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Coghlan C, Daubenspeck D, González LS, Feider A, Chaney MA. Management of Incidental Aortic Valve Mass. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00240-9. [PMID: 37164804 DOI: 10.1053/j.jvca.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 05/12/2023]
Affiliation(s)
- Colleen Coghlan
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, IL
| | - Danisa Daubenspeck
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, IL
| | - Laura S González
- Department of Anesthesiology, Division of Cardiac Anesthesiology, Medical College of Wisconsin, Milwaukee, WI
| | - Andrew Feider
- Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Mark A Chaney
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, IL.
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Miller A, Prasad K, Quach WT, Lin GT, Smetak M, Langerman A. Talking with Patients about Surgical Trainees. THE JOURNAL OF CLINICAL ETHICS 2023; 34:98-102. [PMID: 36940349 DOI: 10.1086/723315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
AbstractTraining of resident physicians is essential for the care of future patients. While surgical trainee involvement is necessary, its disclosure to patients can often be omitted or underplayed by surgeons. The informed consent process and the underlying ethical principles make evident that patients should be informed of trainee involvement. In this review we explore the importance of disclosure, current themes in practice, and the optimal discussion for which we should strive.
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Ethics Consultation in Surgical Specialties. HEC Forum 2021; 34:89-102. [PMID: 33674985 PMCID: PMC7934986 DOI: 10.1007/s10730-021-09447-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2021] [Indexed: 11/24/2022]
Abstract
Multiple studies have been performed to identify the most common ethical dilemmas encountered by ethics consultation services. However, limited data exists comparing the content of ethics consultations requested by specific hospital specialties. It remains unclear whether the scope of ethical dilemmas prompting an ethics consultation differ between specialties and if there are types of ethics consultations that are more or less frequently called based on the specialty initiating the ethics consult. This study retrospectively assessed the incidence and content of ethics consultations called by surgical vs. non-surgical specialties between January 1, 2013 to December 31, 2018 using our RedCap Database and information collected through the EMR via our Clinical and Translational Science Center. 548 total ethics consultations were analyzed (surgical n = 135, non-surgical n = 413). Our results demonstrate that more surgical consults originated from the ICU, as opposed to lower acuity units (45.9% vs. 14.3%, p ≤ 0.001), and surgical patients were more likely to have a DNR in place (37.5% vs. 22.2%, p = 0.002). Surgical specialties were more likely to call about issues relating to withholding/withdrawing life-sustaining treatment (p ≤ 0.001), while non-surgical specialties were more likely to call about issues related to discharge planning (p = 0.001). There appear to be morally relevant differences between consults classified as the “same” that are not entirely captured by the usual ethics consultations classification system. In conclusion, this study highlights the unique ethical issues experienced by surgical vs. non-surgical specialties. Ultimately, our data can help ethics consultation services determine how best to educate various hospital specialties to approach ethical issues commonly experienced within their field.
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Wu CW, Huang TY, Randolph GW, Barczyński M, Schneider R, Chiang FY, Silver Karcioglu A, Wojtczak B, Frattini F, Gualniera P, Sun H, Weber F, Angelos P, Dralle H, Dionigi G. Informed Consent for Intraoperative Neural Monitoring in Thyroid and Parathyroid Surgery - Consensus Statement of the International Neural Monitoring Study Group. Front Endocrinol (Lausanne) 2021; 12:795281. [PMID: 34950109 PMCID: PMC8689131 DOI: 10.3389/fendo.2021.795281] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
In the past decade, the use of intraoperative neural monitoring (IONM) in thyroid and parathyroid surgery has been widely accepted by surgeons as a useful technology for improving laryngeal nerve identification and voice outcomes, facilitating neurophysiological research, educating and training surgeons, and reducing surgical complications and malpractice litigation. Informing patients about IONM is not only good practice and helpful in promoting the efficient use of IONM resources but is indispensable for effective shared decision making between the patient and surgeon. The International Neural Monitoring Study Group (INMSG) feels complete discussion of IONM in the preoperative planning and patient consent process is important in all patients undergoing thyroid and parathyroid surgery. The purpose of this publication is to evaluate the impact of IONM on the informed consent process before thyroid and parathyroid surgery and to review the current INMSG consensus on evidence-based consent. The objective of this consensus statement, which outlines general and specific considerations as well as recommended criteria for informed consent for the use of IONM, is to assist surgeons and patients in the processes of informed consent and shared decision making before thyroid and parathyroid surgery.
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Affiliation(s)
- Che-Wei Wu
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Liquid Biopsy and Cohort Research, and Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tzu-Yen Huang
- Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Gregory W. Randolph
- Department of Otolaryngology, Harvard Medical School, Boston, MA, United States
| | - Marcin Barczyński
- Department of Endocrine Surgery, Third Chair of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Rick Schneider
- Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle, Martin-Luther-University, Halle-Wittenberg, Germany
| | - Feng-Yu Chiang
- Department of Otolaryngology, E-Da Hospital, School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | | | - Beata Wojtczak
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Francesco Frattini
- Department of Surgery, Ospedale di Circolo, ASST, Settelaghi, Varese, Italy
| | - Patrizia Gualniera
- Forensics Division, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Hui Sun
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Frank Weber
- Department of General, Visceral and Transplantation Surgery, University of Duisburg-Essen, Essen, Germany
| | - Peter Angelos
- Department of Surgery and MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, United States
| | - Henning Dralle
- Department of General, Visceral and Transplantation Surgery, University of Duisburg-Essen, Essen, Germany
| | - Gianlorenzo Dionigi
- Division of Surgery, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- *Correspondence: Gianlorenzo Dionigi,
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Al Samaraee A, Samier A. Intraoperative decision making in bariatric surgery. Qatar Med J 2020:23. [PMID: 33282708 PMCID: PMC7684556 DOI: 10.5339/qmj.2020.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 06/11/2020] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Surgeons may encounter unexpected anatomical or pathological findings during various bariatric surgical procedures for which they must make prompt and critical decisions that had not been planned prior to the operation. In this practice review, we present our experiences with unexpected challenges and on-table decision making in bariatric surgery to share our knowledge with colleagues who may encounter the same challenges during bariatric surgery. This paper's content is of applied learning and practical value focusing on challenging intraoperative decision making; however, it does not discuss the details of the various techniques used during surgery. METHODS This work is a single-center retrospective review of operations carried out on patients who had unexpected intraoperative findings during bariatric surgery despite the implementation of detailed preoperative evaluations that would have otherwise suggested standard procedures. These findings resulted in abandoned surgery or laparoscopic sleeve gastrectomy instead of the intended Roux-en-Y gastric bypass. RESULTS A total of 449 patients had received various bariatric interventions in our unit between 2012 and 2016. Eleven patients, representing approximately 2.4% of the total number of patients surveyed had met the inclusion criteria and were added to the final list for analysis. The mean age of the included patients was 40.82 years (range: 30-51 years), and seven of the patients, representing approximately 63.6% of the included cases, were female. The mean body mass index of the 11 cases was 40.8 (range: 38-48). Only two cases (18.9%) had had their surgery abandoned; the rest (81.1%) had received laparoscopic sleeve gastrectomy instead of Roux-en-Y gastric bypass. None of the 11 patients had perioperative morbidity or mortality. CONCLUSION Intraoperative decision making for unexpected findings in bariatric surgery is challenging. In these circumstances, surgeons must make prompt and critical decisions, including abandoning the operation. The available literature on this subject is unsurprisingly limited because of the rarity of such findings.
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Affiliation(s)
- Ahmad Al Samaraee
- Department of General & Bariatric Surgery, Darlington Memorial Hospital, Darlington, UK
| | - Akeil Samier
- Department of General & Bariatric Surgery, Darlington Memorial Hospital, Darlington, UK
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Bhimani AD, Macrinici V, Ghelani S, Huang EY, Khan NI, Saw TA, Mejia A. Delving Deeper Into Informed Consent: Legal and Ethical Dilemmas of Emergency Consent, Surrogate Consent, and Intraoperative Consultation. Orthopedics 2018; 41:e741-e746. [PMID: 30222792 DOI: 10.3928/01477447-20180912-10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 02/05/2018] [Indexed: 02/03/2023]
Abstract
Informed consent is gaining an ever-important place in modern medicine. The practice of patient-centered medicine along with evidence-based medicine requires a balance between the patient's wishes and the physician's oath to do no harm. Surrogate consent, emergency consent, and intraoperative consultation are 3 situations prone to legal and ethical dilemmas in the fulfillment of informed consent. By examining the proposed models and legal precedents that address the challenges in informed consent, discussion of these dilemmas in the context of both law and bioethics may provide a better understanding of how to resolve them. [Orthopedics. 2018; 41(6):e741-e746.].
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