Integrated Marketing Communication Plan

Integrated Marketing Communication Plan The main aim of the Integrated Marketing Communication plan is to acquire one-third (33%) of DiGi Telecommunications market share over the next 3 years in Malaysia. We are being appointed as the marketing consultant by DiGi Telecommunications in Malaysia and we have analyze the firms marketing strategy in the field of their prospective segments, the chosen target market, SWOT analysis, brand awareness, product design, product positioning, advertising and sales promotion. As a marketing consultant, we have notice that the DiGi Telecommunications utilized generic marketing strategy such as low cost leader in DiGi Prepaid brand services, resulted in a number of first industry benchmarks for simplicity and innovation, differentiated goods and services satisfy the needs of customers through a sustainable competitive advantage. In fact, in 31st March 2010, DiGi Telecommunications had 7.9 million mobile subscriptions, also the third largest mobile operator in Malaysia. In Integrated Marketing plan, we will contribute in the area such as group or segment those types of potential and existing customers that are most likely to benefit from our DiGi product line. Continuing with that, we will set up our IMC objectives to achieve our aim, which also covers the promotional mix for each of the tools as well. Further, we shall be looking at the budget that we need for the whole IMC plan. Lastly, we will evaluate the media tools that we select to see whether are effective or not. 2.0 Situation Analysis DiGi.Com Berhad is listed on Bursa Malaysia Securities Berhad and is part of the global telecommunications provider, Telenor Group. Its mobile service operations are undertaken by its wholly-owned subsidiary, DiGi Telecommunications Sdn. Bhd. DiGi started opetaions in May 1995 when it launched its fully digital GSM1800 services, the first digital mobile communications service in Malaysia. Over the last five years, DiGis revenue has more than doubled to approximately RM4.9 billion with a subscriber base of 7.7 million. DiGi focuses on making it easy, affordable, convenience and providing the best deals to ensure its customer experience in mobile and internet services. DiGi presence as leader in prepaid services resulted in a number of firsts that have set industry benchmarks for creativity and innovation. These services are offered under the DiGi Prepaid brand name. DiGis postpaid services under the DiGi Postpaid brand name and DiGi Business deliver quality voice as well as value-added mobile content and data services to both individual and corporate customers. In late 2008, DiGi launched its 14.4 Mbps 3G/ HSPA network, the Groups mobile broadband and mobile internet have been well received by the market. Now DiGis mobile internet services have a proposition synonymous called Quality internet for less. (Source: DiGi Annual Report 2009)Æ’Â  Appendix 6 2.1 Corporate Objectives and Marketing Objectives Vision: To be seen as stars in excellent customer experience Mission: To exceed the customers expectations, by delivering mobile and internet services easier and offer the best deal Corporate Objectives: To lead in sustainable and ethical business into every aspects of the organization To treat every people fairly and responsibly to empower them to reach full potential To minimize the environmental impact and offering climate-friendly solutions to the customers To go beyond financial contributions and look for ways to serve the community (Source: DiGi Annual Report 2009)Æ’Â  Appendix 6 Marketing Objectives: Delivering excellent customer experience that are simple, innovative and of best value DiGi business Customers are free to choose a new mobile service provider without having to change to a new number To facilitate the exchange of information between mobile service providers for porting transactions and update routing information to all mobile service providers. (Source: DiGi Telecommunication, CPA MNP General FAQ)Æ’Â  Appendix 7 2.2 SWOT Analysis We have done the SWOT analysis for DiGi Telecommunications. Strengths -Effective branding and marketing -Great innovation -Lowest prepaid charge rate Opportunities -Newest 3G broadband provider -New approach to attract corporate customers -Celcom and DiGi collaboration Weaknesses -Large international shareholders -Low revenue market share -High implement of new services Threats -Competition in terms of coverage -Product imitation -Spam Issue Strengths The DiGis Yellow Coverage Fellow (YCF) idea has won confidence from customers where it gives better coverage to all users around nation. Additionally, DiGi often set up booths in locations with many teenagers to win a lot of customers. DiGi is the first telco in Malaysia that launches fully digital cellular network, GSM1800 services. In DiGi Campus package, the charge rate for sms is 0 cent to family and friends, and with the lowest call charge that further charge will be waived after usage of RM2. (Source: Sun Zi, Scribd)Æ’Â  Appendix 8 Weaknesses The revised dividend policy sought to distribute minimum 80% of Groups annual profit to shareholders. This policy put pressure on DiGi on dividend payment. Furthermore, the CFO of DiGi stated that they have a very low revenue market share which is only 16%. In addition, DiGi is always implementing new products or services. The chairman says company would meet some stress on margins due to the higher level of handset subsidy offered for iPhone sales. Opportunities On 22th September 2009, DiGi officially launched the 14.4 Mbps network Turbo 3G in Malaysia. DiGi is the first 3G broadband provider in Malaysia that invests in the latest High Speed Packet Access (HSPA) technology in Malaysia. DiGi has tried to attract corporate customers through a sexy approach, by giving winner the chance to be one day pilot. The campaign gains positive feedbacks and expect to attract corporate customers. Additionally, Celcom, DiGi and their respective major shareholders Axiata Group and Telenor Asia signed the Memorandum of Understanding (MoU) for advanced network collaboration. This sharing model is geared to generate significant operational and cost efficiency for both operators. (Source: Penang and Sabah first to enjoy DiGis Turbo 3GTM for mobile phone)Æ’Â  Appendix 9 (Source: DiGi business takes sexy approach to attract corporate customers)Æ’Â  Appendix 10 (Source: Celcom and DiGi sign MoU for advanced network collaboration)Æ’Â   Appendix 11 Threats Maxis has make an announcement that they will spend RM 1.4 billion to improve their 2G and 3G network coverage from 60% to 80% nationwide by year-end. This make the situation worse for DiGi, as increasing coverage can make customers to switch from DiGi in seeking of higher quality network coverage. DiGi always face the threats of competitors imitation. Very soon after a new services or products launch, its competitors will launch the similar package. On 24th September 2010, Maxis launch iPhone 4 simultaneously with DiGi. Maxis has come out with a Maxis Do Not Disturb Campaign to solve Spam sms. This campaigns purpose is to protect consumers privacy. (Source: Maxis service to improve with spending of RM1.4 bil)Æ’Â  Appendix 12 2.3 Product Line Digi Telecommunications is a mobile communications services provider which provides services such as voice/data Prepaid and Postpaid services, DiGi Internet, and DiGi Business. Besides that, it also provides a few special offers for DiGizens, such as Mobile Lifestyle, International Services, and Personal Insurance Coverage. (Please refer to appendix 13) Product Life Cycle Product Life Cycle consist of five stages, which are development, introduction, growth, maturity, and decline. The current situation of DiGi Telecommunications Sdn Bhd is on the maturity stage as the sales revenue of DiGi has begin to slowdown and the net profit, even the market share has also decreased. Besides that, instead of introducing a new product into the market, DiGi is now focusing more on modifying and changing the characteristics of existing products, such as introducing new packages for prepaid and postpaid by offering different rates and features compared to the previous products. 3.0 Objectives Aim: DiGi brand to acquire 1/3 (33%) of Telecommunication market share over the next 3 years in Malaysia. (From 2010) The primary purpose of setting objectives is to state what is to be accomplished in order to direct an organizations efforts and allow the organization to evaluate effectiveness. To prove that IMC objectives were effective, we should follow SMART Specific, Measurable, Achievable, Reasonable and Timeline. Three IMC plan main objectives: 1. To strengthen the competitive advantage preferring DiGi as the most innovative Telecommunication in Malaysia. (From start of January 2011, until end of December 2011) 2. To increase the market share to 28% start from January 2011, finishing at the end of December 2011. 3. To build positive brand equity among all mobile users towards DiGi Telecommunications within one year. First Objective The competitive advantage of DiGi is the innovation it offers on its services. One of the latest innovations that DiGi provides is the DiGis Turbo 3G broadband service. DiGi is the first telecommunication service provider in Malaysia that provides 14.4Mbps High Speed Packet Assess (HSPA) technology. The purpose of this objective is to attract mobile users from competitors to become DiGi users. Second Objective Our second objective is to increase market share to 28% from existing market share of 25%. This means that we have to increase 3% within year 2011 and it represents 903,000 new subscribers. The reason for setting increase of 3% market share is to achieve our companys aim, which is to acquire 33% market over next 3 years. To achieve 33% market share from 25% market within 3 years means each year we have to increase an average of 2.6% market share. Third Objective The third objective is to build positive brand equity among all mobile users towards DiGi Telecommunications. Brand equity is referring to the power of a brand, affiliation with the goodwill and brand recognition of consumers. Moreover, when a company successfully built the positive brand equity, consumers will stick to the brand even the price is higher than competitors. It allows the DiGi Telecommunications to reduce the cost on promotion, and set a premium price for the products and services in the future, which will also enables a brand to generate higher sales volume and higher profits among the competitors. 4.0 Tools The effectiveness of our Integrated Marketing Communication plan is mainly depends on the successfully integration between different marketing tools. It is an important part of communication process. (Please refer to appendix 14) There are wide selections of marketing tools that can be used to bring significant impact on customers perception on DiGi telecommunication. In order to achieve our IMC plan objectives, we have chosen two tools which are advertising and sales promotion. 4.1 Advertising Our advertising tool is further divided into TV commercial advertising, radio broadcasting, and printed media-newspaper. All these three advertising tools carry different purposes and importance for achieving our IMC main objectives. The three objectives that we have created for our advertising tools are: To refresh mobile users that DiGi is always approachable by implementing continuity advertising over one year. To maintain DiGi telecommunications as the most affordable prepaid service in Malaysia. To sustain the benchmark of best commercial advertisement among telecommunications industry in Malaysia. 4.1.1 Television Commercial Advertising Television is a media channel that will be able to deliver our advertising message to a wide diverse audience. The advertisement showed on television commercials is creative and demonstrative. Besides that, it has the ability to convey our message with sight, sound and motion. Television commercial also allows immediacy of messages to be easily interpreted by audience. The channels that we have selected to advertise are TV3 and ntv7 which is under media prima. Media primas channels are TV3 (30% viewers), tv9 (9% viewers), NTV7 (6% viewers) and 8TV (5% viewers). The reason why we chose TV3 is because it has the highest viewership of 30% among all the channels under media prima. The 30% of viewers are majority made up of 95% Malays. Even though NTV 7 is the third rated among the four media primas channels, we chose to advertise in this channel because it has the highest percentage of Chinese viewership which is 70%. 4.1.2 Radio Broadcasting Radio broadcasting is one of the mediums with the broadest exposure. Advertising on radio is more cost-effective compared to ads on television. Besides that, radio broadcasting has selectivity and audience segmentation according to different radio channels. In Malaysia, there are a total of 30 radio channels. The radio station that we have chose to advertise our advertisement is hitz.fm. The reason of us choosing this particular channel is because hitz.fm has the highest listenership of English channels in Malaysia, reaching 1.58 million (9.2%). On the other hand, Fly fm is rated second position with 728,000 (4.3%) listeners followed by MIX fm with 451,000 (2.6%) listeners. 4.1.3 Printed Media Newspaper Printed media newspaper is one of the most famous printed medium in advertising. This is so because newspaper is able to reach geographically dispersed audience all over Malaysia. Besides that, newspapers have immediacy. In other words, it is tangible and audiences are able to re-view the advertisements at anytime and anywhere according to individuals convenience. The newspaper company that we have chosen to publish our advertisement is The Star. The reason of us choosing this company because it is the top rated newspaper company in Malaysia, followed by Utusan Malaysia at second place and Berita Harian at third. The Star has a total of 981,000 readers daily. As for Sundays, Sunday Star has a total of 935,000 readers. 4.2 Sales Promotion Sales promotion offers a tangible added value to encourage and accelerate a response. There are two basic types of sales promotions: the consumer promotions and trade promotions. For our sales promotions, we chose to implement consumer promotions. Consumer promotions are pull strategy in which it uses incentives to encourage end-users to buy a brand. The campaign that we planned to organize for our sales promotion is DiGis Fan-Tastic Bonanza! The purpose of this sweepstakes is to attract new subscribers to DiGi telecommunications and further increase our current market share from 25% to 28%. In addition, we plan to increase 900,000 new mobile subscribers to DiGi via this campaign. The three objectives for our sales promotion are: To retain brand loyalty of DiGizens within the period of one year (from start of January 2011 to end of December 2011) To capture end-users to choose DiGi as the primary telecommunications choice To build a strong and friendly customer relationship among mobile users in Malaysia 5.0 Budgeting Budgeting for IMC plan requires a good estimate of the cost of each element of the plan. In this IMC plan, we choose Objective and Task Budgeting method. Objective and Task Budgeting method is an estimate of the cost of each IMC task identified by zero-based planning. The reason that we chose this method is because this method can help us to determine for our marketing communication objectives and the tasks that needed to be done to accomplish each objective. In order to run our IMC plan, we request for an estimated amount of RM10million for all tools. First and foremost, there are three main objectives in our IMC plan. These three objectives bring different impact in our whole IMC campaign. In order to achieve these three objectives, we must carry out some promotional tools. Advertising was the primary medium needed in the DiGi Telecommunications to achieve the two objectives which are: 1. To strengthen the competitive advantages preferring DiGi as the most innovative Telecommunications in Malaysia 2. To build positive brand equity brand equity among all mobile users towards DiGi Telecommunications. All the three advertising tools chosen are needed to maximize the effects of our objectives and also to build up consumer mindset as DiGi is always the smarter choice in a long-run period, so we estimated around RM8 million in our advertising tools which allocated into three areas, which are TVC advertising, radio broadcasting, and printed-media (newspapers). For TV commercial advertising, we advertise in channel TV3 and NTV7 that costs RM3 million for both channels, while for radio, we will broadcast into Hitz.fm station that costs RM1 million. Whereas for newspapers, we will published into The Star newspapers, that costs RM3 million. The budget is huge as these three advertising tools will be implemented frequently for the duration of one year. Sales promotion will be the second promotional tools for DiGi Telecommunications, ongoing through DiGi sweepstakes. From DiGi sweeptakes, we will receive more than just the products and its image, it may also gives a favorable impression among our target audience. One of the biggest prize that give out is the luxury HONDA ACCORD, followed by SONY VAIO, iPad and also free DiGi reloads. All these prizes total up will be RM2 million for the duration of 1 year. One of the objectives is to increase the market share to 28%, this need to be achieved through attracting more new subscribers to DiGi with the support of sales promotion. It further enables DiGi Telecommunications to achieve our IMC aim, which is to acquire 1/3 (33%) of Malaysia telecommunications market share. 6.0 Implementation of Tools The implementation process is specific actions to be taken to execute the strategy set for our marketing communication tools. It is an important aspect of MC strategy which is the timing and scheduling. 6.1 Advertising The schedule of advertising will be shown in appendix 15. (Please refer to appendix 15) 6.2 Sales Promotion The DiGis Fan-Tastic Bonanza! that we have planned to organize will last for entire year, starts from 1st January 2011 until 30th November 2011. Evaluation and selection of winners will be done in December 2011 and prizes will be completely distributed before 1st January 2012. The qualification of enter this contest is top up with at least RM10 for prepaid users or sign up for new postpaid, broadband, and business plan. The order of the prizes will be set as: Prizes Product Items Units Grand Prize Honda Accord 2.4 VTi-L 1 Second Prize Sony Vaio X series 50 Third Prize Apple iPad 100 Consolation Prize Free top up of RM100 10,000 7.0 Evaluation The evaluation process is essential in IMC plan as it measures how well the effort meets our objectives. Successful marketing communication can makes customers remember our brand and bring them into our store. For our IMC plan, we do two evaluations on our advertising tools and sales promotion tools. 7.1 Advertising For advertising tools, what we want to evaluate is the effectiveness of our message reach our target audience. On how we evaluate the effectiveness, we will calculate on the data recorded by media service provider. The reason why we need to evaluate this is to check whether our advertising has successfully build positive brand equity and image in customer mindset. The criteria are 3 million viewership. 7.2 Sales Promotion In sales promotion, what we want to evaluate is the effectiveness of attracting new subscribers. On how we evaluate the effectiveness, we will calculate on the increase in new subscribers for all categories: prepaid, postpaid, broadband, and business plans. For the reason why we want to evaluate this is because the increase in new subscribers will increase DiGis market share, from 25% to 28%. Thus, the criteria are the increase of 903000 new subscribers. 7.3 Contingency Plan The evaluation process for both marketing tools will be done each half year, first in June and second in December. For advertising, if we cannot achieve half of the total amount within six month, we will increase the frequency of advertising for each advertising tools. Hence, we allocated 1 million budgets from advertising to prepare for this uncertainty. The sales promotion, sweepstakes is important in attracting new subscribers. If we cannot attract 450,000 new subscribers in the first six month, more prizes will be added in to increase the attractiveness of our sweepstakes. For this, we allocated around RM300000 and the additionally prize will be added as special prize.

Mysterious Statue of a Boy in the Park :: Free Descriptive Essay About A Place

As soon as I entered the park, I went looking for the statue of the little boy that I remembered so well from last summer. I knew it was on the south side of the park, but I was not sure exactly where. As soon as I began my quest, I could faintly smell roses, a smell so familiar from the endless warm summer days that Jordan and I would spend next to the rose garden, in front of the statue. I knew I was getting close. Next, I saw the roses in the distance from where I was, walking towards the stairs that lead to the rose garden. I remembered walking in the same general direction. I was closer. Then I got to the stairs. As I was walking down the steps I looked to my right. There was a statue of a beautiful woman, not the right statue. Finally, I looked to my left, and there it was. My heart skipped a beat. I could remember the very first time I saw that statue. It was a hot day in mid-July when Jordan and I first stumbled upon it. Last summer while I was living in the dorms, Jordan was my best friend; we spent every waking moment together. One day we decided to walk in the park, we got to the rose garden and were talking about the roses until we saw the little boy. We were both so amazed by the statue, yet we could not figure out why. Starting from that moment, we spent a great amount of time at the statue last summer. As I walked up to it, I could almost see Jordan standing next to the statue turning to say something about it to me that we had not noticed before, but that was last summer. Like I said, Jordan was a very close friend of mine, but when I moved back to Michiga n last year, we grew apart. Standing by the statue I could remember sitting next to it for hours just talking, and looking at the statue with him. The first thing I did was get up very close to the statue and examine it once again. It is of a boy who is between the ages of twelve and fifteen, he is mostly naked, covered only with a cloth hanging by a thin belt over his genitals. Mysterious Statue of a Boy in the Park :: Free Descriptive Essay About A Place As soon as I entered the park, I went looking for the statue of the little boy that I remembered so well from last summer. I knew it was on the south side of the park, but I was not sure exactly where. As soon as I began my quest, I could faintly smell roses, a smell so familiar from the endless warm summer days that Jordan and I would spend next to the rose garden, in front of the statue. I knew I was getting close. Next, I saw the roses in the distance from where I was, walking towards the stairs that lead to the rose garden. I remembered walking in the same general direction. I was closer. Then I got to the stairs. As I was walking down the steps I looked to my right. There was a statue of a beautiful woman, not the right statue. Finally, I looked to my left, and there it was. My heart skipped a beat. I could remember the very first time I saw that statue. It was a hot day in mid-July when Jordan and I first stumbled upon it. Last summer while I was living in the dorms, Jordan was my best friend; we spent every waking moment together. One day we decided to walk in the park, we got to the rose garden and were talking about the roses until we saw the little boy. We were both so amazed by the statue, yet we could not figure out why. Starting from that moment, we spent a great amount of time at the statue last summer. As I walked up to it, I could almost see Jordan standing next to the statue turning to say something about it to me that we had not noticed before, but that was last summer. Like I said, Jordan was a very close friend of mine, but when I moved back to Michiga n last year, we grew apart. Standing by the statue I could remember sitting next to it for hours just talking, and looking at the statue with him. The first thing I did was get up very close to the statue and examine it once again. It is of a boy who is between the ages of twelve and fifteen, he is mostly naked, covered only with a cloth hanging by a thin belt over his genitals.

A Feared Ruler? :: essays research papers

Machiavelli was a man who was not worried about what was morally correct, but rather, what was politically deserved. He was in fact an honest and religious man, but he has become known for trickery and double-dealing. He thought that princes would have to start tricking his enemies, or even his people for the good of his state. In my opinion, his theory, â€Å"It is better to be feared than loved† is saying that when the people fear their ruler, the ruler will most likely get what he wants. When a ruler has control and intimidation over his people, they will most likely do what he says and follow his rules, out of fear. Some people might argue and say that if a ruler is loved than people will respect him and follow his rules. This is true, except, it is harder to get people to love and respect their ruler so much as to do everything they are told, than it is to get them to fear their ruler. Out of the three monarchs: Louis of France, Henry of England, and Ferdinand of Spain, I think Louis definitely exhibited Machiavelli’s theory the best. Louis depended on trickery, intimidation and bribery to get what he wanted. These three characteristics are exactly what Machiavelli believes in. Louis wanted to weaken the powers on the great lords in France so that he had all the power. Any noble that resisted Louis’s rule was bribed or threatened until the noble agreed with Louis. Once there was a cardinal who disobeyed Louis. He was locked in a small cage for 11 years. He couldn’t even stand up or sit down. The people under Louis’ rule were very scared of him that they were willing to put up anything to impress and agree with him. Louis was aiming for people to fear him though. I think he felt that it would in fact be easier to get people to fear him rather than respect him.

Into the Wild Essay

Chris McCandless temperament types were introverted, i, f, and j. When it comes to the extroversion and introversion preferences, Chris prefers introversion. According to the MBTI Basics, introverts prefer doing things alone or in small groups. This preference is evident in the character of McCandless in the story. In reference to McCandless’ relationship with others it is well shown through the relationship he has with his car. Chris took trips alone. He liked doing things by himself. He even left his car not by choice, but he ended up loving the open road and traveling by foot. Krakauer 28). A person who prefers extroversion would not likely travel alone because they need other people to remain energized. Therefore, one can infer that Chris had a propensity toward introversion and took trips to get away from others and society, probably to re-energize. When it comes to the sensing and intuition preferences, McCandless prefers sensing. According to the MBTI Basics, Sense’s prefer actual facts and remembering details that are important to them. This preference is evident in the character of McCandless. In reference to Chris’ way of feeling something out before making a decision shows that his temperament type was sensing. Chris shows us how he is a sensor when he reached the Morelos Dam and the Mexican border: worried that he would be denied entry because he was carrying no identification, he sneaked into Mexico by paddling through the dam’s open floodgates and shooting the spillway below. (Krakauer 34). A person who is intuitive reads â€Å"between the lines’ they do everything very precisely and plans ahead. They know every step of the way. That’s why this shows Chris is Sensing because he just does things and then learns from them. He doesn’t plan ahead he learns by doing. When it comes to the thinking and feeling preferences, McCandless prefers thinking. According to the MBTI Basics, thinkers sometimes miss or don’t value the â€Å"people’ part of a situation. This preference is evident in the character of Chris in the story. In reference of how he handled situations with people it shows that he was a thinker and not a feeler. Chris has sent a postcard to Burres telling her where he was and that it was good to hear she was still alive. Burres told Chris that she would come and visit him but before her and her boyfriend Bob, were preparing to drive to see him they found a backpack leaning up against their van. She recognized it as Chris’s. Chris explained in a letter that he had grown tired of Bullhead, tired of punching a clock, tired of the â€Å" plastic people† he worked with, and decided to get the hell out of town. (Krakauer 43). A feeling person would have at least waited until they came to visit so they could interact and then leave not just leave a note. Chris explained the people around him as â€Å" plastic† and this explains why he was more of a thinker. He did not value people because he was fine on his own. When it comes to the judging and perceiving preferences, Chris preferred Perceiving. According to the MBTI Basics, perceivers prefer a flexible and spontaneous way of life, and like to understand and adapt to the world rather than to organize it. This explains Chris’s character perfectly. His whole story was about perceiving. Chris escaped into the wilderness because he didn’t want to live life in a planned or orderly way. Even the orderly things that he did do such as work at McDonald’s in Bullhead he still did things his way and at his own pace. Lori a second assistant manager said â€Å"He could do the job—he cooked in the back—but he always worked at the same slow pace, even during lunch rush, no matter how much you would get on him to hurry. †(Krakauer 40). A person that is judging would prefer to have things decided, and they would have a list of things to do and when they were going to do them. Chris was not this way.

Pathological gambling intervention Essay

When looking at pathological gambling we ask ourselves how someone gets to the point of addiction. In that regard there are both internal and external factors, beahior and environment related aspects leading to someone’s impulsive urge to gamble. Speaking of which, impulsivity can be a direct factor of a pathological gambler, Impulsive people are naturally more prone to gambling problems because of their nature and personality. That is not to say that all impulsive people will develop gambling habits or problems but they could if the right factors were in play at the right times. Inability to control impulses and also inability to delay gratification are two major impulsivity-related symptoms of pathological gamblers (McCormick & Taber, 1988). Other behavior factors include, coping strategies, high stress levels, family history, gender as males tend to be more prone to this affliction and â€Å"Pathological gamblers have been known to also exhibit antisocial behavior which is related to the impulse control disorder causing antisocial behavior such as exhibited in antisocial personality disorder† (Slutske et al. , 2001). The environment one grows up in Also plays a valuable role in understanding gambling. It’s a common misconception that pathological gamblers are only those that are near major casinos. That can be a tendency but in todays society technology has opened the door to universal in gambling before impossible. With computers and the internet people are now able to gamble straight from their homes on sports, online poker, etc. This boom in technology has allowed more people, from more places and economic statuses and younger ages be able to easily get involved in gambling. Our group even met a professional gambler who would have all of his bets placed on his computer before noon and then do nothing the rest of the day. Technology has extended the reach of gambling to social circles that before may have not been affected. Predisposing, Reinforcing, Enabling Factors Predisposing factors are what set someone up with the highest chances of being a pathological gambler. An addictive personality makes anyone more susceptible as well as having addictions or just gambling itself run in the family. A persons level of impulsivity is also a huge factor, an impulsive person is more likely to give into reckless decisions and follow the activities that give a rush sensation. Impulsive people have problems with delaying gratification making addictive and compulsive tendencies stand out. †Pathological gambling is a problem of impulse control. The more accessible gambling is, the harder it is to maintain the control. †(3) Predisposing factors can also be socioeconomic status, does one have the funds to feed the addiction, or did one one grow up in rough situations and use gambling as a crutch or coping strategy, the factors are vast and varying. Environment as brought up by the last quotation can also be a predisposing factor. Does one have access and how easily plays into an addiction. The closer one is to gambling the more likely they will partake. That used to entail how close someone was to casinos or legal areas of gambling and in many cases still does as more areas are becoming gambling friendly and more funerals pop up in for example, Oklahoma, Louisiana and Missouri, However with technology and the internet, access has become easier for all regardless, of location, sex, race, or economic status. With gambling there are different stages, stages that can reinforce the behavior because despite popular belief many gamblers are reinforced even when they don’t win. â€Å"WINNING PHASE Here the gambler is winning more than losing, has achieved a minimum of one big win. This early big win, bolsters the confidence of the gambler, causing ego to inflate, superior thinking and feeling over other participants. The gambler in this phase begins to spend more time gambling, is gambling for and with larger amounts of money. Winning streak begins to wane, losses start. LOSING PHASE In the losing phase, the gambler begins betting even larger amounts. The gambler accepts the fact that these losses are part of the game. The gambler bets on the long shots, knowing chances are not good for winning, however will pay big if win occurs. The gambler is now losing more than winning. In an attempt to gain back the money lost, the gambler spends more time gambling. Gambler must frequently lie to family, friends, employer, even casinos to convince them that the gambler is still a happy person and all around good person. Deep financial troubles begin. Using lying techniques, the gambler is able to convince employer, family, etc. , of some type of cataclysmic disaster, which requires a borrowing of large amounts of money. Soon the gambler is using this bailout to gamble more. The gambler life has now become unmanageable, family life is increasingly difficult, with deterioration occurring. DESPERATION PHASE During this phase, the majority of the gambler’s time is preoccupied with gambling on all levels. The gambler has no control over the gambling, to alleviate the inner pain, the gambler gambles, knowing the odds of wining are gone, and it does not matter. Lying is out of control. The gambler has one focus and one goal†¦get money in which to gamble with regardless of costs. Family life has deteriorated to the point of non-existence. Illegal activity is now a norm. †(paraphrased from Journal of Addictive Disorders) These phases help explain the reinforcement of pathological gambling along with more well known factor such as the adrenaline rush, the gamblers fallacy, instant gratification and payout. Enabling factors help keep a pathological gambler stuck in their ways and should be avoided as much as possible. Enabling factors can include dwelling on regrets, the focus of could’ve beens. (Pathological Gambling Resources) Looking for quick fixes for gambling addiction can also end up making the problem worse, pathological gambling is an illness that needs in depth treatment and support to be overcome, not a quickfix as those never entail the lifestyle change necessary to change an addicts life. Excluding those afflicted from normal activities or interactions as punishment or a means to help is also a counter intuitive strategy, Addicts need love and support and pushing them away may only compound upon the problem. Furthermore â€Å"Enabling is when you do anything that helps the gambler to continue with his addiction. For example, if you pay his bills for him, lend or give him money, you become an enabler. If you lie to help him cover his lies, you are an enabler. Or if you offer ultimatums in order to control his behavior, you are an enabler. Even if you in any way, directly or indirectly, make it easier for him to continue with his compulsive gambling, you are an enabler. †(Nguyen) Just like an accomplice is guilty in a murder an enabler is guilty through association. Although these may relieve the problem temporarily in some situations, it is always adding to the problem and hurting the addict. Goals And Objectives Our goals are a little more long-term related and the objectives are more specific short term goals. We are focusing more on educational endeavors for the families and friends of the afflicted as this builds the supportive environment necessary to truly help pathological gamblers. Our goals will focus on creating an increase in awareness in the Austin area of pathological gambling, it’s causes and effects, on individuals as well as the community as a whole. We want to create larger supportive environment in the community through the families and friends of the afflicted primarily through educational and awareness increase regimes. As well as provide increase in overall education on the matter for the community, even those not directly affected. As previously mnetioned these goals are broad and wide reaching. Our objectives however are more specific. We want to introduce educational, communication and family based interventions for the increase in awareness of pathological gambling. We will also work with the community and families to ensure interventions are done correctly and effectively fulfilling the needs of the afflicted and their loved ones. Finally but not least in importance we want to gain access to funding and support that will help establish effective educational based, wide reaching and successful intervention programs and learning processes.

Gerontology Case Study Essays

Gerontology Case Study Essays Gerontology Case Study Essay Gerontology Case Study Essay Comprehensive Scholarly Paper Gerontology is the scientific study of old age, the process of aging, and the particular problems of old people. With maturation the elderly suffer from age- related changes that effect their overall health and day to day living. Even those these changes provide limitations that can be lived with, these changes can also exacerbate many medical conditions. The elderly client I decided to evaluate, H. J. is a 76 year old african american female, that has a past medical history of chronic heart failure, myocardial infarction, hypertension, asthma, and renal mass. H. J. also has a past surgical history of a left mastectomy. She is retired and lives at home by herself and has one daughter. Some of her medical conditions are definitely effected by age as well as lifestyle. With age the heart and blood vessels undergo many changes. In the heart with age the SA node loses some of its cells, this may result in a lower heart rate. Abnormal rhythms such as atrial fibrillation, these arrhythmia are often due to heart failure. Hypertension in the elderly is also common. With an increase in age the systolic blood pressure can increase up to 20 mmHg on its own. : The baroreceptors become less sensitive with aging. This may explain why many older people have orthostatic hypotension. With all of these heart changes it is important that the elderly are educated about lifestyle changes. While H. J was a patient in the hospital she ordered a heart healthy diet, which helps control blood pressure and cholesterol. The patient also had a history of a stroke, which also has to do with lack of blood flow to the brain. The prevalence of all these medical conditions increase with age when the elderly are not properly taking care of themselves. It is important to be eating a healthy diet, exercising, and refraining from the abuse of substances. By this client being a previous intravenous drug abuser she is even more exposed to complication. Drug abuse can, cause cardiovascular conditions ranging from abnormal heart rate to heart attacks. Injected drugs can also lead to collapsed veins and infections of the blood vessels and heart valves. There are many considerations when it comes to medications and the elderly. Age-related changes often affect the action and availability of the medications in the body. Many of the elderly are also non-adherent to medication. For example although H. J was administered several medications in the hospital such as lovenox, protonix, Plavix, bactroban, methadone, and multivitamins, there was no list of medications in her file for reconciliation and I am almost certain it is because she refuses to take them. Just in that day I witnessed her refuse several medications as well as labs, while in the hospital. Following her many hospital visits she has been ordered several medications to be continued at home, but does not want to take them for her own ersonal reasons. There are many factors that can contribute to non-adherence which include; depression, cognitive impairment, isolated living conditions, finances, beliefs, adverse effects and knowledge deficit. It is likely this patient did not want to about how much the medicine could help her if she did take it. The medicine she was sure to take was her methadone. Methadone is mainly given to patients who suffered from a drug dependency and causes irritability when in between doses. Drug users who are struggling with a dependency definitely have a cognitive impairment and are ot often thinking with a clear head. Polypharmacy is also a issue with the elderly because of drug interactions. The elderly are more at risk for medication-medication interactions due to the fact they are prescribed so many medications. H. J did not have many functional limitations documented on her chart. She was able to feed herself without assistance, but did require assistance getting to the bedside commode. Since she is unable to get to the restroom alone in the hospital, it is a wonder how she maintains living at home alone. With her ambulation problems he is definitely at risk for falls at home. Each year, one in every three adults age 65 and older falls. Falls can cause moderate to severe injuries, such as hip fractures and head traumas, and can increase the risk of early death. It is important to teach older adults who live at home alone how to decrease the risks of falls. They must remove tripping hazards such as rugs, improve lighting, and add grab bars where needed. Instrumental activities of daily living would be even more difficult to complete for H. J. Assessment of her functional status in the hospital showed that some level ssistance would be necessary at home to complete tasks such as medication management, transportation, and bathroom assistance. Upon assessment I did observe some cognitive impairment which I believe was due to the effects of medication. Prior to the administration of methadone H. J was very uncooperative and unable to answer basic questions related to pain rating and orientation. She did not want to be bothered or assessed at all. About an hour and a half later following her medication administration she was much more talkative playful and willing to answer any questions I had to ask. She was also even willing to explain why she refused her MRI which was due to claustrophobia. Elderly people are more likely than younger patients to develop cognitive impairment as a result of taking medications. This reflects age- and disease-associated changes in brain neurochemistry and drug handling. The client felt very relaxed and at ease when her daughter came to visit. H. J was even more lively and at ease when her daughter came to visit. Family support is very important to the elderly. Without family visits or attenti on, the elderly may fall into a depression, or feel all alone. A big part of any elder care program is to give emotional support. Studies show that this can improve life expectancy by several years, and create a more positive and optimistic environment for the aged. H. J lives independently at home, but with the amount of assistance she requires in the hospital setting revealed that assistive devices such as a cane or walker may be necessary. After observation I also think it would be a excellent idea for her to move in with a family member or live in a assisted living facility if someone in the family is unable to provide care. Many elderly people will live without assistance until it is offered or they are hurt. Transitioning from independent living to assisted living can be difficult. It is important to remind the client that they are not being stripped of their independence. include educating her. Most of her issues, such as refusal of medication stem from not being educated on how medication and lifestyle changes can help with her overall health. Many elderly clients are set in there ways and are not educated about modern methods of treatment. None of the nurses really explained to her why he should get the MRI or take lovenox when she refused them. Sometimes a personal relationship needs to be built, so that a client can understand you genuinely have their best interest at hand. Physical therapy would also be a recommendation. Physical therapy is a non-medicinal method to increase strength, flexibility, range of motion, endurance and alleviate pain. Falling is such a big risk for the elderly, physical therapy puts patients at a lower risk for falls. People often are unsure about physical therapy because of the financial aspect, but some Medicare nd Medicaid plans cover the costs. I would also recommend another type of housing option. A continuing care retirement community or assisted living facility would be good options. They both offer nursing home care, however a assisted living community would go a little further and offer meals, social activities. Having elderly clients transition from a independent home setting to an assisted living facility can be difficult and also is sometimes associated with a negative image, but it is important to explain to the client how much safer it is. Their are many myths about age. People believe that with age decline is inevitable, but it is important to remember that regardless of age every elderly person should have the right and opportunity continue to live a safe, comfortable, and enjoyable life. And even with decline there are many options out there to make sure there is good quality of life available to patients that are suffering. References Aging changes in the heart and blood vessels: MedlinePlus Medical Encyclopedia. (2012, September 4). U. S National Library of Medicine. Retrieved December 9, 2013, from nlm. nih. ov/medlineplus/ency/article/004006. tm Aging changes in the kidneys and bladder: MedlinePlus Medical Encyclopedia. (2012, November 10). U. S National Library of Medicine. Retrieved December 9, 2013, from http:// www. nlm. nih. gov/medlineplus/ency/article/004010. htm Falls Among Older Adults: An Overview. (2013, September 20). Centers for Disease Control and Prevention. Retrieved December 9, 2013, from cdc. gov/homeandrecreationalsafety/ falls/adultfalls. html Feature, W. (n. d. ). Physical Therapy a Boon for Seniors. WebMD. Retrieved December 9, 2013, from webmd. om/healthy-aging/features/ hysical-therapy-benefits-for-seniors Miller, C. A. (20122012). Nursing for wellness in older adults (Sixth ed. ). Philadelphia: Wolters Kluwer/Lippincott Williams Wilkins. Moore, A. (1999, July 15). Result Filters. National Center for Biotechnology Information. Retrieved December 9, 2013, from ncbi. nlm. nih. gov/pubmed/10459729 The Importance of Family Support for Elderly Well?„ Being. (2011, April 27). San Diego Home Care. Retrieved December 9, 2013, from http:// homehealthcaresandiego. wordpress. com/2011104/27/the-importance-of-family- support-for-elderly-well-being/

Transsexuals and those who choose gender re-assignment surgery

Transsexuals and those who choose gender re-assignment surgery Free Online Research Papers With the help of modern medicine, many transsexuals throughout the country and globe are able to experience relief from the gender conflicts they experience. Becoming educated about transsexuals and the facts surrounding gender re-assignment surgery are key ingredients for tolerating and accepting this prevailing hamlet. According to the text, â€Å"medical estimates place transgenderism at about 1 in 30,000 for MTF and 1 in 100,000 for FTM. However, many gender activists claim that these figures vastly underestimate the true prevalence and are based on statistics of the number of sex reassignment surgeries performed rather than the overall number of people who are living transgender lives [and] prevalence may be at least 10 times higher† (Hock, p. 385). With numbers this great, and possibly greater, it is highly probable to cross paths with such a person in an educational, social or work setting, and some people may even â€Å"date, have sex with, and even marry a postop erative transsexual and be unaware of the person’s transgender status unless he or she† were to divulge the truth (Hock, p. 386). Ergo, tolerance and acceptance of transsexuals and those who choose gender re-assignment surgery is even more exigent. The first step to achieving a complete understanding of gender re-assignment surgery is briefly educating oneself on the history of transsexuals and gender re-assignment surgery. The concept of transsexuals has been referred to in classic literature by such authors as Herodotus and Shakespeare and â€Å"[w]ell known historical examples of psychosexual inversion span the time from the Roman emperor Caligula to the famous French diplomat Chevalier d’Eon† (Edgerton, Knorr and Callison). In 1830, â€Å"German author Friedreich first called attention to this syndrome in the medical literature†; in 1870, â€Å"Westphal was the first to give a clear and complete description† of transvestism; in 1949, Cauldwell was the first to coin the term transexualism (Edgerton, Knorr and Callison). Regarding the birth of gender re-assignment surgery, there are varying opinions. Some believe that early â€Å"examples relate to practices carried out in ancient cultures. Gender reassignment surgery (GRS) developed from reconstructive procedures for congenital abnormalities. Some surgery was disguised, techniques were not recorded, and operations were carried out in secret† (Goddard, Vickery, Terry). However, it is also argued that even though â€Å"castration has been used throughout recorded history, and penectomies have not been unknown, it is not always clear that people given these operations desired any change of sex† (Edgerton, Knorr and Callison). Therefore, the first documented case of GRS was reported in 1931 by Abraham. (Edgerton, Knorr and Callison) During the 1950s, Sir Harold Gillies and gynecologist Dr. Georges Burou developed the first of two methods for male-to-female gender re-assignment surgery, which â€Å"used invagination of the penile skin sheath to form a vagina†(Goddard, Vickery, Terry). Howard Jones from Johns Hopkins developed the second method of this avant garde concept, which used penile and scrotal skin flaps. Both methods serve as the basis for all male-to-female gender re-assignment surgeries performed today. While development of male-to-female GRS was in progress, Burou was also independently developing female-to-male gender re-assignment surgery in his Clinique du Parc in Casablanca. His method consisted of â€Å"the anteriorly pedicled penile skin flap inversion vaginoplasty† and this â€Å"technique was to become the gold standard of skin-lined vaginoplasty in transsexuals† (Hage, Karim, Laub). According to the text, gender re-assignment surgery has evolved into a multi step process that requires â€Å"psychological counseling, hormone therapy, and a pre-surgical transition period† before surgery can even take place. For both transitions, there are several surgeries that have â€Å"anatomically very realistic† results. A male-to-female gender re-assignment surgery may involve any or all of the following: penectomy (removal of the penis), uroplasty (rerouting of the urethra), orchiectomy (removal of the testicles), vaginoplasty (the use of penile skin to construct labia and a vagina), breast implants, chondrolaryngoplasty (reduces the size of the Adam’s apple) and phonosurgery (raises voice pitch). A female-to-male gender re-assignment surgery may involve any or all of the following: mastectomy (removal of breasts), hysterectomy (removal of uterus, fallopian tubes and ovaries), metadioplasty (creation of small erectile phallus from the clitoris), pha lloplasty (formation of a penis from tissue taken from other areas of the body and transplanted using microsurgical techniques in the genital area; requires a penile implant for erection), uroplasty, scrotoplasty (reshaping and stretching of the labia to resemble a scrotum and the insertion of silicone prosthetic testicles). If performed in the United States, such surgeries can cost anywhere from $18,000 to $50,000 while other countries such as Thailand offer GRS costing anywhere from $7,000 to $10,000.(Hock, p. 386) The first gender re-assignment to receive media attention was the male-to-female re-assignment of Christine Jorgensen. Christine, born a man, lived as George Jorgensen until she had her gender re-assignment surgery in February of 1953. Christine grew up knowing that she was biologically a man but psychologically a woman and after her service in the military ended, she began hormone therapy consisting of the female hormone estradiol. Because of the nescience that enveloped the United States medical community concerning gender re-assignment surgery during the 1950s, Christine found it difficult to find a doctor willing to help her resolve her gender conflict and reach her goals. Eventually, a doctor in Denmark was able to perform surgery that consisted of a bilateral orchiectomy, removal of the scrotum and a penectomy. Several years after this initial surgery, Christine had cosmesis surgery to construct a vagina. As a result of the media coverage she received, Christine became â€Å"a spokesperson for transgender, gay, and lesbian causes† (Hock, p. 386). Sexual and physical health after gender re-assignment surgery is a major concern for candidates. One study conducted by the Department of Plastic Surgery, Ghent University Hospital, Gent, Belgium states that â€Å"[t]actile and erogenous sensitivity in reconstructed genitals is one of the goals in sex reassignment surgery† (Selvaggi, Monstrey, Ceulemans, T’Sjoen, De Cuypere, Hoebeke). The study outlines â€Å"specific surgical tricks used to preserve genital and tactile sensitivity† that focus on the preservation of the clitoris, the inguinal nerve, two dorsal nerves of the clitoris for phalloplasty and preservation of the glans penis, the prepuce and the penile shaft for vaginoplasty. The study states that a â€Å"long-term sensitivity evaluation† was performed on the â€Å"27 reconstructed phalli and 30 clitorises† of the 105 total phalloplasties and 127 vaginoclitoridoplasties performed over a ten year period of time at the Ghent University H ospital. The study concludes that â€Å"all female-to-male and 85% of male-to-female patients reported orgasm† and the tactile sensitivity techniques that are practiced at the hospital are essential for achieving such results. (Selvaggi, Monstrey, Ceulemans, T’Sjoen, De Cuypere, Hoebeke) For obvious reasons, gender re-assignment surgery is a major medical procedure. Any surgery presents the possibility of adverse health effects and urogenital surgical procedures are no different. They can include a variety of issues from urinary tract problems to sensations of phantom genitals to Lupus Erythematosus Tumidus. One study in Japan suggests that through the course of their research, â€Å"several complications occurred such as partial flap necrosis, rectovaginal fistula formation and hypersensitivity of the neoclitoris† (Namba, Sugiyama, Yamashita, Tokuyama, Hasegawa, Kimata). Every person is different and while there are factors that contribute to such problems, it is difficult to predict what adverse effects, if any, someone who elects for these types of procedures will experience. In 2007, a research study based on the hypothesis that Lupus Erythematosus Tumidus can be induced by gender re-assignment surgery was published in the Journal of Rheumatology. The study highlights that the pathology of Lupus Erythematosus Tumidus is both intrinsic and extrinsic. It is stated that â€Å"[t]he intrinsic abnormalities are complicated, with diverse genetic polymorphisms described in different ethnic groups, strongly suggesting that the actual pathology underlying the immunologic disarray might not be the same for each patient† (Zandman-Goddard, Solomon, Barzilai, Shoenfeld). Extrinsic factors are outlined in the same study as the exposure to â€Å"drugs capable of modulating immune responses such as exogenous estrogens.† The study indicates that it is presenting information about â€Å"the first reported case of sex reassignment surgery and the subsequent development of cutaneous lupus† and that the purpose of the report is to â€Å"emphasize t hat environmental triggers including high doses of estrogens as part of sex reassignment surgery may lead to the development of lupus in a nonpredisposed individual.† One study published in Archives of Sexual Behavior , the official publication of the International Academy of Sex Research, observed â€Å"preoperative preparations, complications and physical and functional outcomes of male-to-female sex reassignment surgery† on 232 patients. Each patient had penile-inversion vaginoplasty and sensate clitoroplasty which was performed by the same surgeon using the same technique on each patient. It is reported that almost all the patients stopped hormone therapy and received electrolysis to remove genital hair prior to the gender re-assignment surgery. While none of the patients â€Å"reported rectal-vaginal fistula or deep-vein thrombosis†, at least a third of the patients â€Å"reported urinary stream problems.† (Lawrence) Another problem linked with gender re-assignment surgery is reported episdoes of phantom genitals which is comparable to the phantom limb phenomenon. First described by Weir Mitchell in 1871, phantom limb is the â€Å"vivid sensation of still having a limb although it has been amputated† (Ramachandran, McGeoch). Since these episodes are not restricted to people with amputated limbs, it is reported to also occur â€Å"after amputation of the penis or a breast [and] 60% of men who have had to have their penis amputated for cancer will experience a phantom penis† (Ramachandran, McGeoch). The first documented case of â€Å"‘phantom penis’ was reported by Crone in 1951 (Namba, Sugiyama, Yamashita, Tokuyama, Hasegawa, Kimata). Recent studies have shown that phantom sensations may be a result of â€Å"‘cross’ activation between the de-afferented cortex and surrounding areas† (Ramachandran, McGeoch). Another contributing factor to phanto m limb is that â€Å"our body image is innately ‘hard-wired’ into our brains† and it is interesting to note that â€Å"congenitally limbless patients can still experience phantom sensations† (Ramachandran, McGeoch). In the aforementioned study, researchers hypothesized that â€Å"due to a dissociation during embryological development, the brains of transsexuals are ‘hard-wired’ in manner, which is opposite to that of their biological sex.† Proving or disproving this hypothesis will be essential to â€Å"showing the basis of transsexuality and provide farther evidence that we have a gender specific body image, with a strong innate component that is ‘hard-wired’ into our brains. This would furnish us with a better understanding the mechanism by which nature and nurture interact to link the brain-based internal body image with external sexual morphology† (Ramachandran, McGeoch). With an understanding that this phenomenon plagues a greater pool of people than once assumed, researchers from the Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan observed and documented the sensations of phantom erectile penis in 14 male-to-female patients that they performed vaginoplasty surgery on during an almost seven year period. Their conclusions state that just after their gender re-assignment surgery â€Å"some patients feel that their penises still exist, but by several weeks postoperatively, this sensation has disappeared† but that there was one case where the â€Å"sensation of a phantom erectile penis persisted for much longer† (Namba, Sugiyama, Yamashita, Tokuyama, Hasegawa, Kimata). One 52 year old patient who underwent male-to-female re-assignment during this study reported â€Å"the feeling of a phantom erectile penis for over six months and was enhanced when the patient was standing.† After a second surgery, the phantom sensation disappeared. Since transsexuals seeking gender re-assignment surgery are trying to reach a goal that includes lifestyle satisfaction, research has been conducted to find out if gender re-assignment surgery will actually help transsexuals reach this goal. While there are possible adverse physical effects to gender re-assignment surgery, one study says that â€Å"[n]o single complication was significantly associated with regretting SRS. Satisfaction with most physical and functional outcomes of SRS was high; participants were least satisfied with vaginal lubrication, vaginal touch sensation, and vaginal erotic sensation† (Lawrence). Another study also reported on by Lawrence â€Å"examined factors associated with satisfaction or regret following sex reassignment surgery (SRS) in 232 male-to-female transsexuals operated on †over a six year period of time. A vast majority of the patients who participated in this study reported â€Å"that they were happy with their SRS results and t hat SRS had greatly improved the quality of their lives. None reported outright regret and only a few expressed even occasional regret.† While one may feel dissonance as a transsexual, gender re-assignment surgery patients have been proven to be â€Å"better adjusted in life† than those who continue their struggle â€Å"trapped† in the wrong body. (Hock, p. 386) A few issues rarely traversed in the medical field that are pertinent to the understanding and tolerance of transsexuals and gender re-assignment surgery are recommended for further study and observation. For example, there is limited research or published studies concerning transsexuals who have undergone GRS and their adjustment to society, or furthermore, society’s adjustment to them. It would be intriguing to learn if transsexuals feel as though society accepts them more before or after their surgery. Another issue that would be intriguing, is to learn about patients’ postoperative relationships. The text says that a transsexuals new genitals are so anatomically real that it is possible to meet, date, have sex with or even marry such a person without even realizing it. This deserves further study. While a transsexual manages their gender dissonance, gender re-assignment surgery has proven to be a feasible solution. With references in classic literature and well known historical figures, transexualism has been around for hundreds of years. Study and development of gender re-assignment surgeries are relatively new, but the field has many pioneers who are striving to help improve the quality of life for transsexuals across the globe. As with any surgery, gender re-assignment surgery poses several risks, most of them postoperative. Since gender re-assignment surgery is both physically serious and irreversible, and has possible adverse affects such as Lupus, urinary tract issues or even phantom genitalia, the decision to have such procedures is a long process. Beginning with intense psychological preparation, hormone therapy and a period of transition, gender re-assignment surgery can not be completed until all these steps are completed successfully. On a promising note, stu dies conducted on overall satisfaction of patients who receive GRS overwhelmingly show that patients now feel a greater quality of life and are satisfied with their decision of gender re-assignment. References Bullough, 1975. Transexualism in History, Archives of Sexual Behavior, 4(5). January 18, 2009. Edgerton, Knorr, Callison, 1970. The Surgical Treatment of Transsexual Patients, Plastic and Reconstructive Surgery, 45(1). January 18, 2009. Goddard, Vickery, Terry, 2007. Development of Feminizing Genitoplasty for Gender Dysphoria, Journal of Sexual Medicine, 4(4). January 19, 2009. Hage, Karim, Laub, 2007. On the Origin of Pedicled Skin Inversion Vaginoplasty: Life and Work of Dr. Georges Burou of Casablanca, Annals of Plastic Surgery, 59(6). January 18, 2009. Lawrence, 2003. Factors Associated with Satisfaction or Regret Following Male-to-Female Sex Reassignment Surgery, Archives of Sexual Behavior, 32(4). January 19, 2009. Lawrence, 2006. Patient-Reported Complications and Functional Outcomes of Male-to-Female Sex Reassignment Surgery, Archives of Sexual Behavior. January 18, 2009. Namba, Sugiyama, Yamashita, Tokuyama, Hasegawa, Kimata, 2008. Phantom erectile penis after sex reassignment surgery, Acta Medica Okayama, 62(3). January 18, 2009. Ramachandran, McGeoch, 2007. Occurrence of phantom genitalia after gender reassignment surgery, Medical Hypotheses, 69(5). January 18, 2009. Selvaggi, Monstrey, Ceulemans, T’Sjoen, De Cuypere, Hoebeke, 2007. Genital Sensitivity after sex reassignment surgery in transsexual patients, Annals of Plastic Surgery, 58(4). January 18, 2009. Zandman-Goddard, Solomon, Barzilai, Shoenfeld, 2007. Lupus Erythematosus Tumidus Induced by Sex Reassignment Surgery, The Journal of Rheumatology, 34(9). January 19, 2009. Hock, 2007. Human Sexuality, Gender: Expectations, Roles, and Behaviors, 373-374 385-386. Upper Saddle River, New Jersey: Prentice Hall. 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