Candida auris in US Correctional Facilities.

Candida auris is an emerging fungal pathogen that typically affects patients in healthcare settings. Data on C. auris cases in correctional facilities are limited but are needed to guide public health recommendations. We describe cases and challenges of providing care for 13 patients who were transferred to correctional facilities during January 2020-December 2022 after having a positive C. auris specimen. All patients had positive specimens identified while receiving inpatient care at healthcare facilities in geographic areas with high C. auris prevalence. Correctional facilities reported challenges managing patients and implementing prevention measures; those challenges varied by whether patients were housed in prison medical units or general population units. Although rarely reported, C. auris cases in persons who are incarcerated may occur, particularly in persons with known risk factors. Measures to manage cases and prevent C. auris spread in correctional facilities should address setting-specific challenges in healthcare and nonhealthcare correctional environments.

A visiting otolaryngology team in northern Ontario - demographics, clinical presentation and barriers to access.

CONTEXT: Approximately 20% of Canadians reside in rural or remote communities where access to medical specialties such as otolaryngology remains challenging due to long wait times and distance to services. The purpose of this study was to characterize patient demographics, common clinical diagnoses, and barriers to accessing otolaryngology services, in a remote Northern Ontario setting. A secondary objective was to describe a care model that provides multi-subspecialty otolaryngology services to a remote community. ISSUE: A team of academic otolaryngologists provided annual (2020-2021) subspecialty services in otology, neurotology, rhinology, head and neck oncology, and pediatrics to a remote hospital with admitting, general anesthesia and surgical resources. Data regarding patient demographics, otolaryngology-related diagnosis, wait times and distance travelled were recorded. Data were obtained for 276 patients treated in the clinic. The median age was 47 years (range 0-85 years). The most common otolaryngological conditions were hearing loss (n=62) and nasal obstruction (n=34). Nearly 30% of patients traveled further than 150 km to access care, and 62% waited 3-6 months for a consultation. LESSONS LEARNED: This is the first study to characterize the demographics and range of otolaryngological disorders encountered in a remote Northern Ontario setting. The results have identified specific otolaryngology needs and barriers to access to care. The data can be used to guide healthcare providers and administrators on resource allocation to optimize the delivery of otolaryngology services.

Identification of a Novel Homozygous Multi-Exon Duplication in RYR2 Among Children With Exertion-Related Unexplained Sudden Deaths in the Amish Community.

Importance: The exome molecular autopsy may elucidate a pathogenic substrate for sudden unexplained death. Objective: To investigate the underlying cause of multiple sudden deaths in young individuals and sudden cardiac arrests that occurred in 2 large Amish families. Design, Setting, and Participants: Two large extended Amish families with multiple sudden deaths in young individuals and sudden cardiac arrests were included in the study. A recessive inheritance pattern was suggested based on an extended family history of sudden deaths in young individuals and sudden cardiac arrests, despite unaffected parents. A family with exercise-associated sudden deaths in young individuals occurring in 4 siblings was referred for postmortem genetic testing using an exome molecular autopsy. Copy number variant (CNV) analysis was performed on exome data using PatternCNV. Chromosomal microarray validated the CNV identified. The nucleotide break points of the CNV were determined by mate-pair sequencing. Samples were collected for this study between November 2004 and June 2019. Main Outcomes and Measures: The identification of an underlying genetic cause for sudden deaths in young individuals and sudden cardiac arrests consistent with the recessive inheritance pattern observed in the families. Results: A homozygous duplication, involving approximately 26 000 base pairs of intergenic sequence, RYR2's 5'UTR/promoter region, and exons 1 through 4 of RYR2, was identified in all 4 siblings of a family. Multiple distantly related relatives experiencing exertion-related sudden cardiac arrest also had the identical RYR2 homozygous duplication. A second, unrelated family with multiple exertion-related sudden deaths and sudden cardiac arrests in young individuals, with the same homozygous duplication, was identified. Several living, homozygous duplication-positive symptomatic patients from both families had nondiagnostic cardiologic testing, with only occasional ventricular ectopy occurring during exercise stress tests. Conclusions and Relevance: In this analysis, we identified a novel, highly penetrant, homozygous multiexon duplication in RYR2 among Amish youths with exertion-related sudden death and sudden cardiac arrest but without an overt phenotype that is distinct from RYR2-mediated catecholaminergic polymorphic ventricular tachycardia. Considering that no cardiac tests reliably identify at-risk individuals and given the high rate of consanguinity in Amish families, identification of unaffected heterozygous carriers may provide potentially lifesaving premarital counseling and reproductive planning.

Impact of brief education on healthy seniors' attitudes and healthcare choices about Alzheimer's disease and associated symptoms.

ABSTRACTObjective:The primary objective of this study was to determine whether a brief education session about Alzheimer's disease (AD) stages and associated behavioral and psychological symptoms of dementia (BPSD) changes healthy seniors' treatment choices. A secondary objective was to determine whether pharmacotherapy to reduce BPSD would be preferred over other potentially more restrictive interventions. METHODS: Participants (n = 32; 8 men; aged > 64years; no self-reported dementia diagnosis) were assigned to one of ten group sessions during which they received information about AD and BPSD. Our a-priori hypotheses were: (1) education about AD stages significantly changes care preferences in moderate and severe stages, i.e. less active treatment options (no CPR/hospitalization) are chosen as the disease progresses; and (2) most participants prefer pharmacotherapy over restraints and seclusion to manage BPSD. The main outcome measure was a change in the interventions chosen including CPR and hospitalization. Participants completed three questionnaires and two decisional grids before and after the information session. Qualitative data were derived from discussions during the session. RESULTS: Participants expressed a wide range of attitudes about AD, BPSD, and their management. Those who are born in Canada, had a proxy, and a university education, each have around half of the odds of receiving treatment compared to those in the complementary group. (OR 0.47, 0.40, 0.43) Finally, not knowing someone with AD increases the odds of wanting a treatment by around six times (OR 6.4). Pharmacological measures were preferred over restraints. CONCLUSIONS: Education about dementia and advance directives should consider the person's educational background and experience with dementia. Discussing BPSD may impact a person's advance directives and preferences.

Pursuing Criminal Charges Against Patients who are Reported as Having Assaulted Healthcare Professionals: Considerations.

In two separate events in early 2014, a nurse was threatened with bodily harm by a patient in an inpatient psychiatry unit in Toronto. The nurses involved pursued criminal charges against the patients who made these threats. In response to questions regarding the procedure of criminally charging patients, and the supports available, a panel presentation was organized and presented for the inter-professional team. The key points from the panel are provided here as a resource for other organizations. This paper provides considerations learned from the Toronto Police Services, a Registered Nurse, a Nurse Manager, a Psychiatrist, a Bioethicist, a Legal representative and from Employee Relations.

A novel approach to managing hemolyzed specimens.

Hemolyzed specimens continue to cost the laboratory time and money. However, the core laboratory at Georgia Regents Health System, Inc. has instituted a novel approach to managing this problem. The purpose of this study was to determine whether the laboratory's new approach had a significant impact on the turn-around time (TAT) and cost of processing hemolyzed and non-hemolyzed specimens in the laboratory. The investigators queried the laboratory information systems for hemolyzed and non-hemolyzed specimens categorized as routine or STAT from the core laboratory and calculated statistical differences between the groups with respect to TAT and cost.The investigators found a statistically significant difference in the time it takes to process STAT hemolyzed specimens versus non-hemolyzed specimens with the new approach. Because of the new approach, hemolyzed specimens were actually processed as fast as, or faster than non-hemolyzed specimens in the core laboratory.

Reflections on 'autistic integrity'.

Autism, particularly its moderate to severe forms, has prompted considerable scientific study and clinical involvement because the associated behaviours imply disconnections with valued features of a 'good' life, such as close relationships, enjoyment, and adaptability. Proposed causes of autism involve potent philosophical concepts including consciousness, identity, mind, and relationality. The concept of autistic integrity is used by Barnbaum in The Ethics of Autism: Among Them, But Not of Them to help provide moral justification to stop efforts to cure adults with autism, especially if the cause is presumed to be a lack of a theory of mind.(1) This article has two goals: (1) to apply four familiar definitions or characterizations of integrity to the case of moderate to severe autism, and (2) to examine whether autistic integrity does provide the moral justification Barnbaum seeks.

Infection prevention disaster preparedness planning for long-term care facilities.

BACKGROUND: Long-term care facilities (LTCFs) are defined as residential institutions that provide care to people who are unable to live independently. Planning for infection prevention in disaster situations is essential for LTCFs because of the increased risk inherent in their patient population. Experiences with past disasters, such as pandemic influenza and Hurricane Katrina, have demonstrated where LTCFs are lacking in preparedness and opportunities for improvement. Little guidance is currently available to assist these facilities in creating an infection prevention component for their disaster plans. This paper is intended to guide the development of an infection prevention component of the LTCF disaster plan. METHODS: A literature review and Internet search were conducted in September 2010. A spreadsheet was created with infection prevention topics for disaster plans that were identified. Recommendations were divided into themes/domains for simplification and clarity. RESULTS: Fifty-eight articles, planning documents/reports, and Web-based training programs were identified and screened. Of the sources screened, 33 publications were determined to be relevant; 22 of which were peer-reviewed journal articles, and 11 were state, federal, or regulatory agency publications. CONCLUSION: Whereas there were multiple publications related to the difficulties and risk factors LTCFs face in disasters, there were no publications that specifically addressed infection prevention in disasters or planning specific to infection prevention concerns in disasters in long-term care. LTCF administrators or others responsible for disaster planning in LTCFs are encouraged to use this article as a guide to developing comprehensive infection prevention policies and protocols for their emergency operations plan.

How research ethics' protections can contribute to public policy: the case of community treatment orders.

Though community treatment orders (CTOs) were first used in 1986 in Australia, debate about their clinical and ethical merits continues even today. For some, the benefits of reduced frequency and duration of involuntary hospitalizations are believed to adequately outweigh the harms of restricted liberties in community living. For others, however, such benefits are believed to be achievable by simply arranging integrated, devoted community resources sans any threat of forced re-hospitalization. In response to this enduring controversy, this article examines the ethical merits of community orders using a novel approach. "Novel" because the examination is based on research ethics and its foundational principles. When hospital and community clinicians, family members, consumer/survivors, and advocacy groups discussed the idea of amending Ontario's mental health legislation to permit CTOs in the late 1990s, evidence of their effects and efficacy was very limited. Moreover, an order was characterized much like standard pharmacological or medical therapies because the person or an appropriate substitute decision maker's consent was necessary to authorize the order or make it valid. These two factors prompted this retrospective analysis: if CTOs--as a public policy initiative--had been treated like most other promising therapies, would any different ethics-related concerns have been raised that, in turn, would have benefited the public debate and the legislature's decisions? In other words, if respected safeguards that apply to new drugs and medical devices had applied to CTOs, would anything have changed?

Personal protective equipment use and allocation in home health during disasters.

BACKGROUND: Home health preparedness for disasters is imperative, including the need to identify essential resources to protect home health professionals from exposure during an event. Access to personal protective equipment (PPE) is expected to be limited during a disaster, and PPE distribution and allocation needs to be prearranged to minimize infection transmission risk. This article outlines the appropriate use and allocation of PPE for home health agencies as part of disaster planning. METHODS: A literature review and Internet search were conducted in July-August 2010. A spreadsheet was created delineating the best practices related to PPE use and allocation identified by each source. Recommendations were divided into themes/domains for simplification and clarity. RESULTS: A total of 46 articles, planning documents/reports, and Web-based training programs were identified and screened. Of these, 28 were deemed relevant, including 12 journal articles and 16 published reports, book chapters, planning documents, or training programs. Themes for PPE use and allocation in home health during disasters in the literature included identifying the types of PPE used in home health, determining PPE needs, storing PPE, allocating PPE when resources are limited or depleted, disposing of PPEl, and educating staff. CONCLUSION: Having access to the correct types and quantities of PPE during a disaster will be essential to home health agencies. The information presented in this article can assist home health agencies in developing emergency management plans that address planning issues related to PPE.

Priority setting up close.

Published accounts of specific priority-setting projects in healthcare are relatively few. This article chronicles the collaborative efforts of a professional practice lead and a bioethicist to strengthen the priority-setting process for a specific home care service. The project included two features not often reported in other priority-setting projects: the entire "frontline team" was involved for the project's duration, and a group of parents was canvassed for their views. Informed by both Daniels's "accountability for reasonableness" approach and challenges levied against it, the article explains the evolution of an assessment procedure, eligibility and priority criteria, and guiding substantive principles and concludes with the "lessons learned" by the project leads.

Capturing professionalism in pre-service education: professionalism tool development and implementation.

Recognizing that all health professions educational programs seek to graduate students possessing characteristics embodying the nebulous concept of professionalism, educators in four imaging and radiation science programs and a clinical laboratory science program collaborated to create a measurement tool for professionalism in pre-service education. The Student Professional Behavior Evaluation Tool and the process for its development and implementation are described.

Student molecular laboratory performance outcomes in a baccalaureate CLS program.

UNLABELLED: As new molecular assays are developed in research laboratories and approved by the Food and Drug Administration (FDA) for clinical use, molecular diagnostics becomes an integral discipline of clinical laboratory science. Since 2001, guidelines of the National Accreditation Agency for Clinical Laboratory Science (NAACLS) have required that CLS Educational Programs incorporate molecular diagnostics into the curriculum. SETTING: In fall of 2005, CLS faculty/researchers, affiliated with a baccalaureate program in an academic medical university, incorporated molecular diagnostic lecture content with online virtual laboratories into the Clinical Chemistry course. Then beginning in fall of 2006, manual performance of molecular laboratory exercises was introduced. OBJECTIVE: The aim of this study was to assess whether inclusion of hands-on molecular laboratories improved student outcomes on molecular questions during the final course examination. METHOD: CLS faculty evaluated student learning by written examination of lecture and laboratory content. Researchers performed two-sample t-tests to establish if significant differences existed in molecular questions scores achieved by students exposed to virtual and hands-on exercises. RESULTS: The researchers found a statistically significant difference in examination performance between the students that had a hands-on experience and students with virtual laboratory experience only. Further data analysis suggested that hands-on experiential laboratories had the greatest effect on students who performed in the middle percentiles. CONCLUSION: The researchers proposed that in order to improve examination scores of the weakly performing students other interventions may be necessary such as more lecture or laboratory time. This prompted development of a full time clinical molecular methods course, separate from Clinical Chemistry.