Polio survivors perceptions of a multi-disciplinary rehabilitation programme.

PURPOSE: Post-polio syndrome refers to a late complication of the poliovirus infection. Management of post-polio syndrome is complex due to the extensive symptomology. European and United Kingdom guidelines have advised the use of rehabilitation programmes to manage post-polio syndrome. There is a paucity of research in relation to the effectiveness of rehabilitation interventions. The objective of this study is to explore polio survivor's perceptions of an in-patient multi-disciplinary rehabilitation programme. METHODS: Semi-structured interviews of community dwelling polio survivors who attended in-patient rehabilitation programme in the United Kingdom. Thematic analysis was used to describe and interpret interview data. RESULTS: Participants' experiences were influenced by past experiences of polio and their self-concept. Participants generally had a positive experience and valued being with other polio survivors. Positive strategies, such as pacing and reflection changed their mind-sets into their lives after the programme, though they still faced challenges in daily living. Some participants supported others with post-polio syndrome after completing the programme. CONCLUSIONS: Our research identified that participants experienced long term positive benefits from attending a rehabilitation programme. Strategies that users found helpful that explored the effectiveness of interventions to manage polio are not cited within a Cochrane review. If we are to recognise the lived experience and service user empowerment within a model of co- production it is essential that patient preferences are evaluated and used as evidence to justify service provision. Further research is required with polio survivors to explore how best rehabilitation programmes can adopt the principles of co-production. Implications for Rehabilitation The patients' expertise and lived experience must be at the centre of a rehabilitation programme. Strategies such as pacing and reflection are perceived as important strategies to enable self-management of polio and post-polio syndrome despite the limited evidence base to support these interventions. Polio rehabilitation programmes should not be time limited and commissioners and therapists need to ensure that follow up support is provided. When measuring outcomes patient preferences and views must be evaluated.

A moral profession: Nurse educators' selected narratives of care and compassion.

BACKGROUND:: Lack of compassion is claimed to result in poor and sometimes harmful nursing care. Developing strategies to encourage compassionate caring behaviours are important because there is evidence to suggest a connection between having a moral orientation such as compassion and resulting caring behaviour in practice. OBJECTIVE:: This study aimed to articulate a clearer understanding of compassionate caring via nurse educators' selection and use of published texts and film. METHODOLOGY:: This study employed discourse analysis. PARTICIPANTS AND RESEARCH CONTEXT:: A total of 41 nurse educators working in universities in the United Kingdom (n = 3), Ireland (n = 1) and Canada (n = 1) completed questionnaires on the narratives that shaped their understanding of care and compassion. FINDINGS:: The desire to understand others and how to care compassionately characterised educators' choices. Most narratives were examples of kindness and compassion. A total of 17 emphasised the importance of connecting with others as a central component of compassionate caring, 10 identified the burden of caring, 24 identified themes of abandonment and of failure to see the suffering person and 15 narratives showed a discourse of only showing compassion to those 'deserving' often understood as the suffering person doing enough to help themselves. DISCUSSION:: These findings are mostly consistent with work in moral philosophy emphasising the particular or context and perception or vision as well as the necessity of emotions. The narratives themselves are used by nurse educators to help explicate examples of caring and compassion (or its lack). CONCLUSION:: To feel cared about people need to feel 'visible' as though they matter. Nurses need to be alert to problems that may arise if their 'moral vision' is influenced by ideas of desert and how much the patient is doing to help himself or herself.

The efficacy of complementary therapy for patients receiving palliative cancer care.

Involving patients in their own care is associated with improved health outcomes. Complementary therapies are popular among patients and enable them to receive the palliative care they want and need. However, the range of complementary therapy services available to patients need to be evaluated for efficacy. This study evaluated the complementary therapy services offered at one cancer outpatient clinic in the UK, with the aim of evaluating the effect of complementary therapies on patient wellbeing and to systematise concerns and categories of wellbeing in order to improve service provision. A sample of 60 patients rated their feelings of wellbeing on a Likert scale before and after a series of six complementary therapies. They were also asked which concerns they had and, after treatment, were asked about factors that may influence their wellbeing. The data were analysed quantitatively by t-test and Wilcoxon signed ranks and the results show a statistically significant improvement in wellbeing. The concerns were assigned into super categories to aid service provision and the other factors that influence general wellbeing were assessed to categorise areas of patient needs that may be addressed in patient care. These results highlight important areas for investigation, which have implications for service provision in palliative cancer care.

A research-based mantra for compassionate caring.

BACKGROUND: The United Kingdom introduced the Six C's strategy to help address deficits in approaching nursing care in a compassionate and caring manner. OBJECTIVE: To identify the book, article, poem, film or play that most influenced nurse educators' understanding of care and compassion and to articulate a clearer understanding of compassionate caring. DESIGN: A qualitative study applying discourse analysis to respondents' questionnaires and their nominated narrative. SETTINGS AND PARTICIPANTS: 41 nurse educators working in 5 universities in the UK (n=3), Republic of Ireland and Canada participated. 39 items (10 books, 2 journal articles, 10 poems, 15 films and 2 plays) were nominated. FINDINGS: The desire to understand others and how to care compassionately characterised choices. Three main themes emerged. Abandonment of, and failure to see, the suffering person was evident in 25 narratives. Connecting with others was shown in 25 narratives as being able to truly seeing the other person. Comforting others was supported by 37 narratives with examples of kindness and compassion. CONCLUSION: Published narratives are valuable in developing compassionate responses. An annotated list is provided with suggestions for educational uses to help develop compassionate caring in student nurses. Compassionate, caring nurses recognise that patients need them to: "See who I am; Be present with me; Do not abandon me."

Human embryonic stem cells: a model for human ageing in vitro.

Stem cells have been used to investigate developmental processes and may be used as a therapeutic source of material for regenerative medicine and cancer. Here we propose the use of human embryonic stem cells, which represent a youthful phenotype, as models for experimentally investigating human ageing.

The therapeutic potential of human embryonic stem cells.

Due to lack of suitable organ donors, future degenerative diseases and traumas could be treated with stem cell engraftment. To do this, large numbers of cells must be grown and maintained in culture. These cells must also be capable to differentiate into all the cells of the body. Embryonic stem cells fulfill many of the necessary criteria for clinical translation for use in therapeutic transplantation for a myriad of diseases. There are still many issues including immunological, cell cycling and differentiation that must be overcome for them to reach their potential use in the clinical arena.

From embryos to embryonic stem cells: biopolitics and therapeutic potential.

The inner cell mass of the preimplantation blastocyst, from which all the cells of the body develop, is a source of embryonic stem cells. These cells can be maintained in their undifferentiated state over long periods in culture and yet retain their pluripotency. The generation of human stem cells capable of differentiating into all the cell types of the human body opens the way for the use of these cells in therapeutic transplantation for a myriad of diseases. However, as discussed here, there are a number of logistical, biological, and clinical hurdles that must be overcome prior to the use of these cells in routine clinical practice.

From embryos to embryonic stem cells: biopolitics and therapeutic potential.

The inner cell mass of the preimplantation blastocyst, from which all the cells of the body develop, is a source of embryonic stem cells. These cells can be maintained in their undifferentiated state over long periods in culture and yet retain their pluripotency. The generation of human stem cells capable of differentiating into all the cell types of the human body opens the way for the use of these cells in therapeutic transplantation for a myriad of diseases. However, as discussed here, there are a number of logistical, biological, and clinical hurdles that must be overcome prior to the use of these cells in routine clinical practice.

Stem cell and related therapies: nurses and midwives representing all parties.

Nurses and midwives are part of health care in all the stages of our lives from preconception to death. Recent scientific advances have introduced new techniques of screening and diagnosis linked to stem cell isolation and therapies. These could affect us at any age and therefore nurses will be involved as carers and patients advocates for these techniques. In this article stem cell techniques and therapies are outlined, as well as some of the ethical challenges faced by various nursing groups, whether in adult, learning difficulties, mental health, paediatric, primary care, public health or health visiting areas. Nurses have to understand the ethical issues and the rights of all parties (donor, recipient and families), which may conflict with each other, to be able to weigh up the benefits and costs to each group involved. Answers have to be found on a case-by-case basis within local moral frameworks and law. Nurses represent all parties in these therapies and act as advocates for every patient group. They need to act in an interprofessional environment to promote the best interests of all their clients, both clinically and ethically.

The function of stem cells and their future roles in healthcare.

Adult stem cells from bone marrow have been used in the treatment of cancer for many years. Recently, however, interest has developed in the isolation and growth of adult, cord and embryonic stem cells for use in regenerative medicine. Their therapeutic use will undoubtedly be implemented in nursing practice in a variety of clinical areas. This article is a brief introduction to stem cells and addresses the biology of these cells and their potential clinical applications, looking at three possible diseases as examples: myocardial infarction, type 1 diabetes and osteoarthritis.

An overview of education and 'new genetics'.

Research and development in the field of genetics and the Human Genome Project will have a major impact on the future of health care and the services on offer for users. The authors discuss the importance of educating nurses about genetic developments so that they can apply this knowledge to practice.

Multiple differentiation programs in K562 erythroleukemia cells and their regulation.

The chronic myeloid leukemia-derived cell line K562 expresses, in its uninduced state, notable erythroid features. However, in addition to the presence of well-characterized "erythroid-specific" molecules, such as hemoglobin and glycophorin A, there is increasing evidence of both granulopoietic and megakaryocytic differentiation in this cell line. In this chapter we have further characterized erythroid and nonerythroid features in order to investigate the range of differentiation programs expressed by uninduced K562 cells. Also we have extended these observations by attempting to manipulate the expression of the different lineage-specific components of the phenotype of the K562 cell line in induction experiments. The aim of these studies was to attempt to determine the extent and significance of multipotentiality in K562. The relationship of our findings on the phenotype of K562 to the nature of multipotent hemopoietic stem cells and their differentiated progeny in normal and malignant hemopoiesis is discussed.

Expression of red cell specific determinants during differentiation in the K562 erythroleukaemia cell line.

A human haemopoietic cell line (K562) which exhibits various erythroid characteristics, has been utilised as a model system for studying erythropoietic differentiation. We have analysed the alterations in expression of cell membrane determinants which accompany the induction of Hb synthesis. We confirm that the K562 cell line exhibits a number of erythroid features: it expresses immunologically detectable membrane proteins, glycophorin A and spectrin and can ber induced, by addition of haemin or n-butyrate, to synthesise Hb. N and i-like blood group activities are demonstrable in uninduced K562, but band 3, ABH and other major alloantigens characteristic of mature erythrocytes are lacking. The acquisition of cell surface antigens typifying erythroid or other haemopoietic lineages has not been demonstrated following induction, although certain properties not associated with morphologically recognisable red cell precursors are lost. The relevance of these findings to the foetal nature and possible multipotentiality of the K562 cell line are discussed.