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A Critical History of Bioethics
Published in Joel Michael Reynolds, Christine Wieseler, The Disability Bioethics Reader, 2022
The commission identified three primary principles that function like what a social scientist would call ends or values – and these principles were argued to be “among those generally accepted in our cultural tradition”: respect for persons, beneficence, and justice. These three were satisfied through the practices of informed consent, risk-benefit analysis, and the selection of research subjects, respectively (National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research 1978). These later were expanded and renamed as autonomy, beneficence, non-maleficence, and justice (Beauchamp and Childress 2009). To massively generalize, the ethical question in such an analysis is whether the means in question (human gene editing, cochlear implants, bone-lengthening surgery) maximize these four principles, ends, or values.
Healthcare Politics
Published in Kant Patel, Mark Rushefsky, Healthcare Politics and Policy in America, 2019
The field of economics offers several analytic tools that can be useful in health policymaking/decision-making as well as evaluation of health programs to determine its impact, effectiveness, and efficiency. Some of these tools include the following: cost–benefit analysis in the healthcare field can provide an analysis of expenditure of health resources relative to benefits. Such analysis can help determine whether the cost of a given program can be justified compared to the benefit it provides. It can also help in setting priorities when decisions or choices must be made in the face of limited resources. Risk–benefit analysis can allow policymakers to weigh the potential for undesirable outcomes and side-effects against the potential positive outcome of a policy/program or a medical treatment. Cost-effectiveness analysis involves comparing several different intervention strategies using common units of costs and benefits. The Center for Disease Control and Prevention (CDC) utilizes cost analysis, economic evaluation, regulatory and budget impact analysis, and health impact assessment in public health programs (“Public Health Economics and Methods” n.d.). Almost all state governments conduct cost–benefit analysis but the quality and impact of such analysis vary. At the federal level, the use of cost–benefit analysis is required in many federal agencies particularly with respect to regulatory decision-making (White and Silloway 2016).
Medication and dementia
Published in Graham A. Jackson, Debbie Tolson, Textbook of Dementia Care, 2019
The decision whether or not to prescribe a drug for someone with any condition appears at first straightforward. The doctor diagnoses the condition, there is a drug available for the condition, the doctor prescribes the drug that the patient then takes reliably and the patient therefore benefits. However prescribing decisions are rarely this simple, and perhaps nowhere less so than for people with dementia. Every decision to prescribe requires a careful risk-benefit analysis, weighing up the potential benefits of the drug to that individual against the potential adverse effects, and then communicating that to the patient, their carers or those with legal authority to make decisions on their behalf, and taking their views into account. This issue is particularly germane when considering the use of restrictive measures to enforce treatment, such as covert administration or use of mental health or capacity legislation.
Resident factors associated with American board of internal medicine certification exam failure
Published in Medical Education Online, 2023
Preston H. Seaberg, Juliana M. Kling, Molly C. Klanderman, Carolyn Mead-Harvey, Kathryn E. Williams, Helene R. Labonte, Atul Jain, Gretchen E. Taylor, Janis E. Blair
We performed a retrospective study of all residents who graduated from the Internal Medicine Residency Program at Mayo Clinic in Arizona from 1998 through 2017. The program has full ACGME accreditation, and its size gradually increased from an initial 6 residents per class to its current 12 residents per class. The program is affiliated with a tertiary care hospital in a large metropolitan area in the Southwest USA. Residents in the program during the study period were provided access to ABIM-CE preparation resources, including the Medical Knowledge Self-Assessment Program, MedStudy Internal Medicine Board Review, and the opportunity to participate in a funded, off-site ABIM-CE preparatory course. Residents with IM-ITE performance below a prespecified score were enrolled in an individualized education plan with access to another question bank and check-ins from an associate program director. The study protocol was approved by the Institutional Review Board of the Mayo Clinic in Arizona (application 13–000080). The Board conducted a risk-benefit analysis, determined the study constituted minimal risk research, and waived the requirement to obtain informed consent.
Immune checkpoint inhibition in early-stage triple-negative breast cancer
Published in Expert Review of Anticancer Therapy, 2022
Revati Varma, Matthew Wright, Jame Abraham, Megan Kruse
In this setting, neoadjuvant pembrolizumab is administered over 24 weeks at 200 mg every 3 weeks for eight doses or 400 mg every 6 weeks for four doses IV for 30 minutes. The pembrolizumab is given with concurrent NACT consisting of paclitaxel and carboplatin followed by an anthracycline and cyclophosphamide. Similarly, irrespective of pCR status, adjuvant pembrolizumab is administered for up to 27 weeks at 200 mg every 3 weeks for nine doses or 400 mg every 6 weeks for five doses IV over 30 minutes. In clinical practice, pembrolizumab is recommended for eligible patients with early-stage TNBC that is considered high-risk, meaning that the tumor is at least 2 cm in size or at least N1 nodal stage. Eligible patients include those who do not have relative contraindications to immunotherapy such as a poorly controlled autoimmune disorder, immunodeficiency or immunosuppression. Despite limited evidence, those with impaired or dysregulated immune function are suspected to be at increased risk of developing significant irAEs and/or be intolerant of immune checkpoint inhibitors thus use of pembrolizumab in this population must be done with caution. There also may be concern that underlying immune dysregulation can impair the efficacy of immune checkpoint inhibitors. Patients with well controlled autoimmune conditions have been found to safely tolerate immune checkpoint inhibitors. Ultimately, as with any medical decision, a risk-benefit analysis is required for each individual patient along with shared-decision making.
Optimizing Physiology During Prehospital Airway Management: An NAEMSP Position Statement and Resource Document
Published in Prehospital Emergency Care, 2022
Daniel P. Davis, Nichole Bosson, Francis X. Guyette, Allen Wolfe, Bentley J. Bobrow, David Olvera, Robert G. Walker, Michael Levy
Advanced airway management and insertion of an advanced airway are recognized as uncomfortable and potentially painful (73). Thus, an ethical obligation exists to address patient comfort during advanced airway management. In addition, reducing patient anxiety and pain may reduce or prevent brain injury and lower intracranial pressure, which have therapeutic benefits in patients with ischemic or traumatic brain injury (74). Furthermore, anxiolysis, analgesia, and/or paralysis may facilitate ventilation and reduce or avoid perfusion, oxygenation, and ventilation complications during positive-pressure ventilation. Thus, priority should be given to the administration of medication to reduce anxiety and pain. If paralysis is necessary for patient safety, oxygenation, or ventilator asynchrony, then adequate sedation and analgesia must be administered. Prehospital clinicians must monitor and recognize signs of alertness and treat appropriately to maintain adequate level of sedation, particularly with use of neuromuscular blocking agents. However, the adverse effects of these medications must be considered in the risk-benefit analysis. Sedatives and analgesics may reduce sympathetic tone, which may be an integral part of the compensatory response to hypovolemia/hypoperfusion. In addition, many sedative and analgesic agents reduce preload or cause systemic vasodilation, both of which may result in hypotension. Furthermore, some agents have direct cardiac suppressive effects.