Advanced breast cancer

Advanced breast cancer Background Cancer accounts for 13% of all deaths in 2007, making it the largest cause of mortality worldwide and is the leading cause of premature death in Scotland. 2,22 Out of the staggering figure of 27,500 new cases that were diagnosed on that same year in Scotland, 4044 of them are breast cancer cases, making breast cancer the most commonly diagnosed cancer among Scottish women.3 In the UK, 16-20% of women have advanced breast cancer and approximately 40-50% of those diagnosed with early or localised breast cancer may eventually develop metastatic disease. Breast cancer is usually defined using a staging system known as the Tumour, Node and Metastasis Staging System (TNM) and stage III and IV are known as advanced stages of the disease with stage III being locally advanced and or has spread to regional lymph nodes and stage IV describing the presence of metastases at distant sites such as the bone, brain, or lung.23 In the elderly group of female cancer patients, the prevalence of breast cancer is highest at 4% and these post-menopausal women make up 80% of all breast cancer patients, hence proving that the risk increases with age.1 Apart from age, other factors like family history, uninterrupted oestrogen exposure, early menarche, late menopause, late first pregnancy, hormone replacement therapy, obesity, not breast feeding, taking oral contraceptives and past breast cancer may all attribute to a higher risk of developing breast cancer.9 Over the last decade, mortality rates from breast cancer have dropped by almost 14%, despite having more women diagnosed with the disease. In 2000-2004, the survival rate for breast cancer patients has also bumped up to 84% compared to a mere 64% 20 years earlier.4Improvement in prognosis, screening techniques such as mammography, ultrasound and Magnetic Resonance Imaging(MRI), earlier diagnosis of cancers in women participating in the Scottish Breast Screening Programme, a myriad of new hormonal and chemotherapy treatments, and better organisation and patient care plans has attributed to the substantial increase in incidence and survival rate of breast cancer patients. Women today are also encouraged to perform self breast examinations, hence are familiar with the shape and feel of their breasts, as well as to look out for abnormities like a new discrete lump, nipple discharge, unilateral persistent pain especially in post-menopausal women or pain associated with a lump and skin changes comprising of skin tethering, ulceration, abscess or inflammation.However, there is still a disparity between women from different social classes in terms of combating this disease. Women from more affluent backgrounds are more likely to have their breast cancer diagnosed earlier, have slower disease progression from the time of diagnoses and higher survival rates compared to women from poorer socioeconomic backgrounds. Women from more deprived communities are more likely to be diagnosed with the advanced stage of the disease. Pathogenesis Cancer or malignant neoplasm which literally means new growth is a disease manifested in the form of uncontrolled cell proliferations, dedifferentiation and loss of function, invasiveness and metastasis.6 Breast cancer usually forms from the inner lining of milk ducts or the lobules that supply the ducts with milk. In patients with Breast Cancer, women who inherit a single defective copy of tumour suppressor genes BRCA1 or BRCA 2 have a marked higher risk of developing breast cancer in their lifetime. The presence of a defective BRCA1 or BRCA 2 gene can invoke changes in several cellular systems including the signaling pathways and receptors of growth factors and cell cycle tranducers, the apoptotic machinery which responsible for programmed cell death that normally disposes of abnormal cells, the secretion of telomerase, and local blood vessels which results in tumour-directed angiogenesis to supply nutrients to these tumours both aids the proliferation of cancer cells.7,8 Breast cancer cells are able to invade other tissues like the lymph nodes as they no longer exercise the same restraints as the normal cells and they also secrete enzymes like metalloproteainase to break down the extracellular matrix, conferring them mobility. Metastases are secondary tumours normally found in the advanced stage of breast cancer formed by cells released from the primary tumour and have reached and have established themselves at other sites like the lung brain or the bones which are common sites for metastatic cancers of breast origin through blood vessels and lymphatics. The tissues of lung, brain and bone origin express high levels of CXR4 chemokine receptors produced by the breast cancer cells, facilitating the selective accumulation of the cells at these sites.6 Treatment Options There are three main approaches to treating breast cancer, namely surgical excision, irradiation and a host of systemic disease-modifying therapies or a combination and is chosen based on the stage of breast cancer. However, when caring for patients with advanced breast cancer, the goal of treatment of advanced breast cancer is to palliate symptoms, improve survival and quality of life. There are notably three types of systemic disease-modifying therapies to treat advance breast cancer namely endocrine therapy, chemotherapy and biological therapy. Endocrine Therapy Oestrogen exposure has been instrumental in inducing mutations that can lead to breast cancer as they can stimulate cell growth in most of human breast cancer cell lines expressing Oestrogen Receptor (ER) ÃŽÂ ± .8 Clinical studies have proven that more than half of breast carcinomas are ER ÃŽÂ ± positive and respond fairly well to endocrine therapy. Drugs are aimed either to change the ER signaling pathways or prevent estrogen synthesis.7 Tamoxifen and 3rd generation Aromatase Inhibitors (AI) have been used for advance breast cancer with the former being effective in premenopausal, perimenopausal and post menopausal women. Pre-menopausal and perimenopausal cancer patients with ER positive tumours should be offered Tamoxifen tablets 20 mg daily, an oestrogen -receptor antagonist and ovarian ablation or the administration of LHRH agonists such as Buserelin or Goserelin as first-line treatment.5,12 Both options are just as effective in terms of tumour response and overall surviva l rates. The latter group of drugs, AI, are the preferred choice for post-menopausal women only with no prior history of endocrine therapy or have been previously been treated with Tamoxifen. AI work predominantly by suppressing oestrogen levels in post-menopausal women by blocking the conversion of androgens to oestrogens in the peripheral tissues. However, they do not inhibit ovarian oestrogen synthesis, hence can cause an elevation in oestradiol levels in pre-menopausal women. Anastrozole and Letrozole are non-steroidal AIs are known to be as efficacious as Tamoxifen as first -line treatment of metastatic breast cancer. 14Exemestane is a steroidal AI used as second-line treatment in advanced breast cancer in post-menopausal women in whom anti-oestrogen therapy has failed. Fulvestrant, an oestrogen receptor antagonist also confers short term benefits in the clinical setting for post-menopausal women who was previously prescribed a non-steroidal AI, delaying the need for chemotherapy. 13AI h ave been associated with an increased progression-free survival and 13% decrease risk of mortality and lower incidence of vaginal bleeds and blood clots. However, patients given AI are more prone to hot flushes and gastro-intestinal symptoms. 5 Other endocrine therapies available include older and less popular therapies such as progestogen and androgen for pre-menopausal women and stilboesterol and trilostane for post-menopausal women. 5 Chemotherapy Both ER positive and negative patients with advanced breast cancer would benefit from either a choice of two or three regiments of chemotherapy and classes of drugs commonly prescribed includes antharacyclines, taxanes, capecitabine, vinorelbine, gemcitabine, alkylating agents like cyclophosphamide and platinum based drugs like carboplatin.5 Anthracyclines such as Epirubicin, Mitoxantrone and Doxorubicin are prescribed as first line chemotherapy as they boost modest survival advantage in patients with advanced breast cancer and are superior to non-anthracycline regimens.1,5Doxorubicin is commonly given via injection into a fast running infusion at 21 day intervals as extravastation can cause severe tissue damage. It exerts a cytotoxic effect by interfering with DNA and RNA synthesis by inhibiting DNA toposiomerase II action. The metabolites are excreted through the bile, hence elevated bilirubin levels are indicative of a need to reduce the dosage. 6,12 Higher accumulation of doses may result in cardiopathy precipitating to heart failure, hence cardiac monitoring is deemed important in managing cancer patients taking it and a limit of total cumulative doses is set at 450 mg/m2.Other symptoms of toxicity includes myelodysplasia and neutropenic sepsis. Doxorubicin is also available in liposomal formulations which are safer in terms of reduced incidents of cardiotoxicity and local necrosis but is not recommended by the Scottish Medicines Consortium for treatment of metastatic breast cancer.1,12 Both Epirubicin,an anthracycline derivative, and Mitoxantrone ,an anthracenedione derivative,are structurally related to Doxorubicin, hence similar drug activity could be predicted for all three drugs.12 Mitoxantrone given intravenously is licenced to treat metastatic breast cancer and has been well tolerated by patients.However, side effects like myelosuppression and cardiotoxicity are evident and cardiac examinations are recommended after a cumulative dose of 160 mg/m2.12When both drugs are compared in a clinical trial, Epirubicin boosts higher response rates despite demonstrating a higher percentage of toxicity related side effects.20Clinical trials suggest the efficacy of Epirubicin in treating advanced breast cancer is comparable to Doxorubicin as similar response rates were recorded when equal doses were given. These trials also indicated that patients taking Epirubicin had fewer episodes of congestive heart failure and other complications resulting from cardiotoxicity. Therefo re, it could be surmised that Epirubicin is the drug of choice in this regimen .However,a limit of 0.9-1 g/m2 was still imposed when Epirubicin is given to avoid cardiotoxicity. 1,12 Due to the ineffectiveness of single-agent anthracycline therapies in impeding disease progression, combination therapies are often considered for the treatment of advanced breast cancer after failure of with anthracycline monotherapy, provided that the patient is able to tolerate additional toxicity and have a higher chance of response.5 There are clinical evidence suggesting that a combination of anthracycline and taxanes like Doxorubicin and Docetaxel have resulted in better tumour response, delayed progression time compared and reduce risk of mortality to anthracycline monotherapy. The benefits of this synergistic combination, however, did not include improved survival and side effects experienced were more numerous such as thrombocytopenia, alopecia in 75% of these patients,a 10% increase in peripheral neuropathy and neutropenia in 40 to 68% of these patients.1,5 A combination of Epirubicin and Docetaxel would be a better choice as it is just as potent as the Doxycycline and Pac litaxel combination but deemed free of side effects like cardiotoxicity and fluid retention whereas neutropenia was the dose-limiting toxicity .21 Systemic chemotherapy should be offered to patients whom antrhracyclines are contraindicated in cases of cardiac disease hypertension,the elderly, those who have received myocardial irradiation ,those receiving radiotherapy for breast cancer or had receive prior adjuvant treatment with anthracycline. Docetaxel monotherapy is prescribed as the first-line drug followed by single-agent Vinorelbine or Capecitabine as the second-line treatment. Third-line treatment encompasses the use of either Vinorelbine or Capecitabine of which was not offered previously.5 Docetaxel, a member of the taxane group derived from a naturally occurring compound from the bark of yew trees, is licensed to treat locally advanced or metastatic breast cancer. It acts by stabilizing microtubules in the polymerized state, preventing cell division. Side effects associated with Docetaxel are myelosupression, peripheral neuropathy, cardiac conduction defects with arrhythmias, alopecia, muscle pain, nausea and vomiting . Patients currently on Docetaxel are also susceptible to leg oedema and hypersensitivity reactions, which can be ameliorated by taking Dexamethasone orally.1,6,12 Antimetabolites like Capecitabine is a rationally designed tumour-activated and tumour-selective fluoropyrimidine carbamate thatis metabolized to generate 5-fluorouracil at the tumour site which would then be converted to fluorodeoxyuridine monophosphate (FDUMP), a fraudulent nucleotide and interact and inhibit thymidilate synthetase,preventing the synthesis of 2-deoxythymidilate (DTMP),which is vital for DNA synthesis.17Capecitabine has a role in second-line or third-line treatment of chemotherapy for patients of locally advanced or metastatic breast cancer either in combination with Docetaxel or given orally alone at a dose of 1250 mg/m2 twice daily for a forthnight and subsequent courses are repeated after a 7-day interval. Vinorelbine is a semi-synthetic analogue of vinblastine, a vinca alkaloid derived from Madagascar periwinkle. Unlike taxanes, it is targeted at tubulin of mitotic microtubules to form tubulin dimers which prevents spindle formation in dividing cells leading to mitotic arrest at metaphase resulting in cell death. 6 Besides inhibiting mitosis, its effects are also significant in inhibiting leucocyte phagocytosis, chemotaxis and axonal transport in neurons. Hence, side effects includes neutropenia which was found to be the dose-limiting, peripheral or autonomic neuropathy which manifests as peripheral paraestesia, loss of deep tendon reflexes and motor weakness,constipation and abdominal pain. Neurotoxicity caused by Vinorelbine is considered relatively mild compared to other vinca alkaloids even at maximum tolerated dose as it preferentially binds to mitotic over axonal microtubules. 6,12 Vinorelbine is an option to anthracycline or taxane pre-treated patients with advanced breast canc er as second-line or third-line chemotherapy given via intravenous administration at a dose of 30mg/m2 in 250 ml of normal saline over 1 hour. Alternatively, Vinorelbine can be given orally at a dose of 60 mg/m2 for 3 weeks and can be increased if the patient shows good tolerance to the regime to maximum dose of 160 mg once weekly. A clinical response rates of 16-60% was seen with Vinorelbine as a single agent, 28-77% in combination chemotherapy.5, 16 A study comparing Vinorelbine in intravenous(i.v.) form used in combination with Capecitabine given orally and a combination therapy of Vinorelbine and Capecitabine both in oral formulations was done to observe the efficacy of both combinations in anthracycline and taxane pretreated patients with metastatic breast cancer. Despite showing a marginally higher percentage in control of the disease in the oral group,improved survival rates and lower incidence of neutropenia and thrombocytopenia were associated with the i.v. group.17 This study has also shown that a combination of Vinorelbine with Capecitabine therapy may confer advantages as both have unique mechanisms of action, different proposed mechanism of drug resistance and relatively non-overlapping toxicity profiles. However, this combination has yet to be recommended by the NICE or SIGN guidelines as it has yet to be proven to be cost-effective. The recommendation for systemic chemotherapy by NICE is done following a cost-utility analysis which compares chemotherapy regiments in terms of survival, quality of life and associated costs of 17 different strategies drawn up. From the table below, strategies that gives the best survival rates and quality of life are combinations 3,4,13 and 15.However,combinations 3 and 4 that offer Gemcitabine and Docetaxel as the first line are somewhat more costly by approximately  £ 10 000 in total costs compared to combinations 13 and 15.It is also proven here that offering Docetaxel as a first-line drug is also superior to Paclitaxel as survival rates and quality of life are slightly poorer in combinations 8 and 10. 5 Biological Therapy New agents to specifically target molecular processes have been developed over the last decade like Tratuzumab, Bevacizumab and Lapatinib which are all used to treat advanced breast cancer. Tratuzumab, the sole drug of its kind recommended by NICE for use in the UK, is a recombinant humanized monoclonal antibody which binds to Human Epidermal Growth Factor (HER2) on the cancer cells with HER2 over expression and impedes the growth. Hence, HER2 status should be assessed before commencing this therapy as only a quarter of patients with advanced breast cancer have HER2 positive tumours. Tratuzumab is given intravenously in combination with Paclitaxel, Docetaxel or Vinorelbin has been well tolerated. 5,11However, once disease progression occur outside the central nervous system, Tratuzumab should be discontinued. Bevacizumab is another monoclonal antibody aimed at affecting the growth of tumour blood vessels and Lapatinib affects the metabolic pathways of the HER2 and Epidemal Growth Fac tor Receptor (EGFR). 5,23. Surgery Surgical intervention comprises of conservation surgery which involves the removal of the tumour with a rim of surrounding breast tissue with retention of the breast followed by radiation therapy and mastectomy which is usually followed by breast reconstruction. However, these surgical procedures are limited to patients diagnosed with primary operable breast cancer or as palliative surgery for locally advanced breast cancer as they may not confer much benefits to patients diagnosed with later stages of breast cancer.1,11,19 Some patients may have already underwent surgery which was not very successful in eliminating the disease.1 Treatment Recommendation Hormonal therapies are the recommended first-line therapy for patients with an ER positive tumour, are widely used and are said to be appropriate for 70 % of patients who have hormone receptor -positive advance breast cancer. However, in circumstances whereby the disease is life-threatening or the patient has an ER negative tumour, the hormonal therapy would be of no benefit to these patients. At the time of initial diagnosis, the oestrogen receptor (ER) was accessed and the results came out positive before considering commencing on endocrine therapy. Several factors like previous endocrine therapy including adjuvant therapy, the extent and period of response to the therapy and menopausal status have to be taken into account before prescribing hormonal therapy. 5The patient is 62 years of age and is considered to be post-menopausal, hence would benefit tremendously when given aromatase inhibitors(AI),regardless of whether she is tamoxifen naÃÆ' ¯ve. A choice of non-steroidal AIs o f either Anastrozole 1 mg daily or Letrozole 2.5 daily could be given orally. However, if she has a prior history of non-steroidal AIs and she failed to respond well to it, she should be given either Exemestane 25 mg orally or Fulvestrant 250 mg via intramuscular injection into the gluteal muscle every 4 weeks.5,12 Chemotherapy would be the second choice of treatment following failure to respond to hormonal therapy. If anthracyclines are not contraindicated for this patient, Epirubicin would be a good choice. Initial doses of 75 mg/m 2 of Epirubicin could be given intravenously every three weeks.20The addition of Docetaxel 75 mg/m2in combination with Epirubicin 90 mg/m2 both by intravenous infusions could be given should Epirubicin monotherapy fails. Docetaxel monotherapy could also be given as an intravenous infusion at a dose of100 mg/m2 as a 1-hour intravenous infusion every 3 weeks should anthracyclines be contraindicatedas first-line chemotherapy. Vinorelbine monotherapy could be given intravenously at a dose of 30 mg/m2 for days 1 and 8 of a cycle or whereares Capecitabine monotherapy could be given orally at a dose 1250 mg/m2 twice daily for two weeks. If the patient fails to respond to the entire treatment, the last resort would be to offer support and palliative care to this patient. Pain Management Pain is usually associated with progression of cancer with three quarters of patients with advanced cancer reporting pain during treatment. The principles for treating pain in cancer patients are outlined by the World Health Organisation (WHO) analgesic ladder: Patients are the prime assessor of pain and should have treatment outcomes monitored regularly using visual analogue scales, numerical rating scales. Patients usually start with non-opioids and then progress stepwise to step 2 and step 3. However, critics have debated that the progression to step 2 analgesics was obsolete as inadequate pain control was an issue despite having to endure similar adverse effects when given step 3 analgesics and recommended a immediate step up to step 3. Most patients with advanced breast cancer will be on step 3 for pain control. Oral morphine with an initial dose of 5-20 mg every four hourly, adjusted according to patients response, would be the first-line therapy to treat severe pain in cancer before switching to a modified release preparation once the patient is stabilized on it. Breakthrough pain should be managed while on a modified release preparation by prescribing oral morphine at 1/6th of the total daily dose to be taken when necessary. The use of adjuvants such as antidepressants like Venlafaxine and anticonvulsants like Gaba-pentin are recommended for neuropathic pain. 18 Managing Complications Complications that may arise from treating patients with advance breast cancer includes lymphoedema,cancer-related fatigue,uncontrolled local disease,bone metastases and brain metastases. Lymphoedema may occur due to damage to lymph nodes and vessels following surgery and radiotherapy or as a sign of loco-regional disease progression. This condition can be managed through manual lymphatic drainage, multi-layer lymphoedema bandaging,goos skin care and remedial exercise. Cancer-related fatigue may be well managed by identifying the factors causing lethargy which may be a host of psychological, nutritional and cognitive factors apart from the cancer itself and them treating them accordingly. Patients may also develop local disease characterized by ulceration on the chest wall and axilla, fungating tumours that may bleed and exude discharge, causing pain and giving off repulsive odours. Hence, good wound management should be adopted in relation to preventing dire consequences when wounds are left unattended. Out of the three categories, cancer with distant metastases is the hardest to treat and is considered an incurable disease with palliative care being the sole priority in treatment plans. A diagnosis of metastatic disease could be confirmed with the use of positron emission tomography fused with computed tomography (PET-CT) and bone scintilography.1As bone metastases may be a long-term condition, management involves prevention of skeletal events, pain control with Biphosphonates,radiotherapy and cementoplasty and treating complications such as fractures,immobility and spinal cord compression.5,18 Brain metastases may develop in multiple sites in these patients as most drugs used in chemotherapy cannot penetrate the blood brain barrier, especially in women with HER2-overexpressing tumours. Diagnosis of brain tumours ultimately mean a loss of independence, physical deterioration, communication difficulties,psychological distress and issues regarding body image.Treatment regimens includ es surgery for patients who have solitary metastasis, corticosteroids for symptomatic relief of inflammation and radiotherapy.

Information Processing Theory Essay

Information processing is a theoretical approach used to analyze human behavior (psychology) and learning processes (education). Information processing, in the pedagogical perspective, may be defined as the process of acquiring knowledge based on memory structures and information in different stages of information or mental processing. (Think Quest Team, 2007) It deals with thinking, storing, remembering and forgetting information. (NSW HSC Online, 2007) Information processing and the cognitive learning theory are closely associated with each another. This is because their propositions are similar in content. Information processing theory emerged at the dawn of the computer age (Hall, 2007). This theory suggests that memory and computers have common features. Moreover, it proposes that perceived information goes through three stages within the memory structure: sensory registers (where information is perceived and processed through the senses), short-term memory (where information is shortly stored and encoded), and long-term memory (where information is stored for easy retrieval). (NSW HSC Online, 2007) There are several principles that support this theory. First, there is an assumption that the capacity of the memory is limited. This means that at times, there may be barriers that affect processing of information. It is advantageous to identify why there is difficulty in information processing. Through this, resolutions may be formulated to address this issue. Second, there is a need for control mechanism. Control mechanism directs the extent of use of memory capacity. For instance, new information may require more processing than the regular day-to-day tasks. Third, information flow is two-way. We acquire information through our senses, process it in our memory in the same way that we create responses in our memory, and carry them out through our senses. Fourth, the genetic make-up of humans is meant for information processing. For instance, infants do not learn to think from other people. Their curiosity allows them to think and develop their senses. (Huitt, 2003) Information processing applied as an approach in the classroom setting, gains broader meaning and undeniable importance. The theory recommends a variety of techniques and methods to make teaching more efficient. Information processing also provides several tools and procedures that teachers may use to enhance thinking skills and extend mental capacity among the students. The learning process through information processing starts with the activation of schema, defined as the state of existing knowledge structures prior to the introduction of new information. Schema is often altered to accommodate new information. Therefore, new information related to the learner’s schema is more meaningful to them. (NSW HSC Online, 2007) Activation of schema is followed by acquisition of new information by the learner. Information processing postulates that in processing and in the retrieval of information, it is necessary to ensure that information is significant to the learner for him to be able to relate previous knowledge or schema to new information. The information is processed to fit schema, or in some instances to complement schema. The information is then stored in the long-term memory for future retrieval. There are also various key concepts to remember in applying information processing theory in the classroom setting. First, it is easier to remember significant information. Learners remember information that is interesting and relevant to their personal lives. Second, words are easily remembered based on their position in the text. For instance, words written in the beginning and in the end are easier to remember than words written in the mid area of the text. Third, repetition is efficient for memory retention. Memory retention is best improved through repetition and practice. Fourth, learning should be systematic. When learners make lists to organize lessons learned, information is easier to remember. Fifth, much effort should be exerted in processing information. Information that is processed in depth is easily stored in the long-term memory. Sixth, information processing is affected by schema. If information does not relate to a person’s schema, then there would difficulty in information processing. Lastly, there is a necessity to provide advance organizers for students. Advance organizers aids and prepares the learner for the next lesson. (Huitt, 2003) In the classroom setting, the teacher must come up with a lesson plan that follows a thorough procedure. Systematic procedures must be followed in information processing because there are limitations to memory capacity and thinking processes. Teachers must make sure that purpose of the previous step is achieved before moving on the next step. For instance, activation of schema comes first before the processing of information. To follow this step, the teacher must first provide stimulus that catches the attention of the students. Consequently, the learner perceives and processes this information in his sensory registers and short-term memory, allowing him to respond to the stimulus. The next step is to ensure that the information you teach is retained in the learner’s long-term memory. This can be achieved by following key concepts previously enumerated. In applying information processing in the classroom setting, keep in mind that its primarily goal is for students to learn by enhancing memory retention and maximizing information processing and capacity. The teacher must be guided with the key concepts and principles governing information processing theory to achieve greater success in meeting educational goals and objectives. References Hall, R. (2007). Information Processing Theory. Retrieved November 22, 2007. http://medialab. umr. edu/rhall/educational_psychology/2001/vl2a/info_new. html Huitt, W. (2003). The Information Processing Approach to Cognition. Educational Psychology Interactive. Valdosta, GA: Valdosta State University. Retrieved November

Issues Affecting Communication in the Workplace

This essay will focus primarily on three main issues that can undermine effective communication namely cultural diversity, emotions and language (Robbins et al. 2011 p. 331). The importance of feedback in an organisation to improve communication would also be reviewed (Iyer & Israel 2012 p. 55). Through feedback received, communication unveils opportunities to improve the individual and general performances of the organisation (Daneci-Patrau 2011 p. 496).Communication in an organisation comprises of many dimensions spanning formal and informal means of internal communication and external communications (Iyer & Israel 2012 p. 52). Communication is an ongoing process in which feelings, ideas, values and perceptions are transferred from one person to another through symbols which can be in the form of nonverbal, verbal and graphic communication (Dwyer 2009). Organisational communication refers to the transferring of information among members of an organisation, as well as in correctly u nderstanding the message contained in the information (Daneci-Patrau 2011p. 88). In order for an organisation to function effectively coordination of all aspects of the organisation must be achieved and this can only be done through effective communication which enables the organisation to meet its goals and objectives (Daneci-Patrau 2011). Effective communication is necessary in understanding management behaviour, reducing misunderstanding and building trust in and amongst members of an organisation (Daneci-Patrau 2011).Managers play an important role in ensuring the flow of communication through the organisation by using an effective system whereby feedback is received and acted upon (Daneci-Patrau 2011 496). Dwyer (2009 p. 9) states that leaders and managers with effective communication skills are able to work directly with people thereby minimising direct controls and encouraging more understanding, commitment, motivation and productivity within the organisation.The occurrence o f misunderstanding and inefficiency in an organisation can be attributed to lack of communication (Iyer & Israel 2012). Means of communication has grown significantly with the advancement in technology. Managers now have access to various communication channels such as emails, teleconferencing, computers, mobile phones and fax which speeds up the business of communicating (Alger, Delahunty & Diamantopoulos 1997).Communication channels must be established through appropriate methods and on all levels in an organisation both on an individual and group level between various people in the workplace ranging from clients, who are either internal or external to the organisation, staff members from within and outside it, those in managerial positions and line personnel (Klenk & Hickey 2010). The role of an organisation and management is to facilitate and coordinate communication within the organisation.Klenk & Hickey (2010) states that organisational communication relates to the transaction al and symbolic process that facilitates the coordination of activities through mutual adjustments of behaviour of individual parts to achieve a common goal. Communication in an organisation is not just the mere exchange of information, it is more comprehensive than that and includes constructive meanings between members of the organisation who influence each other in the context of asymmetrical power relationships during which they compete for power, resources and legitimacy (Klenk and Hickey 2010).Managers within organisations are in positions of power and personal influence in their relationships with employees and should be proactive in communicating with staff (White, Vanc & Stafford 2010). A number of studies have linked internal communication and the degree to which employees are given feedback to their job satisfaction and performance (White, Vanc & Stafford 2010).Vos (2009) measures performance in the communication area based on the following criteria: the management must s upport the holistic assessment of the organisation, the assessment must be an integral part of the communication function, the assessment process must be a team activity and those responsible for implementing these changes must be part of the team, the assessment must be well-prepared and well-organised and before commencement, those concerned should be well-informed of the organisation’s communication activities. Communication breakdown occurs when the message is not fully understood by the receiver.Breakdowns occur in situations when messages are distorted or blocked in some ways (Alger, Delahunty & Diamantopoulos 1997). These breakdowns are of major concern to the organisation as it may cost them both time and money (Alger, Delahunty & Diamantopoulos 1997). The first undermining factor we will be looking at is culture. Cultural diversity in the workplace is increasingly growing as most organisations today are multicultural in nature (Robbins et al. 2011). Culture is dynami c and a constantly changing in nature over time (Dwyer 2009).Communication barriers can also arise from different languages spoken, values and customs of individuals from various ethnic backgrounds. (Robbins, DeCenzo, Coulter &Woods 2011, p. 331). Culture refers to the norms, beliefs, customs, ethics, codes, mores, values, sentiments, behaviour and attitudes of individuals in a society (Kumar & Chakravarthi 2009). The more common the culture between two people, the greater the likelihood of achieving mutual understanding and effective communication(Alger, Delahunty & Diamantopoulos 1997).Culture can form barriers in communication when individuals are not aware of each other’s differences in values or customs (Kumar & Chakravarthi 2009). Managers today work with people from different nationalities and it is therefore important for them to be culturally competent through gaining knowledge of the cultural aspects of individual and countries they interact with to ensure effective and efficient communication (Todarita & Ranf 2009). Another issue that can undermine effective communication is one’s emotion.Emotions refer to the physiological and psychological state at the immediate time of communication (Smeltzer & Waltman 1984). Robbins et al. (2011) also defines emotions in regards to communication, as how a receiver feels when the message is received and how he or she interprets it. There are two types of emotional abilities namely managing emotions and the use of emotions to facilitate thinking and communication associated with job performance in an organisation (Lindebaum 2009).Emotional Intelligence (EI) is a term that is used to substantiate personal skills and characteristics that are responsible for the ways in which individuals behave, feel and relate to others in a job context (Dwyer 2009). Emotionally intelligent leaders are able to have the social skills and awareness to associate effectively in different settings (Dwyer 2009). In personal, social and business relationships, managers are able to build satisfying relationships nd make effective decisions based on their EI (Dwyer 2009). When emotions are running high, individuals often disregard rational and objective thinking process and substitute it with emotional judgements (Robbins et al. 2011, p. 331). ‘Learning to recognise emotions and empathise with others, developing high self-esteem, managing emotional upsets and anger are all emotional skills that managers and staff should learn’ (Dwyer 2009). In addition, use of language can affect communication adversely.To communicate effectively managers must learn to be clear and concise and tailor their language at an appropriate level so that their audience understands the meaning (Alger, Delahunty & Diamantopoulos 1997 p. 256). Due to the diverse backgrounds of employees in an organisation, different patterns of speech are formed easily in a specialized environment and this developed technical language i s known as jargon (Robbins et al. 2011).Although jargon may greatly help communication within specialized groups, it can impede communication among individuals who are not conversant with the language (Understanding and Managing Organisational Behaviour 2006). Age, education and cultural backgrounds are variables that influence the language a person uses and the definitions the individual applies to it (Robbins et al. 2011). An example of incorporating a language for better communication can be seen in Denmark where predominantly speaking Danish organisations are obliged to adopt English into their organisation (Tange & Lauring 2009). Language management and social interaction within the multilingual workplace national and corporate languages serve different needs and purposes, which is particularly evident  in  a country such as Denmark, where corporate language planning involves the imposition of an English  lingua franca  on  organisations  that are traditionally Dani sh-speaking’ (Tange & Lauring 2009). Tange & Lauring (2009) provides that language usage within multinational companies has suggested that multilingualism creates a complex managerial situation with great implications for cross-cultural communication. When communicating across cultures, awareness of the meaning of the words and idiomatic expressions in the language of another culture can prevent communication barriers and their consequences’ (Dwyer 2009 p. 41). Furthermore, feedback system is an example of a system that managers can use to improve communication in their respective organisation. Kaymaz (2011) defines feedback as the most important stage in the communication process. Communication is a two way process, and managers must be prepared to give feedback to employees and in return encourage feedback from employees (Hitt, Black, Porter & Hanson 2007).Receiving feedback is important as it indicates to the sender that their message has been received and correctly understood and interpreted (Robbins et al. 2011). Once received, feedback can trigger another idea from the sender, initiating yet another cycle of communication which triggers yet another round of feedback, thereby continuing the cyclical nature of the communication process (Understanding and Managing Organisational Behaviour 2006). The provision of feedback helps reduce the likelihood of misinterpretation to occur in the workplace (Iyer & Israel 2012 p. 2). For example in an organisation that sells goods and services directly to customers, the organisation can evaluate their performance by encouraging feedback from customers based on employee service and conduct. ‘Customer feedback can help to identify problem areas and strengths, and generate ideas for service improvements’ (Wirtz, Tambyah & Mattila 2010). Measuring performance should not be seen as extra work but rather as part of normal business operations. Feedback should be seen as a method for continuous assess ment and improvement.In this sense, it can be seen as a strategic feedback system that improves communication within the organisation in general. Performance measurement leads to transparency and in turn drives innovation and creativity (Vos 2009). In conclusion, organisations do not have independent existence, they associate with many groups and individuals by means of effective communication and feedback to achieve their results and desired outcomes (Alger, Delahunty & Diamantopoulos 1997). Interaction with organisations occurs through different channels of communication and by different methods.All organisations and managers need to be aware of the communication patterns that occur within their environment to ensure effective communication (Alger, Delahunty & Diamantopoulos 1997 p. 117). The complex world of management today presents countless occasions to those in managerial positions to express their ideas and convince or persuade others to accept their ideas (Showry & Manasa 2 012). However, it can be an ordeal if one fails to focus on the critical foundation which is effective communication (Showry & Manasa 2012).Factors such as language, culture and emotions can undermine effective communication in an organisation but through feed-back achieved, communication discloses opportunities to improve the individual and general performances of the organisation (Daneci-Patrau 2011). From this essay we can draw on the significance of effective communication in an organisation and how the lack of it can result in decreased productivity, poor interpersonal relationships between employees and employers and be the cause of other serious workplace issues that could lead to other negative outcomes (Mallet Hammer 2005). ReferencesAlger G, Delahunty, J, Diamantopoulos, A 1997, Business Management, 2nd edn, Oxford University Press. Daneci-Patrau, D. 2011, ‘Formal Communication in Organisation’, Economics, Management and Financial Markets, vol. 6, no. 1, pp. 4 87-497. Dwyer, J 2009, Communication in Business: Strategies and skills, 4th edn, Pearson Education Australia, Frenchs Forest. Hitt,M A, Black J S, Porter, L W, Hanson, D 2007 Management, Pearson Education Australia. Iyer, S, & Israel, D 2012, ‘Structural Equation Modelling for Testing the Impact of Organization Communication Satisfaction on Employee Engagement’,  South Asian Journal Of Management, 19, 1, pp. 1-81. Kaymaz, K 2011,  Ã¢â‚¬ËœPerformance Feedback: Individual Based Reflections and the Effect on Motivation’, Business and Economics Research Journalvol. 2, no. 4, pp. 115-134. Klenk, NL & Hickey, GM 2010, ‘Communication and Management Challenges in Large, Cross-sector Research Networks: A Canadian Case Study’,  Canadian Journal of Communication, vol. 35, no. 2, pp. 239-263. Kumar, M & Chakravarthi, K 2009, ‘Cross-Cultural Communication’,  ICFAI Journal of Soft Skills, 3, 2, pp. 43-47. Lindebaum, D 2009, ‘Rhetoric or Remedy? A Critique on Developing Emotional Intelligence', Academy Of Management Learning & Education, 8, 2, pp. 25-237. Mallet-Hammer, B 2005 ‘Communication in the Workplace’ Research Paper, University of Wisconsin, viewed 14 August 2012 . Robbins, S, DeCenzo, D, Coulter, M & Woods, M 2011, Management: The Essentials, Pearson, Frenchs Forest. Showry, M & Manasa, K 2012, ‘Effective Communication for Professional Excellence’, IUP Journal Of Soft Skills, pp. 39-46 Smeltzer, LR & Wlatman L 1984, Managerial Communication-Strategic Approach, Louisiana State University, John Wiley & Sons.Tange, H & Lauring, J 2009, ‘Language management and social interaction within the multilingual workplace’,  Journal of Communication Management,  vol. 13, no. 3, pp. 218-232. Todarita, E & Ranf, DE 2009, ‘The Necessity and Efficient Usage of Managerial Communication within Organisations during Crisis Situations. Drawing-Up the Content of a Crisis Planningà ¢â‚¬â„¢,  Annales Universitatis Apulensis : Series Oeconomica,  vol. 11, no. 2, pp. 796- 804. Understanding and Managing Organisational Behaviour 2006, Delta Publishing Company, California.Vos, M 2009, ‘Communication quality and added value: a measurement instrument for Municipalities’, Journal of Communication Management, vol. 13, no. 4, pp. 362-377. White, C, Vanc, A & Stafford, G 2010, ‘Internal Communication, Information Satisfaction, and Sense of Community: The Effect of Personal Influence’, Journal Of Public Relations Research, vol. 22, no. 1, pp. 65-84. Wirtz, J, Tambyah, SK, Mattila, AS 2010, Organizational learning from customer feedback Received by service employees: A social capital perspective, Journal of Service Management, vol. 21, no. 3, pp. 363-387.

The Right to Fight Achieving Gender Equality on the Battlefield Essay

Abstract: Warfare has for centuries been the sole province of men, providing a rite of passage for male-dominated societies the world over.   The notion that women can function as soldiers – and that fighting units can function with women – is a new one, but there is ample evidence to show that women belong in combat and that the team concept that is so important to a fighting unit is not threatened by gender integration. The Right to Fight: Achieving Gender Equality on the Battlefield Warfare has always been, with only very limited exceptions, the work of men.   No modern society relies, and virtually no premodern society relied, on women as combat soldiers. – Kingsley Browne. Since Homer’s time, warfare has been the definitive male rite of passage.   It is so inextricably linked to the essence of what it means to be a man in Western society that nothing is comparable.   Symbols can be powerful cultural markers, and the spear of Ares and the mirror of Aphrodite are still profoundly important tokens of gender identity.   That identity means that women behave according to their feminine nature, and men act based on their masculine impulses.   In America, sports reinforce the same basic message that many primitive societies imparted to their young men: a male could not claim status as a man until he had distinguished himself in battle (Browne, 2007). Today, women have achieved equality in many fields of endeavor that once were the sole province of men.   The most notable among these is warfare.   Women advanced into battle, shoulder-to-shoulder with their male compatriots, risking death and dismemberment in Iraq, Afghanistan and other hot spots.   Men and women have not changed significantly, at least not physically.   Yet technology has had a profound impact on the nature of combat.   High-tech weaponry, and a higher-than-ever degree of specialization in modern armed forces have made it possible, even desirable, for women to contribute on the battlefield and behind the scenes.   More importantly, these new opportunities have made it possible for women to show what they can do in the line of fire.   The result of all this is that women are integral to America’s armed forces, a situation that would have been inconceivable just a few decades ago. In Co-ed Combat: The New Evidence that Women Shouldn’t Fight the Nation’s Wars, Kinsgley Browne argues that the secret to esprits de corps, that â€Å"x factor† that determines how well soldiers fight as a unit, is good, old-fashioned male bonding.   Soldiers who are under fire risk their lives together, which creates a special psychological link that is uniquely male.   â€Å"A striking feature of men’s wartime memoirs is the deep emotional connection they display toward their comrades, a connection often compared favorably in strength to the male-female bond† (Browne, 2007).   This is an ancient tradition, one that characterized the Greek hoplite units that marched in lock-step, one soldier protecting with his shield the exposed flank of the infantryman next to him.   Of course, the â€Å"male-female bond† had a meaning of its own within the Greek fighting units where homosexuality was considered beneficial in the sense that it stre ngthened the bond between soldiers. Other observers take a different view of the bonding factor.   One school of thought asserts that the kind of inter-personal relationships implied in male bonding are actually counter-productive from a military standpoint.   The â€Å"team† concept that military organizations seek to inculcate are businesslike in nature.   Instead, it is argued that â€Å"task-bonding† is the ideal for which the military strives because it fosters relationships within the context of teamwork (Fenner and DeYoung, 2001).   Within this definition, women not only have a place but may be necessary in that the team requires multiple talents and characteristics to reach its full functional potential.   â€Å"To be successful, the sum of their efforts must be greater than their individual efforts.   Team members should not all be the same size and have the same skills if the team is to be successful† (Ibid). Thus, the old notion that male bonding is essential to the functioning of a fighting unit breaks down according to a more modern definition of â€Å"team.†Ã‚   This is also true in team sports, which have for decades been integrated.   Women take part in team sports at the high school and college levels at a higher rate than ever before.   (Watching the U.S. women’s soccer team compete in the World Cup, it is hard to believe that anyone could harbor skepticism about women forming tight bonds in a competitive environment.)   Today, women are professional soccer and basketball players.   Not only are females capable of competing at a remarkably high level, they are capable of competing alongside men.   In this, we can see that bonding does not necessarily have to break down along gender lines, that there is not necessarily an overwhelming sexual polarity at work in the team dynamic (Fenner and DeYoung, 2001). Of course, the most important examples are to be found within the military itself.   There are numerous examples of men and women bonding as combat colleagues capable of collaborating strictly as soldiers for the greater good of unit and country.   In fact, studies have shown that the more stressful the situation, the more successfully men and women come together as soldiers† (Ibid).   A study of male and female students at the U.S. Air Force Academy revealed that students form relationships that are well worth maintaining once they enter the service.   â€Å"These young men and women bond so strongly†¦that their leaders know it will be problematic if they cannot transfer primary loyalty to the larger institution and the military mission in general to uphold the Constitution† (Ibid). So much for male female friendships in school and training but what happens when men and women come together in the most critical combat situations?   Can men function without feeling as though they need to protect women in their command, and doesn’t that dynamic threaten the safety of all concerned?   According to many military experts, the presence of women in a combat unit makes no appreciable difference.   â€Å"The general concept of women in the infantry is that the squad bonds,† said Army Major Mary Finch. â€Å"If women train with their units, the members will know she can and will do her job†¦The guys will accommodate her† (Skaine, 1999).   Others say the nature of modern warfare and the weapons used to prosecute it effectively takes gender out of the equation.   High-tech artillery and highly accurate surface-to-surface missiles make men and women soldiers equally vulnerable and indiscriminate targets (Ibid). For others, it’s a simple matter of motivation.   Women who are inspired to fight for their country do so for the same reason as men and should be respected for their choice.   Young women want to go to college, learn job skills and accrue benefits just as young men do and are willing to do their hitch and assume the same risks.   They also pay the same price when things don’t go as planned.   When SPC Christine Mayes was killed, her fiancà ©e commented that her situation was no more or less remarkable than any other soldier, and that her gender had nothing to do with it.   When it came down to it, she was a soldier killed in action in the Gulf War.   â€Å"She didn’t really want to be over there any more than the rest of them, but that’s what she got paid for; that’s what she did† (Ibid.)   Nevertheless, it’s still difficult for many not to distinguish between men and women soldiers when it comes to battlefield casualti es. Operation Desert Shield/Sword marked a kind of turning point for women in combat.   Officially speaking, women did not serve in â€Å"combat† positions, though there were women casualties.   The media has been, in general, remarkably slow to express widespread support for women in combat, reflecting what may be called the general opinion of the public at large.   Part of the struggle, admittedly, has been the media’s reticence when it comes to overlooking the image of women as wives/mothers/caregivers.   As recently as the Gulf War the press was guilty of this kind of objectivization, categorizing women who sincerely desired to serve alongside men.   Images in the media at the time showed â€Å"these battle-dressed ‘mommies’ tearfully hugging their babies good-bye, sensationalized sexual activities between men and women in the field, and exaggerated pregnancy rates among deployed servicewomen† (Simon, 2001).   At best, they were labeled à ¢â‚¬Å"damagers of readiness;† at worst â€Å"sexual distractions† (Ibid). This unfortunate state of affairs has its roots firmly in the 20th century.   Women have been present in combat situations for centuries, but World War II brought them into contact with life-threatening situations at an unprecedented level.   More than 400 American women died in circumstances termed â€Å"non-combat,† and women made contributions on many levels other than nursing or logistical support.   Women served as interpreters, interrogators and as intelligence operatives, often in life-threatening situations.   Nevertheless, after the war men remained steadfastly against, even hostile toward, the very suggestion that women might be assets in combat situations.   Women who served with distinction in the Pacific were denied medals because it angered men.   They were called â€Å"whores† or â€Å"lesbians† (Skaine, 1999). Events from recent years cannot be said to have helped the situation.   The Tailhook incident from 1991 probably set the cause of women in the military back 10 years.   Well-publicized attempts to integrate women in venerable all-male military institutions, such as VMI and The Citadel, were horrific examples of gender discrimination, yet reinforced among many the feeling that women don’t belong in traditional male military roles.   If females couldn’t handle the hazing or the rigorous male code at The Citadel, the thinking went, how could they be expected to hold up under actual fire?   Operation Desert Shield/Storm helped change the paradigm, though even at that the military establishment resisted U.S. Rep. Pat Schroeder’s recommendation that some women be assigned to combat situations.   Schroeder’s ideas were turned down, with policy setters insisting that the military was no place to conduct a â€Å"social experiment† and certainly not in life-and-death combat scenarios (Skaine, 1999). Integration has, of course, become a fact of life but it can’t be considered a â€Å"slam dunk.†Ã‚   In spite of the advantages to be derived from women serving in the military, it still represents a major change in the military’s modus operandi, and a fundamental change in philosophy.   Statistics bear out the fact that it has been anything but a seamless transition.   Since gender integration, attrition rates for first-term Army soldiers have reached record highs (Simon, p. 137).   Attrition sat at about 20 percent in the early1990s; after integration, that figure reached 37 percent in 1996 and was flirting with 50 percent by the year 2000 (Ibid).   â€Å"In the Army, overwhelming data on attrition rates refutes the conclusions of soldier surveys that suggest gender integration is a military success. (Ibid).   Other symptoms include domestic violence and sexual imposition, though these have not amounted to chronic problems. In many ways, the military mirrors the customs and prejudices of the society from which it is drawn.   As such, it is not surprising that there should be difficulties creating a gender-integrated fighting force that protects a country that harbors gender-sensitive perspectives in so many walks of life.   As long as it’s taken to bring gender equality to America’s military, the most constructive view may be that it has happened at all.   Civil rights weren’t a reality for African-Americans until more than a century after the Civil War, but it did finally come about.   Winston Churchill once said that Americans always do the right thing after exhausting every other possible alternative.   One may say that women were given the opportunity to show what they can do in combat only after nearly every excuse for not including them was proposed.   If that is the case, then justice was served when women were given the right to serve. References Browne, K. (2007).   Co-Ed Combat: The New Evidence that Women Shouldn’t Fight the Nation’s Wars.   New York: Penguin Group. 89, 135. Fenner, L.M. and DeYoung, M. (2001). Women in Combat: Civic Duty or Military Liability? Washington, DC: Georgetown University Press.   17, 19. Simon, R.J. (2001). Women in the Military.   Piscataway, NJ: Transaction Publishers. 17, 137. Skaine, R. (1999).   Women at War: Gender Issues of Americans in Combat.   Jefferson, NC: McFarland and Company, Inc. 57, 170.