Community hospital ethics consultation: Evaluation and comparison with a University Hospital Service

A request that an ethics committee or consultant analyze the ethical issues in a case, delineate ethical options, or make a recommendation need not automatically but often does elicit legal information. In a recent book in which ethics consultants described cases on which they had worked, almost all cited a legal case or statute that had shaped the consultation process. During a period of just a few months, case consultation done under the auspices of one university hospital ethics committee involved interpretation of statutes on living wills, durable powers of attorney, competency, confidentiality, guardianship, AIDS testing, and disability (personal observation). At another hospital, 30% of ethics consultations were thought to involve legal issues. Attorneys at a third hospital estimated that virtually every case involves legal issues. The notion that ethics consultation is an “amalgam” of medicine, ethics, interpersonal skills, and law is gaining currency. Ethics consultation has become a channel through which law enters the clinical setting.

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Impact of the COVID-19 pandemic and its related psychological effect on orthopedic surgeries conducted in different types of hospitals in Taiwan

Journal of Orthopaedic Surgery ◽

10.1177/2309499021996072 ◽

2021 ◽

Vol 29 (1) ◽

pp. 230949902199607 ◽

Cited By ~ 1

Author(s):

Chia-Lung Shih ◽

Peng-Ju Huang ◽

Hsuan-Ti Huang ◽

Chung-Hwan Chen ◽

Tien-Ching Lee ◽

...

Keyword(s):

Community Hospital ◽

University Hospital ◽

Total Knee Arthroplasties ◽

Peak Period ◽

Number Of Patients ◽

Total Knee ◽

Investigation Period ◽

Orthopedic Diseases ◽

The University ◽

The Impact

Aim: Taiwan’s response to the coronavirus disease 2019 (COVID-19) differed in that it successfully prevented the spread without having to shutdown or overburden medical services. Patients’ fear regarding the pandemic would be the only reason to reduce surgeries, so Taiwan could be the most suitable place for research on the influence of psychological factors. This study aimed to assess the impact of patients’ fear on orthopedic surgeries in Taiwan amid the peak period of the COVID-19 pandemic. Patients and Methods: The investigation period included the COVID-19 pandemic (March 2020 to April 2020) and the corresponding period in the previous year. The following data on patients with orthopedic diseases were collected: outpatient visits, hospital admission, and surgical modalities. Results: The COVID-19 pandemic led to a 22%–29% and 20%–26% reduction in outpatients, 22%–27% and 25%–37% reduction in admissions, and 26%–35% and 18%–34% reduction in surgeries, respectively, at both hospitals. The weekly mean number of patients was significantly smaller during the COVID-19 pandemic for all types of surgery and elective surgeries at the university hospital, and for all types of surgery, elective surgeries, and total knee arthroplasties at the community hospital. Further, patients visiting the community hospital during the pandemic were significantly younger, for all types of surgery, elective surgeries, and total knee arthroplasties. Conclusions: The reduction in orthopedic surgeries in Taiwan’s hospitals during COVID-19 could be attributed to patients’ fear. Even without restriction, the pandemic inevitably led to a reduction of about 20%–30% of the operation volume.

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The Resident in the Non-University Hospital (Continued)

PEDIATRICS ◽

10.1542/peds.30.3.497a ◽

1962 ◽

Vol 30 (3) ◽

pp. 497-498

Author(s):

EDWIN D. HARRINGTON

Keyword(s):

Medical Education ◽

Community Hospital ◽

University Hospital

I read Dr. Fink's letter in the April issue of Pediatric (29:678, 1962) with great interest. As we have considered this problem at a community hospital in suburban Philadelphia it has seemed to us necessary to answer two questions: (1) What is the problem? and (2) Who is responsible for the solution of the problem? Essentially, we see the problem of adequate inpatient coverage as a service problem, not a problem in medical education. I would agree with Dr. Fink that his patients "would undoubtedly receive better care with a qualified resident on duty."

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Interlaboratory Comparison of University Hospital Referee Laboratories and Community Hospital Laboratories, Using Results of the 1968 College of American Pathologists Clinical Chemistry Survey

American Journal of Clinical Pathology ◽

10.1093/ajcp/58.3.281 ◽

1972 ◽

Vol 58 (3) ◽

pp. 281-296 ◽

Cited By ~ 7

Author(s):

Bradley E. Copeland ◽

Laurence P. Skendzel ◽

Roy N. Barnett

Keyword(s):

Interlaboratory Comparison ◽

Community Hospital ◽

Clinical Chemistry ◽

University Hospital

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Axillary surgery in breast cancer patients treated with breast-conserving surgery at german breast cancer centers within the last 14 years – comparison of a university center and a community hospital

Senologie - Zeitschrift für Mammadiagnostik und -therapie ◽

10.1055/a-0868-8241 ◽

2019 ◽

Vol 16 (01) ◽

pp. 59-66

Author(s):

Amelie de Gregorio ◽

Peter Widschwendter ◽

Susanne Albrecht ◽

Nikolaus de Gregorio ◽

Thomas Friedl ◽

...

Keyword(s):

Breast Cancer ◽

Community Hospital ◽

Breast Conserving Surgery ◽

University Hospital ◽

Axillary Lymph ◽

Breast Cancer Patients ◽

University Hospitals ◽

Cancer Centers ◽

Axillary Surgery ◽

Over Time

Abstract Background Guideline recommendations for axillary surgical approach in breast cancer (BC) treatment changed over the last decade. Methods Data from all invasive BC patients (n = 5344) treated with breast conserving surgery (BCS) at the breast cancer centers of the University Hospital Ulm (U‑BCC) and the community hospital Dachau (D‑BCC) were included into a retrospective analysis for assessing information on axillary surgery between 2003 and 2016 based on the documented cancer registry data. Results The average annual rate of sentinel node biopsy (SNB) was 85.5 % and 87.2 % in Ulm and Dachau, respectively. SNB was performed more precisely at the U‑BCC with a median of 2.4 resected lymph nodes (LN) compared to a median of 3.2 resected LN in Dachau. Median number of resected LN for axillary lymph node dissection (ALNE) showed a statistically significant reduction over time in Ulm (rs = − 0.82; p < 0.001) and Dachau (rs = − 0.76; p = 0.002). The rate of secondary ALNE (after SNB; 2° ALNE) decreased significantly in U‑BCC (rs = − 0.76; p = 0.002) while it remained stable in D‑BCC. The influential publication of the Z0011 study in 2010 resulted in a significant reduction of secondary ALNE (24.1 % pre Z0011 and 14.4 % postZ0011; p < 0.001) in Ulm. Conclusion Changes in axillary surgery over time can be seen in the annual statistics of the reviewed BCCs. With BCS, mostly SNB was performed and numbers of removed LN in ALNE have decreased. In the U‑BCC, the rate of 2° ALNE dropped after the publication of the Z0011 data. The fact that no such decrease for 2° ALNE was found in D‑BCC suggests that university hospitals implement new data and research results into clinical routine earlier than peripheral community hospitals.

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Tu1567 Perioperative Outcome After Pancreatic Head Resections: Consecutive Single Surgeon Series in a Specialized University Hospital and in a Community Hospital

Gastroenterology ◽

10.1016/s0016-5085(13)64204-3 ◽

2013 ◽

Vol 144 (5) ◽

pp. S-1128 ◽

Cited By ~ 1

Author(s):

Ulrich Adam ◽

Hartwig Riediger ◽

Ulrich F. Wellner ◽

Tobias Keck ◽

Ulrich T. Hopt ◽

...

Keyword(s):

Community Hospital ◽

Pancreatic Head ◽

University Hospital ◽

Perioperative Outcome

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A new form of community hospital service for the elderly.

BMJ ◽

10.1136/bmj.284.6318.840 ◽

1982 ◽

Vol 284 (6318) ◽

pp. 840-841

Author(s):

D L Beales

Keyword(s):

Community Hospital ◽

The Elderly ◽

Hospital Service ◽

New Form

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Physicians’ and nurses’ expectations and objections toward a clinical ethics committee

Nursing Ethics ◽

10.1177/0969733013478308 ◽

2013 ◽

Vol 20 (7) ◽

pp. 771-783 ◽

Cited By ~ 9

Author(s):

Maximiliane Jansky ◽

Gabriella Marx ◽

Friedemann Nauck ◽

Bernd Alt-Epping

Keyword(s):

Clinical Ethics ◽

Ethical Issues ◽

Ethics Consultation ◽

Ethics Committees ◽

Ethics Committee ◽

University Hospital ◽

Sufficient Information ◽

Interprofessional Communication ◽

Clinical Ethics Committee ◽

Ethical Conflicts

The study aimed to explore the subjective need of healthcare professionals for ethics consultation, their experience with ethical conflicts, and expectations and objections toward a Clinical Ethics Committee. Staff at a university hospital took part in a survey (January to June 2010) using a questionnaire with open and closed questions. Descriptive data for physicians and nurses (response rate = 13.5%, n = 101) are presented. Physicians and nurses reported similar high frequencies of ethical conflicts but rated the relevance of ethical issues differently. Nurses stated ethical issues as less important to physicians than to themselves. Ethical conflicts were mostly discussed with staff from one’s own profession. Respondents predominantly expected the Clinical Ethics Committee to provide competent support. Mostly, nurses feared it might have no influence on clinical practice. Findings suggest that experiences of ethical conflicts might reflect interprofessional communication patterns. Expectations and objections against Clinical Ethics Committees were multifaceted, and should be overcome by providing sufficient information. The Clinical Ethics Committee needs to take different perspectives of professions into account.

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A register-based study comparing planned rehabilitation following acute stroke in 2011 and 2017

Scientific Reports ◽

10.1038/s41598-021-02337-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Malin C. Nylén ◽

Hanna C. Persson ◽

Tamar Abzhandadze ◽

Katharina S. Sunnerhagen

Keyword(s):

Stroke Unit ◽

Community Hospital ◽

Binary Logistic Regression ◽

University Hospital ◽

Impaired Consciousness ◽

University Hospitals ◽

Cross Sectional ◽

Severe Stroke ◽

Stroke Units ◽

Explanatory Variables

AbstractThis cross-sectional, register-based study aimed to explore patterns of planned rehabilitation at discharge from stroke units in Sweden in 2011 and 2017 and identify explanatory variables for planned rehabilitation. Multivariable binary logistic regression was used to identify variables that could explain planned rehabilitation. There were 19,158 patients in 2011 and 16,508 patients in 2017 with stroke, included in the study. In 2011, 57% of patients were planned for some form of rehabilitation at discharge from stroke unit, which increased to 72% in 2017 (p < 0.001). Patients with impaired consciousness at admission had increased odds for planned rehabilitation (hemorrhage 2011 OR 1.43, 95% CI 1.13–1.81, 2017 OR 1.66, 95% CI 1.20–2.32), (IS 2011 OR 1.21, 95% CI 1.08–1.34, 2017 OR 1.49, 95% CI 1.28–1.75). Admission to a community hospital (hemorrhage 2011 OR 0.56, 95% CI 0.43–0.74, 2017 OR 0.39, 95% CI 0.27–0.56) (IS 2011 OR 0.63, 95% CI 0.58–0.69, 2017 OR 0.54, 95% CI 0.49–0.61) or to a specialized non-university hospital (hemorrhage 2017 OR 0.66, 95% CI 0.46–0.94), (IS 2011 OR 0.90, 95% CI 0.82–0.98, 2017 OR 0.76, 95% CI 0.68–0.84) was associated with decreased odds of receiving planned rehabilitation compared to admission to a university hospital. As a conclusion severe stroke was associated with increased odds for planned rehabilitation and patients discharged from non-university hospitals had consistently decreased odds for planned rehabilitation.

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