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Clinical ethics

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https://www.readbyqxmd.com/read/28430569/courage-and-compassion-virtues-in-caring-for-so-called-difficult-patients
#1
Michael Hawking, Farr A Curlin, John D Yoon
What, if anything, can medical ethics offer to assist in the care of the "difficult" patient? We begin with a discussion of virtue theory and its application to medical ethics. We conceptualize the "difficult" patient as an example of a "moral stress test" that especially challenges the physician's character, requiring the good physician to display the virtues of courage and compassion. We then consider two clinical vignettes to flesh out how these virtues might come into play in the care of "difficult" patients, and we conclude with a brief proposal for how medical educators might cultivate these essential character traits in physicians-in-training...
April 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28429143/how-to-treat-lumbar-disc-herniation-in-pregnancy-a-systematic-review-on-current-standards
#2
REVIEW
Alberto Di Martino, Fabrizio Russo, Luca Denaro, Vincenzo Denaro
PURPOSE: In this systematic review, we aim to illustrate the current and safe concepts in the assessment, diagnosis and management of herniated lumbar disc (HLD) during pregnancy. METHODS: A systematic review and reporting on the diagnosis, treatment and clinical results of HLD during pregnancy is performed. RESULTS: The MRI represents the first level and safest diagnostic tool for pregnant women affected by spinal problems allowing for a noninvasive and detailed radiological examination of the spine...
April 20, 2017: European Spine Journal
https://www.readbyqxmd.com/read/28428732/access-to-information-and-counselling-older-cancer-patients-self-report-a-cross-sectional-survey
#3
Kristin Vassbotn Guldhav, Randi Jepsen, Siri Ytrehus, Ellen Karine Grov
BACKGROUND: An increasingly older population, improved diagnostics and treatment increase the number of older cancer survivors, thus more than 60% of those affected by cancer are over the age of 65. Symptom relief and the prevention of functional impairment are important tasks for home care nursing, considering that patients can live a long time with their cancer disease and related side effects. The aim of this study was to investigate the extent to which cancer patients over the age of 65 reported access to information and counselling from home care nursing services, including those offered by the cancer coordinator...
2017: BMC Nursing
https://www.readbyqxmd.com/read/28426872/importance-and-difficulties-of-pursuing-rtms-research-in-acute-stroke
#4
James R Carey, Diane M Chappuis, Marsha J Finkelstein, Kate L Frost, Lynette K Leuty, Allison L McNulty, Lars I E Oddsson, Erin M Seifert, Teresa J Kimberley
Although much research has been done on repetitive transcranial magnetic stimulation (rTMS) in chronic stroke, only sparse research has been done in acute stroke despite the particularly rich potential for neuroplasticity in this stage. We attempted a preliminary clinical trial in one active, high-quality inpatient rehabilitation facility (IRF) in the -United States. But after enrolling only 4 patients in the grant period, the study was stopped because of low enrollment. The purpose of this paper is to offer a perspective describing the important physiologic rationale for including rTMS in the early phase of stroke, the reasons for our poor patient enrollment in our attempted study, and recommendations to help future studies succeed...
March 1, 2017: Physical Therapy
https://www.readbyqxmd.com/read/28426520/nursing-practice-research-and-education-in-the-west-the-best-is-yet-to-come
#5
Heather M Young, Susan Bakewell-Sachs, Linda Sarna
PURPOSE: This paper celebrates the 60th anniversary of the Western Institute of Nursing, the nursing organization representing 13 states in the Western United States, and envisions a preferred future for nursing practice, research, and education. BACKGROUND: Three landmark calls to action contribute to transforming nursing and healthcare: the Patient Protection and Affordable Care Act of 2010; the Institute of Medicine report Future of Nursing: Leading Change, Advancing Health; and the report Advancing Healthcare Transformation: A New Era for Academic Nursing...
April 20, 2017: Nursing Research
https://www.readbyqxmd.com/read/28426448/clinical-and-ethical-challenges-in-heart-transplantation-from-donation-after-circulatory-determined-death-donors
#6
Stephen Large, Steven Tsui, Simon Messer
PURPOSE OF REVIEW: The aim of this study was to describe the development of a clinical programme of heart transplantation from nonheart beating (or donation after circulatory determined death, DCD) donors. DCD is an established practice in abdominal and lung transplantation. The opportunity for sufferers of advanced heart failure provided by DCD heart transplantation is described. RECENT FINDINGS: Work shows that the arrested DCD heart is viable and has a 30-min tolerance to anoxia at normal body temperature making transplantation possible...
April 19, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28426313/substance-use-criteria-to-restrict-medicaid-coverage-of-hepatitis-c-treatment-cost-versus-ethics
#7
Joshua M Liao, Michael A Fischer
Medicaid programs provide health insurance coverage for many patients with hepatitis C, a public health problem for which effective but very expensive treatments are now available. Facing constrained budgets, most states adopted prior authorization criteria for sofosbuvir, the first of these agents. Using fee-for-service utilization data from 42 Medicaid programs in 2014, we found that strict behavioral criteria-those that limited coverage on the basis of drug or alcohol use and included specific abstinence or treatment requirements-were associated with significantly less spending on sofosbuvir...
April 20, 2017: American Journal of Public Health
https://www.readbyqxmd.com/read/28424653/disentangling-stigma-from-functional-neurological-disorders-conference-report-and-roadmap-for-the-future
#8
Karen S Rommelfanger, Stewart A Factor, Suzette LaRoche, Phyllis Rosen, Raymond Young, Mark H Rapaport
A multidisciplinary expert review of key issues and future directions from the conference "Controversial labels and clinical uncertainties: psychogenic disorders, conversion disorder, and functional symptoms." On October 9 and 10, 2015, a conference entitled "Controversial labels and clinical uncertainties: psychogenic disorders, conversion disorder, and functional symptoms" was held at the Center for Ethics, Emory University, Atlanta, GA, USA. This conference brought together a select group of 30 distinguished thought leaders and practitioners, including ethicists, researchers, clinicians, humanities scholars, and advocates to discuss the unique challenges and controversies related to the diagnosis, treatment, and stigma for patients with what is currently recognized as functional ("psychogenic") neurological disorders...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28424538/metal-complexes-in-cancer-therapy-an-update-from-drug-design-perspective
#9
REVIEW
Umar Ndagi, Ndumiso Mhlongo, Mahmoud E Soliman
In the past, metal-based compounds were widely used in the treatment of disease conditions, but the lack of clear distinction between the therapeutic and toxic doses was a major challenge. With the discovery of cisplatin by Barnett Rosenberg in 1960, a milestone in the history of metal-based compounds used in the treatment of cancers was witnessed. This forms the foundation for the modern era of the metal-based anticancer drugs. Platinum drugs, such as cisplatin, carboplatin and oxaliplatin, are the mainstay of the metal-based compounds in the treatment of cancer, but the delay in the therapeutic accomplishment of other metal-based compounds hampered the progress of research in this field...
2017: Drug Design, Development and Therapy
https://www.readbyqxmd.com/read/28423837/a-terminology-in-general-practice-family-medicine-to-represent-non-clinical-aspects-for-various-usages-the-q-codes
#10
Marc Jamoulle, Julien Grosjean, Melissa Resnick, Ashwin Ittoo, Arthur Treuherz, Robert Vander Stichele, Elena Cardillo, Stéfan J Darmoni, Frank S Shamenek, Marc Vanmeerbeek
The hereby proposed terminology called "Q-Codes" can be defined as an extension of the International Classification of Primary Care (ICPC-2). It deals with non-clinical concepts that are relevant in General Practice/Family Medicine (GP/FM). This terminology is a good way to put an emphasis on underestimated topics such as Teaching, Patient issues or Ethics. It aims at indexing GP/FM documents such as congress abstracts and theses to get a more comprehensive view about the GP/FM domain. The 182 identified Q-Codes have been very precisely defined by a college of experts (physicians and terminologists) from twelve countries...
2017: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/28423815/mobile-medical-apps-and-mhealth-devices-a-framework-to-build-medical-apps-and-mhealth-devices-in-an-ethical-manner-to-promote-safer-use-a-literature-review
#11
Mary Sharp, Declan O'Sullivan
This paper presents a preliminary literature review in the area of ethics in the development of Mobile Medical Apps and mHealth. The review included both direct health apps and also apps marketed under the area of well-being in addition to mHealth devices. The following words and combinations of them were used to carry out the search for publications, mHealth, Apps, Ethics. The search engines used were Google Scholar, and PubMed. The paper is restricted to publications since 2012. The total number of papers found was 1,920 of which 84 were reviewed...
2017: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/28423747/establishment-of-requirements-and-methodology-for-the-development-and-implementation-of-greymatters-a-memory-clinic-information-system
#12
Archana Tapuria, Matt Evans, Vasa Curcin, Tony Austin, Nathan Lea, Dipak Kalra
INTRODUCTION: The aim of the paper is to establish the requirements and methodology for the development process of GreyMatters, a memory clinic system, outlining the conceptual, practical, technical and ethical challenges, and the experiences of capturing clinical and research oriented data along with the implementation of the system. METHODS: The methodology for development of the information system involved phases of requirements gathering, modeling and prototype creation, and 'bench testing' the prototype with experts...
2017: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/28422848/teriparatide-as-a-nonoperative-treatment-for-tibial-and-femoral-fracture-nonunion-a-case-report
#13
Li Xiaofeng, Xu Daxia, Chen Yunzhen
RATIONALE: Fracture nonunion is a great challenge for orthopedic surgeons. Many surgical interventions are associated with significant pain and heavy economic burden. Therefore, our aim was to evaluate the outcomes of a new nonoperative treatment for fracture nonunion. PATIENT CONCERNS: A 44-year-old man suffered closed fractures of the right tibia and left femur. Eleven months after surgery, there was no radiographic healing between fracture fragments. DIAGNOSES: Fracture nonunion of the right tibia and left femur...
April 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28421889/overall-assessment-of-human-research-and-ethics-committees-in-the-united-arab-emirates
#14
Mahera Abdulrahman, Satish Chandrasekhar Nair
Growing demand for human health research in the United Arab Emirates (UAE) has prompted the need to develop a robust research ethics oversight. Examination of the structure, function, and practices of the human research ethics committees (HRECs), followed by evaluation of standards for measuring research output, was conducted. Results indicate that among the HRECs, 90% followed International Council for Harmonization-Good Clinical Practice guidelines, 66.6% have been in operation for more than 5 years, 95% reviewed proposals within 8 weeks, and 56% reviewed for scientific merit apart from ethics...
April 2017: Journal of Empirical Research on Human Research Ethics: JERHRE
https://www.readbyqxmd.com/read/28421865/it-s-not-all-about-moral-reasoning-understanding-the-content-of-moral-case-deliberation
#15
Mia Svantesson, Marit Silén, Inger James
BACKGROUND: Moral Case Deliberation is one form of clinical ethics support described as a facilitator-led collective moral reasoning by healthcare professionals on a concrete moral question connected to their practice. Evaluation research is needed, but, as human interaction is difficult to standardise, there is a need to capture the content beyond moral reasoning. This allows for a better understanding of Moral Case Deliberation, which may contribute to further development of valid outcome criteria and stimulate the normative discussion of what Moral Case Deliberation should contain...
January 1, 2017: Nursing Ethics
https://www.readbyqxmd.com/read/28421642/how-do-we-know-what-makes-for-best-practice-in-clinical-supervision-for-psychological-therapists-a-content-analysis-of-supervisory-models-and-approaches
#16
Gillian E Hardy, Chloe Simpson-Southward, Glenn Waller
Clinical supervision for psychotherapies is widely used in clinical and research contexts. Supervision is often assumed to ensure therapy adherence and positive client outcomes, but there is little empirical research to support this contention. Regardless, there are numerous supervision models, but it is not known how consistent their recommendations are. This review aimed to identify which aspects of supervision are consistent across models, and which are not. A content analysis of 52 models revealed 71 supervisory elements...
April 19, 2017: Clinical Psychology & Psychotherapy
https://www.readbyqxmd.com/read/28421331/two-troubling-trends-in-the-conversation-over-whether-clinical-ethics-consultants-have-ethics-expertise
#17
Abram Brummett, Christopher J Ostertag
In a recent issue of the Journal of Medicine and Philosophy, several scholars wrote on the topic of ethics expertise in clinical ethics consultation. The articles in this issue exemplified what we consider to be two troubling trends in the quest to articulate a unique expertise for clinical ethicists. The first trend, exemplified in the work of Lisa Rasmussen, is an attempt to define a role for clinical ethicists that denies they have ethics expertise. Rasmussen cites the dependence of ethical expertise on irresolvable meta-ethical debates as the reason for this move...
April 18, 2017: HEC Forum: An Interdisciplinary Journal on Hospitals' Ethical and Legal Issues
https://www.readbyqxmd.com/read/28420664/the-uk-cardiac-and-vascular-surgery-interventional-anaemia-response-caviar-study-protocol-for-an-observational-cohort-study-to-determine-the-impact-and-effect-of-preoperative-anaemia-management-in-cardiac-and-vascular-surgical-patients
#18
Marisa Chau, Toby Richards, Caroline Evans, Anna Butcher, Timothy Collier, Andrew Klein
INTRODUCTION: Preoperative anaemia is linked to poor postsurgical outcome, longer hospital stays, greater risk of complications and mortality. Currently in the UK, some sites have developed anaemia clinics or pathways that use intravenous iron to correct iron deficiency anaemia prior to surgery as their standard of care. Although intravenous iron has been observed to be effective in a variety of patient settings, there is insufficient evidence in its use in cardiac and vascular patients...
April 18, 2017: BMJ Open
https://www.readbyqxmd.com/read/28419814/high-intensity-focused-ultrasound-for-treatment-of-symptomatic-benign-thyroid-nodules-a-prospective-study
#19
Brian Hung-Hin Lang, Yu-Cho Woo, Carlos K H Wong
Purpose To evaluate first-year efficacy and changes in pressure symptoms and health-related quality of life (HRQOL) after ultrasonographically (US) guided high-intensity focused ultrasound (HIFU) ablation of symptomatic benign thyroid nodules. Materials and Methods After ethics approval and informed consent were obtained, a prospective trial was conducted. Patients with a symptomatic benign thyroid nodule were given a choice of HIFU treatment or active surveillance. Clinical and US examinations, pressure symptom scores (visual analog scale), and HRQOL questionnaires (short form-12 survey) were evaluated at baseline and at 3, 6, and 12 months...
April 18, 2017: Radiology
https://www.readbyqxmd.com/read/28419750/the-effectiveness-of-virtual-and-augmented-reality-in-health-sciences-and-medical-anatomy
#20
Christian Moro, Zane Štromberga, Athanasios Raikos, Allan Stirling
Although cadavers constitute the gold standard for teaching anatomy to medical and health science students, there are substantial financial, ethical, and supervisory constraints on their use. In addition, although anatomy remains one of the fundamental areas of medical education, universities have decreased the hours allocated to teaching gross anatomy in favor of applied clinical work. The release of virtual (VR) and augmented reality (AR) devices allows learning to occur through hands-on immersive experiences...
April 17, 2017: Anatomical Sciences Education
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