Mulligan Vs Maitland Talar Glide Health And Social Care Essay

Mulligan Vs Maitland Talar Glide Health And Social Care Essay Does Mulligans anterior-to-posterior talar glide is effective in improving dorsiflexion in subjects with acute ankle inversion sprain than Maitlands anterior-to-posterior talar glide mobilization. Design: Experimental, Comparative, Randomized Controlled Trail-single blinded study. Participants: 90 samples with acute ankle inversion sprain diagnosed by radiologist through X-Ray imaging will be collected with convenience sampling. Intervention: Based on inclusion and exclusion criteria subjects randomly allocated to 3 groups of intervention- Group I Mulligans anterior-to-posterior talar glide along with RICE, Group II Maitlands anterior-to-posterior talar glide along with RICE, Group III RICE (control group) for 2 weeks. Outcome Measures: Pre and Post session, measurement of dorsiflexion range of motion will be taken with Modified Lidcombe templates. Duration: The expected duration of study is considered 8months for ethical clearance, data collection and analysis, editing and publis hing. Budget: An estimation of Rs 30,000 is made including the investigation, instruments, materials and refreshments. BACKGROUND Ankle is a complex joint which is categorized as a hinge joint. It is one of the important component for ambulation in humans. Ankle sprains are one of the commonest injuries in athletics. It accounts for 20% of all sports injuries (Bergfeld J; 2004).In India, incidence rate of ankle sprain accounts for 0.31% of the population and the chances of re-injury is seen as high as 78-80% despite the continued research in this field (Statistics for ankle sprain; 2003). The pathomechanics for ankle inversion injury is inversion and plantar flexion of the ankle joint. There is loss of dorsiflexion and inversion range of motion which is attributed to pain and swelling (Denegar CR et al; 2002), (Collins et al; 2004).According to Denegar C et al (2002) the loss of dorsiflexion range of motion is due to restriction of posterior talar glide. This suggests that in an acute ankle inversion sprain the loss of dorsiflexion range of motion could be due to mechanical dysfunction in talocrural joint. The conventional treatment for acute ankle sprain is RICE (rest, ice, compression, elevation).The main aim of conventional treatment (RICE) is primarily to reduce pain and inflammation (Starkey JA; 1976), (Slatyer MA et al; 1997). The conventional treatment (RICE) with early movement is found to be more effective for reducing pain, swelling and improving mobility (Dettori et al; 1994). Because of the ineffectiveness of conventional treatment for treating the positional dysfunction caused due to acute ankle inversion injury the joint becomes more susceptible to injury (Hertel J et al, 1999). Manual Therapy focuses on reduction of pain and correction of the postural and movement dysfunction due to ankle sprain. According to Maitland grades of mobilization grade I and II mobilization is used in acute condition and grade II mobilization is seem effective in reducing pain and improving dorsiflexion range of movement in acute musculoskeletal conditions. Maitland grades of mobilization improves the ankle dorsiflexion in acute ankle inversion sprain (Green et al; 2001) and reduces pain by modulation of nervous tissue (Vincenzino B et al; 1998). According to Maitland GD (1986), passive joint mobilization improves the range of movement by gentle oscillatory movement of the articular surfaces that creates movement of the mobile segments by a means other than the muscles .According to Collins et al (2004), Mulligans mobilization with movement technique is effective in reducing pain and improves dorsiflexion of ankle joint. A single case study done by O Brien, B.Vincenzino (1998) sh owed that Mulligan Mobilization with movement technique on acute ankle sprain improved the range of movement (dorsiflexion and inversion), functional outcome and reduced the pain. According to pilot study conducted by John-Mark Chesney, Erin Morris, Mulligans mobilization with movement technique and taping had significant effect on temporal and spatial parameters of gait. Immediate decrease in pain and an early return to function are claimed to be result of Mulligans mobilization with movement Mulligan 1995; Vincenzino Wright 1995; Hetherington 1996). However, the lack of adequate evidence in literature for the effectiveness of Mulligans anterior-to-posterior talar glide with movement technique in acute ankle inversion sprain failed to prove its clinical and statistical significance in research methods. The above literature also shows lack of studies done to compare the effects of Maitland and Mulligan mobilization technique in treatment of acute ankle inversion sprain. Hence, the aim of the study is to find the immediate effect of Mulligans anterior-to-posterior talar mobilization with movement technique in acute ankle inversion sprain with RICE and compare the results with that of Maitland anterior-to-posterior talar glide mobilization with RICE for treatment of acute ankle inversion sprain. REVIEW OF LITERATURE Ankle joint is a complex joint due to its articular, ligamentous and tendinous anatomy. The anterior talofibular ligament restricts anterior translation and internal rotation of talus inside the mortise. The coupled motion during plantar flexion happens as internal rotation and anterior translation of talus aided by deltoid ligament. The calcaneofibular ligament restricts inversion of the talocrural and subtalar joint. The posterior talofibular ligament restricts inversion and internal rotation after calcaneofibular ligament and anterior talofibular ligament undergo injury. According to Konradsen and Voight (2002) an inversion torque was produced on loading a cadaveric leg, when the unloaded foot was positioned in 30 degree inversion, full plantar flexion and 10 degree internal tibial rotation. The collision with 20 degree inverted foot in swing phase follow through forced the foot into full limit of inversion, plantar flexion and internal tibial rotation. According to Denegar CR et al (2002) in normal biomechanics the instantaneous axis of rotation of talocrural joint translates posteriorly during dorsiflexion, but in anterior malaligned talus or with restricted posterior talar glide the axis of rotation is shifted anteriorly leading to joint dysfunction. According to Baumhauer JF et al (1995) previous history of sprain, limited range of motion and reduced dorsiflexor and plantar flexor strength ratio, elevated eversion to inversion ratio have been attributed to predisposing to inversion injury. According to Eren OT et al (2003) high malleolar index (posteriorly positioned fibula) is attributed to predisposing factor to sprain. Average malleolar index was +11.5 degree in subjects with ankle sprain and +5.85 degree in normal controls. Green T in 2001 used a Modified Lidcombe Template to measure the pain free dorsiflexion range of motion occurring in talocrural joint. The template consisted of 2 boards joined by an adjustable hinge. One board served as a footplate and other was placed under the subjects calf. The adjustable hinge served as the axis of rotation of template in vertical plane and the board placed under the subjects calf allowed for adjustment in horizontal plane. The measurement was standardized by measuring both force applied and the angle of dorsiflexion at which the subject first experienced the pain (Matyas T, Bach T; 1985). The force applied was standardized throughout the trail by spring balance and the direction of force was standardized by spirit level attached to the spring. The device showed high intrarater and interrater reliability of which 29% were in exact agreement and 84.5% were within 2 degrees, ICC=0.94. The conventional management of ankle sprain is RICE in acute stage of injury. The functional treatment procedures with early initiation of weight bearing as tolerated, early mobilization, proprioceptive training, balance training has been advocated to provide early functional rehabilitation to subjects. According to Bahr R (2004) and Bruce Beynnon B, (2004) the management of sprain concentrates on static and dynamic stability, gaining normal ankle range of motion, optimal strength of peroneal, dorsiflexors, plantar flexors, and invertor muscles of ankle and retraining ankle strategy. According to Kerkhoffs et al (2002) functional treatment is superior to immobilization and surgical intervention in areas of pain on activity, quality of performance on return to sport/work, objectives instability on x-ray views and patient satisfaction. Manual therapy in ankle inversion sprain Maitlands Mobilization Green et al (2001) conducted a randomized controlled trial of passive accessory joint mobilization on acute ankle inversion sprain. The study included 38 subjects with acute ankle inversion sprain( Elizabeth L et al (2008) conducted a study in which 10 subjects were taken with immobilized ankle for at least 14 days and presented with at least 5 degree of dorsiflexion deficit compared to contralateral ankle. A crossover design was employed and subjects received Maitlands grade 3 mobilization in one group and control intervention (no treatment) in other group. Results showed that joint mobilization led to a reduction in pain and improvements in pain-free dorsiflexion. Mulligan mobilization with movement technique Collins et al (2004) conducted a double-blinded randomized controlled trial with a crossover design approach. In this study 14 subjects with grade 2 ankle sprain were taken. The dorsiflexion in weight-bearing and thermal pain threshold were calculated. All the subjects undergo 3 treatment conditions-Mulligans mobilization with movement technique for dorsiflexion, placebo group and control group (no treatment).Results showed that the talar anterior-to-posterior glide improved the recovery rate in treatment with Mulligans mobilization with movement technique. The study conducted by Collins N was done on subjects with sub acute ankle sprain. T OBrien, B.Vincenzino (1998) conducted a single case study to investigate the effects of Mulligans with movement technique mobilization for acute lateral ankle sprain. The technique used in this study was posterior glide to distal fibular while patient actively inverted the ankle. In the study 2 subjects with acute ankle sprain were used to control for natural resolution of ankle sprain. Subject I underwent ABAC protocol while subject II BABAC protocol where A was no treatment phase B was treatment phase and C was post treatment return to sport phase. The outcome measures Modified Kaikkonen test functional outcome, VAS for pain and range of dorsiflexion and inversion were measured pre and post of each intervention session. Results showed rapid improvement of range of motion (inversion and dorsiflexion) and immediate decrease in pain. Hence from the above studies we can infer that anterior-to-posterior talar glide technique in both Maitland and Mulligan mobilization is effective in treating ankle inversion sprain than the RICE protocol alone. The above studies also infer that Maitlands grades of mobilization is significantly effective in improving dorsiflexion range in acute ankle sprain. However, Mulligans mobilization had shown effective results in treating ankle sprain in subacute condition. The study done by T OBrien, B.Vincenzino (1998) shows the effectiveness of Mulligans mobilization with movement technique in improving dorsiflexion range of motion in acute ankle sprain but the study design leads to limitation of generalization of its findings. However, it does provide the knowledge to conduct a random clinical trail in utility of Mulligans mobilization with movement technique in the treatment of acute ankle inversion sprain and to compare the results with Maitlands grades of mobilization to find the best e ffective treatment method for improving the recovery rate in acute ankle inversion sprain. IDENTIFICATION OF RESEARCH PROPOSAL QUESTION Does Mulligans anterior-to-posterior talar glide is effective in improving dorsiflexion in subjects with acute ankle inversion sprain than Maitlands anterior-to-posterior talar glide mobilization. ALTERNATE HYPOTHESIS Mulligans anterior-to-posterior talar glide is effective than Maitlands grades of mobilization in improving dorsiflexion range of motion in subjects with acute ankle inversion sprain. NULL HYPOTHESIS Mulligans anterior-to-posterior talar glide is not effective than Maitlands grades of mobilization in improving dorsiflexion range of motion in subjects with acute ankle inversion sprain. METHODOLOGY Design An Experimental, Comparative, Randomized Controlled Trail design. The study will be single blinded to avoid any possible bias. The subjects will be allocated to 3 group of interventions-Mulligans anterior-to-posterior talar glide with movement technique with RICE, Maitlands anterior-to-posterior talar glide mobilization with RICE, and third group RICE alone .Outcome measure will measure the degree of dorsiflexion pre and post to each session which will be measured by the assessor blinded to the allocation of subjects to the groups. Subjects The study will be conducted by recruiting 90 samples through convenience sampling by giving advertisements and notices to orthopaedic and physiotherapy department in MS Ramaiah Memorial hospital and the hospitals nearby its surrounding areas. The subjects recruited will be diagnosed for acute ankle inversion sprain and referred by radiologist through X-Ray imaging. To maintain the homogeneity of the groups all the subjects will be recruited based on Inclusion and exclusion criteria. Inclusion criteria-All subjects of age group 20-30years of age, History of ankle inversion injury with pain over lateral aspect of ankle ( ETHICAL APPROVAL The ethical approval will be taken from Ethical Board of MS Ramaiah Memorial Hospital along with the permission of other hospitals near by its surroundings. Subjects will be given a copy of informed consent with the details of the study and the confidentiality of patients personnel information and data obtained after the study will be maintained. Subjects can withdraw from study at any given point of time. VENUE/LOCATION OF THE STUDY The study will be conducted in MS Ramaiah Memorial Hospital Physiotherapy Department, Bangalore. A RANDOMIZED CONTROLLED TRAIL STUDY An experimental randomized controlled trail -single blinded study will be conducted on 90 subjects with acute ankle inversion sprain. The technique of the interventions will be finalized during the study and side-effects or any error in the intervention will be noted and rectified. RESEARCH METHOD AND EXPERIMENTAL INTERVENTION 90 samples will be recruited by convenience sampling. The samples will be assessed for acute ankle inversion sprain by X-Ray imaging done by the radiologist in radiology department of MS Ramaiah Memorial Hospital. The subjects will be randomly assigned to 3 groups by chit method. Each group will be assigned 30 subjects. The researcher who will conduct the study is a qualified physiotherapist who specializes in manual therapy. After the allocation of the group the experimental group I will receive Mulligans anterior to posterior talar glide along with active dorsiflexion of ankle which will be followed by RICE application. The mobilization will be performed in weight bearing in which the therapist applies a postero-anterior force to distal leg through a treatment belt while stabilizing the foot and talus (Mulligan; 1999).The experimental group II will receive Maitlands anterior-to-posterior talar glide (Grade II) followed by RICE application. The mobilization will be performed with subject lying supine and the ankle will be positioned over the edge of plinth with proximal hand of therapist stabilizing the distal tibia and fibula while the distal hand will mobilize the talus with posteriorly directed oscillation(Maitland;1977).Group III will receive RICE treatm ent for maximum of 2 weeks. Subjects in experimental group I and II will be treated every second day for maximum of 2 weeks. Therefore 6 sessions of treatment over 14 days will be done. Three sets of 10 repetitions will be applied with 1 minute between sets (Exelby, 1996) in both mobilization technique. Pain experienced during treatment will result in immediate cessation of technique and exclusion of the subject from study. OUTCOME MEASURES Dorsiflexion range of motion will be measured by Modified Lidcombe template. The template enabled standardized measurement of dorsiflexion range of movement. The axis of rotation of ankle was aligned with adjustable axis of rotation of template. The spring balance attached to the footplate measure the force applied in the standardized direction. A hydrogoniometer placed on the footplate measures the range of dorsiflexion in degrees. The template have a high intrarater and interrater reliability of which 29% were in exact agreement and 84.5% were within 2 degrees, ICC=0.94. Hydrogoniometer have high intraclass coefficients (0.84-0.99) which revealed high agreement between the raters (Lex D.De jong et al; 2007) RESULTS AND DATA ANALYSIS The dorsiflexion range of movement measured will be in degrees which represent a parametric data. The data collected pre and post of each 6 session in group I and group II will be analyzed by related t test (i.e. within the group) and unrelated t test will be done to compare between the group I and group II for dependent variable. One way ANOVA will be used for analysis of data from all the 3 groups along with Scheffe test to find the most effective group for treatment of acute ankle inversion sprain. The level of significance will be set at 0.5; the probability will be calculated based on the t value with degree of freedom table. The confidence interval will be kept to 95%. ANNEXURE PROJECT TIMELINE The overall estimated time required for the completion of the study is 8months i.e. 1 month for ethical clearance, 4 months for the randomized controlled trail, data collection and data analysis, 1 month for writing up and presenting results and 2 months for publishing results. Tasks 1 2 3 4 5 6 7 8 Ethical clearance + Randomized controlled trail amend data collection tools + Data collection + + + Data analysis + + Writing up presenting results + Publishing results + + BUDGET The overall estimation of the budget is Rs30, 000 which includes X-RAY imaging Rs20, 000 (90 subjects) Modified Lidcombe Template and hydrogoniometer Rs5000 Stationary Rs1000 Transportation and refreshments Rs4000 INFORMED CONSENT Introduction This is an informed consent given to a subject who wishes to participate in research study. Please red the informed consent carefully or you can ask anyone of your relative who you trust can read this informed consent for you in your language by translating it. Please feel free to ask any questions you have about this informed consent or research study in your mind. Please sign the consent form only after you have no doubts about the research study or consent form. Do not sign the consent form under any kind of pressure. Title of Research Project Immediate effects of Mulligans anterior-to-posterior talar glide with movement technique versus Maitlands anterior-to-posterior talar glide for pain free dorsiflexion in acute ankle inversion sprain. Investigator SUMIT KIMOTHI M. Sc in Clinical Physiotherapy. Purpose Of Study Acute ankle sprain has high percentage re-injury. Mulligans mobilization with movement technique helps in improving dorsiflexion range of motion by correction of positional dysfunction of joint. This study is to find the effect of Mulligans mobilization with movement technique and compare it with effects of Maitlands grades of mobilization in treatment of acute ankle inversion sprain. Description of Study After being diagnosed with acute ankle inversion sprain you will be sent to the physiotherapy department in physiotherapy department. The researcher will explain you about the treatment technique and the study and an informed consent will be given to you based on your decision your participation will be decided. If you wish to participate a treatment technique selected for the respective group in which you will allocated will be performed on you and the assessment will be taken before and after the treatment session. The duration of treatment is 2 weeks and if there is any changes, you will be informed prior. Possible Risks or Complication The treatment technique itself has no side-effects or complication and it will be performed by a qualified physiotherapist in Manual Therapy. Treatment Alternative If the therapy is not effective to you, you will be provided with an alternative treatment with free of cost. Financial Implications All the expenses regarding the research work including the investigation, transportation, food expenses and treatment will be free of cost. Potential Benefits The study may be beneficial to society and individuals of similar condition. You can benefit by improving you condition with help of this treatment. Participation Participation in this research study is voluntary. If the participant wants to withdraw he/she can withdraw at any given point of time. CONSENT FORM I have read the foregoing information, or it has been read to me. I have had the opportunity to ask questions about it and any questions that I have asked have been answered to my satisfaction. I consent voluntarily to participate as a participant in this research and understand that I have the right to withdraw from the research at any time without in any way affecting my medical care. Name of the participant _____________________ Signature of participant _____________________ Date: _____________________ Day/month/year ___________________ If illiterate A literate witness must sign (if possible, this person should be selected by the participant and should have no connection to the research team). I have witnessed the accurate reading of the consent form to the potential participant, and the individual has had the opportunity to ask questions. I confirm that the individual has given consent freely. Name of witness ___________________ AND Thumb print of participant Signature of witness ___________________ Date: ______________ Day/month/year ______________ I have accurately read or witnessed the accurate reading of the consent form to the potential participant, and the individual has had the opportunity to ask questions. I confirm that the individual has given consent freely. Print Name of Researcher _________________ Signature of Researcher ___________________ Date __________ Day/month/year ____________ A copy of this Informed Consent Form has been provided to participant ____________ (initialed by the researcher/assistant) For more information contact: Sumit Kimothi M. Sc in clinical physiotherapy, MS Ramaiah Memorial Hospital, Bangalore. 9916261101 ASSESSMENT CHART Name : Age : Sex : Site of Disorder : Mode of Treatment : Measurement : Parameters Before Treatment After Treatment Dorsiflexion range of motion Signature of Clinician : Signature of Chief Physiotherapist :

Record Retrieval System Essay

Chapter 1 The Problem and Its Scope Introduction Technology plays an important role in retrieving patient records in the lives of every patient, an office staff and a medical hospital because of the big boom of technology across the globe it enhanced the services of health institutions. Big, small hospitals or even clinics use the advantage of technology that gave ease to every transaction made especially on important document stored and released for patients. Every record is important just like birth certificates that every parent will retrieve from a hospital for future use of their children, a medical record or laboratory results needed by doctors for medical purposes. For the past decades, medical hospitals all over the world are using a paper system in the retrieval of patient’s records. Patient Record Retrieval is the process of getting the patient records back from a repository or a place where records are stored. Such as, an outpatient record is stored in the deck of folders, envelopes mostly sorted by family names, and there are hundreds or thousands in one of the corner of the office. Patients come and will retrieve records if needed anytime and does not have the assurance that a record will be able to retrieve in a short period of time. Medical centers in the country, it maybe prestigious or not, has also encountered the same problems as other countries encountered, scattered records are everywhere and occupied the whole space of the office, adds manpower for processing transaction and waste of office supplies and most especially retrieval services are slow. Government hospitals have many patients most especially poor people from rural areas and retrieving patient records in the hospital is the common problem. Negros Oriental Provincial Hospital is a government health agency intended for the poor and one of its services is to retrieve records of patients. One problem that clients lost their patience is because of turtle-like services of the agency in retrieving records. Factors that the hospital has a slow service in retrieving patient records and it is because records are very hard to locate that consumes couple of minutes in retrieving for a specific record being requested. In addition to the problems of Negros Oriental Provincial Records Department is that the paper  system consumes the office space, waste of paper materials and additional personnel for locating records. Thus, with all problems encountered by Negros Oriental Provincial Hospital Records Department in retrieving records, the researchers came up a solution to have a new computerized patient records retrieval system. Review of Related Literature, Studies and Systems Review of Related Literature Patients record a collection of documents that provides an account of each episode in which a patient visited or sought treatment and received care or a referral for care from a health care facility. The record is confidential and is usually held by the facility, and the information in it is released only to the patient or with the patient’s written permission. A problem-oriented medical record also contains a master problem list. The patient record is often a collection of papers held in a folder, but it may be computerized. Retrieval of medical record has been a significant means of communication between the Provider, Payer and Legal community. For decades it has been an extremely manual driven, paper driven process and time consuming process. With the advent of technology, issue of regulatory guidelines of PHI security and confidentiality such as Privacy Rules or HIPAA, Medical Record Retrieval and Release of Information is an industry which has undergone and is going through a lot of transformation. Earlier being done by the organizations themselves, this service is now being outsourced to specialists with the end goal to reduce retrieval time by process automation, reduce paper usage, and abide by the stringent HIPAA and Privacy rules. Retrieving medical records isn’t overly difficult, but it is a process with specific requirements. For example, medical records aren’t always stored at a physician’s office. First, the medical provider needs to be contacted and asked about where the medical records request forms should be sent. Once the correct mailing address has been obtained, the record request forms as well as a HIPAA authorization form and a check for copy charges needs to be sent. In a perfect world, the provider would receive the request and fill it right away. However, it’s not unusual for a request to sit in a pile on some clerk’s desk making follow-up calls an absolute necessity. Lehnart et al. defines a patient record management system as a system that stores demographic, and medical information from ancillary services such as registration, lab, radiology, pathology, pharmacy, consultation and transcription.They state that a record management system is not simply automated updates of paper based charts, but rather a dynamic system used to help health care workers make better informed dragonesses. According to Gaillour et al. a record management system is only effective at achieving the goals of increasing quality of care and lowering costs if the organization re†designs it’s current workflow and practices. Hence a very user† friendly system needs to be created to mitigate the risk of user dissatisfaction towards the new system. Fromberg et al. claim the clinical benefits to such a system includes easier, more rapid access to patient data charts; Improved clinical decision making and disease management; More educated patients about their own ailments; An increase in time to spend consulting with patients; An increased perception of patient care and theoretically a better working environment. All these benefits overall translate to better patient care. More benefits include a more efficient workflow, as duplicate tasks would not be performed as the need to re gather information would be eliminated as all data pertaining to the patient is readily available at all times. Time taken to execute administration functions, such as capturing patient demographics, drop dramatically. According to Dassenko and Slowinski, an average of up to 15 minutes was saved per patient on the patients first visit and further 20 minutes on each subsequent visit as a result of implementing a computer based patient record. Fischer and Bloude (1999) states findings that the retrieval of paper records was time consuming and finding the required information amongst many documents for certain patients could be a lengthy process. Wellen et al (1998) emphasized the advantage of EPR because it enables information be Time is saved by EPR in not requiring the whole patient file to be used to find to available quickly about specific requirements perhaps just one piece information. Coiera (2003) EPR added that information instantaneously drugs though many documents. with EPR instead of requiring a search such as allergies to particular could be obtained information strategy states that in the EPR system the patient records should be secure, accurate, and legible. They can be easily accessed by authorized staff and in addition to use for individual patients can be incorporated in research. Data can also be available for the improvement of quality. Bush (2002)recommended introducing and using an appropriate EPR system since it helps to reduce costs and ongoing expenses in providing multiple users access to faster. Distance is information, data protection and backups. An EPR backup system is more economical than the manual system since it saves space, time to locate and access information and maintenance costs. Abdellhak et al (1996) and Young (2000) state that physical control of a file are not always available, EPR data can be accessed at any provides adequate security. However, sometimes as many as 30% of which is not possible with paper records. Englebardt and Nelson (2002) and Reynolds (2003) agree that an increasing number of paper records approved workstation are authorized difficult more Robert(2002) one the information for the right reason. Especially Friedman (2005) considered security for confidentiality must be ensured this is and relevant with EPR systems even if it makes authorized access access patient record especially in emergency cases. Kirshna and authorized person. Where as a paper based system is available to only one person at a time to point out that an EPR system can  be used simultaneously by more than Amatayku (2004) drew attention to access policy which needs not only a ban sharing passwords but also a reminder of the possible legal consequences. Schmitz (1979 p.74) described an early EPR system at a time when â€Å"there is as yet no such thing as a fully electronic medical record†. The benefits were then seen to be â€Å"timeliness, accuracy, completeness and availability† resulting from†having physicians interact directly with an electronic management information system† (Schmitz 1979, p.75). He seems to have been one of the pioneers in anticipating the potential of EPR, and the benefits from professional input. Kovner (1990), who considered the use of electronic records for patient history and current treatments. The availability of computer systems from 1990 onwards further helped to prove the arguments raised by the two authors above. This availability changed medical record keeping to electronic methods, which were beneficial in many ways. methods of recording have reduced the size of records despite the fact that they contain very much more information. By using computers, doctors can easily access information from more than one source. The organization of records for ease of access is essential for efficiency and the importance of the service is recognized by supervisors in charge. Good organization and management requires good leadership to ensure efficiency and co-operation and a constant improvement performance. In addition to the above observations, Meijden et al (2000) measured the attitudes towards electronic patient record among physicians and nurses. The researchers noted that the experienced physicians and nurses were move positive, whereas the inexperienced ones found EPR to be more time consuming for data entry and retrieval, and they were concerned about their familiarity with computers and the need for training. This study implies that one has to be experienced in making the optimum use of EPR systems. Furthermore, an EPR system proves to have more effect on improving quality of patient care. Bickford (1995)noted the in as a restriction potential that EPR systems have for improving patient health costs, adding satisfaction for providers, researchers and administrators. Dick and Steen (1991) argued that patient records should include more information than just treatment details for as proposed by earlier researchers such as Kovner (1990), example, guiding problem solving, decision analysis, reminders, and risk assessment ,an do the relevant details(Dick & Steen1991,p.37). The system could prompt staff about additional considerations not available in paper records. The system would be accessible at all times. Similarly, a report by the Institute of Medicine (IOM 1997) helped to argue further that an electronic patient record is to be as the one that is specifically designed to support users through of complete and accurate data, practitioner reminders and alerts, clinical understood availability decision support systems, links to bodies of medical knowledge and other aids. Novak(2005) considered EPRs as time saving which can be life saving, transfers to cost other physicians history, effective whilst maintaining confidentiality and, making easy and immediate. However A personal EPR can contain a total medical complicated. EPR systems have to a greater extent improved patients records and facilitated  the selection of the most appropriate treatment. Amongst these advantages, Burton et al with the patient’s input can be created when records are retrieved much Lane & Hayward (1999) investigated the value of electronic patient records make adequate and legible records has been reduced to take only a few minutes per patient, when physicians’ time is tightly scheduled. However, Soper (2000) observed that more time to see a patient, together commented that the time taken to. Furthermore, the above author noted that accessibility of record sat a made possible. Electronic records are more legible and can resolve the problem of misplaced documents and the opportunity to show parents the records of their children if required. For  GPs and found them to be considerable, but there were doubts about the system on a larger. Furthermore, (Atkinson 1997; British Medical Association 2002). The training of users on EPR scale in hospital use. Mansoor (2002) Training the users in manipulating EPR systems has proved to be easier them to familiarize themselves with other aspects of computer supports the observation in that physicians use systems motivates applications. Computers for administrative purposes as well as EPR systems, and are keen to acquire computer skills and knowledge to enhance their clinical practice. They learn how to access computer based information and to how to make the best use of such resources. Svenningsen (2003) found the advantages of EPR included no loss of records, ease of access for all medical staff, some reduction in professionals. The same was the case for Smith, (2003) who considered good medication errors, better documentation, and more co-ordination between leadership and supportive staff were essential for a planning, strong successful EPR system. Benefits include accurate medication lists, legible notes and physician. Having experienced EPR he would never revert to paper records. Seems to summarize the general point of view of those who have experienced prescriptions. This the change from manual to electronic systems. Amatayakul (2005) emphasized the value of EPRs providing reminders to alert hospital staff to particular problems which may arise, and improve decision making, in addition to reducing errors. At the same time much information is still being handwritten in many hospitals and the electronic records do not necessarily include information which would assist decision making. Also it was helpful to have systems which work similarly in different places e.g. surgeries, clinics and hospitals. The benefits of EPR as outlined by Ginneken (2002, p. 115) included Flexibility in content and use, integration and adaptability to change. Once consensus is reached on terminology, architecture, and legislation, the EPR  will become as established as the Hippocratic Oath record has been for centuries†.It seems from the literature that benefits have been obvious in all the countries that have adopted the system, and even those who originally had difficulties in making the changes now express no regrets, because they have experienced the great advantage of electronic systems. There was a reported reluctance to change which needs to be overcome by a good training programme, and some people under-estimate their capabilities to cope with different systems ( Loomis & Ries 2002). As Huston (2004) noted, to such a change would require an agreed standard procedure and provision for the transition period. Faber(2003)draws attention to the fact that several authors new and implement argue that the implementation of EPR can fail if the assumed nature of the medical work being considered does not match the real aspects of that work. Related Studies and System According to the study of abdullah, f. Epr system in hamad medical corporation   Qatar that it greatly resolved the dissatisfaction with the existing manual patient  Record system expressed both doctors and nurses referred to many defects of the  Present manual system which caused irritation and potential exposure to reducing  Patient safety. Such obstacles can affect the improvement of patient care and delay Important treatment. From the findings the major problem of the traditional paper  Based record system appears to be misfiling of records causing difficulties in obtaining   Information quickly in emergencies. Thus the newly EPR system benefited the   Hamad medical in terms of the accuracy,legibility, confidentiality and time saving  in the patient records. Another study from Droma, Fahad et al. in automation of the patient record management sytem in St Francis Hospital Nsambya that Patient record management systems in hospital today necessitate a competent administration when handling patients, generating reports from cashier, patient details which serves as a key factor for the flow of business transactions in St Francis Hospital Nsambya. Unfortunately the current Record management system leads to misplacement of drug details, payment details, and late release of reports and insecurity to records. This research project is aimed at computerizing all the records about patients, staff and drug suppliers. In order to achieve this goal, a thorough System Study and investigation was carried out and data was collected and analyzed about the current system using document and data flow diagrams. The concept of report production has been computerized hence, no more delay in report generation to the hospital manager. Errors made on hand held calculators are dealt out completely The method used to develop the system include iterative waterfall model approach, dataflow, logical and entity relationship diagram were used to design the system and finally the language used were MySql, php, HTML, CSS and JavaScript. Atkinson (1997), whilst seeing the benefits of EPR systems, also that they could change clinical practice, and that there could be problems of controlling access to them. His research also reported anxieties that were expressed regarding the possibility of computer failure. The argument shows that the electronic record system has a â€Å"back up† scheme for computer failure patient which automatically prevents information from being lost. In addition, even if the benefits of EPR are recognized,found that the time taken to learn procedures was an obstacle to their use. A software engineering consultant, Sam Simple was hired to design a Computerized Patient Record system for a hospital. Each patient’s record in the database consists of a patient’s name, address, age, phone number, next of kin, name of parents, phone number, birth date and place, social security number, occupation, marital status, religion, military service, treatment history, family background, lifestyle information such as drug history and sexual  preferences, diagnostic and testing information, and insurance information. At the initial meeting held to discuss the project requirements, a hospital representative indicated to Simple that the hospital had conducted research on CPR systems prior to hiring him. Based on the report produced from the hospital’s research, it considered that user authentication to verify users’ ID and password at login was sufficient for their system, as far as the system security was concerned. However, Simple learned from a study that 85 percent of the passwords on a typical computer system were guessable. According to Dr. Marie Sy, CHITS, an electronic medical record (EMR) specifically designed for the community health centers in the Philippines, was developed through a collaborative and participative process involving health workers and the Information and Communication Technology (ICT) community, using the primary health care approach and guided by the open source philosophy. â€Å"The development of CHITS that the paper record retrieval time was decreased from 2.41 minutes to less than 5 seconds,† has resulted in increased efficiency of health workers, allowing them to spend more time for patient care, improved data quality; streamlin ed records management; and data-guided decision-making, both operationally and strategically,† Dr. Sy added. The development of EPR in most countries has been rapid in recent years with some differences to meet local requirements. Beaumont (1999) noted the advantage of electronic records in the UK, including simultaneous access from multiple locations, legibility, ease of exchange of data, and confidentiality. He compares the advantages with those of paper records which are: easily transported; easy to read; require no training and are never â€Å"out of order†. According to Beaumont’s personal experience, electronic records are an improvement on medical handwriting which is often illegible. In addition, he noted a need for training in the details of categories which the manual records should contain, just as computers may be â€Å"down†, so misfiled patient records can be equally frustrating. Frolick, (n. d. ) noted that electronic patient records in USA are of great benefit to patients, because they are not subject to loss, illegibility or inaccuracy, and assist in guiding patients’ daily treatment. In addition, the records would be readily available for research and accessible directly on the users’ screen. Furthermore, Madison(1997) reported Dr. Paul King’s opinion that the ability to create, and retrieve  charts quickly was of importance and time saving. The choice of the best EPR in USA for a particular department as important and there should be a wide range of availability of a system for selection. By the immediate accessibility of the right technical information lives could be saved, and this is the most important consideration of all. In addition to aspects such as time saving and quality of care, Kowalsky (2002)observed that, to make the system comprehensive and cost effective was a large task and integrating existing systems was difficult. Much as the EPR systems are suggested to provide the best solutions to improve patient record keeping, several authors have observed a number of challenges to them. For example, Fields & Duncker (2003) mentioned that although EPR systems are planned to be universal in UK by 2008, there were doubts about this. The complexity of the task and the need to complete it rapidly caused concern after previous NHS computerisation problems. There was anxiety and the need to convince staff of the benefits of the system. Bishop (2003) referred to availability, as being able to use the information or the source desired i. e., hardware, software or networks. The same issues were discussed by Singh et al. (2004) who noted that primary care in USA is complex and includes safety problems, with no two providers being alike. EPR imposed on any health system can have unpredictable effects, reducing or increasing safety. To some extent EPR could distract a GP from properly recording observations, but, if used correctly, would greatly assist in providing immediate and accurate information. In practice it is essential that all staff are familiar with EPR systems, if these are to be used effectively, and all aware of hazards and how to avoid them. Similarly, Pizziferri et al (2005) considered one factor which inh ibits the use of EPR in USA was the concern that it may take more time than paper records. A study of 20 physicians’ use of time at primary health centres was recorded, before and after the introduction of EPR, and a decrease in time was noted. This was also the case with dictating notes, reading, and writing; however searching for data was much faster than before. The researchers concluded that EPR took less time than manual records but that there was a need to identify EPR users who had difficulty with the system. Mikkelsen & Aasly (2005) of the neurology department at St Olave’s Hospital, Norway analysed electronic patient records and how the system affected performance, e. g. the ability to access information. Records for a neurological department were of variable accuracy because of lack of precise definitions, and were a potential threat to the safety of the system. Strict procedures are required to ensure accuracy and sufficient relevant information. The Steiermà ¤rkischeKrankenanstaltenGes.m.b.H. (KAGes), the governing body of the Styrian hospitals. Out of a new MIS, termed OpenMedocs, has been conducted. This system shall simplify the management, the access to and the exchange of health-related patient information. It is a centrally managed system at the headquarter of KAGes in Graz. The core of OpenMedocs is an electronic patient record (EPR) system. All documents concerning patients are stored in this system. Thus, it is possible to receive documents from a patient which have been generated in different hospitals ’at the push of a button’. Since almost all medical information of the hospitals concerning patients is managed in the ERP system, it is possible to avoid various disadvantages of ’traditional documentation’, like multiple medical attendance or local constraints of usage of retrieval possibilities, and user-oriented presentation of data should help, among other things, to speed up and to improve the quality of the medical decision-making process of physicians. Since the roll-out of OpenMedocs, the amount of these patient-related documents increased continuously. Thus, the efï ¬ cient storage and the timely retrieval of documents in the EPR system have gained considerable importance. The Problem Statement of the Problem This present study tries to analyze, design, develop, test and implement a Record Retrieval System for Negros Oriental Provincial Hospital. This study attempts to answer the following questions. 1. What is the current retrieval system used by Negros Oriental Provincial Hospital Records Department in retrieving records? 2. What are the problems encountered by retrieval section employees in the retrieval of patient’s records in NOPH Records Department? 3. What are the requirements needed for the development of the Computerized Retrieval System for Negros Oriental Records Department Retrieval Section? 4. How secure and manageable is the Computerized Retrieval System for NOPH Records Section? 5. How beneficial is the Computerized Retrieval System for  Negros Oriental Provincial Hospital Records Department Retrieval Section. Hypothesis H0: There is an existing problem with the current retrieval system of Negros Oriental Provincial Hospital Records Department. H1: Negros Oriental Hospital Records Department is in need of a new system that will help them improve their service. Technical Background Design Concept Input Data Captured Process Working with records Output Showing results by print outs Storage of the patient records Figure 1 It shows the input, process and output of the patient record retrieval system that in input in order to retrieved such records they need a personal information and the records they want to be retrieved in a system. In Process it is where the records has been process in order they could release the record and in output it is where the records have been already retrieved and ready to release to the authorized person. Design Method Figure 2 Agile Approach The methodology that use in developing the system is agile the researcher use  agile since it promotes adaptive planning, evolutionary development and delivery; time boxed iterative approach and encourages rapid and flexible response to change. A conceptual framework promotes foreseen interactions throughout the development cycle. There are five phases in this methodology the requirements, design, implementation, test and deployment. In requirements phase in which the requirements for the software are gathered and analyzed. This is equivalent to researching and brainstorming what the product requires. Examples can include general features, architecture discussions, workflow discussions and general product discovery. Design phase this is which will have all the requirements defined for the product. Implementation phase during the development, needed to test the code as well as get feedback from the customer on progress. Feedback from the customer can include mockups, front-end designs, and usability. Testing phase bugs and defects are always a constant in the software development process. It is important that there are good quality assurance standards to eliminate general issues. Deployment the software application is finally deployed and live. Once this occurs, a support plan needs to be in place for maintenance and general support on potential future issues. Significance of the Study Negros Oriental Provincial Hospital Record Department.The study will serve as a new instrument for the technological advancement that greatly benefits for Negros Oriental Provincial Hospital. This computerized system is intended to lessen the manpower which will lead to a faster and more accurate record retrieval process which will lead to profitability of the Negros Oriental Provincial Hospital. Employees. The job of the employees will become more accurate and efficient through the use of the proposed system. This leads to less error which saves time and energy on the side of the workers. Employees can also focus on other tasks assigned that will make them more productive. Patients. The service of Negros Oriental Provincial Hospital to the patient will become more convenient. Less time will be consumed during the retrieval process. This will also lessen time for patients to wait for their records to be release. The study is also expected to increase the satisfaction of the patients to the services of the Negros Oriental Provincial Hospital. Researchers This study is a great achievement for the researchers because it  will improve their skills in technical writing. The experiences while doing the research build up their characters and teach them values like creativity, working hard, team building and responsibility and time management. It also builds friendship and camaraderie among the co-researchers. It also gives them an overview of the IT industry and trains them to prepare to the competitive professional field. Questionnaire Directions: Please put a checkmark on the selected choice. Name (Optional):____________________________________ Age:______ Gender:____________ Department:______________________ I. The current system that NOPH are using in retrieving records: 1. What is the present system used by Negros Oriental Provincial Hospital Records Department Retrieval Section? __ Manual Retrieval __ ComputerizedRetrieval If manual, what are the tools or things used in retrieving records or how a single record is retrieved according to its arrangement? _By folders _By logbooks _By envelopes _By family names _By cabinets _By disease/injury Others (Specify):______________________ If computerized, what are the applications used? _ Microsoft Excel _Microsoft Word _Microsoft Access _Others(Specify):_____________________________ II. The problems encountered by employees in retrieving records: 2. What are the problems encountered by Negros Oriental Provincial Hospital Records Department in retrieving records? _Unarranged Documents _Difficulty in finding records _Lost Documents _ Mountainous Stocked Files _Crowded area Others(Specify):______________________________ III. Particular documents that Negros Oriental Hospital retrieve. 3. What are the common documents that hospital clients retrieved mostly? _Birth certificates _Death certificates _Laboratory results Others(Specify):___________________________________ References: Related Literature http://medical-dictionary.thefreedictionary.com/patient+record http://www.wipro.com/industries/healthcare-segments/medical-records-retrieval.aspx http://www.sunbeltreporting.com/sunbelt-blog/bid/45059/Benefits-of-Outsourcing Medical-Records-Retrieval) Fischer, J. S. & Blonde, L., 1999. Impact of an electronic medical record on diabetes practice workflow. Clinical Diabetes, 17(2), 10-12. Wellen, D. et al., 1998. The electronic medical oncology record: misconceptions, barriers, and benefits. Cancer Management, 3 (5), 6-8. Coiera, E., 2003. Guide to health informatics. 2†³d ed. London: Arnold. Bush, J., 2002. Looking for a good electronic medical records system? Family Practice Management, 9(1), 50-51. Lenhart, J. G., Honess, K., Covington, D., and Johnson, K. E. â€Å"An Analysis of Trends, Perceptions, and Use Patterns of Electronic Medical Records Among Family Practice Residency Programs.† Family Medicine, February 2000, 32: 109† 114. Gaillour, F. â€Å"Rethinking the CPR: Is Perfect the Enemy of the Good?† Healthcare Management Technology[serial online], May 1999, 20: 22†25.32 Fromberg, R., and Amatayakul, M. â€Å"CPRI and the Future of Computer†based Patient Records.† Healthcare Financial Management, July 1995, 49: 48 Dassenko, D., and Slowinski, T. â€Å"Using the CPR to Benefit a Business Office.† Healthcare Financial Management, July 1995, 49: 68†70, 72†73 Abdelhak, M., et al., 2001. Health information: management of a strategic resource. 2nd ed. Philadelphia: W. B. Saunders. Englebardt, S. P. & Nelson, R., 2002. Health care informatics an interdisciplinary approach. USA: Mosby. Friedman, B. 2005. Health Records get personal: a technology outlook for consumer access to personal health information. Journal of American Health Information Management Association, 76(1), 42-45. Amatayakul, M., 2004. Electronic health records: a practical guide for professionals and organizations. USA: AHIMA. Schmitz, H. H., 1979. Hospital information systems. London: Aspen Systems Corporation. Kovner, A. R., 1990. Health care delivery in the United States. New York: Springer Publishing Company. Meijdan, M. J. V. et al., 2000. The user in the design process of an EPR. Studies in Health Technology and Informatics. 77,224-228. Bickford, C. J., 1995. The concept model of the electronic health record development of the CPR and CPRs concept models. Toward an electronic patient ecord? 95 Proceedings. 0 ed. IL, USA: Kelvyn Press. Dick, R. S. & Steen, E. B., 1991. The computer-based patient record, an essential technology for health care. Washington D. C.: National Academy Press. Novak, K., 2005. Reducing costs through electronic health records and services. Benefits and Compensation Digest, 42(10), 40. Burton, L. C. et al., 2004. Using electronic health records to help coordinate care. The Milbank Quarterly, 82(3), 457-581. Lane, V. & Hayward, P., 1999. Medical records. The Lancet, 353 (9149), 330. Soper, W., 2002. Why I love my EPR. Family Practice Management Journal, 9(9),1-7. Mansoor, E., 2002. Computer skills among medical learners. Journal of Ayub Medical College (JAMC), 14(3), 13-15. Svenningsen, S., 2003. Electronic patient records and medical practice, reorganization of roles, responsibilities, and risks. PhD thesis, Department of Organization and Industrial Sociology, CBS- Copenhagen Business School. Ginneken, A. M. V., 2002. The computerized patient record: balancing effort and benefit. International Journal of Medical Informatics, 65(2), 97-119. Amatayakul, M., 2005. Are you using an EHR-really? Healthcare Financial Management, 59(11), 126-128. Loomis, G. A. et al., 2002. If electronic medical records are so great, why aren’t family physicians using them? Journal of Family Practice, 51(7), 636-641. Huston, J. L., 2004. The need for mandatory clinical recording standards. Clinical Medicine, 4(3), 255-257. Faber, M. G, 2003. Design and introduction of an electronic patient record: how to involve users? Methods of Information in Medicine, 42(4), 371-375. Related Studies Abdullah, Foziyah., August 2007.Electronic Patient Records System in Hamad Medical Corporation, Qatar: Perspectives and Potential Use. Droma, Fahad. et al.,An automated system for patient record management: a case study of St. Francis Hospital Nsambya. http://dspace3.mak.ac.ug/xmlui/handle/10570/443 Atkinson, C., 1997. A case study on development an electronic patient record in the UK. Requirements Engineering, 2(1), 1-14. Kibbe, David, MD, MBA, and Bard, Mark R., MHA, MBA. (1997). How Safe Are Computerized Patient Records?. Journal of Family Practice Management, May 1997 Vol. 4 No. 5 . Retrieved April 2, 2002 from American Academy of Family PhysiciansWebsite: http://cpmcnet.columbia.edu/dept/dental/Dental_Informatics/AOFC_Course/DI_Clinical/CPR.html http://www.pchrd.dost.gov.ph/index.php/2012-05-23-07-46-36/2012-05-24-00-01-11/5111-electronic-medical-record-system-chits-can-retrieve-patient-record-in-five-seconds-expert Beaumont, R., 1999. The electronic patient/healthcare record (EPRIEHR). 8 `h ed., [accessed 5.4.2004]. Frolick, M. N., [n. d. ]. Using electronic medical records to improve patient care, , [accessed2 6.03.2004]. Madison, D., 1997. Breaking away from paper. Healthcare Informatics, 14(10), 4-6. Kowalsky, C. A., 2002. The computerized patient record. Journal of Medical Education, 3(3), 1-6. Fields, B. & Duncker, E., 2003. The impact of electronic health records on crossprofessional healthcare work,

Cross Culture Management Exam Questions with Answers

Chapter 1 Q. 1. please, provide TWO examples which show that people around the world are still very different from each other, despite advances in technology and transportation. 1. In England children need to wear uniforms at school, but in Latvian schools nobody wears them. 2. Black schools and white schools still exist, as well as schools on religion Q. 2. Please give ONE example that shows that management is not the same everywhere around the world. 1. In China for example, business ppl don’t like to sign papers, they are more open for mutual trust, if u want to sign paper with them, they will think that u don’t trust them, but In Eu or Usa everything must be signed and written down to ensure that there won’t be any problems. Q. 3. Please explain why some Chinese negotiators among themselves refer to their western counterparts as harmless barbarians. Chinese ppl evaluate only their own culture, and because of the culture differences towards theirs aren’t the same, they criticise western culture. If u want to do business with Chinese then u will need to understand them, they won’t do anything. ) Q. 4. Please explain the 4 quadrants of the Johari window in your own words. Q. 5. ONE advantage and ONE disadvantage of having stereotypes Advantage: Help process new information by comparing it with past experience and knowledge. Disadvantage: It blocks our mental ‘’file’’ we ma ke our mindless open for other knowledge or information. Therefore we think things about people that might not be true Chapter 2 Q. 1. More important than observing behaviour is understanding the meaning of that behaviour. Please explain this statement and provide two examples. Observing behaviour is not enough. What is important is the meaning of that behaviour. This distinction is important as the same behaviour can have different meanings and different behaviours can have the same meaning. Example: Eye contact in Western culture means showing trust and honesty whereas in Asia it is a sign of disrespect and aggression. Example: In Usa showing OK sign with fingers means – approving smth, but in Brazil it means – literally â€Å"screw you† Q. 2. Please, explain the three layers of this model and give an example of each layer 1. Artefacts and behaviour – by observing (greeting rituals, dress code, use of titles of first and last name) 2. Beliefs and values (the way things are) – by interviews and surveys (getting know the meaning of behaviour) 3. Assumptions (space, language, time) – Interference and interpretation (distance between people as expressed in greeting rituals and ways of interacting) Q. 3. Please, choose a cultural artefact and explain its underlying belief/values. Dress code – For every culture there is different meaning in business dress codes: 1. USA – rolled up sleeves are considered a signal of getting down to business 2. Germany – Always wearing casual form even if it’s really hot – showing that they are here to work 3. French – reluctant to remove ties and jackets – because it’s official meeting Q. 4. Saying that our colleagues are late to a meeting because they are Latin misses the point. Please explain why. For example: is time seen as past/present or future assumption or monochromic / polychromic in Latin. Thus we need to better understand the behaviour observed to appreciate each other. Chapter 3 Q. 1. Please explain the 5 dimensions of Hofstede Q. 3. Space: Public (group oriented) vs. Private (more task-cantered); Time orientation: Past, Present, Future; Action: doing vs. being; Time focus: monochromic vs. polychromic; Communication: high-context vs. low context. Q. 4. 3 characteristics of high context communication and 3 characteristics of low context communication. High: other things have to be considered ( listener has to read between the line when listening to a person or reading sth. 1. Reading â€Å"between the lines† 2. Influenced by closeness of human relationships 3. Not everything is explicitly stated Low: Explicit orders given by person, listener doesn’t have to listen or read between the lines. 1. Meanings are explicitly stated in text. 2. Direct and linear communication. 3. Based on feelings CH 5. Q. 1. Please, explain the differences between the rational analytic approach and the subjective approach. Which approach do you prefer and why? I prefer rational analytic approach, because it’s more based on facts and figures, since it is more important when making decisions. Q. 2. Please describe 3 characteristics of each strategy. 1. Controlling model is more objective, more specific and low context. . Adapting model – more flexible, more qualitative, information gathered from personal sources like friends and colleagues. Q. 3. Please, provide 3 concrete examples of cultural differences you might have to deal with in a merger process. 1. Americans working with Japanese ppl; 2. The meaning of behaviour; (Brazilians and American s) 3. Q. 4. In what ways may differences in national culture hinder or facilitate internationalization efforts (page 139 – 141)? Notion of culture distance explains it as the greater the difference in home versus host country culture, the greater potential difficulties. Chapter 7 Q. 1. Which four cross cultural competences for managing differences abroad can be distinguished? Explain each competence in a few lines 1. Awareness of one’s cultural worldview 2. Attitude towards cultural differences 3. Knowledge of different cultural practices and worldviews 4. Cross-cultural skills Q. 3. Please, explain the different phases of a culture shock. 1. An initial stage of elation and optimism (the honeymoon) 2. A period of irritability, frustration, and confusion (the morning after) 3. And then a gradual adjustment to the new environment (happily ever after) Ch. 8 Mention ONE disadvantage and TWO disadvantages of a multicultural team. Do they tend to perform much better or worse than monoculture teams? Please explain your answer. Disadvantages: greater potential for frustration and dissatisfaction; richness of the diversity make interpersonal conflict and communication problems; different cultural assumptions. Advantages: contribute to new ways of looking at old problems, creating the opportunity for greater creativity and innovation The problem is ‘how to get settled’ or how to arrive at a common ground. Diverse groups have to confront differences in attitudes, values, behavior, experience, background, expectations, and even language. The ocean metaphor is used in the book several times. How can you link each level of the ocean metaphor to the strategies for managing tasks? Artifacts (level 1) such as the use of titles of first and last name, the presence and form of agenda, amount of social vs. task orientated. The beliefs and values (level 2) are indicated in discussions regarding the roles of the leader (hierarchy) and the structure of meetings. The underlying assumption (level 3) has to do with the use of power, individualism.

Solution for Air Pollution - 1088 Words

2 March, 2008 The Solution for Air Pollution Society as a whole faces many environmental problems, and as a result, environmental awareness tends to be a pressing issue. Every day, people recycle cans, glass bottles, and newspapers. Many people buy bottled water, or own filters for their tap water, as a health precaution from the pollutants in normal everyday drinking water. Air pollution is perhaps the biggest environmental issue the Earth is facing. Automobiles are responsible for a notable amount of the air pollution problem. Of course, on the other hand so are factories. If the fight against air pollution were to be taken to a higher level, putting pressure on factories that produce air pollution will have a greater effect†¦show more content†¦There are many practical, cost-effective measures that can be taken to reduce the emissions of air pollutants, including the adoption of energy conservation measures and switching to natural gas. Many existing Clean Air Act programs, such as the acid rain program, and the gro und-level ozone smog programs, if properly implemented, will do much to reduce the concentration of fine particles by controlling the pollutants. These give a hopeful outlook that the air pollution problem can cease to exist in the severe form that it now does, and with the support of not only governmental agencies and non-profit organizations, but also the help of everyday citizens, the problem can be overcome in no time. The air that people breathe everyday is critical to the very existence of not only civilization, but also the entire Earth; therefore, taking care of it should be a priority to everyone that inhabits it. A commitment needs to be made by all. It is not necessary for everyone to be radical protesters against factories and automobile manufacturers, but if everyone were to get involved, even in the slightest way, such as carpooling to work, the air that is inhaled by all as a matter of survival would be increasingly cleaner. The air pollution created by these factories is dangerous to the environment and to the health of people everywhere. â€Å"Industrial air pollution isShow MoreRelatedAir Pollution: Is Their a Solution Essay1794 Words   |  8 PagesAir Pollution Is Their Solution By Theresa Yeannakis SCI/275 Andra Johnson Sunday, April 18, 2010 When did we first experience air pollutions? Could it have been in the A.D era when cave people built small fires to survive? Or has it become an issue since the early 80`s. No one will be able to specifically say but what we can attest to is that since the A.D era we have contributed several times over to Air Pollution. We risk breathing in dangerous chemicals every time we breathe. 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