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.

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.

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.

Evidence based practice and advanced competencies in a MHS-CLS program.

The goals, curriculum, implementation, and immediate impacts of an entry-level Master of Health Science in Clinical Laboratory Science (MHS-CLS) degree are described as compared to the baccalaureate program (BS-CLS) in the same institution. The MHS-CLS program was instituted in fall semester, 2008; the inaugural class graduated in spring semester 2010. To document the need for the MHS-CLS, program statistics, such as the number of students entering the current BS-CLS program with previous baccalaureate degrees, numbers of students graduating with biology and chemistry degrees in the United States, CLS workforce shortages and pending retirement statistics were used. The shortage of CLS practitioners able to perform and publish evidence-based practice research also supported program need. The MHS-CLS curriculum includes advanced courses, advanced competencies incorporated into existing BS-CLS courses, and a capstone research project in evidence based practice.

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.

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.

A typology of evidence based practice research heuristics for clinical laboratory science curricula.

A typology of EBP research heuristics was defined relative to clinical laboratory science levels of practice. Research skills requisite for CLS baccalaureate level are associated mainly with quality control of analytic processes. Research skills at master's level are associated with pre- and post-analytic investigations, as well. Doctoral level CLS practice portends to utilize research skills facilitating quality investigations at the systems level.

In addition to benefits and harms: the relevance of the political.

When working with parents of deaf children, clinicians and educators should explicitly add political-justice considerations to benefit-harm considerations in their ethical analyses of available interventions to prevent or reverse children's hearing impairments.

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.

A quality improvement cycle: hemolyzed specimens in the emergency department.

OBJECTIVE: To determine the cause of and possible solution for an excessive number of hemolyzed specimens received from the emergency department (ED) of a large medical center. DESIGN: The clinical laboratory staff collected data on hemolyzed specimens for all departments of the medical center. The clinical laboratory management team and ED management team intervened with training and surveillance of the ED staff to heighten the awareness of the problem. SETTING: The clinical chemistry laboratory of a large medical center. MAIN OUTCOME MEASURE: The number of specimens submitted by inpatient departments and the ED was measured in relationship to the number ofhemolyzed specimens received from the departments. The clinical laboratory measured specimen processing times and turnaround times to determine their role in possibly contributing to the large number of hemolyzed specimens. Direct observation by a certified phlebotomist documented anecdotal evidence of the ED staffs phlebotomy practices. ED and clinical laboratory practitioners communicated realistic impressions of the medical centers problem with hemolyzed specimens. RESULTS: The laboratory processing times were not responsible for the hemolyzed specimens. The collection equipment was not responsible for the hemolyzed specimens. The ED had an excessive number ofhemolyzed specimens when compared to the rest of the medical center. The collection techniques in the ED appeared to be the origin of the problem. CONCLUSION: The intervention of the laboratory manager with the ED chief and nurse manager abated some of the professional arrogance between the departments. The dialogue educated the staffs about specific data that pointed to a possible origin of the problem. The ED chief placed his department on surveillance against problematic draws. Communication was improved between the two departments. However, only a moderate improvement in the number of hemolyzed specimens was noted. More training of medical center departments in phlebotomy and periodic proficiency evaluation of the all staff was indicated as a possible long-term solution.

A comparison in academic performance between distance and on-campus students in allied healthcare education.

The primary purpose of this study was to examine the differences in background characteristics and academic performance of students in distance learning and on-campus programs in allied healthcare education at one medical university in the Eastern United States. The study depended on data from 252 students, drawn from three disciplines, clinical laboratory science, health information administration, and nuclear medicine. The study employed the chi-square test and t-test for analyzing the data. The study's findings suggested no significant differences in terms of the background characteristics of gender and previous academic performance between distance and on-campus students. However, the two groups of students differed significantly in terms of their age composition such that, as expected, distance learning students comprised the majority of older students (25 years and older) relative to their on campus counterparts. The study further showed that, when assessed in terms of their final grade point averages as well as certification pass rates, distance and on campus students were indistinguishable from each other. Similar results were found when final GPA scores within the three separate disciplines were compared and in certification scores in two out of the three disciplines. However, the certification scores of nuclear medicine technology students were found to be significantly different between the two groups, in which on-campus students earned a significantly higher score than their counterparts in the distance learning program. Administrators and educators who are considering offering distance learning as a method of degree obtainment in allied healthcare education need data, such as reported in this study, when determining if distance learning can be as effective as on-campus learning in allied healthcare education.

Evaluating distance learning in clinical laboratory science.

OBJECTIVE: The purpose of this study was to determine if there were any significant differences in academic performance between distance students and on-campus students in clinical laboratory science. DESIGN: A quantitative causal comparative research design was used. SETTING: The research study was conducted at an academic health sciences university in the eastern United States. PATIENTS OR OTHER PARTICIPANTS: Anecdotal graduate data were collected from students that had graduated from the Clinical Laboratory Science (CLS) program. INTERVENTIONS: The students had either received their CLS education via distance or through the traditional on-campus methods. MAIN OUTCOME MEASURES: Academic performance was the major outcome measured. This was determined by comparing distance students' final grade point average (GPA) scores and certification scores to their on-campus counterparts. RESULTS: The researchers found no significant difference in gender between distance and on-campus students; however, there was a significant difference in age. On average the distance students were older than their on-campus counterparts. There were no significant differences found for mean overall admission GPA, mean math science admission GPA, mean final GPA score, and mean certification score. There were also no differences found in any of the subcategories of the certification exam except for urinalysis. For the urinalysis subcategory the distance students significantly outperformed their on-campus counterparts. Correlation studies showed that there were significant positive correlations between overall admission GPAs, math science admission GPAs, final GPA scores, and certification scores. CONCLUSIONS: The researchers have shown that distance learning CLS graduates are as academically prepared as their on-campus counterparts.