Medical Ethics Research Articles

The effect of sleep on swimming performance

There has been extensive research on sleep, including the stages, deprivation, and importance. The benefits of sleep have been known for a long period of time and the recommended 8h is widely accepted. There is limited research into the importance of sleep for athletes, especially swimmers. There is also very little research into university athletes. It is important to understand the effect on student-athletes as their lifestyle, diet and general day-to-day life differ from elite athletes. The aim of the study was to investigate if quality of sleep affects swimming performance in university level swimmers. Ethical approval was given by the Northumbria University Faculty of Health and Life Science Ethics Committee. 11 student-athletes from the Northumbria University swimming team were recruited for the study. The sample size was determined by the size of the swimming team and those who volunteered. Participants completed a 50 and 200 m freestyle timed swim in the morning and the Pittsburgh Sleep Quality Index (PSQI) questionnaire. The times were compared between morning and evening, and between those deemed to have good quality sleep compared to poor quality sleep. The data was tested for normality and analysed using a paired t-test and Wilcoxon, depending on the normality of the data. For the 200 m swim, performance was quicker in the evening (P = 0.013). Eight out of the 11 swimmers (66%) were deemed to have poor quality sleep, one of those having a sleeping disorder. These results are in line with another study looking at the time of day on swimming performance (Nunes, et al. [2021]. Chronobiology International., 38, 1), where a significant difference was found in performance in a 400 m swim (between morning and evening), and no difference in a 50 m swim. As 66% of participants were found to have poor quality sleep, this highlights the importance of sleep and understanding the effects of sleep deprivation. The findings of the study reveal that the athletes performed better in the evening (18:00 hrs) compared to the morning (07:00 hrs). This is important when planning competitions and training programs. By understanding that athletes perform better in the evening when they’re more motivated and alert, coaches can plan more sessions in the evening than in the morning. This can also be considered for BUCS events, as the performance standard will be higher later in the day.

Bioethics, climate change, and civilization

Anthropogenic climate change, with co-factors, threatens civilization, and thus human health. I first show that climate change is an important element of a system of hazards called “Limits to Growth”. I then argue that the interaction of climate change and other Limits to Growth elements risks civilization “failure” and possibly its “collapse”. Either consequence, were one to occur, entails profound risks to global population health, yet appreciation of this is still largely outside the health literature. I then discuss these relationships (including with civilization's destiny) with bioethical schools. The oldest of these (also called medical ethics) is strongly related to health and medicine, but in a later (1970) formulation the prefix “bio” is broader than human biology, though this school also has roots in human health. Van Rensselaer Potter, widely recognized as the founder of this school, subtitled it “the science of survival”. This subtitle seems to acknowledge an at least implicit risk to civilization. I also briefly discuss environmental ethics. By calling for greater discussion of the risk of civilization failure (or its collapse) this paper makes an important and original contribution to bioethics, however conceptualized. The major scholarly contribution of this paper is its call for the human health literature to refresh its consideration of Limits to Growth, to reconsider aspects that have become marginalized in the health literature, and for health workers to deepen their engagement with related literatures, especially of human ecology. We must contemplate the unthinkable if we are to help avert it.

Values in public health: an argument from trust

Research on the role of values in science and objectivity has typically approached trust through its epistemic aspects. Yet, recent work on public trust in science has emphasized the role of non-epistemic values in building and maintaining trust. This paper will use a concept of trust that adds concerns about justice to epistemic conditions to investigate this problem in relation to public health. I will argue that trust-conducive values, particularly justice, are relevant in deciding which value influences are legitimate in scientific decision-making. Drawing on public health ethics, I will provide a consequentialist justification for employing trust-conducive values. While several concepts of justice have been explored in the context of public health, I will further draw on public health ethics, focusing on a view that brings together both distributive and procedural aspects. For illustration, I will use the case of cardiovascular disease prevention, particularly how concerns about justice apply when choosing between population-based and individual-based approaches.

The relationship between nurses’ moral competency and missed nursing care: a descriptive-correlational study

BackgroundWhen any aspect of patient care is overlooked or delayed, it is known as Missed Nursing Care (MNC), leading to adverse events such as medication errors, infections, increased mortality rates, and poor prognosis. Moral competence is crucial for clinical nurses as it guarantees high-quality patient care in nursing practice. Thus, this study aimed to investigate the correlation between moral competencies and MNC among nurses.MethodsThis study was conducted with a descriptive-correlational design. The participants in the study were nurses who were currently enrolled at Shahid Beheshti University of Medical Sciences. In order to recruit nurses for the study, a convenience sampling method was implemented. The study tools were completed by a total of two hundred nurses. Research tools included a demographic questionnaire, the Moral Competence of Clinical Nurses Questionnaire, and the Kalisch and Williams Missed Nursing Care (MISSCARE) survey.Ethical considerationThis study was approved by the Medical Ethics and Law Research Center of Shahid Beheshti University of Medical Sciences.ResultsThe mean scores of moral competencies and MNC were 151.83 ± 12.60 and 42.71 ± 9.38, respectively. In other words, descriptive statistics showed that the moral competence score was more than 75%, and the MNC score was less than 50%. Also, there was a significant negative correlation between the total scores of moral competencies and MNC (r = -0.38, p < 0.001), indicating that more moral competence was correlated with lower levels of MNC.ConclusionThe study revealed a negative correlation between nurses’ moral competence and MNC, suggesting that enhancing moral competence could reduce MNC. To reduce MNC occurrences, hospitals, and organizations should prioritize moral competency, according to our research.

Realist process evaluation of occupational performance coaching: protocol

IntroductionA cluster randomised controlled trial, the Meaning, Agency and Nurturing Autonomy (MANA) study, is underway comparing the effects of occupational performance coaching (OPC) and usual care on the social participation,...

The problem of the resilience of medical workers in the context of modern medical ethics

The problem of the resilience of medical workers in the context of modern medical ethics

Exploring medical humanities from heterogeneous focus groups: A thematic analysis.

Medical humanities has evolved to encompass a multidisciplinary approach, integrating humanities, social sciences, and arts into medical education and practice. Despite its flourishing development, the definition of medical humanities still requires refinement to be inclusive of various cultures and regions. This study aimed to explore perceptions among students, physicians, and nurses, with a focus on the definition, learning, and implementation of medical humanities. We conducted four heterogeneous focus groups, comprising 4th-year and 6th-year medical students, physicians (including three medical humanities educators), and nurses. Data collection utilized semi-structured guiding questions, followed by thematic analysis. The transcripts were manually analyzed in their original Mandarin, and participant names were anonymized to ensure that the authors remained unaware of the participants' identities throughout the study. The analysis identified three themes and 16 subthemes. Theme 1, "Medical Humanities Properties," included four subthemes: variety, evolvement, clinical relevancy, and the value of humaneness. Theme 2, "Medical Humanities Contents," comprised seven subthemes: self-cultivation, communication, empathy, cultural competence, medical ethics and law, embodiment, and one subtheme open for interpretation in varying circumstances. Theme 3, "Medical Humanities Cultivation," included five subthemes: personal growth, curriculum, multimedia, clinical experience, and metacognition. Our study introduces a three-layered framework of medical humanities, emphasizing the field's dynamic nature and the critical role of experiential learning in developing key competencies such as empathy, awareness, and communication. This framework incorporates the concept of "self-cultivation" from Eastern philosophy, accentuating the significance of well-being for health-care professionals. The research not only enriches medical humanities education and practice by incorporating Eastern perspectives but also deepens the overall understanding of humanity in health care.

An ecological dynamics approach to promote physical literacy and well-being of primary school children: a cluster randomised controlled trial study protocol

BackgroundLittle is known about the impact of an ecological dynamics (ED) intervention (EDI) on primary school children’s physical literacy and well-being in the Hong Kong context. The aim of this...

Closed-loop transcutaneous auricular vagus nerve stimulation for the improvement of upper extremity motor function in stroke patients: a study protocol.

Transcutaneous auricular vagus nerve stimulation (taVNS) has garnered attention for stroke rehabilitation, with studies demonstrating its benefits when combined with motor rehabilitative training or delivered before motor training. The necessity of concurrently applying taVNS with motor training for post-stroke motor rehabilitation remains unclear. We aimed to investigate the necessity and advantages of applying the taVNS concurrently with motor training by an electromyography (EMG)-triggered closed-loop system for post-stroke rehabilitation. We propose a double-blinded, randomized clinical trial involving 150 stroke patients assigned to one of three groups: concurrent taVNS, sequential taVNS, or sham control condition. In the concurrent group, taVNS bursts will synchronize with upper extremity motor movements with EMG-triggered closed-loop system during the rehabilitative training, while in the sequential group, a taVNS session will precede the motor rehabilitative training. TaVNS intensity will be set below the pain threshold for both concurrent and sequential conditions and at zero for the control condition. The primary outcome measure is the Fugl-Meyer Assessment of Upper Extremity (FMA-UE). Secondary measures include standard upper limb function assessments, as well as EMG and electrocardiogram (ECG) features. Ethical approval has been granted by the Medical Ethics Committee, affiliated with Zhujiang Hospital of Southern Medical University for Clinical Studies (2023-QX-012-01). This study has been registered on ClinicalTrials (NCT05943431). Signed informed consent will be obtained from all included participants. The findings will be published in peer-reviewed journals and presented at relevant stakeholder conferences and meetings. This study represents a pioneering effort in directly comparing the impact of concurrent taVNS with motor training to that of sequential taVNS with motor training on stroke rehabilitation. Secondly, the incorporation of an EMG-triggered closed-loop taVNS system has enabled the automation and individualization of both taVNS and diverse motor training tasks-a novel approach not explored in previous research. This technological advancement holds promise for delivering more precise and tailored training interventions for stroke patients. However, it is essential to acknowledge a limitation of this study, as it does not delve into examining the neural mechanisms underlying taVNS in the context of post-stroke rehabilitation.

BIBLIOMETRIC ANALYSIS OF PHD, RESIDENCY DISSERTATIONS AND MASTER'S THESES IN PUBLIC HEALTH DEPARTMENTS IN TÜRKİYE BETWEEN 1970–2022

It was aimed to evaluate all theses conducted in public health departments between 1970 and 2022 in Türkiye. All public health theses (n=2623) indexed in Türkiye's Council of Higher Education Thesis Center were included. Each thesis was multi-tagged with subtopics. Trends in the field over five decades were examined. The most frequently studied subtopics are occupational safety (n=386, 10.63%), non-communicable diseases (n=373, 10.28%), and health promotion (n=339, 9.34%). the least ones are travel health (n=3, 0.08%), public health ethics (n=6, 0.17%), and health law (n=9, 0.25%). This study proposes an interactive scientific subtopic map based on conducted theses in the public health field in Türkiye. There is a need for a balanced distribution of our scientific energy so that critical areas in public health are not neglected.

Migration health ethics in Southeast Asia: a scoping review

Background Asia hosts the second-largest international migrant population in the world. In Southeast Asia (SEA), key types of migration are labour migration, forced migration, and environmental migration. This scoping review seeks to identify key themes and gaps in current research on the ethics of healthcare for mobile and marginalised populations in SEA, and the ethics of research involving these populations. Methods We performed a scoping review using three broad concepts: population (stateless population, migrants, refugees, asylum seekers, internally displaced people), issues (healthcare and ethics), and context (11 countries in SEA). Three databases (PubMed, CINAHL, and Web of Science) were searched from 2000 until May 2023 over a period of four months (February 2023 to May 2023). Other relevant publications were identified through citation searches, and six bioethics journals were hand searched. All searches were conducted in English, and relevant publications were screened against the inclusion and exclusion criteria. Data were subsequently imported into NVivo 14, and thematic analysis was conducted. Results We identified 18 papers with substantial bioethical analysis. Ethical concepts that guide the analysis were ‘capability, agency, dignity’, ‘vulnerability’, ‘precarity, complicity, and structural violence’ (n=7). Ethical issues were discussed from the perspective of research ethics (n=9), clinical ethics (n=1) and public health ethics (n=1). All publications are from researchers based in Singapore, Thailand, and Malaysia. Research gaps identified include the need for more research involving migrant children, research from migrant-sending countries, studies on quality of migrant healthcare, participatory health research, and research with internal migrants. Conclusions More empirical research is necessary to better understand the ethical issues that exist in the domains of research, clinical care, and public health. Critical examination of the interplay between migration, health and ethics with consideration of the diverse factors and contexts involved is crucial for the advancement of migration health ethics in SEA.

Person-centred care intervention to promote self-efficacy in patients following a myocardial infarction (P2MIR): a protocol of a qualitative study for cultural adaptation within a Portuguese healthcare context

IntroductionCardiovascular diseases remain a leading cause of death worldwide. Recovery from myocardial infarction is challenging as the causes of symptoms span multiple aspects of health not just physical conditions. Evidence...

Advocacy and Bioethics: Aspiration, Obligation, and Negotiation.

AbstractA long-standing tenet of healthcare clinical ethics consultation has involved the neutrality of the ethicist. However, recent pressing societal issues have challenged this viewpoint. Perhaps now more than ever before, ethicists are being called upon to take up roles in public health, policy, and other community-oriented endeavors. In this article, I first review the concept of professional advocacy and contrast this conceptualization with the role of patient advocate, utilizing the profession of nursing as an exemplar. Then, I explore the status of advocacy in clinical ethics and how this conversation intersects with the existing professional obligations of the bioethicist, arguing that the goals of ethics consultation and ethical obligations of the clinical ethicist are compatible with the role of professional advocate. Finally, I explore potential barriers to professional advocacy and offer suggestions for a path forward.

Analysis of 20 Years of Ethics Consultations at a U.S. Children's Hospital.

AbstractEmpirical studies of pediatric clinical ethics cases are scant in the biomedical and bioethics literature. In this study, more than 100 detailed records of clinical ethics consultations spanning from 2000 to 2020 at a moderately sized U.S. Mid-Atlantic children's hospital were abstracted and analyzed. Findings of the analysis were generally consistent with other studies in pediatric clinical ethics, with additional insight into aspects of moral distress associated with cases, family engagement with consultations, and other characteristics of interest also documented. Over the 20-year time frame, ethics consults were completed on average twice a year, with a detectable upward trend. Consultations were requested across the spectrum of services and units within the hospital, with critical care environments represented most frequently and genetic and neurological conditions being the most common primary diagnoses. Ethical analysis most commonly related to questions around the principles of autonomy and beneficence.

Healthcare without borders: Creating a shared medical decision-making model to support global patients at Northwestern Memorial Hospital

Individuals from across the globe increasingly elect to travel to the USA for the primary purpose of receiving healthcare. These border crossings create opportunities for rich cultural exchange, as well as for direct conflict between the basic values and preferences of global patients and their healthcare team(s). A series of ethics cases at Northwestern Memorial Hospital, where clinicians were morally distressed by the request of families of global patients to withhold medical information about life-threatening disease from the patient, led to a new partnership between the International Health and Medical Ethics teams. This paper describes the development, implementation and outcome of that creative collaboration: an innovative upstream preventive ethics initiative that honours the primary obligation of Western healthcare providers to uphold informed consent and patient autonomy while honouring a wide scope of preferences in communication and decision making identified among this patient population.

Genetic testing in cancer care: An assessment of current practice in Africa.

e13784 Background: Genetic testing provides forprecision oncologic intervention, improving outcomes and minimizing traditional cytotoxicity. It has caused a dramatic change in the oncology landscape but remains underutilized in Africa. Data on genetic alterations associated with cancer in people of African descent continue to be inadequate due to multi-layered factors such as availability and cost of testing, provider awareness and knowledge, and availability and cost of targeted therapy. With cancer projected to be the leading cause of mortality in Africa within the next two decades, identifying the current patterns of testing and reasons for low uptake is crucial for developing strategies to improve cancer care and outcomes in Africa. This study aimed to map the current utilization pattern of cancer genetic testing among oncologists in Africa. Methods: An online cross-sectional survey was administered to oncologists practicing in Africa. Responses were collected between September 2023 and January 2024 following IRB approval from the Lagos University Teaching Hospital Health Research and Ethics Committee. Surveys were administered in English and French. Results: 245 oncologists across 28 African countries participated in this study. The mean age of respondents was 41.6 (SD: 8.3), with 64.5% being male and Nigerians comprising the largest proportion (33.0%). The majority of respondents practice in public/government-owned facilities (44.1%), and 64.5% held consultant/attending positions. Survey findings showed that 69.8% of oncologists lacked confidence in understanding/interpreting genetic test results, 93.5% expressed the need for assistance in interpreting results, and 64.1% were unable to discuss findings confidently with patients. The most ordered test was BRCA1/2 (47.3%), while ABC and RB1 genes were the least commonly ordered (0.008% and 0.02%, respectively). The primary reason for ordering genetic tests (63.3%) was the potential to guide treatment planning. However, 54.7% reported not referring any patients for genetic testing in the past year. Barriers to testing included the high cost of tests (78%) and targeted therapies (60.4%). Furthermore, 67.8% of respondents lacked previous formal training in cancer genetics with nearly all respondents (97.6%) expressing interest in formal training and a preference for online courses (71.8%). Conclusions: This survey highlights the critical need to develop the capacity for understanding cancer genetic testing and targeted treatment options among oncologists in Africa. To optimize uptake, strategies must be developed to reduce testing costs through resource pooling and to reduce the high cost of targeted treatment. Oncologists should be encouraged to prioritize testing that guides actionable targets to promote the uptake of targeted treatment options in Africa.

Efficacy and safety of SBRT combined with sintilimab and IBI305 in patients with advanced HCC and previously failed immunotherapy: study protocol of a phase 2 clinical trial

IntroductionHepatocellular carcinoma (HCC) is a leading cause of cancer-related death in China. The combination of immune checkpoint inhibitors (ICIs) and antiangiogenic drugs, such as bevacizumab and tyrosine kinase inhibitors, has...

Effect of liver transplants with retrograde reperfusion on early postoperative recovery of liver function and its risk factors

BackgroundThe purpose of this study was to investigate effect of liver Transplants (LT) with retrograde reperfusion on early postoperative recovery of liver function and its risk factors.MethodsWe conducted a retrospective analysis of clinical data from 136 liver transplantation (LT) patients at the 900th Hospital of the Chinese People’s Liberation Army Joint Support Army, covering the period from January 2015 to January 2021. All participants provided informed consent, adhering to medical ethics guidelines. Patients were stratified into two groups based on the liver perfusion technique used: retrograde reperfusion (RTR, n = 108) and initial portal reperfusion (IPR, n = 28). Our study focused on a subset of 23 patients from each group to compare postoperative liver function recovery. The final analysis included 86 RTR and 28 IPR cases after excluding 8 RTR patients who underwent initial hepatic artery reperfusion and 14 who received simultaneous hepatic artery and portal vein reperfusion. Further subdivision within the RTR group identified 19 patients with early hepatic allograft dysfunction (EAD) and 67 without, allowing for an assessment of the influence of preoperative and intraoperative parameters, as well as perfusion methods, on EAD incidence post-LT.ResultsAlanine aminotransferase (ALT) was 329 (211 ~ 548) and 176 (98 ~ 282) U/L on the 3rd and 7th day after RTR, respectively, which was significantly lower than 451 (288 ~ 918) and 251 (147 ~ 430) U/L in the IPR group (Z =-1.979, -2.299, P = 0.048, 0.021). Aspartate aminotransferase (AST) on postoperative days 3, 5, and 7 was 252 (193, 522), 105 (79, 163), and 93 (41, 135) U/L in the RTR group, respectively; it was also significantly lower than 328 (251, 724), 179 (129, 306), and 150 (91, 200)U/L in the IPR group (Z=-2.212, -3.221, -2.979; P = 0.027, 0.001, 0.003). Logistic regression analysis showed that MELD score was an independent risk factor for EAD after LT.ConclusionRTR LT is more favorable for patients’ early postoperative liver function recovery. For patients undergoing LT for RTR, preoperative MELD score was an independent risk factor for their postoperative development of EAD.

Developmental aspects of metabolic syndrome in children under treatment with gastrointestinal lipase inhibitors

Alongside the increasing trends in obesity rates, there is a documented rise in the prevalence of metabolic syndrome (MetS) in children, dictating that each component of MetS should be identified as early as possible;and the treatment goal consists of reducing obesity, managing metabolic complications, insulin resistance, and also addressing hypertension (HTN).Aim of the study. To determine risk factors, the role of certain proinflammatory markers (TNF α, hs-CRP), and adipokines (leptin, adiponectin) in the onset of MetS in children and their evolution under treatment with gastrointestinal lipase inhibitors (GLI). Material and methods. The presented results were obtained as part of a project within the State Program 2020-2023 titled “Evolutionary Aspects of Metabolic Syndrome in Children Under Treatment with Gastrointestinal Lipase Inhibitors”, project number 20.80009.8007.33. The study included 57 children with MS (IDF, 2007). Depending on the pharmacological therapy associated with non-pharmacological treatment, the children in the research were divided into 3 groups: Group I- 23 children who received orlistat (orlip) - GLI, Group II - 15 children who received Angiotensin Converting Enzyme Inhibitors (ACEIs), and Group III - 19 children who received both GLI and ACEIs. The control group consisted of 50 normotensive and normal-weight children of similar age (gender ratio: 1:1). Risk factors, body mass index (BMI), waist circumference (WC), blood pressure values, total cholesterol (TC), LDL-C, HDL-C, triglycerides (TG), basal glycemia (BG), serum insulin, TNFα, hs-CRP, leptin, and adiponectin were analyzed initially and at the 3-month interval.The study protocol was approved by the Medical Ethics Committee of the Institute of Cardiology, Republic of Moldova (minutes no.2 dated February 20, 2020).Results: The majority of children in the study had a history of hereditary aggravated HTN and obesity, were sedentary or moderately sedentary, and had poor dietary habits. Among the components of MetS (IDF, 2007) associated with abdominal obesity, the following predominated: hypertension in 38 (66.7%) children, hypertriglyceridemia - 32 (56.1%%) children, increased basal blood glucose (BG) - 17(29.8%) children and hypo-HDL-C - 11 (19.3%) children. BMI at the 3-month interval from the initiation of medication decreased most significantly in group I (-4.025±1.267 kg/ m2), followed by group II (-3.33±0.972 kg/m2), and III (-3.046±0.840 kg/m2). WC decreased most notably in group III (-10.63±3.732 cm) compared to group II (-9.167±1.783 cm) and group I (-4.700±2.352 cm). Similar trends were observed for blood pressure values: group III (-18.75±1.897 mm Hg) vs group II (-12.167±1.359 mm Hg) vs group I (-3.900±4.613 mm Hg). LDL-C decreased essentially in group II (-0.46±0.211 mmol/l), while TG decreased in group III (-0.77±0.325 mmol/l) and II (-0.53±0.112 mmol/l). HDL-C increased by +0.60±0.274 mmol/l in group I, by +0.15±0.066 mmol/l in group II, and by +0.12±0.031 mmol/l in group III. Serum insulin decreased predominantly in group III (-9.36±4.53 µU/ mL). Similar trends were observed for BG (group III -1.24±0.322 mmol/l). TNF α decreased most significantly in group III (-2.65±0.911 pg/ml) compared to group I (-1.24±0.508 pg/ml) and group II (-1.61±1.018 pg/ml). hs-CRP decreased mainly in group I (-0.69±0.785 mg/l) and group II (-0.74±0.593 mg/l) compared to group III (-0.42±0.617 mg/l). Leptin values decreased significantly in all study groups at the 3-month interval from the initiation of medication (group I by-8.80±3.64 ng/ml, group II by -10.92±4.084 ng/ml, group III by -9.75±6.172 ng/ml). Adiponectin values increased by+1.83±1.087 µg/L in group III of the study.Conclusion: In combination with a calorie-restricted diet, regular physical exercise, and behavioral modifications, treatment with ILG and ACEIs in children with MetS in the study contributed to a decrease in the degree of obesity, blood pressure values, and normalization of the lipid and glucose profile, respectively. Additionally, it highlighted both the importance of prevention, early detection, and management of obesity, as well as the causal link between obesity, hypertension, and chronic inflammation.

Neonatal Resuscitation Online Registry in Shenzhen: protocol for a prospective, multicentre, open, observational cohort study

IntroductionPreterm birth complications and neonatal asphyxia are the leading causes of neonatal mortality worldwide. Surviving preterm and asphyxiated newborns can develop neurological sequelae; therefore, timely and appropriate neonatal resuscitation is...