scholarly journals Psychiatry on a Shoestring: Developing New Standards of Care for a Severe, Prolonged, and Widespread Emergency

CNS Spectrums ◽  
2021 ◽  
Vol 26 (2) ◽  
pp. 168-168
Author(s):  
James E. Black
Keyword(s):  
Native American ◽  
Ethical Decision Making ◽  
Indigenous Communities ◽  
Ethical Framework ◽  
Standards Of Care ◽  
Crisis Planning ◽  
Study Objective ◽  
State Hospitals ◽  
Healthcare Rationing ◽  
The Right

AbstractStudy ObjectiveThe COVID-19 crisis has severely stressed our healthcare system and pushed our economy to the brink. This long emergency will probably cause years of severe suffering in every region. Health expenses greatly increased, supply chains were disrupted, and governments coped with much less revenue. Good clinicians plan for ALL contingencies, and we need to consider that the current disaster may get much worse. How can we adapt psychiatry to a long emergency? This goes far beyond previous work on crisis standards of care because the emergency is severe, prolonged, and widespread. If we had to spend much less on psychotropics, which meds stay on the formulary? If we have to close hospitals, which patients get a bed? What adaptations could be used if demand exceeds the supply of providers? Very little is known about how to make severe, permanent cuts to healthcare. Our previous systematic review found no scholarship addressing the ethics of severe and prolonged healthcare rationing. Global catastrophes need a global health policy, but this one has no experts. The present study starts the project by surveying experts with related experience that could be useful in future plans.MethodWe used purposive sampling to find 18 professionals with experience in healthcare rationing from underserved, indigenous communities, homeless programs, and African nations. We also interviewed ethicists, pharmacists, administrators, NGO clinicians, and military. Interviews were transcribed and coded using basic inductive techniques. Because so little is known about this topic, we used grounded theory, an iterative approach to guide further sampling, refine interviews, and make some preliminary conclusions.ResultsParticipants all agreed this crisis planning is extremely important and complex. They described diverse concerns regarding ethical decision making, with some having confidence with top-down government policy, and others recommending a grassroots approach. Minority participants had less confidence in government. There was no consensus on any best ethical framework. Most had confidence that clinicians will ultimately do the right thing. Native American leaders had confidence in a holistic, preventive approach. All agreed that social justice should be central in measuring economic impact of long emergencies and choosing ethical options. We collected suggestions for innovative approaches to rationing.ConclusionsThis research program illuminates the difficult ethical questions about adapting psychiatry to a prolonged, widespread, and severe emergency. Our interviews identify areas where severe but ethical cuts can be made in medications, hospitals, clinical staff, and administration. Next steps include evidence-based formularies, utilitarian staff cuts, and ethical standards for closing beds or revamping state hospitals. Underserved and diverse communities with rationing experience must have a voice in the discussion.

scholarly journals Musings on Native American language reclamation and sociolinguistics

2020 ◽  
Vol 2020 (263) ◽  
pp. 85-90
Author(s):  
Wesley Y. Leonard
Keyword(s):  
Native American ◽  
Indigenous Communities ◽  
Indigenous Languages ◽  
Community Members ◽  
Native American Languages ◽  
Heritage Languages ◽  
Production Of Knowledge ◽  
The Right ◽  
Native American Language

AbstractSociolinguistic approaches to Native American languages are best conducted as part of a project of “language reclamation,” argues Wesley Y. Leonard. He discusses how framings of Indigenous languages as “endangered,” while in some ways well-intentioned, replicate the distance of language communities from scholarly research. An emphasis on reclamation – “efforts by Indigenous communities to claim the right to speak their heritage languages” – highlights the role of the community members in the production of knowledge on and the revival of Native American languages.

Awareness and Decision Making in Professional Ethics

2000 ◽  
Vol 5 (1) ◽  
pp. 19-27 ◽  
Author(s):  
Ronny Swain
Keyword(s):  
Decision Making ◽  
Professional Ethics ◽  
Ethical Decision Making ◽  
Code Of Ethics ◽  
Professional Autonomy ◽  
Ethical Awareness ◽  
Ethical Decisions ◽  
The Right ◽  
Aid Decision

The paper describes the development of the 1998 revision of the Psychological Society of Ireland's Code of Professional Ethics. The Code incorporates the European Meta-Code of Ethics and an ethical decision-making procedure borrowed from the Canadian Psychological Association. An example using the procedure is presented. To aid decision making, a classification of different kinds of stakeholder (i.e., interested party) affected by ethical decisions is offered. The author contends (1) that psychologists should assert the right, which is an important aspect of professional autonomy, to make discretionary judgments, (2) that to be justified in doing so they need to educate themselves in sound and deliberative judgment, and (3) that the process is facilitated by a code such as the Irish one, which emphasizes ethical awareness and decision making. The need for awareness and judgment is underlined by the variability in the ethical codes of different organizations and different European states: in such a context, codes should be used as broad yardsticks, rather than precise templates.

What services are available for the treatment of transsexuals in Great Britain?

2002 ◽  
Vol 26 (6) ◽  
pp. 210-212 ◽  
Author(s):  
S. Murjan ◽  
M. Shepherd ◽  
B. G. Ferguson
Keyword(s):  
Great Britain ◽  
Local Level ◽  
International Standards ◽  
Standards Of Care ◽  
High Court ◽  
Health Authorities ◽  
Legal Situation ◽  
Specialist Services ◽  
Assessment And Treatment ◽  
The Right

AIMS AND METHODWe conducted a questionnaire survey of all 120 health authorities and boards responsible for the commissioning of services for the assessment and treatment of transsexual people in England, Scotland and Wales, in order to identify the nature of the input offered and assess conformity to current international standards of care.RESULTSEighty-two per cent of the commissioning authorities responded and confirmed that most health authorities/boards provide a full service for the treatment of transsexuals, although this would be delivered at a local level in only 20% of cases. However, 11 commissioning authorities gave confused and inaccurate responses and three other health authorities appear to hold views on the commissioning of these specialist services that are not in keeping with the current legal situation and a recent High Court ruling, which establishes the right of transsexual people to NHS assessment and treatment.CLINICAL IMPLICATIONSThere are discrepancies in prioritisation and provision of clinical services for this group that are not standard across Great Britain.

Adapting Standards of Care Under Extreme Conditions

2009 ◽  
Vol 3 (2) ◽  
pp. 111-116 ◽  
Author(s):  
Kristine M. Gebbie ◽  
Cheryl A. Peterson ◽  
Italo Subbarao ◽  
Kathleen M. White
Keyword(s):  
Public Health ◽  
Health Professionals ◽  
Control Policy ◽  
Standard Of Care ◽  
White Paper ◽  
Ethical Framework ◽  
Standards Of Care ◽  
State Legislation ◽  
Routine Tasks ◽  
Criminal Charges

ABSTRACTThe filing of criminal charges against a group of clinicians in New Orleans for failure to meet expected standards of care following the hurricanes of 2005 made the growing concern among health professionals about care provided during extreme emergencies or disasters all too real. Questions about what may lead to censure, penalties from licensing boards, or lawsuits have come from nurses, physicians, and many other licensed health professionals. A panel convened by the American Nurses Association that included representatives of medical, public health, hospital, and government agencies considered the ethical, professional, and practical aspects of meeting standards of care in such circumstances. Clinicians are reminded that in emergencies, it is only the circumstances that change (perhaps radically); neither the individual’s professional competency nor the basic professional standard of care is different. In making prioritized decisions under such circumstances, the individual’s ethical framework is utilitarian, and there are 3 areas for action, even when some routine tasks are set aside: maintain worker and patient safety; maintain airway, breathing, and circulation; and establish or maintain infection control. Policy recommendations such as state legislation for the adoption of comprehensive immunity for volunteer health care workers, and the establishment of a medical review panel as arbitration board are also suggested. The resulting white paper summarizes the issues and provides guidance to individual professionals, institutions in which they work, and emergency planners. (Disaster Med Public Health Preparedness. 2009;3:111–116)

Analysis of High-Density Surface EMG and Finger Pressure in the Left Forearm of Violin Players: A Feasibility Study

2017 ◽  
Vol 32 (3) ◽  
pp. 139-151 ◽  
Author(s):  
Paolo Cattarello ◽  
Roberto Merletti ◽  
Francesco Petracca
Keyword(s):  
Pressure Sensors ◽  
Surface Emg ◽  
High Density ◽  
String Instruments ◽  
Activation Patterns ◽  
Study Objective ◽  
Left Hand ◽  
Density Surface ◽  
The Right ◽  
Finger Pressure

Wrist and finger flexor muscles of the left hand were evaluated using high-density surface EMG (HDsEMG) in 17 violin players. Pressure sensors also were mounted below the second string of the violin to evaluate, simultaneously, finger pressure. Electrode grid size was 110x70 mm (12x8 electrodes with interelectrode distance=10 mm and Ø=3 mm). The study objective was to observe the activation patterns of these muscles while the violinists sequentially played four notes—-SI (B), DO# (C#), RE (D), MI (E)—-at 2 bows/s (one bow up in 0.5 s and one down in 0.5 s) and 4 bows/s on the second string, while producing a constant (CONST) or ramp (RAMP) sound volume. HDsEMG images obtained while playing the notes were compared with those obtained during isometric radial or ulnar flexion of the wrist or fingers. Two image descriptors provided information on image differences. Results showed that the technique was reliable and provided reliable signals, and that recognizably different sEMG images could be associated with the four notes tested, despite the variability within and between subjects playing the same note. sEMG activity of the left hand muscles and pressure on the string in the RAMP task were strongly affected in some individuals by the sound volume (controlled by the right hand) and much less in other individuals. These findings question whether there is an individual or generally optimal way of pressing violin strings with the left hand. The answer to this question might substantially modify the teaching of string instruments.

scholarly journals Mechanical injuries of the eyeball: Frequency, structure, and possibility of the prevention

2006 ◽  
Vol 134 (1-2) ◽  
pp. 11-21 ◽  
Author(s):  
Milos Jovanovic
Keyword(s):  
Visual Acuity ◽  
Term Treatment ◽  
Wound Management ◽  
Working Population ◽  
Eye Injuries ◽  
Penetrating Injuries ◽  
Permanent Disability ◽  
Study Objective ◽  
Long Term Treatment ◽  
The Right

Introduction. Some factors significant for development of mechanical injuries of the eyeball have been analyzed in the study. Objective. Basic objective of such analysis was prevention and reduction of these injuries. Method. Mechanical injuries of the eyeball in patients hospitalized at the Institute of Eye Disease, CCS in Belgrade, in five year period have been analyzed. Only patients with severe eye injuries were hospitalized. The following parameters were analyzed: sex, age, occupation of patients, residence, time of the inflicted injury, i.e. by months in a year, days in a week and hours in a day, place and way of inflicting the injury as well as visual acuity on admission. In addition, the type of injury was analyzed, i.e. contusion or penetrating with all resulting complications. Finally, the timing of primary surgical management of the eye injury was specified, if required. Results. A total number of hospitalized patients with mechanical eye injuries was 1642 during the last five years, meaning that one injury occurred daily. There were 1381 males and 261 females, meaning that males were 5.3 times more the victims of mechanical eye injuries. Out of all the injured, 861 (52.4%) were from rural environment, while 781 (47.6%) were urban population. The proportion of injuries of the right or the left eye was nearly equal, while both eyes were simultaneously injured in 21 (1.3%) cases. The injuries were inflicted in all ages, but most frequently in working population ranging from 16 to 55 years, accounting for 60.8%. Unfortunately, a lot of the injured were children up to 15 years of age - 19.4%. The most commonly injured were workers - 39.8%, followed by students - 17.5%. A piece of wood was the cause of injury in 21.8%, sharp and pointed objects in 17.2%, hammer and metal in 14.2%, glass in 11.6%, and other different causes in varying percentage. There were also rare causes of injuries, such as those caused by zip, dog bite, rooster?s bill, etc. According to months in a year and days in a week, the injuries were almost evenly distributed. Considering the period of a day, even 77.4% of the injuries occurred during daytime, from 10 a.m. to 10 p.m. The highest percentage - 43.5% - of the injuries occurred while working something out of working place, while 24.5% of injuries were inflicted at working places. On admission, the majority of patients - 32.9% had visual acuity L+P+, but this visual acuity ranged from amaurosis to 1.0. There were 746 (45.4%) contusion injuries and 870 (53.0%) penetrating injuries. The rest were the injuries of other ocular adnexa. The majority of primary wound managements were performed in the first 24 hours of the injury - 67.1%. Conclusion. It may be concluded that working population and students are most commonly injured, and that men are five times more frequently injured than women; then, a piece of wood, sharp objects and glass are the most often causes of injury; the number of contusion and penetrating injuries is equal, and that required primary surgical wound management is most often performed in the first 24 hours from the injury. Further analysis of these factors suggests that many of these injuries could have been prevented, and consequently long-term treatment and treatment costs could have been evaded. Most important is that permanent disability due to visual impairment or even blindness of the injured eye could have been avoided.

scholarly journals Transnationalism as a Decolonizing Strategy? ‘Trans-Indigenism’ and Native American Food Sovereignty

2018 ◽  
Vol 53 (s1) ◽  
pp. 413-423
Author(s):  
Zuzanna Kruk-Buchowska
Keyword(s):  
United States ◽  
Native American ◽  
Knowledge Production ◽  
Food Sovereignty ◽  
Indigenous Communities ◽  
The United States ◽  
Scientific Paradigms ◽  
Nation States ◽  
In Trans ◽  
Indigenous Methods

Abstract The aim of this paper is to analyze how Indigenous communities in the United States have been engaging in trans-Indigenous cooperation in their struggle for food sovereignty. I will look at inter-tribal conferences regarding food sovereignty and farming, and specifically at the discourse of the Indigenous Farming Conference held in Maplelag at the White Earth Reservation in northern Minnesota. I will show how it: (1) creates a space for Indigenous knowledge production and validation, using Indigenous methods (e.g., storytelling), without the need to adhere to Western scientific paradigms; (2) recovers pre-colonial maps and routes distorted by the formation of nation states; and (3) fosters novel sites for trans-indigenous cooperation and approaches to law, helping create a common front in the fight with neoliberal agribusiness and government. In my analysis, I will use Chadwick Allen’s (2014) concept of ‘trans-indigenism’ to demonstrate how decolonizing strategies are used by the Native American food sovereignty movement to achieve their goals.

scholarly journals Dynamic neuropathy of the common peroneal nerve at the level of the fibular head (literature review and case report)

2019 ◽  
Vol 21 (1) ◽  
pp. 54-59
Author(s):  
M. G. Bashlachev ◽  
G. Yu. Evzikov ◽  
V. A. Parfenov ◽  
N. B. Vuitsyk ◽  
F. V. Grebenev
Keyword(s):  
Ankle Joint ◽  
Peroneal Nerve ◽  
Correct Diagnosis ◽  
Clinical Manifestations ◽  
Common Peroneal Nerve ◽  
Diagnostic Methods ◽  
Fibular Head ◽  
Study Objective ◽  
The Common ◽  
The Right

The study objective is to report a case of dynamic neuropathy of the common peroneal nerve at the level of the fibular head and to discuss diagnostic methods and neurosurgical treatment. Materials and methods. We report a case of dynamic neuropathy of the common peroneal nerve at the level of the fibular head in a female patient. The patient was treated in the Neurology Clinic of I.M. Sechenov First Moscow State Medical University. We analyzed clinical manifestations and compared them with the data described in research literature. Results. Upon admission, the patient complained of pain in the anterolateral surface of the right shin and in the dorsum of the foot during walking. At rest, the patient experienced no pain. We observed no motor or sensory disorders typical of nerve root disorders at the level of L5. Lasegue’s test was negative. The patient had a positive Tinel’s sign in the area of the right fibular head. In order to clarify the diagnosis, we performed a repeated extension test in the right ankle joint and it was positive. The patient underwent surgery that included peroneal nerve decompression and neurolysis at the level of the fibular head. In the postoperative period, the patient had complete pain relief. Conclusion. Due to the difficulties in the diagnostics of dynamic neuropathy of the common peroneal nerve, this disease is often mistaken for radiculopathy at the level of L5. Thorough clinical examination, testing for Tinel’s sign in the area of the fibular head, and repeated extension test in the ankle joint ensure the correct diagnosis and reduce the frequency of ineffective surgeries on the lumbar spine. Surgical decompression of the common peroneal nerve at the level of the fibular head with obligatory opening of the entrance to the nerve canal is an effective method of treatment in such patients.

scholarly journals If We Show Them Will They Come? Attitudes of Native American Youth Towards Higher Education

2020 ◽  
Vol 4 (2) ◽  
pp. 99-105
Author(s):  
Emmerentine Oliphant ◽  
Sharon B. Templeman
Keyword(s):  
Native American ◽  
Health Research ◽  
Indigenous Health ◽  
Ways Of Knowing ◽  
Indigenous Communities ◽  
Native Community ◽  
Research Methodologies ◽  
General Validity ◽  
Native Canadian ◽  
Indigenous Ways Of Knowing

Indigenous health research should reflect the needs and benefits of the participants and their community as well as academic and practitioner interests. The research relationship can be viewed as co-constructed by researchers, participants, and communities, but this nature often goes unrecognized because it is confined by the limits of Western epistemology. Dominant Western knowledge systems assume an objective reality or truth that does not support multiple or subjective realities, especially knowledge in which culture or context is important, such as in Indigenous ways of knowing. Alternatives and critiques of the current academic system of research could come from Native conceptualizations and philosophies, such as Indigenous ways of knowing and Indigenous protocols, which are increasingly becoming more prominent both Native and non-Native societies. This paper contains a narrative account by an Indigenous researcher of her personal experience of the significant events of her doctoral research, which examined the narratives of Native Canadian counselors’ understanding of traditional and contemporary mental health and healing. As a result of this narrative, it is understood that research with Indigenous communities requires a different paradigm than has been historically offered by academic researchers. Research methodologies employed in Native contexts must come from Indigenous values and philosophies for a number of important reasons and with consequences that impact both the practice of research itself and the general validity of research results. In conclusion, Indigenous ways of knowing can form a new basis for understanding contemporary health research with Indigenous peoples and contribute to the evolution of Indigenous academics and research methodologies in both Western academic and Native community contexts.

scholarly journals Who owns the news? The "right to be forgotten” and journalists’ conflicting principles

2021 ◽  
Author(s):  
Ivor Shapiro ◽  
Brian MacLeod Rogers
Keyword(s):  
Ethical Decision Making ◽  
Ethical Issues ◽  
Historical Record ◽  
The European Union ◽  
Ethical Implications ◽  
Right To Be Forgotten ◽  
Digital Journalism ◽  
Negative Impacts ◽  
The Right

“The right to be forgotten” (RTBF) is a relatively new concept in human-rights law, but it deals in root ethical issues familiar to news people and their sources. Editors must routinely weigh the news’ long-term role as a “historical record” against its potential negative impacts on individuals. In the digital-journalism era, publication is at the same time both more enduring and less static, creating new parameters and possibilities for ethical decision-making. Because news content may be seen by more people in more places for much longer, the potential to do lasting good or harm is greater, but, because digital publication is more retractable and redactible than legacy platforms, the possibility of correction, clarification and removal creates both new harm-reduction opportunities and new challenges to the historical record. Also known as a “right to erasure” or “right to oblivion,” the RTBF, now accepted in the European Union, recognizes that, even in the age of Google, people should retain some degree of control over information about themselves and their pasts. (Factsheet on the ‘Right to be Forgotten’ ruling (C131-12), n.d.; Manna, 2014; Rosen, 2012). This paper will explore both legal and ethical implications of the issue.

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