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Medical decisionmaking

Daniel N Ricotta, James J Parris, Ritika S Parris, David N Sontag, Kenneth J Mukamal
BACKGROUND: In cases where patients are unable to provide informed consent and have no surrogate decisionmaker, a hospital must seek guardian appointment as a legally recognized surrogate decision-maker. OBJECTIVE: The aim of this study was to examine the magnitudes of length of stay (LOS) beyond medical clearance and healthcare costs among patients referred for guardianship. DESIGN, SETTING, PATIENTS: This was a retrospective cohort study of all 61 adult inpatients in a single tertiary care hospital requiring guardianship between October 1, 2014, and September 30, 2015, matched with up to 3 controls from the same discharging services and hospitalized for at least as long as the date of clearance for referred patients...
February 5, 2018: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Rosamond Rhodes, James J Strain
Palliative care has had a long-standing commitment to teaching medical students and other medical professionals about pain management, communication, supporting patients in their decisions, and providing compassionate end-of-life care. Palliative care programs also have a critical role in helping patients understand medical conditions, and in supporting them in dealing with pain, fear of dying, and the experiences of the terminal phase of their lives. We applaud their efforts to provide that critical training and fully support their continued important work in meeting the needs of patients and families...
January 2018: Cambridge Quarterly of Healthcare Ethics: CQ: the International Journal of Healthcare Ethics Committees
Christiane S Hartog, Ulf Bodechtel
Family-centered care in the ICU is a quality criterion of modern intensive care. Relatives are not just visitors, caregivers and involved stakeholders, but also partners for the medical team, especially when eliciting patient preferences and during shared decisionmaking. The move towards family-centered care signifies that traditional roles are changing; family-centered care is becoming a critical component of optimizing patient outcomes in the ICU.
January 2018: Deutsche Medizinische Wochenschrift
Scott Levin, Matthew Toerper, Eric Hamrock, Jeremiah S Hinson, Sean Barnes, Heather Gardner, Andrea Dugas, Bob Linton, Tom Kirsch, Gabor Kelen
STUDY OBJECTIVE: Standards for emergency department (ED) triage in the United States rely heavily on subjective assessment and are limited in their ability to risk-stratify patients. This study seeks to evaluate an electronic triage system (e-triage) based on machine learning that predicts likelihood of acute outcomes enabling improved patient differentiation. METHODS: A multisite, retrospective, cross-sectional study of 172,726 ED visits from urban and community EDs was conducted...
September 6, 2017: Annals of Emergency Medicine
D Musil, M Balejová, M Horníková, A Chrdle, N Mallátová, O Nyč, V Chmelík, J Gallo, D Jahoda, J Stehlík
PURPOSE OF THE STUDY This study aims to articulate regional guidelines for curative and suppressive antibiotic therapy of total joint replacement infections. MATERIAL AND METHODS When developing the standard, used as source materials were the published foreign guidelines for antibiotic therapy of prosthetic joint infections, the analysis of resistance of bacterial strains conducted in the Hospital in České Budějovice, a.s. and the assessment of strain resistance for the Czech Republic published by the European Antimicrobial Resistance Surveillance Network (EARS-Net)...
2017: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca
Marc A Probst, Hemal K Kanzaria, Elizabeth M Schoenfeld, Michael D Menchine, Maggie Breslin, Cheryl Walsh, Edward R Melnick, Erik P Hess
Shared decisionmaking has been proposed as a method to promote active engagement of patients in emergency care decisions. Despite the recent attention shared decisionmaking has received in the emergency medicine community, including being the topic of the 2016 Academic Emergency Medicine Consensus Conference, misconceptions remain in regard to the precise meaning of the term, the process, and the conditions under which it is most likely to be valuable. With the help of a patient representative and an interaction designer, we developed a simple framework to illustrate how shared decisionmaking should be approached in clinical practice...
November 2017: Annals of Emergency Medicine
Lina Daouk-Öyry, Afif Mufarrij, Maya Khalil, Tina Sahakian, Miriam Saliba, Rima Jabbour, Eveline Hitti
STUDY OBJECTIVE: To develop a competency model for emergency physicians from the perspective of nurses, juxtapose this model with the widely adopted Accreditation Council for Graduate Medical Education (ACGME) model, and identify competencies that might be unique to the nurses' perspective. METHODS: The study relied on secondary data originally collected as part of nurses' assessment of emergency physicians' nonclinical skills in the emergency department (ED) of an academic medical center in the Middle East...
September 2017: Annals of Emergency Medicine
Philippe Amat
INTRODUCTION: Therapeutic decision-making is essentially the key to our clinical practice, and its most medical feature. The history of orthodontics is studded with multiple intellectual debates and stand-offs between conflicting treatment philosophies, the authors of which all aspire to a balance guaranteeing optimal treatment for their patients. Among the wealth of published data, which items should we select to ensure balanced treatment decisions in our daily practice and how can we remain serene in the face of the uncertainty and loneliness engendered by therapeutic decision-making process? MATERIALS AND METHODS: Evidence-based orthodontics is an aid to clinical decisionmaking...
December 2016: L' Orthodontie Française
Philipp Kellmeyer, Thomas Cochrane, Oliver Müller, Christine Mitchell, Tonio Ball, Joseph J Fins, Nikola Biller-Andorno
Closed-loop medical devices such as brain-computer interfaces are an emerging and rapidly advancing neurotechnology. The target patients for brain-computer interfaces (BCIs) are often severely paralyzed, and thus particularly vulnerable in terms of personal autonomy, decisionmaking capacity, and agency. Here we analyze the effects of closed-loop medical devices on the autonomy and accountability of both persons (as patients or research participants) and neurotechnological closed-loop medical systems. We show that although BCIs can strengthen patient autonomy by preserving or restoring communicative abilities and/or motor control, closed-loop devices may also create challenges for moral and legal accountability...
October 2016: Cambridge Quarterly of Healthcare Ethics: CQ: the International Journal of Healthcare Ethics Committees
Debjani Mukherjee
Mr. Hope's family's expectations and his staff's concerns raise important issues about surrogate decisionmaking, communication regarding prognosis, and staff angst. Unfortunately, Mr. Hope himself is unable to reliably understand and communicate his preferences, especially for complex medical decisions, so the ethics consultant is left to negotiate the disagreement between his family and his healthcare providers, who presumably both believe they are acting in his best interest.
July 2016: Cambridge Quarterly of Healthcare Ethics: CQ: the International Journal of Healthcare Ethics Committees
Tyler S Gibb, Michael J Redinger
In its simplest interpretation, this is a case about goals of care and appropriate code status. At the outset, we must confess that we found this case to be extremely interesting-not for the novelty of the issues or its ethical complexity but because it is truly a case of the ordinary. Too often when teaching or discussing clinical ethics cases, we are distracted by the exotic and the unusual and ignore the mundane cases that every practicing clinical ethicist must be able to competently manage. 1,2,3.
July 2016: Cambridge Quarterly of Healthcare Ethics: CQ: the International Journal of Healthcare Ethics Committees
Catherine A Marco, Arvind Venkat, Eileen F Baker, John E Jesus, Joel M Geiderman
Prescription drug monitoring programs are statewide databases available to clinicians to track prescriptions of controlled medications. These programs may provide valuable information to assess the history and use of controlled substances and contribute to clinical decisionmaking in the emergency department (ED). The widespread availability of the programs raises important ethical issues about beneficence, nonmaleficence, respect for persons, justice, confidentiality, veracity, and physician autonomy. In this article, we review the ethical issues surrounding prescription drug monitoring programs and how those issues might be addressed to ensure the proper application of this tool in the ED...
November 2016: Annals of Emergency Medicine
Małgorzata Szeroczyńska, Marek Czarkowski, Małgorzata Krajnik, Romuald Krajewski, Leszek Pawłowski, Anna Adamczyk, Agnieszka Barczak-Oplustil, Piotr Aszyk, Andrzej Kobyliński, Tomasz Pasierski, Piotr Sobański, Wojciech Bołoz On Behalf Of The Polish Working Group On End-Of-Life Ethics
INTRODUCTION In numerous countries legislation has been put in place allowing citizens to appoint persons authorized to make medical decisions on their behalf, should the principal lose such decision‑making capacity. OBJECTIVES The paper aimed to prepare a draft proposal of legal regulations introducing into Polish legislation the institution of the health care agent. PATIENTS AND METHODS The draft proposal has been grounded in 6 expertise workshops, in conjunction with several online debates. RESULTS The right to appoint a health care agent should apply to all persons of full legal capacity, and to minors over 16 years of age...
May 5, 2016: Polskie Archiwum Medycyny Wewnętrznej
(no author information available yet)
The medical team found the patient to lack medical decisionmaking capacity. However, the team felt that the patient was still able to respond appropriately to some situations. KS had displayed a consistent refusal of all medical treatments that made her uncomfortable or caused pain. During her sister's visits, the patient would be much more receptive to eating. A meeting was planned with the patient's sister in which the ethicist explained that the patient was not able to make her own decisions. The patient's sister agreed that she would honor the patient's wishes but would let the team make any decisions outside of what she knew about the patient's preferences...
April 2016: Cambridge Quarterly of Healthcare Ethics: CQ: the International Journal of Healthcare Ethics Committees
Ruaim Muaygil
This case presents several fundamental ethical issues. The first issue is the patient's refusal of treatment (a nasogastric tube [NGT] insertion). Second, the patient's refusal of a seemingly beneficial treatment, combined with her medical history, ultimately necessitates an assessment of her decisionmaking capacity. Third, the sister's reluctance to participate in decisionmaking requires a discussion of appropriate surrogate decisionmakers. Finally, the main ethical component to this case is a cultural one, which should be addressed appropriately...
April 2016: Cambridge Quarterly of Healthcare Ethics: CQ: the International Journal of Healthcare Ethics Committees
Shilpa Shashidhara
This case illustrates the dilemma that occurs when a patient refuses treatment. When a patient refuses recommended interventions, it can cause much distress among the medical team and family. On the surface, the ethical issue appears to be in regard to treatment refusal. However, when we look deeper, it becomes evident that the question is truly about whether the patient has the ability to make this treatment decision, given her worsening dementia, recent hemorrhage, and depression. In this case, an essential component of an ethics consultation would be to assess this patient's decisionmaking capacity to determine if her refusals are informed...
April 2016: Cambridge Quarterly of Healthcare Ethics: CQ: the International Journal of Healthcare Ethics Committees
Ruchika Mishra
KS is a 76-year-old Burmese woman who presented to the hospital with right-sided weakness that had begun two days prior. Although KS had been diagnosed earlier with dementia and had a medical history of stroke, she was living at a nursing home and was able to walk on her own and use her right arm to feed herself. Since her last stroke three years ago, she had also developed aphasia, and her speech has been minimal. During her current hospitalization, KS was found to have a cerebral hemorrhage, but after consultation with neurosurgery, the team determined that no medical interventions were available, and a higher level of care was not required...
April 2016: Cambridge Quarterly of Healthcare Ethics: CQ: the International Journal of Healthcare Ethics Committees
Kim J Overby, Joseph J Fins
In 1996, Sandra Jensen became the first person with Down syndrome to receive a heart-lung transplant. Although it took place almost 20 years ago, her experience continues to shed light on contemporary challenges that individuals with neurodevelopmental disorders face in securing access to transplantation. While overt discrimination has decreased, barriers persist in physician referrals, center-specific decisionmaking regarding wait-listing, and the provision of accommodations for optimizing the assessment and medical management of these individuals...
April 2016: Cambridge Quarterly of Healthcare Ethics: CQ: the International Journal of Healthcare Ethics Committees
Jeanne Snelling
Use of the best-interests test as the legal standard to justify medical treatment (or its cessation) in respect to legally incompetent adults or minors has come under sustained critique over the years. "Best interests" has variously been alleged to be indeterminate as well as susceptible to majoritarian ideology and inherent bias. It has also been alleged to be inferior to rights-based approaches. Against the background of several particularly hard cases involving minors discussed by Gillett in a prior article in this journal, this article considers some of these critiques...
January 2016: Cambridge Quarterly of Healthcare Ethics: CQ: the International Journal of Healthcare Ethics Committees
Hui-Lian Che, Mei-Yu Yeh, Ru-Shang Jiang, Shu-Mei Wu
Taiwanese nurses face increasingly demanding working conditions along with a distinctive culture where family members participate in medical decisionmaking. This research explores Taiwanese nurses' perceptions of patient education, with a focus on the difficulties. Data were collected by in-depth focus group discussions with nursing staff (n=53) from the medical and surgical wards of two teaching hospitals. Transcripts were analyzed and revealed six themes: source of fulfillment and pressure; excessive workload; alternating between patients; not knowing who to teach; difficulty in communication; and disrupted confidence and work rhythm...
March 2016: Nursing & Health Sciences
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