Primary central nervous system lymphoma: implication of high-dose chemotherapy followed by auto-SCT

Primary central nervous system lymphoma is a rare and distinct subtype of non-Hodgkin's lymphoma that is sensitive to radiation and chemotherapy. Decisions regarding the initial therapeutic approach are influenced by age and risk of therapy-related neurotoxicity. Despite several albeit small phase II studies, and the acknowledged need for larger prospective trials, there is supporting evidence to consider auto-SCT following induction chemotherapy in patients with good performance status. The international extranodal lymphoma study group is conducting a randomized phase II study comparing consolidative radiation therapy to high-dose therapy. Novel therapeutic options including early aggressive approach with upfront auto-SCT and strategies to prevent relapse following transplantation is an area of focus.     

Nurses' attitudes and concerns pertaining to HIV and AIDS

A pilot study was conducted to identify nurses' attitudes and concerns pertaining to the care of people with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) Data were collected using an anonymous, voluntary questionnaire, which was made available to all nurses at a Wellington Area Health Board (New Zealand) hospital Of 562 nursing staff, 286 (51%) responded, of which 74 (25 9%) had previously attended an HIV/AIDS workshop for Area Health Board staff Of those staff handling blood, 132 (49 4%) always wore gloves, and only half of the respondents (n = 148, 51%) treated all body fluids as potentially HIV positive The possible attrition rate from nursing positions in the canvassed hospital was 2 8%, with a further 43 (15 0%) undecided about resigning from their post Only 56 nurses (12 5%) believed the employer did not provide adequate safety measures The provision of education regarding HIV/AIDS, by the employer, was considered inadequate by 61 (213%) respondents This study demonstrates that further safety and education needs should be attended to or reinforced     

Withdrawal of life-support treatment: the experience of critical care nurses

Technological advances in health care have made it possible to restore and prolong life for patients who would have died in the past. Unfortunately, one consequence of this is that some patients linger in intensive care units (ICUs), dependent on the technologies but with no hope of recovery. Therefore, decisions regarding withdrawal of life-support treatment are increasingly being faced by the health-care team.

This study aimed to explore the lived experience of critical care nurses who had cared for patients during withdrawal of life-support. The methodology employed was interpretive phenomenology. Interviews were conducted with seven critical care nurses, with the meanings of the experience of withdrawal of life-support treatment for these nurses extrapolated from the narratives and clustered into themes.

The study highlighted the importance of honest communication during the processes of decision-making and withdrawal of treatment. It was important for these nurses to be sure that family members were well-informed regarding the process of withdrawal of life-support treatment and that they could provide support and ensure that the patient's comfort and dignity were maintained during the process. The need to debrief after the event became evident but formal debriefing processes were rarely undertaken.     

Duplication of chromosome region 4q28.3-qter in monozygotic twins with discordant phenotypes

We describe monozygotic twins with partially discordant phenotypes who were found to have a duplication of chromosome region 4q28.3-qter. The duplicated region of chromosome 4 resulted from an unbalanced segregation of a balanced maternal (4;22)(q28.3;p13) translocation. Duplication of the long arm of chromosome 4 has been described in >60 patients; however, it usually results from the unbalanced segregation of a parental balanced translocation and has an associated monosomy. Twenty cases of dup 4q without an associated monosomy have been reported, and this is the only case of dup 4q28. 3-qter. All cases of dup 4q are reviewed, and phenotypic aspects are analyzed. Issues of monozygotic twinning and other birth defects also are addressed.     

夜班护士麻痹症状群:临床心理学的一种新现象?

夜间工作被认为可破坏生理节奏[1] ,而另一些卫生学专家认为夜间工作能引起抑郁症状反应[2 ] 。夜班护理工作确实可能成为一种特别的应激[3 ] ;因此实习护士常常需要心理支持 ,以帮助他们作好应对和适应的准备[4] 。对“夜班护士麻痹症状群”(ｎｉｇｈｔｎｕｒｓｅｓ’ｐａｒａｌｙｓ ｉｓ)这一现象曾有过报导[5] ,但尚没有科学研究来证明这种现象的存在。这种现象被描述为往往当护士在寂静不动时 ,有一种无力的感觉。例如护士在夜间坐病室观祭台执行观察任务时 ,神志清醒 ,但在短时间内不能按要求移动肢体。在这种情况下 ,他人的触动或低声…     

Donor Experiences of Second Marrow or Peripheral Blood Stem Cell Collection Mirror the First,but CD34+ Yields Are Less

Little is known about the experiences of individuals donating peripheral blood stem cells (PBSCs) or marrow for a second time. To study this, unrelated donors making a second donation through the National Marrow Donor Program between 2004 and 2013 were evaluated. Experiences of second-time donors giving marrow (n?=?118: first donation was PBSC in 76 and marrow in 42) were compared with those making only 1 marrow donation (n?=?5829). Experiences of second-time donors giving PBSCs (n?=?602) (first donation was PBSCs in 362; marrow in 240) were compared to first-time PBSC donors (n?=?16,095). For donors giving a second PBSC or marrow donation there were no significant differences in maximum skeletal pain, maximum symptoms measured by an established modified toxicity criteria, and recovery time compared with those who donated only once. Notably, the yield of marrow nucleated cells and PBSC CD34⁺ cells with second donations was less. As previously noted with single first-time donations, female (PBSCs and marrow) and obese donors (PBSCs) had higher skeletal pain and/or toxicity with a second donation. PBSC donors who experienced high levels of pain or toxicity with the first donation also experienced high levels of these symptoms with their second donation and slower recovery times. In conclusion, for most donors second donation experiences were similar to first donation experiences, but CD34⁺ yields were less. Knowledge of the donor's first experience and stem cell yields may help centers decide whether second donations are appropriate and institute measures to improve donor experiences.