Benefits of Dual Appointments in Academic Research and Bedside Nursing.

Research and clinical practice can inform and improve each other.

How Might Antibiotic Stewardship Programs Influence Clinicians' Autonomy and Organizations' Liability?

Federal and state governments mandate some health care organizations to implement antibiotic stewardship programs (ASPs). Some early adopters developed model ASPs that have helped set industry standards; other benchmarks will likely be forged in subsequent regulation, legislation, and jurisprudence. This article considers how ASP designs can affect professional autonomy, especially of frontline antibiotic stewards who are usually physicians and pharmacists.

Should Antimicrobial Resistance Limit Access to an Organ Transplant?

Burkholderia cenocepacia (B cenocepacia) is a gram-negative bacteria associated with significant morbidity and mortality following lung transplantation. Most US transplant programs consider B cenocepacia colonization to be an absolute contraindication to transplantation. This article argues that, if clinicians have good clinical reasons to expect poor outcomes for patients with B cenocepacia, then offering transplantation anyway is an abrogation of clinicians' fiduciary duties.

Opportunities for Global Health Diplomacy in Transnational Robotic Telesurgery.

Globally, barriers to the widespread adoption of robotic surgery have worsened existing inequities in surgical care between low- and middle- income countries (LMICs) and high-income countries (HICs). This article advocates for the creation of sustainable robotic surgery programs in LMICs by drawing from ethical and philosophical theories, including preference utilitarianism, procedural justice, structural violence, and human rights. On this basis, robotic telesurgery is proposed as a form of global health diplomacy (GHD) between LMICs and HICs, and particular emphasis is placed on considerations in robotic surgery GHD program negotiations between LMICs and HICs and on political and ethical questions related to the transnational use of artificial intelligence.

Which Skills Are Key to Public Health Leaders' Success in Crisis Management?

Under-resourced and fragmented public health infrastructure has contributed to a poor pandemic response in the United States. There have been calls to redesign the Centers for Disease Control and Prevention and to increase its budget. Lawmakers also have introduced bills aiming to change public health emergency powers at the local, state, and federal levels.

What Should Be Roles of Federal Clinician Governors in Motivating Equity in Locally Coordinated Triage Protocols?

This commentary on a case examines racially inequitable outcomes, especially for Black patients, resulting from use of Sequential Organ Failure Assessment (SOFA) scores to triage patients during the COVID-19 pandemic and how inequitable outcomes in triage protocols could be reduced. It also considers the nature and scope of clinician governor responses to members of federally protected classes who are disadvantaged by use of the SOFA score and argues that clinician leaders of the Centers for Disease Control and Prevention, specifically, should provide federal guidance that motivates clear legal accountability.

How Should Clinicians Own Their Roles as Past and Present Exacerbators of Health Inequity and as Present and Future Contributors to Health Equity?

To improve health outcomes, the science and practice of medicine must move quickly in response to new information. Yet, in other important ways, health professionals must operate slowly and in a mode of intentional stillness to center empathy and light a path from empathy to solidarity. Solidarity, or standing with, prompts efforts to create circumstances in which disadvantaged communities can achieve health equity.

Using the Health Belief Model to improve influenza vaccination rates.

Vaccination rates for influenza are lower than expected each year in the United States. Multiple factors contribute to low vaccination rates, including poor access to healthcare, lack of insurance, and patient perception of risk and benefit. A better working understanding of the Health Belief Model can help clinicians understand the psychologic factors that contribute to low vaccination rates and help clinicians improve patient understanding and uptake of the influenza vaccine.

Values Imposition and Ethical Pluralism: An Argument Against Standardized Ethical Directives for Healthcare Ethics Consultants.

In the article "An Argument for Standardized Ethical Directives for Secular Healthcare Services," Abram L. Brummett and Jamie C. Watson argue that, parallel to the directives of the Roman Catholic Church, secular healthcare ethics consultants (HECs) need substantive standardized ethical guidelines (what they call SEGs) that would constitute a best practice across all HECs in the U.

Defining Drugs that are High-Risk Associations for Drug Reactions Within the Hospital Setting.

Objective: We sought to evaluate medication exposures during an entire hospitalization, with the goal of describing medications and demographic conditions that are associated with developing a drug eruption during hospitalization.

Methods: 468 patients that developed a cutaneous drug eruption were identified from a cohort of 18,140 unique inpatients with dermatologic diagnoses; medication lists and demographic information were assimilated, and drug eruption frequency tables were created.

Results: The agents most commonly associated with drug eruptions included many antineoplastic, antifungal, and antibiotic therapeutics: idarubicin (27.

Ironic Currency.

A 3-panel comic illustrates an offer of data to pay for health care services.

ICU survivorship: What PAs need to know.

The number of people surviving critical illnesses is larger than ever. Many of these patients will rely on physician assistants (PAs) to facilitate their care after discharge from the ICU. As a result, PAs must be able to recognize and treat the numerous short- and long-term challenges this vulnerable population faces, especially given the recent surge of critically ill patients resulting from the COVID-19 pandemic.

Are Financial Incentives Appropriate Means of Encouraging Medication Adherence Among People Living With HIV?

Background: Financial incentives have been shown to improve antiretroviral (ARV) adherence for people living with HIV, but scholars have argued that this commodifies treatment and have debated the ethics of doing so. This article summarizes research on ethical processes and factors involved in an intervention that successfully improved ARV adherence among socially vulnerable people living with HIV.

Methods: Thirty qualitative interviews were conducted with intervention participants and field notes documenting organizational processes were analyzed.

Designing Nudges for Success in Health Care.

Nudges are subtle changes to the design of the environment or the framing of information that can influence our behaviors. There is significant potential to use nudges in health care to improve patient outcomes and transform health care delivery. However, these interventions must be tested and implemented using a systematic approach.

Diagnosis and Management of Esophagogastric Junction Outflow Obstruction.

Esophagogastric junction outflow obstruction (EGJOO) is an abnormal topographic pattern seen on high-resolution manometry. EGJOO is characterized by an elevated median integrated relaxation pressure with intact or weak peristalsis, thus not meeting the criteria for achalasia. This diagnosis has a female predominance and is associated with varying presenting symptoms.

Genome Editing, Ethics, and Politics.

For the better part of a dozen years and over 3 US presidential terms, heated debates about the ethics of cloning and embryonic stem cell research helped to define the American political landscape. Current lack of public controversy about regulation of human genome editing does not signal that ethical issues about engineering human embryos have been settled. Rather, while genome editing raises old ethical questions about the value of human life, eugenics, and the weight of unintended consequences, it also came into being in a political landscape that vastly differs from the early aughts when bioethics was last a major topic of political controversy.

Implementing Dietary Modifications and Assessing Nutritional Adequacy of Diets for Inflammatory Bowel Disease.

Guidelines for dietary recommendations and nutritional therapy for patients with inflammatory bowel disease (IBD) are lacking, and patients are moving toward popular defined diets for relief of symptoms and inflammation. However, many proposed diets involve elimination of specific foods or food groups and may exacerbate or inadequately replete micronutrient deficiencies that are prevalent in patients with IBD at baseline. Further, limited data are available to guide clinicians on the use of dietary protocols for IBD.

Glucocorticoid Treatment of Symptomatic Sarcoidosis in 2 Morbidly Obese Patients.

Corticosteroid management for patients with sarcoidosis requires the need for close monitoring to detect and manage any complications that may arise during treatment.

How Forcefully Should Clinicians Encourage Treatment When Disagreement Persists About Obesity Risk?

Pediatric obesity is a major public health problem, and weight reduction in children and adolescents with obesity is associated with improvement in health outcomes. This case of an adolescent diagnosed with obesity whose mother disagrees with the diagnosis illustrates challenges often encountered in clinical practice, including (1) diagnosing a disease in an asymptomatic patient whose future risk for negative health outcomes is uncertain, (2) addressing ethical implications of naming a stigmatizing disease, and (3) resolving conflicting goals and opinions of a patient, caregiver, and physician. Suggestions for navigating disagreement and implementing courses of action are discussed.

Perianal Fistulas in Patients With Crohn's Disease, Part 2: Surgical, Endoscopic, and Future Therapies.

The treatment of perianal fistulas remains a clinical challenge despite the significant advances that have been made in the management of luminal inflammatory bowel disease. In combination with medical therapies, surgical management of perianal fistulas is important for both infection control and definitive repair. Older surgical techniques include the placement of draining and cutting setons and endorectal advancement flaps.

Perianal Fistulas in Patients With Crohn's Disease, Part 1: Current Medical Management.

Despite significant advances in the treatment of luminal inflammatory bowel disease, the treatment of perianal fistulas remains a clinical challenge. Perianal fistulas are traditionally described using the Parks classification based on their relationship to the external and internal anal sphincters. Traditional therapy for perianal fistulas focuses on antibiotics such as metronidazole or ciprofloxacin.