Critical-care resource allocation during the coronavirus disease 2019 pandemic in Singapore: A brief narrative review

2020 ◽  
pp. 201010582094743
Author(s):  
Elisha Wan Ying Chia ◽  
Kuang Teck Tay
Keyword(s):  
Health Care ◽  
Resource Allocation ◽  
Critical Care ◽  
Health Care Professionals ◽  
Narrative Review ◽  
Conduct Literature ◽  
Ethical Guidelines ◽  
Scarce Resources ◽  
Literature Searches ◽  
Critical Care Resource

In the midst of the coronavirus disease 2019 (COVID-19) pandemic, where cases continue to increase exponentially every day, it is important to consider the future implications that this may have on the health-care system, the most feared situation being a shortage of critical-care resources, where difficult decisions have to be made about the allocation of scarce resources. In this brief narrative review, we conduct literature searches for COVID-19 ethical guidelines on critical-care resource allocation. Synthesising this information, we evaluate the relevant ethical principles and thereafter provide recommendations contextualised to Singapore. This brief narrative review aims to serve as a useful set of guiding principles for health-care professionals in Singapore, should the need for allocation of scarce resources arise.

Clostridium botulinum and the Clinical Laboratorian: A Detailed Review of Botulism, Including Biological Warfare Ramifications of Botulinum Toxin

2004 ◽  
Vol 128 (6) ◽  
pp. 653-662 ◽  
Author(s):  
James G. Caya ◽  
Rashmi Agni ◽  
Joan E. Miller
Keyword(s):  
Health Care ◽  
Differential Diagnosis ◽  
Health Care Professionals ◽  
Clinical Laboratory ◽  
Therapeutic Approaches ◽  
Data Synthesis ◽  
Literature Searches ◽  
Pertinent Data ◽  
Prompt Diagnosis ◽  
Timely Treatment

Abstract Objective.—This review article is designed to thoroughly familiarize all health care professionals with the history, classification, epidemiology, clinical characteristics, differential diagnosis, diagnostic evaluation (including laboratory-based testing), treatment, and prognosis of botulism. It is especially targeted toward clinical laboratorians and includes a detailed enumeration of the important clinical laboratory contributions to the diagnosis, treatment, and monitoring of patients with botulism. Finally, the bioterrorism potential for botulism is discussed, with an emphasis on the clinical laboratory ramifications of this possibility. Data Sources.—Included medical periodicals and textbooks accessioned from computerized and manual medical literature searches. More than 1000 medical works published from the 1800s through 2003 were retrieved and reviewed in this process. Data Synthesis.—Pertinent data are presented in textual and tabular formats, the latter including 6 tables presenting detailed information regarding the clinical parameters, differential diagnosis, diagnostic studies, laboratory testing, and therapeutic approaches to botulism. Conclusions.—Because botulism is such a rare disease, a keen awareness of its manifestations and prompt diagnosis are absolutely crucial for its successful treatment. The bioterrorism potential of botulism adds further urgency to the need for all health care professionals to be familiar with this disease, its proper evaluation, and timely treatment; the need for such urgency clearly includes the clinical laboratory.

scholarly journals Safeguarding Abuse in Health Care

2018 ◽  
Vol 12 (2) ◽  
pp. 5-10
Author(s):  
Chanda Karki Bhandari ◽  
Gehanath Baral
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Care Facility ◽  
Health Care Facility ◽  
Healthcare Facility ◽  
Structural Level ◽  
Care Providers ◽  
Ethical Guidelines ◽  
Abuse In Health Care

Aims: The aim of the review is to understand the concept of abuse in health care in general and its various forms. It includes- review what is meant by healthcare and health care abuse; identify its various forms and to recognize who may be the most potential victims; find out the reasons of abuse by health care providers; and know the role of  ethical guidelines and institutional policy in confronting abuse in health care.Methods: Literatures and publications on the subject were searched in order to identify research studies investigating abuse in health care that were studied, analyzed and presented.  Results: Abuse in health care today is an emerging concept in need of a clear analysis and definition. At the same time, boundaries to the related concepts are not demarcated. Medical professionals and institutions are being targeted worldwide today for negligence and the medical litigation has become a huge challenge. Throughout history, health care professionals have been trusted because of their competency and caring abilities. However, the disturbing reality is that physical and psychological maltreatment of patients do occur in the health care settings throughout the world. The abuse can vary from treating someone with disrespect in a way which significantly affects the person's quality of life, to causing actual physical suffering. Differently able and dependent people are more susceptible to such abuse. Work overload, Staff burnout, lack of information and instructions were also indicated to underlie instances of abuse in health care.Conclusions: We in the healthcare facility should first accept that abuse in health care does occur and causes distress. This change needs to occur at individual, cultural and structural level. Next step will be for the staffs to be aware of abuse in health care when it happens and recognize it as such. It is always better to create a situation where we could prevent abuse from happening at health centers. Hospital personnel must implement a change in workplace culture to stop abusive behaviors wherever they occur. Each and every health care facility should be client friendly and respecting their rights. Effective ethical guidelines were needed to minimize abuse as existing ethical codes were found to be ineffective and above all there was a lack of awareness of the contents of the relevant ethical documents.

scholarly journals Accountability for Reasonableness, for Priority Setting and Resource Allocation: A Case Scenario

2015 ◽  
Vol 6 (2) ◽  
pp. 23-25 ◽  
Author(s):  
Zoheb Rafique
Keyword(s):  
Health Care ◽  
Resource Allocation ◽  
Developing Country ◽  
Priority Setting ◽  
Case Scenario ◽  
Scarce Resources ◽  
Accountability For Reasonableness

The purpose of this paper is to discuss the accountability for reasonableness and its four conditions. This explains the priority setting and resource allocation for scarce resources. In this article it is discussed that how the scarce resources in a developing country like Pakistan be allocated in health care. This is explained with the help of case scenario.

scholarly journals Health equity and distributive justice considerations in critical care resource allocation

2020 ◽  
Vol 8 (8) ◽  
pp. 758-760 ◽  
Author(s):  
Panagis Galiatsatos ◽  
Allen Kachalia ◽  
Harolyn M E Belcher ◽  
Mark T Hughes ◽  
Jeffrey Kahn ◽  
...  
Keyword(s):  
Resource Allocation ◽  
Critical Care ◽  
Distributive Justice ◽  
Health Equity ◽  
Critical Care Resource

scholarly journals Age Alone is not Adequate to Determine Healthcare Resource Allocation during the COVID-19 Pandemic

2020 ◽  
Vol 23 (1) ◽  
pp. 152-154 ◽  
Author(s):  
Manuel Montero-Odasso ◽  
David B. Hogan ◽  
Robert Lam ◽  
Kenneth Madden ◽  
Christopher MacKnight ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Resource Allocation ◽  
Critical Care ◽  
Critical Care Unit ◽  
Geriatric Medicine ◽  
Well Being ◽  
Health Care Resource ◽  
Clinical Frailty Scale ◽  
Sole Criterion

Background The Canadian Geriatrics Society (CGS) fosters the health and well-being of older Canadians and older adults worldwide. Although severe COVID-19 illness and significant mortality occur across the lifespan, the fatality rate increases with age, especially for people over 65 years of age. The dichotomization of COVID-19 patients by age has been proposed as a way to decide who will receive intensive care admission when critical care unit beds or ventilators are limited. We provide perspectives and evidence why alternatives approaches should be used Methods   Practitioners and researchers in geriatric medicine and gerontology have led in the development of alternative approaches to using chronological age as the sole criterion for allocating medical resources. Evidence and ethical based recommendations are provided. Results Age alone should not drive decisions for health-care resource allocation during the COVID-19 pandemic. Decisions on health-care resource allocation should take into consideration the preferences of the patient and their goals of care, as well as patient factors like the Clinical Frailty Scale score based on their status two weeks before the onset of symptoms. Conclusions Age alone does not accurately capture the variability of functional capacities and physiological reserve seen in older adults. A threshold of 5 or greater on the Clinical Frailty Scale is recommended if this scale is utilized in helping to decide on access to limited health-care resources such as admission to a critical care unit and/or intubation during the COVID-19 pandemic.

scholarly journals Digital Support for Patients Undergoing Bariatric Surgery: Narrative Review of the Roles and Challenges of Online Forums (Preprint)

2019 ◽  
Author(s):  
Anna Robinson ◽  
Andrew K Husband ◽  
Robert D Slight ◽  
Sarah P Slight
Keyword(s):  
Bariatric Surgery ◽  
Health Care ◽  
Weight Loss ◽  
Health Care Professionals ◽  
Well Being ◽  
Narrative Review ◽  
Future Research ◽  
Accurate Information ◽  
Online Forums ◽  
Care Giving

BACKGROUND The internet has become an important medium within health care, giving patients the opportunity to search for information, guidance, and support to manage their health and well-being needs. Online forums and internet-based platforms appear to have changed the way many patients undergoing bariatric surgery view and engage with their health, before and after weight loss surgery. Given that significant health improvements result from sustained weight loss, ensuring patient adherence to recommended preoperative and postoperative guidance is critical for bariatric surgery success. In a patient cohort with high information needs preoperatively, and notoriously high attrition rates postoperatively, online forums may present an underutilized method of support. OBJECTIVE The aim of this study was to conduct a narrative review focusing on the developing roles that online forums can play for patients with bariatric conditions preoperatively and postoperatively. METHODS A literature search was conducted in October-November 2019 across 5 electronic databases: Scopus, EMBASE, PsycINFO, CINAHL, and MEDLINE. Qualitative or mixed methods studies were included if they evaluated patients undergoing bariatric surgery (or bariatric surgery health care professionals) engaging with, using, or analyzing online discussion forums or social media platforms. Using thematic analysis, themes were developed from coding patterns within the data to identify the roles and challenges of online forums for patients undergoing bariatric surgery. RESULTS A total of 8 studies were included in this review, with 5 themes emerging around (1) managing expectations of a <i>new life</i>; (2) decision making and signposting; (3) supporting information seeking; (4) facilitating connectedness: peer-to-peer social and emotional support; and (5) enabling accessibility and connectivity with health care professionals. CONCLUSIONS Online forums could offer one solution to improving postoperative success by supporting and motivating patients. Future research should consider how best to design and moderate online forums for maximal effectiveness and the sharing of accurate information. The surgical multidisciplinary team may consider recommendations of online peer-support networks to complement care for patients throughout their surgical journey.

scholarly journals A best-fit solution: transforming an NHS Library and Knowledge Service in readiness for a new hospital building without a traditional library space

2021 ◽  
Vol 109 (3) ◽  
Author(s):  
Rebecca Jean Scott
Keyword(s):  
Health Care ◽  
Clinical Setting ◽  
Health Care Professionals ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Development Framework ◽  
Literature Searches ◽  
The Hill ◽  
Best Fit ◽  
Knowledge Services

Background: Over a decade ago, the Hill report argued that a shift in vision was required to change the perception of National Health Service (NHS) Library and Knowledge Services (LKS) in England from “book repositories” to essential services that underpin clinical decision-making by patients, carers, and health care professionals. Health Education England’s Knowledge for Healthcare: A Development Framework for Library and Knowledge Services in England 2015–2020 advocates embedding librarians within clinical and management teams in order to provide access to high-quality evidence at the point of need.Case presentation: In April 2019, Royal Papworth Hospital relocated twelve miles from its historic village location in Papworth Everard to its new state-of-the-art hospital on the Cambridge Biomedical Campus. The design for this new hospital did not accommodate a traditional library space and therefore necessitated a transformation of the LKS. The organization opted to embed the LKS staff into the clinical setting and relegate 80% of the print collection to off-site storage. This project and its associated steps are presented as an example of health care library transformation.Conclusion: Embedding the LKS team in the clinical setting, engaging in proactive outreach activity, and improving our marketing led to a 44% increase in literature searches requested compared to the same eleven-month period in the previous year. A 40% decrease in our print book loans indicates additional barriers to using a click-and-collect service and the need for greater investment in our e-book provision. However, early outcomes for our best-fit service transformation are positive. Having an open, dual mindset has enabled the service to embrace change and maximize emerging opportunities to collaborate with clinical staff on new projects.

scholarly journals Az igazságosság és a besorolás etikai problémái az egészségügyben, különös tekintettel a COVID–19-járvány olaszországi tapasztalataira

2020 ◽  
Vol 161 (45) ◽  
pp. 1899-1907
Author(s):  
Orsolya Márta Péter
Keyword(s):  
Health Care ◽  
Intensive Care ◽  
Life Expectancy ◽  
Health Care Professionals ◽  
Scarce Resources ◽  
Probability Of Survival ◽  
Sensitive Issue ◽  
Life Saving ◽  
Heated Debate ◽  
Utilitarian Approach

Összefoglaló. A 2020. év elején kirobbant COVID–19-világjárvány többek között ráirányította a figyelmet az életmentő-életfenntartó kezelések igazságos elosztásának érzékeny kérdésére is. Európán belül elsőként Olaszországot sújtotta a katasztrófa, a válsághelyzetben pedig az érzéstelenítés, fájdalomcsillapítás, újraélesztés és intenzív ellátás területén tevékenykedő szakemberek olasz társasága, a SIAARTI 2020. március 6-án közzétett egy 15 pontos ajánlást. E szerint utilitarista megközelítéssel a rendelkezésre álló szűkös erőforrásokat azon betegek kezelésére kellene fordítani, akik túlélési esélye nagyobb, valamint több életévre számíthatnak a jövőben, mert ez biztosíthatja a lehető legtöbb ember számára a lehető legnagyobb hasznot. A javaslat komoly szakmai vitát robbantott ki, amely egyértelművé tette, hogy az orvosi eszközök igazságos elosztására vonatkozó diskurzust feltétlenül folytatni kell, nemcsak Olaszországon belül, hanem a pandémiától sújtott többi államban is. Orv Hetil. 2020; 161(45): 1899–1907. Summary. Among other queries, the explosion of the COVID-19 pandemic at the beginning of 2020 has firmly put in focus the sensitive issue of how to allocate scarcely available life-saving treatments in a fair and just manner. The first European country to face an emergency caused by the pandemic was Italy. In a rapidly escalating crisis, on 6th March 2020, the Italian Society of Anaesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI) issued a series of 15 recommendations, suggesting that a utilitarian approach should be adopted in Italian health care and the extremely scarce resources should be reserved for patients with a greater probability of survival and life expectancy, in order to maximize the benefits for the largest possible number of people. The recommendations generated a heated debate among health care professionals, thereby evidencing that similar discussions must be initiated and pursued in all countries affected by the pandemic. Orv Hetil. 2020; 161(45): 1899–1907.

Sign in / Sign up

Export Citation Format

Share Document