scholarly journals Slow motion ethics: Narrative responsibility in clinical care

2021 ◽  
pp. 147775092110572
Author(s):  
Daryl Pullman
Keyword(s):  
Medical Humanities ◽  
Narrative Theory ◽  
Clinical Care ◽  
Slow Motion ◽  
Patient Encounter ◽  
Ethical Implications ◽  
The Past ◽  
Moral Responsibilities ◽  
Physician Patient ◽  
Field Of Inquiry

Narrative theory is a dynamic and evolving field of inquiry that has made tremendous inroads in the medical humanities over the past 40 years. Numerous authors have popularized the idea that “thinking narratively” can produce important insights about the illness experience for physician and patient alike. This paper draws on aspects of narrative theory to emphasize the moral responsibilities that arise when we step into another person's life narrative, becoming a character in her or his story. This has especially significant ethical implications for the physician–patient encounter in that each character in this shared story experiences time somewhat differently. This gives rise to the notion of “slow motion ethics” and a somewhat unique perspective on the moral responsibilities clinicians bear toward their patients.

scholarly journals Predicting Clinical Outcomes Using Molecular Biomarkers

2016 ◽  
Vol 8 ◽  
pp. BIC.S33380 ◽  
Author(s):  
Harry B. Burke
Keyword(s):  
Decision Making ◽  
Clinical Outcomes ◽  
Clinical Decision Making ◽  
Clinical Care ◽  
Clinical Decision ◽  
Molecular Biomarkers ◽  
The Past ◽  
Diagnosis And Prognosis ◽  
Molecular Therapies ◽  
Physician Patient

Over the past 20 years, there has been an exponential increase in the number of biomarkers. At the last count, there were 768,259 papers indexed in PubMed.gov directly related to biomarkers. Although many of these papers claim to report clinically useful molecular biomarkers, embarrassingly few are currently in clinical use. It is suggested that a failure to properly understand, clinically assess, and utilize molecular biomarkers has prevented their widespread adoption in treatment, in comparative benefit analyses, and their integration into individualized patient outcome predictions for clinical decision-making and therapy. A straightforward, general approach to understanding how to predict clinical outcomes using risk, diagnostic, and prognostic molecular biomarkers is presented. In the future, molecular biomarkers will drive advances in risk, diagnosis, and prognosis, they will be the targets of powerful molecular therapies, and they will individualize and optimize therapy. Furthermore, clinical predictions based on molecular biomarkers will be displayed on the clinician's screen during the physician–patient interaction, they will be an integral part of physician–patient-shared decision-making, and they will improve clinical care and patient outcomes.

Holism, Chinese Medicine and Systems Ideologies: Rewriting the Past to Imagine the Future

2018 ◽  
Author(s):  
Volker Scheid
Keyword(s):  
Eighteenth Century ◽  
Chinese Medicine ◽  
Medical Humanities ◽  
Science And Technology Studies ◽  
Human Beings ◽  
The Past ◽  
Starting Point ◽  
The Us ◽  
Shared Objective ◽  
Definition Of

This chapter explores the articulations that have emerged over the last half century between various types of holism, Chinese medicine and systems biology. Given the discipline’s historical attachments to a definition of ‘medicine’ that rather narrowly refers to biomedicine as developed in Europe and the US from the eighteenth century onwards, the medical humanities are not the most obvious starting point for such an inquiry. At the same time, they do offer one advantage over neighbouring disciplines like medical history, anthropology or science and technology studies for someone like myself, a clinician as well as a historian and anthropologist: their strong commitment to the objective of facilitating better medical practice. This promise furthermore links to the wider project of critique, which, in Max Horkheimer’s definition of the term, aims at change and emancipation in order ‘to liberate human beings from the circumstances that enslave them’. If we take the critical medical humanities as explicitly affirming this shared objective and responsibility, extending the discipline’s traditional gaze is not a burden but becomes, in fact, an obligation.

Novel Drugs and Biologics of 2016: A Boom for Neurodrugs in the Pipelin

2017 ◽  
Vol 10 (5) ◽  
pp. 3809-3814
Author(s):  
D Samba Reddy
Keyword(s):  
Muscular Atrophy ◽  
Clinical Care ◽  
New Drugs ◽  
Essential Medicines ◽  
High Demand ◽  
The Past ◽  
Novel Drugs ◽  
Innovative Products ◽  
Cns Drugs ◽  
The U.S

This article provides a brief overview of novel drugs approved by the U.S. FDA in 2016.  It also focuses on the emerging boom in the development of neurodrugs for central nervous system (CNS) disorders. These new drugs are innovative products that often help advance clinical care worldwide, and in 2016, twenty-two such drugs were approved by the FDA. The list includes the first new drug for disorders such as spinal muscular atrophy, Duchenne muscular dystrophy or hallucinations and delusions of Parkinson’s disease, among several others. Notably, nine of twenty-two (40%) were novel CNS drugs, indicating the industry shifting to neurodrugs. Neurodrugs are the top selling pharmaceuticals worldwide, especially in America and Europe. Therapeutic neurodrugs have proven their significance many times in the past few decades, and the CNS drug portfolio represents some of the most valuable agents in the current pipeline. Many neuroproducts are vital or essential medicines in the current therapeutic armamentarium, including dozens of “blockbuster drugs” (drugs with $1 billion sales potential).  These drugs include antidepressants, antimigraine medications, and anti-epilepsy medications. The rise in neurodrugs’ sales is predominantly due to increased diagnoses of CNS conditions. The boom for neuromedicines is evident from the recent rise in investment, production, and introduction of new CNS drugs.  There are many promising neurodrugs still in the pipeline, which are developed based on the validated “mechanism-based” strategy. Overall, disease-modifying neurodrugs that can prevent or cure serious diseases, such as multiple sclerosis, epilepsy, and Alzheimer’s disease, are in high demand. 

INFORMING HISTORICAL RESEARCH IN ACCOUNTING AND MANAGEMENT: TRADITIONS, PHILOSOPHIES, AND OPPORTUNITIES

1997 ◽  
Vol 24 (2) ◽  
pp. 111-149 ◽  
Author(s):  
Lee D. Parker
Keyword(s):  
Historical Research ◽  
Business History ◽  
Historical Knowledge ◽  
The Past ◽  
Field Of Inquiry ◽  
Historical Thought ◽  
The Way

Historical research in accounting and management, hitherto largely neglected as a field of inquiry by many management and accounting researchers, has experienced a resurgence of interest and activity in research conferences and journals over the past decade. The potential lessons of the past for contemporary issues have been rediscovered, but the way forward is littered with antiquarian narratives, methodologically naive analyses, ideologically driven interpretation and ignorance of the traditions, schools and philosophy of the craft by accounting and management researchers as well as traditional and critical historians themselves. This paper offers an introduction to contributions made to the philosophies and methods of history by significant historians in the past, a review of some of the influential schools of historical thought, insights into philosophies of historical knowledge and explanation and a brief introduction to oral and business history. On this basis the case is made for the philosophically and methodologically informed approach to the investigation of our past heritage in accounting and management

It’s Time to Talk to Prehospital Providers: Feedback Disparities among Ground-Based Emergency Medical Services Providers and its Impact on Job Satisfaction

2021 ◽  
pp. 1-9
Author(s):  
Sarayna S. McGuire ◽  
Anuradha Luke ◽  
Aaron B. Klassen ◽  
Lucas A. Myers ◽  
Aidan F. Mullan ◽  
...  
Keyword(s):  
Job Satisfaction ◽  
Patient Care ◽  
Emergency Medical Services ◽  
Performance Feedback ◽  
Life Support ◽  
Clinical Care ◽  
Medical Services ◽  
The Past ◽  
Emergency Medical ◽  
Overall Job Satisfaction

Abstract Objective: Performance feedback on clinical care and patient outcomes is a cornerstone of medical education, yet it remains lacking in the prehospital environment. Research seeking to establish the quantity of feedback provided to Emergency Medical Services (EMS) has been limited and studies focused on complimentary feedback or how feedback relates to EMS job satisfaction are lacking. The objectives of this study were to measure the frequency and nature of feedback received by EMS agencies and to identify the importance of receiving feedback as it relates to EMS job satisfaction. Methods: This was an anonymous, survey-based study of twenty-nine Basic Life Support (BLS) and fifteen Advanced Life Support (ALS) agencies located in Southeastern Minnesota (USA). Descriptive statistics and Fisher exact tests were used. The study was deemed exempt by the Mayo Clinic Institutional Review Board. Results: Ninety-four responses were included from nineteen different EMS agencies, including sixty-one (64.9%) paramedics and thirty-three (35.1%) emergency medical technicians (EMTs). One-half of all respondents reported that they had not received any type of feedback in the past 30 days, while another 43.6% of respondents indicated that they had only received feedback one to three times in the same time period. Twenty (60.6%) EMTs reported receiving no feedback in the past 30 days, compared with twenty-seven (44.3%) paramedics (P = .123). Of respondents receiving feedback, 65.9% reported never or rarely receiving positive reinforcing feedback and 60.6% reported never or rarely receiving constructive criticism or feedback regarding something that did not go well with patient care or transport. The majority of respondents were dissatisfied with the quantity (86.1%) and quality (73.4%) of feedback received. An overwhelming majority (93.6%) indicated that feedback on patient care or outcomes was important in influencing their overall job satisfaction. This high importance was maintained across all demographic groups. Conclusion: Within the cohort of survey respondents, a paucity of feedback received by EMS personnel is a source of dissatisfaction for EMS providers. Feedback on patient care strongly relates to overall job satisfaction. These findings suggest system-wide opportunities for structured feedback processes, focusing upon both quality and quantity of delivered feedback, to improve both patient care and staff satisfaction.

Children’s assent within clinical care: A concept analysis

2020 ◽  
pp. 136749352097630
Author(s):  
Marjorie Montreuil ◽  
Justine Fortin ◽  
Eric Racine
Keyword(s):  
Clinical Care ◽  
Concept Analysis ◽  
Process Of Care ◽  
Deliberative Process ◽  
Ethical Implications ◽  
Rights Of The Child ◽  
Healthcare Decision Making ◽  
Psychological Harm ◽  
Practical Implications ◽  
Made In

Seeking children’s assent has been put forward as a way to foster children’s involvement in the healthcare decision-making process. However, the functions of the concept of assent within clinical care are manifold, and methods used to recognize children’s capacities and promote their involvement in their care remain debated. We performed an instrumentalist concept analysis of assent, with 58 included articles. Final themes were jointly identified through a deliberative process. Two distinct perspectives of assent were predominant: as an affirmative agreement for a specific decision and as part of a continuous, interactive process of care. Differing standards were provided as to how and when to apply the concept of assent. The concept of dissent was largely omitted from conceptions of assent, especially in situations for which children’s refusal would lead to severe health consequences. Ethical implications included fostering autonomy, reducing physical/psychological harm to the child, respecting the child as a human being, and fulfilling the universal rights of the child. There remain important gaps in the theory of assent and its desirable and possible practical implications. Practical standards are largely missing, and evidence supporting the claims made in the literature requires further investigation.

Entrepreneurial Identity: A Review and Research Agenda

2021 ◽  
pp. 104225872110137
Author(s):  
Miruna Radu-Lefebvre ◽  
Vincent Lefebvre ◽  
Eliana Crosina ◽  
Ulla Hytti
Keyword(s):  
Research Agenda ◽  
Integrative Review ◽  
The Past ◽  
Field Of Inquiry

Over the past three decades, research on entrepreneurial identity (EI) has grown particularly rapidly, yet in seemingly disparate directions. To lend structure to this fragmented field of inquiry, our systematic integrative review maps and integrates EI research based on antecedents, content, outcomes as well as their relationships. In so doing, we reveal that the field revolves around two primary conceptualizations of EI as Property or Process. We suggest future avenues for examining the interplay between EI and temporal, socio-cognitive, and spatial contexts, and for investigating and theorizing overlooked mechanisms of reconstructing and losing EI.

Bare Nature

2017 ◽  
Vol 21 (1) ◽  
pp. 4-17 ◽  
Author(s):  
Rob Shields
Keyword(s):  
Direct Costs ◽  
Consumption Patterns ◽  
State Of Exception ◽  
Ethical Challenge ◽  
Natural Ecosystems ◽  
Implicit Relation ◽  
Personal Cost ◽  
Ethical Implications ◽  
The Past ◽  
The Status

This article considers the ethical implications of a stance toward or relation with the natural environment that could be characterized as dominant across many sectors of not only the economy but consumption patterns generally. Despite popular perception or denial of climate change over the past decades, this is an implicit relation toward the collateral risks and damages to ecosystems by human activity. Not only are livelihoods sustained on the basis of natural resources but the direct costs of hydrocarbon development are borne locally in the environment. For some, this is understood to be without a personal cost despite the fears expressed. The article quotes from interviews with residents. It stages a broader, continuing conversation about the ambivalence of being dependent on hydrocarbons. This article explores the difficulty of developing an ethical engagement with the nonhuman and natural ecosystems when they are relegated to the status of what will be referred to as “bare nature.” Rather than state of exception or standing reserve, nonhuman nature is only present as a form of absence and as nonentities and does not present an ethical challenge or claim.

Sex Offenders and Cyproterone Acetate—A Review of Clinical Care

1986 ◽  
Vol 26 (4) ◽  
pp. 279-282 ◽  
Author(s):  
David Torpy ◽  
Arden Tomison
Keyword(s):  
Sex Offenders ◽  
Cyproterone Acetate ◽  
Clinical Care ◽  
The Past

The literature on the use of cyproterone acetate in the treatment of sex offenders is examined. Seven patients who had received this treatment in the past five years are reviewed in the light of these publications.

scholarly journals “Prefer not, eh?”: Re-Scribing the Lives of the Great War Poets in Contemporary British Historical Fiction

2018 ◽  
pp. 125
Author(s):  
María Cristina Pividori
Keyword(s):  
Historical Fiction ◽  
Great War ◽  
Historiographic Metafiction ◽  
Siegfried Sassoon ◽  
Ethical Implications ◽  
The Past ◽  
British Fiction ◽  
Post War ◽  
War Experience ◽  
The Great War

Although the First World War has become history by now, the memory of the war continues to be repeatedly fictionalised: retrospectively inspired narratives are often regarded as more genuine and far-reaching than historical or documentary accounts in their rendition of the past. Yet, memory is creatively selective, reflecting a highly-conflicted process of sifting and discerning what should be remembered, neglected or amplified from the stream of war experience. In his book about Pat Barker, Mark Rawlinson argues that “historical fiction has been transformed in the post-war period by the way writers have exploited the porous and unstable demarcation between fiction and no fiction, stories and history” (14). Jill Dawson’s The Great Lover (2009), Geoff Akers’s Beating for the Light: The Story of Isaac Rosenberg (2006) and Robert Edric’s In Zodiac Light (2008) have not become best sellers like Barker’s Regeneration trilogy; yet, they too represent the predominant commemorative drift in contemporary British fiction about the Great War. Without doubt, these three authors have followed in Barker’s steps in their purpose of holding a mirror to real people and real events in the past and of deciphering the deleted text of ‘the war to end all wars.’ However, while Barker chose to write about the often-anthologised Wilfred Owen and Siegfried Sassoon, Dawson, Akers and Edric base their narratives on the writings, and lives, of Rupert Brooke, Isaac Rosenberg and Ivor Gurney respectively. My discussion of these three novels will explore the various ways in which the past can be accessed and interpreted from the present and represented in fiction. The authors’ decisions as to what historical instances to unravel do not just reveal the relation that contemporary British fiction entertains with the Great War and with history, but also how the past erupts in the present to interrogate it. Taking three salient features of Hutcheon’s “historiographic metafiction” (1988)—intertextuality, parody and paratextuality—as my theoretical points of departure, I will explore the dominant frameworks and cultural conditions (that is the propagation of either patriotic or protest readings) within which the Great War has been narrated in the novels and the new approaches, opportunities and ethical implications of using historical and literary sources to re-scribe a previously non-existent version of the lives of the iconic Great War Poets.

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