Comparison of Stroke Rehabilitation Guidelines

Comparison of Stroke Rehabilitation Guidelines Stroke is considered to be the third cause of death and disability for millions of people in developed countries (1). Stroke is the clinical manifestation of a wide range of pathologies, with different etiologies and prognoses, and many risk factors. Stroke is defined as a syndrome characterized by rapidly developing clinical symptoms and/or signs of focal loss of cerebral function, in which symptoms last more than 24 hours or lead to death, with no apparent cause other than that it is a vascular origin. Stroke victims who survive the first attack may have persisting impairments such as cognitive impairments, upper and lower limb impairments and speech disabilities. The United Kingdoms prevalence of stroke in the population is estimated to be 47 per 10000 making stroke the most common cause of adult physical disability (1; 2; 3). In the United State the Veterans Health Administration (VHA) estimated that 15000 veterans are in hospitals with a diagnosis of stroke every year (4). Stroke rehabilitation is a main factor in helping stroke survivors to regain their functional ability when medical and surgical interventions are limited (5). Physical therapy plays a major role in stroke rehabilitation. Physical therapists choose the duration and type of therapy given and provide education for stroke patients. Stroke rehabilitation aims at giving the patients the ability to regain maximum and full potential in functional activities and restoration of motor control (6; 7; 8; 5). Three main factors in rehabilitation contribute to the speed and quality of recovery. These factors are: treatment session duration and frequency, type of treatment approach used for rehabilitation, and providing education about the condition for patients during and after therapy (2; 3; 7; 8; 9). Physical therapy rehabilitation for stroke patients is designed to impact the disabilities and impairments associated with post stroke conditions. Rehabilitation is mainly aimed at limiting any deterioration of impairments and maximizing the functional level for patients suffering from stroke. To be able to deliver this, physical therapists should follow a certain set of guidelines which will insure better outcomes and avoid unnecessary practices that could prolong and delay optimum gain of function (6; 7). It is unclear whether physical therapists in Kuwait follow any specific guidelines in stroke rehabilitation. Therefore, it would be plausible to learn more about current local rehabilitation procedures. This may help in the further development of local rehabilitation procedures and practice guidelines, optimization of treatment and rehabilitation management, improvement in stroke patients health and quality of life, and minimization of conflicted rehabilitation practices that prolong therapy which in turn affect and burden the health system with increased number of patients (6; 8; 10; 11). We hypothesize that physical therapist in Kuwait rehabilitation do not follow stroke rehabilitation guidelines and science based practices in stroke rehabilitation. Therefore the aims of this study are to: Explore if stroke rehabilitation in Kuwait follow general guidelines of stroke rehabilitation regarding frequency of treatment sessions and duration of each session. Investigate if physical therapists specializing in the field of neuroscience in Kuwait follow general guidelines of stroke rehabilitation regarding their treatment approaches. Identify if education is being provided for stroke patients about their condition during and after rehabilitation. Literature Review: Stroke is defined as a syndrome in which clinical symptoms and/or signs of cerebral function loss develop rapidly, and last for more than 24 hours or result in death. Stroke can be classified according to the cause, which is either ischemic or hemorrhagic. Ischemic strokes account for 85% of all strokes, while 15% account for hemorrhagic strokes. Over 10% of patients who had a first stroke will have a second one within a year, and the risk of recurrence within 5 years is 15-42% (1). There are a wide range of conditions that lead to stroke, such as hypertension and diabetes. Each year, 5.45 million deaths are attributed to stroke, and over 9 million survive. Survivors often experience a wide range of persisting impairments. Common impairments include Physical disability, cognitive impairment, Lower limb impairments, and speech difficulties (1). Rehabilitation is an important part after survival from a stroke. Rehabilitation was defined in the New Zealand guideline for management of stroke as a problem-solving and educational process aimed at reducing the disability and handicap experienced by someone as a result of disease, always within the limitations imposed by both available resources and the underlying disease (12). Its of utmost importance that the stroke patient understands, and receives education concerning his/her condition and what limitations may persist, even after rehabilitation (12). Reker D. M. et al, researched whether adherence to post stroke guidelines was associated with greater patient satisfaction. They used a prospective inception cohort study design for new stroke admissions, including post-acute care, and they made follow-up interviews at 6 months after the stroke injury. Two hundred and eighty eight patients were included in the study, from eleven Veterans Affairs medical centers (VAMCs). The main outcome measures used in this study were: 1) compliance with the Agency for Healthcare Research and Quality (AHRQ), 2) patient satisfaction with care provided, and 3) stroke-specific instruments. Results have shown that, for every 10% percent increase in guidelines compliance, the average value of patient satisfaction increases by 1.5 points for the mean overall satisfaction score, which ranges from 4 to 39, and includes items for hospital satisfaction, home satisfaction, and overall satisfaction. The study concluded that compliance to AHRQ guidelines is sign ificantly associated with patient satisfaction (7). Several comparisons between Stroke Rehabilitation Protocols/ guidelines have been performed. This is beneficial in establishing the best treatment, with regards to dosing, intensity, duration, as well as efficiency and efficacy of interventions. A study by McNaughton H, et al examined the practice and outcomes of stroke rehabilitation between New Zealand and the United States facilities. This study used a Prospective observational cohort design and included 1161 participants from six United States (U.S.) Rehabilitation facilities and 130 participants from one New Zealand rehabilitation facility, all above the age of 18 years. In this study, New Zealand patients were older than the United States patients. However, the severity of initial stroke was higher for the U.S. patients. Despite that fact, patients in the U.S. were discharged earlier. They also had more intensive therapy, represented in higher durations spent with physical therapy and occupational therapy professionals. Also, U .S therapists tended to spend less time on assessment and non-functional activities, while focusing more on active management of patients. Results showed that, U.S. participants had better outcomes represented by changes in Functional Independence Measure FIM scores and fewer discharges to institutional care (13.2% vs. 21.5%). This study illustrates that duration and intensity of therapy can be adjusted to gain a better outcome. Also, it is important to know which activities are being done in the treatment session, and find out if they contribute to a better outcome of rehabilitation (10). Horn et al. investigated the effect of specific rehabilitation therapies in stroke rehabilitation on outcomes, taking into account the differences between patients. In this study, they wanted to examine the associations between patient characteristics, rehabilitation therapies, neurotropic medication, nutritional support, and time of starting therapy with functional outcomes and discharge destination for stroke inpatients. Discharge total, motor, and cognitive FIM (functional independence measure) scores and discharge destinations were registered for 830 patients with moderate or severe strokes from five U.S. inpatient rehabilitation facilities. Results showed that earlier initiation of rehabilitation, time spent in higher-level rehabilitation activities, such as upper-extremity control, gait and problem solving, usage of newer psychiatric medications, and gastric feeding, were all associated with better outcomes. The study also illustrated that a variety of Physical Therapy, Occupat ional Therapy, and Speech Language Pathology activities were correlated with higher or lower FIM scores. On one hand, more minutes spent per day on PT gait activities, OT upper-extremity control activities and home management, and SLP problem solving activities were associated significantly with higher FIM scores. On the other hand, more minutes spent per day on PT bed mobility and sitting, OT bed mobility, and SLP auditory comprehension and orientation were consistently associated with lower FIM scores (11). One study described Physical Therapy intervention for stroke patients in inpatient facilities within the U.S. (13). Six rehabilitation facilities in the U.S. included 972 subjects with stroke injury. Variables studied were time spent in therapy, and content and activities that were used in rehabilitation. The mean duration of stay in the inpatient facilities was 18.7 days, and received PT was on an average of 13.6 days. Patient spent 57.15 minutes on average for Physical therapy treatment every day. Activities of gait, transferring, and pre-functional activities, which include strengthening exercises, balance training, and motor learning, were the most performed interventions. Also, therapists included activities that incorporated different functions into one functional activity. This study implicated that a focus of physical therapist when providing treatment is optimizing functional activities, as they were the most frequent activities performed. However, activities to remediate im pairments and to compensate for lost functions were also included in the treatment sessions (13). Brocklehurst et al. investigated the use of physical therapy, occupational therapy, and speech therapy for patients suffering from stroke, as they mentioned that those interventions formed the basis of stroke rehabilitation. The study included 135 stroke patients from five general and one geriatric hospital, in South Manchester. Of the 135 subjects, 107 received PT, 35 received OT, and 19 received speech therapy. Results were obtained after measuring the rate of change in function over a one year period. Patients, who had more severe disabilities, and the worst prognosis, were more likely to get physical therapy treatment. Factors that determine type and specificity of physical therapy to stroke rehabilitation were also examined. Some of the factors were extent of disability, and disability-associated morbidities, such as fecal incontinence, spasticity, sensory loss and dysphasia. Even though the most disabled received the most physical therapy treatment, they showed the least improv ement in function even after six months of therapy. This study also concluded that patients, whose progress was poorest, received more physical therapy (5). Hsiu-Chen Huang et al. investigated the impact of timing and dose of rehabilitation delivery on the functional recovery of patients suffering from stroke. In this study, a retrospective review of medical charts was done for 76 patients who were admitted to a regional hospital for a first-ever stroke. Patients had multidisciplinary rehabilitation programs, including PT, OT, and a continuous rehabilitation for at least three months. The main outcome measure for this study was the Barthel index, taken at initial assessment, one month, three months, six months and one year after stroke. Results of this study showed that there is a dose-dependent effect of rehabilitation on functional outcome improvements of stroke patients. Also, earlier delivery of rehabilitation is associated with lasting effects on functional recovery up to one year post-stroke (14). It is unclear whether physical therapists follow evidence based practice many countries of the world including Kuwait. There is no doubt the era of evidence based practice is upon us for many reasons including better treatment outcomes, patient satisfaction, reimbursement amongst others. In one survey study, conducted by Iles and Davidson, examination of physical therapists current practice in Australia was undertaken. This study found that there are several barriers in the way of evidence-based practice. Those barriers included time to stay up to date, access to journals, access to summaries of evidence that are easy to understand, and lack of personal skills in looking for and evaluating research evidence (15). Salbach et al. examined the determinants of research use in clinical decision making among physical therapists treating post-stroke patients. Two hundred and sixty three physical therapists from the state of Ontario, Canada, responded to a survey questionnaire, containing items for evaluating practitioner and organizational characteristics and perception of research believed to be influencing evidence-based practice. The survey also contained the frequency of using research evidence in clinical decision making in a typical month. Results showed that, only a small percentage of therapists (13.33%) reported using research in clinical decision making six times a month or more. However, most therapists (52.9%) reported using research 2-5 times a month, while 33.8% used research 0-1 time per month. In this study, research use was associated with the academic preparation in the principles of Evidence-Based Practice (EBP), research participation, service as a clinical instructor, being self -effective in implementing EBP, attitude towards research, perceived organizational support of research use, and access to bibliographic databases at work. This study concluded that a third of therapists rarely apply research evidence in clinical decision making. Suggested interventions to promote research use included education in the principles of EBP, EBP self-efficacy, having a positive attitude towards research, and involvement in research (8). A study by Ogiwara, made a comparison between the bases of treatment between Japanese physical therapists, and Swedish therapists. They investigated the reasons why the Japanese choose certain approaches of treatment when handling stroke patients, and then compared the results with those of Swedish therapists. Swedish therapists attributed their choice of treatment to hands-on experience and participation in practical courses, in which various techniques are taught. Bobaths approach was the only method that was commonly continued to be used after graduation in both countries. Results have illustrated that Swedish therapists were more interested in new methods of treatment (91%), whereas only 77% of Japanese therapists had an interest. Implication of their results might mean that Japanese therapists are interested in their treatment approach, and also show that introducing new approaches of treatments takes a longer time in comparison to Sweden. Additionally, Swedish therapists tend t o make a combination of treatment approaches, while Japanese physical therapists tend to follow only one particular approach. Several reasons were speculated for addressing the differences in treatment protocols, some of which were: 1) diversity of cultures, 2) diversity of health the care system, 3) availability of equipment and space needed to follow a certain new approach, 4) belief of efficacy of a certain approach and 5) the language barrier imposed on Japanese therapist, and availability of translated literature. This study showed that there are several barriers and differences encountered when the need of application of new approaches is desired (9). Wachters-Kaufmann et al. conducted a study regarding the conferring of information for stroke patients and caregivers. Their study investigated how information was provided to patients and caregivers and how they actually preferred to be informed. The actual and desired information correspond in terms of content, frequency, and method of presentations well as the actual and desired information. The study was done in the North of the Netherlands and the stroke unit of University hospital Groningen. The General practitioners (GP) distributed a guide from a community-based study of cognitive disorders and quality of life (CognitiVA) after a stroke. The guide was given three months after the stroke. For the final measurement of the study, which was 12 months later, the patients and caregivers participated in a telephone survey, which asked about three things: 1) professional stroke-care providers, 2) other sources of information, 3) the guide. Fifty one patients and 38 caregivers were co ntacted, of which 18 patients and 11 caregivers declined to be interviewed for various reasons. The results showed that the GPs, neurologist, and physical therapists were both the actual and desired information providers. As for the content, the actual content was the guide, whereas the desired was mostly medical information concerning the course of the disease, its cause, consequences, and treatment. Regarding the frequency, the actual and desired was within 24 hours of the stroke, and one day to two weeks later, and after two weeks. As for the method of presentation of information, the patients and caregivers mostly desired only verbal (73% patients, 89% caregivers) (16). Methods: This comparative design research project will compare the stroke rehabilitation program implemented in Kuwait with the established guidelines for stroke rehabilitation in the United States of America. The rehabilitation program stroke patients are receiving in Kuwaits Ministry of Health hospitals, specifically, Al-Jahra, Mubarak, Farwanya, Physical Medicine and Rehabilitation, and Al-Sabah hospitals will be investigated. Subjects of the study will be physical therapists practicing in the stroke rehabilitation field. We will provide physical therapists experienced in stroke rehabilitation with self-administered questionnaires, which will be collected after one week. We will also examine patient records over a three week period. To access the records, we will get permission from the head of the physical therapy department of each hospital as well as each hospitals director. Institutional Review Board (IRB) approval will be obtained prior to any data collection. Approval from the Minist ry of Healths IRB will be obtained as well as approval from Kuwait University. Data will then be compared with the established American Stroke Guidelines. All data gathered during the study will be kept under lock and key. Any identifiable information obtained from patient files and records will only be accessible to the primary investigator. No identifiable information will be used for publication purposes. Confidentiality will be insured throughout the study duration. Subjects: The subjects of this study will be physical therapists working in Kuwaits Ministry of Health hospitals neurology department and with experience in out-patient stroke rehabilitation. Tools: To investigate the frequency and duration of treatment, we will look into the records, which are the patients files. There is also a section in the questionnaire that will ask about the frequency and duration of sessions. As for finding out the treatment approach patients are receiving, a self-administered questionnaire will be distributed at selected MOH hospitals, specifically at Al-Jahra, Mubarak, Farwanya, Physical Medicine and Rehabilitation, and Al-Sabah hospitals. Therapists will be given the questionnaire to fill out. In order to evaluate the type of education given to patients, educational guides, or pamphlets, about the patients condition available at the hospital and distributed to patients will be looked at. The questionnaire will also ask about different patient education techniques used by the participants. For comparison of data, we will compare the data we obtain with the American Stroke Association guidelines. Questionnaire: The questionnaire will consist of several questions used in the Ogiwara (9) questionnaire as well as others pertinent to our study population. The questionnaire will consist of four parts: demographic information questions concerning the therapists professional history and experience Questions concerning the rehabilitation program: treatment approach, and frequency and duration of sessions. questions concerning the types of education techniques Each questionnaire will have a cover letter explaining the purpose of the study, and a consent form. Data Analysis The data will be analyzed using SPSS (Statistical Package for Social Sciences) (v. 17.0) to describe means, standard deviations, frequencies, and percentages. Once the data is analyzed, we will compare the data we collected with the general guidelines and treatment approaches in the literature. Expected Outcomes and Recommendations Our expectation for this study is that physical therapists in the state of Kuwait will not be following the American stroke rehabilitation guidelines. Due to cultural differences between the two countries, establishing new guidelines for the stroke rehabilitation in Kuwait might be necessary, addressing the nature of referral to physical therapy in Kuwait, and making recommendations for increasing treatment duration if needed. Also, it should be mentioned what type of special equipment might be used in the process of rehabilitation. References: Rudd A, Olfe C.W. (2002, Feb). Aetiology and pathology of stroke. Vol. 9, pg 32-36. Hafsteinsdottir T.B, Vergunst M, Lindeman E, Schuurmans M. (2010, 29 July). Educational needs of patients with a stroke and their caregivers: A systematic review of the literature. www.elsevier.com/locate/pateducou Hoffman T, McKenna K, Herd C, Wearing S. Written stroke materials for stroke patients and their careers: perspectives and practices of health professionals. Top Stroke Rehabil 2007;14(1):88-97 Duncan P, Zorowitz R, Bates B, Choi J, Glasberg J, Graham G, Katz R, Lamberty K, Reker D. Management of Adult Stroke Rehabilitation Care: A Clinical Practice Guideline. (Stroke. 2005; 36:e100-e143.) Brocklehurst J.C, Andrews K, Richards B, Laycock P. J. (1978, 20 MAY). How much physical therapy for patients with stroke? Vol. 1, 1307- 1310. British Medical journal. Kollen, B, Kwakkel G, Lindeman E. (2006, 11 July). Functional Recovery after Stroke: A Review of Current Developments in Stroke Rehabilitation Research. Vol.1, No.1, 75-80. Reker D.M, Duncan P. W, Horner R.D, Hoenig H, Samsa G.P, Hamilton B, Dudley T.K.(2002, June) Post acute Stroke Guideline Compliance Is Associated With Greater Patient Satisfaction. Arch Phys Med Rehabil Vol. 83, pg 750-756. Salbach N, Guilcher S, Jaglal S, Davis A. (2010) Determinants of research use in clinical decision making among physical therapists providing services post-stroke: a cross-sectional study. http://www.implementationscience.com/content/5/1/77 Ogiwara S. (1997) Physical therapy in stroke rehabilitation: A comparison of bases for treatment between Japan and Sweden.vol.9 Pg. 63-69, Journal of physical therapy sciences. McNaughton H, DeJong G, Smout J, Melvin L, Brandstater M. (2005, Dec) A Comparison of Stroke Rehabilitation Practice and Outcomes between New Zealand and United States Facilities. Vol. 86, suppl.2, Arch Phys Med Rehabil. Horn D, DeJong G. Smout J, Gassaway J, James R, Conroy B. (2005, Dec) Stroke Rehabilitation Patients, Practice, and Outcomes: Is Earlier and More Aggressive Therapy Better? Vol. 86, pg. 101-114, suppl. 2, Arch Phys Med Rehabil. Life after stroke: New Zealand guideline for management of stroke (November 2003). Jette D.U, Latham N.K, Smout R.J, Gassaway J, Slavin M.D, Horn S.D (2005, March) Physical Therapy Interventions for Patients with Stroke in Inpatient Rehabilitation Facilities. Vol. 85, num. 3, pg. 238-248, physical therapy. Huang H, Chung K, Lai D, Sung S. The Impact of Timing and Dose of Rehabilitation Delivery on Functional Recovery of Stroke Patients (J Chin Med Assoc: May 2009 , Vol 72, No 5) Iles R, Davidson M. Evidence based practice: a survey of physiotherapists current practice. Physical therapy. Res. Int. 11(2) 93-103 (2006) Watchers-Kaufmann C, Schuling J, The H, Jong B. Actual and desired information provision after a stroke. Patient Education and Counseling 56 (2005) 211-217 Appendices Appendix 1 American Stroke Association Guidelines: E. Patient and Family/Caregiver Education Background The patient and family/caregivers should be given information and provided with an opportunity to learn about the causes and consequences of stroke, potential complications, and the goals, process, and prognosis of rehabilitation. Recommendations Recommend that patient and family/caregiver education be provided in an interactive and written format. Recommend that clinicians consider identifying a specific team member to be responsible for providing information to the patient and family/caregiver about the nature of the stroke, stroke management rehabilitation and outcome expectations, and their roles in the rehabilitation process. Recognize that the family conference is a useful means of information dissemination. Recommend that patient and family education be documented in the patients medical record to prevent the occurrence of duplicate or conflicting information from different disciplines. N. Educate Patient/Family, Reach Shared Decision about Rehabilitation Program, and Determine Treatment Plan Objective ensure the understanding of common goals among staff, family, and caregivers in the stroke rehabilitation process and, therefore, optimize the patients functional recovery and community reintegration. Recommendations Recommend that the clinical team and family/caregiver reach a shared decision about the rehabilitation program.   Ãƒâ€šÃ‚  Ãƒâ€šÃ‚  The clinical team should propose the preferred environment for rehabilitation and treatments on the basis of expectations for recovery.   Ãƒâ€šÃ‚  Ãƒâ€šÃ‚  Describe to the patient and family the treatment options, including the rehabilitation and recovery process, prognosis, estimated length of stay, frequency of therapy, and discharge criteria.   Ãƒâ€šÃ‚  Ãƒâ€šÃ‚  The patient, family, caregiver, and rehabilitation team should determine the optimal environment for rehabilitation and preferred treatment. Recommend that the rehabilitation program be guided by specific goals developed in consensus with the patient, family, and rehabilitation team. Recommend that the patients family/caregiver participate in the rehabilitation sessions and be trained to assist patient with functional activities, when needed. Recommend that patient and caregiver education be provided in an interactive and written format. Provide the patient and family with an information packet that may include printed material on subjects such as the resumption of driving, patient rights/responsibilities, support group information, and audiovisual programs on stroke. Recommend that the detailed treatment plan be documented in the patients record to provide integrated rehabilitation care. Intensity of Therapy The heterogeneity of the studies in all aspects-patients, designs, treatments, comparisons, outcome measures, and results-combined with the borderline results in many of the trials limits the specificity and strength of any conclusions that can be drawn from them. Overall, the trials support the general concept that rehabilitation can improve functional outcomes, particularly in patients with lesser degrees of impairment. Weak evidence exists for a dose-response relationship between the intensity of the rehabilitation intervention and the functional outcomes. However, the lack of definition of lower thresholds, below which the intervention is useless, and upper thresholds, above which the marginal improvement is minimal, for any treatment, makes it impossible to generate specific guidelines. Partridge et al did not find any differences in functional and psychological scores at 6 weeks in 104 patients randomized between a standard of 30 and 60 minutes of physical therapy. Kwakkel et al randomized 101 middle-cerebral-artery stroke patients with arm and leg impairment to additional arm training emphasis, leg training emphasis, or arm and leg immobilization, each treatment lasting 30 minutes, 5 days a week, for 20 weeks. At 20 weeks the leg training group scored better for ADLs, walking, and dexterity than the control group, whereas the arm training group scored better only for dexterity. The clinical trials provide weak evidence for a dose response relationship of intensity to functional outcomes.

Aiims and Objectives

Task 1 – The aims and objectives of Tesco & Nike Aims: An aim is a goal of which a business wants to achieve. For example, some businesses aim to expand whilst others aim to survive. Another aim that a business can have is selling as much as possible whilst others aim to improve the quality of their products. Objective: An objective is what a business wants to achieve but more precise targets than aim. For example an objective for a business can be to sell 1000 more products than we sold last year, sell more products than its competitors, make ? 0,000 more profit than the previous year. Aim vs Objective: The difference between an aim and an objective is that an objective is more precise and measureable than an aim. For example an aim can be to make more profit, whilst an objective can be to make ? 10,000 more profit than the previous year. The best type of objectives is a SMART objective. SMART stands for the following; S – Specific M – Measurable A – Agre ed R – Realistic T – Time constrained An example of a SMART objective is ‘to increase in sales of organic products to ? 1 billion by 2006’. This is a specific objective, it is also measurable and is time constrained it must be achieved by 2006, given customer interest in organic product, it is also realistic, and if this objective has also been agreed with suppliers and store managers, this it is a SMART objective, but if Tesco had merely said it wanted ‘to increase sales of organic product’ then this is not SMART, and it also cannot be measured easily. Why an objective must be measurable? An objective of a business must be measurable in order to see if the business has reached its aim, however if it is necessary a business can change its objective in order to meet its aim. A business can make its objective measurable; instead of saying we will make more profit. A business can make its objective measurable by giving it a time to measure; therefore a measurable objective can be we will make ? 10,000 more profit than the previous year. Aims of Nike: †¢ Nike is aiming to upgrade its profit by more than 50% in the next five years. From the Internet. †¢ Nike is aiming on developing low-cost canvas footwear in developing countries in the next 3 years. From the Internet. †¢ Nike is aiming to keep their brand as the largest sportswear brand in the world, by preventing Adidas from outshining them. From the Internet. †¢ By the next year Nike is aiming to show in its adverts, and annual reports that it has good intentions with regards to working conditions. From the Internet. †¢ Nike is aiming for 50% Revenue Growth over Next Five Years. From the Internet. †¢ Nike is aiming to upgrade its volume more than 50% in the next fives years. From the Internet. Aims of Tesco: †¢ Tesco is aiming to upgrade its profit by more than 50% in the next five years. From the Internet. †¢ Tesco is aiming to understand their customers better than anyone in the next 3 years. From the Internet. Tesco is aiming to make their company the largest supermarket in the next 8 years, by outshining global competitors such as Wal-Mart and Carrefour. From the Internet. †¢ Tesco are aiming to provide 150 more organic products than the previous year. From the Internet. †¢ By the next year Tesco is aiming to show in its adverts, and annual reports that it has good intentions with regards to working conditions. From the Internet. Aims and objectives of Tesco and Nike: All types of businesses including Tesco and Nike must be professionally organised in order to achieve the aims and objectives that it has set itself. Businesses including Tesco and Nike must have aims to find out which department that they need to improve in, in order to improve the business as a whole. Businesses including Tesco and Nike must make objectives to find out how they are going to achieve the aims that it has set itself. Why the aims and objectives of Nike and Tesco differ: The aims and objectives of my two chosen organisation which are called Tesco and Nike differ because Tesco is more like a supermarket which sells foods, and also non-food goods and services such as jewellery, books, CDs, and clothes. Whilst Nike is more like a giant sports organisation which doesn’t sell non-food goods, but it sells sports products such as trainers and clothes. The main objective of Nike is to protect and improve Nike’s position as the number one athletic brand in America and around the world; this proves that Nike has the ambition to make their organisation as big as possible, Nike are only interested in expanding their organisation. Comparison of business aims: Moreover Tesco’s main objective is to take over Homebase and Argos in sales of homeware, electrical goods and services, this proves that Tesco doesn’t want to only be known as a food retailer organisation, but they also want to be known as an organisation which also offers their customers competitive prices in homeware, and electrical goods and services. Tesco and Nike have different aims because they’re in different categories of business, moreover they are also in a different sector of business and ownership. Tesco try to fulfil the needs of their customers, they do this by providing their customers with products which are of good quality. Tesco’s main aim to improve the popular products that are amongst their customers that they already have; thereafter they should bring in more products that their customers are in need of. Furthermore, in present time Tesco are trying to progress their company in the electronic, gaming and clothing sector at an affordable cost. So as a result even though its only of a minority Tesco also happen to cover some other sectors such as; clothing, gaming and electronic. Tesco will choose aims that suit them and are reasonable in other words aims that can be achieved. Tesco acknowledge that fact that other branded products will be expensive to buy and will not suit the company as in order to make great profits the prices of the products must be sold expensively, therefore in order to sort out this problem Tesco have made their own brand of high quality of products at a low and reasonable price, hence Tesco has the title of being one of the cheapest supermarkets in Britain. However other supermarkets such as Asda and Sainsbury’s also have their own branded products. Tesco posses a great quality that all businesses crave to posses; and that quality is none other than the fact that Tesco is incredibly organised. I know for a fact that Tesco are organised, because I remember going to Tesco and I witnessed the fact that products that are relevant are in the same section so that it makes easier for the customers to find their desired product and compare the prices with similar products for example they locate baby products in the same section near each other, so that parents looking to buy baby cereal and baby yoghurt will not suffer the exhaustion of travelling to the other end of the supermarket. Tesco also name the sections so that customers don’t get confused. The thing that I also like about Tesco is that they locate baby stuff in sections that are near to each other so once again the customer doesn’t need to walk across to the other side of the supermarket to get a cereal and the other side to get pampers. However other supermarket that I’ve seen with my own eyes such as Asda also do this. I say that Tesco and Asda are the most organised supermarket in Britain ( Judging from my own eyes), Both supermarkets have new/ products with special offers near the entrance; they use this method to make sure that new/ products with special offers is the first thing that the customers sees, hence the customer will not miss the special offer or a new product. Another reason why they do this is because Tesco acknowledges the fact that customers like to see what’s new and that if they can’t find the new roduct/s then they will start to ask the staff, this will make them busy and also stop the staff from concentrating on their work. Nike is a company that sells and manufacture all type of sports wear and products. The advantages that Nike has are that they both manufacture and sell products that their customers have an interest in. In order for Nike to sell more goods and services they (Nike) sponsor sport stars such as Cristiano Ronaldo, Roger Federer and Tiger Woods. You can observe that these sport stars are one of the best and on top in their profession, hence they have a big fan base and these fans like to imitate their idols and wear similar clothing; due to the fact these sports stars posses an enormous fan base is noteworthy because it will mean that the fans will buy the Nike products, that the sports stars are wearing. However this doesn’t come in cheap, as the sports stars get paid an enormous amount for wearing the Nike clothing range. The followings is how much each Sport star get paid by Nike. †¢ Cristiano Ronaldo – Currently gets ? 6 million a year sponsorship. †¢ Roger Federer – Currently gets ? 8. 4607875 million a year sponsorship †¢ Tiger Woods – Currently gets ? 13. 0165962 million a year sponsorship Although these Sports stars get paid generously, I however think that they are worth it ‘because they have helped Nike to generate sales. However Adidas who are Nike’s competition also have endorsement deals for Sport starts most notably David Beckham. However my other business (Tesco) will not be able to sponsor sports stars as their main speciality is by selling food products especially groceries and sport stars are not relevant to what they sell therefore the sport stars won’t be able to generate more profit for Tesco moreover the other reason is that Nike’s financial situation is better than Tesco’s therefore Tesco won’t afford to pay the enormous amount anyways that is needed to pay these huge sports stars with enormous fan base behind them. The aims and objectives of Tesco and Nike is differs because Nike is very different to Tesco as Nike only has few Niketowns shops as they sell their wide range of sports products to shops such as JD and Sports Direct but Tesco sell their own branded products and products that are not Tesco branded therefore Nike and Tesco will have different aims and objectives as both the businesses are ran differently and located in different areas. Moreover it can also be different because all the Niketowns I see are densely populated such as the one in Oxford, moreover Nike products can be bought in batch (shops such as JD and Sports Direct buy in batch, because they will save capital from buying in batch) but this cannot be done in Tesco as Tesco locate themselves in a location near some type of estate which has a lot of people there so that their customers don’t take long journeys and as a result goods and services are sold individually; because of this fact the aims and objectives of Tesco and Nike will differ. Nike have factories to make their products whilst Tesco buy their goods and services from other people whilst they also sell their own branded products some of which are made in the store (such as bread and other groceries) therefore it will be fresh for customers to consume. This is one of the reasons why the aims and objectives of Tesco differ. Moreover Nike and Tesco can also have few similar aims and objectives because the ownership of both Tesco and Nike is public limited company which means that shares are traded on the stock exchanged, however the interesting reason for Tesco and Nike being a public limited company is because of their enormous size. If both Nike and Tesco were owned by a sole trader or by a partnership except being owned by a public limited company then due to their enormous size it would be very difficult to raise enough funds for Tesco and Nike. Similarly, both companies are owned by shareholders. Tesco and Nike are not successful on meeting their aims and objective, because they haven’t released a statement saying that they have been successful on achieving their aims and objectives. |Similarities: |Differences: | |Both Tesco and Nike are aiming to upgrade their profit by more |Tesco is aiming to become the largest supermarket in the world | |than 50% in the next five years whilst Nike is aiming to protect their no. 1 status of being | | |the largest sportswear brand in the world | |By the next year both Tesco and Nike are aiming to show in |Tesco is aiming to understand their customers better than | |their adverts, and annual reports that they have good |anyone in the next 3 years whilst Nike is aiming for 50% | |intentions with regards to working conditions. |Revenue Growth over Next Five Years. | Suggestion of business aims: I would suggest for Tesco to aim to manufacture (Tesco branded) sporting products such as treadmill, rower and cycle for women by the next year as women of this generation have no-time to go to the gym and they want to stay in shape, be fit whilst others want to lose however Tesco should manufacture (Tesco branded) weights and other home gym equipments as most men want to get a toned physique; if Tesco manufacture these (Tesco branded) products in the near future then they will meet the demands of their customers, and because it’s Tesco branded it should be reasonably cheap. Tesco should perhaps imitate Nike and sponsor a famous fitness model for the advertisement of the products I have suggested. I would suggest Nike to aim to introduce interesting and exciting fitness programmes by the next year for people who suffer to lose weight/gain muscle or don’t know how to lose weight/gain or simply need to be motivated to lose weight/gain muscle; this will make Nike wider and more appealing to their customers as they will not only be helping their customers but also beating their competitive businesses such as Adidas and Reebok because both of these Nike’s do not sell fitness programmes to their customers which will give Nike an edge of their competitive businesses. Nike should also then sponsor a world famous fitness model to advertise the product that I have suggested. From my own experience I think that although Nike have a range of great quality products they however don’t have them in competitive prices and this is what some customers complain about (me, and my friends), wearing Nike looks cool but the prices on the clothes is just too much, therefore the product that I suggest Nike to manufacture should be very competitive. The difference between Nike and Tesco is that Tesco have cheap products whilst the products of Nike are very expensive and other customers who are less fortunate will have to dig deep in their pockets to buy the Nike product that they desire. I suggest Nike to make their products cheaper as we are in the recession and some people don’t have jobs so they won’t be able to afford it, plus some have had their salary cut down due to the recession. Another suggestion that I would like to make for both of my companies is that I think that they should both aim to join with their biggest competitor by the next 3 years which will contribute in my companies to expand to such an extent that no business can reach their heights, as the less superstores are around the less options the customers have and the more likely the customers will go to Tesco or Nike. Or if they don’t like the idea of joining with their competitors then I would suggest both of my companies to start using franchises for their business; and thereby aim to have 5,000 new franchises in the next 5 years. This will allow my business to expand and grow faster and more cheaply, than buying all the branches. This will also benefit the franchisees; due to the fact that my companies are very popular, well-known and familiar to people across the globe and it is also promoted and advertised both nationally and internationally thereby the franchisee will not have to bother to advertise which will save him/her cost. The franchisee will also benefit from advices on how to run the business and usually have exclusive and special rights to operate in a certain location which could really help boost __________________________________________________________ Sources/References http://www. mirrorfootball. co. uk/news/Cristiano-Ronaldo-wins-pound-6million-Nike-contract-article26148. html http://tennisinfoblog. com/roger-federer-to-sign-new-lucrative-10-year-contract-with-nike http://www. google. co. uk/search? hl=en&rls=com. microsoft%3Aen-gb%3AIE-SearchBox&q=convert+13+dollars+to+pounds&meta=&aq=f&aqi=&aql=&oq=&gs_rfai

I Am A Professor At Texas State University - 934 Words

Diversity Role My name is Alyssa Nguyen and I am a professor at Texas State University. I like to define myself by the things that I love and what I have accomplished in life. Unfortunately, others define me by my accent. It is difficult living in America with English as my second language (Question 1). When people sign up for classes, they avoid Asian-sounding last names. On websites such as Rate My Professor, students rate â€Å"American† last names 80 percent higher on clarity than Asian professors (Jaschik, 2015). I have worked very hard to learn English and am proud of how I have prospered. Having English as a second language has given me many opportunities in adapting to other cultures, participating in intercultural communication and overcoming diverse stereotypes (Thesis Statement). Although I come from a different country, my day is not much different than the average American. I eat, sleep, work, cook, clean and also breathe the same air all of you breathe every day. When I wake up, I make breakfast and head to school to see all my striving pupils and prepare them for their lessons of the day. After work, I sometimes like to practice yoga, cook something new (no not sushi), or even go out with a few friends of mine (Question 2). Working as a professor at Texas State has been an amazing experience. I work in the Mathematics Department as an Algebra teacher. My favorite thing about teaching algebra is getting to see the look on the students’ faces when they finallyShow MoreRelatedApplying for the University of Texas for a Master in Science of Computers850 Words   |  4 PagesStatement of Purpose I am applying to University of Texas at Dallas to pursue Master of Science program in Computer Science with special reference to Operating Systems and Computer Architecture. Ten years from now, I envisage myself as research professional in an organization or a faculty at one of the leading university. 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Animal Testing And Why It Should Continue - 1390 Words

Isaiah Tuppince Mr. Greer English 2 October 21st, 2015 Animal Testing and Why It Should Continue Jeremy Bentham once said, â€Å"The question is not, ‘Can they reason?’ nor, ‘Can they talk?’ but ‘Can they suffer?’† Animal testing is becoming a conflict right now and I believe that Animal testing should be stopped because it is cruel and inhuman, Alternative testing technologies exist, the lack of reliability, and it is expensive. Another quote once said was by Martin Luther King Jr stating â€Å"Never, never be afraid to do what’s right, especially if the well-being of a person or animal is at stake† That quote is saying why do wrong when right can be done, especially when people and animals are involved. Animals have feelings and enjoy life as much as humans do so keeping them in captivity and testing drugs on them is cruel and inhuman. It is understandable that animal testing is helpful, and we can t test drugs on humans, but when alternative testing options are available ther e is no reason to keep animals in captivity and test drug, harm, and kill them. Center for Alternatives to Animal Testing (CAAT) is a program that was designed to begin vitro testing. This program was established by Johns Hopkins. The CAAT was created in 1988 and funded by more than 70 corporations (Hunter). These corporations funded this program to change animal testing a find alternative ways to test drugs other than on animals. Millions of dollars were given to this program by these corporations toShow MoreRelatedAnimal Testing And The World Of Scientific Research1746 Words   |  7 PagesAnimals used in laboratories dates as far back as the 17th century (Unknown, 2015)6. When I first read this statistic, it was surprising because the amount of time testing has been around really makes one think about the advancements made because of that. 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People are taking these animals from their homes to research and study things that could easily be tested using alternate methods. So a very important question stands, why do corporations continue to test on animals? Due toRead MoreThe Dark Side Of Animal Testing1255 Words   |  6 PagesSide of Animal Testing Every year, a multitude of animals of all different shapes, sizes, and species are taken from their homes. These animals are subjected to animal testing, the use of animals in order to gain control over the variables that affect our bodies behavior. People are taking these animals from their homes to research and study things that could easily be tested using alternate methods. So a very important question stands, why do corporations continue to test on animals? Due to