Speak up! Factors that influence involvement of nurses in oncological multidisciplinary team meetings

Purpose – Nurses are capable of acting as advocates for patients since they hold valuable knowledge on patient preferences and their psychosocial needs. Yet, in practice they tend to contribute little to multidisciplinary team meetings (MDTMs). This study analyses the factors that influence whether or not nurses will speak up and increase patient-centred decision-making in MDTMs.Design/methodology/approach – A multiple case study with cross-case comparison of twelve tumour groups across two Belgian hospitals was conducted. Data collection involved fifty structured non-participant observations and 41 semi-structured interviews with participants from the twelve tumour groups.Originality/value – This study yields factors that increase the opportunities for nurses to speak up in MDTMs to enhance patient-centred decision-making. The findings help in the design of future interventions concerning multidisciplinary teamwork, that address nurses’ contributions to augment patient-centred care

Variations in follow-up services after inpatient stroke rehabilitation: A multicentre study

Background: Care after discharge from inpatient stroke rehabilitation units varies across Europe. The aim of this study was to compare service delivery after discharge. Methods: A total of 532 consecutive patients after stroke were recruited from 4 European rehabilitation centres in Germany, Switzerland, Belgium and the UK. At 2-month intervals, clinical assessments and structured interviews were carried out to document functional status and delivery of services after discharge. Significant factors for receiving follow-up services were analysed using a logistic generalized estimating equation model. Results: After controlling for case-mix, the results showed that Belgian patients were most likely to receive physical therapy but least likely to receive occupational therapy. German patients were least likely to receive nursing care. UK patients were less likely to receive medical care from their general practitioner compared with the other patient groups. Conclusion: Clinical characteristics did not explain the variations in service delivery after discharge from inpatient stroke rehabilitation. The decision-making processes involved in the provision of follow-up services need to be better documented. To improve our understanding of events post-discharge, the influence of non-clinical factors, such as healthcare regulations, should be explored further

Structure and mechanism of a canonical poly(ADP-ribose) glycohydrolase

Poly(ADP-ribosyl)ation is a reversible post-translational protein modification involved in the regulation of a number of cellular processes including DNA repair, chromatin structure, mitosis, transcription, checkpoint activation, apoptosis and asexual development. The reversion of poly(ADP-ribosyl)ation is catalysed by poly(ADP-ribose) (PAR) glycohydrolase (PARG), which specifically targets the unique PAR (1''-2') ribose-ribose bonds. Here we report the structure and mechanism of the first canonical PARG from the protozoan Tetrahymena thermophila. In addition, we reveal the structure of T. thermophila PARG in a complex with a novel rhodanine-containing mammalian PARG inhibitor RBPI-3. Our data demonstrate that the protozoan PARG represents a good model for human PARG and is therefore likely to prove useful in guiding structure-based discovery of new classes of PARG inhibitors

Visualization of poly(ADP-ribose) bound to PARG reveals inherent balance between exo- and endo-glycohydrolase activities

Poly-ADP-ribosylation is a post-translational modification that regulates processes involved in genome stability. Breakdown of the poly(ADP-ribose) (PAR) polymer is catalysed by poly(ADP-ribose) glycohydrolase (PARG), whose endo-glycohydrolase activity generates PAR fragments. Here we present the crystal structure of PARG incorporating the PAR substrate. The two terminal ADP-ribose units of the polymeric substrate are bound in exo-mode. Biochemical and modelling studies reveal that PARG acts predominantly as an exo-glycohydrolase. This preference is linked to Phe902 (human numbering), which is responsible for low-affinity binding of the substrate in endo-mode. Our data reveal the mechanism of poly-ADP-ribosylation reversal, with ADP-ribose as the dominant product, and suggest that the release of apoptotic PAR fragments occurs at unusual PAR/PARG ratios

Psychopolitics: Peter Sedgwick’s legacy for mental health movements

This paper re-considers the relevance of Peter Sedgwick's Psychopolitics (1982) for a politics of mental health. Psychopolitics offered an indictment of ‘anti-psychiatry’ the failure of which, Sedgwick argued, lay in its deconstruction of the category of ‘mental illness’, a gesture that resulted in a politics of nihilism. ‘The radical who is only a radical nihilist’, Sedgwick observed, ‘is for all practical purposes the most adamant of conservatives’. Sedgwick argued, rather, that the concept of ‘mental illness’ could be a truly critical concept if it was deployed ‘to make demands upon the health service facilities of the society in which we live’. The paper contextualizes Psychopolitics within the ‘crisis tendencies’ of its time, surveying the shifting welfare landscape of the subsequent 25 years alongside Sedgwick's continuing relevance. It considers the dilemma that the discourse of ‘mental illness’ – Sedgwick's critical concept – has fallen out of favour with radical mental health movements yet remains paradigmatic within psychiatry itself. Finally, the paper endorses a contemporary perspective that, while necessarily updating Psychopolitics, remains nonetheless ‘Sedgwickian’

Coupled Motions Direct Electrons along Human Microsomal P450 Chains

Directional electron transfer through biological redox chains can be achieved by coupling reaction chemistry to conformational changes in individual redox enzymes

Challenges, solutions and research priorities for sustainable rangelands

Australia’s rangeland communities, industries, and environment are under increasing pressures from anthropogenic activities and global changes more broadly. We conducted a horizon scan to identify and prioritise key challenges facing Australian rangelands and their communities, and outline possible avenues to address these challenges, with a particular focus on research priorities. We surveyed participants of the Australian Rangeland Society 20th Biennial Conference, held in Canberra in September 2019, before the conference and in interactive workshops during the conference, in order to identify key challenges, potential solutions, and research priorities. The feedback was broadly grouped into six themes associated with supporting local communities, managing natural capital, climate variability and change, traditional knowledge, governance, and research and development. Each theme had several sub-themes and potential solutions to ensure positive, long-term outcomes for the rangelands. The survey responses made it clear that supporting ‘resilient and sustainable rangelands that provide cultural, societal, environmental and economic outcomes simultaneously’ is of great value to stakeholders. The synthesis of survey responses combined with expert knowledge highlighted that sustaining local communities in the long term will require that the inherent social, cultural and natural capital of rangelands are managed sustainably, particularly in light of current and projected variability in climate. Establishment of guidelines and approaches to address these challenges will benefit from: (i) an increased recognition of the value and contributions of traditional knowledge and practices; (ii) development of better governance that is guided by and benefits local stakeholders; and (iii) more funding to conduct and implement strong research and development activities, with research focused on addressing critical knowledge gaps as identified by the local stakeholders. This requires strong governance with legislation and policies that work for the rangelands. We provide a framework that indicates the key knowledge gaps and how innovations may be implemented and scaled out, up and deep to achieve the resilience of Australia’s rangelands. The same principles could be adapted to address challenges in rangelands on other continents, with similar beneficial outcomes

Wasting Breath in Hamlet

This is the final version. Available on open access from Palgrave via the DOI in this recordThis chapter draws on instances of disordered breathing in Hamlet in order to examine the cultural signifcance of sighs in the early modern period, as well as in the context of current work in the feld of medical humanities. Tracing the medical history of sighing in ancient and early modern treatises of the passions, the chapter argues that sighs, in the text and the performance of the tragedy, exceed their conventional interpretation as symptoms of pain and disrupt meaning on the page and on stage. In the light of New Materialist theory, the air circulating in Hamlet is shown to dismantle narratives of representation, posing new questions for the future of medical humanities