scholarly journals The Edge of Perinatal Viability: Understanding the Dutch Position

2021 ◽  
Vol 9 ◽  
Author(s):  
L. De Proost ◽  
E. J. T. Verweij ◽  
H. Ismaili M'hamdi ◽  
I. K. M. Reiss ◽  
E. A. P. Steegers ◽  
...  
Keyword(s):  
Cultural Context ◽  
Active Management ◽  
Shared Decision ◽  
Individual Freedom ◽  
Extreme Prematurity ◽  
Abortion Law ◽  
Dutch Guideline ◽  
European Guidelines ◽  
High Age ◽  
Active Care

The current Dutch guideline on care at the edge of perinatal viability advises to consider initiation of active care to infants born from 24 weeks of gestational age on. This, only after extensive counseling of and shared decision-making with the parents of the yet unborn infant. Compared to most other European guidelines on this matter, the Dutch guideline may be thought to stand out for its relatively high age threshold of initiating active care, its gray zone spanning weeks 24 and 25 in which active management is determined by parental discretion, and a slight reluctance to provide active care in case of extreme prematurity. In this article, we explore the Dutch position more thoroughly. First, we briefly look at the previous and current Dutch guidelines. Second, we position them within the Dutch socio-cultural context. We focus on the Dutch prioritization of individual freedom, the abortion law and the perinatal threshold of viability, and a culturally embedded aversion of suffering. Lastly, we explore two possible adaptations of the Dutch guideline; i.e., to only lower the age threshold to consider the initiation of active care, or to change the type of guideline.

scholarly journals Qualitative exploration of factors associated with shared decision-making in diabetes management: a health care provider’s perspective

2020 ◽  
Vol 32 (7) ◽  
pp. 464-469
Author(s):  
Amena Moazzam Baig ◽  
Ayesha Humayaun ◽  
Sara Mehmood ◽  
Muhammed Waqar Akram ◽  
Syed Abbass Raza ◽  
...  
Keyword(s):  
Decision Making ◽  
Qualitative Research ◽  
Grounded Theory ◽  
Shared Decision Making ◽  
Cultural Context ◽  
Diabetes Management ◽  
Treatment Options ◽  
Healthcare Providers ◽  
Shared Decision ◽  
Depth Interviews

Abstract Objective Internationally, patient–doctor interaction has shifted from the paternalist model to the shared decision-making (SDM) model, which is an essential part of effective management of chronic illnesses, especially diabetes. It is a relatively new concept in Pakistan, and data about healthcare providers’ perspectives are lacking. The aim was to explore significant facilitators and barriers to effective SDM as perceived by endocrinologists. Design A qualitative research using in-depth interviews based on grounded theory was done. It was written in line with the Consolidated Criteria for Reporting Qualitative Research checklist. Setting The interviews were conducted at the workplace of the endocrinologist between April and July 2019. Participants Prominent endocrinologists of Pakistan residing in Lahore were approached for in-depth interviews. The transcripts were analyzed simultaneously, and theme saturation was achieved in 11 interviews. Main outcome measures Thematic analysis of data done using grounded theory. Results Four major and two minor themes were identified. The most cited barriers to effective SDM from the doctors’ side were the shortage of time during consultations and the absence of formal training of clinicians in communication skills. However, the patients’ hesitation in questioning the doctor, perceiving him as a paternalist ‘messiah’ in society and lack of education limits their ability to understand and comprehend treatment options. Conclusion There are many barriers perceived by providers as well as clients/patients by effectively using SDM. Local cultural context is influencing a lot.

scholarly journals Long-QT Syndrome and Competitive Sports

2018 ◽  
Vol 7 (3) ◽  
pp. 187 ◽  
Author(s):  
Frédéric Schnell ◽  
Nathalie Behar ◽  
François Carré ◽  
◽  
◽  
...  
Keyword(s):  
Long Qt Syndrome ◽  
Sport Participation ◽  
Retrospective Studies ◽  
Competitive Sports ◽  
Shared Decision ◽  
Cardiac Events ◽  
Long Qt ◽  
European Guidelines ◽  
Medical Clearance ◽  
Qt Syndrome

Long QT syndrome (LQTS) is an inherited channelopathy which exposes athletes to a risk of sudden cardiac death. Diagnosis is more difficult in this population because: the QT interval is prolonged by training; and the extreme bradycardia frequently observed in athletes makes the QT correction formula less accurate. Based on limited clinical data which tend to demonstrate that exercise, especially swimming, is a trigger for cardiac events, participation in any competitive sports practice is not supported by 2005 European guidelines. However, based on recent retrospective studies and adopting a different medical approach, involving the patient-athlete in shared decision making, the 2015 US guidelines are less restrictive, especially in asymptomatic genotype-positive/phenotype-negative athletes. These guidelines also consider giving medical clearance to competitive sport participation in asymptomatic athletes with appropriate medical therapy.

Management of conflicts of interests of ESC guideline authors

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Seggewiss ◽  
N Schurig ◽  
T Lempert
Keyword(s):  
Quality Criteria ◽  
Standard Of Care ◽  
International Standards ◽  
Active Management ◽  
National Standard ◽  
Conflicts Of Interests ◽  
Cancer Society ◽  
European Guidelines ◽  
Esc Guidelines ◽  
Medical Guidelines

Abstract Introduction According to WHO definition medical guidelines are systematically developed statements to support the decisions of clinicians and patients about appropriate health care for specific clinical situations. Guidelines should be based on on results of randomized trials and independence from economic interests. Therefore, not only detailed declaration but also active management of conflicts of interests (COI) of guideline committee members should be declared. The public database LeitlinienWatch (GuidelineWatch) analyzes German and European guidelines with respect to COI declaration and management. Methods Between 2015 and 2019 nine German National Standard of Care guidelines (NVL), 10 German Cancer Society (DKG) guidelines, and 10 ESC guidelines were compared according to five criteria. Each criterion was scored 0–3 points (Table). Furthermore, up to 3 extra points could be awarded for methodological quality. Results Overall, guidelines of NVL (11.3±3.5) and DKG (9.8±3.3) achieved more points than ESC guidelines (2.8±0.4; p<0.00001). ESC-guidelines scored points only by documentation of COI and sometimes an extra bonuspoint for an internal review process. In all ESC guidelines >50% of the authors had COI. These conflicts did not lead to an exclusion of lead authors or abstentions from voting. A public accessible review was standard practice in NVL-guidelines and more often performed in DKG-guidelines but was lacking in ESC guideline process. Overall, NVL- and DKG-guidelines showed better handling of COI (Table). Conclusion Declaration and management of COI are quality criteria for medical guidelines. Current ESC guidelines do not meet international standards for COI management. Therefore, the rules for the ESC guideline process need to be revised. Funding Acknowledgement Type of funding source: None

scholarly journals Proposed use of shared decision making (SDM) to facilitate informed patient choice in the management of cholestasis of pregnancy (ICP)

2020 ◽  
Vol 11 (2) ◽  
pp. 117-120
Author(s):  
Cassandra E Henderson MD ◽  
Shadi Rezai ◽  
Richard A Giovane
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Term Infant ◽  
Patient Choice ◽  
Late Preterm ◽  
Active Management ◽  
Shared Decision ◽  
Early Term ◽  
Standard Clinical Practice ◽  
Cholestasis Of Pregnancy

Despite a paucity of data that intrahepatic cholestasis of pregnancy (ICP) is a risk for unexplained term fetal demise, active management to achieve delivery between 36 0/7 and 37 0/7 weeks remains standard clinical practice. This practice continues despite conflicting evidence associating ICP with increased stillbirth risk, disregarding the simultaneous presence of voluminous data attesting to the perinatal and pediatric hazards associated with late preterm and early-term deliveries. This clinical risk correlation between possible antenatal death versus the potential long-term consequences for iatrogenic late preterm or early term infant born from an ICP affected pregnancy warrants inclusion of shared decision making to elicit the patient’s values and preferences during the ICP management option informed consent process.

Liu Feng-Shueh (1925--)

2018 ◽  
Author(s):  
Chen Ya-ping
Keyword(s):  
Higher Education ◽  
Indigenous People ◽  
Cultural Context ◽  
Professional Training ◽  
Modern Dance ◽  
Dance Education ◽  
First Person ◽  
Individual Freedom ◽  
Cultural Issues ◽  
Chinese Dance

Dr. Liu Feng-Shueh is a modern dance pioneer in Taiwan. She was the first person to conduct systematic experimentation with the formal elements and creative methods of modern dance in postwar Taiwan. Her research into historical Chinese dance since the 1950s has produced reconstructions of court and ceremonial dances from the Tang (618–907 CE), Sung (960–1279 CE) and Ming (1368–1644 CE) dynasties. This has enriched her interpretation of modern dance within the Chinese cultural context. As a choreographer, she has attended to the dialogue between tradition and modernity through upholding the value of individual freedom in creation while devoting herself to finding contemporary meanings for traditional dance forms and cultures. In a career that has spanned over six decades, Liu has studied the dance traditions of Taiwanese indigenous people and has choreographed modern dances inspired by them. These works raise important social and cultural issues faced by contemporary indigenous societies. In addition, she has been one of the most important leaders in Taiwan’s dance education with influence ranging from dance for children to professional training in higher education.

scholarly journals The Real Self and the Ideal Self

2021 ◽  
Author(s):  
Floriana Irtelli ◽  
Federico Durbano ◽  
Barbara Marchesi
Keyword(s):  
Human Health ◽  
Cultural Context ◽  
The Self ◽  
Individual Freedom ◽  
Social Changes ◽  
Ideal Self ◽  
Human Needs ◽  
The Individual ◽  
Real Self ◽  
The Ideal

Every human psychic aspect, even the development of the Self, cannot be considered separately from the financial and cultural context in which it is inserted: ad a Matteo of fact the realization of individual freedom is correlated to broader economic and social changes, which influence the individual on self-realization. In the chapter, various theories about this topic and about the ideal self are explored, and it concludes by considering that self expression helps people to satisfy their real emotions and their real self, it also highlights the fact that self-realization and self-expression are among the highest needs on the human needs scale, and they affect human health.

Culture and the plasticity of perception

2020 ◽  
Vol 43 ◽  
Author(s):  
Michael Lifshitz ◽  
T. M. Luhrmann
Keyword(s):  
Cultural Context ◽  
Sensory Experience ◽  
Cultural Learning ◽  
The World

Abstract Culture shapes our basic sensory experience of the world. This is particularly striking in the study of religion and psychosis, where we and others have shown that cultural context determines both the structure and content of hallucination-like events. The cultural shaping of hallucinations may provide a rich case-study for linking cultural learning with emerging prediction-based models of perception.

The Role of Shared Decision-Making in Audiologic Rehabilitation

2014 ◽  
Vol 21 (1) ◽  
pp. 15-23 ◽  
Author(s):  
Helen Pryce ◽  
Amanda Hall
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Behavior Changes ◽  
Shared Decision ◽  
Patient Centered ◽  
Treatment Information ◽  
Centered Care ◽  
Potential Risks ◽  
Audiologic Rehabilitation

Shared decision-making (SDM), a component of patient-centered care, is the process in which the clinician and patient both participate in decision-making about treatment; information is shared between the parties and both agree with the decision. Shared decision-making is appropriate for health care conditions in which there is more than one evidence-based treatment or management option that have different benefits and risks. The patient's involvement ensures that the decisions regarding treatment are sensitive to the patient's values and preferences. Audiologic rehabilitation requires substantial behavior changes on the part of patients and includes benefits to their communication as well as compromises and potential risks. This article identifies the importance of shared decision-making in audiologic rehabilitation and the changes required to implement it effectively.

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