Effect of a Nurse-Led Protocol on Time to Treatment of Partial Occlusions in Central Venous Access Devices in Pediatric Oncology.

Central venous access devices (CVADs) are the standard of care in pediatric oncology. Occlusion is a common complication that can lead to delays in therapy, readmission, and CVAD removal and reinsertion. Early treatment of partial occlusions using a standardized protocol may restore patency and increase life span of CVADs. The objective of this study was to develop and evaluate a nurse-led protocol to manage partial CVAD occlusions in pediatric oncology and autologous bone marrow transplant patients. The protocol enabled nurses to manage partially occluded CVADs by administering thrombolytic therapy following an algorithm and patient-specific standing order. The primary outcome was time from recognition of the partial occlusion to instillation of a thrombolytic. Secondary outcomes were thrombolytic dwell time, number of complete occlusions, and CVAD life span. We used a quasi-experimental, after-only, nonequivalent control group design to compare patients not exposed (retrospective cohort, n = 137) and patients exposed (prospective cohort, n = 101) to the nurse-led protocol. Mann-Whitney U tests were used to compare time to treatment, dwell time, and CVAD life span between cohorts, and χ2 was used to compare the proportion of occlusions classified as complete. Time to treatment was significantly lower in the prospective cohort (M = 99.9 minutes) versus the retrospective cohort (M = 483.7 minutes), U = 1366.50, p < .01, as was thrombolytic dwell time, U = 282.50, p < .01. Proportion of complete occlusions and CVAD life span did not differ between cohorts. The nurse-led protocol was effective to manage partial CVAD occlusions in pediatric oncology patients.

Representations of grapho-motor patterns unique to Chinese character writing: evidence from a patient with mirror writing.

This study investigated the grapho-motor patterns used in writing Chinese characters. A Chinese patient, CSC, who demonstrated post-brain-injury mirror writing, was recruited. In Experiment 1, non-mirrored writing responses were obtained when CSC was instructed to copy asymmetrical non-verbal symbols and pictures. Resembling the patterns observed in a patient's writing reported in a previous study, it was hypothesized that CSC's mirror writing was a result of untransformed preserved grapho-motor patterns. In Experiments 2 and 3, CSC was further instructed to copy real Chinese characters, pseudo-characters with authentic radicals and logographemes (i.e., stroke clusters that frequently occur in radicals), and Hangul characters with stroke clusters resembling the shapes of authentic logographemes. The results showed that CSC demonstrated mirror writing only when authentic Chinese orthographic units were involved. Non-mirrored writing responses were obtained from stimuli without authentic Chinese orthographic units. In sum, CSC's performance supported the existence of grapho-motor patterns of Chinese orthographic units represented in the brain. Theoretical implications were discussed.

Brief education to promote maternal influenza vaccine uptake: A randomized controlled trial.

BACKGROUND: Although pregnant women are the highest priority group for seasonal influenza vaccination, maternal influenza vaccination rates remain suboptimal. The purpose of this study was to evaluate the effect of a brief education intervention on maternal influenza vaccine uptake. METHODS: During the 2013-14 and 2014-15 influenza seasons, we recruited 321 pregnant women from the antenatal clinics of 4 out of 8 public hospitals in Hong Kong with obstetric services. Hospitals were geographically dispersed and provided services to pregnant women with variable socioeconomic backgrounds. Participants were randomized to receive either standard antenatal care or brief one-to-one education. Participants received telephone follow-up at 2 weeks postpartum. The primary study outcome was self-reported receipt of influenza vaccination during pregnancy. The secondary outcomes were the proportion of participants who initiated discussion about influenza vaccination with a health care professional and the proportion of participants who attempted to get vaccinated. RESULTS: Compared with participants who received standard care, the vaccination rate was higher among participants who received brief education (21.1% vs. 10%; p=0.006). More participants in the education group initiated discussion about influenza vaccination with their HCP (19.9% vs. 13.1%; p=0.10), but the difference was not statistically significant. Of participants who did not receive the influenza vaccine (n=271), 45 attempted to get vaccinated. A significantly higher proportion of participants who attempted to get vaccinated were in the intervention group (82.2% vs. 17.8%; p<0.001). If participants who had attempted vaccination had received the vaccine, vaccination rates would have been substantially higher (44.1% vs. 15%; p<0.001). Twenty-six participants were advised against influenza vaccination by a healthcare professional, including general practitioners, obstetricians, and nurses. CONCLUSION: Although brief education was effective in improving vaccination uptake among pregnant women, overall vaccination rates remain suboptimal. Multicomponent approaches, including positive vaccination recommendations by healthcare professionals, are needed to promote maternal influenza vaccination. CLINICAL TRIAL REGISTRATION: www.clinicaltrials.gov (NCT01772901).

Perceptions of Hong Kong Chinese women toward influenza vaccination during pregnancy.

INTRODUCTION: Pregnant women are the highest priority group for seasonal influenza vaccination. However, their vaccination uptake remains suboptimal. The purpose of this study is to explore Hong Kong women's perceptions of the threat of influenza infection during pregnancy, the risks and benefits of influenza vaccination, and their decision-making processes. METHODS: We used a qualitative descriptive design and recruited women who had just given births to a live infant from April to June 2011. Participants were recruited from a large teaching hospital in Hong Kong and were interviewed in the immediate postpartum period. RESULTS: A total of 32 postpartum women were interviewed, and two had been vaccinated during pregnancy. Following thematic analysis, three themes emerged: perceived risk of influenza infection, perceived risk of influenza vaccine, and decision-making cues. Overall, participants held negative impressions about influenza vaccination during pregnancy, and they underestimated the threat of influenza to themselves and their fetus. They were also confused about the safety and efficacy of the influenza vaccine and the differences between preventive strategies and treatment for influenza. Most participants reported that their health care providers (HCPs) did not offer or recommend vaccination. Because of negative media reports about vaccination, participants were hesitant to receive the vaccine. Motivating forces for vaccine acceptance were a perceived high prevalence of circulating influenza during their pregnancy and HCP recommendations and reassurances that the vaccination was safe, effective, and beneficial for the fetus. CONCLUSION: Vaccination promotion strategies need to focus on encouraging HCPs to take the initiative to discuss vaccination with their pregnant clients and provide accurate and unbiased information about the risks of influenza and the benefits of vaccination.

A comprehensive review of influenza and influenza vaccination during pregnancy.

Influenza is a highly infectious respiratory disease that can impose significant health risks leading to increased morbidity and mortality. Receiving influenza vaccination is the most important and effective means of preventing the infection and its related complications. During pregnancy, physiological changes increase susceptibility to influenza infection, and women contracting infectious diseases during pregnancy are more likely to have adverse pregnancy and neonatal outcomes. Influenza vaccination during pregnancy is safe for both pregnant women and their fetus, and pregnant women are now the highest priority group for vaccination. Despite the accumulated evidence of the benefits and safety of influenza vaccination during pregnancy, uptake among pregnant women remains suboptimal. Concerns about the vaccine's safety persist, and the fear of birth defects remains the predominant barrier to vaccination. Targeted interventions have been shown effective in enhancing influenza vaccination uptake among pregnant women. Reluctance to be vaccinated should be addressed by offering accurate information to counteract the misperceptions about the risk of influenza infection during pregnancy as well as to educate mothers about the safety and benefits of influenza vaccination. High-quality randomized controlled trials are recommended to evaluate the effectiveness of individual or multifaceted approaches to increase vaccine uptake.

Determinants of uptake of influenza vaccination among pregnant women - a systematic review.

BACKGROUND: Pregnant women have the highest priority for seasonal influenza vaccine. However, suboptimal coverage has been repeatedly noted in this population. To improve vaccine uptake, reviewing the determinants of vaccination is of increasing importance. METHODS: A detailed literature search was performed up to November 30, 2013 to retrieve articles related to uptake of influenza vaccination during pregnancy. RESULTS: Forty-five research papers were included in the review. Twenty-one studies assessed the coverage of seasonal influenza vaccination, 13 studies assessed coverage of A/H1N1 pandemic vaccination and 11 studies assessed both. Vaccination uptake ranged from 1.7% to 88.4% for seasonal influenza, and from 6.2% to 85.7% for A/H1N1 pandemic influenza. Many pregnant women were unaware that they were at high risk for influenza and its complications during pregnancy. They were also more likely to underestimate the threat of influenza to themselves and their fetus. Moreover, they had substantial concerns about the safety and efficacy of the influenza vaccine during pregnancy. Negative media reports contributed to the perception that influenza vaccination during pregnancy was risky and could result in adverse pregnancy outcomes. Although health care providers' (HCPs) recommendations were consistently associated with vaccine uptake, most did not recommend the vaccine to their pregnant clients. CONCLUSIONS: Influenza vaccination uptake among pregnant women is suboptimal and HCPs rarely recommend it. Positive vaccination recommendations from HCPs as well as direct access to the vaccine would likely substantially improve vaccination acceptance.

Prevalence and predictors of maternal seasonal influenza vaccination in Hong Kong.

BACKGROUND: Pregnant women infected with influenza virus are more likely to experience severe complications when compared with their non-pregnant peers. Yet influenza vaccine uptake is low among pregnant women. The purpose of this study was to assess the prevalence of seasonal influenza vaccine uptake among pregnant women in Hong Kong and to identify predictors of vaccine uptake. METHODS: Using a multi-center cross-sectional design, we recruited 2822 new mothers during their immediate postpartum stay from all eight public obstetric hospitals in Hong Kong. We assessed antenatal maternal influenza vaccination status as well as health beliefs and perceptions toward influenza and influenza vaccination. Bivariable and multivariable logistic regression was used to identify the predictors of vaccination uptake. RESULTS: Only 49 (1.7%; 95% CI 1.3-2.3%) participants were vaccinated during their pregnancy. Fear that the vaccine would cause harm to the fetus or themselves were the most common reasons for not being vaccinated. Being aware of the vaccination recommendations (OR=2.69; 95% CI 1.06-6.82), being advised by a health-care provider (OR=6.30; 95% CI 3.19-12.46), history of vaccination (OR=2.47; 95% CI 1.25-4.91), perceived susceptibility to influenza infection (OR=3.67; 95% CI 1.64-8.22), and perceived benefits of influenza vaccination (OR=9.98; 95% CI 3.79-26.24) were all independently associated with vaccination. Perceived barriers to vaccination (OR=0.17; 95% CI 0.07-0.40) were strongly associated with failure to vaccinate. CONCLUSIONS: Low seasonal influenza vaccination uptake among Hong Kong pregnant women was related to a number of factors, all of which are amenable to interventions. Vaccination promotion strategies need to focus on encouraging health-care providers to discuss vaccination with their pregnant clients and in providing pregnant women with accurate and unbiased information about the risks of influenza infection and the benefits of vaccination.

Determinants of 2009 A/H1N1 influenza vaccination among pregnant women in Hong Kong.

During the 2009­2010 A/H1N1 influenza pandemic, pregnant women infected with the virus experienced excess morbidity and mortality when compared with other groups. Once a vaccine was available, pregnant women were a priority group for vaccination. Only a few studies have reported on the uptake of 2009 A/H1N1 influenza vaccine among pregnant women during the pandemic and none were from Asia. The purpose of this study was to examine factors associated with 2009 A/H1N1 influenza vaccine uptake among pregnant women in Hong Kong. Using a multi-center, cross-sectional design, we recruited 549 postpartum women from four post-natal wards in Hong Kong over a 4-month period during the second wave of the A/H1N1 influenza pandemic in the winter and spring of 2010. Only 6.2% (n = 34) of participants had received the 2009 A/H1N1 influenza vaccine and 4.9% (n = 27) had received the seasonal influenza vaccine. The most common reasons for not receiving the 2009 A/H1N1 vaccine were fear of causing harm to themselves or their fetus. A high knowledge level (OR = 19.06; 95% CI 5.55, 65.48), more positive attitudes (OR = 3.52; 95% CI 1.37, 9.07), and having a family member who had the 2009 A/H1N1 influenza vaccine (OR = 7.69; 95% CI 2.92, 20.19) were independently and positively associated with vaccination. Study results show an unacceptably low uptake of the pandemic A/H1N1 influenza vaccine among pregnant women in Hong Kong. Interventions to increase influenza vaccine knowledge and uptake among this group should be a priority for future pandemic planning and seasonal vaccination campaigns.

Tumor endothelial marker 8 overexpression in breast cancer cells enhances tumor growth and metastasis.

Tumor vasculature is known to express high levels of the longest splice variant of tumor endothelial marker 8 (TEM8). Little is known about its expression by tumor cells. Five of eight cell breast cancer cell lines tested expressed significant levels of the longest TEM8 splice variant (TEM8.1), and to a lesser extent, the shortest splice variant (TEM8.3). Breast cancer cell lines expressing high levels of TEM8 are known to be more invasive and typify a more aggressive basal-like phenotype. In vivo studies in the 4T1 murine model showed enhanced tumor growth associated with increased tumor vascularity and metastasis to lymph nodes and lungs. These data suggest that TEM8.1 expression in breast cancer cells confers a more aggressive, proangiogenic phenotype.

Signaling and apoptosis differences between severe hypoxia and desferoxamine treatment of human epithelial cells.

The mechanisms by which cells undergo proliferation arrest or cell death in response to hypoxia are still not completely understood. Originally, we showed that HeLa and Hep3B carcinoma cells undergo different proliferation responses in hypoxia. We now show that these 2 cell lines also have different cell death responses to severe hypoxia, with HeLa showing both cell cycle arrest and apoptosis (as early as 12 h after hypoxia treatment), and Hep3B showing resistance to both. Hypoxia-induced apoptosis in Hela was associated with decreases of both phospho-S473- and -T308-AKT and loss of AKT function, whereas Hep3B cells were resistant to hypoxia-induced apoptosis and did not lose phospho-AKT or AKT function. We then decided to test if our observations were confirmed using a hypoxia mimic, desferoxamine. Desferoxamine treatment yielded cell cycle arrest in HeLa and moderate arrest in Hep3B but, surprisingly, did not induce notable apoptosis of either cell line with up to 24 h of treatment. Hypoxia-treated normal human mammary epithelial cells also showed hypoxia-induced apoptosis. Interestingly, in these cell lines, there was a complete correlation between loss of phospho-AKT and (or) total AKT, and susceptibility to hypoxia-induced apoptosis. Our data suggests a model in which regulated loss of active AKT at a precise time point in hypoxia may be associated with apoptosis in susceptible cells.