A personal reflection: using theoretical frameworks to understand the impact of starting university on health and wellbeing

This article presents a personal reflection using theoretical frameworks as the basis of understanding multifaceted influences on the personal health of the primary author since beginning undergraduate university degree studies in nursing. It also explores theoretical and lay definitions of health and wellbeing, before analysing influences on health from a personal perspective. This illustrates how understanding, developed through the use of theoretical frameworks, can enable individuals to enhance their own health and wellbeing

Factors affecting patient’s decision-making about treatment for cancer: a literature review.

Decision-making about cancer treatment is complex. This literature review explores factors that impact on patients’ decision-making about treatment. Results were returned in MEDLINE, British Library, PsycINFO and Science Direct databases. These were filtered, using a PRISMA flowchart and inclusion and exclusion criteria applied. Six original papers, assessed as high quality using Critical Skills Appraisal Programme checklists, were reviewed. Data was collated and thematically analysed. Four themes were developed: communication and information giving, children and family influences, hope and treatment toxicities. These themes demonstrate the complexity of factors that influence decision-making about treatment and reinforce the importance of nurses, particularly clinical nurse specialists, using effective communication skills to make shared decision-making a reality. Developing a strong therapeutic relationship and getting to know patients over the course of their cancer journey, using communication tools, enables nurses to recognise and respond to emotional cues from patients and to start sensitive conversations about factors affecting them. Facilitating information sharing around treatment decision-making enhances patient’s experience by supporting their autonomy

Reflecting on health and wellbeing as a student nurse: a personal journey

This article presents a reflection of my personal health journey since starting university as a student nurse. Focusing on social, physical and psychological aspects of health, it explores the impact of stress and the cessation of exercise on my health and wellbeing. The similarities and differences of lay and theoretical definitions of health are examined, and a personal definition of health is presented. The discussion presents my understanding of health as a student nurse, and analyses how loneliness has impacted on my health and wellbeing during the first two terms of university

Deconstructing the outsider puzzle: The legitimation journey of novelty

The proposition that outsiders often are crucial carriers of novelty into an established institutional field has received wide empirical support. But an equally compelling proposition points to the following puzzle: the very same conditions that enhance outsiders' ability to make novel contributions also hinder their ability to carry them out. We seek to address this puzzle by examining the contextual circumstances that affect the legitimation of novelty originating from a noncertified outsider that challenged the status quo in an established institutional field. Our research case material is John Harrison's introduction of a new mechanical method for measuring longitude at sea-the marine chronometer- which challenged the dominant astronomical approach.We find that whether an outsider's new offer gains or is denied legitimacy is influenced by (1) the outsider's agency to further a new offer, (2) the existence of multiple audiences with different dispositions toward this offer, and (3) the occurrence of an exogenous jolt that helps create a more receptive social space. We organize these insights into a multilevel conceptual framework that builds on previouswork but attributes a more decisive role to the interplay between endogenous and exogenous variables in shaping a field's shifting receptiveness to novelty. The framework exposes the interdependencies between the micro-, meso-, and macro-level processes that jointly affect an outsider's efforts to introduce novelty into an existing field

Quantitation of Human Seroresponsiveness to Merkel Cell Polyomavirus

Merkel cell carcinoma (MCC) is a relatively uncommon but highly lethal form of skin cancer. A majority of MCC tumors carry DNA sequences derived from a newly identified virus called Merkel cell polyomavirus (MCV or MCPyV), a candidate etiologic agent underlying the development of MCC. To further investigate the role of MCV infection in the development of MCC, we developed a reporter vector-based neutralization assay to quantitate MCV-specific serum antibody responses in human subjects. Our results showed that 21 MCC patients whose tumors harbored MCV DNA all displayed vigorous MCV-specific antibody responses. Although 88% (42/48) of adult subjects without MCC were MCV seropositive, the geometric mean titer of the control group was 59-fold lower than the MCC patient group (p<0.0001). Only 4% (2/48) of control subjects displayed neutralizing titers greater than the mean titer of the MCV-positive MCC patient population. MCC tumors were found not to express detectable amounts of MCV VP1 capsid protein, suggesting that the strong humoral responses observed in MCC patients were primed by an unusually immunogenic MCV infection, and not by viral antigen expressed by the MCC tumor itself. The occurrence of highly immunogenic MCV infection in MCC patients is unlikely to reflect a failure to control polyomavirus infections in general, as seroreactivity to BK polyomavirus was similar among MCC patients and control subjects. The results support the concept that MCV infection is a causative factor in the development of most cases of MCC. Although MCC tumorigenesis can evidently proceed in the face of effective MCV-specific antibody responses, a small pilot animal immunization study revealed that a candidate vaccine based on MCV virus-like particles (VLPs) elicits antibody responses that robustly neutralize MCV reporter vectors in vitro. This suggests that a VLP-based vaccine could be effective for preventing the initial establishment of MCV infection

Self-help interventions for symptoms of depression, anxiety and psychological distress in patients with physical illnesses: a systematic review and meta-analysis

Psychological distress, depression and anxiety are common in most physical diseases, and self-help interventions, if effective, might be an important approach to improve outcomes as they are inexpensive to provide to large numbers of patients. The primary aim of this review was to assess randomised controlled trials examining the impact of self-help interventions on symptoms of depression, anxiety and psychological distress in patients with physical illness. Systematic searches of electronic databases resulted in twenty-five eligible studies for meta-analysis (n = 4211). The results of the primary meta-analyses revealed a significant improvement in depression symptoms, in favour of the intervention group (SMD = − 0.13, 95% CI: − 0.25, − 0.02, p = 0.02, I2 = 50%). There were no significant differences in symptoms of anxiety (SMD = − 0.10, 95% CI: − 0.24, 0.05, p = 0.20, I2 = 63%) or psychological distress (SMD = − 0.14, 95% CI: − 0.40, 0.12, p = 0.30, I2 = 72%) between intervention and control conditions. Several subgroup and sensitivity analyses improved effect sizes, suggesting that optimal mental health outcomes may be obtained in patients without neurological conditions, and with interventions based on a therapeutic model (such as cognitive behavioural therapy), and with stress management components. This review demonstrates that with appropriate design and implementation, self-help interventions may potentially improve symptoms of depression in patients with physical conditions