Background: A structured family meeting (FM) is recommended within 72 h of admission for trauma patients with high risk of mortality or disability. Multidisciplinary FMs (MDFMs) may further facilitate decision-making. We hypothesized that FM within three hospital days (HDs) or MDFM would be associated with increased use of comfort measures. Materials and methods:We reviewed all adult trauma deaths at an academic level 1 trauma center from December 2014 to December 2017. Death in the first 24 h or on nonsurgical services were excluded. Demographics, injury characteristics, FM characteristics, and outcomes such as length of stay (LOS) were recorded. Early FM was defined as occurring within three HDs; MDFM required attendance by two or more specialty teams.Results: A total of 177 patients were included. Median LOS was 6 d (interquartile range 4-12). FMs were documented in 166 patients (94%), with 57% occurring early. MDFM occurred in 49 (28%), but usually occurred later (median HD 5 and interquartile range 2-8). Early FM was associated with reduced LOS (5 versus 11 d, P < 0.001), ventilator days (4 versus 9 d, P < 0.001), and deaths during a code (1.2% versus 13.2%, P < 0.001). MDFM was associated with higher use of comfort measures (88% versus 68%, P < 0.05). Of patients who transitioned to comfort care status (n = 130, 73.4%), code status change occurred earlier if an early FM occurred (5 versus 13 d, P < 0.001).Conclusions: MDFM is associated with increased comfort care measures, whereas early FM is associated with reduced LOS, ventilator days, death during a code, and earlier comfort care transition.

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Ovarian tissue cryopreservation is the key step towards the establishment of an ovarian tissue bank or the preservation of ovarian tissue for patients scheduled for gonadotoxic cancer therapies, aiming for fertility restoration later on. Conventional cryopreservation, or slow freezing, has been the mainstay of ovarian tissue cryopreservation. Vitrification has recently emerged as a new trend for biological specimen preservation. It has shown increasing success over slow freezing, especially with oocytes, which is mainly attributed to avoiding ice formation. Much research is underway to investigate the application of vitrification to ovarian tissue. Ovarian tissue vitrification may have specific challenges and requirements that differ from single cell or oocyte vitrification. The medical literature was searched for studies on ovarian tissue vitrification using the keywords: ovary, ovarian tissue, transplantation, vitrification, cryopreservation, and freezing. After authors' agreement, relevant citations were analyzed. Thirty studies reported the ovarian tissue vitrification of 11 species, using different vitrification methods and different outcome measures. The vitrification of ovarian tissue is a promising alternative to slow freezing. However, proper ovarian tissue preparation and the specific method of vitrification are both key factors that determine the viability and functionality of preserved tissue in other applications, notably transplantation.

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Study type diagnostic test, level III.

A new blood culture system resulted in significant increases in the rates of positive, contaminated, and pathogen BCx. After the new system, multiple hospital units had contamination rates >3%. These data suggest that a "better" BCx system may not be superior regarding overall infection rates. More research is needed to determine the impact of identifying more contaminants and pathogens with the new system.

Background Missed documentation for critical care time (CCT) for dying patients may represent a missed opportunity for physicians to account for intensive care unit (ICU) services, including end-of-life care. We hypothesized that CCT would be poorly documented for dying trauma patients. Methods Adult trauma ICU patients who died between December 2014 and December 2017 were analyzed retrospectively. Critical care time was not calculated for patients with comfort care code status. Critical care time on the day prior to death and day of death was collected. Logistic regression was used to determine factors associated with documented CCT. Results Of 147 patients, 43% had no CCT on day prior to death and 55% had no CCT on day of death. 82% had a family meeting within 1 day of death. Family meetings were independently associated with documented CCT (OR 3.69, P = .008); palliative care consultation was associated with decreased documented CCT (OR .24, P < .001). Conclusions Critical care time is not documented in half of eligible trauma patients who are near death. Conscious (time spent in family meetings and injury acuity) and unconscious factors (anticipated poor outcomes) likely affect documentation.