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AMA Journal of Ethics

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https://www.readbyqxmd.com/read/29905139/the-four-quadrant-approach-to-ethical-issues-in-burn-care
#1
Chad M Teven, Lawrence J Gottlieb
Burn injuries raise questions about decision-making capacity, informed consent, medical decision making, patient autonomy, the patient-physician relationship, and medical futility that must be acutely addressed. A commonly used approach to managing ethical challenges focuses on moral principles including respect for patient autonomy, beneficence, nonmaleficence, and justice. Another paradigm for ethical analysis is the "four-quadrant" approach, which poses questions for a given case regarding medical indications, patient preferences, quality of life, and contextual features...
June 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29905138/ask-me-about-my-pearls-burn-care-ethics-and-creative-writing
#2
Debra Ann Reilly, Steve Langan
Channeling feelings into the written word rather than the scalpel was at the heart of the creative writing challenge that the first author (DR) accepted when she joined the Seven Doctors Project at the University of Nebraska Medical Center in 2008. Burnout has become recognized as a factor undermining physicians' quality of life, and the practice of creative writing helps mitigate stress and sustain a successful practice. When physicians partner with and are mentored by a seasoned creative writer, creative writing can serve as an exercise in ethical reflection, which is particularly valuable at mid-career; this is the subject of the following dialogue between one physician writer and the facilitator of the Seven Doctors Project creative writing class...
June 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29905137/getting-past-dax
#3
Monica L Gerrek
Much has been written about Dax Cowart's tragic burn injury, treatment, and recovery. While Dax's case is certainly important to conversations regarding decision making in burn care, his is not the only story there is. In this article, the case of Andrea Rubin, also a severe burn survivor, is introduced as another voice in this conversation. Her experience during treatment and recovery is very different from Dax's and should cause us to at least pause and reconsider how we think about treatment and decision making in burn care...
June 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29905136/ethics-of-burn-wound-care-in-a-low-middle-income-country
#4
Shelley Wall, Nikki Allorto, Ross Weale, Victor Kong, Damian Clarke
This review focuses on burn care in low- and middle-income countries (LMICs). It attempts to put the burden of disease in perspective by showing that burn care is under-resourced across the spectrum of LMICs and by interrogating the ethical dilemmas and challenges that staff face in caring for burn patients in this environment, with a focus on South Africa. More specifically, it will attempt to address the following issues: the threshold for utilizing the intensive care unit (ICU), how to balance treatment against cost, the percentage burn considered survivable and how it should be determined, the use of skin from both cadavers and living related donors, and the appropriate ethical guidelines for LMICs...
June 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29905135/defining-adequate-quality-and-safety-metrics-for-burn-care
#5
Laura S Johnson, Jeffrey W Shupp
While current evidence-based practices might be applicable to caring for patients with routine diseases and common injury patterns, their application to burn care is less clear. Quality metrics created for large patient populations have failed to account for diseases that are not included in landmark research. Tasked to provide not only medically appropriate but also high-quality and cost-effective care for patients, burn clinicians must find a balance between patient-specific quality metrics and external quality metrics...
June 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29905134/problems-and-costs-that-could-be-addressed-by-improved-burn-and-wound-care-training-in-health-professions-education
#6
Patrick T Delaplain, Victor C Joe
The current system of burn care delivery attempts to meet the needs of the nearly 500 000 patients in the United States who require medical treatment annually. However, specialization of care and lack of fundamental burn and wound care knowledge among graduating medical trainees has unintended consequences, leaving the system inefficient, with inherent inequities in care delivery and with the potential to be overwhelmed in a mass casualty event. While increasing accessibility to specialty burn centers through technology could mitigate some of these problems, increased education is more practical...
June 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29905133/a-model-to-improve-detection-of-nonaccidental-pediatric-burns
#7
Lauren C Nigro, Michael J Feldman, Robin L Foster, Andrea L Pozez
Context: Pediatric burn patients warrant thorough evaluation because a sizeable proportion of pediatric burns are nonaccidental. Design: A multidisciplinary method involving an internal child protection team (CPT) was developed and used to identify suspected nonaccidental pediatric burns in all pediatric burn patients 5 years of age or younger who were evaluated by the CPT and social workers at our institution over a 55-month period. Results: We identified 343 cases for review that fit our age criteria, 6 of which we identified as cases of suspected abuse or neglect...
June 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29905132/should-cosmetic-outcome-influence-discussions-about-goals-of-care-for-severely-burned-patients
#8
Yuk Ming Liu, Kathleen Skipton Romanowski
We focus on surrogate decision making and, specifically, the topic of cosmetic outcomes following burn injury in a case in which potential surrogates dispute what the patient would have wanted. In particular, we examine the choice and role of surrogate decision makers in light of ethical principles that guide surrogate decision making. We also examine whether and when cosmesis should enter into goals of care discussions and consider potential roles cosmetic outcomes could play in such discussions. Finally, we discuss how caregivers should respond when surrogate decision makers suggest cosmetic results as a reason for withdrawing care...
June 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29905131/when-is-it-appropriate-to-put-a-live-donor-at-risk-to-help-another-patient
#9
Anjay Khandelwal
This article considers the nature and scope of ethical decision making in monozygotic sibling (MZS) skin grafting. Although rare, identical twin-to-twin skin grafting has been reported with excellent survival rates in burn patients. Of 16 cases published to date, only a few address the ethical decision making process that is involved with monozygotic sibling skin grafting; this article discusses clinical indications and ethical challenges.
June 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29905130/is-it-ethical-to-treat-pain-differently-in-children-and-adults-with-burns
#10
Sharmila Dissanaike
This commentary discusses ethical implications of the common practice of treating children's and adults' burn pain differently. Physicians have obligations to ensure that (1) their own discomfort with children's pain doesn't lead them to make pain management decisions that could place a patient at greater risk and (2) to engage in thoughtful, individualized pain management strategies. Long-term consequences of overzealous pain medication administration, for example, could include delayed recovery and integration or opioid dependence...
June 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29781428/response-to-metaphorically-or-not-violence-is-not-a-contagious-disease
#11
Gary Slutkin, Charles Ransford, Daria Zvetina
No abstract text is available yet for this article.
May 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29781427/metaphorically-or-not-violence-is-not-a-contagious-disease
#12
Michael B Greene
No abstract text is available yet for this article.
May 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29763398/does-family-presence-in-the-trauma-bay-help-or-hinder-care
#13
Benny L Joyner
Family presence during a pediatric resuscitation remains somewhat controversial. Opponents express concern that family presence would be detrimental to team performance and that exposure to such a traumatic event could put family members at risk of posttraumatic stress. Proponents argue that family presence affords families a sense of closure by easing their anxieties and assuring them that everything was done for their loved ones in addition to improving clinicians' professional behavior by humanizing the patient...
May 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29763397/-memento-mori-and-photographic-perspective-of-roadside-trauma
#14
David B Nance, Sara Scarlet, Elizabeth B Dreesen
David Nance's photographs invite us to cross the liminal space between road and roadside and to consider the experience that trauma surgeons share with injured patients and the families of the injured and the dead. Just as trauma surgeons use the tools of science and surgery to make order out of the chaos of "the scene," so patients' families use art, found objects, and grief to transform anonymous roadsides into specific, personal remembrances. Bound together by the uncertainties of trauma, we can all stand at the side of the road bearing witness to both the inevitability and unpredictability of death...
May 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29763396/the-evolving-surgeon-image
#15
Heather J Logghe, Tyler Rouse, Alec Beekley, Rajesh Aggarwal
The stereotype of the abrasive, technically gifted white male surgeon is ubiquitous among members of the public and the medical profession. Yet modern surgeons are far more diverse and socially adept than the stereotype suggests. While the stereotype is largely a relic of days gone by, it continues to influence patients' expectations and surgeons' interactions with their clinical colleagues. The #ILookLikeASurgeon movement and subsequent #NYerORCoverChallenge demonstrate the changing face of surgery and the roles of social media in resisting the social and cultural force of long-standing stereotypes...
May 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29763395/what-is-the-institutional-duty-of-trauma-systems-to-respond-to-gun-violence
#16
Sara Scarlet, Selwyn O Rogers
In the past, trauma centers have almost exclusively focused on caring for patients who suffer from physical trauma resulting from violence. However, as clinicians' perspectives on violence shift, violence prevention and intervention have been increasingly recognized as integral aspects of trauma care. Hospital-based violence intervention programs are an emerging strategy for ending the cycle of violence by focusing efforts in the trauma center context. These programs, with their multipronged, community-based approach, have shown great potential in reducing trauma recidivism by leveraging the acute experience of violence as an opportunity to introduce services and assess risk of re-injury...
May 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29763394/gun-violence-research-and-the-profession-of-trauma-surgery
#17
Allan B Peetz, Adil Haider
The effects of violence are clearly a central component of any trauma surgeon's job. The role trauma surgeons should play in its prevention and advocacy, however, is not clearly defined. In this article, we discuss the statistics and lack of research on gun violence and survey some of the moral frameworks that define a trauma surgeon's professional responsibilities in violence prevention at a practice and a policy level.
May 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29763393/defining-community-and-consultation-for-emergency-research-that-requires-an-exception-from-informed-consent
#18
Samuel A Tisherman
Trauma care requires rapid interventions to optimize the chances for survival. Many patients are either in shock or unconscious and are, therefore, unable to provide informed consent even for standard procedures. Research-related interventions must similarly be initiated rapidly with no opportunity to obtain consent from the patient or the patient's legally authorized representative. Federal regulations allow for an exception from informed consent in these circumstances once the investigators complete a process of community consultation and public disclosure...
May 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29763392/should-family-be-permitted-in-a-trauma-bay
#19
Matthew Traylor
This essay explores how some of the arguments advanced for and against family presence during cardiopulmonary resuscitation might apply to the question of whether family should be permitted in the trauma bay. While the first section suggests that many of the proposed benefits might apply to family presence during trauma resuscitations, the second section contends that family presence in the trauma bay could detract from the quality of patient care, violate patient privacy, and be psychologically damaging for the witnessing family...
May 1, 2018: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29763391/should-trauma-physicians-treat-a-severely-injured-patient-for-the-sake-of-elucidating-preferences-about-organ-donation
#20
Sandra R DiBrito, Macey L Henderson
Organ donation potential is not a motivator of care in the trauma bay, and it is ethically problematic to consider organ donor potential during the active resuscitation of a trauma patient. Despite organ donation being a public good, the role of the trauma physician is to maintain focus on the patient as an individual and to respect a patient's right to life and autonomy. This tenet of medicine is the foundation of the trust that a community and individuals must have in order for the health care system to function...
May 1, 2018: AMA Journal of Ethics
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