Thèse de doctorat : Médecine. Immunologie : Université de Nantes : 2004. / Bibliogr. f. 169-184.

Thèse de doctorat : Médecine. Immunologie : Université de Nantes : 2006. / Bibliogr.

Reproduction de : Thèse d' exercice : Médecine générale : Nancy 1 : 2002. / Thèse : 2002NAN11161. Titre provenant de l'écran-titre.

Reproduction de : Thèse de doctorat : Médecine. Immunologie - Biostatistiques : Nantes : 2007. / Bibliogr.

Thesis (Ph. D.)--York University, 2001. Graduate Programme in Philosophy. / Typescript. Includes bibliographical references (leaves 365-382). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://wwwlib.umi.com/cr/yorku/fullcit?pNQ66368.

Thesis (Ph. D.)--University of Queensland, 2002. / Includes bibliographical references.

Hjärta och lever är vitala organ och när de inte fungerar blir konsekvenserna förödande. Under 2013 genomfördes 55 hjärttransplantationer och 161 levertransplantationer i Sverige. Transplantation är en lång och svår process som generellt leder till förbättrad livskvalitet. Patienten går från att ha varit nära döden till att få en ny chans till livet. Det är en stor omställning som kan vara svår att förstå och hantera. Syftet var att beskriva patienters existentiella upplevelser efter en lever- eller hjärttransplantation. En litteraturöversikt gjordes där totalt 10 kvalitativa artiklar granskades och analyserades. Resultatet visar tre huvudteman. Det första temat var Det nya livet som visar hur patienten genomgår en känslomässig berg-och-dalbana när de försöker finna sitt nya jag i livet. Det andra temat benämns som Paradoxala känslor där tacksamhet blandat med skuld är centralt. Den andliga dimensionens betydelse är det sista temat där patienten vänder sig till högre makter för att klara av sin livssituation. Diskussionen tar upp huvudfynden från resultatet samt sjuksköterskans roll i patientens helandeprocess. Slutsatserna som dras är att patientens upplevelser är unika och att vårdpersonalen behöver mer utbildning i existentiella frågor för att bättre kunna bemöta patienten.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Background: Liver transplantation is a curative method for end-stage liver diseases, small unresectable hepatocellular carcinoma and acute liver failure. The discovery of immunosuppressive drugs increases the survival rate of liver transplanted recipients by reducing the incidence of graft rejection. Several complications such as renal dysfunction and increase risk of malignancy result from life-long treatment of transplanted recipients with immunosuppressant. If recipients are over-immunosuppressed, the risk of infection might be increased. On the other hands, if recipients are under-immunosuppressed, the risk of rejection would be increased. It should be useful if a test or a bio-marker that could predict and differentiate infection and rejection in transplanted recipients. Therefore, patients could be treated before adverse conditions. Although therapeutic drug monitoring has been performed as a routine test, it is mainly targeted for minimizing drug toxicity but little help in predicting infection and rejection. A new assay named Cylex? Immuknow? assay is designed to measure global cell mediated immunity of immunosuppressed population, by quantifying the amount of ATP synthesis by CD4+ T cells in response to PHA stimulation. It is undergoing evaluation in assessing the immune status of patients in order to predict the risk of infection and rejection, and also other conditions. (1, 2) Objectives: In this pilot study, we would like to evaluate ImmuKnow for predicting the risk of infection and rejection in liver transplanted recipients in Hong Kong. Methods: Blood samples were collected from liver transplanted recipients at different time intervals. The immune cell response of these patients was measured by Immuknow assay. Patients with low immune response might have a high risk of infection, patients with high immune response might have a high risk of rejection, and patients with moderate immune response should be clinically stable. Results and conclusion: Twenty-six blood samples were collected from eight transplanted recipients. The average Immuknow assay value for the post-transplant samples was 304.6 ng/mL ATP which represented moderate immune cell response according to the interpretation table. (Table 3) This was reasonable as the subjects were all clinically stable by well-controlled immunosuppression. The result was consistent with other studies. (1, 3) However, the association between low immune cell response and infection, and the association between high immune cell response and graft rejection could not be investigated as both of these conditions were not found in this pilot study. A larger study including episodes of infection and rejection should be conducted in order to evaluate the value of Immuknow assay more completely. / published_or_final_version / Pathology / Master / Master of Medical Sciences

Haematological stem cell transplantation (HSCT) is a revolutionary treatment for haematological malignancies. Although HSCT is potentially curative, patients usually develop stomatitis which is a common and debilitating complication after the transplantation. Furthermore, stomatitis may predispose patients to various complications which are associated with significantly increased morbidity and mortality. In some studies, ice water mouthwash has been shown to be an effective method for the prevention of stomatitis. However, a high-level evidence-based protocol on the prevention of stomatitis has not been fully developed and it is not commonly practiced in most HSCT centers at present. A well established protocol can help to minimize the patients’ suffering and avoid prolonged hospitalization. The nurses who are involved in patient education, assessment, care for, and coping with stomatitis, play an important role to bring these innovations into practice. In this regard, this translational research aims at developing an evidence-based protocol on using ice water mouthwash in the prevention of stomatitis for patients undergoing autologous HSCT. A systematic search for relevant literatures was performed with the use of five electronic databases. Six relevant studies were found. Critical appraisal on the relevant studies was conducted. The level of evidence extracted from the studies was graded according to the Scottish Intercollegiate Guidelines Network (SIGN) and were synthesized to establish the protocol for patients in the proposed setting. The implementation potential of the protocol was assessed in terms of the transferability, feasibility, and cost benefit ratio. An implementation and evaluation plan was established for comprehensive evidence-based protocol development. The successful implementation of the protocol will be beneficial for the patients undergoing HSCT as it may hasten their recovery, shorten their hospital stay, and minimize their distressing experience and suffering. / published_or_final_version / Nursing Studies / Master / Master of Nursing