scholarly journals Ethicists, doctors and triage decisions: who should decide? And on what basis?

2020 ◽  
pp. medethics-2020-106499 ◽  
Author(s):  
Silvia Camporesi ◽  
Maurizio Mori
Keyword(s):  
Critically Ill ◽  
Healthcare Professionals ◽  
Moral Distress ◽  
Clinical Judgments ◽  
National Context ◽  
Level Of Evidence ◽  
Life Saving ◽  
Triage Decisions ◽  
Made In ◽  
Do So

We report here an emerging dispute in Italy concerning triage criteria for critically ill covid-19 patients, and how best to support doctors having to make difficult decisions in a context of insufficient life saving resources. The dispute we present is particularly significant as it juxtaposes two opposite views of who should make triage decisions, and how doctors should best be supported. There are both empirical and normative questions at stake here. The empirical questions pertain to the available level of evidence that healthcare professionals would rather not be left alone with their ‘clinical judgments’ to make triage decisions, and to the accounts of distributive justice that doctors and healthcare professionals rely on, when making triage decisions. The normative questions pertain to how this empirical evidence should inform guidelines on how prioritisation decisions are made in a context of emergency, and who gets to have the authority to do so. This debate goes beyond the discussion of the care of critically ill patients with COVID-19 and has broader implications beyond the national context for the discussion of how to relieve moral distress in contexts of imbalances between healthcare resources and clinical needs of a population.

scholarly journals National health system cuts and triage decisions during the COVID-19 pandemic in Italy and Spain: ethical implications

2021 ◽  
pp. medethics-2020-106898
Author(s):  
Maurizio P Faggioni ◽  
Fermín Jesús González-Melado ◽  
Maria Luisa Di Pietro
Keyword(s):  
Healthcare Professionals ◽  
Moral Distress ◽  
National Health System ◽  
Healthcare Systems ◽  
Respiratory Support ◽  
Protective Measures ◽  
Ethical Implications ◽  
Adequate Care ◽  
Support Treatment ◽  
Triage Decisions

In this paper, we analyse the most important documents establishing the criteria for the treatment and exclusion of COVID-19 patients, especially in regard to the giving of respiratory support, in Italy and Spain. These documents reflect a tension that stems from limited healthcare resources which are insufficient to save lives that, under normal conditions, could have been saved, or at least could have received the best possible treatment. First, we analyse the healthcare systems of these two countries before the spread of the virus, both of which have seen decreases in the number of intensive care beds and have been marked by financial cuts during the last ten years. It is a fact that a greater number of people, especially those over 70 years of age, have been left without respiratory support treatment, and therefore, there have been a greater number of deaths. It is also a fact that there has been a higher infection rate among healthcare professionals due to the delay in the management of protective measures and the inability to provide adequate care for those in nursing homes, as recognised by WHO. In the context of this health emergency, healthcare professionals have suffered a real ‘moral distress’ because, knowing first-hand the causes of the limitation of resources, they have had to put triage protocols into practice. Finally, we set forth a series of concrete ethical proposals with which to face the successive waves of COVID-19 infection, as well as other future pandemics.

scholarly journals Why do patients struggle with their medicines?—A phenomenological hermeneutical study of how patients experience medicines in their everyday lives

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255478
Author(s):  
Joanne M. Fuller ◽  
Emmelie Barenfeld ◽  
Inger Ekman
Keyword(s):  
Everyday Life ◽  
Lived Experience ◽  
Healthcare Professionals ◽  
Daily Routine ◽  
Qualitative Design ◽  
Everyday Lives ◽  
Life Saving ◽  
Patients Experience ◽  
Do So

Why do so many people struggle with their medicines despite decades of research on medicines taking? Research into how people experience medicines in their everyday life remains scarce with the majority of research in this area of focusing on whether or not people take their medicines as prescribed. Hence, this study used a phenomenological hermeneutical qualitative design to gain a deeper understanding of individuals’ perspectives on the lived experience of medicine-taking. Findings from this study highlight five main themes where participants experience medicines as: 1) life-saving and indispensable, 2) normal and a daily routine, 3) confusing and concerning, 4) unsuitable without adjustment, and 5) intrusive and unwelcome. These results can be the basis for mutually agreed prescribing through a co-creative approach that aims at enhancing open and honest dialogues between patients and healthcare professionals in partnership about medicines.

Bioactivity of Marine Natural Product Xyloketals

2020 ◽  
Vol 17 ◽  
Author(s):  
Biswajit Panda ◽  
Amal Kumar Gooyee
Keyword(s):  
Natural Products ◽  
Marine Natural Product ◽  
Ischemic Brain Injury ◽  
Ischemic Brain ◽  
Activity Inhibition ◽  
Life Saving ◽  
Behavior Suppression ◽  
Major Emphasis ◽  
Made In

: Oceans can play a major role in supplying life-saving medicines in the world in future. Although considerable progress has been made in finding new medicines from marine sources, large efforts are still necessary to examine such molecules for clinical applications. Xyloketals are an important group of natural products with various powerful and prominent bioactivities such as inhibition of acetylcholine esterase, antioxidant activity, inhibition of L-calcium channels, radicalscavenging behavior, suppression of cell proliferation, reduction of neonatal hypoxic-ischemic brain injury, etc. This review describes the isolation and structural characterization of all xyloketal natural products giving major emphasis on their bioactivity.

Big Questions in Ecology and Evolution

2009 ◽  
Author(s):  
Thomas N. Sherratt ◽  
David M. Wilkinson
Keyword(s):  
Partial Solution ◽  
Fundamental Importance ◽  
Evolutionary Perspective ◽  
Text Book ◽  
Broad Audience ◽  
The Future ◽  
The Tropics ◽  
Made In ◽  
Do So

Why do we age? Why cooperate? Why do so many species engage in sex? Why do the tropics have so many species? When did humans start to affect world climate? This book provides an introduction to a range of fundamental questions that have taxed evolutionary biologists and ecologists for decades. Some of the phenomena discussed are, on first reflection, simply puzzling to understand from an evolutionary perspective, whilst others have direct implications for the future of the planet. All of the questions posed have at least a partial solution, all have seen exciting breakthroughs in recent years, yet many of the explanations continue to be hotly debated. Big Questions in Ecology and Evolution is a curiosity-driven book, written in an accessible way so as to appeal to a broad audience. It is very deliberately not a formal text book, but something designed to transmit the excitement and breadth of the field by discussing a number of major questions in ecology and evolution and how they have been answered. This is a book aimed at informing and inspiring anybody with an interest in ecology and evolution. It reveals to the reader the immense scope of the field, its fundamental importance, and the exciting breakthroughs that have been made in recent years.

scholarly journals What is common and what is different: recommendations from European scientific societies for triage in the first outbreak of COVID-19

2021 ◽  
pp. medethics-2020-106969
Author(s):  
Joana Teles Sarmento ◽  
Cristina Lírio Pedrosa ◽  
Ana Sofia Carvalho
Keyword(s):  
Public Health ◽  
Healthcare Professionals ◽  
Public Health Emergency ◽  
Fair Allocation ◽  
Ethical Values ◽  
Scientific Societies ◽  
Decision Tools ◽  
Life Saving

A public health emergency, as the COVID-19 pandemic, may lead to shortages of potentially life-saving treatments. In this situation, it is necessary, justifiable and proportionate to have decision tools in place to enable healthcare professionals to triage and prioritise access to those resources. An ethically sound framework should consider the principles of beneficence and fair allocation. Scientific Societies across Europe were concerned with this problem early in the pandemic and published guidelines to support their professionals and institutions. This article aims to compare triage policies from medical bodies across Europe, to characterise the process of triage and the ethical values, principles and theories that were proposed in different countries during the first outbreak of COVID-19.

The Role of Histones and Heparin in Sepsis: A Review

2021 ◽  
pp. 088506662199232
Author(s):  
Xiaojuan Zhang ◽  
Xin Li
Keyword(s):  
Septic Shock ◽  
Multiple Organ ◽  
Clinical Settings ◽  
The Past ◽  
Life Saving ◽  
Extracellular Histones ◽  
Sepsis And Septic Shock ◽  
Development And Management ◽  
Made In

Septic shock with multiple organ failure is a devastating situation in clinical settings. Through the past decades, much progress has been made in the management of sepsis and its underlying pathogenesis, but a highly effective therapeutic has not been developed. Recently, macromolecules such as histones have been targeted in the treatment of sepsis. Histones primarily function as chromosomal organizers to pack DNA and regulate its transcription through epigenetic mechanisms. However, a growing body of research has shown that histone family members can also exert cellular toxicity once they relocate from the nucleus into the extracellular space. Heparin, a commonly used anti-coagulant, has been shown to possess life-saving capabilities for septic patients, but the potential interplay between heparin and extracellular histones has not been investigated. In this review, we summarize the pathogenic roles of extracellular histones and the therapeutic roles of heparin in the development and management of sepsis and septic shock.

Quel corpus pour l’étude du dialecte niçois ?

2021 ◽  
Vol 137 (2) ◽  
pp. 344-361
Author(s):  
Philippe Del Giudice
Keyword(s):  
Middle Ages ◽  
Written Language ◽  
Linguistic Features ◽  
Descriptive Grammar ◽  
Written Production ◽  
Starting Point ◽  
Social Use ◽  
Over Time ◽  
Made In ◽  
Do So

Abstract A new project has just been launched to write a synchronic, descriptive grammar of Niçois, the Occitan dialect of Nice. In this article, I define the corpus of the research. To do so, I first review written production from the Middle Ages to the present. I then analyze the linguistic features of Niçois over time, in order to determine the precise starting point of the current language state. But because of reinforced normativism and the decreasing social use of Niçois among the educated population, written language after WWII became artificial and does not really correspond to recordings made in the field. The corpus will thus be composed of writings from the 1820’s to WWII and recordings from the last few decades.

scholarly journals Tips and Pearls for Tracheostomy during the Covid-19 Pandemic

2021 ◽  
Vol 25 (03) ◽  
pp. e459-e462
Author(s):  
Darwin Kaushal ◽  
Shilpa Goyal ◽  
Nithin Prakasan Nair ◽  
Kapil Soni ◽  
Bikram Choudhury ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Present Article ◽  
Critically Ill ◽  
Current Literature ◽  
Literature Search ◽  
Scientific Evidence ◽  
Early Tracheostomy ◽  
Life Saving ◽  
Number Of Patients ◽  
Elective Tracheostomy

AbstractThe number of critically-ill coronavirus disease 2019 (Covid-19) patients requiring mechanical ventilation is on the rise. Most guidelines suggest keeping the patient intubated and delay elective tracheostomy. Although the current literature does not support early tracheostomy, the number of patients undergoing it is increasing. During the pandemic, it is important that surgeons and anesthesiologists know the different aspects of tracheostomy in terms of indication, procedure, tube care and complications. A literature search was performed to identify different guidelines and available evidence on tracheostomy in Covid-19 patients. The purpose of the present article is to generate an essential scientific evidence for life-saving tracheostomy procedures.

scholarly journals The 1930s Horror Adventure Film on Location in Jamaica: ‘Jungle Gods’, ‘Voodoo Drums’ and ‘Mumbo Jumbo’ in the ‘Secret Places of Paradise Island’

Humanities ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 62
Author(s):  
Emiel Martens
Keyword(s):  
American Literature ◽  
American Empire ◽  
Sound Film ◽  
Mumbo Jumbo ◽  
First Sound ◽  
African Caribbean ◽  
The Caribbean ◽  
Black Populations ◽  
Made In ◽  
Do So

In this article, I consider the representation of African-Caribbean religions in the early horror adventure film from a postcolonial perspective. I do so by zooming in on Ouanga (1935), Obeah (1935), and Devil’s Daughter (1939), three low-budget horror productions filmed on location in Jamaica during the 1930s (and the only films shot on the island throughout that decade). First, I discuss the emergence of depictions of African-Caribbean religious practices of voodoo and obeah in popular Euro-American literature, and show how the zombie figure entered Euro-American empire cinema in the 1930s as a colonial expression of tropical savagery and jungle terror. Then, combining historical newspaper research with content analyses of these films, I present my exploration into the three low-budget horror films in two parts. The first part contains a discussion of Ouanga, the first sound film ever made in Jamaica and allegedly the first zombie film ever shot on location in the Caribbean. In this early horror adventure, which was made in the final year of the U.S. occupation of Haiti, zombies were portrayed as products of evil supernatural powers to be oppressed by colonial rule. In the second part, I review Obeah and The Devil’s Daughter, two horror adventure movies that merely portrayed African-Caribbean religion as primitive superstition. While Obeah was disturbingly set on a tropical island in the South Seas infested by voodoo practices and native cannibals, The Devil’s Daughter was authorized by the British Board of Censors to show black populations in Jamaica and elsewhere in the colonial world that African-Caribbean religions were both fraudulent and dangerous. Taking into account both the production and content of these movies, I show that these 1930s horror adventure films shot on location in Jamaica were rooted in a long colonial tradition of demonizing and terrorizing African-Caribbean religions—a tradition that lasts until today.

scholarly journals Civil Disobedience in Times of Pandemic: Clarifying Rights and Duties

2021 ◽  
Author(s):  
Yoann Della Croce ◽  
Ophelia Nicole-Berva
Keyword(s):  
Working Conditions ◽  
Healthcare Professionals ◽  
Medical Profession ◽  
Civil Disobedience ◽  
Duty Of Care ◽  
Normative Evaluation ◽  
The Law ◽  
Descriptive Sense ◽  
Public Demonstration ◽  
Do So

AbstractThis paper seeks to investigate and assess a particular form of relationship between the State and its citizens in the context of the COVID-19 pandemic, namely that of obedience to the law and its related right of protest through civil disobedience. We do so by conducting an analysis and normative evaluation of two cases of disobedience to the law: (1) healthcare professionals refusing to attend work as a protest against unsafe working conditions, and (2) citizens who use public demonstration and deliberately ignore measures of social distancing as a way of protesting against lockdown. While different in many aspects, both are substantially similar with respect to one element: their respective protesters both rely on unlawful actions in order to bring change to a policy they consider unjust. We question the extent to which healthcare professionals may participate in civil disobedience with respect to the duty of care intrinsic to the medical profession, and the extent to which opponents of lockdown and confinement measures may reasonably engage in protests without endangering the lives and basic rights of non-dissenting citizens. Drawing on a contractualist normative framework, our analysis leads us to conclude that while both cases qualify as civil disobedience in the descriptive sense, only the case of healthcare professionals qualifies as morally justified civil disobedience.

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