Dissection and graded - Assignment Example

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Ethical issues arising in epidemiological researches can be observed by consultation and scrutiny. Close attention to ethics can lead to effective planning, implementation and growth of various researches and…
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Discussion and Graded Assignment Discussion In recent epidemiological studies, ethics have an important position. Ethical issues arising in epidemiological researches can be observed by consultation and scrutiny. Close attention to ethics can lead to effective planning, implementation and growth of various researches and public health awareness programs. The recent interest in ethical issues among epidemiologists puts forward its importance in human health and in health care resources (Coughlin, 2006). There are various treatable and preventable diseases which can be dealt with if genetic testing is done. A progressive disorder can be dealt with if proper genetic testing is done, but at times unpreventable diseases are found out by genetic testing. In these cases there are ethical issues which may arise. An example of an ethical issue arising due to genetic testing is the chance of someone using a person’s personal information against someone which could prove to be harmful. Hence it can be clearly stated that genetic testing is a matter of privacy and individual choice. Laws passed by HIPAA and GINA protect personal information of those being tested and eradicate the chances of discrimination (Norrgard, 2008).
Coughlin, S. S. (2006). Ethical issues in epidemiologic research and public health practice. Emerging themes in epidemiology, 3(16), 1-10.
Norrgard, K. (2008). Ethics of genetic testing: medical insurance and genetic discrimination. Nature Education, 1(1), 90.
Graded Assignment: Prophylactically Administered Antibiotics
1. You are an epidemiologist at a county hospital. The hospital has asked you to examine the effects of antibiotics administered to patients before surgery that involves opening of the chest cavity. The time frame for administration of antibiotics to patients before surgery is 2-hour intervals for up to 24 hours. The overall objective of the study is to reduce surgical infections and deaths associated with surgery. The hospital administration has given you 15 years to complete the study.
The purpose of administering antibiotics prophylactically is important prior to any surgery. The main need for this administration is to prevent any possible post-surgery infections. The possible wound infections result in extended stays of patients at hospitals. These infections develop due to microbial virulence factors, local factors, surgical techniques and systemic factors. Over the years epidemiologists at the hospital facility worked to choose the best suitable antibiotic. The antibiotic had low toxicity and low chances of allergies. The antibiotic of choice was given 30 minutes before the surgery. The concentration of the drug given was adjusted with the duration of surgery. In surgeries which involved incising the chest cavity, the antibiotic of choice was cefazolin (Holzheimer, 2001). A comparative study was carried out between the efficacies of two antibiotics. The antibiotics were vancomycin and cefazolin, which worked in preventing surgical site infections. Patients over 18 years who were scheduled for chest surgeries were randomly given vancomycin 12 hourly or cefazolin every 8 hours. The administration of prophylactically antibiotics started with anesthesia induction and continued for 24 hours. The subjects included 885 patients out of which 452 got vancomycin and 433 got cefzolin. The percentage of surgical site infection was 9-9.5% in both the cases. This trial indicated that the efficacy of these drugs in avoiding post-operative infections was the same (Finkelstein et al, 2002).
2. You are the epidemiologist who has completed the 15-year study to examine the effects of antibiotics administered to patients before surgery involving opening of the chest cavity. After 15 years, the emergence of antibiotic-resistant infections has complicated the task of reducing surgical infections and deaths associated with surgery. The hospitaladministration has now asked you to evaluate a new antibiotic treatment based on the results of your previous study.
A first generation antibiotic named cefazolin was used. Based on the availability and cost, cefazolin was the agent of choice used in the hospital.The trial showed there was a drift toward frequent organ-space infections and infections with β-lactam–resistant organisms among patients receiving cefazolin(Finkelstein et al, 2002). In patients where there is assumption of staphylococcal infections in methicillin resistant patients or in patients undergoing prosthetic valve surgeries prophylactically cefazolin should be accompanied by vancomycin. The emergence of methicillin resistance among cefazolin users has directed towards the use of a stronger glycopeptide called vancomycin. Vancomycin can be given in patients who are at risk for pre-operative methicillin resistance colonization and in patients who are at risk for post-sternotomy infections. It has also been suggested that patients going through valvular operation should receive vancomycin. Studies conducted over the years show that vancomycin might prevent methicillin resistant colonization but the drug does not have a broad spectrum of action. The drug has lesser power to penetrate tissues and bones. The drug has limited bactericidal action accompanied by less desired pharmo-kinetics. Trials put forward that application of vancomycin alone raises the incidence of surgical site infection1s. Hence ideally vancomycin should be administered with an additional aminoglycoside to avoid surgical site infections and blood stream infections (Engelman et al, 2007).
Engelman, R., Shahian, D., Shemin, R., Guy, T. S., Bratzler, D., Edwards, F., Jacobs, M., ... Bridges, C. (April 01, 2007). The Society of Thoracic Surgeons Practice Guideline Series: Antibiotic Prophylaxis in Cardiac Surgery, Part II: Antibiotic Choice. The Annals of Thoracic Surgery, 83, 4, 1569-1576.
Finkelstein, R., Rabino, G., Mashiah, T., Bar-El, Y., Adler, Z., Kertzman, V.. & Milo, S. (2002). Vancomycin versus cefazolin prophylaxis for cardiac surgery in the setting of a high prevalence of methicillin-resistant staphylococcal infections. The Journal of thoracic and cardiovascular surgery, 123(2), 326-332.
Holzheimer, R. G., & In Mannick, J. A. (2001). Surgical treatment: Evidence-based and problem-oriented. München [etc.: Zuckschwerdt. Read More
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