Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
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Otolaryngol Head Neck Surg · Aug 2008
ReviewMaking difficult ethical decisions in patient care during natural disasters and other mass casualty events.
Recent experiences in the United States with unprecedented terrorist attacks (9/11) and a devastating natural disaster (Hurricane Katrina) have demonstrated that the medical care of mass casualties during such disasters poses ethical problems not normally experienced in civilian health care. It is important to 1) identify the unique ethical challenges facing physicians who feel an obligation to care for victims of such disasters and 2) develop a national consensus on ethical guidelines as a resource for ethical decision making in medical disaster relief. ⋯ It is necessary to develop a national consensus on the ethical guidelines for physicians who care for patients, victims, and casualties of disasters, and to formulate a virtue-based, yet practical, ethical approach to medical care under such extreme conditions. An educational curriculum for medical students, residents, and practicing physicians is required to best prepare all physicians who might be called upon, in the future, to triage patients, allocate resources, and make difficult decisions about treatment priorities and comfort care. It is not appropriate to address these questions at the time of the disaster, but rather in advance, as part of the ethics education of the medical profession. Important issues for resolution include inpatient and casualty triage and prioritization, medical liability, altered standards of care, justice and equity, informed consent and patient autonomy, expanding scope of practice in disaster medicine, and the moral and ethical responsibilities of physicians to care for disaster victims.
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Otolaryngol Head Neck Surg · Jul 2008
Historical ArticleA brief history of medicine's Hippocratic Oath, or how times have changed.
Medicine has experienced many changes over the last three thousand years and surprisingly, the good and the bad of these changes can be found in the evolution of the wording of the Hippocratic Oath. This commentary reveals why the original Oath became a part of modern medicine's rite of passage and how society is now changing the very reason that the Hippocratic Oath was brought into the world of medical ethics. By examining the modern language of the Oath, it is possible to understand how these words have diluted its meaning and intent. The long-term consequences of these changes cannot be foreseen, but history has shown what can happen without a strong oath to guide the practitioner.
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Otolaryngol Head Neck Surg · Jul 2008
Impact of newly revised sterile medication compounding guidelines USP {797} on allergy vial preparation.
To highlight newly revised guidelines on sterile medication compounding released by the United States Pharmacopeia (USP 797) in December 2007, and the implications on immunotherapy vial preparation. ⋯ Offices preparing immunotherapy vials should consider formalizing and implementing vial preparation guidelines. These guidelines should be based on expert opinion, experience, and scientific literature.
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Otolaryngol Head Neck Surg · Jul 2008
Polysomnographic outcome of adenotonsillectomy for obstructive sleep apnea in children under 5 years old.
To determine success rates after adenotonsillectomy for obstructive sleep apnea (OSA); postoperative polysomnogram (PSG) results were compared with preoperative results in children younger than 5 years. ⋯ On PSG criteria, most children with OSA significantly improved after adenotonsillectomy, but a number had persisting abnormalities. Postoperative PSG should be considered to identify unresolved OSA.