Delivering effective nursing care to children and young people outside of a hospital setting

This report may be reproduced for the purposes of private research and study; in addition, excerpts may be included in professional journals or conference presentations as long as acknowledgement is given and there is no association with advertisingOver the course of the last fifty years, there has been a reduction of approximately 75 per cent in the total number of children’s hospital beds in the United Kingdom [UK]; at the same time, there has been an increase in the amount and range of care now being provided in other environments that are located within outside of hospital settings. This shift in terms of the location and provision of care has meant that there has been an impact on the preparation and training that healthcare staff require. The Health Outcomes Forum specifically recommended: “That HEE [Health Education England] address the workforce education, training and development requirements (including capacity and capability) to refocus service provision at home or closer to home” (Department of Health, 2012: 52). This scoping project was financed and commissioned by Health Education North Central and East London Local Education and Training Board [HE NCEL LETB] in January 2014 and was undertaken by the University of Hertfordshire between February 2014 - August 2014. The project was funded to facilitate the consideration of the educational needs of the nursing workforce in relation to out of hospital care for children and young people, thus enabling the future potential development of out of hospital services to meet the health needs of the children and young people living in the HE NCEL geographical are

Site-based decision-making: the preceptions of parents, teachers, and administrators in an elementary school in Texas

While researchers studied site-based decision-making (SBDM) in depth in the 1990’s, mostly from the perspective of its effects on student achievement (Hopkins, Munumer, 1999; Bauer & Bogotch, 1997, Bell, 1996)), a dearth of the studies were quantitative in nature, often comparing student groups’ performance on a pretest and post test (Leithwood & Menzies, 1998). Results indicate that SBDM does not significantly affect student achievement (Schuttloffel, (2000; Dempster, 1999; Wohlstetter, 1993; White, 1989); however, few research studies focus on stakeholders’ beliefs about SBDM (Reyes, Scribner & Scribner, 1999; Hoetger, 1998; Griffin, 1995; Ovando, 1994; Wagstaff & Reyes, 1993). In this narrative case study, the researcher discerns successful, unsuccessful, and missing SBDM implementation strategies through stakeholders’ stories about their experiences on an elementary school SBDM committee in a central Texas district. The literature review includes the historical context of early reforms, a description of localized control, and anticipated SBDM outcomes. The researcher explains theoretical frames and conflicting research findings including the benefits and pitfalls. Two research questions frame the study: (1) What are the experiences of stakeholders involved with SBDM that illustrate the workable, unworkable, and needed implementation strategies? (2) What themes emerge from stakeholders’ stories that can further inform policy makers and educational leaders about SBDM implementation strategies that are workable and needed? The study represents each stake holder-group’s narrative; teachers, parents, and administrators. The district was selected based on its extensive SBDM experience and recognized district performance rating. The school was selected based on its three-year improved performance and Dr. Horn’s five-year tenure. The data included the review: (1) of minutes from SBDM meetings, (2) field notes from observations of SBDM meetings, (3) of transcripts from individual interviews with SBDM members and non-members, and (4) a focus group interview with the campus SBDM committee. Through the emergent themes from their stories, the stakeholders’ perceptions expand the extant knowledge about and contribute to the practice of SBDM. Policy makers and educational leaders gain information to further inform the implementation of SBDM.Educational Administratio

Effective nursing care of children and young people outside hospital

THIS ARTICLE presents an exploratory study that was financed and commissioned by Health Education, North Central and East London (NCEL), and the local education and training board (LETB); it was undertaken by the University of Hertfordshire between February and August 2014. The research was funded to explore the educational needs of the nursing workforce in relation to out-of-hospital care for children and young people in the UK. The data will be used to inform the development of service provision. Read More: http://journals.rcni.com/doi/10.7748/ncyp.27.5.28.e610 Open Access with Creative Commons Attribution 3.0 Unported (CC BY 3.0). Copyright © 2017 RCN Publishing Company Ltd.Aim To assess the preparation required to ensure a workforce of nurses who can provide high quality out-of-hospital services for children and young people. Methods Using mixed methods, questionnaires were sent to young people and community children’s nursing teams, interviews were conducted with academic staff and clinical nurses, and focus groups were undertaken with pre-registration children’s nursing students. Findings Nurses’ communication skills and clinical abilities were most important to young people. There is a range of opinions about optimum out-of-hospital clinical experience. Pre- and post-qualification education and recruitment in this area, therefore, need attention. Conclusion Out-of-hospital care presents problems, but is developing rapidly. Adequate, updated training, supervision and resources are needed.Peer reviewe

Candida dubliniensis Meningitis as Delayed Sequela of Treated C. dubliniensis Fungemia

We present a case of Candida dubliniensis meningitis that developed 2 months after apparently successful treatment of an episode of C. dubliniensis candidemia in a heart-lung transplant recipient in Australia. This case highlights the importance of follow-up in patients with candidemia or disseminated infection, especially in immunosuppressed patients

Evaluation of commercially available RNA amplification kits for RNA sequencing using very low input amounts of total RNA

This article includes supplemental data. Please visit http://www.fasebj.org to obtain this information.Multiple recent publications on RNA sequencing (RNA-seq) have demonstrated the power of next-generation sequencing technologies in whole-transcriptome analysis. Vendor-specific protocols used for RNA library construction often require at least 100 ng total RNA. However, under certain conditions, much less RNA is available for library construction. In these cases, effective transcriptome profiling requires amplification of subnanogram amounts of RNA. Several commercial RNA amplification kits are available for amplification prior to library construction for next-generation sequencing, but these kits have not been comprehensively field evaluated for accuracy and performance of RNA-seq for picogram amounts of RNA. To address this, 4 types of amplification kits were tested with 3 different concentrations, from 5 ng to 50 pg, of a commercially available RNA. Kits were tested at multiple sites to assess reproducibility and ease of use. The human total reference RNA used was spiked with a control pool of RNA molecules in order to further evaluate quantitative recovery of input material. Additional control data sets were generated from libraries constructed following polyA selection or ribosomal depletion using established kits and protocols. cDNA was collected from the different sites, and libraries were synthesized at a single site using established protocols. Sequencing runs were carried out on the Illumina platform. Numerous metrics were compared among the kits and dilutions used. Overall, no single kit appeared to meet all the challenges of small input material. However, it is encouraging that excellent data can be recovered with even the 50 pg input total RNA

Development of the HT&Me intervention to support women with breast cancer to adhere to adjuvant endocrine therapy and improve quality of life.

BACKGROUND: Breast cancer is the most common cancer in women worldwide. Approximately 80% of breast cancers are oestrogen receptor positive (ER+). Patients treated surgically are usually recommended adjuvant endocrine therapy (AET) for 5-10 years. AET significantly reduces recurrence, but up to 50% of women do not take it as prescribed. OBJECTIVE: To co-design and develop an intervention to support AET adherence and improve health-related quality-of-life (QoL) in women with breast cancer. METHODS: Design and development of the HT&Me intervention took a person-based approach and was guided by the Medical Research Council framework for complex interventions, based on evidence and underpinned by theory. Literature reviews, behavioural analysis, and extensive key stakeholder involvement informed 'guiding principles' and the intervention logic model. Using co-design principles, a prototype intervention was developed and refined. RESULTS: The blended tailored HT&Me intervention supports women to self-manage their AET. It comprises initial and follow-up consultations with a trained nurse, supported with an animation video, a web-app and ongoing motivational 'nudge' messages. It addresses perceptual (e.g. doubts about necessity, treatment concerns) and practical (e.g. forgetting) barriers to adherence and provides information, support and behaviour change techniques to improve QoL. Iterative patient feedback maximised feasibility, acceptability, and likelihood of maintaining adherence; health professional feedback maximised likelihood of scalability. CONCLUSIONS: HT&Me has been systematically and rigorously developed to promote AET adherence and improve QoL, and is complemented with a logic model documenting hypothesized mechanisms of action. An ongoing feasibility trial will inform a future randomised control trial of effectiveness and cost-effectiveness

Twin peaks: the Omicron SARS-CoV-2 BA.1 and BA.2 epidemics in England

BACKGROUND Rapid transmission of the SARS-CoV-2 Omicron variant has led to record-breaking incidence rates around the world. Sub-lineages have been detected in many countries with BA.1 replacing Delta and BA.2 replacing BA.1. METHODS The REal-time Assessment of Community Transmission-1 (REACT-1) study has tracked SARS-CoV-2 infection in England using RT-PCR results from self-administered throat and nose swabs from randomly-selected participants aged 5+ years. Rounds of data collection were approximately monthly from May 2020 to March 2022. RESULTS In March 2022, weighted prevalence was 6.37% (N=109,181), more than twice that in February 2022 following an initial Omicron peak in January 2022. Of the lineages determined by viral genome sequencing, 3,382 (99.97%) were Omicron, including 346 (10.2%) BA.1, 3035 (89.7%) BA.2 and one (0.03%) BA.3 sub-lineage; the remainder (1, 0.03%) was Delta AY.4. The BA.2 Omicron sub-lineage had a growth rate advantage (compared to BA.1 and sub-lineages) of 0.11 (95% credible interval [CrI], 0.10, 0.11). Prevalence was increasing overall (reproduction number R=1.07, 95% CrI, 1.06, 1.09), with the greatest increase in those aged 55+ years (R=1.12, 95% CrI, 1.09, 1.14) among whom estimated prevalence on March 31, 2022 was 8.31%, nearly 20-fold the median prevalence since May 1, 2020. CONCLUSIONS We observed unprecedented levels of SARS-CoV-2 infection in England in March 2022 and an almost complete replacement of Omicron BA.1 by BA.2. The high and increasing prevalence in older adults may increase hospitalizations and deaths despite high levels of vaccination. (Funded by the Department of Health and Social Care in England.

Therapeutic DNA vaccine induces broad T cell responses in the gut and sustained protection from viral rebound and AIDS in SIV-infected rhesus macaques.

Immunotherapies that induce durable immune control of chronic HIV infection may eliminate the need for life-long dependence on drugs. We investigated a DNA vaccine formulated with a novel genetic adjuvant that stimulates immune responses in the blood and gut for the ability to improve therapy in rhesus macaques chronically infected with SIV. Using the SIV-macaque model for AIDS, we show that epidermal co-delivery of plasmids expressing SIV Gag, RT, Nef and Env, and the mucosal adjuvant, heat-labile E. coli enterotoxin (LT), during antiretroviral therapy (ART) induced a substantial 2-4-log fold reduction in mean virus burden in both the gut and blood when compared to unvaccinated controls and provided durable protection from viral rebound and disease progression after the drug was discontinued. This effect was associated with significant increases in IFN-γ T cell responses in both the blood and gut and SIV-specific CD8+ T cells with dual TNF-α and cytolytic effector functions in the blood. Importantly, a broader specificity in the T cell response seen in the gut, but not the blood, significantly correlated with a reduction in virus production in mucosal tissues and a lower virus burden in plasma. We conclude that immunizing with vaccines that induce immune responses in mucosal gut tissue could reduce residual viral reservoirs during drug therapy and improve long-term treatment of HIV infection in humans

Exponential growth, high prevalence of SARS-CoV-2, and vaccine effectiveness associated with the Delta variant.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections were rising during early summer 2021 in many countries as a result of the Delta variant. We assessed reverse transcription polymerase chain reaction swab positivity in the Real-time Assessment of Community Transmission–1 (REACT-1) study in England. During June and July 2021, we observed sustained exponential growth with an average doubling time of 25 days, driven by complete replacement of the Alpha variant by Delta and by high prevalence at younger, less-vaccinated ages. Prevalence among unvaccinated people [1.21% (95% credible interval 1.03%, 1.41%)] was three times that among double-vaccinated people [0.40% (95% credible interval 0.34%, 0.48%)]. However, after adjusting for age and other variables, vaccine effectiveness for double-vaccinated people was estimated at between ~50% and ~60% during this period in England. Increased social mixing in the presence of Delta had the potential to generate sustained growth in infections, even at high levels of vaccination.The study was funded by the Department of Health and Social Care in England. Sequencing was provided through funding from the COVID-19 Genomics UK (COG-UK) Consortium. P.E. is Director of the Medical Research Council (MRC) Centre for Environment and Health (MR/L01341X/1, MR/S019669/1). P.E. acknowledges support from Health Data Research UK (HDR UK); the National Institute for Health Research (NIHR) Imperial Biomedical Research Centre; NIHR Health Protection Research Units (HPRUs) in Chemical and Radiation Threats and Hazards, and Environmental Exposures and Health; the British Heart Foundation Centre for Research Excellence at Imperial College London (RE/18/4/34215); and the UK Dementia Research Institute at Imperial (MC_PC_17114). S.R., C.A.D. acknowledge support: MRC Centre for Global Infectious Disease Analysis, NIHR HPRU in Modelling and Health Economics, Wellcome Trust (200861/Z/16/Z, 200187/Z/15/Z), and Centres for Disease Control and Prevention (US, U01CK0005-01-02). G.C. is supported by an NIHR Professorship. H.War. acknowledges support from an NIHR Senior Investigator Award and the Wellcome Trust (205456/Z/16/Z). We thank The Huo Family Foundation for their support of our work on COVID-19. Quadram authors gratefully acknowledge the support of the Biotechnology and Biological Sciences Research Council (BBSRC); their research was funded by the BBSRC Institute Strategic Programme Microbes in the Food Chain BB/R012504/1 and its constituent project BBS/E/F/000PR10352. We thank members of the COVID-19 Genomics Consortium UK (COG-UK) for their contributions to generating the genomic data used in this study. COG-UK is supported by funding from the MRC, part of UK Research & Innovation (UKRI), NIHR and Genome Research Limited, operating as the Wellcome Sanger Institute

Investigation of the international comparability of population-based routine hospital data set derived comorbidity scores for patients with lung cancer

Introduction: The International Cancer Benchmarking Partnership (ICBP) identified significant international differences in lung cancer survival. Differing levels of comorbid disease across ICBP countries has been suggested as a potential explanation of this variation but, to date, no studies have quantified its impact. This study investigated whether comparable, robust comorbidity scores can be derived from the different routine population-based cancer data sets available in the ICBP jurisdictions and, if so, use them to quantify international variation in comorbidity and determine its influence on outcome. Methods: Linked population-based lung cancer registry and hospital discharge data sets were acquired from nine ICBP jurisdictions in Australia, Canada, Norway and the UK providing a study population of 233 981 individuals. For each person in this cohort Charlson, Elixhauser and inpatient bed day Comorbidity Scores were derived relating to the 4–36 months prior to their lung cancer diagnosis. The scores were then compared to assess their validity and feasibility of use in international survival comparisons. Results: It was feasible to generate the three comorbidity scores for each jurisdiction, which were found to have good content, face and concurrent validity. Predictive validity was limited and there was evidence that the reliability was questionable. Conclusion: The results presented here indicate that interjurisdictional comparability of recorded comorbidity was limited due to probable differences in coding and hospital admission practices in each area. Before the contribution of comorbidity on international differences in cancer survival can be investigated an internationally harmonised comorbidity index is required