Response of the oral tissues to prolonged uninterrupted coverage by a removable partial denture. Case report

The response of hard and soft oral tissues to prolonged uninterrupted wearing of a removable partial prosthesis in a Nigerian patient is discussed. To our knowledge only one case has been reported in the literature. In this case additional mucosal changes to the reported caries-free pattern is discussed.     

Is the doctrine of double effect irrelevant in end‐of‐life decision making?

In this paper, we consider three arguments for the irrelevance of the doctrine of double effect in end‐of‐life decision making. The third argument is our own and, to that extent, we seek to defend it. The first argument is that end‐of‐life decisions do not in fact shorten lives and that therefore there is no need for the doctrine in justification of these decisions. We reject this argument; some end‐of‐life decisions clearly shorten lives. The second is that the doctrine of double effect is not recognized in UK law (and similar jurisdictions); therefore, clinicians cannot use it as the basis for justification of their decisions. Against this we suggest that while the doctrine might have dubious legal grounds, it could be of relevance in some ways, e.g. in marking the boundary between acceptable and unacceptable practice in relation to the clinician's duty to relieve pain and suffering. The third is that the doctrine is irrelevant because it requires there to be a bad effect that needs justification. This is not the case in end‐of‐life care for patients diagnosed as dying. Here, bringing about a satisfactory dying process for a patient is a good effect, not a bad one. What matters is that patients die without pain and suffering. This marks a crucial departure from the double‐effect doctrine; if the patient's death is not a bad effect then the doctrine is clearly irrelevant. A diagnosis of dying allows clinicians to focus on good dying and not to worry about whether their intervention affects the time of death. For a patient diagnosed as dying, time of death is rarely important. In our conclusion we suggest that acceptance of our argument might be problematic for opponents of physician‐assisted death. We suggest one way in which these opponents might argue for a distinction between such practice and palliative care; this relies on the double‐effect doctrine's distinction between foresight and intention.     

Benefits of information technology training to National Health Service staff in Wales

The use of computers in the National Health Service (UK) as a workplace is fundamental to its future. However, there is evidence of a paucity of information technology skills within the workforce and therefore, information technology skill training is essential. The National Health Service in Wales has been using the European Computer Driving Licence qualification to educate its staff in order to cover this skill gap. This paper reports on an evaluation of the perceived benefits to staff, both clinical and non-clinical, working for the National Health Service in Wales of information technology training through the European Computer Driving Licence qualification. Results show that there is an increase in confidence in terms of tasks undertaken but also towards other general life skills. Additionally, for those respondents with clinical contact, there is a perceived increase both in the time available with and the quality of care, given to patients. As the continued move towards a computer orientated healthcare system occurs, the information technology skills obtained through but not limited to training schemes such as European Computer Driving Licence will become of paramount importance, particularly as the single most important failure for technology-related projects in healthcare is a lack of readiness.