Occupational Health and Safety (OH&S) in the workplace. Essay

Occupational Health and Safety (OH&S) in the workplace requires co-operation from both employers and employees to ensure that the workplace is a healthy and safe environment. Both employees and employers are required to co-operate by the rights and responsibilities that are set for them. OH&S is the safety procedures in place in every enterprise to ensure both the health and safety of each and every employee. It is the responsibility of employers, who are legally (due to the OH&S Act 1996, 2001 amendment) and morally obliged to provide a safe and healthy environment. It is also the employee’s responsibility to co-operate with employers in maintaining health and safety at work. Read more: Measures that prevent fires from starting essay Employers are required to: -Provide a safe and healthy workplace -Provide and maintain a safe system of work -Provide the required resources (safety clothing & equipment) -Provide information and training for employees to work in a safe and healthy environment -Provide a process to identify, assess and then eliminate unsafe practices and hazards -All relevant laws must be followed -Ensure that employees carry out workplace rules. In the same way, employees have the right to be provided with the above-mentioned elements from their employers. It is also the employee’s obligation to abide by these regulations. Any employee who fails to meet their responsibilities can be disciplined under award conditions. WorkCover is also responsible for safety in the workplace. They are required to conduct regular checks in the workplace to ensure that the OHS act is being followed and that hazards are kept to a minimum. In most states, workers are represented through either an OHS representative or an OHS Committee depending on the size of the enterprise. Hazards are categorised into 4 different sections; Physical, Chemical, Ergonomic and Biological. It is important to be aware that a hazard does not have to be seen for it to exist. Quite often hazards you can’t see – such as ultra violet radiation, are only appreciated when it is too late to prevent damage. Many hazards have been made known in the workplace. Some of these include:  ·Exposed wires  ·Power leads on ground  ·Equipment in walkways  ·Temperature often too hot or too cold  ·Glare from windows and lights These hazards can be fixed by ensuring that the OHS committee is kept informed of these problems, and they can then ensure that they are fixed, in cases such as exposed wires. Things such as anti-glare screens can help the prevent the glare on the computer screens, and also moving employees desks  away from the air-conditioning vent can help with the temperature problems. Another cause for concern is the ergonomic factors. People do not sit in their chairs correctly and are causing backaches and injuries. To prevent injuries you should have;  ·Feet flat on the floor  ·Knees at a 90 degree angle  ·Back at 90-100 degrees  ·Relaxed shoulders and;  ·Forearm support Employees should take regular breaks and use their workstations ergonomically so that fewer injuries occur. There are also a few more Acts such as the Anti Discrimination Act (1977) and the Sex Discrimination Act 1984 and Workers Compensation Act 1987, which are all there to protect employees in the workplace. The Anti Discrimination Act aims to protect all employees in the work environment from being discriminated against on many things such as:  ·Race  ·Colour  ·Religion  ·Gender  ·Age  ·Sexuality If an employee feels as though they are being discriminated against, for any of the fore mentioned things then they should first try to approach the perpetrator and ask them to stop. If this behaviour continues, or they feel they cannot approach the perpetrator then they should report immediately to their employer or supervisor for further action. The Sex Discrimination Act aims to protect employees from being sexually harassed by someone in the workplace. Sexual harassment is any unwanted attention in an incorrect manner, whether it be:  ·Making sexual comments  ·Making sexual gestures  ·Asking someone out on a date continuously  ·Sending inappropriate materials Again if this happens, you should approach the perpetrator and let them know how you are feeling. If this behaviour continues, or they feel they cannot approach the perpetrator then they should report immediately to their employer or supervisor for further action. The Workers Compensation Act is where employers insure workers against the possibility of suffering injury arising out of or in the course of employment. If an injury does occur the worker can apply for Workers Compensation where they can receive money to cover their losses, and to pay for medical treatment. Workers Compensation can also be paid to the families of workers who die because of a work injury. In conclusion, it is evident that co-operation from both employers and their employees is needed to ensure that the work place is a healthy and safe  environment, with the help of legislations along the way.

What is Artistic Beauty essays

What is Artistic Beauty essays Dr. Marck L. Beggs, Director M.L.A. Program What is Artistic Beauty? From the beginning of time, men and women have scrutinized, categorized, and compared components of their surroundings in an attempt to better understand their world. In the Bibles Genesis account, Adam, seemingly in appreciation of Eves uniqueness and beauty, poetically proclaims her, bone of my bones and flesh of my flesh; she shall be called woman, for she was taken out of man.[Gen. 2:23 NIV] Much later, artists, writers, and philosophers have sought to understand beauty, balance, and perfection the sublime. Their struggle to define perfection and to set standards of beauty was termed aesthetics or, the science of the beautiful, in 1753 by German philosopher Alexander Gottlieb Baumgarten. Baumgarten was considered the first modern philosopher to approach the question of beauty systematically, introducing the term aesthetics and defining the experience of beauty as the sensory recognition of perfection. [Danto 1]. The works of his contemporary, Immanuel Kant, express the notion that beautiful objects are without a specific purpose and that judgments of beauty are not expressions of mere personal preference but, rather, universal. Similarly, Encarta defines aesthetics as: A branch of philosophy concerned with the essence and perception of beauty and ugliness, dealing with the question of whether such qualities are objectively present in the things they appear to qualify, or whether they exist only in the mind of the individual; hence, whether objects are perceived by a particular mode, the aesthetic mode, or whether instead the objects have, in themselves, special aesthetic qualities. Philosophy also asks if there is a difference between the beautiful and the sublime. [Danto 1] However, even with a definition at hand, arriving at a consensus on precisely what c...

Genre Definition and Examples in Literature

Genre Definition and Examples in Literature In literature, every piece of writing falls under a general category, also known as a genre. We experience genres is other parts of our daily lives, such as movies and music, and in each case, the individual genres typically have distinctive styles in terms of how they are composed. At the most basic level, there are essentially three main genres for literature - poetry, prose and drama - and each can be broken down even further, resulting in dozens of subgenres for each.  Some resources will cite only two genres: fiction and non-fiction, though many classics will argue that fiction and non-fiction can, and do, both fall under poetry, drama or prose.  Ã‚   While there is much debate over what constitutes a genre in literature, for the purposes of this article, we will break down the classic three. From there, we will outline some of the subgenres for each, including those that some believe should be classified as main genres. Poetry Poetry is a style of writing that tends to be written in verses, and typically employs a rhythmic and measured approach to composition. It characteristically is known for evoking emotional responses from readers through its melodic tone and use of creative language that is often imaginative and symbolic in nature. The word â€Å"poetry† comes from the Greek word â€Å"poiesis† which essentially means, making, which is translated into the making of poetry. Poetry is typically divided into two main subgenres, narrative and lyric, which each have additional types that fall under their respective umbrellas. For example, narrative poetry includes ballads and epic tales, while lyric poetry includes sonnets, psalms and even folk songs. Poetry can be fiction or nonfiction. Prose Prose is essentially identified as written text that aligns with the flow of conversation in sentence and paragraph form, as opposed to verses and stanzas in poetry. Writing of prose employs common grammatical structure and a natural flow of speech, not a specific tempo or rhythm as is seen in traditional poetry. Prose as a genre can be broken down into a number of subgenres including both fiction and nons of prose can range from news, biographies and essays to novels, short stories, plays and fables. The subject matter, if it is fiction versus nonfiction and length of the work, are not taken into consideration when classifying it as prose, but rather the style of writing that is conversational is what lands works in this genre. Drama Drama is defined as theatrical dialogue that is performed on stage and traditionally is comprised of five acts. It is generally broken down into four subgenres including comedy, melodrama, tragedy and farce. In many cases, dramas will actually overlap with poetry and prose, depending on the writing style of the author. Some dramatic pieces are written in a poetic style, while others employ a more casual writing style seen in prose, to better relate to the audience. Like both poetry and prose, dramas can be fiction or nonfiction, though most are fictional or inspired by real life, but not completely accurate. The Genre and Subgenre Debate Beyond these three basic genres, if you conduct an online search for â€Å"genres of literature,† you will find dozens of conflicting reports that claim any number of main genres that exist. There is often debate over what constitutes genre, but in most cases, there is a misunderstanding of the difference between genre and subject matter. It’s common for subject matter to be considered a genre in not only literature, but also in movies and even games, both of which are often based on or inspired by books. These subjects can include biography, business, fiction, history, mystery, comedy, romance and thrillers. Subjects may also include cooking, self help, diet and fitness, religion and many many more.  Ã‚   Subjects and subgenres, however, can often be intermixed. Though, it can be  a challenge to determine how many subgenres or subjects actually exist, as there are differing opinions on each, and new ones are created regularly. For example, young adult writing has become increasingly popular, and some would classify it as a subgenre of prose. The difference between genre and subject is often blurred by the world around us. Think of a time when you last visited a bookstore or library. Most likely, the books were divided into sections - fiction and non-fiction for sure - and further categorized based on the type of books, such as self-help, historic, science fiction and others. Many people assume that these categorizations of subject matter are genre, and as a result, common language today has adopted a casual use of genre to mean subject.

Analyzing Value Net for Omni Hotel & Resort Essay

Analyzing Value Net for Omni Hotel & Resort - Essay Example Customers that are satisfied with their experience are highly likely to tell their friends about it. A second way customers could add value to the firm is by becoming recurrent customers of the company. Rivals – The company faces competition from direct and indirect rivals. All four and five star hotels in Texas are direct competition of Omni Hotels. Homes that rent their facilities for short monthly contracts are an indirect competitor of the firm as well as condos. Three direct competitors of Omni Hotels in the Corpus Christ marketplace are Days Inn Beach, Radisson Hotel, and Knights Inn. The rivals of the company represent a threat to the business organization. Omni has over 50 hotels across the United States (Omnihotels, 2011). The Corpus Christi hotel can add value and turn this threat into an opportunity by forming marketing alliances with other competitors. All the registered hotels in Corpus Christi can form a cash pool to advertise the region to tourist inside and outside of the United States. Such an initiative would increase the total tourism money that the region receives which would benefit the entire hospitality industry. Suppliers – In the hospitality industry suppliers have little power over hotels. Hotel chains such as Omni enjoy several competitive advantages including power to buy in bulk and take advantage of economies of scale, high variety of supplier options, and greater brand value than their suppliers. Several key suppliers that Omni Hotel must emphasize include food suppliers, cleaning suppliers, and bathroom supplies. The food suppliers are instrumental toward the success of hotel operated restaurants. Tourists are willing to pay a premium prices as long as they receive superb service and quality food. The organization can add value in its supply acquisition by advertising to the customers that they can take for free any supplies in from the room such as

Notes Term Paper Example | Topics and Well Written Essays - 1000 words

Notes - Term Paper Example An effort has been made to present notes that have practical implications. Notes of a fictitious company are as under: 1. The consolidated financial statements have been prepared in accordance with International Financial Reporting Standards (IFRS) as applicable to UK, and the Interpretations of International Financial Reporting Standards (IFRIC). Principal financial accounting and valuation methods used to prepare consolidated financial statements are set out in each of the following sections. The accounting methods are generally unchanged as compared to the previous year. 4. The consolidated financial statement includes the financial statements of the Principal and the group companies in which group holds stake (its subsidiaries) until 31st December of each year. Majority stakes of the group deem to exist if the group can determine the financial and managerial policies of a subsidiary in order to obtain economic advantages. a. In case of acquisition of a company, the capital is consolidated using acquisition method. The assets and liabilities of respective subsidiaries are valued at market value attributable at the time of acquisition. If the acquisition costs exceed the attributable current market value of the acquired identifiable assets and liabilities, the capitalised difference is shown as goodwill; otherwise it is immediately adjusted against income. The Non- Controlling interests are reported as part of the current values of the stated assets and liabilities corresponding to their respective interests. d. The earnings as well as assets and liabilities of associated companies are incorporated in this consolidated financial statement using the equity method of accounting. Interests in associated companies are given in SFP as acquisition costs adjusted by changes in the group share of net income following acquisition, and losses due to depreciation. Losses that exceed the

Electronics Coursework Example | Topics and Well Written Essays - 2500 words

Electronics - Coursework Example The gain of an amplifier is usually given in decibels or its unit less if the input and output variables are the same (all current, voltage or power. The power gain of an amplifier depends on the sources and load resistances used and its voltage gain. The amplifier should be linear in most cases hence its gain should be constant. Electronic amplifiers find their applications in Radios, Television Transmitters, Receivers, and high-fidelity stereo equipments, Microcomputers, and other electronic digital equipments. The 1Mï â€" and 10kï â€" potentiometer/decade boxes were used to set VCE and VBE to the values shown in table 1 to give the input characteristics of the BJT. The voltages across RB were measured and recorded for all measurements of VCE and VBE. The 10kï â€" potentiometer/decade box was s3et to its maximum value so that the output characteristics could be determined. The 1Mï â€" potentiometer/decade box was adjusted to set Ib to 10ï  ­A, and the desired values of RB were calculated using the measured values of RB. the value of 10kï â€" potentiometer/decade box was adjusted for all values of VCE in table 2 of the results analysis while Ib was kept constant. The voltage across the 100ï â€" resistor was measured and recorded for each combination of VCE and IB. In common emitter configuration, the input is connected between the base and the emitter while the output is taken between collector and emitter. The emitter is the common terminal as shown in the above figure. Emitt er base voltage is the input voltage, base current flows in the circuit and then the in the output resister, hence there will be high power and voltage gains and its output and input voltage ratio is moderate hence this configuration is commonly used. Increasing the supply voltage causes the base current to be lower for a given value of base-emitter voltage; this implies that higher values of supply voltage leads to greater collector-base junction reverse bias, hence greater depletion region

Use of Honey as Medicine in Wound Healing: Analysis

Use of Honey as Medicine in Wound Healing: Analysis The aim of the assignment is to critique the research article, Standardised antibacterial honey (medihoney) with standard therapy in wound care: randomized clinical trial (2009) by Robson, Dodd Thomas. The tool used for this is Step by Step Guide to Critiquing Research by Ryan, Coughlan; Cronin (2007). Critique is an objective, critical, and balanced appraisal of a research reports various dimensions (Polit and Beck, 2004). The study was on the use of honey as medicine in wound healing. The research was done in the United Kingdom by a group of registered nurses and statistical masters. The study was completed in the year 2007 and was published in the Journal of Advanced Nursing (JAN). The study was based on the use of honey for wound dressing as an antibiotic and wound healing agent. Arguably, the article is well written as it is concise and it does not contain any languages that are characterised to any particular group and are grammatically correct. The layout of the study is good and are given in a good order and kept the academic style of writing. Research reports are like stories, a story should be written in a way which catches the attention of the reader, like as research report should have a readable style. The current researches writing style is good, and is well understandable. No personal views are expressed in the study. The writer had omitted personal pronouns to get an ease in the reading. Credibility variables concentrate on how believable the work appears and focus on the researchers qualification and ability to undertake and accurately present the study (Coughlan et al, 2007). The researchers were well qualified for the current study as their qualifications were stated in the article. Mostly nurses are eligible to do this type of study as they know the effect of dressing a wound. Statisticians also have a role in a research as there are so many calculations which were also included in the study. Methodology of a study is based on the credibility of the qualitative data and its subsequent findings (Polit Hunger, 1999) The title of the article gave an idea of the topic that and what the study is related to. The title is accurate and clear, too long or short titles can make the reader confusing (Coughlan et al, 2007). Too long or short titles can be confusing and misleading to the readers (Coughlan et al, 2007). In the study title is concise and is readable and has its reliability, the title is short too. The title is not more than 10- 15 words. Abstract is a brief description or an outline of the entire article. The abstract should give a clear idea about the research and should include information regarding the purpose of the study, method, sample size and selection which is given clearly in the current article(Coughlan et al, 2007), And from the abstract the reader should able to find out the overall idea about the study. They have also pointed out for further research on this topic with some recommendations. The present study has an agreeable abstract which conveys idea about the study which is simple, clear and interesting for the readers. The abstract is not too long and also explains about the method, sample size and the selection method. The abstract gave an over view of the topic. The abstract also opens an end to further researches. The introduction of the study will always be based on the research problem. Research problem is an enquiry which can be done through a disciplinary way (Polit and Beck, 2004). The purpose of a research highlights the overall sketch of main arguments and theory of the relevant research (Polit Hungler, 1999). In the current research the purpose of the study is stated clearly and an overall idea of the study is been included in the introduction of the research. The research problem is identified and clearly stated in the study. The research was carried out in a step by step process. The article has a flow and a have an ease in reading and all the links are clear. Critical summary of a topic which puts the topic or the research problem into a context is called as the literature review (Polit Beck, 2004). Literature review always points out to the previous studies of the current topic. The review should be logical and its critical analysis should be balanced (Cougllan et al, 2007). In the present study the literature review is clearly illustrated and it is logically presented. The literature review offers a critical analysis. The reviews are mostly facts which were proved by proceeds. A good literature review will always have a good introduction (Cougllan et al, 2007), which is followed in this by the writer. Frame work refers to the overall structure of a report which is based on a theory which was previously proved (Polit Hungler, 1999). Hypotheses are from a primary source and of an empirical nature. Theoretical frame work is what which is found confusing by a researcher. A theoretical frame work is been identified in ethics. The theoretical frame work has been clearly stated step by step clearly. A sound theoretical frame work also identifies the various concepts being studied and relationship between those concepts. The theory is true and the hypothesis is relevant for the study. Theoretical frame work tends to be better developing in experimental and quasi-experimental studies and often poorly developed or nonexistent in descriptive studies (Burns Grove, 1999). The purpose of the aims and objectives is to create a link between the initially stated purposes of the study or research problem (Coughlan et al, 2007). Aims and objectives are the observations or measurement that reflects on the physical reality which is interpreted by the individuals, and can be argued that even such observations may be open to subjectivity (Gerrish Lacey 2006). There is an aim for the study which is clearly stated in the abstract, introduction and also in the study. The hypothesis which is a statement or fact which can be tested or verified (Holloway Wheeler, 2002). The research questions and the hypothesis is clearly identified and stated in the study. The hypothesis and the research questions reflect on the literature review. The samples were chose with a great caution so as to minimise the errors. Samples are the selected units from a population, and sampling is the process of selecting appropriate people from a population for the research (Wood Haber, 1994). The samples were chosen randomly from a group and were informed about the research and the procedures and the effect of the current procedure. The sample which was chose for the study was appropriate as they were patients who were having wounds. The size of the sample was also adequate as a small sample will not help in an appropriate conclusion. The size of the sample is also important in quantitative research as small samples are at risk of being overly representative of small groups within the target population. There was no inclusion or exclusion for the study as they chose an appropriate sample with ethical consideration. The risk of sampling errors decrease as larger sample used (Coughlan et al, 2007). Autonomy infers that an individual has the right to freely decide to participate in a research study without fear of coercion and with the full knowledge of what is being investigated. Ethical committee or institutional review boards have to give approval before the research can be undertaken. There role is to determine the principles and to evaluate the validity of the research (Coughlan et al, 2007). There was ethical consideration for the data collection. All the participants of the study were fully informed about the research. All the participants were protected from all type of in case after effect, and were autonomous. Confidentiality of the subjects was censured by the researcher, and ensured the permission from an ethical committee. In a research study the researcher should ensure that the reader should understand what is meant by the terms and concepts which are used in the research. All the operational terms, theories and concepts in the current study has been clearly identified explained and illustrated in the study, and have given proper reference and citations for the rational and the explanations. The organisation, reduction and transformation of the data of a study in order for a review are called as data analysis (Holloway Wheeler, 2002). The methodology or the research design was clearly given to review the study. One of the main instruments in a study is methodology. The data gathering instruments of the methodology is cited in the study. The instrument used is appropriate as they could clearly get many results out of it. In the study 109 subjects participated in the research. The system of analysing the facts with the collected data from the research is called as data analysis (Polit Beck, 2004). Data analysis in quantitative research studies is often seen as a process which loses courage (Coughlan et al, 2007). Most of the data analysis is associated with complex language and statistical notations. The researcher should clearly identify what statistical tests were undertaken why these test was used and what were the results, which have been stated in the current article. In the current study analyse of the data is done in a better way. The strength and limitations of the study is also included in the study to revel the validity and reliability of the study. The discussion of a study should flow logically from the data and should be related to the literature review thus placing the study in context (Russell, 2002). In the discussion part of the research is linked back to the literature review. The discussion part contains the strength and limitations of the study which is referred to the previous study that are made on the same subjects. All the limitations are also generalizability discussed. The research also extends an open end for further research on different aspects of his study; other recommendations are also given to the current study. When doing a research or a research critique it is essential to quote the source of the information obtained, that should be included as in text or end text reference. In a research study the significance of the findings should be stated but these should be conceder within the overall strengths and limitations of the study (Polit Beck, 2006). The reference should help the writer to find the source as quickly as possible (Pears Shields). The copy of others idea is conceder as plagiarism which is serious offence. For the current study the researcher has used the Harvard referring system. The researcher has referred many books and research articles for his study and all the references have been quoted as in text and end text references. All the books referred for the study are appropriate as they are related to the subject or to the research vocabularies. The researcher was very much cautious about the plagiarism. Evaluating the research article with the critiquing tool by Michael Coughlan and team members it was found that the study is arguable with credibility and reliability. The writers have carefully used the strategies in doing a research. The research is readable and understanding by lay men. Holistic Nurse Prescribing: A Case Study Holistic Nurse Prescribing: A Case Study Introduction 1 the patient and their presenting symptoms. Mr Pickles presents an interesting, complex and therapeutically challenging problem. In essence he is a gentleman with multisystem pathology who presents with an almost incidental finding which he was clearly reluctant to discuss. It is a common finding amongst experienced healthcare professionals that in any consultation it is the last 30 seconds which is the most important. As the patient stands up to go, there is the just while Im here moment when they can bring up an issue that really troubles them and may not be the real presented reason for the consultation. In this essay we shall discuss the various aspects of this situation and the measures we can take to try to help him. (Parker and Lawton 2003) 2.a holistic assessment of the pt, including any relevant medical social and psychological issues. If we start with the initial presenting symptom under discussion the impotence it is easier to work backwards from that to discuss the possible pathophysiology that can be relevant. Impotence is said to occur whenever the male fails to get an erection when it is required. This, in itself is neither unusual nor necessarily pathological. It becomes a significant symptom when the male repeatedly fails to get an erection that is sufficient for intercourse. It is quite possible to get full spontaneous erections and yet still be impotent. This is one of the major diagnostic features that distinguishes the psychogenic impotence from the purely physical. (Ackerman MD, Carey MP. 1995) There are a number of obvious physical causes of erectile dysfunction that are relevant to Mr Pickles (see on), but equally there are a number of possible psychogenic causes that may be either primary factors or possibly secondary contributory factors in the aetiology of his problems. The fact that he has recently undergone major cardiac surgery is a very relevant factor. Patients will frequently suffer from a major change in body perception when they have come to a close realisation of their own mortality. If we add to this the fact that, as the major breadwinner in the family, it is likely that Mr Pickles would have felt a major blow to his self-esteem when he was made redundant from a responsible high esteem job and forced to become a taxi driver with long working hours. This is quite apart from the anxiety and fatigue that such a job would engender.(Beck J. 1995) It is possible that the medication that Mr Pickles is taking may have a bearing on his erectile dysfunction as the male erection is dependent on the hydrostatic pressure of the blood for its maintenance. Any medication that reduces the average blood pressure, will effectively reduce the capacity to acquire and maintain an erection. In addition to this the adrenergic beta-blocker group will also selectively block the sympathetic pathways that are vital to the neurovascular control of the mechanisms of erection. Pathophysiology of diabetes and impotence Both of these topics are huge subjects, so in this essay we will restrict out considerations to those aspects which are relevant to Mr Pickles and his problems. We know that Diabetes Mellitus affects about 2% of the UK population with a specifically higher incidence in both the Asian and Afro-Caribbean communities(Nathan 1998). There is also a marked genetic component in the development of Diabetes Mellitus. Mr Pickles has Type II diabetes mellitus which is associated with a number of factors including a high BMI and increasing age. At 56 yrs. old he is currently at the peak incidence age for Type II diabetes mellitus (Gregg et al. 2003). Diabetes Mellitus is known to be associated with a number of complications. The prevalence and incidence of the complications, in general, tends to increase with the length of time that the patient has been diabetic. There is also an independent variable for complications that is directly proportional to the degree of control (as measured by the HbA1 levels). In general terms, the better the control the lower the incidence of complications (Kissebah et al. 1999) As far as Mr Pickles is concerned, there are two major complications of Type II diabetes mellitus that are directly linked with impotence and they are cardio-(macro)vascular disease and neuropathy. (Wagner et al. 1998) We can deduce that Mr Pickles has macrovascular disease by virtue of the fact that he his recovering from a CABG. And this may well be a very relevant factor in his erectile dysfunction but also there is the question of neuropathy which typically occurs in about 2.4% of the general population, but this figure rises to above 8% in the diabetic patient over the age of 60 yrs. ( Hughes 2002) Impotence tends to occur, in varying degrees, in about 10-15% of men under 40 yrs. Its incidence increases with age to the extent that 40% of men at the age of 40 yrs report a degree of impotence and this prevalence rises to 70% at the age of 70 yrs. (Gregoire 1999). If we add to this basic clinical picture the fact that there are other factors such as hypertension, smoking, cardiac neurosis, loss of self-confidence, depression and iatrogenic causes (medication etc.) all of which may well be relevant to Mr Pickles, then it can be seen that there are a plethora of potential causes of his erectile dysfunction. (Barnes, DE. 2004) Both of the first two causes (hypertension and smoking) are independent risk factors for impotence, quite apart for the fact that they are also risk factors for the development of the macrovascular complications of Diabetes Mellitus (Bowering 2001) Mr Pickles diabetic state has been recently well controlled (HbA1 of 6.5%). This is important as the incidence of development of diabetic complications is reduced by between 34-76% (depending on the particular study) for every 10% reduction in the average HbA1 reading. (Bowering 2001). In addition to all of these considerations, atherosclerosis is also a major complication of Type II diabetes mellitus, which, presumably is relevant to Mr Pickles because of his CABG, and this may be a major factor in the development of his erectile dysfunction. Management plan 3.a plan/strategy based on critical understanding of physiological and pharmaceutical issues. Any management plan must firstly be based on an accurate diagnosis. At this point in time we do not have this luxury. As we have discussed, there are anyone of a huge number of possibilities in the aetiology of Mr Pickles erectile dysfunction problem. When confronted with a problem such as this, any experienced healthcare professional may reasonably chose to manage the problem by making a rational judgement of the probabilities of any one particular cause being relevant. Implicit in such a management strategy is the fact that there are some causes that my be correctable (iatrogenic, psychological, and life style related) and there are some that may not (macrovascular damage, neuropathy and atherosclerosis). It is reasonable, in such circumstances, to discuss the situation openly with Mr Pickles and discuss with him the various treatment options. Patient empowerment and education is a vital strategy to adopt in circumstances such as this as Mr Pickles is far more likely to comply and respond if he understands the rationale behind the treatment plan.(Howe and Anderson 2003) We would suggest that an appropriate strategy would be to initially tackle the situation on two fronts. The psychological aspects of the erectile dysfunction are probably best discussed with an experienced psychologist or councillor who has expertise in this particular area. This is important because there is a considerable skill in eliciting the relevant factors from the patient. Many patients are reticent about talking openly about their imitate sexual details and there has to be a careful build up of trust and empathy on both sides. Factors such as good eye contact and a non-judgemental body stance are essential on the part of the healthcare professional if the optimal result is to be obtained Not only can the issues that are relevant be explored, but also any one of a number of psychological treatment techniques can be employed. This is a matter of considerable clinical judgement and skill and therefore probably best done by an experienced healthcare professional in that area. The pharmaceutical area can also be addressed as Atenolol is clearly not the best anti hypertensive to use as, not only will it reduce the blood pressure (which it clearly is important to do) but it also produces a counter productive beta-blockade which will not help the erectile dysfunction problem. The difficulty is that, after the CABG, Atenolol does have a degree of action on the suppression of ectopic electrophysiological foci in the myocardium which is a recognised complication of the procedure. It also is thought to have a cardioprotective effect post-myocardial infarction. It is probably a good idea to change his anti-hypertensive medication, but in the circumstances, it is probably better to seek the advice of the surgical team who performed the CABG. before making the transition. The question of Viagra has been raised by Mr Pickles. This is not as straight forward as it might initially appear. Viagra has been shown to work well in these circumstances. It has the downside that it allows sexual intercourse which is associated with increased peaks of blood pressure. As Mr Pickles is still in the postoperative recovery phase (16 weeks) it would again be sensible to consult with the surgical team as to their advice on the issue. The other problem with Viagra is that if it transpires that the long term aetiology is actually psychological rather than purely physical, then the prescription of Viagra will often breed a feeling of psychological dependence which may firstly be both inappropriate and unnecessary and secondly, very hard to break. It is probably therefore inappropriate to consider such options at this stage in the management. 4.legal and professional accountability should be discussed. The legal and professional issues are largely covered in the making of a management plan. In any area of professional competence, the best defence against criticism or censure, is the fact that a healthcare professional works from a rational evidence-based plan. It is for this reason that we have set out the rational and reasoning for the plan that we have chosen to adopt. It is actually quite permissible (legally) for a healthcare professional to be wrong on any given issue, as long as they have come to a reasoned and rational decision based on the facts that were placed before them. And behaved in a way that the majority of their professional colleagues believe is reasonable in the circumstances. It is, of course, central to these considerations, that all actions are carefully and fully recorded in the patients notes Prescribing decisions 5.a critical discussion of influences on prescribing decisions. The area of prescribing for Mr Pickles is clearly important. To some extent, we have covered the reasoning behind the change of prescription earlier in this essay. There is a common misconception amongst many members of the public (and indeed many of the less experienced healthcare professionals) that the solution to every problem comes in the form of tablets on a prescription. The whole area of patient empowerment and education is often filled with issues of lifestyle change, healthy living, self care and positive thinking which can frequently be more effective that simply giving the patient a prescription. (Boule NG et al. 2001) In the context of the NHS, it is a common observation that sometimes a prescription is given because it is the most expedient short-term measure in a given situation, (Dawes RM et al. 1974), however, time invested in an explanation to a patient as to why other measures might be equally as important is rarely time wasted., (Corrigan B. 1974) Future management 6.consider your future prescribing activity based on experience gained from this case study. In any professional area of activity, the author likes to use the mechanism of reflective practice to allow a critical assessment of a past course of action to modify future actions when faced with a similar situation. (Gibbs, G 1988) On careful reflection of this case, I believe that I may have acted rather rashly in stopping the Atenolol as a first choice. On reflection, I believe that the Atenolol did need to be changed for any one of a number of other anti-hypertensive agents but I feel that, in retrospect, I would have been wiser to take advice from the surgical team before I made that decision. Further reflection and discussion with other healthcare professionals (Marks-Moran Rose 1996), suggested that another appropriate course of action would have been to stop the antihypertensive medication altogether for a short period. This is on the grounds that his hypertension was not severe and was hitherto well controlled. If the erectile dysfunction was simply a reflection of the fact that the medication was holding his blood pressure down to a level where erection could not easily occur, a few days off the medication may allow a transient increase in his blood pressure to the point that erection could occur. As long as one was careful to monitor his blood pressure to ensure that it did not rise too far, I have been advised that this would represent a reasonable therapeutic trial to establish whether the underlying causes were mainly physical or physiological.(Wagner G et al 1998). On the face of it, this does seem reasonable but I believe that I would have to take further advice before I was fully comfortable with that decision. It follows from what has already been discussed, that I also feel that I may have been too quick to consider the pharmacological interventions before making a complete holistic assessment of the patient. There are clearly a number of lifestyle adjustments that may be relevant here such as weight loss and increasing exercise and looking for a new focus in life (to minimise any element of depression) which would be comparatively easy to achieve with appropriate empowerment and education of the patient. (Funnell R et al 2004) All in all, this is not a straight forward case. There are many elements which require careful and considered assessment. I believe that it is one of those cases that helps to point out that although there is a huge emphasis to be placed on modern scientific understanding and application of medical principles, there is also a very large element of human understanding and caring that is so very important to the successful management of patients such as Mr Pickles (Waterlow J. 1998) References Ackerman MD, Carey MP. 1995 Psychologys role in the assessment of erectile dysfunction: historical precedents, current knowledge and methods. 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