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To examine the use of vitamin D supplements during infancy among the participants in an international infant feeding trial.
Information about vitamin D supplementation was collected through a validated FFQ at the age of 2 weeks and monthly between the ages of 1 month and 6 months.
Infants (n 2159) with a biological family member affected by type 1 diabetes and with increased human leucocyte antigen-conferred susceptibility to type 1 diabetes from twelve European countries, the USA, Canada and Australia.
Daily use of vitamin D supplements was common during the first 6 months of life in Northern and Central Europe (>80 % of the infants), with somewhat lower rates observed in Southern Europe (>60 %). In Canada, vitamin D supplementation was more common among exclusively breast-fed than other infants (e.g. 71 % v. 44 % at 6 months of age). Less than 2 % of infants in the USA and Australia received any vitamin D supplementation. Higher gestational age, older maternal age and longer maternal education were study-wide associated with greater use of vitamin D supplements.
Most of the infants received vitamin D supplements during the first 6 months of life in the European countries, whereas in Canada only half and in the USA and Australia very few were given supplementation.
One of the most harmful adverse consequences of conflicts of interest in research is the potential introduction of bias into the science of medicine and the denigration of the integrity of scientific research. A number of facts support the concerns that financial conflicts influence the integrity of medical research. The potential for conflicts of interest can never be eliminated, but conflicts of interest can be managed and, in some cases, reduced. Strategies for doing so are most useful when they are matters of institutional and editorial policies that are focused on preventing the adverse effects of conflict of interest and are not unduly burdensome. Disclosure is the most common first step in managing conflicts of interest. Public disclosure of raw scientific data and independent monitoring of research are additional mechanisms for managing conflicts of interest. Policies and guidance on conflicts of interest are changing rapidly.
Do-not-resuscitate (DNR) orders may be written if cardiopulmonary resuscitation (CPR) would be physiologically futile, or at the request of patients who feel that CPR would result in poorer quality of life. Pre-hospital DNR policies have emerged recently and serve three primary purposes: to provide continued respect for patient autonomy following hospital discharge, prevent futile resuscitation efforts in the field, and protect the well-being of emergency medical service (EMS) personnel. This chapter explains this concept citing the case study of a 67-year-old male with oxygen-dependent COPD requiring a series of electroconvulsive therapies (ECT) for severe depression refractory to medical therapy. Patients with preexisting DNR orders often require anesthesia for surgical procedures necessitated by the need to improve quality of life. The American Society of Anesthesiologists and the American College of Surgeons have drafted guidelines for the management of the patient with a presurgical DNR order.
Quality improvement (QI)/quality assurance (QA) has evolved from an informal retrospective review of individual cases involving critical incidents, to large retrospective analyses and evaluation of physicians, departments, hospitals, and healthcare systems. Some forms of QI activity actually represent human subjects research, with potential for patient harm. As such, similar ethical imperatives should apply in protecting patients from unconsented research when QI initiatives involve significant changes in patient care. As rationing and cost-containment efforts increase, institutional review boards (IRBs) may come under increasing pressure, and therefore experience conflicts of interest, with regard to evaluation of cost-containment QI activities. The Electronic Medical Record (EMR) carries powerful potential as a tool in QI and cost-containment efforts. Use of patient records carries risk for future privacy conflicts necessitating revision of the Code of Federal Regulations (CFR) and OHRP's regulatory authority in federal policy creation.
Ethical issues facing anesthesiologists are more far-reaching than those involving virtually any other medical specialty. In this clinical ethics textbook, authors from across the USA, Canada and Europe draw on ethical principles and practical knowledge to provide a realistic understanding of ethical anesthetic practice. The result is a compilation of expert opinion and international perspectives from clinical leaders in anesthesiology. Building on real-life, case-based problems, each chapter is clinically focused and addresses both practical and theoretical issues. Topics include general operating room care, pediatric and obstetrical patient care, the intensive care unit, pain practice, research and publication, as well as discussions of lethal injection, disclosure of errors, expert witness testimony, triage in disaster and conflicts of interest with industry. An important reference tool for any anesthesiologist, whether clinical or research-oriented, this book is especially valuable for physicians involved in teaching residents and students about the ethical aspects of anesthesia practice.
This chapter explains the burdens of surrogate decision-making decision-making citing a case study of an 80 year-old widowed woman admitted for elective total hip replacement but post-surgery loses the decision-making capacity. Many European countries have autonomy-based models of decision-making for competent patients, and hierarchies for surrogate decision-making for incapacitated patients that are similar to that in the US. It may be possible to prevent confusion about the appropriate surrogate by asking all hospitalized and preoperative patients with decision-making capacity to identify their preferred surrogate decision maker(s) early in their hospital stay. Ethics and palliative care consultants can help evaluate apparent discrepancies. Decision-making capacity is assessed by evaluating patients' abilities to understand information about their condition and treatment options; appreciate that the decision at hand will affect them; explain their reasoning; and arrive at a choice consistent with their values and beliefs or a discussion of the patient's life and values.