PurposeTo illuminate patients’ lived experiences of going through the process of being diagnosed with chronic obstructive pulmonary disease (COPD).Patients and methodsA phenomenological-hermeneutic analysis was applied in the interpretation of interviews with eight persons diagnosed with mild or moderate COPD.ResultsOne main theme ‘living in negotiation’, and three themes ‘living with a body out of step with the diagnosis’, ‘dealing with the past’, and ‘being challenged by the future’ reflected the process participants were living through in their quest for acceptance and a new balance in life. Participants found that the diagnostic processes were confusing, and that the diagnosis itself was ‘a slap in the face’. Unclear messages gave rise to fluctuating between an understanding of the condition as ‘not too severe’, insecurity, and fear. Shame and guilt related to the diagnosis had origins in the past, and in combination with the idea of ‘chronic’ the COPD diagnosis interfered with the present moment and gave rise to uncertainty for the future. The understanding of the present is related to negotiations not only with the past, but also with the future. Thus temporal aspects of the diagnosis are of great significance for the process of finding acceptance.ConclusionRegardless of disease severity, the diagnosis seems to be a breakdown of life, which puts life itself at stake. Medical professionals should be aware that the way the diagnosis is disclosed and communicated has considerable significance for how individuals understand and deal with their illness. The diagnosis should be communicated face-to-face, clearly and with empathy, and followed by information about COPD. Physicians should allow time and listen to the patients’ stories, and thus develop a shared understanding of the temporal aspect of the illness and patients’ needs and concerns. Thus, good communication is essential in determining whether the patient remains in negotiation, or enters a process toward acceptance and new understanding.
Background: The nature of free, uncomplexed prostate-specific antigen (PSA) in the circulation is still unknown. In this study, we developed novel anti-PSA antibodies using PSA produced by a metastasized cancer cell line, LNCaP, as an immunogen. Methods: Hybridoma cell lines were screened with different methods that aimed at finding antibodies specific for the forms of free PSA produced by LNCaP cell line. Obtained antibodies were further studied for their characteristics related to previously characterized monoclonal antibodies. Results: Numerous anti-PSA antibodies were obtained, of which four represented unique epitopes previously unrecognized by us. One free-PSA-specific antibody was bound to PSA on two distinct epitopes, and one antibody was bound to the carboxyl-terminal peptide of PSA. Two antibodies were found to bind to the peptide sequence adjacent to the internal cleavage site Lys145-Lys146. These antibodies failed to recognize internally cleaved PSA at Lys145-Lys146. We could not find anti-proPSA antibodies despite the fact that LNCaP PSA contained more than one-half of the zymogen form of PSA. Conclusions: We report, for the first time, novel anti-PSA antibodies that do not recognize internally cleaved PSA at Lys145-Lys146 and thus are specific for intact, unclipped PSA.
Some patients in nursing homes require extra attention to enable staff to detect and manage deterioration at an early stage. Nursing skills are vital to make systematic observations and assessments of a patient’s condition. It is challenging for nurses in nursing homes to make professional decisions without being able to consult other nurses. To improve the quality and safety of health care for patients and their relatives, the focus must be on working to ensure patient safety in nursing homes. Simulation-based learning can be one way to increase reflection on patient safety and develop health professionals’ knowledge, skills and attitudes, while protecting patients from unnecessary risks. Simulation-based learning as a method in medical education offers activities that mimic a clinical environment, where students can practice procedures and decision-making and where their critical thinking can be enhanced through role-play, videos or simulators. While simulation often takes place in a simulation center, in situ simulation refers to a learning activity that takes place in participants’ everyday work environment where they actually provide patient care. In this chapter, we aim to describe nurses’ experiences of in situ simulation and their subsequent reflections on patient safety in nursing homes. Data were collected from two focus groups with 5–6 nurses per group. The transcribed material was analyzed using qualitative content analysis, and two categories were identified that described the nurses’ experiences: “to doubt oneself” and “being dependent on others”.
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