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Cancer occurs when there is an abnormal growth of cells cheap 200 mg modafinil mastercard, which can form lumps or tumours discount 200 mg modafinil, or can spread through the bloodstream and lymphatic system to other parts of the body buy 100mg modafinil mastercard. Benign tumour cells stay in one place in the body and are not usually life-threatening order modafinil 100 mg without prescription. Malignant tumour cells are able to spread to invade nearby tissues and other parts of the body buy modafinil 200 mg with visa, which is a process called metastasis. Finding cancer early and getting treat- ment before it spreads can greatly help improve your chances of survival. While we think of cancer as one disease, it is actually a group of more than 100 different diseases. It can involve any tissue of the body and have many different forms in each body area. The four most common types of cancer in Canada are breast, prostate, lung, and colon. A great deal of research has focused on the underlying causes of abnormal cell growth. We do know that certain factors, such as free radical damage, genetics, diet, and lifestyle, are involved. While many of us may blame our family history, only about 5–10 percent of cancers are attributed to faulty genes. Having a family history may increase your risk of certain cancers, but researchers feel that whether or not those genes are “switched on” may depend largely on lifestyle and environment. These critical yet often overlooked factors play a role not only in prevention but also in the treatment and recovery from cancer. Based on current incidence rates, 39 percent of Canadian women will develop cancer during their lifetimes. Cancer is a very broad subject and it is beyond the scope of this chapter to discuss each type and make individualized recommendations. The goal here is to provide you with information on known risk factors for the most common forms of cancer, how to reduce your risk of getting cancer, and how to improve your chances of survival if 152 you have cancer. If you have been diagnosed with cancer, it is critical that you consult with your health care provider to create an individualized program. In many cases, dietary and lifestyle strategies and supplements can be taken along with your other treatments. Certain supplements, however, could interact with chemotherapy or other medical treatments, so it is important to work with your health care provider. Research shows that overall 30–35 percent of all cancers can be prevented by be- ing active, eating well, and maintaining a healthy body weight. It may take months or years before there are any signs or symptoms, and these symptoms can vary greatly depending on the location of the cancer. Some substances used in pesticides are classified as known, probable, or possible carcinogens. Exposure to many different risk factors may increase a person’s risk more than the risk associated with each individual toxin or chemical, so it is important to avoid as many known risk factors as possible. Researchers looked at a group of 44,778 pairs of twins from Finland, Sweden, and Denmark, in order to assess the risks of cancer for the twins of people with cancer. The researchers concluded that inherited genetic factors make only a minor contribution to the susceptibility of breast, prostate, and colorectal cancer. More importantly, they con- cluded that environmental factors make a major contribution to all of the 28 anatomi- cal sites of cancer studied (New England Journal of Medicine, 2000: 343; 78–85). Today there are numerous options for medical treat- ment including chemotherapy, radiation, surgery, and hormone therapy. For those who have cancer, a good nutritional program can help prevent weight loss, aid digestion, support immune function, and boost energy levels. Dietary Recommendations Foods to include: C • Boost fibre intake: aim for 25–30 g daily of soluble and insoluble fibre. Eat 2 tbsps of milled flaxseed every day: it provides fibre and contains compounds that help in the prevention of cancer. Foods that contain the highest amounts of pesticide residue include peaches, strawberries, apples, spinach, nectarines, celery, pears, cherries, potatoes, peppers, and raspberries. If organics are not available or cost-prohibi- tive, wash your produce with lots of water and scrub the skins. In 1992, a review of 200 studies showed that cancer risk in people consuming diets high in fruits and vegetables was only one-half that in those consuming few of these foods. It is clear that there are components in a plant-based diet that can reduce cancer risk, but few Canadians get the recommended intake of these foods (Nutrition and Cancer, 1992; 18 (1): 1–29).

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The term; when physicians speak of strokes buy modafinil 100 mg online, they are refer- books included Attachment (1969) buy generic modafinil 100mg, Separation (1973) proven 100mg modafinil, ring to thromboses buy modafinil 100mg overnight delivery, hemorrhages purchase modafinil 100mg fast delivery, or embolisms. Initially, his theories were attacked by ly, the term stroke refers to the loss of blood to a part of traditional psychoanalysts (including Anna Freud) who the brain and the resulting tissue damage. But as variables involved, strokes are often not correctly diag- psychologists and psychiatrists revised Freud’s theories, nosed. Often, especially with very mild events, a patient they realized that Bowlby’s theories were both innova- will attribute odd sensations to something else. He continued his speaking, if tissue damage occurred in the right brain association with Tavistock, but he also spent more time hemisphere, the victim may experience some degree of at his vacation home on the Isle of Skye, off the Scottish paralysis on the left side of the body, a distortion of vi- coast, with his family. If the tissue affected is on of Charles Darwin,was published in 1990, only months the left side of the brain, patients may experience some before his death of a stroke on September 2 on Skye. Milite Other common brain disorders include the array of conditions caused by head trauma. Injuries to the head can, obviously, vary tremendously, but such injuries all Further Reading result in biochemical abnormalities in the brain. New York, the head has been injured in some way, a tremendous Basic Books, 1969, 1973, 1980. Lon- often have detrimental effects on brain cells, including don, Routledge, 1993. Recent medical advances have uncovered some drugs and treat- ments that can offset this after-effect of trauma, and physicians now know that brain cells can be replaced in Brain disorders adults, a procedure that was thought impossible only a decade ago. Doctors now have the ability to procure ac- Any of the various disorders associated with the curate images of the brain from magnetic resonance human brain, including stroke, trauma, and tu- mors. It has recently been reported that neurology, the The incidence of brain tumors has increased in re- study of the brain, is the fastest growing specialty in the cent years, although it is not certain if this trend is sim- life sciences. Nonetheless, treatments devised thus far have of the more prevalent brain disorders. Researchers have found varieties of brain disorders that affect humans, including that certain genes inside tumors are capable of creating Alzheimer’s disease, Parkinson’s disease, epilepsy, resistance to drugs being used to destroy the tumor. The four principal Developmental neurologic disorders of the brain in- sections of the human brain are the brain stem, the dien- clude well-known brain diseases such as Alzheimer’s, cephalon, the cerebrum, and the cerebellum. Most of these disorders are now known to be inheritable, passed from one generation to another genetically. Re- The brain stem cent research has isolated the gene that causes strains of The brain stem connects the brain with the spinal Alzheimer’s, Huntington’s disease, and several other cord. Cerebral palsy, a devastating devel- brain and spinal cord pass through the medulla—a part opmental neurologic disorder involving severe muscle of the brain stem—via fibers. The fibers on the right side and coordination deterioration, has been attributed to of the medulla cross to the left and those on the left cross stroke in newborn infants. The medulla also controls spent the following studying brain disorders: the heartbeat, the rate of breathing, and the diameter of Alzheimer’s disease, $305 million; stroke, $116 million; the blood vessels and helps to coordinate swallowing, multiple sclerosis, $80 million; Parkinson’s disease, $72 vomiting, hiccupping, coughing, and sneezing. Another million; epilepsy, $55 million; and head injury, $51 mil- component of the brain stem is the pons (meaning lion. Conveying impulses between the cerebral Further Reading cortex, the pons, and the spinal cord is a section of the “Cognitive Impairment to Dementia. The diencephalon The diencephalon lies above the brain stem and em- bodies the thalamus and hypothalamus. The thalamus Brain is an important relay station for sensory information, in- Part of the central nervous system located in the terpreting sensations of sound, smell, taste, pain, pres- skull. Controls mental and physical actions of the sure, temperature, and touch; the thalamus also regulates organism. The hypothalamus con- trols a number of body functions, such as heartbeat rate The brain, with the spinal cord and network of and digestion, and helps regulate the endocrine system nerves, controls information flow throughout the body, and normal body temperature. The hypothalamus inter- voluntary actions, such as walking, reading, and talking, prets hunger and thirst, and it helps regulate sleep, and involuntary reactions, such as breathing and heart- anger, and aggression. Encased within the skull, The cerebrum the brain of an average adult weight about 3 lb (1. For example, spoken and written language are three-layer membrane called the meninges. Earthworm brain Deutocerebrum Cerebrum Protocerebrum Stomatogastric system Infundibulum Pituitary gland Ventral Cerebellum nerve cord Midbrain Pons Brain Tritocerebrum Thoracic ganglia Medulla stem Subesophageal oblongata ganglion Spinal cord B. Bird brain Comparison of the brains of an earthworm, an insect, a bird, and a human. Motor areas of the pus callosum had been destroyed, scientists realized that cerebrum control muscle movements.

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Artificial ventilation should meet physiological deficits (metabolic oxygen demand and carbon dioxide elimination) cheap modafinil 200mg visa. These terms are therefore not used here buy modafinil 100 mg otc, but readers should be aware of their existence and meanings cheap 100mg modafinil fast delivery. Carbon dioxide removal requires active tidal ventilation and so is affected by inspiratory pressure tidal volumes expiratory time buy modafinil 100 mg online. Manipulating these factors can optimise ventilation while minimising complications safe 200mg modafinil. Normal adult alveolar ventilation is about four litres each minute; normal cardiac output is about five litres each minute. Shunting can also occur at tissue level (reduced oxygen extraction ratio, see Chapter 20). Care of ventilated patient The care of ventilated patients should be holistic—the sum of many chapters in this book, especially in Part I. Artificial ventilation causes potential problems with: ■ safety ■ replacing normal functions ■ system complications Ventilated patients have respiratory failure, so ventilator failure or disconnection may be fatal. Modern ventilators include alarms and default settings, but each nurse should check, and where appropriate reset, alarm limits for each patient; Pierce (1995) recommends a ‘rule of thumb’ margin of 10 per cent for alarm settings. Alarms may fail and so nurses should observe ventilated patients both aurally and visually. This necessitates appropriate layout of bed areas to minimise the need for nurses to turn their backs on their patients. Back-up facilities in case of ventilator, power or gas failure should include: ■ manual rebreathing bag, with suitable connections ■ oxygen cylinders ■ equipment for reintubation Additional safety equipment may also be needed (e. Positive pressure ventilation is unphysiological; increased intrathoracic pressure compromises many other body systems (especially cardiovascular), causing problems identified later in this and many other chapters. Intensive care nursing 28 Fighting ventilation (dysynchrony between ventilator and patient-initiated breaths) should not occur, almost all modern ventilators incorporate trigger modes. However patient discomfort from ventilation (coughing, gagging—often from oral tracheal tubes, including biting on tubes) may cause problems. Nurses should monitor effects of ventilation, providing comfort where possible (e. When physical restraint cannot be avoided, it is best limited to manual restraint, using the minimum force necessary, which should be released as soon as possible. Tidal volume Tidal volume affects gas exchange, but can also cause shearing damage to lungs; settings should therefore balance immediate needs of oxygenation and carbon dioxide removal against potential lung damage/healing. While not too dissimilar to peak flow volumes, normal respiration preferentially distributes air to dependent lung bases (especially when standing) (Ryan 1998), matching maximal ventilation with optimum perfusion; lying down reduces the functional residual capacity by about one-third, thus artificial ventilation distributes gas unevenly, overdistending upper lung zones (Ryan 1998). Patients at greatest risk from alveolar trauma usually have poor compliance, low functional lung volumes and hypoxia, creating dilemmas between adequate oxygenation and risks of lung damage. When patient-initiated negative pressure exceeds the set trigger level, patients can ‘breath through’ the ventilator. With most ventilatory modes, triggered breaths are in addition to preset volumes, but included in measured expired minute volume. Incorporating triggering/sensitivity into ventilators aids weaning and facilitates patient comfort by overcoming the problems of ‘fighting’. At rest, self-ventilation negative pressure is approximately −3 mmHg (Adam &; Osborne 1997); trigger levels below this can cause discomfort (fighting). Early methods of immersing expiratory port tubing into water (hence measurement in cmH2O) have been replaced by resistance valves (usually incorporated into ventilators). However, frequent small tidal volumes may achieve minute volume limits without clearing airway dead space. Once a breath is triggered, pressure support delivers gas until the preset peak airway pressure is reached. Thus pressure support encourages patients to initiate breaths, but replaces shortfall in volume from weak respiratory muscles. However tidal volumes are sufficiently consistent; alveolar ventilation is optimised (Bohm & Lachmann 1996) with minimal barotrauma. Flow-by Triggering (and pressure support) require sufficient negative pressure to open a closed valve, causing a delay in ventilation, increasing work of breathing and causing possible distress to patients.

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Ley and Morris (1984) examined the effect of written information about medication and found that it increased knowledge in 90 per cent of the studies generic 100mg modafinil with mastercard, increased compliance in 60 per cent of the studies buy cheap modafinil 200mg online, and improved outcome in 57 per cent of the studies buy modafinil 200mg fast delivery. Ley’s cognitive hypothesis model generic 200mg modafinil otc, and its emphasis on patient satisfaction purchase 200mg modafinil amex, under- standing and recall, has been influential in terms of promoting research into the com- munication between health professionals and patients. In addition, the model has prompted the examination of using information to improve the communication process. As a result of this, the role of information has been explored further in terms of its effect on recovery and outcome. On the basis that the stress caused by surgery may be related to later recovery, Janis (1958) interviewed patients before and after surgery to examine the effects of pre-operative fear on post-operative recovery. Janis examined the differences between pre- operative extreme fear, moderate fear and little or no fear on outcome. Extreme fear was reflected in patients’ constant concern, anxiety and reports of vulnerability, moderate fear was reflected in reality orientation with the individual seeking out information, and little or no fear was reflected by a state of denial. Janis suggested that moderate fear results in the individual developing a defence mechanism, developing coping strategies, seeking out relevant information, and rehearsing the outcome of the surgery. This approach may lead to increased confidence in the outcome, which is reflected in the decreased post-operative distress. However, there is conflicting evidence regarding this ‘U’ shaped relationship between anxiety and outcome (see Johnston and Vogele 1993). Using information to improve recovery If stress is related to recovery from surgery, then obviously information could be an important way of reducing this stress. There are different types of information that could be used to effect the outcome of recovery from a medical intervention. These have been described as (1) sensory information, which can be used to help individuals deal with their feelings or to reflect on these feelings; (2) procedural information, which enables indi- viduals to learn how the process or the intervention will actually be done; (3) coping skills information, which can educate the individual about possible coping strategies; and (4) behavioural instructions, which teach the individual how to behave in terms of factors such as coughing and relaxing. Researchers have evaluated the relative roles of these different types of information in promoting recovery and reducing distress. They reported that sensory and coping information reduced the need for pain killers and in addition reduced the hospital stay by three days. Young and Humphrey (1985) gave information to patients going into hospital, and found that information specific to how they could survive hospital reduced the distress and their length of stay in the hospital. Johnston (1980) found that pre-operative information can influ- ence recovery and reduce anxiety, pain rating, length of hospitalization and analgesic intake. Although the reasons why pre-operative information is so successful remain unclear, it is possible that pre-operative information may be beneficial to the individual in terms of the reduction of anxiety by enabling the patient to mentally rehearse their anticipated worries, fears and changes following the operation; thus any changes become predictable. These results therefore suggest that information com- municated correctly by the doctor or the health professional may be an important part of reducing the distress following hospitalization or a hospital intervention. This traditional approach has motivated research into health professional’s medical knowledge, which is seen as a product of their training and education. Accordingly, the communication process is seen as origin- ating from the health professional’s knowledge base. Boyle (1970), although emphasizing patients’ knowledge, also provided some insights into doctors’ knowledge of the location of organs and the causes of a variety of illnesses. The results showed that although the doctor’s knowledge was superior to that of the patient’s, some doctors wrongly located organs such as the heart and wrongly defined problems such as ‘constipation’ and ‘diarrhoea’. It has also been found that health professionals show inaccurate knowledge about diabetes (Etzwiler 1967; Scheiderich et al. Over recent years, due to government documents such as Health for All and the Health of the Nation, primary care team members are spending more time on health promotion practices, which often involve making recommendations about changing behaviours such as smoking, drinking and diet. Research has consequently examined health professionals’ knowledge about these practices. The results showed high levels of correct knowledge for statements such as ‘most people should eat less sugar’ and ‘most people should eat more fibre’, and relatively poor accuracy for statements such as ‘cholesterol in food is the most important dietary factor in controlling blood lipid levels’. The authors concluded that primary health care professionals show generally good dietary knowledge but that ‘there is clearly an urgent need to develop better teaching and training in the dietary aspects of coronary heart disease’. Ley’s cognitive hypothesis model of communication includes a role for the patient and emphasizes patient factors in the communication process as well as doctor factors such as the pro- vision of relevant information. This approach has encouraged research into the wider role of information in health and illness.

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