Systems of communication in school-nurse led care coordination: A concept analysis.

AIM: To analyze the concept of systems of communication in school nurse-led care coordination to develop an operational definition that will inform intervention development. BACKGROUND: Communication has been identified as an essential attribute in care coordination. However, previous concept analyses of care coordination did not clearly define systems of communication or consider the context of school-based care coordination. Defining and conceptualizing systems of communication has important implications for improving school nurse-led care coordination. METHODS: Concept analysis was conducted using Walker and Avant's eight-step concept analysis method. The literature was searched to identify supporting literature that was analyzed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. RESULTS: Systems of communication in school nurse-led care coordination can be defined as systems wherein care team members, led by the school nurse, collaborate by communicating information and knowledge through an individualized healthcare plan that is student/family-centered and shared through information systems. Attributes require developing an individual health plan that incorporates care coordination needs, information sharing with student/family consent, and a clear delineation of team member roles. Consequences include student/family outcomes, team member knowledge, and efficiency and accuracy of information. CONCLUSIONS: Concept clarification and a synthesized definition allow for more effective measurement development for effective communication in school nurse-led care coordination. Students with healthcare needs in the school environment require systems of communication that efficiently work toward school nurse-led care coordination that addresses the student's health and academic outcomes.

S14 protein in breast cancer cells: direct evidence of regulation by SREBP-1c, superinduction with progestin, and effects on cell growth.

Most breast cancers exhibit brisk lipogenesis, and require it for growth. S14 is a lipogenesis-related nuclear protein that is overexpressed in most breast cancers. Sterol response element-binding protein-1c (SREBP-1c) is required for induction of lipogenesis-related genes, including S14 and fatty acid synthase (FAS), in hepatocytes, and correlation of SREBP-1c and FAS expression suggested that SREBP-1c drives lipogenesis in tumors as well. We directly tested the hypothesis that SREBP-1c drives S14 expression and mediates lipogenic effects of progestin in T47D breast cancer cells. Dominant-negative SREBP-1c inhibited induction of S14 and FAS mRNAs by progestin, while active SREBP-1c induced without hormone and superinduced in its presence. Changes in S14 mRNA were reflected in protein levels. A lag time and lack of progestin response elements indicated that S14 and FAS gene activation by progestin is indirect. Knockdown of S14 reduced, whereas overexpression stimulated, T47D cell growth, while nonlipogenic MCF10a mammary epithelial cells were not growth-inhibited. These data directly demonstrate that SREBP-1c drives S14 gene expression in breast cancer cells, and progestin magnifies that effect via an indirect mechanism. This supports the prediction, based on S14 gene amplification and overexpression in breast tumors, that S14 augments breast cancer cell growth and survival.