Breaking Bad News During Prenatal Screening: The Role of Professional Obstetricians and Midwives in Greece

INTRODUCTION

Breaking bad news is one of the most difficult responsibilities in medical practice. Although medical staff in clinical practice often encounter situations that necessitate the announcement of unpleasant news, there is a lack of training regarding their communication with patients and their families. Effective interaction between medical staff and pregnant women constitutes a crucial component of breaking down unpleasant news. This research aimed to investigate the knowledge and attitude of health professionals, particularly obstetricians, and midwives, regarding the announcement of bad news during prenatal screening.

METHODS

The study was conducted between September 2017 and April 2018. One hundred professional obstetricians and midwives involved in fetal and prenatal medicine in Greece were part of the study. The study consisted of two parts: the first covered the emotional state of healthcare professionals during the announcement of unpleasant news, and the second covered the appropriate way to inform unpleasant results during prenatal testing.

RESULTS

In this study, only 41% of the participants considered that they felt comfortable discussing issues related to the diagnosis of an unpleasant result during prenatal testing with the pregnant woman/patient, or her relatives, and 85% accepted that they had experienced feelings of sadness, anxiety, or guilt when announcing unpleasant results. Furthermore, 87% of the participants believed that the non-verbal communication component (eye contact, body language) plays an important role in breaking bad news. Finally, 65% considered that prolonged monitoring of the ultrasound screen during prenatal screening does not increase the anxiety of pregnant women when carried out for a better medical opinion.

CONCLUSIONS

Delivering bad news during prenatal screening creates stress for the parents. As far as the ethical, cultural, psychological, and legal complicity of healthcare professionals is concerned, communicating unpleasant news has been a subject of discussion by many experts. It is important to understand the concerns of women regarding the risks of counseling.

The Cognitive Approach to Bioethical Issues in Perinatal Care in Greece

Background and aim: Current practice in prenatal diagnosis becomes challenging with new bioethics issues emerging constantly during daily clinical routine. Although fetal interventions are driven by a motivation to improve the health of the fetus, progress in fetal therapies raises issues of maternal autonomy. The objective of this article is to assess bioethics in prenatal diagnosis in Greece as well as bioethics education.

Methods: The study was conducted between October 2018 and December 2019. Two hundred and twenty eligible responders were involved in fetal and perinatal medicine in Greece. The questionnaire was developed as a Likert scale. Part 1 covered the participants' general opinion about bioethics. Part 2 covered ethical dilemmas likely to arise when routine screening presents a complicated result.

Results: In the study, 92.3% of the participants considered that the branch of bioethics is necessary in medical practice. Regarding challenging bioethics issues, only 86% of the participants consider that the miscarriage risk should be discussed after an invasive procedure. Furthermore, it is not clear for responders whether informed consent is a medical or legal obligation (43% vs 33%) and whether information should be provided orally or written (49% vs 46%). Finally, 32% of healthcare practitioners declare that they are not fully aware of the law concerning the rights of the fetus.

Conclusions: Although healthcare professionals acknowledge the distinct role of bioethics, mismanagement of ethical dilemmas reveals that under-graduate teaching of this discipline is not addressed effectively. Identifying the parameters that would improve the learning process would make a significant contribution in the routine clinical practice.

Substitution F569S converts UapA, a specific uric acid-xanthine transporter, into a broad specificity transporter for purine-related solutes

UapA, a highly specific uric acid-xanthine transporter in Aspergillus nidulans, is a member of a large family of nucleobase-ascorbate transporters conserved in all domains of life. We have investigated structure-function relationships in UapA, by studying chimeric transporters and missense mutations, and showed that specific polar or charged amino acid residues (E412, E414, Q449, N450, T457) on either side of an amphipathic alpha-helical transmembrane segment (TMS10) are critical for purine binding and transport. Here, the mutant Q449E, having no uric acid-xanthine transport activity at 25 degrees C, was used to isolate second-site revertants that restore function. Seven of them were found to have acquired the capacity to transport novel substrates (hypoxanthine and adenine) in addition to uric acid and xanthine. All seven revertants were found to carry the mutation F569S within the last transmembrane segment (TMS14) of UapA. Further kinetic analysis of a selected suppressor showed that UapA-Q449E/F569S transports with high affinity (K(M) values of 4-10 microM) xanthine, hypoxanthine and uracil. Uptake competition experiments suggested that UapA-Q449E/F569S also binds guanine, 6-thioguanine, adenosine or ascorbic acid. A strain carrying mutation F569S by itself conserves high-capacity, high-affinity (K(M) values of 1.5-15 microM), transport activity for purine-uracil transport. Compared to UapA-Q449E/F569S, UapA-F569S has a distinct capacity to bind several nucleobase-related compounds and different kinetic parameters of transport. These results show that molecular determinants external to the central functional domain (L9-TMS10-L10) are critical for the uptake specificity and transport kinetics of UapA.