Bibliografias temáticas / Sen palliativ fas

Literatura científica selecionada sobre o tema "Sen palliativ fas"

Autor: Grafiati

Publicado: 23 de junho de 2021

Última modificação: 1 de fevereiro de 2022

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Artigos de revistas sobre o assunto "Sen palliativ fas":

Hariprasad, Gururao, Roopa Hariprasad, Lalit Kumar, Amit Kaushik e Alagiri Srinivasan. "Proteomics of the ascitic fluid for the differentiation of advanced ovarian cancer." Journal of Clinical Oncology 30, n.º 15_suppl (20 de maio de 2012): e15510-e15510. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.e15510.

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e15510 Background: Ovarian cancers are classified as primary, if it arises in the ovary and secondary or metastatic, if the origin is from other parts of the body. The clinical manifestations of these cancers in the advanced stage are very similar making it difficult to distinguish clinically, hiostopathologically and radiologicaly. The therapeutics and management of the primary and secondary malignancies are completely different. While, the advanced primary malignancies are treated by cytoreduction followed by chemotherapy, the metastatic tumors are treated mainly with palliative chemotherapy. The prognosis is better for primary than secondary ovarian cancer making their diagnosis very crucial for patient care. Methods: 1D and 2D-gel based proteomic approaches were used to study the differentially expressed proteins in the ascitic fluid of patients (10 primary and 4 secondary) with advanced ovarian cancer. The relative ratios of the protein expression were estimated by densitometric analysis. The bands/spots with more than three fold difference were subjected to in-gel trypsin digestion and identified by mass spectrometric analysis. The differential expression of one of the proteins was further validated by western blot experiments and ELISA. Results: Programmed Cell Death 1-Ligand 2 and apolipoprotein A1 were seen to be up regulated in the advanced primary ovarian cancer while apolipoprotein A4, and chain L, humanized version of the anti-human fas antibody Hfe7a were seen to be up regulated in the metastatic variant. Validation for the expression of apolipoprotein A1 shows that a 61.8ng/ml cut off is ideal to differentiate the primary and secondary advanced ovarian cancers. The assay has 100% sensitivity, 75% specificity, positive predictive value of 90.9%, negative predictive value of 100%, accuracy of 92.85% and a pre-test odds positive of 2.5. Conclusions: Proteomics of ascitic fluid is useful for the differentiation of advanced ovarian cancers. There are proteins which are differentially expressed in the ascitic fluid of patients with primary and secondary ovarian cancer. Apolipoprotein A1 is a potential biomarker that can be used to differentiate the closely mimicking clinical scenarios of advanced ovarian cancer.

Heery, Christopher Ryan, Ravi A. Madan, Marijo Bilusic, Joseph W. Kim, Nishith K. Singh, Myrna Rauckhorst, Clara Chen et al. "Interim analysis of a phase II randomized clinical trial of samrium-153 (Sm-153) with or without PSA-TRICOM vaccine in metastatic castration-resistant prostate cancer after docetaxel." Journal of Clinical Oncology 30, n.º 15_suppl (20 de maio de 2012): 2526. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.2526.

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2526 Background: A prior randomized, placebo-controlled, multi-center phase 2 trial of PSA-TRICOM (PROSTVAC) demonstrated an overall survival benefit. Sm-153 is a radiopharmaceutical that targets osteoblastic bone lesions. Preclinical data indicated that Sm-153 could alter tumor phenotype, causing upregulation of Fas, MHC Class I, and tumor-associated antigens, making tumor cells more amenable to immune-mediated killing. Methods: This is a phase 2 multi-center trial design intended to randomize 68 patients (pts) to Sm-153 with or without PROSTVAC. Eligibility included castrate resistant prostate cancer bone metastases, no visceral disease, prior docetaxel, ECOG ≤2, and normal organ function. Sm-153 was given at 1mCi/kg IV on day 8 and then every 12 weeks. PROSTVAC was given on days 1, 15, 29, then every 4 weeks. The 1° endpoint is a comparison of progression-free survival at 4 months (mo) utilizing PCCWG, but not PSA criteria. 68 patients will provide 80% power to detect a difference of 15% vs. 40% without progression at 4 mo with a one-tailed alpha = 0.10 assuming Fisher’s exact test comparing these fractions as the primary method of analysis. 2° endpoints are OS, ORR, PSA changes, immunologic, toxicity, and palliation. Reported here is the result of a pre-specified interim analysis, which required ≥20% conditional power to detect 15% vs. 40% without progression at 4 months for the trial to continue. Results: Of 37 enrolled pts, 3 were not evaluable for PFS. PFS and PSA findings are found below. Hematologic toxicities (anemia, thrombocytopenia, neutropenia, or lymphocytopenia) are most common, with grade 3 or 4 thrombocytopenia occurring in 22% and 26% of treatment cycles on Arms A and B, respectively. The conditional power for the comparison of fractions without progression at 4 mo is 77%. Conclusions: This interim analysis suggests the combination of PROSTVAC and Sm-153 is well tolerated with similar toxicity profile to Sm-153 alone. The early indication of improved TTP warrants continued study accrual. [Table: see text]

Santana-Davila, R., M. Ellliott, C. Hook, S. Kaufmann, L. Letendre, R. Pruthi, A. Tefferi, D. Van Dyke, A. Wiktor e M. R. Litzow. "Trisomy 13 in patients with hematological malignancies". Journal of Clinical Oncology 25, n.º 18_suppl (20 de junho de 2007): 7055. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.7055.

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7055 Introduction: Cytogenetic abnormalities have been shown to be the most important determinant of prognosis in patients with acute myeloid leukemia (AML). In AML, trisomy 13 has been placed in the intermediate prognostic category although recent reports associate it with a more dismal outcome. The number of cases reported in the literature are relatively few, we reviewed our experience with trisomy 13 in hematologic malignancies to determine its significance and prognosis. Methods: We conducted a clinicopathological review of cases seen in our institution from January of 1990 to October of 2006. Our cytogenetic records were searched for patients, who had a hematological disorder whose non-stimulated bone marrow karyotype was found to have trisomy 13 as a sole abnormality. In men the absence of the Y chromosome was not regarded as a separate abnormality. Results: A total of 27 patients were identified. The median age was 76 years (range 25–87), 22/27 were male. The number of cases and diseases identified were 15 with AML, 5 with a myelodysplastic syndrome, 4 with an uncategorized myelodysplastic/myeloproliferative disorder, 2 with acute lymphoblastic leukemia and 1 with a chronic myeloproliferative disorder. Of the AML group 7 were M0 according to the FAB classification, 2 patients were identified to have M4 and another two M2. A single case each of M1 and M6 was also identified. In these 15 patients, 9 underwent induction chemotherapy, which consisted of intermediate dose Ara-C in 3 cases, anthracycline plus Ara-C in 5 patients, and daunorubicin, vincristine and prednisone in 1. Another 3 patients were given palliative treatment. For the rest of the subjects the type of treatment was unknown. A CR was obtained in 6 patients, 1 patient underwent a myeloablative stem cell transplant. Death has occurred in 24 patients, the median survival of the entire group was 5.4 months. In the patients with AML the median survival was 4.7 months, of the patients who achieved a CR the median survival was 9.5 months. Conclusions: We describe one of the largest series reported to date of trisomy 13 in hematologic malignancies and found that trisomy 13 is associated with male gender and an older age at presentation, as well as a poor prognosis. In AML its presence is associated with an FAB-M0 phenotype and its occurrence should be regarded as a high-risk feature. No significant financial relationships to disclose.

Golan, Talia, Dikla Atias, Camila Avivi, Iris Barshack e Raanan Berger. "Ascitic derived primary pancreatic cancer cell cultures from different patients as a platform for personalized medicine." Journal of Clinical Oncology 30, n.º 15_suppl (20 de maio de 2012): e14646-e14646. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.e14646.

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e14646 Background: In Pancreatic Cancer (PC) challenges in drug development include: obtaining metastatic cancer tissue for research, developing and validating biomarkers predicative for personalized therapeutic decisions. We have recently developed a novel therapeutic model for PC to address these challenges based on the isolation of viable PC cells derived from ascitic fluid. Methods: Ascitic fluid was obtained from PC patients undergoing palliative paracentesis. In several patients ascites was obtained several times during the course of their disease. Ascitic-derived primary PC cells were isolated, cultured and identified for each patient in vitro. Informed consent was obtained for all patients. Results: We successfully established ascitic-derived primary cell cultures in 87% (53/61) of the ascites obtained. Homogeneous epithelial PC enriched cell cultures were identified; CK 7/8 (epithelial marker) staining by FACS in 90-95% of the cells, IHC strong staining of CK 7 and negative staining for CK 5/6 in the majority of cells in the cultures. We observed a wide range in doubling time and migration properties among the patients' cell cultures. The diverse nature of each individual patient's cell cultures were further demonstrated by varying chemo-sensitivity to gemcitabine and additional therapeutic agents. Morphological changes were observed at different stages of disease, most cells initially displayed a characteristic epithelial morphology. With more advanced disease a mixed morphological appearance "epithelial-mesenchymal" was seen and up regulation of various epithelial-mesenchymal-transition markers were observed by real-time PCR. Conclusions: We have developed a unique primary ascitic-derived PC cell culture model. These cell lines have the potential to serve as a relevant model to study signaling pathways in PC progression, and to assess the sensitivity to therapeutic agents in a short time frame, therefore supporting personalized treatment decisions.

Yassin, Mohamed A., Firyal A. Ibrahim, Hanadi R. El-Ayoubi, Ruba Y. Taha, Ibrahim A. El-Hijji, Riham H. Negmeddine, Halima A. El-Omri et al. "Clinico-Pathological Profile and Outcome of Acute Myeloid Leukemia: An Experience of Al-Amal Hematology/Oncology Center In Qatar". Blood 116, n.º 21 (19 de novembro de 2010): 4384. http://dx.doi.org/10.1182/blood.v116.21.4384.4384.

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Abstract Abstract 4384 AML is a group of neoplastic disorders resulting from clonal expansion of immature hematopoietic cells in the bone marrow, blood and other tissues. AML represents approximately 90% of all acute leukemias in adults. The median age at diagnosis is 65 years. Geographic variations in the incidence and subtype of AML have been reported in different parts of the world. The classification of AML has evolved from the standard morphological FAB classification to the most recent 2008 World Health Organization (WHO) classification that consider the morphological, immunological, cytogenetic, genetic, and clinical features. In this study we report and for the first time from Qatar the clinico-pathological features and the outcome of adult patients diagnosed as AML between January 2006 and January 2010 at Al-Amal Oncology/Hematology Center. Diagnosis was based on combined morphologic, immunophenotypic & cytogenetic studies. Seventy three patients were found to have AML accounting for 73% of all adult acute leukemias diagnosed in our center. Age was between 17 and 100 years with a median age of 40 years. Fifty five patients were males and 18 were females with a male to female ratio of 3:1. Most of the patients were non-Qatari (83.5%). The most common FAB subtype was AML –M2 (27.3%). The second most prevalent is AML-M3 (23.2%). Within this group (17.7%) were of the classical hyper granular type, while (82.3%) showed different morphological variants. Cytogenetic analysis was attempted in 64 cases. Intermediate was the most common cytogenetic risk group (64%). The most common clinical presentations were Bleeding tendency (55 patients), symptomatic anemia (52 patients) and fever (29 patients). Fifty patients were treated in our center in Qatar. Pre-treatment death occurred in 14 patients (8 patients presented with septic shock and 6 with intracranial haemorrhage). Three patients were initially palliative, 33 patients received treatment in forms of 2 inductions with Doxorubicin + Cytosine Arabinoside (DA 3+7) and 3 consolidations with Cytosine Arabinoside, pre-treatment required in 13 patients, 2 of them required leukopharesis and 11 underwent cyto-reduction by hydroxy-carbamide. Complete remission was achieved in 28 patients (85%), and 5 patients were resistant disease. Patients were followed from 60 to 1620 days with average of 429 days and Median of 330 days. As of June 2010, 24 (73%) patients are still alive, and 9 (27%) patients died. Infection was the main cause of death. In conclusion AML in Qatar have a lower median age, and an increase incidence of AML-M3 (Acute Promyelocytic) subtype that exhibit significant morphological heterogenecity (variant APL). Doxorubicin is still in use for induction in our center due to unavailability of other anthracyclines. Despite this, cardiac toxicity was not seen in our cases so far, and our complete remission and disease free survival are comparable to international data. Disclosures: No relevant conflicts of interest to declare.

Sander, Annette, Martin Zimmermann, Dirk Reinhardt, Michael Dworzak, Gertjan Kaspers e Ursula Creutzig. "Improvement of Survival after Relapse in Pediatric AML Over the Last Two Decades Is Related to a Standardized, Consistent and Intensive Relapse Treatment." Blood 112, n.º 11 (16 de novembro de 2008): 963. http://dx.doi.org/10.1182/blood.v112.11.963.963.

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Abstract Long-term survival rates in pediatric AML have been improved by intensification of firstline treatment during the last two decades. However, relapse remains a major obstacle to further improvement of prognosis. The aim of this study was to analyze treatment results in the total group of relapse patients from 1987 to 2007 (n=378) according to the intensity of the first-line treatment in studies AML-BFM -87, -93 and -98 (1987–2003), duration of first remission, modalities of relapse treatment, and achievement of a second remission. Treatment: Intensity of first-line treatment increased mainly from study AML-BFM 87 to the following studies, AML-BFM 93/98. Until 1997, relapse treatment was not yet standardized. From 1997 to september 2001, treatment according to AML-BFM REZ 97 or IDA-FLAG protocols was recommended, and as of october 2001, according to the international protocol Relapsed AML 2001/01. Patients: From a total of 1,251 patients with de novo AML registered in studies AMLBFM -87, -93 and -98, 378 patients relapsed until October 2007. The cumulative incidence of relapse was 30.2% and did not differ significantly between the three studies (31.5% vs. 28.0% vs. 31.5%, respectively). Patient characteristics (age, sex, FAB type, cytogenetics and risk group classifications) during first-line treatment were equally distributed over the three study populations with 26% standard risk (SR) and 74% high-risk (HR) patients. Relapses occurred mainly in the bone marrow (92%), combined or isolated in the CNS (15%) and other extramedullary sites (6%). Results: The 5-year overall survival (OS) for the total group of patients was 23.5% (SE 3%). OS after relapse increased with study periods: initial treatment according to AML-BFM-87 = 18% (SE 4%), AML-BFM-93 = 21% (SE 4%), AML-BFM 98 = 31% (SE 4%), plogrank 0.012. Simultaneously, the proportion of patients who were transplanted in 2nd complete remission rose significantly between the study periods (41% vs. 46% vs. 59%, plogrank =0.004). Duration of 1st remission was a major prognostic factor (³1 year vs. <1 year from diagnosis): 5-year OS 36% (SE 4%) vs.13 % (SE 2%), plogrank <0.0001. From a total of 376 patients with documented relapse treatment, 303 patients received intensive chemotherapy consisting of either elements from upfront protocols or specific relapse therapy elements, 20 had other treatments and 52 no or palliative treatment. No significant difference in survival was observed between the different intensive re-induction schedules. The proportion of patients without or with palliative treatment decreased significantly from study AML-BFM 87 (23%) to studies AML-BFM 93/97 (11%), plogrank =0.004, illustrating a trend to recognize a realistic chance of cure for relapsed AML in children. 199 out of 364 patients with remission data (54.6 %) achieved a second remission (CR2). CR2 was the most relevant prognostic factor for survival (5-year OS: 43%, SE 4% vs. 1%, SE 1% for non-responders). This was also seen for OS after stem cell transplantation (SCT): 5 year OS in CR2 = 45% (SE 4%) vs. 7% (SE 5%) in non-responders. 153 of 199 patients (77%) were transplanted in CR2 (127 allogeneic, 26 autologous). OS was similar regarding both transplant types for this cohort (allogeneic/ incl. haploidentical SCT = 45%, SE 5% vs. autologous SCT = 50%, SE 10% plogrank 0.44) with better 5-year survival rates after SCT in late relapse (OS = 51%, SE 6% vs. 58%, SE 11% plogrank 0.54) than in early relapse (OS = 33%, SE 7% vs. 29%, SE 17%; plogrank 0.85). The percentage of early and late relapse was similar in autologous (27% early relapses vs. 73% late relapses) and in allogeneic transplants (35% vs. 65%, p 0.2). Conclusion: In childhood AML, the implementation of a consistent and standardized relapse treatment substantially improved OS after first relapse over the last two decades. Due to a stringent treatment strategy within relapse protocols including stem cell transplantation and improvement of supportive care, the number of patients receiving no or only palliative treatment has declined continuously. Achievement of a second remission remains the most important prognostic factor regarding survival after AML relapse. Once CR2 is achieved, SCT is recommended. Patients who do not respond to relapse treatment are candidates for new therapeutic options.

Luño, Elisa, Carmen Sanzo, Fermin Jonte, Jose Maria Vicente, Dolores Carrera, Francesc Sole, Pablo Chamorro e Araceli Martinez. "Elderly Patients with De Novo Acute Myeloid Leukemia (AML): Prognostic Factors in 132 Cases." Blood 108, n.º 11 (16 de novembro de 2006): 4454. http://dx.doi.org/10.1182/blood.v108.11.4454.4454.

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Abstract The aim was to determine the predictive value of karyotype in 132 patients ≥65 years in a series of 404 cases with de novo AML. 61 females and 71 males with median age 71 years (65–91). FAB subtype were: 14 (10.6%) M0, 21 M1, 37 M2, 14 (10.6%) M3, 16 M4 (only one M4Eo), 21 M5, 8 M6, 1 M7 (vs 4% M0, 25,7% M3 in <65 years p=0.004). The prognostic value of clinical, pathologic and cytogenetic factors was evaluated by Kaplan-Meier estimate and compared by log-rank, Breslow and Tarone test, for overall survival (OS) and continuous complete remission (CCR). Chi-square analysis for comparisons of remission rates were. The impact of prognostic factors was studied using Cox regression model. p≤0.01, M=median, m=months. Cytogenetic abnormalities were seen in 62.1% of cases including: 32 (24,2%) complex abnormalities, 18 of them with >5 aberrations (vs 7,3% in <65 years p<0.001), twelve (9,1%) t(15;17), 7 trisomy 8, 3 trisomy 21, 3 trisomy 11, 3 del(7q), 2 t(8;21), 2 t(9;22), 2 del(5q), two 3q21q26 rearrangement, one inv h (16), one 11q rearrangement, one monosomy 7 and 8 with other abnormalities. One normal karyotype had FLT3 and NPM1 mutations. Karyotype was classified by SWOG and MRC classification. 21.2% showed trilineage myelodysplasia (TMDS) (vs 10% in <65 years p=0.003). 80 patients received intensive chemotherapy (11 with AML-M3 also received ATRA). Only 53.8%(43/80) achieved CR(vs 78 % in <65 years p<0.001) and this was lowest in complex karyotype (13.3%).The 5-year OS and CCR probability was: 6,2% (M=2.9 m) and 13,8% (M=1.5 m).The longest OS was for t(15;17) with 41,7% surviving at 5 years (M=10.0 m); normal karyotypes survive 2,28% and other abnormalities had very short survival (p<0.0001). Patients with complex karyotypes survive 0% at 17 months and all had relapsed at 5,3. Probability of relapse in t (15;17) was 51.31 % at 5 years (M 12,30), and this was higher in normal karyotype (93,4%), trisomy 8 (100%) and other abnormalities (100%) (p=0.0008). A longer OS was seen in patients with leucocytes ≤ 10×109/L (p=0.0006), subtype M3 (p=0.009)/t(15;17) (p<0.0001) who received ATRA (p=0.0001) and without TMDS (p=0.0043). FAB subtypes distinct of M3 (p=0.0046), age adapted chemotherapy treatment (p=0.0004) and complex karyotypes (p=0.0007) were unfavourable prognostic factors for CCR. The survival of cytogenetic groups according SWOG and MCR was significantly different (p=0.0005, p =0.0021 for OS; p<0.0001, p=0.0001 for CCR). Multivariate analysis showed that karyotype, TMDS and leucocytes are independent factor for OS. The higher risk of dead is for unfavourable (OR 2.94 p=0,008) and unknown (OR 2,52 p=0,03) cytogenetic SWOG groups. Only unfavourable SWOG karyotypes and chemotherapy without ATRA are independent factor for relapse risk. The elderly novo AML has a similar clinical-biological profile that the secondary AML, because of high frequency in undifferentiated subtypes, frequent TMDS, high percentage of complex abnormalities and poor CR, CCR and OS. This matter suggest that their aetiology is probably a lengthy exposure to environmental toxins. That’s the reason because it’s essential the cytogenetic study to decide induction chemotherapy or palliative support. Elderly patients with de novo AML which shown unfavourable SWOG abnormalities, failure to achieve CR, relapse promptly and have short survival. In this age group, today, only therapy designed to target specific molecular rearrangements has good prognostic.

Santana-Davila, Rafael, Shernan G. Holtan, Rhett Ketterling, Ryan A. Knudson, David P. Steensma, Dong Chen, James Hoyer, Curtis A. Hanson e Ayalew Tefferi. "Deletion 5q in AML: A Clinicopathological Description of 79 Cases from a Single Institution". Blood 112, n.º 11 (16 de novembro de 2008): 2523. http://dx.doi.org/10.1182/blood.v112.11.2523.2523.

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Abstract Deletion 5q in Acute Myeloid Leukemia (AML): a Clinicopathological Description of 79 Cases From a Single Institution Rafael Santana-Davila, Shernan G. Holtan, Rhett P. Ketterling, Ryan A. Knudson, David P. Steensma, Dong Chen, James D. Hoyer, Curtis A. Hanson, Ayalew Tefferi. Background: Deletion 5q (del(5q)) is a lenalidomide-sensitive cytogenetic abnormality commonly seen in patients with myeloid disorders. In this study we analyze the clinicopathological characteristics of patients with AML and del(5q). Methods: Patients with del(5q) and AML were identified through a database query of our institutional cytogenetic database from May, 1992 through December, 2005. Both peripheral blood and bone marrow specimens from each patient were morphologically examined by a hematopathologist (DC, JDH and/or CAH). A morphologic diagnosis was given based on current WHO criteria. A critical review of the patient history was performed for each patient. Results: A total 79 patients were identified. Median age was 71 (range 39–87) years, 56% (n=43)were female. The most common subtype according to the FAB classification was M2 (n=23, 29%). In 35 (44%) patients AML developed a median of 9.4 (range 1–294) months since the diagnosis of a pre-existing myeloid malignancy, of which myelodysplastic syndrome accounted for 24 (9 cases of MDS NOS, 6 of RA, 6 of RAEB1, 2 of RAEB-2, and a single RARS), a myeloproliferative neoplasm in 10 (4 cases of a CMPD NOS, 4 cases of PV and a single case of ET and PMF each) and 1 case of a prior history of AML with a t(8;21). The del(5q) was documented in 7 of this 24 patients in the antecedent hematologic disorder. Neither a history of prior exposure to cytotoxic agents nor a prior myeloid disorder was found in 44% (n=35) of the patients. Del(5q) was commonly associated with a complex karyotype (n=67), however in 9 patients it was found to be the sole abnormality. The most frequent breakpoint was q13q33 (n=47) followed by q15q33 (n=12). Initial pathological description did not identify any morphological abnormalities in 6 cases, in contrast myelodysplasia involving at least two cell lines was appreciated in 58% (n=46) of the patients. The median survival was 2.8 months. The majority of the subjects (n=51, 65%) received palliative treatment, 7 patients were lost to follow up and no treatment information was available for review and the remaining 21 received induction chemotherapy with a curative intent, in this group median survival was 8.8 months with 52% (n=11) of patients achieving a complete response. Surprisingly the only factor that appeared to alter survival in the whole group was the presence of the breakpoint in chromosome 5 being distal to q15 (median 2.8 vs 4.1 months, p=0.025) Conclusions: This study constitutes the largest review of del(5q) in AML, its presence is currently associated with advanced age and a poor survival. Close to half of the patients in our series were classified as de novo AML. Although more commonly encountered as part of a complex karyotype it can also be present as a single abnormality. The different cytogenetic characteristics of the del(5q) may impact survival and this deserves further investigation. Figure. Survival of patients with AML and del(5q) in which the breakpoint was found to be distal to q15 (straight line) compared with patients in which the breakpoint was proximal to q13 (dotted line). Figure. Survival of patients with AML and del(5q) in which the breakpoint was found to be distal to q15 (straight line) compared with patients in which the breakpoint was proximal to q13 (dotted line).

Teses / dissertações sobre o assunto "Sen palliativ fas":

Moraga, Lynch Claudia. "Palliativ vård : Sjuksköterskors upplevelser av omvårdnad i sen palliativ fas". Thesis, Mälardalens högskola, Akademin för hälsa, vård och välfärd, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:mdh:diva-54056.

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Werner, Ellinor, e Felicia Ström. "Livskvaliteten hos patienter i sen palliativ fas : Munhälsans betydelse". Thesis, Mälardalens högskola, Akademin för hälsa, vård och välfärd, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:mdh:diva-54235.

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Hjelm, Annelie, e Patrik Svedling. "Existentiellt lidande i sen palliativ fas : En systematisk litteraturstudie utifrån vårdpersonals erfarenheter". Thesis, Mälardalens högskola, Akademin för hälsa, vård och välfärd, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:mdh:diva-46700.

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Bakgrund: När patienter vårdas i sen palliativ fas är existentiellt lidande något som kan drabba patienterna oavsett om de vårdas på vårdavdelningar, genom hemsjukvård eller på specialiserad palliativ vårdavdelning. Detta kan innebära att de behöver få stöd och lindring i sitt existentiella lidande av vårdpersonalen då existentiella behov ska bli mötta för att dessa patienter ska erhålla en god livskvalitet. Syfte: Att beskriva vårdpersonals erfarenheter av att vårda patienter med existentiellt lidande i sen palliativ fas. Metod: Kvalitativ litteraturstudie med beskrivande syntes.Resultat: Efter analysen framkom två teman och sex subteman. Temat Meningsfullt vårdande inkluderar Att få patienterna att öppna upp genom förtroendefulla relationer och Att hitta sätt att stödja patienterna. Temat Utmaningar i vårdandet inkluderar Att finna en balans i sin professionella roll, Att identifiera existentiellt lidande, Att hantera svåra samtal och Att begränsas av yttre förutsättningar. Slutsats: Vårdpersonalen använder enkla medel i omvårdnaden såsom att enbart dela tystanden vilket ger ett meningsfullt vårdande men möjligheterna att identifiera och lindra patienternas existentiella lidande hämmas av tidsbrist och patienternas mentala och fysiska hälsa. Även vårdpersonalens egen dödsrädsla och tron att deras kunskaper brister eller att samtal om döden ökar lidandet minskar möjligheterna för att lindra existentiellt lidande.
Background: Existential suffering can afflict patients in late palliative phase, regardless whether they are cared for in a ward, receive home healthcare or in a specialized palliative care unite. This may mean that health professionals need to support the patients and provide relief in their existential suffering since meeting their existential needs is important in order for the patients to receive a good quality of life. Aim: To describe health professionals' experiences of caring for patients with existential suffering in late palliative phase. Method: A qualitative approach, through a literature study with a descriptive synthesis. Results: After the analysis two themes and six subthemes emerged. The theme Meaningful caring includes Getting the patients to open up through trustful relationships and Finding ways to support the patients. The theme Challenges in caring includes Finding a work-life balance, Identifying existential suffering, Managing difficult conversations and Being limited by external conditions. Conclusion: Nursing actions such as solely sharing the silence resulting in meaningful caring are often used but time restraints and the patients’ overall health conditions limits the possibilities to identify and ease their existential suffering. Additionally, health professionals' death anxiety and experienced knowledge gaps or beliefs that death conversations increase suffering limits the possibilities to ease existential suffering.

Näsman, Emil, e Josefine Lindh. "Sjuksköterskans upplevelse av att vara verksam inom palliativ vård i den sena palliativa fasen inom hospice : En allmän litteraturöversikt". Thesis, Blekinge Tekniska Högskola, Institutionen för hälsa, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:bth-21484.

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Bakgrund: Det har skett stora framsteg på forskningsfronten inom palliativ vård för patienter och dess närstående, men det behövs mer kunskap om sjuksköterskans perspektiv. Den palliativa vården inom hospice har hög personalomsättning och en orsak kan vara en bristfällig eller felaktig bild av vad den palliativa vården innebär. En djupare förståelse för sjuksköterskans upplevelse av den palliativa vården i den sena palliativa fasen inom hospice kan leda till att framtida sjuksköterskor som väljer detta område får en tydligare bild av vad som väntar dem. Det kan också bidra till att öka kvaliteten på vården som erbjuds. Syfte: Litteraturstudiens syfte var att beskriva sjuksköterskors upplevelse av att vara verksam inom palliativ vård i den sena palliativa fasen inom hospice. Metod: Studien är en allmän litteraturöversikt baserad på vetenskapliga artiklar, som utgår från en kvalitativ metod med induktiv ansats. Analysen är utförd med Fribergs femstegsmodell. Resultat: I litteraturstudien så identifierades tre huvudteman: Sjuksköterskans upplevelse av förutsättningar för personlig och professionell utveckling, sjuksköterskans upplevelse av det personcentrerade förhållandet till patienten och sjuksköterskans upplevelse av sedering i den sena palliativa fasen. Resultatet visade på att sjuksköterskor hade ett brett spektrum av upplevelser kring den palliativa vården i den sena fasen inom hospice. Resultatet visade på tre centrala fynd, Den personcentrerade vårdens ömsesidiga dimension, etiska dilemman i samband med palliativ sedering, och vikten av självkännedom och möjlighet till reflektion. Slutsats: Den personcentrerade vården är en central del av den palliativa vården och innebär ett ömsesidigt utbyte. Den interdisciplinära kommunikationen är viktig för styrningen av den palliativa vårdens inriktning i den sena palliativa fasen, då läkare och sjuksköterskor ofta kan ha delade meningar om vad som är viktigast för patienten. Självkännedom är ett viktigt verktyg för sjuksköterskan inom palliativ vård i den sena palliativa fasen, när det kommer till existentiella frågor och personliga utmaningar i samband med patientens bortgång.

Sammer, Sarris, e Al Hakeem Nisreen. "Att vårda patienter under sen palliativ fas till vård i livets slutskede ur sjuksköterskans perspektiv". Thesis, Blekinge Tekniska Högskola, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:bth-21500.

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Fischer, Lina, e Rebecka Jönsson. "Synligt- och osynligt stöd : Anhörigas upplevelser av stöd när en familjemedlem vårdas i sen palliativ fas". Thesis, Kristianstad University College, Department of Health Sciences, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:hkr:diva-4293.

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When a family member is being cared for in palliative care relatives often need support to be able to support their family member. The purpose of the literature review was to illuminate the nursing staff’s support from the relatives’ perspective when a family member is being cared in a late palliative phase. The study is a literature review, there already existing research are surveyed. The findings were structured into two parts, tangible- and the intangible support. Tangible support is a one-way support; to receive information and that someone takes over. Intangible support is support within an interpersonal relation, when the nursing staff in one way or another respond to the relatives needs; that someone shows consideration, to be met with honesty, someone who gives time and to be given opportunity to feel hope. The support could make relatives feel secure and in control. Tangible- and intangible support are connected and form wholeness, but it is important to notice that there are two kinds of support and the relatives are in need of both.

Nowik, Iwona. "Sjuksköterskors erfarenhet av samtal med närstående till personer med demenssjukdom vid övergången till sen palliativ fas : en kvalitativ studie". Thesis, Sophiahemmet Högskola, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:shh:diva-2696.

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Demens är en obotlig sjukdom som leder till döden. En stor andel personer som bor i permanenta särskilda boendeformer i Sverige lider av demenssjukdom. Det ligger ett stort ansvar för omvårdnaden av personer med demenssjukdom på sjuksköterskan, som bland annat informerar och samtalar med närstående när livet hos den demenssjuke närmar sig slutet. Identifiering av hinder och förutsättningar för genomförande av dessa samtal bidrar till en bättre förståelse och utveckling av detta område. Syftet med denna studie var att belysa sjuksköterskors erfarenheter av att samtala med närstående till personer med demenssjukdom i samband med övergången till sen palliativ fas på särskilda boenden.En kvalitativ studie med semistrukturerade intervjuer genomfördes, där sju sjuksköterskor som arbetade vid demensenheter inkluderades. Data analyserades med kvalitativ innehållsanalys med induktiv ansats. Resultatet utgörs av 8 kategorier: vårdplanering, personcentrerad vård, information och kommunikation, kunskap och utbildning, övergång till sen palliativ fas, teamarbete, LCP och att dö hemma.Denna studie påvisar hinder som kan uppstå i genomförande av brytpunktsamtal med närstående till personer med demenssjukdom. Några av dem är bristande kunskaper om demenssjukdomar hos närstående, brist på tidig planering av vården vid den sista tiden och osäkerhet bland sjuksköterskorna kring att hantera svåra samtal. Vidare presenteras förbättringsförslag som kan öka tryggheten och säkerheten i vården och på så sätt kan förbättra situationen för sjuksköterskor vid brytpunktssamtal. De två viktigaste förbättringsförslagen är dels att skapa en bättre kontinuitet i omvårdnadsarbetet och dels att organisera kontinuerliga utbildningar för att höja kompetensen hos omvårdnadspersonalen.
Dementia is an incurable disease that leads to death. A large proportion of people living in nursing homes in Sweden have dementia. Nurses have a great responsibility for the care of people with dementia since they, among other things, carry out informative communication with the family when the resident approaches the end of life. Identification of barriers and facilitators for such communication could lead to a better understanding and development of this matter. The purpose of this study was to illuminate nurses’ experiences of conversations with families of people with dementia in the transition to end-of-life care in nursing homes.A qualitative study with semi-structured interviews was conducted, where seven nurses, working in nursing homes specialized in dementia, were included. A qualitative content analysis with an inductive approach was performed. The result consists of 8 categories: planning of care, person-centred care, information and communication, knowledge and education, transition to end-of-life care, teamwork, LCP and to die home.This study identified challenges that might hinder breakpoint communication with families of people with dementia. Some of them are families’ lack of knowledge about dementia, lack of early planning of end-of-life care and uncertainties among nurses on how to handle difficult conversations. Furthermore, improvement suggestions are presented that can increase the safety in care and improve the situation for the nurses in breakpoint communication. The two most important suggestions are the creation of a better continuity in the nursing and to organize continuous educations to increase the competence among staff.Keywords:

Nilsson, Emelie, e Anna Zlotkowska. "Att kunna förbereda sig för framtiden : En litteraturstudie om närståendes upplevelser av stöd när en familjemedlem vårdas i sen palliativ fas i hemmet". Thesis, Kristianstad University College, Department of Health Sciences, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:hkr:diva-5225.

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Bakgrund: På senare tid har närståendes roll i vården fått en ökad betydelse. I Sverige insjuknar varje år 50 000 individer i cancer. När sjukdomen övergått i sen palliativ fas väljer allt fler patienter att vårdas den sista tiden av livet i hemmet. Mer ansvar läggs därigenom på närstående vilket lett till ett ökat behov av stöd åt närstående. Syfte: Syftet med litteraturstudien var att belysa närståendes upplevelse av stöd när en familjemedlem med cancer vårdas i sen palliativ fas i hemmet. Metod: Studien är en litteraturöversikt baserad på vetenskapliga artiklar från tidigare forskning. Resultat: Resultatet visade att närståendes upplevelse av stöd fanns i att klara av vardagen och att kunna förbereda sig för framtiden. Däremot framkom även att närstående upplevde avsaknad av stöd, som fanns i att känna sig otillräcklig och att känna sig övergiven. Närstående upplevde information kring familjemedlemmens sjukdom, vårdandet av den döende samt vad närstående kunde förvänta sig av framtiden framkom som ett stöd av betydelse. Närstående upplevde sig inte bli sedda av professionella vårdgivare vilket bidrog till att närstående kände sig ensamma i den svåra situation dem befann sig i. Slutsats: Då närstående befinner sig i en situation där deras behov av stöd inte alltid tillgodoses, är det av vikt att professionella vårdgivare i alla avseenden inkluderar och uppmärksammar närståendes individuella behov av stöd.

Background: The role played by next of kins in the public health care system has, of late, become increasingly important. Every year 50,000 people contract cancer in Sweden. During the final stages of life, when the illness has reached the late palliative phase, an increasing amount of patients choose to be nursed at home. Subsequently, more responsibility is placed upon relatives and their need of support increases. Purpose: The purpose with this study was to illustrate next of kin’s experiences of support when a member of the family suffering from cancer was nursed at home during the late palliative phase. Method: The study is an overview of literature based on scientific articles from previous research. Findings: The study’s findings show that next of kins experienced most support in situations associated with coping with the daily chores or when having to prepare themselves for the future. However, next of kins also experienced a lack of support and reported feeling insufficient and abandoned. Information about the family member’s illness and nursing of the same as well as a comprehension of what they, as next of kins, might expect of the future constituted a significant support. Nevertheless, they felt ignored in contacts with professional health care providers which contributed to a feeling of loneliness. Conclusion: When next of kins find themselves in a situation where their needs of support is not always fully satisfied, it is of great importance that professional health care providers notice and include the next of kins individual needs of support in all respects.

Almqvist, Sara, e Emelie Manfred. "Att som sjuksköterska möta existentiella frågor i den palliativa vårdens sena fas : en systematisk litteraturstudie". Thesis, Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap (HV), 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-43862.

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Bakgrund Inom palliativ vård möter sjuksköterskor huvudsakligen existentiella frågor relaterade till döden. Dock är det inte alltid sjuksköterskor vill möta dessa frågor, vilket kan skapa lidande för patienten. Vald teoretisk referensram utgörs av Travelbee’s teori om mellanmänskliga relationer och Watson’s teori om att skapa en hjälpande och tröstande relation. Syfte Att belysa sjuksköterskans erfarenheter av existentiella frågor i möten med patienter som vårdas i den palliativa vårdens sena fas. Metod Metoden utgörs av en systematisk litteraturstudie där artiklar hittades i databaserna Cinahl, PubMed och PsycINFO. 10 artiklar valdes ut för analys efter kvalitetsgranskning och diskuterades mot vald teoretisk referensram. Resultat Resultatet beskrivs utifrån tre teman med de nio subteman som identifierats. Resultatets tre teman är: att uppmärksamma existentiella frågor, att våga möta existentiella frågor och att skapa förutsättningar för att möta existentiella frågor. Slutsats Vår systematiska litteraturstudie belyser vikten av att som sjuksköterska kunna uppmärksamma, våga möta och kunna skapa förutsättningar för att möta existentiella frågor. Dock finns det brister inom sjuksköterskans kompetensområde och organisation. Därmed kan vi dra slutsatsen att det finns behov av utbildning avseende existentiell vård inom sjuksköterskans kompetensområde och tydligare riktlinjer från organisationen för att förbättra sjuksköterskors förmåga att möta existentiella frågor.

Johansson, Sara, e Emelia Olausson. "Att vara partner till en person med obotlig cancer i en tidig palliativ fas : -En narrativ studie med ett partnerperspektiv". Thesis, Blekinge Tekniska Högskola, Institutionen för hälsa, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:bth-17531.

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Bakgrund: Att vara partner till en person med obotlig cancer i den tidiga palliativa fasen, kan bli en omfattande livsförändring, associerat med en lång sorgeprocess. Cancern kan leda till bland annat en känsla av begränsad tid, sorg och ökad risk för ohälsa, om stöd inte erbjuds. Syfte: Syftet var att beskriva hur det är att vara partner till en person med obotlig cancer, i en tidig palliativ fas. Metod: Narrativ design med litteraturstudie som datainsamlingsmetod och dataanalys i form av en kvalitativ innehållsanalys enligt Graneheim och Lundman (2004). Resultat: Innehållsanalysen ledde fram till tre huvudkategorier med tillhörande tolv underkategorier. Den första huvudkategorin – ”Partnern hyser egna tankar och känslor” – avser partnerns egna tankar och känslor under sjukdomsförloppet, som inbegriper underkategorierna ”En pendel ensam mellan hopp och hopplöshet”, ”En oviss framtid”, ”Varför händer det här mig?” och ”Viktigt att ha någon”. Den andra huvudkategorin – ”Partnern ser den vårdade personen på olika sätt” – beskriver partnerns perspektiv till den vårdade personen, och omfattas av underkategorierna ”Jobbigt att stå bredvid obotlig cancer”, ”Känner inte igen personen”, ”Relationens upp- och nedgångar” och ”Kan ibland se förbi sjukdomen”. Den tredje, och slutgiltiga, huvudkategorin – ”Partnern och den vårdade personen bär på tankar och känslor tillsammans” – utgår från partnern och den vårdade personens gemensamma tankar och känslor, och innefattar underkategorierna ”En kamp tillsammans”, ”En gemensam pendel mellan hopp och hopplöshet”, ”Viktigt att ta tillvara på de bra stunderna” och ”Vara den bärande väggen för varandra”. Slutsats: I den tidiga palliativa fasen av obotlig cancer, genomgår partnern många känslomässiga påfrestningar, varpå stöd blir en nödvändighet för att underlätta bearbetningen under sjukdomsförloppet. Ett av målen med palliativ vård, är att partnern får stöd och information. Emellertid, får partnern sällan det stöd som erfordras. Av den anledningen, behövs mer kunskap och spridning av den om partnerns upplevelser.

Livros sobre o assunto "Sen palliativ fas":

Yennurajalingam, Sriram, e Eduardo Bruera, eds. Hospice and Palliative Medicine and Supportive Care Flashcards. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190633066.001.0001.

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In the United States, the subspecialty of hospice and palliative medicine has seen rapid growth since it was recognized by the American Board of Medical Specialties. During the past decade, there has been a dramatic increase in the number of palliative care programs and improved access to palliative and hospice for patients with life-limiting illness. There has also been an increase in the educational opportunities as well as growth of fellowship programs to train palliative care fellows. Unfortunately, there are limited study aids available for learning and retaining essential concepts in palliative care. Hospice and Palliative Medicine and Supportive Care Flashcards is a comprehensive, evidence-based book of flashcards for clinicians caring for patients who require hospice and palliative care and supportive care. Written in a clinical scenario/vignette, question-and-answer format by experts with first-hand experience in the field, the flashcards are highly readable and serve as a source of fast answers to clinical questions in the field. A total of 300 flashcards are organized into chapters by disease and provide readers with up-to-date information that follows the core curriculum of American Board of Hospice and Palliative Medicine for ease of use and rapid review for exams. This book will equip care professionals with key concepts related to the assessment and management of palliative care, making it an ideal point-of-care quick reference for physicians, nurse practitioners, fellows, residents, and students.