Pain medicine : the official journal of the American Academy of Pain Medicine
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Principle-based ethical theory is currently available to guide health care professionals in clinical decision-making when they face ethical dilemmas. These principles include respect for autonomy (RA), nonmaleficence (NM), beneficence (B), and distributive justice. It is, however,unknown which principles, if any, guide physicians and nurses in this decision-making. The goal of our study was to explore how anesthesiologists, surgeons, nurses, and nurse anesthetists reason in the face of a moral dilemma. ⋯ Anesthesiologists tend to transfuse Jehovah’s Witness patients more than did the others. Together with surgeons, they explicitly justify their decision-making less frequently when compared with nurses and nurse anesthetists. Further education in ethical theory is appreciated and needed.
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Review Meta Analysis
Efficacy and safety of mu-opioid antagonists in the treatment of opioid-induced bowel dysfunction: systematic review and meta-analysis of randomized controlled trials.
Opioid-induced bowel dysfunction (OBD) is characterized by constipation, incomplete evacuation, bloating, and increased gastric reflux. OBD occurs both acutely and chronically, in multiple disease states, resulting in increased morbidity and reduced quality of life. ⋯ Insufficient evidence exists for the safety or efficacy of naloxone or nalbuphine in the treatment of OBD. Long-term efficacy and safety of any of the opioid antagonists is unknown, as is the incidence or nature of rare adverse events. Alvimopan and methylnaltrexone both show promise in treating OBD, but further data will be required to fully assess their place in therapy.
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Review
Painful diabetic neuropathy: epidemiology, natural history, early diagnosis, and treatment options.
To facilitate the clinician's understanding of the basis and treatment of painful diabetic neuropathy (PDN). ⋯ A better understanding of the peripheral and central mechanisms resulting in PDN is likely to promote the development of more targeted and effective treatment.
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Comparative Study
Physicians charged with opioid analgesic-prescribing offenses.
To provide a "big picture" overview of the characteristics and outcomes of recent criminal and administrative cases in which physicians have been criminally prosecuted or charged by medical boards with offenses related to inappropriate prescribing of opioid analgesics. ⋯ Criminal or administrative charges and sanctions for prescribing opioid analgesics are rare. In addition, there appears to be little objective basis for concern that pain specialists have been "singled out" for prosecution or administrative sanctioning for such offenses.