ABSTRACT
INTRODUCTION: Multidisciplinary teams (MDTs) are integral to oncology management, involving specialised healthcare professionals who collaborate to develop individualised treatment plans for patients. However, as cancer care grows more complex, MDTs must continually adapt to better address patient needs. This scoping review will explore barriers and challenges MDTs have encountered in the past decade; and propose strategies for optimising their utilisation to overcome these obstacles and improve patient care. METHODS AND ANALYSIS: The scoping review will follow Arksey and O'Malley's framework and begin with a literature search using keywords in electronic databases such as PubMed/MEDLINE, Scopus and PsychINFO, covering the period from January 2013 to December 2022 and limited to English language publications. Four independent reviewers will screen titles and abstracts based on predefined inclusion criteria, followed by full-text review of selected titles. Relevant references cited in the publications will also be examined. A Preferred Reporting Items for Systematic reviews and Meta-Analyses flow diagram will be utilised to illustrate the methodology. Data from selected publications will be extracted, analysed, and categorised for further analysis. ETHICS AND DISSEMINATION: The results of the scoping review will provide a comprehensive overview of the barriers and challenges encountered by oncology MDTs over the past decade. These findings will contribute to the existing literature and provide insights into areas that require improvement in the functioning of MDTs in oncology management. The results will be disseminated through publication in a scientific journal, which will help to share the findings with the wider healthcare community and facilitate further research and discussion in this field. TRIAL REGISTRATION DETAILS: The protocol for this scoping review is registered with Open Science Framework, available at DOI 10.17605/OSF.IO/R3Y8U.
Subject(s)
Health Facilities , Health Personnel , Humans , Databases, Factual , Interdisciplinary Studies , Patient Care Team , Research Design , Review Literature as TopicABSTRACT
BACKGROUND: The negative impact of unnecessary diagnostic tests on healthcare systems and patients has been widely recognized. Medical researchers in various countries have been devoting effort to reduce unnecessary diagnostic tests by using different types of interventions, including information and communications technology-based (ICT-based) intervention, educational intervention, audit and feedback, the introduction of guidelines or protocols, and the reward and punishment of staff. We conducted a review of ICT based interventions and a comparative analysis of their relative effectiveness in reducing unnecessary tests. METHOD: A systematic Boolean search in PubMed, EMBase and EBSCOhost research databases was performed. Keyword search and citation analysis were also conducted. Empirical studies reporting ICT based interventions, and their implications on relative effectiveness in reducing unnecessary diagnostic tests (pathology tests or medical imaging) were evaluated independently by two reviewers based on a rigorously developed coding protocol. RESULTS: 92 research articles from peer-reviewed journals were identified as eligible. 47 studies involved a single-method intervention and 45 involved multi-method interventions. Regardless of the number of interventions involved in the studies, ICT-based interventions were utilized by 71 studies and 59 of them were shown to be effective in reducing unnecessary testing. A clinical decision support (CDS) tool appeared to be the most adopted ICT approach, with 46 out of 71 studies using CDS tools. The CDS tool showed effectiveness in reducing test volume in 38 studies and reducing cost in 24 studies. CONCLUSIONS: This review investigated five frequently utilized intervention methods, ICT-based, education, introduction of guidelines or protocols, audit and feedback, and reward and punishment. It provides in-depth analysis of the efficacy of different types of interventions and sheds insights about the benefits of ICT based interventions, especially those utilising CDS tools, to reduce unnecessary diagnostic testing. The replicability of the studies is limited due to the heterogeneity of the studies in terms of context, study design, and targeted types of tests.
Subject(s)
Communication , Health Personnel , Delivery of Health Care , Diagnostic Imaging , HumansABSTRACT
Hydrogels comprised of alginate and gelatin have demonstrated potential as biomaterials in three dimensional (3D) bioprinting applications. However, as with all hydrogel-based biomaterials used in extrusion-based bioprinting, many parameters influence their performance and there is limited data characterising the behaviour of alginate-gelatin (Alg-Gel) hydrogels. Here we investigated nine Alg-Gel blends by varying the individual constituent concentrations. We tested samples for printability and print accuracy, compressive behaviour and change over time, and viability of encapsulated mesenchymal stem cells in bioprinted constructs. Printability tests showed a decrease in strand width with increasing concentrations of Alg-Gel. However due to the increased viscosity associated with the higher Alg-Gel concentrations, the minimum width was found to be 0.32mm before blends became too viscous to print. Similarly, printing accuracy was increased in higher concentrations, exceeding 90% in some blends. Mechanical properties were assessed through uniaxial compression testing and it was found that increasing concentrations of both Alg and Gel resulted in higher compressive modulus. We also deemed 15min crosslinking in calcium chloride to be sufficient. From our data, we propose a blend of 7%Alg-8%Gel that yields high printability, mechanical strength and stiffness, and cell viability. However, we found the compressive behaviour of Alg-Gel to reduce rapidly over time and especially when incubated at 37°C. Here we have reported relevant data on Alg-Gel hydrogels for bioprinting. We tested for biomaterial properties and show that these hydrogels have many desirable characteristics that are highly tunable. Though further work is needed before practical use in vivo can be achieved.
Subject(s)
Biocompatible Materials/chemistry , Bioprinting/methods , Hydrogels/chemistry , Tissue Scaffolds/chemistry , Alginates , Gelatin , Mechanical Phenomena , Tissue Engineering/methods , ViscosityABSTRACT
Hydrogels containing hyaluronic acid (HA) and methylcellulose (MC) have shown promising results for three dimensional (3D) bioprinting applications. However, several parameters influence the applicability bioprinting and there is scarce data in the literature characterising HAMC. We assessed eight concentrations of HAMC for printability, swelling and stability over time, rheological and structural behaviour, and viability of mesenchymal stem cells. We show that HAMC blends behave as viscous solutions at 4°C and have faster gelation times at higher temperatures, typically gelling upon reaching 37°C. We found the storage, loss and compressive moduli to be dependent on HAMC concentration and incubation time at 37°C, and show the compressive modulus to be strain-rate dependent. Swelling and stability was influenced by time, more so than pH environment. We demonstrated that mesenchymal stem cell viability was above 75% in bioprinted structures and cells remain viable for at least one week after 3D bioprinting. The mechanical properties of HAMC are highly tuneable and we show that higher concentrations of HAMC are particularly suited to cell-encapsulated 3D bioprinting applications that require scaffold structure and delivery of cells.
Subject(s)
Biocompatible Materials/chemistry , Bioprinting/methods , Hyaluronic Acid/chemistry , Methylcellulose/chemistry , Tissue Engineering/methods , Tissue Scaffolds/chemistry , Animals , Bioprinting/instrumentation , Buffers , Cell Survival , Compressive Strength , Hydrogels/chemistry , Mesenchymal Stem Cells/cytology , Mesenchymal Stem Cells/metabolism , Microscopy, Phase-Contrast , Rheology , Sheep , Stem Cells/cytology , Stress, Mechanical , TemperatureABSTRACT
The angular resolution of ground-based optical telescopes is limited by the degrading effects of the turbulent atmosphere. In the absence of an atmosphere, the angular resolution of a typical telescope is limited only by diffraction, i.e., the wavelength of interest, λ, divided by the size of its primary mirror's aperture, D. For example, the Hubble Space Telescope (HST), with a 2.4-m primary mirror, has an angular resolution at visible wavelengths of ~0.04 arc seconds. The atmosphere is composed of air at slightly different temperatures, and therefore different indices of refraction, constantly mixing. Light waves are bent as they pass through the inhomogeneous atmosphere. When a telescope on the ground focuses these light waves, instantaneous images appear fragmented, changing as a function of time. As a result, long-exposure images acquired using ground-based telescopes--even telescopes with four times the diameter of HST--appear blurry and have an angular resolution of roughly 0.5 to 1.5 arc seconds at best. Astronomical adaptive-optics systems compensate for the effects of atmospheric turbulence. First, the shape of the incoming non-planar wave is determined using measurements of a nearby bright star by a wavefront sensor. Next, an element in the optical system, such as a deformable mirror, is commanded to correct the shape of the incoming light wave. Additional corrections are made at a rate sufficient to keep up with the dynamically changing atmosphere through which the telescope looks, ultimately producing diffraction-limited images. The fidelity of the wavefront sensor measurement is based upon how well the incoming light is spatially and temporally sampled. Finer sampling requires brighter reference objects. While the brightest stars can serve as reference objects for imaging targets from several to tens of arc seconds away in the best conditions, most interesting astronomical targets do not have sufficiently bright stars nearby. One solution is to focus a high-power laser beam in the direction of the astronomical target to create an artificial reference of known shape, also known as a 'laser guide star'. The Robo-AO laser adaptive optics system, employs a 10-W ultraviolet laser focused at a distance of 10 km to generate a laser guide star. Wavefront sensor measurements of the laser guide star drive the adaptive optics correction resulting in diffraction-limited images that have an angular resolution of ~0.1 arc seconds on a 1.5-m telescope.
Subject(s)
Astronomy/instrumentation , Optics and Photonics/instrumentation , Telescopes , Astronomical Phenomena , Astronomy/methods , Infrared Rays , Lasers , Optics and Photonics/methods , Ultraviolet RaysABSTRACT
Type Ia supernovae have been used empirically as 'standard candles' to demonstrate the acceleration of the expansion of the Universe even though fundamental details, such as the nature of their progenitor systems and how the stars explode, remain a mystery. There is consensus that a white dwarf star explodes after accreting matter in a binary system, but the secondary body could be anything from a main-sequence star to a red giant, or even another white dwarf. This uncertainty stems from the fact that no recent type Ia supernova has been discovered close enough to Earth to detect the stars before explosion. Here we report early observations of supernova SN 2011fe in the galaxy M101 at a distance from Earth of 6.4 megaparsecs. We find that the exploding star was probably a carbon-oxygen white dwarf, and from the lack of an early shock we conclude that the companion was probably a main-sequence star. Early spectroscopy shows high-velocity oxygen that slows rapidly, on a timescale of hours, and extensive mixing of newly synthesized intermediate-mass elements in the outermost layers of the supernova. A companion paper uses pre-explosion images to rule out luminous red giants and most helium stars as companions to the progenitor.
ABSTRACT
Type Ia supernovae are thought to result from a thermonuclear explosion of an accreting white dwarf in a binary system, but little is known of the precise nature of the companion star and the physical properties of the progenitor system. There are two classes of models: double-degenerate (involving two white dwarfs in a close binary system) and single-degenerate models. In the latter, the primary white dwarf accretes material from a secondary companion until conditions are such that carbon ignites, at a mass of 1.38 times the mass of the Sun. The type Ia supernova SN 2011fe was recently detected in a nearby galaxy. Here we report an analysis of archival images of the location of SN 2011fe. The luminosity of the progenitor system (especially the companion star) is 10-100 times fainter than previous limits on other type Ia supernova progenitor systems, allowing us to rule out luminous red giants and almost all helium stars as the mass-donating companion to the exploding white dwarf.
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Anaerobic cultures of Shewanella oneidensis MR-1 reduced toxic Ag(I), forming nanoparticles of elemental Ag(0), as confirmed by X-ray diffraction analyses. The addition of 1 to 50 microM Ag(I) had a limited impact on growth, while 100 microM Ag(I) reduced both the doubling time and cell yields. At this higher Ag(I) concentration transmission electron microscopy showed the accumulation of elemental silver particles within the cell, while at lower concentrations the metal was exclusively reduced and precipitated outside the cell wall. Whole organism metabolite fingerprinting, using the method of Fourier transform infrared spectroscopy analysis of cells grown in a range of silver concentrations, confirmed that there were significant physiological changes at 100 microM silver. Principal component-discriminant function analysis scores and loading plots highlighted changes in certain functional groups, notably, lipids, amides I and II, and nucleic acids, as being discriminatory. Molecular analyses confirmed a dramatic drop in cellular yields of both the phospholipid fatty acids and their precursor molecules at high concentrations of silver, suggesting that the structural integrity of the cellular membrane was compromised at high silver concentrations, which was a result of intracellular accumulation of the toxic metal.
Subject(s)
Metabolism/drug effects , Shewanella/drug effects , Shewanella/metabolism , Silver/toxicity , Amides/metabolism , Cell Wall/ultrastructure , Cytoplasm/ultrastructure , Lipid Metabolism , Metal Nanoparticles/ultrastructure , Microscopy, Electron, Transmission , Nucleic Acids/metabolism , Oxidation-Reduction , Shewanella/growth & development , Shewanella/ultrastructure , Silver/metabolism , Spectroscopy, Fourier Transform InfraredABSTRACT
The metal-reducing bacteria Geobacter sulfurreducens, Shewanella oneidensis and Veillonella atypica, use different mechanisms to transform toxic, bioavailable sodium selenite to less toxic, non-mobile elemental selenium and then to selenide in anaerobic environments, offering the potential for in situ and ex situ bioremediation of contaminated soils, sediments, industrial effluents, and agricultural drainage waters. The products of these reductive transformations depend on both the organism involved and the reduction conditions employed, in terms of electron donor and exogenous extracellular redox mediator. The intermediary phase involves the precipitation of elemental selenium nanospheres and the potential role of proteins in the formation of these structures is discussed. The bionanomineral phases produced during these transformations, including both elemental selenium nanospheres and metal selenide nanoparticles, have catalytic, semiconducting and light-emitting properties, which may have unique applications in the realm of nanophotonics. This research offers the potential to combine remediation of contaminants with the development of environmentally friendly manufacturing pathways for novel bionanominerals.
Subject(s)
Biodegradation, Environmental , Geobacter/metabolism , Shewanella/metabolism , Sodium Selenite/metabolism , Veillonella/metabolism , Geobacter/ultrastructure , Microscopy, Electron, Transmission , X-Ray Absorption SpectroscopyABSTRACT
Geobacter sulfurreducens reduced Ag(I) (as insoluble AgCl or Ag(+) ions), via a mechanism involving c-type cytochromes, precipitating extracellular nanoscale Ag(0). These results extend the range of metals known to be reduced by Geobacter species and offer a method for recovering silver from contaminated water as potentially useful silver nanoparticles.
Subject(s)
Geobacter/metabolism , Metal Nanoparticles , Silver/metabolism , Cytochromes c/metabolism , Oxidation-ReductionABSTRACT
While surface-enhanced Raman scattering (SERS) can increase the Raman cross-section by 4-6 orders of magnitude, for SERS to be effective it is necessary for the analyte to be either chemically bonded or within close proximity to the metal surface used. Therefore most studies investigating the biochemical constituents of microorganisms have introduced an external supply of gold or silver nanoparticles. As a consequence, the study of bacteria by SERS has to date been focused almost exclusively on the extracellular analysis of the Gram-negative outer cell membrane. Bacterial cells typically measure as little as 0.5 by 1 mum, and it is difficult to introduce a nanometer sized colloidal metal particle into this tiny environment. However, dissimilatory metal-reducing bacteria, including Shewanella and Geobacter species, can reduce a wide range of high valence metal ions, often within the cell, and for Ag(I) and Au(III) this can result in the formation of colloidal zero-valent particles. Here we report, for the first time, SERS of the bacterium Geobacter sulfurreducens facilitated by colloidal gold particles precipitated within the cell. In addition, we show SERS from the same organism following reduction of ionic silver, which results in colloidal silver depositions on the cell surface.
Subject(s)
Extracellular Space/metabolism , Geobacter/cytology , Geobacter/metabolism , Intracellular Space/metabolism , Spectrum Analysis, Raman/methods , Cell Membrane/metabolism , Colloids , Cytoplasm/metabolism , Gold/metabolism , Oxidation-Reduction , Silver/metabolism , Surface PropertiesABSTRACT
The ability of metal-reducing bacteria to produce nanoparticles, and their precursors, can be harnessed for the biological manufacture of fluorescent, semiconducting nanomaterials. The anaerobic bacterium Veillonella atypica can reduce selenium oxyanions to form nanospheres of elemental selenium. These selenium nanospheres are then further reduced by the bacterium to form reactive selenide which could be precipitated with a suitable metal cation to produce nanoscale chalcogenide precipitates, such as zinc selenide, with optical and semiconducting properties. The whole cells used hydrogen as the electron donor for selenite reduction and an enhancement of the reduction rate was observed with the addition of a redox mediator (anthraquinone disulfonic acid). A novel synchrotron-based in situ time-resolved x-ray absorption spectroscopy technique was used, in conjunction with ion chromatography and inductively coupled plasma-atomic emission spectroscopy, to study the mechanisms and kinetics of the microbial reduction of selenite to selenide. The products of this biotransformation were also assessed using electron microscopy, energy-dispersive spectroscopy, x-ray diffraction and fluorescence spectroscopy. This process offers the potential to prepare chalcogenide-based nanocrystals, for application in optoelectronic devices and biological labelling, from more environmentally benign precursors than those used in conventional organometallic synthesis.
ABSTRACT
We present a case of brachial artery mycotic aneurysm caused by methicillin-resistant Staphylococcus epidermidis in a patient with infective endocarditis. A 66-year-old woman suffered two transient ischemic attacks over an 8-week period secondary to septic emboli from mitral valve endocarditis. Following valve replacement surgery, the patient was troubled by persisting paresthesia in the right hand. A mycotic aneurysm of the brachial artery was diagnosed, and surgical repair was successfully undertaken. The purpose of this case report is to highlight an unusual causative organism for mycotic aneurysm and to underline the increasing threat of multi-drug-resistant bacteria as a cause of vascular disease.