The patient and clinician experience of informed consent for surgery: a systematic review of the qualitative evidence.

BACKGROUND: Informed consent is an integral component of good medical practice. Many researchers have investigated measures to improve the quality of informed consent, but it is not clear which techniques work best and why. To address this problem, we propose developing a core outcome set (COS) to evaluate interventions designed to improve the consent process for surgery in adult patients with capacity. Part of this process involves reviewing existing research that has reported what is important to patients and doctors in the informed consent process. METHODS: This qualitative synthesis comprises four phases: identification of published papers and determining their relevance; appraisal of the quality of the papers; identification and summary of the key findings from each paper while determining the definitiveness of each finding against the primary data; comparison of key themes between papers such that findings are linked across studies. RESULTS: Searches of bibliographic databases returned 11,073 titles. Of these, 16 studies met the inclusion criteria. Studies were published between 1996 and 2016 and included a total of 367 patients and 74 health care providers. Thirteen studies collected data using in-depth interviews and constant comparison was the most common means of qualitative analysis. A total of 94 findings were extracted from the primary papers and divided into 17 categories and ultimately 6 synthesised findings related to: patient characteristics, knowledge, communication, the model patient, trust and decision making. CONCLUSIONS: This qualitative meta-aggregation is the first to examine the issue of informed consent for surgery. It has revealed several outcomes deemed important to capture by patients and clinicians when evaluating the quality of a consent process. Some of these outcomes have not been examined previously in research comparing methods for informed consent. This review is an important step in the development of a COS to evaluate interventions designed to improve the consent process for surgery. REGISTRATION: The study protocol was registered on the international prospective register for systematic reviews (PROSPERO ID: CRD42017077101).

Tobacco use among American Indian/Alaska Native youth in Wisconsin.

The Great Lakes Inter-Tribal Council investigated the level of tobacco use among American Indian/Alaska Native (AI/AN) youth to help Tribal communities appropriately target tobacco prevention and intervention efforts. A youth tobacco survey of AI/AN middle school students in Wisconsin was conducted. Nine hundred six AI/AN students in grades 6-8 at 15 tribal and public schools were surveyed with the Great Lakes Inter-Tribal Council Youth Tobacco Survey (GLITC YTS) Overall, 79% of students reported having tried some tobacco product; 45% reported currently using some form of tobacco. Tobacco use among AI/AN middle school students was higher than that of middle school students participating in the Wisconsin Youth Tobacco Survey.

Native American infant mortality in Wisconsin.

An infant mortality rate is an important public health measure because it may indicate unmet health needs or unfavorable environmental factors. The infant mortality rate for Native Americans in Wisconsin has decreased over the past several years, although there remains a discrepancy between Native Americans, all races combined and the Healthy People 2000 goal. The Wisconsin American Indian Infant Mortality Review Project (WAIIMR) conducted a study to understand local underlying factors that contributed to infant deaths and to recommend local health initiatives that could be developed to have a positive impact on the health of infants and mothers. The results from the WAIIMR Project and more recent Wisconsin birth record data are discussed in this paper. Two risk factors, levels of prenatal care and maternal smoking during pregnancy, show discrepancies between races and warrant further investigation. Native American communities in Wisconsin are addressing risk factors affecting maternal and child health through projects such as Honoring Our Children and The Michigan/Wisconsin Epidemiology Center.

Genetic relationships of the genes encoding the human proteasome beta subunits and the proteasome PA28 complex.

Genomic clones were obtained for the genes encoding the beta subunits of the human proteasome and for the associated proteasome activators PA28alpha and beta (PSME1 and PSME2, respectively). Fluorescence in situ hybridization was used to map the gene encoding the beta subunit PSMB3 (beta3 hs, HsC10-II) to chromosome band 2q35, PSMB2 (beta4 hs, HsC7-I) to band 1p34.2, and PSMB4 (beta7 hs, HSBpros 26) to band 1q21. Genes encoding the alpha and beta subunits of the PA28 complex were found closely linked on chromosome band 14q11.2, within 1 Mb of the beta proteasome locus PSMB5 (beta5 hs, MB1, X). These data complete the mapping of the human proteasome beta subunit loci. With the exception of the genes encoding the PSMB9 and PSMB8 (LMP2 and LMP7, respectively) subunits, the beta genes were not closely linked in the human genome. Both PSMB2 and PSMB4 mapped to a region of chromosome 1 that is proposed to be paralogous to other regions of the human genome where beta proteasome genes map: chromosome 6 containing the major histocompatibility complex (MHC) and chromosome 9. The independent regulation of expression of all of these genes, implied by this study, is consistent with a key role for proteasome assembly in coordination of the complex.