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Medical intervention, a life saver or a life changer?
Published in Catherine Proot, Michael Yorke, Challenges and Choices for Patient, Carer and Professional at the End of Life, 2021
Catherine Proot, Michael Yorke
Medical intervention can also take the form of regular maintenance medication or implants, and we probably all know at least one person who would not be alive if it was not for such support. Chemotherapy is the use of powerful drugs to kill off cancers, but they can and do also cause negative reactions in patients. What are the factors associated with the continuance or cessation of such treatments? Is good health a divine right to which all other life issues are seconded? Side effects, demands on patient and family, withdrawal, consequences and cost and the like need to be the subject of careful discussion and skilled management.
Recent Advances in the Utilization of Bioengineered Plant-Based Nanoparticles
Published in Richard L. K. Glover, Daniel Nyanganyura, Rofhiwa Bridget Mulaudzi, Maluta Steven Mufamadi, Green Synthesis in Nanomedicine and Human Health, 2021
Charles Oluwaseun Adetunji, Olugbenga Samuel Michael, Muhammad Akram, Kadiri Oseni, Olerimi Samson E, Osikemekha Anthony Anani, Wilson Nwankwo, Hina Anwar, Juliana Bunmi Adetunji, Akinola Samson Olayinka
The first-line ATDs are the first choice in the drug-susceptible TB therapy due to their high efficacy and least side effects. The drug-susceptible TB therapy consists of intensive and continuance phase: the first phase consists of the first-line ATDs for the passé of four months while the latter phase lasts for four to six months (Pandey et al., 2003b). The treatment is performed under the scheme of directly observed therapy known as DOTS in India.
Ethics and Brain Death
Published in David Lamb, Death, Brain Death and Ethics, 2020
This question is bound up with the problem of prognosis and of the planning it implies. It calls for a comparison of alternatives. Whereas the scope of the first question is limited to objective clinical evidence, and draws upon established medical facts, this second question may involve ethical, religious and economic considerations, and may involve answers which reflect different moral attitudes towards the quality of residual life. Questions concerning whether the patient is alive or dead, like questions concerning pregnancy, or meningitis, demand a yes-no answer. But answers to the question ‘Should the patient be allowed to die?’ are not immediately clear-cut. They entail a consideration of a wide range of possibilities, ranging from the continuance of intensive life-support to the withdrawal of some, but not all, forms of treatment. When deciding if the patient is dead, deference to the expertise of the physician is needed. When deciding whether the patient should be allowed to die, one may have to refer to legal, ethical, economic and political matters, and one must take into consideration the known wishes of the patient, relatives and others. When the first question (is the patient dead?) has been answered affirmatively, the second question is obviously meaningless.
Decision-making and challenges within the evolving treatment algorithm in spinal muscular atrophy: a clinical perspective
Published in Expert Review of Neurotherapeutics, 2023
Lakshmi Balaji, Michelle A Farrar, Arlene M D’Silva, Didu S Kariyawasam
Due to the safety profile, regulatory recommendations incorporate selectivity of patients for gene transfer therapy who are in optimal health, including at an adequate nutritional baseline, well hydrated and in the absence of concurrent infection. Prior to gene therapy infusion, a range of tests should be conducted to determine clinical suitability. These include AAV9 antibody testing (<1:50 confers suitability); assessment of liver function (clinical exam, aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin, prothrombin time, albumin, partial thromboplastin time (PTT) and international normalized ratio (INR); creatinine; complete blood count (hemoglobin and platelet count) and Troponin-I). In terms of post-dosing surveillance, recommendations include continuance of steroids until liver function tests are below 2 × the upper limit of normal, and weekly surveillance of liver functions in particular during steroid course and over the weaning period, followed by fortnightly monitoring for a month post steroid cessation. Liver functions have to be monitored monthly thereafter for three months post cessation. Prompt consultation with a hepatologist or gastroenterologist should be undertaken for children with persistent transaminitis, despite administration of oral steroids. Immune mediated hepatotoxicity may necessitate adjustment of corticosteroid dose and duration [8].
Assessment of the Psychometric Properties of the Organisational Commitment Scale for Physicians in Pakistan
Published in Hospital Topics, 2022
Ammara Ajmal, Umer Saleem, Ayesha Ajmal, Tokie Anme
In 1991, Allen and Meyer declared the multidimensional construct of organizational commitment and proposed a three-component view of commitment (Meyer and Allen 1991). According to this approach, the connection between employee and organization can assume three distinct forms. ‘Affective commitment’ refers to the employee’s emotional attachment to their organization; employees with high affective commitment stay with the organization because they want to. Employees with higher affective commitment show higher performance (Karem et al. 2019). ‘Continuance commitment’ refers to the employee’s awareness of the cost associated with leaving the organization; employees with continuance commitment stay with the organization because they feel they have to continue because of the financial advantages (Karem et al. 2019). The third form, ‘normative commitment’, refers to the employee’s sense of obligation to the organization; employees with high normative commitment stay with the organization because they ought to. Normative commitment is under the influence of employee’s view about the mutual benefits between the organization and the employee (Mohamed 2018). Commitment is assessed more accurately and meaningfully based on these three types.
Examining the relationship between neuroticism and post-concussion syndrome in mild traumatic brain injury
Published in Brain Injury, 2019
Zachary C. Merz, Katherine Zane, Natalie A. Emmert, John Lace, Alexandra Grant
Furthermore, some research suggests individuals may report more PCS symptoms on questionnaires rather than directly to medical providers(62), thus creating the potential for inflated symptom reporting. Thirdly, it is unclear to what extent additional medical and/or psychiatric diagnoses may be influencing reporting rates across the PCSS and if the onset of those conditions coincided with the sustainment of reported concussion or if they are more longstanding difficulties potentially exacerbated by injury. This is an important distinction as these variables have been shown to directly relate to the onset and continuance of PCS symptoms. While results of the current study did not suggest any difference in reporting in individuals with and without psychotherapeutic history, there exists many other acute and/or chronic psychosocial variables which could be responsible for PCS symptom persistence. Fourth, while we attempted to control for personality trait-based measurements of depression, these items were not developed and validated as a screening measure for state-based depressive symptomatology. Finally, the male-to-female participant ratio suggested that women were more likely to complete the survey. While a large number of concussions are believed to go undiagnosed and untreated, these rates likely do not reflect current epidemiological rates of those who do seek care in medical environments. As such, this may limit the generalizability of the current study.