NEWS Ensuring respect and dignity in the ICU
Identifying loss of dignity and lack of respectful treatment as preventable harms in healthcare, researchers at Johns Hopkins have taken on the task of defining and ensuring respectful care in the intensive care unit (ICU). Their novel, multi-method approach is presented in a dedicated supplement to the journal Narrative Inquiry in Bioethics. “In healthcare, the importance of respect and
dignity is often invoked, but has not been clearly defined in regard to treatment in the ICU,” said Jeremy Sugarman, the Harvey M. Meyerhoff Professor of Bioethics and Medicine at the Johns Hopkins Berman Institute of Bioethics. “To prevent harms related to respect and dignity in the ICU there is a prerequisite need for clarity regarding what exactly constitutes optimal treatment in this regard, and then to develop methods to measure it.” To lay that groundwork, bioethics scholars on the research team developed a conceptual model
HRT may increase risk of stroke
Hormone Replacement Therapy (HRT) does not protect post-menopausal women against cardiovascular disease and may increase risk of stroke, according to a recent study. Research, published in the Cochrane Library, looked at data from more than 40,000 women across the world. The results found no evidence that HRT provides any protective effects against death from cardiovascular disease, non-fatal heart attacks or angina, either in healthy women or women with pre-existing heart disease. However, the researchers did find some evidence of a small increased risk of stroke for post-menopausal women. Maureen Talbot, British Heart Foundation,
senior cardiac nurse, commented: “It is important that women have a full understanding of the risks and benefits of HRT and they should talk this through with their GP.”
defining three sources of patient dignity: shared humanity, personal narrative, and autonomy. Each of these sources of dignity demands respect, said Leslie Meltzer Henry, a professor at the Berman Institute and first author of the article outlining the conceptual model. “In the modern healthcare system, there is
risk of technology-focused communication and decision-making taking precedence over dignity- respecting care,” Prof Henry commented. The conceptual model describes the types of
respect that each source of dignity requires in the ICU, and offers a framework for identifying and rectifying threats to patients’ dignity in that setting. For example, the article states: “Respecting the dignity of patients as human beings begins with not objectifying them. When clinicians refer to patients by name, look them in the eye, introduce themselves, and describe the care they are providing, they treat patients as people rather than objects.”
The research team collected data through
interviews with patients and families in the ICU, focus groups with healthcare professionals who work in the ICU, and direct observations. Four consensus areas were identified on what constitutes treatment with respect and dignity in the ICU: treatment as a human being, treatment as a unique individual, treatment as a patient who is entitled to receive professional care, and treatment with sensitivity to the patient’s critical condition and vulnerability in the ICU.
The study of respect and dignity in the ICU is the bioethics component of the larger ‘Emerge’ project at Johns Hopkins, led by the Armstrong Institute for Patient Safety and Quality and funded by the Gordon and Betty Moore Foundation. The project aims to decrease preventable harms in the ICU through systems engineering approaches.
http://muse.jhu.edu/journals/ narrative_inquiry_in_bioethics/toc/
nib.5.1A.html.
NICE recommends device for prostate treatment
New guidance has been released by the National Institute for Health and Care Excellence (NICE) recommending Olympus Medical’s transurethral resection in saline (TURis) system for use in surgery to reduce the size of enlarged prostate glands in men. NICE published the guidance in light of the potential it offers NHS hospitals to realise substantial cost savings of £285-£375 per patient while also improving patient outcomes. NICE has concluded that the use of TURis
for transurethral resection of the prostate (TURP) for benign prostate enlargement (BPE) avoids the risk of transurethral resection (TUR) syndrome and reduces the need for blood transfusions. TURis also demonstrated equivalent efficacy to monopolar systems – long considered the ‘gold standard’ for TURP. Additionally the Committee found that, as a
result of using TURis, there is potential to reduce the length of hospital stay and its
‘Patchwork’ ovarian cancer more deadly
The most common type of ovarian cancer is more deadly if it consists of a patchwork of different groups of cells, according to a Cancer Research UK study published in PLOS Medicine. Serous ovarian cancers containing a variety
of genetically-different cells were more likely to become resistant to treatment and come back again than cancers made of more similar cells. Women with this type of tumour also died sooner than those with less varied tumours. The scientists, from the Cancer Research UK
Cambridge Institute, Cambridge University and Addenbrooke’s Hospital, analysed DNA from 135 samples of serous ovarian cancers from 14
10 THE CLINICAL SERVICES JOURNAL
patients having chemotherapy. The team is the first to measure the genetic variety – called tumour heterogeneity – in a solid tumour and link this to cancer survival. Tumour heterogeneity begins as tumours
evolve from a single damaged cell, which quickly changes and develops into a patchwork of different cell groups. Each patch of cells contains a similar but distinct set of DNA errors, so can look and behave differently from other cell clusters. This makes treating the disease more challenging, with some groups of tumour cells being more resistant to chemotherapy than others.
Lead researcher Dr James Brenton, from the
Cancer Research UK, Cambridge Institute, said: “Our research is important because it helps make sense of the genetic chaos inside tumours. It’s another step closer to cracking the code on cancer biology so that we can understand sooner how patients will respond to treatment – and how to develop better drugs for this hard to treat cancer in the future.” The team also found that gene faults
contributing to drug resistance were present in some parts of tumours before treatment began, replacing the previous belief that chemotherapy caused these genetic changes.
APRIL 2015
associated risks for each patient, as well as reducing hospital readmissions. Not only may these benefits improve patient satisfaction and outcomes, but could also result in improved waiting list times, general health system efficiency and increased hospital revenue by switching to day-case procedures. Approximately 15,000 TURP procedures are
carried out each year in England and Wales. With potential savings of between £285 and £375 per patient, at least four million pounds could be saved per year by NHS implementation of the new NICE guidance.
www.nice.org.uk/guidance/mtg23.
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