Senior surgical resident autonomy and teaching assistant cases: A prospective observational study

IntroductionTeaching assistant (TA) cases allow senior residents (SR) to gain autonomy. We compared the safety profiles of TA cases performed under direct vs. indirect staff supervision.MethodsProspective observational study of operative cases where a SR served as the TA between 7/2014-6/2017 (n = 161). Patient/operative characteristics, 30-day outcomes, and SR survey data were compared by level of supervision.ResultsCase mix included 68 laparoscopic appendectomies (42%), 49 laparoscopic cholecystectomies (30%), 10 I&Ds (6%), 10 umbilical hernia repairs (6%), 4 port placements (3%), and 11 others. Indirectly supervised cases were shorter (61 vs. 76 min, p < 0.01), with less blood loss (11 vs. 24 ml, p < 0.05), and lower conversion rates (0% vs. 5.7%, p < 0.05). Perceived difficulty was high in 20% of cases with indirect vs. 49% with direct supervision (p < 0.01). Mean SR comfort was high (4.4 vs. 4.6 out of 5) regardless of level of staff supervision. 30-day complications did not differ for indirect vs. direct supervision (all p = NS).DiscussionCarefully selected TA cases offer SRs opportunities to practice autonomy without sacrificing operative time or patient safety.     

Une brève histoire de l’éthique et son application en psychiatrie

This article reviews the concepts and history of ethical principles in psychiatry and their evolution over time from Antiquity to the present highlighting advances made in patient rights. We also discuss the WPA's new Code of Ethics that was developed in 2020 and which succeeds the Declaration of Hawaii of 1977 and the Declaration of Madrid of 1996. The Code is divided into four sections that cover the practice of psychiatry in clinical practice, education, research and publication as well as in public mental health. We also discuss the new ethical issues that this Code entails.     

Interprofessional care co-ordinators: the benefits and tensions associated with a new role in UK acute health care

While more flexible models of service delivery are being introduced in UK health and social care, little is known about the impact of new roles, particularly support worker roles, on the work of existing practitioners. This action research study aimed to explore the impact of one such new role, that of interprofessional care co-ordinators (IPCCs). The general (internal) medical service of a UK hospital uses IPCCs to provide support to the interprofessional team and, in doing so, promote efficiency of acute bed use. Using a range of methods, mainly qualitative, this action research study sought to explore the characteristics and impact of the role on interprofessional team working. While the role's flexibility, autonomy and informality contributed to success in meeting its intended objectives, these characteristics also caused some tensions with interprofessional colleagues. These benefits and tensions mirror wider issues associated with the current modernisation agenda in UK health care.     

The Developmental Method in Drama Therapy

No abstract available for this article.     

Consent in obstetric anaesthesia

Consent to medical treatment is a vital process that should occur prior to any procedure or intervention in a competent adult. There are ethical and legal reasons for doctors to ensure that valid, adequate consent has been obtained from a patient. It is generally accepted that written consent is acceptable, however, discussions regarding consent should be clearly documented, including specific risks discussed. Labouring women may have to consent for procedures when in severe pain, under the influence of strong analgesics, or in a time-pressured situation. However, the parturient is presumed to be competent. A competent pregnant woman may decline treatment for any reason, even if it puts her or her unborn child at risk of harm or death.