Breast Cancer and Palliative Care Issues

Breast Cancer and Palliative Care Issues Hina Mirza The purpose of this writing is to highlight issues of the patient in palliative consideration, which a patient faced throughout the disease process and at terminal stage of illness. Moreover, it will drag one’s attention towards some strategies to deal patient with advance cancer. A 54 year old female with known case of ductal cell carcinoma of left breast, came to the hospital with the complaint of oozing and pain in fungating wound large in size present at the primary site of tumor. When I encountered the patient, she was very drowsy and unable to talk due to mouth ulcers that have been developed a week ago. Upon taking history from the patient’s attendants, they verbalize that the patient got breast cancer for 1.5 years and since then she was on homeopathic treatment. Moreover, the patient initially didn’t inform anyone about her disease, not even to her husband. Later, when symptoms got exacerbate she disclosed her problem to the family members. Consequently, she was taken to a cancer hospital, where a doctor recommended her for a biopsy. Thus, the results revealed breast carcinoma. Even after, she didn’t consult to the doctor and continued her homeopathic medication. While taking care of the patient, I got an opportunity to approach her about the reasons behind postponement in the diagnosis and the variables that make her condition decline. One of the reasons she gave in regards to not counseling a specialist or not having a legitimate treatment was monetary instability, an alternate reason was absence of awareness with respect to tumor treatment and misconceptions identified with its side effects. Besides, after a time of 1 year when her condition got crumble and a tumor in her breast uncovered as fungating wound, a relative took her again to the cancer hospital, from that point she was referred to the Baitul Sukoon for palliative consideration. The patient verbalizes torment because of mouth ulcers and as indicated by speciali sts her tumor has been metastasized to different parts of the body including liver and brain. Moreover, the patient likewise expressed that she will give priority to the treatment other than surgery on the grounds that she is afraid about losing her breast and it will alter her body image. In addition to it, the patient’s attendant stated that her nutrition pattern has been also effected which causes weakness. The patient was prepared and very much aware of her condition. For a week she has been on laxatives and as indicated by the specialist she had developed encephalopathy. Following 2 weeks of hospitalization; she died because of deteriorated condition. Breast cancer is a serious health issue among women throughout the world. According to a consultant at Shaukat Khanam Memorial Cancer Hospital, in Pakistan it is estimated that 1 in 9 women develops breast cancer once at any stage of their life. Cancer affects a person not only physically, but also cause spiritual, sexual, and psychological distress. When considering a physical domain of the patient in palliative care, she was suffering from pain and mouth ulcers which as a result altered her communication pattern. On the other hand, she was very drowsy, her dietary intake has also decreased and the patient has not passed stools for 2 days. Looking forward to the above mentioned symptoms firstly, mouth sore is among common indications in cancer patient in light of the fact that when patients are in critical condition, they lack oral hygiene as a result becomes more prone to infection. In addition to it, infections in cancer patients remain a major complication due to effects of malig nancy i.e. neutropenia. These patients require prompt antibiotics (Bodey, 2004). As the patient mentioned in the above scenario was getting augmentation. As indicated by literature, oral cavity plays a vital role in communication and dietary pattern and in cancer patient alterations in the oral cavity is common because of the certainty of diminished in preventive consideration (Eilers Million, 2011). Secondly, impaired oral cavity results in decreased intake of food that is critical at this stage of cancer. Decline in nutrition is considered normal at the terminal stage of life as a result malnutrition, cachexia is commonly found in patient with palliative care (Capra, ferguson, Ried, 2001). Thirdly, the patient was showing symptoms of encephalopathy. As literature evidenced that as an outcome of some metabolic disturbance, encephalopathy is a common clinical syndrome in cancer patients (Lore, Anne, Patrick, Simon, 2012). Relating it to the above scenario, the patient has been be d ridden for 2 months, not passing stool and she has been on laxative since 2 weeks. The purpose of giving laxative was to prevent hyper ammonia in the body which can cause encephalopathy. According to Willson, Nott, Broadbridge, Price (2013) hepatic encephalopathy as a result of liver infiltration is common among metastatic malignancy. Analyzing the psycho-social factors that becomes hindrance to care and approach to treatment as part palliative care were fear related to losing her breast, unawareness of the patient and her family members about disease and treatment options linked with socio-cultural barriers, financial issues, and preference towards alternative drugs i.e. homeopathic treatment. According to a research it was found that patients with breast cancer who consulted a doctor had fear of mastectomies. Firstly, the reason behind fear was lack of awareness about treatment option available for breast cancer such as procedures that are less invasive like lumpectomies. Due to the fact, women avoid availing proper check up and maintained non-compliance to the cancer therapy (Memon et al., 2013). Secondly, among socio-cultural barriers, lack of information related to disease due to low education reported by women. This ultimately delays the approach to health care, even with prominent signs and symptoms of a di sease such as nodule, edema and erythema. One of the reasons behind avoidance is social myths, society including friends and family gives different meaning to these symptoms, which minimize its seriousness. Moreover, cultural barriers have strong impact on getting awareness related to breast cancer. According to Banning, Hassan, Faisal, Hafeez (2010) many Asian women do not perform self breast examination because of a taboo related to touching own body parts, feeling embarrassment to discuss intimate body parts and to consult a male physician. According to literature myths around the pathology of breast cancer causes late diagnosis and hindrance to care (Goncalves et al., 2014). Thirdly, cancer treatment is considered financially devastating burden to the family because they have to pay for the treatment by themselves (Daher, 2012). Therefore, initiating treatment becomes psychologically distressing for the patient and for the family. Relating it to the scenario, the patient didnâ €™t disclose her problem to the family member due to myths and unawareness related to disease. Lastly, in my opinion the main factor that contributes to delay in diagnosis and worse the patient’s condition was preferences for homeopathic medicine and this again could be linked with lack of awareness related to the availability of treatment options. According to a research it’s commonly reported that individual with cancer seek alternative medicine due to misconception associated with treatment options (Daher, 2012). Moreover, unconventional methods, including traditional herbal medicine and healers over doctors for cancer treatment also reported in a study of women associated with delay seeking medical advice (Memon et al., 2013). Numerous factors contribute towards, delay and obstruction in treatment of breast malignancy. In terms of prioritize the variables that add to delay in diagnosis were unawareness related to the options available for treatment, socio-cultural hindrances, choosing alternative medicine, and financial issues. On individual level health professionals must respect autonomy of the patient and inclination of treatment. It is ones obligation to explain potential harm of such alternative treatment. Besides, when health care prrovider experience patients with breast tumor, they should explain its risk factors and preventive measures to the patient and their family members for precautionary purpose. On hospital level, staff should be well trained to deal cross culturally and care for the patient with interdisciplinary aspects and according to patients needs. These can include care according to patient’s comfortability level, counseling patient’s family regarding disease and helping them to select suitable and appropriate treatment options. Moreover, the Government should organize an awareness program to educate the patient with respect to primary prevention, which includes awareness related to self breast examination, treatment options that are less invasive as a secondary prevention and tertiary prevention that should include the concept of palliative care, and information about the institution that provide palliative and hospice care. On the other hand, female health care professionals should be given first priority to be trained to deal with culturally sensitive issues. Together, these contributions can help to eradicate issues related to breast cancer and will support patients suffering from it. References Banning,M., Hassan,M., Faisal,S., Hafeez,H. (2010). Cultural interrelationships and the lived experience of Pakistani breast cancer patients.European Journal of Oncology Nursing. doi:10.1016/j.ejon.2010.05.001 B-Articles. (n.d.). Retrieved from https://www.shaukatkhanum.org.pk/news-a-events/events/228.html BODEY,G. (1986). Infection in cancer patients: A continuing association.American Journal of Medicine. doi:10.1016/0002-9343(86)90510-3 Capra,S., Ferguson,M., Ried,K. (2001). Cancer: impact of nutrition intervention outcome—nutrition issues for patients.Nutrition. doi:10.1016/S0899-9007(01)00632-3 Daher,M. (2012). Cultural beliefs and values in cancer patients.Annals of Oncology. doi:10.1093/annonc/mds091 Eilers,J., Million,R. (2011). Clinical Update: Prevention and Management of Oral Mucositis in Patients with Cancer.Seminars in Oncology Nursing. doi:10.1016/j.soncn.2011.08.001 Gonà §alves,L.C., Travassos,G.L., Almeida,A.M., Guimarà £es,A.N., Gois,C.F. (2014). Barriers in health care to breast cancer: perception of women*. Retrieved from DOI: 10.1590/S0080-623420140000300002 Kingsley,C. (2010).Cultural and Socioeconomic Factors Affecting Cancer Screening, Early Detection and Care in the Latino Population. Lore,L., Anne,S., Patrick,S., Simon,V.B. (2012). Neoplasm Related Encephalopathies. InMiscellanea on Encephalopathies A Second Look(pp.91-120). INTECH Open Access Publisher. Memon,Z.A., Shaikh,A.N., Rizwan,S., Sardar,M.B. (2013). Reasons for Patient’s Delay in Diagnosis of Breast Carcinoma in Pakistan. Retrieved from DOI:http://dx.doi.org/10.7314/APJCP.2013.14.12.7409 Willson,K.J., Nott,L.M., Broadbridge,V.T., Price,T. (2013). Hepatic Encephalopathy Associated With Cancer or Anticancer Therapy.Gastrointest Cancer Research,6(1), 11-16. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3597933/

Conservation of Endangered Marsupials Essay -- Breeding Genetics Repro

Conservation of Endangered Marsupials Marsupials are creatures that are a very unique group of mammals. Many creatures are becoming threatened, and some have already become extinct. Threatened marsupials could be a pool of agricultural, medicinal, or genetic wealth that we do not yet have the technology to utilize. There are many methods to conserving these genetic pools; one of which is through reproduction manipulation. Artificial insemination, embryo transfer, and nuclear transfer are ways in which marsupials can be conserved if proper adjustments are made. Special considerations for artificial insemination of marsupials include equipment for collection and distribution, freezing, cryoprotectant and storage, and seasonality issues. Special considerations for embryo transfer include seasonality, collection, equipment for distribution, cryoprotectant and storage, and synchronizing both cycle and lactation of recipient. Special considerations of nuclear transfer include seasonality, protecting the compromised embr yo, uterine compatibility, gestation, and synchronization of both estrus and lactation due to embryonic diapause. If all adjustments are considered, then successful artificial insemination, embryo transfer, or nuclear transfer can occur. Examples of such successes will be discussed as well as some trial and errors. With more research and technological development, conservation of endangered or threatened marsupials can become more efficient to ensure the survival of these genetic marvels. Introduction Marsupials are very unique creatures with rare attributes which indicate the link between modern mammals and more primitive species. The possibility of extinction is threatening marsupial populations; so... ...supials. Reproduction, Fertility, and Development 13: 653-659. Taggart, D. A. 1994. A Comparison of Sperm and Embryo Transport in the Female Reproductive Tract of Marsupials and Eutherian Mammals. In Marsupial Reproduction: Gametes, Fertilization, and Early Development Reproduction, Fertility and Development 6, 31-52. CSIRO Australia. Temple-Smith, Peter D. 2003. Integrating Reproductive Sciences into Recovery Programmes for Declining and Extinct Marsupial Populations. In Reproductive science and integrated conservation, ed. William Holt, Amanda Pickard, John C. Rodger, David Wildt. Cambridge University Press, Cambridge. Tyndale-Biscoe, Hugh, Marilyn Renferee. 1987. Reproductive Physiology of Marsupials. Cambridge University Press, Cambridge. Youngs, Curtis. March 31, 2005. Personal Interview. Iowa State University. Dr. of Animal Science.

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Definition and Examples of Peer Response in Composition

In composition studies, peer response is a form of collaborative learning in which writers meet (usually in small groups, either face-to-face or online) to respond to one anothers work. Also called peer review and peer feedback.In Steps to Writing Well (2011), Jean Wyrick summarizes the nature and purpose of peer response in an academic setting: By offering reactions, suggestions, and questions (not to mention moral support), your classroom colleagues may become some of your best writing teachers. The pedagogy of student collaboration and peer response has been an established field in composition studies since the late 1970s. See the observations below. Also see: Collaborative WritingAudienceAudience AnalysisAudience Analysis ChecklistFeedbackHolistic GradingImplied AudienceOnline Journals for Composition InstructorsRevisionWriting CenterWriting PortfolioWriting Process Observations The teacherless writing class . . . tries to take you out of darkness and silence. It is a class of seven to twelve people. It meets at least once a week. Everyone reads everyone elses writing. Everyone tries to give each writer a sense of how his words were experienced. The goal is for the writer to come as close as possible to being able to see and experience his own words through seven or more people. Thats all.(Peter Elbow, Writing Without Teachers. Oxford University Press, 1973; rev. ed. 1998)Writing collaboratively has all the characteristics that theorists of cognitive development maintain are essential for the intellectual commitments of adulthood: The experience is personal. The response groups promote intellectual risk-taking within a community of support. They allow students to focus on issues that invite the application of academic knowledge to significant human problems. Thinking and writing are grounded in discussion and debate. Reading and responding to peers writing a sks for interpersonal and personal resolution of multiple frames of reference. In this sense, collaborative writing courses at all levels provide an essential opportunity to practice becoming members of an intellectual, adult community.(Karen I. Spear, Peer Response Groups in Action: Writing Together in Secondary Schools. Boynton/Cook, 1993)Peer Review Guidelines for the ReviewerIf you are the reviewer, remember that the writer has spent a long time on this work and is looking to you for constructive help, not negative comments. . . . In that spirit, offer suggestions about how to revise some of the awkward places, rather than merely listing them. Instead of saying This opener doesnt work! indicate why it doesnt work and offer possible alternatives. . . .It is also important that you try to read the piece from the point of view of the intended audience. Do not try to reformulate a technical report into a novel or vice versa. . . .As you read, make no comments to the author--save the m for later. If you need to ask the writer for clarification of the prose, that is likely a flaw in the writing and needs to be noted for discussion after you have finished reading the entire piece.(Kristin R. Woolever, About Writing: A Rhetoric for Advanced Writers. Wadsworth, 1991)Students gain confidence, perspective, and critical thinking skills from being able to read texts by peers on similar tasks.Students get more feedback on their writing than they could from the teacher alone.Students get feedback from a more diverse audience bringing multiple perspectives.Students receive feedback from nonexpert readers on ways in which their texts are unclear as to ideas and language.Peer review activities build a sense of classroom community.Benefits and Pitfalls of Peer Response[A] number of practical benefits of peer response for L2 [second-language] writers have been suggested by various authors:On the other hand, researchers, teachers, and student writers themselves have identified potential and actual problems with peer response. The most prominent complaints are that student writers do not know what to look for in their peers writing and do not give specific, helpful feedback, that they are either too harsh or too complimentary in making comments, and that peer feedback activities take up too much classroom time (or the corollary complaint that not enough time is allotted by teachers and the students feel rushed).(Dana Ferris, Response to Student Writing: Implications for Second Language Students. Lawrence Erlbaum, 2003) Also Known As: peer feedback, peer review, collaboration, peer criticism, peer evaluation, peer critique