Evidenced based practice Essay
Evidenced based practice
This paper discuses a research proposal on the above topic. Study on the effectiveness on the bone marrow transplant is essential to determine the best practice possible to revive patients back to health. The study will review on the literature available for the topic and discuss the current practice. The study will consider authoritative literature based on the topic and what is related to it. This paper will focus on the methodology to be used, methods of analysis of the data that are available and their advantages and disadvantages, if any and appropriateness.
Research problem Bone marrow transplant is not a very old venture and is not a common practice even in most of the large hospitals in most part of the country. While issues of patient’s health demand a further exploration into this topic, the practice is not common and the practitioners are few. Bone marrow transport is an expensive venture that needs to be well planned and organized in order to help the patient. Resulting complexities are not usually determined due to sufficient lack of exploration or use of best/informed practice.
The best way possible can be sought by use of research by establishing the issues surrounding bone marrow transplant to make practitioners aware of the implications and the best way to approach the diagnosis. This research will attempt to answer some of these and other related questions surrounding bone marrow transplant. Methodology The research will consider collecting data from primary and secondary resources. Primary resources will include materials like interview questionnaires. Twenty questionnaires will be issued to people who have experience with or have been affected by the illness or the case of transplant.
Questionnaires will focus on amongst other issues, the health history of the patient before and after transplant, the care undertaken after transplant, their position on the impact of the transplant and the cost. This will be expected to give a light on the appropriateness of the transplant by judging the impact and its results. The researcher will issue the questionnaires on a sampling technique to the interviewees who will be given adequate time of about three days to fill them and then they will be collected.
The researcher will also focus on the secondary sources of data like books, articles and journals on health so as to establish the documented issues surrounding the transplant, methods to deal with complexions arising, doctors views and opinions and the best practice so far. The researcher will compare documented evidences from internet sources, relate them with the primary source data and opinions and give recommendations on the best way possible. The materials will be considered in establishment of the available literature on the issue of bone marrow transplants and the complexity surrounding it.
At least 5 documented cases will be considered. Graphical data representation will be considered for the cases considered and data collected will be analyzed by scoring method. Reliability for the data in the cases will also be considered by considering the validity of the used instruments, and analysis done using cronbach alpha, test=retest, inter-rater reliability methods. Data storage will be done by secondary text material and in electronic form. Research questions The researcher will attempt to answer the following questions; What is the current practice in the field of bone marrow transplant and its effectiveness?
What are some of the cases where current practice was evidenced to result into difficulties and how did they solve the problems? What are the implications to the patient and the personnel, if any, surrounding the bone marrow transplant and how can they be avoided? The above questions will be expected give the researcher information on the whole issue of bone marrow to cover the purpose of the research study by shedding light on the current practice and the best way possible to deal with implications arising for the implant. Literature review
The first successful bone marrow transplant which is used to treat various diseases was carried out in 1968. Bone marrow is responsible for the production of red blood, platelets and white blood cells. The transplant which involves inclusion of bone marrow from a donor into the patient’s body without use of methods like chemotherapies and radiation diagnosis which can be used to destroy the patients’ defective cells but can also kill healthy, can be used to diagnose patients of plastic anemia, leukemia, cancer, some of the solid tumors. It can either be allogenic or syngenic where the latter case depicts an identical twin donor.
Tests are done on the blood to specially determine the viability of the transplant and avoid cases of the graft-verses-host disease and graft rejection (see ‘Bone marrow transplant’, n. d. ). Implications in the bone marrow transplant A study carried out for the cases of the stem cell transplant indicated that there was a 23% incidence of death, of the above 5000 transplant cases due to arising complications. Complications can arise if the cells of bone marrow transplanted fail to recognize the HLA-Human Leukocyte Antigen of the rest body part and attack it by antibodies.
This is known as Graft verses Host disease (GVHD) and the acute type normally occurs the first three months while a chronic type can develop from the acute type and cause symptoms to occur for long. The acute type is characterized by appearance of red spots on the body-feet, hands, face which spreads into a rash across the body and may develop to blisters; watery or bloody diarrhea; jaundice; stomach cramps and fever, while the other is characterized by dry eyes; dry and sensitive mouth; skin hardening; loss of hair; and an itchy dry rash which may spread all over the body.
These include other symptoms. The liver and lugs of the patient may be affected in serious cases of GVHD. The immune system of the patient is weakened by the transplant and a risk of contracting illnesses is increased and more worsened by use of immunosuppressant (see Bone marrow transplant. Risks). Reduction of complication Currently, there is evidence that the complications as a result of transplant can reduce if one has a sister or brother as his/her donor, absence of other serous complications/ bad conditions of health, and if a patient is younger.
Studies have indicated that younger patients have more probability of a successful diagnose. Thus it is advisable that patients will be aware if they suffer from the illness before it is too late to increase chances of success. An Immunosuppressant can be used together with corticosteroids can be used to stop the release of the antibodies from the bone marrow which has been incorporated.
The side effects of using corticosteroids may add other problems of affecting the other immune system and they may cause changes in mood, hypertension or highly blood pressure, itchiness, tingling and numbness on body parts, diarrhea, vomiting, convulsions and fever. Patients must be therefore taught how to deal with the situation arising due to complications. Discussing with patients before undergoing a transplant of this nature is important.
The physicians should not be allowed not be allowed to use the concept of futility as defined by since it has been viewed to be a powerful tool to relieve physicians to talk with patients (Wolf, 1988) and according to Cranford and Gostlin (1992) it can be used when the patient is using facilities or medical attention that can be more usefully available for care of another patient. (Perry, Rivlin & Goldstone, 1999) suggests four ways that can be emphasized to improve care of Bone Marrow Transplant patients with life-threatening conditions.
These are: increment of data which is available to determine the likelihood of survival of patients under certain conditions which includes reporting on poor results; ensuring the establishment of patients’ views before transplanting in discussion while encouraging written advance directives and counseling; drawing of guidelines in advance in order to offer guidance for use of particular therapies which can be used to resolve conflicting responsibilities of the physician; and formalization of withdrawal of care of patients under conditions of hopelessness.
References Bone marrow transplant. Columbia Presbyterian medical center. Herbert Irving comprehensive Cancer Center BMT Newsletter. Retrieved from http://cpmcnet. columbia. edu/dept/medicine/bonemarrow/bmtinfo. html on 4 October 2008. Bone marrow transplant. Risks. Healthy Encyclopedia. 21 August 2008. Retrieved from http://www. nhsdirect. nhs. uk/articles/article. aspx? articleId=621§ionId=29 on 4 October 2008. Cranford R. , Gostlin L.
(1992). Futility: A concept in search of a definition. Law Med Health Care. Vol. 20. pp. 307-309. Perry A. , Rivlin M. , Goldstone A. Bone Marrow Transplant patients with life-threatening organ failure: When should treatment stop? January 1999. Journal of Clinical Oncology. Vol. 17. no. 1. pp. 298-303. Pdf available at www. jco. ascopubs. org. Wolf SM. (1988). Conflict between doctor and patient. Law Med Health Care. Vol. 16. pp. 197-203.