Pilot Study in Investigating Material Financial Toxicity Markers by Age in Cancer Patients.

Purpose: Studies have shown that financial toxicity can reduce survival, decrease quality of life, and reduce compliance with treatments. The aim of this retrospective study was to investigate material markers of financial toxicity, including insurance coverage, financial assistance, and balances due among adolescent and young adult (AYA) (18-39), adult (40-64), and senior adult (>65) patients with a sarcoma diagnosis after the Affordable Care Act became effective. Methods: This study performed a retrospective analysis of possible indicators within the material domain of financial toxicity in sarcoma patients, a common diagnosis in young adult patients. Indicators of financial toxicity included: insurance status and number of insurances, charity care, accessing financing options, or having an unpaid balance referred to a collection's agency. Results: The cumulative charges per patient were similar between AYA, adult, and senior adult populations at an average of $194,329 (standard deviation [SD] = $321,425), $236,724 (SD = $368,345), and $188,030 (SD = $271,191), respectively. AYA patients were more likely than adult and senior adult patients to have Medicaid coverage (income-based government insurance) (22.1% vs. 8.4% vs. 1.2%), receive charity care (5.3% vs. 2.6% vs. 1.2%), or have a balance referred to a collection's agency (9.2% vs. 5.8% vs. 1.2%). Conclusions: This study suggests that younger cancer patients are more likely to suffer material financial strain and additional financial resources may need to be made available to ensure they can receive care without an increase of financial toxicity markers and undue financial stress.

Moving on after critical incidents in health care: A qualitative study of the perspectives and experiences of second victims.

AIMS: To gain a deeper understanding of nurses and midwives' experiences following involvement in a critical incident in a non-critical care area and to explore how they have 'moved-on' from the event. DESIGN: An interpretive descriptive design guided inductive inquiry to interpret the meaning of moving-on. METHODS: Purposive sampling recruited 10 nurses and midwives. Data collection comprised semi-structured interviews, memos and field notes. Data were concurrently collected and analysed during 2016-2017 with NVivo 11. The thematic analysis enabled a coherent analytical framework evolving emerging themes and transformation of the data into credible interpretive description findings, adhering to the COREQ reporting guidelines. RESULTS: The findings revealed five main themes: Initial emotional and physical response, the aftermath, long-lasting repercussions, workplace support and moving-on. CONCLUSION: This study shed light on the perceptions of nurses and midwives who lived through the impact of critical incidents. Through their lens, the strategies engaged in to move-on were identified and their call for organizational and collegial support received a voice.

The impact of critical incidents on nurses and midwives: A systematic review.

AIMS: To synthesise the existing literature, which focuses on the impact of critical incidents on nurses and midwives, and to explore their experiences related to the support they received in the current healthcare environment to move on from the event. DESIGN: Systematic review and qualitative synthesis. DATA SOURCES: The electronic databases CINAHL, MEDLINE, PsycINFO, PubMed, Embase and Nursing and Allied Health (ProQuest) were systematically searched from 2013-2018, and core authors and journals identified in the literature were manually investigated. REVIEW METHODS: Qualitative studies of all research design types written in English were included according to the PRISMA reporting guidelines. The methodological quality of included studies was evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. RESULTS: A total of 7,520 potential publications were identified. After removal of duplicate citations, study selection and appraisal process, 11 qualitative primary research papers progressed to the meta-synthesis by meta-aggregation. The 179 findings and sub-findings from the included studies were extracted, combined and synthesised into three statements addressing three different aspects within the context of critical incidents: the experiences of the impact, the perceptions of support and the ability to move on. CONCLUSION: This review illuminated that moving-on after critical incidents is a complex and wearisome journey for nurses and midwives. More attention should to be drawn to second victims within general nursing and midwifery practice to strengthen their ability to navigate the aftermath of critical incidents and reclaim the professional confidence indispensable to remain in the workforce.

NMD3 regulates both mRNA and rRNA nuclear export in African trypanosomes via an XPOI-linked pathway.

Trypanosomes mostly regulate gene expression through post-transcriptional mechanisms, particularly mRNA stability. However, much mRNA degradation is cytoplasmic such that mRNA nuclear export must represent an important level of regulation. Ribosomal RNAs must also be exported from the nucleus and the trypanosome orthologue of NMD3 has been confirmed to be involved in rRNA processing and export, matching its function in other organisms. Surprisingly, we found that TbNMD3 depletion also generates mRNA accumulation of procyclin-associated genes (PAGs), these being co-transcribed by RNA polymerase I with the procyclin surface antigen genes expressed on trypanosome insect forms. By whole transcriptome RNA-seq analysis of TbNMD3-depleted cells we confirm the regulation of the PAG transcripts by TbNMD3 and using reporter constructs reveal that PAG1 regulation is mediated by its 5'UTR. Dissection of the mechanism of regulation demonstrates that it is not dependent upon translational inhibition mediated by TbNMD3 depletion nor enhanced transcription. However, depletion of the nuclear export factors XPO1 or MEX67 recapitulates the effects of TbNMD3 depletion on PAG mRNAs and mRNAs accumulated in the nucleus of TbNMD3-depleted cells. These results invoke a novel RNA regulatory mechanism involving the NMD3-dependent nuclear export of mRNA cargos, suggesting a shared platform for mRNA and rRNA export.