Validity and reliability of the Critical Care Pain Observation Tool: A replication study

Because critically ill patients are often not able to self report the presence of pain, an observer rating scale, the Critical Care Pain Observation Tool (CPOT) was developed for pain assessment of critically ill patients. This research examines the reliability and validity of the CPOT via replication of the original research study that developed the tool. Utilizing a repeated measures design, two nurse observers used the CPOT to score patient pain behaviors during rest, with repositioning and after repositioning. Results show fair to almost perfect interrater reliability and good discriminant validity of the instrument. The Critical Care Pain Observation Tool is a promising instrument for assessment of pain in critically ill patients

Peripheral Brain Derived Neurotrophic Factor (BDNF) in Bulimia Nervosa: A Systematic Review

Currently, there is limited understanding of the etiology of BN. While multifaceted etiology is likely, several neurobiological factors may play a role. Brain derived neurotrophic factor (BDNF), a potential biomarker linked to eating and weight disorders, is one factor of recent investigation. This paper examined studies comparing BDNF blood levels in BN to healthy control (HC) subjects.Methods: A systematic review of the literature was conducted utilizing five databases (PubMed, CINAHL, EMBASE, PsycINFO, and Medline). Key terms included eating disorders, BDNF, and bulimia nervosa.Conclusions: BDNF blood levels appear lower in BN than in HC subjects; however, studies are needed to examine the influence of possible correlates including symptom severity, mood, medications, exercise, and substance use. Bulimia nervosa (BN) is an eating disorder characterized by episodes of eating a large amount of food in a short period of time with a subjective experience of loss of control (American Psychiatric Association [APA], 2013). The caloric content resulting from the binge episodes is then compensated in some way such as self-induced vomiting or laxative misuse (APA, 2013). The onset of the disorder typically occurs during adolescence or young adulthood and affects more women than men (Hudson, Hiripi, Pope, & Kessler, 2007). BN is associated with significant medical morbidity including electrolyte imbalances, dental erosion, and arrhythmias (Mehler, 2011). Currently there is limited understanding of the etiology of BN. Several biomarkers have been implicated in the etiology of BN, including brain derived neurotrophic factor (BDNF) (Nakazato, Hashimoto, Shimizu, Niitsu, & Iyo, 2012). The purpose of this review is to examine investigations to date to further elucidate the possible role of BDNF in BN

Extensive Genomic Diversity among Bovine-Adapted Staphylococcus aureus: Evidence for a Genomic Rearrangement within CC97

peer-reviewedStaphylococcus aureus is an important pathogen associated with both human and veterinary disease and is a common cause of bovine mastitis. Genomic heterogeneity exists between S. aureus strains and has been implicated in the adaptation of specific strains to colonise particular mammalian hosts. Knowledge of the factors required for host specificity and virulence is important for understanding the pathogenesis and management of S. aureus mastitis. In this study, a panel of mastitis-associated S. aureus isolates (n = 126) was tested for resistance to antibiotics commonly used to treat mastitis. Over half of the isolates (52%) demonstrated resistance to penicillin and ampicillin but all were susceptible to the other antibiotics tested. S. aureus isolates were further examined for their clonal diversity by Multi-Locus Sequence Typing (MLST). In total, 18 different sequence types (STs) were identified and eBURST analysis demonstrated that the majority of isolates grouped into clonal complexes CC97, CC151 or sequence type (ST) 136. Analysis of the role of recombination events in determining S. aureus population structure determined that ST diversification through nucleotide substitutions were more likely to be due to recombination compared to point mutation, with regions of the genome possibly acting as recombination hotspots. DNA microarray analysis revealed a large number of differences amongst S. aureus STs in their variable genome content, including genes associated with capsule and biofilm formation and adhesion factors. Finally, evidence for a genomic arrangement was observed within isolates from CC97 with the ST71-like subgroup showing evidence of an IS431 insertion element having replaced approximately 30 kb of DNA including the ica operon and histidine biosynthesis genes, resulting in histidine auxotrophy. This genomic rearrangement may be responsible for the diversification of ST71 into an emerging bovine adapted subgroup

Older Adult Narrative of the Experience of Cardiac Surgery

Thesis advisor: Dorothy A. JonesCardiac surgery is frequently performed as a surgical intervention within the United States; but there is little known about how the older adult (70 years of age or greater) experiences cardiac surgery and recovery over time. This qualitative research study utilized narrative methodology to interview 13 older adults to inform understanding of the older adult's cardiac surgical experience. The purpose of this study was to describe the story of the older adult both coming to surgery (preoperative period) and during the transitional time of the acute recovery period following cardiac surgery (up to 8 weeks after cardiac surgery). The primary research question asked was "What stories do older adults tell of their experience of cardiac surgery from the preoperative period through the first 2 months postoperatively?" Using narrative analysis of participant discourse, consisting of both structural (re-storying of narrative content) and thematic analysis of interview content, there emerged an overarching story of older adult experience of cardiac surgery which can be described thematically as: Moving toward healing: engaged in and appreciating life while conscious of time passing amidst the primacy and struggle of the symptom experience. Knowledge gained from this study can help to broaden the understanding of the experience and the trajectory of older adult recovery after cardiac surgery, and also serves to inform nursing education and practice models, nursing interventions, instrument development and innovative models of care designed to support the perioperative care of older adults.Thesis (PhD) — Boston College, 2015.Submitted to: Boston College. Connell School of Nursing.Discipline: Nursing

Effect of Maternal Diet on Maternal Milk and Breastfed Infant Gut Microbiomes: A Scoping Review

While it is widely recognized that nutrition during pregnancy and lactation can affect the microbiome of breast milk as well as the formation of the infant gut microbiome, we are only just beginning to understand the extent to which maternal diet impacts these microbiomes. Given the importance of the microbiome for infant health, we conducted a comprehensive review of the published literature to explore the current scope of knowledge regarding associations between maternal diet and the breast milk and infant gut microbiomes. Papers included in this review assessed either diet during lactation or pregnancy, and the milk and/or infant gut microbiome. Sources included cohort studies, randomized clinical trials, one case-control study, and one crossover study. From an initial review of 808 abstracts, we identified 19 reports for a full analysis. Only two studies assessed the effects of maternal diet on both milk and infant microbiomes. Although the reviewed literature supports the importance of a varied, nutrient-dense maternal diet in the formation of the infant’s gut microbiome, several studies found factors other than maternal diet to have a greater impact on the infant microbiome

SETD2 transcriptional control of ATG14L/S isoforms regulates autophagosome-lysosome fusion

Macroautophagy/autophagy is an evolutionarily conserved and tightly regulated catabolic process involved in the maintenance of cellular homeostasis whose dysregulation is implicated in several pathological processes. Autophagy begins with the formation of phagophores that engulf cytoplasmic cargo and mature into double-membrane autophagosomes; the latter fuse with lysosomes/vacuoles for cargo degradation and recycling. Here, we report that yeast Set2, a histone lysine methyltransferase, and its mammalian homolog, SETD2, both act as positive transcriptional regulators of autophagy. However, whereas Set2 regulates the expression of several autophagy-related (Atg) genes upon nitrogen starvation, SETD2 effects in mammals were found to be more restricted. In fact, SETD2 appears to primarily regulate the differential expression of protein isoforms encoded by the ATG14 gene. SETD2 promotes the expression of a long ATG14 isoform, ATG14L, that contains an N-terminal cysteine repeats domain, essential for the efficient fusion of the autophagosome with the lysosome, that is absent in the short ATG14 isoform, ATG14S. Accordingly, SETD2 loss of function decreases autophagic flux, as well as the turnover of aggregation-prone proteins such as mutant HTT (huntingtin) leading to increased cellular toxicity. Hence, our findings bring evidence to the emerging concept that the production of autophagy-related protein isoforms can differentially affect core autophagy machinery bringing an additional level of complexity to the regulation of this biological process in more complex organisms.Peer reviewe

A cost comparison study to review community versus acute hospital models of nursing care delivered to oncology patients

Purpose: Ireland's Sláintecare health plan is placing an increased focus on primary care. A community oncology nursing programme was developed to train community nurses to deliver care in the community. While the initial pilot was proven to be clinically safe, no cost evaluation was carried out. This study aims to compare the costs of providing cancer support services in a day-ward versus in the community. Methods: 183 interventions (40 in day-ward and 143 in community) were timed and costed using healthcare professional salaries and the Human Capital method. Results: From the healthcare provider perspective, the day-ward was a significantly cheaper option by an average of €17.13 (95% CI €13.72 - €20.54, p < 0.001). From the societal perspective, the community option was cheaper by an average of €2.77 (95% CI -€3.02 – €8.55), although this was a non-significant finding. Sensitivity analyses indicate that the community service may be significantly cheaper from the societal perspective. Conclusions: Given the demand for cost-viable options for primary care services, this programme may represent a national option for cancer care in Ireland when viewed from the societal perspective

MMP1 and MMP7 as Potential Peripheral Blood Biomarkers in Idiopathic Pulmonary Fibrosis

Naftali Kaminski and colleagues find increased levels of specific proteins in the bloodstream of individuals with idiopathic pulmonary fibrosis, and suggest that these proteins may ultimately provide a biomarker for the disease

U.S. medical resident familiarity with national tuberculosis guidelines

<p>Abstract</p> <p>Background</p> <p>The ability of medical residents training at U.S. urban medical centers to diagnose and manage tuberculosis cases has important public health implications. We assessed medical resident knowledge about tuberculosis diagnosis and early management based on American Thoracic Society guidelines.</p> <p>Methods</p> <p>A 20-question tuberculosis knowledge survey was administered to 131 medical residents during a single routinely scheduled teaching conference at four different urban medical centers in Baltimore and Philadelphia. Survey questions were divided into 5 different subject categories. Data was collected pertaining to institution, year of residency training, and self-reported number of patients managed for tuberculosis within the previous year. The Kruskal-Wallis test was used to detect differences in median percent of questions answered correctly based on these variables.</p> <p>Results</p> <p>The median percent of survey questions answered correctly for all participating residents was 55%. Medical resident knowledge about tuberculosis did not improve with increasing post-graduate year of training or greater number of patients managed for tuberculosis within the previous year. Common areas of knowledge deficiency included the diagnosis and management of latent tuberculosis infection (median percent correct, 40.7%), as well as the interpretation of negative acid-fast sputum smear samples.</p> <p>Conclusion</p> <p>Many medical residents lack adequate knowledge of recommended guidelines for the management of tuberculosis. Since experience during training influences future practice pattterns, education of medical residents on guidelines for detection and early management of tuberculosis may be important for future improvements in national tuberculosis control strategies.</p

Adjuvant Chemotherapy Guided by a 21-Gene Expression Assay in Breast Cancer

BACKGROUND The recurrence score based on the 21-gene breast cancer assay predicts chemotherapy benefit if it is high and a low risk of recurrence in the absence of chemotherapy if it is low; however, there is uncertainty about the benefit of chemotherapy for most patients, who have a midrange score. METHODS We performed a prospective trial involving 10,273 women with hormone-receptor–positive, human epidermal growth factor receptor 2 (HER2)–negative, axillary node–negative breast cancer. Of the 9719 eligible patients with follow-up information, 6711 (69%) had a midrange recurrence score of 11 to 25 and were randomly assigned to receive either chemoendocrine therapy or endocrine therapy alone. The trial was designed to show noninferiority of endocrine therapy alone for invasive disease–free survival (defined as freedom from invasive disease recurrence, second primary cancer, or death). RESULTS Endocrine therapy was noninferior to chemoendocrine therapy in the analysis of invasive disease–free survival (hazard ratio for invasive disease recurrence, second primary cancer, or death [endocrine vs. chemoendocrine therapy], 1.08; 95% confidence interval, 0.94 to 1.24; P=0.26). At 9 years, the two treatment groups had similar rates of invasive disease–free survival (83.3% in the endocrine-therapy group and 84.3% in the chemoendocrine-therapy group), freedom from disease recurrence at a distant site (94.5% and 95.0%) or at a distant or local–regional site (92.2% and 92.9%), and overall survival (93.9% and 93.8%). The chemotherapy benefit for invasive disease–free survival varied with the combination of recurrence score and age (P=0.004), with some benefit of chemotherapy found in women 50 years of age or younger with a recurrence score of 16 to 25. CONCLUSIONS Adjuvant endocrine therapy and chemoendocrine therapy had similar efficacy in women with hormone-receptor–positive, HER2-negative, axillary node–negative breast cancer who had a midrange 21-gene recurrence score, although some benefit of chemotherapy was found in some women 50 years of age or younger