Sickle Cell Disease
Recent years have seen a number of different investigations of the issues involved in the transition of care -- from pediatric-oriented to adult-oriented services -- for those who suffer from sickle cell disease. Although different researchers have taken a number of different approaches to the question, which I hope to survey in order to provide some report on the current state of opinion regarding transition of care, all are agreed that the current flurry of investigative interest stems ultimately from a piece of very good news: the vertiginous decline in mortality rates for children suffering from sickle cell disease. The historic response to a diagnosis of pediatric sickle cell disease was to minimize patient and parental expectations for prognosis, for the prospect of reaching adulthood would be slight indeed. Telfair Loosier (2004) note that survival rates for pediatric sickle cell disease have improved so vastly that the vast majority of cases are now likely to live past the age of eighteen: they assess survival rates past eighteen at 94% for sickle cell disease itself, and 98% for the milder forms of the disease. Six years later, Quinn Rogers et al. (2010) note that the statistics have changed drastically even with the current cohort of pediatric patients: the ultimate cause of death for young adult sickle cell disease sufferers has itself shifted, and in the 2010 study population all of the deaths they recorded occurred after the age of eighteen. But the largest demographic cluster of deaths occurs shortly after the transition to adulthood at eighteen, now raising the question of what providers can do differently, or concentrate on, in this critical period in the management of the illness. Hence the recent increase in research interest, as researchers hope to determine how health care providers may best respond to the changing face of this disease, especially in light of Quinn Rogers et al.'s implication that the medical transition process may now hold more culpability for the majority of deaths than the disease. I hope that a survey of the relevant literature will show the broad consensus that exists regarding the crucial issue of transition of care from pediatric to adult.
The basic mechanism of sickle cell disease is well understood and Davies and Oni (1997) provide a good summary -- sickle cell disease is a disorder of hemoglobin, the blood's own mechanism for effecting oxygen transfer from the lungs to be transported elsewhere in the body, causing the distinctive sickle shape of the red blood cells. The most common clinical problems compained of are vaso-occlusion, with attendant risk of vaso-occlusive crisis, usually expressed by the patient as extreme pain. Severity of the disease is measured by the incidence of these severe pain episodes, and the disease can lead to death by pulmonary complication, cerebrovacular accidents, or infections (to which sickle cell sufferers are particularly prone, due to an immunocompromised state caused by the spleen's inability to process fully the sickle cells themselves). Sickle cell disease is genetically transmitted, and relate to the presence of a single gene (the "sickle Beta globin gene"). It is thought that this gene achieved particular prevalence among the African genetic populations because it also carries with it a phenotypical increase in level of protection against malarial infection, and thus the evolutionary mechanism for its survival (despite its role in the aetiology of sickle cell disease, which easily proves fatal) is explained in these terms. But the genetic prevalence is remarkable: Davies and Oni (1997) estimate it as "up to 1 in 4 West Africans and 1 in 10 Afro-Caribbeans" is a carrier of the gene.
Obviously any assessment of sickle cell disease must take into account the fact that the preponderance of those afflicted by it are African-American. Numerous studies have been done to investigate this specifically, with the sociologic and economic difficulties that are potentially entailed by such a racially-defined patient population, but the most significant conclusions come in the assessment specifically of pediatric care for sickle cell disease. Slaughter and Dilworth-Anderson (1988) specifically surveyed the African-American population to assess standards of family-provided pediatric care, in the presence of and absence of a strong traditional family structure (with two married parents). They concluded that the majority of supportive care came from extended kin networks but with an attendant problem of decline in such support between diagnosis and later childhood. Meanwhile Barakat Lutz et al. (2005) offer an additional complication to the question of pediatric care: adherence to treatment protocols leads to lower overall quality of life for affected children. They specifically note...
Nurses Perception: Effects of the New Sickle Cell Disease Program on the Management and Care Ofadults With Sickle Cell Disease Description of the relationship between extant literature and the hypothesis Description of the research design Description of research methodology Description of study subjects Description of Instrumentation or Treatment Description of data collection procedures Nurses Perception: Effects of the New Sickle Cell Disease Program on the Management and Care of Adults with Sickle Cell Disease. The purpose of this
This is (still, for the present time, at least), the law on medical procedures to terminate pregnancy, which are available (and eligible for federal funding assistance) to anyone whose personal religious beliefs allow them. Those whose religious beliefs prohibit abortion at any time after conception need never contemplate the procedure, but their religious position is not incorporated into U.S. law. Like abortion, Americans not opposed to stem cell research
Salmonella Fig 1. Salmonella Bacteria The first thing to note about Salmonella (seen in Fig. 1) is that it is a bacteria, and therefore a living organism. However the term "Salmonella" is used loosely in daily conversation to specify an illness caused by that bacteria in humans, and in other animals. Most people have some vague recollection of a "salmonella outbreak" caused by a contaminated food supply being reported in the media,
The scientists ran the DNA computer only in a test tube. They foresaw the need for an injectable version for intracellular activities, which could take decades to devise.7 In response to the fear of nonscale robots going around inside the body, the scientists said they placed safeguards into their systems.7 When more reliable DNA computers are invented with fewer mistakes, people could become more comfortable with injectable robots and accept
Our semester plans gives you unlimited, unrestricted access to our entire library of resources —writing tools, guides, example essays, tutorials, class notes, and more.
Get Started Now