Ulcers - Research Paper Example

First Last Dr. First Last 6 September 2007 Ulcers Ulcers are a very common ailment affecting over 25 million Americans. Many more are affected worldwide and it is estimated that more than two thirds of the world population is either suffering or is at risk of developing ulcers (“How Common: The Key to Cure”). Ulcers are lesions or holes in the inner protective lining of the stomach. If left untreated, these cause severe damage to the stomach as softer tissue is exposed to the highly acidic contents of the stomach. Ulcers are of various types that include duodenal and peptic ulcers. Additionally, related symptoms and diseases such as gastritis commonly appear together with an ulcer. Patients with these conditions are at significantly higher risk of developing “gastric cancer and mucosal-associated-lymphoid-type (MALT) lymphoma” (“Illnesses: The Key to Cure”). Ulcers were traditionally thought to have been caused by excessive stress, spicy foods and acids in the stomach. Till recently, treatment could be classified more management rather than cure of the problem and included lifestyle and food intake changes. In terms of medication, it was prescribed to limit acid production in the stomach which only prevented further damage but could not eliminate the problem completely. In 1982, Robin Warren and Barry Marshall in their original paper published in 1982 established a link between the bacteria helicobacter pylori and ulcers (“History of Ulcer Diagnosis and Treatment”). However, it was not till the mid-nineties that the medical community began to take their research seriously when it was agreed that more than 80% of ulcers were caused by this bacteria. Prior to this discovery and its acceptance, it was generally thought that no bacteria could survive in the highly acidic environment of the stomach. The regimen for treatment of ulcers and gastritis were subsequently radically changed and shifted to the usage of antibiotics to control the spread and elimination of H. Pylori. A patient suffering from infection by H. Pylori can exhibit one or more of many symptoms. These may include pain in the upper abdomen that typically occurs on an empty stomach, in mornings and between meals (“Symptoms: Disease Listing, Helicobacter pylori”). Other symptoms include nausea, vomiting, loss of appetite and even occasional bleeding in severe conditions. Heartburn is another symptom that might occur though every case of heartburn does not go back to presence of Helicobacter Pylori. It is recommended by CDC (“Tested: The Key to Cure”) that patients with a history of duodenal or peptic ulcers should be tested for the presence of H. Pylori. Those patients that have recovered from stomach cancers are also recommended tests for H. Pylori. Patients with initial symptoms of dyspepsia are not necessarily tested. Diagnostics tests of children must only be recommended by a specialist. There are three types of tests that can be used for diagnosis: 1. A blood test provides 80% to 95% accurate diagnosis. In this test, a small sample of blood drawn from the patient is sent to the lab for testing. 2. A breath test in which a harmless liquid is given to the patient to drink and a breath sample is taken within one hour. This test has an accuracy of 92% to 98%. 3. An invasive method of endoscopy may be used in which a tube with a camera is inserted into the stomach via the mouth and small samples from the stomach’s lining taken. This test can only be performed at properly equipped locations and by an expert. Most cases are diagnosed using either a blood test or a breath test. Endoscopy is used only where conclusive evidence is required and is also considered the reference test for H. Pylori. As mentioned earlier, ulcers were thought to have been caused by spicy foods, lifestyle issues, over production of acids or stress. Since the discovery that ulcers are, in reality, caused by H. Pylori, an antibiotic treatment is recommended. Antibiotics are given together with acid-reducing medications for relief and the treatment takes place from between 10 days to 2 weeks (“Treatment: Disease Listing, Helicobacter pylori”). There are several medication regimens approved by the CDC and are selected on a case to case basis and on the basis of resistance to bacteria strains developed in patients. 2. Evidence-Based Health Care Without the Availability Of Information Technology By its nature, evidence based healthcare depends on the latest patient information, current practice guidelines, community health information and latest research on clinical results. It is therefore clear that information availability forms the foundation for its success. The concept of using previous research and information to make decisions about patient treatment is quite old. However, in recent decades, fast paced developments in technology have resulted in a paradigm shift in the way information could be used. As a result, ease and speed of information availability has presented a new challenge to the medical community. A practitioner in USA, for example, can no longer afford to ignore easily accessible research available in Europe and risk a compromise on the quality of patient care. While ignorance can no longer be an excuse, it is even more difficult to keep up with the rapidly expanding pool of information in various communities and available worldwide. Most of this information is now online and accessible either through the Internet or private networks. Sifting through this repository of information makes usage of Information Technology a necessity. Clinicians today do not have the time to read paper-based abstracts and developments. . The enormity and speed of available information brings a new meaning to the phrase “how to search”. Old methods of reviewing and studying paper based journals and documents are fast becoming obsolete. An IT based system is the only way through which practitioners can locate data and research relevant to their work. An obvious but necessary challenge is to choose the right tools and getting the required training to use them. Accessing electronic research information through the Internet and online search engines also requires an initial learning curve. Another aspect to necessity of using electronic information tools is a sort of “competition” for information between the patient and the practitioner. Patients are increasingly more aware of their conditions and also of several answers to their problems. The practitioner needs swift access to sources which are only available electronically to stay abreast of developments and be able to answer patient’s queries. It is only be being more aware of the latest developments and debates in healthcare that a physician can stay ahead of the patient and instill the confidence required in a patient-physician relationship. Better patient care can also be undertaken if the clinician has access to online information on the patient’s history. While such information is subject to misuse or legalities of privacy, it does bring the quality of care to a much higher level. Privacy and legal implications must be for those users of information who breach the trust of the patient while the rest of the medical community should be able to use this information to improve the quality of care. Like all forms of information, health related information also increases the responsibility on the clinician to use it appropriately. Evidence based medicine is a combination of “current best evidence” and the “judicious” use of it (Sackett et al.71-72). More information can not be a substitute for individual and specific care and the practitioner needs to apply judgment to decide on the information’s relevance and applicability to the patient’s situation. 3. Protocol for Writing a Research Paper A research paper requires careful compilation of ideas into words. It is also necessary to ensure that the ideas are well researched and coherent. In order to bring quality to the paper, a protocol has been developed to make sure important steps in writing it are not skipped and that errors are minimized. It is important to note that blind adherence to the protocol is not recommended and judgment be applied in case there are any special requirements for writing the paper. The first step is to study the research requirements and write down important points. These may include the number of pages expected, the writing style standard to be used, the type of information to be used and the possible resources (such as library, Internet or specific journals) to access this information. The second step is to create a broad plan for completing the paper with dates specified for milestones during the progress. This plan will form a blueprint for progress during completion of work. The plan must be realistic and buffers kept for any overruns in the time schedule. The subsequent steps will follow this plan as closely as possible and any deviations noted and incorporated into the plan. The third step is to generate broad ideas on what could be included in the paper. These ideas do not need to be refined or even second-guessed. Ideas will be dropped or expanded upon automatically as the work progresses. Fourthly, decide on the structure of the paper and how it will be organized. This structure can be modified later near the completion of the paper. The fifth step is to write a brief outline of the paper as it comes to the mind. It does not have to be perfect and will use some of the ideas written earlier. The next step, sixth, is to perform an initial research by going through the existing literature on the topic. This literature is to be accessed from relevant published or online resources such as books, journals, periodicals, newspapers etc. In the seventh step, in light of initial research, narrow the ideas generated in the third step. Write a brief draft or summary that will form the basis for the paper’s final form. In the eighth step, do an extensive literature review based on the summary of the paper. Access several sources and write a brief description of what the source is about and how it relates to the research paper being written. In the ninth step, begin expanding on the structure of the paper, incorporate ideas and include relevant sources from the literature review. It is important to write points and brief outlines wherever possible as these form the skeleton of the paper. The tenth step is to continue referring to literature review and writing and expanding on what has been completed by the ninth step. Steps eight and nine are to be repeated until a final draft of the paper is ready. During these iterative steps, the structure of the paper may be modified. In the eleventh step, the draft is reviewed and revised dispassionately. The focus here is to ensure that the paper meets the requirements, is coherent, is well argued and supported by good sources. Finally, proofreading of the paper is done. 4. Telemedicine Introduction: In a very literal sense, telemedicine is the provision of medicine and related services over a communication medium. Broadly speaking, it may cover several areas including and not limited to communication and consultation between researchers, between healthcare providers, between institutions, between laboratories and finally between healthcare providers and patients. This interaction has been going on for centuries in one way or the other but the advancement in technology and communications has made it possible to present new ways of treating patients and provide the quality of care that was hitherto impossible to imagine. It is possible, for example, to run a test on a patient and have results instantly available for expert comments to a consultant sitting thousands of miles away. In order to demonstrate how telemedicine can assist the elderly with chronic medical conditions, an example is discussed below. Elderly Patient Example: Jones (name not real) suffered a severe pain in the chest radiating into his left arm. He also complained of breathlessness and general anxiety. Taken to a hospital immediately, he was given emergency treatment and diagnosis revealed early stages of myocardial infarction. He was 62 at the time. In the next few days, an angioplasty was performed and a stent was placed in one of his arteries. Jones was a regular smoker, over-weight and had a sedentary lifestyle. On discharge from hospital, he was advised to stop smoking immediately, suggested a diet improvement program, regular exercise and given lifelong medication. Four years later, Jones lives alone, 15 miles away from the nearest hospital. He is supposed to keep a regular record of his vital signs, weight, cholesterol test results, exercise regimen and medicine intake. Every three months, he is to take his record to his physician at the hospital for routine checkup and advice. Mr. Jones is a classic example of an elderly patient with a chronic disease. Before discussing the benefits of telemedicine for him, it is important to consider demographics he is part of. Demographics: Jones is part of a large chunk of population that is aging and also suffers from chronic medical conditions. Better medical care translates to higher life expectancy with the result that more and more people will be joining this group. High costs of medical care coupled with over-stretched healthcare system poses a challenge to the industry and the medical professionals. Telemedicine for Mr. Jones: At the age of 68 and with a history of CHD (chronic heart disease), he is still a high risk patient. A visit to his physician every three months is a difficulty for him. A potential risk for him is that, in the case of a slowly deteriorating condition or a worsening lifestyle, the physician may get the information much later than it might benefit the patient. Technology exists today where he can install a simple software on his computer at home and keep a record of his medication, vitals, cholesterol tests, and lifestyle monitoring. The software will connect to another system at the hospital through a regular phone line connection where his database is maintained. An alarm will be generated at the physician’s computer if any health information changes beyond thresholds set by him. These thresholds would have been set by the physician knowing Mr. Jones’ history, prescription and advice If such a situation occurs, Mr. Jones could be contacted immediately for treatment. It is also possible for Mr. Jones to avoid visiting the laboratory, wait for his results and then entering his data through the keyboard. Home based automated and appropriately configured devices are now available that can perform the same function for him at home. Relevant to his needs, weighing scales, blood pressure monitors and cholesterol testing equipment today have new models that can connect directly to a computer and save data automatically. All he would need to do is to connect these devices to the computer, perform the simple home-based tests. These tests would automatically load into the software installed and subsequently forwarded to the hospital or care agency through the phone line or Internet. He could answer questions about his exercise routine or even connect his exercise equipment to the computer as well. Benefits: Through telemedicine Mr. Jones can save his trips to the laboratories and keep a constant liaison with his physician or his healthcare institution. This may even reduce the number of times in a year that he needs to visit the hospital physically. Proactive treatment could be provided to him in case of a deteriorating condition or advice in case of non-compliance with lifestyle requirements. Without telemedicine, the physician would only find out of his condition and progress on his next visit. In conclusion, telemedicine holds a promise for the aging population. Many applications can be considered such as provision of specialist care at remote areas through video conferencing. 5. Decision Making During Purchase of an Advanced Technology The decision making process is a complex one where many factors have a role in its outcome. Purchase of advance technology equipment in the healthcare industry adds further dimensions to these factors. To review what information must be available with the decision maker and what choices need to be made, an example of purchase of Magnetic Resource Imaging or MRI equipment is discussed. Purpose: The purpose and usage for which the MRI equipment is being bought drives how the decision process would be followed. For example, questions such as whether the equipment will be used for one institution only or will it be shared by several, what type of diagnostic requirements are expected etc. must be very clearly answered and the decision maker must be aware of them. In essence, better requirements definition result in better evaluations. General principles: As with any technology purchase, some basic information is critical to ensure that an informed decision is being made. Competing products must be reviewed and a comparison of their features, costs and delivery timelines must be made. Expensive technology equipments that last a longer time may also have expensive technical support and maintenance. These must be taken into consideration and added to the total cost of ownership over a period of time. This period of time could be taken as an estimated number of years the MRI would be deemed useful to the organization. Availability of upgrade options and their costs should be noted. It is also important to explore any financing options available for the purchase of MRI equipment. It must be decided whether an outright purchase is feasible or longer term financing is a better option. If the equipment is to be shared across institutions, the decision maker must be clear about what level of cost sharing would be possible. Also, another useful information is the expected usage volume and pattern of the technology which could be compared over time with the cost of acquiring it. Special Considerations in Healthcare Industry: High value and advanced technology purchases in the healthcare industry require consideration of specific dimensions while making the decision to buy. In the US, for example, higher costs of new equipment add to the total cost of healthcare and necessitate stricter insurance plans for patients. Many of these plans require the patient to co-pay for health services. On the other hand, if cheaper equipment with lesser technological advantage is used, the quality of care gets negatively affected. This aspect is also true for public health services. The decision to buy lies somewhere on the sliding scale of priority between reduction of costs versus the benefit to the patient and the quality of care administered. This is a delicate balance which confronts most medical organizations today. It is essential, therefore, to consider ways to reduce costs as well as give the maximum benefit and quality of care to the patient. The measure and perception about quality of patient care has different meanings depending on who defines it. Physicians may define it as “excellence of services” and “quality of interaction” with the patient (Blumenthal). Hospitals, insurance companies and HMOs may define it is optimum usage of resources while delivering health services (Blumenthal). While making a purchase, both perspectives must be recorded. When quality of care from the patient-physician perspective is of prime importance, enough weight must be given to medical specialists’ opinion. It is also evident that pooling of resources reduces costs which in turn translate to the ability to buy more advanced technologies. For example, a “mobile” MRI with all features may be more feasible compared with a fixed one. In this way, the technology is available to multiple practitioners within the vicinity. Patients can also benefit from “telemedicine” capabilities of the new equipment. The MRI can be connected to a network using which imaging data and pictures can be sent electronically for review rather than simply giving a print of the images or a CD containing this data. If the MRI has wireless network connectivity options, it has the potential to stay more useful over time and improve delivery of services to the patient. In conclusion, better planning, having the right information and making the optimum choices, it is possible to tilt the balance in favor of benefits in the cost/benefit equation without incurring very high incremental costs. Works Cited “How Common: The Key to Cure”. Centre for Disease Control. 28 Sep 2006. 6 Sep 2007. “Illnesses: The Key to Cure”. Centre for Disease Control. 28 Sep 2006. 6 Sep 2007. “History of Ulcer Diagnosis and Treatment”. Centre for Disease Control. 28 Sep 2006. 6 Sep 2007. “Symptoms: Disease Listing, Helicobacter pylori”. Centre for Disease Control. 12 Oct 2005. 6 Sep 2007. “Tested: The Key to Cure”. Centre for Disease Control. 28 Sep 2006. 6 Sep 2007. “Treatment: Disease Listing, Helicobacter pylori”. Centre for Disease Control. 12 Oct 2006. 6 Sep 2007. Sackett, David L., William M C Rosenberg, J A Muir Gray, R Brian Haynes, and W Scott Richardson. "Evidence based medicine: what it is and what it isnt". British Medical Journal. 312:7032(1996): 71-72. 5 Sep 2007 Blumenthal, David. " The Origins of the Quality-of-Care Debate". New England Journal of Medicine. 335:15(1996):1146-1149. 6 Sep 2007 < http://content.nejm.org/cgi/content/full/335/15/1146> Read More