This description of a large cohort of patients broadens the spectrum of clinical disease phenotypes linked to
CARD11
DN mutations, including atopy, cutaneous viral and respiratory infections, ...hypogammaglobulinemia, autoimmunity, neutropenia, and lymphoma.
Hydrophobic Blocks Facilitate Lipid Compatibility and Translocon Recognition of Transmembrane Protein Sequences Stone, Tracy A; Schiller NinaauthorCenter for Biomembrane Research, Department of Biochemistry and Biophysics, Stockholm University, SE-106 91 Stockholm, SwedenScience for Life Laboratory, Stockholm University, Box 1031, SE-171 21 Solna, Sweden; von Heijne GunnarauthorCenter for Biomembrane Research, Department of Biochemistry and Biophysics, Stockholm University, SE-106 91 Stockholm, SwedenScience for Life Laboratory, Stockholm University, Box 1031, SE-171 21 Solna, Sweden ...
2015
Journal Article
Background. A standard phenotype of frailty was associated with an increased risk of adverse outcomes including mortality in a recent study of older adults. However, the predictive validity of this ...phenotype for fracture outcomes and across risk subgroups is uncertain. Methods. To determine whether a standard frailty phenotype was independently associated with risk of adverse health outcomes in older women and to evaluate the consistency of associations across risk subgroups defined by age and body mass index (BMI), we ascertained frailty status in a cohort of 6724 women ≥ 69 years and followed them prospectively for incident falls, fractures, and mortality. Frailty was defined by the presence of three or more of the following criteria: unintentional weight loss, weakness, self-reported poor energy, slow walking speed, and low physical activity. Incident recurrent falls were defined as at least two falls during the subsequent year. Incident fractures (confirmed with x-ray reports), including hip fractures, and deaths were ascertained during an average of 9 years of follow-up. Results. After controlling for multiple confounders such as age, health status, medical conditions, functional status, depressive symptoms, cognitive function, and bone mineral density, frail women were subsequently at increased risk of recurrent falls (multivariate odds ratio = 1.38, 95% confidence interval CI, 1.02–1.88), hip fracture (multivariate hazards ratio MHR = 1.40, 95% CI, 1.03–1.90), any nonspine fracture (MHR = 1.25, 95% CI, 1.05–1.49), and death (MHR = 1.82, 95% CI, 1.56–2.13). The associations between frailty and these outcomes persisted among women ≥ 80 years. In addition, associations between frailty and an increased risk of falls, fracture, and mortality were consistently observed across categories of BMI, including BMI ≥ 30 kg/m2. Conclusion. Frailty is an independent predictor of adverse health outcomes in older women, including very elderly women and older obese women.
Restricting availability of essential amino acids (EAAs) limits aminoacylation of tRNAs by their cognate EAAs and activates the nutrient-sensing kinase, general control nonderepressible 2 (GCN2). ...Activated GCN2 phosphorylates eukaryotic initiation factor 2 (eIF2), altering gene-specific translation and initiating a transcriptional program collectively described as the integrated stress response (ISR). Central GCN2 activation by EAA deprivation is also linked to an acute aversive feeding response. Dietary methionine restriction (MR) produces a well-documented series of physiological responses (increased energy intake and expenditure, decreased adiposity, and increased insulin sensitivity), but the role of GCN2 in mediating them is unknown. Using Gcn2(-/-) mice, we found that the absence of GCN2 had no effect on the ability of MR to reduce body weight or adiposity, increase energy intake and expenditure, increase hepatic transcription and release of fibroblast growth factor 21, or improve insulin sensitivity. Interestingly, hepatic eIF2 phosphorylation by MR was uncompromised in Gcn2(-/-) mice. Instead, protein kinase R-like endoplasmic reticulum (ER) kinase (PERK) was activated in both intact and Gcn2(-/-) mice. PERK activation corresponded with induction of the ISR and the nuclear respiratory factor 2 antioxidant program but not ER stress. These data uncover a novel glutathione-sensing mechanism that functions independently of GCN2 to link dietary MR to its metabolic phenotype.
Communication errors have a negative impact on patient safety. It is therefore essential that healthcare professionals have the skills and confidence to speak up assertively when patient safety is at ...risk. Although the facilitators to and barriers of assertive communication have been the subject of previous reviews, evidence regarding the effectiveness of interventions designed to enhance assertive communication is lacking. Thus, this paper reports the findings from a systematic review of the effectiveness of assertiveness communication training programs for healthcare professionals and students.
The objective of this review is to identify, appraise and synthesise the best available quantitative evidence in relation to the effectiveness of assertiveness communication training programs for healthcare professionals and students on levels of assertiveness, communication competence and impact on clinicians’ behaviours and patient safety.
The databases included: CINAHL, Cochrane library, EMBASE, Informit health collection, MEDLINE, ProQuest nursing and allied health, PsycINFO, Scopus and Web of Science. The search for unpublished studies included: MedNar, ProQuest Dissertations & Theses A&I. Studies published in English from 2001 until 2016 inclusive were considered.
The review included original quantitative research that evaluated (a) any type of independent assertiveness communication training program; and (b) programs with assertiveness training included as a core component of team skills or communication training for healthcare professionals and students, regardless of healthcare setting and level of qualification of participants.
Studies selected based on eligibility criteria were assessed for methodological quality and the data were extracted by two independent researchers using the Joanna Briggs Institute critical appraisal and data extraction tools.
Eleven papers were critically appraised using the Joanna Briggs Institute critical appraisal checklists. Eight papers from the USA, Australia, Ireland, and Taiwan were included in the review.
Interventions to improve assertive communication were reported to be effective to some degree with all targeted groups except experienced anaesthesiologists. Face-to-face and multimethod programs, support from leaders, teamwork skills training and communication techniques adapted from the aviation industry were identified as appropriate approaches for optimising the effectiveness of assertiveness communication training programs. Behavioural change as the result of assertiveness interventions was evaluated by observer-based rating scales during simulation, whilst self-perceived knowledge and attitudes were evaluated using validated scales. Future research should consider evaluation of sustained effect on behaviour change and patient safety.
Summary of key points
The US Preventive Task Force (USPSTF) has updated screening criteria by expanding age range and reducing smoking history required for eligibility; the International Lung Screen ...Trial (ILST) data have shown that PLCOM2012 performs better for eligibility than USPSTF criteria.
Screening adherence is low (4%–6% of potential eligible candidates in the United States) and depends upon multiple system and patient/candidate‐related factors.
Smoking cessation in lung cancer improves survival (past prospective trial data, updated meta‐analysis data); smoking cessation is an essential component of lung cancer screening.
Circulating biomarkers are emerging to optimize screening and early diagnosis.
COVID‐19 continues to affect lung cancer treatment and screening through delays and disruptions; specific operational challenges need to be met.
Over 70% of suspected malignant lesions develop in the periphery of the lungs. Bronchoscopic navigational techniques have been steadily improving to allow greater accuracy with target lesion approximation and therefore diagnostic yield.
Fibre‐based imaging techniques provide real‐time microscopic tumour visualization, with potential diagnostic benefits.
With significant advances in peripheral lung cancer localization, bronchoscopically delivered ablative therapies are an emerging field in limited stage primary and oligometastatic disease.
In advanced stage lung cancer, small‐volume samples acquired through bronchoscopic techniques yield material of sufficient quantity and quality to support clinically relevant biomarker assessment.
Aims
The aims of this paper are to (a) outline the design and implementation of an evidence‐based assertiveness communication workshop for Japanese nursing students; and (b) report on the evaluation ...of nursing students’ satisfaction with the workshop using the Satisfaction with Assertiveness Communication Training Program Survey.
Background
A body of research attests to the relationship between assertive communication and patient safety. This paper reports the design and evaluation of an assertiveness communication training programme designed to enhance students’ ability to communicate safety in clinical practice.
Design
A culturally appropriate and evidence‐based assertiveness communication workshop, informed by Gagne's instructional design principles, was implemented for third‐year nursing students in two Japanese higher educational institutions in December 2017. A descriptive study design was used to evaluate the workshop.
Methods
Students’ perceptions of the workshop were evaluated using the Satisfaction with Assertiveness Communication Training Program Survey, which includes ten items that are rated using a 5‐point Likert scale from strongly disagree 1 to strongly agree 5. Data were analysed using descriptive statistics. The Revised Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) guidelines were used in the reporting of this study.
Results
A total of 111 students from a population of 150 participated in the study giving a response rate of 74%. The overall mean satisfaction score was 4.12 indicating a high level of agreement with each of the survey items. With the exception of two items, the mean scores were above 4.0. “Confidence in using assertiveness communication skills” and “Utilising role‐plays to practice learnt skills” received mean scores of 3.71 and 3.90, respectively.
Conclusion
Given the compelling research about the importance of assertive communication in health care, the results from this study support continuing investment in assertiveness communication training programmes for nursing students.
Relevance to clinical practice
Assertive communication is an essential communication skill for safe nursing practice. Culturally appropriate assertiveness communication training programmes are of particular relevance in hierarchical healthcare contexts.
The paper discusses an innovative educational approach that compared the use of different textual forms as stimulus materials in the teaching of an introductory mental health course.
Practitioners in ...many disciplines, including nursing, appreciate the value of narratives in making sense of experiences, challenging assumptions and enhancing learning: they enable exploration of reality from different perspectives and create an emotional resonance. Narratives help nursing students to uncover embedded meanings, values and beliefs; they can include written texts, illustrated texts or picture books.
180 students enrolled in an elective undergraduate nursing course.
This project afforded students the choice of critically analysing (a) a chapter from one of two autobiographies, (b) an illustrated text, or (c) an illustration from a picture book. Each text was a narrative account from a personal or carer's perspective of the experience of mental illness. Their written submissions were then analysed by means of a qualitative descriptive approach.
In analysis of the autobiographies students tended to paraphrase the authors' words and summarise their experiences. Those choosing the illustrated text were able to link the images and text, and provide a deeper and more insightful level of interpretation, albeit influenced by the author's personal account and expressed emotions; however, those analysing a picture book illustration demonstrated a surprising level of critical and creative thinking, and their interpretations were empathetic, insightful and thoughtful.
The use of picture books, although not a common approach in nursing education, appears to engage students, challenge them to think more deeply, and stimulate their imagination.
Anti-HSV therapies are only suppressive because they do not eliminate latent HSV present in ganglionic neurons, the source of recurrent disease. We have developed a potentially curative approach ...against HSV infection, based on gene editing using HSV-specific meganucleases delivered by adeno-associated virus (AAV) vectors. Gene editing performed with two anti-HSV-1 meganucleases delivered by a combination of AAV9, AAV-Dj/8, and AAV-Rh10 can eliminate 90% or more of latent HSV DNA in mouse models of orofacial infection, and up to 97% of latent HSV DNA in mouse models of genital infection. Using a pharmacological approach to reactivate latent HSV-1, we demonstrate that ganglionic viral load reduction leads to a significant decrease of viral shedding in treated female mice. While therapy is well tolerated, in some instances, we observe hepatotoxicity at high doses and subtle histological evidence of neuronal injury without observable neurological signs or deficits. Simplification of the regimen through use of a single serotype (AAV9) delivering single meganuclease targeting a duplicated region of the HSV genome, dose reduction, and use of a neuron-specific promoter each results in improved tolerability while retaining efficacy. These results reinforce the curative potential of gene editing for HSV disease.
Hierarchy and power characterize health‐care relationships around the world, constituting a barrier to assertive communication and a risk to patient safety. This issue is more problematic and complex ...in countries such as Japan, where deep‐seated cultural values related to hierarchy and power persist. The current paper is the second of two that present the findings from a study exploring Japanese nurses’ views and experiences of how cultural values impact assertive communication for health‐care professionals. We conducted semistructured interviews with 23 registered nurses, following which data were analyzed using directed content analysis. Two overarching themes emerged from the analysis: hierarchy/power and collectivism. In the present study, we focus on cultural values related to hierarchy and power, including differences in professional status, gender imbalance, seniority/generation gap, bullying, and humility/modesty. The findings from our research provide meaningful insights into how Japanese cultural values influence and constrain nurses’ communication and speaking up behaviors, and can be used to inform educational programs designed to teach assertiveness skills.
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