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Canadian Journal of Anaesthesia =... Apr 2023There are two anatomic formulations of death by neurologic criteria accepted worldwide: whole-brain death and brainstem death. As part of the Canadian Death Definition... (Review)
Review
There are two anatomic formulations of death by neurologic criteria accepted worldwide: whole-brain death and brainstem death. As part of the Canadian Death Definition and Determination Project, we convened an expert working group and performed a narrative review of the literature. Infratentorial brain injury (IBI) with an unconfounded clinical assessment consistent with death by neurologic criteria represents a nonrecoverable injury. The clinical determination of death cannot distinguish between IBI and whole-brain cessation of function. Current clinical, functional, and neuroimaging assessments cannot reliably confirm the complete and permanent destruction of the brainstem. No patient with isolated brainstem death has been reported to recover consciousness and all patients have died. Studies suggest a significant majority of isolated brainstem death will evolve into whole-brain death, influenced by time/duration of somatic support and impacted by ventricular drainage and/or posterior fossa decompressive craniectomy. Acknowledging variability in intensive care unit (ICU) physician opinion on this matter, a majority of Canadian ICU physicians would perform ancillary testing for death determination by neurologic criteria in the context of IBI. There is currently no reliable ancillary test to confirm complete destruction of the brainstem; ancillary testing currently includes evaluation of both infratentorial and supratentorial flow. Acknowledging international variability in this regard, the existing evidence reviewed does not provide sufficient confidence that the clinical exam in IBI represents a complete and permanent destruction of the reticular activating system and thus the capacity for consciousness. On this basis, IBI consistent with clinical signs of death by neurologic criteria without significant supratentorial involvement does not fulfill criteria for death in Canada and ancillary testing is required.
Topics: Humans; Brain Death; Canada; Brain; Brain Stem; Brain Injuries
PubMed: 37138155
DOI: 10.1007/s12630-023-02427-0 -
JMIR Research Protocols Oct 2021Early in the development of the COVID-19 pandemic, it was evident that health care workers, first responders, and other essential workers would face significant stress...
BACKGROUND
Early in the development of the COVID-19 pandemic, it was evident that health care workers, first responders, and other essential workers would face significant stress and workplace demands related to equipment shortages and rapidly growing infections in the general population. Although the effects of other sources of stress on health have been documented, the effects of these unique conditions of the COVID-19 pandemic on the long-term health and well-being of the health care workforce are not known.
OBJECTIVE
The COVID-19 Study of Healthcare and Support Personnel (CHAMPS) was designed to document early and longitudinal effects of the pandemic on the mental and physical health of essential workers engaged in health care. We will investigate mediators and moderators of these effects and evaluate the influence of exposure to stress, including morbidity and mortality, over time. We will also examine the effect of protective factors and resilience on health outcomes.
METHODS
The study cohort is a convenience sample recruited nationally through communities, professional organizations, networks, social media, and snowball sampling. Recruitment took place for 13 months to obtain an estimated sample of 2762 adults who provided self-reported information administered on the web through structured questionnaires about their work environment, mental and physical health, and psychosocial factors. Follow-up questionnaires will be administered after 6 months and annually thereafter to ascertain changes in health, well-being, and lifestyle. Participants who consented to be recontacted form the longitudinal cohort and the CHAMPS Registry may be contacted to ascertain their interest in ancillary studies for which they may be eligible.
RESULTS
The study was approved by the Institutional Review Board and launched in May 2020, with grants from Travere Therapeutics Inc, McKesson Corporation, anonymous donors, and internal funding from the M. Louise Fitzpatrick College of Nursing at Villanova University. Recruitment ended in June 2021 after enrolling 2762 participants, 1534 of whom agreed to participate in the longitudinal study and the registry as well as to be contacted about eligibility for future studies.
CONCLUSIONS
The CHAMPS Study and Registry will enable the acquisition of detailed data on the effects of extended psychosocial and workplace stress on morbidity and mortality and serve as a platform for ancillary studies related to the COVID-19 pandemic.
TRIAL REGISTRATION
ClinicalTrials.gov NCT04370821; https://clinicaltrials.gov/ct2/show/NCT04370821.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)
DERR1-10.2196/30757.
PubMed: 34582354
DOI: 10.2196/30757 -
MCN. the American Journal of Maternal...To describe knowledge and attitudes of maternity nurses and other ancillary direct caregivers about addictive substance use by pregnant women and new mothers and to...
OBJECTIVE
To describe knowledge and attitudes of maternity nurses and other ancillary direct caregivers about addictive substance use by pregnant women and new mothers and to evaluate their perceptions of role preparation, resources available, and educational needs.
STUDY DESIGN METHODS
We surveyed maternity nurses and ancillary members of the maternity care team to assess knowledge and attitudes about caring for women with addictive substance use. Data were analyzed using descriptive, parametric, and nonparametric statistics.
RESULTS
Respondents (N = 109) from a southwestern Magnet community hospital were 100% female, predominantly nurses (89%), and worked mostly on mother-baby or labor and delivery units. They had high average knowledge scores and most had positive attitudes. When asked about preparation to care for pregnant women and new mothers with addictive substance use, some perceived that they were not able to carry out their role due to lack of knowledge.
CLINICAL IMPLICATIONS
Findings suggest most maternity nurses have the knowledge and skills they believe are needed to care for women who use addictive substances during pregnancy and postpartum. Most have positive attitudes, but approximately one third may need interventions to encourage and further support empathy and acceptance. Education and skill-building for maternity nurses and other team members related to caring for women using addictive substances may be worth consideration; however, there is minimal evidence of their efficacy. Evaluations of these types of programs are needed in maternity settings.
Topics: Adult; Female; Health Knowledge, Attitudes, Practice; Health Personnel; Humans; Male; Maternal-Child Nursing; Middle Aged; Postpartum Period; Professional-Patient Relations; Social Stigma; Substance-Related Disorders; Surveys and Questionnaires
PubMed: 33630491
DOI: 10.1097/NMC.0000000000000703 -
Experimental and Clinical... Apr 2024Brain death is defined as the complete and irreversible cessation of the entire brain function, including the brainstem. For the most part, the diagnosis is clinical,... (Review)
Review
Brain death is defined as the complete and irreversible cessation of the entire brain function, including the brainstem. For the most part, the diagnosis is clinical, and ancillary testing is only needed when clinical criteria are not satisfied. Differences exist in brain death diagnosis policy in the confirmation of brain death with ancillary testing and the particular test used. Demonstration of the absence of cerebral circulation is a reliable indicator of brain death. Currently, there are no agreed-on universal criteria for ancillary imaging investigation. However, several guidelines and meta-analyses have referred to radionuclide imaging as the most reliable, accurate, and validated ancillary imaging procedure in the confirmation of brain death. Whenever available, lipophilic agents should be preferred using tomographic imaging in all or as needed. False results may occur because of slight temporal delays in flow-function interaction, and such findings may carry prognostic information. Detectable cerebral circulation in the clinical presence of brain death most probably indicates that the process of dying is not yet complete. The results of radionuclide studies may also suggest that the loss of viability in a significant proportion of brain tissue is not compatible with life.
Topics: Brain Death; Humans; Predictive Value of Tests; Cerebrovascular Circulation; Brain; Radiopharmaceuticals; Reproducibility of Results; Perfusion Imaging; Prognosis
PubMed: 38775696
DOI: 10.6002/ect.BDCDSymp.L15 -
Archives of Pathology & Laboratory... Mar 2023A variety of inflammatory processes affect the pancreatobiliary tree. Some form mass lesions in the pancreas, mimicking pancreatic ductal adenocarcinoma, and others...
CONTEXT.—
A variety of inflammatory processes affect the pancreatobiliary tree. Some form mass lesions in the pancreas, mimicking pancreatic ductal adenocarcinoma, and others cause strictures in the bile ducts, mimicking cholangiocarcinoma. Acute pancreatitis, chronic pancreatitis, autoimmune pancreatitis, and paraduodenal groove pancreatitis have distinct cytopathologic features that, when correlated with clinical and imaging features, may lead to correct classification preoperatively. In biliary strictures sampled by endobiliary brushing, the uniform features are the variable presence of inflammation and reactive ductal atypia. A potential pitfall in the interpretation of pancreatobiliary fine-needle aspiration and duct brushing specimens is ductal atypia induced by the reactive process. Recognizing cytologic criteria that differentiate reactive from malignant epithelium, using ancillary testing, and correlating these features with clinical and imaging findings can lead to the correct preoperative diagnosis.
OBJECTIVE.—
To summarize the cytomorphologic features of inflammatory processes in the pancreas, describe the cytomorphology of atypia in pancreatobiliary specimens, and review ancillary studies applicable for the differential diagnosis of benign from malignant ductal processes for the purpose of best pathology practice.
DATA SOURCES.—
A PubMed review was performed.
CONCLUSIONS.—
Accurate preoperative diagnosis of benign and malignant processes in the pancreatobiliary tract can be achieved with application of diagnostic cytomorphologic criteria and correlation of ancillary studies with clinical and imaging findings.
Topics: Humans; Acute Disease; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Constriction, Pathologic; Cytology; Pancreatic Neoplasms; Pancreatitis
PubMed: 36848529
DOI: 10.5858/arpa.2021-0595-RA -
CytoJournal 2022Morphological and architectural pattern evaluations play a major role in the rpretation of hematopoietic neoplasms. However, confirmation of diagnosis, classification,... (Review)
Review
Morphological and architectural pattern evaluations play a major role in the rpretation of hematopoietic neoplasms. However, confirmation of diagnosis, classification, prognosis, and risk stratification are highly dependent on the utilization of multiple ancillary studies. The importance of these ancillary studies increases in evaluating serous fluid samples, as these samples lack architecture and patterns. Likewise, the morphology can be disturbed by sample preparation. The most common ancillary studies utilized are flow cytometry, immunohistochemistry for immunophenotyping, Fluorescent In Situ Hybridization (FISH), cytogenetics for structural and gene rearrangements, and molecular studies for mutational analysis. Among them, flow cytometry analysis is the handiest test to perform with high diagnostic yield on serous fluid specimens. In this article we will discuss the use, caveat, and role of the most common ancillary studies on serous fluid specimen evaluation. This review article will be incorporated finally as one of the chapters in CMAS (CytoJournal Monograph/Atlas Series) #2. It is modified slightly from the chapter by the initial authors (Choladda Vejabhuti, MD and Chung-Che (Jeff) Chang, MD, PhD) in the first edition of Diagnostic Cytopathology of Serous Fluids.
PubMed: 35510118
DOI: 10.25259/CMAS_02_13_2021 -
Contemporary Clinical Trials Feb 2023Falls and decreased physical function increase markedly with age and result in injury, hospitalization, and premature death. Emerging studies show potential benefits of...
Rationale and design of an ancillary study evaluating the effects of the cocoa flavanol and/or multivitamin interventions on falls and physical performance outcomes in the COcoa Supplement and Multivitamin Outcomes Study (COSMOS).
BACKGROUND
Falls and decreased physical function increase markedly with age and result in injury, hospitalization, and premature death. Emerging studies show potential benefits of supplemental cocoa extract on physical performance, including grip strength and walking speed in older adults. However, there are no large, long-term randomized controlled trials of effects of supplemental cocoa extract on falls, muscle performance, and/or fall-related injuries.
METHODS
The COcoa Supplement and Multivitamin Outcomes Study (COSMOS) is a double-blind, placebo-controlled, 2 × 2 factorial trial investigating effects of supplementation with cocoa extract (500 mg/d, including 80 mg (-)-epicatechin) and/or a multivitamin on prevention of cardiovascular disease and cancer in 21,442 women (≥65 years) and men (≥60 years).
COSMOS
Effects on Falls and Physical Performance is an ancillary study to COSMOS that will clarify effects of cocoa extract and/or multivitamin supplementation on falls, physical performance, and incident fracture outcomes in older adults. Injurious fall(s) resulting in healthcare utilization and recurrent falls were regularly assessed by follow-up questionnaires in the overall cohort. Incident fractures were also assessed by annual questionnaires. Circumstances surrounding falls and any fall-related injuries will be confirmed by medical record review. Effects of the interventions on 2-year changes in physical performance measures (grip strength, walking speed, and the Short Physical Performance Battery) will be tested in a clinic sub-cohort (n = 603).
CONCLUSION
Results from this ancillary study will determine whether supplemental cocoa extract slows age-related declines in physical performance and decrease injurious and recurrent falls and fall-related injuries and fractures that are major public health problems in older adults.
Topics: Male; Humans; Female; Aged; Accidental Falls; Vitamins; Dietary Supplements; Cacao; Plant Extracts; Randomized Controlled Trials as Topic
PubMed: 36621596
DOI: 10.1016/j.cct.2023.107078 -
Drug and Alcohol Dependence Jan 2022Supervised consumption services (SCS) prevent drug related harms for people who use drugs (PWUD) and often require a feasibility study before implementation. While there... (Review)
Review
BACKGROUND
Supervised consumption services (SCS) prevent drug related harms for people who use drugs (PWUD) and often require a feasibility study before implementation. While there is a growing feasibility study literature, it has not been synthesized for use by researchers and SCS planners. We conducted a scoping review of feasibility studies reporting on preferred SCS design characteristics, staffing models and ancillary services.
MATERIALS AND METHODS
We searched academic databases and grey literature sources with key terms related to SCS and feasibility studies. Team members reviewed search results and included feasibility studies with findings relevant to SCS design, staff, or ancillary services. The research methods and findings from included studies regarding design elements were charted, collated, and reported.
RESULTS
The search yielded 1347 results; 26 met eligibility criteria for review. Most reported preferences for SCS location, hours and wait times. Few reported preferences for security, space allocation by type of drug use, and onsite opioid prescribing. PWUD generally preferred aligning design elements with the goal of harm reduction for clients while other stakeholders valued treatment as a goal. Specific considerations varied by implementation context.
CONCLUSIONS
These results can be used by SCS planners and researchers to help resolve implementation concerns and improve uptake among PWUD, which is critical during an overdose crisis. Future feasibility studies should ask about design preferences that may be significant to uptake but are not commonly covered in studies. These should also explore how context influences preferences to develop an evidence-based framework for context-specific design decisions.
Topics: Analgesics, Opioid; Drug Overdose; Feasibility Studies; Harm Reduction; Humans; Practice Patterns, Physicians'
PubMed: 34847503
DOI: 10.1016/j.drugalcdep.2021.109179 -
Journal of Medical Ethics Oct 2021This study aimed to describe how parents and physicians experienced the informed consent interview and to investigate the aspects of the relationship that influenced... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
This study aimed to describe how parents and physicians experienced the informed consent interview and to investigate the aspects of the relationship that influenced parents' decision during the consent process for a randomised clinical trial in a tertiary neonatal intensive care unit (NICU). The secondary objective was to describe the perspectives of parents and physicians in the specific situation of prenatal informed consent.
SETTING
Single centre study in NICU of the Centre Hospitalier Intercommunal de Créteil, France, using a convenience period from February to May 2016.
DESIGN
Ancillary study to a randomised clinical trial: Prettineo. Records of interviews for consent.
POPULATION
parents and physicians. Mixed study including qualitative and quantitative interview data about participants' recall and feelings about the consent process. Interviews were reviewed using thematic discourse analysis.
RESULTS
Parents' recall and understanding of the study's main goal and design was good. Parents and physicians had a positive experience, and trust was one of the main reasons for parents to consent. Misunderstanding (bad comprehension) was the main reason for refusal.Before birth, three situations can compromise parents' consent: the mother already consented to participate in other studies, the absence of the father during the interview and the feeling that the baby's birth is not an imminent possibility.
CONCLUSIONS
Confronting parents and physicians' perspectives in research can help us reach answers to sensitive issues such as content and timing of information. Each different types of study raises different ethical dilemmas for consent that might be discussed in a more individual way.
Topics: Humans; Infant, Newborn; Informed Consent; Motivation; Parental Consent; Parents; Prospective Studies; Trust
PubMed: 32079742
DOI: 10.1136/medethics-2019-105597 -
Journal of Thoracic Disease Jun 2023Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is the standard for evaluating mediastinal and hilar lesions. EBUS-TBNA is limited by small...
BACKGROUND
Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is the standard for evaluating mediastinal and hilar lesions. EBUS-TBNA is limited by small volume of material obtained for immunohistochemistry (IHC) and ancillary studies important for oncological therapies. The Franseen Acquire needle is designed for EBUS-transbronchial needle core biopsy (TBNB) allowing larger core sizes with evidence in gastroenterology literature but little in pulmonology. This study reports the first Asia-Pacific experience of EBUS-TBNB and adequacy of samples for diagnosis and ancillary studies.
METHODS
A retrospective cohort study of EBUS-TBNB at the Royal Adelaide Hospital was conducted between December 2019 and May 2021. Diagnostic rate, adequacy for ancillary studies and complications were evaluated. Samples were flushed into formalin for histological processing with no rapid on-site cytological evaluation (ROSE). For suspected lymphoma, samples were flushed into HANKS for flow cytometry. Cases performed with the Olympus Vizishot during the same 18-month were similarly analysed.
RESULTS
One hundred and eighty-nine patients were sampled with the Acquire needle. Diagnostic rate was 174/189 (92.1%). Where reported [146/189 (77.2%)], average core aggregate sample size was 13.4 mm × 10.7 mm × 1.7 mm. For non-small cell lung cancer (NSCLC) cases, 45/49 (91.8%) had adequate tissue for programmed cell death-ligand 1 (PD-L1). 32/35 (91.4%) adenocarcinoma cases had sufficient tissue for ancillary studies. There was one false negative malignant lymph node at the first Acquire procedure. There were no major complications. One hundred and one patients were sampled with the Vizishot needle. Diagnostic rate was 86/101 (85.1%) with only 25/101 (24.8%) having reported tissue cores (P<0.0001 of Vizishot) with the remaining samples processed via cell block.
CONCLUSIONS
Acquire EBUS-TBNB diagnostic rate is comparable to historical data with >90% of cases having sufficient core material for ancillary studies. There appears to be a role for the Acquire alongside the standard of care for the work up of lymphadenopathy and particularly for lung cancer.
PubMed: 37426168
DOI: 10.21037/jtd-22-1747