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2016年小儿外科伦理会议/一场辩论:1. 小儿外科护理的区域化 2. 外科创新的伦理引入 3. 应对外科实践中的压力:恢复力、幸福感与职业倦怠

2016 CAPS ethics session/Ein debate: 1. Regionalization of pediatric surgical care 2. Ethical introduction of surgical innovation 3. Addressing stress in a surgical practice: resiliency, well-being, and burnout.

作者信息

Bagwell Charles E, Chiu Priscilla, Fecteau Annie, Gow Kenneth W, Mueller Claudia M, Price David, Zigman Andrew F

机构信息

Division of Pediatric Surgery, Virginia Commonwealth University/Medical College Of Virginia, Richmond, VA, USA.

Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON, Canada.

出版信息

J Pediatr Surg. 2017 May;52(5):864-871. doi: 10.1016/j.jpedsurg.2017.01.025. Epub 2017 Jan 29.

Abstract

The following is the conference proceeding of the Second Ein Debate from the 48th Annual Meeting of the Canadian Association of Paediatric Surgeons held in Vancouver, BC, from September 22 to 24, 2016. The three main topics for debate, as prepared by the members of the CAPS Ethics Committee, are: 1. Regionalization of care: pros and cons, 2. Innovation in clinical care: ethical considerations, and 3. Surgeon well-being: caring for the caregiver. The authors of this paper, as participants in the debate, were assigned their positions at random. Therefore, the opinions they express within this summary might not reflect their own viewpoints. In the first discussion, arguments for and against the regionalization of pediatric surgical care are discussed, primarily in the context of a case of BA. In the pro argument, the evidence and lessons learned from different European countries are explored as well as different models to provide the best BA care outside of large teaching centers. In the counterargument, the author explains how regionalization of care could be detrimental for the patient, the family, the regional center, and for the health care system in general. In the debate on surgical innovation the authors define surgical innovation. They review the pertinent ethical principles, explore a model for its implementation, and the role of the institution at which the innovation is proposed. In the third section, surgeon well-being is examined, and recent literature on surgeon resiliency and burnout both at the attending and resident level is reviewed.

摘要

以下是2016年9月22日至24日在不列颠哥伦比亚省温哥华市举行的加拿大儿科学会外科医生第48届年会第二次爱因斯坦辩论的会议记录。由加拿大儿科学会伦理委员会成员拟定的三个主要辩论主题分别是:1. 医疗服务区域化:利弊;2. 临床护理创新:伦理考量;3. 外科医生的福祉:关爱护理人员。本文作者作为辩论参与者,被随机分配立场。因此,他们在本总结中表达的观点可能并不反映其自身看法。在第一场讨论中,主要结合一例胆管闭锁病例,讨论了支持和反对儿外科护理区域化的观点。正方观点探讨了从不同欧洲国家获取的证据和经验教训,以及在大型教学中心之外提供最佳胆管闭锁护理的不同模式。反方观点中,作者解释了护理区域化如何可能对患者、家庭、区域中心以及整个医疗系统产生不利影响。在关于外科创新的辩论中,作者对外科创新进行了定义。他们回顾了相关伦理原则,探讨了其实施模式以及提出创新的机构所起的作用。在第三部分,研究了外科医生的福祉,并回顾了近期关于主治医生和住院医生层面外科医生恢复力和职业倦怠的文献。

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