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Bioethics Grand Rounds

Wed, January 25, 2017, 12:00pm
Location: 
UH Ford Amphitheater & Lobby

Meredith Walton presents "Opting In or Opting Out: The Ethical Principles Underlying Two Methods of Organ Donation."

Abstract: Recent legislation in France adopting an opt-out system of organ donation has again brought the issue of presumed consent in organ donation to the forefront of ethical discussion.  Proponents of the legislation have used the idea of ‘normative consent’ to justify it, as well as the expected increase in donation rates. But those opposed have argued that it strips the individual of their autonomy and does not in fact increase donation rates.This presentation seeks to define opt-in and opt-out systems of organ donation, explore principles of autonomy and consent surrounding the issue and reflect on whether adopting an opt-out system will truly increase the rate of organ donation

Bioethics Grand Rounds -Scott Grant MD, MBE

Wed, May 24, 2017, 12:00pm
Location: 
UH Ford Auditorium

Scott Grant, MD, MBE, University of Chicago: "Dealing with complications and poor outcomes and surgical futility"

Scott Grant, MD, MBE, University of Chicago

Abstract: Surgical complications are ubiquitous and effect all surgeons. This talk will review how surgical ethics is distinct from traditional medical ethics in that surgeons have a greater and more direct responsibility for the outcomes of their patients than medical doctors. It will review how surgery harms before healing and the importance of weighing risks and benefits in decision making. Ways of assessing perioperative risk and preventing complications will be reviewed. Strategies for coping with complications will be described. Human error theory and the "Swiss cheese" model of human error will briefly be discussed. The SPIKES protocol for breaking bad news will be reviewed. Different definitions of futility will be described. Various procedural approaches to futility disputes will be analyzed. The best tool in approaching challenging "futility" situations will be described - open and honest communication between the patient or surrogate and the physician.

Funded by National Institutes of Health

Funding Years: 2015-2020

Every day in hospitals across the country, patients with severe stroke and their families are faced with decisions about life-sustaining treatments in the initial hours of admission. These decisions about resuscitation status, invasive treatments, or possible transitions to comfort care are typically made by a surrogate decision- maker due to communication or cognitive deficits in the patient. This surrogate must consider the patient's life goals and values to determine if their loved one would choose on-going intensive treatments where they may survive and yet have long term disabilities, or prioritize comfort and accept the likelihood of an earlier death. Serving as a surrogate decision maker for a patient in the intensive care unit can have long lasting negative consequences. However, almost nothing is known about surrogate decision makers in diverse populations with stroke. Hispanic Americans are now the largest minority group in the US, rapidly growing and aging, with Mexican Americans comprising the largest subgroup. Multiple disparities have been identified in stroke incidence and outcome between Mexican Americans and non-Hispanic Whites, particularly in the use of life- sustaining treatments. Minority populations may be particularly vulnerable to inadequate communication about end-of-life issues due to socioeconomic disadvantage, poor health literacy, and lack of provider empathy and health system strategies to improve communication. However, Mexican American culture includes strong values of family support and religiosity that may have a positive influence on discussions about life-sustaining treatment and adapting to stroke-related disabilities. There is currently a critical gap in understanding the perspectives and outcomes of stroke surrogate decision makers, making it impossible to design interventions to help diverse populations of patients and families through this incredibly trying time.

PI(s): Lewis Morgenstern, Darin Zahuranec

Co-I(s): Lynda Lisabeth, Brisa Sanchez

Funded by the National Institutes of Health.

Funding Years: 2009-2013.

Because women have different perspectives and different life experiences than their male colleagues, new ideas and approaches are likely to emerge from their participation in the academic enterprise. Faculty diversity is critically important for advancing the research, educational, and clinical missions of medical schools. Efforts to decrease disparities must be informed by an understanding of the mechanisms by which gender differences develop, as this proposal seeks to illuminate. For more information, visit NIH Reporter

PI(s): Reshma Jagsi 

Funded by Department of Veterans Affairs

Funding Year: 2012

Successful diabetes management is dependent on the patient - provider partnership. However, a full discussion of potential benefits, harms, costs, and burdens associated with each medication option is often too much for a brief clinic visit. This project uses AHRQ-developed consumer guides as inspiration for a tailored program that assists with this decision-making. The current iDECIDE intervention serves as the base of the program, with updates geared toward making it more specific to veterans.

Aim 1: Update current iDECIDE program to make it more appropriate for the VA setting. 

Angela Fagerlin (PI)

Center for Health Communications Research (CHCR) Project

 

Funded by the National Institutes of Health

Funding years: 2009-2014

The proposed project aims to explore and examine the experiences and preferences regarding communication about positive newborn screening results of key stakeholders (parents, primary care physicians, clinical geneticists, and state newborn screening officials) involved in the three key stages: notification about the initial positive screen; follow-up testing and evaluation; and parental notification of the final results of the evaluation. For more information, visit NIH Reporter.

PI: Beth Tarini

CBSSM Seminar: Kevin Kerber, MD

Wed, December 03, 2014, 3:00pm to 4:00pm
Location: 
NCRC 16-266C

 Kevin Kerber, MD
Associate Professor of Neurology, Medical School
Director, Dizziness Clinic

Title: Implementation of Evidence-Based Practice for Benign Paroxysmal Positional Vertigo

Summary: A wide gap exists between the evidence-base for processes to diagnose and treat Benign Paroxysmal Positional Vertigo (BPPV) and the use of these processes in real world medicine. The investigators will present their work-in-progress regarding an implementation strategy to increase the use of BPPV processes in emergency department presentations of dizziness.

Funded by the National Institutes of Health

Funding Years: 2015-2016

POINT is a randomized, double-blind, multicenter clinical trial to determine whether clopidogrel 75mg/day (after a loading dose of 600mg) is effective in improving survival free from major ischemic vascular events (ischemic stroke, myocardial infarction, and ischemic vascular death) at 90 days when initiated within 12 hours time last known free of new ischemic symptoms of TIA or minor ischemic stroke in subjects receiving aspirin 50-325mg/day.

PI(s): Claiborne Johnston

Co-I(s):  J. Donald Easton, Mary Farrant, William Barsan, Holly Battenhouse, Robin Conwit, Catherine Dillon, Jordan Elm, Anne Lindblad, Lewis Morgenstern, Sharon Poisson, Yuko Palesch

Raymond De Vries is involved in a new research study led by Akbar Waljee, MD, MSc, which will develop a risk-based strategy to help providers tailor timing of treatments among CHC Veterans to ensure that those who most need urgent therapy get it as quickly as possible.

Using democratic deliberation, Dr. De Vries will engage Veterans to learn their thoughts and preferences about such a strategy, which will help with its implementation in a clinical setting.

Click here for more details.

Funded by Department of Veterans Affairs

Funding Years: 2009-2012

Because CRC-predictive genetic tests offer the potential to optimize CRC screening efforts, improving the communication and use of such tests by the millions of veterans who are screened for CRC each year could result in both improved cancer surveillance and more efficient (and potentially reduced) VA resource utilization. Our study will provide empirical data about practical risk communication methods that can be used in the future by VA clinicians to present genetic tests to veterans and about patient-level barriers which will inhibit acceptance of genetic tests that predict colorectal cancer risk within the VA patient population. By evaluating alternate methods of communicating genetic test results before such tests actually become available, we hope to identify optimal approaches that can be integrated into VA genomics initiatives from the very start.

Angela Fagerlin (PI)

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