ABSTRACT
BACKGROUND: Treatment for people with kidney disease is often associated with complicated combinations of medicines. Logistical challenges with traditiona paper-based prescribing means that these patients are particularly susceptible to medication-relation errors and harm. AIM: To improve the quality of care that people with kidney disease receive across Wales through a Value-Based digital transformation programme. SETTING: Renal units within the National Welsh Renal Clinical Network (WRCN). DEVELOPMENT: A novel Electronic Prescribing & Medicines Administration (EPMA) system, integrated into a patient care record and linked to a patient portal was developed in South West Wales (SWW) region of the WRCN, enabled by the Welsh Government (WG) Efficiency Through Technology Fund. National upscale was enabled through the WG Transformation Fund. IMPLEMENTATION: EPMA was designed and rolled out initially in SWW region of the WRCN (2018). A dedicated delivery team used the blueprint to finalise and implement a strategy for successful national roll-out eventually across all Wales (completed 2021). EVALUATION: A multi-factorial approach was employed, as both the technology itself and the healthcare system within which it would be introduced, were complex. Continuous cycles of action research involving informal and formal qualitative interviews with service-users ensured that EPMA was accessible and optimally engaging to all target stakeholders (patients and staff). Results confirmed that EPMA was successful in improving the quality of care that people with kidney disease receive across Wales, contributed to Value-Based outcomes, and put people who deliver and access care at the heart of transformation. CONCLUSION: Key findings of this study align directly with the national design principles to drive change and transformation, put forward by the WG in their plan for Health and Social Care: prevention and early intervention; safety; independence; voice; seamless care.
Subject(s)
Delivery of Health Care , Humans , WalesABSTRACT
Regulation of expression of the class I major histocompatability complex (MHC class I) at the maternal fetal interface may play a critical role in embryo survival and the establishment of pregnancy in cattle. However, information concerning immunoregulation of implantation in cattle remains quite limited. Therefore, our current research is concerned with characterizing the expression and regulatory effect of a number of immune factors in the developing bovine embryo. We have analysed the effect of embryo culture in vitro (IVC) in medium supplemented with progesterone (P4): leukemia inhibitory factor (LIF), interferon gamma (IFNG), interleukin (IL)-1B, IL3, IL4, IL10 and granulocyte-colony stimulating factor (G-CSF) on in vitro embryo development and expression of the bovine non-classical MHC class I genes NC2, NC3 and N4 in blastocysts. Cytokine supplementation during IVC did not affect cleavage rate or blastocyst development. However, embryo mRNA expression of NC2, NC3 and NC4 was significantly (p≤0.05) modified in a gene- and cytokine-specific manner. Sequence analysis of the promoter regions of these genes confirmed the presence of appropriate binding sites through which the cytokine signalling could be mediated. In contrast to the lack of effect on in vitro blastocyst development, the non-classical MHC-I expression data suggests a preferential immunomodulatory role of these cytokines during preimplantation embryo development.
Subject(s)
Blastocyst/metabolism , Gene Expression Regulation, Developmental/physiology , Histocompatibility Antigens Class I/biosynthesis , RNA, Messenger/biosynthesis , Animals , Blastocyst/cytology , Blastocyst/immunology , Cattle , Cytokines/immunology , Cytokines/metabolism , Cytokines/pharmacology , Embryo Culture Techniques , Female , Gene Expression Regulation, Developmental/drug effects , Histocompatibility Antigens Class I/immunology , Pregnancy , RNA, Messenger/immunology , Response Elements/physiologyABSTRACT
Fertility in cattle is a major component of many agricultural enterprises and there is pressure to devise methods to improve this. A number of approaches are ongoing, one of which is to better understand the cellular and molecular events of the development of reproductive tissues and to use these as targets for developing new strategies. Microarray technologies now allow us the potential to determine the transcriptional profile of expressed genes in a given tissue. This review focuses on the types of microarrays available for studies in cattle and concludes that genes associated with one or more of the cellular processes of cell survival/death, intracellular signalling, transcription and translation, cell division and proliferation and cellular metabolism are the main transcriptional pathways that control the development of ovarian follicles, oocytes, early embryos and the uterine endometrium about the time of the establishment of pregnancy.
Subject(s)
Cattle/physiology , Embryo, Mammalian/metabolism , Gene Expression Profiling/veterinary , Oligonucleotide Array Sequence Analysis/veterinary , Reproduction/genetics , Reproduction/physiology , Animals , Cattle/embryology , Cattle/genetics , Cell Communication/physiology , Embryonic Development/genetics , Female , Male , Pregnancy , Signal Transduction/physiologyABSTRACT
We report a neurological disease among Cree Indian children in a northern Quebec village. The disease manifests as severe mental retardation, cerebral atrophy with white matter changes and calcifications, and systemic immunological abnormalities. Eleven cases are known in five families. The familial incidence of cases and the high degree of parental consanguinity suggest a genetic contribution. We propose that this entity may be caused by an unusual viral infection in a genetically vulnerable host.
