Biomedical subjects
Linda Barnes
Publications and source records attributed to Linda Barnes.
Integrating complementary and alternative medicine into pediatric training.
The Center for Pediatric Integrative Medical Education and Boston Healing Landscape Project represent diverse approaches to integrative medicine and its practice. The relationship and collegial collaboration between the two programs illustrates the extent to which they complement one another. Both recognize the importance of curriculum geared to different levels of learners and of interventions introduced across the full curriculum. Both use case-based learning, although each focuses on different kinds of CAM and different case models. The Center for Pediatric Integrative Medical Education promotes interactive didactics with hands-on, direct experiential learning. The BHLP applies active-learning pedagogy, through experiential learning and its teaching case model. Both programs understand that, given the ongoing interaction among medical students, residents, fellows, and faculty, each group's training in CAM must reinforce the others for a larger system to change.
Considering culture, complementary medicine, and spirituality in pediatrics.
Whether or not it is apparent, cultural and spiritual diversity exist in many clinical encounters, both with patients and with colleagues. These issues may cloud other concerns, contribute to inadequate or misleading communication, and affect lifestyle and therapeutic choices. Given the rapid rise in complementary therapies and the growing diversity in North America, the challenges of providing sensitive, compassionate, comprehensive care are compounded. Reflecting on the ways cultural backgrounds, religious beliefs and complementary medicine affect physicians, colleagues and patients may enrich, clarify, deepen, and improve the effectiveness of our clinical practice. The cases presented here offer an opportunity for role playing and reflection to support this process.
Faculty and resident attitudes about spirituality and religion in the provision of pediatric health care.
OBJECTIVE: To characterize pediatricians' attitudes toward spirituality/religion (S/R) in relationship to the practice of pediatrics. METHODS: Pediatric faculty (n = 100) and residents (n = 65) in an urban academic medical center completed a questionnaire about their attitudes toward and clinical practices related to S/R. Study variables included the strength of personal S/R orientation, attitudes toward S/R, clinicians' discussion of S/R with patients and families, self-reported S/R behaviors, the medical conditions that warrant discussion of S/R, and attitudes toward praying with patients if asked to do so. RESULTS: Sixty-five percent of pediatricians felt that faith plays a role in healing, and 76% reported feeling comfortable praying with a patient if asked to do so. Ninety-three percent would ask about S/R when discussing a life-threatening illness, and 96% when discussing death and dying. A strong personal S/R orientation was associated with beliefs that the pediatrician should discuss S/R with the patient (P <.01); beliefs that faith plays a role in healing (P <.01); and feelings that patients would like to discuss S/R with their pediatrician (P <.01), that the doctor-patient relationship would be strengthened by discussion of S/R (P <.01), and that physicians should call on an S/R leader for an illness or death (P <.01). Personal S/R orientation was not related to whether physicians reported that they discuss S/R issues with their patients (P =.08). Residents were more likely than faculty to state that it is appropriate to pray with patients if asked to do so (P <.05), and compared with pediatricians who were science majors in college, pediatricians who were nonscience majors in college felt more comfortable praying with patients if asked to do so (P <.01). CONCLUSIONS: In an urban, inner-city, academic medical center, pediatric residents and faculty have an overall positive attitude toward the integration of S/R into the practice of pediatrics.
Brain donation for research: consent and re-consent post Alder Hey.
BACKGROUND: Recent scandals relating to the unconsented retention and use of human organs in the UK have led to widespread changes to governance and ethical frameworks for research throughout England and Wales. Ethics committees now ask for proof of specific consent where general medical research consent was once sufficient. In order to meet these new requirements ongoing medical research studies have had to replace existing consent forms with more detailed ones that must be signed anew by prospective donors. In this paper we discuss how one such study has tackled this process of re-consent. METHOD: The MRC Cognitive Function and Ageing Study has recently been asked to consider renewal of consent on all individuals with existing signed intentions to donate brain tissue. We approached 218 of our respondents successfully for more detailed consent. RESULTS: All agreed to genetic research and only a very small proportion did not want samples used by commercial companies or collaborators abroad. Our interviewers reported that respondents were perplexed by the need to give consent again with more detailed forms, as they considered they had already received sufficient information and had given implicit consent for all the detailed uses of their tissues and their original signing of a broad consent. CONCLUSION: Such re-consenting has considerable implications for study infrastructure and costs of research. It did not alter the outcome and it seems unlikely that the public, or our respondents, would see regular updating of consent to constitute an efficient use of public research funds.