The changing role of the tissue viability nurse: an exploration of this multifaceted post

This article explores the role of the tissue viability nurse in the UK and discusses the diversity of the role and key attributes and skills required to run a successful service. The article highlights that services differ between organisations and that there is a lack of clarity of the core functions of the role published in the literature. This is compounded by an absence of valid and reliable tools that can be used to measure the effectiveness of the tissue viability service. This article suggests it is now time to revisit the tissue viability role and explore the competencies required, and offer guidance as to the qualifications required for this multifarious post to enable staff to manage the changing needs of a diverse patient group

Exploring the role of the Tissue Viability Nurse

Aim: To explore the role and identify key responsibilities of the Tissue Viability Nurse (TVN) in the UK. Methods: Mixed methodology using questionnaires distributed via SurveyMonkey and semi-structured interviews. Results: 261 respondents completed the online questionnaire and seven participated in semi-structured interviews. Of the 261 respondents to the questionnaire, 63.7% were employed as TVNs. Almost all respondents claimed to have access to a tissue viability service and the mean TVN team size was 4.7. Some 81.9% of respondents stated they had a team vision, with 75.9% stating that their service had set criteria for referrals. Analysis showed a statistical significance (χ2 (1)=16.6; p<0.001) between TVNs’ and non-TVNs’ knowledge of the referral criteria, with the latter being more aware. There was a variety of other titles used for the role, with interviewees affirming this was poorly understood by patients. Discussion: The results of this study identified that there is no national job title for the TVN role. Data identified that patients do not fully understand the title ‘Tissue Viability Nurse’. The TVN role is complex and not just about the management of a wound. However, what is also clear from the analysis of the data is that there are no clear criteria, or educational level, for the role. Data also suggest that review of current service provision, including partnership working with the multidisciplinary team and industry, is required to develop national competencies, guidance and quality assurance measures

Allele-dependent processing pathways generate the endogenous human leukocyte antigen (HLA) class I peptide repertoire in transporters associated with antigen processing (TAP)-deficient cells

The transporters associated with antigen processing (TAP) allow the supply of peptides derived from the cytosol to translocate to the endoplasmic reticulum, where they complex with nascent human leukocyte antigen (HLA) class I molecules. However, infected and tumor cells with TAP molecules blocked or individuals with nonfunctional TAP complexes are able to present HLA class I ligands generated by TAP-independent processing pathways. These peptides are detected by the CD8(+) lymphocyte cellular response. Here, the generation of the overall peptide repertoire associated with four different HLA class I molecules in TAP-deficient cells was studied. Using different protease inhibitors, four different proteolytic specificities were identified. These data demonstrate the different allele-dependent complex processing pathways involved in the generation of the HLA class I peptide repertoire in TAP-deficient cells.This work was supported by Fundación para la Investigación y Prevención del SIDA en España Foundation grants.S

The effectiveness of a health promotion with group intervention by clinical trial. Study protocol

<p>Abstract</p> <p>Background</p> <p>The promotion of health and the interventions in community health continue to be one of the pending subjects of our health system. The most prevalent health problems (cardiovascular diseases, cancer, diabetes...) are for the most part related to life habits. We propose a holistic and integral approach as the best option for tackling behavior and its determinants. The research team has elaborated the necessary educational material to realize group teaching, which we call "Health Workshops". The goal of the present study is to evaluate the effectiveness of these Health Workshops in the following terms: Health Related Quality of Life (HRQOL), incorporate and maintain a balanced diet, do physical activity regularly, maintain risk factors such as tension, weight, cholesterol within normal limits and diminish cardiovascular risk.</p> <p>Methods/Design</p> <p>Controlled and random clinical testing, comparing a group of persons who have participated in the Health Workshops with a control group of similar characteristics who have not participated in the Health Workshops.</p> <p>Field of study: the research is being done in Health Centers of the city of Barcelona, Spain.</p> <p>Population studied: The group is composed of 108 persons that are actually doing the Health Workshops, and 108 that are not and form the control group. They are assigned at random to one group or the other.</p> <p>Data Analysis: With Student's t-distribution test to compare the differences between numerical variables or their non parametric equivalent if the variable does not comply with the criteria of normality. (Kolmogorov-Smirnof test). Chi-square test to compare the differences between categorical variables and the Logistic Regression Model to analyze different meaningful variables by dichotomous analysis related to the intervention.</p> <p>Discussion</p> <p>The Health Workshop proposed in the present study constitutes an innovative approach in health promotion, placing the emphasis on the person's self responsibility for his/her own health.</p> <p>The rhythm of a weekly session during 8 weeks with recommended activities to put into practice, as well as the support of the group is an opportunity to incorporate healthy habits and make a commitment to self-care. The sheets handed out are a Health Manual that can always be consulted after the workshop ends.</p> <p>Trial registration</p> <p>Clinical Trials.gov Identifier: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01440738">NCT01440738</a></p

Pre- and postnatal high fat feeding differentially affects the structure and integrity of the neurovascular unit of 16-month old male and female mice

Compelling experimental and clinical evidence supports a role for maternal obesity in offspring health. Adult children of obese mothers are at greater risk of obesity, diabetes, coronary heart disease and stroke. These offspring may also be at greater risk of age-related neurodegenerative diseases for which mid-life obesity is a risk factor. Rodent diet-induced obesity models have shown that high fat (HF) diet consumption damages the integrity of the blood-brain barrier (BBB) in the adult brain. However, there is currently little information about the effect of chronic HF feeding on the BBB of aged animals. Moreover, the long-term consequences of maternal obesity on the cerebrovasculature of aged offspring are not known. This study determined the impact of pre- and postnatal HF diet on the structure and integrity of cerebral blood vessels in aged male and female mice. Female C57Bl/6 mice were fed either a 10% fat control (C) or 45% HF diet before mating and during gestation and lactation. At weaning, male and female offspring were fed the C or HF diet until sacrifice at 16-months of age. Both dams and offspring fed the HF diet weighed significantly more than mice fed the C diet. Postnatal HF diet exposure increased hippocampal BBB leakiness in female offspring, in association with loss of astrocyte endfoot coverage of arteries. Markers of tight junctions, pericytes or smooth muscle cells were not altered by pre- or postnatal HF diet. Male offspring born to HF-fed mothers showed decreased parenchymal GFAP expression compared to offspring of mothers fed C diet, while microglial and macrophage markers were higher in the same female diet group. In addition, female offspring exposed to the HF diet for their entire lifespan showed more significant changes in vessel structure, BBB permeability and inflammation compared to male animals. These results suggest that the long-term impact of prenatal HF diet on the integrity of cerebral blood vessels differs between male and female offspring depending on the postnatal diet. This may have implications for the prevention and management of age- and obesity-related cerebrovascular diseases that differentially affect men and women

A novel category of antigens enabling CTL immunity to tumor escape variants: Cinderella antigens

Deficiencies in MHC class I antigen presentation are a common feature of tumors and allows escape from cytotoxic T lymphocyte (CTL)-mediated killing. It is crucial to take this capacity of tumors into account for the development of T-cell-based immunotherapy, as it may strongly impair their effectiveness. A variety of escape mechanisms has been described thus far, but progress in counteracting them is poor. Here we review a novel strategy to target malignancies with defects in the antigenic processing machinery (APM). The concept is based on a unique category of CD8+ T-cell epitopes that is associated with impaired peptide processing, which we named TEIPP. We characterized this alternative peptide repertoire emerging in MHC-I on tumors lacking classical antigen processing due to defects in the peptide transporter TAP (transporter associated with peptide processing). These TEIPPs exemplify interesting parallels with the folktale figure Cinderella: they are oppressed and neglected by a stepmother (like functional TAP prevents TEIPP presentation), until the suppression is released and Cinderella/TEIPP achieves unexpected recognition. TEIPP-specific CTLs and their cognate peptide-epitopes provide a new strategy to counteract immune evasion by APM defects and bear potential to targeting escape variants observed in a wide range of cancers

Alternative Antigen Processing for MHC Class I: Multiple Roads Lead to Rome

The well described conventional antigen processing pathway is accountable for most peptides that end up in MHC class I molecules at the cell surface. These peptides experienced liberation by the proteasome and transport by the peptide transporter TAP. However, there are multiple roads that lead to Rome, illustrated by the increasing number of alternative processing pathways that have been reported during last years. Interestingly, TAP-deficient individuals do not succumb to viral infections, suggesting that CD8 T cell immunity is sufficiently supported by alternative TAP-independent processing pathways. To date, a diversity of viral and endogenous TAP-independent peptides have been identified in the grooves of different MCH class I alleles. Some of these peptides are not displayed by normal TAP-positive cells and we therefore called them TEIPP, for ‘T-cell epitopes associated with impaired peptide processing’. TEIPPs are hidden self-antigens, are derived from normal housekeeping proteins and are processed via unconventional processing pathways. Per definition, TEIPPs are presented via TAP-independent pathways, but recent data suggest that part of this repertoire still depend on proteasome and metalloprotease activity. An exception is the C-terminal peptide of the ER-membrane spanning ceramide synthase Trh4 that is surprisingly liberated by the signal peptide peptidase (SPP), the proteolytic enzyme involved in cleaving leader sequences. The intramembrane cleaving SPP is thereby an important contributor of TAP-independent peptides. Its family members, like the Alzheimer’s related presenilins, might as well, according to our preliminary data. Finally, alternative peptide routing is an emerging field and includes processes like the unfolded protein response, the ER-associated degradation and autophagy-associated vesicular pathways. These data convince us that there is a world to be discovered in the field of unconventional antigen processing