An Elephant in the Emergency Department: Symptom of Disparities

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Summary Article 1
In the article “An Elephant in the Emergency Department: Symptom of Disparities in Cancer Care,” the authors argue reliance on emergency departments (EDs) for cancer diagnosis could be one explanation for cancer disparities. The article argues organizations like the Institute of Medicine (IOM) that clearly shown that there exist health disparities for cancer care and outcomes. A retrospective analysis of data from a tumor registry and administrative discharge was conducted after increased incidents of use of ED for initial diagnosis of cancer in a primary safety net facility in Jacksonville-Duval County (Livingood et al., 2016). The safety net facility has higher numbers of Medicaid and uninsured patients seeking treatment. Almost 80 percent of people residing where the safety net hospital is located are African Americans. The authors’ aim in this study was to examine the extent ED was applied in initial diagnosis of cancer and the factors that explain such outcomes.
The results of the study show that 32 percent of patients admitted in the safety net hospital for cancer received their diagnosis through ED. African American patients were 146 percent likely to receive an initial cancer diagnosis through ED. Some of the contributing factors associated with the neighborhood in Jacksonville are high unemployment rate, lower household income, and low high school graduates. Results of the study reveal that patients residing in Jacksonville city had a 170 percent likelihood of an initial cancer diagnosis in ED. Majority of the patients rely on Medicaid and Medicare, which limits their ability to seek preventive care or early intervention. Patients diagnosed with cancer through ED have a 156 percent risk of receiving a stage 4 diagnosis and have lower survival rate.
Summary Article 2
The article “Integration of Genomics in Cancer Care” aims to educate nurses the role of genetics-genomics integration in cancer care. One important technique the article aims to create awareness about is personalized medicine. The authors argue that personalized medicine makes use of information about a patient’s genes, proteins, and the environment in prevention, diagnosing, and treating illnesses. Similarly, nurses can educate patients and families how genomics influence cancer prevention, detection, diagnosis, and treatment (Santos et al., 2013). The authors also argue that nurses should understand sporadic, familial, and hereditary cancer to better inform families. Sporadic cancer is somatic or occurs through abnormal gene expression, familial occurs at the expected age in more than one close relative, and hereditary occurs through a single gene mutation.
An individual or family at risk of cancer can be evaluated through cancer risk assessment (CRA) for example, examining age and type of cancer a close family had. The article also argues that genomics of tumor profiling can be used to determine its genomic, proteins, and epigenomic. Identifying the molecular markers and classifying tumors increases prediction and prognosis. Another technique is immunohistochemistry, which helps identify the protein expression in each cancer to assist in administering treatment unique to the cancer. Another important feature in genomics that nurses should understand is microarray analysis. Microarray is a technique that evaluates genomic alteration of multiple genes concurrently. The process allows comparing gene expression such as is evident in a tumor and in normal tissue. Santos et al conclude by stating that understanding genomics role in cancer assists in cancer management-targeted therapy, as well as pharmacogenetics. For example, specific cancer treatments have associated toxicities that nurses should be able to tell apart to effectively help manage the adverse reactions in patients.
Summary Article 3
The article “Understanding acute pancreatitis” notes that pancreatitis is a condition caused by inflammation of the pancreas. Acute pancreatitis occurs when the digestive enzymes begin to digest the pancreas itself (Krenzer, 2016). The stages of the disease begin with activation of trypsin, lipase, and other enzymes inside the pancreas, release of cytokines and other proinflammatory mediators that auto-digest the pancreas, and in the last stage, injury may result. One type of pancreatitis is mild acute pancreatitis where fat and excess fluid surround the pancreas. Severe acute pancreatitis is caused by intra-abdominal infections that can lead to organ failure. The early symptoms of acute pancreatitis include sharp, twisting pain on upper abdominal area, nausea, and vomiting. Other symptoms include bowel sounds, diarrhea, fever, weakness, and hypotension.
Diagnosis of acute pancreatitis involves an ultrasound to determine if there are gallstones, CT scan to examine the pancreas, and sometimes endoscopic retrograde cholangiopancreatography (ERCP) or magnetic resonance to view the bile ducts and pancreas. Treatment depends on whether the condition is mild or severe. Initial plan in managing acute pancreatitis requires checking blood circulation, I.V. hydration, stabilizing oxygen saturation, and monitoring pain intensity (Krenzer, 2016). Opioids like fentanyl should be used for pain management. Drugs like fentanyl can also help in lowering the secretion of pancreatic enzymes, which assists in reducing inflammation. The patient should avoid eating for the time being to avoid continued secretion of the enzymes. Resumption of diet should begin with clear liquids and low-fat diet. If gallstones are present, ERCP can be ap...