Midterm Outcomes of the INBONE II Total Ankle Arthroplasty.

As the number of total ankle arthroplasties (TAA) performed continues to increase, understanding midterm outcomes can guide both implant selection and preoperative patient counseling. The purpose of this study was to investigate midterm results including the survival rate and reasons for revision for the INBONE II TAA. Patients undergoing a primary TAA with the study implant and minimum of 4.

Online monitoring of financial capacity in older adults: Feasibility and initial findings.

Introduction: Impairment in financial capacity places older adults at risk of fraud or abuse and can be a harbinger of loss of independence. Online automated monitoring of financial transactions offers an objective, unobtrusive, and continuous data collection strategy to minimize risk and to detect early changes in an important complex activity of daily living.

Methods: Ninety-three participants used an online financial activity monitoring platform that extracted metrics related to use and potential departures from established patterns of financial behavior.

Intermediate-term Experience With the STAR Total Ankle in the United States.

Background:: Limited intermediate and no real long-term follow-up data have been published for total ankle arthroplasty (TAA) in the United States. This is a report of clinical follow-up data of a prospective, consecutive cohort of patients who underwent TAA by a single surgeon from 1999 to 2013 with the Scandinavian Total Ankle Replacement (STAR) prosthesis.

Methods:: Patients undergoing TAA at a single US institution were enrolled into a prospective study.

Comparison of the Vacuum Mattress versus the Spine Board Alone for Immobilization of the Cervical Spine Injured Patient: A Biomechanical Cadaveric Study.

Study Design: A biomechanical cadaveric study.

Objective: We sought to determine the amount of motion generated in an unstable cervical spine fracture with use of the vacuum mattress versus the spine board alone. Our hypothesis is that the vacuum mattress will better immobilize an unstable cervical fracture.

Ethics and evidence-based medicine: is there a conflict?

This article addresses the advantages, disadvantages, and traps to which evidence-based medicine (EBM) may lead and suggests that, to be ethically valid, EBM must be aimed at the patient's best interests and not at the financial interests of others. While financial considerations are by no means trivial, it is hypocritical - if not dangerous - to hide them behind words like "evidence" or "quality."

Framing issues in health care: do American ideals demand basic health care and other social necessities for all?

This paper argues for the necessity of universal health care (as well as universal free education) using a different argument than most that have been made heretofore. It is not meant to conflict with but to strengthen the arguments previously made by others. Using the second paragraph of the Declaration of Independence and the Preamble to the Constitution we argue that universal health care in this day and age has become a necessary condition if the ideals of life, liberty and the pursuit of happiness are to be more than an empty promise and if the discussion of "promoting of general welfare" in the preamble is to have any meaning.

Healthcare and the hospital chaplain.

Many chaplains and most chaplaincy programs in the United States--with encouragement from their accrediting organization, the Association for Clinical Pastoral Education (ACPE)--have begun to assume a more proactive stance toward patients, healthcare professionals, and healthcare facilities. Some chaplains and chaplaincy programs have begun to engage in activities that have ranged from initiating conversations with and perusing the medical records of patients who have not requested their services to proposing that they be permitted to do "spiritual assessments" on patients--in some instances whether these patients have been explicitly informed and have agreed to this beforehand. Moreover, many chaplains and chaplaincy programs have begun to assume that chaplains are full-fledged members of the healthcare team, complete with access to patients' medical records both to gather information and to make notations of their own.

Healthcare systems and motivation.

Despite the fact that most American physicians, at least until around the 1970s, stood in the way of developing a universal healthcare system, most are generally not happy with the current state of healthcare--or its lack thereof--today. The primary reasons for this general unhappiness are that insurance companies and managed care have successfully conspired to remove much of the physician's autonomy (via imposed time constraints, burdensome paperwork, the time-consuming chore of having to defend going against stringent treatment algorithms that are often inappropriate for some patients) and the satisfaction of knowing their patients. Few physicians in managed care organizations (MCOs) are able to practice without constant and blindly algorithmic interference concerning the diagnostic tests and therapeutic interventions they order.

Oaths for physicians--necessary protection or elaborate hoax?

The ritual of taking an oath upon graduating from medical school is, with a few exceptions, a routine requirement for graduation. Albeit that many students believe that they have taken the Hippocratic Oath, this is virtually never the case. Very often students themselves write many of these oaths, and taking such an oath impresses the student as well as the public, who are potential patients.

In defense of paternalism.

This paper argues that we have wrongly and not for the patient's benefit made a form of stark autonomy our highest value which allows physicians to slip out from under their basic duty which has always been to pursue a particular patient's good. In general - I shall argue - it is the patient's right to select his or her own goals and the physician's duty to inform the patient of the feasibility of that goal and of the means needed to attain it. If the goal is not one that is possible, the patient, with the physician and family, must select a feasible goal and then discuss the costs/benefits of various approaches.

Age discrimination at its best: should chronological age be a prime factour in medical decision making?

This paper briefly reviews the papers in this special section of HCA and makes the point--a point which should be obvious--that statistics are useful only as guidelines but tell one nothing about the individual patient in front of you. Chronological age merely shows what is true of most but decidedly not of all patients in a particular age group. To ration on the basis of age alone is unfair to the individual denied treatment and damaging to the community because it disturbs the solidarity which comes about because most members of the community feel that the community has obligations beyond those of not directly harming them; indeed, what produces solidarity is the feeling that members of a community will do their best to come to each others help.

Use and abuse of bioethics: integrity and professional standing.

This paper sets out to examine the integrity and professional standing of "Bioethics." It argues that professions have certain responsibilities that start with setting criteria for and credentialing those that have met the criteria and goes on to ultimately have social responsibilities to the community. As it now stands we claim that Bioethics--while it certainly has achieved some progress in the way medicine has developed--has failed to become a profession and has to a large extent failed in its social responsibility.

Advance directives. Good, bad or indifferent.

The author writes about various alternatives once decisional capacity is lost. So-called advance directives come in two forms: the living will and an appointed proxy for health care. The US--were these have been legally binding for over 20 years in all states--is a useful laboratory for studying the effect.

Principalism at the bed-side.

Using an actual case, this paper examines a number of ways in which physicians deal with such a case and with the various "principles" and ethical theories to which they are apt to appeal. It goes on to suggest that using Dewey's method of solving problems is most applicable at the bed-side.

Education, practice and bioethics: growing barriers to ethical practice.

While Bioethics is now taught at all medical colleges in the United States as well as in other nations, and while discussions about Bioethics have become frequent in most medical journals there are increasing barriers to teaching and incorporating what has been taught into daily practice. I shall discuss some of these barriers and suggest that integrating the teaching of Bioethics throughout the curriculum after presenting some of the basic theory and methodology is the most effective way of teaching this vital subject. Furthermore, courses in health care ethics are often taught as something distinct and distinguishable from one's medical practice.

Bioethics: past, present, and an open future.

The development of bioethics, spurred by the Nazi era and initiated in recent times largely in the United States, appears to be taking hold across at least the Western world. To date it lacks the necessary trappings of a true profession: that is, it lacks self-definition, criteria, and a method of assuring that those who call themselves bioethicists not only have appropriate training but function appropriately. Partly this is because the very term "appropriate" has not been defined! These are tasks that the new guard, with perhaps the advice and help of those of us from the old guard, will have to address.

Bioethics at the crossroad.

Bioethics and its offspring Health-care Ethics have a variety of uses and obligations among which and perhaps most importantly is their social obligation. This paper raises questions as to Bioethics fulfilling the necessary criteria for a profession, suggests that it can serve as a link between individual and communal problems, discusses the task of health-care ethics as well as ways of teaching it, lists some of the obligations of health-care ethics professionals and discusses the dangers to and failings of these health-care professionals today. It concludes that we are at a crossroads in which we must choose between our own personal security and comfort and fulfilling our social role.

Presuming consent, presuming refusal: organ donation and communal structure.

Donating, distributing and ultimately transplanting organs each has distinct ethical problems. In this paper I suggest that the first ethical question is not what should be done but what is a fair way in which each of these problems can be addressed. Experts--whether these be transplant surgeons, policy analysts, political scientists or ethicists--can help guide but cannot by themselves make such decisions.

Physician assisted dying and death with dignity: missed opportunities and prior neglected conditions.

This paper argues that the world-wide debate about physician assisted dying is missing a golden opportunity to focus on the orchestration of the end of life. Such a process consists of far more than adequate pain control and is a skill which, like all other skills, needs to be learned and taught. The debate offers an opportunity to press for the teaching of this skill.