This statement is offered to update and expand on the prior American Society for Reproductive Medicine preimplantation genetic testing (PGT) opinion, elucidate the current clinical and technical ...complexities specific to PGT for monogenic conditions, assist providers in supporting patient understanding of and access to this technology, and offer considerations for the development of future clinical and laboratory guidelines on PGT for monogenic conditions.
Clinicians should encourage disclosure between intimate partners but should maintain confidentiality in cases where there is no prospect of harm to the partner and/or offspring. In cases where a ...member of a couple refuses to disclose relevant health information to the other partner and there exists a risk of harm to the unaware partner and/or offspring, clinicians may refuse to offer care and should decline to treat if full informed consent is not possible because of the lack of disclosure. This document replaces the previously published document of the same name, last published in 2018.
Purpose: Family-clinician communication in the intensive care unit (ICU) about withholding and withdrawing life support occurs frequently, yet few data exist to guide clinicians in its conduct. The ...purpose of this study was to develop an understanding of the way this communication is currently conducted.
Methods: We identified family conferences in the ICUs of 4 Seattle-area hospitals. Conferences were eligible if the physician leading the conference believed that discussion about withholding or withdrawing life support or the delivery of bad news was likely to occur and if all conference participants consented to participate. Fifty conferences were audiotaped, transcribed, and analyzed by using the principles of grounded theory.
Results: We developed 2 frameworks for describing and understanding this communication. The first framework describes communication content, including introductions, information exchange, discussions of the future, and closings. The second framework describes communication styles and support provided to families and other clinicians and includes a variety of techniques such as active listening, acknowledging informational complexity and emotional difficulty of the situation, and supporting family decision making. These frameworks identify what physicians discuss, how they present and respond to issues, and how they support families during these conferences.
Conclusions: This article describes a qualitative methodology to understand clinician-family communication during the ICU family conference concerning end-of-life care and provides a frame of reference that may help guide clinicians who conduct these conferences. We also identify strategies clinicians use to improve communication and enhance the support provided. Further analyses and studies are needed to identify whether this framework or these strategies can improve family understanding or satisfaction or improve the quality care in the ICU.
Copyright 2002, Elsevier Science (USA). All rights reserved.
The Pre-IVF Treatment with a GnRH Antagonist in Women with Endometriosis (PREGnant) Trial (clinicaltrials.gov no. NCT04173169) was designed to test the hypothesis that 60-day pre-treatment with an ...oral GnRH antagonist in women with documented endometriosis and planning an IVF cycle will result in a superior live birth rate to placebo. Eight hundred fourteen women are required from 4 national sites. To determine the feasibility of using an electronic medical record (EMR)-based strategy to recruit 204 participants at the Colorado site, we conducted a survey of women within the UCHealth system. Eligible women, identified using relevant ICD-10 codes, were invited to complete a 6-question survey to assess planned utilization of IVF, potential interest in participation, and whether delays in treatment due to COVID-19 would influence their decision to participate. Of 6354 age-eligible women with an endometriosis diagnosis, 421 had a concurrent infertility diagnosis. After eliminating duplicates, 212 were emailed a survey; 76 (36%) responded, 6 of whom reported no endometriosis diagnosis. Of the remaining 70, 29 (41%) were planning fertility treatment; only 19 planned IVF. All 19 expressed interest in participation. COVID-19 delays in treatment were not considered as a factor affecting participation by 8/19; the remaining 11 felt that it would "somewhat" affect their decision. None reported that they would not consider participation because of COVID-19. EMR-based recruitment for an endometriosis clinical trial is feasible although the overall yield of participants is low. Delays in treatment due to COVID-19 did not appear to overly influence potential recruitment.
Mechanistic (COWPOLL and MOLLY) and empirical (IPCC Tier 2 and ELLIS) models were used to predict enteric CH4 emissions from 2 summer pasture systems and 4 winter feeding strategies for cow calf ...production in the Western Canadian Parkland. The models used average values for nutrient composition of diets, body weight and body condition score of multi- and primiparous cows to predict 90d emissions for each strategy. Average values were determined from data collected over 5 production years with British-Continental crossbred cows assigned to each strategy for life. Each production year began in June with summer grazing of cow calf pairs (n=288/yr including 76 primiparous cows) assigned to either alfalfa-grass (AG) or grass (G) pastures until weaning in September. November post weaning, pregnant cows (n=240/yr) were assigned to either extended grazing (EG) of dormant regrowth of perennial pastures and swathed annual crops, or one of 3 diets fed in a drylot: hay (HY), straw/barley (SB; 700 oat straw:300 steam-rolled barley grain dry matter (DM)), or silage/straw (SS; 400 barley silage:600 oat straw DM). Cows were fed common diets between weaning and wintering, and pre-calving and grazing of summer pastures. Differences in prediction of enteric CH4 emissions were much bigger among models (26–35%) than among systems (3–5%). For suckled beef cows, the mechanistic and empirical models predicted similar enteric CH4 between AG and G summer pasture groups. The COWPOLL, MOLLY and ELLIS models predicted enteric CH4 emissions from dry pregnant cows to be higher for EG and HY than SB and SS winter feeding strategy groups. In contrast, IPCC Tier 2 predictions were lowest for EG. Enteric CH4 emissions from cow calf production can be lowered in the winter by feeding dry pregnant cows conserved feeds containing straw combined with barley silage or grain, rather than hay alone. A more comprehensive assessment is required to determine the net contribution of extended grazing or drylot feeding programs to greenhouse gas mitigation strategies for beef production. Finally, the substantially higher differences in the prediction of enteric CH4 emissions among models than among production systems preclude their use for regulatory purposes in their current form.
This article is part of the special issue entitled: Greenhouse Gases in Animal Agriculture – Finding a Balance between Food and Emissions, Guest Edited by T.A. McAllister, Section Guest Editors; K.A. Beauchemin, X. Hao, S. McGinn and Editor for Animal Feed Science and Technology, P.H. Robinson.
Khakbazan, M., Durunna, O. N., Sirski, T. K., Brewin, D. G., Huang, J., Berry, N., Iwaasa, A. D., Scott, S. L., Robins, C. D., Block, H. C. and Lardner, H. A. 2015. The effects of spring versus ...summer calving on beef cattle economic performance in western Canada. Can. J. Anim. Sci. 95: 475–486. The choice of calving date influences the net revenue of a calving operation as it affects the number of days that calves spend in each feeding phase and when they are subsequently marketed. These two factors determine the costs, revenue, and risk (variance) of each calving system for the calving phase of a beef system. The majority of cow–calf producers in western Canada have adopted early calving (EC) in spring due to management factors. However, late calving (LC) in the summer is an alternative beef calving system associated with higher returns due to lower system costs and higher beef prices. It may offer a better match between cow nutritional requirements and pasture availability. The objective of this study was to compare the revenues and risks for a traditional EC system and an alternative LC system at three sites in western Canada. Biological and economic data from three field experimental sites in western Canada (Brandon Research Centre in Manitoba, Western Beef Development Centre in Lanigan, Saskatchewan and Semi-Arid Prairie Agriculture Research Centre in Swift Current, Saskatchewan) were used to determine the costs and benefits of the alternative beef calving system. The results showed that even though the EC has higher cost than the LC, the EC is slightly better than LC in terms of higher net revenue potential, but it comes at a greater risk due to higher revenue variances. The EC system is usually more preferable for risk-neutral producers, whereas the LC system is more preferable for risk-averse producers.
This article provides findings on the role of the nurse in simulated team-based error disclosures. Triangulation of 3 qualitative data sets revealed that a tension exists for nurses in the error ...disclosure process as they attempt to balance professional boundaries. Study findings point to multilevel strategies including cultural, structural, and educational approaches to enhancing the key roles that nurses need to play in error disclosure to patients and families.
Background: Multiple-choice exams are not well suited for assessing communication skills. Standardized patient assessments are costly and patient and peer assessments are often biased. Web-based ...assessment using video content offers the possibility of reliable, valid, and cost-efficient means for measuring complex communication skills, including interprofessional communication. Description: We report development of the Web-based Team-Oriented Medical Error Communication Assessment Tool, which uses videotaped cases for assessing skills in error disclosure and team communication. Steps in development included (a) defining communication behaviors, (b) creating scenarios, (c) developing scripts, (d) filming video with professional actors, and (e) writing assessment questions targeting team communication during planning and error disclosure. Evaluation: Using valid data from 78 participants in the intervention group, coefficient alpha estimates of internal consistency were calculated based on the Likert-scale questions and ranged from α = .79 to α = .89 for each set of 7 Likert-type discussion/planning items and from α = .70 to α = .86 for each set of 8 Likert-type disclosure items. The preliminary test-retest Pearson correlation based on the scores of the intervention group was r = .59 for discussion/planning and r = .25 for error disclosure sections, respectively. Content validity was established through reliance on empirically driven published principles of effective disclosure as well as integration of expert views across all aspects of the development process. In addition, data from 122 medicine and surgical physicians and nurses showed high ratings for video quality (4.3 of 5.0), acting (4.3), and case content (4.5). Conclusions: Web assessment of communication skills appears promising. Physicians and nurses across specialties respond favorably to the tool.
Durunna, O. N., Baron, V., Scott, S. L., Robins, C., Khakbazan, M. and Block, H. C. 2015. Effects of resting perennial pastures during the sensitive pre-dormancy period in western Manitoba: Pasture ...productivity and beef cattle performance. Can. J. Anim. Sci. 95: 129â141. The objective of this experiment was to determine whether avoiding grazing during the sensitive pre-dormancy period (ca. 6 wk prior to a dormancy-inducing frost) would improve forage production, stand quality, alfalfa persistence and animal productivity in perennial pastures. There were two pasture species (PS), alfalfaâgrass (AG) or grass (G), and three grazing phases. Phase I was conventional rotational grazing of all AG and G sections. In Phase II, one half of AG and G was rotationally grazed (conventional treatment, CT) while the other half was not (rested treatment, RT). Resting AG and G in Phase II required transferring RT animals to swath-graze early-seeded cereals. In Phase III, RT animals that swath-grazed in Phase II were moved to graze the rested sections of the pastures while those that grazed the unrested sections (CT animals) were transferred to swath-graze late-seeded cereals. There was no PS (P>0.05) or rest period (P>0.13) effect on total forage yield, carrying capacity, forage disappearance and forage residues. There was no effect (P>0.13) of resting on botanical composition or yield in AG. The current study did not observe significant benefits of resting on pasture yield, botanical composition or animal performance.
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