...David Sackett. EBP is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.” (Sackett D, 1996) Defining what is meant by EBP allows this essay to discuss the controversies and key debates surrounding the use of EBP in nursing practice. These include ethical concerns, reliability, and validity as well as collection on of...
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...Are Controlled Clinical Trials Really Ethical? Case Study In 2009, two cousins, Thomas and Brandon were diagnosed with the same type of deadly skin cancer within a 2 month time frame of each other. To date, here is no cure for skin cancer and once diagnosed the average life expectancy is approximately 8 months. Current standard of care treatments are aimed at shrinking the tumors and prolonging life. Unfortunately, these standard of care treatments only work in a very small percentage of patients and are very toxic with terrible side effects. Thomas learned of a new Phase 3 clinical research trial sponsored by Roche with an unapproved yet promising drug. His doctor explained that in earlier trials, a majority of volunteer patients who took the wonder drug had seen a drastic reduction in the size of their tumors with very few side effects. The only way ill patients can get the drug is by participating in this trial. The trial is a randomized controlled trial (RCT) which means half of the volunteers will get the experimental drug while the other half will be treated with another standard of care treatment. The purpose of the standard or control arm is to allow researchers to compare the long term effects of the new drug to that of the current standard treatment and determine whether it actually shrinks tumors and prolong remissions. Participants have a 50/50 chance of being placed in either arm of the study. Arm assignments are random and cannot be changed. With limited options...
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...While the field of prosthetics and medical enhancement may be a relatively new field, the history of medicine is well over 2000 years old. The concept of medical ethics have been a backbone of the practice from the start, “The most famous document in medical history, the Hippocratic Oath (c. 400 B.C.E.), which established a model of ethical and professional behavior for healers” (Paul 1399). According to the article “I. United States” written by a biomedical ethicist and a member of the medical ethics committee: the development of bioethics can best be understood against the background of the development of medicine in the United States from 1900. The twentieth century saw enormous growth in American medicine—in scientific understanding, the...
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...Instructor: Robert Crane Abstract Efficacy of antidepressants is under such scrutiny by the general public, because of a few scientists. Antidepressants are the most researched substance worldwide. The long history of research analysis proves the efficacy of antidepressants, but there are those who will falsely interpret clinical trials, or pool together selected studies to justify their claims. Scientists will agree that there are many flaws with antidepressant research, but with ever increasing new ways to re-test old research, the evidence of positive improvements are becoming harder to deny. This report shows that even though scientists are trying to disprove the effectiveness of antidepressants, the evidence of the scientific facts prove that antidepressants work for depression. Table of Contents List of Figures and Tables iv Glossary of Terms v General Information vii Thesis Statement vii Report Audience vii Author’s Purpose vii Argumentative Requirements Fulfillment Statement vii Introduction 1 Americans and Depression 2 Background of Depression and Antidepressants 4 Depression 4 Antidepressants 5 Depression Scale 5 Clinical Trials 6 Claims..................... 6 The Truth ......................................................................................................................................6 Prescribing methods 8 Placebo Effect 8 Efficacy of Antidepressants 9 Antidepressants and Levels of Depression 9 New Research 10 Pharmaceutical...
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...POSTPARTUM DEPRESSION: LITERATURE REVIEW OF RISK FACTORS AND INTERVENTIONS Donna E. Stewart, MD, FRCPC E. Robertson, M.Phil, PhD Cindy-Lee Dennis, RN, PhD Sherry L. Grace, MA, PhD Tamara Wallington, MA, MD, FRCPC ©University Health Network Women’s Health Program 2003 Prepared for: Toronto Public Health October 2003 Women’s Health Program Financial assistance by Health Canada Toronto Public Health Advisory Committee: Jan Fordham, Manager, Planning & Policy – Family Health Juanita Hogg-Devine, Family Health Manager Tobie Mathew, Health Promotion Consultant – Early Child Development Project Karen Wade, Clinical Nurse Specialist, Planning & Policy – Family Health Mary Lou Walker, Family Health Manager Karen Whitworth, Mental Health Manager Copyright: Copyright of this document is owned by University Health Network Women’s Health Program. The document has been reproduced for purposes of disseminating information to health and social service providers, as well as for teaching purposes. Citation: The following citation should be used when referring to the entire document. Specific chapter citations are noted at the beginning of each chapter. Stewart, D.E., Robertson, E., Dennis, C-L., Grace, S.L., & Wallington, T. (2003). Postpartum depression: Literature review of risk factors and interventions. POSTPARTUM DEPRESSION: LITERATURE REVIEW OF RISK FACTORS AND INTERVENTIONS Table of Contents EXECUTIVE SUMMARY 2 OVERALL METHODOLOGICAL FRAMEWORK 5 CHAPTER 1: RISK FACTORS FOR...
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...Introduction There is a lot of controversy on nutritional supplements and performance/health claims that go along with them. Many claims come and go without a lot of hassle, but none has generated the commotion of the interest or debate surrounding creatine (Cr). Many people believe Cr is another weight gaining powder or steroid alternative (Plisk and Kreider, 1999). What those people do not know is Cr is also found in the human body naturally as opposed to supplementation. Individuals know the name creatine but may not understand the science behind it. The use of Cr has become very widespread, usually in the supplement form Cr monohydrate. Every since the discovery of the ability to increase Cr and phosphocreatine (PCr) inside the human muscles by oral ingestion of supplemental Cr has led to many studies showcasing the benefits of exercise performance. Cr monohydrate supplementation shows significant results to increase the human body’s ability to maintain power output during high-intensity exercise and increase the rate of PCr to resynthesis during the recovery phase of intermittent high intensity exercise (Volek and Kraemer, 1996). My goal is to provide significant information on natural Cr functions, Cr as a supplement, ways the human body utilize Cr to enhance athletic performance, and how society views/uses Cr. Effects of Creatine in the Human Body Creatine was discovered by a French scientist named Chevreul in 1832 but it was not until 1847 did another scientist...
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....WHAT IS QUALITY OF LIFE AND HEALTH-RELATED QUALITY OF LIFE? A REVIEW OF THE CONCEPTS AND SOME ATTEMPTS AT MEASUREMENT Quality of life research, then, spans a range of topics, from quality of life in the last year of life (Lawton et al. 1990) to quality of life in urban environments (Rogerson et al. 1989). As was illustrated earlier, quality of life is an amorphous concept, that has a usage across many disciplines -- geography, literature, philosophy, health economics, advertising, health promotion and the medical and social sciences (e.g. sociology and psychology). It is a vague concept; it is multidimensional and theoretically incorporates all aspects of an individual's life. Quality of life has also been defined as the `output' of the inputs of the physical and the spiritual (Liu 1974); as the degree to which a person accomplishes life goals (Cella and Cherin 1987); and even quantified crudely as a formula in which quality of life (QL) is a product of one's natural endowment (NE) and the effort made on one's behalf by the family (H) and society (S), such that QL ]] NE ]] H ]] S (Shaw 1977). The meaning of the concept of quality of life is thus arguably dependent on the user of the term, his or her understanding of it, and his or her position and agenda in the social and political structure (Edlund and Tancredi 1985): `Quality of life is a vague and ethereal entity, something that many people talk about, but which nobody very clearly knows what to do about' (Campbell...
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...make it unavailable for public hospitals, and those who are poor may not be able to benefit from this technology, but this transfer from traditional methods in medicine must happen, as technology affected all aspects of our lives. Robot might sound as a very modern scientific invention, but it is not as the first time “robot” was introduced and coined was in 1921, in a play written by the Czech writer Karel Capek, and since then robots took a place in many aspects of our lives, they also take place in dangerous and highly precise tasks, such as aviation, and here we will discuss the medical usage of robots, starting from the history, to political and economic questions, also Psychological considerations and sociological effects , and the ethical considerations. The first laparoscopic cholecystectomy using robots was performed in 1987, since then, the procedures performed in similar ways have grown “at a pace consistent with improvements in technology and the technical skill of surgeons.” (Surg) this surgery is known as minimally invasive as incisions are smaller, there is less...
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...data to quantitate the relative contribution of postfertilization effects. Despite the lack of quantitative data, the principles of informed consent suggest that patients who may object to any postfertilization loss should be made aware of this information so that they can give fully informed consent for the use of oral contraceptives. Arch Fam Med. 2000;9:126-133 Oral contraceptives (OCs) are among the most extensively studied and used medications in the world,1 and are accessible without a prescription in some countries, although still virtually unavailable in others. In America, OCs have contributed to an increased acceptability of birth control,2 although, for many patients, decisions about contraception still have moral, ethical, and religious implications.3,4 For patients who believe that human life begins at fertilization (conception), a method of birth control that has the potential of interrupting development after fertilization (a postfertilization effect) may not be...
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...Over the past several decades, highly skilled professionals have attempted to address several issues regarding antipsychotic drugs used to treat school-aged children with Attention Deficit/Hyperactivity Disorder (ADHD). The distribution of these ADHD medications have steadily increased over the years, which has, on one hand, presented a possible solution to the escalating diagnosis of Attention Deficit/Hyperactivity Disorder, and on the latter, brought into question the ethics and effectiveness of these medications. Health officials, parents, and the children themselves struggle to come to an agreement when deciding whether or not medication is the best solution. The Debate Over Medicating Children with Attention Deficit/Hyperactivity Disorder In the spring of 2004, Jacqueline A. Sparks, an associate professor of family therapy at the University of Rhode Island, and Barry L. Duncan, a cofounder of the Institute for the Study of Therapeutic Change, investigated the ethics and effectiveness behind the distribution of ADHD medications as a modern treatment method for children with Attention Deficit/Hyperactivity Disorder. Even though, “appropriate identification and treatment of symptoms for psychiatric illnesses (such as ADHD) during childhood and adolescence is critical” (ScienceDaily). Sparks and Duncan note that, “ADHD is arguably the most controversial topic in recent mental health history. The ADHD diagnosis is not defined by a biological marker (Leo & Cohen, 33), but is...
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...Charleston, SC, USA Abstract Tube feeding can be an appropriate and effective means of providing nutrition for individuals who are unable to achieve adequate nourishment orally because of various medical problems. However, the delivery of nutrients by tube feeding can cause ethical dilemmas in cases where the effectiveness of tube feeding diminishes and medical complications increase. The decision to tube feed is often influenced by regional and cultural preferences, as well as the high cost of providing mealtime assistance. The effectiveness and appropriateness of tube feeding has been the subject of much debate as it applies to those with severe cognitive impairments and those who are in a persistent vegetative state (PVS). Recent research shows that in these vulnerable populations, tube feeding alone does not necessarily prevent malnutrition and risk of infection or improve functional status and comfort. While advanced directives allow an individual to make decisions about his or her care at the end of life, court cases and religious doctrine examine the individual’s right to autonomous decision making in opposition to preserving the sanctity of life. As long as the outcome of this debate is largely undecided, the process of dying may be prolonged for those who can no longer advocate for themselves. Keywords: Enteral feeding, tube feeding, ethics, persistent vegetative state, dementia, palliative care Introduction Nutrients are introduced into the body in...
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...Psychology Not to be confused with Phycology, Physiology, or 1 Etymology Psychiatry. Further information: Outline of psychology and Index The word psychology literally means, “study of the soul" of psychology articles (ψυχή psukhē, “breath, spirit, soul” and -λογία -logia, “study of” or “research”).[10] The Latin word psycholoPsychology is an academic and applied discipline that gia was first used by the Croatian humanist and Latinist involves the scientific study of mental functions and Marko Marulić in his book, Psichiologia de ratione anbehaviors.[1][2] Psychology has the immediate goal of imae humanae in the late 15th century or early 16th understanding individuals and groups by both establish- century.[11] The earliest known reference to the word ing general principles and researching specific cases,[3][4] psychology in English was by Steven Blankaart in 1694 and by many accounts it ultimately aims to benefit in The Physical Dictionary which refers to “Anatomy, society.[5][6] In this field, a professional practitioner or which treats the Body, and Psychology, which treats of researcher is called a psychologist and can be classified the Soul.”[12] as a social, behavioral, or cognitive scientist. Psychologists attempt to understand the role of mental functions in individual and social behavior, while also exploring the physiological and biological processes that underlie cognitive functions and behaviors. 2 History Psychologists explore concepts such as perception...
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...WHO DRUG INFORMATION V O L U M E 10 N U M B E R 4 19 9 6 P R O P O S E D INN LIST 76 INTERNATIONAL NONPROPRIETARY NAMES FOR P H A R M A C E U T I C A L S U B S T A N C E S WORLD HEALTH ORGANIZATION • GENEVA Volume 10, Number 4, 1996 World Health Organization, Geneva WHO Drug Information Contents General Policy Topics Meeting the challenge of biotechnology 175 Regulatory Matters Acellular pertussis vaccine for infants Breath test for Helicobacter pylori Restrictions on use of anorectics Coumarin: regulatory action Laxatives: reclassification of common ingredients Is melatonin a prescription drug? NSAIDS, antimicrobials and angioedema Drug-induced liver disease Fluoxetine and hepatitis Hepatitis B vaccine and musculoskeletal reactions Pyrithyldione-diphenhydramine and agranulocytosis Roxithromycin associated with cardiac arrhythmias 187 187 187 188 189 189 189 189 190 190 190 190 Reports on Individual Drugs Confirmation of increased chloroquine resistance in South Africa Which malaria drug for children? Post-malaria neurological syndrome and mefloquine Driving ability in cancer patients treated with morphine Hormone replacement therapy and venous thromboembolism 177 177 177 178 179 Safety Issues Documentation requirements for approval: safety Drug safety monitoring centres 180 181 Recent Publications WHO Expert Committee on Specifications for Pharmaceutical Preparations: Thirty-fourth report International Nonproprietary...
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...Shaping Parental Authority over Children’s Bodies ALICIA OUELLETTE* INTRODUCTION....................................................................................................... 956 I. SCULPTING, SHAPING, AND SIZING CHILDREN: FOCUS CASES.............................. 959 A. WESTERNIZING ASIAN EYES..................................................................... 960 B. HORMONES FOR STATURE ........................................................................ 961 C. LIPOSUCTION ON A TWELVE YEAR OLD.................................................... 963 D. GROWTH STUNTING ................................................................................. 964 II. THE LAW, MEDICINE, PARENTAL RIGHTS, AND CHILDREN’S BODIES ................. 966 A. BACKGROUND LAW ................................................................................. 966 B. APPLICATION IN SHAPING CASES .............................................................. 969 C. ROOM FOR REGULATION .......................................................................... 971 III. WHAT IS REALLY WRONG WITH MEDICAL AND SURGICAL SHAPING OF CHILDREN? ............................................................................................................ 973 A. THE NONSUBORDINATION PRINCIPLE AS A LIMIT ON INDIVIDUAL RIGHTS 974 B. CHILDREN AS PERSONS, PARENTAL RIGHTS ............................................. 977 C. MEDICAL AND SURGICAL SHAPING OF CHILDREN IS DIFFERENT ............... 981 IV. CONCERNING...
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...National League for Nursing Evaluation and Learning Advisory Committee (ELAC) ANNOTATED BIBLIOGRAPHY ON ASSESSMENT AND EVALUATION ELAC Members: Marilyn H. Oermann (Chair) Karen Saewert (Chair-elect) Pamela Rutar Suzanne Yarbrough Sub-committee Members: Reba Childress Dawne-Marie Dunbar Sally Erdel Barbara Haas Evelyn Hayes Debra Hurd Sheila Kyle Gayle Preheim, Chair Linda Siktberg Gale R. Woolley, Chair A comprehensive literature review was completed, reflecting best practices in assessment, evaluation, and grading in nursing. This annotated bibliography of the literature is organized into four areas: assessment and evaluation in (a) the classroom, (b) the online environment, (c) clinical practice, and (d) learning and simulation laboratories. There is a fifth section that provides references on the assessment of psychomotor learning and performance; that section is not annotated. This work was completed by members of ELAC and its subcommittees as noted above. 1 CLASSROOM ASSESSMENT Ahmad, N. (2002). Evaluation of teaching: Through eyes of students. Plano: Institutional Research Office, Collin County Community College District. This article reviews the student evaluations instruments used to evaluate learning and faculty in the classroom. The purpose of this article was to search for come standardized instruments of student evaluations. Instruments used are: Individual Developmental and Educational Assessment (IDEA), Student Assessment of...
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