Consumer Participation in Personalized Psychiatry

2021 ◽  
pp. 493-502
Author(s):  
Neha P. Chaudhary ◽  
Harris A. Eyre
Keyword(s):  
Clinical Decision Making ◽  
New Technologies ◽  
Ethical Issues ◽  
Research Policy ◽  
Clinical Care ◽  
Consumer Participation ◽  
Research Subjects ◽  
Research Practices ◽  
Treatment And Prevention ◽  
Personalized Psychiatry

Personalized psychiatry represents a paradigm shift that is long overdue. It is characterized by shifting screening, diagnosis, treatment, and prevention practices away from a “one size fits all” approach to one tailored to patients’ unique clinical, social, digital, and biological (e.g., genetic and epigenetic) profiles to enhance outcomes. This shift from traditional approaches to more tailored, personalized practices not only opens up an opportunity for, but also emphasizes the need for consumer participation in the design of these practices. This participation could be through research, policy, ethics discussions, clinical care, or novel solution development. This chapter outlines the rationale for consumer participation in personalized psychiatry and provides insights and examples of ways in which to enhance this participation. The outcome is novel solution development that appropriately focuses on end-user needs by incorporating consumer contributions to both product design as well as testing. Validation of new technologies prior to their implementation can be difficult through current research practices; however, consumers can help expand research practices by identifying the highest-priority questions to answer, advocating for necessary resources and influencing the design of models for joint clinical decision-making. As both research subjects and the ultimate beneficiaries or users of new technologies, consumers also have a critical perspective on ethical issues unique to personalized psychiatry—one that absolutely needs to be considered as this field continues to grow. The authors conclude that there is no substitute for the consumer voice.

scholarly journals ACADEMIA’S ROLE TO DRIVE CHANGE IN THE ORTHOTICS AND PROSTHETICS PROFESSION

2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Géza Kogler ◽  
Christopher Hovorka
Keyword(s):  
Technology Use ◽  
Clinical Training ◽  
Clinical Decision Making ◽  
New Technologies ◽  
Clinical Care ◽  
Clinical Decision ◽  
The United States ◽  
Academic Program ◽  
Number Of Patients ◽  
Curricular Emphasis

This position paper outlines the important role of academia in shaping the orthotics and prosthetics (O&P) profession and preparing for its future. In the United States, most healthcare professions including O&P are under intense pressure to provide cost effective treatments and quantifiable health outcomes. Pivotal changes are needed in the way O&P services are provided to remain competitive. This will require the integration of new technologies and data driven processes that have the potential to streamline workflows, reduce errors and inform new methods of clinical care and device manufacturing. Academia can lead this change, starting with a restructuring in academic program curricula that will enable the next generation of professionals to cope with multiple demands such as the provision of services for an increasing number of patients by a relatively small workforce of certified practitioners delivering these services at a reduced cost, with the expectation of significant, meaningful, and measurable value. Key curricular changes will require replacing traditional labor-intensive and inefficient fabrication methods with the integration of newer technologies (i.e., digital shape capture, digital modeling/rectification and additive manufacturing). Improving manufacturing efficiencies will allow greater curricular emphasis on clinical training and education – an area that has traditionally been underemphasized. Providing more curricular emphasis on holistic patient care approaches that utilize systematic and evidence-based methods in patient assessment, treatment planning, dosage of O&P technology use, and measurement of patient outcomes is imminent. Strengthening O&P professionals’ clinical decision-making skills and decreasing labor-intensive technical fabrication aspects of the curriculum will be critical in moving toward a digital and technology-centric practice model that will enable future practitioners to adapt and survive. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/36673/28349 How To Cite: Kogler GF, Hovorka CF. Academia’s role to drive change in the orthotics and prosthetics profession. Canadian Prosthetics & Orthotics Journal. 2021; Volume 4, Issue 2, No.21. https://doi.org/10.33137/cpoj.v4i2.36673 Corresponding Author: Géza F. KoglerOrthotics and Prosthetics Unit, Kennesaw State University.E-Mail: [email protected] ID: https://orcid.org/0000-0003-0212-5520

scholarly journals What do clinicians want? Understanding frontline addiction treatment clinicians’ preferences and priorities to improve the design of measurement-based care technology

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Justin S. Tauscher ◽  
Eliza B. Cohn ◽  
Tascha R. Johnson ◽  
Kaylie D. Diteman ◽  
Richard K. Ries ◽  
...  
Keyword(s):  
Addiction Treatment ◽  
Clinical Decision Making ◽  
New Technologies ◽  
Clinical Care ◽  
Ease Of Use ◽  
Sorting Task ◽  
Multiple Use ◽  
Card Sorting ◽  
Measurement Based Care ◽  
Treatment Settings

Abstract Background Measurement-based care (MBC) is the practice of routinely administering standardized measures to support clinical decision-making and monitor treatment progress. Despite evidence of its effectiveness, MBC is rarely adopted in routine substance use disorder (SUD) treatment settings and little is known about the factors that may improve its adoptability in these settings. The current study gathered qualitative data from SUD treatment clinicians about their perceptions of MBC, the clinical outcomes they would most like to monitor in MBC, and suggestions for the design and implementation of MBC systems in their settings. Methods Fifteen clinicians from one publicly-funded and two privately-funded outpatient SUD treatment clinics participated in one-on-one research interviews. Interviews focused on clinicians’ perceived benefits, drawbacks, and ideas related to implementing MBC technology into their clinical workflows. Interviews were audio recorded, transcribed, and coded to allow for thematic analysis using a mixed deductive and inductive approach. Clinicians also completed a card sorting task to rate the perceived helpfulness of routinely measuring and monitoring different treatment outcomes. Results Clinicians reported several potential benefits of MBC, including improved patient-provider communication, client empowerment, and improved communication between clinicians. Clinicians also expressed potential drawbacks, including concerns about subjectivity in patient self-reports, limits to personalization, increased time burdens, and needing to learn to use new technologies. Clinicians generated several ideas and preferences aimed at minimizing burden of MBC, illustrating clinical changes over time, improving ease of use, and improving personalization. Numerous patient outcomes were identified as “very helpful” to track, including coping skills, social support, and motivation for change. Conclusions MBC may be a beneficial tool for improving clinical care in SUD treatment settings. MBC tools may be particularly adoptable if they are compatible with existing workflows, help illustrate gradual and nonlinear progress in SUD treatment, measure outcomes perceived as clinically useful, accommodate multiple use cases and stakeholder groups, and are framed as an additional source of information meant to augment, rather than replace, existing practices and information sources.

Identifying and Addressing Ethical Issues with Use of Electronic Health Records

2018 ◽  
Vol 23 (1) ◽  
Author(s):  
Susan McBride ◽  
Mari Tietze ◽  
Catherine Robichaux ◽  
Liz Stokes ◽  
Eileen Weber
Keyword(s):  
Decision Making ◽  
Electronic Health Records ◽  
Clinical Decision Making ◽  
Ethical Decision Making ◽  
Ethical Issues ◽  
Clinical Care ◽  
The United States ◽  
Unintended Consequences ◽  
Health Records ◽  
Electronic Health

With the passage of the Health Information Technology for Economic and Clinical Health Act in 2009, the United States, as of 2017, has achieved 95% saturation with electronic health records as a means to document healthcare delivery in acute care hospitals and guide clinical decision making. Evidence is mounting that EHRs are resulting in unintended consequences with patient safety implications. Clinical teams confront usability challenges that can present ethical issues requiring ethical decision-making models to support clinicians in appropriate action on behalf of safe, effective clinical care. The purpose of this article is to identify and address ethical issues raised by nurses in use of electronic health records. We provide a case scenario with application of the Four Component Model and describe a study of nurse experiences with the EHR. The nursing Code of Ethics, Nursing Scope and Standards, and Legal Implications are reviewed, and we conclude with recommendations and a call to action.

Confronting the grey zone after severe brain injury

2019 ◽  
Vol 3 (6) ◽  
pp. 707-711 ◽  
Author(s):  
Andrew Peterson ◽  
Adrian M. Owen
Keyword(s):  
Brain Injury ◽  
Ethical Issues ◽  
Vegetative State ◽  
Clinical Care ◽  
Grey Zone ◽  
Severe Brain Injury ◽  
New Methods ◽  
Legal Decision Making ◽  
Technological Developments ◽  
The Brain

In recent years, rapid technological developments in the field of neuroimaging have provided several new methods for revealing thoughts, actions and intentions based solely on the pattern of activity that is observed in the brain. In specialized centres, these methods are now being employed routinely to assess residual cognition, detect consciousness and even communicate with some behaviorally non-responsive patients who clinically appear to be comatose or in a vegetative state. In this article, we consider some of the ethical issues raised by these developments and the profound implications they have for clinical care, diagnosis, prognosis and medical-legal decision-making after severe brain injury.

scholarly journals A day in the life: a qualitative study of clinical decision-making and uptake of neurorehabilitation technology

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Courtney Celian ◽  
Veronica Swanson ◽  
Maahi Shah ◽  
Caitlin Newman ◽  
Bridget Fowler-King ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
New Technologies ◽  
Clinical Decision ◽  
Relative Advantage ◽  
Personal Attributes ◽  
Design Work ◽  
Cognitive Limitations ◽  
Knowledge And Beliefs ◽  
Cord Injury

Abstract Background Neurorehabilitation engineering faces numerous challenges to translating new technologies, but it is unclear which of these challenges are most limiting. Our aim is to improve understanding of rehabilitation therapists’ real-time decision-making processes on the use of rehabilitation technology (RT) in clinical treatment. Methods We used a phenomenological qualitative approach, in which three OTs and two PTs employed at a major, technology-encouraging rehabilitation hospital wrote vignettes from a written prompt describing their RT use decisions during treatment sessions with nine patients (4 with stroke, 2 traumatic brain injury, 1 spinal cord injury, 1 with multiple sclerosis). We then coded the vignettes using deductive qualitative analysis from 17 constructs derived from the RT literature and the Consolidated Framework for Implementation Research (CFIR). Data were synthesized using summative content analysis. Results Of the constructs recorded, the five most prominent are from CFIR determinants of: (i) relative advantage, (ii) personal attributes of the patients, (iii) clinician knowledge and beliefs of the device/intervention, (iv) complexity of the devices including time and setup, and (v) organizational readiness to implement. Therapists characterized candidate RT as having a relative disadvantage compared to conventional treatment due to lack of relevance to functional training. RT design also often failed to consider the multi-faceted personal attributes of the patients, including diagnoses, goals, and physical and cognitive limitations. Clinicians’ comfort with RT was increased by their previous training but was decreased by the perceived complexity of RT. Finally, therapists have limited time to gather, setup, and use RT. Conclusions Despite decades of design work aimed at creating clinically useful RT, many lack compatibility with clinical translation needs in inpatient neurologic rehabilitation. New RT continue to impede the immediacy, versatility, and functionality of hands-on therapy mediated treatment with simple everyday objects.

Death, taxes and uncertainty: Economic motivations in end-of-life decision making

2021 ◽  
pp. 147775092110114
Author(s):  
George Slade Mellgard ◽  
Jacob M Appel
Keyword(s):  
End Of Life ◽  
Ethical Issues ◽  
Conflicts Of Interest ◽  
Clinical Care ◽  
Third Party ◽  
Ethical Conflicts ◽  
Financial Interests ◽  
End Of Life Decision ◽  
Death Taxes

Economic motivations are key drivers of human behavior. Unfortunately, they are largely overlooked in literature related to medical decisionmaking, particularly with regard to end-of-life care. It is widely understood that the directions of a proxy acting in bad faith can be overridden. But what of cases in which the proxy or surrogate appears to be acting in good faith to effectuate the patient’s values, yet doing so directly serves the decision-maker’s financial interests? Such situations are not uncommon. Many patients care as deeply about economic wellbeing of their families as they do for their own lives and health. This brief work examines three scenarios that raise ethical issues regarding the role of pecuniary motives in making critical medical decisions. Each scenario presents a potential financial conflict of interest between an incapacitated patient and a third-party decision-maker and offers a framework for integrating ethical and legal concerns into clinical care. It is our hope that this work prepares physicians for unexpected ethical conflicts of interest and enables them to further the interests of his or her patients.

The Ethics of Mobile Health Technology

2017 ◽  
Vol 41 (S1) ◽  
pp. S39-S39
Author(s):  
S. Galderisi ◽  
F. Caputo
Keyword(s):  
Health Equity ◽  
Mobile Health ◽  
New Technologies ◽  
Ethical Issues ◽  
Professional Associations ◽  
Health Technology ◽  
Ethical Guidelines ◽  
High Quality ◽  
Quality Healthcare ◽  
Health Technologies

IntroductionMobile health (m-health) technology has been growing rapidly in the last decades. The use of this technology represents an advantage, especially for reaching patients who otherwise would have no access to healthcare. However, many ethical issues arise from the use of m-health. Health equity, privacy policies, adequate informed consent and a competent, safe and high quality healthcare need to be guaranteed; professional standards and quality of doctor-patient relationship in the digital setting should not be lower than those set for in-person practice.AimsTo assess advantages and threats that may arise from the wide use of m-health technologies, in order to guarantee the application of the best medical practices, resulting in the highest quality healthcare.MethodsA literature search has been conducted to highlight the most pressing ethical issues emerging from the spreading of m-health technologies.ResultsFew ethical guidelines on the appropriate use of m-health have been developed to help clinicians adopt a professional conduct within digital settings. They focus on the need for professional associations to define ethical guidelines and for physicians to take care of their education and online behavior when using m-health technologies.ConclusionsThe rapid spreading of m-health technologies urges us to evaluate all ethical issues related to its use. It would be advisable to produce an ethical code for the use of these new technologies, to guarantee health equity, privacy protection, high quality doctor-patient relationships and to ensure that m-health is not chosen over traditional care for merely economic purposes.Disclosure of interestSG received honoraria or Advisory board/consulting fees from the following companies: Lundbeck, Janssen Pharmaceuticals, Hoffman-La Roche, Angelini-Acraf, Otsuka, Pierre Fabre and Gedeon-Richter. All other authors have declared.

Test genetici e consenso informato

2012 ◽  
pp. 68-95
Author(s):  
Marco Seri ◽  
Claudio Graziano ◽  
Daniela Turchetti ◽  
Juri Monducci
Keyword(s):  
Dna Sequencing ◽  
Human Genetics ◽  
Ethical Issues ◽  
Clinical Care ◽  
Genomic Medicine ◽  
Genome Project ◽  
Ethical Challenges ◽  
Sequencing Technologies ◽  
The Human Genome Project

The pace of discovery in the field of human genetics has increased exponentially in the last 30 years. We have witnessed the completion of the Human Genome Project, the identification of hundreds of disease-causing genes, and the dawn of genomic medicine (clinical care based on genomic information). Reduction of DNA sequencing costs, thanks to the so-called "next generation sequencing" technologies, is driving a shift towards the era of "personal genomes", but scientific as well as ethical challenges ahead are countless. We provide an overview on the classification of genetic tests, on informed consent procedures in the context of genetic counseling, and on specific ethical issues raised by the implementation of new DNA sequencing technologies.

Sign in / Sign up

Export Citation Format

Share Document