Objectives: Lung ultrasound (LUS) plays an increasing role in diagnosis and monitoring of interst... more Objectives: Lung ultrasound (LUS) plays an increasing role in diagnosis and monitoring of interstitial lung disease (ILD). Connective tissue disorders (CTD) frequently cause ILD, and often presents symptomatically after irreversible fibrosis has ensued. As point-of-care musculoskeletal ultrasound (US) is commonly utilised by rheumatologists, translating this US expertise towards LUS places the rheumatologist in a position to screen for ILD. However, a standardised curriculum for the rheumatology community is lacking. The aim of this study is to determine the effectiveness of a formalised lung US training course for rheumatologists. Methods: Four rheumatology fellows and four board-certified rheumatologists participated in a 4-hour training session. Pre-course, post-course and 6-month follow-up surveys evaluated perceptions towards previous US experience, training, clinical utility and attitudes toward lung US. Didactics explained the protocols utilised in ILD evaluation. Evaluation of knowledge in US physiology, lung anatomy, artifact and pathology recognition were done through written exams before, after training, and at 6 months and through a practical exam using live models and simulation. Results: Temporally there was overall improvement in written test scores. Improvement was noted in overall practical skill score following training course (17.4% vs. 92.9%, p<0.001), in written test scores 49.3% vs. 72.5% p<0.001), and pathology identification (26.5% vs. 79.6%, p<0.001). Six-month follow assessments were similar to post-test results revealing similar written scores (70.6%) and practical scores (89.7%). Conclusions: This formalised lung ultrasound training course was effective in improving skills and knowledge of rheumatology specialists.
Debates regarding clinical ethicists' scope of practice are not novel and will continue to ev... more Debates regarding clinical ethicists' scope of practice are not novel and will continue to evolve. Rapid changes in healthcare delivery, outcomes, and expectations have necessitated flexibility in clinical ethicists' roles whereby hospital-based clinical ethicists are expected to be woven into the institutional fabric in a way that did not exist in more traditional relationships. In this article we discuss three emerging roles: the ethicist embedded in the interdisciplinary team, the ethicist with an expanded educational mandate, and the ethicist as a therapeutic presence in the patient care space. Such expanded capacities offer more robust, positive contributions to institutional culture, stakeholders' relationships, and patient-centered care.
Journal of social work in end-of-life & palliative care
Hospital ethics committees (HECs) are typically charged with addressing ethical disputes, conflic... more Hospital ethics committees (HECs) are typically charged with addressing ethical disputes, conflicts, and dilemmas that arise in the course of patient care. HECs are not widely viewed as having a therapeutic role for health care professionals who experience psychological distress or anticipatory grief in the course of discharging professional duties. A case is presented in which an ethics consultation was requested, chiefly, to secure emotional support for health care professionals who had been asked by a patient to discontinue life-sustaining treatments. As the case demonstrates, HECs may be called upon to provide emotional support and reassurance to health care professionals who willingly carry out psychologically difficult actions, even though these actions may be ethically uncontroversial. In providing this service, the HEC may not necessarily engage in its customary activity of deliberating an ethics issue and resolving a conflict but may still provide valuable assistance, as in...
Objectives: Lung ultrasound (LUS) plays an increasing role in diagnosis and monitoring of interst... more Objectives: Lung ultrasound (LUS) plays an increasing role in diagnosis and monitoring of interstitial lung disease (ILD). Connective tissue disorders (CTD) frequently cause ILD, and often presents symptomatically after irreversible fibrosis has ensued. As point-of-care musculoskeletal ultrasound (US) is commonly utilised by rheumatologists, translating this US expertise towards LUS places the rheumatologist in a position to screen for ILD. However, a standardised curriculum for the rheumatology community is lacking. The aim of this study is to determine the effectiveness of a formalised lung US training course for rheumatologists. Methods: Four rheumatology fellows and four board-certified rheumatologists participated in a 4-hour training session. Pre-course, post-course and 6-month follow-up surveys evaluated perceptions towards previous US experience, training, clinical utility and attitudes toward lung US. Didactics explained the protocols utilised in ILD evaluation. Evaluation of knowledge in US physiology, lung anatomy, artifact and pathology recognition were done through written exams before, after training, and at 6 months and through a practical exam using live models and simulation. Results: Temporally there was overall improvement in written test scores. Improvement was noted in overall practical skill score following training course (17.4% vs. 92.9%, p<0.001), in written test scores 49.3% vs. 72.5% p<0.001), and pathology identification (26.5% vs. 79.6%, p<0.001). Six-month follow assessments were similar to post-test results revealing similar written scores (70.6%) and practical scores (89.7%). Conclusions: This formalised lung ultrasound training course was effective in improving skills and knowledge of rheumatology specialists.
Debates regarding clinical ethicists' scope of practice are not novel and will continue to ev... more Debates regarding clinical ethicists' scope of practice are not novel and will continue to evolve. Rapid changes in healthcare delivery, outcomes, and expectations have necessitated flexibility in clinical ethicists' roles whereby hospital-based clinical ethicists are expected to be woven into the institutional fabric in a way that did not exist in more traditional relationships. In this article we discuss three emerging roles: the ethicist embedded in the interdisciplinary team, the ethicist with an expanded educational mandate, and the ethicist as a therapeutic presence in the patient care space. Such expanded capacities offer more robust, positive contributions to institutional culture, stakeholders' relationships, and patient-centered care.
Journal of social work in end-of-life & palliative care
Hospital ethics committees (HECs) are typically charged with addressing ethical disputes, conflic... more Hospital ethics committees (HECs) are typically charged with addressing ethical disputes, conflicts, and dilemmas that arise in the course of patient care. HECs are not widely viewed as having a therapeutic role for health care professionals who experience psychological distress or anticipatory grief in the course of discharging professional duties. A case is presented in which an ethics consultation was requested, chiefly, to secure emotional support for health care professionals who had been asked by a patient to discontinue life-sustaining treatments. As the case demonstrates, HECs may be called upon to provide emotional support and reassurance to health care professionals who willingly carry out psychologically difficult actions, even though these actions may be ethically uncontroversial. In providing this service, the HEC may not necessarily engage in its customary activity of deliberating an ethics issue and resolving a conflict but may still provide valuable assistance, as in...
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