scholarly journals Ethical factors determining ECMO allocation during the COVID-19 pandemic

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Bernadine Dao ◽  
Julian Savulescu ◽  
Jacky Y. Suen ◽  
John F. Fraser ◽  
Dominic J. C. Wilkinson
Keyword(s):  
Online Survey ◽  
Ethical Decision ◽  
International Study ◽  
Decision Procedures ◽  
Ethical Guidelines ◽  
Ethical Debate ◽  
Life Sustaining Treatment ◽  
Guidelines And Recommendations ◽  
Professional Guidance ◽  
Current Guidelines

Abstract Background ECMO is a particularly scarce resource during the COVID-19 pandemic. Its allocation involves ethical considerations that may be different to usual times. There is limited pre-pandemic literature on the ethical factors that ECMO physicians consider during ECMO allocation. During the pandemic, there has been relatively little professional guidance specifically relating to ethics and ECMO allocation; although there has been active ethical debate about allocation of other critical care resources. We report the results of a small international exploratory survey of ECMO clinicians’ views on different patient factors in ECMO decision-making prior to and during the COVID-19 pandemic. We then outline current ethical decision procedures and recommendations for rationing life-sustaining treatment during the COVID-19 pandemic, and examine the extent to which current guidelines for ECMO allocation (and reported practice) adhere to these ethical guidelines and recommendations. Methods An online survey was performed with responses recorded between mid May and mid August 2020. Participants (n = 48) were sourced from the ECMOCard study group—an international group of experts (n = 120) taking part in a prospective international study of ECMO and intensive care for patients during the COVID-19 pandemic. The survey compared the extent to which certain ethical factors involved in ECMO resource allocation were considered prior to and during the pandemic. Results When initiating ECMO during the pandemic, compared to usual times, participants reported giving more ethical weight to the benefit of ECMO to other patients not yet admitted as opposed to those already receiving ECMO, (p < 0.001). If a full unit were referred a good candidate for ECMO, participants were more likely during the pandemic to consider discontinuing ECMO from a current patient with low chance of survival (53% during pandemic vs. 33% prior p = 0.002). If the clinical team recommends that ECMO should cease, but family do not agree, the majority of participants indicated that they would continue treatment, both in usual circumstances (67%) and during the pandemic (56%). Conclusions We found differences during the COVID-19 pandemic in prioritisation of several ethical factors in the context of ECMO allocation. The ethical principles prioritised by survey participants were largely consistent with ECMO allocation guidelines, current ethical decision procedures and recommendations for allocation of life-sustaining treatment during the COVID-19 pandemic.

scholarly journals Management of multiple brain metastases: a patterns of care survey within the German Society for Radiation Oncology

2021 ◽  
Author(s):  
Johannes Kraft ◽  
Michael Mayinger ◽  
Jonas Willmann ◽  
Michelle Brown ◽  
Stephanie Tanadini-Lang ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Radiation Oncology ◽  
Online Survey ◽  
Whole Brain Radiotherapy ◽  
German Society ◽  
Patterns Of Care ◽  
Prognostic Scores ◽  
Mutational Status ◽  
Hippocampal Avoidance ◽  
Current Guidelines

Abstract Purpose The treatment of brain metastases (BM) has changed considerably in recent years and in particular, the management of multiple BM is currently undergoing a paradigm shift and treatment may differ from current guidelines. This survey was designed to analyze the patterns of care in the management of multiple BM. Methods An online survey consisting of 36 questions was distributed to the members of the German Society for Radiation Oncology (DEGRO). Results In total, 193 physicians out of 111 institutions within the German Society for Radiation oncology responded to the survey. Prognostic scores for decision making were not used regularly. Whole brain radiotherapy approaches (WBRT) are the preferred treatment option for patients with multiple BM, although stereotactic radiotherapy treatments are chosen by one third depending on prognostic scores and overall number of BM. Routine hippocampal avoidance (HA) in WBRT is only used by a minority. In multiple BM of driver-mutated non-small cell lung cancer origin up to 30% favor sole TKI therapy as upfront treatment and would defer upfront radiotherapy. Conclusion In multiple BM WBRT without hippocampal avoidance is still the preferred treatment modality of choice regardless of GPA and mutational status, while SRT is only used in patients with good prognosis. Evidence for both, SRS and hippocampal avoidance radiotherapy, is growing albeit the debate over the appropriate treatment in multiple BM is yet not fully clarified. Further prospective assessment of BM management—ideally as randomized trials—is required to align evolving concepts with the proper evidence and to update current guidelines.

scholarly journals COVID-19—Awareness and Practice of Dentists in Saudi Arabia

2021 ◽  
Vol 18 (1) ◽  
pp. 330
Author(s):  
Bassel Tarakji ◽  
Mohammad Zakaria Nassani ◽  
Faisal Mehsen Alali ◽  
Anas B. Alsalhani ◽  
Nasser Raqe Alqhtani ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Infection Control ◽  
Dental Treatment ◽  
Clinical Symptoms ◽  
Dental Clinic ◽  
Health Authorities ◽  
Environmental Surfaces ◽  
Guidelines And Recommendations ◽  
Current Guidelines ◽  
Dental Professionals

Dental professionals have a major role in the fight against the spread and transmission of COVID-19. This study aimed to evaluate awareness and practice of dentists in Saudi Arabia regarding COVID-19 and the utilization of infection control methods. A 24-item questionnaire was developed and distributed through social media to 627 dentists working in Saudi Arabia. 177 questionnaires were completed (28.2% response rate). Most dentists were aware about the transmission, incubation time and main clinical symptoms of COVID-19. Almost 83% of the respondents appreciate the risk of droplets, aerosols and airborne particles in transmission of COVID-19 in the dental clinic. Among the common practices of participants are measuring patient’s body temperature before undertaking a dental treatment (88.7%), cleaning the environmental surfaces at the dental clinic after each patient (91.5%) and restriction of dental treatment to emergency cases (82.5%). It seems that practicing dentists in Saudi Arabia are fairly aware about COVID-19. The practices of the surveyed dentists appear to be mostly consistent with the current guidelines and recommendations for infection control of COVID-19 in the dental clinic. Some drawbacks in knowledge and a number of inappropriate practices can be identified and require the attention of health authorities.

Hindrances to achieve professional confidence: The nurse’s participation in ethical decision-making

2017 ◽  
Vol 26 (3) ◽  
pp. 715-727 ◽  
Author(s):  
Anne Storaker ◽  
Dagfinn Nåden ◽  
Berit Sæteren
Keyword(s):  
Decision Making ◽  
Data Storage ◽  
Ethical Decision ◽  
Ethical Decision Making ◽  
Research Question ◽  
Daily Practice ◽  
Clinical Work ◽  
Ethical Guidelines ◽  
Science Data ◽  
Written Information

Background: Research suggests that nurses generally do not participate in ethical decision-making in accordance with ethical guidelines for nurses. In addition to completing their training, nurses need to reflect on and use ethically grounded arguments and defined ethical values such as patient’s dignity in their clinical work. Objectives: The purpose of this article is to gain a deeper understanding of how nurses deal with ethical decision-making in daily practice. The chosen research question is “How do nurses participate in ethical decision-making for the patient?” Design and method: We use Gadamer’s philosophical hermeneutics as well as Kvale and Brinkmann’s three levels of understanding in interpreting the data material. Nine registered nurses were interviewed. Ethical considerations: The Ombudsman of Norwegian Social Science Data and the head of the hospital approved the investigation. The participants received both oral and written information about the study and they gave their consent. We informed the participants that the participation was voluntary and that they were free to withdraw at any point in the course of the study. The requirement of anonymity and proper data storage was in accordance with the World Medical Association Declaration of Helsinki (1964). The participants were assured that privacy, and confidentiality would be duly protected. Results: Four key themes emerged: (1) confusion in relation to professional and operational expectations of role, (2) ideal somnolence, (3) inadequate argumentation skills, and (4) compound pressure. Conclusion: Ethical ideals appear to be latent in the mindset of the participants; however, the main finding of this investigation is that nurses need to activate the ideals and apply them into practice. Furthermore, management needs to initiate professional reasoning and interdisciplinary discussions leading to common goals for patients.

scholarly journals ACTION-IO as a platform to understand differences in perceptions, attitudes, and behaviors of people with obesity and physicians across countries – the Israeli experience

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Dror Dicker ◽  
Batya Kornboim ◽  
Rakefet Bachrach ◽  
Naim Shehadeh ◽  
Shani Potesman-Yona ◽  
...  
Keyword(s):  
Weight Loss ◽  
Weight Management ◽  
Online Survey ◽  
International Study ◽  
Direct Patient Care ◽  
Link Type ◽  
Full Responsibility ◽  
Medical Need ◽  
Treatment Of Obesity ◽  
Israeli Experience

Abstract Background Obesity is a highly prevalent, complex, and chronic relapsing disease with a considerable unmet medical need. We aimed to identify perceptions, attitudes, behaviors, and barriers to effective obesity treatment among people with obesity (PwO) and physicians in Israel. Methods The ACTION-IO study was an online survey conducted in 11 countries, including Israel. Findings from the Israeli cohort are reported here. Israeli respondents were PwO (body mass index of ≥30 kg/m2 based on self-reported height and weight) and physicians primarily in direct patient care. Results In total, 750 PwO and 169 physicians completed the survey in Israel. Although most PwO (70%) and physicians (95%) perceived obesity as a chronic disease, the majority of PwO assumed full responsibility for their own weight loss (88%) compared with only 19% of physicians who placed the responsibility for weight loss on their patients with obesity. Many PwO (62%) and physicians (73%) agreed that a complete change in lifestyle would be required for PwO to lose weight and felt that treatment of obesity should be a team effort between different healthcare professionals (HCPs; 80 and 90%, respectively). Dietitians were considered by 82% of physicians to be the most effective professionals in helping PwO achieve their weight loss goals. Many PwO (69%) liked that their HCP initiated weight management discussions and 68% of those who had not previously discussed their weight would like their HCP to initiate the conversation. However, among PwO who had discussed their weight with an HCP, 59% considered the discussions to be a little helpful or not at all helpful. The beliefs that patients have little interest in or motivation for losing weight were identified by physicians as the main reasons (71 and 70%, respectively) for not initiating weight management discussions. Conclusions In line with the ACTION-IO international study, our Israeli dataset reveals a need to improve awareness, primarily among physicians, on the physiologic basis and clinical management of obesity, including how to approach weight and weight management discussions during patient consultations. Trial registration Registered at ClinicalTrials.gov, NCT03584191. Data first posted on ClinicalTrials.gov: 12 July 2018 - ‘Retrospectively registered’.

scholarly journals Comfort Discussing HIV Pre-Exposure Prophylaxis with Patients Among Physicians in an Urban Emergency Department

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S439-S439 ◽  
Author(s):  
Brett Tortelli ◽  
Douglas Char ◽  
William Powderly ◽  
Rupa Patel
Keyword(s):  
At Risk ◽  
Emergency Department ◽  
Online Survey ◽  
The United States ◽  
Emergency Physicians ◽  
Primary Care Specialty ◽  
Risk Patients ◽  
Prep Awareness ◽  
Exposure Prophylaxis ◽  
Current Guidelines

Abstract Background HIV pre-exposure prophylaxis (PrEP) is effective but underutilized in the United States. The emergency department offers an opportunity to access at-risk individuals for PrEP referral. While several studies have described provider awareness and acceptance of PrEP, these studies have focused largely on infectious diseases, HIV, and primary care specialty physicians. Thus, PrEP awareness, knowledge, and concerns among emergency physicians remain unknown. We sought to determine provider comfort in discussing PrEP with patients among emergency physicians in Missouri. Methods We conducted an online survey among 88 emergency physicians at Washington University in St. Louis from February 2017 to March 2017 in St. Louis, Missouri. The survey included demographics, comfort discussing PrEP, having ever heard of PrEP (awareness), knowledge of the current CDC prescribing guidelines, concerns with use, and knowing local PrEP referral information. The questions were asked on a Likert scale and dichotomously categorized. We evaluated predictors of physician comfort of discussing PrEP with patients using multiple logistic regression. Results Sixty-seven participants completed the survey; 64.1% were faculty. Most (79.1%) were PrEP aware, however, only 23.9% were knowledgeable of current guidelines and 22.7% of referral information. Concerns included lack of efficacy (53.7%), side effects (89.6%), and the selection for HIV resistance (70.1%). Comfort discussing PrEP was 43.3%. When adjusting for the concern of efficacy, having PrEP knowledge (OR: 5.43; CI: 1.19–30.81) and having referral knowledge (OR: 7.82; CI: 1.93–40.98) were significantly associated with comfort in discussing PrEP. Conclusion We found moderate PrEP awareness among emergency physicians, but also high levels of discomfort in discussing PrEP with their patients. Future provider training should include addressing misinformation surrounding the concerns with PrEP use and prescribing, reviewing current guidelines, and providing local referral resources for PrEP patient care. Emergency department settings can facilitate PrEP awareness and referral to care among at-risk patients to help reduce national HIV incidence. Disclosures All authors: No reported disclosures.

Ethics and Evaluative Consultations with Children in Small to Mid-Sized Australian Non-Government Organisations

2017 ◽  
Vol 17 (1) ◽  
pp. 4-11 ◽  
Author(s):  
Leanne Kelly
Keyword(s):  
Decision Making ◽  
Empirical Research ◽  
Ethical Decision ◽  
Ethical Decision Making ◽  
Program Improvement ◽  
Ethical Guidelines ◽  
Ethical Considerations ◽  
Decision Making Processes ◽  
Children’S Voices

The value of listening to children's voices is well acknowledged. The vast body of literature surrounding this topic discusses children's voices in pedagogy, theory, methodology, and through empirical research. While some of this literature has focused on ethical considerations surrounding evaluative consultations with children in applied practice settings, there is a shortage of literature specifically relevant to small and medium-sized nongovernment organisations (NGOs). These organisations typically conduct consultations on a smaller scale and with fewer resources than their larger counterparts. This paper refers to Australian ethical guidelines using a practice example from a mid-sized NGO to examine ethics in child consultation from a practice-based program improvement perspective. The paper examines whether consultations with children always require formal ethics approval and discusses terminology and considerations surrounding ethical decision making processes.

Should euthanasia and assisted suicide for psychiatric disorders be permitted? A systematic review of reasons

2020 ◽  
Vol 50 (8) ◽  
pp. 1241-1256
Author(s):  
Marie E. Nicolini ◽  
Scott Y. H. Kim ◽  
Madison E. Churchill ◽  
Chris Gastmans
Keyword(s):  
Systematic Review ◽  
Policy Making ◽  
Assisted Suicide ◽  
Qualitative Content Analysis ◽  
Self Determination ◽  
Future Research ◽  
Decisional Capacity ◽  
Goals Of Medicine ◽  
Ethical Debate ◽  
Life Sustaining Treatment

AbstractBackgroundEuthanasia and assisted suicide (EAS) based on a psychiatric disorder (psychiatric EAS) continue to pose ethical and policy challenges, even in countries where the practice has been allowed for years. We conducted a systematic review of reasons, a specific type of review for bioethical questions designed to inform rational policy-making. Our aims were twofold: (1) to systematically identify all published reasons for and against the practice (2) to identify current gaps in the debate and areas for future research.MethodsFollowing the PRISMA guidelines, we performed a search across seven electronic databases to include publications focusing on psychiatric EAS and providing ethical reasons. Reasons were grouped into domains by qualitative content analysis.ResultsWe included 42 articles, most of which were written after 2013. Articles in favor and against were evenly distributed. Articles in favor were mostly full-length pieces written by non-clinicians, with articles against mostly reactive, commentary-type pieces written by clinicians. Reasons were categorized into eight domains: (1) mental and physical illness and suffering (2) decisional capacity (3) irremediability (4) goals of medicine and psychiatry (5) consequences for mental health care (6) psychiatric EAS and suicide (7) self-determination and authenticity (8) psychiatric EAS and refusal of life-sustaining treatment. Parity- (or discrimination-) based reasons were dominant across domains, mostly argued for by non-clinicians, while policy reasons were mostly pointed to by clinicians.ConclusionsThe ethical debate about psychiatric EAS is relatively young, with prominent reasons of parity. More direct engagement is needed to address ethical and policy considerations.

scholarly journals A Survey of UK Centres on Low Iodine Diet Recommendations prior to Radioiodine Ablation Therapy for Differentiated Thyroid Cancer

2019 ◽  
Vol 9 (3) ◽  
pp. 132-138 ◽  
Author(s):  
Clare Yvonne England ◽  
Laura Moss ◽  
Matthew Beasley ◽  
Ingrid Haupt-Schott ◽  
Georgia Herbert ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Working Group ◽  
Online Survey ◽  
Normal Diet ◽  
Ablation Therapy ◽  
Radioiodine Ablation ◽  
Simple Question ◽  
The Uk ◽  
Practice Methods ◽  
Current Guidelines

Background: Guidelines suggest that a low iodine diet (LID) is advised prior to radioiodine ablation (RIA) for thyroid cancer. We aim to describe current practice regarding LID advice in the UK, determine uptake of the 2016 UK LID Working Group diet sheet and discover whether there are differences in practice. Methods: We used an online survey distributed between November 2018 and April 2019 to centres in the UK that administer 131I. We asked questions on whether a LID is advised, for how long, how advice is presented, whether and how compliance is measured and whether treatment is delayed if LID advice is not followed. Results: Fifty-six clinicians from 47 centres that carry out RIA for thyroid cancer responded. Forty-four centres (94%) advise a LID prior to RIA, the majority for 14 days (82%). Two-thirds of the centres use the UK LID Working Group diet sheet. Patients are told to resume normal eating when 131I is administered at 17 centres (39%), with 18 (41%) advising waiting for 24–48 h after administration. Most centres (95%) use only a simple question or do not assess compliance. Only 2 (5%) indicate that RIA would be delayed if someone said they had not followed LID advice. Conclusions: UK practice regarding LID prior to RIA for thyroid cancer is consistent with current guidelines, but non-adherence does not usually delay RIA. The UK Low Iodine Diet Working Group diet sheet is widely recognised and used. Practice could be improved by centres working to harmonise advice on when to restart a normal diet.

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