Sunday, March 31, 2019

The Formation Of Malaysia 1963 History Essay

The brass Of Malaysia 1963 History Essay creationThe procedureation of Malaysia is on 16 folk 1963. Tunku Abdul Rahman proposed Malaysia and capital of capital of capital of capital of Singapore made, Sabah, Sarawak and B excreteei in the British colony constitution. All four colonies ab initio agreed to join the Federation. - -However, this suggestion was objected to, because they claim the Philippines claim Sabah. The proposal overly received from Indonesia opposed to it as a conspiracy of neo-colonialism by the Sukarno and the right on Indonesian communistic Party of view.In 1955, and later in 1959, Singapore had suggested that it be fused with Malaya. But this proposal was rejected Malaya. At that time, Singapores creation including China and Malaysia worried that this may affect the racial piece of writing, which is mostly Malay. in that respect atomic number 18 too concerns, the Communist Party, their activities be still rampant in Singapore, Malaya and obstacle s that may affect the struggle to eliminate the threat of fabianism.- -However, four geezerhood later, the Malaysia license, Tunku Abdul Rahman, the Malayan Prime Minister, democracy that he said in his diction proposed nuclear fusion of Malaya, Singapore and the Borneo territories of Sabah, Sarawak, and Brunei took the part by surprise on twenty-seventh may 1961. Because the evoke of politics and delivery in Singapore and the a nonher(prenominal) territories so his suddenly change his mind.The proposal in addition to accelerate in Sarawak, Sabah and Brunei, the immediate effect of political development. Election for the first time to be held in Brunei and Sabah in 1962. However, continued Philippine and Indonesian opposition light-emitting diode to the sending of a United Nations mission to Borneo in 1963, which also report that the public opinion was in favoured of joining Malaysia. Brunei then pulled out due to an armed revolt staged to oppose its entry to Malaysia. Singapore was use of the newly formed Malaysia in 1963 only withdrew in 1965.ANSWERWhat ar the factors that affect the formation of Malaysia? Factors that led to the proposed conjugation because of Tunku Abdul Rahman is have with the desire for scotch purposes, Singapore is one of them. Singapores large industrial enterprises and large universe of discourse, added as an burning(prenominal) trading port in the region for more than one position. Tunku Abdul Rahman is also trying to get rid of the colonial these colonies. Malaya independence has reached four historic period ago. Although Singapore has implemented a large extent, an autonomous form _or_ system of government, Sabah and Sarawak, Britain is still genuinely(prenominal) much under control.In Brunei, Sudan to maintain his autocratic power, just now the residents were force to receive advice from the UK. Tunku Abdul Rahman believes that a merger with Malaya pass on speed up these colonies independence from Brita in.- -An otherwise factor is the bastion of communism more than Singapore. Over time, their activities did not stop. And then by Singapores Minister Mentor Lee Kuan Yew, who, with disputes about the tap in the mid 50s frustration, led to the decision of his Government to draw whatsoever(a) of the Communists, hoping to find favor with them, and last soften their blow. However, continue to adhere to the activities of the Communist Party and eventually formed his own political party, known as the Socialist Front, they were forced to resign from the government. Fear of Malaya provide be in grave danger should corroborate the CPC decided to cross-strait their allies in Malaya, Tunku Abdul Rahman believes that the merger with Singapore will make it easier to deal with the Communists.- -In addition to Singapore, Sarawak, communism is also booming, where the Communist Party formed an underground association, to play its associations of workers and peasants of the students. In addition, there are in the midst of these areas of cultural similarity. United Overseas composition of the world, and there is a Malayan Malays, Chinese and Indians mixed array. By some members of UMNO Malays outnumbered by the initial fear of being dispersed, they were convinced that the social sense of equilibrium will be a Borneo territories, including most of the Malays and native groups, and the Malay Asia combined re savvyy.The factors that affect the formation of Malaysia are also avoids the threats and communist influence by other territories. More and more, the independence of Sabah, Sarawak, Brunei and Singapore also need to cover up. The defense of indigenous communities and the safeguard the interest of indigenous rights in Sabah and Sarawak are very important for Tunku Abdul Rahman to take care and concern about it.Who is swelled the phone numbers the formation of Malaysia? That is Sabah, Sarawak, Brunei and Singapore. Their response are very important when formation of M alaysia. And also the process of formation of Malaysia is important too. The process is Malaysia solidarity military commission, Cobbold equip, inter-governmental committee, and Singapore referendum.Sabah is giving the issue about the party pro-anti Malaysia, Sarawak is giving the issue about there are no stinting different, Brunei is giving the issue about believe that they brook independence by their own, no need depend with others, while Singapore is giving the issue about the party people of Singapore.The chairman of Malaysia solidarity advisory committee is Tun Haji Mohammad Fuad Stephens, previously known as, Donald Stephens. He contend a key role in negotiating the independence of Sabah. He collects the data from the citizen to form the formation of Malaysia. Malaysia Solidarity Consultative Committee (MSCC) to inform the people of the benefits of the merger.The chairman of Cobbold missionary station is Lord Cobbold. He is going to Sabah and Sarawak to collect the data from the citizen when formation of Malaysia. He will discuss the merger of Sabah and Sarawaks response. Two months later, received thousands of letters to and Sabah and Sarawak and the many public meetings of the thousands of interviews, come to a consensus. Only one-third of third of the population rejected the merger, want to join Malaya before achieved their independence. Wholeheartedly support the merger or other two-thirds or support, on the grounds that its rights be retained. won the majority in favor of the merger, which is approved by the British.The chairman of Inter-governmental committee is Lord Landsdowne and Tun Abdul Rayak. The function of inter-governmental committee is forming a Federation of Malaya. It is concentrated on Islam, Malay, education and integration.In Malaya, Singapore remains, so the initial interest, eager to merge with Malaya, Tunku Abdul Rahmans proposal in 1961. His efforts paid off, September 1, 1962 referendum showed that 71.1% of the population , Singapore supported the merger. Singapore is committed to autonomy, education, income and labor, while the central government will operate in Kuala Lumpur. Its free entrepot status will also be maintained. such as Singapore, Brunei, also keen to merge because of its ruler, Sultan Ali Saifuddin was hoping to get greater protection from the likes of Malaya. AM Azahari, the opposition party, the party discipline Front leader, hardly strongly against the merger, and which resulted in one of the Brunei government, he was defeated in the resistance. Azahari an ulterior motive merge all the territories and the North Borneo Brunei placed in their reins.When the organic law of Malaysia, Indonesia and the new establishment rejected due to their own ulterior motives, Philippines. Sabah claimed by the Philippines, pointed out that the Sultanate of Sulu under the Sabah belongs to the Philippines came. Therefore, the Philippines is not recognized as an independent state official statement s or the occurrence of on16th September 1963 Malaysia.- -CONCLUSIONHowever, North Borneo and Singapore declared August 31, 1963 sovereignty. Indonesias opposition, and later upgraded to a military conflict with Malaysia. Indonesia, Sarawak and Sabah as the colonial province of new forms of Borneo Island in Malaysia (b regulariseing Kalimantan, Indonesia), they laid claim.In order to look into that Indonesia, Malaysia is not neo-colonialism, a referendum by the United Nations and Lord Cobbold Commission Cobbold leadership, organization, form, substantial to determine whether the people of Sabah and Sarawak wished to join Malaysia. The end result, which indicates strong support for Malaysias Sabah and Sarawak amid people, Malaysia has paved the way, and declared the road.OF Federation of Malaysia subsequently announced the formation of 16 September 1963, Malaysia. Independence Day celebration is still held on August 31, the original Malaya Independence Day.Malaysia has enjoyed 53 y ears of independence, is known as a sovereign state of the world. We can achieve the economic, political and well-disposed stability, to the developed countries rapidly. Although Malaysia is a pluralistic ordering, different ethnic composition, they can live, vernacular cooperation, some(prenominal) in uniformity to build a strong and developed state of matter presence. Understanding between races, but also created theme hotshot, played in shaping the political stability of Malaysia as a very important role in the country.QUESTION 22.1 INTRODUCTION bran-new economic constitution (NEP) is a socio-economic program in the Malaysia which was introduced in 1971 by Prime Minister Tun Abdul Razak, Dato Hussein. Implementation of divide and rule policy will ecstasy the British in the Malay community cohesion. The British were promote the arrival of labor from China and India in the interest of the colonial economy of tin mining, trading and farming. Separation of Singapore from M alaysia in 1965 due to the imagination of Malaysia to the Philippines which was not directly dispute the status and privileges of the Malays has diapi-naming of Lee Kuan Yew fueled anti-Chinese and anti-Malay. spread over events that occurred on May 13, 1969 have revealed the true manifestation of the feelings of the three largest ethnic groups in Malaysia. Bloody events also forcing the government to declare a state of emergency. This declaration has led to a parliamentary system of government is suspended. Since the Japanese occupation during the Second World War, Japan adopted a policy of anti-Chinese and pro-Malay bias has angered the Chinese and the Malays. National Consultative Council was established to run across the effectiveness of the NOC, the National Consultative Council which is responsible for discussing and reviewing issues of national unity and make up ones mind to find a way multi-ethnic society.Unity to be achieved not only involve the consolidation race but wa s found to be economic and social unification should be done. In connection with the National Consultative Council have agreed to form a national ideology that became known as the Pillars of the five key principlesKepercayaan kepada TuhanKesetiaan kepada Raja dan NegaraKeluhuran PerlembagaanKedaulatan Undang-UndangKesopanan dan KesusilaanNew frugal Policy was established through the Majlis Perundingan Negara as a catalyst to egest meagreness and restructure society. Majlis Perundingan Negara also recommended the government to create the Jabatan Perpaduan Negara to implement the activities of the Muhibah in the form of Muhibah and Pejabat Muhibah at the federal, state, region and area has been established under the commissariat of the Essential Regulations (Pejabat Muhibah) 1969 which was gazetted on July 18, 1969.- -- -- -2.1.1 ANSWERThe objective of NEP was national unity but it also aims to restructure the socio-economic instability that exists in this country. As we know th at a balanced distribution of economic importance in creating a joined nation, as well as taking into account the impoverishment and the unfitness of some people to compete with other people then the NEP was knowing to improve the situation.The uncreated objective of this introduction is to create national unity by reducing the economic, social, cultural, placement and so forth. n other words, DEBs designed to eliminate race in the country with all the general poverty among the Malays and other Bumiputras, this is precisely the most particular and the earliest settlers of the country. DEB will ensure that all ethnic Malays and Indians in particular, will be the similar for Chinas successfulness. In these times, until today, our leaders believe that when all the games are the same country will enjoy stability and prosperity, peaceableness and harmony.With the equitable sharing of the prosperity of all, the three main competition will be happy and conform to in Malaysia, which w ill greatly help in the maintenance of peace and harmonious country. With the new economic policy, the Government must ensure that the May 13, 1969 racial riots will not happen again in the future.With advert share of prosperity all, the three major races in Malaysia will be happy and contented this will contribute greatly in maintaining peace, and harmony in the country. With the New Economic Policy, the government wants to ensure that the incidents of racial riots of 13 May 1969 will never happen again in the future.2.2 INTRODUCTIONThe tension between those who are wealthy and not wealthy is a result of poverty. It was found that the Malays are facing more poverty than other races. Found also the Malays are still lagging behind and little able to compete with other races even though Malaysia had good economic growth. The NEP was designed as a long-term program that will run for 20 years, starting from 1970 to 1990. Development plans under the New Economic Policy is carried out t hrough a two-pronged strategyrestructuring of society to reduce and eventually eliminate the identification of race with economic function.eradication of poverty disregarding of race2.2.1 ANSWERGoals of poverty eradication is achieved, the strategy focused on eliminating poverty in rural and urban areas. Based on 1970 population census shows that about 49.3% of all poor families in the Philippines income below the poverty line (income poverty line 1970 population is RM200.00) and about 86% of that number are in rural areas.To achieve this objective, the government has implemented a variety of services and facilities through the provision of education, health, water and electricity. In addition, option is given to the poor to get help, such as fertilizer aid assistance program, educational scholarships and textbooks, supplementary food to children and low-cost housing program. bring forth employment opportunities for all groups of people who are unemployed. To provide opportunitie s for transfer of persons workings in low productivity sectors to more lucrative sectors. Increase the productivity and income. Reducing the income gap between races between urban and rural areas and between regions and also modernize rural life. Need to establish indigenous groups and moneymaking(prenominal) companies. Organize a working environment that reflects the racial composition in Malaysia.- -Toward the end date of the NEP, the objectives to eradicate poverty have been achieved.To ensure that both goals were achieved in the NEP, the government has tried to improve the economic situation and at the same time, eliminating the identification of race with economic function. Based on the imbalance between the races, the government has launched several programs such as industry and trade, agriculture, mining, construction, stockpile and agriculture. To achieve the second goal of the NEP, various strategies have been designed, includingReducing the imbalance in the structure o f employment to the participation of various races in the primary sector will reflect the position of the labor force by 1990 the racial composition.Adding to the fast part of the people of Pakistan in possession of the fecund sector. Special attention will be focused on indigenous people are a bit behind compared to other races. elevation productivity and living standards of poor people in rural areas.To ensure the establishment of a commercial and industrial community among the Malays and natives as they negociate and own at least 30% of all levels of economic exercise such as MARA, Bank Pembangunan, Bank Bumiputera, Amanah Saham Nasional.Advancing the state and region that are considered backward by the new regional development such as DARA, KESEDAR, KEJORA and so on.2.2.2 CONCLUSIONAs a conclusion, New Economic Policy, aimed at national unity through poverty eradication and restructuring of society in the context of a strong national security. All national development program s and policies introduced by the government during planned and implemented to achieve the supra objectives. This will require not only the determined efforts of the government and its employees, but it requires a change of attitude, energy and mindset of people from the private sector.Although the NEP was hailed in some quarters as having reduced the socioeconomic disparity between the Chinese minority and Malay majority, others accused it of having reduced non-Malays to the status of inferior citizens by cementing ketuanan Melayu (Malay supremacy). The NEP is often invoked as part of the Malay Agenda, which is in turn part of the Malaysian social contract granting Malays special rights in deliver for citizenship for non-Malays.

The Makeover Beauty Salon Marketing Essay

The Make everywhere steady dish parlour tradeing EssayIntroductionThe Makeover lulu beauty shop is a beauty beauty shop that aims at rendering maximum client cheer by providing the better(p) serve, using eminent quality products, and building a pleasant environment at an holdable price, to meet the watch of customers of both social status. I am the possessor of The Makeover sweetie beauty beauty shop and I perceive an un live up to customer need for a low-cost beauty parlor that provides maximum flexibility and great customer attention. Using this strategy, The Makeover saucer salon volition gain much reputation and pee long-term relationships with its customers.The Makeover sweetheart Salon is the only atomic number 18a salon to be on transmission line and fully miscell each and go out gain the most aggressive foodstuffing campaign of any some other(a) bea salon.The Makeover sweetie Salon lead target deuce variant market segmentsyoungsters tes tament typic eithery win up 70-75% of the clientele.Young mothers with children.http//www.bplans.com/ blur_salon_ condescension_plan/images/bc49aab41b914ef99dca65af1ff71a82.pngFuture OpportunitiesThe main segment of the population that is targeted by the salon is the younger generation, which is the youth. It has been noniced that adolescents wish incompatible and bran- bleak locutions, which are apart from others. They give care to look very limited and The Makeover Beauty Salon has alone the operator to satisfy the needs of the main targeted group.This opportunity pull up stakes be researched and substantial on a trial basis. For guinea pig, every weekend, citizenry can go to the salon and i exit do their take upup or hairs-breadth. If successful, it could draw a major radical source of income without creating the need for additional ply or production space.The management team of The Makeover Beauty SalonI go away be the only omnibus of the salon. I peris h alone render as assistant, Miss Shazia. The latter takes the responsibility of supervising the workers when I forget not be present at the salon. Miss Shazia has a phase in management of salon and she has two years of experience from some other salon.I nurse similarly appointed two caretakers, Mrs Aisha and Miss Dolly, who pull up stakes take care of customers children when the customers exit be pampering themselves. Growth opportunities modify employee retention within our industry. The salon ac contendledges the need for growth of the individual.II The patronageThe companyAfter a tedious search for a suited place for the salon, finally one was found at the centre of the island. The post of the salon would be perfect, as it can welcome customers from all over Mauritius. The exact location is in the centre of Curepipe. The recently completed highroad in the surrounding laissez passershundreds of thousands of local residents, shoppers from outside the area, and travel ers that use this new highway.With this high concentration of customers thereis no big and sophisticated salon in the locality. This is one of the main advantages of stretching the salon at that particular location. operate and products offeredThe Makeover Beauty Salon is considered an innovating beauty salon which offers a wide stray of go that intromitHair takes, relaxers, perms, colors, shampoo, conditioning, curling, reconstructing, weaving, and wavingNailsmanicures, pedicures, polish, sculptured nailsSkin likeEuropean s pillowcaseh cranial nerves, body waxing, massageMakeup bridal constitution, casual makeup, baronial makeup, amongst othersService is offered on a bye-in basis or by appointment. The Makeover Beauty Salon go forth emphasize a customer-centric service where the customers needs are always the priority.The Makeover Beauty Salon will also switch hair care products, which is forecasted to account for active 15% of bargains. These professional-quality supp lies will allow shampoos, conditioners, brushes, combs, and other styling aids.Company Over takeThe Makeover Beauty Salon is located in Curepipe and will offer inexpensive priced, convenient hair styling. The Makeover Beauty Salon will accept walk-ins as well as appointments for the entire family. The salon will grow its market share based on superior customer attention. The Salon is a family hair salon, also known as a riotous hair salon and this new salon has everything to set up a new path and disguise people in an unhoped-for way. It is owned by Miss Chellen, who has recently returned from the United States, with innovative ideas, afterwards advanced studies about the fashion and makeup line, and also in beauty salon management.Company OwnershipThe Makeover Beauty Salon will be entirely owner by me. I bring done a stage in Beauty Salon management and a degree in General Cosmetology in the United States. I also worked in a salon for more than than 5 years there. I have a very friendly cost in the salon and when I am tutoring.Salons motto The trend begins hereVision MissionThe Makeover Beauty Salons vision is to create a harmonious, productive, and profitable salon environment, supplying the biotic community with Avon cosmetology.The mission statement is very clear The Makeover Beauty Salon has been accomplished to set a new path in the beauty line by providing an exceptional service which aims at satisfying people of all age. Through its services, the salon aims at exceeding customers expectations.ObjectivesTo cater for the fast changing trends of makeup and hairstyles.To make people look more special and contrastive from others.To supply services and products that enhances our clients physical appearance and mental relaxation.Keys to Success make out up the salon in a location easily cordial to everyone.The environment should be very appealing, friendly and relaxing.Try to be as innovative as possible in styles.Dare to try something new. ma ke at complete customer propitiation by offering the best service at affordable prices.The Makeover Beauty Salon can best be described as presently universe in the care of cosmetology, education, and wellness. In recent times our anchor strengths have been customer service.The Makeover Beauty Salon will use automation to pass on hold of clients. check to studies, it takes 3 times the amount of effort to attract a new client than the effort to retain a satisfied client. at present, 10% of all salons are automated. in the vicinity, 3 salons are automated and none use the technology to market and track clients. Automation is a key to growing and maintaining our target market.Goals and ObjectivesIt is the goal of The Makeover Beauty Salon to provide the community with an institution of cosmetology that targets all socioeconomic standings and is a model for the industry nationally. inaugural SummaryAfter several(prenominal) months of search for a salon to purchase, the owner decide d to start a salon from the ground up. The Makeover Beauty Salon will incur the following start-up beComputer with point of sale terminal.Computer with printer for back office.Five cutting commits, each station requires a groom chair, cabinet, large mirror, blow dryer, curling iron, electric razor, several pairs of scissors, spray bottle, two sided mirror, and assorted combs and brushes.Desk for reception area.Three couches for the reception area. uncover shelf for sale of retail products.Assorted plants.Assorted toys for the children. efficacious fees for business formation and generation/review of contracts.http//www.bplans.com/hair_salon_business_plan/images/6ff2aec4851d460cb0a964e4122e4fa2.pngStartup fundingStart-up Expenditure to storehouse$2000Start-up Assets to Fund$104,000 centre accompaniment Required$106,000AssetsNon-cash Assets from Start-up$8,450 immediate payment Requirements from Start-up$89,720Additional change Raised$0 coin Balance on Starting find$89,720 cont ribute Assets$98,170Liabilities and big(p)Liabilities ongoing borrowing$0 long-term Liabilities$40,000Accounts collectible (Outstanding Bills)$0 some other receive Liabilities (interest-free)$0 bestow Liabilities$40000Capitalplotted enthronisationChellen$100,000Investor 2$0Other$0Additional enthronization Requirement$0Total Planned Investment$100,000Loss at Start-up (Start-up Expenses)($1,100)Total Capital$98,900Total Capital and Liabilities$104,000Total Funding$106,000Start-upRequirementsStart-up ExpensesLegal$1,000Stationery etc.$100Other$0Total Start-up Expenses$2,000Start-up AssetsCash Required$89,720Other latest Assets$0Long-term Assets$7,000Total Assets$104,000Total Requirements$106,000III Management TeamI will be running(a) full time at the Makeover Beauty Salon. She will be in charge of all recruitment and training, purchasing, and retail sales. Apart from the assistant manager and the two caretakers, I will also employ a receptionist totake care of all of the appo intments as well as the people who walk in, and be responsible for the point of sale.The receptionist will be paid an periodical wage. I even plan to hire some part-time hair stylists during wedding periods and the eves of festivals, which will operate on an hourly/ thrill basis.I thought of using a partial commission basis to create incentives for greater customer attention. The better service employees provide to their customers, the greater customer satis evention will be derived and the more money they will make off commissions. Miss Chellen will be pleased to pay for this character reference of performance.IV Organizational StructureThe formal structure of The Makeover BeautyThe New looking for salon will be like a flat organisation structure. It is supervised closely by the founder. Thus, efficiency is maintained and so is the satisfaction of customers. The salon is structured as follows in the diagram below. sendorChildren Caretakers film director of salonAssisstant Mana gerPart-timersPart-timersPart-timersDiagram 1 This represents the business structure.Intellectual airscrewThe patent license, trademark and copyright agreements have al make up been applied for approval.V Industry AnalysisSWOT AnalysisStrengthsoutstanding location.Well-qualified employees with advanced hair cutting skills with a wide style collection, andCustomer-focused business practices.A wide range of services offered. Cutthroat prices.WeaknessesAs a new entrant to the market, The Makeover Beauty Salon lacks brand equity that many other salons have gained over years of service.Large costs related with a start-up company.OpportunitiesA steady growing market that is traditionally unaffected by the economic environment.The ability to decrease marginal fixed costs as the customer base grows.Increasing sales opportunities as more people from an individual family visits The Makeover Beauty Salon.ThreatsCompetition from already established salons.A change in traffic patterns as they relate to the mall where The Makeover Beauty Salon is located.The hair styling industry is highly divided with national chains, some of which operates several(a) franchises catering to all the market segments, and also including thousands of mom and pop salons that are very limited in scale and services. This makes for an extremely aggressive market that has low barriers to entry and exit. Moreover, the customers of hair styling have considerable control imputable to the low switching costs they have. However, most companies have tried to lease only one general strategy in gaining more reputation. The Makeover Beauty Salon is of the view that that it is possible to offer a differentiated service through superior customer service at no greater considerable cost if the right employee incentives are provided.With this strategy in mind, the salons map is to boost the number of clients served by at to the lowest degree 30% per year. mug MarketThe Makeover Beauty Salon will be targeti ng two different groups of customers, but will lay more emphasis on the youths. It will work hard to distinctly appeal to each of these groups. By centre on more than one group, the salon is minimizing its risk that in a downturn one group will negatively affect the company.Market SegmentationThe Makeover Beauty Salon will target three different market segmentsYoungsters will normally make up 70-75% of the clientele, as they are very conscious about looking good, having perfectly trimmed eyebrows and they like to keep changing their styles regularly.Young mothers with children. Most young children are notoriously difficult when it comes to getting haircuts. A family style salon is a more laid-back place that allows the children to play while they are clenching and thence will work with the parents in calming the kids nerves when they are ready for their shearing.Target Market Segment StrategyThe Makeover Beauty Salon will target each of the two groups separately. The youngsters wi ll be pampered in a very bright, appealing, colorful and attractive atmosphere. Employees will use the latest equipment turn over with them, which would suit their preferences and with which they will feel at ease.The Makeover Beauty Salon will alsotarget mothers with children by offering the kids toys to play with while they wait and child-friendly hair stylists. Moreover, children will receive a special rate reflecting the fact that childrens hair grows so fast that it can be costly to keep up with regular cuts, as well as the recognition that it generally takes lesser time to cut a childs hair so it should be naturally less expensive.Competition and Buying PatternsThe Makeover Beauty Salon competitors includeTraditional barbers. They do not work on appointments as it offers an open door service. While barbers are willing to give you whatever cut you want, they are generally providing straight forward haircuts, typically on the conservative side. The advantages of a barber are they are low-cost and easy to use. Their disadvantages is ofttimes conservative styling capacities, sometimes a long wait as the barber may be an old timer who enjoys to chit chat.Franchised quick salons. An example of this would be Supercuts or Best Cuts. In essence this is a franchised var. of The Makeover Beauty Salon. The advantage of this style is the store will be the alike(p) from location to location and some people like this predictability.Independent salons. These salons typically focus on a circumstantial niche and do not serve a large group of customers. The advantages to these could be an independent salon that caters for all of your needs. The disadvantage is that because they tend to be more focused, more a great deal than not this type of salon will not offer just now whatcustomers are looking for.Competitive EdgeThe Makeover Beauty Salon aims to be very different from the beauty salons which offer only one or two services. From surveys, it has been concluded th at customers often get frustrated as they have to get their hair done at one place and facial and makeup done at another place. This becomes very annoying for clients as they have to travel a lot and it is tiresome as well. accordingly the Makeover Beauty Salon plans to offer all these services under the kindred roof. As such, clients will be more at ease to make themselves beautiful.There exist several salons that are already proving the same services as the Makeover Beauty Salon, but they charge very high prices which everybody cannot afford as these salons are situates mostly in towns, where high rent have to be paid. Therefore, to attract the maximum number of customers, the Makeover Beauty Salon plans to offer better quality service than the other salons, but at affordable prices so that everyone can afford making then look beautiful, especially the youngsters, as they are the one that the salon is targeting at.Basically the atmosphere predominant at the Makeover Beauty Salo n will be very familiar and relaxing, where clients would love to be pampered. A welcoming drink will be served to clients as they enter the salon they can chose amongst tea, coffee, juice, soft drink. A television will be located in the waiting room and a radio in the hair-drying area, as this may take some time.VI Marketing PlanMarketing StrategyThe Makeover Beauty Salon has a very simple marketing strategy satisfying its clients. Miss Chellen is of the view that when a customer leaves her salon, he/she should have a new look which would be perfect for the occasion the latter would be attending, and the latter should also be representing the Makeover Beauty Salon through his/her makeup and hairstyle the client should be a medium of portraying the salons qualities, service and image.Miss Chellen has no plans to bare her new salon. According to researches, a satisfied customer is able to crop 11 14 people positively. Therefore, the owner of the salon is of the view that its t he satisfied customers that will bring new customers to her salon and her business grows. She has, in her mind, a strategy to reward her potential clients who are able to attract new customer into the salon.gross revenue StrategyThe Makeover Beauty Salon sales approach will be based on exceptionally professional communications with the customer. Normally the quick salons lay emphasis on being quick and inexpensive, often at the cost of customer service. Anytime that a potential customer will talk with someone at the Makeover Beauty Salon, the owner/employee will have an opportunity to impress the customer. Employee training will emphasize prehension these opportunities.The Makeover Beauty Salon will also have the chance to change magnitude sales of its retail hair care products every time it has a customer in the chair. The Makeover Beauty Salon offers interesting discounts on the hair care products for employees to use these products, so that they can explain to the customer abou t their personal experiences. Additionally, the Makeover Beauty Salon offers a product-based commission structure for the hair care products where they give away the product to the employee for commissions for selling the items to their customers. These personal testimonials and commission structure will allowthe salon to generate good sales from the retail hair care products. sales forecastsThe rootage diagram supra depicts the first years forecast of the Makeover Beauty Salon sales. In the first 4 months, sales will be very steady as the salon will experience new customers, who will get to know about the services that the salon offers. During the subsequent months, an increase in all the services offered is anticipate, as the customers will be satisfied with the service of the salon. sales Forecast division 1 yr 2Year 3SalesYoungsters$20,150$35,260$41,100Women with small children$2,015$3,526$4,110Retail hair care products$29,225$32,975$40, five hundredTotal Sales$51,390$71,761$8 5,710Direct Cost of SalesYear 1Year 2Year 3Youngsters$2,600$4,750$4,900Women with small children$260$475$490Retail hair care products$14,500$26,000$27,500Subtotal Direct Cost of Sales$17,360$31,225$32,890VII Operation PlanFacilitiesThe salon will be offering home styling and makeup for brides or any other special weekends, but for that, an appointment is compulsory this should be done at least 3 weeks before the due date. Potential clients will not be charged with the travelling costs.Hours of operationThe salon will be open week from 8 am to 5pm on Monday to Saturday. However, on Saturdays and globe holidays, it will be opened from 10 am to 1 pm.Employee fostering trainingEmployees will be trained not only in their specific styling duties but in the philosophy and applications of our construct. They will receive prolonged instruction from the owner and be kept informed of the latest data concerning styling and makeup applications through continuous training.Systems Control sA big emphasis is being put on extensive research into the quality and integrity of our products. They will invariably be tested for our own high standards of effectiveness and professionalism. decorative products costs and inventory control will be handled by our figurer system and checked daily by management.FacilitiesThe salon will be offering home styling and makeup for brides or any other special weekends, but for that, an appointment is compulsory this should be done at least 3 weeks before the due date. Potential clients will not be charged with the travelling costs.Hours of operationThe salon will be open week from 8 am to 5pm on Monday to Saturday. However, on Saturdays and public holidays, it will be opened from 10 am to 1 pm.Employee Training EducationEmployees will be trained not only in their specific styling duties but in the philosophy and applications of our concept. They will receive extensive information from the owner and be kept informed of the latest infor mation concerning styling and makeup applications through continuous training.Systems ControlsA big emphasis is being placed on extensive research into the quality and integrity of our products. They will constantly be tested for our own high standards of effectiveness and professionalism. Cosmetic products costs and inventory control will be handled by our computer system and checked daily by management.VIII Financial PlanStart-up FundingStart-up Expenses to Fund$1,817Start-up Assets to Fund$60,600Total Funding Required$62,417AssetsNon-cash Assets from Start-up$60,100Cash Requirements from Start-up$500Additional Cash Raised$0Cash Balance on Starting Date$500Total Assets$60,600Liabilities and CapitalLiabilitiesCurrent Borrowing$0Long-term Liabilities$61,917Accounts Payable (Outstanding Bills)$0Other Current Liabilities (interest-free)$0Total Liabilities$61,917CapitalPlanned InvestmentOwner$500Investor$0Additional Investment Requirement$0Total Planned Investment$500Loss at Start-up (Start-up Expenses)($1,817)Total Capital($1,317)Total Capital and Liabilities$60,600Total Funding$62,417Important AssumptionsThe following section will point important Financial Assumptions.General AssumptionsYear 1Year 2Year 2Plan Month123Current Interest Rate10.00%10.00%10.00%Long-term Interest Rate10.00%10.00%10.00% tax Rate30.00%30.00%30.00%Other000 communicate Cash settleThe cash flow depends on assumptions for inventory turnover, payment days, and accounts due management. Our projected same-day collections are critical, and are reasonable and customary in the salon industry. We do not expect to need significant additional complement even when we reach the less profitable months, as they are expected.http//www.bplans.com/hair_salon_business_plan/images/d5e510e0cfe04c2484123f1575a810dc.pngProjected Cash FlowYear 1Year 2Year 3Cash authorizedCash from OperationsCash Sales$277,143$504,802$525,337Subtotal Cash from Operations$277,143$504,802$525,337Additional Cash ReceivedSales Tax, VAT, HST/GST Received$0$0$0New Current Borrowing$0$0$0New Other Liabilities (interest-free)$0$0$0New Long-term Liabilities$0$0$0Sales of Other Current Assets$0$0$0Sales of Long-term Assets$0$0$0New Investment Received$0$0$0Subtotal Cash Received$277,143$504,802$525,337ExpendituresYear 1Year 2Year 3Expenditures from OperationsCash Spending$251,600$275,200$279,200Bill Payments$101,816$172,090$181,489Subtotal worn-out(a) on Operations$353,416$447,290$460,689Additional Cash SpentSales Tax, VAT, HST/GST give Out$0$0$0Principal repayment of Current Borrowing$0$0$0Other Liabilities Principal Repayment$0$0$0Long-term Liabilities Principal Repayment$0$0$0Purchase Other Current Assets$0$0$0Purchase Long-term Assets$0$0$0Dividends$0$0$0Subtotal Cash Spent$353,416$447,290$460,689Net Cash Flow($76,273)$57,513$64,648Cash Balance$20,307$77,820$142,467Projected Balance Sheet of The Makeover Beauty SalonYear 1Year 2Year 3AssetsCurrent AssetsCash$20,307$77,820$142,467Other Current Assets$0$0$ 0Total Current Assets$20,307$77,820$142,467Long-term AssetsLong-term Assets$7,320$7,320$7,320Accumulated Depreciation$1,464$2,928$4,392Total Long-term Assets$5,856$4,392$2,928Total Assets$26,163$82,212$145,395Liabilities and CapitalYear 1Year 2Year 3Current LiabilitiesAccounts Payable$11,945$14,341$14,968Current Borrowing$0$0$0Other Current Liabilities$0$0$0Subtotal Current Liabilities$11,945$14,341$14,968Long-term Liabilities$45,000$45,000$45,000Total Liabilities$56,945$59,341$59,968Paid-in Capital$60,000$60,000$60,000Retained Earnings($1,100)($90,782)($37,130)Earnings($89,682)$53,652$62,557Total Capital($30,782)$22,870$85,427Total Liabilities and Capital$26,163$82,212$145,395Net Worth($30,782)$22,870$85,427IX diminutive Risk factorsManagement Risks It can be considered the identification, assessment, and prioritization of risks followed by coordinated and stinting application of resources to minimize, monitor, and control the probability and/or impact of unfortunate event or to m aximize the realization of opportunities. Risks can come from uncertainty in monetary markets, project failures and legal liabilities in the Makeover Beauty Salon.Other potential Management risks may beDefective products/services.Health and safety incidents. improper equipment.(e.g. damaged wires or sockets)Environmental risks (e.g. noise pollution and the use of eco-friendly product) scientific obsolescence.Theft of assetsMarketing Risks Marketing is a risk and you cant go on happily thinking that whatever youre doing is working for the best of the organization. By the time you do so, the market will have shifted from under your feet. more or less marketing risks may beGovernment action ( pass faithfulness to limit the time for using salon till late night) twin (imitation of ideas is done quickly by competitors)Operating Risks It is a risk arising from instruction execution of a companys business functions. As such, it is a very broad concept including e.g fraud risks, legal ris ks, physical or environmental risks in the Makeover Beauty Salon.Other forms of operating risks may bethe type of product received from suppliersthe neighbourhood problem which can halt workthe defect that hairstyle is not done according to customer wishregulation which employee dont acceptculture for where on a day some worker have to leave for prayerFinancial Risks It is basically any risk related with any form of financing. Risk is probability of unfavorable condition in financial sector it is the probability of actual return being less than expected return for a business company.Intellectual Property Infringement It is the assault of an intellectual prop

Saturday, March 30, 2019

Raja Mandala Theory And Its Relevance History Essay

Raja Mandala surmise And Its Relevance History EssayChanakya assignd that each say is environ by many states, out of which integrity would be a internal adversary. Other states might be all(a)ies, vassals, so-so(p)s or hostile. The business leader should focus on the natural adversary and defeat it.Chanakya advised the great force finger to be practical(a)al in his approach towards his enemies and prudence in choice of contrary polity. He was a invitest spineless surr breaker or foolhardy valour. He preferred cessation oer war in most cases. He s embolden that when the phase of show up to be run into from choosing mingled with war and peace were same, the nance must choose peace. He took into consideration the losses of troops, expenditure and absence seizure from home plot giving this advice. He in addition said that if the equipoise of reason were not to become favourable as a issuing of war, peace must be chosen.28Circle of StatesAccording to Chanakya, the queer, his friend, and his friends friend be the triad primary kings constituting a stripe of states. As distributively of these three kings possesses an compriseer(a)(prenominal) five elements of sovereignty much(prenominal) as the minister, the realm, the fort, the treasury, and the army a circle of states consists of eighteen elements. The three Circles of States having the resistance, the middle king, or the neutral king at the centre of each of the three circles are different from that of the conqueror. frankincense there are four primary Circles of States, twelve kings, sixty elements of sovereignty, and cardinal elements of states. Each of the twelve primary kings pick up their elements of sovereignty, violence, and end. effectiveness is power, and happiness is the end.Strength is of three types power of deliberation macrocosm the intellectual potence a prosperous treasury and a strong army cosmos the strength of sovereignty and martial power being the phys ical strength.The end too is of three kinds that which is get-at-able by deliberation is the end of deliberation that which is attainable by the strength of sovereignty is the end of sovereignty and that which is to be secured by perseverance is the end of martial power. The possession of power and happiness in a greater degree makes a king superior to an early(a) in a less degree, inferior and in an equal degree, equal. because the king was of all time required to augment his power and elevate his happiness.29 sise Methods of Foreign policyThe states participate in diplomacy and war utilise the six methods of exotic policy. To understand the concept of Raja Mandala theory, the six methods of foreign policy enunciated by Chanakya must be dumb. These cater for different situations in internationalist dealings.30(a) Samdhi. The peace treaties were to be concluded with specific conditions that enabled the state to set up welfare and development, fix concretions or use the p eriod as one arm of dual policy. Chanakya said that treaty could unconstipated be entered into with ones enemy and may be broken when one grows strong. The interests of the state being supreme, such(prenominal) betrayals were justified.(b) Vigraha. The policy of hostility was recommended to be followed by the stronger state. The hostilities could be conducted as open, secret, unavowed or clandestine attacks. Diplomatic wars too were discussed extensively by Chanakya. Having had to strife naturalized and proxy wars, India in addition to make doing militarily, has been dealing with this on a diplomatic level as substantially.(c) Asana. The policy of re main(prenominal)ing neutral was recommended by Chanakya to be followed when both states were equal. The Chinese observed neutrality in the cold war amongst the States and erstwhile USSR and utilized their efforts towards development. India was the lead story proponent of non-alignment and in following the policy was able to get the outdo of both the Western and easternern Blocs. India must be amongst the a couple of(prenominal)er nations in the world that can acquire weapon systems, atomic applied science, industrial knowhow and even supembrasure for permanent membership of UNSC from USA and Russia.(d) Yana. Posturing for war was an primal decision that the king had to take. The preparation for war and the foresightful march entailed t fossil oil close to expenditure and prolonged absence from the capital, and then necessitated careful consideration sooner taking such a decision. After the attack on fan tan on 13 December 2001, the armed forces were mobilised. The forces remained in the offensive seat for a complete year. While the war never took place, many skirmishes on the line of control occurred. The tensions on the line of control brought international constrict upon Pakistan resulting in imposition of sanctions on the terrorist groups and the leaders in February 2002. The go alongd p ressure resulted in a c placidityfire agreement in 2003 that holds good till date.(e) Samsraya. The policy of seeking protection of a stronger king could be practised by move into into bond papers or by signing a treaty. Various alliances make during the cold war indicate that this policy is relevant even today. In 1971 when war with Pakistan was imminent, India signed a treaty of Friendship with USSR as a guard duty against intervention by USA and mainland china on behalf of Pakistan. Pakistans alliance with China in can be seen as a performer of seeking protection against India.(f) Dvaidhibhava. This was the policy of seeking peace with one king in do to pursue hostilities with an many other. China, which has territorial disputes with both India and Japan, asserts cordial dealing with one while getting into a diplomatic row with other in order to channelize the complete effort of the state to master the objectives it sets for itself.81. Special Cases. Chanakya envisaged certain situations wherein he considered the role of kings who could bring the outcome of a conflict without being directly involved. In context of India-Pakistan dealing, China could be classified as middle king as described by Chanakya. Pakistan could micturate some problems in the course of Sino-India conflict, but would not gibe the description of a middle king, being weaker than both India and China. However, USA, Russia and even UN jibe the bill of a neutral king, a king who is to a greater extent(prenominal) tendinous than the belligerents but does not share the borders with the deuce.Parshingraha. The attack in the rear in diplomatic, scotch or psychological sphere had been described as an definitive aspect of foreign policy by Chanakya. It could be in form of posturing or sup behavioring insurgency movements as well. China has been stir magnitude her influence in Indias neighbourhood through sparing and diplomatic initiatives. In the last week of November 2012, Maldives annulled the contract of an Indian firm soon later its cabinet had returned from China. India too has developed adjacent ties with countries like Afghanistan, Iran, Mongolia, Japan, in the south Korea and Vietnam in order to counter the influence of Pakistan and China in their neighbourhood.31Objectives of Foreign PolicyChanakya said that the objective of foreign policy was to increase the power of a state. Military, intellect and morale were vital components of power according to Chanakya32. The king had to ceaselessly watch his power by using appropriate foreign policy. The slashing dealingship between power and progress was essential to be understood and had to be attained through implementing the right policy and correct exercise within the circle of states. some(prenominal) India and China pretend been projecting their power in a different ways. While India has laid emphasis on soft power, China has embraced the policy of projecting comprehensive national powe r to included military and economic might in addition to its heathen influence around the world to exert influence on the policies of other nations.Chanakya had said that peace could be do with the enemy albeit as a temporary measure to gain clock time to enhance own power. The wars in modern era are also fought on economic and cyber space. Both India and China are growing economies and the process is judge to stabilise in another 20 to 30 days. They live isobilateral flip path into billions of dollars e very(prenominal) year disdain being rivals for markets and captive resources. If the two were to go in any form of war at yield, the impact on their harvesting would be catastrophic. Moreover, the modern economies being inter-woven, it would get a domino effect on all the leading economies of the world. Thus, the set abide the two countries would find would be dynamic and would set their progress back in a big way. The two countries see adopted a very pragmatic app roach and cooperate at various international and not let the disputes over edge or South China Sea over shadow the areas of cooperation.China maintains friendly relations with India at the same time supports Pakistan in all its misadventures. China has invested a great deal in infrastructure in Pakistan. The armed forces of Pakistan are being equipped by the Chinese at a frantic pace. China has little to gain directly from Pakistan except for access to the sea through Gwadar Port33. The main purpose of propping up Pakistan is to divert Indias focus. Although growing at a lush pace, the resources with India are limited and thus can optimally focus on one front only.Relative Power. Chanakya said that the king must always strive to enhance his power in comparison to the enemy. The carnal knowledge power can be improved by making oneself stronger or by denuding the power of the enemy.34Indias military strength is dissipated on two fronts outwardly and internal security duties. India must strengthen her relations with Japan, Taiwan, South Korea and other littorals of South China Sea to force China to focus on many fronts at the same time. USA has depictd all possible serve to India in recent years to make China focus more on India. The aim of USA is to gain her own interests in the peaceful Ocean parting, Indian Ocean and the oil rich West Asia. The policymakers meet to be careful in using the US card while dealing with China. Reliance on USA to provide deterrence against China, though beneficial in poor term, would be counterproductive in long run. India will have to become stronger economically, diplomatically and militarily to enhance her relative power in long run.Having realised her inferiority in conventional battlefield, Pakistan resorted to proxy war. The diversion of resources of Indian Army helped it achieve parity on the conventional battlefield. India responded by raising Rashtriya Rifles Battalions to deal with insurgency. The situation is no w returning to normalcy. In 1998, Pakistan tested nuclear weapons in rejoinder to trials by India. The science of nuclear weapons and projectile delivery system by Pakistan gave her the deterrence capableness and thus it avoided a war in 2002. However, the development of ballistic missile defence system by India would nullify the deterrence ability strengthened by Pakistan35.Relative power is dynamic and its balance continues to revision at all times. Every move by India, China or Pakistan draws response by the adversary. India would have to continually monitor the development in China, Pakistan and also within the countries that can be described as the inner circle of these countries in the circle of states.Preference of Peace Over ConflictThe king had to adopt policies that would enhance the power of the state and economic and material well being of its subjects. This would necessitate improving infrastructure, increasing avenues for employment, to make for mines and natur al resources, and at the same time to deter similar progress of the enemy. A state that was in a position to grow in power more speedyly both in quality and quantity than the adversary could conk out the enemys progress some time. Two states were to make peace when growth could be achieved by doing so. Hostility with the enemy was to be opened if it ensured better growth than the enemy. If the adversaries were neither in a position to destroy the progress of each other nor in a position to safeguard their own progress in case of hostilities, every endeavour was to be made to maintain peace.36Pakistan. India is developing faster than Pakistan in all fields. The tool of Jihad that had been utilise by Pakistan to disrupt peace in India and to enable USA fight USSR in Afghanistan has become bane for very existence of Pakistan. Peaceful and stable Pakistan is essential for Indias growth.37India has offered assistance toPakistan to help her overcome these challenges.Chanakya had advoc ated destruction of enemy as and when the opportunity presented itself. The world order today is different from the times of Chanakya. whatsoever hostile act by India would bring immediate sanctions from the comity of nations and thus will destroy the economic progress and well being of the state. Moreover, if the state of Pakistan were to disintegrate, the terrorist groups would reign supreme and they would most likely target India like never before. A large-mouthed swell of refugees would migrate and cause demographic and economic catastrophe for India. The population that has been brought up on the staple of blaming India for every distress will turn their anger against India. Thus, when seen in the larger context, the policy being adopted by India is in sync with Chanakyas thought process that professes economic growth and welfare of citizens as a primary duty of the state.China. notwithstanding the size of the GDPs and the growth rate, India and China are only to acquire a truly middle class status. The Chinese economy is industry control while Indian economy is services driven. In order to continue on the path of growth, both fatality to add millions of new jobs every year.38The creation of so many new jobs requires unhindered economic activities. The present path of economic growth leaves adequate space for both the states to coexist peacefully.In order to create millions of jobs every year, India will have to change to an industrial economy. In a decade or two, the two countries would end up competing for the raw materials and markets. This could lead to conflict between the two. It would be provident for India to develop her military capabilities. Improvement in human development index would ensure that the manpower is educationally and technically qualified to absorb the technology at the given time.India is surrounded by large number of junior-grade countries that are being wooed by China. These countries resent the perceived big fraternal attitude of India. In November 2012, the government of Maldives cancelled the contract of GMR for development of the airport. Nepal-India relations have taken a downward spiral due to disrespect by Indian government as well as the bureaucracys rock-ribbed and inconsistent behaviour. One of the glaring examples of such neglect is the absence rebuke to Nepal by any of the Indian Prime Ministers, since 200239. Bangladesh too has been antagonised over Indias waver to finalise the water sharing agreement. India has to work towards bringing these countries back to her fold. dealings with Threats Posed by China and Pakistan using ArthashastraForging Alliances/ Partnership.(a) Chanakya was of the opinion that beat alliances should be resorted to when needed40. War being one of the methods of executing foreign policy of the nation, the diplomacy has to garner a favourable opinion and if not, at least a neutral attitude from the comity of nations.(b) From the very root word Pakistan en tered into military alliances like CENTO and SEATO. India entered into a 20 year treaty of knowledge with USSR. Since the 90s Pakistan became closer to China to overcome the impact of sanctions imposed by USA. The alliance between Pakistan and China assures Pakistan of some degree of deterrence against India.(c) India has forged closer relations with USA and maintained the historical relations with Russia. The cooperation achieved has been catalyst in enabling the Indian military to modernize at a rapid pace, thus gradually building up a deterrence capability against China. Herein India needs to maintain a very fine balance, as close relations with USA, China and Russia are conditional relationant for the development of the country. The challenge for India is to manage her ties in such a manner that she is not seen as leaning towards any country in particular, nor is seen as a country that is indecisive.(d) USA. During the visit of Mr Leon Panetta in June 2012, India politely told USA that there is a need to re-calibrate the US policy called Rebalancing of Military Strategy with focus on Asia-Pacific that envisages deployment of at least 60% of US Naval assets in Asia-Pacific41. The concern of India being that the policy would increase the militarisation in its immediate neighbourhood and such rapid militarisation would throw Indias modernisation plans out of gear.(e) India has enhanced bilateral cooperation with US and participates in a number of joint military exercises without entering into any formal military alliance. The support that had been extended by USA to Pakistan in last half a century plays in the minds of Indian policy makers while deciding on the extent of military cooperation with USA. The US insistence on signing CISMOA, LSA, EUMA and BECA make the policy makers in India sceptical. Moreover, by openly embracing USA, India does not want to upset China42.(f) Littorals of South China Sea. India has indicated that she would prefer cooperation w ith countries like Japan, Vietnam, Philippines and others in working out an favorable solution to the South China Sea dispute. In last few years, India has participated in number of military exercises with Japan, Singapore and Vietnam. If the navies of these countries enforce a stuff of Malacca and Sunda Straits, China will be put on the back foot. The entire transhipment of oil and gas would then be channelised through Arakan region of Myanmar and Gwadar port in Pakistan. The domination of Bay of Bengal and Arabian Seas by the Indian Navy would quickly result in enforcing a blockade to model the outcome of war.(g) Myanmar. India has improved her relations with the Myanmar in recent years. The people of Kachin have been known to resent Chinese activities in the region. India should exploit this resentment and twine the government of Myanmar to limit the Chinese activities, China can be further contained.(h) Iran. To avoid the SLOCs dominated by India, China needs to open a trans hipment route through Central Asia. The Chabahar and Bandar Abbas ports in Iran could be the ports of transhipment. India lost some ground in Iran after siding with USA over nuclear issue. By attending the NAM conference in Tehran, Dr Manmohan Singh tried to make some amends to the earlier mistakes. In his visit, the Indias vigour and security issues were discussed by the PM43.(j) Iran could be a partner of strategic significance for India. The relations between Pakistan and Iran took a downward spiral during the 80s whereas India and Iran cooperated in supporting the Tajik groups opposed to Pakistan back Pashtun groups in Afghanistan. Pakistan became closer to Saudi Arabia, who is a staunch rival of Iran. The officials of Iran and Pakistan have accused each other of aiding the insurgents in Baluchistan44.(k) India has stood by its commitments in Iran despite the pressure from US and EU. China too has supported Iran and done so more boldly than India. In addition to the vast reserv es of oil and gas, Iran is significant as it is a littoral state of Persian disconnection and Caspian Sea. It provides a gateway to the landlocked Central Asian Republics. China has been suit Iran to gain a foothold in West Asia and enhance energy security. The route from Iran, Central Asian Region (CAR) and into China would enable China to avoid the SLOCs that are vulnerable to interception by India and other South East Asian countries.(l) It is unlikely that Iran would become a party to containing Chinese influence due to her animosity with USA. However, India should work towards exploiting Irans sensitivities towards developments in Baluchistan and Afghanistan and Pakistans proximity to Saudi Arabia. India should exploit get Iran onboard in containing Pakistan from the West.(m) Afghanistan. Afghanistan has been apprehensive of Pakistans intentions in the region. On many occasion President Karzai has blamed Pakistan for the troubles in his country. Pakistans open support to Tali ban means that interdict South and Eastern Afghanistan, rest of the country is unlikely to warm up to Pakistan in near future. Afghans are known to be fond of Indian culture. Indias plowshare towards development activities in Afghanistan has further endeared her to the Afghans. Unlike China, India has not yet acquired any stakes in the unexplored natural resources of the country.(n) India should work very closely with the Afghan government and keep Pakistan out of the region. India must be prepared to provide security forces for filling the void left by the withdrawal of ISAF in 2014. The aid being provided to Afghanistan could be linked with retention Pakistan out. India must ensure that Taliban does not gain entry into Afghan governmental arena. This would deny the strategic depth that Pakistan so badly craves.45Create a Divide between China and Pakistan. Chanakya talked of creating division amongst the enemy to weaken them. Sino- Pakistan relations are not as deep as are made out to be. China tilts towards Pakistan to secure its own geopolitical interests. It props up Pakistan militarily to keep Indias armed forces engaged on the Western borders. The Gwadar port and Karakoram highway provide China with an overland guile j and Islamists in Pakistan46.(a) Make Gwadar Port Unviable Option. The port held a vision of prosperity for Pakistan and to provide the Pakistan Navy with strategic depth along its coastline. It provided China with an opportunity to radiate its oil import routes and extend its presence in the Indian Ocean. Chinas interests in Gwadar port are to diversify and secure its crude oil import oil routes and to extend its presence in the Indian Ocean.47It would enable monitor naval activities of both US India in the region.(b) India Iran have had reservations about the project from beginning. Iran responded by constructing Chabahar port and road tie in joining Iran, Afghanistan and Tajikistan with Indias assistance. Plans to extend a road from Iran through Herat, Mazar-e-Sharif and Sherkhan Bandar in Afghanistan and onwards to China too have been discussed.48(c) The fragile state of lines of communication in POK region was bring outed in January 2010 when the Attabad landslip cut off the Karakoram highway49. The Baluchistan province in Pakistan stay cheeky with ever increasing levels of violence.(d) Iran remains peaceful and stable making Chabahar port more loving alternative to Gwadar. China has repeatedly used its shun power in support of Iran over the nuclear standoff. Irans energy reserves and good relations with Afghanistan Central Asian countries are of significance to China as well. India and Iran enjoy good relations. Like Iran, India too enjoys good relations with Afghanistan and Central Asian countries. If situation in Afghanistan stabilises in near future, Iran remains peaceful but Balochistan remains restive, use of Chabahar would become more attractive and economical in comparision to Gwadar.(d) Chi nas Aspirations as a Super Power. Most of the incidents of act of terrorism in the world have been tracked back to Pakistan. Despite its contribution in the GWOT, Pakistan is viewed as a state that harbours terrorists and fundamentalists. Osama Bin Laden was killed in a safe house located within a few kilometres of Pakistans military academy. As an aspiring super power, China will have to pressurise Pakistan to rein in the fundamentalist and terrorist groups. Aspirations of China and Pakistans support to terrorist groups make the two to partners who cannot be natural allies. India should take every opportunity to highlight this issue at various forums and bilateral meets. The academicians and the think tanks should be asked to create verbally articles and papers that would embarrass China on this issue. When Pakistan looses Chinas support, it would be forced to change its policies and thus the menace of terrorism would reduce to a very large extent. The probability of external war on two fronts would also be minimised.(e) Uyghur Separatists Movement. Since its incorporation into China in 1950s, Uighurs have organized more than cd uprisings50. The ethnic strife has taken a religious twist in the last few years51. The Chinese leaders have uttered apprehension that Pakistan may not be able to contain the links between the separatists and the Islamists in Pakistan. China had in the past resorted to curtailing border trade and closing the Karakoram Highway to contain the unrest. Such measures send a type to Pakistan that China would not hesitate to freeze the relations if required, in order to curtail the separatist movement52. act Neighbours. Chanakya in his treatise had been categorical that a friendly or a neutral neighbour is essential for the growth and stability of a state. He also warned against the dangers of an adversary becoming important in the neighbourhood. China has been using her diplomatic and economic clout in marginalising Indias influence in the neighbourhood. Indian government has to understand that these nations are on the development curve and therefore need huge investments. For many years India invested in the development of these countries to the extent she could. China has bigger reserve of foreign exchange than India and is ready to suffer economic losses in short term. The investments made by China have enhanced her influence in these countries.The government of India has started exploring the historical and cultural links and soft power to strengthen relations with the neighbours. The Indian government provides billions of dollars as aid to Afghanistan, Sri Lanka, Bangladesh, Myanmar, Nepal and Bhutan. It has entered into trade agreements with all her neighbours that may be more favourable to the neighbours than to India. The volume of trade between India and her neighbouring countries has steadily increased in the recent years.The efforts have yielded positive results. Sri Lankan officials have been harping about the very good and very ancient links with India. The aid to the displaced Tamils is not viewed with scorn as in earlier times. Homage was paying(a) to the martyrs of the IPKF in Sri Lanka in 2012. India-Pakistan trade has been on the rise with Indian exports to Pakistan heave by over 30% per year53. The Awami League government in Bangladesh is working towards generating a favourable public opinion towards permitting transit facilities to India and the Indian government too has shown inclination towards signing a treaty on sharing of river waters. With Myanmar, relations have been growing stronger. Aang San Suu Kyi visited India in 2012. The economic ties and trade have grown manifolds in recent years. India still has work to do on improving relations with Nepal. The relations with Nepal have been stagnant since the Maoists came to power. With Maldives, relations took a downturn over the controversy over the operating of international airport in Male by GMR. The Government of India suspended financial aid to Maldives as a retaliation to revoking of the GMRs contract by the Maldives government.Engaging China and Pakistan till Own Military Capability is Developed. To realise their authoritative potential, India and China need an environment of peace and stability. Both the countries have unbroken the disputes on the back burner while focussing on areas of convergence. The trade between both has been growing at a steady rate and is expected to touch $100 billion in 2015.54Talks to resolve the boundary disputes continue to be held at regular intervals. Talks with Pakistan have made a slower progress in recent years. CBMs have been in place for many years. The two countries have signed an agreement to ease visa restrictions.55Sporting ties too are being resumed between the two countries. Such measures will bring the people closer and thus create pressure on the governments to resolve the disputes at the earliest.107. Chanakya identified military natural selection as an important facet of foreign policy. The government of India seeks peaceful coexistence with the neighbours. However, to safeguard her nati

Patient with Congestive Heart Failure

longanimous with Congestive Heart FailurePatient S.V. is a 54 years old female. She is a postmenopausal ho engagementwife and her family history is not cosmos recorded. She is a non-smoker and does not drink alcohol at all. She has no-known medicate allergic. The historic medical history showed us that Madam S.V. is having, woebegone arthritis (RA), hypertension (HPT) for 10 years and diabetes mellitus (DM) for 7 years. She was admitted to the hospital on a couple of(prenominal) weeks ago receivable(p) to congestive nubble bereavement.Madam S.V.s drugs history includeT. furosemide40mg odOedema HFT. perindopril4mg odHF HPTT. spironol lay outone25mg odHFT. Losec (Omeprazole)20mg bdDuodenal ulcerationP. Calcium lactate1 puff odCalcium supplementT. Rocatriol0.25mg bdVita minute of arc D supplementT. Metformin500mg bdDMT. vitamin Bc5mg odFolate inadequacyT. Methotrexate20mg/weekRAclinical dataThe abnormal extend of FBC whitethorn imputable to folate deficiency that readyd by side effect of methotrexate. Besides that, long-suffering was having noble neutrophile number for his differential count which is 8.7 k/L (normal mountain range 1.9-8.7 k/L). This whitethorn collect to the long-term use of corticorsteroid. Patients total carbon dioxide in the blood was two times higher than normal range (23-27 Vol%). factor II time and INR of the enduring was low PT =11.1 sec (normal range = 11.9-14.5 sec), INR = 0.82 (normal range 2-4). tho, the reason is unknown.Diagnosiscardiogram and chest X-ray were carried egress and the results showed that long-suffering was having sinus tachycardia and megacardia. Cardiovascular system of unhurried as well had been checked. It found that the affected role was having a 3rd flavour sound. Hence, the forbearing was diagnosed with congestive heart calamity (CHF).Clinical progressDAY 1Patient is admitted to the hospital at 10.30am by ambulance. She is weak but conscious and alert. The tolerant role complains that she is shortness of touch (SOB) and her sleep has been interrupted due to SOB. It tidy sum in addition be considered as paroxysmal nocturnal dyspnoea (PND) which is sudden, serious SOB at darkness that awakes a person from sleep, often coughing and wheezing.At the same time, she also experiences from chest discomfort and swelling leg. Besides that, the patient also shows the symptoms of cushings syndrome much(prenominal)(prenominal)(prenominal) as moonface and hirstuism. The blood pressure (BP) and pulse grade (PR) of Madam S.V. argon found to be quite high as well, which is 118/87mm/Hg and 146b/min respectively.Test ordered include FBC, RP, LFT, ABG, Coagulation foot race, UE, CXR, ECG and random glucose establish.Nebulizer is disposed(p) to patient once she is admitted. She is also on high prevail bury oxygen 15L/min at the same time to ease the worry of SOB. Salfasalazine 1g bd is added to patient. The management plan is to carry protrude lung function runnin g die hard, treat to on the face mask for oxygen supply, revise all test results, limit quiet and continue with old medications.DAY 2Patient hushed complain of minimal SOB and minimal chest ail. Another refreshed complain, headache, has been recorded. Her BP and PR go for been slowly declined but they ar relieve not within the normal range.T. bisoprolol 2.5mg od is added for a better suss out of HPT and HF. Management plan include restrict fluid DAY 3Patient is no longer complaining for allthing. She has no chest pain and SOB whatsoever more than. Her PR has back to normal range. However her BP is still just virtually higher than normal range. Management plan is same as sidereal solar mean solar day 2. Sulphasalazine since the condition of RA is improved.DAY 4Patient is feeling well, well-situated and tolerating orally. Her BP and PR be within the normal range. The management plan is to realize a CRX report, patient abide be discharged if normal result is obt ained and continue old medications.Pharmaceutical care issuesthither are few things destiny to be taken care of in this case. Firstly, the patient is having the line of nausea and vomiting and no action is taken to solve this problem. antiemetic drug (H1 receptor antagonist, cyclizine D2 receptor antagonist, halopiridol) should be given. At the same time, underlying cause of nausea and vomiting has to be identified if possible. This whitethorn ca utilise by side effect of perindopril.Secondly, patient is having cushings syndrome due to long-term economic consumption of steroids for her rheumatoid arthritis. However, on that point is no any record some the steroids intake for patient in clinical notes. Hence, we have to ask GP or patient to make sure that whether she has stopped fetching steroids or still continue with it. harmonise to CSM, long-term corti addresseroids therapy should be withdrew step by step. Abrupt discontinuation of corticosteroids therapy may cause severe symptoms because normal production of steroids by the body has been affected. The panelling may be turn offd rapidly down to physiological drugs (prednisolone 7.5mg daily). Then, the progress of pane reducing lav be slowed down. The patient is hirudism which is one of the symptoms of cushings syndrome. This problem preserve be overcome by local measures such as shaving, or depilation such as using wax or scan (eg eflornithine).The dose of T.folate for patient which is 5mg once daily is indicated for manipulation of megaloblastic anemia. However, the FBC test result does not show any symptoms of megaloblastic anemia. The dose of T.folate should be 5mg once daily if it is indicated for folate deficiency induced by mehtotrexate. simple eye film should be carried out to make sure that whether the patient is having megaloblastic anemia or not. FBC, serum folate and serum B12 are authorized indicator of folate status. Real indication of T.folate has to be clarified with mend forrader dispense the drug.Oedema problem never been improved since the day patient been admitted into the hospital. Restrict fluid intake and strict I/O charting is carried out. However, patient is not compliance to it. Some simple self-care techniques can be taught to patient to reduce the build up of fluid. Counsel the patient about the importance of following Strict I/O chart. Dose of furosemide can be increase if oedema doesnt improve.The blood pressure of patient is still not stable yet. Patient has to be counseled to improve her fast and mannerstyle. It is also necessary to monitor BP of patient regularly. Increasing dose of -blocker can be considered if BP is not reducing. However, due to its negative inotropic effect, -blocker should be started in rattling low dose and increase gradually.Lastly, upon discharge, check off all appropriate medications are prescribed and patient is counseled suitably. We have to tell patient that Perindopril is added in and ensure patien ts compliance with medication. Patient should be told to avoid alcohol and cranberry juice and confab GP if anything goes wrong.Disease overviewIncidenceHeart hardship (HF) affects 0.3-2% of general population. In 2001, officially there are 11500 deaths are recorded in the UK due to HF. The incidence graze increase by double each cristal from age 45. It affects 3-5% of those over 65 years and 8-16% of those over 75 years. The Rotterdam adopt shows that prevalence is higher in men compared to women.PathophysiologyHeart failure can be defined as inability of the heart to supply capable blood flow to meet the bodys needs. HF can result from any disorder that reduces ventricular filling (diastolic disfunction) and myocardial contractility (systolic disfunction). The leading causes of HF are coronary artery infirmity and HPT. As cardiac function decreases after(prenominal) myocardiac injury, the heart relies on few compensatory mechanisms. Although those compensatory mechanisms c an initially plead the cardiac function, they are responsible for HF symptoms and contribute to disease progression. An initiating til nowt such as acute MI can cause the HF pass on becomes a systemic disease whose progression is largely mediated by neurohormones and autocrine/paracrine factors such as agiotensin II, norepinephrine, aldosterone, natriuretic peptides, and so on. Some drugs may incense HF due to their inotropic, cardiotoxic and sodium-/water- retention properties.DiagnosisA complete history, natural examination and appropriate lab testing are essential in initial evaluation of patients suspected from having HF. The signs and symptoms are the key for early detection. Breathlessness, angina, endure and wheeze are special K signs and symptoms. Patient complains that she is having SOB and PND.Electrocardiogram (ECG) and B-type natriuretic peptides (BNP) are essential tests for e actually patient with suspected HF. ECG is carried out once the patient is admitted int o the hospital. Madam S.V. was detected to have sinus tachycardia by ECG which is one for the common ECG abnormalities in HF. Others common ECG abnormalities include sinus bradycardia, a discharge fibrillation, ventricular arrhythmias and so on. Plasma BNP is not measured in this case.Chest X-ray (CXR) is also an essential constituent of diagnostic work-out in HF. It is very useful for detection of cardiomegaly, pulmonary over-crowding and pleural fluid accumulation. It also demonstrates the presence of any pulmonary disease or infection that provide lead to dyspnoea. Via CXR, patient is detected from having cardiomegaly which is also one of the abnormalities for HF.Echocardiography (ECHO) should be performed shortly if one or somewhat(prenominal) ECG and BNP get an abnormal result. ECHO is widely available and untroubled and provides essential information on aetiology of HF. However, ECHO is not carried out in this case. Some other tests such as FBC, RP, LFT, ABG, UE and rando m glucose test have been carried out to exclude others possible conditions.Pharmacology basis of drug therapyDiureticsThe most important function of diuretic drug is to act by decreasing Na+ resorption. Diuretic drugs can forbid Na+ reabsorption by actions on different transport mechanism, which are located at different sites in nephron. All diuretics are acting on the phenobarbital surface of the nephron. They are protein bound in blood and reach the vasiform fluid by secretion into proximal convoluted tubule utilizing the organic pungent transport mechanism. They are mostly use to ascendancy symptoms of breathlessness and fluid retention. However, they do not alter disease progression or aspirate survival. Thus they are not considered mandatory therapy for patients without fluid retention.Loop diuretics for exemplification furosemide is most widely used if compared to other thiazide. It produces diuresis with NaCl loss. It also has vasodilative action which is let unacco mpanied mediated via prostaglandin. This will increase blood flow in the medulla and hence contributes to their natriuretic effect. Unlike thiazides, circle diuretics principal(prenominal)tain their forte in the presence of impaired nephritic function, although higher doses may be necessary. Thizide diuretics are relatively weak diuretics and used alone infrequently in HF. However, thiazide like metolazone can be used in the combination with loop diuretic to promote effective diuresis.Angiotensin-Converting Enzyme Inhibitors (ACEIs)ACE is binding to the plasm membrane and can also exist as a disintegrable enzyme. The ACEIs act by substrate competition by binding in the Leu-His binding pocket on ACE. Thus, action of angiotensin-I is inhibited. They also decrease the assimilation of angiotensin II and aldosterone and attenuating many of their deleterious make, including reducing ventricular remodelling, myocardial fibrosis, vasoconstriction and sodium and water retention. In a ddition, they also very helpful in reducing blood pressure due to arterial vasodilation. However, they will inhibit the breakdown of bradykinin which contributes to strong hypotensive action and cough.There are soon 11 ACEIs available for clinical use with similar structure and properties, including captopril, enalapril, lisinopril and others. ACEIs are indicated in all browses I to IV of heart failure which stated in NYHA. Potassium sparing diuretics should be stopped before starting ACEI. ACEIs may increase the venture of renal failure in patient with high dose diuretics, elderly, those with existing renal dysfunction and patients with grade IV HF. Hence regular renal function observe is infallible once patient has stabilized on drug.-blockers-blockers can be either selective for 1-adrenoceptor which is cardioselective such as atenolol, bisoprolol and metoprolol or non-selective which can act on both 1-and 2-adrenocepors such as propranolol and timolol. Blockade of 1-receptor s will decrease rate and force of contraction of heart. Meanwhile, 2-adrnoceptor blockade inhibits adrenaline-induced vasodilatation mediated by these receptors. Via these mechanisms, heart rate and cardiac output can be bring down. Beneficial effect of -blockers may result from antiarrhythmic effects, slowing ventricular remodelling, decrease myocyte death, up(a) LV systolic function, decreasing heart rate, and ventricular wall stress.The use of -blockers is not suitable for patients who have unstable HF. Patients should receive a -blocker even if symptoms are mild or well controlled with ACEI and diuretic therapy. Because of negative inotropic effects of -blockers, they should be started in very low doses with slow upward dose titration to avoid any symptomatic worsening. -blockers may worsen HF in the short term, but if use with caution they may be very useful in preventing long-term alloy.Aldosterone antagonistsAldosterone antagonists such as spironolactone and eplerenone al so can be called as potassium sparing diuretics. They act on aldosterone-sensitive portion of nephron (last part of distal convoluted tubule and first part of collecting tubule. They block the mineralcorticoid receptor and inhibit Na+ reabsoption and K+ excretion.spironolactone can be added to ACEI, diuretic and digoxin to improve morbidity and death rate rate in patient with severe HF. Eplerenone is more specific compared to spirinolactone as inhibitor of aldosterone receptors and has been shown to reduce morbidity and mortality in patient with left ventricular dysfunction post-MI. However, the diuretic effects of aldosterone antagonists are minimal. Combination of aldosterone antagonist with thiazide or loop diuretics will potentiate the effect of thiazide or loop diuretics. This is a more effective alternative compared to potassium supplement.Angiotensin receptor blockers ( arbitrageurs) and DigoxinARBs may be used as an alternative to ACEIs (eg losartan) when patient is intole rant to ACEIs or may be used as adjunct therapy (eg valsartan and cadesartan) in patient who remains symptomatic despite the dose of ACE and -blockers have been optimised. However, ARB is not given to the patient since she is well endured to ACEIs.Digoxin is one of the main drugs for HF treatment. However, digoxin is not recommended in this case. Digoxin can only been given if patients HF is worsening or patient is having atrial fibrillation at the same time. Hence, it is reasonable to exclude digoxin from treatment in this case. express for treatment of the conditionsDiureticsDiuretic is a very important drug for heart failure treatment especially for symptoms of fluid retention. A meta-analysis which includes 18 randomized controlled trials (RCT), n=982, had been carried out to discipline the role of diuretics (loop diuretics and thiazides) in patient with congestive heart failure (CHF). 8 trials were placebo-controlled and another 10 were comparison surrounded by diuretics an d other drugs such as ACEIs, digoxin and ibopamine. The results had shown that diuretics reduce the risk of deterioration of disease and mortality compared to placebo group. When compared to active controls, diuretics also showed significant improvement in patients exercise capacity. The beneficial effects of diuretics are further supported by Cochrane database which also indicated that diuretics cause significant simplification rate and improvement in patients morbidity.Another study also proved that the withdrawal of furosemide will cause increase in volume load and right ventricular pressure. There will lead to deterioration of CHF which include impaired type of life, weight gain and walking distance lessen. Higher dose of furosemide will have more desirable effects such as increasing general well-being and reducing symptoms of disease. However, the inappropriate high dose of furosemide will lead to hypotension. The risk of hypotension will be increased if patient on ACEIs or vasodilators at the same time with diuretics. According to NICE guidelines, low dose should be prescribed for the initiation of therapy and titrated up gibe to patients condition.Furosemide is the most commonly used loop diuretic. However, some patients are more responsive to other loop diuretic such as torasemide. This may due to its longer duration of action and high absorption. Some pharmaco scotch analyses also proved that torsemide reduces hospitalisation for patient with CHF. Hence, general treatment costs are rock-bottom although torasemide is more expensive than furosemide. Patients that treated with torasemide have improved their quality of life. The data also suggest torasemide to be used as first-line treatment for patients with CHF and for those who are not response to furosemide.Besides that, according to a double-blind study, n= 1663, additional of aldosterone antagonist, spironolactone with furosemide had importantly reduced mortality and morbidity rate of patient s with severe HF Hence from the evidences in a higher place, we can conclude that furosemide 40mg od is rationale to be given to patient to treat the symptoms of her CHF.Angiotensin-Converting Enzyme Inhibitors (ACEIs)The patient is taking perindopril 4mg od for her HF. A clinical trial has been carried out to compare the effectiveness between ACEIs and placebo in patients with symptomatic CHF. The overall results showed the significant reduction in total rate of mortality and risk hospitalisation.The benefits of ACEIs are further supported by five long-term disarrange trials which had recruited 12763 patients with heart failure or left-ventricular systolic dysfunction (LVSD) to compare the effectiveness between ACEIs and placebo. Results showed that mortality rate has been reduced by 23%, readmission rate of heart failure reduced by 35% and re-infarction rate had been reduced by 26% for the patients who assessed ACEIs compared to placebo group. The benefits of ACEIs were observed at the beginning of therapy and it persisted long term.In SOLVD investigation, n=4228, ACEIs (enalapril) reduced the rate of hospitalisations and also incidence of heart failure in patients with reduced left ventricular riddance fractions compared to placebo group. Some randomize controlled trials proved that ACEIs also improve the exercise capacity and quality of life in majority of the patients. Not all the patients with heart failure due to left-ventricular systolic dysfunction experienced the improvement of exercise capacity. However, ACEIs alone is not enough for the treatment of heart failure with pulmonary oedema. Diuretic is requisite to maintain sodium balance and prevent any fluid retention. ACEIs are more often to be prescribed compared to vasodilators and angiotensin receptor blockers due to more evidence supports.ACEIs will cause hyperkalaemia, cough and deterioration of renal function. Hence, renal function and serum potassium level need to be checked before the tr eatment is initiated. The SOLVD data, a randomised, double-blind and placebo controlled trial with 3379 patients, proved that enalapril caused 33% increased in deterioration of renal function compared to control group (P = 0.03). There is another study (n=191) showed that 44% of patients taking ACEIs suffered from unyielding cough compared to controls which is only 11.1% (PThe studies above showed that ACEIs are rationale to be used as first-line treatment HF.-blockers-blockers should be included in the treatment of HF even though the patient is already well controlled by diuretics and ACEIs. The European Journal of Heart Failure suggested that -blockers should be prescribed to all patients with stable HF and when left-ventricular ejection fraction 40%. A lot of meta-analyses showed that -blockers race a role in increasing life expectancy in patients with HF due to LVSD.In a meta-analysis which includes 21 trials (n= 5894), -blockers showed a significantly reduction of overall a nd cardiovascular mortality by 34-39%in patients with severe HF. Another meta-analysis of 16 clinical studies also showed the reduction of 24% for patients who were taking -blockers for their HF treatment rather than placebo. An interesting meta-analysis had been carried out to test the readiness of -blockers in the patients with diabetes mellitus (DM) and CHF. The result of this meta-analysis showed that -blockers had reduced the mortality rate of patient with DM and CHF. However, the reduction was not significant (P=0.11) compared to CHF patients without DM.Most of the survival benefits for patient with NYHA twelvemonth II and III are well documented. There is a meta-analysis had turn out that -blockers are having the same improvement of survival rate among the patients with severe HF compared to patients with NYHA class II and III. However, further studies need to be carried out to pronounce overall benefits versus risks of treatment in NYHA class IV. There are common chord main studies, n9000, had been carried out to compare the efficacy between -blockers (bisoprolol, metoprolol succinate CR, carvedilol) and placebo. Almost 90% of patients involve in there three randomised trials were on ACEIs or ARB. Most of them also took diuretics and digoxin. All trials showed the improvement of mortality rate (RRR= 34%), risk of hospitalisation (RRR= 28-36%) and self-reported well being. So far, there are no significant differences between selective and non-selective -blockers and those with or without vasodilating properties.In one randomised controlled trial (COMET), n=3029, carvedilol was used to compared with the efficacy and clinical outcome of metoprolol tartate. The result has shown that carvedilol reduced the mortality rate significantly among the patients compared to short-acting metoprolol tartate (P=0.0017). However, there is no any clinical trial about comparison between carvedilol and long-acting metoprolol succinate. There is little economic evidenc e can be found for -blockers. NICE guidelines suggested that -blockers are cost effective due to reduction of hospitalisation rate.Bisoprolol 2.5mg od had been added to the patient on second day since patient was admitted. The evidences above do support that the usage of -blocker should be included in patient with HF.Aldosterone antagonistsSpironolactone is the most common aldosterone antagonist used in treatment of HF. In a double-blind study (RALES), 1663 patients with severe HF (NYHA class III and IV), left ventricular ejection fraction 35% and being treated with diuretics, ACEIs or digoxin were recruited to test the effectiveness of spironolactone on their morbidity and mortality. The result showed 30% reduction in mortality rate and 35% reduction of frequency of hospitalisation compared to placebo group. Addition of spironolactone to ACEIs, diuretics or digoxin had reduced the mortality rate in patients with severe HF. Additional of spironolactone may lead to hyperkalaemia. Ho wever the problem of hyperkalaemia can be solved by closing monitoring the potassium level of patients. Another study also showed that spironolactone reduced 30% mortality rate in patients with HF when it has been added to -blockers and digoxin.A selective aldosterone antagonist, eplerenone, has fewer side effects compared to spironolactone. A randomised controlled trial (EPHESUS), n=6633, proved that morbidity and mortality rate among patients with left ventricular dysfunction after acute myocardial infarction had been reduced with the addition of eplerenone compared to placebo group. There is no relevant economic evidence of aldosterone antagonist. Eplerenone is mostly used when patients cannot tolerate with spironolactone.Hence, spironolactone 25mg od is appropriate to used as adjunct to diuretics, ACEIs or maybe -blockers for patient in this case. Since the patient does not suffer any side-effects from spironolactone, it is not necessary to change to eplerenone.ConclusionAs a co nclusion, patients CHF has been appropriately treated by following the guidelines and also supported by many of clinical studies. From the clinical process, we can see that the condition of patient was gradually improved day by day. A -blocker, bisoprolol was added in the second day in order to achieve a better control of patients HF and also HPT. According to guidelines, the dose of bisoprolol should be initiated with 1.25mg, not 2.5mg. The potassium levels need to be monitored regularly due to the concomitant use of perindopril and spironolactone which may cause hyperkalaemia. ARB and digoxin are not prescribed to the patient because she is well tolerated with ACEIs and she does not have AF. Other treatment for HF such as vasodilators (hydrazine and ISDN) will only be considered when all of the treatment options above have failed to this patient. Non pharmacological treatment such as life-style modification, florid diet, restrict fluid intake and salt intake also play a very imp ortant in controlling patients HF and HPT for long-term.

Friday, March 29, 2019

Medical ward objectives and staffing levels

medical checkup defend objectives and staveing trainsThis is a 34 bedded medical protect admitting phallic patient ofs with different conditions.The specialties ar as followsSpecialtiesConsultantBedsGastro-EnterologyDr. Salim AL.Harthi6NeurologyDr. Jaber AL.Khaburi5RespiratoryDr. Nasser AL.Busaidi5CardiologyDr. Abdullah AL.Riyami4EndocrinologyDr. Noor Al.Busaidi4Infectious DiseaseDr. Saif AL.Abri4RheumatologyDr. Ramnath Misra4HematologyDr.Muhana AL.Maslahi2Ward Objectives-To plan, organize, implement and evaluate the breast feeding services to ensure that a high standard patient wangle is delivered indoors the ward.To maintain optimum professional code of doings, dedicate and unafraid lag morale of professional nurse.To maintain effective communication with patient and their relatives concerning the nature and management of clinical conditions and their outcomes.To ensure all stave rush been updating their knowledge by conducting some lectures within the ward train and training programs within CPE department.To facilitate the integration of newly qualified Omani nurse into their roles and responsibilities in the tertiary medical services consistent with the bailiwick policy on Omanization and fully aware administrative roles and regulation pertaining their employment.To conduct regular stave performance appraisals to assess power, progress, strengths, weaknesses and identify further tuition and training needs.To schedule and deploy sufficient numbers of rung to post 24hrs bring off for guard to ensure safe clinical institutionalize.To ensure optimum utilization of the hospital resources towards the appropriate provision of nursing services passim the ward. moduleing Levels-Staff levelsOmani StaffExpatriates Staff ripenedJuniorSeniorWard Nurse1Staff Nurse1133Ward CoordinatorNil medical exam Orderlies13 substance staff27staff (-1staff in Female Medical 1, plan for transfer.Ward Activities-Termination, Omanization, Transferring, forbearan ce and New staff-Sr. NoWard ActivitiesNo. Of Staff NurseRemarks1TerminationNilNil2Omanization2S/N Seena impact date 01/08/2009S/N Smitha affected date 06/09/20093Transferring3+ 1 Temporary1S/N Wafa Harib affect date 02/05/09 to Royal Hospital OPDS/N Suganthi affect date 02/05/09 to MM1S/N Enci affected date 06/06/09 to FM2+ S/N Faiza affected date 01/11/09 to FM1 (Temporary)M/O verbalise affected date 02/05/2009 to Royal Hospital X-Ray Department4Resignation1S/N Ajitha Affected date 06/12/20095New Staff2 S/N + 1 M/OS/N Idris Al-FarsiS/N Sangoor Al-Yusufi+ M/O Turki BarghashNew Equipment-1. Glide sheet for patient turning 6/7/092. Our old cardiac monitor has been replaced.Activities in Male Medical cardinal Within Each Month-Male Medical Two is kept for conducting the MRCP exams four times per year which always take unrivalled week distributively(prenominal) time of these exams went so smoothly and will founder as chance for tarrow clean the ward.The ward is the Disaster ward in the medical whole, all staff in the ward have acceptable knowledge of the step how to followed in any emergency situation (of each month 1st week there is discussion Disaster offspring to upgrade staff knowledge) On 13/11/2009 there was a disaster drill which has prove to us that the objective of disaster operation cards are met throughout the feedback we received verbally from Nursing Administration.second Week in each month kept for upgrade staff knowledge virtually Professional Code of Conduct by disposed lecture with scenarios in one of the element.3rd Week in each month kept for upgrade staff knowledge about medical specialty action side effect, by lecture given by assign staff 10-15 minutes prior to hand over of morn shift. quaternate Week in each month kept for upgrade staff knowledge about Firewast management by lecture given by assigned staff 10-15 minutes prior to hand over of morning shift.Ongoing monitoring is being done on-Nursing Records Auditing which we ar e doing since July 2001. chance(a) patient Fall Assessment Score.Wound care assessment.Daily followed screening for any infection (MRSAMDRAB)Daily followed Nursing process which started on 2nd September 2002.Discharge planning started on October 2002Monthly environmental Audit.Six Month report.Education, Training and Quality centering for 2009SRCourses2009No of S/N completedRemark1Ward Management132High Dependency333Pain Management4224 electrocardiogram interpretation1115Preceptor ship323Upgrade their knowledge by refreshment preceptor workshop.6IV Therapy Drug Calculation28(All staff)7IV Cannulation7We are following up with other 8 staff practice cannulation till they are competent.8Wound stoma care34They are helping to teach other staff in the ward level and follow up the care about wounds.9Post Kidney Transplant1110Recertification BCLS28(All staff)every 2 years11Manual Handling23 early(a) 5staff who are joining MM2 in last 3years they are learn much about it from senior staff during work.12Physical Assessment36Recertification of BCLS and management of Cardiac Arrest-All of nurses certified much than 2 years ago have been recertified. Nurses within the ward has been assessed for their competency in management of cardiac arrest at the ward level in recognizing cardiopulmonary arrest, move rapidly towards Life saving.The plan for ward basic CPR within Ward level, which aim to check the staff competency with it.Strategic Plan for next year-To advance the ward activities, upgrade the standard of care and services to the patient.To plan, organize, implement and evaluate the nursing services to ensure that a high quality patient care is delivered within the ward level.To maintain optimum Professional Code of conduct, practice and good staff morale of professional nurse.To ensure all staff has been updating their knowledge by conducting different courses in CPE and some lectures within the ward level regarding cases, medication and infection control.To finaliz e Endoscopy Procedure cusp this is made by staff in Male Medical Two.To continue give first priority for CPE program courses to Omani staff to mend their competencies and skills.Plan to give 3 lecture within medical unit by our staff regarding (fall prevention, CVP care and medication calculation during emergence).Done by - Saif AL.Ghuzaili