Ethical Considerations in Psychological Consultation to Critical Care Settings

This chapter discusses the ethical and professional standards affecting psychologists who provide consultation as members of interdisciplinary treatment teams in critical care and intensive care settings. The authors describe the unique characteristics of critical and intensive care units and how they contribute to complex life and death decisions, which in turn can result in unique moral, ethical, and clinical psychological dilemmas. In particular, this chapter focuses on the ethical quandaries that are commonly faced by psychologists in these highly specialized medical settings, and provides a mechanism for resolving ethical conflicts when they occur. Case examples are provided, each of which illustrate one of the ten ethical standards listed in the American Psychological Association’s code of ethics. Lastly, a model for maintaining ethical situational awareness in psychological consultations in critical care settings is proposed to serve as a guide for psychologists as they navigate and ultimately resolve challenging ethical dilemmas.

Precision Medicine Approaches to Cancer Diagnosis and Treatment: Focus on Cancer Stem Cell Biomarkers

Background:Recent research evidence has revealed that cancer cells contain a subpopulation of cancer stem cells (CSCs) that can remain even after traditional oncology therapies (e.g.: surgical resection of a tumor, radiation therapy (RT), and chemotherapy (ChT)), and can subsequently regenerate the original tumor or metastases, which are resistant to standard anticancer treatments. Such a resistance can be activated in various CSC populations,viadifferent signal transduction pathways.Conclusion:The signaling pathways (e.g.: NANOG, Wnt/β-catenin, Hedgehog, Notch, signal transducer and activator of transcription 3 (STAT 3), and phosphoinositide 3-kinase (PI3K)) play a crucial role in the CSCs, leading to tumorigenesis and metastatic spread. Therefore, their detailed analysis, including innovative biomarkers, is necessary to develop the effective, novel therapies that will specifically target CSCs, in patients with aggressive cancers. This review briefly outlines the concept of CSCs, and key components of CSC dysregulation in the signaling pathways. Furthermore, it describes some innovative strategies, such as: Single-Cell Sequencing (SCS), Circulating Tumor Cells (CTCs), Disseminated Tumor Cells (DTCs), cell-free DNA (cfDNA), and circulating tumor DNA (ctDNA) that may have critical importance in the detection, early diagnosis, prognosis and monitoring of patients with various, difficult to treat malignancies (e.g.: breast or gastrointestinal cancers). It also focuses on some barriers to achieving the clinical management goals (for both patients with cancers and the interdisciplinary treatment teams), as well as suggests some solutions, how to overcome them, in personalized oncology approaches.

Drug therapy in patients subject to outpatient compulsory mental health care

Rationale, aims and objectives: The use of coercion in mental health services is controversial. Little is known about drug therapy in patients subject to ambulant compulsory mental healthcare. The purpose of this study was to describe the drug therapy and follow-up in patients subject to ambulant compulsory mental healthcare at Sorlandet Hospital, Norway and, if possible, to improve drug therapy through specific advice from a consultant pharmacist.Method: Relevant information was obtained from the medical records of the included patients. Drug reviews were processed. Identified drug-related problems (DRPs) were presented to the interdisciplinary treatment teams and initiatives were documented. Results: Of the 101 patients subject to ambulant compulsory mental healthcare, 77 patients met the inclusion criteria. On average each patient used 3.6 drugs overall. All patients were using at least one antipsychotic agent, 83 % used depot injections. We identified 68 DRPs in 51 patients. Of these, 54 DRPs were concurred by the psychiatrist treating the patient. The most common type of concurred DRP was "lack of monitoring". The most common initiative was "discussion in the multidisciplinary team or with the patient". Conclusion: Even though the indication was clear, drugs were not always prescribed. Or they were prescribed in too low doses, according to the request of the patient. Among the presented DRPs a high proportion was concurred on, but few alterations were made immediately. A pharmacist can contribute to improving drug therapy, but pharmacists are not currently regular members of the interdisciplinary treatment team.

Splitting on a Pediatric Consult Liaison Service

Objective: Although the concepts of splitting and projective identification have been useful in explaining certain group phenomena on adult psychiatric and medical wards, their application to pediatric settings has not been addressed in the literature. The authors demonstrate that early identification, staff conferencing, and family/staff conferencing can diffuse these dynamics in an academic pediatric setting. Method: The existing literature on splitting and projective identification is reviewed. Case vignettes are then used to illustrate the manifestations of splitting and projective identification in a pediatric setting and to demonstrate intervention strategies modified for children and their families from the adult literature. Results: Splitting and projective identification can be interrupted in pediatric settings with early identification, staff conferencing, and family/staff conferencing. The cooperation of pediatric clinicians is critical in the implementation of these intervention strategies. Conclusions: The development of liaison support groups for pediatric residents and interdisciplinary treatment teams will enlist their cooperation in identifying splitting early, and in employing staff conferencing and family/staff conferencing to diffuse this group dynamic which, if left unchecked, can disrupt professional relationships and compromise the treatment of pediatric patients.