Clinical Nurse Specialist Job Planning Toolkit

Clinical Nurse Specialist Job Planning ToolkitThe toolkit is the first of its kind for clinical nurse specialists in Northern Ireland and has been achieved in partnership with PHA, NIPEC, the Health and Social Care Trusts, Northern Ireland Cancer Network, and the Royal College of Nursing.�

Job Planning Guidance Toolkit for Clinical Nurse Specialist Roles

This job planning toolkit has been developed by the Public Health Agency (PHA) in partnership with the Northern Ireland Practice and Education Council for Nursing and Midwifery (NIPEC). This job planning toolkit was designed for nurses in roles who have the title Clinical Nurse Specialist and carry a defined caseload of patients and/or run their own clinics. The toolkit provides information to support: ��.������������ Clinical Nurse Specialists in meeting the requirements of their job

Phase 1 Delivering care "A framework for nursing and Midwifery Workforce planning to support person centred care in Northern Ireland"

Delivering Care - Nurse staffing in Northern Ireland is the outcome of a commission undertaken by the PHA Director of Nursing from the DHSSPS Chief Nursing Officer and approved by the Minister of Health in 2014.� The aim of the Delivering Care project is to support the provision of quality care which is safe and effective in hospital and community settings.

Pathway analysis of glioblastoma tissue after preoperative treatment with the EGFR tyrosine kinase inhibitor gefitinib--a phase II trial.

Amplification of the epidermal growth factor receptor (EGFR) gene is one of the most common oncogenic alterations in glioblastoma (45%) making it a prime target for therapy. However, small molecule inhibitors of the EGFR tyrosine kinase showed disappointing efficacy in clinical trials for glioblastoma. Here we aimed at investigating the molecular effects of the tyrosine kinase inhibitor gefitinib on the EGFR signaling pathway in human glioblastoma. Twenty-two patients selected for reoperation of recurrent glioblastoma were treated within a phase II trial for 5 days with 500 mg gefitinib before surgery followed by postoperative gefitinib until recurrence. Resected glioblastoma tissues exhibited high concentrations of gefitinib (median, 4.1 μg/g), 20 times higher than respective plasma. EGFR-pathway activity was evaluated with phosphorylation-specific assays. The EGFR was efficiently dephosphorylated in treated patients as compared to a control cohort of 12 patients. However, no significant effect on 12 pathway constituents was detected. In contrast, in vitro treatment of a glioblastoma cell line, BS-153, with endogenous EGFRwt amplification and EGFRvIII expression resulted not only in dephosphorylation of the EGFR, but also of key regulators in the pathway such as AKT. Treating established xenografts of the same cell line as an in vivo model showed dephosphorylation of the EGFR without affecting downstream signal transductors, similar to the human glioblastoma. Taken together, gefitinib reaches high concentrations in the tumor tissue and efficiently dephosphorylates its target. However, regulation of downstream signal transducers in the EGFR pathway seems to be dominated by regulatory circuits independent of EGFR phosphorylation.

Map of ecological networks for landscape planning

This paper presents a method based on a geographical information system (GIS) to model ecological networks in a fragmented landscape. The ecological networks are generated with the help of a landscape model (which integrate human activities) and with a wildlife dispersal model. The main results are maps which permit the analysis and the understanding of the impact of human activities on wildlife dispersal. Three applications in a study area are presented: ecological networks at the landscape scale, conflicting areas at the farmstead scale and ecological distance between biotopes. These applications show the flexibility of the model and its potential to give information on ecological networks at different planning scales.

Regional and hemispheric determinants of language laterality: Implications for preoperative fMRI.

Language is typically a function of the left hemisphere but the right hemisphere is also essential in some healthy individuals and patients. This inter-subject variability necessitates the localization of language function, at the individual level, prior to neurosurgical intervention. Such assessments are typically made by comparing left and right hemisphere language function to determine "language lateralization" using clinical tests or fMRI. Here, we show that language function needs to be assessed at the region and hemisphere specific level, because laterality measures can be misleading. Using fMRI data from 82 healthy participants, we investigated the degree to which activation for a semantic word matching task was lateralized in 50 different brain regions and across the entire cortex. This revealed two novel findings. First, the degree to which language is lateralized across brain regions and between subjects was primarily driven by differences in right hemisphere activation rather than differences in left hemisphere activation. Second, we found that healthy subjects who have relatively high left lateralization in the angular gyrus also have relatively low left lateralization in the ventral precentral gyrus. These findings illustrate spatial heterogeneity in language lateralization that is lost when global laterality measures are considered. It is likely that the complex spatial variability we observed in healthy controls is more exaggerated in patients with brain damage. We therefore highlight the importance of investigating within hemisphere regional variations in fMRI activation, prior to neuro-surgical intervention, to determine how each hemisphere and each region contributes to language processing. Hum Brain Mapp, 2010. © 2010 Wiley-Liss, Inc.

Preoperative chemoradiotherapy in rectal cancer induces changes in the expression of nuclear β-catenin: prognostic significance.

BACKGROUND Preoperative chemoradiotherapy (CRT) is the cornerstone of treatment for locally advanced rectal cancer (LARC). Although high local control is achieved, overall rates of distant control remain suboptimal. Colorectal carcinogenesis is associated with critical alterations of the Wnt/β-catenin pathway involved in proliferation and survival. The aim of this study was to assess whether CRT induces changes in the expression of β-catenin/E-cadherin, and to determine whether these changes are associated with survival. METHODS The Immunohistochemical expression of nuclear β-catenin and membranous E-cadherin was prospectively analysed in tumour blocks from 98 stage II/III rectal cancer patients treated with preoperative CRT. Tumour samples were collected before and after CRT treatment. All patients were treated with pelvic RT (46-50 Gy in 2 Gy fractions) and 5-fluorouracil (5FU) intravenous infusion (225 mg/m2) or capecitabine (825 mg/m2) during RT treatment, followed by total mesorectal excision (TME). Disease-free survival (DFS) was analysed using the Kaplan-Meier method and a multivariate Cox regression model was employed for the Multivariate analysis. RESULTS CRT induced significant changes in the expression of nuclear β-catenin (49% of patients presented an increased expression after CRT, 17% a decreased expression and 34% no changes; p = 0.001). After a median follow-up of 25 months, patients that overexpressed nuclear β-catenin after CRT showed poor survival compared with patients that experienced a decrease in nuclear β-catenin expression (3-year DFS 92% vs. 43%, HR 0.17; 95% CI 0.03 to 0.8; p = 0.02). In the multivariate analysis for DFS, increased nuclear β-catenin expression after CRT almost reached the cut-off for significance (p = 0.06). CONCLUSIONS In our study, preoperative CRT for LARC induced significant changes in nuclear β-catenin expression, which had a major impact on survival. Finding a way to decrease CRT resistance would significantly improve LARC patient survival.

Safety in vicinity of industrials plants: risk assessment and land use planning

The aim of this book is to survey on different Land Use Planning and safety approaches in vicinity of industrial plants. As this research is associated with three broad fields of Land Use Planning, safety and security, the set principle is to avoid unnecessary and over detailed information, but including the useful ones to provide a comprehensive resource which can be applicable for several purposes. Besides, the proposed method, which is explained in Chapter 7, can initiate a new field for future of Land Use Planning in vicinity of industrial plants.

Dummy run and conformity indices in the ongoing EORTC low-grade glioma trial 22033-26033: First evaluation of quality of radiotherapy planning.

PURPOSE: Early assessment of radiotherapy (RT) quality in the ongoing EORTC trial comparing primary temozolomide versus RT in low-grade gliomas. MATERIALS AND METHODS: RT plans provided for dummy cases were evaluated and compared against expert plans. We analysed: (1) tumour and organs-at-risk delineation, (2) geometric and dosimetric characteristics, (3) planning parameters, compliance with dose prescription and Dmax for OAR (4) indices: RTOG conformity index (CI), coverage factor (CF), tissue protection factor (PF); conformity number (CN = PF x CF); dose homogeneity in PTV (U). RESULTS: Forty-one RT plans were evaluated. Only two (5%) centres were requested to repeat CTV-PTV delineations. Three (7%) plans had a significant under-dosage and dose homogeneity in one deviated > 10%. Dose distribution was good with mean values of 1.5, 1, 0.68, and 0.68 (ideal values = 1) for CI, CF, PF, and CN, respectively. CI and CN strongly correlated with PF and they correlated with PTV. Planning with more beams seems to increase PTV(Dmin), improving CF. U correlated with PTV(Dmax). CONCLUSION: Preliminary results of the dummy run procedure indicate that most centres conformed to protocol requirements. To quantify plan quality we recommend systematic calculation of U and either CI or CN, both of which measure the amount of irradiated normal brain tissue.

Iowa Department of Human Rights - Division of Criminal and Juvenile Justice Planning, Agency Performance Plan

Annual Report, Agency Performance Plan

Prise en charge nutritionnelle préopératoire. [Preoperative nutritional support.]

Undernutrition is an independent factor of postoperative morbidity and mortality The aim of a preoperative nutritional support is to enhance immune muscular and cognitive functions, and to support wound healing This nutritional support (e g dietary management enteral or parenteral nutrition) should be limited to high risk situations with a beneficial effect of nutrition for the patient undernutrition major surgery and elderly Preoperative nutritional support should be scheduled for atleast 7 to 10 days before the surgery During the preoperative period the type and route of an eventual postoperative nutritional assistance should be anticipated In the case of emergency surgery nutritional assessment of the patient should be done as soon as possible before surgery or in the 48 h postoperative period Finally, in elective surgery, preoperative fasting should be limited to 2-3 hours for clear liquids and 6 hours for solids (C) 2010 Published by Elsevier Masson SAS

ERPN Enterprise Resource Planning Newsletter, February 2001, Vol.1, no.1

Newsletter for Information Technology Department