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Chen Q, Ma Y, Labude M, Schaefer GO, Xafis V, Mills P. Making sense of it all: Ethical reflections on the conditions surrounding the first genome-edited babies. Wellcome Open Res 2021; 5:216. [PMID: 34395922 PMCID: PMC8340653 DOI: 10.12688/wellcomeopenres.16295.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 11/20/2022] Open
Abstract
In November 2018 the birth of the first genome-edited human beings was announced by Chinese scientist, He Jiankui. The ensuing ethical controversy, institutional investigations and legal proceedings led to the revision of standards, rules and procedures at many levels. Arguably, however, these developments have not fundamentally changed the conditions or the culture that nourished He Jiankui's vaulting ambition in the first place and enabled it to find expression. In this paper we explore the clinical, regulatory and societal circumstances of the 'gene-edited baby' case, the political, cultural and economic conditions that created a radical and dangerous climate for biotechnology innovation, and the responsibilities of the international research community, many of whose members were apprised of Dr He's intentions. The aim is not to heap anathemas on the heads of implicated individuals but to draw attention to the need for different communities (researchers, authorities and domestic publics) to play a part actively in the governance of biomedical innovation and for research to be bridled by human values.
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Affiliation(s)
- Qi Chen
- Centre for Bioethics, Medical School, Xiamen University, Xiamen, 361102, China
| | - Yonghui Ma
- Centre for Bioethics, Medical School, Xiamen University, Xiamen, 361102, China
| | - Markus Labude
- Centre for Biomedical Ethics, National University of Singapore, Singapore, 117597, Singapore
| | - G Owen Schaefer
- Centre for Biomedical Ethics, National University of Singapore, Singapore, 117597, Singapore
| | - Vicki Xafis
- Centre for Biomedical Ethics, National University of Singapore, Singapore, 117597, Singapore
| | - Peter Mills
- Nuffield Council on Bioethics, London, WC1B 3JS, UK
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Chen Q, Ma Y, Labude M, Schaefer GO, Xafis V, Mills P. Making sense of it all: Ethical reflections on the conditions surrounding the first genome-edited babies. Wellcome Open Res 2020; 5:216. [PMID: 34395922 PMCID: PMC8340653 DOI: 10.12688/wellcomeopenres.16295.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2020] [Indexed: 12/31/2022] Open
Abstract
In November 2018 the birth of the first genome-edited human beings was announced. The ensuing ethical controversy, institutional investigations and legal proceedings led to the revision of standards, rules and procedures at many levels. Arguably, however, these developments have not fundamentally changed the conditions or the culture that nourished He Jiankui's vaulting ambition in the first place and enabled it to find expression. In this paper we explore the clinical, regulatory and societal circumstances of the 'gene-edited baby' case, the political, cultural and economic conditions that created a radical and dangerous climate for biotechnology innovation, and the responsibilities of the international research community, many of whose members were apprised of Dr He's intentions. The aim is not to heap anathemas on the heads of implicated individuals but to draw attention to the need for different communities (researchers, authorities and domestic publics) actively to play a part in the governance of biomedical innovation and for research to be bridled by human values.
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Affiliation(s)
- Qi Chen
- Centre for Bioethics, Medical School, Xiamen University, Xiamen, 361102, China
| | - Yonghui Ma
- Centre for Bioethics, Medical School, Xiamen University, Xiamen, 361102, China
| | - Markus Labude
- Centre for Biomedical Ethics, National University of Singapore, Singapore, 117597, Singapore
| | - G Owen Schaefer
- Centre for Biomedical Ethics, National University of Singapore, Singapore, 117597, Singapore
| | - Vicki Xafis
- Centre for Biomedical Ethics, National University of Singapore, Singapore, 117597, Singapore
| | - Peter Mills
- Nuffield Council on Bioethics, London, WC1B 3JS, UK
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Improved Patient Flow and Provider Efficiency After the Implementation of an Electronic Health Record. Comput Inform Nurs 2019; 37:513-521. [PMID: 31385814 DOI: 10.1097/cin.0000000000000553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Electronic health records are used widely across the nation in many different types of healthcare facilities. Electronic health record systems can provide more accurate and complete information about a patient's health, improve patient safety, and improve patient care. The purpose of this project is to evaluate a provider efficiency and workflow program at a hospital-owned, freestanding urgent care system after implementation of an electronic health record. A retrospective, longitudinal approach was used to evaluate the implementation of an electronic health record system among six freestanding urgent care clinics. The logic model was used as a guiding framework to determine whether provider efficiency and patient flow were improved. Data were collected from participants via an online survey, electronic health record data review, paper chart review, and direct observation of providers. An evaluation of a provider efficiency program using door-to-triage, door-to-provider, door-to-discharge, and average length of stay at each urgent care clinic was collected. The results indicate improvement in all areas after implementation of the electronic health record in all six urgent care settings. The average length of stay decreased from 109 minutes in 2014 to 73 minutes in 2016.
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Gou L, Gao J, Yang H, Gao C. The landscape of CAR T-cell therapy in the United States and China: A comparative analysis. Int J Cancer 2018; 144:2043-2050. [PMID: 30307029 DOI: 10.1002/ijc.31924] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 09/19/2018] [Accepted: 09/24/2018] [Indexed: 12/30/2022]
Abstract
The clinical trials of CAR T-cell therapy are growing fast in recent years, and most of the trials are initiated by sponsors from the United States and China. Exhibiting the distinctions between the clinical trials in the two countries is of great value for understanding the panorama of CAR T-cell clinical trials and forecasting the future of this promising therapy. We analyzed the critical elements of 289 clinical trials posted on the clinicaltrials.gov website by sponsors from the two countries and evaluated the efficacy data in available 50 published CAR T-cell studies. Our analysis shows that China has become the country with the largest number of CAR-T cell clinical trials by the end of 2017, while overall subject sample size and study center numbers are still larger, and the design of the clinical trials is more cautious in the United States. There are obvious differences between the two countries in CAR-targeted antigens in solid tumors and genetic modifications besides CARs for enhancing the potency of CAR T-cells. Although the currently available response rates are promising in both countries, it is inexpedient to conclude that the clinical efficacy is comparable between the two countries considering the smaller patient sample sizes and discrete distribution of median cell doses in China. And finally, the flexible regulatory regime of cell therapy in China, which expedites the bursting of CAR T-cell therapy, is also firstly introduced in our study.
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Affiliation(s)
- Lijuan Gou
- Department of Peadiatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jianchao Gao
- Office of Clinical Evaluation of Biological Products, Center for Drug Evaluation, China Food and Drug Administration, Beijing, China
| | - Huan Yang
- Office of Clinical Evaluation of Biological Products, Center for Drug Evaluation, China Food and Drug Administration, Beijing, China
| | - Chenyan Gao
- Office of Clinical Evaluation of Biological Products, Center for Drug Evaluation, China Food and Drug Administration, Beijing, China
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Wu SW, Chen T, Pan Q, Wei LY, Xuan Y, Li C, Wang Q, Song JC. Establishment of a Comprehensive Evaluation System on Medical Quality Based on Cross-examination of Departments within a Hospital. Chin Med J (Engl) 2018; 130:2872-2877. [PMID: 29176146 PMCID: PMC5717868 DOI: 10.4103/0366-6999.219163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Suo-Wei Wu
- Medical Administration Department, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Tong Chen
- Medical Administration Department, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Qi Pan
- Medical Administration Department, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Liang-Yu Wei
- Medical Administration Department, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Yong Xuan
- Medical Administration Department, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Chao Li
- Medical Administration Department, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Qin Wang
- Medical Administration Department, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Jing-Chen Song
- Medical Administration Department, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
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Wu SW, Chen T, Pan Q, Wei LY, Wang Q, Li C, Song JC, Luo J. Establishment of a Quantitative Medical Technology Evaluation System and Indicators within Medical Institutions. Chin Med J (Engl) 2018; 131:1327-1332. [PMID: 29786047 PMCID: PMC5987505 DOI: 10.4103/0366-6999.232804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: The development and application of medical technologies reflect the medical quality and clinical capacity of a hospital. It is also an effective approach in upgrading medical service and core competitiveness among medical institutions. This study aimed to build a quantitative medical technology evaluation system through questionnaire survey within medical institutions to perform an assessment to medical technologies more objectively and accurately, and promote the management of medical quality technologies and ensure the medical safety of various operations among the hospitals. Methods: A two-leveled quantitative medical technology evaluation system was built through a two-round questionnaire survey of chosen experts. The Delphi method was applied in identifying the structure of evaluation system and indicators. The judgment of the experts on the indicators was adopted in building the matrix so that the weight coefficient and maximum eigenvalue (λ max), consistency index (CI), and random consistency ratio (CR) could be obtained and collected. The results were verified through consistency tests, and the index weight coefficient of each indicator was conducted and calculated through analytical hierarchy process. Results: Twenty-six experts of different medical fields were involved in the questionnaire survey, 25 of whom successfully responded to the two-round research. Altogether, 4 primary indicators (safety, effectiveness, innovativeness, and benefits), as well as 13 secondary indicators, were included in the evaluation system. The matrix is built to conduct the λ max, CI, and CR of each expert in the survey, and the index weight coefficients of primary indicators were 0.33, 0.28, 0.27, and 0.12, respectively, and the index weight coefficients of secondary indicators were conducted and calculated accordingly. Conclusions: As the two-round questionnaire survey of experts and statistical analysis were performed and credibility of the results was verified through consistency evaluation test, the study established a quantitative medical technology evaluation system model and assessment indicators within medical institutions based on the Delphi method and analytical hierarchy process. Moreover, further verifications, adjustments, and optimizations of the system and indicators will be performed in follow-up studies.
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Affiliation(s)
- Suo-Wei Wu
- Department of Medical Administration, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Tong Chen
- Department of Medical Administration, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Qi Pan
- Department of Medical Administration, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Liang-Yu Wei
- Department of Medical Administration, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Qin Wang
- Department of Medical Administration, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Chao Li
- Department of Medical Administration, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Jing-Chen Song
- Department of Medical Administration, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Ji Luo
- Department of Medical Administration, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
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