A focused immune response targeting the homotypic binding domain of the carcinoembryonic antigen blocks the establishment of tumor foci in vivo.

Metastatic forms of cancers remain the main cause of death in cancer patients. In this study, we demonstrate that directing a sustained antibody response towards the homotypic binding function of CEA interferes with the implantation and development of tumor foci in CEA-expressing transgenic (CEA.Tg) mice. Specifically, vaccinating CEA.Tg mice with a recombinant, altered self-form of the CEA Ig V-like N domain led to the production of circulating IgG1 and IgG2a antibodies that inhibited CEA-mediated adhesion of murine carcinoma expressing CEA (MC38.CEA) and mediated antibody-dependent lysis of tumor cells. Moreover, vaccinated CEA.Tg mice were resistant to the development of tumor nodules in the lungs and the peritoneal cavity, suggesting that mounting a focused antibody response to the CEA N domain may represent a simple therapeutic strategy to control the establishment of metastatic foci in cancer patients.

The Healthy Addiction Treatment Recovery Model: Developing a Client-Driven, Nurse-Led Addiction Nursing Model.

ABSTRACT: The current model of nursing within international addiction services has been described as task oriented and reactive. Yet, it is known that nursing models should be led by client need and operate within the domain of the client and their wider environment. The aim of this study was to address this gap within addiction nursing and to develop an evidence-based addiction nursing model.To objectively assess the needs of clients, a cross-sectional survey was implemented within a representative selection of six drug treatment clinics and a sample of clients in receipt of opiate agonist treatment in Dublin, Ireland. The Opiate Treatment Index with the General Health Questionnaire embedded was used to measure heroin use, polydrug use, infectious disease risk, physical health, psychological adjustment, criminality and social well-being. To develop the addiction model, a mapping of relevant features of potential nursing models was conducted by nurses working in addiction services.The key finding from the client assessments was a lack of psychological adjustment; a cutoff score of 4 was recommended. The mean score among women was 11 (95% CI [8, 14]), and that among men was 8 (95% CI [6, 10]). Findings from the mapping of models highlighted the benefits of the BRENDA, FRAMES, and Tidal models. A focus on practical implementation and measurable outcomes was stressed. Results informed the development of the Healthy Addiction Treatment Recovery Model. The model refocused services on clients' objective needs and eradicated entrenched practices.

Clients' Views on the Importance of a Nurse-Led Approach and Nurse Prescribing in the Development of the Healthy Addiction Treatment Recovery Model.

Globally, from America to Europe and beyond, the need for the expansion of the role of nurse practitioners has been recognized within the healthcare professions. However, little emphasis has been placed on assessing the views of clients, and within the addiction services, the voice of clients can be additionally marginalized as a result of treatment philosophies, stigma, and resource constraints. The aims of this study were to establish from clients their nursing needs and to use these findings alongside an objective measurement of clients' health, to inform the development of a nurse-led treatment model.A cross-sectional survey with open-ended questions on client nursing needs was conducted in 2017 within a representative sample of six clinics in Dublin, Ireland. A convenience sample of 131 clients were interviewed. Interviews were analyzed using thematic analysis.Findings were both as expected and surprising. Clients articulated the role of the nurse in their physical care; however, unexpectedly, clients identified nurses as an essential source of psychological support and expressed the wish for the role to be expanded in terms of managing methadone treatment and accessing additional services and resources.Results contributed to the formation of the nurse-led, client mental-health-focused, Healthy Addiction Treatment Recovery Model for addiction nursing services. In terms of national policies, findings provided new evidence articulated by service users on their desire for the expansion of nurse prescribing in addiction services and an expansion of the role to more adequately address client needs.

Heart failure patients with ventricular dysynchrony: management with a cardiac resynchronization therapy device.

Despite an array of treatment modalities, the overall prognosis for patients with severe heart failure remains bleak. Biventricular pacing, or cardiac resynchronization therapy, is gaining increasing acceptance as a compelling treatment for those individuals with advanced heart failure (New York Heart Association functional class III or IV). This article provides a brief description of the atrial and ventricular conduction disturbances common in patients with advanced heart failure. Current indications for therapy are outlined, as are recent results of cardiac resynchronization therapy trials. The implant procedure is described to provide a comprehensive overview of this innovative approach to re-establishing normal electromechanical activity and synchronous right and left ventricular contractions. Patient care, before and after device implant, is also summarized. The focus on patient education throughout this article may allow it to serve as a reference for health care providers involved in the care of patients with severe heart failure.

Barriers to and facilitators of hepatitis C testing, management, and treatment among current and former injecting drug users: a qualitative exploration.

Hepatitis C (HCV) infection is common among injecting drug users (IDUs), yet accessing of HCV care, particularly HCV treatment, is suboptimal. There has been little in-depth study of IDUs experiences of what enables or prevents them engaging at every level of HCV care, including testing, follow-up, management and treatment processes. This qualitative study aimed to explore these issues with current and former IDUs in the greater Dublin area, Ireland. From September 2007 to September 2008 in-depth interviews were conducted with 36 service-users across a range of primary and secondary care services, including: two addiction clinics, a general practice, a community drop-in center, two hepatology clinics, and an infectious diseases clinic. Interviews were analyzed using a grounded theory approach. Barriers to HCV care included perceptions of HCV infection as relatively benign, fear of investigations and treatment, and feeling well. Perceptions were shaped by the discourse about HCV and "horror stories" about the liver biopsy and treatment within their peer networks. Difficulties accessing HCV care included limited knowledge of testing sites, not being referred for specialist investigations and ineligibility for treatment. Employment, education, and addiction were priorities that competed with HCV care. Relationships with health care providers influenced engagement with care: Trust in providers, concern for the service-user, and continuity of care fostered engagement. Education on HCV infection, investigations, and treatment altered perceptions. Becoming symptomatic, responsibilities for children, and wanting to move on from drug use motivated HCV treatment. In conclusion, IDUs face multiple barriers to HCV care. A range of facilitators were identified that could inform future interventions.