Background. Advances in genetics may change the practice of medicine in many ways. Ascertaining practitioners' perceptions about managing the risk of familial breast cancer can give an insight into ...the current and expected impact on general practice to inform relevant education. Little is known about the practice nurses' (PNs) views of the new genetics in comparison with those of the GP. Objectives. Our aim was to describe and compare the views of GPs and PNs on their experiences and expectations of the new genetics in relation to managing familial risk of breast cancer. Method. A questionnaire, assessing views on the current and future impact of genetic advances in general and on the management of women with a familial risk of breast cancer, was sent to all GPs and PNs in the 66 practices of the Cambridge and Huntingdon Health Authority. Results. There was a 69% response rate. The words ‘cautious’, ‘mixed feelings’, ‘hopeful’ and ‘optimistic’ were used most frequently in response to views on genetic advances, but PNs chose more positive words than GPs (P < 0.001). PNs were also more optimistic than GPs in relation to the future positive impact of genetics on practice (P < 0.0001). Sixty-one per cent of GPs and 45% of PNs agreed that genetic advances in relation to breast cancer were already affecting their work. A minority of practitioners had attended recent educational events in risk assessment for breast cancer, and only 8% of GPs reported a practice policy on familial breast cancer risk management. Conclusions. GPs and PNs show a cautious optimism in relation to advances in genetics, with PNs most optimistic. Many perceive that genetic advances in relation to breast cancer are already affecting their workloads, yet educational attendance and practice policies are lacking. Given PN involvement, multi-professional education may be appropriate. Education about risk management, including family history and genetics, might be better integrated into more general teaching on the prevention and management of breast cancer, than taught alone.
The aim of this study was to characterise lymphocyte cell population trafficking throughout the mucosal immune system following influenza virus infection. This information will be used as a “gold ...standard” to investigate the efficacy of a DNA vaccine candidate. Virus-specific immune responses were quantitated in terms of specific antibody and CD8
+ T cell frequency and distribution of response. Initial ELISA results demonstrated an IgG isotype-dominated response throughout the mucosal immune system predominantly seen in the mediastinal lymph node (MedLN). The IgA response observed in the MedLN was 70–100% virus-specific while the IgG response was an average of 20% virus-specific. Time point analysis showed initial virus-specific antibody produced in the MedLN and spleen, which spread to the lungs and nasal associated lymphoid tissue (NALT) and began to wane after day 21. Initial ELISPOT results following influenza infection demonstrated a mesenteric LN response perhaps indicating a wave of virus-specific CD8
+ T cells circulating throughout the mucosal immune system. Interestingly, DNA immunisation with plasmid expressing influenza nucleoprotein also produced a virus-specific T cell response in the NALT. It is hoped that this study will elucidate information regarding the common mucosal immune system and determine biological markers that correlate to vaccine efficacy.
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