ABSTRACT
Palliative care is rarely delivered by one provider; for most patients their care will be managed by community and one or more hospital teams at the least. This can be problematic for patients, their family and friends, and health professionals. Evidence suggests that, in general, providers work in isolation from each other. Although formal processes are in place for transfer of information between the sectors on discharge between acute and community sectors, there is a de facto lack of communication and therefore a lack of appreciation of the working practices within each environment. This resulting lack of collaboration between teams can lead to disruptive care that detracts from the holistic philosophy purported to be the basis of supportive and palliative care (National Institute for Health and Clinical Excellence (NICE) 2004; Department of Health (DH) 2000). In October 2005, 20% of a clinical nurse specialist's (CNS) full-time post was dedicated to working between the palliative care teams of Central Manchester and Manchester Children's NHS Trust (CMMC) and Central Manchester PCT (CMPCT). The aim was to improve communication and dialogue to promote more effective integrated working between the two sites and develop effective interprofessional working. This article will evaluate the impact of this new post, after 18 months, on collaboration between the teams, their practices and their patients. Finally, it will offer recommendations for future development.
Subject(s)
Communication , Interprofessional Relations , Nurse Clinicians/organization & administration , Palliative Care/organization & administration , Patient Care Team/organization & administration , Attitude of Health Personnel , Continuity of Patient Care/organization & administration , Cooperative Behavior , England , Health Services Needs and Demand , Holistic Health , Humans , Nurse Clinicians/psychology , Nurse's Role/psychology , Nursing Evaluation Research , Nursing Methodology Research , Palliative Care/psychology , Philosophy, Medical , Philosophy, Nursing , Program Evaluation , Total Quality Management/organization & administrationABSTRACT
BACKGROUND: RNA interference (RNAi) in animals and post-transcriptional gene silencing (PTGS) in plants are related phenomena whose functions include the developmental regulation of gene expression and protection from transposable elements and viruses. Plant viruses respond by expressing suppressor proteins that interfere with the PTGS system. RESULTS: Here we demonstrate that both transient and constitutive expression of the Tobacco etch virus HC-Pro silencing suppressor protein, which inhibits the maintenance of PTGS in plants, prevents dsRNA-induced RNAi of a lacZ gene in cultured Drosophila cells. Northern blot analysis of the RNA present in Drosophila cells showed that HC-Pro prevented degradation of lacZ RNA during RNAi but that there was accumulation of the short (23nt) RNA species associated with RNAi. A mutant HC-Pro that does not suppress PTGS in plants also does not affect RNAi in Drosophila. Similarly, the Cucumber mosaic virus 2b protein, which inhibits the systemic spread of PTGS in plants, does not suppress RNAi in Drosophila cells. In addition, we have used the Drosophila system to demonstrate that the 16K cysteine-rich protein of Tobacco rattle virus, which previously had no known function, is a silencing suppressor protein. CONCLUSION: These results indicate that at least part of the process of RNAi in Drosophila and PTGS in plants is conserved, and that plant virus silencing suppressor proteins may be useful tools to investigate the mechanism of RNAi.
