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Tarabeih M, Amiel A, Na'amnih W. The view of the three monotheistic religions toward xenotransplantation. Clin Transplant 2024; 38:e15192. [PMID: 37975531 DOI: 10.1111/ctr.15192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 10/28/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Abstract
Xenotransplantation, transplanting animal organs into humans, may offer a solution to the shortage of organs for transplantation. This would increase the chances for scheduled, elective transplantation, even for patients currently ineligible for receiving a human organ. However, xenotransplantation raises specific ethical and philosophical issues, that is, a personal identification of the body parts with the soul and spirit, the relationships between humans and animals, and challenges related to issues of medical and social ethics. The three monotheistic religions have laws and perspectives pertaining to xenotransplantation. This scholarly review examines the theology and viewpoints of the three monotheistic religions and their concerns regarding xenotransplantation (interspecies) in terms of religious-legal rulings, the ethical considerations related to the procedure, through religious scriptures and rulings of scholars of the three faith communities. This review should be viewed as a continuation of an extensive investigation of these issues, as the field of transplantation advances toward clinical trials. It was found that there are no fundamental religious reasons presented by any of the three religions to prohibit the use of animal organs as a means of treating severe and life-threatening conditions. However, there are certain limitations prescribed by each religion relating to the treatment of the animals and the choice of organs to be transplanted.
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Affiliation(s)
- Mahdi Tarabeih
- School of Nursing Science, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel
| | - Aliza Amiel
- School of Nursing Science, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel
| | - Wasef Na'amnih
- School of Nursing Science, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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O'Donohoe PK, Shelley O. Allograft use associated with better than predicted survival following burn injury. Burns 2023; 49:2020-2022. [PMID: 37838559 DOI: 10.1016/j.burns.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/06/2023] [Indexed: 10/16/2023]
Affiliation(s)
- Patrick Killian O'Donohoe
- National Burns Unit, Department of Plastic & Reconstructive Surgery, St James's Hospital, James's Street, Dublin 8, Ireland.
| | - Odhran Shelley
- National Burns Unit, Department of Plastic & Reconstructive Surgery, St James's Hospital, James's Street, Dublin 8, Ireland.
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Ness TE, Tabb ZJ, Malek J, Placencia FX. Uninformed Origins: Should We Be Advising Parents on the Source of Medicines and Therapies? HEALTH CARE ANALYSIS 2023; 31:186-195. [PMID: 37535146 DOI: 10.1007/s10728-023-00458-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 08/04/2023]
Abstract
Respecting patient autonomy through the process of soliciting informed consent is a cornerstone of clinical ethics. In pediatrics, until a child becomes an adult or legally emancipated, that ethical tenet takes the form of respect for parental decision-making authority. In instances of respecting religious beliefs, doing so is not always apparent and sometimes the challenge lies not only in the healthcare provider's familiarity of religious restrictions but also their knowledge of medical interventions themselves which might conflict with those restrictions. We examine a case of a newborn receiving animal-derived surfactant, a common scenario in neonatology, and present considerations for providers to weigh when confronting when such an intervention might conflict with parent's religious beliefs. We end with strategizing ways to address this issue as a medical community.
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Affiliation(s)
- Tara E Ness
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA.
- Texas Childrens Hospital, Houston, TX, USA.
| | - Zachary J Tabb
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA
- Texas Childrens Hospital, Houston, TX, USA
| | - Janet Malek
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA
| | - Frank X Placencia
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA
- Texas Childrens Hospital, Houston, TX, USA
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Smith N, Williams L, Harding S, Singh K, Soomro DES, Alawi S, Chowdhury M, Deogan V, Parker E, Henson A, Easton F, Leung N, Staples A, Srivastava S, Adamali H, Barratt SL. Factoring patients' beliefs and values into decisions around anticoagulation: a community-led multi-cycle quality improvement project. Future Healthc J 2023; 10:301-305. [PMID: 38162220 PMCID: PMC10753224 DOI: 10.7861/fhj.2023-0034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Low-molecular-weight heparin (LMWH), prescribed for prophylaxis of venous thromboembolism, is derived from porcine animal products. An audit in our Trust showed that most healthcare professionals (95%, n=58/61) did not consider religious or dietary preferences when prescribing LMWH. Focus groups with local stakeholders helped develop project aims. Quality improvement methods were used to develop, test and optimise interventions over two cycles in our medical unit. Interventions included written and audiovisual information for patients, a staff eLearning module, a policy to guide switching from LMWH to a synthetic alternative and a written prompt reminding doctors to consent patients before prescribing LMWH. The proportion of patients being appropriately consented for LMWH prescriptions increased following our interventions (from <5% at baseline to >80%). Patient and staff feedback was positive, with high demand for a non-animal-derived alternative to LMWH. Simple measures, increasing awareness and knowledge among staff and patients, can improve the number of patients being appropriately consented for LMWH prescriptions.
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Bokek-Cohen Y, Gonen LD, Tarabeih M. The muslim patient and medical treatments based on porcine ingredients. BMC Med Ethics 2023; 24:89. [PMID: 37891587 PMCID: PMC10612269 DOI: 10.1186/s12910-023-00975-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 10/19/2023] [Indexed: 10/29/2023] Open
Abstract
Porcine-derived products serve as an effective solution for a wide range of human ailments; however, there may be objections to their use due to Islamic religious prohibitions on consuming products derived from pigs. In order to enhance the cultural competence of medical practitioners who treat Muslim individuals, which constitute about one fifth of the world population, this study aimed at evaluating the knowledge and positions of Muslim patients on this subject. A questionnaire presenting 15 uses of porcine-derived materials was filled out by 809 Muslims. The level of knowledge about the permissibility of these uses and participants' position on whether it should be approved was assessed. Findings show that Muslims are not familiar with Islamic religious jurisprudence that permits the use of porcine products to save lives after it has undergone an essential transformation known as Istihala. The respondents expressed a negative attitude towards the medical use of porcine-derived substances based on imprecise knowledge about the permissibility of use of porcine-derived materials, devices and treatments. We offer recommendations for improving the informed consent obtained from Muslim patients prior to conducting porcine-based treatments.
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Affiliation(s)
- Ya'arit Bokek-Cohen
- Tel Aviv University, 30 Haim Levanon Street, Tel Aviv Postal code, Tel Aviv, 6997801, Israel.
| | | | - Mahdi Tarabeih
- The Academic College of Tel-Aviv-Yaffo, 2 Rabenu Yerucham St., Tel Aviv Postal code, Tel Aviv, 6161001, Israel
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Silk G, Vetharajan N, Blohm A, Teeling F, Keen K, Sullivan N, Kiran M. Are vegans being overlooked in our prescribing practices: An orthopaedic perspective from Bristol, United Kingdom. J Clin Orthop Trauma 2023; 44:102250. [PMID: 37817761 PMCID: PMC10561050 DOI: 10.1016/j.jcot.2023.102250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/30/2023] [Accepted: 09/21/2023] [Indexed: 10/12/2023] Open
Abstract
Aim Bristol is considered the vegan capital of the UK. The UK vegan index reveals that Bristol has 360,000 Google searches each month for Vegan content. However, the possible animal source of the medications we prescribe is not commonly contemplated. Medications in the UK must pass through animal trials prior to licensing and therefore cannot be vegan. There are, alternatives available for some medications, that do not contain animal products. The aim of this study is to review the presence of content of animal origin (CAO) in common medicines in Trauma and Orthopaedics (T&O) and explore alternatives. Methods We evaluated the presence and source of CAO in commonly used medications in T&O practice. The British National Formulary (BNF), our local pharmacy guidelines and the online Summary of Product Characteristics (SPCs) for the medications were reviewed. We also assessed the suitability of current COVID-19 vaccines for patients who have reservations against CAO. Results All unfractionated or standard heparin is porcine in origin; Fondaparinux is a simple alternative. Cholecalciferol (vitamin D3) manufacture involves the use of lanolin from sheep's wool. Vitamin D2 (ergocalciferol) is an alternative with no CAO. All widely available Covid-19 vaccines in the UK are suitable for administration to vegans and all religious faiths. Propofol, widely used as an anaesthetic agent, contains egg proteins. Conclusion Disclosure of animal content would help patients make informed choices. With an increasingly informed population and ethnic diversity, we should be aware of the drugs that may contain animal products so that we can offer alternatives. Sometimes, pharmaceutical companies cannot guarantee or differentiate the specific sources of animal-derived ingredients, as various suppliers are used in the manufacturing process and the sources can change on a regular basis. Patients are more likely to adhere to prescribed medicines if they have been involved in prescribing decisions.
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Affiliation(s)
- Gwithyen Silk
- University Hospitals Bristol and Weston NHS Foundation Trust, United Kingdom
| | - Niraj Vetharajan
- University Hospitals Bristol and Weston NHS Foundation Trust, United Kingdom
| | - Alice Blohm
- University Hospitals Bristol and Weston NHS Foundation Trust, United Kingdom
| | - Fiona Teeling
- University Hospitals Bristol and Weston NHS Foundation Trust, United Kingdom
| | - Katie Keen
- University Hospitals Bristol and Weston NHS Foundation Trust, United Kingdom
| | - Niall Sullivan
- University Hospitals Bristol and Weston NHS Foundation Trust, United Kingdom
| | - Manish Kiran
- University Hospitals Bristol and Weston NHS Foundation Trust, United Kingdom
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Staud CJ, Resch A, Christ A, Borger A, Zaussinger M, Teufelsbauer M, Worel N, Radtke C. Skin Bank Establishment in Treatment of Severe Burn Injuries: Overview and Experience with Skin Allografts at the Vienna Burn Center. J Clin Med 2023; 12:4717. [PMID: 37510832 PMCID: PMC10381394 DOI: 10.3390/jcm12144717] [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: 06/08/2023] [Revised: 07/09/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Depending on their extent, burn injuries require different treatment strategies. In cases of severe large-area trauma, the availability of vital skin for autografting is limited. Donor skin allografts are a well-established but rarely standardized option for temporary wound coverage. Ten patients were eligible for inclusion in this retrospective study. Overall, 202 donor skin grafts obtained from the in-house skin bank were applied in the Department of Plastic and Reconstructive and Aesthetic Surgery, Medical University of Vienna. Between 2017 and 2022, we analysed the results in patient treatment, the selection of skin donors, tissue procurement, tissue processing and storage of allografts, as well as the condition and morphology of the allografts before application. The average Abbreviated Burn Severity Index (ABSI) was 8.5 (range, 5-12), and the mean affected total body surface area (TBSA) was 46.1% (range, 20-80%). In total, allograft application was performed 14 times. In two cases, a total of eight allografts were removed due to local infection, accounting for 3.96% of skin grafts. Six patients survived the acute phase of treatment. Scanning electron microscope images and histology showed no signs of scaffold decomposition and intact tissue layers of the allografts. The skin banking program and the application of skin allografts at the Vienna Burn Center can be considered successful. In severe burn injuries, skin allografts provide time by serving as sufficient wound coverage after early necrosectomy. Having an in-house skin banking program at a dedicated burn centre is particularly advantageous since issues of availability and distribution can be minimized. Skin allografts provide a reliable treatment option in patients with extensive burn injuries.
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Affiliation(s)
- Clement J Staud
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Annika Resch
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Alexandra Christ
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Anton Borger
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Maximilian Zaussinger
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Maryana Teufelsbauer
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Nina Worel
- Department of Transfusion Medicine and Cell Therapy, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Christine Radtke
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
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Bokek-Cohen Y. The Need to Adjust the Informed Consent for Jewish Patients for Treatments Involving Porcine Medical Constituents. J Immigr Minor Health 2023; 25:142-150. [PMID: 35849274 DOI: 10.1007/s10903-022-01383-z] [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: 06/23/2022] [Indexed: 01/07/2023]
Abstract
In order to obtain full informed consent for medical treatments, it is imperative to provide patients of diverse ethnic backgrounds with all relevant information. Since the pig is considered an impure animal in Judaism, Jewish patients may wish to be informed of porcine-derived substances used in treating. The present study is the first to explore the level of knowledge of Jewish participants as to whether the medical use of pig is permitted by their religion, and the extent to which they believe it should be permitted. 714 Jewish participants completed a study questionnaire that included 15 medical uses of pigs. Findings indicated that the knowledge of Jewish law regarding these uses is a significant mediator in predicting the attitude toward the permissibility of these uses. I conclude with practical recommendations as to how to enhance cultural competence and improve the informed consent process when treating Jewish patients with porcine-derived constituents.
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Affiliation(s)
- Ya'arit Bokek-Cohen
- School of Nursing, The Israel Academic College of Ramat Gan, 87 Ruttenberg St., 5227528, Ramat Gan, Israel. .,School of Nursing, The Academic College of Tel Aviv Jaffa, 10 Hever HaLe'umim St, 7475588, Tel Aviv, Israel.
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Bokek-Cohen Y, Tarabeih M. The Use of Porcine-Derived Materials for Medical Purposes: What do Muslim and Jewish Individuals Know and Opine About It? JOURNAL OF BIOETHICAL INQUIRY 2022; 19:599-612. [PMID: 36063344 DOI: 10.1007/s11673-022-10203-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/10/2022] [Indexed: 06/15/2023]
Abstract
Porcine-derived medical products represent an effective solution for a wide range of human suffering, yet this may contradict Muslim and Jewish religious prohibitions against consuming pig. The present study evaluated the level to which Muslim and Jewish participants are knowledgeable about the conditions permitting porcine-based treatments and explored their attitudes toward the permissibility of these treatments. A questionnaire that presented fifteen medical uses of porcine-derived products was completed by 809 Muslims and 714 Jews. Neither Muslim nor Jewish participants are knowledgeable about the religious rulings of their religions which permit the use of pig for life saving. Participants of both groups objected to the view that porcine-derived materials should be permitted. The findings imply that the attitude toward porcine-derived materials for medical use is contingent upon the knowledge or lack thereof that individuals have regarding the permissibility of such use. We offer useful recommendations to improve the informed consent process before conducting porcine-based treatments.
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Affiliation(s)
- Ya'arit Bokek-Cohen
- School of Social Sciences, Academic College of Israel in Ramat-Gan, 87 Ruttenberg St., Postal code 5227528, Ramat-Gan, Israel.
- , Holon, Israel.
| | - Mahdi Tarabeih
- School of Nursing, 2 Rabenu Yerucham St., Postal code 6161001, Tel Aviv, Israel
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Gill S, Prakash M, Forghany M, Vaderhobli RM. An ethical perspective to using bone grafts in dentistry. J Am Dent Assoc 2022; 153:88-91. [PMID: 34996535 DOI: 10.1016/j.adaj.2021.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 09/17/2021] [Accepted: 09/21/2021] [Indexed: 01/15/2023]
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Bhamra N, Jolly K, Darr A, Bowyer DJ, Ahmed SK. Intra-operative use of biological products-Are we aware of their derivatives? Int J Clin Pract 2021; 75:e14633. [PMID: 34270848 DOI: 10.1111/ijcp.14633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 07/06/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Global medical advances within healthcare have subsequently led to the widespread introduction of biological products such as grafts, haemostats, and sealants. Although these products have been used for many decades, this subject is frequently not discussed during the consent process and remains an area of contention. METHODS A nationwide confidential online survey was distributed to UK-based junior registrars (ST3-5), senior registrars (ST6-8), post-CCT fellows, specialist associates/staff grade doctors and consultants working in general/vascular surgery, neurosurgery, otolaryngology, oral and maxillofacial surgery and plastic surgery. RESULTS Data were collected from a total of 308 survey respondents. Biological derivatives were correctly identified in surgical products by only 25% of survey respondents, only 19% stated that they regularly consent for use of these products. Our results demonstrate that most participants in this study do not routinely consent (81%) to the intra-operative use of biological materials. An overwhelming 74% of participants agreed that further education on the intra-operative use of biological materials would be valuable. DISCUSSION This study highlights deficiencies in knowledge that results in potential compromise of the consenting process for surgical procedures. A solution to this would be for clinicians to increase their awareness via educational platforms and to incorporate an additional statement on the consent form which addresses the potential intraoperative use of biological products and what their derivatives may be. CONCLUSION Modernising the current consent process to reflect the development and use of surgical biological products will help to ensure improved patient satisfaction, fewer future legal implications as well as a better surgeon-patient relationship.
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Affiliation(s)
- Navdeep Bhamra
- Department of Otolaryngology, The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Karan Jolly
- Department of Otolaryngology, The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Adnan Darr
- Department of Otolaryngology, The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Duncan J Bowyer
- Department of Otolaryngology, Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - Shahzada K Ahmed
- Department of Otolaryngology, University Hospitals Birmingham NHS Trust, Birmingham, UK
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Khalaf ME, Abubakr NH, Alenezi HM, Ziada HM. Patients' Perspectives of Grafting Materials in Implant Dentistry: A Qualitative Analysis. J Int Soc Prev Community Dent 2021; 11:428-436. [PMID: 34430505 PMCID: PMC8352050 DOI: 10.4103/jispcd.jispcd_82_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] [Received: 03/14/2021] [Revised: 04/04/2021] [Accepted: 04/24/2021] [Indexed: 11/29/2022] Open
Abstract
AIMS The aim of this study was to evaluate the cultural, psychological, and religious influences on the choice of autografts, allografts, xenografts, and synthetic bone products for the grafting procedure and with implant placement. MATERIALS AND METHODS A qualitative methodology was employed, using the principles of the constant comparative method of the grounded theory; to investigate how people perceive and understand their experiences regarding the graft materials in implant dentistry. The data were collected using detailed qualitative interviews, till saturation was achieved, from 10 patients. RESULTS The three main themes that emerged in the analysis were: (a) grafting material preference, (b) religious and psychological influences, and (c) trust the doctor and cost influences. The three themes that emerged seemed to be interrelated. There were many statements of preference or rejection of choice based on religious, cultural, and psychological influences. CONCLUSIONS Within the limitations of this study, three themes emerged and they indicated that the influence on the grafting material's choice is unique to every individual; it also shares similarities, based on common religious and cultural values.
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Affiliation(s)
- Mai E Khalaf
- Department of General Dental Practice, Faculty of Dentistry, Kuwait University, Kuwait
| | - Neamat H Abubakr
- Department of Biomedical Sciences, School of Dental Medicine, University of Nevada, Las Vegas, NV, USA
| | - Hanadi M Alenezi
- Department of General Dental Practice, Faculty of Dentistry, Kuwait University, Kuwait
| | - Hassan M Ziada
- Department of Clinical Dental Sciences, School of Dental Medicine, University of Nevada, Las Vegas, NV, USA
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Rodger D. Why we should stop using animal-derived products on patients without their consent. JOURNAL OF MEDICAL ETHICS 2021; 48:medethics-2021-107371. [PMID: 34103364 DOI: 10.1136/medethics-2021-107371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/14/2021] [Indexed: 06/12/2023]
Abstract
Medicines and medical devices containing animal-derived ingredients are frequently used on patients without their informed consent, despite a significant proportion of patients wanting to know if an animal-derived product is going to be used in their care. Here, I outline three arguments for why this practice is wrong. First, I argue that using animal-derived medical products on patients without their informed consent undermines respect for their autonomy. Second, it risks causing nontrivial psychological harm. Third, it is morally inconsistent to respect patients' dietary preferences and then use animal-derived medicines or medical devices on them without their informed consent. I then address several anticipated objections and conclude that the continued failure to address this issue is an ethical blind spot that warrants applying the principles of respect for autonomy and informed consent consistently.
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Affiliation(s)
- Daniel Rodger
- Institute of Health and Social Care, London South Bank University, School of Allied and Community Health, London SE1 0AA, UK
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14
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Hodge S, Greaves N, Murray D. The Use of Bovine Pericardial Patches in Vascular Surgery: Where do we Draw the Line in Obtaining Informed Consent? Ann Vasc Surg 2021; 76:536-541. [PMID: 33905843 DOI: 10.1016/j.avsg.2021.03.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/07/2021] [Accepted: 03/16/2021] [Indexed: 11/28/2022]
Abstract
For a patient undergoing a carotid endarterectomy, induction with propofol, administration of heparin at the time of vessel clamping, use of a bovine pericardial patch for angioplasty, covering the wound with a hydrocolloid dressing and post-operative aspirin administration exposes the patient to animal products at every stage, from the moment they walk through the door. A number of articles have advocated obtaining informed consent when using animal products in healthcare but where should the line be drawn? METHODS A narrative review of the literature, specifically focussing on secular and religious beliefs about the use of animal products in healthcare. Application of ethical principles and GMC guidance to formulatea discussion with regards to the use of bovine pericardium in vascular surgery. Advanced literature search carried out using Pubmed and Google Scholar databases comparing patch material used forcarotid endarterectomy. RESULTS Disclosing the use of animal derived constituents in surgery is warranted under Beauchamp and Childress' four principals and highlighted in GMC guidance. Obtaining consent for the use of animalderived constituents at the time of surgery is something that should become a fundamental component of the written consent process and alternatives should be sought where available and practicable. CONCLUSION This review highlights the evidence available and discusses our current standpoint from both a legal and ethical aspect.
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Affiliation(s)
- Stacie Hodge
- Department of Vascular and Endovascular Surgery, Manchester University NHS Trust, Manchester, United Kingdom.
| | - Nicholas Greaves
- Department of Vascular and Endovascular Surgery, Manchester University NHS Trust, Manchester, United Kingdom
| | - David Murray
- Department of Vascular and Endovascular Surgery, Manchester University NHS Trust, Manchester, United Kingdom
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15
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Babos MB, Perry JD, Reed SA, Bugariu S, Hill-Norby S, Allen MJ, Corwell TK, Funck JE, Kabir KF, Sullivan KA, Watson AL, Wethington KK. Animal-derived medications: cultural considerations and available alternatives. J Osteopath Med 2021; 121:361-370. [PMID: 33694349 DOI: 10.1515/jom-2020-0052] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 10/20/2020] [Indexed: 11/15/2022]
Abstract
CONTEXT Cultural competency is a cornerstone of patient-centered health care. Religious doctrines may define appropriate consumption or use of certain animals and forbid use of others. Many medications contain ingredients that are animal-derived; these medications may be unacceptable to individual patients within the context of their religious beliefs and lifestyle choices. Knowledge of animal-derived medications as a component of cultural competency can facilitate a dialogue that shifts focus from the group to the individual, away from cultural competency toward cultural humility, and away from a paternalistic provider/patient dynamic toward one of partnership. OBJECTIVES To explore how animal-derived drug components may impact medication selection and acceptability from the perspective of patients, physicians, and religious leaders as evidenced by studies that explore the question via survey or questionnaire. A secondary objective is to use the context of animal-derived drug products as a component of cultural competency to build a framework supporting the development of cultural humility. METHODS A systematic search was performed in the PubMed, CINAHL, Cochrane, and ProQuest databases using combinations of the following terms: "medication selection," "medication," "adherence," "pharmaceutical preparations," "religion and medicine," "religion," "animal," "dietary," "porcine," and "bovine." Studies that reported using surveys or questionnaires to examine patient, physician, or religious leader perspective on animal-derived medications published in English between 1990 and 2020 were included. Review articles, opinion pieces, case reports, surveys of persons other than patients, religious leaders, or physicians, and studies published in languages other than English were excluded. Three authors independently reviewed articles to extract information pertaining to perspectives on animal-based medication ingredients. RESULTS Eight studies meeting the described criteria were found that queried beliefs or knowledge of patients, religious leaders, or physicians regarding medications and medical products of biologic origin. Those studies are described in full in this review. CONCLUSIONS Knowledge of animal-derived ingredients may help open conversations with patients around spiritual history and cultural competency, particularly for those patients belonging to religious sects with doctrines that define appropriate use of human- or animal-derived products. Further formal study is needed to explore more fully the extent to which religious beliefs may impact selection of animal- or human-derived medications. Guidelines developed from this knowledge may aid in identifying individual patients with whom the discussion may be particularly relevant. More studies are needed to quantify and qualify beliefs regarding animal-derived medication constituents.
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Affiliation(s)
- Mary Beth Babos
- Lincoln Memorial University - DeBusk College of Osteopathic Medicine, Harrogate, TN, USA
| | - Joseph D Perry
- Lincoln Memorial University - DeBusk College of Osteopathic Medicine, Harrogate, TN, USA
| | - Sara A Reed
- Lincoln Memorial University - DeBusk College of Osteopathic Medicine, Harrogate, TN, USA
| | - Sandra Bugariu
- Lincoln Memorial University - DeBusk College of Osteopathic Medicine, Harrogate, TN, USA
| | - Skyler Hill-Norby
- Lincoln Memorial University - DeBusk College of Osteopathic Medicine, Harrogate, TN, USA
| | - Mary Jewell Allen
- Lincoln Memorial University - DeBusk College of Osteopathic Medicine, Harrogate, TN, USA
| | - Tara K Corwell
- Lincoln Memorial University - DeBusk College of Osteopathic Medicine, Harrogate, TN, USA
| | - Jade E Funck
- Lincoln Memorial University - DeBusk College of Osteopathic Medicine, Harrogate, TN, USA
| | - Kaiser F Kabir
- Lincoln Memorial University - DeBusk College of Osteopathic Medicine, Harrogate, TN, USA
| | - Katherine A Sullivan
- Lincoln Memorial University - DeBusk College of Osteopathic Medicine, Harrogate, TN, USA
| | - Amber L Watson
- Lincoln Memorial University - DeBusk College of Osteopathic Medicine, Harrogate, TN, USA
| | - K Kelli Wethington
- Lincoln Memorial University - DeBusk College of Osteopathic Medicine, Harrogate, TN, USA
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Jamie K, Sharples G. The Social and Material Life of Antimicrobial Clay: Exploring Antimicrobial Resistance, Medicines' Materiality, and Medicines Optimization. FRONTIERS IN SOCIOLOGY 2020; 5:26. [PMID: 33869434 PMCID: PMC8022547 DOI: 10.3389/fsoc.2020.00026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/25/2020] [Indexed: 06/12/2023]
Abstract
While sociologists have made significant theoretical contributions to the antimicrobial resistance (AMR) debate, little attention has been given to the antimicrobial products themselves. Here we advocate a significant new direction which centers on the social and material life of antimicrobials, specifically on what they are made from and how this affects their use. This focus is timely because, in the context of declining efficacy of biomedical antibiotics, diverse materials are increasingly taking center stage in research and drug discovery as potential agents for new antimicrobial treatments. Of particular significance are natural antimicrobials, such as plants, honey and clay, whose antimicrobial potential is well-documented and which are increasingly moving into mainstream antimicrobial research. Alongside this biomedical focus, we suggest that the social and material lives of these antimicrobial materials require attention to (i) highlight the ways they have been, and continue to be, used in diverse cultures globally, (ii) explore ways we might theorize these materials within wider AMR debates, and (iii) examine the impact of antimicrobials' materiality on their use by patients. This article takes the example of clay, whose antimicrobial properties are well-established and which has been used to treat wounds and gastrointestinal problems for millennia. We first locate clay as an exemplar of a wider shift toward natural products drug discovery in pharmaceutical science and antimicrobial research. We then offer a number of theoretical "ways in" for sociologists to begin making sense of clay as it comes under the western biomedical gaze. We map these conceptual lenses on to clay's physical and symbolic mobility from its use in the global south into western biomedical research and commercialization. We particularly concentrate on post-colonial theory as a means to understand clay's movement from global south to north; laboratory studies to examine its symbolic transformation to a black-boxed antimicrobial artifact; and valuation practices as a lens to capture its movement from the margins to the mainstream. We finish by reflecting on the importance of materiality in addressing optimal use of medicines and by advocating an interdisciplinary approach to AMR which positions sociology as a key contributor to AMR solutions.
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Affiliation(s)
- Kimberly Jamie
- Department of Sociology, Durham University, Durham, United Kingdom
| | - Gary Sharples
- Department of Biosciences, Durham University, Durham, United Kingdom
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Shanks LA, Cronshaw A, Alexander KS, Davies JA, O’Boyle CP. Evaluation of EpiProtect® microbial cellulose burns dressings in young children. Scars Burn Heal 2020; 6:2059513120940503. [PMID: 32850135 PMCID: PMC7425250 DOI: 10.1177/2059513120940503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION EpiProtect® is a biosynthetic cellulose dressing indicated for the treatment of superficial burns and the dressing of deep burns. Prior to this study the youngest reported patient treated with EpiProtect® was aged 13 years. METHOD Data were collected prospectively for patients aged < 5 years, presenting to the Children's Burns Unit with ⩾ 2% total body surface area (TBSA) burns sustained by any mechanism. RESULTS Thirty children were treated (median age = 17 months, age range = 1-61 months). Thirty-six burn depths were documented: superficial partial thickness (SPT) in 53% (n=19); mid-partial thickness (MPT) in 33% (n=12); deep partial thickness (DPT) in 11% (n=4); and full thickness (FT) in 3% (n=1). Median burn size was 4.5% TBSA (range = 2%-12%). EpiProtect® was applied under general anaesthesia in all cases. The median length of stay (LOS) was two days (range = 0-6 days). EpiProtect® was tolerated well and provided effective analgesia for subsequent dressing changes. Median healing time was 13 days (SPT burns), 14 days (MPT) and 24 days (DPT burns). Three patients required split skin grafting. Hypertrophic scarring arose in one patient. DISCUSSION This case series represents the youngest published patient group to have been treated with EpiProtect®. Authors conclude that EpiProtect® provides a safe, reliable and well-tolerated dressing option for all burn depths in young children. Importantly, EpiProtect® is culturally neutral and may be used in situations which, for cultural reasons, may preclude the use of animal-derived products. Further studies are warranted to evaluate pain scores, burn depth, size and LOS correlation, and comparative analysis between dressing types. LAY SUMMARY Burn injuries in the paediatric population are common and often require multiple dressing changes. Dressing changes can be painful and distressing to both children and their care givers. This article describes the experience of using a synthetically derived burns dressing, called EpiProtect®, in children aged ⩽ 5 years. Thirty patients were recruited with varying depths of scald burns and all underwent application of EpiProtect® dressing. The results suggested that EpiProtect® was a user-friendly dressing that can be used to treat partial-thickness burns and to dress full-thickness (FT) burns. It was well-tolerated and provided effective analgesia at the time of dressing changes. There was no incidence of increased burn wound infection rates and all wounds healed. In addition, as EpiProtect® is a synthetic product, it has the benefit of being culturally neutral, which is advantageous in a culturally diverse population. Further studies are warranted to evaluate the effectiveness of this dressing and to compare it to similar dressings that are available.
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Affiliation(s)
- Lindsay A Shanks
- Department of Paediatric Burns and Plastic Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Andrea Cronshaw
- Department of Paediatric Burns and Plastic Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - K Skaria Alexander
- Department of Paediatric Burns and Plastic Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Medical School, University of Nottingham, Nottingham, UK
| | - Jonathan A Davies
- Department of Paediatric Burns and Plastic Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Ciaran P O’Boyle
- Department of Paediatric Burns and Plastic Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Medical School, University of Nottingham, Nottingham, UK
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Abstract
3D bioprinting involves engineering live cells into a 3D structure, using a 3D printer to print cells, often together with a compatible 3D scaffold. 3D-printed cells and tissues may be used for a range of purposes including medical research, in vitro drug testing, and in vivo transplantation. The inclusion of living cells and biomaterials in the 3D printing process raises ethical, policy, and regulatory issues at each stage of the bioprinting process that include the source of cells and materials, stability and biocompatibility of cells and materials, disposal of 3D-printed materials, intended use, and long-term effects. This chapter focuses on the ethical issues that arise from 3D bioprinting in the lab-from consideration of the source of cells and materials, ensuring their quality and safety, through to testing of bioprinted materials in animal and human trials. It also provides guidance on where to seek information concerning appropriate regulatory frameworks and guidelines, including on classification and patenting of 3D-bioprinted materials, and identifies regulatory gaps that deserve attention.
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Affiliation(s)
- Eliza Goddard
- ARC Centre of Excellence for Electromaterials Science, Humanities and Social Sciences, La Trobe University, Melbourne, VIC, Australia.
| | - Susan Dodds
- ARC Centre of Excellence for Electromaterials Science, Office of the Deputy Vice-Chancellor (Research and Industry Engagement), La Trobe University, Melbourne, VIC, Australia.
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Jaganathan SK, Prasath Mani M, Khudzari AZM, Fauzi bin Ismail A. Physicochemical assessment of tailor made fibrous polyurethane scaffolds incorporated with turmeric oil for wound healing applications. INTERNATIONAL JOURNAL OF POLYMER ANALYSIS AND CHARACTERIZATION 2019. [DOI: 10.1080/1023666x.2019.1676010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Saravana Kumar Jaganathan
- Department for Management of Science and Technology Development, Ton Duc Thang University, Ho Chi Minh City, Vietnam
- Faculty of Applied Sciences, Ton Duc Thang University, Ho Chi Minh City, Vietnam
| | - Mohan Prasath Mani
- School of Biomedical Engineering and Health Sciences, Faculty of Engineering, Universiti Teknologi Malaysia, Skudai, Malaysia
| | - Ahmad Zahran Md Khudzari
- IJN-UTM Cardiovascular Engineering Center, School of Biomedical Engineering and Health Sciences, Faculty of Engineering, UniversitiTeknologi Malaysia, Skudai, Malaysia
| | - Ahmad Fauzi bin Ismail
- Advanced Membrane Technology Research Centre (AMTEC), School of Chemical and Energy Engineering, Universiti Teknologi Malaysia, Skudai, Malaysia
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Superiority of silver-foam over porcine xenograft dressings for treatment of scalds in children: A prospective randomised controlled trial. Burns 2019; 45:1401-1409. [PMID: 31230798 DOI: 10.1016/j.burns.2019.04.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/13/2019] [Accepted: 04/04/2019] [Indexed: 02/08/2023]
Abstract
AIM Our aim was to compare two different regimens for the treatment of children with partial-thickness scalds. These were treated with either a porcine xenograft (EZderm®, Mölnlycke Health Care, Gothenburg, Sweden) or a silver-foam dressing (Mepilex® Ag, Mölnlycke Health Care, Gothenburg, Sweden). METHODS We organised a prospective randomised clinical trial that included 58 children admitted between May 2015 and May 2018 with partial-thickness scalds to The Burn Centre in Linkoping, Sweden. The primary outcome was time to healing. Secondary outcomes were pain, need for operation, wound infection, duration of hospital stay, changes of dressings, and time taken. RESULTS The patients treated with silver-foam dressing had a significantly shorter healing time. The median time to 97% healing for this group was 9 (7-23) days compared to 15 (9-29) days in the porcine xenograft group (p = 0.004). The median time to complete healing for the silver-foam group was 15 (9-29) days and for the porcine xenograft group 20.5 (11-42) days (p = 0.010). Pain, wound infection, duration of hospital stay, and the proportion of operations were similar between the groups. Number of dressing changes and time for dressing changes were lower in the silver-foam dressing group (p = 0.03 for both variables). CONCLUSIONS We compared two different treatments for children with partial-thickness scalds, and the data indicate that wound healing was faster, fewer dressing changes were needed, and dressing times were shorter in the silver-foam group.
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Jolly K, Darr A, Aslanidou A, Bowyer D, Ahmed S. The intra‐operative use of biological products: A multi‐centre regional patient perspective of a potential consenting conundrum. Clin Otolaryngol 2019; 44:831-835. [DOI: 10.1111/coa.13367] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/16/2019] [Accepted: 05/12/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Karan Jolly
- Department of Otolaryngology University Hospitals Birmingham NHS Trust Birmingham UK
| | - Adnan Darr
- Department of Otolaryngology Shrewsbury and Telford Hospital NHS Trust Shrewsbury UK
| | - Anastasia Aslanidou
- Department of Otolaryngology University Hospitals Birmingham NHS Trust Birmingham UK
| | - Duncan Bowyer
- Department of Otolaryngology Shrewsbury and Telford Hospital NHS Trust Shrewsbury UK
| | - Shahzada Ahmed
- Department of Otolaryngology University Hospitals Birmingham NHS Trust Birmingham UK
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Jaganathan SK, Mani MP, Prabhakaran P, Supriyanto E, Ismail AF. Production, blood compatibility and cytotoxicity evaluation of a single stage non-woven multicomponent electrospun scaffold mixed with sesame oil, honey and propolis for skin tissue engineering. INTERNATIONAL JOURNAL OF POLYMER ANALYSIS AND CHARACTERIZATION 2019. [DOI: 10.1080/1023666x.2019.1602919] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Saravana Kumar Jaganathan
- Department for Management of Science and Technology Development, Ton Duc Thang University, Ho Chi Minh City, Vietnam
- Faculty of Applied Sciences, Ton Duc Thang University, Ho Chi Minh City, Vietnam
- IJN-UTM Cardiovascular Engineering Centre, School of Biomedical Engineering and Health Sciences, Faculty of Engineering, Universiti Teknologi Malaysia, Skudai 81300, Malaysia
| | - Mohan Prasath Mani
- School of Biomedical Engineering and Health Sciences, Faculty of Engineering, Universiti Teknologi Malaysia, Skudai 81310, Malaysia
| | - Praseetha Prabhakaran
- Department of Biosciences, Faculty of Science, Universiti Teknologi Malaysia, Skudai 81310, Malaysia
| | - Eko Supriyanto
- IJN-UTM Cardiovascular Engineering Centre, School of Biomedical Engineering and Health Sciences, Faculty of Engineering, Universiti Teknologi Malaysia, Skudai 81300, Malaysia
| | - Ahmad Fauzi Ismail
- Advanced Membrane Technology Research Centre (AMTEC), School of Chemical and Energy Engineering, Faculty of Engineering, Universiti Teknologi Malaysia, Skudai 81310, Malaysia
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Rodger D, Blackshaw BP. Using animal-derived constituents in anaesthesia and surgery: the case for disclosing to patients. BMC Med Ethics 2019; 20:14. [PMID: 30777063 PMCID: PMC6379939 DOI: 10.1186/s12910-019-0351-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 02/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Animal-derived constituents are frequently used in anaesthesia and surgery, and patients are seldom informed of this. This is problematic for a growing minority of patients who may have religious or secular concerns about their use in their care. It is not currently common practice to inform patients about the use of animal-derived constituents, yet what little empirical data does exist indicates that many patients want the opportunity to give their informed consent. DISCUSSION First we review the nature and scale of the problem by looking at the groups who may have concerns about the use of animal-derived constituents in their care. We then summarise some of the products used in anaesthesia and surgery that can contain such constituents, such as anaesthetic drugs, surgical implants and dressings. Finally, we explore the problem of animal-derived constituents and consent using Beauchamp and Childress' four principles approach, examining issues of autonomy, beneficence, nonmaleficence and justice. Disclosing the use of animal-derived constituents in anaesthesia and surgery is warranted under Beauchamp and Childress' four principles approach to the problem. Although there exist systemic and practical challenges to implementing this in practice, the ethical case for doing so is strong. The Montgomery ruling presents additional legal reason for disclosure because it entails that patients must be made aware of risks associated with their treatment that they attach significance to.
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Affiliation(s)
- Daniel Rodger
- Department of Allied Health Sciences, School of Health and Social Care, London South Bank University, 103 Borough Road, London, SE1 0AA England
| | - Bruce P. Blackshaw
- Department of Philosophy, School of Philosophy, Theology and Religion, University of Birmingham, Birmingham, England
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Varkey M, Visscher DO, van Zuijlen PPM, Atala A, Yoo JJ. Skin bioprinting: the future of burn wound reconstruction? BURNS & TRAUMA 2019; 7:4. [PMID: 30805375 PMCID: PMC6371568 DOI: 10.1186/s41038-019-0142-7] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 01/08/2019] [Indexed: 01/17/2023]
Abstract
Burns are a significant cause of trauma, and over the years, the focus of patient care has shifted from just survival to facilitation of improved functional outcomes. Typically, burn treatment, especially in the case of extensive burn injuries, involves surgical excision of injured skin and reconstruction of the burn injury with the aid of skin substitutes. Conventional skin substitutes do not contain all skin cell types and do not facilitate recapitulation of native skin physiology. Three-dimensional (3D) bioprinting for reconstruction of burn injuries involves layer-by-layer deposition of cells along with scaffolding materials over the injured areas. Skin bioprinting can be done either in situ or in vitro. Both these approaches are similar except for the site of printing and tissue maturation. There are technological and regulatory challenges that need to be overcome for clinical translation of bioprinted skin for burn reconstruction. However, the use of bioprinting for skin reconstruction following burns is promising; bioprinting will enable accurate placement of cell types and precise and reproducible fabrication of constructs to replace the injured or damaged sites. Overall, 3D bioprinting is a very transformative technology, and its use for wound reconstruction will lead to a paradigm shift in patient outcomes. In this review, we aim to introduce bioprinting, the different stages involved, in vitro and in vivo skin bioprinting, and the various clinical and regulatory challenges in adoption of this technology.
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Affiliation(s)
- Mathew Varkey
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27101 USA
| | - Dafydd O. Visscher
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, 1081 HV Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Paul P. M. van Zuijlen
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, 1081 HV Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Burn Center, Red Cross Hospital, 1942 LE Beverwijk, The Netherlands
- Association of Dutch Burn Centres, 1942 LE Beverwijk, The Netherlands
| | - Anthony Atala
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27101 USA
| | - James J. Yoo
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27101 USA
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Karlsson M, Olofsson P, Steinvall I, Sjöberg F, Thorfinn J, Elmasry M. Three Years' Experience of a Novel Biosynthetic Cellulose Dressing in Burns. Adv Wound Care (New Rochelle) 2019; 8:71-76. [PMID: 30809423 PMCID: PMC6389762 DOI: 10.1089/wound.2018.0790] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 07/06/2018] [Indexed: 11/19/2022] Open
Abstract
Objective: The use of porcine xenograft (PX) is widely spread in burn care. However, it may cause immunologic responses and other ethical and cultural considerations in different cultures. Therefore, there is a need for alternatives. The aim of this work is to test a novel biosynthetic cellulose dressing (Epiprotect®) on burn patients. Approach: Charts from 38 patients with superficial burns (SBs) (n = 18) or excised burns (n = 20) that got biosynthetic cellulose dressing instead of PX at a national burn center during 3 years were reviewed. Time to healing, length of stay, and wound infection were extracted from the medical records. Results: SBs hospitalization time was 11 days comparable to PXs reported by others. In the excised group, median duration of hospital stay was 35 days. Time to healing was 28 days. Seven wound infections were confirmed in the superficial group (39%) and 11 infections in the excised group (61%). Patients with superficial wounds reported pain relief on application. Innovation: A dressing (17 × 21 cm) consisting of biosynthetic cellulose replacing PX. Conclusion: Outcome of treatment of SBs or temporary coverage of excised deep burns with biosynthetic cellulose is comparable to treatment with PX. However, biosynthetic cellulose has benefits such as providing pain relief on application and ethical or cultural issues with the material is nonexistent.
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Affiliation(s)
- Matilda Karlsson
- Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden
| | - Pia Olofsson
- Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Ingrid Steinvall
- Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Folke Sjöberg
- Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Department of Anaesthesiology and Intensive Care, Linköping University, Linköping, Sweden
| | - Johan Thorfinn
- Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Moustafa Elmasry
- Department of Plastic Surgery, Hand Surgery, and Burns, Linköping University, Linköping, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Surgery Department, Suez Canal University, Ismailia, Egypt
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Kommentar II zum Fall: „Heparin für Muslime – Wissenslücke: nicht vegan und nicht halal“. Ethik Med 2018. [DOI: 10.1007/s00481-018-00513-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Affiliation(s)
- Patrick S. Phelan
- Division of Public Health Sciences, Department of Surgery, School of Medicine, Washington University, St. Louis, MO, USA
| | - M. Laurin Council
- Division of Dermatology, Department of Medicine, School of Medicine, Washington University, St. Louis, MO, USA
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Vijayavenkataraman S. A Perspective on Bioprinting Ethics. Artif Organs 2018; 40:1033-1038. [PMID: 28374411 DOI: 10.1111/aor.12873] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/12/2016] [Accepted: 09/01/2016] [Indexed: 12/12/2022]
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Gilbert F, O'Connell CD, Mladenovska T, Dodds S. Print Me an Organ? Ethical and Regulatory Issues Emerging from 3D Bioprinting in Medicine. SCIENCE AND ENGINEERING ETHICS 2018; 24:73-91. [PMID: 28185142 DOI: 10.1007/s11948-017-9874-6] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 01/11/2017] [Indexed: 06/06/2023]
Abstract
Recent developments of three-dimensional printing of biomaterials (3D bioprinting) in medicine have been portrayed as demonstrating the potential to transform some medical treatments, including providing new responses to organ damage or organ failure. However, beyond the hype and before 3D bioprinted organs are ready to be transplanted into humans, several important ethical concerns and regulatory questions need to be addressed. This article starts by raising general ethical concerns associated with the use of bioprinting in medicine, then it focuses on more particular ethical issues related to experimental testing on humans, and the lack of current international regulatory directives to guide these experiments. Accordingly, this article (1) considers whether there is a limit as to what should be bioprinted in medicine; (2) examines key risks of significant harm associated with testing 3D bioprinting for humans; (3) investigates the clinical trial paradigm used to test 3D bioprinting; (4) analyses ethical questions of irreversibility, loss of treatment opportunity and replicability; (5) explores the current lack of a specific framework for the regulation and testing of 3D bioprinting treatments.
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Affiliation(s)
- Frederic Gilbert
- University of Tasmania, Hobart, Australia.
- ARC Centre of Excellence for Electromaterials Science (ACES), Wollongong, Australia.
| | - Cathal D O'Connell
- ARC Centre of Excellence for Electromaterials Science (ACES), Wollongong, Australia
- University of Wollongong, Wollongong, Australia
| | - Tajanka Mladenovska
- ARC Centre of Excellence for Electromaterials Science (ACES), Wollongong, Australia
- Department of Surgery, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia
| | - Susan Dodds
- University of Tasmania, Hobart, Australia
- ARC Centre of Excellence for Electromaterials Science (ACES), Wollongong, Australia
- University of New South Wales, Sydney, Australia
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Vijayavenkataraman S, Lu W, Fuh J. 3D bioprinting – An Ethical, Legal and Social Aspects (ELSA) framework. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.bprint.2016.08.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Mullan CJ, Pagoti R, Davison H, McAlinden MG. An audit of consent for allograft use in elective orthopaedic surgery. Ann R Coll Surg Engl 2016; 98:254-7. [PMID: 26924483 DOI: 10.1308/rcsann.2016.0070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction Patients receiving musculoskeletal allografts may be at risk of postoperative infection. The General Medical Council guidelines on consent highlight the importance of providing patients with the information they want or need on any proposed investigation or treatment, including any potential adverse outcomes. With the increased cost of defending medicolegal claims, it is paramount that adequate, clear informed patient consent be documented. Methods We retrospectively examined the patterns of informed consent for allograft bone use during elective orthopaedic procedures in a large unit with an onsite bone bank. The initial audit included patients operated over the course of 1 year. Following a feedback session, a re-audit was performed to identify improvements in practice. Results The case mix of both studies was very similar. Revision hip arthroplasty surgery constituted the major subgroup requiring allograft (48%), followed by foot and ankle surgery (16.3%) and revision knee arthroplasty surgery (11.4%) .On the initial audit, 17/45 cases (38%) had either adequate preoperative documentation of the outpatient discussion or an appropriately completed consent form on the planned use of allograft. On the re-audit, 44/78 cases (56%) had adequate pre-operative documentation. There was little correlation between how frequently a surgeon used allograft and the adequacy of consent (Correlation coefficient -0.12). Conclusions Although the risk of disease transmission with allograft may be variable, informed consent for allograft should be a routine part of preoperative discussions in elective orthopaedic surgery. Regular audit and feedback sessions may further improve consent documentation, alongside the targeting of high volume/low compliance surgeons.
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Affiliation(s)
| | - R Pagoti
- Musgrave Park Hospital , Belfast , UK
| | - H Davison
- Musgrave Park Hospital , Belfast , UK
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32
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Nelson EA, Adderley U. Venous leg ulcers. BMJ CLINICAL EVIDENCE 2016; 2016:1902. [PMID: 26771825 PMCID: PMC4714578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Leg ulcers usually occur secondary to venous reflux or obstruction, but 20% of people with leg ulcers have arterial disease, with or without venous disorders. Between 1.5 and 3.0 in 1000 people have active leg ulcers. Prevalence increases with age to about 20 in 1000 people aged over 80 years. METHODS AND OUTCOMES We conducted a systematic overview, aiming to answer the following clinical questions: What are the effects of treatments for venous leg ulcers? What are the effects of organisational interventions for venous leg ulcers? What are the effects of advice about self-help interventions in people receiving usual care for venous leg ulcers? What are the effects of interventions to prevent recurrence of venous leg ulcers? We searched: Medline, Embase, The Cochrane Library, and other important databases up to March 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview). RESULTS At this update, searching of electronic databases retrieved 116 studies. After deduplication and removal of conference abstracts, 63 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 43 studies and the further review of 20 full publications. Of the 20 full articles evaluated, four systematic reviews were updated and four RCTs were added at this update. We performed a GRADE evaluation for 23 PICO combinations. CONCLUSIONS In this systematic overview, we categorised the efficacy for 13 interventions based on information about the effectiveness and safety of advice to elevate leg, advice to keep leg active, compression stockings for prevention of recurrence, compression bandages and stockings to treat venous leg ulcers, laser treatment (low level), leg ulcer clinics, pentoxifylline, skin grafting, superficial vein surgery for prevention of recurrence, superficial vein surgery to treat venous leg ulcers, therapeutic ultrasound, and topical negative pressure.
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Fernández RF, Bucchi C, Navarro P, Beltrán V, Borie E. Bone grafts utilized in dentistry: an analysis of patients' preferences. BMC Med Ethics 2015; 16:71. [PMID: 26486125 PMCID: PMC4618514 DOI: 10.1186/s12910-015-0044-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 07/14/2015] [Indexed: 11/30/2022] Open
Abstract
Background Many procedures currently require the use of bone grafts to replace or recover bone volume that has been resorbed. However, the patient’s opinion and preferences must be taken into account before implementing any treatment. Researchers have focused primarily on assessing the effectiveness of bone grafts rather than on patients' perceptions. Thus, the aim of this study was to explore patients' opinions regarding the different types of bone grafts used in dental treatments. Methods One hundred patients were randomly chosen participated in the study. A standardized survey of 10 questions was used to investigate their opinions regarding the different types of bone grafts used in dental treatments. Descriptive statistics were calculated for the different variables, and absolute frequencies and percentages were used as summary measures. A value of p <0.05 was selected as the threshold for statistical significance. Results The highest rate of refusal was observed for allografts and xenografts. The grafts with the lowest rates of refusal were autologous grafts (3 %) and alloplastics (2 %). No significant differences were found between the various types of bone grafts in the sociodemographic variables or the refusal/acceptance variable. Similarly, no significant relations were observed between a specific religious affiliation and the acceptance/refusal rates of the various types of graft. Conclusions Allografts and xenografts elicited the highest refusal rates among the surveyed patients, and autologous bone and alloplastics were the most accepted bone grafts. Moreover, no differences were found in the sociodemographic variables or religious affiliations in terms of the acceptance/refusal rates of the different bone grafts.
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Affiliation(s)
- Ramón Fuentes Fernández
- Research Centre in Dental Sciences, Dental School, Universidad de La Frontera, Manuel Montt #112, 4781176, Temuco, Chile.
| | - Cristina Bucchi
- Research Centre in Dental Sciences, Dental School, Universidad de La Frontera, Manuel Montt #112, 4781176, Temuco, Chile.
| | - Pablo Navarro
- Mathematics and Statistic Department, Universidad de La Frontera, Temuco, Chile.
| | - Víctor Beltrán
- Research Centre in Dental Sciences, Dental School, Universidad de La Frontera, Manuel Montt #112, 4781176, Temuco, Chile.
| | - Eduardo Borie
- Research Centre in Dental Sciences, Dental School, Universidad de La Frontera, Manuel Montt #112, 4781176, Temuco, Chile. .,Department of Dental Materials and Prosthodontics, Dental School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
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Wound bed preparation 2014 update: management of critical colonization with a gentian violet and methylene blue absorbent antibacterial dressing and elevated levels of matrix metalloproteases with an ovine collagen extracellular matrix dressing. Adv Skin Wound Care 2015; 27:1-6. [PMID: 24521847 DOI: 10.1097/01.asw.0000443269.63406.f9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Wound bed preparation (WBP) is a paradigm for holistic patient care that includes treatment of the cause along with patient-centered concerns before optimizing the components of local wound care (debridement, infection/inflammation, moisture balance, and, when required, the edge effect). This review incorporates a methylene blue and gentian violet bound foam dressing for critical colonization and an ovine collagen extracellular matrix dressing for reduction of elevated levels of matrix metalloproteases into the WBP paradigm.
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Leodoro B, Chang A, Cama JK. Live sibling skin allografts for severe burns in a paediatric patient: A viable option in developing countries. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2014. [DOI: 10.1016/j.epsc.2014.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Vyas KS, Vasconez HC. Wound Healing: Biologics, Skin Substitutes, Biomembranes and Scaffolds. Healthcare (Basel) 2014; 2:356-400. [PMID: 27429283 PMCID: PMC4934597 DOI: 10.3390/healthcare2030356] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 07/08/2014] [Accepted: 08/19/2014] [Indexed: 12/25/2022] Open
Abstract
This review will explore the latest advancements spanning several facets of wound healing, including biologics, skin substitutes, biomembranes and scaffolds.
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Affiliation(s)
- Krishna S Vyas
- Division of Plastic Surgery, Department of Surgery, University of Kentucky, Kentucky Clinic K454, 740 South Limestone, Lexington, KY 40536, USA.
| | - Henry C Vasconez
- Division of Plastic Surgery, Department of Surgery, University of Kentucky, Kentucky Clinic K454, 740 South Limestone, Lexington, KY 40536, USA.
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Mayberry JF, Arora A. Correspondence. Br J Hosp Med (Lond) 2014; 75:474-5. [DOI: 10.12968/hmed.2014.75.8.474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- John F Mayberry
- Professor of Gastroenterology University Hospitals of Leicester NHS Trust Leicester LE5 4PW
| | - Alok Arora
- Acute Medical Registrar Bristol Royal Infirmary Bristol BS2 8HW
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Har-el YE, Gerstenhaber JA, Brodsky R, Huneke RB, Lelkes PI. Electrospun soy protein scaffolds as wound dressings: Enhanced reepithelialization in a porcine model of wound healing. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.wndm.2014.04.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Eriksson A, Burcharth J, Rosenberg J. Animal derived products may conflict with religious patients' beliefs. BMC Med Ethics 2013; 14:48. [PMID: 24289542 PMCID: PMC4220589 DOI: 10.1186/1472-6939-14-48] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Accepted: 11/21/2013] [Indexed: 11/26/2022] Open
Abstract
Background Implants and drugs with animal and human derived content are widely used in medicine and surgery, but information regarding ingredients is rarely obtainable by health practitioners. A religious perspective concerning the use of animal and human derived drug ingredients has not thoroughly been investigated. The purpose of this study was to clarify which parts of the medical and surgical treatments offered in western world-hospitals that conflicts with believers of major religions. Methods Religious and spiritual leaders of the six largest religions worldwide (18 branches) were contacted. A standardised questionnaire was sent out regarding their position on the use of human and animal derived products in medical and surgical treatments. Results Of the 18 contacted religious branches, 10 replied representing the 6 largest religions worldwide. Hindus and Sikhs did not approve of the use of bovine or porcine derived products, and Muslims did not accept the use of porcine derived drugs, dressings or implants. Christians (including Jehovah’s Witnesses), Jews and Buddhists accepted the use of all animal and human derived products. However, all religions accepted the use of all these products in case of an emergency and only if alternatives were not available. Conclusions The views here suggest that religious codes conflict with some treatment regimens. It is crucial to obtain informed consent from patients for the use of drugs and implants with animal or human derived content. However, information on the origin of ingredients in drugs is not always available to health practitioners.
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Affiliation(s)
- Axelina Eriksson
- Department of Surgery D, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, Herlev DK2730, Denmark.
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Oerlemans AJM, van Hoek MEC, van Leeuwen E, van der Burg S, Dekkers WJM. Towards a richer debate on tissue engineering: a consideration on the basis of NEST-ethics. SCIENCE AND ENGINEERING ETHICS 2013; 19:963-81. [PMID: 23229374 DOI: 10.1007/s11948-012-9419-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 11/06/2012] [Indexed: 05/04/2023]
Abstract
In their 2007 paper, Swierstra and Rip identify characteristic tropes and patterns of moral argumentation in the debate about the ethics of new and emerging science and technologies (or "NEST-ethics"). Taking their NEST-ethics structure as a starting point, we considered the debate about tissue engineering (TE), and argue what aspects we think ought to be a part of a rich and high-quality debate of TE. The debate surrounding TE seems to be predominantly a debate among experts. When considering the NEST-ethics arguments that deal directly with technology, we can generally conclude that consequentialist arguments are by far the most prominently featured in discussions of TE. In addition, many papers discuss principles, rights and duties relevant to aspects of TE, both in a positive and in a critical sense. Justice arguments are only sporadically made, some "good life" arguments are used, others less so (such as the explicit articulation of perceived limits, or the technology as a technological fix for a social problem). Missing topics in the discussion, at least from the perspective of NEST-ethics, are second "level" arguments-those referring to techno-moral change connected to tissue engineering. Currently, the discussion about tissue engineering mostly focuses on its so-called "hard impacts"-quantifiable risks and benefits of the technology. Its "soft impacts"-effects that cannot easily be quantified, such as changes to experience, habits and perceptions, should receive more attention.
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Affiliation(s)
- A J M Oerlemans
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Consideration of religious sentiments while selecting a biological product for knee arthroscopy. Knee Surg Sports Traumatol Arthrosc 2013; 21:1577-86. [PMID: 23143388 DOI: 10.1007/s00167-012-2292-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 10/29/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE There is an increasing use of various synthetic and biological products in orthopaedics. The use of a biological product can be a major area of concern for patients of various cultures/religions. The purpose of this work is to study various restrictions in different faiths and their compatibility with available products focused on cartilage repair. METHODS A systematic search in several databases, CINAHL, EMBASE, Global health, PubMed, MEDLINE and the Cochrane collaboration, was performed to find out various religious beliefs of some major religions regarding the use of animal products. Hindu, Muslim, Christian, Jewish and Buddhist faiths were studied to find out whether animal-derived surgical implants are permitted. Major religious scholars were asked about their opinions, and guidelines related to human/religious ethics were evaluated. A market survey was carried out to find out biological contents of various products and their compatibility. RESULTS Jews and Muslims have religious restrictions for porcine products, while Hindus reject bovine products. Vegetarian Hindus reject usage of any animal product. Most Christians do not have any restrictions except those who follow vegetarian dietary regulations. Though there is no prohibition for the use of animal products in Buddhism, a code of non-violence to animals is being followed. However, difference of opinion exists about interpretation of these dietary guidelines for surgical usage amongst various scholars. CONCLUSION Products of biological origin have a definite restriction for various religions, with few exceptions. Surgeons should know the source of the product and should be aware of the basic requirements of the patient's faith. Patient should be informed about the source of the product and alternative if available, and an informed consent may be considered. LEVEL OF EVIDENCE Type of study, Level V.
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Abstract
BACKGROUND Venous leg ulceration is a recurrent, chronic, disabling condition. It affects up to one in 100 people at some time in their lives. Standard treatments are simple dressings and compression bandages or stockings. Sometimes, despite treatment, ulcers remain open for months or years. Sometimes skin grafts are used to stimulate healing. These may be taken, or grown into a dressing, from the patient's own uninjured skin (autografts), or applied as a sheet of bioengineered skin grown from donor cells (allograft). Preserved skin from other animals, such as pigs, has also been used (xenografts). OBJECTIVES To assess the effect of skin grafts for treating venous leg ulcers. SEARCH METHODS For this update we modified the search strategies and conducted searches of The Cochrane Wounds Group Specialised Register (searched 27 July 2012); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 7); Ovid MEDLINE (2008 to July Week 3 2012); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, July 26, 2012); Ovid EMBASE (2008 to 2012 Week 29); and EBSCO CINAHL (2008 to 26 July 2012). We did not apply date or language restrictions. SELECTION CRITERIA Randomised controlled trials (RCTs) of skin grafts in the treatment of venous leg ulcers. DATA COLLECTION AND ANALYSIS Two review authors independently undertook data extraction and assessment of study quality. MAIN RESULTS For this update of the review, we identified one new trial, bringing the total to 17 trials (1034 participants) - all of which were generally at moderate or high risk of bias. In 12 trials participants also received compression bandaging.Eleven trials compared a graft with standard care in which no graft was used. Two of these trials (102 participants) compared a dressing with an autograft; three trials (80 participants) compared frozen allografts with dressings, and two trials (45 participants) compared fresh allografts with dressings. Two trials (345 participants) compared tissue-engineered skin (bilayer artificial skin) with a dressing. In two trials (97 participants) a single-layer dermal replacement was compared with standard care.Six trials compared alternative skin grafting techniques. The first trial (92 participants) compared autografts with frozen allograft, a second (51 participants) compared a pinch graft (autograft) with porcine dermis (xenograft), the third (110 participants) compared growth-arrested human keratinocytes and fibroblasts with placebo, the fourth (10 participants) compared an autograft delivered on porcine pads with an autograft delivered on porcine gelatin microbeads, the fifth trial (92 participants) compared a meshed graft with a cultured keratinocyte autograft, and the sixth trial (50 participants) compared a frozen keratinocyte allograft with a lyophilised (freeze-dried) keratinocyte allografts.Significantly more ulcers healed when treated with bilayer artificial skin than with dressings. There was insufficient evidence from the other trials to determine whether other types of skin grafting increased the healing of venous ulcers. AUTHORS' CONCLUSIONS Bilayer artificial skin, used in conjunction with compression bandaging, increases venous ulcer healing compared with a simple dressing plus compression. Further research is needed to assess whether other forms of skin grafts increase ulcer healing.
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Gaucher S, Duchange N, Jarraya M, Magne J, Rochet JM, Stéphanazzi J, Hervé C, Moutel G. Severe adult burn survivors. What information about skin allografts? Cell Tissue Bank 2012; 14:505-10. [PMID: 23229877 DOI: 10.1007/s10561-012-9350-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Accepted: 01/11/2012] [Indexed: 11/29/2022]
Abstract
During the acute phase of a severe burn, surgery is an emergency. In this situation, human skin allografts constitute an effective temporary skin substitute. However, information about the use of human tissue can not be given to the patients because most of the allografted patients are unconscious due to their injury. This study explored the restitution of information on skin donation to patients who have been skin allografted and who have survived their injury. A qualitative study was conducted due to the limited number of patients in ability to be interviewed according to our medical and psychological criteria. 12 patients who had been treated between 2002 and 2008 were interviewed. Our results show that 10 of them ignored that they had received skin allografts. One of the two patients who knew that they had received allografts knew that skin had been harvested from deceased donor. All patients expressed that there is no information that should not be delivered. They also expressed their relief to have had the opportunity to discuss their case and at being informed during their interview. Their own experience impacted their view in favor of organ and tissue donation.
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Affiliation(s)
- Sonia Gaucher
- Laboratoire d'éthique médicale et médecine légale, Université Paris Descartes, Sorbonne Paris Cité, EA 4569, 45 rue des Saints-Pères, 75006, Paris, France,
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Teh BM, Marano RJ, Shen Y, Friedland PL, Dilley RJ, Atlas MD. Tissue engineering of the tympanic membrane. TISSUE ENGINEERING PART B-REVIEWS 2012; 19:116-32. [PMID: 23031158 DOI: 10.1089/ten.teb.2012.0389] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Tympanic membrane (TM) perforations are common, with current treatments for chronic perforations involving surgery, using various graft materials, from autologous cartilage or fascia through to paper patch. Recent research developments in this field have begun applying the principles of tissue engineering, with appropriate scaffolds, cells, and bioactive molecules (BMs). This has revolutionized the therapeutic approach due to the availability of a wide range of materials with appropriate compatibility and mechanical properties to regenerate the membrane acoustics and may also represent a paradigm shift in the management of TM perforations in an outpatient setting without surgery. However, many factors need to be considered in the fabrication of a bioengineered TM. This review discusses the issues associated with current treatment and examines TM wound healing relevant to the construction of a bioengineered TM. It also describes the tissue-engineering approach to TM regeneration by summarizing currently used scaffolds, BMs, and cells in TM wound healing. Finally, it considers the design of scaffolds, delivery of BMs, and cell engraftment toward potential clinical application.
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Affiliation(s)
- Bing Mei Teh
- Ear Sciences Centre, School of Surgery, The University of Western Australia, Nedlands, Australia.
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Clover AJP, Lane O'Neill B, Kumar AHS. Analysis of attitudes toward the source of progenitor cells in tissue-engineered products for use in burns compared with other disease states. Wound Repair Regen 2012; 20:311-6. [DOI: 10.1111/j.1524-475x.2012.00779.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Arun H. S. Kumar
- Centre for Research in Vascular Biology; University College Cork; Cork; Ireland
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Lin L, Perets A, Har-el YE, Varma D, Li M, Lazarovici P, Woerdeman DL, Lelkes PI. Alimentary ‘green’ proteins as electrospun scaffolds for skin regenerative engineering. J Tissue Eng Regen Med 2012; 7:994-1008. [DOI: 10.1002/term.1493] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 01/20/2012] [Accepted: 01/24/2012] [Indexed: 01/05/2023]
Affiliation(s)
- Leko Lin
- School of Biomedical Engineering, Science and Health Systems; Drexel University; Philadelphia PA USA
| | - Anat Perets
- School of Biomedical Engineering, Science and Health Systems; Drexel University; Philadelphia PA USA
| | - Yah-el Har-el
- School of Biomedical Engineering, Science and Health Systems; Drexel University; Philadelphia PA USA
| | - Devika Varma
- School of Biomedical Engineering, Science and Health Systems; Drexel University; Philadelphia PA USA
| | - Mengyan Li
- School of Biomedical Engineering, Science and Health Systems; Drexel University; Philadelphia PA USA
| | | | | | - Peter I. Lelkes
- School of Biomedical Engineering, Science and Health Systems; Drexel University; Philadelphia PA USA
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Nelson EA. Venous leg ulcers. BMJ CLINICAL EVIDENCE 2011; 2011:1902. [PMID: 22189344 PMCID: PMC3275133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Leg ulcers usually occur secondary to venous reflux or obstruction, but 20% of people with leg ulcers have arterial disease, with or without venous disorders. Between 1.5 and 3.0/1000 people have active leg ulcers. Prevalence increases with age to about 20/1000 in people aged over 80 years. METHODS AND OUTCOMES We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of standard treatments, adjuvant treatments, and organisational interventions for venous leg ulcers? What are the effects of advice about self-help interventions in people receiving usual care for venous leg ulcers? What are the effects of interventions to prevent recurrence of venous leg ulcers? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2011 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS We found 101 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS In this systematic review we present information relating to the effectiveness and safety of the following interventions: compression bandages and stockings, cultured allogenic (single or bilayer) skin replacement, debriding agents, dressings (cellulose, collagen, film, foam, hyaluronic acid-derived, semi-occlusive alginate), hydrocolloid (occlusive) dressings in the presence of compression, intermittent pneumatic compression, intravenous prostaglandin E1, larval therapy, laser treatment (low-level), leg ulcer clinics, multilayer elastic system, multilayer elastomeric (or non-elastomeric) high-compression regimens or bandages, oral treatments (aspirin, flavonoids, pentoxifylline, rutosides, stanozolol, sulodexide, thromboxane alpha(2) antagonists, zinc), peri-ulcer injection of granulocyte-macrophage colony-stimulating factor, self-help (advice to elevate leg, to keep leg active, to modify diet, to stop smoking, to reduce weight), short-stretch bandages, single-layer non-elastic system, skin grafting, superficial vein surgery, systemic mesoglycan, therapeutic ultrasound, and topical treatments (antimicrobial agents, autologous platelet lysate, calcitonin gene-related peptide plus vasoactive intestinal polypeptide, freeze-dried keratinocyte lysate, mesoglycan, negative pressure, recombinant keratinocyte growth factor, platelet-derived growth factor).
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Bailey SM, Hendricks-Muñoz KD, Mally PV. Animal Origins of Surfactant: A Survey of Neonatologists’ Perceptions and Practices Regarding Parent Information Sharing. ACTA ACUST UNITED AC 2011. [DOI: 10.1080/21507716.2011.566597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Jenkins ED, Yip M, Melman L, Frisella MM, Matthews BD. Informed consent: cultural and religious issues associated with the use of allogeneic and xenogeneic mesh products. J Am Coll Surg 2010; 210:402-10. [PMID: 20347731 DOI: 10.1016/j.jamcollsurg.2009.12.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Revised: 12/01/2009] [Accepted: 12/02/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND Our aim was to investigate the views of major religions and cultural groups regarding the use of allogeneic and xenogeneic mesh for soft tissue repair. STUDY DESIGN We contacted representatives from Judaism, Islam, Buddhism, Hinduism, Scientology, and Christianity (Baptists, Methodists, Seventh-Day Adventists, Catholics, Lutherans, Church of Jesus Christ of Latter-Day Saints, Evangelical, and Jehovah's Witnesses). We also contacted American Vegan and People for the Ethical Treatment of Animals (PETA). Standardized questionnaires were distributed to the religious and cultural authorities. Questions solicited views on the consumption of beef and pork products and the acceptability of human-, bovine-, or porcine-derived acellular grafts. RESULTS Dietary restrictions among Jews and Muslims do not translate to tissue implantation restriction. Approximately 50% of Seventh-day Adventists and 40% of Buddhists practice vegetarianism, which may translate into a refusal of the use of xenogeneic tissue. Some Hindus categorically prohibit the use of human tissue and animal products; others allow the donation and receipt of human organs and tissues. PETA is opposed to all uses of animals, but not to human acellular grafts or organ transplantation. Some vegans prefer allogeneic to xenogeneic tissue. Allogeneic and xenogeneic acellular grafts are acceptable among Scientologists, Baptists, Lutherans, Evangelicals, and Catholics. Methodists, Jehovah's Witnesses, and The Church of Jesus Christ of Latter-Day Saints leave the decision up to the individual. CONCLUSIONS Knowledge of religious and cultural preferences regarding biologic mesh assists the surgeon in obtaining a culturally sensitive informed consent for procedures involving acellular allogeneic or xenogeneic grafts.
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Affiliation(s)
- Eric D Jenkins
- Department of Surgery, Washington University School of Medicine, St Louis, MO 63110, USA
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de Vries RBM, Oerlemans A, Trommelmans L, Dierickx K, Gordijn B. Ethical aspects of tissue engineering: a review. TISSUE ENGINEERING PART B-REVIEWS 2009; 14:367-75. [PMID: 18834330 DOI: 10.1089/ten.teb.2008.0199] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Tissue engineering (TE) is a promising new field of medical technology. However, like other new technologies, it is not free of ethical challenges. Identifying these ethical questions at an early stage is not only part of science's responsibility toward society, but also in the interest of the field itself. In this review, we map which ethical issues related to TE have already been documented in the scientific literature. The issues that turn out to dominate the debate are the use of human embryonic stem cells and therapeutic cloning. Nevertheless, a variety of other ethical aspects are mentioned, which relate to different phases in the development of the field. In addition, we discuss a number of ethical issues that have not yet been raised in the literature.
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Affiliation(s)
- Rob B M de Vries
- Section Ethics, Philosophy, and History of Medicine, Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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