Reply to reaction on 'Organ donation after euthanasia starting at home in a patient with multiple system atrophy - case report'

We would like to respond to the comment we received from our colleagues on our case report about organ donation after euthanasia starting at home. We reply to their statements on medical and legal aspects, and provide more information on our view of informed consent.

Creativity: A viable and valuable competency in medicine? A qualitative exploratory study

PURPOSE

To explore and describe medical students, postgraduate medical trainees, and medical specialists' perceptions of creativity, the importance they attach to creativity in contemporary healthcare, and, by extension, how they feel creativity can be taught in medical education.

METHODS

The authors conducted seven semi-structured focus groups with medical students (n = 10), postgraduate medical trainees (n = 11) and medical specialists (n = 13).

RESULTS

Participants had a trifurcated perception of creativity, which they described as a form of art that involves thinking and action processes. Facing complex patients in a rapidly changing healthcare landscape, doctors needed such a multifaceted perspective to be able to adapt and react to new and often complex situations that require creativity. Furthermore, participants identified conditions that were perceived to stimulate and inhibit creativity in healthcare and suggested several techniques to learn creativity.

CONCLUSION

Participants perceived creativity as a form of art that involves thinking and action processes. Creativity is important to tackle the challenges of current and future workplaces, because it stimulates the search for original solutions which are needed in a rapidly changing healthcare landscape. Participants proposed different methods and techniques to promote creativity learning. However, we need further research to design and implement creativity in medical curricula.

Moral distress and ethical climate in intensive care medicine during COVID-19: a nationwide study

Background

The COVID-19 pandemic has created ethical challenges for intensive care unit (ICU) professionals, potentially causing moral distress. This study explored the levels and causes of moral distress and the ethical climate in Dutch ICUs during COVID-19.

Methods

An extended version of the Measurement of Moral Distress for Healthcare Professionals (MMD-HP) and Ethical Decision Making Climate Questionnaire (EDMCQ) were online distributed among all 84 ICUs. Moral distress scores in nurses and intensivists were compared with the historical control group one year before COVID-19.

Results

Three hundred forty-five nurses (70.7%), 40 intensivists (8.2%), and 103 supporting staff (21.1%) completed the survey. Moral distress levels were higher for nurses than supporting staff. Moral distress levels in intensivists did not differ significantly from those of nurses and supporting staff. “Inadequate emotional support for patients and their families” was the highest-ranked cause of moral distress for all groups of professionals. Of all factors, all professions rated the ethical climate most positively regarding the culture of mutual respect,  ethical awareness and support. “Culture of not avoiding end-of-life-decisions” and “Self-reflective and empowering leadership” received the lowest mean scores. Moral distress scores during COVID-19 were significantly lower for ICU nurses (p < 0.001) and intensivists (p < 0.05) compared to one year prior.

Conclusion

Levels and causes of moral distress vary between ICU professionals and differ from the historical control group. Targeted interventions that address moral distress during a crisis are desirable to improve the mental health and retention of ICU professionals and the quality of patient care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12910-021-00641-3.

Delayed Convulsions and Brief Contralateral Hemiparesis After Retrobulbar Block

OBJECTIVE

This case report describes convulsions and hemiparesis after retrobulbar injection with good outcome in a patient undergoing outpatient cryocoagulation of his right eye.

CASE REPORT

We report a young man in which localized convulsions of the ipsilateral face occurred 9 minutes after retrobulbar injection followed shortly by convulsions of the contralateral arm and leg. After the convulsions, the patient experienced left-sided hemiparesis resolving approximately 1 hour after the injection. There was no hemodynamic instability during this period. It was difficult to determine the exact cause of convulsions and hemiparesis.

CONCLUSIONS

We believe these complications occurred because of unintentional injection of local anesthetic agent into the subarachnoid space without affecting the brainstem. Possible mechanisms of spread of local anesthetic agent into the central nervous system after retrobulbar block are discussed.