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Nature Reviews. Cancer Mar 2020The tumour microenvironment plays a critical role in determining tumour fate. Within that environment, and indeed throughout epithelial tissues, cells experience... (Review)
Review
The tumour microenvironment plays a critical role in determining tumour fate. Within that environment, and indeed throughout epithelial tissues, cells experience competition with their neighbours, with those less fit being eliminated by fitter adjacent cells. Herein we discuss evidence suggesting that mutations in cancer cells may be selected for their ability to exploit cell competition to kill neighbouring host cells, thereby facilitating tumour expansion. In some instances, cell competition may help host tissues to defend against cancer, by removing neoplastic and aneuploid cells. Cancer risk factors, such as high-sugar or high-fat diet and inflammation, impact cell competition-based host defences, suggesting that their effect on tumour risk may in part be accounted for by their influence on cell competition. We propose that interventions aimed at modifying the strength and direction of cell competition could induce cancer cell killing and form the basis for novel anticancer therapies.
Topics: Animals; Biomarkers, Tumor; Cell Transformation, Neoplastic; Disease Management; Disease Susceptibility; Epithelial-Mesenchymal Transition; Gene Expression Regulation, Neoplastic; Humans; Neoplasms; Signal Transduction; Stress, Physiological; Tumor Microenvironment
PubMed: 31932757
DOI: 10.1038/s41568-019-0231-8 -
Anales de Pediatria Aug 2021Pain recognition and management continues to be a challenge for health professionals in Neonatal Intensive Care Units. Many of the patients are routinely exposed to... (Review)
Review
Pain recognition and management continues to be a challenge for health professionals in Neonatal Intensive Care Units. Many of the patients are routinely exposed to repeated painful experiences with demonstrated short- and long-term consequences. Preterm babies are a vulnerable high-risk population. Despite international recommendations, pain remains poorly assessed and managed in many Neonatal Intensive Care Units. Due to there being no general protocol, there is significant variability as regards the guidelines for the approach and treatment of pain between the different Neonatal Intensive Care Units. The objective of this article is to review and assess the general principles of pain in the initial stages of development, its recognition through the use of standardised scales. It also includes its prevention and management with the combination of pharmacological and non-pharmacological measures, as well as to establish recommendations that help alleviate pain in daily clinical practice by optimising pain and stress control in the Neonatal Intensive Care Units.
Topics: Humans; Infant, Newborn; Intensive Care Units, Neonatal; Pain; Pain Management
PubMed: 34332948
DOI: 10.1016/j.anpede.2020.10.006 -
Journal of Advanced Nursing Dec 2018The aim of this study was to analyse the relationships among structural empowerment, the leadership style of managers, and the engagement of nurses in a health...
AIM
The aim of this study was to analyse the relationships among structural empowerment, the leadership style of managers, and the engagement of nurses in a health organization of Spain.
BACKGROUND
Transformational leadership has an impact on patient security and satisfaction as well as the well-being and engagement of healthcare workers. Empowerment is a management practice that is fundamental for professional growth and positively affects the quality of patient care.
DESIGN
A cross-sectional study.
METHODS
Randomized sample of 131 nurses recruited from 11 health centres with different levels of care was surveyed to assess managers' leadership style, nurse empowerment, and work engagement. The data were analysed by descriptive and correlational statistics and hierarchical mediated regression.
RESULTS
The transformational leadership of the nurse manager directly and positively influences the structural empowerment of nurses. The structural empowerment of nurses directly and positively influences engagement. The transformational leadership of managers positively influences nurse engagement through the mediating effect of structural empowerment.
CONCLUSION
The structural empowerment of nurses acts as a mediator between the transformational leadership of nurse managers and nurse engagement.
PRACTICAL IMPLICATION
The transformational leadership of nurse managers at the unit level has a double impact on staff nurses: first, increasing empowerment and second, increasing the engagement of the nurse staff.
Topics: Adult; Attitude of Health Personnel; Cross-Sectional Studies; Female; Humans; Interprofessional Relations; Leadership; Male; Nurse Administrators; Nurse's Role; Nurses; Nursing Staff, Hospital; Power, Psychological; Spain
PubMed: 30019477
DOI: 10.1111/jan.13805 -
Journal of Thrombosis and Thrombolysis Jan 2019Stress-induced cardiomyopathy (SCM), is a reversible cardiomyopathy characterized by transient systolic dysfunction following an acute physiologic stress.... (Review)
Review
Stress-induced cardiomyopathy (SCM), is a reversible cardiomyopathy characterized by transient systolic dysfunction following an acute physiologic stress. Thromboembolism occurs at a high frequency in patients with intracardiac thrombus secondary to SCM, with one systematic review reporting a rate of 33.3%. The risk of thrombus formation following SCM has been associated with left-ventricular (LV) contraction abnormalities, catecholaminergic surge, and other associated comorbidities. However, established guidelines for screening and management of intracardiac thrombus in the setting of SCM do not exist at present due to a lack of sufficient clinical trial data. The purpose of this article is to discuss the pathophysiological theory and previously documented evidence from cases of LV thrombus secondary to SCM, and to present our recommendations for management of intracardiac thrombus secondary to SCM.
Topics: Anticoagulants; Cardiomyopathies; Disease Management; Humans; Stress, Physiological; Thromboembolism; Thrombosis
PubMed: 30328054
DOI: 10.1007/s11239-018-1729-8 -
Internal Medicine Journal Dec 2021Fibromyalgia presents with symptoms of widespread pain, fatigue, sleeping and cognitive disturbances as well as other somatic symptoms. It often overlaps with other... (Review)
Review
Fibromyalgia presents with symptoms of widespread pain, fatigue, sleeping and cognitive disturbances as well as other somatic symptoms. It often overlaps with other conditions termed 'central sensitivity syndromes', such as irritable bowel syndrome, chronic fatigue syndrome and temporomandibular disorder. Central sensitisation, mediated by amplified processing in the central nervous system, has been identified as the key pathogenic mechanism in these disorders. The term 'central sensitivity' can be used to describe collectively the clinical presentation of these disorders. Fibromyalgia is highly prevalent in most rheumatic diseases as well as non-rheumatic chronic diseases and if unrecognised results in high morbidity. It is diagnosed clinically after excluding important differential diagnoses. Diagnostic criteria have been developed as tools to help identify and diagnose fibromyalgia. Such tools can fulfil an important need when managing patients with rheumatic disease and other chronic diseases as a way to identify fibromyalgia and improve patient outcomes. Treatment involves an integrated approach including education, exercise, stress reduction and pharmacological therapies targeting the central nervous system. This approach is suitable for all presentations of central sensitivity and some central sensitivity syndromes have additional treatment options specific to the clinical presentation.
Topics: Chronic Disease; Fatigue Syndrome, Chronic; Fibromyalgia; Humans; Pain; Pain Management
PubMed: 34139045
DOI: 10.1111/imj.15430 -
Acta Medica Croatica : Casopis... 2016Psychodermatologic disorders are conditions involving an interaction between the mind and the skin. Correlation between psychiatric and dermatological disorders is a... (Review)
Review
Psychodermatologic disorders are conditions involving an interaction between the mind and the skin. Correlation between psychiatric and dermatological disorders is a highly complex relation considering etiology, diagnostic procedures and treatment. There are three major groups of psychodermatological disorders: psychosomatic (psychophysiologic) disorders, primary psychiatric disorders and secondary psychiatric disorders. Psychosomatic disorders are dermatological diseases which can be exacerbated or worsened by emotional stress, but are not caused directly by stress. Emotional stress can exacerbate many chronic dermatoses like urticaria, eczema, psoriasis, acne, seborrheic dermatitis, atopic dermatitis, alopecia areata, psychogenic purpura, rosacea, atypical pain syndromes and hyperhidrosis. The treatment of patients with the resistant chronic dermatosis can be difficult when stress is not recognized as a provoking factor. Primary psychiatric disorders are psychiatric conditions which induce development of various skin changes, e.g trichotillomania, factitial dermatitis, neurotic excoriations, delusions of parasitosis and dysmorphophobia. They include psychiatric disorders with anxiety, compulsive- opsessive and depressive symptoms and pathologic delusional ideas or hallucinations regarding the skin. Secondary psychiatric disorders appear as a result of a certain disfiguring skin disease that induces psychologic suffering such as loss of self-confidence, anxiety and social phobia. This category includes diseases like psoriasis, chronic eczema, various ichthyosiform syndromes, rhinophyma, multiple neurofibromas, severe acne, and other cosmetically disfiguring cutaneous lesions. The therapeutic approach of psychodermatological disorders should be multidisciplinary including primary care physicians, dermatologist, psychiatrist and psychologist. It is very important to educate dermatologists in the diagnostic procedures and therapy of psychiatric disorders which sometimes coexist with the skin disease. Majority of psychodermatological disorders can be treated with cognitive-bihevioral psychotherapy, psychotherapeutic stress-and-anxiety-management techniques and psychotropic drugs. Psychopharmacologic treatment includes anxiolytics, antidepressants, antipsychotics and mood stabilizer.
Topics: Disease Management; Humans; Mental Disorders; Mind-Body Therapies; Psychophysiologic Disorders; Psychotropic Drugs; Skin Diseases
PubMed: 29087669
DOI: No ID Found -
Care Management Journals : Journal of... Dec 2016Illness is a combination of pathophysiology and associated thoughts, emotions, and behaviors. Given the large number of treatments that are discretionary and preference...
Illness is a combination of pathophysiology and associated thoughts, emotions, and behaviors. Given the large number of treatments that are discretionary and preference sensitive, one goal is accurate diagnosis of patient preferences. Reliance on biomedical treatments (e.g., medication and procedures) may overlook important opportunities for improved health such as amelioration of stress and distress and training in more effective coping strategies.
Topics: Disease Management; Humans; Patient Preference; Resilience, Psychological
PubMed: 28914226
DOI: 10.1891/1521-0987.17.4.155 -
Infection Dec 2018Due to the increase of severely immunocompromised patients, of invasive procedures including central intravascular catheters, and of the use of broad-spectrum... (Review)
Review
AIMS
Due to the increase of severely immunocompromised patients, of invasive procedures including central intravascular catheters, and of the use of broad-spectrum antibiotics, the incidence of Candida bloodstream infections has risen intensely in the last decades. Candida bloodstream infection is a serious disease with high mortality. Optimized diagnostic and therapeutic management can improve outcome. Thus, the aim of our mini-review is to highlight important and often missed opportunities in the management of Candida bloodstream infection.
METHODS
We searched the published literature and describe the essentials in the management of Candida bloodstream infection.
RESULTS
Four essentials were identified: (1) isolation of Candida spp. from a blood culture should always be considered relevant and requires treatment. Daily blood cultures should be drawn to determine cessation of candidemia. (2) Central venous catheter (CVC) and/or other indwelling devices should be removed. (3) Echinocandins are the first choice. Antifungal treatment should be continued for at least 14 days after cessation of fungemia. Susceptibility testing should be performed to identify resistance and to facilitate transition to oral treatment. (4) In persistent candidemia, echocardiography is an important investigation; ophthalmoscopy should be considered.
CONCLUSION
Further efforts should be undertaken to increase the adherence to the essentials in the management of Candia bloodstream infection.
Topics: Antifungal Agents; Candidiasis; Central Venous Catheters; Disease Management; Echinocandins; Fungemia; Humans
PubMed: 30218311
DOI: 10.1007/s15010-018-1218-1 -
Circulation Jun 2024The "2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy" provides recommendations to guide clinicians in the management of...
2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines.
AIM
The "2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy" provides recommendations to guide clinicians in the management of patients with hypertrophic cardiomyopathy.
METHODS
A comprehensive literature search was conducted from September 14, 2022, to November 22, 2022, encompassing studies, reviews, and other evidence on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through May 23, 2023, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate.
STRUCTURE
Hypertrophic cardiomyopathy remains a common genetic heart disease reported in populations globally. Recommendations from the "2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy" have been updated with new evidence to guide clinicians.
Topics: Humans; American Heart Association; Cardiology; Cardiomyopathy, Hypertrophic; Disease Management; United States
PubMed: 38718139
DOI: 10.1161/CIR.0000000000001250 -
The American Journal of Clinical... Jul 2017Cancer affects a growing proportion of the population as survival improves. The illness and its treatment brings a substantial burden of symptoms, including pain,... (Review)
Review
Cancer affects a growing proportion of the population as survival improves. The illness and its treatment brings a substantial burden of symptoms, including pain, anxiety, insomnia, and grief. Here, the uses of hypnosis in the treatment of these cancer-related problems will be reviewed. The utility of measuring hypnotizability in the clinical setting will be discussed. The current neurobiology of hypnotizability and hypnosis will be reviewed. Methods and results of using hypnosis for pain control in acute and chronic settings will be presented. Effects of hypnotic analgesia in specific brain regions associated with pain reduction, notably the dorsal anterior cingulate cortex and the somatosensory cortex, underlies its utility as a potent and side-effect free analgesic. Methods for helping those with cancer to better manage their anxiety, insomnia, and grief will be described. These involve facing disease-related stressors while dissociating the experience from somatic arousal. Given the serious complications of medications widely used to treat pain, anxiety, and insomnia, this article provides methods and an evidence base for wider use of techniques involving hypnosis in cancer care. Altering patients' perception of pain, disease-related stress, and anxiety can help change the reality of their life with cancer.
Topics: Anxiety; Humans; Hypnosis; Neoplasms; Pain; Pain Management; Sleep Initiation and Maintenance Disorders; Stress, Psychological
PubMed: 28557681
DOI: 10.1080/00029157.2017.1290577