Adverse Event Management in Chemotherapy Cancer Patients

Adverse Event Management in Chemotherapy Cancer Patients Results RESULTS In this prospective interventional study conducted at the KMCH hospital during a period of December 2013 to July 2014, a total of 63 cancer patients who received chemotherapy from the comprehensive cancer center of the hospital were included in the study. ASSESSMENT OF PATIENT CHARACTERISTICS The demographic details among the subjects revealed that most of the cancer cases fall in the age group of 40-59, having 52.38% patients in this age group followed by 34.92% patients in the age group of ≠¥ 60 years old [Table 2 Figure 1]. Out of this, the majority of patients receiving chemotherapy were females, 55.55% whereas males were only 44.44%. [Table 3 Figure 2] Evaluation of the subjects based on their education level revealed that out of the total population 66.66% falls in the category of educated while 33.33% were uneducated. [Table 4 Figure 3] On analysing the subjects based on their diagnosis, gastrointestinal (GI) cancers (33.33%) were found to be the most common diagnosis followed by breast cancer (17.46%). [Table 5 Figure 4] Assessment of comorbidities revealed hypertension (22.22%) as the most common comorbidity seen amongst our subjects, closely followed by diabetes mellitus (19.04%). [Table 6 Figure 5] Among the different types of adverse effects documented the predominant types consisted of fatigue (84.12%) and insomnia (68.25%). [Table 7 Figure 6] ASSESSMENT OF IMPROVEMENT IN PATIENT’S QoL Study population: 63 Analysis: Friedman’s Test This analysis was carried out for evaluating the change in QoL of the patients as part of the adverse event management given from pre-intervention assessment to first and second review of the patients. We found that adverse event management had a significant effect on the QoL of the patients with regard to global health status, functional scales, symptom scales and symptom and limitation scales (P Global Health Status/QoL: The global health status showed a significant change with improvement from 1.02 in the pre-intervention assessment to 2.04 and 2.94 in the first and second reviews respectively. This change was statistically significant with a P-value of 0.0001. Functional Scales: The assessment of functional scales showed that the physical functioning of the cancer patients improved with time. During the pre-intervention assessment, the mean rank was 1.24 which then increased to 2.29 2.48 over the next 2 reviews respectively. The improvement was significant with the P-value of 0.0003. The scale of role functioning also varied clearly with time, it improved from 1.34 during the initial assessment to 2.16 and 2.50 at follow-up visits. This change was statistically significant with the P-value of .0001. The emotional functioning scale increased from an initial value of 1.54 in the initial assessment to 2.07 and 2.39 at the subsequent visits respectively. This improvement was statistically significant with a P-value of 0.0002. Also, the social functioning showed a significant improvement in the score from an initial value of 1.41 at the initial assessment to 2.17 and 2.42 over the follow up period of first and second review respectively. This change was statistically significant with a P-value of 0.0001. Symptom Scales: On assessing the symptom scales, symptom in the form of fatigue decreased over the study period from an initial value of 2.86 at the initial assessment to 1.78 and 1.37 in the subsequent reviews. This change was statistically significant with a P-value of 0.0001. The symptom scale of nausea and vomiting also showed a significant improvement from 2.60 at pre-intervention assessment to 1.95 and 1.45 in the follow up period which was statistically significant with a P-value of 0.0003. The pain symptomatology decreased from a value of 2.52 in the initial assessment to 1.87 and 1.61 during the follow up period. This was a statistically significant improvement with a P-value of 0.0003. The symptom scale of dyspnoea also decreased from the initial value of 2.37 to 1.93 in the first review and 1.71 during the second review, which was a statistically significant change with a P-value of 0.0001. As far as symptomatology in the form of insomnia is concerned, it decreased from the initial value of 2.67 in the pre-intervention assessment to 1.83 and 1.49 in the subsequent reviews with a statistically significant change which gives a P-value of 0.0002. When symptom in the form of appetite loss was assessed, it showed a marked decrease from a mean rank of 2.52 at the initial assessment to 1.85 and 1.63 during the first and second reviews respectively. This improvement was statistically significant with the P-value 0.0001. The symptom scale of constipation improved over the study period from an initial mean of 2.37 to 1.88 and 1.75 in the subsequent follow ups of first and second review which was a statistically significant change with a P-value of 0.0001 while diarrhoea also decreased from a mean rank of 2.22 at initial assessment to 1.93 in the first review and 1.85 during the second review. This change was statistically significant with a P-value of 0.0002. Symptom and Limitation Scales: Limited normal eating or drinking habits of the patients also decreased from a mean rank of 2.72 in the pre-intervention assessment to a value of 1.94 and 1.33 in the successive assessments. This improvement was statistically significant with a P-value of 0.0003. The symptom in the form of sore mouth improved over the study period from an initial value of 2.17 to 1.95 and 1.87 in the next 2 consecutive reviews which was a statistically significant change with a P-value of 0.0004. Limitation in the activities due to adverse effects also showed a significant improvement from an initial value of 2.60 to 1.97 and 1.44 in the following 2 reviews respectively. This progress was statistically significant with a P-value of 0.0003. Knowledge about infection and its prevention showed a noteworthy improvement in the study period. The value decreased from 2.98 in the initial assessment to 1.72 and 1.30 in the subsequent reviews which was a statistically significant change with a P-value of 0.0002. Difficulty in managing symptoms also showed a drastic improvement from an initial value of 2.96 in the pre-intervention assessment to 1.73 and 1.31 in the next 2 reviews with a statistically significant change at a P-value of 0.0001. ASSESSMENT OF PATIENT’S QoL AGAINST AGE Study Population: 63 Analysis: One-way ANOVA The patient’s QoL against age was assessed in order to determine whether age has any influence on the adverse event management and we found that age has significant role in global health status, functional scales as well as on symptom scale and symptom and limitation scales (P Global Health Status: In our study, the global health status was found to have a significant improvement among the age group of 18-39 during reviews 1 (P=0.035) and 2 (P=0.003). Functional Scales: Physical functioning was at its higher side in the age group of 18-39 from the initial assessment (P=0.043) and the functioning was significantly improved and maintained during the successive reviews (P= 0.0001). Role functioning was found to be higher in the age group of 40-59 from the pre-intervention assessment (P=0.004) which was found to have improved during the first review (P=0.0001) and this improvement was sustained over the second review (P=0.0001) as well. At the same time, emotional functioning showed a significant improvement during the first review (P=0.0003) among this age group which was further maintained in the subsequent review. Social functioning also showed a significant change among the population above 59 years by the second review (P=0.0002). Symptom Scales: Symptom in the form of nausea and vomiting was seen mostly in the age group of 40-59 years. It showed a significant reduction from the initial assessment (P=0.023) to first review (P=0.011) and the improvement was upheld in the second review. The normal eating or drinking habits were also significantly reduced (P=0.018) highly among this group of patients which was considered to be secondary to the high level of nausea and vomiting experienced. The symptom was further improved during the subsequent follow ups but the change was not statistically significant. Fatigue was most commonly seen among the ≠¥ 60 age group and it showed a significant reduction from the initial assessment (P=0.026) to first review (P=0.039) and second review (P=0.0002). Symptom and Limitation Scales: Limitation in the activities due to adverse effects showed a significantly high reduction in the patients of 18-39 age group during their second review (P=0.026). And, in the knowledge regarding infection, its prevention and management, patients among the 40-59 age group also showed a statistically significant improvement during their second review (P=0.022). In addition, management of symptoms based on the instructions given had also shown a significant improvement among this group of patients from review 1 (P=0.047) to review 2 (P=0.004). ASSESSMENT OF PATIENT’S QoL AGAINST COMORBIDITIES Study Population: 63 Analysis: Independent t-test Among our study population, 25 patients presented with comorbidities. The purpose of this analysis was to check whether comorbidity plays any role in adherence management and we found that it only has a significant effect on the normal eating or drinking habits as well as on awareness about infection and management of symptoms (P Patients with comorbidities showed a significantly normal eating or drinking habits during the baseline assessment (P=0.002) and was improved further during the study period. In the knowledge regarding infection, its prevention and management, the patients without comorbidities showed a significant improvement during review 1 (P=0.009) which was sustained in review 2 (P=0.014) as well. Also, this category of patients showed a significant ability to manage the symptoms with the instructions given which was found to be improved during their first review (0.007). ASSESSMENT OF PATIENT’S QoL AGAINST EDUCATION Study Population: 63 Analysis: Independent t-test This analysis was performed to determine whether education has a role in the adverse event management and we found that patients with education shows significant improvement in physical functioning, role functioning, fatigue, appetite loss, limitation of activities and awareness about infection (P In educated patients, physical functioning was higher from the baseline assessment (P=0.015) which was further maintained throughout the first review (P=0.030) and second review. Role functioning was also higher and maintained among this group from the initial assessment (P=0.008). The symptom fatigue also shown a remarkable improvement by second review (P=0.006) alongside knowledge about infection (P=0.039). Appetite loss shown a reduction during first review (P=0.010) which was further improved and maintained throughout the follow up period while limitation in activities were considerably low from the baseline assessment (0.032) which was sustained throughout the study period. [Table 11] EVALUATION OF THE ADVERSE EVENT MANAGEMENT The evaluation is done using results of quality of life assessment as well as through patient interviews during their reviews. The patients were asked about the usefulness of the adverse event management and tools provided and they were also asked to report the tips they had used. Among our subjects, the symptom of nausea was found among 39 patients [Table 12] and vomiting was seen among 32 patients [Table 13]. They had shown a considerable improvement throughout the study period and most of them were able to report at least one tip they had used. The tip that had been reported by most patients were â€Å"If the smell of food bothers you, let the food cool down before you eat it† and also the patients started taking the anti-emetics prescribed even on days they were experiencing less severe nausea or vomiting. Out of the study population 48 were found to experience fatigue and the symptom was improved and the improvement was sustained throughout the study period. â€Å"Listen to your body, rest when you tired† and â€Å"do activities that are most important† were the tips used by most of the patients [Table 14]. Appetite loss was another symptom experienced by 32 of the subjects which further improved during the study period. â€Å"Drink soups that are easy to swallow† was the tip mostly reported, closely followed by â€Å"watch television while you eat†. [Table 15] About 24 of the patients experienced constipation [Table 16] while 15 had diarrhoea [Table 17]. The symptoms were improved during the follow up period and the patients were able to report the tips they had used and found beneficial. Most of the patients tried including more fruits and vegetables into the diet and also as instructed when the symptom was severe they consulted the physician and taken the medication. Among the study population 12 had mouth sores which improved over time and most of them had tried the mouth wash recipe and drinking through straw as per the tips provided to them [Table 18]. As far as the identification, prevention and management of infection was concerned, most of the study population was found to be lacking any knowledge in these, which then increased considerably during the study period with the information provided regarding the infection [Table 19].

Why Do Students Cheat?

Professor Anderman’s research shows that eighty-five percent of students have cheated in high school; this drastic number exists due to the fact that students want to attend excellent colleges. The competitive high school environment has constant pressure to succeed; therefore, thus, many students depend on cheating in order to receive the grades that he or she desires. Because cheating has become an ordinary resolution for many students, more and more students do so every day, mimicking the action of their peers.Unfortunately, the eighty-five percent of students who cheat would prefer a higher score than the chance to grow as a learner. All of the cheating boils down to one simple concept: college acceptances. To begin, students cheat in order to get accepted to the college of their choice. As Kolker explains, students believe that, â€Å"College, more than ever, determines success. † As a high school student in 2013, one will constantly hear other students saying, â⠂¬Å"I need to get into a top college, my whole future depends on it! † and â€Å"Oh man, I didn’t do well on that test, now I am not going to get into college.†In this day and age, teenagers have a mind-set that they only attend high school in order to be accepted into a prestigious college, rather than learning and developing as a student. These students only think about what they must do in order for top colleges to choose them; thus, if cheating is the answer, they will cheat to receive the better grade. Anderman’s research discovered that, â€Å"The most impulsive cheaters cheated less often when they believed the point of the test was to help them master the material, not just get a score.†This concept is seen in an AP Calculus class of high school juniors and seniors. The teacher has a policy that quizzes are not factored into the student’s grade; however, tests are a very important factor for the student’s grade. The quizzes are designed to help the students learn, while the tests are designed to test the student’s abilities by receiving a score. In this situation, when there is an upcoming quiz, many students are very lackadaisical and rarely study for the assessment.Conversely, on a test day, the calculus students run around frantically trying to receive questions and answers from students who have already taken the same test, a prime example of cheating. Thus, this proves that students cheat in order to receive a high grade, as they don’t cheat for a quiz that does not determine their final grade. The next criminal in this cheating era is the SAT. Eshagoff, a student who participated in the Long Island SAT scandal, stated, â€Å"By giving him an amazing score, I totally give him †¦Ã‚  a new lease on life,† proving that students view the SAT as determining their future.Evidentially, something in this system is corrupt when one test is what determines whether or not a boy receive s a â€Å"new lease on life. † It is this idea that causes drastic cheating rings. Students believe that their entire life is predestined to failure if they do not succeed on major tests; therefore, they resort to cheating. This relates to Anderman’s theory that, â€Å"If everything is always high-stakes, you’re going to create an environment conducive to cheating.†It is very tempting for a student with awful grades to cheat because he or she knows that he or she has an opportunity to receive an exemplary score on the SAT. This student would consider the fact that without cheating, he or she would most likely go to a below average college which some students view as unacceptable in this college dominating culture, where everyone links the rest of their life to the college they attend. This is why the vast cheating rings occur, such as the Long Island SAT scandal: to enhance ones chances of going to a better college.Unfortunately, cheating will continue as long as it is the social norm. Dan Airley, a Duke social scientist, explains that students are more likely to cheat if everyone else is cheating as well. He explains, â€Å"There is right and wrong, and there is what people around us tell us is right and wrong. The people around us are often more powerful. † If many students are clearly cheating while taking a test, the chances that other students will cheat too increase greatly.This is demonstrated through the Carnegie Mellon experiment, where actors were hired to portray cheating students to see how the actual students would respond. The variable was that in one room, the actor was wearing University of Pittsburgh apparel. However, in the other room, the actor was wearing Carnegie Mellon apparel. The study resulted in more students cheating in the room with the University of Pittsburgh actor than in the room with the Carnegie Mellon actor. This is due to Airley’s idea that, â€Å"The people around us are often more powerful.  Ã¢â‚¬ The Carnegie Mellon students are apart of a community with the Carnegie Mellon â€Å"student† who cheated; consequently, they viewed it as acceptable to cheat because their fellow classmate was cheating. Yet, the University of Pittsburgh â€Å"student† is an outsider and as a result, the other students do not associate themselves with him; thus, fewer students follow his academic dishonest actions. Airley used an excellent analogy to relate this scenario with speeding on the road. He states, â€Å"There’s a speed limit, but you see people around you driving at a certain speed, and you get used to it pretty quickly.†As Airley explains, it is significantly easier to do something that is obviously immoral when everyone else is participating too. The pressure to succeed in high school in order to attend a prestigious university produces an environment where cheating is somewhat acceptable, enough that eighty-five percent of students have admitted to cheating before. This is a never-ending chain, as cheating becomes tolerable to students once everyone else is participating in this unjust act.The preconceived notion that all that matters in a teenager’s life is the colleges they are accepted to has developed a culture in which being academically dishonest has become the standard. Whether it is creating a texting group to distribute test questions and answers, asking friends for help on a test that they already took, or having someone else take the SAT for you, cheating has become an everyday part of high school life. In American culture, a college acceptance letter is far more important to a student than his or her dignity and honesty, something that must change within our society.

Character Analysis of Shylock in William Shakespeare´s...

The presentation of a character may affect the amount of sympathy the character gains from the audience. Shakespeare presents the character of Shylock as a flesh eating, greedy and obsessive character in his play ‘merchant of Venice’; by doing this Shakespeare manipulates the response Shylock gets from the audience in Act 4 Scene 1. Our response is manipulated by S. so most of the audience, by the end of the play, feel none or very little sympathy towards the character of Shylock. The audience see the side of Shylock, who is driven by the desire for revenge. At the start of the play Shylock says in his soliloquy ‘If I can catch him once upon the hip’ this shows his crave to catch Antonio out, it also shows that all Shylock wants is the upper hand; to have power over Antonio. In that same speech he also says ‘feed fat the ancient grudge’ indicating that he will feed fat of Antonio as a way of revenge and this will be the only thing that satisfies him to the full. Shakespeare uses alliteration in this speech, which makes it more memorable for the audience so they can remember the thoughts of Shylock. S. also associates Shylock with cannibalism, it gives the audience a clear indication that Shylock’s aim is to Kill Antonio. Therefore when Shylock is stripped from his chance of rev enge, the audience may not feel sympathy for him as they know that is intention was to kill Antonio, and he had a clear motive for it. Shylock’s motive may actually be the fact that he is losing

Rifles for Watie by Harold Keith Essay - 891 Words

General Information 1. The title of my novel is Rifles for Watie. 2. The author of my novel is Harold Keith. 3. The publisher of my novel is Harper Trophy. 4. My novel was published in 1957. Plot 5. The protagonist in my novel is Jeff Davis Bussey. 6. Jeff Bussey was a 16 year-old Kansas farm boy with brown eyes and a dimpled chin. He had a tanned face and a humorous smile. Jeff reacts decisively to situations. An example of this was the decision he made to go to war after the bushwhackers attacked his family. 7. Jeff is loyal in character. An example is him not backing out of the war even knowing that his next step might be his last. Jeff reacts morally to situations, an example is when he did not want to be in the†¦show more content†¦Jeff learned that he was not very nice. Captain Asa scared David so much that he went home before furlough. The next day Jeff went home on furlough to see his family. When Jeff was telling his family about his new life in the army, Jeffs father remembered Clardy from the Mexican war. His father said that Clardy was a strange fellow whom nobody trusted. Clardy wanted to be colonel of the Mississippi Volunteer rifles, but when Jeffery Davis got the job he moved far away from the south. The next day, on his way back to Fort Leavenworth, he sees Davids mom forcing David to go back to the Fort. They return together. When Jeff returned, the army broke camp and started the long march to Springfield, Missouri. The sergeant was Millholland, who Jeff liked much more than Clardy. The next evening they camped 25 miles away from Springfield. When Jeff shot his gun to clean it, he got arrested and was taken before Clardy. As his punishment, he got all-night sentry duty. The battle was going to be at Wilsons Creek, Missouri. The north planed to attack the rebels at dawn and by surprise. They failed to surprise the rebels, lost hundreds of men and the battle. The day after the battle, Jeff had to report for ambulance duty. The field hospital was 2 large gray tents thrown together in a clump of trees. When Jeff was scanning the field of people, he saw lots of dangerously injured people, none of them looked happy