Ethical aspects of risk communication

Clinical decision-making is becoming increasingly complex because of greater patient access to information, more clinical options and the emphasis on patient-centred care with informed decision-making. Risk communication should form part of evidence-based clinical practice, and it is important to think about what happens when clinicians adopt different consultation approaches. In this article, the ethical consequences of risk communication are analysed by looking at how the paternalistic and shared decision-making models of consultation demonstrate different ethical implications, based around a clinical scenario. To do this, we have applied the ethical principles of autonomy, utility and justice to these models. We show that the different models of consultation place varying degrees of emphasis on risk communication, patient autonomy and biomedical utility. This has implications for the way care is delivered both for the individual patient and for the population as a whole

A stitch in time saves nine: perceptions about colorectal cancer screening after a non-cancer colonoscopy result. Qualitative study

Objectives To explore perceptions of colorectal cancer (CRC) screening among participants who have experienced a 'false alarm' for CRC, and to explore perceptions about the relevance of screening for themselves or others. Methods Semi-structured interviews with screening participants who had participated in the Danish CRC screening program and experienced a 'false alarm' for colorectal cancer. A thematic analysis was performed, based on an interpretive tradition of ethnography. Results Perceptions about CRC screening after a non-cancer colonoscopy result were characterized by trust in the colonoscopy result showing no CRC, and satisfaction with the screening offer despite the risk for 'false alarm'. The patient-involving behavior of the healthcare professionals during the examination was for most participants a cornerstone for trusting the validity of the colonoscopy result showing no CRC. Strong notions about perceived obligation to participate in screening were common. Conclusions Prominent themes were trust in the result, satisfaction with the procedure, and moral obligations to participate both for themselves and for others. Practice implications Information to future invitees after a 'false alarm' experience could build on peoples' trust in the validity of a previous non-cancer result and should underscore the importance of subsequent screening even after a 'false alarm' for cancer

Tales from the wild East: Traiding with Central and Eastern Europe

In the former system of trade in the countries of Central and Eastern Europe the State controlled imports and exports. Firms, both domestic and foreign, now have the potential to respond directly to local demand. The aim of the research was to identify how small firms in the South East of England who are exporting to Central and Eastern Europe, have responded to these developments. In particular the authors wanted to explore the stories respondents told about how they become involved in exporting and what their experience of this was

Use Of A Unique Long Pre-curved Sheath To Facilitate Femoral Placement Of Coronary Sinus Catheters

Methods: Catheterization of the coronary sinus (CS) from the femoral vein is widely used during electrophysiologic procedures. Access to the CS may be difficult. To address this problem we explored the utility of a long pre-formed (SAFL™) sheath in a cohort of consecutive patients requiring CS cannulation in the electrophysiology laboratory. This unique sheath has distal curvatures in 2 planes, potentially facilitating CS cannulation.Results: 68 patients were studied with an average age of 63±16 years. In twelve patients (18%), standard femoral CS cannulation was ineffective. In six of these patients, the SAFL™ sheath allowed for cannulation, and in six the subclavian approach was required. There were no significant differences in age, left ventricular ejection fraction, or echocardiographically estimated pulmonary artery systolic pressure between the various subgroups. There was a trend towards a larger left atrial size in the atrial flutter group (46mm±7.9) versus all others (40.6mm±6.3, P=.076). Left atrial size was 37 mm in the femoral sheath-requiring group versus 44 mm in all others (P=NS).Conclusion: Utilization of a unique commercially available long preformed sheath helps to provide femoral CS catheter access in selected cases in the electrophysiology laboratory

Working with interpreters: the challenges of introducing Option Grid patient decision aids

Objective We aimed to observe how an Option GridTM decision aid for clinical encounters might be used where an interpreter is present, and to assess the impact of its use on shared decision making. Methods Data were available from three clinical consultations between patient, clinician (a physiotherapist), and interpreter about knee osteoarthritis. Clinicians were trained in the use of an Option Grid decision aid and the tool was used. Consultations were audio-recorded, transcribed, and translated by independent translators into English. Results Analysis revealed the difficulties with introducing a written decision aid into an interpreted consultation. The extra discussion needed between the clinician and interpreter around the principles and purpose of shared decision making and instructions regarding the Option Grid decision aid proved challenging and difficult to manage. Discussion of treatment options while using an Option Grid decision aid was predominantly done between clinician and interpreter. The patient appeared to have little involvement in discussion of treatment options. Conclusion Patients were not active participants within the discussion. Further work needs to be done on how shared decision making can be achieved within interpreted consultations. Practice Implications Option Grid decision aids are not being used as intended in interpreted consultations

Downtown Winnipeg: Developments and Investments, 2005 - 2013

This IUS In-Brief explores the rapid upswing in investment in Winnipeg's downtown over the last eight years by collecting and mapping the changes that have taken place during this frenzied period of development

Nonuniformity of the 1/N1/N Expansion for Two-Dimensional O(N)O(N) Models

We point out that the $1/N$ expansion, which is widely invoked to infer properties of the $2D$ $O(N)$ models, is nonuniform in the temperature, i.e. with decreasing temperature the $1/N$ expansion truncated at a fixed order deviates more and more from the true answer. This fact precludes the use of the expansion to deduce low temperature properties such as asymptotic scaling for those models. By contrast, in the $1D$ $O(N)$ chains, there are no signs of such a nonuniformity.Comment: 10 pages, MPI-PhT/94-4