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Justice
Published in Robert S. Holzman, Anesthesia and the Classics, 2022
Conscience clauses† and provider refusal rules have brought the justice controversy in patient care into sharp focus. Examples include in vitro fertilization services to a same-sex couple or the provision of assisted suicide in a state in which it is legal. This protects the beliefs of the physician, who is nevertheless professionally and ethically obligated to refer the patient to someone from whom the care can be obtained. But a physician might also object to treating a specific patient, in which case it is not the treatment that is morally troubling but the patient him- or herself. Because the state licenses medical professionals and grants them sole authority to provide medical services to patients, physicians assume a positive duty to provide these treatments to the public.4,5 Therefore, physicians who object to certain treatments have an ethical obligation to inform their patients about the availability of such (legal) medical services and to refer patients to other willing clinicians.
Disorders of Consciousness
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
The history, physical examination, and electrocardiogram (ECG) are the core of the diagnostic workup. In most patients, there is an obvious precipitant and no investigations are required, or at most an ECG and hemoglobin. The need for further investigations is determined by the certainty of the clinical diagnosis and nature of the clinical findings.
Conceptions of Care and Caring
Published in A. O. Mahendran, Moments of Rupture: The Importance of Affect in Medical Education and Surgical Training, 2019
I suggest that it is at this interface of Real Care – the unpredictable nature of a clinical encounter – that the role of the doctor is constructed for the patient in an enduring and forceful manner. In a world that is increasingly technologized, in part to detach from the human propensity for error, the value and professional longevity of a doctor may lie in how she mediates the contingency of clinical practice to give patients much-needed reassurance and comfort. If a doctor is successful in this endeavour, then she may paradoxically give patients that elusive factor: a sense of certainty in their medical care.
Sixth Annual Enhanced Recovery After Surgery Symposium highlights: work in progress or standard care?
Published in Baylor University Medical Center Proceedings, 2023
Lucas Fair, Elizabeth Duggan, Evan P. Dellinger, Nicole Bedros, Kimberly Godawa, Cynthia Krusinski, Rachel Curran, Charlette Hart, Alex Zhu, Walter Peters, James Fleshman, Alessandro Fichera
Data for practitioners to visually relate to the improved care are essential for successful integration of ERAS into service lines. In order to have the data to improve quality of care, teams rely on nursing charting. It may seem insignificant or redundant to chart nursing care. However, the details of compliant pathway adherence are essential to validate the reason for improvement in patient care. It is important to trend certain elements of care to validate an impact on patient outcomes. Relating high risk for poor outcomes to methods of preventing complications using protocols such as ERAS requires compulsive data collection. Nursing data entry can serve that role prospectively. Not only does charting help care for the patient contemporaneously and better predict outcomes for the same patient at the next encounter, but it will also help care for other patients in the future.
Disproportionality analysis of adverse neurological and psychiatric reactions with the ChAdOx1 (Oxford-AstraZeneca) and BNT162b2 (Pfizer-BioNTech) COVID-19 vaccines in the United Kingdom
Published in Expert Opinion on Drug Safety, 2023
Matilde Otero-Losada, Nikolai Petrovsky, Abdallah Alami, James A. Crispo, Donald Mattison, Francisco Capani, Christopher Goetz, Daniel Krewski, Santiago Perez-Lloret
Limitations of our study are that we did not enough information to control for imbalances in the characteristics of the vaccinated subjects nor to adjust for other factors potentially associated with the reported AEFIs. We also lacked enough information to check for associations between the AEFIs among each other. Spontaneous, passive reporting of AEFIs to the national pharmacovigilance system has some limitations [23]. The system relies on the vaccinee and/or the family, immunization providers, and healthcare workers’ reports. Both, some diagnoses may lack the required certainty level, and some common conditions may be underreported. A reporter bias might have been present for some reactions [24]. Bell’s palsy reports may have been spurred by the early findings of an imbalance in reported clinical trials with a higher number of cases of facial paralysis seen in subjects receiving Pfizer or Moderna mRNA vaccines as compared to control subjects [25]. This may have led to overreporting Bell’s Palsy in connection with the mRNA vaccines, misleadingly making the association more robust. Finally, some reports linked Bell’s Palsy and GBS to COVID-19 infection in unvaccinated people [26,27]. Untangling the relationship between infection, vaccines, and these AEFIs requires more data.
Speech-language pathology managers’ perceptions of a videofluoroscopic swallow study eLearning programme to support training and service delivery
Published in International Journal of Speech-Language Pathology, 2021
Shana T. Taubert, Clare L. Burns, Elizabeth C. Ward, Kellie A. McCarthy, Nicola Graham
Participants described various features of the VFSS eLearning design and content that facilitated widespread uptake. The categories and sub-categories within this theme are summarised in Table I. Managers considered that the programme comprehensively incorporated the range of technical and procedural requirements for VFSS skill development and in doing so, facilitated a greater understanding of the complexity of operating the clinic. They felt reassured that the programme’s systematic structure and evidence-based approach facilitated learning of VFSS principles and guidelines, and the practical downloadable resources (e.g. barium recipes and clinical reasoning algorithms) were beneficial in supporting clinic operations. The standardisation and uniformity of training provided by the eLearning programme was also seen as a benefit to the state health network: “You know that every site trains in VFSS … theory … the same way”. “More consistent … approaches at a state-wide level… are certainly going to be an advantage to our patients”. For these reasons, 11 of the 13 services interviewed reported that they had adopted the eLearning as an integral part of VFSS training and the remaining two were planning on utilising the programme for future VFSS training.