1
|
Approach of the Clinicians Practicing in Intensive Care Units to Brain Death Diagnosis and Training Expectations in Turkey: A Web-Based Survey. Transplant Proc 2020; 52:2916-2922. [PMID: 32660750 DOI: 10.1016/j.transproceed.2020.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 04/21/2020] [Accepted: 05/12/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND For health professionals, recognizing and diagnosing brain death is vital for the development of organ transplantation. However, cadaveric organ donation rates remain insufficient, and this problem has become one of the most serious obstacles in the treatment of end-organ failure. OBJECTIVES This study examines the attitude and knowledge level of clinicians who practice in intensive care units (ICUs) concerning the determination of brain death and describes the hindrances in diagnosing brain death. MATERIALS AND METHODS A survey study was designed with 26 questions, including questions regarding the determination of characteristics of respondents' trainings, practicing preferences, and their knowledge and approach toward brain death diagnosis. Clinicians practicing in ICUs in Turkey were invited to the survey. RESULTS A total of 244 surveys were fully completed. Physicians working at the university hospitals or university-affiliated hospitals answered the basic knowledge questions about brain death more accurately (P < .001). Also, physicians employed in university or university-affiliated hospitals feel more capable in diagnosing brain death (P = .002) and are more willing to receive education on the brain death issue (P < .001). CONCLUSION There is a gap separating the practices suggested in guidelines and the daily practice of ICU clinicians working in state hospitals or private institutions. Academic organizations producing and leading the education curricula may assist in informing ICU clinicians who should be trained.
Collapse
|
2
|
Affiliation(s)
- Beatrice E Lechner
- From the Women and Infants Hospital of Rhode Island, Warren Alpert Medical School, Brown University, Providence
| |
Collapse
|
3
|
ARAKI T, YOKOTA H, FUSE A. Brain Death in Pediatric Patients in Japan: Diagnosis and Unresolved Issues. Neurol Med Chir (Tokyo) 2015; 56:1-8. [PMID: 26548741 PMCID: PMC4728143 DOI: 10.2176/nmc.ra.2015-0231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 10/11/2015] [Indexed: 11/26/2022] Open
Abstract
Brain death (BD) is a physiological state defined as complete and irreversible loss of brain function. Organ transplantation from a patient with BD is controversial in Japan because there are two classifications of BD: legal BD in which the organs can be donated and general BD in which the organs cannot be donated. The significance of BD in the terminal phase remains in the realm of scientific debate. As indicated by the increasing number of organ transplants from brain-dead donors, certain clinical diagnosis for determining BD in adults is becoming established. However, regardless of whether or not organ transplantation is involved, there are many unresolved issues regarding BD in children. Here, we will discuss the historical background of BD determination in children, pediatric emergencies and BD, and unresolved issues related to pediatric BD.
Collapse
Affiliation(s)
- Takashi ARAKI
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Tokyo
| | - Hiroyuki YOKOTA
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Tokyo
| | - Akira FUSE
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Tokyo
| |
Collapse
|
4
|
Abstract
OBJECTIVE To evaluate if a family presence educational intervention during brain death evaluation improves understanding of brain death without affecting psychological distress. DESIGN Randomized controlled trial. SETTING Four ICUs at an academic tertiary care center. SUBJECTS Immediate family members of patients suspected to have suffered brain death. INTERVENTIONS Subjects were group randomized to presence or absence at bedside throughout the brain death evaluation with a trained chaperone. All randomized subjects were administered a validated "understanding brain death" survey before and after the intervention. Subjects were assessed for psychological well-being between 30 and 90 days after the intervention. MEASUREMENTS AND MAIN RESULTS Follow-up assessment of psychological well-being was performed using the Impact of Event Scale and General Health Questionnaire. Brain death understanding, Impact of Event Scale, and General Health Questionnaire scores were analyzed using Wilcoxon nonparametric tests. Analyses were adjusted for within family correlation. Fifty-eight family members of 17 patients undergoing brain death evaluation were enrolled: 38 family members were present for 11 brain death evaluations and 20 family members were absent for six brain death evaluations. Baseline understanding scores were similar between groups (median 3.0 [presence group] vs 2.5 [control], p = 0.482). Scores increased by a median of 2 (interquartile range, 1-2) if present versus 0 (interquartile range, 0-0) if absent (p < 0.001). Sixty-six percent of those in the intervention group achieved perfect postintervention "understanding" scores, compared with 20% of subjects who were not present (p = 0.02). Median Impact of Event Scale and General Health Questionnaire scores were similar between groups at follow-up (Impact of Event Scale: present = 20.5, absent = 23.5, p = 0.211; General Health Questionnaire: present = 13.5, absent = 13.0, p = 0.250). CONCLUSIONS Family presence during brain death evaluation improves understanding of brain death with no apparent adverse impact on psychological well-being. Family presence during brain death evaluation is feasible and safe.
Collapse
|
5
|
Marck CH, Weiland TJ, Neate SL, Hickey BB, Jelinek GA. Australian emergency doctors' and nurses' acceptance and knowledge regarding brain death: a national survey. Clin Transplant 2012; 26:E254-60. [DOI: 10.1111/j.1399-0012.2012.01659.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2012] [Indexed: 01/05/2023]
Affiliation(s)
- Claudia H. Marck
- Emergency Practice Innovation Centre (EPIcentre); St Vincent's Hospital; Melbourne; Vic.; Australia
| | | | | | | | | |
Collapse
|
6
|
Tawil I, Gonzales SM, Marinaro J, Timm TC, Kalishman S, Crandall CS. Do medical students understand brain death? A survey study. JOURNAL OF SURGICAL EDUCATION 2012; 69:320-325. [PMID: 22483131 DOI: 10.1016/j.jsurg.2011.11.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 11/17/2011] [Accepted: 11/30/2011] [Indexed: 05/31/2023]
Abstract
BACKGROUND A lack of understanding of brain death has been demonstrated among physicians, and may stem from knowledge deficits at the medical school level. The authors sought to evaluate current understanding of brain death and knowledge gaps among U.S. medical students at a single center. METHODS Using a validated "Understanding Brain Death" survey tool, the authors surveyed the student body at an accredited four year medical school. A score of 5/5 on this scale indicated an expert level of understanding. The investigators identified areas of knowledge gaps, and compared brain death expertise throughout the curriculum progression. RESULTS The overall response rate was 69% (212 of 306 students). Mean scores were 3.1, 3.9, 4.1, and 4.0 (out of 5) among first through fourth year classes respectively. Understanding of brain death differed across the medical school classes (p <0.0001). 33% (N=70) of all students attained scores of 5 indicating an expert level of understanding brain death. By class; 18% of first year students demonstrated expert levels of understanding, compared to 31% of second year students, 48% of third year students, and 39% of fourth year students. CONCLUSIONS The level of understanding of brain death is low among the student body in a four year accredited U.S. medical school. This knowledge gap persists among graduating students as most do not attain an expert understanding of brain death. A more comprehensive brain death curriculum should be implemented in order to adequately equip physicians with this fundamental knowledge.
Collapse
Affiliation(s)
- Isaac Tawil
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico 87131, USA.
| | | | | | | | | | | |
Collapse
|
7
|
Nakagawa TA, Ashwal S, Mathur M, Mysore M. Clinical report—Guidelines for the determination of brain death in infants and children: an update of the 1987 task force recommendations. Pediatrics 2011; 128:e720-40. [PMID: 21873704 DOI: 10.1542/peds.2011-1511] [Citation(s) in RCA: 150] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To review and revise the 1987 pediatric brain death guidelines. METHODS Relevant literature was reviewed. Recommendations were developed using the GRADE system. CONCLUSIONS AND RECOMMENDATIONS (1) Determination of brain death in term newborns, infants and children is a clinical diagnosis based on the absence of neurologic function with a known irreversible cause of coma. Because of insufficient data in the literature, recommendations for preterm infants less than 37 weeks gestational age are not included in this guideline. (2) Hypotension, hypothermia, and metabolic disturbances should be treated and corrected and medications that can interfere with the neurologic examination and apnea testing should be discontinued allowing for adequate clearance before proceeding with these evaluations. (3) Two examinations including apnea testing with each examination separated by an observation period are required. Examinations should be performed by different attending physicians. Apnea testing may be performed by the same physician. An observation period of 24 hours for term newborns (37 weeks gestational age) to 30 days of age, and 12 hours for infants and chi (> 30 days to 18 years) is recommended. The first examination determines the child has met the accepted neurologic examination criteria for brain death. The second examination confirms brain death based on an unchanged and irreversible condition. Assessment of neurologic function following cardiopulmonary resuscitation or other severe acute brain injuries should be deferred for 24 hours or longer if there are concerns or inconsistencies in the examination. (4) Apnea testing to support the diagnosis of brain death must be performed safely and requires documentation of an arterial Paco(2) 20 mm Hg above the baseline and ≥ 60 mm Hg with no respiratory effort during the testing period. If the apnea test cannot be safely completed, an ancillary study should be performed. (5) Ancillary studies (electroencephalogram and radionuclide cerebral blood flow) are not required to establish brain death and are not a substitute for the neurologic examination. Ancillary studies may be us d to assist the clinician in making the diagnosis of brain death (i) when components of the examination or apnea testing cannot be completed safely due to the underlying medical condition of the patient; (ii) if there is uncertainty about the results of the neurologic examination; (iii) if a medication effect may be present; or (iv) to reduce the inter-examination observation period. When ancillary studies are used, a second clinical examination and apnea test should be performed and components that can be completed must remain consistent with brain death. In this instance the observation interval may be shortened and the second neurologic examination and apnea test (or all components that are able to be completed safely) can be performed at any time thereafter. (6) Death is declared when the above criteria are fulfilled.
Collapse
|
8
|
Guidelines for the determination of brain death in infants and children: An update of the 1987 Task Force recommendations*. Crit Care Med 2011; 39:2139-55. [DOI: 10.1097/ccm.0b013e31821f0d4f] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
9
|
Flodén A, Berg M, Forsberg A. ICU nurses' perceptions of responsibilities and organisation in relation to organ donation--a phenomenographic study. Intensive Crit Care Nurs 2011; 27:305-16. [PMID: 21872472 DOI: 10.1016/j.iccn.2011.08.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Revised: 07/16/2011] [Accepted: 08/06/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVES According to the Istanbul declaration, health services should create better routines for identifying potential donors. A previous study involving 702 intensive and critical care (ICU) nurses revealed that only 48% trusted clinical diagnosis of brain death without a confirmatory cerebral angiography. The aim was to study ICU nurses' perceptions of their experiences of professional responsibilities and organisational aspects in relation to organ donation and how they understand and perceive brain death. METHODS A phenomenographic method was chosen. Data collection (interviews) took place in Sweden and included fifteen nurses; one man and fourteen women, from six hospitals serving different geographic areas. RESULTS The findings pertain to three domains: ICU nurses' perceptions of (1) their professional responsibility, (2) the role of the organisation regarding organ donation and (3) death and the diagnosis of brain death. CONCLUSION The ambiguity and various perceptions of brain death diagnosis seem to be a crucial aspect when caring for a brain dead patient. The lack of structured and sufficient organisation also appears to be a limiting factor. Both these aspects are essential for the ICU nurses' opportunities to fulfil their professional responsibility during the organ donation process.
Collapse
Affiliation(s)
- Anne Flodén
- The Unit for Organ and Tissue Donation, Sahlgrenska University Hospital Bla straket 5, SE-413 45 Gothenburg, Sweden.
| | | | | |
Collapse
|
10
|
Stockwell JA, Pham N, Fortenberry JD. Impact of a computerized note template/checklist on documented adherence to institutional criteria for determination of neurologic death in a pediatric intensive care unit. Pediatr Crit Care Med 2011; 12:271-6. [PMID: 21037506 DOI: 10.1097/pcc.0b013e3181fe27da] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Variability exists in the documentation of death by neurologic criteria in children. We hypothesized that the use of a note template/checklist, which included directive (educational) prompts based on institutional neurologic determination of death criteria, improved thoroughness of documentation within our institutional guidelines for the neurologic determination of death. DESIGN Retrospective chart review. SETTING Twenty-one bed pediatric intensive care unit in a freestanding pediatric teaching hospital. PATIENTS Children 0-18 yrs undergoing evaluation for cessation of neurologic function from May 2000 to June 2006. INTERVENTIONS Introduction of a computerized note template/checklist with educational prompts to document cessation of neurologic function. MEASUREMENTS AND MAIN RESULTS Documentation of 15 specific elements derived from our institution's neurologic determination of death guidelines was evaluated. Age, gender, primary diagnosis, observation interval between examinations, the use of appropriate ancillary testing, and apnea test element documentation were also studied. There were 490 deaths in the pediatric intensive care unit, of which 82 (16.7%) had at least one examination for cessation of neurologic function. Neurologic determination of death examination was performed 136 times in 78 patients (mean 1.74 examinations/patient); four charts were missing. Life support was withdrawn before the second examination in 14.1% of patients. Documentation was handwritten for 37.5% of the notes. The mean number of examination elements documented by handwritten note was 11.1 ± 2.2 vs. 14.9 ± 0.7 in the template/checklist group (p < .0001). Use of a template/checklist was associated with neurologic determination of death documentation of 98.6% of essential elements compared with 73.9% of the elements in handwritten notes (p < .0001). Compliance with intervals between examinations conformed to guidelines in 64.0% of cases. Documentation of apnea duration and pco2 increase was significantly greater with the template/checklist (p < .025 and p < .001, respectively). CONCLUSIONS Use of a note template/checklist to guide and document neurologic determination of death improved adherence to institutional criteria for assessment of cessation of neurologic function.
Collapse
Affiliation(s)
- Jana A Stockwell
- Emory University School of Medicine, Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA
| | | | | |
Collapse
|
11
|
Tawil I, Marinaro J, Brown LH. Development and Validation of a Tool for Assessing Understanding of Brain Death. Prog Transplant 2009; 19:272-6. [DOI: 10.1177/152692480901900314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Death by neurological criteria is often misunderstood by laypersons even though they make decisions about withdrawal of care and organ donation. No validated questionnaire for determining laypersons' understanding of brain death exists. Such a tool could be useful in clinical, educational, and research settings. Methods Brain death experts and a focus group of laypersons were used to develop a 5-item questionnaire with face validity. The questionnaire explores 3 concepts: apnea, irreversibility, and differentiation between cardiac death, brain death, and persistent vegetative state. The questionnaire was administered to separate groups of laypersons and experts and was readministered 7 to 10 days later. Test-retest reliability for individual items and overall score was measured by using Spearman rank correlation. Internal consistency of the questionnaire was measured by using Cronbach α. Utility of the questionnaire in discriminating between scores of laypersons and experts was evaluated by using a t test. Results Twelve laypersons and 13 experts participated. The test-retest correlation was significant for all questions (Spearman ρ range, 0.43–0.94) and raw score (Spearman ρ=0.91, P < .001). Internal consistency was fair (Cronbach α = 0.64). The questionnaire enabled discrimination of laypersons from experts, with mean (SD) raw scores of 3.0 (1.1) vs 4.8 (0.6), respectively ( t test, P < .001). Removal of 1 item improved internal consistency (Cronbach α =0.70), but with a corresponding decrease in discriminatory ability. Conclusions This simple 5-item questionnaire for evaluating understanding of brain death has test-retest reliability, internal consistency, and can be used to discriminate between persons who do and do not understand brain death.
Collapse
Affiliation(s)
- Isaac Tawil
- University of New Mexico Health, Sciences Center, Albuquerque
| | | | | |
Collapse
|
12
|
Tawil I, Marinaro J, Brown L. Development and validation of a tool for assessing understanding of brain death. Prog Transplant 2009. [DOI: 10.7182/prtr.19.3.103l2822n4536391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
13
|
Macdonald ME, Liben S, Carnevale FA, Cohen SR. Signs of life and signs of death: brain death and other mixed messages at the end of life. J Child Health Care 2008; 12:92-105. [PMID: 18469294 DOI: 10.1177/1367493508088546] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Brain death is a medical, legal and cultural category constructed to fill an important need created by evolving medical technologies and practices. However, managing life and death via organ transplants and brain death criteria is not without controversy; there remains much confusion and ambivalence in both lay and medical populations regarding both organ donation and the diagnostic category of brain death. By way of a case study of cranial trauma taken from a larger study of bereaved parents, this article discusses how, from a parent's perspective, brain death and organ donation are neither morally nor medically straightforward concepts. The case study presented in this article demonstrates the necessity for more research and clinical training in communication issues regarding brain death and end-of-life care with families in critical care situations.
Collapse
Affiliation(s)
- Mary Ellen Macdonald
- Insituttes of Health Research New Emerging Team: Family Caregiving in Palliative and End-of-life Care, Montreal, Canada.
| | | | | | | |
Collapse
|
14
|
Mathur M, Petersen L, Stadtler M, Rose C, Ejike JC, Petersen F, Tinsley C, Ashwal S. Variability in pediatric brain death determination and documentation in southern California. Pediatrics 2008; 121:988-93. [PMID: 18450904 DOI: 10.1542/peds.2007-1871] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Because the concept of brain death is difficult to define and to apply, we hypothesized that significant variability exists in pediatric brain death determination and documentation. METHODS Children (0-18 years of age) for whom death was determined with neurologic criteria between January 2000 and December 2004, in southern California, were included. Medical charts were reviewed for documented performance of 14 specific elements derived from the 1987 brain death guidelines and confirmatory testing. RESULTS A total of 51.2% of children (142 of 277 children) referred to OneLegacy became organ donors. Care locations varied, including PICUs (68%), adult ICUs (29%), and other (3%). One patient was <7 days, 6 were 7 days to 2 months, 22 were 2 months to 1 year, and 113 were >1 year of age. The number of brain death examinations performed was 0 (4 patients), 2 (122 patients), 3 (14 patients), or 4 (2 patients). Recommended intervals between examinations were followed for 18% of patients >1 year of age and for no younger patients. A mean of only 5.5 of 14 examination elements were completed by neurologists and pediatric intensivists and 5.8 by neurosurgeons. No apnea testing was recorded in 60% of cases, and inadequate PaCO(2) increase occurred in more than one half. Cerebral blood flow determination was performed as a confirmatory test 74% of the time (83 of 112 cases), compared with 26% (29 of 112 cases) for electroencephalography alone. CONCLUSIONS Children suffering brain death are cared for in various locations by a diverse group of specialists. Clinical practice varies greatly from established guidelines, and documentation is incomplete for most patients. Physicians rely on cerebral blood flow measurements more than electroencephalography for confirmatory testing. Codifying clinical and testing criteria into a checklist could lend uniformity and enhance the quality and rigor of this crucial determination.
Collapse
Affiliation(s)
- Mudit Mathur
- Division of Pediatric Critical Care, Children's Hospital, Loma Linda University, Loma Linda, California 92350, USA.
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Cohen J, Ami SB, Ashkenazi T, Singer P. Attitude of health care professionals to brain death: influence on the organ donation process. Clin Transplant 2007; 22:211-5. [DOI: 10.1111/j.1399-0012.2007.00776.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
16
|
Fernández González N, Fernández Fernández M, Rey Galán C, Concha Torre A, Medina Villanueva A, Menéndez Cuervo S. Muerte encefálica y donación en población infantil. An Pediatr (Barc) 2004; 60:450-3. [PMID: 15105000 DOI: 10.1016/s1695-4033(04)78304-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Brain death is the irreversible cessation of intracranial neurologic function and is considered as the person's death. The objective of this study was to describe the characteristics of pediatric donors in the Hospital Central de Asturias from October 1995 to October 2002. METHODS We performed a retrospective and descriptive study of the dead children who were potential donors in the pediatric intensive care unit (PICU). RESULTS Of 43 dead children, 15 (34.9 %) were diagnosed with brain death. In four patients (family refusal in one, sepsis in two and brain tumor in one) there was no donation. In all patients, the diagnosis of brain death was based on clinical examination and electroencephalogram. Doppler ultrasonography and technetium-99m hexamethylpropyleneamineoxamine (Tc-99-HMPAO) scanning was also performed in three and nine patients respectively. The mean age of the donors was 8.1 years (range: 13 months-15 years). The male/female ratio was 3/1. The cause of death was multiple trauma in six children, brain hemorrhage in three, cardiac arrhythmias in three, lightning strike in one, diabetic ketoacidosis in one, septic shock in one and hypovolemic shock in one. The median interval between admission and brain death was 1.4 days (range: 3 hours-12 days). The time of organ support between brain death and donation was 8.4 hours (range: 6-13 hours). The most frequent complications after brain death were central diabetes insipidus in 90.9 % of the patients, hyperglycemia in 54.5 % and hypokalemia in 45.4 %. During support 72.7 % of the patients required inotropic aid. CONCLUSIONS In our PICU more than one-third of the dead children suffered brain death, and most became donors. The most frequent cause of brain death was multiple trauma. Coordination with the transplant team and the training of medical staff are important to achieve a high percentage of donations.
Collapse
Affiliation(s)
- N Fernández González
- Unidad de Cuidados Intensivos Pediátricos, Departamento de Pediatría, Hospital Universitario Central de Asturias, Celestino Villamil s/n, 30006 Oviedo, Spain
| | | | | | | | | | | |
Collapse
|
17
|
Woodrum DE, McCormick TR. Misguided good intentions. J Perinatol 2002; 22:72-4. [PMID: 11840246 DOI: 10.1038/sj.jp.7210659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A 3-day-old infant unexpectedly developed cardiopulmonary arrest at home. A resuscitation process was initiated and the infant was transported to a nearby community hospital where a highly respected senior pediatrician assumed responsibility for the prolonged resuscitation. Following cessation of aggressive support measures, the infant resumed gasping/respiratory efforts. The pediatrician admitted to occluding the infant's nose and mouth just before death. Several of the important medical issues and ethical distinctions are discussed.
Collapse
Affiliation(s)
- David E Woodrum
- Department of Pediatrics, University of Washington, Seattle, WA 98195-6320, USA
| | | |
Collapse
|
18
|
Abstract
Although all of this information may create the impression that caring for a potential organ donor is an exceedingly complex task, in the authors' experience, this often is not true, and much energy can--and should--be devoted to the care of the bereaved family. Of crucial importance are the early recognition of brain death and the consequent radical switch of the treatment goal from preservation of the patient's brain and life to preservation of organs for the lives of others. Care for the donor is the natural extension of care for a critically ill or injured patient. During the foregoing discussion, the authors had to stress the absence of sound evidence on many points. Because many reports originate from transplant centers dedicated to a specific organ, gaining a comprehensive view on management options in the ICU further is hampered. Thus, this situation leaves another field in which investigations originating from pediatric intensivists could provide evidence urgently needed to make optimal choices. The next decade should see the thyroid hormone controversy solved by at least one controlled prospective study and the differential applicability of inotropic, vasoactive, or fluid-centered strategies. It seems self-evident that only graft survival and related parameters can form adequate endpoints for future studies.
Collapse
Affiliation(s)
- N Lutz-Dettinger
- Division of Pediatric Intensive Care, Ghent University Hospital, Ghent, Belgium.
| | | | | |
Collapse
|
19
|
Feldman J, Slavin S. Planning for the Evaluation of a Pediatric End-of-Life Curriculum. J Palliat Med 2000; 3:487-92. [PMID: 15859704 DOI: 10.1089/jpm.2000.3.4.487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Decision making at the end of life can be complex and emotionally challenging for healthcare providers, particularly in pediatrics. Unfortunately, few undergraduate and graduate medical education curricula adequately address these issues. In this article, we describe the plan and progress to date of the design, implementation, and evaluation of an end-of- life curriculum for pediatric residents. NEEDS ASSESSMENT Prior to the development of a formal end-of-life curriculum, a survey was given to a single cohort of residents four times over the course of their training to assess their attitudes toward end-of-life issues and their experience with the informal curriculum in residency. Entering pediatric residents felt relatively uncomfortable dealing with death and dying, but by the end of training, residents felt more comfortable dealing with these issues. Residents were relatively ambivalent about the degree to which their education helped them to deal with end-of-life issues. CURRICULUM DEVELOPMENT AND EVALUATION PLAN A number of curricular interventions were developed including a noon conference series, grand rounds presentations, a 3-hour seminar on giving bad news, and written information for the housestaff manual. The curriculum was implemented in the fall of 1999. The impact of the curriculum will be assessed using a single interventional group with historical control study design. The evaluation instruments will include the previously used survey and an objective written examination. The 3-hour seminar will be assessed with a pre-test post-test crossover design using standardized patients. DISCUSSION This rigorous, feasible, and cost-effective approach to curriculum development is intended to serve as a model for end-of-life education in pediatric residencies.
Collapse
Affiliation(s)
- J Feldman
- Department of Pediatrics, UCLA School of Medicine, Los Angeles, California 90095, USA
| | | |
Collapse
|
20
|
Affiliation(s)
- W D Doty
- Sacred Heart Regional Heart Institute, Pensacola, Florida, USA
| | | |
Collapse
|