An Ethical Dilemma: The Dishonest Doctor

The process of sloving an ethical dilemma is presented through use of a case study involiving a dishonest doctor and a cancer patient. The described decision making process contributes to compliance with the Joint Commission on Accreditation of Healthcare Organization standard regarding ethics and patient care. Curtin's ethical decision-making framework is employed in this described process. Ethical principles and philosophies are considered in attempting to find the best ethical solution for the dilemma detailed in the case study.
Source material is from personal experience and observation as well as published literature. In addition to being a JCAHO standard, the author concludes that a decision-making framework is useful in solving ethical dilemmas.     

Oxytocin modulates the link between adult attachment and cooperation through reduced betrayal aversion

An experiment examined whether and how the relationship between individual differences in social attachment and cooperation is modulated by brain oxytocin, a neuropeptide implicated both in parent-child bonding, and in social approach. Healthy males completed a validated attachment style measure, received intranasal oxytocin or placebo, and privately chose between cooperation and non-cooperation in an incentivized social dilemma with an anonymous stranger. Attachment anxiety--the tendency to fear rejection by others--had few effects and was not modulated by oxytocin. However, oxytocin interacted with attachment avoidance--the tendency to fear dependency and closeness in interpersonal relations. Especially among participants high rather than low in attachment avoidance, oxytocin reduced betrayal aversion, and increased trust and cooperation compared to placebo. Effects of attachment avoidance and oxytocin on cooperation were mediated by betrayal aversion, and not by affiliation tendencies.     

Counselling teenage girls on problems related to the 'protection of family honour' from the perspective of school nurses and counsellors

Approximately 1,500 young immigrant women living in Sweden sought help from various public organisations during 2004 due to problems related to Protection of Family Honour (PFH). Often they seek help from school nurses and counsellors. Information on how the school nurses and counsellors manage this complex PFH phenomenon is limited in Sweden. The aim was to generate a theoretical model that illuminates the experiences of school counsellors and school nurses counselling teenage girls, who worry about problems related to protection of family honour. Data were collected through individual interviews of the school welfare staff. The study subjects included welfare staff from six upper-secondary schools consisting of four nurses and six counsellors. Grounded theory methods were used to generate new knowledge as this is a new field of research. The staff's main goal was to provide the best support and help for the teenage girls. In addition, they wanted to be true to their professional ethics and values. However, this was difficult and created professional dilemmas because some teenage girls prevented them from doing what they thought was needed to support the teenage girls and protect them from violence. As a result, staff sometimes felt hampered, unable to help or able to help only in ways hidden from the teenage girls' families.     

高三酰甘油血症性急性胰腺炎复发患者血脂控制困境的质性研究

目的 了解高三酰甘油血症性急性胰腺炎复发患者血脂控制面临的困境,为开展健康教育以满足患者需求提供参考。方法 采用现象学研究方法,对15例高三酰甘油血症性急性胰腺炎复发患者进行半结构式访谈,运用Colaizzi七步分析法对访谈资料进行分析。结果 提炼出4个主题：疾病相关知识缺乏（对血脂控制的长期性认知不足,对用药认知存在误区,对定时监测存在认知误区）,支持系统不足（家庭饮食与建议饮食之间失衡,难以获得专业性、有实际指导意义的信息）,社会约束（重返工作后血脂控制难度增加,就医成本影响治疗监测）,长期饮食限制加重对限制饮食的渴望。结论 需合理评估高三酰甘油血症性急性胰腺炎复发患者需求,帮助患者正确认识疾病,引导其积极寻找解决血脂控制不良问题的方法,以控制血脂水平。     

临床护理人员面对人员配备不足的感受和反应

目的：探讨临床护理人员面对人员配备不足的感受和反应。方法：运用质性研究中的现象学方法对25位来自上海4个不同等级医院的护士进行深入访谈。结果：护理人员面对人员配备不足的反应为自行解决,尽力而为;报告领导,寻求帮助;服从安排,自我调整;耐心沟通,求得谅解;无奈接受,无力无助。结论：护理人员能积极有效应对人员配备不足带来的压力,护理管理者应合理配备人员,预防和减轻人员紧缺给护士和病人带来的负面影响。     

A multifunctional envelope type nano device (MEND) for gene delivery to tumours based on the EPR effect: A strategy for overcoming the PEG dilemma

Gene and nucleic acid therapy are expected to play a major role in the next generation of medicine. We recently developed a multifunctional envelope-type nano device (MEND) for use as a novel non-viral gene delivery system. Poly(ethylene glycol) (PEG)ylation is a useful method for achieving a longer circulation time for delivery of the MEND to a tumour via the enhanced permeability and retention (EPR) effect. However, PEGylation strongly inhibits cellular uptake and endosomal escape, which results in significant loss of activity for the delivery system. For successful gene delivery for cancer treatment, the crucial issue associated with the use of PEG, the ‘PEG dilemma’ must be addressed. In this review, we describe the development and applications of MEND, and discuss strategies for overcoming the PEG dilemma, based on the manipulation of intracellular trafficking of cellular uptake and endosomal release using functional devices such as specific ligands, cleavable PEG systems and endosomal fusogenic/disruptic peptides.     

Recommending Unfunded Innovative Cancer Therapies: Ethical vs. Clinical Perspectives among Oncologists on a Public Healthcare System—A Mixed-Methods Study

Over the past decade, there has been a growing development of innovative technologies to treat cancer. Many of these technologies are expensive and not funded by health funds. The present study examined physicians’ perceptions of the ethical and clinical aspects of the recommendation and use of unfunded technologies for cancer treatment. This mixed-methods study surveyed 127 oncologists regarding their perceptions toward using unfunded innovative cancer treatment technologies, followed by in-depth interviews with 16 oncologists. Most respondents believed that patients should be offered all treatment alternatives, regardless of their financial situation. However, 59% indicated that they often face dilemmas regarding recommending new unfunded treatments to patients with financial difficulties and without private health insurance. Over a third (38%) stated that they felt uncomfortable discussing the cost of treatment with patients. A predictive model found that physicians facing patients whose medical condition worsened due to an inability to access new treatments, and who expressed the opinion that physicians can assist in locating funding for patients who cannot afford treatments, were more likely to recommend unfunded innovative therapies to patients (F = 5.22, R² = 0.15, p < 0.001). Subsequent in-depth interviews revealed four key themes: economic considerations in choosing therapy, patient–physician communication, the public healthcare fund, and discussion of treatment costs. Physicians feel a professional commitment to offer patients the best medical care and a moral duty to discuss costs and minimize patients’ financial difficulty. There is a need for careful and balanced use of innovative life-prolonging technologies while putting patients at the center of discourse on this complex and controversial issue. It is essential to develop a psychosocial support program for physicians and patients dealing with ethical and psychosocial dilemmas and to set guidelines for oncologists to conduct a comprehensive and collaborative physician–patient discourse regarding all aspects of treatment.