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November 3, 2012

Essay on Oral Muscositis

Oral Mucositis
Article Critiques
Management of oral and gastrointestinal Mucositis
To find a detailed article to write the literature review of my thesis I searched with the key words oral Mucositis management. I searched in the Stanford medical library and this article was available in the library. This article provides a thorough introduction and provides the background knowledge related to oral and gastrointestinal Mucositis stating that the oral and gastrointestinal Mucositis due to cancer therapies such as high-dose chemotherapy and / or radiation prolongs to be an important clinical problem and there have been some strategies adopted to understand the roots of the oral and gastrointestinal Mucositis and development and treatments. The articles addresses example with the focus on evidence-based guidelines as presented by the Multinational Association of Supportive Care in Cancer (MASCC) in collaboration with the International Society of Oral Oncology (ISOO).
As defined in the article, Mucositis is the painful irritation and ulceration of the mucous membranes inside layer the digestive tract is  most of the times  a cruel  effect of different therapies for the treatment of cancer such as  chemotherapy and radiotherapy . The article written by  D. E. Peterson, R.-J. Bensadoun2 and F. Roila on behalf of the ESMO Guidelines Working Group present the risk factors associated with the Mucositis in a brief and simple way.
These risks include many painful changes in the patient. Oral Mucositis and gastrointestinal (GI) may have a bad affect up to 100% of patients taking high-dose chemotherapy and hematopoietic stem cell transplantation (HSCT), 80% of patients with head and neck cancer, radiation they be given, and a great number of patients receiving chemotherapy. The article has defined and explained two Incidence of oral and gastrointestinal Mucositis that include Incidence of oral and gastrointestinal Mucositis in patients undergoing hematopoietic stem-cell transplantation and incidence of Mucositis associated with standard multicycle chemotherapy (with or without radiotherapy) for non-Hodgkin’s lymphoma and breast, lung and colorectal cancers.
The management of Oral Mucositis and its treatment guidelines are discussed in the article. Interdisciplinary systematic development of oral hygiene protocols are recommended in the article. As part of the protocols, using a soft toothbrush that is replaced on a regular basis is also suggested in line with high-quality clinical practice.
Mucositis assessment: According to the study, a variety of existing rating scales for the measurement of oral Mucositis. Most scales used for clinical care include collective as oral symptoms, signs and functional impairment. These last scales are especially important in the evaluation and assessment of clinical trials based on oral Mucositis in contrast; there are a limited number of instruments obtainable for assessment of gastrointestinal Mucositis.
The article finally indicates the incidence of oral Mucositis in patients receiving high-dose head and neck radiation and mentions that Incidence of World Health Organization (WHO) grade 3 or 4 oral Mucositis in patients being treated regularly with high-dose head and neck radiation to the oral cavity approaches 85%, but it has been seen that almost all patients have some level of oral Mucositis.

Oral Mucositis
Article Critique
Implementation of a standardized protocol for prevention and management of oral Mucositis in patients undergoing hematopoietic cell transplantation
The article is in a PDF form and has been taken from the Ebsco database. Oral Mucositis is a very painful and incapacitating affects patients undergoing chemotherapy, radiotherapy with no other treatment. It is characterized by the emergence mouth sores that make everyday activities difficult or impossible to achieve. The purpose of this study and the statistical analysis conducted is to develop a protocol of care for oral Mucositis and the prevention and management of Mucositis in HCT patients and to assess the clinical impact of the implementation of the suggested preventions and management.
The article explains Chemotherapy in a brief account and mentions that Chemotherapy is the use of certain chemical substances to treat disease. It is a treatment technique in its own right as well as surgery. The first known use of chemotherapy was in use from the bark of quinine by the Indians of Peru, in the treatment of fevers such as malaria. Cancer is the uncontrolled growth of cells (cell degeneration) due to genetic mutations (DNA damage) and, sometimes, with a hereditary predisposition to develop tumors. Most chemotherapeutic medicines work by discontinuing mitosis (cell division), effectively targeting dividing cells too quickly. Since these substances can damage cells, they are called 'cytotoxic'. Some of these molecules cause a real "suicide cell" apoptosis.
Oral Mucositis has appeared to be as one of the most adverse, significant and devastating reactions associated directly with cancer chemotherapy.  It affects up to 80% of patients who are treated with the cancer chemotherapy conditioning for hematopoietic cell transplantation (HCT). The article presents a study with the methodology and the results of the study conducted.
 The method adopted for the study (presented in the article) was simple and all patients admitted to the hematology-oncology for chemotherapy with high dose followed by autologous or allogeneic HCT were eligible to participate for the study. A new protocol Mucositis consisting of a system of particular oral care had been started for the prevention and treatment of Mucositis.
 Assessment of Mucositis started on access to hospital and the patient was assessed using a rating scale of Mucositis daily by the doctor and the helpers like nurses. The new procedure was part of Mucositis HCT admission orders of service for each patient. The group of patients treated under the new protocol Mucositis was evaluated and compared with retrospective control group consisted of patients who underwent management of oral Mucositis under the earlier standard of care. The primary objectives were to evaluate and measure the occurrence, severity and period of oral Mucositis. Secondary objectives incorporated days requiring narcotics, febrile neutropenia, antimicrobial therapy, and length of the stay in the hospital.
According to the results of the study available in the article the Implementation of a standardized oral care protocol for Mucositis management showed the results of decreased incidence, duration and severity of Mucositis, and also reduced the global negative impact of Mucositis prominently.  The research and study is concluded with the statement that the future studies may further assess the global impact by adjusting for confusing factors.
In my opinion the main goal of the study presented in the article was to reduce the incidence and severity of Mucositis and to decrease or reduce further Mucositis related complications in the duration of the transplant method that is a sign of hope for the cancer patients and very helping for the students studying in this specific field to research or to make their own research.

Oral Mucositis
Article Critiques
Putting Evidence Into Practice: Evidence-Based Interventions for the Management of Oral Mucositis
I searched this well written article that is related to my area of research from lane library. My focus is on developing a nursing protocol for cancer center nurses on oral care
specifically for head and neck cancer patients and implementing the teachings and this article seemed very helping to me to get advanced on my to research. Also, the article talks about other intervention in order to reduce the severity of oral Mucositis.
The article points out those Nursing-sensitive patient outcomes are the results that are achieved through or considerably impacted by nursing interventions. The interventions must be within the scope of nursing practice and essential to the process of nursing care. The research of this article further declares that Nurses have a critical role in all aspects of managing Mucositis, including assessing it, teaching oral care, managing pharmacologic interventions, and helping patients who are under high depression due to their difficulty and regularly require the emotional help and counseling and help them to the cope with symptom distress.
There are many worst affects of the chemotherapy on emotional basis and Depression is one of them. Emotional distress, helplessness, loss of self esteem is disorder that accompanies cancer.
 I believe the challenge is to differentiate the psychological component of fatigue, that inherent to the disease and its treatment. If depression is diagnosed, it is the role of nurses to treat the patient at first stage before the patient is diverted to the psychologists.
The article provides a detailed literature review on the description of oral care. The research data present in this article identifies and indicates that oral care Prevents aspiration pneumonia, cancer, and heart disease. In the case cancer is diagnosed, oral care protocols facilitates greatly to decrease the harming effects of oral Mucositis in the patients being treated for cancer. The article is comprised of many studies done to identify and develop the nursing protocol for cancer center nurses. Other inventions like Allopurinol, Sucralfate and Multi-agent are thoroughly discussed in the article to better understand what is being updated in the field of cancer. Expert Opinion about the Bland Rinses is the best part of the article however this part could be given in so much more detail in the article.
This is a brief but helping section of the article. “Rinses are used to remove loose debris and aid with oral hydration. Bland rinses include 0.9% saline (normal saline), sodium bicarbonate, and a saline and sodium bicarbonate mixture.” (Debra J, 2008)  The article has been concluded in a very comprehensive way and it presents Implications for Nursing Practice and Research that could help me in developing my 3rd chapter of the thesis.
According to the details about Implications for Nursing Practice although the standard plans should provide a basis for care, Nurses must strive to develop individualized plans that are designed to provide the best results for each patient. This includes assessing a patient's ability and willingness to perform the treatments offered by oral route.

Oral Mucositis
Article Critique
Attitudes and practices of nurses on a pediatric cancer and stem cell transplant ward: adaptation of an oral care protocol
This study presented in this journal article is basically the evaluation of the current practices and role of nurses in the reduction and decrease the severity of oral Mucositis and understanding of oral health for hematology and oncology patients. In this well researched article, a questionnaire in black and white directed to 33 nurses on the pediatric cancer and blood disorders unit of Children’s Medical Center of Dallas incorporated questions on oral assessment, oral hygiene, and case-based questions. There is much research and specific information gathered to write this article and this information is used to develop an oral care protocol.
According to the article there are evidences found which inform that oral health care teaching through intervention and personal experiences can be an effective training tool for nursed and other medical staff. The intervention containing 6 steps (that the nurses were asked to follow ) specially designed and was prepared and put together as a part of this study combined specific detail from the questionnaire with the research material specific to oral care for pediatric cancer patients experiencing HSCT and cancer treatment.
The research done regarding the attitude and the current practices of nurses found that nurses were skillful and resourceful in diagnosing the conditions that were visible and prominent including Mucositis and pseudo membranous candidacies, but they were not found much proficient when diagnosing not as much of easily recognizable conditions such as xerostomia. The nurses were found to have insufficient information and training of the treatment and oral hygiene protocols for the conditions of cancer patients that they could and could not diagnose. Another important thing found during the study is that almost every one of them (nurses and other medical staff) had a sympathetic attitude towards the cancer patients.
 The article provides a protocol and the protocol is chiefly based on the questionnaire. The results of the questionnaire included information gathering, oral hygiene protocol, and evaluation of viral infection, evaluation of fungal infection, oral assessment guide, and treatment protocol. Through information gathering, an oral health care policy may be developed and put into practice to help in the treatment of children experiencing care for malignancies.
The article is concluded with a thoughtful conclusion and points out those deficiencies are in practice in oral care for the patients of pediatric oncology.  Keeping the results of the study in the view we can say that the better communication is indispensible between the dental surgeons and their team members and there is a need of improved communication between the dental medical professionals and nurses in order to educate and train each other and develop a better oral care in the hospital.
The nurses may not have the skills like doctors but their experience is worth counting and can help the dentists to get things better in the hospital. Through the assessment of skills and practices in a hospital, strategies for patient care may be formed as a guide for contributors.  Finally, according to the article further research is needed to evaluate the effectiveness of these strategies.

Oral Mucositis
Article Critique
          Development and Implementation of an Oral Care Protocol for Patients with Cancer
 This article has been taken from the database of Ebsco. According to the research of the article the growth of mucositis in patients treated for cancer can be devastating. It indicates that Health professionals spend much time evaluating prognostic indicators to improve treatment and patient survival. The healthcare providers knowing the fact that depression is an independent prognostic factor and that it is their major responsibility to solve the issue of depression in the cancer patients must "seek to do what those of cardiology trying.
Intervention examinations for treating severe depression among the cancer patients and low risk for STIs As patient advocates, oncology nurses must "examine the practice and ensure that their packs include psychosocial assessment and patients visits to the psychiatrists as an indispensible part of care against the cruel disease of cancer.
The article indicates the fact that the development of mucositis in patients being treated for cancer can have shocking and very harmful effects. Mucositis can origin a cascade phenomenon that has the quality to interfere with almost every aspect of a patient’s life. As such, the impact of oral mucositis on a patient’s physical and psychological comfort and quality of life can be significant.
Psychological issues remain stigmatized in the context of adaptation to cancer. Therefore, patients often do not say not to ask their doctors and doctors of their distress on the psychological problems of their patients.
Not detected and treated  anxiety of cancer patients on time leads to several problems: to make difficult decisions and adherence to treatment, further visits to doctors and emergency rooms, and more time and stress for 'oncology team early assessment and review of emergency leads in early treatment and prompt psychological distress, the improvement of medical care.
The article is summed up with the conclusion that because mucositis is an issue regularly observed in cancer patients, investigating the best researches and conducting the comprehensive studies the best interventions to manage the devastating treatment side effect was critical. By doing meticulous research on the causes and treatment of mucositis in addition to what other facilities were doing in this regard, the author of the article has developed a protocol that nurses could begin without the help of other medical professionals.
The oral care protocols simple and easy to know, with an oral assessment guide and interventions based on a score. Normal as a mouth rinse with proper brushing, flossing, and checking the oral cavity on regular basis is the starting point of the protocol. By starting the protocol, the author of the article seems hopeful to decrease the incidence and severity of mucositis in patients getting treatment for cancer.  As for the weakness of the article this is important to mention that until now the authors have not done a formal study to evaluate the efficiency and helpfulness of the protocol

Article Critique

Extracted from the various reputable research journals related to nursing the article focuses upon the standards and measurement benchmarks that need to be established for the assessment of the oral mucositis disease, the need due to which the need of such an assessment criterion has been designed is primarily because of the fact that the earlier medical reports upon which the diagnosis of mucositis was based upon did not provide the clinician with the appropriate technique and method according to which it would plan the subsequent course of treatment for curing the disease.
The instruments that were set did not provide patients or clinicians with the potential to solve or cure the disease in the appropriate way rather in some circumstances and cases it was reported that the treatment that was being applied to cure the disease was manifesting itself in the form of various adverse effects upon patients that were taking those recommended medications.
As a result of the false medication consultancy many patients had to suffer from the negative health repercussions due to which clinicians had to put their reputation at stake and the medical institute had to suffer from the harm of posing a direct threat to the credibility of the organization. Even though the article does not enlighten upon these medical cases that turned into bitter experiments but it would have been better if these cases would have been included in the research paper as it would have provided people and readers with an in depth analysis of the magnitude of the gravity of the situation and the subsequent repercussions that it can have upon the health of the patient. In addition it is very commendable to see that a proper research framework has been formulated to establish proper criteria through which the assessment about the disease and its effects can be evaluated and subsequently figured out.
The research has provided with an effective instrument through which the research can be conducted and its results can also be subsequently evaluated. In addition to this the research also provides with the ways and methods through which the proposed model of research can be modified and altered to suit the requirements and compatibility of the clinicians that are making use of the model. For the convenience of clinicians a scale and standard has been established which has the appropriate standard according to the signs and symptoms of the patient and the respective results of the patient that the condition corresponds to.
The role of basic oral care and good clinical
Practice principles in the management
Of oral mucositis
Article Critique
The article is based upon the oral and clinical practice that need to be adhered and implemented in order to contract the possible incidence of oral mucositis among people. The research has been conducted in a very thorough way regarding the steps that need to be applied and utilized for shielding oneself from the adverse health effects of mucositis primarily because of the sub standard and inadequate steps that are applied for the ways through which oral healthcare is used and applied by patients.
Even though the article seems to be thoroughly researched there are a couple of loopholes that need to be pointed in the way it has been conducted. A complete table has been provided in the article that accentuates upon the samples and the methods through which oral health care needs to be applied and the ways that have been proposed by different researches that have been made by different clinicians.
However at the same time another important thing that needs to be pinpointed here is the fact that the steps through which oral hygiene and care can be developed are very amateurish and do not conform with the standards that have been used in the conduction of the entire research or the sources through which data and information has been incorporated in the entire research.
Some of these basic oral care procedures that have been provided are very generalized and therefore are not really specific to the disease of oral mucositis, hence in that context the research does not satisfy the criterions of a proper research and applied methodology. Nevertheless at the same time it is also important that the positive points of the research are also highlighted in terms of the appreciable clinical practices that have especially been recommended by the research that need to be applied by clinicians in order to fulfill the dental practices in an effective way.

Implementation of an Oral Care Protocol
And its Effects on Oral Mucositis
Article Critique
Written by Rebecca Hogan the article entitled is one of the finest articles that can be presented when analyzing the different dimensions and dynamics of oral mucositis. The article focuses and accentuates upon all different sides of oral healthcare that need to be analyzed and assessed for the proper identification and the ways through which the disease effects the health of the patient are carefully enlightened.
Some of the positive points that have been projected by the article are the epidemiological statistics and figures that have been presented in the research to provide the relationship between the treatments that have been applied for curing the disease of cancer and the subsequent effects that it manifests itself in the form of the development of this disease.
With the help of the framework tools and blocks that has been presented the article has been able to provide a comprehensible manifestation of the compound effects that are associated with the incidence of mucositis and the subsequent effects that the disease develops upon organs of the digestive system, electrolyte imbalance, ulceration, diarrhea and leading ultimately to death.
In addition to this it is also important to mention that the prophylactic measures that have been applied for the prevention of the disease have also been quoted directly from the sources they have been extracted from in order to establish their credibility and at the same time also convince the reader about the different components and ingredients that are used in the manufacturing of toothpaste to prevent the incidence of the disease which is very encouraging.
Management Of oral
Article Critique
Written by Janet S. Fulton, Gena J. Middleton, and Jeffrey T. McPhail the article focuses upon the different ways of management that are applied in the overcoming of oral mucositis. In the beginning of the research the reasons behind the occurrence and incidence of oral mucositis in which the reasons of chemotherapy and the use of radiation for the overcoming of oncological disorders have also been discussed.

An interesting dimension that the research intends to focus upon are the measures that the nurses need to apply and exercise in order to provide a better and more stable environment for patients from the disease of mucositis and the ways through which it can be overcome by the accurate application of nursing practices and methods.

In order to come up with effective, quantitative and credible results the researches planned and chalked out a proper questionnaire in which different responses and feedback regarding the perceptions of nurses and the methods that they employ for taking care of patients were registered and their subsequent responses from the questions were noted down and then evaluated to process the desired results.

Similarly the result of the questionnaire and the survey that was organized was made further credible with the participation of dentists and with nurse participation being more than 59% in the survey.

 Furthermore it also manifests the fact that nurse and other medical proficient are well versed and acquainted with the medical procedures and practices that are applied and employed in the curing of this disease and therefore their overwhelming participation in the survey also manifests that medical experts are well acquainted with the management of the disease which plays a pivotal role in overcoming in the adverse biological effects of the disease in the long run.

Promulgation of guidelines for mucositis
Management: educating health care
Professionals and patients

Article Critique

The article written by Deborah B. McGuire, Judith Johnson and Cesar Migliorati accentuates and emphasizes upon the ways through which the adequate and medically approved techniques and measures can be applied for devising an effective solution for the promulgation of reforms and policies that can help in the reduction of oral mucositis.

 An interesting notion that has been employed while conducting the research of this article solely focuses upon the ways and measures that need to be employed to ensure that the potentials that have been employed are also implemented and exercised in order to ensure that they are effectively fulfilled.

In this context a quantitative approach towards the conduction of research has been employed through which most of the respondents belonging to the field agreed with the fact that people that have had radiotherapy or chemotherapy treatments in the past are most likely to suffer from oral mucositis as compared to others.

Another worth appreciating aspect of this is that the results of the questionnaire have been published in the questionnaire which provides it a distinguishing look as compared to other researches as the viewer can readily see the results and can also assess them on the basis of the material that is provided by these researches. 


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