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Ethics of care

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https://www.readbyqxmd.com/read/27926654/neonatal-abstinence-syndrome-and-ethical-approaches-to-the-identification-of-pregnant-women-who-use-drugs
#1
Mishka Terplan, Howard Minkoff
The United States is experiencing an epidemic of opioid use, addiction, and neonatal abstinence syndrome. Consequentially, a great deal of public, and public health, attention has turned toward the timely recognition of pregnant women who use drugs. We explore the clinical efficacy and ethical acceptability of different methods of identification-contrasting drug testing (using biologic samples such as urine) with screening (using an instrument or questionnaire) under both universal and selective approaches within the current legal and social landscape, which is fraught with potential adverse consequences for both the woman and her child...
December 2, 2016: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27926646/treatment-of-a-pregnant-patient-in-a-persistent-vegetative-state
#2
Matthew P Romagano, William E Scorza, Stephen E Lammers, Carole Dorr, John C Smulian
BACKGROUND: Brain injury leading to a persistent vegetative state during pregnancy involves difficult medical and ethical decisions. CASE: A 21-year-old multigravid woman entered a persistent vegetative state at 20 1/7 weeks of gestation after cardiac arrest with postanoxic brain injury from a suspected drug overdose. The clinical disciplines responsible for her case formed a collaborative care plan involving ventilator, nutrition, and medication support of the mother and regular fetal monitoring and ultrasound testing...
December 2, 2016: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27925849/development-and-prospective-federal-state-wide-evaluation-of-a-device-for-height-based-dose-recommendations-in-prehospital-pediatric-emergencies-a-simple-tool-to-prevent-most-severe-drug-errors
#3
Jost Kaufmann, Bernhard Roth, Thomas Engelhardt, Alex Lechleuthner, Michael Laschat, Christoph Hadamitzky, Frank Wappler, Martin Hellmich
OBJECTIVE: Drug dosing errors pose a particular threat to children in prehospital emergency care. With the Pediatric emergency ruler (PaedER), we developed a simple height-based dose recommendation system and evaluated its effectiveness in a pre-post interventional trial as the Ethics Committee disapproved randomization due to the expected positive effect of the PaedER on outcome. METHODS: Pre-interventional data were retrospectively retrieved from the electronic records and medical protocols of the Cologne Emergency Medical Service over a two-year period prior to the introduction of the PaedER...
December 7, 2016: Prehospital Emergency Care
https://www.readbyqxmd.com/read/27925381/doctors-use-of-mobile-devices-in-the-clinical-setting-a-mixed-methods-study
#4
Arany Nerminathan, Amanda Harrison, Megan Phelps, Karen M Scott
AIM: To explore how doctors use mobile devices in the clinical setting and understand drivers for use. METHODS: A mixed methods study was used with doctors in a paediatric and adult teaching hospital in 2013. A paper based survey examined mobile device usage data by doctors in the clinical setting. Focus groups explored doctors' reasons for using or refraining from using mobile devices in the clinical setting, and their attitudes about others' use. RESULTS: The survey, completed by 109 doctors, showed that 91% owned a smartphone and 88% used their mobile devices frequently in the clinical setting...
December 7, 2016: Internal Medicine Journal
https://www.readbyqxmd.com/read/27925103/health-needs-and-nursing-care
#5
Cristina Buischi Petersen, Regina Aparecida Garcia de Lima, Magali Roseira Boemer, Semiramis Melani Melo Rocha
Objective: to present the concept of needs according to different approaches to discuss the possibility of health care that incorporates a broader view of human vulnerabilities in health services. Methods: the arguments are founded on nursing theorists who worked on the construction of frameworks relevant to care, based on needs and on philosophers who show the possibility of identifying the vulnerabilities of human beings, defending art as a therapeutic instrument that can promote health care...
November 2016: Revista Brasileira de Enfermagem
https://www.readbyqxmd.com/read/27924420/-austrian-guideline-for-palliative-sedation-therapy-long-version-results-of-a%C3%A2-delphi-process-of-the-austrian-palliative-society-opg
#6
Dietmar Weixler, Sophie Roider-Schur, Rudolf Likar, Claudia Bozzaro, Thomas Daniczek, Angelika Feichtner, Christoph Gabl, Bernhard Hammerl-Ferrari, Maria Kletecka-Pulker, Ulrich H J Körtner, Hilde Kössler, Johannes G Meran, Aurelia Miksovsky, Bettina Pusswald, Thomas Wienerroither, Herbert Watzke
BACKGROUND: Palliative sedation therapy (PST) is an important and ethically accepted therapy in the care of selected palliative care patients with otherwise unbearable suffering from refractory distress. PST is increasingly used in end-of-life care. Austria does not have a standardized ethical guideline for this exceptional practice near end of life, but there is evidence that practice varies throughout the country. OBJECTIVE: The Austrian Palliative Society (OPG) nominated a multidisciplinary working group of 16 palliative care experts and ethicists who established the national guideline on the basis of recent review work with the aim to adhere to the Europeans Association of Palliative Care's (EAPC) framework on palliative sedation therapy respecting Austrians legal, structural and cultural background...
December 6, 2016: Wiener Medizinische Wochenschrift
https://www.readbyqxmd.com/read/27923340/-decision-support-for-the-therapy-planning-for-young-refugees-and-asylum-seekers-with-posttraumatic-disorders
#7
Cornelia Reher, Franka Metzner
Decision Support for the Therapy Planning for Young Refugees and Asylum-Seekers with Posttraumatic Disorders Due to the Convention on the Rights of the Child and § 6 of the Asylum Seekers' Benefit Act, there are legal and ethical obligations for the care of minor refugees suffering from trauma-related disorders. In Germany, psychotherapeutic care of adolescent refugees is provided by specialized treatment centers and Child and Adolescent psychiatries with specialized consultation-hours for refugees. Treatment of minor refugees is impeded by various legal and organizational barriers...
December 2016: Praxis der Kinderpsychologie und Kinderpsychiatrie
https://www.readbyqxmd.com/read/27922557/embryonic-stem-cell-research-a-policy-analysis
#8
Hermine Warren
Many health care issues generate minimal passion, promoting benign commentary and support from the various stakeholders involved. Stem cell research does not fall into this category, and on the contrary, embryonic stem cell (ESC) research has continued to foster controversy and emotion. Since 1998, which marked the first successful laboratory isolation of ESCs, this research continues to ignite moral, ethical, and legal debate over its efficacy. The focus of this policy analysis is to introduce the issues, examine and address the various perspectives that surround ESC research, and present policy options and/or solutions that may be used to successfully create a policy consensus regarding this much debated topic...
October 2016: Plastic Surgical Nursing
https://www.readbyqxmd.com/read/27922202/current-practices-for-screening-consent-and-care-of-related-donors-in-france-haematopoietic-stem-cell-transplantation-coordinator-nurses-perceptions
#9
A Polomeni, C Bompoint, A Gomez, E Brissot, A Ruggeri, R Belhocine, M Mohty
Haematopoietic stem cell transplantation-coordinating nurses (HSCT-CNs) play an important role in informing related donors (RDs) and in organising human leucocyte antigen (HLA) tests, pre-donation workup and stem cells collection. Our pilot study aimed to explore French HSCT-CNs' perceptions of RD care issues. Twenty-nine French HSCT adult units were sent a questionnaire on the subject of donation procedures, HSCT-CNs' data and their professional experience of related donation issues. Twenty-two HSCT-CNs returned a completed questionnaire, and 90% of HSCT units were involved to some degree in both patient and donor care...
December 6, 2016: European Journal of Cancer Care
https://www.readbyqxmd.com/read/27920416/re-evaluating-the-inhibition-of-stress-erosions-revise-a-protocol-for-pilot-randomized-controlled-trial
#10
Waleed Alhazzani, Gordon Guyatt, John C Marshall, Richard Hall, John Muscedere, Francois Lauzier, Lehana Thabane, Mohammed Alshahrani, Shane W English, Yaseen M Arabi, Adam M Deane, Tim Karachi, Bram Rochwerg, Simon Finfer, Nick Daneman, Nicole Zytaruk, Diane Heel-Ansdell, Deborah Cook, On Behalf Of
INTRODUCTION: Clinicians routinely administer stress ulcer prophylaxis to mechanically ventilated patients in the intensive care unit (ICU), most commonly prescribing proton pump inhibitors (PPIs). However, the incidence of gastrointestinal (GI) bleeding from stress ulceration is low and recent observational studies suggest these agents may increase infections. Therefore, a large randomized clinical trial (RCT) is needed to inform modern practice. The aim of this multicenter pilot trial is to determine the feasibility of performing a large RCT to investigate the efficacy and safety of withholding intravenous pantoprazole...
November 2016: Annals of Saudi Medicine
https://www.readbyqxmd.com/read/27920347/effectiveness-of-pediatric-palliative-care-education-on-pediatric-clinicians
#11
Niang-Huei Peng, Cheng-Han Lee, Min-Chun Lee, Li-Chi Huang, Yue-Cune Chang, Joetta DeSwarte-Wallace
A lack of knowledge and skills in pediatric palliative care may create hesitation in caring for children with serious life-threatening conditions and their families. Our research examined the effectiveness of pediatric palliative care training for pediatric clinicians. A pretest-posttest study provided educational training in pediatric palliative care to pediatric clinicians and used a pretest and a posttest to assess outcomes. Fifty pediatric clinicians attended this research with 83.3% response rate. After training, participants reported significantly increased confidence in a variety of areas, including providing emotional support to clinicians, personal knowledge, skills, and communication; ethical and legal concerns; and providing emotional support to dying children and their families...
December 5, 2016: Western Journal of Nursing Research
https://www.readbyqxmd.com/read/27920164/epistemic-injustice-in-healthcare-encounters-evidence-from-chronic-fatigue-syndrome
#12
Charlotte Blease, Havi Carel, Keith Geraghty
Chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) remains a controversial illness category. This paper surveys the state of knowledge and attitudes about this illness and proposes that epistemic concerns about the testimonial credibility of patients can be articulated using Miranda Fricker's concept of epistemic injustice. While there is consensus within mainstream medical guidelines that there is no known cause of CFS/ME, there is continued debate about how best to conceive of CFS/ME, including disagreement about how to interpret clinical studies of treatments...
December 5, 2016: Journal of Medical Ethics
https://www.readbyqxmd.com/read/27919862/spinal-cord-injury-assessing-tolerability-and-use-of-combined-rehabilitation-and-neuroaid-saturn-study-protocol-of-an-exploratory-study-in-assessing-the-safety-and-efficacy-of-neuroaid-amongst-people-who-sustain-severe-spinal-cord-injury
#13
Ramesh Kumar, Ohnmar Htwe, Azmi Baharudin, Mohammad Hisam Ariffin, Shaharuddin Abdul Rhani, Kamalnizat Ibrahim, Aishah Rustam, Robert Gan
BACKGROUND: Spinal cord injury (SCI) is a devastating condition with limited therapeutic options despite decades of research. Current treatment options include use of steroids, surgery, and rehabilitation. Nevertheless, many patients with SCI remain disabled. MLC601 (NeuroAiD), a combination of natural products, has been shown to be safe and to aid neurological recovery after brain injuries and may have a potential role in improving recovery after SCI. OBJECTIVE: The aim of this study is to evaluate the safety and efficacy of NeuroAiD amongst people who sustain SCI in the study setting...
December 5, 2016: JMIR Research Protocols
https://www.readbyqxmd.com/read/27919384/health-information-professionals-in-a-global-ehealth-world-ethical-and-legal-arguments-for-the-international-certification-and-accreditation-of-health-information-professionals
#14
Eike-Henner W Kluge
BACKGROUND: Issues such as privacy, security, quality, etc. have received considerable attention in discussions of eHealth, mHealth and pHealth. However, comparatively little attention has been paid to the fact that these methods of delivering health care situate Health Information Professionals (HIPs) in an ethical context that is importantly different from that of traditional health care because they assign a fiduciary role to HIPs that they did not have before, their previous technical involvement notwithstanding...
January 2017: International Journal of Medical Informatics
https://www.readbyqxmd.com/read/27917505/might-constraint-be-compatible-with-care-home-care-as-a-situational-ethics
#15
Antoine Hennion, Pierre A Vidal-Naquet
Respecting the autonomy and will of people has legitimately led to strictly control the use of constraint in care activities, and promote a care ethics centred around people's needs and wills. But constraint is underlying in any action aiming at making people do something, even with their consent, especially when their ability to evaluate what is best for them may be altered. Ceaselessly present in care, this ordinary, silent constraint should not be only deemed as a necessary evil to be prevented. In contrast with this legally-based view, the paper adopts a pragmatic perspective...
December 5, 2016: Sociology of Health & Illness
https://www.readbyqxmd.com/read/27917391/adrift-in-the-gray-zone-irb-perspectives-on-research-in-the-learning-health-system
#16
Sandra Soo-Jin Lee, Maureen Kelley, Mildred K Cho, Stephanie Alessi Kraft, Cyan James, Melissa Constantine, Adrienne N Meyer, Douglas Diekema, Alexander M Capron, Benjamin S Wilfond, David Magnus
BACKGROUND: Human subjects protection in healthcare contexts rests on the premise that a principled boundary distinguishes clinical research and clinical practice. However, growing use of evidence-based clinical practices by health systems makes it increasingly difficult to disentangle research from a wide range of clinical activities that are sometimes called "research on medical practice" (ROMP), including quality improvement activities and comparative effectiveness research. The recent growth of ROMP activities has created an ethical and regulatory gray zone with significant implications for the oversight of human subjects research...
2016: AJOB Empirical Bioethics
https://www.readbyqxmd.com/read/27915463/the-our-hope-approach-for-ethics-and-communication-about-neonatal-neurological-injury
#17
REVIEW
Eric Racine, Emily Bell, Barbara Farlow, Steven Miller, Antoine Payot, Lisa Anne Rasmussen, Michael I Shevell, Donna Thomson, Pia Wintermark
Predicting neurological outcomes of neonates with acute brain injury is an essential component of shared decision-making, in order to guide the development of treatment goals and appropriate care plans. It can aid parents in imagining the child's future, and guide timely and ongoing treatment decisions, including shifting treatment goals and focusing on comfort care. However, numerous challenges have been reported with respect to evidence-based practices for prognostication such as biases about prognosis among clinicians...
December 4, 2016: Developmental Medicine and Child Neurology
https://www.readbyqxmd.com/read/27915459/the-role-of-accompagnement-in-the-end-of-life-debate-in-france-from-solidarity-to-autonomy
#18
Marie Gaille, Ruth Horn
This article traces the way autonomy has become a recognised value in health care in France. In a country that based its social fundamentals on the very idea of solidarity for many years, autonomy has long been considered a foreign 'Anglo-American principle'. Taking the example of the end-of-life debate, the article shows, however, how the use of the French term 'accompagnement' allowed autonomy to be redefined and to be associated with the concept of solidarity. Exploring the arguments used over the past 25 years in professional guidelines, parliamentary reports, ethics committee reports, and legal texts, the authors describe the shift that took place in public and legal discourses on end-of-life care...
December 3, 2016: Theoretical Medicine and Bioethics
https://www.readbyqxmd.com/read/27915265/the-ethics-of-unilateral-implantable-cardioverter-defibrillators-and-cardiac-resynchronization-therapy-with-defibrillator-deactivation-patient-perspectives
#19
Margaret Daeschler, Ralph J Verdino, James N Kirkpatrick
AIMS: Decisions about deactivation of implantable cardioverter defibrillators (ICDs) are complicated. Unilateral do-not-resuscitate (DNR) orders (against patient/family wishes) have been ethically justified in cases of medical futility. Unilateral deactivation of ICDs may be seen as a logical extension of a unilateral DNR order. However, the ethical implications of unilateral ICD deactivation have not been explored. METHODS AND RESULTS: Sixty patients who had an ICD or cardiac resynchronization therapy with defibrillator (CRT-D) were interviewed at a quaternary medical centre outpatient electrophysiology practice...
December 2, 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/27914589/-big-data-and-their-perspectives-in-radiation-therapy
#20
REVIEW
Sébastien Guihard, Juliette Thariat, Jean-Baptiste Clavier
The concept of big data indicates a change of scale in the use of data and data aggregation into large databases through improved computer technology. One of the current challenges in the creation of big data in the context of radiation therapy is the transformation of routine care items into dark data, i.e. data not yet collected, and the fusion of databases collecting different types of information (dose-volume histograms and toxicity data for example). Processes and infrastructures devoted to big data collection should not impact negatively on the doctor-patient relationship, the general process of care or the quality of the data collected...
November 30, 2016: Bulletin du Cancer
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