Andrew R Barnosky

University of Michigan, Ann Arbor, Michigan, United States

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Publications (11)22.88 Total impact

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    ABSTRACT: For medical students, the emergency department (ED) often presents ethical problems not encountered in other settings. In many medical schools there is little ethics training during the clinical years. The benefits of reflective essay writing in ethics and professionalism education are well established. The purpose of this study was to determine and categorize the types of ethical dilemmas and scenarios encountered by medical students in the ED through reflective essays. During a 4(th)-year emergency medicine rotation, all medical students wrote brief essays on an ethical situation encountered in the ED, and participated in an hour debriefing session about these essays. Qualitative analysis was performed to determine common themes from the essays. The frequency of themes was calculated. The research team coded 173 essays. The most common ethical themes were autonomy (41%), social justice (32.4%), nonmaleficence (31.8%), beneficence (26.6%), fidelity (12%), and respect (8.7%). Many of the essays contained multiple ethical principles that were often in conflict with each other. In one essay, a student grappled with the decision to intubate a patient despite a preexisting do-not-resuscitate order. This patient encounter was coded with autonomy, beneficence, and nonmaleficence. Common scenarios included ethical concerns when caring for critical patients, treatment of pain, homeless or alcoholic patients, access to care, resource utilization, and appropriateness of care. Medical students encounter patients with numerous ethically based issues. Frequently, they note conflicts between ethical principles. Such essays constitute an important resource for faculty, resident, and student ethics training. Copyright © 2014 Elsevier Inc. All rights reserved.
    No preview · Article · Dec 2014 · Journal of Emergency Medicine

  • No preview · Article · Nov 2013 · Annals of Emergency Medicine

  • No preview · Article · Oct 2013 · Annals of Emergency Medicine
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    ABSTRACT: There is limited empirical research exploring the nature of clinical ethical consultations within the oncology population. Our objective was to review and describe clinical ethics consultations at two National Cancer Institute-designated comprehensive cancer centers to identify opportunities for systems improvement in clinical care and opportunities for staff education. This case series is derived from two institutional prospectively maintained clinical ethics consultation databases. All ethics consultations from 2007 through 2011 that related to adult patients with cancer were included. A total of 208 eligible patient cases were identified. The most common primary issues leading to ethics consultation were code status and advance directives (25%), surrogate decision making (17%), and medical futility (13%). Communication lapses were identified in 45% of patient cases, and interpersonal conflict arose in 51%. Before ethics consultation, 26% of patients had do-not-resuscitate orders, which increased to 60% after ethics consultation. Palliative care consultation occurred in 41% of patient cases. Ethics consultations among patients with cancer reflect the complexities inherent to their clinical management. Appropriately honoring patients' wishes within the context of overall goals of care is crucial. Thoughtful consideration of the role of and relationship with palliative care experts, communication barriers, sources of interpersonal conflict, symptom control, and end-of-life care is paramount to optimal management strategies in this patient population.
    Full-text · Article · Jun 2013 · Journal of Oncology Practice
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    ABSTRACT: The novel H1N1 influenza pandemic renewed the concern that during a severe pandemic illness, critical care and mechanical ventilation resources will be inadequate to meet the needs of patients. Several published protocols address the need to triage patients for access to ventilator resources. However, to our knowledge, none of these has addressed the pediatric populations. We used a systematic review of the pediatric critical care literature to evaluate pediatric critical care prognosis and multisystem organ failure scoring systems. We used multiple search engines, including MEDLINE and EMBASE, using a search for terms and key words including including multiple organ failure, multiple organ dysfunction, PELOD, PRISM III, pediatric risk of mortality score, pediatric logistic organ dysfunction, pediatric index of mortality pediatric multiple organ dysfunction score, "child+multiple organ failure + scoring system." Searches were conducted in the period January 2010-February 2010. Of the 69 papers reviewed, 22 were used. Five independently derived scoring systems were evaluated for use in a respiratory pandemic ventilator triage protocol. The Pediatric Logistic Organ Dysfunction (PELOD) scoring system was the most appropriate for use in such a triage protocol. We present a pediatric-specific ventilator triage protocol using the PELOD scoring system to complement the NY State adult triage protocol. Further evaluation of pediatric scoring systems is imperative to ensure appropriate triage of pediatric patients.
    No preview · Article · Jun 2012 · Disaster Medicine and Public Health Preparedness
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    Andrew G Shuman · Andrew R Barnosky · Charles F Koopmann
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    ABSTRACT: To create a case-based curriculum designed to teach and discuss the tenets of clinical medical ethics within an otolaryngology department. Survey-based study in a single-institution, academic otolaryngology department. Case-based departmental ethics grand rounds were implemented on a quarterly basis within an academic department of otolaryngology. One-hour sessions were designed to use challenging cases volunteered by clinicians within the department to create a forum for discussion and education about clinical medical ethics. A four-question satisfaction survey was administered to participating clinicians to measure the impact of the program. Five grand rounds were held over 16 months from 2009 to 2011, with four to six cases presented per session. Sessions were well attended and received, with broad coverage of topics and lively discussions. The mean survey score was 18 (median, 19; standard deviation, 2) out of a maximum possible score of 20. When asked if the sessions helped to advance their skills and comfort within the field of medical ethics, 100% of respondents agreed or strongly agreed. A total of 86% of respondents agreed or strongly agreed that the sessions would change how they practiced medicine in a way that would benefit their patients. It is feasible to successfully implement case-based ethics grand rounds within an otolaryngology department. Participants demonstrated a gratifying level of approval, and a stated desire to implement the principles learned within their clinical practice.
    Preview · Article · Feb 2012 · The Laryngoscope
  • Lauren B Smith · Andrew Barnosky

    No preview · Article · Nov 2011 · Physician executive
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    ABSTRACT: An abstract is unavailable. This article is available as HTML full text and PDF.
    Full-text · Article · Jun 2011 · Academic medicine: journal of the Association of American Medical Colleges
  • David I Shalowitz · Andrew Barnosky · Lauren Barrett Smith

    No preview · Article · Sep 2009 · Infection Control and Hospital Epidemiology
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    ABSTRACT: We are currently in the midst of the 2009 H1N1 pandemic, and a second wave of flu in the fall and winter could lead to more hospitalizations for pneumonia. Recent pathologic and historic data from the 1918 influenza pandemic confirms that many, if not most, of the deaths in that pandemic were a result of secondary bacterial pneumonias. This means that a second wave of 2009 H1N1 pandemic influenza could result in a widespread shortage of antibiotics, making these medications a scarce resource. Recently, our University of Michigan Health System (UMHS) Scarce Resource Allocation Committee (SRAC) added antibiotics to a list of resources (including ventilators, antivirals, vaccines) that might become scarce during an influenza pandemic. In this article, we summarize the data on bacterial pneumonias during the 1918 influenza pandemic, discuss the possible impact of a pandemic on the University of Michigan Health System, and summarize our committee's guiding principles for allocating antibiotics during a pandemic.
    Full-text · Article · Sep 2009 · Biosecurity and bioterrorism: biodefense strategy, practice, and science
  • Andrew G Shuman · Andrew R Barnosky
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    ABSTRACT: The ethical principle of autonomy is explored as it applies to situations in which patients' capacities to make decisions are questionable. A 40-year-old man presented to the Emergency Department with an epidural hematoma, and refused to undergo emergent surgical treatment. Considering the acutely life-threatening nature of his problem and the inability to confirm the patient's capacity in the presence of a traumatic brain injury, the decision was made to proceed with emergent surgical treatment without consent. The concept of conditional autonomy is introduced, defined, and employed to defend the process whereby a select group of patients may be treated without full knowledge of their wishes.
    No preview · Article · May 2009 · Journal of Emergency Medicine