Issues from Cicek Olcay’s Health Analysis
The medical report of Cicek Olcay presents the health complexities of a 53-year-old Turkish lady as recorded at Day-Procedure-Unit (D.P.U.). The scenario typically identifies a lady who ignores a health-watching lifestyle. Ordinarily, persons who are 40 and above should take their health seriously in terms of what they consume, and are equally responsive to medical diagnoses (Machi, 2001). This is necessary for standardizing aging body systems.
Cicek Olcay’s medical report identifies a history of mental health, L.U.S.C.S., colonoscopy, and smoking. These amounted to her suffering an acute right upper quadrant pain for 2 months; she was seen by a senior surgical registrar and Surgeon a week to when her report was recorded at D.P.U. Following initial investigations, it is noted that Cicek was booked for elective surgery concerning cholecystitis and cholelithiasis.
Cicek Olcay engaged herself with bad habits against health and exhibited a lot of negligence to it (regarding the fact that she missed her morning medication upon admission at the DPU). It should be recommended for such a patient appropriate dieting; especially when her health-less attitude and age are taken into consideration (Lorenz et. al., 2000).
Investigation of Report and Demonstration of Relevance to the Enquiry
The report indicates a serious deterioration in Cicek Olcay’s health that should be monitored more closely. Cicek Olcay requires a little more than ordinary treat-and-discharge. She needs the help of a specialist psychiatrist to consistently emphasize to her the need for a closer monitor of her health. The lady requires keeping to a consistent good health-stand.
The medical report, therefore, agrees perfectly with her conductions and is utilizable for her treatment. It has been noted that Cicek was transferred by the anesthetist and the anesthetic nurse to the post-anesthetic recovery room (P.A.R.U.) where the P.A.R.U nurse continued to monitor Cicek every 5 minutes until she met the P.A.R.U. discharge criteria. Cicek recovered from the procedure well, and after 30 minutes her condition met the discharge criteria and she was ready for discharge back to the day procedure unit.
The PARU nurse informed the DPU that Cicek was ready to return and upon return to prepare Cicek for transfer to the ward. Cicek complained of shoulder tip pain afterward. Cicek’s transfer to the DPU was canceled and in consultation with the anesthetist, she remained in the P.A.R.U. for further pain relief. After a further 15 minutes, Cicek was reviewed by the surgeon and anesthetist in the P.A.R.U and they requested that she remain in hospital overnight for further pain relief.
The report identifies that good health is not all about feeling energetic and capacitated but is rather a life-long watch on the kind of food intake, nourishment as well as a consistent medical assessment of the functionality of the body and the organs. Studies have reviewed that to a large extent, the healthiness of our systems is also reliant on the sufficiency of rest and proper exercising (Wagner et al., 1984).
Exercise is not just a physical activity but also a mental practice of attaining self-peacefulness. Gillams & Lees (2000) have recommended that individuals, especially adults who are above 40 years of age, most afford to check the condition of their health at least once in every six months; otherwise, it is appropriate for people above the age of forty to consult medical practitioners for a check on their health’s state once every three months (Lode et al.,1998).
Preventing harm and improving the practice quality is a necessary tool for ensuring patient’s safety without necessary laying blames on them; through this device, it is a preferred option to interact with Cicek to question asked for the singular purpose of improving her safety- this could be apprised and applied to her through the integration of evidence and clinical expertise.
Evidence to Nursing Practice
The Cicek scenario stresses the need for treating patients with special concern for their safety. The safety of patients is becoming a more pronounced theme in delivering healthcare services in recent days (Okuno et al., 1999). This of course is not surprising based on the fact that the healthcare sector; pharmacy, nursing, and medicine has had a close watch on ethics in the fore of practice as a new dimension to bringing about better delivery to the patient (Fiorentini et. al., 2000).
Also, only recently, there is an increase in the awareness of the consequences of failure to be practical in the adaptation of ethical imperatives. There is a general awareness of the technique which is employable in bringing about realism to the noxious ideal of not preventing harm in healthcare practices.
Realizing the weight of failure to acknowledge the possibility of bringing about reduced harm in medicine has fortunately brought about intensification into researching flourishingly on the safety of patients as well as the desire of investing into researches on the safety of patients (Geoghegan & Scheele1999).
For instance, a publication on the subject matter by the Agency-For-Health-Research-And-Quality (AHRQ) received tremendous assistance from America’s department-of-defense as well as several other publications that have been evident of the resulting blossom of research on the subject in discussion (Curley et. al., 1999).
No doubt, the advent of emphasis on patients’ safety in the healthcare sector is appropriate and very timely. A decade or two ago, the application of systems-thinking to the safety of patients was ‘unenlightened’ and would not be welcome. Perhaps up to this day, preventable patient harm is again and again linked with error– which is fundamentally human-natured– particularly at the level of utilization of ‘liable medical systems’ (Luna-Perez, et. al., 1998).
To a lot of minds, the occurrence of this kind of error has to be met with blames and punishments. However, presently, system thinking is ubiquitously acceptable in the healthcare sector largely based on its success to introduce a continuous process of improvement that has brought about a reduction in the threat to continual practices in healthcare as compared to earlier reliance on accusations-of-error (Johns & Houlston, 2001).
In any case, system thinking is not naturally occurring- particularly as could be seen in the healthcare profession (Kemeny & Fata, 2001). The healthcare practitioner is adequately trained and is acculturated to realize the selfless responsibility and to have a mastery of the knowledge/skills required for assisting sickly ones or patients – who are for the majority of the times dependent and vulnerable (Neeleman et. al., 2001).
Of course in the knowledge of this, one is convinced that Hippocrates and Florence-Nightingale in their dictum have no harmful effects on healthcare practitioners in individual ways- neither does it have any harmful effects to the a system whereby they find themselves working in (Copur et. a., 2001).
Improvements of well-precise and cautiously constructed performance procedures are crucial in the process of carrying out a provider’s real performance and evaluating performance with the real aim of getting standard (Kemeny & Fata 1999). With the widespread experience of HCE who are ready to engage the provider to increase performance procedure that will efficiently appraise the accurate level to which the proper and projected course of outcome is being followed and the level to which the projected results are being realized (Heslin, et. al., 2001).
Understanding Patient Safety Events
Cicek’s anesthetic record IS PRESENted as follow:
S3 f = ASA 3, Female
G.A. intense bradycardia at last colonoscopy, uterine caesarian pt was O.K
F.H = no significant family history
(DKETM) illegible insignificant anesthetist writing.
Med: NKA = Nil Known Allergies teeth own MPT 3 snorer = pt has a night snore and may have sleep apnea that has not been investigated or the pt. has not given information to the anesthetist. Reflux + = pt has reflux.
To this effect, the D.P.U. proffers widespread know-how in providing medical documentation appraisal services which looks out to see that the service being rendered to Cicek is perfects, essential, and up to standard based on the laydown rule, as noted in a similar situation (Dancey et. al., 2000). The D.P.U. must put together a unique understanding put together to actualize Cicek’s safety in the area of fee-for-service and manage-care-reviews (van Riel et. al., 2000).
Naming Blaming / Shaming
The capability to arrive at a decision base on informed knowledge in health care delivery is often hindered by a lack of proper information on the results of the present practices (Bilchik & Allegra, 2001). The D.P.U. has to look out to assist performances advancement efforts of the health-care-providers in each area they serve (Landheer et. al., 2001).
This is recommended for realizing successful, resourceful, and economical delivery of excellent health care services, with the help of resource experts and their accuracy in different data collection, collation, and reporting (Cromheecke, et. al., 1999). The so-called healthcare diagnostics involve excellent procedure, creating metrics and baseline plan design, and evaluating healthcare style (Huang et. al., 2002).
Physician’s values encompass and demonstrate the recognition that several integral healthcare aspects are reliant on units that may include life-value and quality judgment that is integrally a subject of analytical methods (Fong et. al., 1999). It is the fore concern of Physician’s Value and Patient Autonomy to make clear aspects of practices of medicine which are principally subjected to methods that are scientific and applicable for ensuring the most accepted predictions of clinical treatment results; although debates linger on the authenticity of the desirability of these outcomes.
It is the advocacy of Physician’s Value and Patient Autonomy to ensure thrives of recent clinical decision-making which must be reliant on the usage of ‘best’ up-to-date scientific evidence (Cromheecke et. al., 1999). For this school of thought, Physician’s Value and Patient Autonomy offers the following three (3) key merits:
- It gives the most accepted and objective alternatives in the determination and maintenance of consistent and committed qualitative standards which are safer for utilization in the practice of medicine;
- It aids in achieving speed in processes of converting medical researches and findings into medical practices; and
- It avails the potency for the reduction of costs in Medicare or healthcare, considerably.
This school of thought which supports Physician’s Value and Patient Autonomy is not without opposition as it is otherwise considered that Physician’s Value and Patient Autonomy risks downplay of the vitality of medical experiences and expert opinions. It is also argued that the terms used by clinical trials in the definition of ‘best’ practices are complicated and not routinely replicable and are not practical (Heslin, et. al., 2001).
Subsequently, there are emergent movements such as the Cochrane Collaboration- which was instrumented to retort Archie Cochrane’s call for the development of instantaneous systematic evaluations of randomly regulated trials which encompass all sectors in health care utilizing the most excellent available evidence in healthcare decision-making processes (Kemeny & Fata, 2001).
A persistent challenge that has continued to be associated with Physician’s Value and Patient Autonomy translation of knowledge and how to ensure an effective day-to-day clinician decision making regarding appropriate values on existing ‘best evidence’. Once too occurring, clinicians are ignorant of existing evidence or neglect the applications (Zalley et. al., 2001). Otherwise, the values of clinicians vary considerably from patients, hence even when clinicians are sentient of the evidence there is the tendency that their suggestions would be fellable without the involvement of patients in the processes of making decisions.
Legal, Ethical and Professional Problems of Medical error
Errors in the health care sector could be grouped as those that are based on skills, those that are based on the rule, those that are reliant on knowledge as well as several others such as those which are inclined to judgment there is a very clear line when nonnegligent and negligent errors are ex-rayed in law.
Diagnostic imaging infers technology-driven medical practice through which the health situation of a patient is investigated by healthcare personnel. Imaging devices are utilized for capturing images through x-raying, scanning, and ultra-sounding of internal organs for onward medical prediction, interpretation of diagnostics.
Due to the constant emergence of dieses or complexity of existent ones, medical imaging has transformed through the years to meet up the transitional demands of emergent and occurring modalities in a structural format. Through the sophistication of imagining tech, it is possible to transfer patients’ demographics, examination properties, imageries, or numerical data is secured and highly efficient ways.
The reliability of medical imagining is functional of artificial intelligence through articulate structuring of models which are precedent on earlier investigations of a particular circumstance in algorithm formats that could be fed with finite collections of observations. This paper will present studies on predicting treatment response using medical imaging information with specified inclination to algorithms –of-data-acquired through clear data analyses.
In their research, Glover et. al.,(2000) studied an optimal time for medical imaging utilizing the pet device for prediction of patients’ response to neoadjunctive-chemotherapy. The study was effective in its measurement of mean standards for up-taking midpoint-neoadjunctive values in chemotherapy which reflected an approximately seventy-seven percent low-patients response, and a hundred percent high response which achieved a 93% area roc. The paper will adopt similar analytical approaches in its presentation of the subject matter.
The perdition of treatment on a patient at this instance would depend on the localization/number of the liver metastases and there would be a consideration of the several clinical parameters that relate to the patient. The chances for resectioning colorectal patients with liver metastases stand at 30% (Heslin et. al., 2001).
In any case, the possibility for the patients to survive in five years is just about 30% to 48% as compared to the five percent of chances for survival for patients with liver-metastases which are not liver-surgery amenable (Popov et. al., 2002).
It is the responsibility of radiologic imaging to analyze the condition of the liver by assessing the availability or the non-availability of liver metastases when considering surgery of better predictions as well as for evaluating successes of other patients’ chemotherapy. even though there has been the use of transabdominal-sonography in assessing the liver, the method is not without its shortcomings: there has to be a consideration of the operator’s level of understanding which in most cases reflects the reviewer of equivocal results in patients who (induced with chemotherapy) express fatty liver infiltrations.
Abramson, R., Rosen, M., Perry, J., Brophy, P., Raeburn, L., & Stuart, K. (2000). Cost- Effectiveness of Hepatic Arterial Chemoembolization for Colorectal Liver Metastases Refractory to Systemic Chemotherapy. Radiology, 216, 485- 491.
Bilchik, A.J., Wood, T.F., & Allegra, D.P. (2001). Radiofrequency ablation of unresectable hepatic malignancies: lessons learned. Oncologist, 6, 24-33.
Copur, M.S., Capadano, M., Lynch, J., Goertzen, T., McCowan, T., Brand, R., & Tempero, M. (2001). Alternating hepatic arterial infusion and systemic chemotherapy for liver metastases from colorectal cancer: a phase II trial using intermittent percutaneous hepatic arterial access. J Clin Oncol, 19, 2404- 2412.
Cromheecke, M., de-Jong, K.P., and Hoekstra, H.J. (1999). Current treatment for colorectal cancer metastatic to the liver. Eur J Surg Oncol, 25, 451-463.
Curley, S.A., Izzo, F., Delrio, P., Ellis, L.M., Granchi, J., Vallone, P., Fiore, F., Pignata, S., Daniele, B., and Cremona, F. (1999). Radiofrequency ablation of unresectable primary and metastatic hepatic malignancies: results in 123 patients. Ann Surg, 230, 1-8.
Dancey, J.E., Shepherd, A., Paul, K., Sniderman, K.W., Houle, S., Gabrys, J., Hendler, A.L., & Goin, J.E. (2000). Treatment of nonresectable hepatocellular carcinoma with intrahepatic 90Y-microspheres. J Nucl Med, 41, 1673-1681.
Fiorentini, G., Poddie, D.B., Giorgi, U.D., Guglielminetti, D., Giovanis, P., Leoni, M., Latino, W., Dazzi, C., Cariello, A., Turci, D., & Marangolo, M. (2000). Global approach to hepatic metastases from colorectal cancer: indication and outcome of intra-arterial chemotherapy and other hepatic-directed treatments. Med Oncol, 17, 163-173.
Fong, Y., Fortner, J., Sun, R.L., Brennan, M.F., & Blumgart, L.H. (1999). Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg, 230,309-318.
Geoghegan, J.G., & Scheele, J. (1999). Treatment of colorectal liver metastases. Br J Surg, 6,158-169.
Gillams, A.R., & Lees, W.R. (2000). Survival after percutaneous, image-guided, thermal ablation of hepatic metastases from colorectal cancer. Dis Colon Rectum, 43, 656-661.
Heslin, M.J., Medina-Franco, H., Parker, M., Vickers, S.M., Aldrete, J., & Urist, M.M. (2001).Colorectal hepatic metastases: resection, local ablation, and hepatic artery infusion pump are associated with prolonged survival. Arch Surg, 136, 318-323.
Huang, A., McCall, J.M., Weston, M.D., Mathur, P., Quinn, H., Henderson, D.C., & Allen- Mersh, T.G. (2002). Phase I study of percutaneous cryotherapy for colorectal liver metastasis. Br J Surg, 89, 303-310.
Johns LE., & Houlston RS. (2001). A systematic review and meta-analysis of familial colorectal cancer risk. Am J Gastroenterol, 96, 2992-3003.
Kemeny, N., & Fata, F. (1999). Arterial, portal, or systemic chemotherapy for patients with hepatic metastasis of colorectal carcinoma. J Hepatobiliary Pancreat Surg, 6, 39-49.
Kemeny, N., & Fata, F. (2001). Hepatic-arterial chemotherapy. Lancet Oncol, 2,418-428.
Landheer, M.L., Therasse, P., & van de Velde, C.J. (2001). The importance of quality assurance in surgical oncology in the treatment of colorectal cancer. Surg Oncol Clin N Am, 10, 885-914.
Lode, H.N., Xiang, R., Becker, J.C., Gillies, S.D., Reisfeld, R.A. (1998). Immunocytokines: a promising approach to cancerimmunotherapy. Pharmacol Ther, 80, 277-292.
Lorenz, M., Staib-Sebler, E., Hochmuth, K., Heinrich, S., Gog, C., Vetter, G., Encke, A., & Muller, H.H. (2000). Surgical resection of liver metastases of colorectal carcinoma: short and long-term results. Semin Oncol, 27,112-119.
Luna-Perez, P., Rodriguez-Coria, D.F., Arroyo, B., & Gonzalez-Macouzet, J. (1998). The natural history of liver metastases from colorectal cancer. Arch Med Res, 29, 319-324.
Machi, J. (2001).Radiofrequency ablation for multiple hepatic metastases. Ann Surg Oncol, 8, 379-380.
Neeleman, N., Wobbes, T., Jager, G.J., & Ruers, T.J. (2001). Cryosurgery as treatment modality for colorectal liver metastases.Hepatogastroenterology, 48, 325- 359.
Okuno, K., Kaneda, K., & Yasutomi, M. (1999). Regional IL-2-based immunochemotherapy of colorectal liver metastases. Hepatogastroenterology, 46,1263-1267.
van Riel, J.M., van Groeningen, C.J., Albers, S.H., Cazemier, M., Meijer, S., Bleichrodt, R. van den Berg, F.G., Pinedo H.M., & Giaccone, G. (2000). Hepatic arterial 5- fluorouracil in patients with liver metastases of colorectal cancer: single-centre experience in 145 patients. Ann Oncol, 11, 1563-1570.
Wagner, J.S., Adson, M.A., Van Heerden, J.A., Adson, M.H., & Ilstrup, D.M. (1984).The natural history of hepatic metastases from colorectal cancer. A comparison with resective treatment. Ann Surg, 199, 502-508.
Zealley, I.A., Skehan, S.J., Rawlinson, J., Coates, G., Nahmias, C., & Somers, S. (2001). Selection of patients for resection of hepatic metastases: improved detection of extrahepatic disease with FDG pet. Radiographics, 21, 55-69.