History of Leukemia Treatment

History of Leukemia Treatment Four months later, a young German professor at the University of Wurzburg named Rudolf Virchow published a similar case. The patients blood was overgrown with white blood cells, forming dense and pulpy pools in her spleen. At autopsy, Virchow found layers of white blood floating above the red. He called the disease weisses Blut white blood. In 1847, he changed the name to leukemia from leukos, the Greek word for white. Virchow was a pathologist in training. He believed that all living things were made of cells, which were the basic units of life. And that cells could grow in only two ways: either by increasing the number of cells, or by increasing its size. He called these two modes hyperplasia and hypertrophy. Looking at cancerous growths through his microscope, Virchow concluded that cancer was hyperplasia in its extreme form. By the time Virchow died in 1902, a new theory of cancer had slowly come together out of these observations. Cancer an aberrant, uncontrolled cell division creating tumors that would attack and destroy organs and normal tissues. These tumors could also spread (metastasize) to other parts of the body such as lungs and brains. Leukemia is a malignant overgrown of white cells in the blood. It comes in several forms. It could be chronic and indolent. Or it could be acute and violent. The second version comes in further subtypes, based on the type of white blood cells involved. Cancers of the myeloid cells are called Acute myeloid leukemias (AML); cancer of immature lymphoid cells are called Acute lymphoblastic leukemias; and cancers of the more mature lymphoid cells are called lymphomas. ALL is the most common leukemia found in children. Sidney Faber, the third of fourteen children, was born in Buffalo, New York, in 1903. His father, Simon Farber, had immigrated to America from Poland in the late 19th century and worked in an insurance agency. Having completed his advanced training in pathology in the late 1920s, Farber became the first full-time pathologist at the Childrens Hospital in Boston. His specialty was pediatric pathology, the study of childrens diseases. Yet Farber was driven by the hunger to treat patients. Sitting in his basement laboratory one day in the summer of 1947, he was inspired to focus his attention to the oldest and most hopeless variants of leukemia childhood leukemia. The disease had been analyzed, classified, and subdivided meticulously, but with no therapeutic or practical advances. The package from New York was waiting in the laboratory that December morning. As he pulled out the glass vials of chemicals from the package, he was throwing open a new way of thinking about cancer. An insatiable monster Sydney Farbers package of chemicals arrived at a pivotal moment in the history of medicine. In the late 1940s, new miracle drugs appeared at an astonishing rate. But cancer had refused to fall into step in the victories of postwar medicine. It remained a black box. To cure a cancer, doctors had only two options: cutting it out with surgery, or incinerating it with radiation. Proposals to launch a national response against cancer had ebbed and flowed in America since the early 1900s. By 1937, cancer had magnified in the public eye. In June, a joint Senate-House conference was held to draft legislation to address the issue. On August 5, President Roosevelt signed the National Cancer Institute Act, creating a new entity called the National Cancer Institute (NCI) to coordinate cancer education and research. But World War II had shifted the nations priority from cancer research to the war. The promised funds from Congress never materialized, and the NCI languished in neglect. The social outcry about cancer also drifted into silence. If a cure for leukemia was to be found, Farber reasoned, it would be found within hematology the study of normal blood. In 1928, a young English physician named Lucy Wills discovered that folic acid, a vitamin-like substance found in fruits and vegetables, could restore the normal genesis of blood in nutrient-deprived patients. Farber wondered whether folic acid could restore the normalcy of blood in children with leukemia. As he injected synthetic folic acid into a cohort of leukemia children, Farber found that folic acid actually accelerated the growth of leukemia rather than stopping it. He stopped the experiment in a hurry. Farber was intrigued by the response of the leukemia cells to folic acid. intrigued. What if he could find a drug to cut off the supply of folic acid to the cells an antifolate? Farbers supply of folic acid had come from the laboratory of an old friend a chemist called Yellapragada Subbarao or Yella. Yella was a physician turned cellular physiologist. Having finished his medical training in India, Yella could not practice medicine in America because he had no license. He started as a night porter at a hospital, switched to a day job as a biochemist, and joined Lederle Lab in 1940. Enzymes and receptors in cells work by recognizing molecules using their chemical structure. With a slight alteration of the recipe, Yello could create variants of folic acid, and some of the variants could behave like antagonists to folic acid. He sent the first package of antifolates to Farbers lab in the late summer of 1947. On August 16, 1947, in the town of Dorchester in New England, Robert Sandler, a two-year-old boy was brought to Childrens Hospital in Boston. He had been ill with a wax and wane fever for over two weeks, and the condition had worsened. His spleen wasÂÂ   enlarged, and his blood sample had thousands of immature lymphoid leukemic blasts. His twin brother, Elliot, was in perfect health. Farber had received the first package of antifolates from Yella a few weeks before Sandlers arrival. On September 6, 1947, Farber injected Sandler with pteroylaspartic acid or PAA, the first of Yellas antifolates. PAA had little effect. On December 28, Farber received a new version of antifolate aminopterin. Farber injected the boy with it. The response was remarkable. The white cell count stopped its astronomical ascend, hovered at a plateau, and then dropped. And the leukemic blasts gradually flickered out in the blood and then disappeared. By New Years Eve, the count had dropped to one-sixth of its peak value, bottoming out at a near normal level. The cancer hadnt vanished, but it had temporarily abated. Sandlers remission was unprecedented in the history of leukemia. Farber started treating the slow train of children with childhood leukemia arriving at his clinic. An incredible pattern emerged: antifolates could destroy leukemia cells and make them disappear for a while. But the cancer would relapse after a few months of remission, refusing to respond to even the most potent of Yellas drugs. Robert Sandler died in 1948. In June 1948, Farber published his study in the New England Journal of Medicine. The paper was received with skepticism, disbelief and outrage. The obliteration of an aggressive cancer using a chemical drug was unprecedented in the history of cancer. Dyeing and Dying A systemic disease demands a systemic cure. Could a drug kill existing cancer cells without hurting normal cell tissues? The chemical world is full of poisons. The challenge is to find a selective poison that will eradicate cancer cells without killing the patient. In 1856, an 18-year-old student in London named William Perkin stumbled into an inexpensive chemical dye that could be made from scratch. Perkin called it aniline mauve. His discovery was a godsend for the textile industry because aniline mauve is easier to produce and store than vegetable dyes. Perkin also discovered that its parent compound could act as a building block for other dyes to produce derivatives with a vast spectrum of vivid colors. In the mid-1860s, Perkin flooded the textile factories of Europe with a suite of new synthetic dyes in various color. The German chemist rushed to synthesize their own dyes to muscle their way into the textile industry in Europe. They synthesized not only dyes and solvents, but an entire universe of new molecules such as phenols, bromides, alcohols, and amides, chemicals never encountered in nature. In 1878, a 24-year-old medical student named Paul Ehrlich did an experiment usingÂÂ   chemical dyes to stain animal tissues. He discovered the dyes seemed to be able to differentiate among chemicals hidden inside the cells, staining some and sparing others. In 1882, working with Robert Koch, Ehrlich discovered another new chemical stain that could pick up one class of germs from a mixture of microbes. In the late 1880s, Ehrlich found that certain toxins when injected in animals could produce antitoxins,ÂÂ   which could be used to neutralize the toxin with extraordinary specificity. If biology was a mix-and-match game of chemicals, Ehrlich thought, what if some chemical could differentiate bacterial cells from animal cells so that it could kill the bacteria cells without hurting the animal? So he began with a hunt for anti-microbial chemicals. After testing hundreds of chemicals, he found a dye derivative that can act as an antibiotic drug for mice and rabbits infected with Trypanosoma gondii (a parasite). He called the chemical Trypan Red, after the color of the dye. And in 1910, his laboratory discovered arsphenamine (Salvarsan), the first effective medicinal treatment for syphilis. His success on Trypan Red and Salvarsan proved that chemicals could be found to cure diseases with specificity. He called these chemicals magic bullets for their capacity to kill with specificity. Between 1904 and 1908, he attempted to find an anticancer drug using his vast arsenal of chemicals. None of them worked. What was poison to cancer cells, he found, was also poison to normal cells because cancer cells and normal cells were so similar that made it almost impossible to differentiate. Ehrlich died in 1915 at age 61. In 1917, two years after his death, Germany used a chemical weapon at the battle of Ypres in Belgium, in the form of chlorine gas. The gas killed two thousand soldiers that night. In 1919, pathologist found the survivors bone marrows were all depleted, with the blood-forming cells all dried up.

Decision Making Evaluation Paper Essay

Re-organization and Layoff: Decision Making Evaluation Paper Management has many changes they adjust to daily. Some of the changes come from firing and lay-off employees. When these changes do take place they can change how the organization develops. Management will have to be able to handle change and still keep the organization developing in a positive direction. According to â€Å"Work Systems† (20150, â€Å"Selecting and implementing significant change is one of the most challenging undertakings that face an organization† (2015). It is vital to an organization to have properly trained management to handle these issues Recommendation from two creative solutions identified from week 4 Why the solution would help the middle income customer (credible sources) for support Business decision should make based on solution When an organization is considering layoffs the first thing they should do is decide whether the layoffs are necessary and can they do it legally. Then consider other resources for example, hiring freeze or no pay raises and promotions. They can also reduce authorized overtime, pay cuts, teleworking, and other cost cutting. Making sure you have solid legal grounds and have a legitimate business reason. Some other steps organizations can take are reviewing actual policies and past practices, check written personnel policies, check employment contracts, and review collective bargaining agreements. You can also consider offering severance or other termination benefits. By implementing some of these alternatives fewer works will question if a layoff is truly necessary. References Guerin, L. (n.d.). Making Layoff Decisions | Nolo.com. Retrieved January 31, 2015, from http://www.nolo.com/legal-encyclopedia/making-layoff-decisions-29949.html Work Systems. (2015). Retrieved from httttp://worksystems.com/services/organizational_change.html

Abnormal Deviation in international exchange Essay

You are a Finance Manager at a company in your city. Your company purchase goods from international markets. You are planning to buy equipment worth AED55 million. You have decided to save the company some money and you have proposed to check the exchange rate for 5 days at www.xe.com for the currency of the country where you want to buy the equipment. You managed to secure two quotations from different suppliers from different countries using different currencies. The equipment is needed in January 2015. Transportation cost AED5 million and is paid in here to a UAE transportation company. The balance amount should be used to purchase the equipment. The transportation of the equipment is agreed to be arriving in UAE on the 5th of January 2015. It takes 3 days to fly the equipment to UAE. Whatever purchasing you are planning should be done in advance to give room for transporting the equipment. See more: Satirical essay about drugs The foreign supplier has agreed to give you a quotation for the equipment that is valid for 7 days. You want to take advantage of the quoted prices. The Equipment is quoted in both British pounds and in Euros. The Equipment is costing BP £860 000 and it is also quoted in EUROâ‚ ¬ 1 090 000. You had a meeting with your CEO and you both agreed to check the market performance of these two currencies and purchase the equipment when it is giving you a competitive advantage. The Activities to do: Check the exchange rate for a period of 5 days and create a table of comparisons of how much will be your Dh50m worth on each of the five days in both Euros and GB pounds. Choose the currency you will use for your transactions. [15 marks] Calculate how much it will cost the company in Dirhams to buy the equipment on the first day of monitoring the exchange rate. Explain the impact of your action. [15 marks] Calculate how much it will cost the company in Dirhams to buy the equipment on the second day of monitoring the exchange rate. Explain the impact of your action. [15 marks] Calculate how much it will cost the company in Dirhams to buy the equipment on the third day of monitoring the exchange rate. Explain the impact of your action. [15 marks] Calculate how much it will cost the company in Dirhams to buy the equipment on the fourth day of monitoring the exchange rate. Explain the impact of your action. [15 marks] Calculate how much it will cost the company in Dirhams to buy the equipment on the fifth day of monitoring the exchange rate. Explain the impact of your action. [15 marks] Write a report to support your decision for the transaction you have done. In your recommendation outline what makes your decision the best decision for the company. Consider every day you were monitoring the currencies, as the day you made a decision and purchased that equipment. Was that the best decision and why? [10 marks] Solution Table of comparison Conversion of DH to GBP 1dh = 0.173796 GDP 50,000,000 Ãâ€" 0.173796 GBP = 8,689,800 Conversion of DH to EURO 1DH = 0.221629 EURO 50,000,000 Ãâ€" 0.221629 EURO = 11,081,450 change Days Value of EURO (+ 1.44) Change in value % change Value of POUND (+0.3885) Change in value % change 1 11,241,023 159,573 1.44 8,723,516 33,716 0.388 2 11,402,894 161,870 1.46 8,757,363 33,747 0.390 3 11,567,096 164,202 1.48 8,791,342 33,979 0.391 4 11,733,663 166,566 1.50 8,825,452 34,110 0.393 5 11,902,627 168,965 1.52 8,859,695 34,243 0.394 Will use EURO as my currency in the transactions. Cost of the equipments on the first day in DH. 101.44100 Ãâ€" 1,090,000 = â‚ ¬ 1,105,696 1 DH = 0.221629 1,105,696 à · 0.221629 = DH 4,988,950. Impact The exchange rate create a positive impact in difference in the price of equipment with an increase of DH 75,300. Cost of the equipments on the second day in DH. Purchases costed = â‚ ¬ 1,090,000 100 + 1.46% = 101.46% 101.46100 Ãâ€" 1,090,000 =â‚ ¬ 1,105,914 1 DH = 0.221629 1,105,914 à · 0.221629 =DH 4,989,934 Impact The exchange rate create a positive impact in difference in the price of equipment with an increase of DH 76,284. Cost of the equipment on the third day in DH Purchases costed = â‚ ¬ 1,090,000 101.48100 Ãâ€" 1,090,000 =â‚ ¬ 1,106,132 1 DH = 0.221629 1,106,132 à · 0.221629 =DH 4,990,917 Impact The exchange rate create a positive impact in difference in the price of equipment with an increase of DH 77, 267. Cost of the equipment on the fourth day in DH Purchases costed = â‚ ¬ 1,090,000 101.50100 Ãâ€" 1,090,000 =â‚ ¬ 1,106,350 1 DH = 0.221629 1,106,350 à · 0.221629 =DH 4,991,901 Impact The exchange rate create a positive impact in difference in the price of equipment with an increase of DH 78,251. Cost of the equipment on the fifth day in DH Purchases costed = â‚ ¬ 1,090,000 101.52100 Ãâ€" 1,090,000 =â‚ ¬ 1,106,568 1 DH = 0.221629 1,106,568 à · 0.221629 =DH 4,992,885 Impact The exchange rate create a positive impact in difference in the price of equipment with an increase of DH 79,235. REPORT ON DECISION FOR TRANSACTION FOR PURCHASING EQUIPMENTS The above transaction was appropriate since it has brought a good comparison between the exchange rate in both quotations AED/EURO. Findings It can be observed that by use of this transaction the finance manager can be able to save for the company. The transaction of this equipment will take less than AED 50 millions Conclusion This method is best used when carrying out official transaction for example which government is involved. Recommendation This kind of transaction should be encouraged since it help in stabilizing the country currency. We find that the effect of exchange rate behave differently in the five days meaning that in each an everyday the currency get an additional value. It hence strengthens currency. References The great Soviet Encyclopidia, 3rd edition (1970 – 1979).@2010. The gale group, IncCassel Guster (DSecember 1918) â€Å"Abnormal Deviation in international exchange,† 28, No 112. The economic journal. Pp.413 – 415.UBS’S â€Å"prices and earnings† report. Source document

Factors Impacting On The Effectiveness Of Palliative Care - Free Essay Example

Sample details Pages: 9 Words: 2753 Downloads: 3 Date added: 2017/06/26 Category Medicine Essay Type Analytical essay Did you like this example? Palliative care can vary significantly in its effectiveness according to condition, location, and type of patient (WHO, 2011; Gomes et al., 2013). This has long been recognised as an issue: Higginson et al. (2003) suggested that it has been difficult to prove the effectiveness of palliative care given the broad range of providers and the diverse nature of the clients. Don’t waste time! Our writers will create an original "Factors Impacting On The Effectiveness Of Palliative Care" essay for you Create order The World Health Organisation (WHO, 2011) has argued that palliative care has generally been unduly focused on the needs of cancer patients and is unsuited for the increase in older patients with diverse needs that are more common in many parts of the world. Part of this variation is the differences between the type of care required for various conditions and the fact that sometimes specialised care for a variety of conditions is required (Preston et al. 2014). There are also challenges posed to meeting patients wishes for palliative care through patient-centred care, and Gomes et al. (2013) suggest that the desire of most patients to die at home can stretch resources or result in palliative care provision not reaching the wishes of their clients. Likewise, the extent to which palliative care can be effectively provided through interaction with other care providers, and the role of family or informal carers is often unclear (Hanson et al., 2012). This has led to a range of views on t he effective provision of palliative care. In this essay, first the challenges posed by an aging population and the challenge of providing specialist care to specific population groups will be considered. Second, the challenge of providing home-based palliative care will be discussed. Third, the challenges of developing effective communication between caregivers and the family will be evaluated. Fourth, ways in which informal caregivers may be involved in palliative care will be discussed. Finally, the arguments for earlier intervention in some cases will be evaluated. The World Health Organisation argues that an important factor impacting upon the effectiveness of palliative care is the aging population in most countries that is coupled with a lack of attention to their complex needs (WHO, 2011). Older people more commonly experience multiple health problems, resulting in the need for such complex health needs to be more effectively supported (WHO, 2011). The model for palliativ e care traditionally focuses upon support for single diseases such as cancer, whereas people aged over 85 years are more likely to die from cardiovascular disease. There are also multiple debilitating diseases, such as dementia, osteoporosis and arthritis, and may require palliative care at any point in their illness trajectory (Gardiner et al., 2011). WHO (2011) indicate that palliative care does not usually form a part of traditional disease management, and with a combination of diseases the point at which palliative care is needed may become increasingly difficult to determine. The need for integration between different agencies is also cited as an important factor affecting older people (WHO, 2011). As such, palliative care for older adults must take into account the increasing variety of conditions that may develop, which is something that is not yet common amongst many care providers. Solutions to these issues proposed by WHO (2011) include the need for palliative and prima ry care providers to receive more effective training in the needs of older people, and to gain a clearer understanding of the syndromes that affect this population group. This also includes a more effective understanding of the pharmacokinetics of opiates for pain management, and issues that are caused by comorbidity (Gardiner et al., 2011). Palliative physicians also need to improve their understanding of long-term care, including the administrative and clinical issues that are associated with older people dying in care homes. Likewise, inter-agency collaboration in palliative care is required to ensure that diverse needs are met through carers with different specialisms (Neilson et al., 2013). This means that palliative care needs to adopt a more personalised approach that takes into account the specific needs of clients, making collaborative approaches more common (Vitillo Puchalski, 2014). As such, partnership working is likely to play an increasingly prominent role in palliati ve care provision in the future. Similar concerns involving the specialised care for specific groups is identified by Vollenbroich et al. (2012), who investigate the potential for providing home care for children. These results suggested that where a specialised paediatric care team was used, there were high improvements in the childrens symptoms and quality of life. Additional benefits were seen as the reduction of the administrative barriers and improvement in aspects of communication between the care teams and the family. This supports arguments made by WHO (2011) which suggests greater specialisation is required to take into account the different diversities of patients who need palliative care. However, one aspect that is not identified by Vollenbroich et al. (2012) is the challenge posed by whether the condition should be considered as of greatest importance or whether the demographic considerations are needed (Gardiner et al., 2011). This suggests that perceptions of the a ge at death can significantly affect the patients needs in palliative care, and further research may be required to investigate the extent to which such suppositions are borne out in practice. The place in which palliative care is provided is also a significant factor when considering how far the care meets the wishes of the patients. The extent to which people can opt for their place of death is an important factor affecting the effectiveness of palliative care. In the European Union, most people do not die at home (WHO, 2011). However, this is the preferred place of death for most people. In England, 58% of deaths occur in NHS hospitals, 18% at home, 4% in hospices, and 3% in other places. There is clearly an interest amongst many patients for dying at home. JordhÃÆ' ¸y et al. (2010) report on an intervention programme staged by the University Hospital of Trondheim, Norway, which was intended to enable patients to spend more time at home and for them to die there should they prefer. This demonstrates that in order to achieve this end, close cooperation was necessary with the community health-care providers, and a multidisciplinary consultant team was needed to coordinate the care provision. This research demonstrated that intervention patients spent a smaller proportion of the last month of life in nursing homes than was possible for the control sample (JordhÃÆ' ¸y et al. 2010). This illustrated that to increase the proportion of patients who were able to die at home, a significant investment of resources would be needed. This manifested itself in the need for greater levels of training in palliative care for community care staff, thus increasing the costs associated with the provision of care (JordhÃÆ' ¸y et al. 2010). Similar considerations were made by Gomes et al. (2013), who argue that providing palliative care at home increases the chances of dying at home, while reducing symptom burden that people experience as a part of an advanced ill ness. This also reduces the intensity of grief for family members if the patient dies (Gomes et al., 2013). However, Gomes et al. (2013) suggest that it is possible to provide home palliative care without significantly raising costs, but this is challenged by reports such as WHO (2011) who argue that for many patients, the complexity of the conditions experienced undermine the potential for home care to be effectively provided. Smith et al. (2014) suggest, however, that the context of increasing costs of healthcare means that the potential for palliative care to be provided in the home environment should be more closely investigated. In particular, this outlines that the quality of care can be significantly improved for home-based care, and in some cases the costs may be reduced by the fact that they may be spread between existing caregivers. Communication between the patients and family members is often cited as an important factor leading to improved palliative care. Hannon et al. (2012) suggest that in contexts where family members are taken into account and given a role, family meetings can account for a significant improvement to the weekly workload for staff members. The study suggested that such meetings improved the particular areas of concern and worry for family members (Hannon et al., 2012). This demonstrates that such meetings can play an important role improving the experience of palliative care and indicate that one of the important roles of caregivers lies in the support that is given to the families of the patients as well as to the patients themselves (Hannon et al., 2014). However, although such meetings are considered appropriate and effective they may be undermined by the time constraints, the availability of appropriate staff, and the limitations of resources (Hannon et al., 2014). This may lead to less emphasis being placed on such aspects of palliative care, particularly where the benefit is not directed wholly towards the patient. Ne vertheless, against this criticism is the extent to which such issues may result in the needs of the patient being better identified by consultation with family members (Gomes et al., 2013). It can be argued that this would represent an area of particular benefit to the provision of palliative care. Harding et al. (2011) point out that informal caregivers are of significance in providing effective palliative care. Given the diversity of the care provided by this group, there is a need for a range of intervention strategies to provide appropriate support, depending on the needs of the patient. However, Harding et al. (2011) suggest that the range of models that are available to meet caregivers needs. Likewise, Harding et al. (2012) emphasise the significant costs to informal caregivers in terms of the emotional, physical and financial demands that informal caregiving places upon them. The conclusions of these studies indicate that support should be provided specifically to the car egiver and tailored closely to their needs, and the drawback of many existing approaches was the fact that interventions were not tailored to the caregivers needs. This is an important aspect for improving palliative care, as many patients prefer the services of informal caregiving, and this can also reduce the burden on professional healthcare if appropriate (Aslakson et al., 2014). The potential for providing support that is tailored to the needs of the informal caregivers would seem an important and effective means by which the quality of palliative care can be improved (BrandstÃÆ' ¤tter et al., 2014). Zimmerman et al. (2014) identify that there are limitations to the provision of palliative care in home settings that depend upon the condition of the patient. In their study, patients with advanced cancer tend to have a much lower quality of life that worsens as their condition progresses. This suggests that for some patients, palliative care should be provided at an earlier stage than is usually the case. However, such developments would depend upon the prognosis, and in such cases it is important to avoid premature judgment. Yoong et al. (2013) also suggest that early palliative care can prove beneficial in situations where patients have advanced lung cancer. This suggests that the benefits allow the palliative care teams to focus on fostering relationships with patients and their families, and improving illness understanding amongst patients and caregivers. The potential for adopting a comprehensive approach in this case provided psychosocial benefits, such as improving the coping mechanisms for patients alongside the management of medical treatment (Bajwah et al., 2012). The research thus indicates that the involvement of palliative care teams at an earlier stage in the treatment may be appropriate for some conditions and may provide significant benefits to the quality and effectiveness of care. In conclusion, many of the arguments discussed sug gest that there is an important case to be made for a greater diversity in approaches to palliative care. The need to take into account the diversity in the psychosocial needs of different population groups illustrate the importance of a more personalised approach to palliative care. Likewise, the challenge in meeting patients wishes to die at home requires significant attention as this can clearly provide significant benefits to patients. The research also indicates that greater engagement with family members can help support patients and prove of wider benefit to the carers. This also indicates that the involvement of informal caregivers is also a significant area of development, given the wide-ranging role they can play in the provision of palliative care. The introduction of palliative care at an earlier stage may allow benefits to the care process, particularly where the patient is cared for at home, as it helps foster an effective working relationship between different parties . Thus far, the key deficiencies of palliative care are largely that it appears to be focused on particular conditions and specific locations; the challenge is to broaden the type of patient that can be cared for, provide greater support to informal carers and family members, and be more responsive to the wishes of the patient. References Aslakson, R., Cheng, J., Vollenweider, D., Galusca, D., Smith, T. J., Pronovost, P. J. (2014). Evidence-based palliative care in the intensive care unit: a systematic review of interventions. Journal of Palliative Medicine, 17(2), 219-235. BrandstÃÆ' ¤tter, M., KÃÆ' ¶gler, M., Baumann, U., Fensterer, V., KÃÆ' ¼chenhoff, H., Borasio, G. D., Fegg, M. J. (2014). Experience of meaning in life in bereaved informal caregivers of palliative care patients. Supportive Care in Cancer, 22(5), 1391-1399. Bajwah, S., Higginson, I. J., Ross, J. R., Wells, A. U., Birring, S. S., Patel, A., Riley, J. (2012). Specialist palliative care is more than drugs: a retrospective study of ILD patients. Lung, 190(2), 215-220. Bruera, E., Yennurajalingam, S. (2012). Palliative care in advanced cancer patients: How and when?. The Oncologist, 17(2), 267-273. Gardiner, C., Cobb, M., Gott, M., Ingleton, C. (2011). Barriers to providing palliative care for older people in acute hospitals. Age and Ageing, 40(2), 233-238. Gomes, B., Calanzani, N., Curiale, V., McCrone, P., Higginson, I. J. (2013). Effectiveness and costà ¢Ã¢â€š ¬Ã‚ effectiveness of home palliative care services for adults with advanced illness and their caregivers. The Cochrane Library. https://www.update-software.com/BCP/WileyPDF/EN/CD007760.pdf Hannon, B., OReilly, V., Bennett, K., Breen, K., Lawlor, P. G. (2012). Meeting the family: measuring effectiveness of family meetings in a specialist inpatient palliative care unit. Palliative and Supportive Care, 10(1), 43-49. Hannon, B., Swami, N., Pope, A., Rodin, G., Dougherty, E., Mak, E., Zimmermann, C. (2014). The oncology palliative care clinic at the Princess Margaret Cancer Centre: an early intervention model for patients with advanced cancer. Supportive Care in Cancer, 23(4), 1073-1080. Harding, R., Epiphaniou, E., Hamilton, D., Bridger, S., Robinson, V., George, R., Higginson, I. J. (2012). What are the perceived needs and chal lenges of informal caregivers in home cancer palliative care? Qualitative data to construct a feasible psycho-educational intervention. Supportive Care in Cancer, 20(9), 1975-1982. Hanson, L. C., Rowe, C., Wessell, K., Caprio, A., Winzelberg, G., Beyea, A., Bernard, S. A. (2012). Measuring palliative care quality for seriously ill hospitalized patients. Journal of Palliative Medicine, 15(7), 798-804. Harding, R., List, S., Epiphaniou, E., Jones, H. (2011). How can informal caregivers in cancer and palliative care be supported? An updated systematic literature review of interventions and their effectiveness. Palliative Medicine, 26(1), 7-22. Higginson, I. J., Finlay, I. G., Goodwin, D. M., Hood, K., Edwards, A. G., Cook, A., Normand, C. E. (2003). Is there evidence that palliative care teams alter end-of-life experiences of patients and their caregivers?. Journal of Pain and Symptom Management, 25(2), 150-168. JordhÃÆ' ¸y, M. S., Fayers, P., Saltnes, T., Ahlner-Elm qvist, M., Jannert, M., Kaasa, S. (2010). A palliative-care intervention and death at home: a cluster randomised trial. The Lancet, 356(9233), 888-893. Neilson, S. J., Kai, J., McArthur, C., Greenfield, S. (2013). Using social worlds theory to explore influences on community nurses experiences of providing out of hours paediatric palliative care. Journal of Research in Nursing, 18(5), 443-456. Preston, N., Dunleavy, L., Rigby, J., Griggs, A., Salt, S., Parr, A., Payne, S. (2014). Overcoming barriers to research in palliative care: results from a consensus exercise. Palliative Medicine, 28(6), 745-745. Smith, S., Brick, A., OHara, S., Normand, C. (2014). Evidence on the cost and cost-effectiveness of palliative care: A literature review. Palliative Medicine, 28(2), 130-150. Vitillo, R., Puchalski, C. (2014). World Health Organization authorities promote greater attention and action on palliative care. Journal of Palliative Medicine, 17(9), 988-989. Vollenbroich, R ., Duroux, A., Grasser, M., BrandstÃÆ' ¤tter, M., Borasio, G. D., FÃÆ' ¼hrer, M. (2012). Effectiveness of a pediatric palliative home care team as experienced by parents and health care professionals. Journal of Palliative Medicine, 15(3), 294-300. Yoong, J., Park, E. R., Greer, J. A., Jackson, V. A., Gallagher, E. R., Pirl, W. F., Temel, J. S. (2013). Early palliative care in advanced lung cancer: a qualitative study. JAMA Internal Medicine, 173(4), 283-290. Zimmermann, C., Swami, N., Krzyzanowska, M., Hannon, B., Leighl, N., Oza, A., Lo, C. (2014). Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. The Lancet, 383(9930), 1721-1730.