Research on human populations: national and international ethical guidelines

An Ethical Justification for Expanding the Notion of Effectiveness in Vaccine Post-Market Monitoring: Insights from the HPV Vaccine in Canada

Health regulators must carefully monitor the real-world safety and effectiveness of marketed vaccines through post-market monitoring in order to protect the public's health and promote those vaccines that best achieve public health goals. Yet, despite the fact that vaccines used in collective immunization programmes should be assessed in the context of a public health response, post-market effectiveness monitoring is often limited to assessing immunogenicity or limited programmatic features, rather than assessing effectiveness across populations. We argue that post-market monitoring ought to be expanded in two ways to reflect a 'public health notion of post-market effectiveness', which incorporates normative public health considerations: (i) effectiveness monitoring should yield higher quality data and grant special attention to underrepresented and vulnerable populations; and (ii) the scope of effectiveness should be expanded to include a consideration of the various social factors that maximize (and minimize) a vaccine's effectiveness at the population level, paying particular attention to how immunization programmes impact related health gradients. We use the case of the human papillomavirus vaccine in Canada to elucidate how expanding post-market effectiveness monitoring is necessary to close the gap between clinical practice and public health, and to ensure that vaccines are effective in a morally relevant sense.

Midwives and nurses awareness of patients' rights

AIM

to determine the level of awareness of patients' rights among midwives and nurses working in the third and fourth largest cities in Turkey.

METHODS

cross-sectional descriptive survey conducted among participants working in university hospitals, state hospitals and village clinics. Questionnaires were distributed to 150 midwives and 350 nurses working in university hospitals (n = 200), state hospitals (n = 100) and village clinics (n = 100); 60% (n = 298) of the forms were returned.

FINDINGS

fifty-one per cent (n = 152) of midwives and nurses stated that they had not read any legislation related to patients' rights. Seventy-five per cent (n = 222) of respondents were aware of the legal arrangements. Only 34% (n = 74) of participants who knew of any legal basis for patients' rights said that legislation was in the form of a directive. No significant differences were observed in midwives' answers compared with nurses' answers.

CONCLUSION

violation of patients' rights and health professionals' ignorance of appropriate practice means that there is an urgent need to reconsider how to approach this issue. It should be included in continuing education programmes at both graduate and postgraduate midwifery and nursing schools, and also demands more research.

The approach taken by the physicians working at educational hospitals in Izmir towards patient rights

OBJECTIVE

Considered as a reflection of human rights in our modern day, patient rights have been gaining increasing importance. This particular subject has been discussed from various perspectives in different countries and legal sanctions imposed. "Patient Rights Directives" in Turkey came into effect in 1988. The present study was carried out in order to determine how well the physicians working in Izmir, the third largest city of Turkey, are aware and informed of these directives.

METHODS

Our study is an observational-cross sectional descriptive one. The research was conducted among the physicians working in nine training hospitals in Izmir province using a random sampling method. 1,500 questionnaires with 19 multiple-choice questions were distributed in the study. 567 of the forms were returned. Statistical assessment of the data obtained was carried out using the x(2) test on SPSS 10.0 Windows Program.

RESULTS

Of the physicians participating in the study, 43% were female and 57% male. The average age was 32 +/- 7.76 years. 40% of the participating physicians were not aware of the legal arrangements (directive). 63% of the participants stated that they had not read any kind of legislation related to patients' rights. Only 34% of the participants knew that the legal sanctions were put into effect in the form of "directive."

CONCLUSION

Legal arrangements related to patient rights in the world are being put into effect within the framework of human rights. Turkey is one of the first countries to have completed the legal procedures in this field.

PRACTICE IMPLICATIONS

We believe it is necessary that this particular issue be included both in the training programs of the medical faculties and supported by all parts of the society including physicians if these legal procedures are to work effectively.

Critical care computing: outcomes, confidentiality, and appropriate use

This article reviews the current limitations of computerized outcome predictor models and severity scoring systems. A logical extension of predictor models, a "computational futility metric," is proposed with a discussion of potential uses and abuses. These types of electronic surveillance will not solve the problem of society's denial of death or resolve the allocation of medical resources. Issues related to the protection of patients and physicians under electronic epidemiologic surveillance are discussed.