AJOB primary research最新文献

{"title":"Medical Students’ Willingness to Engage in Television Promotional Activities","authors":"N. Farber, Jacqueline F. Kerkow, M. Devereaux","doi":"10.1080/21507716.2010.539996","DOIUrl":"https://doi.org/10.1080/21507716.2010.539996","url":null,"abstract":"Direct-to-consumer (DTC) advertising poses significant ethical challenges. We conducted a survey about the likelihood that medical students would endorse pharmaceutical and herbal remedies on television. A survey asked how likely all medical students enrolled at the University of California, San Diego, School of Medicine in the spring of 2009 would be to promote products on television. Hypothetical scenarios varied according to whether products were beneficial, whether they had potential for harm, and how much money was offered for the promotion. Seventy-four percent of respondents were likely to promote at least one product, yet 73% indicated medical professionals should avoid such activities. Food and Drug Administration (FDA)-approved medications were more likely to be promoted compared with herbal remedies (p < .001). Students were more likely to endorse low- versus high-risk products (p < .001). There was a significant increase in likelihood to endorse based on increasing amounts of remuneration (p = .03). In conclusion, a majority of students would endorse at least one product on television, despite respondents’ attitudes that such activities should be avoided by “medical professionals.” Medical schools should educate students about conflicts of interest in caring for patients while advocating for or being influenced by pharmaceutical or herbal product firms.","PeriodicalId":89316,"journal":{"name":"AJOB primary research","volume":"29 1","pages":"31 - 37"},"PeriodicalIF":0.0,"publicationDate":"2010-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85884449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Iranian Study or a Kashanian One?","authors":"K. Aramesh","doi":"10.1080/21507716.2010.532530","DOIUrl":"https://doi.org/10.1080/21507716.2010.532530","url":null,"abstract":"In the absence of published well-designed studies about the various ethical aspects of doctor–patient relationships in Iran, the article by Sheikhtaheri and Farzandipour is a valuable source of information about one of the most important aspects of this relationship, namely, the informed consent process (Sheikhtaheri and Farzandipour 2010). A major concern, however, may arise in the minds of readers: “To what extent does Kashan represent Iran?” Located in the central part of Iran, Kashan is a relatively small town in the middle of the desert. By population, Kashan is ranked as the 26th largest city in Iran. The population of the city itself is about 270,000, which is a small number in comparison to larger cities like Tehran with a population of about 7,700,000 and Mashhad with a population of about 2,400,000. Bearing in mind the population of Iran, which is more than 70,000,000, it is obvious that Kashan represents a very small part of the Iranian population. People in the centrally located, small cities of Iran are known for their traditional culture and conservative lifestyle, as well as lower socioeconomic status and educational level in comparison with the larger cities like Tehran, Isfahan, or Shiraz. Consequently, one of the more prominent features of medical practice and doctor–patient relationships in such communities is their paternalistic nature. The situation, of course, is rather different in the more developed urban areas of the country. Therefore, to obtain a more complete picture of the situation in Iran, one should take into account a wide variety of patient populations, ranging from small health care centers located in rural areas, to modern and expensive private hospitals located in the northern parts of Tehran, serving people who belong to the highest socioeconomic classes. There are at least three other published Iranian studies exploring some components of informed consent in Iran. In one of them, performed in 2006 in a large hospital complex in Tehran, 299 patients admitted to general internal medicine or surgery wards were interviewed. The results showed that Iranian patients were highly interested in receiving information about their condition and participating in clinical decision making. The mean (SD) scores representing patients’ desire for receiving information and participat-","PeriodicalId":89316,"journal":{"name":"AJOB primary research","volume":"56 1","pages":"17 - 18"},"PeriodicalIF":0.0,"publicationDate":"2010-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90317192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Of Principles and P Values","authors":"E. Evans","doi":"10.1080/21507716.2010.539997","DOIUrl":"https://doi.org/10.1080/21507716.2010.539997","url":null,"abstract":"Empirical and conceptual work in bioethics often focuses on issues relating to what might be termed the consensus tenets of bioethics, namely, a collection of foundational principles (e.g., autonomy, beneficence, and justice) and related concepts (e.g., informed consent, shared decision-making, and institutional review boards [IRBs]). The successful uptake of these principles is demonstrated by their prominence in the academic research literature, domestic and international guidelines, policy and regulations, and even the popular discourse. Informed consent is regarded as a nearly indispensable requirement of ethical [clinical] practice or research, and health care professionals are expected to actively engage patients or their surrogates in the process of shared decision making. Researchers and health care professionals must protect the interests of research participants and patients. Government regulatory agencies generally require independent ethical review of research involving human subjects. Thus, despite the diverse array of disciplines constituting the field of bioethics, those working in the field share a general framework and vocabulary with which to analyze and respond to difficult ethical issues. That the concept of informed consent, for example, is understood and accepted across a wide range of professional and lay communities has resulted in the development of a large body of evidence that has improved biomedical policies and practices. A simple but powerful example is the use of various types of visual aids and alternative media to improve the informed consent process in populations with low literacy rates or unfamiliarity with basic scientific concepts (Woodsong and Karim 2005). Even when research and analysis is intended to challenge the status, role, or interpretation of core values and principles, recognition and understanding of them provide an important starting place. The consensus tenets can be understood as the background assumptions of empirical and conceptual work in bioethics, and, like any background assumptions, they should be the subjects of ongoing critical inquiry. Although earlier discussions emphasized the purported differences between “Western” and “Asian” (or in some cases “European”) approaches to bioethics, evidential and normative support for these positions has weakened (Macklin 1999). Instead of trying to sharpen into absolutes","PeriodicalId":89316,"journal":{"name":"AJOB primary research","volume":"1105 1","pages":"2 - 3"},"PeriodicalIF":0.0,"publicationDate":"2010-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79752885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical Paternalism or Parental Autonomy in Decision Making: A Portuguese Study in Premature Newborns","authors":"E. Silva, W. Osswald","doi":"10.1080/21507716.2010.526171","DOIUrl":"https://doi.org/10.1080/21507716.2010.526171","url":null,"abstract":"Health care providers and parents may have distinctive roles in the decision-making process regarding the care and treatment of premature babies. In this paper, we explore the process of decision making among doctors, nurses, and parents in premature care units (neonatal intensive care unites, NICUs) located in the central region of Portugal. Forty-one semistructured interviews with doctors, nurses, and mothers were conducted and analyzed. There is evidence that the medical teams provide a considerable amount of information to parents of premature babies, although sometimes unfavorable prognostic data are omitted. Mothers showed a high degree of confidence in the skill and knowledge of the medical professionals and accepted the latter's role in making decisions regarding the care and treatment of their premature babies. Only when invasive procedures or surgery were serious possibilities was something resembling written informed consent obtained. Ethics committees were seldom consulted. The results show that in the region surveyed, parents neither are invited nor appear to demand a role in making medical decisions that affect their babies. No conflicts between medical providers and parents were detected, suggesting that informed consent and the participation of parents in medical decisions regarding the care and treatment of their babies are not considered necessary or useful in this particular area by the respective parties, in contrast with the tenets of autonomy-based ethics.","PeriodicalId":89316,"journal":{"name":"AJOB primary research","volume":"12 1","pages":"4 - 8"},"PeriodicalIF":0.0,"publicationDate":"2010-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78667493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Review of Doug Wojcieszak, James W. Saxton, Esq., and Maggie M. Finkelstein, Esq., Sorry Works!: Disclosure, Apology, and Relationships Prevent Medical Malpractice Claims","authors":"Court D. Lewis","doi":"10.1080/21507716.2010.542583","DOIUrl":"https://doi.org/10.1080/21507716.2010.542583","url":null,"abstract":"Doug Wojcieszak, James Saxton, and Maggie Finkelstein’s book Sorry Works!: Disclosure, Apology, and Relationships Prevent Medical Malpractice Claims is a handbook for healthcare professionals that offers evidenced-based information and strategies for ameliorating victims’ feeling of anger and mitigating litigation after cases of medical error. The authors do not offer much in the way of direct philosophical argument, but the book is a nice addition to an otherwise lacking area of research in bioethics. The book offers bioethicists, and readers in general, both a framework from which to understand the issues involved in the aftermath of medical error and a resource on which to base normative claims of what should occur after such cases. Wojcieszak’s personal experience with medical error and his professional experience with tort reform, public relations, and medical malpractice claims enable him to offer valuable insights into the issues of medical malpractice and error. As the founder of the Sorry Works! Coalition, he teaches healthcare professionals and insurance companies that full-disclosure methods work as a means to striking a middle-ground solution between healthcare and insurance professionals who want “[f]ewer lawsuits and better control over liability exposure” and victims who want “swift justice with no constitutional limits” (9). The book gains added legitimacy with the addition of Saxton and Finkelstein, who contribute their vast amounts of legal expertise and medical malpractice litigation experience. The combined forces of the authors make Sorry Works! a valuable tool for not only physicians, hospitals, insurance companies, tort lawyers, and victims (or surviving loved-ones), but also anyone else who is engaged with the issues and implications of medical error.","PeriodicalId":89316,"journal":{"name":"AJOB primary research","volume":"79 1","pages":"38 - 39"},"PeriodicalIF":0.0,"publicationDate":"2010-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79074887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Language of Hope: Therapeutic Intent in Stem-Cell Clinical Trials","authors":"C. Scott, Mindy C. DeRouen, L. Crawley","doi":"10.1080/21507716.2010.505899","DOIUrl":"https://doi.org/10.1080/21507716.2010.505899","url":null,"abstract":"Electronic registries for clinical trials present an opportunity for miscommunication of benefits and risks to potential subjects. We explored early phase clinical trials registered on the National Library of Medicine's ClinicalTrials.gov for inappropriate language patterns (terms and statements) that could convey therapeutic intent. We sampled early-phase heart disease clinical trial records involving stem cells registered on Clincaltrials.gov between April 24, 2004, and September 18, 2008, and randomly selected heart disease drug trials from the same period for comparison. Trial sponsorship and location were coded. Textual data were extracted from titles, purpose, outcome measures, and detailed description statements and coded for readability and the presence of therapeutic language. Content and multiple correspondence analyses were employed to explore language patterns suggestive of therapeutic intent. We found statistically significant differences in therapeutic language use between stem cell (n = 72, median statement frequency 3.5, IQR 1–7) and drug trial (n = 72 median statement frequency 1, IQR 0–3.5) records; Mann–Whitney U = 1808.5, p = .001. A correspondence plot, accounting for 65% of data variability, suggests correspondences among patterns of therapeutic language, regional location, and type of sponsorship between the two record types. Individual-, institute-, and government-sponsored stem-cell trials showed a tendency toward high frequency use of therapeutic statements. This study, the first to explore the potential for therapeutic miscommunication in electronic registries, suggests the need for greater scrutiny of language used in registered trials. Recommendations are offered to improve the integrity of records submitted to ClinicalTrials.gov.","PeriodicalId":89316,"journal":{"name":"AJOB primary research","volume":"1 1","pages":"11 - 4"},"PeriodicalIF":0.0,"publicationDate":"2010-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74402703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethics in Humanitarian Aid Work: Learning From the Narratives of Humanitarian Health Workers","authors":"L. Schwartz, C. Sinding, M. Hunt, L. Elit, L. Redwood-campbell, N. Adelson, L. Luther, J. Ranford, S. DeLaat","doi":"10.1080/21507716.2010.505898","DOIUrl":"https://doi.org/10.1080/21507716.2010.505898","url":null,"abstract":"Little analysis has been made of ethical challenges encountered by health care professionals (HCPs) participating in humanitarian aid work. This is a qualitative study drawing on Grounded Theory analysis of 20 interviews with health care professionals who have provided humanitarian assistance. We collected the stories of ethical challenges reported by expatriate HCPs who participated in humanitarian and development work. Analysis of the stories revealed that ethical challenges emerged from four main sources: (a) resource scarcity and the need to allocate them, (b) historical, political, social and commercial structures, (c) aid agency policies and agendas, and (d) perceived norms around health professionals’ roles and interactions. We discuss each of these sources, illustrating with quotes from the respondents the consequences of the ethical challenges for their personal and professional identities. The ethical challenges described by the respondents are both familiar and distinct for bioethics. The findings demonstrate a need to provide practical ethics support for humanitarian health care workers in the field.","PeriodicalId":89316,"journal":{"name":"AJOB primary research","volume":"11 1","pages":"45 - 54"},"PeriodicalIF":0.0,"publicationDate":"2010-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84833586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"State Intervention in Couples’ Reproductive Decisions: Socioethical Reflections Based on the Practice of Preimplantation Genetic Diagnosis in France","authors":"C. Bouffard, Julie-Kim Godin, Bénédicte Bévière","doi":"10.1080/21507716.2010.505897","DOIUrl":"https://doi.org/10.1080/21507716.2010.505897","url":null,"abstract":"Adopting socioethical and anthropological perspectives, this article addresses the impact of state intervention in the reproductive life of couples who consult for preimplantation genetic diagnosis (PGD) in France. Our main objective is to identify and analyze the socioethical problems flowing from French legislation as related to PGD and from its implementation. Methods included review and analysis of the relevant literature, ethnographic research in the three centers accredited to perform PGD, and participant observation (990 hours), with 79 semistructured interviews. Ethical problems identified were: (1) discrimination based on sexual orientation and the requirement for adherence to a traditional model of the couple and the family; (2) inequities in access to PGD; (3) restrictions on couples’ autonomy; and (4) breaches of respect for private life. We conclude that the state could improve the ethical conditions in which PGD is practiced by: (1) establishing educational programs in ethics to support members of multidisciplinary centers for prenatal diagnosis; (2) conducting empirical studies on the social acceptability of PGD; and (3) conducting empirical studies on the extent of state intervention in the reproductive life of couples likely to have recourse to reprogenetic services.","PeriodicalId":89316,"journal":{"name":"AJOB primary research","volume":"10 1","pages":"12 - 30"},"PeriodicalIF":0.0,"publicationDate":"2010-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78318215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Euthanasia and Palliative Care in Belgium: The Attitudes of Flemish Palliative Care Nurses and Physicians Toward Euthanasia","authors":"B. Broeckaert, J. Gielen, T. van Iersel, S. van den Branden","doi":"10.1080/21507716.2010.505900","DOIUrl":"https://doi.org/10.1080/21507716.2010.505900","url":null,"abstract":"Little research has been carried out to determine the attitudes of palliative care professionals to euthanasia. This research aimed to find out how Flemish palliative care nurses and physicians think about euthanasia. An anonymous questionnaire was sent to all physicians (147) and nurses (589) employed in palliative care teams and institutions in Flanders (Belgium). The questionnaire contained a demographic part, and an attitudinal part, consisting of a long series of ethical statements using a 5-point Likert-scale. Four hundred fifteen nurses (response rate 70.5%) and 99 physicians (67.3%) responded. A cluster analysis of the euthanasia questions resulted in three clusters: (moderate) opponents of euthanasia (n = 105, 23%), moderate advocates of euthanasia (n = 161, 35.2%), and staunch advocates of euthanasia (n = 191, 41.8%). A majority in all clusters believe that as soon as a patient experiences the benefits of good palliative care, most requests for euthanasia disappear and that all palliative care alternatives must be tried before a euthanasia request can be considered. Being a member of the cluster of the (moderate) opponents of euthanasia is associated with being male (p = .01), being older (p = .05), increasing years of experience in palliative care (p = .02), and being a physician (p = .02). Since most Flemish palliative care nurses and physicians are not absolutely against voluntary euthanasia, their attitudes seem to differ from the attitudes of their palliative care colleagues elsewhere. However, the attitudes of the Flemish palliative care nurses and physicians are largely contextual. For a very large majority, euthanasia is an option of last resort only.","PeriodicalId":89316,"journal":{"name":"AJOB primary research","volume":"14 1","pages":"31 - 44"},"PeriodicalIF":0.0,"publicationDate":"2010-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90990665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Touting Stem Cells—We Have Seen the Enemy and He Is Us","authors":"A. Caplan, A. Tsou","doi":"10.1080/21507716.2010.507425","DOIUrl":"https://doi.org/10.1080/21507716.2010.507425","url":null,"abstract":"In the pantheon of potential medical cure-alls, stem-cell therapy has enjoyed a long and storied existence in the public imagination. Widely believed to be one of the most promising avenues for treatment of otherwise untreatable diseases, stem-cell therapy has been used as a key element in the treatment of many blood disorders with great success (Kline 2006). As newer forms of adult, embryonic, induced, fetal, and cloned stem cells appear, the interest among those afflicted with otherwise incurable ailments in their clinical application grows accordingly. Sadly, the number of ways in which patients with terminal and chronic diseases may be potentially exploited is growing rapidly as well (Murdoch and Scott 2010; Caplan and Levine 2010). Like many technological innovations, the widespread availability of the Internet has proved characteristically double-edged. Patients now possess the capability to be well informed about available clinical trials and ongoing research involving novel forms of stem cells. Paradoxically, online information has also created unprecedented opportunities for disingenuous vendors of stem cell “treatments” to disseminate misinformation and exploit the desperation of the chronically and terminally ill. In such a climate, simply warning patients to be wary of potential medical hucksters is ethically inadequate (Caplan and Levine 2010). The increasingly complex nature of medical research and sheer volume of information available to prospective patients and their families represent genuine obstacles for patients trying to discern fact from fiction. Would-be patients may be ill-equipped to judge the therapeutic potential of various interventions or be unduly influenced by unsubstantiated claims of efficacy. Prospective patients are highly susceptible to being ill-informed about the latest “research,” lied to by quacks and charlatans, or deficient in their knowledge about the unreliability of biological materials being used by those touting stem cell “therapies” with the sole aim of lining their pockets. These challenges remain insufficiently acknowledged, much less garnering adequate responses. However, in seeking to form","PeriodicalId":89316,"journal":{"name":"AJOB primary research","volume":"126 1","pages":"1 - 3"},"PeriodicalIF":0.0,"publicationDate":"2010-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76545525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}