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Big data refers to extremely large data generated at high volume, velocity, variety, and veracity. The nurse scientist is uniquely positioned to leverage big data to suggest novel hypotheses on patient care and the healthcare system. The purpose of this paper is to provide an introductory guide to understanding the use and capability of big data for nurse scientists. Herein, we discuss the practical, ethical, social, and educational implications of using big data in nursing research. Some practical challenges with the use of big data include data accessibility, data quality, missing data, variable data standards, fragmentation of health data, and software considerations. Opposing ethical positions arise with the use of big data, and arguments for and against the use of big data are underpinned by concerns about confidentiality, anonymity, and autonomy. The use of big data has health equity dimensions and addressing equity in data is an ethical imperative. There is a need to incorporate competencies needed to leverage big data for nursing research into advanced nursing educational curricula. Nursing science has a great opportunity to evolve and embrace the potential of big data. Nurse scientists should not be spectators but collaborators and drivers of policy change to better leverage and harness the potential of big data. [ABSTRACT FROM AUTHOR]

This study investigates the views of contemporary Muslim jurists about withdrawing treatment of the terminally ill. Its aim is threefold. Firstly, it analyses jurists' views concerning core themes within the process of withdrawing treatment. Secondly, it provides insight into fatwas about withdrawing treatment. Thirdly, it compares these views with current medical standards in Europe and the Atlantic world on withdrawing treatment. The data consisted of six papers by Muslim jurists presented at the conference of the Islamic Fiqh Council in 2015. We conducted a directed content analysis (DCA) through a predetermined framework and compiled an overview of all previous fatwas referred to in the papers, which are also analysed. The results show that the general consensus is that if health cannot be restored, treatment may be withdrawn at the request of the patient and/or his family or on the initiative of the doctor. The accompanying fatwa emphasizes the importance of life-prolonging treatment if this does not harm the patient. It becomes apparent in the fatwa that the doctor has the monopoly in decision-making, which is inconsistent with current medical standards in Europe. Managing disclosure in view of the importance of maintaining the hope of Muslim patients may challenge the doctor's obligation to share a diagnosis with them. [ABSTRACT FROM AUTHOR]

Suicide is a major global public health issue, and in recent years, there has been increasing recognition of the problem of physician suicide. This American College of Physicians policy paper examines, from the perspective of ethics, the issues that arise when individuals and institutions respond to physician suicides and when they engage in broader efforts aimed at physician suicide prevention. Emphasizing the medical profession as a unique moral community characterized by ethical and professional commitments of service to patients, each other, and society, this paper offers guidance regarding physician suicide and the role of a healing community. The response to an individual physician suicide should be characterized by respect and concern for those who are grieving, the creation of a supportive environment for suicide loss survivors, and careful communication about the event. Because suicide is a complex problem, actions aimed at preventing suicide must occur at the individual, interpersonal, community, and societal levels. The medical community has an obligation to foster a culture that supports education, screening, and access to mental health treatment, beginning at the earliest stages of medical training. [ABSTRACT FROM AUTHOR]

Bedside handover is the delivery of the nurse-to-nurse handover at the patient's bedside. Although increasingly used in nursing, nurses report many barriers for delivering the bedside handover. Among these barriers is the possibility of breaching the patient's privacy. By referring to this concept, nurses add a legal and ethical dimension to the delivery of the bedside handover, making implementation of the method difficult or even impossible. In this discussion article, the concept of privacy during handovers is being discussed by use of observations, interviews with nurses, and interviews with patients. These findings are combined with international literature from a narrative review on the topic. We provide a practice-oriented answer in which two mutually exclusive possibilities are discussed. If bedside handover does pose problems concerning privacy, this situation is not unique in healthcare and measures can be taken during the bedside handover to safeguard the patient. If bedside handover does not pose problems concerning privacy, privacy is misused by nurses to hide professional uncertainties and/or a reluctance toward patient participation. Therefore, a possible breach of privacy—whether a justified argument or not—is not a reason for not delivering the bedside handover. [ABSTRACT FROM AUTHOR]

Purpose: Throughout the world, mobility devices are usually distributed using product-based business models, where a device is provided to a user, and serviced or replaced when the user returns to the clinic with an issue. Moving to a service-based business model can provide continuous and customised support for the user, and provide the clinicians and manufacturers with better data to base their decisions on. This study reviews papers on assistive technology service-based business models and considerations in designing such a model to optimise economic and social value. It then applies the findings to the mobility device space. Method: A systematic literature search was undertaken in PubMed, Web of Science, and OVID databases to analyse studies that discuss service delivery models used to provide assistive products. Inductive thematic analysis determined the themes, facilitators and barriers associated with providing a service. Findings were applied to mobility device service provision. Results and conclusion: Themes from the 29 relevant papers were grouped into four categories: Access (affordability/availability/education), Utility (customisability/usability/adaptability), Integrity (quality/sustainability/impact), and Compliance (policy/privacy/security). The most common themes were customisability, affordability, availability, and education. There is a need for service-based delivery models to replace conventional product-based models, and many considerations to optimise their design. No publications discussed the design and implementation of a service-based model for mobility device provision that uses modern sensors, software and other digital technologies to optimise the service. Service-based models that use modern digital technologies are new for the mobility device field, but much can be learnt from other fields. IMPLICATIONS FOR REHABILITATION: Service-based business models that make use of modern digital technologies are likely to improve ongoing individual rehabilitation, but they are new for the mobility device field and currently lack research and evidence-based practice. The systematic review found that modern digital technologies like sensors, apps, and AI might be useful for providing ongoing support and more personalised rehabilitation for users of assistive products. To provide ongoing support for end-users, a successful design of service-based business model for assistive products should be accessible, both physically and financially, as well as easy to customise and adapt over time. [ABSTRACT FROM AUTHOR]

This paper examines the integration of artificial intelligence (AI) in radiotherapy for cancer treatment. The importance of radiotherapy in cancer management and its time-intensive planning process make AI adoption appealing especially with the escalating demand for radiotherapy. This review highlights the efficacy of AI across medical domains, where it surpasses human capabilities in areas such as cardiology and dermatology. Focusing on radiotherapy, the paper details AI's applications in target segmentation, dose optimization, and outcome prediction. It discusses adaptive radiotherapy's benefits and AI's potential to enhance patient outcomes with much improved treatment accuracy. The paper explores ethical concerns, including data privacy and bias, stressing the need for robust guidelines. Educating healthcare professionals and patients about AI's role is crucial as it acknowledges potential job-role changes and concerns about patients' trust in the use of AI. Overall, the integration of AI in radiotherapy holds transformative potential in streamlining processes, improving outcomes, and reducing costs. AI's potential to reduce healthcare costs underscores its significance with impactful change globally. However, successful implementation hinges on addressing ethical and logistical challenges and fostering collaboration among healthcare professionals and patient population data sets for its optimal utilization. Rigorous education, collaborative efforts, and global data sharing will be the compass guiding its' success in radiotherapy and healthcare. [ABSTRACT FROM AUTHOR]

This paper provides the first comprehensive analysis of ethical issues raised by artificial intelligence (AI) in veterinary medicine for companion animals. Veterinary medicine is a socially valued service, which, like human medicine, will likely be significantly affected by AI. Veterinary AI raises some unique ethical issues because of the nature of the client–patient–practitioner relationship, society's relatively minimal valuation and protection of nonhuman animals and differences in opinion about responsibilities to animal patients and human clients. The paper examines how these distinctive features influence the ethics of AI systems that might benefit clients, veterinarians and animal patients—but also harm them. It offers practical ethical guidance that should interest ethicists, veterinarians, clinic owners, veterinary bodies and regulators, clients, technology developers and AI researchers. [ABSTRACT FROM AUTHOR]

Gestational surrogacy is ethically complex, generating very different responses in law and policy worldwide. This paper argues that contemporary surrogacy law and policy, across many jurisdictions, fail to give sufficient attention to the significance of the relationship between the child and the gestational surrogate. This failure risks repeating the mistakes of historical, discredited approaches to adoption and donor‐assisted conception. This paper argues that proper recognition of the significance of gestation must be an organising principle in surrogacy law and policy. The paper begins by pointing to examples of surrogacy law and practice where the role of the gestator is unacceptably minimised, most notably the framing of the surrogate as a mere 'carrier'. It goes on to examine the nature of gestation, including consideration of contemporary scholarship on the metaphysics of pregnancy and emerging work in epigenetics, and argues that current evidence supports the view that the gestational relationship must be taken more seriously than it currently is. The paper then draws analogies with parenthood in donor‐assisted conception and adoption to argue that approaches to parental status in novel family formations that fail to promote transparency and seek to deny the truth of familial relationships are doomed to fail. The paper concludes by suggesting some implications for law and policy that flow from placing sufficient emphasis on the gestational role. The overarching thesis of this paper is that gestational surrogacy is ethically permissible when these fundamental requirements are adhered to, and that surrogacy law should proceed on this basis. [ABSTRACT FROM AUTHOR]

Conducting research studies with vulnerable populations on sensitive topics such as adolescent pregnancy can be challenging depending on methodological approaches and ethical issues that may arise before, during, and after data collection. This methodological paper was developed based on experiences and lessons learned from a critical ethnographic study conducted to determine and understand the cultural and personal meaning of unintended adolescent pregnancy in the Rwandan context and to explore the perceived consequences and management of unintended adolescent pregnancy with and for single adolescent mothers. The purpose of this methodological paper is to discuss methodological and ethical challenges encountered while conducting this research, as well as various approaches used to overcome these challenges, and to provide guidance to researchers interested in conducting research about similar or other sensitive topics. Future researchers facing similar challenges should prioritize community engagement strategies, such as building strong relationships with gatekeepers and leaders, to facilitate access to potential participants. Additionally, researchers should engage in continuous ethical reflection and adaptation throughout the study, adjusting strategies if necessary to ensure the well-being and autonomy of participants. As a result of the practical and methodological strategies provided in this reflective paper, researchers could be able to navigate practical, methodological, and ethical challenges effectively while conducting sensitive studies on topics such as adolescent pregnancy. [ABSTRACT FROM AUTHOR]

Rationale Aims and Objectives Method Results and Conclusion The Joint Commission emphasizes the importance of cultural competence and effective communication in quality medical care, particularly during end‐of‐life (EOL), when decisions are influenced by diverse cultural and religious backgrounds. For Orthodox Jewish patients, the philosophical framework used for EOL decision‐making may conflict with that used in traditional Western medical ethics. In this paper, we explore the complexities of EOL decision‐making for devout Jewish patients and highlight how approaches may differ from a Western ethical framework.This paper aims to familiarize clinicians with EOL preferences of Orthodox Jewish patients, organized into an ethical framework called ‘casuistic deontology’. Leading with an open‐minded approach emphasizing cultural humility, we explore ways in which integrating this perspective can allow for culturally appropriate and compassionate EOL care.Using a case study methodology, we focus on a 79‐year‐old Orthodox Jewish male hospitalized with severe injuries. The patient's medical course is analyzed, highlighting how the decisions made by his family in consultation with their Rabbi may differ from the decisions made with a philosophy of a Western ethical framework.This case illustrates the ethical tensions that may arise when Western medical practices intersect with Orthodox Jewish beliefs, particularly regarding brain death, resuscitation, and artificial nutrition. We underscore the need for cultural sensitivity when approaching EOL decision‐making, allowing for compassionate and comprehensive care that respects religious perspectives. This paper helps provide a structure for clinicians to navigate the complex EOL care needs for the devout Jewish patient in a manner consistent with their cultural and religious identity. [ABSTRACT FROM AUTHOR]

Simple Summary: Large datasets concerning childhood cancers are rare. Therefore, it is important to fully exploit all available data, which are distributed over several resources, including biomaterials, images, clinical trials, and registries. With privacy-preserving record linkage (PPRL), datasets can be merged, without disclosing the patients' identities. Although PPRL is already implemented or described in various settings, use case descriptions are fragmented and incomplete. The present paper gives an overview of current and future use cases of PPRL in childhood cancer. We screened the literature, projects, and trial protocols, analysed a hypothetical patient journey, and discussed use cases with experts. All the identified use cases were structured along six key dimensions. We conclude that PPRL is a key concept in childhood cancer. Therefore, PPRL strategies should already be considered when starting research projects, to avoid distributed data silos, to maximise the knowledge derived from collected data, and, ultimately, to improve outcomes for children with cancer. Large datasets in paediatric oncology are inherently rare. Therefore, it is paramount to fully exploit all available data, which are distributed over several resources, including biomaterials, images, clinical trials, and registries. With privacy-preserving record linkage (PPRL), personalised or pseudonymised datasets can be merged, without disclosing the patients' identities. Although PPRL is implemented in various settings, use case descriptions are currently fragmented and incomplete. The present paper provides a comprehensive overview of current and future use cases for PPRL in paediatric oncology. We analysed the literature, projects, and trial protocols, identified use cases along a hypothetical patient journey, and discussed use cases with paediatric oncology experts. To structure PPRL use cases, we defined six key dimensions: distributed personalised records, pseudonymisation, distributed pseudonymised records, record linkage, linked data, and data analysis. Selected use cases were described (a) per dimension and (b) on a multi-dimensional level. While focusing on paediatric oncology, most aspects are also applicable to other (particularly rare) diseases. We conclude that PPRL is a key concept in paediatric oncology. Therefore, PPRL strategies should already be considered when starting research projects, to avoid distributed data silos, to maximise the knowledge derived from collected data, and, ultimately, to improve outcomes for children with cancer. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) software that analyzes medical images is becoming increasingly prevalent. Unlike earlier generations of AI software, which relied on expert knowledge to identify imaging features, machine learning approaches automatically learn to recognize these features. However, the promise of accurate personalized medicine can only be fulfilled with access to large quantities of medical data from patients. This data could be used for purposes such as predicting disease, diagnosis, treatment optimization, and prognostication. Radiology is positioned to lead development and implementation of AI algorithms and to manage the associated ethical and legal challenges. This white paper from the Canadian Association of Radiologists provides a framework for study of the legal and ethical issues related to AI in medical imaging, related to patient data (privacy, confidentiality, ownership, and sharing); algorithms (levels of autonomy, liability, and jurisprudence); practice (best practices and current legal framework); and finally, opportunities in AI from the perspective of a universal health care system. [ABSTRACT FROM AUTHOR]

Age and Ageing is now inviting papers on healthcare improvement for older people. In this article we outline the nature and scope of healthcare improvement and reference improvement models and the tools and methods of improvement science. We emphasise the issues of sustainability, including scale and spread; evaluation – including associated ethical consideration and the involvement of patients and the public in healthcare improvement and associated research. Throughout we refer to resources the authors have found useful in their own work, and provide a bibliography of sources and web-links which will provide essential guidance and support for potential contributors to this new category of submission to Age and Ageing. [ABSTRACT FROM AUTHOR]

This American College of Physicians position paper aims to inform ethical decision making surrounding participation in short term global health clinical care experiences. Although the positions are primarily intended for practicing physicians, they may apply to other health care professionals and should inform how institutions, organizations, and others structure short-term global health experiences. The primary goal of short-term global health clinical care experiences is to improve the health and well-being of the individuals and communities where they occur. In addition, potential benefits for participants in global health include increased awareness of global health issues, new medical knowledge, enhanced physical diagnosis skills when practicing in low technology settings, improved language skills, enhanced cultural sensitivity, a greater capacity for clinical problem solving, and an improved sense of self-satisfaction or professional satisfaction. However, these activities involve several ethical challenges. Addressing these challenges is critical to protecting patient welfare in all geographic locales, promoting fair and equitable care globally, and maintaining trust in the profession. This paper describes 5 core positions that focus on ethics and the clinical care context and provides case scenarios to illustrate them. [ABSTRACT FROM AUTHOR]

This paper critiques the restrictive criteria for germline genome editing recently proposed by Chin, Nguma, and Ahmad in this journal. While praising the authors for resisting fervent calls for an outright ban on clinical applications of the technology, this paper argues that their approach is nevertheless unduly restrictive, and may thus hinder technological progress. This response advocates for weighing potential benefits against risks without succumbing to excessive caution, proposing that ethical oversight combined with genetic scrutiny at the embryo stage post-editing can enable responsible use of the technology, ultimately reducing the burden of genetic diseases and enhancing human health, akin to how IVF transformed reproductive medicine despite strong initial opposition. [ABSTRACT FROM AUTHOR]

This paper addresses the critiques based on trade-offs and normativity presented in response to our target article proposing the Public Health Emergency Risk and Crisis Communication (PHERCC) framework. These critiques highlight the ethical dilemmas in crisis communication, particularly the balance between promoting public autonomy through transparent information and the potential stigmatization of specific population groups, as illustrated by the discussion of the mpox outbreak among men who have sex with men. This critique underscores the inherent tension between communication effectiveness and autonomy versus fairness and equity. In response, our paper reiterates the adaptability of the PHERCC framework, emphasizing its capacity to tailor messages to diverse audiences, thereby reducing potential stigmatization and misinformation. Through community engagement and feedback integration, the PHERCC framework aims to optimize the effectiveness of communication strategies while addressing ethical concerns. Furthermore, by involving affected communities in the communication strategy from the onset, the framework seeks to minimize ethical trade-offs and enhance the acceptance and effectiveness of public health messages. [ABSTRACT FROM AUTHOR]

Technologic advancements and the evolving digital health landscape have offered innovative solutions to several of our health care system's issues as well as increased the number of digital interactions and type of personal health information that is generated and collected, both within and outside of traditional health care. This American College of Physicians' position paper discusses the state of privacy legislation and regulations, highlights existing gaps in health information privacy protections, and outlines policy principles and recommendations for the development of health information privacy and security protections that are comprehensive, transparent, understandable, adaptable, and enforceable. The principles and recommendations aim to improve on the privacy framework in which physicians have practiced for decades and expand similar privacy guardrails to entities not currently governed by privacy laws and regulations. The expanded privacy framework should protect personal health information from unauthorized, discriminatory, deceptive, or harmful uses and align with the principles of medical ethics, respect individual rights, and support the culture of trust necessary to maintain and improve care delivery. [ABSTRACT FROM AUTHOR]

The environment in which physicians practice and patients receive care continues to change. Increasing employment of physicians, changing practice models, new regulatory requirements, and market dynamics all affect medical practice; some changes may also place greater emphasis on the business of medicine. Fundamental ethical principles and professional values about the patient-physician relationship, the primacy of patient welfare over self-interest, and the role of medicine as a moral community and learned profession need to be applied to the changing environment, and physicians must consider the effect the practice environment has on their ethical and professional responsibilities. Recognizing that all health care delivery arrangements come with advantages, disadvantages, and salient questions for ethics and professionalism, this American College of Physicians policy paper examines the ethical implications of issues that are particularly relevant today, including incentives in the shift to value-based care, physician contract clauses that affect care, private equity ownership, clinical priority setting, and physician leadership. Physicians should take the lead in helping to ensure that relationships and practices are structured to explicitly recognize and support the commitments of the physician and the profession of medicine to patients and patient care. [ABSTRACT FROM AUTHOR]

Honorary authorship is the inclusion of an author on an article whose contribution does not warrant authorship. We conducted an Internet-based survey among first authors publishing in Indian biomedical journals from 2012 to 2013 to study the frequency and factors associated with honorary authorship. The response rate was 27% (245/908) with the prevalence of perceived, International Committee of Medical Journal Editors (ICMJE)-defined, and unperceived honorary authorship of 20.9% (50/239), 60% (147/245), and 46.9% (115/245), respectively. Those residing in India were found to list more honorary authors. We hope to increase awareness of the ICMJE authorship guidelines and the general issue of honorary authorship among researchers in India and elsewhere. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Examination of de-classified Monsanto documents from litigation in order to expose the impact of the company’s efforts to influence the reporting of scientific studies related to the safety of the herbicide, glyphosate. METHODS: A set of 141 recently de-classified documents, made public during the course of pending toxic tort litigation, In Re Roundup Products Liability Litigation were examined. RESULTS: The documents reveal Monsanto-sponsored ghostwriting of articles published in toxicology journals and the lay media, interference in the peer review process, behind-the-scenes influence on retraction and the creation of a so-called academic website as a front for the defense of Monsanto products. CONCLUSION: The use of third-party academics in the corporate defense of glyhphosate reveals that this practice extends beyond the corruption of medicine and persists in spite of efforts to enforce transparency in industry manipulation. [ABSTRACT FROM AUTHOR]

Social media tools, including blogs, social networks, and media-sharing sites, help nutrition and dietetics practitioners reach broader audiences and connect directly with the public. In many ways, social media has transformed the practice of dietetics and has opened up new avenues for communicating food and nutrition information. Social media has been an effective tool for virtual nutrition counseling, patient education, peer-to-peer support, and public health campaigns. Increasingly, nutrition and dietetics practitioners are using social media to network and collaborate with colleagues, conduct a job search, stay current with new research, champion a cause, promote products or services, and build a business. The potential role of social media in the profession is far reaching, yet there are important guidelines to follow related to ethics and professionalism. When using social media, nutrition and dietetics practitioners must remember that they are governed by the same Code of Ethics that guides all other aspects of practice. In addition, it is critical to have a thorough understanding of all the factors related to social media professionalism, including disclosure rules from the Federal Trade Commission, patient/client privacy and confidentiality as covered by the Health Insurance Portability and Accountability Act, and copyright laws that protect intellectual property. In today’s digital age, it is essential for nutrition and dietetics practitioners to recognize the professional opportunities and challenges of social media. Failing to effectively and ethically use social media can reflect poorly on the individual practitioner and the profession. Certain violations may have legal implications. The purpose of this Academy of Nutrition and Dietetics practice paper is to provide guidance on social media’s relevance, potential applications, best practices, benefits, and risks. [ABSTRACT FROM AUTHOR]

Rapport is generally considered an essential component of successful interviewing, where participants are willing to share and divulge information. The present paper contributes to the research on rapport in qualitative interviewing by exploring ethical tensions that researchers may experience when conducting qualitative interviews with vulnerable participants. The analysis is based on semi-structured interviews with nine researchers from various fields within social sciences who had extensive experience in doing research with diverse vulnerable groups. We identified six ethical tensions related to building rapport with people in vulnerable life situations that cover issues concerning both too little and too much rapport. Findings illustrate that rapport as the 'ideal' for the researcher-participant relationship may need nuancing. The study concludes that researchers undertaking qualitative interviews on sensitive topics need to have a conscious awareness of ethical tensions that may arise when building rapport with their participants [ABSTRACT FROM AUTHOR]

“Those who cannot remember the past are condemned to repeat it.” This maxim underscores the importance of historical awareness in medicine, particularly for obstetricians and gynecologists (ObGyns). ObGyns significantly impact societal health through their care for pregnant women, fetuses, and newborns, uniquely positioning them to advocate for health initiatives with lasting societal benefits. Despite its importance, the history of medicine is underrepresented in medical curricula, missing opportunities to foster critical thinking and ethical decision-making. In today’s climate of threatened reproductive rights, vaccine misinformation, and harmful ideologies, it is imperative for ObGyns to champion comprehensive historical education. The history of medicine, particularly in relation to societal issues – such as racism, discrimination, genocides, pandemics, and wars – provides valuable context for addressing challenges like maternal mortality, reproductive rights, vaccine hesitancy, and ethical issues. Understanding historical milestones and notable ethical breaches, such as the Tuskegee Study and the thalidomide tragedy, informs better practices and safeguards patient rights. Technological advancements in hygiene, antibiotics, vaccines, and prenatal care have revolutionized the field, yet contemporary ObGyns must remain vigilant about lessons learned from past challenges and successes. Integrating historical knowledge into medical training enhances clinical proficiency and ethical responsibility, fostering innovation and improving health outcomes. By reflecting on historical achievements and their impacts, current and future ObGyns can advance the field, ensuring comprehensive and ethically sound approaches to patient care. This paper highlights the crucial role of historical knowledge in shaping modern ObGyn practices, advocating for its integration into medical education to address contemporary health challenges and ethical considerations. [ABSTRACT FROM AUTHOR]

Background: The implementation of emerging technologies has resulted in an increase of data breaches in healthcare organisations, especially during the COVID-19 pandemic. Health information and cybersecurity managers need to understand if, and to what extent, breach types and locations are associated with their organisation's business type. Objective: To investigate if breach type and breach location are associated with business type, and if so, investigate how these factors affect information systems and protected health information in for-profit versus non-profit organisations. Method: The quantitative study was performed using chi-square tests for association and post-hoc comparison of column proportions analysis on an archival data set of reported healthcare data breaches from 2020 to 2022. Data from the Department of Health and Human Services website was retrieved and each organisation classified as for-profit or non-profit. Results: For-profit organisations experienced a significantly higher number of breaches due to theft, and non-profit organisations experienced a significantly higher number of breaches due to unauthorised access. Furthermore, the number of breaches that occurred on laptops and paper/films was significantly higher in for-profit organisations. Conclusion: While the threat level of hacking techniques is the same in for-profit and non-profit organisations, certain breach types are more likely to occur within specific breach locations based on the organisation's business type. To protect the privacy and security of medical information, health information and cybersecurity managers need to align with industry-leading frameworks and controls to prevent specific breach types that occur in specific locations within their environments. [ABSTRACT FROM AUTHOR]

With the increasing application of Natural Language Processing (NLP) in Medicine at large, medical educators are urged to gain an understanding and implement NLP techniques within their own education programs to improve the workflow and make significant and rapid improvements in their programs. This paper aims to provide twelve essential tips inclusive of both conceptual and technical factors to facilitate the successful integration of NLP in medical education program evaluation. These twelve tips range from advising on various stages of planning the evaluation process, considerations for data collection, and reflections on preprocessing of data in preparation for analysis and interpretation of results. Using these twelve tips as a framework, medical researchers, educators, and administrators will have an understanding and reference to navigating applications of NLP and be able to unlock its potential for enhancing the evaluation of their own medical education programs. [ABSTRACT FROM AUTHOR]

This paper provides a discourse analysis of 12 Swedish sexuality education texts intended for preschool practitioners and published between 1969 and 2021. Using Fairclough's framework, we identify three discourses about children's sexual play in relation to children's sexual agency in the texts: child sexuality as encouraged and entangled with adult sexuality; child sexuality as conditioned by what is perceived as normal or abnormal in children; and child sexuality as repressed. These three discourses mainly appear chronologically, but also overlap and connect with one another. When analysis begins from children's position and a theoretical understanding of children's and adults' agency as interdependent, it becomes possible to see how the child is construed as agentic, and how the adult role changes from encouraging sexual play to regulating and monitoring behaviour so that it does not occur. Over time, discourse on young children's sexual play has changed our understanding of both adults and children. Adults are increasingly construed as less knowledgeable in relation to young children's sexuality, and young children have become understood as more dangerous and in need of having their sexuality constrained and civilised. [ABSTRACT FROM AUTHOR]

For many emergency physicians (EPs), deciding whether or not to allow a patient suffering the ill effects of opioid use to refuse care is the most frequent and fraught situation in which they encounter issues of decision-making capacity, informed refusal, and autonomy. Despite the frequency of this issue and the well-known impacts of opioid use disorder on decision-making, the medical ethics community has offered little targeted analysis or guidance regarding these situations. As a result, EPs demonstrate significant variability in how they evaluate and respond to them, with highly divergent understandings and application of concepts such as decision-making capacity, informed consent, autonomy, legal repercussions, and strategies to resolve the clinical dilemma. In this paper, we seek to provide more clarity to this issue for the EPs. Successfully navigating this issue requires that EPs understand the specific effects that opioid use disorder has on decision-making, and how that in turn bears on the ethical concepts of autonomy, capacity, and informed refusal. Understanding these concepts can lead to helpful strategies to resolve these commonly-encountered dilemmas. [ABSTRACT FROM AUTHOR]

The COVID‐19 pandemic catapulted Telehealth to the forefront of Emergency Medicine (EM) as an alternative way of assessing and managing patients. This challenged the traditional idea that EM can only be practised within brick‐and‐mortar EDs. Many Emergency Physicians may find the idea of practising Telehealth in Emergency Medicine (TEM) confronting, particularly in the absence of training and clear practice guidelines. The purpose of the present paper is to describe the current use of TEM in Australasia, and outline the advantages and barriers in adopting this practice domain. [ABSTRACT FROM AUTHOR]

Introduction: Doctors hold a prima facie duty to respect the autonomy of their patients. This manifests as the patient's 'right' not to know when patients wish to remain unaware of medical information regarding their health, and poses ethical challenges for good medical practice. This paper explores how the emergence of digital health technologies might impact upon the patient's 'right' not to know. Method: The capabilities of digital health technologies are surveyed and ethical implications of their effects on the 'right' not to know are explored. Findings: Digital health technologies are increasingly collecting, processing and presenting medical data as clinically useful information, which simultaneously presents large opportunities for improved health outcomes while compounding the existing ethical challenges generated by the patient's 'right' not to know. Conclusion: These digital tools should be designed to include functionality that mitigates these ethical challenges, and allows the preservation of their user's autonomy with regard to the medical information they wish to learn and not learn about. [ABSTRACT FROM AUTHOR]

The question that this paper tries to answer is Q: "Can good academic bioethics be done without commitment to moral theory?" It is argued that the answer to Q is an unequivocal "Yes" for most of what we could call "critical bioethics," that is, the kind of bioethics work that primarily criticizes positions or arguments already in the literature or put forward by policymakers. The answer is also "Yes" for much of empirical bioethics. The second part of the paper then provides an analysis of Q in relation to "constructive bioethics," that is, bioethics work aimed at providing an argument for a particular position. In this part, it is argued that a number of the approaches or methods used that initially look like they involve no commitment to moral theory, nevertheless, involve such a commitment. This is shown to be the case for reflective equilibrium, mid-level theory, the use of theory fragments, and argument by analogy. [ABSTRACT FROM AUTHOR]

Risk and crisis communication (RCC) is a current ethical issue subject to controversy, mainly due to the tension between individual liberty (a core component of fairness) and effectiveness. In this paper we propose a consistent definition of the RCC process in public health emergencies (PHERCC), which comprises six key elements: evidence, initiator, channel, publics, message, and feedback. Based on these elements and on a detailed analysis of their role in PHERCC, we present an ethical framework to help design, govern and evaluate PHERCC strategies. The framework aims to facilitate RCC, incorporating effectiveness, autonomy, and fairness. It comprises five operational ethical principles: openness, transparency, inclusivity, understandability, and privacy. The resulting matrix helps understanding the interplay between the PHERCC process and the principles of the framework. The paper includes suggestions and recommendations for the implementation of the PHERCC matrix. [ABSTRACT FROM AUTHOR]

This paper was written in the framework of my internship at the National Commission for Bioethics and Technoethics of the Hellenic Republic. It constitutes an attempt at exploring the ethical and legal dilemmas of the medical practice of telepsychiatry. Telepsychiatry, as well as other forms of telemedicine, has become a prevalent way through which patients gain access to healthcare and with many research papers reporting on its effectiveness and advantages, telepsychiatry has gained a lot of proponents in the scientific and healthcare community. However, several questions regarding the ethical and legal nature of the practice remain unanswered and this can put patients and other users of telemental health services under risk for basic rights violations. In this paper, at first the scientific data supporting the use of telepsychiatry will be cited. In addition to that, there will be discussion of several ethical dilemmas that have been reported concerning the use of telemedicine in psychiatry during the past few years and there will be reference to the medical code of ethics. Following that, there will be reference to the existing legislation for telepsychiatry in Greece and the legal issues that can arise will be analyzed. In spite of the fact that the advantages and ethical pitfalls of telepsychiatry are common in many countries, the focus of this paper will be on Greece’s code of medical ethics and legislation due to the lack of relevant bibliography on the matter, even though telepsychiatry is widely used by Greek patients. Finally some suggestions will be made on what ought to be ameliorated in regards to the current conditions, so as to make sure telepsychiatry is in line with the basic principles of bioethics. [ABSTRACT FROM AUTHOR]

Nowadays, the Internet of Things (IoT) is used in every domain, especially in the healthcare system it plays a very important role in our life and made our life easier by providing various facilities in every area. On the Internet of Medical Things (IoMT), IoT devices collect real-time data from patients and send it to the cloud through the Internet. These gathered data are extorted to centralized processing and computational power. Centralization can lead to a single point of failure, data modification, snooping, security, and privacy evasion. Blockchain can resolve such issues by providing decentralized computational power and better storage capacity for IoT data. Therefore, integrating IoT and blockchain technologies can be an intelligent way to implement a decentralized IoT-based smart healthcare system. We find that integration of the blockchain and IoT is persuasive and can cause remarkable transformations across the healthcare system. We discussed blockchain and its applicability in the healthcare industry. The paper explores blockchain's dimensions, making the innovative healthcare system more secure and stable. We provide a comparative analysis of well-known recent research on IoT-based smart healthcare system security using blockchain based on different parameters such as architecture, data integrity, medical information sharing, distributed electronic health records, patient encryption key, access control, hardware implementation, etc. The paper focuses on the current security issues in IoT-based smart healthcare systems, architectures, taxonomy, and research gap and their possible solutions we point out various research challenges that should be considered before the deployment of a blockchain network in an IoT setting. This paper will be helpful to new researchers to get an overview of IoT-based healthcare system security. [ABSTRACT FROM AUTHOR]

The essay outlines a four-phase triage process made by a fictive Talmudic rabbi working on an equally fictive hospital COVID-19 ward. The rabbi bases his decision on four different Talmudic texts, proceeding one by one, with each text building on the preceding one, until he is ready to allocate his scarce medical resources to one of the patients, thus being forced to deny them to others. Along the way, the paper will examine how this Talmudic reasoning can also be applied to the patient, or even a potential patient, clarifying the demands of the individual's ethical responsibility to avoid triage situations in the first place through social distancing and even more so through getting vaccinated. The paper argues that the rabbi has a number of Talmudic tools at hand that make his decision easier, not because he strictly follows Jewish law, but because of the rich experience standing behind Jewish legal traditions, making a universally valid ethical justification of difficult decisions possible. The essay proposes that including such theological material in triage guidelines would help make those decisions more acceptable in the long run, especially for societies in which religious traditions still play a certain role in the cultural consciousness. [ABSTRACT FROM AUTHOR]

Despite having worked in higher education for over twenty years, I am still, first and foremost, a practicing nurse. My employer requires me to be a nurse and my regulator regards what I do as nursing. My practice is regulated by the Code and informed by nursing ethics. If I am nurse, practicing nursing, does that mean that my students are my patients? This paper considers how the relationship that I have with my students can be informed by the ethics of the nurse/patient relationship. After some initial theoretical preparation concerning argument from analogy, the paper identifies some areas for comparison between the two relationships. Areas of similarity and difference identify two areas of concern: Nurse education and educators regularly engage in coercion and surveillance in an attempt to increase student success, both of which would be considered outside nursing ethics. It is concluded that these coercive practices are not conducive to an environment where character is cultivated. Despite current financial and workforce pressures, nurse lecturers and more especially their managers would do well to return to the professional ethics of nursing to question and guide their practice. [ABSTRACT FROM AUTHOR]

The steady growth of corporate interest and influence in the health care sector over the past few decades has created a more business-oriented health care system in the United States, helping to spur for-profit and private equity investment. Proponents say that this trend makes the health care system more efficient, encourages innovation, and provides financial stability to ensure access and improve care. Critics counter that such moves favor profit over care and erode the patient-physician relationship. American College of Physicians (ACP) underscores that physicians are permitted to earn a reasonable income as long as they are fulfilling their fiduciary responsibility to provide high-quality, appropriate care within the guardrails of medical professionalism and ethics. In this position paper, ACP considers the effect of mergers, integration, private equity investment, nonprofit hospital requirements, and conversions from nonprofit to for-profit status on patients, physicians, and the health care system. [ABSTRACT FROM AUTHOR]

Rapid advances in digital hearing technologies, also known as hearables, are expected to disrupt the direct‐to‐consumer health market. For older adults with higher incidence of hearing loss, such disruption could reduce hearing problems, increase accessibility to hearing aids, and mitigate related stigmas. This paper delves into the intersection of disruptive innovation and hearables within the realm of biomedical ethics. Through a comprehensive exploration, we shed light on the ethical implications surrounding hearables. By critically evaluating the key ethical advantages and drawbacks, we find that no single concern presents an insurmountable a priori objection to hearables. We conclude with some ideas to maximize the benefits of hearables and further promote opportunities for equitable hearing health. [ABSTRACT FROM AUTHOR]

We report on a qualitative Group Survey study involving four healthcare professionals (HCPs) and eight people living with HIV who were recipients of care in the United Kingdom (UK). The survey aimed to bring participants' perspectives into dialogue and establish consensus about how communication between HCPs delivering HIV care and their patients could be improved in the context of the routine care consultation. Responses from both parties were anonymously collated, thematically analysed, and shared back with participants in two subsequent survey rounds to support consensus-building on matters of concern and identify thematic insights. In this paper, we report three themes for informing future designs of tools and services to support communication between patients and HCPs: Patient-clinician relationship for trusted sharing; Self-reporting psychosocial information to support Whole-person care; and Perceived barriers for online trusted sharing with HCPs. Our findings highlight key areas of concern and further investigation is needed to understand how self-reported information may be meaningfully captured, interpreted and processed by HCPs in ways that are trusted by patients who voice privacy and security concerns. [ABSTRACT FROM AUTHOR]

This paper aims to explore how children's achieving privacy is interwoven with parental recognition of their agency, by providing empirical accounts of family lives in Türkiye. Building on a relational understanding of agency and privacy, it debates both concepts as social constructs that can be distinctively understood in western and Turkish cultures. It employs ethnographic research with children aged 10–14 years and their families to illustrate everyday contexts of parental privacy invasions and children's exercise of relational agency in response. A relational approach towards achieving agency and privacy as an interlaced process mirrors children's experience of power asymmetries within family relationships. [ABSTRACT FROM AUTHOR]

A large proportion of hospital inpatients are affected by cognitive impairment, posing challenges in the provision of their care in busy, fast-paced acute wards. Signs and symbols, known as visual identifiers, are employed in many U.K. hospitals with the intention of helping healthcare professionals identify and respond to the needs of these patients. Although widely considered useful, these tools are used inconsistently, have not been subject to full evaluation, and attract criticism for acting as a shorthand for a routinized response. In order for visual identifiers to be used effectively in acute care settings, thorough consideration must be given to the ethical and legal issues that are engaged in this context, and their potential benefits and harms must be weighed and balanced. This paper proposes a set of legal and ethical principles that can be used to guide the implementation of visual identifiers. Together, these principles provide a framework applicable in the design and implementation phases to systematically identify relevant considerations arising from the use of these tools. We outline some tensions that arise between principles and conclude that selecting a preferred moral framework could help to guide decision-making, as does clarity around the purpose and objectives of the identifier. [ABSTRACT FROM AUTHOR]

Clinical judgement has become a central topic in both medicine and the philosophy since the 1960s. With the development of evidence-based medicine in the 1990s, clinical judgment is expected to be more sensitive to the needs and preferences of patients in the face of threats from positivist approaches that are considered to neglect individuality. This paper addresses this problem in the light of a philosophy of medicine that is more sensitive to the historical components of epistemology, ontology, and ethics. The analysis is directed to the 19th century in order to elucidate the tensions about the place of medical knowledge and the commitment, for the sake of professional improvement, to provide clinical judgment with new methods. This trip to the past is useful to understand the current transformations in the field of medicine, especially the way in which they help constitute new types of patients, new types of professional ethos, and new forms of relationship between these actors. [ABSTRACT FROM AUTHOR]

Artificial Intelligence (AI) carries the potential for unprecedented disruption in radiology, with possible positive and negative consequences. The integration of AI in radiology holds the potential to revolutionize healthcare practices by advancing diagnosis, quantification, and management of multiple medical conditions. Nevertheless, the ever‑growing availability of AI tools in radiology highlights an increasing need to critically evaluate claims for its utility and to differentiate safe product offerings from potentially harmful, or fundamentally unhelpful ones. This multi‑society paper, presenting the views of Radiology Societies in the USA, Canada, Europe, Australia, and New Zealand, defines the potential practical problems and ethical issues surrounding the incorporation of AI into radiological practice. In addition to delineating the main points of concern that developers, regulators, and purchasers of AI tools should consider prior to their introduction into clinical practice, this statement also suggests methods to monitor their stability and safety in clinical use, and their suitability for possible autonomous function. This statement is intended to serve as a useful summary of the practical issues which should be considered by all parties involved in the development of radiology AI resources, and their implementation as clinical tools. [ABSTRACT FROM AUTHOR]

This article is prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee and provides educators recommendations for optimizing inclusive education for our students with disabilities. Medical educators are increasingly encountering students with disabilities and have the responsibility of ensuring requirements are met. Medical education committee members from the US and Canada reviewed the literature on disabilities in medical student education to identify best practices and key discussion points. An iterative review process was used to determine the contents of an informative paper. Medical schools are required to develop technical standards for admission, retention, and graduation of their students to practice medicine safely and effectively with reasonable accommodation. A review of the literature and obstetrics and gynecology expert opinion formed a practical list of accommodation strategies and administrative steps to assist educators and students. Medical schools must support the inclusion of students with disabilities. We recommend a collaborative approach to the interactive process of determining reasonable and effective accommodations that includes the students, a disability resource professional and faculty as needed. Recruiting and supporting medical students with a disability strengthens the diversity commitment and creates a more inclusive workforce. Medical School Education Medical schools have the responsibility to train a diverse physician workforce including those with disabilities. The integration of students with disabilities is important and should be done in a structured and timely manner that maximizes the individual's abilities and incorporates reasonable accommodations in the clinical learning environment. Though the definition of disability traverses a wide variety of diagnoses, this review highlights sensory and physical disabilities and the various accommodations to facilitate access and successful completion of required objectives. [ABSTRACT FROM AUTHOR]

Visual impairment-related disabilities have become increasingly pervasive. Current reports estimate a total of 36 million persons with blindness and 217 million persons with moderate to severe visual impairment worldwide. Assistive technologies (AT), including text-to-speech software, navigational/spatial guides, and object recognition tools have the capacity to improve the lives of people with blindness and low vision. However, access to such AT is constrained by high costs and implementation barriers. More recently, expansive growth in mobile computing has enabled many technologies to be translated into mobile applications. As a result, a marketplace of accessibility apps has become available, yet no framework exists to facilitate navigation of this voluminous space. We developed the BLV (Blind and Low Vision) App Arcade: a fun, engaging, and searchable curated repository of app AT broken down into 11 categories spanning a wide variety of themes from entertainment to navigation. Additionally, a standardized evaluation metric was formalized to assess each app in five key dimensions: reputability, privacy, data sharing, effectiveness, and ease of use/accessibility. In this paper, we describe the methodological approaches, considerations, and metrics used to find, store and score mobile applications. The development of a comprehensive and standardized database of apps with a scoring rubric has the potential to increase access to reputable tools for the visually impaired community, especially for those in low- and middle-income demographics, who may have access to mobile devices but otherwise have limited access to more expensive technologies or services. A wide array of assistive mobile applications now serve as low cost, convenient, and effective alternatives to standard tools in the rehabilitation domain. Given an extensive (and growing) marketplace of assistive apps, we highlight the importance of developing standardized evaluation frameworks that serve to assess the merit, functionality, and accessibility of tools in respective rehabilitation fields. To provide an introduction to a novel resource accessible to the public to exhibit verified and reliable assistive apps for the visually impaired community, especially for those in low- and middle-income demographics who may not have access to common technologies and services. [ABSTRACT FROM AUTHOR]

Fear and anxiety can interfere profoundly with a person's ability to deliberate. Patients sometimes face critical medical decisions while subject to intense emotions which involve catastrophic (or wishful) convictions about the future. Medical teams, and even psychiatrists and bioethicists, lack a model for what to do in such cases. Philosophical accounts of autonomy and the clinical criteria for decision‐making capacity derived from them fail to address cases in which emotions do not merely skew judgment but rather block decision‐making capacity itself. This paper provides an account of when emotions undermine a person's freedom to deliberate, which is the basis of the capacity for autonomy. People subject to what I call 'concretized emotions' meet the cognitive criteria for decision‐making capacity. Yet their emotions dictate their views of reality and prevent them from meeting the basic conditions for deliberation. To deliberate one needs to be able to think through alternatives, and this thinking through alternatives needs to be responsive to evidence. With concretized fear, both the ability to think through alternatives and the ability to respond cognitively to evidence is undermined. The person can engage in apparent deliberation, but her thought processes regarding the feared matter are characterized by the rigid view that things are just as they seem from her emotional view. This paper develops a theoretical and clinical model for a more appropriate and nuanced approach to acting responsibly toward patients subject to intense fear and related emotional states that block their decision‐making capacity. [ABSTRACT FROM AUTHOR]

Application for Research Ethics Committee (REC) approval and the conduct of medical research is paper intensive. This retrospective study examined all applications to a single REC in the south of England over one year. It estimated the mass of paper used, comparing the proportional paper consumption of different trial types and during different stages of the research process, quantifying the consumption in terms of carbon dioxide emissions. In 2009, 68 trials were submitted to the REC. Total paper consumption for the REC process and study conduct was 176,150 sheets of A4 paper (879 kg), equivalent to an estimated 11.5 million sheets (88 tonnes, 2,100 trees) a year for the UK; the REC process accounted for 26.4%. REC applications and the conduct of approved trials generate considerable environmental impact through paper consumption contributing to the NHS's carbon footprint. Paper use might be reduced through the implementation of digital technologies and revised research methods, namely changing attitudes in both researchers and ethics committees. [ABSTRACT FROM AUTHOR]

From 28 February to the end of March 2012, the Italian media reacted fiercely to the Giubilini and Minerva paper published in the Journal of Medical Ethics a few days earlier. The first article viewed the proposal as analogous to 'barbaric invasions', but in a first stage of the debate it could be seen as a case of the usual controversy between Catholics and secularists. Then emotive reactions prevailed and a flood of papers expressed strong opposition to 'infanticide'. The authors were even deemed insane; the fact that both are Italian certainly increased interest in the subject as well as surprise at their proposal, which some reckoned to be an insult to their 'national identity'. Even freedom of academic research and discussion was put in question, and defenders of free debate were accused of being supporters of the theory of infanticide. [ABSTRACT FROM AUTHOR]

This American College of Physicians position paper aims to inform ethical decision making surrounding participation in short-term global health clinical care experiences. Although the positions are primarily intended for practicing physicians, they may apply to other health care professionals and should inform how institutions, organizations, and others structure short-term global health experiences. The primary goal of short-term global health clinical care experiences is to improve the health and well-being of the individuals and communities where they occur. In addition, potential benefits for participants in global health include increased awareness of global health issues, new medical knowledge, enhanced physical diagnosis skills when practicing in low-technology settings, improved language skills, enhanced cultural sensitivity, a greater capacity for clinical problem solving, and an improved sense of self-satisfaction or professional satisfaction. However, these activities involve several ethical challenges. Addressing these challenges is critical to protecting patient welfare in all geographic locales, promoting fair and equitable care globally, and maintaining trust in the profession. This paper describes 5 core positions that focus on ethics and the clinical care context and provides case scenarios to illustrate them. [ABSTRACT FROM AUTHOR]

Abstract: The Ugandan Ministry of Health emphasises the pivotal position of women in securing the nation''s health. Drawing on the concept of therapeutic landscapes, this paper explores media constructions of health in Uganda in order to question what role these may play in creating or undermining a ‘therapeutic landscape’ which supports women''s empowerment in a health context. The paper argues for the importance of understanding discursively constructed notions of health in order to ground the promotion of a health care strategy in the everyday lives and discourses of the users implicated. Given the Ugandan government''s current drive to both empower women and push an agenda of formally provided health care, this paper provides an exploratory analysis of how far newspapers facilitate or hinder this vision. [Copyright &y& Elsevier]