consent

同意
  • 文章类型: Journal Article
    关于医疗纠纷诉讼,律师和保险公司关注知情同意文件。不幸的是,对于注射富血小板血浆(PRP)没有获得知情同意的标准方案.本研究的目的是创建一个预先设计的,专门用于PRP注射的循证知情同意书。获得了有关PRP注射的医学法律影响的当前证据,以及PRP注射中的一般知情同意和特别知情同意。此外,我们采用半结构化方法采访了骨科医师和过去1年接受PRP注射的患者.PRP注射的合法有效且基于证据的知情同意书可确保权利,鼓励患者和外科医生之间的公开沟通和透明度。此外,如果发生了诉讼,知情同意书将是外科医生辩护中的重要文件,可以承受律师和司法机构的审查。法律专家制定并审查了基于证据的PRP注射知情同意书,以确保遵守法律规定。PRP注射知情同意书的最终形式在我们的机构进行了一年的管理和验证。
    Regarding medico-legal malpractice suits, lawyers and insurers focus on informed consent documentation. Unfortunately, there is no standard protocol for obtaining informed consent for platelet-rich plasma (PRP) injections. The objective of the present study was to create a pre-designed, evidence-based informed consent form specifically for PRP injections. The current evidence on the medico-legal implications of PRP injections was accessed, as well as informed consent in general and specifically informed consent in PRP injections. Additionally, we interviewed orthopaedic surgeons and patients who had undergone PRP injections in the past year using a semi-structured approach. A legally valid and evidence-based informed consent form for PRP injections ensures rights, encouraging open communication and transparency between the patient and surgeon. Moreover, if a lawsuit arose, informed consent would be a critical document in surgeons\' defence and would withstand scrutiny from lawyers and the judiciary. An evidence-based informed consent form for PRP injections was elaborated and reviewed by a legal expert to ensure adherence to legal proprieties. The final form of the informed consent for PRP injection was administered for one year and validated at our institution.
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  • 文章类型: Journal Article
    在儿科肿瘤学中,出于许多原因,在整个护理途径中提出了遗传和基因组测试(例如,癌症表征,确定最合适的治疗方法,临床试验的患者选择,组织/器官捐献者的鉴定,或复发预测风险)。尽管有许多不同的方法(体细胞或种系测试,靶向基因或基因组测序),受牵连的个人面临着可能相交的情况,并且比较起来很有趣。没有研究确定和分析这些儿科肿瘤学新实践的可用工作。这篇叙述性文献综述的目的是描述癌症儿童的伦理和心理观点,父母,当基因或基因组检测被提议作为癌症管理的一部分时,医疗保健专业人员。18篇文章符合纳入标准,并使用MAXQDA进行了全面编码。他们的分析表明,关于遗传和基因组测试的主观含义,矛盾的领域(治疗的愿望,对知识的渴望,不确定性,患者及其父母报告的罪恶感)似乎反映了医疗保健专业人员的担忧。关于易感性测试的伦理和心理问题,在遗传性视网膜母细胞瘤和Li-Fraumeni综合征的背景下长期讨论,为更广泛地讨论儿科肿瘤学中的遗传和基因组检测途径提供了一个有用的起点.
    In pediatric oncology, genetic and genomic tests are proposed throughout the care pathway for many reasons (e.g., cancer characterization, identification of the most appropriate treatment, patient selection for clinical trials, identification of tissue/organ donors, or risk of relapse prediction). Despite the many different approaches (somatic or germline testing, targeted gene or genome sequencing), the implicated individuals are confronted with situations that may intersect and that are interesting to compare. No study has identified and analyzed the available works on these new practices in pediatric oncology. The aim of this narrative literature review was to describe the ethical and psychological perspectives of children with cancer, parents, and healthcare professionals when genetic or genomic testing is proposed as part of the cancer management. Eighteen articles met the inclusion criteria and were comprehensively coded using MAXQDA. Their analysis showed that concerning the subjective implications of genetic and genomic testing, the areas of ambivalence (desire of treatment, desire for knowledge, uncertainty, and guilt) reported by patients and their parents seem to mirror the healthcare professionals\' concerns. The ethical and psychological issues about predisposition testing, long discussed in the context of hereditary retinoblastoma and Li-Fraumeni syndrome, represent a useful starting point for a wider discussion of a genetic and genomic testing pathway in pediatric oncology more broadly.
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  • 文章类型: Journal Article
    道德的4个基本原则(慈善,非恶意,自主性,和正义)可以指导妊娠患者在分娩和分娩期间的临床决策,以及接受非产科手术时。与患者进行基于证据的决策对话有助于获得知情同意。当母胎冲突发生时,在分娩和非产科手术期间,应考虑对双方的基于利益的义务,讨论和决定有据可查。劳动不是妇女提供护理同意的障碍。在处理剖宫产时,有必要在循证临床判断和患者自主性之间取得仔细的平衡。
    The 4 basic principles of ethics (beneficence, nonmaleficence, autonomy, and justice) can guide clinical decision-making for the pregnant patient during labor and delivery, as well as when undergoing nonobstetric surgery. An evidence-based decision-making conversation with the patient facilitates obtaining informed consent. When maternal-fetal conflict arises, both during labor and delivery and nonobstetric surgery, beneficence-based obligations to both parties should be considered, with discussions and decisions well documented. Labor is not an impediment to women providing consent for care. A careful balance between evidence-based clinical judgment and patient autonomy is necessary when addressing cesarean delivery.
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  • 文章类型: Journal Article
    背景技术手外科医师被指控使用多种方式来增强蒙哥马利裁决之后的同意过程。人工智能语言模型已被建议作为可能有助于同意的患者教育工具。方法我们将用于腕管释放的每个知情决策在线(EIDO)患者信息传单的质量和可读性与人工智能语言模型ChatGenerativePretrainedTransformer(GPT)进行了比较。结果使用DISCERN评分,ChatGPT的信息质量明显更高,ChatGPT为71/80,EIDO为62/80(p=0.014)。使用kappa统计量,DISCERN评分者间观察者的可靠性很高(0.65)。Flesch-Kincaid对ChatGPT的可读性评分为12.3,对EIDO的可读性评分为7.5,这表明ChatGPT信息的阅读年龄更为复杂。结论与EIDO信息传单相比,人工智能语言模型ChatGPT以可读性为代价产生了高质量的信息,用于腕管释放同意。
    Background Hand surgeons have been charged with the use of diverse modalities to enhance the consenting process following the Montgomery ruling. Artificial Intelligence language models have been suggested as patient education tools that may aid consent. Methods We compared the quality and readability of the Every Informed Decision Online (EIDO) patient information leaflet for carpal tunnel release with the artificial intelligence language model Chat Generative Pretrained Transformer (GPT). Results The quality of information by ChatGPT was significantly higher using the DISCERN score, 71/80 for ChatGPT compared to 62/80 for EIDO (p=0.014). DISCERN interrater observer reliability was high (0.65) using the kappa statistic. Flesch-Kincaid readability scoring was 12.3 for ChatGPT and 7.5 for EIDO, suggesting a more complex reading age for the ChatGPT information. Conclusion The artificial intelligence language model ChatGPT produces high-quality information at the expense of readability when compared to EIDO information leaflets for carpal tunnel release consent.
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  • 文章类型: Journal Article
    基于社区的姑息治疗(CBPC)临床医生在第一次遇到患者时,有时会遇到道德上收费的情况:患者的配偶,或其他亲人或照顾者,撤销患者的有效知情同意书以启动护理。虽然代理人通常是出于保护本能,在其他情况下,代理人出于自身利益行事。本文考虑了成年人撤销另一名成年人的有效知情同意以启动姑息治疗服务是否在道德上合理。本文从三个角度考察了这种情况:患者给予或放弃知情同意的能力,代理人对替代判断或最佳利益的意图和使用,以及临床医生提供临床护理的责任。这种伦理分析认为,即使代孕者充当干扰或反对力量,CBPC临床医生也有道德责任为已获得有效知情同意的患者提供姑息治疗服务。
    Community-based palliative care (CBPC) clinicians sometimes contend with an ethically charged scenario when they encounter patients for the first time: The patient\'s spouse, or other loved one or caregiver, revokes the patient\'s valid informed consent to initiate care. While surrogates are usually motivated by protective instincts, there are other situations where surrogates act out of self-interest. This article considers whether it is ever ethically justified for an adult to revoke another adult\'s valid informed consent to initiate palliative care services. The article examines this scenario from three perspectives: the patient\'s capacity to give or relinquish informed consent, the surrogate\'s intent and use of substituted judgment or best interest, and the clinician\'s duty to provide clinical care. This ethical analysis argues that CBPC clinicians have an ethical responsibility to provide palliative care services for patients who have given valid informed consent for those services even when a surrogate acts as an interfering or oppositional force.
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  • 文章类型: Journal Article
    大学生中涉及物质的强奸正在增加,特别是女性(Koss等人。,2022年)。解决强奸问题需要首先在调查中准确衡量它,以了解它的真实范围和性质。我们对40名年轻人进行了认知访谈,通过要求参与者对该结构的不同操作进行评论,对性经历调查中涉及酒精和其他药物(AOD)的强奸项目的结构效度进行了定性测试。我们的发现表明,不同的措辞引起了参与者对项目的不同解释。具体来说,结果表明,(1)受访者认为不同的操作是一系列严重程度不同的事件;(2)一些参与者关注的是犯罪者的意图和责任,而不是机会主义的行为;(3)研究参与者一致选择其中一种操作描述为"被引导"(未经同意即被吸毒).与会者还提供了问卷中未描述的其他情况,并分享了他们对项目的解释。结果强调了完善调查语言以正确衡量涉及AOD的强奸的重要性,并使我们能够了解如何量身定制适当的问题以获得最佳理解。研究结果表明,将涉及AOD的强奸的几个项目包括在诸如性经历调查之类的问卷中,每个项目都解决了受害者中毒的不同情况。结果也可能对性暴力预防计划产生重要影响,应该讨论同意,意图,和责任,特别是在AOD消费的背景下。
    Substance-involved rape is increasing among college students, particularly women (Koss et al., 2022). Addressing rape requires first measuring it accurately in surveys to understand its true scope and nature. We used cognitive interviews with 40 young adults to qualitatively test the construct validity of an alcohol- and other drugs (AOD)-involved rape item in the Sexual Experiences Survey by asking participants to comment on different operationalizations of this construct. Our findings revealed that different phrasings elicited different interpretations of the items by participants. Specifically, the results indicated that (1) respondents viewed the different operationalizations as a sequence of events with varying severity; (2) some participants focused on the intentionality and responsibility of the perpetrator as opposed to opportunistic perpetration; and (3) study participants consistently chose one of the operationalizations as describing \"being roofied\" (being drugged without consent). Participants also contributed additional scenarios not described in the questionnaire and shared their interpretations of the items. The results underscore the importance of refining survey language to properly measure AOD-involved rape and allow us to understand how to tailor appropriate questions for best comprehension. The findings indicate the benefit in including several items about AOD-involved rape in questionnaires such as the Sexual Experiences Survey, with each item addressing different scenarios of victim intoxication. The results could also have important implications for sexual violence prevention programs, which should discuss consent, intentions, and responsibility specifically in the context of AOD consumption.
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  • 文章类型: Journal Article
    护士在实践中经常面临道德问题和伦理困境,例如,病人对治疗的决定与护士自己的观点相冲突。虽然护理和助产委员会的标准:护士的专业实践和行为标准,助产士和护理协会为护士提供指导实践的总体框架,重要的是,护士了解支撑伦理护理的四个主要原则-自主性,仁慈,非恶意和正义。本文探讨了这四个原则以及它们与护士道德决策的关系。作者还探讨了2019年冠状病毒病(COVID-19)大流行是如何测试护士职业道德的。具有道德决策意识可以通过为护士提供有尊严和尊重的治疗患者的理论框架来增强护士的实践。
    Nurses are regularly confronted with moral questions and ethical dilemmas in their practice, for example where a patient\'s decisions about their treatment conflict with the nurse\'s own views. While the standards contained in the Nursing and Midwifery Council The Code: Professional Standards of Practice and Behaviour for Nurses, Midwives and Nursing Associates provide nurses with an overarching framework to guide practice, it is important that nurses understand the four main principles that underpin ethical care - autonomy, beneficence, non-maleficence and justice. This article examines these four principles and how they relate to nurses\' ethical decision-making. The author also explores how nurses\' ethics were tested by the coronavirus disease 2019 (COVID-19) pandemic. Having an awareness of ethical decision-making can enhance nurses\' practice by providing them with a theoretical framework for treating patients with dignity and respect.
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  • 文章类型: Journal Article
    英格兰在2020年转向了选择退出同意制度,旨在增加可用器官的数量。西班牙也实行退出制度,但与英格兰相比,每百万人口的器官捐赠几乎是英格兰的两倍。我们旨在确定同意政策的差异和相似之处,两国死者捐赠的文件和程序采用比较定性的内容和语篇分析。西班牙更简单,本地定制的文件,家庭审查和处理信息的时间可能会更短,在西班牙有更多的途径导致器官捐献,以及对个人在生活中做出的决定提供更强有力的法律保护。西班牙文件中的语言是支持和保证之一。相比之下,英国的文件显得令人困惑,因为增加的目的是保护NHS免受风险,并对以前的文件版本进行修改,以反映法律的变化,而不是完全重铸。如果英格兰的目标是达到类似西班牙的同意率,那么这项分析就突出了可以加强英国系统的机会——通过给予个人在器官捐献者登记簿上记录的决定合法权重,同时统一和简化同意政策和程序,以支持家庭和医疗保健专业人员。
    England switched to an opt-out system of consent in 2020 aiming to increase the number of organs available. Spain also operates an opt-out system yet has almost twice the organ donations per million population compared with England. We aimed to identify both differences and similarities in the consent policies, documents and procedures in deceased donation between the two countries using comparative qualitative content and discourse analysis. Spain had simpler, locally tailored documents, the time taken for families to review and process information may be shorter, there were more pathways leading to organ donation in Spain, and more robust legal protections for the decisions individuals made in life. The language in the Spanish documents was one of support and reassurance. Documents in England by comparison appeared confusing, since additions were designed to protect the NHS against risk and made to previous document versions to reflect the law change rather than being entirely recast. If England\'s ambition is to achieve consent rates similar to Spain this analysis has highlighted opportunities that could strengthen the English system-by giving individuals\' decisions recorded on the organ donor register legal weight, alongside unifying and simplifying consent policies and procedures to support families and healthcare professionals.
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  • 文章类型: Journal Article
    数字表型,或个人感应,是一个研究领域,旨在量化使用数字技术的人的特征和特征,通常用于医疗保健目的。在这篇评论中,我们讨论了有关使用社交媒体作为用于数字表型的人工智能(AI)模型的训练数据的新兴道德问题。特别是,我们描述了社交媒体用户明确同意的道德需求,特别是在敏感信息,如与神经多样性相关的标签被刮擦的情况下。我们还倡导在使用社交媒体数据开发医疗保健AI模型时使用基于社区的参与式设计原则。
    Digital phenotyping, or personal sensing, is a field of research that seeks to quantify traits and characteristics of people using digital technologies, usually for health care purposes. In this commentary, we discuss emerging ethical issues regarding the use of social media as training data for artificial intelligence (AI) models used for digital phenotyping. In particular, we describe the ethical need for explicit consent from social media users, particularly in cases where sensitive information such as labels related to neurodiversity are scraped. We also advocate for the use of community-based participatory design principles when developing health care AI models using social media data.
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  • 文章类型: Journal Article
    目的:已知充分的术前信息可以改善患者的预后。我们旨在评估接受肠造口形成的儿科患者和家庭的围手术期教育。
    方法:邀请英国儿科手术中心招募年龄在6-16岁的造口原位或在过去2年内逆转的患者。为潜在参与者发布了患者和父母问卷。
    结果:83名患者/父母二分体返回了问卷。中位年龄为11.5岁(范围4.1-17.8),其中48%(n=40)是选择性形成的。父母对他们围手术期的了解程度进行了评分(0较差,10高度知情)。与心理和社会影响相比,父母对手术问题和造口护理的了解更好(7.45vs6.11;p<0.0001)。54%的人报告了手术并发症,但与心理社会问题相比,将造口列为最糟糕的事情(24.4%)的患者要少得多:袋泄漏引起的困扰(90.8%;p<0.0001),自我意识(54.1%;p=0.0001),活动受限(40.2%;p=0.03)。
    结论:父母对医学和实践方面了解得很好,但对造口的心理和生活方式影响了解得较少。手术并发症对患者的影响不如对日常生活的影响重要。社会心理信息的增加将使家庭为有气孔的生活做好更好的准备。
    OBJECTIVE: Adequate preoperative information is known to improve patient outcomes. We aimed to evaluate perioperative education for paediatric patients and families undergoing intestinal stoma formation.
    METHODS: UK paediatric surgery centres were invited to recruit patients aged 6-16 years with a stoma in situ or reversed within the last 2 years. Patient and parent questionnaires were posted for potential participants.
    RESULTS: Eighty-three patient/parent dyads returned questionnaires. Median age was 11.5 years (range 4.1-17.8), with 48% (n = 40) formed electively. Parents rated how well-informed they felt perioperatively out of 10 (0 poorly, 10 highly informed). Parents were better informed about surgical issues and stoma care than psychological and social impacts (7.45 vs 6.11; p < 0.0001). 54% reported surgical complications but significantly fewer patients listed these amongst the worst things about having a stoma (24.4%) when compared with psychosocial issues: distress from bag leaks (90.8%; p < 0.0001), self-consciousness (54.1%; p = 0.0001), and restricted activity (40.2%; p = 0.03).
    CONCLUSIONS: Parents felt well-informed for medical and practical aspects but less well-informed of psychological and lifestyle impacts of having a stoma. Surgical complications were less important to patients than the impact on daily life. Increased psychosocial information would enable families to be better prepared for life with a stoma.
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