Workplace exposure to engineered nanomaterials: The Italian path for the definition of occupational health and safety policies

This study explores the way the publication of a National White Book on health and safety risks that affect workers in jobs involving Nanotechnologies and Nanomaterials influenced the key Italian stakeholders attitude toward this issue and identifies the standpoints and priorities shared among researchers and stakeholders to develop a policy framework to address this issue.     

Predictors of Recording an Event During Prolonged Inpatient Video Electroencephalogram Monitoring in Children

BackgroundDistinguishing between seizures and nonepileptic events is a key challenge in pediatric neurology. The diagnostic gold standard is prolonged inpatient video electroencephalogram monitoring. However, little is known about preadmission characteristics that are predictive of recording an event during such monitoring.MethodsThis is a retrospective chart review of children undergoing prolonged inpatient video electroencephalogram monitoring between 2009 and 2012 at a tertiary referral center for the purpose of distinguishing between seizures and nonepileptic events. Demographic information, medical history, event characteristics, and inpatient monitoring course were abstracted.ResultsTwo-hundred thirteen children were identified. The median recording duration was 25 hours (interquartile range 22.4-48.5), and median time to event of interest (among those with an event recorded) was 4.5 hours (interquartile range 1.4-18.8). An event of interest was recorded in 66% of patients. At the event level, 20% of recorded events were associated with an electroencephalogram correlate, which refers to a change in the pattern seen on the electroencephalogram during a seizure. At the patient level, 112 (79.4%) with events recorded had only nonepileptic events recorded, 25 (17.7%) had only seizures recorded, and 4 (2.8%) had both recorded. Recording an event was predicted by the presence of intellectual disability (P = 0.001), greater preadmission event frequency (P < 0.001), and shorter latency since most recent event (P < 0.001).ConclusionsProlonged inpatient electroencephalogram monitoring captured an event of interest in two-thirds of patients, with most of these events captured within less than four and a half hours of recording onset. Several factors predict a greater yield with prolonged inpatient video electroencephalogram monitoring—including event frequency, latency since the most recent event, and the presence of intellectual disability—and can be used to counsel patients regarding this study for the purpose of event capture in the context of shared decision making.     

Breaking bad news about cancer in China: Concerns and conflicts faced by doctors deciding whether to inform patients

ObjectivesWe aimed to explore how doctors in China decide whether to inform cancer patients about diagnosis and prognosis.MethodsWe conducted in-depth, semi-structured interviews with 24 doctors and residents from a leading hospital in Hunan, China. Data were analyzed by content analysis.ResultsDoctors routinely told the family about cancer first, then withheld information from patients if the family did not want to tell the patient. Three main themes emerged in relation to hiding bad news from patients: 1) fear that most patients lack resilience to cope with bad news; 2) fear of direct or legal conflict with the family, and 3) a value conflict between respecting the patient’s “right to know” and respecting the family’s interest in protecting the patient.ConclusionsDoctors consider decisions to withhold information from cancer patients to be a non-ideal but necessary compromise of the patient’s “right to know.” Culturally adjusted training and guidelines could help with including the patient in information disclosure while still respecting China’s cultural value of family decision-making.Practice ImplicationsFuture training and guidelines should help doctors mediate between patient and family interests and understand changing laws and regulations. Other important elements include reflection, senior mentorship, self-awareness, and building trust.     

The experiences and perspectives of family surrogate decision-makers: A systematic review of qualitative studies

ObjectiveSurrogate decision-makers play an increasingly important role in the lives of older adults who have lost their ability to make decisions. Currently, there is a lack of evidence to support family surrogates in making a variety of decisions. Additionally, a greater understanding of family caregivers’ experiences and perspectives toward making surrogate decisions is needed.MethodsThis study employed a qualitative systematic review and thematic synthesis of the research evidence using the methodologies of the Joanna Briggs Institute (2014) and Thomas and Harden (2008).ResultsDecisions were classified per three main types: intensive care treatment, end-of-life treatment, and placement. Six themes were identified concerning surrogates’ experiences: struggle and reluctance, seeking reassurance, communication with healthcare professionals, family support, older adults’ wishes, and negative impact.ConclusionFamily surrogates often lack adequate preparation and education regarding decision-making. Quality communication between surrogates and healthcare providers helps reduce the anxiety and guilt experienced when making surrogate decisions. Further research is required to elucidate these experiences with more cultural and racial nuances.Practice implicationsThis review informs healthcare providers’ awareness of the challenges faced by surrogates and fosters improved surrogate decision-making experiences.     

Physicians’ information seeking behavior in patients presenting with heart failure symptoms – Does gender of physician and patient matter?

ObjectiveTo examine differences in the anamnesis in heart failure patients by patient and physician gender.MethodsA factorial experimental design with video vignettes was applied. While the dialog of an initial encounter because of heart failure symptoms was identical in all videos, patients, played by professional actors, differed in terms of gender (male/female), age (55 years/75 years) and Turkish migration history (no/yes). After viewing the video, 128 physicians (50 % female) were asked if they wanted to ask additional questions (yes/no) and if so, what they wanted to ask (open ended). A coding frame was conducted for the open ended question.ResultsCompared to male physicians, female physicians more often said they wanted to ask additional questions, especially about psychosocial aspects. Physicians, particularly female physicians, wanted to ask male patients more often about lifestyle aspects compared to female patients.ConclusionAlthough the dialog was identical in all videos, some variations in the anamnestic approach regarding physician and patient gender were identified. This is in contrast to current heart failure guidelines that recommend a detailed anamnesis in all patients presenting themselves with heart failure symptoms.Practice ImplicationsPrimary care physicians should reflect how possible gender stereotypes may influence their anamnestic behavior.     

Interplay between components of pupil-linked phasic arousal and its role in driving behavioral choice in Go/No-Go perceptual decision-making

In decision-making tasks, neural circuits involved in different aspects of information processing may activate the central arousal system, likely through their interconnection with brainstem arousal nuclei, collectively contributing to the observed pupil-linked phasic arousal. However, the individual components of the phasic arousal associated with different elements of information processing and their effects on behavior remain little known. In this study, we used machine learning techniques to decompose pupil-linked phasic arousal evoked by different components of information processing in rats performing a Go/No-Go perceptual decision-making task. We found that phasic arousal evoked by stimulus encoding was larger for the Go stimulus than the No-Go stimulus. For each session, the separation between distributions of phasic arousal evoked by the Go and by the No-Go stimulus was predictive of perceptual performance. The separation between distributions of decision-formation-evoked arousal on correct and incorrect trials was correlated with decision criterion but not perceptual performance. When a Go stimulus was presented, the action of go was primarily determined by the phasic arousal evoked by stimulus encoding. On the contrary, when a No-Go stimulus was presented, the action of go was determined by phasic arousal elicited by both stimulus encoding and decision formation. Drift diffusion modeling revealed that the four model parameters were better accounted for when phasic arousal elicited by both stimulus encoding and decision formation was considered. These results suggest that the interplay between phasic arousal evoked by both stimulus encoding and decision formation has important functional consequences on forming behavioral choice in perceptual decision-making.     

Palliative care for disabled children and young people

Palliative care for disabled children and young people embraces holistic, high quality, evidence-based care, recognition and timely management of symptoms, recognition and discussion with the multidisciplinary team and with families about the possibility of dying and care and support through life, death and bereavement.Systems are being piloted across the UK to collect data about who and where children and young people with palliative care needs are and to ensure robust funding mechanisms are established for provision of care in an equitable way.Decision-making within a legal and ethical framework is paramount in this area of clinical practice, along with clinical networking within care pathways to ensure care delivered is of the highest standard.     

Risk factors for persistent frequent use of the primary health care services among frequent attenders: A Bayesian approach

Abstract

Objectives . The aim of this study was to examine risk factors that predict persistent healthcare frequent attendance among a frequent attender (FA) population. Design. Prospective cohort study without intervention. Setting. Primary healthcare centre in Tampere, Finland. Subjects. A total of 85 primary healthcare working-age patients participated in the study. All participants were FAs in the first study year. Main outcome measures. We identified two groups of patients: temporary FAs and persistent FAs. A patient was considered as a persistent FA if he or she visited the health centre at least eight times a year for at least three out of four follow-up years. Some 59 different variables were examined as potential risk factors for persistent FA. P-course, a web-based Na ï ve Bayesian classification tool, was used for the modelling of the data. Results. In our model, the most influential predictive risk factors for persistent frequent attendance in an FA population were female gender, body mass index above 30, former frequent attendance, fear of death, alcohol abstinence, low patient satisfaction, and irritable bowel syndrome. New observations were high body mass index, alcohol abstinence, irritable bowel syndrome, low patient satisfaction, and fear of death. Conclusions. In FA analyses, distinction between temporary and persistent frequent attendance should be made. Our Bayesian model could be used for identifying persistent FAs in uncertain situations. The model can quite easily be further developed as a practical decision support tool for general practitioners. However, before its use in practice, the external validity of the model will need to be defined.