Health Care Analysis最新文献

Shared decision-making ("SDM") has increased in acceptance and become a gold standard in medical decision-making over the last two decades. Despite this, there continues to be disagreement about several facets of SDM that many existing models or versions do not sufficiently address, including: that there is a lack of agreement about which version or model of SDM to utilize in practice; that there are practical limitations on when SDM ought to be utilized; that SDM may be required to use different "harm thresholds" when making decisions for patients who have lost decision-making capacity or competence, or for those who have never had such capacity in the first place; and that many existing models of SDM succumb to what is known as the "framing problem," among other concerns. Elsewhere, this author presented a model of SDM titled, the Professionally-Driven Zone of Patient or Surrogate Discretion (or, Professionally-Driven ZPSD) as a more comprehensive and defensible way forward. This article sets out to expand on the expected benefits of the model, and apply it to several case studies in the acute-care setting in order to demonstrate its functionality as a model of SDM.

This study aims to evaluate scientific publications on "Medical Informatics" and "Data Privacy" using a bibliometric approach to identify research trends, the most studied topics, and the countries and institutions with the highest publication output. The search was carried out utilizing the WoS Clarivate Analytics tool across SCIE journals. Subsequently, text mining, keyword clustering, and data visualization were applied through the use of VOSviewer and Tableau Desktop software. Between 1975 and 2023, a total of 7,165 articles were published on the topic of data privacy. The number of articles has been increasing each year. The text mining and clustering analysis identified eight main clusters in the literature: (1) Mobile Health/Telemedicine/IOT, (2) Security/Encryption/Authentication, (3) Big Data/AI/Data Science, (4) Anonymization/Digital Phenotyping, (5) Genomics/Biobank, (6) Ethics, (7) Legal Issues, (8) Cloud Computing. On a country basis, the United States was identified as the most active country in this field, producing the most publications and receiving the highest number of citations. China, the United Kingdom, Canada, and Australia also emerged as significant countries. Among these clusters, "Mobile Health/Telemedicine/IOT," "Security/Encryption/Authentication," and "Cloud Computing" technologies stood out as the most prominent and extensively studied topics in the intersection of medical informatics and data privacy.

This paper questions the conventional wisdom that physicians must suppress anger in response to patient misbehaviour. It distinguishes the emotion of anger from its expression, which leans toward concerned frustration and disappointment for the sake of professionalism in patient care. Drawing on the framework of person-centred health care as a virtue ethic, the paper first suggests four reasons why and when physician anger toward patient behaviour may occasionally be appropriate: the inevitability of sometimes feeling angry, anger as a cognitive and behavioural resource, physician well-being, and potential patient benefit. The paper then proposes five conditions under which physician anger displays may be prudent as a measured response that balances emotional expression with professional conduct: ethical intention, rational justification, proportionality, problem-focused constructive expression, and precision. Potential benefits of this conceptualization of prudent anger include improved physician wellbeing, enhanced communication, and patient education to address perceived patient misbehaviour. The paper advocates for a cultural shift in health care environments to help allow for more authentic expression of physician frustration, aiming to harness prudent anger as a catalyst for positive change in patient-physician relationships and systemic improvements in health care delivery.

Medicine has always existed in a marketplace, and there have been extensive discussions about the ethical implications of commerce in health care. For the most part, this discussion has focused on health professionals' interactions with pharmaceutical and other health technology industries, with less attention given to other types of commercial influences, such as corporatized health services and fee-for-service practice. This is a significant lacuna because in many jurisdictions, some or all of healthcare is delivered in the private sector. Using the exemplar of Assisted Reproductive Technologies (ART), this paper asks: what, if any, responsibilities do doctors have to challenge the distorting influence of commerce in healthcare, other than those arising from their own interactions with health technology companies? ART provides a good focus for this question because it is an area of practice that has historically been provided in the private sector. First, we describe a range of concepts that offer helpful heuristics for capturing how and when doctors can reasonably be said to have responsibilities to resist commercial distortion, including: complicity, acquiescence, wilful ignorance, non-wilful ignorance, and duplicity. Second, we present ways that individual doctors can act to stop questionable behaviour on the part of their colleagues, clinics/corporations, and their profession. Third, we note that there are many situations where change cannot be achieved by individuals acting alone, and so we consider the responsibilities of health professionals as collectives as well as the role that professional bodies and regulators should play.

A few months after national vaccination campaigns were initiated around early 2021, the discussion regarding the mandatory vaccination of healthcare workers started gaining ground in most European states and also in the United States. The debate on whether healthcare workers should be required to be vaccinated has been fueled by three main reasons: the high transmissibility rate of the Delta variant, which posed a significant risk to national healthcare systems across Europe and the Americas, as well placing high pressure on intensive care units even in the summer months (a); states' inability to impose general lockdowns and social distancing measures during the 2022 winter due to financial hardship and fears of an ongoing recession (b); and governmental unwillingness to implement restrictive measures, having in mind their populations' tiredness from previous lockdowns (c). This paper will explore the legal and managerial implications of mandatory vaccination among healthcare workers and will argue that it has the capacity to be a successful part of effective national healthcare systems in the search for responsible professionals to staff them. It will argue that national vaccination strategies are dependent on states' national healthcare models. It will show how the major difference in healthcare models of the two states chosen as examples have affected their vaccination policies and their reception by healthcare personnel. Finally, it will prove that the advantages of mandatory vaccination for healthcare personnel outweigh prospected disadvantages, irrespective of ethical, or legal justification is applied. This research will go through the key points of the legislative provisions of the two states (a); it will delve into their legal (b) and managerial implications (c); and finally, it will go through the policy questions which arose (d). It will prove how selective mandatory vaccination policies may be applied to national healthcare systems with foundational differences in their conception. Thus, it will demonstrate that selective mandatory vaccination is a viable option both for models approaching health from a societal perspective, and from the liberal ones.

This essay places contemporary efforts to understand and respond to the crisis of physician burnout in historical perspective, proposing that the origins of such efforts lie in nineteenth century concerns over "nervous exhaustion," well before the term "physician burnout" was coined by social scientists in the early 1970s. Only very recently, however, have physician-scholars started to bring more sophisticated tools to bear in conceptualizing the problem, moving from a "systems approach" to the most recent efforts to frame the issue as a problem of corporate culture. The essay proposes that these different approaches to physician burnout illustrate the changing self-images of the medical profession over the last century and a half. Because such self-images are embedded in normative assumptions, contextualizing physician burnout in these terms reveals the crisis to be as much social and political as professional.

Historically, the transgender population has faced prejudice and discrimination within society. The purpose of diagnostic terms is to direct clinical care and facilitate insurance coverage. However, the existence of a medical diagnosis for gender nonconformity can exacerbate the stigmatization of transgender people with adverse consequences on their emotional health and social life. Whether transgenderism and gender dysphoria are indeed a psychopathological condition or even any kind of nosological entity is a contested issue. Many advocates of human rights, trans activists, social scientists, and clinicians support either the removal of gender incongruence from the list of mental disorders or at least its transfer to a separate category. Reforming the classification is an intermediate step toward depathologization and permits access to transgender-related care. Nonetheless, it partly preserves the stigma associated with abnormality and puts the availability of psychiatric care at risk. A more radical approach dictates that the classification of diseases serves exclusively medical purposes and must be dissociated from the respect for the legitimacy of one's autonomy and dignity. In the long term, only a swing in societal values can detach stigma from mental and physical illnesses. Enhancing collective respect for life, human rights, and diversity is the best way to achieve cohesion and well-being among members of society. Health professionals can be pioneers of social change in this field.

The pervasive effects of increasingly restrictive migration policies on the health of immigrant populations in the U.S. have been well-documented, but not so much concerning the unique experiences of Brazilian immigrants, a subgroup of the Latino/a/x population. Considering that, this narrative review article employs a research design that is both conceptual and exploratory-to understand the possible connections and associations between restrictive immigration policies and negative health outcomes among Brazilian immigrants in the U.S. Findings indicate that Brazilian immigrants in the U.S. face an array of health and non-health related challenges, including racism and poor working conditions, with undocumented individuals experiencing worse outcomes. Studies highlight the complex relationship between immigration policies and health and emphasize the detrimental effects of deportation fear, healthcare access obstacles, and mental health repercussions due to hostile immigration policymaking and generalized anti-immigrant sentiment. More research is needed to understand the unique challenges faced by the Brazilian immigrant population concerning several mental and physical health outcomes.