Recovery Capital and Social Networks Among People in Treatment and Among Those in Recovery in York,England

Recovery has been associated with a transition in social networks and peer influences in terms of moving away from using peers and engaging in social networks, including those in recovery. This article uses a quantitative data approach to compare a group of individuals who described themselves as in recovery from alcohol and other drug (AOD) problems with a group from the same city involved in alcohol and drug treatment. The measures used included social network involvement and an assessment of recovery capital. Those in recovery had more people in recovery in their social networks, fewer people in active use in their networks, and were much more likely to be involved in formal recovery support groups. They also reported higher quality of life, lower depression and anxiety, and higher levels of personal and social capital. The groups hardly overlapped at all in their functioning, and one of the major challenges of a recovery model will be reconciling the positive recovery networks and cultures of recovery with the narrower and less recovery focused world of many users of structured treatment services. Understanding the mechanisms for the transition from using to recovery communities is essential to understanding a core component of the recovery journey.     

Atezolizumab and bevacizumab-induced encephalitis in advanced hepatocellular carcinoma: Case report and literature review

Introduction:On the basis of the results of the IMBRAVE-150 trial, the combination of atezolizumab, a programmed cell death ligand 1 (PD-L1) antibody, as well as bevacizumab, a vascular endothelial growth factor (VEGF) antibody, represents a promising novel first-line therapy in patients with advanced hepatocellular carcinoma (HCC). Despite favorable safety data, serious adverse events have been described. However, central nervous system complications such as encephalitis have rarely been reported. We present the case of a 70-year-old woman with hepatitis C virus (HCV)-related liver cirrhosis and advanced HCC who developed severe encephalitis after only one cycle of atezolizumab/bevacizumab.Patient concerns:Ten days after administration, the patient presented with confusion, somnolence, and emesis. Within a few days, the patient''s condition deteriorated, and mechanical ventilation became necessary.Diagnosis:Cerebrospinal fluid (CSF) analysis showed increased cell count and elevated protein values. Further work-up revealed no signs of an infectious, paraneoplastic, or other autoimmune cause.Intervention:Suspecting an atezolizumab/bevacizumab-related encephalitis, we initiated a high-dose steroid pulse therapy as well as repeated plasmapheresis, which resulted in clinical improvement and remission of CSF abnormalities.Outcome:Despite successful weaning and transfer to a rehabilitation ward, the patient died of progressive liver cancer 76 days after initial treatment with atezolizumab/bevacizumab, showing no response.Conclusion:This case illustrates that rapid immunosuppressive treatment with prednisolone can result in remission even of severe encephalitis. We discuss this case in the context of available literature and previously reported cases of atezolizumab-induced encephalitis in different tumor entities, highlighting the diagnostic challenges in oncologic patients treated with immune checkpoint-inhibitors.     

Complete genome sequence of an M1 strain of Streptococcus pyogenes

The 1,852,442-bp sequence of an M1 strain of Streptococcus pyogenes, a Gram-positive pathogen, has been determined and contains 1,752 predicted protein-encoding genes. Approximately one-third of these genes have no identifiable function, with the remainder falling into previously characterized categories of known microbial function. Consistent with the observation that S. pyogenes is responsible for a wider variety of human disease than any other bacterial species, more than 40 putative virulence-associated genes have been identified. Additional genes have been identified that encode proteins likely associated with microbial "molecular mimicry" of host characteristics and involved in rheumatic fever or acute glomerulonephritis. The complete or partial sequence of four different bacteriophage genomes is also present, with each containing genes for one or more previously undiscovered superantigen-like proteins. These prophage-associated genes encode at least six potential virulence factors, emphasizing the importance of bacteriophages in horizontal gene transfer and a possible mechanism for generating new strains with increased pathogenic potential.     

Respiratory syncytial virus disease burden in adults aged 60 years and older in high‐income countries: A systematic literature review and meta‐analysis

BackgroundRespiratory syncytial virus (RSV)‐associated acute respiratory infection (ARI) is an underrecognized cause of illness in older adults. We conducted a systematic literature review and meta‐analysis to estimate the RSV disease burden in adults ≥60 years in high‐income countries.MethodsData on RSV‐ARI and hospitalization attack rates and in‐hospital case fatality rates (hCFR) in adults ≥60 years from the United States, Canada, European countries, Japan, and South Korea were collected based on a systematic literature search (January 1, 2000–November 3, 2021) or via other methods (citation search, unpublished studies cited by a previous meta‐analysis, gray literature, and an RSV‐specific abstract booklet). A random effects meta‐analysis was performed on estimates from the included studies.ResultsTwenty‐one studies were included in the meta‐analysis. The pooled estimates were 1.62% (95% confidence interval [CI]: 0.84–3.08) for RSV‐ARI attack rate, 0.15% (95% CI: 0.09–0.22) for hospitalization attack rate, and 7.13% (95% CI: 5.40–9.36) for hCFR. In 2019, this would translate into approximately 5.2 million cases, 470,000 hospitalizations, and 33,000 in‐hospital deaths in ≥60‐year‐old adults in high‐income countries.ConclusionsRSV disease burden in adults aged ≥60 years in high‐income countries is higher than previously estimated, highlighting the need for RSV prophylaxis in this age group.     

Relationship Between Nurses and Physicians in Terms of Organizational Culture: Who Is Responsible for Subordination of Nurses?

Aim

To investigate how nurses and physicians perceive organizational culture, their integration into the organizational processes, and relations within a health care team.

Methods

We performed a cross-sectional study that included 106 physicians and 558 nurses from 14 Slovenian hospitals in December 2005. The hospitals were randomly selected. We distributed the questionnaires on the same day to physicians and nurses during a morning shift. The total number of distributed questionnaires represented a 20% of each personnel category at each hospital. The following variables were studied: organizational culture, integration of nurses and physicians in hospital processes, and subordination of nurses to physicians.

Results

Physicians and nurses favored a culture of internal focus, stability, and control. Both groups estimated that they had a low level of personal involvement in their organizations and indicated insufficient involvement in work teams, while nurses also thought that they were subordinated to physicians (mean ± standard deviation, 3.6 ± 0.9 on a scale from 1 to 5) more than physicians thought so (2.7 ± 1.0; P<0.001). Control orientation correlated positively with the subordination of nurses (P<0.005) and negatively with personal integration in an organization (P<0.005).

Conclusion

We found out that subordination of nurses can be explained by market culture, level of personal involvement, and the level of education. Our research showed that the professional growth of nurses was mainly threatened by organizational factors such as hierarchy, control orientation, a lack of cooperation and team building between physicians and nurses, as well as insufficient inclusion of both physicians and nurses into change implementation activities.In Schein''s words: "Organizational culture refers to a shared value system derived over time that guides members as they solve problems, adapt to the external environment, and manage relationships” (1). Many authors agree that Schein''s is the most complete definition of organizational culture (1). Schein defines it as follows: “Organizational culture is the pattern of shared basic assumptions – invented, discovered, or developed by a given group as it learns to cope with its problems of external adaptation and internal integration – that has worked well enough to be considered valid and, therefore, to be taught to new members as the correct way to perceive, think, and feel in relation to those problems.”Organizational culture is a factor leading to a successful implementation of changes in health care organizations and fostering learning through work processes (2). The culture should encourage change implementation and at the same time establish work quality as a value. Shortell et al (2) describe different health care subcultures, such as physicians – managers, physicians – nurses, employees – leaders, unit cultures, team cultures, and professional group cultures. Subcultures are one of the major obstacles in achieving the common goals of an organization, because the broad differentiation of work leads to a differentiation of tasks and, consequently, to a differentiation of goals within the various departments/units (2). There is a body of research devoted to the improvement of collaboration between health care workers, with a significant portion of it suggesting shared learning as an important means of increasing collaboration (3). Shortell et al (4) believe that physicians should be aware of the fact that they cannot be the only ones responsible for a patient. They must work in a team and collaborate with all health care professionals and patients. Degeling et al (5) claim that medicine has historically had patronizing relationship toward nursing. Nursing is usually depicted as practical, female, moral, and subsidiary, as compared with the scientific, male, instrumental, and superordinate orientations of medicine. These elements have provided justification for the claimed centrality in the internal organization of nursing, whose operation, in turn, has tended to privilege medicine’s claimed diagnostic and curative role and relegate nursing to that of subservience and support. Degeling et al (5) also claim that conventional models of nursing depict nurses as disciplined, altruistic auxiliaries, who support medicine in applying its knowledge and expertise.The cooperation between nursing and medicine is of strategic importance for high-quality patient care and for creating a positive work environment for both groups of health care professionals. The cooperation should not be created only on a personal level, but also on a professional level, while achieving health care goals.This study focuses on the ways nurses and physicians perceive organizational culture, their integration into the organizational processes, and perception of relations within a health care team.