How to implement a "standard of care" regulatory model for pharmacists.

National pharmacy associations have increasingly explored regulation according to a "standard of care." In such a model, pharmacists can provide a wide range of clinical services aligned with their education and training. Based on Idaho's experience implementing this model, there are five critical steps states must take to enact a standard of care: 1) Adopt a broad definition of "practice of pharmacy;" 2) Allow elasticity for practice innovation over time; 3) Decide which limited instances still necessitate prescriptive regulation; 4) Eliminate all unnecessary regulations; and 5) Strengthen accountability for deviations from the standard of care. States wishing to adopt a standard of care approach can follow this five-step process to enhance patient care and mitigate the lag that is otherwise constant between laws and practice.

Caring for Patients With Acute Respiratory Distress Syndrome: Summary of the 2023 ESICM Practice Guidelines.

This article summarizes the 2023 updated ARDS guidelines from the European Society of Intensive Care Medicine, including the guidelines' methods, findings, and implications, along with reflections on next steps.

Standards of Care for Transgender and Gender Diverse People.

This article summarizes the recent update of guidelines on health care for transgender and gender diverse people, including primary care, gender-affirming care, mental health care, and education of the clinical workforce.

Love Your Patient as Yourself: On Reviving the Broken Heart of American Medical Ethics.

This article presents a radical claim: American medical ethics is broken, and it needs love to be healed. Due to a unique set of cultural and economic pressures, American medical ethics has adopted a mechanistic mode of ethical reasoning epitomized by the doctrine of principlism. This mode of reasoning divorces clinicians from both their patients and themselves. This results in clinicians who can ace ethics questions on multiple-choice tests but who fail either to recognize a patient's humanity or to navigate the ethical quandaries into which they are frequently thrown. Drawing on personal experience as well as the philosophical work of Augustine of Hippo, Simone Weil, and Iris Murdoch, we propose a novel ethical approach grounded in a conception of neighbor love, specifically, the virtue of love understood as attention to a sufferer's humanity. We conclude with five practical recommendations for reimagining medical ethics education oriented around the virtue of love.

To Sir, With Love.

In this biography, the life of William Hugh Isbister is traced through three continents, where he planted the seeds of academic surgery into a generation of leaders in colorectal surgery. This ultimately improved the care for thousands of patients. His last station in Saudi Arabia made a huge impact on the country. I hope this article inspires others to write about their mentors who were important in their development as surgeons and physicians. Short biographies of these important figures will serve as a valuable historical record for generations to come.

Is the evidence-based medicine movement counter-productive: are randomised controlled trials the best approach to establish evidence in complex healthcare situations?

In the modern era, evidence-based medicine (EBM) has been embraced as the best approach to practising medicine, providing clinicians with 'objective' evidence from clinical research. However, for presentations with complex pathophysiology or from complex social environments, sometimes there remains no evidence, and no amount of research will obtain it. Yet, health researchers continue to undertake randomised controlled trials (RCT) in complex environments, ignoring the risk that participants' health may be compromised throughout the trial process. This paper examines the role of research that seeks to obtain evidence to support EBM. We provide examples of RCTs on ear disease in Aboriginal populations as a case-in-point. Decades of ear research have failed to yield statistically significant findings, demonstrating that when multiple factors are at play, study designs struggle to balance the known disease process drivers, let alone unknown drivers. This paper asks the reader to consider if the pursuit of research is likely to produce evidence in complex situations; or if perhaps RCTs should not be undertaken in these situations. Instead, clinicians could apply empirical evidence, tailoring treatments to individuals while taking into account the complexities of their life circumstances.

Recommendations for Care of Survivors of Head and Neck Cancer.

This JAMA Clinical Guidelines Synopsis summarizes the American Head and Neck Society's 2021 consensus statement on care of survivors of head and neck cancer.

Lamatiste käsitlus: ennetamine ja ravi / Management of bedsores: prevention and treatment

A bedsore is a localized damage to the skin and/or subcutaneous tissue that usually occurs due to pressure in the area of ​​bony prominences or a combination of displacement, friction and pressure. When lying down, a person's quality of life deteriorates for a long time, the need for care and aids, the costs of health services and the burden on caregivers increase. At the same time, it is possible to prevent or reduce the occurrence of bedsores. As a result of a study conducted in European countries, it was found that the general prevalence of bedsores among hospitalized patients is 18%, but the frequency varies in different countries [1]. There are no data on the prevalence of bedsores in Estonia, because the occurrence and occurrence of bedsores in Estonian treatment and welfare institutions are not systematically registered or coded. At the same time, there is no reason to believe that the incidence of bedsores is lower in Estonia than in developed countries. The practice of diagnosing and treating bedsores varies in treatment and care institutions, so not all the best evidence-based options are always used for the prevention and treatment of bedsores.

Lamatis on lokaalne naha ja/või nahaaluskoe kahjustus, mis tekib tavaliselt luueendite piirkonnas surve tõttu või nihkumise, hõõrdumise ja surve koosmõjul. Lamatise tekkel halveneb pikaks ajaks inimese elukvaliteet, suurenevad hooldus- ja abivahendite vajadus, tervishoiuteenuste kulud ning hooldajate koormus. Samas on lamatise teket võimalik ennetada või vähendada. Euroopa riikides tehtud uuringu tulemusena leiti, et lamatiste üldine levimus on hospitaliseeritud patsientide seas 18%, kuid eri riikides sagedus varieerub [1]. Andmed lamatiste levimuse kohta Eestis puuduvad, sest Eesti ravi- ja hoolekandeasutustes lamatiste teket ja esinemist ei registreerita ega kodeerita süsteemselt. Samas ei ole alust arvata, et lamatiste esinemissagedus oleks Eestis väiksem kui arenenud maades. Lamatiste diagnoosimise ja ravi praktika on ravi- ja hooldeasutustes erinev, mistõttu ei kasutata lamatiste ennetuseks ning raviks alati kõiki parimaid tõenduspõhiseid võimalusi.