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1.
Health Res Policy Syst ; 19(1): 47, 2021 Mar 31.
Artículo en Inglés | MEDLINE | ID: mdl-33789671

RESUMEN

BACKGROUND: At the height of the COVID-19 pandemic, Thailand had almost depleted its critical care resources, particularly intensive care unit (ICU) beds and ventilators. This prompted the necessity to develop a national guideline for resource allocation. This paper describes the development process of a national guideline for critical resource allocation in Thailand during the COVID-19 pandemic. METHODS: The guideline development process consisted of three steps: (1) rapid review of existing rationing guidelines and literature; (2) interviews of Thai clinicians experienced in caring for COVID-19 cases; and (3) multi-stakeholder consultations. At steps 1 and 2, data was synthesized and categorized using a thematic and content analysis approach, and this guided the formulation of the draft guideline. Within step 3, the draft Thai critical care allocation guideline was debated and finalized before entering the policy-decision stage. RESULTS: Three-order prioritization criteria consisting of (1) clinical prognosis using four tools (Charlson Comorbidity Index, Sequential Organ Failure Assessment, frailty assessment and cognitive impairment assessment), (2) number of life-years saved and (3) social usefulness were proposed by the research team based on literature reviews and interviews. At consultations, stakeholders rejected using life-years as a criterion due to potential age and gender discrimination, as well as social utility due to a concern it would foster public distrust, as this judgement can be arbitrary. It was agreed that the attending physician is required to be the decision-maker in the Thai medico-legal context, while a patient review committee would play an advisory role. Allocation decisions are to be documented for transparency, and no appealing mechanism is to be applied. This guideline will be triggered only when demand exceeds supply after the utmost efforts to mobilize surge capacity. Once implemented, it is applicable to all patients, COVID-19 and non-COVID-19, requiring critical care resources prior to ICU admission and during ICU stay. CONCLUSIONS: The guideline development process for the allocation of critical care resources in the context of the COVID-19 outbreak in Thailand was informed by scientific evidence, medico-legal context, existing norms and societal values to reduce risk of public distrust given the sensitive nature of the issue and ethical dilemmas of the guiding principle, though it was conducted at record speed. Our lessons can provide an insight for the development of similar prioritization guidelines, especially in other low- and middle-income countries.


Asunto(s)
Cuidados Críticos , Enfermedad Crítica , Asignación de Recursos para la Atención de Salud , Accesibilidad a los Servicios de Salud , Pandemias , Guías de Práctica Clínica como Asunto , Toma de Decisiones , Revelación , Ética Médica , Recursos en Salud , Hospitalización , Humanos , Unidades de Cuidados Intensivos , Pronóstico , Discriminación Social , Valores Sociales , Participación de los Interesados , Tailandia , Confianza
4.
Medicine (Baltimore) ; 100(12): e24816, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33761642

RESUMEN

ABSTRACT: Antihypertensive drugs have been of significant interest to the pharmaceutical industry due to increasing sales opportunities in a global market. The financial relationships between pharmaceutical companies and the Japanese Society of Hypertension (JSH) have a possible influence on clinical practices in Japan. This study examined the distribution of pharmaceutical payments made to the authors of the revised Guidelines for the Management of Hypertension (JSH2019) and the transparency of the Conflict of Interest disclosure that each author made.We retrospectively obtained publicly available data regarding payments made by Japanese pharmaceutical companies to all authors of the JSH2019 in 2016. We also collected data on individual financial disclosure of JSH2019 authors to investigate whether their self-reported financial relationship with companies were compliant to the financial disclosure policy of JSH2019.The total and mean payment values reported by pharmaceutical companies were $4,246,436 and $21,447, respectively. Of the 198 authors, 171 (86.4%) authors received at least 1 payment. Of 74 authors required to disclose their conflict of interest (COI) the authors, one-third failed to follow the COI policy covering the clinical guidelines.Major pharmaceutical companies selling antihypertensive drug products in the Japanese market had a significant financial connection with the JSH2019 authors. Financial relationships between pharmaceutical companies and authors or Japanese medical societies are raising significant concerns about the credibility of clinical guidelines and the potentially biases and undue influences that they may cause, especially with respect to adverse prescription patterns.


Asunto(s)
Conflicto de Intereses/economía , Industria Farmacéutica/economía , Hipertensión/tratamiento farmacológico , Guías de Práctica Clínica como Asunto , Sociedades Científicas/economía , Antihipertensivos/normas , Antihipertensivos/uso terapéutico , Revelación/ética , Revelación/estadística & datos numéricos , Industria Farmacéutica/ética , Industria Farmacéutica/estadística & datos numéricos , Humanos , Japón , Sesgo de Publicación , Estudios Retrospectivos , Sociedades Científicas/ética , Sociedades Científicas/normas
5.
BMC Complement Med Ther ; 21(1): 68, 2021 Feb 19.
Artículo en Inglés | MEDLINE | ID: mdl-33607994

RESUMEN

BACKGROUND: Despite the growing conventional healthcare coverage in Eritrea, traditional medicine (TM) remains an essential source of healthcare service to the population. This study, therefore, aims at exploring the attitude, societal dependence, and pattern of TM use of the Gash-Barka community. METHODS: A cross-sectional study was conducted between December 2018 and January 2019 in Gash-Barka region, one of the six regions of Eritrea. Two-stage stratified cluster sampling design was used to provide representative sample of households. The data collected through face-to-face interview using a structured questionnaire was entered twice and analyzed using CSPro7.2 and SPSS 23, respectively. Both descriptive and analytical analyses were performed to test statistical significance. RESULTS: Of the total 210 participants, 202 completed the interview with a response rate of 96.2%. Almost 97% of the respondents were aware of the general existence of TM. About half of the respondents (47.4%) had visited traditional health practitioners (THPs) at least once in their lifetime. The majority of the respondents claimed their medical condition had been improved (63.2%), were satisfied with the outcome (76.8%), and had not encountered complications (95.2%) due to TM use. Around 40% of the respondents admitted they do not disclose previous TM use to conventional health practitioners. Females are more likely to have had ever visited THPs (AOR = 1.85, CI: 1.01, 3.38) and use TM in the future (AOR = 2.26, CI: 0.92, 5.14) than males. Moreover, those who had visited THPs before (COR = 8.30, CI: 3.25, 21.20) are more likely to use TM as a primary treatment choice and prefer to use TM in the future (AOR = 4.40, CI: 1.97, 9.83) than those who had never visited THPs. About 61% of the total families claimed they had circumcised at least one female child, and 96.8% disclosed they had circumcised at least one male child. Out of which, 89.2% of the circumcisions were done by THPs. CONCLUSION: TM is popular and widely relayed upon by Gash-Barka residents with exposure of children to harmful TM practices. Since the reliance of the community on TM is expected to continue, further representative studies are recommended to inform regulatory interventions and integrate TM into the health system.


Asunto(s)
Prestación de Atención de Salud , Medicina Tradicional Africana , Aceptación de la Atención de Salud , Adulto , Actitud , Niño , Circuncisión Femenina , Estudios Transversales , Revelación , Eritrea , Femenino , Humanos , Masculino , Persona de Mediana Edad , Características de la Residencia , Encuestas y Cuestionarios
6.
Curr Opin Anaesthesiol ; 34(2): 173-175, 2021 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-33577207

RESUMEN

PURPOSE OF REVIEW: Disclosure after medical error is a complex process that goes beyond a single provider and the patient. The types and severity of errors occurring in the practice of anesthesiology may have more implications for patients, requiring a thoughtful approach to the patient, their families and the healthcare system as a whole. RECENT FINDINGS: Tenants of the disclosure have been established. Simulation for trainees and practitioners allows for education and preparation for such events. SUMMARY: Despite education and systems-based improvements in quality and safety in medicine, errors will undoubtably occur. Communication with patients and their families after an event is key in maintaining trust in the therapeutic relationship. A concerted effort is required by a team to ensure a well-executed disclosure.


Asunto(s)
Revelación , Errores Médicos , Anestesiología , Comunicación , Humanos
8.
J Athl Train ; 56(2): 157-163, 2021 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-33596598

RESUMEN

CONTEXT: Mandated concussion education has aimed to improve student-athlete knowledge; however, some collegiate student-athletes continue to not disclose concussion. Concussion knowledge may not be the only factor influencing reporting, as student-athlete sex, sport, and pressure from external stakeholders (eg, coaches, teammates, fans, parents or family) have all been documented as influencing collegiate concussion-reporting behavior. OBJECTIVE: To examine factors associated with concussion nondisclosure in collegiate student-athletes. DESIGN: Cross-sectional study. SETTING: Four National Collegiate Athletic Association Division I and two Division II universities. PATIENTS OR OTHER PARTICIPANTS: A total of 1125 collegiate student-athletes completed the survey, and 741 provided viable responses and were included for data analysis. MAIN OUTCOME MEASURE(S): We used a 10- to 15-minute electronic or paper-and-pencil survey that asked about personal and sport demographics, diagnosed concussions and nondisclosed concussion history, concussion knowledge, and level of agreement regarding pressure to play after a head impact experienced during collegiate sport participation. Significant univariable factors were entered into a multivariable logistic regression analysis. RESULTS: Sex (P = .005), sport-risk type (P < .001), diagnosed concussion history (P < .001), concussion knowledge (P = .017), and pressure from coaches (P < .001), teammates (P < .001), fans (P = .024), and parents or family (P = .003) were factors associated with concussion nondisclosure in individual univariable logistic regressions. After we conducted multivariable analyses, male sex (P = .001), high concussion-risk sport participation (P = .048), diagnosed concussion history (P < .001), increased concussion knowledge (P = .013), and experiencing pressure from coaches to continue playing after sustaining a hit to the head (P = .002) were factors associated with concussion nondisclosure in collegiate student-athletes. CONCLUSIONS: Our results suggest that concussion-education programs should go beyond the identification of signs and symptoms to include the dangers of continuing to play, long-term consequences, and transparency about concussion protocols. Comprehensive concussion-education programs should involve coaches and athletes to improve the reporting culture.


Asunto(s)
Atletas/estadística & datos numéricos , Traumatismos en Atletas/diagnóstico , Conmoción Encefálica/diagnóstico , Revelación , Adolescente , Estudios Transversales , Femenino , Humanos , Masculino , Michigan , Ohio , Pennsylvania , South Carolina , Deportes , Estudiantes/estadística & datos numéricos , Encuestas y Cuestionarios , Universidades , Adulto Joven
9.
J Environ Manage ; 285: 112095, 2021 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-33561729

RESUMEN

Focusing on green technology innovation, the paper researches its motivation and implementation results from the perspective of internal corporate management. The impact of top manager team faultlines on green technology innovation and the moderating role of environmental information disclosure in the relationship between green technology innovation and financial performance are discussed. Using listed manufacturing corporate data obtained from China Stock Market & Accounting Research database, the hypotheses are tested. It is found that there is an inverted U-shaped relationship between task-related faultline and green technology innovation, while bio-demographic faultline has no significant influence on green technology innovation. In addition, both green technology innovation and environmental information disclosure have positive effects on financial performance, while the moderating effect of environmental information disclosure on innovation-performance doesn't exist. Combined with the research results, the practical implications for policy makers and managers and future research avenue are proposed.


Asunto(s)
Comercio , Invenciones , China , Revelación
11.
Anaesthesia ; 76 Suppl 1: 18-26, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33426664

RESUMEN

The risks of regional anaesthesia relate primarily to the technical nature of the procedure, chief among them being neurological. While rare, the direct relationship between nerve damage and the procedure itself means that patients need to be aware of this complication when consent is sought. In order to give valid consent, a patient must be informed. The extent of the information required has been defined by a 2015 legal ruling which established that the standard is the expectation of a reasonable patient, rather than the information deemed consequential by a reasonable doctor. The implications of this for clinicians are profound, and mean that the process of consent must, for example, include alternatives to the proposed treatment. Additionally, patients must have capacity and give their consent without coercion. Effective communication of risk can be challenging. As well as the barriers to comprehension that can result from language, literacy and numeracy, clinicians need to be aware of their own biases, often in favour of a regional anaesthetic approach. Patients also have biases, and doctors must be aware of these in order to best target their provision of information. Careful use of language and employing adjuncts such as information leaflets and visual aids can help to maximise the individual's autonomy. Particular care must be taken in special situations such as where patients have capacity issues or time is limited by the emergency nature of the intervention.


Asunto(s)
Anestesia de Conducción/efectos adversos , Anestesiología/legislación & jurisprudencia , Revelación , Humanos , Consentimiento Informado , Relaciones Médico-Paciente , Factores de Riesgo
12.
Aust Vet J ; 99(4): 93-107, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33506514

RESUMEN

BACKGROUND: Veterinary registration processes, including disclosure of disability or misconduct, vary across jurisdictions in Australasia, and there is currently no clear mechanism for the communication of registration requirements to prospective or current students. Procedures for registration of graduating students are evolving but are not necessarily responsive to conflicting imperatives for confidentiality, protection of stakeholder interests and graduate support. OBJECTIVE: To obtain opinions from members of the veterinary profession in Australasia on issues relating to graduate registration, including communication between veterinary schools and registration bodies. METHOD: This was an online survey. RESULTS: Responses were received from 245 members of the profession, including employers, educators, current students, recent graduates and board members. Respondents agreed on the importance of the survey topic to all stakeholder groups, and responses reflected the complex, contestable and nuanced nature of inherent concepts. Responses were strongly polarised between individuals with an appetite for reform, improved discourse around disability and remediation of unprofessional conduct and those with concerns and experiences suggesting boards and educators could not responsibly manage processes that included increased disclosure of disability or prior conduct. CONCLUSION: Issues related to disability and misconduct should be addressed separately in any change to registration processes. A harmonisation of registration processes across jurisdictions is desirable, but the legal implications of any potential changes require careful consideration. There is a need for improved support of disability, remediation of misconduct and a desire to promote diversity within the profession. The survey evoked strong emotions, and future discussion requires sensitivity, empathy and insight.


Asunto(s)
Revelación , Facultades de Medicina Veterinaria , Animales , Humanos , Estudios Prospectivos , Estudiantes , Encuestas y Cuestionarios
13.
Recenti Prog Med ; 112(1): 15-18, 2021 01.
Artículo en Italiano | MEDLINE | ID: mdl-33512353

RESUMEN

It was a very dark year for EBM. One of the side effects of the Covid-19 pandemic is a severe compression of the evidences. Here are some worrying events. May 2020: the saga of hydroxychloroquine. October 2020: the nitazoxanide case. November 2020: Trump Administration Interferes on Expert Opinion. December 2020: the results of the trials on the first two vaccines were announced in press releases, leaving many scientific uncertainties. Peter Piot, head of the London School of Hygiene & Tropical Medicine noted that none of the CoViD-19 vaccines have offered much data to date. «It is frustrating that all of these announcements are delivered via press release, and not give us a chance to review the actual data. We desperately need total transparency on evidence and data¼, says Piot. Better now to relaunch the spread of EBM. In the issue, we have included the best EBM-based readings from the Club for Evidence-Based in Gastroenterology & Hepatology (ebgh.it).


Asunto(s)
Acceso a la Información , Medicina Basada en la Evidencia/tendencias , Pandemias , Antivirales/uso terapéutico , Brasil , /epidemiología , Ensayos Clínicos como Asunto , Revelación , Humanos , Hidroxicloroquina/uso terapéutico , Italia , Política , Propaganda , Tiazoles/uso terapéutico , Estados Unidos
14.
Am J Public Health ; 111(2): e1-e2, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33439704
15.
Quintessence Int ; 0(0): 0, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33491396

RESUMEN

Objective: This study aimed to compare the clinical outcomes in dental prophylaxis between rubber cup polishing and an air polishing system using erythritol powder, with or without prior dental plaque disclosure. Method and materials: In this single-blind, randomized, controlled, split-mouth clinical trial, healthy participants with full-mouth plaque score ≥ 60% were recruited. Quadrants in each participant were randomly assigned to four treatment groups: air polishing with prior plaque disclosure; air polishing without plaque disclosure; rubber cup polishing with prior plaque disclosure; or rubber cup polishing without plaque disclosure. Plaque scores and treatment time for each quadrant were recorded. Posttreatment satisfaction questionnaires for both the participants and operators were also completed. Results: In total, 88 participants consisting of 42 men and 46 women (mean age 23.1 ± 2.0 years) were recruited. Air polishing with prior plaque disclosure had significantly lower posttreatment marginal mean plaque score (21.7 ± 17.5%) compared to air polishing (33.5 ± 23.4%) or rubber cup polishing (34.5 ± 19.7%) without prior plaque disclosure (P < .001). Marginal mean treatment time for air polishing (325 seconds; SE = 10 seconds) was significantly shorter compared to rubber cup polishing (407 seconds; SE = 15 seconds) (P < .001). Both the participants and operators preferred air polishing over rubber cup polishing (P < .001). Conclusion: Prior plaque disclosure enhanced the effectiveness of plaque removal. Air polishing exhibited better treatment efficiency than rubber cup polishing and was the patients' and clinicians' preferred treatment modality.


Asunto(s)
Placa Dental , Goma , Adulto , Placa Dental/prevención & control , Pulido Dental , Profilaxis Dental , Revelación , Femenino , Humanos , Masculino , Método Simple Ciego , Adulto Joven
16.
BMC Palliat Care ; 20(1): 6, 2021 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-33407388

RESUMEN

BACKGROUND: Patient participation is a key foundation of advance care planning (ACP). However, a patient himself/herself may be left out from sensitive conversations such as end-of-life (EOL) care discussions. The objectives of this study were to investigate patients' participation rate in the discussion of Cardiopulmonary Resuscitation (CPR) / Do-Not-Attempt-Resuscitation (DNAR) order, and in the discussion that the patient is at his/her EOL stage (EOL disclosure), and to explore their associated factors. METHODS: This is a retrospective chart review study. The participants were all the patients who were hospitalized and died in a university-affiliated teaching hospital (tertiary medical facility) in central Tokyo, Japan during the period from April 2018 to March 2019. The following patients were excluded: (1) cardiopulmonary arrest on arrival; (2) stillbirth; (3) under 18 years old at the time of death; and (4) refusal by their bereaved family. Presence or absence of CPR/DNAR discussion and EOL disclosure, patients' involvement in those discussions, and their associated factors were investigated. RESULTS: CPR/DNAR discussions were observed in 336 out of the 358 patients (93.9%). However, 224 of these discussions were carried out without a patient (patient participation rate 33.3%). Male gender (odds ratio (OR) = 2.37 [95% confidence interval (CI) 1.32-4.25]), living alone (OR = 2.51 [1.34-4.71]), and 1 year or more from the date of diagnosis (OR = 1.78 [1.03-3.10]) were associated with higher patient's participation in CPR/DNAR discussions. The EOL disclosure was observed in 341 out of the 358 patients (95.3%). However, 170 of the discussions were carried out without the patient (patient participation rate 50.1%). Patients who died of cancer (OR = 2.41[1.45-4.03]) and patients without mental illness (OR=2.41 [1.11-5.25]) were more likely to participate in EOL disclosure. CONCLUSIONS: In this clinical sample, only up to half of the patients participated in CPR/DNAR discussions and EOL disclosure. Female, living with family, a shorter period from the diagnosis, non-cancer, and mental illness presence are risk factors for lack of patients' participation in CPR/DNAR or EOL discussions. Further attempts to facilitate patients' participation, based on their preference, are warranted.


Asunto(s)
Planificación Anticipada de Atención/estadística & datos numéricos , Revelación/estadística & datos numéricos , Trastornos Mentales/epidemiología , Neoplasias/mortalidad , Participación del Paciente/estadística & datos numéricos , Órdenes de Resucitación , Cuidado Terminal , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/mortalidad , Trastornos Cerebrovasculares/mortalidad , Femenino , Humanos , Hepatopatías/mortalidad , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Características de la Residencia , Enfermedades Respiratorias/mortalidad , Factores Sexuales , Factores de Tiempo
18.
Artículo en Inglés | MEDLINE | ID: mdl-33435230

RESUMEN

Universities are now becoming more active in the field of Corporate Social Responsibility (CSR). Nevertheless, they do not appear to be granting the same degree of importance to the dissemination of these activities. This article analyses the voluntary corporate social responsibility information disclosed by leading USA universities. We created several indexes of corporate social responsibility information disclosure and examined main universities' characteristics that affect corporate social responsibility disclosure by these entities. The findings obtained show that the universities are strongly committed to the dissemination of corporate social responsibility information, and that a university's size, affiliation, public/private status and ranking position are the factors most significantly affecting its online disclosure of general corporate social responsibility information. These findings could be useful for university administrators, especially those in public universities, highlighting the importance of developing and supporting policies and incentives to promote CSR disclosure and thus attract new students and meet social expectations about the ethical behaviour of universities.


Asunto(s)
Revelación , Universidades , Humanos , Políticas , Responsabilidad Social
19.
Afr J AIDS Res ; 19(4): 312-322, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33337977

RESUMEN

This article explores the experiences of HIV-positive adolescents disclosing their status to romantic partners in Bulawayo, Zimbabwe. Disclosure of HIV status continues to be one of the most pressing issues facing adolescents, especially those in relationships, yet health care workers have minimal tailored guidance on how to approach this except to encourage full disclosure. Motives for disclosure were: guilty conscience; legal and ethical obligations; preventing partners being infected; and supportive people, honesty and trust. Disclosure was done on a one-on-one basis in public spaces such as roadsides where the adolescents usually met, or in health care facilities through the help of health care workers, and through mobile phones using WhatsApp. Results revealed that disclosure was associated with negative and positive outcomes ranging from disruption of relationships, depression, breaches of confidential information and, in some instances, relationship and marriage assurance. However, results clearly showed that adolescents living with HIV struggle with disclosure because the process is complex and loaded with emotions and the outcomes can be unpredictable and difficult to handle. Optimism towards treatment, social support, rationalisation, and social comparison through attributing new meanings to the disease were employed to deal with negative outcomes of disclosure. Therefore, the development and implementation of evidence-based initiatives to raise awareness and train the youth to disclose is recommended. Through their experiences, we can learn what works well and what needs to be strengthened.


Asunto(s)
Revelación , Infecciones por VIH/psicología , Parejas Sexuales/psicología , Adolescente , Revelación/estadística & datos numéricos , Femenino , Personal de Salud/psicología , Humanos , Masculino , Motivación , Apoyo Social , Zimbabwe/epidemiología
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