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Background: Cancer immunotherapy approaches that elicit immune cell responses, including T and NK cells, have revolutionized the field of oncology. However, immunosuppressive mechanisms restrain immune cell activation within solid tumors so additional strategies to augment activity are required. Methods: We identified the co-stimulatory receptor NKG2D as a target based on its expression on a large proportion of CD8+ tumor infiltrating lymphocytes (TILs) from breast cancer patient samples. Human and murine surrogate NKG2D co-stimulatory receptor-bispecifics (CRB) that bind NKG2D on NK and CD8+ T cells as well as HER2 on breast cancer cells (HER2-CRB) were developed as a proof of concept for targeting this signaling axis in vitro and in vivo. Results: HER2-CRB enhanced NK cell activation and cytokine production when co-cultured with HER2 expressing breast cancer cell lines. HER2-CRB when combined with a T cell-dependent-bispecific (TDB) antibody that synthetically activates T cells by crosslinking CD3 to HER2 (HER2-TDB), enhanced T cell cytotoxicity, cytokine production and in vivo antitumor activity. A mouse surrogate HER2-CRB (mHER2-CRB) improved in vivo efficacy of HER2-TDB and augmented NK as well as T cell activation, cytokine production and effector CD8+ T cell differentiation. Conclusion: We demonstrate that targeting NKG2D with bispecific antibodies (BsAbs) is an effective approach to augment NK and CD8+ T cell antitumor immune responses. Given the large number of ongoing clinical trials leveraging NK and T cells for cancer immunotherapy, NKG2D-bispecifics have broad combinatorial potential. [ABSTRACT FROM AUTHOR]

Purpose: To identify utility-based patient-reported outcome measures (PROMs) for assessing health-related quality of life (HRQoL) in cardiac rehabilitation and secondary prevention programs (CR) and appraise existing evidence on their measurement properties. Secondly, to link their items to the International Classification of Functioning Disability and Health (ICF) and the International Consortium of Health Outcome Measures (ICHOM) domains for cardiovascular disease (CVD). Methods: Eight databases were searched. The review followed the COSMIN and JBI guidelines for measurement properties systematic reviews and PRISMA 2020 reporting guidelines. Non-experimental and observational empirical studies of patients ≥ 18 years of age with CVD undergoing CR and assessed quality of life (QoL) or HRQoL using utility-based PROMs or one accompanied by health state utilities were included. Results: Nine PROMs were identified with evidence on measurement properties for three measures: the German translations of SF-12, EQ-5D-5L, and MacNew heart disease HRQoL questionnaire. There was moderate quality evidence for responsiveness and hypothesis testing of the SF-12 and EQ-5D-5L, and high-quality evidence for responsiveness and hypothesis testing for the MacNew. All items of SF-12 and EQ-5D were linked to ICF categories, but four items of the MacNew were not classified or defined. All the PROM domains were mapped onto similar constructs from the ICHOM global sets. Conclusion: Three utility-based PROMs validated in CR were identified: the German versions of the EQ-5D and SF-12 and the MacNew questionnaire. These PROMs are linked to a breadth of ICF categories and all ICHOM global sets. Additional validation studies of PROMs in CR are required. [ABSTRACT FROM AUTHOR]

Background: Although guidelines recommend guideline‐directed medical therapy (GDMT) for patients with acute coronary syndrome (ACS), implementation is limited in clinical practice. Aim: To assess the level of GDMT in ACS patients after discharge who attended cardiac rehabilitation (CR) programs and association with clinical outcomes. Method: A cross‐sectional study was conducted in 13 rural and 10 metropolitan CR programs via all modes of delivery (face‐to‐face, telephone, or general practice‐hybrid) operating in South Australia, Australia. ACS patients were included if they were ≥18 years of age and were referred and attended CR programs with medication details recorded in their hospital discharge summary. GDMT was assessed according to the Australian clinical guidelines for the management of acute coronary syndromes 2016. Prescription of all the four recommended medication classes was considered optimal. Logistic regression and χ2 test were used for association. Ethical approval was granted by the South Australian Department for Health and Wellbeing Human Research Ethics Committee (Reference No. HREC/15/SAH/63) and the Northern Territory Department of Health Human Research Ethics Committee (Reference No. HREC 2015‐2484) which included a waiver of consent per the National Statement on Ethical Conduct in Human Research and the study conforms with the Good Clinical Practice Guidelines. Results: Of the 1229 patients included, 74.6% were male and 41.1% had acute myocardial infarction. Only 39.7% of patients received optimal prescription. Prescription of any three or two medication class combinations occurred for 78.3% and 94.1% of patients, respectively. Optimal GDMT was associated with fewer hospital admissions (odds ratio = 0.647, 95% confidence interval 0.424–0.987, p = 0.043) with no significant gender association. Women were less likely to be prescribed angiotensin converting enzyme inhibitors (p = 0.003), angiotensin receptor blockers (p = 0.007), statins (p = 0.005), and any two (p < 0.001) and three combinations (p = 0.023) of medication classes. Conclusion: GDMT prescription was suboptimal in patients with ACS before attendance at CR. Primary care and CR clinicians have missed an opportunity to implement best practice guideline recommendations, particularly for women. [ABSTRACT FROM AUTHOR]

Background: Approximately 70% of Australians do not attend cardiac rehabilitation (CR). A potential solution is integrating CR into primary care. Objective: To propose a business model for primary care providers to implement CR using current Medicare items. Discussion: Using the chronic disease management plan, general practitioners (GPs) complete four clinical assessments at 1-2 weeks, 8-12 weeks, and 6 and 12 months after discharge. The net benefit of applying this model, compared with claiming the most used standard consultation Item 23, in Phase II CR is up to $505 per patient and $543 in Phase III CR. The number of rural GPs providing CR in partnership with the Country Access To Cardiac Health (CATCH) through the GP hybrid model has increased from 28 in 2021 to 32 in 2022. This increase might be attributed to this value proposition. The biggest limitation is access to allied health services in the rural areas. [ABSTRACT FROM AUTHOR]

Objective: To investigate cardiac rehabilitation utilisation and effectiveness, factors, needs and barriers associated with non-completion. Design: We used the mixed-methods design with concurrent triangulation of a retrospective cohort and a qualitative study. Setting: Economically disadvantaged areas in rural Australia. Participants: Patients (≥18 years) referred to cardiac rehabilitation through a central referral system and living in rural areas of low socioeconomic status. Main measures: A Cox survival model balanced by inverse probability weighting was used to assess the association between cardiac rehabilitation utilization and 12-month mortality/cardiovascular readmissions. Associations with non-completion were tested by logistic regression. Barriers and needs to cardiac rehabilitation completion were investigated through a thematic analysis of semi-structured interviews and focus groups (n = 28). Results: Among 16,159 eligible separations, 44.3% were referred, and 11.2% completed cardiac rehabilitation. Completing programme (HR 0.65; 95%CI 0.57–0.74; p < 0.001) led to a lower risk of cardiovascular readmission/death. Living alone (OR 1.38; 95%CI 1.00–1.89; p = 0.048), having diabetes (OR 1.48; 95%CI 1.02–2.13; p = 0.037), or having depression (OR 1.54; 95%CI 1.14–2.08; p = 0.005), were associated with a higher risk of non-completion whereas enrolment in a telehealth programme was associated with a lower risk of non-completion (OR 0.26; 95%CI 0.18–0.38; p < 0.001). Themes related to logistic issues, social support, transition of care challenges, lack of care integration, and of person-centeredness emerged as barriers to completion. Conclusions: Cardiac rehabilitation completion was low but effective in reducing mortality/cardiovascular readmissions. Understanding and addressing barriers and needs through mixed methods can help tailor cardiac rehabilitation programmes to vulnerable populations and improve completion and outcomes. [ABSTRACT FROM AUTHOR]

This study aimed to review the current literature exploring the utility of noninvasive ocular imaging for the diagnosis of peripheral artery disease (PAD). Our search was conducted in early April 2022 and included the databases Medline, Scopus, Embase, Cochrane, and others. Five articles were included in the final review. Of the five studies that used ocular imaging in PAD, two studies used retinal color fundus photography, one used optical coherence tomography (OCT), and two used optical coherence tomography angiography (OCTA) to assess the ocular changes in PAD. PAD was associated with both structural and functional changes in the retina. Structural alterations around the optic disc and temporal retinal vascular arcades were seen in color fundus photography of patients with PAD compared to healthy individuals. The presence of retinal hemorrhages, exudates, and microaneurysms in color fundus photography was associated with an increased future risk of PAD, especially the severe form of the disease. The retinal nerve fiber layer (RNFL) was significantly thinner in the nasal quadrant in patients with PAD compared to age-matched healthy individuals in OCT. Similarly, the choroidal thickness in the subfoveal region was significantly thinner in patients with PAD compared to controls. Patients with PAD also had a significant reduction in the retinal and choroidal circulation in OCTA compared to healthy controls. As PAD causes thinning and ischemic changes in retinal vessels, examination of the retinal vessels using retinal imaging techniques can provide useful information about early microvascular damage in PAD. Ocular imaging could potentially serve as a biomarker for PAD. PROSPERO ID: CRD42022310637 [ABSTRACT FROM AUTHOR]

Background/Aims: Patient-centred care is the delivery of a high-quality healthcare service that appropriately responds to the needs and preferences of patients. Addressing participants' needs and preferences in healthcare services is essential to improving patients' experiences and clinical outcomes. This article aimed to evaluate patient-reported experiences of standard cardiac rehabilitation programmes and the Country Heart Attack Prevention model of care, as well as design and standardise patient-reported experience measures. Methods: This was a cross-sectional study with a multi-method analysis. Participants (n=818) ≥18 years old with cardiovascular disease who attended cardiac rehabilitation programmes across all modes of delivery before (1 January 2017 to 30 June 2021), during (1 July 2021 to 30 June 2022) and after implementation of the Country Heart Attack Prevention model (1 July 2022 to 30 December 2022) responded to the patient satisfaction surveys. Participant data from before and after implementation of the model were categorised as 'not exposed', while those who received cardiac rehabilitation during this period were categorised as 'exposed'. A total of 170 participants provided qualitative feedback. Summary t-test was used to compare the means of the quantitative responses, and thematic analysis was used to generate themes from the qualitative feedback. Results: The overall patient-reported satisfaction scores for those not exposed (n=685) and exposed (n=133) to the Country Heart Attack Prevention model of care were 77.1% and 85.9%, respectively (mean difference=−8.8; 95% confidence interval=−10.2, −7.4; P≤0.05). Themes for positive feedback included education and information, communication and friendly advice. Themes for improvement included follow-up duration, more face-to-face contact and waiting time. Conclusions: Overall patient-reported satisfaction scores were significantly higher for participants who were exposed to the Country Heart Attack Prevention model of care compared with those who were not exposed. Addressing feedback on areas for improvement in cardiac rehabilitation services can promote attendance, completion and improved health outcomes of patients. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study is to report on the development and evaluation of the co-designed website for delivering interactive self-directed cardiac rehabilitation (CR). Methods and results: Multi-method user experience design framework was used to co-design the web application and complete usability testing. Participants were recruited based on their eligibility for CR. Thematic analysis collected the participants' design specifications and lived experiences. The System Usability Scale (SUS) was administered at the completion of the website development and the usability testing workshops. This collected the participants' perceptions of the website's effectiveness, efficiency, and their satisfaction. Website development and usability testing workshops included 39 and 35 participants with a mean age of 66.5 (SD 11.7) and 68.6 (SD 11.2), respectively. Both genders were equally represented across both workshops with 19 (48.7%) and 16 (45.7%) women. Workshop themes guided the design process. The mean SUS scores increased from 66.7 (SD 16.8) to 73.6 (21), P = 0.26. Easiness of use (P = 0.03), integration of the website functions (P ≤ 0.001), and consistency (P = 0.038) significantly improved from website development to usability testing. The proportion of participants rating it as excellent increased from 20.5% to 42.9%, P = 0.11. Conclusion: The evolution of our CR website development was completed with an improvement in usability. Upcoming evaluation of this intervention will report on its effectiveness. Graphical Abstract [ABSTRACT FROM AUTHOR]

Due to limited resources and constant, ever-changing healthcare challenges, health economics is essential to support healthcare decisions while improving health outcomes. Economic evaluation methodology facilitates informed decision-making related to the efficient allocation of resources while positively impacting clinical practice. In this paper, we provide an overview of economic evaluation methods and a real-world example applying one method of economic evaluation (cost-utility analysis) in nursing research. [ABSTRACT FROM AUTHOR]

Aims: This review aimed to investigate the effectiveness of nurse-led interventions vs. usual care on hypertension management, lifestyle behaviour, and patients' knowledge of hypertension and associated risk factors. Methods: A systematic review with meta-analysis was conducted following Joanna Briggs Institute (JBI) guidelines. MEDLINE (Ovid), EmCare (Ovid), CINAHL (EBSCO), Cochrane library, and ProQuest (Ovid) were searched from inception to 15 February 2022. Randomized controlled trials (RCTs) examining the effect of nurse-led interventions on hypertension management were identified. Title and abstract, full text screening, assessment of methodological quality, and data extraction were conducted by two independent reviewers using JBI tools. A statistical meta-analysis was conducted using STATA version 17.0. Results: A total of 37 RCTs and 9731 participants were included. The overall pooled data demonstrated that nurse-led interventions may reduce systolic blood pressure (mean difference −4.66; 95% CI −6.69, −2.64; I2 = 83.32; 31 RCTs; low certainty evidence) and diastolic blood pressure (mean difference −1.91; 95% CI −3.06, −0.76; I2 = 79.35; 29 RCTs; low certainty evidence) compared with usual care. The duration of interventions contributed to the magnitude of blood pressure reduction. Nurse-led interventions had a positive impact on lifestyle behaviour and effectively modified diet and physical activity, but the effect on smoking and alcohol consumption was inconsistent. Conclusion: This review revealed the beneficial effects of nurse-led interventions in hypertension management compared with usual care. Integration of nurse-led interventions in routine hypertension treatment and prevention services could play an important role in alleviating the rising global burden of hypertension. Registration: PROSPERO: CRD42021274900 Graphical Abstract [ABSTRACT FROM AUTHOR]

Access to health care is a universal human right and key indicator of health system performance. Spatial access encompasses geographic factors mediating with the accessibility and availability of health services. Equity of health service access is a global issue, which includes access to the specialized nursing workforce. Nursing research applying spatial methods is in its infancy. Given the use of spatial methods in health research is a rapidly developing field, it is timely to provide guidance to inspire greater application in cardiovascular research. Therefore, the objective of this methods paper is to provide an overview of spatial analysis methods to measure the accessibility and availability of health services, when to consider applying spatial methods, and steps to consider for application in cardiovascular nursing research. Central Illustration: Central Illustration [ABSTRACT FROM AUTHOR]

Introduction: Failings in providing continuity of care following an acute event for a chronic disease contribute to care inequities for First Nations Peoples in Australia, Canada, and Aotearoa (New Zealand). Methods: A rapid narrative review, including primary studies published in English from Medline, Embase, PsycINFO, and Cochrane Central, concerning chronic diseases (cancer, cardiovascular disease, chronic kidney disease, diabetes, and related complications), was conducted. Barriers and enablers to continuity of care for First Nations Peoples were explored considering an empirical lens from the World Health Organization framework on integrated person-centred health services. Results: Barriers included a need for more community initiatives, health and social care networks, and coaching and peer support. Enabling strategies included care adapted to patients' cultural beliefs and behavioural, personal, and family influences; continued and trusting relationships among providers, patients, and caregivers; and provision of flexible, consistent, adaptable care along the continuum. Discussion: The support and co-creation of care solutions must be a dialogical participatory process adapted to each community. Conclusions: Health and social care should be harmonised with First Nations Peoples' cultural beliefs and family influences. Sustainable strategies require a co-design commitment for well-funded flexible care plans considering coaching and peer support across the lifespan. [ABSTRACT FROM AUTHOR]

Preclinical and clinical studies demonstrate that T cell‐dependent bispecific antibodies (TDBs) induce systemic changes in addition to tumor killing, leading to adverse events. Here, we report an in‐depth characterization of acute responses to TDBs in tumor‐bearing mice. Contrary to modest changes in tumors, rapid and substantial lymphocyte accumulation and endothelial cell (EC) activation occur around large blood vessels in normal organs including the liver. We hypothesize that organ‐specific ECs may account for the differential responses in normal tissues and tumors, and we identify a list of genes selectively upregulated by TDB in large liver vessels. Using one of the genes as an example, we demonstrate that CD9 facilitates ICAM‐1 to support T cell–EC interaction in response to soluble factors released from a TDB‐mediated cytotoxic reaction. Our results suggest that multiple factors may cooperatively promote T cell infiltration into normal organs as a secondary response to TDB‐mediated tumor killing. These data shed light on how different vascular beds respond to cancer immunotherapy and may help improve their safety and efficacy. Synopsis: T cell‐dependent bispecific antibodies induce adverse systemic changes in addition to tumor killing. This study shows how different vascular beds respond to cancer immunotherapy, suggesting that reducing leukocyte‐endothelial interactions may limit the accumulation of T cells, thereby alleviating off‐tumor adverse responses. An in‐depth characterization of acute systemic responses to T cell‐dependent bispecific antibodies is presented.Immunological and vascular responses in the liver are observed that are more striking than the tumor responses.Liver response shows a vascular‐subtype‐dependent pattern.Transcriptional programs and candidate factors are uncovered that could account for the undesirable response. [ABSTRACT FROM AUTHOR]

Diabetes-related foot ulceration presents an increasing risk of lower limb amputation globally, driving the search for new treatment technologies. Our single-centre prospective observational study reports on the impact of bilayer biodegradable synthetic matrix technology (NovoSorb® BTM) on the healing and amputation rates of a diabetic foot ulceration cohort. Consecutive patients with a diabetes-related foot ulceration treated with NovoSorb BTM, between December 2019 and October 2021, were followed for 12 months. Complete wound healing and amputation outcomes were observed. Amputation risk was stratified using the Wound, Ischaemia and foot Infection (WIfI) classification system. Study outcomes were compared with recently published meta-analysis data to evaluate the impact of the synthetic matrix. In total, 25 NovoSorb BTM applications to 23 wounds in 22 patients were observed. Complete wound healing was observed in 15 of the wounds, 3 retained chronic wounds, 3 required minor amputation and 2 required major limb amputation. Further, 12-month WIfI amputation risk analysis saw 18 patients stratified to WIfI stage 4, 4 to WIfI stage 3 and 1 to WIfI stage 1. Our observed 12-month major amputation rates were 11.1% (n = 2) for stage 4 and 0% for stages 3 and 1. Our early experience suggests that NovoSorb BTM is a safe and effective treatment for moderate to severe diabetes-related foot ulceration. While larger-scale data are required, NovoSorb BTM may represent a promising new addition to the armamentarium of clinicians, who strive to achieve limb salvage in this complex cohort of patients. [ABSTRACT FROM AUTHOR]

Background: The standard 12-lead Holter ambulatory ECG monitor is complex in construction and uncomfortable for the wearer. A 12-lead equivalent ECG monitor was developed based on the EASI configuration with electronic-textile electrodes to meet these needs. Objective: In this study, we evaluated the accuracy and reliability of the EASI 12-lead equivalent ECG prototype. Results: The ECG hardware reproduced cardiac abnormalities from a ProSim 3.0 Vital signal simulator without significant deviation from a reference C.P. 200™ 12-Lead resting ECG. The vest and textile electrodes were subjected to 10 washing cycles. The joint connecting the snap fastener and the integrated wires were the weakest points, starting to fail after eight washing cycles; however, ten cycles of washing did not produce a noticeable loss of signal quality. The compression pressure for a stable-skin electrode interface of the vest was experimentally determined to be 15.92mmHg (minimum compression pressure at the ‘I’ electrode position) and 29.45mmHg (maximum compression pressure at ‘E’ electrode position). Conclusion: The textile-based ECG smart vest was non-inferior to standard 12-lead resting ECG and could be an alternative solution to monitor patients outside of a hospital setting, pending a larger scale trial with a clinical population. [ABSTRACT FROM AUTHOR]

Background: Numerous investigations have revealed significant relations between pain and fatigue in individuals with persistent pain conditions. However, the direction of influence between pain and fatigue remains unclear. Shortcomings of design and analytic approaches used in previous research limit the nature of conclusions that can be drawn about possible causal or directional relations between pain and fatigue. The present study investigated the temporal relation between changes in pain and changes in fatigue in individuals with musculoskeletal pain enrolled in a 10-week behavioral activation intervention. On the basis of previous findings, it was hypothesized that analyses would support a bi-directional relation between pain and fatigue.Methods: The study sample consisted of 104 individuals with chronic musculoskeletal pain participating in a 10-week standardized rehabilitation intervention. Measures of pain intensity and fatigue were completed pre-, mid-, and post-treatment. The three-wave data panel permitted examination of the direction of influence between pain and fatigue through the course of the intervention. A random-intercept cross-lagged panel model (RI-CLPM) was used to examine the temporal relation between pain and fatigue.Results: Consistent with previous research, cross-sectional analyses of pre-treatment data revealed significant correlations between measures of pain and fatigue. Significant reductions in pain and fatigue were observed through the course of treatment (d = 0.33 and d = 0.66, p < .001, respectively). RI-CLPM revealed that pain severity predicted later fatigue (pre to mid-treatment standardized path coefficient (β) = 0.55, p = 0.02; mid to post-treatment β = 0.36, p = 0.001); however, fatigue did not predict later pain severity.Conclusions: Discussion addresses the processes that might underlie the temporal relation between pain and fatigue. Clinical implications of the findings are also discussed. [ABSTRACT FROM AUTHOR]

Person-centred care advocates for co-design of all healthcare services and research interventions by the end-user. Co-design is widely used, but the methodological approaches, evaluation, and reporting of outcomes are often poorly defined. One methodology for co-design is the User Experience Design which provides guidance and theoretical frameworks to inform development and reporting measures. This article outlines the application of this approach in the development of a web-based cardiac rehabilitation program and reports on the very positive experiences of the patients involved in the process and how their input strategically influenced outcomes. [ABSTRACT FROM AUTHOR]

Aim: To present the first iteration of the caring life‐course theory. Background: Despite requiring care from birth to death, a person's universal or fundamental care needs and the subsequent care provision, either by self or others, has yet to be presented within a life‐course perspective. Accurately describing the care people require across their lifespan enables us to identify who, what type, how and where this care should be provided. This novel perspective can help to legitimise a person's care needs and the support they require from wider care systems and contexts. Design: Discussion paper outlines theory development. We adopted an inductive approach to theory development, drawing upon existing literature and the team's diverse experiences. Our theoretical insights were refined through a series of collaborative meetings to define the theory's constructs, until theoretical saturation was reached. Discussion: Fourteen constructs are identified as essential to the theory. We propose it is possible, using these constructs, to generate caring life‐course trajectories and predict divergences in these trajectories. The novel contribution of the theory is the interplay between understanding a person's care needs and provision within the context of their lifespan and personal histories, termed their care biography, and understanding a person's care needs and provision at specific points in time within a given care network and socio‐political context. Impact for Nursing: The caring life‐course theory can provide a roadmap to inform nursing and other care industry sectors, providing opportunities to integrate and deliver care from the perspective of the person and their care history, trajectories and networks, with those of professional care teams. It can help to shape health, social and economic policy and involve individuals, families and communities in more constructive ways of talking about the importance of care for improved quality of life and healthy societies. [ABSTRACT FROM AUTHOR]

We aim to report the co-design of the implementation strategy of a telehealth-enabled cardiac rehabilitation model of care in rural and remote areas of Australia. The goal of this model of care is to increase cardiac rehabilitation attendance and completion by country patients with cardiovascular diseases.We hypothesise that a model of care co-designed with stakeholders will address patients' needs and preferences and increase participation. We applied the Model for Large Scale Knowledge Translation and engaged with patients, clinicians and health service managers across six local health networks in rural South Australia. They informed the design of a web-based cardiac rehabilitation programme and the delivery of the expanded telehealth service.The stakeholders defined face-to-face, telephone, web-based or combinations as choices of mode of delivery to patients referred to cardiac rehabilitation. A case-managed programme supported by a web portal with an interface for patients and clinicians was considered more appropriate to the local context than a self-managed programme. A business model was developed to enable the sustainability of cardiac rehabilitation clinical assessments through primary care. The impact of the model of care on cardiac rehabilitation attendance/completion, clinical outcomes, patient-reported outcomes and patient-reported experiences and cost-effectiveness will be tested in a 12-month follow-up study. [ABSTRACT FROM AUTHOR]

Background/Aims: Maternal and infant morbidities associated with pregnant women with cardiac conditions are a global issue contingent upon appropriate care. This study aimed to describe the clinical variables and their association with the adherence scores to perinatal guidelines for pregnant women with cardiac conditions. The clinical variables included cardiac, perinatal, and neonatal outcomes and complications. Methods: Using a retrospective cross-sectional medical record audit, data were abstracted and categorised as cardiac, obstetric, and neonatal predictors. Linear regression modelling was used to find the mean difference (MD) in adherence scores for each predictor, including a 95% confidence interval (CI) and a significance value for all the three categories' clinical outcomes. Results: This maternal cohort's (n = 261) cardiac complications were primarily arrhythmias requiring treatment (29.9%), particularly SVT (28%), a new diagnosis of valvular heart disease and congenital heart disease (24%) and decompensated heart failure (HF) (16%). Women with HF had associated increased adherence scores (MD = 3.546, 95% CI: 1.689, 5.403) compared to those without HF. Elective LSCS mode of delivery was associated with a higher adherence score (MD = 5.197, 95% CI: 3.584, 6.811) than non-elective LSCS subgroups. Babies admitted to intensive /special care had greater adherence to the guidelines (MD = 3.581, 95% CI: 1.822, 5.340) than those not requiring the same care. Conclusions: Some pregnancy associated complications and morbidities were associated with higher adherence scores, reflecting that a diagnosis, identification of morbidities or risk factors, initiation of appropriate multidisciplinary involvement and adherence to guidelines were associated. Conversely, potentially avoidable major complications such as sepsis were associated with a low adherence score. Trial registration: ACTRN12617000417381. [ABSTRACT FROM AUTHOR]

Purpose: This study analysed the effect of online negative word-of-mouth (nWOM) firestorms in the retail banking sector. By understanding negative sentiment and sentiment recovery across an entire retail banking sector, the research exposed a unique view of banking in South Africa. Design/methodology/approach: The study made use of both a sentiment and topic analysis of over 1.7 million social media posts in South Africa. The methodology made use of both NLP and human validation techniques to measure changes in social media sentiment during online firestorms. This measurement included each of South Africa's major retail banks over a twelve month period. Findings: From the analysis, key trigger characteristics for these firestorms (product failures, service failures, social failures and communication failures) were categorised. In addition, the average duration of a firestorm was calculated and factors that impact sentiment recovery were explored. Originality/value: The study was located in South Africa and, unlike firm level studies, researched nWOM for the whole retail banking sector. A theoretical footprint depicting the typical anatomy of a firestorm was derived in order to aid stakeholders to be more vigilant and better equipped to provide correct intervention in such times of crisis. [ABSTRACT FROM AUTHOR]

Objectives: To investigate causes of death of people with cancer alive five years after diagnosis, and to compare mortality rates for this group with those of the general population. Design, setting, participants: Retrospective cohort study; analysis of South Australian Cancer Registry data for all people diagnosed with cancer during 1990–1999 and alive five years after diagnosis, with follow‐up to 31 December 2016. Main outcome measures: All‐cause and cancer cause‐specific mortality, by cancer diagnosis; standardised mortality ratios (study group v SA general population) by sex, age at diagnosis, follow‐up period, and index cancer. Results: Of 32 646 people with cancer alive five years after diagnosis, 30 309 were of European background (93%) and 16 400 were males (50%); the mean age at diagnosis was 60.3 years (SD, 15.7 years). The median follow‐up time was 17 years (IQR, 11–21 years); 17 268 deaths were recorded (53% of patients; mean age, 80.6 years; SD, 11.4 years): 7845 attributed to cancer (45% of deaths) and 9423 attributed to non‐cancer causes (55%). Ischaemic heart disease was the leading cause of death (2393 deaths), followed by prostate cancer (1424), cerebrovascular disease (1175), and breast cancer (1118). The overall standardised mortality ratio (adjusted for age, sex, and year of diagnosis) was 1.24 (95% CI, 1.22–1.25). The cumulative number of cardiovascular deaths exceeded that of cancer cause‐specific deaths from 13 years after cancer diagnosis. Conclusions: Mortality among people with cancer who are alive at least five years after diagnosis was higher than for the general population, particularly cardiovascular disease‐related mortality. Survivorship care should include early recognition and management of risk factors for cardiovascular disease. [ABSTRACT FROM AUTHOR]

Background/Aims Research has shown that health literacy can influence an individual's ability to practise self-care, particularly for patients with heart failure. This study aimed to assess health literacy and its relationship with heart failure knowledge and self-care practices in this patient group. Methods An observational sub-study was conducted with the data from a large randomised control trial that evaluated the relationship between patients' health literacy, general literacy, knowledge of heart failure and self-care. Results A total of 36 participants were recruited, of which 33 (89.9%) had adequate levels of health literacy. Health literacy was positively associated with heart failure knowledge. However, 67.7% of participants with adequate health literacy were found to have inadequate levels of self-care management.Conclusions Health literacy may facilitate better heart failure knowledge, but it does not necessarily lead to improved self-care management in patients with heart failure. This suggest that clinicians need to put more emphasis on translating knowledge into behavioural changes for self-care in this patient group. [ABSTRACT FROM AUTHOR]

Background. Only 20-40% of candidates actually attend cardiac rehabilitation programs in Australia, with attendance numbers remaining unchanged in the last 20 years. Common barriers to cardiac rehabilitation are geographical isolation, work responsibilities and transportation. Web-based cardiac rehabilitation can provide an alternative, patient centred, flexible delivery option. Objective. The objective of this study was to describe how patientgenerated input, through a workshop on desired content and features, informs technology and implementation specifications for the patient portal of a cardiac rehabilitation website. Methods. UX Design theoretical framework, using a co-design workshop, with thematic analysis and a survey. Results. We recruited 7 participants and 1 cardiac rehabilitation coordinator. The median age of participants was 75.0 (IQR 74.0-78.0), 4 (57.1%) were male and all had completed a cardiac rehabilitation program. Most used a smart phone (5, 71.4%) and Facebook (6, 85.7%). Four themes were identified: input information, format of information, usability and support of health behavior change, informing the next iteration of the workshops and contribute to the cardiac rehabilitation patient website development. [ABSTRACT FROM AUTHOR]

Health professionals operate within time and resource constrained environments, which can create barriers to engage in learning. There is increasing recognition that a large proportion of learning in the workplace is informal, unstructured, and occurring in the absence of an educator. The experiential nature of workplace learning, environmental constraints, and part-time health workforces require that learning be accessible, flexible, and engaging. [ABSTRACT FROM AUTHOR]

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Background/aims: Heart failure self-care is important for achieving optimal patient outcomes. Interactive information technology has been shown to enhance self-care knowledge and behaviours. This study aimed to codevelop and evaluate with consumers an avatar app for teaching heart failure self-care. Methods: Consumer participation and pre-post test methods. Findings: A total of six heart failure patients, two patients' family members and 15 heart failure clinicians and app developers participated in the development of the app. Overall, 13 people completed the app's feasibility testing and demonstrated a significant improvement in heart failure knowledge (P=0.020), self-care maintenance (P=0.027) and self-care confidence (P=0.002). Self-care management did not improve significantly (P=0.113) and satisfaction with learning using the app was very high (90%). Conclusions: The codevelopment approach used in this project resulted in a high level of user satisfaction. Consumers felt the app was a very feasible mechanism of heart failure education delivery. [ABSTRACT FROM AUTHOR]

Background: For pregnant women with a known cardiac condition or those who develop cardiac disease during pregnancy, there is an increased risk of complications during pregnancy, to both mother and foetus. To reduce this risk, best practice guidelines have been developed and available in South Australia for several years. Measuring clinical practice against the guideline recommendations verifies real-life practice and an essential part of any clinical practice quality improvement project by identifying gaps. This study is the first report on adherence to statewide perinatal guidelines for these women in South Australia. Objectives: To evaluate adherence to evidence-based clinical practice perinatal guidelines To identify predictors of adherence. Make comparisons across three practice settings examined. Design: A retrospective cross-sectional observational design that analysed data from medical records. Setting: Three SA Health public metropolitan, university-affiliated teaching hospitals with an obstetric service within a ten-year timeframe (2003–2013). Participants: 271 admissions of women who were categorised as 'pre-existent' or 'newly acquired' cardiac condition during their pregnancy. Outcome measures: Adherence to guidelines was measured using a purposefully designed scoring system across the three sites. The researcher chose a minimum acceptable score of 17 applicable to the 'newly acquired' group and 35 for the 'pre-existent' group. Results: Overall adherence to the perinatal guidelines for the combined groups (n = 271) reported a mean score of 16.3, SD ± 6.7, with a median score of 17. Women in the 'newly acquired' group scored less compared to women in the 'pre-existent' group (Estimate -2.3, CI -3.9,-0.7). Variance in adherence was observed across the three hospitals (P value <0.0001). The most significant predictor of adherence to guidelines was pre-pregnancy cardiac consultation which increased the likelihood of preconception care by Odds ratio 18.5 (95%, CI 2, 168). Similarly, compliance with mental health screening was associated with improved adherence to antenatal assessments (OR: 11.3(95% CI 4.7, 27.3). Conclusion: There was overall suboptimal adherence to the statewide guidelines for women with cardiac conditions in pregnancy. The variance in the level of adherence across the three hospitals correlated with the exposure to higher acuity cases, and that appropriate up- referral to a higher acuity hospital was intrinsically linked to better adherence. Recommendations include preconception counselling, and to ensure that all health practitioners have the skills, sufficient training and time to complete a comprehensive initial antenatal assessment Trial registration: ACTRN12617000417381 [ABSTRACT FROM AUTHOR]

Background Symptoms of fatigue have been shown to be associated with heightened levels of disability in patients suffering from a wide range of debilitating health and mental health conditions. The role of fatigue as a determinant of work disability in individuals with work-related musculoskeletal disorders (WRMD) has received little attention. The present study examined the role of fatigue as a determinant of work-disability in individuals with WRMDs. Methods Participants included 117 individuals with WRMDs who completed measures of pain severity, fatigue, depression and disability before and after participating in a behavioral activation rehabilitation intervention. Results Cross-sectional analyses on pre-treatment measures revealed that fatigue contributed significant variance to the prediction of self-reported disability, beyond the variance accounted for by pain severity and depression. Prospective analyses revealed that reductions in fatigue through the course of treatment predicted occupational re-engagement following termination of the intervention. Conclusions The results of the present study suggest fatigue contributes to occupational disability, independent of the effects of pain and depression. The findings also suggest that meaningful reductions in fatigue might be achieved through psychosocial interventions that promote gradual re-integration into discontinued activities, increase participants' exposure to success and achievement experiences, and reduce the severity of depressive symptoms. Behavioural activation interventions such as the one used in the present study might contribute to more positive occupational outcomes in work-disabled individuals who report high levels of fatigue. [ABSTRACT FROM AUTHOR]

Background: Early identification of acute coronary syndrome is crucial for a patient's likelihood of survival. Point-of-care testing of cardiac troponin is a rapid test of cardiac troponin that can be conducted closer to where clinical care is delivered, with a significant shorter turnaround time. Point-of-care testing of troponin may improve timely diagnosis of acute coronary syndrome. Aim: To examine existing evidence on the effectiveness of point-of-care testing of troponin for acute coronary syndrome management in the emergency department. Methods: A systematic review of randomised controlled trials was conducted across databases, and grey literature. Results: No study evaluated adherence to acute coronary syndrome management guidelines. One of the five studies that assessed length of stay showed a statistically significant reduction (P=0.035). Two of the three studies that measured time to disposition in emergency department demonstrated statistically significant effects (P=0.04 vs P=0.05) favouring point-of-care testing of troponin. One study demonstrated statistically significant effects on successful discharge to home from emergency department (P=0.001). No significant effects were reported for mortality or accuracy. Conclusion: Point-of-care testing of troponin can significantly reduce time to disposition in emergency department and successful discharge home. Translation of this evidence into clinical practice is recommended. [ABSTRACT FROM AUTHOR]

Purpose: People affected by cancer who live in rural Australia experience inferior survival compared to their urban counterparts. This study determines whether self-reported physical and mental health, as well as health-promoting behaviours, also differ between rural and urban Australian adults with a history of cancer.Methods: Weighted, representative population data were collected via the South Australian Monitoring and Surveillance System between 1 January 2010 and 1 June 2015. Data for participants with a history of cancer (n = 4295) were analysed with adjustment for survey year, gender, age group, education, income, family structure, work status, country of birth and area-level relative socioeconomic disadvantage (SEIFA).Results: Cancer risk factors and co-morbid physical and mental health issues were prevalent among cancer survivors regardless of residential location. In unadjusted analyses, rural survivors were more likely than urban survivors to be obese and be physically inactive. They were equally likely to experience other co-morbidities (diabetes, chronic obstructive pulmonary disease, cardiovascular disease, arthritis or osteoporosis). With adjustment for SEIFA, rural/urban differences in obesity and physical activity disappeared. Rural survivors were more likely to have trust in their communities, less likely to report high/very high distress, but equally likely to report a mental health condition, both with and without adjustment for SEIFA.Conclusions: There is a need for deeper understanding of the impact of relative socioeconomic disadvantage on health (particularly physical activity and obesity) in rural settings and the development of accessible and culturally appropriate interventions to address rural cancer survivors' specific needs and risk factors. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In this study, we examined the effectiveness of a self‐management intervention delivered to people with heart failure in Vietnam. It used teach‐back, a cyclical method of teaching content, checking comprehension, and re‐teaching to improve understanding. A single‐site cluster randomized controlled trial was conducted, and six hospital wards were randomized into two study groups. On the basis of ward allocation, 140 participants received either usual care or the teach‐back heart failure self‐management intervention plus usual care. The intervention involved, prior to discharge, an individual educational session on heart failure self‐care, with understanding reinforced using teach‐back, a heart failure booklet, weighing scales, diary, and a follow‐up phone call 2 weeks post‐discharge. The control group received usual care and the booklet. Outcomes were heart failure knowledge, self‐care (maintenance, management and confidence), and all‐cause hospitalizations assessed at 1 and 3 months (end‐point). Upon completion of the study, the intervention group had significantly greater knowledge and self‐care maintenance than the control group. Other outcomes did not differ between the two groups. The teach‐back self‐management intervention demonstrated promising benefits in promoting self‐care for heart failure patients. [ABSTRACT FROM AUTHOR]

In the article, the author discusses the connection between oral and heart health and how dental factors can affect the success of surgery and reduce the risks of complications like infective endocarditis.

Taming the cytokine beast: Bispecific antibodies, which are engineered to engage a cancer cell antigen and activate T cells to kill the cancer cell, are showing clinical promise. Unfortunately, they can also cause major side effects as a result of uncontrolled immune activation and cytokine release. Li et al. found a way to separate the beneficial effects from the harmful ones by showing that activation of tumor necrosis factor–α signaling is necessary for the toxic systemic cytokine release but not for successful cancer treatment. The authors identified several ways to inhibit the dangerous signaling pathway and demonstrated them in mouse models, with no loss of anticancer efficacy. T cell–retargeting therapies have transformed the therapeutic landscape of oncology. Regardless of the modality, T cell activating therapies are commonly accompanied by systemic cytokine release, which can progress to deadly cytokine release syndrome (CRS). Because of incomplete mechanistic understanding of the relationship between T cell activation and systemic cytokine release, optimal toxicity management that retains full therapeutic potential remains unclear. Here, we report the cell type–specific cellular mechanisms that link CD3 bispecific antibody–mediated killing to toxic cytokine release. The immunologic cascade is initiated by T cell triggering, whereas monocytes and macrophages are the primary source of systemic toxic cytokine release. We demonstrate that T cell–generated tumor necrosis factor–α (TNF-α) is the primary mechanism mediating monocyte activation and systemic cytokine release after CD3 bispecific treatment. Prevention of TNF-α release is sufficient to impair systemic release of monocyte cytokines without affecting antitumor efficacy. Systemic cytokine release is only observed upon initial exposure to CD3 bispecific antibody not subsequent doses, indicating a biological distinction between doses. Despite impaired cytokine release after second exposure, T cell cytotoxicity remained unaffected, demonstrating that cytolytic activity of T cells can be achieved in the absence of cytokine release. The mechanistic uncoupling of toxic cytokines and T cell cytolytic activity in the context of CD3 bispecifics provides a biological rationale to clinically explore preventative treatment approaches to mitigate toxicity. [ABSTRACT FROM AUTHOR]

Objective: To identity differences between a general access index (Accessibility/ Remoteness Index of Australia; ARIA+) and a specific acute and aftercare cardiac services access index (Cardiac ARIA). Research design and methods: Exploratory descriptive design. ARIA+ (2011) and Cardiac ARIA (2010) were compared using cross-tabulations (chi-square test for independence) and map visualisations. All Australian locations with ARIA+ and Cardiac ARIA values were included in the analysis (n = 20,223). The unit of analysis was Australian locations. Results: Of the 20,223 locations, 2757 (14% of total) had the highest level of acute cardiac access coupled with the highest level of general access. There were 1029 locations with the poorest access (5% of total). Approximately two thirds of locations in Australia were classed as having the highest level of cardiac aftercare. Locations in Major Cities, Inner Regional Australia, and Outer Regional Australia accounted for approximately 98% of this category. There were significant associations between ARIA+ and Cardiac ARIA acute (χ2 = 25250.73, df = 28, p<0.001, Cramer’s V = 0.559, p<0.001) and Cardiac ARIA aftercare (χ2 = 17204.38, df = 16, Cramer’s V = 0.461, p<0.001). Conclusions: Although there were significant associations between the indices, ARIA+ and Cardiac ARIA are not interchangeable. Systematic differences were apparent which can be attributed largely to the underlying specificity of the Cardiac ARIA (a time critical index that uses distance to the service of interest) compared to general accessibility quantified by the ARIA+ model (an index that uses distance to population centre). It is where the differences are located geographically that have a tangible impact upon the communities in these locations–i.e. peri-urban areas of the major capital cities, and around the more remote regional centres. There is a strong case for specific access models to be developed and updated to assist with efficient deployment of resources and targeted service provision. The reasoning behind the differences highlighted will be generalisable to any comparison between general and service-specific access models. [ABSTRACT FROM AUTHOR]

Background: Adverse events occur in health care. Detection and reporting of deterioration therefore have a critical role to play. Patient and family member (consumer) involvement in patient safety has gained powerful support amongst global policymakers. Few studies, with none taking a rigorous qualitative approach, have drawn upon consumers' experiences to establish their preferences in consumer reporting of patient deterioration programmes. Objective: To explore consumers' experiences of previous reporting of patient deterioration; their preferred educational strategies on this role and recommended pathways in a consumer reporting of patient deterioration model. Design, setting and participants: An interpretive, qualitative research design was utilized. Nine focus group interviews were undertaken across Adelaide, capital city of South Australia. Interviews were audio‐taped, transcribed and analysed thematically. Twenty‐six adults described, then reflected, on previous experiences of reporting patient deterioration. Results: Overarching themes incorporated consumers' experiences and patient/family education. Three themes emerged in relation to consumers' experiences: feelings, thoughts and actions. Five themes arose on educating consumers: content, timing, format, information providers and information recipients. The consumers' deep reflections on their past reporting experiences led to the development of a new model for consumer reporting of patient deterioration. Conclusions: Consumers' views on ways to improve consumer reporting of patient deterioration processes emerged. These improvements include structured educational programmes for staff advocating open health‐care professional/consumer communication, educational materials developed and tested with English‐speaking and culturally and linguistically diverse consumers and a model with three consumer reporting pathways. [ABSTRACT FROM AUTHOR]

Aims: Heart failure (HF) patients are taught to identify a rapid 5 lb body‐weight gain for early detection of cardiac decompensation. Few data support this common advice. The study aim was to determine whether a 5 lb weight gain in 1 week and signs and symptoms of HF increased risk for unplanned physician or emergency department (ED) visits or hospital admission in rural HF patients. Methods and results: This was a secondary analysis of a randomized trial. Patients tracked body weight and HF symptoms using diaries. We included patients adherent to daily diaries >50% over 24 months (N = 119). Mean age was 69 ± 11 years; 77% (65) were male, and 67% completed diaries. A weight gain of 5 lb over 7 days was associated with a greater risk for ED visits but not hospital admission [hazard ratio (HR) 1.06, 95% confidence interval (CI) 1.04, 1.08; P < 0.0001 vs. HR 1.01, 95% CI 0.88, 1.16; P = 0.79]. Increased dyspnoea over 7 days was associated with a greater risk of ED visits and hospital admissions (HR 9.64, 95% CI 3.68, 25.22; P < 0.0001 vs. HR 5.89, 95% CI 1.73, 20.04; P = 0.01). Higher diary adherence was associated with older age, non‐sedentary behaviour, lower depression, and HF knowledge. Conclusions: Heart failure patients are counselled to observe for body‐weight gain. Our data do not support that a 5 lb weight gain was associated with hospital admission. Dyspnoea was a better predictor of ED visits and hospital admissions. Daily tracking of dyspnoea symptoms may be an important adjunct to daily weight to prevent hospitalization. [ABSTRACT FROM AUTHOR]

Globally, the increasing prevalence of heart failure is a burden on health‐care systems, especially in under‐resourced countries, such as Vietnam. We describe a prospective single‐site, cluster randomized controlled trial of an intervention designed to teach adult patients about heart failure and how to undertake self‐care activities. The intervention, delivered by a nurse, comprises of an individual teaching session using teach‐back, a heart failure booklet, weighing scales, a diary to document daily weight, and a follow‐up phone call 2 weeks after hospital discharge. Teach‐back is a process of asking patients to repeat information and for the nurse to fill any gaps or misunderstanding until adequate understanding is demonstrated. The control group will receive usual education plus the heart failure (HF) booklet. A total of 140 participants will be allocated into two study groups. The level of randomization is at the ward level. The primary outcome (HF knowledge) and secondary outcomes (self‐care behaviors and all‐cause hospitalizations) will be measured at 1 and 3 months. This study will make an important contribution regarding a protocol of teach‐back and chronic disease self‐management. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

T cell–dependent bispecific antibodies with bivalent low affinity binding to HER2 are more selective for tumor cells that overexpress the target. Less can be more for tumor targeting: HER2 is a receptor tyrosine kinase that is often overexpressed in breast cancer. Unfortunately, many normal tissues also express HER2, resulting in toxicity from HER2-targeted treatments. Slaga et al. have developed a T cell–dependent bispecific antibody that binds to both HER2 and the CD3 protein on T cells, helping redirect the T cells to recognize tumor cells. To improve treatment safety, the authors selected an antibody that binds two HER2 molecules at a time, but with low affinity for each one, making it selective for tumors that have a high density of surface HER2 relative to healthy tissues. A primary barrier to the success of T cell–recruiting bispecific antibodies in the treatment of solid tumors is the lack of tumor-specific targets, resulting in on-target off-tumor adverse effects from T cell autoreactivity to target-expressing organs. To overcome this, we developed an anti-HER2/CD3 T cell–dependent bispecific (TDB) antibody that selectively targets HER2-overexpressing tumor cells with high potency, while sparing cells that express low amounts of HER2 found in normal human tissues. Selectivity is based on the avidity of two low-affinity anti-HER2 Fab arms to high target density on HER2-overexpressing cells. The increased selectivity to HER2-overexpressing cells is expected to mitigate the risk of adverse effects and increase the therapeutic index. Results included in this manuscript not only support the clinical development of anti-HER2/CD3 1Fab–immunoglobulin G TDB but also introduce a potentially widely applicable strategy for other T cell–directed therapies. The potential of this discovery has broad applications to further enable consideration of solid tumor targets that were previously limited by on-target, but off-tumor, autoimmunity. [ABSTRACT FROM AUTHOR]