The Effectiveness of Nutrition Specialists on Pediatric Weight Management Outcomes in Multicomponent Pediatric Weight Management Interventions: A Systematic Review and Exploratory Meta-Analysis

Background

Nutrition specialists are considered key members of multicomponent pediatric weight management intervention teams, but to date, their contribution has not been quantified.

The invisible nature of learning: Patient education in nursing

BackgroundLearning for patients and their families within nurses’ patient- and family-education practice is an important part of person- and family-centred care. Patients and their families must master health promotional or management strategies to optimise their health outcomes. Support is often provided by nurses, but how nurses facilitate each patient’s and their family’s learning, using cognitive learning principles, seems invisible in the nursing literature.AimThis discussion paper examines the important role of cognitive learning within nurses’ patient- and family-education practice. How learning is enabled, the differences between teaching and learning and the role of learning principles are discussed. Shortcomings are identified and possible ways to address these within nurses’ practice are considered.MethodsThe discussion draws on the limited current literature surrounding cognitive learning principles in nurses’ practice and nurses’ awareness of learning principles. Readers are encouraged to question their current conceptualisation of learning and their perceptions and use of learning principles in their practice.Findings and discussionThe learning process within nursing is overshadowed by explanations of teaching strategies, determinants of learning and the learning principles of one specific theorist. The principles of cognitive learning and their role in patient- and family-education are poorly described and possibly poorly understood. This creates a fundamental knowledge gap in nursing practice.ConclusionA significant rethink about the role of learning principles within nurses’ patient- and family-education practice is overdue. These principles need to be explored further by involving nurses, patients and their families to identify how nurses are perceiving and using learning principles in their practice.     

Renal Neoplasia in Tuberous Sclerosis: A Study of 41 Patients

ObjectiveTo study the clinical features and identify unique renal neoplasia subtypes and their prognostic implications in individuals with tuberous sclerosis complex (TSC).Patients and MethodsThe Mayo Clinic nephrectomy registry included 37 patients with TSC diagnosed between 1970 and 2018. Four additional patients were identified from the pathology consultation and autopsy files. All available renal tumors were further characterized using immunohistochemistry and fluorescence in situ hybridization. Clinicopathologic features and follow-up were obtained from the medical record. The American Association for Cancer Research Project GENIE registry was accessed using cBioPortal for molecular profiling of angiomyolipoma (AML).ResultsA total of 276 renal tumors from 41 patients were analyzed. Renal tumors were classified into 9 distinct morphological subtypes, with AML predominating (238 [86%]). Interestingly, all these tumors acted in a benign fashion except one renal cell carcinoma with clear cells and fibromyomatous stroma and one epithelioid AML that metastasized. Molecular profiling studies revealed that epithelioid AMLs were enriched for alterations of TP53, RB1, and ATRX. Eight patients died of direct complications of TSC, including 3 of end-stage renal disease. To date, none have died of a renal epithelial neoplasm.ConclusionThe identification of unique renal neoplasia subtypes may provide important clues to establish a diagnosis of TSC, and in the somatic setting, this finding has important implications for accurate prognostication. These tumors tend to be indolent, and only 2 of 276 tumors in our study exhibited metastatic behavior. Our results support multidisciplinary management with a focus on preservation of renal function.     

An Evaluation of e-CHECKUP TO GO in Canada: The Mediating Role of Changes in Social Norm Misperceptions

Background: Alcohol use and related problems are key concerns among colleges, and web-based interventions to mitigate these issues are increasingly popular across campuses. A variety of programs are commercially available and have demonstrated efficacy in reducing alcohol use and consequences; however, little is known about how these programs reduce alcohol outcomes. Objectives: The e-CHECKUP TO GO program (e-CHUG) is the briefest electronic intervention available and over 600 institutions are using it internationally. The present study evaluates the impact of the e-CHUG program on drinking outcomes and examines changes in perceived norms as a potential mediator of intervention efficacy in a sample of first-year Canadian university residence students. This is the first Canadian evaluation of e-CHUG. Methods: First year Canadian university students (N = 245) living in residence in August 2014 participated in a randomized control trial to evaluate the efficacy of e-CHUG program compared to an assessment-only control condition. Follow-up assessments were completed at 3-months and 5-months. Norm misperceptions and drinking outcomes were measured. Results: At 3-month and 5-month follow-up assessments program participants had lower norm misperceptions about peers drinking compared to control participants. Changes in norm misperceptions at 3-months mediated the effect of the program on drinking outcomes at 5-months. There were no sex differences in the associations. Conclusions/Importance: Findings suggest that e-CHECKUP TO GO may be a promising strategy for addressing norm misperceptions and subsequently drinking for Canadian students.     

Ex vivo modelling of the formation of inflammatory platelet-leucocyte aggregates and their adhesion on endothelial cells,an early event in sepsis

Septicaemia is an acute inflammatory reaction in the bloodstream to the presence of pathogen-associated molecular patterns. Whole blood stimulation assays capture endotoxin-induced formation of aggregates between platelets and leucocytes using flow cytometry. We wanted to assess extent of spontaneous aggregate formation in whole blood stimulation assays and compare the effects of endotoxin and heat-killed, clinically relevant, bacterial pathogens on aggregate formation and then on adhesion of aggregates to TNFα-stimulated endothelial cells. We found that endotoxin (from Escherichia coli or Salmonella enteritidis) was not a suitable stimulus to provoke platelet-leucocyte aggregates in vitro, as it did not further increase the extent of aggregates formed spontaneously in stasis of hirudin-anticoagulated blood. Specifically, whole blood samples stimulated with or without LPS produced aggregates with a mean surface area of 140.97 and 117.68 μm², respectively. By contrast, incubation of whole blood with heat-killed Klebsiella pneumoniae or Staphylococcus aureus produced significantly enhanced and complex cellular aggregates (with a mean surface area of 470.61 and 518.39 μm², respectively) which adhered more frequently to TNFα (and free fatty acid)-stimulated endothelial cells. These were reliably captured by scanning electron microscopy. Adhesion of cellular aggregates could be blocked by incubation of endothelial cells with a commercial P-selectin antibody and an angiopoietin-2 ligand trap. In conclusion, we have developed an in vitro method that models the acute inflammatory reaction in whole blood in the presence of sepsis-relevant bacterial pathogen surfaces.