Empathy and structural injustice in the assessment of patient noncompliance

Bioethics ◽  
2021 ◽  
Author(s):  
Yolonda Wilson
1990 ◽  
Vol 29 (03) ◽  
pp. 243-246 ◽  
Author(s):  
M. A. A. Moussa

AbstractVarious approaches are considered for adjustment of clinical trial size for patient noncompliance. Such approaches either model the effect of noncompliance through comparison of two survival distributions or two simple proportions. Models that allow for variation of noncompliance and event rates between time intervals are also considered. The approach that models the noncompliance adjustment on the basis of survival functions is conservative and hence requires larger sample size. The model to be selected for noncompliance adjustment depends upon available estimates of noncompliance and event rate patterns.


2021 ◽  
pp. 1-20
Author(s):  
Annette Zimmermann ◽  
Chad Lee-Stronach

Abstract It is becoming more common that the decision-makers in private and public institutions are predictive algorithmic systems, not humans. This article argues that relying on algorithmic systems is procedurally unjust in contexts involving background conditions of structural injustice. Under such nonideal conditions, algorithmic systems, if left to their own devices, cannot meet a necessary condition of procedural justice, because they fail to provide a sufficiently nuanced model of which cases count as relevantly similar. Resolving this problem requires deliberative capacities uniquely available to human agents. After exploring the limitations of existing formal algorithmic fairness strategies, the article argues that procedural justice requires that human agents relying wholly or in part on algorithmic systems proceed with caution: by avoiding doxastic negligence about algorithmic outputs, by exercising deliberative capacities when making similarity judgments, and by suspending belief and gathering additional information in light of higher-order uncertainty.


2000 ◽  
Vol 90 (5) ◽  
pp. 240-246 ◽  
Author(s):  
AE Burns

Use of cannulated bone screws, as compared with use of traditional bone screws, has been reported to decrease surgical time, allow for more precise screw placement, and reduce sources of error. Cannulation of the smaller-size screws that are routinely used in foot surgery has not been available until the last few years. This article reports on the use of the small cannulated screws manufactured by Alphatec Manufacturing, Inc (Palm Desert, California). The screw sizes available in the Mini Lag Screw System are 2.7, 3.5, and 4.0 mm. A long-term clinical and radiographic prospective evaluation of 70 procedures performed on 49 patients was conducted. The follow-up time for all patients was 2 years. None of the 70 implants fractured, and seven procedures (in seven patients) resulted in some type of implant-fixation failure. All of the fixation failures, however, appeared to be related to an untoward event or patient noncompliance. These smaller cannulated screws proved to be a reliable and effective means of fixation in foot surgery.


1971 ◽  
Vol 20 (6) ◽  
pp. 509???515 ◽  
Author(s):  
Pauline Vincent

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Abdulla Al-Sayyari

Abstract Background and Aims Many patients start HD with central venous catheter (CVC) which has multiple complications This study aims at identifying the physicians’ perspectives regarding the reasons of delayed AVF creation Method This is a cross-sectional questionnaires-based survey designed at discovering the physicians' opinions and perception about the reasons for the delay in the creation of permanent vascular access and patient’s factors, physicians factors, and hospital factors leading to this delay, Results There was a total of 212 participants, of whom 131 (61.8%) were of consultant level. The three most important factors associated with delay in AVF creation were “denial of kidney disease or the need of AVF” (76.4%), “dialysis fears and practical concern” (75.9%) and “the patient refusing to undergo AVF surgery” (73.1%). Significantly fewer consultants (42.7%) than below consultants (45.7%) pointed out that “patient noncompliance with nephrology appointments” was a significant factor (p=0.046). The most important physicians & hospital factors was “insufficient conduction of pre-dialysis care and education about AVF initiation to the patient (63.7%) The respondents were asked to choose one of four possible factors that they felt was the main factor in delaying AVF creation. Over two thirds (68.4%) chose the patient factor as the main factor There was no significant difference in this response whether the respondents were consultants or below consultants (p=0.8)) Conclusion The most agreed on factors associated with AVF creation delay are the denial of the need for dialysis, fear of dialysis and practical concern, insufficient conduction of pre-dialysis care and education about AVF initiation to the patient, and late referral to a nephrologist. a validated approach to patients' selection and referral to vascular access creation that could be applied on different types of patient in different regions is required .


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