scholarly journals Ethical Advice for an Intensive Care Triage Protocol in the COVID-19 Pandemic: Lessons Learned from The Netherlands

2020 ◽  
Vol 13 (2) ◽  
pp. 157-165
Author(s):  
Marcel Verweij ◽  
Suzanne van de Vathorst ◽  
Maartje Schermer ◽  
Dick Willems ◽  
Martine de Vries
Keyword(s):  
Intensive Care ◽  
The Netherlands ◽  
Lessons Learned ◽  
Ethical Guidelines ◽  
Patient Organizations ◽  
Care Workers ◽  
Triage Protocol ◽  
Medical Selection ◽  
Ic Treatment

Abstract At the height of the COVID-19 crisis in the Netherlands a shortness of intensive care beds was looming. Dutch professional medical organizations asked a group of ethicists for assistance in drafting guidelines and criteria for selection of patients for intensive care (IC) treatment in case of absolute scarcity, when medical selection criteria would no longer suffice. This article describes the Dutch context, the process of drafting the advice and reflects on the role of ethicists and lessons learned. We argue that timely interaction between clinical and ethical expertise is necessary since the distinction between medical and non-medical considerations is not as clearcut as sometimes assumed. Furthermore, pragmatic considerations related to the specifics of an epidemic are of importance, for example, in relation to prioritizing health care workers. As a consequence, any protocol already present before the pandemic would need alterations to fit the current situation. The ‘fair innings’ criterion we proposed, rephrased as an argument of intergenerational solidarity, was considered reasonable by professionals as well as patient organizations. While it is desirable to draft ethical guidelines in ‘peacetime’ as a matter of pandemic preparedness, the pressure of an actual crisis facilitates decision-making, although it will also complicate a more democratic approach.

Unequal Coverage

2017 ◽  
Keyword(s):  
Affordable Care Act ◽  
Insurance Coverage ◽  
The United States ◽  
Lessons Learned ◽  
Citizenship Status ◽  
Role Of Government ◽  
Care Workers ◽  
The Everyday ◽  
The Law

Unequal Coverage documents the everyday experiences of individuals across the United States as they attempted to access coverage and care in the five years following the passage of the Affordable Care Act (ACA). The contributors to this edited volume employ research methods rooted in ethnography and focused on how reform was actually experienced on the ground by frontline health care workers, the newly insured, and those who remained uninsured. The book argues that while the ACA did extend social protections to some groups previously excluded from health insurance, its design- and controversy-plagued implementation also created new forms of exclusion. Access to affordable coverage options were highly segmented by state of residence, income, and citizenship status. To explain and contextualize the stratified experiences of health reform that the book’s authors documented across nine states, Unequal Coverage explores interrelated themes from medical anthropology: stratified citizenship, risk, and responsibility. In the years since its enactment, some 20 million uninsured Americans gained access to insurance coverage. And yet, the law remained unpopular and politically vulnerable. This book illustrates lessons learned from the contentious implementation of the ACA and reveals how the law became a flashpoint for battles over inequality, fairness, and the role of government.

scholarly journals Role of intensive care unit environment and health-care workers in transmission of ventilator-associated pneumonia

2010 ◽  
Vol 4 (05) ◽  
pp. 282-291 ◽  
Author(s):  
Noyal Mariya Joseph ◽  
Sujatha Sistla ◽  
Tarun Kumar Dutta ◽  
Ashok Shankar Badhe ◽  
Desdemona Rasitha ◽  
...  
Keyword(s):  
Health Care ◽  
Pseudomonas Aeruginosa ◽  
Intensive Care ◽  
Acinetobacter Baumannii ◽  
Health Care Workers ◽  
Ventilator Associated Pneumonia ◽  
Strict Adherence ◽  
Environment And Health ◽  
Care Workers

Background: Pseudomonas aeruginosa and Acinetobacter baumannii have been reported to cause outbreaks of ventilator-associated pneumonia (VAP) in several studies. The high prevalence of these pathogens prompted us to study the different strains of these pathogens prevailing in our intensive care units (ICUs) and determine the role of ICU environment and health-care workers (HCWs) in the transmission of infection. Methodology: A prospective study was performed over a period of 15 months in two ICUs of Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India. Surveillance samples were collected from the HCWs and the ICU environment. Quantitative antibiogram typing and PCR-RFLP were used for comparison of the isolates from the surveillance samples and VAP patients. Results: Pseudomonas aeruginosa and Acinetobacter baumannii were the most common potential VAP pathogens isolated from the surveillance cultures. Eight strains of Pseudomonas aeruginosa were present in our ICUs, but multi-drug resistant (MDR) strain 2 and strain 4 were the most prevalent strains. Six strains of Acinetobacter baumannii were found in our ICUs, of which MDR strain 1 and strain 3 were the most common. The strains of Pseudomonas aeruginosa and Acinetobacter baumannii observed in the VAP patients were also found in the ICU milieu. Only one HCW was found to be the carrier of a Pseudomonas aeruginosa strain present in a VAP patient. Conclusions: The ICU environment was observed to be the potential reservoir for VAP pathogens; therefore, strict adherence to environmental infection control measures is essential to prevent health-care-associated infections.

The adaptation of design thinking in auditing

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Linda MEIJER-WASSENAAR ◽  
Diny VAN EST
Keyword(s):  
The Netherlands ◽  
Design Thinking ◽  
Public Organizations ◽  
Design Framework ◽  
The Right ◽  
The Way

How can a supreme audit institution (SAI) use design thinking in auditing? SAIs audit the way taxpayers’ money is collected and spent. Adding design thinking to their activities is not to be taken lightly. SAIs independently check whether public organizations have done the right things in the right way, but the organizations might not be willing to act upon a SAI’s recommendations. Can you imagine the role of design in audits? In this paper we share our experiences of some design approaches in the work of one SAI: the Netherlands Court of Audit (NCA). Design thinking needs to be adapted (Dorst, 2015a) before it can be used by SAIs such as the NCA in order to reflect their independent, autonomous status. To dive deeper into design thinking, Buchanan’s design framework (2015) and different ways of reasoning (Dorst, 2015b) are used to explore how design thinking can be adapted for audits.

Exercise in intensive care units, safety and hemodynamic monitoring

2020 ◽  
Vol 19 (1) ◽  
pp. 3
Author(s):  
Giulliano Gardenghi
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Hemodynamic Monitoring ◽  
Artificial Respiration ◽  
Exercise Physiology ◽  
Ventilatory Support ◽  
Early Mobilization ◽  
Cycle Ergometer ◽  
Search Terms

Introduction: Patients in the intensive care unit (ICU) have several deleterious effects of immobilization, including weakness acquired in the ICU. Exercise appears as an alternative for early mobilization in these patients. Objective: This work aims to highlight the hemodynamic repercussions and the applicability of exercise in the ICU. Methods: An integrative literature review was carried out, with articles published between 2010 and 2018, in the Lilacs, PubMed and Scielo databases, using the following search terms: exercise, cycle ergometer, intensive care units, early mobilization, mechanical ventilation, artificial respiration. Results: 13 articles were included, addressing hemodynamic monitoring and the role of exercise as early mobilization, with or without ventilatory support. The exercise sessions were feasible and safe within the ICU environment. Conclusion: Physical exercise can be performed safely in an ICU environment, if respecting a series of criteria such as those presented here. It is important that the assistant professional seeks to prescribe interventions based on Exercise Physiology that can positively intervene in the functional prognosis in critically ill patients.Keywords: exercise, intensive care units, patient safety.

Role of Sildenafil in the Treatment of Persistent Pulmonary Hypertension of Newborn (PPHN) - Should it Be Withdrawn from Market of Bangladesh due to Threat of being Misuses

2020 ◽  
Vol 35 (2) ◽  
pp. 100-104
Author(s):  
Maksudur Rahman ◽  
Mohammad Abdullah Al Mamun ◽  
MAK Azad Chowdhury ◽  
Abu Sayeed Munsi
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cardiac Intensive Care Unit ◽  
Cross Sectional ◽  
Cardiac Intensive Care ◽  
Hospital Protocol

Background: Recently it has been apprehended that sildenafil, a drug which has been successfully using in the treatment of PPHN and erectile dysfunction in adult, is going to be withdrawn from the market of Bangladesh due to threat of its misuses. Objective: The aim of this study was to see the extent of uses of sildenafil in the treatment of PPHN and importance of availability of this drugs in the market inspite of its probable misuses. Methods: This cross sectional study was conducted in neonatal intensive care unit (NICU), special baby care unit (SCABU) and cardiac intensive care unit (CICU) of Dhaka Shishu (Children) Hospital from June, 2017 to May 2018. Neonates with PPHN were enrolled in the study. All cases were treated with oral sildenefil for PPHN along with others management according to hospital protocol. Data along with other parameters were collected and analyzed. Results: Total 320 patients with suspected PPHN were admitted during the study period. Among them 92 (29%) cases had PPHN. Male were 49(53 %) cases and female were 43(47%) cases. Mean age at hospital admission was 29.7±13.4 hours. Based on echocardiography,13(14%) cases had mild, 38 (41%) cases moderate and 41(45%) cases severe PPHN. Mean duration of sildenafil therapy was 11.9±7.1 days. Improved from PPHN were 83 (90%) cases. Mortality was 10% (9). Conclusion: In this study it was found that the incidence of PPHN is 29% among the suspected newborns. Sildenafil is successfull in improving the oxygenation of PPHN and to decrease the mortality of neonates. DS (Child) H J 2019; 35(2) : 100-104

Prawne aspekty eutanazji w Holandii

2016 ◽  
Vol 14 (3) ◽  
pp. 243-253
Author(s):  
Grzegorz Stefanowicz
Keyword(s):  
The Netherlands ◽  
Assisted Suicide ◽  
Public Authority ◽  
Dutch Society ◽  
On Demand ◽  
Limited Length ◽  
The Law ◽  
Death On Demand ◽  
The Way

This article undertakes to show the way that has led to the statutory decriminalization of euthanasia-related murder and assisted suicide in the Kingdom of the Netherlands. It presents the evolution of the views held by Dutch society on the euthanasia related practice, in the consequence of which death on demand has become legal after less than thirty years. Due attention is paid to the role of organs of public authority in these changes, with a particular emphasis put on the role of the Dutch Parliament – the States General. Because of scarcity of space and limited length of the article, the change in the attitudes toward euthanasia, which has taken place in the Netherlands, is presented in a synthetic way – from the first discussions on admissibility of a euthanasia-related murder carried out in the 1970s, through the practice of killing patients at their request, which was against the law at that time, but with years began more and more acceptable, up to the statutory decriminalization of euthanasia by the Dutch Parliament, made with the support of the majority of society.

The problem of woman’s emansipation in the feuilleton “Amazonia: a very inept story” by Mykola Chirsky

2020 ◽  
pp. 71-76
Author(s):  
Iryna Rusnak
Keyword(s):  
Scientific Understanding ◽  
The Other ◽  
Literary Studies ◽  
Ethical Guidelines ◽  
Compositional Structure ◽  
Urgent Task ◽  
The Subject ◽  
The One ◽  
Artistic Heritage

The author of the article analyses the problem of the female emancipation in the little-known feuilleton “Amazonia: A Very Inept Story” (1924) by Mykola Chirsky. The author determines the genre affiliation of the work and examines its compositional structure. Three parts are distinguished in the architectonics of associative feuilleton: associative conception; deployment of a “small” topic; conclusion. The author of the article clarifies the role of intertextual elements and the method of constantly switching the tone from serious to comic to reveal the thematic direction of the work. Mykola Chirsky’s interest in the problem of female emancipation is corresponded to the general mood of the era. The subject of ridicule in provocative feuilleton is the woman’s radical metamorphoses, since repulsive manifestations of emancipation becomes commonplace. At the same time, the writer shows respect for the woman, appreciates her femininity, internal and external beauty, personality. He associates the positive in women with the functions of a faithful wife, a caring mother, and a skilled housewife. In feuilleton, the writer does not bypass the problem of the modern man role in a family, but analyses the value and moral and ethical guidelines of his character. The husband’s bad habits receive a caricatured interpretation in the strange behaviour of relatives. On the one hand, the writer does not perceive the extremes brought by female emancipation, and on the other, he mercilessly criticises the male “virtues” of contemporaries far from the standard. The artistic heritage of Mykola Chirsky remains little studied. The urgent task of modern literary studies is the introduction of Mykola Chirsky’s unknown works into the scientific circulation and their thorough scientific understanding.

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