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There is controversy about how to manage requests by patients or surrogates for treatments that clinicians believe should not be administered. This multisociety statement provides recommendations to prevent and manage intractable disagreements about the use of such treatments in intensive care units. The recommendations were developed using an iterative consensus process, including expert committee development and peer review by designated committees of each of the participating professional societies (American Thoracic Society, American Association for Critical Care Nurses, American College of Chest Physicians, European Society for Intensive Care Medicine, and Society of Critical Care). The committee recommends: (1) Institutions should implement strategies to prevent intractable treatment conflicts, including proactive communication and early involvement of expert consultants. (2) The term \"potentially inappropriate\" should be used, rather than futile, to describe treatments that have at least some chance of accomplishing the effect sought by the patient, but clinicians believe that competing ethical considerations justify not providing them. Clinicians should explain and advocate for the treatment plan they believe is appropriate. Conflicts regarding potentially inappropriate treatments that remain intractable despite intensive communication and negotiation should be managed by a fair process of conflict resolution; this process should include hospital review, attempts to find a willing provider at another institution, and opportunity for external review of decisions. When time pressures make it infeasible to complete all steps of the conflict-resolution process and clinicians have a high degree of certainty that the requested treatment is outside accepted practice, they should seek procedural oversight to the extent allowed by the clinical situation and need not provide the requested treatment. (3) Use of the term \"futile\" should be restricted to the rare situations in which surrogates request interventions that simply cannot accomplish their intended physiologic goal. Clinicians should not provide futile interventions. (4) The medical profession should lead public engagement efforts and advocate for policies and legislation about when life-prolonging technologies should not be used. The multisociety statement on responding to requests for potentially inappropriate treatments in intensive care units provides guidance for clinicians to prevent and manage disputes in patients with advanced critical illness.

Dexmethylphenidate, and potentially other methylphenidates used in the treatment of attention deficit hyperactivity disorder (ADHD), may cause severe muscle pain and stiffness. Medication side effects should be considered as the possible cause if a patient with ADHD develops severe symptoms. Dexmethylphenidate, and potentially other methylphenidates used in the treatment of attention deficit hyperactivity disorder (ADHD), may cause severe muscle pain and stiffness. Medication side effects should be considered as the possible cause if a patient with ADHD develops severe symptoms.

In 1997, the Society for Critical Care Medicine (SCCM) published a statement regarding futile and inadvisable treatments. Recently, five critical care organizations published a consensus statement supporting and expanding upon the 1997 SCCM statement, and the SCCM issued a companion statement defining futile and potentially inappropriate interventions. In all of these statements, there is agreement that the term futile should be used only when an intervention cannot accomplish the intended physiologic goal. The organizations provide recommendations for optimizing communication, however even when clinicians use excellent communication techniques, there are times when competing ethical considerations mean that a surrogate persists in requesting an intervention that the clinician does not believe is justified. In such cases, clinicians should not label the requested intervention as futile, because doing so is disrespectful to patients and families, overly empowers clinicians, and stifles communication. When clinicians believe that they are justified in declining such a request due to differences in values or beliefs, they should refer to the requested treatment as \"potentially inappropriate,\" indicating that the disagreement is based on values, and that any decision to withhold the requested intervention is preliminary until reviewed through a fair process.

American and Japanese laws, customs, and practices in end-of-life decision-making differ significantly. We present a case with which one of the authors was involved to illustrate some of the key legal and cultural differences in the declaration of brain death, limiting and withdrawing life-prolonging interventions, and healthcare ethics consultation practices. The analysis presented facilitates understanding of similarities and differences between Japanese and American healthcare ethics specifically in regards to end-of-life care. Further, the analysis provides insights that can aid in developing policies and practices in regions where multiple cultures coexist.American and Japanese laws, customs, and practices in end-of-life decision-making differ significantly. We present a case with which one of the authors was involved to illustrate some of the key legal and cultural differences in the declaration of brain death, limiting and withdrawing life-prolonging interventions, and healthcare ethics consultation practices. The analysis presented facilitates understanding of similarities and differences between Japanese and American healthcare ethics specifically in regards to end-of-life care. Further, the analysis provides insights that can aid in developing policies and practices in regions where multiple cultures coexist.

In the PICU, when we hear hoof–beats, we think: \"Well, it's most likely horses, but what if it is actually a herd of elephants wearing horseshoes just to throw us off?\" Yeah, her seizures might be just new–onset idiopathic seizures, that's very possible. Great hospital, great neurosurgeon, great operating room (OR) team, but having someone cut into your child's brain is always scary. Finding the right specialist; helping get an appointment quickly; advocating for rapid workup and treatment; advocating at the bedside for timely analgesics, appropriate anxiolytics, and, when necessary, rapid assessment by a physician can all significantly improve the care of a loved one.

Shared decision making has been officially supported by every major critical care organisation in the USA and Europe, the American Medical Association, the American Academy of Pediatrics, and others. 1-3 Indeed, the first recommendation in the American College of Critical Care Medicine's guidelines for family support is that healthcare providers should partner with families in making difficult choices. 4 In the USA and elsewhere, too often have doctors shied away from active participation in decision making due to a mistaken belief that value-laden decisions should be made only by patients or their surrogate decision makers. 1 In order to provide optimal care, doctors must be willing and able to bear some, or at times the majority, of the burden when difficult decisions must be made. Because healthcare providers should tailor their recommendations and decisions to the values expressed by the patient (or on behalf of the patient by others), blanket default options are generally not appropriate unless there is a clear 'best' option.

The American Society for Bioethics and Humanities promulgated standards for clinical ethics consultants and is currently developing a national Quality Attestation in Clinical Ethics Consultation to assist facilities in ensuring that those performing clinical ethics consultations meet minimum standards. As the field moves towards such professionalization, there is a need to provide access to qualified clinical ethicists at a broad range of medical facilities. Currently, however, there are insufficient numbers of trained clinical ethicists to staff all healthcare facilities, and many facilities lack the necessary resources to hire staff clinical ethicists. In this review, we describe several models for providing expert clinical ethics support to remote facilities that lack access to qualified clinical ethicists. Based on this analysis, we recommend telemedicine as the optimal model providing expert support to local ethics committee members tasked with providing clinical ethics consultation services.

The past and present effects of historical racism on the health of, and care for, those labeled minorities is well documented. Grier and Cobbs analyzed the effects of historical racism and current oppressions and humiliating disenfranchisements on African Americans as they transition into adulthood. Research in clinical settings has demonstrated that African American children receive less counseling during well child visits and have lower rates of treatment of mental health disorders. Additionally, African American children with appendicitis are hospitalized less frequently, have higher rates of perforation and a greater delay to surgical management, and experience increased rates of appendix rupture. With the exception of Alegria, the authors cited earlier found these results troubling but suggested no provider-based possible cause; Alegria and her colleagues suggested providers be given incentives to reduce their negative attitudes toward minority youths. Washington also discussed the impact of racism on children, concluding that \"African American children are still being harmed not only by abusive experimentation but also by the fear of research that follows in its wake. An implicit bias is an inflexible, unconscious belief about a particular category of people. Categorizing groups is an inevitable aspect of human nature and may be positive or negative. Implicit bias operates in an unintentional manner, is activated quickly and unknowingly, and exerts its influence on perception, memory, and behavior.

The overall aim of this project was to ascertain the utilization of a custom-designed telemedicine service for patients to maintain close contact (via videoconference) with family and friends during hospitalization. We conducted a retrospective chart review of hospitalized patients (primarily children) with extended hospital length of stays. Telecommunication equipment was used to provide videoconference links from the patient's bedside to friends and family in the community. Thirty-six cases were managed during a five-year period (2006 to 2010). The most common reasons for using Family-Link were related to the logistical challenges of traveling to and from the hospital—principally due to distance, time, family commitments, and/or personal cost. We conclude that videoconferencing provides a solution to some barriers that may limit family presence and participation in care for hospitalized patients, and as a patient-centered innovation is likely to enhance patient and family satisfaction.