In order to help older adults with cardiovascular disease navigate complex decisions, clinicians must know tenets of medical ethics and have good communication skills. The elements of decision making capacity and info...In order to help older adults with cardiovascular disease navigate complex decisions, clinicians must know tenets of medical ethics and have good communication skills. The elements of decision making capacity and informed consent are reviewed, using relevant clinical ex- amples to illustrate the basic concepts. The shared decision making model, by which clinician and patient work together to determine the plan of care, is described. Useful communication techniques to implement shared decision making are suggested.展开更多
Objective:To explore the relationship between nursing professional values and ethical climate and nurses'professional quality of life.Methods:The present study is a descriptive,cross-sectional work in which 400 nu...Objective:To explore the relationship between nursing professional values and ethical climate and nurses'professional quality of life.Methods:The present study is a descriptive,cross-sectional work in which 400 nurses from various wards of hospitals in the south-east of Iran were studied.Data were collected using a questionnaire consisting of four sections:demographics,Nurses'Professional Values Scale-Revised(NPVS-R),the Hospital Ethical Climate Survey(HECS),and the Professional Quality of Life Scale(ProQOL).Results:The total mean scores for professional values were 105.29±15.60.The total mean score for the ethical climate was 100.09±17.11.The mean scores for the indexes of compassion satisfaction,burnout,and secondary traumatic stress were 45.29±8.93,34.38±6.84,and 32.15±7.02 respectively.The relationships between professional values and the indexes of compassion satisfaction(r=0.56),burnout(r=0.26),and secondary traumatic stress(r=0.18)were found to be positive and significant(P<0.001).Also,the relationships between ethical climate and the items of compassion satisfaction(r=0.60,P<0.001),burnout(r=0.15,P=0.002)were found to be positive and significant.Conclusion:An understanding of nurses'perception of professional values and improving the ethical climate at work can help nursing administrators identify more effective strategies toward increasing compassion satisfaction and lessening bumout and work-related stress.展开更多
This article begins with three problems of ＂dual loyalties＂ in medicine, the supposed fact that military physicians are, as medical officers, sometimes required to do what violates ordinary medical ethics--for examp...This article begins with three problems of ＂dual loyalties＂ in medicine, the supposed fact that military physicians are, as medical officers, sometimes required to do what violates ordinary medical ethics--for example, ignore medical need in order to treat their own wounded before civilians or wounded enemy, help make chemical or biological weapons more deadly, or assist at a rough interrogation. These problems are analyzed as special cases of a problem that could arise in any profession, a problem easily resolved using a theory of professional ethics （more or less） absent from medical ethics until now though common outside. Employing a physician--rather than an ordinary officer, some other kind of healer, or scientist--is to enter a sort of ＂Ulysses contract＂ requiring the physician＇s professional standards to preempt obligations otherwise applying to an employee. In this way, the article also illustrates the benefits that might accrue to medical ethics from drawing （more than is now common） on other fields of practical ethics.展开更多
Background and aims:Objective To investigate the current situation of ICU nurses'hospital ethical climate in China and analyze the correlation and influencing factors of hospital ethical climate.In order to provid...Background and aims:Objective To investigate the current situation of ICU nurses'hospital ethical climate in China and analyze the correlation and influencing factors of hospital ethical climate.In order to provide a new direction and idea for creating the good hospital ethical climate,relieving the nurses'job burnout and stabilizing the nursing team.Methods:A total of 226 ICU nurses from 6 tertiary Tianjin hospitals were selected as subjects,and the Chinese version hospital ethical climate scale and psychological empowerment scale were used for investigation.Results:The gender and labor relationship of ICU nurses affected the perception of nurses'hospital ethical climate;hospital ethical climate and psychological empowerment were positively correlated;stepwise regression analysis showed that labor relationship and psychological empowerment can explain 58.5%variation rate of hospital ethical climate.Conclusion:We should pay attention to the current situation of the hospital ethical climate of ICU nurses.Managers should create a comfortable working environment not only to provide good material conditions for nurses and transfer of right,but also to pay attention to the nurses'mental state and negative impact of ethical issues.Hospital managers should reasonably allocate human resources,establish effective incentive and assessment standards,reasonable reward and punishment system and promotion mechanism.To provide comprehensive learning resources and channels.To improve nurses'awareness of their own professional value.Creating a harmonious and positive hospital ethical climate,reduce the impact of ethical issues on nurses,improve nurses'enthusiasm and satisfaction.展开更多
Although the Japan Society of Obstetrics and Gynecology （JSOG） endorses new-type PGD using CGH for only carriers of balanced chromosomal translocations, it is against the ethical guidelines of the JSOG to decide whe...Although the Japan Society of Obstetrics and Gynecology （JSOG） endorses new-type PGD using CGH for only carriers of balanced chromosomal translocations, it is against the ethical guidelines of the JSOG to decide whether or not embryos should be implanted due to aneuploidy discovered as a result of new-type PGD. In the author＇s opinion, it should be at the discretion of the JSOG＇s own randomized controlled trials, which should involve multiple facilities, whether or not a scientific basis can be found for the value of the new-type PGD in cases of recurrent miscarriage, in cases of implantation failure, and in cases where the women are of advanced maternal age. Dr. Netsu＇s 36 cases of selective reduction may be against the Japanese Maternal Health Protection Law that prohibits abortion due to congenital disease, but with the backdrop that there are many abortions that are performed as a result of parental convenience in Japan, it is difficult to understand the difference between the over 300,000 abortions that are performed every year in Japan and Dr. Netsu＇s prescribed surgery which is designed to selectively reduce fetuses with congenital disease for the purpose of evading physical danger for women with multiple gestations.展开更多
Forensic medical workers are faced with unique ethical challenges in their attempt to deliver medical care in a custodial environment.We first figure out the reasons why the doctor is standing opposed to the patient t...Forensic medical workers are faced with unique ethical challenges in their attempt to deliver medical care in a custodial environment.We first figure out the reasons why the doctor is standing opposed to the patient through questionnaire and interview of the prison doctor in Shanghai,China,which turn to be a bilateral issue.Both sides should take more active approaches and put themselves to the right position to contribute to a better medical environment in the prison hospital,which can reduce medical tangles and help the criminals to accomplish their reform process.展开更多
A closer look to the state of affairs of the elderly in Indonesia has disclosed the fact that the Indonesian elderly facing what this paper is coined as ＂multiple vulnerabilities.＂ On the one hand, Indonesian demogr...A closer look to the state of affairs of the elderly in Indonesia has disclosed the fact that the Indonesian elderly facing what this paper is coined as ＂multiple vulnerabilities.＂ On the one hand, Indonesian demographic is showing that the Indonesian people are getting old. The fertility rate has significantly decreased since 1970 when the total fertility rate decreases from 5.0 to 2.1 in 2025. This alone gives rise to various problems of the elderly, among whom are the dependency ratio, aging index, potential support ratio, and the feminization of aging. These problems show the level of vulnerability of the Indonesian elderly. From the perspective of the dependency ratio, for example, the number of people under the age of 15 and above 65 who depend on the labor force （15-64 years） has increased since 1970, from 7.0 to 29.0 in 2050. Again, this shows the high level of vulnerability of Indonesian elderly given that the dependency ratio itself has influenced on health care, living arrangements and family support, and so on. Aside from that, the economic burden will be very visible in the workforce. On the other hand, the policies on the elderly are still far from maximum realization. Law on the Welfare of the Elderly （13/1998） has recommended that every hospital must have geriatrics and gerontology section, yet only 8 hospitals fulfill the requirement. The situation is worsened due to the lack of adequate medical staff at the health center, which can serve elderly patients in a professional and humane way. Again, this brings forth the other side of the state of the elderly in Indonesia, which indicates the high level of their vulnerability. In this paper I will analyze the state of vulnerability of the elderly people in Indonesia from the perspective of ethics of vulnerability and personalism. I consider these two approaches as representing all ethical discussion about the ethical treatment of the elderly due to their characters of valuing the elderly as persons with dignity. Thus, this paper will show that the elderly in Indonesia is in danger of not being treated humanely.展开更多
A comparison of how MR released to the insurance company Assist Card from a Chinese medical facility Hengyang HP vs from a US facility Stutter Health was roughly displayed. The former MR was for Mafia, a Colombian Ass...A comparison of how MR released to the insurance company Assist Card from a Chinese medical facility Hengyang HP vs from a US facility Stutter Health was roughly displayed. The former MR was for Mafia, a Colombian Assist Card cardholder, worked and got hospitalized in China, the later MR for Kong Lijun, a Chinese StarrChina cardholder, visited and got medical treatments in USA, they shared Assist Card international traveling and insurance assistance. In both cases, Assist Card got MR for the patient from the facilities that gave them treatments. As a third party, Assist Card went through different procedures to claim MR from Hengyang HP vs from Stutter Health. It managed to have got three MRs and three FTF and was pushing a fourth MR from Hengyang HP in about ten days, while it got only one MR from Stutter Health in ten days after twists and turns. The over cooperative or obedient tendency toward Assist Card＇s requests made Hengyang HP vulnerable and controllable, while the strict MR release procedures in Stutter Health made Assist Card passive and helpless.展开更多
Background Patient autonomy is a leading principle in bioethics and a basis for shared decision making. This study explores conditions for an autonomous choice experienced by older adults who recently underwent trans-...Background Patient autonomy is a leading principle in bioethics and a basis for shared decision making. This study explores conditions for an autonomous choice experienced by older adults who recently underwent trans-catheter aortic valve replacement （TAVR）. Methods Qualitative study entailing semi-structured interviews of a purposive sample often older （range 73-89, median 83.5 years） adults after TAVR （median 23 days）. The study setting was a cardiac department at a university hospital performing TAVR since 2010. Analysis was by systematic text condensation. Results Even when choice seemed hard or absent, TAVR-patients deliberately took the chance offered them by processing risk assessment, ambivalence and fate. They regarded declining the treatment to be worse than accepting the risk related to the procedure. The experience of being thoroughly advised by their physician formed the basis of an autonomous trust. The trust they felt for the physicians＇ recommendations mitigated ambivalence about the procedure and risks. TAVR patients expressed feelings consistent with self-empowerment and claimed that it had to be their decision. Even so, choosing the intervention as an obligation to their family or passively accepting it was also reported. Conclusions Older TAVR patients＇ experience of an autonomous decision may encompass frank tradeoff; deliberate physician dependency as well as a resilient self-view. Physicians should be especially aware of how older adults＇ subtle cognitive declines and inclinations to preserve their identities which can influence their medical decision making when obtaining in- formed consent. Cardiologists and other providers may also use these insights to develop new strategies that better respond to such inherent complexities.展开更多
OBJECTIVE To analyze clinical characteristics and treatment methods of the patients with adenocarcinoma of the uterine cervix （AUC） and adenosquamous carcinoma of the cervix （ASCC）. To compare the survival time of...OBJECTIVE To analyze clinical characteristics and treatment methods of the patients with adenocarcinoma of the uterine cervix （AUC） and adenosquamous carcinoma of the cervix （ASCC）. To compare the survival time of the patients in 2 groups and analyze the prognostic factors. METHODS Clinical data of both 123 patients with AUC and 32 patients with ASCC treated at the Cancer Hospital, Chinese Academy of Medical Science （CAMS） ＆ Peking Union Medical College （PUMC）, were retrospectively analyzed. RESULTS The median age of the AUC patients was 50 years, and that of the ASCC patients was 44, P = 0.019. Poorly-differentiated （grade 3） cases accounted for 59.5% of the total ASCC patients, while only 32.5% of the AUC patients were in grade 3, P = 0.002. In 123 AUC patients, relapse or failure of the treatment occurred in 63 of the patients （51.2%）, and the median relapse time was 6 months （0-59 months）. In 32 ASCC patients, relapse or failure of the treatment occurred in 8 of these patients （51.2%）, with a median relapse time of 4.5 months （0-52 months）. The overall 5-year survival rate of the AUC patients was 49.8%, which was significantly lower than that of the ASCC patients （74.1%）, P = 0.015. The 5-year survival rates of the ASCC patients in Stage Ⅰ-Ⅲ were higher than that of the AUC patients with the same stages. However, statistical significant difference could only be found among the patients in Stage II, P = 0.006. The 5-year survival rates of the ASCC patients with various differential grade were higher than those of the AUC patients with the same differential grade, but statistical significant difference could only be found among the patients in the two groups with moderately differentiation, P = 0.039. It was found by Cox regression analysis that only clinical stage （P 〈 0.001） and histological type （P = 0.046） were the independent prognostic factors. CONCLUSION Clinical stage and histological type were the independent prognostic factors of the AUC and ASCC patients. The prOgnosis of ASCC patients is better than that of the AUC patients.展开更多
文摘In order to help older adults with cardiovascular disease navigate complex decisions, clinicians must know tenets of medical ethics and have good communication skills. The elements of decision making capacity and informed consent are reviewed, using relevant clinical ex- amples to illustrate the basic concepts. The shared decision making model, by which clinician and patient work together to determine the plan of care, is described. Useful communication techniques to implement shared decision making are suggested.
基金The study was funded by the Research Department at Fasa University of Medical Sciences,Fasa,Iran
文摘Objective:To explore the relationship between nursing professional values and ethical climate and nurses'professional quality of life.Methods:The present study is a descriptive,cross-sectional work in which 400 nurses from various wards of hospitals in the south-east of Iran were studied.Data were collected using a questionnaire consisting of four sections:demographics,Nurses'Professional Values Scale-Revised(NPVS-R),the Hospital Ethical Climate Survey(HECS),and the Professional Quality of Life Scale(ProQOL).Results:The total mean scores for professional values were 105.29±15.60.The total mean score for the ethical climate was 100.09±17.11.The mean scores for the indexes of compassion satisfaction,burnout,and secondary traumatic stress were 45.29±8.93,34.38±6.84,and 32.15±7.02 respectively.The relationships between professional values and the indexes of compassion satisfaction(r=0.56),burnout(r=0.26),and secondary traumatic stress(r=0.18)were found to be positive and significant(P<0.001).Also,the relationships between ethical climate and the items of compassion satisfaction(r=0.60,P<0.001),burnout(r=0.15,P=0.002)were found to be positive and significant.Conclusion:An understanding of nurses'perception of professional values and improving the ethical climate at work can help nursing administrators identify more effective strategies toward increasing compassion satisfaction and lessening bumout and work-related stress.
文摘This article begins with three problems of ＂dual loyalties＂ in medicine, the supposed fact that military physicians are, as medical officers, sometimes required to do what violates ordinary medical ethics--for example, ignore medical need in order to treat their own wounded before civilians or wounded enemy, help make chemical or biological weapons more deadly, or assist at a rough interrogation. These problems are analyzed as special cases of a problem that could arise in any profession, a problem easily resolved using a theory of professional ethics （more or less） absent from medical ethics until now though common outside. Employing a physician--rather than an ordinary officer, some other kind of healer, or scientist--is to enter a sort of ＂Ulysses contract＂ requiring the physician＇s professional standards to preempt obligations otherwise applying to an employee. In this way, the article also illustrates the benefits that might accrue to medical ethics from drawing （more than is now common） on other fields of practical ethics.
文摘Background and aims:Objective To investigate the current situation of ICU nurses'hospital ethical climate in China and analyze the correlation and influencing factors of hospital ethical climate.In order to provide a new direction and idea for creating the good hospital ethical climate,relieving the nurses'job burnout and stabilizing the nursing team.Methods:A total of 226 ICU nurses from 6 tertiary Tianjin hospitals were selected as subjects,and the Chinese version hospital ethical climate scale and psychological empowerment scale were used for investigation.Results:The gender and labor relationship of ICU nurses affected the perception of nurses'hospital ethical climate;hospital ethical climate and psychological empowerment were positively correlated;stepwise regression analysis showed that labor relationship and psychological empowerment can explain 58.5%variation rate of hospital ethical climate.Conclusion:We should pay attention to the current situation of the hospital ethical climate of ICU nurses.Managers should create a comfortable working environment not only to provide good material conditions for nurses and transfer of right,but also to pay attention to the nurses'mental state and negative impact of ethical issues.Hospital managers should reasonably allocate human resources,establish effective incentive and assessment standards,reasonable reward and punishment system and promotion mechanism.To provide comprehensive learning resources and channels.To improve nurses'awareness of their own professional value.Creating a harmonious and positive hospital ethical climate,reduce the impact of ethical issues on nurses,improve nurses'enthusiasm and satisfaction.
文摘Although the Japan Society of Obstetrics and Gynecology （JSOG） endorses new-type PGD using CGH for only carriers of balanced chromosomal translocations, it is against the ethical guidelines of the JSOG to decide whether or not embryos should be implanted due to aneuploidy discovered as a result of new-type PGD. In the author＇s opinion, it should be at the discretion of the JSOG＇s own randomized controlled trials, which should involve multiple facilities, whether or not a scientific basis can be found for the value of the new-type PGD in cases of recurrent miscarriage, in cases of implantation failure, and in cases where the women are of advanced maternal age. Dr. Netsu＇s 36 cases of selective reduction may be against the Japanese Maternal Health Protection Law that prohibits abortion due to congenital disease, but with the backdrop that there are many abortions that are performed as a result of parental convenience in Japan, it is difficult to understand the difference between the over 300,000 abortions that are performed every year in Japan and Dr. Netsu＇s prescribed surgery which is designed to selectively reduce fetuses with congenital disease for the purpose of evading physical danger for women with multiple gestations.
文摘Forensic medical workers are faced with unique ethical challenges in their attempt to deliver medical care in a custodial environment.We first figure out the reasons why the doctor is standing opposed to the patient through questionnaire and interview of the prison doctor in Shanghai,China,which turn to be a bilateral issue.Both sides should take more active approaches and put themselves to the right position to contribute to a better medical environment in the prison hospital,which can reduce medical tangles and help the criminals to accomplish their reform process.
文摘A closer look to the state of affairs of the elderly in Indonesia has disclosed the fact that the Indonesian elderly facing what this paper is coined as ＂multiple vulnerabilities.＂ On the one hand, Indonesian demographic is showing that the Indonesian people are getting old. The fertility rate has significantly decreased since 1970 when the total fertility rate decreases from 5.0 to 2.1 in 2025. This alone gives rise to various problems of the elderly, among whom are the dependency ratio, aging index, potential support ratio, and the feminization of aging. These problems show the level of vulnerability of the Indonesian elderly. From the perspective of the dependency ratio, for example, the number of people under the age of 15 and above 65 who depend on the labor force （15-64 years） has increased since 1970, from 7.0 to 29.0 in 2050. Again, this shows the high level of vulnerability of Indonesian elderly given that the dependency ratio itself has influenced on health care, living arrangements and family support, and so on. Aside from that, the economic burden will be very visible in the workforce. On the other hand, the policies on the elderly are still far from maximum realization. Law on the Welfare of the Elderly （13/1998） has recommended that every hospital must have geriatrics and gerontology section, yet only 8 hospitals fulfill the requirement. The situation is worsened due to the lack of adequate medical staff at the health center, which can serve elderly patients in a professional and humane way. Again, this brings forth the other side of the state of the elderly in Indonesia, which indicates the high level of their vulnerability. In this paper I will analyze the state of vulnerability of the elderly people in Indonesia from the perspective of ethics of vulnerability and personalism. I consider these two approaches as representing all ethical discussion about the ethical treatment of the elderly due to their characters of valuing the elderly as persons with dignity. Thus, this paper will show that the elderly in Indonesia is in danger of not being treated humanely.
文摘A comparison of how MR released to the insurance company Assist Card from a Chinese medical facility Hengyang HP vs from a US facility Stutter Health was roughly displayed. The former MR was for Mafia, a Colombian Assist Card cardholder, worked and got hospitalized in China, the later MR for Kong Lijun, a Chinese StarrChina cardholder, visited and got medical treatments in USA, they shared Assist Card international traveling and insurance assistance. In both cases, Assist Card got MR for the patient from the facilities that gave them treatments. As a third party, Assist Card went through different procedures to claim MR from Hengyang HP vs from Stutter Health. It managed to have got three MRs and three FTF and was pushing a fourth MR from Hengyang HP in about ten days, while it got only one MR from Stutter Health in ten days after twists and turns. The over cooperative or obedient tendency toward Assist Card＇s requests made Hengyang HP vulnerable and controllable, while the strict MR release procedures in Stutter Health made Assist Card passive and helpless.
文摘Background Patient autonomy is a leading principle in bioethics and a basis for shared decision making. This study explores conditions for an autonomous choice experienced by older adults who recently underwent trans-catheter aortic valve replacement （TAVR）. Methods Qualitative study entailing semi-structured interviews of a purposive sample often older （range 73-89, median 83.5 years） adults after TAVR （median 23 days）. The study setting was a cardiac department at a university hospital performing TAVR since 2010. Analysis was by systematic text condensation. Results Even when choice seemed hard or absent, TAVR-patients deliberately took the chance offered them by processing risk assessment, ambivalence and fate. They regarded declining the treatment to be worse than accepting the risk related to the procedure. The experience of being thoroughly advised by their physician formed the basis of an autonomous trust. The trust they felt for the physicians＇ recommendations mitigated ambivalence about the procedure and risks. TAVR patients expressed feelings consistent with self-empowerment and claimed that it had to be their decision. Even so, choosing the intervention as an obligation to their family or passively accepting it was also reported. Conclusions Older TAVR patients＇ experience of an autonomous decision may encompass frank tradeoff; deliberate physician dependency as well as a resilient self-view. Physicians should be especially aware of how older adults＇ subtle cognitive declines and inclinations to preserve their identities which can influence their medical decision making when obtaining in- formed consent. Cardiologists and other providers may also use these insights to develop new strategies that better respond to such inherent complexities.
文摘OBJECTIVE To analyze clinical characteristics and treatment methods of the patients with adenocarcinoma of the uterine cervix （AUC） and adenosquamous carcinoma of the cervix （ASCC）. To compare the survival time of the patients in 2 groups and analyze the prognostic factors. METHODS Clinical data of both 123 patients with AUC and 32 patients with ASCC treated at the Cancer Hospital, Chinese Academy of Medical Science （CAMS） ＆ Peking Union Medical College （PUMC）, were retrospectively analyzed. RESULTS The median age of the AUC patients was 50 years, and that of the ASCC patients was 44, P = 0.019. Poorly-differentiated （grade 3） cases accounted for 59.5% of the total ASCC patients, while only 32.5% of the AUC patients were in grade 3, P = 0.002. In 123 AUC patients, relapse or failure of the treatment occurred in 63 of the patients （51.2%）, and the median relapse time was 6 months （0-59 months）. In 32 ASCC patients, relapse or failure of the treatment occurred in 8 of these patients （51.2%）, with a median relapse time of 4.5 months （0-52 months）. The overall 5-year survival rate of the AUC patients was 49.8%, which was significantly lower than that of the ASCC patients （74.1%）, P = 0.015. The 5-year survival rates of the ASCC patients in Stage Ⅰ-Ⅲ were higher than that of the AUC patients with the same stages. However, statistical significant difference could only be found among the patients in Stage II, P = 0.006. The 5-year survival rates of the ASCC patients with various differential grade were higher than those of the AUC patients with the same differential grade, but statistical significant difference could only be found among the patients in the two groups with moderately differentiation, P = 0.039. It was found by Cox regression analysis that only clinical stage （P 〈 0.001） and histological type （P = 0.046） were the independent prognostic factors. CONCLUSION Clinical stage and histological type were the independent prognostic factors of the AUC and ASCC patients. The prOgnosis of ASCC patients is better than that of the AUC patients.
