Professional integrity in maternal – fetal innovation and research: an essential component of perinatal medicine

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Laurence B. McCullough ◽  
John H. Coverdale ◽  
Frank A. Chervenak
Keyword(s):  
Randomized Clinical Trials ◽  
Historical Account ◽  
Moral Integrity ◽  
Perinatal Medicine ◽  
Professional Integrity ◽  
Ethical Argument ◽  
Innovation Research ◽  
Clinical Innovation ◽  
Intellectual Integrity

Abstract Objectives Clinical innovation and research on maternal–fetal interventions have become an essential for the development of perinatal medicine. In this paper, we present an ethical argument that the professional virtue of integrity should guide perinatal investigators. Methods We present an historical account of the professional virtue of integrity and the key distinction that this account requires between intellectual integrity and moral integrity. Results We identify implications of both intellectual and moral integrity for innovation, research, prospective oversight, the role of equipoise in randomized clinical trials, and organizational leadership to ensure that perinatal innovation and research are conducted with professional integrity. Conclusions Perinatal investigators and those charged with prospective oversight should be guided by the professional virtue of integrity. Leaders in perinatal medicine should create and sustain an organizational culture of professional integrity in fetal centers, where perinatal innovation and research should be conducted.

scholarly journals COVID-19: Role of Nutrition and Supplementation

Nutrients ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 976
Author(s):  
Fiorenzo Moscatelli ◽  
Francesco Sessa ◽  
Anna Valenzano ◽  
Rita Polito ◽  
Vincenzo Monda ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Viral Infections ◽  
Overweight And Obesity ◽  
Shortness Of Breath ◽  
Nutritional Interventions ◽  
The World ◽  
Diet Regimen ◽  
Specific Diet

At the end of 2019, a new coronavirus (COVID-19) appeared on the world scene, which mainly affects the respiratory system, causing pneumonia and multi-organ failure, and, although it starts with common symptoms such as shortness of breath and fever, in about 2–3% of cases it leads to death. Unfortunately, to date, no specific treatments have been found for the cure of this virus and, therefore, it is advisable to implement all possible strategies in order to prevent infection. In this context, it is important to better define the role of all behaviors, in particular nutrition, in order to establish whether these can both prevent infection and improve the outcome of the disease in patients with COVID-19. In the literature, it is widely shown that states of malnutrition, overweight, and obesity negatively affect the immune system, leading to viral infections, and several studies have shown that nutritional interventions can act as immunostimulators, helping to prevent viral infections. Even if several measures, such as the assumption of a specific diet regimen, the use of dietary supplements, and other similar interventions, are promising for the prevention, management, and recovery of COVID-19 patients, it is important to highlight that strong data from randomized clinical trials are needed to support any such assumption. Considering this particular scenario, we present a literature review addressing several important aspects related to diet and SARS-CoV-2 infection, in order to highlight the importance of diet and supplementation in prevention and management of, as well as recovery from COVID-19.

scholarly journals Education in developing countries and reducing maternal mortality: a forgotten piece of the puzzle?

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Vedran Stefanovic
Keyword(s):  
Developing Countries ◽  
Maternal Mortality ◽  
Meta Analysis ◽  
Perinatal Care ◽  
Substantial Improvement ◽  
Global Strategy ◽  
Perinatal Medicine ◽  
Technological Advances ◽  
Women's Role

Abstract Despite substantial improvement in reducing maternal mortality during the recent decades, we constantly face tragic fact that maternal mortality (especially preventable deaths) is still unacceptably too high, particularly in the developing countries, where 99% of all maternal deaths worldwide occur. Poverty, lack of proper statistics, gender inequality, beliefs and corruption-associated poor governmental policies are just few of the reasons why decline in maternal mortality has not been as sharp as it was wished and expected. Education has not yet been fully recognized as the way out of poverty, improvement of women’s role in the society and consequent better perinatal care and consequent lower maternal mortality. Education should be improved on all levels including girls, women and their partners, medical providers, religious and governmental authorities. Teaching the teachers should be also an essential part of global strategy to lower maternal mortality. This paper is mostly a commentary, not a systematic review nor a meta-analysis with the aim to rise attention (again) to the role of different aspects of education in lowering maternal mortality. The International Academy of Perinatal Medicine should play a crucial role in pushing the efforts on this issue as the influential instance that promotes reflection and dialog in perinatal medicine, especially in aspects such as bioethics, the appropriate use of technological advances, and the sociological and humanistic dimensions of this specific problem of huge magnitude. The five concrete steps to achieve these goals are listed and discussed.

scholarly journals Conscientious Objection in Healthcare and Moral Integrity

2016 ◽  
Vol 26 (1) ◽  
pp. 7-17 ◽  
Author(s):  
MARK WICCLAIR
Keyword(s):  
Health Professionals ◽  
Conscientious Objection ◽  
Alternative Conceptions ◽  
Moral Integrity ◽  
Specific Context ◽  
Moral Space ◽  
Social Component ◽  
Intellectual Integrity ◽  
Moral Convictions

Abstract:There are several reasons for accommodating health professionals’ conscientious objections. However, several authors have argued that among the most important and compelling reasons is to enable health professionals to maintain their moral integrity. Accommodation is said to provide “moral space” in which health professionals can practice without compromising their moral integrity. There are, however, alternative conceptions of moral integrity and corresponding different criteria for moral-integrity-based claims. It is argued that one conception of moral integrity, the identity conception, is sound and suitable in the specific context of responding to health professionals’ conscientious objections and their requests for accommodation. According to the identity conception, one maintains one’s moral integrity if and only if one’s actions are consistent with one’s core moral convictions. The identity conception has been subject to a number of criticisms that might call into question its suitability as a standard for determining whether health professionals have genuine moral-integrity-based accommodation claims. The following five objections to the identity conception are critically examined: (1) it does not include a social component, (2) it is a conception of subjective rather than objective integrity, (3) it does not include a reasonableness condition, (4) it does not include any substantive moral constraints, and (5) it does not include any intellectual integrity requirement. In response to these objections, it is argued that none establishes the unsuitability of the identity conception in the specific context of responding to health professionals’ conscientious objections and their requests for accommodation.

Diffusion, translation and the neglected role of managers in the fashion setting process: The case of MANS

2011 ◽  
Vol 42 (2) ◽  
pp. 149-164 ◽  
Author(s):  
Kees van Veen ◽  
Jelle Bezemer ◽  
Luchien Karsten
Keyword(s):  
Life Cycle ◽  
Active Role ◽  
Historical Account ◽  
Role Changes ◽  
Management Fashion ◽  
Setting Process

In this article, we reconstruct the lifecycle of MANS, a less well-known Dutch management fashion. Studying less well-known fashions is necessary because it challenges existing understandings of management fashions. First, it is argued how such reconstructions can be helpful. It creates a need to combine existing diffusion and translation perspectives on management fashions, it accentuates existing limitations, and it brings unnoticed aspects of management fashions to the forefront. Second, a detailed historical account of the lifecycle of MANS itself will be presented to illustrate these points. Finally, two remarkable and new aspects of MANS are discussed. To begin with, MANS shows an active role of (collectives of) managers in different phases of the life cycle. Additionally, MANS draws attention to role changes of individuals involved. Concepts are not only diffused and translated by different individuals in different roles, but concepts also stimulate individuals to move from one role to another.

scholarly journals Characterizing Highly Benefited Patients in Randomized Clinical Trials

2017 ◽  
Vol 13 (1) ◽  
Author(s):  
Vivek Charu ◽  
Paul B. Rosenberg ◽  
Lon S. Schneider ◽  
Lea T. Drye ◽  
Lisa Rein ◽  
...  
Keyword(s):  
Randomized Clinical Trials ◽  
Controlled Trial ◽  
New Method ◽  
Usual Model ◽  
Randomized Controlled ◽  
Working Model ◽  
Large Numbers ◽  
High Benefit ◽  
Two Stages

AbstractPhysicians and patients may choose a certain treatment only if it is predicted to have a large effect for the profile of that patient. We consider randomized controlled trials in which the clinical goal is to identify as many patients as possible that can highly benefit from the treatment. This is challenging with large numbers of covariate profiles, first, because the theoretical, exact method is not feasible, and, second, because usual model-based methods typically give incorrect results. Better, more recent methods use a two-stage approach, where a first stage estimates a working model to produce a scalar predictor of the treatment effect for each covariate profile; and a second stage estimates empirically a high-benefit group based on the first-stage predictor. The problem with these methods is that each of the two stages is usually agnostic about the role of the other one in addressing the clinical goal. We propose a method that characterizes highly benefited patients by linking model estimation directly to the particular clinical goal. It is shown that the new method has the following two key properties in comparison with existing approaches: first, the meaning of the solution with regard to the clinical goal is the same, and second, the value of the solution is the best that can be achieved when using the working model as a predictor, even if that model is incorrect. In the Citalopram for Agitation in Alzheimer’s Disease (CitAD) randomized controlled trial, the new method identifies substantially larger groups of highly benefited patients, many of whom are missed by the standard method.

scholarly journals Gabapentin as an adjuvant therapy to splinting in carpal tunnel syndrome (CTS): a systematic review and meta-analysis of randomized controlled trials

2020 ◽  
Vol 56 (1) ◽  
Author(s):  
Ahmed M. Ahmed ◽  
Osama G. Hassan ◽  
Ahmed A. Khalifa
Keyword(s):  
Systematic Review ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Pinch Strength ◽  
Symptom Severity Scale ◽  
Significant Difference ◽  
Tunnel Syndrome

Abstract Background Carpal tunnel syndrome (CTS) is a common upper limb entrapment neuropathy; severe cases are treated surgically and mild to moderate can be managed conservatively. The purpose of this systematic review and meta-analysis was to define the efficacy of gabapentin as an adjuvant to splinting in the treatment of mild to moderate CTS. Methods A systematic search through 13 databases, randomized clinical trials (RCTs) reporting the use of gabapentin with splinting in CTS were included and analyzed. Results Three RCTs including 170 patients were eligible. There was no significant difference between gabapentin plus splinting and splinting alone in 5 measured parameters: (1) Symptom Severity Scale (SSS) [MD (95% CI) = − 0.76 (− 2.46–0.93), p = 0.378], (2) Functional Status Scale (FSS) [MD (95% CI) = − 0.23 (− 1.40–0.94), p = 0.701], (3) visual analogue scale (VAS) to assess pain [MD (95% CI) = − 0.6 (− 1.47–0.27), p = 0.174], (4) Grip strength [MD (95% CI) = − 0.11 (− 0.70–0.48), p = 0.718], and (5) pinch strength [MD (95% CI) = 0.72 (− 0.10–1.54), p = 0.083]. Conclusion This review provides low-quality evidence that gabapentin plus nocturnal splinting is not superior to splinting alone. More high-quality trials are needed to determine the role of this drug as an adjuvant in the management of CTS.

Tracheotomy in comparison with tracheopathia for prolonged intubation of the lungs in surgical patients

2020 ◽  
pp. 79-86
Author(s):  
A. A. Teuvov ◽  
A. M. Baziev ◽  
Z. N. Lovpache ◽  
T. G. Tlupova ◽  
A. I. Sardiyanov
Keyword(s):  
Critically Ill ◽  
Randomized Clinical Trials ◽  
Patient Survival ◽  
Surgical Patients ◽  
Surgical Wound ◽  
Prolonged Intubation ◽  
Clinically Significant ◽  
Critically Ill Adults ◽  
Ill Adults

A comparative analysis of the MEDLINE, EMBASE, CINAHL and Cochrane Registry databases was carried out to identify the advantages of puncture-dilatation tracheostomy methods over standard tracheotomy in critically ill patients. In addition, bibliographies and selected conference proceedings were reviewed; included randomized clinical trials comparing puncture-dilatation techniques with standard tracheotomy in critically ill adults, which reported clinically significant outcomes. The extracted data are focused on the criteria for the validity of the studies and the results relevant to practice. Puncture methods are less traumatic and can reduce the likelihood of infection of the surgical wound. Compared to the traditional method, a puncture tracheostomy can be applied in just 2 minutes,which can play a significant role in the prognosis of patient survival. The role of the experience of the operators performing the procedures has a significant impact on the results, which cannot be formally and quantitatively assessed in our analysis.

scholarly journals The role of cultural and structural factors in the explanation of marginal social position in the USA: Scopes and dilemmas

Sociologija ◽  
2013 ◽  
Vol 55 (3) ◽  
pp. 395-416
Author(s):  
Stefan Jankovic
Keyword(s):  
Cultural Factors ◽  
Social Position ◽  
Structural Factors ◽  
Historical Account ◽  
Culture Of Poverty ◽  
Behavioural Patterns ◽  
Cultural Grounding ◽  
The Usa ◽  
The Relationship

The paper gives a historical account of the genesis of marginal social position explanations in the USA, with special emphasis on the characteristics, related to the generating of cultural factors in explanation. In this light, the two fundamental and interrelated concepts are being indentified - the culture of poverty and the underclass, whose conceptual genesis, in a causal manner, varies between structural and cultural grounding. Due the translation of perceived minority behavioural patterns into the dimensions used for defining the marginal social position, conceptual validity of the underclass has been heavily disputed. At the same time, dilemmas created by the implementation of cultural factors constructed in that way open up broader issues of the relationship between culture and structure, lines of determination and the possibility of a consistent explanation of marginal social position.

scholarly journals The effect of renin-angiotensin-aldosterone blockers on SARS-CoV-2 infection in adults: a systematic review of studies and meta-analyzes

2021 ◽  
pp. 26-33
Author(s):  
М. V. Leonova
Keyword(s):  
Cohort Studies ◽  
Randomized Clinical Trials ◽  
Ace Inhibitor ◽  
Scientific Evidence ◽  
Renin Angiotensin ◽  
Risk Of Death ◽  
Risk Of Mortality ◽  
Duration Of Hospitalization ◽  
Severity Of The Disease

The article discusses the role of immune dysregulation of the renin-angiotensin-aldosterone system (RAAS) in the pathogenesis of COVID-19 infection, the participation of ACE2 for the penetration of the SARS-CoV-2 coronavirus into cells and the possible role of RAAS blockers, which have a direct effect on the pathological activity of the RAAS, in the development of and the severity of the disease. It is noted that the beneficial organoprotective effects of ACE inhibitors and ARBs may protect against SARS-CoV-2 infection, and their withdrawal may lead to clinical decompensation in patients at high risk of cardiovascular risk. Since then, a number of observational cohort studies have been carried out to address the main questions: does the use of an ACE inhibitor or ARB increase the risk of contracting the novel SARS-CoV-2 coronavirus, and whether the use of RAAS blockers is associated with worse outcomes of COVID-19 disease. The article provides an overview of the scientific evidence on the relationship between the use of RASS blockers and COVID-19 infection. Several cohort studies and two meta-analyzes found no association between prior use of an ACE inhibitor/ARB and the risk of COVID-19 infection (RR 0.96–0.99). In studies on the study of clinical and laboratory features of the action of RAAS blockers in COVID-19, a significantly larger number of subpopulations of T-lymphocytes CD3+ and CD8+, lower concentrations of biomarkers (C-reactive protein, ferritin, IL-6, procalcitonin), as well as a lower viral load. In clinical outcomes, with the use of an ACE inhibitor/ARB, there was a lower incidence of severe/critical forms, and a shorter duration of hospitalization. In large cohort studies with >1000 patients, the use of an ACE inhibitor/ARB was not associated with an increase in the risk of death in patients with COVID-19 (RR < 1.0), and some studies showed a 37–67% decrease in RR. Meta-analyzes also confirmed the absence of the effect of RAAS blockers on the risk of mortality, and in the population of patients with hypertension, a significant reduction in the risk of mortality and severe course of COVID-19 was revealed. Most international associations of specialists, as well as the Russian Cardiological Society, are recommended to continue the use of RAAS blockers in patients with cardiovascular diseases and not to be canceled in case of COVID-19 disease. Further randomized clinical trials are needed to generate new evidence.

scholarly journals The Role of Green Intellectual Capital on Competitive Advantage: Evidence from Balinese Financial Institution

2019 ◽  
Vol 3 (3) ◽  
pp. 227
Author(s):  
Anak Agung Putu Gede Bagus Arie Susandya ◽  
Putu Diah Kumalasari ◽  
Ida Ayu Ratih Manuari
Keyword(s):  
Human Capital ◽  
Competitive Advantage ◽  
Intellectual Capital ◽  
Financial Institution ◽  
Critical Factor ◽  
Research Field ◽  
Relational Capital ◽  
Innovation Research ◽  
Structural Capital

The purpose of this study is to analyze the role of green intellectual capital on competitive advantage of Lembaga Perkreditan Desa (Balinese Financial Institution). The study tested by using data collected from a sample of 120 respondents that were randomly picked from 35 Lembaga Perkreditan Desa in Denpasar. Findings suggested that green human capital, green relational capital, and green structural capital affect competitive advantage at 17.6%. Furthermore, green human capital and green structural capital had positive effect on competitive advantage. Meanwhile, green relational capital did not affect competitive advantage. The eco-friendly concept remains a critical factor to gain company’s competitive advantage. This study provides insight into green innovation research field.

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