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Medical ethics

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https://www.readbyqxmd.com/read/28647725/percutaneous-coronary-intervention-patients-and-cardiologists-experiences-of-the-informed-consent-process-in-northern-england-a-qualitative-study
#1
Joy Probyn, Joanne Greenhalgh, Janet Holt, Dwayne Conway, Felicity Astin
OBJECTIVE: Informed consent is central to ethical medical practice, but little is known about how the process takes place in clinical practice. Percutaneous coronary intervention (PCI) is a common revascularisation procedure. Studies report that patients overestimate benefits, forget the risks and are unaware of alternative treatments. The aim of this study was to describe PCI patients' and cardiologists' experiences of the informed consent process in acute care settings. DESIGN/SETTING/PARTICIPANTS: A qualitative study with a maximum variation sample of elective and acute PCI patients and cardiologists taking their consent, recruited from a district general hospital and tertiary centre...
June 24, 2017: BMJ Open
https://www.readbyqxmd.com/read/28646217/why-do-physicians-lack-engagement-with-smoking-cessation-treatment-in-their-copd-patients-a-multinational-qualitative-study
#2
Eva Anne Marije van Eerd, Mette Bech Risør, Mark Spigt, Maciek Godycki-Cwirko, Elena Andreeva, Nick Francis, Anja Wollny, Hasse Melbye, Onno van Schayck, Daniel Kotz
Smoking cessation is the only effective intervention to slow down the accelerated decline in lung function in smokers with chronic obstructive pulmonary disease. Nevertheless, physicians often do not routinely provide evidence-based smoking cessation treatment to their patients. To understand underlying reasons, we explored how physicians engage in smoking cessation treatment in their chronic obstructive pulmonary disease patients. In total, 21 focus group discussions were held with general practitioners and pulmonologists in seven different countries in Europe and Asia...
June 23, 2017: NPJ Primary Care Respiratory Medicine
https://www.readbyqxmd.com/read/28646035/a-matter-of-life-and-death
#3
Justice Baker
Cases concerning the withdrawal or withholding of artificial nutrition and hydration from patients in a vegetative or minimally conscious state raise difficult medical, legal and ethical questions including the diagnosis and classification of disorders of consciousness, the legal processes to be followed, and the legal and ethical principles to be applied when making decisions. There is also an issue as to whether it is necessary or appropriate for such decisions to be taken by judges. This article, based on a lecture given in Oxford in October 2016, considers a number of these issues and concludes that any consideration of the question from the patient's point of view must include an objective analysis of what is in his or her best interests, as well as subjective expressions of wishes and feelings...
June 23, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28645981/work-related-psychosocial-factors-and-onset-of-metabolic-syndrome-among-workers-a-systematic-review-and-meta-analysis-protocol
#4
Asuka Sakuraya, Kazuhiro Watanabe, Norito Kawakami, Kotaro Imamura, Emiko Ando, Yumi Asai, Hisashi Eguchi, Yuka Kobayashi, Norimitsu Nishida, Hideaki Arima, Akihito Shimazu, Akizumi Tsutsumi
INTRODUCTION: Metabolic syndrome is an important public health target because of its high prevalence worldwide. Work-related psychosocial factors have been identified as determinants of metabolic syndrome components. However, there have been no systematic reviews or meta-analyses conducted to evaluate the relationship between work-related psychosocial factors and metabolic syndrome as an aggregated cluster. The aim of this study is to examine this association from published prospective studies...
June 22, 2017: BMJ Open
https://www.readbyqxmd.com/read/28645964/the-predictive-value-of-serial-changes-in-diaphragm-function-during-the-spontaneous-breathing-trial-for-weaning-outcome-a-study-protocol
#5
Pengmin Zhou, Zhongheng Zhang, Yucai Hong, Huabo Cai, Hui Zhao, Peifeng Xu, Yiming Zhao, Shengping Lin, Xuchang Qin, JiaWei Guo, Yun Pan, Junru Dai
INTRODUCTION: There is a variety of tools being used in clinical practice for the prediction of weaning success from mechanical ventilation. However, their diagnostic performances are less than satisfactory. The purpose of this study is to investigate the value of serial changes in diaphragm function measured by ultrasound during the spontaneous breathing trial (SBT) as a weaning predictor. METHODS AND ANALYSIS: This is a prospective observational study conducted in a 10-bed medical emergency intensive care unit (EICU) in a university-affiliated hospital...
June 23, 2017: BMJ Open
https://www.readbyqxmd.com/read/28644788/initiatives-for-responding-to-medical-trainees-moral-distress-about-end-of-life-cases
#6
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/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/28644783/how-should-integrity-preservation-and-professional-growth-be-balanced-during-trainees-professionalization
#8
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/28644781/teaching-clinical-ethics-at-the-bedside-william-osler-and-the-essential-role-of-the-hospitalist
#9
Matthew William McCarthy, Joseph J Fins
As the field of hospital medicine celebrates its twenty-first anniversary, we believe it is time to expand its mission to play an even greater role in medical education. Given hospitalists' proximity to students and clinical material, members of this growing cohort of physicians are uniquely positioned to teach normative reasoning, professionalism, communication, and medical ethics in real time to trainees on the wards. But, to do so, we must reimagine the role of the hospitalist in graduate and postgraduate medical education...
June 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28644780/avoiding-racial-essentialism-in-medical-science-curricula
#10
Lundy Braun, Barry Saunders
A wave of medical student activism is shining a spotlight on medical educators' sometimes maladroit handling of racial categories in teaching about health disparities. Coinciding with recent critiques, primarily by social scientists, regarding the imprecise and inappropriate use of race as a biological or epidemiological risk factor in genetics research, medical student activism has triggered new collaborations among students, faculty, and administrators to rethink how race is addressed in the medical curriculum...
June 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28643812/-conscience-clause-in-end-of-life-care
#11
Ludovica De Panfilis, Daniela Cattaneo, Luisanna Cola, Maddalena Gasparini, Corinna Porteri, Daniela Tarquini, Alessandro Tiezzi, Simone Veronese, Silvia Zullo, Eugenio Pucci
The article proposes a critical reflection on issues that appeal to the conscience clause as part of end of life care can produce and what can guarantee freedom of conscience, self-determination of those involved and respect for the dignity of the sick person. After a philosophical and normative analysis, the article is organized on the basis of two important documents for discussion: a position paper of Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva (SIAARTI) signed by several scientific societies "Grandi insufficienze d'organo end stage: cure intensive o cure palliative?" and the Design of Law currently being debated "Norme in materia di consenso informato e di disposizioni anticipate di trattamento"...
May 2017: Recenti Progressi in Medicina
https://www.readbyqxmd.com/read/28643811/-from-mild-cognitive-impairment-to-dementia-what-is-the-role-of-public-health
#12
Nicola Vanacore, Alessandra Di Pucchio, Eleonora Lacorte, Ilaria Bacigalupo, Flavia Mayer, Giulia Grande, Matteo Cesari, Marco Canevelli
Mild cognitive impairment (MCI) is a nosological entity proposed by Petersen in 1999 with the objective of identifying an early stage of dementia. The new diagnostic criteria for dementia, both those promoted by the International Working Group (IWG) and those defined by the National Institute of Aging (NIA), subsequently introduced a new model that starts with a preclinical phase, then proceeds with a prodromal phase, and ends with a phase of dementia. The condition known as subjective cognitive disorder (SCD) is included between the preclinic and the prodromal phases...
May 2017: Recenti Progressi in Medicina
https://www.readbyqxmd.com/read/28643577/an-assessment-of-advance-relatives-approach-for-brain-death-organ-donation
#13
Carine Michaut, Antoine Baumann, Hélène Gregoire, Corinne Laviale, Gérard Audibert, Xavier Ducrocq
BACKGROUND: Advance announcement of forthcoming brain death has developed to enable intensivists and organ procurement organisation coordinators to more appropriately, and separately from each other, explain to relatives brain death and the subsequent post-mortem organ donation opportunity. Research aim: The aim was to assess how potentially involved healthcare professionals perceived ethical issues surrounding the strategy of advance approach. RESEARCH DESIGN: A multi-centre opinion survey using an anonymous self-administered questionnaire was conducted in the six-member hospitals of the publicly funded East of France regional organ and tissue procurement network called 'Prélor'...
January 1, 2017: Nursing Ethics
https://www.readbyqxmd.com/read/28642690/autonomy-in-depressive-patients-undergoing-dbs-treatment-informed-consent-freedom-of-will-and-dbs-potential-to-restore-it
#14
Timo Beeker, Thomas E Schlaepfer, Volker A Coenen
According to the World Health Organization, depression is one of the most common and most disabling psychiatric disorders, affecting at any given time approximately 325 million people worldwide. As there is strong evidence that depressive disorders are associated with a dynamic dysregulation of neural circuits involved in emotional processing, recently several attempts have been made to intervene directly in these circuits via deep brain stimulation (DBS) in patients with treatment-resistant major depressive disorder (MDD)...
2017: Frontiers in Integrative Neuroscience
https://www.readbyqxmd.com/read/28641960/-involuntary-commitment-of-the-psychiatric-patient-legal-regulations-and-critical-aspects
#15
M Ibáñez Bernáldez, M Casado Blanco
Traditionally, medical care received by psychiatric patients involved their separation from the society through their isolation in closed institutions, thereby setting a stigmatising trend on the sick, and by extension on mental illness, a practice that somehow has remained until now. The profound changes in the field of psychiatry have been important and are reflected in the therapeutic field, as well as in the legislative one, and have contributed to establish changes concerning the social opinion about psychiatric patients...
June 19, 2017: Semergen
https://www.readbyqxmd.com/read/28640812/challenges-in-preparing-and-implementing-a-clinical-trial-at-field-level-in-an-ebola-emergency-a-case-study-in-guinea-west-africa
#16
Sara Carazo Perez, Elin Folkesson, Xavier Anglaret, Abdoul-Habib Beavogui, Emmanuel Berbain, Alseny-Modet Camara, Evelyn Depoortere, Annabelle Lefevre, Piet Maes, Kristian Nødtvedt Malme, Jean-Marie Denis Malvy, Sien Ombelet, Geertrui Poelaert, Daouda Sissoko, Alexis Tounkara, Pierre Trbovic, Pascal Piguet, Annick Antierens
During the large Ebola outbreak that affected West Africa in 2014 and 2015, studies were launched to evaluate potential treatments for the disease. A clinical trial to evaluate the effectiveness of the antiviral drug favipiravir was conducted in Guinea. This paper describes the main challenges of the implementation of the trial in the Ebola treatment center of Guéckédou. Following the principles of the Good Clinical Research Practices, we explored the aspects of the community's communication and engagement, ethical conduct, trial protocol compliance, informed consent of participants, ongoing benefit/risk assessment, record keeping, confidentiality of patients and study data, and roles and responsibilities of the actors involved...
June 2017: PLoS Neglected Tropical Diseases
https://www.readbyqxmd.com/read/28640031/identifying-gaps-in-the-performance-of-pediatric-trainees-who-receive-marginal-unsatisfactory-ratings
#17
Su-Ting T Li, Daniel J Tancredi, Alan Schwartz, Ann Guillot, Ann Burke, R Franklin Trimm, Susan Guralnick, John D Mahan, Kimberly A Gifford
PURPOSE: To perform a derivation study to determine in which subcompetencies marginal/unsatisfactory pediatric residents had the greatest deficits compared with their satisfactorily performing peers and which subcompetencies best discriminated between marginal/unsatisfactory and satisfactorily performing residents. METHOD: Multi-institutional cohort study of all 21 milestones (rated on four or five levels) reported to the Accreditation Council for Graduate Medical Education, and global marginal/unsatisfactory versus satisfactory performance reported to the American Board of Pediatrics...
June 20, 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28639871/an-innovative-streaming-video-system-with-a-point-of-view-head-camera-transmission-of-surgeries-to-smartphones-and-tablets-an-educational-utility
#18
Rafael Oliveira Chaves, Pedro Armando Valente de Oliveira, Luciano Chaves Rocha, Joacy Pedro Franco David, Sanmari Costa Ferreira, Alex de Assis Santos Dos Santos, Rômulo Müller Dos Santos Melo, Edson Yuzur Yasojima, Marcus Vinicius Henriques Brito
PURPOSE: In order to engage medical students and residents from public health centers to utilize the telemedicine features of surgery on their own smartphones and tablets as an educational tool, an innovative streaming system was developed with the purpose of streaming live footage from open surgeries to smartphones and tablets, allowing the visualization of the surgical field from the surgeon's perspective. The current study aims to describe the results of an evaluation on level 1 of Kirkpatrick's Model for Evaluation of the streaming system usage during gynecological surgeries, based on the perception of medical students and gynecology residents...
June 1, 2017: Surgical Innovation
https://www.readbyqxmd.com/read/28639775/-%C3%A2-living-facing-death-improving-lausanne-s-medical-students-%C3%A2-attitude-toward-end-of-life-issues
#19
Emmanuel Tamchès, Lazare Benaroyo, Marc Antoine Bornet, Jean-Pierre Hornung, Gian Domenico Borasio
The optional course « Living facing death » is the result of an innovative educational approach jointly developed by CHUV's Palliative Care Service, Lausanne's School of Medicine, Medical Ethics Unit and the students' association « Doctors & Death ». It is intended for 3rd and 4th grade medical students and was inspired by previous experiences conducted at Harvard Medical School. Its primary objective is to help students to « take some distances ». A mixed quantitative/qualitative satisfaction questionnaire was administered to all participating students at the completion of the course...
May 24, 2017: Revue Médicale Suisse
https://www.readbyqxmd.com/read/28638969/introduction-childhood-and-disability
#20
EDITORIAL
Erica K Salter
From growth attenuation therapy for severely developmentally disabled children to the post-natal management of infants with trisomy 13 and 18, pediatric treatment decisions regularly involve assessments of the probability and severity of a child's disability. Because these decisions are almost always made by surrogate decision-makers (parents and caregivers) and because these decision-makers must often make decisions based on both prognostic guesses and potentially biased quality of life judgments, they are among the most ethically complex in pediatric care...
June 21, 2017: HEC Forum: An Interdisciplinary Journal on Hospitals' Ethical and Legal Issues
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