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Case study of physiotherapy treatment of a patient with rheumatoid arthritis
Dostálová, Barbora ; Kozáková, Alena (advisor) ; Jarošová, Hana (referee)
Title: Case study of physiotherapy treatment of a patient with rheumatoid arthritis Aims: The main goal of my thesis was to use knowledge gained during studies of physiotherapy in a practical case of a patient treatment and to get feedback of the therapy that was used. The therapy included: an investigation, a proposal of the therapy, a procedure for the therapy and an evaluation of the effect of the therapy. Methods: The first part of my thesis is focused on the theoretical issue of rheumatoid arthritis. The main topic of this part is a clinical picture through which rheumatoid arthritis can come out. I also focused on arthral and non-arthral, neurological, symptoms. At the end of the thesis the physical therapy is discussed. The second part includes the actual diagnosis elaboration of a case study of physiotherapy treatment of a patient with rheumatoid arthritis. It was created during my practice in the Institute of Rheumatology in Prague, from 11th January until 21st January. The part includes an entry investigation, a short-term and a long-term therapy schedule, therapeutic units, an output investigation and an efficiency of the used therapy. The main aim of the therapy was to reduce pain and to restore the strength of muscles and the latitude of joints Results: With a high support of a medical...
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Importance of HSD17B1 gene amplification in breast cancer
MAŠOVÁ, Michaela
Breast cancer is the most common female tumour disease. Although, the incidence is constantly growing, mortality of this disease is decreasing. However, there are still occurrences, where the conventional therapy failed. One of the important therapeutic attribute is hormone dependence of breast cancer and status of growth factor receptor HER2 (Her-2/neu, c-erbB-2). Treatment of the breast cancer with higher expression of estrogene or progesterone receptors (ER or PR) could be targeted-into blockade of these receptors or in the case of HER2 we could blockade it´s function with monoclonal antibody trastuzumab or lapatinib. Because of aggression of HER2 positive tumour cells, this subtype of breast cancer belonged to the group of patients with the worst prognosis. Thanks to targeted (biological) therapy belongs this patients into the group with the best treatable breast cancer today. However, in some of the hormone-dependent breast cancer cases the treatment fails. One of the reasons could be the product of HSD17B1 gene that is involved in metabolism of these hormones. Moreover, this gene is localized on chromosome 17 (like HER2 gen) and therefore it´s aberration could be suspected. Because the FISH probe for HSD17B1 gene is not commercially available, we prepared it by using transgenic E. coli bacterial clones. The specifity was checked on chromosomal spreads. In this presented thesis, we investigated 50 patient´s breast cancer samples by using fluorescent in situ hybridization to determine the status of HSD17B1 gene. Amplification of the gene could be important in the treatment of breast cancer and in resistance to antihormonal therapy. Next, we tried to check, if the status of HSD17B1 gene could be dependent on status of HER2 gene or if it correlates for example with patient´s age at time of diagnosis etc. Although, the statistical important correlations were not found, it seems, that HSD17B1 gene is lightly increased in some cases. In the next phase the study will be extended of another patient samples and the clinical dates and analysis in relation to HSD17B1 will be done. This is a pilot project. The main goal was to prepare HSD17B1 gene probe intended for commercialization and check the probe on the set of patients with breast cancer.
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Tumor microenvironment: Cancer-associated fibroblasts and their biological function in tumors derived from squamous epithelium
Nedvědová, Tereza ; Kodet, Ondřej (advisor) ; Brábek, Jan (referee)
The incidence of carcinomas originating from squamous cell epithelium increases with population ageing as well as in younger people. The treatment is demanding for both the patient and whole health system. For the successful therapy, there is a need to understand the development and spreading of the tumor to target them specifically. Tumors consist of tumor stroma and malignant cells. Cancer cells are organized in a hierarchic order and the major problem are cancer stem cells. Adult stem cells are defined as cells with the capacity to self-renew as well as the ability to generate differentiated cells within the tumor. Resistance to targeted therapy can improve survival of these cells and is responsible for cancer relapse. Tumor stroma constitutes another important part of tumor. It is composed of non-cancer cells and extracellular matrix and has become recognized as a major factor in cancer growth and metastation. The stroma includes vascular and immune cells and especially cancer associated fibroblasts (CAFs). These cells are not malignant per se, nevertheless their role in supporting cancer growth and survival is important, so they have become an attractive target for treatment. There are several hypotheses made to explain the origin of CAFs. The question is whether the origin of all CAFs in one...
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Effect of biological treatment on functional ability and mobility of patients with ankylosing spondylitis
Hušková, Barbora ; Pavelka, Karel (advisor) ; Smolíková, Libuše (referee)
CHARLES UNIVERSITY IN PRAGUE 2ND FACULTY OF MEDICINE Department of Rehabilitation and Sport Medicine Barbora Hušková The influence of biological treatment on functional ability and mobility of patients with ankylosing spondylitis bachelor thesis Prague 2012 Abstract This thesis is primarily a literature search of knowledge about ankylosing spondylitis (AS), supplemented by two case studies of specific patients. The theoretic part describes the characteristics of AS as the main representative of spondylarthritides, including its diagnosis and testing methods. It also contains an overview of current approaches and strategies of a treatment. It focuses on biological treatment with TNF-α blockers. The practical part of the thesis illustrates the findings on the example of a patient with AS treated with biological therapy. It evaluates the subjective feelings in response to treatment and compares the results of treatment with standard therapy (i.e., without biological treatment) on another patient under otherwise similar conditions.
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Nursing care by children on biological treatment for Crohn's disease
KOUBOVÁ, Marta
This bachelor's work with the title: Nursing care of children with the Crohn´s disease going through biological treatment concerns with the care specifics which are necessary for the child´s patient during biological treatment giving. The Crohn´s disease has been along with the ulcerous colitis called by omnibus term for idiopatic intestinal inflammation characterised also by the abbreviation IBD from the English Inflammatory Bowel Disease. It refers to chronic inflammatory intestinal disease which affects intestine segmentally with intestine mucous membrane hitting in total thickness and has been characterised by remise and relapse phases. In the treatment connection, the aim is life quality improvement not only at the children but also at the adults. In the curative scheme the biological treatment has a high therapeutic potential which is from the costs viewpoint applied at relatively small sample of patients. For this bachelor´s work objects fulfillment was qualitative research investigation. Within research investigation were two aims determined. First goal was finding if nurses know specifics of the nursing care of children with the Crohn´ s disease. Second goal was to find out if nurses know biological treatment giving principles. On the basis of mentioned bachelor´s work aims the explorative questions were set: Which knowledge do nurses have of care at the children with the Crohn´s disease going through biological treatment? How do nurses ensure specific nursing care of children with the Crohn´s disease going through biological treatment? Which principles do nurses consider important at the care of the Crohn´s disease children going through biological treatment? The empirical part of bachelor´s work was processed in the form of data qualitative analysis using semi-structured talks and participated hidden monitoring. The research file consisted of eight respondents who participate upon applications of biological treatment at children with the Crohn´s disease diagnostics. Respondents answerred on the basis of own knowledge and acquired experience. The conversations were processed using open coding technique method pencil and paper. The categories and codes were processed into thought maps representing also respondents answers. The research investigation was added by semi-structured talk with the child´s gastroenterologist ensuring the biological care. The hidden participated monitoring was other used method taken at the same research file during the biological treatment application with focus on nursing care. Under the bachelor´s work will be organized the course on the basis of theoretical part and acquired results in the children´s ward of the České Budějovice hospital with orientation on nurses applying biological treatment and also on nurses unknowing in this problems.
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The biologic treatment of patiens with Inflammatory bowel diseases
BARTYZALOVÁ, Martina
The thesis titled Biological Therapy in Patients with Inflammatory Bowel Diseases deals with the needs of clients with Crohn's disease and ulcerative colitis prior and after biological therapy. The role of nurses in biological therapy centres, including the application of this therapy, was also investigated. Crohn's disease and ulcerative colitis are inflammatory bowel diseases. They are chronic inflammatory diseases of the gastrointestinal tract, which are accompanied by ample extraintestinal symptoms. This thesis also deals with biological therapy that involves the administration of highly effective substances of biological nature that inhibit specific sites of inflammatory reactions. This therapy is provided in centres of biological therapy and is used not only in gastroenterology but also in rheumatology and oncology. Teams of experts work in biological therapy centres; the task of these teams is to provide a comprehensive holistic health care. The thesis is divided into a theoretical part and an empirical part. The theoretical part focuses mainly on Crohn's disease, ulcerative colitis and biological therapy that helps patients suffering from these diseases. The methodological section employed qualitative research using in-depth semi-structured interviews with patients suffering from idiopathic inflammatory bowel diseases and with nurses who deal with these patients when applying biological therapy. Since head nurses from gastroenterology departments did not wish to record the interviews with a recorder, they were recorded in writing and transcribed subsequently. The questions dealt with the issues of biological therapy in connection with inflammatory bowel diseases. All the acquired data was processed with the Atlas.ti programme, which is designed for encoding, processing and interpretation of large amounts of textual and graphic qualitative data. Based on the research, an educational brochure for patients suffering from inflammatory bowel diseases was complied as well as educational materials for nurses starting work in biological therapy centres. Furthermore, the results can be used by nurses in practice and nursing students too.
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Specifics of work of nurses in the centers of biological treatment.
MENCLOVÁ, Šárka
Specifics of the Work of a Nurse in Biological Therapy Centres? The bachelor thesis was written in theoretical form with the aim to map the problems of biological therapy. The method of research and analysis of the available present sources related to the topic was applied to the thesis elaboration. Biological therapy represents a new type of treatment trying to create such a compound that is capable of targeted immune system suppressing or strengthening to influence a pathological process in an ill or impaired organism as accurate as possible. Because of high costs the treatment by biological preparations had to be concentrated to centres. Quality teams of people that are able to assess effectively for which patient the therapy is suitable and safe work at the centres. Patient registers enable efficient treatment and long-term monitoring of medical safety. Attention is also paid to equipment and environment of the centres. The chapter Specifics of Nurse Work focuses on professional knowledge and skills of a nurse in biological therapy application. The main task of a nurse is to provide complex, individual holistic nursing care based on quality verbal and non-verbal communication and educational activity. The next part deals with the individual spheres of medicine with the best experience with biological therapy. In gastroenterology, where idiopathic intestine inflammations of Crohn?s disease and ulcerous colitis are treated by means of TNF-? blocking substances, the substances are administered in the form of infusion or subcutaneously. Nurses thus have to be aware of treatment process, treatment principle and side effects linked to the therapy. Excellent results are achieved with biological therapy in the rheumatology centre in treatment of rheumatoid arthritis, ankylosing spondylitis also known as Bechterew's disease, psoriatic arthritis and juvenile idiopathic arthritis. ATTRA Registry, which is one of the most important tools for patient monitoring from the beginning of the therapy, is also mentioned here. The work of nurses in the oncology centre focuses on monitoring the side effects linked to the therapy. Side effects linked to biological therapy are more specific than those in cytostatic therapy. It thus depends on nurse?s observation skills, her ability to decide what symptoms should be focused on during the therapy and ability to respond to them in timely manners. The last centre analysed in the thesis is the dermatology centre, where they have experience with therapy of a chronic disease called psoriasis vulgaris. The information provided from the available data has shown us that although the therapy is highly costly, its purposeful application is economically effective at least thanks to the fact that timely commencement of therapy enables patient life quality improvement without possible disability. Although the therapy is not able to cure the patients completely, its main goal is to slow down the disease prognosis and to free the patients from the pains linked to the disease.
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Difficult to treat asthma in adults from the nurse´s point view
LAHODOVÁ, Danka
Summary The quality of life of patients with bronchial asthma is influenced by severe everyday difficulties, including nocturnal symptoms, limitation of physical activities or a more frequent hospitalization. Therefore, it is necessary that the medical staff take special care and individual approach to the patients with difficult treatable asthma. Objective 1: Find out limitations in customary daily activities of the patients with severe asthma. Patients stated that they are restricted in their customary daily activities including sport activities. Objective 2: Find out the nurse?s participation in the care for asthmatics. The objective was achieved; the nurse takes part in the care of patients with difficult treatable asthma from the first visit in the ambulance. She makes the first contact with patients, assists the doctors, takes examination material, carries out certain examinations or helps out with them and takes part in the nursing care. Objective 3: Find out the role of a nurse during biological treatment of patients with difficult treatable asthma. Essential is to make a relationship between the nurse and the patient, to educate the patient, to reeducate him and to provide nursing care. According to these objectives we have put three research questions. The first question is: ?In what customary daily activities is the patient with asthma restricted?? During the research interviews we discovered that the most difficult period for the patients was, when they had to leave their jobs because of the disease. Furthermore, clients stated that they handle daily activities at their own pace and it always depends on their current health. Patients try to keep their condition by doing leisure sport activities. The second question is ?How does the nurse engage family in the care of an asthmatic?? From the interviews we found out that family engages in the care when breathing problems occur and the patient is not able to deal with it on his own. Family ensures the feeling of patient?s safety. The nurse provides family with information on how to avoid asthmatic fits, how to help during the fit and where to find this information. Patients with difficult treatable asthma and their families have to be provided with appropriate information. It results from our research that family accompanies the patient very rarely during the visits in the ambulance for the treatment of difficult treatable asthma, only in case of health impairment. Clients visit the ambulance mostly on their own without any companions. Question 3 is ?What is the nurse?s role during the biological treatment of the patient with difficult treatable asthma?? We discovered that nurse?s role starts with educating the patient in order to abide by the rules of treatment regime and with assessing individual needs of the patient. She teaches him how to change the behavior due to the disease, responsibility for his health and helps him to deal with limitation which the disease brings. Moreover, the nurse is the bearer of the nursing care, applies the biological treatment. It is important to gain trust and build cooperation with the patient.
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Influence of biological therapy on the level of self-sufficiency in patients with rheumatoid arthritis
JELENOVÁ, Michaela
Rheumatoid arthritis is a chronic autoimmune disease manifested mainly by stiffness and pain in joints. The main trouble of the disease lies in deterioration of patients´ quality of life resulting form painful syndromes and impaired function of joints. This progressive disease often leads to disability and invalidity, therefore rheumatic arthritis is an important therapeutic and social problem due to demanding nursing and social care and financial requirements. Significant changes in rheumatic arthritis treatment have occurred recently. Biological treatment has become a new therapeutic method. Data suggesting that this kind of therapy may slow or even halt the x-ray progression of the disease have been obtained.
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Treatment of Patients in a Specialized Establishment - a Centre for the Cure of Rheumatological Disorders in the South Bohemian Region
Valentová, Monika ; Střítecký, Rudolf (advisor) ; Augustinová, Sevda (referee)
Rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis belong among serious disorders, that effect joints and connective tissue. The patients suffer from pain and stiffness. Disease modifying drugs are an important part in the management of rheumatical disorders. When disease modifying drugs are failing, than biologic treatment is applied. For biologic treatment are registred etanercept (Enbrel), adalimumab (Humira), rituximab (MabThera), abatacept (Orencia) and infliximab (Remicade). In the Czech Republic was established the National registry of rheumatic disorders. There is a need of long term observations of patients, who have biologic treatment, to evaluate safety and socioeconomic data of the biologic treatment.
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