New guidelines seek to address misdiagnosis of disorders of consciousness
by Xavier Symons | 11 Aug 2018 |
About four in 10 people who are thought to be unconscious are actually aware, according to new clinical guidelines for disorders of consciousness published in the journal Neurology.
The guidelines, which outline best practice for managing patients in vegetative and minimally conscious states, are the product of an extensive consultation process with members of three speciality societies -- the American Academy of Neurology (AAN), American Congress of Rehabilitation Medicine and the National Institute on Disability, Independent Living, and Rehabilitation Research.
Among its key recommendations, the document advocates for a careful evaluation of patients by a clinician with specialized training in management of disorders of consciousness, such as a neurologist or brain injury rehabilitation specialist. The evaluation should be repeated several times early in recovery—especially during the first three months after a brain injury.
“People are sometimes misdiagnosed due to underlying impairments that can mask awareness,” said guideline lead author Joseph T. Giacino, of Harvard Medical School and Spaulding Rehabilitation Hospital in Boston. “An inaccurate diagnosis can lead to inappropriate care decisions and poor health outcomes. Misdiagnosis may result in premature or inappropriate treatment withdrawal, failure to recommend beneficial rehabilitative treatments and worse outcome”.
The article states notes that, while the prognosis of patients with prolonged disorders of consciousness differs greatly, some will eventually be able to function on their own and some will be able to go back to work. According to the guideline, approximately one in five people with severe brain injury from trauma will recover to the point that they can live at home and care for themselves without help.
Saturday, August 11, 2018
Every year, about 1.5 million cases of euthanasia take place in the United States. Does this have a negative impact on healthcare workers? Sorry, about 1.5 million cases of cat and dog euthanasia take place. But the question is still relevant. Veterinarians, veterinary assistants and shelter workers experience great stress at having to put animals down.
The emotional connection between the work of human doctors and animal doctors is closer than you might think. Owners often react to a pet’s death with the intensity of grief which appears equivalent to the loss of a beloved relative.
So the moral stress which vets experience is relevant. Suicide amongst vets has been the topic of several studies. “Veterinarians are four times more likely than members of the general population and two times more likely than other health professionals to die by suicide,” according to a 2012 study in the journal of The American Association of Suicidology, Suicide and Life-Threatening Behaviour.
Why? Performing euthanasia day in, day out, also appears to make some vets less able to resist the temptation to commit suicide. The authors of the 2012 study found that “... all else being equal, veterinarians may be more likely than members of other professions to enact a lethal attempt when they desire suicide because their exposure to euthanasia has rendered them less fearful of death."
Aren’t there lessons in these finding which are relevant to doctors who euthanize their patients? Sometimes doctors in Belgium or the Netherlands are quoted as saying that the death they helped was beautiful or peaceful. Could that be bravado masking their own nonchalance about human death?
How many times have we all heard the argument, “You wouldn’t let a dog suffer like this...” Its logic is that if the suffering of animals and humans is essentially the same, they both should be released from suffering in the same way. But if the animal-human parallel works for the patient, why not for the doctor? If we allow euthanasia, surely we can expect the same burn-out rates and the same suicide rates as veterinarians ... at least the same. That should scare us all – especially the doctors who will be responsible.
The emotional connection between the work of human doctors and animal doctors is closer than you might think. Owners often react to a pet’s death with the intensity of grief which appears equivalent to the loss of a beloved relative.
So the moral stress which vets experience is relevant. Suicide amongst vets has been the topic of several studies. “Veterinarians are four times more likely than members of the general population and two times more likely than other health professionals to die by suicide,” according to a 2012 study in the journal of The American Association of Suicidology, Suicide and Life-Threatening Behaviour.
Why? Performing euthanasia day in, day out, also appears to make some vets less able to resist the temptation to commit suicide. The authors of the 2012 study found that “... all else being equal, veterinarians may be more likely than members of other professions to enact a lethal attempt when they desire suicide because their exposure to euthanasia has rendered them less fearful of death."
Aren’t there lessons in these finding which are relevant to doctors who euthanize their patients? Sometimes doctors in Belgium or the Netherlands are quoted as saying that the death they helped was beautiful or peaceful. Could that be bravado masking their own nonchalance about human death?
How many times have we all heard the argument, “You wouldn’t let a dog suffer like this...” Its logic is that if the suffering of animals and humans is essentially the same, they both should be released from suffering in the same way. But if the animal-human parallel works for the patient, why not for the doctor? If we allow euthanasia, surely we can expect the same burn-out rates and the same suicide rates as veterinarians ... at least the same. That should scare us all – especially the doctors who will be responsible.
 Michael Cook Editor BioEdge |  |  |  |
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