When to stop? Decision-making when children’s cancer treatment is no longer curative: a mixed-method systematic review

BACKGROUND: Children with cancer, parents, and clinicians, face difficult decisions when cure is no longer possible. Little is known about decision-making processes, how agreement is reached, or perspectives of different actors. Professionals voice concerns about managing parental expectations and beliefs, which can be contrary to their own and may change over time. We conducted the first systematic review to determine what constitutes best medico-legal practice for children under 19 years as context to exploring the perspectives of actors who make judgements and decisions when cancer treatment is no longer curative. METHODS: Theory-informed mixed-method thematic systematic review with theory development. RESULTS: Eight legal/ethical guidelines and 18 studies were included. Whilst there were no unresolved dilemmas, actors had different perspectives and motives. In line with guidelines, the best interests of the individual child informed decisions, although how different actors conceptualized ‘best interests’ when treatment was no longer curative varied. Respect for autonomy was understood as following child/parent preferences, which varied from case to case. Doctors generally shared information so that parents alone could make an informed decision. When parents received reliable information, and personalized interest in their child, they were more likely to achieve shared trust and clearer transition to palliation. Although under-represented in research studies, young people’s perspectives showed some differences to those of parents and professionals. For example, young people preferred to be informed even when prognosis was poor, and they had an altruistic desire to help others by participating in research. CONCLUSION: There needs to be fresh impetus to more effectively and universally implement the ethics of professionalism into daily clinical practice in order to reinforce humanitarian attitudes. Ethical guidelines and regulations attempt to bring professionals together by articulating shared values. While important, ethics training must be supported by institutions/organizations to assist doctors to maintain good professional standards. Findings will hopefully stimulate further normative and descriptive lines of research in this complex under-researched field. Future research needs to be undertaken through a more deliberative cultural lens that includes children’s and multi-disciplinary team members’ perspectives to more fully characterize and understand the dynamics of the decision-making process in this specific end-of life context

Anaphylaxis Associated with Peanuts and Nuts in Late Mexican Adolescents: A Population Based Study

Background: There is a lack of information regarding anaphylaxis that is triggered by the peanut and nuts in countries with emerging economies. We aimed to identify the factors that are related to the prevalence of secondary anaphylaxis that results from ingesting peanuts or nuts. Materials and Methods: A cross-sectional, population-based study was conducted in which we applied a structured questionnaire to a random sample of 1992 adolescents, aged 15 to 18 years. After identifying those subjects with presence of adverse symptoms after food intake, we then asked if this was due to the ingestion of the peanuts or nuts. Factors associated with anaphylaxis were identified through the odds ratio estimation using logistic regression in a multivariate analysis model. Results: The prevalence of global anaphylaxis caused by the peanuts and nuts was 0.9%, n=17 (95% CI: 0.5% to 1.4%); 0.6%, n=12 (95% CI: 0.3% to 1.1%) with any type of nut, and 0.3%, n=7 (95% CI: 0.2% to 0.7%) with the peanut; anaphylaxis caused exclusively by the peanut was recorded at 0.2% (95% CI: 0.1% to 0.6%). Notably, one case of anaphylaxis was triggered by five types of nuts (almond, pecan, Brazilian nut, cashew, and pistachio), another by 4 types (hazelnut, peanut, walnut, pecan, and cashew), there were 9 cases that were prompted by only one food (5 peanut, 2 cashew, 1 chestnut, 1 almond). The only factor found to be associated with anaphylaxis was a personal history of pollen allergy, odds ratio: 10.12 (p = 0.046). Conclusion: The prevalence of anaphylaxis induced by peanuts or nuts in the Mexican population varies from 0.5 to 1.4%; and the personal history of pollen allergy was the only associated factor with anaphylaxis

High-Speed Photothermal Patterning of Doped Polymer Films.

Organic semiconductors (OSCs) offer a new avenue to the next-generation electronics, but the lack of a scalable and inexpensive nanoscale patterning/deposition technique still limits their use in electronic applications. Recently, a new lithographic etching technique has been introduced that uses molecular dopants to reduce semiconducting polymer solubility in solvents and a direct-write laser to remove dopants locally, enabling rapid OSC etching with diffraction limited resolution. Previous publications postulated that the reaction that enables patterning is a photochemical reaction between photoexcited dopants with neutral solvent molecules. In this work, we analyze the photoinduced dissolution kinetics of F4TCNQ doped P3HT films using time-resolved in situ optical probing. We find two competing mechanisms that control de-doping and dissolution: the first is the photochemical reaction posited in the literature, and the second involves direct heating of the polymer by the laser, inducing increased solubility for both the polymer and dopant. We show that the wavelength-specific photochemical effect is dominant in low photon doses while the photothermal effect is dominant with high excitation rates regardless of laser wavelength. With sufficiently high optical intensity input, the photothermal mechanism can in principle achieve a high writing speed up to 1 m/s. Our findings bring new insights into the mechanisms behind laser direct writing of OSCs based on dopant induced solubility control and enable ultraprecise fabrications of various device configurations in large-scale manufacturing

Informed consent: its importance for retrolective research and medical science progress

In retrolective research, the information necessary to answer the research question is directly generated from medical records and other clinical-documentary sources. This article analyzes the waiver of informed consent and privacy notice when research is retrolective, from which two lines of argument emerge: one is the physician’s duty to protect patient dignity, integrity, right to self-determination and privacy, as well as the confidentiality of the information obtained from him; the other is retrolective research contribution to the control of diseases and society’s health improvement. Waiver of informed consent or privacy notice documented in the medical record is important for retrolective research, but it has ethical implications for researchers who do not comply with the rationality and personal responsibility they have before society

Prevalence of allergic sensitization to bee, mosquito and red ant in children with allergic disease

Background: The allergic sensitization to insects of the Hymenoptera and Culicidae order in pediatric population is studied with low frequency. Objective: To determine the prevalence of sensitization to bees, mosquito and fire ants in children with allergic diseases. Material and method: A retrolective and descriptive study was carried out in a pediatric allergy service. The registers of the cutaneous reactivity to bees, mosquitos and fire ants done among January 2009 to December 2011 were analyzed. The frequency of sensitization to insects and its confidence interval to 95% was estimated. Results: The sample included 613 patients, 41% were girls. The age average of the group was 6.2 ± 3.7 years. The allergic sensitization to mosquito was 15% (CI 95%: 12.4-18.1), bees 14.2% (CI 95%: 11.4-16.9) and fire ants 6% (CI 95%: 6.0-6.8) older that non-sensitized, 7.1 vs 6.0 years old (p=0.011) and 7.4 vs 6.1 years old (p=0.042), respectively. During fall and winter seasons, fire ant sensitization was observed with more frequency. Conclusions: In our knowledge this is the first report in Mexico related with sensitization frequency to bees, mosquitos and fire ants carried out on children. Also, our results suggest that sensitization to these insects should be identified more often

Additional file 1: of Decision-making on therapeutic futility in Mexican adolescents with cancer: a qualitative study

Topic guide. Outline of the topic guide. An interview topic guide. (DOCX 34 kb