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  1 / 2701 MEDLINE  
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[PMID]:27777269
[Au] Autor:Savulescu J; Wartolowska K; Carr A
[Ad] Endereço:Faculty of Philosophy, Oxford Uehiro Centre for Practical Ethics, Oxford, UK.
[Ti] Título:Randomised placebo-controlled trials of surgery: ethical analysis and guidelines.
[So] Source:J Med Ethics;42(12):776-783, 2016 Dec.
[Is] ISSN:1473-4257
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Use of a placebo control in surgical trials is a divisive issue. We argue that, in principle, placebo controls for surgery are necessary in the same way as for medicine. However, there are important differences between these types of trial, which both increase justification and limit application of surgical studies. We propose that surgical randomised placebo-controlled trials are ethical if certain conditions are fulfilled: (1) the presence of equipoise, defined as a lack of unbiased evidence for efficacy of an intervention; (2) clinically important research question; (3) the risk to patients is minimised and reasonable; (4) there is uncertainty about treatment allocation rather than deception; (5) there is preliminary evidence for efficacy, which justifies a placebo-controlled design; and (6) ideally, the placebo procedure should have some direct benefit to the patient, for example, as a diagnostic tool. Placebo-controlled trials in surgery will most often be justified when surgery is performed to improve function or relieve symptoms and when objective outcomes are not available, while the risk of mortality or significant morbidity is low. In line with medical placebo-controlled trials, the surgical trial (1) should be sufficiently powered and (2) standardised so that its results are valid, (3) consent should be valid, (4) the standard treatment or rescue medication should be provided if possible, and (5) after the trial, the patients should be told which treatment they received and there should be provision for post-trial care if the study may result in long-term negative effects. We comment and contrast our guidelines with those of the American Medical Association.
[Mh] Termos MeSH primário: Temas Bioéticos
Pesquisa Biomédica/ética
Cirurgia Geral/ética
Efeito Placebo
Ensaios Clínicos Controlados Aleatórios como Assunto/ética
Projetos de Pesquisa
Procedimentos Cirúrgicos Operatórios/ética
[Mh] Termos MeSH secundário: Análise Ética
Ética em Pesquisa
Guias como Assunto
Seres Humanos
Ensaios Clínicos Controlados Aleatórios como Assunto/métodos
Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171226
[Lr] Data última revisão:
171226
[Sb] Subgrupo de revista:E; IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE
[do] DOI:10.1136/medethics-2015-103333


  2 / 2701 MEDLINE  
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[PMID]:29206796
[Au] Autor:Levin PE; Moon D; Payne DE
[Ad] Endereço:Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York.
[Ti] Título:Overlapping and Concurrent Surgery: A Professional and Ethical Analysis.
[So] Source:J Bone Joint Surg Am;99(23):2045-2050, 2017 Dec 06.
[Is] ISSN:1535-1386
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Overlapping and concurrent surgeries form a continuum of simultaneous surgical practice in which a single surgeon has 2 or more patients in operating rooms at the same time. Undeniably, in an acute life-or-limb-threatening presentation, it may be essential for a surgeon to care for 2 individual patients simultaneously. These situations are different from scheduled elective surgery. Concurrent surgery is defined as the attending surgeon not being present for "critical and key" portions of a procedure. Billing for concurrent surgical procedures is a violation of the U.S. Centers for Medicare & Medicaid Services guidelines. The American College of Surgeons Statement of Principles (April 2016), adopted by the American Academy of Orthopaedic Surgeons, judges the practice of concurrent surgery to be "inappropriate." Overlapping surgery, although permissible under regulatory guidelines in the United States, presents substantial professional, bioethical, and legal concerns, and threatens our obligation as orthopaedic surgeons to respect the primacy of patient welfare and an individual's autonomy.
[Mh] Termos MeSH primário: Análise Ética
Salas Cirúrgicas
Procedimentos Ortopédicos/ética
Padrões de Prática Médica/ética
[Mh] Termos MeSH secundário: Seres Humanos
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171208
[Lr] Data última revisão:
171208
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171206
[St] Status:MEDLINE
[do] DOI:10.2106/JBJS.17.00109


  3 / 2701 MEDLINE  
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[PMID]:28953737
[Au] Autor:Dorfman RG; Vaca EE; Fine NA; Schierle CF
[Ad] Endereço:Chicago, Ill. From the Division of Plastic Surgery, Northwestern Memorial Hospital.
[Ti] Título:The Ethics of Sharing Plastic Surgery Videos on Social Media: Systematic Literature Review, Ethical Analysis, and Proposed Guidelines.
[So] Source:Plast Reconstr Surg;140(4):825-836, 2017 Oct.
[Is] ISSN:1529-4242
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Recent videos shared by plastic surgeons on social media applications such as Snapchat, Instagram, and YouTube, among others, have blurred the line between entertainment and patient care. This has left many in the plastic surgery community calling for the development of more structured oversight and guidance regarding video sharing on social media. To date, no official guidelines exist for plastic surgeons to follow. Little is known about the ethical implications of social media use by plastic surgeons, especially with regard to video sharing. A systematic review of the literature on social media use in plastic surgery was performed on October 31, 2016, with an emphasis on ethics and professionalism. An ethical analysis was conducted using the four principles of medical ethics. The initial search yielded 87 articles. Thirty-four articles were included for analyses that were found to be relevant to the use of social media in plastic surgery. No peer-reviewed articles were found that mentioned Snapchat or addressed the ethical implications of sharing live videos of plastic surgery on social media. Using the four principles of medical ethics, it was determined that significant ethical concerns exist with broadcasting these videos. This analysis fills an important gap in the plastic surgery literature by addressing the ethical issues concerning live surgery broadcasts on social media. Plastic surgeons may use the guidelines proposed here to avoid potential pitfalls.
[Mh] Termos MeSH primário: Análise Ética/métodos
Guias de Prática Clínica como Assunto
Procedimentos Cirúrgicos Reconstrutivos/ética
Mídias Sociais/ética
Gravação em Vídeo
[Mh] Termos MeSH secundário: Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171113
[Lr] Data última revisão:
171113
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170928
[St] Status:MEDLINE
[do] DOI:10.1097/PRS.0000000000003695


  4 / 2701 MEDLINE  
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[PMID]:28473036
[Au] Autor:DeMartino ES; Wordingham SE; Stulak JM; Boilson BA; Fuechtmann KR; Singh N; Sulmasy DP; Pajaro OE; Mueller PS
[Ad] Endereço:Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
[Ti] Título:Ethical Analysis of Withdrawing Total Artificial Heart Support.
[So] Source:Mayo Clin Proc;92(5):719-725, 2017 May.
[Is] ISSN:1942-5546
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: To describe the characteristics of patients who undergo withdrawal of total artificial heart support and to explore the ethical aspects of withdrawing this life-sustaining treatment. PATIENTS AND METHODS: We retrospectively reviewed the medical records of all adult recipients of a total artificial heart at Mayo Clinic from the program's inception in 2007 through June 30, 2015. Management of other life-sustaining therapies, approach to end-of-life decision making, engagement of ethics and palliative care consultation, and causes of death were analyzed. RESULTS: Of 47 total artificial heart recipients, 14 patients or their surrogates (30%) requested withdrawal of total artificial heart support. No request was denied by treatment teams. All 14 patients were supported with at least 1 other life-sustaining therapy. Only 1 patient was able to participate in decision making. CONCLUSION: It is widely held to be ethically permissible to withdraw a life-sustaining treatment when the treatment no longer meets the patient's health care-related goals (ie, the burdens outweigh the benefits). These data suggest that some patients, surrogates, physicians, and other care providers believe that this principle extends to the withdrawal of total artificial heart support.
[Mh] Termos MeSH primário: Coração Artificial/ética
Cuidados para Prolongar a Vida/ética
Insuficiência de Múltiplos Órgãos/mortalidade
Suspensão de Tratamento/ética
[Mh] Termos MeSH secundário: Adulto
Diretivas Antecipadas/ética
Diretivas Antecipadas/estatística & dados numéricos
Idoso
Causas de Morte
Tomada de Decisões/ética
Análise Ética
Feminino
Coração Artificial/efeitos adversos
Coração Artificial/estatística & dados numéricos
Seres Humanos
Masculino
Futilidade Médica/ética
Meia-Idade
Avaliação de Resultados (Cuidados de Saúde)/estatística & dados numéricos
Procurador
Estudos Retrospectivos
Análise de Sobrevida
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:171025
[Lr] Data última revisão:
171025
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170506
[St] Status:MEDLINE


  5 / 2701 MEDLINE  
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[PMID]:28421885
[Au] Autor:Peter E; Friedland J
[Ad] Endereço:1 University of Toronto, Ontario, Canada.
[Ti] Título:Recognizing Risk and Vulnerability in Research Ethics: Imagining the "What Ifs?"
[So] Source:J Empir Res Hum Res Ethics;12(2):107-116, 2017 Apr.
[Is] ISSN:1556-2654
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Research ethics committees (RECs) may misunderstand the vulnerability of participants, given their distance from the field. What RECs identify as the vulnerabilities that were not adequately recognized in protocols and how they attempt to protect the perceived vulnerability of participants and mitigate risks were examined using the response letters sent to researchers by three university-based RECs. Using a critical qualitative method informed by feminist ethics, we identified an overarching theme of recognizing and responding to cascading vulnerabilities and four subthemes: identifying vulnerable groups, recognizing potentially risky research, imagining the "what ifs," and mitigating perceived risks. An ethics approach that is up-close, as opposed to distant, is needed to foster closer relationships among participants, researchers, and RECs and to understand participant vulnerability and strength better.
[Mh] Termos MeSH primário: Análise Ética
Comitês de Ética em Pesquisa
Ética em Pesquisa
Consentimento Livre e Esclarecido/ética
Segurança do Paciente
Sujeitos da Pesquisa
Populações Vulneráveis
[Mh] Termos MeSH secundário: Feminismo
Seres Humanos
Imaginação
Pesquisa Qualitativa
Recognição (Psicologia)
Pesquisadores
Medição de Risco
Pensamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171003
[Lr] Data última revisão:
171003
[Sb] Subgrupo de revista:E; IM
[Da] Data de entrada para processamento:170420
[St] Status:MEDLINE
[do] DOI:10.1177/1556264617696920


  6 / 2701 MEDLINE  
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[PMID]:28417521
[Au] Autor:Jellema H; Kremer S; Mackor AR; Molewijk B
[Ti] Título:Evaluating the Quality of the Deliberation in Moral Case Deliberations: A Coding Scheme.
[So] Source:Bioethics;31(4):277-285, 2017 May.
[Is] ISSN:1467-8519
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Moral Case Deliberation (MCD) is an up and coming form of ethics support wherein clinical professionals deliberate about moral questions they face in their work. So far, it has been unclear what quality of deliberation in MCD is entailed and how to evaluate this quality. This article proposes a coding scheme that fits the theoretical background of MCD and allows researchers to evaluate the quality of the deliberation in MCDs. We consider deliberation in MCD to be of good quality when participants enrich their own understanding of a case by being exposed to the viewpoints of others. In order to have such an enriching effect, the deliberation in an MCD ought to involve different kinds of arguments from the perspectives of different stakeholders and in favour of different resolutions to the case; and the process of deliberation ought to be critical but constructive.
[Mh] Termos MeSH primário: Análise Ética
Consultoria Ética
Ética Clínica
Estudos de Avaliação como Assunto
Resolução de Problemas
Projetos de Pesquisa
[Mh] Termos MeSH secundário: Seres Humanos
Princípios Morais
Avaliação de Programas e Projetos de Saúde
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170913
[Lr] Data última revisão:
170913
[Sb] Subgrupo de revista:E; IM
[Da] Data de entrada para processamento:170419
[St] Status:MEDLINE
[do] DOI:10.1111/bioe.12346


  7 / 2701 MEDLINE  
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[PMID]:28417519
[Au] Autor:Wäscher S; Salloch S; Ritter P; Vollmann J; Schildmann J
[Ti] Título:Methodological Reflections on the Contribution of Qualitative Research to the Evaluation of Clinical Ethics Support Services.
[So] Source:Bioethics;31(4):237-245, 2017 May.
[Is] ISSN:1467-8519
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:This article describes a process of developing, implementing and evaluating a clinical ethics support service intervention with the goal of building up a context-sensitive structure of minimal clinical-ethics in an oncology department without prior clinical ethics structure. Scholars from different disciplines have called for an improvement in the evaluation of clinical ethics support services (CESS) for different reasons over several decades. However, while a lot has been said about the concepts and methodological challenges of evaluating CESS up to the present time, relatively few empirical studies have been carried out. The aim of this article is twofold. On the one hand, it describes a process of development, modifying and evaluating a CESS intervention as part of the ETHICO research project, using the approach of qualitative-formative evaluation. On the other hand, it provides a methodological analysis which specifies the contribution of qualitative empirical methods to the (formative) evaluation of CESS. We conclude with a consideration of the strengths and limitations of qualitative evaluation research with regards to the evaluation and development of context sensitive CESS. We further discuss our own approach in contrast to rather traditional consult or committee models.
[Mh] Termos MeSH primário: Análise Ética
Consultoria Ética/normas
Ética Clínica
Estudos de Avaliação como Assunto
Pesquisa Qualitativa
Projetos de Pesquisa
[Mh] Termos MeSH secundário: Comunicação
Tomada de Decisões
Seres Humanos
Resolução de Problemas
Avaliação de Programas e Projetos de Saúde
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170913
[Lr] Data última revisão:
170913
[Sb] Subgrupo de revista:E; IM
[Da] Data de entrada para processamento:170419
[St] Status:MEDLINE
[do] DOI:10.1111/bioe.12347


  8 / 2701 MEDLINE  
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[PMID]:28417518
[Au] Autor:de Snoo-Trimp J; Widdershoven G; Svantesson M; de Vet R; Molewijk B
[Ti] Título:What Outcomes do Dutch Healthcare Professionals Perceive as Important Before Participation in Moral Case Deliberation?
[So] Source:Bioethics;31(4):246-257, 2017 May.
[Is] ISSN:1467-8519
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: There has been little attention paid to research on the outcomes of clinical ethics support (CES) or critical reflection on what constitutes a good CES outcome. Understanding how CES users perceive the importance of CES outcomes can contribute to a better understanding, use of and normative reflection on CES outcomes. OBJECTIVE: To describe the perceptions of Dutch healthcare professionals on important outcomes of moral case deliberation (MCD), prior to MCD participation, and to compare results between respondents. METHODS: This mixed-methods study used both the Euro-MCD instrument and semi-structured interviews. Healthcare professionals who were about to implement MCD were recruited from nursing homes, hospitals, psychiatry and mentally disabled care institutions. RESULTS: 331 healthcare professionals completed the Euro-MCD instrument, 13 healthcare professionals were interviewed. The outcomes perceived as most important were 'more open communication', 'better mutual understanding', 'concrete actions', 'see the situation from different perspectives', 'consensus on how to manage the situation' and 'find more courses of action'. Interviewees also perceived improving quality of care, professionalism and the organization as important. Women, nurses, managers and professionals in mentally disabled care rated outcomes more highly than other respondents. CONCLUSIONS: Dutch healthcare professionals perceived the MCD outcomes related to collaboration as most important. The empirical findings can contribute to shared ownership of MCD and a more specific use of MCD in different contexts. They can inform international comparative research on different CES types and contribute to normative discussions concerning CES outcomes. Future studies should reflect upon important MCD outcomes after having experienced MCD.
[Mh] Termos MeSH primário: Atitude do Pessoal de Saúde
Comportamento Cooperativo
Análise Ética
Consultoria Ética
Ética Clínica
Resolução de Problemas
[Mh] Termos MeSH secundário: Comunicação
Seres Humanos
Princípios Morais
Países Baixos
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170913
[Lr] Data última revisão:
170913
[Sb] Subgrupo de revista:E; IM
[Da] Data de entrada para processamento:170419
[St] Status:MEDLINE
[do] DOI:10.1111/bioe.12354


  9 / 2701 MEDLINE  
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[PMID]:28417517
[Au] Autor:Metselaar S; Widdershoven G; Porz R; Molewijk B
[Ti] Título:Evaluating Clinical Ethics Support: A Participatory Approach.
[So] Source:Bioethics;31(4):258-266, 2017 May.
[Is] ISSN:1467-8519
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:The current process towards formalization within evaluation research, in particular the use of pre-set standards and the focus on predefined outcomes, implies a shift of ownership from the people who are actually involved in real clinical ethics support services (CESS) in a specific context to external stakeholders who increasingly gain a say in what 'good CESS' should look like. The question is whether this does justice to the insights and needs of those who are directly involved in actual CESS practices, be it as receivers or providers. We maintain that those actually involved in concrete CESS practices should also be involved in its evaluation, not only as respondents, but also in setting the agenda of the evaluation process and in articulating the criteria by which CESS is evaluated. Therefore, we propose a participatory approach to CESS evaluation. It focuses on (1) the concrete contexts in which CESS takes place, (2) reflective and dialogical learning processes, and (3) how to be democratic and inclusive. In particular, this approach to CESS evaluation is akin to realist evaluation, dialogical evaluation, and responsive evaluation. An example of a participatory approach to evaluating CESS is presented and some critical issues concerning this approach are discussed.
[Mh] Termos MeSH primário: Participação da Comunidade
Análise Ética
Consultoria Ética/normas
Ética Clínica
Estudos de Avaliação como Assunto
Resolução de Problemas
[Mh] Termos MeSH secundário: Comunicação
Comportamento Cooperativo
Pessoal de Saúde
Seres Humanos
Princípios Morais
Participação do Paciente
Avaliação de Programas e Projetos de Saúde
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170913
[Lr] Data última revisão:
170913
[Sb] Subgrupo de revista:E; IM
[Da] Data de entrada para processamento:170419
[St] Status:MEDLINE
[do] DOI:10.1111/bioe.12348


  10 / 2701 MEDLINE  
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[PMID]:28417516
[Au] Autor:Finder SG; Bartlett VL
[Ti] Título:Discovering What Matters: Interrogating Clinician Responses to Ethics Consultation.
[So] Source:Bioethics;31(4):267-276, 2017 May.
[Is] ISSN:1467-8519
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Against the background assumptions that (a) knowing what clinical ethics consultation represents to those with whom ethics consultants work most closely is a necessary component for being responsible in the practice of ethics consultation, and (b) the complexities of soliciting and understanding colleague evaluations require another inherent responsibility for the methods by which ethics consultations are evaluated, in this article we report our experience soliciting, analyzing, and trying to understand retrospective evaluations of our Clinical Ethics Consultation Service. These evaluations were collected through a quality assessment effort at our institution. Drawing from the qualitative elements of our survey instrument, we describe unexpected variations among the requests for ethics consultation and the retrospective reports from those colleagues making the requests. Focusing on just one aspect - the reason for request - raised several core questions about how we should evaluate those retrospective reports, what could be learned from the differences that we were now encountering, and what we could learn about the process of evaluating our practices. Working through these questions, we suggest several issues to consider in ongoing efforts to describe and evaluate clinical ethics consultation: the role of time and memory in evaluating retrospective evaluations, the importance of attending to the language of moral shift or disruption with which our colleagues describe their experiences, and how to understand the role of ethics consultation in creating 'moral space' (a la Margaret Urban Walker's conception) for colleagues to process their moral experiences.
[Mh] Termos MeSH primário: Atitude do Pessoal de Saúde
Análise Ética
Consultoria Ética
Ética Médica
Estudos de Avaliação como Assunto
Motivação
Resolução de Problemas
[Mh] Termos MeSH secundário: Eticistas
Ética Clínica
Seres Humanos
Linguagem
Memória
Princípios Morais
Avaliação de Programas e Projetos de Saúde
Estudos Retrospectivos
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170913
[Lr] Data última revisão:
170913
[Sb] Subgrupo de revista:E; IM
[Da] Data de entrada para processamento:170419
[St] Status:MEDLINE
[do] DOI:10.1111/bioe.12345



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