The role of the immune system in brain metastasis

Metastatic brain tumors are the most common brain tumors in adults. With numerous successful advancements in systemic treatment of most common cancer types, brain metastasis is becoming increasingly important in the overall prognosis of cancer patients. Brain metastasis of peripheral tumor is the result of complex interplay of primary tumor, immune system and central nervous system microenvironment. Once formed, brain metastases hide behind the blood brain barrier and become inaccessible to chemotherapies that are otherwise successful in targeting systemic cancer. The approval of immune checkpoint inhibitors for several common cancers such as advanced melanoma and lung cancers brings with it the opportunity and obligation to further understand the mechanisms of immunosuppression by tumors that spread to the brain as well as the interaction between the brain environment and tumor microenvironment. In this review paper we define the central role of the immune system in the development of brain metastases. We performed a comprehensive review of the literature to outline the molecular mechanisms of immunosuppression used by tumors and how the immune system interacts with the central nervous system to facilitate brain metastasis. In particular we discuss the tumor-type-specific mechanisms of metastasis of cancers that preferentially metastasize to the brain as well as the therapies that effectively modulate the immune response, such as immune checkpoint inhibitors and vaccines

Should you test or treat partners of patients with gonorrhea, chlamydia, or trichomoniasis?

Empiric treatment of partners of female or heterosexual male patients diagnosed with gonorrhea or chlamydia using expedited partner therapy (having the index patient deliver therapy to the partner) decreases the risk of persistent or recurrent infection in the index patient (strength of recommendation [SOR]: A, metaanalysis). The effect is greater for gonorrhea than chlamydia. By contrast, expedited partner therapy for trichomoniasis appears equivalent to a test-first approach (SOR: B, single randomized controlled trial [RCT])

Wound management provided by advanced practice nurses: a scoping review protocol.

OBJECTIVE: The objective of this review is to examine the current state of the literature regarding wound care provided by advanced practice nurses globally. Specifically, this review will examine the similarities and differences in the wound care practice of advanced practice nurses, including nurse practitioners, clinical nurse specialists, and advanced practice registered nurses. INTRODUCTION: Advanced practice nurses have graduate education and advanced scope of practice. The addition of advanced wound care training provides unique opportunities for advanced practice nurses to provide wound care. INCLUSION CRITERIA: This review will consider advanced practice nurses who are nurse practitioners or registered nurses with graduate education and advanced training (certification/education) in wound care. The wound care can be provided independently or as a part of a team, in any setting. METHODS: The proposed review will be conducted in accordance with the JBI methodology for scoping reviews. The databases searched will include MEDLINE, CINAHL, ProQuest Nursing and Allied Health, Cochrane Database of Systematic Reviews, and Scopus. To reflect changes in advanced practice nursing scope of practice, searches will be limited to articles published from 2011. Articles in languages other than English will be translated. Titles and abstracts will be independently reviewed by two reviewers, and relevant sources will be retrieved in full and reviewed. Any disagreements will be resolved through discussion or with an additional reviewer. The similarities and differences in wound care practice (type of wound, practice setting, treatments) will be extracted using a data extraction tool. Any modifications will be detailed in the scoping review. Extracted data will be presented in a descriptive format

Supporting Collaborative Efforts in Implementing Evidence-Based Reading Interventions: The Role of Online Databases

The purpose of this article is to provide an explanation of how effective reading interventions are identified. Through a review of the National Reading Panel’s general findings, along with a review of systems currently used to evaluate and disseminate specific reading interventions, a discussion of what works in reading is presented. The Evidence-Based Intervention (EBI) Network is presented as a resource for facilitating collaboration across disciplines. Finally, a framework to guide collaborating professionals in the implementation of evidence-based reading interventions is proposed

Physical assessment skills taught in nursing curricula: a scoping review.

OBJECTIVE: This scoping review sought to establish the current state of knowledge regarding physical assessment skills taught globally in undergraduate nursing curricula. Explicitly, the review aimed to determine which skills are being taught via curricula and which skills are performed by students in clinical placements, as well as what physical assessment skills are being used by registered nurses in practice. INTRODUCTION: Nursing programs are expected to teach the physical assessment skills required for entry-level registered nurses to practice competently. The discrepancy lies in determining which skills are essential to teach entry-level nurses and which are unessential. INCLUSION CRITERIA: Studies that examined physical assessment skills taught to students in any undergraduate registered nursing program or used by registered nurses in practice were considered. Physical assessments included all techniques or skills taught in any year of a university or college teaching global registered nursing curricula. METHODS: Databases searched included MEDLINE (Ovid), CINAHL Complete (EBSCO), Scopus, and Cochrane Central Register of Controlled Trials (Ovid). Sources of unpublished studies included ProQuest Dissertations and Theses Global, OpenGrey, Open Access Theses and Dissertations, and Google Scholar. Studies published in English between January 2008 and November 2019 were included. Two independent reviewers screened titles and abstracts. Studies meeting the inclusion criteria were imported into the Covidence systematic review manager. Extracted data were presented in a descriptive format, including characteristics of included studies and relevant key findings. RESULTS: Thirteen records were extracted for synthesis: one integrated review, one author reflection, one mixed methods study, and 10 quantitative studies. The sources represented a global context: the United States, New Zealand, Turkey, Australia, Norway, Korea, Italy, and one of unknown origin. Three studies examined physical assessment skills routinely taught in global nursing curricula. Three studies explored physical assessment skills routinely used by students during nursing programs. Seven studies examined which physical assessment skills were routinely performed by registered nurses in practice. In the studies, there were 98 to 122 physical assessment skills taught in global nursing programs. However, only 33 skills were routinely taught in curricula, and of those, only 20 were the same across all studies (core skills). Students in nursing programs routinely performed 30 physical assessment skills, and six of the 30 skills were the same across all studies (core skills). Of the six core skills routinely performed by students, five were also routinely taught in nursing curricula in the included studies. Registered nurses routinely performed 39 physical assessment skills, and 11 skills were the same across all studies (core skills). Ten of the physical assessment skills taught in curricula were routinely performed by registered nurses in practice. CONCLUSION: This scoping review provides insight into physical assessment skills taught in nursing curricula and used by registered nurses in practice. This knowledge is essential for curriculum revisions and planning as it provides insight on how to best meet the needs of future nursing students

What are the benfits and risks of IUDs in adolescents?

Little available evidence specifically addresses the benefits and risks of intrauterine devices (IUDs) in adolescents. Most studies have evaluated IUD use in nulliparous adults. Levonorgestrel IUDs cause less menstrual bleeding than oral contraceptive pills (OCPs) in adult nulliparous women without differences in complications or pregnancy rates (strength of recommendation [SOR]: B, one RCT). Levonorgestrel IUDs appear to have similar expulsion and continuation rates in adolescents and adults (SOR: B, one prospective study). Adult nulliparous women who discontinue IUDs have subsequent birth rates similar to women who stop using OCPs or barrier methods. (SOR: B, limited quality evidence)