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[PMID]: 29511602
[Au] Autor:de Lima Pereira A; Southgate R; Ahmed H; O'Connor P; Cramond V; Lenglet A
[Ad] Address:Médecins Sans Frontières (MSF), Operational Centre Amsterdam (OCA), Kobanê, Syria.
[Ti] Title:Infectious Disease Risk and Vaccination in Northern Syria after 5 Years of Civil War: The MSF Experience.
[So] Source:PLoS Curr;10, 2018 Feb 02.
[Is] ISSN:2157-3999
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Introduction: In 2015, following an influx of population into Kobanê in northern Syria, Médecins Sans Frontières (MSF) in collaboration with the Kobanê Health Administration (KHA) initiated primary healthcare activities. A vaccination coverage survey and vaccine-preventable disease (VPD) risk analysis were undertaken to clarify the VPD risk and vaccination needs. This was followed by a measles Supplementary Immunization Activity (SIA). We describe the methods and results used for this prioritisation activity around vaccination in Kobanê in 2015. Methods: We implemented a pre-SIA survey in 135 randomly-selected households in Kobanê using a vaccination history questionnaire for all children <5 years. We conducted a VPD Risk Analysis using MSF 'Preventive Vaccination in Humanitarian Emergencies' guidance to prioritize antigens with the highest public health threat for mass vaccination activities. A Measles SIA was then implemented and followed by vaccine coverage survey in 282 randomly-selected households targeting children <5 years. Results: The pre-SIA survey showed that 168/212 children (79.3%; 95%CI=72.7-84.6%) had received one vaccine or more in their lifetime. Forty-three children (20.3%; 95%CI: 15.1-26.6%) had received all vaccines due by their age; only one was <12 months old and this child had received all vaccinations outside of Syria. The VPD Risk Analysis prioritised measles, Haemophilus Influenza type B (Hib) and Pneumococcus vaccinations. In the measles SIA, 3410 children aged 6-59 months were vaccinated. The use of multiple small vaccination sites to reduce risks associated with crowds in this active conflict setting was noted as a lesson learnt. The post-SIA survey estimated 82% (95%CI: 76.9-85.9%; n=229/280) measles vaccination coverage in children 6-59 months. Discussion: As a result of the conflict in Syria, the progressive collapse of the health care system in Kobanê has resulted in low vaccine coverage rates, particularly in younger age groups. The repeated displacements of the population, attacks on health institutions and exodus of healthcare workers, challenge the resumption of routine immunization in this conflict setting and limit the use of SIAs to ensure sustainable immunity to VPDs. We have shown that the risk for several VPDs in Kobanê remains high. Conclusion: We call on all health actors and the international community to work towards re-establishment of routine immunisation activities as a priority to ensure that children who have had no access to vaccination in the last five years are adequately protected for VPDs as soon as possible.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180311
[Lr] Last revision date:180311
[St] Status:In-Data-Review

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[PMID]: 29362795
[Au] Autor:Foa EB; McLean CP; Zang Y; Rosenfield D; Yadin E; Yarvis JS; Mintz J; Young-McCaughan S; Borah EV; Dondanville KA; Fina BA; Hall-Clark BN; Lichner T; Litz BT; Roache J; Wright EC; Peterson AL; STRONG STAR Consortium
[Ad] Address:Department of Psychiatry, School of Medicine, University of Pennsylvania, Philadelphia.
[Ti] Title:Effect of Prolonged Exposure Therapy Delivered Over 2 Weeks vs 8 Weeks vs Present-Centered Therapy on PTSD Symptom Severity in Military Personnel: A Randomized Clinical Trial.
[So] Source:JAMA;319(4):354-364, 2018 01 23.
[Is] ISSN:1538-3598
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Importance: Effective and efficient treatment is needed for posttraumatic stress disorder (PTSD) in active duty military personnel. Objective: To examine the effects of massed prolonged exposure therapy (massed therapy), spaced prolonged exposure therapy (spaced therapy), present-centered therapy (PCT), and a minimal-contact control (MCC) on PTSD severity. Design, Setting, and Participants: Randomized clinical trial conducted at Fort Hood, Texas, from January 2011 through July 2016 and enrolling 370 military personnel with PTSD who had returned from Iraq, Afghanistan, or both. Final follow-up was July 11, 2016. Interventions: Prolonged exposure therapy, cognitive behavioral therapy involving exposure to trauma memories/reminders, administered as massed therapy (n = 110; 10 sessions over 2 weeks) or spaced therapy (n = 109; 10 sessions over 8 weeks); PCT, a non-trauma-focused therapy involving identifying/discussing daily stressors (n = 107; 10 sessions over 8 weeks); or MCC, telephone calls from therapists (n = 40; once weekly for 4 weeks). Main Outcomes and Measures: Outcomes were assessed before and after treatment and at 2-week, 12-week, and 6-month follow-up. Primary outcome was interviewer-assessed PTSD symptom severity, measured by the PTSD Symptom Scale-Interview (PSS-I; range, 0-51; higher scores indicate greater PTSD severity; MCID, 3.18), used to assess efficacy of massed therapy at 2 weeks posttreatment vs MCC at week 4; noninferiority of massed therapy vs spaced therapy at 2 weeks and 12 weeks posttreatment (noninferiority margin, 50% [2.3 points on PSS-I, with 1-sided α = .05]); and efficacy of spaced therapy vs PCT at posttreatment. Results: Among 370 randomized participants, data were analyzed for 366 (mean age, 32.7 [SD, 7.3] years; 44 women [12.0%]; mean baseline PSS-I score, 25.49 [6.36]), and 216 (59.0%) completed the study. At 2 weeks posttreatment, mean PSS-I score was 17.62 (mean decrease from baseline, 7.13) for massed therapy and 21.41 (mean decrease, 3.43) for MCC (difference in decrease, 3.70 [95% CI,0.72 to 6.68]; P = .02). At 2 weeks posttreatment, mean PSS-I score was 18.03 for spaced therapy (decrease, 7.29; difference in means vs massed therapy, 0.79 [1-sided 95% CI, -∞ to 2.29; P = .049 for noninferiority]) and at 12 weeks posttreatment was 18.88 for massed therapy (decrease, 6.32) and 18.34 for spaced therapy (decrease, 6.97; difference, 0.55 [1-sided 95% CI, -∞ to 2.05; P = .03 for noninferiority]). At posttreatment, PSS-I scores for PCT were 18.65 (decrease, 7.31; difference in decrease vs spaced therapy, 0.10 [95% CI, -2.48 to 2.27]; P = .93). Conclusions and Relevance: Among active duty military personnel with PTSD, massed therapy (10 sessions over 2 weeks) reduced PTSD symptom severity more than MCC at 2-week follow-up and was noninferior to spaced therapy (10 sessions over 8 weeks), and there was no significant difference between spaced therapy and PCT. The reductions in PTSD symptom severity with all treatments were relatively modest, suggesting that further research is needed to determine the clinical importance of these findings. Trial Registration: clinicaltrials.gov Identifier: NCT01049516.
[Mh] MeSH terms primary: Implosive Therapy/methods
Military Personnel/psychology
Psychotherapy/methods
Stress Disorders, Post-Traumatic/therapy
[Mh] MeSH terms secundary: Adult
Afghan Campaign 2001-
Female
Humans
Iraq War, 2003-2011
Linear Models
Male
Severity of Illness Index
Time Factors
[Pt] Publication type:COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T; RESEARCH SUPPORT, U.S. GOV'T, NON-P.H.S.
[Em] Entry month:1801
[Cu] Class update date: 180311
[Lr] Last revision date:180311
[Js] Journal subset:AIM; IM
[Da] Date of entry for processing:180125
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.21242

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[PMID]: 29188292
[Au] Autor:Santavirta T; Santavirta N; Gilman SE
[Ad] Address:Institute for Housing and Urban Research, Uppsala University and Swedish Institute for Social Research, Stockholm University, Uppsala, Sweden.
[Ti] Title:Association of the World War II Finnish Evacuation of Children With Psychiatric Hospitalization in the Next Generation.
[So] Source:JAMA Psychiatry;75(1):21-27, 2018 Jan 01.
[Is] ISSN:2168-6238
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Importance: Although there is evidence that adverse childhood experiences are associated with worse mental health in adulthood, scarce evidence is available regarding an emerging concern that the next generation might also be affected. Objective: To compare the risk of psychiatric hospitalization in cousins whose parents were vs were not exposed to the Finnish evacuation policy that involved a mean 2-year stay with a Swedish foster family. Design, Setting, and Participants: This multigenerational, population-based cohort study of Finnish individuals and their siblings born between January 1, 1933, and December 31, 1944, analyzed the association of evacuee status as a child during World War II in the first generation with the risk of psychiatric hospitalization among offspring in the second generation. Evacuee status during World War II was determined using the Finnish National Archive's registry of participants in the Finnish evacuation. Data on evacuee status were linked to the psychiatric diagnoses in the Finnish Hospital Discharge Register from January 1, 1971, through December 31, 2012, for offspring (n = 93 391) born between January 1, 1950, and December 31, 2010. Sex-specific Cox proportional hazards regression models were used to estimate hazard ratios for risk of psychiatric hospitalization during the follow-up period. Because offspring of evacuees and their nonevacuated siblings are cousins, the Cox proportional hazards regression models included fixed effects to adjust for confounding factors in families. Data analysis was performed from June 15, 2016, to August 26, 2017. Exposures: Parental participation in the evacuation during World War II (coded 1 for parents who were evacuated and placed in foster care and 0 for those not evacuated). Main Outcomes and Measures: Offspring's initial admission to the hospital for a psychiatric disorder, obtained from the Finnish Hospital Discharge Register from January 1, 1971, through December 31, 2012. Results: Of the 93 391 study persons, 45 955 (49.2%) were women and 47 436 (50.8) were men; mean (SD) age in 2012 among survivors was 45.4 (6.58) years. Female offspring of mothers evacuated to Sweden during childhood had an elevated risk of psychiatric hospitalization (hazard ratio for any type of psychiatric disorder: 2.04 [95% CI, 1.04-4.01]; hazard ratio for mood disorder: 4.68 [95% CI, 1.92-11.42]). There was no excess risk of being hospitalized for a psychiatric disorder among women whose fathers were exposed to the Finnish evacuation policy during World War II or among men whose mothers or fathers were exposed. Conclusions and Relevance: In a prior follow-up study of the Finnish evacuees, girls evacuated to Swedish foster families during World War II were more likely to be hospitalized for a psychiatric disorder-in particular, a mood disorder-in adulthood than their nonevacuated sisters. The present study found that the offspring of these individuals were also at risk for mental health problems that required hospitalization and suggests that early-life adversities, including war-related exposures, may be associated with mental health disorders that persist across generations.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180311
[Lr] Last revision date:180311
[St] Status:In-Data-Review
[do] DOI:10.1001/jamapsychiatry.2017.3511

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[PMID]: 29510752
[Au] Autor:Quinn V JM; Amouri OF; Reed P
[Ad] Address:Prague Center for Global Health, Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University, Studnickova 7, 121 00, Praha, Czech Republic. john.quinn@lf1.cuni.cz.
[Ti] Title:Notes from a field hospital south of Mosul.
[So] Source:Global Health;14(1):27, 2018 Mar 06.
[Is] ISSN:1744-8603
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:This short letter from the field is offered as a rapid communiqué of the emergency medical situation in Mosul and surrounding areas on the eve of the final onslaught to liberate the city. This letter is based on emergency medical work at two World Health Organization (WHO) and Ministry of Health (MoH) Iraq lead Role II+ Field Hospital facilities south of Mosul City from April to June 2017; these facilities are currently and temporarily managed and administered by private medical industry until full handover to MoH Iraq, with WHO support and expert facilitation. The prominence of non-state actors in the conflict, using hybrid warfare tactics that maximize casualties, makes health security a particular challenge for the global community. This challenge requires health leaders and other actors in the region to set clear strategic goals that support public health of the many millions displaced, maimed and affected by the war. Whether in clinical medicine, development, peace and stability operations, or global health diplomacy, the shared values and conviction to best serve vulnerable communities and mitigate morbidity must embrace the lessons of evidenced based practice derived from military medical experience. WHO is leading the charge in disaster response for the conflict in Iraq, and many challenges remain. This might also include developing a new process in emergency medical response that utilizes private contracting to improve efficiency in delivery and overall sustainability.
[Pt] Publication type:LETTER
[Em] Entry month:1803
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:In-Data-Review
[do] DOI:10.1186/s12992-018-0346-9

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[PMID]: 29509587
[Au] Autor:Spittal PM; Malamba SS; Ogwang MD; Musisi S; Ekwaru JP; Sewankambo NK; Pearce ME; Jongbloed K; Patel SH; Katamba A; Blair AH; Muyinda H; Schechter Obc MT
[Ad] Address:School of Population and Public Health, University of British Columbia, Vancouver, Canada BC Children's Hospital Research Institute, Vancouver, Canada.
[Ti] Title:Cango Lyec (Healing the Elephant): Gender differences in HIV infection in post-conflict Northern Uganda.
[So] Source:J Acquir Immune Defic Syndr;, 2018 Mar 02.
[Is] ISSN:1944-7884
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: As previously encamped resettle, potential for rapid HIV transmission in post-conflict Northern Uganda is concerning. Women in particular may be experiencing heightened vulnerability resulting from war-related sexual violence. SETTING: Cango Lyec (Healing the Elephant) Project is a cohort involving conflict-affected people in three districts in Northern Uganda. METHODS: Eight randomly selected communities were mapped and a census was conducted. Participants aged 13-49 years completed questionnaires in Luo on war-related experiences, mental health, sexual vulnerabilities, and socio-demographics. Blood samples were tested for HIV and syphilis. Baseline data from all sexually active participants was used to determine gender differences in HIV prevalence. Multivariate modeling determined correlates of HIV by gender. RESULTS: Among 2008 participants, HIV prevalence was higher among women (17.2; 95%CI:14.7-19.7) compared to men (10.6; 95%CI:8.0-13.2, <0.001). Among women, correlates of HIV included: war-related sexual assault (AOR:1.95; 95%CI:1.16-3.26); probable depression (AOR:2.22; 95%CI:1.46-3.37); probable PTSD (AOR:2.03; 95%CI:1.45-2.84); experiencing ≥12 traumatic events (AOR:2.04; 95%CI:1.31-3.18); suicide ideation (AOR:1.67; 95%CI:1.22-2.28); living in a female-headed household (AOR:2.76; 95%CI:1.70-4.49); first sexual partner ≥10 years older (AOR:1.69; 95%CI:1.07-2.67); sex exchange (AOR:5.51; 95%CI:1.76-17.31); having 2 (AOR:2.54; 95%CI:1.23-5.23) or 3+ (AOR:4.65; 95%CI:2.65-8.18) sexual partners; inconsistent condom use (AOR:0.40; 95%CI:0.29-0.57); genital ulcers (AOR:3.08; 95%CI:2.16-4.38); active syphilis (AOR:4.33; 95%CI:1.22-15.40); and ill health without medical care (AOR:2.02; 95%CI:1.22-3.34). Among men, correlates of HIV included no condom at sexual debut (AOR:1.92; 95%CI:1.30-2.83) and genital ulcers (AOR:4.40; 95%CI:1.35-14.40). CONCLUSION: Women are disproportionately impacted by HIV, trauma, and depression in this conflict-affected population. Trauma-informed HIV prevention and culturally-safe mental health initiatives are urgently required.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:Publisher
[do] DOI:10.1097/QAI.0000000000001671

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[PMID]: 29388699
[Au] Autor:Samojlik T; Selva N; Daszkiewicz P; Fedotova A; Wajrak A; Kuijper DPJ
[Ad] Address:Mammal Research Institute, Polish Academy of Sciences, Stoczek 1c, 17-230, Bialowieza, Poland.
[Ti] Title:Lessons from Bialowieza Forest on the history of protection and the world's first reintroduction of a large carnivore.
[So] Source:Conserv Biol;, 2018 Feb 01.
[Is] ISSN:1523-1739
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Understanding how the relationships between large carnivores and humans have evolved and have been managed through centuries can provide relevant insights for wildlife conservation. The management history of many large carnivores has followed a similar pattern, from game reserved for nobility, to persecuted pests, to conservation targets. We reconstructed the history of brown bear (Ursus arctos) management in Bialowieza Forest (Poland and Belarus) based on a detailed survey of historical literature and Russian archives. From the end of the Middle Ages to the end of 18th century, the brown bear was considered "animalia superiora" (i.e., game exclusively reserved for nobility and protected by law). Bears, also a source of public entertainment, were not regarded as a threat. Effective measures to prevent damages to traditional forest beekeeping were already in practice. In the beginning of 19th century, new game-management approaches allowed most forest officials to hunt bears, which became the primary target of hunters due to their valuable pelt. This, together with an effective anticarnivore policy enhanced by bounties, led to bear extirpation in 1879. Different approaches to scientific game management appeared (planned extermination of predators and hunting levels that would maintain stable populations), as did the first initiatives to protect bears from cruel treatment in captivity. Bear reintroduction in Bialowieza Forest began in 1937 and represented the world's first reintroduction of a large carnivore motivated by conservation goals. The outbreak of World War II spoiled what might have been a successful project; reproduction in the wild was documented for 8 years and bear presence for 13. Soft release of cubs born in captivity inside the forest but freely roaming with minimal human contact proved successful. Release of captive human-habituated bears, feeding of these bears, and a lack of involvement of local communities were weaknesses of the project. Large carnivores are key components of ecosystem-function restoration, and site-specific histories provide important lessons in how to preserve them for the future.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher
[do] DOI:10.1111/cobi.13088

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[PMID]: 29521786
[Au] Autor:Featherstone PJ
[Ad] Address:John V Farman Intensive Care Unit, Addenbrooke's Hospital, Cambridge, UK.
[Ti] Title:Improvised Anesthesia, Surgery, and Resuscitation in Far East Prisoner of War Camps, 1942 to 1945.
[So] Source:Int Anesthesiol Clin;56(2):3-18, 2018.
[Is] ISSN:1537-1913
[Cp] Country of publication:United States
[La] Language:eng
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:In-Data-Review
[do] DOI:10.1097/AIA.0000000000000183

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[PMID]: 29521172
[Au] Autor:Shama G
[Ad] Address:Department of Chemical Engineering, Loughborough University, Loughborough, UK.
[Ti] Title:Hans Enoch and vivicillin.
[So] Source:J Med Biogr;:967772018764001, 2018 Jan 01.
[Is] ISSN:1758-1087
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:Hans Emmanuel Enoch (1896-1991) was born in Hamburg, the son of a manufacturer of sera and vaccines. Upon his father's death, he took charge of the Hamburg Serum Werke. Following the rise of Hitler, he came to be pilloried in the Nazi press for allegedly having poisoned the population of Hamburg and was imprisoned for a time. He immigrated to England in 1935 where he had secured a position with the International Serum Company in Norwich. Following the outbreak of war, he was interned as an enemy alien, eventually ending up in Canada. In 1941, he was permitted to return to England, but wartime conditions prevented him from continuing to manufacture sera. At about this time, penicillin was making the headlines, and coupled with accounts of its miraculous properties, was the news that all production was reserved exclusively for the armed forces. Enoch decided to meet the public clamour for penicillin by producing a crude version which he termed 'vivicillin.' News of this spread globally, and he came to incur the disdain of Howard Florey for the attendant publicity. Notwithstanding this, vivicillin was to prove itself effective and its use led to the saving of lives.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:Publisher
[do] DOI:10.1177/0967772018764001

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[PMID]: 29521159
[Au] Autor:Lahav Y; Siegel A; Solomon Z
[Ad] Address:a I-Core Research Center for Mass Trauma , Tel-Aviv University , Tel-Aviv , Israel.
[Ti] Title:Twofold trauma exposure - the dual function of attachment avoidance.
[So] Source:Attach Hum Dev;:1-18, 2018 Mar 09.
[Is] ISSN:1469-2988
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:Spouses of traumatized war veterans might suffer from distress following indirect exposure to combat and direct exposure to domestic abuse. Yet the effect of this twofold trauma exposure is far from being fully understood. Theory views attachment security as a personal resource mitigating adversity, whereas attachment insecurities intensify distress. Nevertheless, there are mixed results concerning the effects of attachment in the aftermath of trauma. Furthermore, the role of trauma exposure levels regarding the effects of attachment remains largely uninvestigated. Filling these gaps, this study assessed female military spouses 30 (T1) and 38 (T2) years after the 1973 Yom Kippur War. Direct (domestic abuse) and indirect (veteran partners' posttraumatic stress symptoms) trauma exposure, attachment, depression, and anxiety were assessed. Findings indicated an interaction between the trauma types in predicting spouses' anxiety. Domestic abuse moderated the relations between attachment and distress. Although attachment anxiety had nonsignificant effects on anxiety among low-level domestic abuse sufferers, it predicted elevated anxiety among high-level domestic abuse sufferers. Furthermore, while attachment avoidance predicted elevated distress among low-level domestic abuse sufferers, its effects dissolved or became positive in nature among high-level domestic abuse sufferers. Discussion focuses on evolutionary explanations of the functions of attachment under different conditions of threat.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:Publisher
[do] DOI:10.1080/14616734.2018.1448998

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[PMID]: 29520702
[Au] Autor:Connolly CJD
[Ad] Address:USS George H W Bush (CVN 77), Unit 100331 Box 2304 CRMD, FPO, AE, 09513, USA. john.connolly@cvn77.navy.mil.
[Ti] Title:The Just War Tradition: A Model for Healthcare Ethics.
[So] Source:HEC Forum;, 2018 Mar 08.
[Is] ISSN:1572-8498
[Cp] Country of publication:Netherlands
[La] Language:eng
[Ab] Abstract:Healthcare ethics committees, physicians, surgeons, nurses, families, and patients themselves are constantly under pressure to make appropriate medically ethical decisions concerning patient care. Various models for healthcare ethics decisions have been proposed throughout the years, but by and large they are focused on making the initial ethical decision. What follows is a proposed model for healthcare ethics that considers the most appropriate decisions before, during, and after any intervention. The Just War Tradition is a model that is thorough in its exploration of the ethics guiding a nation to either engage in or refuse to engage in combatant actions. In recent years, the Just War Tradition has expanded beyond the simple consideration of going to war or not to include how the war is conducted and what the post-war phase would look like ethically. This paper is an exploration of a healthcare ethics decision making model using the tenets of the Just War Tradition as a framework. It discusses the initial consult level of decision making prior to any medical intervention, then goes further in considering the ongoing ethical paradigm during medical intervention and post intervention. Thus, this proposal is a more holistic approach to healthcare ethics decision making that encourages healthcare ethics committees to consider alternate models and ways of processing so that ultimately what is best for patient, family, staff, and the environment is all taken into consideration.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:Publisher
[do] DOI:10.1007/s10730-018-9348-5


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