Background: Ethics education and research on medical residents is needed because, unlike medical students or experienced doctors, medical residents have to perform multiple roles simultaneously – student, teacher and clinician – thus exposing them to unique ethical stressors. In this paper we reviewed the literature concerning ethics education in postgraduate pediatrics training programs. Our goal was not to simply describe educational strategies and programs, but also to explore measurements and experiences of current practices to address gaps in ethics education during residency.Method: We conducted a structured literature review to explore the extent of ethics education in pediatric residency programs. Results: Twelve relevant studies were found. The studies suggest that existing training regimens are insufficient to meet the real life ethical challenges experienced in actual practice, particularly with respect to palliative care and the commission of clinical errors. Conclusions: The increasing diversity of culture and beliefs in the clinical workplace is also serving to complicate educational needs. An interdisciplinary approach, spread over the entirety of a physician’s training, is a proposed solution worthy of more attention.
Objective: To evaluate and compare the effectiveness of tubeless percutaneous nephrolithotomy (PCNL) and tubed PCNL by using small bore nephrostomy tube (12Fr) in children for the management of nephrolithiasis. Material and methods:This study was a retrospective analysis of 35 children where tubed PCNL (Group 1) was done in 18, and tubeless PCNL (group 2) in 17 patients from January 2010 to December 2016. Charts were reviewed for age, mass, stone size, operative time, hospital stay and stone-free rates.These variables were compared between the two groups. SPSS version 21 was used for data analysis. The data were shown as mean±standard deviation for continuous variables.Categorical variables were presented in percentages.Results: There is no difference in terms of age, stone sizes, operative times, hospital stays, stone-free rates and post-PCNL complications between the two groups (p>0.05). The mean drop in hemoglobin level was 0.7±0.1 g/dL and 1.3±0.2 g/dL in Groups 1 and 2, respectively (p= 0.01). Conclusion:Tubeless PCNL in children is a safe option in well selected cases.
BACKGROUND: Cervicogenic headache (CGH) is a common condition that results in significant disability. To treat this dysfunction, Mulligan described sustained natural apophyseal gliders (SNAGs) as a manual therapy approach. However, only inconclusive short-term evidence exists for treating CGH with SNAGs. OBJECTIVE: The present study aims to investigate the effect of SNAGs in the treatment of CGH. METHODS: Fourty female patients ranging from 20 to 40 years with CGH were randomly assigned to two groups: 20 in a treatment group and 20 in a control group. SNAGs were applied to the treatment group while the control group received placebo treatment. Both groups received their respective treatment for 20 minutes, alternately three times per week, for a total of 12 times in four weeks. The outcome measures were the Neck Disability Index (NDI) and the Visual Analogue Scale (VAS). Participants were assessed at baseline and at the end of each week. The data was analyzed using SPSS version 20. Independent t-testing was used to reveal changes between groups. One-way ANOVA was used to determine changes within groups. The level of significance was P< 0.05. RESULTS: Twenty participants (100%) in the treatment group and 17 (85%) in the control group had a history of headache aggravation with active movements or passive head positioning. There was no significant difference at baseline (p> 0.05), indicating that both groups were homogeneous at the time of recruitment. The p value (p< 0.05) showed a significant difference in pain and level of disability at three and four weeks (p< 0.05) in patients treated with SNAGs. However, the cervical range of motion (ROM) showed a statistically significant improvement in flexion and extension in the treatment group (p< 0.05) while there was no significant improvement in side flexion and rotation ROM in both groups (p> 0.05). CONCLUSION: This study found that SNAGs were effective in reducing pain and neck disability and improved ROM in females with CGH.
Here we determined the role of various genomic islands in E. coli K1 interactions with phagocytic A. castellanii and nonphagocytic brain microvascular endothelial cells. The findings revealed that the genomic islands deletion mutants of RS218 related to toxins (peptide toxin, α-hemolysin), adhesins (P fimbriae, F17-like fimbriae, nonfimbrial adhesins, Hek, and hemagglutinin), protein secretion system (T1SS for hemolysin), invasins (IbeA, CNF1), metabolism (D-serine catabolism, dihydroxyacetone, glycerol, and glyoxylate metabolism) showed reduced interactions with both A. castellanii and brain microvascular endothelial cells. Interestingly, the deletion of RS218-derived genomic island 21 containing adhesins (P fimbriae, F17-like fimbriae, nonfimbrial adhesins, Hek, and hemagglutinin), protein secretion system (T1SS for hemolysin), invasins (CNF1), metabolism (D-serine catabolism) abolished E. coli K1-mediated HBMEC cytotoxicity in a CNF1-independent manner. Therefore, the characterization of these genomic islands should reveal mechanisms of evolutionary gain for E. coli K1 pathogenicity.
social distancing measures introduced during the COVID-19 pandemic. We identified the need to seek feedback from the patients attending these clinics. Methods We designed a questionnaire for patients who had attended a virtual clinic in General Surgery, using both Qualitative and Quantitative questions. We contacted 100 patients who attended a range of clinics ran by over 10 different General Surgical Consultants between 25th March 2020 and 30th April 2020. A team of junior doctors and clinical assistants were recruited to contact patients. Patients were contacted via telephone to ask if they would be happy to complete the survey which would be emailed to them, if they did not have an email address a shorter survey was completed over the phone. Results In total we had 73 responses to the survey. Data collected suggests that virtual clinics are well received by patients. 48% (n=35) answered that they were overall 'very satisfied' with the care received in the virtual clinic, and 79.6% (n=43) felt that their care did not suffer as a result of non-face to face contact. Most patients would recommend a virtual clinic to their friend or family 77% (n=56), however if given the option 60% (n=43) would prefer a face to face clinic appointment. Conclusions As the pandemic progresses it is important to identify ways in which good patient care can be delivered whilst not putting patients at risk of contracting the virus. Virtual clinics not only maintain patient safety but also have many other benefits to patients as identified in this study. This study suggests that perhaps the use of virtual clinics should continue and could be utilised by surgical departments to provide efficient patient centred care.
Ethics are at the core of healthcare provision. Good medical practice reflects ethics and professionalism in action and ethics should drive our behavior when providing medical care. The patients trust their treating doctor to be competent and ethical in their communication and also in the clinical decision-making. The expectations from the doctors are even more during the times when patients are critical. For the doctors and nurses providing the care, it may be very challenging, as those critical times are highly stressful for patients and attendants and can result in less than optimal outcome. Under these trying moments we face issues in communication and care provision which may look to be not conforming to the ethical standards. This editorial highlights the importance to adhere to the rules of ethics in many different critical situations, which may arise in emergency departments or in critical care units. But the principles outlined deserve to be learned by every healthcare staff member. Key words: Critical Illness; Health Status; Humans; Intensive Care; Intensive Care Units; Critical Care / ethics; Decision Making / ethics; Dissent and Disputes; Physicians / ethics; Terminal Care / ethics Citation: Khan AS, Sattar A, Khan H. Providing critical care in ethical way. Traditions and ethics should go hand in hand. Anaesth. pain intensive care 2020;24(6):568-571. Received – 3 September 2020, Reviewed – 13 September 2020, Accepted – 31 October 2020
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