Role of Donor Activating KIR–HLA Ligand–Mediated NK Cell Education Status in Control of Malignancy in Hematopoietic Cell Transplant Recipients

AbstractSome cancers treated with allogeneic hematopoietic stem cell transplantation (HSCT) are sensitive to natural killer cell (NK) reactivity. NK function depends on activating and inhibitory receptors and is modified by NK education/licensing effect and mediated by coexpression of inhibitory killer-cell immunoglobulin-like receptor (KIR) and its corresponding HLA I ligand. We assessed activating KIR (aKIR)-based HLA I–dependent education capacity in donor NKs in 285 patients with hematological malignancies after HSCT from unrelated donors. We found significantly adverse progression-free survival (PFS) and time to progression (TTP) in patients who received transplant from donors with NKs educated by C1:KIR2DS2/3, C2:KIR2DS1, or Bw4:KIR3DS1 pairs (for PFS: hazard ratio [HR], 1.70; P = .0020, Pcorr = .0039; HR, 1.54; P = .020, Pcorr = .039; HR, 1.51; P = .020, Pcorr = .040; and for TTP: HR, 1.82; P = .049, Pcorr = .096; HR, 1.72; P = .096, Pcorr = .18; and HR, 1.65; P = .11, Pcorr = .20, respectively). Reduced PFS and TTP were significantly dependent on the number of aKIR-based education systems in donors (HR, 1.36; P = .00031, Pcorr = .00062; and HR, 1.43; P = .019, Pcorr = .038). Furthermore, the PFS and TTP were strongly adverse in patients with missing HLA ligand cognate with educating aKIR-HLA pair in donor (HR, 3.25; P = .00022, Pcorr = .00045; and HR, 3.82; P = .027, Pcorr = .054). Together, these data suggest important qualitative and quantitative role of donor NK education via aKIR-cognate HLA ligand pairs in the outcome of HSCT. Avoiding the selection of transplant donors with high numbers of aKIR-HLA-based education systems, especially for recipients with missing cognate ligand, is advisable

Doświadczenia położnych w prowadzeniu porodów u kobiet z prenatalną diagnozą zagrażającą życiu płodu (Midwives' experience of delivering women with Life-Threatening Fetal Diagnosis)

Introduction: Taking care of a woman in the delivery room who is giving birth to a baby affected by a life-limiting foetal condition is a difficult experience for a midwife. Material and methods: In a qualitative study, semi-structured interviews were conducted with 10 midwives who are actively working in delivery rooms at four hospitals in various regions of Poland. The interviews were recorded, and then transcribed and analysed using the content analysis method with the MAXQDA tool. Results: From the experiences of midwives who deliver babies for women after an unfavourable prenatal diagnosis for the baby, two main themes and four sub-themes were identified. Within the first theme, “Impact in the scope of personal experience”, identified sub-themes included “Difficult but positive experiences” and “Confronting one's own emotions”. Within the second theme, “Impact in the scope of interaction with others”, identified sub-themes included “Empathising with the woman” and “Community with other midwives”. Conclusions: Taking care of a woman giving birth to a baby affected by a life-limiting fetal condition is for midwives an experience that is difficult, but ultimately positive and enriching for their personal and professional identity. Midwives need to be prepared through education to effectively deal with the problems which appear in their everyday practice. Psychological support for midwives is insufficient; an opportunity to participate in training courses would enable them to develop their skills related to handling difficult situations, coping with stress, and above all the ability to talk to mothers and fathers of the babies in those situations that are so difficult for the parents.Background: Opieka nad rodzącą na sali porodowej, która rodzi dziecko po diagnozie o letalnym rokowaniu jest trudnym doświadczeniem dla położnej. Metoda: W tym badaniu jakościowym przeprowadzono wywiady półstrukturalne z 10 położnymi aktywnie pracującymi na sali porodowej w czterech szpitalach w różnych regionach Polski. Wywiady zostały nagrane a następnie spisane i przeanalizowane przy użyciu metody analizy treści za pomocą narzędzia MAXQDA. Wyniki: Z doświadczeń położnych, które prowadzą porody u kobiet po niepomyślnej diagnozie prenatalnej dla dziecka, wyodrębniono dwa tematy i cztery podtematy. W pierwszym temacie „Oddziaływanie w obszarze osobistego doświadczenia” wyróżniono podtematy: „doświadczenia trudne ale pozytywne” oraz „konfrontacja z własnymi emocjami”. W drugim temacie „Oddziaływanie w obszarze interakcji z innymi” wyłoniono podtematy: „współodczuwanie” z rodzącą, oraz „community” z innymi położnymi. Wnioski: Opieka nad kobietą rodzącą letalnie chore dziecko jest dla położnych doświadczeniem trudnym, to finalnie, pozytywnym i ubogacającym ich tożsamość osobistą i zawodową. Konieczne jest edukacyjne przygotowanie położnych do skutecznego radzenia sobie z problemami, które pojawiają się w ich codziennej praktyce. Wsparcie psychologiczne dla położnych jest niewystarczające, możliwość uczestnictwa w kursach dokształcających, pozwoliłoby rozwinąć umiejętności radzenia sobie w sytuacjach trudnych, radzenia sobie ze stresem, ale przede wszystkim umiejętności przeprowadzania rozmów z kobietami oraz ojcami dziecka w tak trudnej dla rodziców sytuacji

Parental experiences of prenatal education when preparing for labor and birth of infant with a lethal diagnosis

Abstract Aim The aim of this study was to describe the unique experiences of parents facing a Life Limiting Fetal Conditions (LLFC) diagnosis, who chose to continue with their pregnancy, as they prepare for childbirth through individual and group prenatal education. Design A qualitative study. Methods We employed the phenomenological approach and the Colaizzi strategy to analyse semi‐structured interviews. Thirteen persons were interviewed. The participants were couples (n = 6) and women (n = 7) who received LLFC and were preparing for birth. Results We described three main paths of prenatal education chosen by parents with LLFC: 'Searching for normality' concerned people participating in conventional prenatal classes (AC) who tried to avoid confronting the situation they faced; ‘Searching for communitas’ concerned the participation in special AC selected for the opportunity of sharing experiences; ‘Searching for an individual way’ concerned people who resorted to individual preparation for childbirth, often as a result of delayed planning. Parents should have a choice of various paths of birth preparation, that best meet their preferences

'Ten poród jest trudny, ale piękny' - doświadczenia rodziców związane z urodzeniem dziecka z diagnozą o śmiertelnym rokowaniu

Introduction: The experience of childbirth, during which parents welcome and say goodbye to their child at the same time, is an unimaginably difficult/traumatic experience. This study aims to explore parents' experiences following the birth of a terminally ill baby. Material and methods: Semi-structured, in-depth interviews were conducted in this qualitative study. The interviews were developed using content analysis, by coding and constructing themes in iterative, collaborative meetings, using the MAXQDA tool. Thirteen parents took part in the study: nine women following a prenatal diagnosis with a lethal prognosis for their child and four fathers of those children. Results: Content analysis revealed two main themes and two sub-themes. The first theme is “Embracing bad news during pregnancy” and the second theme is “This birth is difficult but beautiful”, within which the following sub-themes were identified: “Joy of meeting the baby” and “Saying goodbye to your child is important”. Conclusions: For parents who were preparing for childbirth after prenatal diagnosis with a lethal prognosis for their child, the experience of childbirth had positive implications. Meeting their newborn child was an important moment for them, an affirmation of their parenthood. Parents emphasised that the time to say goodbye to their child was a celebration of their brief parenthood.Background: Doświadczenie porodu podczas którego rodzice witają i jednocześnie żegnają swoje dziecko, jest niewyobrażalnie trudnym/traumatycznym doświadczeniem. Zbadanie doświadczeń rodziców, wynikających z narodzin letalnie chorego dziecka. Metoda: W tym badaniu jakościowym przeprowadzono półstrukturalne wywiady pogłębione. Wywiady zostały opracowane przy użyciu analizy treści, poprzez kodowanie i konstruowanie tematów w trakcie iteracyjnych, zespołowych spotkań, za pomocą narzędzia MAXQDA. W badaniu wiło udział 13 rodziców, dziewięć kobiet po prenatalnej diagnozie o letalnym rokowaniu dla dziecka i czterech ojców dziecka. Wyniki: Analiza treści ujawniła dwa główne tematy i dwa podtematy. Pierwszy temat: „Oswojenie trudnych informacji w okresie ciąży”, w ramach drugiego tematu: „ Ten poród jest trudny ale piękny”, wyodrębniono podtematy: „radość ze spotkania z dzieckiem” i podtemat: „ czas pożegnania jest ważny”. Wnioski: Dla rodziców, którzy przygotowywali się do porodu po prenatalnej diagnozie o letalnym rokowaniu dla dziecka, doświadczenie porodu miało pozytywne implikacje. Spotkanie z nowonarodzonym dzieckiem było dla nich ważnym momentem, potwierdzeniem ich rodzicielstwa. Rodzice podkreślali, że czas pożegnania z dzieckiem był celebrowaniem ich krótkiego rodzicielstwa

‘Do we need doulas…?’ – Perspectives of maternity care managers on the role of doulas in Poland

Abstract Aim The purpose of this study was to analyse perinatal care managers' perspectives on the role of doulas in Poland and to consider how managers' perspectives might affect the opportunities for doulas to practice in individual hospitals. Design This is a qualitative descriptive study. Method The total of 17 hospitals was selected for the study. Semi‐structured interviews were conducted with 11 manager staff members. Results Three groups of facilities were identified: ‘0’ (n = 6) – refused to give interviews, ‘A’ (n = 8) – marginal experience in working with doulas, and ‘B’ (n = 3) – regular experience in working with doulas. The hospitals from Group A showed indifference towards working with doulas. Group B declared a positive attitude towards such cooperation. Attitudes towards doulas vary among executives and are related to the frequency of doula‐assisted births. Our results indicate factors that may influence the attitude of medical staff towards doulas and which may contribute to improve future initiatives meant to facilitate collaboration between midwives and doulas. Patient or Public Contribution This study explored the lived experiences of perinatal care managers

Dostępność i wyzwania perinatalnej opieki paliatywnej w Polsce

Introduction: This article examines the legal status and level of accessibility to perinatal palliative care (PPC) in Poland, with a focus on the number of services provided and the number of parents receiving PPC services. Material and methods: The desk research was based on information obtained from the National Health Fund regarding the number of units that signed a contract for the provision of guaranteed PPC services from 2018 to the first half (January–June) of 2022; the number of parents receiving the service from 2018 to 2022; and the number of services provided by a doctor, a psychologist and by primary care midwives (PCMs). In addition, the Map of Health Needs and National Transformation Plan data were used to prepare the data. Results: In Poland, since 2018, PPC services have been provided with public funds under contracts signed with the National Health Fund. Since 2022, these type of services has been provided by 17 centres. Care was provided to 1,860 pregnant women diagnosed with lethal foetal anomaly and to four fathers. There are still voivodeships in which there is a lack of provision of PPC services that are financed from the state budget. Conclusions: In Poland, there is no full accessibility to publicly funded PPC in every voivodeship. The lack of a sufficient number of PPC centres and the lack of a uniform national standard of practice for this type of care — provided in hospices, hospitals and home settings — prevents women from having continuity of professional perinatal care. There is a need to ensure the quality of the services provided and make progress towards the employment of midwives in PPC facilities by service providers to ensure that women receive obstetric care from the moment of an adverse diagnosis, professional preparation for childbirth and the postnatal period.Introduction: This article examines the legal status and level of accessibility to perinatal palliative care (PPC) in Poland, with a focus on the number of services provided and the number of parents receiving PPC services. Material and methods: The desk research was based on information obtained from the National Health Fund regarding the number of units that signed a contract for the provision of guaranteed PPC services from 2018 to the first half (January–June) of 2022; the number of parents receiving the service from 2018 to 2022; and the number of services provided by a doctor, a psychologist and by primary care midwives (PCMs). In addition, the Map of Health Needs and National Transformation Plan data were used to prepare the data. Results: In Poland, since 2018, PPC services have been provided with public funds under contracts signed with the National Health Fund. Since 2022, these type of services has been provided by 17 centres. Care was provided to 1,860 pregnant women diagnosed with lethal foetal anomaly and to four fathers. There are still voivodeships in which there is a lack of provision of PPC services that are financed from the state budget. Conclusions: In Poland, there is no full accessibility to publicly funded PPC in every voivodeship. The lack of a sufficient number of PPC centres and the lack of a uniform national standard of practice for this type of care — provided in hospices, hospitals and home settings — prevents women from having continuity of professional perinatal care. There is a need to ensure the quality of the services provided and make progress towards the employment of midwives in PPC facilities by service providers to ensure that women receive obstetric care from the moment of an adverse diagnosis, professional preparation for childbirth and the postnatal period