Anesthesiology trainees face ethical, practical and relational challenges in obtaining informed consent

BACKGROUND: Categorizing difficulties anesthesiologists have in obtaining informed consent may influence education, performance, and research. This study investigated the trainees' perspectives and educational needs through a qualitative analysis of narratives. METHODS: The Program to Enhance Relational and Communication Skills-Anesthesia used professional actors to teach communication skills and relational abilities associated with informed consent. Before attending the program, participants wrote about a challenging informed consent experience. Narratives were analyzed by two researchers following the principles of grounded theory. The researchers independently read the narratives and marked key words and phrases to identify reoccurring challenges described by anesthesiologists. Through rereading of the narratives and discussion, the two researchers reached consensus on the challenges that arose and calculated their frequency. RESULTS: Analysis of the 39 narratives led to the identification of three types of challenges facing anesthesiologists in obtaining informed consent. Ethical challenges included patient wishes not honored, conflict between patient and family wishes and medical judgment, patient decision-making capacity, and upholding professional standards. Practical challenges included the amount of information to provide, communication barriers, and time limitations. Relational challenges included questions about trainee competence, mistrust associated with previous negative experiences, and misunderstandings between physician and patient or family. CONCLUSIONS: The ethical, practical, and relational challenges in obtaining informed consent colored trainees' views of patient care and affected their interactions with patients. Using participant narratives personalizes education and motivates participants. The richness of narratives may help anesthesiologists to appreciate the qualitative aspects of informed consent

Physical mechanisms produced in the development of nursery almond trees (Prunus dulcis Miller) as a response to the plant adaptation to different substrates

[EN] Aims: The aim pursued in this work is to compare the changes induced in the plant of young almond tree by two different culture media, analysing how those changes are interrelated with a better adaptation of the plant to the open field. Methods: Two different rootstocks, GF 677 and GxN rootstock Garnem® (GN), were tested in two types of growing media: substrate 1, consisting on a substrate prepared on request and based on a mixture of 25% silica, 38% vaporized peat and 37% of washed river sand and substrate 2, based on cocopeat with coarse particle size (10¿25 mm). All plants received the same nutritive solution during the analysis. Twenty weeks after the plantation trees were uprooted and several parameters were recorded in both vegetative and radicular systems to observe the impact of the substrates. Results: The results of this study indicated that the use of different substrates produces statistically significant changes not only in root development and distribution but also in the vegetative growth. Plants grown under cocopeat substrate presented, among others, further development of the trunk and an increase in the total fresh weight of the radicular system produced mostly by a massive increase of absorbing roots, while plants under substrate 1 presented greater root system longitude. Conclusions: The selection of an appropriate substrate in the nursery of almond trees is a key factor in the early development of the young tree. Knowledge about root growth and root architecture during the first stages of development would help nursery industry to determine which should be the most suitable substrate regarding later field adaptation, survival and plant performance, focusing on the soil and climatic characteristics of the final destination of the plant.Mondragón-Valero, A.; López- Cortés, I.; Salazar Hernández, DM.; Fernández De Córdova Martínez, PJ. (2017). Physical mechanisms produced in the development of nursery almond trees (Prunus dulcis Miller) as a response to the plant adaptation to different substrates. Rhizosphere. 3(1):44-49. doi:10.1016/j.rhisph.2016.12.002S44493