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Bedside ethics

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https://www.readbyqxmd.com/read/29079198/the-internist-as-clinical-ethics-consultant-an-antidote-to-the-barbarism-of-specialisation-in-hospital-practice
#1
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
#2
(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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
https://www.readbyqxmd.com/read/28838311/a-smartphone-based-consultation-system-for-acute-burns-methodological-challenges-related-to-follow-up-of-the-system
#9
Marie Hasselberg, Lee Wallis, Paul Blessing, Lucie Laflamme
BACKGROUND: A smartphone-based consultation system for acute burns is currently being implemented in the Western Cape, South Africa. Even though studies indicate that similar systems for burns tend to support valid diagnosis and influence patient management, the evidence is still sparse. There is a need for more in-depth evaluations, not least in resource-constrained settings where mHealth projects are increasing. OBJECTIVE: This article describes the consultation system and assessments in relation to its implementation with a special focus on methodological challenges...
June 2017: Global Health Action
https://www.readbyqxmd.com/read/28802557/parents-perspectives-of-closeness-and-separation-with-their-preterm-infants-in-the-nicu
#10
Stephanie C Treherne, Nancy Feeley, Lyne Charbonneau, Anna Axelin
OBJECTIVE: To discover parents' perceptions of closeness to and separation from their preterm infants in the NICU. DESIGN: Qualitative descriptive. SETTING: Urban Level III NICU. PARTICIPANTS: Twenty parents of preterm infants in the NICU. METHODS: After ethics approval, data were collected with a smartphone application created for this study. Parents recorded their descriptions of moments of closeness and separation over a 24-hour period in the NICU...
August 9, 2017: Journal of Obstetric, Gynecologic, and Neonatal Nursing: JOGNN
https://www.readbyqxmd.com/read/28776144/-validation-of-medical-ethical-decisions-at-the-bedside-by-the-autopsy-experience-of-the-ethics-committee-at-the-stuttgart-clinic
#11
REVIEW
A Bosse, C Schupp
BACKGROUND: Ethics consultations in a clinical setting can be challenging, specifically with respect to limiting therapeutic interventions in terminally ill patients. Some decisions will even be controversial. OBJECTIVE: Can a clinical autopsy be used to confirm the recommendations given by the ethics committee, i. e. limitation of therapy to palliative care? MATERIAL AND METHODS: We report an exemplary case of a patient with endocarditis and subsequent septic cerebral infarction...
September 2017: Der Pathologe
https://www.readbyqxmd.com/read/28651620/an-assessment-of-the-factors-affecting-the-commercialization-of-cell-based-therapeutics-a-systematic-review-protocol
#12
David Pettitt, Zeeshaan Arshad, Benjamin Davies, James Smith, Anna French, Doug Cole, Kim Bure, Sue Dopson, David DiGiusto, Jeff Karp, Brock Reeve, Richard Barker, Georg Holländer, David Brindley
BACKGROUND: Cellular-based therapies represent a platform technology within the rapidly expanding field of regenerative medicine and are distinct from conventional therapeutics-offering a unique approach to managing what were once considered untreatable diseases. Despite a significant increase in basic science activity within the cell therapy arena, alongside a growing portfolio of cell therapy trials and promising investment, the translation of cellular-based therapeutics from "bench to bedside" remains challenging, and the number of industry products available for widespread clinical use remains comparatively low...
June 26, 2017: Systematic Reviews
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
#13
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/28644781/teaching-clinical-ethics-at-the-bedside-william-osler-and-the-essential-role-of-the-hospitalist
#14
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/28612650/pediatric-nurses-ethical-difficulties-in-the-bedside-care-of-children
#15
Kwisoon Choe, Yoonjung Kim, Yoonseo Yang
BACKGROUND: Pediatric nurses experience ethically difficult situations in their everyday work. Several studies have been conducted to reveal ethical issues among pediatric nurses; we do not think their ethical difficulties have been explored sufficiently from their own perspective. OBJECTIVES: This study aimed to explore the ethical difficulties faced by pediatric nurses during bedside care for hospitalized children. METHODS: A phenomenological approach was used to collect and analyze interview data from 14 female pediatric nurses in South Korea...
January 1, 2017: Nursing Ethics
https://www.readbyqxmd.com/read/28594678/transplantation-of-bioprinted-tissues-and-organs-technical-and-clinical-challenges-and-future-perspectives
#16
Dino J Ravnic, Ashley N Leberfinger, Srinivas V Koduru, Monika Hospodiuk, Kazim K Moncal, Pallab Datta, Madhuri Dey, Elias Rizk, Ibrahim T Ozbolat
: Three-dimensional (3D) bioprinting is a revolutionary technology in building living tissues and organs with precise anatomic control and cellular composition. Despite the great progress in bioprinting research, there has yet to be any clinical translation due to current limitations in building human-scale constructs, which are vascularized and readily implantable. In this article, we review the current limitations and challenges in 3D bioprinting, including in situ techniques, which are one of several clinical translational models to facilitate the application of this technology from bench to bedside...
July 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28577552/determining-the-amount-of-training-needed-for-competency-of-anesthesia-trainees-in-ultrasonographic-identification-of-the-cricothyroid-membrane
#17
Katia F Oliveira, Cristian Arzola, Xiang Y Ye, Jefferson Clivatti, Naveed Siddiqui, Kong E You-Ten
BACKGROUND: Airway guidelines recommend the use of ultrasound to localize the cricothyroid membrane prior to airway manipulation in difficult airways. In this study, we aimed to determine the amount of training anesthesia trainees would need to achieve competence in bedside ultrasound to identify the cricothyroid membrane. METHODS: This is a prospective non-randomized cohort study in the Department of Anesthesia at Mount Sinai Hospital (Toronto, Ontario, Canada)...
June 2, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28572102/complementary-health-practitioners-in-the-acute-and-critical-care-setting-nursing-considerations
#18
Debra Kramlich
In response to the rising demand by patients and their families for complementary health approaches, hospitals are increasingly integrating complementary health approaches with their conventional medical practices to create healing environments. Results of the 2010 Complementary and Alternative Medicine Survey of Hospitals indicated that the top 6 inpatient modalities included pet therapy, massage therapy, music or art therapy, guided imagery, relaxation therapy, and Reiki and therapeutic touch. Whether complementary health approaches are provided by complementary health practitioners through hospital-based integrative medicine programs, volunteer practitioners, or bedside nurses, the regulatory, legal, ethical, and safety concerns remain constant...
June 2017: Critical Care Nurse
https://www.readbyqxmd.com/read/28553902/how-situational-diagnosis-helps-disentangle-ethical-and-psychological-features-of-complex-cases
#19
Jerry Joseph Ignatius, Walter Baile
We review Marguerite S. Lederberg's 1999 Acta Oncologica article entitled "Disentangling Ethical and Psychological Issues: A Guide for Oncologists," in which she introduces a method of analysis that facilitates clarification of ethical and psychological aspects of complex cases. Based on her understanding of the dynamics at play in patients', family members', and physicians' experiences, Lederberg formulated what she calls "situational diagnosis," a guide on how to distinguish ethical from psychological issues at the bedside or when an ethics consultation is requested...
May 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28301693/the-clue
#20
Tyler Tate
As I stood outside of Carlos's room, I felt caught on the horns of a dilemma. It seemed impossible to truly "be there" for Carlos without sacrificing my other intern duties. This tension pervaded much of my residency training, as I often found myself spending more time completing chart notes, answering pages, and giving sign out than I did at the bedside with my patients. I knew I had a duty to "do my job"-I could not let my team down. But what about my duty to Carlos, a duty to act on my intuition and try to "get to the bottom" of his illness, if that was even possible? And what about my thirteen other patients? Wasn't I was their doctor as well? I have spent countless hours studying the ethical frameworks for medical rationing...
March 2017: Hastings Center Report
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