ABSTRACT

Abstract

Consent and confidentiality Informed consent: patients listen and read, but what information do they retain? [comment] Turner P, Williams C. New Zealand Medical Journal 2002; 115(1164): U218. AIM: To determine the percentage of knowledge retained immediately following an outpatient consultation for total hip and knee joint arthroplasty, and whether any improvement in that knowledge occurred after reading an information leaflet about the operation. METHODS: Patients on the waiting list for joint replacement surgery were given verbal information during the consultation about basic operative details, post-operative programme, and potential complications. A questionnaire was completed asking them to recall these details. They were then given information leaflets to read. Six weeks later, they were contacted again and asked the same questions. RESULTS: Immediately following a consultation, patients recall only a small percentage of information. In particular, retention of post-operative recovery time frames, and possible operative complications is poor. Despite an information booklet, patients’ level of knowledge deteriorates from the initial consultation. CONCLUSIONS: Verbal and written information supplied to a patient may be understood, but it is easily and quickly forgotten. In an increasingly medicolegal environment, it is essential to gain informed consent from a patient when performing interventions. The provision of an information booklet may provide nothing more than proof for the surgeon of information provision to the patient. (Authors’ abstract) Readability standards for informed-consent forms as compared with actual readability Readability standards for informed-consent forms as compared with actual readability Paasche-Orlow MK, Taylor HA, Brancati FL. New England Journal of Medicine 2003; 348(8): 721–6. BACKGROUND: Institutional review boards (IRBs) are charged with safeguarding potential research subjects with limited literacy but may have an inadvertent role in promulgating unreadable consent forms. We hypothesized that text provided by IRBs in informed-consent forms falls short of the IRBs’ own readability standards and that readability is influenced by the level of research activity, local literacy rates, and federal oversight. METHODS: To test these hypotheses, we conducted a cross-sectional study linking data from several public-use sources. A total of 114 Web sites of US medical schools were surveyed for IRB readability standards and informed-consent-form templates. Actual readability was measured with the Flesch–Kincaid scale, which assigns a score on the basis of the minimal grade level required to read and understand English text (range, 0–12). Data on the level of research activity, local literacy rates, and federal oversight were obtained from organizational Web sites. RESULTS: The average readability score for text provided by IRBs was 10.6 (95% confidence interval, 10.3–10.8) on the Flesch–Kincaid scale. Specific readability standards, found on 61 Web sites (54%), ranged from a fifth-grade reading level to a 10th-grade reading level. The mean Flesch–Kincaid scores for the readability of sample text provided by IRBs exceeded the stated standard by 2.8 grade levels (95% confidence interval, 2.4–3.2;Pv0.001). Readability was not associated with either the level of research funding (P~0.89) or local rates of literacy (P~0.92). However, the 52 schools that had beenmade subject to oversight by the Office for Human Research Protections (46%) had lower Flesch– Kincaid scores than the other schools (10.2 vs. 10.9, P~0.005). CONCLUSIONS: IRBs commonly provide text for informed-consent forms that falls short of their own readability standards. Federal oversight is associated with better readability. Copyright 2003 Massachusetts Medical Society. (Authors’ abstract) The requirements of the Data Protection Act 1998 for the processing of medical data Boyd P. Journal of Medical Ethics 2003; 29(1): 34–5. The Data Protection Act 1998 presents a number of significant challenges to data controllers in the health sector. To assist data controllers in understanding their obligations under the act, the Information Commissioner has published guidance, The Use and Disclosure of Health Data, which is reproduced here. The guidance deals, among other things, with the steps that must be taken to obtain patient data fairly, the implied requirements of the act to use anonymised or psuedonymised data where possible, an exemption applicable principally to records based research, the right of patients to object to the processing of their data, and the interface of the act and the common law duty of confidence. (Author’s abstract) Some limits of informed consent O’Neill O. Journal of Medical Ethics 2003; 29(1): 4–7. Many accounts of informed consent in medical ethics claim that it is valuable because it supports individual autonomy. Unfortunately there are many distinct conceptions of individual autonomy, and their ethical importance Journal of Audiovisual Media in Medicine, Vol. 26, No. 4, pp. 182–186 ISSN 0140-511X printed/ISSN 1465-3494 online/03/040182-05 # 2003 Institute of Medical Illustrators DOI: 10.1080/01405110310001633128 varies. A better reason for taking informed consent seriously is that it provides assurance that patients and others are neither deceived nor coerced. Present debates about the relative importance of generic and specific consent (particularly in the use of human tissues for research and in secondary studies) do not address this issue squarely. Consent is a propositional attitude, so intransitive: complete, wholly specific consent is an illusion. Since the point of consent procedures is to limit deception and coercion, they should be designed to give patients and others control over the amount of information they receive and opportunity to rescind consent already given. (Author’s abstract) Security of medical multimedia Tzelepi S, Pangalos G, Nikolacopoulou G. Medical Informatics & the Internet in Medicine 2003; 27(3): 169–84. The application of information technology to health care has generated growing concern about the privacy and security of medical information. Furthermore, data and communication security requirements in the field of multimedia are higher. In this paper we describe firstly the most important security requirements that must be fulfilled by multimedia medical data, and the security measures used to satisfy these requirements. These security measures are based mainly on modern cryptographic and watermarking mechanisms as well as on security infrastructures. The objective of our work is to complete this picture, exploiting the capabilities of multimedia medical data to define and implement an authorization model for regulating access to the data. In this paper we describe an extended rolebased access control model by considering, within the specification of the role–permission relationship phase, the constraints that must be satisfied in order for the holders of the permission to use those permissions. The use of constraints allows role-based access control to be tailored to specifiy very fine-grained and flexible content-, contextand time-based access control policies. Other restrictions, such as role entry restriction also can be captured. Finally, the description of system architecture for a secure DBMS is presented. (Authors’ abstract) Legal and ethical issues in the use of anonymous images in pathology teaching and research [Review] Tranberg HA, Rous BA, Rashbass J. Histopathology 2003; 42(2): 104–9. The privacy of patients’ health information is of paramount importance. However, it is equally important that medical staff and students have access to photographs and video recordings of real patients for training purposes. Where the patient can be identified from such images, his or her consent is clearly required to both obtain the image and to use it in this way. However, the need for consent, both legally and ethically, is much less convincing where the patient cannot, by the very nature of the image, be identified from it. This is the case for many images used in the teaching of clinical medicine, such as videos taken of laparoscopies, images of internal organs and unlabelled X-rays. [References: 28] (Authors’ abstract) Forensic photography Background correction in forensic photography (I). Photography of blood under conditions of non-uniform illumination or variable substrate color – theoretical aspects and proof of concept Wagner JH, Miskelly GM. Journal of Forensic Sciences 2003; 48(3): 593–603. The combination of photographs taken at two or three wavelengths at and bracketing an absorbance peak indicative of a particular compound can lead to an image with enhanced visualization of the compound. This procedure works best for compounds with absorbance bands that are narrow compared with ‘average’ chromophores. If necessary, the photographs can be taken with different exposure times to ensure that sufficient light from the substrate is detected at all three wavelengths. The combination of images is readily performed if the images are obtained with a digital camera and are then processed using an image processing program. Best results are obtained if linear images at the peak maximum, at a slightly shorter wavelength, and at a slightly longer wavelength are used. However, acceptable results can also be obtained under many conditions if non-linear photographs are used or if only two wavelengths (one of which is at the peak maximum) are combined. These latter conditions are more achievable by many ‘mid-range’ digital cameras. Wavelength selection can either be by controlling the illumination (e.g., by using an alternate light source) or by use of narrow bandpass filters. The technique is illustrated using blood as the target analyte, using bands of light centered at 395, 415, and 435 nm. The extension of the method to detection of blood by fluorescence quenching is also