Publications by authors named "Gillam L"
The use of puberty blockers and gender-affirming hormones by transgender adolescents is the subject of an ongoing public debate. In this paper, we address one central ethical aspect of the debate - the question of what sort of benefits these treatments provide and how to evaluate the significance of these benefits in relation to risks. We argue that the intended benefit of these treatments is best understood as appearance congruence, namely, to create or maintain alignment of physical appearance with one's gender identity.
View Article and Find Full Text PDFAims: To explore the experiences, and perceptions of nurses who are told to withhold clinical information from children diagnosed with serious illnesses.
Design: An interpretative qualitative phenomenological design was used for the study. Sampling was purposive and data were collected using semi-structured interviews from nurses working in a paediatric setting within the preceding 5 years.
Article Synopsis
- Historically, women with aortic stenosis have been underdiagnosed and faced worse outcomes compared to men, leading to the need for better treatment recognition and participation in clinical trials.
- The SMART trial aimed to compare the clinical and hemodynamic outcomes of women with small aortic annuli receiving either self-expanding valves (SEVs) or balloon-expandable valves (BEVs) during transcatheter aortic valve replacement.
- In a study of 621 women, no significant differences were observed in the main clinical outcomes between the SEV and BEV groups after 12 months, but SEVs showed a lower rate of bioprosthetic valve dysfunction.
Article Synopsis
- Aortic valve replacement (AVR) is crucial for patients with severe aortic regurgitation (AR), but some with moderate AR may also face high mortality if untreated.
- A study analyzed over 81,000 patients with AR to understand how various clinical factors, like left ventricular function and heart dilation, influence mortality risk.
- The findings indicate that both moderate and severe AR, along with specific cardiac damage markers, significantly increase mortality risk, suggesting a need for further investigation on AVR for those with less severe AR but concerning clinical features.
Heart Failure and Secondary Mitral Regurgitation: A Contemporary Review.
J Soc Cardiovasc Angiogr Interv
December 2023
Article Synopsis
- Secondary mitral regurgitation (SMR) in heart failure patients is linked to high morbidity and mortality, prompting increased scientific focus and improved diagnostic methods like echocardiography and cardiac imaging.
- Treatment has evolved to include guideline-directed medical therapies, aimed at addressing the underlying heart issues, along with diuretics and cardiac resynchronization therapy, which can help alleviate symptoms and improve survival.
- Innovative procedures like transcatheter edge-to-edge repair (TEER) show promise in enhancing survival and quality of life for symptomatic patients, emphasizing the need for a multidisciplinary approach to optimize treatment strategies for high-risk individuals.
In clinical ethics consultations, clinical ethicists bring moral reasoning to bear on concrete and complex clinical ethical problems by undertaking ethical deliberation in collaboration with others. The reasoning process involves identifying and clarifying ethical values which are at stake or contested, and guiding clinicians, and sometimes patients and families, to think through ethically justifiable and available courses of action in clinical situations. There is, however, ongoing discussion about the various methods ethicists use to do this ethical deliberation work.
View Article and Find Full Text PDFObjective: To examine i) how ethical frameworks can be used in concrete cases of parent-doctors' disagreements for extremely preterm infants born in the grey zone to guide such difficult decision-making; and ii) what challenges stakeholders may encounter in using these frameworks.
Design: We did a case analysis of a concrete case of parent-doctor disagreement in the grey zone using two ethical frameworks: the best interest standard and the zone of parental discretion.
Results: Both ethical frameworks entailed similar advantages and challenges.
Background: The prognostic value of cardiac damage staging classification based on the extent of extravalvular damage has been proposed in moderate/severe aortic stenosis (AS).
Objectives: The purpose of this study was to assess the association of cardiac damage staging with mortality across the spectrum of patients with AS following aortic surgical or transcatheter aortic valve replacement (AVR).
Methods: We conducted a pooled meta-analysis of Kaplan-Meier-derived reconstructed time-to-event data from studies published through February 2023.
Article Synopsis
- The study analyzed real-world data on aortic regurgitation (AR) severity to assess patient evaluations by the Heart Valve Team, rates of aortic valve replacement (AVR), and mortality among untreated patients.
- Data were collected from over a million patients from various US institutions, focusing specifically on those with documented AR severity from echocardiograms.
- Findings revealed that patients with moderate-to-severe AR had low rates of Heart Valve Team evaluations and AVR and experienced increased mortality rates, highlighting the need for earlier referrals for better outcomes.
International and national oncofertility networks, including the US-led Oncofertility Consortium, FertiProtekt, and the Danish Network, have played pivotal roles in advancing the discipline of oncofertility over the last decade. Many other countries lack a shared approach to pediatric oncofertility health service delivery. This study aims to describe baseline oncofertility practices at Australian New Zealand Children's Haematology/Oncology Group centers in 2019-2021, describe binational priorities for care, and propose a 5-year action plan for best practice to be implemented by the newly formed Australian New Zealand Consortium in Children, Adolescents, and Young Adults (CAYA) Oncofertility (ANZCO).
View Article and Find Full Text PDFBackground: Patients with severe aortic stenosis and a small aortic annulus are at risk for impaired valvular hemodynamic performance and associated adverse cardiovascular clinical outcomes after transcatheter aortic-valve replacement (TAVR).
Methods: We randomly assigned patients with symptomatic severe aortic stenosis and an aortic-valve annulus area of 430 mm or less in a 1:1 ratio to undergo TAVR with either a self-expanding supraannular valve or a balloon-expandable valve. The coprimary end points, each assessed through 12 months, were a composite of death, disabling stroke, or rehospitalization for heart failure (tested for noninferiority) and a composite end point measuring bioprosthetic-valve dysfunction (tested for superiority).
Article Synopsis
- Frailty linked to worse outcomes post-transcatheter aortic valve replacement (TAVR) and is often underpinned by sarcopenia, which includes muscle mass, strength, and performance, though their impact on TAVR outcomes hasn't been fully studied.
- In a study of 445 patients with severe aortic stenosis, significant percentages were found to have slow gait (56%), weak grip (59%), and low muscle mass (42%); only slower gait speed showed a clear link to increased mortality after TAVR.
- The research indicates that while overall body fat measurements and sarcopenia criteria influence mortality risk, lower visceral fat and slow gait speed are main factors affecting post-TAVR death rates.
Background/objectives: Shared decision-making is widely accepted as the best approach for end-of-life decision-making for children with life-limiting conditions. Both paediatricians and parents find benefit in preparing for such decisions. However, little detail is known about this preparatory process.
View Article and Find Full Text PDFBackground: Nurses play an integral role in the care of children hospitalised with a serious illness. Although information about diagnostics, treatments, and prognosis are generally conveyed to parents and caregivers of seriously ill children by physicians, nurses spend a significant amount of time at the child's bedside and have an acknowledged role in helping patients and families understand the information that they have been given by a doctor. Hence, the ethical role of the nurse in truth disclosure to children is worth exploring.
View Article and Find Full Text PDFBackground: The CLASP IID randomized trial (Edwards PASCAL TrAnScatheter Valve RePair System Pivotal Clinical Trial) demonstrated the safety and effectiveness of the PASCAL system for mitral transcatheter edge-to-edge repair (M-TEER) in patients at prohibitive surgical risk with significant symptomatic degenerative mitral regurgitation (DMR).
Objectives: This study describes the echocardiographic methods and outcomes from the CLASP IID trial and analyzes baseline variables associated with residual mitral regurgitation (MR) ≤1+.
Methods: An independent echocardiographic core laboratory assessed echocardiographic parameters based on American Society of Echocardiography guidelines focusing on MR mechanism, severity, and feasibility of M-TEER.
One-Year Outcomes From the CLASP IID Randomized Trial for Degenerative Mitral Regurgitation.
JACC Cardiovasc Interv
October 2023
Background: The CLASP IID (Edwards PASCAL TrAnScatheter Valve RePair System Pivotal Clinical) trial is the first randomized controlled trial comparing the PASCAL system and the MitraClip system in prohibitive risk patients with significant symptomatic degenerative mitral regurgitation (DMR).
Objectives: The study sought to report primary and secondary endpoints and 1-year outcomes for the full cohort of the CLASP IID trial.
Methods: Prohibitive-risk patients with 3+/4+ DMR were randomized 2:1 (PASCAL:MitraClip).
Objectives: We aimed to explore the psychometric properties of the first known online asynchronous multiple mini-interview (MMI) designed for fairness with subgroup analyses by key characteristics, usability and acceptability.
Design: Cross-discipline multimethod evaluation.
Setting: One UK University.
Background: Favorable 6-month outcomes from the CLASP IID Registry (Edwards PASCAL transcatheter valve repair system pivotal clinical trial) demonstrated that mitral valve transcatheter edge-to-edge repair with the PASCAL transcatheter valve repair system is safe and beneficial for treating prohibitive surgical risk degenerative mitral regurgitation (DMR) patients with complex mitral valve anatomy.
Objectives: The authors sought to assess 1-year safety, echocardiographic and clinical outcomes from the CLASP IID Registry.
Methods: Patients with 3+ or 4+ DMR who were at prohibitive surgical risk, had complex mitral valve anatomy based on the MitraClip Instructions for Use, and deemed suitable for treatment with the PASCAL system were enrolled prospectively.
Background: The American College of Cardiology/American Heart Association guidelines recommend the assessment and grading of severity of aortic stenosis (AS) as mild, moderate, or severe, per echocardiogram, and recommend aortic valve replacement (AVR) when the AS is severe.
Objectives: The authors sought to describe mortality rates across the entire spectrum of untreated AS from a contemporary, large, real-world database.
Methods: We analyzed a deidentified real-world data set including 1,669,536 echocardiographic reports (1,085,850 patients) from 24 U.