Introduction. Although residents frequently lead end-of-life (EOL) discussions in the intensive care unit (ICU), training in EOL care during residency has been required only recently, and few educational interventions target EOL communication in the ICU. This study evaluated a simulation-based intervention designed to improve resident EOL communication skills with families in the ICU. Methods. Thirty-four second-year internal medicine residents at a large urban teaching hospital participated in small group sessions with faculty trained in the “VitalTalk” method. A Likert-type scale questionnaire measured self-assessed preparedness before, immediately following, and approximately 9 months after intervention. Data were analyzed using Wilcoxon rank-sum analysis. Results. Self-assessed preparedness significantly improved for all categories surveyed (preintervention mean; postintervention mean; p value), including discussing bad news (3.3; 4.2; p < 0.01), conducting a family conference (3.1; 4.1; p < 0.01), discussing treatment options (3.2; 3.9; p < 0.01), discussing discontinuing ICU treatments (2.9; 3.5; p < 0.01), and expressing empathy (3.9; 4.5; p < 0.01). Improvement persisted at follow-up for all items except “expressing empathy.” Residents rated the educational quality highly. Conclusion. This study provides evidence that brief simulation-based interventions can produce lasting improvements in residents' confidence to discuss EOL care with family members of patients in the ICU.
Introduction-To probe the interplay between radiotracer stability and somatostatin receptor affinity, Tyr 3 -octreotate and six variations of its peptide sequence, for which the Re-cyclized products were previously reported, were radiolabeled with 99m Tc and investigated for their in vitro stability.Methods-Radiolabeling of the peptides was effected by ligand exchange from 99m Tcglucoheptonate, and the desired products were purified by radio-RP-HPLC. The in vitro stability in phosphate-buffered saline, mouse serum, and cysteine solutions at physiological temperature and pH for all seven 99m Tc-cyclized peptides was determined by radio-RP-HPLC and radio-TLC. Normal CF-1 mouse biodistribution studies were performed for three of the 99m Tc-cyclized peptides.Results-Based on the fully characterized Re-cyclized peptide analogues, four 99m Tccoordination motifs were proposed for the 99m Tc-cyclized peptides. Technetium-99m-cyclized Tyr 3 -octreotate derivatives with N 2 S 2 metal coordination modes and large metal ring sizes were susceptible to oxidation and loss of 99m Tc in the form of 99m TcO 4 − , as evidenced by their instability in the various solutions under physiological conditions (15-58% intact at 24 h). As anticipated, the addition of a third cysteine to the sequence stabilized the 99m Tc metal coordination, and peptides with NS 3 coordination modes remained >85% intact out to 24 h. No significant differences were observed in the biodistribution studies performed with three peptides of varying stabilities.Conclusions-Improvements in stability were not sufficient to outweigh the low somatostatin receptor affinity for the peptides in this study. Further improvements in the peptide sequence and/ or metal coordination are needed to result in a radiodiagnostic/radiotherapeutic pair for targeting the somatostatin receptor.
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