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Ambiguity leads to uncertainty: ambiguous demands to blood donors.

https://arctichealth.org/en/permalink/ahliterature71425
Source
Scand J Caring Sci. 2003 Mar;17(1):74-7
Publication Type
Article
Date
Mar-2003
Author
Torill Christine Lindstrøm
Anne Røsvik
Author Affiliation
Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway. torill.lindstrom@psysp.uib.no
Source
Scand J Caring Sci. 2003 Mar;17(1):74-7
Date
Mar-2003
Language
English
Publication Type
Article
Keywords
Adult
Attitude to Health
Bias (epidemiology)
Blood Donors - education - psychology
Blood Transfusion - adverse effects
Educational Status
Female
Humans
Infection Control
Informed Consent - standards
Life Style
Male
Middle Aged
Norway
Questionnaires - standards
Risk factors
Semantics
Sexual Behavior
Abstract
Blood donors must respond to standard control questions and comply to certain demands before donating blood, to exclude possible recent contamination. This study investigates whether donors had adequate knowledge about 'the immunological window period', and whether the standard questionnaire in use was understandable and clear. It was found that nearly 40% of the donors had inadequate knowledge about 'the immunological window period' and that 10-40% of the donors would respond in various ways to different interpretations of the formulations of the questionnaire, indicating that the questionnaire was ambiguous. It was concluded that these factors could increase the risk of donating on wrong conditions. Demands and control questions posed to donors must be void of ambiguous formulations and take proper account of actual human sexual behaviours and life styles. Finally, it is suggested that blood banks must offer practical solutions (such as a 'fake donation') for temporarily rejected donors in order to respect their private integrity.
PubMed ID
12581298 View in PubMed
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An analysis of research guidelines on the collection and use of human biological materials from American Indian and Alaskan Native communities.

https://arctichealth.org/en/permalink/ahliterature49171
Source
Jurimetrics. 2002;42(2):165-86
Publication Type
Article
Date
2002
Author
Richard R Sharp
Morris W Foster
Author Affiliation
Program in Environmental Health Policy and Ethics, National Institute of Environmental Health Sciences, USA.
Source
Jurimetrics. 2002;42(2):165-86
Date
2002
Language
English
Publication Type
Article
Keywords
Biological Specimen Banks - ethics - utilization
Cultural Characteristics
Genetic Research - ethics
Guidelines
Human Experimentation - ethics - standards
Humans
Indians, North American - genetics
Information Dissemination
Informed Consent - standards
Inuits - genetics
Research - standards
Research Design
Research Subjects
Researcher-Subject Relations
Abstract
American Indian and Alaskan Native communities have expressed concern about the use of human biological materials in research. These concerns have prompted research sponsors and professional organizations to develop guidelines for investigators working with these communities. This paper reviews research guidelines and presents recommendations that reflect "best practices" for working with North American indigenous communities in the collection, storage, and distribution of human biological materials for research. These recommendations strike a reasonable balance between three imperatives in research: (1) minimizing harm, (2) treating sample contributors with respect, and (3) promoting intellectual freedom to pursue a range of research questions. The recommendations can be used in designing appropriate methods of collecting and using human biological materials from members of American Indian and Alaskan Native communities and will likely be applicable to other historically disadvantaged communities as well.
PubMed ID
15119331 View in PubMed
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Canadian Association of Gastroenterology consensus guidelines on safety and quality indicators in endoscopy.

https://arctichealth.org/en/permalink/ahliterature127304
Source
Can J Gastroenterol. 2012 Jan;26(1):17-31
Publication Type
Conference/Meeting Material
Article
Date
Jan-2012
Author
David Armstrong
Alan Barkun
Ron Bridges
Rose Carter
Chris de Gara
Catherine Dube
Robert Enns
Roger Hollingworth
Donald Macintosh
Mark Borgaonkar
Sylviane Forget
Grigorios Leontiadis
Jonathan Meddings
Peter Cotton
Ernst J Kuipers
Author Affiliation
Division of Gastroenterrology, McMaster University, Hamilton, Ontario, Canada. armstro@mcmaster.ca
Source
Can J Gastroenterol. 2012 Jan;26(1):17-31
Date
Jan-2012
Language
English
Publication Type
Conference/Meeting Material
Article
Keywords
Ambulatory Care Facilities - standards
Canada
Clinical Competence - standards
Endoscopy, Gastrointestinal - education - standards
Humans
Informed Consent - standards
Patient Discharge - standards
Quality Indicators, Health Care - standards
Abstract
Increasing use of gastrointestinal endoscopy, particularly for colorectal cancer screening, and increasing emphasis on health care quality, highlight the need for clearly defined, evidence-based processes to support quality improvement in endoscopy.
To identify processes and indicators of quality and safety relevant to high-quality endoscopy service delivery.
A multidisciplinary group of 35 voting participants developed recommendation statements and performance indicators. Systematic literature searches generated 50 initial statements that were revised iteratively following a modified Delphi approach using a web-based evaluation and voting tool. Statement development and evidence evaluation followed the AGREE (Appraisal of Guidelines, REsearch and Evaluation) and GRADE (Grading of Recommendations, Assessment, Development and Evaluation) guidelines. At the consensus conference, participants voted anonymously on all statements using a 6-point scale. Subsequent web-based voting evaluated recommendations for specific, individual quality indicators, safety indicators and mandatory endoscopy reporting fields. Consensus was defined a priori as agreement by 80% of participants.
Consensus was reached on 23 recommendation statements addressing the following: ethics (statement 1: agreement 100%), facility standards and policies (statements 2 to 9: 90% to 100%), quality assurance (statements 10 to 13: 94% to 100%), training, education, competency and privileges (statements 14 to 19: 97% to 100%), endoscopy reporting standards (statements 20 and 21: 97% to 100%) and patient perceptions (statements 22 and 23: 100%). Additionally, 18 quality indicators (agreement 83% to 100%), 20 safety indicators (agreement 77% to 100%) and 23 recommended endoscopy-reporting elements (agreement 91% to 100%) were identified.
The consensus process identified a clear need for high-quality clinical and outcomes research to support quality improvement in the delivery of endoscopy services.
The guidelines support quality improvement in endoscopy by providing explicit recommendations on systematic monitoring, assessment and modification of endoscopy service delivery to yield benefits for all patients affected by the practice of gastrointestinal endoscopy.
Notes
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Comment In: Can J Gastroenterol. 2012 Jan;26(1):15-622288067
PubMed ID
22308578 View in PubMed
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The Canadian Survey of Standards of Electroconvulsive Therapy Practice: a call for accreditation.

https://arctichealth.org/en/permalink/ahliterature119796
Source
Can J Psychiatry. 2012 Oct;57(10):634-42
Publication Type
Article
Date
Oct-2012
Author
Peter Chan
Peter Graf
Murray Enns
Nicholas Delva
Ian Gilron
J Stuart Lawson
Caroline Gosselin
Simon Patry
Roumen Milev
Mark Jewell
Barry Martin
Author Affiliation
Clinic Department of Psychiatry, University of British Columbia, Vancouver, British Columbia. peter.chan2@vch.ca
Source
Can J Psychiatry. 2012 Oct;57(10):634-42
Date
Oct-2012
Language
English
Publication Type
Article
Keywords
Accreditation - statistics & numerical data
Adult
Ambulatory Care - methods - standards - statistics & numerical data
Canada
Electroconvulsive Therapy - methods - standards
Guideline Adherence - standards
Health Care Surveys
Humans
Informed Consent - standards
Mental Disorders - therapy
Practice Guidelines as Topic
Psychotropic Drugs - therapeutic use
Questionnaires
Reference Standards
Standard of Care - statistics & numerical data
Abstract
To report the results of the policies and procedures subsection of a nationwide electroconvulsive therapy (ECT) survey: Canadian Electroconvulsive Therapy Survey/Enquête canadienne sur les electrochocs.
We contacted 1273 registered health care institutions in Canada and invited the 175 centres identified as providing ECT to complete a comprehensive postal questionnaire. Nonresponding sites were repeatedly reminded and then eventually contacted by telephone.
Sixty-one per cent (107/175) of the institutions returned survey questionnaires. Most (84%) of the responding sites have a written general policy for the delivery of ECT. Only 27% of respondents indicated having some written policy for managing concurrent medications during ECT, and practice was quite variable regarding individual psychotropics. Informed consent was usually obtained by the attending physician (88%), and most sites indicated conveying information before ECT by using interdisciplinary and multimodal means. Almost all of the sites (93%) discharged outpatients with accompaniment home by a responsible adult.
It is reassuring to note that general ECT policies and procedures do exist in most Canadian ECT centres. Wider variations in practice were observed in several areas, such as the elements of consent provided to patients and families, the use of concurrent medications, and the degree of supervision on discharge home after outpatient ECT. However, adherence to these policies was not captured by the results of the survey. Based on experiences in other countries, establishing a Canadian ECT accreditation service could further improve standards of practice.
PubMed ID
23072955 View in PubMed
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Consent revisited: points to consider.

https://arctichealth.org/en/permalink/ahliterature170824
Source
Health Law Rev. 2005;13(2-3):33-8
Publication Type
Article
Date
2005

Documenting a transfusion: how well is it done?

https://arctichealth.org/en/permalink/ahliterature164478
Source
Transfusion. 2007 Apr;47(4):568-72
Publication Type
Article
Date
Apr-2007
Author
Gail Rock
Ray Berger
Diane Filion
Donna Touche
Doris Neurath
George Wells
Susie Elsaadany
Mohammed Afzal
Author Affiliation
Department of Pathology, and the Department of Epidemiology, University of Ottawa, Ottawa, Ontario, Canada. cag@ca.inter.net
Source
Transfusion. 2007 Apr;47(4):568-72
Date
Apr-2007
Language
English
Publication Type
Article
Keywords
Blood Transfusion - standards - statistics & numerical data
Canada
Documentation - standards - statistics & numerical data
Humans
Informed Consent - standards - statistics & numerical data
Medical Records - standards - statistics & numerical data
Quality Assurance, Health Care - standards - statistics & numerical data
Retrospective Studies
Abstract
Current practice in transfusion medicine promotes clear documentation of transfusion-related events including the fact that the patient has been informed of the related risks and benefits.
A retrospective review of 1005 patient charts was carried out to determine documentation.
Most patients were from general surgery (10.8%) and cardiac surgery (14.1%). In 75 percent of cases the physician had not documented that any discussion had occurred regarding the risks and/or benefits or alternatives. Only 12 percent of charts included information that the patient was subsequently told what blood components were given to them. The discharge summary recorded transfusion information in 32.1 percent of cases whereas the consult note had this information in 26.3 percent. Chart records matched the transfusion medicine records in 60.6 percent of cases. The most common error was in the blood unit identification number.
While accepted in theory, the practice of documenting patient information on transfusion is not well done.
Notes
Comment In: Transfusion. 2007 Apr;47(4):557-817381609
PubMed ID
17381613 View in PubMed
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Ethical considerations for the conduct of antidementia trials in Canada.

https://arctichealth.org/en/permalink/ahliterature163863
Source
Can J Neurol Sci. 2007 Mar;34 Suppl 1:S32-6
Publication Type
Article
Date
Mar-2007
Author
John D Fisk
Author Affiliation
Department of Psychiatry, Medicine and Psychology, Dalhousie University, Halifax, Nova Scotia, Canada.
Source
Can J Neurol Sci. 2007 Mar;34 Suppl 1:S32-6
Date
Mar-2007
Language
English
Publication Type
Article
Keywords
Canada
Clinical Protocols - standards
Clinical Trials as Topic - ethics - standards
Conflict of Interest
Dementia - drug therapy
Humans
Informed Consent - standards
Mental Competency - standards
Patient Education as Topic - standards
Placebos
Risk Assessment - ethics - standards
Abstract
Clinical trials in persons with dementia bring into focus the ethical dilemmas frequently confronting the clinician-scientist. Despite the existence of various ethical guidelines, most with common underlying principles, few are specific to dementia. A particular difficulty is finding a balance between respect for the autonomy of the individual and the protection of vulnerable persons, while at the same time defining an acceptable risk/benefit ratio for the study. The availability of symptomatic treatments for Alzheimer's disease also now make it difficult to argue that withholding treatment from those in the placebo arm of a clinical trial fulfills one's duty to provide best care. Those conducting clinical trials must be knowledgeable about existing legislation and ethical guidelines in order to justify to themselves and others, the design of clinical trials and their risks. They must be prepared to educate patients and family members about dementia and research, determine each potential subject's competence to consent, and ensure that decisions about participation are in accordance with the best interests of the subject. Ethical conduct of clinical trials of new antidementia therapies will require that everyone involved understands the values and beliefs that guide their decision-making and the potentially conflicting roles facing the clinician-scientist.
PubMed ID
17469679 View in PubMed
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Ethics in qualitative health research.

https://arctichealth.org/en/permalink/ahliterature181167
Source
Ann R Coll Physicians Surg Can. 2002 Dec;35(8 Suppl.):563-6
Publication Type
Article
Date
Dec-2002
Author
Kathleen M Oberle
Author Affiliation
Faculty of Nursing, University of Calgary, 2500 University Dr. N.W., Calgary AB T2N 1N4, Canada. oberle@ucalgary.ca
Source
Ann R Coll Physicians Surg Can. 2002 Dec;35(8 Suppl.):563-6
Date
Dec-2002
Language
English
Publication Type
Article
Keywords
Behavioral Research - ethics
Canada
Confidentiality
Consent Forms
Ethics Committees, Research
Ethics, Research
Guidelines as Topic
Health Services Research - ethics
Humans
Informed Consent - standards
Privacy
Qualitative Research
Research Design
Research Subjects
Researcher-Subject Relations
Risk assessment
Abstract
Since the release of the Tri-Council Policy Statement (TCPS), there has been a growing interest in research ethics concommitant with an increase in the use of qualitative design for health research. Qualitative studies present unique ethical problems that may be poorly understood by researchers and research ethics boards (REBs).
To describe the ethical problems in qualitative research, and to make recommendations that will help researchers develop ethical qualitative proposals, and help REBs review these proposals.
Review of literature and philosophical analysis.
Qualitative studies raise unique issues with respect to methods, protection from harm, informed consent, privacy, and confidentiality, all of which are central to the principles of the TCPS. The problems are partly inherent, as the design tends to emerge as the study proceeds, and the research question may change. Researchers and REBs must become more aware, through education and critical reflection, of the types of problems that might arise in these studies, and of the approaches that might be taken to minimize risk to participants.
PubMed ID
15015501 View in PubMed
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26 records – page 1 of 3.