scholarly journals Occupational Challenges in Physicians with Substance Use Disorder: A Qualitative Study

2021 ◽  
pp. 025371762110205
Author(s):  
Darshan Shadakshari ◽  
Krishna Prasad Muliyala ◽  
Deepak Jayarajan ◽  
Arun Kandasamy
Keyword(s):  
Substance Use ◽  
Work Environment ◽  
Interpersonal Relationships ◽  
Ethical Issues ◽  
Clinical Care ◽  
Tertiary Care ◽  
Addiction Medicine ◽  
Physician Health ◽  
Career Growth ◽  
Depth Interviews

Background: Substance use disorders (SUDs) in physicians impact their professional responsibilities toward patients. Understanding the difficulties of physicians with SUDs would facilitate early identification and reduce the complications they face in various domains, particularly in settings where there are no physician-health care programs. In this background, we aimed to understand the challenges physicians with SUDs face at their workplace. Methods: Qualitative in-depth interviews of 21 physicians receiving treatment from a tertiary care addiction medicine center for their SUD were conducted and, based on the transcripts from the interview after coding and recoding, through inductive content analysis, themes and subthemes were identified. Results: The following occupational challenges were identified: direct consequences of the psychoactive effect of the substance, adverse effects on clinical care and service delivery, impairment in regularity and punctuality, changes in the physicians’ behaviors, changes in the work environment and diverse responses of colleagues and the hospital administration toward substance use-related actions, ethical issues at workplace, and effects on career growth. Conclusions: SUDs in physicians have a significant impact on their functioning at work, affecting patient care, interpersonal relationships as well as career growth. Knowledge of occupational challenges among physicians with SUD will help us in understanding the severity of the problem.

scholarly journals P063: Identification of emergency department patients for referral to rapid-access addiction services: A retrospective chart review

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S86
Author(s):  
J. Hann ◽  
H. Wu ◽  
A. Gauri ◽  
K. Dong ◽  
N. Lam ◽  
...  
Keyword(s):  
Emergency Department ◽  
Substance Use ◽  
Chart Review ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Care Team ◽  
Addiction Medicine ◽  
Multivariable Logistic Regression Model ◽  
Factors Associated ◽  
Extract Information

Introduction: Emergency Department (ED) visits related to substance use are rapidly increasing. Despite this, few Canadian EDs have immediate access to addiction medicine specialists or on-site addiction medicine clinics. This study characterized substance-related ED presentations to an urban tertiary care ED and assessed need for an on-site rapid-access addiction clinic (RAAC). Methods: This prospective enrollment, retrospective chart review was conducted from June to August 2018. Adult patients presenting to the ED with a known or suspected substance use disorder were enrolled by any member of their ED care team using a 1-page form. Retrospective chart review of the index ED visit was conducted and the Emergency Department Information System was used to extract information related to the visit. A multivariable logistic regression model was fit to examine factors associated with recommendation for referral to a hypothetical on-site RAAC.This prospective enrollment, retrospective chart review was conducted from June to August 2018. Adult patients presenting to the ED with a known or suspected substance use disorder were enrolled by any member of their ED care team using a 1-page form. Retrospective chart review of the index ED visit was conducted and the Emergency Department Information System was used to extract information related to the visit. A multivariable logistic regression model was fit to examine factors associated with recommendation for referral to a hypothetical on-site RAAC. Results: Of the 557 enrolment forms received, 458 were included in the analysis. 64% of included patients were male and 36% were female, with a median age of 35.0 years. Polysubstance use was seen in 23% of patients, and alcohol was the most common substance indicated (60%), followed by stimulants (32%) and opioids (16%). The median ED length of stay for included patients was 483 minutes, compared to 354 minutes for all-comers discharged from the ED during the study period. 28% of patients had a previous ED visit within 7 days of the index visit, and an additional 17% had a visit in the preceding 30 days. The ED care team indicated ‘Yes’ for RAAC referral from the ED for 66% of patients, for a mean of 4.3 patients referred per day during the study period. Multivariable analysis showed that all substances (except cannabis) correlated to a statistically significant increase in likelihood for indicating ‘Yes’ for RAAC referral from the ED (alcohol, stimulants, opioids, polysubstance; p < 0.05). Patients presenting to the ED with a chief complaint related to substance use were also more likely to be referred (p = 0.01). Conclusion: This retrospective chart review characterized substance-related presentations at a Canadian urban tertiary care ED. Approximately four patients per day would have been referred to an on-site RAAC had one been available. The RAAC model has been implemented in other Canadian hospitals, and collaborating with these sites to begin developing this service would be an important next step.

scholarly journals Knowledge regarding law and ethics among nurses at a tertiary care hospital in rural India

2018 ◽  
Vol 5 (9) ◽  
pp. 3882
Author(s):  
Thirunavukarasu M. R. ◽  
Velmurugan A.
Keyword(s):  
Ethical Issues ◽  
Clinical Skills ◽  
Clinical Care ◽  
Tertiary Care ◽  
Healthcare Providers ◽  
Healthcare Team ◽  
Care Hospital ◽  
Ethical Practices ◽  
Law And Ethics ◽  
Study Results

Background: Excellence in clinical skills along with a sound knowledge of standard practices related to bioethics and its application in the clinical settings is essential for healthcare providers. Nurses play a pivotal role in the healthcare team, being involved in various aspects like clinical care, research and medical education. It is essential for nurses to be aware of the ethical practices for effective patient care.Methods: It was a hospital-based descriptive study. A pre-tested questionnaire covering socio-demographic information and questions regarding law and ethics was used to collect the information. Nurses with more than one year experience and those who offered voluntary informed consent were included in the study. The study covered 50 staff nurses from both gender.Results: The study showed that majority of the participants (78%) had inadequate knowledge, nearly 7% of them are having moderate knowledge and only 4% are having adequate knowledge regarding law and ethics in Nursing.Conclusions: The study shows the need for increase in awareness regarding ethical issues associated with clinical practice and research among nurses. The study results were used to prepare a booklet on ethics and law for nurses and given to all the participants. Similar studies can be conducted among other members of the health care team (doctors, interns, researchers and trainee nurses) to generalize the results. Group discussions and workshops can be conducted for nurses and other members to promote the need for ethical practices.

Confronting the grey zone after severe brain injury

2019 ◽  
Vol 3 (6) ◽  
pp. 707-711 ◽  
Author(s):  
Andrew Peterson ◽  
Adrian M. Owen
Keyword(s):  
Brain Injury ◽  
Ethical Issues ◽  
Vegetative State ◽  
Clinical Care ◽  
Grey Zone ◽  
Severe Brain Injury ◽  
New Methods ◽  
Legal Decision Making ◽  
Technological Developments ◽  
The Brain

In recent years, rapid technological developments in the field of neuroimaging have provided several new methods for revealing thoughts, actions and intentions based solely on the pattern of activity that is observed in the brain. In specialized centres, these methods are now being employed routinely to assess residual cognition, detect consciousness and even communicate with some behaviorally non-responsive patients who clinically appear to be comatose or in a vegetative state. In this article, we consider some of the ethical issues raised by these developments and the profound implications they have for clinical care, diagnosis, prognosis and medical-legal decision-making after severe brain injury.

scholarly journals Intimate Partner Violence and Structural Violence in the Lives of Incarcerated Women: A Mixed-Method Study in Rural New Mexico

2021 ◽  
Vol 18 (12) ◽  
pp. 6185
Author(s):  
Shilo St. Cyr ◽  
Elise Trott Jaramillo ◽  
Laura Garrison ◽  
Lorraine Halinka Malcoe ◽  
Stephen R. Shamblen ◽  
...  
Keyword(s):  
Intimate Partner Violence ◽  
Substance Use ◽  
New Mexico ◽  
Rural Communities ◽  
Interpersonal Relationships ◽  
Rural Women ◽  
Partner Violence ◽  
Qualitative Interviews ◽  
Incarcerated Women ◽  
Intimate Partner

Intimate partner violence (IPV) is a common feature in the lives of incarcerated women returning to rural communities, enhancing their risk of mental ill-health, substance use, and recidivism. Women’s experiences of IPV intersect with challenges across multiple social–ecological levels, including risky or criminalizing interpersonal relationships, geographic isolation, and persistent gender, racial, and economic inequities. We conducted quantitative surveys and qualitative interviews with 99 incarcerated women in New Mexico who were scheduled to return to micropolitan or non-core areas within 6 months. Quantitative and qualitative data were analyzed separately and then triangulated to identify convergences and divergences in data. The findings underscore how individual and interpersonal experiences of IPV, substance use, and psychological distress intersect with broad social inequities, such as poverty, lack of supportive resources, and reluctance to seek help due to experiences of discrimination. These results point to the need for a more proactive response to the mutually constitutive cycle of IPV, mental distress, incarceration, and structures of violence to improve reentry for women returning to rural communities. Policy and treatment must prioritize socioeconomic marginalization and expand community resources with attention to the needs of rural women of color.

scholarly journals Overuse of Health Care in the Emergency Services in Chile

2021 ◽  
Vol 18 (6) ◽  
pp. 3082
Author(s):  
Ximena Alvial ◽  
Alejandra Rojas ◽  
Raúl Carrasco ◽  
Claudia Durán ◽  
Christian Fernández-Campusano
Keyword(s):  
Public Health ◽  
Emergency Services ◽  
Clinical Care ◽  
Tertiary Care ◽  
Public Health Policies ◽  
The Public ◽  
Healthcare Network ◽  
Use Of Emergency Services ◽  
Low Coverage ◽  
Different Levels

The Public Health Service in Chile consists of different levels of complexity and coverage depending on the severity and degree of specialization of the pathology to be treated. From primary to tertiary care, tertiary care is highly complex and has low coverage. This work focuses on an analysis of the public health system with emphasis on the healthcare network and tertiary care, whose objectives are designed to respond to the needs of each patient. A review of the literature and a field study of the problem of studying the perception of internal and external users is presented. This study intends to be a contribution in the detection of opportunities for the relevant actors and the processes involved through the performance of Triage. The main causes and limitations of the excessive use of emergency services in Chile are analyzed and concrete proposals are generated aiming to benefit clinical care in emergency services. Finally, improvements related to management are proposed and the main aspects are determined to improve decision-making in hospitals, which could be a contribution to public health policies.

scholarly journals Collective Identity Supporting Sustainability Transformations in Ecovillage Communities

2021 ◽  
Vol 13 (15) ◽  
pp. 8148
Author(s):  
Ciska Ulug ◽  
Lummina Horlings ◽  
Elen-Maarja Trell
Keyword(s):  
Interpersonal Relationships ◽  
Collective Identity ◽  
The United States ◽  
Community Life ◽  
Collective Identities ◽  
Ethnographic Data ◽  
Mainstream Society ◽  
Sustainability Principles ◽  
Depth Interviews ◽  
Scholarly Attention

Ecovillages are collective projects that attempt to integrate sustainability principles into daily community life, while also striving to be demonstration projects for mainstream society. As spaces of experimentation, they can provide valuable insights into sustainability transformations. Through shared values and interpersonal connections, ecovillages possess collective identities, which provide a platform for enacting their ideals. However, many ecovillage residents question how to best enhance their role as models, resource centers, and pieces of a greater movement toward sustainability transformations, while simultaneously preserving their unique community and identity. In relation to the above, this paper addresses the questions: What can collective identity in ecovillage communities teach us about the objective and subjective dimensions of sustainability transformations? Furthermore, how can the perspective of collective identity highlight challenges for ecovillages for initiating sustainability transformations? Sustainability transformations encompass objective (behaviors) and subjective (values) dimensions; however, the interactions between these spheres deserve more scholarly attention. Using ethnographic data and in-depth interviews from three ecovillages in the United States, this paper reveals the value in collective identity for underscoring belonging and interpersonal relationships in sustainability transformations. Furthermore, the collective identity perspective exposes paradoxes and frictions between ecovillages and the societal structures and systems they are embedded within.

scholarly journals Canadian Nationwide Survey on Pediatric Malnutrition Management in Tertiary Hospitals

Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2635
Author(s):  
Koen Huysentruyt ◽  
Kim Brunet-Wood ◽  
Robert Bandsma ◽  
Leah Gramlich ◽  
Bonnie Fleming-Carroll ◽  
...  
Keyword(s):  
Health Care Professionals ◽  
Care Pathway ◽  
Clinical Care ◽  
Tertiary Care ◽  
Nationwide Survey ◽  
Nutritional Screening ◽  
Pediatric Hospitals ◽  
Adoption And Implementation ◽  
Clinical Care Pathway

Background: Disease-associated malnutrition (DAM) is common in hospitalized children. This survey aimed to assess current in-hospital practices for clinical care of pediatric DAM in Canada. Methods: An electronic survey was sent to all 15 tertiary pediatric hospitals in Canada and addressed all pillars of malnutrition care: screening, assessment, treatment, monitoring and follow-up. Results: Responses of 120 health care professionals were used from all 15 hospitals; 57.5% were medical doctors (MDs), 26.7% registered dietitians (RDs) and 15.8% nurses (RNs). An overarching protocol for prevention, detection and intervention of pediatric malnutrition was present or “a work in progress”, according to 9.6% of respondents. Routine nutritional screening on admission was sometimes or always performed, according to 58.8%, although the modality differed among hospitals and profession. For children with poor nutritional status, lack of nutritional follow-up after discharge was reported by 48.5%. Conclusions: The presence of a standardized protocol for the clinical assessment and management of DAM is uncommon in pediatric tertiary care hospitals in Canada. Routine nutritional screening upon admission has not been widely adopted. Moreover, ongoing nutritional care of malnourished children after discharge seems cumbersome. These findings call for the adoption and implementation of a uniform clinical care pathway for malnutrition among pediatric hospitals.

Death, taxes and uncertainty: Economic motivations in end-of-life decision making

2021 ◽  
pp. 147775092110114
Author(s):  
George Slade Mellgard ◽  
Jacob M Appel
Keyword(s):  
End Of Life ◽  
Ethical Issues ◽  
Conflicts Of Interest ◽  
Clinical Care ◽  
Third Party ◽  
Ethical Conflicts ◽  
Financial Interests ◽  
End Of Life Decision ◽  
Death Taxes

Economic motivations are key drivers of human behavior. Unfortunately, they are largely overlooked in literature related to medical decisionmaking, particularly with regard to end-of-life care. It is widely understood that the directions of a proxy acting in bad faith can be overridden. But what of cases in which the proxy or surrogate appears to be acting in good faith to effectuate the patient’s values, yet doing so directly serves the decision-maker’s financial interests? Such situations are not uncommon. Many patients care as deeply about economic wellbeing of their families as they do for their own lives and health. This brief work examines three scenarios that raise ethical issues regarding the role of pecuniary motives in making critical medical decisions. Each scenario presents a potential financial conflict of interest between an incapacitated patient and a third-party decision-maker and offers a framework for integrating ethical and legal concerns into clinical care. It is our hope that this work prepares physicians for unexpected ethical conflicts of interest and enables them to further the interests of his or her patients.

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