Navigating Ethics of Physician-Patient Confidentiality: A Communication Privacy Management Analysis

The ethics of physician-patient confidentiality is often fraught with contradictions. Privacy boundaries are not always clear, and patients can leave an interaction with their physicians feeling uncomfortable about the security of their private medical information. The best way to meet confidentiality and privacy management expectations that patients have may not be readily apparent. Without realizing it, a physician may communicate a patient's information in ways that are inconsistent with that person's perceptions of how his/her medical information should be treated. A proposed model is presented as a tool for physicians to better serve the privacy and confidentiality needs of their patients. This model depends on the communication privacy management (CPM) perspective that emerged from a 35-year research program investigating how people regulate and control information they consider private and confidential. A physician's use of this model enables the ability to establish a confidentiality pledge that can address issues in understanding the best way to communicate about privacy management with patients and more likely overcome potential negative outcomes

A description of approachable nurses: An exploratory study, the voice of the hospitalized child

Purpose: The 1989 Convention on the Rights of the Child drew international attention to the right of a child to be heard. Researchers have enhanced the child’s voice in many settings, albeit few in the hospital. Nurse researchers investigating the hospital experiences of children have identified positive and negative patterns of communication. Potential characteristics of an approachable nurse were hinted at, although none explored the concept of approachability. Design and methods: A qualitative, descriptive research design, including semi-structured interviews with seven school age children (ages 8-12, four girls and three boys) in a pediatric oncology service, was used to gain children’s perceptions and descriptions of approachable nurses. Drawings were used to supplement and glean a greater understanding of descriptive characteristics. All but one child had endured multiple hospitalizations related to their diagnosis of cancer. Interviews were recorded and data were content analyzed using immersion/crystallization and editing organizational styles. Results: The children had experiences with more than one approachable nurse and described approachable nurses as smiling and happy, playful, creative, competent and willing to talk and listen to them. Conclusion and practice implications: The school age children in this study were able to describe their perceptions of an approachable nurse. The voices of these children illuminate the importance of nurses’ words and behaviors and provide exemplars of approachable nurses. It can be argued that the responsibility remains with nurses to create an environment where in hospitalized children feel their voices are heard, they are understood and respected with unprecedented dignity

Surrogate Decision Makers and Proxy Ownership: Challenges of Privacy Management in Health Care Decision Making

This study explored the communicative experiences of surrogates who served as decision makers for patients who were unable to convey health information and choices about treatment options. Drawing on assumptions from communication privacy management theory (Petronio, 2002), 35 surrogates were interviewed to explore how they navigated the role of guardian of patients’ private health information while the patient was hospitalized. This research determined that not only are surrogates guardians and thereby co-owners of the patients’ private health information, they actually served in a “proxy ownership” role. Surrogates described obstacles to both obtaining and sharing private health information about the patient, suggesting that their rights as legitimate co-owners of the patients’ information were not fully acknowledged by the medical teams. Surrogates also described challenges in performing the proxy ownership role when they were not fully aware of the patient’s wishes. Theoretical and practical implications of these challenges are discussed

Noncyclic covers of knot complements

Hempel has shown that the fundamental groups of knot complements are residually finite. This implies that every nontrivial knot must have a finite-sheeted, noncyclic cover. We give an explicit bound, $\Phi (c)$, such that if $K$ is a nontrivial knot in the three-sphere with a diagram with $c$ crossings and a particularly simple JSJ decomposition then the complement of $K$ has a finite-sheeted, noncyclic cover with at most $\Phi (c)$ sheets.Comment: 29 pages, 8 figures, from Ph.D. thesis at Columbia University; Acknowledgments added; Content correcte

Degenerations of ideal hyperbolic triangulations

Let M be a cusped 3-manifold, and let T be an ideal triangulation of M. The deformation variety D(T), a subset of which parameterises (incomplete) hyperbolic structures obtained on M using T, is defined and compactified by adding certain projective classes of transversely measured singular codimension-one foliations of M. This leads to a combinatorial and geometric variant of well-known constructions by Culler, Morgan and Shalen concerning the character variety of a 3-manifold.Comment: 31 pages, 11 figures; minor changes; to appear in Mathematische Zeitschrif

Two-sided combinatorial volume bounds for non-obtuse hyperbolic polyhedra

We give a method for computing upper and lower bounds for the volume of a non-obtuse hyperbolic polyhedron in terms of the combinatorics of the 1-skeleton. We introduce an algorithm that detects the geometric decomposition of good 3-orbifolds with planar singular locus and underlying manifold the 3-sphere. The volume bounds follow from techniques related to the proof of Thurston's Orbifold Theorem, Schl\"afli's formula, and previous results of the author giving volume bounds for right-angled hyperbolic polyhedra.Comment: 36 pages, 19 figure

A meta-analysis of MitraClip combined with medical therapy vs. medical therapy alone for treatment of mitral regurgitation in heart failure patients

Aims: Survival benefit of percutaneous mitral valve repair with the MitraClip over conservative treatment of functional mitral regurgitation (MR) remains unclear. The purpose of this meta-analysis is to compare survival outcomes of MitraClip with those of medical therapy in patients with functional MR. Methods and results: A comprehensive literature search of PubMed, MEDLINE, and Google Scholar was conducted including studies evaluating MitraClip vs. medical therapy with multivariate adjustment and with >80% of patients with functional MR. Death from any cause was the primary endpoint, while freedom from readmission was the secondary one, evaluated with random effects. These analyses were performed at study level and at patient level including only functional MR when available, evaluating the effect of MitraClip in different subgroups according to age, ischaemic aetiology, presence of implantable cardioverter defibrillator/cardiac resynchronization therapy, and left ventricular ejection fraction and volumes. We identified six eligible observational studies including 2121 participants who were treated with MitraClip (n = 833) or conservative therapy (n = 1288). Clinical follow-up was documented at a median of 400 days. At study-level analysis, MitraClip, when compared with medical therapy (P = 0.005), was associated with significant reduction of death (P = 0.002) and of readmission due to cardiac disease. At patient-level analysis, including 344 patients, MitraClip confirmed robust survival benefit over medical therapy for all patients with functional MR and among the most important subgroups. Conclusions: Compared with conservative treatment, MitraClip is associated with a significant survival benefit. Importantly, this superiority is particularly pronounced among patients with functional MR and across all the main subgroups

Living together apart: Perceived concealment as signal of exclusion in marital relationships

This article examines how perceiving concealment in close relationships influences marital well-being. It suggests that the perception of concealment from a partner signals separateness from one's partner and contributes to feelings of perceived partner exclusion. These feelings of exclusion, in turn, should negatively affect relational quality. These predictions are tested in a prospective study among 199 newlywed couples. Results suggest that perceiving concealment reduced marital adjustment and trust and increased conflict over time. Importantly, change in perceived partner exclusion mediated these effects. This article demonstrates that the perception of concealment (a) has deleterious effects on relational well-being in the long run and (b) is harmful in part because it elicits feelings of exclusion. © 2009 by the Society for Personality and Social Psychology, Inc

Triangulated Surfaces in Twistor Space: A Kinematical Set up for Open/Closed String Duality

We exploit the properties of the three-dimensional hyperbolic space to discuss a simplicial setting for open/closed string duality based on (random) Regge triangulations decorated with null twistorial fields. We explicitly show that the twistorial N-points function, describing Dirichlet correlations over the moduli space of open N-bordered genus g surfaces, is naturally mapped into the Witten-Kontsevich intersection theory over the moduli space of N-pointed closed Riemann surfaces of the same genus. We also discuss various aspects of the geometrical setting which connects this model to PSL(2,C) Chern-Simons theory.Comment: 35 pages, references added, slightly revised introductio