Advanced breast cancer clinical nursing curriculum: review and recommendations

Purpose. The needs and concerns of patients with advanced breast cancer are changing at every phase of the care intervention. Management and coordination of hospital resources and services are also steadily evolving. The objective of the present expert report is to define a new oncology nursing role specialising in advanced breast cancer, to help guide patients throughout the whole healthcare itinerary. Methods. A group of eight experts in oncology nursing and medical oncology defined the content index of the curriculum document. A systematic review of bibliography was carried out, and the relevant contents were extracted. Based on these contents and the participants’ experience, recommendations were formulated and validated through a Delphi questionnaire and a participative meeting. Results. The advanced breast cancer clinical nurse (ABCCN) should develop a clinical, psychosocial role focused on coordinating patients in the healthcare network. The nurse would be in charge of evaluating and supervising the care administered and the healthcare resources used. The ABCCN should be aware and participate in the protocols and available resources, be able to solve conflicts, deal with burn-out signs and have clinical, coaching and team-working abilities. The proposed curriculum provides a specific process for the care of patients, as well as an implementation process. Conclusions. The ABCCN’s role is crucial to assume the best care and the optimisation of available resources. This review and consensus document provides the required tools for the implementation in hospitals (AU)

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Advanced breast cancer clinical nursing curriculum: review and recommendations.

PURPOSE: The needs and concerns of patients with advanced breast cancer are changing at every phase of the care intervention. Management and coordination of hospital resources and services are also steadily evolving. The objective of the present expert report is to define a new oncology nursing role specialising in advanced breast cancer, to help guide patients throughout the whole healthcare itinerary. METHODS: A group of eight experts in oncology nursing and medical oncology defined the content index of the curriculum document. A systematic review of bibliography was carried out, and the relevant contents were extracted. Based on these contents and the participants' experience, recommendations were formulated and validated through a Delphi questionnaire and a participative meeting. RESULTS: The advanced breast cancer clinical nurse (ABCCN) should develop a clinical, psychosocial role focused on coordinating patients in the healthcare network. The nurse would be in charge of evaluating and supervising the care administered and the healthcare resources used. The ABCCN should be aware and participate in the protocols and available resources, be able to solve conflicts, deal with burn-out signs and have clinical, coaching and team-working abilities. The proposed curriculum provides a specific process for the care of patients, as well as an implementation process. CONCLUSIONS: The ABCCN's role is crucial to assume the best care and the optimisation of available resources. This review and consensus document provides the required tools for the implementation in hospitals.

Principios bioéticos aplicados a la odontología estética / Bioethical principles applied to cosmetic dentistry

El tema objeto de este artículo, fue dirigido a saber orientar la conducta que se debe seguir en la resolución del caso clínico de operatoria, según los principios de la bioética, al momento de ofrecerle las distintas opciones de tratamiento a un paciente. Se presenta un caso específico, el cual fue analizado desde un marco legal y ético, utilizando herramientas de análisis y reflexión, que llevaron a concluir que el bienestar y felicidad del paciente son la prioridad al momento de brindarle la atención que este requiere, y que no deben dejarse de lado sus necesidades y anhelos. Partiendo del establecimiento de un consentimiento informado que plasma de forma escrita el futuro tratamiento y la posterior aceptación por parte de la paciente, se procedió a explicar de qué manera son violados los principios fundamentales de la bioética y como esta situación pudo llegar a afectar de manera negativa la salud física y mental del ser humano o persona que padece la enfermedad

Clinical practice guidelines in cancer in Catalonia: process and methodology

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[Impact of cancer in Catalonia: consequences for priorities in the prevention, diagnosis and treatment of cancer]. / Impacto del cáncer en Cataluña: consecuencias para las prioridades en prevención, diagnóstico y tratamiento.

BACKGROUND: The results of analysis of incidence, survival and mortality should be applied to set the priorities in cancer prevention and screening and improvement of cancer care in Catalonia. POPULATION AND METHODS: A review of the impact of cancer in Catalonia and its foreseeable tendencies, as well as the recent proposals made across Europe regarding cancer prevention and care, was carried out. RESULTS: The main priority in prevention continues to be smoking prevention in all age groups but especially among young women and people with a low socioeconomic position, together with overweight and obesity reduction, dietary improvements, and avoidance of excessive sun exposure. Colorectal cancer screening should cover all people aged 50 to 69 years old. Cancer care should be based on a multidisciplinary approach, with clinical practice guidelines, and should take into account the psychosocial and rehabilitation aspects of care. Areas that deserve greater efforts to improve oncology care are outcomes assessment among hospitals and improvements in coordination among centers and health professionals. CONCLUSIONS: The main priority should be to apply current knowledge to clinical practice, both in diagnosis and in treatment, within a multidisciplinary framework to improve outcomes. Other priorities aimed at reducing the impact of cancer in Catalonia are reducing the prevalence of smoking and obesity and extending the coverage of colorectal cancer screening to the target population.

Impacto del cáncer en Cataluña: consecuencias para las prioridades en prevención, diagnóstico y tratamiento / Impact of cancer in Catalonia: consequences for priorities in the prevention, diagnosis and treatment of cancer

FUNDAMENTO: El análisis de la evolución de la incidencia, la supervivencia y la mortalidad debe aplicarse para establecer las prioridades de prevención del cáncer y mejora de la atención oncológica en Cataluña. POBLACIÓN Y MÉTODO: Se revisa el impacto del cáncer en Cataluña y sus tendencias previsibles y las propuestas recientemente elaboradas en Europa sobre prevención del cáncer y mejora de la atención oncológica. RESULTADOS: La reducción del tabaquismo en todas las edades, pero especialmente en jóvenes, mujeres y personas de bajo nivel socioeconómico, continúa siendo el principal objetivo preventivo, junto con la reducción del sobrepeso y la obesidad, la mejora de la dieta y de la exposición solar excesiva. El cribado de cáncer de colon y recto debe cubrir toda la población catalana de 50-69 años. La atención oncológica debe orientarse más a modelos multidisciplinarios, basados en guías de práctica clínica y que tengan en cuenta los aspectos psicosociales y de rehabilitación. La evaluación sistemática de resultados en los centros hospitalarios y la mejora de la coordinación entre centros y profesionales son las asignaturas pendientes de la atención oncológica, que deben ser utilizadas para mejorar el proceso asistencial. CONCLUSIONES: Aplicar el conocimiento actual a la práctica clínica, tanto en el diagnóstico como en el tratamiento, con una orientación multidisciplinaria debe permitir mejorar los resultados clínicos en nuestro país. Reducir el tabaquismo y la obesidad y extender el cribado del cáncer colorrectal son otras prioridades que repercutirán en el impacto del cáncer en Cataluña

BACKGROUND: The results of analysis of incidence, survival and mortality should be applied to set the priorities in cancer prevention and screeningand improvement of cancer care in Catalonia. POPULATION AND METHODS: A review of the impact of cancer in Catalonia and its foreseeable tendencies, as well as the recent proposals made across Europe regarding cancer prevention and care, was carried out. RESULTS: The main priority in prevention continues to be smoking prevention in all age groups but especially among young women and people with a low socioeconomic position, together with overweight and obesity reduction, dietary improvements, and avoidance of excessive sun exposure. Colorectal cancer screening should cover all people aged 50 to 69 years old. Cancer care should be based on a multidisciplinary approach, with clinical practice guidelines, and should take into account the psychosocial and rehabilitation aspects of care. Areas that deserve greater efforts to improve oncology care are outcomes assessment among hospitals and improvements in coordination among centers and health professionals. CONCLUSIONS: The main priority should be to apply current knowledge to clinical practice, both in diagnosis and in treatment, within a multidisciplinary framework to improve outcomes. Other priorities aimed at reducing the impact of cancer in Catalonia are reducing the prevalence of smoking and obesity and extending the coverage of colorectal cancer screening to the target population

Cigarette smoke condensate inhibits ENaC alpha-subunit expression in lung epithelial cells.

Cigarette smoke has been associated with lung fluid accumulation and increased risk of acute respiratory distress syndrome. It was postulated that ENaC alpha-subunit, which plays a critical role in lung fluid absorption, is affected by cigarette smoke. Cigarette smoke condensate (CSC) was used to treat a human lung epithelial cell line. ENaC alpha-subunit expression was measured using immunoblotting, quantitative PCR and promoter-reporter assays. The current authors found that CSC, without affecting cell survival, suppressed alpha-subunit expression at the transcriptional level in a dose- and time-dependent fashion. This suppression is neither related to nicotine nor due to an increase of hydrogen peroxide levels in CSC-treated cells. CSC also suppressed alpha-subunit core promoter activity. Dexamethasone, which activates the core promoter, was able to attenuate the inhibitory effect of CSC. However, in the presence of CSC, dexamethasone was unable to elicit a full-scale activation of alpha-subunit expression. This inhibition of dexamethasone was partially reversed by withdrawal of CSC. The present results demonstrate that cigarette smoke condensate inhibits ENaC alpha-subunit expression at the transcriptional level through its promoter. This inhibition could be reversed by dexamethasone. The results also suggest that higher doses of dexamethasone may be needed to activate alpha-subunit expression in smokers' lungs compared with nonsmokers' lungs, and that quitting smoking might improve the effectiveness of dexamethasone.

Técnicas de modificación conductual aplicables en la clínica odontológica / Behavior modification techniques applied in the dental clinic

El objetivo de este artículo consistió en dar a conocer las diferentes técnicas de modificación de la conducta para tratar los tipos de problemas de la misma que se pueden presentar en los pacientes durante la atención odontológica. Las técnicas de modificación de conducta son útiles para crear conductas nuevas que nunca se habían observado en el repertorio conductual del paciente, mantener o incrementar conductos deseables y reducir conductas que entorpezcan el desempeño en la clínica odontológica

Motivación, expectativas y metas implicadas en el desempeño estudiantil en la clínica odontológica

El objetivo de este artículo consistió en que el estudiante se desenvuelva como cogestor de su aprendizaje, estimularse para formar parte del proceso educativo motivándose hacia el logro y conduciéndose hacia alcanzar sus expectativas y subsecuentemente sus metas durante su desempeño clínico odontológico que lo ayudarán a ir en búsqueda de la excelencia, capaz de asumir su desempeño clínico, perseverar en él, desarrollarlo y resolver cualquier contratiempo que se le presente en el proceso.

The objective of this article consisted of that the student develops like manager of his learning, stimulating itself to comprise of the educative process being motivated themselves towards the profit and conducting themselves towards subsequently reaching its expectations and its goals during its dentistry clinical performance that will help it to go in search of the excellence, able to assume their clinical performance, to persist in him, to develop it and to solve any misfortune that appears to him in the process.

Sentimientos negativos implicados en el desempeño estudiantil en la clínica odontológica / Negative feelings involved in student performance in dental clinics

El objetivo de este artículo consistió en que el estudiante reconociera y aprendiera a manejar sus sentimientos con la ayuda mínima y eventual de las demás personas. Llegará a conocer profunda y significativamente los sentimientos involucrados durante la realización de procedimientos clínicos que lo ayudarán a descubrir sus recursos para establecer relaciones interpersonales importantes y para lograr una independencia e interdependencia efectiva. Se plantearon sistemas de apoyo para los estudiantes de odontología, ofreciéndose recomendaciones que pudieran ser llevadas a cabo para incrementar la productividad en la sala clínica

Conductas deseables para el desempeño en la clínica / Desirable behaviors for the performance in the dental clinic

En este trabajo se plantearon las conductas que se consideran como deseables para un buen desempeño en la clínica odontológica, como son preservar o evitar la postergación, organización del tiempo y planificación de actividades, proactividad, seguridad, positividad y cooperación, asertividad, consultar, permitir un margen de error, proponer soluciones y no problemas, evitar el estrés, compresión, interdependencia y desarrollar valores con el objeto de que el estudiante mejore su desempeño en las actividades clínico odontológicas

Differential expression of menin in sporadic pituitary adenomas.

Pituitary adenomas represent one of the key features of multiple endocrine neoplasia type 1. The gene involved in this syndrome (MEN1) is a putative tumor suppressor, that codes for a 610-amino acid nuclear protein termed 'menin'. Analyses of sporadic pituitary adenomas have so far failed to reveal MEN1 mutations or defects in MEN1 transcription in these tumors. In the present study we detected menin protein expression in a panel of normal and tumoral pituitary tissues, using a monoclonal antibody against the carboxy-terminus of menin. In the normal human pituitary gland, strong nuclear staining for menin was detectable in the majority of the endocrine cells of the anterior lobe, without a clear association with a particular hormone-producing type. In sporadic pituitary adenomas, menin expression was variable, with a high percentage of cases demonstrating a significant decrease in menin immunoreactivity when compared with the normal pituitary. Interestingly, metastatic tissues derived from one pituitary carcinoma had no detectable menin levels. Altogether, our data provide the first information regarding the status of menin expression in human normal and neoplastic pituitary as determined by immunohistochemistry (IHC).

Translocation t(4; 6)(q21; q27) in a case of primary thrombocythaemia in transformation.

We report a case of primary thrombocythaemia showing a translocation t(4; 6)(q21; q27) five years after diagnosis. The patient had been treated with hydroxyurea. The clinical picture at the time was consistent with transformation. Karyotypic abnormalities are rare in this disease and are reviewed.

Expression and functional properties of proteins encoded in the x-II ORF of HTLV-I.

With the aim of identifying viral proteins that contribute to the distinctive properties of HTLV-I biology and pathogenicity, several laboratories have investigated the coding potential of the X region of the genome, which includes five partially overlapping open reading frames (ORFs). We and others have shown that, in addition to the essential regulatory proteins Rex and Tax, a number of accessory proteins encoded in the X region can be produced by alternative splicing and multicistronic translation. One X region ORF, termed X-II, produces two protein isoforms named Tof/p30II and p13II, which are expressed from a doubly- and singly-spliced mRNA, respectively. Initial functional analyses demonstrated that Tof/p30II is a nucleolar/nuclear protein that possesses a region capable of binding to RNA, and p13II is a mitochondrial protein that alters the morphology and function of this organelle. Together with data from other laboratories demonstrating the production of antibodies and CTL against x-II ORF products in HTLV-I infected subjects and the requirement of this ORF for efficient viral replication in vivo, these findings suggest that further characterization of Tof/p30II and p13II will yield insight into remaining undefined aspects of HTLV-I pathogenicity and replication.

Identification of a domain in human immunodeficiency virus type 1 rev that is required for functional activity and modulates association with subnuclear compartments containing splicing factor SC35.

The activity of human immunodeficiency virus Rev as a regulator of viral mRNA expression is tightly linked to its ability to shuttle between the nucleus and cytoplasm; these properties are conferred by a leucine-rich nuclear export signal (NES) and by an arginine-rich nuclear localization signal/RNA binding domain (NLS/RBD) required for binding to the Rev-responsive element (RRE) located on viral unspliced and singly spliced mRNAs. Structure predictions and biophysical measurements indicate that Rev consists of an unstructured region followed by a helix-loop-helix motif containing the NLS/RBD and sequences directing multimerization and by a carboxy-terminal tail containing the NES. We present evidence that the loop portion of the helix-loop-helix region is an essential functional determinant that is required for binding to the RRE and for correct intracellular routing. Data obtained using a protein kinase CK2 phosphorylation assay indicated that the loop region is essential for juxtaposition of helices 1 and 2 and phosphorylation by protein kinase CK2. Deletion of the loop resulted in partial accumulation of Rev in SC35-positive nuclear bodies that resembled nuclear bodies that form in response to inhibition of transcription. Accumulation of the DeltaLoop mutant in nuclear bodies depended on the presence of an intact NES, suggesting that both the loop and the NES play a role in controlling intranuclear compartmentalization of Rev and its association with splicing factors.

The p13II protein of HTLV type 1: comparison with mitochondrial proteins coded by other human viruses.

In addition to the essential regulatory proteins Rex and Tax, the HTLV-1 genome encodes several accessory proteins of yet undefined function. One of these "orphan" proteins, named p13(II), was recently shown to be selectively targeted to mitochondria and to induce specific changes in mitochondrial morphology suggestive of altered inner membrane permeability and swelling. This represented the first report of a retroviral gene product targeted to mitochondria, and suggested that p13(II)-induced alterations in the function of this organelle may play a role in HTLV-1 replication and/or pathogenesis. The more recent findings that both Vpr and Tat of HIV-1 are targeted to mitochondria reinforces the proposed relevance of mitochondrial metabolism to the life cycle of retroviruses. Thus, p13(II), Vpr, and Tat can be added to the growing list of mitochondrial proteins produced by clinically important human viruses, including Epstein-Barr virus, human cytomegalovirus, and hepatitis B virus. Mitochondria are known to play a critical role by providing an amplification loop required for the execution of signaling pathways leading to programmed cell death. The functional consequences of the interactions between viral proteins and mitochondria described so far have been attributed to either the positive or negative control of apoptotic responses mediated by this organelle. Further analysis of the effects of p13(II) on mitochondrial function is likely to add to our understanding of the mechanisms underlying the development of HTLV-1-associated diseases.

Protein kinase C-alpha mediates endothelial barrier dysfunction induced by TNF-alpha.

We tested the hypothesis that protein kinase C-alpha (PKC-alpha) mediates tumor necrosis factor-alpha (TNF-alpha)-induced alterations in permeability of pulmonary microvessel endothelial monolayers (PEM). The permeability of PEM was assessed by the clearance rate of Evans blue-labeled albumin. PEM lysates were analyzed for PKC-alpha mRNA (Northern cDNA blot), protein (Western immunoblot), and activity (translocation and phosphorylation of myristoylated arginine-rich C kinase substrate). Incubation of PEM with TNF-alpha (1,000 U/ml) for 4 h resulted in increases in 1) PKC-alpha protein, 2) cytoskeletal-associated PKC-alpha, 3) PKC-alpha activity, and 4) permeability to albumin. The TNF-alpha-induced increase in PKC-alpha protein, PKC-alpha activity, and permeability was prevented by a 4-h pretreatment with PKC-alpha antisense oligonucleotide but not by the scrambled nonsense oligonucleotide. The TNF-alpha-induced increase in permeability to albumin was prevented by myristoylated protein kinase C inhibitor (an inhibitor of PKC-alpha/beta, 100 microM) and calphostin (an inhibitor of the classic and novel PKC isotypes, 200 nM). The treatment with calphostin from 0.5 to 3.0 h after TNF-alpha still prevented barrier dysfunction induced by 4 h of TNF-alpha treatment. The data indicate that prolonged activation of PKC-alpha, maintained by a translation-dependent pool of PKC-alpha protein, mediates TNF-alpha-induced increases in endothelial permeability in PEM.

Screening for depression in mothers bringing their offspring for evaluation or treatment of depression.

OBJECTIVE: Numerous studies have shown that the highest risk for first onset of depression occurs in women of childbearing years and that there is a strong association between lifetime rates of depressive disorders in mothers and their offspring. This association is found regardless of whether the mother or child is the targeted patient. However, little is known about rates of current depression in mothers who bring their offspring to outpatient clinics for evaluation and/or treatment of depression. This information might be useful in developing intervention strategies. METHOD: One hundred seventeen mothers bringing their offspring for evaluation or treatment for depression were screened with the Patient Problem Questionnaire to determine current symptoms of depression, anxiety disorders, and substance abuse as well as current psychiatric treatment. RESULTS: Thirty-six (31%) of the mothers screened positive on the Patient Problem Questionnaire for a current psychiatric disorder. Sixteen (14%) screened positive for current major depression, 20 (17%) for panic disorder, 20 (17%) for generalized anxiety disorder, two (2%) for alcohol abuse, and one (1%) for drug abuse. In addition, 50 (43%) of the mothers had psychiatric symptoms that did not meet the diagnostic threshold for any of the above disorders. Twenty-six (22%) of mothers expressed suicidal ideation or intent. Only five (31%) of the 16 mothers diagnosed with major depression were currently receiving any psychiatric treatment. CONCLUSIONS: A substantial number of mothers bringing their offspring for evaluation or treatment of depression were themselves currently depressed and untreated. The treatment of depressed mothers may help both the mothers and their depressed offspring.

Tumor necrosis factor-alpha-induced activating protein-1 activity is modulated by nitric oxide-mediated protein kinase G activation.

We tested the hypothesis that protein kinase (PK)G activation in response to nitric oxide ((*)NO) mediates tumor necrosis factor (TNF)-alpha-induced activation of the transcription factor activating protein-1 (AP-1) in pulmonary microvessel endothelial monolayers (PEM). The DNA-binding activity of AP-1 was assessed using the electrophoretic mobility shift assay. TNF treatment (1,000 U/ml) for 4 h induced a significant increase in DNA binding of AP-1. The effects of TNF were prevented by the superoxide radical scavenger superoxide dismutase (SOD) (100 U/ml), the (*)NO synthase inhibitor aminoguanidine (100 microM), the guanylate cyclase inhibitor ODQ (100 microM), and the PKG inhibitors KT5823 (1 microM) and 8-bromo-cyclic guanosine monophosphate (cGMP)-thioate (100 microM). Spermine-NO (1 microM) and L-arginine (400 microM) prevented the aminoguanidine-induced ablation of AP-1 activation in response to TNF. Phosphorylation of H-Arg-Lys-Ile-Ser-Ala-Ser-Glu-Phe-Asp-Arg-Pro-Leu-Arg-OH (BPDEtide), a specific substrate for PKG, measured the activity of cGMP-dependent protein kinase (PKG). TNF for 0.5 h induced an increase in PKG activity that was prevented by aminoguanidine, ODQ, KT5823, and 8-bromo-cGMP-thioate; however, SOD had no effect. The PKG agonist 8-bromo-cGMP (100 microM), when given alone, increased PKG activity but induced significant DNA-binding activity of AP-1 only when given in the ODQ + TNF Group. SIN-1 (1 mM, a peroxynitrite agonist) increased DNA-binding activity of AP-1. SOD prevented SIN-1-induced AP-1 activation, a response similar to that of the SOD + TNF Group. PEM were transfected with the chloramphenicol acetyltransferase (CAT) reporter plasmid pBLCAT2, which contains a regulation sequence responsive to AP-1. The pharmacologic profile of TNF-induced CAT activity was identical to TNF-induced DNA binding by AP-1. Thus, TNF-induced AP-1-dependent gene transcription is modulated by (*)NO-dependent mediated activation of PKG.