Integration of the Saline Process on Holistic Patient Care to Improve Student Understanding of Interprofessional Team Roles, Values, and Ethics

Description of the Problem: Healthcare practitioner students currently report feeling underprepared to provide holistic and spiritual care to their patients upon transitioning into practice, and there is currently little data on the efficacy of holistic care-focused interventions on interprofessional outcomes. The goal of this research was to assess the impact of an interprofessional training session on holistic care on student perceptions of interprofessional 1) roles/responsibilities and 2) values/ethics. The Innovation: A live, interactive interprofessional training session to address holistic patient care was implemented in fall of 2017. Students’ pre- and post-training perceptions of their confidence in study outcomes were assessed using a survey instrument. Critical Analysis: Significant positive changes were seen in students’ perceived ability to participate in team discussions and clarify misconceptions regarding their role in healthcare following the training. Students had high confidence in interacting ethically at pre-test and sustained that confidence. Next Steps: Live, interactive educational interventions with skills practice and group discussions can help to increase students’ awareness of team roles and responsibilities, as well as expand their understanding of the values and ethics within healthcare professions

Investigation of novel deep eutectic systems for the reduction of water usage in leather manufacture

Water in the wet processes of leather manufacture acts as a solvent, transportation medium, support system and is an integral component of the collagen matrix stability at the macro and molecular levels. There have been proposals as to what extent water can be substituted with non-aqueous media, partly due to its role in collagen and processing. As the water content increases from bulk to float water, the system acts as a transport medium for chemical as well as a support system in processing vessels. Here, Deep Eutectic Solvents (DES) are investigated as an alternative solvent system to conventional tanning systems. The novel solvent is non-aqueous, has a high solubility for metal salts, low toxicity, is readily biodegradable and operates at variable temperatures without the release of harmful vapours. These properties make the DES system a potential alternative in leather processing, improving reagent uptake with the potential of lowering effluent discharge. The research focuses on the role of the solvent associated with stabilising collagen, such as the influence of inter- and intra-fibrillar, as well as bulk water, using type 2 DES systems. Thermal, mechanical analysis and electron microscopy were undertaken to determine the effects of the solvent system. The studies indicated that the solvent used, as well as the choice of counter ion, have an important effect on the thermal and mechanical stability of collagen

Comparison of FACS and PCR for detection of BCMA-CAR-T cells

Chimeric-antigen-receptor (CAR)-T-cell therapy is already widely used to treat patients who are relapsed or refractory to chemotherapy, antibodies, or stem-cell transplantation. Multiple myeloma still constitutes an incurable disease. CAR-T-cell therapy that targets BCMA (B-cell maturation antigen) is currently revolutionizing the treatment of those patients. To monitor and improve treatment outcomes, methods to detect CAR-T cells in human peripheral blood are highly desirable. In this study, three different detection reagents for staining BCMA-CAR-T cells by flow cytometry were compared. Moreover, a quantitative polymerase chain reaction (qPCR) to detect BCMA-CAR-T cells was established. By applying a cell-titration experiment of BCMA-CAR-T cells, both methods were compared head-to-head. In flow-cytometric analysis, the detection reagents used in this study could all detect BCMA-CAR-T cells at a similar level. The results of false-positive background staining differed as follows (standard deviation): the BCMA-detection reagent used on the control revealed a background staining of 0.04% (±0.02%), for the PE-labeled human BCMA peptide it was 0.25% (±0.06%) and for the polyclonal anti-human IgG antibody it was 7.2% (±9.2%). The ability to detect BCMA-CAR-T cells down to a concentration of 0.4% was similar for qPCR and flow cytometry. The qPCR could detect even lower concentrations (0.02-0.01%). In summary, BCMA-CAR-T-cell monitoring can be reliably performed by both flow cytometry and qPCR. In flow cytometry, reagents with low background staining should be preferred

Treatment of adult ALL patients with third-generation CD19-directed CAR T cells: results of a pivotal trial

BACKGROUND: Third-generation chimeric antigen receptor (CAR)-engineered T cells (CARTs) might improve clinical outcome of patients with B cell malignancies. This is the first report on a third-generation CART dose-escalating, phase-1/2 investigator-initiated trial treating adult patients with refractory and/or relapsed (r/r) acute lymphoblastic leukemia (ALL). METHODS: Thirteen patients were treated with escalating doses of CD19-directed CARTs between 1 × 106 and 50 × 106 CARTs/m2. Leukapheresis, manufacturing and administration of CARTs were performed in-house. RESULTS: For all patients, CART manufacturing was feasible. None of the patients developed any grade of Immune effector cell-associated neurotoxicity syndrome (ICANS) or a higher-grade (≥ grade III) catokine release syndrome (CRS). CART expansion and long-term CART persistence were evident in the peripheral blood (PB) of evaluable patients. At end of study on day 90 after CARTs, ten patients were evaluable for response: Eight patients (80%) achieved a complete remission (CR), including five patients (50%) with minimal residual disease (MRD)-negative CR. Response and outcome were associated with the administered CART dose. At 1-year follow-up, median overall survival was not reached and progression-free survival (PFS) was 38%. Median PFS was reached on day 120. Lack of CD39-expression on memory-like T cells was more frequent in CART products of responders when compared to CART products of non-responders. After CART administration, higher CD8 + and γδ-T cell frequencies, a physiological pattern of immune cells and lower monocyte counts in the PB were associated with response. CONCLUSION: In conclusion, third-generation CARTs were associated with promising clinical efficacy and remarkably low procedure-specific toxicity, thereby opening new therapeutic perspectives for patients with r/r ALL. Trial registration This trial was registered at www.clinicaltrials.gov as NCT03676504

Poor Use of Cardiac Rehabilitation Among Older Adults: A Self-regulatory Model for Tailored Interventions

Background A greater number of older adults now live with coronary heart disease (CHD). This poses a significant public health problem, because older adults are at high risk for CHD-related mortality and morbidity. Overwhelming data support the benefits of cardiac rehabilitation for secondary prevention, yet only a small portion of eligible older adults receive it. Methods and Results Whereas many studies examined factors that affect the use of cardiac rehabilitation among older adults, few interventions aimed to improve their cardiac rehabilitation participation rates. A substantial body of evidence indicates that an individual’s illness perceptions play a pivotal role in health behavior, and may be a promising target for intervention. Drawing from the theoretic and empiric findings of others, a self-regulatory model is proposed that explicates how CHD perceptions of older adults may influence participation in cardiac rehabilitation. Conclusion The model may provide a useful guide for the development of effective interventions tailored to older adults