Background
It is unknown how many distressed patients receive the additional supportive care recommended by Australian evidence-based distress management guidelines. The study identifies the (1) ...distress screening practices of Australian cancer services; (2) barriers to improving practices; and (3) implementation strategies which are acceptable to service representatives interested in improving screening practices.
Method
Clinic leads from 220 cancer services were asked to nominate an individual involved in daily patient care to complete a cross-sectional survey on behalf of the service. Questions related to service characteristics; screening and management processes; and implementation barriers. Respondents indicated which implementation strategies were suitable for their health service.
Results
A total of 122 representatives participated from 83 services (51%). The majority of respondents were specialist nurses or unit managers (60%). Approximately 38% of representatives’ services never or rarely screen; 52% who screen do so for all patients; 55% use clinical interviewing only; and 34% follow referral protocols. The most common perceived barriers were resources to action screening results (74%); lack of time (67%); and lack of staff training (66%). Approximately 65% of representatives were interested in improving practices. Of the 8 implementation strategies, workshops (85%) and educational materials (69%) were commonly selected. Over half (59%) indicated a multicomponent implementation program was preferable.
Conclusions
Although critical gaps across all guideline components were reported, there is a broad support for screening and willingness to improve. Potential improvements include additional services to manage problems identified by screening, more staff time for screening, additional staff training, and use of patient-report measures.
► This study used a livelihood vulnerability assessment method to identify sources of vulnerability and factors and processes that mediated households’ resilience in three remote fishing communities ...in Solomon Islands. ► The findings show that fisheries-related issues are not systematically recognized as being major sources of vulnerability, even for communities that depend heavily on marine resources for their income and food security, highlighting the need for a broader vulnerability assessment process to identify entry points for fisheries management. ► The analysis revealed a growing concern amongst coastal Solomon Islands populations for a combination of local (internal) and more global (external) contingencies and shocks, such as the erosion of social values and fear of climate change. ► The results demonstrate that social processes such as community cohesion, good leadership, and individual support to collective action are critical factors influencing the perception that people have about the capacity of their community to cope with change.
Successful management of socio-ecological systems not only requires the development and field-testing of robust and measurable indices of vulnerability and resilience but also improved understanding of the contextual factors that influence societal capacity to adapt to change. We present the results of an analysis conducted in three coastal communities in Solomon Islands. An integrated assessment map was used to systematically scan the communities’ multiple dimensions of vulnerability and to identify factors affecting households’ perception about their capacity to cope with shocks (resilience). A multivariate probit approach was used to explore relationships amongst factors. Social processes such as community cohesion, good leadership, and individual support to collective action were critical factors influencing the perception that people had about their community's ability to build resilience and cope with change. The analysis also suggests a growing concern for a combination of local (internal) and more global (external) contingencies and shocks, such as the erosion of social values and fear of climate change.
Purpose
People affected by chronic diseases such as cancer report high levels of distress and a need for psychosocial support. It is unclear whether telephone-based services for people affected by ...chronic disease are a practical setting for implementing distress screening, referral protocols and rescreening to direct supportive care where it is needed. This systematic review aimed to describe the published literature regarding distress screening and supportive care referral practices in telephone-based services for people affected by chronic diseases such as cancer.
Methods
A systematic literature search of MEDLINE, Embase, PsycInfo, CINAHL, Cochrane and Scopus was conducted in February 2018. Included quantitative studies involved: patients or caregivers affected by chronic diseases including cancer and describe a health service assessing psychosocial needs or distress via telephone. Extracted data included the type of cancer or other chronic disease, sample size, screening tool, referral or rescreening protocols, and type of health service.
Results
The search identified 3989 potential articles with additional searches returning 30 studies (
n
= 4019); fourteen were eligible for full-text review. Of the 14 studies, 13 included cancer patients. Studies were across multiple settings and identified nine distress screening tools in use.
Conclusion
The reviewed studies indicate that validated distress-screening tools are being used via telephone to identify distress, particularly in relation to cancer. Screening-driven supportive care referrals are also taking place in telephone-based services. However, not all services use an established referral protocol. Ongoing rescreening of callers’ distress is also limited despite it being an important recommendation from psycho-oncology guidelines.
Barrett's oesophagus is a precursor of oesophageal adenocarcinoma. In this common condition, squamous epithelium in the oesophagus is replaced by columnar epithelium in response to acid reflux. ...Barrett's oesophagus is highly heterogeneous and its relationships to normal tissues are unclear. Here we investigate the cellular complexity of Barrett's oesophagus and the upper gastrointestinal tract using RNA-sequencing of single cells from multiple biopsies from six patients with Barrett's oesophagus and two patients without oesophageal pathology. We find that cell populations in Barrett's oesophagus, marked by LEFTY1 and OLFM4, exhibit a profound transcriptional overlap with oesophageal submucosal gland cells, but not with gastric or duodenal cells. Additionally, SPINK4 and ITLN1 mark cells that precede morphologically identifiable goblet cells in colon and Barrett's oesophagus, potentially aiding the identification of metaplasia. Our findings reveal striking transcriptional relationships between normal tissue populations and cells in a premalignant condition, with implications for clinical practice.
Purpose
People diagnosed with cancer experience high distress levels throughout diagnosis, treatment, and survivorship. Untreated distress is associated with poor outcomes, including worsened quality ...of life and higher mortality rates. Distress screening facilitates need-based access to supportive care which can optimize patient outcomes. This qualitative interview study explored outpatients’ perceptions of a distress screening process implemented in an Australian cancer center.
Methods
Adult, English-speaking cancer outpatients were approached to participate in face-to-face or phone interviews after being screened by a clinic nurse using the distress thermometer (DT). The piloted semi-structured interview guide explored perceptions of the distress screening and management process, overall well-being, psychosocial support networks, and improvement opportunities for distress processes. Thematic analysis was used.
Results
Four key themes were identified in the 19 interviews conducted. Distress screening was found to be generally acceptable to participants and could be conducted by a variety of health professionals at varied time points. However, some participants found “distress” to be an ambiguous term. Despite many participants experiencing clinical distress (i.e., DT ≥ 4), few actioned referrals; some noted a preference to manage and prevent distress through informal support and well-being activities. Participants’ diverse coping styles, such as positivity, acceptance, and distancing, also factored into the perceived value of screening and referrals.
Conclusion and implications
Screening models only measuring severity of distress may not be sufficient to direct care referrals, as they do not consider patients’ varying coping strategies, external support networks, understanding of distress terminology, and motivations for accessing supportive care services.
To examine the prevalence and clustering of six health risk behaviours (smoking, alcohol, inadequate sun protection, physical inactivity, and inadequate fruit and vegetable consumption) among ...severely disadvantaged individuals.
A cross‐sectional touch screen computer survey was conducted with 383 clients attending a social and community welfare organisation in New South Wales. Participants were assessed on smoking status, alcohol consumption, fruit and vegetable consumption, physical activity, sun protection and socio‐demographic characteristics. Descriptive statistics, factor analysis and logistic regression were used to assess the prevalence, clustering and socio‐demographic predictors of health risk behaviours.
Ninety‐eight per cent of the participants reported inadequate vegetable consumption, 62.7% reported inadequate fruit consumption, 82.5% reported inadequate sun protection, 61.7% smoked tobacco, 51.4% consumed alcohol at risky levels and 36.5% were insufficiently active. Most participants (87%) reported three or more risk behaviours. Male participants, younger participants and those with lower education were more likely to smoke tobacco and consume alcohol.
The prevalence of health risk behaviours among a sample of typically hard‐to‐reach, severely disadvantaged individuals is extremely high.
Future intervention development should take into account the likelihood of health risk clustering among severely disadvantaged groups.
We demonstrated that the transduction of Wnt11 into mesenchymal stem cells (MSCs) (MSC
) promotes these cells differentiation into cardiac phenotypes. In the present study, we investigated the ...paracrine effects of MSC
on cardiac function and angiogenesis.
Conditioned medium was collected from MSC
(CdM
) and their control cells (CdM
). CdM
, especially obtained from MSC
exposed to hypoxia, significantly promoted human umbilical vein endothelial cells (HUVECs) migration and increased capillary-like tube (CLT) formation, which was blocked by Wnt11 neutralizing antibody. Wnt11 protein was significantly higher in CdM
compared to that in CdM
. Directly treating HUVECs with recombinant Wnt11 protein significantly increased CLT formation, which was abrogated by treating cells with the JNK inhibitor SP600125, as well as the PKC inhibitor Calphostin-C. Moreover, the transfection of Wnt11 to HUVECs (H
) significantly increased CLT formation and HUVEC migration, as well as upregulated p-pan-PKC and p-JNK expression. Injection of CdM
into the peri-infarct region in a rat acute myocardial infarction (AMI) model significantly improved cardiac function, reduced infarct size, and increased myocardial blood flow and blood vessel density in the ischemic area.
Wnt11 released from MSC
increased angiogenesis and improved cardiac function via non-canonical Wnt-PKC-JNK dependent pathways.
Using a novel program, SignalSleuth, and a database containing authenticated polyadenylation poly(A) sites, we analyzed the composition of mRNA poly(A) signals in Arabidopsis (Arabidopsis thaliana), ...and reevaluated previously described cis-elements within the 3'-untranslated (UTR) regions, including near upstream elements and far upstream elements. As predicted, there are absences of high-consensus signal patterns. The AAUAAA signal topped the near upstream elements patterns and was found within the predicted location to only approximately 10% of 3'-UTRs. More importantly, we identified a new set, named cleavage elements, of poly(A) signals flanking both sides of the cleavage site. These cis-elements were not previously revealed by conventional mutagenesis and are contemplated as a cluster of signals for cleavage site recognition. Moreover, a single-nucleotide profile scan on the 3'-UTR regions unveiled a distinct arrangement of alternate stretches of U and A nucleotides, which led to a prediction of the formation of secondary structures. Using an RNA secondary structure prediction program, mFold, we identified three main types of secondary structures on the sequences analyzed. Surprisingly, these observed secondary structures were all interrupted in previously constructed mutations in these regions. These results will enable us to revise the current model of plant poly(A) signals and to develop tools to predict 3'-ends for gene annotation.
Mangroves are an imperilled biome whose protection and restoration through payments for ecosystem services (PES) can contribute to improved livelihoods, climate mitigation and adaptation. Interviews ...with resource users in three Solomon Islands villages suggest a strong reliance upon mangrove goods for subsistence and cash, particularly for firewood, food and building materials. Village-derived economic data indicates a minimum annual subsistence value from mangroves of US$ 345–1501 per household. Fish and nursery habitat and storm protection were widely recognized and highly valued mangrove ecosystem services. All villagers agreed that mangroves were under threat, with firewood overharvesting considered the primary cause. Multivariate analyses revealed village affiliation and religious denomination as the most important factors determining the use and importance of mangrove goods. These factors, together with gender, affected users’ awareness of ecosystem services. The importance placed on mangrove services did not differ significantly by village, religious denomination, gender, age, income, education or occupation. Mangrove ecosystem surveys are useful as tools for raising community awareness and input prior to design of PES systems. Land tenure and marine property rights, and how this complexity may both complicate and facilitate potential carbon credit programmes in the Pacific, are discussed.
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