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Frontiers in Psychology 2022The literature suggests that the moral sense is based on innate abilities. In fact, it has been shown that children show the capacity for moral discernment, emotions and...
The literature suggests that the moral sense is based on innate abilities. In fact, it has been shown that children show the capacity for moral discernment, emotions and prosocial motivations from an early age. However, the moral sense is a complex construct of an evolutionary and social nature that evolves under the influence of interpersonal relationships. The emergence and development of moral sense is a challenge that has prompted many research studies with the aim of achieving a clear comprehension of moral development. However, success has been scarce, and studies relevant to this subject are limited. Thus, a systematic review of studies relevant to this topic was conducted to clearly establish how moral sense emerges and develops. An Ovid search was conducted to retrieve relevant items for this systematic review. The databases that were electronically visited are Cross-reference, Google Scholar and PubMed. Strict inclusion and exclusion criteria were imposed on the retrieved items to retain only relevant resources. Twenty-six studies were found valid for inclusion in this systematic review. The results of these studies were presented differently: In order to effectively analyze the selected papers and bring out the results more clearly, a categorization of the approaches adopted in the studies was carried out. The approaches identified were: "Natural Moral Sense," "Social Relationships and Moral Development," and "Environmental Factors and Moral Development." The evidence that emerged from the analysis of the papers was collected to produce a general basic model that explains moral development while also serving as a link between the various studies. First, moral sense is found to be innate in humans; individuals can naturally respond morally to various dilemmas. As seen among children and young infants, moral sense naturally exists. Second, it can be socially nurtured through social interactions and exposure to various environmental factors. Various research studies were reviewed in this systematic review to obtain a consensus on how moral sense emerges and develops. From the systematic review, the moral sense is found to be innate. However, moral development is fostered by social interactions and environmental factors.
PubMed: 35615195
DOI: 10.3389/fpsyg.2022.887537 -
BMC Public Health Sep 2018While critically important, child sexual violence (CSV) research poses numerous ethical and safety challenges. Recently, the studies dedicated to understanding and... (Review)
Review
BACKGROUND
While critically important, child sexual violence (CSV) research poses numerous ethical and safety challenges. Recently, the studies dedicated to understanding and addressing CSV in India have been on the rise, but no published ethical guidelines to direct such research currently exist. To help inform ethical and safety recommendations for the design, conduct, and reporting of future CSV research in India and similar settings, we systematically reviewed the ethics and safety practices reported in recent Indian CSV literature.
METHODS
A multi-tiered approach was used to understand current ethical practices and gaps: 1) systematic review of Indian CSV studies published over the past decade, 2) examination of existing guidelines on related topics to develop an ethical framework, 3) development of an ethics checklist based on the recommendations from the surveyed guidelines, and 4) application of the checklist to each of the reviewed studies.
RESULT
Our search yielded 51 eligible studies. From each, data from 6 major thematic areas was extracted: informed consent, confidentiality, selection, training, and protection of study team members, validity of CSV measurement methods, measures to minimize participant harm, and participant compensation. Several gaps were noted: only two-thirds reported approval by ethics committees, obtaining informed consent, and assured participants of confidentiality. Only 25% (13/51) reported assessing ongoing CSV risk and providing necessary support services, none noted whether ongoing CSV was reported to authorities (required by Indian law), and none reported safeguards to protect staff from the effects of conducting CSV research. Further, 43% (22/51) limited surveillance of CSV to one form of abuse and/or used a "loaded term," increasing the potential for underreporting.
CONCLUSIONS
Through enhancing understanding of current ethical practices and gaps in CSV research in India, this systematic review informs reporting protocols and future guidelines for CSV research in India and other similar settings.
Topics: Child; Child Abuse, Sexual; Confidentiality; Ethics, Research; Humans; India; Informed Consent
PubMed: 30261867
DOI: 10.1186/s12889-018-6036-y -
Journal of Pain and Symptom Management Apr 2024The provision of person-centered dignity-conserving care is central to palliative care. It is important to reevaluate current methods of assessing dignity as the concept... (Review)
Review
CONTEXT
The provision of person-centered dignity-conserving care is central to palliative care. It is important to reevaluate current methods of assessing dignity as the concept of dignity is multifaceted.
OBJECTIVES
The aim of this study is to understand the tools which are used to assess a patient's dignity and the elements of dignity evaluated in these tools.
METHODS
Two independent and concurrent Systematic Evidence-Based Approach guided systematic scoping reviews (SSR in SEBA) on existing dignity assessment tools and on accounts of assessments of dignity were carried out. The SSR in SEBA on dignity assessment tools involving PubMed, Embase, PsycINFO, Cochrane Database of Systematic Reviews, Scopus, and CINAHL databases saw 22 full-text articles included from the 645 articles reviewed. The SSR in SEBA on accounts of assessments of dignity featured in the PubMed database identified 102 full-text articles which saw 46 articles included.
RESULTS
The domains identified were factors affecting patients' definition of dignity; elements of dignity-conserving care; and components of effective tools.
CONCLUSION
Current accounts to assess dignity and assessment tools fail to capture shifting self-concepts of dignity holistically. A portfolio-like appraisal of dignity is proposed to achieve assessments that are timely, longitudinal, and patient-specific. Portfolio-based assessments by members of the multidisciplinary team will better direct timely evaluations of relevant aspects of changing concepts of dignity, without losing the patient's holistic perception of dignity.
Topics: Humans; Palliative Care; Personhood; Respect; Systematic Reviews as Topic; Terminal Care
PubMed: 38092260
DOI: 10.1016/j.jpainsymman.2023.12.008 -
The Cochrane Database of Systematic... Oct 2017Fibromyalgia (FM) is a clinically well-defined chronic condition of unknown aetiology characterised by chronic widespread pain that often co-exists with sleep problems... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Fibromyalgia (FM) is a clinically well-defined chronic condition of unknown aetiology characterised by chronic widespread pain that often co-exists with sleep problems and fatigue. People often report high disability levels and poor health-related quality of life (HRQoL). Drug therapy focuses on reducing key symptoms and disability, and improving HRQoL. Anticonvulsants (antiepileptic drugs) are drugs frequently used for the treatment of chronic pain syndromes.
OBJECTIVES
To assess the benefits and harms of anticonvulsants for treating FM symptoms.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 8, 2013), MEDLINE (1966 to August 2013), PsycINFO (1966 to August 2013), SCOPUS (1980 to August 2013) and the reference lists of reviewed articles for published studies and www.clinicaltrials.gov (to August 2013) for unpublished trials.
SELECTION CRITERIA
We selected randomised controlled trials of any formulation of anticonvulsants used for the treatment of people with FM of any age.
DATA COLLECTION AND ANALYSIS
Two review authors independently extracted the data of all included studies and assessed the risks of bias of the studies. We resolved discrepancies by discussion.
MAIN RESULTS
We included eight studies: five with pregabalin and one study each with gabapentin, lacosamide and levetiracetam. A total of 2480 people were included into anticonvulsants groups and 1099 people in placebo groups. The median therapy phase of the studies was 13 weeks. The amount and quality of evidence were insufficient to draw definite conclusions on the efficacy and safety of gabapentin, lacosamide and levetiracetam in FM. The amount and quality of evidence was sufficient to draw definite conclusions on the efficacy and safety of pregabalin in FM. Therefore, we focused on our interpretation of the evidence for pregabalin due to our greater certainty about its effects and its greater relevance to clinical practice. All pregabalin studies had a low risk of bias. Reporting a 50% or greater reduction in pain was more frequent with pregabalin use than with a placebo (risk ratio (RR) 1.59; 95% confidence interval (CI) 1.33 to 1.90; number needed to treat for an additional beneficial outcome (NNTB) 12; 95% CI 9 to 21). The number of people who reported being 'much' or 'very much' improved was higher with pregabalin than with placebo (RR 1.38; 95% CI 1.23 to 1.55; NNTB 9; 95% CI 7 to 15). Pregabalin did not substantially reduce fatigue (SMD -0.17; 95% CI -0.25 to -0.09; 2.7% absolute improvement on a 1 to 50 scale) compared with placebo. Pregabalin had a small benefit over placebo in reducing sleep problems by 6.2% fewer points on a scale of 0 to 100 (standardised mean difference (SMD) -0.35; 95% CI -0.43 to -0.27). The dropout rate due to adverse events was higher with pregabalin use than with placebo use (RR 1.68; 95% CI 1.36 to 2.07; number needed to treat for an additional harmful outcome (NNTH) 13; 95% CI 9 to 23). There was no significant difference in serious adverse events between pregabalin and placebo use (RR 1.03; 95% CI 0.71 to 1.49). Dizziness was reported as an adverse event more frequently with pregabalin use than with placebo use (RR 3.77; 95% CI 3.06 to 4.63; NNTH 4; 95% CI 3 to 5).
AUTHORS' CONCLUSIONS
The anticonvulsant, pregabalin, demonstrated a small benefit over placebo in reducing pain and sleep problems. Pregabalin use was shown not to substantially reduce fatigue compared with placebo. Study dropout rates due to adverse events were higher with pregabalin use compared with placebo. Dizziness was a particularly frequent adverse event seen with pregabalin use. At the time of writing this review, pregabalin is the only anticonvulsant drug approved for treating FM in the US and in 25 other non-European countries. However, pregabalin has not been approved for treating FM in Europe. The amount and quality of evidence were insufficient to draw definite conclusions on the efficacy and safety of gabapentin, lacosamide and levetiracetam in FM.
Topics: Acetamides; Amines; Anticonvulsants; Conflict of Interest; Cyclohexanecarboxylic Acids; Fibromyalgia; Gabapentin; Humans; Lacosamide; Levetiracetam; Piracetam; Pregabalin; gamma-Aminobutyric Acid
PubMed: 28991361
DOI: 10.1002/14651858.CD010782.pub2 -
Nursing Ethics Mar 2018The ethics and value bases in healthcare are widely acknowledged. There is a need to improve and raise awareness of ethics in complex systems and in line with competing... (Review)
Review
BACKGROUND
The ethics and value bases in healthcare are widely acknowledged. There is a need to improve and raise awareness of ethics in complex systems and in line with competing needs, different stakeholders and patients' rights. Evidence-based strategies and interventions for the development of procedures and practice have been used to improve care and services. However, it is not known whether and to what extent ethics can be developed using interventions.
OBJECTIVES
To examine ethics interventions conducted on healthcare professionals and healthcare students to achieve ethics-related outcomes.
RESEARCH DESIGN
A systematic review.
METHODS
Five electronic databases were searched: CINAHL, the Cochrane Library, Philosopher's Index, PubMed and PsycINFO. We searched for published articles written in English without a time limit using the keywords: ethic* OR moral* AND intervention OR program OR pre-post OR quasi-experimental OR rct OR experimental AND nurse OR nursing OR health care. In the four-phased retrieval process, 23 full texts out of 4675 citations were included in the review. Data were analysed using conventional content analysis. Ethical consideration: This systematic review was conducted following good scientific practice in every phase.
FINDINGS
It is possible to affect the ethics of healthcare practices through professionals and students. All the interventions were educational in type. Many of the interventions were related to the ethical or moral sensitivity of the professionals, such as moral courage and empowerment. A few of the interventions focused on identifying ethical problems or research ethics.
CONCLUSION
Patient-related outcomes followed by organisational outcomes can be improved by ethics interventions targeting professionals. Such outcomes are promising in developing ethical safety for healthcare patients and professionals.
Topics: Ethics, Medical; Health Personnel; Humans; Randomized Controlled Trials as Topic; Students, Health Occupations
PubMed: 28393607
DOI: 10.1177/0969733017700237 -
European Journal of Human Genetics :... Dec 2022Direct-to-consumer genetic testing (DTC-GT) is becoming increasingly widespread. The aim of this research was to systematically review the literature published on... (Review)
Review
Direct-to-consumer genetic testing (DTC-GT) is becoming increasingly widespread. The aim of this research was to systematically review the literature published on healthcare professionals' knowledge and views about DTC-GT, as an update to a 2012 systematic review. The secondary aim was to assess the knowledge and views of healthcare professionals on the ethical and legal issues pertaining to DTC-GT. A systematic search was performed to identify all relevant studies that have been conducted since 2012. Studies fulfilled the inclusion criteria if they were primary research papers conducted on healthcare professionals about their knowledge and views on health-related DTC-GT. PubMed, Embase, CINAHL, PsycINFO and Medline databases were searched from 2012 to May 2021. Title and abstract were screened, and full texts were reviewed by two study authors independently. New papers included were appraised and data were extracted on study characteristics, knowledge and views on DTC-GT, and ethical and legal issues. A narrative synthesis was conducted. Nineteen new papers were included, along with eight papers from the previous review. There was considerable variation in study participants with differing views, awareness levels, and levels of knowledge about DTC-GT. Genetic counsellors and clinical geneticists generally had more concerns, experience, and knowledge regarding DTC-GT. Ten ethical concerns and four legal concerns were identified. Healthcare professionals' knowledge and experience of DTC-GT, including awareness of DTC-GT ethical and legal concerns, have only minimally improved since the previous review. This emphasises the need for further medical learning opportunities to improve the gaps in knowledge amongst healthcare professionals about DTC-GT.
Topics: Humans; Delivery of Health Care; Direct-To-Consumer Screening and Testing; Genetic Testing; Health Personnel; Morals
PubMed: 36220915
DOI: 10.1038/s41431-022-01205-8 -
A Systematic Review and Meta-Analysis of the Association Between Perceived Injustice and Depression.The Journal of Pain Jun 2021Perceived injustice is increasingly recognized as a risk factor for problematic recovery, with a growing body of evidence documenting its association with heightened... (Meta-Analysis)
Meta-Analysis
Perceived injustice is increasingly recognized as a risk factor for problematic recovery, with a growing body of evidence documenting its association with heightened pain, disability, medication use, anger and post-traumatic stress. The aim of this paper was to systematically review and critically appraise the association between perceived injustice and depressive symptomatology across a wide range of medical and mental health populations, including acute and chronic pain samples. A search of published, English language studies in the PubMed, EMBASE, CINAHL, and PsycINFO databases from 1990 to June 2020 was performed. Thirty-three studies met inclusion criteria with a total sample of 5,425 individuals (61% female), primarily with acute injury or chronic pain. Results indicated a moderate to strong positive association between perceived injustice and depressive symptomatology (meta-analysis pooled effect of r = .57, 95% confidence interval [.55, .58], P< .001). A narrative synthesis of regression models indicated standardized beta coefficients between .19 and .66, with perceived injustice consistently contributing significant unique variance to the prediction of depression in final regression equations. Selection bias and response bias were common limitations in the studies. The clinical implications of an association between injustice and depression in acute and chronic pain are discussed. PROSPERO: CRD42019143465. PERSPECTIVE: This review demonstrates that in acute injury and chronic pain samples, perceived injustice is associated with depression. These findings could help clinicians in the field of pain and rehabilitation identify who may be at greater risk for a problematic recovery trajectory.
Topics: Depression; Humans; Social Justice; Social Perception
PubMed: 33465504
DOI: 10.1016/j.jpain.2020.12.009 -
American Journal of Surgery Jul 2022Previous systematic reviews have found high burnout in healthcare professionals is associated with poorer patient care. However, no review or meta-analysis has... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Previous systematic reviews have found high burnout in healthcare professionals is associated with poorer patient care. However, no review or meta-analysis has investigated this association in surgeons specifically. The present study addressed this gap, by examining the association between surgeon burnout and 1) patient safety and 2) surgical professionalism.
METHODS
A systematic review was performed in accordance with PRISMA guidelines. We included original empirical studies that measured burnout and patient care or professionalism in surgeons. Six databases were searched (PsycINFO, Ovid MEDLINE(R), EMBASE, Cochrane Database, CINAHL, and Web of Science) from inception to February 2021. An adapted version of the Cochrane Risk of Bias tool was used to assess study quality. Meta-analysis and narrative synthesis were utilised to synthesise results.
RESULTS
Fourteen studies were included in the narrative review (including 27,248 participants) and nine studies were included in the meta-analysis. Burnout was associated with a 2.5-fold increased risk of involvement in medical error (OR = 2.51, 95% Cl [1.68-3.72]). The professionalism outcome variables were too diverse for meta-analysis, however, the narrative synthesis indicated a link between high burnout and a higher risk of loss of temper and malpractice suits and lower empathy. No link was found between burnout and patient satisfaction.
CONCLUSION
There is a significant association between higher burnout in surgeons and poorer patient safety. The delivery of interventions to reduce surgeon burnout should be prioritised; such interventions should be evaluated for their potential to produce concomitant improvements in patient safety.
Topics: Burnout, Professional; Burnout, Psychological; Humans; Patient Safety; Professionalism; Surgeons
PubMed: 34974884
DOI: 10.1016/j.amjsurg.2021.12.027 -
The International Journal on Drug Policy Jul 2023In the past decade, a body of evidence has reported that dietary supplement use is related to prohibited performance enhancing substance use (i.e., doping). To help... (Meta-Analysis)
Meta-Analysis Review
In the past decade, a body of evidence has reported that dietary supplement use is related to prohibited performance enhancing substance use (i.e., doping). To help international and national sport organisations understand the degree to which dietary supplement use is related to doping, the objectives of this systematic review and meta-analysis were to 1) compare the prevalence of doping between dietary supplement users and non-users and 2) identify whether supplement use is related to doping social cognitive factors. We searched for studies sampling athletes and that measured both dietary supplement use and doping in EMBASE, MEDLINE, PsychINFO, CINAHL and SPORTDiscus from database creation to May 2022. Risk of bias was assessed using JBI Critical Appraisal Checklist for cross-sectional studies and the STROBE checklist. Twenty-six cross-sectional studies, involving 13,296 athletes were included. Random-effect models revealed that doping was 2.74 (95% CI=2.10 to 3.57) times more prevalent in dietary supplement users (pooled prevalence = 14.7%) than non-users (6.7%), and that users reported stronger doping intentions (r=0.26, 0.18 to 0.34) and attitudes (r=0.21, 0.13 to 0.28) compared to non-users. Preliminary evidence also suggests that dietary supplement users were less likely to dope if they were more task oriented and had a stronger sense of morality. Results of the review are limited by the cross-sectional design used in all studies and lack of consistency in measurement of dietary supplement use and doping. Data indicate that athletes using dietary supplements are more likely to self-report doping Anti-doping policy should, therefore, target dietary supplement use in anti-doping education programmes by providing alternative strategies for performance enhancement or highlighting the safest ways they can be consumed. Similarly, as a large proportion of athletes use dietary supplements without doping, further research is needed to understand the factors that protect a dietary supplement user from doping. No funding was received for the review. A study protocol can be found here: https://osf.io/xvcaq.
Topics: Humans; Cross-Sectional Studies; Dietary Supplements; Sports; Athletes; Intention; Doping in Sports
PubMed: 37267738
DOI: 10.1016/j.drugpo.2023.104077 -
PloS One 2016Research in the end-of-life context has explored the sense of dignity experienced by patients with advanced disease, examining the factors associated with it. Whereas... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Research in the end-of-life context has explored the sense of dignity experienced by patients with advanced disease, examining the factors associated with it. Whereas certain perspectives regard dignity as an intrinsic quality, independent of external factors, in the clinical setting it is generally equated with the person's sense of autonomy and control, and it appears to be related to patients' quality of life. This study aims to explore the relationship between perceived dignity, autonomy and sense of control in patients at the end of life.
METHODS
We conducted a systematic review and meta-ethnography using reciprocal translation and line-of-argument synthesis. The search strategy used MeSH terms in combination with free-text searching of the Pubmed, Web of Science, CINAHL, PsycINFO and Cochrane databases, from their inception until 2015. This identified 186 articles, after excluding duplicates. The inclusion criterion was primary qualitative studies in which dignity, autonomy and control at the end of life were explored. Studies were evaluated using the CASP guidelines.
RESULTS
Twenty-one studies recording the experiences of 400 participants were identified. Three themes emerged: a) dignity mediated by the loss of functionality, linked to the loss of control; b) dignity as identity; and c) autonomy as a determining factor of perceived dignity, understood as the desire for control over the dying process and the desire for self-determination. We propose an explanatory model which highlights that those patients with an intrinsic sense of dignity maintained a positive view of themselves in the face of their illness.
CONCLUSION
This synthesis illustrates how dignity and autonomy are intertwined and can be perceived as a multidimensional concept, one that is close to the notion of personal identity. The ability to regard dignity as an intrinsic quality has a positive impact on patients, and the design of care strategies should take this into account.
Topics: Anthropology, Cultural; Humans; Personal Autonomy; Personhood; Qualitative Research; Quality of Life; Right to Die; Suicide, Assisted; Terminal Care
PubMed: 27010323
DOI: 10.1371/journal.pone.0151435