A case of acute myeloid leukemia (AML) with an unreported combination of chromosomal abnormalities: gain of isochromosome 5p, tetrasomy 8 and unbalanced translocation der(19)t(17;19)(q23;p13)

BACKGROUND: Acute myeloid leukemia (AML) comprises a spectrum of myeloid malignancies which are often associated with distinct chromosomal abnormalities, and the analysis of such abnormalities provides us with important information for disease classification, treatment selection and prognosis. Some chromosomal abnormalities albeit recurrent are rare such as tetrasomy 8 or isochromosome 5p. In addition, erratic chromosomal rearrangements may occur in AML, sometimes unbalanced and also accompanied by other abnormalities. Knowledge on the contribution of rare abnormalities to AML disease, progression and prognosis is limited. Here we report a unique case of acute monoblastic leukemia with gain of i(5)(p10), tetrasomy 8, an unbalanced translocation der(19)t(17;19)(q23;p13.3) and mutated NPM1. RESULTS: Bone marrow cells were examined by conventional karyotyping, fluorescence in situ hybridization (FISH) and mutation analysis at diagnosis and follow-up. At diagnosis we detected trisomy 8, an unbalanced translocation der(19)t(17;19)(q23;p13.3) and mutated NPM1. During the course of the disease we observed clonal evolution with gain of i(5)(p10), tetrasomy 8 and eventually duplication of der(19)t(17;19)(q23;p13.3). By using the der(19)t(17;19) as clonal marker, we found that i(5)(p10) and tetrasomy 8 were secondary genetic events and that tetrasomy 8 had clonally evolved from trisomy 8. CONCLUSIONS: This case of acute monoblastic leukemia presents a combination of rare chromosomal abnormalities including the unbalanced translocation der(19)t(17;19)(q23;p13.3), hitherto un-reported in AML. In addition, our case supports the hypothesis of a step-wise clonal evolution from trisomy 8 to tetrasomy 8 in AML. Reporting and collecting data of rare chromosomal abnormalities will add information to AML disease, progression and prognosis, and may eventually translate to improved patient management

Lactancia materna del prematuro en un hospital amigo del niño

O objetivo foi descrever as experiências maternas relacionadas ao aleitamento materno de prematuros em uma unidade neonatal de um Hospital Amigo da Criança. Trata-se de um estudo qualitativo exploratório-descritivo, realizado em 2015. Participaram da pesquisa seis mães de prematuros hospitalizados em um Hospital Amigo da Criança. A coleta das informações foi realizada por meio de entrevista semiestruturada. Empregou-se a análise de conteúdo do tipo temática. Emergiram três categorias temáticas: Dificuldades enfrentadas durante o processo de aleitamento materno; Rotina de ordenha no banco de leite humano e Sentimentos relacionados ao aleitamento materno do filho prematuro. Conclui-se que, neste cenário, as mães vivenciaram dificuldades, tais como as condições clínicas do bebê e sentimentos de estresse e ansiedade. No entanto, sentiram satisfação em poder amamentar seus filhos prematuros e auxiliar na recuperação. Ainda foi possível identificar a importância da atuação da equipe de saúde nesse processo.The objective was to describe maternal experiences related to breastfeeding of premature infants in a neonatal unit of a baby-friendly hospital. This is a qualitative exploratory-descriptive study conducted in 2015. Six mothers of premature infants hospitalized in a baby-friendly hospital participated in the research. Information was collected through semi-structured interviews. Thematic content analysis was used. Three thematic categories emerged: Difficulties faced during the breastfeeding process; Human milk bank milking routine and Feelings related to breastfeeding of a premature child. It is concluded that, in this scenario, mothers experienced difficulties, such as the baby's clinical conditions and feelings of stress and anxiety. However, they were pleased to be able to breastfeed their premature children and assist in recovery. It was also possible to identify the importance of health team performance in this process.El objetivo fue describir las experiencias maternas relacionadas con la lactancia materna de bebés prematuros en una unidad neonatal de un Hospital Amigo del Niño. Este es un estudio cualitativo exploratorio descriptivo realizado en 2015. Seis madres de bebés prematuros hospitalizados en un Hospital Amigo del Niño participaron en la investigación. La información se recopiló a través de entrevistas semiestructuradas. Se utilizó el análisis de contenido temático. Surgieron tres categorías temáticas: dificultades enfrentadas durante el proceso de lactancia materna; Rutina de ordeño del banco de leche humana y sentimientos relacionados con la lactancia materna en niños prematuros. Se concluye que, en este escenario, las madres experimentaron dificultades, como las condiciones clínicas del bebé y los sentimientos de estrés y ansiedad. Sin embargo, estaban contentas de poder amamantar a sus hijos prematuros y ayudarlos en la recuperación. También fue posible identificar la importancia del desempeño del equipo de salud en este proceso

Organisationale Identität : Messung der Veränderung am Beispiel einer Fusion und Transformation

Innerhalb der Organisationswissenschaften hat sich die Domäne „Organisationale Identität“ während der letzten drei Jahrzehnte als eigenständiger Forschungsbereich entwickelt. Die drei Säulen „Zentralität, Kontinuität und Einzigartigkeit“ begründen das wissenschaftliche Konzept und werden in diesem Fall mit einem quantitativen Messinstrument durch die Elemente Organisationale Identitätsstärke, Ökonomischer Identitätstyp, Patientenversorgung, Forschung, Lehre und Zuversicht in Anwendung einer Längsschnittstudie im Rahmen einer Fusion von drei Krankenhäusern und Transformation zu einem Universitätsklinikum beschrieben. Der erste Messzeitpunkt (T1) zeigt die Wahrnehmung der Organisationsmitglieder vor der Fusion, die beiden weiteren Messungen (T2, T3) wurden nach dem Merger durchgeführt und stellen den Zeitverlauf der einzelnen Identitätselemente dar. Die Validierung des Instrumentes erfolgte durch Konstrukt- und Kriteriumsvalidität durch die gleichzeitige Messung benachbarter Konzepte (Identifizierung, Image, Commitment, Führung, Kooperation und Verhalten). Die Ergebnisse bieten einen Vorschlag der quantitativen Darstellung des Konzeptes Organisationaler Identität eines Universitätsklinikums an, wobei im Wesentlichen eine Stabilität des kontinuierlichen Identitätselements Patientenversorgung, eine wenig erfolgsrelevante Wahrnehmung des neu zu integrierenden Elements Forschung und die Formation einer Hybrid-Identität, sowohl durch den Einfluss der unterschiedlichen Standorte, wie auch der Professionalen Identitäten zu beobachten ist. Diese Arbeit könnte eine Anregung für weiterführende quantitative und künftige Arbeiten des Forschungsbereichs Organisationale Identität sein.During the last three decades the domain „organizational identity“ has reached a distinct research area within organizational sciences. The scientific concept is comprised of the three pillars „centrality, continuity and diversity“ and measured for this case by the identity elements organizational identity strength, economic identity type, patient care, research, teaching and confidence by means of a longitudinal study with a quantitative survey instrument within the context of a merger from three hospitals to one university hospital. The first measuring time point (T1) offers the perception of the organization members before the merger, the other two measurements (T2, T3) are carried out past fusion and show the developlment of the identity elements in detail over time. The validation of the measurement instrument is shown by construct and criterion-related validity through simultane measurement of adjacent constructs (identification, image, commitment, leadership, cooperation and behaviour). The results offer a suggestion of a quantitative description of the scientific concept organizational identity of an university hospital, where essentially it should be mentioned a stability of the continuous identity element patient care, the new identity type research, which is perceived as little relevant to success of the organization and an observed formation of a hybrid-identity, justified by the different parts and fusion partner and also the professional identities of the organization. This study could be an inspiration for further quantitative and general work on the research field of organizational identity.eingereicht von Herber Gabriele, M.Sc.Abweichender Titel laut Übersetzung der Verfasserin/des VerfassersUniversität Linz, Dissertation, 2019OeBB(VLID)366368

Lactancia materna del prematuro en un hospital amigo del niño

O objetivo foi descrever as experiências maternas relacionadas ao aleitamento materno de prematuros em uma unidade neonatal de um Hospital Amigo da Criança. Trata-se de um estudo qualitativo exploratório-descritivo, realizado em 2015. Participaram da pesquisa seis mães de prematuros hospitalizados em um Hospital Amigo da Criança. A coleta das informações foi realizada por meio de entrevista semiestruturada. Empregou-se a análise de conteúdo do tipo temática. Emergiram três categorias temáticas: Dificuldades enfrentadas durante o processo de aleitamento materno; Rotina de ordenha no banco de leite humano e Sentimentos relacionados ao aleitamento materno do filho prematuro. Conclui-se que, neste cenário, as mães vivenciaram dificuldades, tais como as condições clínicas do bebê e sentimentos de estresse e ansiedade. No entanto, sentiram satisfação em poder amamentar seus filhos prematuros e auxiliar na recuperação. Ainda foi possível identificar a importância da atuação da equipe de saúde nesse processo.The objective was to describe maternal experiences related to breastfeeding of premature infants in a neonatal unit of a baby-friendly hospital. This is a qualitative exploratory-descriptive study conducted in 2015. Six mothers of premature infants hospitalized in a baby-friendly hospital participated in the research. Information was collected through semi-structured interviews. Thematic content analysis was used. Three thematic categories emerged: Difficulties faced during the breastfeeding process; Human milk bank milking routine and Feelings related to breastfeeding of a premature child. It is concluded that, in this scenario, mothers experienced difficulties, such as the baby's clinical conditions and feelings of stress and anxiety. However, they were pleased to be able to breastfeed their premature children and assist in recovery. It was also possible to identify the importance of health team performance in this process.El objetivo fue describir las experiencias maternas relacionadas con la lactancia materna de bebés prematuros en una unidad neonatal de un Hospital Amigo del Niño. Este es un estudio cualitativo exploratorio descriptivo realizado en 2015. Seis madres de bebés prematuros hospitalizados en un Hospital Amigo del Niño participaron en la investigación. La información se recopiló a través de entrevistas semiestructuradas. Se utilizó el análisis de contenido temático. Surgieron tres categorías temáticas: dificultades enfrentadas durante el proceso de lactancia materna; Rutina de ordeño del banco de leche humana y sentimientos relacionados con la lactancia materna en niños prematuros. Se concluye que, en este escenario, las madres experimentaron dificultades, como las condiciones clínicas del bebé y los sentimientos de estrés y ansiedad. Sin embargo, estaban contentas de poder amamantar a sus hijos prematuros y ayudarlos en la recuperación. También fue posible identificar la importancia del desempeño del equipo de salud en este proceso

Current Challenges in the Post-Transplant Care of Liver Transplant Recipients in Germany

Improving long-term patient and graft survival after liver transplantation (LT) remains a major challenge. Compared to the early phase after LT, long-term morbidity and mortality of the recipients not only depends on complications immediately related to the graft function, infections, or rejection, but also on medical factors such as de novo malignancies, metabolic disorders (e.g., new-onset diabetes, osteoporosis), psychiatric conditions (e.g., anxiety, depression), renal failure, and cardiovascular diseases. While a comprehensive post-transplant care at the LT center and the connected regional networks may improve outcome, there is currently no generally accepted standard to the post-transplant management of LT recipients in Germany. We therefore described the structure and standards of post-LT care by conducting a survey at 12 German LT centers including transplant hepatologists and surgeons. Aftercare structures and form of cost reimbursement considerably varied between LT centers across Germany. Further discussions and studies are required to define optimal structure and content of post-LT care systems, aiming at improving the long-term outcomes of LT recipients