is when respondents’ answers to one question help us predict how they will answer other questions. If two items are empirically related to each other, we can argue that both items reflect the same concept and we can, therefore, include them in the same index. To determine if your items are empirically related, crosstabulations, correlation coefficients, or both may be used. Index Scoring The third step in index construction is scoring the index. After you have finalized the items you are including in your index, you then assign scores for particular responses, thereby making a composite variable out of your several items. For example, let’s say you are measuring religious ritual participation among Catholics and the items included in your index are church attendance, confession, communion, and daily prayer, each with a response choice of yes, I regularly participate or no, I do not regularly participate. You might assign a 0 for does not participate and a 1 for participates. Therefore, a respondent could receive a final composite score of 0, 1, 2, 3, or 4 with 0 being the least engaged in Catholic rituals and 4 being the most engaged. Index Validation The final step in constructing an index is validating it. Just like you need to validate each item that goes into the index, you also need to validate the index itself to make sure that it measures what it is intended to measure. There are several methods for doing this. One is called item analysis in which you examine the extent to which the index is related to the individual items that are included in it. Another important indicator of an index’s validity is how well it accurately predicts related measures. For example, if you are measuring political conservatism, those who score the most conservative in your index should also score conservative in other questions included in the survey.

Fiction ( Creaton from your imagination) Essay Example | Topics and Well Written Essays - 1750 words

Fiction ( Creaton from your imagination) - Essay Example His life is all the more inspirational for me as his favorite sport is the same that is mine – cricket. In fact we do play together every now and then whenever we get time or it should be, whenever he gets time from his busy routine and hectic life. My uncle has had his due share of problems and struggles during his life. He has seen the highs and lows of life and I can safely conclude that he is all rounder by all measures of imagination. He has witnessed success when he was down in the dumps and face humiliation in the form of losses, both in terms of financial value as well as psychological pressures, but it is his genius that he never turned back on his principles and strong ideological limits and thus defeated whatever came in his way. His developmental process is such that he has only looked at the brighter side of things and never touched the negative as according to him, doing the latter can reap nothing but misery for both the individual as well as the people related with him or her. Thus he molded his life in such a manner which would only provide him solace and peace of mind whenever he was in hot waters and nothing right came across him. He has seen financial losses that took away quite a huge sum of his bank balanc e in late 1980s when he was doing a roaring business of textile designing yet he did not succumb under pressure from people related to him and the near and dear ones advised him to divest whatever was left in the business. He continued and marched along at the same speed, so much so that now he has his own textile factory located in the outskirts of the city. He has been a model of inspiration for one and all and I can safely call him my mentor whenever I run into any problem in my day to day life. His advice is always that has brought a new lease of life in me and helped me see things in a more positive fashion rather than just sitting and sulking over the

Math Assignment Example | Topics and Well Written Essays - 250 words

Math - Assignment Example The food industry then converts 10 ounces to grams by multiplying each ounce by 29 grams. Hence the total weight of the products is 290 grams. And if there are 9 grams of fat the percentage of fat is 9/290Ãâ€"100%=3.1% The procedure used by the food industry is misleading. The correct way to calculate the fat content is to multiply the number of grams of fat by 9 to get the calories. (Each gram of fat is converted to 9 calories). Next divide the fat content by the total calories and multiply by 100% to get the percentage of calories derived from fat. In this case the label stated that 10 ounce serving contained a total of calories. Most of the people are health conscious and want to eat food items that are fat free. They get inclined towards the fat free label on the food item that they purchase and regard that they are consuming the products that are useful for fat reduction. But this may be misleading and the fact is that despite what their labels say, actually do contain some amount of trans- fat per serving. (â€Å"10 Surprising Foods That Contain Trans Fat†, 2012) The use of terms like â€Å"low fat† can be misleading: â€Å"90 per cent fat free† means 10 per cent fat, not that it contains 10 percent of the fat that a competitor’s products might have. (Reynolds, p.207) Cereal: Let us take the cereal Ambrosial Venetian Vineyard Granola which has 230 calories and 7 g of fat per 1/2 cup serving, it contains 5 g of fiber, 6 g of protein, and 10% of your daily dose of iron.(Benner, 2011) From the above calculations it is clear that the customers shall have fair knowledge on the food items that they purchase and we can see that according to the Food Standards Code, â€Å"it is proposed that all claims will have to be scientifically substantiated and not misleading. Foods will also have to meet certain criteria to be eligible to carry health

Ethnic group Essay Example for Free

Ethnic group Essay In this section, we will discuss race, ethnicity, and multiculturalism and how they are depicted in the show. These concepts are somehow illustrated in this television series. Race, in the American society, has been typified by black skin color. The unique cultural traits and the sense of community African-Americans share reflect their ethnicity. On the other hand, Kady, the youngest child in the Kyle family, represents multiculturalism through her knowledge of multiple languages. The following section will define, operationalize, and describe these concepts and how they are evident in the show. Race is a category of people used to differentiate people in terms of physical appearance, particularly skin color. People who have the same physical characteristics are from the same race. The concept that is used to operationalize race is skin color. In this show, the dominant race is â€Å"black† but there are a few characters that are â€Å"white. † People who have a dark skin color are considered non-Caucasians. In this series, the racial minority is the Caucasian because the non-Caucasians are the dominant group that makes up most of the characters. Therefore, race is largely unmentioned during the show because most of the characters are from the same race. However, there is one episode in season two where there was an argument between two different races, the Caucasians and the non-Caucasian. At the beginning of this episode, Michael is forced to take his family out for a meal. He is annoyed when he realized that the restaurant is expensive and the service isn’t good enough. Michael’s evening worsens as he gets to sit next to Stuart Tyler’s family, a guy whom he got angry at in the gas station for taking to long to gas up his tank. A few minutes later, Stuart starts insulting Michael’s kids, citing their smell, while Michael insults Stuart’s kids by telling Stuart that â€Å"they look like squirrels. † Afterwards, Michael apologizes to Stuart but seconds later they argue again on who’s the bigger man. They make amends again but then argue cause Stuart held Michael’s lobster without washing his hands after urinating. When they starting singing â€Å"Happy Birthday† for Stuart’s wife, Stuart interrupts in the middle and is irritated by the fact that Michael isn’t singing. The arguing just keeps going and going and things never got any better. They leave the restaurant at odds with one another. Michael and Stuart’s altercation evidenced friction between Caucasian and non-Caucasians but apart from this episode, race is not a point of reference throughout the scope of the show. Consequently, race is insignificant in this show and is proven to be unimportant within the Kyle family. An ethnic group is a group of people who have common national or cultural characteristics. An ethnic group has five main characteristics: (1) unique cultural traits such as language, clothing, holiday, or religious practices; (2) a sense of community; (3) a feeling of ethnocentrism; (4) ascribed membership from birth; and (5) tendency to occupy a distinct geographic area (Caron 269). The social structures ethnicity groups strengthen social solidarity. Social structures are the stable pattern of social relationships that exist within a group or society (Soci1002E, Lect. 5, 2012). The main ethnic group in the show is the African-Americans. The unique cultural traits and the sense of belonging is what will be used to operationalize ethnicity. The sense of belonging within the African-Americans in the show is what empowers this ethnic group. A social structure is the stable pattern of social relationships that exists within a particular group or society (Soci 1002E, Lecture 6, 2012). The African-Americans in the show share the same language, and a sense of belonging. The language that the African-Americans use is English as it is their first language in their country and state. Michael’s youngest daughter is learning Spanish and Swahili but her mother tongue is English. Throughout the show, the Kyle family develops relationships with other African-Americans individuals. Michael married an African-American woman. Junior impregnated an African-American woman; Vanessa. Claire and Kady retain African-American boyfriends. Also, Junior has many African-Americans friends. All these relationships prove that the African-American community shares a sense of belonging. The language and the sense of community is what make the African-Americans a powerful ethnic group in the show. Multiculturalism is a philosophy that respects ethnic diversity within a community that encourages people to learn about other cultures. A multicultural person acknowledges and accepts diverse cultures other than his or her own and tries to learn from them. The way this concept is measured is by understanding and learning other cultures, especially through its’ language. Kady Kyle, Michael’s youngest child, is the precocious one out of Michael’s sons and daughters. She is referred to as â€Å"the cute one† because she is the youngest one in the family. â€Å"The cute one† strongly supports the idea of multiculturalism through her musical talent. In the Episode †Making the Grade†, the Kyle family are sitting at a table while Michael Kylie checks out his sons’ report card. After they are done celebrating Claire’s outstanding report card, Michael calls on Kady to come and sit on his lap. Kady innocently says, â€Å"I don’t have a report card. † â€Å"Yes, but you do go to school, right? You go to music class. How are you doing there? † replies her father. â€Å"Well, I learned a new song called Itsy Bitsy Spider† she answered. Her father then claims that he never heard this song before and asks her to sing it for him. She starts singing the song until he father interrupts her and tells her to sing the song in Spanish. So she starts singing in Spanish until her father tell hers to sing it in Swahili, a language spoken by several countries in East Africa. Kady is learning about other cultures through their language at a very young age. She is willing to learn more about other languages and is doing so through an artistic way. She found an interesting way to connect music and culture together which is very smart for someone her age. By choosing this concept, we concentrated on the cultural diversity aspect of the television show. This scene allowed us to demonstrate my knowledge in understanding the sociological concept, multiculturalism. The scene depicts a multicultural young girl who is eager to discover other cultures, especially its’ language. To conclude, these three concepts are demonstrated in a way or the other. After operationalizing, analyzing these sociological concepts, and applying them in My Wife and Kids, we discovered that ethnicity and multiculturalism are clearly portrayed, while race isn’t really significant in the show. Race isn’t really depicted in the show but the constant disagreement between Michael and Stuart reveals a slight conflict between the non-Caucasians and the Caucasians. The African-Americans have proven that they are a strong ethnic group through their culture and sense of community. In the show, they all speak the same language and have several relationships between each other. Kady Kyle’s comprehension of other cultures is what ascertains that multiculturalism is evident in the show.

What is the Relationship Between the Formation of a Modern Chinese Iden

From September 18th, 1931, the date of undeclared Japanese invasion into Manchuria, to August 14th, 1945 marking the end of the War of Resistance, China experienced unprecedented suffering and loss in its struggle for survival. Throughout this time, social, economic, and political conditions underwent severe changes. In the eyes of the world, the Japanese committed sins beyond repentance, and half a century later, no development is evident in this respect. Yet, the War of Resistance gave rise to an invaluable aspect of Chinese culture that defines the nation today. Dr. Sun Yat Sen talked of a nation divided, four hundred million people who shared customs, habits and race, but could not advance in the face of the international world without one truly essential attribute â€Å"...in the world today what position do we occupy?... we should †¦ be advancing in the front rank with the nations of Europe and America. But the Chinese people have only family and clan solidarity; they do not have national spirit. Therefore even though we have four hundred million people gathered together in one China, in reality they are just a heap of loose sand.† (Tamura, 1998, pp.148). It was the Opium Wars, where Western technological development exposed China's military weakness and the subsequent broken treaties of 1922 and 1928, when China’s Western allies failed to intervene in Japan's invasion of Manchuria in September 1931 (Lin, 1936, pp.368) that forced the issue of â€Å"nationalism† on China during latter half of the 19th century. In the decades following the humiliation suffered at the hands of the ‘barbarians’ during the Opium wars, influential and progressive thinkers such as Feng Guifen and Zou Rong, among others, threw themselves passionately into th... ... the history of modern China. Historical Journal, pp.523--543. Spence, J. (2013). The search for modern China. 3rd ed. New York: Norton, pp.137-387. Spitzer, K. (2012). Why Japan is still not sorry enough. [online] Available at: http://nation.time.com/2012/12/11/why-japan-is-still-not-sorry-enough/ [Accessed 1 May. 2014]. Tamura, E. (1998). China - understanding its past. 1st ed. Honolulu: Univ. of Hawai'i Press. Taylor, J. (2009). The generalissimo. 1st ed. Cambridge, Mass.: Belknap Press of Harvard University Press. The Economist, (2013). The Legacy of the Sino-Japanese War- An Interview with Rana Mitter. [video] Available at: http://www.economist.com/news/books-and-arts/21579797-how-struggle-against-japans-brutal-occupation-shaped-modern-china-start-history [Accessed 30 Apr. 2014]. Yeh, W. (2000). Becoming Chinese. 1st ed. Berkeley: University of California Press.

The Business Value of Information Systems. Case Study: Amazon.Com

THE BUSINESS VALUE OF INFORMATION SYSTEMS CASE STUDY: AMAZON Isabel Maria Arroyo Moreno Business Information Technology Module BSc Business Management with HR Greenwich School of Management, University of Plymouth (London) Submission date: 8th December 2011 Word count: 2. 776 Table of Contents Executive Summary4 The Business Value of Information Systems5 Introduction5 Business Value of Information5 Business Information Management through Information Systems6 The Value of Information Systems6 Customer Relationship Management (CRM) Systems6 Enterprise Resource Planning (ERP) Systems7 Supply Chain Management (SCM) Systems8 Information Systems and the Changing Business Environment8 Amazon. com Information Systems10 Introduction10 Amazon. com’s Information Systems Value10 Amazon’s Customer Relations Management (CRM) system11 CRM System Business Value11 Amazon’s Enterprise Resource Management (ERP) System Value13 Amazon. com’s Supply Chain Management (SCM) system13 Amazon. com’s SCM system Value13 Amazon IS and the external changing environment †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 5 Conclusion†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 16 ? Executive Summary Business information management requires the use of information systems, which make possible the conversion of data into useful information to be used by decision makers in organisations (Chaffey, 2004) The acquisition and further deployment of such systems requires organisations to make expensive investments prior to know whether they are going to produce the desired business improvements. Therefore, delivering value for money from information systems investments has become a very serious issue for many organisations. There are several examples in both the private and public sector of expensive failures, but there are fewer published cases of success (Ward, 2006) The purpose of the present paper is to explain how added business value emerges from the use of information systems. The paper begins with a review of the related literature and then, it takes a practical approach through a case study analysis which intends to set out the value of information systems to a successful organisation such as Amazon. Therefore, the case study will illustrate how different information systems have enabled Amazon to achieve a solid competitive advantage by improving its marketing techniques and the efficiency of its distribution channels in a time in which the fast development of technologies have come to redefine the commerce model within the retail industry. Indeed, the use of Internet has changed the way in which people acquire goods and services, and nowadays there is a strong shift towards online shopping that is forcing retailers to go onto the Net if they want to remain competitive. In this regards, Amazon has been a pioneer in using information systems to anticipate changes in the retail industry environment, and in addition, it provides the perfect example of how a company can obtain value for money from information system investments. ? The Business Value of Information Systems Introduction Business information management is essential to organisations in order to support strategic decisions. Information adds value to organisations as it allows improving products and services, reducing business costs and developing new innovations. Information systems are used in order to manage business information in such a way that allows organisations to increase profitability, to improve productivity and to gain other intangible benefits with the objective of achieving sustainable competitive advantage and company success. In addition, the use of information systems allow organisations to adapt to external changes in the business environment, otherwise they could not remain competitive. Business Value of Information Information management is essential to businesses in order to support operational processes, organisational performance, and strategic decisions affecting their position in the market place. According to Marchand (2000) information can create value for organisations by: †¢Adding value to products and services through a better understanding of customer characteristics and needs, as customer activities are monitored to develop competitive strategies. Reducing costs and making business processes and operations more efficient, as information enables organisations to use fewer resources and to improve communication. †¢Supporting organisational strategic decisions and helping with risk management assessment †¢Enabling innovations and new product and service developments (Chaffey, 2004; Oestreich, 2010) Business Information Management through Information Systems Business information management involves the use of information systems (IS) which, according to the UK Academy for IS, are â€Å"the means by which organisations and people, using information technologies resources, gather, process, store, use and disseminate information†. (www. ukais. org; Chaffey, 2004) Therefore, IS are computer based systems that collect, process and stores data, making possible its conversion into useful management information –data mining process- to be used by decision makers within organisations. (Davis & Olson, 1985; Lucas, 1990; McLeod, 1995 cited by Ramesh, 1997). The Value of Information Systems During the 1990s, there was a great argument about the real value delivered by expensive organisational investments on IT and IS, as studies found out that there was weak correlation between IS investments and increased business performance (Solow, 1987; Brynjolfsoon, 1993; Strassman, 1997 cited by Dans, 2003; Chaffey, 2004) However, studies by Delone and McLean (1992, 2003) and by Jacks (2009) demonstrated the importance of IS to the creation of business value and competitive advantage. Jacks, 2011) According to Jacks (2011) IS make organisations successful by either: †¢Increasing profitability: sales growth, profits, ROI, reduced costs, market share increase. †¢Increasing productivity: business process outcomes, operational efficiency, service performance †¢Intangible benefits: customer satisfaction and loyalty, industry performance, quality improvement. Customer Relationship Management (CRM) Systems CRM systems are intended to build and sustain long-term business relationships with customers of an organisation. Organisations may increase their profitability if they can retain customers and sell additional products to them. Research by Reicheld and Schefter (2000) showed that by retaining 5% more customers, online companies can increase their profits by 25% to 95%. (Chaffey, 2004) Consequently, CRM systems focus on the activities aimed to market products and services to customers in a more efficient way. By understanding customer characteristics and needs, organisations can elaborate tailored marketing campaigns to acquire, retain, extend and select potential customers, which ultimately will translate into increased sales and organisational profitability (Steinberg, 2006; Chaffey, 2004; Lee-Kelly, 2003) Table 4: Marketing activities of CRM CRM marketing activitiesObjectiveInformation based marketing techniques Customer acquisitionGain new customersTailored marketing communication Customer retentionEncourage repeated purchasesPersonalized/tailored ommunications Customer extensionUp-sell (more expensive products) Cross-sell (additional products) Personalised/tailored communication Customer selectionIdentify the most responsive groups of customersDatabase analysis and modelling Enterprise Resource Planning (ERP) Systems ERP systems integrate all departments and functions across an organisation, thus eliminating IS’ isolation in departments such as finance, HR, marketing and the w arehouse, and replacing them with a single system where all important information is connected together (Wailgum, 2008; Steinberg, 2006). ERP systems add value to organisations by: †¢Integrating customer order information: ERP systems integrate order information, product shipment and invoices in one single system, enabling organisations to improve order tracking, and to coordinate inventory and shipment among different locations simultaneously. Therefore, the order process speeds faster through the organisational departments, and customers get their orders faster and with fewer mistakes. †¢Reducing inventories: ERP systems streamline the order fulfilment process and help with the delivery process, thus improving the flow of the organisation’s supply chain. Wailgum, 2008; Steinberg, 2006) Supply Chain Management (SCM) Systems SCM systems coordinate all supply activities of a company such as supply and distribution network, logistic activities and inventory management; and these add value to an organisation by (Gabe, 2010; Chaffey, 2004): †¢Increasing process efficiency: SCM systems help to reduce t he cycle time of business processes and the resources needed to execute them, thus reducing costs per order. †¢Reducing supply chain’s complexity: SCM systems enable organisations to order directly from suppliers, thus reducing the costs of distribution. Improving data integration within the supply chain: SCM systems enable information sharing on product demand between the organisation and its suppliers, which improves inventory management efficiency through the use of VMI (vendor-managed inventory). The benefits include reduced cost of paper processing and lower inventory holdings. †¢Reducing costs: SCM systems enables organisation to outsource certain assets, to lower costs through price competition and to offer better service quality. (Steinberg, 2006; Chaffey, 2004) Information Systems and the Changing Business Environment The environmental influences on any organisation change rapidly, and therefore it is important to continuously monitor the current environment and to anticipate future trends through â€Å"environmental scanning or sensing† activities, in order to respond to changes accordingly. Organisations that either do not monitor environmental factors or do not respond to changes adequately may lose competitiveness or even incur in failure. As example, IS managers need to constantly assess the relevance of new technologies and to monitor technology trends and innovations in order to remain competitive. (Chaffey, 2004). ? Amazon Information Systems Introduction Amazon is the biggest online retailer in world, although many consider that it is more a leading software developer or â€Å"information systems’ company with a little pick, pack and ship service† (Hof, 2003). This world-class retailer, which began doing business as an online bookseller in the mid 90s, has changed with the time and currently it offers its customers a wide variety of products such as electronics, clothes, beauty products, and so on. In addition, Amazon operates as a service provider allowing other retailers to sell on its site and it also commercializes cloud storage services and its own tablet post-PC device –Kindle-. Businessweek, 2003; Hof, 2003; Jenkinson, 2005) Therefore, Amazon has become the Net’s premier shopping destination in 2011, and data, information technology and information systems constitute its most valuable assets. (Manjoo, 2011). Amazon’s Information Systems Value Between 2001 and 2003, Amazon investe d $300,000 into building new distribution centres and acquiring information systems software. However, experts hardly criticised the company asserting that it would never recover the investment, (Gabe, 2010) and even financial analysts such as Lehman and Brothers expressed concerns over its cash flow situation. Foley, 2000) Although it took Amazon long time to become profitable, additional revenues rose once the company got enough customers and sales to pay off the initial IS investments, and their bet for information systems technology enabled the company to overcome competitors such as Barnes and Nobles in the 90s and more recently Wal-Mart Stores Inc (Hof, 2003; Gabe, 2010). Amazon uses information systems to improve profitability faster and its current financial situation, strategic position, market share, and intangible benefits give evidence of that the company’s IT and IS strategies worked as expected. According to Hottovy’s report (2011) Amazon doubled in size from 2008 to 2011 with $34 billion in net sales and its current revenue growth is close to 40%. The company has a valuation of $325 per share and generates return on invested capital exceeding the 50% – note that Amazon invests mainly in IT and IS technologies –. Moreover, it has an active customer base of 137 million users that accounts for an annual growth rate of 20%. All in all, Amazon has one of the most capital efficient-models in e-commerce and its low cost operations, network effect and focus in customer service provide the company sustainable competitive advantage (Hottovy, 2011). Amazon uses ERP, SCM and CRM information systems. Oracle (ERP) built a multi-terabyte database for the company, while SCM software was acquired to control costs and to improve shipping and logistics efficiency. In addition, Amazon’s CRM system intends to work up e-marketing efforts through the analysis of customer’s preferences and the provision of products for specific segments (Foley, 2000). Amazon’s Customer Relations Management (CRM) system Amazon’s CRM system uses the following applications to gather customer information: †¢A database of customers with personal, profile and transactional data which include their purchase history and activities †¢An order processing system that includes the record of credit card information and is linked to a delivery system †¢A web-page system that takes customer information such as customer feedback, personal interests, wish list and product review records, and customises formats. †¢Automated communication ystems: e-mail and message systems and order information systems that ensure personalised and relevant communication with customers (Hof, 2003; Jenkinson, 2005; Hottovy, 2011) CRM System Business Value Amazon’s CRM system creates business value through integrating customer sales, services and communications effectively (Jenkinson, 2005; Manjoon, 2011) In order to detect patterns of consumer behaviour, customer information is analysed by data mining experts using statistical CRM and artificial intelligence (SAS) software; while collaborative filtering technology automatically analyzes past customer purchases. The analysis provides processed information that serves to elaborate profiles of customer individual interests, which enables Amazon to send them tailored product recommendations in order to increase product sales (Foley, 2000; Hof, 2003; Jenkinson, 2005). In addition, CRM data mining activities also compare individual profiles to other customer profiles and bring them together into similar groups. As result, the company has taken traditional campaign techniques and move into faster campaigns to target different customer segments more effectively. Thus, Amazon has the ability either to launch broad campaigns to millions of customers, or more focused campaigns to a few thousands and tailored recommendations to individuals, due to a better understanding of customer characteristics and needs (Foley, 2000; Hof, 2003). Summarizing, Amazon’s CRM system combine advertising, service and selling to acquire customers in order to encourage repeated purchases through cross selling and up selling tailored marketing techniques. Jenkinson, 2005) As a result, Amazon has achieved high levels of customer commitment and loyalty. Research by Millward Brown (BrandZ study) showed that 54% of US buyers are loyal to the company, as compared with a 10% of the industry average; while a 67% of its orders are from repeated customers. Moreover, Amazon customers are more likely to buy at a higher rate than loyal customers across the category, as 40% of Amazon customers are frequent users compared to an 8% of the average category (Jenkinson, 2005). ? Amazon’s Enterprise Resource Management (ERP) System Value Oracle is the ERP system used by Amazon and it consists of a multi-terabyte database that integrates all the information related to customer orders such as purchase history, product shipment and invoices, thus enabling to streamline the order fulfilment process (Wailgum, 2008) Oracle automates the steps of this process by taking customer orders and process them into invoices, so when a customer comes online to buy a product the order system communicates directly with the warehouse system to find the adequate distribution centre, while customers receive communications about their purchase status and delivery times (Bacheldor, 2004) The company recognises that without this system it would be very difficult to coordinate and control the flow of merchandise in their business operations (Bell, 2011). Such integration of information creates business value by allowing Amazon to speed faster the order fulfilment process, as we ll as to improve visibility of order tracking and to reduce distribution mistakes. In fact, the company has reduced its customer service contacts per order by 50% since 1999 due to fewer distribution mistakes (Businessweek, 2003). Amazon’s Supply Chain Management (SCM) system Back in 2000, Amazon. om made expensive IS investments into building its high quality automated warehouses, and nowadays their supply chain is one of the most efficient and sophisticated in the world (Jenkinson, 2004; Businessweek, 2003, Gabe, 2010). A CRM system controls all supply chain activities of Amazon, such as transportation management, shipping activities and inventory planning, with the aim of reducing operational costs and optimizing logistic operations (Gabe, 2010) Amazon’s SCM system Value In 2000, Amazon’s operational costs accounted for about a 15% of sales revenue because the process of picking and packing different products was not very efficient. Employees had to enter dat a into the system manually and chutes holding pending orders were backed up when products did not arrive on time. (Businessweek, 2003) Nowadays, the implementation of a SCM system has enabled Amazon to reduce the cycle time and the resources needed to complete its operational processes, thus making them more efficient. The SCM system examines Amazon’s customer demand to identify items that are often purchased together in order to place them at the front of the supply lines, thus enabling to speed faster the process flow (Businessweek, 2003) The SCM system also allows to find where the items are physically located, so after receiving an order the system will send a picker where the product is shelved. In the case of multi-orders, the system generates optimised pick lists, finding the shortest possible route for picking the product. (Gilmour, 2003). As a result, Amazon’s operation costs fell down from 15% of total sales revenue in 2000 to a 5% in 2003, and lower costs have enabled the company to offer more product discounts and free shipping in orders over $25 (Businessweek, 2003). Moreover, Amazon’s CRM system enables information sharing on product demand between the company and its suppliers, which improves inventory management efficiency. Amazon’s CRM system is linked to its suppliers’ IS in order to share information in real time about orders and shipment. Thus, Amazon can hold lower levels of inventory stock in warehouses as it receives goods from its suppliers only when needed and accordingly to customer demand levels. Hof, 2003; Foley, 2000) Thanks to the CRM system, Amazon reduces costs by carrying only a 15 day’s worth of inventory while traditional retailers must stock up to 160 days’ worth of inventory in their warehouses (Hof, 2003). In addition, information systems’ i ntegration between suppliers and Amazon enables customers to buy goods directly from suppliers. The company forwards orders to its suppliers which get the product to customers directly; therefore the complexity of the supply chain and costs of distribution get reduced. (Knowledge Wharton, 2009). Amazon’s IS and the changing external environment. Information systems have provided Amazon with competitive advantage since it as been able to adapt its business model better than its competitors to the changes that the retail industry has experienced during the past decade such as the shift towards online shopping due to a more widespread use of Internet (Manjoo, 2011) Thus, Amazon forced traditional retailers to go onto the Net in the 90s (Hof, 2003), while nowadays, it has the best record with new products -as they are constantly monitoring environmental changes- and their web services, cloud computing services and Kindle device are true innovations that have changed the rest of t he industry (Manjoo, 2011) ? Conclusion This paper demonstrates the importance of information management and information systems to the creation of organisational business value and competitive advantage. According to Jacks, information systems contribute to organisational success by increasing profitability and productivity, and providing other intangible benefits such as customer loyalty. Subsequently, Amazon’s case study illustrates the perfect example of how an organisation obtains value for money of their information systems investments. The effective use of information systems has allowed the company to improve the efficiency of its distribution channels, to provide cost effective convenient products to its customers and to achieve the highest levels of customer retention and loyalty within the e-retail industry, which ultimately has helped Amazon to increase profitability and to achieve a solid financial position. In addition, information systems have provided the company with notorious competitive advantage over their competitors since it has been able to better adapt its business model to the changes that the retail industry has experienced during the past decade, such as the shift towards online shopping due to a more widespread use of Internet. ? REFERENCE LIST †¢Books and journals 1. Bausch, P. (2003) Amazon Hacks: 100 Industrial-Strength Tips and Tools (1st Edition) O’Relly. USA 2. Chaffey, D. et al (2004) Business Information Management: Improving Performance using Information Systems (1st Edition) Prentice Hall Pearson Education. England 3. Hottovy, R. (2011) â€Å"Amazon. com AMZN Hare Stock Focus† Morningstar StockInvestor Vol. 11 Iss: 2 pp. -9 [Online] Available at: http://web. ebscohost. com/bsi/pdfviewer/pdfviewer? sid=d0f8a490-3601-4df8-b033-0d48d0b16c5a%40sessionmgr113&vid=11&hid=8 [Accessed on 18/11/2011] 4. Jacks, T. et al (2011) â€Å"A Framework for the I mpact of IS on Organizational Performance†. Business Process Manager Journal Vol. 17 No. 5, pp. 846-870 [Online] Emerald Group Publishing. Available at: www. emeraldinsight. com/1463-7154. htm [Accessed 18/11/2011] 5. Lee-Kelley, L. et al (2003) â€Å"How e-CRM can enhance customer loyalty† Marketing Intelligence and Planning Jounal Vol. 21 Iss: 4, pp. 239-248 [Online] Available at: http://colinwatsonleeds. co. uk/RMarticles/LEEKeeley. df [Accessed on 18/11/2011] 6. Melville N. et al (2004) â€Å"Information Technology and Organisational Performance: An Integrative Model of IT Business Value†. MIS Quarterly & The Society for Information Management Vol. 28 Iss: n. 2, January, pp. 283-322 [Online] Available at: http://www. misq. org/review-information-technology-and-organizational-performance-an-integrative-model-of-it-business-value. html[Accessed 18/11/2011] 7. Oestreich, T. (2010) â€Å"The Value of Information† Journal of Management Excelence Issue 9, Ju ne 2010. Oracle [Online] Available from: http://www. oracle. com/us/solutions/thoughtleadership/journal-mgmt-excellence-june-2010-116920. df [Accessed on 12/11/2011] †¢Publications 8. Bacheldor, B. (2004)† From Scratch: Amazon Keeps Supply Chain Close to Home† Informationweek [Online] Available from: http://www. executivemanagementskills. com/pdf/amazon. pdf [Accessed on 11/11/2011] 9. Businessweek (2003) â€Å"Reprogramming Amazon† Bloomberg Businessweek December 23th [Online] Available at: http://www. businessweek. com/magazine/content/03_51/b3863115_mz063. htm [Accessed on 18/11/2011] 10. Dans, E. (2003) IT Does Matter. European Business Forum [Online] Available at: http://profesores. ie. edu/enrique_dans/download/IT%20Does%20Matter%20-%20EBF. pdf [ Accessed on 18/11/2011] 11. Foley, J. 2000) â€Å"Amazon’s IT Agenda† Informationweek. com News, November 6th [Online] Available at: http://www. informationweek. com/811/amazon. htm [Accessed on 1 8/11/2011] 12. Gabe, M. (2010) â€Å"Lessons in Distribution† Mortgage Banking [Online] Available at: http://www. allbusiness. com/banking-finance/banking-lending-credit-services-mortgage/14266140-1. html [Accessed on 18/11/2011] 13. Gilmour, K. (2003) â€Å"Amazon Warehouse† Internet Magazine, Sept. 2003 [Online] Available from: http://www. kimgilmour. com/articles/archive/amazon_warehouse. html [Accessed on 14/11/2011] 14. Hof, R. (2003) â€Å"Amazon. com: The Wild World of e-commerce† Business Week Archives [Online] Available at: http://www. usinessweek. com/1998/50/b3608001. htm [Accessed on 18/11/2011] 15. Jenkinson, A. (2005) â€Å"Amazon: Bounding Customers with Integrated Service† Centre for Integrated Marketing, University of Luton [Online] Available at: http://www. centreforintegratedmarketing. com/gfx/documents/amazon_bonding_customers_with_integrated_service. pdf [Accessed on 18/11/2011] 16. Knowledge Wharton (2009) â€Å"Fit for the Holidays : Amazon is Shaping Up and Shipping Out†. [email  protected] [Online] Available from: http://knowledge. wharton. upenn. edu/articlepdf/2382. pdf? CFID=172480957&CFTOKEN=80041908&jsessionid=a8305ac77adc802c10107e653f5a2f715b56 [Accessed on 14/11/2011] 7. Manjoo, F. (2011) â€Å"The Great Tech War of 2012† Fastcompany October 19th [Online] Available at: http://www. fastcompany. com/magazine/160/tech-wars-2012-amazon-apple-google-facebook [Accessed on 18/11/2011] 18. Ray, R. (2010) â€Å"True CRM: It is Beyond Technology† Smallbiztechnology, June 29th [Online] Available at: http://smallbiztechnology. com/archive/2010/06/true-crm-its-beyond-technology. html/ [ Accessed 18/11/2011] 19. Ramesh, A. et al (1997) â€Å"Establishing a management information system† FAO Corporate document Repository. [Online] Available at: http://www. fao. org/docrep/W5830E/w5830e0k. htm [Accessed on 10/11/2011] 20. Steinberg, M. 2006) â€Å"Enterprise Applications: A Conceptual L ook at ERP, CRM and SCM† Hill Associates Inc. [Online] Available at: http://www. hill. com/resources/whitepapers/enterprise_apps. pdf [Accessed on 18/11/2011] 21. Ward, J. (2006) â€Å"Delivering Value from Information Systems and Technology Investments: Learning from success†. [Online] Available at: http://www. som. cranfield. ac. uk/som/dinamic-content/research/documents/deliveringvaluereport. pdf [Accessed on 12/11/2011] 22. Wailgum, T. et al (2008) â€Å"ERP Definition and Solutions† Cio. com [Online] Available from: http://www. cio. com/article/40323/ERP_Definition_and_Solutions [Accessed on 16/11/2011]

Family Health Assessment Essay

Introduction Family is considered the natural and fundamental unit of the society. The family members make up the family as a structure. Family includes members of different age group from newborns to elders. The family’s activities and reactions influence the patterns of the family as a whole (Edelman, Kudzma, & Mandle 2014, p.2014). The ultimate goal of the nursing is to expedite the health of the family. Family health assessment defines the assessment of actual and potential problem of individual (Gordan 1994). The goal of nursing is giving direct and indirect care to the person and community in terms of assessment, diagnosis, nursing interventions, implementation and evaluation. Historically conceptual models are using to assess the family in nursing practice. Health assessment included with subjective and objective data. Here Gordan’s 11 functional health assessment patterns are using to assess this family. The Gordon’s functional assessment patterns are a valuable tool for assessing and evaluating the family’s traditional health patterns, and permitting the health care provider to look at the inside of the overall health of the particular family. Family Background The family I selected belongs to an African ethnic group. This essay discuss the health pattern and functions of Nyennoh’s family. This is a nuclear family with mother of age 32 father 34 and three children of age groups eleven years old boy, nine years old girl and five years old boy. Both of the parents are working, and splitting their days to taking care of the children. Mother is working as a nurse at the hospital for three days and father working as a respiratory therapist at the neighborhood hospital for  three days. They all going to neighborhood school. Among their three children nine year old girl is diagnosed with sickle cell anemia since her birth. They are Christians and true believers in God. â€Å"Values and Health perception means the level of the individual’s level of commitment to maintain health’’ (Gordon 1994). Read more:  Essays About Assess Individual in Health Care This particular family is very efficient to manage their day today living effectively regardless of the health issues. They both in health field, they know how to manage the condition and their perception of sickle cell anemia is excellent. Assessment of nutritional status is the intake of healthy eating and drinking pattern and adequate amount of healthy food. Types of food including the growth and development of the family and restrictions and concerns about their perception of health. They maintain healthy eating habits through having restrictions. Their main food items include vegetables, rice, fish and fruits. They are very attentive to balance their diet to prevent anemia as a family. Parents always encourage kids to eat healthy food and drink plenty of water to keep them healthy especially the girl with sickle cell anemia. Adequate rest and sleep is essential to maintain good health. Inadequate sleep may lead to physiological problem and psychological problems. A person should sleep average 6-8 hours at night. Nyennoh’s family has no sleep deprivation. They go to bed at 9 o’clock and get up 6 o’clock in the morning. They have a good sleeping pattern so they never use any medication to induce sleep. The elimination pattern is varies in individual. This family is not experiencing any bladder or bowel problems. There is no evidence of diarrhea or constipation in the family. Bowel movements and regularly in every day. Parents always take special attention to the children to avoid constipation especially girl with sickle cell anemia to prevent any cuts and bruises. To maintain the concept of health activity and exercise pattern are the effective indicator of individual’s life. This family is very active. They are very particular about activity and exercise. They go for walks everyday as a family 30 minutes in the neighborhood or park. The girl with sickle cell has some restrictions to away from vigorous activities to prevent any dehydration or joint pain or cuts or bruises. She is a very knowledgeable girl about her illness.

Palliative care is an approach that improves the quality of life The WritePass Journal

Palliative care is an approach that improves the quality of life 1  Ã‚   Introduction Palliative care is an approach that improves the quality of life 1  Ã‚   Introduction1.1 Definition of Palliative care1.2 Public health context of palliative care1.3   Care pathways in palliative care  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   1.4 Pharmaceutical care context of palliative care1.5 Transfer of information in Palliative Care1.6 Electronic Palliative Care Summary2. Aim and 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 providin g pharmaceutical care to palliative care patients.3.Methods3.1 Description of literature searching3.2   Identification of current practice3.3 Current information transfer to support practice4.Results5. Discussion6. ConclusionRelated 1  Ã‚   Introduction 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.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  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   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:   Ã‚  Ã‚  Ã‚  Ã‚  Pathway for Improving the Care of the Dying (PICD) (Australia)   Ã‚  Ã‚  Ã‚  Ã‚  Palliative Care for Advanced Disease (PCAD) pathway (USA)   Ã‚  Ã‚  Ã‚  Ã‚  Department of Veteran’s Affairs (DVA) Palliative Care Clinical Pathway (Australia)   Ã‚  Ã‚  Ã‚  Ã‚  Gold Standards Framework (GSF) for community Palliative Care (UK)   Ã‚  Ã‚  Ã‚  Ã‚  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-hours Pharmaceutical 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 during 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 avai lable 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. 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 palliative and end of life care needs is co-ordinated effectively between specialities and across care setti ngs 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.