Many businesses exist and flourish because they are successful in satisfying a need in the market. These needs are determined by the consumers who are considered an important component of any business endeavour. The primary reason for a business existence is to continue identifying consumer needs and then come up with tangible responses to address these needs. This requirement makes business companies spend a considerable amount of effort and intellect in analysing the behaviour of the consumers in order to effectively formulate appropriate marketing strategies that would assist the firm in effective production and delivery. Smart, D. T.,
Share this: Facebook Twitter Reddit LinkedIn WhatsApp 1.0 Terms of Reference The aim of this report is to reduce the risk of the development of pressure ulcers in acutely unwell patients within a local National Health Service (NHS) Trust hospital. The report will recognise the stakeholders who are involved in pressure ulcer prevention and explore how interprofessional working can help to improve effective care of such patients and reduce their risk of pressure damage. Executive Summary 1.1 This report advises that the foundation of pressure ulcer prevention is repositioning (National Pressure Ulcer Advisory Panel (NPUAP), 2016). It provides evidence to suggest that those patients most at risk of pressure ulcers are those with impaired mobility, impaired nutrition and poor posture (National Institute for Health and Care Excellence (NICE), 2014). 1.2 The report highlights that traditionally it was nurses who should determine interventions in order to prevent pressure ulcers (Soban et al., 2017). In spite of this, the report goes on to demonstrate the importance of other stakeholders within pressure ulcer prevention. Nonetheless, these stakeholders still rely on nurse referrals in order to be made aware of patients who are at risk of a pressure ulcers, therefore highlighting the importance of communication within the multi-disciplinary team (MDT). 1.3 The report identifies four stakeholders: Nursing staff; the Service User; Dieticians and Occupational Therapists. In addition, it discusses pressure ulcer prevention from the stakeholders perspective and how they could work collaboratively in order to ensure the best care. 1.4 The report suggests that easier recognition of those patients at risk of pressure ulcers may be beneficial for all stakeholders involved in their care. It also recommends that with a more honed use of Intentional Rounding tools, a patient’s position could be considered more regularly. Furthermore, the report also recommends additional education on pressure ulcer risk reduction for both staff and patients. 2.0 Introduction 2.1 Background The purpose of this report is to consider how effective interprofessional working can help to reduce the amount of pressure ulcers seen in an acute hospital trust. The National Pressure Ulcer Advisory Panel (NPUAP) (2016) define a pressure ulcer as a localised injury to the skin and/or underlying tissue, typically over a bony prominence. These are as a result of sustained pressure or sustained pressure together with shear. Pressure damage may also occur as a result of the use of medical devices which cause damage, for example, oxygen tubing (NPUAP, 2016). The National Institute for Health and Care Excellence (NICE) (2014) state that whilst all patients have a potential risk of developing a pressure ulcer, those patients that are seriously ill, have impaired mobility, impaired nutrition or poor posture pose the largest risk. In order for staff to identify those patients who are most at risk of developing a pressure ulcer, tools which provide a risk score, such as the Waterlow score (Waterlow, 2005) may be useful. However, these tools should not be used in isolation, they should be used together with clinical judgement (Payne, 2016). The European Pressure Ulcer Advisory Panel (EPUAP), NPUAP and the Pan Pacific Pressure Injury Alliance (PPPIA) updated their Clinical Practice Guidelines for Prevention and Treatment of Pressure Ulcers in 2019 (EPUAP, NPUAP, PPPIA, 2019). Consequently, in January 2019, a local NHS Trust hospital amended their clinical guidelines for pressure ulcer prevention (Placement hospital, 2019). These guidelines recommend an evidence-based and multidisciplinary approach to pressure ulcer prevention and include the updated pressure classification system (Placement hospital, 2019). Whilst the trust has seen an improved performance in pressure ulcer numbers in the year 2017/18, it still aims to continue to improve on its achievements to date (Placement hospital, 2019). 2.2 Research Evidence from research suggests that pressure ulcers may cause patients significant pain and distress which in turn may lead to anxiety and depression (Stinson, Ferguson and Porter-Armstrong, 2017). A mixed methods systematic review by Gorecki et al., (2011) obtained reports from patients regarding their pressure ulcer pain. Descriptions ranged from ‘sore and hurting’ to ‘torturing, terrible and exhausting’. This research suggests that pain from pressure ulcers may be debilitating, affecting the patient’s psychological wellbeing, which consequently may impact on their daily life. Research by Clarkson et al., (2016) looked at whether MDT working is promoted as best practice for pressure ulcer prevention and whether it is being practiced effectively. Their research suggested that Occupational Therapists and Health Care Assistants had a more positive attitude to pressure ulcer prevention than nurses. The research concluded that whilst pressure ulcer prevention has historically been seen as a nursing issue, some pressure ulcer causes may help to be prevented by working with the Therapy Service Team (Clarkson et al., 2016). NPUAP (2016) advise that the foundation of pressure ulcer prevention is pressure relief through repositioning. This includes the use of equipment such as pressure-reducing mattresses, chair cushions and heel cushions. NPUAP (2016) do not endorse a specific time interval for repositioning, but the frequency should be individually agreed whilst considering the patients tissue tolerance, their skin condition, their level of activity and mobility and their general medical condition. 2.3 Statistics Despite the guidelines from NPUAP (2016) and EPUAP (2014) pressure ulcers remain to have a significant financial impact on the health service, with treatment costing considerably more than prevention (Stinson, Ferguson and Porter-Armstrong, 2017). The cost of pressure ulcer care to the NHS has been estimated as between £1.4 billion and £2.1 billion annually (Dealey, Posnett and Walker, 2012), emphasising the importance of pressure ulcer prevention. 3.0 Main Body 3.1 Stakeholders There are many stakeholders involved in the reduction of pressure ulcers, however, for the purposes of this report, Nursing staff, Service Users, Dieticians and Occupational Therapists have been discussed. 3.1.1 Specialist Nurses, Nurses and Nursing Assistants Traditionally, the prevention of pressure ulcers has been determined by nursing interventions (Soban et al., 2017). Individualised care plans, as recommended in NICE (2014) guidelines, are developed and documented by nurses on the patient’s admission which encompass skin assessments, mobility, any comorbidities and whether there is any need for additional equipment, for example, pressure relieving mattresses. It is after these assessments that nurses are accountable and responsible for referrals to be made to appropriate stakeholders for further review (NMC, 2019). NPUAP (2016) suggest that the foundation of pressure ulcer prevention is repositioning, with the frequency of the repositioning being individually determined after considering the patients tissue tolerance, activity level and mobility. Local NHS trust guidance states that a pressure ulcer assessment, adapted from Waterlow (2005) must be completed within six hours of admission on the ward or when there is a change in the patient’s condition (Placement hospital, 2019). During the admission process, the nurse initiates either a high or low risk Intentional Rounding schedule, to be completed electronically either one or two hourly by nursing staff. Intentional Rounding tools were initially developed in the United States; however, the United Kingdom implemented them as part of the recommendations from the Francis Inquiry (2013) with the aim of improving patient outcomes (Sims et al., 2018). Intentional Rounding is a system of routinely checking on patients at regular intervals (Morgan et al., 2016) and include positioning as a key element (Sims et al., 2018). This activity could enable tasks such as changing position to be anticipated and addressed, therefore each patient could be reviewed for their risk of pressure ulcers with each rounding task completed. In the local NHS hospital trust Intentional Rounding is a task that is often seen as being delegated to Nursing Assistants. Research has suggested that nursing support workers are commonly used for this task, ensuring that any relevant care requirements are then reported back to the Registered Nurse (Roche et al., 2017). In spite of this, further research suggests that it is in fact registered nurses who score significantly higher on a pressure ulcer prevention questionnaire than nursing assistants. Furthermore, it is those staff who had attended additional training that score the highest (Meyer et al., 2019). This suggests that staff education is an important factor in the success of Intentional Rounding (Sims et al., 2019), indeed, it should not just be seen as a tick box exercise completed from observing patients from afar. In spite of the study by Meyer et al., (2019), there is still limited research to support the fact that Intentional Rounding reduces the incidence of pressure ulcers (Harris et al., 2017). This implies that the success of Intentional Rounding schedules relies for the most part on the compliance and engagement of the staff conducting them (Morgan et al., 2016). 3.1.2 Service Users The impact of pressure ulcers on a service user’s quality of life include pain, depression, sepsis, gangrene and sometimes death (McGinnis et al., 2014). Pressure Ulcer pain can be debilitating, with service users describing it as the most bothersome problem, reporting that the pain is “endless” (Gorecki et al., 2011). Pain can reduce both physical and social activities and the individual can find it difficult to get into a comfortable position. Furthermore, individuals have also described pain at a potential pressure ulcer site as a precursor to a pressure ulcer developing (McGinnis et al., 2014). This suggests that an early assessment of the skin’s condition is paramount in order to observe any skin changes before any damage occurs. The principal patient-related risk factors for the development of pressure ulcers are activity and mobility (Woodhouse et al., 2015). Individuals with reduced mobility may rely on healthcare professionals to reposition them, with positions being maintained with the use of pillows and/or cushions (Woodhouse et al., 2015). In contrast to guidelines from NPUAP (2016), NICE guidelines (2014) suggest that adults at risk of pressure ulcers should be repositioned at least every six hours, with ‘high risk’ adults to be repositioned every four hours. NICE Guidelines (2014) also encourage those adults who are high risk to change their position by themselves at least four hourly if they are able to do so. Repositioning is a critical part of prevention of pressure ulcers, and staff should take responsibility to educate both service users and their families to fully participate in this activity, encouraging small position shifts when they are able (Miles, Nowicki and Fulbrook, 2014). 3.1.3 Dieticians In the local NHS trust, in order for Dieticians to become involved in the care of patients, they rely on receiving a referral from nursing staff after the patient’s admission (Placement hospital, 2019). Nutritional deficiency and insufficient dietary intake are significant risk factors for pressure ulcer development (Saghaleini et al., 2018). Tissue viability and preservation of skin require an adequate nutritional intake. Factors which can influence a service users’ nutritional status include issues with swallowing, declining cognition, mobility issues and lack of appetite may affect the level of tissue tolerance (Saghaleini et al., 2018). The nutritional status of the service user should be part of the assessment of pressure ulcer risk (NICE, 2014). The Association of UK Dietitians (2019) describe one role of a dietician is to try and prevent and manage pressure ulcers by optimising the patient’s nutrition status. They suggest that pressure ulcers may occur in overweight or underweight service users, with the skin requiring a good supply of fluid and nutrients to maintain good circulation and to keep it supple. A balanced diet and a healthy body weight will help to reduce the risk of developing a pressure ulcer (The Association of UK Dietitians, 2019). The British Association for Parenteral and Enteral Nutrition (BAPEN), 2016 launched a screening tool in the UK in 2003, the ‘Malnutrition Universal Screening Tool’ (‘MUST’). This tool is completed by nursing staff and identifies those who may be at nutritional risk. The Services Users identified, together with those who score ‘at risk’ for pressure damage on the Waterlow score (2005) should then be referred to the dietetics team (BAPEN, 2016). NICE (2012) recommend that all hospital inpatients should be screened for malnutrition using a validated screening tool, for example, ‘MUST’. The dietetics team will also work alongside other members of the MDT. Discussions with doctors and pharmacists may highlight any of the service users’ medications which may be causing a reduction in appetite, and the Speech and Language Therapists (SALT) could be spoken to if there are any swallowing impairments which may impact on nutritional intake. Occupational Therapists can assist by giving equipment aids to those who cannot feed themselves (Jaul, 2010). Research suggests that nutritional supplementation, which assists in providing additional calories and protein, may help to prevent the development of pressure ulcers, with these being given either orally or through enteral feeding (Jaul, 2010). Benefits and risks of enteral feeding should be discussed with other members of the Multidisciplinary Team, the service user and their family members. 3.1.4 Occupational Therapists In the local NHS trust Occupational Therapists rely on a referral from the nursing team to become involved in patient’s care (Placement hospital, 2019). Wounds may negatively affect a person’s ability to participate in their usual routines, this may impact on self-care, work, social activities and sleep, therefore impacting on a person’s quality of life (Amini, 2018). The Occupational Therapist’s role is to improve people’s ability to function as independently as possible (Royal College of Occupational Therapists, 2019). Within pressure ulcer prevention this could include providing modifications to the environment whilst the wound is healing and providing adaptive equipment to assist with the activities of daily living. An Occupational Therapist can also help to position the body in order to alleviate points of pressure, for example, distribution of weight and postural alignment. They may also provide education to service users in skin care techniques, including moisture control and prevention of dry skin, plus suggesting transfer techniques to minimise the risk of tearing the skin (Amini, 2018). Members of Allied Health Professionals, such as Occupational Therapists, could have a great potential to be largely involved in prevention of pressure ulcers. However, in spite of this, research has shown some difficulties are still being found. Worsley et al., (2018) observed that some Occupational Therapists had experienced situations whereby they had moved patients from their bed to the chair to encourage movement, but consequently had been asked not to sit patients out due to a lack of nursing staff who can return the patient back to bed. Worsley et al., (2018) also reported a lack of communication with regard to pressure ulcer prevention, some Occupational Therapists did not feel confident to discuss pressure ulcer prevention with the nurses because they thought they had more knowledge than them. 3.1.5 Interprofessional working The Interprofessional working relationship between Nursing staff, Dieticians and Occupational Therapists should enable goals to be established and prevention plans to be prepared. These should then be evaluated regularly (EPUAP, NPUAP, PPPIA, 2019). In order to support effective interprofessional working for pressure ulcer prevention, early recognition of an at-risk patient, via a risk assessment, should be carried out with prompt referrals to the appropriate teams (NICE, 2014). Patients who are at-risk of pressure ulcers should be made easily recognisable to all members of the MDT, which should then remind all staff to reposition patients. The importance of repositioning, together with advice regarding a healthy diet, should be communicated to all staff on the ward. The identified stakeholders all have a role in the reduction of pressure ulcers within the local health trust (Placement hospital, 2019). Therefore, it could be said that collaborative working is necessary to ensure the best possible care. 5.0. Conclusion NICE guidelines (2014) have stated that the risk of pressure ulcers for patients is greatest when they have impaired mobility, impaired nutrition and poor posture, therefore it could be concluded that input from the Occupational Therapist and Dietician are invaluable to prevent pressure ulcers developing. However, it is currently the nurse’s responsibility to make these patients known to these members of the multi-disciplinary team. It is only then that they provide their input regarding equipment, nutrition and education. With NPUAP (2016) suggesting that repositioning is the foundation of pressure ulcer prevention, Intentional Rounding tools present an ideal opportunity for nursing staff to provide an ongoing assessment of their patients position and comfort after the initial admission process has taken place, allowing for referrals to other members of the MDT, not only on admission, but throughout the patients stay in hospital. Communication between the members of the MDT could possibly still be improved. Worsley et al., (2018) suggests that education is lacking within teams as to who’s responsibility pressure ulcer prevention is. Furthermore, Soban et al., (2017) suggest that traditionally pressure ulcer prevention is determined by nursing interventions. However, whilst it may be the nurse who refers the patient to other members of the MDT, maybe if patients were easily recognisable as being at risk, both by a visual prompt at the bedside and by ensuring it is on the handover sheet, then referrals could take place not only on the admission of the patient, but any time that is necessary. Perhaps this may then go towards prompter pressure ulcer prevention for the patient. 6.0 Recommendations 6.1 Education and training for staff SPECIFIC Continue to include pressure ulcer prevention education for all healthcare professionals within annual training sessions, specifying the role of the MDT within this training. Ensure that the completion of Intentional Rounding tools is part of this training. MEASURABLE The training is within the annual training skills programme, plus ongoing training by staff on the ward. ACHIEVABLE Intentional Rounding can be part of training scenarios. Tissue Viability Specialist nurses could provide further training and workshops for all members of the MDT. REALISTIC It is feasible to include this within the annual training programme. TIME RELATED Can be implemented straight away. 6.2 Patient Education SPECIFIC Ensure patients are educated on the importance of movement to prevent pressure ulcers. MEASURABLE When Intentional Rounding is completed by staff on the ward, reminders to move could be given to the patient. ACHIEVABLE Incorporated within the Intentional Rounding tools. REALISTIC Staff to be trained in annual training sessions and passed on to colleagues and reminders in handover. TIME RELATED Can be implemented straight away. 6.3 ‘At risk of pressure ulcers’ sticker to be used above bed SPECIFIC A sticker could be placed above the bed to ensure all staff who come into contact with patient are aware of their pressure ulcer risk. MEASURABLE Nurses or Nursing Assistants can ensure the sticker is in place once patient is identified as high risk. ACHIEVABLE Small financial implication in producing stickers but should reduce financial implications in the long run. REALISTIC Stickers are used already for patients who are risk of falls, therefore this should not be an issue to produce for pressure ulcer risk. TIME RELATED Could be implemented once stickers have been produced. Funding could be sought from hospital budget. 6.4 ‘At risk of pressure ulcers’ to be highlighted within handover SPECIFIC Ensure that handover sheets include whether a patient is at risk of pressure ulcers. MEASURABLE Nurses to include this within handover template and highlighted to next shift. ACHIEVABLE Incorporated within handover. REALISTIC Handovers are already in circulation. TIME RELATED Can be implemented straight away. 7.0. References Amini, D. (2018) ‘Role of Occupational Therapy in Wound Management’, The American Journal of Occupational Therapy, Volume 72, pp. 1-9. BAPEN (2016) Screening
A PEST analysis looks at the political, economic, socio and technological factors which may affect an organisation. Worthing and Britton (2006, P 475) Write that “it seeks to predict the extent to which change is likely to occur, and its possible consequences towards and organisation” The following is a pest analysis for House of Fraser and detailed explanation of each factor. POLITICAL/LEGAL ISSUES None ECONOMIC FACTORS Downturn in the economy Competition from Supermarkets such as Asda and Sainsbury Lower disposable incomes Drop in property prices Sales tax increase SOCIAL CULTURAL ISSUES People looking to cut down on expenditure Changes in trends of types of clothing Save money to purchase a new home Leisure activities TECHNOLOGICAL FACTORS Surge of online retailers Counterfeit products being sold via websites such as EBay Fast growth of technology Economical The major effect for House of Fraser has come with the economic collapse of the financial markets which started in 2008. This mainly happened as Bauger purchased a large minority share in House of Fraser as well as many other retail stores, it was backed by Icelandic Bank landsbanki which collapsed and started pulling the plug on bauger. Bauger has therefore had difficulty obtaining new investors for its business. House of Fraser claim that business will still run as normal since it was a minority share; however, suppliers have recently become worried but have received reassurance from HOF. Thompson (2009) In June 2009, the former CE of Baugur, Gunnar Sigurdsson, rejoined the board at House of Fraser. Sigurdsson stepped down from House of fraser in late 2008 following the collapse of Baugur, the investment group he led, which held a stake in the department store. Baugur’s shares were subsequently transferred to Icelandic bank Landsbanki. As families continue to tighten their budget and look to by cheaper items, the economic impact could affect House of Fraser for years to come. With competition being created by Supermarkets such as Asda and Sainsbury which work at the lower end of the market, House of Fraser may not be as successful until the economy becomes strong again. Furthermore, the British Retail consortium has warned that retailers will have a tough 2010 ahead of as the uncertainty continues within the economy. BBC Online (2010) Another factor which may play a role is with the housing market. As families see their equity shrink with the drop in home prices and home prices outside many first time buyers budgets, families will now look to save as much as possible in order to purchase a home and with that, will reduce excessive expenditure in order to achieve this. Technology A major impact to stores which sell designer has been websites such as EBay. Counterfeit items which may have made in China for example, have affected a wide range of markets, including: Technology Clothing Consumer electronics Counterfeit clothing is created and then sold on the internet at sometimes a tenth of the price, causing many retailers to lose valuable business. This can be seen with G-star jeans. The price of these Jeans in House of Fraser is £100; (House of Fraser, 2010) this same counterfeit item can be purchased on eBay for £12. (Ebay, 2010) The UK designer clothing market grew by 2.5% in 2007, to reach a total of £2 billion. Womenswear was the star performer at 3.2% growth, driven especially by strong sales of top-end ranges where consumers look for differentiation, newness, quality and exclusivity. Menswear was solid, whilst children’s designerwear is declining. The designer market is not insulated from the economic downturn: some companies admit weaker sales growth in 2008 H1, and aggressive markdowns in the June sales showed there was a lot of stock to be cleared. There is a ‘material change in sentiment’ and while top-end is still strong, many feel this is not the time for ostentation. Creating the luxury experience in-store is crucial, and new trends see more stores offering more product areas and services to attract customers and keep them in longer. …more » Social and cultural issues As many consumers have been hit by the downturn and with the loss of jobs, families may now be looking to cut down expenditure. Disposable incomes are at an all time low which will effect where many consumers shop. Even coming out of the recession, many families will now start to save their disposable income out of fear of another recession hitting and will want to be able to weather the storm better. They may therefore shop for lower brand name goods and look to save a larger portion of their income. Many individuals are now looking to stay fit as there has also been a large push from the government regarding this. They will therefore spend a portion of their income in order to keep fit which will include gym membership, further reducing disposable incomes. 3.2 Porter’s five forces model This model looks at external elements affecting the company directly. It can be used by an organisation to see how these threats may affect negatively or whether they can be used in order to provide the organisation with a competitive edge. Worthington et al (2005, p214) Writes that “it is a tool which can be used both to analyze current market position and in the formulation of strategic policies” Competitive rivalry This is a list of the main rivals to House of Fraser Debenhams plc Marks and Spencer Group plc Arcadia Group Limited Burberry Group plc Laura Ashley Holdings PLC John Lewis Partnership plc Buyers Potential entrants Over the last few years, there has been a large growth in retailers which now sell clothing items all under one store. Most notable has been the merger of the US giant Wal-mart with Asda. Asda now sells its own brand of clothing called George which has helped it gain a large amount of the clothing market share. This has affected clothing retailers as supermarkets such as Asda and Sainsbury, have a one stop shop where families can now shop for food and clothing all under one roof, saving consumer’s time. Furthermore, Supermarkets’ share of the clothing market increased from around 10% in 2000 to 23% in 2008. Keynote (2009) Another major player in the market is Primemark. As the economic downturn hit, primemark saw sales rise significantly. Even though they have had a negative image due to accusations of them using child labourers in China and not selling branded items, consumers still purchased items from their stores as they looked to save as much money as possible. And with the lower prices than average, Primemark has become stiff competition for many retailers. Substitutes Substitutes of house of Fraser include a variety of websites which sells clothing, footwear and furniture directly to consumers. Mail order companies are another example of substitutes which include large companies such as Littlewoods. Buyer When it comes to retail, most buyers do not have much if not any bargaining power. However, with the downturn in the economy, buyers have become more prices sensitive. Consumers who purchase certain brand name items may now lower there requirement in order to stay within budget, however, retailers have also been cutting down prices in order to keep these same customers coming in. There is however a threat that some consumers will now look to purchase items online from other retailers in order to purchase the same brand, but at a lower price. Supplier House of Fraser has been moving towards creating more of its own brand name products, therefore, there does not seem to be much threat from suppliers and they do not seem to have much bargaining power. Competitor analysis House of Fraser had a change of management during the 90’s due to major losses and the closing of many stores. This saw the company move towards the more upmarket brand and the taking in of more private labels. This in return has helped it establish itself as an exclusive brand. (Glasgow University Archive Services, 2003). However, Mintel (2009) also states that the timing to keep moving upmarket may be incorrect due to the fact that it may miss out consumers in the lower price bracket. People want to know where they stand in volatile markets and a change in emphasis could unsettle loyal customers. The conversion of its Swindon premises to an outlet store further muddies the waters. Any more such conversions could potentially risk obscuring the House of Fraser retail brand and its identity. (Mintel, 2009) The major competitors to House of Fraser have been John Lewis, Debenhams and Marks and Spencer. Please see appendix 5.1 for a breakdown of the number of outlets for each competitor and their sales amount for 2007/08 Debenhams is one the larger retailers within this group but have also been suffering from high costs and also seems to be struggling. One major issue includes the huge debt which is estimated to be around £1billion. However, they have been expanding both the amount of stores and their product line. Recent flagship store openings include the Westfield Centre store in London which opened in October 2008. The general market Debenhams concentrates is the middle class market, however, there main target has been towards women aged between 25-55. Mintel reports that data shows that Debenhams generally has a strong bias towards women. Furthermore, Debenhams also has its own product similar to what other retailers are producing. The strongest competitor in the group is John Lewis which has been able to build a loyal customer base, show strong profits and seems to be in a position to expand in the future. One thing that has helped John Lewis sustain growth has been its own brand development and also the fact they sale lower price household goods and does not cherry pick high margin products. They also offer a free nationwide devilry service for orders over £30 compared to house of Frasers order over £50 policy. (Mintel, 2009) Marks
Article “Cloud-based Analytics: Supporting Healthcare’s Digital Transformation”, health and medicine homework help
Article “Cloud-based Analytics: Supporting Healthcare’s Digital Transformation”, health and medicine homework help.
WRITE A CRITICAL REVIEW OF ARTICLE: Please Read and Summarize above Article “Cloud-based Analytics: Supporting Healthcare’s Digital Transformation” in APA style format (4-5 pages). Students should also integrate answers to the following three questions in their papers:§ What is the author trying to say?§ What is the significance of what you read?§ How does the material influence you?WRITING A CRITICAL REVIEW OF AN ARTICLE What is a critical review?A critical review is much more than a simple summary; it is an analysis and evaluation of a book, article, or other medium. Writing a good critical review requires that you understand the material, and that youKnow how to analyze and evaluate that material using appropriate criteria. Steps to writing an effective critical review:ReadingSkim the whole text to determine the overall article, structure and methodology. This will help you better understand how the different elements fit together once you begin reading carefully. Read critically. It is not enough to simply understand what the author is saying; it is essential to challenge it. Examine how the article is structured, the types of reasons or evidence used to support the conclusions, and whether the author is reliant on underlying assumptions or theoretical frameworks. Take copious notes that reflect what the text means AND what you think about it. AnalyzingExamine all elements. All aspects of the text—the structure, the methods, the reasons and evidence, the conclusions, and, especially, the logical connections between all of these—should be considered. The types of questions asked will vary depending on the discipline in which you are writing, but the following samples will provide a good starting point: StructureWhat type of text is it? (For example: Is it a primary source or secondary source? Is it original research or a comment on original research?)What are the different sections and how do they fit together? Are any of the sections particularly effective (or ineffective)?MethodologyIs the research quantitative or qualitative? Does the methodology have any weaknesses?How does the design of the study address the hypothesis?Reasons/EvidenceWhat sources does the author use (interviews, peer-reviewed journals, government reports, journal entries, newspaper accounts, etc.)?What types of reasoning are employed (inductive, deductive, abductive)? What type of evidence is provided (empirical, statistical, logical, etc.)? Are there any gaps in the evidence (or reasoning)?ConclusionsDoes the data adequately support the conclusion drawn by the researcher(s)? Are other interpretations plausible?Are the conclusions dependent on a particular theoretical formulation? What does the work contribute to the field?LogicWhat assumptions does the author make?Does the author account for all of the data, or are portions left out? What alternative perspectives remain unconsidered?Are there any logical flaws in the construction of the argument?Writing: Formulate a answers based on your overall evaluation. A strong review will acknowledge both strengths and limitations. Ensure that your review summary answers the assignment. then your review summary should focus strictly on the material in the article and your analysis and evaluation of it.
Article “Cloud-based Analytics: Supporting Healthcare’s Digital Transformation”, health and medicine homework help
MHA507 Florida A&M University 9/10 CN9 Leveraging Informatics In Health Sector Report
online assignment help MHA507 Florida A&M University 9/10 CN9 Leveraging Informatics In Health Sector Report.
Resource: How to Plot Data onto a Map in Microsoft Excel PDF Read the following scenario:Now that you know where the outbreaks are located and which age groups are most affected, your organization wants to map out the areas that pose the highest exposure risk. Create a symbols map using Microsoft® Excel® and the data provided in the High Risk Areas document to determine the areas of the country with the most risk. Review the “Plotting Data onto a Map in Microsoft® Excel® PDF document for instructions on completing this portion of the assignment.Write a 350- to 525-word report of your analysis of the data.Include an answer to the following questions:Which cities (states) are high risk and low risk?What areas of the country are high risk and low risk?What else can be deduced after evaluating the chart? Include your map within the report, not separately. Label as a Figure according to APA formatting. Also, include title and reference pages.Cite at least 2 scholarly references to support your assignment. Feel free to use supplemental readings as references, if from peer-reviewed journals. DO NOT use “.com” commercial, “.edu” education, “.org” or “.net” proprietary sources. Okay to use one .gov reference, such as CDC or NIH Format your citations according to APA guidelines.
MHA507 Florida A&M University 9/10 CN9 Leveraging Informatics In Health Sector Report
VBA in Excel
VBA in Excel. I’m working on a Excel question and need guidance to help me study.
Problem 1: Super Coder [20 points]
You’ve just joined a new business analytics department and your first assignment involves analyzing an Excel VBA program written by a former employee of the company. This employee, who liked people to call him “super coder”, wrote a small Excel VBA program that did something with customer account data. The file you’ve inherited is named FlagOverdueAccts-BigMess.xlsm and it contains a subroutine called procedure1(). The file itself was named by the annoyed employee who inherited the totally uncommented code.
Part 1.1 – Cleaning and Commenting
Thoroughly comment the code so that anyone with basic VBA experience will know exactly what is going on in the program. Fix up the indentation and add appropriate blank lines to make the subroutine more readable.
You’ll notice that Range(“A3”) appears a few times. Modify code to avoid hard coding in the cell reference “A3”).
Several of the variables have “bad variable names” – rename them to something more appropriate. In particular, here are the Dim statements for some of the poorly named variables:
Dim cell1 As Range
Dim cell2 As Range
Dim n As Integer
Dim dollars As Currency
Fix the button captions. Rename the procedure1() and procedure2() Subs with more appropriate names
Part 1.2 – Program Enhancements
Modify the first procedure so that:
The results range is sorted in descending order by amount due.
Finish procedure2() so that it clears out the results as intended. Obviously, it needs to work no matter how many or how few rows are in the results table. Rename procedure2 to something more appropriate.
Problem 2: Break Even [20 points]
Finish up the BreakEven-W12-Problem.xlsm problem we started in class. See BreakEven-W12-Demo.xlsm for how it should look and work. Both files are available in the Downloads-Module05-VBA.zip file. There are also Screencasts on Moodle that walk you through the solution (yes, the answers are in the videos). This problem is designed to introduce you to basic range object referencing and manipulation. To get 15/20, you must get the “basic version” working correctly (described in the program comments) and to get 20/20 you need to get the “above and beyond version” working correctly. That’s the version that the Demo file illustrates and includes the message when the break even point is detected and the Goal Seek part.
Problem 3: User defined functions for log snooping [20 points]
I’ve provided you with a file called access_log.txt. It’s an Apache server log. For those of you don’t know, Apache is the primary server software underlying the internet. Learn more at http://httpd.apache.org/. You can read about the format of Apache log files at http://httpd.apache.org/docs/1.3/logs.html#common.
In this problem, you are taking on the role of a security analyst who is checking into some possible irregular traffic hitting your servers.
Browse the file to get sense of structure
IP address (or domain name)
HTTP command (GET, POST, HEAD, …)
return code (2xx is good, 3xx is redirect, 4xx is error, 5xx is ?)
data size returned
Part 3.1 – Manually import log file into Excel
Import the access_log.txt file into Excel. Import it as a TAB DELIMITED file so that each record gets imported into Column A in your spreadsheet. Here’s a screenshot of the top of my Excel file:
Save your file as apache_log_functions.xlsm (yes, as a macro-enabled workbook). You’ll be doing all the work for this problem in this file and you’ll be turning it in as part of the assignment.
Part 3.2 – Creating a function to extract date and time from a log file line
Let’s assume you want to be able to quickly filter lines by dates or times of the log line. You’ll see there is a datetime stamp right after a left bracket – “[“. To make this easy you are going to create a simple VBA function that returns the datetime value for a single line passed into the function. Then you could use this function in a worksheet formula in some column to the right of your data. Each row containing the string of interest will end up with a datetime value and then you could Autofilter the whole range and just see the records of interest. For lines which don’t contain dates, we’ll have our function return a zero.
This function will be called GetApacheDateTime. It will take one input arguments. The first is a string representing an Apache log line. To help you out, here’s a code skeleton. I STRONGLY SUGGEST YOU USE THIS CODE SKELETON.
Remember, you can and should debug and test your user defined function using the Immediate Window, or the spreadsheet itself, or a “tester Sub”. See the Variables and Procedure Basics screencast which covers creating, using and testing user defined functions.
IMPORTANT: Remember, functions take input arguments and return values. As you can see from the screenshot above, the first input argument is a string. So, your function should NOT reference anything else in the workbook or worksheet other than the argument passed in. That’s the whole point of functions. Also, as you can see from the function declaration, your function will simply return an Excel datetime value. It will NOT explicitly modify the spreadsheet. The spreadsheet will get modified when you use the function in a cell. A user defined function is just like any other Excel function.
Once you have it working, use it in formulas in Column B and then filter so that only those records from March 9, 2004, are shown. Here’s what the answer will look like.
Hacker Extra – Grabbing the HTTP command
While you are pretty excited about your GetApacheDateTime() function, you decide you’d like to also have a function that returns the HTTP command – e.g. GET or POST or whatever, along with the URL. For example, from a line that looks like this:
188.8.131.52 – – [09/Mar/2004:01:48:28 -0800] “GET /favicon.ico HTTP/1.1” 200 1078
you’d like your function to return
as a string. Notice we do NOT want the HTTP/1.1. We just want the HTTP command and the URL. We’ll call this function GetApacheHTTPCommand(). Just like the previous function, it takes a string representing the log line as its only input. As in the previous part, if you get this working, use it in Column C to show me that it works. Here’s my output.
Since this is a Hacker Extra, no screenshot. But, here’s a few hints:
Obviously the HTTP command along with the URL appears between the double quotes.
There’s a space between the HTTP command and the URL.
The URL ends with the last character before a space.
VBA in Excel
AJA Review #2
AJA Review #2. Can you help me understand this History question?
The instructor recommends allotting 300 minutes to complete this assignment. Time Recommendation: 180 minutes to read the academic journal article and 120 minutes to write and edit the 2-page review. This is only a recommendation, you may spend more or less time on this assignment depending on your ability and availability.
Historians love to review the works of other historians. Whenever a new history book is written, the historical profession selects experts in particular fields of studies to determine the value and contribution the new work will have on the academic discipline. Upon completion of the course’s reading, each student will be considered an expert and be required to read an academic article and submit a 2-page review (minimum). Students are encouraged to celebrate the author’s accomplishments, but also challenge anything that seems substandard. Style and creativity play a crucial role in the success of your review.
Pick one of the Academic Journal Articles below:
Antigay Prejudice and the 1979 Backlash against Disco.pdf
Birth Control and the Black Community in the 1960s.pdf
Bloody Christmas and the Irony of Police Professionalism.pdf
Chinese American Women Defense Workers.pdf
Diet and Masculinity in Postwar America.pdf
Japanese Americans and Racism in CA Impact WWII.pdf
Lincoln and Eleanor Ragsdale, Collaboration, and Community Activism in Phoenix.pdf
McCarthyism, Mexican Americans, and the Los Angeles Committee for Protection.pdf
Remembering a Vietnam War Firefight.pdf
Ronald Reagan and Student Unrest in California.pdf
Two pages (minimum)
12 point font
Each paper should include the following:
The author’s purpose in writing the article
The author’s main thesis
The author’s challenging of other historical viewpoints
The evidence utilized by the author (specifically primary sources)
How could the author make the work stronger?
The recommended audience for the article?
Explain how this article contributes to understanding the history of the United States
An example of how this article supports/contradicts Eric Foner’s Give Me Liberty
Suggested reading to accompany this work (not required, but helpful)
Click here for a step by step guide to writing a successful AJA Review
Click here to discover the difference between a primary and secondary source.
Instructions for Submitting
On the right-hand side of the screen click on the icon that says “SUBMIT ASSIGNMENT”
Click on the tab “File Upload” to attach your AJA Review.
Click on the tab “Text Entry” if you wish to copy and paste OR write your review in the box provided.
Be sure to click “SUBMIT ASSIGNMENT” after you finishing uploading the document. If you need help converting pages click on this link.
The AJA Rubric (1) (1)
The AJA Rubric (1) (1)
This criterion is linked to a Learning OutcomePage and Format Requirement
30.0 ptsMeets minimum page requirement (2 full pages).
5.0 ptsDoes not meet minimum page requirement (1.5 pages or less)
This criterion is linked to a Learning OutcomeAJA Requirements and Quality
30.0 ptsAnswers the specific AJA requirements. Incorporates pertinent and detailed information from scholarly work. Maintains focus/avoids being sidetracked by tangents. Presents all information clearly and concisely and in an organized manner. Avoids distracting grammar/spelling/etc. problems.
25.0 ptsAnswers most of the AJA requirements, however, may miss one of the following (thesis, purpose, relationship to history, or target audience). Incorporates pertinent and detailed information from scholarly work. Maintains focus/avoids being sidetracked by tangents. Presents all information clearly and concisely and in an organized manner. Avoids distracting grammar/spelling/etc. problems.
20.0 ptsAnswers many of the AJA requirements, however, missed more than one of the following (thesis, purpose, relationship to history, or target audience). Incorporates pertinent and detailed information from scholarly work. Maintains focus/avoids being sidetracked by tangents. Presents all information clearly and concisely and in an organized manner. Avoids distracting grammar/spelling/etc. problems.
15.0 ptsMay have met all the AJA requirements, however did not incorporate pertinent and detailed information from the scholarly work and/or sidetracked off into a reactionary tangent. Presents information in a manner that is sometimes unclear, and/or has significant organization problems. Avoids distracting grammar/spelling/etc. problems.
10.0 ptsMay have met all the AJA requirement, however did not incorporate pertinent and detailed information from the scholarly work and/or sidetracked off into a reactionary tangent. Provides no information that can be understood or related to the specific topic May lack any recognizable organization May contain enough distracting grammar/spelling/etc. problems to make it substantially incomprehensible.
This criterion is linked to a Learning OutcomePrimary Source Identification
20.0 ptsIdentified 3 specific primary sources.
15.0 ptsIdentified 2 specific primary sources.
10.0 ptsIdentified 1 specific primary source.
8.0 ptsIdentified primary sources, but not specific.
1.0 ptsIdentified the wrong source.
0.0 ptsNo attempt made to identify primary sources.
This criterion is linked to a Learning OutcomeTextbook Critical Analysis
20.0 ptsSupport/contradict the textbook with a direct quote from textbook.
15.0 ptsSupport/contradiction validated with page number or chapter reference instead of a direct quote.
10.0 ptsSupport/contradiction asserted without any specific validation from the textbook using a direct quote. Does include a generalized narrative of why support/contradict the textbook.
5.0 ptsSupport/contradiction asserted without any specific validation from the textbook using a direct quote. Also lacks any sort of generalize narrative of why support or contradiction was proposed.
2.0 ptsStudent stated that it did not support or contradict the textbook without validation.
1.0 ptsStudent obviously did not read the book so their analysis of support or contradiction is too general, too vague, and/or incorrect.
0.0 ptsNo support/contradiction of the textbook.
Total Points: 100.0
AJA Review #2