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Raquel M Schears

Publications and source records attributed to Raquel M Schears.

10 recordsLinked to original sources
PubMed2006

Death, dying, and last wishes.

Issues regarding patient care near the end of life can be challenging and rewarding for emergency physicians. Knowledge of the patient's wishes is essential, and may be accomplished by advance directives or communication with patients and surrogates. Resuscitative efforts are appropriate for many patients, but inappropriate for others. The goals of medicine remain the following: providing optimal health care, provision of the best possible symptom control, communication, empathy, and caring. As death approaches, provision of the best possible medical care, in accordance with the patient's wishes, can be rewarding for patients, families, and health care providers.

Advance Directives↗
PubMed2004

Universal screening for interpersonal violence: inability to prove universal screening improves provision of services.

OBJECTIVE: Universal screening for interpersonal violence is recommended despite a lack of confirmed efficacy. We hypothesized that the detection of violence via universal screening would result in high intervention rates for victims. METHODS: Women aged 18-65 years presenting to an emergency department were screened using a standard protocol. Medical and social work records were reviewed for positively screened patients. Outcomes included whether victims received counseling/referral services. Secondary outcomes were the documentation of services offered and safety assessment performed. RESULTS: A total of 1732 patients were evaluated; 615 (35.5%) responded positively to at least one query. Patients had a mean age of 34.7+/-12 years, 79% were non-white, 19% were married, and 76% had completed high school. Twenty-five out of 606 victims (4%) had documentation of violence. Residents were more likely than faculty or nurses to document domestic violence [3.3% (95% confidence interval 1.8-4.8%) versus 2.1 (0.9-3.4) versus 0.7 (0.0-1.4)]. The documentation of police contact, suicide/homicide risk, weapon presence, safety assessment and outside resource referrals occurred in less than 2% of charts. Only two victims were referred to social work (0.3%; 0-0.9%). CONCLUSION: Even in an institution with a heavy emphasis and training on interpersonal violence and alternative mechanisms for universal screening we could not prove that the identification of victims resulted in counseling/referral being offered in the emergency department.

Adolescent↗
PubMed2004

Confronting the ethical challenges to informed consent in emergency medicine research.

The Society for Academic Emergency Medicine believes that protection of human subjects is vital in emergency medicine research and that, whenever feasible, informed consent is at the heart of that protection. At the same time, the emergency setting presents unique barriers to informed consent both because of the time frame in which the research is performed and because patients in the emergency department are a vulnerable population. This report reviews the concept of informed consent, empirical data on patients' cognitive abilities during an emergency, the federal rules allowing exemption from consent under certain circumstances, issues surrounding consent forms, and the new Health Insurance Portability and Accountability Act regulations as they relate to research. The authors conclude that, in many circumstances, informed consent is possible if the researcher is diligent and takes time to adequately explain the study to the potential subject. In cases in which it is possible to obtain consent, precautions must be taken to ensure that subjects have decision-making capacity and are offered time to have their questions answered and their needs met. Sometimes resuscitation and other emergency medicine research must be conducted without the ability to obtain consent. In these cases, special protections of subjects under the exception from consent guidelines must be followed. Protection of research subjects is the responsibility of every researcher in emergency medicine.

Emergency Medicine↗
PubMed2004

Ethics seminars: the ethical debate on practicing procedures on the newly dead.

Emergency medicine and its academic teaching programs face an ethical dilemma surrounding the question of practicing procedures on the newly dead. For many years, procedures have been practiced on the newly dead, but few institutions have had policies addressing the practice. This article considers the ethical arguments both for and against practicing procedures on the newly dead without consent, reviews the empirical studies on the subject, and presents the positions of other professional societies, before concluding with the position of the Society for Academic Emergency Medicine (SAEM). SAEM strongly encourages all emergency medicine training programs to develop a policy and make that policy available to the institution, educators, trainees, and the public. The practice should not occur behind closed doors or on an ad hoc basis without clearly articulated guidelines. With improvements in technology, including patient simulation and virtual reality, the need for the practice may decrease, but there is no current evidence that is compelling regarding the best methods of teaching procedural skills. Given the importance of protecting trust in the profession of medicine and the existing evidence that the public would expect that consent be obtained, SAEM recommends that families be asked for consent prior to practicing procedures on the newly dead.

Death↗
PubMed2003

Prehospital resuscitation practices: a survey of prehospital providers.

Numerous factors affect decision making in the prehospital provision of resuscitative care. This study was undertaken to determine current practices involved in the initiation, continuation and termination of resuscitative efforts, and the impact of advance directives, in the prehospital resuscitation setting. This cross-sectional mailed questionnaire surveyed 3807 members of the National Association of Emergency Medical Technicians. The study instrument included questions regarding the termination and withholding of resuscitative efforts in the prehospital setting, as well as survival rates, local protocols and compliance with advance directives. Of 1546 respondents (41% response rate), with a mean 9.0 years of experience, most (89%) indicated that they would withhold resuscitative efforts in the presence of an official state-approved advance directive. However, very few providers would withhold resuscitative efforts if only an unofficial document (4%) or verbal report of an advance directive (10%) were available. Providers with more than 10 years experience were more likely to withhold resuscitation attempts in the presence of only a verbal report of an advance directive (p = 0.02, Chi-square), and were more likely to withhold resuscitation attempts in situations they considered futile (p = 0.001, Chi-square). Most (77%) respondents have local EMS guidelines for termination of resuscitation in the prehospital setting, but 23% of those consider existing guidelines to be inadequate. The majority of prehospital providers stated that they honor official state-approved advance directives, but do not follow directives from unofficial documents or verbal reports of advance directives. More experienced providers stated that they withhold resuscitative efforts more often in futile situations, or in the presence of unofficial advance directives. Advance directives should be utilized more uniformly among patients who wish to forgo resuscitative efforts in the event of cardiac arrest. Because many local protocols are judged to be inadequate, we support the institution of improved clinical guidelines regarding the prehospital termination of resuscitative efforts.

Advance Directives↗
PubMed2002

Societal opinions regarding CPR.

Resuscitative measures are traditionally undertaken for most patients with cardiac arrest, unless an advance directive exists. This long-standing default presumption of patients' wishes to undergo resuscitation has never been proven. This study was undertaken to determine societal preferences of the general public regarding resuscitation. A cross-sectional survey was administered at community events to 724 volunteer participants over a 16-month period. For 6 hypothetical clinical scenarios (previously piloted and validated), respondents indicated personal preferences regarding resuscitation attempts for themselves. Most respondents indicated preferences for resuscitative efforts in a scenario depicting a young, healthy patient (96%), whereas few would desire resuscitative efforts for an elderly, debilitated patient (27%) (P <.01, Fisher's exact test). Nearly all (98%) respondents showed a trend (by scalogram analysis) toward refusal of resuscitative efforts in scenarios depicting more elderly, debilitated patients. Respondents had inaccurate perceptions of survival rates after cardiac arrest; the mean estimated survival rate was 50% (range 0%-100%). Although the majority of respondents had a personal physician (82%), only 10% of respondents had ever discussed death or resuscitation with their physicians. This study shows a trend in personal opinion among the general public toward refusal of resuscitative efforts in clinical scenarios with poor prognoses. Because so few patients have completed advance directives, physician awareness of such public opinions may be useful in decision-making in end-of-life care, particularly when caring for patients without advance directives. These public opinions support the feasibility of establishing societal consensus regarding resuscitation preferences, which may be useful in the development of federal and local guidelines and policies.

Adolescent↗