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https://www.readbyqxmd.com/read/27738255/feasibility-of-conducting-prospective-observational-research-on-critically-ill-dying-patients-in-the-intensive-care-unit
#1
Amanda van Beinum, Laura Hornby, Sonny Dhanani, Roxanne Ward, Jane Chambers-Evans, Kusum Menon
Studying patients during the end of life is important, as it has the potential to lead to improvements in care for the dying. For patients who die after a controlled withdrawal of life-sustaining therapies in the intensive care unit, information about the natural history of death and the process of removing life support has additionally led to advances in practice for deceased organ donation. However, this unique population of severely critically ill and imminently dying patients has been difficult to study, largely due to assumptions made by research teams and ethics boards alike about the logistical difficulties of obtaining consent and completing research procedures before or during the process of withdrawal of life-sustaining therapies...
October 13, 2016: Journal of Medical Ethics
https://www.readbyqxmd.com/read/27716629/ethical-considerations-in-the-translation-of-regenerative-biofabrication-technologies-into-clinic-and-society
#2
I A Otto, C C Breugem, J Malda, A L Bredenoord
Biofabrication technologies have the potential to improve healthcare by providing highly advanced and personalized biomedical products for research, treatment and prevention. As the combining of emerging techniques and integrating various biological and synthetic components becomes increasingly complex, it is important that relevant stakeholders anticipate the translation of biofabricated 3D tissue products into patients and society. Ethics is sometimes regarded as a brake on scientific progress, yet from our perspective, ethics in parallel with research anticipates societal impacts of emerging technologies and stimulates responsible innovation...
October 7, 2016: Biofabrication
https://www.readbyqxmd.com/read/27649916/creating-a-culture-of-ethical-practice-in-health-care-delivery-systems
#3
Cynda Hylton Rushton
Undisputedly, the United States' health care system is in the midst of unprecedented complexity and transformation. In 2014 alone there were well over thirty-five million admissions to hospitals in the nation, indicating that there was an extraordinary number of very sick and frail people requiring highly skilled clinicians to manage and coordinate their complex care across multiple care settings. Medical advances give us the ability to send patients home more efficiently than ever before and simultaneously create ethical questions about the balance of benefits and burdens associated with these advances...
September 2016: Hastings Center Report
https://www.readbyqxmd.com/read/27613475/feasibility-of-monomodal-analgesia-with-iv-alfentanil-during-burn-dressing-changes-at-bedside-in-spontaneously-breathing-non-intubated-patients
#4
Mathieu Fontaine, Jacques Latarjet, Jacqueline Payre, Jean-Charles Poupelin, François Ravat
INTRODUCTION: The severe pain related to repeated burn dressing changes at bedside is often difficult to manage. However these dressings can be performed at bedside on spontaneously breathing non-intubated patients using powerful intravenous opioids with a quick onset and a short duration of action such as alfentanil. The purpose of this study is to demonstrate the efficacy and safety of the protocol which is used in our burn unit for pain control during burn dressing changes. PATIENTS AND METHODS: Cohort study began after favorable opinion from local ethic committee has been collected...
September 6, 2016: Burns: Journal of the International Society for Burn Injuries
https://www.readbyqxmd.com/read/27563584/vertical-integration-of-basic-science-in-final-year-of-medical-education
#5
Sudha Jasmine Rajan, Tripti Meriel Jacob, Sowmya Sathyendra
BACKGROUND: Development of health professionals with ability to integrate, synthesize, and apply knowledge gained through medical college is greatly hampered by the system of delivery that is compartmentalized and piecemeal. There is a need to integrate basic sciences with clinical teaching to enable application in clinical care. AIM: To study the benefit and acceptance of vertical integration of basic science in final year MBBS undergraduate curriculum. MATERIALS AND METHODS: After Institutional Ethics Clearance, neuroanatomy refresher classes with clinical application to neurological diseases were held as part of the final year posting in two medical units...
July 2016: International Journal of Applied and Basic Medical Research
https://www.readbyqxmd.com/read/27501786/back-to-the-bedside-making-clinical-decisions-in-patients-with-prolonged-unconsciousness
#6
Derick Wade
In 1993, the UK High Court decided that Tony Bland was unaware of himself and his environment, had no interest in medical treatment and allowed withdrawal of treatment. Subsequently, the court has reviewed all cases of stopping feeding and hydration in people with a prolonged disorder of consciousness. Their focus has been on determining whether the person is in the permanent vegetative state, because this avoids considering what is in a person's Best Interests. Consequently, much resource is spent distinguishing the vegetative state from the minimally conscious state and often clinical decisions are delayed or not made because of the requirement to go to court...
August 8, 2016: Journal of Medical Ethics
https://www.readbyqxmd.com/read/27475009/geriatric-resuscitation
#7
REVIEW
Thomas Perera, Alexis Cortijo-Brown
The geriatric population makes up a large portion of the emergency patient population. Geriatric patients have less reserve and more comorbid diseases. They are frequently on multiple medications and are more likely to require aggressive treatment during acute illness. Although it may not be obvious, it is important to recognize the signs of shock as early as possible. Special care and monitoring should be used when resuscitating the elderly. The use of bedside ultrasound and monitoring for coagulopathies are discussed...
August 2016: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27439568/-it-s-a-matter-of-patient-safety-understanding-challenges-in-everyday-clinical-practice-for-achieving-good-care-on-the-surgical-ward-a-qualitative-study
#8
Eva Jangland, Berit Nyberg, Pia Yngman-Uhlin
BACKGROUND: Surgical care plays an important role in the acute hospital's delivery of safe, high-quality patient care. Although demands for effectiveness are high in surgical wards quality of care and patient safety must also be secured. It is therefore necessary to identify the challenges and barriers linked to quality of care and patient safety with a focus on this specific setting. AIM: To explore situations and processes that support or hinder good safe patient care on the surgical ward...
July 21, 2016: Scandinavian Journal of Caring Sciences
https://www.readbyqxmd.com/read/27422169/somatosensory-attention-identifies-both-overt-and-covert-awareness-in-disorders-of-consciousness
#9
Raechelle M Gibson, Srivas Chennu, Davinia Fernández-Espejo, Lorina Naci, Adrian M Owen, Damian Cruse
OBJECTIVE: Some patients diagnosed with disorders of consciousness retain sensory and cognitive abilities beyond those apparent from their overt behavior. Characterizing these covert abilities is crucial for diagnosis, prognosis, and medical ethics. This multimodal study investigates the relationship between electroencephalographic evidence for perceptual/cognitive preservation and both overt and covert markers of awareness. METHODS: Fourteen patients with severe brain injuries were evaluated with an electroencephalographic vibrotactile attention task designed to identify a hierarchy of residual somatosensory and cognitive abilities: (1) somatosensory steady-state evoked responses, (2) bottom-up attention orienting (P3a event-related potential), and (3) top-down attention (P3b event-related potential)...
September 2016: Annals of Neurology
https://www.readbyqxmd.com/read/27337526/ethical-considerations-and-challenges-in-first-in-human-research
#10
Nut Koonrungsesomboon, Junjira Laothavorn, Juntra Karbwang
First-in-human (FIH) research is a translational process to move a new potential therapy from bench to bedside. Major ethical challenges of an FIH trial arise because of the indeterminate nature of the risks involved and the controversial risk-benefit justification. Severe adverse events and death of subjects who participated in FIH research in the past have led to an increased attention on ethical considerations in the design and conduct of such research. Furthermore, novel therapies in the current decade, such as molecular-targeted, gene transfer, and pluripotent stem cells therapies, have led to numerous emerging ethical challenges or different ethical assessment and justification frameworks for FIH research...
June 6, 2016: Translational Research: the Journal of Laboratory and Clinical Medicine
https://www.readbyqxmd.com/read/27274747/whole-genome-sequencing-as-a-genetic-test-for-autism-spectrum-disorder-from-bench-to-bedside-and-then-back-again
#11
Michael J Szego, Ma'n H Zawati
Autism spectrum disorder (ASD) is characterized by repetitive patterns of behaviour and impairments in social interactions and communication abilities. Although ASD is a heterogeneous disorder, it is a highly genetic condition for which genetic testing is routinely performed. Microarray analysis is currently the standard of care genetic test for ASD, however whole genome sequencing offers several key advantages and will likely replace microarrays as a frontline genetic test in the near future. The 2nd Consultation on Translation of Genomic Advances into Health Applications took place in the spring of 2014 to broadly explore the current and potential impacts of genomic advances in supporting personalized and family-centered care for autism and related developmental conditions...
2016: Journal of the Canadian Academy of Child and Adolescent Psychiatry
https://www.readbyqxmd.com/read/27244253/the-ethical-and-practical-challenges-of-value-based-cancer-care-at-the-patient-s-bedside
#12
Daniel A Goldstein
No abstract text is available yet for this article.
July 1, 2016: JAMA Oncology
https://www.readbyqxmd.com/read/27233133/spme-as-a-promising-tool-in-translational-medicine-and-drug-discovery-from-bench-to-bedside
#13
Krzysztof Goryński, Paulina Goryńska, Agnieszka Górska, Tomasz Harężlak, Alina Jaroch, Karol Jaroch, Sofia Lendor, Cezary Skobowiat, Barbara Bojko
Solid phase microextraction (SPME) is a technology where a small amount of an extracting phase dispersed on a solid support is exposed to the sample for a well-defined period of time. The open-bed geometry and biocompatibility of the materials used for manufacturing of the devices makes it very convenient tool for direct extraction from complex biological matrices. The flexibility of the formats permits tailoring the method according the needs of the particular application. Number of studies concerning monitoring of drugs and their metabolites, analysis of metabolome of volatile as well as non-volatile compounds, determination of ligand-protein binding, permeability and compound toxicity was already reported...
May 9, 2016: Journal of Pharmaceutical and Biomedical Analysis
https://www.readbyqxmd.com/read/27212709/adversaries-at-the-bedside-advance-care-plans-and-future-welfare
#14
Aidan Kestigian, Alex John London
Advance care planning refers to the process of determining how one wants to be cared for in the event that one is no longer competent to make one's own medical decisions. Some have argued that advance care plans often fail to be normatively binding on caretakers because those plans do not reflect the interests of patients once they enter an incompetent state. In this article, we argue that when the core medical ethical principles of respect for patient autonomy, honest and adequate disclosure of information, institutional transparency, and concern for patient welfare are upheld, a policy that would allow for the disregard of advance care plans is self-defeating...
October 2016: Bioethics
https://www.readbyqxmd.com/read/27157349/when-rights-just-won-t-do-ethical-considerations-when-making-decisions-for-severely-disabled-newborns
#15
D Micah Hester, Cheryl D Lew, Alissa Swota
Children born with severe handicapping conditions, where survival and quality of survival is indeterminate, present special challenges for families and health-care professionals tasked with deciding the best courses of treatment and care. The case of Baby G presents an opportunity to compare the relative effectiveness of ethical versus rights theories in providing guidance about what obligations are owed to such children at bedside and how those obligations pertain to broader societal duties in a rights framework...
2016: Perspectives in Biology and Medicine
https://www.readbyqxmd.com/read/27096360/normalizing-the-environment-recapitulates-adult-human-immune-traits-in-laboratory-mice
#16
COMPARATIVE STUDY
Lalit K Beura, Sara E Hamilton, Kevin Bi, Jason M Schenkel, Oludare A Odumade, Kerry A Casey, Emily A Thompson, Kathryn A Fraser, Pamela C Rosato, Ali Filali-Mouhim, Rafick P Sekaly, Marc K Jenkins, Vaiva Vezys, W Nicholas Haining, Stephen C Jameson, David Masopust
Our current understanding of immunology was largely defined in laboratory mice, partly because they are inbred and genetically homogeneous, can be genetically manipulated, allow kinetic tissue analyses to be carried out from the onset of disease, and permit the use of tractable disease models. Comparably reductionist experiments are neither technically nor ethically possible in humans. However, there is growing concern that laboratory mice do not reflect relevant aspects of the human immune system, which may account for failures to translate disease treatments from bench to bedside...
April 28, 2016: Nature
https://www.readbyqxmd.com/read/27094380/sleep-assessment-by-patients-and-nurses-in-the-intensive-care-an-exploratory-descriptive-study
#17
Leanne M Aitken, Rosalind Elliott, Marion Mitchell, Chelsea Davis, Bonnie Macfarlane, Amanda Ullman, Krista Wetzig, Ashika Datt, Sharon McKinley
BACKGROUND: Sleep disruption is common in intensive care unit (ICU) patients, with reports indicating reduced quality and quantity of sleep in many patients. There is growing evidence that sleep in this setting may be improved. AIM: To describe ICU patients' self-report assessment of sleep, examine the relationship between patients' self-reported sleep and their reported sleep by the bedside nurse, and describe the strategies suggested by patients to promote sleep...
April 16, 2016: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
https://www.readbyqxmd.com/read/26988848/palliative-care-education-in-emergency-medicine-residency-training-a-survey-of-program-directors-associate-program-directors-and-assistant-program-directors
#18
Chadd K Kraus, Marna R Greenberg, Daniel E Ray, Sydney Morss Dy
CONTEXT: Emergency medicine (EM) residents perceive palliative care (PC) skills as important and want training, yet there is a general lack of formal PC training in EM residency programs. A clearer definition of the PC educational needs of EM trainees is a research priority. OBJECTIVES: To assess PC competency education in EM residency programs. METHODS: This was a mixed-mode survey of residency program directors, associate program directors, and assistant program directors at accredited EM residency programs, evaluating four educational domains: 1) importance of specific competencies for senior EM residents, 2) senior resident skills in PC competencies, 3) effectiveness of educational methods, and 4) barriers to training...
May 2016: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/26878407/efficacy-of-the-nurse-ethicist-in-reducing-moral-distress-what-can-the-nhs-learn-from-the-usa-part-2
#19
Georgina Morley
In the second of two interrelated articles exploring the concept of moral distress, this article will discuss the efficacy of the nurse ethicist in reducing moral distress. The author will draw on the current literature and on her experiences while in the USA to discuss the ways in which moral distress is being addressed at the team/unit and institutional/organisational levels. It is argued that the nature of moral distress in the UK should be explored further, and that many of the tools used to mitigate moral distress in the USA, such as clinical ethics committees and healthcare ethics consultants, could be adopted more widely in the UK, both to reduce moral distress and to foster more ethical healthcare institutions...
February 11, 2016: British Journal of Nursing: BJN
https://www.readbyqxmd.com/read/26840879/abnormal-findings-in-peers-during-skills-learning
#20
Andy Wearn, Miriam Nakatsuji, Harsh Bhoopatkar
BACKGROUND: Peer physical examination (PPE), where students examine each other, is common in contemporary clinical skills learning. A range of benefits and risks have been explored in the literature. One persistent concern has been the identification and management of abnormal physical findings. Two previous studies have attempted to quantify the risk, one through the discussion of two exemplar cases and the other with a retrospective student survey. METHODS: Here, we report the first prospective study of the number and type of abnormalities encountered as part of early clinical skills learning in a medical programme...
February 3, 2016: Clinical Teacher
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