Development Of Clear Guidelines Research Articles

Addressing positive multi-cancer early detection tests in head and neck Surgery: Experience with head and neck work up for high-risk referrals

ObjectivesBlood-based multi-cancer early detection (MCED) tests are now commercially available. However, there are currently no consensus guidelines available for head and neck cancer (HNC) providers to direct work up or surveillance for patients with a positive MCED test. We seek to describe cases of patients with positive MCED tests suggesting HNC and provide insights for their evaluation. MethodsRetrospective chart review of patients referred to Otolaryngology with an MCED result suggesting HNC. Patients enrolled in prospective MCED clinical trials were excluded. Cancer diagnoses were confirmed via frozen-section pathology. ResultsFive patients were included (mean age: 69.2 years, range 50–87; 4 male) with MCED-identified-high-risk for HNC or lymphoma. Only patient was symptomatic. After physical exam and follow-up head and neck imaging, circulating tumor HPV DNA testing, two patients were diagnosed with p16 + oropharyngeal squamous cell carcinomas and underwent appropriate therapy. A third patient had no evidence of head and neck cancer but was diagnosed with sarcoma of the thigh. The remaining two patients had no evidence of malignancy after in-depth workup. ConclusionsIn this retrospective study, 2 of 5 patients referred to Otolaryngology with a positive MCED result were diagnosed with HPV + oropharyngeal squamous cell carcinoma. We recommend that positive HNC MCED work up include thorough head and neck examination with flexible laryngoscopy and focused CT or MRI imaging. Given the potential for inaccurate MCED tissue of origin classification, PET/CT may be useful in specific situations. For a patient with no cancer identified, development of clear guidelines is warranted.

Review of strategies to prevent infections related to ultrasound-guided nerve blocks and vascular access

Ultrasound guidance has become ubiquitous in the clinical practice of regional anesthesia and vascular access. Because the ultrasound transducer and an acoustic coupling medium (e.g. ultrasound gel) are applied directly to the patient’s body, the contact of a non-sterile ultrasound transducer with the site of intervention during the breach of the skin integrity by the needle carries the risk of infection transmission. Surprisingly, however, recommendations on how to prevent ultrasound-related outbreaks are often conflicting. With the increasing use of ultrasound in interventional procedures, such as vascular access, regional anesthesia, and pain medicine, the development of clear guidelines on how to prevent infection from patient to patient is essential for patient and operator safety. This review aims to provide a current understanding of the mechanisms and prevalence of infection transmission and to summarize the current recommendations for infectious precautions with interventional ultrasound. We also provide practically implementable and pragmatic recommendations for infectious precautions, based on the available information.

Perioperative antibiotic prophylaxis in Australian burns patients

Background: Perioperative antibiotic prophylaxis is perceived to reduce intraoperative bacteraemia and prevent surgical site infections, however, the evidence for its use in burns surgery is limited. Excessive use of perioperative antibiotics has become a growing concern. The authors aimed to audit the prescribing practices of perioperative antibiotic prophylaxis at the Victorian Adult Burns Service and determine whether the duration of antibiotic prophylaxis influenced the risk of postoperative wound infection, bacte-raemia and antibiotic resistance. Methods: This retrospective chart review included all acute adult burns patients who had an operation between November 2018 and November 2019. Basic demographic data, burn specific data and data on perioperative antibiotic use were collected. The outcome measures were wound infection, bacteraemia, other infections and presence of resistant organisms. Results: Results demonstrated that almost all patients (98.6%) received perioperative antibiotic prophylax-is. In comparison, there was no significant difference between the rate of postoperative wound infection, bacteraemia or antibiotic resistance between patients receiving a short or long course of antibiotics. Conclusion: The results of our study demonstrate variable use of perioperative antibiotic prophylaxis with-in one burns unit. There were many cases of unsubstantiated use of long courses of antibiotics without apparent benefit for clinical outcomes of wound infection or bacteraemia. With the growing concern over antibiotic overuse and development of resistance, there is an increasing need for development of clear guidelines for antibiotic use in burns surgery.

Improving the Adoption and Evolution of Data Standards for Fossil Specimens

As we atomize and expand the digital representation of specimen information through data standards, it is critical to evaluate the implementation of these developments, including how well they serve discipline-specific needs. In particular, fossil specimens often present challenges because they require information to be captured that is seemingly parallel to, but not entirely aligned with, that of their extant counterparts. Previous work to evaluate data sharing practices of paleontology collections has shown an imbalance in the use of Darwin Core (DwC) (Wieczorek et al. 2012) terms and many instances of underutilized terms (Little 2018). To expand upon that broad assessment and encourage better adoption of evolving standards and data practices by fossil collections, a more in-depth review of term usage is necessary. Here we review specific DwC terms that are underutilized or that present challenges for fossil occurrence records, and we examine the subsequent impact on data discovery of paleo specimens. We conclude by sharing options for improving standards implementation within a paleo context. We see key patterns and challenges in current implementation of DwC in paleo collections, as evidenced by evaluations of the typical mappings found in occurrence records for fossil specimens, data flags applied by aggregators, and discussions within the paleo collections community. These can be organized into three broad groupings. Group 1: Some DwC terms (or classes of terms) are clear to implement, but are underutilized due to issues that are also found within the neontological community. Example: Location. In the case of terms related to the Location class, paleontology has a need for a way to deal with sensitive locality information. The sensitivity here typically relates to laws restricting the sharing of locality information to protect fossil sites versus neontological requirements to protect threatened, rare, or endangered species. The end goal of needing to fuzz locality information without completely making the specimen record undiscoverable or unusable is the same. There is a need for better education at the paleo data provider-level related to standards for recording and sharing information in this category, which could be based on existing neontological community standards. Group 2: A second group of DwC terms often seem clear to implement, but the terminology used to describe and define them might be unfamiliar to paleontologists or read as unnecessary for fossil occurrences. This uncertainty about the applicability of a term to paleo data can often result in data not being mapped or fully shared. Example: recordedBy (= collector). In these cases, a simple translation of what the definition means in verbiage that is familiar to paleontologists, or the inclusion of paleo-oriented examples in the DwC documentation, can make implementation clear. Group 3: A third group of issues relates to DwC terms, classes, and/or extensions that are more complicated in the context of fossil vs. neontological data. In some cases use of these terms is complicated for neontological data as well, but perhaps for different reasons. The terms impacted by these challenges can sometimes have the same general use, but due to the nature of fossil preservation, or because a term has a different meaning within the discipline of paleontology, additional layers of uncertainty or ambiguity are present. Examples: Resource Relationship/Interactions, Individual count, Preparations, Taxon. Review of these terms and their related classes and/or the extensions they are part of has revealed that they might require qualification, further explanation, additional vocabulary terms, or even the need for special handling instructions when data are ingested and normalized at the aggregator level. This group of issues is more complicated to resolve, but the problems are not intractable and can progress toward solutions through further discussion within the community, active participation in the standards development and review process, and development of clear guidelines. Strategically assessing these terms and generating discipline-specific guidelines to be used by the paleo community can improve the mobilization and discovery of fossil occurrence data. Documenting these paleo data practices not only helps data providers, it also increases the utility of these data within the broader research community by clearly outlining how the terms were used. Overall, this discipline-focused approach to understanding the implementation of data standards like DwC at the term level, helps to increase knowledge sharing across the paleo community, improves data quality and standards adoption, and moves these datasets towards alignment with best practices like the FAIR (Findable, Accessible, Interoperable, Reusable) data principles.

The attitudes, role & knowledge of mental health nurses towards euthanasia because of unbearable mental suffering in Belgium: A pilot study

Introduction Euthanasia because of unbearable mental suffering (UMS euthanasia) has been legal in Belgium since 2002, under certain circumstances that govern careful practice. Despite the legal framework, there are specific difficulties and concerns regarding UMS euthanasia. Mental health nurses are often involved in the process, but little is known about their attitudes towards UMS euthanasia, their role and their knowledge. Aim To determine the attitudes, role and knowledge of mental health nurses regarding UMS euthanasia. Methods A cross-sectional survey was performed at a convenience sample of four psychiatric hospitals in Belgium (n=133) as a pilot study. Self-administered questionnaires were provided to mental health nurses. Results Half the nurses in our sample had been involved at least once in the process of UMS euthanasia. A large majority of mental health nurses were supportive of UMS euthanasia. Nurses show differences in attitudes related to the different psychiatric pathologies of the patients, and in whether or not minors are involved. In some cases, they believed that the mental suffering of psychiatric patients can be unbearable and irreversible and that psychiatric patients can be competent to voluntarily request UMS euthanasia. Nurses stated that they have an important role in the UMS euthanasia process, but also demanded more knowledge and clear guidelines to implement the procedure. Discussion Nurses have a key role regarding UMS euthanasia but face several challenges: the recent process, resistance to a multidisciplinary approach by psychiatrists and an unclear role defined by the legal framework. Nurses do not appear to have a common voice on the topic and the development of clear guidelines appears to be essential. Social recovery can offer a way out of an UMS euthanasia request, but it will not always offer a solution. Implications for Practice Sufficient attention must be paid to how mental health nurses can be involved in the process of UMS euthanasia at various levels: bedside practice, healthcare management, education and policy. A form of systematic cooperation between nurses, physicians and patients can contribute to the utmost careful decision-making process needed in these cases. There is a need for proper training in: knowledge of psychiatric pathologies and remaining treatment options; communication skills; the legal framework and all its difficulties; transdisciplinary and multicultural approaches; ethical reflection and how nurses handle their own emotions.

Neonatal nurses’ perceptions of supportive factors and barriers to the implementation of skin-to-skin care in extremely low birth weight (ELBW) infants - A qualitative study

There is currently a lack of evidence around perceptions of implementation of skin-to-skin care (SSC) in infants weighing <1000 gms amongst neonatal nurses. Majority of published work mainly focuses on infants weighing <2500 gms. AimThis study aimed to investigate neonatal nurses’ perceptions of supportive factors and barriers to the implementation of SSC in extremely low birth weight (ELBW) infants in a tertiary level neonatal intensive care unit (NICU) in London. MethodsA broad qualitative approach that included semi-structured interviews with seven neonatal nurses was used. ResultsAll seven nurses interviewed supported SSC in ELBW infants. There was a general consensus on barriers of its implementation. Humidity was perceived as a significant barrier for SSC in ELBW infants. Other barriers included concerns for infant safety, insufficient training, increased workload, lack of clear guidelines and management support. ConclusionsThis study identified supportive factors and barriers of SSC in ELBW infants in a tertiary neonatal unit. It ascertained the facilitation of parental readiness, development of clear guidelines, provisions of continuing education as well as organisational support as supportive factors in the implementation of SSC in ELBW infants. Furthermore, humidity was perceived as an additional barrier for SSC in these infants.

Paramedic management of out-of-hospital cardiac arrest secondary to hyperkalaemia

Hyperkalaemia is a potentially life-threatening metabolic emergency and is the most common electrolyte disorder associated with death. The author attended an incident where a patient suffered asystolic cardiac arrest from hyperkalaemia and was subsequently resuscitated successfully to hospital discharge with good neurological outcome. This piece intends to review all relevant available literature with the aim of developing recommendations to aid paramedics in managing cardiac arrest secondary to Hyperkalaemia. Despite the lack of current good-quality evidence for pharmacological interventions, systematic reviews available have led to the development of clear guidelines. The use of calcium chloride and sodium bicarbonate is recommended, and these are both carried by Critical Care Paramedics (CCPs). Salbutamol therapy has the strongest evidence base of any intervention available out of hospital. It should be considered after the use of the aforementioned medications if the patient achieves ROSC. Consideration must also be taken as to whether the patient would benefit from being moved to hospital to reach vital interventions such as insulin/dextrose therapy and dialysis.

Brain Death

The concept of “brain death” is one that has been controversial over time, requiring the development of clear guidelines to diagnose and give prognoses for patients after devastating neurologic injury. This review discusses the history of the definition of brain death, as well as the most recent guidelines and practice parameters on the determination of brain death in both the adult and pediatric populations. We provide specific and detailed instructions on the various clinical tests required, including the brain death neurologic examination and the apnea test, and discuss pitfalls in the diagnosis of brain death. This review also considers the most recent literature and guidelines as to the role of confirmatory tests making this diagnosis. Key Words: apnea test, brain death, brainstem reflex, death examination

The perioperative management of patients on antiplatelet agents and anticoagulants presenting for plastic surgical operations: a survey of current practice in the UK

A significant proportion of patients who present for plastic surgical procedures take aspirin or other antiplatelet agents (clopidogrel or nonsteroidal anti-inflammatory drugs) or are on anticoagulants (e.g. warfarin). Although there have been several reports in the literature regarding the perioperative management of patients presenting for dermatologic surgery, there have been no such reports pertaining to the wider scope of plastic surgical practice. In the absence of clear guidelines for the perioperative management of these patients presenting for plastic surgical practice, we have undertaken a pilot survey of the current practices of consultant plastic surgeons in the UK. The aims of this study were to determine whether there was uniformity of practice, and whether the modes of practice differed from those outlined in the literature for other related specialities. A postal survey of 235 plastic surgical consultants was conducted. The response rate was 48%. Overall, most respondents (84%) stated that their practice was primarily based on personal preference, and only 28% stated that it was based on the local Unit policy. Only 23% of the Consultants based their practice on evidence-based medicine. There appeared to be significant variations in current practice amongst plastic surgeons. Some aspects of practice were found to vary from those recommended in the literature for other related specialities. We hope that the findings of this study will highlight the significant non-uniformity of practice within this speciality and that this may form the basis for the development of clear guidelines of the entire spectrum of plastic surgery for the preoperative management of this group of patients in the future.

Test accommodations and alternative assessment for students with a disability in Australia

An important contemporary issue in special education is the extent to which students with a disability are included in all mainstream educational activities, including educational accountability. In line with other Western countries, the extent of national testing conducted by Australian schools will increase in the near future. At the moment, the participation of students with a disability in national testing is low and it is unlikely to significantly increase without the development of clear guidelines about allowable accommodations in testing, and the development of alternative assessment protocols for students with high support needs. This paper reviews the recent literature on both accommodations and alternative testing for students with a disability and makes a number of recommendations about the inclusion of students with a disability in national and in school‐based testing.

Test Accommodations and Alternative Assessment for Students with a Disability in Australia

An important contemporary issue in special education is the extent to which students with a disability are included in all mainstream educational activities, including educational accountability. In line with other Western countries, the extent of national testing conducted by Australian schools will increase in the near future. At the moment, the participation of students with a disability in national testing is low and it is unlikely to significantly increase without the development of clear guidelines about allowable accommodations in testing, and the development of alternative assessment protocols for students with high support needs. This paper reviews the recent literature on both accommodations and alternative testing for students with a disability and makes a number of recommendations about the inclusion of students with a disability in national and in school‐based testing.

Cancer symptom management in the elderly.

Clear and concise written guidelines must designate accountability for coordination of the persons involved. As might be assumed by the preceding discussion, the process takes considerable time and effort. The development of clear guidelines is a long term venture and usually does not occur quickly. In some cases a nearby agency may have developed a useful protocol that when shared with area providers, is quickly accepted. However, one to two years is not uncommon to developing a complex plan of care or protocol which can be used effectively and is specific to the conditions in a particular setting. Written guides, when developed correctly, should save all providers' time, and ensure better client care. Clear directions regarding the care to be provided and well-established lines of communication can save health care providers time and increase the likelihood of better health outcomes for the client. The coordination of planning within the home care agency, and across professional, agency and geographic boundaries is a prerequisite for successful cancer symptom management. The central aim in planning is to enhance the family's ability to manage independently and to facilitate continuity of care in the use of health care services. For the client to have the greatest potential for symptom amelioration, the home care agency must assume a major role in the coordination of care providers in the delivery of care.