Informed consent

知情同意
  • 文章类型: Journal Article
    随着《个人信息保护法》(POPI法案)的生效,围绕在社交媒体上使用和分享照片的道德规范受到了关注。
    目的是确定用途,在南非一所牙科学校的合格和本科口腔健康从业者中,道德实践和在社交媒体上分享牙科摄影。
    2022年,西开普大学牙科学院的工作人员和学生使用了横断面研究设计。卡方检验和Fisher精确检验用于确定不同毕业状态与各种人口统计学因素之间的关联。
    来自80名本科生和46名合格的口腔保健医生,大多数人都知道摄影可以用于牙科,87.3%(n=110)拍摄了对患者进行牙科治疗的照片。只有60.3%的参与者参加了涉及社交媒体和数字摄影问题的道德课程。几乎80%(n=100)的参与者认为他们不需要在分享之前提及他们将与患者一起使用的所有社交媒体平台的照片。
    牙科摄影正在被一些大学级别的学生和教职员工使用,有时在社交媒体平台上分享。并非所有参与者都参加了有关临床摄影的伦理课程。牙科培训需要包括牙科摄影的伦理课程和在社交媒体上分享照片的使用。
    关于所有本科和研究生课程中临床照片的良好道德实践,消除任何不确定性。
    UNASSIGNED: The ethics surrounding the use and sharing of photographs on social media has come under the spotlight as the Protection of Personal Information Act (POPI Act) has come into play.
    UNASSIGNED: The aim is to determine the use, ethical practice and sharing of dental photography on social media among qualified and undergraduate oral health practitioners at a dental school in South Africa.
    UNASSIGNED: A cross-sectional study design was used on staff and students at the University of the Western Cape\'s Dental Faculty in 2022. Chi-squared and Fisher\'s exact tests were used to determine associations between the different graduation statuses and various demographic factors.
    UNASSIGNED: From the 80 undergraduate students and 46 qualified oral healthcare practitioners, the majority were aware that photography could be used in dentistry, and 87.3% (n = 110) took photographs of the dental treatments performed on their patients. Only 60.3% of the participants attended an ethical course that addressed issues with social media and digital photography. Almost 80% (n = 100) of the participants did not feel that they needed to mention all the social media platforms that they would use with their patients\' photographs before sharing.
    UNASSIGNED: Dental photography is being used and sometimes shared on social media platforms by some students and staff at university level. Not all participants have attended an ethical course on clinical photography. Dental training needs to include an ethical course on dental photography and the use of sharing photographs on social media.
    UNASSIGNED: Good ethical practice regarding clinical photographs in all undergraduate and postgraduate curriculums, to eliminate any uncertainty.
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  • 文章类型: Journal Article
    背景:本文通过评估潜在参与者的需求,探讨了在瑞士建立大规模基于人群的队列和生物样本库的可行性,期望,以及对提供健康信息的基础设施的担忧,生活方式,和曝光轨迹,疾病的发展,和风险因素随着时间的推移。
    方法:我们在瑞士健康研究试点阶段(2020-2021年)使用了基于情景的问卷,涉及来自沃州和伯尔尼州的1349名20-69岁的成年人。我们在R和定性内容分析的支持下进行了描述性统计,对n=374个与研究态度相关的公开回答进行了定性内容分析。
    结果:我们强调了基于场景的方法的好处和挑战,讨论试验阶段中代表的样本,并提出了建立完整队列的含义。我们还报告了参与者对健康研究的态度和以前的经验。我们分析有关知情同意和反馈的参考文献,对瑞士健康研究的态度,以及关于改进其范围的建议,设计,和仪器。结果表明,参与国家健康研究的兴趣很高(90%),85%的随机人群样本愿意加入长期队列。只有43%的人熟悉生物银行,44%的人倾向于普遍同意。对瑞士的公共研究的信任度很高,但对其他国家或私营部门的研究人员的信任度较低。超过95%的人表示愿意完成在线调查问卷,接受体检,并捐赠生物样本。几乎所有参与者都想从他们的研究中心访问中了解医学测试的结果(99.5%)和暴露于环境压力源(95%)。监测睡眠的首选工具,身体活动,和饮食是已知的智能手机应用程序与自动数据管理。
    结论:总体而言,这项研究揭示了对个性化健康研究的积极态度,具有强烈的分享数据和样本的意愿。关键见解集中于知情同意参与的含义,抽样和代表性的相关性,以及个性化反馈的重要性和挑战,特别是关于环境健康的问题。调查结果强调参与者的支持性但反身性立场,强调在个性化健康研究中调整研究价值与个人价值的重要性。这些见解有助于细化范围,设计,以及未来队列研究的工具。
    BACKGROUND: This paper explores the feasibility of establishing a large-scale population-based cohort and biobank in Switzerland by assessing potential participants\' needs, expectations, and concerns about such an infrastructure providing information on health, lifestyle, and exposure trajectories, the development of disease, and risk factors over time.
    METHODS: We utilized a scenario-based questionnaire in the Swiss Health Study pilot phase (2020-2021), involving 1349 adults aged 20-69 from the cantons Vaud and Bern. We conducted descriptive statistics supported by R and qualitative content analysis of n = 374 open responses related to attitudes towards research.
    RESULTS: We highlight the benefits and challenges of the scenario-based approach, discuss the sample represented in the pilot phase, and present implications for building a full cohort. We also report on participants\' attitudes towards and previous experience with health research. We analyze references regarding informed consent and feedback, attitudes towards the Swiss Health Study, and recommendations on improving its scope, design, and instruments. Results indicate a high interest (90%) in participating in a national health study, with 85% of a random population sample willing to join a long-term cohort. Only 43% were familiar with biobanks, and 44% preferred general consent. Trust was high for Swiss-based public research but lower for researchers from other countries or private sector. Over 95% expressed willingness to complete online questionnaires, undergo physical examination, and donate biosamples. Almost all participants wanted to know the outcomes of the medical tests (99.5%) and the exposure to environmental stressors (95%) from their study center visit. Preferred tools for monitoring sleep, physical activity, and diet were known smartphone apps with automatic data management.
    CONCLUSIONS: Overall, the study reveals a positive attitude towards personalized health research, with a strong willingness to share data and samples. Key insights focus the meaning of informed consent for participation, the relevance of sampling and representativeness, as well as the significance and challenges of personalized feedback, especially regarding environmental health concerns. Findings emphasize participants\' supportive yet reflexive stances, underscoring the importance of aligning research values with individual values in personalized health research. These insights contribute valuable considerations for refining the scope, design, and instruments of future cohort studies.
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  • 文章类型: Journal Article
    最近,针对国家卫生服务医院的临床过失索赔增加了一倍,8%的索赔是由于“未能警告/知情同意”而提出的。“这项研究旨在评估大型三级神经科学中心神经外科部门目前对手术同意问题的国家法律框架和专业指南的依从性,并制定改善同意程序的策略。
    电子病历(EPR)被访问以收集有关外科手术的人口统计数据和信息。进行了电话问卷调查。神经外科注册人员接受了采访。提交人会见了信托的法律团队,神经心理学的领导,和信托的同意线索。
    58名患者被纳入分析。在问卷的受访者中,98%的人认为他们在同意过程中得到了充分的信息。当患者同意时,所有注册服务商都认为他们解释了该程序的原因,详细的好处,和主要风险,包括不常见和罕见的风险。然而,50%承认没有具体讨论术后恢复时间或替代方案。只有15%的人承认通过EPR记录或通过给患者的全科医生的信。
    知情同意是临床医生和患者之间沟通的微妙时刻。定期培训和良好的沟通技巧有助于员工专注于最相关的同意方面,应在适当的环境和家庭支持下交付。视听辅助工具可以支持该过程,但不能取代良好的沟通。
    UNASSIGNED: In recent times, clinical negligence claims against National Health Service hospitals have doubled, with 8% of claims being made due to \"failure to warn/informed consent.\" This study aimed to assess the current compliance of the neurosurgical division within a large tertiary neuroscience center with the national legal framework and professional guidelines around the issue of surgical consent and to develop strategies to improve the consent process.
    UNASSIGNED: Electronic patient records (EPR) were accessed to collect demographic data and information regarding the surgical procedures. Telephone questionnaires were carried out. Neurosurgical registrars were interviewed. The author met with the trust\'s Legal team, the neuropsychology lead, and the trust\'s consent lead.
    UNASSIGNED: Fifty-eight patients were included in the analysis. Of the respondents to the questionnaire, 98% felt that they were adequately informed during the consent process. When consenting patients, all registrars felt that they explained the reason for the procedure, detailed benefits, and major risks, including uncommon and rare risks. However, 50% admitted to not specifically discussing the postoperative recovery time or alternatives. Only 15% admitted to documenting on the EPR or through a letter to the patient\'s General Practitioner.
    UNASSIGNED: Informed consent is a delicate moment of communication between a clinician and the patient. Regular training and good communication skills help staff to focus on the most relevant aspects of consent, which should be delivered in an appropriate environment and with family support. Audio-visual aids can support the process but do not replace good communication.
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  • 文章类型: Journal Article
    背景:近年来,电子知情同意(eConsent)的使用在欧洲有所扩大,尤其是在大流行期间。招募率慢和参与者外展的局限性是临床研究中经常面临的挑战。鉴于文献中报道的eConsent和团体咨询的好处,在SWITCH-ON研究的招募中实施了eConsent组。我们旨在探索参加SWITCH-ON研究小组的参与者的经验,并评估其未来使用的潜力。
    方法:SWITCH-ON研究旨在分析二价COVID-19加强疫苗接种后健康人群的免疫原性。成功招募了4134名年龄在18-65岁之间的医护人员,并发送了一份关于他们在eConsent小组中的经历的问卷。在完成的399份问卷中(回复率为92%),39名参与者未加入eConsent组。剩余的360个响应包括在最终分析中。定量和定性数据分别采用描述性统计分析和专题分析。
    结果:参与者发现,小组eConsent是一种有效的方法,它允许他们听到彼此的问题和关切,并创造了一种团结的感觉。然而,有限的隐私,在小组中提问的障碍,和同伴压力可以限制组eConsent的使用。一百六十五(46%)参与者认为eConsent组适合招募患有疾病或疾病的参与者,而87(24%)报告了这种方法的局限性。其余参与者认为,eConsent组的适用性取决于研究人群的疾病或状况,一对一的对话应该总是可用的。经历过一对一和小组同意的参与者在未来的研究中分享了不同的首选同意格式。
    结论:一项低风险疫苗接种研究的参与者对eConsent组进行了积极评价。参与者建议使用网络研讨会提供有关研究的一般信息,然后是每个参与者的单独会话,将保留eConsent组的好处,并最大限度地减少它带来的限制。此建议的设置解决了隐私问题,并使组eConsent更易于实现。
    背景:ClinicalTrials.govNCT05471440(7月22日注册,2022年)。
    BACKGROUND: Electronic informed consent (eConsent) usage has expanded in recent years in Europe, especially during the pandemic. Slow recruitment rate and limitations in participant outreach are the challenges often faced in clinical research. Given the benefits of eConsent and group counselling reported in the literature, group eConsent was implemented in recruitment for the SWITCH-ON study. We aim to explore the experience of participants who attended group eConsent for the SWITCH-ON study and evaluate its potential for future use.
    METHODS: SWITCH-ON study aims to analyse the immunogenicity of a healthy population following bivalent COVID-19 booster vaccination. Four hundred thirty-four healthcare workers aged 18-65 were successfully recruited and sent a questionnaire about their experience with group eConsent. Out of 399 completed questionnaires (response rate 92%), 39 participants did not join group eConsent. The remaining 360 responses were included in the final analysis. Quantitative and qualitative data were reported using descriptive statistical analysis and thematic analysis respectively.
    RESULTS: Participants found that group eConsent was an efficient method that it allowed them to hear each other\'s questions and concerns and created a sense of togetherness. However, limited privacy, barriers to asking questions in a group, and peer pressure can limit the use of group eConsent. One hundred sixty-five (46%) participants thought that group eConsent was suitable to recruit participants with diseases or conditions, while 87 (24%) reported limitations with this method. The remaining participants suggested that applicability of group eConsent depended on the diseases or conditions of the study population, and one-to-one conversation should always be available. Participants who had experienced both one-to-one and group eConsent shared different preferred consent formats for future studies.
    CONCLUSIONS: Group eConsent was positively evaluated by the participants of a low-risk vaccination study. Participants advised using webinars to provide general information about the study, followed by an individual session for each participant, would retain the benefits of group eConsent and minimise the limitations it posed. This proposed setting addresses privacy questions and makes group eConsent easier to implement.
    BACKGROUND: ClinicalTrials.gov NCT05471440 (registered on 22nd of July, 2022).
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  • 文章类型: Journal Article
    Introduction: Before and after photographs (BAPs) in breast surgery have been identified as important components of the informed consent process. Currently, there is limited consensus on the contents and presentation of BAPs. This study collected the opinions of prior and prospective patients on this topic. Methods: A survey, based on criteria identified by our previous nominal group technique (NGT) study, was designed to obtain patient perspectives on BAPs in breast surgery. Amazon Mechanical Turk, a validated crowd-sourcing tool, was used to identify and survey a group of 72 participants who indicated that they had undergone or were planning to undergo breast surgery. Likert items were analyzed using either chi-squared or Fisher\'s exact test. Results: Most respondents were cis-gendered-women (89%), Caucasian (83%), and between 31 and 41 years old (38%). Respondents agreed that BAPs are important to the consent process, for enabling patient-centered care, and should be presented in standardized sets. BAPs should be more accessible through different platforms, display multiple time points to show the healing process, and have multiple views including close-ups of scars. Photos should be unaltered except for de-identification, and have more diversity with regard to patient gender, age, skin color, and body mass index. These results align with results from our NGT study. Conclusion: Through this study we have identified many criteria that BAPs should meet according to prior and prospective breast surgery patients. Surgeons should think critically about how they present BAPs during the consent process to ensure effective patient-centered care.
    Introduction : En chirurgie mammaire, les photos avant-après (PAP) font partie des aspects importants du processus de consentement éclairé. À l’heure actuelle, le consensus sur le contenu et la présentation des PAP est limité. La présente étude visait à recueillir l’avis de patientes passées et prospectives sur le sujet. Méthodologie : Les chercheurs ont préparé un sondage reposant sur les critères qu’ils avaient établis lors de leur étude antérieure sur la technique du groupe nominal (TGN) pour obtenir les points de vue des patients sur les PAP en chirurgie mammaire. Ils ont utilisé l’outil de production participative validé MechanicalTurk d’Amazon pour repérer et sonder un groupe de 72 participants qui ont indiqué avoir subi ou planifié de subir une chirurgie mammaire. Ils ont analysé les énoncés de l’échelle de Likert au moyen du test du chi carré ou de la méthode exacte de Fisher. Résultats : La plupart des répondants étaient des femme cisgenres (89%), blanches (83%), âgées de 31 à 41 ans (38%). Ces répondants ont convenu que les PAP constituent un aspect important du processus de consentement, qu’elles favorisent des soins axés sur les patients et qu’elles doivent être présentées sous forme d’ensembles standardisés. Les PAP devraient être plus accessibles sur diverses plateformes, présenter divers moments du processus de guérison et de multiples points de vue, y compris des gros plans des cicatrices. Les photos devraient être inaltérées, à part pour la désidentification, et refléter une plus grande diversité de genres, d’âges, de couleurs de peau et d’indices de masse corporelle. Ces résultats concordent avec ceux de l’étude antérieure par la TGN. Conclusion : Grâce à la présente étude, les chercheurs ont relevé de nombreux critères que doivent respecter les PAP selon les patients passés et prospectifs en chirurgie mammaire. Les chirurgiens devraient recourir à la réflexion critique quant à la manière de présenter les PAP pendant le processus de consentement pour s’assurer de prodiguer des soins efficaces axés sur les patients.
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  • 文章类型: Journal Article
    小儿脊柱手术是一种高度复杂的手术,可能会带来从疼痛到神经损伤的风险,甚至死亡。这项全面的小型审查探讨了在小儿脊柱手术之前获得有效且有意义的知情同意书(IC)的当前最佳实践。包括支持有效理解和理解的方式。对文献进行了评估,以探索患者或其监护人对外科IC的理解以及多媒体工具作为可能的促进者的作用。在整个审查中讨论的证据,基于法律和伦理的观点,揭示了患者和监护人在实现理解和理解方面面临的挑战,尤其是面对紧张的医疗情况时。在这种情况下,多媒体工具的引入成为一种以患者为中心的策略,有助于提高理解力和减少术前不确定性.这篇综述强调了为儿科患者获得IC的量身定制方法的必要性,并提出了共享决策(SDM)在手术讨论过程中的潜在作用。
    Pediatric spine surgery is a high complexity procedure that can carry risks ranging from pain to neurological damage, and even death. This comprehensive mini review explores current best practice obtaining valid and meaningful informed consent (IC) prior to pediatric spinal surgery, including modalities that support effective comprehension and understanding. An evaluation of the literature was performed to explore understanding of surgical IC by patients or their guardians and the role of multimedia tools as a possible facilitator. The evidence discussed throughout this review, based on legal and ethical perspectives, reveals challenges faced by patients and guardians in achieving comprehension and understanding, especially when facing stressful medical situations. In this context, the introduction of multimedia tools emerges as a patient-centered strategy to help improve comprehension and decrease pre-operative uncertainty. This review highlights the need for a tailored approach in obtaining IC for pediatric patients and suggests a potential role of shared decision-making (SDM) in the surgical discussion process.
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  • 文章类型: Journal Article
    这项研究确定了澳大利亚人信任人类研究伦理委员会(HREC)批准使用基因组数据的情况-未经明确同意-并考虑了基因组数据共享设置的影响。和应答者属性,公众信任。调查结果(N=3013)显示,某些情况比其他情况更有利于公众信任,当未来的研究有益时,当隐私得到保护时,豁免得到认可,但在其他情况下获得的支持较少。尽管如此,结果表明,态度受到的影响超过这些具体情况,使用不同的数据共享设置,和参与者属性,影响观点。最终,这项研究提出了与澳大利亚授权放弃同意时使用HREC标准相关的问题和担忧.
    This research identifies the circumstances in which Human Research Ethics Committees (HRECs) are trusted by Australians to approve the use of genomic data - without express consent - and considers the impact of genomic data sharing settings, and respondent attributes, on public trust. Survey results (N = 3013) show some circumstances are more conducive to public trust than others, with waivers endorsed when future research is beneficial and when privacy is protected, but receiving less support in other instances. Still, results imply attitudes are influenced by more than these specific circumstances, with different data sharing settings, and participant attributes, affecting views. Ultimately, this research raises questions and concerns in relation to the criteria HRECs use when authorising waivers of consent in Australia.
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  • 文章类型: Journal Article
    背景:本研究旨在调查现代患者信息来源的整合,比如视频,基于互联网的资源,和科学摘要,在门诊择期手术中纳入传统的患者知情同意过程。目标是优化知情同意体验,提高患者满意度,并促进患者和外科医生之间的共同决策(SDM)。通过探讨不同的患者知情同意格式及其对患者满意度的影响,这项研究旨在改善医疗保健实践并最终提高患者治疗效果.这项研究的结果将有助于不断努力改善公立医院的知情同意程序并推进以患者为中心的护理。
    方法:数据收集发生在德国一家著名公立医院的日托诊所,形成前瞻性临床研究的组成部分。该研究专门针对接受过皮肤癌手术干预的个体。为了进行细致的数据检查,利用统计软件SPSS21版。在本研究过程中,适当地采用了卡方检验。其目的是仔细检查患者经验中与四个不同类别的知情同意有关的细微差别。viz.,口头知情同意讨论(口头ICD),书面知情同意讨论(书面ICD),视频辅助知情同意讨论(视频辅助ICD),和数字辅助知情同意书讨论(数字辅助ICD)。该调查的主要数据集是通过对160名患者的目标队列进行结构化问卷认真收集的。在这个样本中,观察到性别的平衡代表,包括82名男性和78名女性。他们的集体年龄跨度从18岁到92岁,平均年龄71岁。在2017年7月至2018年8月期间,采用随机选择方法将参与者纳入本研究。
    结果:在所有研究问题的组间观察到显著差异,突出患者反应的变化。视频辅助和数字辅助IC在患者对信息的满意度方面被评为优于书面和口头IC。发现四个研究组的人口统计学特征具有可比性。
    结论:这项研究的结果表明,在知情同意过程中结合数字技术可以在门诊选择性皮肤癌手术期间增强患者的理解。这些结果对于提高患者满意度和改善医院环境中的SDM流程具有重要意义。
    BACKGROUND: This study aims to investigate the integration of modern sources of patient information, such as videos, internet-based resources, and scientific abstracts, into the traditional patient informed consent process in outpatient elective surgeries. The goal is to optimize the informed consent experience, enhance patient satisfaction, and promote shared decision making (SDM) between patients and surgeons. By exploring different patient informed consent formats and their impact on patient satisfaction, this research seeks to improve healthcare practices and ultimately enhance patient outcomes. The findings of this study will contribute to the ongoing efforts to improve the informed consent process in public hospitals and advance patient-centred care.
    METHODS: Data collection occurred at the day care clinic of a prominent German public hospital, forming an integral component of a prospective clinical investigation. The study exclusively focused on individuals who had undergone surgical intervention for skin cancer. For the purpose of meticulous data examination, the statistical software SPSS version 21 was harnessed. In the course of this study, a chi-square test was aptly employed. Its purpose was to scrutinize the nuances in patient experiences pertaining to informed consent across four distinct categories, viz., oral informed consent discussion (Oral ICD), written informed consent discussion (Written ICD), video-assisted informed consent discussion (video-assisted ICD), and digitally assisted informed consent discussion (digital-assisted ICD). The primary dataset of this inquiry was diligently gathered via a structured questionnaire administered to a targeted cohort of 160 patients. Within this sample, a balanced representation of genders was observed, encompassing 82 males and 78 females. Their collective age span ranged from 18 to 92 years, with an average age of 71 years. A randomized selection methodology was employed to include participants in this study during the period spanning from July 2017 to August 2018.
    RESULTS: Significant differences were observed across the groups for all research questions, highlighting variations in patient responses. Video-assisted and digital-assisted IC were rated as superior in patient satisfaction with information compared to written and oral IC. Demographic profiles of the four study groups were found to be comparable.
    CONCLUSIONS: The findings of this study indicate that the incorporation of digital technologies in the informed consent process can enhance patient understanding during outpatient elective skin cancer surgeries. These results have important implications for increasing patient satisfaction and improving the SDM process within the hospital environment.
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  • 文章类型: Journal Article
    目的:我们尝试对三种不同的知情同意培训形式进行随机对照试验,以评估其有效性。我们招募了503名临床研究专业人员,他获得了50美元的参与。偶然发现显示,完成研究培训协议的依从性出乎意料地低,导致统计能力不足,无法检验我们最初的假设。在这份报告中,我们对数据进行了二次分析,对观察到的低依从性进行表征和评估.这涉及使用文献的平均阅读时间,速读时间,和视频播放速度来计算完成三种训练格式所需的时间帧。
    结果:只有13%的参与者在合理的时间内完成了培训。此外,只有46%的参与者在尽可能短的时间内完成了培训.这些发现让我们质疑在线研究培训是否有效,因为如果参与者没有实际完成培训,任何培训都不会有效。鉴于临床研究专业人员对教育培训的广泛要求,我们认为举证责任在于培训计划,以证明它们具有积极作用。
    OBJECTIVE: We attempted to conduct a randomized controlled trial of three different informed consent training formats to evaluate their effectiveness. We recruited 503 clinical research professionals, who received $50 for participation. Incidental findings showed unexpectedly low rates of compliance with completing the study training protocols, resulting in insufficient statistical power to test our original hypotheses. In this report, we conducted a secondary analysis of the data in which we characterize and evaluate the observed low compliance. This involved using literature on average reading times, speed-reading times, and video play speeds to calculate the timeframes required to complete the three training formats.
    RESULTS: Only 13% of participants completed the training in a reasonable timeframe. Furthermore, only 46% of participants completed the training in the minimum possible timeframe. These findings lead us to ask whether online research training is effective, since no training can be effective if participants do not actually complete the training. Given extensive requirements for educational training among clinical research professionals, we feel the burden of proof is on training programs to demonstrate that they have positive effects.
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  • 文章类型: Journal Article
    本文讨论了在FACILITATE项目的背景下将临床试验数据返回给患者的重要性,该项目旨在开发一种以参与者为中心的方法来系统地返回个体临床试验数据。它反映了需要一个伦理框架来支持临床试验数据的返回。讨论围绕着发展中的便利伦理框架,特别关注构成框架基础的道德原则,以及如何将这些原则付诸实践的指导。
    This paper discusses the importance of return of clinical trial data to patients in the context of the FACILITATE project that aims to develop a participant-centric approach for the systematic return of individual clinical trial data. It reflects on the need for an ethical framework to support the return of clinical trial data. The discussion revolves around the developing FACILITATE ethical framework, specifically focusing on the ethical principles that form the foundation of the framework and guidance on how to implement those principles into practice.
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