Identifying factors which enhance the self-management of type 2 diabetes: A systematic review with thematic analysis

YesBackground: Individuals with type 2 diabetes play a pivotal role in their health. Enhancing the self-management of diabetes can improve blood glucose control, and quality of life, and reduce diabetes-related complications. We have identified factors influencing the self-management of type 2 diabetes to inform strategies that may be applied in the long-term management of blood glucose control. Methods: We conducted a systematic literature review of recent studies published between January 2010 to December 2020 to identify the available evidence on effective self-management strategies for type 2 diabetes. The databases used for the searchers were Scopus, PubMed, Science Direct, CINAHL, and Google Scholar. We assessed English language publications only. The screening of titles was duplicated by two researchers. We then conducted a thematic analysis of the key findings from eligible publications to identify reoccurring messages that may augment or abate self-management strategies. Results: We identified 49 relevant publications involving 90,857 participants. Four key themes were identified from these publications: Individual drive, social capital, Knowledge base, and Insufficient health care. High motivation and self-efficacy enabled greater self-management. The importance of family, friends, and the health care professional was salient, as were the negative effects of stigma and labelling. Enablers to good self-management were the level of support provided and its affordability. Finally, the accessibility and adequacy of the health care services emerged as fundamental to permit diabetes self-management. Conclusions: Self-management of type 2 diabetes is an essential strategy given its global presence and impact, and the current resource constraints in health care. Individuals with type 2 diabetes should be empowered and supported to self-manage. This includes awareness raising on their role in self-health, engaging broader support networks, and the pivotal role of health care professionals to inform and support. Further research is needed into the capacity assessment of healthcare systems in diabetes medicine, targeted low-cost resources for self-management, and the financial requirements that enable self-management advice to be enacted.While this research did not receive any specific project funding, KRB is funded by a University of Otago Pacific Ph.D. Scholarship. ANR is funded as a Research Fellow by the National Heart Foundation

Dataset for the reporting of carcinoma of renal tubular origin:recommendations from the International Collaboration on Cancer Reporting (ICCR)

AIMS The International Collaboration on Cancer Reporting (ICCR) has provided detailed datasets based upon the published reporting protocols of the Royal College of Pathologists, The Royal College of Pathologists of Australasia and the College of American Pathologists. METHODS AND RESULTS The dataset for carcinomas of renal tubular origin treated by nephrectomy was developed to provide a minimum structured reporting template suitable for international use and incorporated recommendations from the 2012 Vancouver Consensus Conference of the International Society of Urological Pathology and the fourth edition of the World Health Organization Bluebook on tumours of the urinary and male genital systems published in 2016. Reporting elements were divided into those, which are Required and Recommended components of the report. Required elements are; specimen laterality, operative procedure, attached structures, tumour focality, tumour dimension, tumour type, WHO/ISUP grade, sarcomatoid/rhabdoid morphology, tumour necrosis, extent of invasion, lymph node status, surgical margin status, AJCC TNM staging and co-existing pathology. Recommended reporting elements are; pre-operative treatment, details of tissue removed for experimental purposes prior to submission, site of tumour(s) block identification key, extent of sarcomatoid and/or rhabdoid component, extent of necrosis, presence of tumour in renal vein wall, lymphovascular invasion and lymph node status (size of largest focus and extranodal extension). CONCLUSIONS It is anticipated that the implementation of this dataset in routine clinical practise will inform patient treatment as well as provide standardized information relating to outcome prediction. The harmonisation of data reporting should also facilitate international research collaborations. This article is protected by copyright. All rights reserved

Exploiting the Role of Endogenous Lymphoid-Resident Dendritic Cells in the Priming of NKT Cells and CD8+ T Cells to Dendritic Cell-Based Vaccines

Transfer of antigen between antigen-presenting cells (APCs) is potentially a physiologically relevant mechanism to spread antigen to cells with specialized stimulatory functions. Here we show that specific CD8+ T cell responses induced in response to intravenous administration of antigen-loaded bone marrow-derived dendritic cells (BM-DCs), were ablated in mice selectively depleted of endogenous lymphoid-resident langerin+ CD8α+ dendritic cells (DCs), suggesting that the antigen is transferred from the injected cells to resident APCs. In contrast, antigen-specific CD4+ T cells were primed predominantly by the injected BM-DCs, with only very weak contribution of resident APCs. Crucially, resident langerin+ CD8α+ DCs only contributed to the priming of CD8+ T cells in the presence of maturation stimuli such as intravenous injection of TLR ligands, or by loading the BM-DCs with the glycolipid α-galactosylceramide (α-GalCer) to recruit the adjuvant activity of activated invariant natural killer-like T (iNKT) cells. In fact, injection of α-GalCer-loaded CD1d−/− BM-DCs resulted in potent iNKT cell activation, suggesting that this glycolipid antigen can also be transferred to resident CD1d+ APCs. While iNKT cell activation per se was independent of langerin+ CD8α+ DCs, some iNKT cell-mediated activities were reduced, notably release of IL-12p70 and transactivation of NK cells. We conclude that both protein and glycolipid antigens can be exchanged between distinct DC species. These data suggest that the efficacy of DC-based vaccination strategies may be improved by the incorporation of a systemic maturation signal aimed to engage resident APCs in CD8+ T cell priming, and α-GalCer may be particularly well suited to this purpose

Increasing the potency of dendritic cell based vaccines for the treatment of cancer

Tumours can be eradicated by T cells that recognise unique tumour-associated antigens. These T cells are initially stimulated by dendritic cells (DCs) that have acquired antigens from tumour tissue. Vaccination strategies that increase the frequencies of tumour-specific T cells by enhancing the activity of DCs are being evaluated in the clinic as novel cancer therapies. Our hypothesis is that existing DC-based vaccination strategies can be improved by stimulating toll-like receptor (TLR) signalling in the DCs, and also by encouraging interactions with iNKT cells, as these two activities are known to enhance DC function. It was also hypothesised that superior T cell responses could be induced by combining these two activities together. We used the TLR 4 agonist monophosphoryl lipid A (MPL) alone and in combination with other TLR agonists to achieve effective activation of bone marrow-derived DCs (BM-DCs) cultured in-vitro, which was characterised by upregulated expression of maturation markers on the cell surface, and enhanced release of pro-inflammatory cytokines. Some TLR agonist combinations provided significantly enhanced activities in this regard, notably the combination of MPL with either the TLR 2 agonist Pam3Cys, or the TLR 7/8 agonist Resiquimod. Although in-vitro activated BM-DCs were unable to induce stronger antigen-specific CD8+ T cell responses after intravenous injection when compared to BMDCs without TLR stimulation, enhanced CD8+ T cell responses were achieved in-vivo with the co-administration of TLR ligands, implying that TLR stimulation needed to act on cells of the host. Further studies identified the langerin-expressing CD8ɑ+ splenic DC subset in the spleen as recipients of antigen that was transferred from injected cells, and that these recipients were participants in the cross-presentation and T cell priming activities driving the CD8+ T cell response after vaccination. Antigen-loaded BM-DCs carrying the NKT cell ligand ɑ-galactosylceramide (ɑ-GalCer) were found to consistently increase antigen-specific CD8+ T cell responses in-vivo, and also cytotoxic responses as seen in cytotoxic killing assays. Again, langerin-expressing CD8ɑ+ splenic DCs were shown to be involved in this response by acquiring antigen and ɑ-GalCer from the injected vaccine BM-DCs. Finally, it was possible to achieve even greater CD8+ T cell responses in-vivo by injecting BM-DCs carrying antigen and ɑ-GalCer, together with timely co-administration of the TLR agonist. These results suggest a reassessment of the activities of DC-based vaccines to include the important role of “courier” to DCs already resident in the host that can be exploited to improve vaccination outcomes

Engaging postgraduate students undertaking clinical pharmacology using gosoapbox for problem-based learning

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