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Organ transplantation and Presumed Consent

Organ transplantation and Presumed Consent. Laura McIntosh. Current Policy. Considered. Not Considered. Blood type Body size Degree of illness Geographic distance Tissue type Total wait time. Race Gender Income Celebrity Social status. Presumed Consent. Elective Consent

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Organ transplantation and Presumed Consent

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  1. Organ transplantation and Presumed Consent Laura McIntosh

  2. Current Policy Considered Not Considered • Blood type • Body size • Degree of illness • Geographic distance • Tissue type • Total wait time • Race • Gender • Income • Celebrity • Social status

  3. Presumed Consent • Elective Consent • “Opt-in” system allows individuals to elect to register as an organ donor to provide their organs as gifts after their death • Presumed consent • “Opt-out” system assumes individuals are donors unless they explicitly choose to be removed from the list

  4. Argument for Presumed Consent • Supported by over half of the country (Health Resources and Services Administration, 2013) • 2/3 of the US believes that PC would result in more available organs each year • PC could increase the number of available organs by 150% (Bailey, 2008) • Has the possibility to increase the number of total gifts per year (Health Resources and Services Administration, 2013) • Utilitarian: good for the greatest number (Beachamps & Childress, 2009)

  5. Argument for Presumed Consent • Supported by nurses (Independent nurse, 2008) • PC could take the psychological strain away from families during their time of grief (Bailey, 2008) • It is easier to agree to an existing policy (PC) than to actively refuse it • Many donations are lost due to inaction (Donate Life California, 2011) • Passive refusal from unregistered individuals results in loss

  6. Argument against Presumed Consent • Presumed consent is not consent • The organs are just taken, no consent is given • Undue pressure on families at a vulnerable time • It is not a donation • Organs taken by assumption are no longer gifts • Organ acceptance becomes a “right” rather than a gift (which is often why people become donors)

  7. Argument against Presumed Consent • Presents the Organ Procurement Offices as savages • Creates the assumption that patients will not be saved to the full extent of medical possibility, but rather allowed to die so their organs are available • Discriminates against those who cannot speak English or those with mental health issues • Too much work • Discrimination in terms of disclosure of mental health status

  8. Argument against Presumed Consent • No real evidence shows that it would increase the number of available organs • Spain: 35.5 DPM (donors per million/ population) • Portugal: 27.9 DPM • USA: 26.1 DPM • California: 23.3 DPM

  9. Possible Solution • “Opt-in or out” system • DMV forms will have an required portion regarding organ donation • Individuals must either opt-in or opt-out at the time of licensure • Some states already have this system • Could possibly increase the number of individuals who opt-out, but more likely will increase the number who opt-in

  10. References • Bailey, A. (2008). Presumed common sense. British Journal of Nursing, 17 (7), 411. • Beauchamp, T. L. (2009). Principles of Biomedical Ethics (6th Edition ed.). New York, NY, USA: Oxford University Press. • Donate Life California. (2011). Presumed consent: An attractive concept with unattractive results. Retrieved 4 10, 2014, from Donate Life California Donor Registry: http://donatelifecalifornia.org/education/faqs/presumed-consent/ • Health Resources and Services Administration. (2013). National survey of organ donation attitudes and behaviors. National Department of Health and Human Services, Health Resources and Services Administration. • Health Resources and Services Administration. (2014, 4 10). Selected Statutory and Regulatory History of Organ Transplantation. Retrieved 4 10, 2014, from Donate the Gift of Life: http://www.organdonor.gov/legislation/legislationhistory.html • Nurses vote to back presumed consent. (2008). Independent Nurse, 10.

  11. Effectiveness of Therapy Modalities in Multiple Sclerosis Laura McIntosh

  12. Intro/ Background • Multiple sclerosis (MS) causes muscle fatigue (Knowles et al., 2011) • It is recommended to find a successful type of exercise that reduces symptoms, but does not cause excessive fatigue (Salem et al., 2011) • Nurses need to be aware of current research to educate patients about cost-effective and therapeutic exercises

  13. PICOT Question • Is pool therapy more easily implemented and more successful in reducing fatigue than traditional weight-bearing physical therapy for people with multiple sclerosis (MS)?

  14. Key Points of Literature Review • Home Health Nurses: important for MS • Nurse-directed home care positively impacts quality of life for people with MS (Kowles et al., 2011) • Traditional Exercise: effective • Research generally agrees that traditional weight bearing exercise is effective in reducing fatigue in MS (Wier et al., 2011) • Current research involves adjunct therapies like yoga (Doulatabad et al., 2013)

  15. Key Points of Literature Review • Pool Exercise: effective • Research often focuses on group (i.e. community) exercise and finds it to be effective in reducing fatigue (Salem, et al., 2011) • Traditional vs. Pool: pool more effective, traditional more easily implemented • One study directly compared pool to traditional exercise and found that pool exercise is more effective in reducing fatigue than traditional (Castro-Sanches, et al., 2012) • Pool exercise was more successful, but also more expensive and difficult to implement (Castro-Sanches, et al., 2012)

  16. Clinical Implications • Home health • Home health should focus equally if not more on the psychosocial aspect (Akkus & Akdemir, 2011) • Traditional Exercise • Nurses should be aware that typical assessment tools are not sensitive enough to the manifestations MS (Brichetto, et al., 2013) • General positive results of exercise (i.e. weight loss, increased self-esteem) are confounding variables, but should be used as encouragement for patients (Brichetto, et al., 2013)

  17. Clinical Implications • Pool Exercise • Physical properties of water (Roehrs & Karst., 2004) • Nurses should advise about bowel and bladder control issues for the pool (Roehrs & Karst, 2004)

  18. Potential Barriers • Cost • Sample size • All studies were too small • Length of study • All studies were too short • Inadequate assessment tools (Brichetto, et al., 2013) • Lack of sensitivity • Discriminatory against severely disabled

  19. Ethical Considerations • Patient right to leave study • Need for larger studies • Privacy concerns • Bowel and bladder problems in the pool

  20. Conclusion • Research clearly demonstrates the effectiveness of both types of exercise on reducing fatigue in people with MS • Pool exercise is more effective • Traditional exercise is more easily implemented • Nurses must advocate for community programs, and be aware of the benefits of each type of activity • More research is needed to conclusively determine whether traditional weight-bearing exercise or pool exercise is more effective in reducing fatigue in MS

  21. References • Akkus, Y., & Akdemir, N. (2011). Improving the quality of life for multiple sclerosis patients using the nurse-based home visiting model. Scandinavian Journal of Caring Sciences , 295-303. doi: 10.1111/j.1471-6712.2011.00933.x • Brichetto, G., Rinaldi, S., Spallarossa, P., Battaglia, M. A., & Carvalho, M. L. (2013). Efficacy of physical therapy in multiple sclerosis as measured with the modified fatigue impact scale and ambulation index: A retrospective study. Neurorehabilitation, 33 (1), 107-112. doi: 10.3233/NRE-130933 • Castro-Sanches, A. M., Mataran-Penarracho, G. A., Lara-Palomo, I., Saavedra-Hernandez, M., Arroyo-Morales, M., & Moreno-Lorenzo, C. (2012). Hydrotherapy for the treatment of pain in people with multiple sclerosis: Arandomized control trial. Evidence-Based Complementary and Alternative Medicine , 1-8. doi:10.1155/2012/473963 • Doulatabad, S. N., Nooreyan, K., Doulatabad, A. N., & Noubandegani, Z. M. (2013). The effects of pranayama, hatha and raja yoga on physical pain and the quality of life of women with multiple sclerosis. Traditional Complementary Alternative Medicine , 49-52. doi.10.41314.ajtcam.v10il.8 • Knowles, M. R. (2011). Homecare support to improve adherence in multiple sclerosis. British Journal of Neuroscience Nursing, 7 (5), 655-659. Retrieved from, http://web.a.ebscohost.com/ehost/detail?sid=8a0c88fd-9f69-4b44-b9ed-ff5f7b2e558d%40sessionmgr4002&vid=19&hid=4107&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=rzh&AN=2011352084. • Lerderal, A., Celius, E. G., & Moum, T. (2008, September 4). Perceptions of illness and its development in patients with mulitple sclerosis: A prospective cohort study. Journal of Advanced Nursing , 184-192. doi: 10.1111/j.1365-2648.2008.04862.x • Miller, L., Paul, L., Mattison, P., & McFayden, A. (2011). Evaluation of a home-based physiotherapy programme for those with moderate to severe multiple sclerosis: A randomized controlled pilot study. Clinical Rehabilitation, 25 (8), 720-730. doi: 10.1177/0269215511398376 • Roehrs, T. G., & Karst, G. M. (2004). Effects of an aquatic exercise program on quality of life measures for individuals with progressive multiple sclerosis. Journal of neurologic physical therapy, 28 (2), 63-71. Retrieved from, http://web.a.ebscohost.com/ehost/detail?sid=8a0c88fd-9f69-4b44-b9ed-ff5f7b2e558d%40sessionmgr4002&vid=29&hid=4107&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=rzh&AN=2004181453. • Salem, Y., Hiller Scott, A., Karpatikin, H., Concert, G., Haller, L., Kaminsky, E., et al. (2011). Community-based group aquatic programme for individuals with multiple sclerosis: a pilot study. Disability and Rehabilitation, 33 (9), 720-728. doi: 10.3109/09638288.2010.507855 • Smith, C. M., Hale, L. A., Olson, K., & Baxter, G. D. (2013). Healthcare provier beliefs about exercise and fatigue in people with multiple sclerosis. Journal of Rehabilitation Research and Development, 50, 733-744. Retrieved from http://dx.doi.org/10.1682/ JRRD.2 012.01.0012 • Toomey, E., & Coote, S. B. (2012). Physical rehabilitation interventions in nonambulatory people with multiple sclerosis: a systematic review. International Journal of Rehabilitiation Research, 35 (4), 281-291. Retrieved from, http://dx.doi.org/10.1097/ MRR.0b013e32835a241a. • While, A., Forbes, A., Ullman, R., & Mathes, L. (2008). The role of specialist and general nurses working with people withe multiple sclerosis. Journal of Clinical Nursing, 18, 2635-2648. Retrieved from, http://dx.doi.org/10.1682/JRRD.2010.03.0035. • Wier, L. M., Hatcher, M. S., Triche, E. W., & Lo, A. C. (2011). Effect of robot-assisted versus conventional body-weight-supported treadmill training on quality of life for people with multiple sclerosis. Journal of rehabilitation research and Development, 48 (4), 483-492. doi:10.1682/JRRD.2010.03.0035 • Wilbanks, J. (2012). Disease-modifying therapies for multiple sclerosis: Focus on future direction. Formulary, 47, 392-399. Retreived from, http://web.a.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=8a0c88fd-9f69-4b44-b9ed-ff5f7b2e558d%40sessionmgr4002&vid=14&hid=4107.

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