L. Hale, Katrina Kirksey Harper, Anna Bovill Shapiro
Each year, as many as 98,000 hospital deaths in the United States can be attributed to medical error. Considering that at least half of all medical errors go unreported, the impact they have on mortality, morbidity, prolonged hospital stay, rising hospital costs, and the doctor-patient relationship cannot be overemphasized. At the heart of the dilemma are patients and their family members, who rely on clinicians to provide optimal medical care, devoid of mistakes and error, and want an apology if an error has taken place. In this review, we discuss the moral obligation of hospitals to disclose medical error, no matter what the impact. Whereas in the past, a paternalistic approach to medicine viewed this acknowledgment as weakness, there is now a consensus to advocate for full disclosure, apology, and discussions that facilitate early disclosure of error using teams representing administration, patient care liaisons, and treatment providers. Many institutions now recognize that medical errors are commonly the result of a breakdown of checks and balances, and an increasing number are implementing protocols that target system errors to prevent similar future occurrences. We examine institutions across the United States that take a proactive approach by assembling “communication and resolution” programs to address the concerns of patients and their families through the process of disclosure. We also explore barriers to disclosure, which are attributed to lack of training, fear of litigation, and the “shame and blame culture.” We discuss the benefit, to both patient and provider, of disclosure of accountability as we move toward a culture of strengthening systems and improving patient care and patient-provider relationships. Key words: apology, culture, disclosure, error, resolution
{"title":"Disclosure of Error in the Intensive Care Unit","authors":"L. Hale, Katrina Kirksey Harper, Anna Bovill Shapiro","doi":"10.2310/tywc.8025","DOIUrl":"https://doi.org/10.2310/tywc.8025","url":null,"abstract":"Each year, as many as 98,000 hospital deaths in the United States can be attributed to medical error. Considering that at least half of all medical errors go unreported, the impact they have on mortality, morbidity, prolonged hospital stay, rising hospital costs, and the doctor-patient relationship cannot be overemphasized. At the heart of the dilemma are patients and their family members, who rely on clinicians to provide optimal medical care, devoid of mistakes and error, and want an apology if an error has taken place. In this review, we discuss the moral obligation of hospitals to disclose medical error, no matter what the impact. Whereas in the past, a paternalistic approach to medicine viewed this acknowledgment as weakness, there is now a consensus to advocate for full disclosure, apology, and discussions that facilitate early disclosure of error using teams representing administration, patient care liaisons, and treatment providers. Many institutions now recognize that medical errors are commonly the result of a breakdown of checks and balances, and an increasing number are implementing protocols that target system errors to prevent similar future occurrences. We examine institutions across the United States that take a proactive approach by assembling “communication and resolution” programs to address the concerns of patients and their families through the process of disclosure. We also explore barriers to disclosure, which are attributed to lack of training, fear of litigation, and the “shame and blame culture.” We discuss the benefit, to both patient and provider, of disclosure of accountability as we move toward a culture of strengthening systems and improving patient care and patient-provider relationships.\u0000Key words: apology, culture, disclosure, error, resolution","PeriodicalId":196621,"journal":{"name":"DeckerMed Transitional Year Weekly Curriculum™","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125182266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Erectile dysfunction (ED) is a common condition in the aging population that can be broadly classified as organic, psychogenic, or mixed. A thorough evaluation of a patient with ED begins with acknowledging that it is intimately related to a host of medical, neurologic, and psychological conditions. Providers should be confident in their ability to obtain a relevant history, perform a targeted physical exam, and, when indicated, select appropriate diagnostic testing. Patients should also be evaluated for associated urologic conditions, including male hypogonadism and lower urinary tract symptoms, the treatment of which may improve ED symptoms. It is also important that clinicians be aware that ED may be a “sentinel event” for undiagnosed cardiovascular disease as the implications of intervention can potentially be lifesaving. This review contains 7 figures, 10 tables and 138 references Key words: cardiovascular disease, Doppler ultrasonography, erectile dysfunction, hypogonadism, lower urinary tract symptoms, male impotence, metabolic syndrome, penile tumescence, Peyronie disease, premature ejaculation, sexual desire, testosterone
{"title":"Erectile Dysfunction: Evaluation, Including Diagnostic Studies (Doppler Ultrasound, Cavernosography/Cavenosometry)","authors":"S. Helo, N. Tadros, K. McVary","doi":"10.2310/tywc.11111","DOIUrl":"https://doi.org/10.2310/tywc.11111","url":null,"abstract":"Erectile dysfunction (ED) is a common condition in the aging population that can be broadly classified as organic, psychogenic, or mixed. A thorough evaluation of a patient with ED begins with acknowledging that it is intimately related to a host of medical, neurologic, and psychological conditions. Providers should be confident in their ability to obtain a relevant history, perform a targeted physical exam, and, when indicated, select appropriate diagnostic testing. Patients should also be evaluated for associated urologic conditions, including male hypogonadism and lower urinary tract symptoms, the treatment of which may improve ED symptoms. It is also important that clinicians be aware that ED may be a “sentinel event” for undiagnosed cardiovascular disease as the implications of intervention can potentially be lifesaving.\u0000This review contains 7 figures, 10 tables and 138 references\u0000Key words: cardiovascular disease, Doppler ultrasonography, erectile dysfunction, hypogonadism, lower urinary tract symptoms, male impotence, metabolic syndrome, penile tumescence, Peyronie disease, premature ejaculation, sexual desire, testosterone","PeriodicalId":196621,"journal":{"name":"DeckerMed Transitional Year Weekly Curriculum™","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134240823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Acute kidney injury (AKI) is one of the most common complications occurring among intensive care unit (ICU) patients and is independently associated with a higher risk of mortality. In critically ill patients, AKI presentation is heterogeneous, varying from asymptomatic elevations in serum creatinine to the need for dialysis in the context of multiorgan failure. Within this range of clinical presentation, the kidney is often overlooked because improving and maintaining cardiac performance are the focus. In addition, aggressive fluid resuscitation may impose significant demands on the kidney wherein the normal excretory capacity may be overwhelmed. ICU patients often have underlying comorbidities, including chronic kidney disease and heart failure, which further limit the range of renal capacity. Drug and nutritional administration contribute to the demand for fluid removal to maintain fluid balance. The dissimilarities of the critical care environment and the extra demand kidney capacity highlight the need for different strategies for management and treatment of AKI in the critically ill patients. We focus this review on the general and nondialytic therapy of AKI. This reference contains 5 figures, 3 tables and 90 references Key words: Acute kidney injury, fluid resuscitation, loop diuretics, vasoactive agents, fluid overload, hiperkalemia, and metabolic acidosis.
{"title":"Conservative Management of Acute Kidney Injury","authors":"R. Claure-Del Granado, E. Macedo, R. Mehta","doi":"10.2310/tywc.12037","DOIUrl":"https://doi.org/10.2310/tywc.12037","url":null,"abstract":"Acute kidney injury (AKI) is one of the most common complications occurring among intensive care unit (ICU) patients and is independently associated with a higher risk of mortality. In critically ill patients, AKI presentation is heterogeneous, varying from asymptomatic elevations in serum creatinine to the need for dialysis in the context of multiorgan failure. Within this range of clinical presentation, the kidney is often overlooked because improving and maintaining cardiac performance are the focus. In addition, aggressive fluid resuscitation may impose significant demands on the kidney wherein the normal excretory capacity may be overwhelmed. ICU patients often have underlying comorbidities, including chronic kidney disease and heart failure, which further limit the range of renal capacity. Drug and nutritional administration contribute to the demand for fluid removal to maintain fluid balance. The dissimilarities of the critical care environment and the extra demand kidney capacity highlight the need for different strategies for management and treatment of AKI in the critically ill patients. We focus this review on the general and nondialytic therapy of AKI.\u0000\u0000This reference contains 5 figures, 3 tables and 90 references\u0000Key words: Acute kidney injury, fluid resuscitation, loop diuretics, vasoactive agents, fluid overload, hiperkalemia, and metabolic acidosis.\u0000 ","PeriodicalId":196621,"journal":{"name":"DeckerMed Transitional Year Weekly Curriculum™","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127807362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The aim of this review is to help clinicians optimize treatment of infections and reduce adverse events. With that goal in mind, we discuss the basis for the selection of antibiotics for the surgical patient in the intensive care unit (ICU), the mechanism of antibiotic action, and resistance of pathogens to antibiotic therapy—factors that may affect antibiotic levels, the rationales for dosing, and the role of antimicrobial stewardship programs. The evaluation and management of infections in critically ill patients are uniquely different from those of the general patient population. Age, medical comorbidities, alterations in anatomy, changes in vascular supply, insertion of vascular conduits, and orthopedic hardware are some factors that increase the risk of infection and influence antibiotic choice in the surgical ICU patient. Key words: antibiotics, antibiotic resistance, antibiotic stewardship, intensive care unit
{"title":"Appropriate Antibiotic Selection and Use for Intensive Care Unit Patients, Part I: Rationale for Antibiotic Choices","authors":"R. Pino, Molly L. Paras, E. Shenoy","doi":"10.2310/tywc.8030","DOIUrl":"https://doi.org/10.2310/tywc.8030","url":null,"abstract":"The aim of this review is to help clinicians optimize treatment of infections and reduce adverse events. With that goal in mind, we discuss the basis for the selection of antibiotics for the surgical patient in the intensive care unit (ICU), the mechanism of antibiotic action, and resistance of pathogens to antibiotic therapy—factors that may affect antibiotic levels, the rationales for dosing, and the role of antimicrobial stewardship programs. The evaluation and management of infections in critically ill patients are uniquely different from those of the general patient population. Age, medical comorbidities, alterations in anatomy, changes in vascular supply, insertion of vascular conduits, and orthopedic hardware are some factors that increase the risk of infection and influence antibiotic choice in the surgical ICU patient. \u0000Key words: antibiotics, antibiotic resistance, antibiotic stewardship, intensive care unit","PeriodicalId":196621,"journal":{"name":"DeckerMed Transitional Year Weekly Curriculum™","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123732304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This review covers the major presentations affecting the aorta: aortic aneurysms (abdominal aortic aneurysms and thoracic aortic aneurysms), acute aortic syndromes (including aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer), other nonacute aortic processes, and traumatic disease of the aorta. The section on abdominal aortic aneurysms covers screening, clinical presentation, diagnostic evaluation, management to reduce the risk of aneurysm rupture, open surgical treatment and endovascular aortic repair, and the role of medical therapy. The section on thoracic aortic aneurysms also covers pathophysiology, etiology, and inherited and inflammatory conditions. Aortic dissections affect either the ascending aorta (type A) or the descending aorta (type B) and may be classified as acute or chronic. The discussion of aortic dissection describes the clinical presentation, diagnostic steps and decisions, and treatment for both type A and type B dissections. The figures include two algorithms: a potential management strategy for patients with thoracic aortic aneurysm and a logical procedure for the evaluation and treatment of a suspected aortic dissection. Figures also include illustrations, computed tomographic images, and echocardiograms of various aortic presentations. Tables list normal aortic dimensions by computed tomographic angiography and echocardiography, etiology and associated factors in diseases of the aorta, revised Ghent criteria for the diagnosis of Marfan syndrome, size criteria for elective surgical intervention in thoracic aortic aneurysm, and independent predictors of in-hospital death. Also included is a follow-up imaging timeline for acute aortic syndromes. This review contains 9 figures, 6 tables, and 132 references.
{"title":"Diseases of the Aorta","authors":"Anna M. Booher, K. Eagle","doi":"10.2310/tywc.1101","DOIUrl":"https://doi.org/10.2310/tywc.1101","url":null,"abstract":"This review covers the major presentations affecting the aorta: aortic aneurysms (abdominal aortic aneurysms and thoracic aortic aneurysms), acute aortic syndromes (including aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer), other nonacute aortic processes, and traumatic disease of the aorta. The section on abdominal aortic aneurysms covers screening, clinical presentation, diagnostic evaluation, management to reduce the risk of aneurysm rupture, open surgical treatment and endovascular aortic repair, and the role of medical therapy. The section on thoracic aortic aneurysms also covers pathophysiology, etiology, and inherited and inflammatory conditions. Aortic dissections affect either the ascending aorta (type A) or the descending aorta (type B) and may be classified as acute or chronic. The discussion of aortic dissection describes the clinical presentation, diagnostic steps and decisions, and treatment for both type A and type B dissections. The figures include two algorithms: a potential management strategy for patients with thoracic aortic aneurysm and a logical procedure for the evaluation and treatment of a suspected aortic dissection. Figures also include illustrations, computed tomographic images, and echocardiograms of various aortic presentations. Tables list normal aortic dimensions by computed tomographic angiography and echocardiography, etiology and associated factors in diseases of the aorta, revised Ghent criteria for the diagnosis of Marfan syndrome, size criteria for elective surgical intervention in thoracic aortic aneurysm, and independent predictors of in-hospital death. Also included is a follow-up imaging timeline for acute aortic syndromes.\u0000This review contains 9 figures, 6 tables, and 132 references.","PeriodicalId":196621,"journal":{"name":"DeckerMed Transitional Year Weekly Curriculum™","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128703597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The incidence of kidney cancer is rising. Due to the widespread use of abdominal imaging for unrelated indications, small renal masses have been increasingly detected incidentally. A better understanding of the biology underlying the different tumor types arising from the kidney cortex has opened new avenues to define diagnosis, prognosis, and treatment strategies. Complete surgical resection remains the standard approach to treat renal neoplasms, and no systemic treatments have proven to be effective after a curative intent surgery. Approximately 30 to 40% of patients with kidney cancer will experience recurrence after a definitive treatment and will ultimately succumb to their disease. Drugs targeting the vascular endothelial growth factor and mammalian target of rapamycin pathways have significantly changed the outcome of patients with metastatic renal cell carcinoma (mRCC). Recently, the new era of immunotherapy has brought a new breath to the treatment of mRCC and will integrate into the landscape of treatment, improving clinical outcome. This review contains 3 figures, 7 tables and 129 references Key words: benign kidney tumors, cystic renal mass, kidney cancer, kidney neoplasms, metastatic renal cell carcinoma, renal cell carcinoma, small renal masses
{"title":"Kidney Neoplasia","authors":"A. Fay, P. Barrios, F. Schutz, C. Barrios","doi":"10.2310/tywc.12043","DOIUrl":"https://doi.org/10.2310/tywc.12043","url":null,"abstract":"The incidence of kidney cancer is rising. Due to the widespread use of abdominal imaging for unrelated indications, small renal masses have been increasingly detected incidentally. A better understanding of the biology underlying the different tumor types arising from the kidney cortex has opened new avenues to define diagnosis, prognosis, and treatment strategies. Complete surgical resection remains the standard approach to treat renal neoplasms, and no systemic treatments have proven to be effective after a curative intent surgery. Approximately 30 to 40% of patients with kidney cancer will experience recurrence after a definitive treatment and will ultimately succumb to their disease. Drugs targeting the vascular endothelial growth factor and mammalian target of rapamycin pathways have significantly changed the outcome of patients with metastatic renal cell carcinoma (mRCC). Recently, the new era of immunotherapy has brought a new breath to the treatment of mRCC and will integrate into the landscape of treatment, improving clinical outcome.\u0000 \u0000This review contains 3 figures, 7 tables and 129 references\u0000Key words: benign kidney tumors, cystic renal mass, kidney cancer, kidney neoplasms, metastatic renal cell carcinoma, renal cell carcinoma, small renal masses","PeriodicalId":196621,"journal":{"name":"DeckerMed Transitional Year Weekly Curriculum™","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126861375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Glomerular diseases of the kidneys are associated with a limited array of clinical syndromes, including asymptomatic hematuria and/or proteinuria, acute nephritis, nephrotic syndrome, rapidly progressive glomerulonephritis, and chronic glomerulonephritis. The specific diseases that underlie these syndromes are numerous and heterogeneous. Broadly, they may be divided into primary and secondary disorders depending on whether the kidneys are the sole organs affected or whether other organ systems are also involved in the disease processes. A systematic approach involving a careful history, physical examination, assessment of renal function, and urinalysis (composition and microscopy) and protein excretion, combined with biochemical and serologic testing, can provide important clues to diagnosis and prognosis. Renal biopsy is often required for a complete and accurate diagnosis as well as a prognosis and therapeutic decision making. This review contains 4 figures, 6 tables and 92 references Key words: glomerular filtration rate, glomerulonephritis, hematuria, nephrotic syndrome, proteinuria, renal biopsy, serum complement
{"title":"Approach to the Patient with Glomerular Disease","authors":"R. Glassock, A. S. Vriese, F. Fervenza","doi":"10.2310/tywc.12019","DOIUrl":"https://doi.org/10.2310/tywc.12019","url":null,"abstract":"Glomerular diseases of the kidneys are associated with a limited array of clinical syndromes, including asymptomatic hematuria and/or proteinuria, acute nephritis, nephrotic syndrome, rapidly progressive glomerulonephritis, and chronic glomerulonephritis. The specific diseases that underlie these syndromes are numerous and heterogeneous. Broadly, they may be divided into primary and secondary disorders depending on whether the kidneys are the sole organs affected or whether other organ systems are also involved in the disease processes. A systematic approach involving a careful history, physical examination, assessment of renal function, and urinalysis (composition and microscopy) and protein excretion, combined with biochemical and serologic testing, can provide important clues to diagnosis and prognosis. Renal biopsy is often required for a complete and accurate diagnosis as well as a prognosis and therapeutic decision making.\u0000\u0000This review contains 4 figures, 6 tables and 92 references\u0000Key words: glomerular filtration rate, glomerulonephritis, hematuria, nephrotic syndrome, proteinuria, renal biopsy, serum complement","PeriodicalId":196621,"journal":{"name":"DeckerMed Transitional Year Weekly Curriculum™","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130615922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kidney transplant is the best form of renal replacement therapy for most end-stage kidney disease patients due to improved quality of life and superior patient survival compared to chronic maintenance dialysis. Long-term outcome of kidney allograft recipients depends on the longevity of the allograft and optimal management of their comorbidities such as cardiovascular disease risk factors. According to organ procurement and transplant data in the United States, 14.5% of the deceased donor kidney wait list comprised patients who failed their first allograft and were awaiting second kidney transplant. Optimal immunosuppression management is key to both short- and long-term outcomes of allograft transplant by preventing rejection while avoiding or minimizing risk of over immunosuppression such as with infections and neoplasia. Cardiovascular disease is the leading cause of mortality after kidney transplant. It accounts for approximately 50% of deaths in the post transplant period and 30% of deaths among patients with preserved renal allograft function. Hence, it is crucial to optimally manage cardiovascular risk factors such as hypertension and diabetes post transplant. In this chapter, we review medical management of kidney transplant recipients, including commonly used induction therapies, maintenance immunosuppressive agents, and posttransplant medical complications such as posttransplant diabetes mellitus, hypertension, cardiovascular disease, bone disease, and BK viral infection. This review contains 1 table and 47 references Key Words: kidney transplantation, immunosuppression, rejection, post transplant diabetes mellitus (PTDM), BK viral infection, calcineurin inhibitors,
{"title":"Medical Management of Transplant Patients","authors":"N. Vadivel, N. Goes","doi":"10.2310/tywc.12075","DOIUrl":"https://doi.org/10.2310/tywc.12075","url":null,"abstract":"Kidney transplant is the best form of renal replacement therapy for most end-stage kidney disease patients due to improved quality of life and superior patient survival compared to chronic maintenance dialysis. Long-term outcome of kidney allograft recipients depends on the longevity of the allograft and optimal management of their comorbidities such as cardiovascular disease risk factors. According to organ procurement and transplant data in the United States, 14.5% of the deceased donor kidney wait list comprised patients who failed their first allograft and were awaiting second kidney transplant. Optimal immunosuppression management is key to both short- and long-term outcomes of allograft transplant by preventing rejection while avoiding or minimizing risk of over immunosuppression such as with infections and neoplasia. Cardiovascular disease is the leading cause of mortality after kidney transplant. It accounts for approximately 50% of deaths in the post transplant period and 30% of deaths among patients with preserved renal allograft function. Hence, it is crucial to optimally manage cardiovascular risk factors such as hypertension and diabetes post transplant. In this chapter, we review medical management of kidney transplant recipients, including commonly used induction therapies, maintenance immunosuppressive agents, and posttransplant medical complications such as posttransplant diabetes mellitus, hypertension, cardiovascular disease, bone disease, and BK viral infection.\u0000This review contains 1 table and 47 references\u0000Key Words: kidney transplantation, immunosuppression, rejection, post transplant diabetes mellitus (PTDM), BK viral infection, calcineurin inhibitors,","PeriodicalId":196621,"journal":{"name":"DeckerMed Transitional Year Weekly Curriculum™","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116086980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The role of genetics in medicine is changing quickly. New discoveries are rapidly bridging the chasm from bench to bedside, and in addition to medical advances, thousands of people are exploring their genetic traits and ancestry through direct-to-consumer companies. Staying abreast of these changes and their potential implications for patient care can be difficult. To help, we suggest several high-level points of reference regarding the current state of genomic medicine, with a focus on the ethical and social issues raised by these technologies. This review covers the rise of genomic medicine, information overload, direct access to genetic information, genetic discrimination, and informed consent. Tables list the American College of Medical Genetics and Genomics recommendations for reporting of incidental findings in clinical exome and genome sequencing, an excerpt from the Genetic Information Nondiscrimination Act, and genetics education resources for physicians. This review contains 3 tables, and 44 references. Key words: Genomic medicine, genetic medicine, medical genetics, genetic testing, direct-to-consumer genetics, genetic discrimination
{"title":"Preparing for the Ethical Practice of Precision Medicine","authors":"M. Allyse, R. Sharp","doi":"10.2310/tywc.1465","DOIUrl":"https://doi.org/10.2310/tywc.1465","url":null,"abstract":"The role of genetics in medicine is changing quickly. New discoveries are rapidly bridging the chasm from bench to bedside, and in addition to medical advances, thousands of people are exploring their genetic traits and ancestry through direct-to-consumer companies. Staying abreast of these changes and their potential implications for patient care can be difficult. To help, we suggest several high-level points of reference regarding the current state of genomic medicine, with a focus on the ethical and social issues raised by these technologies. This review covers the rise of genomic medicine, information overload, direct access to genetic information, genetic discrimination, and informed consent. Tables list the American College of Medical Genetics and Genomics recommendations for reporting of incidental findings in clinical exome and genome sequencing, an excerpt from the Genetic Information Nondiscrimination Act, and genetics education resources for physicians.\u0000This review contains 3 tables, and 44 references.\u0000Key words: Genomic medicine, genetic medicine, medical genetics, genetic testing, direct-to-consumer genetics, genetic discrimination","PeriodicalId":196621,"journal":{"name":"DeckerMed Transitional Year Weekly Curriculum™","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124905851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Brain death is the state of irreversible loss of the clinical functions of the brain. A patient must meet strict criteria to be declared brain dead. They must have suffered a known and demonstrably irreversible brain injury and must not have a condition that could render neurologic testing unreliable. If the patient meets these criteria, a formal brain death examination can be performed. The three findings in brain death are coma or unresponsiveness, absence of brainstem reflexes, and apnea. Brain death is closely tied to organ donation, because brain-dead patients represent approximately 90% of deceased donors and thus a large majority of donated organs. This review details a definition and overview of brain death, determination of brain death, and controversy over brain death, as well as the types of organ donation (living donation versus deceased donation), donation after brain death, and donation after cardiac death. A figure presents a comparison of organ donation after brain death and after cardiac death, and a table lists the American Academy of Neurology Criteria for Determination of Brain Death. This review contains 1 highly rendered figure, 3 table, and 20 references.
{"title":"Brain Death and Organ Donation","authors":"D. Hoeksma","doi":"10.2310/tywc.1459","DOIUrl":"https://doi.org/10.2310/tywc.1459","url":null,"abstract":"Brain death is the state of irreversible loss of the clinical functions of the brain. A patient must meet strict criteria to be declared brain dead. They must have suffered a known and demonstrably irreversible brain injury and must not have a condition that could render neurologic testing unreliable. If the patient meets these criteria, a formal brain death examination can be performed. The three findings in brain death are coma or unresponsiveness, absence of brainstem reflexes, and apnea. Brain death is closely tied to organ donation, because brain-dead patients represent approximately 90% of deceased donors and thus a large majority of donated organs. This review details a definition and overview of brain death, determination of brain death, and controversy over brain death, as well as the types of organ donation (living donation versus deceased donation), donation after brain death, and donation after cardiac death. A figure presents a comparison of organ donation after brain death and after cardiac death, and a table lists the American Academy of Neurology Criteria for Determination of Brain Death.\u0000This review contains 1 highly rendered figure, 3 table, and 20 references.","PeriodicalId":196621,"journal":{"name":"DeckerMed Transitional Year Weekly Curriculum™","volume":"517 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133464074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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