By J. Innostian. Roberts Wesleyan College.
Pathologic examination of nerves shows axonal degeneration with regeneration affecting both myelinated and unmyelinated axons buy generic wellbutrin sr 150 mg. Foot and toe dorsiﬂexion and foot everters are initially affected, with loss of ankle jerks. The associated weakness is reversible, with recovery taking months after drug discontinuation, although some patients have persistent minor residual deﬁcits. It is usually best to ‘‘dose through’’ rather than reduce vincristine in the presence of neuropathy while employing ankle–foot orthoses and physical therapy, unless the neuropathy threa- tens walking. Cranial neuropathies (often unilateral rather than bilateral) are less common, but may result in jaw pain or facial weakness upon infusion early in treat- ment. Vincristine must be avoided in children with Charcot–Marie–Tooth disease, in which there is risk of irre- versible paralysis with administration of the drug. It is essential that the clinician inquire about a family history of this disease, pes cavus, or neuropathy before administering this drug. Children will show depression of vibratory sensa- tion and loss or proprioception, sometimes with refusal to walk or bear weight. Muscle cramps occur more commonly with cisplatin neuropathy than vincristine neuropathy. This high-frequency hearing loss is irreversible and progresses with increased cumulative dosage. Prior radiotherapy may enhance damage, as the radiotherapy can cause an obliterative cochlear arteritis. Other agents associated with neuropathy in the setting of childhood cancer are listed in Table 6. Table 6 Chemotherapeutics Associated with Neuropathy Carboplatin Cisplatin Cytarabine (rare) Doxorubicin (rare) Etoposide Paclitaxel Procarbazine Teniposide Thalidomide Vinblastine Vincristine Neurologic Effects of Cancer 263 MYOPATHY In the oncology setting, myopathy is noted commonly with the prolonged adminis- tration of dexamethasone in patients with brain tumors or prednisone or other ster- oids in children with other malignancies.
In self-administered Is quick and easy for questionnaires discount wellbutrin sr 150mg free shipping, respondents respondents to tick boxes – might not be willing to write might be more likely to a long answer and decide to answer all the questions. How do you know the meaning of a blank answer when you come to the analysis? Can use open questions to Can include a section at the ﬁnd out all the possible end of a closed-ended responses before designing a questionnaire for people to closed-ended questionnaire. HOW TO CONSTRUCT QUESTIONNAIRES/ 89 WORDING AND STRUCTURE OF QUESTIONS When constructing each question think about the words you use. Try not to use words which may have a double mean- ing or be misinterpreted, as some words have diﬀerent meanings for diﬀerent groups of people. And, above all, avoid questions which will cause annoyance, frustration, oﬀence, embarrassment or sadness. You should never make someone feel uncomfortable, for what- ever reason, as a result of ﬁlling in your questionnaire. Check that a question is not double-barrelled, that is, two ques- tions in one. Also, avoid negative questions – the type which have ‘not’ in them as this can be confusing, especially when a respondent is asked to agree or disagree. X Make sure that your questions don’t contain some type of prestige bias. This phrase refers to questions which could embarrass or force respondents into giving a false answer. They might do this if they do not want to look ‘bad’ in front of the researcher, or they might do it because it is expected behaviour. Questions about income or educational qualiﬁcations might illicit this type of response, so you need to be careful about how you try to obtain this information. X Some issues may be very sensitive and you might be bet- ter asking an indirect question rather than a direct ques- tion.