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Medical students and graduates’ perceptions of preparation to face a patient's death
(2023-01-01)
Ferrada, Pedro Lavín
;
Christian, Dominga Rodríguez
;
BECA INFANTE, JUAN PABLO
Historically, death has been socially accepted, but for the last decades it has been hidden in hospitals, transforming physicians into “death specialists''. Thus, medical graduates should feel prepared to assume this responsibility accompanying the patient and their family through the process. With this in consideration, the present work explores students´ and graduates´ perceptions of preparation to face a patient's death (SPEM) in a Chilean Medical school and identifies SPEM-associated characteristics. An observational study was performed using a digital form sent by email to interns and 2018 and 2019 graduates of the Facultad de Medicina CAS-UDD, in which they were asked about their SPEM and possible SPEM-related variables. The results showed that 63% and 31% of interns and graduates reported feeling inadequately prepared or unprepared to address a patient's death, respectively. During the first two years of their profession, 71% of graduates faced a patient's death. There was a significant correlation between the SPEM and death-facing training. Considering these results and the previous evidence of the positive impact that classes and courses have on SPEM, it is suggested that an obligatory course should be added to improve SPEM in medical students.
1Scopus© Citations 1 1
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Intracranial Angioplasty and Stent Placement After Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) Trial: Present State and Future Considerations<sup>⋆</sup>
(2012)
Adnan I Qureshi
;
Fahmi M. Al‐Senani
;
Shakir Husain
;
Nazli A. Janjua
;
Giuseppe Lanzino
<jats:sec><jats:title>ABSTRACT</jats:title></jats:sec><jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>The results of prematurely terminated stenting and aggressive medical management for preventing recurrent stroke in intracranial stenosis (SAMMPRIS) due to excessively high rate of stroke and death in patients randomized to intracranial stent placement is expected to affect the practice of endovascular therapy for intracranial atherosclerotic disease. The purpose of this report is to review the components of the designs and methods SAMMPRIS trial and to describe the influence of those components on the interpretation of trial results.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>A critical review of the patient population included in SAMMPRIS is conducted with emphasis on “generalizability of results” and “bias due to cherry picking phenomenon.” The technical aspects of endovascular treatment protocol consisting of intracranial angioplasty and stent placement using the Gateway balloon and Wingspan self‐expanding nitinol stent and credentialing criteria of trial interventionalists are reviewed. The influence of each component is estimated based on previous literature including multicenter clinical trials reporting on intracranial angioplasty and stent placement.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>The inclusion criteria used in the trial ensured that patients with adverse clinical or angiographic characteristics were excluded. Self‐expanding stent as the sole stent, technique of prestent angioplasty, periprocedural antiplatelet treatment, and intraprocedural anticoagulation are unlikely to adversely influence the results of intracranial stent placement. A more permissive policy toward primary angioplasty as an acceptable treatment option may have reduced the overall periprocedural complication rates by providing a safer option in technically challenging lesions. The expected impact of a more rigorous credentialing process on periprocedural stroke and/or death rate following intracranial stent placement in SAMMPRIS such as the one used in carotid revascularization endarterectomy versus stenting trial remains unknown.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSION</jats:title><jats:p><jats:bold>The need for developing new and effective treatments for patients with symptomatic intracranial stenosis cannot be undermined. The data support modification but not discontinuation of our approach to intracranial angioplasty and/or stent placement for intracranial stenosis. There are potential patients in whom angioplasty and/or stent placement might be the best approach, and a new trial with appropriate modifications in patient selection and design may be warranted.</jats:bold></jats:p></jats:sec>
Scopus© Citations 26 1
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Prognostic significance of early urinary catheterization after acute stroke: Secondary analyses of the international HeadPoST trial
(2020)
Menglu Ouyang
;
Laurent Billot
;
Lili Song
;
Xia Wang
;
Christine Roffe
<jats:sec><jats:title>Background</jats:title><jats:p> An indwelling urinary catheter (IUC) is often inserted to manage bladder dysfunction, but its impact on prognosis is uncertain. We aimed to determine the association of IUC use on clinical outcomes after acute stroke in the international, multi-center, cluster crossover, Head Positioning in Acute Stroke Trial (HeadPoST). </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> Data were analyzed on HeadPoST participants (n = 11,093) randomly allocated to the lying-flat or sitting-up head position. Binomial, logistic regression, hierarchical mixed models were used to determine associations of early insertion of IUC within seven days post-randomization and outcomes of death or disability (defined as “poor outcome,” scores 3–6 on the modified Rankin scale) and any urinary tract infection at 90 days with adjustment of baseline and post-randomization management covariates. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Overall, 1167 (12%) patients had an IUC, but the frequency and duration of use varied widely across patients in different regions. IUC use was more frequent in older patients, and those with vascular comorbidity, greater initial neurological impairment (on the National Institutes of Health Stroke Scale), and intracerebral hemorrhage as the underlying stroke type. IUC use was independently associated with poor outcome (adjusted odds ratio (aOR): 1.40, 95% confidence interval (CI): 1.13–1.74), but not with urinary tract infection after adjustment for antibiotic treatment and stroke severity at hospital separation (aOR: 1.13, 95% CI: 0.59–2.18). The number exposed to IUC for poor outcome was 13. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> IUC use is associated with a poor outcome after acute stroke. Further studies are required to inform appropriate use of IUC. </jats:p></jats:sec>
Scopus© Citations 4 3
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Effect of positive end-expiratory pressure on lung injury and haemodynamics during experimental acute respiratory distress syndrome treated with extracorporeal membrane oxygenation and near-apnoeic ventilation
(2021)
Joaquin Araos
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Leyla Alegria
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Aline Garcia
;
Pablo Cruces
;
Dagoberto Soto
1Scopus© Citations 15
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c-Abl activates RIPK3 signaling in Gaucher disease
(2021)
M.J. Yañez
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F. Campos
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T. Marín
;
A.D. Klein
;
A.H. Futerman
10Scopus© Citations 17
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Ethical issues of organ donation after circulatory death: Considerations for a successful implementation in Chile
(2021)
Pablo Pérez Castro
;
Sofía P. Salas
Scopus© Citations 3 1
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Impacto social de la despenalización de la muerte médicamente asistida
(2021)
Javiera Bellolio
;
Pedro Rosso R.
Scopus© Citations 1 2
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Integrin Alpha E (CD103) Limits Virus-Induced IFN-I Production in Conventional Dendritic Cells
(2021)
Vikas Duhan
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Vishal Khairnar
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Simo Kitanovski
;
Thamer A. Hamdan
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KLEIN POSTERNACK, ANDRES DAVID
<jats:p>Early and strong production of IFN-I by dendritic cells is important to control vesicular stomatitis virus (VSV), however mechanisms which explain this cell-type specific innate immune activation remain to be defined. Here, using a genome wide association study (GWAS), we identified Integrin alpha-E (<jats:italic>Itgae</jats:italic>, CD103) as a new regulator of antiviral IFN-I production in a mouse model of vesicular stomatitis virus (VSV) infection. CD103 was specifically expressed by splenic conventional dendritic cells (cDCs) and limited IFN-I production in these cells during VSV infection. Mechanistically, CD103 suppressed AKT phosphorylation and mTOR activation in DCs. Deficiency in CD103 accelerated early IFN-I in cDCs and prevented death in VSV infected animals. In conclusion, CD103 participates in regulation of cDC specific IFN-I induction and thereby influences immune activation after VSV infection.</jats:p>
1Scopus© Citations 4
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Muerte súbita en epilepsia
(2018)
Mauricio Velásquez
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ALEJANDRO DE MARINIS PALOMBO
;
Evelyn Benavides
Scopus© Citations 2 1
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A tetrameric peptide derived from bovine lactoferricin as a potential therapeutic tool for oral squamous cell carcinoma: A preclinical model
(2017)
Víctor Alfonso Solarte
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CONGET MOLINA, PAULETTE ANDREA
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Jean-Paul Vernot
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Jaiver Eduardo Rosas
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Zuly Jenny Rivera
32 1Scopus© Citations 12

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