Informed consent for image-guided procedures: a nationwide survey of perceptions and current practices.

AIM: To characterise the current landscape of informed consent practices for image-guided procedures, including location of consent, guideline availability, and utility of decision-aid resources. MATERIALS AND METHODS: A survey of 159 interventional radiologists was conducted from April through June 2022. The survey evaluated participant demographics (gender, practice type, and level of training) and consent practices. Fifteen questions investigated discussion of benefits, risks, and alternatives, who obtained consent, location of consent conversations, how decision-making capacity is assessed, availability of formal guidance on consent discussions, and if and how decision-aids are used. RESULTS: Most respondents (93.7%) were "extremely" or "very" comfortable discussing the benefits and risks of image-guided procedures during informed consent. Most respondents were "very" comfortable discussing alternative treatments within radiology (86.8%) while fewer felt confident regarding alternatives outside radiology (46.5%). Most respondents indicated obtaining consent in a pre-procedure area (89.9%), while 12.7% of respondents obtained consent in the procedure room. Of the respondents, 66.7% did not have formal education or documented guidance on what providers should disclose during consent. Ninety-two respondents (57.9%) reported using decision aids. The type of decision aid varied, with most reporting using illustrations or drawings (46.6%). Decision aid utility was more prevalent in non-teaching/academic (71.4%) versus academic (61%) institutions (p=0.02). CONCLUSION: Regardless of demographics, interventionalists are confident in discussing benefits, risks, and alternative image-guided therapies, but are less confident discussing alternative treatment options outside of radiology. Formal education on informed consent is less common, and the use of decision aids varies between teaching and non-teaching institutions.

Utilisation of goals of care discussions and palliative care prior to image-guided procedures near the end of life.

AIM: To characterise image-guided procedures performed near the end of life and the use of goals of care discussions (GOC) and palliative care consultation (PCC) prior to these procedures. MATERIALS AND METHODS: Retrospective chart review of 3,714 consecutive inpatient procedures performed for 2,351 patients and 8,206 outpatient procedures performed for 5,225 patients within a suburban medical system. Data were collected on demographics, procedures performed, mortality, and use of GOC or PCC prior to the procedures. Procedures near the end of life were classified as emergent, elective, or palliative. Logistic regression was used to assess for demographic disparities in care. RESULTS: Nine percent of inpatients died within 30 days of their procedure, 57% of which were within the same hospitalisation. Of these patients, 59% had a documented GOC and 35% had a PCC. Similarly, 7% of outpatients died within 6 months of their procedure. A minority of these patients had a documented GOC (37%) or PCC (13%). There were few statistically significant demographic disparities in this care and the associated odds ratios were small. CONCLUSION: A wide array of image-guided procedures is performed near the end of life. GOC and PCC are underutilised prior to these procedures. Few demographic disparities exist in this care.

Proteoglycan synthesis by fibroblast cultures initiated from regions of adult bovine tendon subjected to different mechanical forces.

Fibroblast cultures were initiated from two distinct regions of the adult bovine deep flexor tendon and synthesis of 35S-labeled proteoglycans by these cultures was investigated. The proximal/tensional region of the tendon was composed of linearly arranged dense collagen bundles, and its glycosaminoglycan hexosamine content was only 0.2% of the dry weight of the tissue. The proteoglycans of this region were predominantly small (Kav = 0.5 on Sepharose CL-4B). Cells placed into culture from this region attached to the substratum readily, and the radiolabeled proteoglycans from these cultures were 90% small proteoglycans. In a more distal region of the tendon that is subjected to compressive forces, the collagen was arranged as a network of fibrils separated from each other by a matrix that stained intensely with Alcian blue. The glycosaminoglycan content of this compressed region was up to 5-fold higher than in the proximal region, and as much as 50% of the proteoglycans were large molecules (eluted from Sepharose CL-4B in the Vo). Cells placed into culture from the distal/compressed region did not attach to the substratum as readily as those from the proximal region and were characterized by the presence of numerous cytoplasmic lipid inclusions. The [35S]proteoglycans synthesized by the distal tendon fibroblast cultures were divided into two approximately equal populations of large and small proteoglycans having elution characteristics similar to the proteoglycans extracted from this tissue. The distinct profiles of proteoglycan production were maintained by the cells in culture for several weeks, although eventually the amount of large proteoglycan synthesized by the distal tendon fibroblast cultures diminished. Both regions of tendon contained predominantly type I collagen, and collagen production was about 10% of the total protein synthesized by both cell cultures. These observations indicate that adult tendon fibroblasts in culture express stable synthesis of proteoglycan populations similar to those found in the region of tendon from which they were derived.

Development policy and the evaluation of community self-help: the Harambee school movement in Kenya.

PIP: This attempt to objectively assess the costs and benefits of involvement in the harambee education movement for individuals and families is directed at policymakers and is an exercise in policy analysis. Evaluative studies of this nature are essential to the improvement of the of the overall quality of policymaking. Despite general agreement that harambee education projects involving secondary schools differ in many ways from types of self-help projects, few attempts have been made to assess the long-term social impact of the harambee education movement. For nearly 2 decades Kenya's harambee movement has flourished and has been largely viewed as a positive contribution to national development. Between 1969-79, the total value of contributions to self-help projects rose from around $6 million to almost $27 million, demostrating the substantial inputs of local communities to the economic growth of the country as a whole. Policymakers, after initial reservations about independent self-help, in recent years have come to rely on such activities as complementary to the government's efforts. Self-help activities aimed at expanding educational opportunity are the most significant in terms of both monetary resources expended and the scope of human involvement. Benefits are difficult to extimate. The growing number of students in harambee schools does not necessarly indicate that the majority of these students are acquiring marketable skills or that their consequent levels of academic training will prepare them to complete successfully in the job market with the average student educated in government-sponsored schools. The evidence, in fact, clearly points in the opposite direction. Yet, politicians, policymakers, and citizens continue to regard harambee activities for expanding educational opportunities atall levels as necessary contributions to Kenya's development program and to individual achievement. The direct cost to government for harambee education can be compared with the direct private expenditure on this type of ecucation. The 1976 annual private investment in harambee education was $45 million. The most direct benefits from harambee efforts are reaped by wealthier regions and communities in Kenya. The greaes social benefits derived from the government's policy toward the harambee school movement are political benefits. By symbolically drawing linkages between its national development strategy and independent self-help activities, the government can elicit the tacit support of rural communities. Direct social costs of such a policy are minimal. The indirect, long-term costs may result in disastrous, unintended consequences as the pool of educated and unemployed youths expands and as resulting ethnic and class inequalities sharpen and crystallize.^ieng