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New maps of development: new visions of maturity.

Two modes of moral reasoning are distinguished in boys' and girls' discussions of moral dilemmas: one oriented to justice and rights, one to care and response. These different modes are associated with different forms of self-definition and reflect different images of relationships. The contrasting images of hierarchy and web derive from childhood experiences of inequality and interdependence which give rise to the ideals of justice and of care. The representation of these two lines of development and their interplay yields a new mapping of human growth.

Child↗

Anatomical dissection: why are we cutting it out? Dissection in undergraduate teaching.

Anatomy teaching and, more specifically, the use of dissection in undergraduate anatomy teaching is undergoing a sea change in Australian medical schools. Until as recently as the 1970s, all medical students in Australia underwent an extensive course in dissection, taking up as much as 700 hours of curriculum time. Today, dissection is compulsory in only a minority of anatomy departments. There has been much discussion about the use of dissection in anatomy teaching, and both sides of the argument have considerable merit. Less widely discussed have been the other benefits of anatomical dissection, such as the development of surgical skills, an appreciation of whole-body pathology, and the teaching of ethical and moral issues that are central to the development of the professional doctor. Dissection still has an important role to play in undergraduate medical education.

Anatomy↗

Pharmacy staff training and development: upside-down thinking in a changing profession.

We suggest that the most fundamental change in staff development that must occur is recognition of the need for a professional belief system as the basis for any pharmaceutical care activity. Values derived from fundamental moral ideals and professional beliefs foster the development of attitudes and behaviors. It would be wrong to suggest or imply that such a change need only occur in postbaccalaureate training. The development of personal and professional value systems in existing primary professional training programs is inadequate--we do not yet do enough to develop people before they enter practice. Nevertheless, to say that this failure of the professional education system precludes us from taking action within professional departments is unwise. The primary skills that must be developed during the next decade involve the ability of the practitioner to competently make informed, patient-specific decisions necessary for effective pharmaceutical care. Such decisions are made not only on the basis of a practitioner's knowledge but on the basis of his or her beliefs and values as well. The practitioner also must be willing to assume responsibility for the consequences of those decisions. The pharmacist who professes to deliver pharmaceutical care can no longer be shielded by assigning to the physician the ultimate responsibility for the patient's drug-therapy outcomes. Facilitating the development of a value system and attitude that enhance the pharmacist's ability to make such decisions must be a principal focus of staff training and development in the coming years.(ABSTRACT TRUNCATED AT 250 WORDS)

Education, Pharmacy, Continuing↗

The competing discourses of HIV/AIDS in sub-Saharan Africa: discourses of rights and empowerment vs discourses of control and exclusion.

The competing discourses of HIV/AIDS circulating in sub-Saharan Africa are identified. These are medical, medico-moral, developmental (distinguishing between 'women in development' and gender and development perspectives), legal, ethical, and the rights discourse of groups living with HIV/AIDS and of African pressure groups. The analytical framework is that of discourse analysis as exemplified by Michel Foucault. The medical and medico-moral are identified as dominant. They shape the perceptions of the pandemic, our responses to it, and to those living with HIV/AIDS. However, dissident activist voices are fracturing the dominant frameworks, and are mobilising a struggle for meaning around definitions of gender, rights, and development.

Acquired Immunodeficiency Syndrome↗

Development and evaluation of a short-term training design for health professionals.

A study was conducted to assess how a training program on adolescent development affected health professionals and their work performance. Several mechanisms were used to evaluate the impact of the workshop. Changes in trainees' attitudes and knowledge about adolescent development were measured with pre- and posttraining tests. For five test components: attitude, psychosocial, cognitive, general knowledge and case study applications, the cognitive section differentiated significantly between trainee and comparison groups. On-site observations and interviews were conducted to gauge whether training information was incorporated and applied within the job setting. Short-term training, evaluated at six weeks posttraining, affected basic theoretical knowledge of adolescent development, which in turn improved morale through greater understanding of the complexities of adolescent behavior. Moreover, the evaluation process itself was an effective teaching mechanism, since the various evaluation components interacted with the workshop materials, creating a more comprehensive learning experience for the participants. On-site observations demonstrated that application of workshop materials was often constrained at the work site. Additional practice, organizational support for training objectives and extensive follow-up may be necessary to assure that training materials are applied at the work site.

Adolescent↗

Inter-laboratory transfer of HPLC methods: problems and solutions.

As high-performance liquid chromatography (HPLC), the premier analytical technique in the pharmaceutical industry, becomes more ubiquitous, methods are more frequently being transferred from one laboratory to another. This review will discuss sources of failures to reproduce HPLC procedures, ranging from sample handling and preparation, through mobile phase, injector, column, detector and data manipulation problems. Also to be considered will be the precautions that should be taken, when initially developing a method, to obviate future problems. These precautions include using stable, well-defined analytical columns, buffered mobile phases, low wavelengths (or a mass-sensitive detector) and internal tests for accuracy; based on the author's experiences. Since the laboratory that originally developed the procedure has the moral obligation and, perhaps, the regulatory responsibility to "guarantee" that the method will perform successfully elsewhere, a series of increasingly comprehensive steps will be given, based on practice, to be followed by the laboratory that could not reproduce the procedure. Also to be discussed are approaches for treating methods that were initially successful but have slowly deteriorated and now fail, and several examples of procedures that were not reproducible in some other laboratories.

Chromatography, High Pressure Liquid↗

A code of ethics for the medical dosimetrist--the American Association of Medical Dosimetrists experience.

The Committee on Protocol and Ethics of the American Association of Medical Dosimetrists (AAMD) has developed a Code of Ethics for a radiation oncology society of medical dosimetrists. The purpose of the code of ethics is fourfold: (1) Establish an ideal of professional conduct specific to the medical dosimetry profession; (2) Develop a statement of the moral values and commitment of the AAMD; (3) Recognize professional relationships and obligations; and (4) Define goals to which the medical dosimetrist should aspire. The Code of Ethics was adopted as AAMD policy in October 1995.

Ethics, Professional↗

A code of ethics for the medical dosimetrist--the American Association of Medical Dosimetrists experience.

The Committee on Protocol and Ethics of the American Association of Medical Dosimetrists (AAMD) has developed a Code of Ethics for a radiation oncology society of medical dosimetrists. The purpose of the code of ethics is fourfold: (1) Establish an ideal of professional conduct specific to the medical dosimetry profession; (2) Develop a statement of the moral values and commitment of the AAMD; (3) Recognize professional relationships and obligations; and (4) Define goals to which the medical dosimetrist should aspire. The Code of Ethics was adopted as AAMD policy in October 1995.

Ethics, Medical↗

The post anesthesia care unit experience: a family-centered approach.

The Post Anesthesia Care Unit (PACU) visitation program of Memorial Sloan-Kettering Cancer Center needed revision. The process was disorganized, visits were unescorted, and nurses and physicians were resistant. A committee was formed with the goal of developing a new unit philosophy and improving the overall process. Committee steps included reviewing the literature, educating staff about the benefits of visitation, empowering nurses to incorporate family visitation into patient care, and providing family education. As a result, staff attitudes changed, and nurses now contact the family within 90 minutes of the patient's arrival to the PACU to develop an individualized visitation plan. Morale is high, and nurses take pride in meeting the needs of patients and families.

Cancer Care Facilities↗

Value of HCC surveillance in a landscape of emerging surveillance options: Perspectives of a multi-stakeholder modified Delphi panel.

HCC surveillance is recommended by liver professional societies but lacks broad acceptance by several primary care and cancer societies due to limitations in the existing data. We convened a diverse multidisciplinary group of cancer screening experts to evaluate current and future paradigms of HCC prevention and early detection using a rigorous Delphi panel approach. The experts had high agreement on 21 statements about primary prevention, HCC surveillance benefits, HCC surveillance harms, and the evaluation of emerging surveillance modalities. The experts agreed that current data have methodologic limitations as well as unclear generalizability to Western populations. Although a randomized clinical trial of surveillance versus no surveillance is unlikely feasible, they concurred that alternative designs, such as a comparison of 2 surveillance modalities, could provide indirect evidence of surveillance efficacy. The panel acknowledged the presence of surveillance harms, but concurred the overall value of surveillance appears high, particularly given a greater emphasis on benefits over harms by both patients and clinicians. The experts underscored the importance of a framework for measuring both benefits and harms when evaluating emerging surveillance strategies. The panel acknowledged performance metrics of emerging methods may differ from other cancer screening programs given differences in populations, including higher risk of cancer development and competing risk of morality, and differences in diagnostic workflow in patients at risk of HCC. These data provide insights into the perceived value of HCC surveillance in an era of emerging blood- and imaging-based surveillance strategies.

Humans↗

Not just autonomy--the principles of American biomedical ethics.

The Principles of Biomedical Ethics by Tom L Beauchamp and James F Childress which is now in its fourth edition has had a great influence on the development of bioethics through its exposition of a theory based on the four principles: respect for autonomy; non-maleficence; beneficence, and justice (1). The theory is developed as a common-morality theory, and the present paper attempts to show how this approach, starting from American common-morality, leads to an underdevelopment of beneficence and justice, and that the methods offered for specification and balancing of principles are inadequate.

Beneficence↗

13. Children in Australian society.

Although children in Australia generally have good health, some alarming indicators of poor health and wellbeing exist, which are related to major socioeconomic discrepancies. The pathways connecting socioeconomic disadvantage to child health outcomes are complex and poorly understood. Reducing social disadvantage requires strategies beyond the health arena, involving political, moral, cultural and economic initiatives. Developing "social capital"--cohesion in communities, a sense of belonging and involvement in community affairs--may be a key strategy in improving health indicators. Overseas studies of early intervention and home visiting programs in early childhood have shown improvements in child health and development outcomes. Similar programs have been introduced in Australia and face considerable challenges in their widespread roll-out and evaluation. Health professionals need to develop practical ways to interact with community programs and thus improve social capital.

Adolescent↗

Life-sustaining treatment. A legal-ethical dilemma.

The U.S. Supreme Court decision in Cruzan by Cruzan v. Harmon will have a major impact on how we will care for patients in a persistent vegetative state. Each healthcare institution will need to review its life-sustaining treatment policies to match the guidelines established by the Supreme Court. Nurse executives also need to develop strategies to manage staff morale in coping with the conflicts surrounding the issues of preservation of life, quality of life, and patient/family choice regarding treatment.

Adult↗

Recognition and reward: a unit-based program.

Reward and recognition programs often are the tools that hospital administrators use when morale is low. Yet, when developing a program, staff nurses seldom are involved in meaningfully impacting the structure. Through the process of empowerment and decentralization, a large non-profit hospital encourages innovative programs to reward and recognize nurses.

Career Mobility↗

A code of ethics for the medical dosimetrist--the American Association of Medical Dosimetrists experience.

The Committee on Protocol and Ethics of the American Association of Medical Dosimetrists (AAMD) has developed a Code of Ethics for a radiation oncology society of medical dosimetrists. The purpose of the code of ethics is fourfold: (1) Establish an ideal of professional conduct specific to the medical dosimetry profession; (2) Develop a statement of the moral values and commitment of the AAMD; (3) Recognize professional relationships and obligations; and (4) Define goals to which the medical dosimetrist should aspire. The Code of Ethics was adopted as AAMD policy in October 1995.

Ethics, Medical↗