Challenges to professionalism and ethics in perioperative clinical practice

2021 ◽  
pp. 1-7
Author(s):  
Bid Kumar
Keyword(s):  
Clinical Practice ◽  
Patient Care ◽  
Perioperative Medicine ◽  
Ethical Practice ◽  
Long Term Outcomes ◽  
End Points ◽  
Workplace Conflicts ◽  
Assessment And Treatment ◽  
Laboratory Investigations

Perioperative medicine can pose myriad challenges to professionalism and ethical practice. Medicine is a science, but definite end points, and predictable results and outcomes do not consistently occur. There is the potential for error during all steps of a patient's assessment and treatment. Examination findings, laboratory investigations, diagnosis, plans for and outcomes of surgery and long-term outcomes can all be uncertain and/or not meet expectations. Factors including pressures in the workplace, conflicts, ego, prescribed guidelines and pathways, the need to achieve healthcare targets, desire for autonomy and need to maintain multidisciplinary involvement in patient care can lead to an environment in which it is challenging for professionalism and ethics to thrive.

Different treatment options for Takayasu arteritis patients with moderate-to-severe aortic regurgitation: long-term outcomes

Rheumatology ◽  
2020 ◽  
Author(s):  
Xuesen Cheng ◽  
Zuozhi Li ◽  
Aimin Dang ◽  
Naqiang Lv ◽  
Qian Chang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Conservative Treatment ◽  
Aortic Regurgitation ◽  
Takayasu Arteritis ◽  
Baseline Risk ◽  
Long Term Outcomes ◽  
End Points ◽  
Severe Aortic Regurgitation ◽  
All Cause Mortality

Abstract Objectives To determine the prognosis of Takayasu arteritis (TA) patients with moderate-to-severe aortic regurgitation treated with surgical vs conservative treatment and to identify independent prognostic factors of long-term outcomes. Methods Between January 2002 and January 2017, 101 consecutive TA patients with moderate-to-severe aortic regurgitation treated with either surgical (n = 38) or conservative (n = 63) treatments were investigated in this retrospective observational case–control study. The primary end point was all-cause mortality, and the secondary end point comprised the combined end points of death, non-fatal stroke and cardiac events (non-fatal myocardial infarction and congestive heart failure). Propensity score matching was used to reduce the bias of baseline risk factors. Results The unadjusted all-cause 10-year mortality in the conservative group was increased compared with the surgical group (28.2% vs 7.4%; log-rank P = 0.036), and the combined end points showed the same trend (52.1% vs 25.3%; log-rank P = 0.005). After an adjustment of baseline risk factors, the conservative treatment was associated with reduced survival rates of both all-cause mortality [hazard ratio (HR): 8.243; 95% CI: 1.069, 63.552; P = 0.007] and combined end points (HR: 6.341; 95% CI: 1.469, 27.375; P = 0.002). Conservative treatment (HR: 3.838, 95% CI: 1.333, 11.053; P = 0.013) and left ventricular end-diastolic diameter (HR: 1.036, 95% CI: 1.001, 1.071; P = 0.042) were risk factors for increased combined end points. Conclusion Surgical treatment improves the outcomes of patients with moderate-to-severe aortic regurgitation due to TA. The dilated left ventricle indicated a worse prognosis.

Moral Distress

2018 ◽  
Author(s):  
Alisa Carse ◽  
Cynda Hylton Rushton
Keyword(s):  
Clinical Practice ◽  
Patient Care ◽  
Moral Distress ◽  
Ethical Practice ◽  
Moral Resilience

Moral distress, a response to moral adversity that imperils integrity under conditions of constraint, has been studied for more than three decades. The context of clinical practice, the complexities of healthcare, clinicians’ roles, and broader society, alongside exponential advances in technology and treatment, create circumstances that regularly imperil integrity. These circumstances create the conditions for burnout, disengagement, and imperiled patient care. Specifically, they foster powerlessness, frustration, anger, diminished moral responsiveness, disillusionment, and shame. The cumulative dynamic of moral distress results in myriad detrimental consequences affecting the bodies, emotions, minds, and souls of clinicians. Transforming these experiences requires a shift in orientation toward restoring and preserving integrity by cultivating capacities of moral resilience and strategies to foster systemic ethical practice.

scholarly journals Contemporary Medical Education: Revolution Versus Evolution

2021 ◽  
Author(s):  
Louis Maximilian Buja
Keyword(s):  
Medical Education ◽  
Clinical Practice ◽  
Academic Medicine ◽  
Disruptive Innovation ◽  
Long Term Outcomes ◽  
The Social ◽  
Medical Education System ◽  
Traditional Approaches ◽  
The Impact

Contemporary and traditional approaches to undergraduate medical education (UME) and graduate medical education (GME) are compared and differences are highlighted. A case is made that the contemporary medical education system is being subject to the downside of disruptive innovation with unintended and potentially detrimental long-term outcomes for academic medicine and clinical practice. The impact on various constituencies is discussed. Proposed solutions are presented. The challenges for education of the best possible physicians are daunting but must be met to honor the social contract between medicine and society.

Long term outcomes in left ventricular non-compaction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Casas ◽  
G Oristrell ◽  
J Limeres ◽  
L Gutierrez Garcia-Moreno ◽  
R Barriales ◽  
...  
Keyword(s):  
Cardiovascular Events ◽  
Phenotypic Expression ◽  
Major Adverse Cardiovascular Event ◽  
Left Ventricular ◽  
Long Term Outcomes ◽  
Adverse Cardiovascular Event ◽  
End Points ◽  
Multicentric Study ◽  
Prognostic Stratification

Abstract Background Left ventricular non-compaction (LVNC) is a highly heterogeneous entity with a wide phenotypic expression. Risk factors have not been well established and prognostic stratification remains challenging. Objectives Describe long term outcomes of LVNC patients and determine predictors of cardiovascular events. Methods Prospective multicentric study of consecutive patients fulfilling imaging criteria for LVNC. Demographic, ECG, imaging and genetic variables were collected. End points were heart failure (HF), ventricular arrhythmias (VA), systemic embolisms (SE) and all-cause death. Major adverse cardiovascular event (MACE) was described as the combination of the four previous end points. Results 592 patients from 13 referral centres were included from 2000 to 2018. Mean age at diagnosis was 45 years, 252 (43%) were female and mean LVEF was 48% (Table 1). During a median follow-up of 55 months (IQR 24–90), 144 (25%) patients presented HF, 101 (18%) VA, 27 (5%) SE and 33 (6%) died. MACE occurred in 223 (39%) patients. In multivariate analysis, independent predictors of HF were LVEF (OR 0.9), PSAP (OR 1.17) and late gadolinium enhancement (LGE) (OR 1.3). VA were independently associated with LVEF (OR 0.97) and LGE (OR 2.51). Independent predictors of SE were LVEF (OR 0.96) and LA diameter (OR 1.07). No independent predictors of all-cause death could be described. MACE were independently associated with LVEF (OR 1.04) and PSAP (OR 1.08) (Table 1). Among patients who underwent genetic testing (340, 57%), genotype was associated with outcomes: MYH7 and ACTC1 variants were protective while multiple mutations, TTN and MYBPC3 variants exhibited worse prognosis. Conclusions In a large prospective multicentric cohort of LVNC patients, there was a moderate long term incidence of cardiovascular events. LVEF and fibrosis were the main predictors and genotype was a modifier of outcomes. These factors might be used to risk stratify LVNC patients. Funding Acknowledgement Type of funding source: None

scholarly journals Efficacy, Safety and Long-term Outcomes of Nicorandil Use in Patients with Stable Ischemic Heart Disease According to the Results of Randomized and Observational Studies

2019 ◽  
Vol 15 (5) ◽  
pp. 641-648
Author(s):  
Yu. V. Lukina ◽  
N. P. Kutishenko ◽  
S. Yu. Martsevich
Keyword(s):  
Heart Disease ◽  
Clinical Practice ◽  
Comparative Analysis ◽  
Ischemic Heart Disease ◽  
Ischemic Heart ◽  
Long Term Outcomes ◽  
Stable Ischemic Heart Disease ◽  
The Impact ◽  
Real Clinical Practice

Working Group of the NIKEA Study. Yekaterinburg: Akulina E.N., Reznik I.I.; Izhevsk: Grebnev S.A., Yezhov A., Shinkareva S.E.; Krasnodar: Kudryashov E.A., Skibitsky A.V., Skibitsky V.V., Fendrikova A.V.; Krasnoyarsk: Altayev V.D., Matyushin G.V., Nemik D.B., Pitaev R.R., Samokhvalov E.V., Stolbikov Yu.Yu.; Moscow: Balashov I.S., Voronina V.P., Gaisenok O.V., Dmitrieva N.A., Zagrebelny A.V., Zakharova A.V., Zelenova T.I., Kolganova E.V., Leonov A.S., Lerman O.V., Maximova M.A., Sladkova T.A., Shestakova G.N.; Novosibirsk: Kuimov A.D., Shurkevich A.A.; Omsk: Goodilin V.A., Loginova E.N., Nechaeva G.I.; Orel: Zhuravleva L.L., Lobanova G.N., Luneva M.M., Mitroshina T.N.; Orenburg: Kondratenko V.Yu., Libis R.A.; Rostov-on-Don: Dubishcheva N.F., Kalacheva N.M., Kolomatskaya O.E., Romadina G., Skarzhinskaya N.S., Chesnikova A.I., Chugunova I.B.; Ryazan: Dobrynina N.V., Nikolaev A.S., Trofimova Ya.M., Yakushin S.S.; Tula: Berberfish L.D., Gomova T.A., Gorina G.I., Dabizha V.G., Zubareva L.A., Nadezhkina K.N., Nikitina V.F., Renko I.E., Soin I.A., Yunusova K.N.Background. Nicorandil is an antianginal drug for which, the ability to positively influence the prognosis of patients (pts) with stable ischemic heart disease (IHD) was confirmed in a randomized controlled trial (RCT) of IONA (the Impact Of Nicorandil in Angina). To study whether the results of RCTs are reproduced in real clinical practice seems to be an actual scientific and practical task.Aim. To compare the data on the effectiveness and safety of nicorandil in pts with stable IHD obtained in the NIKEA observational study (OS) and in the IONA randomized study.Material and methods. 590 pts with IHD and stable angina pectoris were included in the OS NIKEA. All pts were recommended to take nicorandil in addition to the standard antiischemic therapy. 21 months after being included in the study, 524 pts received a phone call. During the telephone contact with pts or their relatives, the life status of pts was determined. According to these results of the survey data were obtained, that 15 people died and 509 pts were alive. The events included in the primary combined endpoint (PCEP) were also determined: death from all causes, new cases of acute myocardial infarction and acute cerebrovascular accident, unscheduled operations of myocardial revascularization, hospitalization for decompensation of chronic heart failure, atrial fibrillation, unstable angina, information on taking nicorandil and other drug therapy, adverse events of drug treatment have been reported. A comparative analysis of the results of the OS NIKEA and RCT IONA was carried out. The results of the IONA study were taken according to the publication in the Lancet 2002. A comparative analysis of the results of the effectiveness of nicorandil in real practice (according to the OS results) was performed with the data obtained in the RCT: the nicorandil/placebo groups in the RCT were compared with the adherent/non-adherent nicorandil groups in the OS.Results. The follow-up duration in both studies was similar and averaged 1.6±0.5 years at RCT IONA and 1.8±0.4 years at NIKEA study. The average age of pts was 67,0±8,0 years in RCT and 65.1±9.6 years in OS. In pts of OS more pronounced comorbidity was noted (cardiovascular diseases, diabetes mellitus). Drugs that favorably affect the prognosis in pts with IHD were more often prescribed to NIKEA study pts (p<0.05). In both RCTs and OS, the antianginal effectiveness of nicorandil was confirmed. According to the OS results, a reduction in the number of angina attacks and a decrease in the need for short-acting nitrates were demonstrated. The frequency of PCEP components was higher in RCT.Conclusion. Long-term outcomes according to the NIKEA observational program for various components of the PCEP turned out to be similar to the results of RCT IONA. It is demonstrated the efficacy of nicorandil in real clinical practice. 

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