Should Long-Term Consequences of NICU Care Be Discussed in Terms of Prognostic Uncertainty or Possible Harm?

We will examine several ethical considerations in the resuscitation of infants born at the margin of gestational viability in analyzing a case of preterm labor. More specifically, we will discuss the obligations of physicians in characterizing expected outcomes, both mortality and long-term morbidity, for extremely premature infants and how potential adverse outcomes should be framed-as complications of prematurity itself or as iatrogenic complications of care. We will also explore how the concept of a "trial of therapy" can support parents and neonatologists in decision making concerning withholding or withdrawing care for periviable infants.

Conjoint Sessions With Clinical Pharmacy and Health Psychology for Chronic Pain: Enhancing Participation in Behavioral Management.

This quality improvement project suggests the utility of an interdisciplinary, coordinated team approach to chronic pain management and behavioral health services.

Medical Schools' Willingness to Accommodate Medical Students with Sensory and Physical Disabilities: Ethical Foundations of a Functional Challenge to "Organic" Technical Standards.

Students with sensory and physical disabilities are underrepresented in medical schools despite the availability of assistive technologies and accommodations. Unfortunately, many medical schools have adopted restrictive "organic" technical standards based on deficits rather than on the ability to do the work. Compelling ethical considerations of justice and beneficence should prompt change in this arena.

Ethical Considerations about EHR-Mediated Results Disclosure and Pathology Information Presented via Patient Portals.

Electronic health records (EHR) now include patient portals where patients can obtain clinical reports, including notes, radiology reports, and laboratory/anatomic pathology results. Although portals increase patient access to information, no guidelines have been developed for hospitals about appropriate delays in posting different types of pathology reports to the EHR. Delays exist as a matter of policy to allow physicians time to answer questions and provide emotional support when discussing sensitive results with patients.

Requests for VIP Treatment in Pathology: Implications for Social Justice and Systems-Based Practice.

Preferential treatment of patients whom we deem "very important" is a practice that is common in our health care system. The impact of this designation and the care that results is rarely studied or scrutinized. Although we assume that this type of treatment results in superior outcomes, this assumption can be wrong for a variety of reasons, which we discuss here.

I Might Have Some Bad News: Disclosing Preliminary Pathology Results.

Cytopathology is a subspecialty of pathology in which pathologists frequently interact directly with patients. Often this interaction is in the context of fine needle aspiration (FNA) procedures performed at the bedside by the cytopathologist or by another clinician with the cytopathologist present. Patient requests for preliminary results in such settings raise fundamental questions about professional scope of practice and communication of uncertainty that apply not merely to pathologists but to all clinicians.

Characteristics of High-Functioning Collaborations Between Primary Care and Podiatry in VHA Patient Aligned Care Teams.

The key to high-functioning PACT/Podiatry teams rests with the quality of the communication between providers.

Improving patients' readiness for coronary artery bypass graft surgery.

Background: Preoperative interventions improve outcomes for patients after coronary artery bypass surgery (CABG).

Objective: To reduce mortality for patients undergoing urgent CABG.

Methods: Eight centers implemented preoperative aspirin and statin, preinduction heart rate less than 80/min, hematocrit greater than 30%, blood sugar less than 150 mg/dL (8.

Positive rights, negative rights and health care.

In the current debate about healthcare reform in the USA, advocates for government-ensured universal coverage assume that health care is a right. Although this position is politically popular, it is sometimes challenged by a restricted view of rights popular with libertarians and individualists. The restricted view of rights only accepts 'negative' rights as legitimate rights.

Standards of care for diabetes: what's new?

Each year, the American Diabetes Association (ADA) publishes standards of medical care for people with diabetes. The ADA updates these standards based on the latest evidence so that healthcare professional scan incorporate this evidence into their care. The standards also summarize and rate the levels of evidence on which the recommendations are based.

Closing the schools: lessons from the 1918-19 U.S. influenza pandemic.

When the novel strain of A/H1N1 influenza first appeared in spring 2009, closing schools was initially a common and often challenging strategy implemented in many communities. Arguments for and against closing schools are likely to arise anew if influenza spikes in the fall of 2009. Policymakers and community officials considering this and other nonpharmaceutical responses can learn from the experiences of ninety-one years ago, during the 1918-19 influenza pandemic that killed thousands of Americans.