1. The purpose of the study was to assess the necessity of adjuvant chemotherapy as part of the everyday clinical practice for the patients with resected stage II colon cancer who are also medically fit. The other purpose was to select the patients who presented with poor prognosis and to give details of the possible approaches to the oncologists to use apart from the adjuvant chemotherapy in practice.
2. The practice guidelines used in the study were meant to help the health caregivers and patients in making sound decisions about the proper health care that should be provided for particular clinical situations. The guidelines could also assist in contributing to quality care given to the patients and also decreasing the associated costs (Benson III et al., 2004). The guidelines being voluntary are used to explain the administration of therapies to be used in clinical purposes. The other purpose of the guidelines is to find out the appropriate questions to be used to form more questions for research and further investigations.
3. The practice guidelines may help in producing better health care since they enhance the medical practice as the health care provider is guided in every step given hence the final outcome being better care to the patient. The practice guidelines also help to reduce the unnecessary variations in medical practice meaning that costs of having to seek further medications are reduced as well as enhancing the care given currently (Benson III et al., 2004). The guidelines help in the decision making concerning the right support tools to be used by the practitioners and this prevents the incidences of applying any other tool that could raise the charges yet it is not necessary. The ability to self-evaluate and assess the external quality of the care provided ensures that every practice done is in accordance with what should be done.
4. The strategies used by the oncologist to discuss the chemotherapy with patients include involving the patients in making the decision. For example, weighing between the possible risks and benefits of the treatment should it be undertaken and help the patient make the right decision. The oncologist should also be able to identify the chances of recurrence or death as a result of cancer if chemotherapy is started and if it is not started then inform the patient who will then make a choice.
5. The findings of the study state that the decision to undertake the adjuvant chemotherapy is dependent on several factors. The factors include; choice by the patient after getting all the necessary information, benefits and risks of treatment and the characteristics of the tumor (Benson III et al., 2004). The findings from the study
do not support the use of adjuvant therapy outside the clinical trials. The clinical decision is solely based on the factors mentioned above.
Benson III, A. B., Schrag, D., Somerfield, M. R., Cohen, A. M., Figueredo, A. T., Flynn, P. J., ... &Brouwers, M. (2004). American Society of Clinical Oncology recommendations on adjuvant chemotherapy for stage II colon cancer. Journal of Clinical Oncology, 22(16), 3408-3419.
1. The purpose of the study was to investigate the efficacy and safety of the closed ICUs in patients with acute renal failure. The study involved the collection of data from patients suffering from acute renal failure both in the wards and also in the ICU.
2. a. The multiple past studies on epidemiology of acute renal failure have not been conclusive. The inadequate information provided brings controversy on the kind of renal support that should be given to the patients with acute renal failure considering that there should be dialysis and ICU support for them.
b. The main difference in the setting of the patients in the present study was that the investigation took place in the State of Victoria where 24 ICUs were used (Cole et al., 2000). Furthermore, the study included all the patients who had acute renal failure. In the other studies, however, the research was carried out in 13 tertiary-care hospitals in Spain and Madrid (Liano et al., 1996). The patients considered for the study were only age fourteen years and above and suffering from acute renal failure.
3. From the study, we find that ARF is a disease being managed in ICU due to the dysfunction to the multiple organs and not only in the nephrology wards. The incidence of the disease is also higher than that of acute respiratory distress syndrome (Cole et al, 2000). The other finding is that patients with severe ARF could develop unhealthy renal dysfunction. Also, septic shock and sepsis have been identified as the main causes of the severe ARF in the ICU. Finally, the other finding is that ARF is not the only disease for patients in ICU as they also suffer from other critical conditions like circulatory and respiratory failures.
4. In the study, patients with poor prognosis trigger the need for critical care due to the kind of management that they need. The other trigger for the need for ICU is the development of severe oliguria in patients with ARF. The trigger callas for an urgent need to prevent instead of only treating the excessive uremia and fluid increase. Renal dysfunction in patients with ARF requires dialysis sessions and this calls for the need to be admitted to the ICU for proper management of the condition.
5. The major concerns raised based on the management of patients with severe ARF include the use of too many resources, the need for expensive technology and who should be in charge of them (Cole et al., 2000). The patients with severe
ARF could develop renal dysfunction which requires some surgery procedures where they may develop septic state hence the need for an appropriate strategy for managing the condition. The other concern raised is the artificially inflated mortality in patients undergoing dialysis and may use mechanical ventilation due to persistent oliguria. The need to transfer the ARF patients to the ICU means that the workload for nurses is increased, more resources needed and expertise development.
Cole, L., Bellomo, R., Silvester, W., & e Victorian Severe Acute Renal Failure Study Group, J. H. R. F. T. (2000). A prospective, multicenter study of the epidemiology, management, and outcome of severe acute renal failure in a “closed” ICU system. American Journal of Respiratory and Critical Care Medicine, 162(1), 191-196.
Liano, F., Pascual, J., & Madrid Acute Renal Failure Study Group. (1996). Epidemiology of acute renal failure: a prospective, multicenter, community-based study. Kidney International, 50(3), 811-818.
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