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https://www.readbyqxmd.com/read/28644792/what-moral-distress-in-nursing-history-could-suggest-about-the-future-of-health-care
#1
Andrew Jameton
The concept of moral distress was defined in 1984 as (a) the psychological distress of (b) being in a situation in which one is constrained from acting (c) on what one knows to be right. A substantial literature on the subject has developed, primarily in nursing ethics. The aforementioned elements of distress are applied here to areas of clinical and organizational significance: (a) distress from causing intimate pain during care of the dying, (b) constraints stemming from proximate and background challenges of health care organizations, and (c) changing perspectives on therapeutic technologies derived from global environmental perspectives...
June 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28644791/culture-and-moral-distress-what-s-the-connection-and-why-does-it-matter
#2
Nancy Berlinger, Annalise Berlinger
Culture is learned behavior shared among members of a group and from generation to generation within that group. In health care work, references to "culture" may also function as code for ethical uncertainty or moral distress concerning patients, families, or populations. This paper analyzes how culture can be a factor in patient-care situations that produce moral distress. It discusses three common, problematic situations in which assumptions about culture may mask more complex problems concerning family dynamics, structural barriers to health care access, or implicit bias...
June 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28644790/strategies-for-promoting-high-quality-care-and-personal-resilience-in-palliative-care
#3
Katherine E Heinze, Heidi K Holtz, Cynda H Rushton
Palliative care (PC) clinicians are faced with ever-expanding pressures, which can make it difficult to fulfill their duties to self and others and lead to moral distress. Understanding the pressures that PC clinicians face and the resources that could be employed to ease their moral distress is crucial to maintaining a healthy PC workforce and to providing necessary PC services to patients. In this paper, we discuss recommendations related to two promising pathways for supporting PC clinicians in providing high-quality PC: (1) improving systemic PC delivery and (2) strategies to promote ethical practice environments and individual resilience...
June 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28644789/what-is-the-role-of-ethics-consultation-in-the-moral-habitability-of-health-care-environments
#4
Wendy Austin
Ethics consultation has traditionally focused on the provision of expert guidance to health care professionals when challenging quandaries arise in clinical cases. Its role, however, is expanding as demands on health care organizations are negatively impacting their moral habitability. A sign of this impact can be seen in the moral distress experienced by staff and administrators, such that some leave their positions and their organizations. Ethics consultation, more broadly conceived, can be a major asset in ensuring that ethical practice is meaningfully supported, that moral distress is mitigated, and that the organizational environment is morally habitable...
June 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28644788/initiatives-for-responding-to-medical-trainees-moral-distress-about-end-of-life-cases
#5
M Sara Rosenthal, Maria Clay
Moral distress frequently arises for medical trainees exposed to end-of-life cases. We review the small literature on best practices for reducing moral distress in such cases and propose two areas to target for moral distress reduction: medical education and organizational ethics programs. Students require training in end-of-life dialogues and truthful prognostication, which are not generally available without skilled mentors. But physician-mentors and teachers can suffer from lingering moral residue themselves, which can affect the teaching culture and student expectations...
June 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28644787/who-is-experiencing-what-kind-of-moral-distress-distinctions-for-moving-from-a-narrow-to-a-broad-definition-of-moral-distress
#6
Carina Fourie
Moral distress, according to Andrew Jameton's highly influential definition, occurs when a nurse knows the morally correct action to take but is constrained in some way from taking this action. The definition of moral distress has been broadened, first, to include morally challenging situations that give rise to distress but which are not necessarily linked to nurses feeling constrained, such as those associated with moral uncertainty. Second, moral distress has been broadened so that it is not confined to the experiences of nurses...
June 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28644786/antecedents-and-consequences-of-medical-students-moral-decision-making-during-professionalism-dilemmas
#7
Lynn Monrouxe, Malissa Shaw, Charlotte Rees
Medical students often experience professionalism dilemmas (which differ from ethical dilemmas) wherein students sometimes witness and/or participate in patient safety, dignity, and consent lapses. When faced with such dilemmas, students make moral decisions. If students' action (or inaction) runs counter to their perceived moral values-often due to organizational constraints or power hierarchies-they can suffer moral distress, burnout, or a desire to leave the profession. If moral transgressions are rationalized as being for the greater good, moral distress can decrease as dilemmas are experienced more frequently (habituation); if no learner benefit is seen, distress can increase with greater exposure to dilemmas (disturbance)...
June 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28644785/what-should-physicians-do-when-they-disagree-clinically-and-ethically-with-a-surrogate-s-wishes
#8
Terri Traudt, Joan Liaschenko
When patients' surrogates and physicians disagree about the appropriateness of aggressive treatment in intensive care units (ICUs), physicians can experience surrogates' demands as sources of moral distress. This article addresses the virtues and communication strategies needed to respond appropriately in such situations. Specifically, we offer a framework and language that rely on moral community to facilitate common ground and alleviate moral distress.
June 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28644784/how-should-physicians-respond-when-the-best-treatment-for-an-individual-patient-conflicts-with-practice-guidelines-about-the-use-of-a-limited-resource
#9
Edmund G Howe
The case presents a physician's ethical conflict, due to limited resources, between his obligations to meet the needs of a community and those of his patient. Elements of the decision-making process (and who should make the decision) are discussed, including the limitations of what ethical reasoning can offer and risks of arbitrary outcomes. Additionally, potential benefits to physicians and their patients of discussing these conflicts, including reducing the physician's moral distress, are noted. I argue that physicians' abilities to make "right" decisions in such situations are limited, and I suggest ways in which physicians can try to preserve their relationships with patients...
June 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28644783/how-should-integrity-preservation-and-professional-growth-be-balanced-during-trainees-professionalization
#10
Eli Weber, Sharon Gray
People can experience moral distress when they regard themselves as expected to pursue a course of action they believe to be morally wrong. However, beliefs that give rise to moral distress are sometimes underdeveloped. Experiences of moral distress are not uncommon for medical trainees, who are still in the process of forming their professional identities and whose identity-constituting beliefs might therefore be subject to ongoing revision. Thus, it is important for health professions training programs to incorporate case-based ethics education sessions into their structure to help identify and alleviate trainees' moral distress, provide ethics education, and create a "safe space" for trainees to talk openly about moral concerns related to clinical practice...
June 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28644782/how-should-resident-physicians-respond-to-patients-discomfort-and-students-moral-distress-when-learning-procedures-in-academic-medical-settings
#11
Bonnie M Miller
In this scenario, a medical student, Lauren, experiences moral distress because she feels that learning to perform a procedure on a patient who requested not to be used for "practice" puts her own interests above the patient's. Lauren might also worry that the resident physician is misrepresenting her abilities. The resident physician could help alleviate Lauren's distress and align her interests with the patient's by more clearly explaining the training situation to the patient and seeking the patient's approval...
June 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28644583/a-slice-of-hospital-toast-a-day-keeps-the-doctors-at-bay
#12
S Martin, C Hill
Anecdotal evidence over the years has suggested that toast made in hospital, so called 'hospital toast' tastes better than toast made at home, or anywhere else for that matter. We carried out a prospective, multi-professional study to determine the views and the toast eating habits of NHS staff. Fifty members of NHS staff were surveyed across two hospital trusts. This included nursing staff, doctors from various specialties and allied health professionals. Results were overwhelming, a staggering 96% admitted to enjoying a slice of hospital toast while at work...
December 12, 2016: Irish Medical Journal
https://www.readbyqxmd.com/read/28644246/effects-of-exercise-on-the-immune-function-of-pediatric-patients-with-solid-tumors-insights-from-the-papec-randomized-trial
#13
Carmen Fiuza-Luces, Julio R Padilla, Jaime Valentín, Elena Santana-Sosa, Alejandro Santos-Lozano, Fabián Sanchis-Gomar, Helios Pareja-Galeano, Javier S Morales, Steven J Fleck, Margarita Pérez, Alvaro Lassaletta, Luisa Soares-Miranda, Antonio Pérez-Martínez, Alejandro Lucia
The purpose of this study was to assess the effects of an in-hospital exercise intervention during neoadjuvant chemotherapy on the inflammatory profile and immune cell subpopulation in 20 children with solid tumors (control [n = 11] and exercise group [n = 9]). Although no significant interaction (group × time) effect was found with an analysis of variance test, we found a trend toward an interaction effect for natural killer cells expressing the immunoglobulin-like receptor KIR2DS4, with their numbers remaining stable in the exercise group but increasing in controls...
June 21, 2017: American Journal of Physical Medicine & Rehabilitation
https://www.readbyqxmd.com/read/28644074/reinforcing-marginality-maternal-health-interventions-in-rural-nicaragua
#14
Birgit Kvernflaten
To achieve Millennium Development Goal 5 on maternal health, many countries have focused on marginalized women who lack access to care. Promoting facility-based deliveries to ensure skilled birth attendance and emergency obstetric care has become a main measure for preventing maternal deaths, so women who opt for home births are often considered 'marginal' and in need of targeted intervention. Drawing upon ethnographic data from Nicaragua, this paper critically examines the concept of marginality in the context of official efforts to increase institutional delivery amongst the rural poor, and discusses lack of access to health services among women living in peripheral areas as a process of marginalization...
June 23, 2017: Anthropology & Medicine
https://www.readbyqxmd.com/read/28643845/on-the-advancement-of-therapeutic-penality-therapeutic-authority-personality-science-and-the-therapeutic-community
#15
Ruari-Santiago McBride
In this article I examine the advancement of therapeutic penality in the UK, a penal philosophy that reimagines prison policy, practices and environments utilising psychological knowledge. Adopting a historical approach, I show how modern therapeutic penality is linked to the emergence of personality science in the nineteenth century and the development of the democratic therapeutic community (DTC) model in the twentieth century. I outline how at the turn of the twenty-first century a catalytic event generated a moral panic that led the British government to mobilise psychological knowledge and technologies in an attempt to manage dangerous people with severe personality disorder...
June 23, 2017: Sociology of Health & Illness
https://www.readbyqxmd.com/read/28643389/combined-molecular-modelling-and-3d-qsar-study-for-understanding-the-inhibition-of-nqo1-by-heterocyclic-quinone-derivatives
#16
Claudia Lopez-Lira, Jans H Alzate-Morales, Margot Paulino, Jaime Mella-Raipán, Cristian O Salas, Ricardo A Tapia, Jorge Soto-Delgado
A combination of three-dimensional quantitative structure-activity relationship (3D-QSAR), and molecular modelling methods were used to understand the potent inhibitory NAD(P)H:quinone oxidoreductase 1 (NQO1) activity of a set of 52 heterocyclic quinones. Molecular docking results indicated that some favourable interactions of key amino acid residues at the binding site of NQO1 with these quinones, would be responsible for an improvement of the NQO1 activity of these compounds. The main interactions involved are hydrogen bond of the amino group of residue Tyr128, π-stacking interactions with Phe106 and Phe178, and electrostatic interactions with flavin adenine dinucleotide (FADH) cofactor...
June 23, 2017: Chemical Biology & Drug Design
https://www.readbyqxmd.com/read/28642871/promoting-mental-health-in-italian-middle-and-high-school-a-pilot-study
#17
Franco Veltro, Valentina Ialenti, Manuel Alejandro Morales García, Emiliana Bonanni, Claudia Iannone, Marinella D'Innocenzo, Antonella Gigantesco
AIM: In Italy, a handbook has been developed based on the principles of cooperative learning, life skills, self-effectiveness, and problem-solving at high school level. Early studies have shown the handbook's effectiveness. It has been hypothesized that the revised handbook could be more effective in middle schools. METHOD: The study design is a "pre- and posttest" that compares the results obtained from 91 students of the high schools with those of the 38 students from middle schools...
2017: BioMed Research International
https://www.readbyqxmd.com/read/28642771/transcriptomic-analysis-of-avocado-hass-persea-americana-mill-in-the-interaction-system-fruit-chitosan-colletotrichum
#18
Luis-Ángel Xoca-Orozco, Esther Angélica Cuellar-Torres, Sandra González-Morales, Porfirio Gutiérrez-Martínez, Ulises López-García, Luis Herrera-Estrella, Julio Vega-Arreguín, Alejandra Chacón-López
Avocado (Persea americana) is one of the most important crops in Mexico as it is the main producer, consumer, and exporter of avocado fruit in the world. However, successful avocado commercialization is often reduced by large postharvest losses due to Colletotrichum sp., the causal agent of anthracnose. Chitosan is known to have a direct antifungal effect and acts also as an elicitor capable of stimulating a defense response in plants. However, there is little information regarding the genes that are either activated or repressed in fruits treated with chitosan...
2017: Frontiers in Plant Science
https://www.readbyqxmd.com/read/28642001/regarding-mechanical-circulatory-support-in-adults-with-congenital-heart-disease-is-it-time-to-lower-the-threshold-for-use
#19
EDITORIAL
Roosevelt Bryant, David L S Morales
No abstract text is available yet for this article.
May 29, 2017: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/28641950/cholinergic-signaling-plasticity-maintains-viscerosensory-responses-during-aspiculuris-tetraptera-infection-in-mice-small-intestine
#20
Egina C Villalobos-Hernández, Carlos Barajas-López, Elizabeth A Martínez-Salazar, Roberto C Salgado-Delgado, Marcela Miranda-Morales
Intestinal parasites alter gastrointestinal (GI) functions like the cholinergic function. Aspiculuris tetraptera is a pinworm frequently observed in laboratory facilities, which infests the mice cecum and proximal colon. However, little is known about the impact of this infection on the GI sensitivity. Here, we investigated possible changes in spontaneous mesenteric nerve activity and on the mechanosensitivity function of worm-free regions of naturally infected mice with A. tetraptera. Infection increased the basal firing of mesenteric afferent nerves in jejunum...
June 3, 2017: Autonomic Neuroscience: Basic & Clinical
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