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Books on the topic 'Patient allocation'

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Published: 10 December 2022
Last updated: 29 January 2023

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1

David, Guy. Integration and task allocation: Evidence from patient care. Cambridge, MA: National Bureau of Economic Research, 2011.

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2

Brown, Roswyn Ann. The social organisation of work in two paediatric wards: In relation to patient and task allocation. [s.l.]: typescript, 1986.

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3

Frederic, Kilner John, Orr Robert D. 1941-, Shelly Judy Allen, and Center for Bioethics and Human Dignity., eds. The changing face of health care: A Christian appraisal of managed care, resource allocation, and patient-caregiver relationships. Grand Rapids, Mich: William B. Eerdmans Pub., Paternoster Press, 1998.

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4

The limits of principle: Deciding who lives and what dies. Westport, Conn: Praeger, 1998.

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5

Office, General Accounting. VA health care: Allocation of resources to medical facilities in the Sun Belt : report to congressional requesters. Washington, D.C: The Office, 1986.

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6

Office, General Accounting. VA health care: Resource allocation methodology has had little impact on medical centers' budgets : report to the Committee on Veterans' Affairs, U.S. Senate. Washington, D.C: The Office, 1989.

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7

Zivin, Joshua Graff. AIDS treatment and intrahousehold resource allocations: Children's nutrition and schooling in Kenya. Cambridge, Mass: National Bureau of Economic Research, 2006.

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8

Life on the line: Ethics, aging, ending patients' lives, and allocating vital resources. Grand Rapids, Mich: W.B. Eerdmans Pub. Co., 1992.

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9

Putting patients first, increasing organ supply for transplantation: Hearing before the Subcommittee on Health and Environment of the Committee on Commerce, House of Representatives, One Hundred Sixth Congress, first session, April 15, 1999. Washington: U.S. G.P.O., 1999.

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10

United States. Congress. Senate. Committee on Labor and Human Resources., ed. Putting patients first: Resolving allocation of transplant organs : joint hearing before the Subcommittee on Health and Environment of the Committee on Commerce, House of Representatives, and the Committee on Labor and Human Resources, U.S. Senate, One Hundred Fifth Congress, second session, June 18, 1998. Washington: U.S. G.P.O., 1998.

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11

Groom, L. Allocation of scarce resources, the internal market and the rights of NHS patients: Do we still have an equitable NHS?. Oxford: Oxford Brookes University, 1996.

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12

1947-, Saint-Arnaud Jocelyne, ed. L' allocation des ressources rares en soins de santé: L'exemple de la transplantation d'organes : actes du colloque tenu les 14 et 15 mai 1996 à l'Université McGill dans le cadre du 64e congrès de l'Association canadienne-française pour l'avancement des sciences. Montréal: Acfas, 1997.

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13

Office, General Accounting. VA health care: Resource allocation methodology has had little impact on medical centers' budgets : report to the Committee on Veterans' Affairs, U.S. Senate. Washington, D.C: The Office, 1989.

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14

Alternatives in Jewish bioethics. Albany: State University of New York Press, 1997.

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15

Nichols, Eve K. Expanding access to investigational therapies for HIV infection and AIDS: March 12-13, 1990, conference summary. Washington, D.C: National Academy Press, 1991.

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16

Veatch, Robert M., Amy Haddad, and E. J. Last. Justice. Edited by Robert M. Veatch, Amy Haddad, and E. J. Last. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190277000.003.0006.

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This chapter considers the pharmacist’s duty based on the principle of justice. It addresses issues of allocation of health resources. It first addresses allocations among patients, then the tension between the interests of patients and others, and finally justice in broad issues of public policy. The cases deal with the pharmacist’s conflicts between serving a patient in crisis and a hypochondriac, funding compassionate use pharmaceuticals, the tension between the interests of a patient and her husband, obesity and the allocation of a scarce drug, payment for erectile dysfunction therapy, and the conflict between giving attention to a patient in great need and a promise to give attention to another less urgent patient.
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17

Walts, Lynn Maddox. PATIENT CLASSIFICATION SYSTEM: AN INTEGRATED METHOD FOR MEASURING NURSING INTENSITY AND OPTIMIZING RESOURCE ALLOCATION. 1992.

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18

Center for Bioethics and Human Dignity (Corporate Author), John Frederic Kilner (Editor), Robert D. Orr (Editor), and Judith Allen Shelly (Editor), eds. The Changing Face of Health Care: A Christian Appraisal of Managed Care, Resource Allocation, and Patient-Caregiver Relationships (Horizons in Bioethics Series). Wm. B. Eerdmans Publishing Company, 1998.

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19

When Science Offers Salvation: Patient Advocacy and Research Ethics. Oxford University Press, USA, 2001.

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20

Scholle, Carol Curio. Rapid Response Team Organization and Activation (DRAFT). Edited by Raghavan Murugan and Joseph M. Darby. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190612474.003.0002.

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The Rapid Response System (RRS) is organized into four basic components. These components include an activation limb, a response limb, a quality assurance infrastructure, and an administrative component. These components remain consistent despite campus size, physical layout, patient population, available technical resources, and personnel. Oversight of the RRS is provided by the patient safety, risk management experts, as well as clinical experts to maintain high quality of care delivered to acutely ill patients. Administrative support in the development of policy, allocation of resources, and communicating a strong and clear message regarding the mission and vision of the RRS is invaluable. In this chapter, we review each element of the RRS.
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21

Thiele, Holger, and Uwe Zeymer. Cardiogenic shock in patients with acute coronary syndromes. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0049.

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Cardiogenic shock complicating an acute coronary syndrome is observed in up to 10% of patients and is associated with high mortality still approaching 50%. The extent of ischaemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis of the cardiogenic shock patient. Careful risk assessment for each patient, based on clinical criteria, is mandatory, to decide appropriately regarding revascularization by primary percutaneous coronary intervention or coronary artery bypass grafting, drug treatment by inotropes and vasopressors, mechanical left ventricular support, additional intensive care treatment, triage among alternative hospital care levels, and allocation of clinical resources. This chapter will outline the underlying causes and diagnostic criteria, pathophysiology, and treatment of cardiogenic shock complicating acute coronary syndromes, including mechanical complications and shock from right heart failure. There will be a major focus on potential therapeutic issues from an interventional cardiologist’s and an intensive care physician’s perspective on the advancement of new therapeutical arsenals, both mechanical percutaneous circulatory support and pharmacological support. Since studying the cardiogenic shock population in randomized trials remains challenging, this chapter will also touch upon the specific challenges encountered in previous clinical trials and the implications for future perspectives in cardiogenic shock.
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22

Thiele, Holger, and Uwe Zeymer. Cardiogenic shock in patients with acute coronary syndromes. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199687039.003.0049_update_001.

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Cardiogenic shock complicating an acute coronary syndrome is observed in up to 10% of patients and is associated with high mortality still approaching 50%. The extent of ischaemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis of the cardiogenic shock patient. Careful risk assessment for each patient, based on clinical criteria, is mandatory, to decide appropriately regarding revascularization by primary percutaneous coronary intervention or coronary artery bypass grafting, drug treatment by inotropes and vasopressors, mechanical left ventricular support, additional intensive care treatment, triage among alternative hospital care levels, and allocation of clinical resources. This chapter will outline the underlying causes and diagnostic criteria, pathophysiology, and treatment of cardiogenic shock complicating acute coronary syndromes, including mechanical complications and shock from right heart failure. There will be a major focus on potential therapeutic issues from an interventional cardiologist’s and an intensive care physician’s perspective on the advancement of new therapeutical arsenals, both mechanical percutaneous circulatory support and pharmacological support. Since studying the cardiogenic shock population in randomized trials remains challenging, this chapter will also touch upon the specific challenges encountered in previous clinical trials and the implications for future perspectives in cardiogenic shock.
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23

Thiele, Holger, and Uwe Zeymer. Cardiogenic shock in patients with acute coronary syndromes. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199687039.003.0049_update_002.

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Cardiogenic shock complicating an acute coronary syndrome is observed in up to 10% of patients and is associated with high mortality still approaching 50%. The extent of ischaemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis of the cardiogenic shock patient. Careful risk assessment for each patient, based on clinical criteria, is mandatory, to decide appropriately regarding revascularization by primary percutaneous coronary intervention or coronary artery bypass grafting, drug treatment by inotropes and vasopressors, mechanical left ventricular support, additional intensive care treatment, triage among alternative hospital care levels, and allocation of clinical resources. This chapter will outline the underlying causes and diagnostic criteria, pathophysiology, and treatment of cardiogenic shock complicating acute coronary syndromes, including mechanical complications and shock from right heart failure. There will be a major focus on potential therapeutic issues from an interventional cardiologist’s and an intensive care physician’s perspective on the advancement of new therapeutical arsenals, both mechanical percutaneous circulatory support and pharmacological support. Since studying the cardiogenic shock population in randomized trials remains challenging, this chapter will also touch upon the specific challenges encountered in previous clinical trials and the implications for future perspectives in cardiogenic shock.
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24

Thiele, Holger, and Uwe Zeymer. Cardiogenic shock in patients with acute coronary syndromes. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199687039.003.0049_update_003.

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Cardiogenic shock complicating an acute coronary syndrome is observed in up to 10% of patients and is associated with high mortality still approaching 50%. The extent of ischaemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis of the cardiogenic shock patient. Careful risk assessment for each patient, based on clinical criteria, is mandatory, to decide appropriately regarding revascularization by primary percutaneous coronary intervention or coronary artery bypass grafting, drug treatment by inotropes and vasopressors, mechanical left ventricular support, additional intensive care treatment, triage among alternative hospital care levels, and allocation of clinical resources. This chapter will outline the underlying causes and diagnostic criteria, pathophysiology, and treatment of cardiogenic shock complicating acute coronary syndromes, including mechanical complications and shock from right heart failure. There will be a major focus on potential therapeutic issues from an interventional cardiologist’s and an intensive care physician’s perspective on the advancement of new therapeutical arsenals, both mechanical percutaneous circulatory support and pharmacological support. Since studying the cardiogenic shock population in randomized trials remains challenging, this chapter will also touch upon the specific challenges encountered in previous clinical trials and the implications for future perspectives in cardiogenic shock.
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25

Rie, Michael A. Medico-legal liability in critical care. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0027.

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The Oxford Textbook of Critical Care is an English language international text that recognizes the English Common Law as the foundation of contemporary judicial precedents governing obligations and responsibilities within the patient–doctor relationship. Although medical ethics and their recognition are generally known, Common Law interpretation of resource consumption and entitlement limits to critical care services has varied widely. Case examples of enduring professional negligence are offered. While legal systems may have differing origins, the imbalance between resource allocation and lawful definition of entitlement limitations requires further clarity within the law. Preserving professional integrity requires active public education and professional group dialogue with governments and the courts. Such patient advocacy will both preserve the rule of law and patient trust in all critical care professionals.
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26

Olsen, Jan Abel. Unwarranted variations in healthcare utilization. Oxford University Press, 2017. http://dx.doi.org/10.1093/oso/9780198794837.003.0016.

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This chapter explores the increasing evidence of small area variations in healthcare utilization. While variations are expected when morbidities differ, the policy concern is on the unwarranted variations that cannot be explained by variation in patient illness or patient preferences. First, such variations represent inequity in access to healthcare. Second, the variations suggest inefficient resource allocation, because of diminishing marginal productivity of healthcare on health. Unwarranted variations are ubiquitous and persistent. When seeking to explain the observed variations, clinical care is categorized into three groups: (1) ‘effective care’, (2) ‘preference-sensitive care’, and (3) ‘supply-sensitive care’. The smallest degree of variations is observed for ‘effective care’. For some types of elective surgeries of the other two care categories it is not unusual to observe a 5- to 10-fold difference in highest and lowest utilization rates across otherwise similar regions.
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27

Patients and the populous: American attitudes toward the allocation of organs in transplantation, 1994 : research report. Richmond, Va: UNOS, 1994.

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28

Chan, Caroline. Allocating resources by modeling cardiac patient flow using a system dynamics approach. 2005.

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29

VA health care: Resource allocation methodology should improve VA's financial management : briefing report to the Committee on Veterans' Affairs, United States Senate. Washington, D.C: The Office, 1987.

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30

Isaac, Margaret, and Jared Randall Curtis. Ethical decision making in withdrawing and withholding treatment. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0387.

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Many patients in the USA and across the world die after having received care in an intensive care unit (ICU). Allocating resources equitably and honouring the wishes of patients and their families are essential components of intensive care. Physician and patient preferences regarding end-of-life care and regarding decision control vary by individual, region, and country, shaped and influenced by a variety of factors including cultural and religious beliefs. Surrogate decision-makers are widely called upon to perform a difficult task—to help make decisions when patients lack capacity or the ability to communicate their preferences. Communication between clinicians and families in the ICU can be enhanced by using a variety of techniques. Advance directives can help guide surrogate decision-makers and physicians. Additionally, discussions of cardiopulmonary resuscitation preferences can be improved by explicit discussions of prognosis, which can help patients and surrogate decision-makers more accurately understand the potential risks and benefits of their decisions.
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31

Institute of Medicine (U.S.). Committee on the Ryan White CARE Act: Data for Resource Allocation, Planning and Evaluation, ed. Measuring what matters: Allocation, planning, and quality assessment for the Ryan White Care Act. Washington, D.C: National Academies Press, 2004.

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32

Ryan White Care ACT Data for Resource Allocation Planning and Evaluation Committee, Institute of Medicine, Board on Health Promotion and Disease Prevention, and Planning and Evaluation. Measuring What Matters: Allocation, Planning, and Quality Assessment for the Ryan White CARE Act. National Academies Press, 2004.

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33

Measuring What Matters: Allocation, Planning, and Quality Assessment for the Ryan White CARE Act. National Academies Press, 2004.

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34

Bilirakis, Michael. Putting Patients First: Resolving Allocations Of Transplant Organs Hearing Before The Committee On Labor And Human Resources, U.s. Senate. Diane Pub Co, 1998.

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35

Trends on the level and impact of budgetary allocations to orphans and other vulnerable children. Harare: NANGO, 2007.

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36

Heginbotham, Christopher. Ethics and Values of Commissioning Mental Health Services. Edited by John Z. Sadler, K. W. M. Fulford, and Werdie (C W. ). van Staden. Oxford University Press, 2014. http://dx.doi.org/10.1093/oxfordhb/9780198732372.013.51.

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Commissioning is a cyclical process of that demands an understanding of the needs of prospective and current patients and service users, knowledge of community and institutional assets for psychiatric care, information on those public private and independent organizations available and willing to provide services, a wide and deep understanding of psychiatric nosology and treatments available, an ability to turn this information into a contract that is negotiated with the relevant providers, a recognition of cost and quality, a resource allocation methodology, and a system of measurement and clinical governance. Care planning, needs assessment, service development, and contracting disciplines each have their own ethical codes and values bases; by using values-based systems that engage patients and seek to meet patients lived experience, commissioners can shape the most appropriate service relevant to the patients’ recovery objectives.
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37

Cavanagh, Patrick, Lorella Battelli, and Alex Holcombe. Dynamic Attention. Edited by Anna C. (Kia) Nobre and Sabine Kastner. Oxford University Press, 2014. http://dx.doi.org/10.1093/oxfordhb/9780199675111.013.016.

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The authors review how attention helps track and process dynamic events, selecting and integrating information across time and space to produce a continuing identity for a moving, changing target. Rather than a fixed ‘spotlight’ that helps identify a static target, attention needs a mobile window or ‘pointer’ to track a moving target, picking up pieces of evidence along the way to determine not just what the target is, but what it is doing. Behavioural studies show that this dynamic version of attention is model-based, using familiar trajectories to help identify a target and to guide encoding of continuing input from its path. Attention has very coarse temporal resolution for both static and moving targets. However, when the focus of selection is on the move, a given location on a moving target’s path can be selected for extremely brief instants, as little as 50 ms, compared to the typical ‘dwell time’ or minimum duration of attention selection at a fixed location, of 200 ms or more. To determine the path of a moving object, attention must accurately process and sort the onsets and offsets in order to match an offset to the subsequent onset. This aspect of dynamic attention has been called the ‘when’ pathway and patient studies show that it is a qualitatively different system from spatial attention, being completely based in the right parietal lobe for events in both hemifields. Finally, like the salience map of spatial attention, temporal attention may have its own map that guides allocation to upcoming, current, and recent moments to select information at the appropriate time, changing the experience of time as it does so.
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38

US GOVERNMENT. Putting patients first: Resolving allocation of transplant organs : Joint hearing before the Subcommittee on Health and Environment of the Committee on ... Congress, second session, June 18, 1998. For sale by the U.S. G.P.O., Supt. of Docs., Congressional Sales Office, 1998.

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39

Brown, Matthew. Recognition of the importance of neuropathic pain epidemiology. Edited by Paul Farquhar-Smith, Pierre Beaulieu, and Sian Jagger. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198834359.003.0071.

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The landmark paper discussed in this chapter is ‘Prevalence of chronic pain with neuropathic characteristics in the general population’, published by Bouhassira and Lantéri-Minet in 2008. Understanding the extent to which a specific condition affects a population is of great importance, for two main reasons. First, robust epidemiological data influences relevant legislators and policymaking, leading to improvements in the allocation of scarce healthcare resources. Second, epidemiology studies alert clinicians and academics to deficiencies and oversights in current treatment. For decades, chronic pain resided in a twilight world, under-recognized and under-resourced, while patients suffered. Papers such as this pioneering work by Bouhassira and Lantéri-Minet started to turn the tide with respect to chronic pain’s profile in the pathological pecking order. It is important because it demonstrated in unarguable fashion the degree to which chronic neuropathic pain blights the lives of a significant proportion of the population.
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40

Elder, Grahame J. Metabolic bone disease after renal transplantation. Edited by Jeremy R. Chapman. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0288.

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Patients who undergo kidney transplantation have laboratory, bone, and soft tissue abnormalities that characterize chronic kidney disease mineral and bone disorder (CKD-MBD). After successful transplantation, abnormal values of parathyroid hormone, fibroblast growth factor 23, calcium, phosphate, vitamin D sterols, and sex hormones generally improve, but abnormalities often persist. Cardiovascular risk remains high and is influenced by prevalent vascular calcification, and fracture risk increases due to a combination of abnormal bone ‘quality’, compounded by immunosuppressive drugs and reductions in bone mineral density. Patients with well managed CKD-MBD before transplantation generally have a smoother post-transplant course, and it is useful to assess patients soon after transplantation for risk factors relevant to the general population and to patients with CKD. Targeted laboratory assessment, bone densitometry, and X-ray of the spine are useful for guiding therapy to minimize post-transplant effects of CKD-MBD. To reduce fracture risk, general measures include glucocorticoid dose minimization, attaining adequate 25(OH)D levels, and maintaining calcium and phosphate values in the normal range. Calcitriol or its analogues and antiresorptive agents such as bisphosphonates may protect bone from glucocorticoid effects and ongoing hyperparathyroidism, but the efficacy of these therapies to reduce fractures is unproven. Alternate therapies with fewer data include denosumab, strontium ranelate, teriparatide, oestrogen or testosterone hormone replacement therapy, tibolone, selective oestrogen receptor modulators, and cinacalcet. Parathyroidectomy may be necessary, but is generally avoided within the first post-transplant year. A schema is presented in this chapter that aims to minimize harm when allocating therapy.
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41

Veatch, Robert M., Amy Haddad, and E. J. Last. Case Studies in Pharmacy Ethics. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190277000.001.0001.

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The third edition of Case Studies in Pharmacy Ethics presents a comprehensive series of cases faced by pharmacists that raise ethical issues, with chapters arranged in a manner that simultaneously presents the topics that would be covered in a course on ethical theory. After an introduction, the book is divided into three parts. The introduction takes up four basic issues in ethical theory: the source, meaning, and justification of ethical claims; the two major ways of determining if acts are morally right; how moral rules apply to specific situations; and what ought to be done in specific cases. Part I deals with conceptual issues. Chapter 1 presents a five-step model the pharmacist can use for ethical problem solving. Chapter 2 addresses identification of value judgments in pharmacy and separation of ethical from nonethical value judgments. Chapter 3 looks at where the pharmacist should turn to find the source of ethical judgments. Part II presents cases organized around the major principles of ethics: beneficence and nonmaleficence, justice and the allocation of resources, autonomy, veracity (dealing honestly with patients), fidelity (including confidentiality), and avoidance of killing. Part III presents cases organized around topics that present ethical controversy: abortion, sterilization, and contraception; genetics and birth technologies; and mental health and behavior control. The remaining chapters cover drug formularies and drug distribution systems; health insurance, health system planning, and rationing; pharmaceutical research; consent to drug therapies; and terminally ill patients. The book includes links to professional codes of ethics and a glossary.
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42

Cohen, Stacy A., Margaret M. Haglund, and Larissa J. Mooney. Treatment Options for Older Adults with Substance-Use Disorders. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199392063.003.0010.

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Due to co-occurring medical disorders, psychosocial differences, functional and cognitive limitations related to aging, and the potential for multiple medication interactions, unique considerations must be made when addressing the diagnosis and treatment of SUDs among the elderly. Better information is needed on all fronts, from initial screening and assessment, to triaging to appropriate levels of care, to behavioral therapies and pharmacological treatment. Guidelines should help direct providers, families, and patients identify appropriate and individualized treatment programs. Encouragingly, outcomes appear to be as good, if not better, in the older population than in younger adults treated for SUDs. As the “baby boomer” population ages, more older adults will need treatment for illicit drug use, alcoholism, and the misuse of prescription medications. Greater education and awareness of this growing problem will increase attention paid by clinicians and policymakers allocating resources to address the treatment of SUDs in the older population.
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43

Straub, Rainer H. Neuroendocrine system. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0022.

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Endocrine abnormalities are very common in patients with chronic autoimmune rheumatic diseases (CARDs) due to the systemic involvement of the central nervous system and endocrine glands. In recent years, the response of the endocrine (and also neuronal) system to peripheral inflammation has been linked to overall energy regulation of the diseased body and bioenergetics of immune cells. In CARDs, hormonal and neuronal pathways are outstandingly important in partitioning energy-rich fuels from muscle, brain, and fat tissue to the activated immune system. Neuroendocrine regulation of fuel allocation has been positively selected as an adaptive programme for transient serious, albeit non-life-threatening, inflammatory episodes. In CARDs, mistakenly, the adaptive programmes are used again but for a much longer time leading to systemic disease sequelae with endocrine (and also neuronal) abnormalities. The major endocrine alterations are depicted in the following list: mild activation of the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system, inadequate secretion of ACTH and cortisol relative to inflammation, loss of androgens, inhibition of the hypothalamic-pituitary-gonadal axis and fertility problems, high serum levels of oestrogens relative to androgens, fat deposits adjacent to inflamed tissue, increase of serum prolactin, and hyperinsulinaemia (and the metabolic syndrome). Neuroendocrine abnormalities are demonstrated using this framework that can explain many CARD-related endocrine disturbances. This chapter gives an overview on pathophysiology of neuroendocrine alterations in the context of energy regulation.
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44

Straub, Rainer H. Neuroendocrine system. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199642489.003.0022_update_002.

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Endocrine abnormalities are very common in patients with chronic autoimmune rheumatic diseases (CARDs) due to the systemic involvement of the central nervous system and endocrine glands. In recent years, the response of the endocrine (and also neuronal) system to peripheral inflammation has been linked to overall energy regulation of the diseased body and bioenergetics of immune cells. In CARDs, hormonal and neuronal pathways are outstandingly important in partitioning energy-rich fuels from muscle, brain, and fat tissue to the activated immune system. Neuroendocrine regulation of fuel allocation has been positively selected as an adaptive programme for transient serious, albeit non-life-threatening, inflammatory episodes. In CARDs, mistakenly, the adaptive programmes are used again but for a much longer time leading to systemic disease sequelae with endocrine (and also neuronal) abnormalities. The major endocrine alterations are depicted in the following list: mild activation of the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system, inadequate secretion of ACTH and cortisol relative to inflammation, loss of androgens, inhibition of the hypothalamic-pituitary-gonadal axis and fertility problems, high serum levels of oestrogens relative to androgens, fat deposits adjacent to inflamed tissue, increase of serum prolactin, and hyperinsulinaemia (and the metabolic syndrome). Neuroendocrine abnormalities are demonstrated using this framework that can explain many CARD-related endocrine disturbances. This chapter gives an overview on pathophysiology of neuroendocrine alterations in the context of energy regulation.
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45

Straub, Rainer H. Neuroendocrine system. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199642489.003.0022_update_003.

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Endocrine abnormalities are very common in patients with chronic autoimmune rheumatic diseases (CARDs) due to the systemic involvement of the central nervous system and endocrine glands. In recent years, the response of the endocrine (and also neuronal) system to peripheral inflammation has been linked to overall energy regulation of the diseased body and bioenergetics of immune cells. In CARDs, hormonal and neuronal pathways are outstandingly important in partitioning energy-rich fuels from muscle, brain, and fat tissue to the activated immune system. Neuroendocrine regulation of fuel allocation has been positively selected as an adaptive programme for transient serious, albeit non-life-threatening, inflammatory episodes. In CARDs, mistakenly, the adaptive programmes are used again but for a much longer time leading to systemic disease sequelae with endocrine (and also neuronal) abnormalities. The major endocrine alterations are depicted in the following list: mild activation of the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system, inadequate secretion of ACTH and cortisol relative to inflammation, loss of androgens, inhibition of the hypothalamic-pituitary-gonadal axis and fertility problems, high serum levels of oestrogens relative to androgens, fat deposits adjacent to inflamed tissue, increase of serum prolactin, and hyperinsulinaemia (and the metabolic syndrome). Neuroendocrine abnormalities are demonstrated using this framework that can explain many CARD-related endocrine disturbances. This chapter gives an overview on pathophysiology of neuroendocrine alterations in the context of energy regulation.
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46

Fleck, Leonard M. Precision Medicine and Distributive Justice. Oxford University PressNew York, 2022. http://dx.doi.org/10.1093/oso/9780197647721.001.0001.

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Abstract Wicked ethical problems have been generated by precision medicine due to both the wiliness of cancer and the fragmentation of health care financing in the United States. The wiliness of cancer has resulted in these targeted cancer therapies yielding only very marginal gains in life expectancy for most patients at very great cost, thereby threatening the just allocation of health care resources. As a life-threatening phenomenon, cancer is not morally special. Philosophers have high hopes for the utility of their theories of justice. However, metastatic cancer and costly precision medicines generate extremely complex problems of health care justice that none of these theories can address adequately. What is needed instead is a political conception of health care justice (following Rawls) and a fair and inclusive process of rational democratic deliberation governed by public reason. A basic assumption is that society has only limited health care resources to meet unlimited health care needs (generated by emerging medical technologies). The primary ethical and political virtue of rational democratic deliberation is that it allows citizens as citizens to fashion autonomously shared understandings of how to address fairly the complex problems of health care justice generated by precision medicine. Still, in a pluralistic world, ideally just outcomes are a moral and political impossibility. Wicked problems can metastasize if rationing decisions are made invisibly, in ways effectively hidden from those affected by those decisions. A fair and inclusive process of democratic deliberation makes wicked problems visible to public reason.
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47

VA health care: Resource allocation methodology should improve VA's financial management : briefing report to the Committee on Veterans' Affairs, United States Senate. Washington, D.C: The Office, 1987.

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48

Medicine, Institute of, and Roundtable for the Development of Drugs and Vaccines Against AIDS. Expanding Access to Investigational Therapies for HIV Infection and AIDS. National Academies Press, 1991.

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49

Expanding Access to Investigational Therapies for HIV Infection and AIDS. National Academies Press, 1991.

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50

M, Hardy Leslie, and Institute of Medicine (U.S.). Committee on Prenatal and Newborn Screening for HIV Infection., eds. HIV screening of pregnant women and newborns. Washington, D.C: National Academy Press, 1991.

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