•CNSs identify clinical problems and initiate system-level clinical projects.•CNSs are clinical experts; the better the expert work the less visible it becomes.•CNSs work is articulation; managing ...intersections of people, technology, organizations.•Articulation work was facilitated by self-agency, trust, influence.•Explains why the CNS role is often considered invisible and ambiguous.
Advanced practice registered nurses (APRN) are expected to contribute to improved patient outcomes. Traditionally, clinical nurse specialists (CNS) have been the APRN role that led system-level nursing practice initiatives to advance care for specialty populations. Little is known about the work processes used by CNSs to achieve outcomes.
This study identified common processes used by CNSs working in a variety of practice settings and specialties to advance nursing practice and achieve improved clinical outcomes.
Qualitative descriptive methods were used; a purposeful sample of CNSs with completed system-level projects participated in focus groups. Data were analyzed using standard content analysis process.
CNSs engaged in intricate interactions identified as articulation work involving the management of intersections between people, technology and organizations. This expert work is largely invisible. Self-agency, trust, and influence are a nexus upon which CNS work processes revolve.
The findings provide insight into CNS work processes, lend credibility to the CNS's leadership abilities, and help explain why the CNS role and practice is often considered invisible and ambiguous.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Previous research highlighted that a fundamental rethink of the measurement of domestic abuse was needed in the Crime Survey for England and Wales (CSEW). The research reported here aimed to develop ...and test new questions on domestic abuse for the CSEW to improve the headline prevalence measure, including frequency of abuse, to develop a way of measuring controlling or coercive behavior within the overall prevalence measure, and to develop a measure of the impact of abuse. The research included focus groups and interviews with victims (n = 27) to assess a set of draft questions and cognitive testing of revised questions with victims and the general public (n = 42). A final set of 24 questions was developed for use with victims of both intimate partner and family abuse, with an additional question for family abuse. The new questions were found to echo victim experiences and were deemed acceptable and reliable measures by victims and the general public for domestic abuse, including controlling and/or coercive behavior and impact. An analytical approach was recommended to improve the headline prevalence measure of domestic abuse by establishing ‘high’ and ‘low’ abuse profiles using measures of both behavior and impact.
Background
This study aimed to describe the clinical outcomes of total pancreatectomy with islet autotransplantation (TP‐IAT) in Australia.
Methods
Individuals selected for TP‐IAT surgery according ...to the Minnesota Criteria (Appendix) without evidence of diabetes were evaluated including time to transplantation from pancreatectomy, islet numbers infused and post‐transplantation HbA1c, C‐peptide, total daily insulin and analgesic requirement.
Results
Sixteen individuals underwent TP‐IAT from Australia and New Zealand between 2010 and 2020. Two recipients are deceased. The median islet equivalents/kg infused was 4244 (interquartile range (IQR) 2290–7300). The median C‐peptide 1 month post‐TP‐IAT was 384 (IQR 210–579) pmol/L and at median 29.5 (IQR 14.5–46.5) months from transplant was 395 (IQR 139–862) pmol/L. Insulin independence was achieved in eight of 15 (53.3%) surviving recipients. A higher islet equivalents transplanted was most strongly associated with the likelihood of insulin independence (P < 0.05). Of the 15 surviving recipients, 14 demonstrated substantial reduction in analgesic requirement.
Conclusion
The TP‐IAT programme in Australia has been a successful new therapy for the management of individuals with chronic pancreatitis including hereditary forms refractory to medical treatment to improve pain management with 50% insulin independence rates.
This study describes the Australian experience of total pancreatectomy with islet autotransplantation. Sixteen individuals underwent total pancreatectomy with islet autotransplantation in Australia from 2010 to 2020.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Nonalcoholic steatohepatitis (NASH) is often linked with disorders that are clearly associated with insulin resistance (IR): obesity, type 2 diabetes mellitus, and hypertriglyceridemia. We tested the ...hypotheses that (1) IR is an essential requirement for the development of NASH and (2) a high association between IR and liver disease is relatively specific for NASH. We measured body mass index (BMI), waist/hip ratio, and fasting serum lipid, insulin, C-peptide, and glucose levels in 66 patients with NASH (21 with advanced fibrosis and 45 with mild fibrosis). IR was determined by the homeostasis model assessment (HOMA). We also determined the strength of the association of NASH with insulin resistance syndrome (IRS) as defined by World Health Organization criteria. To assess whether the finding of IR was relatively specific to NASH rather than simply to obesity or liver disease, we compared the results of a subset of 36 patients with less-severe NASH with 36 age- and sex-matched patients with chronic hepatitis C virus (HCV) of comparable fibrotic severity. IR was confirmed in 65 patients (98%) with NASH, and 55 (87%) fulfilled minimum criteria for IRS. IR was found in lean as well as in overweight and obese patients. The IR values and the prevalence of IRS (75% vs. 8.3%) were significantly higher in those with NASH than in comparable cases of HCV. Hyperinsulinemia was attributable to increased insulin secretion rather than decreased hepatic extraction. In conclusion, most patients with NASH have IRS, and there is a near-universal association between NASH and IR irrespective of obesity. IR is present in mild as well as advanced cases of NASH but is unusual in chronic HCV of similar fibrotic severity. (HEPATOLOGY .)
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
DNA damage triggers polyubiquitylation and degradation of the largest subunit of RNA polymerase II (RNAPII), a “mechanism of last resort” employed during transcription stress. In yeast, this process ...is dependent on Def1 through a previously unresolved mechanism. Here, we report that Def1 becomes activated through ubiquitylation- and proteasome-dependent processing. Def1 processing results in the removal of a domain promoting cytoplasmic localization, resulting in nuclear accumulation of the clipped protein. Nuclear Def1 then binds RNAPII, utilizing a ubiquitin-binding domain to recruit the Elongin-Cullin E3 ligase complex via a ubiquitin-homology domain in the Ela1 protein. This facilitates polyubiquitylation of Rpb1, triggering its proteasome-mediated degradation. Together, these results outline the multistep mechanism of Rpb1 polyubiquitylation triggered by transcription stress and uncover the key role played by Def1 as a facilitator of Elongin-Cullin ubiquitin ligase function.
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•Def1 protein is proteolytically processed in response to transcription stress•Processing is ubiquitin and proteasome dependent•Processed Def1 (pr-Def1) accumulates in the nucleus, where it binds RNAPII•Using its CUE domain, pr-Def1 then recruits Elongin-Cullin via Ela1’s UbH domain
DNA damage induces proteasome-dependent proteolytic processing of Def1, releasing an activated protein fragment, which highlights how irreversible proteasome-mediated cleavage of a protein can act as a posttranslational modification in this signaling pathway.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Purpose
In 2020 the England and Wales Office for National Statistics commissioned the research reported here to review the current questions on domestic abuse in the Crime Survey for England and ...Wales (CSEW) and to establish how better data for policy and practice might be produced. The CSEW is a representative population survey that since the early 2000s has provided ongoing measurement of domestic abuse via a dedicated domestic abuse module, with regular publication of headline prevalence and other descriptive data. At the same time the measurement of domestic violence in the CSEW has also been the subject of ongoing debate and critique, in particular whether it is appropriate to use catch-all prevalence measures in the context of policy, practice and commissioning of services.
Method
The research included analysis of CSEW user survey data (N = 39), focus group and individual interviews with male and female victims/survivors (N = 11), consultation with core stakeholders (N = 18), and consideration of international surveys and recent legislation.
Results
Current CSEW questions do not capture domestic abuse accurately or reflect lived experience, coercive control needs to be seen at the core of domestic abuse, and while physical assault is an important part of measuring domestic abuse establishing frequency through counting events is probably impossible.
Conclusion
A fundamental rethink of the current CSEW self-completion module is required, with a wider set of questions about domestic abuse and impact. A revised module should identify and provide estimation of prevalence for different ‘abuse profiles’ that would complement improved headline measures and better inform policy and practice.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Measuring outcomes of clinical nurse specialist (CNS) practice is essential for demonstrating accountability. Literature is limited with respect to the scope of reported CNS outcomes. The National ...Association of Clinical Nurse Specialists' (NACNS) published listing of CNS outcomes could serve as an outcome measurement framework. Revalidation of these outcomes is an important step in creating a structured outcome measurement approach. The purpose of this descriptive study was to assess CNSs' perceptions of the ongoing validity of NACNS published outcomes. A Web-based survey asked participants to describe, for each of 42 outcomes, the frequency of outcome accountability, importance to practice, and frequency of monitoring. Of the 427 surveys returned, 347 (81%) were included in analysis. Findings demonstrated concordance between identified outcomes and actual CNS practice. When job descriptions included the CNS outcomes, more CNSs reported using the outcomes in practice. Both accountability and importance predicted the monitoring of outcomes (p < .001). This study demonstrated the ongoing validity of NACNS outcomes. Nurse educators must ensure that CNS program curricula are based on the NACNS framework and that successful achievement of program outcomes are congruent with the framework. These outcomes have potential for use as a conceptual framework for guiding future CNS outcome investigations and ongoing monitoring systems. Finally, the findings of this study give voice to CNS practice and provide knowledge about expectations for practice outcomes.
•Measuring outcomes of clinical nurse specialist (CNS) practice is essential for demonstrating accountability and effectiveness.•This descriptive study was carried out to assess CNSs' perceptions of the ongoing validity of outcomes published by the National Association of Clinical Nurse Specialists (NACNS).•Findings demonstrated concordance between identified outcomes and actual CNS practice.•Being accountable for an outcome and recognizing the outcome as important predicted whether the outcome was monitored.•Outcomes published by NACNS have potential for use as a conceptual framework for guiding future CNS outcome investigations and ongoing monitoring systems.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
This paper explores the use of chemical control by perpetrators as part of coercive controlling intimate partner violence and abuse, defined as the nonconsenting use of prescribed and nonprescribed ...medication (including vaccines), and/or other substances to coerce or control, reducing the victim-survivor's capacity for independence, freedom, and health. Based on testimonies of 37 victims-survivors and nine domestic abuse practitioners in the UK we identify varying tactics used to chemically coerce and control, deepening our understanding about the continually changing forms of domestic violence and abuse and enhancing the potential for a more robust response through better informed policy and practice.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK, VSZLJ
The PACE trial found that, when added to specialist medical care (SMC), cognitive behavioural therapy (CBT), or graded exercise therapy (GET) were superior to adaptive pacing therapy (APT) or SMC ...alone in improving fatigue and physical functioning in people with chronic fatigue syndrome 1 year after randomisation. In this pre-specified follow-up study, we aimed to assess additional treatments received after the trial and investigate long-term outcomes (at least 2 years after randomisation) within and between original treatment groups in those originally included in the PACE trial.
The PACE trial was a parallel-group randomised controlled trial of patients meeting Oxford criteria for chronic fatigue syndrome who were recruited from six secondary care clinics in the UK between March 18, 2005, and Nov 28, 2008. Participants were randomly allocated to receive SMC alone or plus APT, CBT, or GET. Primary outcomes (were fatigue measured with Chalder fatigue questionnaire score and physical functioning with short form-36 subscale score, assessed 1 year after randomisation. In this long-term follow-up, we sent postal questionnaires to assess treatment received after the trial and outcomes a minimum of 2 years after randomisation. We assessed long-term differences in outcomes within and between originally randomised groups. The PACE trial is registered at http://isrctn.org, number ISRCTN54285094.
Between May 8, 2008, and April 26, 2011, 481 (75%) participants from the PACE trial returned questionnaires. Median time from randomisation to return of long-term follow-up assessment was 31 months (IQR 30-32; range 24-53). 210 (44%) participants received additional treatment (mostly CBT or GET) after the trial; with participants originally assigned to SMC alone (73 63% of 115) or APT (60 50% of 119) more likely to seek treatment than those originally assigned to GET (41 32% of 127) or CBT (36 31% of 118; p<0·0001). Improvements in fatigue and physical functioning reported by participants originally assigned to CBT and GET were maintained (within-group comparison of fatigue and physical functioning, respectively, at long-term follow-up as compared with 1 year: CBT -2·2 95% CI -3·7 to -0·6, 3·3 0·02 to 6·7; GET -1·3 -2·7 to 0·1, 0·5 -2·7 to 3·6). Participants allocated to APT and to SMC alone in the trial improved over the follow-up period compared with 1 year (fatigue and physical functioning, respectively: APT -3·0 -4·4 to -1·6, 8·5 4·5 to 12·5; SMC -3·9 -5·3 to -2·6, 7·1 4·0 to 10·3). There was little evidence of differences in outcomes between the randomised treatment groups at long-term follow-up.
The beneficial effects of CBT and GET seen at 1 year were maintained at long-term follow-up a median of 2·5 years after randomisation. Outcomes with SMC alone or APT improved from the 1 year outcome and were similar to CBT and GET at long-term follow-up, but these data should be interpreted in the context of additional therapies having being given according to physician choice and patient preference after the 1 year trial final assessment. Future research should identify predictors of response to CBT and GET and also develop better treatments for those who respond to neither.
UK Medical Research Council, Department of Health for England, Scottish Chief Scientist Office, Department for Work and Pensions, National Institute for Health Research (NIHR), NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust, King's College London.
To compare meal-time glycaemia in adults with type 1 diabetes mellitus (T1D) managed with multiple daily injections (MDI) vs. insulin pump therapy (IPT), using self-monitoring blood glucose (SMBG), ...following diabetes education.
Adults with T1D received carbohydrate-counting education and a bolus calculator: MDI (Roche Aviva Expert) and IPT (pump bolus calculator). All then wore 3-weeks of masked-CGM (Enlite, Medtronic). Meal-times were assessed by two approaches: 1) Set time-blocks (breakfast 06:00–10:00hrs; lunch 11:00–15:00hrs; dinner 17:00–21:00hrs) and 2) Bolus-calculator carbohydrate entries signalling meal commencement. Post-meal masked-CGM time-in-range (TIR) 3.9–10.0 mmol/L was the primary outcome.
MDI(n = 61) and IPT (n = 59) participants were equivalent in age, sex, diabetes duration and HbA1c. Median (IQR) education time provided did not differ (MDI: 1.1 h (0.75, 1.5) vs. IPT: 1.1 h (1.0, 2.0); p = 0.86). Overall, daytime (06:00–24:00hrs), lunch and dinner TIR did not differ for MDI vs. IPT participants but was greater for breakfast with IPT in both analyses with a mean difference of 12.8%, (95 CI 4.8, 20.9); p = 0.002 (time-block analysis).
After diabetes education, MDI and IPT use were associated with similar day-time glycemia, though IPT users had significantly greater TIR during the breakfast period. With education, meal-time glucose levels are comparable with use of MDI vs. pumps.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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