Healthy as a trout – as delicate as a dragon-fly

Travail créatif / Creative WorkLes hôpitaux de réadaptation offrent un contraste saisissant entre le personnel, qui est en grande partie jeune, en forme et en bonne santé, et les patients, qui ont subi des événements importants, souvent brutaux, qui changent leur vie. Combler le fossé entre ces deux mondes n’est pas facile, mais il peut aussi être difficile de concilier les valeurs des patients hospitalisés avant une blessure ou une maladie à ceux qui sont la voie de la guérison. Ceux qui travaillent dans la médecine de réadaptation promeuvent souvent un modèle de processus de consentement parce qu’ils comprennent que les patients avec des blessures fraîches peuvent avoir besoin de temps pour adapter leurs valeurs à leur nouvelle vie. Malgré cette compréhension, il peut être un défi de déterminer la meilleure façon de respecter l’autonomie du patient, tout en aidant ces mêmes patients à apprécier quelques-unes des limites de leurs capacités. La rédaction du récit personnel qui suit, tiré de ma propre expérience d'éthicienne de soins de santé et un patient réticent, m’a donné un meilleur aperçu de ces perplexités. Cette réflexion explore mon changement d’approche dans ma pratique professionnelle – et surtout dans ma vision de l’autonomie du patient – à la lumière de ma propre expérience avec la dépression post-partum.Rehabilitation hospitals provide a striking contrast between young, fit and largely able-bodied staff and patients who have experienced significant, often sudden, life-changing events. Bridging the gap between these worlds is not easy, but it can also be difficult to reconcile the values that the patients held before injury or illness with those that have begun to emerge on the road to recovery. Those working in rehabilitation medicine often endorse a process model of consent because they understand that patients with fresh injuries may need time for their values to adapt to their new lives. Despite this understanding, it can be a challenge to understand how best to respect patient autonomy whilst helping those same patients to appreciate some of the limits on their abilities. Drafting the following personal narrative, drawn from my own experience as a healthcare ethicist and reluctant patient, gave me greater insight into these perplexities. This reflection explores my changing approach to my professional practice – and especially my view of patient autonomy – in light of my own experience with post-partum depression

Protocol for the isolation and purification of human follicular dendritic cells for functional assays

In this protocol, we detail how to isolate and purify human follicular dendritic cells (FDCs) from lymphoid tissues. FDCs play a vital role in antibody development by presenting antigens to B cells in germinal centers. The assay involves enzymatic digestion and fluorescence-activated cell sorting and is successfully applied to various lymphoid tissues, including tonsils, lymph nodes, and tertiary lymphoid structures. Our robust technique enables the isolation of FDCs and facilitates downstream functional and descriptive assays. For complete details on the use and execution of this protocol, please refer to Heesters et al

Associations of dry skin, skin care habits, well‐being, sleep quality and itch in nursing home residents : results of a multicentre, observational, cross‐sectional study

Aim: Dry skin is one of the most frequent cutaneous problems in aged long-term care residents. Although it is clinically relevant, the impact on quality of life is unclear. The objective was to measure well-being, sleep quality and itch in nursing home residents being 65 years and older and to explore possible associations with demographics, dry skin and skincare habits. Design: Multicentre, observational, cross-sectional. Methods: Sleep quality was assessed with the Richards-Campbell Sleep Quality Questionnaire, well-being with the WHO-Five Well-being Index and itch with the 5-D Itch scale. Skin dryness was measured using the Overall Dry Skin score. Results: A total of 51 residents were included. The item scores of the sleep quality and itch questionnaires were strongly associated with each other. Demographics, dry skin and skincare habits were not associated with the questionnaires. It is unclear whether basic skincare activities can improve the quality of life in this population

Data Segmentation in Electronic Health Information Exchange: Policy Considerations and Analysis

The issue of whether and, if so, to what extent patients should have control over the sharing or withholding of their health information represents one of the foremost policy challenges related to electronic health information exchange. It is widely acknowledged that patients\u27 health information should flow where and when it is needed to support the provision of appropriate and high-quality care. Equally significant, however, is the notion that patients want their needs and preferences to be considered in the determination of what information is shared with other parties, for what purposes, and under what conditions. Some patients may prefer to withhold or sequester certain elements of health information, often when it is deemed by them (or on their behalf) to be sensitive, whereas others may feel strongly that all of their health information should be shared under any circumstance. This discussion raises the issue of data segmentation, which we define for the purposes of this paper as the process of sequestering from capture, access or view certain data elements that are perceived by a legal entity, institution, organization, or individual as being undesirable to share. This whitepaper explores key components of data segmentation, circumstances for its use, associated benefits and challenges, various applied approaches, and the current legal environment shaping these endeavors

The mediating roles of workplace support and ethical work environment in associations between leadership and moral distress:a longitudinal study of Canadian health care workers during the COVID-19 pandemic

Introduction: The COVID-19 pandemic has resulted in heightened moral distress among health care workers (HCWs) worldwide. Past research has shown that effective leadership may mitigate potential for the development of moral distress. However, no research to date has considered the mechanisms by which leadership might have an influence on moral distress. We sought to evaluate longitudinally whether Canadian HCWs’ perceptions of workplace support and ethical work environment would mediate associations between leadership and moral distress.Methods: A total of 239 French- and English-speaking Canadian HCWs employed during the COVID-19 pandemic were recruited to participate in a longitudinal online survey. Participants completed measures of organizational and supervisory leadership at baseline and follow-up assessments of workplace support, perceptions of an ethical work environment, and moral distress.Results: Associations between both organizational and supervisory leadership and moral distress were fully mediated by workplace supports and perceptions of an ethical work environment.Discussion: To ensure HCW well-being and quality of care, it is important to ensure that HCWs are provided with adequate workplace supports, including manageable work hours, social support, and recognition for efforts, as well as an ethical workplace environment