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Graziano F, Calandri E, Borghi M, Giacoppo I, Verdiglione J, Bonino S. Multiple sclerosis and identity: a mixed-methods systematic review. Disabil Rehabil 2024:1-18. [PMID: 39155841 DOI: 10.1080/09638288.2024.2392039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 08/08/2024] [Accepted: 08/09/2024] [Indexed: 08/20/2024]
Abstract
PURPOSE This systematic review addressed the following topics: (1) psychometric measures used to evaluate the identity/self in MS patients; (2) impact of MS on the identity/self of patients; (3) relationships between the identity/self and the adjustment to MS. METHOD Five electronic databases were searched for all peer-reviewed empirical studies published up to April 2024 (PROSPERO CRD42023485972). Studies were eligible if they included MS patients and examined identity/self through quantitative, qualitative, or mixed-method study design. MMAT (Mixed Method Appraisal Tool) checklist was used to assess the quality of included studies. After conducting narrative synthesis (quantitative studies) and thematic synthesis (qualitative studies), an integration was undertaken following a convergent segregated approach. RESULTS Forty-three studies were included (13 quantitative, 26 qualitative, and four mixed methods). Studies used measures of "self" to refer to specific domains, and of "identity" to highlight the individual's uniqueness and continuity of experience over time. MS causes a loss of various aspects of self (physical, working, family, and social self) and identity discontinuity. Maintaining a positive self-concept and integrating MS into one's identity are associated with better adjustment to MS. CONCLUSION Clinicians should consider the centrality of identity redefinition for the promotion of MS patients' adjustment to the illness.
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Affiliation(s)
- Federica Graziano
- Department of Psychology, University of Torino, Turin, Italy
- Cosso Foundation, Turin, Italy
| | | | - Martina Borghi
- Cosso Foundation, Turin, Italy
- CRESM (Regional Referral Centre for Multiple Sclerosis), AOU San Luigi Gonzaga Hospital, Turin, Italy
| | - Ilenia Giacoppo
- Department of Psychology, University of Torino, Turin, Italy
| | | | - Silvia Bonino
- Department of Psychology, University of Torino, Turin, Italy
- Cosso Foundation, Turin, Italy
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Lane AM. Chronic Sorrow in Stage 4 Cancer: A Spiritual Challenge. J Patient Exp 2024; 11:23743735241241953. [PMID: 38529205 PMCID: PMC10962036 DOI: 10.1177/23743735241241953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
Living with Stage 4 cancer impacts how individuals conceptualize themselves and how they conduct their everyday lives. Within this synopsis, I describe my experiences living with progressing Stage 4 breast cancer. The construct of chronic sorrow is applied to my experiences. I suggest that grief and chronic sorrow are largely spiritual issues and give examples of my spiritual practices. Finally, recommendations are offered for healthcare professionals.
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Affiliation(s)
- Annette M Lane
- Faculty of Health Disciplines, Athabasca University, Athabasca, Canada
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Waddington C, Flanagan K, Clements H, Harding E, van der Byl Williams M, Walton J, Crutch S, Stott J. Grief and loss in people living with dementia: a review and metasynthesis of qualitative studies. Aging Ment Health 2024; 28:408-421. [PMID: 37970882 DOI: 10.1080/13607863.2023.2280925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES This review seeks to synthesise qualitative studies that focus on the experience of grief and loss in people living with dementia. METHODS Included studies were quality appraised, synthesised and analysed using inductive thematic analysis. RESULTS 19 studies were selected for inclusion in the final review and metasynthesis, including 486 participants (115 participants living with dementia, 152 family carers, 219 professionals). Five key dimensions of grief in people living with dementia were identified during the analysis process: grieving for the person I used to be, grieving for how others see me, grieving for the person I will become, grieving for those who have died and what helps me with my grief. CONCLUSION It is evident that people living with dementia can experience grief related to a range of previous, current and anticipated losses. Many of the studies included in this review did not directly include people living with dementia in their research and did not ask participants directly about their experience of grief and loss. As grief is a highly personal and individual experience, further research addressing the experience of grief that directly includes participants living with dementia is required, in order to improve awareness of grief-related needs and to develop and deliver support to meet these needs.
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Affiliation(s)
- Claire Waddington
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Katie Flanagan
- Centre for Ageing Population Studies, Primary Care and Population Health, University College London, London, UK
| | - Henry Clements
- Clinical Education and Health Psychology, University College London, London, UK
| | - Emma Harding
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | | | - Jill Walton
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Sebastian Crutch
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - Joshua Stott
- ADAPT Lab, Clinical Education and Health Psychology, University College London, London, UK
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Podolinská L, Čáp J. Dignity of patients with multiple sclerosis: a qualitative descriptive study. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2021. [DOI: 10.15452/cejnm.2021.12.0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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Fernandes MA, Nóbrega MMLD, Zaccara AAL, Freire MEM, Andrade FFD, Costa SFGD. FAWCETT ANALYSIS AND EVALUATION MODEL APPLIED TO THE THEORY OF CHRONIC SORROW. TEXTO & CONTEXTO ENFERMAGEM 2021. [DOI: 10.1590/1980-265x-tce-2020-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: to analyze the Theory of Chronic Sorrow, following the model of analysis and evaluation of Nursing theories proposed by Jacqueline Fawcett. Method: a reflective study, developed through the investigation of the Theory of Chronic Sorrow and its application in the nursing practice. The sample consisted of eighteen studies that used the theory as a reference. A Model for Analysis and Evaluation of Nursing Theories was used, which involved, in the first stage, a detailed examination of the referred theory in terms of scope, context and content. In the second stage - evaluation - the criteria of clarity, significance, internal consistency, parsimony, testability, empirical adequacy and pragmatic adequacy were used. Result: This is a mid-range theory that is predictive in relation to the scope. As for the context, it is based on the stress and adaptation model. The content presents well-defined and interrelated concepts. The concepts of meta-paradigm have significance, internal consistency and are operable. It features a usable instrument: The Chronic Sorrow Questionnaire, reliable as a tracking tool to detect the presence of chronic sorrow. The theory is parsimonious, it can be used with chronic diseases and directed to people in the final phase of life and their family caregivers. Conclusion: this study may contribute to indicate the use of the Theory of Chronic Sorrow and support nursing care in promoting effective strategies and, consequently, improve the comfort of patients and their families in coping with chronic sorrow.
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Žiaková K, Čáp J, Miertová M, Gurková E, Kurucová R. An interpretative phenomenological analysis of dignity in people with multiple sclerosis. Nurs Ethics 2020; 27:686-700. [PMID: 31994972 DOI: 10.1177/0969733019897766] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Dignity is a fundamental concept in healthcare. The symptoms of multiple sclerosis have a negative effect on dignity. Understanding of lived experience of dignity in people with multiple sclerosis is crucial to support dignity in practice. RESEARCH AIM The aim was to explore the sense of dignity experienced by people with multiple sclerosis. RESEARCH DESIGN AND PARTICIPANTS An interpretative phenomenological analysis design was adopted, using data collected through face-to-face interviews with 14 participants. ETHICAL CONSIDERATIONS The study was approved by the faculty Ethical Committee (No. EC 1828/2016). FINDINGS Four interconnected superordinate themes emerged from analysis: Loss of a fully-fledged life: Violating the dignity-of-self; To accept and fight: Promoting the dignity-of-self; Contempt and rudeness: Indignity-in-relation; and Those who know and see, help: Promoting dignity-in-relation. The loss of former fully-fledged life has a dramatic impact on integrity and impaired dignity-of-self. Accepting illness and changed identity impaired by multiple sclerosis was the step that the participants considered to be important for reacquiring the sense of dignity. The participants encountered misunderstandings, prejudices, embarrassment, insensitive remarks, labelling, unwillingness and impersonal treatment as indignities. Acceptance of their condition, needed support, the feeling of being part of a group, sensitivity and the sharing of problems had a positive effect on their dignity. DISCUSSION Continual changes in functional ability threaten an individual's identity and were experienced as violations of dignity. Based on this, participant's dignity-of-self was not a moral, but much more existential value. Acceptance of changed identity and fighting spirit were important for restoring their dignity-of-self. The misunderstandings, prejudices and unwillingness had a negative impact on their dignity-in-relation. On the other side, support from others in fighting promoted their dignity-in-relation. CONCLUSION Dignity is manifested as a complex phenomenon of lived experience of people with multiple sclerosis and also an umbrella concept for providing good quality of person-centred care.
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Žiaková K, Čáp J, Miertová M, Gurková E. Dimensions of personal dignity of patients with multiple sclerosis: a qualitative narrative review. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2019. [DOI: 10.15452/cejnm.2019.10.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Chronic Sorrow in the Elderly. Arch Psychiatr Nurs 2017; 31:647-648. [PMID: 29179834 DOI: 10.1016/j.apnu.2017.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 04/12/2017] [Indexed: 10/19/2022]
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Okanli A, Tanriverdi D, Ipek Coban G, Asi Karakaş S. The Relationship Between Psychosocial Adjustment and Coping Strategies Among Patients With Multiple Sclerosis in Turkey. J Am Psychiatr Nurses Assoc 2017; 23:113-118. [PMID: 28368734 DOI: 10.1177/1078390316680027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a disease with significant psychosocial adjustment challenges. OBJECTIVE The objective of the study was to assess the psychosocial adjustment and coping strategies in patients with MS and to put forth the relationships between them. DESIGN The sample group comprised 85 outpatients with MS who were admitted to the Neurology Clinic of a university hospital for treatment between October 2007 and July 2008. Data were acquired via an information form and the Psychosocial Adjustment to Illness Scale and Coping Strategy Indicator. RESULTS It was determined that 55% of the patients had poor psychosocial adjustment levels. Statistically significant relationship was found between Psychosocial Adjustment to Illness Scale-Self-Report and problem solving as well as seeking social support coping strategies ( p < .01). Psychosocial adjustment got worse with decreasing problem-solving and seeking-social support coping strategies of patients. CONCLUSIONS The psychosocial adjustment to MS of patients is closely related with effective coping strategies. The results have emphasized the significant role of mental health and social services and coping strategies regarding the comprehensive care needs of these patients.
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Affiliation(s)
- Ayse Okanli
- 1 Ayse Okanli, PhD, Medeniyet University, Istanbul, Turkey
| | - Derya Tanriverdi
- 2 Derya Tanriverdi, PhD, Gaziantep University, Gaziantep, Turkey
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Soundy A, Roskell C, Elder T, Collett J, Dawes H. The Psychological Processes of Adaptation and Hope in Patients with Multiple Sclerosis: A Thematic Synthesis. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/ojtr.2016.41003] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Soundy A, Roskell C, Adams R, Elder T, Dawes H. Understanding Health Care Professional-Patient Interactions in Multiple Sclerosis: A Systematic Review and Thematic Synthesis. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/ojtr.2016.44018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Marrie RA, Reingold S, Cohen J, Stuve O, Trojano M, Sorensen PS, Cutter G, Reider N. The incidence and prevalence of psychiatric disorders in multiple sclerosis: a systematic review. Mult Scler 2015; 21:305-17. [PMID: 25583845 PMCID: PMC4429164 DOI: 10.1177/1352458514564487] [Citation(s) in RCA: 316] [Impact Index Per Article: 35.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Psychiatric comorbidity is associated with lower quality of life, more fatigue, and reduced adherence to disease-modifying therapy in multiple sclerosis (MS). OBJECTIVES The objectives of this review are to estimate the incidence and prevalence of selected comorbid psychiatric disorders in MS and evaluate the quality of included studies. METHODS We searched the PubMed, PsychInfo, SCOPUS, and Web of Knowledge databases and reference lists of retrieved articles. Abstracts were screened for relevance by two independent reviewers, followed by full-text review. Data were abstracted by one reviewer, and verified by a second reviewer. Study quality was evaluated using a standardized tool. For population-based studies we assessed heterogeneity quantitatively using the I² statistic, and conducted meta-analyses. RESULTS We included 118 studies in this review. Among population-based studies, the prevalence of anxiety was 21.9% (95% CI: 8.76%-35.0%), while it was 14.8% for alcohol abuse, 5.83% for bipolar disorder, 23.7% (95% CI: 17.4%-30.0%) for depression, 2.5% for substance abuse, and 4.3% (95% CI: 0%-10.3%) for psychosis. CONCLUSION This review confirms that psychiatric comorbidity, particularly depression and anxiety, is common in MS. However, the incidence of psychiatric comorbidity remains understudied. Future comparisons across studies would be enhanced by developing a consistent approach to measuring psychiatric comorbidity, and reporting of age-, sex-, and ethnicity-specific estimates.
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Affiliation(s)
- Ruth Ann Marrie
- Department of Internal Medicine, University of Manitoba, Canada/Department of Community Health Sciences, University of Manitoba, Canada
| | | | - Jeffrey Cohen
- Mellen Center for MS Treatment and Research, Cleveland Clinic, USA
| | - Olaf Stuve
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern, USA
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Italy
| | | | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, USA
| | - Nadia Reider
- Department of Community Health Sciences, University of Manitoba, Canada
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Pagnini F, Bosma CM, Phillips D, Langer E. Symptom changes in multiple sclerosis following psychological interventions: a systematic review. BMC Neurol 2014; 14:222. [PMID: 25433519 PMCID: PMC4253984 DOI: 10.1186/s12883-014-0222-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 11/11/2014] [Indexed: 02/08/2023] Open
Abstract
Background Multiple Sclerosis is a disease of the central nervous system involving a variety of debilitating physical, sensory, cognitive and emotional symptoms. This literature review evaluated the impact of psychological interventions on the physiological symptoms associated with the illness. Methods A systematic literature search was conducted using Medline, PsycINFO, Scopus, and the Cochrane Library databases, as well as reference lists. Relevant studies were selected and assessed according to a preset protocol. Results The search produced 220 articles, with 22 meeting inclusion criteria for the review. A total of 5,705 subjects with Multiple Sclerosis were analyzed. Results from the included studies indicate a general improvement in both psychological and physiological outcomes following psychological treatment. The most highly influenced physical symptoms include fatigue, sleep disturbances, pain, and physical vitality. Conclusions Findings from the review suggest a positive relationship between psychological interventions and physiological Multiple Sclerosis symptoms. Implications for future research are discussed.
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Affiliation(s)
- Francesco Pagnini
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy. .,Niguarda Ca' Granda Hospital, Milan, Italy. .,Department of Psychology, Harvard University, Cambridge, MA, USA.
| | - Colin M Bosma
- Department of Psychology, Harvard University, Cambridge, MA, USA.
| | - Deborah Phillips
- Department of Psychology, Harvard University, Cambridge, MA, USA.
| | - Ellen Langer
- Department of Psychology, Harvard University, Cambridge, MA, USA.
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Audulv Å, Packer T, Versnel J. Identifying gaps in knowledge: A map of the qualitative literature concerning life with a neurological condition. Chronic Illn 2014; 10:192-243. [PMID: 25085905 DOI: 10.1177/1742395313516133] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To describe patterns in the qualitative literature regarding the everyday experience of living with a neurological condition; to identify areas of depth as well as gaps in the existing knowledge base. METHODS An extensive search of the literature yielded 474 articles meeting the inclusion criteria. Data extraction, based on scrutiny of both abstract and full text article included country of origin, diagnosis, stated aim, methodological framework/design, participants, and data collection method(s). Studies were categorized into 27 topics within four broad foci. RESULTS Four broad foci describe the field: impact and management, daily activities and occupations, impact on family, and the healthcare experience. Overall the research is unevenly distributed by diagnosis; some are well represented while others are the subject of little research. Even diagnoses well represented in quantity can be limited in breadth. DISCUSSION Possible explanations for the patterns of emphasis include: a focus on issues and problems, highlighted points of contact between patients and healthcare providers, and ability of participants to voice their views. The literature is also characterized by limited across diagnoses research or that comparing the experience of people with different diagnoses. There is a need for more research in particular diagnoses; more varied data collection methods and acknowledgement of ethnicity, gender, discrimination, and social inequalities.
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Affiliation(s)
- Åsa Audulv
- Department of Nursing, Mid Sweden University, Sundsvall, Sweden School of Occupational Therapy, Dalhousie University, Halifax, Canada
| | - Tanya Packer
- School of Occupational Therapy, Dalhousie University, Halifax, Canada
| | - Joan Versnel
- School of Occupational Therapy, Dalhousie University, Halifax, Canada
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Soundy A, Benson J, Dawes H, Smith B, Collett J, Meaney A. Understanding hope in patients with Multiple Sclerosis. Physiotherapy 2012; 98:344-50. [DOI: 10.1016/j.physio.2011.05.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Accepted: 05/15/2011] [Indexed: 11/16/2022]
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Noorda G, van Achterberg T, van der Hooft T, Smeitink J, Schoonhoven L, van Engelen B. Problems of adults with a mitochondrial disease - the patients' perspective: focus on loss. JIMD Rep 2012; 6:85-94. [PMID: 23430944 PMCID: PMC3565683 DOI: 10.1007/8904_2011_121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 11/25/2011] [Accepted: 11/28/2011] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE This study aimed to identify problems as experienced by adults with a mitochondrial disease. We chose to describe these problems from the patients' perspective as we thought this would give optimal input for care improvement. DESIGN A qualitative design using the grounded theory approach, involving single individual open interviews with 16 adults with a mitochondrial disease. RESULTS This study revealed "loss" as the main concept, where one loss often preceded other losses. Respondents mentioned loss of energy as the most basic loss in having a mitochondrial disease, leading to multiple varied losses in all areas of daily life. Looking back, they mentioned psychosocial-spiritual problems and dealing with actual and expected future losses as most prominent and difficult. In our study, we determined seven comprehensive themes: "loss of energy", "loss of independence and autonomy", "loss of social participation", "loss of personal identity", "loss of dreams and future" as well as "lack of health care" and "coping and adjustment". CONCLUSIONS In this first study on this theme, we developed a theory about patient's losses related to mitochondrial disease. They experience a variety of problems in the physical, psychological, social and spiritual human domain. Patients experience a lack of health care and professional support as well. They use various strategies to manage their multiple losses and experience circumstances in which it is difficult to manage them effectively. The results can be used as a guide for improving health care, education and research and might result in an improved quality of life.
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Affiliation(s)
- Greet Noorda
- Department of Paediatrics, Radboud University Nijmegen Medical Centre, 9101, Internal Post Number 833, 6500, Nijmegen, The Netherlands,
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Quality of Life in Patients With Multiple Sclerosis in Turkey: Relationship to Depression and Fatigue. J Neurosci Nurs 2010. [DOI: 10.1097/jnn.0b013e3181ecb019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
BACKGROUND The PRISMS (Prevention of Relapses and disability by Interferon beta-1a Subcutaneously in Multiple Sclerosis) study was initiated in 1994, at which time there were few disease-modifying drugs for multiple sclerosis (MS). The PRISMS series of studies has since provided up to 8 years of clinical, magnetic resonance imaging (MRI), safety, and immunogenicity data on the use of subcutaneous (sc) interferon (IFN) beta-1a in patients with relapsing-remitting MS. This review is the first collation of all these data in one article, with a look ahead to the next generation of studies involving the new formulation of sc IFN beta-1a. METHODS Published efficacy, safety, and immunogenicity data, in terms of prospectively defined endpoints and later post hoc analyses, from years 1-8 of the PRISMS series are summarized and collated for the first time. Some of the studies of sc IFN beta-1a that evolved from the PRISMS studies are also discussed. FINDINGS In the 2-year, double-blind, randomized, placebo-controlled study, IFN beta-1a (22 or 44 mcg three times weekly [tiw]) was associated with significantly lower relapse rates, disability progression, and MRI burden of disease compared with placebo (p <or= 0.05). Subsequently, in the 2-year extension, patients previously receiving placebo were re-randomized to active treatment, and a further 2 years of open-label treatment confirmed good long-term safety and therapeutic efficacy. Follow-up visits at years 7 or 8 (68.2% of initial population) demonstrated a continued benefit for patients originally randomized to the 44-mcg dose compared with those receiving the 22-mcg dose or whose treatment had been delayed by 2 years. Neutralizing antibodies were more common in patients receiving the 22-mcg dose and attenuated treatment efficacy during years 1-4. CONCLUSION Class I and long-term data from PRISMS support the use of sc IFN beta-1a tiw as a first-line treatment for MS, as evidenced by sustained efficacy rates, acceptable safety profiles, and high patient retention rates.
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Affiliation(s)
- Bruce A Cohen
- Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA.
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Liedström E, Isaksson AK, Ahlström G. Chronic sorrow in next of kin of patients with multiple sclerosis. J Neurosci Nurs 2008; 40:304-11. [PMID: 18856252 DOI: 10.1097/01376517-200810000-00009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The well-being of patients' next of kin can be an important factor with regard to the care and rehabilitation of patients with multiple sclerosis (MS). The aim of this qualitative study was to explore the presence and meaning of chronic sorrow in a group of next of kin of patients with MS. Using a semistructured interview guide as a basis, 44 next of kin were interviewed. The results showed that 35 (80%) of the participants were considered to have chronic sorrow based on predetermined criteria. Three main themes characterized the meaning of chronic sorrow: loss of security, loss of sense of community in family life, and loss of joy and recreation. This study indicates that nurses need to devote greater attention to the well-being of next of kin, offering support programs to help them cope with chronic sorrow.
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