Ethical Challenges Posed by Advanced Veterinary Care in Companion Animal Veterinary Practice

Advanced veterinary care (AVC) of companion animals may yield improved clinical outcomes, improved animal welfare, improved satisfaction of veterinary clients, improved satisfaction of veterinary team members, and increased practice profitability. However, it also raises ethical challenges. Yet, what counts as AVC is difficult to pinpoint due to continuing advancements. We discuss some of the challenges in defining advanced veterinary care (AVC), particularly in relation to a standard of care (SOC). We then review key ethical challenges associated with AVC that have been identified in the veterinary ethics literature, including poor quality of life, dysthanasia and caregiver burden, financial cost and accessibility of veterinary care, conflicts of interest, and the absence of ethical review for some patients undergoing AVC. We suggest some strategies to address these concerns, including prospective ethical review utilising ethical frameworks and decision-making tools, the setting of humane end points, the role of regulatory bodies in limiting acceptable procedures, and the normalisation of quality-of-life scoring. We also suggest a role for retrospective ethical review in the form of ethics rounds and clinical auditing. Our discussion reenforces the need for a spectrum of veterinary care for companion animals.

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Association Between Elevated Hemolysis at Diagnosis and Early Mortality and Risk of Thrombosis In Paroxysmal Nocturnal Hemoglobinuria (PNH) Patients with Cytopenia

Blood ◽

10.1182/blood.v116.21.4241.4241 ◽

2010 ◽

Vol 116 (21) ◽

pp. 4241-4241 ◽

Cited By ~ 1

Author(s):

Jin Seok Kim ◽

Jong Wook Lee ◽

Sung-Soo Yoon ◽

Je-Hwan Lee ◽

Deog-Yeon Jo ◽

...

Keyword(s):

Quality Of Life ◽

Risk Factor ◽

Abdominal Pain ◽

Conflicts Of Interest ◽

Significant Risk ◽

Significant Risk Factor ◽

Poor Quality ◽

Severe Fatigue ◽

Life Threatening

Abstract Abstract 4241 Introduction: PNH is a rare, progressive and life threatening disease driven by chronic hemolysis leading to thrombosis, renal impairment, pain, severe fatigue, poor quality of life and premature death. Thrombosis is the leading cause of death (accounting for 40–67% of PNH-related deaths) and was recently identified as a significant risk factor for mortality in Asian PNH patients. Abdominal pain is a common and distressing symptom in PNH and has also been found to be risk factor for thrombosis and mortality in PNH patients. In PNH patients with concomitant aplasia/cytopenias (PNH-cytopenia), the symptoms associated with hemolytic PNH (i.e., severe fatigue and anemia) may be attributed to a hypocellular marrow, potentially masking the life threatening risk of hemolysis-mediated thrombosis and abdominal pain. Here we evaluate the correlation of clinical risk factors with hemolytic symptoms in cytopenic PNH patients. Methods: We retrospectively analyzed medical charts of 286 PNH patients from the National Data Registry in South Korea to identify aplastic PNH patients with evidence of hemolytic symptoms at the time of diagnosis. We defined PNH-cytopenia patients with evidence of at least 2 of the following hematological values at diagnosis: Hgb <10 g/dL; ANC <1.5×109/L; thrombocytopenia <100×109/L. Hemolysis was defined as LDH °Ã1.5 fold above the upper limit of normal (ULN). Results: The median patient age was 37 years (range: 8 to 88 years) and median PNH duration was 7.8 years. At diagnosis, median PNH granulocyte clone was 49% and LDH was 3.9-fold above ULN. Median platelet count was 99×109/L and median ANC was 1.2×109/L, 21% with ANC <1.0×109/L. PNH-cytopenia was identified at diagnosis in 42% of PNH patients. PNH-cytopenic patients experienced a similar prevalence of hemolytic symptoms and mortality compared to PNH patients with no evidence of cytopenia (PNH) (see table below). Thrombosis was equally prevalent in PNH-cytopenia compared to PNH (12% vs18%; P=0.175). Abdominal pain was equally prevalent in PNH-cytopenia and PNH (52% vs 42%; P=0.112) and there was similar mortality between the 2 groups (13% vs 11%; P=0.631). There was a significantly higher prevalence of mortality (14% vs 4%; p=0.048), thrombosis (22% vs 4%; p=0.003) and abdominal pain (53% vs 32%; p=0.007) in patients with elevated hemolysis (°Ã LDH 1.5 above ULN) compared to patients without hemolysis. We found that 69% of PNH-cytopenia patients demonstrated elevated hemolysis at diagnosis. Thrombosis was identified in 17% of PNH-cytopenia patients with elevated hemolysis compared to 3% with no evidence of elevated LDH (p=0.051); abdominal pain (59% vs 32%; p= 0.012) and death (16% vs 3%; p=0.070) were higher in PNH-cytopenia patients with hemolysis compared to PNH-cytopenia patients without hemolysis. CONCULSION: These data demonstrate that the presence of hemolysis at diagnosis is associated with of life-threatening thrombosis, poor quality of life, and mortality in PNH patients. Despite the evidence of hypoplasia, PNH-cytopenia patients with hemolysis demonstrate a higher risk of life-threatening thrombosis, pain, and mortality. These data indicate that hemolysis is a potential risk factor for life- threatening complications independent of the presence of cytopenia in patients with PNH. Treatment for PNH patients with cytopenias should focus on both controlling hemolysis as well as improving hypoplasia. Disclosures: No relevant conflicts of interest to declare.

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The growth of pet obesity

Veterinary Record ◽

10.1136/vr.l6498 ◽

2019 ◽

Vol 185 (Suppl 1) ◽

pp. 1-3

Keyword(s):

Quality Of Life ◽

Companion Animals ◽

Poor Quality

Pet obesity is on the rise, bringing with it increased risks of ill health and poor quality of life for companion animals. The profession is, rightly, concerned. But is it clear on the complex, interconnected causes for this change and well equipped to confront them? Some argue a greater degree of understanding is required. Claire Read reports.

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KUALITAS HIDUP PASIEN STROKE DI POLIKLINIK RAWAT JALAN RUMAH SAKIT SWASTA YOGYAKARTA

Media Ilmu Kesehatan ◽

10.30989/mik.v7i3.274 ◽

2019 ◽

Vol 7 (3) ◽

pp. 232-237

Author(s):

Hana Larasati ◽

Theresia Titin Marlina

Keyword(s):

Quality Of Life ◽

Social Relations ◽

Hemorrhagic Stroke ◽

Poor Quality ◽

Social Dimension ◽

Stroke Patients ◽

Sampling System ◽

Post Stroke ◽

Psychological Dimension

Background: stroke is a disorder of nervous system function that occurs suddenly and is caused by brain bleeding disorders that can affect the quality of life physical dimensions, social dimensions, psychological dimensions, environmental dimensions. Based on the result of Lumbu study (2015) the number of samples were 71 people collected data using the (WHOQOL-BREF). There were 56 people (78,9%) had the poor quality of life of post stroke. The mean of post-stroke quality of life domain was physical domain (45,27%), psychological domain (49,87%), social relations domain (48,15%) and environmental domain (50.01%). Objective: the purpose of the study was know the quality of life of the stroke patients in Outpatient Polyclinic of Private Hospital in Yogyakarta. Methods: used descriptive quantitative by using questionnaire test of purposive sampling system based on patients who have been affected of ischemic or hemorrhagic stroke before, number 30 respondents. Result: quality of life of stroke patient of medium physical dimension (67%), psychological dimension (71%), social dimension (67%), dimension good environment (63%). Conclusion: the quality of life of stroke patients of physical dimension, psychological dimension, and moderate social dimension, while the quality of life of stroke patients were good environmental dimension. Keywords: Hemorrhagic stroke, ischemic stroke, quality of life

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Faculty Opinions recommendation of Factors associated with poor quality of life among cervical cancer survivors: implications for clinical care and clinical trials.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718634930.793502075 ◽

2014 ◽

Author(s):

David Kushner ◽

Laura Huffman

Keyword(s):

Quality Of Life ◽

Cervical Cancer ◽

Clinical Trials ◽

Cancer Survivors ◽

Clinical Care ◽

Poor Quality ◽

Factors Associated

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The Ethics of AI in Biomedical Research, Patient Care, and Public Health

The Oxford Handbook of Ethics of AI ◽

10.1093/oxfordhb/9780190067397.013.45 ◽

2020 ◽

pp. 702-718 ◽

Cited By ~ 1

Author(s):

Alessandro Blasimme ◽

Effy Vayena

Keyword(s):

Public Health ◽

Patient Care ◽

Biomedical Research ◽

Disease Surveillance ◽

Ethical Issues ◽

Ethical Review ◽

Ethical Challenges ◽

Healthcare Provision ◽

Social Scientists ◽

Ethical Frameworks

This chapter explores ethical issues raised by the use of artificial intelligence (AI) in the domain of biomedical research, healthcare provision, and public health. The litany of ethical challenges that AI in medicine raises cannot be addressed sufficiently by current regulatory and ethical frameworks. The chapter then advances the systemic oversight approach as a governance blueprint, which is based on six principles offering guidance as to the desirable features of oversight structures and processes in the domain of data-intense biomedicine: adaptivity, flexibility, inclusiveness, reflexivity, responsiveness, and monitoring (AFIRRM). In the research domain, ethical review committees will have to incorporate reflexive assessment of the scientific and social merits of AI-driven research and, as a consequence, will have to open their ranks to new professional figures such as social scientists. In the domain of patient care, clinical validation is a crucial issue. Hospitals could equip themselves with “clinical AI oversight bodies” charged with the task of advising clinical administrators. Meanwhile, in the public health sphere, the new level of granularity enabled by AI in disease surveillance or health promotion will have to be negotiated at the level of targeted communities.

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354 To refer or not to refer?: ethical challenges of appropriate patient selection to obtain optimum survival and quality of life post lung transplant

Journal of Cystic Fibrosis ◽

10.1016/s1569-1993(17)30691-4 ◽

2017 ◽

Vol 16 ◽

pp. S153

Author(s):

J. Robertson ◽

K. MacDonald

Keyword(s):

Quality Of Life ◽

Patient Selection ◽

Lung Transplant ◽

Ethical Challenges

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Hyperhidrosis: prevalence and impact on quality of life

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37562017000000379 ◽

2018 ◽

Vol 44 (4) ◽

pp. 292-298 ◽

Cited By ~ 5

Author(s):

Erica Nishida Hasimoto ◽

Daniele Cristina Cataneo ◽

Tarcísio Albertin dos Reis ◽

Antonio José Maria Cataneo

Keyword(s):

Quality Of Life ◽

Poor Quality ◽

Cluster Sampling ◽

Excessive Sweating ◽

Medical Evaluation ◽

Primary Hyperhidrosis ◽

Systematic Cluster ◽

The City ◽

Impaired Quality

ABSTRACT Objective: To determine the prevalence of primary hyperhidrosis in the city of Botucatu, Brazil, and to evaluate how this disorder affects the quality of life in those suffering from it. Methods: A population survey was conducted in order to identify cases of hyperhidrosis among residents in the urban area of the city, selected by systematic cluster sampling. In accordance with the census maps of the city, the sample size should be at least 4,033 participants. Ten interviewers applied a questionnaire that evaluated the presence of excessive sweating and invited the subjects who reported hyperhidrosis to be evaluated by a physician in order to confirm the diagnosis. Results: A total of 4,133 residents, in 1,351 households, were surveyed. Excessive sweating was reported by 85 residents (prevalence = 2.07%), of whom 51 (60%) were female. Of those 85 respondents, 51 (60%) agreed to undergo medical evaluation to confirm the diagnosis and only 23 (45%) were diagnosed with primary hyperhidrosis (prevalence = 0.93%). Of the 23 subjects diagnosed with primary hyperhidrosis, 11 (48%) reported poor or very poor quality of life. Conclusions: Although the prevalence of self-reported excessive sweating was greater than 2%, the actual prevalence of primary hyperhidrosis in our sample was 0.93% and nearly 50% of the respondents with primary hyperhidrosis reported impaired quality of life.

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