Patients prefer clinical handover at the bedside; Nurses do not: Evidence from a Discrete Choice Experiment

Background: Shift-to-shift bedside handover is advocated as a patient-centred approach, yet its enactment is challenging. Objectives: To describe and compare the preferences of both patients and nurses in the implementation of bedside handover in a Swedish University Hospital. Design: A discrete choice experiment (DCE) survey. Settings: University setting, four medical wards in two hospitals. Participants: Adult medical patients (n = 218) and registered nurses (n = 101) Methods: The survey was administered by an electronic tablet-assisted face-to-face survey. Respondents made repeated choices between two hypothetical bedside handover alternatives and a third alternative of ‘handover away from the bedside’. Handover alternatives were described according to six attributes: invitation to participate, number of nurses present at the handover, family member, carer or trusted friend (of the patient) allowed to be present, level of (patient) involvement, what information related to your (patient) care is discussed. Choice data were analyzed using a mixed logit model. Results: A total of 1308 (patients) and 909 (nurses) choice observations were included in the preference models. Patients showed a strong preference for handover at the bedside compared to nurses. Nurses generally preferred handover away from the bedside. Patients perceived their level of involvement in handover as highly important, being able to speak, hear what was said being the most important characteristic, closely followed by being invited to participate and asked questions as well as being heard. Nurses considered patients being invited to participate most important, followed by level of involvement. Different options for handing over sensitive information were not perceived of importance by patients or nurses. There was substantial variation at the individual level across both patients and nurses for where and how handover is delivered. Conclusions: In this study, patients strongly preferred handover at the bedside, while the nurses considered patients to be invited to participate to be the most important preference but generally preferred handover to take place away from the bedside, all else equal. When implementing bedside handover in a Swedish context this must be considered, although participation is a prerequisite for bedside handover. Differences between patients and nurses’ preferences could jeopardize future introduction of bedside handover in Swedish health care, and might explain why bedside handover is still not very common in hospital wards

Patient preferences for participation in patient care and safety activities in hospitals

BackgroundActive patient participation is a patient safety priority for health care. Yet, patients and their preferences are less understood. The aim of the study was to explore hospitalised patients&rsquo; preferences on participation in their care and safety activities in Sweden.MethodsExploratory qualitative study. Data were collected over a four-month period in 2013 and 2014. Semi-structured interviews were conducted with 20 patients who were admitted to one of four medical wards at a university hospital in Sweden. Data were analysed using thematic analysis.ResultsNine men and eleven women, whose median age was 72 years (range 22&ndash;89), were included in the study. Five themes emerged with the thematic analysis: endorsing participation; understanding enables participation; enacting patient safety by participation; impediments to participation; and the significance of participation. This study demonstrated that patients wanted to be active participants in their care and safety activities by having a voice and being a part of the decision-making process, sharing information and possessing knowledge about their conditions. These factors were all enablers for patient participation. However, a number of barriers hampered participation, such as power imbalances, lack of patient acuity and patient uncertainty. Patients&rsquo; participation in care and patient safety activities seemed to determine whether patients were feeling safe or ignored.ConclusionThis study contributes to the existing literature with fundamental evidence of patients&rsquo; willingness to participate in care and safety activities. Promoting patient participation begins by understanding the patients&rsquo; unique preferences and needs for care, establishing a good relationship and paying attention to each patient&rsquo;s ability to participate despite their illness.<br /

Role of the HSP90-Associated Cochaperone p23 in Enhancing Activity of the Androgen Receptor and Significance for Prostate Cancer

Prostate tumor growth initially depends on androgens, which act via the androgen receptor (AR). Despite androgen ablation therapy, tumors eventually progress to a castrate-resistant stage in which the AR remains active. The mechanisms are poorly understood but it may be that changes in levels or activity of AR coregulators affect trafficking and activation of the receptor. A key stage in AR signaling occurs in the cytoplasm, where unliganded receptor is associated with the heat shock protein (HSP)90 foldosome complex. p23, a key component of this complex, is best characterized as a cochaperone for HSP90 but also has HSP90-independent activity and has been re-ported as having differential effects on the activity of different steroid receptors. Here we report that p23 increases activity of the AR, and this appears to involve steps both in the cytoplasm (increasing ligand-binding capacity, possibly via direct interaction with AR) and the nucleus (en-hancing AR occupancy at target promoters). We show, for the first time, that AR and p23 can interact, perhaps directly, when HSP90 is not present in the same complex. The effects of p23 on AR activity are at least partly HSP90 independent because a mutant form of p23, unable to bind HSP90, nevertheless increases AR activity. In human prostate tumors, nuclear p23 was higher in malignant prostate cells compared with benign/normal cells, supporting the utility of p23 as a therapeutic target in prostate cancer. © 2012 by The Endocrine Society

The effects of thiopurine therapy on health-related quality of life in Inflammatory Bowel Disease patients

<p>Abstract</p> <p>Background</p> <p>The effect of thiopurine immunomodulators on health-related quality of life (HRQoL) in patients with inflammatory bowel disease (IBD) has been controversial. The aims were to evaluate the HRQoL in patients with IBD treated with thiopurines and assess the short- and long-term impacts of the treatment on HRQoL.</p> <p>Methods</p> <p>Ninety-two consecutive patients who started treatment with thiopurines were prospectively included. Evaluation of HRQoL was performed at months 0, 6, and 12 using two questionnaires, the Short-Form Health Survey (SF-36) and the Inflammatory Bowel Disease Questionnaire (IBDQ).</p> <p>Results</p> <p>Baseline score of IBDQ was 4,6, range (2,31-6,84), with an impairment of the five dimensions of HRQoL compared with inactive patients. Results obtained in 8 dimensions of SF-36 showed worse HRQoL than Spanish general population. At 6 months patients had a significant improvement in overall IBDQ score -5,8 (1,58 -6,97)- and also in all IBDQ dimensions. All the 8 dimensions of SF-36 obtained a significant improvement. At twelve months score of IBDQ was 6,1, range (2,7-6,98), with improvement in all dimensions compared with baseline and 6 months. SF-36 showed a similar significant improvement in all subscales.</p> <p>Conclusions</p> <p>Thiopurine immunomodulators alone or with other treatments have a positive and long lasting impact on HRQoL of IBD patients.</p

Identification of Stage-Specific Breast Markers using Quantitative Proteomics

YesMatched healthy and diseased tissues from breast cancer patients were analyzed by quantitative proteomics. By comparing proteomic profiles of fibroadenoma (benign tumors, three patients), DCIS (noninvasive cancer, three patients), and invasive ductal carcinoma (four patients), we identified protein alterations that correlated with breast cancer progression. Three 8-plex iTRAQ experiments generated an average of 826 protein identifications, of which 402 were common. After excluding those originating from blood, 59 proteins were significantly changed in tumor compared with normal tissues, with the majority associated with invasive carcinomas. Bioinformatics analysis identified relationships between proteins in this subset including roles in redox regulation, lipid transport, protein folding, and proteasomal degradation, with a substantial number increased in expression due to Myc oncogene activation. Three target proteins, cofilin-1 and p23 (increased in invasive carcinoma) and membrane copper amine oxidase 3 (decreased in invasive carcinoma), were subjected to further validation. All three were observed in phenotype-specific breast cancer cell lines, normal (nontransformed) breast cell lines, and primary breast epithelial cells by Western blotting, but only cofilin-1 and p23 were detected by multiple reaction monitoring mass spectrometry analysis. All three proteins were detected by both analytical approaches in matched tissue biopsies emulating the response observed with proteomics analysis. Tissue microarray analysis (361 patients) indicated cofilin-1 staining positively correlating with tumor grade and p23 staining with ER positive status; both therefore merit further investigation as potential biomarkers.Cyprus Research Promotion Foundation, Yorkshire Cancer Researc

Quality of life in inflammatory bowel diseases : Aspects on interventions and unconventional treatments

Crohn s disease (CD) and ulcerative colitis (UC) are chronic inflammatory bowel diseases (IBD) of unknown aetiology and characterized by periods of remission and exacerbation. Disabling bowel symptoms, untoward effects of treatments and interventions, the risk of developing colorectal cancer in longstanding UC, ignorance of the disease, disappointment in conventional medicine, all these features may influence the patient s health related quality of life (HRQOL) in various ways. The aims of this study were to assess the attitudes to and the use of complementary and alternative medicine (CAM) among patients with IBD, and to evaluate interventions such as a group based educational programme, colonoscopic surveillance, treatment with leukocyte apheresis and its effect on HRQOL, functional health status, general state of health as well as anxiety and coping ability in patients with IBD. Two hundred and eighty-nine IBD patients in four different countries answered a self-administered questionnaire concerning the use of and attitudes to CAM. Fifty-one percent used some form of alternative therapy. The usage was higher in North America than in Europe. The six most commonly used therapies were: exercise (28%), prayer (18%), counselling (13%), massage (11%), chiropractic (11%) and relaxation (10%). Only 7% used acupuncture or homeopathy and 5% used herbal medicine. Forty-one patients with longstanding, extensive/total UC in remission undergoing colonoscopic colorectal cancer (CRC) surveillance were compared with two groups of UC patients not undergoing surveillance. Four self-administered questionnaires were used: Sickness Impact Profile (SIP), Health Index (HI), State Trait Anxiety Inventory (STAI) and Sense of Coherence (SOC). No significant differences between the groups studied were found using any of the questionnaires nor before or after the colonoscopy. Thirty-four UC patients underwent weekly one hour apheresis sessions with a selective leukocyte adsorptive device for five consecutive weeks. HRQOL was measured by the Inflammatory Bowel Disease Questionnaire (IBDQ) before, at week 3, and after treatment. The mean IBDQ increased from 138 (range 97-208) at start to 154 (95-214) at week 3 (p=0.001) and 163 (117-216) after treatment (p=0.0006). When analysed separately, the IBDQ bowel, systemic and emotional dimensions improved significantly during the study. Forty-four IBD patients in remission or with low disease activity were randomized to a group-based medical and psychological/psychosocial intervention or to a control group. The intervention comprised nine weekly sessions with lectures and psychological/psychosocial group treatment. HRQOL was measured by the IBDQ and coping by the SOC before, at 6 and 12 months. The control patients received conventional medical and psychosocial treatment. No significant change was observed for IBDQ before (173.9) and after the intervention at month 6 (175.7), or at month 12 (171.8) or when comparing intervention (171.8) and controls (173.7) at month 12. Similarly, no significant differences in SOC scores were observed. However, the mean values from a visual analogue scale (VAS) and the results from a content analysis showed a positive trend. There is an increased interest in CAM among IBD patients, and this may reflect the patients disappointment of conventional medicine. Complicated and invasive interventions such as colonoscopic surveillance (for detecting CRC), and selective leukocyte apheresis do not seem to impair HRQOL in UC patients. A group based medical and psychological/psychosocial intervention was highly appreciated in IBD patients, but no effect on HRQOL could be demonstrated by using standard HRQOL or coping measurements

3D-Printed Geodesic Reflective Luneburg Lens Antenna for X-Band

With the rise of 5G and the increasing number ofdevices, novel antenna designs are needed to meet the demandof the future. In this report, the authors present a design andexperimental verification of a 3D-printed Geodesic ModulatedReflective Luneburg lens antenna working at the X-Band, 8-12GHz. The lens profile is calculated from the refractive index of aflat system using transformation optics. Furthermore, the lens ismodulated to minimize the height and chamfers are implementedto reduce reflections. A sliding waveguide connected to a coaxialcable is used to excite the lens while the transmitted signal isradiated from a sinusoidal flare. A copper-lined PLA substrateconstitutes the 3D-printed lens. The authors achieved a S11 below-10 dB across the spectrum and a realized gain exceeding 10 dBacross the sweeping angles at 12 GHz, showcasing the usabilityas a directed antenna.Med det nya 5G nätverket och den ökandemängden enheter behövs nya antenner för att möta framtidensefterfrågan. I denna rapport presenterar författarna en designoch experimentell verifiering av en 3D-printad geodesisk moduleradreflekterande Luneburg linsantenn i X-bandet, 8-12 GHz.Linsprofilen beräknas från brytningsindexet för ett platt systemmed transformationsoptik. Dessutom är linsen modulerad föratt minimera höjden och kantavfasningar implementeras föratt minska reflektioner. En glidande vågledare ansluten till enkoaxialkabel används för att excitera linsen medan den sända signalenutstrålas från en vågledare med sinusformad avrundning.Ett kopparfodrat PLA-substrat utgör den 3D-printade linsen.Författarna uppnådde en S11 under -10 dB över spektrumet ochen realiserad förstärkning överstigande 10 dB över svepvinklarnavid 12 GHz, vilket visar linsens användbarhet som riktad antenn.Kandidatexjobb i elektroteknik 2021, KTH, Stockhol