The use of electronic medical record systems raises important ethical concerns about patient privacy and confidentiality, medical errors, expectations of structured data entry by clinicians, documentation integrity, and provider-patient interaction. Clinicians and health care organizations need to define best practices and policies in the use of EMR systems to improve quality and maintain clinician efficiency without compromising patient welfare and safety.

<p>In today's competitive hospital marketing environment, it is imperative that administrators ensure that their hospitals are operating as efficiently and as effectively as possible.“Doing more with less” has become a mandate for hospital administrators and employees. The current research replicates and extends previous work devoted to this topic by examining the <i>job resourcefulness</i> construct in a hospital setting. Job resourcefulness, an individual difference variable, assesses the degree to which employees are able to overcome resource constraints in the pursuit of job-related goals. The work builds upon previous work and contributes to the hospital marketing literature by examining the relationships between resourcefulness, personality influencers, role stressors, and job tenure. Research implications and suggestions for future work in the area are presented.</p>

Ethical dilemmas are encountered frequently in long term facilities, encompassing a myriad of concerns related to end of life care, rehospitalization, artificial hydration and nutrition, capacity for decision making, use of sedation, and dealing with conflict that may arise amongst those caring for and about the patient. Having a formalized means of sorting through difficult cases is often not readily available in long term care facilities that have limited staffing and are often a remote distance from tertiary care centers where clinical ethicists tend to live professionally. A method is proposed to provide patients, families, and staff a means by which to systematically work through ethical dilemmas when formal ethics consultation is not available.

PURPOSE.: Anterior ocular tissues exposed to high levels of toxic ultraviolet (UV) radiation may undergo physiologic changes leading to diseases that can alter the ocular surface, particularly in the stem cell-rich limbal region. UV radiation-blocking hydrogel contact lenses provide protection across the ocular surface, which varies according to the lens thickness. METHODS.: A novel fiber optic spectrophotometer front-end system has been developed to measure lens transmission curves at test points across lens surfaces to determine optical properties based on the Beer-Lambert law. Factors determining the transmission curves include the hydrogel lens used, its refractive index, whether a UV radiation-blocking dopant is incorporated, the water content, and the thickness of the lens. Test lenses of equal power were placed over a detecting fiber optic and illuminated by a deuterium source, and transmission spectra were recorded. The small optical sampling size allowed the spectral transmission profile to be determined across the lens surface, and comparisons were made with different lenses. RESULTS.: Transmission curves across the lenses showed greater UV radiation-blocking capacity at the thicker peripheral region, with the 50% cutoff wavelength moving toward the visible spectrum by 10 nm from the center to the periphery. In addition, the ability to determine the spatially specific absorption coefficient and the related UV radiation protection factor was demonstrated. CONCLUSIONS.: The system measures spatial variation in lens transmission and comparing different lens types while overcoming many of the handling limitations of cuvette-based spectrophotometer methods. The data show good agreement with published transmission curves and allow intralens and interlens comparisons.

Informed consent belongs to a new way to understand doctor-patient relationships from a perspective permitting a principle of autonomy. Seen from this viewpoint, we speak of a medical relationship understood as being a mutual relationship. For a decision to be autonomous, it must be intentional, taken after adequately understanding all the pertinent information and totally free from outside influences. We must realize that from both theoretical and practical views objections exist; these include paternalism, comprehension difficulties, or patient refusal to exercise informed consent. Informed consent presents a reality and a challenge for our profession since it is much more complex than a simple signature on a document.

Judgment and actions based on scientific evidence are modified by the unique caregiver-patient relationship. Caregivers relying exclusively upon "rational" decisions in line with evidence-based clinical recommendations avoid their relational responsibility. The "noble" purpose illustrates that decisions to treat can be at the same time pointless and valuable. Dia (through)- logue (knowledge) makes it possible to go beyond informed consent, which holds caregivers responsible for providing information and patients for the decision to treat. Finally, where healing is no longer achievable and autonomy dies away, compassion rather than therapeutic tenacity might be the answer. These examples are explained corresponding to the philosophical ideas of respectively Emmanuel Levinas en Roger Burgraeve (noble purpose), Martin Buber (dialogical thinking) and Daniel C. Dennett (autonomy loss).

Do medical ethics committees exist in the MERCOSUR? What is their role and its constitution? How are patients' rights to be respected? Informed consent.