scholarly journals Cancer During Pregnancy: How to Handle the Bioethical Dilemmas?—A Scoping Review With Paradigmatic Cases-Based Analysis

2020 ◽  
Vol 10 ◽  
Author(s):  
Diogo Alpuim Costa ◽  
José Guilherme Nobre ◽  
Susana Baptista de Almeida ◽  
Marisa Horta Ferreira ◽  
Inês Gonçalves ◽  
...  
Keyword(s):  
Decision Making ◽  
Pregnant Woman ◽  
Scoping Review ◽  
Ethical Issues ◽  
Case Reports ◽  
Grey Literature ◽  
Real Life ◽  
Published Data ◽  
Ethical Frameworks ◽  
Theoretical Approaches

Ethical issues that arise during the care of a pregnant woman with cancer are challenging to physicians, policymakers, lawyers, and the bioethics community. The main purpose of this scoping review is to summarize existing literature regarding the bioethical dilemmas when a conflict arises in the maternal-fetus dyad, like the one related to cancer and pregnancy outcomes. Moreover, we illustrate the decision-making process of real-life case reports. Published data were searched through the PubMed and Google Scholar databases, as well as in grey literature, using appropriate controlled keywords in English and Portuguese. After identification, screening, eligibility and data extraction from the articles, a total of 50 was selected. There are several established ethical frameworks for conflict resolution and decision-making. Pragmatic theoretical approaches include case-based analysis, the ethics of care, feminist theory, and traditional ethical principlism that scrutinizes the framework of autonomy, justice, beneficence, and non-maleficence. In addition, society and practitioner values could mediate this complex ethical interplay. The physician must balance autonomy and beneficence-based obligations to the pregnant woman with cancer, along with beneficence-based obligations to the fetus. Ethical challenges have received less attention in the literature, particularly before the third trimester of pregnancy. Best, unbiased and balanced information must be granted both to the patient and to the family, regarding the benefits and harms for the woman herself as well as for the fetal outcome. Based on a previously validated method for analyzing and working up clinical ethical problems, we suggest an adaptation of an algorithm for biomedical decision-making in cancer during pregnancy, including recommendations that can facilitate counseling and help reduce the suffering of the patient and her family.

scholarly journals Cancer Before the Third Trimester of Pregnancy: How to Handle the Bioethical Dilemmas?- A Literature Review

2020 ◽  
Author(s):  
Diogo Alpuim Costa ◽  
J. Guilherme Nobre
Keyword(s):  
Pregnant Woman ◽  
Ethical Issues ◽  
Case Reports ◽  
Ethics Consultation ◽  
Ethical Challenges ◽  
Third Trimester ◽  
Ethical Frameworks ◽  
The Third ◽  
Theoretical Approaches ◽  
Case Based

Background: ethical issues that arise during the care of a pregnant woman with cancer are challenging to physicians, policymakers, lawyers, and the bioethics community. This article is restricted to a discussion of ethical dilemmas and controversial case reports, mainly focused before the third trimester of pregnancy, when a conflict could exist between cancer and pregnancy outcomes.Methods: published literature was retrieved through searches in PubMed or Medline, CINAHL, the Cochrane and Google Academic in April 2020, using appropriate controlled keywords (cancer, neoplasm, pregnancy, ethics). Results were restricted to review articles, ethical perspectives, clinical practice guidelines and case-based teaching guides.Discussion: when a conflict arises in the maternal-foetus dyad, like the one related with cancer treatment and the risk of foetal demise, a range of ethical frameworks might be useful to consider in the decision-making process. Pragmatic theoretical approaches include case-based analysis, ethics of care, feminist theory, and traditional ethical principlism using the framework of autonomy, beneficence, non-maleficence, and justice. Also, societal and practitioner values could add value and an ethics consultation may be helpful to mediate conflict resolution. The physician must balance autonomy and beneficence-based obligations to the pregnant woman with cancer, along with beneficence-based obligations to the foetus.Conclusions: ethical challenges have received less attention in the literature, particularly before the third trimester of pregnancy. Best, unbiased and balanced information must be granted both to the patient and to the family, regarding the benefits and harms for the woman herself as well as for the foetal outcome.

scholarly journals Engaging Tomorrow’s Doctors in Clinical Ethics: Implications for Healthcare Organisations

2020 ◽  
Author(s):  
Laura L. Machin ◽  
Robin D. Proctor
Keyword(s):  
Decision Making ◽  
Clinical Ethics ◽  
Ethical Issues ◽  
Medical Curriculum ◽  
Real Life ◽  
System Quality ◽  
Ethical Frameworks ◽  
Ethics Support ◽  
Ethics Teaching ◽  
The Impact

Abstract Clinical ethics can be viewed as a practical discipline that provides a structured approach to assist healthcare practitioners in identifying, analysing and resolving ethical issues that arise in practice. Clinical ethics can therefore promote ethically sound clinical and organisational practices and decision-making, thereby contributing to health organisation and system quality improvement. In order to develop students’ decision-making skills, as well as prepare them for practice, we decided to introduce a clinical ethics strand within an undergraduate medical curriculum. We designed a programme of clinical ethics activities for teaching and assessment purposes that involved using ethical frameworks to analyse hypothetical and real-life cases in uni- and inter- professional groups. In this paper, we draw on medical student feedback collected over 6 years to illustrate the appeal to students of learning clinical ethics. We also outline the range of benefits for students, healthcare organisations, and the field of clinical ethics arising from tomorrow’s doctors experiencing clinical ethics early in their training. We conclude by briefly reflecting on how including clinical ethics within tomorrow’s doctors curricular can secure and continue future engagement in clinical ethics support services in the UK, alongside the dangers of preparing students for organisational cultures that might not (yet) exist. We anticipate the findings presented in the paper will contribute to wider debates examining the impact of ethics teaching, and its ability to inform future doctors’ practice.

scholarly journals Artificial intelligence for good health: a scoping review of the ethics literature

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Kathleen Murphy ◽  
Erica Di Ruggiero ◽  
Ross Upshur ◽  
Donald J. Willison ◽  
Neha Malhotra ◽  
...  
Keyword(s):  
Public Health ◽  
Artificial Intelligence ◽  
Global Health ◽  
Population Health ◽  
Health Systems ◽  
Scoping Review ◽  
Industrial Revolution ◽  
Ethical Issues ◽  
Grey Literature ◽  
Ethical Implications

Abstract Background Artificial intelligence (AI) has been described as the “fourth industrial revolution” with transformative and global implications, including in healthcare, public health, and global health. AI approaches hold promise for improving health systems worldwide, as well as individual and population health outcomes. While AI may have potential for advancing health equity within and between countries, we must consider the ethical implications of its deployment in order to mitigate its potential harms, particularly for the most vulnerable. This scoping review addresses the following question: What ethical issues have been identified in relation to AI in the field of health, including from a global health perspective? Methods Eight electronic databases were searched for peer reviewed and grey literature published before April 2018 using the concepts of health, ethics, and AI, and their related terms. Records were independently screened by two reviewers and were included if they reported on AI in relation to health and ethics and were written in the English language. Data was charted on a piloted data charting form, and a descriptive and thematic analysis was performed. Results Upon reviewing 12,722 articles, 103 met the predetermined inclusion criteria. The literature was primarily focused on the ethics of AI in health care, particularly on carer robots, diagnostics, and precision medicine, but was largely silent on ethics of AI in public and population health. The literature highlighted a number of common ethical concerns related to privacy, trust, accountability and responsibility, and bias. Largely missing from the literature was the ethics of AI in global health, particularly in the context of low- and middle-income countries (LMICs). Conclusions The ethical issues surrounding AI in the field of health are both vast and complex. While AI holds the potential to improve health and health systems, our analysis suggests that its introduction should be approached with cautious optimism. The dearth of literature on the ethics of AI within LMICs, as well as in public health, also points to a critical need for further research into the ethical implications of AI within both global and public health, to ensure that its development and implementation is ethical for everyone, everywhere.

scholarly journals Health science communication strategies used by researchers with the public in the digital and social media ecosystem: a systematic scoping review protocol

BMJ Open ◽  
2018 ◽  
Vol 8 (1) ◽  
pp. e019833 ◽  
Author(s):  
Guillaume Fontaine ◽  
Andréane Lavallée ◽  
Marc-André Maheu-Cadotte ◽  
Julien Bouix-Picasso ◽  
Anne Bourbonnais
Keyword(s):  
Social Media ◽  
Scoping Review ◽  
Science Communication ◽  
Grey Literature ◽  
Communication Channels ◽  
Health Science ◽  
Published Data ◽  
The Public ◽  
Review Team ◽  
Media Ecosystem

IntroductionThe optimisation of health science communication (HSC) between researchers and the public is crucial. In the last decade, the rise of the digital and social media ecosystem allowed for the disintermediation of HSC. Disintermediation refers to the public’s direct access to information from researchers about health science-related topics through the digital and social media ecosystem, a process that would otherwise require a human mediator, such as a journalist. Therefore, the primary aim of this scoping review is to describe the nature and the extent of the literature regarding HSC strategies involving disintermediation used by researchers with the public in the digital and social media ecosystem. The secondary aim is to describe the HSC strategies used by researchers, and the communication channels associated with these strategies.Methods and analysisWe will conduct a scoping review based on the Joanna Briggs Institute’s methodology and perform a systematic search of six bibliographical databases (CINAHL, EMBASE, IBSS, PubMed, Sociological Abstracts and Web of Science), four trial registries and relevant sources of grey literature. Relevant journals and reference lists of included records will be hand-searched. Data will be managed using the EndNote software and the Rayyan web application. Two review team members will perform independently the screening process as well as the full-text assessment of included records. Descriptive data will be synthesised in a tabular format. Data regarding the nature and the extent of the literature, the HSC strategies and the associated communication channels will be presented narratively.Ethics and disseminationThis review does not require institutional review board approval as we will use only collected and published data. Results will allow the mapping of the literature about HSC between researchers and the public in the digital and social media ecosystem, and will be published in a peer-reviewed journal.

scholarly journals Quality of patient, family, caregiver and public engagement in decision-making in healthcare systems: a scoping review protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e032788
Author(s):  
Clayon Hamilton ◽  
M Elizabeth Snow ◽  
Nancy Clark ◽  
Shannon Gibson ◽  
Maryam Dehnadi ◽  
...  
Keyword(s):  
Decision Making ◽  
Scoping Review ◽  
Family Caregiver ◽  
Research Question ◽  
Grey Literature ◽  
Healthcare Systems ◽  
Evaluation Framework ◽  
Bibliographic Databases ◽  
Scientific Article

IntroductionTo advance person- and family-centred healthcare, government initiatives have supported the engagement of patients and family caregivers in decision-making in healthcare systems. There is, however, no consensus on how to define success for such initiatives. This scoping review aims to identify the key elements for defining the quality of patient and family caregiver engagement in decision-making across the engagement domains (individual, community/organisation, system) of British Columbia’s healthcare system. We will use those elements to develop a conceptual evaluation framework.Methods and analysisThis scoping review follows Arskey and O’Malley’s methodology. (1) The research question was identified through team discussions. (2) Articles for data source will be identified using a librarian-informed search strategy for seven bibliographic databases as well as grey literature sources. (3) Selected articles will be relevant to the evaluation of patient and family caregiver engagement in healthcare systems. (4) Two researchers will independently extract data into predefined and emerging categories. (5) The researchers will reconcile and organise the identified elements. The research team’s collective perspective will then refine the elements, and select, interpret and summarise the results. (6) Persons from key stakeholder groups will be consulted to refine the emergent conceptual framework.Ethics and disseminationWe will seek ethics approval for the stakeholder consultation. This study follows an integrated knowledge translation approach. The results will inform evaluation of the Patients as Partners Initiative of the British Columbia Ministry of Health, and will be disseminated as a scientific article, a research brief, and presentations at conferences and stakeholder meetings.

scholarly journals Artificial Intelligence for Good Health: A Scoping Review of the Ethics Literature

2020 ◽  
Author(s):  
Kathleen Murphy ◽  
Erica Di Ruggiero ◽  
Ross Upshur ◽  
Donald J. Willison ◽  
Neha Malhotra ◽  
...  
Keyword(s):  
Public Health ◽  
Artificial Intelligence ◽  
Global Health ◽  
Population Health ◽  
Health Systems ◽  
Scoping Review ◽  
Industrial Revolution ◽  
Ethical Issues ◽  
Grey Literature ◽  
Ethical Implications

Abstract Background Artificial intelligence (AI) has been described as the “fourth industrial revolution” with transformative and global implications, including in healthcare, public health, and global health. AI approaches hold promise for improving health systems worldwide, as well as individual and population health outcomes. While AI may have the potential to advance health equity within and between countries, we must consider the ethical implications of its deployment in order to mitigate its potential harms, particularly for the most vulnerable. This scoping review addresses the following question: What ethical issues have been identified in relation to AI in the field of health, including from a global health perspective? Methods Eight electronic databases were searched for peer reviewed and grey literature using the overarching concepts of health, ethics, and AI, and their related terms. Records were independently screened by two reviewers and were included if they reported on AI in relation to health and ethics and were written in the English language. Data was charted on a piloted data abstraction form, and a descriptive and thematic analysis was performed. Results Upon reviewing 12,722 articles, 103 met the predetermined inclusion criteria. The literature was primarily focused on the ethics of AI in health care, particularly on carer robots, diagnostics, and precision medicine, but was largely silent on ethics of AI in public and population health. The literature highlighted a number of common ethical concerns related to privacy, trust, accountability, and bias. Largely missing from the reviewed literature was the ethics of AI in global health, particularly in the context of low- and middle-income countries (LMICs). Conclusions The ethical issues surrounding AI in the field of health are both vast and complex. While AI holds the potential to improve health and health systems, our analysis suggests that its introduction should be approached with cautious optimism. The dearth of literature on the ethics of AI within LMICs, as well as in public health, also points to a critical need for further research into the ethical implications of AI within both global and public health, to ensure that its development and implementation is ethical for everyone, everywhere.

scholarly journals Artificial Intelligence for Good Health: A Scoping Review of the Ethics Literature

2021 ◽  
Author(s):  
Kathleen Murphy ◽  
Erica Di Ruggiero ◽  
Ross Upshur ◽  
Donald J. Willison ◽  
Neha Malhotra ◽  
...  
Keyword(s):  
Public Health ◽  
Artificial Intelligence ◽  
Global Health ◽  
Population Health ◽  
Health Systems ◽  
Scoping Review ◽  
Industrial Revolution ◽  
Ethical Issues ◽  
Grey Literature ◽  
Ethical Implications

Abstract Background: Artificial intelligence (AI) has been described as the “fourth industrial revolution” with transformative and global implications, including in healthcare, public health, and global health. AI approaches hold promise for improving health systems worldwide, as well as individual and population health outcomes. While AI may have potential for advancing health equity within and between countries, we must consider the ethical implications of its deployment in order to mitigate its potential harms, particularly for the most vulnerable. This scoping review addresses the following question: What ethical issues have been identified in relation to AI in the field of health, including from a global health perspective? Methods: Eight electronic databases were searched for peer reviewed and grey literature published before April 2018 using the concepts of health, ethics, and AI, and their related terms. Records were independently screened by two reviewers and were included if they reported on AI in relation to health and ethics and were written in the English language. Data was charted on a piloted data charting form, and a descriptive and thematic analysis was performed. Results: Upon reviewing 12,722 articles, 103 met the predetermined inclusion criteria. The literature was primarily focused on the ethics of AI in health care, particularly on carer robots, diagnostics, and precision medicine, but was largely silent on ethics of AI in public and population health. The literature highlighted a number of common ethical concerns related to privacy, trust, accountability and responsibility, and bias. Largely missing from the literature was the ethics of AI in global health, particularly in the context of low- and middle-income countries (LMICs). Conclusions: The ethical issues surrounding AI in the field of health are both vast and complex. While AI holds the potential to improve health and health systems, our analysis suggests that its introduction should be approached with cautious optimism. The dearth of literature on the ethics of AI within LMICs, as well as in public health, also points to a critical need for further research into the ethical implications of AI within both global and public health, to ensure that its development and implementation is ethical for everyone, everywhere.

scholarly journals What is the evidence for the impact of gardens and gardening on health and well-being: a scoping review and evidence-based logic model to guide healthcare strategy decision making on the use of gardening approaches as a social prescription

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e036923 ◽  
Author(s):  
Michelle Howarth ◽  
Alison Brettle ◽  
Michael Hardman ◽  
Michelle Maden
Keyword(s):  
Decision Making ◽  
Scoping Review ◽  
Grey Literature ◽  
Well Being ◽  
Evidence Based ◽  
Long Term Conditions ◽  
Logic Models ◽  
Health Strategy ◽  
The Impact ◽  
Health And Well Being

ObjectiveTo systematically identify and describe studies that have evaluated the impact of gardens and gardening on health and well-being. A secondary objective was to use this evidence to build evidence-based logic models to guide health strategy decision making about gardens and gardening as a non-medical, social prescription.DesignScoping review of the impact of gardens and gardening on health and well-being. Gardens include private spaces and those open to the public or part of hospitals, care homes, hospices or third sector organisations.Data sourcesA range of biomedical and health management journals was searched including Medline, CINAHL, Psychinfo, Web of Knowledge, ASSIA, Cochrane, Joanna Briggs, Greenfile, Environment Complete and a number of indicative websites were searched to locate context-specific data and grey literature. We searched from 1990 to November 2019.Eligibility criteriaWe included research studies (including systematic reviews) that assessed the effect, value or impact of any garden that met the gardening definition.Data extraction and synthesisThree reviewers jointly screened 50 records by titles and abstracts to ensure calibration. Each record title was screened independently by 2 out of 3 members of the project team and each abstract was screened by 1 member of a team of 3. Random checks on abstract and full-text screening were conducted by a fourth member of the team and any discrepancies were resolved through double-checking and discussion.ResultsFrom the 8896 papers located, a total of 77* studies was included. Over 35 validated health, well-being and functional biometric outcome measures were reported. Interventions ranged from viewing gardens, taking part in gardening or undertaking therapeutic activities. The findings demonstrated links between gardens and improved mental well-being, increased physical activity and a reduction in social isolation enabling the development of 2 logic models.ConclusionsGardens and gardening can improve the health and well-being for people with a range of health and social needs. The benefits of gardens and gardening could be used as a ‘social prescription’ globally, for people with long-term conditions (LTCs). Our logic models provide an evidence-based illustration that can guide health strategy decision making about the referral of people with LTCs to socially prescribed, non-medical interventions involving gardens and gardening.

scholarly journals Multidetector computed tomography has replaced conventional intravenous excretory urography in imaging of the kidneys: A scoping review of multidetector computed tomography findings in renal tuberculosis

2018 ◽  
Vol 22 (1) ◽  
Author(s):  
Ntombizakhona B.A. Mthalane ◽  
Nondumiso N.M. Dlamini
Keyword(s):  
Computed Tomography ◽  
Multidetector Computed Tomography ◽  
Scoping Review ◽  
Case Reports ◽  
Grey Literature ◽  
Developed Countries ◽  
Excretory Urography ◽  
Original Research ◽  
Imaging Characteristics ◽  
Low Sensitivity

Background: Tuberculosis (TB) is a worldwide infectious disease burden, especially in non-developed countries, with increased morbidity and mortality among human immunodeficiency virus (HIV)-infected patients. Extrapulmonary TB is rare and renal TB is one of the commonest manifestations. The end result of renal TB is end-stage renal disease; however, this can be avoided if the diagnosis is made early. The diagnosis of renal TB is challenging because of the non-specific presentation and low sensitivity of clinical tests. Although the sequel of TB infection in the kidney causes varying manifestations depending on the stage of the disease, multidetector computed tomography (MDCT) is capable of demonstrating early findings. We performed a 20-year scoping review of MDCT findings in renal TB to promote awareness.Aim: To identify specific MDCT imaging characteristics of renal TB, promote early diagnosis and increase awareness of the typical imaging features.Methods and material: We searched published and unpublished literature from 1997 to 2017 using a combination of search terms on electronic databases. We followed the Joanna Briggs Institute guidelines.Results: A total of 150 articles were identified, of which 145 were found through electronic search engines and 5 were obtained from grey literature. Seventy-nine articles that fulfilled our inclusion criteria were reviewed. These included original research, case reports, literature review, organisational reports and grey literature.Conclusion: Multidetector computed tomography can reproduce images comparable with intravenous excretory urography; together with advantages of being able to better assess the renal parenchyma and surrounding spaces, it is important in suggesting the diagnosis of renal TB and clinicians should consider including MDCT when investigating patients with recurrent urinary tract infection not responding to usual antimicrobial therapy. 

scholarly journals Adopting an ethical approach to migration health policy, practice and research

2021 ◽  
Vol 6 (7) ◽  
pp. e006425
Author(s):  
Kristine Husøy Onarheim ◽  
Kolitha Wickramage ◽  
David Ingleby ◽  
Supriya Subramani ◽  
Ingrid Miljeteig
Keyword(s):  
Decision Making ◽  
Health Policy ◽  
Policy Making ◽  
Ethical Issues ◽  
Health Workers ◽  
Decision Makers ◽  
Ethical Challenges ◽  
Ethical Frameworks ◽  
Ethical Approach ◽  
Trade Offs

Migration health is affected by decision making at levels ranging from global to local, both within and beyond the health sector. These decisions impact seeking, entitlements, service delivery, policy making and knowledge production on migration health. It is key that ethical challenges faced by decision makers are recognised and addressed in research and data, clinical practice and policy making on migration health. An ethical approach can provide methods to identify ethical issues, frameworks for systematising information and suggesting ethically acceptable solutions, and guidance on procedural concerns and legitimate decision making processes. By unpacking dilemmas, conflicts of interests and values at stake, an ethical approach is relevant for all who make decisions about migration health policy and practice. Adopting an ethical approach to migration health benefits governments, organisations, policy makers, health workers, data managers, researchers and migrants themselves. First, it highlights the inherent normative questions and trade-offs at stake in migration health. Second, it assists decision makers in deciding what is the ethically justifiable thing to do through an ‘all things considered’ approach. Third, ethical frameworks and technical guidance set normative and practical standards for decision makers facing ethical questions – from ‘bedside rationing’ to collection of big data or in policy making – that can ensure that migrants’ interests are considered. Fourth, there is a need for greater transparency and accountability in decision making, as well as meaningful participation of migrant groups. An ethical approach connects to public health, economic and human rights arguments and highlights the urgent need to mainstream concerns for migrants in global and national health responses.

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