Medical Ethics Research Articles

The impact of tau-PET in a selected memory clinic cohort: rationale and design of the TAP-TAU study

BackgroundTau-PET is a diagnostic tool with high sensitivity and specificity for discriminating Alzheimer’s disease (AD) dementia from other neurodegenerative disorders in well-controlled research environments. The role of tau-PET in real-world clinical practice, however, remains to be established. The aim of the TAP-TAU study is therefore to investigate the impact of tau-PET in clinical practice.MethodsTAP-TAU is a prospective, longitudinal multi-center study in 300 patients (≥ 50 years old) with mild cognitive impairment or mild dementia across five Dutch memory clinics. Patients are eligible if diagnostic certainty is < 85% after routine dementia screening and if the differential diagnosis includes AD. More specifically, we will include patients who (i) are suspected of having mixed pathology (e.g., AD and vascular pathology), (ii) have an atypical clinical presentation, and/or (iii) show conflicting or inconclusive outcomes on other tests (e.g., magnetic resonance imaging or cerebrospinal fluid). Participants will undergo a [18F]flortaucipir tau-PET scan, blood-based biomarker sampling, and fill out questionnaires on patient reported outcomes and experiences. The primary outcomes are change (pre- versus post- tau-PET) in diagnosis, diagnostic certainty, patient management and patient anxiety and uncertainty. Secondary outcome measures are head-to-head comparisons between tau-PET and less invasive and lower cost diagnostic tools such as novel blood-based biomarkers and artificial intelligence-based classifiers.ResultsTAP-TAU has been approved by the Medical Ethics Committee of the Amsterdam UMC. The first participant is expected to be included in October 2024.ConclusionsIn TAP-TAU, we will investigate the added clinical value of tau-PET in a real-world clinical setting, including memory clinic patients with diagnostic uncertainty after routine work-up. Findings of our study may contribute to recommendations regarding which patients would benefit most from assessment with tau-PET. This study is timely in the dawning era of disease modifying treatments as an accurate etiological diagnosis becomes increasingly important.Trial registrationThis trial is registered and authorized on December 21st, 2023 in EU Clinical Trials with registration number 2023-505430-10-00.

Moral challenges and understanding of clinical ethics in Tanzanian hospitals: Perspectives of healthcare professionals.

Healthcare professionals encounter many moral challenges in their daily clinical practice. However, there have been few studies on the subject matter in Tanzania. This study aims to provide an account of moral challenges faced by healthcare professionals in Tanzanian hospitals, their understanding of clinical ethics, and the ethics education they have received. Many participants reported receiving some kind of ethics training through formal education and on-the-job training. Some participants understood ethics in healthcare settings as adherence to established laws, regulations, guidelines, procedures, norms, and rules essential in clinical practice. Analysis of the data identified four themes of moral challenges. These challenges are related to 1) decision-making and communication in clinical practice, 2) scarcity of medical resources and prioritization in clinical practice, 3) withdrawal of curative treatment, and 4) conflicts between professional judgment, religious convictions and adherence to alternative treatments. Based on the findings, we suggest a context-sensitive form of clinical ethics training to prepare healthcare professionals to recognize and address these moral challenges.

Insomnia as a predictor of treatment outcomes in adolescents receiving concentrated exposure treatment for OCD

BackgroundResearch suggests that individuals with obsessive-compulsive disorder (OCD) frequently experience insomnia. Some previous studies have suggested that insomnia may predict treatment outcomes, but the evidence is limited, especially for adolescents. This study examined the prevalence of insomnia in an adolescent OCD patient sample, explored the correlation between OCD and insomnia, and tested whether levels of insomnia at baseline predict outcomes for adolescent patients receiving the Bergen 4-Day Treatment (B4DT) for OCD.MethodsForty-three adolescent OCD patients who received B4DT were selected for this study. Treatment outcome was quantified as change in Children Yale-Brown Obsessive Compulsive Scale (CY-BOCS) scores across time from pre- to posttreatment and 3-month follow-up. Insomnia symptoms were measured by the Bergen Insomnia Scale (BIS). Linear mixed models were used to examine the relationship between the BIS and changes in CY-BOCS scores. We controlled for symptoms of general anxiety disorder measured by the GAD-7 and depression symptoms measured by the PHQ-9.ResultsIn this sample, 68.4% of the patients scored above the cutoff for insomnia on the BIS. There was a moderate correlation between baseline CY-BOCS and BIS that did not reach statistical significance (r = .32, p = .051). High BIS scores before treatment were significantly associated with poorer treatment outcomes, as measured by changes in CY-BOCS over time (p = .002). The association between baseline insomnia and change in OCD symptoms remained significant (p = .033) while controlling for GAD-7 and PHQ-9.ConclusionInsomnia is common among adolescents with OCD, and these data suggest that these patients may be at increased risk for poor treatment outcomes. Future research to explore mechanisms and adjunctive treatments is warranted.Trial registrationThe study was approved by the Regional Committee for Medical and Health Research Ethics of Northern Norway (REK Nord: 2023/606482).

ЭТИКА И ДЕОНТОЛОГИЯ КАК БАЗОВЫЙ ПРИНЦИП РАБОТЫ МНОГОПРОФИЛЬНОГО РЕАБИЛИТАЦИОННОГО ЦЕНТРА, ПРИМЕНЯЮЩЕГО МЕТОДЫ НАУЧНОЙ МУЗЫКОТЕРАПИИ

This article presents literary data on the history of the formation of norms and rules of medical ethics. It substantiates the position on the need to comply with them in medical and preventive institutions not only by doctors or nurses, but also by employees of other specialties, such as psychologists, music therapists, etc. The advantages of combining medicine and art, innovative technologies in scientific music therapy, and the norms of medical ethics in practical activities are shown using the example of the multidisciplinary rehabilitation center «Doctor Music from Estonia». Compliance with these principles has ensured a reputation as an advanced organization, as well as respect and trust from the population. Such experience may be useful for other medical and preventive organizations.

The chronic wound characterisation study and biobank: a study protocol for a prospective observational cohort investigation of bacterial community composition, inflammatory responses and wound-healing trajectories in non-healing wounds

IntroductionChronic wounds affect 1%–2% of the global population, with rising incidence due to ageing and lifestyle-related diseases. Bacterial biofilms, found in 80% of chronic wounds, and scattered single-cell bacteria may...

Optimised treatment of patients with enlarged lateral lymph nodes in rectal cancer: protocol of an international, multicentre, prospective registration study after extensive multidisciplinary training (LaNoReC)

IntroductionInadequate treatment of enlarged lateral lymph nodes (LLNs) in rectal cancer patients is associated with an increased lateral local recurrence (LLR) risk, despite neoadjuvant treatment and total mesorectal excision (TME)...

One Woman, One Nation: The Heroic Story of Dr. Stella Adadevoh.

In 2014, Nigeria faced a near-existential threat when Ebola was introduced to Lagos, a city of over 20 million people. Dr. Stella Ameyo Adadevoh (1956-2014), a physician at First Consultant Hospital, played a pivotal role in preventing the spread of the virus by making the crucial decision to quarantine the index case, Patrick Sawyer, despite intense governmental pressure to release him. This review explores Dr. Adadevoh's life, her heroic actions during the Ebola crisis, and the lasting impact of her work on Nigeria's public health system. It also highlights the ethical and professional challenges she faced, including balancing patient autonomy with the need for public safety. Through her brave decision-making, Dr. Adadevoh sacrificed herself to save countless lives and ensured Nigeria's swift containment of the deadly virus, leaving behind an inspirational legacy of medical ethics, leadership, and courage that continues to influence public health policy today. This paper highlights the lessons learned from her actions, emphasizing the critical role of decisive leadership in managing infectious disease outbreaks and the profound selflessness and courage she demonstrated.

UTILITY OF AUTOMATED HEMATOLOGY ANALYZER IN THE DETECTION OF MALIGNANT CELLS IN SEROUS EFFUSIONS

Abstract Introduction/Objective Although microscopic examination is the gold standard for body fluid malignant cytology, it has a higher turnaround time and inter observed variability. Screening of serous effusions for malignant cells using haematology methods of automated analysis provides a rapid and objective result to the clinicians for initiating necessary treatment. Automated haematology analysers are equipped with body fluid (BF) mode that can detect high fluorescence cells body fluid (HF-BF) cells, mononuclear and polymorphonuclear (PMN) cells using flowcytometry laser scatter principles. The high fluorescence parameters useful for identifying malignant cells in the effusions Methods/Case Report The study was performed between February 2023to Februart 2024 at AIG Hospitals, Hyderabad after obtaining approval from the medical ethics committee of thehospital. Body fluidswere collected in K2 EDTA vaccutainer. Simultaneous preparation of smears for microscopic examination and morphometry wasdone and the smears were stained using Romanowsky stain (Leishmann &amp; Giemsa). Cytospin smears were prepared by cyto- centrifugation (Sakura cyto- tix). The slides were stained by Hematoxylin and eosin, May Grunwald Giemsa (MGG) and Papanicolaou (PAP) stains for morphological differentiation and detection of malignant cells. Cell blocks were prepared after through mixing of the fluid using direct sedimentation method and the slides were stained by haematoxylin and eosin stain. IHC was performed where ever necessary. Results (if a Case Study enter NA) A total of 258 fluid samples comprising of 223 ascitic and 35 pleural fluids. Medical statistical software version 20.2 was used for statistical analysisof the results. Considering fluid cell block analysis as the gold standard the patient population was divided into 2 groups, malignant (8 samples) and non- malignant cell group(250 samples). Cytological examination of cytospins smears has shown to have the highest specificity, PPV and NPV in the detection of malignant effusions. Conclusion Our study shows that cytology and histopathological examination of body fluids remains the gold standard for the detection of malignant cells. The HF-BF parameter acts as a rapid, useful tool to predict the presence of malignant cells in serous effusions and select samples for microscopic reviewing that would have otherwise gone undiagnosed. We believe that with defining cut off values for the HF-BF parameter may be used as an adjunct diagnostic tool.

Coercive public health policies need context-specific ethical justifications.

Public health policies designed to improve individual and population health may involve coercion. These coercive policies require ethical justification, and yet it is unclear in the public health ethics literature which ethical concepts might justify coercion, and what their limitations are in applying across contexts. In this paper, we analyse a number of concepts from Western bioethics, including the harm principle, paternalism, the public interest, and a duty of easy rescue. We find them plausible justifications for coercion in theory, but when applied to case studies, including HIV testing in Malawi, vaccine mandates in South Africa, and prohibitions of antibiotic use in livestock in the EU, their limitations become clear. We argue that the context-specificity of ethical justifications for coercion has been overlooked, and there is more work needed to identify context-relevant ethical justifications for coercive policies in various settings and for various populations, rather than relying on universalising Western bioethical justifications across all contexts.

Ishāq bin Ali al-Ruhawi, a pioneer in medical professionalism in the 9th century AD.

Professionalism and medical ethics, while similar, are often viewed in different contexts. An historical and social science analysis reveals that professionalism is a complex skill that can be developed over time. The key components of professionalism, as defined by the American Physical Therapy Association, include accountability, altruism, compassion, excellence, integrity, professional duty, and social responsibility. Throughout history, physicians have been concerned with medical ethics and professionalism. In the Golden Age of Islam, principles such as excellence, honour, integrity, accountability, and duty were important in shaping the professional behavior of physicians. Adab al-Tabib, an ancient work, by Ishāq bin Ali al-Ruhawi focuses on ethical guidelines and teachings related to medical ethics in the Islamic civilization. Many of the ethical issues in this book are of foremost importance as components of professionalism. However while the examples of medical ethics guidelines that pre-existed Adab al-Tabib such as the Hippocratic Oath, are not mentioned. As one of the first statutes of medical ethics in Islamic civilization, Ruhawi is a model for many doctors in the Golden Age of Islam, and over the years his principles have greatly influenced the professional view of physicians.

Practice and reflections on regional mutual recognition of clinical research ethics review——based on survey results from medical and health institutions in Jiangsu Province

With the continuous advancement of medical research, the number of multi-center clinical studies has been steadily increasing, bringing about significant challenges to ethical review. Improving the efficiency and quality of ethical review has become a necessity driven by national policies and the development of the industry. Mutual recognition of ethical reviews is one of the most effective ways to enhance the efficiency of ethical review in multi-center clinical trials. The promotion of mutual recognition of ethical reviews is both feasible and practically significant; however, progress has been less than ideal. Through conducting surveys, this study attempts to understand the status of mutual recognition of ethical reviews in Jiangsu Province, identify the reasons hindering the implementation of mutual recognition, and propose possible solutions. The results indicate that while most medical and health institutions are aware of the policies related to mutual recognition of ethical reviews, the majority remain in a wait-and-see attitude. Ensuring policy guarantees and the high quality and homogeneity of ethical review across institutions are considered necessary conditions for achieving mutual recognition of ethical reviews.

Medical ethics and in vitro fertilisation

Not available.

Clinical and genetic analysis of a child with Spondyloocular syndrome due to compound heterozygous variants of XYLT2 gene

To explore the clinical characteristics and genetic etiology of a child with Spondyloocular syndrome (SOS) in order to enhance the awareness and understanding of this disease. A 3.5-year-old boy with SOS who had presented at the Department of Medical Genetics of Hunan Children's Hospital on August 10, 2023 due to the repeated fractures for over 2 years and after binocular cataract surgery was selected as the study subject. Clinical data of his pedigree were collected, and peripheral venous blood samples were collected for the extraction of genomic DNA and subjected to trio-whole exome sequencing. Candidate variants were verified by Sanger sequencing and analyzed with bioinformatic software. This study was approved by the Medical Ethics Committee of Hunan Children's Hospital (Ethics No. KYAQ2022-263). The child had manifested repeated fractures, bilateral bowed femur, osteoporosis, cataract, atrial septal defect, and developmental delay. Ultrasonography has revealed fetal edema, peritoneal effusion, pleural effusion and polyhydramnios. Trio-whole exome sequencing and Sanger sequencing revealed that he has harbored compound heterozygous variants of the XYLT2 gene, namely c.1103_1104delAG (p.Gln368Argfs*8) and c.1238_1253delinsA (p.Val413_Pro418delinsGlu), which were inherited from his phenotypically normal father and mother, respectively. Neither variant was reported previously. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG) and recommendations from the Clinical Genome Resource (ClinGen), the c.1103_1104delAG was predicted as a pathogenic variant (PVS1+PM2_Supporting+PP4), whilst the c.1238_1253delinsA was predicted as a likely pathogenic variant (PM4+PM3+PM2_Supporting+PP4). The c.1103_1104delAG and c.1238_1253delinsA compound heterozygous variants of the XYLT2 gene probably underlay the pathogenesis in this child. Above finding has enriched the phenotypic and mutational spectrum of SOS, and provided a basis for the clinical diagnosis, treatment, prognosis assessment and genetic counseling for this pedigree.

Medical ethics and internal medicine

Recent scientific and technological advances in medicine have raised a number of ethical and regulatory problems, to which medicine alone can no longer provide adequate answers. Bioethics, as an interdisciplinary reflection, essentially deals with the ethical and regulatory aspects posed by biology in general; medical ethics, on the other hand, deals with the more specific aspects of medicine.

Methodology and ethics in medicine.

Not available.

Ethics and technological evolution in contemporary medicine

Not available.

Peran Hukum Kesehatan dalam Melindungi Peserta Program Badan Penyelenggara Jaminan Sosial Kesehatan Berdasarkan Undang-Undang Nomor 24 Tahun 2011

The role of health law is crucial in ensuring the protection of participants in the National Health Insurance (BPJS Kesehatan) program, as regulated by Law No. 24 of 2011. This law provides a legal basis for the implementation of the national health insurance program, which aims to promote the welfare of society by providing equitable access to quality healthcare services. Health law functions to protect the rights of BPJS participants by ensuring that they receive healthcare services that meet established standards without discrimination.Furthermore, this law mandates the state to provide comprehensive and inclusive health insurance. Through the role of BPJS Kesehatan, health law also regulates the supervision and enforcement of accountability from healthcare providers, both in terms of service quality and financial management. Healthcare institutions collaborating with BPJS are required to comply with professional standards and medical ethics, as well as being responsible for patient safety.In the event of violations, health law provides a mechanism for participants to file complaints and seek justice through legal channels. The application of administrative and criminal sanctions for violators is also part of the legal protection efforts for participants. Therefore, the role of health law not only ensures access to services but also guarantees that the rights of BPJS participants are fulfilled in receiving fair and quality healthcare services.

Medical Responsibility in the Colombian Context: A Review of Negligence from the Legal Framework and Ethical Perspective

This article explores medical responsibility and negligence from an ethical and legal perspective within the Colombian context. It highlights causes of negligence such as deficiencies in professional training and organizational problems. The article emphasizes "objective imputation as key to determining the criminal responsibility of the physician" (Alvarado D. 2019). The objectives include analyzing the current legal framework in Colombia and assessing the link between medical ethics and legal responsibility. The methodology builds upon a thorough examination of specialized literature, including peer-reviewed scientific articles in medicine and law, as well as legal documents and ethical regulations. A targeted search was conducted across various bibliographic databases including Google Scholar, Redalyc, Scielo, Dialnet, Biomed Central, Miguel De Cervantes Virtual Library, and BVS virtual health library.

Practices and attitudes of herbalists regarding informed consent in Uganda: a qualitative study

BackgroundInformed consent (IC) is a fundamental principle in medical ethics that upholds respect for patient autonomy. Although widely applied in healthcare, its feasibility and implementation in herbal medicine have been underexplored. This study therefore aimed to explore the practices and attitudes of herbalists regarding informed consent.MethodsTo achieve these objectives, a qualitative cross-sectional study was conducted from June to December 2020. Twenty-one in-depth interviews with herbalists and four key informant interviews with leaders of the different traditional medicine organizations were conducted. The data were analyzed thematically using NVivo version 12 software.ResultsSixteen of the twenty-one participants acquired oral herbal medicine knowledge from their relatives. Although a positive inclination toward obtaining IC was evident, the focus was on disclosing basic information. Discussions of alternative treatments and herbal specifics were less frequent. Disease management decisions often involve shared responsibility within families or societies. Documented IC procedures are rare among herbalists, who deem consent forms unnecessary, although they recognize the potential benefits of IC in fostering trust and professionalism. Challenges hindering IC implementation included regulatory gaps, inadequate skills, and the absence of mechanisms to protect the intellectual property rights of herbal medicine.ConclusionThis study illuminates how educational, cultural, familial, and regulatory factors influence herbalists’ practices and attitudes toward informed consent.

Exploring medical ethics: moral reasoning among new pediatric resident physicians in a tertiary hospital.

Physicians are frequently faced with ethical dilemmas that require answers based in moral reasoning, which develops and evolves during their lives and their medical education. According to Kohlberg, there are three levels of moral reasoning development: pre-conventional (in which decisions are guided by oneself convenience), conventional (focused on obeying society's rules), and post-conventional (decisions are based in universal ethical principles). The aim of this study was to describe the level of moral reasoning among new pediatric resident physicians in a tertiary hospital. This cross-sectional descriptive study was conducted from 2020 to 2023. The Defining Issues Test was used to assess the level of moral reasoning among 195 new pediatric resident physicians in a tertiary hospital. Most resident physicians considered the fourth stage affirmations to be the most important. The median P-index (PI) was 40, and 49% of participants were on the post-conventional level of moral reasoning. The year with the lowest number of new resident physicians on the post-conventional level was 2021. The moral reasoning level among pediatric resident physicians was higher than the average found in general population. This suggests that the education received during the medical formation may influence the individuals' moral development.