Interdisciplinary Teams and Collaboration in a Long Term Care Facility

The purposes of this qualitative study were to discover what influences collaboration had on an interdisciplinary team practicing in a rural Midwestern long-term -care facility, to discover what factors influence collaboration, and to discover what barriers can hinder collaboration for the interdisciplinary team practicing in this facility. In this descriptive, qualitative study, eleven semi-structured in-depth interviews were completed, and a constant comparative method of data analysis was used. The categories that emerged from the data analysis were (a) chronic health conditions, (b) collaboration, (c) communication, (d) expectations, (e) influences that enhance collaboration, and (f) influences that are barriers to collaboration. Influences that enhance collaboration fell into the following subcategories: (a) communion (sharing), (b) community (connectedness), (c) independence, (d) problem-solving, (e) responsibility, and (f) synergism. Barriers to collaboration had eight subcategories: (a) unresolved factors, (b) feelings of isolation, (c) interrelationships, (d) lack of understanding, (e) minimum data set (MDS) and Medicare, (f) physician’s role, (g) unmet expectations, and (h) end-of-life. Themes related to the categories were then discussed. Collaboration is an important and significant factor in a nurse practitioner’s role. Effective collaboration can enhance the knowledge and skills of a nurse practitioner and enhance the relationship of the nurse practitioner with all members of the interdisciplinary team, including the patient

Perturbations in neuroinflammatory pathways are associated with paclitaxel-induced peripheral neuropathy in breast cancer survivors.

Paclitaxel is a common chemotherapy drug associated with the development of chronic paclitaxel-induced peripheral neuropathy (PIPN). PIPN is associated with neuroinflammatory mechanisms in pre-clinical studies. Here, we evaluated for differential gene expression (DGE) in peripheral blood between breast cancer survivors with and without PIPN and for neuroinflammatory (NI) related signaling pathways and whole-transcriptome profiles from other experiments. Pathway impact analysis identified 8 perturbed NI related pathways. Expression profile analysis found 15 experiments having similar whole-transcriptome profiles of DGE related to neuroinflammation and PIPN. These findings suggest that perturbations in pathways associated with neuroinflammation are found in cancer survivors with PIPN

Prospectus, October 21, 1981

STUDENTS HONORED WITH $800; News In Brief; Traditional German menu: Parkland Oktoberfest is October 28; Blood Drive Coming Nov. 4; Females outnumber males; Seminar on children held; Correction; Gissing: Parking problems; Tournaments complete first week; Take charge of studying; Prepare for EMT courses; Library helps handicapped; Parkland can handle 4 snowfall; Coin Show Nov. 1; P.C. Happ\u27nin\u27s: Ski club planning trip, Typewriters transfer, Sigma planning party,$90 to be awarded, Sessions planned, Thomas places third, Divorce seminar today; Watch Those Postal Rates!: Practice bulk mailing when sending your refund forms; Grace Jones\u27 new album shows her character; Social turmoil -- economics run wild; Classifieds; Fast Freddy improves; V-ballers play conference; Golf team prepares for upcoming tourney; Runners place second; Cobras lose bid for regionals; Fast Freddy Contest; Celebrate Halloween; It\u27s Friday! Enjoy Yourself!https://spark.parkland.edu/prospectus_1981/1008/thumbnail.jp

Menopausal-Related Symptoms in Women One Year After Breast Cancer Surgery.

CONTEXT: Approximately 60% to 100% of women with breast cancer experience at least one menopausal-related symptom. Little is known about associations between menopausal status and symptoms in women 12 months after breast cancer surgery. OBJECTIVES: The purpose of this study was to evaluate for differences in occurrence, severity, and distress of symptoms between pre- and postmenopausal women 12 months after breast cancer surgery. METHODS: Women with breast cancer (n = 327) completed the Menopausal Symptoms Scale, which evaluated the occurrence, severity, and distress of 46 common menopausal-related symptoms. Regression analyses were used to evaluate between-group differences in the seven symptoms that occurred in 30% and more of the sample (i.e., hot flashes, night sweats, depression, daytime sweats, joint pain or stiffness, wake during the night, and numbness or tingling). RESULTS: Of the 327 patients with breast cancer, who completed the 12-month assessment, 35.2% were premenopausal and 64.8% were postmenopausal before surgery. In the conditional models, when significant interactions were found, the differences in symptom occurrence rates between pre- and postmenopausal patients depended on their age. CONCLUSION: Regardless of menopausal status, women reported relatively high occurrence rates for several menopausal symptoms. Associations between symptom occurrence rates and menopausal status depended on the patient\u27s age. During the development of a survivorship care plan, clinicians need to assess symptom burden within the context of a woman\u27s menopausal status and salient demographic and clinical characteristics. This approach will assist with the prescription of more effective interventions

Pre-Surgery Demographic, Clinical, and Symptom Characteristics Associated with Different Self-Reported Cognitive Processes in Patients with Breast Cancer

Cancer related cognitive impairment (CRCI) is a common and persistent symptom in breast cancer patients. The Attentional Function Index (AFI) is a self-report measure that assesses CRCI. AFI includes three subscales, namely effective action, attentional lapses, and interpersonal effectiveness, that are based on working memory, inhibitory control, and cognitive flexibility. Previously, we identified three classes of patients with distinct CRCI profiles using the AFI total scores. The purpose of this study was to expand our previous work using latent class growth analysis (LCGA), to identify distinct cognitive profiles for each of the AFI subscales in the same sample (i.e., 397 women who were assessed seven times from prior to through to 6 months following breast cancer surgery). For each subscale, parametric and non-parametric statistics were used to determine differences in demographic, clinical, and pre-surgical psychological and physical symptoms among the subgroups. Three-, four-, and two-classes were identified for the effective action, attentional lapses, and interpersonal effectiveness subscales, respectively. Across all three subscales, lower functional status, higher levels of anxiety, depression, fatigue, and sleep disturbance, and worse decrements in energy were associated with worse cognitive performance. These and other modifiable characteristics may be potential targets for personalized interventions for CRCI

Prospectus, September 30, 1981

SENATORS ELECTED; News In Brief; PC enrollment sets records; Join new Com Club; Parkland extends to area; Choirs sing; Computer linked to aid Chanute growth; Women, meet your auto; Ski Club picks new officers; New art exhibit is reviewed; Best news is no news; ISO elects new officers; Use coupons and \u27garbage\u27 to save on shopping; Mark gives us his various thoughts and views; Be aware and be safe; Go Grape at Grape Expectations; Newhart does better on sit-com; Classifieds; Shelter reaches capacity; Neil Simon has another hit; Butts sets record; Cross country team improving more each meet; DuPage Invitational Summary; Belushi stars in new movie; Volleyball team evens up their record; Sign up for offered seminars; Clinton steps back in timehttps://spark.parkland.edu/prospectus_1981/1011/thumbnail.jp

The ADP receptor P2RY12 regulates osteoclast function and pathologic bone remodeling

The adenosine diphosphate (ADP) receptor P2RY12 (purinergic receptor P2Y, G protein coupled, 12) plays a critical role in platelet aggregation, and P2RY12 inhibitors are used clinically to prevent cardiac and cerebral thrombotic events. Extracellular ADP has also been shown to increase osteoclast (OC) activity, but the role of P2RY12 in OC biology is unknown. Here, we examined the role of mouse P2RY12 in OC function. Mice lacking P2ry12 had decreased OC activity and were partially protected from age-associated bone loss. P2ry12(–/–) OCs exhibited intact differentiation markers, but diminished resorptive function. Extracellular ADP enhanced OC adhesion and resorptive activity of WT, but not P2ry12(–/–), OCs. In platelets, ADP stimulation of P2RY12 resulted in GTPase Ras-related protein (RAP1) activation and subsequent α(IIb)β(3) integrin activation. Likewise, we found that ADP stimulation induced RAP1 activation in WT and integrin β(3) gene knockout (Itgb3(–/–)) OCs, but its effects were substantially blunted in P2ry12(–/–) OCs. In vivo, P2ry12(–/–) mice were partially protected from pathologic bone loss associated with serum transfer arthritis, tumor growth in bone, and ovariectomy-induced osteoporosis: all conditions associated with increased extracellular ADP. Finally, mice treated with the clinical inhibitor of P2RY12, clopidogrel, were protected from pathologic osteolysis. These results demonstrate that P2RY12 is the primary ADP receptor in OCs and suggest that P2RY12 inhibition is a potential therapeutic target for pathologic bone loss

Cerebrospinal Fluid Cortisol Mediates Brain-Derived Neurotrophic Factor Relationships to Mortality after Severe TBI: A Prospective Cohort Study

Distinct regulatory signaling mechanisms exist between cortisol and brain derived neurotrophic factor (BDNF) that may influence secondary injury cascades associated with traumatic brain injury (TBI) and predict outcome. We investigated concurrent CSF BDNF and cortisol relationships in 117 patients sampled days 0–6 after severe TBI while accounting for BDNF genetics and age. We also determined associations between CSF BDNF and cortisol with 6-month mortality. BDNF variants, rs6265 and rs7124442, were used to create a gene risk score (GRS) in reference to previously published hypothesized risk for mortality in “younger patients” (<48 years) and hypothesized BDNF production/secretion capacity with these variants. Group based trajectory analysis (TRAJ) was used to create two cortisol groups (high and low trajectories). A Bayesian estimation approach informed the mediation models. Results show CSF BDNF predicted patient cortisol TRAJ group (P = 0.001). Also, GRS moderated BDNF associations with cortisol TRAJ group. Additionally, cortisol TRAJ predicted 6-month mortality (P = 0.001). In a mediation analysis, BDNF predicted mortality, with cortisol acting as the mediator (P = 0.011), yielding a mediation percentage of 29.92%. Mediation effects increased to 45.45% among younger patients. A BDNF*GRS interaction predicted mortality in younger patients (P = 0.004). Thus, we conclude 6-month mortality after severe TBI can be predicted through a mediation model with CSF cortisol and BDNF, suggesting a regulatory role for cortisol with BDNF's contribution to TBI pathophysiology and mortality, particularly among younger individuals with severe TBI. Based on the literature, cortisol modulated BDNF effects on mortality after TBI may be related to known hormone and neurotrophin relationships to neurological injury severity and autonomic nervous system imbalance