Harsh Truth: Do Healthcare Providers Silence Women Who Experience Intimate Partner Violence

Background: Globally, one-third of women experience abuse from their intimate partners. Since intimate partner violence (IPV) creates a chronic stress environment, affected women suffer from several physical and mental stress-related disorders for which they seek healthcare services in higher proportion to that of non-abused women. Although affected women seek help for the consequences of IPV, addressing the cause, is an important responsibility of healthcare providers. This study aimed to explore how healthcare providers may contribute to silencing of women who have experienced IPV. Subjects and Methods: This was an integrative review. We performed a systematic search of eight databases for articles published between 2007 and 2018. We identified 4507 publications. We included the English language articles that focused on adult women between 18 and 49 years of age, explored the issue of silencing of women who have experienced IPV, and followed a primary research study design. Two reviewers screened the articles using the web application, Rayyan. Quality was assessed using Joanna Briggs Institute Critical Appraisal tools. Results: Five articles were selected for analysis. The findings revealed that healthcare providers might play a significant role in silencing women’s suffering from abuse. Affected women’s unwillingness to act as their own agent in healthcare settings or disclose experiences of IPV was associated with healthcare provider’s inadequate or inappropriate response. Lack of affirmation, validation, and inability to make women feel accepted were the main factors which silenced women who experienced IPV. Both individual-level factors, such as shame, fear, humiliation, hope, and relationship dynamics, and community-level factors, such as cultural norms, and values, seemed to precede the factors related to healthcare providers. Conclusion:A socioecological understanding of the factors influencing silencing of women who have experienced IPV is required. A health care model which takes into consideration the contributing factors at various ecological levels of influence is imperative to guide healthcare providers towards the development of best practices in caring with women who have experienced violence in their intimate relationships. Keywords: intimate, partner, violence, health care, provide

Interpersonal touch interventions for patients in intensive care: A design-oriented realist review

Aim: To develop a theoretical framework to inform the design of interpersonal touch interventions intended to reduce stress in adult intensive care unit patients. Design: Realist review with an intervention design‐oriented approach. Methods: We searched CINAHL, MEDLINE, EMBASE, CENTRAL, Web of Science and grey literature sources without date restrictions. Subject experts suggested additional articles. Evidence synthesis drew on diverse sources of literature and was conducted iteratively with theory testing. We consulted stakeholders to focus the review. We performed systematic searches to corroborate our developing theoretical framework. Results: We present a theoretical framework based around six intervention construction principles. Theory testing provided some evidence in favour of treatment repetition, dynamic over static touch and lightening sedation. A lack of empirical evidence was identified for construction principles relating to intensity and positive/negative evaluation of emotional experience, moderate pressure touch for sedated patients and intervention delivery by relatives versus healthcare practitioners

Respuestas psicológicas disfuncionales en enfermeros de Unidades de Cuidados Intensivos: una revisión sistemática de la literatura

OBJETIVOBuscar evidencias de respuestas psicológicas disfuncionales en Enfermeros de Unidades de Terapia Intensiva, con enfoque en la ansiedad, síntomas depresivos y factores relacionados.MÉTODORevisión sistemática, con evaluación crítica y síntesis de datos de los estudios, llevada a cabo en las bases de datos CINAHL, PubMed y Scopus, en el período de 1999 hasta el presente, utilizándose los siguientes términos de investigación, individualmente o en combinación: "estado mental", "síntomas depresivos", "ansiedad", "enfermeros de UCI", "estrés post traumático", "burnout", "fatiga por compasión" y "estrés psicológico".RESULTADOFueron incluidos trece estudios cuantitativos en Inglés y Griego. Los resultados sugieren un incremento de la carga psicológica en los Enfermeros de UCI comparativamente con otras especialidades de enfermería, así como con la población en general.CONCLUSIÓNEstudios internacionales de investigación acerca de la respuesta psicológica son limitados. Estudios futuros, longitudinales y de intervención, contribuirán a una mejor comprensión del fenómeno.OBJECTIVETo systematically review evidence on dysfunctional psychological responses of Intensive Care Units nurses (ICUNs), with focus on anxiety and depressive symptoms and related factors.METHODA literature search was performed in CINAHL, PubMed and Scopus databases, from 1999 to present, along with a critical appraisal and synthesis of all relevant data. The following key words, separately and in combination, were used: "mental status" "depressive symptoms" "anxiety" "ICU nurses" "PTSD" "burnout" "compassion fatigue" "psychological distress".RESULTSThirteen quantitative studies in English and Greek were included. The results suggested increased psychological burden in ICUNs compared to other nursing specialties, as well as to the general population.CONCLUSIONSStudies investigating psychological responses of ICUNs are limited, internationally. Future longitudinal and intervention studies will contribute to a better understanding of the phenomenon.OBJETIVORever sistematicamente evidências de respostas psicológicas disfuncionais em Enfermeiros de Unidades de Cuidados Intensivos (EUCI), com foco na ansiedade, sintomas depressivos e fatores relacionados.MÉTODOFoi realizada uma pesquisa bibliográfica, com avaliação crítica e síntese de dados dos estudos, nas bases de dados da CINAHL, PubMed e Scopus, para o período de 1999 até ao presente. Foram utilizados os seguintes termos de pesquisa, individualmente ou em combinação: "estado mental" "sintomas depressivos" "ansiedade" "enfermeiros de UCI" "PTSD" "burnout" "fadiga da compaixão" "stress psicológico".RESULTADOForam incluídos treze estudos quantitativos em Inglês e Grego. Os resultados sugerem um aumento da carga psicológica nos EUCI comparativamente com outras especialidades de enfermagem, assim como com a população em geral.CONCLUSÕESEstudos internacionais de investigação sobre a resposta psicológica de EUCI são limitados. Estudos futuros, longitudinais e de intervenção, irão contribuir para uma melhor compreensão do fenômeno

Excitability and synaptic transmission in the enteric nervous system: Does diet play a role?

© Springer International Publishing Switzerland 2016. Changes in diet are a challenge to the gastrointestinal tract which needs to alter its processing mechanisms to continue to process nutrients and maintain health. In particular, the enteric nervous system (ENS) needs to adapt its motor and secretory programs to deal with changes in nutrient type and load in order to optimise nutrient absorption. The nerve circuits in the gut are complex, and the numbers and types of neurons make recordings of specific cell types difficult, time-consuming, and prone to sampling errors. Nonetheless, traditional research methods like intracellular electrophysiological approaches have provided the basis for our understanding of the ENS circuitry. In particular, animal models of intestinal inflammation have shown us that we can document changes to neuronal excitability and synaptic transmission. Recent studies examining diet-induced changes to ENS programming have opted to use fast imaging techniques to reveal changes in neuron function. Advances in imaging techniques using voltage- or calcium-sensitive dyes to record neuronal activity promise to overcome many limitations inherent to electrophysiological approaches. Imaging techniques allow access to a wide range of ENS phenotypes and to the changes they undergo during dietary challenges. These sorts of studies have shown that dietary variation or obesity can change how the ENS processes information-in effect reprogramming the ENS. In this review, the data gathered from intracellular recordings will be compared with measurements made using imaging techniques in an effort to determine if the lessons learnt from inflammatory changes are relevant to the understanding of diet-induced reprogramming

Moral Distress Amongst American Physician Trainees Regarding Futile Treatments at the End of Life: A Qualitative Study.

BACKGROUND: Ethical challenges are common in end of life care; the uncertainty of prognosis and the ethically permissible boundaries of treatment create confusion and conflict about the balance between benefits and burdens experienced by patients. OBJECTIVE: We asked physician trainees in internal medicine how they reacted and responded to ethical challenges arising in the context of perceived futile treatments at the end of life and how these challenges contribute to moral distress. DESIGN: Semi-structured in-depth qualitative interviews. PARTICIPANTS: Twenty-two internal medicine residents and fellows across three American academic medical centers. APPROACH: This study uses systematic qualitative methods of data gathering, analysis and interpretation. KEY RESULTS: Physician trainees experienced significant moral distress when they felt obligated to provide treatments at or near the end of life that they believed to be futile. Some trainees developed detached and dehumanizing attitudes towards patients as a coping mechanism, which may contribute to a loss of empathy. Successful coping strategies included formal and informal conversations with colleagues and superiors about the emotional and ethical challenges of providing care at the end of life. CONCLUSIONS: Moral distress amongst physician trainees may occur when they feel obligated to provide treatments at the end of life that they believe to be futile or harmful.This study was funded by the Health Resources and Service Administration T32 HP10025-20 Training Grant, the Gates Cambridge Scholarship, Society of General Internal Medicine Founders Grant, and the Ho-Chiang Palliative Care Research Fellowship at the Johns Hopkins School of Medicine.This is the author accepted manuscript. The final version is available from Springer via http://dx.doi.org/10.1007/s11606-015-3505-

The Complement Anaphylatoxin C5a Induces Apoptosis in Adrenomedullary Cells during Experimental Sepsis

Sepsis remains a poorly understood, enigmatic disease. One of the cascades crucially involved in its pathogenesis is the complement system. Especially the anaphylatoxin C5a has been shown to have numerous harmful effects during sepsis. We have investigated the impact of high levels of C5a on the adrenal medulla following cecal ligation and puncture (CLP)-induced sepsis in rats as well as the role of C5a on catecholamine production from pheochromocytoma-derived PC12 cells. There was significant apoptosis of adrenal medulla cells in rats 24 hrs after CLP, as assessed by the TUNEL technique. These effects could be reversed by dual-blockade of the C5a receptors, C5aR and C5L2. When rats were subjected to CLP, levels of C5a and norepinephrine were found to be antipodal as a function of time. PC12 cell production of norepinephrine and dopamine was significantly blunted following exposure to recombinant rat C5a in a time-dependent and dose-dependent manner. This impaired production could be related to C5a-induced initiation of apoptosis as defined by binding of Annexin V and Propidium Iodine to PC12 cells. Collectively, we describe a C5a-dependent induction of apoptotic events in cells of adrenal medulla in vivo and pheochromocytoma PC12 cells in vitro. These data suggest that experimental sepsis induces apoptosis of adrenomedullary cells, which are responsible for the bulk of endogenous catecholamines. Septic shock may be linked to these events. Since blockade of both C5a receptors virtually abolished adrenomedullary apoptosis in vivo, C5aR and C5L2 become promising targets with implications on future complement-blocking strategies in the clinical setting of sepsis

Iron Behaving Badly: Inappropriate Iron Chelation as a Major Contributor to the Aetiology of Vascular and Other Progressive Inflammatory and Degenerative Diseases

The production of peroxide and superoxide is an inevitable consequence of aerobic metabolism, and while these particular "reactive oxygen species" (ROSs) can exhibit a number of biological effects, they are not of themselves excessively reactive and thus they are not especially damaging at physiological concentrations. However, their reactions with poorly liganded iron species can lead to the catalytic production of the very reactive and dangerous hydroxyl radical, which is exceptionally damaging, and a major cause of chronic inflammation. We review the considerable and wide-ranging evidence for the involvement of this combination of (su)peroxide and poorly liganded iron in a large number of physiological and indeed pathological processes and inflammatory disorders, especially those involving the progressive degradation of cellular and organismal performance. These diseases share a great many similarities and thus might be considered to have a common cause (i.e. iron-catalysed free radical and especially hydroxyl radical generation). The studies reviewed include those focused on a series of cardiovascular, metabolic and neurological diseases, where iron can be found at the sites of plaques and lesions, as well as studies showing the significance of iron to aging and longevity. The effective chelation of iron by natural or synthetic ligands is thus of major physiological (and potentially therapeutic) importance. As systems properties, we need to recognise that physiological observables have multiple molecular causes, and studying them in isolation leads to inconsistent patterns of apparent causality when it is the simultaneous combination of multiple factors that is responsible. This explains, for instance, the decidedly mixed effects of antioxidants that have been observed, etc...Comment: 159 pages, including 9 Figs and 2184 reference