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Bedside ethics

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https://www.readbyqxmd.com/read/29657179/the-dilemma-of-the-doctor-in-the-family
#1
Joanna K Weinberg
The twelve narratives written by physicians for this symposium address the same question: "What happens when I wear a white physician's coat at the bedside of an ill or dying family member or friend?" This commentary addresses several key themes, which emerged as the author reacted to these narratives: (1) the physicians did not mention policy issues affecting the public inherent in a health system regulated by statutes and paid for by insurers; (2) the physicians did not follow the ethical rule against treating family members; (3) there was no discussion of whether hospital ethics committees or similar advisory bodies might have helped address conflicts as they arose; and (4) there was minimal discussion of Advance Medical Directives and Do Not Resuscitate Orders...
2018: Narrative Inquiry in Bioethics
https://www.readbyqxmd.com/read/29650070/communication-and-ethics-in-the-clinical-examination
#2
REVIEW
Sharon Onguti, Sherine Mathew, Christine Todd
At the heart of every effective patient-physician interaction is a relationship that is built on trust. Cultivating sound communication skills coupled with the awareness and application of ethical principles is integral to this process. One of the foremost challenges in competent practice is negotiating situations that arise at the bedside when such issues as patient autonomy, differing world views, honesty, and cost stewardship come into conflict. It is essential for health care providers to consider how to detect and prioritize these issues as they advocate for high-quality and patient-centered care...
May 2018: Medical Clinics of North America
https://www.readbyqxmd.com/read/29628552/ultrasonographic-optic-nerve-sheath-diameter-as-a-surrogate-measure-of-raised-intracranial-pressure-in-severe-pregnancy-induced-hypertension-patients
#3
Shiv Kumar Singh, Kiran Bhatia
Context: It is a well-known fact that severe pregnancy-induced hypertension (PIH) can be disastrous at times as it can cause a lot of complications to both pregnant women and her baby. Hence, it is always desirable to know the extent of severity by a real-time and easily accessible modality like ultrasound. Aims: The aim of the study was to evaluate the incidence of raised intracranial pressure (ICP) in severe preeclampsia and eclampsia patients using ocular ultrasonography with optic nerve sheath diameter (ONSD) measurement...
January 2018: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/29593024/feasibility-of-improving-cerebral-autoregulation-in-acute-intracerebral-haemorrhage-breathe-ich-study-a-protocol-for-an-experimental-interventional-study
#4
Jatinder S Minhas, Ronney B Panerai, Thompson G Robinson
INTRODUCTION: Cerebral autoregulation (CA) is impaired in a multitude of neurological conditions. Increasingly, clinical studies are correlating the nature of this impairment with prognostic markers. In acute intracerebral haemorrhage (ICH), impairment of CA has been associated with worsening clinical outcomes including poorer Glasgow Coma Score and larger haematoma volume. Hypocapnia has been shown to improve CA despite concerns over hypoperfusion and consequent ischaemic risks, and it is therefore hypothesised that hypocapnia (via hyperventilation) in acute ICH may improve CA and consequently clinical outcome...
March 27, 2018: BMJ Open
https://www.readbyqxmd.com/read/29501285/impact-and-safety-of-open-lung-biopsy-in-patients-with-acute-respiratory-distress-syndrome-ards
#5
G Ortiz, M Garay, D Mendoza, P Cardinal-Fernández
INTRODUCTION: Acute respiratory distress syndrome (ARDS) is an inflammatory lung disorder, and its pathological hallmark is diffuse alveolar damage (DAD). Given that open lung biopsy (OLB) can sometimes result in severe side effects, it is rarely performed in patients with ARDS. AIM: The aims of this study were to describe: (a) the rate of treatment change associated with the histological result; and (b) the incidence of side effects induced by OLB. DESIGN AND PATIENTS: A retrospective, single-center, descriptive observational study was carried out in Hospital Santa Clara (Bogotá, Colombia) from February 2007 to January 2014...
February 28, 2018: Medicina Intensiva
https://www.readbyqxmd.com/read/29482210/hidden-curricula-ethics-and-professionalism-optimizing-clinical-learning-environments-in-becoming-and-being-a-physician-a-position-paper-of-the-american-college-of-physicians
#6
Lisa Soleymani Lehmann, Lois Snyder Sulmasy, Sanjay Desai
Much of what is formally taught in medicine is about the knowledge, skills, and behaviors required of a physician, including how to express compassion and respect for patients at the bedside. What is learned, however, includes not only admirable qualities but also behaviors and qualities that are inconsistent with ethics and professionalism. Positive role models may reinforce the character and values the profession seeks to cultivate; negative ones directly contradict classroom lessons and expectations of patients, society, and medical educators...
February 27, 2018: Annals of Internal Medicine
https://www.readbyqxmd.com/read/29475979/ethical-decision-making-climate-in-the-icu-theoretical-framework-and-validation-of-a-self-assessment-tool
#7
Bo Van den Bulcke, Ruth Piers, Hanne Irene Jensen, Johan Malmgren, Victoria Metaxa, Anna K Reyners, Michael Darmon, Katerina Rusinova, Daniel Talmor, Anne-Pascale Meert, Laura Cancelliere, Làszló Zubek, Paolo Maia, Andrej Michalsen, Johan Decruyenaere, Erwin J O Kompanje, Elie Azoulay, Reitske Meganck, Ariëlla Van de Sompel, Stijn Vansteelandt, Peter Vlerick, Stijn Vanheule, Dominique D Benoit
BACKGROUND: Literature depicts differences in ethical decision-making (EDM) between countries and intensive care units (ICU). OBJECTIVES: To better conceptualise EDM climate in the ICU and to validate a tool to assess EDM climates. METHODS: Using a modified Delphi method, we built a theoretical framework and a self-assessment instrument consisting of 35 statements. This Ethical Decision-Making Climate Questionnaire (EDMCQ) was developed to capture three EDM domains in healthcare: interdisciplinary collaboration and communication; leadership by physicians; and ethical environment...
February 23, 2018: BMJ Quality & Safety
https://www.readbyqxmd.com/read/29464512/feasibility-of-continuous-sedation-monitoring-in-critically-ill-intensive-care-unit-patients-using-the-neurosense-wav-cns-index
#8
Nicholas West, Paul B McBeth, Sonia M Brodie, Klaske van Heusden, Sarah Sunderland, Guy A Dumont, Donald E G Griesdale, J Mark Ansermino, Matthias Görges
Sedation in the intensive care unit (ICU) is challenging, as both over- and under-sedation are detrimental. Current methods of assessment, such as the Richmond Agitation Sedation Scale (RASS), are measured intermittently and rely on patients' behavioral response to stimulation, which may interrupt sleep/rest. A non-stimulating method for continuous sedation monitoring may be beneficial and allow more frequent assessment. Processed electroencephalography (EEG) monitors have not been routinely adopted in the ICU...
February 20, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29460473/when-a-physician-and-a-clinical-ethicist-collaborate-for-better-patient-care
#9
Thalia Arawi, Lama Charafeddine
Bioethics is a relatively new addition to bedside medical care in Arab world which is characterized by a special culture that often makes blind adaptation of western ethics codes and principles; a challenge that has to be faced. To date, the American University of Beirut Medical Center is the only hospital that offers bedside ethics consultations in the Arab Region aiming towards better patient-centered care. This article tackles the role of the bedside clinical ethics consultant as an active member of the medical team and the impact of such consultations on decision-making and patient-centered care...
February 20, 2018: Developing World Bioethics
https://www.readbyqxmd.com/read/29457236/time-is-ethics
#10
Mark Mercurio
Early in my career as a neonatologist, I was called into the hospital for a newborn who would not stop crying. Screaming, really. When I entered the unit, I was greeted by a loud, shrill, distinctive cry. After hearing the history and examining the baby, I just stood there for a while, watching and listening. It took some time, but eventually, I noticed a subtle regularity, a rhythmicity. I took off my watch, placed it on the bed next to the child, and found that the crying briefly grew louder about every six or seven seconds...
January 2018: Hastings Center Report
https://www.readbyqxmd.com/read/29358441/monitoring-intensive-care-unit-performance-impact-of-a-novel-individualised-performance-scorecard-in-critical-care-medicine-a-mixed-methods-study-protocol
#11
Shannon M Fernando, David Neilipovitz, Aimee J Sarti, Erin Rosenberg, Rabia Ishaq, Mary Thornton, John Kim
INTRODUCTION: Patients admitted to a critical care medicine (CCM) environment, including an intensive care unit (ICU), are susceptible to harm and significant resource utilisation. Therefore, a strategy to optimise provider performance is required. Performance scorecards are used by institutions for the purposes of driving quality improvement. There is no widely accepted or standardised scorecard that has been used for overall CCM performance. We aim to improve quality of care, patient safety and patient/family experience in CCM practice through the utilisation of a standardised, repeatable and multidimensional performance scorecard, designed to provide a continuous review of ICU physician and nurse practice, as well as departmental metrics...
January 21, 2018: BMJ Open
https://www.readbyqxmd.com/read/29225889/efficacy-of-sonographic-and-biological-pleurodesis-indicators-of-malignant-pleural-effusion-simple-protocol-of-a-randomised-controlled-trial
#12
Ioannis Psallidas, Hania E G Piotrowska, Ahmed Yousuf, Nikolaos I Kanellakis, Gayathri Kagithala, Seid Mohammed, Lei Clifton, John P Corcoran, Nicky Russell, Melissa Dobson, Robert F Miller, Najib M Rahman
Introduction: Malignant pleural effusion (MPE) is common and currently in UK there are an estimated 50 000 new cases of MPE per year. Talc pleurodesis remains one of the most popular methods for fluid control. The value of thoracic ultrasound (TUS) imaging, before and after pleurodesis, in improving the quality and efficacy of care for patients with MPE remains unknown. Additionally, biomarkers of successful pleurodesis including measurement of pleural fluid proteins have not been validated in prospective studies...
2017: BMJ Open Respiratory Research
https://www.readbyqxmd.com/read/29079198/the-internist-as-clinical-ethics-consultant-an-antidote-to-the-barbarism-of-specialisation-in-hospital-practice
#13
D Real de Asúa, P Rodriguez Del Pozo, J J Fins
The development of hospital clinical ethics in Spain depends almost exclusively on the healthcare ethics committees, which have been criticized for a lack of proximity to the patient's bedside in day-to-day ethical conflicts and for their scarce practical operation, reflected in the low number of consultations they receive. In this study, we reflect on the need to change the current healthcare model in clinical ethics so as to reactivate it and call attention to the essential role of internists as the engine for this change...
October 25, 2017: Revista Clínica Española
https://www.readbyqxmd.com/read/29074905/antimicrobial-resistance-and-antimicrobial-stewardship-programmes-benefiting-the-patient-or-the-population
#14
(no author information available yet)
'...bedside rationing of antimicrobials is 'fair and ethically sound' even if it doesn't promote the short-term best medical interest of the individual patients'.
October 27, 2017: British Dental Journal
https://www.readbyqxmd.com/read/29064517/framtidens-rond-%C3%A2-ett-personcentrerat-och-teambaserat-m%C3%A3-te-med-patienten-den-traditionella-ronden-g%C3%A3-r-inte-att-f%C3%A3-rsvara-etiskt-eller-juridiskt
#15
Anders Ågård, Ingemar Engström, Ulrika Sandén, Valdemar Erling
The aim of this article is to elucidate the traditional ward round from an historical, ethical and legal perspective. On the traditional ward round in hospitals, a senior clinician leads a group of other clinicians and health professionals on a walking tour through the ward to visit the patients for whom they are responsible at bedside. It is a long-lived tradition or routine, which has been substantially resistant to change. We recommend that work designed to improve the ward round should begin from values or ethical principles, such as respecting the patient's integrity and right to participate in decision-making...
October 17, 2017: Läkartidningen
https://www.readbyqxmd.com/read/28984698/relative-importance-assigned-to-health-care-rationing-principles-at-the-bedside-evidence-from-a-portuguese-and-bulgarian-survey
#16
Micaela Moreira Pinho, Ana Pinto Borges
Activity was undertaken to develop a Prioritization Scoring Index for Portugal and Bulgaria that weights the importance given to ethical rationing principles that should guide decisions at the bedside. Data from two random samples of 355 Portuguese and 298 Bulgarian members of the public were collected from an online questionnaire. Questions asked about the level of importance given to specific issues related to patient's prioritization criteria. Responses were analyzed quantitatively with the SPSS. In the process of selecting the patient to treat, Portuguese and Bulgarian respondents seem unanimous in giving greater importance to (i) the treatment outcomes, (ii) the severity of illness, (iii) children, and (iv) patients' fragility...
October 2017: Health Care Manager
https://www.readbyqxmd.com/read/28956795/clinical-ethics-and-the-role-of-clinical-ethics-committees-proposals-for-a-revival-commentary
#17
Carlo Petrini, Walter Ricciardi
The issue addressed in the paper published by the Italian National Bioethics Committee (NBC) entitled "Clinical ethics committees", is highly significant for many reasons. One of these is the fact that the ethics committees charged with assessing clinical trials have so much responsibility and such a heavy work-load that they have little time available for other tasks such as engaging directly with patients "at the bedside", as a result of which the role of committees responsible for assessing clinical cases is especially important...
July 2017: Annali Dell'Istituto Superiore di Sanità
https://www.readbyqxmd.com/read/28940133/ethical-design-of-intelligent-assistive-technologies-for-dementia-a-descriptive-review
#18
REVIEW
Marcello Ienca, Tenzin Wangmo, Fabrice Jotterand, Reto W Kressig, Bernice Elger
The use of Intelligent Assistive Technology (IAT) in dementia care opens the prospects of reducing the global burden of dementia and enabling novel opportunities to improve the lives of dementia patients. However, with current adoption rates being reportedly low, the potential of IATs might remain under-expressed as long as the reasons for suboptimal adoption remain unaddressed. Among these, ethical and social considerations are critical. This article reviews the spectrum of IATs for dementia and investigates the prevalence of ethical considerations in the design of current IATs...
September 22, 2017: Science and Engineering Ethics
https://www.readbyqxmd.com/read/28930709/responding-to-moral-distress-and-ethical-concerns-at-the-intersection-of-medical-illness-and-unmet-mental-health-needs
#19
Donna D McKlindon, Pamela Nathanson, Chris Feudtner
Some of the most difficult clinical ethics consultations involve patients who have both medical and mental health needs, as these cases can result in considerable moral distress on the part of the bedside staff. In this article we examine the issues that such consults raise through the illustrative example of a particular case: several years ago our ethics consultation service received a request from a critical care attending physician who was considering a rarely performed psychosurgical intervention to address intractable and life-threatening agitation and aggression in an adolescent patient for whom standard treatments had proven unsuccessful...
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28843527/factors-associated-with-the-trend-of-physical-and-chemical-restraint-use-among-long-term-care-facility-residents-in-hong-kong-data-from-an-11-year-observational-study
#20
Kuen Lam, Joseph S K Kwan, Chi Wai Kwan, Alice M L Chong, Claudia K Y Lai, Vivian W Q Lou, Angela Y M Leung, Justina Y W Liu, Xue Bai, Iris Chi
BACKGROUND: Negative effects of restraint use have been well-documented. However, the prevalence of restraints use has been high in long-term care facilities in Hong Kong compared with other countries and this goes against the basic principles of ethical and compassionate care for older people. The present study aimed to review the change in the prevalence of physical and chemical restraint use in long-term care facilities (LTCFs) over a period of 11 years in Hong Kong and to identify the major factors associated with their use...
August 23, 2017: Journal of the American Medical Directors Association
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