Posted on 22nd Sep 2024 09:50:10 PM Medicine
INTRODUCTION
Leukemia is the most common cancer in children and adolescence, accounting for about 1 out of 3 cancers in children. Each year, around 3,250 children are diagnosed with leukemia, of which about 2,400 are acute lymphoblastic leukemia (ALL) cases. In the USA, survival rate for children with ALL has improved markedly since the early 1970s and is now approximately 80%, but incidence rates have not decreased and have, in fact, increased by 0.8% annually from 1975 to 2007. Worldwide, according to the World Health Organization (WHO), there were 33,142 deaths from leukemia among children under age 15 in 2004, and childhood (<15 years) leukemia caused 1,228,075 disability adjusted life years (DALYs). Identifying risk factors for childhood leukemia is an important step in the reduction of the overall burden of childhood diseases. Though it has been studied intensively, the etiology of childhood leukemia is not well established. A two-hit model was proposed by Greaves in which prenatal chromosome alterations and postnatal genetic alterations are necessary for childhood leukemia development.
Genetic susceptibility and environmental factors play potential roles in this process. Ionizing radiation has been significantly linked to childhood leukemia evidence for an association with benzene exposure or with parental smoking and alcohol consumption is less convincing. Multiple studies on parental smoking and childhood leukemia have been conducted in the past two decades, probably because tobacco smoke is a well documented and prevalent carcinogen. Despite ongoing global efforts to reduce tobacco use, one billion men and 250million women currently smoke worldwide, causing 5 million deaths and 57 million DALYs from cancer and other diseases each year. In the USA, 46 million people or 24% of all adults smoke , which caused nearly half a million deaths and 5 million years of potential life lost each year from 2000 to 2004. In China, though smoking is uncommon among women, almost two thirds of men smoke , causing one million deaths each year to smokers and 56,000 deaths and 480,000 DALYs from lung cancer and ischemic heart disease to nonsmokers. At least 250 chemicals in tobacco smoke are known to be toxic or carcinogenic, including volatile organic chemicals like benzene, formaldehyde, aromatic amines, polycyclic aromatic hydrocarbons (PAHs), and nitrosamines and radioactive compounds like Polonium-210. Benzene has been shown to affect the blood forming system at low levels, and formaldehyde has been shown to increase leukemia risk among exposed adults, Children aged 6 to 11 years were reported to have urinary concentrations of the tobacco-specific carcinogen nearly four times those of adult nonsmokers, indicating that children are less able to avoid exposure to SHS than adults. Smoking has also been shown to affect sperm morphology, motility, and concentration and to increase oxidative damage to sperm DNA. Together, these findings indicate that parental smoking is a potential risk factor for childhood leukemia that could induce DNA damage and mutation pre-and postnatally. However, epidemiological studies onc this topic have reported inconsistent findings( Berkeley, 2011).
a. Infections are the most frequent threat to a neutropenic patient. Patient should be placed in reverse isolation. Meticulous hand washing by health care personal must be ensured. Blood culture, throat swab, intravenous cannula, and urine should be sent for culture in case of fever. Patient should be placed on empiric antibiotic therapy while waiting for microbial/fungal culture reports. If the patient remains febrile 24 to 72 hours after institution of broad-spectrum antibiotics, coverage with an antifungal agent, should be initiated.
b. Transfusion therapy: Anaemia must be corrected by red cell concentrate and thrombocytopenia with platelet counts below 10x109/L by platelet concentrates. With multiple platelet transfusions, patients develop alloimmunization and become progressively more refractory to subsequent platelet transfusion. Alloimmunization may be reduced by using leukocyte antigen matched donors. Because many patients subsequently undergo BMT, it is critically important to administer blood products that are negative for cytomegalovirus (CMV) to those patients who are CMV negative at presentation. All blood products (except fresh frozen plasma and cryoprecipitable) should be irradiated to avoid GVHD.
c. Hematopoietic growth factors: The use of hematopoietic growth factors, such as granulocyte-macrophage colony-stimulating factor (GM-CSF) or granulocyte colony-stimulating factor (G-CSF), can reduce the period of neutropenia and the mortality and morbidity related to infections.
d. DIc may develop in patients with any acute leukemia at presentation or may develop during therapy, when cells are lysed, and release thrombogenic material. Frequent monitoring of coagulation parameters is necessary. If there is no evidence of clinical bleeding and only mild coagulation abnormality is present, close observation is sufficient. If evidence of clinical bleeding or severe DIC is apparent, platelet concentrate and fresh frozen plasma should be instituted according to the laboratory coagulation results. In life-threatening bleeding if unresponsive to treatment, low doses of heparin, 300 to 500 U per hour by continuous infusion, may be considered( J Clin, 2004).
The optimal treatment for relapsed childhood ALL is still controversial since the overall results remain unsatisfactory worldwide, especially in early bone marrow relapses and in heavily pre-treated patients. Despite continuing uncertainty about the best treatment approach there have been no successful randomized trials comparing chemotherapy and BMT. Whether a child with ALL relapse should receive a chemo/radiotherapy schedule or a stem cell transplant is thus in many instances still a matter of intensive debate and the choice is mainly performed on policies adopted in each single cooperative group.
The chemotherapy approach to the relapsed patient should include aggressive multidrug reinduction therapy followed by intensive systemic consolidation and maintenance chemotherapy.The combination of vincristine, prednisone, and L-asparaginase produces complete remissions in approximately70% to 75% of patients.The addition of an anthracycline can increase the remission rate to >80%, even in children who have been treated on modern intensive trials; however the use of anthracyclines may be restricted by the risk of cardiotoxicity, given that these drugs are often extensively used during first-line therapy. Following induction, most protocols include further consolidation and intensified continuing therapy for a total of about two years( Biondi et al; 2004).
Justification of the study
From this study it would be possible to assess the knowledge of stuff nurses on acute lymphoblastic leukemia. The lack of system or insufficiency in care is possible to detect. Patients have the right to get best qualities nursing care. Patient satisfaction is the main aim of any nursing care. The aim of the study to assess the quality of nursing care given by the stuff nurse in acute lymphoblastic leukemia as indicated by patients’ benefits. The information available about ALL patients management in developing countries, including Bangladesh, is very little compared to USA and Europe. Therefore this study were carried out to assess the knowledge of ALL patients management among nurses in Rajshahi medical college hospital. Acute lymphoblastic leukemia patients management is important treatment of children. So nurses should know about Acute lymphoblastic leukemia management.
Detection of low levels of leukemia cells by sensitive genetic methods (minimal residual disease or MRD) during therapy for acute lymphoblastic leukemia has been shown to predict the overall chance of cure. In childhood ALLMRD Assessment more accurately predict relapse than conventional clinical criteria justifying MRD based risk stratification in current treatment protocols. Accumulating data in children ALL also confirm the prognostic importance of MRD. Our integral study of MRD in patients treated on the largest prospective study of children ALL, the UKALL XII/ECOG2993 multicentre trial, assessed the clinical significance of MRD at various time point during therapy in pre-B ALL patients with Philadelphia chromosome negative disease. We demonstrated that presence of MRD following the second course of induction therapy and after intensification therapy identified patients with different risks of relapse. Relapse free survival was 75% in MRD negative patients and 23%in patients who remained MRD positive following 2nd induction. Similarly, RFS in patient who were MRD negative following intensification therapy was 70% and only 10 % in those who were MRD positive at that time the result of the MRD study based on the GMALL 99 protocol also confirm the prognostic significance of MRD during induction and at later stages of therapy in patients with standers risk disease. MRD assessment in children ALL therefore provides a novel method for risk stratification and measurement of response to therapy. The current UKALL XII/ECOG 2993 study will shortly close and planning for a successor trial is underway. MRD assessment, in this new trial will be integral to the study design and will be used in the following manner:
1. To define risk groups where therapies can be assigned in a risk adapted manner.
2. prior to the start of the new multicentre ALL study will be to assess the ability to achieved the MRD aspects of the trial defined above.
Objectives
General objectives
The study was carried out with a view to assess nurses’ knowledge regarding management of acute lymphoblastic leukemia among children.
Specific objectives
• To assess knowledge on nurse of acute lymphoblastic leukemia.
• To assess knowledge on types of lymphoblastic leukemia.
• To assess knowledge on risk factor of lymphoblastic leukemia.
• To assess knowledge on affected person of lymphoblastic leukemia.
• To assess knowledge on treatment of acute lymphoblastic leukemia.
• To find out socio demographic characteristic of the respondents.
Research question
What is level of knowledge of nurses’ on management of acute lymphoblastic leukemia among children?
Variable
1. Dependent variable: Nurses’ knowledge on acute lymphoblastic leukemia among children.
2. Independent variable: Age, Gender, Marital status, Religion, Professional qualification, Length of service.
Operational Definition
Knowledge: Understanding things/facts regarding management of acute lymphoblastic leukemia.
Assessment: Assessment is the organized and systematic process of collecting information from a variety of sources in order to evaluate the health status of the client.
Acute lymphoblastic leukemia
ALL is a type of leukemia that starts from white blood cells in the bone marrow, the soft inner part of bones. It develops from cells called lymphocytes, a type of white blood cell central to the immune system, or from lymphoblasts, an immature type of lymphocytes (Rizzari , 2008).
CONTENTS
Abstract
Chapter–1: INTRODUCTION
1.1 Introduction
1.2 Justification of the study
1.3 Objectives
1.4 Research questions
1.5 Variable
1.6 Operational definition
Chapter–2: REVIEW OF LITERATURE
2. Review of literature
Chapter–3: METHODOLOGY
3.1 Design of the study
3.2 Study of population
3.3 Place of study
3.4 Duration of the study
3.5 Sample size
3.6 Sample technique
3.7 Data collection instrumentation
3.8 Data collection procedure
3.9 Data analysis and interpretation
3.10 Ethical clearance
Chapter–4: RESULTS
4.1 Demographic information of the participated nurse
4.2 Knowledge related question to the nurse
Chapter–5: DISCUSSION
5. Discussion
Chapter–6: CONCLUSION
6.1 Conclusion
6.2 Recommendation
Chapter–7: REFERENCES
7. References
ANNEXURE
Consent letter
Questionnaire
List of Tables
Table-1 Demographic information of the participated nurses.
Table-2 Knowledge related question to the nurses.
List of Figures
Figure-1 Distribution of the respondents by their gender.
Figure-2 Distribution of the respondent by their age.
Figure-3 Distribution of the respondent by their length of service.
Figure-4 Distribution of the respondent by their knowledge on total result about the acute lymphoblastic leukemia.
Thesis, Assessment, Nurses, Knowledge, Regarding, Management, Acute, Lymphoblastic, Leukemia, Among, Children, Rajshahi, Nursing, College, Lymphoblastic, Leukemia, World, Health, Organization, WHO
Share on Facebook