Journal of Consumer Research, the Journal of Marketing Research, or Research Paper

Journal of Consumer , the Journal of Marketing , or the Journal of Consumer Psychology - Research Paper Example In this experiment, forty university students were used as the participants. The results demonstrated that the participants viewed the brand more positively when a fee is not charged. In the second experiment, the author aimed at understanding how people react to comparable and non-comparable rewards offered back by the brands. In this study, ninety four undergraduate students from a university in North America took part. The results showed that exchange oriented consumers expect comparable benefits from the brand partners. For communal consumers or partners, benefits that are not necessarily comparable but recognize their efforts are accepted. Finally, the author undertook an experiment to examine how the time taken between seeking help and offering of help affects consumer behavior. Ninety five students took part in the study. Results showed that consumers view brands negatively if there is a delay in the return favor request. Overall, the behavior of the participants in the three scenarios demonstrated that consumers’ behavior and attitudes is greatly influenced by the actions of the brands. The use of human subjects allowed for an actual observation of the attitudes and behavior of the participants towards the brands, thereby providing an insight into consumer behavior. The present research, conducted by Anat Keinan and Ran Kivetz (2008), aimed at evaluating the effect of anticipating long term regret in consumer behavior. The authors argue that anticipating long term regret has an effect on consumer preferences and may motivate them to counteract their virtues or good tendencies and engage in virtues. In order to test this hypothesis, the authors used three sets of participants in three different studies. In the first study, the authors asked participants to examine and judge the regrets of others relating to a past decision and then come up with a choice for themselves. 91 train station travelers participated in the study. The

Fire Essay Example | Topics and Well Written Essays - 250 words - 1

Fire - Essay Example One of the reasons behind the success of movie was the increased amount of budget which was spent to produce this movie. The major part of the overall film budget was spent on the fire scene which takes the complete toll of the Chicago city (King). It can be seen in the particular scenic representation of the fire accident which spreads all around the neighborhood taking grasp of the closer blocks as well. The directors have shown people to be in the panic situation trying to save their homes despite the entire neighborhood was on fire. In reality, this is far different because the fire extinguishers and the firemen are allotted to the accident site. People are evacuated from the accident site so that there no more fatalities. Most prominently, the movie projects heroes saving human lives stuck in homes that are on fire. In real life, the heroes saving the human live stuck in the homes on fire are rather the firemen

Mental Health Illness and Stigma Literature Review

Mental Health Illness and Stigma Literature Review 1. Introduction 1.1 Mental illness and stigma Inequalities in health services delivery and utilization for people with mental illness has been widely documented.1 Subsequently this results in poorer outcomes for this population in regard to general health, such as circulatory diseases, mortality from natural causes, and access to interventions .2-4 Several issues have been identified as contributing to these disparities in health service access and delivery, including stigma.5-6Stigma associated with mental illness has been defined as negative attitudes formed on the basis of prejudice or misinformation that are triggered by markers of illness.1-5Illness markers include atypical behaviours, the types of medication prescribed and noticeable medication related adverse effects.5-7These markers allow for the continuation of stigma concerning people with mental illness, but they also allow community pharmacists to identify patients with a broad range of what are often unaddressed health related needs.1 Behavioural and mental disorder s are estimated to account for 12% of the global burden of diseases. Mental health related medications account for >10% of all medications prescribed by general medical practitioners8, therefore, it is an inescapable fact that community pharmacists must interact with patients suffering from mental health problems.9 Mental illness is relevant to practising pharmacists who can play vital roles in the treatment of patients with mental illness.10 Throughout the latter half of the previous century, the diagnosis and pharmacological treatment of mental illness improved radically.9 1990-2000 was proclaimed the Decade of the Brain. to promote the study of disorders of the brain, including mental illnesses.11 Despite these advances, the stigma associated with mental illness remains a compelling negative feature in society.10 Unfortunately health care professionals, including pharmacists are not invulnerable to such harmful attitudes.9 Pharmacists attitudes toward mental illness and the menta lly ill are extremely important because they can affect their professional interactions and clinical decisions.12-13 In addition, they could ultimately affect the delivery of pharmaceutical care which has been defined as the pharmacist assuming the responsibility for positive patient outcomes.14 Activities like medication counselling and monitoring of therapy have been documented to improve both satisfaction and adherence to drug therapy in patients with mental illness.15 It has been pointed out that pharmacists must become more involved in such activities for patients with mental illness.9 1.2 Optimising the use of medications for mental illness Community care offers many advantages over institutional care; however, it can place extra demands on family, friends and primary health care practitioners.16 Health professionals have identified people with mental illness as the most challenging patients to manage.8 The quality and accessibility of community care for people with mental illness needs to be improved.17 The appropriate use of medicines plays an imperative role in the effective management of mental illness, nonetheless, there is evidence that psychotropic medicines are often used inappropriately.18-19 Elderly people are especially susceptible to the effects of psychotropic medicines, and may experience adverse effects such as cardio toxicity, confusion and unwanted sedation .8 Contributing factors to the high rates of non-compliance to psychotropic medicines include, psychosocial problems, the emergence of side effects, and the delayed onset of action of anti-depressant medication.20-21 Medical co-morbidity is also comm on, and polypharmacy increases the risk of medication misuse and drug-drug interactions.22 The World Health Organisation (WHO) has indicated that the inclusion of pharmacists as active members of the health care team can improve psychotropic medication use.23 The benefits of dynamically engaging mental health service users in their own management is supported by both clinical experience and research evidence.24 A systemic review of the role of pharmacists in mental health care, published in 2003, concluded that pharmacists can bring about improvements in the safe and effective use of psychiatric medicines.23 The wide range of pharmaceutical services provided by community pharmacists are potentially well suited to assisting patients and prescribers optimise the use of medications for mental illness.8 2. Method 2.1 Literature search strategy Pubmed (1965-March 2010), International Pharmaceutical Abstracts (1970-March 2010), Embase (1974-March 2010), Cinahl (1981-March 2010) and Psychinfo (1972-March 2010) were searched using text words and MeSH headings including: community pharmacist.s, pharmacist.s, pharmaceutical care, pharmaceutical services, mental illness, mental disorders, stigma and mental illness, mentally ill persons, depression, schizophrenia, bipolar disorder, psychotic disorders, psychotropic drugs, antidepressive agents, benzodiazepines, anxiety agents and antipsychotic agents. ~550 abstracts were read. Reference lists of retrieved articles were checked for any additional relevant published material. Exclusion criteria included articles not published in English, no service provided by pharmacists, not relevant to mental illness, and studies and surveys that were carried out to evaluate pharmacist.s services in hospital inpatient or acute care settings. The literature search identified 88 papers that reporte d or discussed community pharmacist.s involvement in the care of patients with mental illness. 2.2 Inclusion criteria and review procedure For section 3.1 of the discussion, studies and surveys conducted into the attitudes of community pharmacists toward mental illness and the impact of stigma were considered. The literature review procedure for section 3.2 of the discussion, which deals with optimising the use of medication for mental illness, differed from that of 3.1, as studies without control groups, results of postal surveys and qualitative interviews were excluded. Studies with a parallel control group that reported the provision of services by community pharmacists in community and residential aged care facilities were considered. This included trials specifically conducted for individuals with a mental illness, and studies of medication reviews and education initiatives to optimise the use of medication for mental illness. Papers that reported pharmacist.s interventions in nursing homes were included, because community pharmacists frequently provide services to nursing homes. Studies of pharmacist.s activities as part of multi-disciplinary teams were also included. The literature search identified 57 papers that reported or discussed community pharmacy services to optimise the use of medications for mental illness. 3. Discussion 3.1 Mental illness and stigma While the views of the public9 and of certain health care professionals25 and health care students26-28 toward mental illness have been well documented over the years, there are limited numbers of investigations accessing community pharmacists and pharmacy student.s attitudes. Crimson et al.12 examined the attitudes of 250 baccalaureate pharmacy students toward mental illness, Phokeo et al.29 studied the outlook of 283 community pharmacists toward users of psychiatric medication, Cates et al.9 detailed the attitudes of community pharmacists toward both mental illness and the provision of pharmaceutical care to patients with mental illness, and Black et al.1 studied the satisfaction that patients with mental illness have with services provided by community pharmacists. 3.1.1 Community pharmacist.s attitudes toward patients with mental illness In general, pharmacists express positive, unprejudiced attitudes toward mental illness,1, 9, 29, 30 and overall they show encouraging attitudes toward the provision of pharmaceutical care.9 Phokeo et al.29 reported that pharmacists feel uncomfortable inquiring about a patient.s use of psychiatric medication and discussing symptoms of mental illness compared to the medication and symptoms associated with cardiovascular problems. Pharmacists also monitor patients with mental disorders for compliance and adverse effects less frequently than patients with cardiovascular problems. Crimson et al.12 found an association between a personal or family history of mental illness and attitudes of pharmacists toward mental illness. Age and years in practice are also connected with attitudes toward providing pharmaceutical care to patients with mental illness. The older and more experienced pharmacists have more encouraging responses than their counterparts.9Pharmacists are of the opinion, however, that patients with mental illness do not receive adequate information about their medication from their physicians. These patients may also receive less attention from pharmacists compared to medically ill patients, which raises concerns that their drug-related needs are not being met.29 3.1.2 Patient.s attitudes toward community pharmacists Consumers of mental health services generally have a positive perception of community pharmacists and their services, however, expectations are limited to standard pharmacy services, like providing patients with information about their medication and resolving prescription issues when dispensing medications.29 The majority of patients feel at ease while discussing their psychotropic medication and related illnesses with pharmacists.31 Clinically orientated services like working collaboratively with other health care providers, making dosing or treatment recommendations, monitoring response to treatment, and addressing the individuals physical and mental health needs have been found to be unavailable to patients.32 Patients with mental health problems, expectations of community pharmacists are low, and do not match the services that they can provide.33 Although stigma has been perceived to be similar with other health care professional, Black et al.1 revealed that 25% of patients with mental illness have experienced stigma at community pharmacies. 3.1.3 Substance misuse The prevalence of coexisting substance misuse and mental illness (dual diagnosis) has increased over the past decade, and the indications are that it will continue to do so.15 A patient with both a mental illness and a substance misuse problem can face prejudice and stigma from health care professionals, who might question the capacity of dually diagnosed individuals to respond to care.34 A Canadian survey into the attitudes of community pharmacist.s toward mental illness showed that only 55% of respondents agreed that substance misuse is a mental health problem. This finding reflects the perception that addiction represents poor self control or is a self inflicted problem.29 Over recent years, the capacity to intervene pharmacologically in substance misuse has increased greatly, pharmacotherapy is now available for opiate, alcohol and nicotine misuse.19 Some psychiatric patients with comorbid substance abuse achieve stabilisation rapidly, furthermore, severe mental illness does not necessarily predict worse outcomes.35 Socio-economic and emotional aspects are the main challenges to recovery, and case management in the context of integrated community and residential services has been shown to increase medication compliance over time.36 The contribution that community pharmacists have in the management of substance abuse has been well documented.37 Most general psychiatrists are only in the position to give patients 5-10 minutes of brief advise or intervention regarding a substance misuse problem,38 whereas community pharmacist.s are easily accessible to the public and are in a central position to provide specific advice about substance misuse.37 Community pharmacists currently provide dispensing services to drug addicts,38 and they are also the first point of contact for people misusing substances who are not in touch with the substance misuse services.39 3.1.4 Overcoming the barriers created by stigma Studies have indicated that patients prefer to go to the same pharmacy for their medication and other pharmacy needs and a significant number of patients favour to interact with the same pharmacist, which suggests that the relationship they have with their pharmacist plays an imperative role in their health and well being.1 A lack of privacy from failure to use an available private counselling room in the pharmacy contributes to patients feelings of discomfort regarding talking about their medication and their illness.31 Pharmacists are trained to educate and support patients regarding psychotropic medications, including how a drug works, monitoring for treatment response and adverse effects, and guiding patients through the process of stopping treatment, however, there are inconsistencies in the provision of these services.29 The potential for discrimination and stigma in community pharmacies has been well documented and initiatives to improve exposure of pharmacists to persons with mental illnesses in practice and in training has been suggested.23, 29 Pharmacists experience an increased level of discomfort in this therapeutic area as they receive inadequate undergraduate training in mental health.9 Adequate training in mental health is needed to improve the professional interactions of community pharmacists toward users of psychiatric medication.1 3.2 Optimising the use of medications for mental illness Community pharmacists are one of the primary health care providers in the community and have the opportunity to influence patient.s perception of their mental illness. Patients are far less likely to adhere to medications for mental health problems outside the hospital setting. Community pharmacists can significantly contribute to optimising medication use in mental illness through counselling, 40-42 patient education and treatment monitoring, 43-36 medication review services, 30, 47-49 pharmacotherapy meetings with general medical practitioners, 50-54 delivering services to community mental health centres and outpatient clinics,55-57 improving the transfer of information between health care settings,58-60 and being active members of community mental health teams.61-63 3.2.1 Counselling services In the Netherlands, three studies were carried out to highlight the impact of community pharmacist.s medication counselling sessions for people commencing non-tricyclic antidepressant therapy.40, 42 Intervention patients participated in three consecutive counselling sessions which lasted between 10 and 20 minutes each. They also received a take-home video that reiterated the importance of adherence. Throughout the counselling session, pharmacists informed patients about the appropriate use of their medications, which included, providing information about the benefits of taking the medication, informing patients about potential side effects, informing patients about the onset of action for antidepressant medication and explaining the crucial importance of taking their medication on a daily basis. Medication compliance was measured using an electronic pill container that recorded the time and frequency that the cover was opened.41 At the three month follow up the intervention patients had significantly more positive attitudes compared to the controls.40 At six months greater medication compliance was observed with the intervention patients that remained in the study25 55, also apparent improvements in symptoms were noted.41 Research on adherence shows that the patient.s knowledge and beliefs about the benefits of adhering to their medication regime plays a critical role in compliance.64 Non-adherence is not an irrational act but rather a product of poor communication.65 Patient compliance to health care recommendations is more likely when communication is optimal.66 The results of these studies indicated improvements in depressive symptoms,41 more positive attitudes,40 and better compliance to their medication.42 A limitation of this method was that the same pharmacist provided counselling services to both the intervention and the control group. As the intervention studied was multifactorial, it is inconclusive whether the three face-to-face counselling sessions or the take home video were primarily responsible for changes in drug attitude, adherence and the symptom scores.40-42 3.2.2 Patient education and treatment monitoring Four studies have reported results from pharmacist conducted patient education and treatment monitoring services for people prescribed antidepressant medications in the United States.43-46 These services involved the pharmacist taking a medication history, providing information about the prescribed antidepressant medications, and conducting telephone and face-to-face follow-ups. In two of the investigations, one of which was controled43 and the other randomised controlled, 62 medication adherence was calculated by reviewing prescription dispensing data, and reported using an intention-to-treat analysis. Both studies also demonstrated that involvement of the pharmacist was associated with a decrease in the number of visits to other primary health care providers; however, statistical significance was only achieved in one of the studies. Improved adherence to antidepressant medication was reported in both studies, 43-44 although patient satisfaction was only evident in one.44 The other two studies were randomised controlled.45-46 One of the studies was conducted using a self administered health survey,45 while in the other study antidepressant adherence was measured by asking patients how many times a day they took their medication in the past month. The results obtained from these investigations45-46 showed that patients who were taking their medication at the six month follow-up exhibited better antidepressant compliance and improved symptoms. However, antidepressant adherence and depression symptoms scores were similar for both the intervention and control group.46 Given the high rates of antidepressant discontinuation during the first three months of treatment, pharmacists have a potentially crucial role in providing medicines information and conducting treatment monitoring for those patients at high risk of non-compliance. Studies need to be conducted to compare outcomes of pharmacist.s treatment monitoring of people commencing antidepressant medication and o ther health professionals monitoring.8 An investigation into the impact of nurses treatment monitoring, also demonstrated improved medication adherence.67 3.2.3 Medication management reviews Pharmacist conducted medication management reviews are crucial in identifying potential medication related problems among people taking medications for mental illness.8 Medication review services provided by pharmacists comprise of comprehensive medication history taking, patient home interviews, medication regimen reviews, and patient education.68 A randomised controlled study of pharmacist conducted domiciliary medication reviews was carried out in the United States. The patients involved in the study were individuals living independently in the community that were identified to be at high risk of medication misadventure. The results showed a significant decline in the in the overall numbers and monthly costs of medication, however, there was no major difference in cognitive or affective functioning between the intervention and control group. The majority of patients were unwilling to follow the pharmacist.s recommendations to discontinue benzodiazepines and narcotic analgesics.47 The great potential of pharmacist conducted medication reviews for people with mental illness may not be limited to optimising the use of mental health medication.8 Physical health care for people with mental illness is generally less than adequate. This is caused by the tendency among health professionals to focus solely on the management of the mental illness among people with both mental and physical illnesses. Pharmacist conducted medication reviews may be a comprehensive strategy to improve medication use for both mental and physical illness.68 3.2.4 Medication management reviews in nursing homes Older people who are cared for in nursing homes are arguably the most vulnerable patient group, and the useful contribution that pharmacists can make to the care of these patients has been documented.30 Older people are particularly sensitive to the effects of medication,69 regular use of psychotropic medication is associated with an increased risk of recurrent falls,70 and also long term usage is linked with tardive dyskinesia.71 Psychotropic medication use may also be connected with an increased rate of cognitive decline in dementia.72 The beneficial effects of psychotropic medication must be balanced against extrapyramidal and other side effects.73 In 1995 it was reported that psychotropic drug use in Australian nursing homes was 59%, although this figure has fallen in recent years.74 In Ireland, 19% of older people in nursing homes were reported to be taking phenothiazines,75 however, this figure is lower now following a tightening of the licensing indications of thiordazine. In the England, a study showed that 30% of residents in nursing homes were taking antipsychotics.76 Two studies have looked at the appropriateness of psychotropic medication prescribing in the United Kingdom. In Scotland antipsychotic medication use in nursing homes is 24%, it was found that 88% of these prescriptions were inappropriate if the United States criteria for use were applied. In England, 54% of prescriptions were found to be inappropriate according to the United States criteria.77 A study conducted in Denmark suggested that behavioural problems were a determinant for the use of antipsychotics and benzodiazepines, irrespective of the psychiatri c diagnosis of the resident.78 A randomised controlled study of pharmacist-led multidisciplinary initiative to optimise prescribing in 15 Swedish nursing homes was carried out. The study involved pharmacists participating in multidisciplinary team meetings with nurses and physicians at regular intervals within a 12 month period. A significant decline in the use of antipsychotics, benzodiazepines and antidepressants by 19%, 37% and 59%, respectively was observed in the intervention facilities.79 A follow-up investigation of the same intervention and control facilities three years later indicated that the intervention facilities maintained a significantly higher quality of drug use, with far fewer residents being prescribed more than three drugs that could lead to confusion, not-recommended hypnotics and combinations of interacting drugs.48 An additional randomised controlled study showed that pharmacist.s medication reviews in residential care facilities demonstrated significant reductions in the number and cost of medications prescribed. 10.2% fewer residents were administered psychoactive medications and 21.3% fewer hypnotic medications. The impact of medication reviews on mortality was also measured and a noteworthy reduction was observed.49 One study indicated that one hour per week of a pharmacist.s time can make a significant contribution to patient care in nursing homes. It was found that this input was well received by nursing staff and prescribers and that general medical practitioners accepted the pharmacist.s advice in 78% of cases.30 Physician.s recognition was 91% in south Manchester, where 55% of interventions resulted in treatment modifications. Community pharmacist.s in Northamptonshire analysed prescriptions of nursing home residents and provided prescribing advice to general medical practitioners. The advice was accepted in 73% of cases and it was estimated that pharmacist involvement could give a 14% reduction in the cost of prescribing.69 A randomised controlled trial in 1 4 nursing homes in England showed that a brief medication review reduced the quantity of medication overall with no detriment to the mental and physical functioning of the patients.58 A reduction in the use of primary and secondary care resources by pharmacist medication review services has also been shown.80 The recommendations provided by pharmacists included stopping and starting medicines, generic substitution, switching to another medicine, dose modification, changes in administration frequency, formulation change and requests for laboratory tests or nurse monitoring.30 Almost 50% of the recommendations were to stop medication and 66% of these were due to the fact that there was no indication for the drug prescribed. This suggested that medication regimes were not reviewed. Conversely, initiation of a new drug made up 8% of recommendations, which implied that indications were present but not always treated76. Pharmacists have an important part to play in multi-disciplinary heal th teams and they must be integrated into any proposed models of care. Nursing home residents are a vulnerable group of patients who deserve the same high-quality clinical care as people of any age living at home.30 3.2.4 Pharmacotherapy interventions to optimise prescribing Pharmacist.s educational visits to general medical practitioners have been shown to modify prescribing behaviour.54 Four studies have evaluated the impact of pharmacists educational visits to general medical practitioners to optimise the prescribing of benzodiazepines and other psychotropic medications prescribed for mental illness,50-53 two of which showed positive results.52-53 A cluster randomised controlled study carried out in the United States found that pharmacists educational visits to general medical practitioners were associated with a significant decline in the prescribing of potentially inappropriate psychotropic medications in intervention facilities.53 An Australian study of educational visits to general medical practitioners, conducted by three physicians and one pharmacist resulted in a noteworthy decline in the prescribing of benzodiazepines.52 In the Netherlands, groups of local pharmacists and general medical practitioners conduct inter-professional meetings to optimise prescribing. These pharmacotherapy meetings are undertaken as part of routine clinical practice. A cluster randomised study of pharmacotherapy meetings to discuss prescribing of antidepressant medications resulted in a 40% reduction in the prescribing of highly anticholinergic antidepressants, compared to a control group of practitioners that did not partake in these meetings39. The possible awareness of prescribing related issues generated by asking general medical practitioners to conduct a self-audit of their prescribing caused this overall reduction.52-53 Additionally, pharmacist.s initiatives to improve prescribing are most effective when both pharmacists and general medical practitioners have an opportunity to build rapport.39 3.2.5 Community mental health centres and outpatients clinics Two studies were carried out to investigate the effect of pharmacist delivered services to community mental health centres and outpatient.s clinics.56-57 In a controlled trial, pharmacists managed patient cases in a community mental health centre in the United States. Significantly better personal adjustment scores were observed from patients receiving case management from a pharmacist in comparison to those receiving it from a nurse, social worker or psychologist.56The patients also rated themselves as healthier and were considerably less likely to seek help from other health care providers. The medication service provided allowed the pharmacist to adjust medication doses and dose timing, and prescribe or discontinue medications under supervision. The cost effectiveness of incorporating a pharmacist as part of the health care team was also measured. It was estimated that a 60% cost reduction can be achieved when medication monitoring is conducted by a pharmacists instead of a clinic psychiatrist. The pharmacist also performed more medication monitoring of patients per month than the clinic psychiatrist and had more contact with each individual patient .56 In Malaysia, a study of patients discharged from hospital after admission for relapse of schizophrenia, who were identified as having poor medication adherence were allocated to receive pharmacist medication counselling or standard care.57 The importance of compliance to medication was also reinforced by the patient.s psychiatrists at follow up visits. At the 12 month follow-up, patients receiving counselling from a pharmacist and who were exposed to daily or twice daily medication treatments, had significantly fewer relapses that required hospitalisation than patients receiving standard care.57 3.2.6 Integrated mental health services The needs of people with recurrent, severe mental illness fluctuate over time and services must be coordinated, and be able to anticipate, prevent and respond to crisis. Integrated mental health services across primary and specialist services should promote early interaction and allow the provision of continuous care to meet patients needs.58 Prescribed medication is an important component in the successful management of mental illness. Accurate information should be transferred seamlessly between primary and secondary sectors to ensure the optimum care of these patients.59 The simple delivery of information to community pharmacists regarding drugs prescribed at discharge enables comparison with general medical practitioners prescriptions and any discrepancies can be followed up and resolved.82 Discrepancies that may occur can be described as any changes observed between supplies of prescribed drugs, including a wide spectrum of observed events.83 These can range from simple changes between supplies of prescribed drugs to more complex errors that might result in adverse reactions.60 This information transfer enables a cost-effective reduction in all unintentional discrepancies, including those judged to have significant adverse effects on patient care.58 An investigation that evaluated the impact of providing mental health patients with a pharmacist generated medication care plan at the time of discharge found that patients with care plans were less likely to be readmitted to hospital than those without. Information contained in the care plan included l ists of discharge medications, a summary of the patient education that was provided, and the potential adverse effects that need to be assessed. Community pharmacists who received copies of the care plan were also more likely to identify medication related problems for the discharged mental health patients than those pharmacists who were not provided with copies of the care plan, however, the results from this study are not significantly significant.57Other methods of transferring information such as electronic transfer have the potential to be of value in this patient population.84 People with mental illness have complex needs which are not recognised by organised boundaries.58When discussing discharge and after-care in the community, medication management must be prioritised.85Mentally ill patients are vulnerable and medication is a vital part of their well being. It is therefore essential that an accurate transfer of information between care settings minimises the potentially har mful discrepancies that can occur. Community pharmacist.s interaction in this area could prevent such incidents.58 3.2.7 Community mental health teams Most people with bipolar mood disorders and psychotic illnesses in the United Kingdom and Australia are managed by interdisciplinary community mental health teams (CMHTs).86 The potential benefits of greater involvement by pharmacists in CMHTs have been documented and debated for over 30 years.87-90 The majority of clinical team meetings conducted by CMHTs do not involve a pharmacist. A review of CMHTs in New South Wales found that just 1 in 5 had a designated pharmacist.91 Pharmaceutical care programs provided by phar

Percy B. Shelley :: essays research papers

  Ã‚  Ã‚  Ã‚  Ã‚  Percy Bysshe Shelley was born on August 4, 1792 to the extremely conventional Sir Timothy, who, being a man of influence, no doubt wanted his first born son to follow in his footsteps (Richards 671). Shelley, however, had much less conformist views, and was even â€Å"ragged† at Eton for expressing such (Matthews 196). He did not care to learn what his â€Å"tyrants† taught, but was interested rather, in science (which was outlawed from Eton at the time), Godwin, and the French skeptics. The rebellious nature persisted as he grew older and he developed a â€Å"delight† for controversy (Matthews 195). This â€Å"delight† ultimately lead to his expulsion from Oxford because of his writing â€Å"The Necessity of Atheism.† His patience for authority continued to diminish, until he eventually developed a passion.   Ã‚  Ã‚  Ã‚  Ã‚  Shelley wanted to fight tyranny, as well as slavery. His ultimate goal was to lead men to a â€Å"life of freedom, love, and apprehension of the beautiful† (Richards 672). Shelley felt that repression exist because mankind instituted and tolerated it (Matthews 200). He believed that â€Å"Mankind only had to will that there should be no evil, and there would be none† (Ford 161). This idealistic view of the world is evident in the majority of Shelley’s literary works.   Ã‚  Ã‚  Ã‚  Ã‚  In 1819, Shelley wrote â€Å"Song to the Men of England† (Editors 610). This poem was written for the same purpose as many of his others: to urge the working class of Great Britain to rebel. The imagery of a bee hive is evident throughout this piece. In stanza II, for instance, the â€Å"tyrants† are referred to as â€Å"Those ungrateful drones who would / Drain [the] sweat - nay, drink [the] blood.† In stanza III, a reference is made to the working class as the â€Å"Base of England.† The metaphor is picked up again in stanza VII, when Shelley orders the â€Å"Men of England† to â€Å"shrink to [their]...cells† (Editors 611).   Ã‚  Ã‚  Ã‚  Ã‚  The most rebellion-inspiring lines are found in stanza VI:   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Sow seed - but let no tyrant reap;   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Find wealth, - let no impostor heap;   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Weave robes, - let not the idle wear;   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Forge arms, - in your defense to bear. (21-24) This is the second time, in this poem alone, that Shelley refers to the aristocrats and rulers of England as tyrants. This is evidence of his strong desire for political reform. He sincerely felt that the only way to gain freedom was by overthrowing â€Å"entrenched order† (Matthews 199).

Why I have identified the development techniques of HR manager

Assisting the HR managerI would like to assist the HR manager during the next recruitment process as this will help me gain a better understanding of the process. If I assist her during the process rather than observe her I will be getting hands on experience. The benefits of this are being able to gain experience and knowledge from the manager, I will have a better understanding of the process as the manager will be teaching me as I’m assisting her, I will be involved in the process so I will be able to assist her with short listing and interviewing candidates. The drawbacks to this technique is that it may take the HR manager longer to do the recruitment as she will be using time to teach me and it also may affect the process.Reading the policyThe benefits of looking on the intranet and reading the policy are that it is easy to access and read, the policy is up to date as it is on the intranet which is updated monthly, I can print out the policy and read it in my own time, I can make notes and re read the policy as many times as I want until I fully understand the policy. The drawbacks of this are that it may take a long time to read the policy and I may have to read it more than once to understand it.

Tonto’s Dysfunctional Family Tree Essay

America is a multicultural nation. This fact is undeniable. We are a mishmash of people from all parts of the globe, each with a unique story to tell. One of the struggles of being such a diverse nation is that different ethnic groups often fail to understand one another. I believe that cross-cultural writing is a powerful tool that dispels ignorance and fosters greater multicultural understanding. Writing has the power to bring people together. There are many prominent cross-cultural writers in the history of American literature. Each of them has added to a growing genre that explores what it’s like to move to this country in pursuit of the ever-elusive â€Å"American Dream.† Sherman Alexie is one such writer. However, his theme is not one of searching for the â€Å"American Dream.† His theme addresses what happens when the â€Å"American Dream† lands on you. Sherman Alexie is Native American, and his stories expose one of America’s dirty little se crets. In the paragraphs that follow, I will review Alexie’s life, the genre and style in which he writes, and the overall themes of his work. I will analyze the short story, â€Å"Every Little Hurricane†, taken from the anthology, The Lone Ranger and Tonto Fistfight in Heaven. Sherman Alexie was born on October 7, 1966 in WellPoint, Washington. He belongs to the Spokane Tribe of American Indians called the Salish Group. At the time of his birth he had hydrocephalus, a disease in which the patient has an excess of cerebrospinal fluid. The only option was to get an operation that he most likely would not survive. Yet despite these dire predictions, he survived an invasive surgery at the tender age of six months. He didn’t just survive; he thrived. Despite chronic seizures related to his condition, Sherman continues to power through life with extreme determination. He learned to read at the age of three and from then on nothing could hold him back. As a teen attending a reservation school Sherman was shocked to discovered his mother’s name inscribed in one of his textbooks. The realization that the school’s books were decades old led to his determination to leave the poverty-stricken reservation and get a thorough education elsewhere. He earned a spot in one of the top high schools in Reardon, Washington, where he was a star student and athlete. He proceeded to the University of Go nzaga, where his dream was to become a physician. After fainting from disgust in his anatomy class, he had to abandon this dream. It was during this dark time period that he  began abusing alcohol. He then changed his major, a decision that was based on his love for poetry and aptitude for writing. This change of direction brought him to Washington State University where he quit drinking and earned a B.A. in American Studies. Sherman Alexie began his professional career in 1990 when his work was published in Hanging Loose magazine. This initial success gave him the incentive to quit drinking at the age of 23, and he’s been sober ever since. His first collection of short stories, The Lone Ranger and Tonto Fistfight in Heaven, was published in 1993, and that was just the beginning. In 1995 he launched his career as a novelist with Reservation Blues, an expanded version of the characters introduced in the previously mentioned collection. In 2007 he published a young adult novel, The Absolutely True Diary of a Part-Time Indian. This novel is a reflection of his personal experience growing up on the Reservation. Alexie is the winner of numerous honors and awards including the 2001 PEN/Malamud Award, the 1994 PEN/Hemingway Award, the 2007 National Book Award, and the 2010 PEN/ Faulkner Award (www.fallsapart.com). Alexie is a modern writer who is not bound by a single genre. He has written poetry, novels, screenplays, and most notably short stories. As the dominant Native American short story writer of today, he creates unique imagery through recurrent memories, visions and dream sequences. He utilizes diary entries, faux newspaper articles, and multiple storytellers to tell stories within stories. One example of this is seen in â€Å"Trial of Thomas Build-the–Fire†, where Thomas is personified as a number of historical figures. Alexie also uses cultural figures like Crazy Horse, Jesus Christ, Jimi Hendrix, and the Lone Ranger, to accentuate the complexities of his humble characters. According to Leslie Ullman â€Å"He weaves a curiously soft-blended tapestry of humor, humility, pride and metaphysical provocation out of hard realities†¦ the tin-shack lives, the alcohol dreams, the bad luck and burlesque disasters, and the self-destructive courage of his characters.† (Ruby, M. 2011). I believe Ullman’s comment is right on point. All of the stories in The Lone Ranger and Tonto Fistfight in Heaven challenge the reader intellectually, emotionally and spiritually. Alexie seems to have a two-fold purpose for telling his stories. Firstly, he yearns for all Native Americans to keep their memories and heritage alive through the art of storytelling. Secondly, he communicates how modern Native Americans endure the assault of mainstream  culture on their heritage, imagination and spirit. While his writing is modern, traditional or historical elements like powwows, fancy dancing, alcoholism and poverty, are interwoven throughout. His writing juxtaposes sadness with humor, brutality with kindness, and spirituality with materialism. He depicts numerous prominent characters in this collection, rather than just one or two dominant characters. The compilation contains twenty-two short stories that are loosely interconnected. In the first story, â€Å"Every Little Hurricane†, Alexie introduces themes that play out through the rest of the book, such as poverty, despair, death, alcoholism, humiliation, and the hope of transformation. In this story Al exie explains the choice between remembering the pain of the past, and creating a false reality to avoid that pain. Alexie uses the character Victor, who is nine years old, to explain this struggle. The story is told from Victor’s perspective during a New Year’s Eve party at his parents’ home. Disturbed by the drinking and extreme violence, Victor comforts himself by imagining that a hurricane has caused the destruction, rather than his own tribe. The hurricane is a fitting metaphor because it hits on both the emotional turmoil and social chaos prevalent in Victor’s dysfunctional family. Victor is faced with the decision to either remember what really happened, or forget by instead imagining that a hurricane caused the devastation. Ultimately, he chooses to accept the reality of his disturbing childhood. However, even though he chooses to live in the truth, he resorts to finding comfort in the only way he can, which is between the two unconscious bodies of his drunk parents. Alexie points out that the dysfunction in Victor’s family is the result of a long-standing attitude on the Reservation. Violence has become habitual, and therefore accepted. This point is made when Adolph and Arnold (Victor’s uncles) begin to fight, getting mired in â€Å"a misdemeanor that would remain one even if somebody was to die. . . . [For] one Indian killing another did not create a special kind of storm.† (Alexie, p 3) Alexie implies that American Indians have internalized all of the violence that has been perpetrated against them since their first contact with Europeans, so that even murdering one of their own goes almost unnoticed. The oppression that they have suffered has turned them into silent witnesses. According to Victor, â€Å"They were all witnesses and nothing more.† (Alexie, p 3) As the story continues, Alexie points out that  alcoholism is the most serious problem facing Victor’s tribe. Victor’s most powerful memory is of his father crying over the absence of Christmas presents, while getting drunk to escape the pain of the family’s abject poverty. His father continuously opens and closes an empty wallet â€Å"as if the repetition itself could guarantee change. But it was always empty.† (Alexie, p 5) Alexie shows the pervasiveness of alcoholism with continual references to the smell and taste of sweat, smoke, whiskey and blood. These are constant companions of Victor’s existence, so that he actually believes that â€Å"the alcohol seeping through [his parents] skin might get him drunk, might help him sleep.† (Alexie, p 9) From day one Victor is forc ed to gain survival skills to handle extreme fear and poverty. When he sees â€Å"an old, [drunk] Indian man drowned in a mud puddle at the powwow† (Alexie, p 7) he understands that alcoholism is not his family’s problem alone. It is a problem of his entire culture. After completing The Lone Ranger and Tonto Fistfight in Heaven it is obvious to me that Sherman Alexie is as Bob Hershon so aptly put it, â€Å"one of the major lyric voices of our time.† (Alexie, p xiii) His writing pulls the cover off of America’s dirty little secret of what life is like growing up on the Reservation. Many critics have vilified him for perpetuating the stereotype of the drunk Indian. This is not so. Alexie doesn’t write about the destructive effects of alcohol on Indians due to some literary stance or prejudiced perspective. Simply put, he is truth telling. I have wracked my brain to come up with an overall theme for this piece of literature. Then it came to me in a flash. Why not use Alexie’s own words, â€Å"I kept trying to figure out the main topic, the big theme, the overarching idea, the epicenter. And it is this: The sons in this book really love and hate their fathers.† (Alexie, p xxii) Works Cited Alexie, Sherman. The Lone Ranger and Tonto Fistfight in Heaven. New York, NY:Grove Press, 1993, 2005. Falls Apart, Offical Website, http://www.fallsapart.com, 2013 Johansen, Bruce E. Native Americans Today: A Biographical Dictionary. Santa Barbara, Calif: Greenwood Press, 2010. Ruby, Mary. Authors & Artists for Young Adults Vol. 85. Detroit, Mich: Gale / Cengage Learning, 2011.