Publications by authors named "D S Diekema"

467 Publications

Effectiveness and acceptability of intranasal povidone-iodine decolonization among fracture fixation surgery patients to reduce nasal colonization.

Infect Control Hosp Epidemiol 2022 Jun 15:1-3. Epub 2022 Jun 15.

Department of Orthopedics and Rehabilitation, University of Iowa Hospitals & Clinics, Iowa City, Iowa.

We evaluated povidone-iodine (PVI) decolonization among 51 fracture-fixation surgery patients. PVI was applied twice on the day of surgery. Patients were tested for nasal colonization and surveyed. Mean concentrations decreased from 3.13 to 1.15 CFU/mL ( = .03). Also, 86% of patients stated that they felt neutral or positive about their PVI experience.
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http://dx.doi.org/10.1017/ice.2022.134DOI Listing
June 2022

Coronavirus disease 2019 (COVID-19) among nonphysician healthcare personnel by work location at a tertiary-care center, Iowa, 2020-2021.

Infect Control Hosp Epidemiol 2022 Jun 2:1-4. Epub 2022 Jun 2.

Stanford University, Stanford, California, United States.

We describe COVID-19 cases among nonphysician healthcare personnel (HCP) by work location. The proportion of HCP with coronavirus disease 2019 (COVID-19) was highest in the emergency department and lowest among those working remotely. COVID-19 and non-COVID-19 units had similar proportions of HCP with COVID-19 (13%). Cases decreased across all work locations following COVID-19 vaccination.
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http://dx.doi.org/10.1017/ice.2022.148DOI Listing
June 2022

An ethical analysis of obesity as a contraindication of pediatric kidney transplant candidacy.

Pediatr Nephrol 2022 Apr 29. Epub 2022 Apr 29.

Division of Bioethics and Palliative Care Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA.

The inclusion of body mass index (BMI) as a criterion for determining kidney transplant candidacy in children raises clinical and ethical challenges. Childhood obesity is on the rise and common among children with kidney failure. In addition, obesity is reported as an independent risk factor for the development of CKD and kidney failure. Resultantly, more children with obesity are anticipated to need kidney transplants. Most transplant centers around the world use high BMI as a relative or absolute contraindication for kidney transplant. However, use of obesity as a relative or absolute contraindication for pediatric kidney transplant is controversial. Empirical data demonstrating poorer outcomes following kidney transplant in obese pediatric patients are limited. In addition, pediatric obesity is distributed inequitably among groups. Unlike adults, most children lack independent agency to choose their food sources and exercise opportunities; they are dependent on their families for these choices. In this paper, we define childhood obesity and review (1) the association and impact of obesity on kidney disease and kidney transplant, (2) existing adult guidelines and rationale for using high BMI as a criterion for kidney transplant, (3) the prevalence of childhood obesity among children with kidney failure, and (4) the existing literature on obesity and pediatric kidney transplant outcomes. We then discuss ethical considerations related to the use of obesity as a criterion for kidney transplant.
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http://dx.doi.org/10.1007/s00467-022-05572-8DOI Listing
April 2022

Caregiver COVID-19 vaccination for solid organ transplant candidates.

Am J Transplant 2022 Apr 29. Epub 2022 Apr 29.

Department of Pediatrics, University of Washington, Seattle, Washington, USA.

An increasing proportion of transplant centers have implemented a mandate for vaccination against COVID-19 for solid organ transplant candidates. There has been comparatively little exploration of the ethical considerations of mandating vaccination of a candidate's primary caregiver, despite a high risk of transmission given the close nature of contact between the candidate and caregiver. We examine how a caregiver mandate can improve overall utility in organ allocation, particularly in circumstances where vaccine effectiveness at preventing transmission and serious disease is low among recipients but high in caregivers. Our analysis reveals how sensitive such mandates must be to the evolving circumstances of disease severity, transmissibility, and vaccine effectiveness: as the facts change, the degree of benefit gained and therefore the degree of infringement on access to transplant and caregiver choice that is tolerated will likewise change.
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http://dx.doi.org/10.1111/ajt.17078DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9111252PMC
April 2022

Perspectives of Triage Team Members Participating in Statewide Triage Simulations for Scarce Resource Allocation During the COVID-19 Pandemic in Washington State.

JAMA Netw Open 2022 04 1;5(4):e227639. Epub 2022 Apr 1.

Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon.

Importance: The COVID-19 pandemic prompted health care institutions worldwide to develop plans for allocation of scarce resources in crisis capacity settings. These plans frequently rely on rapid deployment of institutional triage teams that would be responsible for prioritizing patients to receive scarce resources; however, little is known about how these teams function or how to support team members participating in this unique task.

Objective: To identify themes illuminating triage team members' perspectives and experiences pertaining to the triage process.

Design, Setting, And Participants: This qualitative study was conducted using inductive thematic analysis of observations of Washington state triage team simulations and semistructured interviews with participants during the COVID-19 pandemic from December 2020 to February 2021. Participants included clinician and ethicist triage team members. Data were analyzed from December 2020 through November 2021.

Main Outcomes And Measures: Emergent themes describing the triage process and experience of triage team members.

Results: Among 41 triage team members (mean [SD] age, 50.3 [11.4] years; 21 [51.2%] women) who participated in 12 simulations and 21 follow-up interviews, there were 5 Asian individuals (12.2%) and 35 White individuals (85.4%); most participants worked in urban hospital settings (32 individuals [78.0%]). Three interrelated themes emerged from qualitative analysis: (1) understanding the broader approach to resource allocation: participants strove to understand operational and ethical foundations of the triage process, which was necessary to appreciate their team's specific role; (2) contending with uncertainty: team members could find it difficult or feel irresponsible making consequential decisions based on limited clinical and contextual patient information, and they grappled with ethically ambiguous features of individual cases and of the triage process as a whole; and (3) transforming mindset: participants struggled to disentangle narrow determinations about patients' likelihood of survival to discharge from implicit biases and other ethically relevant factors, such as quality of life. They cited the team's open deliberative process, as well as practice and personal experience with triage as important in helping to reshape their usual cognitive approach to align with this unique task.

Conclusions And Relevance: This study found that there were challenges in adapting clinical intuition and training to a distinctive role in the process of scarce resource allocation. These findings suggest that clinical experience, education in ethical and operational foundations of triage, and experiential training, such as triage simulations, may help prepare clinicians for this difficult role.
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http://dx.doi.org/10.1001/jamanetworkopen.2022.7639DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9016492PMC
April 2022
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