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Emergence of a Discipline? Growth in US Postsecondary Bioethics Degrees

HASTINGS CENTER REPORT 2016年第2期46卷 19-21页

作者： Lee, Lisa M. McCarty, Frances A. Presidential Commiss Study Bioeth Issues Washington DC USA Albany Med Coll Ctr Biomed Eth Educ & Res Albany NY 12208 USA

Teaching competency in bioethics has been a concern of the field since its start. In 1976, The Hastings Center published the first report on the teaching of contemporary bioethics. Graduate programs culminating in an MA or PhD were not needed at the time, concluded the report. In the future, however, the report speculated, the development and/or changing social priorities may at some point allow, or even require, the creation of new academic structures for graduate education in bioethics. Although that future might be upon us, the creation of a terminal degree in bioethics has its detractors. Scholars have debated whether bioethics is a discipline with its own methods and theoretical grounding, a multidisciplinary field bringing various professional perspectives to bear on particular types of problems, a set of problem-solving skills to resolve moral disagreements, or something else entirely. Whether or not efforts to develop the methods and theory of bioethics have matured to the point that it is now a discipline in the strictest sense, new bioethics training programs have appeared at all postsecondary levels. In this essay, we examine the number and types of U.S. programs and degrees in this growing field.

关键词： BIOETHICS UNIVERSITIES & colleges MASTERS programs (Higher education) DATA analysis software medical coding

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Exploring the feasibility and acceptability of using tactical decision games to develop final year medical students' non-technical skills

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medical TEACHER 2016年第5期38卷 510-514页

作者： Drummond, Iain Sheikh, Gauhar Skinner, Janet Wood, Morwenna Univ Edinburgh Ctr Med Educ Chancellors Bldg Edinburgh EH16 4SB Midlothian Scotland Victoria Hosp Kirkcaldy NHS Fife Kirkcaldy Scotland

Introduction: Clinical decision-making, situation awareness, task management, and teamwork are key non-technical skills (NTS) required by junior doctors. Tactical decision games (TDGs) are low-fidelity classroom-based activities designed to develop proficiency in NTS. This study aimed to explore the feasibility and acceptability of using TDGs as a novel teaching method for final year medical ***: Final year medical students at the University of Edinburgh participated in a single TDG session. Focus groups were then used to explore students' perceptions of participating in the TDG session and transcribed data from the focus groups was thematically ***: Six key themes emerged from the data: the value of non-medical games;giving and receiving feedback;observing and reflecting;recognizing and understanding NTS;dealing with uncertainty and ambiguity, and introducing TDGs into the ***: TDGs are an easy-to-use, low-fidelity method of teaching medical students about the importance of NTS. medical students view TDGs as a valuable learning activity that appears to increase awareness and understanding of the importance of NTS.

关键词： EDUCATIONAL games DECISION making TEACHING methods research FEEDBACK (Psychology) medical students FEASIBILITY studies PROFESSIONAL education CURRICULA (Courses of study) FOCUS groups GAMES GROUNDED theory FINANCING of research STUDENT attitudes UNCERTAINTY DECISION making in clinical medicine TEACHING methods THEMATIC analysis DATA analysis software medical coding STUDY & teaching ATTITUDES

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Contributions of knowledge products to health policy: a case study on the Public Health Status and Forecasts Report 2010

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EUROPEAN JOURNAL OF PUBLIC HEALTH 2016年第6期26卷 922-927页

作者： Hegger, Ingrid Kok, Maarten O. Janssen, Susan W. J. Schuit, Albertine J. van Oers, Hans A. M. Natl Inst Publ Hlth & Environm RIVM POB 1 NL-3720 BA Bilthoven Netherlands Vrije Univ Amsterdam Dept Hlth Sci De Boelelaan 1085 NL-1081 HV Amsterdam Netherlands Vrije Univ Amsterdam EMGO Inst Hlth & Care Res De Boelelaan 1085 NL-1081 HV Amsterdam Netherlands Tilburg Univ Tranzo Sci Ctr Care & Welf POB 90153 NL-5000 TL Tilburg Netherlands

Background: The Dutch Public Health Status and Forecasts report (PHSF Report) integrates research data and identifies future trends affecting public health in the Netherlands. To investigate how PHSF contributions to health policy can be enhanced, we analysed the development process whereby the PHSF Report for 2010 was produced (PHSF-2010). Method: To collect data, a case study approach was used along the lines of Contribution Mapping including analysis of documents from the PHSF-2010 process and interviews with actors involved. All interviews were recorded and transcribed ad verbatim and coded using an inductive code list. Results: The PHSF-2010 process included activities aimed at alignment between researchers and policy-makers, such as informal meetings. However, we identified three issues that are easily overlooked in knowledge development, but provide suggestions for enhancing contributions: awareness of divergent;continuously changing actor scenarios;vertical alignment within organizations involved and careful timing of draft products to create early adopters. Conclusion: To enhance the contributions made by an established public health report, such as the PHSF Report, it is insufficient to raise the awareness of potential users. The knowledge product must be geared to policy-makers' needs and must be introduced into the scenarios of actors who may be less familiar. The demand for knowledge product adaptations has to be considered. This requires continuous alignment efforts in all directions: horizontal and vertical, external and internal. The findings of this study may be useful to researchers who aim to enhance the contributions of their knowledge products to health policy.

关键词： medical policy INTERVIEWING RESEARCH methodology PUBLIC health REPORT writing RESEARCH -- Evaluation FINANCING of research THEMATIC analysis HEALTH literacy medical coding

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Balancing Benefits and Risks of Immortal Data: Participants' Views of Open Consent in the Personal Genome Project

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HASTINGS CENTER REPORT 2016年第1期46卷 36-45页

作者： Zarate, Oscar A. Brody, Julia Green Brown, Phil Ramirez-Andreotta, Monica D. Perovich, Laura Matz, Jacob Silent Spring Inst Nonprofit Res Grp Focused Environm Chem & Hlth Newton MA USA Northeastern Univ Social Sci Environm Hlth Res Inst Boston MA USA Northeastern Univ Dept Sociol & Anthropol Boston MA USA MIT Media Lab Cambridge MA 02139 USA Silent Spring Inst Newton MA USA Univ Arizona Mel & Enid Zuckerman Coll Publ Hlth Soil Water & Environm Sci Tucson AZ 85721 USA Northwestern Univ Stat Evanston IL 60208 USA

An individual's health, genetic, or environmental-exposure data, placed in an online repository, creates a valuable shared resource that can accelerate biomedical research and even open opportunities for crowd-sourcing discoveries by members of the public. But these data become immortalized in ways that may create lasting risk as well as benefit. Once shared on the Internet, the data are difficult or impossible to redact, and identities may be revealed by a process called data linkage, in which online data sets are matched to each other. Reidentification (re-ID), the process of associating an individual's name with data that were considered deidentified, poses risks such as insurance or employment discrimination, social stigma, and breach of the promises often made in informed-consent documents. At the same time, re-ID poses risks to researchers and indeed to the future of science, should re-ID end up undermining the trust and participation of potential research *** ethical challenges of online data sharing are heightened as so-called big data becomes an increasingly important research tool and driver of new research structures. Big data is shifting research to include large numbers of researchers and institutions as well as large numbers of participants providing diverse types of data, so the participants' consent relationship is no longer with a person or even a research institution. In addition, consent is further transformed because big data analysis often begins with descriptive inquiry and generation of a hypothesis, and the research questions cannot be clearly defined at the outset and may be unforeseeable over the long term. In this article, we consider how expanded data sharing poses new challenges, illustrated by genomics and the transition to new models of consent. We draw on the experiences of participants in an open data platformthe Personal Genome Projectto allow study participants to contribute their voices to inform ethical consent pract

关键词： BIOETHICS DATABASES HUMAN genome INFORMED consent (medical law) INTERNET INTERVIEWING RESEARCH methodology medical ethics MOTIVATION (Psychology) PERCEPTION PRIVACY RACE FINANCING of research INSTITUTIONAL review boards (Medicine) THEMATIC analysis DATA security RESEARCH subjects (Persons) -- Psychology PARTICIPANT & researcher DATA analysis software medical coding

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Clinical teaching performance improvement of faculty in residency training: A prospective cohort study

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medical TEACHER 2016年第5期38卷 464-470页

作者： van der Leeuw, Renee M. Boerebach, Benjamin C. M. Lombarts, Kiki M. J. M. H. Heineman, Maas Jan Arah, Onyebuchi A. Univ Amsterdam Profess Performance Res Grp Ctr Evidence Based Educ Acad Med Ctr NL-1012 WX Amsterdam Netherlands Univ Amsterdam Inst Res Dept NL-1012 WX Amsterdam Netherlands Univ Amsterdam NL-1012 WX Amsterdam Netherlands Univ Calif Los Angeles Dept Epidemiol Fielding Sch Publ Health Los Angeles CA 90024 USA

Purpose: The purpose of this study is to investigate how aspects of a teaching performance evaluation system may affect faculty's teaching performance improvement as perceived by residents over time. Methods: Prospective multicenter cohort study conducted in The Netherlands between 1 September 2008 and 1 February 2013. Nine hundred and one residents and 1068 faculty of 65 teaching programs in 16 hospitals were invited to annually (self-) evaluate teaching performance using the validated, specialty-specific System for Evaluation of Teaching Qualities (SETQ). We used multivariable adjusted generalized estimating equations to analyze the effects of (i) residents' numerical feedback, (ii) narrative feedback, and (iii) faculty's participation in self-evaluation on residents' perception of faculty's teaching performance improvement. Results: The average response rate over three years was 69% for faculty and 81% for residents. Higher numerical feedback scores were associated with residents rating faculty as having improved their teaching performance one year following the first measurement (regression coefficient, b: 0.077;95% CI: 0.002-0.151;p=0.045), but not after the second wave of receiving feedback and evaluating improvement. Receiving more suggestions for improvement was associated with improved teaching performance in subsequent years. Conclusions: Evaluation systems on clinical teaching performance appear helpful in enhancing teaching performance in residency training programs. High performing teachers also appear to improve in the perception of the residents.

关键词： Teacher evaluation PSYCHOLOGY Student evaluation of teachers Feedback (Psychology) Teacher development Professional education Teaching -- Evaluation Confidence intervals Hospital medical staff Longitudinal method medical schools -- Faculty medical cooperation Medicine -- Study & teaching Probability theory Regression analysis Research Research -- Finance Scale analysis (Psychology) Self-evaluation Statistics Variables (Mathematics) Data analysis Teaching methods Data analysis -- Software medical coding medical teaching personnel Residents (Medicine) -- Attitudes Clinical competence -- Study & teaching

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Being a Parent to a Young Adult with Mental Illness in Transition to Adulthood

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ISSUES IN MENTAL HEALTH NURSING 2016年第2期37卷 98-105页

作者： Lindgren, Eva Soderberg, Siv Skar, Lisa Lulea Univ Technol Dept Hlth Sci S-95187 Lulea Sweden Mid Sweden Univ Dept Nursing Sci Ostersund Sweden Blekinge Inst Technol Dept Hlth Karlskrona Sweden

Parents of young adults with mental illness may face a continued demand for support, even though their children have reached the age of majority. The aim of this study was to explore relatives' experiences of parenting a young adult with mental illness in transition to adulthood. Individual interviews were conducted and analysed according to Grounded Theory. The results showed that relatives experienced powerlessness and a sense of inescapable duty with limited possibilities to be relieved. With a family nursing approach, relatives can be supported and, when the young adults' needs of care are met, they can be relieved from their burden of responsibility.

关键词： CONTROL (Psychology) GROUNDED theory HEALTH transition INTERVIEWING MENTAL health services MENTAL illness PARENTING PSYCHOLOGY of parents SAMPLING (Statistics) QUALITATIVE research JUDGMENT sampling DATA analysis SOCIAL support BURDEN of care medical coding

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Epidemiology of poisonings, fractures and burns among 0-24 year olds in England using linked health and mortality data

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EUROPEAN JOURNAL OF PUBLIC HEALTH 2016年第6期26卷 940-946页

作者： Baker, Ruth Orton, Elizabeth Tata, Laila J. Kendrick, Denise Univ Nottingham Sch Med Div Primary Care Nottingham England Univ Nottingham Sch Med Div Epidemiol & Publ Hlth Nottingham England

Background: Understanding patterns of injury in England is challenging due to a lack of national injury surveillance data. Through recent linkage of a large primary care research database to hospitalization and mortality data, we describe the epidemiology of poisonings, fractures and burns over a 14-year period. Methods: We used linked English primary care, hospitalisation and mortality data from the Clinical Practice Research Datalink, Hospital Episode Statistics and Office for National Statistics between 1998 and 2011 to establish a cohort of 2,106,420 0-24 year olds. Incidence rates, per 10 000 person-years (PY) were estimated by age, sex, calendar year and socioeconomic status. Using Poisson regression we estimated incidence rate ratios, adjusting for age and sex. Results: Age patterns of injury incidence varied by injury type, with peaks at age 2 (74.3/10 000 PY) and 18 (74.7/10 000 PY) for poisonings, age 13 for fractures (305.1/10 000 PY) and age 1 for burns (116.8/10 000 PY). Over time, fracture incidence increased, whereas poisoning incidence increased only among 15-24 year olds and burns incidence reduced. Poisoning and burns incidence increased with deprivation, with the steepest socioeconomic gradient for poisonings among 20-24 year olds (IRR 2.63, 95% confidence interval 2.24-3.09). Conclusion: Differing patterns according to age and injury type reflect differences in underlying injury mechanisms, highlighting the importance of developing tailored preventative interventions across the life course. Inequalities in injury occurrences support the targeting of preventative interventions to children and young people living in the most deprived areas.

关键词： MORTALITY BURNS & scalds CONFIDENCE intervals CAUSES of death FRACTURES POISONING POISSON distribution FINANCING of research SOCIOECONOMIC factors medical coding

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Adherence to Medication Regimen in Patients with Severe and Chronic Psychiatric Disorders: A Qualitative Study

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ISSUES IN MENTAL HEALTH NURSING 2016年第11期37卷 868-874页

作者： Zarea, Kourosh Fereidooni-Moghadam, Malek Hakim, Ashrafalsadat Ahvaz Jundishapur Univ Med Sci Nursing Care Res Ctr Chron Dis Ahvaz Iran

Nonadherence to treatment is common in patients with chronic psychiatric disorders. Few studies have been conducted in Iran on lack of adherence to medication regimen in patients with severe psychiatric disorders. The present study was carried out with the purpose of gaining insight into the experiences of patients, their family members, and nurses on the medication adherence in patients with severe and chronic psychiatric disorders in selected hospitals in Ahvaz, Iran. A qualitative content analysis study was used in the study and the participants included 7 nurses, 5 patients, and 4 family members. The patients were being treated in psychiatric wards of the hospitals of Ahvaz, in southern Iran. The results of data analysis revealed three main themes: 1) Intentional abandonment of medications;2) Catalysts of medication discontinuation (including side effects, asymptomatic periods, lack of knowledge of family members, and cultural shame of medication use);and 3) Consequences of medication discontinuation. According to the findings of the study, cultural attitudes play an important role in adherence to treatment regimen among the patients with chronic psychiatric disorders. It is recommended to arrange different programs to improve the situation with an emphasis on improving the general attitude of society towards mental illnesses and the need for regular use of the medications.

关键词： ANTIDEPRESSANTS DRUG therapy for mental depression ANTIPSYCHOTIC drugs CONTENT analysis (Communication) CULTURE DRUGS INTENTION INTERVIEWING LONGITUDINAL method BIPOLAR disorder RESEARCH methodology PATIENT compliance PSYCHIATRIC hospitals PSYCHIATRIC nursing QUALITATIVE research JUDGMENT sampling FAMILY relations THEMATIC analysis PATIENTS' attitudes medical coding THERAPEUTIC use DRUG therapy for schizophrenia MENTAL illness drug therapy

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A Comparison of Oral Anticoagulant Use for Atrial Fibrillation in the Pre- and Post-DOAC Eras

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DRUGS & AGING 2016年第6期33卷 427-436页

作者： Brown, Joshua D. Shewale, Anand R. Dherange, Parinita Talbert, Jeffery C. Univ Kentucky Coll Pharm Inst Pharmaceut Outcomes & Policy Dept Pharm Practice & Sci 789 S Limestone St 292E Lexington KY 40536 USA Univ Arkansas Med Sci Div Pharmaceut Evaluat & Policy Little Rock AR 72205 USA Banner Univ Med Ctr South Internal Med Tucson AZ USA

Introduction Direct oral anticoagulants (DOACs) have seen rapid uptake for the prevention of stroke associated with non-valvular atrial fibrillation (NVAF). It is unclear whether use of DOACs represents direct therapeutic substitution over warfarin or if this coincides with an increase in overall treatment rates. This study sought to describe the difference in oral anticoagulant (OAC) use in the pre-DOAC and post-DOAC eras. Methods Incident cases of NVAF were identified from the Truven Marketscan database during the years 2005-2009 ('pre-DOAC') and 2013 ('post-DOAC'). Demographic and clinical characteristics were compared for the overall cohorts and among those who did and did not receive OAC in both time periods. OAC treatment was observed by stroke (CHA(2)DS(2)-VASc) and bleed risk (HAS-BLED) scores. Logistic regression was used to compare the individual characteristics associated with OAC use between the study periods. Results During the pre- and post-DOAC eras, 105,610 and 11,992 NVAF patients were identified. OAC treatment increased from 42.2 to 54.0 % (absolute change 11.8 %, relative change 28.0 %) from the pre- to post-DOAC periods without meaningful differences between the populations. Larger relative increases in OAC treatment were observed for those at high risk of stroke (33.9 % increase) and for those with moderate (30.4 % increase) to high risk (28.6 % increase) of bleed. Other than time period of diagnosis, no patient characteristics differed between those treated with OACs in the pre and post periods. Conclusions There has been an overall increase in OAC use in the NVAF population, attributable to both favorable randomized trial results and aggressive marketing of DOACs in the USA.

关键词： ANTICOAGULANTS (Medicine) STROKE PREVENTION ATRIAL fibrillation NOSOLOGY FINANCING of research WARFARIN COMORBIDITY LOGISTIC regression analysis medical records RESEARCH medical coding THERAPEUTIC use

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Identifying the Barriers to Early Diagnosis and Treatment in Underserved Individuals with Autism Spectrum Disorders (ASD) and Their Families: A Qualitative Study

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ISSUES IN MENTAL HEALTH NURSING 2016年第6期37卷 412-420页

作者： Elder, Jennifer Harrison Brasher, Susan Alexander, Beverly Univ Florida Coll Nursing Gainesville FL USA

Clinical accounts indicate that disparities exist among families of children with Autism Spectrum Disorders (ASD), and that these disparities impede timely diagnosis and intervention. Furthermore, families living in rural areas are more likely to have reduced access to proper care and use alternative, unproven, and potentially harmful treatments. The purpose of this project was to begin addressing these needs by engaging providers and families of children with ASD living in rural and typically underserved areas. The investigators established a Community Advisory Board (CAB) of ASD professionals (e.g., community-based healthcare and service providers, director of a center for disabilities, psychologist, autism researcher, and special education professional). Next, they conducted four focus groups comprised of a total of 35 major stakeholders (e.g., individuals with ASD, parents of individuals with ASD, community-based healthcare and service providers, school teachers) to determine potential resources, barriers to early diagnosis/treatment, and alternative treatment use in children with ASD. Focus group sessions were audio-recorded, transcribed verbatim, and analyzed by three trained independent coders. Community participants identified several barriers to early diagnosis and intervention, as well as a variety of alternative treatments used in children with ASD. Thematic analysis of focus group transcripts showed several overarching themes regarding barriers to early diagnosis and treatment. Findings from this study have implications for practice and future research.

关键词： DIAGNOSIS Autism -- Treatment Action research Community health services Focus groups Research -- Finance Rural conditions Surveys Qualitative research Judgment sampling Thematic analysis medically underserved persons Early diagnosis medical coding Children Autism

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