Working with palliative care physicians to prepare for voluntary assisted dying legislation.

OBJECTIVE: The Victorian Voluntary Assisted Dying Act 2017 (the Act) exposed a spectrum of opinions regarding euthanasia and physician-assisted suicide amongst Victorian palliative care physicians leading to sometimes acrimonious debate. The profession was unable to articulate a unified role in respect of VAD. METHOD: A collaboration between psychiatry and palliative care led to a series of group discussions in order to prepare for the Act and to re-establish professional cohesion. RESULTS: Although the meetings revealed a plurality of views regarding VAD amongst palliative care physicians, the majority were firmly against the Act. Early meetings revealed strong feelings of shock and an inability to proceed. Previous debates resurfaced between those in support and those not in support of VAD. Over time, there was increased acceptance of the need to adapt to the presence of the Act in order to limit its impact on the robust relationship with the patient central to the practice of palliative care. CONCLUSIONS: The implementation of VAD legislation requires an active process to address the challenges it represents for palliative care physicians. Collaborative facilitated meetings can help re-establish group cohesion through affirming the core principles of palliative care which remain independent of VAD.

Support for and willingness to be involved in voluntary assisted dying: a multisite, cross-sectional survey study of clinicians in Victoria, Australia.

BACKGROUND: In the Australian state of Victoria, specialist doctors are central to the operation of voluntary assisted dying (VAD). However, a broad range of clinicians may be involved in the care of patients requesting or using VAD. AIMS: To describe levels of support for and willingness to be involved in VAD and consider factors associated with clinician support for the VAD legislation and physicians' willingness to provide VAD in practice. METHODS: A multisite, cross-sectional survey of clinicians in seven Victorian hospitals. All clinicians were invited to complete an online survey measuring demographic characteristics, awareness of and support for the VAD legislation, willingness to participate in VAD related activities and reasons for willingness or unwillingness to participate in VAD. RESULTS: Of 5690 who opened the survey, 5159 (90.1%) were included in the final sample and 73% (n = 3768) supported the VAD legislation. The strongest predictor of support for the VAD legislation was clinical role. Forty percent (n = 238) of medical specialists indicated they would be willing to participate in either the VAD consulting or coordinating role. Doctors did not differ in willingness between high impact (44%) and low impact specialty (41%); however, doctors specialising in palliative care or geriatric medicine were significantly less willing to participate (27%). CONCLUSION: Approximately 73% of surveyed staff supported Victoria's VAD legislation. However, only a minority of medical specialists reported willingness to participate in VAD, suggesting potential access issues for patients requesting VAD in accordance with the legal requirements in Victoria.

Firearm-related research articles in health sciences by funding status and type: A scoping review.

Federal funding for firearm-related research in the health sciences has incurred Congressional restrictions and executive actions. Little is known about the funding landscape for published scholarship in this field. This study's aim was to characterize the number and sources of funding, including federal and non-federal sources, for firearm-related research articles published in health sciences journals. We performed a scoping review of original, empirical, peer-reviewed articles related to firearms published in health science journals and indexed in PubMed between January 2000 and December 2019, using the PRISMA extension for Scoping Review checklist. Four reviewers independently screened each article twice for inclusion. Included articles were reviewed again to identify funding sources. Articles were characterized as having explicitly declared funding, explicitly declared no funding, or no explicit funding declaration. Among articles with funding, we examined proportions by funding source. 812 articles met the inclusion criteria. 119 (14.7%) of the articles declared not having received any funding, and 240 (29.6%) had no funding declaration. 453 (55.8%) of the articles declared at least one source of funding. Of those, 221 (48.8%) reported at least one federal grant, and 232 (51.2%) reported at least one philanthropic grant. The number of published articles increased by 328.6% between 2000 and 2019. While the volume increased during the study period, the proportion of articles with funding was lower in 2019 (55.6%) than it was in 2000 (87.5%; proportion difference: 31.9%; 95% CI: 16.7%-47.2%). This study highlights the continued funding limitations in this field despite a growing volume of research.

Palliative care physicians' preparation and planning for the implementation of the Voluntary Assisted Dying Act in Victoria.

BACKGROUND: In November 2017, the Victorian Voluntary Assisted Dying (VAD) Act was passed enabling people with a progressive terminal illness to end their life voluntarily. Heated debate abounded including, to some extent within palliative care, which was also challenged with developing processes around the legislation enactment. AIM: In response, the lead author convened a series of meetings of palliative care physicians to: (i) share ideas about preparations being undertaken within services; and (ii) re-establish professional cohesion following the divide that the legislation had presented. METHODS: A series of three closed meetings were held between the legislation passage and its implementation, with all Victorian palliative care physicians invited to attend. Meetings were facilitated by an experienced psychiatrist from outside the field. RESULTS: These meetings proved very valuable as physicians collectively sought to define and respond to challenges, simultaneously reflecting on the personal and professional implications for individuals and the field. Key areas raised including gauging institutional 'readiness' for the legislation through staff surveys; the educational role of palliative care staff of the legislation implications; communication skills training; the role (if any) of palliative care in the processes of VAD; and the perceptions of palliative care itself in health services and the community. It was during the processes of discussing challenges and sharing solutions that the attendees appeared to reaffirm their professional interconnections. CONCLUSION: A description of the key elements of these discussions may be useful to others who may yet face similar circumstances with the introduction of VAD legislation.

Biomechanical Effects of Fiber Patch Augmentation on Rotator Cuff Repairs.

Rotator cuff repairs are a common orthopedic procedure that have a relatively high failure rate when tendon quality is poor. New biotechnology exists that can make tendons with poor quality more amenable to repair. This study examined the biomechanical effects of augmenting a rotator cuff repair with an absorbable fiber patch. Six human cadaveric supraspinatus tendons were prepared into 1-cm wide strips and then repaired to the rotator cuff footprint using a titanium anchor and a single mattress suture. Each shoulder underwent repair with and without a fiber patch. The specimens were subjected to cyclic loading (100 cycles) and load-to-failure (LTF) testing. Gap formation after 100 cycles was measured along with LTF in surviving specimens. Gap formation after 100 cycles was 1.07 mm in the suture-only group and 0.50 mm in the fiber patch-augmented group (P=.002). Load-to-failure was 54.26 N in the suture-only group and 109.53 N in the patch-augmented group (P<.001). The use of a fiber patch to augment rotator cuff repair reduced gap formation and increased LTF. [Orthopedics. 2020; 43(1):42-45.].

Cornelia de Lange syndrome: a case study.

Cornelia de Lange syndrome (CdLS) is a rare dysmorphogenic disorder characterized by growth retardation, severe cognitive limitations, distinctive facial features, and limb reduction anomalies recognizable at birth. Currently, no single criterion is diagnostic for CdLS, and misdiagnosis is not uncommon. Long-term management of the infant with CdLS requires a coordinated effort among many different specialists. This article presents a general overview of Cornelia de Lange syndrome. It concludes with a case study illustrating the many problems infants with CdLS may have and the great amount of teaching and support that is needed by families affected by CdLS.