Ethical Considerations In ICU Preparations For Viral Epidemics

2021 ◽  
Vol 66 (Special Issue) ◽  
pp. 142-143
Author(s):  
Cristina Petrișor ◽  
◽  
Sebastian Tranca ◽  
◽  
Keyword(s):  
Clinical Picture ◽  
Health Care Professionals ◽  
Administrative Support ◽  
Moral Distress ◽  
Ethical Issues ◽  
Ventilatory Support ◽  
H1n1 Influenza ◽  
Modern World ◽  
Medical Systems ◽  
Infected People

"Intensive Care Units (ICUs) admit patients with the most severe forms of the diseases, viral ARDS included. Since the 2009 H1N1 influenza outbreak, ICU preparations and triage have been recommended. The novel COVID-19 clinical picture resembles influenza in terms of organ dysfunction which may start with hypoxemic breathing insufficiency and ultimately, a possibility of evolution towards multiple organ failure. Its current clinical picture is not new for intensivists. However, there are several important differences as far as we know now: there is overall human susceptibility to become infected and nobody can be specifically protected by vaccination. This fact led to large numbers of infected people all over the world, overwhelming medical systems. Almost 10% of COVID-19 infections would be qualified for ICU admittance and ventilatory support. The main ethical issues in ICUs, in time of viral epidemics are: lack of free ICU beds, free ventilator machines, pressures on providing aggressive treatments for people with low chances of survival, dealing with terminally ill patients, high degrees of burnout in the medical team, reporting errors and inadequate behavior of other medical staff, lack of adequate protective equipment, as well as lack of administrative support. All these facts lead to moral distress and high burnout incidences. Administrative preparations, prioritization and triage are important aspects to consider. In conclusion, we all see that the modern world is not prepared enough to face such challenges and from these situations we, all (health care professionals, providers, population and authorities) should learn important personal and professional lessons. "

Clinical manifestations, diagnosis and treatment of HIV infection of stage 4 (severely symptomatic stage) in the practice of a health professional

2020 ◽  
pp. 27-34
Author(s):  
A. Nikitina ◽  
A. Rusanova ◽  
A. Zhilenkova
Keyword(s):  
Hiv Infection ◽  
Health Professional ◽  
Clinical Picture ◽  
Clinical Manifestations ◽  
Significant Problem ◽  
Diagnosis And Treatment ◽  
Modern World ◽  
Infected People ◽  
Stage 4 ◽  
Future Practice

HIV infection is a significant problem in the modern world, because there are more and more infected people every year. This article will consider: the clinical picture, diagnosis and treatment of this disease in different countries. Based on these data, the following conclusions will be made to help doctors in their future practice correctly approach the diagnosis and treatment of patients with this disease.

Moral distress experienced by health care professionals who provide home-based palliative care

2010 ◽  
Vol 71 (9) ◽  
pp. 1687-1691 ◽  
Author(s):  
Kevin Brazil ◽  
Sharon Kassalainen ◽  
Jenny Ploeg ◽  
Denise Marshall
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Health Care Professionals ◽  
Moral Distress ◽  
Home Based

scholarly journals Paediatric paediatric tracheostomy: Changing indications and key complications

2020 ◽  
Vol 8 (6) ◽  
pp. 175-180
Author(s):  
Guilherme Movio ◽  
Ms Shadaba Ahmed
Keyword(s):  
Health Care Professionals ◽  
Survival Rates ◽  
Ventilatory Support ◽  
Upper Airway ◽  
Multidisciplinary Teams ◽  
Vaccination Programs ◽  
Airway Obstructions ◽  
Life Threatening ◽  
Indications And Complications

Background: Paediatric Tracheostomy is a procedure used to ventilate children through a hole in the trachea. Indications for the procedure were once primarily for acute upper airway obstruction due to infections but have now changed. Generally, there is poor knowledge surrounding tracheostomies and a limited knowledge of guidelines amongst health-care professionals. Aim: The aim of this review is to discuss the basis of changes to the indications of paediatric tracheostomy. It  will also investigate the key complications related to the procedure and discuss the importance of multidisciplinary teams being aware of the emergency algorithms for dealing with such complications. Findings: Indications have changed due to advancements in medicine with increased life expectancy and survival rates for children with often life threatening congenital conditions. Tracheostomies can offer these children long term ventilatory support. Upper airway obstructions due to infections are now infrequently indicated for tracheostomy due to successful vaccination programs. Complications today are because of obstructions and decannulations. Intra-operative complications are infrequent, due to refinements in surgical technique. Conclusion: Paediatric Tracheostomy is a rapidly evolving field because of continuous advancements in neonatal and intensive care medicine. The indications and complications have changed together over the last four decades. A greater understanding of tracheostomy complications is requiredfor successful management.

scholarly journals Inhibition of the replication of SARS-CoV-2 in human cells by the FDA-approved drug chlorpromazine

2020 ◽  
Author(s):  
Marion Plaze ◽  
David Attali ◽  
Matthieu Prot ◽  
Anne-Cécile Petit ◽  
Michael Blatzer ◽  
...  
Keyword(s):  
Health Care ◽  
Side Effects ◽  
Antiviral Activity ◽  
Health Care Professionals ◽  
Human Cells ◽  
Clinical Routine ◽  
Infected People ◽  
Typical Antipsychotics ◽  
Urgent Action

AbstractUrgent action is needed to fight the ongoing COVID-19 pandemic by reducing the number of infected people along with the infection contagiousness and severity. Chlorpromazine (CPZ), the prototype of typical antipsychotics from the phenothiazine group, is known to inhibit clathrin-mediated endocytosis and acts as an antiviral, in particular against SARS-CoV-1 and MERS-CoV. In this study, we describe the in vitro testing of CPZ against a SARS-CoV-2 isolate in monkey and human cells. We evidenced an antiviral activity against SARS-CoV-2 with an IC50 of ∼10μM. Because of its high biodistribution in lung, saliva and brain, such IC50 measured in vitro may translate to CPZ dosage used in clinical routine. This extrapolation is in line with our observations of a higher prevalence of symptomatic and severe forms of COVID-19 infections among health care professionals compared to patients in psychiatric wards. These preclinical findings support the repurposing of CPZ, a largely used drug with mild side effects, in COVID-19 treatment.

Validation and psychometric properties of the Spanish version of the Measure of Moral Distress for Health Care Professionals (MMD-HP-SPA)

2021 ◽  
Author(s):  
E. Rodriguez-Ruiz ◽  
M. Campelo-Izquierdo ◽  
A. Estany-Gestal ◽  
A.B. Hortas ◽  
M.S. Rodríguez-Calvo ◽  
...  
Keyword(s):  
Health Care ◽  
Psychometric Properties ◽  
Health Care Professionals ◽  
Moral Distress ◽  
Spanish Version

Bioethics in Unani medicine: Relevant quotes from Kamilussanah, a 10th century manuscript

2022 ◽  
Vol 07 (01) ◽  
pp. 33-36
Author(s):  
Ghazala Javed ◽  
Nandini Kumar
Keyword(s):  
Ethical Issues ◽  
Conventional Medicine ◽  
National Level ◽  
Codes Of Conduct ◽  
Code Of Conduct ◽  
Interdisciplinary Approach ◽  
World Health ◽  
Medical Systems ◽  
Unani Medicine ◽  
Health Organization

The World Health Organization (WHO) in its Alma Ata Declaration, 1978, focuses on the development, promotion and recognition of the traditional medical systems. India has taken steps in this direction by recognising Unani medicine with other traditional medical systems practised in India. Presently, Government is promoting integration of the recognised traditional medical systems with conventional medicine at the national level, as an interdisciplinary approach to providing better patient-centred care. Bioethics is a field of enquiry that examines ethical issues and dilemmas emerging from medical care and research involving humans. Although the term ‘bioethics’ was first mentioned in 1927 and later established as a distinct discipline in 1970s, the ethical principles in various contexts had been described centuries ago in the classical texts pertaining to traditional medical systems. Since ethics as a code of conduct was followed by ancient Unani physicians to safeguard the interests of humanity when providing healthcare, it was felt that a review of classical Unani manuscripts should be attempted to give an insight into codes of conduct described by various Unani physicians. In this paper, a 10th century book, “Kamilussanah” authored by Ali ibn Abbas al-Majoosi, also known as Majoosi (930-994 CE), is reviewed through the prism of ethics.

Fostering medical staff reflection on the technological alienation of parents in the NICU

2021 ◽  
pp. 147775092110618
Author(s):  
Abram Brummett ◽  
Annie B. Friedrich
Keyword(s):  
Medical Staff ◽  
Moral Distress ◽  
Ethical Issues ◽  
Treatment Refusal ◽  
Healthy Newborn ◽  
Incurable Condition ◽  
Life Sustaining Treatment ◽  
Terminal Diagnosis ◽  
The Relationship

We describe a case of parents refusing a tracheostomy for an otherwise healthy newborn. The refusal was not honored because permitting the refusal would have violated state law, which required a child to have a qualifying condition (e.g. a terminal diagnosis, permanent unconsciousness, incurable condition with severe suffering) to remove or withhold life-sustaining treatment. However, this case strained the relationship between the parents and medical staff, who worried about sending the newborn home with a tracheostomy where she was not wanted. While many ethical issues arise in treatment refusal cases like this, we focus on the opportunity for ethicists to help the medical staff reflect on the technological alienation of the parents, which may help foster empathy, reduce moral distress, and strengthen the quality of the doctor-parent-patient triad.

scholarly journals Mortality from respiratory infections and chronic non-communicable diseases before the COVID-19 pandemic in Cali, Colombia.

2020 ◽  
pp. 1-10
Author(s):  
Luis Eduardo Bravo Ocaña ◽  
Paola Collazos ◽  
Elvia Karina Grillo Ardila ◽  
Luz Stella García ◽  
Erquinovaldo Millán ◽  
...  
Keyword(s):  
Respiratory Infections ◽  
Ventilatory Support ◽  
The Elderly ◽  
International Classification Of Diseases ◽  
Mortality Rates ◽  
Communicable Diseases ◽  
Noncommunicable Diseases ◽  
Non Communicable Diseases ◽  
Infected People ◽  
Classification Of Diseases

Introduction: The COVID-19 disease pandemic is a health emergency. Older people and those with chronic noncommunicable diseases are more likely to develop serious illnesses, equire ventilatory support, and die from complications. Objective: To establish deaths from respiratory infections and some chronic non-communicable diseases that occurred in Cali, before the SARS-CoV-2 disease pandemic. Methods: During the 2003-2019 period, 207,261 deaths were registered according to the general mortality database of the Municipal Secretary of Health of Cali. Deaths were coded with the International Classification of Diseases and causes of death were grouped according to WHO guidelines. Rates were standardized by age and are expressed per 100,000 people-year. Results: A direct relationship was observed between aging and mortality from respiratory infections and chronic non-communicable diseases. Age-specific mortality rates were highest in those older than 80 years for all diseases evaluated. Seasonal variation was evident in respiratory diseases in the elderly. Comments: Estimates of mortality rates from respiratory infections and chronic non-communicable diseases in Cali provide the baseline that will serve as a comparison to estimate the excess mortality caused by the COVID-19 pandemic. Health authorities and decision makers should be guided by reliable estimates of mortality and of the proportion of infected people who die from SARS-CoV-2 virus infection.

Ethical Issues in Public Health Nursing

2000 ◽  
Vol 7 (5) ◽  
pp. 425-438 ◽  
Author(s):  
Kathleen Oberle ◽  
Sandra Tenove
Keyword(s):  
Public Health ◽  
Health Care Professionals ◽  
Ethical Issues ◽  
Public Health Nursing ◽  
Ethical Practice ◽  
Ethical Problems ◽  
Relationship Analysis ◽  
Active Choice ◽  
Canadian Context ◽  
Health Nursing

This qualitative study was designed to explore ethical issues in public health nursing in the Canadian context, and to begin to identify strategies to support ethical practice. Twenty-two public health nurses, 11 in rural and 11 in urban settings, were asked to describe ethical problems they had experienced in the course of their work. These participants most often described situations that required a relational response rather than an active choice between options. Their goal was to optimize the good, while at the same time maintaining a supportive relationship. Analysis revealed five interrelated themes, each with several subthemes: relationships with health care professionals; systems issues; character of relationships; respect for persons; and putting self at risk. It was clear that all aspects of public health nursing have ethical components.

Impact of a contemplative end-of-life training program: Being with dying

2009 ◽  
Vol 7 (4) ◽  
pp. 405-414 ◽  
Author(s):  
Cynda Hylton Rushton ◽  
Deborah E. Sellers ◽  
Karen S. Heller ◽  
Beverly Spring ◽  
Barbara M. Dossey ◽  
...  
Keyword(s):  
Training Program ◽  
End Of Life ◽  
Health Care Professionals ◽  
Professional Training ◽  
Online Survey ◽  
Moral Distress ◽  
Dying Patients ◽  
The Stability ◽  
Task Oriented ◽  
The Impact

AbstractObjective:Health care professionals report a lack of skills in the psychosocial and spiritual aspects of caring for dying people and high levels of moral distress, grief, and burnout. To address these concerns, the “Being with Dying: Professional Training Program in Contemplative End-of-Life Care” (BWD) was created. The premise of BWD, which is based on the development of mindfulness and receptive attention through contemplative practice, is that cultivating stability of mind and emotions enables clinicians to respond to others and themselves with compassion. This article describes the impact of BWD on the participants.Methods:Ninety-five BWD participants completed an anonymous online survey; 40 completed a confidential open-ended telephone interview.Results:Four main themes—the power of presence, cultivating balanced compassion, recognizing grief, and the importance of self-care—emerged in the interviews and were supported in the survey data. The interviewees considered BWD's contemplative and reflective practices meaningful, useful, and valuable and reported that BWD provided skills, attitudes, behaviors, and tools to change how they worked with the dying and bereaved.Significance of results:The quality of presence has the potential to transform the care of dying people and the caregivers themselves. Cultivating this quality within themselves and others allows clinicians to explore alternatives to exclusively intellectual, procedural, and task-oriented approaches when caring for dying people. BWD provides a rare opportunity to engage in practices and methods that cultivate the stability of mind and emotions that may facilitate compassionate care of dying patients, families, and caregivers.

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