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INTRODUCTION: Poor communication about serious injury in older adults can lead to treatment that is inconsistent with patient preferences, create conflict and strain healthcare resources. We developed a communication intervention called Best Case/Worst Case-intensive care unit (ICU) that uses daily scenario planning, that is, a narrative description of plausible futures, to support prognostication and facilitate dialogue among patients, their families and the trauma ICU team. This article describes a protocol for a multisite, randomised, stepped-wedge study to test the effectiveness of the intervention on the quality of communication (QOC) in the ICU. METHODS AND ANALYSIS: We will follow all patients aged 50 and older admitted to the trauma ICU for 3 or more days after a serious injury at eight high-volume level 1 trauma centres. We aim to survey one family or like family member per eligible patient 5-7 days following their loved ones admission and clinicians providing care in the trauma ICU. Using a stepped-wedge design, we will use permuted block randomisation to assign the timing for each site to begin implementation of the intervention and routine use of the Best Case/Worst Case-ICU tool. We will use a linear mixed-effects model to test the effect of the tool on family-reported QOC (using the QOC scale) as compared with usual care. Secondary outcomes include the effect of the tool on reducing clinician moral distress (using the Measure of Moral Distress for Healthcare Professionals scale) and patients length of stay in the ICU. ETHICS AND DISSEMINATION: Institutional review board (IRB) approval was granted at the University of Wisconsin, and all study sites ceded review to the primary IRB. We plan to report results in peer-reviewed publications and national meetings. TRIAL REGISTRATION NUMBER: NCT05780918.

Chatbots are "computer agents that can interact with the user" in a way that feels like human-to-human conversation.1 While the use of chatbots for reference service in academic libraries is a topic of interest for both library professionals and researchers, little is known about how they are used in library reference service, especially in academic libraries in Canada. This article aims to fill this gap by conducting a web-based survey of 106 academic library websites in Canada and analyzing the prevalence and characteristics of chatbot and live chat services offered by these libraries. The authors found that only two libraries were using chatbots for reference service. For live chat services, the authors found that 78 libraries provided this service. The article discusses possible reasons for the low adoption of chatbots in academic libraries, such as accessibility, privacy, cost, and professional identity issues. The article also provides a case study of the authors' institution, the University of Calgary, which integrated a chatbot service in 2021. The article concludes with suggestions for future research on chatbot use in libraries. [ABSTRACT FROM AUTHOR]

In terms of utility and technical quality, open-source software solutions have become a common option for many libraries. As barriers to adoption have been reduced and systems such as FOLIO appear poised to change the landscape of LIS technology, it is worth examining how the use of open source can support the normative core values of librarianship and to outline a strategy for critical engagement with the technology that is beneficial to patrons and libraries. Such a strategy will require further codification, institutionalization, and investigation of open source at many levels. [ABSTRACT FROM AUTHOR]

Physician-assisted suicide (PAS)-commonly but misleadingly called 'medical aid in dying' (1)--is now legal in 11 jurisdictions in the US. PAS remains an area of great controversy among physicians, medical ethicists, [...]

Purpose: There has been a proliferation in technologies in the sport performance environment that collect increasingly larger quantities of athlete data. These data have the potential to be personal, sensitive, and revealing and raise privacy and confidentiality concerns. A solution may be the use of synthetic data, which mimic the properties of the original data. The aim of this study was to provide examples of synthetic data generation to demonstrate its practical use and to deploy a freely available web-based R Shiny application to generate synthetic data. Methods: Openly available data from 2 previously published studies were obtained, representing typical data sets of (1) field- and gym-based team-sport external and internal load during a preseason period (n = 28) and (2) performance and subjective changes from before to after the posttraining intervention (n = 22). Synthetic data were generated using the synthpop package in R Studio software, and comparisons between the original and synthetic data sets were made through Welch t tests and the distributional similarity standardized propensity mean squared error statistic. Results: There were no significant differences between the original and more synthetic data sets across all variables examined in both data sets (P >.05). Further, there was distributional similarity (ie, low standardized propensity mean squared error) between the original observed and synthetic data sets. Conclusions: These findings highlight the potential use of synthetic data as a practical solution to privacy and confidentiality issues. Synthetic data can unlock previously inaccessible data sets for exploratory analysis and facilitate multiteam or multicenter collaborations. Interested sport scientists, practitioners, and researchers should consider utilizing the shiny web application (SYNTHETIC DATA—available at https://assetlab.shinyapps.io/SyntheticData/). [ABSTRACT FROM AUTHOR]

In 2021, the assessment-data management librarian at Lehman College Library decided to conduct a privacy audit of the Library's public computers and networks. This audit comprised one of the Library's two annual formal assessments of resources and services. The American Library Association's (ALA) Library Privacy Checklist for Public Access Computers and Networks was selected to review 17 key items related to protecting user privacy and confidentiality. Faculty and staff from Circulation, Library Technology, and Online Learning identified 10 indicators needing work. Suggestions are provided for collaboratively resolving these issues and future steps are described to continuously maximize the online security of the campus community. [ABSTRACT FROM AUTHOR]

The article addresses the pressing issue of ensuring legality in the field of transplantation. The current state of healthcare in Ukraine, the need for high-quality medical services, and the necessity of adapting national legislation to international standards prompt a thorough analysis and improvement of the legal regulation of the transplantation of anatomical materials. The main focus of the article is on identifying violations of legislation in the field of transplantation, analyzing their types, and consequences. Various aspects of offenses are examined, including illegal organ trade, violations of the donor consent procedure, and non-compliance with medical ethics and safety standards during transplantation operations. The peculiarities of violations committed by both medical professionals and other related workers in the transplantation of human anatomical materials are revealed. The authors explore the international experience of transplantation regulation and highlight key points that require attention in Ukrainian legislation. The provisions of the Brussels Declaration on the Laws and Customs of War, the Geneva Conventions, and other international documents establishing norms and principles in this field are analyzed. Violations of these norms can have serious consequences for patients' health and the reputation of medical institutions. The article emphasizes the need to strengthen state control over compliance with legislation in the field of transplantation, improve legal mechanisms of accountability for violations, and create conditions for the effective functioning of the transplantation system in Ukraine. Specifically, the author proposes an original definition of violations of the established order of transplantation of human anatomical materials and provides a classification of violations by areas and forms of activity at each stage of this his process. The study aims to form theoretical and practical foundations for ensuring the legality and ethics of the transplantation of anatomical materials in Ukraine, which is an important step in the development of the medical field and the protection of patients' rights. [ABSTRACT FROM AUTHOR]

Background: Minority populations are utilizing mobile health applications more frequently to access health information. One group that may benefit from using mHealth technology is underserved women, specifically those on community supervision. Objective: Discuss methodological approaches for navigating digital health strategies to address underserved women's health disparities. Description of the innovative method: Using an intersectional lens, we identified strategies for conducting research using digital health technology and artificial intelligence amongst the underserved, particularly those with community supervision. Description of its effectiveness: We explore (1) methodological approaches that combine traditional research methods with precision medicine, digital phenotyping, and ecological momentary assessment; (2) implications for artificial intelligence; and (3) ethical considerations with data collection, storage, and engagement. Discussion: Researchers must address gendered differences related to health, social, and economic disparities concurrently with an unwavering focus on the protection of human subjects when addressing the unique needs of underserved women while utilizing digital health methodologies. Public contribution: Women on community supervision in South Central Texas helped inform the design of JUN, the mHealth app we reported in the case exemplar. JUN is named after the Junonia shell, a native shell to South Texas, which means strength, power, and self‐sufficiency, like the participants in our preliminary studies. [ABSTRACT FROM AUTHOR]

Background: Clinical ethics consultants support mental health professionals in identifying and analyzing moral problems in clinical practice. Objective: Presentation of key ethical concepts and normative theories that are relevant for clinical ethics consultation in mental healthcare. Material and methods: Conceptual and ethical analyses. Results: After distinguishing between morality, ethics and law, moral problems are differentiated from other types of problems encountered in clinical practice. Subsequently, key ethical concepts and the concept of moral distress are clarified. In relation to the normative framework a distinction is made between philosophical ethical theories and medical ethical theories, such as principlism and the ethics of care. Finally, justification tests for ethical decision-making in situations of danger to self or others based on the harm principle and soft paternalism are proposed. Conclusion: Knowledge of key ethical concepts and normative theories is important for the identification and analysis of moral problems in mental healthcare and should be given greater weight in the training of clinical ethics consultants. [ABSTRACT FROM AUTHOR]

Transgender and non‐binary individuals often face bias and a lack of awareness, knowledge, and sensitivity from healthcare professionals. This article aims to raise awareness of the concepts of medical ethics among OBGYNs, so they will be better able to approach complex ethical situations in a clear and structured way when providing obstetric and gynecologic health care for transgender and gender‐diverse patients. [ABSTRACT FROM AUTHOR]

Background: During the COVID‐19 pandemic, intensive care units (ICUs) were under heavy pressure, with a significantly increased number of severely ill patients. Hospitals introduced restrictions, and families could not visit their ill and dying family members. Patients were cared for without privacy, and several died in shared patient rooms, leaving the intensive care nurse to protect the patient's need for loving care in a vulnerable situation at the end of life. Aim: This study aimed to investigate how piloting and watch over were revealed in end‐of‐life care for patients with COVID‐19 in intensive care COVID‐19. Study Design: A qualitative study was conducted with an abductive approach was conducted. Data were collected via semi‐structured interviews to cover the research area while allowing the informant to talk freely about the topic; 11 informants were interviewed. Results: The findings are presented based on four categories: The road to the decision, End‐of‐life care, Farewell of close family members and Closure. Each category and subcategory reveal how piloting and watch over were addressed in the end‐of‐life care of patients with COVID‐19 in the ICU during the pandemic. Overall findings indicated that workload and organization of care directly affect the quality of care given, the acceptance of privacy and the possibility of dignified end‐of‐life care. Conclusions: Workload directly affects the quality of care, risking dehumanization of the patient. Visiting restrictions hindered supporting family members through the various piloting phases. Visiting restrictions also forced the ICU nurses to take on the role of the relative in watching over the patient. Relevance to Clinical Practice: Collaboration with family members is essential for the intensive care nurse to be able to provide a person‐centred and dignified end‐of‐life care. [ABSTRACT FROM AUTHOR]

The article discusses the challenges in defining death, particularly in the context of technological advancements like mechanical ventilators. It highlights the shift towards prioritizing the neurological criterion for determining death over the traditional circulatory and respiratory criteria. The author argues for the neurological criterion as the primary definition of death, drawing on Catholic anthropology and ethical considerations. The article also addresses ethical concerns related to organ transplantation and the need for clarity in defining death to uphold human dignity and trust in medical practices. [Extracted from the article]

Many older adults living with HIV face unique challenges, including comorbidities, loneliness, and isolation. This community-academic partnered study elicited viewpoints from older adults living with HIV about the characteristics of a digital environment ("Virtual Village") to combat against loneliness and isolation. We utilized Choice-Based Conjoint Analyses to determine preferred attributes of a Virtual Village. We also conducted focus groups and interviews with older adults living with HIV and used an iterative, data-driven approach to systematically identify emergent themes. Participants (N = 82) were aged 50–82 years and racially/ethnically diverse. The majority were men (78%), gay (66%), and lived with HIV for ≥15 years (83%). Cost was the factor that most drove participants' preference for joining a Virtual Village. Thematic concerns included lack of technological confidence, internet access, potential for harassment in digital environments, privacy, and preference for in-person interactions. Praises centered on convenience and making connections across geographic distances. Participants emphasized the need for purposive strategies to form a cohesive and supportive community for older adults living with HIV. A moderated environment was recommneded to create a safe, structured, and comfortable digital environment for older adults living with HIV. A Virtual Village should be viewed as a bridge to in-person interactions. [ABSTRACT FROM AUTHOR]

Intergenerational trauma research typically focuses on parent survivors. No specific guidelines are available for conducting research with parent survivors despite potentially unique risks. To investigate research safety with parent survivors, we conducted an online survey of 38 researchers regarding experiences of parent survivors in their research, precautions taken, ethical review experiences, and researchers' mental health during the project(s). Most researchers felt that parent survivors are a unique population that require extra support. However, the response rate was low. Findings show the need for specific research guidelines informed by parent survivors' lived experiences, and to support researchers against vicarious traumatic stress. [ABSTRACT FROM AUTHOR]

Artificial intelligence emerges as a transformative force, offering novel solutions to enhance medical education and mentorship in the specialty of physical medicine and rehabilitation. Artificial intelligence is a transformative technology that is being adopted in nearly every industry. In medicine, the use of artificial intelligence in medical education is growing. Artificial intelligence may also assist with some of the challenges of mentorship, including the limited availability of experienced mentors, and the logistical difficulties of time and geography are some constraints of traditional mentorship. In this commentary, we discuss various models of artificial intelligence in medical education and mentoring, including expert systems, conversational agents, and hybrid models. These models enable tailored guidance, broaden outreach within the physical medicine and rehabilitation community, and support continuous learning and development. Balancing artificial intelligence’s technical advantages with the essential human elements while addressing ethical considerations, artificial intelligence integration into medical education and mentorship presents a paradigm shift toward a more accessible, responsive, and enriched experience in rehabilitation medicine. [ABSTRACT FROM AUTHOR]

Drawing from a practice-based research study in Swedish secondary schools, the aim of this paper is to explore how facts and values are made and unmade as separate and entangled phenomena in sexuality education. In this exploration, we work with a posthumanist approach – agential realism – and more specifically the concept of agential cuts. The empirical material draws from two moments in the teaching of sexuality education, one concerning nakedness and one concerning gender diversity. The analysis puts forward how the lesson topics in relation to school subjects and exercises become significant actors in how facts and values are enacted in the teaching. This implies that facts and values are enacted together-apart within a relational set of interdependency and hence are always present although temporarily more forcefully and ephemeral. To conclude, we discuss the complexities of how facts and values are part of enacting the everchanging knowledge area of sexuality education and urge for acknowledgement of this matter. [ABSTRACT FROM AUTHOR]

The editorial discusses the importance of ethics in orthopaedic surgery practice, emphasizing the balance between patient care and technological advancements. It highlights the evolution of ethical standards in orthopaedics, the fundamental ethical principles guiding surgical practice, and specific challenges in the field. The editorial also addresses ethical considerations for professional colleagues, global health disparities, and ethical issues in research, emphasizing the need for patient-centric care, transparency, and equitable treatment. By adhering to ethical principles, orthopaedic surgeons can enhance patient outcomes while upholding the integrity of the profession. [Extracted from the article]

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]

The article explores the integration of intersectionality in understanding the health disparities faced by Limited English Proficiency (LEP) populations in relation to their legal status. Topics discussed include the impact of immigration status on access to healthcare, the role of language barriers in exacerbating health inequities, and the necessity of adopting an intersectional framework to inform policy and practice.

Background: Research shows that undocumented migrants have difficulties in accessing healthcare. Act 2013:407 came into force in 2013 and entitled undocumented migrants to healthcare that cannot be deferred. To date, studies about undocumented migrants' access to care in Sweden and the impact of Act 2013:407 are sparse. Hence, the aim of this study was to describe professionals' experiences of access to healthcare for undocumented migrants in Sweden and the impact of Act 2013:407. Methods: A qualitative design with semi-structured interviews was employed. Nine interviews were carried out in 2015 with nurses at two NGO healthcare centres for undocumented migrants – and an additional seven interviews in 2022 with staff at an NGO healthcare centre for undocumented migrants and personnel at a regional health and medical care administration. Interpretive description was used for the analyses. Ethical considerations: Permission to carry out the study was obtained from managers at the participating NGOs and the regional health and medical care administration. Participants received verbal and written information about the study, and informed consent was obtained from all participants. Findings: Six categories emerged from the analysis: Changes since the Act was introduced, General problems with healthcare access, Care for undocumented migrants – politics and social economy, Lack of knowledge, 'Healthcare that cannot be deferred' and Being an undocumented migrant. Conclusion: Undocumented migrants' social needs are as great as their needs for healthcare. Healthcare staff are burdened with healthcare cost considerations which affect their judgement of care provision and prioritization. Healthcare staff attitudes towards undocumented migrants affect their access to healthcare. Undocumented migrants in need of healthcare are especially vulnerable due to their legal status, being ill and the fear of being reported and deported. To assure undocumented migrants' access to healthcare and maintain healthcare ethics, the only possible solution is to provide healthcare based on needs. [ABSTRACT FROM AUTHOR]

Introduction: In the past year, the use of large language models (LLMs) has generated significant interest and excitement because of their potential to revolutionise various fields, including medical education for aspiring physicians. Although medical students undergo a demanding educational process to become competent health care professionals, the emergence of LLMs presents a promising solution to challenges like information overload, time constraints and pressure on clinical educators. However, integrating LLMs into medical education raises critical concerns and challenges for educators, professionals and students. This systematic review aims to explore LLM applications in medical education, specifically their impact on medical students' learning experiences. Methods: A systematic search was performed in PubMed, Web of Science and Embase for articles discussing the applications of LLMs in medical education using selected keywords related to LLMs and medical education, from the time of ChatGPT's debut until February 2024. Only articles available in full text or English were reviewed. The credibility of each study was critically appraised by two independent reviewers. Results: The systematic review identified 166 studies, of which 40 were found by review to be relevant to the study. Among the 40 relevant studies, key themes included LLM capabilities, benefits such as personalised learning and challenges regarding content accuracy. Importantly, 42.5% of these studies specifically evaluated LLMs in a novel way, including ChatGPT, in contexts such as medical exams and clinical/biomedical information, highlighting their potential in replicating human‐level performance in medical knowledge. The remaining studies broadly discussed the prospective role of LLMs in medical education, reflecting a keen interest in their future potential despite current constraints. Conclusions: The responsible implementation of LLMs in medical education offers a promising opportunity to enhance learning experiences. However, ensuring information accuracy, emphasising skill‐building and maintaining ethical safeguards are crucial. Continuous critical evaluation and interdisciplinary collaboration are essential for the appropriate integration of LLMs in medical education. Addressing the hype around incorporating large language models and ChatGPT into medical education, Robinson et al. outline how to do it right and wrong. [ABSTRACT FROM AUTHOR]

This article discusses a study on the real-life use of the weight loss medication liraglutide (Saxenda) in patients with obesity in France. The study found that patients who started treatment were generally less socially disadvantaged than those who did not start treatment, possibly due to the higher cost of the medication. The primary reasons for not initiating Saxenda were cost and concerns about side effects. Patients who continued treatment for more than 6 months achieved greater weight loss, and the cost of the medication varied widely. The study suggests that social factors and cost play a significant role in adherence to anti-obesity treatment. [Extracted from the article]

With over 16 years of experience in clinical, research, and educational activities related to transcranial magnetic stimulation (TMS), I have written this article exploring the ethical dimensions of TMS. This article aims to provide valuable and informative content for those unfamiliar with TMS as well as those just starting in the field. Specifically, this article elaborates on four principles of medical ethics, including those applicable to TMS therapy, the disparity between public medical insurance coverage and medical indications in private practice for TMS therapy, and issues concerning research ethics in practice. I also provide recommendations regarding roles and strategies for adoption by academia and those in this field dedicated to making TMS therapy accessible to a larger patient population in a suitable manner. Lastly, it is my hope that this article will serve as a contemporary "Ethics of TMS Neuromodulation", resonating with the inherent human pursuit of "truth, goodness, and beauty" for a sound mind and spirit. [ABSTRACT FROM AUTHOR]

The article offers guidance to radiologic technologists to thrive in level one trauma centers. Challenges faced by radiologic technologists include exposure to traumatic situations, ethical dilemmas, compassion fatigue and burnout, while coping mechanisms for mental well-being include transparent communication, physical work environment management , peer support, professional counseling, mindfulness, self-care, education and professional development.

Background: There is limited information on the ethical issues encountered in living donor organ transplants performed on refugees and asylum seekers. This study investigates the ethical challenges faced by Syrian refugees under temporary protection in Türkiye who engage in living donor organ transplants. Methods: From April to July 2022 in Istanbul, the research employed a qualitative design involving semi-structured, in-depth interviews with 27 participants, including organ donors and recipients. The analysis utilized a thematic analytic method. Results: The findings elucidate two principal themes related to ethical concerns: justice and autonomy. Under the justice theme, several sub-themes emerged, highlighting the multifaceted challenges Syrian refugees face in accessing healthcare services. These include migration and language barriers, significantly impeding their ability to understand medical procedures and rights. Financial difficulties and restricted movement within the country further complicate their access to necessary healthcare. Despite these hurdles, refugees benefit from free access to organ transplantation services and medications, a policy underscoring Türkiye's commitment to healthcare equity for protected populations. The autonomy theme addresses the ethical handling of donor consent and motivation. The results indicate that Syrian refugees undergo a transplantation process free from coercion, with rigorous oversight by organ transplant ethics committees ensuring the prevention of donor abuse. However, despite these protective measures, challenges persist in the informed consent process, primarily due to language barriers that hinder effective communication between healthcare providers and patients. While the efforts of healthcare professionals to assist are recognized as alleviating some difficulties, the broader issues of access to comprehensive health services remain a significant concern. These barriers suggest a need for enhanced linguistic and financial support to improve healthcare accessibility for refugees. Conclusions: This study posits that the healthcare framework provided by Türkiye to Syrians under temporary protection can serve as a model for international human rights and social justice. However, it also emphasizes the importance of addressing the persistent obstacles that limit healthcare access for asylum seekers. Recommendations for policy enhancements focus on improving language services, increasing financial support, and expanding the accessibility of comprehensive health services to ensure equitable health outcomes for refugees. [ABSTRACT FROM AUTHOR]

Background: There are limited comprehensive descriptions of character strengths and virtues specific to the professional identity formation of medical students in the literature. This absence of a satisfactory summation of virtues has stimulated us to attempt a conceptual framework utilizing a tripartite taxonomy. This taxonomy reflects recent interest in and importance of justice and care of the self. Methods: Our taxonomy is grounded within a perennial tradition of medical ethics that focuses on the moral "excellences" or "virtues" that form the character of a good doctor, as acquired over time within a community of practice. Character refers to the whole set of excellences of a practitioner as a member of the medical community. Results: We propose a tripartite taxonomical classification of virtues as Other-Regarding Virtues, Self-Regarding Virtues, and Equal-Regarding Virtues. Though synergistic, each category is readily distinguishable with regard to a fundamental mindset. To thrive, a medical student must develop character strengths that encompass all three categories. Conclusions: Our goal in introducing this tripartite taxonomy is to provide a framework of virtues to contribute to the definition of professional identity. We envision the taxonomy will provide a structure for professional identity formation curriculum development and organize the ever-elusive assessment of professionalism in learners. This taxonomy can also be viewed as an aspirational roadmap for practicing physicians and educators, and as a compass for their daily consciousness. We believe that this taxonomy will enhance the well-being and development of physicians and medical students, and the patients in their care. [ABSTRACT FROM AUTHOR]

The article discusses the use of next-generation sequencing and high DNA input to detect measurable residual disease (MRD) in the peripheral blood of patients with B-cell precursor acute lymphoblastic leukemia (ALL). Traditional MRD assessment in bone marrow samples may miss MRD in peripheral blood, but modern molecular methods can enhance detection. The study found that adjusting traditional MRD assessment strategies can improve MRD detection in peripheral blood, but it may not fully replace bone marrow monitoring. The findings suggest that high DNA input and next-generation sequencing can increase the sensitivity of MRD detection in peripheral blood, especially in cases where bone marrow samples are unavailable. [Extracted from the article]

Background: The Dutch Euthanasia law permits euthanasia in patients with advanced dementia lacking decisional capacity based on advance euthanasia directives. Nevertheless, physicians encounter difficulties assessing the criteria for due care in such cases. This study explores the perspectives of legal experts on the fulfillment of these criteria and the potential for additional legal guidance to support physicians' decision-making processes. Methods: A qualitative study was conducted with legal experts. Two focus group sessions were conducted. The data analysis was conducted iteratively, with the data being interpreted using thematic content analysis and the framework method. Results: Participants emphasize the importance of considering the patient's current wishes and informing them about the limitations of advance euthanasia directives. While representatives and healthcare professionals can assist in interpreting wishes, the final decision regarding euthanasia rests with the physician. The participants also discuss the challenges posed by pre-recorded wishes due to changing preferences. Furthermore, they present different views on the value of life wishes of patients with advanced dementia. While some participants prioritize life wishes over advance euthanasia directives, others question whether such expressions still reflect their will. Participants find it essential to assess unbearable suffering in the context of the current situation. Participants acknowledge the necessity to interpret advance euthanasia directives but also current expressions and they entrust this interpretation to physicians, viewing them as the primary authority, despite consulting multiple sources. Conclusions: The Dutch Euthanasia law's due care criteria are open norms –which are open in substance and require further elaboration, mostly determined on a case-by-case basis to the field standards of the profession–, placing the responsibility on physicians to interpret advance euthanasia directives and patient expressions. Despite potential support from various sources of information, there is limited additional legal guidance available to assist physicians in making decisions. [ABSTRACT FROM AUTHOR]

Background: In Europe and elsewhere in the world, activities are taking place to improve the awareness of children and adolescents (hereinafter: adolescents) regarding their rights and obligations in autonomous decision-making about their own medical treatment and participation in clinical research. Methods: The cross-sectional survey of adolescents was carried out using an anonymous online questionnaire. We obtained consent from the Commission of the Republic of Slovenia for Medical Ethics. Participating young people were invited through the network of primary and secondary schools, the Society of Dystrophy of Slovenia and through the dissemination of electronic messages. The online questionnaire was open from April 25 to May 6, 2023. Young people aged 13 to 20 joined the survey. The association between several factors and awareness of the minimum age limit was tested by univariate logistic regression. All statistical testing was performed at a significance level of 0.05. Results: The responses of 458 respondents were analysed, of which 281 were male. Only 8.3% of participating adolescents knew the age limit set by law for autonomous decision-making about medical treatment at 15 years old. Most answered that a medical institution should inform them about their rights (62.4%). Only 5.02% responded that they do not need their parents' consent when making decisions; 2.6% of respondents answered that they autonomously decided to undergo treatment without their parents' knowledge. The majority obtained information about treatment from a doctor (more than 70%); 42.8% were in favour of new forms of treatment, especially chronic patients (more than 70%); 44.8% had already heard about clinical research, most of them through the media (55.4%); 70% of the respondents answered correctly about making an autonomous decision about participation in research at the age of 18. About three-quarters (75.6%) of respondents who had heard of clinical research believe that an individual should be paid for participating. Conclusions: Our research showed insufficient awareness of the age limit of adolescents regarding medical treatment decisions and clinical research. The prevailing view is that health professionals should inform young people more about their rights. Most adolescents believe they should be paid to participate in clinical research. [ABSTRACT FROM AUTHOR]

Background: HIV affects 1.2 million Americans, with 20% of new diagnoses being 13 to 24-year-olds. Young adult college students are more likely than the general population of 18 to 24-year-olds in the U.S. to engage in sexual practices that increase their risk of STIs. Objectives: This scoping review explores factors that promote or hinder STD/STI/HIV self-testing among U.S. college students. Search Methods: A scoping review of original, experimental (randomized or nonrandomized), observational (longitudinal and cross-sectional), and qualitative or mixed-methods U.S. research was conducted using OVID Medline, OVID Embase, PubMed, CINAHL, Web of Science Core Collection, and Cochrane CENTRAL. English-language studies measured STD/STI/HIV self-test kits and college student testing. Selection Criteria: Inclusion and exclusion criteria were used to narrow down articles that addressed barriers and facilitators to STD/STI/HIV testing, and self-testing among college students in the U.S. Results: Database searches yielded 8,373 articles. After removing duplicates, 6173 items remained. After independent dual-title/abstract screening, 100 papers were full-text reviewed. Seven retrieved articles were unavailable, and 93 were selected for full-text screening. After reviewing the whole text, 89 papers did not fulfill the inclusion requirements and were deleted, leaving 4 articles in the final analysis. Conclusion: Additional research on self-testing among college students in the U.S. is urgently required. The results should guide university health policies on the need to cater to the unique requirements of college students by increasing the availability of healthcare and embracing STD/STI/HIV self-testing. This can enhance testing rates, diminish stigmas, and ultimately contribute to wider endeavors to reduce the transmission of infections in the U.S. [ABSTRACT FROM AUTHOR]

The success of deep learning (DL) relies heavily on training data from which DL models encapsulate information. Consequently, the development and deployment of DL models expose data to potential privacy breaches, which are particularly critical in data-sensitive contexts like medicine. We propose a new technique named DiffGuard that generates realistic and diverse synthetic medical images with annotations, even indistinguishable for experts, to replace real data for DL model training, which cuts off their direct connection and enhances privacy safety. We demonstrate that DiffGuard enhances privacy safety with much less data leakage and better resistance against privacy attacks on data and model. It also improves the accuracy and generalizability of DL models for segmentation and classification of mediastinal neoplasms in multi-center evaluation. We expect that our solution would enlighten the road to privacy-preserving DL for precision medicine, promote data and model sharing, and inspire more innovation on artificial-intelligence-generated-content technologies for medicine. [ABSTRACT FROM AUTHOR]

The literature on organizational ethics has paved the way for a situated and intersubjective understanding of ethics through caring practices. In this article, we try to extend this perspective by looking beyond the interactions of caregivers among themselves or with care seekers to reveal ethics as the ongoing collective accomplishment of a variety of actors. We do so by mobilizing Strauss's theoretical perspective of articulation work in the context of healthcare. Based on an ethnography, we show how actors of care (e.g., nurses, caregivers, or doctors) operate within care arrangements that need to be frequently rearticulated to face ethical threats and protect their patients' well-being. We distinguish three types of rearticulation corresponding to different degrees of rearticulation, individual actor stance, and specific ways of working things out. We discuss their implications for the maintenance of organizational ethics. [ABSTRACT FROM AUTHOR]

The exchange of medical images and patient data over the internet has attracted considerable attention in the past decade, driven by advancements in communication and health services. However, transferring confidential data through insecure channels, such as the internet, exposes it to potential manipulations and attacks. To ensure the authenticity of medical images while concealing patient data within them, this paper introduces a high-capacity and reversible fragile watermarking model in which an authentication watermark is initially generated from the cover image and merged with the patient's information, photo, and medical report to form the global watermark. This watermark is subsequently encrypted using the chaotic Chen system technique, enhancing the model's security and ensuring patient data confidentiality. The cover image then undergoes a Discrete Fourier Transform (DFT) and the encrypted watermark is inserted into the frequency coefficients using a new embedding technique. The experimental results demonstrate that the proposed method achieves great watermarked image quality, with a PSNR exceeding 113 dB and an SSIM close to 1, while maintaining a high embedding capacity of 3 BPP (Bits Per Pixel) and offering perfect reversibility. Furthermore, the proposed model demonstrates high sensitivity to attacks, successfully detecting tampering in all 18 tested attacks, and achieves nearly perfect watermark extraction accuracy, with a Bit Error Rate (BER) of 0.0004%. This high watermark extraction accuracy is crucial in our situation where patient data need to be retrieved from the watermarked images with almost no alteration. [ABSTRACT FROM AUTHOR]

Background: Truth-telling in health care is about providing patients with accurate information about their diagnoses and prognoses to enable them to make decisions that can benefit their overall health. Physicians worldwide, especially in the United Kingdom (U.K.) and the United States (U.S.), openly share such medical information. Bangladesh, however, is a Muslim-majority society with different social norms than Western societies. Therefore, we examined whether Muslim culture supports truth disclosure for patients, particularly how and to what extent medical information about life-threatening diseases is provided to patients in Bangladesh. Methods: This was a phenomenological qualitative study. We conducted thirty in-depth interviews with clinicians, nurses, patients and their relatives at Shaheed Suhrawardy Medical College Hospital in Dhaka, Bangladesh. We also used observations to explore interactions between patients, families and healthcare professionals regarding their involvement in medical decisions and truth disclosure issues. NVivo software was used to identify common themes, and a thematic analysis method was utilised to analyse the datasets. Results: This study identified three recurring themes relevant to the ethics and practice of truth disclosure: best interest rather than autonomy, the ambivalent value of deception and who understands what. The participants revealed that physicians often withhold fatal medical prognoses from terminally ill patients to ensure the best healthcare outcomes. The results indicate that deception towards patients is commonly accepted as a means of reducing burden and providing comfort. The participants opined that true medical information should be withheld from some patients, assuming that such disclosures may create a severe burden on them. Whether or to what extent medical information is disclosed primarily depends on a family's wishes and preferences. Conclusions: While truth disclosure to patients is considered an ethical norm in many cultures, such as in the U.K. and the U.S., the practice of concealing or partially revealing severe medical prognoses to patients is an actual medical practice in Bangladeshi society. This study emphasises the importance of recognising a patient's active involvement and respecting the cultural values that shape family involvement in medical decision-making. These findings may have significant policy and practical implications for promoting patient autonomy within Bangladeshi family dynamics and religious-based cultural values. [ABSTRACT FROM AUTHOR]

The Internet of Medical Things (IoMT) has revolutionized healthcare with remote patient monitoring and real-time diagnosis, but securing patient data remains a critical challenge due to sophisticated cyber threats and the sensitivity of medical information. Traditional machine learning methods struggle to capture the complex patterns in IoMT data, and conventional intrusion detection systems often fail to identify unknown attacks, leading to high false positive rates and compromised patient data security. To address these issues, we propose RCLNet, an effective Anomaly-based Intrusion Detection System (A-IDS) for IoMT. RCLNet employs a multi-faceted approach, including Random Forest (RF) for feature selection, the integration of Convolutional Neural Networks (CNN) and Long Short-Term Memory (LSTM) models to enhance pattern recognition, and a Self-Adaptive Attention Layer Mechanism (SAALM) designed specifically for the unique challenges of IoMT. Additionally, RCLNet utilizes focal loss (FL) to manage imbalanced data distributions, a common challenge in IoMT datasets. Evaluation using the WUSTL-EHMS-2020 healthcare dataset demonstrates that RCLNet outperforms recent state-of-the-art methods, achieving a remarkable accuracy of 99.78%, highlighting its potential to significantly improve the security and confidentiality of patient data in IoMT healthcare systems. [ABSTRACT FROM AUTHOR]

To an individual, pain is unambiguously real. To a caregiver, assessing pain in others is a challenging process shrouded in doubt. To explain this challenge, many assume that pain "belongs" exclusively to the bearer of that experience and accept the dogma that pain is private. However, privacy also entails that it is not possible to identify, share, or communicate that experience with others. Obviously, this is not true and the consequences of pain privacy would be devastating for healthcare. Pain is indeed unique and subjective, but not necessarily private. Pain is in fact readily communicable, though perhaps not as effectively and reliably as caregivers would like. On the other hand, healthcare systems mandate objective metrics in pain diagnosis. Smiley face caricatures are a staple of clinical practice and a universal standard for reporting pain levels. These conditions create a double paradox: Assess a private experience that is inaccessible, and use numerical scales to measure subjective attributes. Navigating this stressful environment, medical professionals experience intellectual dissonance, patients are frustrated, and value-based care is undermined. Offering a way out, first, we refute the privacy and objectification of pain citing philosophical, behavioral, and neuroscientific arguments. We discuss Wittgensteinian views against privacy, explore the clear evolutionary advantage of communicating pain to others, and identify neural circuits in the mammalian brain that contribute to empathy. Second, we highlight the subjectivity of pain, embracing the complexity and uniqueness of an individual's pain. We also provide compelling evidence for brain mechanisms that actively shape the pain experience according to predictive coding principles. Third, we offer a vision for the development of biomarker technologies that assess pain fairly without engendering bias against the patient's narrative. Our recommendations are based on the overwhelming appreciation that "medicine by emoji" is inadequate for capturing the multidimensional nature of pain. Our view is that the most promising candidates for pain biomarkers consist of self-reports as ground truth augmented by physiological signatures of biological relevance to pain. Integration of subjective and objective multimodal features will be key for the development of comprehensive pain assessment models. [ABSTRACT FROM AUTHOR]

This investigation explored the use of the Internet in Spain by young adults with intellectual disability who were active Internet users, as well as their perceptions and those of their relatives about the Internet's potential benefits and risks for this population. Additionally, this study explored changes in these perceptions and the Internet use during the home confinement due to the COVID-19 pandemic. A sample of 35 young adults with intellectual disability and one of their relatives, respectively (i.e. 35 relatives), completed an online survey during May 2020. Results indicated that young people with intellectual disability are aware of the potential risks to a limited extent. In addition, the participants with intellectual disability increased their Internet use and their perception of its benefits during confinement. However, their relatives gave greater importance to the potential risks, but scarcely supervised young adults with intellectual disability when accessing the Internet. We conclude that, beyond computer literacy and web access skills, young people with intellectual disability may need further training on how to identify and deal with the potential risks of the Internet use, and how to maximise its potential benefits. We also highlight the need to provide their relatives with more educational resources. [ABSTRACT FROM AUTHOR]

Background: Patients' continuous use of intelligent medical guidance is important for the application of artificial intelligence (AI) in hospitals. Problem/gap: Previous studies mainly focus on the initial adoption while not examining why patients continually use AI-based medical services. Objective/aim: We aim to explore the factors influencing patients' continuous use of intelligent medical guidance based on the Stimuli-Organism-Response framework. Method: Via online survey data, we used structural equation modelling to test the research model. Results: Our results reveal feature diversity of intelligent medical guidance affect users' perceived extrinsic and intrinsic value, as well as their impact on their continuous usage intention. Research implications: Our research expands the understanding of medical AI applications and provides theoretical and implicational insights for future development. [ABSTRACT FROM AUTHOR]

Background: Young people (YP) are disproportionately affected by the HIV pandemic in sub-Saharan Africa (SSA), but testing rates remain low despite global targets of testing 95% of people with HIV infection by 2030. HIV self-testing (HIVST) has been recently introduced to reach high-risk population groups such as these. Thus, synthesis of emerging evidence on the acceptability and use of HIVST among YP in SSA is needed so that comprehensive information can be generated to inform policy and practice. Methods: We employed a mixed methods systematic review of quantitative and qualitative literature reporting on HIVST among YP involving any design and published in English by 31st of October 2023. The review synthesized quantitative evidence on acceptability and use of HIVST, and qualitative evidence on perspectives of YP about HIVST. We searched databases of published articles (e.g. MEDLINE, CINAHL) and Gray literature sources (e.g. Google, Google Scholar). The concepts for the search included self-testing, HIV/AIDS, and countries in SSA. Two authors independently screened, retrieved full-text, and assessed quality of the studies. Results: A total of 4150 studies were retrieved and 32 studies were finally included in the review. Acceptability of HIVST computed from a single item asking YP on their preference or willingness or demand for HIVST was moderate (34–67%) to high (≥ 67%) among YP in SSA. Nine of the fourteen studies that reported on acceptability found high acceptability of HIVST. Use of HIVST ranged from 0.8 to 100% while in most studies the use rate was below 50%. Key barriers to HIVST use were coping with a positive test in the absence of counselling and support, physical discomfort, and cost of kits. Perceived enablers included perceptions of HIVST as promoting personal empowerment and autonomy; privacy and confidentiality; and convenience in location, time, and skill. Conclusions: HIVST was highly accepted but not well utilized among YP in SSA. YP showed diversified needs with mixed preferences for location, and modalities of service provision. Overall, the review identified heterogeneous evidence in terms of methods, population, outcome measures, and results. The review was registered in the International Prospective Registry of Systematic Reviews (PROSPERO: ID = CRD42021278919). [ABSTRACT FROM AUTHOR]

Background: The biomedical and health informatics (BMHI) fields have been advancing rapidly, a trend particularly emphasised during the recent COVID-19 pandemic, introducing innovations in BMHI. Over nearly 50 years since its establishment as a scientific discipline, BMHI has encountered several challenges, such as mishaps, delays, failures, and moments of enthusiastic expectations and notable successes. This paper focuses on reviewing the progress made in the BMHI discipline, evaluating key milestones, and discussing future challenges. Methods: To, Structured, step-by-step qualitative methodology was developed and applied, centred on gathering expert opinions and analysing trends from the literature to provide a comprehensive assessment. Experts and pioneers in the BMHI field were assigned thematic tasks based on the research question, providing critical inputs for the thematic analysis. This led to the identification of five key dimensions used to present the findings in the paper: informatics in biomedicine and healthcare, health data in Informatics, nurses in informatics, education and accreditation in health informatics, and ethical, legal, social, and security issues. Results: Each dimension is examined through recently emerging innovations, linking them directly to the future of healthcare, like the role of artificial intelligence, innovative digital health tools, the expansion of telemedicine, and the use of mobile health apps and wearable devices. The new approach of BMHI covers newly introduced clinical needs and approaches like patient-centric, remote monitoring, and precision medicine clinical approaches. Conclusions: These insights offer clear recommendations for improving education and developing experts to advance future innovations. Notably, this narrative review presents a body of knowledge essential for a deep understanding of the BMHI field from a human-centric perspective and, as such, could serve as a reference point for prospective analysis and innovation development. [ABSTRACT FROM AUTHOR]

Background/Objectives: Social media has become a significant part of daily life, with platforms like Facebook and WhatsApp dominating usage. The COVID-19 pandemic further increased social media activity, including within the orthopedic community due to restrictions on physical gatherings. Despite the benefits of instant access to educational resources and interaction with experts, the lack of regulated editorial oversight on social media raises concerns about misinformation and privacy. This study aimed to evaluate the role of social media in orthopedic and trauma surgery education, focusing on platform use, user behavior, and engagement with educational content. Methods: A web-based survey was distributed to 912 residents and 728 medical students from the German-speaking Association for Arthroscopy and Joint Surgery (AGA) between June and July 2022. The questionnaire included 21 items covering demographics, platform use, activity patterns, engagement with educational content, and concerns about privacy. Results: Of the 339 respondents (129 medical students), 87% reported daily social media use, primarily via smartphones (93%). The most commonly used platforms were WhatsApp (84%), Instagram (68%), and YouTube (54%). About 26% of the content consumed was related to orthopedics or trauma surgery. While 70% engaged with specialist content by liking, commenting, or sharing, only 32% posted their own content. Additionally, 77% followed healthcare professionals or institutions, and 65% benefited from case presentations with images. Notably, 15% observed content that could violate patient privacy. Conclusions: Orthopedic residents and students are high-volume social media users but engage more passively with professional content. While most value educational material, concerns about privacy violations and inappropriate posts remain prevalent. [ABSTRACT FROM AUTHOR]

Robust data privacy regulations hinder the exchange of healthcare data among institutions, crucial for global insights and developing generalised clinical models. Federated learning (FL) is ideal for training global models using datasets from different institutions without compromising privacy. However, disparities in electronic healthcare records (EHRs) lead to inconsistencies in ML-ready data views, making FL challenging without extensive preprocessing and information loss. These differences arise from variations in services, care standards, and record-keeping practices. This paper addresses data view heterogeneity by introducing a knowledge abstraction and filtering-based FL framework that allows FL over heterogeneous data views without manual alignment or information loss. The knowledge abstraction and filtering mechanism maps raw input representations to a unified, semantically rich shared space for effective global model training. Experiments on three healthcare datasets demonstrate the framework's effectiveness in overcoming data view heterogeneity and facilitating information sharing in a federated setup. [ABSTRACT FROM AUTHOR]

In multicentric studies, data sharing between institutions might negatively impact patient privacy or data security. An alternative is federated analysis by secure multiparty computation. This pilot study demonstrates an architecture and implementation addressing both technical challenges and legal difficulties in the particularly demanding setting of clinical research on cancer patients within the strict European regulation on patient privacy and data protection: 24 patients from LMU University Hospital in Munich, Germany, and 24 patients from Policlinico Universitario Fondazione Agostino Gemelli, Rome, Italy, were treated for adrenal gland metastasis with typically 40 Gy in 3 or 5 fractions of online-adaptive radiotherapy guided by real-time MR. High local control (21% complete remission, 27% partial remission, 40% stable disease) and low toxicity (73% reporting no toxicity) were observed. Median overall survival was 19 months. Federated analysis was found to improve clinical science through privacy-friendly evaluation of patient data in the European health data space. [ABSTRACT FROM AUTHOR]

Background: New employees often exhibit stress reactions to changes in their environment and some of these may result in resignations. Employees in medical institutions are no exceptions. Considering the shortage of nurses in Japan, countermeasures are needed against the resignation of newly graduated nurses. Many studies have indicated that multifaced factors affect the resignation of newly graduated nurses. Even though individual characteristics are important factors in this regard, training and support for newly graduated nurses do not focus on the nurses' characteristics. The purpose of this study is to examine the characteristics influencing the early resignation of newly graduated nurses and suggest ways to support them and prevent their early resignation based on their characteristics. Methods: With the approval of the Ethics Committee, various characteristics of 353 newly graduated nurses (personality, interpersonal relationships, trait anxiety, nurse orientation, desire to be a nurse, and self-proclaimed academic ability) were assessed using a transactional analysis, the State-Trait Anxiety Inventory, and self-reporting numerical rating scales. The characteristics of those who resigned within 1 year (case group) and those who did not (control group) were compared using chi-square test and logistic regression analysis. Results: Our sample of 353 participants included 32 nurses from the case group and 304 nurses from the control group. Most participants showed similar personality traits. However, the control group had a significantly lower percentage with negative self, strong trait anxiety, negative self and strong trait anxiety, and low orientation compared to the case group. Our logistic regression analysis showed that strong trait anxiety and low nurse orientation are significantly related with the early resignation of nurses. Conclusions: The early resignation of newly graduated nurses may be prevented by understanding their characteristics at the time of gaining employment and implementing early intervention programs, such as education programs to reduce anxiety, and helping those with strong trait anxiety and low nurse orientation to find meaning in work. [ABSTRACT FROM AUTHOR]

Background: Professional nurses are trained to provide quality care. Despite the professional nurses' acquired skill and professionalism attributes, the neonate, infant, and under-5-child mortality rates are high in sub-Saharan Africa. This health care report indicates that sub-Saharan Africa countries face a challenge in reaching the Sustainable Development Goal number 3 by the year 2030 (that is, ensuring healthy lives and reducing the mortality rates of children under 5). It has been reported that professionalism in nursing can improve the quality of care and positively change the health outcomes. Methods: This study employed a qualitative exploratory, descriptive design to explore and describe professional nurses' own professionalism attributes to provide quality care to neonates, infants, and under-5 children in the North West province in South Africa. Eight naïve sketches of an all-inclusive sample of invited professional nurses (N = 25; n = 8) were received. The naïve sketch questions were based on the Registered Nurses' Association of Ontario's professionalism attributes. Tesch's eight steps of data-analysis were used, with an independent coder's assistance. Results: The categories included (1) knowledge, (2) spirit of inquiry, (3) accountability, (4) autonomy, (5) advocacy, (6) collegiality and collaboration, (7) ethics and values, and (8) professional reputation, and each category generated sub-themes. Conclusion: Professional nurses are aware of their own professionalism attributes in quality of care of neonates, infants and under-5 children; the 'innovation and visionary' attribute did not emerge, which should receive more attention to strengthen quality care. However, a new attribute, 'professional reputation', reflecting a South African culture-orientated attribute, emerged from the data collected. [ABSTRACT FROM AUTHOR]

This article discusses the importance of preparing graduate nursing students to address environmental health issues and lead nursing green teams. It emphasizes the need to integrate environmental health concepts into nursing school curricula and highlights the role of nurses in addressing climate change and pollution in healthcare settings. The article provides information on the impact of health services on climate change and the formation of nursing green teams to implement sustainability initiatives. It also discusses opportunities and solutions for greening healthcare workplaces, waste management, chemical use, and improving environmental sustainability in healthcare settings. The document includes a list of references and sources for further research on the topic. [Extracted from the article]

This article explores the ethical complexities of openly-expressed medical commentary using recent cancer diagnoses within the British monarchy as illustrative cases. Specifically, it examines tensions between public interest, personal privacy, and professional standards, underlining the adverse implications of conjectural discourse, alongside the role of physicians in enhancing wider medical understanding. [ABSTRACT FROM AUTHOR]