Endurhæfing lungnasjúklinga - flókin og margþætt

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkin

The essential structure of patients’ experience of rehabilitation with emphasis on their self reported needs in the context of rehabilitation : a phenomenological study

Verkefnið er opið nemendum og starfsfólki Háskólans á AkureyriReflection on patients’ needs is a necessary part of the assessment of quality of services. An interpretive phenomenological study aimed to add to the existing knowledge base about the phenomenon patients’ needs in rehabilitation, the patients’ side was explored, which is, unfortunately, a rare perspective in rehabilitation literature. The sample was purposively selected and consisted of twelve individuals aged 26-85 years -seven men, five women - who had experienced rehabilitation therapy at one of three main rehabilitation clinics in Iceland. The participants were seen as co-researchers and their medical diagnoses were heart disease, paralysis, arthritis, chronic lung disease, stroke, chronic fatigue, psychological problems and pain. Six co-researchers had been referred to rehabilitation following an acute event and six because of a chronic state. The study was conducted in accordance with The Vancouver School of Doing Phenomenology and each co-researcher was interviewed one to three times. The end result was sixteen in-depth interviews that were analyzed thematically and interpreted. Six main needs were identified in the co-researchers’ accounts. Firstly, the coresearchers needed to be able to cope with the impact of their acute or chronic problems. They felt that their ability to cope was strongly tied to their own personal traits, their earlier experience and preconceptions, knowing the source of their suffering, and to experience a balance between sleep, rest and activity while in rehabilitation. Secondly, they needed to adapt to a new self since their accident or illness usually meant adapting to new characteristics of self. They needed, however, in the middle of these existential changes to be able to sustain a personal role and needed faith, hope and optimism to succeed. Thirdly, they needed individualized caring, where they needed to be ‘I’ and not just ‘the patient’, they needed to be listened to and heard in a caring relationship where 4 their need for privacy, when needed, was respected. Fourthly, they needed emotional support from family, peers and staff. Furthermore, they needed a sense of security in a stable and homelike environment with available assistance, help and presence. Finally, the co-researchers needed a goal -oriented and progressive care, where realistic and achievable goals were established, where patient education enhanced their independency and they were empowered into a new lifestyle. No generalizations will be drawn from the results, as each co-researcher's experience is unique. However, phenomenological studies can affect services by facilitating understanding and reflection on the subject

Chromosome alterations and E-cadherin gene mutations in human lobular breast cancer

We have studied a set of 40 human lobular breast cancers for loss of heterozygosity (LOH) at various chromosome locations and for mutations in the coding region plus flanking intron sequences of the E-cadherin gene. We found a high frequency of LOH (100%, 31/31) at 16q21-q22.1. A significantly higher level of LOH was detected in ductal breast tumours at chromosome arms 1p, 3p, 9p, 11q, 13q and 18q compared to lobular breast tumours. Furthermore, we found a significant association between LOH at 16q containing the E-cadherin locus and lobular histological type. Six different somatic mutations were detected in the E-cadherin gene, of which three were insertions, two deletions and one splice site mutation. Mutations were found in combination with LOH of the wild type E-cadherin locus and loss of or reduced E-cadherin expression detected by immunohistochemistry. The mutations described here have not previously been reported. We compared LOH at different chromosome regions with E-cadherin gene mutations and found a significant association between LOH at 13q and E-cadherin gene mutations. A significant association was also detected between LOH at 13q and LOH at 7q and 11q. Moreover, we found a significant association between LOH at 3p and high S phase, LOH at 9p and low ER and PgR content, LOH at 17p and aneuploidy. We conclude that LOH at 16q is the most frequent chromosome alteration and E-cadherin is a typical tumour suppressor gene in lobular breast cancer.The Icelandic Research Council and the Icelandic Cancer Societ