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Jonathan Ives 《Health care analysis》2007,15(3):257-259
In this short, rhetorical article, I offer a thought experiment that seeks to make an analogy between ‘life’ and ‘disease’. This article was written whilst under the influence of Nietzsche, and I hope that readers will not mistake the polemical style and the occasional nod towards humour for flippancy. This is a serious subject, and this article attempts to ask, inexplicitly, a serious question. If we do suspend our subjective value judgements about life, and strip away what might be considered the ‘dogma’ of value in life, what effect might this have on our feelings towards voluntary euthanasia, and what can our reaction to that thought experiment tell us? 相似文献
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Paul W. Wales MD Nancy Allen MLS RD CNSC Patricia Worthington MSN RN Donald George MD Charlene Compher PhD RD CNSC LDN FADA FASPEN Daniel Teitelbaum MD 《JPEN. Journal of parenteral and enteral nutrition》2014,38(5):538-557
Background: Children with severe intestinal failure and prolonged dependence on parenteral nutrition are susceptible to the development of parenteral nutrition–associated liver disease (PNALD). The purpose of this clinical guideline is to develop recommendations for the care of children with PN‐dependent intestinal failure that have the potential to prevent PNALD or improve its treatment. Method: A systematic review of the best available evidence to answer a series of questions regarding clinical management of children with intestinal failure receiving parenteral or enteral nutrition was undertaken and evaluated using concepts adopted from the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group. A consensus process was used to develop the clinical guideline recommendations prior to external and internal review and approval by the American Society for Parenteral and Enteral Nutrition Board of Directors. Questions: (1) Is ethanol lock effective in preventing bloodstream infection and catheter removal in children at risk of PNALD? (2) What fat emulsion strategies can be used in pediatric patients with intestinal failure to reduce the risk of or treat PNALD? (3) Can enteral ursodeoxycholic acid improve the treatment of PNALD in pediatric patients with intestinal failure? (4) Are PNALD outcomes improved when patients are managed by a multidisciplinary intestinal rehabilitation team? 相似文献
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Patricia Choban MD Roland Dickerson PharmD BCNSP Ainsley Malone MS RD CNSC Patricia Worthington MSN RN Charlene Compher PhD RD CNSC LDN FADA FASPEN 《JPEN. Journal of parenteral and enteral nutrition》2013,37(6):714-744
Background: Due to the high prevalence of obesity in adults, nutrition support clinicians are encountering greater numbers of obese patients who require nutrition support during hospitalization. The purpose of this clinical guideline is to serve as a framework for the nutrition support care of adult patients with obesity. Method: A systematic review of the best available evidence to answer a series of questions regarding management of nutrition support in patients with obesity was undertaken and evaluated using concepts adopted from the Grading of Recommendations, Assessment, Development and Evaluation working group. A consensus process, that includes consideration of the strength of the evidence together with the risks and benefits to the patient, was used to develop the clinical guideline recommendations prior to multiple levels of external and internal review and approval by the A.S.P.E.N. Board of Directors. Questions: (1) Do clinical outcomes vary across levels of obesity in critically ill or hospitalized non?intensive care unit (ICU) patients? (2) How should energy requirements be determined in obese critically ill or hospitalized non‐ICU patients? (3) Are clinical outcomes improved with hypocaloric, high protein diets in hospitalized patients? (4) In obese patients who have had a malabsorptive or restrictive surgical procedure, what micronutrients should be evaluated? 相似文献
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M. Molly McMahon MD Erin Nystrom PharmD BCNSP Carol Braunschweig PhD RD John Miles MD Charlene Compher PhD RD CNSC LDN FADA 《JPEN. Journal of parenteral and enteral nutrition》2013,37(1):23-36
Background: Hyperglycemia is a frequent occurrence in adult hospitalized patients who receive nutrition support. Both hyperglycemia and hypoglycemia (resulting from attempts to correct hyperglycemia) are associated with adverse outcomes in diabetic as well as nondiabetic patients. This American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Clinical Guideline summarizes the most current evidence and provides guidelines for the desired blood glucose goal range in hospitalized patients receiving nutrition support, the definition of hypoglycemia, and the rationale for use of diabetes‐specific enteral formulas in hospitalized patients. Method: A systematic review of the best available evidence to answer a series of questions regarding glucose control in adults receiving parenteral or enteral nutrition was undertaken and evaluated using concepts adopted from the Grading of Recommendations, Assessment, Development and Evaluation working group. A consensus process was used to develop the clinical guideline recommendations prior to external and internal review and approval by the A.S.P.E.N. Board of Directors. Results/Conclusions: 1. What is the desired blood glucose goal range in adult hospitalized patients receiving nutrition support? We recommend a target blood glucose goal range of 140–180 mg/dL (7.8–10 mmol/L). (Strong) 2. How is hypoglycemia defined in adult hospitalized patients receiving nutrition support? We recommend that hypoglycemia be defined as a blood glucose concentration of <70 mg/dL (<3.9 mmol/L). (Strong) 3. Should diabetes‐specific enteral formulas be used for adult hospitalized patients with hyperglycemia? We cannot make a recommendation at this time. 相似文献
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《American Journal of Public Health (New York, N.Y. : 1912)》1913,3(12):1383-1384
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This paper examines the consequences of a new emphasis on lifestyle in the production, marketing and consumption of pharmaceuticals. Over the past decade, a range of medicines have become available that address aspects of lifestyle, while others have been the subject of lifestyle marketing. We argue, with recourse to a broad literature from the social sciences, economics and health services research and from our study of pharmaceutical consumption, that two processes can be discerned. First, there is a domestication of pharmaceutical consumption, with drugs available via home computers, and marketing of pharmaceuticals that focuses upon private or personal conditions and addresses domestic activities such as sex and cooking. Secondly, there is a pharmaceuticalisation of everyday life as the pharmaceutical industry introduces profitable medicines for a range of daily activities and pharmaceuticals come to be seen by consumers as a 'magic bullet' to resolve problems of daily life. We suggest that the pharmaceuticalisation of daily life links the economics and politics of pharmaceutical production to the private lives of citizens. 相似文献
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