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Vong G. On the Differing Role of Counterexamples in Philosophical Theory and Health Policy. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:114-117. [PMID: 38913467 DOI: 10.1080/15265161.2024.2353835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
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Araujo LG, Shaw M, Hernández E. The Structure of Clinical Ethical Decision-Making: A Hospital System Needs Assessment. HEC Forum 2024:10.1007/s10730-024-09534-5. [PMID: 38850508 DOI: 10.1007/s10730-024-09534-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2024] [Indexed: 06/10/2024]
Abstract
Bioethical dilemmas can emerge in research and clinical settings, from end-of-life decision-making to experimental therapies. The COVID-19 pandemic raised serious ethical challenges for healthcare organizations, highlighting the need to conduct needs assessments of the bioethics infrastructures of healthcare organizations. Clinical ethics committees (CECs) also create equitable policies, train staff on ethics issues, and play a consultative role in resolving the difficulty of complex individual cases. The main objective of this project was to conduct a needs assessment of the bioethics infrastructure within a comprehensive hospital system. A cross-sectional anonymous online survey, including quantitative and qualitative formatted questions. The survey was sent to five key leaders from the organization's hospitals. Survey questions focused on the composition, structure, function, and effectiveness of their facilities' bioethics infrastructure and ethics-related training and resources. Positive findings included that most facilities have active CECs with multidisciplinary membership; CECs address critical issues and encourage team members to express clinical ethics concerns. Areas of concern included uncertainty about how CECs function and the process for resolving clinical ethics dilemmas. Most reported no formal orientation process for CEC members, and many said there was no ongoing ethics education process. The authors conclude that if CECs are a critical institutional resource where the practice of medicine and mission intersect, having well-functioning ethics committees with trained and oriented members demonstrates an essential commitment to the mission. The survey revealed that more needs to be done to bolster the bioethics infrastructure of this institution.
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Affiliation(s)
- Leana G Araujo
- Administration Department, AdventHealth University, Orlando, FL, USA
| | - Martin Shaw
- Center for Ministry Education and Research, AdventHealth University, Orlando, FL, USA.
| | - Edwin Hernández
- Administration Department, AdventHealth University, Orlando, FL, USA
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Levy AM, Grigorovich A, McMurray J, Quirt H, Ranft K, Engell K, Stewart S, Astell A, Kokorelias K, Schon D, Rogrigues K, Tsokas M, Flint AJ, Iaboni A. Implementation of the Dementia Isolation Toolkit in long-term care improves awareness but does not reduce moral distress amongst healthcare providers. BMC Health Serv Res 2024; 24:481. [PMID: 38637814 PMCID: PMC11027277 DOI: 10.1186/s12913-024-10912-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/27/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Healthcare providers may experience moral distress when they are unable to take the ethically or morally appropriate action due to real or perceived constraints in delivering care, and this psychological stressor can negatively impact their mental health, leading to burnout and compassion fatigue. This study describes healthcare providers experiences of moral distress working in long-term care settings during the COVID-19 pandemic and measures self-reported levels of moral distress pre- and post-implementation of the Dementia Isolation Toolkit (DIT), a person-centred care intervention designed for use by healthcare providers to alleviate moral distress. METHODS Subjective levels of moral distress amongst providers (e.g., managerial, administrative, and front-line employees) working in three long-term care homes was measured pre- and post-implementation of the DIT using the Moral Distress in Dementia Care Survey and semi-structured interviews. Interviews explored participants' experiences of moral distress in the workplace and the perceived impact of the intervention on moral distress. RESULTS A total of 23 providers between the three long-term care homes participated. Following implementation of the DIT, subjective levels of moral distress measured by the survey did not change. When interviewed, participants reported frequent experiences of moral distress from implementing public health directives, staff shortages, and professional burnout that remained unchanged following implementation. However, in the post-implementation interviews, participants who used the DIT reported improved self-awareness of moral distress and reductions in the experience of moral distress. Participants related this to feeling that the quality of resident care was improved by integrating principals of person-centered care and information gathered from the DIT. CONCLUSIONS This study highlights the prevalence and exacerbation of moral distress amongst providers during the pandemic and the myriad of systemic factors that contribute to experiences of moral distress in long-term care settings. We report divergent findings with no quantitative improvement in moral distress post-intervention, but evidence from interviews that the DIT may ease some sources of moral distress and improve the perceived quality of care delivered. This study demonstrates that an intervention to support person-centred isolation care in this setting had limited impact on overall moral distress during the COVID-19 pandemic.
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Affiliation(s)
- Anne Marie Levy
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Lazaridis School of Business & Economics, Wilfrid Laurier University, Brantford, Ontario, Canada
| | - Alisa Grigorovich
- Recreation and Leisure Studies, Brock University, St. Catharines, Ontario, Canada
| | - Josephine McMurray
- Lazaridis School of Business & Economics, Wilfrid Laurier University, Brantford, Ontario, Canada
| | - Hannah Quirt
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Kaitlyn Ranft
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Katia Engell
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Steven Stewart
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Arlene Astell
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Occupational Sciences & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
- School of Psychology & Clinical Language Sciences, University of Reading, Berkshire, UK
| | - Kristina Kokorelias
- Department of Occupational Sciences & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
- Department of Geriatrics, Sinai Health and University Health Network, Toronto, Ontario, Canada
| | - Denise Schon
- Chair of Family Council, Lakeside Long Term Care Centre, Toronto, Ontario, Canada
| | - Kevin Rogrigues
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Mario Tsokas
- Ontario Health Central, Toronto, Ontario, Canada
| | - Alastair J Flint
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
| | - Andrea Iaboni
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Azimi H, Rezapour-Nasrabad R, Borhani F, Sadat Hoseini AS, Bolourchifard F. Ethical care in patients with Covid-19: A grounded theory. PLoS One 2024; 19:e0300156. [PMID: 38547233 PMCID: PMC10977892 DOI: 10.1371/journal.pone.0300156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 02/16/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Providing ethical care during the Covid-19 pandemic has become an inevitable challenge due to facing limitations such as fear of contracting the disease, lack of equipment and emergence of ethical conflicts; So that there is no clear picture of how to provide ethical care for patients with Covid-19. The study aimed to explain the ethical care process of patients with Covid-19. METHOD This qualitative study was conducted in 2021-2023 using the grounded theory research method. Data were collected through conducting 21 semi-structured interviews with 19 participants (16 staff nurses, and 3 supervisor). Sampling was started purposively and continued theoretically. Data analysis was performed by the method proposed by Strauss and Corbin. RESULTS The results indicated that starting the process with a problem means a challenge of how to do the right or correct thing for the patient. This process is driven by the feeling of duty and inner commitment to do the right thing. The sense of responsibility or commitment is directly related to the degree of faith in a person. The actions that a nurse takes to fulfill her sense of commitment is called the faith-based behavior process. The process of behavior based on faith is done through two steps. Attaining the satisfaction of God and as well as the satisfaction of one's conscience is the nurses' ultimate goal of doing the right work and being committed. CONCLUSION The process of ethical care of patients with Covid-19 can be different according to the degree of faith and environmental conditions. A higher level of faith and more helpful environmental conditions, the greater the nurse's inner commitments in the first and second steps, as a result, the satisfaction of God and conscience will be greater.
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Affiliation(s)
- Hamideh Azimi
- Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rafat Rezapour-Nasrabad
- Department of Psychiatric Nursing and Management, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fariba Borhani
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Akram Sadat Sadat Hoseini
- Pediatrics and NICU Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Fariba Bolourchifard
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Cuellar-Pompa L, Rodríguez-Gómez JÁ, Novo-Muñoz MM, Rodríguez-Novo N, Rodríguez-Novo YM, Martínez-Alberto CE. Description and Analysis of Research on Death and Dying during the COVID-19 Pandemic, Published in Nursing Journals Indexed in SCOPUS. NURSING REPORTS 2024; 14:655-674. [PMID: 38525696 PMCID: PMC10961780 DOI: 10.3390/nursrep14020050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/25/2024] [Accepted: 03/11/2024] [Indexed: 03/26/2024] Open
Abstract
AIM To offer an overall picture of the research published regarding the different aspects of death and dying during the COVID-19 pandemic in journals covering the field of nursing in the Scopus database. DESIGN bibliometric analysis. METHODS The metadata obtained were exported from Scopus for subsequent analysis through Bibliometrix. Using the VOSviewer co-word analysis function, the conceptual and thematic structure of the publications was identified. RESULTS A total of 119 papers were retrieved, with the participation of 527 authors. The publications were found in 71 journals covering the nursing area. The main lines of research revolved around the keywords "palliative care" and "end-of-life care" in regard to the ethical, psychological, and organizational challenges faced by the health professionals who cared for these patients. CONCLUSION The results obtained offer a range of data and images that characterize the scientific production published on this topic, coming to the conclusion that, due to the multifaceted and multidisciplinary approach to the experience of death, care, and accompaniment in the dying process, bibliometric maps improve the comprehensive understanding of the semantic and conceptual structure of this field of research. This study was retrospectively registered with the OSF Registries on the 14 March 2024.
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Affiliation(s)
- Leticia Cuellar-Pompa
- Instituto de Investigación en Cuidados del Ilustre Colegio de Enfermeros de Santa Cruz de Tenerife, Calle San Martín, 63, 38001 Santa Cruz de Tenerife, Spain
| | - José Ángel Rodríguez-Gómez
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Sección de Enfermería y Fisioterapia, Universidad de La Laguna, Sta. María Soledad, s/n, Apartado 456, C. P., 38200 San Cristóbal de La Laguna, Spain; (J.Á.R.-G.); (M.M.N.-M.); (N.R.-N.)
| | - María Mercedes Novo-Muñoz
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Sección de Enfermería y Fisioterapia, Universidad de La Laguna, Sta. María Soledad, s/n, Apartado 456, C. P., 38200 San Cristóbal de La Laguna, Spain; (J.Á.R.-G.); (M.M.N.-M.); (N.R.-N.)
| | - Natalia Rodríguez-Novo
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Sección de Enfermería y Fisioterapia, Universidad de La Laguna, Sta. María Soledad, s/n, Apartado 456, C. P., 38200 San Cristóbal de La Laguna, Spain; (J.Á.R.-G.); (M.M.N.-M.); (N.R.-N.)
| | - Yurena M. Rodríguez-Novo
- Hospital Universitario Nuestra Señora de la Candelaria, Carretera General del Rosario, 145, 38010 Santa Cruz de Tenerife, Spain;
| | - Carlos-Enrique Martínez-Alberto
- Escuela de Enfermería Nuestra Señora de Candelaria, Carretera General del Rosario, 145, 38010 Santa Cruz de Tenerife, Spain;
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Fontaine G, Smith M, Langmuir T, Mekki K, Ghazal H, Noad EE, Buchan J, Dubey V, Patey AM, McCleary N, Gibson E, Wilson M, Alghamyan A, Zmytrovych K, Thompson K, Crawshaw J, Grimshaw JM, Arnason T, Brehaut J, Michie S, Brouwers M, Presseau J. One size doesn't fit all: methodological reflections in conducting community-based behavioural science research to tailor COVID-19 vaccination initiatives for public health priority populations. BMC Public Health 2024; 24:784. [PMID: 38481197 PMCID: PMC10936009 DOI: 10.1186/s12889-024-18270-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/04/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Promoting the uptake of vaccination for infectious diseases such as COVID-19 remains a global challenge, necessitating collaborative efforts between public health units (PHUs) and communities. Applied behavioural science can play a crucial role in supporting PHUs' response by providing insights into human behaviour and informing tailored strategies to enhance vaccination uptake. Community engagement can help broaden the reach of behavioural science research by involving a more diverse range of populations and ensuring that strategies better represent the needs of specific communities. We developed and applied an approach to conducting community-based behavioural science research with ethnically and socioeconomically diverse populations to guide PHUs in tailoring their strategies to promote COVID-19 vaccination. This paper presents the community engagement methodology and the lessons learned in applying the methodology. METHODS The community engagement methodology was developed based on integrated knowledge translation (iKT) and community-based participatory research (CBPR) principles. The study involved collaboration with PHUs and local communities in Ontario, Canada to identify priority groups for COVID-19 vaccination, understand factors influencing vaccine uptake and co-design strategies tailored to each community to promote vaccination. Community engagement was conducted across three large urban regions with individuals from Eastern European communities, African, Black, and Caribbean communities and low socioeconomic neighbourhoods. RESULTS We developed and applied a seven-step methodology for conducting community-based behavioural science research: (1) aligning goals with system-level partners; (2) engaging with PHUs to understand priorities; (3) understanding community strengths and dynamics; (4) building relationships with each community; (5) establishing partnerships (community advisory groups); (6) involving community members in the research process; and (7) feeding back and interpreting research findings. Research partnerships were successfully established with members of prioritized communities, enabling recruitment of participants for theory-informed behavioural science interviews, interpretation of findings, and co-design of targeted recommendations for each PHU to improve COVID-19 vaccination uptake. Lessons learned include the importance of cultural sensitivity and awareness of sociopolitical context in tailoring community engagement, being agile to address the diverse and evolving priorities of PHUs, and building trust to achieve effective community engagement. CONCLUSION Effective community engagement in behavioural science research can lead to more inclusive and representative research. The community engagement approach developed and applied in this study acknowledges the diversity of communities, recognizes the central role of PHUs, and can help in addressing complex public health challenges.
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Affiliation(s)
- Guillaume Fontaine
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
- Department of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada
| | | | - Tori Langmuir
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Karim Mekki
- Ottawa Public Health, 100 Constellation Dr, Nepean, ON, K2G 6J8, Canada
| | - Hanan Ghazal
- Ottawa Public Health, 100 Constellation Dr, Nepean, ON, K2G 6J8, Canada
| | | | - Judy Buchan
- Peel Public Health, 7120 Hurontario St, Mississauga, ON, L5W 1N4, Canada
| | - Vinita Dubey
- Toronto Public Health, City Hall, 100 Queen St W, Toronto, ON, M5H 2N2, Canada
| | - Andrea M Patey
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
- School of Rehabilitation Therapy, Queen's University, Louise D Acton Building, 31 George St, Kingston, ON, K7L 3N6, Canada
| | - Nicola McCleary
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Emily Gibson
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Mackenzie Wilson
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | | | | | | | - Jacob Crawshaw
- McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Jeremy M Grimshaw
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
- Department of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada
- School of Epidemiology and Public Health, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Trevor Arnason
- Ottawa Public Health, 100 Constellation Dr, Nepean, ON, K2G 6J8, Canada
| | - Jamie Brehaut
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Susan Michie
- Centre for Behaviour Change, University College London, Gower St, London, WC1E 6BT, UK
| | - Melissa Brouwers
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Justin Presseau
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada.
- School of Epidemiology and Public Health, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada.
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier Vanier Hall, Ottawa, ON, K1N 6N5, Canada.
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Kanso A, Homsi N, Chaitou AR, Farfour I, Wehbe H, Tarabay L, Abou-Mrad F. Professional and Psychological Influence of the COVID-19 Pandemic on the Training of Medical Residents. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241262685. [PMID: 38868680 PMCID: PMC11168050 DOI: 10.1177/23821205241262685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 05/31/2024] [Indexed: 06/14/2024]
Abstract
OBJECTIVES Coronavirus disease 2019 (COVID-19) has profoundly impacted residency and fellowship training and education. However, how and to what extent the COVID-19 pandemic in Lebanon compromised the daily involvement of trainees on the clinical and ethical levels is currently unknown, which this study will shed light on. METHODS We conducted a cross-sectional survey (30 questions) targeting medical residents delivering healthcare services in Lebanon. Residents from different specialties were included in the study to assess the effect of the pandemic on their education and the ethical obstacles they faced when dealing with patients. RESULTS A total of 221 postgraduate medical students participated in our study. Results showed that about half of the residents (52.1%) were only able to do a basic physical examination rather than a full examination as a mandatory requirement in the residency curriculum. The majority (60%) agreed that the doctor-patient relationship is contravened. In addition, almost all residents suffered from fear and emotional distress that affected their education (83.7%). CONCLUSION The findings of this study identify the effect of COVID-19 on residents' training, which affects treatment outcomes and greatly impacts the mental well-being of both healthcare workers and patients.
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Affiliation(s)
- Ali Kanso
- Department of Medical Ethics, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
- Department of Internal Medicine, Rafik Hariri University Hospital, Beirut, Lebanon
| | - Natasha Homsi
- Department of Medical Ethics, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
- Department of Family Medicine, Rafik Hariri University Hospital, Beirut, Lebanon
| | - Ali R. Chaitou
- Department of Internal Medicine, Rafik Hariri University Hospital, Beirut, Lebanon
| | - Imadeddine Farfour
- Department of Medical Ethics, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
- Department of ENT Surgery, Al Zahraa Hospital University Medical Center, Beirut, Lebanon
| | - Hussein Wehbe
- Department of Medical Ethics, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
- Department of Orthopedic Surgery, Bahman Medical Center, Beirut, Lebanon
| | - Lubna Tarabay
- Department of Medical Ethics, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Fadi Abou-Mrad
- Department of Medical Ethics, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
- Department of Neurology, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
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Kara MA. Is It Possible to Allocate Life? Triage, Ageism, and Narrative Identity. New Bioeth 2023; 29:322-339. [PMID: 37791914 DOI: 10.1080/20502877.2023.2261735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Triage protocols can exclude older patients for the sake of effectiveness and this may be defended as the older have already had their fair share of life, which can mean fair amounts or complete lives. Nevertheless, if life is considered as a narrative, mentioning amounts might be nonsensical. Narratives have a quality of unity; so, life events are fragments whose meanings are dependent on the meaning of the whole. Thus, time units do not represent a reliable measure of the content of life. In addition, people's experience is different from the external flow of time, making its significance relative. Moreover, to compare the completeness of lives qualitatively, it is necessary to have a common cultural understanding, which is improbable to agree on in a modern society. Therefore, basic assumptions of the accounts that refer to fair shares of lives are mistaken, and these accounts do not support age-based rationing.
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Affiliation(s)
- Mahmut Alpertunga Kara
- History of Medicine and Ethics Department, Faculty of Medicine, Istanbul Medeniyet University Medicine, Istanbul, Türkiye
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Hunt X, Hameed S, Tetali S, Ngoc LA, Ganle J, Huq L, Shakespeare T, Smythe T, Ilkkursun Z, Kuper H, Acarturk C, Kannuri NK, Mai VQ, Khan RS, Banks LM. Impacts of the COVID-19 pandemic on access to healthcare among people with disabilities: evidence from six low- and middle-income countries. Int J Equity Health 2023; 22:172. [PMID: 37653417 PMCID: PMC10472671 DOI: 10.1186/s12939-023-01989-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 08/14/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND The pandemic has placed considerable strain on health systems, especially in low- and middle-income countries (LMICs), leading to reductions in the availability of routine health services. Emerging evidence suggests that people with disabilities have encountered marked challenges in accessing healthcare services and supports in the context of the pandemic. Further research is needed to explore specific barriers to accessing healthcare during the pandemic, and any strategies that promoted continued access to health services in LMICs where the vast majority of people with disabilities live. METHODS Qualitative in-depth interviews were conducted with persons with disabilities in Ghana, Zimbabwe, Viet Nam, Türkiye (Syrian refugees), Bangladesh, and India as part of a larger project exploring the experiences of people with disabilities during the COVID-19 pandemic and their inclusion in government response activities. Data were analysed using thematic analysis. RESULTS This research found that people with disabilities in six countries - representing a diverse geographic spread, with different health systems and COVID-19 responses - all experienced additional difficulties accessing healthcare during the pandemic. Key barriers to accessing healthcare during the pandemic included changes in availability of services due to systems restructuring, difficulty affording care due to the economic impacts of the pandemic, fear of contracting coronavirus, and a lack of human support to enable care-seeking. CONCLUSION These barriers ultimately led to decreased utilisation of services which, in turn, negatively impacted their health and wellbeing. However, we also found that certain factors, including active and engaged Organisations of Persons with Disabilities (OPDs) and Non-Governmental Organizations (NGOs) played a role in reducing some of the impact of pandemic-related healthcare access barriers.
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Affiliation(s)
- Xanthe Hunt
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Room 4009, Education Building, Cape Town, South Africa.
| | - Shaffa Hameed
- International Centre for Evidence on Disability, London School of Hygiene and Tropical Medicine, London, UK
| | - Shailaja Tetali
- Indian Institute of Public Health-Hyderabad, Hyderabad, India
| | - Luong Anh Ngoc
- Center for Training and Research on Substance Abuse - HIV, Hanoi Medical University, Hanoi, Viet Nam
| | - John Ganle
- School of Public Health, University of Ghana, Accra, Ghana
| | - Lopita Huq
- BRAC Institute of Governance and Development, BRAC University, Dakar, Bangladesh
| | - Tom Shakespeare
- International Centre for Evidence on Disability, London School of Hygiene and Tropical Medicine, London, UK
| | - Tracey Smythe
- International Centre for Evidence on Disability, London School of Hygiene and Tropical Medicine, London, UK
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Hannah Kuper
- International Centre for Evidence on Disability, London School of Hygiene and Tropical Medicine, London, UK
| | - Ceren Acarturk
- Department of Psychology, Koc University, Istanbul, Türkiye
| | | | - Vu Quynh Mai
- Center for Population Health Science, Hanoi University of Public Health, Hanoi, Viet Nam
| | - Rifat Shahpar Khan
- BRAC Institute of Governance and Development, BRAC University, Dakar, Bangladesh
| | - Lena Morgon Banks
- International Centre for Evidence on Disability, London School of Hygiene and Tropical Medicine, London, UK
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Harlan EA, Mubarak E, Firn J, Goold SD, Shuman AG. Inter-hospital Transfer Decision-making During the COVID-19 Pandemic: a Qualitative Study. J Gen Intern Med 2023; 38:2568-2576. [PMID: 37254008 PMCID: PMC10228431 DOI: 10.1007/s11606-023-08237-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 05/09/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Inter-hospital patient transfers to hospitals with greater resource availability and expertise may improve clinical outcomes. However, there is little guidance regarding how patient transfer requests should be prioritized when hospital resources become scarce. OBJECTIVE To understand the experiences of healthcare workers involved in the process of accepting inter-hospital patient transfers during a pandemic surge and determine factors impacting inter-hospital patient transfer decision-making. DESIGN We conducted a qualitative study consisting of semi-structured interviews between October 2021 and February 2022. PARTICIPANTS Eligible participants were physicians, nurses, and non-clinician administrators involved in the process of accepting inter-hospital patient transfers. Participants were recruited using maximum variation sampling. APPROACH Semi-structured interviews were conducted with healthcare workers across Michigan. KEY RESULTS Twenty-one participants from 15 hospitals were interviewed (45.5% of eligible hospitals). About half (52.4%) of participants were physicians, 38.1% were nurses, and 9.5% were non-clinician administrators. Three domains of themes impacting patient transfer decision-making emerged: decision-maker, patient, and environmental factors. Decision-makers described a lack of guidance for transfer decision-making. Patient factors included severity of illness, predicted chance of survival, need for specialized care, and patient preferences for medical care. Decision-making occurred within the context of environmental factors including scarce resources at accepting and requesting hospitals, organizational changes to transfer processes, and alternatives to patient transfer including use of virtual care. Participants described substantial moral distress related to transfer triaging. CONCLUSIONS A lack of guidance in transfer processes may result in considerable variation in the patients who are accepted for inter-hospital transfer and in substantial moral distress among decision-makers involved in the transfer process. Our findings identify potential organizational changes to improve the inter-hospital transfer process and alleviate the moral distress experienced by decision-makers.
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Affiliation(s)
- Emily A Harlan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI, USA.
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA.
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA.
| | - Eman Mubarak
- University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Janice Firn
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
- University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Susan D Goold
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Andrew G Shuman
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA
- Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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11
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Bibler TM, Zainab A. Withdrawing extra corporeal membrane oxygenation (ECMO) against a family's wishes: Three permissible scenarios. J Heart Lung Transplant 2023; 42:849-852. [PMID: 36972748 DOI: 10.1016/j.healun.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/13/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023] Open
Abstract
The ethical permissibility of unilaterally withdrawing life-sustaining technologies has been a perennial topic in transplant and critical care medicine, often focusing on CPR and mechanical ventilation. The permissibility of unilateral withdrawal of extracorporeal membrane oxygenation (ECMO) has been discussed sparingly. When addressed, authors have appealed to professional authority rather than substantive ethical analysis. In this Perspective, we argue that there are at least three (3) scenarios wherein healthcare teams would be justified in unilaterally withdrawing ECMO, despite the objections of the patient's legal representative. The ethical considerations that provide the groundwork for these scenarios are, primarily: equity, integrity, and the moral equivalence between withholding and withdrawing medical technologies. First, we place equity in the context of crisis standards of medicine. After this, we discuss professional integrity as it relates to the innovative usage of medical technologies. Finally, we discuss the ethical consensus known at the "equivalence thesis." Each of these considerations include a scenario and justification for unilateral withdrawal. We also provide three (3) recommendations that aim at preventing these challenges at their outset. Our conclusions and recommendations are not meant to be blunt arguments that ECMO teams wield whenever disagreement about the propriety of continued ECMO support arises. Instead, the onus will be on individual ECMO programs to evaluate these arguments and decide if they represent sensible, correct, and implementable starting points for clinical practice guidelines or policies.
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Affiliation(s)
- Trevor M Bibler
- Center for Ethics and Health Policy, Baylor College of Medicine, Houston, Texas.
| | - Asma Zainab
- Department of Cardiovascular Anesthesia, Weill Cornell Medical College, New York, New York; Intensivist Cardiovascular Surgical ICU, DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
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12
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Chih S, Clarke BA, Albert M, Buchan CA, Kafil TS, Kim DH, Kumar D, Smith SJ, Solera Rallo JT, Stubbs MJ, McDonald MA. The COVID-19 Pandemic and Adult Cardiac Transplantation: Impact, Interventions, and Implications. Can J Cardiol 2023; 39:853-864. [PMID: 36965667 PMCID: PMC10035809 DOI: 10.1016/j.cjca.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 03/13/2023] [Accepted: 03/17/2023] [Indexed: 03/27/2023] Open
Abstract
In this review, we provide a comprehensive overview of the impact of the COVID-19 pandemic on adult heart transplantation. We highlight the decline in the number of adult transplantations performed throughout the pandemic as a consequence of restrictions imposed on individual programs and hospitals. There were challenges to maintaining cardiac transplant activity at multiple levels, including organ donation in intensive care units, logistical difficulties with organ procurement, and rapidly changing resource considerations at health system and jurisdictional levels. We also review the impact of COVID-19 on cardiac transplant recipients. Despite the high rates of morbidity and mortality observed during the initial phases of the pandemic among heart transplant patients infected with COVID-19, the availability of effective vaccines, pre-exposure prophylaxis, and specific antiviral therapies have drastically improved outcomes over time. Vaccines have proven to be safe and effective in reducing infections and illness severity, but specific considerations in the immunocompromised solid organ transplant population apply, including the need for additional booster doses to achieve sufficient immunisation. We further outline the strong rationale for vaccination before transplantation wherever possible. Finally, the COVID-19 response created a number of barriers to safe and efficient post-transplantation care. Given the need for frequent evaluation and monitoring, especially in the first several months after cardiac transplantation, the pandemic provided the impetus to improve virtual care delivery and explore noninvasive rejection surveillance through gene expression profiling. We hope that lessons learned will allow us to prepare and pivot effectively during future pandemics and health care emergencies.
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Affiliation(s)
- Sharon Chih
- Division of Cardiology, Heart Failure, and Transplantation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Brian A Clarke
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martin Albert
- Department of Medicine and Critical Care, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada; CIUSSS-NIM Research Centre, Department of Surgery, Montréal Heart Institute, Montréal, Québec, Canada; Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - C Arianne Buchan
- Division of Infectious Diseases, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Canada, Ottawa, Ontario, Canada
| | - Tahir S Kafil
- Division of Cardiology, Heart Failure, and Transplantation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Daniel H Kim
- Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Canada
| | - Deepali Kumar
- Division of Infectious Disease, Transplant Infectious Disease, Ajmera Transplant Centre, University of Toronto, Toronto, Ontario, Canada
| | - Stuart J Smith
- Division of Cardiology, London Health Sciences Centre, Western University, London, Canada
| | - Javier Tomas Solera Rallo
- Division of Infectious Disease, Transplant Infectious Disease, Ajmera Transplant Centre, University of Toronto, Toronto, Ontario, Canada
| | - Michael J Stubbs
- Division of Cardiology, University Health Network, Ajmera Transplant Centre, University of Toronto, Toronto, Ontario, Canada
| | - Michael A McDonald
- Division of Cardiology, University Health Network, Ajmera Transplant Centre, University of Toronto, Toronto, Ontario, Canada.
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Small SS, Lau E, McFarlane K, Archambault PM, Longstaff H, Hohl CM. Research recruitment and consent methods in a pandemic: a qualitative study of COVID-19 patients' perspectives. BMC Med Res Methodol 2023; 23:113. [PMID: 37170077 PMCID: PMC10173898 DOI: 10.1186/s12874-023-01933-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 04/25/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Virtual data collection methods and consent procedures adopted in response to the COVID-19 pandemic enabled continued research activities, but also introduced concerns about equity, inclusivity, representation, and privacy. Recent studies have explored these issues from institutional and researcher perspectives, but there is a need to explore patient perspectives and preferences. This study aims to explore COVID-19 patients' perspectives about research recruitment and consent for research studies about COVID-19. METHODS We conducted an exploratory qualitative focus group and interview study among British Columbian adults who self-identified as having had COVID-19. We recruited participants through personal contacts, social media, and REACH BC, an online platform that connects researchers and patients in British Columbia. We analyzed transcripts inductively and developed thematic summaries of each coding element. RESULTS Of the 22 individuals recruited, 16 attended a focus group or interview. We found that autonomy and the feasibility of participation, attitudes toward research about COVID-19, and privacy concerns are key factors that influence participants' willingness to participate in research. We also found that participants preferred remote and virtual approaches for contact, consent, and delivery of research on COVID-19. CONCLUSIONS Individuals who had COVID-19 are motivated to participate in research studies and value autonomy in their decision to participate, but researchers must be sensitive and considerate toward patient preferences and concerns, particularly as researchers adopt virtual recruitment and data collection methods. Such awareness may increase research participation and engagement.
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Affiliation(s)
- Serena S Small
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, 828 West 10th Ave, 7th Fl, Vancouver, BC, Canada
| | - Erica Lau
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, 828 West 10th Ave, 7th Fl, Vancouver, BC, Canada
| | | | - Patrick M Archambault
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada
- Centre de recherche du Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Holly Longstaff
- Provincial Health Services Authority, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Corinne M Hohl
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, 828 West 10th Ave, 7th Fl, Vancouver, BC, Canada.
- Emergency Department, Vancouver General Hospital, Vancouver, BC, Canada.
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Sattler S, Maskileyson D, Racine E, Davidov E, Escande A. Stigmatization in the context of the COVID-19 pandemic: a survey experiment using attribution theory and the familiarity hypothesis. BMC Public Health 2023; 23:521. [PMID: 36934221 PMCID: PMC10024019 DOI: 10.1186/s12889-023-15234-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 02/07/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has created a global health crisis, leading to stigmatization and discriminatory behaviors against people who have contracted or are suspected of having contracted the virus. Yet the causes of stigmatization in the context of COVID-19 remain only partially understood. Using attribution theory, we examine to what extent attributes of a fictitious person affect the formation of stigmatizing attitudes towards this person, and whether suspected COVID-19 infection (vs. flu) intensifies such attitudes. We also use the familiarity hypothesis to explore whether familiarity with COVID-19 reduces stigma and whether it moderates the effect of a COVID-19 infection on stigmatization. METHODS We conducted a multifactorial vignette survey experiment (28-design, i.e., NVignettes = 256) in Germany (NRespondents = 4,059) in which we experimentally varied signals and signaling events (i.e., information that may trigger stigma) concerning a fictitious person in the context of COVID-19. We assessed respondents' cognitive (e.g., blameworthiness) and affective (e.g., anger) responses as well as their discriminatory inclinations (e.g., avoidance) towards the character. Furthermore, we measured different indicators of respondents' familiarity with COVID-19. RESULTS Results revealed higher levels of stigma towards people who were diagnosed with COVID-19 versus a regular flu. In addition, stigma was higher towards those who were considered responsible for their infection due to irresponsible behavior. Knowing someone who died from a COVID infection increased stigma. While higher self-reported knowledge about COVID-19 was associated with more stigma, higher factual knowledge was associated with less. CONCLUSION Attribution theory and to a lesser extent the familiarity hypothesis can help better understand stigma in the context of COVID-19. This study provides insights about who is at risk of stigmatization and stigmatizing others in this context. It thereby allows identifying the groups that require more support in accessing healthcare services and suggests that basic, factually oriented public health interventions would be promising for reducing stigma.
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Affiliation(s)
- Sebastian Sattler
- Faculty of Sociology, Bielefeld University, Bielefeld, Germany.
- Institute of Sociology and Social Psychology, University of Cologne, Cologne, Germany.
- Pragmatic Health Ethics Research Unit, Institut de Recherches Cliniques de Montréal, Quebec, QC, Canada.
| | - Dina Maskileyson
- Institute of Sociology and Social Psychology, University of Cologne, Cologne, Germany
| | - Eric Racine
- Pragmatic Health Ethics Research Unit, Institut de Recherches Cliniques de Montréal, Quebec, QC, Canada
- Department of Medicine, Université de Montréal, Quebec, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Quebec, Canada
| | - Eldad Davidov
- Institute of Sociology and Social Psychology, University of Cologne, Cologne, Germany
- University of Zurich and University Research Priority Program "Social Networks", Zurich, Switzerland
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Plyushteva A. Negotiating dignity in public geography: The ethics of public engagement in pandemic times. AREA (OXFORD, ENGLAND) 2023; 55:53-61. [PMID: 37057037 PMCID: PMC10083941 DOI: 10.1111/area.12818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 06/21/2022] [Accepted: 06/29/2022] [Indexed: 06/19/2023]
Abstract
In this paper, I reflect on some of the ethical dimensions of public engagement with geographic research. The paper draws on my recent experience of a project entitled 'Not working from home', which sought to make visible the everyday experiences of essential workers during the COVID-19 pandemic. The project was intended as a space for essential workers to document their daily lives using text, images and video, enabling them to engage with each other, while also informing the wider public about the everyday challenges of not working from home during the pandemic. The paper discusses some of the ethical implications and challenges of conducting this project, drawing on a critical engagement with dignity as an ethical framework for public engagement. I discuss the implications of calling workers 'essential', the role of collective and professional identities explored by the participants, and the impact of offering rewards. I also ask some broader questions on the role that the concept of dignity might play in the ethics of public engagement with research in human geography.
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Affiliation(s)
- Anna Plyushteva
- School of Geography and the EnvironmentUniversity of OxfordOxfordUK
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16
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Microneedles for Efficient and Precise Drug Delivery in Cancer Therapy. Pharmaceutics 2023; 15:pharmaceutics15030744. [PMID: 36986606 PMCID: PMC10057903 DOI: 10.3390/pharmaceutics15030744] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/08/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
Cancer is the leading cause of death, acting as a global burden, severely impacting the patients’ quality of life and affecting the world economy despite the expansion of cumulative advances in oncology. The current conventional therapies for cancer which involve long treatment duration and systemic exposure of drugs leads to premature degradation of drugs, a massive amount of pain, side effects, as well as the recurrence of the condition. There is also an urgent demand for personalized and precision-based medicine, especially after the recent pandemic, to avoid future delays in diagnosis or treatments for cancer patients as they are very essential in reducing the global mortality rate. Recently, microneedles which consist of a patch with tiny, micron-sized needles attached to it have been quite a sensation as an emerging technology for transdermal application to diagnose or treat various illnesses. The application of microneedles in cancer therapies is also being extensively studied as they offer a myriad of benefits, especially since microneedle patches offer a better treatment approach through self administration, painless treatment, and being an economically and environmentally friendly approach in comparison with other conventional methods. The painless gains from microneedles significantly improves the survival rate of cancer patients. The emergence of versatile and innovative transdermal drug delivery systems presents a prime breakthrough opportunity for safer and more effective therapies, which could meet the demands of cancer diagnosis and treatment through different application scenarios. This review highlights the types of microneedles, fabrication methods and materials, along with the recent advances and opportunities. In addition, this review also addresses the challenges and limitations of microneedles in cancer therapy with solutions through current studies and future works to facilitate the clinical translation of microneedles in cancer therapies.
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Petrazzuoli F, Collins C, Van Poel E, Tatsioni A, Streit S, Bojaj G, Asenova R, Hoffmann K, Gabrani J, Klemenc-Ketis Z, Rochfort A, Adler L, Windak A, Nessler K, Willems S. Differences between Rural and Urban Practices in the Response to the COVID-19 Pandemic: Outcomes from the PRICOV-19 Study in 38 Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3674. [PMID: 36834369 PMCID: PMC9958860 DOI: 10.3390/ijerph20043674] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
This paper explores the differences between rural and urban practices in the response to the COVID-19 pandemic, emphasizing aspects such as management of patient flow, infection prevention and control, information processing, communication and collaboration. Using a cross-sectional design, data were collected through the online PRICOV-19 questionnaire sent to general practices in 38 countries. Rural practices in our sample were smaller than urban-based practices. They reported an above-average number of old and multimorbid patients and a below-average number of patients with a migrant background or financial problems. Rural practices were less likely to provide leaflets and information, but were more likely to have ceased using the waiting room or to have made structural changes to their waiting room and to have changed their prescribing practices in terms of patients attending the practices. They were less likely to perform video consultations or use electronic prescription methods. Our findings show the existence of certain issues that could impact patient safety in rural areas more than in urban areas due to the underlying differences in population profile and supports. These could be used to plan the organization of care for similar future pandemic situations.
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Affiliation(s)
- Ferdinando Petrazzuoli
- Department of Clinical Sciences, Centre for Primary Health Care Research, Lund University, 21428 Malmö, Sweden
| | - Claire Collins
- Research Centre, Irish College of General Practitioners, D02 XR68 Dublin, Ireland
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Athina Tatsioni
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Gazmend Bojaj
- Department of Management of Health Services and Institution, Heimerer College, 1000 Pristina, Kosovo
| | - Radost Asenova
- Department of Urology and General Practice, Faculty of Medicine, Medical University Plovdiv, 4003 Plovdiv, Bulgaria
| | - Kathryn Hoffmann
- Department of Social- and Preventive Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Jonila Gabrani
- Faculty of Medicine, University of Basel, 4001 Basel, Switzerland
| | - Zalika Klemenc-Ketis
- Department of Family Medicine, Medical Faculty, University of Maribor, Tabroska 8, 2000 Maribor, Slovenia
- Department of Family Medicine, Medical Faculty, University of Ljubljana, Poljanski Nasip 58, 1000 Ljubljana, Slovenia
- Ljubljana Community Health Centre, Metelkova 9, 1000 Ljubljana, Slovenia
| | - Andrée Rochfort
- Research Centre, Irish College of General Practitioners, D02 XR68 Dublin, Ireland
| | - Limor Adler
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6195001, Israel
| | - Adam Windak
- Department of Family Medicine, Jagiellonian University Medical College, 31-061 Krakow, Poland
| | - Katarzyna Nessler
- Department of Family Medicine, Jagiellonian University Medical College, 31-061 Krakow, Poland
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
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Ramirez CC, Farmer Y, Bouthillier ME. Public voices on tie-breaking criteria and underlying values in COVID-19 triage protocols to access critical care: a scoping review. DISCOVER HEALTH SYSTEMS 2023; 2:16. [PMID: 37206881 PMCID: PMC10169297 DOI: 10.1007/s44250-023-00027-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/14/2023] [Indexed: 05/21/2023]
Abstract
Background To reduce the arbitrariness in the allocation of rare resources in intensive care units (ICU) in the context of the pandemic, tiebreakers were considered in some COVID-19 triage algorithms. They were also contemplated to facilitate the tragic decisions of healthcare workers when faced with two patients with similar prognosis and only one ICU bed available. Little is known about the public's perspective on tiebreakers. Objectives To consolidate the available scientific literature on public consultations, particularly on tiebreakers and their underlying values. Also, to obtain an overview of the key arguments presented by the participating public and to identify potential gaps related to this topic. Methods The steps described by Arksey and O'Malley was the preferred method to our approach. Seven electronic databases were searched from January 2020 to April 2022, using keywords for each database: PubMed, Medline, EMBASE, Web of Science, PsycINFO, EBM reviews, CINAHL complete. We also searched in Google and Google Scholar, and in the references of the articles found. Our analysis was mainly qualitative. A thematic analysis was performed to consider the public's perspectives on tiebreakers and their underlying values, according to these studies. Results Of 477 publications found, 20 were selected. They carried out public consultations through various methods: surveys (80%), interviews (20%), deliberative processes (15%) and others (5%) in various countries: Australia, Brazil, Canada, China, France, Germany, India, Iran, Italy, Japan, Korea, Netherlands, Portugal, Spain, Switzerland, Thailand, United Kingdom, and United States. Five themes emerged from our analysis. The public favored the life cycle (50%) and absolute age (45%) as a tiebreaker. Other values considered important were reciprocity, solidarity, equality, instrumental value, patient merit, efficiency, and stewardship. Among the new findings were a preference for patient nationality and those affected by COVID-19. Conclusions There is a preference for favoring younger patients over older patients when there is a tie between similar patients, with a slight tendency to favor intergenerational equity. Variability was found in the public's perspectives on tiebreakers and their values. This variability was related to socio-cultural and religious factors. More studies are needed to understand the public's perspective on tiebreakers. Supplementary Information The online version contains supplementary material available at 10.1007/s44250-023-00027-9.
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Affiliation(s)
- Claudia Calderon Ramirez
- Biomedical Sciences Program, Clinical Ethics, Faculty of Medicine, Université de Montréal, 2900 Bd Édouard-Montpetit, Montréal, Québec H3T 1J4 Canada
| | - Yanick Farmer
- Department of Social and Public Communication, Faculty of Communication, Université du Québec à Montréal, C.P 8888, Succursale Centre-Ville, Montréal, Québec H3C 3P8 Canada
| | - Marie-Eve Bouthillier
- Department of Family and Emergency Medicine and Office of Clinical Ethics, Faculty of Medicine, Université de Montréal, 2900 Bd Édouard-Montpetit, Montréal, Québec H3T 1J4 Canada
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19
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Pisegna JL, BrintzenhofeSzoc K, Shahrokni A, Canin B, Plotkin E, Boehmer LM, Chien L, Malone MV, MacKenzie AR, Krok-Schoen JL. Differences in urban and suburban/rural settings regarding care provision and barriers of cancer care for older adults during COVID-19. Support Care Cancer 2022; 31:78. [PMID: 36562819 PMCID: PMC9780617 DOI: 10.1007/s00520-022-07544-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Care for older adults with cancer became more challenging during the COVID-19 pandemic, particularly in urban hotspots. This study examined the potential differences in healthcare providers' provision of as well as barriers to cancer care for older adults with cancer between urban and suburban/rural settings. METHODS Members of the Advocacy Committee of the Cancer and Aging Research Group, with the Association of Community Cancer Centers, surveyed multidisciplinary healthcare providers responsible for the direct care of patients with cancer. Respondents were recruited through organizational listservs, email blasts, and social media messages. Descriptive statistics and chi-square tests were used. RESULTS Complete data was available from 271 respondents (urban (n = 144), suburban/rural (n = 127)). Most respondents were social workers (42, 44%) or medical doctors/advanced practice providers (34, 13%) in urban and suburban/rural settings, respectively. Twenty-four percent and 32.4% of urban-based providers reported "strongly considering" treatment delays among adults aged 76-85 and > 85, respectively, compared to 13% and 15.4% of suburban/rural providers (Ps = 0.048, 0.013). More urban-based providers reported they were inclined to prioritize treatment for younger adults over older adults than suburban/rural providers (10.4% vs. 3.1%, p = 0.04) during the pandemic. The top concerns reported were similar between the groups and related to patient safety, treatment delays, personal safety, and healthcare provider mental health. CONCLUSION These findings demonstrate location-based differences in providers' attitudes regarding care provision for older adults with cancer during the COVID-19 pandemic.
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Affiliation(s)
- Janell L. Pisegna
- Physical Therapy Program, Geriatric Research Education and Clinical Center VA Eastern Colorado Healthcare System, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | | | - Armin Shahrokni
- Department of Medicine, Gastrointestinal Oncology and Geriatrics Services, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | | | - Elana Plotkin
- Provider Education Programs, Association of Community Cancer Centers, Rockville, Maryland USA
| | - Leigh M. Boehmer
- Provider Education Programs, Association of Community Cancer Centers, Rockville, Maryland USA
| | - Leana Chien
- City of Hope Comprehensive Cancer Center, Duarte, CA USA
| | - Mariuxi Viteri Malone
- Division of Hematology, Florida Cancer Specialists and Research Institute, Venice, FL USA
| | - Amy R. MacKenzie
- Division of Hematology, Thomas Jefferson University, Philadelphia, PA USA
| | - Jessica L. Krok-Schoen
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, 453 W. 10Th Ave., Columbus, OH 43210 USA
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Wu YL, Lin TW, Yang CY, Wang SSC. Demographics, employment, and proximity to covid-19 as predictors of preparedness among Taiwanese health social workers. SOCIAL WORK IN HEALTH CARE 2022; 62:41-58. [PMID: 36448628 DOI: 10.1080/00981389.2022.2147627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 06/08/2022] [Accepted: 11/07/2022] [Indexed: 06/17/2023]
Abstract
COVID-19 struck the world violently and cause negative psychological consequences on health professionals. The preparedness of social workers for the pandemic is critical while facing these challenges and pressures. The study aimed to explore what are the roles of demographic, employment, and proximity to Covid-19 in predicting preparedness for the next wave of COVID among social workers in Taiwan. A total of 158 participants were conveniently sampled and multiple regression, univariate analysis, and two-way ANOVA were conducted. The results demonstrated that the demographic and employment variables significantly predicted preparedness, and there were significant differences among demographics on preparedness and an interaction effect between seniority and age. Consequently, middle-aged social workers with junior seniority years may have more difficulties in their preparation for the current situation. The implication of our findings is also discussed.
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Affiliation(s)
- Yi-Ling Wu
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
| | - Tsai-Wen Lin
- EMI Professional Development Center, National Cheng Kung University, Tainan, Taiwan
| | - Chun-Yi Yang
- Department of Health and Welfare, University of Taipei, Taipei, Taiwan
- Department of Social Work, Taipei City Hospital, Taipei, Taiwan
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21
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Bhattarai S, Adhikari A, Rayamajhee B, Dhungana J, Singh M, Koirala S, Shakya DR. Participatory Approach to Develop Evidence-Based Clinical Ethics Guidelines for the Care of COVID-19 Patients: A Mixed Method Study From Nepal. Front Public Health 2022; 10:873881. [PMID: 35832276 PMCID: PMC9272001 DOI: 10.3389/fpubh.2022.873881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
During health emergencies such as the COVID-19 pandemic, healthcare workers face numerous ethical challenges while catering to the needs of patients in healthcare settings. Although the data recapitulating high-income countries ethics frameworks are available, the challenges faced by clinicians in resource-limited settings of low- and middle-income countries are not discussed widely due to a lack of baseline data or evidence. The Nepali healthcare system, which is chronically understaffed and underequipped, was severely affected by the COVID-19 pandemic in its capacity to manage health services and resources for needy patients, leading to ethical dilemmas and challenges during clinical practice. This study aimed to develop a standard guideline that would address syndemic ethical dilemmas during clinical care of COVID-19 patients who are unable to afford standard-of-care. A mixed method study was conducted between February and June of 2021 in 12 government designated COVID-19 treatment hospitals in central Nepal. The draft guideline was discussed among the key stakeholders in the pandemic response in Nepal. The major ethical dilemmas confronted by the study participants (50 healthcare professionals providing patient care at COVID-19 treatment hospitals) could be grouped into five major pillars of ethical clinical practice: rational allocation of medical resources, updated treatment protocols that guide clinical decisions, standard-of-care regardless of patient's economic status, effective communication among stakeholders for prompt patient care, and external factors such as political and bureaucratic interference affecting ethical practice. This living clinical ethics guideline, which has been developed based on the local evidence and case stories of frontline responders, is expected to inform the policymakers as well as the decision-makers positioned at the concerned government units. These ethics guidelines could be endorsed with revisions by the concerned regulatory authorities for the use during consequent waves of COVID-19 and other epidemics that may occur in the future. Other countries affected by the pandemic could conduct similar studies to explore ethical practices in the local clinical and public health context.
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Affiliation(s)
- Suraj Bhattarai
- Department of Global Health, Global Institute for Interdisciplinary Studies (GIIS), Kathmandu, Nepal
| | - Anurag Adhikari
- Department of Infection and Immunology, Kathmandu Research Institute for Biological Sciences (KRIBS), Lalitpur, Nepal
| | - Binod Rayamajhee
- Department of Infection and Immunology, Kathmandu Research Institute for Biological Sciences (KRIBS), Lalitpur, Nepal
- School of Optometry and Vision Science, Faculty of Medicine and Health, UNSW, Sydney, NSW, Australia
| | - Jaya Dhungana
- Department of Global Health, Global Institute for Interdisciplinary Studies (GIIS), Kathmandu, Nepal
| | - Minu Singh
- Department of Infection and Immunology, Kathmandu Research Institute for Biological Sciences (KRIBS), Lalitpur, Nepal
| | - Sarun Koirala
- Department of Anatomy, B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
- Nepali Unit of International Chair in Bioethics, Dharan, Nepal
| | - Dhana Ratna Shakya
- Nepali Unit of International Chair in Bioethics, Dharan, Nepal
- Department of Psychiatry, B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
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22
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Badalov E, Blackler L, Scharf AE, Matsoukas K, Chawla S, Voigt LP, Kuflik A. COVID-19 double jeopardy: the overwhelming impact of the social determinants of health. Int J Equity Health 2022; 21:76. [PMID: 35610645 PMCID: PMC9129892 DOI: 10.1186/s12939-022-01629-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/03/2022] [Indexed: 12/18/2022] Open
Abstract
Background The COVID-19 pandemic has strained healthcare systems by creating a tragic imbalance between needs and resources. Governments and healthcare organizations have adapted to this pronounced scarcity by applying allocation guidelines to facilitate life-or-death decision-making, reduce bias, and save as many lives as possible. However, we argue that in societies beset by longstanding inequities, these approaches fall short as mortality patterns for historically discriminated against communities have been disturbingly higher than in the general population. Methods We review attack and fatality rates; survey allocation protocols designed to deal with the extreme scarcity characteristic of the earliest phases of the pandemic; and highlight the larger ethical perspectives (Utilitarianism, non-Utilitarian Rawlsian justice) that might justify such allocation practices. Results The COVID-19 pandemic has dramatically amplified the dire effects of disparities with respect to the social determinants of health. Patients in historically marginalized groups not only have significantly poorer health prospects but also lower prospects of accessing high quality medical care and benefitting from it even when available. Thus, mortality among minority groups has ranged from 1.9 to 2.4 times greater than the rest of the population. Standard allocation schemas, that prioritize those most likely to benefit, perpetuate and may even exacerbate preexisting systemic injustices. Conclusions To be better prepared for the inevitable next pandemic, we must urgently begin the monumental project of addressing and reforming the structural inequities in US society that account for the strikingly disparate mortality rates we have witnessed over the course of the current pandemic. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-022-01629-0.
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Affiliation(s)
- Elizabeth Badalov
- City University of New York (CUNY) Hunter College, New York, NY, USA
| | - Liz Blackler
- Ethics Committee Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Amy E Scharf
- Ethics Committee Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Konstantina Matsoukas
- Ethics Committee Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Medical Library Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sanjay Chawla
- Ethics Committee Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Anesthesiology, Pain and Critical Care Medicine Memorial Sloan Kettering Center, New York, NY, USA.,Department of Medicine Memorial Sloan Kettering Center, New York, NY, USA.,Department of Anesthesiology Weill Cornel Medical Center, New York, NY, USA
| | - Louis P Voigt
- Ethics Committee Memorial Sloan Kettering Cancer Center, New York, NY, USA. .,Department of Anesthesiology, Pain and Critical Care Medicine Memorial Sloan Kettering Center, New York, NY, USA. .,Department of Medicine Memorial Sloan Kettering Center, New York, NY, USA. .,Department of Anesthesiology Weill Cornel Medical Center, New York, NY, USA. .,Department of Medicine Weill Cornell Medical Center, New York, NY, USA.
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23
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Bogaert B, Buisson V, Kozlakidis Z, Saintigny P. Organisation of cancer care in troubling times: A scoping review of expert guidelines and their implementation during the COVID-19 pandemic. Crit Rev Oncol Hematol 2022; 173:103656. [PMID: 35337970 PMCID: PMC8942466 DOI: 10.1016/j.critrevonc.2022.103656] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/15/2022] [Accepted: 03/18/2022] [Indexed: 12/12/2022] Open
Abstract
This scoping review mapped the main themes in existing expert guidelines for cancer care issued during the COVID-19 crisis from the period of March 2020-August 2021. The guidelines published during the research period principally relate to the first two waves in Europe and until the beginning of the vaccination campaign. They elaborated recommendations for cancer care reorganisation, in particular triage and quality of care issues. The article highlights the ethical, epistemological, as well as practical reasons that guidelines were not always followed to provide some lessons learned for future crises to enable better guideline development processes. We also elaborate early evidence on the impact of triage decisions and different perspectives on cancer care reorganisation from ethics and social science literature.
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Affiliation(s)
- Brenda Bogaert
- Department of Social Sciences and Humanities, Centre Léon Bérard, Lyon, France.
| | - Victoria Buisson
- Department of Social Sciences and Humanities, Centre Léon Bérard, Lyon, France.
| | - Zizis Kozlakidis
- International Agency for Research on Cancer, World Health Organization, Lyon, France.
| | - Pierre Saintigny
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France; Univ Lyon, Claude Bernard Lyon 1 University, INSERM 1052, CNRS 5286, Centre Léon Bérard, Cancer Research Center of Lyon, Lyon, France.
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24
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Harlan EA, Shuman AG. Chemotherapeutic Shortages: How Do We Prioritize? J Natl Compr Canc Netw 2022; 20:426-428. [PMID: 35390762 DOI: 10.6004/jnccn.2022.7012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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25
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Butler CR, Webster LB, Diekema DS, Gray MM, Sakata VL, Tonelli MR, Vranas KC. Perspectives of Triage Team Members Participating in Statewide Triage Simulations for Scarce Resource Allocation During the COVID-19 Pandemic in Washington State. JAMA Netw Open 2022; 5:e227639. [PMID: 35435971 PMCID: PMC9016492 DOI: 10.1001/jamanetworkopen.2022.7639] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE The COVID-19 pandemic prompted health care institutions worldwide to develop plans for allocation of scarce resources in crisis capacity settings. These plans frequently rely on rapid deployment of institutional triage teams that would be responsible for prioritizing patients to receive scarce resources; however, little is known about how these teams function or how to support team members participating in this unique task. OBJECTIVE To identify themes illuminating triage team members' perspectives and experiences pertaining to the triage process. DESIGN, SETTING, AND PARTICIPANTS This qualitative study was conducted using inductive thematic analysis of observations of Washington state triage team simulations and semistructured interviews with participants during the COVID-19 pandemic from December 2020 to February 2021. Participants included clinician and ethicist triage team members. Data were analyzed from December 2020 through November 2021. MAIN OUTCOMES AND MEASURES Emergent themes describing the triage process and experience of triage team members. RESULTS Among 41 triage team members (mean [SD] age, 50.3 [11.4] years; 21 [51.2%] women) who participated in 12 simulations and 21 follow-up interviews, there were 5 Asian individuals (12.2%) and 35 White individuals (85.4%); most participants worked in urban hospital settings (32 individuals [78.0%]). Three interrelated themes emerged from qualitative analysis: (1) understanding the broader approach to resource allocation: participants strove to understand operational and ethical foundations of the triage process, which was necessary to appreciate their team's specific role; (2) contending with uncertainty: team members could find it difficult or feel irresponsible making consequential decisions based on limited clinical and contextual patient information, and they grappled with ethically ambiguous features of individual cases and of the triage process as a whole; and (3) transforming mindset: participants struggled to disentangle narrow determinations about patients' likelihood of survival to discharge from implicit biases and other ethically relevant factors, such as quality of life. They cited the team's open deliberative process, as well as practice and personal experience with triage as important in helping to reshape their usual cognitive approach to align with this unique task. CONCLUSIONS AND RELEVANCE This study found that there were challenges in adapting clinical intuition and training to a distinctive role in the process of scarce resource allocation. These findings suggest that clinical experience, education in ethical and operational foundations of triage, and experiential training, such as triage simulations, may help prepare clinicians for this difficult role.
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Affiliation(s)
- Catherine R. Butler
- Division of Nephrology, Department of Medicine, University of Washington, Seattle
- Veterans Affairs Health Services Research and Development Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington
| | - Laura B. Webster
- Bioethics Program, Virginia Mason Medical Center, Seattle, Washington
- Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle
| | - Douglas S. Diekema
- Department of Pediatrics, University of Washington School of Medicine, Seattle
- Trueman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, Washington
| | - Megan M. Gray
- Department of Pediatrics, University of Washington School of Medicine, Seattle
| | - Vicki L. Sakata
- Department of Pediatrics, University of Washington School of Medicine, Seattle
- Northwest Healthcare Response Network, Seattle, Washington
| | - Mark R. Tonelli
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle
| | - Kelly C. Vranas
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health and Science University, Portland
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26
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Pietrini P, Lavazza A, Farina M. COVID-19 and Biomedical Experts: When Epistemic Authority is (Probably) Not Enough. JOURNAL OF BIOETHICAL INQUIRY 2022; 19:135-142. [PMID: 35038085 PMCID: PMC8762630 DOI: 10.1007/s11673-021-10157-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 06/01/2021] [Indexed: 05/07/2023]
Abstract
This critical essay evaluates the potential integration of distinct kinds of expertise in policymaking, especially during situations of critical emergencies, such as the COVID-19 pandemic. This article relies on two case studies: (i) herd immunity (UK) and (ii) restricted access to ventilators for disabled people (USA). These case studies are discussed as examples of experts' recommendations that have not been widely accepted, though they were made within the boundaries of expert epistemic authority. While the fundamental contribution of biomedical experts in devising public health policies during the COVID-19 pandemic is fully recognized, this paper intends to discuss potential issues and limitations that may arise when adopting a strict expert-based approach. By drawing attention to the interests of minorities (disenfranchized and underrepresented groups), the paper also claims a broader notion of "relevant expertise." This critical essay thus calls for the necessity of wider inclusiveness and representativeness in the process underlying public health policymaking.
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Affiliation(s)
- Pietro Pietrini
- Scuola Alti Studi Lucca, Piazza S. Francesco, 19, 55100 Lucca, LU Italy
| | - Andrea Lavazza
- Centro Universitario Internazionale, Via Antonio Garbasso 42, 52100 Arezzo, AR Italy
| | - Mirko Farina
- Institute for Humanities and Social Sciences, Universitetskaya St, 1, Innopolis, Republic of Tatarstan Russian Federation 420500
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27
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Ethical Challenges and Coping Strategies about Issues Related to The Healthcare System and Social Issues During the COVID-19 Pandemic: A Narrative Review. JORJANI BIOMEDICINE JOURNAL 2022. [DOI: 10.52547/jorjanibiomedj.10.1.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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28
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Geppert CM, Berkowitz KA, Schonfeld T, Tarzian AJ. COVID-19 Ethics Debrief: Pearls and Pitfalls of a Hub and Spoke Model. THE JOURNAL OF CLINICAL ETHICS 2022. [DOI: 10.1086/jce2022331063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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29
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Psychosocial Implications of COVID-19 on Head and Neck Cancer. Curr Oncol 2022; 29:1062-1068. [PMID: 35200589 PMCID: PMC8870852 DOI: 10.3390/curroncol29020090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/03/2022] [Accepted: 02/10/2022] [Indexed: 11/17/2022] Open
Abstract
The COVID-19 pandemic has fundamentally changed healthcare access, delivery, and treatment paradigms throughout oncology. Patients with head and neck cancer comprise an especially vulnerable population due to the nature of their disease and the transmission mechanism of the SARS-CoV-2 virus. The consequences of triage decisions and delays in care have serious psychosocial implications for patients. The development of structured psychosocial support programs, coupled with clear and consistent communication from treating physicians, can help mitigate perceptions of abandonment and distress that may accompany delays in care. As the unpredictability of the pandemic’s course continues to burden both providers and patients, we must be proactive in addressing the psychosocial implications of these delays in care.
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30
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Tong R. Towards a feminist global ethics. Glob Bioeth 2022; 33:14-31. [PMID: 35185324 PMCID: PMC8856019 DOI: 10.1080/11287462.2021.2011002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
In this article, I explain what makes a global bioethics "feminist" and why I think this development makes a better bioethics. Before defending this assertion explicitly, I engage in some preliminary work. First, I attempt to define global bioethics, showing why the so-called feminist sameness-difference debate [are men and women fundamentally the same or fundamentally different?] is of relevance to this attempt. I then discuss the difference between rights-based feminist approaches to global bioethics and care-based feminist approaches to global bioethics. Next, I agree with a significant number of feminist bioethicists that care is a more fundamental moral value and practice than justice. Finally, I conclude that feminists' insights about care, even more than rights, can bring us closer to achieving an inclusive, diverse, and fair feminist global bioethics.
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31
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Perumalswami CR, Chen E, Martin C, Goold SD, De Vries R, Griggs JJ, Jagsi R. "I'm Being Forced to Make Decisions I Have Never Had to Make Before": Oncologists' Experiences of Caring for Seriously Ill Persons With Poor Prognoses and the Dilemmas Created by COVID-19. JCO Oncol Pract 2022; 18:e89-e97. [PMID: 34324387 PMCID: PMC8758089 DOI: 10.1200/op.21.00119] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE The COVID-19 pandemic has created a new set of problems for clinicians. This study examines the experiences of oncologists providing care to seriously ill persons near the end of life in the context of the COVID-19 pandemic. METHODS Between January 2020 and August 2020, we conducted semistructured, in-depth individual interviews with 22 purposefully sampled oncologists from practices enrolled in the Michigan Oncology Quality Consortium. Deidentified transcripts of the interviews were examined using thematic analysis. RESULTS Our respondents described several novel problems created by the COVID-19 pandemic, including: (1) ethical challenges, (2) the need to manage uncertainty-physically and emotionally-on the part of both patients and oncologists, and (3) the difficulty of integrating technology and communication for seriously ill persons. These problems were made more complex by features of the pandemic: resource scarcity (and the need to fairly allocate poor resources), delays in care, high levels of fear, and the increased importance of advance care planning. Nonabandonment served as a way to cope with increased stress, and the use of telemedicine became an increasingly important medium of communication. CONCLUSION This study offers an in-depth exploration of the problems faced by oncologists as a result of the COVID-19 pandemic and how they navigated them. Optimal decision making for seriously ill persons with cancer during the COVID-19 pandemic must include open acknowledgment of the ethical challenges involved, the emotions experienced by both patients and their oncologists, and the urgent need to integrate technology with compassionate communication in determining patient preferences.
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Affiliation(s)
- Chithra R. Perumalswami
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI,Institute for Healthcare Policy and Innovation, University of Michigan Medical School, Ann Arbor, MI,Chithra R. Perumalswami, MD, MSc, Center for Bioethics and Social Sciences in Medicine, University of Michigan North Campus Research Complex, 2800 Plymouth Rd, Building 14-Room G011, Ann Arbor, MI 48109-2800; Twitter: @ChithraMD; e-mail:
| | - Emily Chen
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Carly Martin
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Susan D. Goold
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI,Institute for Healthcare Policy and Innovation, University of Michigan Medical School, Ann Arbor, MI,Department Internal Medicine, University of Michigan Medical School, Ann Arbor, MI,Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Raymond De Vries
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI,Institute for Healthcare Policy and Innovation, University of Michigan Medical School, Ann Arbor, MI,Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI
| | - Jennifer J. Griggs
- Institute for Healthcare Policy and Innovation, University of Michigan Medical School, Ann Arbor, MI,Department Internal Medicine, University of Michigan Medical School, Ann Arbor, MI,Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Reshma Jagsi
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI,Institute for Healthcare Policy and Innovation, University of Michigan Medical School, Ann Arbor, MI,Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, MI
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32
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Dittborn M, Micolich C, Rojas D, Salas SP. Ethical Challenges Experienced by Healthcare Workers Delivering Clinical Care during Health Emergencies and Disasters: A Rapid Review of Qualitative Studies and Thematic Synthesis. AJOB Empir Bioeth 2022; 13:179-195. [PMID: 35467462 PMCID: PMC9881594 DOI: 10.1080/23294515.2022.2063996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background: The COVID-19 pandemic has posed several ethical challenges worldwide. Understanding care providers' experiences during health emergencies is key to develop comprehensive ethical guidelines for emergency and disaster circumstances.Objectives: To identify and synthetize available empirical data on ethical challenges experienced by health care workers (HCWs) providing direct patient care in health emergencies and disaster scenarios that occurred prior to COVID-19, considering there might be a significant body of evidence yet to be reported on the current pandemic.Methods: A rapid review of qualitative studies and thematic synthesis was conducted. Medline and Embase were searched from inception to December 2020 using "public health emergency" and "ethical challenges" related keywords. Empirical studies examining ethical challenges experienced by frontline HCWs during health emergencies or disasters were included. We considered that ethical challenges were present when participants and/or authors were uncertain regarding how one should behave, or when different values or ethical principles are compromised when making decisions.Outcome: After deduplication 10,160 titles/abstracts and 224 full texts were screened. Twenty-two articles were included, which were conducted in 15 countries and explored eight health emergency or disaster events. Overall, a total of 452 HCWs participants were included. Data were organized into five major themes with subthemes: HCWs' vulnerability, Duty to care, Quality of care, Management of healthcare system, and Sociocultural factors.Conclusion: HCWs experienced a great variety of clinical ethical challenges in health emergencies and disaster scenarios. Core themes identified provide evidence-base to inform the development of more comprehensive and supportive ethical guidelines and training programmes for future events, that are grounded on actual experiences of those providing care during emergency and disasters.
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Affiliation(s)
- Mariana Dittborn
- Paediatric Bioethics Centre, Great Ormond Street Hospital, London, UK;,Center for Bioethics, Faculty of Medicine, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Constanza Micolich
- Palliative Care Unit, Mauricio Heyermann Hospital of Angol, Angol, Chile
| | | | - Sofía P. Salas
- Center for Bioethics, Faculty of Medicine, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
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33
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Jensen HI, Thude BR, Boye LK, Gram BV, Primdahl J, Elkjaer M, Specht K. A cross-sectional study of COVID-19 pandemic-related organizational aspects in health care. Nurs Open 2021; 9:1136-1146. [PMID: 34913276 PMCID: PMC8859060 DOI: 10.1002/nop2.1153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/29/2021] [Accepted: 11/24/2021] [Indexed: 12/20/2022] Open
Abstract
Aim This study explores how healthcare professionals included in the COVID‐19 contingency plan experienced organizational changes, and explores factors associated with the experiences. Additionally, the study aimed to identify learning points for future similar scenarios. Design A cross‐sectional study. Methods A questionnaire survey of healthcare professionals at three Danish hospitals, June 2020. Results A total of 1,448 healthcare professionals completed the questionnaire. Hereof, 813 (57%) were relocated to new settings/new jobs. The majority experienced that their relocation was totally (49%) or partially (31%) imposed, and 51% reported that the overall experience of the new job function was satisfactory. Type of profession and whether relocation to the new job function was imposed were the main variables associated with the overall experience of being part of the contingency plan. Suggestions for future scenarios included training adjusted to individual competencies, more targeted information, voluntariness with consideration of individual needs and clarification of expectations.
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Affiliation(s)
- Hanne Irene Jensen
- Department of Anaesthesiology and Intensive Care, Kolding Hospital, University Hospital of Southern Denmark, Kolding, Denmark.,Department of Anaesthesiology and Intensive Care, Vejle Hospital, University Hospital of Southern Denmark, Kolding, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Bettina Ravnborg Thude
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Medicine, Hospital of Southern Jutland, Sonderborg and Tonder, University Hospital of Southern Denmark, Kolding, Denmark
| | - Lilian Keene Boye
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Emergency Medicine, Hospital of Southern Jutland, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Bibi Valgerdur Gram
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Research Unit of Health Sciences, University hospital of Southern Denmark, Esbjerg, Denmark
| | - Jette Primdahl
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Hospital of Southern Jutland, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Mette Elkjaer
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Emergency Medicine, Hospital of Southern Jutland, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Kirsten Specht
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Orthopaedic Surgery, University Hospital of Southern Denmark, Aabenraa, Denmark
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34
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Arde BOA, Purisima EMR, Ito H, Locsin RC. Reimagining quarantine: Assuring hopefulness in nursing and healthcare. Nurs Inq 2021; 29:e12481. [PMID: 34897884 DOI: 10.1111/nin.12481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 11/27/2022]
Abstract
This article aimed to explore issues of concern related to quarantine, its social consequences and influences, challenging its effects on human behavioral expressions during social isolation. The advent of the coronavirus disease 2019 (COVID-19) pandemic impacted human lives in multifarious ways, threatening the meaning of normalcy. Quarantine, lockdown, isolation, and other terms reflecting conditions limiting human freedoms have become synonymous in importance to safety, security, and survival. To understand human defiance in the face of maintaining limited mobility during the COVID-19 pandemic, reimagining situations of "unfreedoms" is explained as thinking of changes to inspire and improve the meaning of living lives meaningfully. During the pandemic, issues regarding healthcare practices and social behaviors focused much attention on interactive challenges that enhance ways to mitigate the spread of contagious diseases. Illuminating these issues, discussing concerns and highlighting recommendations to engage in alternative approaches and practices, heightens the declaration of efficiency of quarantine outcomes and effectiveness. Implications are proposed with the hope that they may lead the way forward in exercising contemporary healthcare practices.
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Affiliation(s)
| | | | - Hirokazu Ito
- Faculty of Health Sciences, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Rozzano C Locsin
- Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan.,Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
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35
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Suryadi T, Sarjani S, Kulsum K. Resolution of Ethical Dilemmas Using Basic Ethical Principles in Cases of Pregnancy with Severe Symptoms of Coronavirus Disease 2019 Complications. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Coronavirus disease 2019 (COVID-19) can attack the entire population, but is more aggressive in vulnerable populations such as the elderly, patients with chronic diseases, and pregnant women. For pregnant women, the management of COVID-19 treatment provided must be in line with efforts to reduce maternal mortality. The method of this study was a case report. A pregnant woman aged 40 years who was confirmed with severe COVID-19 symptoms. This patient had severe symptomatic hypoxemia and had a hypercoagulable state. Termination of pregnancy in patients is considered for the sake of fetomaternal safety so that an ethical dilemma arises. For this reason, a joint conference was held to get the best solution for the patient and the fetus.
CASE REPORT: Using several basic ethical principles such as beneficence, nonmaleficence, justice, and autonomy, which are supported by the principles of minus malum, double effect, and prima facie, it was decided for the patient to terminate pregnancy to reduce severe symptoms of COVID-19. Termination of pregnancy in pregnant women with confirmed COVID-19 with severe symptoms is still an ethical dilemma that needs to be discussed further. Therefore, ethical considerations in this patient were carried out by reviewing obstetric, pediatric, pulmonology, anesthesia, and internal medicine indications.
CONCLUSION: Termination of pregnancy in this patient with confirmed COVID-19 with severe symptoms can be done. Although termination of pregnancy has not completely saved the mother’s condition, this decision has the potential to provide benefits and safety for the patient and the fetus.
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36
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Westerduin D, Dujardin J, Schuurmans J, Engels Y, Wichmann AB. Making complex decisions in uncertain times: experiences of Dutch GPs as gatekeepers regarding hospital referrals during COVID-19-a qualitative study. BMC Med Ethics 2021; 22:158. [PMID: 34847897 PMCID: PMC8631560 DOI: 10.1186/s12910-021-00725-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 11/11/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND General practitioners often act as gatekeeper, authorizing patients' access to hospital care. This gatekeeping role became even more important during the current COVID-19 crisis as uncertainties regarding COVID-19 made estimating the desirability of hospital referrals (for outpatient or inpatient hospitalization) complex, both for COVID and non-COVID suspected patients. This study explored Dutch general practitioners' experiences and ethical dilemmas faced in decision making about hospital referrals in times of the COVID-19 pandemic. METHODS Semi-structured interviews with Dutch general practitioners working in the Netherlands were conducted. Participants were recruited via purposive sampling. Thematic analysis was conducted using content coding. RESULTS Fifteen interviews were conducted, identifying four themes: one overarching regarding (1) COVID-19 uncertainties, and three themes about experienced ethical dilemmas: (2) the patients' self-determination vs. the general practitioners' paternalism, (3) the general practitioners' duty of care vs. the general practitioners' autonomy rights, (4) the general practitioners' duty of care vs. adequate care provision. CONCLUSIONS Lack of knowledge about COVID-19, risks to infect loved ones, scarcity of hospital beds and loneliness of patients during hospital admission were central in dilemmas experienced. When developing guidelines for future crises, this should be taken into account.
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Affiliation(s)
- Dieke Westerduin
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Janneke Dujardin
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jaap Schuurmans
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Yvonne Engels
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anne B Wichmann
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
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Ruiz-Hornillos J, Hernández Suárez P, Marín Martínez JM, de Miguel Beriain Í, Nieves Vázquez MA, Albert M, Herrera Abián M, Pacheco-Martínez PA, Trasmontes V, Guillén-Navarro E. Bioethical Concerns During the COVID-19 Pandemic: What Did Healthcare Ethics Committees and Institutions State in Spain? Front Public Health 2021; 9:737755. [PMID: 34722445 PMCID: PMC8548706 DOI: 10.3389/fpubh.2021.737755] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/16/2021] [Indexed: 11/26/2022] Open
Abstract
Objectives: Each new wave of the COVID-19 pandemic invites the possible obligation to prioritize individuals' access to vital resources, and thereby leads to unresolved and important bioethical concerns. Governments have to make decisions to protect access to the health system with equity. The prioritization criteria during a pandemic are both a clinical and legal-administrative decision with ethical repercussion. We aim to analyse the prioritization protocols used in Spain during the pandemic which, in many cases, have not been updated. Method: We carried out a narrative review of 27 protocols of prioritization proposed by healthcare ethics committees, scientific societies and institutions in Spain for this study. The review evaluated shared aspects and unique differences and proffered a bioethical reflection. Results: The research questions explored patient prioritization, the criteria applied and the relative weight assigned to each criterion. There was a need to use several indicators, being morbidity and mortality scales the most commonly used, followed by facets pertaining to disease severity and functional status. Although age was initially considered in some protocols, it cannot be the sole criterion used when assigning care resources. Conclusions: In COVID-19 pandemic there is a need for a unified set of criteria that guarantees equity and transparency in decision-making processes. Establishing treatment indications is not the aim of such criteria, but instead prioritizing access to care resources. In protocols of prioritization, the principle of efficiency must vary according to the principle of equity and the criteria used to guarantee such equity.
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Affiliation(s)
- Javier Ruiz-Hornillos
- Departamento de Bioética Clínica, Hospital Universitario Infanta Elena, Madrid, Spain.,Instituto de Investigación Sanitaria, Fundación Jiménez Díaz (IIS-FJD), Madrid, Spain.,Facultad de Medicina de la Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - Pilar Hernández Suárez
- Comité de Ética Asistencial, Comité de Ética de Investigación con Medicamentos, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Juana María Marín Martínez
- Servicio de Urgencias del Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.,Presidente Comité de Ética del Área i del Servicio Murciano de Salud, Murcia, Spain.,Consejo Asesor Regional de Ética Asistencial de Murcia (CAREA), Murcia, Spain
| | - Íñigo de Miguel Beriain
- Facultad de Derecho, Universidad del País Vasco, EuskalHerriko Uniberstiatea, Vizcaya, Spain
| | - María Auxiliadora Nieves Vázquez
- Instituto de Investigación Sanitaria, Fundación Jiménez Díaz (IIS-FJD), Madrid, Spain.,Comité de Ética Asistencial Fundación Jiménez Díaz, Madrid, Spain
| | | | - María Herrera Abián
- Departamento de Bioética Clínica, Hospital Universitario Infanta Elena, Madrid, Spain.,Instituto de Investigación Sanitaria, Fundación Jiménez Díaz (IIS-FJD), Madrid, Spain.,Facultad de Medicina de la Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - Pedro A Pacheco-Martínez
- Departamento de Bioética Clínica, Hospital Universitario Infanta Elena, Madrid, Spain.,Instituto de Investigación Sanitaria, Fundación Jiménez Díaz (IIS-FJD), Madrid, Spain.,Facultad de Medicina de la Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | | | - Encarna Guillén-Navarro
- Sección de Genética Médica, S. Pediatría, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Universidad de Murcia, CIBERER-ISCIII, Murcia, Spain.,Comité de Bioética de España, Madird, Spain
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38
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Froessl LJ, Abdeen Y. The Silent Pandemic: The Psychological Burden on Frontline Healthcare Workers during COVID-19. PSYCHIATRY JOURNAL 2021; 2021:2906785. [PMID: 34631873 PMCID: PMC8497139 DOI: 10.1155/2021/2906785] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 09/14/2021] [Indexed: 01/06/2023]
Abstract
This narrative review explores the full scope of harmful psychological effects of the COVID-19 (Coronavirus Disease of 2019) pandemic on FLHCWs (Frontline healthcare workers). Additionally, we highlight the risk factors for worse outcomes. A literature review identified 24 relevant papers included in this synthesis. The majority of studies reported a high number of mental health conditions in HCWs (Healthcare workers) overall. Working in the frontline setting was repeatedly identified as an independent risk factor for poorer mental health. Additional risk factors, such as gender, occupational pressure, and low level of support from hospital administration, family, and the community, were also commonly identified. In the past, defined interventions have been shown to mitigate the psychological impact of high-stress situations on frontline workers. This review is aimed at identifying individuals at higher risk to help effectively target preventative measures in future stress situations in our healthcare system.
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Affiliation(s)
- Luise J. Froessl
- Pulmonary and Sleep Physicians of Houston, P.A. 501 Orchard Street, Webster, TX 77589, USA
| | - Yazan Abdeen
- Pulmonary and Sleep Physicians of Houston, P.A. 501 Orchard Street, Webster, TX 77589, USA
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39
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Moodley K, Kabanda SM, Kleinsmidt A, Obasa AE. COVID-19 underscores the important role of Clinical Ethics Committees in Africa. BMC Med Ethics 2021; 22:131. [PMID: 34563181 PMCID: PMC8465788 DOI: 10.1186/s12910-021-00696-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 08/13/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has magnified pre-existing challenges in healthcare in Africa. Long-standing health inequities, embedded in the continent over centuries, have been laid bare and have raised complex ethical dilemmas. While there are very few clinical ethics committees (CECs) in Africa, the demand for such services exists and has increased during the COVID-19 pandemic. The views of African healthcare professionals or bioethicists on the role of CECs in Africa have not been explored or documented previously. In this study, we aim to explore such perspectives, as well as the challenges preventing the establishment of CECs in Africa. METHODS Twenty healthcare professionals and bioethicists from Africa participated in this qualitative study that utilized in-depth semi-structured interviews with open-ended questions. Themes were identified through thematic analysis of interviews and open-ended responses. RESULTS Kenya and South Africa are the only countries on the continent with formal established CECs. The following themes emerged from this qualitative study: (1) Lack of formal CECs and resolution of ethical dilemmas; (2) Role of CECs during COVID-19; (3) Ethical dilemmas presented to CECs pre-COVID-19; (4) Lack of awareness of CECs; (5) Lack of qualified bioethicists or clinical ethicists; (6) Limited resources to establish CECs; (7) Creating interest in CECs and networking. CONCLUSIONS This study illustrates the importance of clinical ethics education among African HCPs and bioethicists, more so now when COVID-19 has posed a host of clinical and ethical challenges to public and private healthcare systems. The challenges and barriers identified will inform the establishment of CECs or clinical ethics consultation services (CESs) in the region. The study results have triggered an idea for the creation of a network of African CECs.
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Affiliation(s)
- Keymanthri Moodley
- Department of Medicine, Centre for Medical Ethics and Law, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Siti Mukaumbya Kabanda
- Department of Medicine, Centre for Medical Ethics and Law, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Anita Kleinsmidt
- Department of Medicine, Centre for Medical Ethics and Law, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Adetayo Emmanuel Obasa
- Department of Medicine, Centre for Medical Ethics and Law, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
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40
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Almutairi AF, BaniMustafa A, Alessa YM, Alahmad G. Who should receive treatment? Healthcare professionals' perspectives surrounding the medical management of patients with COVID-19. Risk Manag Healthc Policy 2021; 14:3659-3666. [PMID: 34512053 PMCID: PMC8420774 DOI: 10.2147/rmhp.s325312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/19/2021] [Indexed: 11/23/2022] Open
Abstract
Background The COVID-19 pandemic has resulted in unprecedented challenges for healthcare systems worldwide. This pandemic is much more than a health crisis; it has also raised many ethical challenges. The large number of infected patients amid scarce resources has placed healthcare professionals in a critical situation in which they have to make difficult decisions about how to prioritize their patients. Therefore, the aim of this study is to explore the ethical challenges experienced and perceived by healthcare professionals working in healthcare institutions and research centers in Saudi Arabia. Methods Semi-structured face-to-face interviews were conducted individually with frontline healthcare providers (physicians and nurses), researchers, and decision-makers involved in the management of COVID-19 cases. Each interview lasted up to 90 minutes. The thematic analysis technique was used to analyse the interview data. Findings The participants’ rich experiences, which revealed a number of ethical challenges concerning the provision of medical care to infected patients, were framed around four main themes: treatment challenges related to COVID-19 patients, uncertainty of the medical outcome, medical care discrimination, and decision to discontinue medical treatment. Conclusion The COVID-19 pandemic has posed huge ethical challenges for healthcare professionals that might lead to psychological issues given the emotional toll related to making life-and-death decisions. Recommendation In a situation where no reliable and certain treatment is known or well tested, establishing centralized and responsive ethical committees could help reassure and guide practitioners and address their concerns.
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Affiliation(s)
- Adel F Almutairi
- Science and Technology Unit, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Ala'a BaniMustafa
- Science and Technology Unit, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Yousef M Alessa
- Science and Technology Unit, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Ghiath Alahmad
- Biomedical Ethics, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
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41
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Lainjo B. The Enigmatic COVID-19 Vulnerabilities and the Invaluable Artificial Intelligence (AI). J Multidiscip Healthc 2021; 14:2361-2372. [PMID: 34475763 PMCID: PMC8407667 DOI: 10.2147/jmdh.s321751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/16/2021] [Indexed: 11/24/2022] Open
Abstract
The objective of the study is to conduct an exploratory review of the Covid-19 pandemic by focusing on the theme of Covid-19 pandemic morbidity and mortality, considering the dynamics of artificial intelligence and quality of life (QOL). The methods used in this research paper include a review of literature, anecdotal evidence, and reports on the morbidity of COVID-19, including the scope of its devastating effects in different countries such as the US, Africa, UK, China, and Brazil, among others. The findings of this study suggested that the devastating effects of the coronavirus are felt across different vulnerable populations. These include the elderly, front-line workers, marginalized communities, visible minorities, and more. The challenge in Africa is especially daunting because of inadequate infrastructure, and financial and human resources, among others. Besides, AI technology is being successfully used by scientists to enhance the development process of vaccines and drugs. However, its usage in other stages of the pandemic has not been adequately explored. Ultimately, it has been concluded that the effects of the Covid-19 are producing unprecedented and catastrophic outcomes in many countries. With a few exceptions, the common and current intervention approach is driven by many factors, including the compilation of relevant reliable and compelling data sets. On a positive note, the compelling trailblazing and catalytic contributions of AI towards the rapid discovery of COVID-19 vaccines are a good indication of future technological innovations and their effectiveness.
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42
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Varley E, Varma S. Introduction: medicine's shadowside: revisiting clinical iatrogenesis. Anthropol Med 2021; 28:141-155. [PMID: 34355978 DOI: 10.1080/13648470.2021.1937514] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Drawing on the work of Ivan Illich, our special issue reanimates iatrogenesis as a vital concept for the social sciences of medicine. It calls for medicine to expand its engagement of the injustices that unfold from clinical processes, practices, and protocols into patient lifeworlds and subjectivities beyond the clinic. The capacious view of iatrogenesis revealed by this special issue collection affords fuller and more heterogeneous insights on iatrogenesis that does not limit it to medical explanations alone, nor locate harm in singular points in time. These papers attend to iatrogenesis' immediate and lingering presences in socialities and structures within and beyond medicine, and the ways it reflects or reproduces the racism, sexism, and ableism built into medical logics.
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Affiliation(s)
- Emma Varley
- Anthropology, Brandon University, Brandon, Manitoba, Canada
| | - Saiba Varma
- Anthropology, University of California, San Diego, La Jolla, CA, USA
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43
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Saleh BM, Aly EM, Hafiz M, Abdel Gawad RM, El Kheir-Mataria WA, Salama M. Ethical Dimensions of Public Health Actions and Policies With Special Focus on COVID-19. Front Public Health 2021; 9:649918. [PMID: 34409003 PMCID: PMC8365183 DOI: 10.3389/fpubh.2021.649918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/24/2021] [Indexed: 01/10/2023] Open
Abstract
During pandemics, the ethicists, public health professionals, and human rights advocates raise a red flag about different public health actions that should, at best, be addressed through integrated, global policies. How to rationalize the healthcare resources and prioritize the cases is not a recent challenge but the serious concern about that is how to achieve this while not increasing the vulnerability of the disadvantaged population. Healthcare professionals use different scoring systems as a part of their decision-making so the medical teams and triage committees can allocate resources for predictable health outcomes and prognosis as well as to appropriately triage the patients accordingly. However, the value of the existing scoring systems to manage COVID-19 cases is not well-established yet. Part of this problem includes managing non-COVID patients with chronic medical conditions like non-communicable diseases and addressing their medical needs during the pandemic complex context in a way to avoid worsening their conditions and, on the other hand, avoid hindering the establishment of comprehensive standards for dealing with COVID-19. In this article, we discuss this dilemma as well as how preexisting ethical standards were challenged by COVID-19. We also discuss how monitoring the consistent application of ethical standards during the medical trials of new medications, vaccines, or unproven medical interventions is also a critical issue.
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Affiliation(s)
- Basma M. Saleh
- Institute of Global Health and Human Ecology, School of Science and Engineering, The American University in Cairo, Cairo, Egypt
| | - Eman Mohamed Aly
- Institute of Global Health and Human Ecology, School of Science and Engineering, The American University in Cairo, Cairo, Egypt
| | - Marwa Hafiz
- Institute of Global Health and Human Ecology, School of Science and Engineering, The American University in Cairo, Cairo, Egypt
| | - Rana M. Abdel Gawad
- Institute of Global Health and Human Ecology, School of Science and Engineering, The American University in Cairo, Cairo, Egypt
| | - Wafa Abu El Kheir-Mataria
- Institute of Global Health and Human Ecology, School of Science and Engineering, The American University in Cairo, Cairo, Egypt
| | - Mohamed Salama
- Institute of Global Health and Human Ecology, School of Science and Engineering, The American University in Cairo, Cairo, Egypt
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
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44
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Folayan MO, Ibigbami O, El Tantawi M, Brown B, Aly NM, Ezechi O, Abeldaño GF, Ara E, Ayanore MA, Ellakany P, Gaffar B, Al-Khanati NM, Idigbe I, Ishabiyi AO, Jafer M, Khan ATA, Khalid Z, Lawal FB, Lusher J, Nzimande NP, Osamika BE, Quadri MFA, Roque M, Al-Tammemi AB, Yousaf MA, Virtanen JI, Zuñiga RAA, Okeibunor JC, Nguyen AL. Factors Associated with Financial Security, Food Security and Quality of Daily Lives of Residents in Nigeria during the First Wave of the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7925. [PMID: 34360217 PMCID: PMC8345729 DOI: 10.3390/ijerph18157925] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/16/2021] [Accepted: 07/18/2021] [Indexed: 12/19/2022]
Abstract
An online survey was conducted to identify factors associated with financial insecurity, food insecurity and poor quality of daily lives of adults in Nigeria during the first wave of the COVID-19 pandemic. The associations between the outcome (experience of financial loss, changes in food intake and impact of the pandemic on daily lives) and the explanatory (age, sex, education level, anxiety, depression, HIV status) variables were determined using logistic regression analysis. Of the 4439 respondents, 2487 (56.0%) were financially insecure, 907 (20.4%) decreased food intake and 4029 (90.8%) had their daily life negatively impacted. Males (AOR:0.84), people who felt depressed (AOR:0.62) and people living with HIV -PLHIV- (AOR:0.70) had significantly lower odds of financial insecurity. Older respondents (AOR:1.01) had significantly higher odds of financial insecurity. Those depressed (AOR:0.62) and PLHIV (AOR:0.55) had significantly lower odds of reporting decreased food intake. Respondents who felt anxious (AOR:0.07), depressed (AOR: 0.48) and who were PLHIV (AOR:0.68) had significantly lower odds of reporting a negative impact of the pandemic on their daily lives. We concluded the study findings may reflect a complex relationship between financial insecurity, food insecurity, poor quality of life, mental health, and socioeconomic status of adults living in Nigeria during the COVID-19 pandemic.
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Affiliation(s)
- Morenike Oluwatoyin Folayan
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife 220282, Nigeria
| | - Olanrewaju Ibigbami
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Mental Health, Obafemi Awolowo University, Ile-Ife 220282, Nigeria
| | - Maha El Tantawi
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria 21527, Egypt
| | - Brandon Brown
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Social Medicine, Population and Public Health, School of Medicine, University of California, Riverside, CA 92501, USA
| | - Nourhan M. Aly
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria 21527, Egypt
| | - Oliver Ezechi
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Clinical Sciences, Nigerian Institute of Medical Research, Lagos 101212, Nigeria
| | - Giuliana Florencia Abeldaño
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Institute for Research on Public Health, School of Medicine, University of Sierra Sur, Oaxaca 70805, Mexico
| | - Eshrat Ara
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Government College for Women, Moulana Azad Road, Srinagar Kashmir, J&K 190001, India
| | - Martin Amogre Ayanore
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Health Policy Planning and Management, University of Health and Allied Sciences, PMB 31 Ho, Ghana
| | - Passent Ellakany
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Substitutive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Balgis Gaffar
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Preventive Dentistry, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Nuraldeen Maher Al-Khanati
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Syrian Private University, Damascus 36822, Syria
| | - Ifeoma Idigbe
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Clinical Sciences, Nigerian Institute of Medical Research, Lagos 101212, Nigeria
| | - Anthonia Omotola Ishabiyi
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4001, South Africa
| | - Mohammed Jafer
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Preventive Dental Sciences, Faculty of Dentistry, Jazan University, Jazan 45142, Saudi Arabia
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Abeedha Tu-Allah Khan
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- School of Biological Sciences, University of the Punjab, Quaid-i-Azam Campus, Lahore 54590, Pakistan
| | - Zumama Khalid
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- School of Biological Sciences, University of the Punjab, Quaid-i-Azam Campus, Lahore 54590, Pakistan
| | - Folake Barakat Lawal
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Periodontology and Community Dentistry, University of Ibadan, Ibadan 200212, Nigeria
| | - Joanne Lusher
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- School of Health and Life Sciences, University of the West of Scotland, London E142BE, UK
| | - Ntombifuthi P. Nzimande
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Economic and Human Geography, Faculty of Geosciences, University of Szeged, H-6722 Szeged, Hungary
| | - Bamidele Emmanuel Osamika
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Psychology, Faculty of Environment, Management and Social Sciences, Lead City University, Ibadan 200255, Nigeria
| | - Mir Faeq Ali Quadri
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Division of Dental Public Health, Department of Preventive Dentistry, Jazan University, Jazan 45142, Saudi Arabia
| | - Mark Roque
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Maternity & Childhood Nursing, College of Nursing, Taibah University, Madinah 42223, Saudi Arabia
| | - Ala’a B. Al-Tammemi
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Family and Occupational Medicine, Faculty of Medicine, Doctoral School of Health Sciences, University of Debrecen, H-4032 Debrecen, Hungary
| | - Muhammad Abrar Yousaf
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Institute of Zoology, University of the Punjab, Quaid-i-Azam Campus, Lahore 54590, Pakistan
| | - Jorma I. Virtanen
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Faculty of Medicine, University of Turku, FI-20014 Turku, Finland
| | - Roberto Ariel Abeldaño Zuñiga
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Post Graduate School, University of Sierra Sur, Oaxaca 70800, Mexico
| | - Joseph Chukwudi Okeibunor
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Research Development and Innovations, Assistant Regional Director Cluster, WHO Regional Office for Africa, Brazzaville BP 06, Congo
| | - Annie Lu Nguyen
- Mental Health and Wellness Study Group, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (O.I.); (M.E.T.); (B.B.); (N.M.A.); (O.E.); (G.F.A.); (E.A.); (M.A.A.); (P.E.); (B.G.); (N.M.A.-K.); (I.I.); (A.O.I.); (M.J.); (A.T.-A.K.); (Z.K.); (F.B.L.); (J.L.); (N.P.N.); (B.E.O.); (M.F.A.Q.); (M.R.); (A.B.A.-T.); (M.A.Y.); (J.I.V.); (R.A.A.Z.); (J.C.O.); (A.L.N.)
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 91803, USA
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Developing a sampling method and preliminary taxonomy for classifying COVID-19 public health guidance for healthcare organizations and the general public. J Biomed Inform 2021; 120:103852. [PMID: 34192573 PMCID: PMC8236411 DOI: 10.1016/j.jbi.2021.103852] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 05/09/2021] [Accepted: 06/24/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Development and dissemination of public health (PH) guidance to healthcare organizations and the general public (e.g., businesses, schools, individuals) during emergencies like the COVID-19 pandemic is vital for policy, clinical, and public decision-making. Yet, the rapidly evolving nature of these events poses significant challenges for guidance development and dissemination strategies predicated on well-understood concepts and clearly defined access and distribution pathways. Taxonomies are an important but underutilized tool for guidance authoring, dissemination and updating in such dynamic scenarios. OBJECTIVE To design a rapid, semi-automated method for sampling and developing a PH guidance taxonomy using widely available Web crawling tools and streamlined manual content analysis. METHODS Iterative samples of guidance documents were taken from four state PH agency websites, the US Center for Disease Control and Prevention, and the World Health Organization. Documents were used to derive and refine a preliminary taxonomy of COVID-19 PH guidance via content analysis. RESULTS Eight iterations of guidance document sampling and taxonomy revisions were performed, with a final corpus of 226 documents. The preliminary taxonomy contains 110 branches distributed between three major domains: stakeholders (24 branches), settings (25 branches) and topics (61 branches). Thematic saturation measures indicated rapid saturation (≤5% change) for the domains of "stakeholders" and "settings", and "topic"-related branches for clinical decision-making. Branches related to business reopening and economic consequences remained dynamic throughout sampling iterations. CONCLUSION The PH guidance taxonomy can support public health agencies by aligning guidance development with curation and indexing strategies; supporting targeted dissemination; increasing the speed of updates; and enhancing public-facing guidance repositories and information retrieval tools. Taxonomies are essential to support knowledge management activities during rapidly evolving scenarios such as disease outbreaks and natural disasters.
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Symons X, Matthews S, Tobin B. Why should HCWs receive priority access to vaccines in a pandemic? BMC Med Ethics 2021; 22:79. [PMID: 34176474 PMCID: PMC8236218 DOI: 10.1186/s12910-021-00650-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 06/17/2021] [Indexed: 11/29/2022] Open
Abstract
Background Viral pandemics present a range of ethical challenges for policy makers, not the least among which are difficult decisions about how to allocate scarce healthcare resources. One important question is whether healthcare workers (HCWs) should receive priority access to a vaccine in the event that an effective vaccine becomes available. This question is especially relevant in the coronavirus pandemic with governments and health authorities currently facing questions of distribution of COVID-19 vaccines. Main text In this article, we critically evaluate the most common ethical arguments for granting healthcare workers priority access to a vaccine. We review the existing literature on this topic, and analyse both deontological and utilitarian arguments in favour of HCW prioritisation. For illustrative purposes, we focus in particular on the distribution of a COVID-19 vaccine. We also explore some practical complexities attendant on arguments in favour of HCW prioritisation. Conclusions We argue that there are deontological and utilitarian cases for prioritising HCWs. Indeed, the widely held view that we should prioritise HCWs represents an example of ethical convergence. Complexities arise, however, when considering who should be included in the category of HCW, and who else should receive priority in addition to HCWs.
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Affiliation(s)
- Xavier Symons
- Plunkett Centre for Ethics, Australian Catholic University, 7 Ice Street, Darlinghurst, NSW, 2010, Australia.
| | - Steve Matthews
- Plunkett Centre for Ethics, Australian Catholic University, 7 Ice Street, Darlinghurst, NSW, 2010, Australia.,Thomas More Law School, Level 7, 486 Albert Street, East Melbourne, 3002, Australia
| | - Bernadette Tobin
- Plunkett Centre for Ethics, Australian Catholic University, 7 Ice Street, Darlinghurst, NSW, 2010, Australia
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Barriers and Facilitators of Nurses' and Physicians' Willingness to Work during a Respiratory Disease Outbreak: A Mixed-Methods Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136841. [PMID: 34202234 PMCID: PMC8296986 DOI: 10.3390/ijerph18136841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 11/17/2022]
Abstract
This review was undertaken to identify the perceived barriers and facilitators of nurses’ and physicians’ willingness to work during a respiratory disease outbreak. This mixed-methods systematic review involved the extraction of data from the electronic databases PubMed, Web of Science, CINAHL, and PsycINFO and from a manual search of articles published between 2003 and April 2021. The quality of the included studies was assessed using a mixed-method appraisal tool. A total of 29 studies were eligible for inclusion: 21 quantitative and 8 qualitative. Using the Integrated Behavioral Model, perceived barriers and facilitators were identified under seven categories: demographics, attitude, perceived norm, personal agency, knowledge and skills to perform the behavior, environmental constraints, and habit. The results of this study broaden the understanding of various factors that affect nurses’ and physicians’ willingness to work during a respiratory disease outbreak. These findings will facilitate the modification of current pandemic workplace staffing strategies and practices and will inform preparedness planning for similar situations in the future.
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Vinay R, Baumann H, Biller-Andorno N. Ethics of ICU triage during COVID-19. Br Med Bull 2021; 138:5-15. [PMID: 34057458 PMCID: PMC8195142 DOI: 10.1093/bmb/ldab009] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/25/2021] [Accepted: 03/17/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The coronavirus disease 2019 pandemic has placed intensive care units (ICU) triage at the center of bioethical discussions. National and international triage guidelines emerged from professional and governmental bodies and have led to controversial discussions about which criteria-e.g. medical prognosis, age, life-expectancy or quality of life-are ethically acceptable. The paper presents the main points of agreement and disagreement in triage protocols and reviews the ethical debate surrounding them. SOURCES OF DATA Published articles, news articles, book chapters, ICU triage guidelines set out by professional societies and health authorities. AREAS OF AGREEMENT Points of agreement in the guidelines that are widely supported by ethical arguments are (i) to avoid using a first come, first served policy or quality-adjusted life-years and (ii) to rely on medical prognosis, maximizing lives saved, justice as fairness and non-discrimination. AREAS OF CONTROVERSY Points of disagreement in existing guidelines and the ethics literature more broadly regard the use of exclusion criteria, the role of life expectancy, the prioritization of healthcare workers and the reassessment of triage decisions. GROWING POINTS Improve outcome predictions, possibly aided by Artificial intelligence (AI); develop participatory approaches to drafting, assessing and revising triaging protocols; learn from experiences with implementation of guidelines with a view to continuously improve decision-making. AREAS TIMELY FOR DEVELOPING RESEARCH Examine the universality vs. context-dependence of triaging principles and criteria; empirically test the appropriateness of triaging guidelines, including impact on vulnerable groups and risk of discrimination; study the potential and challenges of AI for outcome and preference prediction and decision-support.
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Affiliation(s)
- Rasita Vinay
- Institute of Biomedical Ethics and History of Medicine, Faculty of Medicine, University of Zurich, Winterthurerstrasse 30, 8006 Zurich, Switzerland
| | - Holger Baumann
- Institute of Biomedical Ethics and History of Medicine, Faculty of Medicine, University of Zurich, Winterthurerstrasse 30, 8006 Zurich, Switzerland.,Department of Philosophy, Zollikerstrasse 117, 8008 Zurich, Switzerland
| | - Nikola Biller-Andorno
- Institute of Biomedical Ethics and History of Medicine, Faculty of Medicine, University of Zurich, Winterthurerstrasse 30, 8006 Zurich, Switzerland
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Odeh M, Kharbat FF, Yousef R, Odeh Y, Tbaishat D, Hakooz N, Dajani R, Mansour A. iOntoBioethics: A Framework for the Agile Development of Bioethics Ontologies in Pandemics, Applied to COVID-19. Front Med (Lausanne) 2021; 8:619978. [PMID: 34095160 PMCID: PMC8175792 DOI: 10.3389/fmed.2021.619978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/29/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Few ontological attempts have been reported for conceptualizing the bioethics domain. In addition to limited scope representativeness and lack of robust methodological approaches in driving research design and evaluation of bioethics ontologies, no bioethics ontologies exist for pandemics and COVID-19. This research attempted to investigate whether studying the bioethics research literature, from the inception of bioethics research publications, facilitates developing highly agile, and representative computational bioethics ontology as a foundation for the automatic governance of bioethics processes in general and the COVID-19 pandemic in particular. Research Design: The iOntoBioethics agile research framework adopted the Design Science Research Methodology. Using systematic literature mapping, the search space resulted in 26,170 Scopus indexed bioethics articles, published since 1971. iOntoBioethics underwent two distinctive stages: (1) Manually Constructing Bioethics (MCB) ontology from selected bioethics sources, and (2) Automatically generating bioethics ontological topic models with all 26,170 sources and using special-purpose developed Text Mining and Machine-Learning (TM&ML) engine. Bioethics domain experts validated these ontologies, and further extended to construct and validate the Bioethics COVID-19 Pandemic Ontology. Results: Cross-validation of the MCB and TM&ML bioethics ontologies confirmed that the latter provided higher-level abstraction for bioethics entities with well-structured bioethics ontology class hierarchy compared to the MCB ontology. However, both bioethics ontologies were found to complement each other forming a highly comprehensive Bioethics Ontology with around 700 concepts and associations COVID-19 inclusive. Conclusion:The iOntoBioethics framework yielded the first agile, semi-automatically generated, literature-based, and domain experts validated General Bioethics and Bioethics Pandemic Ontologies Operable in COVID-19 context with readiness for automatic governance of bioethics processes. These ontologies will be regularly and semi-automatically enriched as iOntoBioethics is proposed as an open platform for scientific and healthcare communities, in their infancy COVID-19 learning stage. iOntoBioethics not only it contributes to better understanding of bioethics processes, but also serves as a bridge linking these processes to healthcare systems. Such big data analytics platform has the potential to automatically inform bioethics governance adherence given the plethora of developing bioethics and COVID-19 pandemic knowledge. Finally, iOntoBioethics contributes toward setting the first building block for forming the field of “Bioethics Informatics”.
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Affiliation(s)
- Mohammed Odeh
- Cancer Care Informatics Programme, King Hussein Cancer Center (KHCC), Amman, Jordan.,Faculty of Environment and Technology, University of the West of England, Bristol, United Kingdom
| | - Faten F Kharbat
- Software Engineering and Computer Science Department, College of Engineering, Al Ain University, Abu Dhabi, United Arab Emirates
| | - Rana Yousef
- Computer Information Systems Department, King Abdullah II School for Information Technology (KASIT), The University of Jordan, Amman, Jordan
| | - Yousra Odeh
- Software Engineering Department, Faculty of Information Technology (FIT), Applied Science Private University, Amman, Jordan
| | - Dina Tbaishat
- Library and Information Science Department, University of Jordan, Amman, Jordan
| | - Nancy Hakooz
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, University of Jordan, Amman, Jordan
| | - Rana Dajani
- Department of Biology and Biotechnology, Hashemite University, Zarqa, Jordan.,Jepson School of Leadership, University of Richmond, Richmond, VA, United States
| | - Asem Mansour
- Cancer Care Informatics Programme, King Hussein Cancer Center (KHCC), Amman, Jordan
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Ditwiler RE, Swisher LL, Hardwick DD. Professional and Ethical Issues in United States Acute Care Physical Therapists Treating Patients With COVID-19: Stress, Walls, and Uncertainty. Phys Ther 2021; 101:6267722. [PMID: 33956143 PMCID: PMC8136052 DOI: 10.1093/ptj/pzab122] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/23/2021] [Accepted: 04/14/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To the authors' knowledge, no peer-reviewed research has explored professional and ethical issues encountered by physical therapists in treating patients with COVID-19. The purpose of this study was to explore the experiences of physical therapists regarding the professional and ethical issues they encountered during the COVID-19 pandemic. METHODS The current study used reflexive thematic analysis, a qualitative research design developed by Braun and Clarke, to analyze individual interviews. RESULTS Analysis of the coded interviews produced 6 primary themes (uncertainty, physical therapist's role, ethical dilemmas and moral distress, emotions, providing care and working conditions, and management and leadership influence) and associated subthemes. CONCLUSION Physical therapists reported numerous professional and ethical issues across the individual, organizational, and societal realms during the COVID-19 pandemic. This study highlights the need for education and resources to prepare physical therapists for professional and ethical issues encountered during pandemics. Specifically, there is a need to define the physical therapist's role in pandemics and prepare physical therapy personnel for dealing with ethical issues, stress, uncertainty, and organizational changes associated with pandemics. Ethical guidelines would support organizations in delineating fair processes for triage and allocation of scarce resources for acute care physical therapy during health care emergencies. IMPACT The COVID-19 pandemic has produced significant changes in health care and physical therapist practice. This study reports results of the first, to our knowledge, research study focusing on professional and ethical issues experienced by physical therapists in acute care during the COVID-19 pandemic. As the United States faces an unprecedented spike in COVID-19 cases and deaths, results of this study may contribute to physical therapists' preparation for and response to professional and ethical issues encountered in acute care during the pandemic.
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Affiliation(s)
- Rebecca E Ditwiler
- Address all correspondence to R. E. Ditwiler, PT, DPT, OCS, Associate Professor, School of Physical Therapy and Rehabilitation Sciences, USF Health Morsani College of Medicine, University of South Florida,
| | - Laura L Swisher
- School of Physical Therapy and Rehabilitation Sciences, University of South Florida, Morsani College of Medicine, Tampa, FL
| | - Dustin D Hardwick
- School of Physical Therapy and Rehabilitation Sciences, University of South Florida, Morsani College of Medicine, Tampa, FL
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