Methods for Prevention of Post-ERCP Pancreatitis

Methods for Prevention of Post-ERCP Pancreatitis Prevention of post endoscopic retrograde cholangiopancreatography pancreatitis Abstract: Pancreatitis is the most common and important complication of ERCP. Several risk factors exist that help to formation and progress pancreatitis. These risk factors may be factors that are related to patient, and factors that related to Procedure, or factors related to operator. All of the risk factors should be considered and as far as possible may be lowered with attention to pathogenesis of the development of post-ERCP pancreatitis. These pathogenesis are include: sphincter spasm, infection, contrast toxicity and pancreatic secretion that induce activation of proteolytic enzymes and inflammatory process. Some of methods and pharmacologic agent assessed for prevention pathogenesis pathway to decrease post-ERCP pancreatitis. Introduction: In about 75 percent of patients after endoscopic retrogradecholangiopancreato-graphy (ERCP) may have elevation in serum amylase ; but acute clinical pancreatitis (defined as a clinical syndrome of abdominal pain and hyperamylasemia) is less common. However, acute pancreatitis is the important complication of ERCP and need to pay attention it to prevent from its morbidity and mortality [1]. Mechanism for post ERCP pancreatitis: The exact mechanism for PEP is unknown. It needs to be a trigger event that turn on the inflammatory process, that can be the fallowing: thermal injury from sphincterotomy, mechanical obstruction to outflow of the pancreatic secretions , papillary edema from attempted multiple cannulations, sphincterotomy etc., injury from guide wire, chemical injury of the contrast, microbiological injury due to introduction of duodenal flora into the pancreas etc [2]. Risk Factors for Post-ERCP Pancreatitis: It is important to identify cases in which there are high risks for pancreatitis that we can prevent the complications of the prophylactic method such as pancreatic stenting or pharmacological prophylaxis. Assessment of both patient- and procedure-related factors is necessary to detect the high-risk cases (Table 1) [3]. Table 1: Risk Factors for Post-ERCP Pancreatitis [3]. Definition of post ERCP pancreatitis: To diagnose PEP need to be at least two of the following criteria: Epigastric pain with radiation to the back, Elevation of amylase and / or lipase at least 3 times higher than normal. Radiological imaging that suggests pancreatitis. Amylase and lipase may have an elevation despite the patients does not has any symptom. Radiological imaging is helpful when the diagnosis is difficult [4]. Methods and pharmacologic prevention of post-ERCP pancreatitis A. the Following techniques should be adhered to in order to decrease the risk of post-ERCP pancreatitis: 1. Endoscopic techniques 2. Cannulation 3. Electrocautery 4. Pancreatic stenting B. Pharnacologic prophylams: Nonsteroidal anti-inflammatory drugs Steroidal anti-inflammatory agents Other anti-inflammatory agents   Allopurinol semapimod- interleukin 10- pentoxifylline- Platelet-activating factor-Epinephrine Inhibitors of pancreatic secretion: Somatostatin- Somatostatin combined with diclofenac- octerotide- calcitonin Agents that stimulate pancreatic secretion and reduce sphincter tone: Secretin Agents that reduce of sphincter tone: Nifedipine-Nitrates-Glyceryl trinitrate botulinum toxin-topical lidocaine Inhibitors of protease activation: Gabexate mesilate- Nafamostat- Ulinastatin- C1-inhibitor- Heparin Antioxidants: N-acetylcysteine- Sodium selenite- Beta- Carotene Antimicrobial agents Antimetabolites : 5-FU (5 Fluoro Uracil)[5]. Some of the drugs that tested in different trials are described below: Pharmacological Prevention for Post-ERCP Pancreatitis: Since the introduction of ERCP, numerous pharmacologic drugs have been assessed to prevent post-ERCP pancreatitis based on their pharmacologic mechanism and their effect on one or more of the factors associated with pancreatic damage (Figure 1) [6]. 1- NSAIDs: NSAIDs (diclofenac or indomethacin) are the most drugs that are using for prevention of post-ERCP pancreatitis [7]. The European Society of Gastrointestinal Endoscopy recommends routine rectal administration of 100 mg diclofenac or indomethacin for prevention of post-ERCP pancreatitis [8]. 2- Glyceryl trinitrate: Glyceryl trinitrate reduces sphincter of Oddi pressure and may uses to prevent post-ERCP pancreatitis. ManuelMoretà ³ in his study assessed that could transdermal glyceryl trinitrate be effective in the prevention of post-ERCP pancreatitis? The results of his study show that transdermal glyceryl trinitrate patch significantly reduces post-ERCP pancreatitis [7]. 3- Nifedipine: Calcium channel inhibitors can prevent the development of experimental pancreatitis. Nifedipine is from the calcium channel blocker drugs and its effect is reducing sphincter spasm. Part done randomized, placebo-controlled trial to determine whether the calcium channel blocker nifedipine prevents post-ERCP pancreatitis. Nifedipine or placebo was administered before and within 6 hours after ERCP. This study failed to show significant effect of nifedipine in the prevention of post-ERCP pancreatitis [8]. 4-Antibiotics: Infections that occur when ERCP is done can activation proteolytic enzymes and lead to pancreatitis. Now there is this question that antibiotics can use in the prevention of post-ERCP pancreatitis. One prospective randomized controlled trial showed that the ceftazidime administration before ERCP significantly decreased the incidence of post-ERCP pancreatitis in the control group that did not receive antibiotic [9]. The quality of the study is questionable because the control group did not received no antibiotic [10]. 5- Risperidone: Ulinastatin inhibited systemic inflammatory responses and may benefit for prevention post-ERCP pancreatitis. Tsujino assessed the effect of risperidone (a selective serotonin 2A antagonist) combined with ulinastatin for the prevention of PEP in high-risk patients. In a multicenter, randomized, controlled trial, patients were randomly compared to administration ulinastatin with or without risperidone. The incidence of PEP was not significantly different between two groups, but pancreatic enzymes level were significantly lower in the risperidone+ulinastatin group as compared with ulinastatin alone [11]. 6- Indomethacin Indometacin is from nonstroidal antiinflamatory drugs that are used for prevention of post-ERCP pancreatitis. Joseph Elmunzer in a multicenter, randomized, placebo-controlled, double-blind clinical trial assigned patients that were high risk for post-ERCP pancreatitis to receive a single dose of indomethacin or placebo immediately after ERCP. Among patients at high risk for post-ERCP pancreatitis, rectal indomethacin significantly reduced the incidence of the post-ERCP pancreatitis [12]. Yaghoobi also assigned one meta-analysis to assessed rectal indomethacin for the prevention of post-ERCP pancreatitis. This meta-analysis showed that the rate of pancreatitis was significantly lower when using indomethacin as compared with placebo. [13]. 7- Corticosteroid: Corticosteroids are anti-inflammatory drugs and may be able to decrease the risk of post-ERCP pancreatitis. In a prospective randomized controlled multicentre study, administration of prednisone did not reduce the incidence of pancreatitis rather than placebo [14]. 8- N-acetyl Cysteine: N-acetyl Cysteine can reduce inflammation and may be useful in post-ERCP pancreatitis. Pezhman Alavi Nejad wants to evaluate efficacy of N-acetyl Cysteine for the Prevention of Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis. He assigned a prospective double blind randomized study. There were significant reduce in the prevalence of acute pancreatitis between the groups. This study shows that NAC could be used for the prevention of post-ERCP pancreatitis [15]. 9- Aprepitant Aprepitant is one drug from the classification of neurokinin-1 receptor antagonists. Upendra Shah wants to assess the efficacy of aprepitant at preventing post-ERCP pancreatitis in high risk patients. A randomized, double-blind, placebo controlled trial assigned. Patients received either placebo or oral aprepitant. Aprepitant could not decrease the incidence of post-ERCP pancreatitis against placebo [16]. pancreatic stents: Abhishek Choudhary assessed a meta-analysis and to determined effect of pancreatic stents for prevention of post-ERCP pancreatitis. This meta-analysis of the RCTs showed that pancreatic stent placement reduces the incidence pancreatitis and hyperamylasemia [17]. Conclusion: Considering the fact that pancreatitis is the most important of the ERCP complications we should pay attention the methods for prevention of post-ERCP pancreatitis. Pancreatic stents are useful for this aim. From the pharmacologic agents, Glyceryl trinitrate, Indometacin and N-acetyl Cysteine could significantly decrease the incidence of post-ERCP pancreatitis. Other drug that assessed in this review article such as Nifedipine, Risperidone, Corticosteroids, and Aprepitant did not show significant effect for prevention of post-ERCP pancreatitis.

Mental Health Act Essay

The main purpose of this act is to allow action to be taken, where necessary, to make sure that people with mental health difficulties or learning difficulties get the care and treatment they need for their own health and safety or for the protection of other people. The Mental Health Act 1983 is the law in most of the united kingdom that allows people with a ‘mental disorder’ to be admitted to hospital, detained and treated without their consent if it is truly needed, and if for their own health and safety or for the protection of other people. The court can also admit people who they believe that could be a danger to themselves and others around them. However the hospital can only keep the person detained for a maximum of six months, but they can decide to discharge the patient but still have on going supervised community treatment. A doctor who is ‘approved’ under section 12 of the Act is approved on behalf of the Secretary of State because they have special expertise knowledge in the diagnosis and treatment of ‘mental disorders’. Doctors who are approved clinicians are automatically also approved under section 12. Section 12 approved doctors have a role in deciding whether someone should be detained in hospital under section 2 and section 3 of the Mental Health Act. An approved clinician is a doctor, a psychologist, a mental health nurse, an occupational therapist or a social worker who has been trained and approved for over at least five years to carry out certain duties under Act. Only approved clinicians can take overall responsibility for the case of someone who has been detained in hospital or put on supervised community treatment – be their ‘responsible clinician’ the legislation states that the nearest relative is someone’s husband, wife or unmarried partner and only of they have been living together for over six months. The person is unmarried or does not have a partner if next of kin will then be there children if they are over 18, however if the child is not over eighteen or there is no child present the next of kin will then be one of their parents. However, a nearest relative should be informed or consulted if mental health professionals are proposing to detain someone for treatment under the Mental Health Act unless it is not practicable to do so, or unless consultation would result in ‘unreasonable delay.’ Medication You may be required to take medication prescribed for you by your doctor if you are on a community treatment order (CTO) under the Mental Health Act. There are rules in place, called consent to treatment, that cover whether you should take it. These rules also ensure that you understand why you need to take the treatment, how it will be given to you and possible side-effects. When you are first given medication for your mental illness, your doctor should: explain what the medication is for. tell you about any side-effects. ask for your consent. What happens next? After one month, if you still give consent to continue taking your medication, your doctor will fill in a certificate to confirm this. However, if you are too unwell to give consent, your doctor must have the agreement of a Second Opinion Appointed Doctor (SOAD) for your treatment to continue. If the SOAD agrees that you should continue with all of your medication, or just some of it, they will fill in a certificate confirming this. Can I change my mind? You can change your mind at any time – even after you have agreed to continue taking your medication. You should talk to your doctor before you make any decisions. What if I do not give my consent? If you refuse your medication while on a community treatment order, your doctor cannot force you to take it. However, if your doctor believes that you may become unwell without taking the treatment, they can recall you back to hospital. Additionally, consent to treatment rules may not apply to you if: Your life is at risk. Your health will deteriorate without the treatment. You are a danger to yourself or others.

Home Hemodialysis - 1457 Words

Qualitative and Quantitative Articles on Home Hemodialysis Elizabeth Hetherington Northeastern University Receiving hemodialysis in the in-patient or outpatient setting is uncomfortable and non-pleasurable. Thankfully, â€Å"the movement of medical care out of institutional settings into patients’ homes has increased in most industrialized countries as part of the general emergence of self- care options in the†¦show more content†¦29). This training helped patients overcome anxiety over needles, use and learn from other patients on NHHD, understand the importance of the patient-clinician relationship, overcoming the mental and physical challenges of learning while ill, and adapting to the individuals techniques. The five themes observed gave light to physicians that technology-related issues involving the machine was a barrier in training, however â€Å"the primary topics volunteered by the participants in the present study were psychosocial in nature† (Halifax, 2009, p. 31). At the end of Visaya’s research she discovered that, â€Å"in terms of the rel ationship between hemodialysis patients’ perceptions, HHD and self-care, 26 out of the 49 participants had positive perceptions regarding HHD† (Visaya, 2010, p. 26). Reflecting on the Patient Perception Survey, â€Å"49 patients found that 46.9% of the patients identified negative perceptions of HHD and 53.1% of the 49 patients identified positive perceptions of HHD† (Visaya, 2010, p. 26). The JPAT identified only 8 of the 49 participants suitable for HHD. Visaya also determined that, â€Å"when a patient scored high on the Patient Perception Survey, meaning he or she has negative perceptions regarding HHD, the patient as well had low levels of social support and communication† (Visaya, 2010, p. 26). â€Å"The associations between a hemodialysis patient’s perception regarding HHD and all other subscalesShow MoreRelatedMs. Conlon Applies The Nursing Process System Or Processes At The Unit / Team / Work Group Level846 Words   |  4 PagesMs. Co nlon applies the nursing process to systems or processes at the unit/team/work group level to improve care. Deirdre has been the primary nurse for 6 hemodialysis patients. She has involved patients and families in monthly interdisciplinary meetings to promote self-efficacy and quality of life. With the help of the interdisciplinary team Deirdre has worked collaboratively to address and reinforce nutritional needs, social/family issues, barriers to care, and safety concerns. All of her primaryRead MoreHeparin In Central Venous Catheters1250 Words   |  5 Pagesthe importance of their placement. To properly investigate central venous catheter (CVC) care; documentation will focus on Heparin flushes as it relates to renal care. The renal dialysis patient undergoes CVC placement as a basis of receiving hemodialysis treatments. It is essentially the first access point placed in preparation of a more permanent access point. Central venous catheters, fistulas, and grafts are considere d the lifeline of a dialysis patient. Their function and patency is of theRead MorePractice : Ethics And Resource Utilization1027 Words   |  5 PagesPractice ( Practice; Ethics; Resource Utilization) Ms. Mancinho continues to strive for excellence and patient care improvements in her position as staff nurse in the hemodialysis unit. She is currently the primary nurse for five of our chronic dialysis patients. 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One problem that is an issue with home dialysis is the amount of educationRead MoreIntegra Lifesciencess Strategic Intent1544 Words   |  7 PagesSuccessful companies, that have endured, rely on their people. People set the organizational strategy and direction. Fresenius Medical Care’s Leadership Strategy The two largest hemodialysis service providers are Fresenius Medical Care and DaVita. These two companies comprise approximately 80 percent of hemodialysis services (Nilesh, 2014). Understanding customer attitude toward a company’s product offerings helps with developing processes and promotional materials designed to assure positiveRead MoreDialysis Experience Essay2931 Words   |  12 Pages Hemodialysis (HD) is one of several renal replacement therapies used for the treatment of end stage kidney disease (ESKD) and kidney failure. Dialysis removes excess fluids and waste products and restores chemical and electrolyte balance. HD involves passing the patient’s blood through an artificial semipermeable membrane to perform the filtering and excretion functions of the kidney. One important step before starting regular hemodialysis sessions is preparing the vascularRead MoreHemodialysis and Peritonial Dialysis4350 Words   |  18 PagesObjectives Aims On the completion of the seminar students gain the knowledge regarding hemodialysis and peritoneal dialysis and will utilize this knowledge with a positive attitude. Specific Objectives The group will able to; * Define dialysis * Describe the history of dialysis * Explain the principles of dialysis * Enumerate the indication of dialysis * Explain details about hemodialysis * Describe details about peritoneal dialysis * List down the Psychosocial IssuesRead MoreThe Fundamental Principles Of Knowing1583 Words   |  7 Pagesthe Nephrologists. As a hemodialysis nurse, the empirical ways of knowing or what we called the art of nursing was immediately applied to the patient. Knowing that the hemodialysis treatment is what the patient needed, the treatment was started at once as ordered by the physician. There was a factual and theoretical explanation of the nursing care. The implementation and reason of the nursing care was logical and formulated to the situation presented. During the hemodialysis treatment, the patient

A Case Study on Clinical Pastoral Education Essay

CLINICAL PASTORAL EDUCATION A CASE STUDY OF â€Å"AMBER BILL† A PATIENT AT ST. PAUL’S HOSPITAL IN SASKATOON BY PATRICK AMPANI CASE STUDY ROAD MAP A. INTRODUCTION AND THEOLOGY OF MINISTRY B. PATIENT’S BACKGROUND INFORMATION C. FIRST ENCOUNTER (VERBATIM) D. PRELIMINARY REFLECTION a. my initial reaction b. main issues c. my plan of action d. psychological theory at work e. spiritual assessment f. theological reflection E. SECOND ENCOUNTER (followed by preliminary reflection including session a-f) F. THIRD ENCOUNTER (followed by preliminary reflection including session a-f) G. CONCLUSION A. INTRODUCTION AND THEOLOGY OF MINISTRY: St. Paul’s Hospital is an acute health care facility†¦show more content†¦Jim was never there for the mother due to the long existing tensions between him and the family. This was a thing of concern for the patient in her dying bed. The patient was anxious about the tensions in the family, on how to deal with it and resolve it, as well, she was anxious about dying. These anxieties enveloped the entire family, and everyone wonders what’s next now that the seeming unifying factor is dying. The dynamism of the family was critical and overwhelming. When I first met Amber, she was quite conversational and lively. In spite of her inherent predicament she was engaging. She could eat and drink on her own, watched TV and sometimes with the help of the staff and her kids she walked some distance and back to her bed. But, as time went on, she declined from some of these activities due to body weakness. She could not eat or drink without being helped. She hardly sat up, or moved her legs or arms; her condition kept deteriorating gradually until everything finally shut down on December 24th, 2009. I met Amber in the course of my daily visitation routine as a chaplain in the hospital. A spiritual care-giver had left a note on my desk indicating that Amber Bill had specifically requested to see a priest. I immediately responded to that concern. 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New Deal Research Paper - 2622 Words

Vibhav Kollu Honors English III December 21, 2010 The New Deal’s Lasting Effect on Society â€Å"I pledge you, I pledge myself, to a new deal for the American people,† President Franklin Delano Roosevelt said after winning his party’s nomination in 1932 (A New Deal for Americans). The 1930s was a time of great economic depression; in response the New Deal was FDR’s plan for America’s recovery. By 1933, when FDR took office, one in four Americans was unemployed. Furthermore, there was widespread hunger, malnutrition, overcrowding, and poor health. The New Deal was made to combat these tragic conditions and it did so through the means of welfare and government intervention. Indeed, the New Deal was a radical change to the way America had†¦show more content†¦This progressive act officially set up a national minimum wage, set up a forty hour work week, guaranteed time-and-a-half for overtime, and prohibited oppressive child labor (Friedrich). These acts dramatically improved labor conditions. A clear improvement in labor could be seen from before to after the New Deal labor reform. Americans, during the 1930s, clearly needed help. Too many were unemployed, struggling, starving, and/or homeless. One of the biggest legacies of the New Deal is that it combated unemployment with jobs in infrastructure. Many agencies and programs were set up to help increase America’s infrastructure and provide many needy people with jobs. One of those organizations was the Works Progress Administration. Incredibly, the WPA employed an average of 2.1 million people annually for a total of almost 8 million people. It had become largest New Deal program and required almost 11 billion dollars to fund it (Friedrich). The WPA was made with one goal in mind: to get people back to work so they can get money in their pockets to survive. The WPA built highways, airfields, public buildings, and did rural rehabilitation such as planting trees. 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Accents Speak Louder Than Speech Free Essays

Accents Speak louder than Speech What is an accent? An accent is the way you pronounce words. Everyone has an accent. It is insoluble to speak without one. We will write a custom essay sample on Accents Speak Louder Than Speech or any similar topic only for you Order Now You might consider yourself and others not to but you do. Usually you get your ‘accent’ from how, where and when you grew up, but not everyone has the same accent as the people who live around them. It might change without you noticing from new life experiences. Why do places develop different accents? The main reason for this is human nature. Usually we have an accent, which is roughly the same as the people we live with, because we want to fit in. That is how you learn speech by picking up the way people pronounce each letter. If a group separates into two groups, ie. If half move to Island A and the other half to Island B, and they are kept isolated for centuries, the pronunciation will be so different that you could almost say they were speaking different languages. This is what happened an interminable amount of time ago. People had no contact with people who lived far away because there were no phones, no radio, and the only travel was by foot. Another reason is that in the places that other countries invaded such as where the Vikings settled. People were influenced by the way they pronounced the vowels, and that is how the accent adapted. In Lancashire there is a theory that when people used to work in very big noisy cotton mills they had to speak in very loud, high pitched, shrilly voices to be heard and they got used to this and influenced the people around them. There used to be a negative perception of regional accents and RP was favoured, now BBC is positively discriminating in favour of regional accents. British town centres which used to be very different are becoming uniform, but what distinguishes them, are the accents and dialects. Also London is now a big influence to accents in England, because people are commuting in and out every day for work, so accents are disappearing in places such as Oxford, Surrey and Sussex. U and Non-U U stands for upper class and non-u stands for middle class. U’s used a looking glass rather than a mirror, wore spectacles rather than glasses, were richer rather than wealthy. Anyone who was not U for example people who talked about serviettes rather than napkins, would betray themselves as in a U’s view, ‘not one of us’. Toilet was actually a very smart word for Edwardians, then the servants picked it up and used it and it went out of fashion. Being marked as u or non-u is not only about your vocabulary but also about the way you pronounce things, an accent. For example butter is ‘orf’ rather than ‘off’. Also you would say that you have a very nice ‘hice’ rather than home. Today people say that a ‘gentleman’ never pushes a trolley at a supermarket but uses a basket. He never eats between meals, which are breakfast, lunch, and dinner. Received Pronunciation RP is the shortened name for Received Pronunciation. It is regionally described as the regional neutral accent. It is widely used as a reference point in dictionaries and as a model for teaching English as a foreign language. The meaning of Received traditionally was ‘’that which is generally accepted† or â€Å"that accepted by the best society†. When people say that someone hasn’t got an accent it is usually referring to RP. How to cite Accents Speak Louder Than Speech, Essay examples

Marketing Management of McDonalds

Question: Discuss about the Marketing Management of McDonalds. Answer: Introduction The reported paper has been developed to identify the market operations of McDonalds, the leading fast food restaurant chain of the world in the Australian target market. By identifying the marketing perspective in the target market, the research study will identify the sustainable marketing strategy suitable for business growth. Meanwhile, the study describes a detail research of the industry including the 5Cs significant for business proposition. The organisational analysis, market research strategy, market development plan and selective marketing tactics of McDonalds have been formulated drawing insights providing suitable marketing concepts and theoretical models (Al-Weqaiyan, 2005). Understandably, the study has been developed based on thorough research supportive for marketing development. Organisational Background McDonalds is one of the largest convenient foods and beverage restaurant chain business in the world. It has employs around 1.6 million people and has stores in more than 115 countries of the world. It is the market leader in the restaurant chain business with several strong competitors such as KFC and Subway (Reece, 2010). The primary reason for the success of McDonalds business is its distinctive competitive strategies, high standards of performance, superior quality of products, and high integrity of people. Around 85 percent of restaurants of McDonalds are owned by franchisees. The mission of the firm is to become the worlds premier convenient food and beverage restaurant business. The company seeks to provide healthy financial rewards to its investors by giving good opportunities for enrichment and growth to its business partners, employees and the communities (Sakas and Konstantopoulos, 2010). The vision of McDonalds is to become a modern and progressive company by delivering its customers a contemporary experience. Modern in the vision statement means to get the brand in the place where it needs to be in todays market. On the other hand, progressive means to get ready for the future expectations of the customers. In order to meet the changing demands of the demographics, McDonalds serves its customers with a huge product range that includes burgers, breakfast, beverages, desserts and many other items. The oldest marketing slogan that is still yet used by the company is Im loving it! began in the year 2003. On the other hand, the company keeps on experimenting with its product range by introducing localised foods (Ramachandra, Chandrashekara and Shivakumar, 2010). Currently, the brand McDonalds and McCafe has grown to be the second largest convenient food and beverage brand in Australia. The brand name is itself enough to attract people to visit the McDonalds stores. Organisational Analysis A SWOT analysis has been presented to discuss the strengths, weaknesses, opportunities and threats of McDonalds: Strengths: The global existence and renowned brand of McDonalds are its primary strengths. Along with that, the successful items and consistency of food quality also acts as strength of the company. Weaknesses: It can be seen through the market research that the declining market share and disgruntled franchisees of the company has emerged to be serious weaknesses of the organisation (Mujtaba and Patel, 2011). On the other hand, the slowed income and revenue growth makes it difficult for the firm to expand its business and hold its market positioning. Opportunities: McDonalds serves only 1 percent of the entire world population and has a good opportunity to expand over the international market. The joint ventures with retailers and supermarkets provide the company with a lower risked opportunity for expanding its business (Mooradian, Matzler and Ring, 2012). On the other hand, the implementation of technology in its service can help the company retain its customers. Threats: The strengths of the competitors are the primary threat for McDonalds. On the other hand, the fluctuation of the currency and global economy makes it difficult for the company to do its customers in the overseas market (Kerin and Peterson, 2001). Customers In the marketing management, identifying the target customers will be the key to long-run success. In the South Australian market, the target consumers can be identified as the most health conscious as well as fast food loving public. Precisely, the target demographic profile is highly educated and professional to say the least (Slater, Hult and Olson, 2010). Hence, the income status of the target demographics will be a significant boost for the fast food restaurant chain business. Meanwhile, in the busiest life schedule of the target demographic profile including children, school and college goers and single-living public, the customers value quality and tasty fast food and timely delivery of orders (Kotler and Keller, 2016). Therefore, the fast food chain must ensure the quality of service to meet the demand of the target customers. In the marketing strategy, the brand name will be efficiently utilised to create an influence on the target demographics. Collaborators In order to create growth in the target market, McDonalds Australia must use their significant supply partners already operating in the other parts of the country. For instance, in the product distribution, Martin Brower can be identified as the major contributor. On the other hand, the beef products, chicken and fish will be supplied by OSI and Australian Food Corporation (Qureshi and Hassan, 2013). Also, Inghams Enterprise, McCain, Simplot and other partners can supply fries, hashbrowns and other food products according to the quality to complete the entire supply chain in the target market. Meanwhile, the quality suppliers can deliver fresh food products and items following the quality audits of the fast food items to maintain the brand identity (Bhuian, 2009). The fast growing fast food industry in the Australian market will be helpful for the business collaborators as well to supply products at a reasonable pricing suitable for companys profit margins. Competitors In the target market of South Australia, McDonalds will face tough competition from KFC, Subway, Hungry Jacks, Red Rooster, and Nandos. Currently, 19.9 percent of market share of fast food restaurant chain industry has been occupied by KFC in Australia. On the other hand, Subway and Hungry Jacks have got 17 percent and 13.1 percent of the entire market share respectively. Among the most popular restaurant chain, the brand identity of McDonalds will definitely work in favour of the organisation to make further market penetration. As far as other new entrants in the market are concerned, the potential threat of new market entrants will be limited (Mujtaba and Patel, 2011). Precisely, to remain competitive in the target market, the quality of fast food items and trademark food products must be presented orderly to the target demographics (Banks, 2016). Moreover, the product segmentation as well as the market segmentation of McDonalds will be effective to stay ahead in the target South A ustralian market. Context A PEST analysis has been conducted herein below to present the other factors that influence the business of McDonalds in the Australian market. Political Factors: The global operations of McDonalds are influenced by the government policies of each country. For example, there are certain political groups in Australia that protest against fast food due to the health implications such as cholesterol and digestive problems (Kawabata, 2013). On the other hand, the company needs to follow several rules and regulations to operate in a smooth manner. Economical Factors: The economic condition of Australia works in favour of the company. The inflation rate in Australia is highly controlled at 1 percent and the good income level of the people provides the firm with better opportunities to expand its business in the country (Kawabata, 2013). Socio-cultural Factors: Australia is a multi-cultural nation with a higher proportion of western people. The Australian population mostly favour fast food for their daily living due to the busy schedule of life (Kawabata, 2013). Technological Factors: The development of technology has made it easier for a restaurant chain business to effectively conduct all its marketing tactics (Kerin and Peterson, 2001). McDonalds provide free Wi-Fi facility and focus on digital advertising to attract more customers. Market Research Strategy In order to collect primary research data from the target market, McDonalds Corporation simply engages renowned research agencies. Meanwhile, the agencies have prepared survey research materials for the selected market area to identify the 5Cs associated with the business structure of the firm (LaPlaca, 2008). By conducting thorough study on the basis of significant methodological consistencies, the market research can define the behaviour of the target demographics, position of the collaborators as well as competitors, threats of new entrants, robust changing business environment and competitive marketing strategy of the other market players. In order to define the customers perspective, random survey study has been conducted to know the choices and preferences of the target demographics (Kotler and Keller, 2016). The research outcome will be helpful to define the best product line and services strategy to impress the consumers. The study research and market intelligence programme on specific market region can collect best information about the localising fast food menus and food items mostly preferred by the target demographics. Thus, positioning strategy of the firm can be structured to get the best response from the target demographic profile (Levy, 2012). Meanwhile, the existing pricing strategy and standard of services of the other market operators can be identified during the study. The research agencies hired by McDonalds to conduct the primary research study will also identify the probability of new entrants by collecting information about the existing market share of the best participants (Abdullah Saif, 2015). Precisely, in the target market, the fast food chain business is a perfect competition. Hence, the entry of a new firm will not make a massive impact on the revenue of the operating firms. Lastly, the role of the collaborators such as the suppliers, distributors and franchisee must be recogni sed before making any business commitment. Thus, the research on the collaborators will help McDonalds to find the collaborators that can provide quality products at a reasonable pricing (Thomadsen, 2007). Developing Marketing Strategy The research study on market will evidently clear out the best segmentation, targeting as well as positioning strategy for McDonalds in the target market as follows: Segmentation Type Segmentation Criteria Target Segment Geographic Density Urban areas Region Domestic market Demographic Age between age group of eight to fifty Gender Males and Females Income Status Low income, middle class income Occupation Students, business professionals and service people Life style Bachelor Newly Married Family including children Psychographic Lifestyle of target demographics The product line of McDonalds has been targeted according to the preferences of different style of people having diverse set of lifestyle Social Class Lower income class, middle class and hard-working class Behavioural Personality fast food loving careless and enjoying people Loyalty of target demographics Hardcore as well as loyal customers Status of target demographics Regular customers Target Market Identifying the target market is a key to success for business growth. In this study, the South Australian market has been determined to be the marketplace for McDonalds. Clearly, the growth of fast food industry in the Australia has encouraged McDonalds to set up new outlets in the South Australian market (Williams, 2015). Value Proposition for the target market In order to make the finest business growth in the target market, customer value proposition will be the key to success. Precisely, efficient value proposition resonate to target demographics must be defined so that the purchasing behaviour of the target demographics can be highly influenced. Herein, the brand identity of McDonalds, quality food items, smart on time delivery features and magnificent service efficiency of the firm can be represented to construct the value proposition (Bhuian, 2009). Positioning Statement Branding of business is extremely important to stay competitive in a target market. Precisely, McDonalds should focus on the target audience providing the best quality and magnificent services. In the South Australian market, distinctive service benefits must be given to the consumers to increase popularity of the fast food restaurant chain (Mujtaba and Patel, 2011). Moreover, unique pricing strategy and discount offers must be promoted at the marketing level to keep the consumers interested. Developing Marketing Tactics A detailed marketing mix has been presented herein below to support the above marketing strategy: Product: McDonalds will introduce localised foods with new varieties to attract new customers. On the other hand, it needs to keep on introducing new food range that will retain back old customers (Wilson and Gilligan, 2005). Furthermore, the company will focus on developing its customer service by delivering food at door step and taking online orders. Place: The Company needs to expand its business in the South Western Australia by using the franchising or joint venture strategy (Sheehan, 2011). McDonalds has planned to open 100 stores in the South Western region of Australia with all sorts of modern facilities and services. Price: McDonalds need to implement a competitive pricing policy in order to fight the high level of competition from KFC and Subway. On the other hand, the company can make use of discount strategy in order to attract more customers (Sheehan, 2011). Promotion: McDonalds is involved in digital advertising and need to focus on its target market. On the other hand, the management needs to use several other promotion techniques such as hoardings, transportation advertisement, and several other modern advertisement techniques (Wilson and Gilligan, 2005). Processes: McDonalds needs to focus on improving its customer service by employing part time workers to deliver quick service during the rush hours (Kotler and Keller, 2016). On the other hand, the company will also provide home delivery services within a particular range to attract more customers. Physical Evidence: In order to deliver physical evidence, the company can provide McDonalds toys to kids to increase their satisfaction level. On the other hand, free gifts can be given to make people remember about their visit to the McDonalds restaurants (Kotler and Keller, 2016). People: McDonalds will hire HR professionals to train the new staffs of the franchisees opening in the new market. Along with that, the company will provide lead chefs and front line managers to the franchisee stores to control the new workforce (Kotler and Keller, 2016). On the other hand, the company will hire part time staffs in order to manage the customers during the rush hours. Conclusion During the marketing management of McDonalds in the target market, specific market analyses and potential segmentation of market should be done as discussed in the marketing strategy section. Precisely, in the robust business environment, the brand name of the organisation can play a major role to create brand positioning in an automatic way. Understandably, to meet the demand of the target demographics, the quality of fast food must be delivered to create significant competitive edge in the target market. Also, the differentiation of food products will be handy in the marketing strategy to stay ahead of the rest of the fast food restaurant chain in the target South Australian market. References Abdullah Saif, N. (2015). How does Marketing Strategy Influence Firm Performance? Implementation of Marketing Strategy for Firm Success.International Journal Of Innovation And Economic Development, 1(3), pp.7-15. Al-Weqaiyan, A. (2005). A Cross-National Study of Repurchase Intentions of Fast-Food Meals.Journal of International Food Agribusiness Marketing, 17(1), pp.95-116. Banks, S. (2016).McDonalds modern marketing menu CMO interview. [online] Marketing Magazine. Available at: https://www.marketingmag.com.au/hubs-c/mcdonalds-modern-marketing-menu-cmo-interview/ [Accessed Jan. 2017]. Bhuian, S. (2009). Developing Country Consumer Fast Food Preferences.Journal of International Food Agribusiness Marketing, 10(1), pp.1-13. Kawabata, M. (2013). Dynamics of Globalization in Food Service Sector.Journal of Marketing Distribution, 15(2), pp.3-23. Kerin, R. and Peterson, R. (2001).Strategic marketing problems. 1st ed. Upper Saddle River, N.J.: Prentice Hall. Kotler, P. and Keller, K. (2016).Marketing management. 15th ed. Pearson Education Australia Pty Ltd. LaPlaca, P. (2008). Industrial marketing management.Industrial Marketing Management, 37(3), pp.245-246. Levy, S. (2012). Marketing management and marketing research.Journal of Marketing Management, 28(1-2), pp.8-13. Mooradian, T., Matzler, K. and Ring, L. (2012).Strategic marketing. 1st ed. Upper Saddle River, N.J.: Pearson Education. Mujtaba, B. and Patel, B. (2011). McDonalds Success Strategy And Global Expansion Through Customer And Brand Loyalty.Journal of Business Case Studies (JBCS), 3(3), p.55. Qureshi, A. and Hassan, M. (2013). Impact of performance management on the organisational performance: An analytical investigation of the business model of McDonalds.International Journal of Academic Research in Economics and Management Sciences, 2(5). Ramachandra, K., Chandrashekara, B. and Shivakumar, S. (2010).Marketing management. 1st ed. Mumbai [India]: Himalaya Pub. House. Reece, M. (2010).Real-time marketing for business growth. 1st ed. Upper Saddle River, N.J.: FT Press. Sakas, D. and Konstantopoulos, N. (2010).Marketing and management sciences. 1st ed. London: Imperial College Press. Sheehan, B. (2011).Marketing management. 1st ed. Lausanne, Switzerland: AVA Pub. Slater, S., Hult, G. and Olson, E. (2010). Factors influencing the relative importance of marketing strategy creativity and marketing strategy implementation effectiveness.Industrial Marketing Management, 39(4), pp.551-559. Thomadsen, R. (2007). Product Positioning and Competition: The Role of Location in the Fast Food Industry.Marketing Science, 26(6), pp.792-804. Williams, A. (2015).Salesforce: McDonalds has captured the future of marketing. [online] Cmo.com.au. Available at: https://www.cmo.com.au/article/579920/has-mcdonald-captured-future-marketing/ [Accessed Jan. 2017]. Wilson, R. and Gilligan, C. (2005).Strategic marketing management. 1st ed. Amsterdam: Elsevier/Butterworth-Heinemann.