Alginate Oligosaccharide-Induced Modification of the lasI-lasR and rhlI-rhlR Quorum-Sensing Systems in Pseudomonas aeruginosa.

Pseudomonas aeruginosa plays a major role in many chronic infections. Its ability to readily form biofilms contributes to its success as an opportunistic pathogen and its resistance/tolerance to antimicrobial/antibiotic therapy. A low-molecular-weight alginate oligomer (OligoG CF-5/20) derived from marine algae has previously been shown to impair motility in P. aeruginosa biofilms and disrupt pseudomonal biofilm assembly. As these bacterial phenotypes are regulated by quorum sensing (QS), we hypothesized that OligoG CF-5/20 may induce alterations in QS signaling in P. aeruginosa QS regulation was studied by using Chromobacterium violaceum CV026 biosensor assays that showed a significant reduction in acyl homoserine lactone (AHL) production following OligoG CF-5/20 treatment (≥2%; P < 0.05). This effect was confirmed by liquid chromatography-mass spectrometry analysis of C4-AHL and 3-oxo-C12-AHL production (≥2%; P < 0.05). Moreover, quantitative PCR showed that reduced expression of both the las and rhl systems was induced following 24 h of treatment with OligoG CF-5/20 (≥0.2%; P < 0.05). Circular dichroism spectroscopy indicated that these alterations were not due to steric interaction between the AHL and OligoG CF-5/20. Confocal laser scanning microscopy (CLSM) and COMSTAT image analysis demonstrated that OligoG CF-5/20-treated biofilms had a dose-dependent decrease in biomass that was associated with inhibition of extracellular DNA synthesis (≥0.5%; P < 0.05). These changes correlated with alterations in the extracellular production of the pseudomonal virulence factors pyocyanin, rhamnolipids, elastase, and total protease (P < 0.05). The ability of OligoG CF-5/20 to modify QS signaling in P. aeruginosa PAO1 may influence critical downstream functions such as virulence factor production and biofilm formation.

The contribution of organisational factors to vicarious trauma in mental health professionals: a systematic review and narrative synthesis.

Background: The negative impact of trauma work has been well documented in mental health professionals. There are three main phenomena used to describe these effects: Secondary Traumatic Stress (STS), Vicarious Trauma (VT) and Compassion Fatigue (CF). To date, the majority of research has focused on the contribution of individual level factors. However, it is imperative to also understand the role of organizational factors. Objectives: This review examines the role of organizational factors in ameliorating or preventing STS, VT, and CF in mental health professionals. We further aimed to identify specific elements of these factors which are perceived to be beneficial and/or detrimental in mitigating against the effects of STS, VT, and CF. Method: Studies were identified by searching the electronic databases Medline, PsycINFO, Embase, Web of Science and SCOPUS with final searches taking place on 10 March 2021. Results: Twenty-three quantitative studies, eight qualitative studies, and five mixed methods studies were included in the final review. A narrative synthesis was conducted to analyse the findings. The results of the review highlight the importance of regular supervision within supportive supervisory relationships, strong peer support networks, and balanced and diverse caseloads. The value of having an organizational culture which acknowledges and validates the existence of STS was also imperative. Conclusions: Organizations have an ethical responsibility to support the mental health professionals they employ and provide a supportive environment which protects them against STS. This review provides preliminary evidence for the types of support that should be offered and highlights the gaps in the literature and where future research should be directed. Further research is needed to evaluate which strategies - and under what conditions - best ameliorate and prevent STS.

Antecedentes: El impacto negativo del trabajo de trauma ha estado bien documentado en los profesionales de la salud mental. Hay tres principales fenómenos usados para describir estos factores: Estrés Traumático Secundario (STS en sus siglas en ingles), Trauma Vicario (VT) y Fatiga por Compasión (CF). Hasta la fecha, la mayoría de la investigación se ha centrado en la contribución de los factores a nivel individual. Sin embargo, es imperativo comprender también el rol de los factores organizacionales.Objetivos: Esta revisión examina el papel de los factores organizacionales en la mejora o prevención de STS, VT y CF en los profesionales de la salud mental. Además, nuestro objetivo fue identificar elementos específicos de estos factores que se perciben como beneficiosos y/o perjudiciales para mitigar los efectos de STS, VT y CF.Método: Los estudios fueron identificados por la búsqueda en la base de datos electrónica de Medline, PsycINFO, Embasse, Web of Science y SCOPUS y las búsquedas finales se realizaron el 10 de marzo del 2021.Resultados: En la revisión final se incluyeron veintitrés estudios cuantitativos, ocho estudios cualitativos y cinco estudios con métodos mixtos. Se realizó una síntesis narrativa para analizar los hallazgos. Los resultados de la revisión destacan la importancia del monitoreo regular dentro de la relación de supervisión y apoyo, redes sólidas de apoyo entre pares y una carga da casos equilibrada y diversa. El valour de tener una cultura organizacional que reconozca y valide la existencia de STS también fue imperativo.Conclusiones: Las organizaciones tienen una responsabilidad ética de apoyar a los profesionales de la salud mental que emplean y brindarles un entorno de apoyo que los proteja contra el STS. Esta revisión provee evidencia preliminar para los tipos de apoyo que se deberían ofrecer y destaca las lagunas en la literatura y hacia dónde se deben dirigir las investigaciones futuras. Se necesita más investigación para evaluar qué estrategias ­ y bajo qué condiciones- mejoran y previenen mejor el STS.

'Palliative care education in nursing homes: a qualitative evaluation of telementoring.

There is an increasing need to support nursing homes in palliative care to reduce suffering and avoid unnecessary hospital admissions at the end of life. Providing education to nursing homes faces many barriers including structural systems and cultural issues. In order to overcome some of these barriers, education using Project Extension for Community Health Outcomes (ECHO) methodology has been delivered to nursing homes throughout a large city in England. This paper aims to explore participant experience in Project ECHO for nursing homes. METHODOLOGY: Qualitative semistructured interviews with a purposive sample of nursing home staff. Interviews were conducted by one researcher and transcribed verbatim. Line-by-line coding and categorisation were used to form themes. RESULTS: Eleven interviews were completed with data saturation reached by interview eight. The following themes were revealed: Barriers and facilitators to accessing Project ECHO, Community of Practice and Communication with nursing homes and data extraction. CONCLUSION: Project ECHO is an accessible, acceptable and engaging way of delivering palliative care education to nursing homes combatting some of the traditional barriers that nursing homes face in accessing training.

A neurological care pathway for meeting the palliative care needs of people with life-limiting neurological conditions.

The expectancy and demand for palliative care provision beyond cancer continues to increase in the Western world. This challenge raises the need for useful tools to support palliative care practitioners and other specialists in caring for people with a range of non-malignant life-limiting diseases. This paper describes the development process and the resulting care pathway for meeting the palliative care needs of people living with neurological conditions. The pathway was designed as a template, suitable for local modification, to support timely referrals and coordination of care through a patient's illness journey incorporating the provision of palliative and end-of-life care. Although the pathway was developed for neurological conditions, it is suggested that presentation of the development process and the care pathway template may support practitioners to develop further pathways for a wider range of life-limiting conditions.

From diagnosis to death: exploring the interface between neurology, rehabilitation and palliative care in managing people with long-term neurological conditions.

This article reports a parallel survey of consultants working in the fields of neurology, rehabilitation and palliative medicine, and explores the interface between the three specialties in providing services for people with long-term neurological conditions. There was general agreement with respect to the core contributions offered by each specialty. However, there were also important areas of overlap which highlight the need for collaborative working practice, and for clinicians to respect the expertise of others in related areas. The survey highlighted a general shortfall in service provision for both palliative care and rehabilitation services for people with long-term neurological conditions, particular in the community. There was also a marked lack of coordination between services. Perhaps not surprisingly, each specialty reported greater ease of access to services within their own field, which further emphasises the need to work closely together.