Browsing by Author "Singh, Pavneet"

Now showing 1 - 4 of 4
  • Thumbnail Image
    ItemOpen Access
    Assessing the credibility and transferability of the patient compassion model in non-cancer palliative populations
    (2018-09-13) Sinclair, Shane; Jaggi, Priya; Hack, Thomas F.; McClement, Susan E.; Raffin-Bouchal, Shelley; Singh, Pavneet
    Abstract Background A lack of evidence and psychometrically sound measures of compassion necessitated the development of the first known, empirically derived, theoretical Patient Compassion Model (PCM) generated from qualitative interviews with advanced cancer inpatients. We aimed to assess the credibility and transferability of the PCM across diverse palliative populations and settings. Methods Semi-structured, audio-recorded qualitative interviews were conducted with 20 patients with life-limiting diagnoses, recruited from 4 settings (acute care, homecare, residential care, and hospice). Participants were first asked to share their understandings and experiences of compassion. They were then presented with an overview of the PCM and asked to determine whether: 1) the model resonated with their understanding and experiences of compassion; 2) the model required any modification(s); 3) they had further insights on the model’s domains and/or themes. Members of the research team analyzed the qualitative data using constant comparative analysis. Results Both patients’ personal perspectives of compassion prior to viewing the model and their specific feedback after being provided an overview of the model confirmed the credibility and transferability of the PCM. While new codes were incorporated into the original coding schema, no new domains or themes emerged from this study sample. These additional codes provided a more comprehensive understanding of the nuances within the domains and themes of the PCM that will aid in the generation of items for an ongoing study to develop a patient reported measure of compassion. Conclusions A diverse palliative patient population confirmed the credibility and transferability of the PCM within palliative care, extending the rigour and applicability of the PCM that was originally developed within an advanced cancer population. The views of a diverse palliative patient population on compassion helped to validate previous codes and supplement the existing coding schema, informing the development of a guiding framework for the generation of a patient-reported measure of compassion.
  • Thumbnail Image
    ItemOpen Access
    Can Self-Compassion Promote Healthcare Provider Well-Being and Compassionate Care to Others? Results of a Systematic Review
    (Wiley, 2017-04) Sinclair, Shane; Kondejewski, Jane; Raffin-Bouchal, Shelley; King-Shier, Kathryn M; Singh, Pavneet
    Background This meta-narrative review, conducted according to the RAMESES (Realist And Meta-narrative Evidence Syntheses: Evolving Standards) standards, critically examines the construct of self-compassion to determine if it is an accurate target variable to mitigate work-related stress and promote compassionate caregiving in healthcare providers. Methods PubMed, Medline, CINAHL, PsycINFO, and Web of Science databases were searched. Studies were coded as referring to: (1) conceptualisation of self-compassion; (2) measures of self-compassion; (3) self-compassion and affect; and (4) self-compassion interventions. A narrative approach was used to evaluate self-compassion as a paradigm. Results Sixty-nine studies were included. The construct of self-compassion in healthcare has significant limitations. Self-compassion has been related to the definition of compassion, but includes limited facets of compassion and adds elements of uncompassionate behavior. Empirical studies use the Self-Compassion Scale, which is criticised for its psychometric and theoretical validity. Therapeutic interventions purported to cultivate self-compassion may have a broader effect on general affective states. An alleged outcome of self-compassion is compassionate care; however, we found no studies that included patient reports on this primary outcome. Conclusion We critically examine and delineate self-compassion in healthcare providers as a composite of common facets of self-care, healthy self-attitude, and self-awareness rather than a construct in and of itself.
  • Thumbnail Image
    ItemOpen Access
    Regulation of Myocardin Expression and Activity in Vascular Smooth Muscle Cells
    (2015-12-15) Singh, Pavneet; Zheng, Xi-Long; Walsh, Michael; Lees-Miller, Susan
    The proliferation of vascular smooth muscle cells (VSMCs) plays a critical role in the development of various vascular diseases such as atherosclerosis. In order for SMCs to proliferate, it is widely believed that cells undergo a phenotypic conversion from a differentiated contractile phenotype to a dedifferentiated synthetic phenotype. The transcription co-activator myocardin is well established to play a role in SMC differentiation and proliferation. Therefore, it is crucial to understand how myocardin expression and activity are regulated in VSMCs. We investigated the regulation of myocardin expression and activity in SMCs at two different levels. (1) Myocardin undergoes ubiquitylation and degradation via UPS, which leads to an increase in its transcriptional activity. However, the E3 ligase responsible for myocardin ubiquitylation has not been identified. Atrogin‐1 is a muscle-specific E3 ligase which down‐regulates myocardin protein during skeletal muscle differentiation. Therefore, it is possible that atrogin‐1 causes ubiquitylation, which leads to proteasome mediated degradation of myocardin protein in VSMCs, thereby increasing myocardin activity. Our results showed that in VSMCs, atrogin‐1 directly interacted with myocardin in the nuclei and caused ubiquitylation and subsequent proteasome mediated degradation of myocardin. UPS-mediated myocardin degradation increased myocardin transcriptional activity through an increase in RNA polymerase II recruitment to myocardin target gene promoters. Moreover, atrogin‐1 expression increased the contractility of VSMCs in vitro and increased the contractile response of mouse aortas to potassium chloride (KCl) and phenylephrine (PE) ex vivo. Atrogin-1 expression also decreased VSMC proliferation in vitro. (2) The NF‐κB pathway is activated by various cytokines such as TNFα. Moreover, myocardin is known to inhibit VSMC proliferation by inhibiting the NF‐κB pathway. However, how the NF‐κB pathway activated by TNFα regulates myocardin remains unknown. We found that TNFα down‐regulated myocardin expression and activity in dedifferentiated cultured VSMCs by activating the NF‐κB pathway. TNFα-mediated myocardin downregulation decreased contractility and increased proliferation in cultured VSMCs. In addition, we found that in differentiated VSMCs, TNFα prevented myocardin mRNA degradation, which resulted in a further increase in myocardin expression and activity. TNFα-mediated myocardin mRNA stabilization resulted in increased contractility of VSMCs.
  • Thumbnail Image
    ItemOpen Access
    What are healthcare providers' understandings and experiences of compassion? The healthcare compassion model: a grounded theory study of healthcare providers in Canada
    (British Medical Journal, 2018-03-14) Sinclair, Shane; Hack, Thomas F; Raffin-Bouchal, Shelley; McClement, Susan; Stajduhar, Kelli; Singh, Pavneet; Hagen, Neil A; Sinnarajah, Aynharan; Chochinov, Harvey Max
    Background Healthcare providers are considered the primary conduit of compassion in healthcare. Although most healthcare providers desire to provide compassion, and patients and families expect to receive it, an evidence-based understanding of the construct and its associated dimensions from the perspective of healthcare providers is needed. Objectives The aim of this study was to investigate healthcare providers’ perspectives and experiences of compassion in order to generate an empirically derived, clinically informed model. Design Data were collected via focus groups with frontline healthcare providers and interviews with peer-nominated exemplary compassionate healthcare providers. Data were independently and collectively analysed by the research team in accordance with Straussian grounded theory. Setting and participants 57 healthcare providers were recruited from urban and rural palliative care services spanning hospice, home care, hospital-based consult teams, and a dedicated inpatient unit within Alberta, Canada. Results Five categories and 13 associated themes were identified, illustrated in the Healthcare Provider Compassion Model depicting the dimensions of compassion and their relationship to one another. Compassion was conceptualised as—a virtuous and intentional response to know a person, to discern their needs and ameliorate their suffering through relational understanding and action. Conclusions An empirical foundation of healthcare providers’ perspectives on providing compassionate care was generated. While the dimensions of the Healthcare Provider Compassion Model were congruent with the previously developed Patient Model, further insight into compassion is now evident. The Healthcare Provider Compassion Model provides a model to guide clinical practice and research focused on developing interventions, measures and resources to improve it.