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ethics triage

Thomas L Lewis, Rachael T Fothergill, Alan Karthikesalingam
INTRODUCTION: Rupture of an abdominal aortic aneurysm (rAAA) carries a considerable mortality rate and is often fatal. rAAA can be treated through open or endovascular surgical intervention and it is possible that more rapid access to definitive intervention might be a key aspect of improving mortality for rAAA. Diagnosis is not always straightforward with up to 42% of rAAA initially misdiagnosed, introducing potentially harmful delay. There is a need for an effective clinical decision support tool for accurate prehospital diagnosis and triage to enable transfer to an appropriate centre...
October 24, 2016: BMJ Open
N Laventhal, A A E Verhagen, T W R Hansen, E Dempsey, P G Davis, G A Musante, A Wiles, W Meadow, A Janvier
OBJECTIVE: Ethically and legally, assertions that resuscitation is in a patient's best interest should be inversely correlated with willingness to forego intensive care (and accept comfort care) at the surrogate's request. Previous single country studies have demonstrated a relative devaluation of neonates when compared with other critically ill patients. STUDY DESIGN: In this international study, physicians in Argentina, Australia, Canada, Ireland, The Netherlands, Norway and the United States were presented with eight hypothetical vignettes of incompetent critically ill patients of different ages...
October 13, 2016: Journal of Perinatology: Official Journal of the California Perinatal Association
Azgad Gold, Rael D Strous
Extreme intentional and deliberate violence against innocent people, including acts of terror and school shootings, poses various ethical challenges, some related to the practice of medicine. We discuss a dilemma relating to deliberate violence, in this case the aftermath of a terror attack, in which there are multiple injured individuals, including the terror perpetrator. Normally, the priority of medical treatment is determined based on need. However, in the case of a terror attack, there is reason to question this...
August 29, 2016: Journal of Medical Ethics
Mary A King, Niranjan Kissoon
No abstract text is available yet for this article.
September 2016: Critical Care Medicine
Sudha Sundar, Caroline Rick, Francis Dowling, Pui Au, Kym Snell, Nirmala Rai, Rita Champaneria, Hilary Stobart, Richard Neal, Clare Davenport, Susan Mallett, Andrew Sutton, Sean Kehoe, Dirk Timmerman, Tom Bourne, Ben Van Calster, Aleksandra Gentry-Maharaj, Usha Menon, Jon Deeks
INTRODUCTION: Ovarian cancer (OC) is associated with non-specific symptoms such as bloating, making accurate diagnosis challenging: only 1 in 3 women with OC presents through primary care referral. National Institute for Health and Care Excellence guidelines recommends sequential testing with CA125 and routine ultrasound in primary care. However, these diagnostic tests have limited sensitivity or specificity. Improving accurate triage in women with vague symptoms is likely to improve mortality by streamlining referral and care pathways...
2016: BMJ Open
Rafael Freire, Clive J C Phillips, Joy M Verrinder, Teresa Collins, Chris Degeling, Anne Fawcett, Andrew D Fisher, Susan Hazel, Jennifer Hood, Jane Johnson, Janice K F Lloyd, Kevin Stafford, Vicky Tzioumis, Paul D McGreevy
The study of animal welfare and ethics (AWE) as part of veterinary education is important due to increasing community concerns and expectations about this topic, global pressures regarding food security, and the requirements of veterinary accreditation, especially with respect to Day One Competences. To address several key questions regarding the attitudes to AWE of veterinary students in Australia and New Zealand (NZ), the authors surveyed the 2014 cohort of these students. The survey aimed (1) to reveal what AWE topics veterinary students in Australia and NZ consider important as Day One Competences, and (2) to ascertain how these priorities align with existing research on how concern for AWE relates to gender and stage of study...
July 21, 2016: Journal of Veterinary Medical Education
Joseph L Nates, Mark Nunnally, Ruth Kleinpell, Sandralee Blosser, Jonathan Goldner, Barbara Birriel, Clara S Fowler, Diane Byrum, William Scherer Miles, Heatherlee Bailey, Charles L Sprung
OBJECTIVES: To update the Society of Critical Care Medicine's guidelines for ICU admission, discharge, and triage, providing a framework for clinical practice, the development of institutional policies, and further research. DESIGN: An appointed Task Force followed a standard, systematic, and evidence-based approach in reviewing the literature to develop these guidelines. MEASUREMENTS AND MAIN RESULTS: The assessment of the evidence and recommendations was based on the principles of the Grading of Recommendations Assessment, Development and Evaluation system...
August 2016: Critical Care Medicine
Chris Kaposy, Fern Brunger, Victor Maddalena, Richard Singleton
In this study, Canadian healthcare ethics consultants describe their use of ethics decision-making frameworks. Our research finds that ethics consultants in Canada use multi-purpose ethics decision-making frameworks, as well as targeted frameworks that focus on reaching an ethical resolution to a particular healthcare issue, such as adverse event reporting, or difficult triage scenarios. Several interviewees mention the influence that the accreditation process in Canadian healthcare organizations has on the adoption and use of such frameworks...
October 2016: Bioethics
E Tensen, J P van der Heijden, M W M Jaspers, L Witkamp
Teledermatology, originating in 1995, has been one of the first telemedicine services to see the light of day. Two decades of teledermatology research is summarized in this review. A literature search was conducted in PubMed. Search terms included "teledermatology," "teledermoscopy," "tele wound care," "telederm*," "(dermatology OR dermoscopy OR wound care OR skin) AND (telemedicine OR ehealth or mhealth OR telecare OR teledermatology OR teledermoscopy)." Inclusion criteria were (i) Dutch or English written papers and (ii) publication year from 2011 to present or (iii) (systematic) reviews with publication year before 2011...
2016: Current Dermatology Reports
Tracy K Koogler
No abstract text is available yet for this article.
August 2016: Acta Paediatrica
M Kulla, S Kraus, F Walcher, R Somasundaram, C E Wrede, L Lampl, M Helm
Background: Up to 11 % of patients in an Emergency Department (ED) present with non-traumatic acute abdominal pain. Based on this presenting symptom, this study aimed to analyse how residents (surgery, internal medicine, anaesthesiology and other fields) working in an ED during their second and third year of education treat these patients. Material and Methods: We performed a prospective, monocentric observation study in an ED in accordance with the STROBE recommendations, following the recommendations from the Ethics Committee of the University of Ulm (application no...
May 2, 2016: Zentralblatt Für Chirurgie
G Bahadur, R Homburg, A Muneer, P Racich, T Alangaden, A Al-Habib, S Okolo
The advent of intracytoplasmic sperm injection (ICSI) has contributed to a significant growth in the delivery of assisted conception technique, such that IVF/ICSI procedures are now recommended over other interventions. Even the UK National Institute for Health Care Excellence (NICE) guidelines controversially recommends against intrauterine insemination (IUI) procedures in favour of IVF. We reflect on some of the clinical, economic, financial and ethical realities that have been used to selectively promote IVF over IUI, which is less intrusive and more patient friendly, obviates the need for embryo storage and has a global application...
June 2016: Human Reproduction
Michael Darmon, Guillaume Ducos, Isaline Coquet, Matthieu Resche-Rigon, Frederic Pochard, Marie Paries, Nancy Kentish-Barnes, Marine Chaize, Benoit Schlemmer, Elie Azoulay
BACKGROUND: Surveys have highlighted perceived deficiencies among ICU residents in end-of-life care, symptom control, and confidence in dealing with dying patients. Lack of formal training may contribute to the failure to meet the needs of dying patients and their families. The objective of this study was to evaluate junior intensivists' perceptions of triage and of the quality of the dying process before and after formal academic training. METHODS: Formal training on ethics was implemented as a part of resident training between 2007 and 2012...
July 2016: Chest
Sukran Sevimli, Sevdegul Karadas, Ahmet Cumhur Dulger
OBJECTIVE: To assess physical and psycho-social problems faced by health professionals, and to analyse the ethical, legal and triage dimensions of disaster medical services. METHODS: The descriptive study was conducted from November 2011 to March 2012 and comprised health professionals from two hospitals of Van, Turkey A specific questionnaire was designed and interviews were conducted face to face. SPSS 13 was used for statistical analysis. RESULTS: Of the 430 health professionals who had experienced one or more earthquakes and were part of the study, 225(52...
February 2016: JPMA. the Journal of the Pakistan Medical Association
Fiona L Mackie, Keren J Carss, Sarah C Hillman, Matthew E Hurles, Mark D Kilby
Prenatal diagnostic testing is a rapidly advancing field. An accurate diagnosis of structural anomalies and additional abnormalities in fetuses with structural anomalies is important to allow "triage" and designation of prognosis. This will allow parents to make an informed decision relating to the pregnancy. This review outlines the current tests used in prenatal diagnosis, focusing particularly on "new technologies" such as exome sequencing. We demonstrate the utility of exome sequencing above that of conventional karyotyping and Chromosomal Microarray (CMA) alone by outlining a recent proof of concept study investigating 30 parent-fetus trios where the fetus is known to have a structural anomaly...
2014: Journal of Clinical Medicine
Henri Julien
The concept of disaster medicine, derivedfrom medical management of casualties caused by terrorist attacks or earthquakes, began to be taught in medical school in 1982. It adapts military intervention tactics to civilian practices, and differentiates major disasters (in which preformed teams are sent to the scene) from disasters with limited effects (predefined plans form the backbone of the rescue organization). Management of blast and crush syndromes, triage, care of numerous burn victims, on-site amputation, necrotomy, medicopsychological support, mass decontamination, and rescue management are some of the aspects with which physicians should be familiar...
December 2013: Bulletin de L'Académie Nationale de Médecine
Jennifer Flynn, Katherine Chubbs, Susan Gladney-Martin, Rick Singleton, Daryl Pullman
This paper addresses the current drug shortage, and examines the ethics framework for dealing with drug shortages developed by our organization. That three-step allocation process and framework was published previously in this journal. Specifically, this paper offers a rationale and justification for the framework's second step, which involves a triage process aimed to ensure that the available drug supply is utilized effectively and ethically.
September 2015: Healthcare Management Forum
C Ris-Stalpers, H Hassani Lahsinoui, S Boussata, J Am van der Post
INTRODUCTION: Placental growth factor (PlGF) levels in maternal circulation are altered in pre-eclampsia and intrauterine growth restriction (IUGR) (Benton et al.) and may have utility in identifying cases associated with placental dysfunction and stratifying pregnancy survival. OBJECTIVES: We sought to determine if a positive PlGF test measured on the Triage PlGF rapid assay (Alere, San Diego) agrees with the clinical diagnosis and predicts preterm delivery. METHODS: EDTA-blood was collected from women admitted to the AMC Obstetrics Department after 20 weeks of gestation with informed consent and according to the protocol approved by the AMC Medical Ethical Board (10/127)...
July 2012: Pregnancy Hypertension
Joanne Lim, Garth Cloete, Dustin T Dunsmuir, Beth A Payne, Cornie Scheffer, Peter von Dadelszen, Guy A Dumont, J Mark Ansermino
BACKGROUND: Pre-eclampsia is one of the leading causes of maternal death and morbidity in low-resource countries due to delays in case identification and a shortage of health workers trained to manage the disorder. Pre-eclampsia Integrated Estimate of RiSk (PIERS) on the Move (PotM) is a low cost, easy-to-use, mobile health (mHealth) platform that has been created to aid health workers in making decisions around the management of hypertensive pregnant women. PotM combines two previously successful innovations into a mHealth app: the miniPIERS risk assessment model and the Phone Oximeter...
2015: JMIR MHealth and UHealth
Nancy S Jecker, Denise M Dudzinski, Douglas S Diekema, Mark Tonelli
Caring for patients affected with Ebola virus disease (EVD) while simultaneously preventing EVD transmission represents a central ethical challenge of the EVD epidemic. To address this challenge, we propose a model policy for resuscitation and emergent procedure policy of patients with EVD and set forth ethical principles that lend support to this policy. The policy and principles we propose bear relevance beyond the EVD epidemic, offering guidance for the care of patients with other highly contagious, virulent, and lethal diseases...
September 2015: Chest
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