Injury Resulting from Crushed Glass Ampules Get access Joseph F. Wasielewski, M.D., Joseph F. Wasielewski, M.D. Joseph F. Wasielewski, M.D., is Chief Resident in Pathology; Susan Girard, MT(ASCP), is Section Head of the Department of Microbiology; and Audrey Lim, MT(ASCP), is Staff Technologist in the Department of Microbiology at St. Francis Hospital in Honolulu, Hawaii. Search for other works by this author on: Oxford Academic PubMed Google Scholar Susan Girard, MT(ASCP), Susan Girard, MT(ASCP) Joseph F. Wasielewski, M.D., is Chief Resident in Pathology; Susan Girard, MT(ASCP), is Section Head of the Department of Microbiology; and Audrey Lim, MT(ASCP), is Staff Technologist in the Department of Microbiology at St. Francis Hospital in Honolulu, Hawaii. Search for other works by this author on: Oxford Academic PubMed Google Scholar Audrey Lim, MT(ASCP) Audrey Lim, MT(ASCP) Joseph F. Wasielewski, M.D., is Chief Resident in Pathology; Susan Girard, MT(ASCP), is Section Head of the Department of Microbiology; and Audrey Lim, MT(ASCP), is Staff Technologist in the Department of Microbiology at St. Francis Hospital in Honolulu, Hawaii. Search for other works by this author on: Oxford Academic PubMed Google Scholar Laboratory Medicine, Volume 11, Issue 9, 1 September 1980, Page 604, https://doi.org/10.1093/labmed/11.9.604 Published: 01 September 1980
Abstract Background Children with medical complexity (CMC) have diverse medical diagnoses and the following characteristics: multisystem disease, functional limitations, high care needs, and high healthcare utilization. CMC have intensive inpatient resource use with associated high healthcare costs. Best practices and service delivery models to guide inpatient care of CMC are not yet established and likely vary considerably among institutions. Objectives The objective of this study is to describe the availability and organization of resources for CMC during inpatient care across Canadian paediatric hospitals and assess how these services are adapted to the specific needs of CMC. Design/Methods This environmental scan was conducted as a cross-sectional, researcher-administered virtual survey. The instrument was developed based on a literature review of inpatient complex care and consensus among a panel of content experts. The survey was pilot tested with two complex care physicians and one with expertise in questionnaire development. The survey was available in both English and French. Survey participants were identified through snowball sampling within the Canadian Paediatric Inpatient Research Network (PIRN) with the aim of identifying a key informant from each paediatric hospital. Consistent members of the research team administered survey questions to participants via Zoom, and responses were entered into the Qualtrics platform. Quantitative survey responses were analyzed using univariate descriptive analysis. Qualitative responses were categorized and described for comparative purposes. Results Ten interviews were conducted representing ten different paediatric hospitals. Although nine had established complex care programs, only one of these had a specific inpatient care team for CMC. The physician-to-patient and nurse-to-patient ratios were the same for CMC and non-CMC patients. All sites had some form of standardized documentation to support inpatient care of CMC, but each had different elements and purposes. Only two sites had conducted formal evaluation of their inpatient program for CMC. Key informants rated their hospital’s ability to meet the specific inpatient needs of CMC as a 6.5 out of 10 (on average), with a range of 4-8. Conclusion These results suggest a relative lack of inpatient resources directed to CMC, with a high proportion of sites having a complex care program but with few that include a dedicated inpatient team. Further, there is a lack of standardization across the country in terms of documentation and best practices. Key informants perceive room for improvement in inpatient care at their sites. Future studies will identify evidence-based best practices that can be further evaluated and spread.
Immunohistochemistry (IHC) and fluorescence in situ hybridisation (FISH) are the only tests currently approved by the US Food and Drug Administration for classifying which patients will benefit from trastuzumab therapy. The accuracy of these two testing methods can be adversely affected by a variety of pre-analytical, analytical and post-analytical factors. According to the latest published recommendations of the panel of the Joint Committee of the American Society of Clinical Oncology and College of American Pathologists for HER2/neu testing, laboratories performing IHC and FISH for HER2/neu status in breast cancer are now required to have a high concordance of at least 95% between IHC and FISH, significantly higher than that in the published literature.To perform a retrospective analysis of the concordance of IHC and FISH analysis for HER2/neu at Singapore General Hospital and review potential causes of disparity between these two methods.A retrospective review of a total of 106 invasive ductal carcinomas evaluated for HER2/neu at the Department of Pathology, Singapore General Hospital between 2007 and 2008 were included in the study. The initial HER2/neu immunostained slides were reviewed independently without knowledge of FISH results, and concordance between IHC and FISH was determined.Concordance between IHC and FISH assay was excellent and within the published range (104/106=98.1%). The discordant cases represent a well-recognised subset of genetic heterogeneity in HER2/neu, which is known to contribute to positive IHC and negative FISH tests.
We co-developed a multi-component virtual care solution (TtLIVE) for the home mechanical ventilation (HMV) population using the aTouchAway™ platform (Aetonix). The TtLIVE intervention includes (1) virtual home visits; (2) customizable care plans; (3) clinical workflows that incorporate reminders, completion of symptom profiles, and tele-monitoring; and (4) digitally secure communication via messaging, audio, and video calls; (5) Resource library including print and audiovisual material.Our primary objective is to evaluate the TtLIVE intervention compared to a usual care control group using an eight-center, pragmatic, parallel-group single-blind (outcome assessors) randomized controlled trial. Eligible patients are children and adults newly transitioning to HMV in Ontario, Canada. Our target sample size is 440 participants (220 each arm). Our co-primary outcomes are a number of emergency department (ED) visits in the 12 months after randomization and change in family caregiver (FC) reported Pearlin Mastery Scale score from baseline to 12 months. Secondary outcomes also measured in the 12 months post randomization include healthcare utilization measured using a hybrid Ambulatory Home Care Record (AHCR-hybrid), FC burden using the Zarit Burden Interview, and health-related quality of life using the EQ-5D. In addition, we will conduct a cost-utility analysis over a 1-year time horizon and measure process outcomes including healthcare provider time using the Care Coordination Measurement Tool. We will use qualitative interviews in a subset of study participants to understand acceptability, barriers, and facilitators to the TtLIVE intervention. We will administer the Family Experiences with Care Coordination (FECC) to interview participants. We will use Poisson regression for a number of ED visits at 12 months. We will use linear regression for the Pearlin Mastery scale score at 12 months. We will adjust for the baseline score to estimate the effect of the intervention on the primary outcomes. Analysis of secondary outcomes will employ regression, causal, and linear mixed modeling. Primary analysis will follow intention-to-treat principles. We have Research Ethics Board approval from SickKids, Children's Hospital Eastern Ontario, McMaster Children's Hospital, Children's Hospital-London Health Sciences, Sunnybrook Hospital, London Health Sciences, West Park Healthcare Centre, and Ottawa Hospital.This pragmatic randomized controlled single-blind trial will determine the effectiveness and cost-effectiveness of the TtLIVE virtual care solution compared to usual care while providing important data on patient and family experience, as well as process measures such as healthcare provider time to deliver the intervention.ClinicalTrials.gov NCT04180722 . Registered on November 27, 2019.
Introduction: Children with medical complexity (CMC) are among the most vulnerable children in society. These children and their families face challenges of fragmented care and are at risk for poorer health outcomes. Families with CMC play a vital role in providing care and navigating the complexities of healthcare systems. It is essential to understand the best ways to engage these families in research to improve the care and optimize the health of CMC. Objectives: This study explored parent engagement within the context of a feasibility study evaluating an Integrated Tertiary Complex Care (ITCC) clinic created to support CMC closer to home. This paper aimed: (1) to understand the family experiences of care and (2) to explore parent engagement in the study. Method: This mixed-methods feasibility study included three components. First, feedback from focus groups was used to identify the common themes that informed interviews with parents. Second, one-on-one interviews were conducted with parents to explore their experience with care, such as the ITCC clinic, using an interpretative description approach. Third, the questionnaires were completed by parents at baseline and 6-months post-baseline. These questionnaires included demographic and cost information and three validated scales designed to measure the caregiver strain, family-centered care, and parental health. The recruitment rate, percentage completion of the questionnaires, and open-ended comments were used to assess parent engagement in the study. Results: The focus groups involved 24 parents, of which 19 (14 women, five men) provided comments. The findings identified the importance of Complex Care Team (CC Team) accessibility, local access, and family-centered approach to care. The challenges noted were access to homecare nursing, fatigue, and lack of respite affecting caregiver well-being. In this study, 17 parents participated in one-on-one interviews. The identified themes relevant to care experience were proximity, continuity, and coordination of care. The parents who received care through the ITCC clinic appreciated receiving care closer to home. The baseline questionnaires were completed by 44 of 77 (57%) eligible parents. Only 24 (31%) completed the 6-month questionnaire. The challenges with study recruitment and follow-up were identified. Conclusion: Family engagement was a challenging yet necessary endeavor to understand how to tailor the healthcare to meet the complex needs of families caring for CMC.
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