Patient and Physician Perspectives on Discussing Addiction Recovery and Spirituality in the Primary Care Setting.

Background: Spirituality is an important component of recovery for many individuals with substance use disorder (SUD). However, few studies have compared patient and physician attitudes on spirituality in SUD recovery.

Objective: This study investigates patient and physician beliefs about the role of spirituality in SUD recovery and about discussing spirituality in relationship to recovery in primary care settings.

Ethical Considerations for Acutely Injured and Future Burn Patients Who Smoke While on Home Oxygen Therapy.

Home oxygen therapy (HOT) is prescribed to patients with pulmonary dysfunction to improve survival and quality of life. However, ignition of oxygen can lead to burns with significant morbidity and mortality. Providers who routinely treat this patient population face an ethical issue: balancing the obligation to provide beneficial treatment to a patient with the responsibility to protect that patient from suffering avoidable burn injuries.

Exploring Patients' and Chaplains' Perspectives About a Spiritual Care Program in the Primary Care Setting.

Background: Spirituality is an important component of social and cultural identity that influences health-related beliefs, decision-making, and coping behaviors. Despite the importance of addressing spirituality in healthcare, research about its impact is limited, especially in the primary care setting.

Objective: This study aimed to explore patients' and chaplains' experiences of receiving or providing spiritual care in the primary care setting.

Everyday Ethics in Ambulatory Pediatrics: Cases and Applications.

This article presents three clinical scenarios that might be encountered in ambulatory pediatrics. The framework for ethical analysis presented by Dr Hughes in a separate article in this issue of the Journal is used to examine these clinical scenarios and demonstrate application of the framework. The three cases involve a physician being asked by parents to write a letter for better housing that would require the doctor to be dishonest; parents who decline to have their 8-month-old daughter vaccinated; and a physician who believes contraception is a sin and therefore would not prescribe it to a sexually active 17-year-old girl.

Public Attitudes Regarding Hospitals and Physicians Encouraging Donations From Grateful Patients.

Importance: Philanthropy is an increasingly important source of support for health care institutions. There is little empirical evidence to inform ethical guidelines.

Objective: To assess public attitudes regarding specific practices used by health care institutions to encourage philanthropic donations from grateful patients.

A medical student scholarly concentrations program: scholarly self-efficacy and impact on future research activities.

Background: The Scholarly Concentrations program was established at Johns Hopkins University School of Medicine in 2009 with the aim of instilling passion for scholarship.

Objective: Our study aimed to determine whether the Scholarly Concentrations program achieves positive changes in medical student self-efficacy in conducting research and, if so, whether this results in future career aspirations toward scholarship.

Design: We used the Clinical Research Appraisal Inventory-Short Form (CRAI-SF) to assess changes in self-efficacy among students completing the Scholarly Concentrations program between 2014 and 2017.

Minority race and male sex as risk factors for non-beneficial gastrostomy tube placements after stroke.

Background: Percutaneous endoscopic gastrostomy (PEG) tubes are widely used for enteral feeding after stroke; however, PEG tubes placed in patients in whom death is imminent are considered non-beneficial.

Aim: We sought to determine whether placement of non-beneficial PEG tubes differs by race and sex.

Design And Setting/participants: In this retrospective cohort study, inpatient admissions for stroke patients who underwent palliative/withdrawal of care, were discharged to hospice, or died during the hospitalization, were identified from the Nationwide Inpatient Sample between 2007 and 2011.

ICU-RESPECT: An index to assess patient and family experiences of respect in the intensive care unit.

Purpose: The purpose of the study is to develop a brief index of patient and family experiences of respect in the intensive care unit (ICU).

Materials And Methods: We designed a questionnaire with 44 items representing 12 themes that emerged from prior in-depth interviews with ICU patients and families. After pilot testing, items with minimal variability were eliminated.

A Direct Observation Checklist to Measure Respect and Dignity in the ICU.

Objective: Treating patients and family members with respect and dignity is a core objective of health care, yet it is unclear how best to measure this in the ICU setting. Accordingly, we sought to create a direct observation checklist to assess the "respect and dignity status" of an ICU.

Design: A draft checklist based on previous work was iteratively revised to enhance accuracy and feasibility.

The essential role of medical ethics education in achieving professionalism: the Romanell Report.

This article-the Romanell Report-offers an analysis of the current state of medical ethics education in the United States, focusing in particular on its essential role in cultivating professionalism among medical learners. Education in ethics has become an integral part of medical education and training over the past three decades and has received particular attention in recent years because of the increasing emphasis placed on professional formation by accrediting bodies such as the Liaison Committee on Medical Education and the Accreditation Council for Graduate Medical Education. Yet, despite the development of standards, milestones, and competencies related to professionalism, there is no consensus about the specific goals of medical ethics education, the essential knowledge and skills expected of learners, the best pedagogical methods and processes for implementation, and optimal strategies for assessment.

Transforming educational accountability in medical ethics and humanities education toward professionalism.

Effectively developing professionalism requires a programmatic view on how medical ethics and humanities should be incorporated into an educational continuum that begins in premedical studies, stretches across medical school and residency, and is sustained throughout one's practice. The Project to Rebalance and Integrate Medical Education National Conference on Medical Ethics and Humanities in Medical Education (May 2012) invited representatives from the three major medical education and accreditation organizations to engage with an expert panel of nationally known medical educators in ethics, history, literature, and the visual arts. This article, based on the views of these representatives and their respondents, offers a future-tense account of how professionalism can be incorporated into medical education.

Ethics skills laboratory experience for surgery interns.

Introduction And Purpose: Ethics curricula are nearly universal in residency training programs, but the content and delivery methods are not well described, and there is still a relative paucity of literature evaluating the effect of ethics curricula. Several commentators have called for more ethics curriculum development at the postgraduate level, and specifically in surgery training. We detail our development and implementation of a clinical ethics curriculum for surgery interns.

Analyzing reflective narratives to assess the ethical reasoning of pediatric residents.

A limiting factor in ethics education in medical training has been difficulty in assessing competence in ethics. This study was conducted to test the concept that content analysis of pediatric residents' personal reflections about ethics experiences can identify changes in ethical sensitivity and reasoning over time. Analysis of written narratives focused on two of our ethics curriculum's goals: 1) To raise sensitivity to ethical issues in everyday clinical practice and 2) to enhance critical reflection on personal and professional values as they affect patient care.

Excellence in Transitional Care of Older Adults and Pay-for-Performance: Perspectives of Health Care Professionals.

Unlabelled: Article-at-a-Glance Background: Care transitions across health care settings are common and can result in adverse outcomes for older adults. Few studies have examined health care professionals' perspectives on important process measures or pay-for-performance (P4P) strategies related to transitional care. A study was conducted to characterize health care professionals' perspectives on (1) successful transitional care of older adults (age 65 years and older), (2) suggestions for improvement, and (3) P4P strategies related to transitional care.

The challenge of promoting professionalism through medical ethics and humanities education.

Given recent emphasis on professionalism training in medical schools by accrediting organizations, medical ethics and humanities educators need to develop a comprehensive understanding of this emphasis. To achieve this, the Project to Rebalance and Integrate Medical Education (PRIME) II Workshop (May 2011) enlisted representatives of the three major accreditation organizations to join with a national expert panel of medical educators in ethics, history, literature, and the visual arts. PRIME II faculty engaged in a dialogue on the future of professionalism in medical education.

Clinician roles and responsibilities during care transitions of older adults.

Objectives: To identify the perceived roles and responsibilities of clinicians during care transitions of older adults.

Design: Qualitative study involving 1-hour in-depth semistructured interviews. Audiotapes of interviews were transcribed, coded, and analyzed, and themes and subthemes were generated.

HCEC pearls and pitfalls: suggested do's and don't's for healthcare ethics consultants.

Members of the Clinical Ethics Consultation Affairs Standing Committee of the American Society for Bioethics and Humanities present a collection of insights and recommendations developed from their collective experience, intended for those engaged in the work of healthcare ethics consultation.

Traditional expectations versus US realities: first- and second-generation Asian Indian perspectives on end-of-life care.

Background: Although end-of-life care preferences vary across racial/ethnic groups, little is known about how cultural values affect end-of-life care preferences among South Asian immigrants and their offspring in the US.

Objective: To examine the perspectives of first- and second-generation South Asians living in the US regarding end-of-life care.

Design: Focus group study.

Everyday ethics in internal medicine resident clinic: an opportunity to teach.

Objectives: Being a good doctor requires competency in ethics. Accordingly, ethics education during residency training is important. We studied the everyday ethics-related issues (i.

Barriers to and facilitators of postpartum follow-up care in women with recent gestational diabetes mellitus: a qualitative study.

Objectives: Women with a history of gestational diabetes mellitus (GDM) have an increased risk of developing type 2 diabetes (T2DM) but often do not return for follow-up care. We explored barriers to and facilitators of postpartum follow-up care in women with recent GDM.

Methods: We conducted 22 semistructured interviews, 13 in person and 9 by telephone, that were audiotaped and transcribed.

Challenges in primary care relationships: seeing it from both sides.

Objective: This qualitative study explored perspectives of primary care providers and patients in challenging relationships.

Methods: In 2007, we conducted semi-structured interviews with providers recruited from 12 clinics affiliated with a U.S.

CURVES: a mnemonic for determining medical decision-making capacity and providing emergency treatment in the acute setting.

The evaluation of medical decision-making capacity and provision of emergency treatment in the acute care setting may present a significant challenge for both physicians-in-training and attending physicians. Although absolutely essential to the proper care of patients, recalling criteria for decision-making capacity may prove cumbersome during a medical emergency. Likewise, the requirements for providing emergency treatment must be fulfilled.

Teaching ethics to paediatrics residents: the centrality of the therapeutic alliance.

Context: Previous research on ethical issues encountered by medical professionals in training and practice have presented the thematic content of the cases they encounter rather than the activities in which clinicians engage and in which they most often encounter ethical issues. We conducted a direct observation study of paediatrics residents and their preceptors seeing patients in an out-patient general paediatrics clinic. Our objectives were to describe the everyday ethics-related issues paediatrics residents encounter as they interact with patients.