AJOB primary research最新文献

{"title":"Using the Best Interests Standard to Generate Actual Duties","authors":"L. Kopelman","doi":"10.1080/21507716.2013.782371","DOIUrl":"https://doi.org/10.1080/21507716.2013.782371","url":null,"abstract":"This claim is puzzling, because if the best interests standard were difficult to apply in practice, then how could it be the prevailing standard? A standard is useful insofar as it can be applied consistently, and if it cannot, it would not be a “prevailing standard” in any meaningful sense. I agree that the best interests standard is the prevailing standard in making recommendations or decisions in pediatrics as well as in other professions. However, I argue that it is generally clear how this standard should be applied in such disciplines and that it is a useful standard for making professional recommendations and decisions for those unable to decide for themselves about what is in their best interests. Deciding what is in someone’s best interest requires some notion of the good to be gained or the harm to be avoided. In medicine, judging what is better, best, or worse is assessed in terms of the goals of medicine. These goals include preventing or curing diseases, prolonging life, minimizing or eliminating disabilities, and relieving pain and suffering. Perhaps those who argue that the best interests standard is difficult to apply are preoccupied with disputes such as what is best to do when the goals of medicine come into conflict or when no clear evidence exists about how to fulfill them. Yet these disputes about how professionals should use the best interests standard occur against a background of general agreement about expectations, norms, data, goals and means to achieve them, reasoning processes, and methodologies for testing and justification, or so I argue. To understand the role of the best interests standard as a useful standard, it is necessary to distinguish some of the different ways it is used (Kopelman 1997; 2007). In what follows, I focus on its use in making decisions for those","PeriodicalId":89316,"journal":{"name":"AJOB primary research","volume":"35 1","pages":"11 - 14"},"PeriodicalIF":0.0,"publicationDate":"2013-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88910130","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":"What Constitutes the Best Interest of a Child? Views of Parents, Children, and Physicians in a Pediatric Oncology Setting","authors":"M. D. de Vries, D. Bresters, G. Kaspers, Mirjam Houtlosser, J. Wit, D. P. Engberts, E. van Leeuwen","doi":"10.1080/21507716.2012.757254","DOIUrl":"https://doi.org/10.1080/21507716.2012.757254","url":null,"abstract":"Background: In pediatrics, the “best interest” standard has become the prevailing standard in decision making even though it proves difficult to apply in practice. Differences in values can lead to different views by families and physicians of what is in the interest of a child. Our aim was to gain insight into the views of parents, children, and physicians in a pediatric oncology setting. Methods: We conducted a qualitative multicenter study, using in-depth semistructured interviews, with 21 children aged 8–18 years undergoing cancer treatment, 26 parents, and 15 pediatric oncologists. Results: At the onset of treatment, parents, children, and physicians had the same views on what is in the interest of the child: survival by following the treatment protocol. In the course of treatment, however, a transition takes place. For families, what constitutes the best interests expands beyond medical considerations, to include the wish to lead a normal life, having control over certain aspects of treatment, and maintaining one's identity (e.g., through religion). These aspects sometimes collide with medical aspects, leading to different professional and familial views about what course of action is appropriate. Conclusions: In order to recognize personal views and avoid conflicts, physicians should explicitly discuss parent and family concerns and opinions in the course of treatment. We present a model of “communicative ethics” to make these issues a subject of discussion. The role of the family in determining what is in the best interest of the child should only be limited when it implies a substantial medical risk of (irreversible) harm to the child.","PeriodicalId":89316,"journal":{"name":"AJOB primary research","volume":"48 1","pages":"1 - 10"},"PeriodicalIF":0.0,"publicationDate":"2013-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73293364","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":"Do Hospitalized Patients in a Nigerian Community Consider Informed Consent Necessary?","authors":"O. Adeleye, E. Tobin","doi":"10.1080/21507716.2012.757257","DOIUrl":"https://doi.org/10.1080/21507716.2012.757257","url":null,"abstract":"Background: African patients often prefer to relinquish their consent powers to their physicians. Physicians may not seek informed consent before medical procedures. This study was conducted to determine whether patients considered their informed consent necessary before medical procedures. Methods: Using a descriptive cross-sectional design, hospitalized adult patients in a Nigerian community were interviewed about their opinions on the necessity of their informed consent. Results: Overall, 92.5% (185/200) believed that their informed consent was necessary prior to a medical procedure. The percentage of participants holding this view ranged from 90 to 100% across most of the demographic and clinical categories. However, most of the participants reported not being adequately informed prior to at least one clinical procedure in the course of their current hospitalization. Conclusions: Most patients want physicians to seek their informed consent prior to clinical procedures. This position does not conflict with the possibility of patients’ eventual choice to authorize their physicians to determine what they consider best for their care. Physicians need retraining and reorientation to ensure that they obtain patients’ informed consent prior to performing medical procedures.","PeriodicalId":89316,"journal":{"name":"AJOB primary research","volume":"34 1","pages":"51 - 56"},"PeriodicalIF":0.0,"publicationDate":"2013-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78004142","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":"Do Medical Students Recall and Use the Language of Ethics They are Taught Preclinically Once They are in the Clinical Training Environment? An Empirical Study in Ethics Education","authors":"L. Kaldjian, L. Shinkunas, V. Forman-Hoffman, M. Rosenbaum, J. Woodhead, Lisa Antes, Jane A. Rowat","doi":"10.1080/21507716.2012.757258","DOIUrl":"https://doi.org/10.1080/21507716.2012.757258","url":null,"abstract":"Background: Ethics education is an established part of the medical school curriculum and typically involves preclinical instruction that includes formal ethical terminology. However, it is not clear whether the language of ethics taught in preclinical settings is applied by students during the clinical years of training. Methods: We used a survey and a content analysis of written reflections to determine whether third-year (clinical) medical students were able to recall and apply ethical principles and other sources of ethical value they were taught as second-year (preclinical) students. Results: The majority of clinical students were able to recall the four ethical principles, appreciated the relevance of preclinical ethics education, and had positive self-assessments of their clinical-ethical reasoning abilities. However, they were less able to recall other (nonprinciple) sources of ethical value and infrequently used ethical terms spontaneously in written reflections about ethically or professionally challenging issues. Conclusions: Ethics educators should consider the extent to which preclinical ethics education depends on a formal language of ethics and should develop ways to reinforce that language meaningfully through experience-based learning opportunities during the clinical years of training, with special emphasis on the way clear ethical reasoning and communication demonstrate respect for other persons.","PeriodicalId":89316,"journal":{"name":"AJOB primary research","volume":"44 1","pages":"23 - 30"},"PeriodicalIF":0.0,"publicationDate":"2013-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81106337","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":"Knowledge of and Training in Research Ethics in an African Health Research Community","authors":"O. Adeleye, T. Ogundiran","doi":"10.1080/21507716.2012.720638","DOIUrl":"https://doi.org/10.1080/21507716.2012.720638","url":null,"abstract":"Background: This study aimed at assessing knowledge of research ethics in a Nigerian health research community based on criteria for ethical research in the national code. It also sought to test the hypothesis that prior research ethics training, higher academic rank, and self-judged adequate knowledge of research ethics were not associated with knowledge of research ethics. Methods: As part of a descriptive, cross-sectional study, lecturers in university medical schools in two Nigerian states completed a structured questionnaire. Results: Of 133 study participants, 100 (75.2%) were trained in research ethics, mostly through workshops (72%). Fifty (37.6%) correctly identified all 10 criteria for ethical research listed. Prior research ethics training, rank, and self-judged adequate knowledge of research ethics were not associated with aggregate scores of research ethics knowledge. Conclusions: The majority of the respondents were trained in research ethics, but knowledge gaps were identified. Health researchers in this setting need to be trained more effectively in research ethics.","PeriodicalId":89316,"journal":{"name":"AJOB primary research","volume":"30 1","pages":"44 - 50"},"PeriodicalIF":0.0,"publicationDate":"2013-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84403788","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":"Informed Consent Forms in Oncology Research: Linguistic Tools Identify Recurrent Pitfalls","authors":"N. Ilic, A. Auchlin, A. Hadengue, A. Wenger, S. Hurst","doi":"10.1080/21507716.2013.788101","DOIUrl":"https://doi.org/10.1080/21507716.2013.788101","url":null,"abstract":"Background: Understanding of informed consent forms (ICFs) for clinical research remains insufficient despite attempts to simplify them. Through linguistic discourse analysis, we sought to identify pitfalls within the text of ICFs that could hinder readers’ understanding of participation in research. Methods: We conducted a linguistic discourse analysis on a qualitative sample of 19 ICFs approved by research ethics committees (RECs) for oncology protocols and explored whether our findings also applied to standard U.S. documents available online. Results: We identified five major categories of language patterns that were problematic with respect to ensuring informed consent. We categorized them as follows: “bypassing consent,” “seeker–supplier inversion,” “interlocking Russian dolls,” “vanishing author,” and “one size fits all.” At least one instance of these findings existed in all analyzed forms (median 10 per ICF, range 1–18) and in national templates and U.S. documents. Conclusions: Linguistic discourse analysis identified recurrent pitfalls in the language of REC-approved ICFs and templates. This approach may provide new tools to improve ICFs.","PeriodicalId":89316,"journal":{"name":"AJOB primary research","volume":"3 1","pages":"39 - 54"},"PeriodicalIF":0.0,"publicationDate":"2013-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88759400","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":"Standard of Prevention in the Real World: A Qualitative Study of Principal Investigators in HIV Biomedical Prevention Trials","authors":"B. Haire, C. Jordens","doi":"10.1080/21507716.2013.782926","DOIUrl":"https://doi.org/10.1080/21507716.2013.782926","url":null,"abstract":"Background: UNAIDS guidelines require that participants in HIV prevention trials are provided with “state-of-the-art” risk reduction measures. Published data showing that new HIV prevention strategies are highly, but not completely, effective problematize “standard of prevention” packages that provide access to condoms and counseling only. This qualitative study asks how principal investigators on HIV prevention studies determine appropriate standards of prevention. It builds on previous work mapping standards of care in HIV prevention trials by investigating how decisions were arrived at, in addition to reporting what was decided. Methods: Semistructured interviews were conducted with 14 principal investigators of biomedical HIV prevention trials. Interviews were transcribed, coded, and analyzed thematically using predetermined categories derived from the ethics literature and spontaneous coding. Results: A spectrum of views was given by informants as to how standard of prevention should be determined, ranging from an ethical requirement to include newly validated technologies as soon as feasible, to a perceived need to reduce the prevention package to make it more like real life, thus enabling subsequent trials to test interventions against basic prevention packages. Each informant argued her position with reference to keeping the size and cost of studies reasonable, the need for conclusive data on the effectiveness of preventive interventions, perceived duties to trial participants, and regulatory requirements. Some saw reconsent as the critical issue in ongoing trials when relevant data from other studies were released. Conclusions: There was no ethical consensus about the standard of prevention among principal investigators. Rational arguments were made to support disparate positions. These results suggest a need to examine and articulate the ways that the narrow aims and obligations of a research study sit within the broader context of disease burden and inequitable access to health care in the resource-poor world in order to address how future research should proceed.","PeriodicalId":89316,"journal":{"name":"AJOB primary research","volume":"4 1","pages":"14 - 25"},"PeriodicalIF":0.0,"publicationDate":"2013-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88306563","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":"Clinical Concerns and the Validity of Clinical Trials","authors":"C. Lidz, C. Benedicto, Karen Albert, P. Appelbaum, L. Dunn","doi":"10.1080/21507716.2013.770105","DOIUrl":"https://doi.org/10.1080/21507716.2013.770105","url":null,"abstract":"Background: The validity of results from clinical trials depends on both clinical researchers and participants consistently and strictly following research protocols. However, clinical trial researchers are also expected to provide excellent medical care to the participants. These two commitments may conflict under some circumstances. Methods: A questionnaire previously used for a national Internet-based survey was adapted to conduct in-depth, semistructured interviews in order to further explore reported attitudes and/or behaviors that indicated that patient well-being sometimes took precedence over strict adherence to the study protocol. We conducted 96 interviews with researchers working on Phase II and/or Phase III clinical trials in a variety of medical fields at four major academic medical centers. Results: Due to concerns for the welfare of their patients, the researchers we interviewed described decisions that involved “individualized” rather than protocol-driven decisions about recruitment, protocol implementation, and termination. The individualized decisions could threaten the validity of the trials. Conclusions: Clinical researchers should be strongly encouraged to carefully document and report selective recruitment, implementation, and termination decisions so that it will be easier to evaluate to whom the results of research studies apply. Those who design clinical trials should be careful to construct them so that the clinicians who carry them out will not feel that implementing the protocol will violate their commitments to good clinical care.","PeriodicalId":89316,"journal":{"name":"AJOB primary research","volume":"36 1","pages":"26 - 38"},"PeriodicalIF":0.0,"publicationDate":"2013-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78025524","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":"A Model for the Assessment of Medical Students’ Competency in Medical Ethics","authors":"A. Favia, Lily Frank, N. Gligorov, Steven Birnbaum, Paul J. Cummins, Robert Fallar, K. Ferguson, K. Mendis, E. Friedman, R. Rhodes","doi":"10.1080/21507716.2013.768308","DOIUrl":"https://doi.org/10.1080/21507716.2013.768308","url":null,"abstract":"Background: This article focuses on the goals of our medical ethics education program and our formative assessments of students’ competency at various points during this education. Methods: Because of the critical relationship between a program's goals and the design of an assessment strategy, we provide an overview of the theoretical basis of our curriculum, our program's objectives, and teaching methods. In order to verify that our students had achieved minimum competency in the objectives of our ethics curriculum, we developed assessments that evaluated their ability to identify and apply ethical principles to clinical cases and to use moral reasoning to resolve dilemmas. We verified the reliability of these assessment instruments by correlating two different Mount Sinai raters’ scores of the same assessments with each other and the validity of these assessments with external reviewers. Results: For interrater reliability, paired raters scored the same student written exercise within 5 points of each other on 119 of the exercises (87% rater consensus). Therefore, we found our assessment tools to be reliable. Regarding validity, all three expert external reviewers agreed that our instruments were well suited for evaluating medical student competency in medical ethics and that they measured what we intended to measure. Conclusions: Our efforts in medical ethics education and competency assessment have produced an integrated model of goals, methodology, curriculum, and competency assessment. The entire model is directed at providing students with the ethical knowledge, skills, and attitudes required of an exemplary physician. We have developed reliable and valid assessment tools that allow us to evaluate the competency of students in medical ethics and to identify students who require remediation, and that are useful for other ethics programs.","PeriodicalId":89316,"journal":{"name":"AJOB primary research","volume":"7 1","pages":"68 - 83"},"PeriodicalIF":0.0,"publicationDate":"2013-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80894196","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 IntegratedEthicsTM Facility Workbook: An Evaluation Tool to Support Health Care Ethics Program Implementation and Quality Management","authors":"M. Bottrell, R. Pearlman, M. Foglia, E. Fox","doi":"10.1080/21507716.2012.751465","DOIUrl":"https://doi.org/10.1080/21507716.2012.751465","url":null,"abstract":"Background: IntegratedEthicsTM (IE) establishes a new model for ethics programs, with the goal of continuously improving “ethics quality” in health care. This article describes the IntegratedEthics Facility Workbook (IEFW), an evaluation tool developed by the National Center for Ethics in Health Care (NCEHC) to help health care facilities improve ethics quality in their organization. The workbook helps facilities to evaluate their local ethics programs relative to specific quality standards established for the IE model. This article describes the origins of the quality standards established for the IE model, explains IEFW conceptual underpinnings and tool development, illustrates how ethics programs use the tool to drive local program quality improvement, and provides longitudinal IEFW national results (2008–2011) for Department of Veterans Affairs (VA) IE programs. Methods: The project uses descriptive analysis of IEFW data submitted by VA facilities from 2008 through 2011. Results: In VA, longitudinal IEFW data demonstrate that facilities have made great strides in improving their ethics programs relative to quality standards defined for IntegratedEthics. Improvements in ethics consultation and preventive ethics practices—particularly related to accountability structures, consistent use of standardized processes, and evaluation of program quality—have been impressive and generally consistent over time. In the area of ethical leadership, facilities have had some success in improving structures and processes (e.g., the top corporate decision making body includes a member with recognized expertise in ethics), but less success in improving behaviors by individual leaders (e.g., involving clinical staff members in major organizational decisions that have ethical implications). Conclusions: The IEFW is a useful tool for monitoring progress in building a high-quality ethics program. [Supplemental materials are available for this article. Go to the publisher's online edition of AJOB Primary Research for the following free supplemental resource: IntegratedEthicsTM Facility Workbook.]","PeriodicalId":89316,"journal":{"name":"AJOB primary research","volume":"37 1","pages":"59 - 70"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81114863","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}