End-of-life care guidelines and care plans in the intensive care unit

The aim of this literature review was to examine end of life (EoL) care practice within the Intensive care unit (ICU). By looking at the literature, it is hoped to suggest how national guidance can be integrated into the ICU setting. Delivering high-quality, patient-centred EoL care is high priority on the UK health agenda. The highly technological environment within ICU can create barriers to recognising death and initiating EoL care planning. Despite recommendations in the literature for the integration of standardised guidance, implementation, compliance and evaluation are yet to be widely reported. This literature review highlights the need for ICU health professionals to embrace EoL guideline recommendations. Development of robust processes is vital to inform future practice

Care of the critically ill patient with a tracheostomy

Tracheostomy insertion and management is increasingly common in critical care units and general wards. Therefore, it is important that nurses are equipped with the appropriate knowledge and skills to meet the individual needs of patients with a tracheostomy safely and competently. This article aims to enhance nurses' understanding of the potential challenges that patients with a tracheostomy may experience, and to guide nurses in providing effective care and support to these patients. It outlines the care that should be provided for patients with a tracheostomy who are critically ill, including methods of humidification and endotracheal suctioning. This article also discusses the effects that a tracheostomy may have on a patient's communication and psychological well-being, and explains the actions that nurses should take in an emergency and if complications occur. [Abstract copyright: © 2019 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

Hard Graft: Collaborative exploration of working class stories in shaping female educator identities

This empirical qualitative study investigates the ways in which working-class roots have shaped educator values and identity. Using collaborative autoethnography, we share an honest insight into the stories of seven female educators drawn together from a variety of health and social care disciplines. The five themes emerging from this research: Connection through differences and commonalities; graft; inner tensions; authenticity ‘I am who I am’ and the bigger picture are tightly interconnected, generating a complex and rich picture of contemporary female educator identity. This supportive and collaborative approach has been transformational in the realisation we are not alone, and it has provided a space to celebrate our ‘otherness’. As a result, we have embraced our collective responsibility to challenge inequalities and foster a more open, accessible and authentic HE future for all

Hard Graft: Collaborative exploration of working class stories in shaping female educator identities

This empirical qualitative study investigates the ways in which working-class roots have shaped educator values and identity. Using collaborative autoethnography, we share an honest insight into the stories of seven female educators drawn together from a variety of health and social care disciplines. The five themes emerging from this research: Connection through differences and commonalities; graft; inner tensions; authenticity ‘I am who I am’ and the bigger picture are tightly interconnected, generating a complex and rich picture of contemporary female educator identity. This supportive and collaborative approach has been transformational in the realisation we are not alone, and it has provided a space to celebrate our ‘otherness’. As a result, we have embraced our collective responsibility to challenge inequalities and foster a more open, accessible and authentic HE future for all

Hard Graft: Collaborative exploration of working class stories in shaping female educator identities

This empirical qualitative study investigates the ways in which working-class roots have shaped educator values and identity. Using collaborative autoethnography, we share an honest insight into the stories of seven female educators drawn together from a variety of health and social care disciplines. The five themes emerging from this research: Connection through differences and commonalities; graft; inner tensions; authenticity ‘I am who I am’ and the bigger picture are tightly interconnected, generating a complex and rich picture of contemporary female educator identity. This supportive and collaborative approach has been transformational in the realisation we are not alone, and it has provided a space to celebrate our ‘otherness’. As a result, we have embraced our collective responsibility to challenge inequalities and foster a more open, accessible and authentic HE future for all

Translational pharmacology of an inhaled small molecule αvβ6 integrin inhibitor for idiopathic pulmonary fibrosis

The αvβ6 integrin plays a key role in the activation of transforming growth factor-β (TGFβ), a pro-fibrotic mediator that is pivotal to the development of idiopathic pulmonary fibrosis (IPF). We identified a selective small molecule αvβ6 RGD-mimetic, GSK3008348, and profiled it in a range of disease relevant pre-clinical systems. To understand the relationship between target engagement and inhibition of fibrosis, we measured pharmacodynamic and diseaserelated end points. Here we report, GSK3008348 binds to αvβ6 with high affinity in human IPF lung and reduces downstream pro-fibrotic TGFβ signaling to normal levels. In human lung epithelial cells, GSK3008348 induces rapid internalization and lysosomal degradation of the αvβ6 integrin. In the murine bleomycin-induced lung fibrosis model, GSK3008348 engages αvβ6, induces prolonged inhibition of TGFβ signaling and reduces lung collagen deposition and serum C3M, a marker of IPF disease progression. These studies highlight the potential of inhaled GSK3008348 as an anti-fibrotic therapy

Self-organization of the human embryo in the absence of maternal tissues.

Remodelling of the human embryo at implantation is indispensable for successful pregnancy. Yet it has remained mysterious because of the experimental hurdles that beset the study of this developmental phase. Here, we establish an in vitro system to culture human embryos through implantation stages in the absence of maternal tissues and reveal the key events of early human morphogenesis. These include segregation of the pluripotent embryonic and extra-embryonic lineages, and morphogenetic rearrangements leading to generation of a bilaminar disc, formation of a pro-amniotic cavity within the embryonic lineage, appearance of the prospective yolk sac, and trophoblast differentiation. Using human embryos and human pluripotent stem cells, we show that the reorganization of the embryonic lineage is mediated by cellular polarization leading to cavity formation. Together, our results indicate that the critical remodelling events at this stage of human development are embryo-autonomous, highlighting the remarkable and unanticipated self-organizing properties of human embryos.This work was supported by the Wellcome Trust grant to M.Z- G. Work in Dr. K.K.N lab was supported by The Francis Crick Institute, which receives its core funding from Cancer Research UK, the Medical Research Council and the Wellcome Trust. Dr. M.N.S. was initially supported by a Ramon Areces Spanish Foundation Fellowship, and subsequently by an EMBO Postdoctoral Fellowship. Dr. S.V was supported by a Post Doc Pool Grant from the Finnish Cultural Foundation. Dr. GR was supported by a Newton Fellowship.This is the author accepted manuscript. It is currently under an indefinite embargo pending publication by Nature Publishing Group

SuTuRe study. Supporting Students to Return to study following course interruption

Background Pre-registration BSc Nursing education in the United Kingdom (UK) is renowned for being a challenging course due to its requirement for 2300 hours each for theoretical and practice-based learning. It is therefore inevitable that some students may need to interrupt their study at some point during the course. In many cases, these students do not return and leave the course which has an impact on the future nursing workforce. Aims To examine the reasons why pre-registration student nurses, interrupt their studies and consider ways to enable them to return successfully and complete the course. Methods The research project was based in one Higher Education Institution (HEI) in the Northwest region of the UK. Interrupted students due to return to study in semester 1 of the 22/23 academic year (n=95) were invited to participate in semi structured interviews. Findings The results of this study found that health, including mental health was the most dominant factor leading to the interruption of study for the students. Conclusion This research has led to the HEI introducing an improved support package for students. Alongside other recommendations it is hoped the changes will reduce attrition and lead to an improved interruption/return to study experience

Nurses\u27 encounters with patients having end-of-life dreams and visions in an acute care setting – A cross-sectional survey study

Aim: This study aimed to estimate the proportion of acute care nurses witnessing end-of-life dreams and visions or having these reported by a patient or relative, and to canvass their related attitudes and beliefs. Design: A cross-sectional survey study was conducted from February 2023 to May 2023. Setting/Participants: Participants were medical and surgical nurses from a 200-bed acute care hospital in metropolitan Australia. Results: Fifty-seven nurses participated from a workforce of 169 (34% response rate), of whom 35 (61%) reported they had encountered end-of-life dreams and visions. The nature of end-of-life dreams and visions encountered was similar to those reported in previous studies by patients and clinicians. Nurses generally held positive attitudes towards end-of-life dreams and visions but identified an unmet need for education and training on this aspect of end-of-life care. Conclusion: Our results suggest that nurses in acute care encounter end-of-life dreams and visions in a similar proportion to oncology and long-term care but lower than in palliative care settings. Education and training regarding end-of-life dreams and visions are needed to ensure the provision of comprehensive, patient-centred end-of-life care. Patient or Public Contribution: No patient or public contribution. Impact: Research in sub-acute and long-term care settings suggests that end-of-life dreams and visions are a common accompaniment to the dying process. No research has yet focused on the acute care setting, despite this being the place of death for the majority of people in most high-income countries. This study demonstrates that acute care nurses encounter end-of-life dreams and visions in similar proportions to oncology and long-term care nurses but lower than palliative care nurses. Acute care nurses would benefit from education and training regarding end-of-life dreams and visions to enable the provision of holistic person-centred end-of-life care. Reporting Method: This study was reported using the STROBE Checklist for cross-sectional studies

Patient and carer experiences of pain care in an Australian regional comprehensive cancer care setting: a qualitative study

Introduction: Pain is a common and distressing symptom in people living with cancer that requires a patient-centred approach to management. Since 2010, the Australian Government has invested heavily in developing regional cancer centres to improve cancer outcomes. This study explored patient and carer experiences of care from a regional cancer centre with specific reference to cancer pain management.Methods: A qualitative approach was used with semi-structured telephone interviews. Participants were outpatients at a regional cancer centre in New South Wales who had reported worst pain of 2 or more on a 0–10 numerical rating scale, and their carers. Questions explored experiences of pain assessment and management, and perceptions of how these were affected by the regional setting. Researchers analysed data using a deductive approach, using Mead and Bower’s (2000) framework of factors influencing patient-centred care.Results: Eighteen telephone interviews were conducted with 13 patients and 5 carers. Participants perceived that living in a regional setting conferred advantages to the patient-centredness of care via influences at the levels of professional context, the doctor–patient relationship, and consultation. These influences included established and ongoing relationships with a smaller number of care providers who were members of the community, and heightened accessibility in terms of travel/parking, flexible appointments, and ample time spent with each patient. The first of these factors was also perceived to contribute to continuity of care between specialist and primary care providers. However, one negative case reported disagreement between providers and a difficulty accessing specialist pain services. Several participants also reported a preference, and unmet need, for non-pharmacological rather than pharmacological pain management.Conclusion: While much research has focused on lack of services and poorer outcomes for people with cancer in rural areas, the Australian regional setting may offer benefits to the patient-centredness of cancer pain management and continuity of care. More research is needed to better understand the benefits and trade-offs of cancer care in regional versus urban settings, and how each can learn from the other. An unmet need for non-pharmacological rather than pharmacological pain management is among the most consistent findings of qualitative studies of patient/carer preferences across settings