Children derive implicit theories in explaining actions of objects and behaviors of people. Such theories are the foundation for causal learning and much sophisticated understanding of the social and physical worlds. Young children are also keenly responsive in the things they can learn from the words and directions directed to them by other people. Such joint attention capacity is the foundation which allows humans to benefit from culturally transmitted knowledge. 
When a child says “thanks” after something is given to him or her, there is an acknowledgement that there is a mutual exchange which is happening; a-give-and-take. As they go through the motions, eventually they come to learn that they should not expect the world on a silver platter. To ensure that children at school treat one another with respect, they should be allowed to get to know one another. Teaching children how to keep an open mind will serve them well throughout their lives; allowing them to discover exciting new friends, unusual activities, and new ways of looking at things. Read online custom writing for more information on this topic.
Chemotherapy Side Effects: Evidence-Based Practice for Reporting Outcomes
Clinical Guideline
Problem Statement
Chemotherapy is a viable treatment choice for many cancer patients. Chemotherapy can have a variety of side effects that range from mild to severe. Dose reductions may be avoided if toxicities are discovered and addressed early, resulting in more effective treatment and disease control or cure. According to Pearce et al. (2017), 84 percent of chemotherapy patients had at least one common side effect, 67 percent of patients had six or more side effects, and 27% of patients had a grade IV, or severe, side effect. Patients encountered more toxicities than professionals recorded throughout clinical studies, according to Di Maio et al. (2015). Patients’ symptoms are frequently explored more closely in clinical trials than in ordinary treatment. If doctors fail to notice side effects and toxicities in clinical trial patients, it is alarming to consider how many side effects may be overlooked or under-assessed in patients who are not enrolled in a clinical trial.
EBP Question
Given the importance of early detection of chemotherapy side effects and the disparity between patient-reported and clinician-reported symptoms, optimal strategies for dealing with these difficulties must be found. While it is a clinician’s obligation to treat symptoms, they will not have the knowledge they need to prescribe appropriate interventions or alter therapy if those symptoms are not successfully conveyed to or assessed by clinicians. The purpose of this work is to explore the available evidence in order to respond to the following question: What are the most effective techniques for reporting and assessing chemotherapy side effects?
Literature Review
The article by Weaver et al (2014), the researchers detailed their research on utilizing a mobile device to monitor symptoms in patients undergoing oral chemotherapy at home in A pilot study: dosage modification of capecitabine using mobile phone toxicity monitoring- assisting patients in their homes. Chemotherapy oral doses might be adjusted based on side effects experienced while undergoing treatment. The phone featured a pre-installed application that patients could use to answer questions about adverse effects. To participate in the trial, the patients were given phones. With this strategy, a 92.9 percent response rate was obtained. Shears et al. (2016) studied the use of an electronic patient-reported outcomes (ePRO) instrument for lung cancer patients, which they completed in the office on a tablet device prior to consultation. 
This study discovered that the ePRO tool was simple to use for both patients and doctors, and that it increased the number and quality of data collected. Basch et al. (2017) conducted research on an ePRO tool that patients utilized in between visits. An email would be sent to an oncology nurse in charge of the patient’s treatment when severe or worsening symptoms were recorded. During clinic appointments, a report of symptoms was also prepared for the treating oncologist to evaluate. The findings of this study revealed that patients not only had a higher quality of life, but also had a five-month increase in overall survival compared to the control group.
Research Synthesis
Synthesis of Research A survey of the literature identified numerous critical elements of chemotherapy treatment toxicities. Chemotherapy patients frequently face a variety of side effects, ranging from moderate to severe. When compared to what patients say, clinicians regularly underestimate the toxicities they suffer. Electronic patient-reported outcomes have been proved to be a viable means of making clinicians more aware of patient-reported toxicity. The use of ePROs has been found to improve quality of life and overall survival in chemotherapy patients.
Clinical Guidelines
Patients and clinicians will benefit from the usage of an ePRO tool to discuss toxicities with healthcare workers. This will help patients and doctors manage chemotherapy side effects more quickly (Weaver et al., 2014). Electronic devices such as the iPad and iPhone enable for faster data collection, interpretation, and recording, as well as immediate data capture and tailored self-management recommendations, which could help significant symptoms be handled more effectively and quickly (Weaver et al., 2014).
Implementation Plan
Staff and patients will need to be trained on how to utilize the software application in order to adopt it for electronic patient reporting of outcomes. Patients will require instructions on how to download and navigate the application on their personal electronic device. The oncology nurse in the clinic will provide this help prior to the start of chemotherapy treatment. Clinic staff and clinicians will also need to be trained on how to obtain the information that patients will enter into the app.
When the clinician receives the patient’s data, he or she can make judgments about how to control toxicities before they become severe. The patient will be presented with a list of symptoms/toxicities from which they can choose and enter data if they are experiencing those symptoms. Each symptom will be rated as mild, moderate, or severe by the patients. If a patient enters that they are having a serious symptom, the app will advise them to call their provider right away. At home, the nurse has a direct line of communication, and data for symptom levels and clarifications is logged and distributed on a report. This communication allows the nurse to have access to the patient’s “logged profile” during treatment and analyze the dose and side effects as needed (Weaver et al., 2014).
Throughout the whole therapy cycle, the nurse can view a precise, clear picture of the patient’s symptoms in real time (Weaver et al., 2014).
Increased patient reporting of toxicities, earlier reporting of toxicities, and improved patient quality of life will be utilized to evaluate this evidence-based protocol. For comparison, the number of toxicities per patient and the severity of symptoms when initially reported in the facility’s electronic health record will be measured two months before and two months after adoption. More symptoms are expected to be documented, and the intensity of symptoms at first documentation will be reduced. To assess the impact of the new ePRO application on quality of life, the FACT-G cancer-specific quality of life questionnaire will be employed (Absolom, 2017; best assignment help). The overall quality of life for all patients at the facility will be assessed shortly before implementation and again two months later.
Barriers to the technological piece include the fact that not everyone is familiar with apps and smart phones. Nurses and technicians are trained to help patients, and demonstrations and helplines are available. Voice-activated devices are also available to help individuals with debilitating arthritis who have trouble seeing tabs, buttons, and icons. Although the majority of Americans own a personal electronic device, people who do not may be unable to use this technique of reporting toxicity unless organizations or insurance companies cover the expense.
This new technology will be implemented with the help of staff and patients. The development of this EBP guideline will aid patients and physicians in reporting and analyzing chemotherapy toxicity in the most effective and efficient manner possible. The method’s effectiveness will boost nurses’ and other oncology staff’s confidence in appropriately monitoring and controlling toxicity effects in real time. The ultimate goal is to improve cancer patients’ quality of life and survival.
Absolom, K., Holch, P., Warrington, L., Samy, F., Hulme, C., Hewison, J., Morris, C., Bamforth, L., Conner, M., Brown, J. & Velikova, G. and on behalf of the eRAPID systemic treatment work group. (2017). Electronic patient self-Reporting of Adverse-events: Patient Information and aDvice (eRAPID): a randomised controlled trial in systemic cancer treatment. BMC Cancer, 171-16.
Basch, E., Deal, A. M., Dueck, A. C., Scher, H. I., Kris, M. G., Hudis, C. & Schrag, D. (2017). Overall survival results of a trial assessing patient-reported outcomes for symptom monitoring during routine cancer treatment. JAMA. 2017;318(2):197-198. doi:10.1001/jama.2017.7156
Di Maio, M., Gallo, C., Leighl, N. B., Piccirillo, M. C., Daniele, G., Nuzzo, F., Gridelli, C., Gebbia, V., Ciardiello, F., De Placido, S., Ceribelli, A., Favaretto, A. G., De Matteis, A., Feld, R., Butts, C., Bryce, J., Signoriello, S., Morabito, A., Rocco, G., & Perrone, F. (2015). Symptomatic toxicities experienced during anticancer treatment: Agreement between patient and physician reporting in three randomized trials. Journal of Clinical Oncology, 33(8), 910-916, doi: 10.1200/JCO.2014.57.9334
Pearce, A., Haas, M., Viney, R., Pearson, S., Haywood, P., Brown, C., & Ward, R. (2017).
Incidence and severity of self-reported chemotherapy side effects in routine care: A prospective cohort study. Plos ONE, 12(10), 1-12. doi:10.1371/journal.pone.0184360
Shears, A., Bayman, N., Harris, M., Lee, L., Haslett, K., Wilson, B., & Faivre-Finn, C. (2016). 136 Electronic patient reported outcomes significantly improved toxicity data collection and were acceptable to both patients and clinicians in lung cancer radiotherapy outpatient clinics. Lung Cancer (01695002), 91S49-S50. doi:10.1016/S0169-5002(16)30153-2
Weaver, A., Love, S., Larsen, M., Shanyinde, M., Waters, R., Grainger, L., Shearwood, V., Brooks, C., Gibson, O., Young, A. M. & Tarassenko, L. (2014). A pilot study: dose adaptation of capecitabine using mobile phone toxicity monitoring – supporting patients in their homes. Supportive Care In Cancer, 22(10), 2677. doi:10.1007/s00520-014-2224-1
Violence and chaos turned to tragedy on Saturday, 12th August 2017, at Charlottesville, Virginia. Hundreds of nationalist, Ku Klux Klan members, and Neo-Nazis planned to stage what they referred to as the largest rally in decades “to take America back”. They clashed with counter protesters in the streets, and where one person was left dead and 19 others injured after a car plowed into crowds. According to Lithwick, eclipses are the most dramatic tools. They are used by the universe to effect change. No one likes change, but eclipses shake people out of their complacency and push them forward no matter if they are ready or not. Such changes may cause conflict and turmoil. Eclipses mess with people understands of light and darkness, both figuratively and literally. This is what transpires the events of August 12. Use python assignment help to do an analysis of related political data for the past ten years.
The eclipse is like the violence and hatred which darkens the hearts of people. Charlottesville experiences of diverse, polyglot city of Los Angeles indicated that racial tolerance is far more pervasive. Human species evolved to differentiate different clan members as in-group or not. People’s tribal minds cannot help to notice racial differences. Charlottesville seemed like return to the bleak era. An era dominated by widespread racial conflicts. But like the eclipse, the light of racial tolerance proves to be far strong; more than the retreating hate and darkness. Racism still exists in America. 
Total solar eclipse appears as an incredible visual spectacle.  But there is also a spectacle of communal and personal growth. The symbolism is evident because the eclipse is associated with riots and violence in Charlottesville. Around this time, everything – feelings, events, and thoughts, takes on a more fated quality. Eclipse symbolizes a rapid change. People of Charlottesville are force to face this change in manner which is uncomfortable. At the time, the sun and its light symbolizes nothing special. It sits where it must sit and burns as it must burn. This is an effective use of symbolism (Szilágyi & Anna, 2017). 
Work cited
Szilágyi, Anna. “Discourse and discrimination in Charlottesville: The rhetoric of white supremacists during the violent unrest in August 2017.” Lodz Works in Pragmatics13.2 (2017): 285-302