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Amoroso L, Fratini A, Baronti R, Ierardi F, Migliaccio ML, Di Schiena M, Rubegni P, Pianigiani E. Skin donations after suicide by acute poisoning. Cell Tissue Bank 2023; 24:265-272. [PMID: 36042071 DOI: 10.1007/s10561-022-10033-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2022] [Indexed: 11/29/2022]
Abstract
The demand for skin tissue allografts to treat burns and other types of injuries increases each year to the extent that categories of donors formerly deemed "unsuitable", such as victims of suicide by polytrauma or poisoning, are now considered. Patients who died by ingestion of/exposure to toxic substances can be accepted as tissue donors after assessment of graft safety to rule out any risks of transferring toxic substances to the recipient. A cadaveric skin donation was obtained from a 57-year-old woman who died from intoxication after ingesting colchicine tablets (0.2 mg/kg). To determine the safety of cadaveric skin allografts, high-performance liquid chromatography-mass spectrometry (LC-MS/MS) was used to identify and quantify colchicine in procured skin. Results revealed that colchicine concentrations were lower than the instrument limit of detection (LOD) of 0.5 ng/mg both in epidermis and dermis. Cell viability assessed through the MTT ([3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide]) test was within standard limits. Thanks to accurate tests performed, which are routinely applied also in clinical diagnostics and forensic toxicology, it was possible to ascertain the safety and suitability of skin tissue for donation.
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Affiliation(s)
- L Amoroso
- Tuscany Region Skin Bank, Department of Dermatology, Santa Maria alle Scotte Hospital, Policlinico Santa Maria Alle Scotte, Viale Bracci, 53100, Siena, Italy.
| | - A Fratini
- Clinical Toxicology and Antidoping Centre, ASL Toscana Centro, Florence, Italy
| | - R Baronti
- Clinical Toxicology and Antidoping Centre, ASL Toscana Centro, Florence, Italy
| | - F Ierardi
- Tuscany Region Skin Bank, Department of Dermatology, Santa Maria alle Scotte Hospital, Policlinico Santa Maria Alle Scotte, Viale Bracci, 53100, Siena, Italy
| | - M L Migliaccio
- Regional Coordination Centre (CRAOT), Careggi Hospital, Florence, Italy
| | - M Di Schiena
- Local Coordination Centre, San Donato Hospital, Arezzo, Italy
| | - P Rubegni
- Tuscany Region Skin Bank, Department of Dermatology, Santa Maria alle Scotte Hospital, Policlinico Santa Maria Alle Scotte, Viale Bracci, 53100, Siena, Italy
| | - E Pianigiani
- Tuscany Region Skin Bank, Department of Dermatology, Santa Maria alle Scotte Hospital, Policlinico Santa Maria Alle Scotte, Viale Bracci, 53100, Siena, Italy
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Urquhart R, Kureshi N, Dirk J, Weiss M, Beed S. Nurse knowledge and attitudes towards organ donation and deemed consent: the Human Organ and Tissue Donation Act in Nova Scotia. Can J Anaesth 2023; 70:245-252. [PMID: 36456763 DOI: 10.1007/s12630-022-02372-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 09/08/2022] [Accepted: 09/08/2022] [Indexed: 12/05/2022] Open
Abstract
PURPOSE In April 2019, the Human Organ and Tissue Donation Act (HOTDA) in Nova Scotia was modified to incorporate a deemed consent model. In this study, we sought to understand intensive care unit (ICU) and emergency department (ED) nurses' knowledge of and confidence around organ donation and transplantation, experiences with organ donors and recipients, attitudes toward organ donation and deemed consent, and perceived opportunities and barriers to a deemed consent approach in view of the legislative change. METHODS We sent an electronic, self-administered survey to all ICU and ED nurses in Nova Scotia. The survey queried respondents on their knowledge of, experience with, and attitudes around organ donation and HOTDA, and opportunities and barriers to the implementation of HOTDA in clinical practice. Survey results were analyzed using descriptive statistics. RESULTS One-hundred and ninety-four nurses responded to the survey. Nearly all (98%) supported organ donation, with 86% having signed an organ donor card to donate organs and/or tissues after death. A considerable majority (89%) also supported the new legislation. Nevertheless, a minority of respondents (13%) believed that deemed consent legislation would be considered a violation of the general principles of freedom and autonomy. The three most identified topics for ongoing training were coordination of the donation process (70%), clinical management of donors (70%), and family issues in decision-making (70%). CONCLUSION Intensive care unit and ED nurses had positive attitudes toward organ donation, including deemed consent model. The findings should inform educational initiatives in Nova Scotia and beyond to optimize organ donation processes and outcomes.
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Affiliation(s)
- Robin Urquhart
- Department of Community Health and Epidemiology, Dalhousie University, Room 413, Centre for Clinical Research, 5790 University Avenue, Halifax, NS, B3H 1V7, Canada.
| | - Nelofar Kureshi
- Division of Neurosurgery, QEII Health Sciences Centre and Dalhousie University, Halifax, NS, Canada
| | - Jade Dirk
- Department of Research & Innovation, Nova Scotia Health, Halifax, NS, Canada
| | - Matthew Weiss
- Transplant Québec, Montréal, QC, Canada.,Mère Enfant Soleil du CHU de Québec, Quebec, QC, Canada
| | - Stephen Beed
- Department of Critical Care, Dalhousie University, Halifax, NS, Canada
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Attitudes and acceptability of organ and tissue donation registration in the emergency department: a national survey of emergency physicians. CAN J EMERG MED 2022; 24:293-299. [PMID: 35124786 PMCID: PMC8818093 DOI: 10.1007/s43678-022-00262-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 01/06/2022] [Indexed: 11/02/2022]
Abstract
Purpose Methods Results Conclusion Supplementary Information
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Manouzi A, Sanatani S, Doan Q. Electrocardiogram in Pediatric Syncope: Practice Variation Among Pediatric Emergency Physicians. Pediatr Emerg Care 2022; 38:e886-e890. [PMID: 34101684 DOI: 10.1097/pec.0000000000002469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We intended to assess emergency department physician's practice pattern and their motivations for obtaining electrocardiograms (ECGs) in pediatric vasovagal syncope presentations. We also explored if borderline ECG findings alters emergency department physicians' management in this population. METHODS We conducted a cross-sectional survey of emergency physicians enrolled in the Pediatric Emergency Research Canada network. The survey questionnaire introduced 2 clinical vignettes presenting a typical vasovagal syncope and a presentation suggestive of a cardiac etiology. Outcome measures included frequency investigations, specialist consultation, and disposition stratified by type of syncope presentation. We also evaluated which specific ECG findings were likely to change physicians' management and explored factors influencing the decision to perform or not perform the ECG. RESULTS The analyzable response rate was 47% (105/225). In the low-risk scenario, 51% of respondents requested an ECG, and none consulted the cardiology service, given that all requested investigations are normal. Forty-five percent of physicians modified their management if an ECG was reported as anything but totally normal. In the high-risk scenario, all respondents requested either a 12-lead ECG or a high-lead ECG, and 94% consulted the cardiology service. Physicians also identified clear differences in the motivations behind their decision to perform an ECG in typical vasovagal syncope. CONCLUSIONS This study highlights the significant practice variation in the evaluation and management of typical vasovagal syncope among physicians, which is informed by complex interactions of patient, provider, and institutional factors and the perceived clinical significance of borderline ECG findings.
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Affiliation(s)
| | - Shubhayan Sanatani
- Children's Heart Centre, Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
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Lee DE, Kim H, Park KH, Park SY, Park SM, Jung YH, Jeong W, Park KH. Analysis of Factors Affecting Emergency Physicians' Attitudes toward Deceased Organ & Tissue Donation. J Korean Med Sci 2021; 36:e329. [PMID: 34931495 PMCID: PMC8688344 DOI: 10.3346/jkms.2021.36.e329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/27/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND This study aimed to investigate differences in knowledge, and attitudes toward deceased organ and tissue donation of emergency physicians. Additionally, we analyzed factors affecting the attitudes toward deceased organ and tissue donation. METHODS We conducted a survey of specialists and residents registered with the Korean Society of Emergency Medicine in December 2020. The respondents' sex, age, position, personal registration for organ donation, experience of soliciting organ donation, participation in related education, knowledge, and attitude about brain death organ donation, and attitude toward stopping life-sustaining treatments were investigated. According to the characteristics of the respondents (specialists or residents, experience and education on organ and tissue donation), their knowledge and attitude toward deceased organ donation were compared. Stepwise hierarchical multiple regression analysis was used to investigate the factors affecting the attitudes toward deceased organ and tissue donation. RESULTS Of the total 428 respondents, there were 292 emergency medicine specialists and 136 medical residents. Specialists and those who registered or wished to donate organs had higher knowledge and attitude scores regarding deceased organ and tissue donation. Those who had experience recommending organ and tissue donation more than 6 times had higher knowledge scores on deceased organ and tissue donation and higher overall scores in attitude. Those who received education from the Korean Organ Donation Agency had higher knowledge scores. Specialists, and those who wished to donate or had registered as organ donors and had a higher life-sustaining treatment attitude score and knowledge about deceased organ and tissue donation, had more positive attitudes toward deceased organ and tissue donation. CONCLUSION For more potential deceased organ and tissue donors to be referred for donation, there should be continuous education for emergency physicians on brain-dead organ and tissue donation-related knowledge and procedures. In addition, institutional or systematic improvements that can lead to organ donation when deciding on the withdrawal of life-sustaining treatment should be considered.
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Affiliation(s)
- Dong Eun Lee
- Department of Emergency Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyun Kim
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
| | - Kwi Hwa Park
- Department of Medical Education, Gachon University College of Medicine, Incheon, Korea
| | - Song Yi Park
- Department of Emergency Medicine, College of Medicine, Dong-A University, Busan, Korea
- Department of Medical Education, College of Medicine, Dong-A University, Busan, Korea
| | - Seung Min Park
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Hun Jung
- Department of Emergency Medicine, Chonnam National University, Gwangju, Korea
| | - Wonjoon Jeong
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Kyung Hye Park
- Department of Medical Education, Yonsei University, Wonju College of Medicine, Wonju, Korea
- Department of Emergency Medicine, Wonju Severance Christian Hospital, Wonju, Korea.
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Sarangi S, Sahu SK, Priyadarshini SR, Das S. Safety and efficacy of corneal tissue harvested from organophosphorous deceased patients. Indian J Ophthalmol 2021; 69:3494-3497. [PMID: 34826982 PMCID: PMC8837339 DOI: 10.4103/ijo.ijo_8_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: To analyze the quality of tissues and outcome of corneal transplants from tissues harvested from the donors of organophosphorus poisoning victims. Methods: A retrospective study was carried out on corneas harvested from organophosphorus poisoning victims between January 2016 and December 2018. Details of quality of tissues and outcome following keratoplasty were collected from the eye bank and outpatient records, respectively. Results: Four hundred and seventy-eight donor corneas were collected from the victims of organophosphorus poisoning during the study period. The mean age of the donor was 38.8 ± 16.5 years. The mean donor-to-preservation time was 6.2 ± 3.2 hours. The mean endothelial cell density on specular microscopy was 2986.5 ± 369.0 cells/mm2. Four hundred and twenty-two (88.2%) donor corneas were utilized. Of the 121 corneas utilized at our institute for transplantation, 73 and 48 corneas were for optical and therapeutic/tectonic indications, respectively. Of the 73 optical grafts, 25 patients were lost-to-follow-up and 58.3% (28/48) who came for one-year follow-up were found to be clear. Conclusion: Donor corneas retrieved from organophosphorus poisoning are safe for transplantation. The postoperative outcome of the tissue utilized from these donors is satisfactory.
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Affiliation(s)
- Swapna Sarangi
- Lady Hardinge Medical College, Connaught Place, New Delhi, Delhi, India
| | - Srikant K Sahu
- Cornea and Anterior Segment Service, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Smruti R Priyadarshini
- Cornea and Anterior Segment Service, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Sujata Das
- Cornea and Anterior Segment Service, L V Prasad Eye Institute, Bhubaneswar, Odisha, India
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Emergency toxicology: Timely antidotes and giving poisoned organs a second life. CAN J EMERG MED 2019; 21:3-4. [DOI: 10.1017/cem.2018.491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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