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Today is a big day for me and very exciting. This morning in partnership with my friends George and David, I left all that I had behind and Joined the great migration, heading to West. We’re in the ship Natalia. We’ve sailed out of New York harbor. We are going to Ameria with confidence that we will be successful in excavation of gold and we will strike it rich. There are any kinds of people on the ship, from low class to higher; also, I think here may be criminals or pilferers. I think so because everyone ho knows about the gold, which was discovered in Ameria, would want to become rich.

For me it’s like I won a lottery because it is free, so I can go there, dig the gold up, pay nothing, become rich and go back. Absolutely astonishing! Our way will take up to five months and I’ve already experienced a sea sickness. I dont have any idea about Ameria, but I hope the best. May 19th, 1849 It took months to get to Ameria, but we are here finally. I stopped in the hotel that is only one in the town. The afternoon of this day was not very bright. I’m kind of not glad because there are a lot of people. I’m afraid that gold won’t be enough to all of us.

I Just want to dig up gold for about $3000 and go back home. ‘ miss my family very much, and I’m afraid that maybe I can’t handle it. May 20th, 1849 I enjoy myself far much better than I expected. My partners and I are ready to go on fields and we have everything that we need for digging and camping. If good luck attends us, I’m confident that the enterprise would be advantage to us all. May 27th, 1849 We walked with the burros, at night cooked our suppers, rolled our blankets around us & lay down on the ground to rest, and slept soundly without any fear.

We passed over some hills that looked dry & barren being burnt up by the sun & the long droughts that we have here. We reached the diggings, being surrounded by holes dug. We couldn’t find a claim for us. At first we walked and asked if the place is free or not. Finally, we found one. We pitched our tents, shouldered our picks, shovels, a pan in hand, and sallied to try our fortunes at gold digging. We did not have very good success at first. I didn’t have any idea if we would ever see a spark of gold.

IVe found the work extremely with no guarantee of success, but by practice and bservation we soon improved our skills in digging, and found a little piece of the shining metal. It was beautiful and rare plus had a romance. June 19th, 1849 This night after work my friends and I shared our dreams to one another. The gold for us is like an independence. After we strike it rich, our dreams can come true. David dreamed about easy life without any work,Just about enjoying his life with a woman whom he’ll love. George dreamed about making his own business. And I want to buy a land, grew grapes and make from it vine or cognac.

November 1st, 1849 By this time we’ve got lots of gold much more than we came for. Thinks are not as simple as I thought. The gold made us greed. In spite of that we are or were friends, we begun to suspect one another, we’ve lost trust to one another. I have a dread that one of them would steal my gold. I feel like I’m in danger. I don’t know what to do. I because of it every night I hide my gold in different places. I have to make up my mind and make a plan what and how to do. But what I knew surely it’s that I want to dig more gold. I need more. November 3rd, 1849 I hate myself.

I killed George yesterday. Being out of my mind, thinking only about money and suspecting everyone around me I did it. I can’t forgive myself. How could I do that. I thought he had taken my gold when I turned to him and saw a bag of gold in his hands. Not thinking of anything I had shot him. Life washing was gone… I dream about those days when there was no gold, about the freedom from gold, when everything was so easy. Even now i want to dig gold. Closing my eyes, I see gold. I am insignificant… I forgot about love, friendship, all those feelings that normal person has.

Reflective model and consultation model

Reflective model and consultation model.

 If able please make mention of the prescribing pyramid also with this assignment, which needs to include:

a) Assessment, history, examination and consultation

b) Knowledge of the relevant pathophysiology

c) Sources of information/advice, legislation, record keeping, public health and decision support systems used to inform prescribing practice

d) Influences identified that affected this prescribing practice, and how these were managed

e) Identify roles and relationships of others involved in prescribing, supplying and administering medicines

f) Rationale for final prescription including drug actions, numerical calculations, activities needed to monitor response to therapy, and modifications that may be necessary to treatment or the referral to other health professionals as appropriate

The assignment relates to an 88yr old gentleman with alzheimers on galantamine 8mg bd, seen at home who lives with his daughter who has lasting power of attorney (both forms i.e. health and financial) due to him being deemed to lack capacity and granddaughter (both in good health and daughter retired and at home full-time carer), he had been seen 8 days previously by myself and my mentor (doctor) and diagnosed with viral rhinosinusitis due to 4 day history of blocked nose, tenderness over frontal sinus and referred pain to the left temple. Prescribed paracetamol 1g qds oral tablet form as over 50kg in weight (77kg) but not a prescription for antibiotics which had been his daughters expectation. (Public health – overuse of antibiotics and how not appropriate) instead watch and wait used with patient and education on why not given/appropriate, advised on adequate hyfration, warm compresses. Patient and daughter reassured and happy with agreed treatment plan, advised to contact if symptoms worsened or didn’t abate. On this review symptoms of purulent nasal secretions and mucosal erythema diagnosed as bacterial rhinosinusitits and prescribed Clarithromycin PO 500MG every 12 hours for 10 days as per my trusts guidelines written to my regions population need. Not In a Streptococcus pneumonae resistant area. Following NICE guidelines (please incorporate)

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