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Monday, March 23, 2020

HearX Group- Artificial Intelligence Classification


Image result for hearx group otoscopeHear X is a start-up in South Africa, it was established in the year of 2015. Several audiologist and engineers came together to create affordable access to hearing healthcare using digital small solutions. The idea was to provide available products that would assess early onset of digital hearing problems among the population. The flagship technology, hearing loss and ear screening technology, it works with calibrated HD headphones. There is more than one million case that was performed in 39 countries. This is a rapid growing technological device that aims at providing patients with hearing impairment the best available hearing healthcare. Currently, in the clinical state, there are seven solutions in health which is a centralized data management platform.

HearScreen is a smartphone test performed using calibrated HD Headphones: this is used for quick hearing tests to determine if there is a hearing loss and suggest if the patient needs immediate medical care.

HearTest can be used to determine the threshold of hearing loss.

PeekAcuity is a visual acuity test.

hearTest Occ Health is the newest product. It is a certified digital, smartphone, audiometer. It gets used by industries to perform hearing tests, a baseline test can be set and hearing can be compared over time. According to the speaker, “employees seem to love the product, because they can go for a quick 30 minutes hearing test on the premise and thereafter get back to work without having to stop the work for a day.   

HearOAE: this is an otoacoustic emission screening and diagnosing tool used for newborn hear screenings; it is used to test newborns hearing to allow the health practitioner to treat the hearing impairment from an early stage onwards.  

HearScope was released through an Indiegogo campaign in the year of 2017. Indiegogo is a crowdfunded campaign.

Artificial Intelligence (AI) in hearScope: AI is the newest feature that was released in hearScope on the 9th March 2020. It has been under development since the year of 2017. hearScope is a smartphone video otoscope that can be used to view the “Tympanic Membrane” and ear canal. It captures images and videos of the Tympanic Membrane and ear canal; audiologists are excited about this product because in developing countries, public clinics and hospitals have a lot of patients and this can assist in triaging patients and ensure that patients receive the correct pre-examination treatment. It also enables patient involvement during an examination, because it enables clinicians to show the patient the images and videos taken of the ear canal and tympanic membrane.

The AI image classification feature assists healthcare practitioners to diagnose ear conditions. The AI model was trained using thousands of images that was all captured by the hearScope hardware. The images were  diagnosed by specialists; the system can diagnose wax obstructions, normal ears, chronic perforations, and abnormalities, which indicates a pathology is present and the patient should consult a specialist. As more images get collected, the AI model can be trained to recognize more pathologies. The AI is working towards being able to diagnose 12 pathologies, such as foreign bodies, cholesteatoma, acute otitis media, otitis media with effusion, myringosclerosis, wet chronic perforations, dry chronic perforations, grommets, wax obstructions, retractions, normal ears and unspecified. It is also planning it add extra pathologies to the system.

General practitioners are between 60-70% confident of diagnosing ear conditions. The AI image classification model has an accuracy of 94% to classify ear conditions, and it can assist health practitioners to confidently diagnose ear conditions. Furthermore, the AI plays a significant role in developing countries due to its low number of specialists, to assist hospitals Otorhinolaryngology (ENT) and general practitioners to screen both children and adults, to be able to triage and refer then accordingly. It helps to determine the type of ear disease to treat, for instance, if a patient complains of pain in the ear, the AI image classification can classify a wax obstruction and the patient can simply go to the clinic and a clinician can remove the wax blockage. The hearScope, with the AI image classification feature can be used by anybody and not only healthcare practitioners. 

A quick notice, with the current situation of Coronavirus (also known as COVID-19), there have been a high increase in inquiries of the AI image classification. Telemedicine has proven to be useful in a case like this; people can purchase a hearScope via the HearX website (www.hearxgroup.com), use the hearScope to self-screen and send the images and videos to their respective general practitioner (family doctor) for a diagnosis.  

The beta-version AI geature has been launched in March, the feature is currently free, but will become paid once the necessary FDA and CE approvals have been received. The AI classification works together with the hearScope hardware; the hardware has a cost incurred on it; the software is free. The hearScope hardware is 200 USD. The price for the AI subscriptions is not yet known.
The device has been under development since the year of 2017 when it was released on IndieGoGo. Various bodies contributed in the development of the product such as the advisory panel (four well known specialist across the world), research partners that assisted with the diagnosis of images, the image collectors, which captures the ear images. The images are validated and there is an exclusion criterion to the images, such as an image of the finger or any image that is not related to the ear. The validated images are further presented to the Panel of Research Diagnosis Partners (PRDP); the PRDP diagnose the situation based on their respective specialties. The hearScope hardware is FDA approved and meets all the hospital standard requirements.

The hardware is expected to be durable for at least 15 years depending on the number of usages on the hardware. The hardware id accompanied with a one-year warranty.
The biggest issue while developing the device, was integrating and improving the quality of the “Collection of Images”. Another problem that arose was finding specialists that can diagnose the images.

The application is also compatible with desktop devices such as Windows, Mac and Linux; however, the device smartphone app is only compliable with android phones. The hardware comes with a storage case for safe keeping. The hardware also has its own packaging such as a stant for the phone, adapter, specula which attaches to the front of the scope, and connectors.
The device is available to use and familiarize with. There are various institutions, such as the Manchester University in the UK or University of Pretoria in South Africa, across the world that have access to the device for academic purposes.

Thursday, March 19, 2020

Coronavirus in Africa-A Worldwide Pandemic


Image result for coronavirus in nigeria updateNigeria has joined the rest of the African countries with restriction on airlines that are arriving from countries with high cases of coronavirus. Nigeria has shut down their airports and land borders to minimize the number of people from entering the country. On Monday, Tunisia suspended all international flights and closed their land borders to prevent the risk of spread of the virus. They also put a restriction on market squares gathering and included a curfew between 6am to 6pm to avoid overcrowded areas. Sudan has sealed off all seaports, land crossings and airports, according to Mohamed Al-Faki Suleiman, a spokesman for Sudan’s Transitional Sovereign Council.
Hundreds of international flights have been canceled and suspended, schools are closes, and there is a restriction limiting travelers from coronavirus-hit countries or there is a ban from visiting some African countries.

Nigeria has banned the entry of travelers from 13 different countries including the US and UK- this was announced on Wednesday due to the rise of cases in the country. "The Federal Government of Nigeria has also suspended the issuance of visa on arrival to travelers from these countries. All travelers returning from these countries prior to the restriction will be in supervised self-isolation, monitored by the NCDC and Port Health Services". The ban will be effective on the 20th of March 2020 and will be revoked until further notice.

Health officials have reported an addition of five cases of COVID-19 in Nigeria; therefore, resulting to a total of eight confirmed cases, which one of the patients have been recovered from the virus, “an Italian man on a business trip in the country”, stated by the authorities.

Egypt has made an announcement on suspending international flights starting on Thursday to prevent the spread of the virus in the country. Also, Egypt has the highest number of Coronavirus case in Africa. Meanwhile, other countries such as Djibouti is yet to report any cases of Coronavirus; however, they have restricted the entry of all international flights in the country, according to a statement made by the US embassy in Djibouti. All international government officials are in support of the travel bans across the world (Stephanie Busari and Bukola Adebayo, 2020)


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REFERENCES:
Stephanie Busari,  and B. A. (2020). Nigeria coronavirus: entry ban for travelers from 13 countries as it announces five new cases - CNN. Retrieved March 19, 2020, from https://www.cnn.com/2020/03/18/africa/nigeria-coronavirus-travel-restrictions-intl/index.html






Monday, March 16, 2020

United Kingdom Response To COVID-19:

Image result for coronavirus in ukWorld Health Organization has declared Europe the epicenter of the pandemic of novel coronavirus. It has also been stated by the WHO that there has been about 5000 death across the world as a result of the virus. In the United Kingdom, 11 people have died due to coronavirus, including one death in Scotland. There has been a rapid spread of coronavirus in the UK resulting to 798 confirmed cases across the country- an increase of 208 in comparison with Thursday. However, health officials believe that the actual number of people that could be infected with the virus is between 5,000 and 10,000. Sir Patrick mentioned that he hopes the British government’s approach to address the virus would create a “herd immunity in UK”(“Coronavirus: UK measures defended after criticism - BBC News,” 2020) .
The prime minister of United Kingdom announced that the British government officials will delay their response to address the outbreak of COVID-19, and warned that Britons that they are facing the “worse public health crisis for a generation” and they should be prepared “to lose their loved ones and family”. The United Kingdom would not be taking the same measures as the result of the other to tackle this rapid outbreak. The government later stated that “it doesn’t believe that shutting down large scale gatherings and closing schools-like Italy, France, Germany and Spain have done would be effective in preventing the spread of the disease”(“UK coronavirus response: What does Britain know that Europe doesn’t? - CNN,” 2020).

REFERENCES:
Coronavirus: UK measures defended after criticism - BBC News. (2020). Retrieved March 16, 2020, from https://www.bbc.com/news/uk-51865915

UK coronavirus response: What does Britain know that Europe doesn’t? - CNN. (2020). Retrieved March 16, 2020, from https://www.cnn.com/2020/03/13/uk/uk-coronavirus-response-boris-johnson-intl-gbr/index.html

Friday, March 13, 2020

100 New Cases in Canada- Prime Minister Justin Trudeau Confirms Wife Positive with Coronavirus


Of recent, Canada has reported 100 cases of Novel Coronavirus disease, COVID-19. Ontario has a total of 42 cases, British Columbia has 46, Quebec has 8 and Alberta has 19 cases of Coronavirus. A former passenger of the Grand Princess cruise ship had been tested positive for the disease. New Brunswick has confirmed its first case (YOUNG, 2020). Even though the outbreak of Coronavirus is expected in Canada, the public health system has prepared a response mechanism to the virus. The PHAC, together with the provincial, territorial and community partners are constantly reevaluating the health risk to the public based on the availability of evidence and research studies (“Coronavirus disease (COVID-19): Outbreak update - Canada.ca,” n.d.). The risk to Canadian travelers abroad varies on their destination, their age and health status. However, the Canadian government suggest that people to prevent all travel or non-essential travel(Laframboise, 2020).
Image result for justin trudeau and coronavirusIt seems that the world is working from a distance (from home) as the novel coronavirus (COVID-19) continues the threaten the health of the public. The Prime Minister of Canada Justin Trudeau is currently working and running his country in self isolation after his wife, Sophie Gregoire Trudeau had tested positive for Coronavirus. Due to the rapid and constant outbreak of COVID-19, dozens of government officials across the world from administrators to heads of state, to take precautionary measures after finding out that they may have been in contact with infected people or may haven tested positive for the coronavirus. Yet, there are no confirmation that suggests that Justin Trudeau might have the virus; nonetheless, he joins the list of officials who removed themselves from their workplace, including top US policy makers, the British Health Minister, Iran’s deputy health minister, France’s culture minister, Australia’s home affairs minister and the president of the European Parliament. On Friday, the 13th of March 13, 2020 Justin Trudeau confirmed via twitter that his wife had been infected with the virus. The Prime Minister would be joining digital meeting and videoconferences with other world leaders about the coronavirus cases (Angela, 2020).
References:


Angela, D. (2020). Justin Trudeau latest to self-isolate as coronavirus has officials running the world from home - CNN. Retrieved March 13, 2020, from https://www.cnn.com/2020/03/12/world/coronavirus-trudeau-politicians-infections-intl/index.html
Coronavirus disease (COVID-19): Outbreak update - Canada.ca. (n.d.). Retrieved March 13, 2020, from https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.html
Laframboise, K. (2020). Quebec calls for isolation of all travellers returning from abroad to limit spread of coronavirus | Globalnews.ca. Retrieved March 13, 2020, from https://globalnews.ca/news/6665502/quebec-coronavirus-march-12/

Wednesday, March 4, 2020

COVID-19, A Decline In The Number Of Cases of COVID-19

New reports indicate that COVID-19 also known as Coronavirus has mounted to 3,123 deaths across the world. Also, there has been a confirmation that there are new cases of Coronavirus resulting to 91,783. NHC have received new reports statin that there are 119 cases in China on Tuesday within 31 provinces and Xinjiang, including 115 cases in Hubei province. 

Furthermore, only four cases were reported on Tuesday outside Hubei, down from 890 on February 3rd, 2020. The NHC stated that there is a decrease in the number of coronavirus cases from the rest of the country. There are about 37 deaths in Hubei among the global death and one in Inner Mongolia Autonomous Region according to NHC. In the meantime, there 143 suspected cases which were reported; in addition, 520 people are still suspected of having the virus across the world. However, on Tuesday, the number of severe cases had reduced by 390 to 6,416, while 2,652 people were medically discharged after recovery.

In whole, 80,270 cases have been confirmed on the mainland, of which 2,981 had died, 27,433 patients are still being treated and 49,856 patients were discharged after recovery (“Global coronavirus cases cross 90,000-mark, spread reduces in China as others see surge - World News,” 2020).



REFERENCES:


Global coronavirus cases cross 90,000-mark, spread reduces in China as others see surge - World News. (2020). Retrieved March 4, 2020, from https://www.indiatoday.in/world/story/global-coronavirus-cases-cross-90-000-mark-1652239-2020-03-04

Monday, March 2, 2020

New Cases of Corona Virus-Ontario Reports


There are three new cases of Novel Coronavirus in Ontario, on Monday, the 2nd of March 2020, bringing a total of 18 cases in the province. The chief medical officer of Health in Ontario, Dr. David Williams was expected to provide more information about the ne cases at a press conference in late afternoon. It was reported that over the weekend, people who recently visited Iran or Egypt, or family members who visited any of those countries had entered Canada, infected with the virus. It has been confirmed that there are 1,501 cases of the virus in Iran with an estimate of 66 deaths in the country. However, a considerable number of people believe that there are more cases of the virus in the country. Egypt has only publicly reported two cases of the virus. Nonetheless, in China, over 80,000 people have been diagnosed with the virus and there are about 2,800 deaths as a result of the virus. Ontario has new three cases: Canada having a total of 27, with eight cases in British Columbia and one in Quebec. The Federal Health Minister Patty Hajdu encourages Canadians to stockpile food and medication in their respective homes in case they should fall sick or a loved on has developed the illness. Elliot suggested that it won’t be necessary to go through such measures; people should go on with their daily lives and be cautious. Anyone with the respective symptoms of COVID-19 should contact their public health unit (JONES, 2020).




REFERENCES:


JONES, A. (2020). 3 new cases of COVID-19 in Ontario, province total now at 18 | Globalnews.ca. Retrieved March 2, 2020, from https://globalnews.ca/news/6618753/covid-19-ontario-coronavirus/



Sudden Infant Death Syndrome:



Image result for SIDS


Sudden Infant Death Syndrome (SIDS) is when a baby less than a year-old dies unexpectedly without any form of explanation or cause. SIDS is also known as Crib Death or Court Death. Most SIDS are associated with irregularity in the portion of the infant’s brain that controls breathing and arousal from sleep (Floyd R. Livingston Jr., MD and Mary L. Gavin, 2020).

Approximately 2,300 babies in the United States die as a result of SIDS per year. Some babies may be at more risk than others. For instance, babies who are between 1-4 months old are at more risk of SIDS; it is usually common in boys than girls, and most deaths occur during fall, winter and early spring (Boston Children’s Hospital, 2020).

Several researchers and clinicians have determined some factors that puts at extra risk. Furthermore, there measures which have been identified by research on protecting children from SIDS. The following are measure followed (Floyd R. Livingston Jr., MD and Mary L. Gavin, 2020):

Early prenatal care
Share bedroom with baby without sharing bed
Use fitted sheet on baby’s mattress and no other bedding.  
Use pacifier to put baby to sleep.
Breastfeed can reduce the risk of SIDS
No history or smoking history during pregnancy.






Image result for SIDS




REFERENCES:


Boston Children’s Hospital. (2020). Sudden Infant Death Syndrome (SIDS) Symptoms & Causes | Boston Children’s Hospital. Retrieved March 2, 2020, from http://www.childrenshospital.org/conditions-and-treatments/conditions/s/sudden-infant-death-syndrome-sids/symptoms-and-causes
Floyd R. Livingston Jr., MD and Mary L. Gavin, M. (2020). Sudden Infant Death Syndrome (SIDS) (for Parents) - Nemours KidsHealth. Retrieved March 2, 2020, from https://kidshealth.org/en/parents/sids.html


Friday, February 28, 2020

New Update on Corona Virus- Also Known as COVID-19

The Centers for Disease Control and Prevention is responding to the current outbreak of CoronaVirus also known as COVID-19 that was first detected in Wuhan City, province of Hubei in China. The virus is said to have spread internationally throughout 50 countries across the world. The name of the virus is known as “SARS-Cov-2” and its disease is named COVID-19. 
On the 30th of January 2020, the International Health Regulations Emergency Committee of World Health Organization declared the outbreak of the virus a “Public Health Emergency of International Concern”. While on the 31st of January 2020, the Health and Human Services Secretary Alex M. Azar II announced that a public health emergency for the United States to aid the country’s healthcare community in responding to COVID-19. 
There is a rapid increase of fear regarding the COVID-19 across the world, but most specifically, California, USA- with a report of 8,400 people after the first possible case of direct contact with infected people of unknown origin. 
New cases have been confirmed in at least 10 countries as of Friday, the 28th of February, 2020, including, New Zealand, Netherlands and Nigeria. Furthermore, there is a significant rise in death cases of COVID-19 ranging with an estimate of 2,850 worldwide. 
Approximately 84, 000 people worldwide have been infected with the deadly virus known as COVID-19 within 50 different countries; including 4000 cases outside of China according to the John Hopkins University report. 



REFERENCES:

https://www.webmd.com/lung/news/20200124/coronavirus-2020-outbreak-latest-updates
https://www.cdc.gov/coronavirus/2019-ncov/summary.html

Monday, January 27, 2020

Lassa Fever-West Africa


Image result for virus icons"Lassa fever is an animal-borne or zoonotic acute viral illness. It has been proven to be endemic in some countries in West Africa such as Sierra Leone, Liberia, Guinea and Nigeria. There is a high risk of the virus spreading in neighboring countries; also, the animal vector for the virus “multimammate rat” (Mastomys natalensis) can be distributed throughout the region (“Lassa Fever | CDC,” 2019).

 The virus was unidentified until the year 1969. The virus is a single-stranded RNA virus belonging to its family “Arenaviridae”.  An estimate of 80% of people who were infected by the virus do not present with the symptoms. About 1 in 5 infections can cause other medical complications as the virus affects other various organs that include liver, spleen and kidneys. Although the virus cannot be contaminated by air, it can be contagious through urine/faeces of the affected person or rat. It has been discovered that it is difficult to detect the virus in affected people because the clinical course of the virus is variable(World Health Organization, 2017).

Image result for lassa fever"
 Nigeria, Sierra Leone, Liberia, and Ghana have the majority of outbreak of the virus. The environment can also be at risk as a result of the population of rat in West and East Africa. There are 100,000-300,000 cases of Lassa fever each year around the world. Sierra Leone and Liberia are impacted the most with an estimate of 5,000 deaths in both countries and 10-16% of hospital admission per year. Children are more prone to the threat. Compared to Ebola Virus of 70% cases, Lassa fever has a fatality rate of 1% to a severe rate of 15%. “An unusually intense outbreak developed in early 2018 in Nigeria with over 300 confirmed positive cases reported in the month of March. Cases were reported in Bauchi, Plateau, Edo, Ondo, and Ebonyi States. Sixteen health workers, at least four of whom died, were diagnosed as of Mar. 4, 2018. Along with high numbers, case fatality rates for this outbreak exceeded 20%. A Weekly Epidemiological Report has been maintained by the Nigeria Centre for Disease Control.” The Nigerian Minister of Health, Professor Isaac Adewale, announced that vaccine against Lassa virus would be arriving by the end of 2018. Dr. Chikwe Ihekweazu, CEO of the Nigeria Centre for Disease Control, has stressed the important advances of improved awareness and expanded ability to test for Lassa fever virus in recent years. Dr. Ihekweazu has encouraged improved adherence to infection prevention measures and community sanitation efforts to control current and future outbreaks of Lassa fever. Lassa fever has rarely been diagnosed in the U.S. There have been only six diagnosed cases since 1969. The last case was diagnosed in May 2015, in New Jersey in a patient traveling from Liberia. U.S. cases have involved international travelers or immigrants who arrived with the infection after exposure to rodents in West Africa(Sandra Gonzalez Gompf, MD, 2019).



References
Lassa Fever | CDC. (2019). Retrieved January 27, 2020, from https://www.cdc.gov/vhf/lassa/index.html

Sandra Gonzalez Gompf, MD, F. (2019). (No Title).
World Health Organization. (2017). Lassa fever. Retrieved January 27, 2020, from https://www.who.int/news-room/fact-sheets/detail/lassa-fever




Thursday, January 23, 2020

The Coronary Virus Outbreak-An Epidemic in China



Image result for virus in china 2020"

World Health Organization have decided not to conclude on declaring the outbreak of a virus in china as a global health emergency. However, they are planning on meeting within some days to acknowledge the degree of the situation(“Coronavirus Live Updates: 1st Death Outside Epicenter Is Reported, but W.H.O. Doesn’t Declare Emergency Yet - The New York Times,” 2020).

The Chinese authorities enforced a lockdown protocol on five cities with an extraordinary effort of containing the outbreak of the virus which has threatened the health of people or made hundreds of people ill; and spread to other parts of the world. The authorities in China have closed transportation lines from Wuhan, the capital of Hubei province. Buses, subways, ferries, airport and train stations are suspended or shut down to any outgoing passengers. The Chinese cities of Huanggang and Ezhou have undertaken the same measures. Smaller cities of Chibi and Zhijiang have developed a travel restrictions(Kuo, 2020).

The Chinese Officials are trying to control the new virus that has spread in the country. There have been 9 casualties and 440 people are sick with the virus. It has been proven that the infection can be contagious among humans. The epidemic virus has spread from Thailand, Japan, South Korea, Taiwan to the United States of America. The Coronavirus was first detected in Wuhan, the central city of China (James Griffiths and Nectar Gan, 2020).  A research study in the United Kingdom estimated that the number of infections in Wuhan is being underestimated. The real number is closer to 1,700 which is based on the rate of exposure to the virus in other cities and countries within a short period of time. There was a case of fatality in the United States as a result of the virus on Tuesday the 22nd of January 2020 in Seattle.

The Ministry of Health and Community Protection has confirmed four cases in United Arab Emirates for Corona Virus. It is has been estimated that the virus has caused 132 fatality and infected about 6000 people across the world. A family of four who arrived in United Arab Emirates was found to be infected with the virus. The Ministry made announcement on Twitter that the infected people were Chinese citizens; and they are currently undergoing medical supervision. Also, the Ministry stated that the health of the infected people is stable. The Ministry emphasized that the epidemiological investigation centers in the country are constantly working to report any sign of virus (Nandkeolyar, 2020).


Moving on, the Romanian president of a Microbiology Society, Alexandru Rafila stated on Monday the 27th of January 2020 that the coronavirus is considered to be a public health emergency around the world according to the World Health Organization. Meanwhile, Dr. Adrian Streinu Cercel, manager of the “Matei Bals” Infectious Disease Institute has ensured Romania is not prone to the threat. About 70% of the cases in China have showed mild forms of the virus and the outbreak is mostly in China and not worldwide (Salceanu, 2020)


 REFERENCES:
Coronavirus Live Updates: 1st Death Outside Epicenter Is Reported, but W.H.O. Doesn’t Declare  Emergency Yet - The New York Times. (2020). Retrieved January 23, 2020, from                                 https://www.nytimes.com/2020/01/23/world/asia/china-coronavirus.html


James Griffiths and Nectar Gan. (2020). China confirms Wuhan virus can be spread by humans - CNN. Retrieved January 23, 2020, from https://www.cnn.com/2020/01/21/asia/china-china-coronavirus-sars-intl-hnk/index.html

Kuo, L. (2020). China virus: five cities locked down and Beijing festivities scrapped | World news | The Guardian. Retrieved January 23, 2020, from https://www.theguardian.com/world/2020/jan/23/coronavirus-panic-spreads-in-china-with-three-cities-in-lockdown

 Nandkeolyar, K. H. (2020). Coronavirus in UAE: Four of a family infected | Health – Gulf News. Retrieved January 29, 2020, from https://gulfnews.com/uae/health/coronavirus-in-uae-four-of-a-family-infected-1.1580273983681

Salceanu, D. (2020). Risk for coronavirus to reach Romania is low, healthcare experts say. Possible case in Romania refuted – The Romania Journal. Retrieved January 29, 2020, from https://www.romaniajournal.ro/society-people/risk-for-coronavirus-to-reach-romania-is-low-healthcare-experts-say-possible-case-in-romania-refuted/

Friday, January 3, 2020

Patient Autonomy; Legal and Ethical Issues?

Image result for patients autonomyMedicine has been recognized over the years as an ethical based practice. Ethical foundation serves as a backbone for setting out a legal policy. Initially, medicine was more of a paternalistic norm which was practiced in the doctor-patient relationship-“a profession where physicians decides what treatment a patient should receive based on their experience and knowledge”; however, recently, the advancement in medicine has changed its concept to a “patient centered care”. This simply means that the healthcare provider only advises and informs the patient on the possible treatment, but the patient makes the decision. This shift from paternalism to patient-oriented care is merely a reflection on the changes of ethical principle in medicine (Brooks & Sullivan, 2002). Therefore, Patient Autonomy is defined as the patient’s right to make their own healthcare decisions without the interference of the physician. Through the aid of patient autonomy, healthcare providers are permitted to educate patients; yet, are not authorized to undermine the decision of the patient (Entwistle, Carter, Cribb, & McCaffery, 2010).  

Patient autonomy is the foundation of professional ethics in medicine. It is significant that a healthcare professional develops the ability to recognize and practice patient autonomy in its different ways (Murgic, Hébert, Sovic, & Pavlekovic, 2015). The respect for patient autonomy in the healthcare sector is a focus on situations where decisions are made based on medical interventions. The goal of autonomy is to provide the patient the right to make their own choices on their respective healthcare services; this is associated with the principle of confidentiality, fidelity, privacy and honesty that are invoked in decisions based on the principle of autonomy (Entwistle et al., 2010). Furthermore, to respect a patient’s autonomy is to yield to their judgement and ensure that they have the absolute freedom to choose without any objection. Therefore, the core values of autonomy is the appreciation for a person, which integrates two moral commitment to “honor autonomy and support those with developing; impaired or recede autonomy”(Nurmsoo, 2014) .

For the past decades, it has been emphasized that patients have had the right to self-determination in healthcare even though the healthcare providers concentrated on the promotion of clinical benefits for their respective patients. Medical benefits as a mandatory service, and the respect for autonomy have increased the tension between patient-physician relationship. The concept of autonomy compels general physicians (GPs) to respect the right of a patient; nonetheless, this makes it challenging for physicians to mitigate and prevent their patients from suffering. While on the other hand, the beneficence principle supports the physician to act according to the medical practice; yet, they refrain from being accused of “Big Brotherism”(Tore Nilstun And, 2000). The concept of autonomous inpatient decision making is centralized by the concept of providing an informed consent (IC) to the patient-to outline the legislative laws and other healthcare policies. To issue an informed consent to the patient, the decision made by them has to be based on the fact that the patient had the ability to make the decision, the physician provided adequate and relevant information to the decision maker, and finally, the decision made by the patient or the patient’s representative was not acted as a result threat or coercion (Kevin W. Coughlin, 2018)

Recent studies have indicated that patient autonomy is important to medical ethics. The findings of the study done by “Perspectives on Psychological Science, a journal of the Association for Psychological Science, psychological scientist Johan Ng”, demonstrated that patient autonomy can lead positive changes in healthcare. The results states that supporting the psychological needs of a patient is fundamental for physicians to help patients sustain their health and wellbeing (Ng, 2012).
The thesis statement, “patient autonomy is considered as a standard in the modern medicine and ethics; and patients are entitled to their healthcare rights from their respective physicians; however, patient autonomy can be biased from a physician’s point of view because  at the moment of treatment, the patient maybe impaired to make the right decisions for themselves”.

BACKGROUND
The beliefs, desires, and decisions of an individual are autonomous when a certain criterion has been met. For instance, if the person’s behavior was a result of weak will or compulsion, then this is known as “Heteronomous” and not “Autonomous”. If the individual has had external factors such as unreflect of socialization, manipulation, coercion; the decision of the person was not autonomous. Furthermore, if the beliefs of a person regarding a subject were false, inconsistent with each other, or the person had little or no information of the subject without their realization, then this is not considered as autonomy (Varelius, J., 2006).

 It has been argued by many that autonomy in the western medical care is treated as a means of obligation than the act of beneficence. Patient autonomy stands for administering care in accordance to the values and believes of the patient; it can also permit them to utilize their freedom for self-realization. While patient autonomy still has its high grounds and morale in places like the United States and Canada (Murgic et al., 2015), some Latin American cultures and Asian Societies still practice paternalism within their healthcare system. In the Latin American society, there is still a great significance in the number of physicians and families who believe in paternalism. For the purpose of assuring the health of the patient, most physicians may have the tendency to withhold information on the diagnosis and prognosis of the patient’s health condition in the form of beneficence. This can or may interfere of overrule the will of the patient (Karime K. Machado, 2012).  Also, in some cases, most of the physician does not participate in the decision making of the patient; however, it is the family of the patient who plays the role of a decision maker because the family’s autonomy and well-being is observed as more significant(Cheng-Tek Tai, 2003). Therefore, it can be considered that patient autonomy does not meet the cultural values of certain countries.
In patient autonomy, there is a constant risk of disconnection between the concept of self-determination and the need for a social medical system (Graber & Tansey, 2005). Patient autonomy involves a person to have the right of authorizing an informed decision about their medical treatment plan which simply means that they can set a limit for any medical intervention rendered to them. Moreover, this brings attention to the fact that patient autonomy can act as a threat to the duties of the healthcare professionals. This implies that physicians would have to go against their knowledge and believes to “save the lives of their patients” to ensure that their patients were well informed of the consequences or inconsequence of their healthcare decision (Evanthia Sakellari, 2003). The more the patient is autonomous over their own decisions, the more the physicians will suffer its consequences. Physicians request for a mental evaluation of a patient if the refusal to treatment was not based on a religion belief. For instance, patients who are cognitive impaired are usually incapable of determining their medical treatment in the context of their best interest. “A hospitalized patient of a medical history of schizophrenia   with a life-threatening; yet, a curable condition, who rejects any medical treatment because the voices in their heads are instructing them to decline the medication given to them by their physicians are likely to receive the necessary treatment for their recovery”(DT, 2019). To summarize, patient autonomy acts a challenge for healthcare providers to have a more professional conduct towards their patients.

Patient autonomy has influenced the doctor-patient relationship over the years. Doctor-patient relationship is crucial in the healthcare system; once it as been established, there must be a consistent commitment to provide an ongoing care to patients  which means that decision making has to be shared between the patient and physician throughout the incubation period of the disease. Furthermore, physicians are mandated by law and ethics to ensure that their patients receive the necessary care throughout the course of their medical condition, no matter the outcome or the challenge. On the other hand, patient autonomy brings about conflict of interest between the physician and the patient as it becomes medical and moral problem. To illustrate more, a cancer patient may decide not to follow-up with their medical intervention if they believe it may not be beneficial to their current health status; however, the physician may be obligated to provide that specific care to their respective patient because they have taken the oath of “do no harm”(Wancata & Hinshaw, 2016). The concept of patient autonomy becomes unsatisfactory in the terms of chronic diseases and primary medical due to the fact that there is a difference in the communication level between the physician and the patient, and that certain decisions may be insignificant compared to the maintenance of the relationship. Although patient autonomy should be respected in a strict manner, the healthcare system should pay a great amount of attention to the particularities of the patients or those who need medical services (Arrieta Valero, 2019).   

CONCLUSION:
In conclusion, patient autonomy is seen as the ethical principle in medical practices. It plays an important role in the improvement and advancement of the quality of healthcare services that a patient receives. While ethics remains the backbone of legal policy, medicine which was initially a paternalistic norm is now transformed to a more patient-centered care. Even though physicians are required to understand and apply patient autonomy in its own various aspect, patient autonomy has proven to have a more negative impact towards the healthcare system. 






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