How an appreciation of politics, power and control informs an ethical attitude towards research into chief nurse leadership

How an appreciation of politics, power and control informs an ethical attitude towards research into chief nurse leadershi

Perspectives and explanations of successful executive nurse leadership in English NHS Trust Boards

tle:07ab31a6-c242-444e-a5ae-ea02765e4fc7:d6bd9758-527a-46cd-bfe2-c433766e8fca:1Background: Executive Nurses are members of English NHS unitary Trust Boards; they hold a complex role that is pivotal to securing high-quality patient care. Executive nurses can be cited as being responsible when care failings are identified. Despite its stated importance, limited research has examined the role in the last 20 years. This study aimed to understand the perceptions of successful executive nurse leadership from the perspective of chief executive officers, medical directors, and senior leaders from within the health system and of executive nurses themselves to explain the potential forces that might explain why successful leadership may be experienced in the way that it is described. In understanding and explaining successful executive nurse leadership, it is hoped that any recommendations could accelerate implementation into practice. Methods: A critical realist and narrative study design was used to conduct semi-structured interviews with 19 participants. The participants shared their stories of successful executive nurse leadership within the boardroom; the data was analysed using critical realist and narrative thematic analysis. The Oxford Brookes University Research Ethics Committee granted ethical approval. Results: A narrative for each participant group was created. The four narratives were formed into a synthesis that created a meta-narrative describing the experience of successful executive nurse leadership and potential explanations of why it may be experienced that way. Executive nurses’ leadership experience can be characterised as a liminal space that they transition through. The potential explanations that form their experiences may lay in the perceptions held by the board about nurses and nursing, including the way the executive nurse talks about nursing to avoid being perceived as too ‘nursey’; the different perceptions between the credibility and authority between the medical director and the executive nurse held by the board and the invisible cultural clashes of New Public Management and professional nursing. Conclusion: Nursing does not speak for itself, meaning that executive nurses must first establish themselves as credible to be influential within the boardroom, in contrast to medicine, which assumes a higher status. Executive nurses lead using a relational approach that under-labours the policy-promoted contemporary leadership approach. Relational leadership capability is potentially drawn from the therapeutic skills acquired as a nurse. It enables executive nurses to build and sustain complex relationships that create collaboration and partnerships to achieve a common goal of providing safe patient care. To succeed, the executive nurse must navigate and be able to contend with the barriers, unconscious bias and prejudices associated with nursing and nurses articulated as ‘nursism’ through Fricker’s (2007) concept of epistemic injustice. Recommendations: For policy, education, practice, and further research focusing on explaining the cultural context of executive nurses, the leadership development of aspiring and future executive nurses. The need to engage with policy influencers within nursing, medicine and health services is recommended. New nursing narratives are needed to challenge the perceptions of nursing and break the silence of the hidden complex work that nursing involves

Evaluation Of Sensitivity To Chemotherapeutants In Successive Generations Of Lepeoptheirus Salmonis From A Resistant Population

There are currently reports of reduced sensitivity to certain lice treatments in different parts of Scotland and world-wide, and research is on-going into the extent and mechanisms of resistance to different treatments (Denholm et al., 2002; Sevatdal & Horsberg, 2003; Sevatdal et al., 2005). In particular, increasing evidence of resistance of Lepeophtheirus salmonis to the chemotherapeutant emamectin benzoate (Lees et al., 2008; Espedal et al., 2010) poses a serious problem to commercial farms because there are few licensed and effective treatments available

Evaluating a process of academic detailing in primary care: an educational programme for acute kidney injury

BackgroundPrimary care has a significant role in AKI management: two-thirds of AKI originates in the community. Through academic detailing (an evidence-based educational approach) we aimed to implement and measure the effect of a primary care-based education programme based around academic detailing and peer-reviewed audit.MethodsThe education programme took place across a large clinical commissioning group (CCG) consisting of 55 primary care practices. All 55 practices participated in large group teaching sessions, 25 practices participated in academic detailing and 28 of the remaining 30 practices performed internal AKI audit. Over a 12 month period, an educational programme was delivered consisting of large group teaching sessions followed by either academic detailing sessions or self-directed AKI audit activity. Academic detailing sessions consisted of a short presentation by a consultant nephrologist followed by discussion of cases. Qualitative feedback was collected from all participants at peer review sessions. Web-based, CCG-wide questionnaires assessed baseline and post-intervention knowledge levels.ResultsNine hundred ninety-six individuals completed the questionnaires (556 at baseline, 440 at 1 yr., 288 participated in both). Exposure to AKI teaching, self-reported awareness and confidence levels were higher in the second questionnaire. There was a significant increase in the percentage of correct answers before and after the intervention (55.6 ± 21% versus 87.5 ± 20%,

Key role of mitochondrial mutation Leu107Ser (COX1) in deltamethrin resistance in salmon lice (Lepeophtheirus salmonis)

The pyrethroid deltamethrin (DTM) is used to treat Atlantic salmon (Salmo salar) against salmon louse (Lepeophtheirus salmonis) infestations. However, DTM resistance has evolved in L. salmonis and is currently common in the North Atlantic. This study aimed to re-assess the association between DTM resistance and mitochondrial (mtDNA) mutations demonstrated in previous reports. Among 218 L. salmonis collected in Scotland in 2018–2019, 89.4% showed DTM resistance in bioassays, while 93.6% expressed at least one of four mtDNA single nucleotide polymorphisms (SNPs) previously shown to be resistance associated. Genotyping at further 14 SNP loci allowed to define three resistance-associated mtDNA haplotypes, named 2, 3 and 4, occurring in 72.0%, 14.2% and 7.3% of samples, respectively. L. salmonis strains IoA-02 (haplotype 2) and IoA-10 (haplotype 3) both showed high levels (~ 100-fold) of DTM resistance, which was inherited maternally in crossing experiments. MtDNA haplotypes 2 and 3 differed in genotype for 17 of 18 studied SNPs, but shared one mutation that causes an amino acid change (Leu107Ser) in the cytochrome c oxidase subunit 1 (COX1) and was present in all DTM resistant while lacking in all susceptible parasites. We conclude that Leu107Ser (COX1) is a main genetic determinant of DTM resistance in L. salmonis

Investigation of deltamethrin resistance in salmon lice (Lepeophtheirus salmonis) provides no evidence for roles of mutations in voltage-gated sodium channels

BACKGROUND The pyrethroid deltamethrin is used to treat infestations of farmed salmon by parasitic salmon lice, Lepeophtheirus salmonis (Krøyer). However, the efficacy of deltamethrin for salmon delousing is threatened by resistance development. In terrestrial arthropods, knockdown resistance (kdr) mutations of the voltage‐gated sodium channel (Nav), the molecular target for pyrethroids, can cause deltamethrin resistance. A putative kdr mutation of an L. salmonis sodium channel homologue (LsNav1.3 I936V) has previously been identified. At the same time, deltamethrin resistance of L. salmonis has been shown to be inherited maternally and to be associated with mitochondrial DNA (mtDNA) mutations. The present study assessed potential roles of the above putative kdr mutation as a determinant of deltamethrin resistance in laboratory strains and field populations of L. salmonis. RESULTS The deltamethrin resistant L. salmonis strain IoA‐02 expresses the LsNav1.3 I936V mutation but was susceptible to the non‐ester pyrethroid etofenprox, a compound against which pyrethroid resistant arthropods are usually cross‐resistant if resistance is caused by Nav mutations. In a family derived from a cross between an IoA‐02 male and a drug‐susceptible female lacking the kdr mutation, deltamethrin resistance was not associated with the genotype at the LsNav1.3 locus (p>0.05). Similarly, in Scottish field populations of L. salmonis, LsNav1.3 I936V showed no association with deltamethrin resistance. In contrast, genotypes at the mtDNA loci A14013G and A9030G were significantly associated with deltamethrin resistance (P less than 0.001). CONCLUSION In the studied L. salmonis isolates, deltamethrin resistance was unrelated to the LsNav1.3 I936V mutation, but showed close association with mtDNA mutations

A causal role for TRESK loss of function in migraine mechanisms

The two-pore potassium channel, TRESK has been implicated in nociception and pain disorders. We have for the first time investigated TRESK function in human nociceptive neurons using induced pluripotent stem cell-based models. Nociceptors from migraine patients with the F139WfsX2 mutation show loss of functional TRESK at the membrane, with a corresponding significant increase in neuronal excitability. Furthermore, using CRISPR-Cas9 engineering to correct the F139WfsX2 mutation, we show a reversal of the heightened neuronal excitability, linking the phenotype to the mutation. In contrast we find no change in excitability in induced pluripotent stem cell derived nociceptors with the C110R mutation and preserved TRESK current; thereby confirming that only the frameshift mutation is associated with loss of function and a migraine relevant cellular phenotype. We then demonstrate the importance of TRESK to pain states by showing that the TRESK activator, cloxyquin, can reduce the spontaneous firing of nociceptors in an in vitro human pain model. Using the chronic nitroglycerine rodent migraine model, we demonstrate that mice lacking TRESK develop exaggerated nitroglycerine-induced mechanical and thermal hyperalgesia, and furthermore, show that cloxyquin conversely is able to prevent sensitization. Collectively, our findings provide evidence for a role of TRESK in migraine pathogenesis and its suitability as a therapeutic target

Maternal inheritance of deltamethrin resistance in the salmon louse Lepeophtheirus salmonis (Krøyer) is associated with unique mtDNA haplotypes

Parasitic infections by the salmon louse, Lepeophtheirus salmonis (Krøyer), cause huge economic damage in salmon farming in the northern hemisphere, with combined treatment costs and production losses in 2014 having been estimated at US$ 350 million for Norway (annual production 1.25 million tonnes). The control of L. salmonis relies significantly on medicinal treatments, supplemented by non-pharmacological approaches. However, efficacy losses have been reported for several delousing agents, including the pyrethroid deltamethrin. The aim of the present study was to analyse the genetic basis of deltamethrin resistance in L. salmonis. Deltamethrin median effective concentrations (EC50) were 0.28 μg L-1 in the drug susceptible L. salmonis strain IoA-00 and 40.1 μg L-1 in the pyrethroid resistant strain IoA-02. IoA-00 and IoA-02 were crossed to produce families spanning one parental and three filial generations (P0, F1-F3). In three families derived from P0 crosses between an IoA-00 sire and an IoA-02 dam, 98.8% of F2 parasites (n = 173) were resistant, i.e. remained unaffected after exposure to 2.0 μg L-1 deltamethrin. F3 parasites from these crosses showed a deltamethrin EC50 of 9.66 μg L-1. In two families of the inverse orientation at P0 (IoA-02 sire x IoA-00 dam), 16.7% of F2 parasites were resistant (n = 84), while the deltamethrin EC50 in F3 animals was 0.26 μg L-1. The results revealed a predominantly maternal inheritance of deltamethrin resistance. The 15,947-nt mitochondrial genome was sequenced and compared among six unrelated L. salmonis strains and parasites sampled from wild salmon in 2010. IoA-02 and three further deltamethrin resistant strains, established from isolates originating from different regions of Scotland, showed almost identical mitochondrial haplotypes. In contrast, the mitochondrial genome was variable among susceptible strains and L. salmonis from wild hosts. Deltamethrin caused toxicity and depletion of whole body ATP levels in IoA-00 but not IoA-02 parasites. The maternal inheritance of deltamethrin resistance and its association with mitochondrial haplotypes suggests that pyrethroid toxicity in L. salmonis may involve molecular targets encoded by mitochondrial genes

Refining dosing by oral gavage in the dog: A protocol to harmonise welfare

Introduction: The dog is a frequently-used, non-rodent species in the safety assessment of new chemical entities. We have a scientific and ethical obligation to ensure that the best quality of data is achieved from their use. Oral gavage is a technique frequently used to deliver a compound directly into the stomach. As with other animals, in the dog, gavage is aversive and the frequency of its use is a cause for welfare concern but little research has been published on the technique nor how to Refine it. A Welfare Assessment Framework (Hall, 2014) was previously developed for use with the laboratory-housed dog and a contrasting pattern of behaviour, cardiovascular and affective measures were found in dogs with positive and negative welfare. Methods: Using the framework, this study compared the effects of sham dosing (used to attempt to habituate dogs to dosing) and a Refined training protocol against a control, no-training group to determine the benefit to welfare and scientific output of each technique. Results: Our findings show that sham dosing is ineffective as a habituation technique and ‘primes' rather than desensitises dogs to dosing. Dogs in the control group showed few changes in parameters across the duration of the study, with some undesirable changes during dosing, while dogs in the Refined treatment group showed improvements in many parameters. Discussion: It is recommended that if there is no time allocated for pre-study training a no-sham dosing protocol is used. However, brief training periods show a considerable benefit for welfare and quality of data to be obtained from the dogs' use

Common Genetic Variants Contribute to Risk of Transposition of the Great Arteries.

RATIONALE: Dextro-transposition of the great arteries (D-TGA) is a severe congenital heart defect which affects approximately 1 in 4,000 live births. While there are several reports of D-TGA patients with rare variants in individual genes, the majority of D-TGA cases remain genetically elusive. Familial recurrence patterns and the observation that most cases with D-TGA are sporadic suggest a polygenic inheritance for the disorder, yet this remains unexplored. OBJECTIVE: We sought to study the role of common single nucleotide polymorphisms (SNPs) in risk for D-TGA. METHODS AND RESULTS: We conducted a genome-wide association study in an international set of 1,237 patients with D-TGA and identified a genome-wide significant susceptibility locus on chromosome 3p14.3, which was subsequently replicated in an independent case-control set (rs56219800, meta-analysis P=8.6x10 CONCLUSIONS: This work provides support for a polygenic architecture in D-TGA and identifies a susceptibility locus on chromosome 3p14.3 nea