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Important Concern (important + concern)
Selected AbstractsRole of Immune Serum in the Killing of Helicobacter pylori by MacrophagesHELICOBACTER, Issue 3 2010Stacey Keep Abstract Background:,Helicobacter pylori infection can lead to the development of gastritis, peptic ulcers and gastric cancer, which makes this bacterium an important concern for human health. Despite evoking a strong immune response in the host, H. pylori persists, requiring complex antibiotic therapy for eradication. Here we have studied the impact of a patient's immune serum on H. pylori in relation to macrophage uptake, phagosome maturation, and bacterial killing. Materials and Methods:, Primary human macrophages were infected in vitro with both immune serum-treated and control H. pylori. The ability of primary human macrophages to kill H. pylori was characterized at various time points after infection. H. pylori phagosome maturation was analyzed by confocal immune fluorescence microscopy using markers specific for H. pylori, early endosomes (EEA1), late endosomes (CD63) and lysosomes (LAMP-1). Results:, Immune serum enhanced H. pylori uptake into macrophages when compared to control bacteria. However, a sufficient inoculum remained for recovery of viable H. pylori from macrophages, at 8 hours after infection, for both the serum-treated and control groups. Both serum-treated and control H. pylori phagosomes acquired EEA1 (15 minutes), CD63 and LAMP-1 (30 minutes). These markers were then retained for the rest of an 8 hour time course. Conclusions:, While immune sera appeared to have a slight positive effect on bacterial uptake, both serum-treated and control H. pylori were not eliminated by macrophages. Furthermore, the same disruptions to phagosome maturation were observed for both serum-treated and control H. pylori. We conclude that to eliminate H. pylori, a strategy is required to restore the normal process of phagosome maturation and enable effective macrophage killing of H. pylori, following a host immune response. [source] Does primary sclerosing cholangitis impact quality of life in patients with inflammatory bowel disease?INFLAMMATORY BOWEL DISEASES, Issue 3 2010Ashwin N. Ananthakrishnan MD Abstract Background: Impairment of health-related quality of life (HRQoL) is an important concern in inflammatory bowel disease (IBD; ulcerative colitis [UC], Crohn's disease [CD]). Between 2%,10% of patients with IBD have primary sclerosing cholangitis (PSC). There has been limited examination of the disease-specific HRQoL in this population compared to non-PSC IBD controls. Methods: This was a retrospective, case,control study performed at a tertiary referral center. Cases comprised 26 patients with a known diagnosis of PSC and IBD (17 UC, 9 CD). Three random controls were selected for each case after matching for IBD type, gender, age, and duration of disease. Disease-specific HRQoL was measured using the Short Inflammatory Bowel Disease Questionnaire (SIBDQ). Disease activity for CD was measured using the Harvey,Bradshaw index (HB) and using the UC activity index for UC. Independent predictors of HRQoL were identified. Results: There was no significant difference in the age, gender distribution, or disease duration between PSC-IBD and controls. There was no difference in use of immunomodulators or biologics between the 2 groups. Mean SIBDQ score was comparable between PSC-IBD patients (54.5) and controls (54.1), both for UC and CD. Likewise, the disease activity scores were also similar (2.8 versus 3.1, P = 0.35). On multivariate analysis, higher disease activity score (,1.33, 95% confidence interval [CI] 95% CI ,1.85 to ,0.82) and shorter disease duration were predictive of lower HRQoL. Coexisting PSC did not influence IBD-related HRQoL. There was a higher proportion of permanent work disability in PSC-IBD (7.7%) compared to controls (0%). Conclusions: PSC does not seem to influence disease-specific HRQoL in our patients with IBD but is associated with a higher rate of work disability. (Inflamm Bowel Dis 2010) [source] Healthcare professionals' perceptions of existential distress in patients with advanced cancerJOURNAL OF ADVANCED NURSING, Issue 7 2010Esther Mok mok e., lau k-p., lam w-m., chan l-n., ng j.s.c. & chan k-s. (2010) Healthcare professionals' perceptions of existential distress in patients with advanced cancer. Journal of Advanced Nursing,66(7), 1510,1522. Abstract Title.,Healthcare professionals' perceptions of existential distress in patients with advanced cancer. Aim., This paper is a report of an exploration of the phenomenon of existential distress in patients with advanced cancer from the perspectives of healthcare professionals. Background., Existential distress is an important concern in patients with advanced cancer; it affects their well-being and needs to be addressed in the provision of holistic care. Method., Focus groups were conducted from November 2008 to February 2009 with physicians, nurses, social workers, occupational therapists, physiotherapists, and chaplains working in a palliative care unit that served patients with advanced cancer in Hong Kong. Data collection and analysis were guided by the grounded theory approach. All categories were saturated when five focus groups had been held with a total number of 23 participants. Findings., We found three causal conditions of existential distress: anticipation of a negative future, failure to engage in meaningful activities and relationships, and having regrets. Three basic (caring, relating and knowing) and six specific (positive feedback, religious support, new experiences, task setting, exploring alternatives and relationship reconciliation) intervening strategies were identified. Whether the intervening strategies would be effective would depend on patients' openness and readiness; healthcare professionals' self-awareness, hopefulness, and interest in knowing the patients; and a trusting relationship between patients and healthcare professionals. A sense of peace in patients was considered a consequence of successful interventions. Conclusion., This paper acknowledges the lack of an accepted conceptual framework of existential distress in patients with advanced cancer. It is based on healthcare professionals' views, and further studies from the perspectives of patients and their families are needed. [source] Duty Hours in Emergency Medicine: Balancing Patient Safety, Resident Wellness, and the Resident Training Experience: A Consensus Response to the 2008 Institute of Medicine Resident Duty Hours RecommendationsACADEMIC EMERGENCY MEDICINE, Issue 9 2010Mary Jo Wagner MD Abstract Representatives of emergency medicine (EM) were asked to develop a consensus report that provided a review of the past and potential future effects of duty hour requirements for EM residency training. In addition to the restrictions made in 2003 by the Accreditation Council for Graduate Medical Education (ACGME), the potential effects of the 2008 Institute of Medicine (IOM) report on resident duty hours were postulated. The elements highlighted include patient safety, resident wellness, and the resident training experience. Many of the changes and recommendations did not affect EM as significantly as other specialties. Current training standards in EM have already emphasized patient safety by requiring continuous on-site supervision of residents. Resident fatigue has been addressed with restrictions of shift lengths and limitation of consecutive days worked. One recommendation from the IOM was a required 5-hour rest period for residents on call. Emergency department (ED) patient safety becomes an important concern with the decrease in the availability and in the patient load of a resident consultant that may result from this recommendation. Of greater concern is the already observed slower throughput time for admitted patients waiting for resident care, which will increase ED crowding and decrease patient safety in academic institutions. A balance between being overly prescriptive with duty hour restrictions and trying to improve resident wellness was recommended. Discussion is included regarding the appropriate length of EM training programs if clinical experiences were limited by new duty hour regulations. Finally, this report presents a review of the financing issues associated with any changes. ACADEMIC EMERGENCY MEDICINE 2010; 17:1004,1011 © 2010 by the Society for Academic Emergency Medicine [source] Heterogeneity and cross section dependence in panel data models: theory and applications introductionJOURNAL OF APPLIED ECONOMETRICS, Issue 2 2007Badi H. Baltagi The papers included in this special issue are primarily concerned with the problem of cross section dependence and heterogeneity in the analysis of panel data models and their relevance in applied econometric research. Cross section dependence can arise due to spatial or spill over effects, or could be due to unobserved (or unobservable) common factors. Much of the recent research on non-stationary panel data have focussed on this problem. It was clear that the first generation panel unit root and cointegration tests developed in the 1990's, which assumed cross-sectional independence, are inadequate and could lead to significant size distortions in the presence of neglected cross-section dependence. Second generation panel unit root and cointegration tests that take account of possible cross-section dependence in the data have been developed, see the recent surveys by Choi (2006) and Breitung and Pesaran (2007). The papers by Baltagi, Bresson and Pirotte, Choi and Chue, Kapetanios, and Pesaran in this special issue are further contributions to this literature. The papers by Fachin, and Moon and Perron are empirical studies in this area. Controlling for heterogeneity has also been an important concern for empirical researchers with panel data methods promising better handle on heterogeneity than cross-section data methods. The papers by Hsiao, Shen, Wang and Weeks, Pedroni and Serlenga and Shin are empirical contributions to this area. Copyright © 2007 John Wiley & Sons, Ltd. [source] Effective Borel measurability and reducibility of functionsMLQ- MATHEMATICAL LOGIC QUARTERLY, Issue 1 2005Vasco Brattka Abstract The investigation of computational properties of discontinuous functions is an important concern in computable analysis. One method to deal with this subject is to consider effective variants of Borel measurable functions. We introduce such a notion of Borel computability for single-valued as well as for multi-valued functions by a direct effectivization of the classical definition. On Baire space the finite levels of the resulting hierarchy of functions can be characterized using a notion of reducibility for functions and corresponding complete functions. We use this classification and an effective version of a Selection Theorem of Bhattacharya-Srivastava in order to prove a generalization of the Representation Theorem of Kreitz-Weihrauch for Borel measurable functions on computable metric spaces: such functions are Borel measurable on a certain finite level, if and only if they admit a realizer on Baire space of the same quality. This Representation Theorem enables us to introduce a realizer reducibility for functions on metric spaces and we can extend the completeness result to this reducibility. Besides being very useful by itself, this reducibility leads to a new and effective proof of the Banach-Hausdorff-Lebesgue Theorem which connects Borel measurable functions with the Baire functions. Hence, for certain metric spaces the class of Borel computable functions on a certain level is exactly the class of functions which can be expressed as a limit of a pointwise convergent and computable sequence of functions of the next lower level. (© 2004 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [source] When Better Is Worse: Envy and the Use of DeceptionNEGOTIATION AND CONFLICT MANAGEMENT RESEARCH, Issue 1 2008Simone Moran Abstract In this article, we describe how envy motivates deception. We find that individuals who envy a counterpart are more likely to deceive them than are individuals who do not envy their counterpart. Across both a scenario and a laboratory study, we explore the influence of envy in a negotiation setting. Negotiations represent a domain in which social comparisons are prevalent and deception poses a particularly important concern. In our studies, we induce envy by providing participants with upward social comparison information. We find that upward social comparisons predictably trigger envy, and that envy promotes deception by increasing psychological benefits and decreasing psychological costs of engaging in deceptive behavior. We discuss implications of our results with respect to negotiations and the role of emotions in ethical decision making. [source] Using non,time,series to determine supply elasticity: how far do prices change the Hubbert curve?OPEC ENERGY REVIEW, Issue 2 2002Douglas B. Reynolds An important concern of OPEC's work is to be able to understand how much supply of oil exists in different countries, in order to help better conserve oil. This paper extends M. King Hubbert's oil production and discovery forecasting model (Hubbert, 1962), using a non,time,series cumulative discovery and production quadratic Hubbert curve and structural shift variables to model technology and regulation changes. The model can be used to determine better world oil supplies. Price is tested, to see how powerful it is for increasing or decreasing oil supply. Using a trend of cumulative production, instead of time, will help to better fix the supply elasticity with respect to price, which is shown to be very inelastic. An interesting question is whether cumulative discovery or production constitutes an I(2) variable. This paper explains that they are not I(2) variables. [source] Stream Restoration in the Upper Midwest, U.S.A.RESTORATION ECOLOGY, Issue 4 2006Gretchen G. Alexander Abstract Restoration activities intended to improve the condition of streams and rivers are widespread throughout the Upper Midwest, U.S.A. As with other regions, however, little information exists regarding types of activities and their effectiveness. We developed a database of 1,345 stream restoration projects implemented from the years 1970 to 2004 for the states of Michigan, Ohio, and Wisconsin in order to analyze regional trends in goals, presence of monitoring, spatial distribution, size, and cost of river restoration projects. We found that data on individual projects were fragmented across multiple federal, state, and county agencies, as well as nonprofit groups and consulting firms. The most common restoration goals reported for this region were in-stream habitat improvement, bank stabilization, water-quality management, and dam removal. The former two were most common in Michigan and Wisconsin, where salmonid fisheries enhancement appeared to be an important concern, whereas water-quality management was most frequent in Ohio. The most common restoration activities were the use of sand traps and riprap, and other common activities were related to the improvement of fish habitat. The median cost was $12,957 for projects with cost data, and total expenditures since 1990 were estimated at $444 million. Over time, the cost of individual projects has increased, whereas the median size has decreased, suggesting that restoration resources are being spent on smaller, more localized, and more expensive projects. Only 11% of data records indicated that monitoring was performed, and more expensive projects were more likely to be monitored. Standardization of monitoring and record keeping and dissemination of findings are urgently needed to ensure that dollars are well spent and restoration effectiveness is maximized. [source] Administering Romance: Government Policies Concerning Pre-marriage Education ProgramsAUSTRALIAN JOURNAL OF PUBLIC ADMINISTRATION, Issue 1 2003Elizabeth Van Acker Recent policy objectives surrounding the institution of marriage are based on strategies aimed at sustaining a stable and morally cohesive society. Policy-makers disapproving of marriage breakdowns often focus on the behaviour of individuals to explain the breakdowns. Policy initiatives seek to ,cure' individuals to overcome the problem of marriage failure. Pre-marriage education programs encourage self-help and depend on individuals solving their own problems. I argue in this paper that this rational view of marriage is flawed because it does not engage with the issue of romance. This is an important concern to administrators because romance often plays a central role in partner choice and people's expectations of marriage. Policy-makers either ignore romance or treat it as a myth to be countered; they rarely discuss how it influences a couple's decision to marry in the first place. I argue that romance should not be dismissed so easily as it plays a significant role in gender relations. Acknowledging romance ought to be a significant part of administering marriage education programs. [source] Electrochemical Quartz Crystal Microbalance Studies on Enzymatic Specific Activity and Direct Electrochemistry of Immobilized Glucose Oxidase in the Presence of Sodium Dodecyl Benzene Sulfonate and Multiwalled Carbon NanotubesBIOTECHNOLOGY PROGRESS, Issue 1 2008Yuhua Su The electrochemical quartz crystal microbalance (EQCM) technique was utilized to monitor in situ the adsorption of glucose oxidase (GOD) and the mixture of GOD and sodium dodecyl benzene sulfonate (SDBS) onto Au electrodes with and without modification of multiwalled carbon nanotubes (MWCNTs) or SDBS/MWCNTs composite, and the relationship between enzymatic specific activity (ESA) and direct electrochemistry of the immobilized GOD was quantitatively evaluated for the first time. Compared with the bare gold electrode at which a little GOD was adsorbed and the direct electrochemistry of the adsorbed GOD was negligible, the amount and electroactivity of adsorbed GOD were greatly enhanced when the GOD was mixed with SDBS and then adsorbed onto the SDBS/MWCNTs modified Au electrode. However, the ESA of the adsorbed GOD was fiercely decreased to only 16.1% of the value obtained on the bare gold electrode, and the portion of adsorbed GOD showing electrochemical activity exhibited very low enzymatic activity, demonstrating that the electroactivity and ESA of immobilized GOD responded oppositely to the presence of MWCNTs and SDBS. The ESA results obtained from the EQCM method were well supported by conventional UV-vis spectrophotometry. The direct electrochemistry of redox proteins including enzymes as a function of their biological activities is an important concern in biotechnology, and this work may have presented a new and useful protocol to quantitatively evaluate both the electroactivity and ESA of trace immobilized enzymes, which is expected to find wider applications in biocatalysis and biosensing fields. [source] Tissue reaction of the rabbit urinary bladder to tension-free vaginal tape and porcine small intestinal submucosaBJU INTERNATIONAL, Issue 6 2002D.M. Rabah Objectives ,To compare the histological tissue reactions of urinary bladder in close contact with polypropylene mesh tension-free vaginal tape (TVT) or porcine small intestinal submucosal (SIS) grafts, as the commercial availability of various materials has considerably simplified sling procedures for treating urinary incontinence, but erosion and infection after using artificial sling materials remain an important concern. Materials and methods ,Thirty female New Zealand rabbits were randomized to three groups, i.e. group A (TVT, 12 animals), group B (SIS, 12) and group C (surgical control, six). Through a laparotomy under anaesthesia and an aseptic technique, the bladder was approached at its dome, where a 0.5 × 1 cm piece of TVT or SIS was fixed in direct contact with the bladder wall. The control group underwent only bladder manipulation with no material applied. Half the animals in each group were killed after 6 weeks and the other half after 12 weeks. The urinary bladder was harvested and examined histologically. Results ,The grafts in both groups were characterized by dense foreign-body type reactions and were mostly attached loosely to the bladder wall by a thin layer of fibrovascular tissue. More importantly, the bladder wall reactions showed no inflammation in all 12 animals in group A (TVT) but three of them had various grades of fibrosis. There was severe transmural inflammation in one animal in group B (SIS); one rabbit had grade I and two had grade II fibrosis. The controls, as expected, showed no bladder wall reactions. Conclusion ,In this descriptive analysis of reaction types elicited on the urinary bladder by these grafts, both materials appeared to be safe. Although TVT elicited fewer and less severe adverse reactions, no statistical conclusions can be drawn. The clinical significance of these findings should emerge from long-term clinical data when they become available. [source] Overproduction of BCR-ABL induces apoptosis in imatinib mesylate-resistant cell linesCANCER, Issue 1 2005Vanessa Desplat Ph.D. Abstract BACKGROUND Imatinib mesylate, a BCR-ABL tyrosine kinase inhibitor, induces apoptosis in chronic myeloid leukemia cells. Resistance to imatinib is currently the most important concern of this treatment. One of the main mechanisms of this resistance is overexpression of BCR-ABL. METHODS In the current study, the authors investigated the correlation between BCR-ABL overexpression and apoptosis in BaF/BCR - ABL and LAMA84 cell lines resistant to imatinib suddenly deprived of the inhibitor, and compared with their sensitive counterpart. RESULTS Removal of imatinib from culture medium led to a decrease in Bcr-Abl protein expression by Day 5, which was sustained for , 3 weeks of imatinib deprivation. Apoptosis was observed after 3 days of imatinib deprivation in resistant lines accompanied by caspase activation, loss of membrane asymmetry (annexin V staining), and alteration of mitochondrial potential (dihexyloxacarbocyanine iodide [DiOC6]). Transient activation of the STAT5/Bcl-xL pathway and Akt kinase activity preceded these responses. CONCLUSIONS Thus, imatinib removal led to apoptosis of BCR-ABL,overexpressing leukemic cells, a phenomenon that could be exploited to sensitize imatinib-resistant cells to the cytotoxic effect of other drugs. Cancer 2005. © 2004 American Cancer Society. [source] Prevention of secondary stroke and transient ischaemic attack with antiplatelet therapy: the role of the primary care physician roleINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 10 2007H. S. Kirshner Summary Background:, Stroke risk is heightened among patients who have had a primary stroke or transient ischaemic attack (TIA). The primary care physician is in the best position to monitor these patients for stroke recurrence. Because stroke recurrence can occur shortly after the primary event, guidelines recommend initiating antiplatelet therapy as soon as possible. Aspirin, with or without extended-release dipyridamole (ER-DP), and clopidogrel are options for such patients. Low-dose aspirin (75,150 mg/day) has the same efficacy as higher doses but with less gastrointestinal bleeding. Clopidogrel remains an option for prevention of secondary events and may benefit patients with symptomatic atherothrombosis, but its combined use with aspirin can harm patients with multiple risk factors and no history of symptomatic cerebrovascular, cardiovascular or peripheral vascular disease. Results:, Low dose aspirin is effective in secondary stroke prevention. Trials assessing aspirin plus ER-DP have shown that the combination is more effective than aspirin monotherapy in preventing stroke, with efficacy increasing among higher risk patients, notably those with prior stroke/TIA. Clopidogrel does not appear to have as much advantage over aspirin in secondary stroke prevention as aspirin plus ER-DP. Smoking cessation and cholesterol, blood glucose and blood pressure control are also important concerns in preventing recurrent stroke. In choosing pharmacological therapy, the physician must consider the individual patient's risk factors and tolerance, as well as other issues, such as use of aspirin among patients with ulcers. Conclusion:, Antiplatelet therapy is effective in secondary stroke prevention. Low dose aspirin can be used first-line, but aspirin plus ER-DP improves efficacy. Clopidogrel is another option in secondary stroke prevention, especially for aspirin-intolerant patients, but it appears to have less advantage over aspirin than aspirin plus ER-DP, and its combined use with aspirin has only marginally better efficacy and increased bleeding risk. [source] Healing and Salvation in Late Modernity: the Use and Implication of Such Terms in the Ecumenical MovementINTERNATIONAL REVIEW OF MISSION, Issue 380-381 2007Vebjørn Horsfjord This article explores developments over the last decades in the way ecumenical texts, primarily originating from world conferences organized by the Commission on World Mission and Evangelism, speak about soteriology. Under the headlines, "Salvation Today" (1973) and "Your Kingdom Come" (1980), terminology inspired by liberation theology took centre stage, and a predominantly immanent understanding of salvation was promoted. In recent years a different terminology has taken over, and it is one that focuses on "healing" and "the fullness of life". At its best, the holistic healing approach manages to take up the important concerns from earlier times, such as economic justice, racism and environmental issues, while at the same time giving more room for existential issues and the experiences of the individual The new healing discourse appears to reflect two different modalities of the church's healing ministry, viz. that which is concerned with the causes of suffering, and that which addresses the experience of suffering. The latter was often ignored in the recent past. The healing discourse gives room for new explorations of practices that have been central in the church throughout its history, such as anointing the sick, and praying for and with them, and hearing individual confessions. Openness towards subjective experience also has implications for the contextualization of the Christian faith. There is a new awareness that not only do the causes of suffering vary from situation to situation but so does the understanding of (what constitutes) suffering itself. Changing or varying understandings of suffering give rise to different approaches to its alleviation, and can inspire a rethinking of how we understand salvation in different contexts. The new healing discourse can also be studied in its relationship to cultural trends known as post-modernity or late modernity. The texts under study display very ambivalent approaches to these developments. There might be a tendency for texts that have concrete experience as their starting point to take a more positive view of these cultural developments than do texts that begin with more general theological observations. [source] Efficacy and Safety of Drug-Eluting Stents: Current Best Available EvidenceJOURNAL OF CARDIAC SURGERY, Issue 6 2006Shahzad G. Raja M.R.C.S. Drug-eluting coronary stents deliver effective local concentrations of antiproliferative drugs (thus avoiding systemic toxicities), without substantially modifying the technique of percutaneous coronary intervention. Studies involving several different stent platforms and antiproliferative drug coatings have recently demonstrated dramatic reductions in restenosis rates, compared to conventional bare metal stents. Although the clinical benefits of drug-eluting stents are increasingly evident, important concerns about their long-term safety and costs have been raised. Furthermore, drug-eluting stents are being claimed to replace coronary artery bypass surgery in the near future. This review article evaluates the current best available evidence on the efficacy and safety of drug-eluting stents with a focus on the impact of this "revolutionary" new technology on the practice of coronary artery bypass surgery. [source] Strategies for improving transition to adult cystic fibrosis care, based on patient and parent views,PEDIATRIC PULMONOLOGY, Issue 6 2001Michael P. Boyle MD Abstract Although general principles guiding the transition of individuals with chronic illness from pediatric to adult care have been established, guidelines specific for the transition of individuals with cystic fibrosis (CF) have not. To aid in the development of CF-specific transition guidelines, an anonymous pretransition questionnaire and posttransition interview were used to assess the concerns and expectations of 60 CF patients and their parents as they went through the transition from pediatric to adult care. Along with demographic and clinical information, respondents were asked to rate on a scale of 1,5 their general attitude toward, or level of concern on 22 questions involving transition concerns, adult program expectations, and general view of transition. The two most important concerns identified by patients prior to transition to adult care were potential exposure to infection (3.4,±,1.3) and having to leave their previous caregivers (3.4,±,1.0). Introduction to the adult CF team prior to transition was associated with significantly lower levels of concern in all areas, particularly about having to leave previous caregivers (3.9,±,0.7 vs. 2.5,±,0.6, P,<,0.004). Age, gender, severity of lung disease, and age at diagnosis were not predictive of level of concern for any area. Parents' most significant concern was ability of their child to care for their CF independently, a concern their children did not share (4.0,±,1.1 vs. 1.5,±,0.5, P,<,0.0001). As their most important expectations for the adult program, patients identified ready phone access to a nurse (4.9,±,0.6) and education about adult CF issues (4.6,±,0.7). The overall attitude toward the development of an adult CF program was overwhelmingly positive for both patients (4.9,±,0.7) and parents (4.9,±,0.3). By allowing patients to interact with the adult team prior to transition and developing transition protocols which address CF-specific issues like infection control and fertility, successful transition from pediatric to adult cystic fibrosis care can be accomplished. Pediatr Pulmonol. 2001; 32:428,436. © 2001 Wiley-Liss, Inc. [source] IS INFORMED CONSENT IN CARDIAC SURGERY AND PERCUTANEOUS CORONARY INTERVENTION ACHIEVABLE?ANZ JOURNAL OF SURGERY, Issue 7 2007Marco E. Larobina Background: Medical and legal published work regularly discusses informed consent and patient autonomy before medical interventions. Recent discussions have suggested that Cardiothoracic surgeons' risk adjusted mortality data should be published to facilitate the informed consent process. However, as to which aspects of medicine, procedures and the associated risks patients understand is unknown. It is also unclear how well the medical profession understands the concepts of informed consent and medical negligence. The aims of this study were to evaluate patients undergoing coronary artery bypass surgery (CABG) and percutaneous coronary intervention (PCI) to assess their understanding of the risks of interventions and baseline level of understanding of medical concepts and to evaluate the medical staff's understanding of medical negligence and informed consent. Methods: Patients undergoing CABG or PCI at a tertiary hospital were interviewed with questionnaires focusing on the consent process, the patient's understanding of CABG or PCI and associated risks and understanding of medical concepts. Medical staff were questioned on the process of obtaining consent and understanding of medicolegal concepts. Results: Fifty CABG patients, 40 PCI patients and 40 medical staff were interviewed over a 6-month period. No patient identified any of the explained risks as a reason to reconsider having CABG or PCI, but 80% of patients wanted to be informed of all risks of surgery. 80% of patients considered doctors obligated to discuss all risks of surgery. One patient (2%) expressed concern at the prospect of a trainee surgeon carrying out the operation. Stroke (40%) rather than mortality (10%) were the important concerns in patients undergoing CABG and PCI. The purpose of interventions was only partially understood by both groups; PCI patients clearly underestimated the subsequent need for repeat PCI or CABG. Knowledge of medical concepts was poor in both groups: less than 50% of patients understood the cause or consequence of an AMI or stroke and less than 20% of patients correctly identified the ratio equal to 0.5%. One doctor (2.5%) correctly identified the four elements of negligence, eight (20%) the meaning of material risk and four (10%) the meaning of causation. Thirty doctors (75%) believed that all complications of a procedure needed to be explained for informed consent. Less than 10% could recognize landmark legal cases. Conclusion: Patients undergoing both CABG and PCI have a poor understanding of their disease, their intervention, and its complications making the attaining of true informed consent difficult, despite their desire to be informed of all risks. PCI patients particularly were highly optimistic regarding the need for reintervention over time, which requires specific attention during the consent process. Medical staff showed a poor knowledge of the concepts of material risk and medical negligence requiring much improved education of both junior doctors and specialists. [source] | ||||||||||||||||