Clinical Competence , Health Care Rationing/ethics , Health Services Needs and Demand/ethics , Pandemics , Surgeons/ethics , Thoracic Surgical Procedures/ethics , Extracorporeal Membrane Oxygenation/ethics , Extracorporeal Membrane Oxygenation/instrumentation , Heart-Assist Devices/ethics , Heart-Assist Devices/supply & distribution , Humans , Respiration, Artificial/ethics , Respiration, Artificial/instrumentation , Surge Capacity/ethics , Ventilators, Mechanical/ethics , Ventilators, Mechanical/supply & distribution
Periodicals as Topic , Scholarly Communication , Social Media , Surgeons , Thoracic Surgical Procedures , Access to Information , Attitude of Health Personnel , Attitude to Computers , Health Knowledge, Attitudes, Practice , Humans , Information Dissemination , Interdisciplinary Communication , Periodicals as Topic/ethics , Scholarly Communication/ethics , Social Media/ethics , Surgeons/ethics , Surgeons/psychology , Thoracic Surgical Procedures/ethics
Codes of Ethics , Ethics, Medical , Social Media/ethics , Surgeons/ethics , Thoracic Surgery/ethics , Thoracic Surgical Procedures/ethics , Attitude of Health Personnel , Attitude to Computers , Confidentiality/ethics , Humans , Moral Obligations , Physician-Patient Relations/ethics , Professionalism/ethics , Truth Disclosure/ethics
Increasing prevalence of mentally ill and handicapped populations requiring surgical thoracic interventions has brought to light their worse associated morbidity and mortality. Baseline functional status, caretaker environment, and mental limitations in day to day life have an impact in the short and long term from these interventions. Aggressive perioperative care, multispecialty approach, technical aspects, palliative procedures, and ethical considerations all play a part in improving outcomes. In this article real cases are presented illustrating points of care and situations for discussion.
Disabled Persons , Mental Disorders/complications , Thoracic Surgical Procedures , Aged , Female , Humans , Male , Middle Aged , Patient Care Team , Perioperative Care , Thoracic Surgical Procedures/ethics
Moral virtues are the complement to ethical principles. They constitute the elements of character that drive habits and daily routines. Certain virtues are especially important in surgery, shaping surgical practice even when no big decisions are at hand. Eight virtues are described and the work they do is explored: trustworthiness, equanimity, empathy, advocacy, compassion, courage, humility, and hope.
Ethics, Professional , Morals , Surgeons/ethics , Thoracic Surgical Procedures/ethics , Workplace , Attitude of Health Personnel , Courage/ethics , Empathy/ethics , Health Knowledge, Attitudes, Practice , Hope/ethics , Humans , Patient Advocacy/ethics , Surgeons/psychology , Trust
Development of novel prognostic, diagnostic, and treatment options will provide major benefits for millions of patients with acute or chronic respiratory dysfunction, cardiac-related disorders, esophageal problems, or other diseases in the thorax. Allogeneic organ transplant is currently available. However, it remains a trap because of its dependency on a very limited supply of donated organs, which may be needed for both initial and subsequent transplants. Furthermore, it requires lifelong treatment with immunosuppressants, which are associated with adverse effects. Despite early clinical applications of bioengineered organs and tissues, routine implementation is still far off. For this review, we searched the PubMed, MEDLINE, and Ovid databases for the following keywords for each tissue or organ: tissue engineering, biological and synthetic scaffold/graft, acellular and decelluar(ized), reseeding, bioreactor, tissue replacement, and transplantation. We identified the current state-of-the-art practices in tissue engineering with a focus on advances during the past 5 years. We discuss advantages and disadvantages of biological and synthetic solutions and introduce novel strategies and technologies for the field. The ethical challenges of innovation in this area are also reviewed.
Organ Transplantation/adverse effects , Regenerative Medicine/methods , Thoracic Surgical Procedures/methods , Tissue Engineering/methods , Bioreactors , Cardiac Surgical Procedures , Digestive System Surgical Procedures , Humans , Immune System Phenomena , Larynx/surgery , Lung/surgery , Organ Transplantation/standards , Regenerative Medicine/ethics , Regenerative Medicine/trends , Stem Cell Transplantation , Thoracic Surgical Procedures/ethics , Thoracic Surgical Procedures/trends , Tissue Engineering/ethics , Tissue Engineering/trends , Tissue Scaffolds , Trachea/surgery
Insurance, Health, Reimbursement/ethics , Medicare/ethics , Moral Obligations , Physicians/ethics , Thoracic Surgical Procedures/ethics , Attitude of Health Personnel , Cardiac Surgical Procedures/economics , Cardiac Surgical Procedures/ethics , Conflict of Interest , Government Regulation , Health Policy/economics , Hippocratic Oath , Humans , Income , Insurance, Health, Reimbursement/economics , Insurance, Health, Reimbursement/legislation & jurisprudence , Medicare/economics , Medicare/legislation & jurisprudence , Physicians/economics , Physicians/legislation & jurisprudence , Thoracic Surgical Procedures/economics , Thoracic Surgical Procedures/legislation & jurisprudence , United States
Cardiac Surgical Procedures/standards , Industry/organization & administration , Societies, Medical/organization & administration , Thoracic Surgical Procedures/standards , Cardiac Surgical Procedures/ethics , Humans , Interprofessional Relations , Organizational Innovation , Quality Control , Reference Standards , Thoracic Surgical Procedures/ethics , United States
Diffusion of Innovation , Evidence-Based Medicine/ethics , Therapies, Investigational/ethics , Thoracic Surgery/ethics , Thoracic Surgical Procedures/ethics , Clinical Competence , Conflict of Interest , Cost-Benefit Analysis , Evidence-Based Medicine/economics , Health Care Costs , Humans , Informed Consent , Practice Guidelines as Topic , Risk Assessment , Therapies, Investigational/adverse effects , Therapies, Investigational/economics , Thoracic Surgery/economics , Thoracic Surgical Procedures/adverse effects , Thoracic Surgical Procedures/economics
The diversity of older patients presents a challenge when deciding whether to recommend thoracic surgery to an individual. Comparable postoperative morbidity and mortality between younger and older patient groups indicate that surgeons are skilled in determining which older patients are most fit for surgery on the basis of comorbidities, performance status, and QOL. Criteria for the inclusion of older patients in thoracic surgical trials have not been described, however. As newer, minimally invasive techniques and limited resections are incorporated into elderly patients' care, criteria for inclusion must be evaluated prospectively in trials designed to establish risk factors for morbidity and mortality in elderly patients traditionally excluded from surgery. In addition, QOL needs to be evaluated specifically in the elderly, and meaningful comparisons need to be made with other elderly patients who do not undergo surgery. Finally, to inform better the ethical debate about whether thoracic surgery benefits a patient of advanced age, longer-term QOL and functional outcomes need to be evaluated. The ethical challenge is finding a delicate balance: on the one hand, avoiding ageism and providing a therapy to older patients that offers the only meaningful chance for improved survival, especially in early-stage disease, and on the other hand, avoiding overzealously providing a therapy with significant morbidity and mortality to older persons who are already at greater risk for functional loss and death.
Ethics, Medical , Quality of Life , Thoracic Surgical Procedures/ethics , Thoracic Surgical Procedures/psychology , Aged , Aged, 80 and over , Geriatric Assessment/methods , Humans , United States