Top tips for smart email - Emphasis

Top tips for keen email Top tips for keen email Its simple to consider email an electronic structure visiting, however to do so can be risky. For example, you may state something in email that you could never place in a letter. However in law they may add up to something very similar. At any rate, email has a changelessness that a possibility comment made over some espresso never would. Email is likewise simple to confound, coming up short on the visual signs (a grin, a wink) of vis-à-vis discussions. What's more, you may never know whether what you compose incites a forceful enthusiastic and conceivably harming reaction. Thus, email is most appropriate for straightforward correspondences, for example, planning gatherings refreshes simple to-take care of issues minutes. It isn't appropriate for: emotive issues convoluted issues analysis. Anything that is probably going to get an emotive reaction is best done eye to eye (troublesome however that might be), or if nothing else with an update or letter. Why? Well simply envision youre giving somebody awful news. The exact opposite thing you need to do is incite them to go insane in a counter email or even to send an irate email to others. Cut the messiness A great many people gripe of getting an excessive number of messages. However, there are approaches to eliminate the quantity of messages you and your partners get. Here are a few hints: Disperse each message just to individuals who truly should see it abstain from replicating to others for data. Withdraw to e-zines and email pamphlets on the off chance that you never read them. (NB. Dont do this with spam see beneath.) Set up channels to record or erase specific sorts of email consequently. Never answer to spontaneous spam to request to be expelled from a mailing list: numerous deceitful organizations utilize this to confirm email addresses before spamming them significantly more. Never use email for complex issues get the telephone. In like manner, stay away from emotive themes like examinations or solicitations for a compensation rise. These are much better managed eye to eye.

Calories restriction and health in medical improvement Thesis

Calories limitation and wellbeing in clinical improvement - Thesis Example Fasting before chemotherapy improves the impact of the chemotherapeutic specialist on the tumor and lessens the harmful reactions of the chemotherapeutic operator on the patient. Be that as it may, before this advantage of calorie limitation could be utilized in people more examinations are require to fortify the discoveries of the twin advantages of calorie limitation. 1. Presentation 1.1. Calories Restriction Over the most recent seven decades proof from creepy crawly and creature contemplates has highlighted the limitation of calorie consumption bringing about increment in life length. These discoveries have prompted enthusiasm creating for a superior comprehension of the sub-atomic systems of calorie limitation that offer the wellbeing guided advantages and making an interpretation of these advantages to individuals, as a methods for beating hazardous sicknesses and conditions for better personal satisfaction and increment in life ranges (Koubova and Gurante, 2003). ... od pressure are viewed as biomarkers for maturing, since there is a connection between's these markers and those ailments ordinarily connected with propelling age or maturing itself. Calorie limitation concentrates in creatures has appeared to lessen these biomarkers related with maturing and thus the holding out of the guarantee for the utilization of calorie limitation with the restorative potential to improve the treatment of illnesses and conditions related with maturing to expand life length in people (Brown, 2008). The cutting edge enthusiasm for calorie limitation can be followed back to 1930s and the exploration of the nutritionist Clive McKay. McKay and his group leading disease inquire about found that serious calorie limitation up to 60% advertisement Librium levels brought about a quantifiable increment in life range in rodents. This intriguing finding stayed in cool stockpiling for almost three decades, as the discoveries were not seen as pertinent to malignant growth lo ok into all things considered. Michael Ross took up this string of examination during the 1960s utilizing Sprague-Dawley rodents, to contemplate the rate of tumors and its age connection. The consequences of expanded life expectancy in rodents brought about by calorie limitation started enthusiasm among gerontologists and gerontology look into. During the 1970s two gatherings of research examination on calorie began, one under Roy Walford at UCLA and the other drove by Edward Masoro and B.P. Yu at the University of Texas (Sprott and Austad, 2006). Walford and his group, with specific accentuation on Richard Weindruch concentrated on the effect of calories limitation on various models that extended from mice to rhesus monkeys to people. A portion of these examinations proceed even today and has prompted general acknowledgment that calorie limitation has gone to be the main intercession that outcomes in life range

How Advertising Work

How Advertising Work How Advertising Work Home›Marketing Posts›How Advertising Work Marketing PostsAdvertising is a mode of communication either verbal or non-verbal which is used mainly by manufacturers to provide information, get attention to and creating awareness of a product or service that a manufacturer wants to sell or promote. The process of advertising reaches the audiences through different channels of communication such as television, internet, radio, neon signs, articles for instance magazines, newspapers and billboards. Different organizations advertise for different purposes. Some advertise to promote an image for their business, to bring in new customers, to create awareness of their products and increase sales by persuading consumers to buy their products. The main aim of advertising is to get your products or services noticed by many as possible (Graydon 2003, p. 3).How does advertising work? To begin with, for advertising to work it is necessary to understand and have knowledge on the basics and principles of marketing because advertising is a form of marketing. One has to determine the target audience and market and also to know what they are selling in addition to the products or services for instance status or self-enhancement (Clow Baack 2007, p. 168). Advertising mainly works through persuasion and also through memory. For an advertisement to be effective, it needs to persuade the target audience and also leave an impact in them that they can use to recall about the advertising.To understand how advertising works we will use a framework to explain. The framework is divided into advertising input, filters, consumer and consumer behaviour (Demetrios Ambler 1999, p. 26). Advertising input involves and targets mainly the consumer. It involves the creation of the message content     scheduling of the media through which the advertisement will reach the audience and repetition. Creation of message content involves designing the advertisement and the necessa ry information to be conveyed through the advertisement for instance Hyundai automobiles, Cars that make Sense will be the message to be conveyed (Garey 2010). Once message is created, the medium of communication is scheduled so as to find the best way to reach a larger audience. A time slot is determined so as to convey the message. The use of repetition is of importance because it has a mental effect such as awareness, memory and attitude towards the brand which determines the consumers’ behaviour. All these components constitute the advertising strategy that will trigger a consumer’s response.The consumer’s response which is determined by several factors such as motivation, ability to process information and attitude towards the advertisement will therefore determine the consumer’s response to the advertisement. These aspects are what are considered as filters of the initial advertisement input (Demetrios Ambler 1999, p. 27). As a result, the consumer’ will then decide either to buy or not to buy the products or services being advertised. As mentioned above, all these processes function to persuade the consumers’ and also leave a mental picture with which they can identify with. The resultant response is that the advertising will have served its purpose which was to relay a message to the target audience about a particular product or service being offered.Some theories used in advertising to create an effect on the target audience include the salience or weak force theory, the persuasion theory, mean-end theory and hierarchy of effects model. The salience or weak force theory is mainly used when the aim is to maintain a brand. In a market there are many consumers with different preferences and also competitors trying to get more customers. The salience theory works to defend and maintain your customers by providing publicity for your products and also reinforcing memory association for the brand (Ehrenberg et al. 1998. p. 2).A brand is said to be salient when a consumer buys the products because it stands out meaning that the consumer is aware of the brand, has considered the brand, and is willing to pay for it, considers purchasing the product again and is assured of the brand in terms of quality. Therefore, in advertising, we look at how many consumers the brand is salient. For a brand to be potentially salient, it has to have a distinctive name and symbol so that the consumer can focus on it. To develop salience for a new product awareness and trial are important. For an existing product, reinforcement and nudging will be effective. The salience theory works mainly by memory traces for the brand. The advertisement will focus on reminding you of an existing product or even through seeing someone with a shirt with the brand name will refresh your memory on the product. This can also be done through memory association with the use of particular colours for a particular brand. All these work to make a brand salient (Ehrenb erg et al. 1998, p. 2- 7).Persuasion theory mainly focuses on brand building and is mainly for short term- growth and to differentiate similar brands. The differentiating of brands through advertising is used to achieve a competitive advantage and give consumers a reason to choose the brand (Ehrenberg et al. 1998, p. 7). To have an effect on customers, advertising using the persuasion theory involves the changing of the products appearance mainly its packaging, offering gifts when you purchase a particular brand and addition of substances such as colour, scent to the products in order to increase sales. All these are persuasive techniques used in advertising.The means- end theory which is used mainly to make consumers identify with a brand suggests that an advertisement should contain some information or a message that can lead a consumer to identify with the product. This is mainly seen with different brands having different catch phrases even warnings. All these create awareness a nd affect the consumers’ perception of a brand. The hierarchy of effects model theory defines six steps that a consumer observes when making a purchase and they include awareness, knowledge, liking, preference, conviction and purchase (Young 2005). With knowledge of such a theory, a manufacturer can create advertisement that will persuade the customers to prefer his brand to the others. As we see that awareness is important in advertisement, this theory begins by emphasizing on awareness as it is the way you can influence consumers.In conclusion, we see that advertisement is very important in communicating about an existing product or service as it can result in an increase in sales. Also advertisement can be channelled through different mediums such as electronic print. For advertisement to be effective it must be persuasive so as to influence the consumers’ behaviour and it should have a mental impact. Theories such as weak-force, persuasion theory, mean- end theory and hierar chy model are used in advertisement to create awareness and impact on the consumers’ behaviour. Though advertising does not necessarily result in increased sales, it is effective in creating awareness of an existing product or service in the market.

The Theory Of Psychology And Social View - 3117 Words

Abstract Although these two great minds of psychology have two different theories on how we as humans develop and learn, they have many similarities. I feel after researching and reading that the two psychologist lives themselves can provide more to the study of psychology and social view. I feel that their theories showed the contrast in ways of their social environment. Vygotsky being of the Russian Empire and the background of the Soviet Union that shows much determination to grow and individualize. And Piaget from the Western capitalist and the individualistic society in which he was raised. Their views can be sat next to each social environment and the thoughts that come from them can be seen in their own cultures on goings. I think that from this you will have a better grasp not only of the theories of the two individuals but a better grasp of the individuals themselves and their cultures they grew up in. Table of Contents Abstract 2 Great Minds born in 1896 the life and theories of two psychologists in cognitive development 5 1896 6 Jean Piaget 6 Albino Sparrow 6 Piaget’s Theories 7 Marriage and children 8 Piagets cognitive theory 9 Lev Vygotsky 10 â€Å"Mental Tools† 11 Zone of Proximal Development 12 The â€Å"More Knowledgeable Other (MKO)† 12 Compare and Contrast 13 Conclusion 15 Works Cited 16 Great Minds born in 1896 the life and theories of two psychologists in cognitive development â€Å"The principle goal of education in the schools should be creating men and women whoShow MoreRelatedInterview With The Personality Theorist1318 Words   |  6 PagesSigmund Freud, and his daughter, Anna Freud. In addition, each theorist will explain what impact they believe their work has had on psychology as they see it today. 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Educational psychology uses five different types of psychology, behavioral, cognitive, developmentalRead MoreSocial Psychology: The Study of Influences Essay1420 Words   |  6 Pagesthat has been explored. Psychology, or the study of â€Å"why†, has been attempting to answer such questions for centuries. Although there are many answers (reflected in the number of schools of psychology), Social psychology attemp ts to explain the environmental factors that lead to a person behavior. By definition, Social Psychology is â€Å"the study of the manner in which the personality, attitudes, motivations, and behavior of the individual influence and are influenced by social groups† (Merriam-WebsterRead MoreKurt Lewin s Influence On Social Psychology Essay1209 Words   |  5 Pagespsychologist who had the biggest impact on social psychology would be Kurt Lewin. Commonly known as the father of social psychology, Lewin put in countless hours of hard work and research in the study of the individual behavior among social situations. By working with other renowned psychologists, creating theories of his own, and leaving a mark on the world that still thrives today, Kurt Lewin is greatly responsible for the many of the advancements of psychology throughout history. Born in a smallRead MoreHistory and Theory Essay973 Words   |  4 PagesHistory and Theory The viewpoints if Sigmund Freud and Carl Rogers have similarities and differences. Both have made significant contribution to the psychology field. The theories from Freud and Rogers are still used in modern psychology. Freud is best known for creating psychoanalysis and Rogers is renowned for developing the person-centered therapy. The subject of this paper pertains to Freud’s and Rogers’ views of their respective theories, how different their theories would be ifRead MoreOne of the Main Divisions Between Mainstream and Critical Social Psychology Is That of the Methods Adopted. Discuss with Reference to the Cognitive Social and at Least One Other Social Psychological Perspective.1698 Words   |  7 Pagesbetween mainstream and critical social psychology is that of the methods adopted. Discuss with reference to the cognitive social and at least one other social psychological perspective. Social psychology has existed for about 100 years, before which psychology was a branch of philosophy. Social psychology studies individuals in their social contexts. It is a diverse discipline made up of many theoretical perspectives and variety of different methods are used in social psychological research. Read MoreThe Study of Human Behavior in Given Situations1613 Words   |  7 PagesPsychology is a social science study that covers diverse subject topics and carries out different forms of research in order to understand the development and function of human beings. It is a scientific study that focuses on peoples mind and its functions especially those affecting behavior in a particular context. Psychology is divided into different branches, and each branch addresses its own form of content in relation to mental processes and behavior. Social psychology is one of the psychologyRead MoreHistory And Theory : Freud And Rogers1125 Words   |  5 PagesHISTORY AND THEORY – Freud and Rogers Sigmund Freud and Carl Rogers are two extremely renowned individuals who have greatly contributed to the history of psychology. Their contributions are the foundation for the tools, techniques, and methodologies used by psychologist today. Although, each psychologist is from different times and developed different methods, they shared a passion for the workings of the human mind. As a result, their drive and foundation has motivated and prompted new theories and researchRead MoreSocial Constructionism, Identity and the Concept of Deviance Essay1409 Words   |  6 PagesSocial Constructionism, Identity and the Concept of Deviance Social constructionist use the term social construction to imply that our understanding of the world in which we live is constructed from the social interactions we have on a daily basis. In reference to identity, social constructionist theory (SCT) proposes that we as social beings actively construct our identities using social tools as the means in which to construct our identities, the foremost one being language. This particularRead MoreInvestigating The Expository Qualification And The Debate Between The Personalistic And Naturalistic Position1574 Words   |  7 Pagesimparted his plans in respect of personalistic and naturalistic position. As a major aspect of this task, the origination of the philosophical perspective was additionally examined, it clarified the improvement and how it develops to present day psychology research. How do the consequences of investigating and considering psychological research help our enthusiasm on individual conduct? Does it give significant proof on their revelations? In this circumstance, we regularly utilize the term history

The Sustainable Century By Design Or Disaster - 9705 Words

The Sustainable Century by Design or Disaster Priorities, Strategies, Tactics Musings for More Better Corporate Sustainability in a Global Economyi Copyright @ 2015 by Marc de Sousa-Shields All rights reserved. In accordance with the US Copy Right Act of 1976, the scanning, uploading, and electronic sharing of any part of this book without the permission of Marc de Sousa Shields and or the publisher constitutions unlawful piracy and theft of the author’s intellectual property. If you would like to use material from the book (other than for review purposes), prior written permission must be obtained by contacting the author/publisher at info@esglobal.com. Thank you for supporting the author’s rights and those of all creative spirits! ii Contents Introduction – The Sustainable Century†¦ or not ............................................................... 3 Chapter One - Market Signals – The Lifeblood of Sustainable Capitalism ..................................................................................................................................... 12 Listening to a Sustainability Market Signal Moment ..................................................................... 16 Conflict Free Oil? ................................................................................................................................. 18 Sustainability is the New Color TealShow MoreRelatedThe Sustainable Century By Design Or Disaster9705 Words   |  39 Pages The Sustainable Century by Design or Disaster Priorities, Strategies, Tactics Musings for More Better Corporate Sustainability in a Global Economyi Copyright @ 2015 by Marc de Sousa-Shields All rights reserved. In accordance with the US Copy Right Act of 1976, the scanning, uploading, and electronic sharing of any part of this book without the permission of Marc de Sousa Shields and or the publisher constitutions unlawful piracy and theft of the author’s intellectual property. If you wouldRead MoreThe Controversial Source of Nuclear Power1275 Words   |  5 Pages †¢ Nuclear Power is widely regarded as a viable choice in enabling sustainable development, especially when renewable energy sources remain in their growing stage of development and distribution. Nuclear Power has many benefits compared to f of However, nuclear power also remains one of the most controversial sources of energy. The debates on it are mainly based along the lines of environmental, safety and security. 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A machine can be defined as a device that uses energy to perform an activity. Nature, which uses solar energy, can therefore be said to be the most sustainable machine. So why not use this as a model to base building design and constructio n off of? Biomimicry, or the study of nature’s models which are then imitated or used for inspiration, is a process to solve design problems. In architectureRead MoreEssay on What is Global Warming?1232 Words   |  5 PagesInconvenient Truth shows us what will happen in the future if we continue to produce waste and pollution. We are the cause of global warming. Global warming turns the earth into an oven. Each year the overall temperature raise, causing more natural disaster and dry lands. If we let this continues, we might even end up in the same wasteland shown in the film Wall-E. 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Review of Related Literature Free Essays

Chapter2 Related Literatures Foreign Literature Eugene F. Brigman, Fundamentals of Financial Management, 5th ed. , (Hinsdale: Holt, Richard and Winston Sounders College Publishing, 2000), pp. We will write a custom essay sample on Review of Related Literature or any similar topic only for you Order Now 840-841. Companies are increasingly employing Inventory System. A computer start with an inventory counts in memory. Withdrawals are recorded by the computer as they are made, and the inventory balance is constantly revised. When the recorded point is reached, the computer automatically places an order, when this new order is received, the recorded balance is increased. Retail stores have carried this system quite far, each item has a magnetic codes, and as on item is checked out, it passes over an electronic reader, which then adjusts the computers inventory balance, at the same time the price is fed to cash register tape. When the balance drops to the recorder point, an order is place. Chapter 3 Research Design The authors aim to develop a automated inventory system which is technically, operationally, and economically feasible for PhilHealth Company, Dagupan City. The method used by the researchers to develop a automated inventory system is Descriptive Method. The researchers conduct several interviews in order to gather information about the present existing conditions of the inventory system, knowing its problems and enhancing it by developing an automated inventory system. Questionnaires were also distributed to all interviewees for additional information. Using the descriptive method, the researchers also observe the functionality of the present inventory system of the PhilHealth, which help them discover that Electronic Data Processing is Advantageous than other. REVIEW OF RELATED LITERATURE The review of the literature for this study focuses on creating computerize inventory system for Cavite State University Marketing Main Campus. In order to create we need to find some helpfull resources about the study. Related Literature Janes (2001) stated that computers are extremely reliable device and very powerful calculators with some great accessories applications like word processing problem for all of business activities, regardless of size, computers have three advantages over other type of office equipment that process information because computer are faster, more accurate more economical. Reyes (2005) task would be time consuming to accomplish manually and more practical with the aid of computers field in cabinet. Dioso (2001) stated that computer assist careful intelligent planning, organizing, actuating and controlling . This maybe observed from the past that they monitor production activities, solve scientific problem and help arrive in tentative answer to a multitude of involve conditions. Ralph M. Stair (1999) emphasized that the development of technology through the years have enabled us to do more with less effort. From the orientation of the light bulb to the industrial revolution and beyond, we have continuously tried to in a more efficient means of doing tasks. Lewis (2002) stated that the reason for using computers vary from person to person. Some of the computers in business are to perform accuracy, to be as productivity, to decrease bottle necks or hassles to alter cash flows or to simples elevate your status. Sybex Inc (1999) stated that visual basic provide a graphical environment in which the users usually designed the forms and control that become the building block of tour application . Visual Basic support many useful tools that will help the user more productivity. Gold Chager et al (2003) said that computer as a device for processing information knew computer plays a significant role†¦ [continues] Inventory Systems Summary According to the U. S. Small Business Administration, â€Å"Inventory refers to stocks of anything necessary to do business† (U. S. Small Business Administration, 2010, pp 1-2). The U. S. Small Business Administration publication describes what constitutes successful inventory management (balancing cost versus benefits of inventory), including 1) Maintaining a wide assortment without spreading the rapidly moving items too thin, 2) Increasing inventory turnover without sacrificing service, 3) Keeping stock low without sacrificing performance , 4) Obtaining lower prices by making volume purchases, 5) Maintaining an adequate inventory without an excess of obsolete items. Anyone in business must understand the business of inventory. Below is a look at six different inventory systems as well as a comparison of the advantages and disadvantages. Wal-Mart Inventory System Wal-Mart runs its stores on a perpetual inventory system. This system records the quantity of items sold as items are purchased. The computer system at Wal-Mart constantly keeps up with additions or deductions from inventory and tells management what items are on hand. The organization also conducts counts of employee manual counts of inventory periodically. When an item arrives at the Wal-Mart distribution center it is scanned into the inventory system. When the items are purchased by the consumer, the point-of-sale system reduces the inventory from that purchase. According to Wal-Mart’s Gail Lavielle, a leaner inventory will help clear out store clutter and help Wal-Mart focus on specific brands and products that consumers want (The Associated Press, 2006). Advantages and Disadvantages of the Wal-Mart Inventory System The advantages of a perpetual inventory system are that inventory is quickly updated in real-time, which gives a constant picture of the inventory status. With this data, inventory counts will be more accurate and allow one to keep up with demand†¦ continues] Anesthesia recordkeeping: Accuracy of recall with computerized and manual entry recordkeeping ProQuest Dissertations and Theses, 2011 Dissertation Author: Thomas Corey Davis Abstract: Introduction: Anesthesia information management systems are rapidly gaining widespread acceptance. Aggressively promoted as an improvement to manual-entry recordkeeping systems in the areas of accuracy, quality improvement, billing and vigilance, these systems record all patient vital signs and parameters, providing a legible hard copy and permanent electronic record. At risk is a potential loss of â€Å"connectedness† to the atient with the use of computerized recordkeeping, perhaps jeopardizing vigilance. Methods: This research analyzed differences in the accuracy of Certified Registered Nurse Anesthetists’ (CRNAs) recall of specific patient variables during the course of an actual anesthetic case. CRNAs using computerized recordkeeping systems were compared to CRNAs using manual entry recordkeeping. Accuracy of recalled values of 10 patient variables was measured – highest and lowest heart rate, systolic blood pressure, inspiratory pressure, and end-tidal carbon dioxide levels, lowest oxygen saturation and total fluid volume. In addition, a filmed educational vignette was presented to evaluate any effect on accuracy of recall following this presentation. Four tertiary care facilities participated in this research. A Solomon four-group research design was selected to control for the effect of pretesting on results of the filmed educational treatment. Results: 214 subjects participated in this study; 106 in the computerized recordkeeping group, and 108 in the manual entry recordkeeping group. Demographic covariates were analyzed to ensure homogeneity between groups and facilities. No significant statistical differences were identified between the accuracy of recall among the groups. There was no statistically significant effect of the educational film vignette on accuracy of recall. Conclusions: There was no difference in the accuracy of practitioners’ recall of patient variables when using computerized or manual entry recordkeeping systems, suggesting little impact on vigilance. The educational film presented did not have an effect on accuracy of recall following the discussion of benefits and limitations of methods of recordkeeping. ABSTRACT ANESTHESIA RECORDKEEPING: ACCURACY OF RECALL WITH COMPUTERIZED AND MANUAL ENTRY RECORDKEEPING By Thomas Corey Davis, PhD A dissertation submitted in partial fulfillment of the requirements for the degree of PhD in Health Related Sciences at Virginia Commonwealth University. Virginia Commonwealth University, 2011 Major Director: Dr. Chuck Biddle Director of Research, Department of Nurse Anesthesia And Dr. Jeffery A. Green Assistant Chief of Anesthesiology, Department of Anesthesia Introduction: Anesthesia information management systems are rapidly gaining widespread acceptance. Aggressively promoted as an improvement to manual-entry recordkeeping systems in the areas of accuracy, quality improvement, billing and vigilance, these systems record all patient vital signs and parameters, providing a legible hard copy and permanent electronic record. At risk is a potential loss of â€Å"connectedness† to the patient with the use of computerized recordkeeping, perhaps jeopardizing vigilance. Methods: This research analyzed differences in the accuracy of Certified Registered Nurse Anesthetists’ (CRNAs) recall of specific patient variables during the course of an actual xiv nesthetic case. CRNAs using computerized recordkeeping systems were compared to CRNAs using manual entry recordkeeping. Accuracy of recalled values of 10 patient variables was measured – highest and lowest heart rate, systolic blood pressure, inspiratory pressure, and end- tidal carbon dioxide levels, lowest oxygen saturation and total fluid volume. In addition, a filmed educ ational vignette was presented to evaluate any effect on accuracy of recall following this presentation. Four tertiary care facilities participated in this research. A Solomon four- group research design was selected to control for the effect of pretesting on results of the filmed educational treatment. Results: 214 subjects participated in this study; 106 in the computerized recordkeeping group, and 108 in the manual entry recordkeeping group. Demographic covariates were analyzed to ensure homogeneity between groups and facilities. No significant statistical differences were identified between the accuracy of recall among the groups. There was no statistically significant effect of the educational film vignette on accuracy of recall. Conclusions: There was no difference in the accuracy of practitioners’ recall of patient variables when using computerized or manual entry recordkeeping systems, suggesting little impact on vigilance. The educational film presented did not have an effect on accuracy of recall following the discussion of benefits and limitations of methods of recordkeeping. 15 CHAPTER ONE: INTRODUCTION In the United States, over 50 million anesthetics are delivered each year (Ishizawa, 2011). For each of these anesthetics, a detailed record is generated that includes vital signs, medications, and events of the surgery or procedure. Patients are monitored according to standards published by both the American Society of Anesthesiologists and the American Association of Nurse Anesthetists (AANA). These standards detail the vital signs and parameters that must be recorded by an anesthesia provider to document the monitoring of oxygenation, ventilation, circulation, and temperature (AANA – scope and standards for nurse anesthesia practice. 2007; ASA, 2005). The first known example of an anesthetic record can be found in the archives of the Massachusetts General Hospital, dated November 30, 1894 (Beecher, 1920). Developed by Dr. E. A. Codman, the record allowed the continuous documentation of heart rate, temperature, and respirations throughout the course of the anesthetic (Beecher, 1920). Systolic blood pressure readings were added to anesthesia records appearing after 1903 (Beecher, 1920). Both Dr. Codman and his contemporary, Dr. H. A. Cushing, indicated the merits of documentation of ether anesthetics, â€Å"It was undoubtedly a step toward improvement in what had been a very casual administration of a dangerous drug (Beecher, 1920)†. 16 The first known example of an automated anesthesia recordkeeping device dates to 1929 (McKesson, 1934). The device recorded three variables, oxygen percentage, respiratory volumes, and pulse pressure, on a continuous paper roll delineated in graphic form (McKesson, 1934). Fluctuations in these variables, primarily that of tidal respirations, indicated variations in the depth of anesthesia delivered, and any interruptions in the spontaneous breathing of the patient (McKesson, 1934). In his concluding remarks, Dr. McKesson indicated that such records would be â€Å"valuable for statistical study,† much as modern anesthesia records are used for quality improvement (McKesson, 1934). Dr. McKesson also stated, â€Å"Automatic recording equipment is a more accurate means for the immediate determination of cause and effect during an administration. Such records stimulate closer observation and increase our knowledge of anesthesia, and should safeguard the patient (McKesson, 1934). † Despite Dr. McKesson’s praise, such means of recording data during an anesthetic did not take precedence over the manual entry chart. Only with the advent of computerized systems introduced in the 1970s is there further mention in the literature of electronic recordkeeping (Drui, Behm, Martin, 1973). With improvements in computing technology, efforts to automate medical records have attempted to ease the task of recordkeeping (Drui et al. , 1973). Applications specific to the anesthesia record have begun to proliferate throughout the United States, due to established benefits of improved billing, legibility of the record, and access to data for quality assessment and improvement programs (Spring et al. , 2007). In a recent survey of academic medical centers, 14% currently utilize an anesthesia information management system (AIMS), 17 ith an additional 29% in the planning or implementation phase (Egger Halbeis, Epstein, Macario, Pearl, Grunwald, 2008) Proposed benefits over traditional manual entry recordkeeping systems (MERS), such as a reduction in workload or increased vigilance, have not been well established (Saunders, 1990). The proposed reduction in workload intended to increase the practitioners’ time for monitoring of the surgical field or other activities of impr oved vigilance could also be spent in activities unrelated to direct patient care (Allard, Dzwonczyk, Yablok, Block, McDonald, 1995). With anesthesia reimbursement reductions and the steady advance of technology into all aspects of medical care, known benefits such as enhanced capture of billing services may result in the adoption of AIMS in many markets currently skeptical about their safety (Levitan, 2008). AIMS are cited as superior to MERS in the areas of time management (Heinrichs, Monk, Eberle, 1997), data collection for quality improvement (Vigoda, Gencorelli, Lubarsky, 2006), and the capture of billing elements (Levitan, 2008). Concerns regarding the recording of artifact data as a potential source for malpractice claims (Feldman, 2004), excessive financial investment, increasing complexity of tasks, and decreasing attentiveness to the patient and monitors, thereby decreasing vigilance, (Abenstein, DeVos, Tarhan, Tarhan, 1992) have all been cited as limitations of AIMS. Studies analyzing vigilance and workload have failed to show significant differences between the two methods (Thrush, 1992). Examining the recall accuracy of specific vital signs, parameters, and events experienced by anesthesia practitioners utilizing AIMS and 18 MER should serve as a starting point for further evaluation of the benefits and risks of recordkeeping systems. Population and Recruitment Certified registered nurse anesthetists (CRNAs) administer more than 30 million of the 50 million anesthetics delivered each year (American Association of Nurse Anesthetists, 2008). This study will draw a sample of CRNAs from a population of more than 200 CRNAs practicing at four medical centers across Virginia. CRNAs assigned to each facility on the day of evaluation will be asked to complete a simple questionnaire. A trained observer will provide each practitioner with brief relief from patient care, after constant attendance of the patient for a minimum of 30 minutes of anesthesia care during the maintenance phase of the case. The CRNA assigned to the case will be asked to turn away from the monitors and complete the questionnaire. The observer will document values directly from the trend data recorded in the patient monitor. To evaluate the accuracy of anesthesia providers’ recall when recordkeeping with AIMS or MERS, a simple instrument has been developed (See Appendix I). Following establishment of face and content validity for this instrument, the research plan will be submitted for approval by the investigational review board (IRB) for Virginia Commonwealth University (VCU). With IRB approval, this instrument will be administered to practicing anesthesia providers participating in the actual delivery of anesthesia, and will require the provider to recall various aspects from the previous 30 minutes of their assigned case. Actual patient data will be collected by the relief CRNA to compare to the practitioners’ recollections. Practitioners utilizing both AIMS and MERS will be evaluated, to allow 19 comparison of any influence of the method of recordkeeping on the accuracy of practitioners’ recall. Four centers will be included in the project, selected by similarities of number of operating rooms, case load, and number of CRNA providers. These facilities are described in Table 1. All sites have agreed to participate in this research. Table 1: Facilities Facility Number of Beds Number of Operating Rooms Number of CRNAS Method of Recordkeeping Virginia Commonwealth University Medical Center (VCUMC) 788 30 41 AIMS Inova Fairfax Hospital (IFH) 833 47 68 AIMS Bon Secours St. Mary’s Hospital 369 30 41 MERS Medicorp Mary Washington Hospital 412 26 51 MERS Research Design A Solomon four group design has been selected for this study. This design minimizes the threat of testing on the outcome through the inclusion of one site that receives neither a pre-test, nor a treatment, but only a post-test. Each of the four facilities will be assigned to one of the four groups of this design as indicated in Table 2. Two sites will receive surveys as pre-tests, two sites will receive education with a trigger film (treatment), and all sites will be surveyed following the time of this presentation and again one month following the trigger film, as a post-test. 20 Table 2: Solomon Four-Group Design Statement of Purpose The purpose of this research is to analyze the practitioner’s accuracy in recalling patient data when using each method of recordkeeping. A second purpose of this research is to assess the effectiveness of a trigger film that details the benefits and limitations of both recordkeeping methods on the subsequent recall accuracy of anesthesia providers. This project seeks to answer two research questions: †¢ Do anesthesia providers using AIMS recordkeeping demonstrate equivalent recall accuracy of specific patient variables, as compared with anesthesia providers using a MERS? †¢ Does the instruction of the benefits and limitations of recordkeeping practices by trigger film influence the recall accuracy of specific patient variables by anesthesia providers using AIMS or MERS? To answer these research questions, the following hypotheses will be analyzed: H 1 For each anesthetic case, there will be no difference in the accuracy of recall of specific patient variables recorded by an anesthesia provider using AIMS or an anesthesia provider using a MERS. H 2 For each anesthetic case, there will be no difference in the accuracy of recall of specific patient variables recorded by an anesthesia provider who Group Survey Trigger Film Survey Survey– 1 month Post – treatment St. Mary’s (MERS) O 1 X O 2 O 3 Inova Fairfax (AIMS) O 4 O 5 O 6 VCUMC (AIMS) X O 7 O 8 Mary Washington (MERS) O 9 O 10 21 has attended a trigger film presentation on the benefits and limitations of recordkeeping methods than a provider that has not received such instruction. Significance In the United States today, approximately 67% of all anesthetics delivered each year are administered by nurse anesthetists (American Association of Nurse Anesthetists, 2007). Since the initiation of anesthesia documentation, the majority of anesthesia providers have recorded this data manually on pre-printed forms. This form of MERS persists in more than 90 percent of anesthesia practices (Levitan, 2008), although the prevalence of AIMS is rapidly increasing (Egger Halbeis et al. , 2008). Improvements in the capture of billing elements, legibility of the record, and enhanced capabilities to review accurate data for quality improvement purposes have caused many experts in the field to brand the adoption of AIMS as inevitable (Levitan, 2008) (Hamilton, 1990) (Vigoda et al. , 2006). In 2001, the Anesthesia Patient Safety Foundation published an initiative to utilize AIMS to improve patient safety (Cooper, 2007). This initiative was created in response to the Institute of Medicine’s landmark report in 1999, which called for efforts to utilize developing technology to reduce the number of medical errors (Kohn, Corrigan, Donaldson, 1999). As recently as March 2008, an article in Anesthesiology News indicated that AIMS would â€Å"revolutionize anesthesia care† (Levitan, 2008). Despite these claims, the safety of AIMS recordkeeping has not been established. Early in the debate, voices called for caution in their use (T. N. Noel, 1986)(Saunders, 22 1990). Studies of vigilance that compare AIMS and MERS have been hindered by confounding variables and small sample size (Thrush, 1992). At the present time, AIMS are utilized by only five to ten percent of anesthesia providers (Levitan, 2008). This small percentage is cited to be due to the high initial cost of AIMS. With the increasing appeal for the implementation of AIMS (Levitan, 2008), there is an excellent opportunity for research into the benefits and limitations of each method of recordkeeping. Before widespread adoption of AIMS, researchers must examine differences in the â€Å"connectedness† of practitioners to the subtle trends of vital signs, parameters, and events that may influence patient safety. Researchers must also explore techniques to educate practitioners to enhance the benefits and minimize the limitations of either recordkeeping system. 23 CHAPTER TWO: REVIEW OF LITERATURE History From the time of development of the first documented use of diethyl ether by Dr. William T. G. Morton in 1842, the safety of anesthesia administration has steadily increased. Initially the task of anesthetizing a patient was relegated to medical students under tutelage of a practicing surgeon, creating an anesthesia provider with a primary focus of studying the surgical procedure being preformed rather than vigilance toward the anesthetized patient. By the turn of the 20 th century, the morbidity and mortality of anesthesia delivery had become unacceptably high, and a provider dedicated to the specialty of anesthesia was sought (Gunn, 2005). At this time, physicians who specialized in anesthesia were few, due to the culture of medicine prevalent at the time. Surgeons recognized the need for anesthetists with specialized training, particularly those who would â€Å"(1) be satisfied with the subordinate role that the work required, (2) make anesthesia their one absorbing interest, (3) not look on the situation of anesthetist as one that put them in a position to watch and learn from the surgeon’s technic {sic}, (4) accept the comparatively low pay, and (5) have the natural aptitude and intelligence to develop a high level of skill in providing the smooth anesthesia and relaxation that the surgeon demanded† (Thatcher, 1953) 24 Most often, this role fell to nurses rather than physicians (Thatcher, 1953). Many of the physicians who administered anesthesia during this time were called in to service from the ranks of medical students studying the practice of surgery, were unskilled in the delivery of anesthetic agents, and often met with tragic results. A personal report shared by Dr. Harvey Cushing from the time of his medical training of a patient’s death under anesthesia indicates not only the challenges of anesthesia delivery, but also the nonchalant attitude towards the mortality ascribed to such mortality by the surgeons at the time. Dr. Cushing was advised by the surgeon, â€Å"that sort of thing happed frequently and I had better forget about it and go on with the Medical School. † As a result of this and other such incidents, Dr. Cushing and his colleague, Dr. E. A. Codman of the Massachusetts General Hospital were encouraged to develop the first known examples of an anesthesia record. These documents recorded respirations, pulse rate, and temperature, along with narrative accounts of the events of the patients’ reactions to the anesthetic. As stated by Dr. Cushing, â€Å"It was undoubtedly a step toward improvement in what had been a very casual administration of a dangerous drug. We do so much better with ether these days, but even so there remains much to learn† (Beecher, 1920). More widespread use of handwritten accounts of anesthesia and surgery were to follow, but not for more than 20 years after these initial accounts. Even at this early date, voices of caution were raised, indicating that the manual documentation of â€Å"too elaborate a record of this kind might take the administrator’s mind from his primary job†. In defense, Dr. Cushing stated, â€Å"I feel most emphatically that it keeps his mind on his job† (Beecher, 1920). 25 Perhaps as a result of similar concerns of distraction and reduced vigilance, in 1929, Dr. E. I. McKesson (1934) developed a device to record respiratory volumes, oxygen percentage, and pulse pressure, from which both the systolic and diastolic blood pressures were derived. Dr. McKesson (1934) advised, â€Å"It is very difficult for one person to count the pulse and respiration, measure the blood pressure and the volume of breathing, to determine the volume of rebreathing or the quantity of carbon dioxid {sic} used (the anesthetic), to note the dosage and a few other factors in their proper sequence and with sufficient frequency to aid in the administration†. Dr. McKesson (1934) also indicates that these same limitations were raised as cause not to keep such a record of anesthesia, to better maintain vigilance focused toward the patient. Through examples of anesthetic records generated by his device, Dr. McKesson (1934) also indicates the first recorded incidence of â€Å"artifact† or erroneous data. Listed in Chart 2 a â€Å"notch† is indicated in the graphic display of respirations. Such a â€Å"notch† indicates a reduction in tidal volume of respirations, as with â€Å"deep narcosis (McKesson, 1934). In this example, this data is indicated to reflect a failure of the anesthetist to maintain an adequate mask seal to the patient’s face, and this is indicated by a handwritten notation on the record. Dr. McKesson (1934) indicated that such records could be applied toward the ongoing research of anesthetic delivery techniques. He also indicated that such automatic recordkeeping had a higher degree of accuracy than handwritten records, many of which may be generated after the completion of the anesthetic rather than at the time of the event. Finally, the value of automatic records could be shown through improved 26 nowledge of anesthesia by the practitioners, resulting in improved patient safety (McKesson, 1934). While prophetic, Dr. McKesson’s opinions and apparatus would not gain widespread use, and the handwritten record persisted with few changes into the distant future. Not until 1973 was there further mention of the benefits to accuracy in anesthesia recordkeeping t hat an electronic system could provide (Drui et al. , 1973). Early Development and Implementation With the introduction in 1972 of a compact computerized calculator, the HP-35, the faithful slide-rule became instantly obsolete (Computer history museum – timeline of computer history. 009). At this time of rapidly developing computing technology, Drui et al (1973) examined anesthesia practice with the intent of improving efficiency and, ultimately, patient care. The authors utilized â€Å"memomotion,† a video imaging system that recorded data slower than actual time, to document the tasks of anesthesiologists. In addition, a trained observer with a stopwatch documented a series of twenty-four tasks, including periods of inactivity. Tasks were then rated according to the percentage of time devoted to the task, and the required knowledge, skill, and importance of each activity. The task of recordkeeping, while occupying a large proportion of the anesthesiologists’ time, was determined to have very low requirements of knowledge, skill, and importance. The authors determined that such an activity of low importance, requiring a minimum of skill and knowledge to perform should be automated (Drui et al. , 1973). Five years later, computing technology had advanced to the point that such automation had become possible, with Zollinger et al (1977) providing a comparison 27 between handwritten anesthesia records and those generated by â€Å"a computerized surveillance system†(Zollinger, Kreul, Schneider, 1977). Over this study of 100 patients, computer generated records were found to produce â€Å"acceptable blood pressure measurements 78 percent of the time,† at a rate of one reading every 2. 5 minutes. The resident anesthesiologists produced handwritten records that documented 94 percent of blood pressure measurements, at an interval of once every five minutes. Discrepancies between the two forms of recordkeeping occurred in 43% of the records, most of which occurred during times of high workload for the provider, such as during induction, or periods of time when the providers’ attention was focused on other tasks. Some of the discrepancies were indicated, â€Å"†¦when the vital signs recorded by the anesthesiologist tended to make the record look smooth† (Zollinger et al. , 1977). Zollinger et al (1977) concluded that the records produced were similar in accuracy, and advocated that computerization of the record could collect data at times when the provider was â€Å"otherwise occupied,† and would eliminate data that was â€Å"underestimated by humans who tended to smooth out a record. Even at this early stage, voices of caution were raised, as the article included comments by a guest editor, calling into question the accuracy of the recording devices employed in the study, and cautioned against â€Å"a ‘hands off’ policy† (Zollinger et al. , 1977). A year later, Shaffer et al (1978) examined the prevalence of handwritten records and the potential use of these documents to improve the quality of anesthesia delivery. The authors cited a survey of 46 hospi tals that revealed that as many as 8 percent did not maintain any form of anesthesia record, and that 17 percent did not record drug 28 dministration or dosages. This finding was supported by a similar study from Great Britain, finding that â€Å"25. 9 percent of the anesthesia records were comprised of a single written entry, 45 percent of the anesthesiologists never analyzed their records, and 51. 6 percent analyzed them only sporadically† (Shaffer, Kaiser, Klingenmaier, Gordon, 1978). Further analysis of the methods of recordkeeping indicated that many limitations of production of these documents existed. These limitations included the difficulties with production of copies, limited space available for documentation, incorrect or omission of entries, and illegibility of handwriting. These limitations indicated a need for greater automation of the anesthetic record, to improve the current deficiencies and reduce the anesthetist’s time spent on the task of recordkeeping. Shaffer et al (1978) surveyed anesthesiologists at their facility to devise a list of attributes for an ideal automated recordkeeping system. Shaffer et al (1978) summarized the survey into four main attributes deemed necessary by over 90 % of respondents: 1. Automatic capture of information with the ability to edit inaccurate or erroneous data. 2. Ability to enter data manually through a keyboard, light pen, or graphic display. 3. Reliability of function 4. Ease of electronic storage and retrieval of information Shaffer et al (1978) concluded that a â€Å"semiautomated† system would be the solution to the limitations of the system and account for the suggested improvements. Such a system would maintain many aspects of the handwritten record, to allow for manual entry and 29 error correction, while providing automated capture of vital signs, allowing for a savings of 33 to 50% of the time spent producing a record by hand. At this time in history, standardization of anesthetic equipment was in its infancy. The Pin-Index system, a method to prevent errors of connecting incorrect gas cylinders to an anesthesia machine, had only recently been introduced (Thompson, 1978). The automated non-invasive blood pressure device manufactured by Applied Medical Research, Tampa Florida, had just been introduced to the field, and was beginning to appear in clinical anesthetizing locations. This device, the Dinamap, provided an automated blood pressure reading with reliability, but provided only a visual display, and not an automated record of readings (Lindop, 1981). Against this background of developing technology, Apple et al (1982) offered a proposal for the development of a semiautomatic recordkeeping system similar to that called for by Shaffer et al in 1978. Apple et al (1982) provides details of the Abbograph, from Abbot Labs in Houston, Texas. The Abbograph provided only vital signs on a graphic plotting device, and had no capability for manual entry, an attribute deemed essential by both research studies. The authors offered a system of their own design, capable of both automatic capture of vital signs, as well as manual entry through a keypad of seven categories of data, including â€Å"anesthetic gases, intravenous fluids, body fluid losses, blood pressure data, ventilator settings, general patient record information and general events. Entry of data into this system could be made at the time of the event, at a later time, or â€Å"time independent,† for patient information that is not time sensitive. To evaluate the device, the authors compared 20 handwritten records and 20 keypad records. Of the entries made by hand, Full document contains 256 pages Abstract: Introduction: Anesthesia information management systems are rapi dly gaining widespread acceptance. Aggressively promoted as an improvement to manual-entry recordkeeping systems in the areas of accuracy, quality improvement, billing and vigilance, these systems record all patient vital signs and parameters, providing a legible hard copy and permanent electronic record. At risk is a potential loss of â€Å"connectedness† to the patient with the use of computerized recordkeeping, perhaps jeopardizing vigilance. Methods: This research analyzed differences in the accuracy of Certified Registered Nurse Anesthetists’ (CRNAs) recall of specific patient variables during the course of an actual anesthetic case. CRNAs using computerized recordkeeping systems were compared to CRNAs using manual entry recordkeeping. Accuracy of recalled values of 10 patient variables was measured – highest and lowest heart rate, systolic blood pressure, inspiratory pressure, and end-tidal carbon dioxide levels, lowest oxygen saturation and total fluid volume. In addition, a filmed educational vignette was presented to evaluate any effect on accuracy of recall following this presentation. Four tertiary care facilities participated in this research. A Solomon four-group research design was selected to control for the effect of pretesting on results of the filmed educational treatment. Results: 214 subjects participated in this study; 106 in the computerized recordkeeping group, and 108 in the manual entry recordkeeping group. Demographic covariates were analyzed to ensure homogeneity between groups and facilities. No significant statistical differences were identified between the accuracy of recall among the groups. There was no statistically significant effect of the educational film vignette on accuracy of recall. Conclusions: There was no difference in the accuracy of practitioners’ recall of patient variables when using computerized or manual entry recordkeeping systems, suggesting little impact on vigilance. The educational film presented did not have an effect on accuracy of recall following the discussion of benefits and limitations of methods of recordkeeping. Paper-Based Versus Electronic Medical Record Keeping For many years, physicians’ offices documented all data in paper-based medical charts. Now, the physician or clinician records the medical data into a computer. Information stored in this manner is known as an electronic-based medical record or EMR. By definition, an EMR is a computerized record of the important health information regarding a patient including the care of that individual and the progress of that patient’s condition (Bonewit-West, Hunt, Applegate, 2009). The use of computers in physicians’ offices is not new. For decades, physicians have used computers and practice management software primarily to schedule appointments and for billing. The government has offered physicians incentives designed to encourage the adoption of electronic medical records to promote medical information accessibility, better patient care, greater efficiency, and financial savings (Hamilton, 2010). In the face of advancing technology, small medical offices must compare the cost, ease of use, and maintenance of electronic medical record systems versus paper-based record keeping. The cost of keeping paper-based and electronic medical records is not just about the actual price tag of the record-keeping systems. The cost of keeping an electronic medical record system (EMR) begins with the initial purchase and implementation of the hardware and EMR software. There are also ongoing maintenance expenses, loss of revenue associated with temporary loss of productivity due to converting paper charts to electronic ones, and the training of the staff (Menachemi Collum, 2011). The way these record systems are stored is very different and can greatly affect the cost as well. EMR records are stored on a server, digitally, in a secure computer database within the office practice (Hamilton, 2010). How to cite Review of Related Literature, Essay examples

My Worst and Best Day free essay sample

My Best and Worst Day There always comes a time in your life where you could vividly distinguish your most best memorable day as well as your worst and saddest. In many cases those are times in your life which you will forever keep with you as long as you live and will remain as your top two until something better and worst happens In your life. My best day as of now would have to be the day of my graduation. I have never had that leaning of being so happy for myself that I had to catch myself holding back tear.With every great story, there has to be a sad one too and that happened to me when my parents decided to sell my first and only puppy. With an extremely busy schedule I always carry, ;RSI sometimes hard to have some time off where I could classify as It being the best day of my life, but that one chance and opportunity happened to me on a hot but exciting day, June 4th 2011. We will write a custom essay sample on My Worst and Best Day or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page That date would stick with me forever because that was the day I graduated from Let High school at the fairgrounds.Ever since I could remember, would always have a calendar and I would count down the years I had left. Believe it or not, it went by fast. Onto my last year of high school, I just wanted to get out. Nothing was hitting me until the last day when we got to see a wonderful, well-edited slideshows of the whole four years the senior class had experienced. I remember the day of my graduation; it was Like if I was getting ready to land on the moll I had my hair done, shaved real clean and made sure I looked sharper then a marine on inspection day.I remember sitting down and seeing my parents and family with a huge smile on their faces, it Just made me feel so proud that I had made them happy. After walking the stage I remember I was alone for a few minutes and I almost began to tear so I had to hold it in. When I got home that was a great time on its own! It was Christmas in June but on steroids! I kept receiving gifts like a laptop, a real Coach Book bag, and a huge class ring Just to name a few. You cannot have your best day without having your worst day. My worst day was hen my parents sold my black German Sheppard named Snoop.Ever since I was younger, I would always beg my parents to get me a dog and the answer was always a solid big fat NO! I always knew that my dad had a thing for German Shepherds, so I always said I wanted one of those. After looking at the towns flyer, I came across this cheap puppy that I Just needed to get. After long years of convincing, I finally hit my moms soft spot and was able to get It! I remember out of 10 puppies, this special one stood out to me so I instantly named him Snoop because at the time Snoop Dog was popular and thought that was a cool name. Every day after school I would play with him and Just walk him around the entire block until him and I was tired. After a few months all the dog food and Vet visits was putting a toll on my parents and I was starting to notice. A week after that, my mom told me she was going to sell him; I did boy. It could not be true! My puppy was going to get sold. I remember like it was yesterday, I locked myself into the bathroom and I dont know what got into me but I broke down and cried a river.After long years, still havent gotten another puppy. Every day you face up and down situations but there easy to store away in the back of your head, but then you got those vivid memories where as hard as you try to forget about them or even relive them, you Just cant. It could be both positive and negative situations, from watching your best friend being forced into a new household without a say, to walking across the stage of your graduation while your family cheers you on. Everyone has their happiest and saddest days.