Uncovering treatment burden as a key concept for stroke care: a systematic review of qualitative research

<b>Background</b> Patients with chronic disease may experience complicated management plans requiring significant personal investment. This has been termed ‘treatment burden’ and has been associated with unfavourable outcomes. The aim of this systematic review is to examine the qualitative literature on treatment burden in stroke from the patient perspective.<p></p> <b>Methods and findings</b> The search strategy centred on: stroke, treatment burden, patient experience, and qualitative methods. We searched: Scopus, CINAHL, Embase, Medline, and PsycINFO. We tracked references, footnotes, and citations. Restrictions included: English language, date of publication January 2000 until February 2013. Two reviewers independently carried out the following: paper screening, data extraction, and data analysis. Data were analysed using framework synthesis, as informed by Normalization Process Theory. Sixty-nine papers were included. Treatment burden includes: (1) making sense of stroke management and planning care, (2) interacting with others, (3) enacting management strategies, and (4) reflecting on management. Health care is fragmented, with poor communication between patient and health care providers. Patients report inadequate information provision. Inpatient care is unsatisfactory, with a perceived lack of empathy from professionals and a shortage of stimulating activities on the ward. Discharge services are poorly coordinated, and accessing health and social care in the community is difficult. The study has potential limitations because it was restricted to studies published in English only and data from low-income countries were scarce.<p></p> <b>Conclusions</b> Stroke management is extremely demanding for patients, and treatment burden is influenced by micro and macro organisation of health services. Knowledge deficits mean patients are ill equipped to organise their care and develop coping strategies, making adherence less likely. There is a need to transform the approach to care provision so that services are configured to prioritise patient needs rather than those of health care systems

Sources of Pharmaceuticals in Water

This chapter focuses on the increasing environmental apprehensions and persistence of numerous organic contaminants so-called emerging contaminants (ECs), including biologically active elements from pharmaceutical source industries. Several types of diverse pharmaceutical-related compounds are being detected in environmental matrices and wastewater treatment units. Owing to this broader occurrence, transformation, and detection of pharmaceutical-related compounds in water matrices, people and legislative authorities are now more concerned about potential sources and ecological consequences of ECs. This is mainly because the free movement of ECs in water matrices is posing noteworthy adverse effects on human, aquatic animals, and naturally occurring plants, even at minimal concentrations. So far, several detection and treatment processes have been proposed and exploited against numerous pharmaceutical-related ECs. The useful and side effects of pharmaceutical-related compounds have been extensively inspected. Owing to this substantial research gap, the sources and environmental persistence of pharmaceutical-related ECs and their direct/indirect adverse effects have now been the topic of intensive studies. From the surface water perspective, wastewater treatment plants (WWTPs) are the major source of pharmaceutical-related ECs. The current chapter spotlights the widespread occurrence, numerous sources, and transportation fate of pharmaceutical-related ECs in water matrices.The work is a part of the project entitled “Contaminantes emergentes y priori-tarios en las aguas reutilizadas en agricultura: riesgos y efectos en suelos, produc-ción agrícola y entorno ambiental” funded by CSIC-Tecnologico de Monterrey under iLink program. All listed authors are also grateful to their representative universities/institutes for providing literature facilities.Peer reviewe

Identification of peptide mimotopes of gp96 using single-chain antibody library

Heat shock proteins such as gp96 are immunogenic and are widely used as vaccines in immunotherapy of cancers. The present study focuses on the use of peptide mimotopes as immunotherapeutic vaccines for prostate cancer. To this end, we developed a 15-mer gp96 peptide mimotope specifically reactive to MAT-LyLu gp96–peptide complex using combinatorial single-chain antibody and peptide phage display library. The immunogenicity of the synthesized gp96 mimotope was analyzed initially in normal BALB/c mice in combination with various adjuvants such as complete Freund’s adjuvant (CFA), aluminum salts (ALUM), granulocyte-macrophage colony-stimulating factor (GM-CSF), and liposome, of which CFA served as a positive control. The antibody response was determined and found that the gp96 mimotope with ALUM showed a significant increase in antibody titer, followed by GM-CSF and liposomes. Further, the T cell (CD4+ and CD8+) populations from splenocytes, as well as IgG isotypes, interleukin-4, and interleukin-5 of gp96 mimotope with ALUM-immunized animals, were analyzed. The results suggest that the gp96 mimotope may elicit a potent and effective antitumor antibody response. Further, the study identifies ALUM and GM-CSF as adjuvant options to drive an appropriate protective immune response as these adjuvants have prior use in humans