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Article ; Online: Ethics Education in Health Sciences Should Engage Contentious Social Issues: Here Is Why and How.

Tilburt, Jon / Hafferty, Fred / Leep Hunderfund, Andrea / Meltzer, Ellen / Thorsteinsdottir, Bjorg

Cambridge quarterly of healthcare ethics : CQ : the international journal of healthcare ethics committees

2024 , Page(s) 1–5

Abstract: Teaching ethics is crucial to health sciences education. Doing it well requires a willingness to engage contentious social issues. Those issues introduce conflict and risk, but avoiding them ignores moral diversity and renders the work of ethics ... ...

Abstract	Teaching ethics is crucial to health sciences education. Doing it well requires a willingness to engage contentious social issues. Those issues introduce conflict and risk, but avoiding them ignores moral diversity and renders the work of ethics education irrelevant. Therefore, when (not if) contentious issues and moral differences arise, they must be acknowledged and can be addressed with humility, collegiality, and openness to support learning. Faculty must risk moments when not everyone will "feel safe," so the candor implied in psychological safety can emerge. The deliberative and social work of ethics education involves generous listening, wading into difference, and wondering together if our beliefs and arguments are as sound as we once thought. By
Language	English
Publishing date	2024-01-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	1146581-5
ISSN	1469-2147 ; 0963-1801
ISSN (online)	1469-2147
ISSN	0963-1801
DOI	10.1017/S0963180123000567
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Zs.A 3650: Show issues

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Article ; Online: Prioritizing health care workers and first responders for access to the COVID19 vaccine is not unethical, but both fair and effective - an ethical analysis.

Thorsteinsdottir, Bjorg / Madsen, Bo Enemark

Scandinavian journal of trauma, resuscitation and emergency medicine

2021 Volume 29, Issue 1, Page(s) 77

Abstract: The Nordic countries have differed in their approach as to how much priority for COVID19 vaccine access should be given to health care workers. Two countries decided not to give health care workers highest priority, raising some controversy. The ... ...

Abstract	The Nordic countries have differed in their approach as to how much priority for COVID19 vaccine access should be given to health care workers. Two countries decided not to give health care workers highest priority, raising some controversy. The rationale was that those at highest risk of dying needed to come first. However, when it comes to protecting those at the highest risk of dying from COVID19, their needs and vulnerabilities need to be considered more broadly than just in terms of the individual protection that vaccination will afford them. Likewise, when considering whether to prioritize health care workers for the vaccine, their crucial role in keeping the health care system operational, and right to a safe work environment need to be factored in. Below we review several ethical arguments for why frontline health care workers and first responders should receive priority access to the COVID19 vaccine.
MeSH term(s)	COVID-19/prevention & control ; COVID-19 Vaccines/therapeutic use ; Delivery of Health Care ; Emergency Responders ; Ethical Analysis ; Health Personnel ; Health Priorities/ethics ; Humans ; Risk Factors ; SARS-CoV-2 ; Scandinavian and Nordic Countries ; Workplace
Chemical Substances	COVID-19 Vaccines
Language	English
Publishing date	2021-06-04
Publishing country	England
Document type	Letter ; Review
ZDB-ID	2455990-8
ISSN	1757-7241 ; 1757-7241
ISSN (online)	1757-7241
ISSN	1757-7241
DOI	10.1186/s13049-021-00886-2
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: The Taming of the Flu: Lessons from the Tragedy of COVID-19 and the Absence of an Influenza Season.

Tande, Aaron J / Binnicker, Matthew / Thorsteinsdottir, Bjorg

The American journal of medicine

2021 Volume 134, Issue 9, Page(s) 1063–1064

MeSH term(s)	COVID-19/epidemiology ; COVID-19/prevention & control ; Humans ; Influenza, Human/prevention & control ; SARS-CoV-2
Language	English
Publishing date	2021-05-25
Publishing country	United States
Document type	Editorial ; Research Support, N.I.H., Extramural
ZDB-ID	80015-6
ISSN	1555-7162 ; 1873-2178 ; 0002-9343 ; 1548-2766
ISSN (online)	1555-7162 ; 1873-2178
ISSN	0002-9343 ; 1548-2766
DOI	10.1016/j.amjmed.2021.04.023
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Article ; Online: Never Waste a Pandemic: Strategies to Increase Advance Care Planning Now.

Alli, Adebisi / Thorsteinsdottir, Bjorg / Carey, Elise C / Havyer, Rachel D

Mayo Clinic proceedings. Innovations, quality & outcomes

2021 Volume 5, Issue 5, Page(s) 946–950

Language	English
Publishing date	2021-09-20
Publishing country	Netherlands
Document type	Journal Article ; Review
ISSN	2542-4548
ISSN (online)	2542-4548
DOI	10.1016/j.mayocpiqo.2021.08.001
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Article ; Online: Combined Oral Contraceptive Pill-Induced Hypertension and Hypertensive Disorders of Pregnancy: Shared Mechanisms and Clinical Similarities.

Gunaratne, Madugodaralalage D S K / Thorsteinsdottir, Bjorg / Garovic, Vesna D

Current hypertension reports

2021 Volume 23, Issue 5, Page(s) 29

Abstract: Purpose of review: Oral contraceptive pill-induced hypertension (OCPIH) and hypertensive disorders in pregnancy (HDP) share common risk factors and pathophysiological mechanisms, yet the bidirectional relationship between these two conditions is not ... ...

Abstract	Purpose of review: Oral contraceptive pill-induced hypertension (OCPIH) and hypertensive disorders in pregnancy (HDP) share common risk factors and pathophysiological mechanisms, yet the bidirectional relationship between these two conditions is not well-established. We review and describe OCPIH and HDP to better understand how hormonal and metabolic imbalances affect hypertension. Recent findings: Oral contraceptive pills continue to be a popular method of contraception, with an incidence of OCPIH ranging from 1-8.5% among OCP users. HDP have an incidence of 5-10% of all pregnancies in the USA and have been shown to be a powerful predictor of lifetime adverse cardiovascular outcomes, including future hypertension. OCPIH and HDP share common risk factors such as age, BMI, past personal and family history of hypertension, as well as pathogenic mechanisms, including alterations in hormonal metabolism and the renin angiotensin aldosterone system; imbalance of vasodilator-vasoconstrictor compounds; and changes in the cardiovascular system. Future research should address additional potential mechanisms that underlie hypertension in these two conditions where endocrine changes, either physiological (pregnancy) or iatrogenic (use of OCP), play a role. This may lead to novel, targeted treatment options to improve hypertension management and overall cardiovascular risk profile management in this subset of young female patients.
MeSH term(s)	Cardiovascular System ; Contraceptives, Oral, Combined/adverse effects ; Female ; Humans ; Hypertension, Pregnancy-Induced/chemically induced ; Pregnancy ; Renin-Angiotensin System ; Risk Factors
Chemical Substances	Contraceptives, Oral, Combined
Language	English
Publishing date	2021-05-13
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Review
ZDB-ID	2057367-4
ISSN	1534-3111 ; 1522-6417
ISSN (online)	1534-3111
ISSN	1522-6417
DOI	10.1007/s11906-021-01147-4
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Zs.A 5522: Show issues

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Article ; Online: Impact of Program Changes Including Telemedicine and Telephonic Care During the COVID-19 Pandemic in Preventing 30-Day Hospital Readmission for Patients in a Care Transitions Program.

Takahashi, Paul Y / Thorsteinsdottir, Bjorg / McCoy, Rozalina G / Ramar, Priya / Canning, Rachel E / Hanson, Gregory J / Baumbach, Lori J / Chandra, Anupam / Philpot, Lindsey M

Journal of primary care & community health

2024 Volume 15, Page(s) 21501319241226547

Abstract: Introduction/objectives: To describe health outcomes of older adults enrolled in the Mayo Clinic Care Transitions (MCCT) program before and during the COVID-19 pandemic compared to unenrolled patients.: Methods: We conducted a retrospective cohort ... ...

Abstract	Introduction/objectives: To describe health outcomes of older adults enrolled in the Mayo Clinic Care Transitions (MCCT) program before and during the COVID-19 pandemic compared to unenrolled patients. Methods: We conducted a retrospective cohort study of adults (age >60 years) in the MCCT program compared to a usual care control group from January 1, 2019, to September 20, 2022. The MCCT program involved a home, telephonic, or telemedicine visit by an advanced care provider. Outcomes were 30- and 180-day hospital readmissions, emergency department (ED) visit, and mortality. We performed a subgroup analysis after March 1, 2020 (during the pandemic). We analyzed data with Cox proportional hazards regression models and hazard ratios (HRs) with 95% CIs. Results: Of the 1,012 patients total, 354 were in the MCCT program and 658 were in the usual care group with a mean (SD) age of 81.1 (9.1) years overall. Thirty-day readmission was 16.9% (60 of 354) for MCCT patients and 14.7% (97 of 658) for usual care patients (HR, 1.24; 95% CI, 0.88-1.75). During the pandemic, the 30-day readmission rate was 15.1% (28 of 186) for MCCT patients and 14.9% (68 of 455) for usual care patients (HR, 1.20; 95% CI, 0.75-1.91). There was no difference between groups for 180-day hospitalization, 30- or 180-day ED visit, and 30- or 180-day mortality. Conclusions: Numerous factors involving patients, providers, and health care delivery systems during the pandemic most likely contributed to these findings.
MeSH term(s)	Humans ; Aged ; Middle Aged ; Aged, 80 and over ; Patient Readmission ; COVID-19/epidemiology ; Pandemics ; Patient Transfer ; Retrospective Studies ; Telemedicine ; Ambulatory Care Facilities
Language	English
Publishing date	2024-01-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	2550221-9
ISSN	2150-1327 ; 2150-1319
ISSN (online)	2150-1327
ISSN	2150-1319
DOI	10.1177/21501319241226547
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Article ; Online: Dysphagia in Older Adults.

Thiyagalingam, Shanojan / Kulinski, Anne E / Thorsteinsdottir, Bjorg / Shindelar, Katrina L / Takahashi, Paul Y

Mayo Clinic proceedings

2021 Volume 96, Issue 2, Page(s) 488–497

Abstract: Dysphagia, which is a geriatric syndrome affecting 10% to 33% of older adults, is commonly seen in older adults who have experienced a stroke or neurodegenerative diseases such as Alzheimer or Parkinson disease. Patients diagnosed as having dysphagia can ...

Abstract	Dysphagia, which is a geriatric syndrome affecting 10% to 33% of older adults, is commonly seen in older adults who have experienced a stroke or neurodegenerative diseases such as Alzheimer or Parkinson disease. Patients diagnosed as having dysphagia can experience malnutrition, pneumonia, and dehydration. Patients can also experience increased rates of mortality and long-term care admission. Providers can identify the specific type of dysphagia for treatment in approximately 80% of patients by asking 5 questions in the patient's history: What happens when you try to swallow? Do you have trouble chewing? Do you have difficulty swallowing solids, liquids, or both? Describe the symptom onset, duration, and frequency? What are the associated symptoms? Providers can then request a videofluoroscopic swallow study or a fiberoptic endoscopic evaluation of swallowing for further evaluation of oropharyngeal dysphagia. If providers are diagnosing esophageal dysphagia, barium esophagraphy or esophagogastroduodenoscopy (EGD) can be used as part of the assessment. Patients can be treated for oropharyngeal dysphagia by using compensatory interventions, including behavioral changes, oral care, dietary modification, or rehabilitative interventions such as exercises and therapeutic oral trials. Providers often address treatment of esophageal dysphagia by managing the underlying etiology, which could include removal of caustic medications or using EGD as a therapeutic modality for esophageal rings. High-quality, large research studies are necessary to further manage the diagnosis and appropriate treatment of this growing geriatric syndrome.
MeSH term(s)	Aged ; Deglutition Disorders/diagnosis ; Deglutition Disorders/etiology ; Deglutition Disorders/therapy ; Geriatric Assessment ; Humans
Language	English
Publishing date	2021-02-03
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	124027-4
ISSN	1942-5546 ; 0025-6196
ISSN (online)	1942-5546
ISSN	0025-6196
DOI	10.1016/j.mayocp.2020.08.001
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Article ; Online: Never Waste a Pandemic

Adebisi Alli, DO, MS / Bjorg Thorsteinsdottir, MD / Elise C. Carey, MD / Rachel D. Havyer, MD

Mayo Clinic Proceedings: Innovations, Quality & Outcomes, Vol 5, Iss 5, Pp 946-

Strategies to Increase Advance Care Planning Now

2021 Volume 950

Keywords	Medicine (General) ; R5-920
Language	English
Publishing date	2021-10-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Spheres of Influence and Strategic Advocacy for Equity in Medicine.

Karches, Kyle / DeCamp, Matthew / George, Maura / Prochaska, Micah / Saunders, Milda / Thorsteinsdottir, Bjorg / Dzeng, Elizabeth

Journal of general internal medicine

2021 Volume 36, Issue 11, Page(s) 3537–3540

Abstract: As the extent of health disparities in the USA has been revealed, particularly during the COVID-19 pandemic, physicians have increasingly attended to their roles as advocates for their patients and communities. This article presents "spheres of influence" ...

Abstract	As the extent of health disparities in the USA has been revealed, particularly during the COVID-19 pandemic, physicians have increasingly attended to their roles as advocates for their patients and communities. This article presents "spheres of influence" as a concept that can help physicians think strategically about how to build upon their clinical work and expertise to promote equity in medicine. The physician's primary sphere of influence is in direct patient care. However, physicians today often have many other roles, especially within larger health care institutions in which physicians often occupy positions of authority. Physicians are therefore well-positioned to act within these spheres in ways that draw upon the ethical principles that guide patient care and contribute materially to the cause of equity for colleagues and patients alike. By making changes to the ways they already work within their clinical spaces, institutional leadership roles, and wider communities, physicians can counteract the structural problems that undermine the health of the patients they serve.
MeSH term(s)	COVID-19 ; Humans ; Leadership ; Pandemics ; Physicians ; SARS-CoV-2
Language	English
Publishing date	2021-05-19
Publishing country	United States
Document type	Editorial
ZDB-ID	639008-0
ISSN	1525-1497 ; 0884-8734
ISSN (online)	1525-1497
ISSN	0884-8734
DOI	10.1007/s11606-021-06893-4
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Zs.A 2205: Show issues

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Article ; Online: Decisional Regret Surrounding Dialysis Initiation: A Comparative Analysis.

Pawar, Aditya S / Thorsteinsdottir, Bjorg / Whitman, Sam / Pine, Katherine / Lee, Alexander / Espinoza Suarez, Nataly R / Organick Lee, Paige / Thota, Anjali / Lorenz, Elizabeth / Beck, Annika / Albright, Robert / Feely, Molly / Williams, Amy / Behnken, Emma / Boehmer, Kasey R

Kidney medicine

2023 Volume 6, Issue 3, Page(s) 100785

Abstract: Rationale & objective: Dialysis comes with a substantial treatment burden, so patients must select care plans that align with their preferences. We aimed to deepen the understanding of decisional regret with dialysis choices.: Study design: This ... ...

Abstract	Rationale & objective: Dialysis comes with a substantial treatment burden, so patients must select care plans that align with their preferences. We aimed to deepen the understanding of decisional regret with dialysis choices. Study design: This study had a mixed-methods explanatory sequential design. Setting & participants: All patients from a single academic medical center prescribed maintenance in-center hemodialysis or presenting for home hemodialysis or peritoneal dialysis check-up during 3 weeks were approached for survey. A total of 78 patients agreed to participate. Patients with the highest (15 patients) and lowest decisional regret (20 patients) were invited to semistructured interviews. Predictors: Decisional regret scale and illness intrusiveness scale were used in this study. Analytical approach: Quantitatively, we examined correlations between the decision regret scale and illness intrusiveness scale and sorted patients into the highest and lowest decision regret scale quartiles for further interviews; then, we compared patient characteristics between those that consented to interview in high and low decisional regret. Qualitatively, we used an adapted grounded theory approach to examine differences between interviewed patients with high and low decisional regret. Results: Of patients invited to participate in the interviews, 21 patients (8 high regret, 13 low regret) agreed. We observed that patients with high decisional regret displayed resignation toward dialysis, disruption of their sense of self and social roles, and self-blame, whereas patients with low decisional regret demonstrated positivity, integration of dialysis into their identity, and self-compassion. Limitations: Patients with the highest levels of decisional regret may have already withdrawn from dialysis. Patients could complete interviews in any location (eg, home, dialysis unit, and clinical office), which may have influenced patient disclosure. Conclusions: Although all patients experienced disruption after dialysis initiation, patients' approach to adversity differs between patients experiencing high versus low regret. This study identifies emotional responses to dialysis that may be modifiable through patient-support interventions.
Language	English
Publishing date	2023-12-20
Publishing country	United States
Document type	Journal Article
ISSN	2590-0595
ISSN (online)	2590-0595
DOI	10.1016/j.xkme.2023.100785
Database	MEDical Literature Analysis and Retrieval System OnLINE

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