Promising Treatment for Alzheimers Disease Essay - 566 Words

Alzheimer’s disease (AD) is a neurodegenerative disorder(1-3) causing progressive loss of cognitive functions leading to dementia and death.(4) Older age is the highest risk factor for AD (3, 5) and the prevalence of AD rises from 3% among those 65-74years to almost 50% among those 85year(2). An estimated 5.2 million Americans of all ages had AD in 2013(1). It currently affects more than 33.9million people worldwide(4) and is predicted to be affecting more than 80million people worldwide by 2040(3) which makes treating AD a pertinent issue to be dealt with at present. Epigenetic (defined as reversible regulation of various genome functions, occurring without change in DNA sequence)(6, 7) , modification has recently emerged as one of the†¦show more content†¦Among them the HDACs linked to cognitive impairment in AD pathology are thought to be Class 1, HDAC 2 associated with associative and spatial memory impairment.(8) Either activating HAT or inhibiting HDAC can defend histone deacetylation but latter has proven more achievable than former(15) HDAC inhibitors are classified into 4 main chemical families. 1. Carboxylic acids- eg Sodium butyrate, valporic acid, 4phenylbutyrate acts on Class 1 HDAC. 2. Hydroxamic acid- eg: Trichosatin, SAHA acts on Class 1 and 2 HDCA. 3. Benzamide group- eg: MS275 acts on Class 1 HDAC and 4. Cyclic tetrapeptides- Tapoxin.(15) Researches have focused mainly on class 1 and class 2 HDACi as treatment option for cognitive enhancement in AD.(21-23) The studies conducted on mouse models with AD related neurodegeneration treated by sodium butyrate(24) (Class 1 HDACi) showed rescue of cognitive functions, by acting through HDAC2 inhibition. The same models treated with SAHA, TSA (Class 2HDACi) and valporic acid (22, 23)(Class 1 HDACi) showed contextual fear and memory loss abolished.(15, 25) Also studies have shown HDACis successfully used as cognitive enhancers in invertebrates. (15) Together these researches shows that targeting histone modifications and HDAC inhibitors can have a promising therapeutic role as cognitive enhancer in AD(11, 12, 19, 26).HDAC inhibitors are also currently researched as treatment option for many disease conditions(27-31). 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Journal of Advanced Nursing for Ethical Issues and Stress

Question: Discuss about theJournal of Advanced Nursing for Ethical Issues and Stress. Answer: In the case presented, an 11 year old boy who once desired chemotherapy to sustain life has deteriorated to the point that he does not want further treatment may be because he thinks that it is prolonging his suffering as well as lowering his chances of life. The client is uncertain of a continued treatment as well a clear about his death when he mentions that he is ready to go to God. However, as his doctor help go through such compromising situation, it is significant to begin with filling the case information into the four topics model which are patient references, medical indications, quality of life as well as contextual features Medical indications; this topic method begins with the medical articulation of the case of the case presented such as prognosis, diagnosis, treatment options if they are there as well as how the client can benefit from all of these. The aspect of medical indications is of paramount when it comes to choosing of the treatment options available to the doctors as well as the family plus the client in the given case. If Jimmy does not go for chemotherapy, lymphoma would end his life in a matter of time. However, knowing a patients clear choice when choosing to forgo a treatment is an ethical imperative bearing in mind that such is nothing less than signing a death warrant. Patient references; this subject looks at the presumed as well as the expressed values or wishes of a client. However, articulating a clients choice is more than just identifying what the client needs as a wish. Its also of great essence to check the patients knowledge of the first topic model that is medical indication relating to the case presented. Going back to the case scenario, the patient has stated clearly that he is not ready for further treatment and that he is ready to die. Although the parents want the treatment to continue, they override the clients decisions and requests the oncologist to proceed with the treatment. With such equivocation, further discussion between Jimmy, his parents and the oncologist becomes of essence for the purpose of increasing clarity. Quality of life; the primary objective of medical treatment is to improve, maintain or restore the quality of life. However when it comes to clinical ethics, it becomes of essence to consider the impact a medication will have on persons quality of life. Fromm the jimmys statement of wanting to be with God, it can be guessed that his assessment of quality of life from his remarks, and he has neither shown a sign on how he want to spend the rest his life. In such instances, it would be prudent to consider jimmys comorbidities. Contextual features; in this subject, the context of a scenario is influenced by several social facets like the dynamics of the family as it is seen in the case scenario with jimmy`s parents. Contextual features include ethical aspects of fairness and justice. However, when it comes to accessing these features in the case scenario, we see jimmy parents convincing him to fight on. Although the patient does not want to continue with dialysis, we understand that its permissible to discontinue chemotherapy, hence there should hardly any fear of legal consequences. There are serious moral problems that are presented in the case presented such as moral unpreparedness, moral disagreements which is shown between the patient and the oncologists regarding the case of chemotherapy. Other moral problems include moral complacency and fanaticism A moral problem or ethical issue is a matter that is hard to overcome or deal with and calls for a moral solution. Clinicians in their day to day life encounter with their patients a number of moral problems that range from simple to complex and cause a lot of distress to the clinicians. In the case of jimmy, the oncologist is presented with several moral problems that calls for moral solution when dealing with the patient who no longer needs medications. The central moral problem that is presented in this case is moral unpreparedness. What happens in this case is that a clinician enters in to a case scenario without being prepared to handle the moral difficulties of a particular situation. In this aspect, the clinician lacks the requisite moral imagination, wisdom, or knowledge that would help him/her to overcome the moral problem at hand. When faced with such a situation, the health professional acts in bad faith by portraying that the situation is at hand when it is not, hence the room for moral error is inevitable. The problem of moral unpreparedness is presented in the case scenario, when the oncologist cannot convince fully the patient who is not prepared for a chemotherapy. Instead, the oncologist does not act professionally when it comes to providing information regarding the need for chemotherapy for the client. Also, he does he does not give a range of treatment options for the client to choose from. In the case presented, it can be assumed that the oncologist does not have the necessary skills that can e nable him to detect the changes in the patient mood and perception that makes him not to opt for a chemotherapy. Moreover, the nurse does not involve the patients and the client altogether in coming up with solutions to overcome the problem the patient is going though. Instead, the parents to the clients tells the oncologists to override the patients decision and proceed with the treatment. In such a situation an oncologist without the skills necessary to handle the situation of such clients can and working in cases of patients with severe medical condition would be at higher risk of putting the clients life at risk. The aspect of moral unpreparedness can also apply to the complexity of sound ethical reasoning as well as ethical health care provision. For the case of an oncologist who is left to handle troubling situation may not only be insufficient in that aspect, but as the case scenario shows his practice can be somehow hazardous. Ultimately, not every moral outcome occurring in hospitals are as unethically as presented in the case scenario of jimmy and the oncologist. Besides, preventable severe moral outcomes may occur on a place level in a hospital set up References 1.PGCEA B. Moral distress and moral courage in everyday nursing practice. Online journal of issues in nursing. 2011 May 1;16(2):1B. 2.Aitamaa E, Leino-Kilpi H, Puukka P, Suhonen R. Ethical problems in nursing management: the role of codes of ethics. Nursing ethics. 2010 Jul;17(4):469-82. 3.Ulrich CM, Taylor C, Soeken K, ODonnell P, Farrar A, Danis M, Grady C. Everyday ethics: ethical issues and stress in nursing practice. Journal of advanced nursing. 2010 Nov 1;66(11):2510-9.