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Aggregated Antibiograms and Monitoring of Drug-Resistant Streptococcus pneumoniae. Highlight and copy the essay number desired format. Community-specific antimicrobial susceptibility data may help monitor trends among drug-resistant Streptococcus pneumoniae and great essays time, guide empiric therapy. Because active, population-based surveillance for invasive pneumococcal disease is accurate but resource intensive, we compared the proportion of penicillin-nonsusceptible isolates obtained from essay number, existing antibiograms, a less expensive system, to that obtained from 1 year of active surveillance for Georgia, Tennessee, California, Minnesota, Oregon, Maryland, Connecticut, and New York. For all sites, proportions of penicillin-nonsusceptible isolates from antibiograms were within 10 percentage points (median 3.65) of those from invasive-only isolates obtained through active surveillance. Only 23% of antibiograms distinguished between isolates intermediate and resistant to in the course of project, penicillin; 63% and 57% included susceptibility results for erythromycin and extended-spectrum cephalosporins, respectively. Aggregating existing hospital antibiograms is a simple and relatively accurate way to estimate local prevalence of penicillin-nonsusceptible pneumococcus; however, antibiograms offer limited data on number isolates with intermediate and high-level penicillin resistance and isolates resistant to other agents. Infections from Streptococcus pneumoniae tax the healthcare system in the United States and other countries. Scientific advances have been made in argumentative essay the treatment and prevention of pneumococcal infections through antibiotics and licensure of essay binary, vaccines for both adults and children; however, the last few decades have witnessed the emergence of S. pneumoniae resistance to college essay, antibiotics ( 1 ). In a multistate, population-based surveillance system that follows invasive disease from pneumococcus and other bacterial pathogens, the percent of isolates resistant to penicillin reached 24% in 1998; concurrent increases in essay binary resistance to other antimicrobial drugs have also been noted among penicillin-resistant pneumococci ( 1 , 2 ). Implications of drug-resistance extend beyond the laboratory and into clinical practice as treatment failures from drug resistance have been reported with meningitis ( 3 – 5 ) and otitis media ( 6 , 7 ). In some studies, increased death and articles argumentative essay, disease in patients hospitalized with pneumonia caused by high-level ?-lactam-resistant pneumococci have been reported ( 8 , 9 ). Essay Number. Measuring pneumococcal resistance to penicillin and park essay, other antibiotics enables epidemiologists and essay number, healthcare providers to bpo resume formats, monitor trends, develop guidelines for optimal empiric therapy, and provide impetus for and ascertain the success of educational efforts promoting the judicious use of antibiotics. Antimicrobial resistance is not uniform across the essay binary number United States ( 10 ). Nonsusceptibility to penicillin among invasive pneumococcal isolates has been shown to range from 15% to 35% among populations in the Centers for Disease Control and Prevention’s (CDC) national surveillance system ( 1 ).

The ideal method for accurate tracking of antimicrobial-resistance patterns in great about time a community may be active, laboratory-based surveillance systems that collect strains for susceptibility testing in a reference laboratory. However, this method can be costly, time-consuming, and resource intensive. Alternative methods of measuring local drug-resistant pneumococci that are less expensive and timelier are needed. One alternative is to use aggregated antibiograms. Essay Binary Number. A study conducted by great time epidemiologists at the Oregon Health Division found that aggregating existing hospital antibiograms, also known as cumulative susceptibility data, provided relatively accurate, community-specific, drug-resistant S. pneumoniae data when compared with active-, laboratory-based surveillance, the standard criterion for binary number, invasive disease.

The investigators also found that use of local laboratory antibiograms was far less expensive and time-consuming when compared with active surveillance. Whether Oregon’s results can be generalized is unknown; however, only 12 hospitals in one city (Portland) were surveyed, and the percent of S. pneumoniae infections nonsusceptible to essay, penicillin was relatively low (14%) ( 11 ). We compared the two methods of surveillance in a larger study that involved sites in geographically disparate areas and represented a larger fraction of the national population and varying degrees of drug resistance across the United States. Our objective was to determine if existing hospital antibiograms could be used to estimate the percent of community-specific, drug-resistant S. pneumoniae in multiple sites. We compared the proportions of drug-resistant S. pneumoniae isolates reported by participating clinical laboratories from the Active Bacterial Core Surveillance (ABCs) sites to proportions obtained by aggregation of existing antibiograms produced by the same ABCs laboratories. Active Laboratory-Based Surveillance. ABCs, a laboratory-based active surveillance system in CDC’s Emerging Infections Program, tracks invasive disease caused by binary number S. pneumoniae and other bacterial pathogens of public health importance ( 12 ). Surveillance areas included in essay on thermosphere this analysis were: California (CA) (San Francisco County), Connecticut (CT) (entire state), Georgia (GA) (20-county area, including Atlanta), Maryland (MD) (6-county area including Baltimore), Minnesota (MN) (7 counties), New York (NY) (7 counties), Oregon (OR) (3-county area including Portland), and binary number, Tennessee (TN) (5 counties). Formats. The total population under surveillance was 17 million. A case of invasive pneumococcal disease was defined as the isolation of S. Essay Number. pneumoniae from a normally sterile site (e.g., blood, cerebrospinal fluid) from a surveillance area resident. Surveillance personnel routinely contacted all clinical microbiology laboratories in their site to identify cases and conducted audits every 6 months to ensure complete reporting. Pneumococcal isolates collected through ABCs were sent to reference laboratories for susceptibility testing by broth microdilution according to the methods of the National Committee for Clinical Laboratory Standards (NCCLS) ( 13 ). Isolates were defined as susceptible, having intermediate resistance, or resistant to agents tested according to satire park, NCCLS definitions ( 14 ). We requested existing antibiograms from all clinical laboratories participating in ABCs. The antibiograms were to cover the most recent 12-month period for which completed data were available at the time of the inquiry (1997 for GA, TN, CA, MN, OR, MD, and CT; 1998 for binary number, NY).

Any identifying information (e.g., hospital name) obtained during collection of in the, antibiogram data was removed before the data were forwarded to study investigators at essay binary number, CDC. Surveillance personnel also used a standardized questionnaire to query each hospital’s infection control practitioner or microbiology supervisor regarding the count dracula essays production and distribution of local antibiograms and whether antibiogram data included sterile isolates, nonsterile site isolates, or duplicates isolates from a single patient. We compiled total numbers of S. pneumoniae isolates identified from the ABCs sites along with the percent of intermediate and resistant isolates, focusing on binary nonsusceptibility to penicillin, macrolides, and extended-spectrum cephalosporins (e.g., cefotaxime, ceftriaxone). We defined nonsusceptible isolates as those that were of in the course, intermediate and high-level resistance or that were simply described as not susceptible to the antibiotic tested. We aggregated data obtained from the participating hospitals within each ABCs site to essay number, produce summary antimicrobial susceptibility percentages. When generating tables comparing percent of nonsusceptible pneumococcal isolates estimated by antibiograms and by ABCs, we used only antibiogram data for bpo resume, the year in question (1997 for all sites excluding New York [1998]); antibiograms covering other periods were excluded from this portion of the analysis. Also, we used only antibiograms that included both the total number of isolates tested and the percent nonsusceptible for each of the binary antibiotics evaluated; this system allowed for aggregation of the laboratory’s data with those from other laboratories. If only a subset of isolates were tested against erythromycin and extended-spectrum cephalosporins, we excluded these results from the aggregated total for erythromycin, cephalosporins, or both. We also calculated the percent of laboratories that included S. Count. pneumoniae susceptibility testing to a variety of other antimicrobial agents and the percent of laboratories generating antibiograms that included susceptibility testing of gram-negative bacteria. To compare the proportions of resistant and susceptible S. pneumoniae isolates detected by the two surveillance methods, we examined the essay binary proportion of hospitals whose aggregated antibiogram data fell within a range of ± 5% and ± 10% compared with that detected through active surveillance.

One hundred and forty-five ABCs laboratories completed the surveys; these laboratories conducted antibiotic susceptibility and on thermosphere, other testing for a total of number, 170 (85%) of the 199 hospital laboratories participating in ABCs at the time the study was undertaken. Of the 145 responding laboratories, 108 (74%) routinely generated antibiograms. The 108 antibiograms created include pneumococcal susceptibility testing results for 140 (70%) of the essay on thermosphere 199 ABCs hospital laboratories. In-house microbiologists typically generated the antibiograms (83%), while infection control practitioners (7%) and pharmacists (10%) created the binary number remaining. Satire Essay. Nearly all laboratories included both sterile site (98%) and essay binary number, nonsterile site (92%) isolates in the antibiograms. Ninety-five percent included inpatient, and in south essay, 79% included outpatient isolates. Forty-six laboratories (43%) included duplicate isolates from number, individual patients in course their antibiograms. When asked how pneumococcal isolates with intermediate susceptibility were categorized, survey responders stated that their laboratory characterized these isolates as intermediate (37%), resistant (32%), susceptible (5%), and nonsusceptible (22%). Binary. This question did not specify the antibiotic tested. Satire In South. Only 25 (23%) laboratories generated antibiograms that included data distinguishing isolates intermediate and resistant to essay number, penicillin; 77% only count indicated whether the binary isolates were susceptible or nonsusceptible.

The average number of isolates included in the summary antibiograms was nearly double the essay number collected through active surveillance; the mean number of pneumococcal isolates (per site) tested for penicillin susceptibility was 417 (range 69–850) for essay binary number, ABCs and essay, 826 (range 383–1,291) for summary antibiograms. Hospitals (n=40) that excluded duplicate isolates from antibiograms averaged similar numbers of isolates (mean 89 isolates) tested for penicillin susceptibility as did hospitals (n=34) whose antibiograms included multiple isolates from a single patient (mean number of isolates tested 88). Essay Binary Number. Of the 140 hospital laboratories whose pneumococcal antibiotic susceptibility testing results were summarized in antibiograms, 96 (70%) created antibiograms with penicillin-susceptibility results in a format that could be aggregated for the year in question. The proportion of laboratories in each site that generated usable penicillin susceptibility data ranged from 70% (MD) to 100% (NY and MN). Antibiograms included susceptibility-testing results for macrolides (63%) and third-generation cephalosporins (57%). The proportion of laboratories for which this susceptibility information was in a format that could be aggregated, however, was smaller for bpo resume, macrolides (44%) and third-generation cephalosporins (39%). For the eight sites, the proportion of penicillin-nonsusceptible isolates from ABCs ranged from 14.5% (NY) to 38.4% (TN), whereas antibiograms yielded a range of 18.5% (CA) to 41.7% (TN) (Table 1).

For all sites the overall proportion of isolates nonsusceptible to penicillin according to antibiograms was within 10 percentage points of the population- and laboratory-based surveillance (ABCs); for binary number, six sites it was within 5 percentage points. The proportion of penicillin-nonsusceptible isolates for each site identified by antibiograms was higher than that generated by ABCs (median difference: 3.65%; range 8.6% to 1.8%). No correlation existed between site-specific levels of penicillin resistance and the magnitude of difference between site-specific penicillin resistance identified by the two methods. The proportions of pneumococcal isolates nonsusceptible to a third-generation cephalosporin and to argumentative essay, erythromycin were lower than the proportion of penicillin-nonsusceptible isolates, regardless of the method used (Tables 2 and 3). Similar to the results for penicillin, the percent of strains nonsusceptible to third-generation cephalosporins or erythromycin as detected by antibiograms tended to be greater than the percent nonsusceptible detected by ABCs. In contrast, the binary number range of the differences for third-generation cephalosporins and erythromycin detected by gatsby essays about the two surveillance methods was larger than the range of differences for penicillin as measured for each ABCs site. The magnitude of the difference in overall susceptibility to third-generation cephalosporins determined by the two surveillance methods was 10% for seven of eight sites and 5% for five sites. The magnitude of the difference in essay binary number susceptibility to erythromycin as determined by the two surveillance methods was 10% for gatsby, all sites and 5% for only four sites. In addition to penicillin, cephalosporins, and essay binary number, macrolides, submitted antibiograms included susceptibility testing results for a variety of other antibiotics that included the following: trimethoprim/sulfamethoxazole (35%), vancomycin (59%), clindamycin (47%), gentamycin (3.9%), and one or more fluoroquinolones (14%). Thirty-eight percent of articles argumentative, antibiograms returned for analysis also included antimicrobial susceptibility testing results for various gram-negative bacteria. The results of number, our study suggest that antibiograms may be an adequate method for essays about time, conducting drug-resistant S. pneumoniae surveillance for many health departments, illustrating the comparability of binary number, aggregated antibiograms that include both sterile and nonsterile site isolates to active, laboratory- and population-based surveillance for invasive isolates.

For more than half the comparisons between the two methods, the difference in antibiotic resistance detected was 5 percentage points, and for 23 (96%) of the great essays time 24 comparisons the difference was 10 percentage points. No significant differences in comparability of the two methods were noted between high- and low-resistance areas. This study indicates that antibiograms may be an alternative tool for evaluating penicillin nonsusceptibility in a region and validates the earlier findings of the Oregon study, conducted in an area of relatively low antibiotic resistance ( 11 ). Although the estimates of level of resistance obtained from number, antibiograms approximated that from ABCs, aggregated antibiogram data tended to show a higher proportion of nonsusceptible isolates within each site and for each antibiotic evaluated. Bpo Resume. This trend is likely due to the inclusion of nonsterile (noninvasive) site isolates. In studies from centers that include both sterile and essay binary, nonsterile isolates, nonsterile site isolates have been found to be equally or more resistant ( 15 – 17 ). On Thermosphere. The reason for this difference is unclear but may reflect differences in serotype distribution between strains causing invasive and noninvasive disease.

Disparity in results between clinical and essay number, reference laboratories could also contribute to this trend; use of the E test (AB Diodisk, Solna, Sweden) by college essay clinical laboratories might vary from the essay binary referent method (broth microdilution) by one half or one dilution ( 18 ). Dracula Essays. In this study, we were unable to examine the binary role of laboratory error or differences in susceptibility-testing methods as a reason for differences in bpo resume results from antibiograms compared with those from essay binary, active surveillance. Compared to penicillin, differences between the two surveillance methods were greater for satire in south, extended-spectrum cephalosporins and essay, erythromycin. Bpo Resume Formats. This finding may be because of smaller numbers of isolates included in the antibiograms, fewer laboratories that included susceptibility testing of S. pneumoniae to these antibiotics, or greater disagreement between clinical and essay, reference laboratory results. We could not include antibiogram-susceptibility testing results for some hospital laboratories because only a subset of the pneumococcal isolates that were tested for essays time, penicillin nonsusceptibility were also tested for susceptibility against third-generation cephalosporins (20 laboratories) and erythromycin (13 laboratories). The potential explanations for why these laboratories tested only number a subset of pneumococcal isolates (i.e., only penicillin-nonsusceptible isolates were tested) against the same antibiotics were not indicated on the antibiograms. We chose to evaluate the comparability of the two surveillance methods by observing how often the percent nonsusceptible isolates estimated by aggregated antibiograms differed by 5 and articles argumentative, 10 percentage points from that estimated by ABCs active surveillance. As there exists no standardized or absolute level of antimicrobial drug resistance that would dictate a change in empiric treatment of pneumococcal infections, we chose a priori two conservative thresholds of difference. A healthcare provider may not modify empiric therapy based on number the differences found in our study, and the magnitude of differences reported here are likely not relevant from a public health perspective.

Trends of pneumococcal antibiotic resistance over time may be of more clinical and epidemiologic relevance than an absolute level. Knowledge of local trends may help communities assess regional antibiotic use and evaluate the effects of local educational measures promoting the judicious use of satire in south, antibiotics. As this study did not span multiple years, we could not document the ability of antibiograms to detect trends. However, given that sentinel surveillance conducted in ABCs sites has been shown to essay, detect pneumococcal resistance trends over time ( 19 ) and that in essay on thermosphere our study antibiograms provided site-specific point estimates of antibiotic resistance similar to those measured by active sruveillance, antibiograms may be able to essay number, follow trends in pneumococcal antimicrobial resistance at the local level. Drawbacks to dracula, this surveillance method include the inability to evaluate resistance to multiple drugs. Relatively few drugs can be evaluated because of laboratory variations in antibiotics selected for susceptibility testing by antibiograms. Health departments that wish to monitor emerging resistance patterns to number, antibiotics, such as vancomycin or fluoroquinolones, might consider a method other than aggregated susceptibility tables, or they might encourage hospital laboratories within a defined community to standardize their susceptibility panels to facilitate aggregation of results. Another limitation of course, antibiograms is the inability to binary, distinguish between intermediate- and satire in south, high-level resistance to penicillin; 77% of antibiograms in our study expressed resistance as percent nonsusceptible rather than distinguishing between intermediate and resistant isolates. This distinction has become relevant for treatment of some infections. For example, NCCLS guidelines recommend different breakpoints by syndrome (meningitis vs. nonmeningitis) for some agents ( 20 ). Aggregating antibiograms is essay binary, useful for infections that are generally community-acquired, but antimicrobial resistance in hospital-acquired infections should be evaluated based on the knowledge of the particular institution’s flora.

Finally, not all hospitals’ laboratories generate antibiograms or generate them in a manner facilitating aggregation across laboratories. However, we demonstrated the comparability of the two surveillance methods despite the fact that the penicillin-nonsusceptibility results, as measured by antibiograms, was known for only 96 (48%) of the 199 ABCs hospital laboratories. This study should help clinicians and public health personnel in state or local health departments determine which surveillance tool for obtaining estimates of antibiotic-resistant S. pneumoniae is best suited to their specific region or community by providing background information on two alternative systems; the benefits and limitations of each system may be reviewed to determine the most useful and practical surveillance tool for a particular region. Antibiograms are relatively inexpensive and essay, easy to use. Essay Binary. Although not measured in our study, epidemiologists in satire in south park essay Oregon found that the cost of active surveillance was approximately 70 times that of aggregating antibiograms for the three-county study area ( 11 ); the high cost of essay number, this type of surveillance, however, is partially due to the fact that ABCs is an integrated system that accomplishes multiple objectives in addition to susceptibility testing of pneumococcal isolates ( 12 ). Satire Park. Most hospitals and laboratories routinely generate antibiograms; therefore, obtaining this information is relatively easy and within the number capacity of local health departments. Active surveillance, on great gatsby essays about the other hand, excludes duplicate isolates for number, a single patient or infection and is able to provide extensive additional information such as risk factors for resistant infections, outcome data, and other laboratory testing such as serotype determination. Active surveillance also limits case and college argumentative, isolate collection to persons who are residents of the defined surveillance area, allowing for calculation of rates of disease. Furthermore, active surveillance provides individual patient-level data, allowing assessment of the impact of specific interventions such as pneumococcal conjugate vaccination of infants and young children. Attainment of binary number, patient-level data through active surveillance also permits detection of possible changes in the incidence of resistant pneumococcal infections (e.g., because of essay on thermosphere, a general decrease in cases of essay, pneumococcal infection among children receiving pneumococcal conjugate vaccine) that might go unnoticed if only the proportion of resistant isolates were tracked (i.e., as done by antibiograms). Increasing antibiotic drug resistance is a problem that is global in scale and that has practical implications for course of project, the treatment and outcome of invasive infections from S. pneumoniae and other bacteria of essay, public health importance.

Clinicians and researchers are now acknowledging the importance of essay, preventing resistant infections through appropriate use of antibiotics and vaccines. Surveillance data are needed to monitor the success of these campaigns and to raise awareness of the problem. Because most local laboratories generate antibiograms routinely, collecting aggregating antibiogram data is an inexpensive and readily available method of measuring local antibiotic resistance levels. Although providing less information than active surveillance, aggregated antibiogram data are a generally accurate way for health departments to essay binary number, generate needed community-specific estimates of pneumococcal resistance. Articles Essay. Dr. Van Beneden is a medical epidemiologist in the Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention. Her research interests include public health surveillance systems for community-acquired bacterial infections, antimicrobial resistance among streptococci, study of vaccines against pneumococcal disease, and group A streptococcal disease. We thank the surveillance officers, clinical microbiologists, laboratory directors, and managers working in ABCs sites for contributing data for this study and Paul Cieslak, Richard Besser, and Anne Schuchat for their helpful and insightful comments on the manuscript. Please use the essay binary number form below to submit correspondence to the authors or contact them at park essay, the following address: Chris Van Beneden, Respiratory Diseases Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd, Mailstop D65, Atlanta, GA 30333, USA; fax: 404-371-5445.

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MTMS Business Plan: Pharmacy Store Model - PowerPoint PPT Presentation. To view this presentation, you'll need to enable Flash. PPT MTMS Business Plan: Pharmacy Store Model PowerPoint presentation | free to binary number download - id: 24eb5-OTUzN. The Adobe Flash plugin is needed to view this content. MTMS Business Plan: Pharmacy Store Model. Patients are more compliant with their medication therapy with pharmacist involvement. . Satire In South Essay. Medication Therapy Management Services (MTMS) . Essay. PowerPoint PPT presentation. Title: MTMS Business Plan: Pharmacy Store Model. MTMS Business PlanPharmacy Store Model Marc Young Linda Byrd Brad Barker Harshal Pandya Wes Wilkerson. Outline Business Concept Assessing Clinical and Quality Management and.

Operations Marketing Strategy Financial Data Projections. MTMS What is it and where did it come from? Background of Medication Management The cost of healthcare is steadily increasing. Better control of a disease state should lower. the overall cost to treat that disease. What have past studies shown us about this idea? The Literature Studies such as the essays Asheville Project used. pharmaceutical care disease state management to. improve personal health outcomes as well as. decrease health system costs. Project ImPACT demonstrated that a. pharmacist-physician team approach improved.

medication therapy compliance and treatment. The Asheville Project Employees of the essay binary city of Asheville, NC and. Mission-St. Josephs Health System were provided. Pharmaceutical Care Services for the treatment of. diabetes. Demonstrated successful economic and clinical. outcomes attributed to pharmacist participation.

Asheville Project (cont) Economic Outcomes Decreased Direct Medical Costs Ranged from course of project, 1622 to essay 3356 per patient per year Increased Productivity Decreased sick leave every year from formats, 1997-2001 One employer estimated an 18,000 per year. increase in productivity. The Asheville Project Long-Term Clinical and. Economic Outcomes of a Community Pharmacy. Diabetes Care Program. Essay Number. Journal of the American. Pharmaceutical Association. Bpo Resume. (43)2. Asheville Project (cont) Clinical Outcomes Disease State Improvement Compared to Baseline Increased number of patients with optimal. Hemoglobin A1c levels at essay binary number, each follow-up 57.7 81.8 of patients had improved A1c levels. at every follow-up Increased number of patients with optimal LDL.

The Asheville Project Long-Term Clinical and. Economic Outcomes of a Community Pharmacy. Diabetes Care Program. Journal of the American. Pharmaceutical Association. Bpo Resume. (43)2. Asheville Project (cont) Clinical Outcomes (cont) Disease State Improvement Compared to Baseline. (cont) 50.0 66.7 of essay number patients had improved LDL levels.

at every follow-up Increased number of patients with optimal HDL. levels 53.3 75.0 of patients had improved HDL levels. The Asheville Project Long-Term Clinical and. Economic Outcomes of a Community Pharmacy. Diabetes Care Program. Journal of the American. Pharmaceutical Association. Count. (43)2. Asheville Project (cont) Clinical Outcomes (cont) Improved Quality of Life Measures The following are some the patients self-reported. findings as a result of the intervention Patients felt more in binary, control of their lives Patients felt they were healthier Patients were instilled with a sense of hope that. they could control their diabetes Patients cited changes in gatsby, lifestyle and an. improved overall quality of life as a result of.

The Asheville Project Participants Perceptions. of Factors Contributing to the Success of a. Patient Self-Management Diabetes Program. Journal of the American Pharmaceutical Associatio. Project ImPACT ImPACT (Improve Persistence And Compliance with. Therapy) conducted by essay number, the APhA Foundation between March. 1996 and October 1999 Idea was to demonstrate that pharmacist/physician. collaboration could promote patient persistence. and compliance with dyslipidemic therapy.

Pharmaceutical Care Services and Results in. Project ImPACT Hyperlipidemia. Journal of the. American Pharmaceutical Association. (40)2. Project ImPACT (cont) Therapy goals were based on the National.

Cholesterol Education Program (NCEP) Persistence defined as a patient who started on. medication, remained on medication subsequent to. drug therapy initiation, and continued to be on. medication as of his or her last visit. Compliance defined as determined through an. evaluation based on essay on thermosphere, the number of missed doses. for each lipid-lowering medication and refill. Pharmaceutical Care Services and essay number, Results in. Project ImPACT Hyperlipidemia. Journal of the. American Pharmaceutical Association. (40)2.

Project ImPACT (cont) Previously Published Data Patients treated without provider collaboration. with Coronary Artery Disease (CAD) on therapy for. dyslipidemia Showed that only 40 of patients continued. therapy at the end of 12 months, a measure of. compliance.

Had only count a range from 8-33 of patients being. successfully treated to goal lipid levels. Pharmaceutical Care Services and Results in. Project ImPACT Hyperlipidemia. Journal of the. American Pharmaceutical Association. Essay Binary Number. (40)2. Project ImPACT (cont) Results of Project ImPACT 62.5 of patients were at dracula essays, NCEP goals at their. last full lipid profile. 73.2 of patients were at or below NCEP goals on. two or more visits during the study. Essay. The persistence rate was 90.1 over an average of.

24 months The compliance rate was 93.6 over an average of. Pharmaceutical Care Services and of project, Results in. Project ImPACT Hyperlipidemia. Journal of the. American Pharmaceutical Association. (40)2. Putting it all together The Asheville Project demonstrated that.

pharmaceutical care could improve long term. health management outcomes in number, several key areas Economic Increased Productivity Decreased Direct Medical Costs Physiological Improved Disease State Management Psychological Improved Quality of Life. Putting it all together Project ImPACT showed that Patients are more compliant with their. medication therapy with pharmacist involvement. Patients have a better chance of great gatsby about time meeting therapy. goals when pharmacists are actively involved with. physicians in their treatment. Medication Therapy Management Services (MTMS) Combining the number principles explored by these two. studies leads to the concepts pursued by MTMS Economic Increase Productivity Decrease Health System Costs Improve Medication Utilization and Decrease Waste Physiological Improve Disease State Management Maximize Benefits Associated with Medication. Compliance Psychological Improve Quality of Life Maximize Patient Independence Improve Patient-Provider Relationship.

Medicare Modernization Act (MMA) The MMA recognizes pharmacists as providers. eligible to in south bill Medicare for cognitive services. As of January 1, 2006 eligible patients will be. able to receive drug therapy management from an. eligible provider to binary number assist with the maintenance. of their chronic diseases. Medicare Patients are eligible for Medication Therapy.

Management services provided they Are enrolled in essay, Medicare Part D Have multiple chronic diseases such as diabetes, asthma, hypertension, hyperlipidemia, heart. failure, etc. Binary Number. Take multiple drugs covered by great time, Medicare Part D Are likely to essay number incur annual costs associated with. Medicare Part D drugs that exceed a level set by. the Department of Health and on thermosphere, Human Services. Medicare Modernization Act (MMA) The MMA recognizes pharmacists as providers. eligible to essay binary bill Medicare for satire essay, cognitive services. As of binary January 1, 2006 eligible patients will be. able to receive drug therapy management from an. eligible provider to assist with the maintenance. of their chronic diseases.

Medicare Patients are eligible for Medication Therapy. Management services provided they Are enrolled in Medicare Part D Have multiple chronic diseases such as diabetes, asthma, hypertension, hyperlipidemia, heart. failure, etc. Take multiple drugs covered by Medicare Part D Are likely to incur annual costs associated with. Medicare Part D drugs that exceed a level set by. the Department of Health and Human Services. Description of Medication Therapy Management. Services (MTMS) MTMS Consensus Definition A distinct service or group of great gatsby about time services that. optimize therapeutic outcomes for essay number, individual.

patients Independent of, but can occur in conjunction. with, the provision of a medication product Encompasses a broad range of in south park professional. activities and responsibilities within the. licensed pharmacists, or other qualified health. care providers, scope of practice.

Outcome Pharmaceutical Healthcare, LC. MTMS Business Concept Most prevalent MTM-related activities Medication therapy management/polypharmacy Disease management Lab testing/screening Wellness programs/ immunizations Important to distinguish between disease state. management and medication use management. The Lewin Report 2005. The Lewin Group. MTMS How do we do it? Comprehensive Medication Review Prescriber Consultation Cost Efficacy Management Identifying Resolving Drug Therapy Problems Patient Compliance Consultation Patient Education Monitoring. Outcome Pharmaceutical Healthcare, LC.

Description of binary number MTM Services Assess patients health status Understand why the on thermosphere prescription was written for. that patient. During education, the pharmacists confirms why. the medication was prescribed. Outcome Pharmaceutical Healthcare, LC. Description of binary MTM Services Monitoring and course, evaluating the patients response. to therapy, including safety and effectiveness Patient prescribed new medication, educated, follow up call to monitor Pharmacist counsels patient on new medication, schedules follow up call, upon follow up, Outcome Pharmaceutical Healthcare, LC. Description of essay MTM Services Perform a comprehensive medication review to. identify, resolve, and bpo resume, prevent medication-related. problems, including adverse drug events Comprehensive Medication Review (CMR) or Brown.

Bag Pharmacist calls patient to essay binary notify them of their. new MTMS visit and schedules a 30 minutes sit. down. Articles College Essay. Pharmacist reviews Rx, OTC, herbal , vitamin, etc. looking for potential drug therapy. Outcome Pharmaceutical Healthcare, LC. Description of MTM Services Provide verbal education and training designed to. enhance patient understanding and essay number, appropriate use. of his/her medications Compliance intervention regarding administration. technique (i.e. asthma rescue inhaler) education Patient is refilling their rescue asthma inhaler. too soon, and great essays, the pharmacist discovers it is due.

to poor technique, which is causing the overuse. Outcome Pharmaceutical Healthcare, LC. Description of MTM Services Coordinate and integrate medication therapy. management services within the broader health. care-management services being provided to the.

patient. The whole patient approach medication AND other. factors that affect their health and. communicating with others on the health care. team. Pharmacist communicates a drug-drug interaction. with the prescriber, who was unaware about binary number the. general practitioners prescribed regimen.

Outcome Pharmaceutical Healthcare, LC. MTMS Business Concept Pharmacy Store Model Goal Provide MTMS in satire in south, accordance with. collaborative practice standards MTMS is a distinct service or group of services. that optimize therapeutic outcomes for individual. Driving Forces Improve quality of care Make money Attract new business Keep current customers. MTMS Business Concept In the Tennessee and Alabama region, a large. percentage of diabetes, hypertension, and. hyperlipidemia patients are eligible for MTMS. Initialize a diabetes management service that. could accommodate hypertension and.

hyperlipidemia. Essay Binary. Evaluate the niche market of CHF, asthma, arthritis or osteoporosis. Driving Forces MTMS will reimburse based on outcomes and time. spent with a patient. This new clinical service increases job. satisfaction of those involved.

Driving Forces With good marketing and product differentiation, new customers may seek out great, our service who. currently dont receive medications from our. store. Potential exists to number collect revenue from product. management as well as product provision. Prospective Customers All Medicare eligible beneficiaries within our. stores local radius. Potential for bpo resume, having fee-for-service and insured. customers for those who meet same criteria. Prospective Customers To be eligible for MTMS reimbursement from CMS, a patient must Have multiple chronic diseases Have multiple Part D drugs Likely Incur annual costs above level set by. Dept.

Health/Human Services (DHHS) (4,000) A provider must register with CMS to receive. The Lewin Report. The Lewin Group International. Strategic Plan Provide pharmaceutical care Identify new revenue Maintain a positive cash flow after XX months. Window of Opportunity CMS Reimbursement starts January 1, 2006.

Fee-for-service or insured patients will broaden. Issues that may affect service The reimbursement for these services may. negatively affect the bottom line for the PDP. and potentially ours as well. Fee-for-service and binary number, other insured customers help.

defray negative reimbursement issues. Issues that may affect service Software and facility upgrades may eventually be. necessary. In The Course. Legal Alabama does not have an explicit collaborative. practice agreement for pharmacists. Tennessee has collaborative practice under medical order provision. Critical relationships Physicians need to refer and maintain patients. within our service. Patients need to know about binary number our service and.

realize its value to return for visits. Staff needs communication, coordination and. Critical Risks and Opportunities Internal Factors Profitability Strength- Potential new revenue stream from CMS, insured and fee for service customers. Weakness- If reimbursement is lower than expected. or enrollment low, could be negative cash flow. Critical Risks and Opportunities Internal Factors Quality Strength- Spending more time with patients gives. us an opportunity to demonstrate our value to. patients and physicians. Weakness- Our staff could fail to in south provide the.

expected standard of care. Critical Risks and Opportunities Internal Factors Customer Service Strength- Our community location and pharmacy. access allows us a leveraged opportunity versus. stand alone clinics. Weakness- Our employees might not meet customer. expectations, especially if customer. expectations arent known. Critical Risks and Opportunities Internal Factors Facilities Strength- Open, friendly environment where. patients feel less threatened to approach. providers. Weakness- Environment may send mixed message.

(retail vs. professional). Hard to binary separate in. customers mind the provision of MTMS service from. Critical Risks and Opportunities Internal Factors Staff Strength- Pharmacists rated as very trustworthy. over multi-year surveys, can capitalize on this.

established perception. Weakness- Will patients feel comfortable with. Critical Risks and OpportunitiesExternal Factors Competition Opportunity- If no or few others provide this. service, could dominate the gatsby time market. Threat- May be difficult to differentiate amongst. competition to customers. Critical Risks and Opportunities External Factors Technology Opportunity- Use of technology can provide.

efficiencies and decision support for essay number, evidence. based patient care. Threat- Vital new technology may not exist or may. Critical Risks and Opportunities External Factors Regulation MTMS approved at articles argumentative, federal level Opportunity- In Tennessee, stated directly for. collaborative practice in pharmacy practice act. Threat- Not directly stated in Alabama Pharmacy. Critical Risks and Opportunities External Factors Reimbursement Opportunity- Potential for both CMS, insured and. cash customers for MTMS. Threat- If expected CMS and essay, insurance.

reimbursement incorrect, cash customers may not. exist in high enough volume for profitability. Critical Risks and OpportunitiesExternal Factors Costs Opportunity- Initially can use low-tech approach. with small number of personnel until. reimbursement level determined. Threat- Software upgrades by vendors, new. equipment and college essay, space may eventually decrease. Critical Risks and Opportunities External Factors Political Climate Opportunity- Pharmacy community very positive.

about potential outcomes, great. recruitment/retention tool. Essay. Threat- Physicians might feel patient care is. being taken away from them. Critical Risks and Opportunities External Factors Customers Opportunity- There is articles argumentative essay, no out of pocket expense. for CMS patients. Threat- Need to communicate the essay number value of the.

service to potential clients to course create a demand. Compliance Issues What documentation is binary number, required to satire in south essay receive. reimbursement beyond ICD codes? How will care be documented and what does CMS and. insurance companies expect? Compliance Issues-Documentation Example Outcomes Encounter Documentation- A five. Outcome Pharmaceutical Healthcare. Risks Inadequate recruitment of number patients Need good marketing campaign for patients and. physicians. Inadequate reimbursement from dracula essays, calculated costs.

and expected efficiencies. Constantly evaluate for ROI. Risks Poor outcomes Practice good evidence based medicine and. communicate with physicians and patients. Excessive competition Create a unique niche market/service. Worst Case Scenario (s) A patient is harmed through our management and. faith is lost in number, our service from essay on thermosphere, physicians. Binary Number. Recruitment falls short of needed goal causing. negative cash flow. Great. Inefficiencies cause recruited patients to go. Assessing Clinical and Quality Management and.

Contribution to Health of essay binary number Community Face to great gatsby essays about time face advice to number clients and other health. care professionals on the safe and great about time, effective use. of medicines. Essay. Point of first contact with healthcare services. for people in community. Pharmacist in position to satire identify clients that. will benefit from service. Contribution to Health of Community Decreased adverse health events Reduced hospital and physician service. utilization One stop shopping for essay number, medications and essay, MTMS.

Contributions (contd) Providing individualized services by a. pharmacist/health care provider Preventing, detecting and reporting adverse drug. reactions, medication errors and drug. interactions Optimizing dose therapy to increase patient. Contributions (contd) Contribute to essay number seamless and safe medicine. management throughout patient health journey. while improving quality of essay life. Support for clients as partners in medication. therapy to improve drug therapy outcomes. Monitor clinical outcomes of prescribed.

Regulatory Boards Alabama Board of Pharmacy Tennessee Board of Pharmacy. Standards of Care Well established treatment guidelines and. Standards of Care. Essay Number. Guidelines and Standards of great essays Care for the. Diagnosis and Management of Arthritis and. Osteoporosis. Essay Number. (Niche market) Guidelines and Standards of Care for diagnosis. and management of diseases of co-morbidities. Diabetes COPD CHF Hypertension Hyperlipidemia Other diagnosis. Outcome Measurements Service Audits Cost containment measures Client/Patient Satisfaction Health Measures Use of articles essay SOAP Notes Teaching Lab Values Quality of Life Collaboration/communication with other healthcare. StaffCertified Pharmacist/Provider Reviews medical history and medications Monitors disease Reviews treatment Educates patient Designs treatment care plans tailored to the. client Coordinates with other clinical professionals.

Ancillary Staff Technician Takes history Takes vital signs Provides educational materials Future Secretary Billing Clerk. Mechanisms for essay number, Continuity of Care/Services Monthly follow-up Referrals to specialized care providers Easy accessibility Telephone Walk-ins Collaboration with healthcare provider HIPPA regulations Permission forms Web Appointments p.r.n. Clinic Space Little or no modifications to an existing. pharmacy. At least 2 separate private areas. One area for intake with technician. One area for counseling with pharmacist. A third area for dracula, instructional videos/DVDs would. Physical Environment Close Proximity to Pharmacy Intake Room No White Walls Appropriate lighting for reading Table for essay binary, computer and client use Chairs Computer Rack or file cabinet for educational.

Brochures/materials Pictures and plants to soften environment. Physical Environment (contd) Counseling Room No white walls Appropriate light Desk for essay, pharmacist Large round table for essay binary number, client and great gatsby essays time, pharmacist with. chairs Exam table, screened if a third room for physical. examination unavailable Computer, fax and essay binary, telephone File cabinet/shelves/drawers for in the course of project, educational. materials and equipment Plants, pictures to soften room. Management of Clinical Expertise Cooperative workflow with a dedicated technician Initially pharmacist will divide time between.

pharmacy and binary number, MTMS services Train the trainer Cooperative/collaborative training with. pharmacist who are in specialized clinical. Location of Services Pharmacy department Private area required for confidentiality Teaching area may be necessary for videos, DVDs, demonstrations, brochures and information. Articles College Argumentative Essay. Must be easily accessible with wheelchair, etc. Will consider acoustics Will consider climate control. Visits Visits will be billable in essay binary number, 5 minute increments. Initial visit will require 30-60 min (15 min with.

technician and 30-45 min w/ pharmacist). F/U visits 5 minutes with Technician and 5-25. min. College Argumentative Essay. w/ Pharmacist Appointments may overlap due to time with each. Visits Visits will be booked every 15-60 min. depending. on visit type. Provisions must be made for walk-in, self-referrals or patients identified by. pharmacists as candidate for essay binary number, services. A separate waiting area with educational videos. will help with workflow and minimize congestion.

if clients need to wait. Types of in south park Visits Medication Therapy Management Services Disease Management visits Follow-up Visits Limited Visits. Anatomy of an Initial Medication Visit Obtain health history Review medications (prescribed, herbal, OTC and. cultural). Perform Physical Assessment and binary, Examination (only. if indicated).

Order and interpret diagnostic/laboratory. studies. In South Essay. Manage medication therapy by creating. individualized care plan. Counsel and teach client. Number. Collaboration and articles college essay, coordination of care. Binary Number. Schedule continued/follow-up care. Anatomy of an in the course Initial Disease Management Visit Obtain health history. Number. Review medications. Perform physical assessment and examination.

(focused). Order and interpret diagnostic/laboratory. studies. Manage disease and medication therapy by. counseling and collaboration. Essay. Create individualized disease management and. medication care plan Counsel and teach client Coordinate care Schedule continued/follow-up care. Anatomy of essay binary number a Follow-up Visit Review health/medication history Review diagnostic/lab studies results Counsel and teach client Answer any questions Clear up any misunderstandings about use of. medications Manage and monitor medication therapy effects Modifies care plan Collaborate with health care provider Schedule follow-up care and articles essay, coordinate care. Anatomy of a Limited Visit Brief visit (5-10 minutes) Identified by pharmacist or self referral.

(Walk-ins) Medication review Medication therapy by counseling (No. individualized care plan) F/U medication visit essential May involve collaboration with physician/ancillary. health care providers. Potential IS Infrastructure PCs (desk or laptop) IS hardware and software to support Client records (Open Source EMR) Documentation Billing Referrals Collaboration Web site. Potential IS Infrastructure (contd) Outcomes Encounter Documentation 5 Step Process Reason Action Result ECA Notes Reference what medications are involved under.

Prescription Information section Personnel Training Software Clinical Training Customer service training Software training. Potential IS Infrastructure (contd) Interface capabilities for binary number, communication with Communication with ancillary services Physician and other health care providers Billing. Always stay in the path of color. Outcomes Pharmaceutical Health Care At Ohio. Pharmacy Ass. Annual Conference April16, 2005. Electronic claim is in the of project, started. Patient information automatically populates.

Outcomes Pharmaceutical Health Care At Ohio. Pharmacy Ass. Annual Conference April16, 2005. Personnel Recruitment Advertise in local schools of pharmacy Schools of essay binary pharmacy are likely to include. specialized training in curriculum. Advertise national schools of pharmacy. In South. Advertise in pharmaceutical journals.

Operational Disadvantages Creating supply and essay, demand for essay, services may be. difficult or slow. Essay Number. Project may be duplicated in community (niche). New Market Capital costs will require funding (equipment, Operational Advantages Payment for gatsby essays time, MTMS based on outcomes and time spent. with client. Essay Number. Specialized market niche (Arthritis and. Osteoporosis) Evidence based interactions Client-centric Easy access Qualified specialists. Service Opportunities Actual text reads MTMS uses as disease examples Diabetes Asthma Hypertension Hyperlipidemia (i.e., high cholesterol) CHF.

Service Opportunities We plan to market to count dracula Osteo Rheumatoid Arthritis Osteoporosis We will handle or refer all disease states Future Possibilities Dialysis Renal Dysthymia (Depression) Depression Impacts. Elderly More Than Physical Illness 1 Alzheimers Screening 2. 1 Depression Impacts Elderly More Than Physical. Illness, Drug Benefit Trends, 17(1), Jan, 2005, p30. 2 Scratch-and-Sniff Test May Help Identify. Alzheimer Patients, Drug Benefit Trends, 17(1), Service Opportunities Advantages Services may not be targeted by essay, other providers Disadvantages May not be Medicare reimbursable. Leading Causes of Disability Among U.S. Satire Park Essay. Adults,

Service Opportunities - Awareness 1 - Just because a patient has the disease. doesnt mean they know about it. Essay. Business Concern Extra cost to park essay promote awareness (screening. fairs?) May need low initial screening costs High Awareness Asthma Arthritis Middle Awareness CHF Diabetes Low Awareness Hypertension Hyperlipidemia Osteoporosis. Service Opportunities - Concerns Stages of Readiness Precontemplation Contemplation Preparation Action Maintenance 2 - Just because a patient knows they have the. disease doesnt mean they are ready to do.

something about it. Essay Binary Number. Business Concern May need to essay on thermosphere do initial screening to determine. customers readiness to essay change Different advice for course of project, different stages? Who are our Customers? Initial Target Cash Customers Eventual Target Medicare Customers Prescribed high-risk medications Unable to afford medications Hospitalized in the last 6 months Multiple medications Questions about Medications High-risk diseases Asthma COPD Diabetes Heart failure High blood pressure. From RiteAid Presentation. How is the Service the Same?How is it Different? Same Pharmacists will Answer patient specific questions Call the binary number physicians office if a problem arises Review current medication list Different Individualized appointment Private consultation Face-to-face meeting with a pharmacist 15-60 minutes Medication evaluation Standardized Comprehensive Consult letter to the physician Therapy recommendations to patient physician.

From RiteAid Presentation. Current Market Status Pioneer Stage many competitors, fragmented. market Market Share limited by demographics only Leadership None, but may develop rapidly Players all sizes, little barriers to entry. Early Adopters/ Pioneers. Basic Missionary Marketing Concepts Go Slow! Dont try to in the of project do everything at essay binary, once. Gatsby. Be Good at One Thing Grow Over Time. Dont assume we know ANYTHING going in, including. how to run our own business! Dont advertise heavily until were sure of the.

quality and essay number, value of the service. Competition Currently wide open, but leaders are emerging. rapidly RiteAid, Walgreen Medicare price is fixed-rate THIS MAY CHANGE We will initially target higher-level services to. Pricing Follow RiteAids Lead Until We Determine Our Own. Advertising All within local radius of Service Provider. Location Physician Notification of essay on thermosphere Services Available MTMS Billboard Patient Brochures Direct Mailing (by local zip code) Flyers Screenings at MTMS Service Location Diabetes, Cholesterol, Blood pressure, Osteoporosis. Brochure Example Brochure Stand Artwork Brochure Front.

Kumbera, P. (4/16/5). Number. Medication Therapy. Management Services by Pharmacists. Paper. presented at articles essay, the Ohio Pharmacists Association. Annual Conference, Columbus, OH. Brochure Example Brochure Back. Kumbera, P. (4/16/5). Medication Therapy. Management Services by Pharmacists.

Paper. presented at essay, the Ohio Pharmacists Association. Annual Conference, Columbus, OH. Service Measurements of MD Referrals Visits of return time between Satisfaction Patient MD Pharmacist Clinical Measures Cost Effectiveness Analysis. From RiteAid Presentation. Medicare Therapy Management Service.

Is it worth it? What benefits can be derived? How to measure these benefits? How to make money from satire park, this? What would we need to essay number make money? Payer Mix Initially aimed at bpo resume formats, general Population. Plans to open service to Medicare patients by 3. months. Plans to number open service to insured patients by articles, 6. months. Need more data to essay predict change in payer profile.

MTMS Payment Protocols. Sample Payment Rates. Assumptions. Salaries Pharmacist - 42/Hour Technician - 10/Hour Customers New Customers 20/Month Follow-Up Attrition Rate 10/Month Limited Visits 10/Month of Months between follow-up Visits - 1 Increase in in south, initial visits - 10/Month. Assumptions. Binary Number. Miscellaneous Achilles Machine - 18,000/machine Education Licensing - 1,200/year Warranty/Service Contract - 200/year Remodeling - 20,000 (one-time fee) Marketing Address List Cost - 500/Month Flyers - 500/Month Billboards - 500/Month Local Radio - 1000/Month Physicians - 1,000/Month Screening Fairs - 300/Month Consulting (AU) - 2,000 /Month. Projected fees cash payment insured. Expected Scenario.

Start making profit by gatsby essays time, month 13 (Feb-07). Return on initial investment making cumulative. profit by essay, month 27 (June-08). 20 new customers an in the course increase in essay binary, the number of. Worst Scenario. Start making marginal profit by month 21. (sept-07). No return on initial investment cumulative.

profit by end of three years. Recommend a termination of project if cumulative. losses exceed 100,000 by end of second year. Best Scenario. Course Of Project. Start making profit by month 11 (Oct-06).

Return on initial investment making cumulative. profit by essay number, month 23(Dec-07). Articles. 25 new customers an increase in the number of.

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Writing the Scholarship Essay : by Kay Peterson, Ph.D. It’s the binary number, hardest part of your scholarship application. But it’s also the bpo resume formats, part of the application where the essay binary number, ‘real you’ can shine through. Make a hit with these tips from scholarship providers: Think before you write.

Brainstorm to generate some good ideas and then create an essay on thermosphere outline to help you get going. Be original. Essay Binary Number. The judges may be asked to review hundreds of essays. It’s your job to make your essay stand out bpo resume formats, from the rest. So be creative in your answers. Show, don’t tell. Use stories, examples and anecdotes to individualize your essay and demonstrate the point you want to make. By using specifics, you’ll avoid vagueness and generalities and make a stronger impression. Develop a theme.

Don’t simply list all your achievements. Decide on a theme you want to convey that sums up the impression you want to number make. Write about experiences that develop that theme. Know your audience. Personal essays are not ‘one size fits all.’ Write a new essay for each application-one that fits the interests and requirements of that scholarship organization. You’re asking to be selected as the representative for that group.

The essay is your chance to essays show how you are the ideal representative. Submit an essay that is neat and readable. Essay. Make sure your essay is neatly typed, and that there is a lot of ‘white space’ on the page. Double-space the gatsby essays, essay, and provide adequate margins (1?-1 1/2?) on all sides. Make sure your essay is well written. Proofread carefully, check spelling and grammar and share your essay with friends or teachers. Another pair of eyes can catch errors you might miss.

Special thanks to the scholarship specialists who contributed these tips: TROA Scholarship Fund. Kathy Borunda, Corporate Development. Society of essay, Hispanic Professional Engineers Foundation. The American Legion. Patti Cohen, Program Manager. Coca-Cola Scholars Foundation. AFSA Scholarship Programs. Thomas Murphy, Executive Director. Konieg Education Foundation. Lisa Portenga, Scholarship Coordinator.

The Fremont Area Foundation. Practice Session: Common Essay Questions — by Roxana Hadad. The essay — It’s the most important part of your scholarship application, and in the of project it can be the hardest. But the binary number, essay shouldn’t keep you from essay on thermosphere, applying. Take a look at some of the binary, most commonly asked essay questions and use them to prepare for your scholarship applications. Great Essays Time. Brainstorm ideas, do some research or create your own ‘stock’ of scholarship essays. When the time comes, you’ll be ready to write your way to scholarship success!

Your Field of Specialization and essay number Academic Plans. Some scholarship applications will ask you to write about your major or field of study. These questions are used to argumentative essay determine how well you know your area of specialization and why you’re interested in it. How will your study of _______ contribute to your immediate or long range career plans? Why do you want to essay be a _______? Explain the importance of (your major) in bpo resume formats today’s society. What do you think the industry of _______ will be like in the next 10 years? What are the most important issues your field is facing today? To test your skills at problem-solving and check how up-to-date you are on current issues, many scholarship applications include questions about problems and number issues facing society. What do you consider to be the single most important societal problem?

Why? If you had the authority to change your school in a positive way, what specific changes would you make? Pick a controversial problem on college campuses and suggest a solution. What do you see as the in the, greatest threat to the environment today? Scholarships exist to reward and encourage achievement. You shouldn’t be surprised to find essay topics that ask you to brag a little. Describe how you have demonstrated leadership ability both in and out of school. Discuss a special attribute or accomplishment that sets you apart. Describe your most meaningful achievements and how they relate to binary number your field of study and your future goals.

Why are you a good candidate to satire park essay receive this award. Who you are is closely tied to essay binary where you’ve been and who you’ve known. To learn more about you, some scholarship committees will ask you to write about your background and major influences. Pick an experience from in the course of project, your own life and explain how it has influenced your development. Number. Who in your life has been your biggest influence and why? How has your family background affected the in south, way you see the world? How has your education contributed to who you are today?

Scholarship sponsors look for essay number, applicants with vision and formats motivation, so they might ask about essay your goals and aspirations. Briefly describe your long- and short-term goals. Where do you see yourself 10 years from now? Why do you want to get a college education? Many scholarship providers have a charitable goal: They want to provide money for students who are going to have trouble paying for college. In addition to essay asking for information about essay binary number your financial situation, these committees may want a more detailed and formats personal account of your financial need. From a financial standpoint, what impact would this scholarship have on essay number, your education? State any special personal or family circumstances affecting your need for financial assistance.

How have you been financing your college education? Some essay questions don’t seem directly related to course your education, but committees use them to test your creativity and get a more well-rounded sense of your personality. Choose a person or persons you admire and explain why. Choose a book or books and that have affected you deeply and explain why. While you can’t predict every essay question, knowing some of the binary number, most common ones can give you a leg up on applications. Count Dracula. Start brainstorming now, and you may find yourself a winner! Essay Feedback: Creating Your Structure — by Kay Peterson, Ph.D. You might think that the secret of a winning scholarship essay is to write about binary number a great idea. But that’s only half the job. Formats. The best essays take a great idea and present it effectively through the structure of the essay. To see how important structure is, let’s look at an essay by Emily H. In her application for the UCLA Alumni Scholarship, Emily responds to the following essay topic: “Please provide a summary of your personal and binary family background, including information about bpo resume formats your family, where you grew up, and perhaps a highlight or special memory of your youth.”

Here’s how Emily responded: To me, home has never been associated with the word “permanent.” I seem to use it more often with the word “different” because I’ve lived in a variety of essay, places ranging from Knoxville, Tennessee, to Los Angeles, California. While everyone knows where Los Angeles is on a map, very few even know which state Knoxville is in. Fortunately, I’ve had the chance to live in the east and west and to articles argumentative view life from two disparate points. I always get the same reaction from people when I tell them that I’m originally from a small town in Tennessee called Knoxville.

Along with surprised, incredulous looks on their faces, I’m bombarded with comments like “Really? You don’t sound or look as if you’re from Tennessee.” These reactions are nearly all the same because everyone sees me as a typical Californian who loves the sunny weather, the beach and the city. They don’t know that I lived in Reading, Pennsylvania, before I moved to Chattanooga, Tennessee, and then moved again to Knoxville, Tennessee. The idea of binary, my living anywhere in the vicinity of the bpo resume, South or any place besides California is inconceivable to many because I’ve adapted so well to the surroundings in binary which I currently find myself. This particular quality, in dracula a sense, also makes me a more cosmopolitan and open-minded person.

Having already seen this much of the world has encouraged me to visit other places like Paris or London and the rest of the world. My open-mindedness applies not only to new places, but also to intriguing ideas and essay number opportunities. This attitude towards life prepares me for course, the vast array of essay binary number, opportunities that still lie ahead in the future. From my experiences of moving place to place, I have also come to acknowledge the deep bond I share with my family. It has helped me realize the importance of supporting each other through tough times. Moving from Tennessee to California meant saying good-bye to the house we had lived in for in south essay, six years, longtime friends and essay binary number the calm, idyllic lifestyle of the country that we had grown to love and savor. But knowing that we had each other to articles college depend on made the transition easier. It also strengthened the number, bond we all shared and placed more value on the time we spent with each other, whether it was at park essay home eating dinner or going on a family trip. Now when I think of the binary, word “home,” I see the bluish-gray house I live in now. In the past, however, “home” has been associated with houses of varying sizes, colors and forms. The only thing that has remained unchanging and bpo resume formats permanent is my family.

I have acknowledged this constancy, knowing well enough that it is, and always will be, a part of me and a unique part of my life. Los Angeles is one of many places in number which I’ve lived. This fact by itself has had a tremendous impact on essay, me. This kind of essay topic can be difficult because it is very general. Binary Number. Emily deftly avoids this pitfall by focusing her essay on one topic: the fact that she’s moved many times. As a result, this essay contains a lot of gatsby time, winning elements: Her opening sentence is great. It really grabs the reader’s attention because it’s unexpected and paradoxical. We want to learn more about her. Her story is essay, unique; she doesn’t rely on cliches. Bpo Resume Formats. She provides a lot of essay binary, detail; we feel the differences among the various cities.

She’s focused the account so we learn just enough, not too much. She tells us why these events are important. Park Essay. Rather than just listing the cities, she tells us how her experiences have affected her. But there are also a number of things she could do to improve her essay: Opening paragraph gets off to a strong start, but quickly loses steam. Essay Binary. The last sentence is too vague. The second paragraph is far too long, and covers too many ideas. The transitions among the various ideas are underdeveloped. There’s a thought progression behind her essay that isn’t supported by the transitions. Bpo Resume Formats. Conclusion is weak and doesn’t capture the essay number, much richer ideas that resonate throughout her essay.

The first thing Emily should do is step back from essay on thermosphere, her essay and think about how she has organized her ideas-that is, what structure has she provided? She can do this by creating an outline of the ideas that appear in her essay. It should look something like this: a. Essay Binary. Emily has lived in satire in south essay a lot of essay number, places. b. Emily has viewed life from two disparate points. 2. Body (one paragraph) a. People don’t guess that Emily is not originally from California. b. That’s because she has adapted so well to her current environment. c. This adaptability has made her open-minded about the world around her, and ready to take new opportunities.

d. She’s also learned to recognize and value the bond with her family, which gives her a sense of about time, permanence throughout all the changes. 3. Conclusion: Los Angeles is one of the places she has lived. As we can see, Emily’s essay is jam-packed with good ideas. With the exception of the conclusion (which she should cut), everything in here is essay binary, meaningful and necessary. In The Course Of Project. What she needs to do now is essay, identify the most important idea for the whole essay and then rearrange the bpo resume formats, points so that they support that idea. What is the overriding idea? I identified a number of fruitful ideas that involve these various points:

Constant change has been challenging, but learning how to deal with change has made Emily ready for more challenges in the future. Constant change has had a paradoxical effect on Emily: It’s taught her both how to be adaptable and number how determine what is truly permanent (i.e. her family). Constant change has taught her all about different parts of the country, but has also taught her that while she grows and changes, she’ll still remain the in the course of project, same person she always was. Once Emily has decided what main idea she wants to communicate, she can then restructure the points to essay number support that idea. She may find that she needs to essays cut some points or develop others more fully. The key is to make it clear how those points relate to the central idea and to use meaningful transitions that point the essay number, way to the next idea. With a new structure in place, Emily should have a unique and winning essay! Once you have determined which scholarships you will apply for, write to them and ask for their scholarship application and requirements. The letter can be a general request for information “form” letter that can be photocopied, but you should be specific about the name of the scholarship you are inquiring about on the envelope. Write to on thermosphere each source as far in advance of their scholarship deadline as possible and don’t forget to essay number send a self-addressed, stamped envelope(SASE) — it not only expedites their reply, but some organizations won’t respond without one. Remember, on the outside of the envelope, list the park essay, name of the specific scholarship you are inquiring about.

That way, the person opening the mail will know where to direct your inquiry. Here is an essay example of what your letter might look like: XYZ Corporation (Ian Scott Smith Scholarship) 1234 56th Street, Suite 890. Metropolis, FL 00000-0000. Dear Scholarship Coordinator: I am a (college) student (give academic year) and will be applying for admission to (a graduate) program for academic year 20__ – __. I would appreciate any information you have available on educational financing, including application forms.

I am enclosing a self-addressed, stamped business size envelope for your convenience in replying. Daniel J. About. Cassidy. 2280 Airport Boulevard. Santa Rosa, CA 95403. Make sure your letter is neatly typed, well written and does not contain grammatical errors or misspelled words. When filling out scholarship application forms, be complete, concise and creative. People who read these applications want to know the real you, not just your name. Essay Number. The application should clearly emphasize your ambitions, motivations and what makes you different.

Be original! You will find that once you have seen one or two applications, you have pretty much seen them all. Usually they are one or two pages asking where you are going to school, what you are going to major in college essay and why you think you deserve the scholarship. Some scholarship sources require that you join their organization. Number. If the organization relates to your field of study, you should strongly consider joining because it will keep you informed (via newsletter, etc.) about developments in formats that field. Other scholarship organizations may want you to promise that you will work for them for essay number, a year or two after you graduate. The Dow Jones Newspaper Fund offers a scholarship for up to $20,000 for journalism, broadcasting, and communications students with the understanding that the student will intern for them for park essay, two years.

This could even yield a permanent job for the student. Your application should be typewritten and neat. I had a complaint from one foundation about essay binary a student who had an excellent background and qualifications but used a crayon to fill out the application. Once your essay is satire, finished, make a master file for it and other supporting items. Photocopy your essay and attach it to the application. If requested include: a resume or curriculum vitae (CV), extracurricular activities sheet (usually one page), transcripts, SAT, GRE, or MCAT scores, letters of recommendation (usually one from a professor, employer and friend) outlining your moral character and, if there are any newspaper articles, etc. about you, it is number, a good idea to include them as well. You might also include your photograph, whether it’s a graduation picture or a snapshot of your working at your favorite hobby. This helps the selection committee feel a little closer to in the course of project you. Binary Number. Instead of just seeing a name, they will have a face to match it. Mail your applications in early , at on thermosphere least a month before the deadline.

**Dr. Peterson has won numerous college and graduate scholarships, including the Jacob Javits Fellowship, the University of California Regents Scholarship and number the National Merit Scholarship. Together we care for our patients and our communities.

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Hello, how can I suggest a resume template to this collection, is there any submission form at DesignsCrazed? check out that website has a warehouse of essay number downloadable cv#8217;s. This #8220;Free Minimalistic Clean Resume | PS AI#8221; is actually mine. Could you change that #8220;Download#8221; to #8220;Source Link#8221; and refer to this page: Thanks in advance. I might have to change that download link anytime, but that Behance site will be always running. This way you won#8217;t end up getting dead links. Thanks you very much for referring to my awesome freebie, Very innovative collection of PSD Web Design which is very useful to me. i am PSD Designer and in the course of project, i am looking to refer this blog for great modern web design ideas. Super! The more we read positive information, the more we recieve good tips that help us to be proficient in the future. We would like to share our freshly made FREE resume template with you. It was inspired by wireframing kits design. Everything is carefully layered, so it#8217;s super easy to edit and use.

The download link is on our Behance page These are amazing! I would also suggest checking out Binary Number? wow#8230;. I’m feeling proud that three of satire those best CV are from number Bangladesh. A small country with a huge talents ! :) So sweet. Yes have seen many talents from Bangladesh and worked with them as well. Looks like your website has been rethemed.

Nice. On Thermosphere? Such a brilliant website you have there. I have seen you guys from old times when there was psdgraphics, freepsdfiles like that. Good times. I had one too. But doesnt matter now. :) The link for essay binary, #8216;Freebie Resume cover letter (PSD)#8217; is currently dead. Can you fix it ? Hi! Do you mind sharing your Etsy template with me? Thanks in advance!

Finally! A site with working INDD download links and nice layouts. Dracula Essays? Thank you! hmm, i thought INDD was most suitable for binary, magazine like designs. Formats? Time to find and make more. Would be great if all the essay number Dropbox designs can be reuploaded to a file transfer service without limits. You might want to try MediaFire or Google Drive. true.. Articles College Argumentative Essay? dropbox is getting bad. Mentioned link is not working. (Dropbox 429 error). Essay Number? can you please help me with this file. thankyou for marketing your website, but no thanks really, cause the cv designs there lack creativity, are very bland and are paid. thanks for providing such an ideas introducing me to a new world of presentation. Gatsby About? Excellent Publication Allie Kingsley, I#8217;m happy that i came across it. Binary Number? ;) thnk you so much. :) Wow! all templates is awesome! thanks for share. Glad to formats, know you like the collection. :) Great posting about free template. hmm it is.

Let me see what can be done. Binary? Thank you from Colombia!! Thanks for sharing. Bpo Resume? I was wondering if you would want to add another model. I#8217;ve just created a pretty different design from what is listed on this page. :)

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To comply with law or as required for legal purposes. We may use Personal Information for essay binary number, investigations or prevention of fraud or network abuse. We may use information we collect to formats contact You about our and/or third-party products, services, and offers that We believe You may find of interest. We may contact You by telephone, postal mail, e-mail, or other methods. You may see advertisements when You visit our Website. We may help advertisers better reach our customers by providing certain customer information, including geographic information, language preferences or demographic information obtained from essay number other companies.

This information is park essay used by advertisers to determine which ads may be more relevant to You. However, we do not share Personal Information outside of our corporate family for essay number, advertising purposes without Your consent. WHEN WE SHARE INFORMATION COLLECTED ABOUT YOU. We do not sell, license, rent, or otherwise provide Your Personal Information to unaffiliated third-parties (parties outside our corporate family) without Your consent. We may, however, disclose Your information to unaffiliated third-parties as follows: With Your Consent. We may disclose Personal Information about You to third-parties with Your consent. Satire Park! We may obtain Your consent in writing; online, through “click-through” agreements; when You accept the terms of disclosures for certain Services; orally, when You interact with our customer service representatives. We encourage You not to share Your password. If You provide Your user account password and/or security question responses to third parties they will have access to Your Personal Information when they access Your user account with Your account password. To Our Service Providers.

We may disclose information to third-party vendors and partners who complete transactions or perform services on our behalf (for example, credit/debit card processing, billing, customer service, auditing, and marketing). In a Business Transfer. We may sell, disclose, or transfer information about You as part of a corporate business transaction, such as a merger or acquisition, joint venture, corporate reorganization, financing, or sale of essay binary, company assets, or in in the the unlikely event of insolvency, bankruptcy, or receivership, in which such information could be transferred to binary third-parties as a business asset in college essay the transaction. For Legal Process Protection. We may disclose Personal Information, and other information about You, or Your communications, where we have a good faith belief that access, use, preservation or disclosure of such information is number reasonably necessary: to satisfy any applicable law, regulation, legal process or enforceable governmental request; to enforce or apply agreements, or initiate, render, bill, and collect for services and course of project, products (including to essay binary collection agencies in order to obtain payment for about, our products and number, services); to protect our rights or interests, or property or safety or that of others; in connection with claims, disputes, or litigation – in court or elsewhere; to facilitate or verify the appropriate calculation of taxes, fees, or other obligations; or. in an emergency situation.

We may provide information that does not identify You personally to third-parties for marketing, advertising or other purposes. HOW WE STORE AND PROTECT THE INFORMATION COLLECTED ABOUT YOU. Protecting Your Information. We use a variety of on thermosphere, physical, electronic, and essay, procedural safeguards to protect Personal Information from unauthorized access, use, or disclosure while it is great gatsby essays under our control. Unfortunately, no data transmission over the internet can be guaranteed to be completely secure. As a result, although we will utilize such measures, we do not guarantee You against the loss, misuse, or alteration of binary number, Personal Information under our control, and essay, You provide Personal Information to us at Your own risk. Binary Number! You should always take care with how You handle and disclose your Personal Information and should avoid sending Personal Information through insecure e-mail, social networks or other internet channels. Retention and Disposal. We retain information only for as long as we have a business or tax need or as applicable laws, regulations and/or government orders allow. When we dispose of Personal Information, we use reasonable procedures designed to erase or render it unreadable (for example, shredding documents and wiping electronic media).

PRIVACY POLICY UPDATES. How We Communicate Changes to This Policy. We may update this Policy at any time to provide updates to or clarification of our practices. If we make changes we may provide You with additional notice (such as adding a statement to the homepage of our Website or sending You a notification). You should refer to this Policy often for college, the latest information and essay binary number, the effective date of any changes. This web site is owned and operated by Viatta Business Ltd . A Partner is an individual who refers customers.

A Referral is an individual who requests a service via the referral link given by on thermosphere, a Partner. With the first order, a Referral acquires a 15% discount on essay, the order, while a Partner receives $50 to the Referral Balance. With further purchases, a Partner earns 5% of the Referral’s total order price. All money earned with the Referral Program is stored on your Referral Balance. A Partner can transfer the money to essay on thermosphere the Bonus Balance and use it to binary number purchase a service.

It is possible to transfer the sum to the Partner’s PayPal account (no less than $20).