Introduction

In the last three decades, there has been considerable quantitative research done by the researchers concerning bullying in schools and this research has been very useful in knowing its pros and cons. This research has helped in the determination and evaluation of the extent of bullying as a major problem. Researchers have also determined the causes and consequences of bullying.

Strong points of Bullying

It has also found out the culprits who are usually involved in bullying along with their types and genders. Both the offenders and victims experience and suffer tremendously due to the menace of bullying. According to the quantitative research, there are a number of adverse effects of bullying on the psychology and social behavior of the sufferers (see Kim & Leventhal, 2008; Kumpulainen, 2008; Nansel, Craig, Overpeck, Saluja, Ruan, and the Health Behaviour in School-aged Children Bullying Analyses Working Group (2004); Srabstein & Piazza 2008). Research on bullying has also been successful in exploring the behavioral patterns and views related to it. Not only this, the phenomenon is now well understood. Despite the fact that research done on the mentioned issue is almost always quantitative, researchers have also studied this issue by using qualitative methods for the collection of data. They have spent the last decade in analyzing this gathered data for studying the menace of bullying.  These studies that are just few in number have been truly helpful in uncovering the intricacies involved in bullying and unfair treatment towards others. The unveiling of these complexities has consequently disclosed the meagerness of the preparation of the bullying construct. It won’t be incorrect to state that this problem needs to be researched in a consistent manner.

Different Perspectives of Bullying

The bullying construct and the problems associated with it have been identified by a number of authors.  According to Arora (1996), Madsen (1996) and Bosworth et al. (1999), bullying has been defined differently in various surveys. However, regardless of its various definitions, it is possible that the people who answered the surveys had different concepts/ideas and this is the reason why their answers didn’t match up with the definitions that the survey included. For this reason, it is not astonishing that the survey data needs validity and verification. In the recent times, various researchers have necessitated to research on bullying considering it from a point of view that is social-ecological (Swearer & Doll, 2001; Swearer & Espelage, 2004). The reason behind this call is the conjectural perspective that has grown out of the contributions of Bronfenbrenner (1977, 1979) and Cairns & Cairns (1991).

The Social Relational Theory and The Theory of Status Relationships

Theories related to social-ecological perspectives place the individual in a context that is nested in his/her role in society. These social contexts consist of his near and dear ones including the family members, relatives, friends, acquaintances, school fellows, office colleagues, neighbors, the society and the general public. The theoretical work done in the contemporary times suggest that bullying can be understood really well by viewing it from this social-ecological perspective.

On the other hand, this perspective is really broad and because of this breadth, it is not possible for the social-ecological theory to figure out and get to the bottom of the inter-personal and related variables that act as contributors for bullying to exist. By knowing all there is to know, social ecological theory makes it easier for the researchers to have a bird’s eye view on the issue. However, this theory is unsuccessful in shedding light and focusing on the interactions that act as major contributors to the dynamics related to both bullies and victims of bullying. As a consequence, it is suggested that for understanding bullying and the aggression related to it that is mostly observed in teenagers; it is necessary to emphasize on the two additional theories related to social-ecological perspective. These two theories are known as the social relational theory and the theory of status relationships. The two mentioned theories begin by introducing relationship elements that intermingle with social contexts. In addition, these theories are also able to deal with bullying characteristics and associated aggression that are most obvious in the high school environment, that is to say intimacy, disagreement, supremacy, and position.

Social-Ecological Framework

The investigators of bullying issue have also proposed a framework related to social-ecological framework that describes the occurrence of bullying and related factors. It is exceedingly important for us to recognize and analyze the social ecology that helps in the establishment and maintenance of the behaviors related with bullying and victimization (Kerns & Prinz, 2002). This understanding and comprehension is necessary for the development and implementation of bullying prevention and intrusion programs that may prove effective in the future. It is an old concept that the individual is influenced and affected by the multiple environments. A lot of research has been done on this notion and people have also written a lot about it. It is not a new idea that family, society and culture play a very important role in molding the personality of an individual and there is a reciprocal interplay between a person and his/her environment (Bronfenbrenner, 1979).  According to the ecological-systems theory, each and every one of the individuals is part of an interconnected system by which individuals are located at the center. This is from this centre that the individual moves out so that he/she could become a part of all the other systems that eventually help him to grow and develop personally/professionally (Bronfenbrenner, 1979).

Bronfenbrenner’s Theory

The interconnectedness of the said systems has been described that ultimately act together for having an impact on the behavior of individuals (Garbarino & DeLara, 2002). Thus, bullying and victimization are being considered as ecological observable facts that are recognized and complete unpredictably (Swearer & Doll, 2001). The Bronfenbrenner’s theory suggests that an infant is an indivisible component of a social network. This social network is consisted of four interrelated systems i.e. microsystem, mesosystem, exosystem and macrosystem.  A number of psychologists have been influenced by Bronfenbrenner’s theory as far as the individual analysis is concerned along with its various environmental systems that have a huge impact. In view of this fact, the ecological systems theory has turned out to be a really significant theory and has also given a basis to the works and contributions of other theorists.

Four Interrelated Systems

The Micro-system is the immediate environment that directly affects people. It consists of one’s family, friends, relatives, colleagues and society. Micro-system is composed of people with whom one has a direct social interaction. According to this theory, people are not simple receivers of the experiences when they socialize with the mentioned social agents. Instead, people are the force that contributes in the micro=system and its construction. The relationship between the micro-systems in an individual’s life makes up the meso-system.  The experiences one has with his family may affect his school life. For instance, neglecting on the part of parents may affect the relationship of a child with teachers at school. The exo-system can be defined as a system that does not allow an individual to play a constructive role in life experiences. However, the micro-systems of the life of such an individual are directly impacted by those non-constructive experiences. For example, if a child has a more close association with his father, he/she may have either a conflicting or a tight bond with his/her mother in case if the father goes abroad for a long period of time. The immediate culture of an individual makes up the involving his/her socioeconomic status, his/her ethnicity, neighborhood etc. For instance, belonging to a poor family may make a person hardworking.

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Introduction

The way telemedicine has revolutionized the healthcare industry is astonishing. Just few decades back, it was an impossible thing to imagine that a patient can be treated without actually visiting a doctor. Times have changed and so have healthcare industry and the treatment options. This paper talks about the numerous ways telemedicine has played a significant role in improving and transforming nursing informatics in particular and healthcare industry in general. It also discusses how the availability and convenient use of telemedicine services have benefitted people throughout the developed and developing world. In the last section, the reasons telemedicine has an illuminating future have been mentioned along with various criticisms of the technology.

Telemedicine

In the contemporary healthcare industry, cost-effectiveness, quality, accessibility, and equity are major issues faced by the clients/patients. In fact, these issues are experienced by people in both developing and developed countries. With the introduction and employment of the modern-day Information and Communication Technologies (ICTs) including smart phones, computers, and the Internet, the researchers and innovators have been successful in alleviating the health problems considering the convenience and inexpensiveness of such technologies. In this regard, the term telemedicine refers to “the use of modern information technology, especially two-way interactive audio/video communications, computers, and telemetry, to deliver health services to remote patients and to facilitate information exchange between primary care physicians and specialists at some distances from each other” (Darkins & Cary, 2000). When it comes to nursing informatics, the development and expansion of telemedicine has considerably changed the ways nurses serve consumers and patients.

Contribution of Telemedicine

Telemedicine has remarkably contributed to nurture a value-based and high-quality environment for the enhancement of patient engagement and satisfaction along with better accessibility and reduced costs. Distance is the basic determinant in the utilization of telemedicine as healthcare professionals use ICTs to remote areas considering the inaccessibility and inconvenience. Thus, ICTs makes it possible for the doctors and patients to share the pertinent details for apt and timely diagnosis, evaluation, research, treatment, and prevention of the disease/medical condition. Nursing informatics has segmented telemedicine into various applications such as cardiological, neurological, dermatological, and respiratory categories to be used in the management of various pathologies, conditions, and diseases.

Alternative of Traditional Method

Furthermore, people in their final stages of AIDS/HIV are benefiting from telemedicine as their human contact is decreased. Yet, the patients are accepted, respected, and treated through telemedicine (Breen & Matusitz, 2009). Similarly, telemedicine has guaranteed patient satisfaction due to a decrease in travelling time, waiting time, and minimization of other issues related to appointments and follow-ups. Telemedicine has turned out to be an incredibly life-saving alternative to traditional methods of healthcare counseling particularly for terminal and debilitated populations living in remote regions.

Telemedicine in Mercy Health System

Mercy Health System (a hospital without a bed) is a virtual care center wherein nurses and doctors keep working around the clock. This one-of-a-kind healthcare facility in the United States offers remote support to 38 smaller hospitals situated in states from Oklahoma to North Carolina (for emergency rooms, intensive-care units, and various other programs). A majority of these hospitals have no on-site physician 24/7. Mercy Virtual President reported a 30% decrease in the number of deaths than anticipated. Also, a 35% decrease in the average length stay of the patients was made possible due to the provision of telemedicine services at the facility. The observations indicate that the lives of 1000+ people were saved with the special assistance provided through telemedicine. According to a trade group, the American Telemedicine Association, remote medical care was provided to more than 15 million Americans in 2015 alone which ultimately grew by 30% the next year (Breen & Matusitz, 2009).

International Impact

On an international level, there has been a considerable interest to bring improvements in the healthcare industry’s safety, quality, cost-effectiveness, and cleanliness through telemedicine. McLean conducted a study to investigate and analyze the impact of telemedicine on the quality and safety of the healthcare. It was revealed that the improvement in the quality of life of patients was apparent. Also, improvements were observed in patients of asthma and chronic heart failure (McLean, Sheikh, Cresswell, Nurmatov, Mukherjee, Hemmi, & Pagliari, 2013).

Telenursing

Information technology usage has actually evolved the nursing roles specifically within home settings. Telehealth nursing or telenursing is focused on patients’ long-term physical wellness and self-management. It can be said that telemedicine has empowered the present-day nurses with a better ability to supervise, gather data, inform, follow-up, and offer multidisciplinary care comprising of pain management, distant involvements, and family support. According to a report, “agencies using telehealth have an average patient-to-nurse ratio of 15:1, as compared with non-telehealth agencies having a ratio of 11:1” (Bashir & Bastola, 2018). Consequently, a remarkable difference could be made if telemedicine is effectively used for the provision of patient care to underserved regions experiencing nursing shortage and inaccessible health care.

Nursing and Telemedicine

The lack of specialists in rural areas results in a majority of patients being devoid of well-timed health care interventions. This gap could be easily filled up if more and more home health agencies with telemedicine facilities train their nurses to care for chronic patients while utilizing ICTs. Such provision of care and sense of security allows the nurses to intervene and manage patient condition under expert physician care (Bashir & Bastola, 2018).

Nurse Informatics Uses

As indicated by the above discussion, there is a rare involvement of hands-on patient care in nursing informatics. As an alternative, nurses make use of technologies and tools to assess the patients’ progress via telemedicine. For instance, blood glucose, blood pressure, and heart rate and other vital signs are recorded and evaluated by using tools. Such equipment is usually set up in the domestic setting wherein the patient is placed. The nurse informaticists educate the patients and their family members about the usage of equipment and how to troubleshoot them if a technical issue arises. Similarly, professionals engaged in nurse informatics also facilitate other health care personnel to use telemedicine and other related equipment in a proper manner.

It needs to be noted here that not every nurse is aware of the recent methods and technologies used in telemedicine. A patient whose treatment involves telemedicine cannot be just evaluated by any nurse. Instead, a nursing trained in nursing informatics and knows how specific technologies are used can help in taking care of the populations treated under the umbrella of ICTs. However, telemedicine nurses are necessitated to possess the same nursing skills that are a prerequisite for all nurses whereby “excellent organization, critical thinking and communication skills are required also, but the most important skill is to understand the technology and its potential and limitations, and have the intuitiveness in how to utilize it to provide the care needed at the time” (Page, 2013). Therefore, nurses interested in using technology to provide high-quality health care must obtain a nursing informatics certification to start with.

Telemedicine Counseling

Telemedicine counseling also helped in reducing the maternal fatigue affecting mothers who had infants with difficult behaviors. Parents who had infants with extremely low birth weight rates were also provided with emotional support and education. Overall, telemedicine resulted in patient satisfaction whereby it reduced cost and travel time along with increased convenience. In a Canadian review of various telemedicine programs, the rural areas had higher patient satisfaction as compared to the urban areas. In comparison to waiting for longer personal counseling, 76% people preferred telemedicine counseling due to its ease and convenience (Breen & Matusitz, 2009).

Telemedicine Knowledge in US

In developed countries, such as the United States of America, the healthcare industry has incorporated telemedicine. Even though several issues have popped up with the implementation in different states including legality problems and reimbursement, it is extremely important for developing countries to learn with USA example and incorporate telemedicine by means of volunteer efforts in the regions where healthcare professionals are unable to reach. Both governments and stakeholders need to ensure that telemedicine must replace the obsolete alternatives to treat populations in far-away regions.

Criticism on Telemedicine

Even though telemedicine is gaining popularity on a large scale, criticism concerned with the quality of care received through telemedicine has also surfaced. According to the opponents of telemedicine, various barriers hinder the growth of telemedicine in some regions including developing countries considering the inadequacy of the infrastructure for proper utilization of the modern Internet technologies. Also, the instability of the electric power supplies, unreliable connectivity of the Internet, computer viruses, and limited availability of bandwidth hinder the adoption of telemedicine (Breen & Matusitz, 2009).

Financial Cost

In addition, the financial cost associated with telemedicine is also a major barrier to the adoption and application of telemedicine services. Training cost, equipment, maintenance, and transportation expenses can be difficult to be managed for developing and underdeveloped countries. The application of telemedicine is also restricted due to lack of knowledge, resources, and local skills. In many countries, the education required to be a competent nursing informatics professional is not available.

Conclusion

Today, the big promises have started to materialize while telemedicine is being implemented to its full potential. The swiftness of deliverance of health care services and increase in the number of nursing informatics professionals, it has become crystal clear that people could not be treated in hospitals alone; the Internet connections, modified insurance standards, availability and cheap usage of smart phones as well as technologically-aware nursing personnel are changing the conventional modes of delivering health care services.

It has been proved that information and communication technologies like cell phones, the Internet, and computers have the propensity to address the health problems on a global level. It can be done through the deliverance of nursing and health services via telemedicine. Telemedicine contributes in improving the as the health care situation and physical wellbeing of deprived populations in remote areas when health care professionals use ICTs for an exchange of the information for diagnosis, treatment, and provision of education to nursing staff and health care providers (though in limited numbers) in such areas. Similarly, the healthcare’s safety, quality, cost-effectiveness, and cleanliness have considerably enhanced worldwide through telemedicine. Though there are various hindrances to the application of telemedicine in developing countries, a focused approach towards its implementation may result in miraculous outcomes for poor nations as the health of the local people is improved.

With certain challenges such as limited coverage by insurers, diagnosing difficulties, and privacy issues, telemedicine is evolving with each passing day. The fact that remote areas have no access to healthcare facilities as well as the increasing aged population signifies that telemedicine will flourish in the future despite the mentioned challenges. One cannot simply ignore the advantages of telemedicine. In this regard, healthcare professionals can play a major role “through the development of strategic, industrywide best practices and regulations” along with the preservation of patient-nurse and patient-physician relationships (“How Will Telemedicine Impact the Future of Health Care”? 2016)

References

Bashir, A., & Bastola, D. R. (2018, May 25). Perspectives of Nurses Toward Telehealth Efficacy and Quality of Health Care: Pilot Study. Retrieved April 11, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5993972/

Breen, G., & Matusitz, J. (2009). An Evolutionary Examination of Telemedicine: A Health and Computer-Mediated Communication Perspective. Social Work in Public Health, 25(1), 59-71. doi:10.1080/19371910902911206

Darkins, A. W., & Cary, M. A. (2000). Telemedicine and Telehealth: Principles, Policies, Performances and Pitfalls. New York: Springer Publishing Company.

How Will Telemedicine Impact the Future of Health Care? (2016, November 03). Nursing@Georgetown. Retrieved April 11, 2019, from https://online.nursing.georgetown.edu/blog/future-of-telemedicine/

McLean, S., Sheikh, A., Cresswell, K., Nurmatov, U., Mukherjee, M., Hemmi, A., & Pagliari, C. (2013). The impact of telehealthcare on the quality and safety of care: a systematic overview. PloS one, 8(8), e71238. doi:10.1371/journal.pone.0071238

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Introduction

With the ingression of a mental illness (such as anxiety, depression, and schizophrenia) in a family, it is not the patient/sufferer who gets affected alone; the family members are also impacted emotionally (and financially). Considering the unique domestic dynamics and circumstances of such a household, family members make endeavors to help the affected by seeking psychological assistance. Thus, a family system is considerably impacted when a member experiences psychological problems (May, 2018).

Issues Faced by the Family

Several issues could be faced by the family members while handling mental illness. In most cases, the mental illness becomes the principal focus of the family ultimately making other issues insignificant. A major issue is that such a situation creates rifts among family members as each member perceives the mental illness differently failing to think of a unanimous decision about the treatment/resolution of the illness. Almost all households wherein there is a mental illness case, the prevalence of feelings of vulnerability, frustration, hurt, and guiltiness prevails (May, 2018). It needs to be mentioned here that family structure and domestic environment play a significant role in contributing to the mental health and behavioral patterns of a person.  Non-supportive families can diminish or neglect a member’s psychological wellbeing ultimately contributing in the causation of a mental illness or its deterioration. In a majority of scenarios, psychologically victimized individuals are dependent on the support of their family. In the absence of this reliability, the entire process of recovery is affected in a negative manner (Boyd, 2018).

Hereditary Mental Disorders

It seems that bipolar disorders, autism, and schizophrenia affect the brain in a similar manner. For the same reason, gene activity is often analyzed by the researchers as a measure to comprehend the causative factors of such psychological states. Individuals who have particular gene variants by birth are more vulnerable to get affected by autism, schizophrenia, and other bipolar disorders (Hamzelou, 2018). It needs to be mentioned here that “scientists have discovered that no single gene is responsible for a mental disorder, several susceptibility genes may interact with one another, and the environment influences genetic expression to increase the risk of developing a mental disorder” (Ritter & Lampkin, 2011)

When things fall apart and personal disaffection or distancing happens, it may not be a continuing process. Time heals the hurt and resentment. Similarly, motivational approach and honest efforts could be used for correcting the biased views concerning mental illness. It is the family that decides what is best for the healthiest environment within the four walls of its home. Motivated people can surprisingly change their thought processes.

Awareness and Acknowledgement of the Illness

Families are irreplaceable. An individual with a disturbing mental condition may get the best treatment when supported by the family. There are a number of ways family members can cope with a mental illness. To begin with, the family members need to learn and acknowledge the diagnosis. However, it is necessary to never describe the patient as the illness. Also, it is extremely important to maintain a positive relationship with the sufferer by being encouraging, supportive, and spending quality time with him/her. Most importantly, a person suffering from a mental illness needs to be understood by his/her family members as his thought process is abnormal. A family needs to be mindful of the patient’s condition and encourage him/her to participate in daily life activities. It is also indispensable to understand that such patients could employ violent means and may attempt suicides. Therefore, it is required to be aware of the nearest mental inpatient facility where the patient could be taken in such a dreadful emergency (May, 2018)

References

Boyd, M. (2018). Psychiatric nursing: Contemporary practice. Philadelphia: Wolters Kluwer.

Hamzelou, J. (2018, February 8). First glimpse of how genes may cause mental health problems. Retrieved April 15, 2019, from https://www.newscientist.com/article/2160697-first-glimpse-of-how-genes-may-cause-mental-health-problems/

May, J. V. (2018, October 18). Mental Illness Affects the Whole Family | Pine Rest Blog. Retrieved April 14, 2019, from https://www.pinerest.org/mental-illness-affects-whole-family-blog/

Ritter, L. A., & Lampkin, S. M. (2011). Community mental health. Sudbury, MA: Jones & Bartlett.

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Comparative Analysis

Today, the Psychological Board Association finds it difficult to decide whether ABA Therapy is better than Social Awareness Communication or not. Several studies have revealed that the advocates of both therapies consider whether a child has been diagnosed with autism or the does the child seem to exhibit symptoms of autism? According to the DSM-5 field test, many children have been diagnosed with autism when they only have Social (Pragmatic) Communication Disorder. Some speech-language pathologists consider that it is better to have the children fully tested before diagnosis of autism.

Differences Between ASD and SCD

There are several differences between ASD and SCD (a red flag for some parents who might suspect that their child was misdiagnosed with ASD). Kids with autism have difficulties in social communication and exhibit repetitive or disruptive behaviors. Some repetitive or disruptive behaviors may include flapping, jumping, and rocking. On the other hand, children with SCD display a consistent behavior and use verbal and non-verbal communication cues across different texts. ASD and SCD have verbal and non-verbal communication difficulties thereby making the diagnosis difficult. However, specialists in both fields still maintain that treating a child for a communication disorder is far easier than treating a child with ABA.  According to them, if a child is given the opportunity to socialize, it will make a child speak and behave properly.

In ASD, the daily schedule, expectation, or chores will benefit the children in processing information visually. In contrast, SCD uses visual supports for a child’s daily schedule, expectations, and chore chart, etc. to allow the kids process information visually as well. Also, planning controlled play dates can also help a child talk faster than using ASD which only focuses on repeating words day in and day out as a reinforcement technique. It must be noted that reinforcing something consistently frustrates and bothers such children as they do not like eye contact, hugging, or touching. Sensitivity issues are challenging for both the children and the respective associations. SCD believes in making consistent interactions with kids and their peers (whether autistic or not) and endeavoring to bring the children out of isolation. ASD, on the other hand, believes in the sensory as a contributive factor in treating children with different spectrum of ASD. In contrast, ABA firmly believes in understanding the behavior of each child and does not rely solely on dialogue therapy. Along with SCD, there are several ABA methods that are used in helping the children to succeed in today’s world.

Bridging the Gap Between Therapists and Parents

Finally, both parties do agree on bridging the gap between therapists and parents to achieve the best results. As SCD is a new diagnosis, the researchers find it difficult to diagnose the two conditions separately.  However, they believe in their new modifications funded by private companies such as Autism Speaks.  The scientists used DSM-5 criteria for both ASD and SCD to reevaluate a large number of families previously assigned to an autism sub-type under DSM-IV.  Most importantly, treatment should address the inimitable needs of the individual as established through evaluation.  The therapies are focused on improving social communication by using speech and language therapy, ABA, Essential Retort Training, Early Start Denver Model, societal skills groups, and Intellectual Behavioral Therapy.

Conclusion

Although there is not a single concrete method to help a child to communicate, it is the bridging of a home, school, and therapies that will help the children later to lead a better life in future.

References

Kim, Y. S., Fombonne, E., Koh, Y., Kim, S., Cheon, K., & Leventhal, B. L. (2014). A Comparison of DSM-IV Pervasive Developmental Disorder and DSM-5 Autism Spectrum Disorder Prevalence in an Epidemiologic Sample. Journal of the American Academy of Child & Adolescent Psychiatry,53(5), 500-508. doi:10.1016/j.jaac.2013.12.021

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Introduction

Anaphylactic shock is a life-threatening condition that can be fatal if treatment is delayed. Anaphylactic shock is defined as “an acute, life-threatening hypersensitivity reaction to a sensitizing substance” (Lewis, Bucher, Heitkemper, & Harding, 2017, p. 1590). When a patient is exposed to a sensitized allergen, the reaction escalates rapidly due to the release of inflammatory mediators ultimately causing vasodilation, circulatory failure, and respiratory distress (Lewis, Bucher, Heitkemper, & Harding, 2017). Due to the rapid progression of the condition, nursing students need to accurately identify clinical manifestations and provide immediate interventions. Otherwise, it can be a matter of life and death. Interestingly, anaphylactic shock is not being treated effectively according to a study in 2014. In a survey, out of 410 pediatrician participants with anaphylaxis scenarios, “just 11.3% of respondents answered all of the questions about management of mild anaphylaxis correctly, while 3.2% correctly answered all of the questions about management of severe anaphylaxis” (Kornusky & Ashley, 2017, p. 3).

According to CINAHL, “Anaphylactic shock is fatal in 0.65-2% of cases; 500-1,000 people die from the condition in the U.S. each year” (Kornusky & Ashley, 2017, p. 2). The purpose of this paper is to educate nursing students on the medical diagnosis of anaphylactic shock as an attempt to decrease the mortality rate of this condition. It encompasses the pathophysiology, signs, symptoms, assessments, diagnostic tests, complications, and interventions.

Pathophysiology

Anaphylactic shock is a severe reaction that is experienced by people when exposed to an allergen. Some of the most common allergens that can cause an anaphylactic reaction can be remembered by the mnemonic: MBLF (Many Boys Love Food) referring to medications, beestings, latex, and food. The antibody principally responsible for these reactions is immunoglobulin E (IgE) (Kemp, 2018). This paper will delve into the two categories that cause anaphylactic shock; immunologic and non-immunologic.

Immunologic

In immunologic anaphylactic shock, IgE is the main culprit. When exposed to the allergen in the lymphoid tissue, B cells start producing IgE cells with the help of T cells. These specially-formulated IgE cells only respond to the specific allergen it was created for. IgE cells then travel through the body’s circulatory system and tissues to attach to mast cells and basophils and continue to circulate throughout the body. Until the allergen is exposed near to the mast cell or basophil, the attached IgE interacts with the allergen. When multiple IgE antibodies are activated with the same allergen, it causes the cell to become activated thus initiating the inflammatory response by intracellular signaling by releasing mediators such as histamines and tryptase. The released cells either directly cause the inflammatory response to surrounding tissues or activate other inflammatory cells such as eosinophils. This process causes even more intracellular signaling and releases even more histamines and tryptase (Kemp, 2018). Histamines directly respond to surrounding tissue by causing vasodilation and encouraging the vessels to leak intracellular fluid from the vascular system. As a result, the blood pressure (BP) drops causing low oxygen perfusion to tissues and swelling. Consequently, shock is caused (Mannarino, 2014). In simpler terms, the allergen must have been sensitized in order for the reaction to develop. Therefore, the patient would have been exposed to the substance beforehand which may or may not have caused an allergic reaction at that time. During the first exposure, the immune system creates an antibody to detect and fight off the allergen to prepare for the next exposure.

Non-immunologic

In the less common non-immunologic anaphylactic shock, specific medications are the primary cause. These types of medications directly activate mast cells and basophils by the receptors without the involvement of IgE. This activation of mast cells and basophils act the same way as the immunologic anaphylactic shock with the production of inflammatory mediators such as histamine. Medications that can cause this type of anaphylactic shock include vancomycin and opiates (Kemp, 2018). It is important for health care providers to consider and observe any allergic reactions when providing such types of medications.

Clinical Manifestations

The two chemical mediators in response to IgE activation that cause clinical manifestations are histamine and tryptase. Low level of histamine can cause tachycardia. However, symptoms of hypotension, itching, bronchospasm, and headache are apparent when the levels are increased. Tryptase is a protease (enzyme that breaks down proteins) produced from mast cells specifically. It acts as a coagulant which facilitates hypotension and increases risk for clots. In rare cases, it can also cause disseminated intravascular coagulation (DIC) (Kemp, 2018).

Researchers from BioMed Research International, Tang et al. conducted a study in 2015 on inpatients’ clinical characteristics of anaphylactic shock. The study indicated that the most common clinical presentation of anaphylactic shock is on the skin (observed in up to 90% of studied cases). Integumentary presentations include hives, erythema, itching, and swelling (Tang et al., 2015). It happens due to the inflammatory response of histamine and other cell mediators released from IgE activation. Most common clinical manifestations shown in participants include, “Rash (62%), Dyspnea (46.3%), Loss of consciousness (38%), Nausea/ Vomiting (27.8%), Pallor (25%), excessive sweating (21.3%), palpitations (18.5%), abdominal pain (13%), facial swelling (12%), Rales heard in the lungs (10.2%), and dizziness (10.2%)” (Tang et al., 2015, p. 3). Hypotension is another expected symptom with anaphylactic shock due to histamine effects on the vascular permeability. Tang et al. (2015) studied the extent the BP drops during anaphylactic shock and found that, “the systolic pressure decreased from 117.4 ± 13.8 mmHg during baseline conditions to 54.3 ± 31.9 mmHg during episodes and the diastolic pressure decreased from 71.6 ± 13.6 mmHg during baseline conditions to 33.9 ± 21.4 mmHg during episodes” (p. 2). This study thus revealed how much the BP can drop during an episode of anaphylactic shock and some clinical presentations to assess while providing early treatment.

Assessments

If the patient is not active in anaphylactic shock, prevention is the key. A thorough health history is important to identify allergies and eliminate those allergens from the patient’s care. If a patient mentions an allergy, it is important to ask questions to explore the type of reactions they get from exposure, how they were exposed in the past, progression of condition, and if they have an EpiPen or use other treatments (Lewis, Bucher, Heitkemper, & Harding, 2017).

While in active anaphylactic shock, the primary assessment is airway, breathing, circulation (ABC’s) and management of life-threatening problems. Assessment should also include mental status to ensure adequate oxygenation to the brain tissue. Signs of angioedema should also be assessed with intubation equipment nearby in case of respiratory failure. Management of these will be discussed in the interventions. Secondary assessment is to determine patient’s history of allergies, allergen exposed to, how they were exposed, how long ago they were exposed, progression of symptoms, and interventions the patient has done (such as medications they took). Finally, it is imperative to assess vital signs and obtain remaining information concerning health history (Campbell & Kelso, 2018).

In general, it is important to assess patients for signs and symptoms of anaphylaxis. As mentioned earlier, one of the first manifestations shown is integumentary signs. Other signs that can indicate anaphylaxis are dyspnea, adventitious lung sounds, hives, pallor, swelling, tachycardia, and hypotension (Tang et al., 2015).

Diagnostic Tests

During the episode of anaphylactic shock, there is no test that specifically diagnoses the condition. It is purely based on the clinical presentation and history of exposure to allergens. However, laboratory tests, electrocardiogram (EKG), and chest x-rays are used to rule out other conditions and aide in the diagnosis of anaphylactic shock. Laboratory tests that simplify the anaphylactic shock diagnosis are a total tryptase serum and histamine in the plasma. Elevation in these levels indicates anaphylactic shock due to the mass production during the inflammatory process when exposed to a sensitized allergen. These tests are more accurate if there are baseline values to compare to after the anaphylactic shock episode. Total tryptase will have a maximum elevation above baseline values (up to 60 minutes) after onset of anaphylaxis and declines to baseline (approximately 2 hours after). Histamine will elevate 10 min after onset of anaphylaxis and declines to baseline by approximately 30 minutes. Therefore, blood should be drawn as soon as possible after the onset of symptoms to be the most accurate for histamine test and approximately 30-60 min after for the tryptase test (Schwartz, 2018).

Other tests should be considered to rule out additional conditions. Due to manifestations on the lungs and respiratory system, a chest x-ray should be done and evaluated to rule out other respiratory conditions, such as sepsis or pneumonia. It is also recommended to evaluate an EKG to assess for myocardial infarction (MI) (Schwartz, 2018). MI can develop due to the Kounis syndrome’s effect on coronary arteries – a complication of anaphylactic shock.

Complications

Complications that result from anaphylactic shock can be tragic. This section will explore some complications of anaphylactic shock to include cardiac and neurological conditions. One of the most tragic cardiac complications of anaphylaxis is sudden death. This occurs as a manifestation of the Kounis syndrome – an acute coronary syndrome that causes the coronary arteries to spasm due to mast cell activation and inflammatory mediators that are released in the inflammatory process during an anaphylactic shock episode. In addition to the pathophysiology of anaphylactic shock, coronary arteries are not being perfused adequately. Contributors of coronary deterioration include “systemic vasodilation, reduced venous return, leakage of plasma and volume loss due to increase vascular permeability, and diminished cardiac output” (Kounis, Soufras, & Hahalis, 2014, p. 228). The coronary arteries that are affected by Kounis syndrome, in addition to anaphylactic shock progression, can progress into a MI and ultimately sudden death (Kounis, Soufras, & Hahalis, 2014). Therefore, assessing an EKG for MI manifestations can lead to early detection and prompt treatment.

In 2018, Michelle Mangold and Mahboob Qureshi, physicians for Touro University Nevada College of Osteopathic Medicine, studied two aspects of anaphylactic shock complications; long-term effects and neurological manifestations. In this study, a patient had an extreme case of anaphylactic shock that resulted in loss of consciousness and four consecutive seizures induced by hypotension. The patient was later intubated and found with a Glasgow Coma Scale (GCS) score of 3. Fortunately, the patient recovered the following day with intact neurological function as evidenced by results from a computed tomography (CT) and magnetic resonance imagining (MRI). However, 8 months later, the patient indicated her vision changed by decrease in distance and depth perception and noticed halos while night driving. She also noticed short-term memory problems and a difference in hand writing. It is said that this may be due to long lasting effects as “the lasting sequela of visual and fine motor skill deficits may very well be a result of hypoxic injury to the brain… It is important to note that the patient had no pre-existing neurologic conditions nor symptoms of such” (Mangold & Qureshi, 2018, p. 4). This case is important to consider when treating patients with anaphylactic shock to make neurological assessments due to hypoxic effects on the brain. It is also significant to consider the increase of time in observation after anaphylactic shock treatment alongside more frequent follow-up appointments to check for long-lasting neurological effects.

Nursing Diagnoses

Nursing diagnoses that are relevant for anaphylactic shock indicate the priority of respiratory and cardiac problems including Ineffective Airway Clearance, Impaired Gas Exchange, and Decreased Cardiac Output (Ackley & Ladwig, 2014).

Ineffective Airway Clearance is relevant due to anaphylactic shock characteristics of bronchospasm, diminished lung sounds, dyspnea, and adventitious lung sounds. Goals should include airway patency. For example, the patient will always maintain a patent airway. This is accurate because if the patient is unable to have airway patency, intubation and other measures may be required. In addition to an accurate time frame, a patient should always have a patent airway even after discharge (Ackley & Ladwig, 2014, p. 129).

Impaired Gas Exchange is pertinent for anaphylactic shock due to the lack of tissue perfusion of oxygen caused by vascular permeability and vasodilation from histamine. Some manifestations are pallor, confusion, and tachycardia. Goals should include improvement of tissue perfusion. For example, the patient will have adequate oxygenation as evidenced by peripheral capillary saturation above 95% until discharge. In other cases, the patient will not show respiratory distress until discharge (Ackley & Ladwig, 2014, p. 375).

Decreased Cardiac Output is germane to anaphylactic shock because it describes the effects of histamine on the body with decreased tissue perfusion, edema, decreased central venous pressure, and dyspnea. Goals should include improvement of tissue perfusion as similar to improved gas exchange. For example, the patient will demonstrate adequate cardiac output as evidenced by blood pressure and heart rate within normal parameters until discharge (Ackley & Ladwig, 2014, p. 179).

Nursing Interventions

The nursing interventions for anaphylactic shock should be immediate once the onset of symptoms occurs. The first step is to remove the allergen causing the problem such as an intravenous (IV) medication. The cornerstone intervention for anaphylactic shock is the administration of an intramuscular injection of epinephrine as soon as possible. To prevent poking yourself with the EpiPen, remember the saying, “Blue to the sky, orange to the thigh.” Unless contraindicated, the patient should be placed in shock position by laying him/her supine with their feet passively elevated. Contraindications would be present if the patient is having respiratory complications of the upper airway (as they should be in high fowler’s position). If the patient is unable to keep a patent airway, as evidenced by stridor or respiratory arrest, intubation should be performed immediately upon assessment. If this is not the case, the patient should still be given supplemental oxygen with 15L/min via nonrebreather mask. The patient should then have two IV catheters inserted; one for emergency medications and the other for volume resuscitation with normal saline (NS) at a rate of 125 mL/hour. Epinephrine is usually infused slowly on the IV after the initial injected dose (Campbell & Kelso, 2018). The nurse should continue monitoring the patient’s vital signs including BP, heart rate, respiratory status, and peripheral capillary saturation. The patient should also be monitored for manifestations of fluid volume overload due to the large quantity of fluids that are being infused.

Epinephrine is an effective treatment for anaphylactic shock for its mechanism of action and preventing histamine and tryptase release from mast cells and basophils. It stops inflammation from progressing. Other beneficial mechanisms are vasoconstriction, bronchodilation, and decreased edema. Other pharmacological treatments that supplement epinephrine, but not used alone, are antihistamine and albuterol. Antihistamines are often administered to help relieve integumentary symptoms such as itching, redness, and hives (mostly caused by histamine). Albuterol is a bronchodilator that is administered to help relieve symptoms of dyspnea due to bronchospasm (caused by cell mediators) (Campbell & Kelso, 2018). Antihistamines and albuterol neither relieve symptoms of shock nor prevent the release of cell mediators from mast cells and basophils. For the same reason, it is paramount to administer epinephrine as priority and only use a supplement.

After treatment and observation period of anaphylactic shock, the nurse should provide comprehensive discharge education to prevent recurrence in the future. It is recommended for patients to schedule a follow up appointment with their immunologist for further evaluation of suspected allergens (Campbell & Kelso, 2018). In addition to an anaphylaxis emergency plan that outlines information about anaphylaxis and self-administering epinephrine, a prescription for an emergency EpiPen must also be given. Overall, it is important to educate the patient on how to avoid the allergen to prevent recurrence.

Conclusion

Anaphylactic shock is a life-threatening condition that can progress rapidly. Delay in epinephrine administration often results in death. To help combat the mortality rate of anaphylactic shock, this paper reviewed the diagnosis of the condition for nursing students. Therefore, nursing students could be more prepared for the rapid assessment and management for this life-threatening condition. To support this, this paper reviewed anaphylactic shock’s clinical manifestations, assessments, complications, and interventions.

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The post Anaphylactic Shock, A Life-Threatening Condition appeared first on Mark8ng.com.

Abstract

Anticancer peptides (ACPs) are promising therapeutic agents  to target and kill cancer cells. The accurate prediction of ACPs from the given peptide sequences remains an open problem in the immunoinformatics field. Recently, machine learning algorithms have emerged as a promising tool tohelp experimental scientists predict ACPs. However, the performance of existing methods still needs to be improved. In this study, we attempt to present a novel approach for the accurate prediction of ACPsnvolving two steps: (i) First, weapplied a two-step feature selection protocol on 7 feature encodings that cover various aspects of sequence information (composition-based, physicochemical properties, and profiles) and obtained their corresponding optimal feature-based models. The resultant predicted probabilities of ACPs were further utilized as feature vectors. (ii) The predicted probability feature vectors were then used as an input to support a vector machine in developing the final prediction model called mACPpred. Cross-validation analysis showed that the proposed predictor performs significantly better as compared to individual feature encodings. Furthermore, mACPpred considerably outperformed the existing methods compared in this study when accurately evaluated on an independent dataset.

Introduction

The complex process due to which normal cells are transformed into abnormal cancer cells is known as carcinogenesis or tumorigenesis [1]. Such processes may be attributed to several factors such as hereditation [2], environment [3], or a change in the physiological microenvironment of the affected cells [4]. Thus, most cancers (regardless of the driving factors) are distinguished by the continuing accumulation of genetic modifications in the founder cells [5]. In general, the division and differentiation of normal cells are strictly regulated by numerous signaling pathways. However, normal cells escape these signals sometimesthus leading to uncontrolled growth and proliferationand later to cancer [1]. According to the World Health Organization (WHO), the most common types of cancers are found in lung, liver, colorectal, stomach, prostate, skin and breast [https://www.who.int/news-room/fact-sheets/detail/cancer]. Every year, cancer devours millions of lives in both developing and developed countries. In 2018, it was anticipated that about 18 million new cancer cases and over 9 million deaths could occur due to cancer [6]. The number of deaths could reach over 13 million by 2030 [7]. In the United States (US) alone, approximately 1.7 million new cancer cases and over 600,000 cancer related deaths are estimated for 2019 [8].

Traditional Methods for Treatment

Traditional methods for the treatment of cancer include surgery, radiation therapy, and chemotherapy. Treatment may also depend on the location, stage of the disease, and patient condition [9]. Despite continuous advancements in the field, these methods are rather expensive and often exhibit damaging effects on normal cells. Additionally, there is a growing concern that cancer cells may develop resistance to chemotherapy and molecularly-targeted therapies [10]. Moreover, cancer cells are known to develop multidrug resistance through a broad range of mechanisms making these cells resistant to the respective drug in use for treatment.and several other compounds [11]. As soon as the molecular mechanism behind cancer (or, as a matter of fact, any disease) is understood, the next logical step is to discover a desirable remedy. [12]. Therefore, there is an urgent need to discover and design novel anti-cancer drugs for combatting against this noxious disease.

The role of Peptides

During the last few decades, the role of peptides as anti-cancer therapeutic agents has been promising. In fact, their effective utilization is apparent from several strategies available to address the progression of tumor growth and spreading of the disease [13]. These anti-cancer peptides (ACPs) have displayed the potential to inactivate various types of cancer cells [11]. ACPs are short peptides (typically 10–50 amino acids in length) that exhibit high specificity, high tumor penetration, and ease of synthesis and modification in addition to low cost of production [14, 15]. Generally, most of the ACPs demonstrate either an α-helical or a β-sheet conformation. However, in some cases, extended structures have also been identified [16]. ACPs can be classified into two major groups; i) peptides that are toxic to both cancerous and normal cells (exhibiting little evidence of selectivity), and ii) peptides that are toxic to cancer cells but not to normal mammalian cells and erythrocytes [11]. The mechanisms involving ACPs effecting cancer cells are not completely understood yet. However, the role of membranolytic or non-membranolytic mechanisms is implicated [11]. Furthermore, the mechanisms that are involved in the inhibition of certain biological processes such as angiogenesis, protein–protein interactions, signal transduction pathways, and gene expression (including the inhibition of enzymes or proteins) have also been highlighted [13].

ACPs Derived from Protein Sequences

Since most of the ACPs are derived from protein sequences [17], the discovery of novel ACPs for cancer treatment will be a focus of research for future studies. It is expected that the number of ACPs will increase with the rapid growth of protein sequences in public databases as a consequence of high-throughput sequencing projects [15]. Identification and development of novel ACPs from experimental methods are costly and time consuming. Therefore, it is essential to develop sequence-based computational methods to promptly identify potential ACP candidates from the sequencing data prior to their synthesis. In this study, we have constructed a lowest redundancy benchmark dataset and used it for the development of a prediction model. To develop a prediction model, we attempted to explore 7 feature encodings; amino acid composition (AAC), dipeptide composition (DPC), composition-transition-distribution (CTD), quasi-sequence-order (QSO), amino acid index (AAIF), binary profile (NC5), and conjoint triad (CTF). To exclude irrelevant features on each of the feature encodings, we first applied a two-step feature selection protocol and identified their corresponding optimal feature-based models. Finally, the predicted probability obtained from the 7feature encoding models was used as an input to support vector machine (SVM) to construct the final model called mACPpred. Furthermore, our recommended method mACPpred achieved consistent performance on both benchmark and independent datasets.

Results

Performance of Various Feature Encodings

Firstly, we examined the capability of each feature encoding in classifying ACPs from non-ACPs. It must be mentioned that optimal ML parameters for each feature encoding were obtained by conducting 10 independent 10-fold cross-validations. The best performance achieved by each feature encoding is shown in Figure 1. Results show that AAIF achieved the best performance with an accuracy of 88.72% while AAC-, QSO-, DPC-, CTD-, CTF-, and NC5-based performance ranked positions 2 to 7 respectively. Overall, the 7 feature encodings achieved a reasonable performance with an accuracy ranging between 81.0-88.7%. Furthermore, we observed that low-ranked feature encodings achieved the highest sensitivity and specificity. For instance, CTF achieved the highest sensitivity of 90.0%(1.5–20% higher than the other encodings). Similarly, NC5 achieved the highest specificity of 91.35%( 1.06–18.0% higher than the other encodings). Although the basic nature of each feature encoding covers a different aspect of sequence information, each contributes towards better prediction. Therefore, it is indispensable to integrate these seven feature encoding-based models into a single model to overcome the limitation(s) of each modeland achieve a more balanced and stable performance.

Comparison of SVM and Other Classifiers

To evaluate the effectiveness of SVM classifiers, we compared the performance of SVM-based classifiers against three other commonly used ML classifiers, namely Random Forest (RF), K-Nearest Neighbors (KNN), and Logistic Regression (LR), on the 7 feature encodings [18]. Using a 10-fold cross-validation test, the performance of the three other methods is shown in Table S1 (Supplementary Materials) and Figure 2. Results revealedthat SVM performed consistently better than the three other classifiers on six out of seven feature encodings. Precisely, the average accuracy achieved by SVM was ~1.1% higher than RF, ~2% higher than LR, and ~6% higher than KNNthereby indicating that SVM has a slight advantage over other methods in classifying ACPs from non-ACPs. Hence, we decided to only utilize the SVM classifiers for further analysis.

Selection of the Optimal Features for Each Encoding

Since DPC, CTF, and other encodings have a larger dimension, some of the features may be redundant or not equally important. Therefore, it is mandatory to apply a feature selection protocol to remove redundant and irrelevant features. There are various feature selection techniques available in the literature [19–23]. However, inspired by recent studies [24–26], we attempted to applied a two-step feature selection procedure to check whether it was capable of reducing feature dimensions and bringing improvement in the overall performance or not . In particular, the F-score algorithm for ranking features (present in each feature encoding) was employedfollowed by a sequential forward search to find the optimal feature set (Figure 3). Table 1 shows the number of features significantly reduced in  case of DPC (66.25%), CTF (58.82%), and NC5 (73%). On the other hand, a slight reduction can be observed in case of AAIF (4.76%), QSO (1.0%), and CTD (10.62%). No reduction was witnessed in the case of AAC.Next, we inspected the performance of each feature encoding based on the unique optimal features and compared it with the respective control (using all features). Figure 4 shows a significant improvement in the performance for three feature encodings; NC5, DPC, and CTF by 4.18%, 3.08%, and 2.63% respectively as compared to their control. CTD and QSO improvement is marginal (<1%) while no improvement is seen in AAC and AAIF. Although AAIF showed no improvement, the number of feature dimensions is slightly reduced. In the case of AAC, all the features are equally important for obtaining the best performance.

To examine whether the optimal features are better than the excluded features for each feature encodings, we developed excluded features-based prediction models using the procedure as described in Section 2.1. We also compared their performance with the control (using all features) and the optimal features. Notably, only four feature encodings (CTD, CTF, DPC, and NC5) were used for this analysis while the remaining three feature encodings (AAC, AAI, and QSO) were excluded considering the size of the optimal feature dimension and the similar controls.. Figure S1 shows that the optimal feature-based models are consistently better than the control and also exclude feature-based models. Explicitly, the average accuracy achieved by the optimal feature-based models is 16.8% higher than the excluded feature-based models and 2.7% higher than the control. It indicates that a two-step feature selection protocol selected more important features thereby contributing to an improved performance. The optimal features for each feature encoding are provided in Table S2 (Supplementary Materials).

Construction of the Final Predictor

The optimal feature-based model obtained for each feature encoding was utilized in the development of a final prediction model. Some of the previous methods used hybrid features (a linear combination of various feature encodings) as an input to an ML classifier for the development of the prediction model without any feature selection techniques [27]. However, we only deliberated on the predicted probability of ACPs (values in the range of 0.0 to 1.0) from 7 individual optimal models as input features to SVM. Later, we developed a final prediction model called mACPpred. Our proposed predictor achieves a Matthews Correlation Coefficient (MCC), accuracy, sensitivity, specificity and AUC of 0.836, 0.917, 0.891, 0.944, and 0.968 respectively. To show the effectiveness of mACPpred, we compared its performance with seven feature encoding predictors (Figure 5A). Specifically, the MCC and accuracy of the proposed predictor was 4.6–13.8% and 3.5–7.3% higher than the individual predictors thus indicating the effectiveness of our approach by integrating various feature encodings and contributions for an improved performance.

It might be possible that methods employing hybrid features (combination of different feature encodings) perform better than the current approach as they utilize multiple elements and complete the feature space as well. To investigate this possibility, we developed six hybrid-feature-based models using the following procedure: (i) Seven feature encodings were ranked according to the accuracy obtained from base-line models (Figure 1) and incorporated with AAI one by one (H1: AAI+AAC; H2: AAI+AAC+QSO; H3: AAI+AAC+QSO+DPC; H4: AAI+AAC+QSO+DPC+CTD; H5: AAI+AAC+QSO+DPC+CTD+CTF; H6: AAI+AAC+QSO+DPC+CTD+CTF+NC5). Each of the hybrid features were used as an input to SVM and their corresponding models were developed using the same procedure as described in Section 2.1. Figure 5B shows the performance comparison of mACPpred with the hybrid-feature-based models where mACPpred performed better with an MCC and accuracy value 3.46–9.5% and 1.7–4.7% higher than the hybrid models respectively. It demonstrates that our approach helped in achieving the best performance.

Performance Comparison on the Independent Dataset

There are several examples where the prediction model showed an excellent performance during cross-validation. However, these performances are not transferrable while evaluating an independent dataset. Hence, an independent evaluation is needed to validate the robustness of the proposed method. Most importantly, the independent dataset constructed in this study did not share greater than 90% sequence identity with our training dataset and other existing methods’ training datasets. Therefre, we compared the performances of mACPpred with the previous methods such as MLACP and iACP. It should be noted that MLACP contains two prediction models based on RF (RFACP) and SVM (SVMACP) and both the models were considered for comparison.

Table 2 shows that mACPpred achieves an MCC, accuracy, sensitivity, specificity, and AUC of 0.829, 0.914, 0.885, 0.943, and 0.967 respectively. More specifically, the MCC and accuracy of mACPpred is 23.7–49.1% and 14.6–33.4% higher respectively than the other methods compared in this study thereby demonstrating that the proposed method is capable of achieving an encouraging performance. It must be noted that it is difficult to get statistical estimation from the above-mentioned threshold-based comparison. Hence, we utilized rank-based comparison using ROC [28] where two AUC values of different methods were assessed by a two-tailed test from which the p value for the observed differences were obtained [29]. Table 2 and Figure 6 show that the mACPpred significantly outperformed the existing predictors on the independent dataset.

Webserver Implementation

mACPpred webserver is accessible for free at the following link: www.thegleelab.org/mACPpred. Users can upload or paste query peptide sequences in the FASTA format. After submitting peptide sequences, retrieved results in a separate interface can be obtained. All datasets used in this study can be downloaded from the following link: http://thegleelab.org/mACPpred/ACPData.html to check the reproducibility of our findings.

Discussion

In this study, we developed a novel predictor called mACPpred to predict ACPs from the given peptide sequence. To develop a predictor, a two-step feature selection protocol was applied on seven feature encodings (AAC, DPC, CTD, CTF, AAI, QSO, and NC5) to obtain optimal feature-based prediction models whose predicted probabilities of ACPs were further used as a feature vector. Finally, the probabilistic feature vector was used as an input to a SVM for development of the final prediction model. The benchmark and independent validation demonstrated that the mACPpred was able to clearly outperform existing predictors compared in this study for ACPs prediction. The novelty of our method is as follows: (i) The benchmark or training dataset has the lowest redundancy among the datasets reported in the literature; (ii) among various feature encodings employed in this study, this is the first instance where CTF and QSO are employed in ACP prediction, and (iii) most of the existing predictors either utilize single feature encodings or a combination of multiple feature encodings. Hence, their feature dimension is very high. However, we have used only seven probabilistic features that cover a wide range of features (position specific, physicochemical, and compositional information). Basically, it transforms the complex high-dimensional feature into a low-dimensional one, further facilitating better discrimination between ACPs and non-ACPs.

Moreover, our approach can be applied to other sequence-based prediction problems including post-translational modifications, peptide function predictions, and DNA/RNA function predictions. Although the proposed predictor has shown an excellent performance as compared to other methods, there is still room for improvement. This may include exploration of other ML algorithms such as decision tree-based [31,32] and neural network-based algorithms [33–35] on the same dataset, incorporation of novel features, and computational approach as implemented in References [36–39], and increasing the size of the training dataset based on the future experimental data. Furthermore, we have implemented our proposed algorithm in the form of a user-friendly web-server for the wider research community to use and implement. It is expected that mACPpred will be helpful in the identification of novel potential ACPs.

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Introduction

The key issues faced currently by healthcare industry are quality, equity, access, and cost-effectiveness. These are the issues that both developed and developing countries are facing. Modern Information and Communication Technologies (ICTs) such as cell phones, the Internet, and computers can address the health problems that are prevalent on a global level as people can communicate with each other exchanging and seeking the relevant information. The use of ICTs for the delivery of the health services is referred to as telemedicine. It provides clinical health care to remote areas through the use of information technology and telecommunication.

In telemedicine, distance is a determinant whereby healthcare professionals can provide healthcare services to remote areas through the utilization of ICTs. This technology allows them to exchange all valid information for treatment, diagnosis, prevention, evaluation, and research. It is also used to educate health care providers. In addition, it aims at improving the health of individuals and communities.

This paper discusses the various ways through which the healthcare industry has been transformed through telemedicine, its impact on safety, quality, and management of health care. Furthermore, it also encompasses numerous methods concerning the continuation of medical education through telemedicine. Also, it also talks about the availability and accessibility of its services in developed and developing countries as well as the barriers to its diffusion.

Telemedicine in Developed and Developing Countries

In the developing countries, one of the major concerns is the access to the basic health care. Telemedicine provides great opportunities in increasing access to the health care. Distant healthcare providers can diagnose, evaluate, treat, and even provide follow-up care to the patients in the developing countries that are not sound economically. The underserved areas can get efficient tertiary care advice through telemedicine. In situations where local healthcare professionals have access to expert help, It enables people to obtain opinions from the specialists; unavailable to them otherwise. This aids in providing reassurance to both patients and doctors.

There has been a decrease, both directly and indirectly, in the number of referrals to facilities located off-site due to its programs. This has also led to the reduction of the need to transfer patients. Telemedicine in developing countries is successfully enabling the remote care and diagnosis beneficial for both health care systems and patients wherein the distance traveled to receive special care as well as the related stress, time, and expenses are reduced. Another benefit offered by the telemedicine programs is that they improve practitioners’ practice in rural areas as they receive the support for professional growth and development through this medium.

Secondary benefits such as connecting remote sites through telecommunication technologies help in overcoming geographical barriers as health care providers around the world can connect to remote and rural sites easily. Thus, it is easy to overcome issues such as flight of human capital or the ‘brain-drain’ problem. The remote training of healthcare professionals fosters their academic growth as they can contact the specialists around the world easily at any time. Thus, the services and skills offered locally are improved significantly. These factors are also proved by the telemedicine program in Mongolia that supports maternal and neonatal health.

As far as Mongolia is concerned, the maternal and infant mortality rate in the country is quite high. In order to overcome this issue, telemedicine support is being provided in the remote provinces of the country for the promotion of maternal and infant health. The services supported by telemedicine in Aimags provinces include fetal monitoring, high-risk pregnancy consultations, use of colposcopy for screening of cervical abnormalities, and prenatal ultrasound diagnostics. Women in remote areas who cannot afford paying for expert opinions can be particularly benefitted through the usage of telemedicine program.

In developed countries, such as the United States of America, it has been incorporated into healthcare services. Although different states face different issues pertaining to the incorporation (like reimbursement and other legality concerns), it is highly recommended to help the underdeveloped countries. In particular, countries that lack adequate healthcare facilities need to incorporate telemedicine through the volunteer efforts of healthcare professionals.

How Telemedicine is Transforming Health Care

There has been a considerable interest internationally in improving the healthcare industry’s safety, quality, cost-effectiveness, and cleanliness. McLean conducted a study to investigate and analyze the impact of telemedicine on the quality and safety of the healthcare. The study found that the quality, standard, and safety of the healthcare were improved. For some of the patients, the improvement in the quality of life was observed. On the other hand, it was not the case for other patients. For example, improvements were observed in patients of asthma and chronic heart failure while no improvements could be seen in diabetic patients. For a total of 15 studies conducted on heart failure patients, 9 reported improvement in the quality of life. Some were so satisfied with the telemedicine services that no considerable difference between normal counseling and tele-counseling could be detected. Furthermore, significant improvement in the quality of life was observed in COPD.

Telemedicine counseling

Telemedicine counseling also helped in reducing the maternal fatigue affecting mothers who had infants with difficult behaviors. Parents that had infants with extremely low birth weight rates were also provided with emotional support and education. All in all,  resulted in patient satisfaction whereby it reduced cost and travel time along with increased convenience. Furthermore, it also helped a majority of patients in follow-up for various diseases. In a Canadian review of various telemedicine programs, the rural areas had higher patient satisfaction as compared to the urban areas. In comparison to waiting for longer personal counseling, 76% of people preferred telemedicine counseling as it was easy and convenient.

Breen and Matusitz Study

Breen and Matusitz conducted a study and described the way through which a telemedicine system can be executed in a variety of medical settings, to strengthen and assist the communication such as the interchange, dialogue, and correspondence between the patient and healthcare provider. It provides training, research, public health, and patient care for diagnosis, receiving, and sending of information about health and administrating care. Analysis of X-rays and educating health professionals may also be done through telemedicine.

Telemedicine Applications

Telemedicine has been segmented into various applications such as cardiological, neurological, dermatological, and respiratory diseases and these are used extensively in the management of various pathologies, conditions, and diseases. It has also been discovered recently that people in their final stages of AIDS/HIV are benefiting from telemedicine as their human contact is decreased and the patients are accepted and treated.

Telemedicine Electronic Devices

The technological forms of the telemedicine are classified into numerous electronic devices such as e-mail services, camera light boxes, telephones, fax machines, remote monitoring systems, interactive television units, video conferencing, and multimedia. In military combat solutions, rapid communication services are provided to medics  who could then treat various casualties in firefights. Serious wounds acquired by the military can easily be managed and treated through telemedicine.

Telemedicine Brings Ease

Breen and Matusitz also report that telemedicine has given patient satisfaction through a decrease in travel time, waiting time, and reduction in hassles to get an appointment from the doctor and follow-up. It has turned out to be an extremely remarkable alternative to traditional methods of counseling especially for remote, terminal, and debilitated populations.

Telemedicine and CME

Wang asserts that telemedicine can provide sustainable improvements to health and help in continuing medical education. Telemedicine systems are also an effective way to online continuing medical education (CME) for physicians. It also offers three principal advantages: the delivery of personal health services to remote areas, patient health education, and continuing medical education. Wang also studied the experiences of telemedicine in Taiwan over the period of 1995-2004. The estimated results of the panel data regression showed that an increase in CME lectures provided online led to an increase in per capita national health expenditure and conventional health services. There is a nonlinear nexus between CME and health indicating an improvement in the health of individuals with greater online CME provision. After reaching an optimum, however, decreasing population health is associated with greater CME lectures.

Telemedicine and Communication

Beck mentions in her report that after years of big promises, it is finally living up to its full potential. The delivery of health care has become more rapid through the Internet connections, changing standards of insurance, the presence of smart phones, and jobs being done by more health providers who use electronic communications. Phones, webcam, and emails are linking the patients to the doctors around the world. The better care of health has been provided by telemedicine at locations where medical expertise cannot reach.

Remote Medical Care

In the new virtual care center, Mercy Health System (a hospital without a bed), nurses and doctors keep working around the clock. This care center provides remote support to 38 smaller hospitals situated in states from Oklahoma to North Carolina (for emergency rooms, intensive-care units and various other programs). Most of these 38 hospitals do not have any on-site physician 24/7. The president of the Mercy Virtual reported a 30% decrease in the number of deaths than anticipated and a 35% decrease in the average length stay of the patients have been observed as monitoring of ICUs took place by Mercy specialists. This indicates that nearly1000 people were saved from dying due to the special assistance provided to the patients. According to a trade group, the American Telemedicine Association, remote medical care has been provided to more than 15 million Americans in 2015. In fact, this number grew by 30% in 2016.

Critics in Telemedicine

Even though telemedicine is spreading widely, there are some critics concerned about the quality of care received . Various barriers hinder the growth of telemedicine in some regions including developing countries as the infrastructure is not sufficient for the proper utilization of the modern Internet technologies. Also, the instability of the electric power supplies, unreliable connectivity of the internet, computer viruses, and limited availability of bandwidth hinder the adoption of telemedicine.

The financial cost is also one of the most important barriers to the adoption and application of telemedicine. Training cost, equipment, maintenance, and transport cost can be difficult to deal with for countries with low income. The application of telemedicine is also limited by knowledge, resources, and local skills.

Conclusion

Based on the studies included in this review, it can be concluded that information and communication technologies like cell phones, the Internet, and computers can address the health problems on a global level. It can be done through the deliverance of healthcare services. The health of the individuals and their communities is significantly improved by telemedicine as the health care services are provided to remote areas by health care professionals using ICTs for an exchange of all valid information for treatment, diagnosis, prevention, evaluation, research and for providing education to health care providers. The healthcare’s safety, quality, cost-effectiveness, and cleanliness have significantly improved internationally . Though there are various hindrances to the spread of telemedicine in developing countries, a focused approach towards its implementation may work wonders for nations as the health of the local people is improved.

References

Beck, Melinda. “How Telemedicine Is Transforming Health Care.” The Wall Street Journal, 2016.

Breen, Gerald-Mark, and Jonathan Matusitz. “An Evolutionary Examination of Telemedicine: A Health and Computer-Mediated Communication Perspective.” Soc Work Public Health, 2010: 59-71.

Mclean, Susannah, Aziz Sheikh, Kathrin Cresswell, Mome Mukherjee, Claudia Pagliari, and Akiko Hemmi. “The Impact of Telehealthcare on the Quality and Safety of Care: A Systematic Overview.” PLoS One, 2013.

Rao, Babar, and Adriana Lomabardi. “Telemedicine: current status in developed and developing countries.” Journal of drugs in dermatology, 2009: 371-375.

Wang, Fuhmei. “Continuing Medical Education via Telemedicine and Sustainable Improvements to Health.” International Journal of Telemedicine and Applications, 2016: 1-6.

WHO. TELEMEDICINE Opportunities and developments in Member States. Global survey on eHealth, Geneva: WHO Press, 2010.

[i] WHO. TELEMEDICINE Opportunities and developments in Member States. Global survey on eHealth, Geneva: WHO Press, 2010, 8.

[ii] WHO. TELEMEDICINE Opportunities and developments in Member States. Global survey on eHealth, Geneva: WHO Press, 2010, 13.

[iii] WHO, 14.

[iv] WHO. TELEMEDICINE Opportunities and developments in Member States. Global survey on eHealth, Geneva: WHO Press, 2010, 15.

[v] WHO, 16.

[vi] Rao, Babar, and Adriana Lomabardi. “Telemedicine: current status in developed and developing countries.” Journal of drugs in dermatology, 2009: 371-375, 372

[vii] Mclean, Susannah, Aziz Sheikh, Kathrin Cresswell, Mome Mukherjee, Claudia Pagliari, and Akiko Hemmi. “The Impact of Telehealthcare on the Quality and Safety of Care: A Systematic Overview.” PLoS One, 2013.

[viii] Mclean, et al. 2013.

[ix] Ibid.

[x] Ibid.

[xi] Breen, Gerald-Mark, and Jonathan Matusitz. “An Evolutionary Examination of Telemedicine: A Health and Computer-Mediated Communication Perspective.” Soc Work Public Health, 2010: 59-71, 63.

[xii] Breen and Matusitz 2010, 64.

[xiii] Ibid.

[xiv] Breen, Gerald-Mark, and Jonathan Matusitz. “An Evolutionary Examination of Telemedicine: A Health and Computer-Mediated Communication Perspective.” Soc Work Public Health, 2010: 59-71, 64.

[xv] Ibid

[xvi] Wang, Fuhmei. “Continuing Medical Education via Telemedicine and Sustainable Improvements to Health.” International Journal of Telemedicine and Applications, 2016: 1-6, 2.

[xvii] Ibid.

[xviii] Beck, Melinda. “How Telemedicine Is Transforming Health Care.” The Wall Street Journal, 2016.

[xix] Ibid.

[xx] Ibid.

[xxi] WHO. TELEMEDICINE Opportunities and developments in Member States. Global survey on eHealth, Geneva: WHO Press, 2010, 19.

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Introduction

It is not an easy task to define globalization but it can be described. The reason is that globalization, in its current usage and tradition, is “a new, complex, dynamic, multidimensional, and worldwide phenomenon, which means different things to different people and different things” (Kiggundu, 2002). Globalization is connected with various chief opportunities and significant challenges. In the same manner, mechanization and globalization have together influenced the quality of food in the contemporary world of today.

Genetically Modified Food

The biggest impact that has been brought on the food quality today by the introduction of machinery and modern scientific techniques is the production of genetically-modified food. The term genetically-modified food is used for all the products that are “produced from organisms where their genetic structure has been adjusted or altered from that which would occur naturally” (“Genetically Modified Food”, 2013). In other words, genetically-modified food refers to the crop plants that are manufactured (to be consumed by animals or human beings) by employing the most up-to-date techniques of molecular biology (Whitman, 2000). In the contemporary society, the introduction of the cultivation of genetically modified organisms (GMOs) and their circulation all over the world has turned out to be a hot topic in a number of countries. This controversy regarding the farming and marketing of GMOs is for the reason that a lot of people are fearful that it may lead to health and environmental effects that are damaging, unfavorable and potentially out of control (“Genetically Modified Food”, 2013).

Process of Production genetically modified food

The process of production of genetically modified food involves the modification of plants in the laboratory for developing or boosting the preferred qualities for instance better herbicide resistance or superior dietetic content. In the previous times, desired traits were developed by the employment of breeding. However, those methods took a lot of time to produce results and were often found to be inappropriate and inaccurate. On the other hand, plants with the perfect desired trait have been created very quickly and with immense accurateness with the use of genetic engineering (Whitman, 2000). This scientific method is regarded a hot issue as a lot of people consider genetically-modified food to be a major concern for the food quality in recent times.

The world population is increasing day by day and it has been predicted that the present number of people will double in the next five decades. Thus, it has become a major challenge for the governments to make sure that that there will be sufficient supplies of food for this ever-increasing population. The advocates of genetically-modified food believe that this challenge can be met by this unique method in several ways. This technology may cause harm to other living organisms unintentionally. Secondly, it lessens the pesticides’ effectiveness. It may also cause allergenicity and unknown effects on human health. On a broader level, the marketing and circulation of genetically-modified food requires a lot of time and money thus making it an expensive process (Whitman, 2000).

Advantages of Genetically-Modified Foods

On the other hand, the advantages of genetically-modified foods include resistance for pests and diseases, tolerance for herbicides and cold as well as resistance for droughts and salinity. Thus, those in favor of genetically-modified foods consider it as the potential solution to a number of problems in the world that are related to hunger and malnutrition.  The mentioned advantages also emphasize on the idea that genetically modified foods can facilitate in the protection and preservation of the environment as they demonstrate increase in farm outputs and lessen the farmers’ dependence on chemical pesticides and herbicides (Whitman, 2000).

Critics on Genetically-Modified Foods

The crops that are produced using genetic engineering have instigated a reaction that is far more complex than placing it within disagreements about communal wellbeing, rights and fair dealing. In simple words, genetically-modified crops are considered by a lot of people as “going against nature” and critically object to the development of such crops. A majority of people also hold the belief that treating nature in a commercial manner is completely against moral and ethical standards. They believe so not because they consider it disadvantageous for health and environment but on the ground that manufacturing and selling such foods is intrinsically immoral.

To cut a long story short, those who are against the production and circulation of genetically modified food are, if truth be told, afraid of it because they don’t understand the technology in real. The opinions of the general public regarding the food biotechnology have not joined together for the reason that the embracing and implementation of this revolutionary technology has been much swifter than peoples’ ability to understand the process and its consequences completely. However, biotechnology and genetically modified can be said to be the future representatives carrying numerous benefits for the human race (“Biotechnology Regulation,” 2000).

Global and Mechanic Impact

Globalization has inflicted other bad impacts on the quality of food products. A majority of traders are used to of making use of dodgy and dishonest methods to earn profits. They do so by using low quality food ingredients so that their products may be bought by the people in lower prices. Many traders employ immoral ways just to survive in the market or to compete with others. The increasing globalization and mechanization of food and agricultural production has raised concerns over their safety and purity.

The richer countries also dump food in the poorer countries in the name of aid. This makes the quality of food rather questionable as there is no check on the purity of the food that is being given to the poor countries by the wealthier ones. The degradation of environment, increased use of chemicals, fertilizers, insecticides and pesticides also puts a question mark on the quality of food that is being presented before the customers.

As far as mechanization is concerned, it has brought significant positive changes to the food industry such as rapidity of processes, advanced irrigation systems, increased yields etc. However, many people are concerned about the distribution of food in an even manner throughout the world. As poorer countries do not still make use of mechanized agriculture, it simply means that the availability of food in greater quantities is not available.

Conclusion

To conclude the whole scenario regarding quality of food in the contemporary times, it is the ultimate responsibility of every government, rich or poor, small or large, to take appropriate measure for the prevention of deceptive practices and corruption in the agricultural sector and food industry. It must be made sure that consumers are protected against any sham and the exchange of goods is facilitated. There are a number of countries that have already taken some steps in this regard and have developed national food standards programs due to their advancement in food chemistry and microbiological studies and research (Lupien & Randell, 1999).

With trade globalization, the availability of food and its diversification has increased all over the planet. This increase has also augmented the probabilities of the food produced in one region affecting the physical condition, healthiness and diet of populace living in other regions. Consequently, it is the need of the time to introduce “global food safety and nutrition measures applicable across borders, institutions and disciplines, including the establishment of evidence-based international standards on food safety and nutrition” (Tritscher, Miyagishima, Nishida & Branca, 2013).

References

Biotechnology Regulation. (2000, Winter).Issues in Science and Technology, 17 (2), 5. Retrieved November 16, 2013, from http://www.questia.com/read/1G1-71962002/biotechnology-regulation

Genetically Modified Food. (2013). Questia. Retrieved November 12, 2013, from http://www.questia.com/library/science-and-technology/life-sciences-and-agriculture/agriculture/genetically-modified-food

Kiggundu, M. N. (2002). Managing Globalization in Developing Countries and Transition Economies: Building Capacities for a Changing World. Westport, CT: Praeger. Print.

Lupien, J. R., & Randell, A. (1999, Winter). Setting Standards for Food Quality. UN         Chronicle, 36 (4), 66. Retrieved November 16, 2013, from        http://www.questia.com/read/1G1-61693392/setting-standards-for-food-quality

Tritscher, A., Miyagishima, K., Nishida, C., & Branca, F. (2013). Ensuring Food Safety and         Nutrition Security to Protect Consumer Health: 50 Years of the Codex Alimentarius             Commission. Bulletin of the World Health Organization , 91(7), 468. Retrieved   November 16, 2013, from http://www.questia.com/read/1G1-347291491/ensuring-food-          safety-and-nutrition-security-to-protect

Whitman, D. B. (2000). Genetically Modified Foods: Harmful or Helpful?. CSA. Retrieved          November 13, 2013, from  http://www.csa.com/discoveryguides/gmfood/review.pdf

 
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Ventilator-associated pneumonia or VAP

Ventilator-associated pneumonia, also referred to as VAP, is an infirmity that occurs almost forty-eight hours subsequent to the receiving of mechanical ventilation and intubation by patients. Therefore, VAP diagnosis calls for a high medical suspicion along with regular assessments of the patients. Respiratory secretions need to be analyzed microbiologically in conjunction with radiographic examinations. VAP (Ventilator-associated pneumonia) is the consequence of several local factors as well as the microbiologic environment within a respective unit. Thus, the clinicians and nurses are required to conduct aggressive surveillance of the mentioned features within a given unit. It needs to be understood that patients suffering from critical illnesses are extremely vulnerable to resistant organisms. For that reason, it is absolutely important to use judicious antibiotics for the treatment and prevention of VAP (Ventilator-associated pneumonia) (Koenig & Truwit, 2006).

Nursing Interventions

As far as nurses are concerned, they can play a highly positive role in preventing Ventilator-associated pneumonia. It is their prime responsibility to adopt respiratory therapy interventions in this regard. It is an extremely encouraging fact that the VAP incidence can be minimized and/or eliminated if preventive techniques are utilized by the clinicians. Even the simplest nursing measures could be helpful in reducing VAP (Ventilator-associated pneumonia) early-onset. Such useful nursing interventions include concentrating on and tackling “modifiable risk factors such as endotracheal and nasogastric tubes, tracheotomy, reintubation, enteral nutrition, corticosteroid administration, gastric pH-modifying agents, supine positioning, prior antibiotic usage, poor infection control practice, and contaminated respiratory equipment, medications, or water” (Koenig & Truwit, 2006). It is also critical to make sure that the applied interventions are aimed at the mortality reduction, morbidity minimization, and cost reduction. The prime objective needs to be the utilization of efficient preventative and treatment methods that ultimately allow Ventilator-associated pneumonia patients to demonstrate improved outcomes (Koenig & Truwit, 2006).

References

Koenig, S. M., & Truwit, J. D. (2006). Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention. Clinical Microbiology Reviews, 19(4), 637-657. doi:10.1128/cmr.00051-05

 
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Introduction

Lou Gehrig’s disease, also known as Amyotrophic Lateral Sclerosis, is a vicious neurological disease with uncertain pathogenesis. This illness progresses continuously as the nerve cells that control voluntary muscles are attacked. Hence, there is a profound effect on the human-controlled muscle actions. The rapid degeneration of brain and spinal cord motor neurons eventually makes it impossible for the patient to receive impulses. The body initially weakens and ultimately paralyzes due to the swift muscle deterioration process (Fang, Ingre, Roos, Kamel, & Piehl, 2015).

Etiology & Epidemiology

A number of factors cause Lou Gehrig’s disease. More than half of the cases demonstrate the presence of genetic mutations. Till this day, the scientists have been successful in identifying two defective proteins; one linked with the regulation of RNA and the other flawed protein is apparent in the process of unnecessary protein clearance. In addition, ALS etiology may also “involve glutamate excitotoxicity, superoxide dismutase mutation, and free-radical neutrotoxicity” (Caterino & Kahan, 2003). As far as its epidemiology is concerned, “the incidence of ASL is approximately 1-2 per 100,000 with a prevalence of about 5 per 100,000, men being affected more commonly than women” (Shoenfeld, 2014).

Symptoms

Lou Gehrig’s disease is represented by a numerous symptoms including cramping, muscle aches, limb weakness, difficulty in the execution of normal activities, trouble in swallowing, slurred speech, and respiratory muscle weakness (Caterino & Kahan, 2003). All the mentioned symptoms weaken the immune system of the ALS patient eventually requiring treatment.

Treatment and Prevention

It is rather unfortunate that no cure has been identified for the prevention of ALS. However, there are a number of preventive methods that can be utilized for helping the Lou Gehrig’s Disease patients to move about independently. The employment of aiding devices and equipments such as wheelchairs, speech synthesizers, and Hoyer lifts could be extremely facilitating for the ALS patients. Computerized devices and specific gadgets are also important in making their lives easier. In case of ventilator issues, mechanical ventilation is also certainly helpful. Hospice care is encouraged when an ALS patient reaches the terminal stage. As far as the ALS treatment is concerned, Rilutek was approved by the Food and Drug Administration in 1995 as the first ALS drug. Whereas it does not cure the disease, this drug is still considered valuable for adding few months to most patients’ lives. Another drug regarded for ALS treatment is Myotrophin for the restoration of damaged neurons. However, its ineffectiveness has not made researchers confirm or approve it as the best drug option (Wade, 2001). It needs to be mentioned that ALS consequences can be best treated through palliative treatment.

How this correlates with my major/career in Nursing?

As a nurse/nursing student, I can play an extremely influential role in treating and caring for ALS patients through the provision of mental, physical, and emotional support. Nurses are required to facilitate Lou Gehrig’s Disease patients’ physical independence and emotional wellbeing with a comprehensive program for rehabilitation. I believe I could encourage ALS patients to participate in routine tasks. Also, engagement in exercises can also help them to live an active life. The provision of regular and suitable medication to the Lou Gehrig’s Disease patients is also a critical responsibility of nurses. Lou Gehrig’s disease is a devastating disease with no cure but the treatment offered by multidisciplinary teams and/or clinicians is effective in improving the quality of life of ALS patients.

References

Caterino, J. M., & Kahan, S. (2003). In a Page: Emergency Medicine. Malden, MA: Blackwell.

Fang, F., Ingre, C., Roos, P., Kamel, F., & Piehl, F. (2015, February 12). Risk factors for amyotrophic lateral sclerosis. Clinical Epidemiology, 7, 181-193. doi:10.2147/clep.s37505

Shoenfeld, Y. (2014). Diagnostic criteria in autoimmune diseases. New Jersey: Humana.

 
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