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  1. Article ; Online: Surgeon Perspectives on Daily Presentation of Ethical Dilemmas: A Qualitative Study.

    Char, Steven / Prager, Kenneth / Dugdale, Lydia / Fischkoff, Katherine

    Journal of the American College of Surgeons

    2023  Volume 237, Issue 5, Page(s) 751–761

    Abstract: Background: Surgeons encounter and navigate a unique set of ethical dilemmas. The American College of Surgeons (ACS) previously identified 6 core ethical issues central to the practice of surgery, but there have been no reports of the true range and ... ...

    Abstract Background: Surgeons encounter and navigate a unique set of ethical dilemmas. The American College of Surgeons (ACS) previously identified 6 core ethical issues central to the practice of surgery, but there have been no reports of the true range and complexity of ethical dilemmas encountered by surgeons in their daily practice. Qualitative research is well positioned to address this question.
    Study design: We conducted in-depth interviews with attending surgeons across multiple surgical subspecialties at a large, urban, academic medical center asking them to describe the most common ethical dilemmas they encounter in day-to-day practice. Interviews were recorded, transcribed, and coded according to a grounded theory, inductive approach.
    Results: Thirty attending surgeons were interviewed, representing twelve different general surgery subspecialties. The majority of dilemmas identified pertained to 4 of the 6 ACS identified core ethical issues: professional obligations, competition of interests, truth telling, and end-of-life care. No participants described dilemmas relating to the themes of confidentiality or surrogate decision-making. Approximately one-third of participants identified ethical issues not well characterized by the ACS core principles, most often relating to the pressure to provide care that is not medically indicated. There was strong support for a formalized surgical ethics curriculum.
    Conclusions: Although the ACS-defined core ethical issues in surgery appropriately captured many ethical dilemmas identified by participants, surgeons described several scenarios not well characterized by these themes. A dedicated surgical ethics curriculum may help to better equip surgeons to navigate the ethical dilemmas they are likely to face in practice.
    MeSH term(s) Humans ; Surgeons ; Confidentiality ; Qualitative Research
    Language English
    Publishing date 2023-10-16
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1181115-8
    ISSN 1879-1190 ; 1072-7515
    ISSN (online) 1879-1190
    ISSN 1072-7515
    DOI 10.1097/XCS.0000000000000802
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Ethical Framework to Guide Decisions of Treatment Over Objection.

    Fischkoff, David / Prager, Kenneth / Dastidar, Joyeeta / Dugdale, Lydia / Neuberg, Gerald / Nemeth, Samantha / Fischkoff, Katherine

    Journal of the American College of Surgeons

    2021  Volume 233, Issue 4, Page(s) 508–516.e1

    Abstract: Background: Whether to proceed with a medical intervention over the objection of a patient who lacks capacity is a common problem facing practitioners. Despite this, there is a notable gap in the literature describing how to proceed in such situations ... ...

    Abstract Background: Whether to proceed with a medical intervention over the objection of a patient who lacks capacity is a common problem facing practitioners. Despite this, there is a notable gap in the literature describing how to proceed in such situations in an ethically rigorous and consistent fashion. We elaborate on the practical application of the 2018 Rubin and Prager 7-question algorithm for ethics consultations about treatment over objection and we describe the impact of each of the 7 questions.
    Study design: We retrospectively review a series of consultations at Columbia University Irving Medical Center between April 2017 and May 2020 for treatment over objection in adult patients determined to lack capacity. Outcomes about the final ethics recommendation and the assessment of each of the 7 questions are reported. The statistical analysis was designed to determine which of the 7 questions in the algorithm were most predictive of the final ethics recommendation.
    Results: In our series, there was an ethics recommendation to proceed over the objection of a patient in 63% of consultations. Although all 7 questions were considered to be important to the ethical analysis of a patient's situation, the presence of logistical barriers to treatment and the imminence of harm to a patient without treatment emerged as the most significant drivers of the recommendation of whether to proceed over objection or not.
    Conclusions: Cases of treatment over objection in a patient lacking capacity are frequently encountered problems that require a careful balance of patient autonomy and a physician's duty of beneficence. The application of the Rubin and Prager 7-question algorithm reliably guides a care team through such a complex ethical dilemma.
    MeSH term(s) Ethics, Medical ; Female ; Humans ; Informed Consent/ethics ; Informed Consent/legislation & jurisprudence ; Male ; Mental Competency/legislation & jurisprudence ; Middle Aged ; Referral and Consultation/ethics ; Retrospective Studies ; Treatment Refusal/legislation & jurisprudence
    Language English
    Publishing date 2021-07-26
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1181115-8
    ISSN 1879-1190 ; 1072-7515
    ISSN (online) 1879-1190
    ISSN 1072-7515
    DOI 10.1016/j.jamcollsurg.2021.07.003
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: An ethical justification for the withdrawal of ventricular assist devices.

    Fischkoff, Katherine / Nakagawa, Shunichi / Blitzer, David / Naka, Yoshifuma

    The Journal of thoracic and cardiovascular surgery

    2020  Volume 160, Issue 1, Page(s) e5

    MeSH term(s) Heart Failure ; Heart Transplantation ; Heart-Assist Devices ; Humans ; Morals
    Language English
    Publishing date 2020-03-10
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 3104-5
    ISSN 1097-685X ; 0022-5223
    ISSN (online) 1097-685X
    ISSN 0022-5223
    DOI 10.1016/j.jtcvs.2020.01.075
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Developing an Algorithm to Guide Resumption of Operative Activity in the COVID-19 Pandemic and Beyond.

    Coleman, Natasha L / Argenziano, Michael / Fischkoff, Katherine N

    Annals of surgery

    2020  Volume 272, Issue 3, Page(s) e236–e239

    MeSH term(s) Algorithms ; COVID-19/epidemiology ; COVID-19/prevention & control ; COVID-19/transmission ; Humans ; Infection Control/organization & administration ; Patient Selection ; Surgical Procedures, Operative ; Triage/organization & administration ; Waiting Lists
    Keywords covid19
    Language English
    Publishing date 2020-06-15
    Publishing country United States
    Document type Journal Article
    ZDB-ID 340-2
    ISSN 1528-1140 ; 0003-4932
    ISSN (online) 1528-1140
    ISSN 0003-4932
    DOI 10.1097/SLA.0000000000004123
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Surgery Scheduling in a Crisis.

    Argenziano, Michael / Fischkoff, Katherine / Smith, Craig R

    The New England journal of medicine

    2020  Volume 382, Issue 23, Page(s) e87

    MeSH term(s) Appointments and Schedules ; Betacoronavirus ; COVID-19 ; Coronavirus Infections ; Critical Care/organization & administration ; Health Care Rationing/methods ; Health Facility Size ; Hospital Administration ; Hospitals, University/organization & administration ; Humans ; Intensive Care Units ; New York City ; Operating Rooms/organization & administration ; Pandemics ; Pneumonia, Viral ; SARS-CoV-2 ; Surgery Department, Hospital/organization & administration ; Triage/methods
    Keywords covid19
    Language English
    Publishing date 2020-05-22
    Publishing country United States
    Document type Letter
    ZDB-ID 207154-x
    ISSN 1533-4406 ; 0028-4793
    ISSN (online) 1533-4406
    ISSN 0028-4793
    DOI 10.1056/NEJMc2017424
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Trends in Comprehensive Thoracic Case Experience Among General Surgery Residents in the Modern Integrated Cardiothoracic Residency Era: Review of Twenty Years of Resident Case Logs.

    Blitzer, David / Benintende, Andrew J / Nemeth, Samantha / Kurlansky, Paul / Antkowiak, Mark / Fischkoff, Katherine / Argenziano, Michael / Takayama, Hiroo

    The American surgeon

    2023  Volume 89, Issue 12, Page(s) 5512–5519

    Abstract: Background: Thoracic surgery training among general surgery residents in the United States is regulated by the Accreditation Council for Graduate Medical Education (ACGME) to ensure exposure to subspecialty fields during residency. Thoracic surgery ... ...

    Abstract Background: Thoracic surgery training among general surgery residents in the United States is regulated by the Accreditation Council for Graduate Medical Education (ACGME) to ensure exposure to subspecialty fields during residency. Thoracic surgery training has changed over time with the placement of work hour restrictions, the emphasis on minimally invasive surgery, and increased subspecialization of training like integrated six-year cardiothoracic surgery programs. We aim to investigate how these changes over the past twenty years have affected thoracic surgery training among general surgery residents.
    Methods: ACGME general surgery resident case logs from 1999 to 2019 were reviewed. Data included exposure to the thorax via thoracic, cardiac, vascular, pediatric, trauma, and alimentary tract procedures. Cases from the above categories were consolidated to determine the comprehensive experience. Descriptive statistics were performed over four 5-year Eras (Era 1:1999-2004, Era 2: 2004-2009, Era 3: 2009-2014, Era 4: 2014-2019).
    Results: Between Era 1 and Era 4, there was an increase in thoracic surgery experience (37.6 ± 1.03 vs 39.3 ± .64;
    Discussion: Over twenty years there has been a similar, to slight increase in thoracic surgery exposure among general surgery residents. The changes seen in thoracic surgery training reflect the overall movement of surgery towards minimally invasive surgery.
    MeSH term(s) Humans ; United States ; Child ; Internship and Residency ; Education, Medical, Graduate ; Specialties, Surgical/education ; Thoracic Surgery/education ; Thoracic Surgical Procedures ; Accreditation ; Clinical Competence ; General Surgery/education ; Workload
    Language English
    Publishing date 2023-02-16
    Publishing country United States
    Document type Journal Article
    ZDB-ID 202465-2
    ISSN 1555-9823 ; 0003-1348
    ISSN (online) 1555-9823
    ISSN 0003-1348
    DOI 10.1177/00031348231157417
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Blood stewardship: conservation and supply of blood components during the severe acute respiratory syndrome coronavirus 2 pandemic.

    Vossoughi, Sarah / Fischkoff, Katherine / DeSimone, Robert A / Schwartz, Joseph

    Transfusion

    2020  Volume 60, Issue 9, Page(s) 2156–2158

    MeSH term(s) Academic Medical Centers/organization & administration ; Blood Banks/organization & administration ; Blood Component Transfusion/methods ; Blood Component Transfusion/statistics & numerical data ; Blood Preservation ; COVID-19/epidemiology ; Emergencies ; Health Services Needs and Demand ; Hospital Shared Services/organization & administration ; Humans ; New York City ; Pandemics ; Resource Allocation ; SARS-CoV-2 ; Triage
    Keywords covid19
    Language English
    Publishing date 2020-07-16
    Publishing country United States
    Document type Letter
    ZDB-ID 208417-x
    ISSN 1537-2995 ; 0041-1132
    ISSN (online) 1537-2995
    ISSN 0041-1132
    DOI 10.1111/trf.15995
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Developing an Algorithm to Guide Resumption of Operative Activity in the COVID-19 Pandemic and Beyond

    Coleman, Natasha L. / Argenziano, Michael / Fischkoff, Katherine N.

    Annals of Surgery

    2020  Volume 272, Issue 3, Page(s) e236–e239

    Keywords Surgery ; covid19
    Language English
    Publisher Ovid Technologies (Wolters Kluwer Health)
    Publishing country us
    Document type Article ; Online
    ZDB-ID 340-2
    ISSN 1528-1140 ; 0003-4932
    ISSN (online) 1528-1140
    ISSN 0003-4932
    DOI 10.1097/sla.0000000000004123
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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