| 21. |
- Casar Borota, Olivera, et al.
(författare)
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Corticotroph Aggressive Pituitary Tumors and Carcinomas Frequently Harbor ATRX Mutations
- 2021
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Ingår i: Journal of Clinical Endocrinology & Metabolism. - : The Endocrine Society. - 0021-972X .- 1945-7197. ; 106:4, s. 1183-1194
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Tidskriftsartikel (refereegranskat)abstract
- Context: Aggressive pituitary tumors (APTs) are characterized by unusually rapid growth and lack of response to standard treatment. About 1% to 2% develop metastases being classified as pituitary carcinomas (PCs). For unknown reasons, the corticotroph tumors are overrepresented among APTs and PCs. Mutations in the alpha thalassemia/mental retardation syndrome X-linked (ATRX) gene, regulating chromatin remodeling and telomere maintenance, have been implicated in the development of several cancer types, including neuroendocrine tumors. Objective: To study ATRX protein expression and mutational status of the ATRX gene in APTs and PCs. Design: We investigated ATRX protein expression by using immunohistochemistry in 30 APTs and 18 PCs, mostly of Pit-1 and T-Pit cell lineage. In tumors lacking ATRX immunolabeling, mutational status of the ATRX gene was explored. Results: Nine of the 48 tumors (19%) demonstrated lack of ATRX immunolabelling with a higher proportion in patients with PCs (5/18; 28%) than in those with APTs (4/30;13%). Lack of ATRX was most common in the corticotroph tumors, 7/22 (32%), versus tumors of the Pit-1 lineage, 2/24 (8%). Loss-of-function ATRX mutations were found in all 9 ATRX immunonegative cases: nonsense mutations (n = 4), frameshift deletions (n = 4), and large deletions affecting 22-28 of the 36 exons (n = 3). More than 1 ATRX gene defect was identified in 2 PCs. Conclusion: ATRX mutations occur in a subset of APTs and are more common in corticotroph tumors. The findings provide a rationale for performing ATRX immunohistochemistry to identify patients at risk of developing aggressive and potentially metastatic pituitary tumors.
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| 22. |
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| 23. |
- Ekman, Inger, 1952, et al.
(författare)
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Feasibility of a nurse-monitored, outpatient-care programme for elderly patients with moderate-to-severe, chronic heart failure
- 1998
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Ingår i: European Heart Journal. - London, United Kingdom : W. B. Saunders Co. Ltd.. - 0195-668X .- 1522-9645. ; 19:8, s. 1254-60
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To evaluate the feasibility of a nurse-monitored, outpatient-care program for elderly patients previously hospitalized with chronic heart failure.Methods and results: Patients with chronic heart failure hospitalized in the medical wards were screened to find those eligible for a randomized study to compare the effect of a nurse-monitored, outpatient-care programme aiming at symptom management, with conventional care. The inclusion criteria were patients classified in New York Heart Association classes III-IV, age 65 years, and eligibility for an outpatient follow-up programme. The total in-hospital population of patients discharged with a heart-failure diagnosis was surveyed. Eighty-nine per cent of all the hospitalized patients (n=1541) were 65 years old. Of these, 69% (n=1058) were treated in the medical wards which were screened. The study criteria were met by 158 patients (15%). No visits to the nurse occurred in 23 cases among the 79 patients randomized to the structured-care group (29%), mainly on account of death or fatigue. The numbers of hospitalizations and hospital days did not differ between the structured-care and the usual-care groups.Conclusions: Given the selection criteria and the outline of the interventions, the outpatient, nurse-monitored, symptom-management programme was not feasible for the majority of these elderly patients with moderate-to-severe, chronic heart failure, mainly because of the small proportion of eligible patients and the high drop-out rate. Management of these patients would have to be more adjusted to their home situation.
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| 24. |
- Ekman, Inger, 1952, et al.
(författare)
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Standard medication information is not enough : poor concordance of patient and nurse perceptions
- 2007
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Ingår i: Journal of Advanced Nursing. - : Wiley-Blackwell. - 0309-2402 .- 1365-2648. ; 60:2, s. 181-186
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Tidskriftsartikel (refereegranskat)abstract
- AIM:This paper is a report of a study to describe patient and nurse perceptions of patient satisfaction with information about the medicines at two heart failure clinics after medication up-titration and information-giving.BACKGROUND:Chronic heart failure is a major cause of hospitalization. Poor adherence to medications increases mortality and heart failure-related hospitalizations. To achieve mutual goal-setting (concordance) regarding medication-taking behaviours, health providers need to understand patient information needs regarding the prescribed medicines.METHODS:A convenience sample of 56 patients with chronic heart failure referred for an up-titration of medicines and information-giving about the condition and treatment completed the Satisfaction about Information about Medicines Scale at their first and last visits. Nurses completed the same questionnaire after each patient's final visit, assessing the patient's need for further information. The data were collected between 2002 and 2004.RESULTS:Patient scores indicated statistically significantly more satisfaction with their information at the final visit compared with the first visit (P = 0.005). However, at the programme conclusion, nurses (n = 7) rated patients to be appropriately informed while patients reported a persistent need for further information (P = 0.011).CONCLUSION:Further research should evaluate more advanced pedagogical strategies such as how to address patients' expectations about the effect of medicines when actual effects of the treatment are related to mortality and morbidity at the population level and may not result directly in symptom relief at an individual level.
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| 25. |
- Ekman, Inger, 1952, et al.
(författare)
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Unmet expectations of medications and care providers among patients with heart failure assessed to be poorly adherent: results from the Chronic Heart Failure Intervention to Improve MEdication Adherence (CHIME) study.
- 2017
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Ingår i: European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology. - : Oxford University Press (OUP). - 1873-1953. ; 16:7, s. 646-654
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Tidskriftsartikel (refereegranskat)abstract
- Ineffective medication management contributes to repeated hospitalisation and death among patients with heart failure. The meaning ascribed to medications and the influence of meaning on how patients manage medications is unknown. The purpose of this study was to explore the meaning and expectations associated with medication use in high-risk, non-adherent patients with heart failure.Patients ( n=265) with heart failure were screened for adherence to prescribed medication using the Morisky medication adherence scale (MMAS). Patients (MMAS score <6; n=44) participated in semistructured interviews, analysed using qualitative content analysis. Of 17 initial themes (223 representative segments), the overarching theme 'unmet expectations' consisted of two subthemes 'working to be heard' by professionals and 'resignation' to both the illness and medications. Patients' expectations were challenged by unexpected work to communicate with providers in general (72 representative segments), and specifically regarding medications (118 representative segments) and feelings of resignation regarding the medication regimen (33 representative segments).These findings suggest that unmet expectations contribute to poor medication management. Improved listening and communication by providers, to establish a common understanding and plan for managing medications may strengthen patient beliefs, resolve feelings of resignation and improve patients' ability to manage medications effectively.
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| 26. |
- Falk, Kristin, 1949, et al.
(författare)
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Breaking the vicious circle of fatigue in patients with chronic heart failure
- 2007
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Ingår i: Qualitative health research. - : SAGE Publications. - 1049-7323 .- 1552-7557. ; 17:8, s. 1020-7
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Tidskriftsartikel (refereegranskat)abstract
- Fatigue is a common symptom in patients with chronic heart failure (CHF). Characteristics of the experience and consequences of fatigue might be unique in these patients. The authors interviewed 15 patients with CHF and analyzed focused online observations of the content discussed in an Internet patient discussion group concerning CHF using grounded theory. The results suggest that fatigue is a circular process in which the consequences of fatigue further exaggerate the experience. However, fatigue could be alleviated by restorative activities. The bodily experience of fatigue was defined as lacking strength and energy and feeling sleepy. Patients reported the mental aspects of fatigue as demoralizing and that they frequently experienced intellectual deficiency. Fatigue leads to sacrificing, which was manifested as refraining, denying oneself, and being isolated. The restoring activities included the categories involuntarily attentive, socially interactive, and mentally absorbed. Interventions aimed to relieve fatigue should focus on restorative activities.
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| 27. |
- Flam, B, et al.
(författare)
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Authors' Response
- 2015
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Ingår i: Journal of intensive care medicine. - : SAGE Publications. - 1525-1489 .- 0885-0666. ; 52:1, s. 493-4
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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