Understanding the needs and preferences for cancer care among First Nations people: An integrative review

AIM

This systematic review aimed to identify the needs and preferences for cancer care services among Australian First Nations people.

DESIGN

Integrative review.

DATA SOURCES

An integrative review was conducted. A wide range of search terms were used to increase the sensitivity and specificity of the searches in electronic databases. Methodological quality assessment, data extraction, was conducted independently by two reviewers, and a narrative synthesis was conducted.

RESULTS

Forty-two studies were included. A total of 2965 Australian First Nations adults, both men and women of various ages across the lifespan, were represented; no First Nations children affected by cancer were represented in the studies. Three themes emerged which included: (1) discrimination, racism and trauma, resulting from colonization, directly impacted First National people's cancer care experience; (2) cultural ways of knowing, being and doing are fundamental to how First Nations people engage with cancer care services; and (3) First Nations people need culturally safe person-centred cancer care services that address practical needs.

CONCLUSION

Most participants represented in this review experienced discrimination, racism and trauma, resulting from colonization, which directly negatively impacted Aboriginal peoples' cancer care experience. While the Optimal Cancer Pathway (OCP) was launched in Australia several years ago, people with cancer may continue to experience distressing unmet care needs.

PATIENT OR PUBLIC CONTRIBUTION

Our team includes both First Nations people, non-First Nations researchers and healthcare professionals with expertise in cancer care. The researchers employed decolonizing restorative approaches to ensure voice, respect, accountability and reciprocity in this review work.

IMPLICATIONS FOR NURSING PRACTICE

Members of the multidisciplinary team including nurses and policymakers should reflect on these findings, ensure that they have up-to-date cultural safety training and stand together with Indigenous and non-Indigenous cancer leaders to take proactive steps to stamp out and dismantle oppression in health, and safely implement the OCP.

Sense of coherence moderates job demand-resources and impact on burnout among nurses and midwives in the context of the COVID-19 pandemic: A cross-sectional survey

AIM

This study aimed to test the propositions using the job demands-resources (JD-R) model for main/moderation/mediation effects of a sense of coherence and practice environment support on mental well-being (anxiety, depression and burnout) outcomes in nurses and midwives in Australia during the COVID-19 pandemic.

DESIGN

Cross-sectional quantitative survey.

DATA SOURCES

The study was a cross-sectional design using self-report questionnaires reported as per the Reporting of Observational Studies in Epidemiology Guidelines. Following human research ethics approval (2020.ETH.00121) participants were recruited to take part in an online anonymous survey using self-report instruments to test the JD-R model in Australia.

RESULTS

156 participant nurses and midwives experienced anxiety, depression and emotional burnout during COVID-19. While a considerable proportion of participants indicated high levels of emotional exhaustion, their responses showed low levels of depersonalization (detached response to other people) and high levels of personal accomplishment (high levels of work performance and competence). A sense of coherence was a significant protective factor for mental health well-being for the participants, which is to say, high levels of sense of coherence were predictive of lower levels of anxiety, depression and burnout in this study sample.

CONCLUSION

It is evident that both nursing and midwifery professions require psychosocial support to preserve their health both in the short and long term. Ensuring individualized tailored support will require a layered response within organizations aimed at individual self-care and collegial peer support.

PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public contribution in this study, as the focus was on nurses and midwives.

Implementing Mycoplasma genitalium testing across a London-based sexual health service: A quality improvement project

Recent national guidelines recommended testing for Mycoplasma genitalium (MG) in clinically-indicated conditions (CIC) including non-gonococcal urethritis (NGU), pelvic inflammatory disease (PID) and epididymo-orchitis. Over five months in 2018 a quality improvement project (QIP) was carried out across three London sexual health clinics with the aim of increasing MG testing rates in CICs. Three Plan-Do-Study-Act (PDSA) cycles were completed: improving IT access, an education event and reminder emails for clinicians who did not test in CIC. To measure testing rates ten patients from each CIC were randomly selected each week and MG testing outcomes were collected. As a balancing measure, we identified the rate of inappropriate MG testing. MG testing rates in patients with NGU increased to 90% following QIP initiation (baseline rate 60%) and this increase was sustained. No increase in MG testing was seen in PID and epididymo-orchitis. Inappropriate MG test rates were high (median of 11%) but remained constant throughout the QIP period. As MG testing is expanding across the UK, we outline a QIP integrating MG testing into a busy multi-site, sexual health service improving testing uptake while not increasing inappropriate testing.

Incorporating HIV/hepatitis B virus/hepatitis C virus combined testing into routine blood tests in nine UK Emergency Departments: the "Going Viral" campaign

OBJECTIVES

Routine HIV screening is recommended in those UK hospitals and primary care settings where the HIV prevalence is > 0.2%. For hepatitis B virus (HBV) and hepatitis C virus (HCV), however, testing is targeted at at-risk groups. We investigated the prevalence of these blood-borne viruses (BBVs) during a routine testing pilot in UK Emergency Departments (EDs).

METHODS

During the "Going Viral" campaign (13-19 October 2014), nine UK EDs in areas of high HIV prevalence offered routine tests for HIV, HBV and HCV to adults having blood taken as part of routine care. Patients who tested positive were linked to care.

RESULTS

A total of 7807 patients had blood taken during their ED visit; of these, 2118 (27%) were tested for BBVs (range 9-65%). Seventy-one BBV tests were positive (3.4%) with 32 (45.1%) new diagnoses. There were 39 HCV infections (15 newly diagnosed), 17 HIV infections (six newly diagnosed), and 15 HBV infections (11 newly diagnosed). Those aged 25-54 years had the highest prevalence: 2.46% for HCV, 1.36% for HIV and 1.09% for HBV. Assuming the cost per diagnosis is £7, the cost per new case detected would be £988 for HCV, £1351 for HBV and £2478 for HIV.

CONCLUSIONS

In the first study in the UK to report prospectively on BBV prevalence in the ED, we identified a high number of new viral hepatitis diagnoses, especially hepatitis C, in addition to the HIV diagnoses. Testing for HIV alone would have missed 54 viral hepatitis diagnoses (26 new), supporting further evaluation of routine BBV testing in UK EDs.

HIV research trials versus standard clinics for antiretroviral-naïve patients: the outcomes differ but do the patients?

Exclusion criteria for HIV treatment-naïve drug trials can be stringent and selection bias exists, making it difficult to extrapolate results into the 'real world' clinical situation. We aim to compare the demographics, virological outcomes and psychosocial complexity in adult HIV-infected treatment-naïve patients from our cohort initiating combination antiretroviral therapy (cART) in research trials versus standard clinics. In our unit from 2006 to 2011, 1202 standard clinic and 69 research trial patients initiated cART; every eighth standard clinics patient was included to create a standard clinics:research trials patient ratio of 2:1. Notes were retrospectively reviewed for patient demographics, attendance rates and virological outcomes. Data from 221 antiretroviral-naïve patients starting cART were analysed: 152 standard clinic patients and 69 from research trials. In the research trials group, there was an overrepresentation of men (p = 0.041), men who have sex with men (p < 0.001), patients of white ethnicity (p = 0.01), employed patients (p = 0.01) and patients using excessive alcohol (p = 0.02). There was equal representation of drug use, depression and referral to psychology, psychiatry and social work in both groups. The research trials group at baseline had significantly higher CD4 counts (p < 0.001), lower viral loads (p = 0.01) and more patients achieved undetectable viral loads at three (p < 0.001), six (p < 0.001) and 24 months (p = 0.033). There is a prevailing common preconception that participants in clinical trials are uncomplicated, unlike their 'real-life' counterparts. We demonstrated important similarities in psychosocial complexity as well as differences in demographics and virological outcomes in trial and non-trial patients. Clinicians need to be aware of these discrepancies to ensure the facilitation of a heterogeneous population participating in research trials.

Individualized homeopathic therapy for male infertility

This prospective observational pilot study investigated the effect of individualized homeopathy on male infertility based on sperm count, hormone values and general health. Forty-five subfertile men were treated with single homeopathic remedies for an average of 10.3 months. The drugs were prescribed on the basis of the overall symptomatic situation. The variables 'sperm density', 'percentage of sperm with good progressive motility' and 'density of sperm with good propulsive motility' improved significantly, especially in cases of oligoasthenozoospermia. The general health of patients improved significantly. The following factors emerged as positive predictors of therapy success: alcohol consumption below 30 g/day, non-smoking, the presence of less than five dental amalgam fillings, no exposure to noxious substances at the workplace and no previous inflammatory genital diseases. The factors stress, age above 36, high coffee consumption and long duration of unwanted childlessness did not have a negative impact on therapy outcome in this study. The rate of improvement in sperm count through homeopathic therapy is comparable to the improvement achieved by conventional therapy, so that individualized-homeopathic treatment may be considered a useful alternative to conventional treatment of subfertile men. For further investigation, a randomised, therapy-controlled clinical study with parallel group design would be useful (homeopathic therapy vs conventional andrological therapy).

Variations on a segmental theme: muscle receptor organs and extensor neuromusculature in the squat lobster Munida quadrispina (Anomura, Galatheidae)

Extensor neuromusculature and the muscle receptor organs (MROs) associated with them have been conserved during the evolution of malacostracan crustaceans, despite species-specific differences between homologous segments in divergent taxa. Investigations of these differences could provide insight into how sensory and neuromuscular elements are modified to accommodate changing behavioural patterns. The most obvious differences between squat lobsters (galatheid anomurans) and macruran decapods, such as crayfish, are the greater dorso-ventral flattening of the galatheid abdomen and its flexed resting posture. To investigate whether the evolution of this altered posture affected extensor neuromusculature and MRO morphology and physiology, we used Methylene Blue staining, cobalt backfilling and extracellular recording techniques to describe these elements in the caudal thoracic and six abdominal segments of the squat lobster Munida quadrispina and compared our results with published descriptions of homologous elements in macrurans. In M. quadrispina, there is segmental variation both in the orientation of the MROs along the abdomen and in their physiological responses to stretch: apparent sensitivity is higher in caudal than rostral MROs. Homologues of three of the four accessory neurones found in crayfish occur, but AN#1 has a major dendrite not present in crayfish. Intersegmental differences in size and morphology of extensor motoneurones occur in M. quadrispina, as have been reported in crayfish, but are dissimilar in the two: abdominal ganglion 5 extensor motoneurones are the largest in M. quadrispina and the smallest in crayfish; this difference correlates with the difference in relative size of axial muscles along the abdomen reported previously for these species. M. quadrispina also differs from macrurans in having a single tonic, and no phasic, MRO on each side of the last abdominal segment. Together, these observations suggest that galatheids have evolved modified or additional neurobehavioural control(s) for the abdomen and tailfan.

Selective breeding for increased cholinergic function: increased serotonergic sensitivity

The effects of the serotonergic antagonist cyproheptadine and the agonist 1(m-chlorophenyl) piperazine (mCPP) on core body temperature, locomotor activity and operant responding for a water reward were determined in two lines of Sprague-Dawley rats selectively bred for differences in sensitivity to the anticholinesterase, diisopropyl fluorophosphate (DFP). Both cyproheptadine and mCPP induced a dose-dependent hypothermia that was significantly greater in the line of rat more sensitive to DFP (the Flinders Sensitive Line--FSL). On the other hand, the mild stimulant effects of cyproheptadine on operant responding and locomotor activity were similar in the two lines, whereas the marked inhibitory effects of mCPP on these two measures were significantly greater in the FSL rats. This study also confirmed that the FSL rats were significantly more sensitive to the hypothermic effects of oxotremorine, a muscarinic agonist, and showed that pretreatment with cyproheptadine reduced the hypothermic effects of oxotremorine to a similar extent in the two lines. These findings indicate that rats selectively bred for increased cholinergic function (FSL) also differ in their sensitivity to serotonergic agonists and antagonists, thereby extending the evidence for cholinergic-serotonergic interactions in the rat.

Segregation of mutant ovalbumins and ovalbumin-globin fusion proteins in Xenopus oocytes. Identification of an ovalbumin signal sequence

The intramolecular signals for chicken ovalbumin secretion were examined by producing mutant proteins in Xenopus oocytes. An ovalbumin complementary DNA clone was manipulated in vitro, and constructs containing altered protein-coding sequences and either the simian virus 40 (SV40) early promoter or Herpes simplex thymidine kinase promoter, were microinjected into Xenopus laevis oocytes. The removal of the eight extreme N-terminal amino acids of ovalbumin had no effect on the segregation of ovalbumin with oocyte membranes nor on its secretion. A protein lacking amino acids 2 to 21 was sequestered in the endoplasmic reticulum but remained strongly associated with the oocyte membranes rather than being secreted. Removal of amino acids 231 to 279, a region previously reported to have membrane-insertion function, resulted in a protein that also entered the endoplasmic reticulum but was not secreted. Hybrid proteins containing at their N terminus amino acids 9 to 41 or 22 to 41 of ovalbumin fused to the complete chimpanzee alpha-globin polypeptide were also sequestered by oocyte membranes. We conclude that the ovalbumin "signal" sequence is internally located within amino acids 22 to 41, and we speculate that amino acids 9 to 21 could be important for the completion of ovalbumin translocation through membranes.

Efficient expression of cloned complementary DNAs for secretory proteins after injection into Xenopus oocytes

Cloned complementary DNAs encoding chicken ovalbumin, chicken prelysozyme and calf preprochymosin, prochymosin and chymosin were inserted downstream from various viral promoters in modified recombinant "shuttle" vectors. Microinjection of the ovalbumin, prelysozyme and preprochymosin constructs into the nuclei of Xenopus laevis oocytes resulted in the synthesis, segregation in membranes and secretion into the extracellular medium of ovalbumin, lysozyme and prochymosin, respectively. Judging from molecular weight estimations, lysozyme and prochymosin were correctly proteolytically processed while ovalbumin, which lacks a cleavable signal sequence, was glycosylated. Injection of the DNA construct encoding prochymosin without its signal sequence resulted in synthesis of prochymosin protein that was localized exclusively in the oocyte cytoplasm. No immunospecific protein was detected after injection of the DNA encoding mature chymosin. In terms of protein expression in oocytes, the Herpes simplex thymidine kinase (TK) promoter was up to sevenfold more effective than the simian virus 40 (SV40) early promoter, and equally as effective as the Moloney murine sarcoma virus long terminal repeat element. Where tested, protein expression in oocytes was much reduced if DNA sequences encoding the SV40 small t intron and its flanking sequences were present in the constructs. S1 nuclease mapping of transcripts produced after injection of DNAs containing the TK promoter indicated that the majority of transcripts initiated at, or within, two bases of the known "cap" site. However, minor transcripts initiating upstream from this site were observed and one (or more) of these transcripts was responsible for the synthesis of an ovalbumin polypeptide containing a 51 amino acid N-terminal extension. This extended protein remained in the oocyte cytosol. When ovalbumin cDNA was inserted into the vectors with opposite polarity to the viral promoter, expression in oocytes resulted in the predominant synthesis and secretion of a variant ovalbumin with a 21 amino acid N-terminal extension, although some full-length ovalbumin was also synthesized and secreted. S1 mapping revealed the presence, in these oocytes, of transcripts of predicted polarity initiating 118 bases upstream from the wild type ovalbumin initiator ATG, at a previously unreported SV40 "promoter". No protein synthesis was detected after the injection of these reverse-orientation constructs into baby hamster kidney (BHK-21) cells.