Improving the Guidelines for Combination Therapy for Type...

I have chosen the above topic because the guidelines are very vague in recommending this combination therapy even though we have clear cut guidelines recommending the use of individual agents in the treatment in Type II Diabetes patients. American diabetes association (1) guidelines recommend advising lifestyle modifications like healthy eating, increased physical activity and weight control, and if the patient fails to meet the target HbA1C levels on lifestyle changes, Metformin is added and over a period of three months, if the patient does not reach the target A1C levels, patient can be started on two drug combinations and we have several options to do this, from sulfonylureas, TZDs ,GLP-1 Analogues, DPP-4 inhibitors and insulin. A search of literature for this combination (2) shows that there are very few clinical studies conducted with the combination of GLP 1 analogues and Insulin and in these studies it was more common to find short-acting GLP-1 RA (exenatide twice daily , liraglutide once daily, lixesanatide once daily) treatment added to an existing insulin regimen (with or without concomitant OAMs) rather than insulin added to existing GLP-1 RA therapy. I will limit the discussion here to only combination treatment of T2D with GLP-1 RA and basal insulin and would like to discuss the above topic under two headings- 1. Adding basal insulin to a patient who is already receiving OHAs + GLP-1 Analogues and discuss the results. What I do in my practice isShow MoreRelatedPharmacokinetic and Pharmacodynamic Interaction of aqueous extract of Cassia auriculata L. leaves and Metformin in rats.1533 Words   |  7 Pagestreatment of diabetes to control the blood sugar level (Berman et al., 2001). Cassia species, are rich sources of polyphenols, anthraquinone derviatives, flavanoids, polysaccrides, saponins, tannins and steroids (Singh et al., 1980; Yen et al., 1998; Ayo et al., 2004), flavanoids, sterols/terpenoids and phenolic acids are known to be antidiabetic bioactive principles. Flavanoids are known to regenerate the damaged ÃŽ ² cells in alloxan induced diabetic rats (Yasir M et al., 2012). Diabetes mellitus, causedRead MoreHow Many Licks Of A Lollipop Does It Take For Get Diabetes?3162 Words   |  13 PagesTake To Get Diabetes? Abstract/Introduction: When people think of causes of death, the big names that come up are usually cancer, heart disease, stroke, Alzheimer’s, and suicide. These are all huge killers, but the underestimated, unthought-of, underdog of them all might just be diabetes. Diabetes is the 7th leading cause of death, with an estimated 29 million suffering from the disease and a prediction that 1 in 3 born in 2000 will develop it. In 2005, 233, 619 deaths were due to diabetes and the rateRead MoreBenefits Of Physical Training Patients With Diabetes And Chronic Kidney Disease2469 Words   |  10 PagesBENEFIT OF PHYSICAL TRAINING IN PATIENTS WITH DIABETES AND CHRONIC KIDNEY DISEASE. Yetunde M. Fajulugbe Department of Pharmacology and Toxicology, Boonshoft School of Medicine, Wright State University Dayton OH. Keywords: Diabetes, Chronic Kidney Disease, Physical Training, Abstract: Introduction Diabetes occur when there is a combination of inadequate secretion of insulin by the pancreatic beta cells and the peripheral insulin resistance. Insulin resistance leads to a reducedRead MoreRisk Factor For Global Disease Burden3283 Words   |  14 PagesSecond, many patients appropriately diagnosed with hypertension fail to achieve the treatment targets recommended by guidelines. This highlights the considerable challenges in implementing risk factor modification and appropriate adherence to antihypertensive therapies long term. Third, uncertainty remains as to the appropriate BP treatment target for high-risk patients. While a target BP 140/90 mm Hg is generally recommended, a lower threshold of 130/80 mm Hg is recommended for patients at high riskRead MoreIn The United States, Approximately Six Million People3312 Words   |  14 PagesIn the United States, approximately six million people are living with some degree and type of heart failure; it is also the number one cause of death in the United States (CDC, 2016). The following research paper details the medical-surgical treatment and nursing care of patients with heart failure, and includes information specific to left-sided heart failure. Left-sided or left ventricular heart failure (LSHF) is most often referred to as congestive heart failure (CHF) in the clinical settingRead MoreCommunity Acquired Pneumonia18251 Words   |  74 Pagesone of the most common infectious diseases prevalent nowadays and affects all ages. It is an acute or chronic infection of one or both lungs caused by microorganisms, such as viruses, bacteria or chemical irritants. (Schmitt, 2011) It has different types, and one of them is Community Acquired Pneumonia (CAP). CAP is a disease in which individuals who have not recently been hospitalized develop an infection of the lungs. It occurs because the areas of the lung which absorbs oxygen (alveoli) from theRead MoreEssay on Liquid Diets4195 Words   |  17 Pagesedu/school/DGIM/Teaching/Modules/obesity.html#RTFToC12). Obesity has been related to high blood pressure, heart disease, respiratory problems, gallstones, insomnia, and some cancers (http://www.fdu.gov/bbs/topics/CONSUMER/CON0007Q.html). Some doctors prescribe liquid diets to patients unable to digest solid foods; however, the majority of liquid diets are used for the purpose of losing weight. HOW DOES IT WORK? Since a reduction of 3,500 calories is needed to lose a pound, most of the liquid diets consist of a very lowRead MoreOsteoporosis: bone Mass7865 Words   |  32 PagesLifestyle change includes preventing falls and exercise; medication includes calcium, vitamin D, bisphosphonates and several others. Fall-prevention advice includes exercise to tone deambulatory muscles, proprioception-improvement exercises; equilibrium therapies may be included. Exercise with its anabolic effect, may at the same time stop or reverse osteoporosis. Signs and symptoms Osteoporosis itself has no specific symptoms; its main consequence is the increased risk of bone fractures. Osteoporotic fracturesRead MoreUse Of Traditional Chinese Medicine During The Treatment Of Schizophrenia Essay7976 Words   |  32 Pageswith severe alterations in mood. Schizophrenia tends to more continuous with illogical thinking, hallucinations and delusions controlling an individual’s actions and thoughts. The causes of schizophrenia are unknown, but research suggests that a combination of physical, genetic, psychological and environmental factors can make people more likely to develop the condition. Genetics play a major role in schizophrenia, but there is no one gene responsible. The greatest risk for developing schizophreniaRead MoreGlaxosmithkline18561 Words   |  75 Pagesdivision, which generates 85% of GSK’s sales. The five largest selling GSK products are Seretide/Advair for asthma and Chronic Obstructive Pulmonary Disease (COPD); Paxil/Seroxat and Wellbutrin, both antidepression drugs; Avandia/Avadamet for type 2 diabetes; and the antibiotic Augmentin. Each of these drugs generated above  £800 million of sales in 2003. GSK produces a broad range of products of special importance to developing countries, including: Anti-malaria drugs Zentel (albendazole), for de-worming

Stem Cell Research For Better or for Worse Essay examples

For as long as humans exist, optimal health continues to remain vital for a productive life. As new medical discoveries increase through generations, humans become healthier, therefore, their life expectancy rises. Stem cell research, a relatively new field, investigates to improve and lengthen human life. The possibility of stem cells to develop prospering health makes them beneficial to the human race. Why do stem cell debates create such a large uproar? Stem cells posses the potential to arise into hundreds of different cells in the body- for this reason stem cells are also referred to as undifferentiated cells. Stem cells’ value also comes from their ability to â€Å"replicate many times, or proliferate† (â€Å"Stem Cell Basics† 1).†¦show more content†¦Although embryonic stem cells contain abilities to enrich human health, a less controversial source of stem cells remains- adult stem cells. Collecting adult stem cells takes place in numerous lo cations of the body such as: bone marrow, muscle, the brain, umbilical cords, and adipose tissue (Guinan 308). Goldstein documents of experimental findings how human brain stem cells â€Å"can achieve ninety to ninety-five perfect purity in combination with several previous steps† (207). However, scientists remained uncertain about the functionality of adult stem cells because they â€Å"typically generate the cell types of the tissues in which they reside† (â€Å"Stem Cell Basics† 1), but in 2006 a Kyoto University team discovered the ability to engineer adult stem cells into pluripotent stem cells (â€Å"New Method† 4). Recent technology allows scientists to â€Å"directly covert somatic cells to pluripotent cells regardless of availability of embryonic cells† (Han 278). This technology may foster the growth of stem cell research because it removes the challenge of accessing to pluripotent cells. Induced pluripotent stem cells potential to à ¢â‚¬Å"promote patient specific and disease specific drug development† (Manohar 1) makes them even more constructive than embryonic stem cells when considering rejection by the host. Induced pluripotent stem cells attain the same flexibility as embryonicShow MoreRelatedEssay about Opening the Door to New Life922 Words   |  4 PagesStem cell research is an important way to enhance the quality of life. Many people believe that stem cell research offers a tremendous amount of potential in medical science, such a topic deserves scrutiny though ethical lenses. The controversy over whether it’s right or wrong will surely continue to go on for many more years and perhaps even decades. Stem cells should be researched and should be allowed, because the possibilities it could provide are endless. To fully grasp the controversy onRead MoreWhy Are Stem Cells Important?1472 Words   |  6 PagesWhy are stem cells important? Why are they so unique? For starters stem cells are able to self-renew infinitely, allowing them to be harvested in the future with correct methods not yet available in these times, this processes known as proliferation. They have two more key unique traits one being their ability to differentiate into other cells that are specialised with functions and characteristics another trait is stem cells being so unspecialized which gives them the ability to emerge as highlyRead MoreEmbryonic And Adult Stem Cell Research Essay1093 Words   |  5 Pages but he is unaware that the type of sickle cell disease from which he is suffering can be cured using stem cells. Scientists have recorded two types of stem cells – embryonic and adult. Stem cells can be retrieved not only from embryos, but also umbilical cords, the placenta, amniotic fluid, and adult tissues and organs (â€Å"Stem Cells,† 2011, p.12). Stem cell research is only a small part of a much larger field of regenerative medicine that includes cell-based therapies, gene technology, and tissueRead MoreStem Cell Research has the Potential to Alleviate Much Suffering1425 Words   |  6 Pageswords of former First Lady Nancy Reagan: â€Å"Embryonic stem cell research has the potential to alleviate so much suffering. Surely, by working together we can harness its life-giving potential.† Stem cell research shows so much promise to help people by treating diseases and other problems through therapy. While it seems as though the clear answer is that we should study stem cells as soon as possible, this is sadly not the case. Stem cell research is an ongoing controversy within politics and the courtsRead MoreStem Cells and Their Effect on Tumor Growth and Cancer Creation997 Words   |  4 PagesZoology Stem Cells and Their Effect on Tumor Growth and Cancer Creation Stem cells are a growing phenomenon in the cancer research world. Researchers are getting closer and closer to a cure, they are exploring other options to treat cancer. Stem cells are relatively new to the medical world, making their first appearance in 1956 (†Timeline for Stem Cell Research†, 1), and as with everything, there are flaws. Despite these flaws, stem cell treatment is something more people are turning to, asRead MoreThe Debate Over Stem Cell Research1601 Words   |  7 PagesThe stem cell controversy has been going on for many years. The two basic controversies surrounding stem cell research is whether or not it is morally justifiable, and if stem cells will ever live up to the medical promises. Most of these controversies concern embryonic stem cells more than any other stem cells. Embryonic stem cells are unspecialized, but have the ability to divide and make specialized cells like muscles, nerves, and skin cells. These cells are found in the early stage of human developmentRead MoreThe Remarkable World Of Stem Cells. Micheal Davis. Writing1695 Words   |  7 PagesRemarkable World of Stem Cells Micheal Davis Writing 301 Mrs. Sargent January 18, 2017 The Remarkable World of Stem Cells Stem cells have been a medical miracle since the dawn of the 20th century, and there next-to-limitless potential has exceeded modern biologists’ wildest dreams. One question to ask however, is what are stem cells, and how do they function to where is makes them such a great medical discovery? In a sort of simplified version to which will give more of a better overall understandingRead MoreThe Importance Of Stem Cell Research1278 Words   |  6 Pagespaper, there has always been a lot of controversy surrounding stem cell research and the ethically rights researchers have obtaining it, let alone experimenting with it. Therefore, it is no surprise that before RCT with stem cells on humans were approved and accepted, trials were done on mice and rats. While it is not ideal and in no way similar to the effects on humans, experiments done during this phase were useful in viewing how stem cells actually alter and impact osteoarthritic joints. In an experimentRead MoreParkinson s Di sease As A Medical Condition1437 Words   |  6 Pagesdetailed medical essay on this disease. This essay established Parkinson’s disease as a recognized medical condition. He based the essay off of six cases he had observed previously and hoped that it would encourage others to study the disease. No such research was performed until finally, sixty years after Parkinson’s essay was published, a French neurologist named Jean Charcot studied the disease and was the first to truly recognize the importance of Parkinson’s work. As a result, he named the diseaseRead MoreEssay about Advances in Parkinson’s Disease1345 Words   |  6 Pageslike movement that many of us take for granted. Lives are changed because of Parkinson’s, but there is hope. Through medical breakthroughs discovered in recent years, my grandpa and many others suffering from Parkinson’s disease have a chance at a better life. History of Parkinson’s Disease Signs or symptoms of Parkinson’s disease have been recorded from years dating all the way back to about 1000 B.C., but the first actual medical diagnosis of the disease was done by James Parkinson in 1817 (Goetz)

Hate Crimes Essay Example For Students

Hate Crimes Essay Hate Crimes Essay and The Mitchell v. Wisconsin Decision The American Heritage Dictionary defines hate as intense dislike or animosity. However, defining hate as the basis for a crime is not as easy without possibly jeopardizing constitutional rights in the process. Hate crime laws generally add enhanced punishments to existing statues. A hate crime law seeks to treat a crime, if it can be demonstrated that the offense was a hate crime differently from the way it would be treated under ordinary criminal law. Since the 1980s, the problem of hate crimes has attracted increasing research attention, especially from criminologists and law enforcement personnel who have focused primarily on documenting the prevalence of the problem and formulation criminal justice responses to it. Lawmakers have passed legislation to encourage data collection and attach enhanced penalties to hate crimes at both state and federal levels. When Americans are assaulted merely because of their real or perceived sexual orientation, gender, or disability, the law should be as tough on their assailants as it currently is tough on criminals who attack based on racial, religious, or ethnic bias. Yet only in rare circumstances can the federal government investigate and prosecute hate violence against gays, lesbians, or bisexuals. Attempts have been made to reach a definition of hate crime, including that it is a crime, most commonly violence, motivated by prejudice, bias or hatred towards a particular group of which the victim is rarely significant to the offender and is most commonly a stranger to him or her. The current law (18 U. Does hate crime imply on any case when a person is convicted for inflicting damage on someone different? It is often difficult to set a benchmark for measuring sufficiency of hate as a cause to label it in front of crime. The term can be conveniently stretched and squeezed by people with different ideas and biases. The four white policemen who brutally beat Rodney King Jr., a black man, half to death for merely speeding is determined by the courts judgment, as officers performing their duty. Hate, to those particular jurors and judge, was not a valid concern. To them, the beating was not due to the officers resentment for a black man, but because they were simply disciplining an offender of the law. To the minority groups, the courts ruling was outrageous. From their point of view, the savage beating was unnecessary and hate was obviously the factor which induce the four cops to perform such a nasty feat. Because people have varying views and opinions, application of the term hate crime is not always relevant. Can we assume the murder of Nicole Simpson by OJ Simpson a hate crime since it involves a black man killing a white woman or are there more in depth twist to the case? People who are willing to do a little thinking, do not just look at the difference of the victim and the convicted and draw conclusions of whether or not the crime is hate related, they examine all the other psychological elements also. The most common way of judgment is to ponder: if the victim was of a different race, religion, or sexual orientation, would the same injurious action still have taken place? In order to picture the virtual scenario, we would need to think critically and be able to delineate out hate, and to do that, we need to understand why people hate. No one is born to be prejudice. It is the society people grow up in that teaches them to be that way. Even while watching a seemingly harmless cartoon, we are taught unconsciously to despise those who are different. The good guys are always a group of the same kind, physically appealing and very American while the bad guys are always bizarre and resemble people from a distant culture we dont recognize. From very young, we develop stereotypes; a direct effect from the workings of society. Popular generalizations such as Black people eating up social security money and Asians trying to buy America are passed around. Yet, in reality, statistics show that much more Whites are on social security than are blacks and only the Japanese Corporations are doing the purchasing, not Asians, particularly Asian Americans who have nothing to do with them besides being Asian. Ironically, society tries to undo our prejudice through education when we enter school. But the prejudice is brought back to us when we meet students who are prejudice, whether we become their friends or their victims of discrimination. Being prejudice upon teaches a person to be prejudice. How a person views something related to racism and hatred, directly reflects on how society has raised them. The American people do not see the bombing of Iraq and Yugoslavia as a hate crime, because we are told what we want to believe, that we are good and they are evil, and there would be no wrong in flexing our superior muscle. But to the Iraqis and Yugoslavians, who lost thousands of lives, the United States is but a racist nation who kills non-American people like killing ants. For if the Iraqis and Yugoslavians were Americans, preferably white, would the U.S value their lives differently? It is ultimately in a persons perception, which concludes what is and .

Summarise the Roles and Responsibilities of National and Local Goverment for Education Policy and Practice free essay sample

Their aim is to improve the opportunities and experiences for all children and the professionals working with them by focusing on giving more support for the poorest and most vulnerable children in England, to ensure they all receive the same level of education and equal opportunities as their peers regardless of background. As well as policy setting they are looking at new ways of developing the quality of services for children under the five outcomes of Every Child Matters. They have also set up and administer school league tables, which do not show how much progress has been made, just high achievement and not all pupils are going to be academic achievers and this will not recommend a school to prospective parents. It should not just publicise results from A* to C at GCSE, but show how much progress has been made by the students. Not all students are going to be academic and would prefer to study vocational courses and this should be taken into account. We will write a custom essay sample on Summarise the Roles and Responsibilities of National and Local Goverment for Education Policy and Practice or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Central government is responsible for the school/education budget; they determine which local authorities should receive it and what amount. The Department of Education is responsible for: * Setting the national curriculum * Early years foundation stage, which the schools and nurseries (including private nurseries * Funding research into projects for education * Workforce reform/promoting integrated working * Developing the roles of voluntary and community organisations, charities and other sectors that work with children Recent governments have realised how important the care and education of young children is and what impact it can have on them. The four nations from the UK have taken slightly different approaches to how early years education will be delivered. We are at present in the early stages of working within their frameworks. In September 2008 the government (English) introduced a new statutory curriculum for children from 0 – 5 years who are being cared for or educated away from their homes. The framework applies to; childminders, after-school clubs, nurseries, pre-schools and schools, irrespective of how they are funded. In addition to the education programme the EYFS also includes welfare requirements. This was designed to ensure that all children regardless of background or circumstances would have access to a quality early years education. There is a series of outcomes for each area of learning so that teachers can measure this and have a clear focus for their work. These outcomes are called the Early Learning Goals. The aim is for the child to meet them by the end of their reception year. These goals are important as they form the building blocks for the children’s later education. Children’s Centres provide a range of early years services from the expectant parent to children aged 0-4 years. These are sometimes described as a’ one stop shop’. This will include childcare, health, parenting and family support services. In the most deprived areas there may be a requirement to ensure the delivery of day-care, where this is unavailable. Many Children’s Centres are located on school premises. Whilst primarily designed to provide services for pre-school children the buildings can also support schools to deliver ‘Extended services’. Many Children’s Centres work in partnership with their local Education Improvement Partnership, to ensure joined up approaches to support families to meet their children’s needs in a ‘learning community’. Children’s Centres are managed as part of the Children’s and Young Peoples Services. Those who manage Centres come from a wide range of backgrounds, including Social Work, Nursing and Teaching and share their particular expertise within the local network of Centres. The centres can offer parenting education and family support services. There may be a day nursery on site which will be registered with OFSTED. Parents should always ask to see the current OFSTED report, or download it from the website. Supporting families in the foundation years, was published by the government in 2011 setting out the government’s intention for more families to benefit from parenting advice and support from pregnancy to the age of five. The parenting class trial was announced in October 2011, by Sarah Teather, Minister for Children and Families. These trial parenting class areas are Camden, Middlesbrough and High Peak in Derbyshire. Parents in these areas can download a voucher for ? 100. These vouchers will provide support with: * Learning through play Parents working together as a team * Communicating and staying calm * Managing sleep issues * Coping with difficult behaviour * Rules and routines * Understanding different stages of your child’s development Vouchers can either be downloaded from the canparent website to a computer or mobile phone, or paper vouchers are being distributed by children’s workforce professionals in the trial areas and vouchers can also be collected from Boots stores in the trial areas. Local Authorities will provide both Registered and Voluntary Registered childcare provision. Any childcare provider must be registered with OFSTED, if they look after children under 8 years for more than two hours a day, for payment. Registered chilminders are inspected against five welfare requirements: * Safeguarding and promoting children’s welfare * Suitable persons * Suitable premises * Organisation * Documentation Inspections of new childcare settings are usually carried out just after registration and then once every three years. The Voluntary Childcare Register is a section of the register that offers the choice to register for those who would not normally do so. They are mainly looking after children aged 8 or over in their own home. By joining this part of the register they are showing parents that they are willing to meet certain requirements relating to people. Premises and provision designed to keep children safe. Parent/Toddler groups are exempt from registration by OFSTED, as parents/carers stay with their children. The second department for education is the Department for Business Innovation and Skills, they are responsible for further and higher education and are aiming to establish a world class education system in the UK, so that we have the highest skills needed for conomic success in a modern world. From September 2013 the school leaving age will rise to 17 and from 2015 it will rise to 18 years. The government have raised the leaving age due to research which shows that young people who carry on learning or training are likely to be healthier and less likely to get into trouble with the police. Students can stay at school, go to college, become an apprentice or join a part time training course. They can earn money and learn new skills at the same time. The main qualifications are: * Diplomas Vocational courses for those who know what career they would like to follow * A levels Academic Subjects * International Baccalaureate offering a wider range of subjects than A level * Functional skills This qualification can form part of the Diploma, usually in Maths, English and IT * Foundation learning has been developed for low achieving 14-19 year olds to help raise participation, attainment and progress From now the learning is more about what the child wants to do and less about what parents want them to do. Parents can help with the decision making process by talking through the child’s choices and offering to support them whatever their choice. New teacher’s standards were introduced by the Department for Education in September 2012. They set a clear baseline of expectations for the practice and conduct of teachers once they are qualified. The teacher’s standards are used to assess all trainees working towards QTS and all those on their induction period. They are also used when assessing the performance of all teachers subject to the Education (school teachers’ appraisal) (England) Regulations 2012. Local Government are responsible for providing advice and support to the schools in their local area. They are responsible for providing staff training and development, special educational needs, the curriculum community cohesion, school management issues, behaviour management and the development of school policies. Local Government will administer committees that deal with education and are responsible for investigations that the authority carries out on employees or potential employees of the authority or governing body of schools. They advise schools on the conditions of service for non-teaching staff and on their grading. They will also provide specifically trained teachers to support pupils who have special needs or need to be assessed for a particular learning need. These services are sometimes free of charge, but schools are usually expected to pay for them. They pass on any changes in policy and offer staff training through their local education development centre and in some cases whole school training. It is the responsibility of the schools to make sure they are up to date with all the current policies which are put in place for children, young people and their families. One of these is the Every Child Matters framework, which is one of the largest provisions that has been put in place for developing their roles in the community. They should have policies in place that meet the expected national requirements and also follow the LEA guidelines. OFSTED have two types of inspection of local authority children’s services: * Inspection of local authority arrangements for the protection of children: These unannounced inspections look at how effective the local child protection service is; and how well the local authority leads its associates in helping and protecting children. The inspection takes eight days. They carry out activities, such as looking at case files, talking to children, young people, parents and carers. They will inform the relevant senior manager if they find any unresolved issues of significant risk or harm to a child or young person. The lead inspector will write the report, which includes grades and it is then published on the website within 22 days, together with a version for children and young people. * Ofsted will inspect a further education college with residential care for young people under 18, such as Hereward College, Coventry. They offer residential placements and the required support for those with disabilities. * Secure Training Centres for young people aged 10-17 years who are on remand or serving a Detention and Training Order, or are subject to a secure order under section 25 of the Children Act 1989. * Residential special school for students with special educational needs * Cafcass provides advice to the family courts and provides support and advice for children and families involved in family court proceedings * Boarding school where children study and live during term time. Independent boarding school charge fees for tuition, board and lodging. Maintained schools only charge for board and lodging Clear lines of responsibility are in existence to ensure children are protected: * Department of Education – overall responsibility for safeguarding and child protection in England * Issue statutory and non-statutory guidance to local authorities * Local authorities – use guidance to produce procedures for services and practitioners * Services use as basis for their policies and procedures All the guidelines are intended to make sure that all services and agencies working with children and young people work together to improve safeguarding.