scholarly journals Compulsory medical intervention versus external constraint in pandemic control

2020 ◽  
pp. medethics-2020-106435
Author(s):  
Thomas Douglas ◽  
Lisa Forsberg ◽  
Jonathan Pugh
Keyword(s):  
Medical Intervention ◽  
Compulsory Treatment ◽  
Ethical Argument ◽  
Medical Interventions ◽  
External Constraints ◽  
External Constraint ◽  
Legal Barriers

Would compulsory treatment or vaccination for COVID-19 be justified? In England, there would be significant legal barriers to it. However, we offer a conditional ethical argument in favour of allowing compulsory treatment and vaccination, drawing on an ethical comparison with external constraints—such as quarantine, isolation and ‘lockdown’—that have already been authorised to control the pandemic in this jurisdiction. We argue that, if the permissive English approach to external constraints for COVID-19 has been justified, then there is a case for a similarly permissive approach to compulsory medical interventions.

scholarly journals Nursing Teleconsultation for the Outpatient Management of Patients with Cardiovascular Disease during COVID-19 Pandemic

2021 ◽  
Vol 18 (4) ◽  
pp. 2087
Author(s):  
Vincenzo Russo ◽  
Roberta Cassini ◽  
Valentina Caso ◽  
Chiara Donno ◽  
Annunziata Laezza ◽  
...  
Keyword(s):  
Cardiovascular Diseases ◽  
Continuity Of Care ◽  
Medical Intervention ◽  
Lipid Lowering ◽  
Outpatient Management ◽  
Medical Interventions ◽  
Artery Disease ◽  
Clinical Conditions ◽  
Mean Time

Introduction: During the COVID-19 outbreak, non-urgent clinic visits or cardiac interventional procedures were postponed to a later date, and the implementation of telemedicine has guaranteed continuity of care for patients with chronic diseases. The aim of our study was to describe the medical interventions following nursing teleconsultation for the outpatient management of patients with cardiovascular diseases during the COVID-19 pandemic. Materials and Methods: All patients who did not attend the follow-up visit from 4 to 15 April 2020 at our institution and who were re-scheduled due to the COVID-19 lockdown were selected to be enrolled in the study. Each patient was followed by a semi-structured telephonic interview performed by a nurse. The outcomes of our study were to assess the patients’ adherence to nursing teleconsultation and the usefulness of nursing teleconsultation to detect clinical conditions in need of medical intervention. Results: In total, 203 patients (81%) underwent nursing teleconsultation in a mean time of 7 ± 3 days from the outpatient visit lost due to the COVID-19 lockdown. Furthermore, 53 patients (26%) showed poor adherence to nursing teleconsultation. Among the 150 patients (mean age 67 ± 10 years; 68% male) who completed the telephonic interview, the nursing teleconsultation revealed the need of medical intervention in 69 patients (46%), who were more likely at very high cardiovascular risk (77% vs. 48%; p < 0.0003) and who showed a higher prevalence of dyslipidemia (97% vs. 64%; p < 0.0001) and coronary artery disease (75% vs. 48%, p < 0.0008) compared to those not in need of any intervention. The up-titration of the lipid-lowering drugs (n: 32, 74%) was the most frequent medical intervention following the nursing teleconsultation. The mean time between the nursing teleconsultation and the date of the rescheduled in-person follow-up visit was 164 ± 36 days. Conclusions: Nursing teleconsultation is a simple and well-tolerated strategy that ensures the continuity of care and outpatient management for patients with cardiovascular diseases during the COVID-19 pandemic.

scholarly journals Effects of an individualized analgesia protocol on the need for medical interventions after adenotonsillectomy in children: a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jian Guo ◽  
Peijun Zhuang ◽  
Kun Liu ◽  
Yuanyuan Wan ◽  
Xuan Wang
Keyword(s):  
Median Duration ◽  
Controlled Trial ◽  
Pain Scale ◽  
Medical Intervention ◽  
Secondary Outcome ◽  
Sleep Study ◽  
Medical Interventions ◽  
Randomized Controlled ◽  
Obstructive Sleep ◽  
Blinded Trial

Abstract Background It has been proposed that the dose of rescue opioids should be individually titrated to the severity of obstructive sleep apnea after adenotonsillectomy. However, a sleep study is not always available before adenotonsillectomy. This randomized, controlled and blinded trial evaluated a strategy of pain control individualized to the results of a fentanyl test, rather than the results of polysomnography, in children after adenotonsillectomy. Methods A total of 280 children (3–10 years old) undergoing elective adenotonsillectomy were randomized into an individualized protocol (IP) group or a conservative protocol (CP) group. All patients received a fentanyl test before extubation. Pain was assessed every 10 min in the recovery room, and rescue morphine was given when the Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS) score was > 6. In the IP group, the dose of rescue morphine was individualized to the results of the fentanyl test (10 μg/kg in the case of a positive result and 50 μg/kg in the case of a negative result). In the CP group, the dose was fixed (25 μg/kg). The primary outcome was the percentage of patients requiring at least one medical intervention. The secondary outcome was the median duration of CHEOPS scores > 6. Results Fewer patients in the IP group than in the CP group required medical interventions [11.9% (16/134) vs 22.3% (29/130), P = 0.025]. The median duration of CHEOPS scores > 6 was shorter in the IP group than in the CP group [20 (95% CI: 17 to 23) min vs 30 (95% CI: 28 to 32) min, P <  0.001]. Conclusions Compared with a conservative dosing approach, this individualized protocol may improve analgesia without a significant increase in respiratory adverse events. Trial registration ClinicalTrials.gov NCT02990910, registered on 13/12/2016.

The Keloid Intervention Benefit Inventory 21: A New Assessment Tool for the Quality of Life of Patients with Auricular Keloids

2021 ◽  
Author(s):  
Daniel Häussler ◽  
Stefanie Hüttemann ◽  
Christel Weiß ◽  
Nicole Karoline Rotter ◽  
Haneen Sadick
Keyword(s):  
Quality Of Life ◽  
Internal Consistency ◽  
Social Impact ◽  
Assessment Tool ◽  
Clinical Symptoms ◽  
Physical Symptoms ◽  
Medical Intervention ◽  
Medical Interventions ◽  
Before And After

Abstract Purpose The assessment of the quality of life (QoL) of patients with chronic diseases before and after medical interventions has gained increasing importance in recent decades. Particularly for patients with visible keloid scars in the head and neck region, standardized measurement tools are either absent or have been shown to be insufficient. The aim of the present study was to create a new standardized questionnaire that is specific to auricular keloid patients and reflects their clinical symptoms and QoL. Methods The Keloid Intervention Benefit Inventory 21 (KIBI-21) questionnaire was developed in two stages. First, a group of experts identified a pool of 26 questions and modified and supplemented the items through a comparison with existing QoL assessments so that they related to keloid-specific clinical symptoms and the QoL of patients with auricular keloids before and after a medical intervention. This questionnaire was distributed to 27 outpatients who had undergone medical interventions for visible auricular keloids. Second, a sequential statistical analysis was conducted. This included a single-item assessment and reduction, analysis for internal consistency, construct validity, and divergence validity as well as a factor analysis. The analyses were performed for the entire questionnaire and for the items in the subcategories General Health, Physical Symptoms, Self-Esteem, and Social Impact. Results The final version of this newly validated and standardized KIBI questionnaire consisted of 21 items, of which each item was assigned to only one subscale. The questionnaire showed a Cronbach's α of 0.84 with a good internal consistency. In the item correlation validity, strong associations were found in all subscales, except for the Social Impact Subscale. Conclusion The keloid-specific QoL questionnaire KIBI-21 proved to be a reliable and reproducible instrument to assess the QoL and clinical symptoms in patients suffering from auricular keloids before and after a medical treatment.

scholarly journals Can evolutionary thinking shed light on gender diversity?

2019 ◽  
Vol 25 (6) ◽  
pp. 351-362 ◽  
Author(s):  
Bernadette Wren ◽  
John Launer ◽  
Michael J. Reiss ◽  
Annie Swanepoel ◽  
Graham Music
Keyword(s):  
Gender Identity ◽  
Gender Diversity ◽  
Medical Intervention ◽  
List Type ◽  
Sex And Gender ◽  
Medical Interventions ◽  
The Core ◽  
Causal Pathways ◽  
And Gender ◽  
Shed Light

SUMMARYIssues of sexual reproduction lie at the core of evolutionary thinking, which often places an emphasis on how individuals attempt to maximise the number of successful offspring that they can produce. At first sight, it may therefore appear that individuals who opt for gender-affirming medical interventions are acting in ways that are evolutionarily disadvantageous. However, there are persuasive hypotheses that might make sense of such choices in evolutionary terms and we explore these here. It is premature to claim knowledge of the extent to which evolutionary arguments can usefully be applied to issues of gender identity, although worth reflecting on the extent to which nature tends towards diversity in matters of sex and gender. The importance of acknowledging and respecting different views in this domain, as well as recognising both the uncertainty and likely multiplicity of causal pathways, has implications for clinicians. We make some suggestions about how clinicians might best respond when faced with requests from patients in this area.LEARNING OBJECTIVESAfter reading this article you will be able to:•understand evolutionary arguments about diversity in human gender identity•identify strengths and weaknesses in evolutionary arguments applied to transgender issues•appreciate the range and diversity of gender experience and gender expression among people who present to specialist gender services, as well as the likely complexities of their reasons for requesting medical intervention.

THE PATIENT’S WILL TO MEDICAL INTERVENTION – PRO FUTURO STATEMENT

2018 ◽  
Vol 1 (XVIII) ◽  
pp. 291-299
Author(s):  
Edyta Przybyłek ◽  
Anna Rej-Kietla ◽  
Sandra Kryska ◽  
Dariusz Zawadzki
Keyword(s):  
Medical Intervention ◽  
Special Importance ◽  
Medical Interventions ◽  
The Future ◽  
The Subject ◽  
Patient’S Will

A patient’s will statement is a document of special importance. In accordance with the provision included in the pro futuro statement, the patient declares that in certain situations in the future he does not want any or specific medical interventions to be taken against him.The purpose of this article is to present the subject of the pro futuro statement with the indication of the problems related to the use of this statement. The issue of a patient’s will statement regarding medical intervention will be analyzed based on available Polish and international legislation related to this issue and the analysis of specialized literature in this area.

Involuntary medical intervention: experience of judicial authorization

2020 ◽  
pp. 241-249
Author(s):  
Nataliya Buraschnickova
Keyword(s):  
Infectious Diseases ◽  
Health Care Professionals ◽  
Legal Regulation ◽  
Medical Intervention ◽  
Medical Interventions ◽  
Judicial Control ◽  
Intervention Measures ◽  
Preventive Vaccination ◽  
The Russian Federation ◽  
Judicial Procedure

We analyze the features of the legal regulation of the issues of providing medical care in an involuntary manner in connection with infectious diseases that pose a danger to society. We formulate the grounds for compulsory application of medical interventions to people with or suspected of having COVID-19. We substantiate the need for involuntary use of various types of medical intervention in situations of mass spread of dangerous infectious diseases. We propose a mechanism for compulsory implementation of medical intervention measures, which involves mandatory judicial control over the legality, necessity and proportionality of their application. It is sub-stantiated that in an epidemic or pandemic, all medical interventions that are authorized to use by health care professionals should be supported by an en-forcement mechanism. In addition, we assume that the court can authorize not only compulsory hospitalization, which is currently explicitly specified in the legislation, but also compulsory medical examination (inspection), re-strictive quarantine measures (isolation), preventive vaccination in a situation of infectious diseases mass spread. We justify the possible allocation of a single section in the Code of Administrative Judicial Procedure of the Russian Federation on judicial control over various types of involuntary medical intervention.

Medical Liability and Liability of Health Institutions in Turkish Law

2007 ◽  
Vol 14 (4) ◽  
pp. 355-367 ◽  
Author(s):  
Ergun Özsunay
Keyword(s):  
Informed Consent ◽  
Medical Treatment ◽  
Administrative Law ◽  
Medical Intervention ◽  
Professional Standards ◽  
Medical Liability ◽  
Private Hospitals ◽  
Medical Interventions ◽  
Malpractice Liability ◽  
Health Institutions

AbstractThis article deals with medical liability of doctors and health institutions under Turkish law. Medical liability is based usually on a medical treatment agreement. This agreement is qualified as "mandate" (Auftrag). Under this agreement doctors are obliged to carry out medical intervention and treatment in accordance with professional standards. Informed consent is a prerequisite for all medical interventions. Treatment without patient's informed consent is a ground of liability. As regards treatment in hospitals medical treatment agreement is concluded between patient and hospital management. Doctors and other health care personnel employed by private hospitals are auxiliaries in medical treatment. Liability for treatment in State or municipality hospitals is based on administrative law. In case of malpractice, liability of physicians and health institutions covers all bodily injuries and material damages as well as immaterial damages. A draft law on liability for malpractice in medical services is being discussed by relevant circles in Turkey.

scholarly journals Violence risk assessment as a medical intervention: ethical tensions

2014 ◽  
Vol 38 (2) ◽  
pp. 75-82 ◽  
Author(s):  
Ashimesh Roychowdhury ◽  
Gwen Adshead
Keyword(s):  
Risk Assessment ◽  
Medical Ethics ◽  
Ethical Theory ◽  
Medical Intervention ◽  
Assessment Process ◽  
Violence Risk ◽  
Risk Assessment Process ◽  
Medical Interventions ◽  
Future Direction ◽  
Professional Judgement

SummaryRisk assessment differs from other medical interventions in that the welfare of the patient is not the immediate object of the intervention. However, improving the risk assessment process may reduce the chance of risk assessment itself being unjust. We explore the ethical arguments in relation to risk assessment as a medical intervention, drawing analogies, where applicable, with ethical arguments raised by general medical investigations. The article concludes by supporting the structured professional judgement approach as a method of risk assessment that is most consistent with the respect for principles of medical ethics. Recommendations are made for the future direction of risk assessment indicated by ethical theory.

Neonatal morbidities and need for intervention in twins and singletons born at 34–35 weeks of gestation

2016 ◽  
Vol 44 (8) ◽  
Author(s):  
Michal J. Simchen ◽  
Avital L. Okrent Smolar ◽  
Mordechai Dulitzky ◽  
Eyal Sivan ◽  
Iris Morag
Keyword(s):  
Medical Center ◽  
Significant Proportion ◽  
Preterm Births ◽  
Medical Intervention ◽  
Late Preterm ◽  
Short Term ◽  
Maternal Characteristics ◽  
Medical Interventions ◽  
Antenatal Steroids ◽  
To Receive

AbstractObjective:To compare indications for delivery and neonatal morbidities between twins and singletons born between 34 and 35 weeks of gestation.Study design:A prospective observational study was performed in which all infants born between January and August 2008, at Sheba Medical Center at 34 0/7–35 6/7 weeks of gestational age were included. Indications for delivery, infants’ morbidities and medical interventions were documented. Twins and singletons were compared for antenatal maternal characteristics, risks of short-term neonatal complications and interventions.Results:One hundred and seventy-three mothers and 229 neonates (114 twins and 115 singletons) were included. Background maternal characteristics as well as the use of antenatal steroids and MgSO4 were similar between the groups. Only 44% of all deliveries were spontaneous, while the rest were indicated deliveries. Twins were born lighter and 31.9% of them were SGA. Nevertheless, singletons were significantly more likely to receive medical interventions such as prolonged oxygen use (>1 day) and phototherapy. All late preterm infants (n=5) needing surfactant administration were singletons. Overall, the risk of needing any medical intervention was significantly higher for singletons compared with twins (OR 1.8, 95% CI 1.02–3.2).Conclusions:A significant proportion of late preterm births is iatrogenic. Twins and singletons are dissimilar with regards to risks of short-term complications. Despite being born smaller and more SGA, twins are at lower risk of requiring medical intervention in the immediate neonatal period compared with singletons.

scholarly journals Air Medical Interventions at Comatose Pediatric Patients in Eastern Romania - Particularities of Airway Managementand Cardio-Pulmonary Resuscitation

2020 ◽  
Vol 71 (2) ◽  
pp. 371-380
Author(s):  
Angel Liviu Trifan ◽  
Liliana Dragomir ◽  
Eva-Maria Elkan ◽  
Violeta Sapira ◽  
Mihaela Lungu ◽  
...  
Keyword(s):  
Randomized Study ◽  
Helicopter Emergency Medical Service ◽  
Medical Intervention ◽  
Medical Systems ◽  
Medical Interventions ◽  
Secondary Interventions ◽  
Cardio Pulmonary Resuscitation ◽  
Emergency Interventions ◽  
Long Term Prognosis ◽  
Epidemiological Characteristics

Pediatric comas are particular situations of terrestrial or aerial medical intervention, requiring knowledge of specific protocols and prioritization and hierarchy of emergency interventions. The reactivity of the comatose child is modified according to multiple biological, physiological parameters and generating pathologies. The study aims to analyze the specific elements of aerial medical interventions with helicopter, HEMS (Helicopter Emergency Medical Service) at comatose child that influences the emergency path, but especially the medium and long term prognosis of these cases. The transfer of comatose children at Galati aeromedical base, both primary and secondary interventions, were studied. The study was a prospective randomized study involving pediatric comas transferred over a 4-year course (2014-2017) according to the criteria in force. A total of 24 children between the ages of 0-18 years were transferred, with primary and secondary interventions. In the study lot, the correlations between Glasgow scores and associated pathology, epidemiological characteristics, therapeutic elements, complications and case evolution were analyzed. A profile of the patient requiring emergency intervention for the comatose state was created, making it possible to predict the services they will need and to design the specialized interventions that will follow the transfer of these patients. Although still intensely disputed due to cost considerations, the air transfer of the comatose child facilitates a more prompt response of medical systems to manage this type of emergency and presents management particularities in pre-hospital. Based on this type of results, a strategy takes shape by which the Romanian emergency system aligns with the continuous improvement of life-saving interventions for children.

Sign in / Sign up

Export Citation Format

Share Document