An ethics-based approach to global health research part 4: Scholarship and publications

Disseminating research findings from global health collaborations is essential to advancing science. However, there are a number of ethical considerations and potential challenges to address to ensure thoughtful and non-exploitative reporting. The factors include the benefits and risks to publication, authorship criteria or values, and the accessibility of forums or journals in which to pursue publication. This paper provides commentary related to planning for writing, communicating intentions to publish, obtaining permissions to publish, risks in internationally collaborative work, authorship principles, and journal selection. Authors' and editors’ knowledge of experienced individuals from both pharmacy literature, medical fields, and general publications is incorporated to provide an assessment of risks and benefits of publication of international global health research.     

病毒性肝炎的基因治疗及其伦理问题

病毒性肝炎迄今仍无特异有效的治疗药物和方法.而近年发展起来的基因治疗可能将是一种有效的治疗方法,并在体外和实验动物中取得了相当的成功,但若应用于人体还需解决很多问题尤其是伦理学问题.     

关于人类基因组密码全面破译的伦理思考

人类基因组密码的破译是人类科学史上的一次革命,同时也带来一系列社会伦理道德的挑战,这些挑战包括基因歧视、基因隐私权的保护、基因治疗的滥用、优生学的担忧等,笔者认为需要制定相关的法律法规来迎接这些挑战。     

Clinical trials: specific problems associated with the use of a placebo-control group

In order to test hypotheses prospectively with hard data and against placebo, the scientific method of clinical trials has been developed. The present paper focuses on specific problems associated with the use of a placebo control group. (a) The placebo highlights the ethical dilemma that a controlled clinical trial can place us in. (b) Also, in a trial an atmosphere is created of enhanced risks of placebo effects. (c) Significantly different from placebo does not necessarily mean clinically relevant. (d) A biased placebo period due to carry-over effect is a common problem of controlled trials with a cross-over or self-controlled design. (e) Likewise an asymmetric placebo group is also a common problem in parallel-group designs. (f) The response to a placebo is generally small in comparison with the response to active treatment and is therefore sometimes more susceptible to bias. It is emphasized that routinely accounting for such problems may further improve the powerful method of controlled clinical trials.     

Ethical issues in neonatal intensive care and physicians' practices: A European perspective

An international project (EURONIC) was carried out to explore the end-of-life decision-making process in a large, representative sample of neonatal intensive care units (NICUs) in eight western European countries: France, Germany, Great Britain, Italy, Luxembourg, the Netherlands, Spain and Sweden. Structured questionnaires were used to record data on NICU organization and policies, and to survey staff views and practices regarding ethical decision-making. One hundred and twenty-two NICUs were recruited by census or random sampling (response rate 86%); 1235 physicians and 3115 nurses completed the staff questionnaire (response rates 89 and 85%, respectively). This paper focuses on the physicians' answers. In all countries but Italy, most physicians reported having been involved at least once in setting limits to intensive care because of a baby's incurable condition and/or poor neurological prognosis. Adopted strategies varied between countries. Practices such as the continuation of current treatment without intensifying it and the withholding of emergency manoeuvres appeared widespread. In contrast, the frequency of doctors reporting withdrawal of mechanical ventilation was highest in the Netherlands (93%), Sweden (91%) and the Great Britain (88%), intermediate in France and Germany, and lowest in Spain and Italy (34 and 21%, respectively).
Conclusion: Ethically problematic clinical cases are approached differently in the various countries. The findings of this study may provide an opportunity for physicians to review their practices critically, in light of how other colleagues proceed, and foster an open discussion about these difficult issues.     

Self-narrative reconstruction after dilemma-focused therapy for depression: A comparison of good and poor outcome cases

Objective: The aim of this study is to improve the understanding of self-changes after an intervention for depression focused on implicative dilemmas, a type of cognitive conflict related to identity. As recent research has highlighted the relevance of identity-related dilemmas in clients with depression, we sought to assess the way in which clients resolve such inner conflicts after a tailored dilemma-focused intervention and how this is reflected in the clients’ self-narratives. Method: We used three instruments to observe differences between good (n?=?5) and poor (n?=?5) outcome cases: (i) the Repertory Grid Technique to track the resolution of dilemmas, (ii) the Change Interview to compile clients’ accounts of changes at posttreatment, and (iii) the Innovative Moments Coding System to examine the emergence of clients’ novelties at the Change Interview. Results: Groups did not differ in terms of the number and relevance of client-identified significantly helpful events. However, between-group differences were found for the resolution of dilemmas and for the proportion of high-level innovative moment (IM) types. Furthermore, a greater self-narrative reconstruction was associated with higher levels of symptom improvement. Conclusions: Good outcome cases seem to be associated with the resolution of conflicts and high-level IMs.     

影响卵巢癌患者持续性化疗的相关因素及对策

目的探讨影响卵巢癌患者持续性化疗的相关因素及应采取的相应对策。方法对十堰市人民医院2009年6月～2010年6月妇科收治的30例不愿持续性化疗的卵巢癌患者,通过交谈法、倾听法、电话随访方式进行调查,分析其不愿持续性化疗的原因,进行有针对性的心理疏导、相关知识宣教,并采取经济支持、健康教育、社会支持等措施。结果 30例患者都愉快地接受持续性化疗。结论实施有效的伦理干预、健康教育、社会支持等措施,可以促进卵巢癌患者坚持化疗,以延长其生命并提高其生活质量。     

The Language of Dissociation

ABSTRACT

Three case studies of inner-city elementary school children illustrate the connection between speech-language disorders and dissociative disorders in children who have known or suspected trauma histories. The role of speech language pathologists in identifying and responding to dissociative symptoms in children is explored. Lack of adequate training concerning the impact of trauma and scarce literature on the communication profiles of dissociative children contributes and greatly impacts the diagnosis, referral, and treatment of these children. The case studies demonstrate how unusual speech and language symptoms and awareness of dissociative features may aid in identifying trauma-related problems and instituting effective treatment. Grounding techniques and specific language interventions can assist children in acquiring the vocabulary needed for communicating both their daily experiences and traumatic histories. The nature of the relationship between dissociation and communication disorders is explored, and the importance of future research, interdisciplinary collaboration, and trauma training in the speech-language curriculum is emphasized.     

Comment droit et éthique s’enrichissent mutuellement dans la prise en charge médicale des personnes avec handicap

Whatever his or her disability, a person has the right to medical care of the same quality as any other patient. The law tries to meet the needs of vulnerable people, regardless of their situation. For example, a minor, disabled or not, may seek a treatment while preserving confidentiality regarding his/her parents. Privacy is a concept that does not begin at 18. In France, the law of 4 March 2002 already addressed this hypothesis; the law of 26 January 2016 modernizing our health system extended it. An adult, disabled or not, may need help not only for administrative and financial procedures, but also for medical or medicosocial matters. The law offers various support solutions with the family, guardian, support person, relatives, caregivers, attorneys involved with a mandate for future protection. In medical practice, a number of situations, simple in theory, can be very problematic. The ethical approach will be essential to help deal with all these questions.