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Robinson J, Goodwin H, Williams L, Anderson N, Parr J, Irwin R, Gott M. The work of palliative care from the perspectives of district nurses: A qualitative study. J Adv Nurs 2023. [PMID: 38108192 DOI: 10.1111/jan.16030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 11/20/2023] [Accepted: 11/30/2023] [Indexed: 12/19/2023]
Abstract
AIM To explore the work of palliative care from the perspectives of district nurses with a focus on the strategies they use to achieve positive outcomes for patients. DESIGN An exploratory descriptive qualitative study. METHODS A combination of group and individual interviews using semi-structured interviewing were used to explore district nurses' views of providing palliative care across two large urban community nursing services. RESULTS Sixteen district nurse participants were interviewed. Three key themes were identified: "Getting what was needed" involved finding solutions, selling a story and establishing relationships. District nurses sought ways to "Stay involved" recognizing the benefit of delaying discharge for some patients. "Completing a nursing task" was a way of managing time constraints and a form of self-protection from having difficult conversations. CONCLUSION This study highlights the importance of understanding the contextual nature of the practice setting in relation to the provision of palliative care. In doing so, it has revealed the strategies district nurses use to overcome the challenges associated with providing palliative care within a generalist workload. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE District nurses experience a tension between managing high patient workloads and remaining patient centred in palliative care. Being task focused is a way of remaining safe while managing a high volume of work and is not always a negative factor in the care they provide. However, focusing on a task while at the same time addressing other unmet needs requires a set of skills that less experienced nurses may not have. IMPACT Palliative care education alone will not improve the quality of palliative care provided by generalist community district nurses. The practice context is an important factor to take into consideration when supporting the integration of palliative care in district nursing. NO PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution was made to this study. REPORTING METHOD We have adhered to the relevant EQUATOR guidelines and used the COREQ reporting method.
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Affiliation(s)
- Jackie Robinson
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Hetty Goodwin
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Lisa Williams
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Natalie Anderson
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Jenny Parr
- Te Whatu Oral Health Counties Manukau, Auckland, New Zealand
| | - Rebekah Irwin
- Te Whatu Oral Health Counties Manukau, Auckland, New Zealand
| | - Merryn Gott
- School of Nursing, University of Auckland, Auckland, New Zealand
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Norton SE, Leman JKH, Khong T, Spencer A, Fazekas de St Groth B, McGuire HM, Kemp RA. Brick plots: an intuitive platform for visualizing multiparametric immunophenotyped cell clusters. BMC Bioinformatics 2020; 21:145. [PMID: 32293253 PMCID: PMC7158154 DOI: 10.1186/s12859-020-3469-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 03/24/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The advent of mass cytometry has dramatically increased the parameter limit for immunological analysis. New approaches to analysing high parameter cytometry data have been developed to ease analysis of these complex datasets. Many of these methods assign cells into population clusters based on protein expression similarity. RESULTS Here we introduce an additional method, termed Brick plots, to visualize these cluster phenotypes in a simplified and intuitive manner. The Brick plot method generates a two-dimensional barcode that displays the phenotype of each cluster in relation to the entire dataset. We show that Brick plots can be used to visualize complex mass cytometry data, both from fundamental research and clinical trials, as well as flow cytometry data. CONCLUSION Brick plots represent a new approach to visualize complex immunological data in an intuitive manner.
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Affiliation(s)
- Samuel E Norton
- Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand
| | - Julia K H Leman
- Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand
| | - Tiffany Khong
- Myeloma Research Group, Australian Centre for Blood Diseases, Alfred Hospital-Monash University, Melbourne, VIC, Australia
- Malignant Hematology and Stem Cell Transplantation, Alfred Hospital, Melbourne, VIC, Australia
| | - Andrew Spencer
- Myeloma Research Group, Australian Centre for Blood Diseases, Alfred Hospital-Monash University, Melbourne, VIC, Australia
- Malignant Hematology and Stem Cell Transplantation, Alfred Hospital, Melbourne, VIC, Australia
| | - Barbara Fazekas de St Groth
- Ramaciotti Facility for Human Systems Biology, The University of Sydney and Centenary Institute, Sydney, Australia
- Discipline of Pathology, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Australia; Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Helen M McGuire
- Ramaciotti Facility for Human Systems Biology, The University of Sydney and Centenary Institute, Sydney, Australia.
- Discipline of Pathology, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Australia; Charles Perkins Centre, University of Sydney, Sydney, Australia.
| | - Roslyn A Kemp
- Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand.
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Aya-Bonilla CA, Morici M, Hong X, McEvoy AC, Sullivan RJ, Freeman J, Calapre L, Khattak MA, Meniawy T, Millward M, Ziman M, Gray ES. Detection and prognostic role of heterogeneous populations of melanoma circulating tumour cells. Br J Cancer 2020; 122:1059-1067. [PMID: 32037400 PMCID: PMC7109152 DOI: 10.1038/s41416-020-0750-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/16/2020] [Accepted: 01/24/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Circulating tumour cells (CTCs) can be assessed through a minimally invasive blood sample with potential utility as a predictive, prognostic and pharmacodynamic biomarker. The large heterogeneity of melanoma CTCs has hindered their detection and clinical application. METHODS Here we compared two microfluidic devices for the recovery of circulating melanoma cells. The presence of CTCs in 43 blood samples from patients with metastatic melanoma was evaluated using a combination of immunocytochemistry and transcript analyses of five genes by RT-PCR and 19 genes by droplet digital PCR (ddPCR), whereby a CTC score was calculated. Circulating tumour DNA (ctDNA) from the same patient blood sample, was assessed by ddPCR targeting tumour-specific mutations. RESULTS Our analysis revealed an extraordinary heterogeneity amongst melanoma CTCs, with multiple non-overlapping subpopulations. CTC detection using our multimarker approach was associated with shorter overall and progression-free survival. Finally, we found that CTC scores correlated with plasma ctDNA concentrations and had similar pharmacodynamic changes upon treatment initiation. CONCLUSIONS Despite the high phenotypic and molecular heterogeneity of melanoma CTCs, multimarker derived CTC scores could serve as viable tools for prognostication and treatment response monitoring in patients with metastatic melanoma.
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Affiliation(s)
| | - Michael Morici
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Xin Hong
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | | | - Ryan Joseph Sullivan
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - James Freeman
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Leslie Calapre
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Muhammad Adnan Khattak
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
- Department of Medical Oncology, Fiona Stanley Hospital, Murdoch, WA, Australia
- School of Medicine, University of Western Australia, Crawley, WA, Australia
| | - Tarek Meniawy
- School of Medicine, University of Western Australia, Crawley, WA, Australia
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Michael Millward
- School of Medicine, University of Western Australia, Crawley, WA, Australia
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Mel Ziman
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
- School of Biomedical Science, University of Western Australia, Crawley, WA, Australia
| | - Elin Solomonovna Gray
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia.
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Calapre L, Giardina T, Robinson C, Reid AL, Al‐Ogaili Z, Pereira MR, McEvoy AC, Warburton L, Hayward NK, Khattak MA, Meniawy TM, Millward M, Amanuel B, Ziman M, Gray ES. Locus-specific concordance of genomic alterations between tissue and plasma circulating tumor DNA in metastatic melanoma. Mol Oncol 2019; 13:171-184. [PMID: 30312528 PMCID: PMC6360370 DOI: 10.1002/1878-0261.12391] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/14/2018] [Accepted: 10/02/2018] [Indexed: 01/28/2023] Open
Abstract
Circulating tumor DNA (ctDNA) may serve as a surrogate to tissue biopsy for noninvasive identification of mutations across multiple genetic loci and for disease monitoring in melanoma. In this study, we compared the mutation profiles of tumor biopsies and plasma ctDNA from metastatic melanoma patients using custom sequencing panels targeting 30 melanoma-associated genes. Somatic mutations were identified in 20 of 24 melanoma biopsies, and 16 of 20 (70%) matched-patient plasmas had detectable ctDNA. In a subgroup of seven patients for whom matching tumor tissue and plasma were sequenced, 80% of the mutations found in tumor tissue were also detected in ctDNA. However, TERT promoter mutations were only detected by ddPCR, and promoter mutations were consistently found at lower concentrations than other driver mutations in longitudinal samples. In vitro experiments revealed that mutations in promoter regions of TERT and DPH3 are underrepresented in ctDNA. While the results underscore the utility of using ctDNA as an alternative to tissue biopsy for genetic profiling and surveillance of the disease, our study highlights the underrepresentation of promoter mutations in ctDNA and its potential impact on quantitative liquid biopsy applications.
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Affiliation(s)
- Leslie Calapre
- School of Medical and Health SciencesEdith Cowan UniversityJoondalupAustralia
| | - Tindaro Giardina
- Anatomical PathologyPathWest Laboratory MedicineQEII Medical CentreNedlandsAustralia
| | - Cleo Robinson
- Anatomical PathologyPathWest Laboratory MedicineQEII Medical CentreNedlandsAustralia
- School of Biomedical ScienceUniversity of Western AustraliaCrawleyAustralia
| | - Anna L. Reid
- School of Medical and Health SciencesEdith Cowan UniversityJoondalupAustralia
| | - Zeyad Al‐Ogaili
- Department of Molecular Imaging and Therapy ServiceFiona Stanley HospitalMurdochAustralia
| | - Michelle R. Pereira
- School of Medical and Health SciencesEdith Cowan UniversityJoondalupAustralia
| | - Ashleigh C. McEvoy
- School of Medical and Health SciencesEdith Cowan UniversityJoondalupAustralia
| | - Lydia Warburton
- Department of Medical OncologySir Charles Gairdner HospitalNedlandsAustralia
| | | | - Muhammad A. Khattak
- School of MedicineUniversity of Western AustraliaCrawleyAustralia
- Department of Medical OncologyFiona Stanley HospitalMurdochAustralia
| | - Tarek M. Meniawy
- QIMR Berghofer Medical Research InstituteBrisbaneAustralia
- School of MedicineUniversity of Western AustraliaCrawleyAustralia
| | - Michael Millward
- QIMR Berghofer Medical Research InstituteBrisbaneAustralia
- School of MedicineUniversity of Western AustraliaCrawleyAustralia
| | - Benhur Amanuel
- School of Medical and Health SciencesEdith Cowan UniversityJoondalupAustralia
- Anatomical PathologyPathWest Laboratory MedicineQEII Medical CentreNedlandsAustralia
- School of MedicineUniversity of Western AustraliaCrawleyAustralia
| | - Melanie Ziman
- School of Medical and Health SciencesEdith Cowan UniversityJoondalupAustralia
- School of Biomedical ScienceUniversity of Western AustraliaCrawleyAustralia
| | - Elin S. Gray
- School of Medical and Health SciencesEdith Cowan UniversityJoondalupAustralia
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McEvoy AC, Warburton L, Al-Ogaili Z, Celliers L, Calapre L, Pereira MR, Khattak MA, Meniawy TM, Millward M, Ziman M, Gray ES. Correlation between circulating tumour DNA and metabolic tumour burden in metastatic melanoma patients. BMC Cancer 2018; 18:726. [PMID: 29986670 PMCID: PMC6038195 DOI: 10.1186/s12885-018-4637-6] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 06/26/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Circulating tumour DNA (ctDNA) may serve as a measure of tumour burden and a useful tool for non-invasive monitoring of cancer. However, ctDNA is not always detectable in patients at time of diagnosis of metastatic disease. Therefore, there is a need to understand the correlation between ctDNA levels and the patients' overall metabolic tumour burden (MTB). METHODS Thirty-two treatment naïve metastatic melanoma patients were included in the study. MTB and metabolic tumour volume (MTV) was measured by 18F-fluoro-D-glucose positron emission tomography/computed tomography (FDG PET/CT). Plasma ctDNA was quantified using droplet digital PCR (ddPCR). RESULTS CtDNA was detected in 23 of 32 patients. Overall, a significant correlation was observed between ctDNA levels and MTB (p < 0.001). CtDNA was not detectable in patients with an MTB of ≤10, defining this value as the lower limit of tumour burden that can be detected through ctDNA analysis by ddPCR. CONCLUSIONS We showed that ctDNA levels measured by ddPCR correlate with MTB in treatment naïve metastatic melanoma patients and observed a limit in tumour size for which ctDNA cannot be detected in blood. Nevertheless, our findings support the use of ctDNA as a non-invasive complementary modality to functional imaging for monitoring tumour burden.
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Affiliation(s)
- Ashleigh C. McEvoy
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027 Australia
| | - Lydia Warburton
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009 Australia
| | - Zeyad Al-Ogaili
- Department of Molecular Imaging and Therapy Service, Fiona Stanley Hospital, Murdoch, WA 6150 Australia
| | - Liesl Celliers
- Department of Molecular Imaging and Therapy Service, Fiona Stanley Hospital, Murdoch, WA 6150 Australia
| | - Leslie Calapre
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027 Australia
| | - Michelle R. Pereira
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027 Australia
| | - Muhammad A. Khattak
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027 Australia
- Department of Medical Oncology, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, WA 6150 Australia
- School of Medicine and Pharmacology, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009 Australia
| | - Tarek M. Meniawy
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009 Australia
- School of Medicine and Pharmacology, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009 Australia
| | - Michael Millward
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009 Australia
- School of Medicine and Pharmacology, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009 Australia
| | - Melanie Ziman
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027 Australia
- School of Biomedical Sciences, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009 Australia
| | - Elin S. Gray
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027 Australia
- Centre for Opthalmology and Visual Science, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009 Australia
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