Framing pub smoking bans: an analysis of Australian print news media coverage, March 1996-March 2003.
(33/170)
OBJECTIVE: To investigate framing strategies used by the Australian Hotels Association (AHA) and tobacco control groups to (respectively) resist or advocate laws providing smoke free bars. METHODS: Online archives of Australian print media were searched 1996 to 2003. A thematic analysis of all statements made by AHA spokespeople and tobacco control advocates was conducted. Direct quotes or journalistic summaries of statements attributed to named people were coded into four broad themes and the slant of articles coded. RESULTS: More than three times as many articles reported issues that were positive (n = 171) than negative (n = 48) for tobacco control objectives. The AHA emphasised negative economic issues and cultural/ideological frames about cultural identity, while tobacco control interests emphasised health concerns as well as cultural/ideological frames about threats to inequitable workplace policies. CONCLUSIONS: Smoke free bars have now been secured, suggesting that health advocates' position prevailed. The inability of the AHA to avoid the core health arguments, its wildly exaggerated economic predictions, and its frequent recourse to claiming smoke bans threatened nostalgic but outmoded vistas of Australian day to day life were decidedly backward looking and comparatively easily dismissed as being out of touch with views held by many in contemporary Australia. Health groups' emphasis on the unfairness in denying the most occupationally exposed group the same protection that all other workers enjoyed under law was powerfully and consistently argued. Australia's recent success in securing dates for the implementation of smoke free pubs is likely to have owed much to the enduring media advocacy by health groups. (+info)
The costs of nonbeneficial treatment in the intensive care setting.
(34/170)
Ethics consultations have been shown to reduce the use of "nonbeneficial treatments," defined as life-sustaining treatments delivered to patients who ultimately did not survive to hospital discharge, when treatment conflicts occurred in the adult intensive care unit (ICU). In this paper we estimated the costs of nonbeneficial treatment using the results from a randomized trial of ethics consultations. We found that ethics consultations were associated with reductions in hospital days and treatment costs among patients who did not survive to hospital discharge. We conclude that consultations resolved conflicts that would have inappropriately prolonged nonbeneficial or unwanted treatments in the ICU instead of focusing on more appropriate comfort care. (+info)
Recently published papers: an ancient debate, novel monitors and post ICU outcome in the elderly.
(35/170)
Tracheostomies have been around for close to 3000 years, so one would hope that the controversies might have been thrashed out by now, but apparently not. Judging by some recent publications it would appear that we still do not know when or how to insert them. Monitoring is fundamental to critical care; two papers describe novel/modified techniques for assessing traumatic brain injury and cardiac output. The intensive care unit imposes a heavy treatment burden, particularly on the elderly. What impact does this have on the lives of the survivors? (+info)
Withholding and withdrawing of life sustaining treatment in the newborn.
(36/170)
The rapid progress of medical technology has resulted in more opportunities to maintain the life of infants in serious and potentially life threatening situations. Whether to treat such infants is a common dilemma. The burden of these difficult decisions rests almost equally on distraught parents and relatives and on the professional staff of neonatal units. Sometimes, either parents or care teams choose to seek a decision from the courts. Ways of reaching the best possible and most inclusive consensus decisions are examined in this review. (+info)
Comparison of disagreement and error rates for three types of interdepartmental consultations.
(37/170)
Previous studies have documented a relatively high rate of disagreement for interdepartmental consultations, but follow-up is limited. We reviewed the results of 3 types of interdepartmental consultations in our hospital during a 2-year period, including 328 incoming, 928 pathologist-generated outgoing, and 227 patient- or clinician-generated outgoing consults. The disagreement rate was significantly higher for incoming consults (10.7%) than for outgoing pathologist-generated consults (5.9%) (P = .06). Disagreement rates for outgoing patient- or clinician-generated consults were not significantly different from either other type (7.9%). Additional consultation, biopsy, or testing follow-up was available for 19 (54%) of 35, 14 (25%) of 55, and 6 (33%) of 18 incoming, outgoing pathologist-generated, and outgoing patient- or clinician-generated consults with disagreements, respectively; the percentage of errors varied widely (15/19 [79%], 8/14 [57%], and 2/6 [33%], respectively), but differences were not significant (P >.05 for each). Review of the individual errors revealed specific diagnostic areas in which improvement in performance might be made. Disagreement rates for interdepartmental consultation ranged from 5.9% to 10.7%, but only 33% to 79% represented errors. Additional consultation, tissue, and testing results can aid in distinguishing disagreements from errors. (+info)
Metabolic syndrome under fire: weighing in on the truth.
(38/170)
In the past two decades, the 'metabolic syndrome' has raised much clinical and research interest and remains a controversial topic. The constellation of commonly coexisting cardiovascular risk factors, now known as the metabolic syndrome, has had many definitions which has added to the confusion surrounding the syndrome. Recently, the controversy has been escalated by a joint statement from the American Diabetes Association and the European Association for the Study of Diabetes calling into question the existence and clinical utility of the metabolic syndrome as a discrete clinical entity. Despite the controversy, there is agreement that the risk factors of abdominal obesity, hypertension, elevated glucose and dyslipidemia commonly coexist in the same patient, and are important to identify when assessing an individual patient's risk. Therefore, whether the 'syndrome' is a distinct clinical entity is not important. By definition, a syndrome is a group of signs or symptoms that commonly group together. It remains a useful clinical tool to raise awareness among health care professionals to look for 'nontraditional' cardiovascular risk factors, such as glucose intolerance or elevated waist circumference, in patients with other components of the syndrome, without negating the importance of identifying and treating the other 'traditional' risk factors not identified in the syndrome. It also reminds clinicians of the importance of lifestyle interventions to treat all of the components of the syndrome. Therefore, the 'metabolic syndrome' continues to serve a useful clinical purpose to raise awareness among health care professionals and aid in identifying high-risk individuals. (+info)
In defense of the randomized controlled trial for health promotion research.
(39/170)
The overwhelming evidence about the role lifestyle plays in mortality, morbidity, and quality of life has pushed the young field of modern health promotion to center stage. The field is beset with intense debate about appropriate evaluation methodologies. Increasingly, randomized designs are considered inappropriate for health promotion research. We have reviewed criticisms against randomized trials that raise philosophical and practical issues, and we will show how most of these criticisms can be overcome with minor design modifications. By providing rebuttal to arguments against randomized trials, our work contributes to building a sound methodological base for health promotion research. (+info)
Experts' attitudes towards medical futility: an empirical survey from Japan.
(40/170)
BACKGROUND The current debate about medical futility is mostly driven by theoretical and personal perspectives and there is a lack of empirical data to document experts and public attitudes towards medical futility. METHODS: To examine the attitudes of the Japanese experts in the fields relevant to medical futility a questionnaire survey was conducted among the members of the Japan Association for Bioethics. A total number of 108 questionnaires returned filled in, giving a response rate of 50.9%. Among the respondents 62% were healthcare professionals (HCPs) and 37% were non-healthcare professionals (Non-HCPs). RESULTS: The majority of respondents (67.6 %) believed that a physician's refusal to provide or continue a treatment on the ground of futility judgment could never be morally justified but 22.2% approved such refusal with conditions. In the case of physiologically futile care, three-quarters believed that a physician should inform the patient/family of his futility judgment and it would be the patient who could decide what should be done next, based on his/her value judgment. However more than 10% said that a physician should ask about a patient's value and goals, but the final decision was left to the doctor not the patient. There was no statistically significant difference between HCPs and Non-HCPs (p = 0.676). Of respondents 67.6% believed that practical guidelines set up by the health authority would be helpful in futility judgment. CONCLUSION: The results show that there is no support for the physicians' unilateral decision-making on futile care. This survey highlights medical futility as an emerging issue in Japanese healthcare and emphasizes on the need for public discussion and policy development. (+info)