Suchergebnisse

"Informed consent (IC) in older adults (≥ 70 years of age) is often complex. This holds even truer in the setting of organ transplantation (OTx), requiring patients to be informed of the risks and benefits associated with multiple options: whether or not to pursue a transplant, to opt for a living – where appropriate – or deceased donor, to consider a variety of choices concerning the potential for poorer organ quality or increased risk of disease transmission and others. IC overlaps with shared decision-making (SDM) in the presence of high-risk procedures, with low levels of certainty, and when two or more treatment alternatives exist. Patient decision aids (PDAs) (i.e. paper-based/electronic evidence-based tools) have been developed to complement and enhance SDM in clinical practice. Studies have proven PDAs to be an effective means to improve transplant knowledge, to foster patient participation, and to diminish decisional conflict across different settings in OTx. However, research is lacking on the effectiveness and appropriateness of these tools in older adults, which are increasingly entitled to receive OTx. The objective of our work is 1) to present the challenges posed by the use of PDAs in this group of patients and 2) to identify gaps so as to inform the agenda for research on this emergent issue. Our findings suggest that future studies should aim to the development, implementation and evaluation of PDAs for the oldest, more vulnerable segments of this specific patient population. "

"The Ethics Consultant (EC), where present, is called on to offer a resolution to ethical dilemmas at different times over the course of treatment. However, it is not yet clear under which particular circumstances the intervention of the EC should be requested when chronic diseases occur following an acute event. As part of the treatment of these evolutionary chronic conditions, the pathway is often complex and may involve multiple actors (i.e. departments, hospitals, and others). The role of the EC is often limited to a single department and to an isolated event. Therefore, there is frequently no possibility to take into consideration all of the options inherent to the entire continuum of care and of their consequences for the patient. From intensive care units, rehabilitation wards, long-term hospitalization, through to palliative care, the pathway presents important ethical-clinical questions for the patient, for the healthcare team, and for family members. For these reasons, our objective is to develop a model of consultation integrating the EC along the continuum of care. By analyzing a series of cases, we developed an integrated model of consultation allowing the EC to intervene at different subsequent stages of the process. Our findings suggest that this model is an effective means to allow the EC to provide support in relation to single events but also to coherently pursue – within a collaborative setting across different departments – a specific course of treatment which is respectful of clinical indications and of patients' and caregivers' preferences along the whole pathway. "

"In the aftermath of the 2014 Ebola outbreak, media coverage was scrutinized for sensationalism, weakness in explaining scientific uncertainty, dehumanization of patients, and lack of contextualization. The current COVID-19 crisis presents an opportunity to assess whether the media learned its lesson. Results are mixed. Early reporting on the origin of COVID-19 in "wet markets" indicates that the media continues to do poorly with contextualization. On the other hand, stories on mortality and the infectiousness of COVID-19 indicate there has been improvement. The situation remains fluid as COVID-19 threatens to transform into a pandemic at the time of submission. Data from new countries may alter the reported rates of lethality and infectiousness, and media reporting on these changes may or may not be responsible. The explosion of social media, as a medium to promote reporting, could provide bioethicists a tool to direct the public to reliable stories and criticize inaccurate ones. Using a bioethics perspective, this poster will critically evaluate the quality of U.S. and Italian news media's reporting on the evolving scientific understanding of COVID-19 and its contextualization. The presentation will employ QR technology to provide links to media coverage of COVID-19 from the U.S. and Italian news media. After critically appraising the quality of COVID-19 reporting, this poster will consider if bioethicists: 1) should provide comment to the media on pandemics; 2) should correct reporting for the public and 3) have a duty to publicly criticize sensationalism in the media. "

"NCES 98-486"--P. [4] of cover. ; "October 1997." ; Shipping list no.: 98-0070-P. ; "Findings from the National Assessment of Educational Progress"--Cover. ; Includes bibliographical references. ; Mode of access: Internet.

"Background. Clinical ethics consultation has been implemented in many health care institutions. Different methods exist for their evaluation. In this paper we present findings from an evaluation of 21 documentation conducted 2019-2020 by means of the Ethics Consultation Quality Assessment Tool (ECQAT). The applicability of the instrument was analyzed based on a) duration of use, b) ease of use, c) comprehensibility of the items. Results. On average, the analysis with the ECQAT takes 11 minutes per protocol. The greatest difficulties in applying the ECQAT arise a) in assessing the counselling-related information and b) in assessing the ethical analysis as well as the recommendations. Here, different demands on the level of detail of the information may lead to different assessments. Furthermore, the transitions of the ethical analysis and the recommendations, which are relevant for the assessment, could not be delimited exactly in parts of the protocols. Discussion. The assessment of documentation represents a limited part of the quality of ethics consultation. In particular, the quality dimensions of the EQAT do not map communicative elements of process quality, which are essential components (if not the core) of ethics consultations. Moreover, the assessment is strongly depending on the format of the protocols, which, depending on the institution, range from a brief overview of the results to a detailed account. Even in light of aforementioned limitations the ECQAT provides an incentive to improve the process quality of (documented) ethics consultation. "

Background and Aim: This study aimed to investigate the expression level of Sine oculis homeobox homolog 1(SIX1) in normal and cancerous cervical tissues. Methods: Real-time PCR was used to evaluate SIX1 expression level in fresh surgically obtained cervical biopsies. Also, cervical specimens were tested for HPV DNA detection by MY09/11, GP5+/6+ nested PCR method. Results: The expression level of SIX1 mRNA in Cervical cancer was markedly higher than in normal cervical tissue (p<0.0001). Moreover, HPV DNA was detected in 100% of cases and 21.05% of controls (P<0.0001). Conclusions: This finding indicates that increased SIX1 expression might be of relevance to the pathogenesis of cervical cancer. Perhaps, studies to find agents that specifically target SIX1, develop novel anti-cancer and anti-metastasis drugs. This idea has to be investigated in future clinical studies.

"The appropriate clinical decision-making of the nurses can improve the patient outcome and reduce costs, otherwise delaying the recovery and preferably the death of the patient especially in acute care setting. The aim of this study was to describe the clinical decision making in care of patients with acute care in critical nurses. This study was a qualitative study conducted in 2020. Purposive sampling was used and continued until saturation. The study involved sixteen semi-structured interviews were conducted with critical nurses who had experience providing care for acute patients in critical care units. Interviews transcript and analyzed by qualitative content analysis. Two major themes were generated from the data included instantaneous decision-making and life-saving of the patient. This process was depended on the nurse's ability to summarize in the moment, to consider everything, to focus on the patient, to combine experience and knowledge, to concern the patient's life, to prevent the deterioration of the patient's conditions and responsibility to their patients "

"Clinical competence means a person's ability to use techniques on time, to communicate effectively with others, and to benefit from the knowledge and clinical reasoning ability when responding to different clinical situations in such a way that a person can use these skills at all times. The aim of the study is the relationship between clinical competence and ethical reasoning and the factors affecting it in nurses working in therapeutic educational centers of Ilam. Methods: In this descriptive-analytical study, 110 nurses working in three therapeutic educational centers in Ilam city were randomly selected. Demographic information forms, standard nursing clinical competence questionnaire (NCCQ), and nursing dilemma test (NDT) were used to collect data. The results also showed a positive and significant relationship between age, level of education, years of work experience, employment status, and occupational role with clinical competence and ethical reasoning (P<0.05). On the other hand, there was an inverse and significant relationship between the workplace and clinical competence and ethical reasoning (P<0.05). Data analysis was carried out using Descriptive statistics (frequency, percentage, mean and standard deviation) and analytical tests (Pearson correlation tests and analysis of variance) in SPSS. P-value< 0.05 was considered as the significance level. Using the results of the present study, nursing education planners and managers can periodically organize workshops on nursing ethics and nursing problems in hospitals and universities. Moreover, clinical competence and ethical reasoning should be taken into account when training nursing personnel in university classrooms and in-service courses "

"In this descriptive-analytical study, 110 nurses working in educational hospitals of the Ilam University of Medical Sciences were included. Participants were selected using a random sampling method. The data collection tools were the demographic information form, the moral intelligence questionnaire of Lenik and Kiel (2005), and the standard clinical competency assessment questionnaire (CIRN). Data were analyzed using SPSS software, version 21. Descriptive and inferential statistical tests were used to analyze the data. The mean ± SD score of nurses' moral intelligence and clinical competency was estimated at 157.59 ± 26.60 and 136.65 ± 46.08, respectively. Fifty-one percent of participants had low clinical competency, and 46% had high clinical competency. There was a significant association between moral intelligence and clinical competency (p<0.05). "

The objective of this paper was to present basic clinical characteristics and outcomes of treating Covid 19 patients during the second wave of the pandemic. In the retrospective study for the period from September 2020 to February 2021 it was analyzed disease history data and radiological lung changes, time from the initial start of the disease until hospitalization, parameters of blood gas analysis, comorbidities, and the outcome. The research covered 409 patients, out of which 263 (64.3%) were males. Average age was 67.07± 12.44 years (min. 20; max. 93). A high comorbidities prevalence (82.9%) was noticed out of which arterial hypertension (69.2%), diabetes mellitus (37.7%) and obesity (24.7%). On the radiological lung scan the most noticed changes were consolidation (46.2%), "ground glass" (41.3%) and interstitial changes (13%). Bilateral lung infiltration was noticed in 91.9% of the patients. Average oxygen saturation was 84.29%±10.28% (min. 35; max. 98; med. 87%). In patients with unilateral lung infiltration, average oxygen saturation was 85.09%±8.60% (med. 89%, min.61% max 98%), while in patients with bilateral lung infiltration average was 84.22%±10.42% (med. 87%, min. 35%, max. 98%). From the total all patients' death was noticed in 35.7% cases. Morbidity of patients with unilateral lung infiltration was 27.3% and in patients with unilateral infiltration 36.4%. Hospital admission in the first week of the disease indicates the severity of the clinical condition and can be a predictor of poor outcome. Bilateral pulmonary infiltration, obesity and diabetes mellitus are risk factors for high mortality.

Background: Duct to mucosa Pancreatico-gastrostomy (DMPG) is a method for reconstruction of pancreatic mass
following pancreaticoduodenectomy (PD). There are still controversies about the benefits of this surgical technique compared to
the old ones. Objectives: This study aimed to evaluate the long-term outcomes of DMPG reconstruction following PD operation.
Method: Through a prospective observational setting, 164 patients, undergoing PD surgery, with diagnosed pancreatic head or
peri-ampullary cancer, were enrolled. A pylorus-preserving PD and DMPG were done for all patients to reconstruct the pancreatic
mass. Patients were followed up to a mean of 21.06±14.12 months. Demographic data, risk factors, tumoral staging, and
postoperative follow-up data were collected for the analytic study. Results: The mean survival of the patients was 21.06±14.23
months after surgery. DGE (delayed gastric emptying) (34.75%), pancreatic fistula (21.34%), bile duct fistula (7.31%), and
hemorrhage (5.5%) were recorded as the most important complication in patients. Some post-operative complications were
significantly observed in patients with diabetes mellitus (pancreatic fistula, increased amylase, and DGE), Smokers (bile duct
fistula, hemorrhage, and increased Amylase), and the elders (bile duct fistula) (p-value 0.05). Conclusions: Although our results
indicate that DMPG reconstruction is a safe technique, our findings did not confirm the priority of this method over the older
techniques.

Background and Aim: Military personnel, parallel to appropriate personality traits to the military environment, need virtues and character strengths(CS) that contain values appropriate to the environment. We designed a model that examines the impact of comprehensive virtues and CS in reducing psychological distress. Methods: The present study is an SEM study. The sample community is an available example of 410 persons of military men in Tehran. We used a demographic information questionnaire, Kessler Psychological Distress Scale (K-10), and Virtues Inventory in Action (VIA-120). Results: findings showed virtues and CS of wisdom, justice, humanity, and transcendence (except for spirituality) are significantly related to psychological distress. With increasing CS, psychological distress in employees decreased, but with increasing virtues, psychological distress in employees increased. The virtues and CS of temperance and courage were not significantly associated with psychological distress. Conclusions: According to the results of this study, military services should pay more attention to the virtues and CS effective in reducing staff distress and strengthening these traits in them.