Læknablaðið : fylgirit - 01.05.2002, Blaðsíða 22

ABSTRACTS / 33RD SNC & 2ND SCNN
duction. Antibodies have been shown to reduce the effects of IFN-
a in viral hepatitis and cancers of the blood or blood-forming
organs, in which recurrence of infection or malignant cells in the
blood can be accurately measured. The antibodies bind to different
epitopes of the interferons, and some of these binding antibodies
are neutralising antibodies (NAB), as measured in antiviral neutra-
lisation assays. The prevalence of NAB formation is most likely
influenced by intrinsic properties of the IFN preparation, such as
different IFN subtypes and their production, purification and
storage conditions. The prevalence is also influenced by the treat-
ment regimen, as a high dose gives a lower frequency of NAB than
does low-dose injection, and short dose intervals may induce earlier
and higher antibody response than long dose intervals. Further, the
NAB response is lower after intravenous and intramuscular versus
subcutaneous administration. The disease apparently also influ-
ences the formation of NAB, as the incidence is lower in cancer
patients than in patients with infectious diseases or MS. Some
studies have shown that the MHC types and race may be important
for inducing IFN antibodies. The assays used for NAB analysis may
influence the NAB prevalence, as different levels of sensitivity give
different results. The timing of the blood sampling is also important.
If blood samples are obtained shortly after the last injection of IFN,
a false-negative value may be observed because antibodies may be
complexed to the injected IFN. IFN-p is not detectable in serum
24-48 hours after the most recent injection, depending on the type
of IFN-b, dosage, route and frequency of administration.
Antibodies to IFN are commonly encountered in IFN-treated
MS, and it has been shown that the prevalence of NAB in MS
depends on the type of IFN-p and treatment regimen. However,
various prevalence rates have been reported from the trials, and the
clinical significance is still debated. Nevertheless, the problem
seems to be similar to that observed in hepatitis and cancer, as
reduced bioavailability and reduced clinical and MRI efficacy has
been demonstrated in NAB-positive MS patients.
In patients with treatment failure during IFN-P treatment
should be analysed for NAB. Patients that are NAB positive should
switch to another immunomodulatory drug like glatiramer acetate
(Copaxone®).
L12 - MS in lceland in the last century with particular emphasis
on the natural history
Benedikz JEG
Dept. of Neurology, Landspítali University Hospital Hringbraut, Reykjavík,
Iceland
Abstract not received.
L13 - Major Nursing Issues in the Rehabilitation of Stroke
Patients
Kirkevold M
Institute of Nursing Science, University of Oslo, Norway
Objective: Summarise results from a series qualitative longitudinal
studies focusing on adjustment and QoL following a stroke and
discuss major implications for rehabilitation nursing.
Material and Methods: In-depth interviews were conducted with
approximately 40 stroke patients during the first year. A field study
focused on nursing care provided in a specialised acute stroke unit.
22 Læknablaðið/Fylgirit 43 2002/88
Patients were interviewed 3 and 8 times by the same interviewer.
The narrative interviews focused on how the stroke impacted on
the lives of the patients over time and how the process of adjust-
ment evolved.
Results: The process of adjustment following a stroke is lengthier
and more complex than earlier supposed. It proceeds through diffe-
rent phases and varies greatly from patient to patient. It is influ-
enced by age, gender, cultural background and earlier experiences.
The adjustment process proceeds through several phases. The
patient must adjust both in terms of bodily, existential or biographi-
cal and daily life issues. Successful adjustment in terms of these
issues are essential for continued quality of life following a stroke.
The field study indicated that caring for stroke patients in the
acute phase involves consoling patients and family, conserving
energy and functions, interpreting the situation of the patients and
the ramifications of the stroke as well as integrating new skills and
functions into the daily structures of daily life of the patients and
the caring efforts of the staff.
Condusion: The process of adjusting following a stroke is far
reaching. It requires systematic and tailored efforts from nurses and
other health professionals in order to foster adjustment and quality
of life following the stroke.
L14 - Surviving To Thriving. My Journey As A Stroke Survivor
Johnson J
For most of us who have experienced a stroke, regaining a life of
quality is a long and arduous journey. First we have to simply
survive the immediate dangers of the stroke. And for the two thirds
of us who do remain alive find ourselves faced with perhaps the
biggest challenge we have ever know in our lifetime. Surviving is a
strong word. It literally means to remain alive, to struggle for
existence and to claim life. It implies hard work, determination and
strength to get beyond those first critical days when we are under
the care of neurology. This concept of surviving carries over to
rehabilitation efforts—a further need for hard work and sweat. The
word thriving means to move beyond surviving to a life where you
prosper, grow rigorously, and/or flourish. To move from surviving
to thriving is a process. There is a blending and movement back and
forth between these two concepts. It takes a conscious effort on the
part of the stroke survivor and all of those who touch and influence
their lives in order to move the rnode of thriving. This process
knows no end—it means that a stroke survivor must set out on a
new life journey that requires them to be constantly seeking,
persevering and working at living life to its fullest. It requires them
to accept that “they cannot control what has happened to them, but
they can control their attitude about what has happened”.
The process, or formula, for thriving as a survivor can be viewed
as analogous to the education process. In school we learn on two
levels: in the classroom where we learn from books along with the
guidance of teachers, and outside the classroom where we put to
practice what we have learned. Teachers are a critical factor in our
learning process - they inspire, motivate, and praise our accomp-
lishments. Take this same process and apply it to stroke recovery.
We soon discover that we have a lot to learn but are nai've as to how
long it will take! We are enrolled in classes for retraining our bodies,
Nurse consultant, Health Quest, Minneapolis, Minnesota, USA
j