When a Patient Leaves Your Care, How Do You Want Them to Feel?

Peacefulness is a potentially healing inner state that can be fostered by skilled interpersonal interactions. Skilled interactions in health care are those in which clinicians focus on making patients feel seen and heard and that their needs are important and can be met. But data collected in health care encounters tend to place value on consumerism and commodification, both of which undermine clinicians' capacities to skillfully interact with patients in ways that support patients feeling comfortable, if not peaceful.

Advancing the Primary Health Care Mandate for Nursing.

A call to increase home visits and human function documenting by nurses.

Reducing falls among residents of retirement homes: A DNP project.

Falls among older adults (OAs) living in retirement homes (RHs) in Canada are a major public health concern due to high morbidity and mortality as well as significant healthcare expenditures. This quality improvement (QI) initiative, conducted for the author's Doctor of Nursing Practice (DNP) project, aimed to decrease fall rates and ED transfers related to falls among OAs in six RHs across the Greater Toronto Area in Ontario, Canada through a multipart intervention with two primary goals. First, the project aimed to facilitate RH NPs' implementation of a comprehensive fall risk assessment and fall prevention strategy in their practice by incorporating the Stopping Elderly Accidents, Deaths & Injuries (STEADI) toolkit into their armamentarium.

A Case Management Approach in Stroke Care: A Mixed-Methods Acceptance Analysis From the Perspective of the Medical Profession.

Purpose Of Study: In terms of continuous and coordinated health care, cross-sectoral care structures are crucial. However, the German health care system is characterized by fragmentation of medical services and responsibilities. This fragmentation leads to multiple interfaces frequently causing loss of information, effectiveness, and quality.

An Elderly Patient with Undiagnosed Type 2 Diabetes Mellitus Presenting for an Emergency Extraction.

In this case a patient has multiple risk factors for diabetes including periodontal disease, family history positive for diabetes, and body mass index of 24 in an Asian American. He has no medical or dental home and upon presenting to the dental office would be a good candidate for diabetes screening.

What Should Clinicians Know About Palliative Psychopharmacology?

The nature and scope of palliative psychiatry and associated ethical implications are debated in the literature. This article examines conceptual limitations of extant accounts of palliative psychiatry, with a focus on psychopharmacological practice, and suggests that modifiable and unmodifiable psychiatric illnesses exist on a spectrum along which broader or narrower palliative psychiatric care approaches can be outlined. The article also discusses how these approaches intersect with questions about whether and to what extent psychiatric medications have symptom-reducing or disease-modifying effects.

How Should Clinicians Ally With Patients Whose Health Is Unlikely to Be Improved by Even Numerous Clinical Encounters?

Patients experiencing homelessness and mental illness face conditions and circumstances that deserve focused ethical and clinical attention. The first commentary on the case applies insights from qualitative research about social determinants of health to these patients' care and dignity. The second commentary describes 3 kinds of power wielded by physicians#x2014;charismatic, social, and Aesculapian#x2014;each of which is considered in terms of whether and to what extent physicians' power should be owned, aimed, or shared.

Ethical Issues in Providing and Promoting Contraception to Women with Opioid Use Disorder.

Women with opioid use disorder (OUD) face unique challenges meeting their reproductive goals. Because the rate of unintended pregnancy in this population is almost 80 percent, there has been a push to increase the use of contraceptives among reproductive-aged women with OUD.1 The patient-level ethical issues of such initiatives, however, are often overlooked.

Exposure to point-of-care ultrasound in PA programs before employment.

Objectives: Point-of-care ultrasound (POCUS) is integral to bedside evaluation of ED patients. This study examines POCUS exposure for physician assistants (PAs) before ED employment.

Methods: A retrospective cross-sectional survey was distributed electronically to PAs employed in 13 EDs across a healthcare system.

Managing pain in seriously ill patients with substance use disorders.

Managing pain can be challenging, especially in patients with serious illnesses and a history of substance use disorders. This article discusses the challenges of addressing pain in these patients and offers perspectives regarding their clinical management.

Emergency-Only Hemodialysis Policies: Ethical Critique and Avenues for Reform.

An estimated 6,500 undocumented immigrants in the United States have been diagnosed with end-stage renal disease (ESRD). These individuals are ineligible for the federal insurance program that covers dialysis and/or transplantation for citizens, and consequently are subject to local or state policies regarding the provision of healthcare. In 76% of states, undocumented immigrants are ineligible to receive scheduled outpatient dialysis treatments, and typically receive dialysis only when presenting to the emergency center with severe life-threatening symptoms.

Mutation Causes Ectodermal Dysplasia in a Patient Mosaic for Turner Syndrome.

plays a role in the proper proliferation and differentiation of ectodermal structures. Mutations in this gene can be responsible for a highly phenotypically variable range of disorders termed . Here, we describe the case of a five-year-old male patient who is mosaic for Turner syndrome (45,X [90%]/46,X isodicentric Y [10%]) and who presented to dermatology with anhidrosis, conical-shaped teeth, and a slowed rate of hair growth with genetic testing subsequently revealing a likely pathogenic heterozygous variant in (c.

Prioritizing Women's Health in Germline Editing Research.

Although women are inextricably involved in the study of germline editing, their interests have not been significantly represented in debates about the evolution of genome editing technology. Discussions have taken place about effects of germline editing on women as parents and members of families, but key discussions about women's health and well-being as patients and subjects are lacking. This neglect is due in part to restrictions on uterine transfer of modified human embryos, a boundary that has now been crossed.

Pediatric Ethics Consultation: Practical Considerations for the Clinical Ethics Consultant.

Clinical ethics consultants face a wide range of ethical dilemmas that require broad knowledge and skills. Although there is considerable overlap with the approach to adult consultation, ethics consultants must be aware of differences when they work with infant, pediatric, and adolescent cases. This article addresses unique considerations in the pediatric setting, reviews foundational theories on parental authority, suggests practical approaches to pediatric consultation, and outlines current available resources for clinical ethics consultants who wish to deepen their skills in this area.

Significant HbA Lowering in Patients Achieving a Hepatitis C Virus Cure.

The immediate clinically significant reduction in hemoglobin A following HCV treatment observed in this study contrasts with the expected rise seen with normal disease progression.

Cardiopulmonary Resuscitation, Informed Consent, and Rescue: What Provides Moral Justification for the Provision of CPR?

Questions related to end-of-life decision making are common in clinical ethics and may be exceedingly difficult. Chief among these are the provision of cardiopulmonary resuscitation (CPR) and do-not-resuscitate orders (DNRs). To better address such questions, clarity is needed on the values of medical ethics that underlie CPR and the relevant moral framework for making treatment decisions.

Videoconferencing Empowers Distance Caregivers to Be More Involved in Care.

Distance caregiving is a relatively new phenomenon associated with today's increasingly mobile society. Distance caregivers (DCGs)-those unable to attend a family member's oncology appointments due to distance-often miss out on supportive services offered to the patient and local family and must rely on secondhand information to keep track of the patient's plan of care. The Frances Payne Bolton School of Nursing at Case Western Reserve University in Cleveland, Ohio, is testing a program to address the needs of this unique demographic by incorporating videoconferencing into patient visits.

Real-Time Visual Tracking of Dynamic Surgical Suture Threads.

In order to realize many of the potential benefits associated with robotically assisted minimally invasive surgery, the robot must be more than a remote controlled device. Currently, using a surgical robot can be challenging, fatiguing, and time consuming. Teaching the robot to actively assist surgical tasks, such as suturing, has the potential to vastly improve both patient outlook and the surgeon's efficiency.

Balancing Demand for Universally Improved Health Outcomes with Need for a Local Standard of Care.

The United States, along with other resource-rich countries, leads global health care by advancing medical care through randomized controlled trials (RCTs). While most medical research is conducted in these resource-rich areas, RCTs, including replications of previous trials, are additionally carried out in low- and middle-income countries. On the basis of positive findings from several RCTs conducted in high-income countries, the Antenatal Corticosteroids Trial (ACT) evaluated the effectiveness of antenatal corticosteroids in reducing neonatal mortality in low- and middle-income countries.