Quality of Life (QoL) in Saudi Adult Patients with Hemophilia Essays

Quality of Life (QoL) in Saudi Adult Patients with Hemophilia Essays Quality of Life (QoL) in Saudi Adult Patients with Hemophilia Essay Quality of Life (QoL) in Saudi Adult Patients with Hemophilia Essay IntroductionTitle:Appraisal of Quality of Life ( QoL ) in Saudi Adult Patients with Hemophilia ( PWH ) ; A cross-sectional survey.Research Problem:Hemophilia is a life-long familial upset characterized byrecurrenthemorrhageeventseither spontaneously or induced by injury. ( 1 ) Hemophilia histories for 65 % of the familial hemorrhage upsets in Saudi Arabia. ( 2 )Patients with hemophilia suffer from repeatedepisodes/of shed blooding into articulations (3) . As a effect, patients will see hurting, stiffness, arthropathy that will take to restriction of their motion ( S ) and finally they may stop up with disablements. These episodes might be deadly if a major bleeding occurred (3) . Hemophilia dose non merely hold an impact on patients’ physical activities, but it besides affect patients’ emotional, psychological and societal province ( 4 ) .The promotion in hemophilia intervention lead to a decrease in the mortality rate ( 5 ) ( uk or Iran from.. to.. in what state, author, twelvemonth what intervention with refrence ) .However,This betterment did non forestall complication from accruing and patients with haemophilias are still fighting from shed blooding episodes’ effects that is restricting their ability to map (5) . Hemophilia is thought to be agreatcause of morbidity and have an impact on quality of life. Nowadays, patients’ quality of life became an of import result that should be considered in clinical determination devising ( 6 the article in bookmark ) .Research rational:Quality of life is a major result that should be evaluated in Saudi grownup patients with haemophilias ( 7 ) . Up to our cognition, there have been no surveies conducted in Saudi Arabia to measure QoL in grownup patients with haemophilias.Research important:Assessment of wellness related quality of life is an indispensable manner to supply valuable information about haemophilia based on Saudi grownup patients’ perceptual experience of their status and the complication of it that might be hard to measure by doctors. ( 8 ) These informations can be utilized to steer future determination ( s ) doing related to the direction of the upset and the betterment of patients’ morbidity. (8)Research inquiry:How hemophilia affects QOL of Saudi grownup patients at King Khalid University Hospital ( KKUH ) , Riyadh, Saudi Arabia?Research hypothesis:It is hypothesized that patient with hemophilia suffer from haples s quality of life.Research aim:Primary aim:* Our purpose is to assess quality of life in Saudi grownup patients with haemophilias at KKUH, Riyadh, Saudi Arabia.Secondary aim:*To place the factors impacting QoL in Saudi grownup patients with haemophilias.to better the wellness provided services to patient with haemophilia.Specific aim:1-To assess quality of life of Saudi grownup patients with haemophilias at KKUH, Riyadh, Saudi Arabia.( aged 18 old ages, managed at KKUH, Riyadh, Saudi Arabia, from septemper-2014 to april-2015 )refrence:1- Maha?2- arwa know it3- Maha?4- Iran5- Korea6-link I sent by mail in novmber 107- 11 Quality of Life in HemophiliaEduardo RemorAutonomous University, Madrid, Spain8- Maha? perceptual experience?Literature reappraisalHemophilia is an familial X-linked hemorrhage upset, characterized by deficient or absent curdling factors. Shed blooding into joint infinites is the trademark of this disease, and in instance of repeated shed blooding episodes hemophilia patients may endure from irreversible alterations inside their articulations, ensuing in ague hurting with decrease of mobility and finally taking to arthropathy that requires an intensive medical intervention and even sometimes, the demand for major orthopaedic processs ( 6 ) .Clinical appraisal of disease position in haemophilia patients is easy done either by physical or radiological scrutiny or even by mensurating the frequence and badness of joint bleeds. Although its of import to measure the patient status clinically, it does non accurately shows the patient’s perceptual experience of the disease and its impact on the health-related quality of life ( HRQoL ) ( 7 ) .HRQoL is defined as the subjective rating of a disease and its intervention impact on different dimensions including physical, societal and emotional facets of life ( 1,8 ) . As for patients with chronic disease like haemophilia, where the remedy is non gettable and the intervention is life-long, it is reall y of import to measure their HRQoL to be able to find the facets that are affected the most by the disease, so that necessary actions is taken under consideration to better the overall quality of life in those patients ( 1,8,9 ) .HRQoL is influenced by different factors including the badness of the disease, the handiness of prophylaxis intervention, the ability of the patient to self-manage his/her status and the handiness to health-care installations ( 3,11 ) .As one survey in Sweden demonstrated that HRQoL is demoing different damages in different disease badnesss, patients with terrible haemophilias were impaired more than those with mild or moderate haemophilias in the physical functioning’ , while in the other manus patients with moderate haemophilia showed more impairment in the general health’ and mental health’ than those with mild or terrible haemophilia ( 9 ) .Patients with sever haemophilias do non ever show a poorer HRQoL in all spheres. As one surve y showed that the get bying dimension in patients with mild signifier of haemophilia is worse than those with sever haemophilias, and that is attributable to the fact that those patient normally neglect their status and intervention because of the deficiency of proper instruction about the possible effects of the disease and besides because they normally do non see a self-generated hemorrhage episodes. So, if those patients had a major post-traumatic hemorrhage they will non hold the full capableness to pull off this state of affairs ( 3 ) . Many surveies showed that prophylaxis intervention is better than on-demand intervention in the long-run ; as it has a major impact on the patient’s HRQoL in footings of bettering the physical operation and cut downing the badness of joint malformations, hurting, infirmary admittances, and the demand for joint-replacement surgeries ( 1,2,4,6,9,10 ) .The topographic point of intervention and the entree to specialise blood centres plays an of import function in the HRQoL, as one survey conducted in Brazil ( 3 ) with specialised services for intervention showed a better consequences than the Turkish survey ( 2 ) were the patients is normally treated in a general infirmary. Another survey conducted in Iran ( 1 ) showed that patients populating in small towns have worse quality of life and that is because of the long distance and the demand for going in order to acquire a proper intervention.In decision, Sing haemophilias as a womb-to-tomb complicated disease, therefore it additions the attending to HQoL of patients affected by the disease and how do they accommodate with its complications which normally presents as shed blooding into articulations that hinder them from making their day-to-day life activates. However, patient’s result dosage non ever relay on disease position but besides could be affected by patient self-care and the entree to wellness attention services. Ultimately, prophylaxis intervention has p roven to be a factor that enhance patient HQoL.Demographic and clinical inquiries age: ___ gender: ( 1 ) male ( 2 ) female educational degree: ( 1 ) nonreader( 2 ) read and compose( 3 ) primary school( 4 ) preparatory school( 5 ) secondary school( 6 ) university or higher business: ( 1 ) non working( 2 ) working, type of work:( 1 ) office work( 2 ) Field work( 3 ) other ( delight specify ) †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦5. living topographic point: ( urban – rural sub rural )4.any old joint hurt:what articulation: shoulder hip cubitus carpus mortise joint other ( delight specify ) †¦ .. none any joint replacing: ( 1 ) no( 2 ) yes ( delight stipulate which 1 ) .5.Using hurting medicine in the past three twelvemonth: ( neer –daily –weekly – monthly )6.Number of shed blooding events in the past three months: ____7. comorbidity? do you endure from any chronic dzyes ( dm htn malignant neoplastic disease bosom other spicify ) or nogoes upCover missiveDear ParticipantWe are 3rd twelvemonth medical pupil, and we are carry oning survey that measures the quality of life of hemophilia patients in KKUH, Riyadh, Saudi Arabia.Measuring the quality of life in heamophilia patient ( O §U?O?O? O §U„O ±O §O?U?U† O §U„OYThe questionnaire has been designed to piece information about how heamophilia affect the day-to-day modus operandi, temper, work or school, societal life and intervention position.Your engagement in this research is wholly voluntary, you have the right to retreat any clip in malice that there is no known hazards for take parting in this s urvey.the questionnaire will necessitate about 10 -15 minute to finish, Your replies will maintain confidential, merely the research workers are allowed to cognize your replies, and it merely will be used for the research model.If you have any farther concerns or inquiries sing this research, please contact Thank you for your cooperationRationale, why the research is of import, and how information will beIRB Statement If you have inquiries sing your rights as a research topic, or if jobs arise which you do non experience you can discourse with the Investigator, delight reach the Institutional Review Board Office at ( 916 ) 366-5359? ? Tax return of the study serves as consent MethodologyStudy design:This is an experimental, cross-sectional survey.Study Setting:The survey will be carried out at King Khalid University Hospital ( KKUH ) in Riyadh, Saudi Arabiaduring the twelvemonth 2014-2015.Participants/study population:Inclusion standards are to be male, 18 old ages or older and hemophilia outpatient in King Khalid University Hospital ( KKUH ) .Exclusion standards are patients who are non holding the capacity to understand the inquiries and patients who refuse to reply the inquiries.Sample size:Sampling technique:Data aggregation methods:Patient’s phone Numberss will be collected from their medical records to obtain information required by a predesigned questionnaire Health-Related Quality of life Questionnaire for Adults ( HAEMO-QoL-A ) which is originally from the United States by MEDTAP_ International and Bayer Biological Products. The questionnaire will be translated into Arabic linguistic communication by two independent English linguistic co mmunication experts and revised by a adviser haematologist. The ( HAEMO-QoL-A ) questionnaire includes 41 inquiries each with six options, distributed on four sets of spheres. First set of inquiries contain 11 inquiries about how haemophilias will impact daily activities. Second set of 11 inquiries are concern about how hemophilia affects patient’s temper and feelings. Another set of 14 inquiries about how hemophilia affects patients work or school life, household and societal life. The last set includes five inquiries to measure patients see with their haemophilia intervention. demographic information will be obtain from patients themselves include ( age, instruction degree, type of work, joint replacing, utilizing of hurting medicines and figure of bleeds in the past three months ) every bit good as the clinical information which will be collected from patient smedical recordsinvolve ( disease badness, type of intervention, inhibitors position and hemophilia type ) .Pilot s urvey:Datas analysis:The consequences informations will be analyzed by Statistical Package for the Social Sciences ( SPSS ) package.Ethical consideration:A verbal consent will be taken from patients by phone and written consent will be attached in both Arabic and English linguistic communications.The consent will be taken from the patients verbally by phone and it will be attached in both Arabic and

The Jury Trial Stage of a Criminal Case

The Jury Trial Stage of a Criminal Case A criminal trial is scheduled if a defendant continues to plead not guilty after the preliminary hearing and plea bargain negotiations have ended. If pre-trial motions have failed to get evidence thrown out or the charges dismissed, and all efforts at plea bargaining have failed, the case proceeds to trial. At the trial, a panel of jurors determines if the defendant is guilty beyond a reasonable doubt or not guilty. The vast majority of criminal cases never get to the trial stage. Most are resolved prior to trial in the pre-trial motion stage or the plea bargain stage. There are several distinct phases of a criminal trial proceeding: Jury Selection In order to choose a jury, typically 12 jurors and at least two alternates, a panel of dozens of potential jurors are summoned to the court. Usually, they will fill out a questionnaire prepared in advance that contains questions submitted by both the prosecution and the defense. Jurors are asked if serving on the jury would present a hardship on them and they are usually asked about their attitudes and experiences that might lead them to be biased in the case before them. Some jurors are typically excused after filling out the written questionnaire. Questioning Potential Jurors Both the prosecution and the defense are then allowed to question the potential jurors in open court about their potential biases and their background. Each side can excuse any juror for cause, and each side is given a number of peremptory challenges which can be used to excuse a juror without giving a reason. Obviously, both the prosecution and the defense want to choose jurors who they think are more likely to agree with their side of the argument. Many a trial has been won during the jury selection process. Opening Statements After a jury is selected, its members get their first view of the case during the opening statements by the prosecution and the defense attorneys. Defendants in the United States are presumed innocent until proven guilty, so the burden is on the prosecution to prove its case to the jury. Consequently, the prosecutions opening statement is first and goes into great detail outlining the evidence against the defendant. The prosecution gives the jury a preview of how it plans to prove what the defendant did, how he did it and sometimes what his motive was. Alternate Explanation The defense does not have to make an opening statement at all   or even call witnesses to testify because the burden of proof is on the prosecutors. Sometimes the defense will wait until after the entire prosecutions case is presented before making an opening statement. If the defense does make an opening statement, it is usually designed to poke holes in the prosecutions theory of the case and offer the jury an alternate explanation for the facts or evidence presented by the prosecution. Testimony and Evidence The main phase of any criminal trial is the case-in-chef in which both sides can present witness testimony and evidence to the jury for its consideration. Witnesses are used in order to lay  a foundation for the admitting of evidence. For example, the prosecution cannot just offer a handgun into evidence until it establishes through witness testimony why the gun is relevant to the case and how it is linked to the defendant. If a police officer first testifies that the gun was found on the defendant when he was arrested, then the gun can be admitted into evidence. Cross-Examination of Witnesses After a witness testifies under direct examination, the opposing side has the opportunity to cross-examine the same witness in an effort to discredit their testimony or challenge their credibility or otherwise shake their story. In most jurisdictions, after the cross-examination, the side who originally called the witness can ask a question on re-direct examination in an effort to rehabilitate any damage that might have been done on cross-examination. Closing Arguments Many times, after the prosecution rests its case, the defense will make a motion to dismiss the case because the evidence presented did not prove the defendant guilty beyond a reasonable doubt. Rarely does the judge grant this motion, but it does happen. It is often the case that the defense does not present witnesses or testimony of its own  because they feel they were successful in attacking the prosecutions witnesses and evidence during cross-examination. After both sides rest their case, each side is allowed to make a closing argument to the jury. The prosecution attempts to strengthen the evidence they presented to the jury, while the defense attempts to convince the jury that the evidence falls short and leaves room for reasonable doubt. Jury Instructions An important part of any criminal trial is the instructions that the judge gives to the jury before they begin deliberations. In those instructions, in which the prosecution and the defense have offered their input to the judge, the judge outlines the ground rules the jury must utilize during its deliberations. The judge will explain what legal principles are involved with the case, describe important concepts of law such as reasonable doubt, and outline to the jury what findings they must make in order to come to their conclusions. The jury is supposed to abide by the judges instructions throughout their deliberation process. Jury Deliberations Once the jury retires to the jury room, the first order of business is usually to elect a foreman from its members to facilitate the deliberations. Sometimes, the foreman will take a quick poll of the jury to find out how close they are to agreement, and get an idea of what issues need to be discussed. If the initial vote of the jury is unanimous or very one-sided for or against guilt, jury deliberations can be very brief, and the foreman reports to the judge that a verdict has been reached. A Unanimous Decision If the jury is not initially unanimous, discussions between jurors continue in an effort to reach a unanimous vote. These deliberations can take days or even weeks to complete if the jury is widely split or has one holdout juror voting against the other 11. If the jury cannot come to a unanimous decision and is hopeless split, the jury foreman reports to the judge that the jury is deadlocked, also known as a hung jury. The judge declares a mistrial and the prosecution has to decide whether to retry the defendant at another time, offer the defendant a better plea deal or drop the charges altogether. Additional Stages: Stages of a Criminal Case