Long-term prognosis of early-onset breast cancer in a population-based cohort with a known BRCA1/2 mutation status.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files. This article is open access.All women in the South Sweden Health Care Region with breast cancer diagnosed aged less than 41 during the period between 1990 and 1995 were contacted in 1996 and offered germline mutation analysis of the BRCA1 and BRCA2 genes. Mutation carriers (n = 20) were compared with noncarriers (n = 201) for overall survival (OS) and risk of contralateral breast cancer (CBC). Mutation carriers were younger at diagnosis and more likely to have ER-negative, PgR-negative and grade III tumors. Median follow-up was 19 years. The 5-, 10-, 15-, and 20-year OS were 60, 45, 39, and 39 % for mutation carriers and 82, 70, 59, and 53 % for noncarriers, respectively (5-year log-rank P = 0.013; 10-year P = 0.008; 15-year P = 0.020; and 20-year P = 0.046). In univariable analysis, there was a trend for an inferior OS for mutation carriers (HR 1.8; 95 % CI 1.0-3.3). When stratified for use of (neo)adjuvant chemotherapy, an inferior OS was significant only for the subgroup of patients who did not receive chemotherapy (HR 3.0; 95 % CI 1.2-7.7). In multivarible analysis, BRCA1/2 mutation status was a significant predictor of OS when adjusting for tumor stage, age, and use of chemotherapy, but not when ER status was also included in the model. The 15-year cumulative risk of CBC was 53 % for mutation carriers and 10 % for noncarriers (HR 5.9; 95 % CI 1.9-18.6); among the noncarriers the risks were 5, 22, and 30 % for patients without close relatives having breast cancer, with second-degree relatives having breast cancer, and with firstdegree relatives with breast cancer, respectively. In conclusion, the poor prognosis of young BRCA1/2 mutation carriers with breast cancer is mainly explained by the prevalent occurrence of negative prognostic factors rather than mutation status per se, and can to at least some extent be abrogated by the use of chemotherapy.Skane County Counsil's Research and Development Foundation The Swedish Breast Cancer Association (BRO) BioCAR

Linköping University Post Print

Empowerment from the perspective of next of kin in intensive car

Empowerment from the perspective of next of kin in intensive care

Aims and objectives. The aim of the study was to describe next of kin empowerment in an intensive care situation. Background. Next of kin is important in reducing intensive care patients’ fear and anxiety. However, admission to an intensive care unit is often recognised as an extremely stressful event, causing next of kin to experience shock, fear, anxiety and vulnerability. More knowledge is needed about how next of kin in intensive care can be strengthen and empowered. Design and methodology. The study was conducted using a phenomenological method and is based on ten interviews with intensive care patients’ next of kin. Findings. Perceptions of both a genuine will and a capacity to help and relieve were found to be essential for next of kin’s experiences of empowerment in an intensive care situation. All informants were strengthened and empowered by a caring atmosphere in which they received continuous, straightforward and honest information that left room for hope, and in which closeness to the patient was facilitated and medical care was experienced as the best possible. Some of the informants were also strengthened by support from other family members and/or by being involved in caring for the patient. Conclusions. The findings emphasise the essential entirety of what is done and how these acts are performed. A warm and positive atmosphere in which next of kin always feel welcome, are met with empathy in an unaffected way, are confirmed and receive support or advice when needed, are crucial to next of kin’s experiences of empowerment. Relevance to clinical practice. Knowledge of how to empower next of kin in an intensive care situation allows caring staff to support these persons in a more sensitive and appropriate way. Findings underline the importance of creating caring relations.This is the authors’ version of the following article:Ingrid Wåhlin, Anna-Christina Ek and Ewa Idvall, Empowerment from the perspective of next of kin in intensive care, 2009, Journal of Clinical Nursing, (18), 18, 2580-2587.which has been published in final form at: http://dx.doi.org/10.1111/j.1365-2702.2008.02744.xCopyright: Blackwell Publishing Ltdhttp://www.blackwellpublishing.com

Empowerment in intensive care : patient experiences compared to next of kin and staff beliefs

Experiences of critically ill patients are an important aspect of the quality of care in intensive care units. If next of kin and staff try to empower the patient, this is probably performed in accordance with their beliefs about what patients experience as empowering. As intensive care patients often have difficulties communicating, staff and next of kin need to interpret their wishes, but there is limited knowledge about how correct picture next of kin and staff have of the intensive care patient’s experiences. The aim of this study was to compare intensive care patients’ experiences of empowerment with next of kin and staff beliefs. Interviews with 11 intensive care patients, 12 next of kin and 12 staff were conducted and analysed using a content analysis method. The findings showed that the main content is quite similar between patient experiences, next of kin beliefs and staff beliefs, but a number of important differences were identified. Some of these differences were regarding how joy of life and the will to fight were generated, the character of relationships, teamwork, humour, hope and spiritual experiences. Staff and next of kin seemed to regard the patient as more unconscious than the patient him/herself did

Empowerment from the perspective of next of kin in intensive care

Aims and objectives. The aim of the study was to describe next of kin empowerment in an intensive care situation. Background. Next of kin is important in reducing intensive care patients’ fear and anxiety. However, admission to an intensive care unit is often recognised as an extremely stressful event, causing next of kin to experience shock, fear, anxiety and vulnerability. More knowledge is needed about how next of kin in intensive care can be strengthen and empowered. Design and methodology. The study was conducted using a phenomenological method and is based on ten interviews with intensive care patients’ next of kin. Findings. Perceptions of both a genuine will and a capacity to help and relieve were found to be essential for next of kin’s experiences of empowerment in an intensive care situation. All informants were strengthened and empowered by a caring atmosphere in which they received continuous, straightforward and honest information that left room for hope, and in which closeness to the patient was facilitated and medical care was experienced as the best possible. Some of the informants were also strengthened by support from other family members and/or by being involved in caring for the patient. Conclusions. The findings emphasise the essential entirety of what is done and how these acts are performed. A warm and positive atmosphere in which next of kin always feel welcome, are met with empathy in an unaffected way, are confirmed and receive support or advice when needed, are crucial to next of kin’s experiences of empowerment. Relevance to clinical practice. Knowledge of how to empower next of kin in an intensive care situation allows caring staff to support these persons in a more sensitive and appropriate way. Findings underline the importance of creating caring relations.This is the authors’ version of the following article:Ingrid Wåhlin, Anna-Christina Ek and Ewa Idvall, Empowerment from the perspective of next of kin in intensive care, 2009, Journal of Clinical Nursing, (18), 18, 2580-2587.which has been published in final form at: http://dx.doi.org/10.1111/j.1365-2702.2008.02744.xCopyright: Blackwell Publishing Ltdhttp://www.blackwellpublishing.com

Staff empowerment in intensive care : Nurses' and physicians' lived experiences

AIM: The purpose of the study was to describe empowerment from the perspective of intensive care staff. What makes intensive care staff experience inner strength and power? BACKGROUND: Intensive care staff are repeatedly exposed to traumatic situations and demanding events, which could result in stress and burnout symptoms. A higher level of psychological empowerment at the workplace is associated with increased work satisfaction and mental health, fewer burnout symptoms and a decreased number of sick leave days. METHOD: Open-ended interviews were conducted with 12 intensive care unit (ICU) staff (four registered nurses, four enrolled nurses and four physicians) in southern Sweden. Data were analysed using a phenomenological method. FINDINGS: Intensive care staff were found to be empowered both by internal processes such as feelings of doing good, increased self-esteem/self-confidence and increased knowledge and skills, and by external processes such as nourishing meetings, well functioning teamwork and a good atmosphere. CONCLUSION: Findings show that not only personal knowledge and skills, but also a supporting atmosphere and a good teamwork, has to be focused and encouraged by supervisors in order to increase staff's experiences of empowerment. Staff also need a chance to feel that they do something good for patients, next of kin and other staff members

Ethical dilemmas before and during anaesthetic induction of young children, as described by nurse anaesthetists

Research on physicians', nurses' and enrolled nurses' experiences of ethical dilemmas have been conducted in many healthcare fields. The aim of this study was to elucidate ethical dilemmas before and during the induction of anaesthesia of children aged three to six years as described by nurse anaesthetists (NAs). Two group interviews with NAs were conducted where they were asked to describe ethically problematic situations. Three situations were chosen from a total of 15: administration of anaesthesia to an already sleeping child, lack of information given to a child, and a child is anaesthetized against his/her will. Conceivable and reasonable alternative options were identified and consequences of the different actions were presented. Finally the conflicts of value were discussed and commented on. The cases describe when a child's rights are given less weight and the child has little opportunity to participate in the decision making. However, parents and NAs acted in the best interest of the child. Analysing and reflecting on situations involving ethical dilemmas would enhance NAs critical thinking and guide NAs in their decision making when providing anaesthesia care