Reassessing the approach to informed consent: The case of unrelated hematopoietic stem cell transplantation in adult thalassemia patients

Introduction: The informed consent process is the legal embodiment of the fundamental right of the individual to make decisions affecting his or her health., and the patient's permission is a crucial form of respect of freedom and dignity, it becomes extremely important to enhance the patient's understanding and recall of the information given by the physician. This statement acquires additional weight when the medical treatment proposed can potentially be detrimental or even fatal. This is the case of thalassemia patients pertaining to class 3 of the Pesaro classification where Allogenic hematopoietic stem cell transplantation (HSCT) remains the only potentially curative treatment. Unfortunately, this kind of intervention is burdened by an elevated transplantation-related mortality risk (TRM: all deaths considered related to transplantation), equal to 30% according to published reports. In thalassemia, the role of the patient in the informed consent process leading up to HSCT has not been fully investigated. This study investigated the hypothesis that information provided by physicians in the medical scenario of HSCT is not fully understood by patients and that misunderstanding and communication biases may affect the clinical decision-making process.Methods: A questionnaire was either mailed or given personally to 25 patients. A second questionnaire was administered to the 12 physicians attending the patients enrolled in this study. Descriptive statistics were used to evaluate the communication factors.Results: The results pointed out the difference between the risks communicated by physicians and the risks perceived by patients. Besides the study highlighted the mortality risk considered to be acceptable by patients and that considered to be acceptable by physicians.Conclusions: Several solutions have been suggested to reduce the gap between communicated and perceived data. A multi-disciplinary approach may possibly help to attenuate some aspects of communication bias. Several tools have also been proposed to fill or to attenuate the gap between communicated and perceived data. But the most important tool is the ability of the physician to comprehend the right place of conscious consent in the relationship with the patient

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Influence of major anions on As(V) adsorption by synthetic 2-line ferrihydrite. Kinetic investigation and XPS study of the competitive effect of bicarbonate

The potential competitive effect of background electrolytes (Na(2)HPO(4) center dot 2H(2)O, NaHCO(3), Na(2)SO(4) and NaCl solutions) on arsenate adsorption onto synthetic 2-line ferrihydrite has been studied by means of kinetic batch experiments conducted at pH values from 4.0 to 10.0 and at anionic concentrations of 0.01 and 0.1 M. The results indicate that the adsorptive capacity of ferrihydrite for arsenate decreases strongly in the presence of phosphate species at pH in the range of 4-10 and in the presence of bicarbonate at pH 8.3 as a consequence of their competitive effect. Analogously to phosphate, a surface interaction of inner-sphere type between ferrihydrite and bicarbonate is suggested. Chloride has negligible effects on arsenate adsorption processes, confirming it as an outer-sphere ion that does not compete with the inner-sphere binding peculiar to arsenate onto ferrihydrite. Sulphate exhibits an intermediate behaviour; at 0.01 M concentration, the competitive effect of sulphate is similar to that of chloride, whereas at 0.1 M concentration sulphate shows a moderate influence on arsenate adsorption. The results of the kinetic studies can be summarised by the following order of competitive capacity: phosphate > carbonate > sulphate > chloride. The process of arsenate adsorption follows pseudo-second order kinetics and the reaction half-time notably increases in the presence of strong competitor anions such as phosphate and carbonate with respect to an ineffective competitor anion such as chloride. Modelling of arsenate adsorption with PHREEQC, according to the Generalized Two-Layer Model, confirms that the pH effect is notably less important than the competitive effect of carbonate species in determining the amount of arsenate adsorbed onto ferrihydrite at pH 8.3 in 0.1 M NaHCO(3) solution, whereas the model greatly underestimates the competitive effect of carbonate species at pH 8.3 in 0.01 M NaHCO(3) solution. The results of the batch experiments in 0.1 M NaHCO(3) solution are substantiated by XPS analyses of ferrihydrite after immersion in the same solution, both with and without dissolved arsenate. XPS confirms the interaction between ferrihydrite surface and arsenate; the binding energy of As3d shifts towards higher binding energies after adsorption with respect to the pure compound Na(2)HAsO(4)center dot 7H(2)O taken as reference standard. In presence of carbonate species, the As3d binding energy is found at intermediate values. XPS quantitative analysis shows a depletion of arsenate on ferrihydrite surface, providing further evidence of the competition of the two species (i.e. arsenate and bicarbonate) for the ferrihydrite adsorption sites. Important environmental implications concerning arsenic mobility, as well as possible application in various fields (e.g. irrigation agriculture, soil decontamination, water treatment), might derive from these findings