Cultural Relativism in the Age of Modernity: Are Human Rights Still up for Debate?

Modernity has given rise to the state as the primary unit in international relations moving away from the primacy of more traditional units such as the clergy, family, etc. Given this shift, the protections offered by these traditional units for individuals have shifted to the responsibility of the state. However, these protections are not a given. Individual rights can be compromised by the state for its overall benefit as states work to maintain and increase power in a globalized world. The concept of human rights has been a response to the primacy of the state, outlining what the state should not do to its citizens and what it is compelled to provide. Though most states have embraced modernity when it comes to the primacy of the state and globalized markets, many have not been so quick to implement human rights. Some leaders argue that these rights are an invasion of their sovereignty and impose Western values that don\u27t fit in with their own cultures. While cultural arguments can be valid, they can also be used by human rights violators as an excuse not to implement human rights norms. While the facets of modernity (the strong state, globalization and capitalism) that benefit elites are readily accepted, the response to that same modernity (human rights) is sometimes rejected as a form of Western imperialism. Various non-Western states many embraced some parts of modernity while rejecting others. Cultural relativism is often the reason for their rejection of human rights but sometimes it is just an excuse. China, Ghana, Iran and Japan all have embraced the modern international community as far as economics and global markets. However, some of these countries have issues with human rights abuses. How true are these arguments of cultural relativism given these states\u27 embrace of other aspects of modernity

HIV and respiratory illness in the antiretroviral therapy era

Respiratory illness is a common manifestation of HIV infection. The availability of effective antiretroviral therapy (ART) has changed the pattern of respiratory ill-health experienced by people living with HIV (PLWH). Among populations with good access to ART, opportunistic respiratory infections such as Pneumocystis jirovecii pneumonia (PCP) are becoming less frequent. However, there is evidence to suggest that these populations may be at greater risk of serious non-AIDS illness including chronic respiratory disease. Although there is remaining uncertainty about the extent to which HIV represents an independent risk-factor for respiratory illness in individuals with a suppressed HIV viral load and immune reconstitution, in many settings PLWH have greater exposure to risk factors for respiratory illness (in particular tobacco smoking), which contribute to this burden of disease. As HIV-positive populations age, management of these conditions will therefore become increasingly important. Healthcare services need to manage this growing burden of chronic respiratory illness and provide access to preventative measures including smoking cessation and immunisation against vaccine-preventable respiratory infections in a way that is appropriate to the populations served

Integrated diagnostic pathway for patients referred with suspected OSA: a model for collaboration across the primary-secondary care interface

BACKGROUND: Obstructive sleep apnoea (OSA) presents a major healthcare challenge with current UK data suggesting that only 22% of individuals have been diagnosed and treated. Promoting awareness and improving access to diagnostics are fundamental in addressing these missing cases and the recognised complications associated with untreated OSA. Diagnosis usually occurs in secondary care with data from our trust revealing long wait times to undertake tests, reach a diagnosis and start treatment. This places a considerable time and emotional burden on the patient and a financial and logistical burden on the hospital. METHODS: We introduced an integrated community-based pathway for the diagnosis of OSA. This comprised a monthly clinic run from within a local general practice (GP) supported by a 'virtual multidisciplinary team' run by the hospital specialist team. Prospective collection of process, outcome and patient satisfaction data was compared with traditional hospital-based pathway data collected retrospectively. SETTING: A central London teaching hospital and GPs within a local commissioning neighbourhood. RESULTS: Between January 2018 and February 2019, 70 were patients referred and managed along the community pathway. Compared with the hospital pathway, data demonstrated a significant reduction in the time taken: from referral to perform a sleep test (29 vs 181 days, p<0.0001), to make a diagnosis (40 vs 230 days, p<0.0001) and commence treatment (127 vs 267, p<0.0001). Patient satisfaction in the community pathway was higher across all domains (p<0.05), fewer hospital outpatient appointments were required and cost estimates suggested an overall saving of up to £290 could be achieved for each patient. CONCLUSION: An integrated community-based pathway results in more timely diagnosis of OSA within a local setting while maintaining specialist input from the hospital team. It is favoured by patients and can reduce unnecessary appointments in secondary care

Current treatment strategies in managing side effects associated with domiciliary positive airway pressure (PAP) therapy for patients with sleep disordered breathing: A systematic review and meta-analysis

Sleep disordered breathing is commonly treated with positive airway pressure therapy. Positive airway pressure therapy is delivered via a tight-fitting mask with common side effects including: leak, ineffective treatment, residual sleep disordered breathing, eye irritation, nasal congestion, pressure ulcers and poor concordance with therapy. This systematic review and meta-analysis aimed to identify the effectiveness of current treatment strategies for managing side effects associated with positive airway pressure therapy. Five databases were searched and 10,809 articles were screened, with 36 articles included in the review. Studies investigated: dressings, nasal spray/douche, chin straps, heated humidification and interfaces. No intervention either improved or detrimentally affected: positive airway pressure concordance, Epworth Sleepiness Score, residual apnoea hypopnea index or interface leak. The review was limited by study heterogeneity, particularly for outcome measures. Additionally, patient demographics were not reported, making it difficult to apply the findings to a broad clinical population. This review highlights the paucity of evidence supporting treatment strategies to manage side effects of positive airway pressure therapy

Dental management considerations for the patient with an acquired coagulopathy. Part 1: Coagulopathies from systemic disease

Current teaching suggests that many patients are at risk for prolonged bleeding during and following invasive dental procedures, due to an acquired coagulopathy from systemic disease and/or from medications. However, treatment standards for these patients often are the result of long-standing dogma with little or no scientific basis. The medical history is critical for the identification of patients potentially at risk for prolonged bleeding from dental treatment. Some time-honoured laboratory tests have little or no use in community dental practice. Loss of functioning hepatic, renal, or bone marrow tissue predisposes to acquired coagulopathies through different mechanisms, but the relationship to oral haemostasis is poorly understood. Given the lack of established, science-based standards, proper dental management requires an understanding of certain principles of pathophysiology for these medical conditions and a few standard laboratory tests. Making changes in anticoagulant drug regimens are often unwarranted and/or expensive, and can put patients at far greater risk for morbidity and mortality than the unlikely outcome of postoperative bleeding. It should be recognised that prolonged bleeding is a rare event following invasive dental procedures, and therefore the vast majority of patients with suspected acquired coagulopathies are best managed in the community practice setting

Improved Mortality But Increased Economic Burden of Disease in Compensated and Decompensated Cirrhosis: A US National Perspective

INTRODUCTION: Cirrhosis remains a major burden on the health care system despite substantial advances in therapy and care. Studies simultaneously examining mortality, readmission, and cost of care are not available. Here, we hypothesized that improved patient care in the last decade might have led to improved outcomes and reduced costs in patients with cirrhosis. MATERIALS AND METHODS: We identified compensated cirrhosis (CC) and decompensated cirrhosis (DC) patients using carefully chosen ICD-9/ICD-10 codes from the Nationwide Readmission Database (NRD) (years 2010 to 2016). We evaluated trends of 30-day all-cause mortality, 30-day readmission, and inflation-adjusted index hospitalization and readmission costs. Factors associated with mortality and readmission were identified using regression analyses. RESULTS: A total of 3,374,038 patients with cirrhosis were identified, of whom nearly 50% had a decompensating event on initial admission. The 30-day inpatient mortality rate for both CC and DC patients decreased from 2010 to 2016. The 30-day readmission rate remained stable for DC and declined for CC. Over the study period, 30-day readmission costs increased for DC and remained unchanged for CC. The median cost for index hospitalization remained nearly unchanged, but the cost of readmission increased for both CC and DC groups. Gastrointestinal diseases and infections were the leading cause of readmission in CC and DC patient groups. CONCLUSION: Inpatient mortality has decreased for CC and DC patients. Readmission has declined for CC patients and remained stable for DC patients. However, the economic burden of cirrhosis is rising

Accuracy and usability of AcuPebble SA100 for automated diagnosis of obstructive sleep apnoea in the home environment setting: an evaluation study

Objectives Obstructive sleep apnoea (OSA) is a heavily underdiagnosed condition, which can lead to significant multimorbidity. Underdiagnosis is often secondary to limitations in existing diagnostic methods. We conducted a diagnostic accuracy and usability study, to evaluate the efficacy of a novel, low-cost, small, wearable medical device, AcuPebble_SA100, for automated diagnosis of OSA in the home environment. Settings Patients were recruited to a standard OSA diagnostic pathway in an UK hospital. They were trained on the use of type-III-cardiorespiratory polygraphy, which they took to use at home. They were also given AcuPebble_SA100; but they were not trained on how to use it. Participants 182 consecutive patients had been referred for OSA diagnosis in which 150 successfully completed the study. Primary outcome measures Efficacy of AcuPebble_SA100 for automated diagnosis of moderate–severe-OSA against cardiorespiratory polygraphy (sensitivity/specificity/likelihood ratios/predictive values) and validation of usability by patients themselves in their home environment. Results After returning the systems, two expert clinicians, blinded to AcuPebble_SA100’s output, manually scored the cardiorespiratory polygraphy signals to reach a diagnosis. AcuPebble_SA100 generated automated diagnosis corresponding to four, typically followed, diagnostic criteria: Apnoea Hypopnoea Index (AHI) using 3% as criteria for oxygen desaturation; Oxygen Desaturation Index (ODI) for 3% and 4% desaturation criteria and AHI using 4% as desaturation criteria. In all cases, AcuPebble_SA100 matched the experts’ diagnosis with positive and negative likelihood ratios over 10 and below 0.1, respectively. Comparing against the current American Academy of Sleep Medicine’s AHI-based criteria demonstrated 95.33% accuracy (95% CI (90·62% to 98·10%)), 96.84% specificity (95% CI (91·05% to 99·34%)), 92.73% sensitivity (95% CI (82·41% to 97·98%)), 94.4% positive-predictive value (95% CI (84·78% to 98·11%)) and 95.83% negative-predictive value (95% CI (89·94% to 98·34%)). All patients used AcuPebble_SA100 correctly. Over 97% reported a strong preference for AcuPebble_SA100 over cardiorespiratory polygraphy. Conclusions These results validate the efficacy of AcuPebble_SA100 as an automated diagnosis alternative to cardiorespiratory polygraphy; also demonstrating that AcuPebble_SA100 can be used by patients without requiring human training/assistance. This opens the doors for more efficient patient pathways for OSA diagnosis