Bortezomib-based induction therapies have shown to increase complete response rates and are used as an upfront therapy for newly diagnosed multiple myeloma patients. The standard treatment uses twice a week bortezomib at 1.3 mg/m^2 with dexamethasone PO on the day of and day after bortezomib, however, peripheral neuropathy is often a dose-limiting factor. For elderly patients with multiple co-morbidities and polypharmacy, we propose an alternate schedule of once a week bortezomib IV at 1.6 mg/m^2 with dexamethasone PO on the day of and day after bortezomib. In this phase II, open-labeled, multi-site study, we hypothesize that patients receiving weekly bortezomib will have comparable efficacy as the standard twice a week schedule with increased convenience and lower toxicity profile, especially related to peripheral neuropathy. METHODS: 50 patients with newly diagnosed symptomatic multiple myeloma who were ineligible for transplant or postponed transplant were enrolled from 12 Veterans Affairs hospitals. One cycle consisted of once a week 1.6 mg/m2 bortezomib IV (days 1, 8, 15, 22) plus dexamethasone PO on the day of and after bortezomib (days 1, 2, 8, 9, 15, 16, 22, 23) for 4 weeks, with the 5th week off of treatment. Responding patients could receive up to 6 cycles. RESULTS: The median age of patients was 71 ± 1.46 years (range: 50-89) with β-2 microglobulin of 5.80 ± 0.46 mg/L and c-reactive protein of 10.61 ± 5.54 mg/L. Patients also had multiple co-morbidities including cardiovascular disease (76%) renal insufficiency (54%) and pulmonary problems (36%) and were receiving a median of 13 concurrent medications at baseline. Of the fifty patients, 43 patients were evaluable for response. Seven patients received <1 cycle or died before response could be evaluated. An objective response rate of 79% was observed in 43 evaluable patients with 14% achieving nCR/CR, and at least VGPR in 44% of patients. The median progression-free survival was 9.6 months and overall survival was 46.5 months. The most common toxicity of all grades was thrombocytopenia (42%), lymphopenia (46%), asthenia (48%), and constipation (38%). Peripheral neuropathy occurred in 24% with grade 3 neuropathy occurring only in 6% of patients. In conclusion, a weekly bortezomib plus dexamethasone regimen is efficacious and safe, with lower neurotoxicity in elderly patients with newly diagnosed multiple myeloma complicated by extensive co-morbidities and polypharmacy.

Published research on diabetes in Ghana is quite limited and relates mainly to incidence and prevalence of the disease with little research on the patients experiences of coping with the diabetes. It is estimated that diabetes affects 6.3% of the Ghanaian population with type 2 diabetes accounting for 90-95% of all cases of diabetes. In Ghana, individuals diagnosed with type 2 diabetes mellitus are confronted with difficulties including the high cost of treatment of the condition, stigmatization, and interruptions to normal physiological processes. In addition, the patients experience, limited clinic accessibility, inadequate drug availability, inadequate numbers of trained staff, as well as limited availability of equipment needed for adequate care of the condition. The review of literature for this current thesis also showed that none of the studies on coping were undertaken in Ghana, but were conducted in the western world where socio-cultural factors are quite diverse from the Ghanaian situation. In the light of the challenges facing diabetic patients as well as the gap observed in literature, the study set out to explore the coping strategies of patients with type 2 diabetes mellitus at a hospital in Ghana. A hermeneutic phenomenological approach to qualitative research was utilized. Twenty seven (27) in-depth interviews carried out with newly diagnosed patients with type 2 diabetes, between August and October 2009 at a hospital in Ghana. Interviews were conducted in the local Ghanaian Twi language and English. Participants who could not speak English were interviewed in Twi language and later translated into English by the researcher. Data analysis used Creswell (1998) approach to qualitative data analysis, which provided a rich description of the essential structures of the phenomenon under study. The study identified patients’ perceptions as to the causes of diabetes mellitus, the social meanings attributed to diabetes (with particular attention paid to the language by Ghanaian people to describe disease condition), and subsequently reactions and resolutions to diagnosis. Patients discussed treatment options, while at the same time remaining hopeful of finding a cure. All patients had a firm spiritual belief system that underpinned their understanding of the causation and treatment of their illness. This combined with various degrees of understanding and acceptance of western explanations of illness influenced the coping strategies employed by patients, which variously reported as positive, negative, and alternative strategies. The study establishes a platform upon which health providers can develop educational programmes for diabetic patients in Ghana, which will address misconceptions about diabetes mellitus in Ghana and the importance of programmes of care, which take account of and build upon the cultural context of ‘being Ghanaian’. Diabetes, at least for Ghanaian patients is more than a biomedical disease. In this sense a biomedical framework in and of itself will not enable healthcare providers to effectively manage this chronic disease in the Ghanaian population, but through the inclusion of an understanding of their spiritual beliefs, healthcare providers can understand the realities of what it is like for Ghanaian diabetes patients to live with diabetes. It is argued that a stronger collaboration and integration between traditional healthcare systems and orthodox healthcare systems will provide the optimum opportunity to maximize patient care in Ghana. Future research should concentrate on better understanding how lay knowledge and health related attitudes, beliefs and behaviours are associated with diabetes in Ghana.

The aim of this study was to explore and describe the components required to build a therapeutic relationship with children diagnosed with Asperger Syndrome. Through this study therapists and other professionals working with these children could be guided to form functioning and healthy therapeutic relationships with children diagnosed with AS. An inductive, qualitative method was used to gain insight into the components required to build a therapeutic relationship with children diagnosed with AS by exploring the opinions and experiences of a selection of therapists from different therapeutic contexts that work with children diagnosed with AS. Six participants working with children diagnosed with AS at schools for children with learning difficulties, Autism and AS or therapists who form part of the referral teams of these schools in the Nelson Mandela Metropolitan took part in the study. Participants consisted of Occupational therapists, Speech therapists, Counselling Psychologists and Clinical Psychologists. The researcher used semi-structured interviews to explore and describe the opinions of the participants on the components required to build a therapeutic relationship with children diagnosed with AS. The results of this study indicated that building a therapeutic relationship with a child diagnosed with AS requires multiple components and a holistic outlook. Preparation in the form of research and being knowledgeable on the AS diagnosis, as well as obtaining thorough background information on the specific child was found to be fundamental. An awareness on the part of therapists and other professionals regarding child-related aspects such as co-morbid disorders; sensory considerations; therapeutic environment; coping with change; obsessions and dependence on the therapist was found to be of value. Other fundamental components that seem to be a requirement for building a therapeutic relationship with children diagnosed with AS were the therapist characteristics: body language and attitude. Therapeutic considerations, such as the importance of setting boundaries and remaining consistent, as well as the teaching aspect involved in building a therapeutic relationship became evident. Furthermore, the education of parents, siblings and other family members, as well as the importance of having fun while building a therapeutic relationship were recognized as important components. Teamwork was another crucial component identified which included parental and / Thesis (MA (Psychology))--North-West University, Potchefstroom Campus, 2013.

The aim of this study was to explore and describe the components required to build a therapeutic relationship with children diagnosed with Asperger Syndrome. Through this study therapists and other professionals working with these children could be guided to form functioning and healthy therapeutic relationships with children diagnosed with AS. An inductive, qualitative method was used to gain insight into the components required to build a therapeutic relationship with children diagnosed with AS by exploring the opinions and experiences of a selection of therapists from different therapeutic contexts that work with children diagnosed with AS. Six participants working with children diagnosed with AS at schools for children with learning difficulties, Autism and AS or therapists who form part of the referral teams of these schools in the Nelson Mandela Metropolitan took part in the study. Participants consisted of Occupational therapists, Speech therapists, Counselling Psychologists and Clinical Psychologists. The researcher used semi-structured interviews to explore and describe the opinions of the participants on the components required to build a therapeutic relationship with children diagnosed with AS. The results of this study indicated that building a therapeutic relationship with a child diagnosed with AS requires multiple components and a holistic outlook. Preparation in the form of research and being knowledgeable on the AS diagnosis, as well as obtaining thorough background information on the specific child was found to be fundamental. An awareness on the part of therapists and other professionals regarding child-related aspects such as co-morbid disorders; sensory considerations; therapeutic environment; coping with change; obsessions and dependence on the therapist was found to be of value. Other fundamental components that seem to be a requirement for building a therapeutic relationship with children diagnosed with AS were the therapist characteristics: body language and attitude. Therapeutic considerations, such as the importance of setting boundaries and remaining consistent, as well as the teaching aspect involved in building a therapeutic relationship became evident. Furthermore, the education of parents, siblings and other family members, as well as the importance of having fun while building a therapeutic relationship were recognized as important components. Teamwork was another crucial component identified which included parental and / Thesis (MA (Psychology))--North-West University, Potchefstroom Campus, 2013.

No description available.

Background: In Sweden, approximately  60,000 people are diagnosed with some sort of cancer every year. Of those, one-fifth are parents with minors. A cancer diagnosis can create great uncertainty for the diagnosed patient and their families. It is important, for many cancer patients, to receive psychological support and that the healthcare professionals, including counselors, who work with this patients possesses the knowledge required to be able to help them in the best way. Aim: I wish to highlight the various copingstrategies and provide greater insight into how parents, diagnosed with cancer and having young children, manage and experience their situation. I also want, from a gender perspective, to see if there are any similarities or differences in how mothers perceive their situation compared to fathers. Method: Descriptive literature review of 9 scientific articles. Results: Many of the coping strategies that parents used was focused on protecting their children. For instance, the parents would hesitate to talk to their children about the diagnosis because they felt that they lacked knowledge on how to talk to children about such a difficult subject In a good way. That led, in some cases, to the fact that some parents concealed the diagnosis or embellished the truth to their children. It also emerged from the study that procedures was one of the most common copingstrategies and seemed to have a positive effect on both the sick parent and the rest of the family.One of the differences between diagnosed mothers and fathers was that the mothers found it difficult to balance their own well-being while being a good parent.The guilt that it resulted in these mothers could be linked to how we see parenting. We could potentially link the guilt that these diagnosed mothers felt trying to find the balance between their own well-being and performing the good mother role to the general way we view parenting in our society today to the way we view parenting. Conclusion: Continues research must be done on how parents diagnosed with cancer and with minor children experience and manage their situation when there seems to be so little research done in this area. The findings of the literature shows that socialworkers and other healthcare staff must, if they do not already have it, acquire knowledge about how these parents can best talk to their children about cancer. It would also be desirable that the curators had an awareness of how the perception of the different parental roles affects both the individual and its environment during the period of illness. Increased awareness leads to increased understanding and increases the chance for the right help and support. / Background: In Sweden, approximately 60,000 people are diagnosed with some sort of cancer every year. Of those, one-fifth are parents with minors. A cancer diagnosis can create great uncertainty for the diagnosed patient and their families. It is important, for many cancer patients, to receive psychological support and that the healthcare professionals, including counselors, who work with this patients possesses the knowledge required to be able to help them in the best way. Aim: I wish to highlight the various copingstrategies and provide greater insight into how parents, diagnosed with cancer and having young children, manage and experience their situation. I also want, from a gender perspective, to see if there are any similarities or differences in how mothers perceive their situation compared to fathers. Method: Descriptive literature review of 9 scientific articles. Results: Many of the coping strategies that parents used was focused on protecting their children. For instance, the parents would hesitate to talk to their children about the diagnosis because they felt that they lacked knowledge on how to talk to children about such a difficult subject In a good way. That led, in some cases, to the fact that some parents concealed the diagnosis or embellished the truth to their children. It also emerged from the study that procedures was one of the most common copingstrategies and seemed to have a positive effect on both the sick parent and the rest of the family.One of the differences between diagnosed mothers and fathers was that the mothers found it difficult to balance their own well-being while being a good parent.The guilt that it resulted in these mothers could be linked to how we see parenting. We could potentially link the guilt that these diagnosed mothers felt trying to find the balance between their own well-being and performing the good mother role to the general way we view parenting in our society today to the way we view parenting. Conclusion: Continues research must be done on how parents diagnosed with cancer and with minor children experience and manage their situation when there seems to be so little research done in this area. The findings of the literature shows that socialworkers and other healthcare staff must, if they do not already have it, acquire knowledge about how these parents can best talk to their children about cancer. It would also be desirable that the curators had an awareness of how the perception of the different parental roles affects both the individual and its environment during the period of illness. Increased awareness leads to increased understanding and increases the chance for the right help and support.

The aim of the study is to investigate how clinicians in psychiatric care for adults consider borderline personality disorder to be manifested in men and women, respectively. Could there be a tendency to over-diagnose women and under-diagnose men? In addition, the purpose of the study is to bring clarity to the reasons for gender differences within borderline personality as perceived by the clinicians. The study is based on an inductive approach, in which interviews have been conducted with twelve clinicians working with borderline personality disorders to gain a deeper understanding of how the clinicians consider the manifestations of gender differences. The clinicians described tendencies for women to deliberate self-harm, have mood swings and problems in relations. Men with borderline personality disorders are described as having a higher degree of e.g. aggressiveness, addiction and criminal behaviour than women with the same diagnosis. Half of the informants think men are under- diagnosed for borderline personality disorders. This may indicate that other diagnoses are given to men instead or that men end up in other treatments. Possible explanations to the gender differences are discussed, such as societal factors, gender roles or criteria for diagnosis based on gender.

Background: One of nine women will at some point in life be treated for breast cancer. When a woman receives a cancer diagnosis, it can be a trigger of a life crisis, which manifests itself in different phases: shock phase, reaction phase, processing phase and reorientation phase. Breast cancer affects the women's lifeworld and create suffering. Aim: The aim of this study was to describe women's experiences of receiving a breast cancer diagnosis. Method: This is a literature-based study of twelve qualitative articles. The articles was analyzed according to a qualitative content analysis of Graneheim and Lundman (2004). Results: The findings of this study were that women with a newly-diagnosed breast cancer went through a life crisis while diagnosed. Three themes emerged; 1: 'To receive the diagnosis of breast cancer'. Subthemes that emerged in this theme was; 'To be in shock', 'Fear of the disease progress and its consequences', and 'Uncertainty about the future'. 2: 'Strategies to master the new life situation'. Subthemes was; 'Activities to manage everyday life', 'Trust in spirituality' and 'To accept the diagnosis'. 3: 'The inherent meaning of support'. Subthemes was; 'The importance of health professionals supportive and informative role' and 'The significance of family and friend's support'. Conclusion: Receiving a breast cancer diagnosis is manifested as multifaceted and had a great impact on women's lives. Spirituality had a great significance for women's life-world. How the diagnosis was received, was highly individual.

Studien syftar till att nå en förståelse för hur en person med Aspergers syndrom förstår sig själv och sin sociala miljö. Antalet personer som diagnostiserats med Aspergers syndrom blir högre men kunskapen bland människorna i samhället inte alltid är uppdaterad och det finns en hel del fördomar om personer med Aspergers syndrom. För att försöka förstå hur personer som själva lever med Aspergers syndrom uppfattar sig själva och sin vardag har jag använt mig utav tre självbiografier skrivna av personer som i vuxen ålder diagnostiserats med Aspergers syndrom. För att uppnå syftet med studien har jag valt att använda mig av hermeneutiken när jag ska försöka förstå författarnas upplevda känslor av sin egna självbild och att leva med Aspergers syndrom. Resultatet av denna studie visar att personer som inte fått sin diagnos Aspergers syndrom som barn under sin uppväxt upplever sig själva som annorlunda ur ett negativt perspektiv då de känner ett utanförskap och stora svårigheter att klara av skolan, både studier och det sociala samspelet. Detta i sin tur kan leda till minskade möjligheter på arbetsmarknaden och en egen försörjning. / The study aims to reach an understanding of how a person with Aspergers syndrom understands himself and his social environment. The number of people diagnosed with Aspergers syndrom are getting higher but the knowledge among the people in the society are not always updated and there are a lot of sterotypes about people with Aspergers syndrom. I am using three book that are written by persons that living with Aspergers syndrom, all three given the diagnos when they were adult. To aim my purpose with this study I choose to use the hermeneutics as method to try to understand how the writers feels about them self and their self-image and what it feels like to be living with Aspergers syndrome. The result of this study shows that persons that has not been diagnosed Aspergers syndrome until their are adult often sees themself as different from a negative perspective when they feel like outsiders, experiencing exclusion and have difficulties to manage the school. Both studies and the social interplay. In the end this might result in decreased possabilitys at the labor market and a self-sufficiency.

BACKGROUND: Inflammatory Bowel Disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), are chronic inflammatory conditions of the bowel that display a rising prevalence in childhood and adolescence. The diagnosis of a chronic condition, such as IBD, in childhood can be overwhelming and stressful for both the patient and caregiver. Parents and family members can play a critical role in providing emotional support for children with newly diagnosed IBD. We hypothesized that dysfunctional patient and parental coping strategies would correlate with increased anxiety and depression in children, worsening clinical disease activity, and increased healthcare utilization. OBJECTIVE: The primary objective of the IBD Coping Study is to assess the stability of coping strategies and psychological stress over the first year following a new diagnosis of IBD. Secondarily, we aim to assess the impact of child and parental coping strategies on disease activity and emotional well-being over the year. METHODS: This is a prospective, longitudinal cohort study of children with newly diagnosed IBD and their parents at Boston Children's Hospital (BCH). Patients between the ages of 9 and 17 years old that have been diagnosed with CD, UC or Indeterminate colitis (IC) within the last 6 months, are English-speaking, and receive routine care at BCH are approached for participation in our study. Participation includes the completion of previously validated psychological metrics for both child and parent at baseline and then again 12 months later. Our instruments include the Children's Depression Inventory (CDI), the Screen for Child Anxiety Related Disorders (SCARED), the IMPACT-III Questionnaire, the Patient Health Questionnaire (PHQ-9), Healthcare Utilization Survey, Pediatric Inventory for Parents (PIP), and the Hospital Anxiety and Depression Scale (HADS). RESULTS: We screened 187 patients with IBD for participation in our study, and roughly 30% of them were eligible for recruitment. To date, we have enrolled a total of 30 patients. Of these patients, there was an equal distribution of male and female participants. The majority of patients were around 14 years of age at the time of IBD diagnosis with a greater number of patients with CD (17) currently represented. We are approaching patients on average about 1.5 months after their initial diagnosis. The baseline average Pediatric Ulcerative Colitis Activity Index (PUCAI) score was 21.15 ± 20.53, whereas the average Pediatric Crohn's Disease Activity Index (PCDAI) score was 3.75 ± 2.50. On CDI items, teenage girls and boys reported increased raw and standardized scores (Raw: 5.83 and 4.83, respectively; Standardized: 43.67 and 44.67, respectively) than their younger counterparts for depressive behaviors, including negative mood and interpersonal problems. Pediatric patients encountered as inpatients reported an overall lower quality of life on IMPACT-III items (103.29 ± 15.11) than those approached in the ambulatory setting (140.36 ± 7.50). On SCARED items, patients met criteria for the potential presence of one or more anxiety disorders. Inpatients also reported being bothered more frequently with respect to hindrances in their sleep, appetite, and daily routines on the PHQ-9 metric. Parents of children with newly diagnosed IBD rely on increased communication with their child's primary GI provider, and their scores reflected lower emotional functioning during an admission period when compared to scores reported during regular scheduled ambulatory visits. Scores collected from the HADS screen demonstrate that 6% and 33% of parents reported a score great enough to be considered a "borderline case" for depression and anxiety measures, respectively. Primary comparisons between child health assessments and parent healthcare utilization depicted concurrent elevations in the same child-parent pair at baseline. CONCLUSION: Our initial findings suggest a clear disparity between emotional stability in children and their parents in outpatient and inpatient settings following a new IBD diagnosis. Healthcare utilization by parents may be linked to adaptive or maladaptive coping, and continuation of our study will substantiate this prediction. In looking ahead, potential interventions may require approaches stratified by age, gender, and hospital setting. Our study supports the need for further investigations into the impact of targeted interventions that promote an improvement in overall quality of life in children with IBD and their family during the first year of post-diagnosis.