1
|
Das MK, Arora NK, Debata P, Chellani H, Rasaily R, Gaikwad H, Meena KR, Kaur G, Malik P, Joshi S, Kumari M. Why parents agree or disagree for minimally invasive tissue sampling (MITS) to identify causes of death in under-five children and stillbirth in North India: a qualitative study. BMC Pediatr 2021; 21:513. [PMID: 34784903 PMCID: PMC8597286 DOI: 10.1186/s12887-021-02993-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 11/04/2021] [Indexed: 12/01/2022] Open
Abstract
Background Information on exact causes of death and stillbirth are limited in low and middle income countries. Minimally invasive tissue sampling (MITS) is increasingly practiced in place of autopsy across several settings. A formative research documented the experiences of counselling and consenting for MITS in north India. Methods This exploratory qualitative study was conducted at a tertiary care hospital in Delhi. During the early implementation of MITS, observations of the counselling and consenting process (n = 13) for under-five child death and stillbirths were conducted. In-depth interviews with MITS team members (n = 3) were also conducted. Observation and interview data were transcribed and inductively analysed using thematic content analysis to identify emerging themes and codes. Results The MITS team participated in daily ward rounds for familiarisation with parents/families. Following death declaration the counselling was done in counselling corner of the ward or adjacent corridor. Mostly the counselling was targeted at the father and family members present, using verbal explanation and the consent document in local language. The key concerns raised by parents/family were possible disfigurement, time needed and possible benefits. Most of the parents consulted family members before consent. Among those who consented, desire for next pregnancy, previous pregnancy or neonatal loss and participation of treating senior doctor were the key factors. The negative experience of hospital care, poor comprehension and distance from residence were the factors for consent refusal. Lesser number of parents of deceased children consented for MITS compared to the neonates and stillbirths. Conclusions The initial experiences of obtaining consent for MITS were encouraging. Consent for MITS may be improved with active involvement of the treating doctors and nurses, better bereavement support, private counselling area along with improvement in quality of care and communication during hospitalisation. Special efforts and refinement in counselling are needed to improve consent for MITS in older children. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02993-6. Information about exact cause of death and stillbirth are essential for appropriate care of children and pregnant women. Autopsy assists in establishing exact cause of death, but not preferred by the parents/families. Minimally invasive tissue sampling (MITS) is a suitable alternate to autopsy for establishing causes of death and stillbirth. A pilot project on MITS was initiated at a tertiary care hospital in north India (New Delhi). An exploratory formative research was conducted to document the experiences of counselling and consenting for MITS. Under this study, observation of the counselling and consenting process for conduct of MITS in under-five children (including neonates) and stillbirths were done. Additionally, in-depth interviews with MITS team members were also conducted. Counselling for MITS was done in one corner of the ward or adjacent corridor and mostly targeted at the father and family members present. Counselling was primarily verbal explanation in local language. The key concerns from parents/family were disfigurement, time needed and possible benefits. Most of the parents consulted family members before decision. Benefit during next pregnancy, past previous pregnancy or neonatal loss and senior treating doctor’s involvement were key factors for consent. Poor quality of care and comprehension were the reasons for refusal.
Collapse
Affiliation(s)
| | | | - Pradeep Debata
- Department of Pediatrics, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, 110029, India
| | - Harish Chellani
- Department of Pediatrics, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, 110029, India
| | - Reeta Rasaily
- Division of Division of Reproductive Biology Maternal and Child Health, Indian Council of Medical Research, New Delhi, 110029, India
| | - Harsha Gaikwad
- Department of Obstetrics and Gynaecology, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, 110029, India
| | - K R Meena
- Department of Pediatrics, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, 110029, India
| | - Gurkirat Kaur
- The INCLEN Trust International, New Delhi, 110020, India
| | | | - Shipra Joshi
- The INCLEN Trust International, New Delhi, 110020, India
| | - Mahisha Kumari
- The INCLEN Trust International, New Delhi, 110020, India
| |
Collapse
|
2
|
Das MK, Arora NK, Kaur G, Malik P, Kumari M, Joshi S, Rasaily R, Chellani H, Gaikwad H, Debata P, Meena KR. Perceptions of family, community and religious leaders and acceptability for minimal invasive tissue sampling to identify the cause of death in under-five deaths and stillbirths in North India: a qualitative study. Reprod Health 2021; 18:168. [PMID: 34348749 PMCID: PMC8336381 DOI: 10.1186/s12978-021-01218-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/28/2021] [Indexed: 11/08/2022] Open
Abstract
Background Minimal invasive tissue sampling (MITS) has emerged as a suitable alternative to complete diagnostic autopsy (CDA) for determination of the cause of death (CoD), due to feasibility and acceptability issues. A formative research was conducted to document the perceptions of parents, community and religious leaders on acceptability of MITS. Methods This qualitative study was conducted at and around the Safdarjung Hospital, Delhi, India. Participants for in-depth interview included the parents who had either child or neonatal death or stillbirth and the key community and religious representatives. The focus group discussions (FGDs) involved community members. Process of obtaining consent for MITS was observed. Data were analyzed inductively manually for emerging themes and codes. Results A total of 104 interviews (parents of deceased children, neonates or stillbirths, n = 93; community members, n = 8 and religious leaders, n = 7), 8 FGDs (n = 72) were conducted and process of obtaining consent for MITS (n = 27) was observed. The participants were positive and expressed willingness to accept MITS. The key determinants for acceptance of MITS were: (1) understanding and willingness to know the cause of death or stillbirth, (2) experience of the healthcare received and trust, (3) the religious and sociocultural norms. Parents and community favored for MITS over CDA when needed, especially where in cases with past stillbirths and child deaths. The experience of treatment, attitude and communication from healthcare providers emerged as important for consent. The decision making process was collective involving the elders and family. No religious leader was against the procedure, as both, the respect for the deceased and need for medical care were satisfied. Conclusions Largely, MITS appeared to be acceptable for identifying the causes of child deaths and stillbirths, if the parents and family are counseled appropriately considering the sociocultural and religious aspects. They perceived the quality of care, attitude and communication by the healthcare providers as critical factors for acceptance of MITS. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-021-01218-4. India tops the chart of childhood deaths and stillbirths globally. The causes of many childhood deaths and stillbirths remain unknown or ill-defined in India. For planning the health policies, program and clinical practices, the cause of death (CoD) and stillbirth are primarily determined by verbal autopsy (VA) method, which has several inherent limitations. The acceptance and implementation of complete diagnostic autopsy (CDA) or full autopsy for CoD determination is limited. Minimally invasive tissue sampling (MITS) is a suitable alternative to full autopsy for CoD determination. MITS has been found to be acceptable and being implemented in some low and middle income countries. Considering the multi-religion and sociocultural contexts of India, an understanding about the perceptions, practices, acceptance and barriers among the parents, community members and religious leaders regarding MITS was necessary for designing appropriate communication strategies and materials for consent. A qualitative study was undertaken in New Delhi, India using in-depth interviews with the parents of deceased children and stillbirths, community leaders, community health workers and religious leaders and focus group discussions with the community members and observation of obtaining consent for MITS. The parents and community members were positive about MITS and expressed willingness to accept it over full autopsy to know the CoD and stillbirths. The factors like past stillbirths and child deaths, experience of the healthcare received and trust, the religious and sociocultural norms emerged as important determinants for acceptance of MITS. The religious leaders were also positive about MITS if needed for treatment and benefit of the family.
Collapse
Affiliation(s)
| | | | - Gurkirat Kaur
- The INCLEN Trust International, New Delhi, 110020, India
| | | | - Mahisha Kumari
- The INCLEN Trust International, New Delhi, 110020, India
| | - Shipra Joshi
- The INCLEN Trust International, New Delhi, 110020, India
| | - Reeta Rasaily
- Division of Reproductive Biology Maternal and Child Health, Indian Council of Medical Research, New Delhi, 110029, India
| | - Harish Chellani
- Department of Pediatrics, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, 110029, India
| | - Harsha Gaikwad
- Department of Obstetrics and Gynaecology, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, 110029, India
| | - Pradeep Debata
- Department of Pediatrics, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, 110029, India
| | - K R Meena
- Department of Pediatrics, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, 110029, India
| |
Collapse
|
3
|
Das MK, Arora NK, Chellani HK, Debata PK, Meena KR, Rasaily R, Kaur G, Malik P, Joshi S, Kumari M. Perceptions of the parents of deceased children and of healthcare providers about end-of-life communication and breaking bad news at a tertiary care public hospital in India: A qualitative exploratory study. PLoS One 2021; 16:e0248661. [PMID: 33735296 PMCID: PMC7971872 DOI: 10.1371/journal.pone.0248661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 03/03/2021] [Indexed: 11/19/2022] Open
Abstract
Background Parents of dying children face unique challenge and expect compassionate support from health care providers (HCPs). This study explored the experiences of the parents and HCPs about the end-of-life care and breaking bad news and related positive and negative factors in Indian context. Methods This qualitative exploratory study was conducted at paediatrics department of a tertiary care hospital in Delhi. In-depth interviews with the parents (n = 49) and family members (n = 21) of the children died at the hospital and HCPs (6 doctors, 6 nurses and 4 support staffs) were conducted. Also events and communication around death of eight children were observed. Data were inductively analysed using thematic content analysis method to identify emerging themes and codes. Results Doctors were the lead communicators. Majority of parents perceived the attitude, communication and language used as by resident doctors as brief, insensitive and sometimes inappropriate or negative. They perceived that the attitude and communication by senior doctor’s as empathetic, positive and complete. Parents recalled the death declaration by resident doctors as non-empathetic, blunt and cold. Most parents received no emotional support from HCPs during and after death of their child. All doctors expressed that death of their patients affected them and their emotions, which they coped through different activities. The overcrowded wards, high workload, infrastructural limitation and no formal communication training added to the emotional stress of the HCPs. Conclusions Majority of the communication by the HCPs during the hospitalisation and end-of-life period were perceived as suboptimal by the parents. The HCPs were emotionally affected and faced end-of-life communication challenges. The study highlights the communication by HCPs and support for parents during the end-of-life communication and breaking bad news. It suggests adoption of context specific communication protocol and materials and training of HCPs in communication to improve the quality of care. The parents of terminally ill and dying children face unimaginably psychological stress and have strong need for compassionate professional support. To improve the parents and family experience, there is need for obtaining feedback and documenting the experiences of parents, family and healthcare providers with reference to the local contexts. There is limited information on parents experience on end-of-life communication related to their child death from Indian context. An exploratory qualitative study was conducted at a tertiary care hospital in India involved in-depth interviews with parents and family of deceased children and healthcare providers (HCPs: doctors, nurses and support staffs) involved in treating children. Parents remembered the communication by junior doctors as brief, inappropriate and insensitive, while the senior doctor’s communication was positive and complete. The death declaration by resident doctors was remembered as non-empathetic, blunt and cold. No emotional support was received by them around and after child’s death. The doctors were affected emotionally with death of the patients, but were constrained with high workload, infrastructural limitations and lack of training in communication. Preparation of context specific, sociocultural appropriate module and communication training for HCPs can improve their competence for providing end-of-life care, breaking bad news and also parents experience.
Collapse
Affiliation(s)
| | | | - Harish Kumar Chellani
- Department of Pediatrics, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, India
| | - Pradeep Kumar Debata
- Department of Pediatrics, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, India
| | - K R Meena
- Department of Pediatrics, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, India
| | - Reeta Rasaily
- Division of Reproductive Biology Maternal and Child Health, Indian Council of Medical Research, New Delhi, India
| | | | | | - Shipra Joshi
- The INCLEN Trust International, New Delhi, India
| | | |
Collapse
|
4
|
Das MK, Arora NK, Rasaily R, Kaur G, Malik P, Kumari M, Joshi S, Chellani H, Gaekwad H, Debata P, Meena KR. Perceptions of the healthcare providers regarding acceptability and conduct of minimal invasive tissue sampling (MITS) to identify the cause of death in under-five deaths and stillbirths in North India: a qualitative study. BMC Health Serv Res 2020; 20:833. [PMID: 32887603 PMCID: PMC7472696 DOI: 10.1186/s12913-020-05693-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 08/31/2020] [Indexed: 11/12/2022] Open
Abstract
Background India contributes the highest share of under-five and neonatal deaths and stillbirths globally. Diagnostic autopsy, although useful for cause of death identification, have limited acceptance. Minimally invasive tissue sampling (MITS) is an alternative to autopsy for identification of the cause of death (CoD). A formative research linked to pilot MITS implementation was conducted to document the perceptions and attitudes of the healthcare professionals and the barriers for implementation. Methods This exploratory qualitative study conducted at a tertiary care hospital in New Delhi, India included the hospital staffs. In-depth interviews were conducted with the doctors, nurses and support staffs from pediatrics, neonatology, obstetrics and forensic medicine departments. Inductive data analysis was done to identify the emerging themes and codes. Results A total of 26 interviews (doctors, n = 10; nurses, n = 9 and support staffs, n = 7) were conducted. Almost all professional and support staffs were positive about the MITS and its advantage for CoD identification including co-existing and underlying illnesses. Some opined conduct of MITS for the cases without clear diagnosis. All participants perceived that MITS would be acceptable for parents due to the non-disfigurement and preferred by those who had unexplained child deaths or stillbirths in past. The key factors for MITS acceptance were appropriate communication, trust building, involvement of senior doctors, and engagement of the counselor prior to deaths and training of the personnel. For implementation and sustenance of MITS, involvement of the institute authority and government stakeholders would be essential. Conclusions MITS was acceptable for the doctors, nurses and support staffs and critical for better identification of the causes of death and stillbirths. The key facilitating factors and challenges for implementing MITS at the hospital in Indian context were identified. It emphasized on appropriate skill building, counseling, system organization and buy-in from institution and health authorities for sustenance of MITS.
Collapse
Affiliation(s)
| | | | - Reeta Rasaily
- Division of Reproductive Biology Maternal and Child Health, Indian Council of Medical Research, New Delhi, 110029, India
| | - Gurkirat Kaur
- The INCLEN Trust International, New Delhi, 110020, India
| | | | - Mahisha Kumari
- The INCLEN Trust International, New Delhi, 110020, India
| | - Shipra Joshi
- The INCLEN Trust International, New Delhi, 110020, India
| | - Harish Chellani
- Department of Pediatrics, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, 110029, India
| | - Harsha Gaekwad
- Department of Obstetrics and Gynaecology, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, 110029, India
| | - Pradeep Debata
- Department of Pediatrics, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, 110029, India
| | - K R Meena
- Department of Pediatrics, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, 110029, India
| |
Collapse
|
5
|
Kraboth Z, Galik B, Tompa M, Kajtar B, Urban P, Gyenesei A, Miseta A, Kalman B. DNA CpG methylation in sequential glioblastoma specimens. J Cancer Res Clin Oncol 2020; 146:2885-2896. [PMID: 32779022 PMCID: PMC7519911 DOI: 10.1007/s00432-020-03349-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/04/2020] [Indexed: 01/21/2023]
Abstract
PURPOSE Glioblastoma is the most aggressive form of brain tumors. A better understanding of the molecular mechanisms leading to its evolution is essential for the development of treatments more effective than the available modalities. Here, we aim to identify molecular drivers of glioblastoma development and recurrence by analyzing DNA CpG methylation patterns in sequential samples. METHODS DNA was isolated from 22 pairs of primary and recurrent formalin-fixed, paraffin-embedded glioblastoma specimens, and subjected to reduced representation bisulfite sequencing. Bioinformatic analyses were conducted to identify differentially methylated sites and pathways, and biostatistics was used to test correlations among clinical and pathological parameters. RESULTS Differentially methylated pathways likely involved in primary tumor development included those of neuronal differentiation, myelination, metabolic processes, synapse organization and endothelial cell proliferation, while pathways differentially active during glioblastoma recurrence involved those associated with cell processes and differentiation, immune response, Wnt regulation and catecholamine secretion and transport. CONCLUSION DNA CpG methylation analyses in sequential clinical specimens revealed hypomethylation in certain pathways such as neuronal tissue development and angiogenesis likely involved in early tumor development and growth, while suggested altered regulation in catecholamine secretion and transport, Wnt expression and immune response contributing to glioblastoma recurrence. These pathways merit further investigations and may represent novel therapeutic targets.
Collapse
Affiliation(s)
- Zoltan Kraboth
- Institute of Laboratory Medicine, School of Medicine, University of Pecs, Pecs, Hungary
- Szentagothai Research Center, University of Pecs, 20. Ifjusag street, Pecs, 7624, Hungary
| | - Bence Galik
- Szentagothai Research Center, University of Pecs, 20. Ifjusag street, Pecs, 7624, Hungary
- Department of Clinical Molecular Biology, Medical University of Bialystok, Białystok, Poland
| | - Marton Tompa
- Institute of Laboratory Medicine, School of Medicine, University of Pecs, Pecs, Hungary
- Szentagothai Research Center, University of Pecs, 20. Ifjusag street, Pecs, 7624, Hungary
| | - Bela Kajtar
- Institute of Pathology, School of Medicine, University of Pecs, Pecs, Hungary
| | - Peter Urban
- Szentagothai Research Center, University of Pecs, 20. Ifjusag street, Pecs, 7624, Hungary
| | - Attila Gyenesei
- Szentagothai Research Center, University of Pecs, 20. Ifjusag street, Pecs, 7624, Hungary
- Department of Clinical Molecular Biology, Medical University of Bialystok, Białystok, Poland
| | - Attila Miseta
- Institute of Laboratory Medicine, School of Medicine, University of Pecs, Pecs, Hungary
| | - Bernadette Kalman
- Institute of Laboratory Medicine, School of Medicine, University of Pecs, Pecs, Hungary.
- Szentagothai Research Center, University of Pecs, 20. Ifjusag street, Pecs, 7624, Hungary.
| |
Collapse
|
6
|
Cameron S, Gillio-Meina C, Ranger A, Choong K, Fraser DD. Collection and Analyses of Cerebrospinal Fluid for Pediatric Translational Research. Pediatr Neurol 2019; 98:3-17. [PMID: 31280949 DOI: 10.1016/j.pediatrneurol.2019.05.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/23/2019] [Accepted: 05/27/2019] [Indexed: 12/18/2022]
Abstract
Cerebrospinal fluid sample collection and analysis is imperative to better elucidate central nervous system injury and disease in children. Sample collection methods are varied and carry with them certain ethical and biologic considerations, complications, and contraindications. Establishing best practices for sample collection, processing, storage, and transport will ensure optimal sample quality. Cerebrospinal fluid samples can be affected by a number of factors including subject age, sampling method, sampling location, volume extracted, fraction, blood contamination, storage methods, and freeze-thaw cycles. Indicators of sample quality can be assessed by matrix-associated laser desorption/ionization time-of-flight mass spectrometry and include cystatin C fragments, oxidized proteins, prostaglandin D synthase, and evidence of blood contamination. Precise documentation of sample collection processes and the establishment of meticulous handling procedures are essential for the creation of clinically relevant biospecimen repositories. In this review we discuss the ethical considerations and best practices for cerebrospinal fluid collection, as well as the influence of preanalytical factors on cerebrospinal fluid analyses. Cerebrospinal fluid biomarkers in highly researched pediatric diseases or disorders are discussed.
Collapse
Affiliation(s)
| | | | - Adrianna Ranger
- Pediatrics, Western University, London, Ontario, Canada; Clinical Neurological Sciences, Western University, London, Ontario, Canada
| | - Karen Choong
- Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Douglas D Fraser
- Pediatrics, Western University, London, Ontario, Canada; Children's Health Research Institute, London, Ontario, Canada; Clinical Neurological Sciences, Western University, London, Ontario, Canada; Physiology and Pharmacology, Western University, London, Ontario, Canada; Translational Research Centre, London, Ontario, Canada.
| |
Collapse
|
7
|
Annaratone L, Marchiò C, Sapino A. Tissues under-vacuum to overcome suboptimal preservation. N Biotechnol 2019; 52:104-109. [PMID: 31150841 DOI: 10.1016/j.nbt.2019.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/23/2019] [Accepted: 05/26/2019] [Indexed: 12/11/2022]
Abstract
The accuracy of histopathological diagnosis is strictly reliant on adequate tissue preservation, which is completely dependent on pre-analytical variables. Among these variables, the time interval between the end of surgical excision to the onset of fixation (the cold ischemia time) may adversely affect preservation of tissue morphology, influencing the interpretation and reproducibility of diagnosis. During this time interval, the activation of enzymes may produce autolysis and degradation of antigens and nucleic acids, thus potentially affecting immunocytochemical and molecular results. Several studies have described under-vacuum at 4 °C storage of fresh surgical specimens as a safe and reliable method to control cold ischemia and preserve fresh tissues, as well as to standardize fixation times and implement tissue-banking. This review article gives a systematic overview of the advantages and drawbacks of the use of under-vacuum tissue preservation and cooling in surgical pathology, highlighting the impact this procedure may have on diagnostic and experimental pathology. It also documents our experience acquired within daily practice and national and international projects.
Collapse
Affiliation(s)
- Laura Annaratone
- Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy.
| | - Caterina Marchiò
- Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy; Candiolo Cancer Institute, FPO-IRCCS, Str. Provinciale 142 km 3.95, 10060, Candiolo (Turin), Italy.
| | - Anna Sapino
- Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy; Candiolo Cancer Institute, FPO-IRCCS, Str. Provinciale 142 km 3.95, 10060, Candiolo (Turin), Italy.
| |
Collapse
|
8
|
Das MK, Arora NK, Rasaily R, Chellani H, Gaikwad H, Banke K. Exploring family, community and healthcare provider perceptions and acceptability for minimal invasive tissue sampling to identify the cause of death in under-five deaths and stillbirths in North India: a qualitative study protocol. Reprod Health 2019; 16:3. [PMID: 30626421 PMCID: PMC6327493 DOI: 10.1186/s12978-019-0665-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 01/02/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Around 5.4 million under-five deaths occur globally annually. Over 2.5 million neonatal deaths and an equivalent stillbirths also occur annually worldwide. India is largest contributor to these under-five deaths and stillbirths. To meet the National Health Policy goals aligned with sustainable development targets, adoption of specific strategy and interventions based on exact causes of death and stillbirths are essential. The current cause of death (CoD) labelling process is verbal autopsy based and subject to related limitations. In view of rare diagnostic autopsies, the minimally invasive tissue sampling (MITS) has emerged as a suitable alternate with comparable efficiency to determine CoD. But there is no experience on perception and acceptance for MITS in north Indian context. This formative research is exploring the perceptions and view of families, communities and healthcare providers regarding MITS to determine the acceptability and feasibility. METHODS The cross-sectional study adopts exploratory qualitative research design. The study will be conducted in New Delhi linked to deaths and stillbirths occurring at a tertiary care hospital. The data from multiple stakeholders will be collected through 53-60 key-informant in-depth interviews (IDIs), 8 focus group discussions (FGDs) and 8-10 death or stillbirth event observations. The IDIs will be done with the parents, family members, community representatives, religious priests, burial site representatives and different health care providers. The FGDs will be conducted with the fathers, mothers, and elderly family members in the community. The data collection will focus on death, post-death rituals, religious practices, willingness to know CoD, acceptability of MITS and decision making dynamics. Data will be analysed following free listing, open coding, selective coding and theme identification. Subsequently 8-10 parents will be approached for consent to conduct MITS using the communication package to be developed using the findings. DISCUSSION The study will provide in-depth understanding of the cultural, social, religious practices related to child death and stillbirth and factors that potentially determine acceptance of MITS. The findings will guide development of communication and counselling package and strategies for obtaining consent for MITS. The pilot experience on obtaining consent for MITS will inform suitable refinement and future practice.
Collapse
Affiliation(s)
- Manoja Kumar Das
- The INCLEN Trust International, F1/5, Okhla Industrial Area, Phase 1, New Delhi, 110020, India.
| | - Narendra Kumar Arora
- The INCLEN Trust International, F1/5, Okhla Industrial Area, Phase 1, New Delhi, 110020, India
| | - Reeta Rasaily
- Division of Reproductive Biology and Maternal Health, Child Health, Indian Council of Medical Research, Ansari Nagar, New Delhi, 110029, India
| | - Harish Chellani
- Department of Pediatrics, Safdarjung Hospital & Vardhman Mahavir Medical College, New Delhi, 110029, India
| | - Harsha Gaikwad
- Department of Obstetrics and Gynaecology, Safdarjung Hospital & Vardhman Mahavir Medical College, New Delhi, 110029, India
| | - Kathryn Banke
- Global Health, Bill and Melinda Gates Foundation, Seattle, WA, 98109, USA
| |
Collapse
|
9
|
Sharpe ME. T-cell Immunotherapies and the Role of Nonclinical Assessment: The Balance between Efficacy and Pathology. Toxicol Pathol 2018; 46:131-146. [PMID: 29471776 PMCID: PMC5843031 DOI: 10.1177/0192623317752101] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Gene-engineered T-cell therapies have the potential to revolutionize the treatment of cancer. These therapies have shown exceptional clinical efficacy specifically in the field of B-cell malignancies and the first products (Kymriah™ and Yescarta™) have recently been approved in the United States for specific indications. The power of these treatments is also linked with a distinct set of toxicities both predicted and unpredicted, including off-tumor activity, cytokine release syndromes, and neurotoxicity, occasionally with fatal consequences. As these therapies begin to reach more patients, it is critical to develop the nonclinical tools to adequately determine the mechanisms driving these toxicities, to assess the safety risks of candidate products, and to develop strategies for safety management.
Collapse
Affiliation(s)
- Michaela E. Sharpe
- Cell and Gene Therapy Catapult, Guy’s Hospital, Great Maze Pond, London, United Kingdom
| |
Collapse
|
10
|
Filler G, Taheri S, McIntyre C, Smith C, Subramanian L, Fusch G, Fusch C. Chronic kidney disease stage affects small, dense low-density lipoprotein but not glycated low-density lipoprotein in younger chronic kidney disease patients: a cross-sectional study. Clin Kidney J 2017; 11:383-388. [PMID: 29992019 PMCID: PMC6007510 DOI: 10.1093/ckj/sfx115] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 08/17/2017] [Indexed: 01/26/2023] Open
Abstract
Background Small, dense low-density lipoprotein (sd-LDL) and glycated LDL (g-LDL) have been associated with cardiovascular disease (CVD) in chronic kidney disease (CKD) in patients >60 years of age. Since young adult and paediatric patients have shorter exposure to Framingham-type risk factors, our study aims to determine whether younger CKD patients exhibit the same sd-LDL and g-LDL pattern. Methods After ethics board approval, this cross-sectional study was conducted at two universities with 44 patients (mean ± standard deviation age 12.6 ± 4.9, range 2-24 years) with CKD stage of 1-5. Laboratory parameters studied were Cystatin C (CysC), CysC estimated glomerular filtration rate (eGFR) (calculated from the Filler formula), sd-LDL, g-LDL and albumin. Lipid samples were measured for sd-LDL and g-LDL using ELISA. Non-linear correlation analysis was performed to determine the relationship between g-LDL, sd-LDL and eGFR. Clinical Trials Registration is at clinicaltrials.gov, NCT02126293, https://clinicaltrials.gov/ct2/show/NCT02126293. Results Triglycerides, but not total cholesterol and calculated LDL, were associated with CKD stages (ANOVA P = 0.0091). As in adults, sd-LDL was significantly associated with CKD stages (ANOVA P = 0.0133), CysC eGFR (r = -0.6495, P < 0.00001), and body mass index (r = -0.3895, P = 0.0189), but not with age. By contrast, there was no significant correlation between g-LDL and CKD stages or CysC eGFR (P = 0.9678). Conclusions Our study demonstrates that only triglycerides and sd-LDL were associated with CKD stages in this young cohort without confounding Framingham-type CVD risk factors. While larger studies are needed, this study suggests that lowering sd-LDL levels may be a potential target to ameliorate the long-term CVD risks in paediatric CKD patients.
Collapse
Affiliation(s)
- Guido Filler
- Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Department of Medicine, Division of Nephrology, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Department of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Children's Health Research Institute, London, ON, Canada
| | - Sepideh Taheri
- Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Christopher McIntyre
- Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Department of Medicine, Division of Nephrology, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Connor Smith
- Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Lakshmimathy Subramanian
- Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Gerhard Fusch
- Department of Paediatrics, McMaster University, Hamilton, ON, Canada
| | - Christoph Fusch
- Department of Paediatrics, McMaster University, Hamilton, ON, Canada
| |
Collapse
|