MedGenMed : Medscape general medicine
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Secondary aortoenteric fistula (SAF) is an uncommon but very important complication of abdominal aortic reconstruction. The complication often occurs months to years after aortic surgery. The clinical manifestation of the aortoenteric fistula is always upper gastrointestinal bleeding. ⋯ The patient did well after the surgical management. Because of the increasing number of elective aortic aneurysm repairs in the aging population, it is likely that more patients with secondary aortoenteric fistula will present to the clinical physicians in the future. So, a high index of suspicion is necessary for prompt diagnosis and treatment of this life-threatening event.
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Many chaplains and most chaplaincy programs in the United States--with encouragement from their accrediting organization, the Association for Clinical Pastoral Education (ACPE)--have begun to assume a more proactive stance toward patients, healthcare professionals, and healthcare facilities. Some chaplains and chaplaincy programs have begun to engage in activities that have ranged from initiating conversations with and perusing the medical records of patients who have not requested their services to proposing that they be permitted to do "spiritual assessments" on patients--in some instances whether these patients have been explicitly informed and have agreed to this beforehand. ⋯ It would appear that such novel activities are being justified by a questionable set of claims and assumptions that includes: (1) the claim that chaplains have a spiritual--as opposed to purely religious--expertise that entitles them to interact with patients and/or significant others (even those who have not requested a chaplain)--presumably without in the least compromising patient autonomy or the confidentiality of the patient/healthcare professional relationship; (2) the assumption that the terms "spirituality" and "religiosity" mutually entail one another; (3) the claim that the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) mandates "spiritual assessments" (which it does not); (4) the assumption that chaplains are full-fledged members of the healthcare team; and (5) the claim that chaplains must, therefore, be permitted access to patients and patients' medical records both to gather information and to make notations of their own. We consider such claims and assumptions disquieting, and suggest that it is high time we revisit the terms "chaplaincy," "healthcare professional," and "member of the healthcare team" in reassessing what our professional commitments to respect and protect the bio-psycho-social integrity of patients require.