 | | Medical Ethics: Challenges in Expanding Access to Dialysis in South Africa—Expensive Modalities, Cost Constraints and Human Rights | Medical Ethics: Challenges in Expanding Access to Dialysis in South Africa—Expensive Modalities, Cost Constraints and Human Rights
Medical Ethics: Challenges in Expanding Access to Dialysis in South Africa—Expensive Modalities, Cost Constraints and Human Rights
Medical Ethics: Challenges in Expanding Access to Dialysis in South Africa—Expensive Modalities, Cost Constraints and Human Rights
Overview
South Africa is a country with two distinct health sectors, which are both characterised by inequalities. Within this context, patients with end stage renal disease face unique and sometimes impenetrable barriers to accessing dialysis. There are a number of reasons for this situation, which include the South African government’s endorsement of discordant, unequal policies, which disadvantage the most vulnerable; a lack of robust national guidelines; and divisive rationing practices, which are ad hoc and place the burden of responsibility for rationing dialysis on the clinician.
In this paper, we trace the socio-economic mechanisms of how we have come to be in this situation, and overlay this with a detailed examination of South African legislation. Finally, we make comprehensive practical recommendations for rectifying the situation, which include engagement with key stakeholders, public-private partnerships, and more equitable funding mechanisms.
Acknowledgement
Authors Harriet Etheredge and June Fabian
Journal Healthcare (Basel) Volume 5 Issue 3
| 3 | | R 455.00 |  |
| | Opioid utilization among pediatric patients treated for newly diagnosed acute myeloid leukemia | Opioid utilization among pediatric patients treated for newly diagnosed acute myeloid leukemia
Opioid utilization among pediatric patients treated for newly diagnosed acute myeloid leukemia
Opioid utilization among pediatric patients treated for newly diagnosed acute myeloid leukemia
Overview
A cohort of pediatric patients with AML treated at hospitals contributing to the Pediatric Health Information System was used to evaluate differences in opioid utilization by sex, age, race, and insurance. Billing data were used to compute the prevalence of opioid exposure and to quantify rates of utilization among those exposed to opioids as days of use per 1000 inpatient days. Multivariable regressions were used to compare opioid prevalence, and rates of utilization among those exposed. The proportion of opioid-exposed patients increased with age, but did not differ by gender, race, or insurance status. There was moderate hospital-level variability in both the prevalence of opioid utilization overall and preference for specific opioid medications. There was greater inconsistency in practice concerning choices for supplemental and alternative opioids than in first-line opioid utilization. Additional work is needed to discern whether observed differences in opioid utilization by age and race reflect a difference in treatment or a difference in the experience of pain. Future studies should also explore the factors which guide decisions on opioid selections in an attempt to explain the variability across institutions.
Acknowledgement
Authors
Kelly D. Getz , Tamara P. Miller, Alix E. Seif , Yimei Li , Yuan-Shung V. Huang, Brian T. Fisher and Richard Aplenc.
Journal PLoS Medicine 2018 Feb Volume 13 Issue 2
Publisher Cross Mark Open Access URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5805309/pdf/pone.0192529.pdf
| 3 | | R 460.00 | |
| | Medical Ethics: Because I want to be informed, to be part of the decision-making”: Patients’ insights on informed consent practices by healthcare professionals in South Africa | Medical Ethics: Because I want to be informed, to be part of the decision-making”: Patients’ insights on informed consent practices by healthcare professionals in South Africa
Medical Ethics: Because I want to be informed, to be part of the decision-making”: Patients’ insights on informed consent practices by healthcare professionals in South Africa
Medical Ethics: Because I want to be informed, to be part of the decision-making”: Patients’ insights on informed consent practices by healthcare professionals in South Africa
Overview
Informed consent (IC) is a legally enforceable right in South Africa based on constitutionally protected rights to bodily integrity and well-being. In terms of the law, patients cannot be involved in medical treatment or research without IC. Healthcare providers must inform patients about diagnosis, risks, benefits, treatment options, and right of refusal in a language that patients understand based their literacy level. This study reports an empirical study on patients’ perceptions of IC as practiced by doctors and nurses in South Africa.
This study reveals that South African patients are aware of the right to IC, but many were vulnerable due to indigence. Barriers to IC include poverty, language, and low educational level. South African patients prefer disclosure of all material risks, better communication skills by healthcare workers, and a shift toward informed or shared healthcare decision-making.
Acknowledgement
Author Chima SC
Journal Nigerian Journal of Clinical Practice Suppl:S46-56.
Publisher: Wolters Kluwer - Medknow
| 3 | | R 455.00 | |
| | Cumulative Sum Analysis of the Learning Curve for Video-assisted Miniliaparotomy Donor Nephrectomy in Healthy Kidney Donors (Nephrectomy) | Cumulative Sum Analysis of the Learning Curve for Video-assisted Miniliaparotomy Donor Nephrectomy in Healthy Kidney Donors (Nephrectomy)
Cumulative Sum Analysis of the Learning Curve for Video-assisted Miniliaparotomy Donor Nephrectomy in Healthy Kidney Donors (Nephrectomy)
Cumulative Sum Analysis of the Learning Curve for Video-assisted Miniliaparotomy Donor Nephrectomy in Healthy Kidney Donors (Nephrectomy)
Overview
Video-assisted mini-laparotomy surgery (VAMS) is a hybrid of open and laparoscopic surgical techniques, so has advantages of both approaches. The learning curve was evaluated using the cumulative sum (CUSUM) method. Measures of surgical performance included total operation time, warm ischemic time, and estimated blood loss. The mean patient age, body mass index, and body surface area were 43.5 years, 23.8kg/m2, and 1.7m2, respectively.
In terms of warm ischemic time and estimated blood loss, the initial learning was achieved after 16 cases and after 9 to 10 cases, one could achieve competency. The VAMS donor nephrectomy learning curve is shorter than for laparoscopic or robotic hand-assisted donor nephrectomy.
Surgeons can become familiar with the procedure and perform it without complications after approximately 16 to 17 operations. This is the first analysis with CUSUM identifying 3 unique learning curve phases for VAMS donor nephrectomy.
Acknowledgement Jee Soo Park , Hyun Kyu Ahn , Joonchae Na , Hyung Ho Lee, Young Eun Yoon , Min Gee Yoon and Woong Kyu Han.
Journal Medicine (2018) 97:17(e0560)
Publisher Wolters Kluwer Health, Inc. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5944565/pdf/medi-97-e0560.pdf
| 3 | | R 445.00 | |
| | Opioids and Immunosuppression in Oncological Postoperative Patients | Opioids and Immunosuppression in Oncological Postoperative Patients
Opioids and Immunosuppression in Oncological Postoperative Patients
Opioids and Immunosuppression in Oncological Postoperative Patients
Overview
Recent animal studies demonstrated immune-suppressive effects of opioid withdrawal resulting in a higher risk of infection. The aim of this study was to determine the impact of remifentanil discontinuation on Post-Anaesthesia Care Unit (PACU)-acquired infection after a schedule of sedo-analgesia of at least 6 days. All patients over 18 years of age with a unit admission of more than 4 days were consecutively selected. The study population was the one affected by surgical pathology of any origin where sedation was based on any hypnotic and the opioid remifentanil was used as analgesic for at least 96 hours in continuous perfusion
Recent animal studies demonstrated immune-suppressive effects of opioid withdrawal resulting in a higher risk of infection. The aim of this study was to determine the impact of remifentanil discontinuation on Post-Anaesthesia Care Unit (PACU)-acquired infection after a schedule of sedo-analgesia of at least 6 days. All patients over 18 years of age with a unit admission of more than 4 days were consecutively selected. The study population was the one affected by surgical pathology of any origin where sedation was based on any hypnotic and the opioid remifentanil was used as analgesic for at least 96 hours in continuous perfusion
Acknowledgement
Authors José Luis Bonilla-García, Manuel Cortiñas-Sáenz and Esperanza del Pozo-Gavilán.
Journal Rev Assoc Med Bras 2017; 63(9) URL: http://www.scielo.br/pdf/ramb/v63n9/0104-4230-ramb-63-09-0753.pdf
| 3 | | R 485.00 | |
| | A Qualitative Exploration of Chronic Pain and Opioid Treatment | A Qualitative Exploration of Chronic Pain and Opioid Treatment
A Qualitative Exploration of Chronic Pain and Opioid Treatment
A Qualitative Exploration of Chronic Pain and Opioid Treatment
Overview
The study explored high risk participants’ experiences with pain management regarding clinical access to and use of prescription opioids. First, participants perceived providers lacked empathy for their pain and/or were not adequately managing their pain. These interactions resulted in participants seeking new providers or mistrusting the medical system. Further, providers’ surveillance of participants’ pain treatment regimen contributed to distress surrounding pain management.
Secondly, study centered on participants’ pain management experiences with prescribed opioid analgesics. Participants felt they were receiving dosages and classes of analgesics that did not sufficiently address their pain, and consequently modified their dosages or rationed prescription opioids. Other participants were reluctant to take analgesics due to their history of illicit drug use. Some participants relapsed to illicit drug use when they felt their prescription opioids did not adequately address their pain needs. Participant struggles with receiving and managing prescribed opioid analgesics suggest a need for: therapies beyond these medications; guidelines for providers specific to this population; and harm reduction trainings for providers.
Acknowledgement
Author Sarina R. Isenberg, Allysha C. Maragh-Bass, Kathleen Ridgeway, Mary Catherine Beach and Amy R. Knowlton.
Journal J Opioid Manag.
URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5560049/pdf/nihms871159.pdf
| 3 | | R 455.00 | |
| | The effect of group exercise frequency on health-related quality of life in institutionalised elderly. | The effect of group exercise frequency on health-related quality of life in institutionalised elderly.
The effect of group exercise frequency on health-related quality of life in institutionalised elderly.
Overview
The study aimed to determine the effect of group exercise frequency on health related quality of life in institutionalized elderly. One hundred participants were recruited for voluntary participation from five aged care facilities, with inclusion being based on the outcome of a medical assessment by a sports physician. A quasi-experimental design was used to compare the effect of a 12 week group exercise programme on two groups of participants using pre-test and post-test procedures.
Mental health and social health benefits can be obtained irrespective of exercise frequency 2X/week or 3X/week. The exercise intervention at a frequency 3X/ week was more effective in improving mental component summary due to a larger effect size obtained compared to the exercise frequency of 2X/week. Additional benefits in vitality were achieved by exercising 3X/week. This may assist the elderly in preserving their independence.
Further targeted longitudinal intervention based studies are required to investigate the impact of intensity, frequency, duration and type of physical activity that is required to obtain mental and physical health benefits.
Acknowledgement
Author Nivash Rugbeer, Serela Ramklass, Andrew Mckune, Johan van Heerden
Journal
Pan African Medical Journal
Publisher
Cross Mark URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5398226/pdf/PAMJ-26-35.pdf
| 3 | | R 400.00 | |
| | Medical Ethics: Ethical considerations in forensic genetics research on tissue samples collected post-mortem in Cape Town, South Africa. | Medical Ethics: Ethical considerations in forensic genetics research on tissue samples collected post-mortem in Cape Town, South Africa.
Medical Ethics: Ethical considerations in forensic genetics research on tissue samples collected post-mortem in Cape Town, South Africa.
Overview
Background: The use of tissue collected at a forensic post-mortem for forensic genetics research purposes remains of ethical concern as the process involves obtaining informed consent from grieving family members. Two forensic genetics research studies using tissue collected from a forensic post-mortem were recently initiated at our institution and were the first of their kind to be conducted in Cape Town, South Africa.
Main body:
This article discusses some of the ethical challenges that were encountered in these research projects. Among these challenges was the adaptation of research workflows to fit in with an exceptionally busy service delivery that is operating with limited resources. Whilst seeking guidance from the literature regarding research on deceased populations, it was noted that next of kin of decedents are not formally recognised as a vulnerable group in the existing ethical and legal frameworks in South Africa. The authors recommend that research in the forensic mortuary setting is approached using guidance for vulnerable groups, and the benefit to risk standard needs to be strongly justified. Lastly, when planning forensic genetics research, consideration must be given to the potential of uncovering incidental findings, funding to validate these findings and the feedback of results to family members; the latter of which is recommended to occur through a genetic counsellor.
Conclusion:
It is hoped that these experiences will contribute towards a formal framework for conducting forensic genetic research in medico-legal mortuaries in South Africa.
Acknowledgement
Author:
Heathfield LJ, Maistry S, Martin LJ, Ramesar R, de Vries J
Journal:
BMC medical ethics.
Publisher:
BioMed Central
https://pdfs.semanticscholar.org/a296/54a617eda8491dcfbb8ed4a67556570de82a.pdf?_ga=2.232073119.1228022994.1520355887-1692294125.1520355887
| 3 | | R 370.00 | |
| | Relation Between Periodontal Status and Pre-Cancerous Condition (Oral Lichen Planus): A Pilot Study. | Relation Between Periodontal Status and Pre-Cancerous Condition (Oral Lichen Planus): A Pilot Study.
Relation Between Periodontal Status and Pre-Cancerous Condition (Oral Lichen Planus): A Pilot Study.
Overview
Objectives: The purpose of the study was to evaluate the periodontal status of OLP patients and compare it with that of healthy controls. Plaque control and rigorous oral hygiene are primary requisites for the treatment of any oro-mucosal disease.
Material and Methods:
Thirty patients with the erosive and reticular form of OLP as a study group and 30 healthy subjects as a control group were selected. The periodontal status of all subjects including gingival index (GI), Russell's periodontal index (PI) and bleeding on probing (BOP) were evaluated in both groups. Finally, the data was analyzed by a paired t-test using SPSS software v. 22.
Results:
The mean values of GI, PI and BOP were observed to be higher in the study group compared to the control group, and this was statistically significant (p < 0.05). The results shown are suggestive that periodontal status was poor in the study group as compared to the control group.
Conclusions:
Further studies need to investigate periodontal status in oral lichen planus patients with larger sample size, and careful follow-up of these will assure an increase in the quality of life of these patients. The patient should be informed regarding the risk of periodontal problems in OLP and should be advised to have regular dental checkups to avoid a worsening of the condition
Acknowledgement
Author:
Rai NP, Kumar P, Mustafa SM, Divakar DD, Kheraif AA, Ramakrishnaiah R, Vellapally S, Dalati MH, Parine NR, Anil S
Journal:
Advances in clinical and experimental medicine
Publisher:
Wroclaw Medical University
http://www.advances.umed.wroc.pl/pdf/2016/25/4/763.pdf
| 3 | | R 380.00 | |
| | Postoperative Pain in Children After Dentistry Under General Anesthesia. | Postoperative Pain in Children After Dentistry Under General Anesthesia.
Postoperative Pain in Children After Dentistry Under General Anesthesia.
Overview
The objective of this study was to determine the prevalence, severity, and duration of postoperative pain in children undergoing general anesthesia for dentistry. This prospective cross-sectional study included 33 American Society of Anesthesiology (ASA) Class I and II children 4-6 years old requiring multiple dental procedures, including at least 1 extraction, and/or pulpectomy, and/or pulpotomy of the primary dentition. Exclusion criteria were children who were developmentally delayed, cognitively impaired, born prematurely, taking psychotropic medications, or recorded baseline pain or analgesic use.
The primary outcome of pain was measured by parents using the validated Faces Pain Scale-Revised (FPS-R) and Parents' Postoperative Pain Measure (PPPM) during the first 72 hours at home. The results showed that moderate-to-severe postoperative pain, defined as FPS-R = 6, was reported in 48.5% of children. The prevalence of moderate-to-severe pain was 29.0% by FPS-R and 40.0% by PPPM at 2 hours after discharge. Pain subsided over 3 days. Postoperative pain scores increased significantly from baseline (P < .001, Wilcoxon matched pairs signed rank test). Moderately good correlation between the 2 pain measures existed 2 and 12 hours from discharge (Spearman rhos correlation coefficients of 0.604 and 0.603, P < .005).
In conclusion, children do experience moderate-to-severe pain postoperatively. Although parents successfully used pain scales, they infrequently administered analgesics.
Acknowledgement
Author:
Wong M, Copp PE, Haas DA
Journal:
Anesthesia progress
Publisher:
American Dental Society of Anesthesiology
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4675339/pdf/i0003-3006-62-4-140.pdf
| 3 | | R 450.00 | |
| | Medical Ethics: Sex differences in medico-legal action against doctors: a systematic review and meta-analysis. | Medical Ethics: Sex differences in medico-legal action against doctors: a systematic review and meta-analysis.
Medical Ethics: Sex differences in medico-legal action against doctors: a systematic review and meta-analysis.
Overview:
Methods: Studies reporting original data, written in English or French, examining the association between sex and medico-legal action against doctors were included. Two reviewers independently extracted study characteristics and outcome data from the full texts of the studies meeting the eligibility criteria. Study quality was assessed using the Newcastle-Ottawa scale. A random effect meta-analysis model was used to summarize and assess the effect of doctors' sex on medico-legal action. Extracted outcomes included disciplinary action by a medical regulatory board, malpractice experience, referral to a medical regulatory body, complaints received by a healthcare complaints body, criminal cases, and medico-legal matter with a medical defence organisation.
Results:
Overall, 32 reports examining the association between doctors' sex and medico-legal action were included in the systematic review (n=4,054,551), of which 27 found that male doctors were more likely to have experienced medico-legal action. 19 reports were included in the meta-analysis (n=3,794,486, including 20,666 cases). Results showed male doctors had nearly two and a half times the odds of being subject to medico-legal action than female doctors. Heterogeneity was present in all meta-analyses.
Conclusion:
Male doctors are more likely to have had experienced medico-legal actions compared to female doctors. This finding is robust internationally, across outcomes of varying severity, and over time.
Acknowledgement
Author:
Unwin E, Woolf K, Wadlow C, Potts HW, Dacre J
Journal:
BMC medicine.
Publisher:
Crossmark
https://bmcmedicine.biomedcentral.com/track/pdf/10.1186/s12916-015-0413-5?site=bmcmedicine.biomedcentral.com
| 3 | | R 400.00 | |
| | Denial of abortion in legal settings. | Denial of abortion in legal settings.
Denial of abortion in legal settings.
Overview
Background: Factors such as poverty, stigma, lack of knowledge about the legal status of abortion, and geographical distance from a provider may prevent women from accessing safe abortion services, even where abortion is legal. Data on the consequences of abortion denial outside of the US, however, are scarce.
Methods: In this article we present data from studies among women seeking legal abortion services in four countries (Colombia, Nepal, South Africa and Tunisia) to assess sociodemographic characteristics of legal abortion seekers, as well as the frequency and reasons that women are denied abortion care.
Results: The proportion of women denied abortion services and the reasons for which they were denied varied widely by country. In Colombia, 2% of women surveyed did not receive the abortions they were seeking; in South Africa, 45% of women did not receive abortions on the day they were seeking abortion services. In both Tunisia and Nepal, 26% of women were denied their wanted abortions.
Conclusions: The denial of legal abortion services may have serious consequences for women's health and wellbeing. Additional evidence on the risk factors for presenting later in pregnancy, predictors of seeking unsafe illegal abortion, and the health consequences of illegal abortion and childbirth after an unwanted pregnancy is needed. Such data would assist the development of programmes and policies aimed at increasing access to and utilisation of safe abortion services where abortion is legal, and harm reduction models for women who are unable to access legal abortion services.
Acknowledgement
Author:
Gerdts C, DePiñeres T, Hajri S, Harries J, Hossain A, Puri M, Vohra D, Foster DG
Journal:
The journal of family planning and reproductive health care.
Publisher:
BMJ Publishing Group Limited | 3 | | R 420.00 | |
| | Annals of Internal Medicine: Patient Safety Strategies Targeted at Diagnostic Errors. | Annals of Internal Medicine: Patient Safety Strategies Targeted at Diagnostic Errors.
Annals of Internal Medicine: Patient Safety Strategies Targeted at Diagnostic Errors.
OVERVIEW
It is apparent that missed, delayed or incorrect diagnosis can lead to inappropriate patient care, poor patient outcome and increased cost. An operational definition of diagnostic errors include diagnosis that are either unintentionally delayed, wrong or missed.
This study was therefore a systematic review aimed at analysing evaluations of interventions to prevent diagnostic errors. Data for this research was however collected through searches from MEDLINE (1966 to October 2012), the Agency for Healthcare Research and Quality’s Patient Safety Network, bibliographies, and prior systematic reviews. During the study, two independent reviewers extracted study data and rated study quality. There were 109 studies that addressed 1 or more interventions such as personnel changes.
The interventions included educational interventions, technique, structured process changes, technology-based systems interventions as well as review methods. However, evidence seemed strongest for technology-based systems (e.g., text message alerting) as well as specific techniques like testing equipment adaptations.
ACKNOWLEDGEMENT
AUTHOR: Kathryn M. McDonald MM, Brian Matesic BS, Despina G. Contopoulos-Ioannidis MD, Julia Lonhart BS BA, Eric Schmidt BA, Noelle Pineda BA, and John P.A. Ioannidis MD DSc
JOURNAL: Annals of Internal Medicine
PUBLISHER: ACP
URL: https://www.acponline.org/ | 3 | | R 400.00 | |
| | Creating a Culture of Mindfulness in Medicine. | Creating a Culture of Mindfulness in Medicine.
Creating a Culture of Mindfulness in Medicine.
OVERVIEW
It is becoming increasingly complex to provide primary care since there is always the need to frequently address multiple medical issues at each patient visit. However, well-documented challenges faced by primary care clinicians have brought growing awareness to the issues of physician wellness and burnout and the potential subsequent impact on patients.
Thus, the objective of this study was to promote the cultivation of mindful awareness throughout our health system, creating a culture of mindfulness in medicine. During this research, a systems-level strategy was developed to promote health and resilience for clinicians and patients by preparing a group of clinician leaders to serve as catalysts to practice and teach mindfulness. The strategy nonetheless included three major steps, namely: (1) Select 5 primary care leaders to help foster mindful¬ness within both health care delivery and education; (2) Provide funds for these leaders to attend advanced mindfulness training designed specifically for clinicians; and (3) Foster mindfulness within our health system and beyond via collaborative planning meetings and seed money for implemen¬tation of projects.
Results indicated that all 5 leaders endorsed the personal value of the mindfulness training, with some describ¬ing it as life-changing.
ACKNOWLEDGEMENT
AUTHOR: Charlene Luchterhand, David Rakel, Cynthia Haq, Lisa Grant, DO, Angela Byars-Winston, Steve Tyska, Kathleen Engles,
JOURNAL: Health Innovations
PUBLISHER: Health Policy Publishing
URL: http://www.healthpolicypublishing.com
| 3 | | R 400.00 | |
| | Development and Validation of a New Prognostic System for Patients with Hepatocellular Carcinoma. | Development and Validation of a New Prognostic System for Patients with Hepatocellular Carcinoma.
Development and Validation of a New Prognostic System for Patients with Hepatocellular Carcinoma.
OVERVIEW
Liver Cancer is the sixth most common type of cancer in the world. It is equally the second most common cause of cancer death in the world. However, prognostic assessment in patients with hepatocellular carcinoma (HCC) remains controversial. Thus, this study sort to develop and validate a new prognostic system for patients with HCC using the Italian Liver Cancer (ITA.LI.CA) database.
During this study, ITA.LI.CA stages were first of all defined using only tumor characteristics. A parametric multivariable survival model was then used to calculate the relative prognostic value of ITA.LI. However, The ITA.LI.CA integrated prognostic score showed optimal discrimination and calibration abilities in Italian patients. Findings from this study further revealed that observed as well as predicted median survival in the training and internal validation sets largely coincided.
The study equally concluded that the ITA.LI.CA prognostic system shows a strong ability to predict individual survival in European and Asian population.
ACKNOWLEDGEMENT
AUTHORS: Fabio Farinati1, Alessandro Vitale1, Gaya Spolverato, Timothy M. Pawlik, TehlaHuo Yun-Hsuan Lee, Anna Chiara Frigo, Anna Giacomin, Edoardo G. Giannini, Francesca Ciccarese, Fabio Piscaglia, Gian Lodovico Rapaccini, Mariella Di Marco, Eugenio Caturelli, Marco Zoli, Franco Borzio, Giuseppe Cabibbo, Martina Felder, Rodolfo Sacco, Filomena Morisco, Elisabetta Biasini, Francesco Giuseppe Foschi, Antonio Gasbarrini, Gianluca Svegliati Baroni, Roberto Virdone, Alberto Masotto, Franco Trevisani, Umberto Cillo1, ITA.LI.CA study group
JOURNAL: PLOS Medicine
PUBLISHER: Public Library of Sciences (PLOS)
URL: https://www.plos.org | 3 | | R 330.00 | |
| | Ebola Virus Disease: Clinical Review. | Ebola Virus Disease: Clinical Review.
Ebola Virus Disease: Clinical Review.
Overview
Ebola transmission may occur as a result of close contact with body fluids of infected patients. The incubation period for Ebola after infection is said to be 5-9 days, with a range of 1-21 days in 95% or more of patients,2 3 with the patients not considered infectious until they develop symptoms.
This article is therefore a clinical review whose objective is to investigate what makes the differential diagnosis of Ebola broad. This article therefore examines the causes of the Ebola virus as we as the pathophysiology of this infection. This article equally went further to examine the infection prevention and control measures are used to curb the spread of Ebola from one country to another.
The hypothesis here was that there is high likelihood of infected people travelling, thus, all countries are expected to have tested and practiced protocols ready for screening and managing Ebola patients. Of course the article also outlined some of the clinical features as well as the symptoms of the virus.
ACKNOWLEDGEMENT
AUTHORS: Nicholas J Beeching, Manuel Fenech, Catherine F Houlihan
JOURNAL: BMJ Open
PUBLISHER: The BMJ group
URL: http://www.bmj.com | 3 | | R 400.00 | |
| | First Aid Course. | First Aid Course.
Dr Cyril Harrisberg.
This self taught Course and Tutorial is designed for Medical or Non Medical Professionals, and will teach vital medical and immediate practical steps to be taken when administering First Aid, or in an Emergency Medical Situation. It can be used by Non Medical Professionals or personnel, or as a refresher for those Medically Trained or in the allied health professions. It can be self taught as a stand alone tutorial, although practise of the maneuvers would add further benefit. | 3 | | R 330.00 | |
| | Hearing Loss in Workers Exposed to Epoxy Adhesives and Noise. | Hearing Loss in Workers Exposed to Epoxy Adhesives and Noise.
Hearing Loss in Workers Exposed to Epoxy Adhesives and Noise.
OVERVIEW
Organic solvents are heavily used in industries and there are evidences that exposure to organic solvents has hazardous effects on hearing. Yet, the effects of organic solvents on hearing are difficult to evaluate. The reason is that workers are usually exposed to a mixture of solvents with widely varying compositions and concentrations. However, the objective of this cross-sectional study was thus to investigate the risk of hearing loss among workers exposed to epoxy adhesives and noise.
During the study, 182 stone workers who were exposed to both epoxy adhesives and noise were recruited. Other participants of the study composed of 89 stone workers who were exposed to noise only, and 43 workers from the administrative staff who had not been exposed to adhesives or noise. The demographic data, occupational history as well as the medical history of participants were obtained through face to-face interviews, arranged physical examinations as well as through pure-tone audiometric tests.
Results from the study however indicated that epoxy adhesives exacerbate hearing impairment in noisy environments, with the main impacts occurring in the middle and high frequencies.
ACKNOWLEDGEMENT
AUTHORS: Hsiao-Yu Yang, Ruei-Hao Shie, Pau-Chung Chen
JOURNAL: Journal of Epidemiology and Community Health
PUBLISHER: BMJ Open Group
URL: http://www.group.bmj.com
| 3 | | R 335.00 | |
| | Influence of work-related psychosocial factors on the prevalence of chronic pain and quality of life in patients with chronic pain. | Influence of work-related psychosocial factors on the prevalence of chronic pain and quality of life in patients with chronic pain.
Influence of work-related psychosocial factors on the prevalence of chronic pain and quality of life in patients with chronic pain.
OVERVIEW
Chronic pain among workers is not only an economic burden but also a major public health concern. Working is also a cause of chronic pain although most people need to continue working despite the pain to make a living except they get a sick leave or retirement.
The hypothesis of this study was that the therapeutic effect of vocational rehabilitation may depend on psychosocial factors related to the workplace. Thus, the aim of the study was to test this hypothesis as well as examine the association of work-related psychosocial factors with the prevalence of chronic pain or health related quality of life (HRQoL) among workers with chronic pain. During this study, 1764 workers aged 20–59 years were examined in the pain-associated cross-sectional epidemiological survey in Japan.
The outcomes of this study were chronic pain prevalence among all workers and low Euro QoL prevalence among workers with chronic pain according to the degree of workplace social support and job satisfaction. One of the significant results of this study was that chronic pain prevalence was higher among males reporting job dissatisfaction compared with those reporting job satisfaction.
ACKNOWLEDGEMENT
AUTHORS: Keiko Yamada, Ko Matsudaira, Hironori Imano, Akihiko Kitamura, Hiroyasu Iso
JOURNAL: Esmo Open: Cancer Horizons
PUBLISHER: BMJ Group
URL: https://www.bmjopen.bmj.com | 3 | | R 360.00 | |
| | Medical Ethics: A Private Right Called Bill. | Medical Ethics: A Private Right Called Bill.
Medical Ethics: A Private Right Called Bill.
OVERVIEW
Privacy is defined by a number of English dictionaries as the quality or condition of being secluded from the presence or view of others. More appropriately privacy is also defined as’ the state of being free from unsanctioned intrusion’.
In 2014, with the advent information technology advances, social networking, sale of database information and negligent protection of personal information, in general, amongst others, the necessity to protect personal and private information has been recognized by the law makers. As such, protection of personal information has been incorporated in various forms of legislation, including the SA Constitution, The Patients’ Rights Charter, the Health Professions Act and the very recent Protection of Personal Information Act (POPI).
The Health Professions Council obligates all registered practitioners to comply with Continuing Professional Development (CPD). The importance of Ethics, Human Rights and Medical Law is emphasized. This article thus encompasses all three in the form of an overview related to the respect for privacy. Of significance is the Bill of Rights.
| 6 | | R 650.00 | |
| | Medical Ethics: Communication in the Doctor Patient Relationship. | Medical Ethics: Communication in the Doctor Patient Relationship.
Medical Ethics: Communication in the Doctor Patient Relationship.
OVERVIEW
The word ‘communication’ is derived from the Latin, ‘communis’ meaning ‘commonness’. In essence, effective communication is the establishment of a common frame of reference between practitioner and patient i.e. ‘all on the same page‘.
At least as long ago as the writing of the Hippocratic Oath, it was well understood that physicians’ communication with their patients was an essential part of successful therapy. The relationship between a practitioner and patient should be based upon trust, which develops primarily through communication. In much of health care, accurate diagnosis and appropriate treatment depend upon the patient’s truthful and complete disclosure of personal health information.
Communication is also a process involving the ‘transmitter’ and receivers. These roles, with particular reference to the practitioner/patient relationship, are interchangeable. There are skills required as there are ethical considerations. | 6 | | R 420.00 | |
| | Medical Ethics: Decision Making in a Professional Practice. | Medical Ethics: Decision Making in a Professional Practice.
Medical Ethics: Decision Making in a Professional Practice.
OVERVIEW
The terms "Ethics" and "Morals" are derived respectively from the Greek and Latin words for "customs, practices and rituals", and what ethicist Robert Bellal has called "the habits of the heart".
Although customs may appear to be superficial behaviors, they often reflect the society's deepest, conscious sense of right and wrong. Ethics as a discipline is the study and analysis of values and standards related to duty, responsibility and right and wrong behaviour.
The obligations that health care professionals have towards their patients, each other and society, derive from ethical values held by the Practitioners discipline and the larger community. Since the time of Hippocrates, some of the more important moral values in health care have included trust, respect for life, benefiting others, avoiding harm to others, confidentiality and collegiality. Reflection of ethical issues is an essential compliment to the professional's specialised knowledge and skills in meeting basic human needs.
| 6 | | R 430.00 | |
| | Medical Ethics: Healthcare Professional’s Patient Relationship. | Medical Ethics: Healthcare Professional’s Patient Relationship.
Medical Ethics: Healthcare Professional’s Patient Relationship.
OVERVIEW
This online course discusses respect and equal treatment; ending a patient-HP relationship; HIV/Aids; sexual attraction; treating family members; communication and consent with a case study included; obstacles for good communication plus case study; abusing medical resources including case study; futile treatment.
The health care profession-patient relationship is the cornerstone of medical practice and therefore of medical ethics. The Declaration of Geneva requires of the health care profession that “The health of my patient will be my first consideration,” and the International Code of Medical Ethics states, “A health care profession shall owe his patients complete loyalty and all the resources of his science.” The traditional interpretation of the health care professional-patient relationship as a paternalistic one, in which the health care professional made the decision and the patient submitted to them, has been widely rejected in recent years, both in ethics and in law.
Since many patients are either unable or unwilling to make decisions about their medical care, however, patient autonomy is often very problematic. This on-line course will deal with two topics that pose particularly vexing problems to Health Care Professionals in their daily practice: respect and equal treatment, communication and consent.
| 6 | | R 630.00 | |
| | Medical Ethics: How parents and practitioners experience research without consent involving Children with life threatening conditions. | Medical Ethics: How parents and practitioners experience research without consent involving Children with life threatening conditions.
Medical Ethics: How parents and practitioners experience research without consent involving Children with life threatening conditions.
INTRODUCTION
Improvements to life-saving treatments for critically ill children have been limited by the ethical and practical challenges involved in seeking consent for clinical trial entry.1 The process of seeking informed consent requires time, but this is severely constrained in emergency situations, such as acute resuscitation and critical care,2 where even minimal treatment delays are likely to be harmful.3 Parents are not always present when a child requires emergency treatment or a mother of a critically ill neonate may be sedated. Children’s critical care set-tings are intensely emotional, and some parents may not wish to be approached about research when their child is critically ill.4 Such challenges pose dif?culties for doctors and nurses recruiting to clinical trials in ensuring that parental consent has been informed, the participation voluntary and the recruitment process adhered to ethical principles.5 The last decade has seen inter-national efforts to ?nd alternatives to prospective informed consent so that vital research can continue to advance evidence-based children’s medicine.1 | 6 | | R 635.00 | |
| | Medical Ethics: The Truth Be Told. | Medical Ethics: The Truth Be Told.
Medical Ethics: The Truth Be Told.
OVERVIEW
“We're having a little problem with lying at my house: My son won't do it”. "Do you like my new car?" asks his work colleague. My son is paralyzed into muteness by his conscience. His friend is hurt. "Couldn't you find something nice to say about it, like the colour?" I ask. I am thinking of the story about Judy Garland, who, after seeing a pal in a terrible play, swept into her friend's dressing room with the line, "How do you do it, my dear, night after night?"
The philosopher Immanuel Kant argued that truth-telling is a "perfect duty," one so basic that it cannot be overridden by other values—not even saving the life of a friend, let alone sparing someone's feelings. In Kant's formulation, if asked outright, a person would be obligated to tell a murderer the whereabouts of his intended victim. Of course, many have responded to Kant with penetrating philosophical counter-arguments
Philosophers Maguire and Fargnoli use Kant's stance on lying to explore the limits of the quest for universal moral principles. "Universalization is an unrealistic and inaccurate abstraction that passes over the fact that there are exceptions to valid moral principles," they write. "To protect other values, like the life of an intended victim or a legitimate secret, exceptions to truth-telling must be made." | 6 | | R 650.00 | |
| | Medical Ethics: Uninformed Consent. | Medical Ethics: Uninformed Consent.
Medical Ethics: Uninformed Consent.
OVERVIEW
There is an argument put forward by medical schemes, administrators and their agents that access to record cards of patients is an automatic right as members of medical schemes, when joining a medical scheme, acknowledge that they are obligated to adhere to the scheme rules which includes provision of personal information; hence consent has been granted.
Importantly, the HPCSA Ethical Rules and recently introduced legislation such as the Protection of Private Information Act dictate that express informed consent must be obtained prior to the performance of professional acts or sharing of personal information.
Consent, therefore based on an assumption or in the absence of express informed consent can only be regarded as uninformed consent. This includes implied consent whereby a patient pitches for an examination or sits in the chair and interpreted by the practitioner as consent.
| 6 | | R 440.00 | |
| | Medical Ethics: What Do International Ethics Guidelines Say In Terms of The Scope of Medical Research Ethics | Medical Ethics: What Do International Ethics Guidelines Say In Terms of The Scope of Medical Research Ethics
Medical Ethics: What Do International Ethics Guidelines Say In Terms of The Scope of Medical Research Ethics
OVERVIEW
The question of ‘which is an ethical issue and which is not’ often arises doing research ethics. There are however many internationally known ethic guidelines and depending on which ethics guideline we consult, we may have various answers to this question. It is however ironical that we do not have a harmonized document which tells us what these various guidelines say and shows us the areas of consensus.
For this study, we extracted relevant information or imperatives from five internationally-known ethics guidelines and took note where the imperatives came from. Results of this research nonetheless indicated that there is no consensus on many of the imperatives and that in only 8.2 % of the imperatives were there at least moderate consensus. The results further indicated that there was a lack of consensus in most of imperatives from the five internationally-known ethics guidelines.
The reason was however partly attributed to the differences among the guidelines in terms of their levels of specification as well as conceptual/ideological differences.
ACKNOWLEDGEMENT
AUTHORS: Rosemarie D. L. C. Bernabe, Ghislaine J. M. W. van Thiel and Johannes J. M. van Delden
JOURNAL: BMC Medical Ethics
PUBLISHER: BioMed Central
URL: https://www.biomedcentral.com
| 6 | | R 425.00 | |
| | Occupational science: An important contributor to occupational therapists’ clinical reasoning | Occupational science: An important contributor to occupational therapists’ clinical reasoning
Occupational science: An important contributor to occupational therapists’ clinical reasoning
Overview
Occupational science has a strong influence in the theoretical as well as research based knowledge within occupational therapy. More so, various studies have revealed that the contributions from occupational science are also reflected in clinical reasoning which is a key occupational therapy competence. Clinical reasoning is also considered as an important element of health professional practice as it provides a link between research and practice.
The purpose of this research is for occupational therapists to strive hard to develop their knowledge of occupational science literature and clinical reasoning competence. Thus, the objective of this research is therefore to debate and discuss ways in which occupational science could contribute even further to occupational therapists’ clinical reasoning and inform the occupational therapy curriculum.
After analyzing different point of views of various occupational therapist, it was concluded that more research on the meanings of occupations is important for occupational therapy as a health care profession. It was equally recommended that the subsequent researches should include explorations of the relationship between occupation and development, how occupation changes over the lifespan, how people organize and engage in their daily occupations, as well as the personal and sociocultural meanings of occupation.
ACKNOWLEDGEMENT
AUTHORS: Hanne Kaae Kristensen & Kirsten Schultz Petersen
JOURNAL: Scandinavian Journal of Occupational Therapy
PUBLISHERS: Tylor & Francis Group
URL: http://dx.doi.org/10.3109/11038128.2015.1083054
| 3 | | R 425.00 | |
| | Placebo effects in trials evaluating 12 selected minimally invasive interventions: a systematic review and meta-analysis. | Placebo effects in trials evaluating 12 selected minimally invasive interventions: a systematic review and meta-analysis.
Placebo effects in trials evaluating 12 selected minimally invasive interventions: a systematic review and meta-analysis.
OVERVIEW
The objective of this study was to analyse the impact of placebo effects on outcome in trials of selected minimally invasive procedures and to assess reported adverse events in both trial arms. The design for this study was nonetheless a systematic review and meta-analysis.
The data for this study was selected by searching MEDLINE and Cochrane library so as to identify systematic reviews of musculoskeletal, neurological and cardiac conditions that were published between January 2009 and January 2014 comparing selected minimally invasive with placebo (sham) procedures. During this research, effect sizes (ES) in the active and placebo arms in the trials’ primary and pooled secondary end points were calculated. The association between end points in the active and sham groups were nevertheless analysed using the linear regression.
This study was however concluded that the generally small differences in ES between active treatment and sham suggest that nonspecific mechanisms, including placebo, are major predictors of the observed effects
ACKNOWLEDGEMENT
AUTHOR: Robin Holtedahl, Jens Ivar Brox, Ole Tjomsland
JOURNAL: Stroke and Vascular Neurology
PUBLISHER: BMJ Open
URL: http://bmjopen.bmj.com/ | 3 | | R 375.00 | |
| | Retrospective analysis of the quality of reports by author-suggested and non-author-suggested reviewers in journals operating on open or single-blind peer review models. | Retrospective analysis of the quality of reports by author-suggested and non-author-suggested reviewers in journals operating on open or single-blind peer review models.
Retrospective analysis of the quality of reports by author-suggested and non-author-suggested reviewers in journals operating on open or single-blind peer review models.
OVERVIEW
The three types of peer review models mostly operated by scholarly journals include single blind, where the reviewers know the identity of the authors but not vice versa; open peer review, where authors and reviewers both know each other’s identity, and finally, the double-blind peer review where the author and reviewer names are both blinded.
The objective of this research was to assess whether reports from reviewers recommended by authors show a bias in quality and recommendation for editorial decision, compared with reviewers suggested by other parties, and whether reviewer reports for journals operating on open or single-blind peer review models differ about report quality and reviewer recommendations. The design of this study was nonetheless, a retrospective analysis of the quality of reviewer reports using an established Review Quality Instrument, and analysis of reviewer recommendations and author satisfaction surveys.
The samples used for this research were two hundred reviewer reports submitted to BMC Infectious Diseases, 200 reviewer reports submitted to BMC Microbiology and 400 reviewer reports submitted to the Journal of Inflammation.
ACKNOWLEDGEMENT
AUTHORS: Maria K Kowalczuk, Frank Dudbridge, Shreeya Nanda, Stephanie L Harriman, Jigisha Patel, Elizabeth C Moylan
JOURNAL: Communication Research
PUBLISHER: BMJ Open
URL: http://bmjopen.bmj.com | 3 | | R 355.00 | |
| | Systematic review of prognostic models for recurrent venous thromboembolism (VTE) post-treatment of first unprovoked VTE. | Systematic review of prognostic models for recurrent venous thromboembolism (VTE) post-treatment of first unprovoked VTE.
Systematic review of prognostic models for recurrent venous thromboembolism (VTE) post-treatment of first unprovoked VTE.
OVERVIEW
Venous thromboembolism (VTE) is a chronic condition with estimated incidence at 1 per 1000 person years. In fact, it is the third most common cardiovascular disease after heart attack.
This condition often presents as deep vein thrombosis (DVT), with some patients suffering an embolism in the lungs known as a pulmonary embolism. Therefore, the objective of this study was to review studies developing or validating a prognostic model for individual venous thromboembolism (VTE) recurrence risk following cessation of therapy for a first unprovoked VTE0. This review basically aims at determining whether reliable prognostic models exist and, if not, what further research is needed within the field.
For this study, bibliographic databases including MEDLINE, EMBASE and the Cochrane Library were searched using index terms relating to the clinical field and prognosis.by the end of the study, 3 unique prognostic models were identified including the HERDOO2 score, Vienna prediction model and DASH score.
ACKNOWLEDGEMENT
AUTHORS: Joie Ensor, Richard D Riley, David Moore, Kym E Snell, Susan Bayliss, David Fitzmaurice
JOURNAL: BMJ Open
PUBLISHER: BMJ Gourp
URL: http://bmjopen.bmj.com | 3 | | R 325.00 | |
| | Understanding quit decisions in primary care: a qualitative study of older GPs | Understanding quit decisions in primary care: a qualitative study of older GPs
Understanding quit decisions in primary care: a qualitative study of older GPs
OVERVIEW
The UK, notably England faces a major and imminent problem in respect of general practitioner (GP) workforce capacity. According to a recent work survey, 54.1% of GPs aged 50 years and older reported a ‘considerable’ or ‘high’ likelihood of quitting direct patient care within 5 years.
The objective of this study was to investigate the reasons behind intentions to quit direct patient care among experienced general practitioners (GPs) aged 50–60 years. This research was a qualitative study based on semi structured interviews with GPs in the South West region of England. The participants for this study were 23 GPs aged 50–60 years. 3 of these GPs had retired from direct patient care before the age of 60, meanwhile 20 intended to quit direct patient care within the next 5 years.
Conclusively, this research highlights aspects of the current professional climate for GPs that are having an impact on retirement decisions.
ACKNOWLEDGEMENT
AUTHORS: Anna Sansom, Raff Calitri, Mary Carter, John Campbell
JOURNAL: Journal of General Practice
PUBLISHER: BMJ Group
URL: http://bmjopen.bmj.com | 3 | | R 360.00 | |
| | What Drives Quality Improvement in Chronic Kidney Disease in Primary Care. | What Drives Quality Improvement in Chronic Kidney Disease in Primary Care.
What Drives Quality Improvement in Chronic Kidney Disease in Primary Care.
OVERVIEW
Chronic kidney disease (CKD) is increasingly becoming a public health issue because it’s very common. More so, CKD is an established, independent risk factor for cardiovascular disease and there are indications that a significant number of patients with CKD die from cardiovascular complications than progress to end-stage kidney disease.
This study was process of evaluating the Quality Improvement in Chronic Kidney Disease (QICKD) study, comparing audit-based education (ABE) and sending clinical guidelines and prompts (G&P) with usual practice, in improving systolic blood pressure control in primary care. This study however took place in 4 primary care practices in England (2received ABE, and 2 G&P). The participants of this study were focus groups conducted with staff from each of the 4 primary care practices.
Based on results of the study, it was concluded that improving quality in CKD is complex. The results also indicated that lack of awareness of clinical guidelines and scepticism about their validity are barriers to change.
ACKNOWLEDGEMENT
AUTHORS: Akin Nihat, Simon de Lusignan, Nicola Thomas, Mohammad Aumran Tahir, Hugh Gallagher
JOURNAL: General Practice
PUBLISHER: BMJ Open
| 3 | | R 365.00 | |
| | Zika Virus Outbreak in Rio de Janeiro, Brazil. | Zika Virus Outbreak in Rio de Janeiro, Brazil.
Zika Virus Outbreak in Rio de Janeiro, Brazil.
OVERVIEW
Brazil was faced with the cocirculation of three above viruses of major public health importance in the year 2015. The emergence of the Zika (ZIKV) virus however brought about serious public health challenges to both public health authorities and clinicians.
It is however imperative to note that clinical features between diseases caused ZIKV, Dengue (DENV) and Chikungunya (CHIKV) as well as the lack of validated serological assays for ZIKV makes accurate diagnosis difficult. This article was therefore the firs published description of the outbreak of Zika virus in Latin America. Recent findings about Zika virus suggest that in a minority of ZIKV cases, neurological diseases can develop and that babies born from mothers with a ZIKV-illness during pregnancy could suffer from congenital abnormalities such as a small brain or a small head.
After analysing the virus, it was then suggested that the clinical characteristics of both the confirmed and the unconfirmed cases proved to be very similar.
ACKNOWLEDGEMENT
AUTHORS: Patricia Brazil et al
JOURNAL: PLOS Negleted Tropical Disease
PUBLISHER: PLOS
URL: http://journals.plos.o | 3 | | R 375.00 | |