RESUMO
Subjective and objective cognitive impairments in Breast Cancer Survivors (BCS) often do not correlate. One important contribution to the reported disparities may be the reliance on mean-based cognitive performance. Cognitive intra-individual variability (IIV) may provide important insights into these reported disparities. Cognitive IIV refers to the fluctuation in performance for an individual on either one cognitive task across a trial or dispersed across tasks within a neuropsychological test battery. The purpose of this systematic review was to search for and examine the literature on cognitive IIV in BCS. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) approach was used to search for all articles related to cognitive IIV in BCS. MEDLINE (via PubMed), Embase, and Scopus databases were searched using detailed search terms and strategies. Initially, 164 articles were retrieved but only 4 articles met the criteria for this systematic review. BCS differed from healthy controls in similar ways across the four studies, generally demonstrating similar performance but showing increased cognitive IIV for the more difficult tasks. Differences were enhanced later during chemotherapy. The four studies provide support for cognitive IIV as a useful measure to detect the subtle objective cognitive change often reported by BCS but frequently not detected by standard normed-based cognitive testing. Unexpectedly, measures of cognitive IIV were not consistently associated with self-reported measures of cognition.
RESUMO
Immunology has its developmental roots in understanding protection of the host from pathogens, leading to the development of vaccines and subsequently identification of soluble and cellular components of the immune system. Thus, immunology education has historically been tightly linked to infectious disease. Decades of research have demonstrated that the complexity and intricacies of the immune system are far greater than perhaps was once imagined. As a system that interfaces with all other organ systems in the body, it plays a key role in both maintaining health and causing life-threatening disease, thereby solidifying its importance in several clinical specialties beyond protective immunity. In the past decade, tremendous advances have taken place in which scientists and physicians have begun to harness the power of the immune system to create immunotherapies to fight cancer, inflammatory syndromes and autoimmune diseases. Thus, the argument can be made that training individuals in the field of immunology is becoming increasingly important. However, immunology is a highly conceptual discipline and understanding how the multiple cellular and soluble components of the immune system work in concert requires knowledge in a number of disciplines, including molecular biology, cell biology, genetics, and biochemistry. Time is needed for students to process, evaluate, and apply this information in meaningful ways. Concomitantly, knowledge in the field of immunology is expanding rapidly, bolstering the need for increased time in the curriculum to facilitate the ability of educators to convey information so that it can be effectively understood and applied. We propose that it is time for a renaissance in immunology education at the undergraduate level to better prepare individuals who will subsequently pursue careers in medicine, related health professions, and research. The purpose of this article is to discuss the current state of undergraduate immunology education with respect to its prevalence and how this compares to other biological disciplines, the need to develop robust immunology curricula at the undergraduate level and the importance of such programs in preparing students for pursuing postgraduate training in the health professions, and research-intensive careers.
Assuntos
Alergia e Imunologia/educação , Currículo , Educação de Graduação em Medicina , Escolha da Profissão , Humanos , Microbiologia , Neurociências , PublicaçõesRESUMO
Most packed red blood cell (PRBC) transfusion research focuses on younger patient populations (younger than 65) given the complexity of care and presence of comorbidities in older adults. The purpose of the current study was to critically examine the current evidence related to PRBC transfusion among older adults (age ≥65). PubMed, CINAHL, and Embase were searched for randomized controlled trials that evaluated blood transfusion in any manner (e.g., prevention, associated outcomes). Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the search resulted in 10 studies focused on cardiac, orthopedic, and gastrointestinal surgery patients. SQUIRE (Standards for QUality Improvement Reporting Excellence) guidelines were used to evaluate studies for bias; the average bias score was 13.0 (SD = 3.4), indicating a low level of bias. Greatest sources of bias were methods to assess completeness/accuracy of data, details about missing data, and costs associated with the study. Interventions to prevent PRBC transfusion in older adults vary widely, and outcomes associated with PRBC transfusion in older adults require further evaluation. [Journal of Gerontological Nursing, 44(3), 39-46.].