Medical Ethics in Qiṣāṣ (Eye-for-an-Eye) Punishment: An Islamic View; an Examination of Acid Throwing

Physicians in Islamic countries might be requested to participate in the Islamic legal code of qiṣāṣ, in which the victim or family has the right to an eye-for-an-eye retaliation. Qiṣāṣ is only used as a punishment in the case of murder or intentional physical injury. In situations such as throwing acid, the national legal system of some Islamic countries asks for assistance from physicians, because the punishment should be identical to the crime. The perpetrator could not be punished without a physician’s participation, because there is no way to guarantee that the sentence would be carried out without inflicting more injury than the initial victim had suffered. By examining two cases of acid throwing, this paper discusses issues related to physicians’ participation in qiṣāṣ from the perspective of medical ethics and Islamic Shari’a law. From the standpoint of medical ethics, physicians’ participation in qiṣāṣ is not appropriate. First, qiṣāṣ is in sharp contrast to the Hippocratic Oath and other codes of medical ethics. Second, by physicians’ participation in qiṣāṣ, medical practices are being used improperly to carry out government mandates. Third, physician participation in activities that cause intentional harm to people destroys the trust between patients and physicians and may adversely affect the patient–physician relationship more generally. From the standpoint of Shari’a, there is no consensus among Muslim scholars whether qiṣāṣ should be performed on every occasion. We argue that disallowing physician involvement in qiṣāṣ is necessary from the perspectives of both medical ethics and Shari’a law

What should accountable care organizations learn from the failure of health maintenance organizations? A theory based systematic review of the literature

Background: Health Maintenance Organization (HMO), were once viewed as the most cost-effective model for achieving such efficient high-quality health care. A decade after the decline of HMOs a similar idea evolves and continues to proliferate under the rubric of Accountable Care Organizations (ACOs).Methods: We performed a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses to identify the reasons for the decline of HMOs, with the ultimate goal of extrapolating findings from HMOs experiences onto ACOs. We searched PubMed, Web of Science, and EMBASE to select original research and reports related to the decline of HMOs in the U.S. Using organizational evolving theory the contents of selected studies were analyzed and categorized according to common characteristics.Results: Although the decline of HMOs varies somewhat from case to case, it follows a fairly consistent pattern with similar causes. These factors were related to wrong ethos, mismanagement, failing to control costs, resistance from provider groups, increased competition, and inadequate IT infrastructure leading to patient dissatisfaction. Patient dissatisfaction in turn led to a managed care backlash, which stimulated the enactment of new restrictive legislation. Restrictive legislation not only negatively impacted the continued growth of HMOs but also accelerated the speed of their decline.Conclusion: ACOs should set realistic goals, align the incentives for physicians and hospitals via shared savings, use non-physician providers such as nurse practitioners, invest on health information technology, practice patient centered approach, make provider and patients accountable, use efficient management methods and improve care coordination

The efficacy and safety of ketamine for depression in patients with cancer: A systematic review

Management of depression in the oncology population includes supportive psychotherapeutic interventions with or without psychotropic medication, which take time to demonstrate effectiveness. Fast-acting interventions, like ketamine, can provide a rapid antidepressant effect; however, there has been limited research on effects of ketamine among cancer patients. The objective of this review is to provide an overview of research on the efficacy and safety of ketamine on depression in patients with cancer. We reviewed the published literature in MEDLINE® (via PubMed®), EMBASE, and Scopus from 1 January 1982 to 20 October 2022. We screened the retrieved abstracts against inclusion criteria and conducted a full-text review of eligible studies. Following extraction of data from included studies, we used a framework analysis approach to summarize the evidence on using ketamine in patients with cancer. All 5 included studies were randomized clinical trials conducted in inpatient settings in China. In all included studies ketamine was administered intravenously. Three studies used only racemic ketamine, and two studies used both S-ketamine and racemic ketamine. All included studies reported ketamine a tolerable and effective drug to control depression symptoms. Included studies showed administration of sub-anesthesia ketamine significantly improves postoperative depression among patients with cancer. [Abstract copyright: © 2023 The Author(s).

Factors Associated with Delay in Thrombolytic Therapy in Patients with ST-Elevation Myocardial Infarction

Background: Treatment delay in the management of ST-elevation myocardial infarction conversely correlates with prognosis and survival of the patients. This study aimed to investigate factors associated with delay in the thrombolytic therapy of these patients in Tehran. Methods: Between 2007 and 2010, the interval between the self-reported time of the onset of symptoms and initiation of the thrombolytic agent in 513 patients with a diagnosis of acute ST-elevation myocardial infarction was recorded. Medical history and socio-demographic characteristics of the patients treated within two hours after the onset of symptoms and patients treated after two hours from the onset of symptoms were compared, and the odds ratios were calculated using logistic regression. Results: The mean age of the patients was 61.2 (SD = 11.1) years, and 76% of the patients were male. The median time between the onset of symptoms and treatment was 158 (SD = 30.4) minutes. Mean for decision time was 61 (SD = 19), which was responsible for 83% of the entire treatment delay. The mean transportation time was 34 (SD = 12) minutes, and the median door-to-needle time was 44 minutes. Odds ratio for history of diabetes mellitus was 1.90 (95% CI: 1.26-2.87), for hypertension was 1.55 (95% CI: 1.08-2.23), and for prior coronary heart disease was 1.47 (95% CI: 1.17-1.84). Conclusion: The most important factor associated with delay in treatment was decision time. Improving emergency medical services dispatch time, obtaining pre-hospital electrocardiograms for early diagnosis, and pre-hospital initiation of thrombolytic therapy may reduce the delay time

Patient Satisfaction Is Associated With Dialysis Facility Quality and Star Ratings

The Dialysis Facility Compare Star Rating and the Quality Incentive Program (QIP) generate separate performance scores from clinical measures, and the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH-CAHPS) survey evaluates patient satisfaction across 6 separate domains related to nephrologists, dialysis facility, and information transmission. This study examined the relationship of the 3 measures for US clinics, modeling the 6 ICH-CAHPS domains as independent variables and QIP and star ratings as dependent variables. Among 3176 dialysis clinics, domains assessing dialysis facility and information transmission had a consistently stronger relationship with QIP and star ratings than the domains assessing nephrologists: QIP, β (95% CI) = 1.62 (1.26-1.97) for dialysis facility staff rating, 0.70 (0.35-1.05) for nephrologists; star rating, odds ratio (95% CI) = 1.38 (1.29-1.49) for dialysis facility staff rating, 1.17 (1.09-1.25) for nephrologists. Patient satisfaction is associated with dialysis care quality, with surprising differences between nephrologists and dialysis facilities

Sharing patient-generated data with healthcare providers: findings from a 2019 national survey.

OBJECTIVE: Our study estimates the prevalence and predictors of wearable device adoption and data sharing with healthcare providers in a nationally representative sample. MATERIALS AND METHODS: Data were obtained from the 2019 Health Information National Trend Survey. We conducted multivariable logistic regression to examine predictors of device adoption and data sharing. RESULTS: The sample contained 4159 individuals, 29.9% of whom had adopted a wearable device in 2019. Among adopters, 46.3% had shared data with their provider. Individuals with diabetes (odds ratio [OR], 2.39; 95% CI, 1.66-3.45; P \u3c .0001), hypertension (OR, 2.80; 95% CI, 2.12-3.70; P \u3c .0001), and multiple chronic conditions (OR, 1.55; 95% CI, 1.03-2.32; P \u3c .0001) had significantly higher odds of wearable device adoption. Individuals with a usual source of care (OR, 2.44; 95% CI, 1.95-3.04; P \u3c .0001), diabetes (OR, 1.66; 95% CI, 1.32-2.08; P \u3c .0001), and hypertension (OR, 1.78; 95% CI, 1.44-2.20; P \u3c .0001) had significantly higher odds of sharing data with providers. DISCUSSION: A third of individuals adopted a wearable medical device and nearly 50% of individuals who owned a device shared data with a provider in 2019. Patients with certain conditions, such as diabetes and hypertension, were more likely to adopt devices and share data with providers. Social determinants of health, such as income and usual source of care, negatively affected wearable device adoption and data sharing, similarly to other consumer health technologies. CONCLUSIONS: Wearable device adoption and data sharing with providers may be more common than prior studies have reported; however, digital disparities were noted. Studies are needed that test implementation strategies to expand wearable device use and data sharing into care delivery

How Health-Care Organizations Implement Shared Decision-Making When It Is Required for Reimbursement: The Case of Lung Cancer Screening

BACKGROUND: The Centers for Medicare and Medicaid Services stipulate shared decision-making (SDM) counseling as a prerequisite to lung cancer screening (LCS) reimbursement, despite well-known challenges implementing SDM in practice. RESEARCH QUESTION: How have health-care organizations implemented SDM for LCS? STUDY DESIGN AND METHODS: For this qualitative study, we used data from in-depth, semistructured interviews with key informants directly involved in implementing SDM for LCS, managing SDM for LCS, or both. We identified respondents using a snowball sampling technique and used template analysis to identify and analyze responses thematically. RESULTS: We interviewed 30 informants representing 23 health-care organizations located in 12 states and 4 Census regions. Respondents described two types of SDM for LCS programs: centralized models (n = 7), in which front-end practitioners (eg, primary care providers) referred patients to an LCS clinic where trained staff (eg, advanced practice nurses) delivered SDM at the time of screening, or decentralized models (n = 10), in which front-end practitioners delivered SDM before referring patients for screening. Some organizations used both models simultaneously (n = 6). Respondents discussed tradeoffs between SDM quality and access. They perceived centralized models as enhancing SDM quality, but limiting patient access to care, and vice versa. Respondents reported ongoing challenges with limited resources and budgetary constraints, ambiguity regarding what constitutes SDM, and an absence of benchmarks for evaluating SDM for LCS quality. INTERPRETATION: Those responsible for developing and managing SDM for LCS programs voiced concerns regarding both patient access and SDM quality, regardless of organizational context, or the SDM for LCS model implemented. The challenge facing these organizations, and those wanting to help patients and clinicians balance the tradeoffs inherent with LCS, is how to move beyond a check-box documentation requirement to a process that enables LCS to be offered to all high-risk patients, but used only by those who are informed and for whom screening represents a value-concordant service

Middle managers’ role in implementing evidence-based practices in healthcare: a systematic review

Abstract Background Middle managers are in a unique position to promote the implementation of evidence-based practices (EBPs) in healthcare organizations, yet knowledge of middle managers’ role in implementation and determinants (e.g., individual-, organizational-, and system-level factors) which influence their role remains fractured, spanning decades and disciplines. To synthesize understanding, we undertook a systematic review of studies of middle managers’ role in healthcare EBP implementation and determinants of that role. Methods We searched MEDLINE/PubMed and Business Source Complete (Ebsco) for literature on middle managers’ role in healthcare EBP implementation and its determinants. We abstracted data from records that met inclusion criteria (i.e., written in English, peer-reviewed, and reporting either a protocol or results of an empirical study) into a matrix for analysis. We summarized categorical variables using descriptive statistics. To analyze qualitative data, we used a priori codes and then allowed additional themes to emerge. Results One hundred five records, spanning across several countries and healthcare settings and relating to a range of EBPs, met our inclusion criteria. Studies of middle managers’ role in healthcare EBP implementation and its determinants substantially increased from 1996 to 2015. Results from included studies suggest that middle managers shape implementation climate in addition to fulfilling the four roles hypothesized in extant theory of middle managers’ role in implementation. However, extant studies offered little understanding of determinants of middle managers’ role. Conclusions Our findings suggest that middle managers may play an important role in facilitating EBP implementation. Included studies offered little understanding regarding the relative importance of various roles, potential moderators of the relationship between middle managers’ roles and EBP implementation, or determinants of middle managers’ role in EBP implementation. Future studies should seek to understand determinants and moderators of middle managers’ role. Clearer understanding may facilitate the translation of evidence into practice