Palliative care Essay Example | Topics and Well Written Essays - 2250 words

Palliative care - Essay Example Twycross (2003) noted that palliative care helps in the treatment of social, emotional, spiritual, and practical problems that the illnesses bring up. Palliative care is advantageous because it can be done the same time with treatments targeted to cure the diseases, that is, when the disease is diagnosed, during treatment, at follow-up stage and at end of life stage. Health care providers such as nurses, doctors, registered dietitians, psychologists, social workers, chaplains, and massage therapists give palliative care. The exercise takes place in cancer centers, hospitals, long-term home care agencies and other care facilities. This essay involves a case scenario where Mark who is 56 years old is referred to the palliative care team because he has many serious illnesses that require extra care from the medical specialists. Mark was admitted due to the post haemodialysis where he was unwell, he also had restless legs and was also vomiting. Mark has a history of hypertension end stage renal failure on haemodialysis, prostate cancer not responding to chemotherapy, a diabetic toe wound, and Type 2 Diabetes. This essay is going to demonstrate a critical understanding of the external influences, which have a direct effect on end of life care and the strategies employed by the practitioners to facilitate the delivery of quality palliative care services. The essay will further evaluate a variety of physical, social, and psychological factors that affect the client’s experience in relation to palliative care. According to the case scenario, the external influences that have a direct effect on End of life care for Mark are the general weaknesses due attacks by dangerous diseases such as renal failure, type 2 diabetes and prostate cancer, which is not responding to chemotherapy. Mitchell (2008) defined End of life care as the care

Week one CYB 634 Assignment Example | Topics and Well Written Essays - 250 words

Week one CYB 634 - Assignment Example This causes unfairness to participants. This can be, however, managed through proper competition rules and ethics so as to make it of value to participate. Valuable competition should include the following: fairness in that everyone is treated the same and those who win should win fairly. Any educational competition should add knowledge to learners and also test the right question of a particular level of education. Transparency is key to any competition where grading and procedure for marking are known and used in the marking process. Transparency calls for check and balance where the result should be reviewed and independent external examiner to ascertain their correctness. There should also be a way to detect cheating and a punishment proposed to it. So as to deter those who are conspiring to cheat on the tests. Cyber competition should include the following event, post analysis tests this where those who have undergone a particular test can be evaluated after some time, e.g. two years to determine if their skills are up to date with current market demand so as to give them a chance of

In Depth Analysis Of The Toyota Motor Corporation Marketing Essay

In Depth Analysis Of The Toyota Motor Corporation Marketing Essay The main products for the company are categorised into three segments they are automobile, finance and housing communication system. The core business was automobile segment engages in the design, manufactures and sales that includes a car smaller than a compact car to luxury and sport vehicles, as well as trucks, SUVs, buses and minivans. Additionally Toyota produces automotive parts and accessories for its own use and for sale to others. Popular models include Land cruiser, Lexus line, Camry (best selling passenger car in America, 2004) and Corolla as well as the Tundra (Motor trends truck of the year, 2000). Toyota annual sales approximately reaches 7.5 million models on all five continents (America, Europe, Asia, Africa and Australia) in which the main markets for both Toyota and Lexus brand vehicle is the United States, followed by Japan. The other highest markets areas are U.K, China, Australia, Canada, Germany, Thailand, Saudi Arabia and the South Africa. In all, Toyota markets vehicles are more than 170 countries/regions. The global main competitors for Toyota are VW group, General Motors, Renault Nissan, Hyundai Kia and Ford. As shown in the appendix1 during the year 2008 Toyota dominates the global light vehicle sales with the highest market share of 14% by overtaking the main rivals like GM and Hyundai Kia in the midst of recession, instead booms the profit. But the position among the competitors changed drastically in the year 2009. The financial summary of Toyota for the year 2009 is tabled as follows. (Billions of yen) The financial report clearly shows that during the year 2009 Toyota made a net loss of  ¥437 billion ($ 4.3 billion) that never happened from the past 1950. It happens due to the worst sales, when company could not sell up to that volume in which that company take out its costs which related to production and sales. Whilst Toyotas president, Fuji Cho openly avowed in the year 2002, that Toyota is aiming for 15% of the global market share by 2010 accommodating itself with the new global vision named as Innovation into the Future. The new theme (vision) consists of four elements they are recycling based society, development of motorization on a global sale, diverse society, and age of information technology. Hence with the severe competition Toyota continues an effortful attempt to attain a goal outlined in the Global Vision 2010 by increasing its competitiveness. ANALYSIS OF THE CURRENT BUSINESS ENVIRONMENT AFFECTING THE AUTOMOBILE INDUSTRY: According to Johnson scholes (1999), different steps to be followed in environmental analysis for finding the strategic position of the organisation they are 1) Assessing the nature of environment, 2) Auditing environmental influences, 3) identifying key competitive forces, 4) identifying competitive position and finally identifying the key opportunities threats. The external environment, as a determined element remain a topic of interest in management literature (Joshi and Campbell 2003; Nahm et al., 2003). Hence, a balance relationship between environment and manufacturing strategy is complex for organisation to achieve success (skinner, 1969; Hayes and Wheelwright, 1984). On the other hand Pagell and Krause (1999,2004) argued that manufacturing flexibility is a global event in high performance organisation regardless of the environment they operate in. However, it is difficult to handle environmental uncertainty (complex) by depending only on primary analysis which is derived from the output of diversity ensuring that different parts of firms responsible for different aspects of diversity are unattached, and given resources and authority to handle their own part of the environment (Johnson and Scholes 1999). Considering the above factors the analysis of Toyota Motor Corporation in the automobile industry is carried out with help of analytical tool kit such as PESTLE and FIVE FORCES. PESTEL ANALYSIS: As shown in the Appendix-II PESTEL analysis for Toyota Automobile Industry is done with respect to the geographical locations of U.S and Japan. The most vital factors from the analysis have been taken and described below to find the current opportunities and threats of the company. The automotive industry is subject to various government regulations including those related to vehicle safety and environmental issues such as emission levels, fuel economy, noise and pollution. Many governments also impose tariffs and other trade barriers, taxes and levies, and enact price or exchange controls. Toyota has incurred and expects to incur in future, significant costs in complying with these regulations. New legislation also subject Toyota to additional expenses in future. As an automotive manufacturer, Toyota may became subject to legal proceedings in respect of various issues, including liability and infringement of intellectual property and Toyota is in fact currently subject to a number of pending legal proceedings could adversely affect Toyotas future financial condition and results of operations. Toyota is subject to various risks associated with conducting business worldwide. These risks include political and economical instability, natural calamities, fuel shortages, interruption in transportation system, wars, terrorism, labour strikes and work stoppages. The occurrence of any of these events in major markets in which Toyota purchases materials, parts and components and suppliers for the manufacture of its products or in which its products are produced, distributed or sold, may results in disruptions and delays in Toyotas business operation may adversely affect Toyotas financial condition and result of operation. The worldwide financial services industry is highly competitive. Increased competition in automobile financing may lead to decreased margins. A decline in Toyotas vehicle unit sales and residual in value risk due to lower used vehicle price increase in the ratio of credit losses and increased funding costs are factors which may impact Toyotas financial operations. The likelihood of these factors materializing has increased as a result of the ongoing rapid worldwide economic deterioration and competition in automobile financing has intensified. If Toyota is unable to adequately respond to the changes and competition in automobile financing, Toyotas financial services operations may adversely affect its financial condition and result of operations. Increase in prices for raw materials that Toyota and Toyotas suppliers use in manufacturing their products or parts and components such as steel, precious metals, non-ferrous alloys including aluminium and plastic parts may lead to higher production costs for parts and components. This could in turn negatively impact Toyotas future profitability because Toyota may not be able to pass all those costs to customers or require its suppliers to obsorb such costs. PORTERS FIVE FORCES: Michael Porter identified five forces that affect an industry. These forces are degree of rivalry, threat of substitutes, barriers to entry, buyer power, and supplier power. For the more on this framework proposed by porter, see Appendix. Viewing the automotive industry through the framework of porters five forces can be helpful in understanding the forces at play. Degree of Rivalry: The automotive industry is highly competitive with Big 3 such as GM, Ford and Daimler Chrysler. In the 1980s the Toyota entered a fairly disciplined U.S market and have been very focused in growing their shares of the market. The great diversity of rivals in terms of cultures and philosophies has intensified rivalry in the Industry. Market growth is slow in the established markets of U.S and Europe, and companies must fight fiercely to eke out gains or prevent losses in market share. However, growth is potentially huge in the rapidly industrializing nations of China and India. In these booming markets Toyota could take advantage of the opportunities to reap handsome awards. The degree of rivalry in the automotive industry is further heightened by fixed costs associated with manufacturing cars and the low switching costs for consumers when buying different makes and models. Threat of Substitutes: The threat of substitutes to the automobile industry is fairly mild. Numerous other forms of transportation are available, but none offer the utility, convenience, independence, and value afforded by automobiles. However there are inherent underlying social and cultural attitudes that keep people from owning automobiles in some parts of the world. Barriers to Entry: The barriers to enter the automobile industry are substantial. For a new company, the start-up capital required to establish manufacturing capacity to achieve minimum efficient scale is prohibitive. An automotive industry is quite specialized and in the event of failure could not be easily re-tooled. Buyer Power: In the relationship between the Toyota and its ultimate consumers, purchasers of finished vehicles, the power axis is tipped in the consumers favour. Consumers wield the greatest power in this relationship due to the fairly standardised nature of the vehicle and the low switching costs associated with selecting from among competing brands. However, Toyota remains marginally powerful due to large customer to produce ratio. The automotive industry is a dynamic place. With the forces above at play, and with history as a guide, it is safe to stay that the Toyota must continue to change, evolve and adapt. OPPORTUNITIES: Increasing Demand for Hybrid Vehicles: Globally it is estimated that the demand for hybrid electric vehicles(HEVs) will be approximately 4 million units by 2015. Rising oil price and more emissions regulation are likely to increase the demand for HEVs, as hybrid vehicles are less polluting and less operating cost (more fuel efficient) when compared to conventional diesel and gasoline engine, Toyota industries has strong focus on devices for plug-in hybrid vehicles. The companys competency on hybrid technology is likely to drive growth in the medium term. Establishment of New Material Handling In North America: Toyota is formulating a program to expand its material handling equipment in North America. In this context, in March 2010, Toyota industries determined to create a newly owned sub-subsidiary, Toyota material handling North America (TMHNA). Previously, both Toyota and Raymond used to closely work together to boost business efficiencies in the areas of manufacturing, quality and procurement. Though, TMHNA has officially created to integrate management and operational activities in North America. Establishment of TMHNA would enhance the regional co-ordination and increase the performance of the material handling equipments products of Toyota industries. Growing Opportunities in Emerging Automotive Products: Toyota is now concentrating on the new markets such as India, China, Russia and Middle East region seeing that these markets are expected to view a strong growth in the future. In addition, Toyota also provides automotive logistic services. The company, with powerful automotive business operations, would be aided by the growing vehicle demand in these emerging markets. THREATS: Kyoto Protocol: The Kyoto protocol for the lessening of carbon emission went into effect in 2005, which results on industrialized countries to cut-down their green house gas emission from the 1990 level by 5.2% by an average level during 2008-2012. Consequently, Toyota appointed the prevention of global warming as one of its strategic management issue and concentrate on measures to reduce global warming, which lead to increase in the cost structure of the company drastically. Intense Competition: Toyota is involved in competition with many automobile companies at home and abroad. Any differences in the allocation of management resources and in competitiveness of cost or technology are likely to impact the companys status in the automobile industry and its business performance. Toyota industries compete with the competitors having large volumes of business and greater financial resources than those of the company. High level of competition in the market place could affect Toyota business operation and could erode in market share. Exchange rate Fluctuation: Toyota industries encompass the production and sales of products and the provision of services worldwide. Toyota is sensitive to the fluctuations in foreign currency exchange rates and is principally exposed to fluctuations in the value of the Japanese Yen, the U.S Dollar and the Euro. In the recent Japanese Yen appreciated significantly against the U.S Dollar. The strengthening of the Japanese Yen against the U.S Dollar can have a material adverse effect on Toyota Industries reported operating results, which may in turn affect the valuation of the company. ANALYSIS OF THE TOYOTA STRATEGIC CAPABILITIES: According to Haberberg and Riepel (2008) capabilities are things that customers and other stakeholders notice when they are dealing with an organisation. Hence it is vital to identify the capabilities of Toyota, which is carried out with the frame work of resource based analysis (appendix- ) and value chain analysis. Value Chain Analysis: One key program is called value stream mapping, an analysis tool the automaker has been using to improve assembly line productivity is supply chain. Toyota manages the supply chain so efficiently that its production process is near perfect and it simply known as TPS (Toyota Production System), which developed by Toyota to deliver more effectively the products which their customers require, in a timelier manner than traditional management approaches. The unique management system of Toyota made a different relation with the suppliers when compare to other competitors, they are Frequent and reliable deliveries from suppliers Quality parts Small lot size Supplier network Communication with suppliers Proximity to the customers Single sourcing Long-term contract Supplier training Reduced lead time. Toyota is not asking suppliers to reduce price and profit instead, to find a way to minimise cost without having any negative impact on customer value. The present situation is Toyotas ability in developing the TPS and in integrating the policies and practises of their own that is the extension of internal policy deployment through their supplier association into the supplier network and the active co-ordination and development of suppliers, directly and indirectly through the widespread application of the Toyota production system. Resource Audit: Resources of Rolls Royce can be grouped under then following four headings they are Physical resources, Human Resources, Financial resources and Intangibles. STRENGTH: Robust RD Capabilities: Toyota industries actively carry out its research and development activities. Its RD activities can be broadly divide into two areas product development and improvements performed independently within each business division and RD undertaken mainly by the RD centre separate from the activities of its business division and with a view toward company wide- management strategy. Strong RD capabilities helps the company to keep up with the latest technological developments in the market and also helps in developing new products and technologies, thus contributing to the rapid growth of the company. Strong Engineering Capabilities: The company has strong engineering capabilities, for instance the Toyota is extending its product portfolio to include hybrid engines and hybrid vehicles. The company also manufactures electric compressor for hybrid vehicles. The companys strong engineering capabilities allow expanding its product portfolio. WEAKNESS: Overdependence on Japan: A Toyota industry is highly dependent on the Japanese market for its revenues. This overdependence on Japan could have a dampening effect on the companys revenues if the companys sales in Japan do not grow as expected. Addition to this the concentration of operation in this area increases Toyota industries exposure to country specific factors such as changes in raw material prices, labour strikes, changes in economic conditions, and most important increasing competition price from low-priced products. Evaluation of Possible Future Strategies for the TOYOTA: After scanning the environment, performing the SWOT analysis, that showed a weakness in Toyota may at the same time huge opportunities. Now we need to know how to use this opportunities to overcome the threats, minimise the weakness and maximise the strength. Toyotas success is largely based on its forward-thinking, innovative management style and its rigorous standards of quality. The Toyota production system is much-studied strategy of design and manufacturing which emphasizes streamlining and elimination of waste giving rise to the Just in Time and Lean manufacturing movements and continuous error checking and improvement. In addition, Toyota has repeatedly been ahead of the trend in investing new technologies. Instead of focusing on reducing labour costs, Toyota has increasingly automated their production facilities. And with the release of the Prius in 1997, Toyota introduced the first mainstream hybrid vehicle, cashing in on the demand for fuel economy and reduced environmental impact. Like the Prius, the section line successfully addressed a new consumer sector, a plan that Toyota will continue to follow. These strategies combine to give Toyota a significant sustainable competitive advantage. In order to realize the image that Toyota is striving to achieve it is important to undertake a paradigm change from the following three perspectives they are are technology development, management and profit structures Acquisition of a Competitor: Acquisition of competitor is known as improvement strategy of expanding its core business. The acquisition will lead to rise in market share (barney and Hesterly, 2010) for Toyota through market penetration, market development and market expansion, if the acquire company is operating in more and different emerging markets. This form of acquisition is called horizontal integration and would lead to an increase in market share and decrease in competition. Toyota to exploit the merging market such as India and China it should acquire the existing competitor so that it is easily strengthen the market position and open new opportunities for competitive advantage New Strategic Capabilities: There are strong competitors for Toyota in the technology, marketing and manufacturing. Therefore to reduce the intensity of rival among the major players, Toyota can look into joint venture strategy to capture the emerging markets such as China, India and Russia. Implementation of Strategic Change: Surviving to highly competitive rapidly changing environment often requires firms to develop strategies that provide the right kind of flexibility to succeed their specific environments, thus achieving fit between the type of flexibility to succeed in their specific environments, thus achieving fit between the type of flexibility pursued and the demand placed by the environment. Negotiating: Negotiation should be there to understand the demand of both buyer and seller and these has a significant impact as the negotiations unfold and implementation begins. Implementation: Implementation is the critical part for the leadership and communication to execute the change management. The changes that should be made for merging should be planned in detail because there are many issues that are expected with acquisition such as integration challenges, culture, control system, financial operation and loss of key personal (Thompson, 2001). In order to overtake these problems Toyota has to do a proper planning and research before the implementation to get the positive outcome. Conclusion: The product developments are in increasing nature because of the emerging new markets and the technological factor is adding value to the company focusing for the next generation, hence I personally recommend on investor to invest with Toyota APPENDIX-II PESTEL ANALYSIS FACTORS IMPACT(opportunities threats) TIME SCALE POLITICAL: Political instabilities, fuel shortages, natural calamities, wars, terrorism and labour strikes Arab oil embargo turned fuel economy into an important automobile policy goal for the U.S government. The occurrences of any of these events will results in disruption and delays in operation. Prolonged disruption may adversely affect the financial conditions of Toyota Toyota Government relation are 1, Reliance on Business association 2, Personalized network and 3, emphasis on harmony. Changes in legislation Continuous process Every 5 years ECONOMICAL: Financial crisis that began in 2007 and accompanying sharp declaration of vehicle sales during 2008 serious challenges for all automakers. Energy crisis. Rise in price of gasoline. Exchange rate fluctuation with respect to Dollar Establishment of new material handling company in north America which will limit the cost of exporting the vehicle to US Alternative energy efficiency technology and more investment in RD Big cars got smaller, small cars got better Drove down demand for big, expensive cars, and pilled in capital from Japan and elsewhere, which helped drive up the dollar In March 2010 Continuous Continuous Continuous SOCIAL: Demand for fuel efficiency by consumers Intense Competition More demand for hybrid electric vehicles Resulted in more choices for buyers and searching opportunities in emerging market Estimated within 2015. Continuous TECHNOLOGY: Rising energy cost and increased emissions regulation are likely to increase the demand for hybrid vehicles. Toyota industries has strong focus on hybrid vehicles Demand to reach within next five years. ENVIRONMENTAL: Kyoto protocol The emergence of government regulation for vehicle safety and emissions. Reduction of green house by 14% from the 1990 level within 2012 4years LEGAL: Toyota may became subject to various legal proceedings in respect of various issues, including product liability and infringement of legal property, and Toyota in fact currently subject to a number of pending legal problems Adversely affect the Toyotas future financial condition and results of operation Continuous NOTE: Analysis mainly based on the Japan and US geographic location Appendix-III Porters Five Force Model New entrants Industry Competitors Intensity of Rivalry Buyers Suppliers Substitutes Appendix-IV Value Chain Analysis Reliance on Business association (internationalization)-well connected to each other and with politicians and bureaucrats. Personalized network- The use of personalized /informal network for political influence and mobilization in Japan is a more visible and frequent activity than in many other industrialized countries. Emphasis on harmony- strong emphasis on harmony among firms and policy makers.

Consumerism Causes Unhappiness Essay -- Cause and Effect Essays

Theresa H., a woman in Massachusetts was, inarguably, strapped. She had lost her $18,000-a-year job several months earlier, and her live-in boyfriend didn't earn much. Health insurance for her and her daughters was out of reach: "I just punt and hope we're healthy," she said. And yet, in her apartment, were the trappings of upper-middle-class comfort. The big-screen TV and VCR. The crush of name-brand toys. And outside, the fairly new Lincoln Town Car--for which she was several months behind on payments. The tableau was at once absurd and sad--but not altogether surprising. We are, after all, a nation of accomplished spenders, slaves to advertising and status symbolism. The conspicuous fruits of our consumption shout out our aspirations and insecurities. This is the phenomenon Juliet Schor explores in The Overspent American. Schor, a University economist, has delivered what amounts to a sequel to her breakthrough 1992 study, The Overworked American. That book, justifiably embraced as gospel by the human-resources intelligentsia, expertly documented the time squeeze faced by two-income families as hours on the job expanded. Americans' leisure time, Schor demonstrated, was vanishing. Why are we killing ourselves this way? In large part, Schor argues now, we work so that we might spend. Americans are engaged in an intensifying "national shopping spree" rooted in competitive emulation--keeping up with the Joneses on a manic scale. "We are impoverishing ourselves," she writes, "in pursuit of a consumption goal that is inherently unachievable." Corrosive consumerism, of course, has existed as long as envy and avarice. Look at the pharaohs' pyramids. And much of Schor's evidence of its current manifestation will seem bl... ...lator." Much of our spending clearly is unnecessary or wasteful, raising troubling moral questions. Moreover, the uphill pursuit of material nirvana is stressing us out. Amid widespread wealth, most Americans aren't content with their lives. Is that such a terrible thing? I'm ambivalent. Ambition, dissatisfaction with the status quo, a desire to improve our lots and those of our children--these are profoundly American, if not universal, traits. They have driven us to stunning accomplishments and global leadership, and few would want the alternative of complacency and stasis. Yet we spend more than we should on Armani and OshKosh B'gosh, and it's making us crazy. Schor would have us on a middle path, one that retains the ardor but loses the insanity. Perhaps it's worth a try. Source Cited Schor, Juliet B. The Overspent American. Boston College Press, 2002.

Troubleshooting Computer Hardware Appendix B

Axia College Material Appendix B Troubleshooting Computer Hardware In this worksheet, you must identify solutions for three separate computer hardware problems. For each solution, you must prepare an answer of at least 150 words within each of the following Answer boxes. Part One: Troubleshooting a Failed Boot |Problem | |The computer fails to boot. | |Details | |Error messages and beeps occur during Power On Self Test (POST) startup.Note: You have not recently upgraded the memory. | |Question | |What are four possible sources for the error messages, and how do you troubleshoot them? | |Hint: You may look at Figure 3-45 in A+ Guide to Managing & Maintaining Your PC. | |Answer | |Four possible problems that could be indicated by error messages and beeps on POST include a dead CMOS battery, hard drive failure,| |video card problem or memory failure.These problems are also listed in the order of the easiest to the most difficult to fix. | | | |CMOS Battery – Power on the comput er and press the required key (such as F2) that is required to enter the BIOS program. Upon | |entering the BIOS make a note of the settings, especially the date and time. If they are set at some point in the past it’s likely| |that the battery could be dead. Also, set the time, turn the PC off, and then reboot. If the time has reset then the battery is | |likely dead and should be replaced. | | |Hard drive failure – If upon boot the screen indicates a message such as No Operating System found it’s likely the hard drive has a| |problem or is not being recognized. Check the BIOS to see if the correct drive type is listed. If not it’s likely the hard drive | |has a problem and a diagnostic tool provided by the manufacturer would be the best solution. | | | |Video card failures – If the computer has no video output check the connections and try the video card in another slot if possible. |You can also try removing and reinserting the card to see if th e machine will recognize it. | | | |Memory Error – Typically a series of beeps can indicate a problem here or some type of error message relating to a failure to read | |at a particular address. You can try removing the memory modules one or two at a time depending on the configuration and try | |booting with the memory in a different slot or without part of the memory to try and deduce which memory module may have failed. | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Part Two: Troubleshooting Memory |Problem | |Error messages indicate a problem with memory. | |Symptom | |Recurring error messages about illegal operations and/or general protection faults appear during normal operation. Note: You have | |not recently upgraded the memory. | |Question | |How might memory be the cause of this problem? How would you go about testing the memory? |If you use a testing utility and determine that memory is not the problem, what are three other thin gs you would suspect to be the | |source of the problem? Describe what you would do to eliminate each possible source. | |Answer | |If there is a problem with the memory it’s likely only at a certain location within the memory module itself and not the entire | |module. Since information is randomly written t different addresses in memory the computer may not always indicate an error | |message. Truly random error messages indicating a problem with illegal operations would likely be a good indicator of the problem | |if no other symptoms exist. | | |There are many tools available for testing memory. These tools will attempt to read/write to all locations on the memory chip to | |find out if any particular address in the memory chip is failing. Another possible way to troubleshoot would be to try the memory | |in a different computer. | | | |If a memory test concludes that there is not a problem with the memory then likely causes could be the memory in the video card, a | |b ad program instruction from a particular program or a problem with the OS installation.If the memory is not the problem then | |additional troubleshooting is required including finding out if the problem only occurs in a certain program. It could be an OS | |issue if it’s when the computer is booted or shut down. Troubleshooting a video card problem may be more difficult and a different| |video card could be tried | Part Three: Troubleshooting a Hard Drive problem |Problem | |The computer shuts down immediately after startup. |Symptom | |When you turn on the computer, the lights on the front panel light up and you hear the fan spin for a moment, but then it shuts down | |immediately. You have urgent data on the hard drive that is not backed up. | |Question | |What is the quickest and easiest way to solve the most urgent problem, which is recovering data from your hard drive? List the major | |steps you must complete to recover data. | |Answer | |The first step would be to attempt to boot the computer using a boot disk that contains core operating system files and then running | |a scan of the hard drive to find out where the errors exist.Sometimes these errors can be fixed or the offending location can be | |erased to prevent the problem. Each of these steps involves risk and if this is for a consumer they should be informed of the risk. | |If a scan of the disk finds the issue and is repaired the computer should be booted and the information backed up immediately. | | | |Another option would be to put the hard drive in another computer as the non-OS drive and attempt to access it from a working OS. | |This may provide the opportunity to retrieve the critical data by directly copying it to the other hard drive or other storage media. | | |If both of the above attempts are not successful then there are programs that attempt to recover data from the hard drive. A boot | |disk should be used or the drive should be placed into another computer. A recov ery tools can scan the entire contents of the drive | |and may be able to recover all or at least some of the files if they are not damaged. If the information is highly critical it can | |be sent to a data recovery professional in order to have the data extracted. While this is not always successful depending on the | |type of failure it’s at least necessary to try and recover the data if possible. |

Dementia to Elderly in Uk

Abstract Dementia is characterized by evidence of short term and long term memory impairment with impaired abstract thinking, impaired judgment, disturbances of higher cortical thinking, and personality changes. It is basically a progressive decline of cerebral utility such as logic, remembrance, language, problem solving, or concentration. This disease greatly harms the day by day performance of a person and is seen more in older people, however, is not a normal part of aging. . INTRODUCTION 1. 1. Aim The aim of this dissertation is to analyze the effects of dementia in older people and to suggest possible solutions for its prevention and treatment. 1. 2. Objectives Primary objective of this research is to see how effective the health care management systems are for the diagnosis, treatment and prevention of dementia syndrome specially keeping in view the population of UK. 1. 3. Dementia defined The International Dictionary of Psychology (Sutherland, 1989) defines it as â€Å"an impairment or loss of mental ability, particularly of the capacity to remember, but also including impaired thought, speech, judgment, and personality. It occurs in senile dementia and in conditions involving widespread damage to the brain or narrowing of the blood vessels†. In the preceding definition, Sutherland introduced a different term, senile dementia. Senile is derived from the Latin adverb senex pertaining to age or growing old. This shows that some dementias occur at later or older ages for reasons not known. Definition of senile dementia as per The International Dictionary of Psychology is that it is â€Å"a progressive syndrome starting in old age with no clear cause, in which intellect, memory, and judgment are impaired; it is often accompanied by apathy or irritability† (Sutherland, 1989, p. 397). 1. 4. How common is dementia? In England only, there are approximately 570,000 people living with dementia. It is expected that this number would double in the coming 30 years (Barberger-Gateau, 2007). Generally dementia arises in people who are 65 years of age above. The chances of developing it are more as one gets old as compare to young people. Roughly, it is anticipated that dementia occurs in: †¢1. 4% of men and 1. 5% of women aged between 65 and 69, †¢3. 1% of men and 2. 2% of women aged between 70 and 74, †¢5. 6% of men and 7. 1% of women aged between 75 and 79, †¢10. 2 % of men and 14. 1% of women aged between 80 and 84, and †¢19. 6% of men and 27. 5% of women aged 85 or over. 2. LITERATURE REVIEW In the preceding paragraphs, we will discuss in detail the different kinds of dementia that occur to people at older age along with a number of causes that lead towards this syndrome. . 1. Types of dementia Following are the different types of dementia recognized so far (Davidson, 2005): †¢Alzheimer's disease, where tiny clusters of protein, known as plaques, start to build up around brain cells. This upsets the regular workings of the brain. †¢Vascular dementia, where troubles with blood distribution result in uneven supply of blood and oxygen to certain parts of the brain. †¢Dementia with Lewy bodies, where irregular structures, known as Lewy bodies, grow inside the brain. †¢Frontotemporal dementia, where the two parts of the brain, frontal and temporal lobes, start to shrink. Not like other types of dementia, frontotemporal dementia typically grows in people who are below 65 years of age and is very rare than other types of dementia. 2. 2. Different Kinds of Dementia Different kinds of dementing disorders exist. One way of classification is according to parts of the brain being affected. Some frequently used classifications are as follows: †¢Cortical dementia: This type of dementia damages the brain particularly affecting the brain's cortex, or outer layer. Problems such as memory, language, thinking, and social behavior results due to this disoder. Sub cortical dementia: It affects parts of the brain below the cortex and causes changes in emotions and movements along with damaging memory. †¢Progressive dementia: It gets worse with the passage of time, thus interfering more and more with cognitive abilities. †¢Primary dementia: This denotes to that form that does not result from any other disease such as AD. †¢Secondary dementia: This type of dementia occurs due to some physical disease or injury. †¢Treatable Dementia: About 10 percent of conditions that cause dementia are treatable. With treatment, the dementia can either be upturned or at least halted. Instances of conditions that cause treatable cases of dementia comprise of the following: ?Normal pressure hydrocephalus ?A brain tumor or brain cancer ?Hypothyroidism ?Vitamin B12 deficiency ?Neurosyphilis ?Reactions to medications ?Poisoning. †¢Non-Treatable Dementia: Types of dementia that currently have no cure include: †¢Lewy body dementia †¢Binswanger's disease †¢Frontotemporal dementia †¢Corticobasal degeneration †¢Certain conditions that can cause childhood dementia †¢HIV-associated dementia Other infections within the brain, such as Creutzfeldt-Jakob disease †¢Huntington's disease and other rare hereditary dementias †¢Head trauma, such as dementia pugilistica (also known as boxer's syndrome). Several types of dementia fit into more than one of these classifications. For instance, AD is considered both a cortical as well as progressive dementia. 2. 3Causes 2. 3 . 1Alzheimer's disease It is the most common cause of dementia, affecting around 417,000 people in the UK. German neurologist Alois Alzheimer first described Alzheimer's disease. According to him, it is a physical disease affecting the brain. All through the course of the disease, plaques and tangles develop in the brain, thus leading to the loss of brain cells. Shortage of some important chemicals in the brain also results due to this disease. These chemicals are concerned with the spread of messages within the brain. 2. 3. 2Vascular dementia Vascular dementia is the second most common form of dementia after Alzheimer's disease. It is caused by problems in the supply of blood to the brain. There are a number of conditions that can cause or increase damage to the vascular system. These include high blood pressure, heart problems, high cholesterol and diabetes. This means it is important that these conditions are identified and treated at the earliest opportunity. 2. 3. 3Dementia with Lewy bodies Dementia with Lewy bodies (DLB) is a form of dementia that has characteristics similar to both Alzheimer's and Parkinson's diseases. It makes around four per cent of all cases of dementia in older people. Lewy bodies, named after the doctor who first identified them in 1912, are tiny, spherical protein deposits found in nerve cells. Their presence in the brain disrupts the brain's normal functioning, interrupting the action of important chemical messengers, including acetylcholine and dopamine. Researchers have yet to understand fully why Lewy bodies occur in the brain and how they cause damage. 2. 3. 4Fronto-temporal dementia The term ‘fronto-temporal dementia' includes conditions such as Pick's disease, frontal lobe degeneration, and dementia associated with motor neurone disease. All these are due to damage to the frontal lobe and/or the temporal parts of the brain. These areas are responsible for our behaviour, emotional responses and language skills. . 3. 5Korsakoff's syndrome Korsakoff's syndrome is a brain disorder usually linked with heavy alcohol utilization over a long period. Sometimes it is referred to as ‘alcohol amnestic syndrome' ? ‘amnestic' meaning loss of memory ? although in rare cases alcohol is not the cause. Although Korsakoff's syndrome is not strictly speaking a dementia , people with the condition suffer loss of short-term memory. 2. 3. 6Creutzfeldt-Jakob disease Prions are contagious agents that onslaught the central nervous system and then occupy the brain, causing dementia. Known prion disease is Creutzfeldt-Jakob disease, or CJD. It was first reported by two German doctors (Creutzfeldt and Jakob) in 1920. 2. 3. 7Aids-related cognitive impairment Individuals with HIV and AIDS occasionally develop cognitive impairment – particularly in the later stages of their sickness. AIDS (acquired immune deficiency syndrome) is caused by the presence of the human immunodeficiency virus (HIV) in the body. HIV attacks the body's immune system, making the person affected more susceptible to infection. HIV-related cognitive impairment can be caused by: ? The direct impact of HIV on the brain Infections (called ‘opportunistic infections') that take advantage of the weakened immune system. 2. 3. 8Binswanger's disease Binswanger's disease is a unusual form of vascular dementia in which harm occurs to the blood vessels in the deep white matter of the brain. Symptoms of Binswanger's mostly occur in people over the age of 60 and it is usually linked with long-ter m hypertension. The disease chiefly affects memory and mental abilities such as thinking and learning. The individual may also experience mood swings, tremors, seizures and problems with walking. 2. 3. 9Huntington's disease Huntington's disease is a progressive inherited disease. It typically becomes obvious in adults in their 30s, even though it can occur earlier or later. There is also a puerile type of Huntington's, which affects children. The route of the disease varies for each person, and dementia can occur at any stage of the illness. 2. 4Diagnosis Diagnosis of dementia is based on the following: †¢History †¢Physical exam †¢Tests The process of identifying dementia is made only if two or more brain functions such as memory and language skills are extensively damaged without loss of consciousness. An early and precise dementia diagnosis can help in early treatment of dementia symptoms and maybe reversing the dementia or stopping its development, if the cause of dementia is reversible (such as normal pressure hydrocephalus, a brain tumor, or B12 deficiency). †¢Patient History History taking is a very important step in identifying dementia. It is important to know how and when symptoms developed and about the patient's overall medical condition. Is there any risk factor involved or there is any family history of similar symptoms along with any medication the person is taking. Physician also try to evaluate the patient's emotional state and the degree of day to day actions being affected in spite of of the fact that patients with dementia frequently are ignorant of or in denial about how their disease is affecting them. Typically the family members also deny the reality of the disease because they take this in the beginning as a usual procedure of aging. Therefore, additional steps are necessary to confirm or rule out a dementia diagnosis. †¢Physical Exam: A physical examination can help in the following: ?Rule out treatable causes of dementia Classify signs of stroke or other disorders that can add to dementia ? Identify indications of other illnesses, such as heart disease or kidney failure that can be related with dementia. A thorough neurological assessment is performed to evaluate the balance, sensory function, reflexes, and other functions of the patient and to spot signs of conditions that may have an effect on the diagnosis of dementia. †¢Tests Used in Diagnosing Dementia Tests that are used to diagnosis dementia include the following: ?Cognitive and neuropsychological tests (Mini-Mental State Examination (MMSE) ? Brain scans (MRI or CT scan) Laboratory tests ?Psychiatric evaluations ?Pre-symptomatic testing. †¢Cognitive and Neuropsychological Tests for Dementia Tests are done to measure memory, language skills, math skills, and other abilities associated to mental functioning to help them analyze a patient's condition precisely. A test called the Mini-Mental ® State Examination (MMSEâ„ ¢) is used to judge cognitive skills in people with assumed dementia. This test examines: ? Orientation ?Memory ?Attention Doctors also use a diversity of other tests and rating scales to categorize explicit types of cognitive problems and abilities. †¢Brain Scan Tests for Dementia Brain scans are carried out to recognize strokes, tumors, or other problems that can result dementia. A brain scan may also demonstrate cortical atrophy (the progressive loss of neurons causes the ridges to become thinner and the sulci to grow wider), which is the deterioration of the brain's cortex (outer layer) and is frequent in many forms of dementia. Brain scans can also spot changes in the brain's organization and function that would propose Alzheimer's disease. †¢Computed Tomography Scan or Magnetic Resonance Imaging The most general types of brain scans are computed tomography (CT) scans and magnetic resonance imaging (MRI). A CT scan of the brain frequently suggested in a patient with suspected dementia. These scans, which use x-rays to detect brain structures, can show evidence of: ?Brain atrophy ?Strokes and transient ischemic attacks (TIAs) ?Changes to the blood vessels ?Other problems (such as hydrocephalus and subdural hematomas). MRI scans use magnetic fields and focused radio waves to detect hydrogen atoms in tissues within the body. They can detect the same problems as CT scans but they are better for identifying certain conditions, such as brain atrophy and damage from small TIAs. †¢Electroencephalograms (EEGs) Electroencephalograms (EEGs) are another tool to assist in inspecting people with suspected dementia. In an EEG, electrodes are placed on the scalp over several parts of the brain in order to detect and record patterns of electrical activity and to check for abnormalities. This electrical activity can indicate cognitive dysfunction in part or all of the brain. Many patients with moderately severe to severe Alzheimer's disease have abnormal EEGs. An EEG may also be used to detect seizures, which occur in about 10 percent of people with Alzheimer's disease. It can also help diagnose Creutzfeldt-Jakob disease. †¢Other Brain Scan Tests Several other types of brain scans allow researchers to watch the brain as it functions. These scans, called functional brain imaging, are not often used as diagnostic tools, but they are important in research and they may ultimately help identify people with dementia earlier than is currently possible. Types of functional brain scans include: ?Functional MRI (fMRI): It uses radio waves and a strong magnetic field to measure the metabolic changes that take place in active parts of the brain. ?Single photon-emission computed tomography (SPECT): It shows the distribution of blood in the brain, which generally increases with brain activity. Positron emission tomography (PET): This scans can detect changes in glucose metabolism, oxygen metabolism, and blood flow, all of which can reveal abnormalities of brain function. ?Magneto encephalography (MEG): This can show the electromagnetic fields produced by the brain's neuronal activity. †¢Laboratory Tests for Dementia Doctors may use a variety of laboratory tests to help diagnose dementia or rule out other conditions, such as kidney failure, which can contribute to symptoms. A partial list of these tests includes: ?A complete blood count (CBC) Blood glucose test, which measures sugar levels in the blood ? Urinalysis ?Drug and alcohol tests (toxicology screen) ?Cerebrospinal fluid analysis (to rule out specific infections that can affect the brain) ? Analysis of thyroid and thyroid-stimulating hormone levels. ?A doctor will order only the tests that he or she feels are necessary to improve the accuracy of a diagnosis. †¢Psychiatric Evaluation The healthcare provider may recommend a psychiatric evaluation to determine if depression or another psychiatric disorder may be causing or contributing to a person's symptoms. Pre-Symptomatic Testing In most cases, testing people before symptoms begin in order to determine if they will develop dementia is not possible. However, in cases involving disorders such as Huntin gton's where a known gene defect is clearly linked to the risk of the disease, a genetic test can help identify people who are likely to develop the disease. Since this type of genetic information can be devastating, people should carefully consider whether they want to undergo such testing. 2. 5Treatment For about 10 percent of conditions that cause dementia, treatment is available that can help reverse or at least slow down its progression. Some examples of these treatable causes of dementia include: †¢A brain tumor †¢Normal pressure hydrocephalus †¢Hypothyroidism. For most cases, treatment does not exist to reverse or halt the disease's progression; however, this does not mean that nothing should be done. People with dementia can benefit to some extent from such things as medications and cognitive training. There are also options for the family to help them cope. 2. 6Risk Factors Scientists have found a number of risk factors for dementia that affect the likelihood of developing one or more kinds of dementia. While these are not causes of dementia, they may increase a person's chances of developing the symptoms referred to collectively as dementia. Some dementia risk factors can be treated or controlled and some cannot Some of these risk factors for dementia are modifiable, while others are not.. Also, certain risk factors are more likely to increase the risk for certain types of dementia. For example, the risk of vascular dementia is strongly correlated with risk factors for stroke. Finally, the more dementia risk factors you have, the greater your chances of having dementia. An example of risk factors for dementia that you cannot change involves getting older (the risk of dementia tends to increase with age). Other dementia risk factors you cannot control include having: †¢Age †¢A family history of dementia †¢Down syndrome †¢Mild cognitive impairment †¢History of a stroke. Dementia risk factors that you can control include: †¢Hypertension †¢hypercholesterolemia †¢Diabetes †¢Atherosclerosis †¢Smoking †¢Heavy alcohol use. †¢Homocysteine levels in the blood. There are also things that can be controlled that increase your risk for developing diabetes, atherosclerosis, and other conditions that may increase your risk of developing dementia. These include: †¢Being overweight or obese †¢Lack of physical activity †¢Unhealthy diet. ?Age Age is the utmost risk aspect for dementia. Dementia influences one in 14 people over the age of 65 and one in six over the age of 80. However, Alzheimer's is not limited to aged people: in the UK, there are 15,000 people under the age of 65 with dementia, although this figure is likely to be an underrated. ?Genetic inheritance Several people fear that they may become heir to Alzheimer's disease, and scientists are presently exploring the hereditary background to Alzheimer's. In most of the cases, the effect of inheritance appears to be minute. If a parent or other family member has Alzheimer's disease, probability of developing the disease is only a slight elevated than if there were no cases of Alzheimer's in the direct family. ?Environmental factors The ecological factors that may add to the onset of Alzheimer's disease have yet to be discovered. Not many years ago, there were concerns that revelation to aluminum might cause Alzheimer's disease. Nevertheless, these fears have largely been discounted. ?Other factors Because of the dissimilarity in their chromosomal structure, people with Down's disorder who live into their 50s and 60s may develop Alzheimer's disease. People who have had stern skull or whiplash wounds also come out to be at increased risk of developing dementia. Boxers who get frequent blows to the head are at risk too. Study has also revealed that people who smoke, and those who have elevated blood pressure or sky-scraping cholesterol levels, augment their risk of developing Alzheimer's. 2. 7 Care of people with dementia People with moderate and advanced dementia typically need round-the-clock care and supervision to prevent them from harming themselves or others. They may also need assistance with daily activities such as eating, bathing, and dressing. Meeting these needs requires patience, understanding, and careful thought from the person's caregivers. For people involved with dementia care, there are some important things to consider. These include such things as: †¢Making the home safe †¢Helping to reduce stressors †¢Providing mental stimulation. Good dementia care always involves the issue of driving. One of the hardest things to do is to take away a person's independence that comes with driving. However, for a number of reasons that we will explain later, people with dementia should not drive. 2. 7. 1Dementia Care and the Home A typical home environment can present many dangers and obstacles to people with dementia, but simple changes can overcome many of these problems. For example, sharp knives, dangerous chemicals, tools, and other hazards should be removed or locked away. Other safety precautions include: †¢Installing bed and bathroom safety rails †¢Removing locks from bedroom and bathroom doors Lowering the hot water temperature to 120 °F (48. 9 °C) or less to reduce the risk of accidental scalding. People with dementia should also wear some form of identification at all times in case they wander away or become lost. Caregivers can help prevent unsupervised wandering by adding locks or alarms to outside doors. 2. 7. 2Reducing Stressors People with dementia ofte n develop behavioral problems because of frustration with specific situations. Understanding and modifying or preventing the situations that trigger these behaviors may help to make life more pleasant for the person with dementia as well as his or her caregivers. For instance, the person may be confused or frustrated by the level of activity or noise in the surrounding environment. Reducing unnecessary activity and noise (such as by limiting the number of visitors and turning off the television when it's not in use) may make it easier for the person to understand requests and perform simple tasks. Caregivers may also reduce confusion in people with dementia by: †¢Simplifying home decorations †¢Removing clutter †¢Keeping familiar objects nearby †¢Following a predictable routine throughout the day. Calendars and clocks also may help patients orient themselves. . 7. 3Mental Stimulation as Part of Dementia Care Caregivers should encourage people with dementia to continue their normal leisure activities as long as they are safe and do not cause frustration. Activities such as crafts, games, and music can provide important mental stimulation and improve mood. Some studies have suggested that participating in exercise and intelle ctually stimulating activities may slow the decline of cognitive function in some people. 2. 7. 4Is Driving Safe? Many studies have found that driving is unsafe for people with dementia. They often get lost and they may have problems remembering or following the rules of the road. They may also have difficulty processing information quickly and dealing with unexpected circumstances. Even a second of confusion while driving can lead to an accident. Driving with impaired cognitive functions can also endanger others. Some experts have suggested that regular screening for changes in cognition might help to reduce the number of driving accidents among elderly people, and some states now require that doctors report people with Alzheimer's disease to their state motor vehicle department. However, in many cases, it is up to the person's family and friends to ensure that the person does not drive. 2. 7. 5How the local authority assesses need Local authority social services departments are the main providers of care and support services. If a person with dementia or their carer is in need of support, they should contact the local social services department to explain. The department will then carry out an assessment of the person's needs and identify what services would be appropriate to meet those needs. This is known as a community care assessment If the department assesses a person as being in need of certain services, it has a duty to provide the services that fall within their eligibility criteria (locally set rules on what type of needs the local authority will meet). The person may have to contribute towards the cost of these services. Local authorities can provide services directly themselves, or may make arrangements for private or voluntary-sector organizations to provide care on their behalf. Services ary from area to area, but range from those that allow someone to remain independent in their own home (such as meals on wheels, day care, equipment and home adaptations) to residential care. The views and preferences of the person receiving the service should always be taken into account. 2. 7. 6Care plans If, after assessing the person's care needs, the social services department agrees that certain services should be provided, it will give the person a written care plan out lining these services. This applies whether the person lives at home or in a care home. Care plans should be reviewed regularly and as needs change. If a review has not been carried out recently, or if one may be necessary, the person or their carer should contact social services and ask for a review. In addition, care homes must provide an individual care plan for each resident. This must be regularly reviewed to take account of changing needs. 2. 7. 7Thinking through the options Once the social services department has confirmed what services the person is eligible to receive, the person and their carer can begin to think through the options. Even if the assessment concludes that the person's needs are not yet urgent enough to receive help from social services, or if some services are not available under the local authority's eligibility criteria, an assessment will give everyone clearer information about the situation and the kinds of help available from other sources. The person or their family or carer could arrange services themselves, or through a voluntary organization or private agency. A key decision is whether the person can remain in their own home, or whether they would prefer to move into sheltered housing or a care home. If they stay in their own home, there are many additional support options available. It is also important to consider the financial implications of the options available. Social services should be able to give an idea of how much the person will have to pay towards the costs of the various services that are arranged through them. Services provided by the NHS, such as community nursing, are free. Anyone who is arranging services themselves, whether through a voluntary organisation or a private agency, will need to make their own enquiries. It is important not to rush into a decision. It might help to also talk to friends and relatives, other carers and your local Alzheimer's Society branch. Local voluntary organisations are a source of further information, advice and practical help. Below is some guidance about what to consider when you are thinking about the kind of care the person in question needs. 2. 7. 8Understanding and respecting the person with dementia It's very important that people with dementia are treated with respect. It is important to remember that a person with dementia is still a unique and valuable human being, despite their illness. If you can understand what the person is going through, it might be easier for you to realise why they behave in certain ways. When a person with dementia finds that their mental abilities are declining, they often feel vulnerable and in need of reassurance and support. The people closest to them – including their carers, health and social care professionals, friends and family – need to do everything they can to help the person to retain their sense of identity and feelings of self-worth. 2. 7. 9Helping the person feel valued The person with dementia needs to feel respected and valued for who they are now, as well as for who they were in the past. There are many things that the people around them can do to help, including: †¢trying to be flexible and tolerant †¢making time to listen, have regular chats, and enjoy being with the person †¢showing affection in a way they both feel comfortable with †¢finding things to do together. Our sense of who we are is closely connected to the names we call ourselves. It's important that people address the person with dementia in a way that the person recognises and prefers. Some people may be happy for anybody to call them by their first name or nickname. †¢Others may prefer younger people, or those who do not know them very well, to address them formally and to use courtesy titles, such as Mr or Mrs. Make sure you explain the person's cultural or religious background, and any rules and customs, to anyone from a different background so that they can behave accordingly. These may include: †¢respectful forms of address †¢what they can eat †¢religious observances, such as prayer and festivals particular clothing or jewellery that the person (or those in their presence) should or should not wear †¢any forms of touch or gestures that are considered disrespectful †¢ways of undressing †¢ways of dressing the hair †¢how the person washes or uses the toilet. Many people with dementia have a fragile sense of self-worth; it's especially important that people continue to treat them with courtesy, however advanced their dementia. †¢Be kind and reassuring to the person you're caring for without talking down to them. †¢Never talk over their head as if they are not there – especially if you're talking about them. Include them in conversations. †¢Avoid scolding or criticising them – this will make them feel small. †¢Look for the meaning behind their words, even if they don't seem to be making much sense. Whatever the detail of what they are saying, the person is usually trying to communicate how they feel. †¢Try to imagine how you would like to be spoken to if you were in their position. †¢Try to make sure that the person's right to privacy is respected. †¢Suggest to other people that they should always knock on the person's bedroom door before entering. If the person needs help with intimate personal activities, such as washing or using the toilet, do this sensitively and make sure the door is kept closed if other people are around. †¢Everyone involved – including the person's friends, family members, carers, and the person with dementia themselves – reacts to the experience of dementia in their own way. Dementia means different things to dif ferent people. There are lots of things you can do to help the person with dementia feel good about themselves. This factsheet offers some suggestions. When you spend time with someone with dementia, it is important to take account of their abilities, interests and preferences. These may change as the dementia progresses. It's not always easy, but try to respond flexibly and sensitively. Dementia affects people's thinking, reasoning and memory, but the person's feelings remain intact. A person with dementia will probably be sad or upset at times. In the earlier stages, the person may want to talk about their anxieties and the problems they are experiencing. †¢Try to understand how the person feels. Make time to offer them support, rather than ignoring them or ‘jollying them along'. †¢Don't brush their worries aside, however painful they may be, or however insignificant they may seem. Listen, and show the person that you are there for them. †¢Make sure that, whenever possible, you inform and consult the person about matters that concern them. Give them every opportunity to make their own choices. †¢Always ex plain what you are doing and why. You may be able to judge the person's reaction from their expression and body language. †¢People with dementia can find choice confusing, so keep it simple. Phrase questions so that they only need a ‘yes' or ‘no' answer, such as ‘Would you like to wear your blue jumper today? ‘ rather than ‘Which jumper would you like to wear today? ‘ †¢Avoid situations in which the person is bound to fail, as this can be humiliating. Look for tasks that they can still manage and activities they enjoy. ive plenty of encouragement. Let them do things at their own pace and in their own way. †¢Do things with the person, rather than for them, to help them retain their independence. †¢Break activities down into small steps so that they feel a sense of achievement, even if they can only manage part of a task. Our self-respect is often bound up with the way we look. Encourage the person to take pride in their appearance, and compliment them on how they look. Make sure that anyone involved in caring for the person has as much background information as possible, as well as information about their present situatio n. This will help them see the person they're caring for as a whole person rather than simply ‘someone with dementia'. It may also help them to feel more confident about finding conversation topics or suggesting activities that the person may enjoy. 2. 8How effective is heath care management? Health care management involves several techniques to cater the needs of the patient. It should be kept in mind that patient is not responsible for the disease and therefore should not be ignored or avoided. With the advancement in technology, different techniques can be used to look after the suffer of this disorder. However, these techniques and ways could only help the victim survive a bit since. Those kinds of dementia which are treatable and such patients have a different perspective and outlook of life as compared to those who are the victims of the untreatable ones. So the care also varies with these two kinds of patients. Effectiveness of the present day health care management system is satisfactory but as said earlier it cannot bring back the life of the victim, however could let him or her survive for few more days with a happy face. 3. DEMENTIA IN UK Following statistics give a clear cut idea about the ratio and proportion of dementia patients in UK: †¢There are currently 700,000 people with dementia in the UK. †¢There are currently 15,000 younger people with dementia in the UK. †¢There are over 11,500 people with dementia from black and minority ethnic groups in the UK. There will be over a million people with dementia by 2025. †¢Two thirds of people with dementia are women. †¢The proportion of people with dementia doubles for every 5 year age group. †¢One third of people over 95 have dementia. †¢60,000 deaths a year are directly attributable to dementia. †¢Delaying the onset of dementia by 5 years wo uld reduce deaths directly attributable to dementia by 30,000 a year. †¢The financial cost of dementia to the UK is over ? 17 billion a year. †¢Family carers of people with dementia save the UK over ? 6 billion a year. †¢64% of people living in care homes have a form of dementia. Two thirds of people with dementia live in the community while one third live in a care home. 4. LIVING WITH DEMENTIA People with dementia have become increasingly involved in the work of the Alzheimer's Society since 2000. Through a national programme called ‘Living with Dementia', people with dementia have been sharing their experiences and knowledge, and raising awareness of dementia at local and national levels. This contribution is crucial to ensure that the Alzheimer's Society develops appropriate information and support for people with dementia. It ensures that people with dementia can influence the work that the Society carries ut on their behalf. On a national level the Living with Dementia programme consults with people with dementia in support of the Alzheimer's Society's work of influencing government policy. †¢People with dementia in action People with dementia are involved in the Alzheimer's Society in a variety of ways: ? Giving presentations and raising public awareness. ?Organising the unique UK wide convention of people with dementia. ?Lobbying MPs and commenting on government legislation. ?Being interviewed by national press and television. ?Recruiting and inducting new staff at the Alzheimer's Society. ?Helping to make the website easier to use. Developing information for other people with dementia and their families. ?Participating in the national consultative body, the Living with Dementia Working group. These are just a few examples. There are many opportunities in the Living with Dementia programme †¢Living with Dementia Programme Various initiatives in the Alzheimer's Society have focused on ways of supporting people living with dementia. Many started as two year pilots in 2001 and 2002, but are now established as a core part of the Alzheimer's Society activity. Examples of current initiatives are listed below: †¢West Kent Computer project Started in 2001. It supports people with dementia using computer equipment, to find new ways of communicating, pursuing interests and have fun. †¢Living with Dementia presentation skills training For people with dementia. Everyone affected by dementia has their own unique story to tell. Personal experiences and views are a powerful way of raising awareness about dementia, making issues come alive. Training people with dementia to share their experience on TV, press and at meetings, helps to reduce the misunderstanding that surrounds dementia and offers hope to people facing the same situation. Providing key skills enables people to undertake publicity work with confidence. †¢Helpcard for people with dementia Developed in 2007 by people with dementia and piloted by people with dementia. The helpcard enables people with dementia to feel confident, not alone and able to ask for help at anytime. It is very useful in emergency situations, and is an effective communication tool that informs others of a person's circumstances. There are three different designs, with three different options for describing particular situations. †¢National conference for people with dementia The Alzheimer's Society has hosted three conferences for people with dementia in London, Newcastle and Birmingham (Thompson, Nanni & Schwankovsky, 1990). The latter two involved members from the Living with Dementia Working group and the Scottish Dementia Working Group, making them the only UK wide events for people with dementia. In Newcastle the ‘Improving Our Lives' feedback included: ?Get out and enjoy life ?Laugh! Confidence ?Remaining the same person after diagnosis ?Open positive communication ?Speak up – have your voice listened to ?Speak to your MP Being denied treatment – medication because of a ‘cost cutting' exercise – it's a disgrace ? Set up an email group ?Done more since having dementia – living my life to the full 5. RESEARCHES Currently, scientists are conducting research on many different aspects of dementia. This research promises to improve the lives of people affected by such symptoms and may eventually lead to ways of pre venting or curing the disorders that result in dementia. Some areas of focus for dementia research include: †¢Causes and prevention †¢Diagnosis †¢Treatment. Researching the Causes and Prevention of Dementia Research on the causes of Alzheimer's disease (and other disorders that are causes of dementia) includes studies of: †¢Genetic factors †¢Neurotransmitters †¢Inflammation †¢Factors that influence programmed cell death in the brain †¢The roles of tau, beta amyloid, and the associated neurofibrillary tangles and plaques in Alzheimer's disease. Some other dementia research scientists are trying to determine the possible roles of cholesterol metabolism, oxidative stress (chemical reactions that can damage proteins, DNA, and lipids inside cells), and microglia in the development of Alzheimer's disease. Current research on dementia prevention and causes includes the following: †¢Research to better understand the role of aging-related proteins (such as the enzyme telomerase) in the development of dementia. †¢Studies of abnormal clumps of proteins in cells. Researchers are trying to learn how abnormal clumps of protein in cells develop, how they affect cells, and how the clumping can be prevented. †¢Studies that examine whether changes in white matter — nerve fibers lined with myelin — may play a role in the onset of Alzheimer's disease. Myelin may erode in Alzheimer's disease patients before other changes occur. This may be due to a problem with oligodendrocytes, the cells that produce myelin. †¢Work being done by scientists to search for additional genes that may contribute to Alzheimer's disease. These researchers have identified a number of gene regions that may be involved in the development of Alzheimer's. Some researchers suggest that people will eventually be screened for a number of genes that contribute to Alzheimer's disease and that they will be able to receive treatments that specifically address their individual genetic risks. However, such individualized screening and treatment is still years away. †¢Studies on insulin resistance. Insulin resistance is common in people with Alzheimer's disease, but it is not clear whether the insulin resistance contributes to the development of the disease or if it is merely a side effect. †¢Several dementia research studies have found a reduced risk of dementia in people who take cholesterol-lowering drugs called statins. However, it is not yet clear if the apparent effect is due to the drugs or to other factors. Therefore, more research is being currently being done be better understand this possible relationship between statins and dementia. †¢ A 2003 dementia research study found that people with HIV-associated dementia have different levels of activity for more than 30 different proteins, compared to people who have HIV but no signs of dementia. The study suggests a possible way to screen HIV patients for the first signs of cognitive impairment, and it may lead to ways of intervening to prevent this form of dementia. Research in this area continues. Research Involving Diagnosis of Alzheimer's Disease Improving early diagnosis of Alzheimer's disease and other disorders that may cause dementia is important not only for patients and families, but also for researchers who seek to better understand the causes of dementia and find ways to reverse or halt them at early stages. Improved diagnosis can also reduce the risk that people will receive inappropriate treatments. †¢In some resea rch, scientists are investigating whether three-dimensional computer models of positron emission tomography (PET) and magnetic resonance imaging (MRI) can identify brain changes typical of early Alzheimer's disease, before any symptoms appear. This research may lead to ways of preventing the symptoms of Alzheimer's disease. †¢One study found that levels of beta amyloid and tau in spinal fluid could be used to diagnose Alzheimer's disease with an accuracy of 92 percent. If other studies confirm the validity of this test, it may allow doctors to identify people who are beginning to develop the disorder before they start to show dementia symptoms. †¢This would allow treatment at very early stages of the disorder, and may help in testing new treatments to prevent or delay symptoms of the disease. Other researchers have identified factors in the skin and blood of Alzheimer's disease patients that are different from those in healthy people. They are trying to determine if these factors can be used to diagnose the disease. Treatment Research †¢Researchers are continually working to develop new drugs for Alzheimer's disease and other causes of dementia. Many researchers believe a vaccine that reduces the number of amyloid plaques in the brain might ultimately prove to be the most effective treatment for Alzheimer's disease. In 2001, researchers began one clinical trial of a vaccine called AN-1792. The research study was halted after a number of people developed inflammation of the brain and spinal cord. †¢Despite these problems, one patient appeared to have reduced numbers of amyloid plaques in the brain. Other patients showed little or no cognitive decline during the course of the study, suggesting that the vaccine may slow or halt the disease. Researchers are now tryi ng to find safer and more effective vaccines for Alzheimer's disease. Researchers are also investigating possible methods of gene therapy for Alzheimer's disease. In one case, researchers used cells genetically engineered to produce nerve growth factor and transplanted them into monkeys' forebrains. The transplanted cells boosted the amount of nerve growth factors in the brain and seemed to prevent degeneration of acetylcholine-producing neurons in the animals. †¢This suggests that gene therapy might help to reduce or delay symptoms of the disease. Researchers are now testing a similar therapy in a small number of patients. Other researchers have experimented with gene therapy that adds a gene called neprilysin in a mouse model that produces human beta amyloid. They found that increasing the level of neprilysin greatly reduced the amount of beta amyloid in the mice and halted the amyloid-related brain degeneration. They are now trying to determine whether neprilysin gene therap y can improve cognition in mice. †¢Since many studies have found evidence of brain inflammation in people with Alzheimer's disease, some researchers have proposed that drugs that control inflammation, such as NSAIDs, might prevent the disease or slow its progression. Studies in mice have suggested that these drugs can limit production of amyloid plaques in the brain. Early studies of these drugs in humans have shown promising results. †¢However, a large NIH-funded clinical trial of two NSAIDs (naproxen and celecoxib) to prevent Alzheimer's disease was stopped in late 2004 because of an increase in stroke and heart attack in people taking naproxen (Aleve ®, Naprosyn ®, Anaprox ®, Naprelan ®), and an unrelated study that linked celecoxib (Celebrex ®) to an increased risk of heart attack. Some research studies on dementia have suggested that two drugs, pentoxifylline and propentofylline, may be useful in treating vascular dementia. Pentoxifylline improves blood flow, while propentofylline appears to interfere with some of the processes that cause cell death in the brain. †¢One research study is testing the safety and effectiveness of donepezil (Aricept ®) for treating mild dementia in patients with Parkinson's dementia, while a nother is investigating whether skin patches with the drug selegiline can improve mental function in patients with cognitive problems related to HIV. . CONCLUSION An appropriate cost effective workup of dementia includes a complete history, a complete physical examination (including a neuropsychiatric evaluation), a CBC, blood glucose, serum electrolytes, serum calcium, serum creatinine, and serum thyroid stimulating hormone (Whitlatch, Feinberg & Tucke, 2005). Other tests should be done only if there is a specific indication for e. g. vitamin B12 and folate if macrocytosis is present (Wilkinson & Lennox, 2005). A CT or MRI should be considered if the onset of dementia is before the age of 65 years, symptoms have occurred for less than 2 years, there is evidence of focal or asymmetrical neurological deficits, the clinical picture indicates normal pressure hydrocephalus, or there is a recent history of fall or other head trauma. If a patient has a history of cancer or is on anticoagulation therapy, then neuro imaging should also be considered. Thus to conclude, it is sufficient to say that dementia, though a dangerous disorder, having not much cures, can be prevented by undergoing certain precautionary measures as illustrated above.