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  Title Collegium Ramazzini response to 'Asbestos, asbestosis, and cancer, the Helsinki criteria for diagnosis and attribution 2014: recommendations' Type Journal Article
  Year 2016 Publication Scandinavian Journal of Work, Environment & Health Abbreviated Journal Scand J Work Environ Health  
  Volume 42 Issue 1 Pages 91-94  
  Keywords  
  Abstract The Collegium Ramazzini recognizes the work of the 2014 expert committee convened by the Finnish Institute of Occupational Health (FIOH) to update the 1997 and 2000 Helsinki criteria on asbestos, asbestosis and cancer in light of new advances in research. The published consensus report of the Helsinki Committee (1) and its more extensive on-line version (http://www.ttl.fi/hcuasbestos) provide a valuable synthesis of many aspects of current knowledge of the hazards of asbestos. The Collegium Ramazzini is, however, very concerned about the sections of the 2014 Helsinki consensus report that discuss criteria for pathological diagnosis of the diseases caused by asbestos. The sections of the Helsinki report dealing with pathology diagnosis are based on a selective reading of the medical literature. They rely too much on certain published articles (2-4) while omitting reference to other important and highly relevant information. They are heavily influenced by the outdated and incorrect concept that analysis of lung tissue for asbestos fibers and asbestos bodies can provide data to contradict exposures that are documented in a reliable occupational history. Further, without any explanation, the most accepted asbestos definition [1982 College of American Pathologists-National Institute of Occupational Safety and Health (CAP-NIOSH)] – which underwent extensive review and endorsement by NIOSH – is now replaced in the 2014 Helsinki criteria by the more restrictive CAP/PPS modification. The latter differs especially in the early histological stages of asbestosis and in the higher numbers of asbestos bodies needed to make the pathological diagnosis of asbestosis (5). These sections of the Helsinki report appear to have been influenced by members of the Helsinki Committee with undisclosed financial conflicts of interest. Applying the 2014 Helsinki report recommendations on pathology diagnosis will lead to: (i) missed diagnoses of cases of disease caused by asbestos; (ii) failure of workers' compensation systems to properly compensate workers who have been exposed to asbestos; and (iii) lost opportunities for public health authorities to recognize asbestos hazards and to prevent asbestos-related disease. For these reasons, relying on lung tissue analysis for the diagnosis and compensation of asbestos-related disease – while ignoring the history of occupational exposure – is unacceptable. Application of these recommendations will cause harm to the health of workers and their families in countries around the world. The Collegium Ramazzini has identified five specific problems with the pathology sections of the 2014 Helsinki consensus report: (i) Over-reliance on the detection of “asbestos bodies” as indicators of past exposure to asbestos. It is now recognized that chrysotile asbestos, the predominant form of asbestos in use today, rarely forms asbestos bodies. Therefore, failure to detect asbestos bodies cannot be used as a criterion for excluding exposure to chrysotile asbestos. Reliance on the detection of asbestos bodies as an index of past exposure to asbestos may lead to false negative diagnoses (5, 6). The Collegium Ramazzini is particularly critical of the suggestion in the 2014 Helsinki consensus report that a finding of “over 1000 asbestos bodies per gram of dry tissue (100 asbestos bodies per gram of wet tissue) or over 1 asbestos body per milliliter of bronchoalveolar lavage fluid as measured by light microscopy in a qualified laboratory” can be used as a guideline “to identify persons with a high probability of exposure to asbestos dust” (p5, 1). This suggestion: is not consistent with the current recognition that chrysotile asbestos rarely forms asbestos bodies; omits any mention of what defines a “qualified laboratory”; fails to address the well-documented variability across laboratories in both counting procedures and standards (7, 8); may lead to unethical, unnecessary, and risky surgical procedures (see below). The Collegium Ramazzini has no concern about using a finding of asbestos bodies as an indicator of past exposure to asbestos. However, there is no reliable basis for the proposed thresholds that must be met before such a conclusion is allowed, and the failure to find asbestos bodies cannot be used to contradict a reliable occupational history of exposure, particularly to chrysotile. (ii) Over-reliance on asbestos fiber counts in lung tissue as an indicator of past exposure to asbestos. Asbestos fiber counts obtained from human lung tissue are now recognized to be a highly insensitive measure of past exposure to chrysotile asbestos. Chrysotile asbestos fibers are well documented to have only a short residence time in lung tissue and, therefore, their measurement in the lung cannot be used as a measure of cumulative past exposure (9-15, 8, 16). As with asbestos bodies, the Collegium Ramazzini has no concern about using a finding of asbestos fibers in lung tissue as an indicator of past exposure to asbestos. However, there is no reliable basis for the failure to find asbestos fibers in lung tissue to be used to contradict a reliable occupational history of exposure, particularly to chrysotile. Short asbestos fibers, less than 5 microns in length, are a further issue here and are not discussed in the Helsinki consensus report. These fibers were originally not counted by most laboratories because they were below the visibility limits of the phase contrast microscope. Today they are readily visible under the electron microscope and are counted by some laboratories and not by others. The Helsinki report considers neither short asbestos fibers nor their possible contribution to the pathogenesis of asbestos-related diseases (17-19, 8). It also does not consider the well-documented wide intra- and inter-laboratory variability in procedures for the counting of short fibers (7, 10, 8) (iii) Use of the scanning electron microscope (SEM) at low magnification as a tool for evaluation of asbestos-related disease. The scanning electron microscope (SEM) at low magnification should not be used for causal attribution in diagnosis of the diseases potentially caused by asbestos because it is incapable of detecting most chrysotile fibers (10, 14, 20, 21) An additional problem with microscopic screening of lung tissue for asbestos bodies and asbestos fibers by SEM at low magnification is that there is wide intra- and inter-laboratory variability in these procedures with no standardization of diagnostic procedures across laboratories (7, 8). For these reasons, use of low-magnification SEM as a diagnostic instrument will lead to false-negative diagnoses, particularly in the case of individuals with a history of exposure to chrysotile. The Collegium Ramazzini recommends instead that the analytical transmission electron microscopy (ATEM) should be the diagnostic instrument of choice for fiber analysis in cases of suspected exposure to asbestos (22). (iv) There is no recognition that chrysotile is the predominant type of asbestos fiber found in pleural mesothelioma tissue. Multiple studies have demonstrated that chrysotile fibers are the predominant type of asbestos fiber found in pleural mesothelioma tissue. The relative abundance of chrysotile fibers in mesothelioma tissue contrasts with their relative scarcity in lung tissue (8, 9, 11-13, 15, 16) (v) Threshold for the development of an asbestos-related lung cancer. The 1997 Helsinki report states: “The relative risk of lung cancer is estimated to increase 0.5-4.0% for each fiber per cubic centimeter per year (fiber-years) of cumulative exposure”. The 2014 Helsinki report (1) states on pages 6 and 7: “Using an estimate of 4% increase of risk for each fibres per cubic centimeter per year (fibre year) of cumulative exposure: 'A cumulative exposure of 25 fibre-years is estimated to increase the risk of lung cancer 2-fold, clinical cases of asbestosis may occur at comparable cumulative exposures.” Setting aside the fact that published studies support a linear dose-response relationship without a threshold (23-26), the 2014 consensus statement ignores its previously acknowledged range of risk estimates and chooses the upper end of the range without comment or explanation. This compounds the error of its failure to acknowledge and reference studies indicating a linear dose-response relationship and instead embraces a statement that implicates a specific threshold. This error is not mitigated by its sop to chrysotile: “'Occupational histories (fibre years of exposure) are probably a better indicator of lung cancer risk from chrysotile than fibre burden analysis' because of the higher clearance rates for chrysotile.” It is the rare occupational history that provides information about fiber years of exposure. These concerns are not new or novel. Rather, they have been recognized for at least the past 25 years (10, 14). As chrysotile has always been the vast majority of the asbestos used globally – and, for at least the past 20 years, has essentially been the only form of asbestos used – these concerns are all the more significant going forward. In conclusion, the Collegium Ramazzini emphasizes that a carefully obtained history of occupational exposure to asbestos is the cornerstone of an accurate diagnosis of the diseases caused by asbestos (27). An occupational history taken by an experienced clinician and supplemented as necessary by an exposure assessment conducted by an experienced industrial hygienist is a far more sensitive and specific indicator of lung cancer risk from chrysotile asbestos than asbestos body counting or lung fiber burden analysis (28, 29). (ABSTRACT TRUNCATED)  
  Address  
  Corporate Author Collegium Ramazzini Thesis  
  Publisher Place of Publication Editor  
  Language English Summary Language Original Title  
  Series Editor Series Title Abbreviated Series Title  
  Series Volume Series Issue Edition  
  ISSN 0355-3140 ISBN Medium  
  Area Expedition Conference  
  Notes PMID:26637163 Approved no  
  Call Number ref @ user @ Serial 90810  
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Author (up) Aasekjaer, K.; Waehle, H.V.; Ciliska, D.; Nordtvedt, M.W.; Hjalmhult, E. url  doi
openurl 
  Title Management Involvement--A Decisive Condition When Implementing Evidence-Based Practice Type Journal Article
  Year 2016 Publication Worldviews on Evidence-Based Nursing Abbreviated Journal Worldviews Evid Based Nurs  
  Volume 13 Issue 1 Pages 32-41  
  Keywords Attitude of Health Personnel; Evidence-Based Practice/*methods; Focus Groups; *Health Knowledge, Attitudes, Practice; Health Personnel/*psychology; Humans; *Leadership; Patient Acceptance of Health Care/*psychology; Surveys and Questionnaires; evidence-based practice; grounded theory; implementation; tailoring principles  
  Abstract BACKGROUND: Even though health professionals have a positive attitude toward evidence-based practice (EBP), they have limited skills when it comes to implementation of EBP. A postprofessional program in EPB has been offered at Bergen University College since 2004. To date, there is limited knowledge of how the graduates of the program implement and make use of the EBP principles in their working environment in different healthcare settings. AIM: The aim of the study was to explore the facilitators and strategies to successful implementation of the steps of EBP as experienced by health professionals who had completed a postgraduate program in EBP. METHODS: Grounded theory was used in gathering and analyzing data from single and focus group interviews of 20 health professionals who had attended a postprofessional program in EBP. Inclusion criteria also required current clinical practice. RESULTS: This study identified a specific set of activities used by health professionals when implementing EBP within their service organization. Creating an interest and understanding of EBP amongst their colleagues appeared to be a challenge, which they addressed by using the generated grounded theory of “tailoring principles.” The dominant condition of this theory was management involvement. LINKING EVIDENCE TO ACTION: This study highlighted the importance of middle-range managers' coordinating and supporting role as a decisive component in the process of implementing EBP to clinical settings in Norway. Moreover, the dynamic complex process of “tailoring principles” also showed how the production of a clinical protocol became an outcome of implementation effectiveness as well as input for further intervention effectiveness. Tailoring the principle of EBP to the organizational and cultural context facilitated the implementation of EBP.  
  Address Associated Professor, Centre for Evidence-Based Practice, Bergen University College, Bergen, Norway  
  Corporate Author Thesis  
  Publisher Place of Publication Editor  
  Language English Summary Language Original Title  
  Series Editor Series Title Abbreviated Series Title  
  Series Volume Series Issue Edition  
  ISSN 1545-102X ISBN Medium  
  Area Expedition Conference  
  Notes PMID:26788799 Approved no  
  Call Number ref @ user @ Serial 95091  
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Author (up) Achuta, V.S.; Grym, H.; Putkonen, N.; Louhivuori, V.; Karkkainen, V.; Koistinaho, J.; Roybon, L.; Castren, M.L. url  doi
openurl 
  Title Metabotropic glutamate receptor 5 responses dictate differentiation of neural progenitors to NMDA-responsive cells in fragile X syndrome Type Journal Article
  Year 2016 Publication Developmental Neurobiology Abbreviated Journal Dev Neurobiol  
  Volume Issue Pages  
  Keywords 2-methyl-6-(phenylethynyl)-pyridine; fragile X syndrome; glutamatergic neurons; induced pluripotent stem cells; metabotropic glutamate receptor 5  
  Abstract Disrupted metabotropic glutamate receptor 5 (mGluR5) signaling is implicated in many neuropsychiatric disorders, including autism spectrum disorder, found in fragile X syndrome (FXS). Here we report that intracellular calcium responses to the group I mGluR agonist (S)-3,5-dihydroxyphenylglycine (DHPG) are augmented, and calcium-dependent mGluR5-mediated mechanisms alter the differentiation of neural progenitors in neurospheres derived from human induced pluripotent FXS stem cells and the brains of mouse model of FXS. Treatment with the mGluR5 antagonist 2-methyl-6-(phenylethynyl)-pyridine (MPEP) prevents an abnormal clustering of DHPG-responsive cells that are responsive to activation of ionotropic receptors in mouse FXS neurospheres. MPEP also corrects morphological defects of differentiated cells and enhanced migration of neuron-like cells in mouse FXS neurospheres. Unlike in mouse neurospheres, MPEP increases the differentiation of DHPG-responsive radial glial cells as well as the subpopulation of cells responsive to both DHPG and activation of ionotropic receptors in human neurospheres. However, MPEP normalizes the FXS-specific increase in the differentiation of cells responsive only to N-methyl-d-aspartate (NMDA) present in human neurospheres. Exposure to MPEP prevents the accumulation of intermediate basal progenitors in embryonic FXS mouse brain suggesting that rescue effects of GluR5 antagonist are progenitor type-dependent and species-specific differences of basal progenitors may modify effects of MPEP on the cortical development. (c) 2016 Wiley Periodicals, Inc. Develop Neurobiol, 2016.  
  Address Autism Foundation, Kuortaneenkatu 7B, Helsinki, FI-00520, Finland  
  Corporate Author Thesis  
  Publisher Place of Publication Editor  
  Language English Summary Language Original Title  
  Series Editor Series Title Abbreviated Series Title  
  Series Volume Series Issue Edition  
  ISSN 1932-8451 ISBN Medium  
  Area Expedition Conference  
  Notes PMID:27411166 Approved no  
  Call Number ref @ user @ Serial 95938  
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Author (up) Al-Dossary, R.N.; Kitsantas, P.; Maddox, P.J. url  doi
openurl 
  Title Residency Programs and Clinical Leadership Skills Among New Saudi Graduate Nurses Type Journal Article
  Year 2016 Publication Journal of Professional Nursing : Official Journal of the American Association of Colleges of Nursing Abbreviated Journal J Prof Nurs  
  Volume 32 Issue 2 Pages 152-158  
  Keywords Clinical leadership; New graduate nurse; Residency programs; Saudi Arabia  
  Abstract Nurse residency programs have been adopted by health care organizations to assist new graduate nurses with daily challenges such as intense working environments, increasing patient acuity, and complex technologies. Overall, nurse residency programs are proven beneficial in helping nurses transition from the student role to independent practitioners and bedside leaders. The purpose of this study was to assess the impact of residency programs on leadership skills of new Saudi graduate nurses who completed a residency program compared to new Saudi graduate nurses who did not participate in residency programs. The study design was cross-sectional involving a convenience sample (n = 98) of new graduate nurses from three hospitals in Saudi Arabia. The Clinical Leadership Survey was used to measure the new graduate nurses' clinical leadership skills based on whether they completed a residency program or not. Descriptive statistics, correlation, and multiple linear regression analyses were conducted to examine leadership skills in this sample of new Saudi graduate nurses. A significant difference was found between residents and nonresidents in their leadership skills (t = 10.48, P = .000). Specifically, residents were significantly more likely to show higher levels of leadership skills compared to their counterparts. Attending a residency program was associated with a significant increase in clinical leadership skills. The findings of this study indicate that there is a need to implement more residency programs in hospitals of Saudi Arabia. It is imperative that nurse managers and policy makers in Saudi Arabia consider these findings to improve nurses' leadership skills, which will in turn improve patient care. Further research should examine how residency programs influence new graduate nurses' transition from student to practitioner with regard to clinical leadership skills in Saudi Arabia.  
  Address Professor, Chair, Health Administration and Policy.; George Mason University, Fairfax, VA 22030-4444.. Electronic address: pmaddox@gmu.edu  
  Corporate Author Thesis  
  Publisher Place of Publication Editor  
  Language English Summary Language Original Title  
  Series Editor Series Title Abbreviated Series Title  
  Series Volume Series Issue Edition  
  ISSN 8755-7223 ISBN Medium  
  Area Expedition Conference  
  Notes PMID:27000200 Approved no  
  Call Number ref @ user @ Serial 95094  
Permanent link to this record
 

 
Author (up) Al-Jundi, W.; Wild, J.; Ritchie, J.; Daniels, S.; Robertson, E.; Beard, J. url  doi
openurl 
  Title Assessing the Nontechnical Skills of Surgical Trainees: Views of the Theater Team Type Journal Article
  Year 2016 Publication Journal of Surgical Education Abbreviated Journal J Surg Educ  
  Volume 73 Issue 2 Pages 222-229  
  Keywords Curriculum; Decision Making; Education, Medical, Graduate; Educational Measurement; Humans; Interdisciplinary Communication; Interprofessional Relations; Leadership; Operating Rooms; Patient Care Team/*standards; Quality of Health Care/standards; Surgeons/*standards; United Kingdom; Interpersonal and Communication Skills; Patient Care; Professionalism; Systems-Based Practice; patient safety; standard of care; task performance and analysis  
  Abstract OBJECTIVE: This study aims to explore the views of members of theater teams regarding the proposed introduction of a workplace-based assessment of nontechnical skills of surgeons (NOTSS) into the Intercollegiate Surgical Curriculum Programme in the United Kingdom. In addition, the previous training and familiarity of the members of the surgical theater team with the concept and assessment of NOTSS would be evaluated. DESIGN: A regional survey of members of theater teams (consultant surgeons, anesthetists, scrub nurses, and trainees) was performed at 1 teaching and 2 district general hospitals in South Yorkshire. RESULTS: There were 160 respondents corresponding to a response rate of 81%. The majority (77%) were not aware of the NOTSS assessment tool with only 9% of respondents reporting to have previously used the NOTSS tool and just 3% having received training in NOTSS assessment. Overall, 81% stated that assessing NOTSS was as important as assessing technical skills. Trainees attributed less importance to nontechnical skills than the other groups (p </= 0.016). Although opinion appears divided as to whether the presence of a consultant surgeon in theater could potentially make it difficult to assess a trainee's leadership skills and decision-making capabilities, overall 60% agree that the routine use of NOTSS assessment would enhance safety in the operating theater and 80% agree that the NOTSS tool should be introduced to assess the nontechnical skills of trainees in theater. However, a significantly lower proportion of trainees (45%) agreed on the latter compared with the other groups (p = 0.001). CONCLUSIONS: Our survey demonstrates acceptability among the theater team for the introduction of the NOTSS tool into the surgical curriculum. However, lack of familiarity highlights the importance of faculty training for assessors before such an introduction.  
  Address Northern General Hospital, Sheffield Vascular Institute, Sheffield, United Kingdom  
  Corporate Author Thesis  
  Publisher Place of Publication Editor  
  Language English Summary Language Original Title  
  Series Editor Series Title Abbreviated Series Title  
  Series Volume Series Issue Edition  
  ISSN 1878-7452 ISBN Medium  
  Area Expedition Conference  
  Notes PMID:26868312 Approved no  
  Call Number ref @ user @ Serial 95095  
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