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Nagao N, Takimoto Y. Clinical Ethics Consultation in Japan: What does it Mean to have a Functioning Ethics Consultation? Asian Bioeth Rev 2024; 16:15-31. [PMID: 38213992 PMCID: PMC10776510 DOI: 10.1007/s41649-023-00257-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 01/13/2024] Open
Abstract
This research examines the current status of clinical ethics consultation (CEC) in Japan through a nationwide study conducted with chairs of ethics committees and clinical ethics committees among 1028 post-graduate clinical teaching hospitals. We also qualitatively analyzed their viewpoints of the CEC's benefits and problems related to hospital consultation services to identify the critical points for CEC and inform the development of a correctly functioning system. The questionnaire included structured questions about hospital CEC organization and service purpose and operation and open-ended questions about the benefits and problems of initiating CEC. The questionnaire comprised the presence/absence of an ethics committee, CEC services and membership when services were implemented, users, and the number of cases handled since inception. In addition, the respondents also provided their impressions of the CEC system's impact on their hospital by describing (a) the benefits of CEC services and (b) the ineffectual or harmful aspects of the CEC system. Qualitative data were examined using qualitative content analysis to determine the impact of establishing a CEC and the difficulties of practice. One hundred twenty-five questionnaires were returned from either the chair of the ethics committee or clinical ethics committee in teaching hospitals. Of these, 90 (72%) reported they provided CEC services. Additionally, 36 respondents (34.6%) reported that their existing research and clinical ethics committees had conducted CEC services, and 35 (33.7%) reported having a newly established clinical ethics committee conducting CEC services. Three positive effects of establishing and four challenges in managing CEC were also identified.
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Affiliation(s)
- Noriko Nagao
- School of Nursing, Kitasato University, Sagamihara, Kanagawa Japan
| | - Yoshiyuki Takimoto
- Department of Biomedical Ethics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Takeshita K, Nagao N, Kaneda H, Miura Y, Kinjo T, Takimoto Y. Report on the Establishment of the Consortium for Hospital Ethics Committees in Japan and the First Collaboration Conference of Hospital Ethics Committees. Asian Bioeth Rev 2022; 14:307-316. [PMID: 36091294 PMCID: PMC9446621 DOI: 10.1007/s41649-022-00219-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 08/26/2022] [Accepted: 08/26/2022] [Indexed: 11/30/2022] Open
Abstract
Hospital ethics committees (HECs) are expected to play extremely broad and pivotal roles such as case consultation, education of staffs on healthcare ethics, and institutional policy formation. Despite the growing importance of HECs, there are no standards for setup and operation of HECs, and composition and activities of HECs at each institution are rarely disclosed in Japan. In addition, there is also a lack of information sharing and collaboration among HECs. Therefore, the authors established the Consortium of
Hospital Ethics Committees (CHEC) in October 2020, which has been regularly hosting a couple of core activities. One is the Healthcare Ethics Forum, held monthly online for CHEC members to freely discuss HECs and healthcare ethics consultation. The other is the Collaboration Conference of Hospital Ethics Committees, intended to provide a place for HEC members and administrative officers from across Japan to exchange information of their HECs, learn from each other, and cooperate to operate HECs appropriately.
In this paper, the authors introduced CHEC as well as reported the results of a questionnaire survey conducted at the first conference among participating facilities, suggesting the diverse structures and activities of HECs in Japan.
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Affiliation(s)
- Kei Takeshita
- Tokai University Hospital, Isehara City, Kanagawa Japan
| | - Noriko Nagao
- Kitasato University Hospital, Sagamihara City, Kanagawa Japan
| | - Hiroyuki Kaneda
- Kansai Medical University Medical Center, Moriguchi City, Osaka Japan
| | - Yasuhiko Miura
- The Jikei University Kashiwa Hospital, Kashiwa City, Chiba Japan
| | - Takanobu Kinjo
- Ryukyu University Hospital, Nakagusuku County, Okinawa, Japan
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Sameer A, Khan M. Knowledge, awareness, and attitude of health professions student's towards end-of-life patient care. ARCHIVES OF MENTAL HEALTH 2021. [DOI: 10.4103/amh.amh_59_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Labude MK, Shen L, Zhu Y, Schaefer GO, Ong C, Xafis V. Perspectives of Singaporean biomedical researchers and research support staff on actual and ideal IRB review functions and characteristics: A quantitative analysis. PLoS One 2020; 15:e0241783. [PMID: 33382683 PMCID: PMC7774925 DOI: 10.1371/journal.pone.0241783] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/20/2020] [Indexed: 01/22/2023] Open
Abstract
Background Biomedical research is overseen by numerous Institutional Review Boards (IRBs) in Singapore but there has been no research that examines how the research review process is perceived by the local research community nor is there any systematic data on perceptions regarding the review process or other research ethics processes and IRB characteristics. The aim of this study was to ascertain general views regarding the overall perceived value of ethics review processes; to measure perceptions about local IRB functions and characteristics; to identify IRB functions and characteristics viewed as important; and to compare these views with those of other international studies. Methods An online survey was used with the main component being the IRB-Researcher Assessment Tool (IRB-RAT), a validated tool, to evaluate perceptions of ideal and actual IRB functions and characteristics held by Singaporean researchers and research support staff. Data were analysed descriptively first, with mean and SD of each item of IRB-RAT questionnaire reported, excluding the respondents whose answers were unknown or not applicable. The Wilcoxon Sign Rank test was used to compare the ideal and actual ratings of each IRB-RAT item, while the Mann-Whitney U test was used to compare the ratings of each IRB-RAT item between respondents with different characteristics. The Z-test was used to compare the mean ratings of our cohort with the mean ratings reported in the literature. The correlation between our mean ideal scores and those of two international studies also employing the IRB-RAT was examined. Results Seventy-one respondents completed the survey. This cohort generally held positive views of the impact of the ethics review process on: the quality of research; establishing and maintaining public trust in research; the protection of research participants; and on the scientific validity of research. The most important ideal IRB characteristics were timeliness, upholding participants’ rights while also facilitating research, working with investigators to find solutions when there are disagreements, and not allowing biases to affect reviews. For almost all 45 IRB-RAT statements, the rating of the importance of the characteristic was higher than the rating of how much that characteristic was descriptive of IRBs the respondents were familiar with. There was a significant strong correlation between our study’s scores on the ideal IRB characteristics and those of the first and largest published study that employed the IRB-RAT, the US National Validation (USNV) sample in Keith-Spiegel et al. [19]. Conclusions An understanding of the perceptions held by Singaporean researchers and research support staff on the value that the ethics review process adds, their perceptions of actual IRB functions and characteristics as well as what they view as central to high functioning IRBs is the first step to considering the aspects of the review process that might benefit from improvements. This study provides insight into how our cohort compares to others internationally and highlights strengths and areas for improvement of Singapore IRBs as perceived by a small sample of the local research community. Such insights provide a springboard for additional research and may assist in further enhancing good relations so that both are working towards the same end.
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Affiliation(s)
- Markus K. Labude
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- * E-mail: (MKL); (VX)
| | - Liang Shen
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yujia Zhu
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - G. Owen Schaefer
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Catherine Ong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Infectious Diseases, University Medicine Cluster, National University Health System, Singapore, Singapore
| | - Vicki Xafis
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- * E-mail: (MKL); (VX)
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Sato H, Yukawa K, Doi M. Supervision of new surgical procedures in Japan: Current practice and supervision issues at university hospitals in Japan. Surgery 2020; 168:1109-1114. [PMID: 33008612 DOI: 10.1016/j.surg.2020.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Sometimes the development of new surgical procedures takes place during patient treatment in clinical practice but can result in undesirable outcomes and social concerns. This study aims to reveal how university hospitals in Japan supervise the implementation of new surgical procedures and what difficulties they confront. METHODS Self-administered questionnaire surveys were conducted, targeting all university-affiliated hospitals in Japan. RESULTS It was found that most university hospitals in Japan supervised new surgical procedures internally, but they considered it difficult and burdensome to review and monitor them, both technically and practically, owing to several factors. CONCLUSION It is advisable to set up more effective and efficient organizational collaborations and implement standard processes of supervision, in both domestic and international clinical settings.
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Affiliation(s)
- Hajime Sato
- Department of Health Policy and Technology Assessment, National Institute of Public Health, Japan.
| | - Keiko Yukawa
- Department of Health Policy and Technology Assessment, National Institute of Public Health, Japan
| | - Mariko Doi
- Department of Health Policy and Technology Assessment, National Institute of Public Health, Japan
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Akabayashi A, Nakazawa E, Akabayashi A. Implementation of Japan's First Clinical Research Regulatory Law: Background, Overview, and Challenges. HEC Forum 2020; 31:283-294. [PMID: 31363880 DOI: 10.1007/s10730-019-09379-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In April 2018, Japan's first law regulating clinical research went into effect. The law aimed to strengthen regulations on research integrity and conflicts of interest, which had been limited under existing administrative guidelines; the law also provided stipulations for legal penalties. The scope of the new regulations, however, is limited entirely to studies that evaluate unapproved drugs or the off-label use of approved drugs, and those that receive funding from companies. On the other hand, the law's application brings numerous complications, including the establishment of new review committees, troublesome procedures for transitioning studies that are currently underway, and ambiguities about the scope of what constitutes best efforts. Thus, the change has led to substantial strain and confusion in the field. This paper offers an overview of the law and its background, and discusses its future prospects from the practical standpoint of managing ethics committees and providing research ethics support in the field.
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Affiliation(s)
- Akira Akabayashi
- Department of Biomedical Ethics, School of Public Health, The University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. .,Division of Medical Ethics, Department of Population Health, New York University School of Medicine, 227 East, 30th Street, New York, NY, 10016, USA.
| | - Eisuke Nakazawa
- Department of Biomedical Ethics, School of Public Health, The University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Aru Akabayashi
- Department of Biomedical Ethics, School of Public Health, The University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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Grey A, Bolland M, Avenell A. Evaluating ethics oversight during assessment of research integrity. Res Integr Peer Rev 2019; 4:22. [PMID: 31720010 PMCID: PMC6836422 DOI: 10.1186/s41073-019-0082-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 10/10/2019] [Indexed: 11/21/2022] Open
Abstract
We provide additional information relevant to our previous publication on the quality of reports of investigations of research integrity by academic institutions. Despite concerns being raised about ethical oversight of research published by a group of researchers, each of the four institutional investigations failed to determine and/or report whether ethics committee approval was obtained for the majority of publications assessed.
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Affiliation(s)
- Andrew Grey
- Department of Medicine, University of Auckland, Private Bag, Auckland, 92019 New Zealand
| | - Mark Bolland
- Department of Medicine, University of Auckland, Private Bag, Auckland, 92019 New Zealand
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Adin CA, Moga JL, Keene BW, Fogle CA, Hopkinson HR, Weyhrauch CA, Marks SL, Ruderman RJ, Rosoff PM. Clinical ethics consultation in a tertiary care veterinary teaching hospital. J Am Vet Med Assoc 2019; 254:52-60. [DOI: 10.2460/javma.254.1.52] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kawachiya S, Bodri D, Hirosawa T, Yao Serna J, Kuwahara A, Irahara M. Endogenous progesterone levels could predict reproductive outcome in frozen embryo replacement cycles supplemented with synthetic progestogens: A retrospective cohort study. Reprod Med Biol 2019; 18:91-96. [PMID: 30655726 PMCID: PMC6332737 DOI: 10.1002/rmb2.12254] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/02/2018] [Accepted: 10/12/2018] [Indexed: 12/02/2022] Open
Abstract
PURPOSE A retrospective, cohort study was conducted between 2009 and 2017 in a private infertility center to determine the predictive value of endogenous estrogen (E2) and progesterone (P4) levels in hormone-replacement frozen embryo replacement (FER) treatment cycles. METHODS A total of 120 consecutive, infertile patients who became pregnant after FER cycles were analyzed (age: 37.4 ± 4.4 years). Electively vitrified blastocysts were created during natural cycle IVF or mild ovarian stimulation treatments and subsequently transferred through delayed vitrified-thawed blastocyst transfer cycles supplemented with estrogens and a combination of synthetic progestogens. Serum E2 and progesterone P4 levels were intensively monitored every five days (from the day after embryo transfer until 9w1d of pregnancy) and compared among patients with a subsequent live birth (n = 76) or first-trimester pregnancy loss (n = 44). RESULTS Endogenous placental activity started as early as 5-6th pregnancy week differing significantly according to pregnancy outcome. For P4, the exponential rise from 6w2d onwards allowed distinguishing between failing and successful conceptions. For P4, lower quartiles of the live birth group did not intersect with upper quartiles of the miscarriage group. CONCLUSIONS Innovative FER protocols incorporating synthetic progestogens allow the correct measurement of endogenous placental activity and could help to monitor early first-trimester ART pregnancies.
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Affiliation(s)
- Satoshi Kawachiya
- Department of Obstetrics and GynecologyTokushima University Graduate School of Biomedical SciencesTokushimaJapan
- Kobe Motomachi Yume ClinicKobeJapan
| | | | | | | | - Akira Kuwahara
- Department of Obstetrics and GynecologyTokushima University Graduate School of Biomedical SciencesTokushimaJapan
| | - Minoru Irahara
- Department of Obstetrics and GynecologyTokushima University Graduate School of Biomedical SciencesTokushimaJapan
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Leslie L, Cherry RF, Mulla A, Abbott J, Furfari K, Glover JJ, Harnke B, Wynia MK. Domains of quality for clinical ethics case consultation: a mixed-method systematic review. Syst Rev 2016; 5:95. [PMID: 27267765 PMCID: PMC4897931 DOI: 10.1186/s13643-016-0273-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 05/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND "Clinical ethics consultation" (CEC) is the provision of consultative services by an individual or team with the aim of helping health professionals, patients, and their families grapple with difficult ethical issues arising during health care. There are almost 25,000 articles in the worldwide literature on CEC, but very few explicitly address measuring the quality of CEC. Many more address quality implicitly, however. This article describes a rigorous protocol for compiling the diverse literature on CEC, analyzing it with a quality measurement lens, and seeking a set of potential quality domains for CEC based on areas of existing, but hitherto unrecognized, consensus in the literature. METHODS/DESIGN This mixed-method systematic review will follow a sequential pattern: scoping review, qualitative synthesis, and then a quantitative synthesis. The scoping review will include categorizing all quality measures for CEC discussed in the literature, both quantitative and qualitative. The qualitative synthesis will generate a comprehensive analytic framework for understanding the quality of CEC and is expected to inform the quantitative synthesis, which will be a meta-analysis of studies reporting the effects of CEC on pre-specified clinical outcomes. DISCUSSION The literature on CEC is broad and diverse and has never been examined with specific regard to quality measurement. We propose a novel mixed-methods approach to compile and synthesize this literature and to derive a framework for assessing quality in CEC. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015023282.
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Affiliation(s)
- Louis Leslie
- School of Medicine, University of Colorado, Anschutz Medical Campus, Denver, CO, USA.
- University of Colorado-Center for Bioethics & Humanities, Fulginiti Pavilion for Bioethics and Humanities, Mailstop B137, 13080 E. 19th Avenue, Aurora, CO, 80045, USA.
| | | | - Abbas Mulla
- School of Medicine, University of Colorado, Anschutz Medical Campus, Denver, CO, USA
| | - Jean Abbott
- Center for Bioethics and Humanities, University of Colorado, Anschutz Medical Campus, Denver, CO, USA
| | - Kristin Furfari
- School of Medicine, University of Colorado, Anschutz Medical Campus, Denver, CO, USA
| | - Jacqueline J Glover
- Center for Bioethics and Humanities, University of Colorado, Anschutz Medical Campus, Denver, CO, USA
| | - Benjamin Harnke
- Health Sciences Library, University of Colorado, Anschutz Medical Campus, Denver, CO, USA
| | - Matthew K Wynia
- School of Medicine, University of Colorado, Anschutz Medical Campus, Denver, CO, USA
- Center for Bioethics and Humanities, University of Colorado, Anschutz Medical Campus, Denver, CO, USA
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Yanagawa H, Katashima R, Takeda N. Research ethics committees in Japan: A perspective from thirty years of experience at Tokushima University. THE JOURNAL OF MEDICAL INVESTIGATION 2015; 62:114-8. [DOI: 10.2152/jmi.62.114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Hiroaki Yanagawa
- Clinical Trial Center for Developmental Therapeutics, Tokushima University Hospital
| | - Rumi Katashima
- Clinical Trial Center for Developmental Therapeutics, Tokushima University Hospital
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Katashima R, Sato C, Kinoshita S, Kawashima S, Yanagawa H. Present status of Japanese ethics committees: a survey in Tokushima Prefecture. THE JOURNAL OF MEDICAL INVESTIGATION 2014; 61:399-403. [PMID: 25264061 DOI: 10.2152/jmi.61.399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Clinical research is important to improve medical quality, and ethics review is essential to conduct clinical research. Since the establishment of the first Japanese ethics committee at the University of Tokushima in 1982, Japanese ethics committees have increased. In this study, we surveyed the status of clinical studies and ethics committees in one Japanese region. The survey was conducted in collaboration with the Tokushima Medical Association. A questionnaire was established and mailed to all medical institutions (n=737) registered to the Tokushima Medical Association in 2012. Among 737, 223 (30.3%) questionnaires were returned and 221 were completed and are included in this analysis (respondents). Among respondents, 51 (23.1%) had performed clinical research, and of these, 17 had established ethics committees (though one was omitted from the following analysis due to an unsatisfactory response). Among 16 ethics committees, review of protocol amendments, review of serious adverse events, annual follow-up of approved protocols, and education for committee members were active in 10 (62.5%), 9 (56.3%), 6 (37.5%) and 4 (25.0%), respectively. Research ethics education was active in 4 (25.0%). Based on the results, we attempt to establish an appropriate system for ethical conduct of health-related research in Tokushima Prefecture.
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Affiliation(s)
- Rumi Katashima
- Clinical Trial Center for Developmental Therapeutics, Tokushima University Hospital
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Mbondji PE, Kebede D, Zielinski C, Kouvividila W, Sanou I, Lusamba-Dikassa PS. Overview of national health research systems in sub-Saharan Africa: results of a questionnaire-based survey. J R Soc Med 2014; 107:46-54. [PMID: 24914128 DOI: 10.1177/0141076814530600] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To assess the state of national health research systems of countries in the World Health Organization (WHO) African Region. DESIGN A questionnaire-based survey METHODS: Structured questionnaires were used to solicit health research systems' relevant information from key informants in each country. SETTING Forty-six Member States of the WHO African Region. PARTICIPANTS Key informants from the ministry of health in each country, with the support of WHO Country Offices. MAIN OUTCOME MEASURES Presence of national health research policy or strategy, priority setting and ethical review of research. RESULTS Of the 44 responding countries, 39 (89%) reportedly had an official national health policy and 37 (84%) had a strategic health plan. A total of 16 (36%) countries reportedly had a functional national health research governance mechanism, nine of which had clear terms of reference; nine (20%) countries had a functional national health research management forum. Functional ethical review committees were reported in 33 countries (75%). CONCLUSIONS National health research systems were weak in the countries assessed. Significantly more resources should be allocated to strengthening these systems.
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Affiliation(s)
| | - Derege Kebede
- World Health Organization Regional Office for Africa, PO Box 6, Brazzaville, Congo
| | - Chris Zielinski
- World Health Organization Regional Office for Africa, PO Box 6, Brazzaville, Congo
| | | | - Issa Sanou
- World Health Organization Regional Office for Africa, PO Box 6, Brazzaville, Congo
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Bodri D, Kawachiya S, Brucker MD, Tournaye H, Kondo M, Kato R, Matsumoto T. Cumulative success rates following mild IVF in unselected infertile patients: a 3-year, single-centre cohort study. Reprod Biomed Online 2014; 28:572-81. [DOI: 10.1016/j.rbmo.2014.01.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 01/08/2014] [Accepted: 01/09/2014] [Indexed: 12/30/2022]
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Walanj AS. Research ethics committees: Need for harmonization at the national level, the global and Indian perspective. Perspect Clin Res 2014; 5:66-70. [PMID: 24741482 PMCID: PMC3980546 DOI: 10.4103/2229-3485.128022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Ethics committee (EC) organization and standardization is an important aspect of clinical research. There is a healthy trend worldwide to register and/or accredit research ECs reviewing clinical research. This article tries to focus on the existing model of ECs worldwide, as against the Indian backdrop. The article reviews literature, journals, websites, and studies conducted in 10 different countries and outlines the working model of ECs in these countries. The challenges faced during the ethical review, especially in case of multicenter trials, have been identified. A solution has been suggested to overcome these challenges, and to ensure the overall smooth functioning of clinical trials. The article proposes the development of national and regional central ECs to counter the current drawbacks in the ethical review mechanisms in India.
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Affiliation(s)
- Aparna Sanjiv Walanj
- Clinical Research Department Head, Ethika Clinical Research Center, Prakruti Hospital, Thane, Maharashtra, India
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Nagao N, Kadooka Y, Asai A. Comparison of ethical judgments exhibited by clients and ethics consultants in Japan. BMC Med Ethics 2014; 15:19. [PMID: 24592932 PMCID: PMC3975850 DOI: 10.1186/1472-6939-15-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Accepted: 02/26/2014] [Indexed: 11/10/2022] Open
Abstract
Background Healthcare professionals must make decisions for patients based on ethical considerations. However, they rely on clinical ethics consultations (CEC) to review ethical justifications of their decisions. CEC consultants support the cases reviewed and guide medical care. When both healthcare professionals and CEC consultants face ethical problems in medical care, how is their judgment derived? How do medical judgments differ from the ethical considerations of CECs? This study examines CECs in Japan to identify differences in the ethical judgment of clients and CEC consultants. Methods The CEC request and response documents of all 60 cases reviewed across Japan between October 2006 and the end of October 2011 were classified in terms of the presence of decisional capacity in the patient. We conducted a qualitative content analysis of the differences in reasoning between client and CEC consultants. Reasoned judgments were verified in individual cases to classify the similarities or differences of opinion between CEC clients and teams. Results As the result of classification of the decisional capacity and the difference of opinion regarding medical care, the most frequent category was 25 cases (41.7%) of “uncertain decisional capacity,” and 23 cases (38.3%) of “withholding of decision-making.” A chi-square analysis was performed on presence of decisional capacity and agreement in decision-making, yielding a statistically significant difference (p < 0.05). The CEC consultants’ reasoning was based on “patient’s preference was ambiguous,” “validity of family as a surrogate,” “estimation of patient preference,” and “patient’s best interest,” whereas the CEC client’s reasoning was based on “consistent family preference was shown/not shown” and “appropriate therapeutic methods to manage patient safety.” Conclusion Differences in opinions were found in cases classified according to decisional capacity. Furthermore, the reasoning behind judgments differed between CEC clients and CEC consultants. The reasoning of CEC consultants was critical and reflective, while for clients it was situational and pragmatic.
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Affiliation(s)
- Noriko Nagao
- Department of Nursing, Kobe University Graduate School of Health Sciences 7-10-2 Tomogaoka, Suma-ku, Kobe, Hyogo 654-0142, Japan.
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Fujita M, Akabayashi A. [The cutting-edge of medicine: Approaching ethical issues in clinical settings]. ACTA ACUST UNITED AC 2012; 101:2059-64. [PMID: 22897013 DOI: 10.2169/naika.101.2059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Misao Fujita
- Department of Biomedical Ethics, The University of Tokyo, Graduate School of Medicine, Japan
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CQ Sources/Bibliography. Camb Q Healthc Ethics 2008. [DOI: 10.1017/s0963180108080389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
These CQ Sources were compiled by Bette Anton.
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Jotkowitz A, Zivotofsky AZ. Stranger at the consultation: increasing the diversity in research ethics consultation. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2008; 8:25-W6. [PMID: 18570095 DOI: 10.1080/15265160802109520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Alan Jotkowitz
- Jakobovits Center for Jewish Medical Ethics, Ben-Gurion University of the Negev, Negev, Beer-Sheva, Israel.
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