Breaking bad news in a cross-language context: A qualitative study to develop a set of culturally and linguistically appropriate phrases and techniques with Zulu speaking cancer patients

ObjectiveBreaking bad news (BBN) in healthcare is common. Guidelines abound but little is documented in an African context. We wanted to describe Zulu speaking patients’ BBN experience and assess their opinions of internationally recommended techniques.MethodsBBN techniques were highlighted from the literature using systematic review methods. Semi-structured focus group interviews with Zulu speaking cancer patients were conducted. Data were analysed using Framework Analysis.ResultsLanguage concordance was central – regardless of whether this necessitated a nurse acting as translator. While non-abandonment, empathy and maintenance of hope was valued by participants, an oft-expressed belief in positive outcomes accounted for mixed responses to phrases implying ambiguity. In contrast, “I wish” phrases were appreciated. Silence received mixed responses with a strong dislike for silence as a front for non-disclosure.ConclusionLanguage-related concerns dictated the bulk of participants BBN perspectives. While cultural and linguistic differences exist, good communication skills, empathy and the maintenance of hope remain central.Practice implicationsBBN in a language in which the patient is fluent, whether mediated or not, should be the standard of care. Cultural and linguistic variance must be born in mind and clinicians should become familiar with the preferences of the communities they serve.     

Accuracy of predonation Hct sampling affects donor safety, eligibility, and deferral rates

BACKGROUND: Safe blood donation depends upon reliable predonation Hct screening. Earstick (ES) capillary samples are frequently used, but they may not be accurate. STUDY DESIGN AND METHODS: Predonation ES and fingerstick (FS) and postdonation venous Hct results were compared in 1960 whole-blood and 210 apheresis donors. The validity of using postdonation venous samples to evaluate predonation ES and FS Hct was assessed in 20 whole-blood donors. The impact of Hct screening method on donor Hct deferrals was examined during periods when either ES or FS sampling was used exclusively. RESULTS: All donors were eligible to donate on the basis of a predonation capillary Hct of > or = 38 percent. In venous samples obtained immediately after donation, 36 percent of whole-blood donors had a Hct <38 percent. With correction for a decrease of approximately 2 Hct units during donation, 20 percent of these donors had a predonation Hct <38 percent. The lowest venous Hct was 23.1 percent. FS samples showed better correlation with venous Hct. Hct discrepancies were similar for apheresis donors. Hct deferrals were significantly higher with FS sampling, especially among women. CONCLUSION: Hct determinations from ES samples overestimate venous Hct. Fingerstick samples are more sensitive in detecting anemia. The accuracy of predonation Hct sampling has implications for donor safety, eligibility, and deferral rates.     

云南省东、西部地区青年学生艾滋病知晓率、性行为及其影响因素分析

目的 了解云南省西部与东部地区青年学生艾滋病的知识和行为。方法 2015年6月采用多阶段抽样方法抽取样本,对云南省东、西部地区的在校青年学生做现况调查。调查表由云南省疾病预防控制中心统一设计,调查内容包括调查对象的基本信息、艾滋病相关知识、危险行为和获得相关服务等情况。使用EpiData 3.0软件建立数据库和SPSS 19.0软件包进行数据处理和统计分析。结果 保山市和曲靖市各调查青年学生800人,艾滋病知晓率分别为61.88%和53.38%,其中保山市高中/中专生艾滋病知晓率（60.00%）显著高于曲靖市（47.00%）（2=10.637,P=0.001）;非条件logistic回归分析显示,大学生（OR=1.402）、知识来源于网络（OR=1.608）和免费宣传材料（OR=1.732）是知晓艾滋病的促进因素;男性（OR=0.715）、最近一年未接受过艾滋病宣传服务（OR=0.582）是艾滋病知晓率低的影响因素。保山市青年学生首次性行为年龄[（19.231.809）岁]高于曲靖市[（17.532.167）岁],差异有统计学意义（t=5.468,P0.01）;保山市性行为发生率和安全套使用率分别为13.75%和53.64%,曲靖市为7.50%和20.00%,其中保山市大学生性行为发生率（23.04%）高于曲靖市（12.77%）（2=8.554,P=0.003）;最近一年艾滋病的宣传服务保山市的接受率（61.38%）高于曲靖市（56.25%）（2=4.337,P=0.037）;保山市发生过性行为的学生艾滋病检测率（32.73%）显著高于曲靖市（13.33%）（2=21.750,P0.001）。结论 云南省东部地区青年学生艾滋病健康教育效果并未因为经济较西部更发达而一定优于西部地区。     

一种国产血液核酸检测系统的性能验证研究

目的对一种国产血液核酸检测系统在本实验室进行献血者乙型肝病毒脱氧核糖核酸(HBV DNA)、丙型肝炎病毒核糖核酸(HCV RNA)、人类免疫缺陷病毒核糖核酸(HIV RNA)检测的性能进行研究,确定该系统是否稳定、准确、可靠。方法根据美国临床实验室标准化协会(CLSI)的相关文件要求,对一种国产血液核酸检测系统HBV DNA、HCV RNA、HIV RNA项目的检测灵敏度、准确度、精密度、抗交叉污染、抗干扰及稳定性进行验证。结果该国产血液核酸检测系统HBV DNA、HCV RNA、HIV RNA的95%检出限分别为4.87(3.84~8.22)IU/mL、7.29(5.68~13.89)IU/mL、30.22(22.90~60.17)IU/mL;对16例阳性样本和32例阴性样本进行混样检测,结果均为反应性,拆分检测阴性样本和阳性样本的检测符合率均为100%;HBV DNA、HCV RNA、HIV RNA阳性样本重复检测的变异系数(CV)分别为4.29%、1.51%、3.73%;将10个阴性样本和10个阳性样本进行阴阳交叉排列单检结果无交叉污染;低浓度HBV(10 IU/mL)、HCV(10 IU/mL)、HIV(40 IU/mL)样本在溶血样本[血红蛋白(Hb)含量为12 g/L]和脂肪样本[甘油三酯(TG)含量为6.13 mmol/L]中的检出均无显著影响;当溶血样本中Hb含量提高至24 g/L、脂肪样本中TG含量提高至11.85 mmol/L时,低浓度样本的检出会受到影响;经过2017年仪器设备的日常核酸检测情况分析,该国产血液核酸检测系统稳定性良好。结论该国产血液核酸检测系统的检测灵敏度、准确度、精密度和抗交叉污染等均达到生产商的检测性能的要求,在标本Hb≤12 g/L以及TG≤6.13 mmol/L时,对低浓度HBV DNA、HCV RNA、HIV RNA的检测无显著影响,满足本实验室检测需求。     

Mesenchymal Stem Cells Seeded on Cross‐Linked and Noncross‐Linked Acellular Porcine Dermal Scaffolds for Long‐Term Full‐Thickness Hernia Repair in a Small Animal Model

Biological meshes are biomaterials consisting of extracellular matrix that are used in surgery particularly for hernia treatment, thoracic wall reconstruction, or silicone implant‐based breast reconstruction. We hypothesized that combination of extracellular matrices with autologous mesenchymal stem cells used for hernia repair would result in increased vascularization and increased strength of incorporation. We cultured autologous adipose‐derived stem cells harvested from the inguinal region of Wistar rats on cross‐linked and noncross‐linked porcine extracellular matrices. In 24 Wistar rats, a standardized 2 × 4 cm fascial defect was created and repaired with either cross‐linked or noncross‐linked grafts enriched with stem cells. Non‐MSC‐enriched grafts were used as controls. The rats were sacrificed at 3 months of age. The specimens were examined for the strength of incorporation, vascularization, cell invasion, foreign body reaction, and capsule formation. Both materials showed cellular ingrowth and neovascularization. Comparison of both tested groups with the controls showed no significant differences in the capsule thickness, foreign body reaction, cellularization, or vascularization. The strength of incorporation of the stem cell‐enriched cross‐linked extracellular matrix specimens was higher than in acellular specimens, but this result was statistically nonsignificant. In the noncross‐linked extracellular matrix, the strength of incorporation was significantly higher in the stem cell group than in the acellular group. Seeding of biological meshes with stem cells does not significantly contribute to their increased vascularization. In cross‐linked materials, it does not ensure increased strength of incorporation, in contrast to noncross‐linked materials. Owing to the fact that isolation and seeding of stem cells is a very complex procedure, we do not see sufficient benefits for its use in the clinical setting.     

The Predictive Ability of the CHADS2 and CHA2DS2-VASc Scores for Bleeding Risk in Atrial Fibrillation: The MAQI Experience

Introduction

Guidelines recommend the assessment of stroke and bleeding risk before initiating warfarin anticoagulation in patients with atrial fibrillation. Many of the elements used to predict stroke also overlap with bleeding risk in atrial fibrillation patients and it is tempting to use stroke risk scores to efficiently estimate bleeding risk. Comparison of stroke risk scores to bleeding risk scores to predict bleeding has not been thoroughly assessed.

Methods

2600 patients followed at seven anticoagulation clinics were followed from October 2009-May 2013. Five risk models (CHADS₂, CHA₂DS₂-VASc, HEMORR₂HAGES, HAS-BLED and ATRIA) were retrospectively applied to each patient. The primary outcome was the first major bleeding event. Area under the ROC curves were compared with C statistic and net reclassification improvement (NRI) analysis was performed.

Results

110 patients experienced a major bleeding event in 2581.6 patient-years (4.5%/year). Mean follow up was 1.0 ± 0.8 years. All of the formal bleeding risk scores had a modest predictive value for first major bleeding events (C statistic 0.66-0.69), performing better than CHADS₂ and CHA₂DS₂-VASc scores (C statistic difference 0.10 - 0.16). NRI analysis demonstrated a 52-69% and 47-64% improvement of the formal bleeding risk scores over the CHADS₂ score and CHA₂DS₂-VASc score, respectively.

Conclusions

The CHADS₂ and CHA₂DS₂-VASc scores did not perform as well as formal bleeding risk scores for prediction of major bleeding in non-valvular atrial fibrillation patients treated with warfarin. All three bleeding risk scores (HAS-BLED, ATRIA and HEMORR₂HAGES) performed moderately well.