Informed consent: how much and what do patients understand?

Objective

We sought to evaluate the degree of patients' understanding of several aspects of the informed consent process for surgery and clinical research.

Methods

We conducted a systematic search of PubMed (1961-2006) to identify relevant articles.

Results

We retrieved 23 and 30 eligible for inclusion articles regarding informed consent for surgery and clinical research, respectively. Regarding surgery, adequate overall understanding of the information provided and of the risks associated with surgery was shown in 6 of 21 (29%) and 5 of 14 (36%) studies providing relevant data, respectively. Regarding clinical research, adequate understanding of the aim of the study, the process of randomization, voluntarism, withdrawal, and the risks and the benefits of treatment was shown in 14 of 26 (54%), 4 of 8 (50%), 7 of 15 (47%), 7 of 16 (44%), 8 of 16 (50%), and 4 of 7 (57%) of studies providing relevant data, respectively. Satisfaction by the amount of the given information was shown in 7 of 12 (58%) studies involving surgery and 12 of 15 (80%) studies involving clinical research.

Conclusions

Further attention should be drawn on enhancing patients' understanding regarding several components of the informed consent process for surgery and clinical research.     

Organizational factors affecting successful adoption of innovative eHealth services: a case study employing the FITT framework

Objective

The paper presents an application of the “Fit between Individuals, Task and Technology” (FITT) framework to analyze the socio-organizational-technical factors that influence IT adoption in the healthcare domain.

Method

The FITT framework was employed as the theoretical instrument for a retrospective analysis of a 15-year effort in implementing IT systems and eHealth services in the context of a Regional Health Information Network in Crete. Quantitative and qualitative research methods, interviews and participant observations were employed to gather data from a case study that involved the entire region of Crete.

Results

The detailed analysis of the case study based on the FITT framework, showed common features, but also differences of IT adoption within the various health organizations. The emerging picture is a complex nexus of factors contributing to IT adoption, and multi-level interventional strategies to promote IT use.

Conclusion

The work presented in this paper shows the applicability of the FITT framework in explaining the complexity of aspects observed in the implementation of healthcare information systems. The reported experiences reveal that fit management can be viewed as a system with a feedback loop that is never really stable, but ever changing based on external factors or deliberate interventions. Management of fit, therefore, becomes a constant and complex task for the whole life cycle of IT systems.     

Ethical issues in anesthesia: the need for a more practical and contextual approach in teaching

Teaching ethics to medical students is one of the current topics of major interest. Issues of ethics pertaining to anesthesia are unique. This article reviews these issues with respect to the preoperative, intraoperative, and postoperative periods. The author shares the experience of incorporating ethical issues into every clinical scenario in the problem-based learning sessions of both undergraduate and postgraduate students. In addition to separate modules in didactic and clinical formats, incorporating the ethical aspects into every clinical problem has many advantages. This approach will stimulate students to ponder over the ethical dimension of every clinical scenario, and the reinforcement of this approach during teaching in the clinical setting may help in inculcating these qualities in the students. Additionally, this approach contextualizes these issues to the local and regional perspective, instead of lecturing on the ethical codes developed elsewhere.     

Effectiveness and acceptability of non-pharmacological interventions to reduce wandering in dementia: a systematic review

BACKGROUND: Wandering occurs in 15-60% of people with dementia. Psychosocial interventions rather than pharmacological methods are recommended, but evidence for their effectiveness is limited and there are ethical concerns associated with some non-pharmacological approaches, such as electronic tracking devices. OBJECTIVE: To determine the clinical and cost effectiveness and acceptability of non-pharmacological interventions to reduce wandering in dementia. DESIGN: A systematic review to evaluate effectiveness of the interventions and to assess acceptability and ethical issues associated with their use. The search and review strategy, data extraction and analysis followed recommended guidance. Papers of relevance to effectiveness, acceptability and ethical issues were sought. RESULTS: (i) Clinical effectiveness. Eleven studies, including eight randomised controlled trials, of a variety of interventions, met the inclusion criteria. There was no robust evidence to recommend any intervention, although there was some weak evidence for exercise. No relevant studies to determine cost effectiveness met the inclusion criteria. (ii) Acceptability/ethical issues. None of the acceptability papers reported directly the views of people with dementia. Exercise and music therapy were the most acceptable interventions and raised no ethical concerns. Tracking and tagging devices were acceptable to carers but generated considerable ethical debate. Physical restraints were considered unacceptable. CONCLUSIONS: In order to reduce unsafe wandering high quality research is needed to determine the effectiveness of non-pharmacological interventions that are practically and ethically acceptable to users. It is important to establish the views of people with dementia on the acceptability of such interventions prior to evaluating their effectiveness through complex randomised controlled trials.     

Scientific papers presented at the European Congress of Radiology: a two-year comparison

The purpose of this report was to determine the rate at which abstracts orally presented at the European Congress of Radiology (ECR) 2001 were published in 2001–2005 Medline-indexed journals and to compare publication rates and factors with presentations at the ECR in two different periods (2001 and 2000). Absolute and relative publication rates (APR, RPR) and different publication-related factors were analysed. From 991 abstracts originating from 52 countries, 449 articles (APR 45%) were subsequently published in 125 journals, most frequently in European Radiology (n=79, 18%). Country of origin statistically (p<0.0001) influences subsequent publication of the abstract, with Germany having the highest number of presentations (n=300) and derived articles (n=175, RPR 58%) whereas Sweden had the highest RPR (82%). Interventional and physics studies had the highest RPR (59% and 58%, respectively). The ECR meeting has a very high and stable APR (ECR 2001: 45% vs ECR 2000: 47%), and the journal European Radiology had the larger number of related publications (18% RPR following ECR 2001 compared with 14% from ECR 2000). Germany had the highest number of presentations and publications for both meetings. The highest RPR for ECR 2001 was found in interventional and physics studies whereas chest and cardiac studies had the highest RPR for ECR 2000.     

对我国疫苗稳定性研究主要技术问题的思考

目的对我国疫苗稳定性研究提出建议。方法对疫苗稳定性研究的重要性、研究目的、研究类型、稳定性研究中存在的几个主要问题进行分析。结果与结论针对疫苗这一重要而特殊产品的稳定性研究提出应考虑的8个技术方面的问题。     

Calculating the costs of work-based training: the case of NHS Cadet Schemes

BACKGROUND: The worldwide shortage of registered nurses [Buchan, J., Calman, L., 2004. The Global Shortage of Registered Nurses: An Overview of Issues And Actions. International Council of Nurses, Geneva] points to the need for initiatives which increase access to the profession, in particular, to those sections of the population who traditionally do not enter nursing. This paper reports findings on the costs associated with one such initiative, the British National Health Service (NHS) Cadet Scheme, designed to provide a mechanism for entry into nurse training for young people without conventional academic qualifications. The paper illustrates an approach to costing work-based learning interventions which offsets the value attributed to trainees' work against their training costs. OBJECTIVE: To provide a preliminary evaluation of the cost of the NHS Cadet Scheme initiative. DATA SOURCE: Questionnaire survey of the leaders of all cadet schemes in England (n=62, 100% response) in December 2002 to collect financial information and data on progression of cadets through the scheme, and a follow-up questionnaire survey of the same scheme leaders to improve the quality of information, which was completed in January 2004 (n=56, 59% response). PRINCIPAL FINDINGS: The mean cost of producing a cadet to progress successfully through the scheme and onto a pre-registration nursing programme depends substantially on the value of their contribution to healthcare work during training and the progression rate of students through the scheme. The findings from this evaluation suggest that these factors varied very widely across the 62 schemes. Established schemes have, on average, lower attrition and higher progression rates than more recently established schemes. Using these rates, we estimate that on maturity, a cadet scheme will progress approximately 60% of students into pre-registration nurse training. CONCLUSIONS: As comparative information was not available from similar initiatives that provide access to nurse training, it was not possible to calculate the cost effectiveness of NHS Cadet Schemes. However, this study does show that those cadet schemes which have the potential to offer better value for money, are those where the progression rates are good and where the practical training of cadets is organised such that cadets meet the needs of patients which might otherwise have to be met by non-professionally qualified staff.