Alyssa Burgart, MD

Abstract

Workplace violence is any physical assault, threatening behavior or other verbal abuse directed toward persons at work or in the workplace. The incidence of workplace violence in healthcare settings in general and more specifically the pain clinic is thought to be underestimated due to hesitancy to report, lack of support from management and healthcare systems, and lack of institutional policies as it relates to violence from patients against healthcare workers. In the following article, we explore risk factors that place clinicians at risk of workplace violence, the cost and impact of workplace violence, how to build a violence prevention program and lastly how to recover from violence in the practice setting.

View details for DOI 10.1136/rapm-2022-104308

View details for PubMedID 36754543

Abstract

ADDENDUM: Please note that in the interim since this paper was accepted for publication, new governmental regulations, pertinent to the topic, have been approved for implementation. The reader is thus directed to this online addendum for additional relevant information: http://links.lww.com/AA/E44.

View details for DOI 10.1213/ANE.0000000000005800

View details for PubMedID 36108183

View details for DOI 10.1007/s11695-021-05393-y

View details for PubMedID 33797732

View details for DOI 10.1016/j.jvs.2020.07.080

View details for PubMedID 32958318

View details for DOI 10.1097/SLA.0000000000004474

View details for PubMedID 32889879

View details for Web of Science ID 000535430200015

View details for DOI 10.1213/ANE.0000000000004656

View details for PubMedID 31922996

Abstract

In the face of ongoing drug shortages, anesthesiologists have been described as having to become "Iron Chefs, challenged to create safe patient outcomes with missing ingredients. Unfortunately, developing responsive ethical guidance for how anesthesiologists should best handle ethical concerns with ongoing and mutable drug shortages is limited by the dearth of studies examining how bedside clinicians actually experience drug shortages and what ethical challenges they encounter. In order to better understand what ethical concerns individual anesthesiologists experience around drug shortages and how they negotiate them, we undertook this qualitative interview study. Methods: We conducted semi-structured interviews with anesthesiologists at three field sites: an academic tertiary care adult hospital that performs approximately 46,000 anesthetics annually comprising cases ranging across all surgical disciplines; the affiliated veteran's affairs hospital that performs 12,000 anesthetics annually; and, the affiliated children's hospital that performs 20,500 anesthetics annually. Results: 29 anesthesiologists were interviewed (17 adult and 12 pediatric anesthesiologists), representing a spectrum of practice areas in clinical anesthesia: general, pediatric, regional, pain, critical care, obstetrics, liver transplant, and palliative medicine. Three themes emerged: (1) uncertainty about responsibility for clinical decisions made in consequence to a shortage; (2) creativity, and its limits, in choosing anesthetic plans; and, (3) disclosure of concerns about shortages (to patients and colleagues). Conclusions: Our data suggests anesthesiologists have unmet needs for ethical guidance on how to approach drug shortages. First is managing responsibility for decisions stemming from a drug shortage. Second, interviewees struggled with disclosure of their concerns, both to patients and to surgical colleagues. A formal shared decision making approach may present the best solution, since the act of structuring a shared decision making conversation or creating a decision making tool will have to incorporate the views of all stakeholders around shortages and their potential clinical consequences.

View details for DOI 10.1080/23294515.2020.1839596

View details for PubMedID 33124970

View details for DOI 10.1080/15265161.2020.1779392

View details for PubMedID 32716767

View details for DOI 10.1080/15265161.2019.1655956

View details for Web of Science ID 000487986000003

View details for DOI 10.1111/petr.13359

View details for Web of Science ID 000476931300005

View details for PubMedID 29313792

Abstract

One of the most complicated ethical issues that arises in children's hospitals today is the issue of whether it is ever permissible to perform a procedure for a minor that will result in permanent sterilization. In most cases, the answer is no. The availability of good, safe, long-acting contraception allows surgical options to be postponed when the primary goal of such surgical options is to prevent pregnancy. But what if a minor has congenital urogenital anomalies or other medical conditions for which the best treatment is a hysterectomy? In those cases, the primary goal of therapy is not to prevent pregnancy. Instead, sterility is an unfortunate side effect of a medically indicated treatment. Should that side effect preclude the provision of a therapy that is otherwise medically appropriate? We present a case that raises these issues, and asked experts in law, bioethics, community advocacy, and gynecology to respond. They discuss whether the best option is to proceed with the surgery or to cautiously delay making a decision to give the teenager more time to carefully consider all of the options.

View details for DOI 10.1542/peds.2016-3992

View details for PubMedID 28562274

View details for Web of Science ID 000398839800075

View details for PubMedID 29020542

View details for DOI 10.1080/15265161.2016.1253963

View details for Web of Science ID 000390115900008

View details for PubMedID 27901425

Abstract

The regulatory demarcations between clinical research and quality improvement (QI) are ambiguous and controversial. Some projects that were undertaken as a form of QI were deemed by regulatory agencies to be research and thus to require institutional review board approval. In the era of personalized medicine, some physicians may ask some patients to participate in n-of-1 trials in an effort to personalize and optimize each patient's medical treatment. Should such activities be considered research, QI, or just excellent personalized medicine? Experts in research, research regulation, and bioethics analyze these issues.

View details for DOI 10.1542/peds.2016-1103

View details for PubMedID 27385811

Abstract

: To determine the current use of the pelvic organ prolapse quantification (POP-Q) by members of the American Urogynecologic Society (AUGS) and the International Continence Society (ICS).: Surgically active members of AUGS and ICS completed a Web-based questionnaire about their use of the POP-Q and included queries regarding respondent's clinical training, surgical experience, and practice setting. Users of POP-Q described their POP-Q use including patient's position, tools used to measure or assist with exposure, use of strain, and bladder volume. Strengths and weaknesses of the POP-Q system were also assessed.: The 308 respondents had a median of 8 years (range, 0-35 years) of independent performance of POP surgery. Most were from the United States (70%), in a shared practice (64%), with at least 2 years of fellowship training (61%), and had trainees participating in patient care (81%). Of the respondents, 76% reported using the POP-Q; however, the technique of POP-Q varied. Of the 24% not using the POP-Q, two-thirds reported past POP-Q use. For these individuals, prolapse description was done using Baden-Walker (57%), descriptive words (38%), or other grades (7%). More than 50% of nonusers reported that the POP-Q is "too time-consuming" or that their "colleagues do not use it.": Although most surveyed members of AUGS and ICS are using the POP-Q, we detected variability in the day-to-day practice of POP-Q use. To further advance the communication benefits of the POP-Q, a revision that provides evidence-based guidance may be a worthwhile refinement.

View details for DOI 10.1097/SPV.0b013e318207c904

View details for Web of Science ID 000209176100003

View details for PubMedID 22453690