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Background: This is Part 3 of the first consensus guidelines for optimal care of patients undergoing emergency laparotomy using an enhanced recovery after surgery (ERAS) approach. This paper addresses organizational aspects of care. Methods: Experts in management of the high-risk and emergency general surgical patient were invited to contribute by the International ERAS® Society. PubMed, Cochrane, Embase, and MEDLINE database searches were performed for ERAS elements and relevant specific topics. Studies were selected with particular attention to randomized clinical trials, systematic reviews, meta-analyses and large cohort studies, and reviewed and graded using the Grading of Recommendations, Assessment, Development and Evaluation system. Recommendations were made on the best level of evidence, or extrapolation from studies on elective patients when appropriate. A modified Delphi method was used to validate final recommendations. Results: Components of organizational aspects of care were considered. Consensus was reached after three rounds of a modified Delphi process. Conclusions: These guidelines are based on best current available evidence for organizational aspects of an ERAS® approach to patients undergoing emergency laparotomy and include discussion of less common aspects of care for the surgical patient, including end-of-life issues. These guidelines are not exhaustive but pull together evidence on important components of care for this high-risk patient population. As much of the evidence is extrapolated from elective surgery or emergency general surgery (not specifically laparotomy), many of the components need further evaluation in future studies. [ABSTRACT FROM AUTHOR]

Background: This is Part 2 of the first consensus guidelines for optimal care of patients undergoing emergency laparotomy (EL) using an Enhanced Recovery After Surgery (ERAS) approach. This paper addresses intra- and postoperative aspects of care. Methods: Experts in aspects of management of high-risk and emergency general surgical patients were invited to contribute by the International ERAS® Society. PubMed, Cochrane, Embase, and Medline database searches were performed for ERAS elements and relevant specific topics. Studies on each item were selected with particular attention to randomized clinical trials, systematic reviews, meta-analyses, and large cohort studies and reviewed and graded using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Recommendations were made on the best level of evidence, or extrapolation from studies on elective patients when appropriate. A modified Delphi method was used to validate final recommendations. Some ERAS® components covered in other guideline papers are outlined only briefly, with the bulk of the text focusing on key areas pertaining specifically to EL. Results: Twenty-three components of intraoperative and postoperative care were defined. Consensus was reached after three rounds of a modified Delphi Process. Conclusions: These guidelines are based on best available evidence for an ERAS® approach to patients undergoing EL. These guidelines are not exhaustive but pull together evidence on important components of care for this high-risk patient population. As much of the evidence is extrapolated from elective surgery or emergency general surgery (not specifically laparotomy), many of the components need further evaluation in future studies. [ABSTRACT FROM AUTHOR]

Even if ultimately unfounded, providing raw data to those who request it reciprocates the participants' contribution to research and builds empowerment.9 Implications for clinicians Clinicians who treat patients and recruit them to genomic research studies will increasingly field requests for raw data. Clinicians who recruit their patients to genomic research studies are often provided with a summary report interpreting clinically relevant results they may choose to share with patients. Keywords: Ethics; Legislation, medical; Medicolegal; Clinical decision-making; Delivery of healthcare; Medical records; Genetic testing; Sequence analysis; Patient rights EN Ethics Legislation, medical Medicolegal Clinical decision-making Delivery of healthcare Medical records Genetic testing Sequence analysis Patient rights 550 552 3 06/21/22 20220615 NES 220615 As the number of requests for raw genomic data increases, policies and protocols reflecting the perspectives of clinicians, patients, researchers and research participants are required Next generation sequencing technologies generate vast quantities of genomic data and can identify significant molecular markers associated with disease development and its response to treatments. [Extracted from the article]

Children have not been severely affected by SARS-CoV-2-related illness but are vulnerable to the economic and social deprivation arising from the pandemic.[1] This document describes unique risks and burdens for children and their care givers during the COVID-19 pandemic. The allocation of intensive care resources applies to all patients needing ICU, not only those with COVID-19, and it applies to the whole population, from newborns to the elderly. Determining eligibility for ICU admission Eligibility for ICU is based both on the clinical need of the patient and their likelihood of benefit from intensive care. How should non-ICU paediatric clinicians prepare for ICU resource scarcity?. [Extracted from the article]

Pain is a common and distressing symptom experienced by intensive care patients. Assessing pain in this environment is challenging, and published guidelines have been inconsistently implemented. The Pain Assessment in INTensive care (PAINT) study aimed to evaluate the frequency and type of physician pain assessments with respect to published guidelines. This observational service evaluation considered all pain and analgesia-related entries in patients' records over a 24-h period, in 45 adult intensive care units (ICUs) in London and the South-East of England. Data were collected from 750 patients, reflecting the practice of 362 physicians. Nearly two-thirds of patients (n = 475, 64.5%, 95%CI 60.9-67.8%) received no physician-documented pain assessment during the 24-h study period. Just under one-third (n = 215, 28.6%, 95%CI 25.5-32.0%) received no nursing-documented pain assessment, and over one-fifth (n = 159, 21.2%, 95%CI 19.2-23.4)% received neither a doctor nor a nursing pain assessment. Two of the 45 ICUs used validated behavioural pain assessment tools. The likelihood of receiving a physician pain assessment was affected by the following factors: the number of nursing assessments performed; whether the patient was admitted as a surgical patient; the presence of tracheal tube or tracheostomy; and the length of stay in ICU. Physician-documented pain assessments in the majority of participating ICUs were infrequent and did not utilise recommended behavioural pain assessment tools. Further research to identify factors influencing physician pain assessment behaviour in ICU, such as human factors or cultural attitudes, is urgently needed. [ABSTRACT FROM AUTHOR]

Ethics is an important topic for theatre staff. They work in a multidisciplinary team usually with an unconscious patient. Ethical dilemmas can often arise during elective and emergency surgery. The teaching of ethics for this arena is often neglected in favour of covering other surgical skills. There is some evidence from studies of surgical specialties that doctors do not feel confident in applying their training in ethics in the clinical environment. This paper suggests a format and describes teaching tools for conducting classroom small group teaching sessions on ethics suitable for the whole theatre team. It outlines some strategies that can be used to stimulate debate, and suggested ground rules to run the session smoothly. Teaching of ethics at undergraduate level can be reinforced by such small group sessions during clinical placements. A short time spent in the classroom discussing such issues is of great benefit to medical staff and patients in this often forgotten, but vitally important topic. [ABSTRACT FROM AUTHOR]

Objective: To determine general attitudes and approaches to complementary and alternative medicine (CAM) among physicians who care for gynecologic oncology patients.Methods: Surveys were mailed to members of the Society of Gynecologic Oncologists and the Michigan Oncology Group. Physicians were asked to rate their general attitude toward CAM.Results: Surveys were obtained from 462 physicians. Gynecologic oncologists and female physicians were more likely to have positive attitudes toward CAM, and to believe that clinical care should integrate conventional and CAM practices, compared with other oncologists and male physicians.Conclusion: Discrepancies exist among oncologists regarding attitude and use of CAM in their practice. Education of physicians regarding the safety and efficacy of CAM modalities may ultimately improve patient care. [ABSTRACT FROM AUTHOR]

Whether the clinician or the patient controls the recording process may differ across technology platforms; for instance, in the Danish example above, the clinician initiated the recordings, whereas with Second Ears the patient would do so. Consent to record a consultation Clinician consent to patient-led recordings Clinicians consider that their consent to be recorded is a key issue. Covert patient-led recordings: for example, a patient recording without the clinician's knowledge or consent. Covert recordings by patients Covert recording by patients is not uncommon; a survey conducted in the UK found that 15% of respondents self-reported recording clinical encounters without permission. [Extracted from the article]

An abstract of the article "Making film vignettes to teach medical ethics," by Carolyn Johnston and Mark Chan is presented.