BACKGROUND: In the years to come, artificial intelligence will become an indispensable tool in medical practice. The digital transformation will undoubtedly affect today\'s medical students. This study focuses on trust from the perspective of three groups of medical students - students from Croatia, students from Slovakia, and international students studying in Slovakia.
METHODS: A paper-pen survey was conducted using a non-probabilistic convenience sample. In the second half of 2022, 1715 students were surveyed at five faculties in Croatia and three in Slovakia.
RESULTS: Specifically, 38.2% of students indicated familiarity with the concept of AI, while 44.8% believed they would use AI in the future. Patient readiness for the implementation of technologies was mostly assessed as being low. More than half of the students, 59.1%, believe that the implementation of digital technology (AI) will negatively impact the patient-physician relationship and 51,3% of students believe that patients will trust physicians less. The least agreement with the statement was observed among international students, while a higher agreement was expressed by Slovak and Croatian students 40.9% of Croatian students believe that users do not trust the healthcare system, 56.9% of Slovak students agree with this view, while only 17.3% of international students share this opinion. The ability to explain to patients how AI works if they were asked was statistically significantly different for the different student groups, international students expressed the lowest agreement, while the Slovak and Croatian students showed a higher agreement.
CONCLUSIONS: This study provides insight into medical students\' attitudes from Croatia, Slovakia, and international students regarding the role of artificial intelligence (AI) in the future healthcare system, with a particular emphasis on the concept of trust. A notable difference was observed between the three groups of students, with international students differing from their Croatian and Slovak colleagues. This study also highlights the importance of integrating AI topics into the medical curriculum, taking into account national social & cultural specificities that could negatively impact AI implementation if not carefully addressed.

Robotics and artificial intelligence have marked the beginning of a new era in the care and integration of people with disabilities, helping to promote their independence, autonomy and social participation. In this area, bioethical reflection assumes a key role at anthropological, ethical, legal and socio-political levels. However, there is currently a substantial diversity of opinions and ethical arguments, as well as a lack of consensus on the use of assistive robots, while the focus remains predominantly on the usability of products. The article presents a bioethical analysis that highlights the risk arising from using embodied artificial intelligence according to a functionalist model. Failure to recognize disability as the result of a complex interplay between health, personal and situational factors could result in potential damage to the intrinsic dignity of the person and human relations with healthcare workers. Furthermore, the danger of discrimination in accessing these new technologies is highlighted, emphasizing the need for an ethical approach that considers the social and moral implications of implementing embodied AI in the field of rehabilitation.

BACKGROUND: Poor communication about serious injury in older adults can lead to treatment that is inconsistent with patient preferences, create conflict and strain healthcare resources. We developed a communication intervention called Best Case/Worst Case-intensive care unit (ICU) that uses daily scenario planning, that is, a narrative description of plausible futures, to support prognostication and facilitate dialogue among patients, their families and the trauma ICU team. This article describes a protocol for a multisite, randomised, stepped-wedge study to test the effectiveness of the intervention on the quality of communication (QOC) in the ICU.
METHODS: We will follow all patients aged 50 and older admitted to the trauma ICU for 3 or more days after a serious injury at eight high-volume level 1 trauma centres. We aim to survey one family or \'like family\' member per eligible patient 5-7 days following their loved ones\' admission and clinicians providing care in the trauma ICU. Using a stepped-wedge design, we will use permuted block randomisation to assign the timing for each site to begin implementation of the intervention and routine use of the Best Case/Worst Case-ICU tool. We will use a linear mixed-effects model to test the effect of the tool on family-reported QOC (using the QOC scale) as compared with usual care. Secondary outcomes include the effect of the tool on reducing clinician moral distress (using the Measure of Moral Distress for Healthcare Professionals scale) and patients\' length of stay in the ICU.
BACKGROUND: Institutional review board (IRB) approval was granted at the University of Wisconsin, and all study sites ceded review to the primary IRB. We plan to report results in peer-reviewed publications and national meetings.
BACKGROUND: NCT05780918.

BACKGROUND: Informed decisions to enrol in the clinical investigations of Alzheimer\'s disease and related dementias (ADRD) require careful consideration of complex risks and uncertain benefits. Decisions regarding whether to receive information about biomarker status are complicated by lack of scientific consensus regarding biomarkers as surrogate endpoints for Alzheimer\'s disease and how information about individual risk should be evaluated and shared with research participants. This study aims to establish stakeholder consensus regarding ethically optimal approaches to sharing individual results with ADRD research participants.
METHODS: This Delphi consensus-building study consists of multiple online surveys conducted with Alzheimer\'s disease research experts, including neurologists, neuropsychologists, ethicists, research oversight specialists and clinical trialists. Panellists will be administered questionnaires developed from a synthesis of researcher- and participant-endorsed considerations and decisional needs identified in published literature and a decisional needs assessment conducted with support from an Alzheimer\'s Association Research Grant. Panellists will also be asked their views on the content and implementation of processes for sharing individual research results. ≥75% agreement will be required to achieve consensus. Response rates, level of agreement, medians, interquartile ranges and group rankings will be analysed. Following each round of data collection, our research team will undertake qualitative content analysis of open-ended responses.
BACKGROUND: Ethical approval will be obtained from the Cleveland Clinic Institutional Review Board (Study Number 22-766). Delphi panellists will receive participant information sheets describing the study before agreeing to participate in the Delphi process. Results from the data we anticipate will be generated through this research and will be submitted for peer-reviewed journal publication and presentation at international conferences.

BACKGROUND: Medical informed consent stands as an ethical and legal requisite preceding any medical intervention. Hospitalized patients face functional health literacy (FHL) challenges when dealing with informed consent forms (ICFs). The legitimacy of ICFs and informed consent procedures in China remains substantially undisclosed. The study\'s aim was to investigate if Chinese patients have adequate FHL to be truly informed before providing medical consent.
METHODS: In this cross-sectional, structured interview-based study, FHL was assessed within the context of the informed consent scenarios in two teaching hospitals (a 1500-bed general tertiary hospital and a 700-bed cancer hospital) affiliated with Shantou University Medical College. Twenty-seven patients admitted across clinical departments, along with their relatives (n = 59), were enrolled in the study after obtaining informed consent. The participants underwent a three-step assessment with two selected ICFs -teach-back skills, perceived understanding (perception), and informed knowledge (cognizance), with each component carrying a maximum score of 10. Data were analyzed with SPSS (version 22.0) for descriptive and inferential statistics, with consideration of significant P values as < 0.05.
RESULTS: The median age (IQR and range) of participants was 35.5 (28 - 49 and 13 - 74) years. Most participants had only high school education (24.4%, 21/86) or below high school education (47.7%, 41/86). The median score (IQR) of FHL assessments-teach-back, perception, and cognizance-was 4.0 (2.5, 5.8), 8.0 (6.8, 8.8), and 6.5 (5.5, 8.0) out of 10, respectively. A moderate correlation was observed between the scores of cognizance and teach-back (r = 0.359, P = 0.002) or perception (r = 0.437, P < 0.001). Multivariate linear regression analysis predicted being a patient and having lower education levels as independent risk factors of inadequate FHL (Ps = 0.001). Lack of patient-centeredness in ICFs, time constraints, and poor clinical communication were identified as barriers impeding informed consent.
CONCLUSIONS: This study demonstrates inadequacy in personal FHL and impaired organizational HL, resulting in compromised informed consent in Chinese teaching hospitals. As a remedy, we propose improving the quality of ICFs and institutionally mandated outcome-focused training on informed consent for all concerned clinicians to enhance medical ethics, ensure quality health care, address patient values, and mitigate potential medical conflicts.

OBJECTIVE: To assess the level of bioethics awareness among healthcare professionals in Pakistan, focusing on the associations with sociodemographic characteristics, training and teaching of ethics, medical ethics practice and specific ethical issues.
METHODS: Cross-sectional study.
METHODS: Public and private hospitals in Haripur, Pakistan.
METHODS: A total of 647 healthcare professionals participated in this study.
METHODS: This study was conducted between March and May 2023, following Strengthening the Reporting of Observational Studies in Epidemiology checklist criterion, involving healthcare professionals with at least 6 months of experience in patient care practice. Providers under close supervision are advised not to respond to the bioethics knowledge, attitudes and practices survey form due to potential ethical dilemmas.
RESULTS: Both physicians and non-physicians need to know more about bioethics. There was a significant difference (p<0.05) in ethical training and teaching based on job categories/designations, with ethical views differing greatly by job designation. Specific ethical issues, such as accepting gifts from patients and pharmaceutical companies, referral fees, advising specific products, disclosure of medical errors, patient confidentiality, not informing patients fully about treatment and performing tasks for financial gain, showed significant associations (p<0.05) with healthcare professional\'s designation. Ethical awareness scores also showed significant differences (p<0.05) based on age, ethnicity, place of posting, professional experience and the organisation\'s ethical guidelines.
CONCLUSIONS: This study highlighted a notable gap in the understanding of certain ethical concerns among healthcare professionals, with nurses showing relatively lower awareness of healthcare practice compared with other professionals. Addressing these issues through targeted training and robust ethical guidelines is critical to improving patient care in Pakistan\'s healthcare system.

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OBJECTIVE: As part of the FERN feasibility study, this qualitative research aimed to explore parents\' and clinicians\' views on the acceptability, feasibility and design of a randomised controlled trial (RCT) of active intervention versus expectant management in monochorionic (MC) diamniotic twin pregnancies with early-onset (prior to 24 weeks) selective fetal growth restriction (sFGR). Interventions could include laser treatment or selective termination which could lead to the death or serious disability of one or both twins.
METHODS: Qualitative semi-structured interviews with parents and clinicians. Data were analysed using reflexive thematic analysis and considered against the Principles of Biomedical Ethics.
METHODS: We interviewed 19 UK parents experiencing (six mothers, two partners) or had recently experienced (eight mothers, three partners) early-onset sFGR in MC twin pregnancy and 14 specialist clinicians from the UK and Europe.
RESULTS: Participants viewed the proposed RCT as \'ethically murky\' because they believed that the management of sFGR in MC twin pregnancy should be individualised according to the type and severity of sFGR. Clinicians prioritised the gestational age, size, decrease in growth velocity, access to the placental vessels and acceptability of intervention for parents. Discussions and decision-making about selective termination appeared to cause long-term harm (maleficence). The most important outcome for parents and clinicians was \'live birth\'. For clinicians, this was the live birth of at least one twin. For parents, this meant the live birth of both twins, even if this meant that their babies had neurodevelopmental impairment or disabilities.
CONCLUSIONS: All three pregnancy management approaches for sFGR in MC twin pregnancy carry risks and benefits, and the ultimate goal for parents is to receive individualised care to achieve the best possible outcome for both twins. An RCT was not acceptable to parents or clinicians or seen as ethically appropriate. Alternative study designs should be considered to answer this important research question.

OBJECTIVE: To evaluate the extent and trends of personal payments from pharmaceutical companies to cardiologists board-certified by the Japanese Circulation Society.
METHODS: A retrospective analysis study using data from a publicly available database.
METHODS: The study focused on payments to cardiologists in Japan.
METHODS: All 15 048 cardiologists who were board-certified by the Japanese Circulation Society as of 2021.
METHODS: The primary outcome was the extent of personal payments to cardiologists in 2016-19. Secondary outcomes included the analysis of trends in these payments over the same period.
RESULTS: Of all 15 048 board-certified cardiologists, 9858 (65.5%) received personal payments totaling $112 934 503 entailing 165 013 transactions in 2016-19. The median payment per cardiologist was $2947 (IQR, $1022-$8787), with a mean of $11 456 (SD, $35 876). The Gini Index was 0.840, indicating a high concentration of payments to a small number of cardiologists. The top 1%, 5% and 10% of cardiologists received 31.6%, 59.4% and 73.5% of all payments, respectively. There were no significant trends in the number of cardiologists receiving payments or number of payments per cardiologist during the study period.
CONCLUSIONS: More than 65% of Japanese cardiologists received personal payments from pharmaceutical companies over the 4-year study period. Although the payment amount was relatively small for the majority of cardiologists, a small number of cardiologists received the vast majority of the payments.

BACKGROUND: As Artificial Intelligence (AI) becomes pervasive in healthcare, including applications like robotic surgery and image analysis, the World Medical Association emphasises integrating AI education into medical curricula. This study evaluates medical students\' perceptions of \'AI in medicine\', their preferences for AI training in education, and their grasp of AI\'s ethical implications in healthcare.
METHODS: A cross-sectional study was conducted among 325 medical students in Kerala using a pre-validated, semi structured questionnaire. The survey collected demographic data, any past educational experience about AI, participants\' self-evaluation of their knowledge and evaluated self-perceived understanding of applications of AI in medicine. Participants responded to twelve Likert-scale questions targeting perceptions and ethical aspects and their opinions on suggested topics on AI to be included in their curriculum.
CONCLUSIONS: AI was viewed as an assistive technology for reducing medical errors by 57.2% students and 54.2% believed AI could enhance medical decision accuracy. About 49% agreed that AI could potentially improve accessibility to healthcare. Concerns about AI replacing physicians were reported by 37.6% and 69.2% feared a reduction in the humanistic aspect of medicine. Students were worried about challenges to trust (52.9%), patient-physician relationships (54.5%) and breach of professional confidentiality (53.5%). Only 3.7% felttotally competent in informing patients about features and risks associated with AI applications. Strong demand for structured AI training was expressed, particularly on reducing medical errors (76.9%) and ethical issues (79.4%).
CONCLUSIONS: This study highlights medical students\' demand for structured AI training in undergraduate curricula, emphasising its importance in addressing evolving healthcare needs and ethical considerations. Despite widespread ethical concerns, the majority perceive AI as an assistive technology in healthcare. These findings provide valuable insights for curriculum development and defining learning outcomes in AI education for medical students.