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Is it possible in clinical practice to perform selection of unrelated donors based on KIR genotypes for AML patients?
FRYČOVÁ, Michaela
Acute myeloid leukemia (AML) is an aggressive malignant disease, during which is for most of the patients only possible treatment the curative allogeneic stem cell transplantation. Besides reaction of the graft against the host is a fundamental limiting factor of the successful transplantation the relapse of the disease. According to several recent published studies, the results of transplantation in patients with AML may be influenced except the HLA genes by others so-called non - HLA genes. Especially there is mounting evidence influence of the donors KIR genes (Killer -cell Immunoglobulin - like receptors) in protection against the relapse after transplantation. HLA and KIR genes are coded on different chromosomes (HLA- sixth chromosome and KIR chromosome 19), therefore are segregated independently and HLA identical donors with recipients usually have different compositions of the KIR genes. Cooley et al. (2010) demonstrated that the specific motifs composition of centromeric and telomeric B haplotypes of KIR genes helps to protect against relapse and increases the chances of complete cure AML. In cases where there are multiple HLA identical unrelated donors (UD) then logically the composition KIR genes by the individual donor could be a criterion in selecting the most appropriate donor, therefore, the one with the greatest potential to protect over the relapse . Based on this study and other data the genetic screening of KIR was started with potential donors, if it was possible to choose from several 10/10 or 10/09 HLA identical UD for the patient. Genotyping was performed by PCR-SSP methodology using commercially available kits. It was performed gene classification 160 preferably identical HLA donors for 55 selected patients with AML. The presence of KIR haplotypes A and B as well as their combinations was determined from the type and number of the KIR genes. All genotypes were entered into the calculator, which allows you to enter up to five potential donors and obtain their assigned into one of three categories according to content KIR B. Groups , "neutral" , "better" , "best" , refer to the appropriate protection against relapse. KIR gene classification in the search for donors revealed 43 donors with AA haplotypes, 90 donors with AB haplotypes and 27 donors with BB haplotypes . After assigning state of the presence KIR B was discovered 107 " neutral " donors , 35 "better " donors and the 18 "best " donors . At 40 (~ 73 %) patients were available donors with the different states of the presence of KIR B. These patients represent a group of patients where the selection criterion of the presence B KIR gene at the donor could be used. We confirmed that the additional selection of HLA-matched unrelated donor on the basis of the content B of KIR genes is feasible. Selection such donor for transplantation may improve the outcome of patients with AML.
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Pick´s disease and the specifics of the nursing care of a patient with this disease
KOPKAŠOVÁ, Lenka
Pick's disease is a degenerative-atrophic process that primarily affects the frontal and temporal lobes of the brain. Besides Alzheimer's disease, it is a lesser known form of dementia which affects people of younger age. Although the exact range of Pick's disease occurrence varies in the literature, the average reported age is between 50-60 years. The disease can change eating habits, cause emotional swings, inappropriate behaviour and sloppy appearance of the patients. The behaviour to others is often selfish, the patients are unable to listen to others and ignore their surroundings. Pick's disease is also characterized by inappropriate sexual behaviour. Globally, the number of dementia patients is still growing and according to expert guesses the increase will continue. Nursing care for patients with dementia is therefore becoming a very actual topic as dementia is called a quiet epidemic of our century. Nurses in their departments quite frequently encounter patients suffering from dementia of various origins at different stages of disability and the staff at healthcare facilities often regard these people as a burden. The aim of this thesis, which is called Pick's Disease and Specifics of Nursing Care for Patients with this Disease, is, based on the theoretical knowledge, to map definitions and diagnosis of Pick's disease, to define the needs of such a patient, and to list the most common problems in the nursing care. It focuses on people with dementia within medical facilities. For proper understanding of the problem, the thesis starts with the anatomy and physiology of the brain and the description of cognitive functions which are affected by the dementia syndrome and the definition of dementia. Based on the studied literature, dementia is divided according to various criteria. It has been found out that dividing dementia is not entirely uniform, but the essential facts and overall opinions of the authors do not diverge. Pick's disease belongs to a group of frontotemporal dementia and its position in this group has changed over time, as it is recorded in the literature. The thesis includes recommendations resulting from the studied literature in the approach to patients with dementia and emphasizes personal communication with the patients and empathetic and humane approach. Although medicine cannot prevent dementia, an early diagnosis of a specific type of dementia and correctly targeted treatment can increase the quality of life not only of the patients but also of their families. I have chosen this topic because I find it very current and interesting. During my nursing practice at the Surgery Department and Aftercare Department, I have met patients suffering from dementia and I did not know how to properly and efficiently communicate with them. For the theoretical part of my work, the methods of explanation, synthesis and induction on the basis of Czech and foreign information sources have been used. The most frequently quoted Czech authors in my thesis are doc. MD. Roman Jirák, PhD., the head of the center for diagnosis and therapy of Alzheimer's disease at the psychiatric clinic of the General University Hospital in Prague, the 1st Medical Faculty of Charles University. This thesis can serve as an informational and educational source both for nurses and the general public who may experience the disease within their families. It would be considered a great success if it helped nurses or family members to diagnose Pick's disease or other dementia at an early stage.
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Constipation - problem of immobile patients
HULIČKOVÁ, Tereza
My thesis deals with constipation in immobile patients. The research was carried out by collecting data using the questionnaire method. The questionnaires were focused on immobile patients of all ages hospitalized in any units in the České Budějovice hospital, Inc. The objective of this thesis was to survey the drinking regimen and eating habits in immobile patients and to analyze their impact on the development of constipation. I set three hypotheses: The first hypothesis suggests that immobile patients´ alimentation does not include an increased requirement for dietary fiber. My research shows that patients´ diet at home contains more fruits, vegetables and whole meal bread. A diet therapist hardly ever comes to see hospitalized immobile patients. Most patients are not on any diet which would limit the intake of particular nutrients. The first hypothesis was confirmed. The second hypothesis suggests that immobile patients do not observe the drinking regimen. The research data analysis shows that patients´ fluid intake is the same no matter if they stay in hospital or at home {--} it is about 1- 2 litres a day. The fluid intake depends on patients´ age, weight and health condition. It is possible to say that immobile patients observe the drinking regimen. The second hypothesis was not confirmed. The third hypothesis suggests that immobile patients do not have enough privacy while they pass stool. They feel ashamed and these feelings also raise the constipation development. There is a lot to improve in this respect, the nursing staff should be aware of the fact that immobile patients need more intimacy at passing bowel motion. It is not surprising that most immobile patients feel the lack of privacy in hospital. In my opinion not enough attention is paid to the question of privacy in hospitals. This has a negative impact on patients´comfort. Patients´ diet should include more dietary fiber. Individual consultations with a diet therapist are advisable for patients. The nursing staff should also focus on the patients´ drinking regimen. The right diet and drinking regimen may contribute to constipation prevention. The empathetic, holistic, psychological and sensitive approach to patients should improve patients´ condition and alleviate their pain. Each nurse should make her best to prevent patients from feeling undignified in hospital.
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Communication as a Part of Everyday Nursing Care at ICUs.
FROLÍKOVÁ, Miloslava
Communication as a Part of Everyday Nursing Care at ICUs Bachelor?s Thesis, worked up and focused on the topic of ?Communication as a Part of Everyday Nursing Care at Intensive Care Units? is engaged in problem area of contemporary communication. In the work?s theoretical section we have dealt with general characteristics of both verbal and non-verbal communication as well as an appropriate communication at the intensive care units with adult or children patients has been described inclusive particularities thereof and its contingent difficulties, too. This section also involves a concept of basal stimulation and its subsequent integration into the nursing attendance at the intensive care units. The work also deals with a nurse?s role within education of the ICU in-patients? family. Objectives and hypotheses are introduced in further section of the Bachelor?s Thesis. The first objective was aimed at identification of possible differences while using communication skill at the ICUs of various medical scopes. The second objective was focused on finding out of prospective utilization of the basal stimulation concept for the purpose of nursing attendance as a communication chance. The third objective set a goal to identify what communication way was preferred by the ICU nurses while providing nursing care. Pursuant to these objectives of the Thesis hypotheses were defined. Hypothesis 1 (H1) anticipated that the communication skill was differentiated according to the scope of the intensive care unit. Hypothesis 2 (H2) supposed that an important element affecting any communication was medical performances frequency. Hypothesis 3 (H3) assumed that the important element affecting any communication was frequency of nursing interventions. Hypothesis 4 (H4) envisaged that time necessity while providing nursing attendance at the ICUs influenced the efficiency of the basal stimulation application with patients. Hypothesis 5 (H5) anticipated that verbal communication was preferred more with patients at the ICUs according to the medical scope. A quantitative method was used for the research investigation of the Bachelor?s Thesis by help of interrogatory investigation. Nameless questionnaires were set and distributed to nurses at the intensive care units of various scopes in the Faculty Hospital Plzeň . It was found out through the research investigation that hypothesis 2 (H2), hypotheses 4 and 5 (H4, H5) were confirmed and hypothesis 1 (H1) and hypothesis 3 (H3) weren?t confirmed. However, all three objectives were fulfilled. At the end of the Bachelor?s Thesis it is especially recommended for providing nursing care at the intensive care units regardless of their medical scope to respect any intimacy of the patients while executing nursing interventions and any efforts to get higher quality of communication skill at treatment of an unconscious patient, to provide education both of theoretical but first of all practical elements of the basal stimulation concept with the nursing staff.
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Stress de-tension of the patient before surgery
Mráčková, Petra ; Mareš, Jiří (advisor) ; Hadaš, Lubomír (referee) ; Pečenková, Jaroslava (referee)
Summary: Main thema of this bachelor's essay was stress de-tension of the patient efore surgery. This thema is above all particularly elaborate in two main parts, respectively theoretical and empirical. There is definition and clarification of term stress in the theoretical part together with using of special medical literature. There is also pointed to factors evoking and causing stress. This essay furthermore points to the relation between stress and pain at the patient,as the same as between stress and not enough communication to the patient before surgery. Next, there are described possibilities of pain treatment. Theoretical part contents also description of hospital surrounding and its influence to stressogenesis at the patient. In fine of theoretical part there are brought managing strategie, which could detend stress of the patient before surgery. In the empirical part, I have tried to find out by quantitative research the most frequent factors and continuities matched to stress at the patient before surgery. The research file was content from patiens of different age groups and different diagnosis, whose were hospitalizated in Masaryk Hospital in Ústí nad Labem.
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Approach and responsibility of today's patiens to cataracta disease.
ZEITHAMOVÁ, Eva
Cataract - Cataract is a disease of the eye lens and can affect all age groups. If left untreated, it can significantly impair vision or lead to blindness. In the theoretical part, I tried to clarify what the cataract actually is, what types of cataract do we have, examination methods, diagnostics, treatment, and nursing care in patients with cataract. In the second part, I tried to explain what the patient awareness is, and how important it is to inform patients about this disease, preoperative and postoperative care as well as after-care in home environment. In the practical part, quantitative survey in a form of questionnaire has been used. The survey took place at the Departmen of Ophthalmology, Jihlava Hospital. I have created two types of questionnaire, for nurses as well as for patients. Results were recorded in bar charts. Three hypotheses are determined for goals. Hypothesis No 1 - younger and younger patients undergo cataract surgery. Hypothesis No 2 - patients are more responsible and well informed. Hypothesis No 3 - level of cooperation with healthcare staff coresponds to anticipations of patient with ocular disease. All three hypotheses were confirmed. Even though the hypothesis No 2 has been confirmed, some patient answers do not indicate it. It is definitely necessary to continue putting stress on awareness, have enough time to inform patients and answer questions of all patients. Results of my work can lead to creation of time space for communication with patient; ensure synoptic and sufficient quantity of information material adequate to the patient needs.
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The nursing care of a geriatric patient who suffers from chronic pain
Jokschová, Lucie ; Mareš, Jiří (advisor) ; Prchalová, Eva (referee) ; Šauer, Karel (referee)
The thesis deals with nursing care of a geriatric patient who suffers from chronic pain and is based on patients' opinions. The theoretical part defines the term "chronic pain" and characterizes its' causes. It also describes various ways of diagnosing chronic pain, ways in which chronic pain can be monitored and how could chronic pain be treated. There is a general nursing plan - according to the model of M.Gordonova - for a geriatric patient with chronic pain treatment worked out at the other part of the thesis. The empiric part of the work deals with patients' opinions. For the research questionnaire was used as the most suitable method for given purpose. 54 geriatric patients suffering from chronic pain, who are hospitalized either in internal department or department for the elderly in Havlíčkův Brod, took part in the research. They were then dividend into 2 groups - men and women - which was also taken into account when evaluating the answers. The questionnaire is focused on character of pain, its' location and intesity with regard to previous week. The target is to find out what patient's preferences in chronic pain treatment are and the level to which daily activities were influenced by pain over the last week. The work results confirmed that the way old people go through and cope with...
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