Co-creation of self-management support during inpatient stroke rehabilitation.

Objective: This study aimed to identify priority self-management skills and behaviours in partnership with stroke survivors, and to co-create approaches to support self-management during inpatient stroke rehabilitation. Methods: Three stroke survivors and two communication partners participated in the three-stage Participatory Action Research project with embedded co-design processes after undertaking inpatient rehabilitation at a metropolitan tertiary hospital. Results: Participants identified key factors influencing self-management during inpatient rehabilitation including motivation, emotional well-being, and fatigue. Three approaches to support people to self-manage post-stroke were co-created. (1) A health professional concierge and early family meeting. (2) A peer support person. (3) Adapting the hospital environment. Conclusion: Findings suggest post-stroke self-management support should commence during inpatient rehabilitation to optimise its research-informed benefits. This support should focus on empowering stroke survivors and their key support people through active involvement in decision-making, and provision of multi-modal individualised education. The impact of hospital environments on emotional-wellbeing and self-management post-stroke also requires further investigation. Innovation: The identification of a health professional concierge as a co-designed solution to the current challenges with self-management support is an innovative recommendation for practice. The findings support changes to the traditional processes of rehabilitation towards a consumer and family-led practices.

Exploring self-management within hospital-based stroke care: current and future opportunities.

PURPOSE: This study explored stroke self-management within a tertiary hospital setting from the perspectives of health professionals working across the continuum of stroke care. MATERIALS AND METHODS: A qualitative descriptive design guided five focus groups in the acute stroke service (n = 2), inpatient rehabilitation (n = 2), and outpatient day hospital service (n = 1). Focus groups were transcribed verbatim and analysed using thematic analysis. RESULTS: Twenty-eight health professionals participated representing medical, nursing, and allied health services. Two themes emerged from the data: Pieces of the puzzle illustrates the inconsistent understanding about self-management with elements of the puzzle described but rarely within the full concept of self-management; Readiness for self-management highlighted that although self-management should commence in the acute setting, there were many factors influencing why this was not always happening. CONCLUSIONS: A consistent conceptualisation and approach to stroke self-management in the hospital setting is required. Interprofessional education and shared intentional language can enhance understanding and practice.IMPLICATIONS FOR REHABILITATIONUnderstanding and application of stroke self-management varies among members of hospital-based stroke teams.Health professionals working in hospital-based stroke care should use the term self-management with their patients.Education of healthcare teams is necessary to develop knowledge about self-management and develop consistent practices across the continuum of care.

Single-Case-Design Study of Finger-to-Axilla Compression Bandaging for Edema of the Hemiplegic Upper Limb.

OBJECTIVE: This single-case study investigated the effectiveness of compression bandaging from the finger to the axilla in reducing poststroke edema in the upper limb. METHOD: Repeated circumferential measurements were recorded at five points along the participants' hand and forearm. Analysis of the data included the generation of graphs, celeration lines, and visual analysis. RESULTS: Five participants with edema (mean 38 days poststroke) were recruited to the study. Fluctuations in edema were observed in all three study phases, with an increasing to decreasing trend in edema between the baseline and intervention phases. There was no clear trend from the intervention to second baseline phase. CONCLUSION: Bandaging from the fingers to the axilla appears to be effective in reducing edema in the hand and forearm. However, return of edema after removal of the bandaging suggest that a greater understanding of underlying mechanisms and the appropriate intervention protocols is warranted.

Efficacy of Compression Gloves in Maintaining Edema Reductions After Application of Compression Bandaging to the Stroke-Affected Upper Limb.

OBJECTIVE: We explored the efficacy of compression gloves in maintaining the benefits gained from compression bandaging of the stroke-affected upper limb. METHOD: Four participants completed a single-case (ABC) design study consisting of a baseline period (Phase A) and compression bandaging of the hand and upper limb (Phase B), followed by the application of a compression glove (Phase C). Edema was measured with circumferential tape at five specified points from the phalanx to the midforearm. All measurements were represented graphically for visual analysis, and celeration lines were calculated to indicate the degree of slope within each phase. RESULTS: Visual analysis indicated fluctuating edema volume during Phase A, decreasing edema volume during Phase B, and a mixed trend during Phase C. CONCLUSION: Compression gloves had mixed benefits in managing reductions in edema volume poststroke. Further research may consider the material, sizing, and style of glove in the development of a maintenance strategy.

ATRX represses alternative lengthening of telomeres.

The unlimited proliferation of cancer cells requires a mechanism to prevent telomere shortening. Alternative Lengthening of Telomeres (ALT) is an homologous recombination-mediated mechanism of telomere elongation used in tumors, including osteosarcomas, soft tissue sarcoma subtypes, and glial brain tumors. Mutations in the ATRX/DAXX chromatin remodeling complex have been reported in tumors and cell lines that use the ALT mechanism, suggesting that ATRX may be an ALT repressor. We show here that knockout or knockdown of ATRX in mortal cells or immortal telomerase-positive cells is insufficient to activate ALT. Notably, however, in SV40-transformed mortal fibroblasts ATRX loss results in either a significant increase in the proportion of cell lines activating ALT (instead of telomerase) or in a significant decrease in the time prior to ALT activation. These data indicate that loss of ATRX function cooperates with one or more as-yet unidentified genetic or epigenetic alterations to activate ALT. Moreover, transient ATRX expression in ALT-positive/ATRX-negative cells represses ALT activity. These data provide the first direct, functional evidence that ATRX represses ALT.

Single-case design evaluation of compression therapy for edema of the stroke-affected hand.

OBJECTIVE. To explore the efficacy of low- and high-stretch compression bandaging for edema management in the stroke-affected upper limb. METHOD. A single-case, ABA-design study was conducted with 8 participants alternately allocated to receive low- or high-stretch bandaging. Edema was measured with circumferential tape at four specified points from the hand to the mid-forearm. All measurements were represented graphically for visual analysis, and celeration lines were calculated to indicate the degree of slope in each phase. RESULTS. Visual analysis indicated fluctuating edema volume in the first baseline phase, decreasing edema volume in the intervention phase, and increasing edema volume in the second baseline phase. The results did not clearly distinguish between the two bandaging groups. CONCLUSION. Compression bandaging may have benefits in the management of edema after stroke. Further research is required to identify factors contributing to the long-term maintenance of reductions gained after compression bandaging.

Loss of wild-type ATRX expression in somatic cell hybrids segregates with activation of Alternative Lengthening of Telomeres.

Alternative Lengthening of Telomeres (ALT) is a non-telomerase mechanism of telomere lengthening that occurs in about 10% of cancers overall and is particularly common in astrocytic brain tumors and specific types of sarcomas. Somatic cell hybridization analyses have previously shown that normal telomerase-negative fibroblasts and telomerase-positive immortalized cell lines contain repressors of ALT activity, indicating that activation of ALT results from loss of one or more unidentified repressors. More recently, ATRX or DAXX was shown to be mutated both in tumors with telomere lengths suggestive of ALT activity and in ALT cell lines. Here, an ALT cell line was separately fused to each of four telomerase-positive cell lines, and four or five independent hybrid lines from each fusion were examined for expression of ATRX and DAXX and for telomere lengthening mechanism. The hybrid lines expressed either telomerase or ALT, with the other mechanism being repressed. DAXX was expressed normally in all parental cell lines and in all of the hybrids. ATRX was expressed normally in each of the four telomerase-positive parental cell lines and in every telomerase-positive hybrid line, and was abnormal in the ALT parental cells and in all but one of the ALT hybrids. This correlation between ALT activity and loss of ATRX expression is consistent with ATRX being a repressor of ALT.

Enhanced isolation of fibroblasts from human skin explants.

Here we describe a method for growing fibroblasts from human skin explants that increases the number of cells obtained by up to two orders of magnitude, thus increasing the amount of material available for research and diagnostic purposes and potentially for cell-based therapies. Explants can be transferred sequentially up to 80 times, if required, at which point the explants appear to be completely depleted of fibroblasts. Utilizing skin samples obtained from 16 donors, aged 18-66 years old, the first 20 transfers produced cultures with lifespan and growth characteristics that were all very similar to each other, but the cultures derived from later transfers had a decreasing replicative capacity. Final cumulative population doublings did not correlate with donor age, but correlated positively with the telomere length at early passage. We also demonstrated that explants can be transduced directly by lentiviral infection, and that cryopreserved tissue can be explanted successfully using this procedure.

Information provision to clients with stroke and their carers: self-reported practices of occupational therapists.

BACKGROUND: The literature promotes the use of a wide range of educational materials for teaching and training clients with chronic conditions such as stroke. Client education is a valuable tool used by occupational therapists to facilitate client and carer ability to manage the stroke-affected upper limb. The aim of this study was to identify what information was provided to clients and carers, how this information was delivered, when the information was delivered and the client factors that influenced the method of information provision. METHODS: Convenience and snowball sampling was used to recruit occupational therapists working in stroke. Twenty-eight participants completed the study questionnaire anonymously and their responses were summarised descriptively. RESULTS: There was a clinically important trend for carers to receive less information than clients. Written and/or verbal information was the favoured method for delivering information related to handling (57%), soft-tissue injury minimisation (46.4%) and oedema management (50%). Information was delivered with decreasing frequency from admission (86%) to discharge (64%). More than 90% of participants indicated that the client's cognitive ability, visual ability, level of communication, primary language and perceptual ability were considered prior to the delivery of information. DISCUSSION: Participants regularly conveyed information to clients and carers with respect to management of the stroke-affected upper limb. However, an increased emphasis on the development of practical self-management skills, awareness of the impact of personal factors and a timeline for information provision may prove useful.

Telomerase-independent telomere length maintenance in the absence of alternative lengthening of telomeres-associated promyelocytic leukemia bodies.

Immortal tumor cells and cell lines employ a telomere maintenance mechanism that allows them to escape the normal limits on proliferative potential. In the absence of telomerase, telomere length may be maintained by an alternative lengthening of telomeres (ALT) mechanism. All human ALT cell lines described thus far have nuclear domains of unknown function, termed ALT-associated promyelocytic leukemia bodies (APB), containing promyelocytic leukemia protein, telomeric DNA and telomere binding proteins. Here we describe telomerase-negative human cells with telomeres that contain a substantial proportion of nontelomeric DNA sequences (like telomerase-null Saccharomyces cerevisiae survivor type I cells) and that are maintained in the absence of APBs. In other respects, they resemble typical ALT cell lines: the telomeres are highly heterogeneous in length (ranging from very short to very long) and undergo rapid changes in length. In addition, these cells are capable of copying a targeted DNA tag from one telomere into other telomeres. These data show that APBs are not always essential for ALT-mediated telomere maintenance.

Cell surface antigens of Mycoplasma species bovine group 7 bind to and activate plasminogen.

Mycoplasma species bovine group 7 bound plasminogen at the cell surface in a lysine-dependent manner. Cell-bound plasminogen was rapidly activated to plasmin by exogenous urokinase, and this activity was associated with plasminogen binding capacity. Binding assays using plasminogen modified with a trifunctional cross-linking agent revealed several binding proteins.