Best practice & research. Clinical anaesthesiology
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Individuals have different values. They seek to express their individuality even when receiving medical care. It is a part of modern medical practice and respect for patient autonomy to show respect for different values. ⋯ However, in some other cases, controversial choices are irrational and are not expressions of our autonomy. Doctors should assist patients to make rational if individual choices. The patient also bears the responsibility for bringing his beliefs to the attention of the clinician.
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Best Pract Res Clin Anaesthesiol · Dec 2006
Confidentiality, 'no blame culture' and whistleblowing, non-physician practice and accountability.
Confidentiality is a core tenet of medical professionalism, which enables the maintenance of trust in a doctor-patient relationship. However, both the amount of personal data stored and the number of third parties who might access this data have increased dramatically in the digital age, necessitating the introduction of various national data protection acts. ⋯ This article explores the evolution of the law and ethics in this area, and draws attention to the difficulties in balancing confidentiality against freedom of information. In addition, the role and responsibilities of the non-physician anaesthetist are examined.
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Frequently, ethical dilemmas for clinicians in ICU focus on the conflict between the sanctity of life principle and other important ethical principles, such as patient autonomy or quality of life. Therefore, this chapter seeks to reveal the ethical tension between the sanctity of life and other competing ethical obligations, clearly outlining how the law in reality is making decisions and what a clinician's duties are in end of life issues.
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The ethics of research, audit and publication have developed mainly within the last fifty years. The Declaration of Helsinki is the universally accepted code of conduct for researchers worldwide. All research has to be approved by an ethics committee, all of which are governed by a centralised structure which is the Central Office for Research Ethics Committees (COREC) in the UK. ⋯ Publication of results thought to be of lesser importance may prove difficult, however, and so there is a temptation to falsify or modify data to make it more attractive. This, together with other activities such as the fabrication of data, plagiarism, dual publication, salami publication, conflicts of interest and irregularities in authorship, have given Editors of journals a number of problems. Many of these issues around publication ethics may prove difficult to detect but the fear of sanctions from employers and professional organisations is a useful deterrent.
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The gastric emptying rate is a carefully regulated process consisting of different mathematically defined phases. The gastric metabolic load, as well as neural regulatory mechanisms and hormonal influences, cooperate in order to achieve a well-balanced emptying of contents from the stomach into the duodenum for absorption in the small intestine. ⋯ We have found that the two peptide hormones ghrelin and glucagon-like peptide- I (GLP- I) have a great impact on the regulation of gastric emptying: ghrelin is a most potent stimulator of gastric contractions and emptying, and GLP- I profoundly inhibits this emptying process. These data suggest possibilities for governing the rate of gastric emptying as a natural step in achieving metabolic balance and control.