The compromise of conscience: Conscientious objection in healthcare

<p>This paper discusses a medical practitioner’s right to conscientiously object to providing a legally available healthcare service in New Zealand, on the grounds of their personal beliefs. Currently, the right to conscientiously object is enshrined in the Health Practitioners Competence Assurance Act 2003 and the Contraception, Sterilisation and Abortion Act. This paper argues the current legislative arrangement regulating a health practitioner’s right to conscientiously object under New Zealand law is vague, and risks cementing uncertainty, due to scope of the protection being unclear. In addition, the current protection risks patient safety, as it does not exclude the right to conscientiously object in medical emergencies, or when the efficacy of the treatment is time dependent. To remedy this unsatisfactory situation, it is recommended that the right to conscientiously object in healthcare be rendered impermissible in the aforementioned scenarios. It is further recommended that direct referral to a non-objecting colleague be mandatory in the event a practitioner wishes to exercise their right to conscientiously object. This is because access to healthcare may be compromised by a practitioner exercising the right to conscientiously object, with no corresponding direct referral requirement, a risk borne by patients.</p>

The compromise of conscience: Conscientious objection in healthcare

<p>This paper discusses a medical practitioner’s right to conscientiously object to providing a legally available healthcare service in New Zealand, on the grounds of their personal beliefs. Currently, the right to conscientiously object is enshrined in the Health Practitioners Competence Assurance Act 2003 and the Contraception, Sterilisation and Abortion Act. This paper argues the current legislative arrangement regulating a health practitioner’s right to conscientiously object under New Zealand law is vague, and risks cementing uncertainty, due to scope of the protection being unclear. In addition, the current protection risks patient safety, as it does not exclude the right to conscientiously object in medical emergencies, or when the efficacy of the treatment is time dependent. To remedy this unsatisfactory situation, it is recommended that the right to conscientiously object in healthcare be rendered impermissible in the aforementioned scenarios. It is further recommended that direct referral to a non-objecting colleague be mandatory in the event a practitioner wishes to exercise their right to conscientiously object. This is because access to healthcare may be compromised by a practitioner exercising the right to conscientiously object, with no corresponding direct referral requirement, a risk borne by patients.</p>

Risk-stratification of HPV-positive women with low-grade cytology by FAM19A4/miR124-2 methylation and HPV genotyping

Background The introduction of primary HPV screening has doubled the number of colposcopy referrals because of the direct referral of HPV-positive women with a borderline or mild dyskaryosis (BMD) cytology (ASC-US/LSIL) triage test. Further risk-stratification is warranted to improve the efficiency of HPV-based screening. Methods This study evaluated the discriminative power of FAM19A4/miR124-2 methylation, HPV16/18 genotyping and HPV16/18/31/33/45 genotyping in HPV-positive women with BMD (n = 294) in two Dutch screening trials. Absolute CIN3+ risks and colposcopy referrals within one screening round were calculated. Results Methylation analysis discriminated well, yielding a CIN3+ risk of 33.1% after a positive result and a CIN3+ risk of 9.8% after a negative result. HPV16/18 and HPV16/18/31/33/45 genotyping resulted in a 27.6% and 24.6% CIN3+ risk after a positive result, and a 13.2% and 9.1% CIN3+ risk after a negative result. Colposcopy referral percentages were 41.2%, 43.2%, and 66.3% for FAM19A4/miR124-2 methylation, HPV16/18 and HPV16/18/31/33/45 genotyping, respectively. The CIN3+ risk after a negative result could be lowered to 2.8% by combining methylation and extended genotyping, at the expense of a higher referral percentage of 75.5%. Conclusion The use of FAM19A4/miR124-2 methylation and/or HPV genotyping in HPV-positive women with BMD can lead to a substantial reduction in the number of direct colposcopy referrals.

Building a predictive model for diagnostics and treatment of infertility

In this work, the tasks of creating a method for clinical prediction of diagnosis and treatment of infertility are formulated and solved. The existing forecasting models for overcoming infertility are considered. Their advantages and disadvantages are determined. The latter are both in the complexity of accounting and forecasting the individual possibilities for conception of the estimated married couples, and in the conservatism of the medical and applied computing technologies used, which reduces the quality and efficiency of forecasts. The structure of infertility is shown after a comprehensive examination of patients over a long period. Five groups of patients were identified, taking into account the characteristics, duration and other causes of infertility. The concepts of the coefficient of reproductive activity (CRA), the indicator of reproductive health (RPH) and the indicator of reproductive readiness (PRH) are introduced, a variant of the calculation of these values is proposed, and the ranges of their possible values are indicated. The PRG was proposed as a key characteristic for clinical prediction in overcoming infertility. Its values can be projected into four groups of outcomes in the diagnosis and treatment of infertility, three of which involve direct referral to a specialized medical institution. The article presents a generalized algorithm for the use of PRG in the predictive activity of doctor Practical recommendations for the use of the PRG by the patient are given. In addition, a computational experiment was carried out to calculate the values of PRG for several patients with further analysis of the results obtained.

Recruiting Low-Income African American Men in Mental Health Research: A Community-Based Participatory Research Feasibility Study

African Americans (AAs) are 20% more likely to develop serious psychological distress compared to Whites but are less likely to use mental health services. The study objective was to evaluate the effectiveness of recruitment strategies to engage AA fathers in a mental health intervention. Using the community-based participatory research (CBPR) approach, a community-academic partnership (CAP) developed and implemented direct and indirect referral strategies to engage AA fathers in a mental health intervention. Direct referral strategies focused on community partner identification of potentially eligible participants, providing information about the study (i.e., study flyer), and referring potential participants to the study. Indirect referrals included posting flyers in local businesses frequented by AA men, radio advertisements, and social media posts from community organizations. From January to October 2019, 50 direct and 1388 indirect referrals were documented, yielding 24 participants screened and 15 enrolled. Of all participants screened, 58% were referred through indirect referral, 38% were referred directly by community partners, and 4% of the participants were referred through both direct and indirect referrals. Twenty percent of those exposed to the direct referral methods and 1% of those exposed to the indirect referral methods were enrolled. The indirect referrals accounted for 60% of enrollment, whereas the direct referrals accounted for 33.3% of enrollment. Collaborating with the community partners to engage hard-to-reach populations in mental health studies allowed for broad dissemination of recruitment methods, but still resulted in low participant accrual. Additional focus on increasing direct referral methods appears to be a fruitful area of CBPR.

Creating the Moorfields’ virtual eye casualty: video consultations to provide emergency teleophthalmology care during and beyond the COVID-19 pandemic

BackgroundThe COVID-19 crisis forced hospitals in the UK dramatically to reduce outpatient activity. To provide continuity of care and to assist patients reluctant or unable to leave their homes, video consultations were rapidly implemented across routine and emergency ophthalmology services.ObjectiveTo describe the deployment and scaling to a large volume of teleophthalmology using a video consultation platform ‘Attend Anywhere’ in Moorfields Eye Hospital’s accident and emergency (A&E) department (London, UK).MethodPatient satisfaction, waiting time, consultation duration, outcome and management were audited following the launch of the new virtual A&E service.ResultsIn the 12 days following the service launch, 331 patients were seen by video consultation. 78.6% of patients (n=260) were determined not to need hospital A&E review and were managed with advice (n=126), remote prescription (n=57), general practitioner referral (n=27), direct referral to hospital subspecialty services (n=26) or diversion to a local eye unit (n=24). Mean patient satisfaction was 4.9 of 5.0 (n=62). The mean consultation duration was 12 min (range 5–31 min) and the wait time was 6 min (range 0–37 min).ConclusionVideo consultations showed greater than expected usefulness in the remote management of eye disease and supported a substantial reduction in the number of people visiting the hospital.

Do reflex comments on laboratory reports alter patient management?

Introduction Laboratory comments appended on clinical biochemistry reports are common in the UK. Although popular with clinicians and the public, there is little evidence that these comments influence the clinical management of patients. Methods We provided reflex automated laboratory comments on all primary care lipid results including, if appropriate, recommendation of direct referral to the West Midlands Familial Hypercholesterolaemia service (WMFHS). Over a two-year period, the number GP referrals from the Wolverhampton City Clinical Commissioning Group (CCG) to the WMFHS were compared with four comparator CCGs of similar population size, who were not provided with reflex laboratory comments. Results Over the study period, the WMFHS received more referrals from Wolverhampton GPs (241) than any other comparator CCG (range 8–65) and greater than the combined referrals (172) from all four comparator CCGs. Conclusion Targeted reflex laboratory comments may influence the clinical management of patients and may have a role in the identification of individuals with familial hypercholesterolaemia.

Shockwave lithotripsy for urolithiasis: a 12-month analysis of referral data to a metropolitan Australian Hospital

Background: Extracorporeal shockwave lithotripsy (SWL) is still an important option in the treatment of renal tract stones. SWL is not without its limitations and alternatives should be considered. This study investigates the referral data to a new SWL planning meeting to identify reasons why SWL was not offered.Methods: A review of 12 months of data prospectively collected at a weekly stone meeting was supplemented with a retrospective chart analysis to identify the source of all referrals for SWL. The principal reason for diverting a patient to other stone management was noted.Results: 142 patients (median age 52 years) were referred for SWL over the 12-month period. SWL was not recommended in 40 (28.2%) patients. SWL was most commonly contraindicated due to excessive stone size±position (32.5%), anatomical complexity (25.0%) and radiolucency on x-ray (10.0%). The majority of patients who were diverted away from SWL were referred from an emergency department (32.5%) and the general urology clinics (20.0%).Conclusions: A significant portion of patients referred for SWL prove unsuitable for this method of stone clearance. This highlights an educational gap amongst clinicians regarding the indications and more importantly contraindications for SWL. Only 6.3% of total referrals originated from general practice suggesting a lack of awareness of the process of direct referral for SWL. Improving this with guidelines will relieve demand in outpatient clinics and help streamline patient care.