Journal of clinical research & bioethics最新文献

{"title":"The Plausibility of Universal Health Care in the United States","authors":"Richard Boudreau","doi":"10.4172/2155-9627.1000298","DOIUrl":"https://doi.org/10.4172/2155-9627.1000298","url":null,"abstract":"Though the United States is one of the wealthiest nations in the world, the disparities in income are only surpassed by the inequalities in access to health care. Because of the close tie between the health care crisis and the fiscal health of the country as a whole, proposals have been made to introduce universal health care, to adapt existing systems and to support efforts, including what has been deemed “ObamaCare” to move towards greater accountability in obtaining and maintaining health insurance for the millions of uninsured and underinsured. Though most countries in the developed world perceive health care as a basic human right, the United States has yet to determine a way of creating and funding a single-payer universal health care system that will address the inequalities that exist and provide a better option for preventative medicine, interventive medicine, and long-term care.One of the central problems for this country is that our political process is divided ideologically and health care paradigms do not appear to address issues on both sides. While there is support for a national health program that would ensure access to the working poor, fiscal conservatives view this as a system that cannot be afforded and that would expand debt in an uncontrollable manner. In fact, there is a clear division between the patriarchal perspectives of the democrats and the growing Tea Party call for personal responsibility.The following study considers the issue of health care in this country, including the current level of expenditure, the lack of access, comparable international efforts, and even state proposed changes that have shown some success in the implementation of universal health care. This study will focus on the way in which innovation and governance have struggled to determine workable paradigms for health care reform. The focus on a single-payer or universal health care system has not led to successful legislative change, and so elements of both arguments will be considered when addressing the best methods for improving access to care and affordability. A proposed plan will be introduced that will consider the best options for improving the following: 1. Affordability; 2. Access to care; 3. Long-term viability; 4. State and federal cooperation; 5. Distribution of funding or services. The proposed plan will address these issues and present some plausible approaches.","PeriodicalId":89408,"journal":{"name":"Journal of clinical research & bioethics","volume":"8 1","pages":"1-21"},"PeriodicalIF":0.0,"publicationDate":"2017-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2155-9627.1000298","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44276195","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 Role of ICH- GCP in Clinical Trial Conduct","authors":"W. Pranali, ile, R. Ghooi","doi":"10.4172/2155-9627.1000297","DOIUrl":"https://doi.org/10.4172/2155-9627.1000297","url":null,"abstract":"The Good Clinical Practice Guideline of the International Conference on Harmonization (ICH-GCP) is an international ethical, scientific and quality standard to harmonize technical procedures and standards, improve quality, speed time to market the drug. This standard is for designing, conducting, performing, monitoring, auditing, recording, analyzing and reporting clinical trials involving human subjects.Mushrooming regulatory requirements of different countries made new drug research very expensive and time consuming, simply because different countries had different requirements. The ICH standardized the requirements so that a drug developed as per the GCP guidelines could be acceptable to any member country of the ICH. Past history of human research abuses led to the inclusion of ethical standards to make them uniform across the ICH region. The guideline lays emphasis on protecting rights, safety, and welfare of human study subjects who participate in studies. In last two decades, these standards have evolved and become pillars of successful global drug development, which we have today. These standards have been revised and updated in 2016, but the core principles remain the same.","PeriodicalId":89408,"journal":{"name":"Journal of clinical research & bioethics","volume":" ","pages":"1-5"},"PeriodicalIF":0.0,"publicationDate":"2017-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2155-9627.1000297","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42762024","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":"Are Advanced Directives Relative? The Ethics of Surrogate Decision Making","authors":"Ramy Sedhom","doi":"10.4172/2155-9627.1000294","DOIUrl":"https://doi.org/10.4172/2155-9627.1000294","url":null,"abstract":"An important aspect of medical ethics is the right to decline medical treatment. A problem is how to honor the wishes of patients who lose their voice and can no longer accept or refuse medical treatment. Although advanced directives are attempts to protect autonomy, decisions are not immutable and may be negotiated by family, loved ones, and other surrogate decision makers. Describes is a case that underscores the importance of advanced care planning, the complexity of decision making, and area for potential improvement.","PeriodicalId":89408,"journal":{"name":"Journal of clinical research & bioethics","volume":"7 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2017-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41646944","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":"Primary Plasma Cell Leukemia Presenting as Heart Failure: A Case Report","authors":"Li Li, T. Wu, Bing Wu, Y. Zhang, Jun Qin","doi":"10.4172/2155-9627.1000296","DOIUrl":"https://doi.org/10.4172/2155-9627.1000296","url":null,"abstract":"Plasma cell leukemia (PCL) is an uncommon and aggressive plasma cell dyscrasia characterized by malignant plasma cells in bone marrow and peripheral blood. The prognosis of PCL patients treated with conventional chemotherapy remains poor. The clinical presentation of PCL features extensive abnormal plasma cells in the peripheral blood and a higher prevalence of organomegaly, with involvement of multiple tissues and organs, the symptoms usually include anemia, bleeding, infection, bone pain, and renal failure. However, PCL presenting as heart failure is very rare. We herein report a case of 45-year-old man primary PCL in which the patient presented atypically as heart failure.","PeriodicalId":89408,"journal":{"name":"Journal of clinical research & bioethics","volume":"8 1","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2017-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45178048","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":"Why Tuberculosis Has Not Been Eradicated? Need for Vision and Bold Innovative Research","authors":"S. S. Nair","doi":"10.4172/2155-9627.1000295","DOIUrl":"https://doi.org/10.4172/2155-9627.1000295","url":null,"abstract":"Tuberculosis has not been eradicated despite advancements in science. Main reason is that research and its utilization have gone into a deep rut because of lack of vision and innovation. Knowledge about epidemiology of tuberculosis is patchy. Some paradoxes and unanswered questions have been highlighted. Finding explanations for these is essential to eradicate tuberculosis. Prevention, diagnosis and treatment of tuberculosis need overhauling. A systematic review is needed to identify facts, myths and gaps in knowledge about all these. Thereafter, new types of research which can answer relevant questions are essential to find explanations for many paradoxes and unanswered questions and to remove lacunae in prevention, diagnosis and treatment of tuberculosis because many decades of present type of research have failed. Only thinking out of the box and carrying out bold innovative research can find needed explanations. Emphasis ought to be on going ahead urgently with bold innovative research to find effective measures required for eradication of tuberculosis. Studies to ascertain factors contributing to spontaneous cure also deserve high priority. Suggestions to make a beginning in innovative research have been given. Some instances of ignoring research findings have been highlighted. Importance of utilization of research findings has been stressed. Any hesitation in funding bold innovative research is a pennywise and pound foolish approach without vision because economic cost of tuberculosis is many times higher than even spending huge amounts, if needed, on such research. Moreover, elimination of suffering from tuberculosis is invaluable.","PeriodicalId":89408,"journal":{"name":"Journal of clinical research & bioethics","volume":" ","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2017-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48768071","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":"Ethical Issues in Patients with Leukemia: Practice Points and Educational Topics for the Clinical Oncologist and Trainees","authors":"Jeffery S Farroni, Phillp A Thompson, Daud Arif, J. Cortes, Colleen M. Gallagher","doi":"10.4172/2155-9627.1000314","DOIUrl":"https://doi.org/10.4172/2155-9627.1000314","url":null,"abstract":"Leukemia represents a complex spectrum of malignancies, involving numerous treatment options and substantial symptom burden for patients. Ethical dilemmas may arise which challenge a physician's clinical management and the patient's goals of care. What is needed is the systematic analysis of the most common issues that confront clinical teams treating patients with leukemia in order to derive best ethical practices for optimized patient care. We examined 312 formal ethics consultations requested for patients with a leukemia diagnosis. We found that the most common ethical issues relate to the level of appropriate intervention, the futility of treatment and surrogate decisionmaking. The underlying causes stem from inadequately addressed psychosocial issues, disagreements between various stakeholders in the patient's care and miscommunication. Illuminating these issues provides areas of focus for the practitioner to refine their practice and inform educational initiatives. The integration of the clinical ethics service into the multidisciplinary team is a mechanism to foster a preventative ethics model and mitigate potential dilemmas.","PeriodicalId":89408,"journal":{"name":"Journal of clinical research & bioethics","volume":"8 1","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2155-9627.1000314","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70309664","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":"Healthcare Organizational Silence: Who is Accountable?","authors":"A. Yaqoob, S. Muhammad","doi":"10.4172/2155-9627.1000321","DOIUrl":"https://doi.org/10.4172/2155-9627.1000321","url":null,"abstract":"Policies and protocols are set to be the benchmark of every organization which brings it towards the mission to meet its vision. Organization without policies or its implementation seems blind in terms of its operation and administration. However, lack of implementation of policies can endorse unethical decisions which mislead the entire organization’s mission and can develop mistrust among the employees that may ultimately breach the principle of ethics.","PeriodicalId":89408,"journal":{"name":"Journal of clinical research & bioethics","volume":"9 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70309701","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":"Knowing-How to Fulfil One's Duties","authors":"Darlei DallAgnol","doi":"10.4172/2155-9627.1000315","DOIUrl":"https://doi.org/10.4172/2155-9627.1000315","url":null,"abstract":"The introduction of respect for patients’ autonomy is a long awaited, and most welcome, development in medical ethics. In daily life, however, some of these duties may clash, leading to dilemmas. Putting the health and well-being of the patient first may sometimes conflict with effectively respecting her autonomy, especially when there is disagreement on the best course of action. What happens if physician A believes, in her best judgment, that x is the best option, but patient B wants y? What does it mean to put the patient’s wellbeing first and, at the same time, respect his autonomy?","PeriodicalId":89408,"journal":{"name":"Journal of clinical research & bioethics","volume":"8 1","pages":"1-1"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2155-9627.1000315","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70309824","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":"Complexity in Bioethics","authors":"Richard Boudreau","doi":"10.4172/2155-9627.1000e116","DOIUrl":"https://doi.org/10.4172/2155-9627.1000e116","url":null,"abstract":"","PeriodicalId":89408,"journal":{"name":"Journal of clinical research & bioethics","volume":"9 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70310064","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":"Ordinary Citizens' Expectations for Regenerative Medicine and Induced Pluripotent Stem Cells Researches in Japan","authors":"Y. Takimoto, E. Nakazawa, A. Tsuchiya, Akabayashi Akira","doi":"10.4172/2155-9627.1000311","DOIUrl":"https://doi.org/10.4172/2155-9627.1000311","url":null,"abstract":"Objective: In order to examine people’s expectations for regenerative medicine and iPS cells researches in Japan, we conducted an attitude survey not only among ordinary citizens but also among patients with age-related macular degeneration. Methods: 2,656 ordinary citizens, 445 age-related macular degeneration patients, and families of 210 agerelated macular degeneration patients answered 5 question items. Results: Knowledge of iPS cell research, expectations for treatment using iPS cells, and Information acquisition of studies using iPS cells were significantly higher among patients and their families, in comparison with citizens. Regarding iPS cells researches, the ordinary citizens were favor of promoting development of therapeutic drugs for intractable diseases rather than \"organ regeneration, including the liver and kidney\" and \"creation of sperm and ova for assisted reproductive technology\". Conclusions: Expectations for regenerative medicine, using iPS cells, were greater both among individuals involved in the disease and ordinary citizens. Especially, they count on development of therapeutic drugs for intractable diseases.","PeriodicalId":89408,"journal":{"name":"Journal of clinical research & bioethics","volume":"8 1","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2155-9627.1000311","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70309099","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}