How health care professionals confront and solve ethical dilemmas – a tale of two countries: Slovenia and Croatia

AimTo assess the differences in the way how Slovenian and Croatian health care professionals (HCPs) confront ethical dilemmas and perceive the role of hospital ethics committees (HECs).MethodsThis cross-sectional, survey-based study involved HCPs from three Slovenian and five Croatian university medical centers (UMC). The final sample sizes were 308 (244 or 79.2% women) for Slovenia and 485 (398 or 82.1% women) for Croatia.ResultsCompared with Croatian physicians, Slovenian physicians reported a higher share of ethical dilemmas regarding waiting periods for diagnostics or treatment, suboptimal working conditions due to interpersonal relationships in the ward, and end-of-life treatment withdrawal, and a lower share regarding access to palliative care and patient information protection. Compared with Croatian nurses, Slovenian nurses reported a lower share of ethical dilemmas regarding the distribution of limited resources, recognizing the patient’s best interests, and access to palliative care. Compared with Croatian other HCPs, Slovenian other HCPs reported a lower burden of ethical dilemmas regarding waiting periods for diagnostics or treatment, distribution of limited resources, and access to palliative care. When encountering an ethical dilemma, all HCPs in both countries would first consult their colleagues. Slovenian and Croatian HCPs recognized the importance of the HECs to a similar extent, but viewed their role differently.ConclusionCroatian and Slovenian HCPs are confronted with different ethical dilemmas and perceive the role of HECs differently.

An ethical dilemma arises when we are confronted with a situation with two morally justifiable solutions, none of which is entirely satisfactory (1). In the course of their daily work, health care professionals (HCPs) encounter a broad range of ethical dilemmas (2-4), which often result in a moral distress for HCPs (5,6). A critical requirement for a successful response to an ethical dilemma is a strong foundation in medical professionalism cultivated during medical training and consolidated during professional work experience and career development (7-9).Slovenia and Croatia, previously the westernmost republics of the former Yugoslavia and now European Union members, share the same historical, geopolitical, economic, and religious background. A recent survey in the largest Slovenian tertiary hospital, the University Medical Center Ljubljana, found that the most important contexts that give rise to ethical dilemmas among HCPs were waiting periods for diagnostics and treatment, suboptimal working conditions due to poor interpersonal relationships, and preserving patients'' dignity, while the least important contexts were biomedical research, organ transplantation, and vaccine hesitancy (10). A study at the University Medical Center Rijeka found similar main ethical dilemmas in Croatian nurses and physicians, which included limiting life-sustaining therapy, euthanasia, and physician-assisted suicide (11).Except these two studies, little to nothing is known about the ethical dilemmas of HCPs in Slovenia and Croatia. In response to this limited evidence, we conducted a prospective survey with a primary objective to assess the differences in the share of ethical dilemmas among different categories of HCPs (physicians, nurses, and other HCPs) in Slovenian and Croatian tertiary hospitals (university medical centers, UMCs). The UMCs were purposively selected because in this kind of hospitals, one encounters complicated cases usually referred from other health care institutions for complex diagnostic and therapeutic procedures, which can often raise ethical issues. The secondary objectives of our survey were to study differences in the opinion on the existence of standard procedures when HCPs are facing an ethical dilemma; to determine whom HCPs consult when facing an ethical dilemma; and to identify the opinion on the importance of hospital ethics committees (HECs) and their role in Slovenia and Croatia.     

Neurobiological underpinnings of cyberbullying: A pilot functional magnetic resonance imaging study

There is a dearth of research that has investigated the neural correlates of cyberbullying, using task‐based functional magnetic resonance imaging (fMRI) and, specifically, in a real‐time context such as observing cyberbullying scenarios. This article presents pilot data from a novel protocol designed to undertake such research with the overall aim being to elucidate the neurobiological underpinnings of cyberbullying via task‐based fMRI (tb‐fMRI)) in passive cyberbystanders. Young adults (N = 32, 18 to 25 years old) viewed six negative (cyberbullying) and six neutral stimuli from the Cyberbullying Picture Series (CyPicS) while undergoing tb‐fMRI. Our results revealed 12 clusters of significantly greater blood‐oxygenation‐level‐dependent (BOLD) responses (family wise error corrected p _FWE < .05) in participants when viewing cyberbullying stimuli compared to neutral stimuli, across a distributed network of regions including left and right middle temporal gyrus, default mode network hubs, left and right posterior cerebellum/vermis, and putamen. Further analysis also revealed greater BOLD response in females compared to males, as well as in those with no prior experience of cyberbullying compared to those with prior experience (despite gender), when viewing the cyberbullying stimuli compared to the neutral stimuli. These results bring us closer to understanding the neurobiological underpinnings that may be associated with cybervictim/bully status and outcomes.     

Nitrogen mustard gel-induced inflammation triggers lymphomatoid papulosis in patients with mycosis fungoides

Lymphomatoid papulosis (LyP) is a paraneoplastic primary cutaneous CD30⁺ lymphoproliferative disorder (LPD) that has been associated with malignant lymphomas, most commonly mycosis fungoides (MF). We observed 10 patients with MF who developed severe inflammation after using nitrogen-mustard (NM) gel from 1 to 8 months and who developed LyP. We hypothesized that NM gel produced local inflammation, which induced CD30 expression in malignant T cells in situ leading to the appearance of LyP papules. The high frequency of induction of LyP lesions in patients with severe inflammation while on treatment with NM gel suggests an association between inflammatory stimuli and development of LyP. Our observation provides insight into the pathogenesis of CD30⁺ LPD.     

Dental maturity in children of short stature, with or without growth hormone deficiency

The aim of this investigation was to study dental maturity in healthy prepubertal children of short stature (height < −2 SD), with or without growth hormone (GH) deficiency, compared to healthy controls. The GH-deficient group (GH level < 10.0 μg/l) included 29 children (11 female. 18 male) with a mean age of 10.2 ± 2.2 years. The GH non-deficient group consisted of 17 children (5 female. 12 male) with a mean age of 8.5 ± 2.1 years. All the children were evaluated for serum concentrations of IGF-1, alkaline phosphatase (ALP), triiodthyronin (T3), thyroxine (T4). thyroid-stimulating hormone (TSH). and fasting plasma insulin: height and bone age were also recorded. Dental maturity was determined from panoramic radiographs. The mean difference between the dental and chronological ages was −0.67 ± 0.89 years in the GH-deficient group compared to 0.23 ± 1.07 years in their controls: in the GH non-deficient group the difference was −0.95 ± 0.82 years compared to controls 0.16 ± 1.06 years in their controls. Compared to chronological age. both bone and dental age were lower in the GH-deficient and GH non-deficient groups. It is concluded that children of short stature, both GH-deficient and GH non-deficient, exhibit a delayed dental age compared to their chronological age- and sex-matched controls. A multiple stepwise regression analysts showed that the sitting height and GH level were the only significant factors associated with dental maturity.     

Influence of the restorative procedure factors on stress values in premolar with MOD cavity: a finite element study

In order to investigate the influence of cusp reduction, cavity isthmus width, and restorative material on stress values in premolar with mesio-occlusal-distal (MOD) cavity, numerical simulations were done on three-dimensional (3D) models of a maxillary second premolar designed using computerized tomography (CT) scan images. The use of four restorative materials (direct resin composite, direct resin composite with resin-modified glass-ionomer cement as the base, indirect resin composite, ceramic), three cavity preparation designs (without cusp coverage, 2-mm palatal cusp coverage, 2-mm palatal and buccal cusp coverage), and two cavity isthmus widths (1/2 and 2/3 intercuspal width) were simulated. After applying a static load of 200 N on the occlusal surface of the tooth, von Mises stresses in the enamel, dentin, and restoration were calculated using finite element analysis (FEA). Stress values in the enamel were primarily influenced by cavity preparation design, while restorative material showed higher contribution in dentin. The lowest stress values were obtained in models with cusp coverage and indirect restorations. Cavity isthmus width had minimal influence on stress values in tooth structures. None of the investigated factors determined stress values in the restoration. In conclusion, the use of ceramic restoration covering both palatal and buccal cusp provided the most favourable stress distribution of premolars with MOD cavity.

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Anti-inflammatory Effects of Novel P2X4 Receptor Antagonists,NC-2600 and NP-1815-PX,in a Murine Model of Colitis

Inflammation - The pharmacological blockade of P2X4 receptors has shown potential benefits in the management of several immune/inflammatory diseases. However, data regarding the involvement of P2X4...     

Detection of misfolded prion protein in blood with conformationally sensitive peptides

BACKGROUND: The long-standing goal of a preclinical diagnostic test for transmissible spongiform encephalopathy (TSE) has recently become urgent because of the discovery that humans with variant Creutzfeldt-Jakob disease can transmit disease via blood transfusions. STUDY DESIGN AND METHODS: The misfolded protein diagnostic (MPD) assay employs a pyrene-labeled palindromic sequence of prion peptides that undergoes a cascade of coil to beta-sheet conversion in the presence of the misfolded prion protein (PrP(TSE)). The ability of the assay to detect PrP(TSE) in brain, serum, and plasma was tested. The basic protocol involved a several-hour incubation of 200-microL sample volumes with the peptide reagent in 96-well plates, after which fluorescence was monitored by a fluorescence plate reader with an excitation wavelength of 350 nm and emission scanning wavelength range of 365 to 600 nm. RESULTS: Target specificity for PrP(TSE) was documented by correlation of assay signal with Western blot signals in brain tissue from TSE-infected, normal, and knockout mice and negative assay signals by use of reagents with different peptide sequences. When applied to plasma or serum, the assay discriminated between samples from a variety of experimental and natural TSE infections compared to uninfected controls, with a sensitivity threshold of approximately 1 infectious dose per mL in pooled plasma from TSE-infected mice. CONCLUSIONS: The MPD assay is a sensitive and specific test for the detection of PrP(TSE) that may be useful in both preclinical and clinical diagnosis of TSE diseases of animals and humans.