Cancer Patient Navigation in Canada: Directions From the North.

OBJECTIVES: Cancer is a complex disease that is experienced by those affected by cancer and their loved ones differently. The importance of cancer patient navigation is quintessential to support those affected through the healthcare system and to supportive resources. Canadian cancer statistics advise of the continued increase of cancer and impacts on health care. With Canada being a large geographical area, large portions of the population live in rural and remote areas with decreased access to health services. In Canada, cancer navigation is different across the country; each province's or territory's health authority creates their own cancer navigation program based on the needs of their patients. This report aims to provide an overview of cancer in Canada, along with the different navigation programs available nationally. Additionally, it will review the role the Canadian Association of Nurses in Oncology/Association canadienne des infirmières en oncologie (CANO/ACIO) plays in creating a community of practice to support cancer patient navigators across the country. METHODS: The information on various provincial and territorial navigation programs was obtained through discussion with the CANO/ACIO Navigation Special Interest Group (SIG). All provinces and territories were interviewed with the exception of Quebec, Prince Edward Island, Nunavut, and Yukon. RESULTS: While the vast majority of navigation has a similar core intent, there are many differences between the provinces and territories in the navigation programs. These differences are based on geographical need and the individual health authorities. CONCLUSIONS: The Canadian Association of Nurses in Oncology/Association canadienne des infirmières en oncologie (CANO/ACIO) provides a community for cancer navigators to connect through a Special Interest Group (SIG), meeting virtually monthly to support each other across Canada to collaborate, identify issues, trends, and challenges. IMPLICATIONS FOR NURSING PRACTICE: Cancer patient navigation is a valuable resource for all individuals with cancer and their loved ones, particularly when faced with difficulties accessing care in rural and remote areas. Cancer patient navigators' scope is similar in intent, despite potential differences in programs. By connecting with other navigators through the CANO/ACIO navigation SIG, navigators across the country can provide a connection to discuss program similarities and barriers and opportunities for cancer navigation programs to work together to support each other and evolve their programs to meet the needs of their provincial and territorial residents.

A novel bluetongue virus serotype 2 strain isolated from a farmed Florida white-tailed deer (Odocoileus virginianus) arose from reassortment of gene segments derived from co-circulating serotypes in the Southeastern USA.

Bluetongue disease is a reportable animal disease that affects wild and farmed ruminants, including white-tailed deer (WTD). This report documents the clinical findings, ancillary diagnostics, and genomic characterization of a novel reassortant bluetongue virus serotype 2 (BTV-2) strain isolated from a dead Florida farmed WTD in 2022. Our analyses support that this BTV-2 strain likely stemmed from the acquisition of genome segments from co-circulating BTV strains in Florida and Louisiana. In addition, our analyses also indicate that genetically uncharacterized BTV strains may be circulating in the Southeastern USA; however, the identity and reassortant status of these BTV strains cannot be determined based on the VP2 and VP5 genome sequences. Hence, continued surveillance based on complete genome characterization is needed to understand the genetic diversity of BTV strains in this region and the potential threat they may pose to the health of deer and other ruminants.

Contemporary challenges for specialist nursing in interstitial lung disease.

The role of clinical nurse specialists (CNSs) in interstitial lung disease (ILD) is evolving in response to clinical guidelines and the growth of clinical research. The role is well established in the UK, although more ILD posts are needed to ensure supply meets clinical demand. This phenomenon is also happening across Europe. An appreciation of the similarities and differences between CNS and advanced nurse practitioners is important given the challenges in defining, developing and supporting this nursing specialisation. Globally, different models exist. In some countries charitable organisations take a leading role in supporting patients. Many European centres look to the National Institute for Health and Care Excellence guidelines and quality standards as a template to develop and evaluate the role of the ILD CNS. We present a UK perspective in the context of a government subsidised healthcare system to promote professional discussion and debate regarding the future of nursing practice in the ILD specialty. KEY POINTS: ILDs are often complex and associated with significant mortality, morbidity and co-morbid conditions that require a technical healthcare skill setThere is worldwide shortage of nurses, low retention rates and retirement of many skilled nursesCollaboration across the ILD interdisciplinary community is needed to safeguard the future of our professions and high-quality patient careThe ILD interdisciplinary and nurse network has identified key priorities to help secure the future of the ILD clinical and academic nurse specialism. EDUCATIONAL AIMS: To explain the similarities and differences between clinical nurse specialists (CNSs) and advanced nurse practitioners (ANPs) in the context of ILD specialismTo review contemporary nursing specialism in the UK's government subsidised healthcare systemTo stimulate discussion and debate across the European/international respiratory community regarding the clinical and academic development of the ILD CNSTo identify key priorities that will support collaboration across the ILD interdisciplinary workforce in clinical practice and research.

A novel recurrent NPM1-TYK2 gene fusion in cutaneous CD30-positive lymphoproliferative disorders.

The spectrum of cutaneous CD30-positive lymphoproliferative disorders (LPDs) includes lymphomatoid papulosis and primary cutaneous anaplastic large cell lymphoma. Chromosomal translocations targeting tyrosine kinases in CD30-positive LPDs have not been described. Using whole-transcriptome sequencing, we identified a chimeric fusion involving NPM1 (5q35) and TYK2 (19p13) that encodes an NPM1-TYK2 protein containing the oligomerization domain of NPM1 and an intact catalytic domain in TYK2. Fluorescence in situ hybridization revealed NPM1-TYK2 fusions in 2 of 47 (4%) primary cases of CD30-positive LPDs and was absent in other mature T-cell neoplasms (n = 151). Functionally, NPM1-TYK2 induced constitutive TYK2, signal transducer and activator of transcription 1 (STAT1), STAT3, and STAT5 activation. Conversely, a kinase-defective NPM1-TYK2 mutant abrogated STAT1/3/5 signaling. Finally, short hairpin RNA-mediated silencing of TYK2 abrogated lymphoma cell growth. This is the first report of recurrent translocations involving TYK2, and it highlights the novel therapeutic opportunities in the treatment of CD30-positive LPDs with TYK2 translocations.

The use of stained cytologic direct smears for ALK gene rearrangement analysis of lung adenocarcinoma.

BACKGROUND: Rearrangements involving the anaplastic lymphoma kinase (ALK) gene are present in approximately 5% of lung adenocarcinomas. Crizotinib is approved for the treatment of lung adenocarcinomas harboring ALK rearrangements. Patients with advanced stage lung cancer are not candidates for surgical resection of their primary tumors. For these patients, cytologic specimens often represent the only diagnostic tissue available. Cell blocks (CBs) are routinely used for molecular studies; however, insufficient CB cellularity can impede the performance of these assays. METHODS: Thirty-two cytology cases of lung adenocarcinomas were analyzed by fluorescence in situ hybridization (FISH) for ALK rearrangements. Diff-Quik-stained smears were examined to identify tumor cell-enriched areas that were marked using a diamond-tipped scribe. Paired ALK rearrangement FISH was performed using smears and CBs in each case. RESULTS: An ALK rearrangement was detected on direct smears and CB sections in 5 (16%) and 4 (13%), respectively, of the 32 cases studied. Concordant FISH results for smears and CBs were observed in 31 (97%) of 32 cases. In the 1 discordant case, an ALK rearrangement was detected on the direct smear but not in the CB. Reverse transcriptase-polymerase chain reaction analysis of this CB revealed the presence of an EML4-ALK rearrangement, thereby confirming a false-negative FISH result in the CB. CONCLUSIONS: Stained cytologic direct smears can be effectively used for ALK rearrangement analysis by FISH. This approach represents a useful safeguard when insufficient CB cellularity is encountered and could prevent delays in treatment in this era of precision medicine.

Pharmacokinetics of methylphenidate transdermal system (MTS): results from a laboratory classroom study.

OBJECTIVE: To evaluate the pharmacokinetic properties of the methylphenidate transdermal system (MTS) in pediatric patients diagnosed with ADHD (attention-deficit/hyperactivity disorder) in a laboratory school setting. METHOD: A phase II, randomized, double-blind, placebo-controlled, laboratory classroom study was conducted with prior dose optimization. Children (aged 6-12 years) with ADHD were titrated over 5 weeks to an optimal clinical MTS dose (10, 15, 20, or 30 mg/9 h). Participants were randomized to 1 week of either MTS or corresponding placebo, followed by crossover to the alternate treatment. Laboratory school evaluations, including pharmacokinetic blood sampling, occurred at the end of each treatment. RESULTS: MTS delivered d- and l-MPH (methylphenidate) into the systemic circulation throughout the 9-hour wear time, and plasma concentrations declined rapidly after patch removal. Over the time-course of clinical effectiveness (2-12 h), mean plasma concentrations of d-MPH at the most frequently titrated doses (15 and 20 mg/9 h) ranged from 4.97 to 28.3 ng/mL. Systemic exposure increased approximately dose proportionately. Plasma concentrations of the l-MPH were approximately one-half to two-thirds those for d-MPH. CONCLUSIONS: Plasma concentrations of the much less active l-MPH were consistently lower than those of d-MPH. The clinical relevance of the MTS pharmacokinetic profile is discussed.

Immune selection for altered antigen processing leads to cytotoxic T lymphocyte escape in chronic HIV-1 infection.

Mutations within cytotoxic T lymphocyte (CTL) epitopes impair T cell recognition, but escape mutations arising in flanking regions that alter antigen processing have not been defined in natural human infections. In human histocompatibility leukocyte antigen (HLA)-B57+ HIV-infected persons, immune selection pressure leads to a mutation from alanine to proline at Gag residue 146 immediately preceding the NH2 terminus of a dominant HLA-B57-restricted epitope, ISPRTLNAW. Although N-extended wild-type or mutant peptides remained well-recognized, mutant virus-infected CD4 T cells failed to be recognized by the same CTL clones. The A146P mutation prevented NH2-terminal trimming of the optimal epitope by the endoplasmic reticulum aminopeptidase I. These results demonstrate that allele-associated sequence variation within the flanking region of CTL epitopes can alter antigen processing. Identifying such mutations is of major relevance in the construction of vaccine sequences.

Abusive behaviour experienced by primary care receptionists: a cross-sectional survey.

BACKGROUND: Receptionists act as gatekeepers to GPs, and thus are often placed in situations of conflict. However, there is a lack of research in this area. OBJECTIVE: The purpose of this study was to identify the incidence and associations of verbal and physical abuse against primary care receptionists, both pre- and post-'zero tolerance'. METHODS: A postal questionnaire was designed, piloted and sent to all reception staff in 50 randomly selected general practices in Leeds. The primary purpose was to identify any verbal or physical abuse experienced in the 12 months prior to the survey and assess the association between abuse experienced and deprivation. RESULTS: Seventy percent of receptionists completed and returned the questionnaire. Over two-thirds of receptionists had experienced verbal abuse in the last year. During the same time period, 60% reported telephone abuse and 55% reported face to face abuse. The incidence of abuse was higher in the year prior to the study than in the preceding period. Practice deprivation was identified as a significant factor for verbal abuse (P = 0.003). CONCLUSION: Verbal abuse against receptionists is significantly associated with the level of deprivation of the practice area. There is no evidence that 'zero tolerance' led to a reduction in abuse experienced by primary care receptionists. All primary care receptionists should receive adequate training on managing abuse.