| | Medical Ethics: The Delinquent Patient | Medical Ethics: The Delinquent Patient
Medical Ethics: The Delinquent Patient
Patients are the lifeblood of a practice, considering that no practice can survive without patients. If you have a service that no patient is willing to pay for, you will never have a stable practice. Patients pay the bills and provide opportunities for your practice to grow.
However, sometimes patients are encountered in practice, who make the lives of the practitioner and staff miserable. Difficult patients can leave you and your staff angry, empty, and frustrated. The way difficult patients are handled will define the quality of the patient experience. Not knowing how to deal with difficult patients may lead to low staff morale, low patient volume and a damaged practice reputation.
At times, managing difficult patients can hinder your ability to get your work done. But if handling difficult patients is seen as an opportunity rather than trouble, you may find that you can strengthen your patient service skills while retaining their business.
Practicing medicine in your own private practice requires a fine balance between caring for patients and running a business. Harry Rosen | 3 | | R480.00 |  |
| | Medical Ethics: Embelishment and Exaggeration in Practice | Medical Ethics: Embelishment and Exaggeration in Practice
Medical Ethics: Embelishment and Exaggeration in Practice
Overview
“I am so hungry I could eat a horse.” “This ice cream is out of this world.”
Exaggeration is common in everyday language, and phrases such as those stated above are well known. Embellishing stories about one's accomplishments or qualifications, whether by exaggeration or misstatement, is part of human nature, experts say, and almost everyone is guilty of it at one time or another. Left unchecked, however, exaggerations that seemed innocuous at first can result in serious, potentially career-ending consequences.
Thanks to the Internet, it is easier than ever to get caught in an exaggeration, experts and others note. But the temptation to embellish has also never been greater, as recession-weary workers feel pressured to justify their worth and a 24-hour news cycle demands that leaders have an immediate, sound-bite-ready answer for everything. If you are prone to exaggeration, however, this could mean that you habitually overstate the truth.
This article examines exaggeration in all its guises but with a particular reference to the risks and responsibilities of a health care provider.
Harry Rosen
| 3 | | R485.00 | |
| | Medical Ethics: Ethical Challenges: Beyond Covid | Medical Ethics: Ethical Challenges: Beyond Covid
Medical Ethics: Ethical Challenges: Beyond Covid
Overview
“Ethical challenges will intensify as the pandemic wanes”.
The disruptions caused by COVID-19 have heightened the risk of unethical behaviour in different sectors, including in healthcare, where trust is our lifeblood. We’ve seen an outbreak of misinformation during the pandemic, ranging from fake cures, false claims, and harmful health advice. We’ve seen bad-acting opportunists take advantage to trade illegitimate or non-compliant products.
For the past two and a half years, the world has been duly tested by the challenges resulting primarily from the COVID-19 pandemic. In response, health care providers have shown tremendous resilience. However, as jurisdictions around the world progressed toward a more hopeful future, the ethical challenges health care providers face are far from over.
In fact, they might intensify.
As the pandemic fades, but taking cognisance of continued threats such as the ‘5th and 6th wave’ in South Africa, many entities as well as individuals will be eager to demonstrate their potential by posting quick wins and an accelerating recovery. Others will continue to navigate the intricacies of government support schemes, and, as those taper, some entities will find themselves on the brink of insolvency. Just as the economic impacts of this crisis unfolded in an uneven and unpredictable manner around the world, so too will recovery efforts. Health care providers must anticipate a continued period of heightened uncertainty and prioritize their ethical responsibilities all the more.
Harry Rosen | 3 | | R425.00 | |
| | Medical Ethics: The Rule of Law in Turbulent Times | Medical Ethics: The Rule of Law in Turbulent Times
Medical Ethics: The Rule of Law in Turbulent Times
Overview
Primarily, as a result of the advent of Covid, planet Earth has been thrown off its axis. South Africa is no exception, with the added aggravation and devastation due to looting, floods, etc.
The consequences to practitioners, practice staff, families and patients have been immeasurable.
Within this turmoil, there have been an avalanche of diverse factors and forces introduced into the healthcare arena, that, in way or another, impact or have the potential to impact on practices.
These factors are discussed in this study.
Harry Rosen
| 3 | | R485.00 | |
| | Medical Ethics: Ethical Pitfalls in Practice | Medical Ethics: Ethical Pitfalls in Practice
Medical Ethics: Ethical Pitfalls in Practice
Overview
We live in a world where we face challenges daily. In technical terms, Ethical Pitfalls relate to that field of research, within the ambit of behavioural ethics , which focuses on how people behave when they're confronted with dilemmas and respond in ways that contradict their values, without even knowing they're doing it. In essence, the conduct of practitioners or staff may knowingly or unknowingly transgress existing ethical boundaries.
In practical terms, when an activity in a practice environment conflicts with moral human principles and affects individuals involved working within the practice, it becomes an ethical issue. While regulator-enforced rules can hold employees and employers accountable for lawbreaking conduct, they can't entirely prevent individuals from acting unethically. Thus, it is the responsibility of the practice owner to address ethical concerns and establish clear guidelines. This coursed discusses this ethical issue.
Harry Rosen
| 3 | | R465.00 | |
| | Medical Ethics - Ethics in Practice | Medical Ethics - Ethics in Practice
Medical Ethics - Ethics in Practice
Overview Ethical issues in a practice environment can be a difficult challenge to navigate for any practice owner. Though there are laws and statutes that exist to hold workers and employers accountable, these alone do not entirely deter employees from behaving unethically. Avoiding ethical issues in the practice always starts with top management. Providing clearly written policies and processes that ensure those policies are both acknowledged and adhered to, can ensure transparency and ethical practices are applied. To effectively detect and, most importantly, deter ethical issues in practice from surfacing in your organization, there are several everyday efforts you can take. Be sure to communicate and enforce a robust code of ethics when making decisions and ask the same of your employees. Remain aware of the discrimination laws that exist in your region. Stay informed on the rules that impact your industry, and ensure your organization is acting in compliance with those regulations. Collaborate with accountants, maintaining transparency and honesty in your financial reports. Be present in your company, making sure your organization and employees alike are always doing the right and ethical thing.
Authors Harry Rosen | 3 | | R460.00 | |
| | Medical Ethics: Professional Practice: A Moral Enterprise | Medical Ethics: Professional Practice: A Moral Enterprise
Medical Ethics: Professional Practice: A Moral Enterprise
Overview Practice as a health care professional is based upon a relationship of mutual trust between patients and health care practitioners. From the perspective of the Health Professions Council of South Africa (HPCSA), to be a good health care practitioner, requires a life-long commitment to sound professional and ethical practices and an overriding dedication to the interests of one’s fellow human beings and society. In essence, the practice of health care professions is considered a moral enterprise. In this spirit the HPCSA presents ethical guidelines to guide and direct the practice of health care practitioners, primarily to protect the public. These guidelines form an integral part of the standards of professional conduct against which a complaint of professional misconduct is evaluated. Conducting business ethically is critical to a company’s success in the marketplace. Customers, suppliers and employees will not support a company that is involved in fraudulent, dishonest or unethical practices. Setting high standards of integrity in business relations and promoting their adherence by employees will enable the company to merit the confidence and support of its customers and the public at large.
Author Harry Rosen
| 3 | | R425.00 | |
| | Medical Ethics: Ethical frameworks for complex medical decision making in older patients: A narrative review | Medical Ethics: Ethical frameworks for complex medical decision making in older patients: A narrative review
Medical Ethics: Ethical frameworks for complex medical decision making in older patients: A narrative review
Overview With an ageing population, physicians are more and more faced with complex medical and moral situations. Medical professional guidelines are often of limited use in these cases. To assist the decision-making process, several ethical frameworks have been proposed. Ethical frameworks are analytical tools that are designed to assist physicians and other involved healthcare workers in complex moral decision-making situations. Most frameworks are step-by-step plans that can be followed chronologically during moral case deliberations. Some of these step-by-step plans provide specific moral guidance as to what would constitute a morally acceptable conclusion, while others do not. In this narrative review we will present and discuss the ethical frameworks used for medically complex situations in older people that have been proposed in literature. Twenty-three studies were included in the review, containing seventeen different frameworks. Twenty studies described step-by-step-frameworks, with the number of steps varying from three to twelve. In four studies suggestions were made as how to balance conflicting moral values. Ethical frameworks are meant to assist healthcare professionals who are faced with morally complex decisions in older patients. In our view, these frameworks should contain a step-by-step plan, moral values and an approach to balancing moral values.
Acknowledgements: Authors Rozemarijn Lidewij van Bruchem-Visser, Gert van Dijk, Inez de Beaufort, Francesco Mattace-Raso Journal Archives of Gerontology and Geriatrics | 3 | | R465.00 | |
| | Medical Ethics: Managed Health Care: Protestation and Dissent? | Medical Ethics: Managed Health Care: Protestation and Dissent?
Medical Ethics: Managed Health Care: Protestation and Dissent?
Overview Recent times has put the words ‘dissent’ and ‘protest’ at the centre of our vocabulary. Practitioners are speaking out against perceived injustices, voicing opposition to interventions they disagree with and organising to effect change. ‘Dissent’ is an expression of opinions at variance with those commonly or officially held. ‘Protest’ is closely related to ‘dissent’ but they are different. ‘Protest is an expression or declaration of objection or disapproval, often in opposition to something where a person is considered powerless to prevent or avoid’. Managed care for SA healthcare in general, is a fact of life.
In essence, for the purpose of this article, Managed Health Care can be defined as a group of activities intended to reduce costs of health care provision and providing health insurance whilst improving the quality of care. Managed care, in practical terms encompasses the management of cost, management of information and management of risk.
It is important for practitioners to have a reasonable understanding of the principles of managed care and the role of the Managed Care Organisations. At times, there are cries of foul play aimed at the interventions instituted by the managed Care Organisations where, in fact, such interventions are indeed lawful.
Author Harry Rosen
| 3 | | R465.00 | |
| | Medical Ethics: Ethics in Practice -The Obligations that Define a Profession | Medical Ethics: Ethics in Practice -The Obligations that Define a Profession
Medical Ethics: Ethics in Practice -The Obligations that Define a Profession
Overview The use of the word ‘profession’ has expanded so far beyond its original meaning that a clear definition has become obscured and marred by colloquial usage. It is not uncommon to find the term ‘professional’ misused to describe sportsmen, tradesmen and even politicians. Yet, when we speak about a ‘professional’ there is a tacit understanding that only individuals engaged in certain occupations belong to that category: doctors, lawyers, teachers. A fundamental distinction between a profession and any other occupation, is that individuals engaged in a profession have an ethical obligation to whomever they provide their services. In other words, a profession is required to have a Code of Ethics. Unlike laws and regulations, which are prescriptive and rigid, the principles of ethics are flexible and how they are applied depends on the individual practitioner. It is these responsibilities and expectations that are the hallmarks of a profession.
Author Harry Rosen
| 3 | | R485.00 | |
| | Medical Ethics - A Labour Intensive 2020 | Medical Ethics - A Labour Intensive 2020
Medical Ethics - A Labour Intensive 2020
A PRACTICAL GUIDE TO LABOUR RELATED ETHICAL AND LEGISLATIVE CHALLENGES IN 2020
Overview The year 2020 has created a world characterised by ‘new norms’, not all of which are because of the COVID 19 pandemic. Examples include the introduction of parental leave entitlement in January 2020 which has been on the cards for some time. Nevertheless, considering the avalanche of information relating specifically to the pandemic, much of which is contradictory , confusion persists for both practice owners and employees when faced with challenges encountered in practice and where the desired guidelines appear unclear.
This article addresses commonly encountered experiences in practice in the form of a practical guide to both practitioner and staff member, employer and employee and encompasses Family Responsibility Leave, new Parental Leave legislation, Smoking at Work, Retirement, Chairing Disciplinary Hearings and COVID 19 in the workplace. This article is entitled ‘Labour Intensive 2020’ which indicates a large amount of work in relation to outputs. Indeed, there is work involved to ensure that the appropriate procedures and actions are instituted in accordance with existing ethical and legislative frameworks.
Nevertheless, there is a well-known axiom that states that the amount of energy required to fix something is far greater than the energy required to prevent it.
Author Harry Rosen
| 3 | | R460.00 | |
| | Medical Ethics: Social Media Violations | Medical Ethics: Social Media Violations
Medical Ethics: Social Media Violations
“I remember when Blackberry and Apple were just fruits.”
Overview
In practical terms, social media increase connectivity and is one of the fastest growing industries in the world.
Social media are forms of electronic communication (such as websites for social networking and microblogging) through which users create online communities to share information, ideas, personal messages, and other content (such as videos)
Businesses large and small are turning to social media as an outreach to potential customers worldwide, to advertise their products and services, and to engage with customers. In recent times we have seen how social signals are becoming an important part of search engine optimization.
There is no doubt that a well- planned social media strategy has the potential to make or take down a brand. For example, Lady Gaga (personal branding) quickly became a smash hit, and social media played a major role in her rise to stardom. Facebook, Twitter, Instagram and all other social media websites are great communication tools. After all, they help us be connected to people from all over the world. However, if poorly managed they can cause huge damage.
Author Harry Rosen
| 3 | | R465.00 | |
| | Medical Ethics: Ethical Guidelines to Social Media | Medical Ethics: Ethical Guidelines to Social Media
Medical Ethics: Ethical Guidelines to Social Media
Ethical Guidelines Social Media Overview
This guideline was developed to help health practitioners understand their obligations when using Social Media. The guideline applies to all health practitioners registered with the Health Professions Council of South Africa Social Media describes the online tools and electronic platforms that people use to share content such as opinions, information, photos, videos, and audio. The use of Social Media is expanding rapidly as individuals and organisations are embracing user-generated content through social networks, internet forums and personal blogs. Health professionals need to be aware that there are potential risks involved in the sharing of information via Social Media, even if the consequences are unintended. A key objective of the HPCSA and its Professional Boards is to guide the profession and protect the public. Some health practitioners may find Social Media beneficial as it allows them to keep updated on the latest healthcare developments through reputable user generated content. Acknowledgement Journal: Ethical and Professional Rules of the Health Professions Council of South Africa
| 3 | | R425.00 | |
| | Medical Ethics: Ethical Guidelines for the Withholding and Withdrawing of Treatment | Medical Ethics: Ethical Guidelines for the Withholding and Withdrawing of Treatment
Medical Ethics: Ethical Guidelines for the Withholding and Withdrawing of Treatment
Overview
Health care practitioners have a responsibility to make the care of their patients their first concern. The guidance in these guidelines is intended to provide an ethical framework of good practice for health care practitioners in circumstances where they are faced with making a decision on whether to withhold or withdraw life-prolonging treatment. It takes account of existing law in this area, that allowing for withholding and withdrawing of life sustaining treatments and that which prohibits killing, active euthanasia, and assisted suicide.
The health care professional may alleviate the suffering of a terminally ill patient by withholding treatment i.e. allowing the natural process of death to follow its course, provided there is consultation with another health care practitioner who is an expert in the field, and where available, discussions with the closest relatives. The HPCSA also expects health care practitioners to observe the provisions of the World Medical Association Declaration on Terminal Illness.
Acknowledgement
Journal: Ethical and Professional Rules of the Health Professions Council of South Africa
| 3 | | R485.00 | |
| | Viral Pneumonia Part 2 | Viral Pneumonia Part 2
Overview The reported incidence of viral pneumonia (see the image below) has increased during the past decade. In part, this apparent increase simply reflects improved diagnostic techniques, but an actual increase appears to have also occurred. Depending on the virulence of the organism, as well as the age and comorbidities of the patient, viral pneumonia can vary from a mild, self-limited illness to a life-threatening disease. This course is divided into 3 parts covering the aspects of Pneumonia leading into the much dreaded COVID 19. The influenza viruses are the most common viral cause of pneumonia. Primary influenza pneumonia manifests with persistent symptoms of cough, sore throat, headache, myalgia, and malaise for more than three to five days. Respiratory syncytial virus (RSV) is the most frequent cause of lower respiratory tract infection in infants and children and the second most common viral cause of pneumonia in adults.
Parainfluenza virus (PIV) is second in importance only to RSV as a cause of lower respiratory tract disease in children and pneumonia and bronchiolitis in infants younger than 6 months. PIV pneumonia and bronchiolitis are caused primarily by the PIV-3 strain. The signs and symptoms include fever, cough, coryza, dyspnea with rales, and wheezing.
Acknowledgements Authors:
Zab Mosenifar and Richard BrawermanThe University of Pretoria | 3 | | R420.00 | |
| | Medical Ethics: Artificial Intelligence Ethics – Too Principled to Fail? | Medical Ethics: Artificial Intelligence Ethics – Too Principled to Fail?
Medical Ethics: Artificial Intelligence Ethics – Too Principled to Fail?
Overview
AI Ethics is now a global topic of discussion in academic and policy circles. At least 63 public-private initiatives have produced statements describing high-level principles, values, and other tenets to guide the ethical development, deployment, and governance of AI. According to recent meta-analyses, AI Ethics has seemingly converged on a set of principles that closely resemble the four classic principles of medical ethics. Despite the initial credibility granted to a principled approach to AI Ethics by the connection to principles in medical ethics, there are reasons to be concerned about its future impact on AI development and governance. Significant differences exist between medicine and AI development that suggest a principled approach in the latter may not enjoy success comparable to the former. Compared to medicine, AI development lacks (1) common aims and fiduciary duties, (2) professional history and norms, (3) proven methods to translate principles into practice, and (4) robust legal and professional accountability mechanisms. These differences suggest we should not yet celebrate consensus around high-level principles that hide deep political and normative disagreement.
Acknowledgment Author
Brent Mittelstadti Journal
Nature Machine Intelligence November 2019
| 3 | | R420.00 | |
| | Medical Ethics: What is the place for philosophy within the field of medicine? A review of contemporary issues in medical ethics | Medical Ethics: What is the place for philosophy within the field of medicine? A review of contemporary issues in medical ethics
Medical Ethics: What is the place for philosophy within the field of medicine? A review of contemporary issues in medical ethics
Overview This extended essay seeks to unpack some of the key aspects of philosophy which are applicable to medical thought and practice. It proceeds via an analytical discussion of the contemporary debate in three key areas of medical ethics: euthanasia, concepts of health and disease and psychiatry. The main claims are as follows:
1. The case for legalising euthanasia is strong on philosophical grounds but there are numerous practical obstacles. 2. Elements from the normative and naturalistic definitions of disease are necessary for a thorough definition that dodges common objections to either. 3. Mental health cannot be subsumed under a purely physicalist model of health rendering it distinctly different from other fields in Medicine.
Through a detailed discussion of three salient issues in the philosophy of medicine, it is argued that the application of profound philosophical thought to medicine and its practices reveals a depth that necessitates exploration before simply following the aims of curing all. Philosophical rigour matched with modern medicine has the potential to engage patients and help them make independent, informed decisions and assist physicians to think more clearly, analytically and empathetically.
Acknowledgement
Author Richard Fenton Journal Philosophy, Ethics and Humanities in Medicine
| 3 | | R465.00 | |
| | Community perspectives on HIV, violence and health surveillance in rural South Africa: a participatory pilot study | Community perspectives on HIV, violence and health surveillance in rural South Africa: a participatory pilot study
Community perspectives on HIV, violence and health surveillance in rural South Africa: a participatory pilot study
Overview
South Africa faces a complex burden of disease consisting of infectious and non–communicable conditions, injury and interpersonal violence, and maternal and child mortality. Inequalities in income and opportunity push disease burdens towards vulnerable populations, a situation to which the health system struggles to respond. There is an urgent need for health planning to account for the needs of marginalized groups in this context. Objectives were to develop a process to elicit the perspectives of local communities in the established Agincourt health and socio-demographic surveillance site (HDSS) in rural north–east South Africa on two leading causes of death: HIV/AIDS and violent assault, and on health surveillance as a means to generate information on health in the locality.
The groups identified a range of social and health systems issues including risky sexual health behaviors, entrenched traditional practices, alcohol and substance abuse, unstable relationships, and debt as causative. Participants also explained how compromised patient confidentiality in clinics, insensitive staff, and a biased judicial system were problematic for the treatment and reporting of both conditions. The discussions provided information not available from other sources on the social and health systems processes through which access to good quality health care is constrained in this setting.
Acknowledgement
Authors Nitya Hullur, Lucia D’Ambruoso, Kerstin Edin, Ryan G Wagner, Sizzy Ngobeni Kathleen Kahn, Stephen Tollman, Peter Byass
Journal Global Health Action Volume 6 Issue 1
| 3 | | R460.00 | |
| | Medical Ethics: Medical Students’ Perspectives on Euthanasia and Physician Assisted Suicide and Their Views on Legalising These Practices in SA | Medical Ethics: Medical Students’ Perspectives on Euthanasia and Physician Assisted Suicide and Their Views on Legalising These Practices in SA
Medical Ethics: Medical Students’ Perspectives on Euthanasia and Physician Assisted Suicide and Their Views on Legalising These Practices in SA
Overview
Euthanasia/physician assisted suicide have been a controversial and sometimes taboo topic for a long time, not only in SA but also internationally. A recent (SA) judicial case has seen the topic debated again. Consensus on accepting or abolishing these practices in SA has yet to be reached. All relevant role players need to be adequately engaged before policy can be informed.
The objectives were to determine the views of future doctors (medical students) regarding euthanasia and physician-assisted suicide (PAS) and to ascertain their stance on its legalisation in South Africa (SA).
Many factors influenced participants’ responses, but differences in opinion between and within the various religious groups were particularly evident in the responses received/ More than half the respondents in this study were open to legalising euthanasia/PAS, substantially more than in previous studies. However, only 41.9% of respondents would consider performing euthanasia/ PAS, for certain patients. Views of other healthcare workers as well as the public are required before policy can be informed.
Acknowledgement
Authors R K Jacobs and M Hendricks
Journal SAMJ RESEARCH | 3 | | R425.00 | |
| | QTc interval prolongation during favipiravir therapy in an Ebolavirus-infected patient | QTc interval prolongation during favipiravir therapy in an Ebolavirus-infected patient
QTc interval prolongation during favipiravir therapy in an Ebolavirus-infected patient
Overview
Life-threatening arrhythmia may be induced by corrected QT (QTc) interval prolongation. Several antimicrobial drugs have been associated with QTc interval prolongation. Favipiravir is an inhibitor of the RNA-dependent RNA polymerase of many RNA viruses, including influenza viruses, arenaviruses, phleboviruses, hantaviruses, flaviviruses, enteroviruses, and noroviruses. Favipiravir has also been used in the recent epidemic of Ebolavirus (EBOV) in West Africa. To date, no significant effects of favipiravir on the QT/QTc interval have been detected. We report a case of QTc interval prolongation during favipiravir therapy in an EBOV-infected patient treated at our institution.
In conclusion, we suggest that favipiravir administered at high doses, together with the cofactors discussed above, may have contributed to inducing a QTc interval prolongation in our EBOV patient. If feasible, ECG monitoring could be advisable during high-dose favipiravir therapy, especially when patients experience electrolyte disturbances and concomitant use of drugs with QTc-prolonging potential. Encephalitis or central nervous system (CNS) pathology may have a role in prolonging QT interval. Acknowledgement
Authors Pierangelo Chinello, Nicola Petrosillo, Silvia Pittalis, Gianluigi Biava, Giuseppe Ippolito, Emanuele Nicastri, on behalf of the INMI Ebola Team
Journal PLoS Neglected Tropical Diseases
Publisher Cross Mark
| 3 | | R390.00 | |
| | Ebolaviruses: New roles for old proteins | Ebolaviruses: New roles for old proteins
Ebolaviruses: New roles for old proteins
Overview
In 2014, the world witnessed the largest Ebolavirus outbreak in recorded history. The subsequent humanitarian effort spurred extensive research, significantly enhancing our understanding of ebolavirus replication and pathogenicity. The main functions of each ebolavirus protein have been studied extensively since the discovery of the virus in 1976; however, the recent expansion of ebolavirus research has led to the discovery of new protein functions. The international containment effort spurred extensive research that is enhancing.
These newly discovered roles are revealing new mechanisms of virus replication and pathogenicity, whilst enhancing our understanding of the broad functions of each ebolavirus viral protein (VP). Many of these new functions appear to be unrelated to the protein's primary function during virus replication. Such new functions range from bystander T-lymphocyte death caused by VP40-secreted exosomes to new roles for VP24 in viral particle formation. This review highlights the newly discovered roles of ebolavirus proteins in order to provide a more encompassing view of ebolavirus replication and pathogenicity. This review highlights the newly discovered roles of ebolavirus proteins in order to provide a more encompassing view of ebolavirus replication and pathogenicity.
Acknowledgement Authors Diego Cantoni and Jeremy S. Rossman Journal PLoS Neglected Tropical Diseases Publisher Cross Mark | 3 | | R420.00 | |
| | More than kin, less than kind: one family and the many faces of diabetes in youth | More than kin, less than kind: one family and the many faces of diabetes in youth
More than kin, less than kind: one family and the many faces of diabetes in youth
More than kin, less than kind: one family and the many faces of diabetes in youth
Overview
Identification of the correct etiology of diabetes brings important implications for clinical management. In this report, we describe a case of a 4-year old asymptomatic girl with diabetes since age 2, along with several individuals in her family with different etiologies for hyperglycemia identified in youth. Genetic analyses were made by Sanger sequencing, laboratory measurements included HbA1c, lipid profile, fasting C-peptide, pancreatic auto-antibodies. We found a Gly178Ala substitution in exon 5 of GCK gene in three individuals co-segregating with diabetes, and type 1 diabetes was identified in two other individuals based on clinical and laboratory data. One individual with previous gestational diabetes and other with pre-diabetes were also described.
We discuss difficulties in defining etiology of hyperglycemia in youth in clinical practice, especially monogenic forms of diabetes, in spite of the availability of several genetic, laboratory, and clinical tools. In conclusion, the accurate molecular and clinical diagnosis has significant impact on clinical management of a multifaceted disease such as diabetes, especially when running on the same family.
Acknowledgement
Authors Luciana F. Franco, Renata Peixoto-Barbosa, Renata P. Dotto, José Gilberto H. Vieira, Magnus R. Dias-da-Silva, Luiz Carlos F. Reis, Fernando M. A. Giuffrida, and Andre F. Reis
Journal Arch Endocrinol Metab.
| 3 | | R390.00 | |
| | 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 | | R455.00 | |
| | 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 | | R455.00 | |
| | Structure and assembly of the Ebola virus nucleocapsid | Structure and assembly of the Ebola virus nucleocapsid
Structure and assembly of the Ebola virus nucleocapsid
Structure and assembly of the Ebola virus nucleocapsid
Overview
Ebola and Marburg viruses are filoviruses: filamentous, enveloped viruses that cause haemorrhagic fever1. Filoviruses are within the order Mononegavirales2 which also includes rabies virus, measles virus, and respiratory syncytial virus. Mononegaviruses have non-segmented, single-stranded negative-sense RNA genomes that are encapsidated by nucleoprotein (NP) and other viral proteins to form a helical nucleocapsid (NC). NC acts as a scaffold for virus assembly and as a template for genome transcription and replication. Insights into NP-NP interactions have been derived from structural studies of oligomerized, RNA-encapsidating NP3–6 and cryo-electron microscopy (cryo-EM) of NC7–12 or NC-like structures11–13. There have been no high-resolution reconstructions of complete mononegavirus NCs.
Here, we have applied cryo-electron tomography and sub-tomogram averaging to determine the structure of Ebola virus NC within intact viruses and recombinant NC-like assemblies. These structures reveal the identity and arrangement of the NC components, and suggest that the formation of an extended alpha-helix from the disordered C-terminal region of NP-core links NP oligomerization, NC condensation, RNA encapsidation, and accessory protein recruitment. Acknowledgement
Author William Wan, Larissa Kolesnikova, Mairi Clarke, Alexander Koehler, Takeshi Noda, Stephan Becker and John A. G. Briggs.
Journal Nature. 2017 November 16; 551(7680-397)
Publisher URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5714281/pdf/emss-74396.pdf
| 3 | | R455.00 | |
| | Establishing Ebola Virus Disease (EVD) diagnostics using GeneXpert technology at a mobile laboratory in Liberia: Impact on outbreak response, case management and laboratory systems strengthening | Establishing Ebola Virus Disease (EVD) diagnostics using GeneXpert technology at a mobile laboratory in Liberia: Impact on outbreak response, case management and laboratory systems strengthening
Establishing Ebola Virus Disease (EVD) diagnostics using GeneXpert technology at a mobile laboratory in Liberia: Impact on outbreak response, case management and laboratory systems strengthening
Establishing Ebola Virus Disease (EVD) diagnostics using GeneXpert technology at a mobile laboratory in Liberia: Impact on outbreak response, case management and laboratory systems strengthening Overview
The 2014-16 Ebola Virus Disease (EVD) outbreak in West Africa highlighted the necessity for readily available, accurate and rapid diagnostics. The magnitude of the outbreak and the re-emergence of clusters of EVD cases following the declaration of interrupted transmission in Liberia, reinforced the need for sustained diagnostics to support surveillance and emergency preparedness. We describe implementation of the Xpert Ebola Assay, a rapid molecular diagnostic test run on the GeneXpert platform, and the subsequent impact on EVD outbreak response, case management and laboratory system strengthening.
During the 18 months of operation, the laboratory tested a total of 9,063 blood specimens, including 21 EVD positives from six confirmed cases during two outbreaks. Collaboration between surveillance and laboratory coordination teams during this and a later outbreak in March 2016, facilitated timely and targeted response interventions. This model of a mobile laboratory equipped with Xpert Ebola test, staffed by local laboratory technicians, could serve to strengthen outbreak preparedness and response for future outbreaks of EVD in Liberia and the region.
Acknowledgement
Authors Philomena Raftery, Orla Condell, Christine Wasunna, Jonathan Kpaka, Ruth Zwizwai, Mahmood Nuha, Mosoka Fallah, Maxwell Freeman, Victoria Harris, Mark Miller, April Baller, Moses Massaquoi, Victoria Katawera, John Saindon, Philip Bemah, Esther Hamblion, Evelyn Castle, Desmond Williams, Alex Gasasira, Tolbert Nyenswah.
Journal PLoS Neglected Tropical Diseases Volume 12 Issue 1
Publisher
Cross Mark
URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5755746/pdf/pntd.0006135.pdf
| 3 | | R465.00 | |
| | Characterization of Influenza Virus Pseudotyped with Ebolavirus Glycoprotein | Characterization of Influenza Virus Pseudotyped with Ebolavirus Glycoprotein
Characterization of Influenza Virus Pseudotyped with Ebolavirus Glycoprotein
Characterization of Influenza Virus Pseudotyped with Ebolavirus Glycoprotein
Overview
We have produced a new Ebola virus pseudotype, E-S-FLU, that can be handled in biosafety level 1/2 containment for laboratory analysis. The E-SFLU virus is a single-cycle influenza virus coated with Ebolavirus glycoprotein, and it encodes enhanced green fluorescence protein as a reporter that replaces the influenza virus hemagglutinin. Infection of cells with the E-S-FLU virus was dependent on the Niemann-Pick C1 protein, which is the well-characterized receptor for Ebola virus entry at the late endosome/lysosome membrane. The E-S-FLU virus was neutralized specifically by an anti-Ebolavirus glycoprotein antibody and a variety of small drug molecules that are known to inhibit the entry of wild-type Ebola virus.
To demonstrate the application of this new Ebola virus pseudotype, we show that a single laboratory batch was sufficient to screen a library of 1,280 pharmacologically active compounds for inhibition of virus entry. The E-S-FLU virus is a new tool for Ebola virus cell entry studies and is easily applied to high throughput screening assays for small-molecule inhibitors or antibodies. Acknowledgement
Author Julie Huiyuan Xiao, Pramila Rijal, Lisa Schimanski, Arun Kumar Tharkeshwar, Edward Wright, Wim Annaert and Alain Townsend.
Journal Journal of Virology
Publisher Cross Mark
URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5790926/pdf/e00941-17.pdf
| 3 | | R445.00 | |
| | Soil-transmitted helminth infection, loss of education and cognitive impairment in school-aged children: systematic review Overview | Soil-transmitted helminth infection, loss of education and cognitive impairment in school-aged children: systematic review Overview
Soil-transmitted helminth infection, loss of education and cognitive impairment in school-aged children: systematic review Overview
Soil-transmitted helminth infection, loss of education and cognitive impairment in school-aged children: systematic review
Overview
Cardiovascular evidence of an adverse influence of soil transmitted helminth (STH) infections on cognitive function and educational loss is equivocal. Prior meta-analyses have focused on randomized controlled trials only and have not sufficiently explored the potential for disparate influence of STH infection by cognitive domain. We re-examine the hypothesis that STH infection is associated with cognitive deficit and educational loss using data from all primary epidemiologic studies published since 2016. Cognitive function was defined in four domains (learning, memory, reaction time and innate intelligence) and educational loss in two domains (attendance and scholastic achievement). Sub-group analyses were implemented by study design, risk of bias (ROB) and co-prevalence of Schistosoma species infection. Influential studies were excluded in sensitivity analysis to examine stability of pooled estimates. Despite the empirical debate regarding the cognitive benefit of de-worming for STH, the current ethical, clinical and health policy environments remain strongly skewed in favor of de-worming for child growth, prevention of anaemia and potentially avoidance of preventable cognitive deficits
Acknowledgement
Author
Noel Pabalan, Eloisa Singian, Lani Tabangay, Hamdi Jarjanazi, Michael J. Boivin, Amara E. Ezeamama
Journal PLoS Neglected Tropical Diseases
URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5766095/pdf/pntd.0005523.pdf
Publisher Cross Mark
| 3 | | R465.00 | |
| | 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
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.
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.
In 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
| 3 | | R370.00 | |
| | 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 | | R400.00 | |
| | Standard of care and guidelines in prevention and diagnosis of venous thromboembolism: medico-legal implications. | Standard of care and guidelines in prevention and diagnosis of venous thromboembolism: medico-legal implications.
Standard of care and guidelines in prevention and diagnosis of venous thromboembolism: medico-legal implications.
Overview
Concerning recent Italian laws and jurisprudential statements, guidelines application involves several difficulties in clinical practice, regarding prevention, diagnosis and therapy of venous thromboembolism. International scientific community systematically developed statements about this disease in order to optimize the available resources in prophylaxis, diagnosis and therapy. Incongruous prevention, missed or delayed diagnosis and/or inadequate treatment of this disease can frequently give rise to medico-legal litigation.
Acknowledgement
Author:
Vassalini M, Verzeletti A, De Ferrari F
Journal:
Monaldi archives for chest disease
Publisher:
PIME Editrice
http://www.monaldi-archives.org/index.php/macd/article/view/25/728
| 3 | | R430.00 | |
| | Injury-related mortality in South Africa: a retrospective descriptive study of postmortem investigations. | Injury-related mortality in South Africa: a retrospective descriptive study of postmortem investigations.
Injury-related mortality in South Africa: a retrospective descriptive study of postmortem investigations.
Overview
Objective: To investigate injury-related mortality in South Africa using a nationally representative sample and compare the results with previous estimates.
Methods: We conducted a retrospective descriptive study of medico-legal postmortem investigation data from mortuaries using a multistage random sample, stratified by urban and non-urban areas and mortuary size. We calculated age-specific and age-standardized mortality rates for external causes of death.
Findings: Postmortem reports revealed 52,493 injury-related deaths in 2009 (95% confidence interval, CI: 46,930-58,057). Almost half (25,499) were intentionally inflicted. Age-standardized mortality rates per 100,000 population were as follows: all injuries: 109.0 (95% CI: 97.1-121.0); homicide 38.4 (95% CI: 33.8-43.0; suicide 13.4 (95% CI: 11.6-15.2) and road-traffic injury 36.1 (95% CI: 30.9-41.3). Using postmortem reports, we found more than three times as many deaths from homicide and road-traffic injury than had been recorded by vital registration for this period. The homicide rate was similar to the estimate for South Africa from a global analysis, but road-traffic and suicide rates were almost fourfold higher.
Conclusion: This is the first nationally representative sample of injury-related mortality in South Africa. It provides more accurate estimates and cause-specific profiles that are not available from other sources.
Acknowledgement
Author: Matzopoulos R, Prinsloo M, Pillay-van Wyk V, Gwebushe N, Mathews S, Martin LJ, Laubscher R, Abrahams N, Msemburi W, Lombard C, Bradshaw D
Journal: Bulletin of the World Health Organization
Publisher: Bulletin of the World Health Organization
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4431514/pdf/BLT.14.145771.pdf
| 3 | | R380.00 | |
| | 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 | | R420.00 | |
| | 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 | | R400.00 | |
| | 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
| 3 | | R400.00 | |
| | 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.
| 3 | | R400.00 | |
| | 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. | 3 | | R350.00 | |
| | 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.
| 3 | | R350.00 | |
| | Medical Ethics: Ethics of the Placebo in Clinical Practice. | Medical Ethics: Ethics of the Placebo in Clinical Practice.
Medical Ethics: Ethics of the Placebo in Clinical Practice.
OVERVIEW
The placebo is not easy to define. As a matter of fact, some scholars are despaired of the possibility of ever finding an adequate definition for the term. However, many current definitions invoke the non-specific nature of the treatment effects as the leading feature of the placebo.
The object of this article was however to address the question of the placebo in clinical practice. This article nonetheless argued that the placebo could be an effective treatment. The article further argued that the use of the placebo does not entail deception. This article equally highlighted guidelines under which the placebo may be used for clinical purposes. This article further suggested that in selected cases, the use of the placebo may also be morally imperative. It is imperative to state that the arguments in this article were presented by three case vignettes.
The article was concluded that the placebo can be beneficial to physicians of many clinical situations
ACKNOWLEDGEMENT
AUTHORS:
Lichtenberg U Heresco-Levy, U Nitzan
JOURNAL:
BMJ Journal of Medical Ethics
| 3 | | R425.00 | |
| | 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.
| 3 | | R420.00 | |
| | 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 | 3 | | R460.00 | |
| | 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." | 3 | | R420.00 | |
| | 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.
| 3 | | R320.00 | |
| | 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
| 3 | | R330.00 | |
| | Patient Safety Strategies Targeted at Diagnostic Errors. | Patient Safety Strategies Targeted at Diagnostic Errors.
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 | | R400.00 | |
| | 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 | | R375.00 | |
| | 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 | | R355.00 | |
| | 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
| 3 | | R375.00 | |