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Integrating genomics into Canadian oncology nursing policy: Insights from a comparative policy analysis

Abstract

Aim

To learn from two jurisdictions with mature genomics-informed nursing policy infrastructure—the United States (US) and the United Kingdom (UK)—to inform policy development for genomics-informed oncology nursing practice and education in Canada.

Design

Comparative document and policy analysis drawing on the 3i + E framework.

Methods

We drew on the principles of a rapid review and identified academic literature, grey literature and nursing policy documents through a systematic search of two databases, a website search of national genomics nursing and oncology nursing organizations in the US and UK, and recommendations from subject matter experts on an international advisory committee. A total of 94 documents informed our analysis.

Results

We found several types of policy documents guiding genomics-informed nursing practice and education in the US and UK. These included position statements, policy advocacy briefs, competencies, scope and standards of practice and education and curriculum frameworks. Examples of drivers that influenced policy development included nurses' values in aligning with evidence and meeting public expectations, strong nurse leaders, policy networks and shifting healthcare and policy landscapes.

Conclusion

Our analysis of nursing policy infrastructure in the US and UK provides a framework to guide policy recommendations to accelerate the integration of genomics into Canadian oncology nursing practice and education.

Implications for the profession

Findings can assist Canadian oncology nurses in developing nursing policy infrastructure that supports full participation in safe and equitable genomics-informed oncology nursing practice and education within an interprofessional context.

Impact

This study informs Canadian policy development for genomics-informed oncology nursing education and practice. The experiences of other countries demonstrate that change is incremental, and investment from strong advocates and collaborators can accelerate the integration of genomics into nursing. Though this research focuses on oncology nursing, it may also inform other nursing practice contexts influenced by genomics.

Protocol for the challenge non-typhoidal Salmonella (CHANTS) study: a first-in-human, in-patient, double-blind, randomised, safety and dose-escalation controlled human infection model in the UK

Por: Smith · C. · Smith · E. · Rydlova · A. · Varro · R. · Hinton · J. C. D. · Gordon · M. A. · Choy · R. K. M. · Liu · X. · Pollard · A. J. · Chiu · C. · Cooke · G. S. · Gibani · M. M.
Introduction

Invasive non-typhoidal Salmonella (iNTS) serovars are a major cause of community-acquired bloodstream infections in sub-Saharan Africa (SSA). In this setting, Salmonella enterica serovar Typhimurium accounts for two-thirds of infections and is associated with an estimated case fatality rate of 15%–20%. Several iNTS vaccine candidates are in early-stage assessment which—if found effective—would provide a valuable public health tool to reduce iNTS disease burden. The CHANTS study aims to develop a first-in-human Salmonella Typhimurium controlled human infection model, which can act as a platform for future vaccine evaluation, in addition to providing novel insights into iNTS disease pathogenesis.

Methods and analysis

This double-blind, safety and dose-escalation study will randomise 40–80 healthy UK participants aged 18–50 to receive oral challenge with one of two strains of S. Typhimurium belonging to the ST19 (strain 4/74) or ST313 (strain D23580) lineages. 4/74 is a global strain often associated with diarrhoeal illness predominantly in high-income settings, while D23580 is an archetypal strain representing invasive disease-causing isolates found in SSA. The primary objective is to determine the minimum infectious dose (colony-forming unit) required for 60%–75% of participants to develop clinical or microbiological features of systemic salmonellosis. Secondary endpoints are to describe and compare the clinical, microbiological and immunological responses following challenge. Dose escalation or de-escalation will be undertaken by continual-reassessment methodology and limited within prespecified safety thresholds. Exploratory objectives are to describe mechanisms of iNTS virulence, identify putative immune correlates of protection and describe host–pathogen interactions in response to infection.

Ethics and dissemination

Ethical approval has been obtained from the NHS Health Research Authority (London—Fulham Research Ethics Committee 21/PR/0051; IRAS Project ID 301659). The study findings will be disseminated in international peer-reviewed journals and presented at national/international stakeholder meetings. Study outcome summaries will be provided to both funders and participants.

Trial registration number

NCT05870150

Validation of CHERG’S Verbal Autopsy-Social Autopsy (VASA) tool for ascertaining determinants and causes of under-five child mortality in Pakistan

by Muhammad Bilal Siddiqui, Chiu Wan Ng, Wah Yun Low, Khadijah Abid

The majority (40%) of the world’s under-five mortality burden is concentrated in nations like Nigeria (16.5%), India (16%), Pakistan (8%), and the Democratic Republic of the Congo (6%), where an undetermined number of under-five deaths go unrecorded. In low-resource settings throughout the world, the Verbal Autopsy-Social Autopsy (VASA) technique may assist assess under-five mortality estimates, assigning medical and social causes of death, and identifying relevant determinants. Uncertainty regarding missing data in high-burden nations like Pakistan necessitates a valid and reliable VASA instrument. This is the first study to validate Child Health Epidemiology Reference Group-CHERG’s VASA tool globally. In Pakistan, data from such a valid and reliable tool is vital for policy. This paper reports on the VASA tool in Karachi, Pakistan. Validity and reliability of the CHERG VASA tool were tested using face, content, discriminant validation, and reliability tests on one hundred randomly selected mothers who had recently experienced an under-five child death event. Data were computed on SPSS (version-21) and R software. Testing revealed high Item-content Validity Index (I-CVI) (>81.43%); high Cronbach’s Alpha (0.843); the accuracy of between 75–100% of the discriminants classifying births to live and stillbirths; and I-CVI (>82.07% and 88.98% respectively) with high accuracy (92% and 97% respectively) for assigning biological and social causes of child deaths, respectively. The CHERG VASA questionnaire was found relevant to the conceptual framework and valid in Pakistan. This valid tool can assign accurate medical and non-medical causes of child mortality cases occurring in Pakistan.

Genomics-informed nursing strategies and health equity: A scoping review protocol

by Dzifa Dordunoo, Jacqueline Limoges, Patrick Chiu, Rebecca Puddester, Lindsay Carlsson, April Pike

Objective

The objective of this scoping review is to map the available evidence on strategies that nurses can use to facilitate genomics-informed healthcare to address health disparities.

Introduction

Advancements in genomics over the last two decades have led to an increase in the delivery of genomics-informed health care. Although the integration of genomics into health care services continues to enhance patient outcomes, access to genomic technologies is not equitable, exacerbating existing health disparities amongst certain populations. As the largest portion of the health workforce, nurses play a critical role in the delivery of equitable genomics-informed care. However, little is known about how nurses can help address health disparities within the context of genomics-informed health care. A review of the literature will provide the necessary foundation to identify promising practices, policy, and knowledge gaps for further areas of inquiry.

Inclusion criteria

We will include papers that explore strategies that nurses can undertake to facilitate genomics-informed care to address health disparities.

Methods

This review will be conducted using JBI methodology for scoping reviews. We will search electronic databases including MEDLINE (OVID), EMBASE, Cochrane Library, PsychInfo, and CINAHL for quantitative and qualitative studies, systematic reviews and grey literature. Theses, books, and unavailable full-text papers will be excluded. The search will be limited to papers from 2013 and beyond. Two reviewers will screen titles and abstracts followed by full-text and disagreements will be resolved by a third reviewer. We will use a data extraction tool using Microsoft Excel and analyse data using descriptive statistics and conventional content analysis. Findings will be presented in the form of evidence tables and a narrative summary. We will report findings using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).

Discussion

Genomics will continue to transform all aspects of health care across the wellness continuum from prevention, assessment, diagnosis, management, treatment, and palliative care. The identification of nursing strategies to address health disparities will build the foundation for policy and practice to ensure that the integration of genomic technologies benefits everyone.

The enrichment process for family caregivers of persons living with dementia: A grounded theory approach

Abstract

Aim

Many persons living with dementia (PLWD) reside in the community and are cared for by family members. The aim of this qualitative study was to gain an understanding the enrichment process for family caregivers of PLWD in Taiwan.

Design

A grounded theory approach with face-to-face semi-structured interviews was conducted with family caregivers of PLWD in Taiwan.

Methods

Interview data from 30 family caregivers of PLWD recruited from dementia clinics or support groups in Taiwan were obtained from the first wave of a larger study conducted from January 2018 to September 2021. Glaser's grounded theory approach with theoretical sampling was used to understand the enrichment process of family caregivers of PLWD.

Results

Analysis indicated the core category that characterized the process of enrichment was ‘holding together’. Caregivers were able to maintain their connection to the person with dementia through activities that deepened their relationship and strengthened their bond. ‘Holding together’ included four components: maintaining continuity, creative interactions, interacting with humour and sharing pleasurable activities. Through these components, family caregivers generated positive interactions and relationships with the person living with dementia and sustained their motivation for caregiving. Three modifying elements facilitated or impeded the process of holding together: ‘previous daily interactions’, ‘caregiving beliefs’ and ‘filial piety’.

Conclusion

Through the enrichment process of ‘holding together’, family caregivers used different strategies to conduct pleasurable and meaningful activities with the person living with dementia to maintain and improve their relationship and enhance their happiness in life.

Impact

To facilitate the enrichment process, health care providers should encourage activities between family caregivers and PLWD that promote continuity, increase interactions, provide humour and foster pleasurable activities.

Reporting Method

This study adhered to the COREQ guideline checklist.

Patient or Public Contribution

No patient or public contribution.

The association of social support and hope with self‐stigma and perceived recovery among people with schizophrenia: The serial mediation effect

Abstract

Background

It is essential to assist individuals with a mental illness who have achieved clinical recovery in their personal recovery. Understanding the relationship between self-stigma and social support and the effects on perceived recovery can be valuable for clinical professionals in helping patients lead meaningful lives.

Aim

To examine the serial mediating roles of social support and perceived hope in self-stigma and the effects on perceived recovery.

Design

A cross-sectional study.

Methods

The study was conducted from September 2019 to June 2020. One hundred and fifty-seven patients with schizophrenia in seven chronic rehabilitation wards were enrolled. Each patient had a Positive and Negative Syndrome Scale score ≤ 60 points, and they regularly participated in occupational rehabilitation. Research tools included demographic data, the Internalized Stigma of Mental Illness Scale (ISMIS), Multidimensional Scale of Perceived Social Support (MSPSS), Herth Hope Index (HHI), and Perceived Recovery Inventory (PRI). IBM SPSS 24.0 was used to analyse the data. Pearson correlation was used to analyse the relationships between variables, and models 4 and 6 of PROCESS macro V3.4 for SPSS were used to examine the mediation model.

Results

The results indicated that self-stigma and perceived recovery in patients with schizophrenia are negatively correlated, that peer support and perceived hope mediate the relationship between them, and that peer support and perceived hope also have a statistically significant serial mediating effect.

Conclusion

The serial mediation effect of peer support and perceived hope on the relationship between self-stigma and perceived recovery was statistically significant in this study.

Impact

This research delves into strategies to assist psychiatric patients in reducing self-stigma and achieving recovery. The findings underscore the heightened significance of peer support for patients in rehabilitative wards and offer valuable insights for medical staff.

Reporting Method

STROBE checklist.

Patient or Public Contribution

No patient or public contribution.

Navigating changes: A qualitative study exploring the health‐related quality of life of breast cancer survivors during the coronavirus disease 2019 pandemic

Abstract

Aims

To explore the impact of the coronavirus disease 2019 pandemic on the health-related quality of life (HRQoL) of breast cancer survivors.

Design

We utilized a qualitative descriptive approach to facilitate interviews among 25 participants, all of whom are survivors of breast cancer and have received treatment in Hong Kong within the preceding 3 years.

Methods

Content analysis was performed to understand how patients' HRQoL views and experiences changed during coronavirus disease 2019 pandemic.

Results

The results included six themes delineating the impact of the coronavirus disease 2019 pandemic: (i) survivor sensitivities in pandemic times, (ii) coping and conditioning in pandemic times, (iii) transforming work and home dynamics in pandemic times, (iv) cognitive resilience and adaptation to the COVID-19 protective measures, (v) social resilience in pandemic times and (vi) healthcare adaptation and coping in pandemic times.

Conclusion

This study provides insights into the experiences and challenges of breast cancer survivors during the coronavirus disease 2019 pandemic. Some survivors had new physical and psychological symptoms, including fear and anxiety, isolation, pain, lymphoedema and burnout, which potentially have long-term impact upon HRQoL.

Implications for the profession and/or patient care

This study highlights the unique challenges faced by breast cancer survivors during the coronavirus disease 2019 pandemic, including accessing healthcare services and the impact of social isolation. Healthcare providers should consider the holistic needs of breast cancer survivors in the provision of health care and develop supportive interventions, including telehealth services and online support groups, to address these challenges and improve their HRQoL.

Impact

Surgery aimed at treating breast cancer or reducing its risk generally influences the appearance of breast areas and donor sites. The continuing effects of these changes on body image and HRQoL are well-reported, although studies have ineffectively examined the initial experiences of women regarding their postoperative appearance, particularly during the pandemic.

Reporting method

The checklist of consolidated criteria for reporting qualitative research (COREQ) was utilized.

Patient or public contribution

A small selection on breast cancer survivors contributed to the design of this study, in particular the content of the semi-structured interviews.

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