Social and situational dynamics surrounding workplace mistreatment: Context matters

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163449/2/job2479_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163449/1/job2479.pd

An exploration of the clinical practice of Rheumatology specialist nurses undertaking consultations with patients starting Methotrexate

Background Rheumatology nursing roles have evolved over the last 25 years to include educating patients prior to commencing drugs such as Methotrexate in consultations. The expansion of their role has not been supplemented by specific training in order to prepare them for this undertaking. Thus, this study was developed to explore how Rheumatology Specialist nurses gained knowledge about consulting with patients on Methotrexate, how they delivered information to patients, and to identify elements of their consultation for further development. Methods This was a mixed-methods practice based study undertaken in three phases. Training, confidence and knowledge were explored with a questionnaire, which constituted Phase I. Phase II explored the lived experiences of the nurses with semi-structured interviews. Phase III explored the interaction between the nurses and patients during a consultation which was video-recorded and analysed using qualitative and quantitative approaches, with the interaction scored against items in the Calgary Cambridge consultation model. Findings The results of the survey (n=97) and the semi-structured interviews findings (n=6) revealed significant variability in training received by Rheumatology Specialist nurses. Confidence took three to 12 months to develop and was related to experience, knowledge and training, with nurses expressing a clear desire for more training. Written information was used by all participants during consultations, usually in the form of the Methotrexate information booklet, which had some benefits, including allowing the nurses to structure their consultations, ensuring that all of the information in the booklet was given to patients. However, it also had the disadvantage of becoming the nurses’ agenda which dominated the consultation, leading to overloading the patients with information and restricting discussion and questions from the patients. Analysis of consultation videos (n=10) supported these findings, demonstrating that whilst all of the important information from the booklet was given, there was a lack of involvement during the consultation of the patient agenda such as ideas, concerns and expectations, with little checking by the nurses to ensure the patients understood the information given. The effect of limited time was apparent. Cues from patients were often ignored or missed which may have been as a result of perceived time pressures or lack of confidence in dealing with questions. The comparison of the nurses’ consultations with the Calgary Cambridge consultation model showed variations in the nurses’ scores. It also raised new observations such as in those consultations which scored higher, the nurses used more illustrative and fewer batonic gestures, whilst the patient did the opposite. Conclusions Whilst Rheumatology Specialist nurses are clearly doing many things well, the education of patients starting drugs such as Methotrexate could be improved by training aimed at improving consultation techniques with the adoption of a modified Calgary Cambridge model consultation technique. Such an approach would benefit from further research to identify whether it results in improving patients’ involvement in the consultation process. The findings from this thesis have led directly to the development of “Top Tips”, published online by Versus Arthritis, to guide nurses during their consultations when giving information to patients about Methotrexate. Further work will include writing a handbook that aims to give nurses more knowledge about how to conduct a consultation with patients based on the Calgary Cambridge consultation model

Rethinking the Composition of a Rational Antibiotic Arsenal for the 21st Century

The importance of the human microbiome in health may be the single most valuable development in our conception of the microbial world since Pasteur\u27s germ theory of the 1860s. Its implications for our understanding of health and pathogenesis are profound. Coupled with the revolution in diagnostics that we are now witnessing - a revolution that changes medicine from a science of symptoms to a science of causes - we cannot continue to develop antibiotics as we have for the past 80 years. Instead, we need to usher in a new conception of the role of antibiotics in treatment: away from single molecules that target broad phylogenetic spectra and towards targeted molecules that cripple the pathogen while leaving the rest of the microbiome largely intact

Transport of prion protein across the blood-brain barrier.

The cellular form of the prion protein (PrP(c)) is necessary for the development of prion diseases and is a highly conserved protein that may play a role in neuroprotection. PrP(c) is found in both blood and cerebrospinal fluid and is likely produced by both peripheral tissues and the central nervous system (CNS). Exchange of PrP(c) between the brain and peripheral tissues could have important pathophysiologic and therapeutic implications, but it is unknown whether PrP(c) can cross the blood-brain barrier (BBB). Here, we found that radioactively labeled PrP(c) crossed the BBB in both the brain-to-blood and blood-to-brain directions. PrP(c) was enzymatically stable in blood and in brain, was cleared by liver and kidney, and was sequestered by spleen and the cervical lymph nodes. Circulating PrP(c) entered all regions of the CNS, but uptake by the lumbar and cervical spinal cord, hypothalamus, thalamus, and striatum was particularly high. These results show that PrP(c) has bidirectional, saturable transport across the BBB and selectively targets some CNS regions. Such transport may play a role in PrP(c) function and prion replication

Inclusive Innovation in Developed Countries: The Who, What, Why, and How

Although widely appreciated as an important driver of economic growth, innovation has also been established as a contributor to increasing economic and social inequalities. Such negative consequences are particularly obvious in the context of developing countries and extreme poverty, where innovation’s contributions to inequalities are considered an issue of social and economic exclusion. In response, the concept of inclusive innovation has been developed to provide frameworks and action guidelines to measure and reduce the inequality-increasing effects of innovation. In developing countries, attention has only recently turned to the role of innovation in increasing inequalities, for example in the context of the degradation of employment in the transition from production to service industries. Although the focus of this early work is primarily on economic growth, innovation in developed countries also contributes to social exclusion, both of groups traditionally subject to social exclusion and new groups marginalized through arising innovations. This article summarizes the origins of the concept of inclusive innovation and proposes a four-dimensional framework for inclusive innovation in developed countries. Specifically, innovation needs to be inclusive in terms of people, activities, outcomes, and governance: i) individuals and groups participating in the innovation process at all levels; ii) the types of innovation activities considered; iii) the consideration of all positive and negative outcomes of innovation (including economic, social, and environmental); and iv) the governance of innovation systems. This framework is intended to guide policy development for inclusive innovation, as well as to encourage academics to investigate all dimensions of inclusive innovation in developed countries

Using health risk assessments to target and tailor: An innovative social marketing program in aged care facilities

The number of Australians over the age of 65 years is expected to double by 2021. Many older Australians suffer from one or more chronic diseases - including cancer, coronary heart disease, respiratory diseases (AIHW, 2009) resulting in increased morbidity and mortality, lower quality of life and a higher need for health care (Hickey and Stilwell, 1991). There is increasing evidence that the adoption of healthy lifestyles can have significant benefits even into older age (Haveman-Nies et al, 2002). This project utilized a social marketing framework to support aged residents of retirement homes to adopt healthy lifestyle behaviours to improve their health

Body Composition, Serum Biomarkers of Inflammation and Quality of Life in Clinically Stable Women with Estrogen Receptor Positive Metastatic Breast Cancer

Limited data exist regarding body composition and associated patient-reported outcomes for women with metastatic BC. Demographic, clinical, blood, and questionnaire data were collected to quantify body composition and explore associations with symptoms, inflammation, and quality of life (QOL) in 41 women with ER + metastatic BC. Diagnostic/surveillance computed tomography (CT) images including the third lumbar region (L3) were obtained to evaluate skeletal muscle (SM) quantity and quality, and abdominal adipose tissue. Frequencies, medians and interquartile ranges are presented, stratified by sarcopenia and obesity (Body mass index (BMI) ≥ 30.0 kg/m2). Overall, 34% (n = 14/41), 49% (n = 20/41), and 34% (n = 14) of women had sarcopenia, myosteatosis, and obesity, respectively. Handgrip strength was compromised in 24% of subjects (n = 10/41). Women with sarcopenia had significantly lower body weight (P = 0.01), BMI (P ≤ 0.001), and whole body SM (P \u3c 0.001), yet reported greater engagement in leisure time exercises (P = 0.05) vs. nonsarcopenic women. Women with obesity had significantly higher levels of abdominal obesity (all values P \u3c 0.0001) and serum biomarkers of inflammation (P values \u3c0.06), yet lower QOL (P = 0.02) vs. women without obesity. The abPGSGA did not differentiate women with sarcopenia. Future interventions should test if improvements in body composition are associated with better outcomes for this vulnerable, emerging population

Seed Viability Testing Guide for Common Wetland Plant Species

Seeds are used in many aspects of plant research as well as in applications such as ecosystem restoration. However, not all seeds are living (i.e., viable). To successfully work with seeds, it is essential to know how many seeds are viable. Seed viability can be assessed through a few different avenues, such as a basic cut test (i.e., is the embryo fully developed), germination assays, x-ray imaging, or the most common—a tetrazolium (TZ) test. This document focuses on best practices for TZ testing for a wide array of common wetland species that have been the focus of research and restoration in the Intermountain West