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MBM Engineering College Sex Hormones Determine Immune Response Article Critique

MBM Engineering College Sex Hormones Determine Immune Response Article Critique.

The critique must include following points: 1.  Introduction: Briefly introduce the topic that is being investigated.2.  Objective of the Study:   What is(are) the purpose(s) of this study.  In other words what key question(s) the author(s) asked in this study to address what was previously unknown or inconclusive about the subject.3.  Background Observations: What are key observations/findings by other authors referenced/discussed in this article on this subject?4.  Key observations:  What are the key findings/results author(s) reported in the article you received?5.  Techniques were employed: What techniques/Materials and Methods/Experimental design were employed to test author’s hypothesis/ seek answers to their key questions?6.  How did this work help in advancing our present understanding of the subject with regard to the previous findings.7.  What is the conclusion/inferences in this article? (Do not copy as is from the article)8.   Give your own perspective and critical analysis – are the data convincing? What other experiments would you have done and why?   Speculate how the outcome may be different.

MBM Engineering College Sex Hormones Determine Immune Response Article Critique

AHIMA Discussion, help

AHIMA Discussion, help.

Use APA for any References used.1. There are three hospitals in your town. You work for Community Hospital, and within a 25 mile radius there is also Middle Hospital and University Hospital. You are serving on a Quality Task Force at your hospital and the task force is comparing death rates for all three hospitals. The task force finds that Community Hospital has the highest death rate and some of the members are alarmed. In a minimum of 500 words, address the following: does the higher death rate at Community Hospital mean that there is lower quality care? What would you bring up in this discussion at the task force meeting? Your discussion should contain a minimum of 2–3 peer-reviewed2.Read the following practice brief published by the American Health Information Management Association (AHIMA) titled “Authorization Requirements for the Disclosure of Protected Health Information (2013 update)” (Updated November 2013), In 500 words, summarize the article. Discuss the important takeaways shared as it relates to the disclosure of patient information. In addition, share your role as a future and/or current healthcare professional will partake to uphold the privacy, security and confidentiality of patient information. Your discussion should contain a minimum of 2–3 peer-reviewed references. http://library.ahima.org/doc?oid=107284#.V2roruuU0dU
AHIMA Discussion, help

IT510 Advanced Information Technology

assignment writing services IT510 Advanced Information Technology.

Submit your system design. The system design is to be submitted as a Word document that is a combination of sections: an introductory summary, a specification, a data design, a user interface design, a system architecture, and a feasibility analysis. Copy the image of your diagram for the specification, data design and user interface sections into your Word document and include text to ensure that the diagram has proper context within the overall system design document. Your audience is IT management and the IT project team. Note that the course project intent is to introduce students to an entire systems analyst process. Each milestone is fairly significant in size if performing an actual project. For the intended learning and exposure to the course project topics, please know thatassumptions will have to be made and that any such assumptions should be documented. Please see attachments. I have already completed everything except the system design portion. The word document that is attached is the document that I have completed. you will only need to complete the system design. IT 510 Final Project Document.pdf – please see the final project PDF for more information on the system design. Payroll Management System Final Project.docx  I completed my assignment on a Payroll management system. Everything is done but the system design. Add the system design portion to the word document. 
IT510 Advanced Information Technology

The History Of Tesco Business Essay

The History Of Tesco Business Essay. TESCO is one of the biggest supermarket having lots of food line, it provides fresh local food with expediency and value in town and city centres. It having a wide range of food and non-food lines, such as stationary electronics, including seasonal items such as garden furniture. The major private sector employer in the UK is TESCO. It has 360,000 employees worldwide. Around 86% of all sales be from the UK. Containing Tesco stores variety from small local Tesco express sites to large Tesco extra’s and superstores the company also operates in 12 countries outside the UK. It is counting china, Japan and turkey. The company has of late open stores in the United States. This international expansion is a part of Tesco’s strategy to diversify and grow the business. In Thailand customers are used to shopping in ‘wet markets’ where the produce is not package which caters for local needs. Tesco needs to ensure it has the right number of people in the right jobs at the right time. To do this, it has a structured process for recruitment and selection to attract applicants for both managerial and operational roles.Tesco aims to ensure all roles work together to drive its business objectives. HRM Human Resource Management in TESCO Organization Business Strategy Tesco’s well established and consistent business strategy has enabled it to strengthen the core UK business and expand into new markets successfully. Tesco’s business strategies are mainly focusing on huge domestic market of financial services, telecoms and non-food. One of the main objectives of Tesco’s business strategy is to create sustainable long term growth and according to the company this could be achieved by expanding into global market. The company initially focused on Asia and central Europe. Most recently it has made its entry into the US market. In 1997 Tesco first decided to diversify and according to the company itself this was the basis of its recent success. As a result of this strategy several new businesses have been created by Tesco for the last 12 years and most of these businesses are profitable and competitive (Tesco plc, n.d.). Tesco has developed its strategies which are primarily focusing on five important factors, 1) its core UK business, 2) community, 3) non-food, 4) retailing services and 5) international market. The company has separate strategies on each of these aspects. Major objectives of Tesco’s business strategy include being a successful retailer internationally, growth of the core UK business, being strong in non-food market, development of various retailing services like telecoms, Tesco personal finance and Tesco.com and finally giving enough importance to community. Tesco’s core UK business is a major part of its entire business as 70% of the group sales and profits of the company are coming from its core UK business. There are almost 2,200 Tesco stores employing around 285,000 people in UK only. There are four different types of Tesco stores in the country. These are 1) express, 2) metro, 3) superstore and 4) extra. In UK there are almost 960 express stores, 170 metro stores, 450 superstores and over 175 extra stores. Apart from these four there are ‘Homeplus’ where non food products, including clothing, are available. Tesco has learned an important lesson from current global recession as it has found out that although in tough time people want more value for their money but they do not want to make any compromise with product quality. Based on its past experiences Tesco has designed its future strategies. Tesco has a world leading customer loyalty program called ‘Clubcard’ which actually has helped the company to understand its customer in a better way (Tesco plc, n.d.). According to Tesco, fulfilling corporate responsibility and creating values for community are crucial for achieving growth. Tesco believes that each and every strategy that they design has impact on the community. Tesco’s strategies regarding corporate responsibility or community include providing active support to local community, providing good jobs to the locals, taking care of the environment etc (Tesco plc, n.d.). Tesco take special care for environment and as a part of this they have launched an environmental store in Manchester on January 12, 2009. The company is aiming to create zero carbon stores in future (Tesco, 2009) Main objective of Tesco’s non food strategy is to become as strong as it is in the food category. Tesco’s ‘Homeplus’ and ‘extra stores’ are the two stores where non food products are available. In 2006 ‘Tesco direct’, an online program where 125,000 products are available, was launched. The company has 25 distribution centres out of which 6 deal with clothing and non-food products (Tesco plc, n.d.). Tesco’s various retailing services include Tesco personal finance (TPF), Tesco.com and Tesco telecoms. In UK, TPF is the most successful supermarket bank. Initially TPF was a joint venture between Tesco and RBS, but in 2008 Tesco decided to buy the fifty percent share of RBS in TPF. All the financial products of TPF are available online. Developing Tesco.com was a strategy of keeping pace with the modern trend. Almost one million people are today using Tesco.com for online shopping. Tesco mobile is a joint venture between Tesco and O2. Currently it is country’s one of the leading telecom service providers (Tesco plc, n.d.). Tesco’s success in international market is based on six major strategies. These are 1) being flexible, 2) acting as local, 3) maintaining focus, 4) using multi formats, 5) developing capabilities and 6) building brands (Tesco plc, n.d.). Mission According to Tesco itself its mission is creating value for the customers for earning their lifetime loyalty. Tesco believe that people who are shopping with the company and who are working with the company are the key for its success. If customers like Tesco’s offerings they will come back to it as a reward. Goals Tesco’s goal is to earn customer loyalty by providing best possible services to them. But apart from this Tesco has several business goals. Major goals of Tesco include being successful retailer in the global market, being a strong brand in the non-food market, strengthening its retailing services, growing its core UK business, giving proper importance to community and fulfil community responsibilities. 2- Identifying the organization’s overall HR strategy and goals: This section will discuss overall Human Resource strategy and goals of Tesco. Tesco is the world’s third largest grocery retailer. It own approximately 470,000 employees around world. (Neville-Rolfe, Babbs and North, et al, 2009) Therefore, managers would make a complete and feasible HRM plan and use different strategies to manage these employees. The Human Resource strategy at Tesco’s revolves around training and development of employees, communication and consultation, and rewards and benefits linked to achieving steering-wheel targets. This way is used to measure the performance management (Anonymous 2003). Following, this paper will mention these main parts of strategies of Tesco. The biggest part of HR strategy of Tesco is training and development. Every year, Tesco will employ a large number of staff. Some of them just graduated from universities or colleges. They have no idea how they will work and the culture of the company. Thus, they will accept a period of training. Tesco promise their employee ‘an opportunity to get on’. (Neville-Rolfe, Babbs and North, et al, 2009) It means each employee has same opportunity to acquire essential skill about their work; they also have opportunity to develop themselves to learn new knowledge. In the UK, skilled specialist employees such as fishmongers and bakers can get recognized qualifications during their careers at Tesco. In 2008, 97.4% of shop-floor and 99.9% of DC employees in the UK were trained to bronze level (competent), which should take four weeks to complete, and 94.2% of shop-floor employees to silver level (expert or experienced), which should take 12 weeks to complete. Tesco exceeded their plan to train 97% of retail and DC staff to bronze level, and 85% of their retail staff to silver level. If the employees know they can grow with the company, it will help Tesco to keep a large number of skilled workers. When Tesco spends money in training, the firm will own enough number of labour forces. In addition, Tesco has an Options development program. In this program, staff could select and learn some skills that they need to grasp for the next work level. One in 30 of all employees at Tesco in the UK participate this program. (Neville-Rolfe, Babbs and North, et al, 2009) Through this program, employees could choice some suitable skills which they like to learn. It has more autonomy to maximize their staff’s enthusiasm. Therefore, Tesco plans to popularize this program in Central Europe and Asia in 2009. Tesco also have a program which focus on employees who just graduate. This program tries to employ the high-potential graduate and to train them for into leadership positions in fast-tracks. Through this program, these high-potential graduates will be fully used as soon as possible. It will reduce the probability of these graduates leaving. Second part is communication and consultation. Tesco want to know the views of employees on problems which affect or maybe affect them or company. Managers will use different types to communicate with them, such as staff question times, face-to-face interview, and Tesco’s internet. In addition, Tesco has annual staff survey and Viewpoint, which are anonymous and confidential. (Neville-Rolfe, Babbs and North, et al, 2009) Tesco uses these approaches to find the problems in working process as soon as possible. And check the plan whether results accord it. If not, the managers could change the plan to amend it. All Employees of Tesco are free to join unions. The unions could represent workers to discuss with company to protect the rights of employees. Moreover, Tesco has a helpline called ‘Protector Line’. It is a 24-hour confidential telephone line and email address for employees to report grievances and ethical concerns. (Neville-Rolfe, Babbs and North, et al, 2009) All reports will be logged and investigated by a special deportment. This is a channel for employees to report grievances. The third part is rewards and benefits. Tesco offers basic wage as high as possible. However, it will base on the work which employees do. In addition, Tesco has a long-term reward plans across its markets. Its management terms could share bonus from the market growing. However, it also will link with their steering-wheel targets. The staff would gain some discounts in the stores. In the future, Tesco will keep extend its strategies to increase its market share. The company’s goal will make HR strategy into a real complete part of its culture, and keep a long time. Conclusion The Human Resource role at any given organization with a well defined framework is very important. It is a very important requirement as a prerequisite of goal achievement in an organization. It has a vital role in decision making since it deals with the most important sector of an organization (Human Resource Management). Tesco’s success is highly attributed to the role of HR department and its components. This has assisted the organization to be in its effective position in the market. Task 2: Management of Physical Resources Task 3: Marketing Introduction This study is conducted to obtain understanding about the global retailer of the grocery and general merchandise, Tesco Private Limited Company. This task consists of marketing analysis of the company. In order to obtain the specific information about the company different marketing frameworks were analyzed. The chief ones among them are SWOT analysis, PESTEL analysis, and Porter’s Five Forces Analysis. The market position of the company will be analyzed with the help of a number of strategic frameworks including analysis of Porter’s Generic Strategies, Bowman’s Clock and Ansoff Matrix. On the basis of the marketing and strategic framework analysis, conclusions will be made. Background of Tesco PLC Tesco Private Limited Company (PLC) is a retail company that specializes in the grocery and general items retailer-ship. Among the top retailers in the world, the company, as per its revenues, holds third position as a retailer in the world (Potter, 2011). According to Deloitte (2010) it is also among the largest companies by profit in the world and it currently holds second position in the list of companies that generates highest profits. The company has a wide network of operations in large numbers of countries across the world including Asia, North America and Europe. In UK which is the centre of its origin, it has over 25 % market share and is a market leader in the UK as well as in other markets like Malaysia, Thailand etc. (Tesco, 2011; Tesco Facts Sheet, 2011; Finch, 2010). Jack Cohen laid the foundation of the company in early nineteen century and first store was established in 1929. The company stocks are traded in the London Stock Exchange under the symbol TSCO. It operates in the diverse business segments in retail industry including grocery, apparel, books etc., as well as services related to financing, DVD rentals and internet services (Tesco Entertainment, 2011). According to Fortune (2010), among the world’s largest companies list, Tesco is currently listed at #85 in the list of Global 500 companies. Market Position Tesco is an international retailer operating in diverse markets. The main activities of the company are in retail markets of UK, USA, Poland, China etc. It also provides financial services like insurance and retail banking services which are provided to its valued customers through its subsidiaries. Its ecommerce business offers grocery and direct sales of related items by online services. Market Objectives and Strategies There are various strategic frameworks and market structuring tools which help to obtain information regarding the risks involved in doing business and the value trade-off. This analysis provides the basis on which strategic planning is developed. In case of Tesco it is employing two strategic plans as its primary market objectives. The first one is to focus on the development of market through effective partnerships with the other suppliers, companies and customers while the second one is related to the diversification of products and services by offering new and innovative products to the customers (Tesco PLC, 2011). The market development strategy involves joint ventures and strategic alliances with the other companies operating in the similar industry to excel in the markets (Hitt et al, 2009).Tesco’s entry in the Chinese and Japanese markets has served as a key growth driver to the company’s revenues and its expansion strategies. The company’s interest in the Asian market is increasing due to growth in these markets and increasing trend of consumer shopping. Micro Environment analysis and Marketing Strategy: Position of offering the best value for the most competitive prices contributed to be Tesco number one retail in the UK. Smart Supply Chain Management and Development strategy, constantly research, seeking in order to meet customers’ needs, introducing new innovation, product quality and price, offering huge product range, store facilities and services, working closely with suppliers, developing and motivating its staff, participating in the formulation of national food industry and environment protection – makes possible to keep strong competitive position within market even through time. Terry Leahy, CEO of Tesco plc states “there are many opportunities for business like Tesco as long as you stay close to customer and adapt to the changing circumstance” (ICSC Research Review, 2008). The group provides online services through its subsidiary Tesco.com, broadband internet connection (Tesco Broadband) and telecommunications services (Tesco Mobile and Home Phone). “Tesco.com is the largest online grocery shopping service in the world; it is the fourth biggest online retailer in the UK, behind Amazon, Dell and Argos. Tesco.com serves 850,000 regular customers in the UK and gets more than 250,000 orders every week” (Datamonitor, 2010). Significant advantages of buying online, such as comparatively low price, large product range and the ability to shop around the clock – enable retailers to draw shoppers’ interest (Gladding, 2005). “Tesco, the United Kingdom’s biggest grocer, has attracted considerable attention because of its ambitious overseas strategy and its successful on-line home delivery service” (Child, 2002). “Since establishing an MVNO with 02 in 2003, Tesco has built up 1.5m mobile subscribers and 250,000 of these visits the mobile portal every month” (New Media Age, 2008). Hence, Tesco makes possible to carry into effect purchasing by using mobile phones and brings new life in m-commerce shopping (New Media Age, 2008). According to company’s recent press release information Tesco.com sales up 20.5%, profit up 21.4%, including Tesco Direct (Tesco, 2010). Datamonitor (2010) in its “Tesco, PLC SWOT Analysis” states that “With a strong foothold in online services, Tesco is well placed to benefit from growing online spending. A strong online presence enables the group to serve new customer segments, avoid investments in physical infrastructure and earn better margins”. The company has an impressive brand image, which is associated with high quality goods and services, huge range of assortments and at the time the best prices. Credible brand name enables the company to launch more new products and new market lines; to go through new markets much easier and quickly, and become successful in this field as well, as it was its entry into the Personal Finance market (Datamonitor, 2010). Through the diversification process, Tesco has increased the range of its operation by entering to new markets of distribution and service supply, such as petrol distribution, banking and insurance, real estate and communications. Such changes and strategy improvements have further reinforced company’s market power above its main competitors. Since the mid-90s, Tesco has been investing in overseas markets, by looking for new opportunities to expand and opening new ways of generating long term growth of shareholders value. Today the Group operates in 12 markets outside the UK, in Europe, Asia and North America. The half of the retail shops are represented beyond the UK (Tesco.com). As a part of international expansion, now Tesco is planning to open wholesale grocery store in India by investing up to $114 million over two years. “It complements our entries into China and the United States, giving us access to another important economy in the world” commented this decision the company’s chief executed (World Trade, 2008). At the same time, Tesco announced that it has set up a South China headquarters office in Guangzhou in order to maintain its’ presence in this country, where the company already has 47 stores and has been running the business over three years long (World Trade, 2008). As a part of supporting its global expansion programme, the company plans to centralise all its overseas business after signing a 100million pounds network and voice contract. Through this network upgrade, Nick Folkes, Tesco’s IT director, commented, that the company will be able to standardise key finance, human resources, data warehouse and sales applications across the whole worldwide operations. The CableThe History Of Tesco Business Essay

Patient Controlled Sedation Technique in Pharmacology Report

Introduction Sedation during diagnostic or therapeutic procedures must be safe and comfortable for patients. To achieve this, Non-anesthesiologists performing sedation should be fully trained in the physiology of sedation, the pharmacology of sedatives and analgesics, the monitoring of patients, and in airway support, ventilatory care, and cardiopulmonary resuscitation. Good sedation practice involves presedation assessment and optimal selection of patients, careful monitoring and support from dedicated staff, and adherence to recovery and discharge criteria. Modern medicine often involves minimally invasive interventions for diagnostic or therapeutic purposes. Apart from producing pain and discomfort, such procedures can invoke fear and anxiety reactions. Increased sympathetic activity with tachycardia and hypertension has the potential to precipitate myocardial ischemia or infarction in susceptible patients. Patients undergoing these interventions often require sedation to enhance procedural safety, comfort, and success. The recent proliferation of these procedures increases the demand for sedation. Sedation carries significant risks to patients, especially when inappropriate techniques are used by inexperienced or untrained personnel. As non-anesthesiologists are increasingly involved in sedation, it is vital for them to understand safety issues and receive proper training. This article reviews various factors affecting the safety of procedural sedation, including the performance of sedation, monitoring guidelines, and training issues. Patient-controlled sedation (Technique and Drugs available) Patient-controlled sedation (PCS) allows the patient to control his/her own level of sedation by triggering an infusion pump to deliver a programmed bolus of sedative when needed. [1] Propofol and midazolam are commonly used for PCS A loading dose may be given by the anesthesiologist initially to achieve the desired sedation, followed by patient-activated boluses to maintain sedation. A background infusion may also be used, especially for longer procedures, as patients often become restless or fatigued. The ability to control one’s own sedation may be anxiolytic and it has been found that many patients actually prefer ‘light’ sedation. Even in phobic patients, PCS has been shown to use 30% less propofol than the clinician-controlled technique. [2] Patient satisfaction, qualities of sedation and operative conditions during PCS are comparable with TCI. When sedatives with a rapid onset of action are used together with a ‘lock-out’ interval, the patient-controlled approach should be safe, as deeply sedated patients usually cease to press the control button. However, it has been reported that an individual patient who deliberately tries to achieve unconsciousness will have an 11% chance of success. [3] A variation of PCS with background infusion is to incorporate a patient-controlled element into TCI. A lower initial target concentration is set and the patient is allowed to increase the target propofol concentration in small increments by controlling the handset. Safety measures include a ‘lock-out’ interval, a maximum permissible target concentration, and a programmed decrement in target concentration after fixed intervals with no demands. One study has shown that 22% of patients developed de-saturation requiring supplementary oxygen therapy with such patient-controlled TCI. [4] Remifentanil Remifentanil is a new, potent, fast-onset, and very short acting intravenous opioid. It is largely non-cumulative, with a context-sensitive half-life independent of the duration of infusion. Most investigators are in agreement on the short discharge times and stable haemo-dynamics achieved with remifentanil use. [5] Get your 100% original paper on any topic done in as little as 3 hours Learn More However, Litman has drawn attention to the high incidence of life-threatening respiratory depression associated with remifentanil use and others have cautioned that careful monitoring of ventilation must be instituted. As a result of its potency and high potential for respiratory depression, remifentanil is not recommended for non-anesthesiologist use or for office-based sedation where there are no facilities available for respiratory support. [6] Environment Sedative sparing effects of music Conjunctive use of favorable music via a headset has been shown to decrease PCS’ use in awake patients undergoing procedures performed under regional anesthesia. The intra-operative music chosen by the patient may assist by providing a familiar auditory environment, distracting the patient from upsetting issues during the procedure. The use of headsets also has the advantage of screening out the background noise of the operating theatre. [7] Quiet environment Noise can increase anxiety levels and this is an issue in the operating theatre or MRI suite. Office-based sedation [8] Sedation is sometimes required for short and minimally painful procedures conducted in the office-based or non-hospital setting. The concerns are essentially the same as those for hospital-care sedation. The sedative and analgesic agents chosen should have a rapid onset and offset of Safety and comfort during procedural sedation action to allow early recovery with minimal haemodynamic disturbance or respiratory depression. Patients selected should not have significant co-existing cardiovascular, respiratory, endocrine, or neurological conditions. Risks of sedation [9] Sedation results in depression of the central nervous system. Loss of consciousness due to sedation shares the same risks as the use of general anesthesia. Risks associated with sedation include: We will write a custom Report on Patient Controlled Sedation Technique in Pharmacology specifically for you! Get your first paper with 15% OFF Learn More Over-sedation, leading to unintentional loss of consciousness; Depression of protective reflexes, predisposing the patient to pulmonary aspiration; Depression of respiration, leading to hypoxemia, myocardial ischemia, and arrhythmia; Depression of the cardiovascular system; Use of a wide variety of drugs, and combinations of drugs with the potential for drug interactions. An adverse outcome is more likely when more than two drugs are administered, or when nitrous oxide is combined with other types of drugs potential for excess dosing to compensate for inadequate analgesia. [10] Individual variations in response to the drugs used, particularly in children, the elderly, and those with pre-existing medical disease. Children aged between 1 and 5 years are at greatest risk, although most have no severe underlying disease [11] Risks relating to inadequate skills or experience of the person administering sedation, such as drug errors, inadequate evaluation, inadequate monitoring, or premature discharge. [12] It is important to note that all sedatives and narcotics can cause problems even when used in recommended doses. All clinical areas employing sedation techniques have reported adverse events. Ways to ensure safety during sedation Staffing Medical practitioners involved with sedation should have a good knowledge of the physiology/pharmacology of sedation, and be competent in patient monitoring and resuscitation. The anesthesiologist is the ideal person to sedate and monitor the patient. [13] Guidelines and training In most circumstances, sedation is conducted by non-anesthesiologists. To prevent or manage complications during sedation, the practitioner has to follow certain safe practice guidelines. Various professional bodies and organizations, such as the Hong Kong College of Anesthesiologists and the Australian and New Zealand College of Anesthetists, have promulgated guidelines to assist the practitioner in performing sedation safely. These guidelines outline the general principles of safe practice without providing specific details. Individual departments need to build their own practice guidelines based on these principles to cater for variations in patients, procedures, practitioner skills, and physical setting. Doctors and nurses involved with sedation should undergo regular recertification of cardiopulmonary resuscitation skills. Protocols for resuscitation such as the Advanced Cardiac Life Support protocol, and for managing complications such as de-saturation, should be adopted in areas where sedation is conducted. The staff involved should also receive training in the use of sedative drugs and in appropriate monitoring of patients. [14] [15] [16] Monitoring Monitoring during sedation is the key to safe practice. The following procedures are recommended. Maintain a constant dialogue with the patient during the procedure. This ensures that the patient has not progressed into unintended deep sedation or loss of consciousness. Complete simple clinical assessments such as patient color, temperature, blood pressure, and pulse are a basic requirement. [17] Use non-invasive blood pressure monitors and pulse oximeters to enhance safety during sedation. Early detection and treatment of hypoxaemia is crucial. The use of electronic monitoring equipment should not be considered a substitute for continuous clinical assessment. [18] Routine supplemental oxygen is recommended to decrease the incidence of de-saturation. [18] Equipment and facilities The area where sedation is conducted should be supplied with appropriate equipment and drugs required for cardiopulmonary resuscitation, and airway, ventilatory, and circulatory support. In addition to monitoring equipment, oxygen, adequate suctioning facilities, airway control devices such as endo-tracheal tubes and laryngoscopes, manual resuscitators, defibrillators, antagonists for benzodiazepines, and opioids should be available. The trolley for performing the procedure must be tiltable. [15] [16] Drug administration A key to minimizing complications in procedural sedation is slow and careful titration of drugs to the desired effect. Adequate time must be allowed for drugs to exert full effect before giving additional doses. [12] Presedation evaluation The medical practitioner responsible for sedating the patient should assess the patient before the procedure. The patient’s American Society of Anesthesiologists (ASA) status should be determined for risk stratification. The patient’s known medical history allows the practitioner to plan appropriate sedation and monitor strategies. Anesthesiologists should be involved in sedation of high-risk patients. [19] Not sure if you can write a paper on Patient Controlled Sedation Technique in Pharmacology by yourself? We can help you for only $16.05 $11/page Learn More Recovery care Vital signs should be monitored until the patient is awake and alert. The patient should be observed until discharge criteria related to conscious state, airway patency, ventilation, and circulation status are met. [20] Medico legal aspects Sedation is an intervention carrying significant risks to the patient. It is necessary to explain all significant risks to the patient and to obtain consent for sedation. It is also important to have another person present during the sedation process to circumvent any potential claims with legal ramifications made by the patient. This is especially important when propofol is used, as sexual delusions can occur in patients during and after propofol administration. The patient may consequently believe he/she was sexually assaulted while under sedation. [21] Conclusion Patient safety and comfort constitute the prime priorities in patient management. The provision of sedation carries the risk of potentially life-threatening complications. Adherence to recommended sedation guidelines is therefore mandatory. Choice of agents, techniques, and medical personnel responsible for the proper care of patients should be based on patients’ specific needs rather than cost and efficiency alone. To ensure the safety of all patients undergoing sedation, training of staff and provision of support facilities for maximal patient care are also critical. References Thorpe SJ, Balakrishnan VR, Cook LB. ‘The safety of patient-controlled sedation’. Anaesthesia 1997, 52:1144-50. Girdler NM, Rynn D, Lyne JP, Wilson KE. ‘A prospective randomized controlled study of patient-controlled propofol sedation in phobic dental patients’. Anaesthesia 2000, 55:327-33. Irwin MG, Thompson N, Kenny GN. ‘Patient-maintained propofol sedation’. Assessment of a target-controlled infusion system. Anaesthesia 1997, 52:525-30. Osborne GA. ‘Monitored patient-controlled sedation: practical technique or academic research tool?’ Eur J Anaesthesiol 1996, 13 (Suppl):13S-7S. Litman RS. Conscious sedation with remifentanil during painful medical procedures. J Pain Symptom Manage 2000;19:468-71. Litman RS. Conscious sedation with remifentanil and midazolam during brief painful procedures in children. Arch Pediatr Adolesc Med 1999;153:1085-8. Koch ME, Kain ZN, Ayoub C, Rosenbaum SH. The sedative and analgesic sparing effect of music. Anesthesiology 1998;89:300-6. Kaplan RF. Sedation and analgesia in pediatric patients for procedures outside the operating room. In: American Society of Anesthesiologists Annual Meeting Refresher Course Lectures 2000;256:1-7. Coplans MP, Curson I. ‘Death associated with dentistry’. Br Dent J, 1982, 153:357-62. Holroyd I, Roberts GJ. ‘Inhalation sedation with nitrous oxide: a review’. Dent Update 2000, 27:141-2,144,146. Cote CJ, Notterman DA, Karl HW, Weinberg JA, McCloskey C. Adverse sedation events in pediatrics: a critical incident analysis of contributing factors. Pediatrics 2000;105:805-14. McKay WP, Noble WH. Critical incidents detected by pulse oximetry during anaesthesia. Can J Anaesth 1988;35:265-9. Joint Commission on Accreditation of Healthcare Organizations: Comprehensive Accreditation Manual for Hospitals, The Official Handbook, JCAHO Publication; 1998. Innes G, Murphy M, Nijssen-Jordan C, Ducharme J, Drummond A. ‘Procedural sedation and analgesia in the emergency department’. Canadian Consensus Guidelines. J Emerg Med 1999, 17:145-56. Guidelines for sedation. The Hong Kong College of Anaesthesiologists. Hong Kong; 1992. Guidelines on conscious sedation for diagnostic, interventional medical and surgical procedures. PS9. Australian and New Zealand College of Anaesthetists; 2001. Oh J. Monitoring during and after intravenous conscious sedation. Int Anesthesiol Clin 1999;37:33-45. Cohen EN, Bellville JW, Brown BW Jr. Anaesthesia: a study of operating room nurses and anesthetists. 122 HKMJ Vol 8 No 2002 Hung et al Anesthesiology 1971;35:343-7. ASA updates its position on monitored anesthesia care. 1998. American Society of Anesthesiologists. Web. Continuum of depth of sedation. Definition of general anesthesia and levels of sedation/analgesia. American Society of Anesthesiologists. Web. Kent EA, Bacon DR, Harrison P, Lema MJ. Sexual illusions and propofol sedation. Anesthesiology 1992;77:1037-8.