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5.
Postgrad Med J ; 96(1141): 708-710, 2020 Nov.
Article in English | MEDLINE | ID: mdl-33139403

ABSTRACT

Medical informed choice is essential for a physician meeting their fiduciary duty when proposing medical and surgical actions, and necessary for a patient to consent or cull the outlined therapeutic approaches. Informed choice, as part of a shared decision-making model, allows widespread give-and-take of ideas between the patient and physician. This sharing of ideas results in a partnership for decision-making and a responsibility for medical and surgical outcomes.Informed choice is indispensible to the patient education process that meets the desired outcome of any covenant-an offer of and acceptance of the proposed treatment. The covenant anchors a true patient-physician partnership with parity and equality in decision-making and medical/surgical outcomes.Medical informed choice flows from ethical and legal principles necessary to meet the acknowledged standard of care. This is codified by statute and fortified in general common law. This espouses a fiduciary relationship where the patient and physician understand and accede to the degree of autonomy the patient requests.The growth of an equal patient-physician relationship requires time. There is no alternative to the time variable when developing a physician-patient relationship. Despite physicians being under pressures to perform more clinical and administrative duties in less time in the corporate model of medicine, time remains the most critical variable when considering informed choice and shared decision-making. Videos, pamphlets and alternate healthcare providers cannot and should not substitute for physician time.


Subject(s)
Information Dissemination , Informed Consent , Moral Obligations , Patient Care Management , Standard of Care , Choice Behavior , Decision Making, Shared , Disclosure/ethics , Disclosure/standards , Humans , Information Dissemination/ethics , Information Dissemination/methods , Informed Consent/ethics , Informed Consent/psychology , Informed Consent/standards , Patient Care Management/ethics , Patient Care Management/legislation & jurisprudence , Patient Care Management/standards , Physician-Patient Relations , Time Factors
8.
Tex Med ; 116(8): 38-40, 2020 Aug 01.
Article in English | MEDLINE | ID: mdl-32866276

ABSTRACT

Under Texas law, physicians treating COVID-19 patients in a volunteer capacity have potential defenses against lawsuits that might arise from that care. But for non-volunteer physicians on the COVID battlefield - often working in harrowing, overloaded settings, high on patient count and low on equipment - the same liability shields don't exist. And with a resurgence in COVID-19 cases and hospitalizations taking hold in June, the Texas Medical Association continued its pandemic-long push to extend liability protections to all frontline physicians, volunteer or not.


Subject(s)
Coronavirus Infections , Liability, Legal , Pandemics , Patient Care Management , Physicians , Pneumonia, Viral , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Humans , Insurance, Liability/legislation & jurisprudence , Needs Assessment , Patient Care Management/ethics , Patient Care Management/legislation & jurisprudence , Patient Care Management/methods , Physicians/ethics , Physicians/legislation & jurisprudence , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , SARS-CoV-2 , Texas/epidemiology , Volunteers/legislation & jurisprudence
11.
Age Ageing ; 49(4): 516-522, 2020 07 01.
Article in English | MEDLINE | ID: mdl-32725209

ABSTRACT

Older people are particularly affected by the COVID-19 outbreak because of their vulnerability as well as the complexity of health organisations, particularly in the often-compartmentalised interactions between community, hospital and nursing home actors. In this endemic situation, with massive flows of patients requiring holistic management including specific and intensive care, the appropriate assessment of each patient's level of care and the organisation of specific networks is essential. To that end, we propose here a territorial organisation of health care, favouring communication between all actors. This organisation of care is based on three key points: To use the basis of territorial organisation of health by facilitating the link between hospital settings and geriatric sectors at the regional level.To connect private, medico-social and hospital actors through a dedicated centralised unit for evaluation, geriatric coordination of care and decision support. A geriatrician coordinates this multidisciplinary unit. It includes an emergency room doctor, a supervisor from the medical regulation centre (Centre 15), an infectious disease physician, a medical hygienist and a palliative care specialist.To organise an ad hoc follow-up channel, including the necessary resources for the different levels of care required, according to the resources of the territorial network, and the creation of a specific COVID geriatric palliative care service. This organisation meets the urgent health needs of all stakeholders, facilitating its deployment and allows the sustainable implementation of a coordinated geriatric management dynamic between the stakeholders on the territory.


Subject(s)
Coronavirus Infections , Geriatric Assessment/methods , Health Services for the Aged , Pandemics , Patient Care Management , Pneumonia, Viral , Regional Medical Programs/organization & administration , Aged , Betacoronavirus/isolation & purification , COVID-19 , Community Networks/organization & administration , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , France/epidemiology , Health Care Rationing/trends , Health Services for the Aged/ethics , Health Services for the Aged/organization & administration , Health Services for the Aged/trends , Humans , Organizational Innovation , Palliative Care/methods , Pandemics/prevention & control , Patient Care Management/ethics , Patient Care Management/organization & administration , Patient Care Management/trends , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , SARS-CoV-2 , Semantic Web , Stakeholder Participation
12.
Can J Cardiol ; 36(8): 1313-1316, 2020 08.
Article in English | MEDLINE | ID: mdl-32505633

ABSTRACT

The COVID-19 pandemic has raised ethical questions for the cardiovascular leader and practitioner. Attention has been redirected from a system that focuses on individual patient benefit toward one that focuses on protecting society as a whole. Challenging resource allocation questions highlight the need for a clearly articulated ethics framework that integrates principled decision making into how different cardiovascular care services are prioritized. A practical application of the principles of harm minimisation, fairness, proportionality, respect, reciprocity, flexibility, and procedural justice is provided, and a model for prioritisation of the restoration of cardiovascular services is outlined. The prioritisation model may be used to determine how and when cardiovascular services should be continued or restored. There should be a focus on an iterative and responsive approach to broader health care system needs, such as other disease groups and local outbreaks.


Subject(s)
Cardiology Service, Hospital , Cardiovascular Diseases , Coronavirus Infections , Ethics, Institutional , Infection Control/methods , Pandemics , Patient Care Management , Pneumonia, Viral , Betacoronavirus/isolation & purification , COVID-19 , Canada/epidemiology , Cardiology Service, Hospital/organization & administration , Cardiology Service, Hospital/trends , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/therapy , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Humans , Models, Organizational , Organizational Innovation , Pandemics/prevention & control , Patient Care Management/ethics , Patient Care Management/methods , Patient Care Management/standards , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , SARS-CoV-2
15.
J Gen Intern Med ; 35(7): 2240-2242, 2020 07.
Article in English | MEDLINE | ID: mdl-32410125

ABSTRACT

The use of personal protective equipment (PPE) has skyrocketed, as providers don masks, glasses, and gowns to protect their eyes, noses, and mouths from COVID-19. Yet these same facial features express human individuality, and are crucial to nonverbal communication. Isolated ICU patients may develop "post intensive-care syndrome," which mimics PTSD with sometimes debilitating consequences. While far from a complete solution, PPE Portraits (disposable portrait picture stickers - 4" × 5") have the potential to humanize care. Preparing for a larger effectiveness evaluation on patient and provider experience, we collected initial qualitative implementation insights during Spring 2020's chaotic surge preparation. Front-line providers reported more comfort with patient interactions while wearing PPE Portraits: "It makes it feel less like a disaster zone [for the patient]." A brief pilot showed signs of significant adoption: a participating physician requested PPE Portraits at their clinic, shift nurses had taken PPE Portraits with them to inpatient services, and masked medical assistant team-members requested PPE Portraits to wear over scrubs. We believe PPE Portraits may support patient care and health, and even potentially healthcare team function and provider wellness. While we await data on these effects, we hope hospitals can use our findings to speed their own implementation testing.


Subject(s)
Coronavirus Infections , Health Personnel , Pandemics , Patient Care Management , Pneumonia, Viral , Portraits as Topic , Protective Clothing , Social Identification , Trauma and Stressor Related Disorders/prevention & control , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/psychology , Coronavirus Infections/therapy , Humans , Interpersonal Relations , Patient Care Management/ethics , Patient Care Management/methods , Patient Care Management/trends , Personal Protective Equipment , Pneumonia, Viral/epidemiology , Pneumonia, Viral/psychology , Pneumonia, Viral/therapy , SARS-CoV-2
16.
Washington; Organización Panamericana de la Salud; mayo 23, 2020. 4 p.
Non-conventional in English, Spanish | LILACS | ID: biblio-1096947

ABSTRACT

La seguridad de las personas con COVID19 debe ser un objetivo prioritario como parte de la calidad de la atención en la prestación de servicios de salud. Al momento casi 200 opciones terapéuticas o combinaciones están siendo investigadas en más de 1.700 ensayos clínicos incluyendo la evaluación en profilaxis y sólo remdesivir ha demostrado algún beneficio, acotado a pacientes hospitalizados con ciertas características.


COVID-19 treatment options currently under study include several antiviral drugs and immune modulators, the antimalarials chloroquine and hydroxychloroquine, corticosteroids, convalescent plasma, pharmaceutical products that target the renin-angiotensin system, hyperbaric oxygen, and nitric oxide, among many others. However, except for remdesivir, which underwent a clinical trial that showed some preliminary positive results, a systematic review by the Pan American Health Organization has so far failed to identify a treatment option that can effectively address the causative agent of COVID-19. The same can be said with regard to prophylaxis. PAHO and WHO are regularly publishing up-to-date summaries of available evidence on the effectiveness of these interventions.


Subject(s)
Humans , Adult , Pneumonia, Viral/prevention & control , Patient Care Management/ethics , Chloroquine/therapeutic use , Coronavirus Infections/prevention & control , Coronavirus Infections/drug therapy , Azithromycin/therapeutic use , Pandemics/prevention & control , Patient Safety/standards , Betacoronavirus
20.
Neonatal Netw ; 38(2): 107-108, 2019 Mar 01.
Article in English | MEDLINE | ID: mdl-31470374

ABSTRACT

Babies in the NICU should be managed in a neurodevelopment-friendly environment. Frequent handling by multiple examiners potentially increases the risk of cross infection. Interruption in kangaroo care is not advisable unless urgent. A minimum of three-point exam should be done (chest, heart, and abdomen) using a stethoscope and gentle palpation. However, the infant should not be wakened from sleep and all handling should be synchronized with the touch time.


Subject(s)
Infant Care , Infant, Newborn, Diseases , Intensive Care, Neonatal , Patient Care Management , Humans , Infant Care/ethics , Infant Care/methods , Infant Care/psychology , Infant, Newborn , Infant, Newborn, Diseases/diagnosis , Infant, Newborn, Diseases/therapy , Intensive Care Units, Neonatal/organization & administration , Intensive Care, Neonatal/ethics , Intensive Care, Neonatal/methods , Intensive Care, Neonatal/psychology , Patient Care Management/ethics , Patient Care Management/methods , Patient Care Management/organization & administration , Patient Comfort , Physical Examination/methods , Physical Examination/psychology , Professional-Family Relations , Time Factors
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