GMS Health Technol Assess. 2014 Nov 26;10:Doc05. doi: 10.3205/hta000121. eCollection 2014.

Assessment vs. appraisal of ethical aspects of health technology assessment: can the distinction be upheld?

Sandman L1, Heintz E2.

Author information

• 1University of Borås, Institutionen för vårdvetenskap, Borås, Sweden.
• 2Swedish Council on HTA (SBU), Stockholm, Sweden.

Abstract

An essential component of health technology assessment (HTA) is the assessment of ethical aspects. In some healthcare contexts, tasks are strictly relegated to different expert groups: the HTA-agencies are limited to assessment of the technology and other actors within the health care sector are responsible for appraisal and recommendations. Ethical aspects of health technologies are considered with reference to values or norms in such a way that may be prescriptive, or offer guidance as to how to act or relate to the issue in question. Given this internal prescriptivity, the distinction between assessment and appraisal seems difficult to uphold, unless the scrutiny stops short of a full ethical analysis of the technology. In the present article we analyse the distinction between assessment and appraisal, using as an example ethical aspects of implementation of GPS-bracelets for people with dementia. It is concluded that for HTA-agencies with a strictly delineated assessment role, the question of how to deal with the internal prescriptivity of ethics may be confusing. A full ethical analysis might result in a definite conclusion as to whether the technology in question is ethically acceptable or not, thereby limiting choices for decision-makers, who are required to uphold certain ethical values and norms. At the same time, depending on the exact nature of such a conclusion, different action strategies can be supported. A positive appraisal within HTA could result in a decision on mandatory implementation, or funding of the technology, thereby making it available to patients, or decisions to allow and even encourage the use of the technology (even if someone else will have to fund it). A neutral appraisal, giving no definite answer as to whether implementation is recommended or not, could result in a laissez-faire attitude towards the technology. A negative appraisal could result in a decision to discourage or even prohibit implementation. This paper presents an overview of the implications of different outcomes of the ethical analysis on appraisal of the technology. It is considered important to uphold the distinction between assessment and appraisal, primarily to avoid the influence of preconceived values and political interests on the assessment. Hence, as long as it is not based on the subjective value judgments of the HTA-agency (or its representative), such an appraising conclusion would not seem to conflict with the rationale for the separation of these tasks. Moreover, it should be noted that if HTA agencies abstain from including full ethical analyses because of the risk of issuing an appraisal, they may fail to provide the best possible basis for decision-makers. Hence, we argue that as long as the ethical analysis and its conclusions are presented transparently, disclosing how well-founded the conclusions are and/or whether there are alternative conclusions, the HTA-agencies should not avoid taking the ethical analysis as close as possible to a definite conclusion.

From U Chicago: How to Achieve Health Equity

N Engl J Med. 2014 Dec 11;371(24):2331-2332.

How to Achieve Health Equity.

Chin MH1.

Author information

• 1From the Section of General Internal Medicine, the Department of Medicine, Chicago Center for Diabetes Translation Research, the MacLean Center for Clinical Medical Ethics, the Robert Wood Johnson Foundation (RWJF) Finding Answers: Disparities Research for Change, and the RWJF Reducing Health Care Disparities through Payment and Delivery System Reform, University of Chicago, Chicago.

Abstract

Two studies in this issue of the Journal indicate that differences in how we deliver care to patients in various racial or ethnic groups have narrowed nationally, but health outcomes remain worse for blacks than for whites. Trivedi et al.1 studied hospitalizations of patients for acute myocardial infarction, heart failure, and pneumonia from 2005 through 2010. They found that racial or ethnic differences decreased for processes of care (i.e., what clinicians do for patients), such as evidence-based prescribing of medications and the administration of flu shots. In contrast, Ayanian et al.2discovered that black enrollees in Medicare Advantage health plans . . .

Betty Chung: Next Generation Sequencing and Personalized Genomic Patient Care (via labmedicineblog.com)

Next Generation Sequencing and Personalized Genomic Patient Care

(Scroll down, 2nd post down)

West J Emerg Med. 2014 Nov;15(7):728-31. doi: 10.5811/westjem.2014.9.24011. Epub 2014 Sep 26.

Ebola virus disease: essential public health principles for clinicians.

Koenig KL1, Majestic C1, Burns MJ2.

Author information

• 1University of California at Irvine, Center for Disaster Medical Sciences and Department of Emergency Medicine, Orange, California.
• 2University of California at Irvine, Department of Emergency Medicine and Department of Medicine, Division of Infectious Diseases, Orange, California.

Abstract

Ebola Virus Disease (EVD) has become a public health emergency of international concern. The World Health Organization and Centers for Disease Control and Prevention have developed guidance to educate and inform healthcare workers and travelers worldwide. Symptoms of EVD include abrupt onset of fever, myalgias, and headache in the early phase, followed by vomiting, diarrhea and possible progression to hemorrhagic rash, life-threatening bleeding, and multi-organ failure in the later phase. The disease is not transmitted via airborne spread like influenza, but rather from person-to-person, or animal to person, via direct contact with bodily fluids or blood. It is crucial that emergency physicians be educated on disease presentation and how to generate a timely and accurate differential diagnosis that includes exotic diseases in the appropriate patient population. A patient should be evaluated for EVD when both suggestive symptoms, including unexplained hemorrhage, AND risk factors within 3 weeks prior, such as travel to an endemic area, direct handling of animals from outbreak areas, or ingestion of fruit or other uncooked foods contaminated with bat feces containing the virus are present. There are experimental therapies for treatment of EVD virus; however the mainstay of therapy is supportive care. Emergency department personnel on the frontlines must be prepared to rapidly identify and isolate febrile travelers if indicated. All healthcare workers involved in care of EVD patients should wear personal protective equipment. Despite the intense media focus on EVD rather than other threats, emergency physicians must master and follow essential public health principles for management of all infectious diseases. This includes not only identification and treatment of individuals, but also protection of healthcare workers and prevention of spread, keeping in mind the possibility of other more common disease processes.

J Trauma Acute Care Surg. 2014 Nov;77(5):749-756.

Establishing components of high-quality injury care: Focus groups with patients and patient families.

Gagliardi AR1, Boyd JM, Evans D, Gerein L, Nathens A, Stelfox HT.

Author information

• 1From the University Health Network (A.R.G.); and Sunnybrook Health Sciences Centre (A.N.), Toronto, Ontario; Department of Community Health Sciences (J.M.B., H.T.S.), and Institute for Public Health (H.T.S.), University of Calgary; and Departments of Medicine (H.T.S.), and Critical Care Medicine (H.T.S.), University of Calgary and Alberta Health Services, Calgary Zone, Calgary, Alberta; Vancouver General Hospital (D.E.), Vancouver; and Interior Health Authority (L.G.), Kelowna, British Columbia, Canada.

Abstract

BACKGROUND:

Each year, injuries affect 700 million people worldwide, more than 5 million people die of injuries, and 68,000 survivors remain permanently impaired. Half of all critically injured patients do not receive recommended care, and medical errors are common. Little is known about the aspects of injury care that are important to patients and their families. The purpose of this study was to explore the views of patients and families affected by injury on desired components of injury care in the hospital setting.

METHODS:

With the use of a grounded theory approach, this qualitative study involved focus groups with injured patients, family members of survivors, and bereaved family members from four Canadian trauma (injury care) centers.

RESULTS:

Thirty-eight participants included injured patients (n = 16), family members of survivors (n = 13), and bereaved family members (n = 9) across four trauma (injury care) centers in different jurisdictions. Participants articulated numerous themes reflecting important components of injury care organized across three domains as follows: clinical care (staff availability, professionalism, physical comfort, adverse events), holistic care (patient wellness, respect for patient and family, family access to patient, family wellness, hospital facilities, supportive care), and communication and information (among staff, with or from staff, content, delivery, and timing). Bereaved family members commented on decision making and end-of-life processes. Subthemes were revealed in most of these themes. Trends by site or type of participant were not identified.

CONCLUSION:

The framework of patient- and family-derived components of quality injury care could be used by health care managers and policymakers to guide quality improvement efforts. Further research is needed to extend and validate these components among injured patients and families elsewhere. Translating these components into quality indicators and blending those with measures that reflect a provider perspective may offer a comprehensive means of assessing injury care.

Neurosci Res. 2014 Nov 18. pii: S0168-0102(14)00290-9. doi: 10.1016/j.neures.2014.10.020. [Epub ahead of print]

The neural bases for valuing social equality.

Aoki R1, Yomogida Y2, Matsumoto K2.

Author information

• 1Tamagawa University Brain Science Institute, 6-1-1, Tamagawa-gakuen, Machida, Tokyo 194-8610, Japan; Japan Society for the Promotion of Science, 5-3-1, Koji-machi, Chiyoda-ku, Tokyo 102-8471, Japan; Division of the Humanities and Social Sciences, California Institute of Technology, Pasadena, CA 91125, United States. Electronic address: qqqqaokiq@yahoo.co.jp.
• 2Tamagawa University Brain Science Institute, 6-1-1, Tamagawa-gakuen, Machida, Tokyo 194-8610, Japan.

Abstract

The neural basis of how humans value and pursue social equality has become a major topic in social neuroscience research. Although recent studies have identified a set of brain regions and possible mechanisms that are involved in the neural processing of equality of outcome between individuals, how the human brain processes equality of opportunity remains unknown. In this review article, first we describe the importance of the distinction between equality of outcome and equality of opportunity, which has been emphasized in philosophy and economics. Next, we discuss possible approaches for empirical characterization of human valuation of equality of opportunity vs. equality of outcome. Understanding how these two concepts are distinct and interact with each other may provide a better explanation of complex human behaviors concerning fairness and social equality.

Front Psychol. 2014 Nov 18;5:1336. doi: 10.3389/fpsyg.2014.01336. eCollection 2014.

The good, the bad, and the timely: how temporal order and moral judgment influence causal selection.

Reuter K1, Kirfel L2, van Riel R3, Barlassina L4.

Author information

• 1Department of Philosophy, Institute of Philosophy II, Ruhr University Bochum Bochum, Germany.
• 2Department of Philosophy, King's College London London, UK.
• 3Faculty of Humanities, Institute for Philosophy, University of Duisburg-Essen Essen, Germany.
• 4Department of Philosophy, University of Sheffield Sheffield, UK.

Abstract

Causal selection is the cognitive process through which one or more elements in a complex causal structure are singled out as actual causes of a certain effect. In this paper, we report on an experiment in which we investigated the role of moral and temporal factors in causal selection. Our results are as follows. First, when presented with a temporal chain in which two human agents perform the same action one after the other, subjects tend to judge the later agent to be the actual cause. Second, the impact of temporal location on causal selection is almost canceled out if the later agent did not violate a norm while the former did. We argue that this is due to the impact that judgments of norm violation have on causal selection-even if the violated norm has nothing to do with the obtaining effect. Third, moral judgments about the effect influence causal selection even in the case in which agents could not have foreseen the effect and did not intend to bring it about. We discuss our findings in connection to recent theories of the role of moral judgment in causal reasoning, on the one hand, and to probabilistic models of temporal location, on the other.

J Med Humanit. 2014 Dec 9. [Epub ahead of print]

Wonder and the Patient.

Evans HM1.

Author information

• 1Centre for Medical Humanities, Durham University, Durham, UK, h.m.evans@durham.ac.uk.

Abstract

Is it possible to distinguish, as sociologist Arthur Frank proposes, an 'ideal of wonder' within which ill persons could recover some of their former sense of life and flourishing, even within the constraints of ill-health? Beyond this, are there more general benefits in terms of health and well-being that could accrue from cultivating an openness to wonder? In this paper I will first outline and defend a notion of wonder that gives philosophical support to Frank's proposal, noting why thinking about medical treatment may readily provoke a sense of wonder. Second I will however limit the normative force of such an 'ideal of wonder' noting its demands and some of the challenges facing it. The paper goes on, third, to conjecture wider benefits within and beyond the clinical encounter arising from being mindful of the wonder of embodied human agency. Fourth the paper will consider alignments between the foregoing analysis and some theoretical commitments in recent work in health geography. Finally I will briefly reconsider the notion of the body-as-territory, and the role of the imagination in bringing it under wonder's gaze.

Case Rep Oncol. 2014 Oct 23;7(3):700-710. eCollection 2014.

The Long-Term Outcomes of Induction Chemoradiotherapy Followed by Surgery for Locally Advanced Non-Small Cell Lung Cancer.

Uramoto H1, Akiyama H1, Nakajima Y1, Kinoshita H1, Inoue T1, Kurimoto F2, Nishimura Y3, Saito Y4, Sakai H2, Kobayashi K5.

Author information

• 1Division of Thoracic Surgery, Saitama Cancer Center, Saitama, Hidaka, Japan.
• 2Division of Thoracic Oncology, Saitama Cancer Center, Saitama, Hidaka, Japan.
• 3Department of Pathology, Saitama Cancer Center, Saitama, Hidaka, Japan.
• 4Department of Radiation Oncology, Saitama Cancer Center, Saitama, Hidaka, Japan.
• 5Department of Respiratory Medicine, Saitama International Medical Center, Hidaka, Japan.

Abstract

BACKGROUND:

Although the concept of induction therapy followed by surgical resection for locally advanced non-small cell lung cancer (LA-NSCLC) has found general acceptance, the appropriate indications and the strategy for this treatment are still controversial.

METHODS:

From 2000 through 2008, 36 patients received concurrent chemoradiotherapy followed by surgery. We retrospectively reviewed these cases, analyzed the outcomes and examined the prognosis.

RESULTS:

The median radiation dose given was 60 Gy. Chemotherapy included a platinum agent in all cases; cisplatin-based chemotherapy was administered to 9 cases, and a carboplatin-based chemotherapy regimen was administered to 27. A complete resection was performed in 94% of the patients. Seventeen (47.2%) patients exhibited a complete pathological response, and downstaging was induced in 26 (72%) cases. The morbidity and 30-day mortality rates were 11.1 and 0%, respectively. The 5-year overall survival rate in the patients with complete resection (n = 33) was 83.3%.

CONCLUSIONS:

Induction chemoradiotherapy followed by surgery for LA-NSCLC provided a favorable prognosis for selected patients. A complete pathological response was found in about half of cases. This strategy is feasible and was associated with low morbidity and high resectability rates, suggesting that it contributed to improving the treatment results.

World J Clin Oncol. 2014 Dec 10;5(5):845-857.

Palliative radiotherapy for bone metastases from lung cancer: Evidence-based medicine?

Fairchild A.

Author information

• Alysa Fairchild, Department of Radiation Oncology, Cross Cancer Institute, Edmonton, AB T6G 1Z2 Alberta, Canada.

Abstract

To review current recommendations for palliative radiotherapy for bone metastases secondary to lung cancer, and to analyze surveys to examine whether global practice is evidence-based, English language publications related to best practice palliative external beam radiotherapy (EBRT) for bone metastases (BM) from lung cancer were sought via literature search (2003-2013). Additional clinical practice guidelines and consensus documents were obtained from the online Standards and Guidelines Evidence Directory. Eligible survey studies contained hypothetical case scenarios which required participants to declare whether or not they would administer palliative EBRT and if so, to specify what dose fractionation schedule they would use. There is no convincing evidence of differential outcomes based on histology or for spine vs non-spine uncomplicated BM. For uncomplicated BM, 8Gy/1 is widely recommended as current best practice; this schedule would be used by up to 39.6% of respondents to treat a painful spinal lesion. Either 8Gy/1 or 20Gy/5 could be considered standard palliative RT for BM-related neuropathic pain; 0%-13.2% would use the former and 5.8%-52.8% of respondents the latter (range 3Gy/1-45Gy/18). A multifraction schedule is the approach of choice for irradiation of impending pathologic fracture or spinal cord compression and 54% would use either 20Gy/5 or 30Gy/10. Survey results regarding management of complicated and uncomplicated BM secondary to lung cancer continue to show a large discrepancy between published literature and patterns of practice.

5 things we almost always get wrong about aging

Brian Alexander

Aging happens. Eventually it catches up with all of us. How soon it does can depend on genes, social life, economics, and a dozen other factors.

But there are plenty of things we get wrong about aging: that we are doomed to becoming crotchety, grumpy, sexless incompetents. Science has dispelled a number of these, including the biggest myth of all: that we have no say in how well we age.   

Another Illinois sugary drink tax proposal: "It's a big idea and it takes some time for people to wrap their arms around it."

Illinois Legislature Attempts Sugary Drink Tax Again

By SEAN CRAWFORD

Another attempt to tax sugary drinks is expected in the upcoming Illinois legislative session. Drinks like soda and even some juice have been linked to obesity, diabetes and other problems. 

Elissa Bassler, with the Illinois Public Health Institute, says a plan that came up in the past year would have imposed a penny per ounce tax on the drinks.  She says the new measure will be similar:

"It's a big idea and it takes some time for people to wrap their arms around it."

How the Obesity Epidemic Drains Medicare and Medicaid

How the Obesity Epidemic Drains Medicare and Medicaid



BY ERIC PIANIN,

The Fiscal Times
December 15, 2014
Federal and state officials are growing alarmed over the mounting share of government-provided health care going toward treating obesity as the number of overweight Americans continues to rise.

In the past half century, the share of obese adults has increased from just one in eight in 1960 to over one in three today. More than a third of all adults and 17 percent of young people are obese, according to some experts. Many overweight people are plagued by related health problems, such as type 2 diabetes, coronary heart disease, stroke, hypertension, arthritis and cancer.


 - See more at: http://www.thefiscaltimes.com/2014/12/15/How-Obesity-Epidemic-Drains-Medicare-and-Medicaid#sthash.7PnHKdfL.dpuf

Annu Rev Public Health. 2014 Dec 10. [Epub ahead of print]

Trade Policy and Public Health.

Friel S1, Hattersley L, Townsend R.

Author information

• 1Regulatory Institutions Network, and Menzies Centre for Health Policy, The Australian National University, ACT 0200, Australia; email: Sharon.friel@anu.edu.au.

Abstract

Twenty-first-century trade policy is complex and affects society and population health in direct and indirect ways. Without doubt, trade policyinfluences the distribution of power, money, and resources between and within countries, which in turn affects the natural environment; people's daily living conditions; and the local availability, quality, affordability, and desirability of products (e.g., food, tobacco, alcohol, and health care); it also affects individuals' enjoyment of the highest attainable standard of health. In this article, we provide an overview of the modern global trade environment, illustrate the pathways between trade and health, and explore the emerging twenty-first-century trade policy landscape and its implications for health and health equity. We conclude with a call for more interdisciplinary research that embraces complexity theory and systems science as well as the political economy of health and that includes monitoring and evaluation of the impact of trade agreements on health. Expected final online publication date for the Annual Review of Public Health Volume 36 is March 18, 2015. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates.

N Engl J Med. 2014 Dec 11;371(24):2298-2308.

Quality and Equity of Care in U.S. Hospitals.

Trivedi AN1, Nsa W, Hausmann LR, Lee JS, Ma A, Bratzler DW, Mor MK, Baus K, Larbi F, Fine MJ.

Author information

• 1From the Providence Veterans Affairs (VA) Medical Center and the Department of Health Services, Policy, and Practice, Brown University School of Public Health - both in Providence, RI (A.N.T.); Oklahoma Foundation for Medical Quality (W.N., A.M.) and the Colleges of Medicine and Public Health, University of Oklahoma Health Sciences Center (D.W.B.) - both in Oklahoma City; VA Pittsburgh Healthcare System, VA Center for Health Equity Research and Promotion (L.R.M.H., M.K.M., M.J.F.), Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine (L.R.M.H, J.S.L., M.J.F.), and the Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh (M.K.M) - all in Pittsburgh; and the Centers for Medicare and Medicaid Services, Baltimore (K.B., F.L.).

Abstract

Background 

Nearly every U.S. hospital publicly reports its performance on quality measures for patients who are hospitalized for acute myocardial infarction, heart failure, or pneumonia. Because performance rates are not reported according to race or ethnic group, it is unclear whether improvements in equity of care have accompanied aggregate improvements in health care quality over time. 

Methods 

We assessed performance rates for quality measures covering three conditions (six measures for acute myocardial infarction, four for heart failure, and seven for pneumonia). These rates, adjusted for patient- and hospital-level covariates, were compared among non-Hispanic white, non-Hispanic black, and Hispanic patients who received care between 2005 and 2010 in acute care hospitals throughout the United States. 

Results 

Adjusted performance rates for the 17 quality measures improved by 3.4 to 57.6 percentage points between 2005 and 2010 for white, black, and Hispanic adults (P<0.001 for all comparisons). In 2005, as compared with adjusted performance rates for white patients, adjusted performance rates were more than 5 percentage points lower for black patients on 3 measures (range of differences, 12.3 to 14.2) and for Hispanic patients on 6 measures (5.6 to 14.5). Gaps decreased significantly on all 9 of these measures between 2005 and 2010, with adjusted changes for differences between white patients and black patients ranging from -8.5 to -11.8 percentage points and from -6.2 to -15.1 percentage points for differences between white patients and Hispanic patients. Decreasing differences according to race or ethnic group were attributable to more equitable care for white patients and minority patients treated in the same hospital, as well as to greater performance improvements among hospitals that disproportionately serve minority patients. 

Conclusions 

Improved performance on quality measures for white, black, and Hispanic adults hospitalized for acute myocardial infarction, heart failure, or pneumonia was accompanied by increased racial and ethnic equity in performance rates both within and among U.S. hospitals. 

(Funded by the Centers for Medicare and Medicaid Services and the Veterans Affairs Health Services Research and Development Career Development Program.).

Why not integrate ethics in Health Technology Assessment: identification and assessment of the reasons

GMS Health Technol Assess. 2014 Nov 26;10:Doc04. eCollection 2014.

Why not integrate ethics in HTA: identification and assessment of the reasons.

Hofmann B.

Author information

• University College of Gjøvik, Gjøvik, Norway ; Centre for Medical Ethics, University of Oslo, Norway.

Abstract

From the conception of HTA in the 1970s it has been argued that addressing ethical issues is an element of HTA, and many methods for integrating ethics in HTA have become available. However, despite almost 40 years with repeated intentions, only few HTA reports include ethical analysis. Why is this so? How come, ethics is a constituent part of HTA, there are many methods available, but ethics is rarely part of practical HTA work? This is the key question of this article and several reasons why ethics is not a part of HTA are identified. A) Ethicists are professional strangers in HTA. B) A common agreed methodology for integrating ethics is lacking. Ethics methodology appears to be C) deficient, D) insufficient, or E) unsuitable. F) Integrating ethics in HTA is neither efficient nor needed for successful HTA. G) Most moral issues are general, and are not specific to a given technology. H) All relevant ethical issues can be handled within other frameworks, e.g., within economics. I) Ethics can undermine or burst the foundation of HTA. Hence, there are many reasons why ethics is not an integrated part of HTA so many years after identifying ethics as constitutive to HTA. These reasons may all explain why it is so, but on closer scrutiny, they do not work as compelling arguments for not addressingethical issues in HTA. Hence, the identified reasons may work well as explanations, but not as justifications. In order to move on from a situation of failure we can: Exclude ethics from definitions of HTA, and as a consequence, establish a separate kind of evaluation (Health Technology Evaluation - HTE). Take the existing definition seriously and actually integrate ethics in the performance of HTA practice. Amend, expand or change HTA so that ethics is more genuinely incorporated. Which of these options to choose is open for discussion, but we need to move away from a situation where we have a definition of HTA which does not correspond with HTA practice.

Respir Med. 2014 Nov 21. pii: S0954-6111(14)00392-8. doi: 10.1016/j.rmed.2014.11.004. [Epub ahead of print]

Molecular characteristics of non-small cell lung cancer with reduced CHFR expression in The Cancer Genome Atlas (TCGA) project.

Brodie SA1, Li G2, Brandes JC3.

Author information

• 1Atlanta VAMC, USA; Department of Hematology and Medical Oncology, Emory University, USA; Winship Cancer Institute, Emory University, USA.
• 2Department of Hematology and Medical Oncology, Emory University, USA; Winship Cancer Institute, Emory University, USA.
• 3Atlanta VAMC, USA; Department of Hematology and Medical Oncology, Emory University, USA; Winship Cancer Institute, Emory University, USA. Electronic address: johann.brandes@emory.edu.

Abstract

BACKGROUND:

CHFR expression has previously been established as a powerful predictor for response to taxane based first-line chemotherapy in non-small cell lung cancer. It is currently unknown however, if reduced CHFR expression correlates with certain molecular subtypes of lung cancer.

PURPOSE:

In order to determine which patients may benefit from CHFR biomarker testing we conducted the present study to characterize clinical and molecular characteristics of patients with reduced vs. high CHFR expression.

APPROACH:

We utilized the extensive molecular and clinical data of the most recent adeno- and squamous cell carcinoma datasets from TheCancer Genome Atlas (TCGA) project. CHFR expression, analyzed by RNA-seq, was classified as high vs. low based on the median CHFR expression level and correlated with the presence or absence of lung cancer specific mutations (EGFR, KRAS, ALK, MET, ERBB2, TP53, STK11, ROS1, RET, NF1, Pik3CA for adenocarcinomas and FGFR1, FGFR2, FGFR3, TP53, STK11, EGFR for squamous cell carcinomas).

RESULTS:

Reduced CHFR expression was associated with EGFR exon19/21 mutations in adenocarcinoma OR 0.23 (95%CI: 0.06-0.88) and male gender in squamous cell carcinoma (OR 0.46 (95%CI 0.23-0.92), p = 0.02).

Nurs Ethics. 2014 Dec 8. pii: 0969733014557119. [Epub ahead of print]

Older people's experiences of their free will in nursing homes.

Tuominen L1, Leino-Kilpi H2, Suhonen R3.

Author information

• 1Hospital District of Helsinki and Uusimaa, Finland; University of Turku, Finland leena.k.tuominen@hus.fi.
• 2University of Turku, Finland; Turku University Hospital, Finland.
• 3University of Turku, Finland.

Abstract

BACKGROUND:

Older people in institutional care should be allowed to live a meaningful life in a home-like environment consistent with their own free will. Research on actualisation of older people's own free will in nursing home context is scarce.

OBJECTIVES:

The purpose of this study was to describe older people's experiences of free will, its actualisation, promoters and barriers in nursing homes to improve the ethical quality of care.

RESEARCH DESIGN:

Fifteen cognitively intact older people over 65 years in four nursing homes in Southern Finland were interviewed. Giorgi's phenomenological method expanded by Perttula was used to analyse the data.

ETHICAL CONSIDERATIONS:

Chief administrators of each nursing home gave permission to conduct the study. Informants' written informed consent was gained.

FINDINGS:

Older people described free will as action consistent with their own mind, opportunity to determine own personal matters and holding on to their rights. Own free will was actualised in having control of bedtime, dressing, privacy and social life with relatives. Own free will was not actualised in receiving help when needed, having an impact on meals, hygiene, free movement, meaningful action and social life. Promoters included older people's attitudes, behaviour, health, physical functioning as well as nurses' ethical conduct. Barriers were nurses' unethical attitudes, institution rules, distracting behaviour of other residents, older people's attitudes, physical frailty and dependency.

DISCUSSION:

Promoting factors of the actualisation of own free will need to be encouraged. Barriers can be influenced by educating nursing staff in client-orientated approach and influencing attitudes of both nurses and older people.

CONCLUSION:

Results may benefit ethical education and promote the ethical quality of older people's care practice and management.