Fences by August Wilson Essay - 650 Words

In the play, Fences, Troy seems to have a complicated relationship with every other character in the play. This applies especially to his relationship with his son, Cory. Troy and Cory have many similarities and differences that complicate their relationship. There are many outside factors that also make matters worse. One of the differences that complicate their relationship is that they have grown up in completely different time periods. A great deal has happened between the times when Troy was growing to the time period that Cory is growing up in. This issue itself causes many other concerns. For instance, Cory is a very talented athlete. He would like to play football in college and would probably receive a scholarship†¦show more content†¦Troy said Cory would be better off not going to football practice and working at the AP store instead. Cory tries to reason with Troy by giving him examples of how African American athletes can be successful, Cory says, The Braves got Hank Aaron and Wes Covington. Hank Aaron hit two home runs today. That makes forty-three. But still, Troy refuses to see any opportunity and tell Cory, Hank Aaron aint nobody. This situation makes me wonder if he is actually scared that Cory will be an amazing athlete and will be better than him. Troy maybe jealous that his son has opportunities to succeed that he never had, no matter how great of an athlete he was, he could have never made it to the pros because of his skin color. Now his son is being recruited by professional teams to play for them. Troy may be against this because he doesnt want his son to be able to live the dream that he was never able to live. This makes their father son relationship very interesting. It is said that fathers typically want their sons to be better off then they are, especially not very wealthy people. You would think in this situation Troy would support Cory in what he wants to do and be happy for him that he has such wonderful opportunities. Troy maybe be acting like this because Troy still lives in a dream world and still thinks he a great base ball player. He has trouble accepting that hisShow MoreRelatedFe nces : Fences By August Wilson1541 Words   |  7 PagesName: Alejandro Ahmed Date: 12/6/16 Unit: American Drama Title: Fences Author: August Wilson Year of Publication: 1986 Fences Study Guide Descriptive i. Overview: â€Å"Fences†, was a play written by August Wilson in 1986. The play communicates the story of the son of an unsuccessful sharecropper, Troy Maxson, who has lived most of his life independently due to his father’s abuse during his childhood. The play focuses on Troy’s interactions and conflicts with other characters, and the complicated relationshipsRead MoreFences by August Wilson791 Words   |  3 Pageshave built fences to keep enemies out and keep those they want to protect inside. In society today, people create metaphorical fences in order to fence in their feelings, while others create literal fences in order to keep the unwanted away. In the play Fences, the Maxon family lives in 1950’s America whose love for sports and one another are questioned at times when they need to be together the most. In the play Fences by August Wilson, two main characters Troy and Cory Maxon build a fence, literallyRead MoreFences, By August Wilson1104 Wor ds   |  5 PagesAfrican-Americans during the middle of the twentieth century were treated differently than those of the white population. Fences, a play by August Wilson, demonstrates the frustration of white dominance during a time when African-Americans were secluded from society. The Maxson family are the main characters of the play, showing the life they lived in their black tenement in Pittsburg in the 1950s. The setting demonstrates the drama of their struggle, frustration, rebellion, and the predicamentsRead MoreAugust Wilson Fences984 Words   |  4 Pagesbecause in order to get what you want you have to fight for it. Two literary works that reflect this quote are Fences, a play about the struggles of African American before and during the Civil Rights Era in the 1950s and 60s, by August Wilson and â€Å"The Yellow Wallpaper† a short story that shows the difference between women and men during that time, by Charlotte Perkins Gilman. ‘Fences’ shows th e revolution the characters face, their actions and what is the result of those choices. Whereas, ‘TheRead MoreThe Fences By August Wilson1813 Words   |  8 PagesIn the Fences, by August Wilson shows that life of African Americans in the U.S. in the 1950s with the story of Troy and his family. Wilson uses the symbol of the fence to show the desires of each character like Rose’s desire is to keep her family together, Troy’s desire is to keep death out and to be not bound forever, and Bono’s desire is to follow Troy, his best friend, as an example of the right way to live and to be with Rose and Troy who are basically his family. Rose and the other seen charactersRead MoreFences, By August Wilson807 Words   |  4 PagesFences â€Å"Some people build fences to keep people out...and other people build fences to keep people in† (61). In the play, Fences, by August Wilson who displays how fences symbolize different situations to represent different characters. The story takes place in Pittsburgh, Pennsylvania in the 1950’s, and in the play fences gives an outlook of providing an obstacle or barrier that is intended to keep something out or in. It shows through the protagonist character, named Troy Maxson and his wifeRead MoreFences by August Wilson883 Words   |  4 PagesFences, written by August Wilson, is a play about a man, named Troy, struggling to support his family during the late 1950’s. In this play, we see that Troy hurts the people closest to him. He has been uncaring towards his wife, Rose, his brother Gabriel and his son, Cory. This is because Troy had nothing to go on but the harsh example set by his father. In Fences, Troy has felt like he has been fenced in all of hi s life, which causes him to fence others in. Troy has felt fenced in all of his lifeRead MoreFences, By August Wilson895 Words   |  4 PagesFences written by August Wilson is an award winning drama that depicts an African-America family who lives in Pittsburg, Pennsylvania during the 1950’s. During this time, the Mason’s reveal the struggles working as a garbage man, providing for his family and excepting life as is. The end of segregation began, more opportunities for African American people were accessible. Troy, who’s the father the Cory and husband of Rose has shoes fill as a working African America man. He is the family breadwinnerRead MoreFences, August Wilson1835 Words   |  8 PagesAs illustrative of the kind of analysis I would bring to Fences, by August Wilson, if my bid to direct is successful, O prose to take direction for a part of Act 1, Scene 3 of the play. This will include possible blocking, camera work, music, and what the actor should be feeling and experiencing while acting the par t. I will examine how crucial it is that the actors portray their characters effectively, and I will offer commentary to assure just that. On the basis of these findings I will determineRead MoreSymbolism In Fences By August Wilson1460 Words   |  6 PagesKeep Love in or Lock it Out?: An Analysis of Symbolism in Fences Symbolism is defined as an artistic and poetic movement or style using symbolic images and indirect suggestion to express mystical ideas, emotions, and states of mind. In Fences by August Wilson, symbolism is used heavily throughout the play in order to represent deeper meanings and add to the emotion of the storyline. In order for the play to have so much depth and emotion, symbolism is crucial to the work itself and the heavy topics

Physician Assisted Suicide And Euthanasia Essay - 1806 Words

Bekah Klemp Sarah Puett WRIT 1401 12/06/16 Physician Assisted Suicide Beginning in the 1970s, terminally ill patients were given the right to refuse life-sustaining treatment to end their own life, a process commonly referred to as euthanasia. They would be taken off life support, and death would be allowed to take its natural course. This idea was controversial at first, but now a bigger issue has taken its place. Many patients claim that they reserve the right to physician assisted suicide—killing oneself with means provided by the physician. Assisted suicide has been deemed a criminal offense by most of the United States; however, four states have now accepted the policy. The Death with Dignity Act, as it was called, originated in Oregon in 1994, and it has since been spread to Vermont, Washington, and California ( ). The controversy over the legalization of this issue has been getting increasingly more prevalent. Advocates of physician assisted suicide believe that it is the patient s right to end their own life. It would permanently end their suffering, and would allow them to have peace of mind in their death. These people point to the Death with Dignity Act in Oregon, claiming it as proof that the legalization of assisted suicide can and will work. On the other hand, we can see many flaws in the process. In addition to saying that it is unethical, many Americans argue that this kind of law will be abused. They claim that before long, many patients will feelShow MoreRelatedEuthanasia And Physician Assisted Suicide865 Words   |  4 Pagessubject for people; add in the idea of assisted suicides and there’s an uproar in society. Euthanasia or physician assisted suicide is a very controversial topic in our society today. Physician assisted suicide by definition is â€Å"suicide by a patie nt facilitated by means (as a drug prescription) or information (as an indication of a lethal dosage) provided by a physician aware of the patient’s intent (Merriam-Webster). There are two modes of looking at assisted suicides; either it’s seen as an absurd immoralRead MoreEuthanasia And Physician Assisted Suicide918 Words   |  4 Pagesallows terminally ill patients to end their lives with the assistance of a physician. According to the legislature, patients who seek assisted-death must only have six months to live and are required to submit a written request as well as two oral requests at least 15 days apart. (Reilly). While Gov. Jerry Brown still has yet to approve this new law, the act has shed light on the topic of euthanasia/physician-assisted suicide. With the pending status of the law, the question remains on whether or notRead MoreEuthanasia Or Physician Assisted Suicide961 Words   |  4 PagesEuthanasia or physician assisted suicide, is the painless kill ing of a patient, suffering from a painful or incurable disease, like cancer, or alzheimer s, the practice is illegal in most countries, including the United States, although in the United States, it is a state decision, the only state in the United States that it is legal in is Oregon. Oregon passed the Death with Dignity Act in 1994, making euthanasia legal for chronically ill patients, the only caveat is that the doctor is allowedRead MoreEuthanasia, And Physician Assisted Suicide863 Words   |  4 Pagesare: euthanasia, and physician assisted suicide. Internationally, assisted suicide is a doctor prescribing drugs that end life. The patient is responsible for taking them. Euthanasia is the medication administered by doctors. Today, four countries have laws that allow euthanasia. (Ellis and Bronwyn) A few have laws for physician assisted suicide, and several countries have no laws against suicide. (Humphry) The United States of America have recently added a 5th state to o ffer assisted suicideRead MorePhysician Assisted Suicide And Euthanasia Essay1039 Words   |  5 PagesPhysician Assisted Suicide Is physician assisted suicide ethical? Physician assisted suicide is an up and coming ethical question that examines a person’s right to their own death. Many people support physician assisted suicide, citing that it can save a lot of pain and suffering. Others claim that the concept of physician assisted suicide is a slippery slope. A slippery slope in the sense that if society accepts euthanasia as a rightful death for the terminally ill, they will potentially acceptRead MoreEuthanasia And Physician Assisted Suicide1629 Words   |  7 Pagesproblems, assisted suicide creates options to reduce the amount of suffering the patient must enduring. Dying with dignity could be beneficial for not only the person who is dying, but also the person’s family and loved ones. This option, however, is often viewed as unethical and immoral throughout society. Physician-assisted suicide offers an option for those with health issues but poses various ethical and social issues. Assisted death is practiced in two different ways: euthanasia and physician-assistedRead MoreEuthanasia And Physician Assisted Suicide997 Words   |  4 PagesEuthanasia and Physician Assisted Suicide: The Right to Die with Dignity (The Legalization, At Risk Groups, and Rebuttal) The possible legalization of voluntary euthanasia and physician assisted suicide brings concerns in regards to how well it will be accepted. There are contradictions that exists between government and church when it comes to the morals and values placed on human life. Although, society has concerns in regards to at risk community groups and the type of treatment availableRead MoreEuthanasia And Physician Assisted Suicide1504 Words   |  7 Pageslegalizing euthanasia and physician-assisted suicide, we would provide â€Å"vulnerable† patients with better overall protection and health care, give patients (who are excruciatingly suffering and have no chance of recovery) the option to end their lives before they ever needed to go through such an ordeal and giving them peace of mind, and spare the families of the patients the emotional pain of watching their loved one slowly and painfully passing away. For these reasons, I believe that euthanasia and Physician-AssistedRead More Euthanasia And Physician Assisted Suicide1249 Words   |  5 Pagesview euthanasia and physician-assisted suicide not as murder or suicide, but rather a release from the pain that holds down and a quicker, less painful way to get to the end that will happen anyways. Euthanasia is becoming much more of a hot topic in the news, both here at home in the US, as well as on the global stage with the new Prime Minister of Canada pushing for a law that would allow nationwide physician assisted death. As of now only a few states have legalized physician-assisted suicideRead MorePhysician Assisted Suicide Or Euthanasia1597 Words   |  7 PagesPhysician assisted suicide or euthanasia should be a right granted to all citizens who are suffering from a degenerative, painful, or fatal condition that would cause them to be unable to enjoy their lives as healthy people do. The right to die with dignity is a fundamental issue that is debated in the spiritual side of everyone. Some of us may have known someone close to them who has seen or gone through an ordeal as watching someone take their last breath. No one should suffer in pain or have their

Complex Nursing

Question: Case Study Report onthe potential impact of chronic and complex conditions on the patient. Answer: Introduction In medical science, the comorbidity refers to one or more than one additional disorders or diseases co-occurring with a primary disorder or disease. According to ACCORD Study Group (2010), it is found that the comorbidity may include behavioural as well as mental disorders along with several related issues. Although the concept of comorbidity initially indicates an association of other diseases or conditions independently along with another medical condition or disorder, it is found that sometimes the sense of this terminology is overlapped with the concept of complications. In the case of prolonged diabetes mellitus, Group (2010) opined that it is very complicated to measure whether the occurrence of coronary artery disease is independent of the primary disease (diabetes mellitus) or it is the comorbidity of the primary disease. In medical science, the comorbidity can be synonymised as polymorbidity, multimorbidity, polypathy, multifactorial diseases, dual diagnosis and pluralpathology (Scirica et al., 2013). In this article, the researcher aims to identify the comorbidities of type 2 diabetes based on a case study. Over View of the Case Study Luigi (77), a retired old man is living in Australia for 40 years with his wife and a son. His health condition is declining from past 15 years as he is suffering from type 2 diabetes. Although he was consuming metformin 500mg BD, it is found that he is careless about his declining health condition. Luigi never pays attention to his overweight or increasing blood sugar level. It is found that he is also very reluctant about his diet chart. Recently, Luigi noticed that his vision is blurring and ankles are swelling. It is also recognized that his blood pressure has increased, and protein, as well as glucose, is present in his urine sample. Later he is diagnosed with "chronic renal failure." The pathophysiology of chronic and complex conditions and their related clinical manifestations According to Malik et al. (2010), the diabetes mellitus type 2 can be characterized as insulin resistance, high blood sugar as well as the relative lack of insulin. The common symptoms of this disease may include frequent urination, increased thirst, as well as unexplained weight loss. On the other hand, Nouwen et al. (2010) opined in their study that diabetes mellitus type 2 is a heterogeneous syndrome, which can be characterized by abnormalities in fat and carbohydrate metabolism. It is also found from the research study that the causes of type 2 diabetes are multifactorial, which may include both environmental as well as genetic elements, which can affect tissues (muscle, adipose tissue, liver, and pancreas) as these are insulin sensitive. The environmental and genetic factors can also have an impact on the beta-cell function. All though both reduced insulin sensitivity and beta-cell dysfunction play an important role in the development of type 2 diabetes, it is found that the res earchers debated about the relative contributions of these two factors to the pathogenesis of type 2 diabetes. The pathophysiology is considered as a junction of physiology with pathology. Pathology is defined by Chen et al. (2012) as the medical discipline, which elaborates conditions typically notices in the period of a disease state. On the other hand, physiology can be best described as the biological discipline, which elaborates mechanisms or process operating within an organism. While discussing the pathophysiology of the type 2 diabetes, it is found that both environmental and genetic factors play an equal role in the occurrence and severity of the disease. However, the mechanisms to control the interplay of environmental factors and the genetic factors are not very clear. Carter et al. (2010) suggested in their research study that there may be some factors that can be possibly linked with beta-cell dysfunction and insulin resistances in the context of the pathogenesis of type 2 diabetes. From the study of Ismail-Beigi et al. (2011), it is found that a majority of patients who are suff ering from type 2 diabetes are diagnosed as obese with central visceral adiposity. Therefore, it can be said that the adipose tissue should play an important role in the pathogenesis of diabetes mellitus type 2. One of the most important paradigms used to explain this link is the visceral / portal hypothesis, which plays a key role in the elevation of the concentration of non-esterified fatty acid. Apart from this paradigm, two new paradigms are also discussed among the researchers, such as "ectopic fat storage syndrome" as well as the adipose tissue as endocrine organ hypothesis. The hypothesis of ectopic fat storage syndrome is focused on the deposition of triglycerides in pancreatic cells, liver, and muscle. On the other hand, the adipose tissue as endocrine organ hypothesis includes the secretion of different adipocytokinase such as leptin, resistin, TNF alpha, which take part in beta- cell dysfunction and insulin resistance. The comorbidity, which is related to this chronic disease are obesity, glaucoma, chronic kidney failure and high blood pressure. According to Inzucchi et al. (2012), due to type 2 diabetes mellitus the adipose tissues get harmed and lead towards the increase of weight. On the other hand, the study showed that the patients with type 2 diabetes mellitus also have uncontrolled hypertension as the blood pressure continuously get elevated. According to Qaseem et al. (2012), the kidneys cells are also affected due to type 2 diabetes mellitus and leads to the acute kidney failure. Increasing level of glucose can also affect the retina and cause blurred vision. And last but not the least occurrence of this chronic disease can lead toward the cardiovascular disease (CVD) and cause heart failure. A discussion of the complexity and chronicity of the patients condition Based on the case study it is found that Luigi is suffering from longstanding type 2 diabetes mellitus (from last 15 years). The health condition of Luigi is continuously declining due to the suffering of type 2 diabetes which is recognised to be a chronic disease. According to Singh et al. (2013), chronicity is considered as a term, which denotes continuance and consistency, in the onset of an illness. It is also found that the chronicity of an illness indicates to the disease, which goes upon for a prolonged treatment. It is found from the research study of Rubino et al. (2010), that diabetes can be considered as a chronic illness, which anchors other illnesses and increases morbidity. Luigi is suffering from this disease for a long time, which has a deep impact on his health. Due to the presence of type 2 diabetes and his negligence he developed other diseases such as chronic kidney failure, glaucoma, high blood pressure as well as overweight. The increasing number of anchored diseases in his body also increased the complexity of his treatment and in his lifestyle. According to Bangalore et al. (2011), it is found that the management of the complex chronic diseases is always difficult as well as critical for the older people. Patient like Luigi, who is suffering from several comorbidities, needs to have special care as well as specific medical attentions. The patients comorbidities According to the case study, Luigi is suffering from a chronic disease (type 2 diabetes mellitus) from past 15 years. As a trained professional nurse, after reviewing his present condition, it can be said that the reason behind the continuous declining of the health of the patient is not only the occurrence of type 2 diabetes mellitus but also the comorbidity-related with this chronic diseases. It is found that Luigi is already suffering from several comorbidities such as glaucoma, dyslipidemia, high blood sugar (hypertension), glucosuria, obesity, cardiovascular disease and acute kidney failure. According to Lee et al. (2011), it is recognized that these comorbidities are the medical conditions that occur and are facilitated by the primary diseases; however, they can also exist as own specific disease. On the other hand, it is also found that it is not necessary that all of the comorbidities should occur in every person who are suffering from the same chronic disease. In this case study it is found that Luigi is suffering from most of the comorbidities of type 2 diabetes but not necessarily all of them. According to the study of Singh et al. (2013), NAFLD (Nonalcoholic fatty liver disease) is one of the most frequently occurring comorbidity of type 2 diabetes; however, after studying the case study, it is found that Luigi was not suffering from NAFLD. Impact of these conditions on the health of the patient and his family According to Qaseem et al. (2012), the occurrence of type 2 diabetes mellitus not only has an impact on the health of a patient but also has an impact on the social life as it interferes with day to day work of the patient. Luigi is unable to perform the outdoor work, which is evidently not supporting the sustainability of the family. Uncontrolled diabetes leads to elevated blood sugar and eventually welcomes the risk of heart failure, damage of blood vessels, nerves and eyes. According to () fifty per cent of the patients with type 2 diabetes undergo heart stroke. Damage of nerves or neuropathy causes numbness of feets, hands and limbs including pain (Chen et al. 2012). Neuropathy accompanied with reduced blood flow in the feet enhances the possibility of foot ulcers and further limb amputation. Retinopathy was found to be the contributing factor of blindness resulting from damage of retinal blood vessels (Lee et al. 2011). According to (Rubino et al. 2010) about 10 % of patients develop visual impairment after being diagnosed with diabetes for fifteen years. On the other hand, the occurrence of type 2 diabetes mellitus and comorbidities of this disease can also have an impact on the family economy. According to Ismail-Beigi et al. (2011), the increasing rate of fees and cost of medicines in Australia for the treatment of diabetes is considered as a burden on the family who has members suffering from type 2 diabetes mellitus. Clinical manifestations and medications of the patients The clinical manifestation of type 2 diabetes may firstly, include diagnosis which can be started with blood testing for sugar levels. Secondly, high blood pressure, obesity, decrease sensation in legs, weak pulse rate, ulcers, infections of the feet are the common symptoms that are helpful for diagnosing diabetes. The laboratory tests may include: FPG (fasting plasma glucose), OGTT (oral glucose tolerance test), random blood glucose test, blood creatinine test, and clinical examination for kidney disease and lipid profile of the patient. To control the type 2 diabetes, it is important to follow a proper diet chart and exercise routines. According to Chen et al. (2012), it is found that those patients with type 2 diabetes who are maintaining a good diet chart have improved from their present condition. A healthy diet chart of a person with type two diabetes mellitus should include low cholesterol, less amount of Trans fat, fewer calories and nutritionally balanced food. Apart from these, it is also found that injection of insulin and other medicines such as metformin are essential. Conclusion After analysing the present condition of the patient as described in the case study, it can be said that Luigi is suffering from chronic type 2 diabetes mellitus, which not only has an impact on his health but also in his social life. He is a 77 years old person and therefore he is less potential to fight against this chronic disease. On the other hand, it is also found the comorbidities of this disease has affected his life style. The reason behind of his health decline is not only the type 2 diabetes mellitus but also the comorbidities such as glaucoma, hypertension, chronic kidney failure and obesity. However, his negligence of diet chart and medicines has lead to the deterioration of his health. Therefore, it can be said that with a better diet chart, medicines and involvement in proper exercise procedure, he will be able to recover himself from the current state. Recommendations After reviewing the current state of Luigi, he is recommended to follow a proper diet chart along with a proper exercise routine. He is recommended to adhere to his medication strictly and also intake medicines for the chronic disease as well as comorbidities. He must control his blood sugar level strictly and avoid using NSAIDS. Reference ACCORD Study Group. (2010). Effects of intensive blood-pressure control in type 2 diabetes mellitus.The New England journal of medicine,362(17), 1575. Bangalore, S., Kumar, S., Lobach, I., Messerli, F. H. (2011). Blood pressure targets in subjects with type 2 diabetes mellitus/impaired fasting glucose observations from traditional and bayesian random-effects meta-analyses of randomized trials.Circulation,123(24), 2799-2810. Carter, P., Gray, L. J., Troughton, J., Khunti, K., Davies, M. J. (2010). Fruit and vegetable intake and incidence of type 2 diabetes mellitus: systematic review and meta-analysis.Bmj,341, c4229. Chen, L., Magliano, D. J., Zimmet, P. Z. (2012). The worldwide epidemiology of type 2 diabetes mellituspresent and future perspectives.Nature Reviews Endocrinology,8(4), 228-236. DeFronzo, R. A., Cersosimo, E., Mandarino, L. J. (2011). Pathogenesis of Type 2 Diabetes Mellitus 6. Group, T. A. S. (2010). Effects of combination lipid therapy in type 2 diabetes mellitus.The New England journal of medicine,362(17), 1563. Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M., ... Matthews, D. R. (2012). Management of hyperglycaemia in type 2 diabetes: a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD).Diabetologia,55(6), 1577-1596. Ismail-Beigi, F., Moghissi, E., Tiktin, M., Hirsch, I. B., Inzucchi, S. E., Genuth, S. (2011). Individualizing glycemic targets in type 2 diabetes mellitus: implications of recent clinical trials.Annals of internal medicine,154(8), 554-559. Kohei, K. A. K. U. (2010). Pathophysiology of type 2 diabetes and its treatment policy.JMAJ,53(1), 41-46. Lee, W. J., Chong, K., Ser, K. H., Lee, Y. C., Chen, S. C., Chen, J. C., ... Chuang, L. M. (2011). Gastric bypass vs sleeve gastrectomy for type 2 diabetes mellitus: a randomized controlled trial.Archives of surgery,146(2), 143-148. Malik, V. S., Popkin, B. M., Bray, G. A., Desprs, J. P., Hu, F. B. (2010). Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk.Circulation,121(11), 1356-1364. Nouwen, A., Winkley, K., Twisk, J., Lloyd, C. E., Peyrot, M., Ismail, K., ... European Depression in Diabetes (EDID) Research Consortium. (2010). Type 2 diabetes mellitus as a risk factor for the onset of depression: a systematic review and meta-analysis.Diabetologia,53(12), 2480-2486. Qaseem, A., Humphrey, L. L., Sweet, D. E., Starkey, M., Shekelle, P. (2012). Oral pharmacologic treatment of type 2 diabetes mellitus: a clinical practice guideline from the American College of Physicians.Annals of internal medicine,156(3), 218-231.