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https://www.readbyqxmd.com/read/28098622/physician-assisted-suicide-and-euthanasia-in-the-icu-a-dialogue-on-core-ethical-issues
#1
Ewan C Goligher, E Wesley Ely, Daniel P Sulmasy, Jan Bakker, John Raphael, Angelo E Volandes, Bhavesh M Patel, Kate Payne, Annmarie Hosie, Larry Churchill, Douglas B White, James Downar
OBJECTIVE: Many patients are admitted to the ICU at or near the end of their lives. Consequently, the increasingly common debate regarding physician-assisted suicide and euthanasia holds implications for the practice of critical care medicine. The objective of this article is to explore core ethical issues related to physician-assisted suicide and euthanasia from the perspective of healthcare professionals and ethicists on both sides of the debate. SYNTHESIS: We identified four issues highlighting the key areas of ethical tension central to evaluating physician-assisted suicide and euthanasia in medical practice: 1) the benefit or harm of death itself, 2) the relationship between physician-assisted suicide and euthanasia and withholding or withdrawing life support, 3) the morality of a physician deliberately causing death, and 4) the management of conscientious objection related to physician-assisted suicide and euthanasia in the critical care setting...
February 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28096705/situational-judgment-tests-reliably-measure-professional-attributes-important-for-clinical-practice
#2
EDITORIAL
Katie Petty-Saphon, Kim A Walker, Fiona Patterson, Vicki Ashworth, Helena Edwards
Over the course of more than 40 years, international research has consistently shown situational judgment tests (SJTs) to be a reliable and valid selection method for assessing a range of professional attributes. However, SJTs still represent a relatively new selection method within the medical profession, and as such it is to be expected that applicant reactions will vary. In this Expert Opinion piece, we respond to Najim et al's article "The situational judgement test: a student's worst nightmare" by highlighting three key clarifications...
2017: Advances in Medical Education and Practice
https://www.readbyqxmd.com/read/28096019/tinker-tailor-deliberate-an-ethnographic-inquiry-into-the-institutionalized-practice-of-bar-coded-medication-administration-technology-by-nurses
#3
M J M H Boonen, Frans J H Vosman, Alistair R Niemeijer
AIM: Explore the practice of nurses working with bar-coded medication administration technology, to gain insight in the impact it has on their work. BACKGROUND: The widespread presumption of using Barcoded Medication Administration Technology (BCMA) is that it will effectively reduce the number of errors in the dispensing of medication to patients. However, it remains unclear whether this is the case in actual practice. METHOD: Two distinct but overlapping research methodologies of Institutional Ethnography and Praxeology were combined as a means to uncover the highly complex practice of BCMA by nurses...
February 2017: Applied Nursing Research: ANR
https://www.readbyqxmd.com/read/28095592/a-practical-approach-to-address-uncertainty-in-stakeholder-deliberations
#4
Robin Gregory, Ralph L Keeney
This article addresses the difficulties of incorporating uncertainty about consequence estimates as part of stakeholder deliberations involving multiple alternatives. Although every prediction of future consequences necessarily involves uncertainty, a large gap exists between common practices for addressing uncertainty in stakeholder deliberations and the procedures of prescriptive decision-aiding models advanced by risk and decision analysts. We review the treatment of uncertainty at four main phases of the deliberative process: with experts asked to describe possible consequences of competing alternatives, with stakeholders who function both as individuals and as members of coalitions, with the stakeholder committee composed of all stakeholders, and with decisionmakers...
January 17, 2017: Risk Analysis: An Official Publication of the Society for Risk Analysis
https://www.readbyqxmd.com/read/28091353/the-development-of-a-national-nutrition-and-mental-health-research-agenda-with-comparison-of-priorities-among-diverse-stakeholders
#5
Karen M Davison, Carla D'Andreamatteo, Scott Mitchell, Pat Vanderkooy
OBJECTIVE: To develop a national nutrition and mental health research agenda based on the engagement of diverse stakeholders and to assess research priorities by stakeholder groups. DESIGN: A staged, integrated and participatory initiative was implemented to structure a national nutrition and mental health research agenda that included: (i) national stakeholder consultations to prioritize research questions; (ii) a workshop involving national representatives from research, policy and practice to further define priorities; (iii) triangulation of data to formulate the agenda; and (iv) test hypotheses about stakeholder influences on decision making...
January 16, 2017: Public Health Nutrition
https://www.readbyqxmd.com/read/28066905/implications-of-genital-mutilation-at-autopsy
#6
Roger W Byard
Given the potential significance of mutilation of the external genitalia in medicolegal fatalities, a review of the literature was undertaken to identify subcategories. Such mutilations may have been sustained sometime before death, around the time of death, or after death. The most common type of ante mortem genital mutilations involves cultural practices such as male circumcision. Less common male mutilations such as subincisions are tribally based. Female genital mutilation is found particularly in African, Middle Eastern, or Asian populations...
January 9, 2017: Journal of Forensic Sciences
https://www.readbyqxmd.com/read/28063865/evaluation-of-a-mastery-learning-intervention-on-hospitalists-code-status-discussion-skills
#7
Rashmi K Sharma, Eytan Szmuilowicz, Adeboye Ogunseitan, Sasha F Jones, Jessica A Montalvo, Kevin J O'Leary, Diane B Wayne
CONTEXT: Although code status discussions (CSD) occur frequently in the hospital setting, discussions often lack content necessary for informed decision making. Simulation-based mastery learning (SBML) has been used to improve clinical skills among resident physicians and may provide a novel way to improve hospitalists' CSD skills. OBJECTIVES: The objective of this pilot randomized controlled trial was to develop and evaluate a CSD SBML intervention for hospitalists...
January 4, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28062349/-best-case-worst-case-training-surgeons-to-use-a-novel-communication-tool-for-high-risk-acute-surgical-problems
#8
Jacqueline M Kruser, Lauren J Taylor, Toby C Campbell, Amy Zelenski, Sara K Johnson, Michael J Nabozny, Nicole M Steffens, Jennifer L Tucholka, Kris L Kwekkeboom, Margaret L Schwarze
CONTEXT: Older adults often have surgery in the months preceding death, which can initiate post-operative treatments inconsistent with end-of-life values. "Best Case/Worst Case" (BC/WC) is a communication tool designed to promote goal-concordant care during discussions about high-risk surgery. OBJECTIVE: To evaluate a structured training program designed to teach surgeons how to use BC/WC. METHODS: Twenty-five surgeons from one tertiary-care hospital completed a two-hour training session followed by individual coaching...
January 3, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28061850/food-safety-knowledge-attitudes-and-practices-of-institutional-food-handlers-in-ghana
#9
Fortune Akabanda, Eli Hope Hlortsi, James Owusu-Kwarteng
BACKGROUND: In large scale cooking, food is handled by many individuals, thereby increasing the chances of food contamination due to improper handling. Deliberate or accidental contamination of food during large scale production might endanger the health of consumers, and have very expensive repercussions on a country. The purpose of this study was to evaluate the food safety knowledge, attitudes, and practices among institutional food- handlers in Ghana. METHODS: The study was conducted using a descriptive, cross-sectional survey of 29 institutions by conducting face to face interview and administration of questionnaire to two hundred and thirty-five (235) institutional food-handlers...
January 6, 2017: BMC Public Health
https://www.readbyqxmd.com/read/28060434/participatory-bioethics-research-and-its-social-impact-the-case-of-coercion-reduction-in-psychiatry
#10
Tineke A Abma, Yolande Voskes, Guy Widdershoven
In this article we address the social value of bioethics research and show how a participatory approach can achieve social impact for a wide audience of stakeholders, involving them in a process of joint moral learning. Participatory bioethics recognizes that research co-produced with stakeholders is more likely to have impact on healthcare practice. These approaches aim to engage multiple stakeholders and interested partners throughout the whole research process, including the framing of ideas and research questions, so that outcomes are tailored to the interests and context, and the type of impact stakeholders envisage...
February 2017: Bioethics
https://www.readbyqxmd.com/read/28052721/the-practice-of-terminal-discharge
#11
Lalit Kumar Radha Krishna, Vengadasalam Murugam, Daniel Song Chiek Quah
'Terminal discharges' are carried out in Singapore for patients who wish to die at home. However, if due diligence is not exercised, parallels may be drawn with euthanasia. We present a theoretical discussion beginning with the definition of terminal discharges and the reasons why they are carried out in Singapore. By considering the intention behind terminal discharges and utilising a multidisciplinary team to deliberate on the clinical, social and ethical intricacies with a patient- and context-specific approach, euthanasia is avoided...
January 1, 2017: Nursing Ethics
https://www.readbyqxmd.com/read/28050656/the-recommendations-of-a-consensus-panel-for-the-screening-diagnosis-and-treatment-of-neurogenic-orthostatic-hypotension-and-associated-supine-hypertension
#12
REVIEW
Christopher H Gibbons, Peter Schmidt, Italo Biaggioni, Camille Frazier-Mills, Roy Freeman, Stuart Isaacson, Beverly Karabin, Louis Kuritzky, Mark Lew, Phillip Low, Ali Mehdirad, Satish R Raj, Steven Vernino, Horacio Kaufmann
Neurogenic orthostatic hypotension (nOH) is common in patients with neurodegenerative disorders such as Parkinson's disease, multiple system atrophy, pure autonomic failure, dementia with Lewy bodies, and peripheral neuropathies including amyloid or diabetic neuropathy. Due to the frequency of nOH in the aging population, clinicians need to be well informed about its diagnosis and management. To date, studies of nOH have used different outcome measures and various methods of diagnosis, thereby preventing the generation of evidence-based guidelines to direct clinicians towards 'best practices' when treating patients with nOH and associated supine hypertension...
January 3, 2017: Journal of Neurology
https://www.readbyqxmd.com/read/28044334/monitoring-the-anaesthetist-in-the-operating-theatre-professional-competence-and-patient-safety
#13
REVIEW
J Larsson
This article about competence and patient safety in anaesthesia was inspired by a statement in the 2015 AAGBI guidelines on monitoring during anaesthesia: 'the presence of an appropriately trained and experienced anaesthetist is important for patient safety during anaesthesia'. The review starts with a structured description of competence, presenting five dimensions of it; the first two dimensions are identical with the two classical attributes of competence, practical skills and theoretical knowledge. Concerning skills, the value of aiming for a high level of proficiency early in a traning programme is pointed out, and deliberate practice is given as an example of a pedagogical model where aiming for excellence is a core idea...
January 2017: Anaesthesia
https://www.readbyqxmd.com/read/28038350/norm-contaminated-area-identification-using-radionuclides-activity-concentration-pattern-in-a-soil-profile
#14
Bogusław Michalik
According to the requirements set by European BSS the exposure of humans and biota to ionizing radiation originating from natural radionuclides but under anthropogenically changed conditions should be managed within the same regulatory framework as other practices. Such situation creates the strong needs to have a reliable method to distinguish whether the particular case of natural radioactivity occurrence has resulted from human activity or it is pure natural phenomenon. In case of current activity of particular NORM industry there are no doubts however, in case of a legacy site, such question becomes crucial...
December 27, 2016: Journal of Environmental Radioactivity
https://www.readbyqxmd.com/read/28033485/acculturation-needs-of-pediatric-international-medical-graduates-a-qualitative-study
#15
Amanda D Osta, Michelle M Barnes, Regina Pessagno, Alan Schwartz, Laura E Hirshfield
: Phenomenon: International medical graduates (IMGs) play a key role in host countries' health systems but face unique challenges, which makes effective, tailored support for IMGs essential. Prior literature describing the acculturation needs of IMGs focused primarily on communication content and style. We conducted a qualitative study to explore acculturation that might be specific to IMG residents who care for children. APPROACH: In a study conducted from November 2011 to April 2012, we performed four 90-minute semistructured focus groups with 26 pediatric IMG residents from 12 countries...
December 29, 2016: Teaching and Learning in Medicine
https://www.readbyqxmd.com/read/28030433/the-case-against-imminent-death-donation
#16
Grace S Lee, Vishnu S Potluri, Peter P Reese
PURPOSE OF REVIEW: Imminent death donation (IDD) is a proposal to procure organs from patients prior to the withdrawal of life support, which is anticipated to lead to death. In this review, we outline substantial concerns that the transplant community should consider when deliberating the possibility of practicing IDD. RECENT FINDINGS: Although there are several compelling theoretical and intuitive reasons to support IDD, its application has been hindered because of inadequate definitions or protocols...
December 26, 2016: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28029609/seeking-control-in-the-midst-of-uncertainty-women-s-experiences-of-choosing-mode-of-birth-after-caesarean
#17
Sarah Munro, Patricia Janssen, Kitty Corbett, Elizabeth Wilcox, Nick Bansback, Jude Kornelsen
PROBLEM: Clinical practice guidelines indicate that over 80% of women with a previous caesarean should be offered a planned vaginal birth after caesarean (VBAC), however only one third of eligible women choose to plan a VBAC. To support informed choices for birth after caesarean, it is necessary to understand the factors that influence women's decision-making. AIM: The goal of this study was to explore attitudes towards and experiences with decision-making for mode of delivery after caesarean from the perspectives of Canadian women...
October 28, 2016: Women and Birth: Journal of the Australian College of Midwives
https://www.readbyqxmd.com/read/28024436/international-consensus-statement-on-the-assessment-of-interprofessional-learning-outcomes
#18
Gary D Rogers, Jill E Thistlethwaite, Elizabeth S Anderson, Madeleine Abrandt Dahlgren, Ruby E Grymonpre, Monica Moran, Dujeepa D Samarasekera
Regulatory frameworks around the world mandate that health and social care professional education programs graduate practitioners who have the competence and capability to practice effectively in interprofessional collaborative teams. Academic institutions are responding by offering interprofessional education (IPE); however, there is as yet no consensus regarding optimal strategies for the assessment of interprofessional learning (IPL). The Program Committee for the 17th Ottawa Conference in Perth, Australia in March, 2016, invited IPE champions to debate and discuss the current status of the assessment of IPL...
December 26, 2016: Medical Teacher
https://www.readbyqxmd.com/read/28005464/improvement-of-darts-performance-following-lucid-dream-practice-depends-on-the-number-of-distractions-while-rehearsing-within-the-dream-a-sleep-laboratory-pilot-study
#19
Melanie Schädlich, Daniel Erlacher, Michael Schredl
In a lucid dream, the dreamer is aware of the dream state and can deliberately practice motor skills. Two field studies indicated that lucid dream practice can improve waking performance in simple motor tasks. The present pilot study investigated the effect of lucid dream practice in a controlled sleep laboratory setting, using a pre-post design with dart throwing in the evening and morning. The experimental group practiced darts in lucid dreams. Because some participants were distracted during lucid dream practice, the group was divided into lucid dreamers with few (n = 4) and many distractions (n = 5)...
December 22, 2016: Journal of Sports Sciences
https://www.readbyqxmd.com/read/27997808/clinical-momentum-in-the-intensive-care-unit-a-latent-contributor-to-unwanted-care
#20
Jacqueline M Kruser, Christopher E Cox, Margaret L Schwarze
Many older adults in the United States receive invasive medical care near the end of life, often in an intensive care unit (ICU). However, most older adults report preferences to avoid this type of medical care and to prioritize comfort and quality of life near death. We propose a novel term, "clinical momentum," to describe a system-level, latent, previously unrecognized property of clinical care that may contribute to the provision of unwanted care in the ICU. The example of chronic critical illness illustrates how clinical momentum is generated and propagated during the care of patients with prolonged illness...
December 20, 2016: Annals of the American Thoracic Society
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