Lung Cancer Cases And The Evidence Used For Decide Patient...

I will be discussing two lung cancer cases and the evidence used to decide patient’s management. NSCLC A 65 year-old woman with known COPD on inhalers presented with a one-month history of a cough and increased shortness of breath. Lung function revealed FEV1 1.40 (54% predicted), TLCO (63% predicted) and patient performance status was 1. She proceeded to have staging CT scan/PET scan/EBUS and investigations all revealed final diagnosis stage IIIA T3N2M0 Non small cell lung cancer squamous (NSCLC). The patient’s case discussed at the lung MDT, decision was for concurrent chemoradiotherapy. I will be discussing evidence for concurrent chemoradiotherapy (CRT )in NSCLC versus sequential chemoradiotherapy and radiotherapy( RT)alone . Approximately 30% of NSCLC presented with stage III of which 12% have stage IIIA and 17.6 % stage IIIB disease. The 5 years’ overall survival OS figures for clinically staged IIIA and IIIB disease 18% and 8% respectively. The poor outcome observed are due to the loco regional failure 30% and distant failure 40-60%. Two randomised phase III trial in patients with staged IIIA NSCLC failed to demonstrate benefit of surgery in stage III N2 disease (Van Meerbeek et al .2007 ).4 Overall survival in patient with stag IIIA NSCLC who received concurrent CRT is 20-25% with median survival of 16-17 months .5 Radical radiotherapy, often combined with concurrent or sequential chemotherapy, is theShow MoreRelatedApproach to Cancer Care Essay2354 Words   |  10 PagesApproach to Cancer care Nursing 410v Grand Canyon University October 5, 2011 Staging is the process of finding out how much cancer there is in the body and where it is located. It is how the doctor learns the stage of a persons cancer. Doctors use this information to plan treatment and to help predict a persons outlook (prognosis). Cancers with the same stage tend to have similar outlooks and are often treated the same way. 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New Years Free Essays

Gabriela J. Bachman Professor Lathrop Writing 1 19 October, 2009 New Years at Home As I described in essay one, New Years for my family is a very important event and we celebrate it with a number of activities based in superstition. According to Wikipedia (1) superstition is defined as â€Å"a credulous belief, not based on reason. We will write a custom essay sample on New Years or any similar topic only for you Order Now The word is commonly applied to beliefs and practices surrounding luck, prophecy and spiritual beings, particularly the irrational belief that future events can be influenced†. Despite the fact that Catholicism is the main religion in my country, all Peruvians believe in superstition. New Years Eve is when people confirm these superstitions by performing a variety of strange rituals such as burning a â€Å"Muneco de Ano Nuevo†, wearing yellow wrist bands, eating grapes at midnight, and placing lentils in our pockets, all these in order to push some luck and prosperity into our life. In the following paragraphs I will be making a deeper analysis on the meaning of these rituals and explaining why these rituals are still being carried by Peruvian families. One of the most famous rituals and the first I described in essay one is building and burning our first â€Å"Muneco de Ano Nuevo. † A â€Å"Muneco de Ano Nuevo† is an effigy of an important public person that had caused a big commotion during the year. Since in the past decades, politics has been a topic that has caused deception and discontent to Peruvians; this is the reason why effigies are mostly created to represent politicians as showed in this passage from essay one: â€Å"we made an effigy of Alberto Fujimori, who was the president at that time, and who didn’t have a good reputation. Since my family is very interested in politics, this ritual is a joy for them. The part of the ritual they enjoy the most is the burning of the effigy. This doesn’t mean we want to see the real person in flames, but we see it as type of anger therapy, as means of getting rid of all the frustrations we have accumulated towards the politician during the past year, hopi ng he will change and consequently, he will help to bring prosperity to our country. Besides releasing our anger, building and urning the â€Å"Muneco† is also intended to bring the family together into a last activity of the ending year, and first activity of the starting year, hoping family unity will be maintained throughout the entire year. Everyone has an important role in this activity. Although my siblings and I were in charge of building the â€Å"Muneco de Ano Nuevo,†, my whole family contributed in different aspects, as this sentence from essay one clearly illustrates it: â€Å"we used mom’s tan pantyhose to build the face, dad’s old blue jeans and black suit jacket to build the body, and my grandfather’s white tennis shoes to make the feet. A very important role in this ritual is the role of the males, which is to protect their children by doing the most dangerous activities involved in this ritual, as this passage from essay one shows â€Å"my dad and uncles closed the street, sat the â€Å"Muneco† in the middle of the street, bath it on gasoline, and lighted it on flames†. A superstition that is more focused with our history is wearing a yellow wristband in New Years Eve. As I said in essay one â€Å"my mom gave to each of us a yellow wrist band which we wore the entire night†. In Peru, yellow is the dominating color of New Year because is associated with hope, happiness, and optimism. Likewise, yellow is the color of the good things in life such as the sun and gold. But this superstition has a deeper meaning of just being the color that identifies a celebration; in fact it has a connection with the past. For our ancestors, the sun was our God, and the gold was the treasure used to venerate him, but when Spain colonized Peru, they stole our gold and forced natives to change their religion. This is the main reason why we celebrate New Year in Yellow, as a way to award homage to our roots and ancestors, hoping our country will never have to go through this pain again. Lastly, two family oriented superstitions that were also mentioned in essay one are eating grapes at midnight and placing lentils in our pockets. Eating grapes right when the clock strikes midnight is a common superstition practiced in Peru and Latin America in general. â€Å"†¦ Right after, my mom and aunts ran to the kitchen to get the grapes (†¦) they handed us a bowl with twelve grapes each, which we ate under the table†. This example, as strange as it seems, involve us getting under the table to eat twelve grapes in only twelve seconds. Per each grape that we eat, which represents a month of the year, we get to ask a wish. If all the grapes are sweet, it means it will be a good year; in contrast, if for example the fourth grape was sour or not as sweet as the other ones, it means that April is not going to be a good month. As for the reason why we have to get under the table to eat the grapes, I think this just help us on concentrating when asking for the wishes and to avoid choking since all the grapes must be eaten very fast. Another family oriented superstition I mentioned is to carry lentils in our pockets during New Years Eve. In my country, people consider lentils as being a very nutritious food because it contains a big amount of proteins, minerals, and vitamins. As I mentioned in essay one â€Å"my mom handed us a handful of lentils that we put in our pockets for the entire night. † The illustration of the mother handing out lentils to her kids symbolizes the love and care the mother has towards their kids, providing nourishment and making sure they have the vitamins they need to grow strong. By practicing this superstition, we believe food will be available on our table throughout the whole year. Also, lentils resemble coins, thus we believe that carrying lentils in our pockets during New Years Eve will bring money to our home. (Transition) Although I have immigrated to a new country and culture, I will maintain these beliefs in my family, and I will pass it onto my children as my grandparents did to my parents, and my parents did to me. And whether or not all these superstitions are true, they have become part of the Peruvian history and folklore, making our New Year’s celebration unique. Work Cited (1) Wikipedia, the Free Encyclopedia. â€Å"Superstition. † Web. 19 Oct. 2009. http://en. wikipedia. org/wiki/Superstition How to cite New Years, Essay examples

A Global Perspective on Social Determinants

Question: Discuss about the Global Perspective on Social Determinants. Answer: Introduction Ebola is a condition with global dimensions attributed to factors such as its rapid and devastating transmission, and high fatality rate. The condition is yet to get a vaccine, hence making it a primary public health management and prevention challenge. Source and Transmission of Ebola Ebola is caused by Ebola virus (a filovirus), which affects humans and other primates (Gunn, 2008). It is a zoonotic disease; however, the natural reservoir is yet to be known regardless of extensive investigation. The primary source of infection has been determined to be non-human primates; but they are not reservoirs of the virus (Public Health England, 2016). According to Public Health Englands 2016 update on Ebola, the first cases in Ebola outbreaks are acquired through human contact with blood, body fluids, secretions or organs of infected animals. The virus has been found in people who handled infected wild animals such as antelopes, either alive or dead, in regions of outbreaks in Africa. Among humans, the virus is transmitted through close and direct physical contact with infected bodily fluids, of which blood, vomit and faeces being the most infectious (WHO, 2014). There are also reports of the virus being detected in urine, semen and breast milk. There is also some risk in saliva and tears, but there are no confirmatory study findings on them. According to WHO (2014), the virus can also be transmitted indirectly through contact with surfaces and objects that have been previously contaminated with infected secretions. Why the Condition Does Not Have a Vaccine Yet One of the most evident reasons hampering the development of the vaccine is attributed to the socio-economic and political forces in regions where the outbreaks often occur. Ebola outbreaks often occur in poor regions of the world, especially West Africa. The local facilities are limited in terms of medical research. Additionally, main pharmaceutical companies worldwide have no interest in vaccine development during the early phases of the disease. It is true that most tropical infectious diseases in poor tropical nations evoke little interest in funding and research for the development of vaccines by pharmaceutical companies (MacNeil Rollin, 2012). The Ebola virus has been detected for several decades but it seems to be neglected (Geisbert Jahrling, 2003). Geisbert and Jahrling further argue that there is minimal commercial interest for the development of this vaccine. Due to the minimal possibility that it may be a worldwide pandemic, there is minimal research and development dir ected for such. The second issue hampering the process is challenges in production cost and logistics. There are complex regulatory and liability issues surrounding the development. There is disagreement among major players such as the US, UK, and France regarding the issues of regulation and liability. Countries such as the UK suggest that producers and distributors of the vaccines should be provided with some form of relief from liability in order to fast-track the process (Cohen Kupferschmidt, 2014). This is however not the same views held by all countries involved in the development. Financing issues also exist. Economic powerhouses of the world are divided between unilateral financing or the use of a multi-donor club strategy (Cohen Kupferschmidt, 2014). In addition, logistical challenges in aspects such as the availability of storage facilities and cold chain capacity of receiving countries, are also inevitable Third, developing treatments for viral diseases proves more challenging compared to developing other treatments such as antibacterial therapy. This is attributed to the fact that viruses produce a few proteins, hence there are fewer targets for treatment. Due to this, it is challenging to develop a vaccine against the virus as the persons immune system has a small target. In addition, the evolution of the virus poses more challenges. Ebola viruses do evolve at a rapid pace; hence it is not certain whether vaccines developed today would be able to offer the same protection against future outbreaks. Still, on laboratory practices, another reason for the lack of a vaccine for the Ebola virus may be attributed to it being a dangerous virus. The virus has a very high mortality rate as high as 90 percent (Public Health England, 2016). Being that such dangerous requires that researchers work with the virus in special facilities equipped with the highest level of safety precautions. This li mits the number of experiments that can be done by researchers around the world. Working with the virus requires a biosafety level 4 laboratory (Rettner, 2014). Lastly, development of a vaccine for a viral condition such as Ebola may be hampered by the lack of human study subjects. Relatively few people do get infected with this condition, and even fewer of these do survive, hence making it difficult to study the virus in human subjects. In addition, there is the lack of new vaccine trial candidates (Wiwanitki Viroj, 2015). Comparing Public Health Management and Prevention of Ebola in Wealthy Vs. Poor Nations For purposes of comparison in this context, United Kingdom will serve as the wealthy nation whereas Uganda will be the poor nation. The UK has never experienced an Ebola outbreak, further, the risk for the same is quite negligible (NHS Choices, 2015). However, the government has always been vigilant whenever outbreaks have occurred anywhere else in the world. Other than local management interventions, the country has also participated in international management at the sites of outbreaks. On the other hand, Uganda has a record of Ebola outbreaks, the latest being the five outbreaks between 2000 and 2012 with 425 cases and 224 deaths occurred (Okware, et al., 2015). In an event of an Ebola outbreak anywhere, the UK government closely monitors the spread of the virus and also takes action both at home and abroad. The initial response is to prepare the NHS by developing and testing the systems for the management of unusual infectious diseases (UK government, 2016). In addition, screening at UKs ports of entry is heightened. Anyone coming into the country and who had a chance of being exposed to the virus is referred for screening. Any passenger coming from the affected countries are also followed up for risk assessment (UK government, 2016). In its response to outbreaks in Africa, UK works with the WHO and the wider international community in combating the infection at the source. On the countrys government website, it also offers support to international agencies such as the world bank, directly offers medical help on the ground, deploys teams of experts from the NHS to offer support, trains frontline workers, supports scientific research and tes ting, and also fast-tracks vaccine trials (UK government, 2016). Ugandas response to the manage the outbreak and also prevent further spread was based on early detection and action, community mobilisation, and international collaboration (Okware, et al., 2015). The countrys efforts were focused on treatment and not just quarantine in an effort to enhance public trust and also promote health seeking behaviours. Early detection and action lead to favourable outcomes and results. This is evidenced by the ability to easily contain the rural outbreaks. Community-imposed quarantines further prevented the spread and introduction of the virus into neighbouring districts. Community mobilisation and leadership were well-adapted to support early case detection and isolation, and also for the purposes of public education and contact tracing (Okware, et al., 2015). Early detection and action facilitated containment of the outbreak to the source. Outbreak control efforts were further supported by the elements of community mobilisation and leadership. Internatio nal support was also sought to augment the nations efforts in containment and management. Survivability was also improved through palliative care measures. Ugandas efforts in isolation and case management in managing the outbreak especially in cases such as the Gulu outbreak evidenced by a reduction in mortality (Lamunu, et al., 2004). As reiterated by Okware, et al., (2015), in summary; Ugandas efforts were; first, strengthening of leadership at the community level, second, strengthening of laboratory capacity for early detection, third, the improvement of supportive treatment and not just quarantine and isolation, fourth, elimination of gaps in barrier nursing through the institutionalisation of infection control policies, and lastly the development of human resource policy and plans to attract and retain workers. References Cohen, J., Kupferschmidt, K. (2014, October 23). Leaked documents reveal behind-the-scenes Ebola vaccine issues. Retrieved from Science: https://www.sciencemag.org/news/2014/10/leaked-documents-reveal-behind-scenes-ebola-vaccine-issues Geisbert, T. W., Jahrling, P. B. (2003). Towards a vaccine against Ebola virus. Expert Review Vaccines, 2(6), 777-789. Gunn, S. W. (2008). Understanding the Global Dimensions of Health. New York: Springer Science Business Media. Lamunu, M., Lutwama, J. J., Kamugisha, J., Opio, A., Nambooze, J., Ndayimirije, N., Okware, S. (2004). Containing a haemorrhagic fever epidemic: the Ebola experience in Uganda (October 2000-January 2001). International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases, 27-37. MacNeil, A., Rollin, P. E. (2012). Ebola and Marburg hemorrhagic fevers: neglected tropical diseases? PLoS Neglected Tropical Diseases, 6(6), e1546. doi:https://dx.doi.org/10.1371/journal.pntd.0001546 NHS Choices. (2015, March 12). Ebola risk remains low as medic flown home. Retrieved from NHS Choices: https://www.nhs.uk/news/2014/07July/Pages/UK-Ebola-case-confirmed-but-risk-remains-low.aspx Okware, S. I., Omaswa, F., Talisuna, A., Amandua, J., Amone, J.Onek, P.Kagwa, P. (2015). Managing Ebola from rural to urban slum settings: experiences from Uganda. African Health Sciences, 15(1), 312-320. Public Health England. (2016, August 19). Ebola: overview, history, origins and transmission. Retrieved from Public Health England: https://www.gov.uk/government/publications/ebola-origins-reservoirs-transmission-and-guidelines/ebola-overview-history-origins-and-transmission Rettner, R. (2014, June 23). Retrieved from LiveScience: https://www.livescience.com/46479-ebola-treatment-cure.html UK government. (2016). How the UK government is responding to Ebola. Retrieved from Gov.uk: https://www.gov.uk/government/topical-events/ebola-virus-government-response/about WHO. (2014, October 6). What we know about transmission of the Ebola virus among humans. Retrieved from World Health Organization : https://www.who.int/mediacentre/news/ebola/06-october-2014/en/ Wiwanitki, S., V. W. (2015). Ebola vaccine 2014: remained problems to be answered. Asian Pacific Journal of Tropical Biomedicine, 85-86.