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At least 19 recordsLinked to original sources
PubMed2001

What happened to our free bioethics search service? The terrible and premature death of BIOETHICSLINE.

BIOETHICSLINE, in existence from 1973 thorough 2000, was a bibliographic database covering the English-language literature on bioethical issues. It reflected the cross-disciplinary field of bioethics. During 2001, the National Library of Medicine is expected to dismantle BIOETHICSLINE and incorporate its data into two of their other databases, PubMed and LOCATORplus. Once this is completed, BIOETHICSLINE, as a unified database, will be discontinued. The users of BIOETHICSLINE will no longer have access to this important and useful resource specifically targeted to the vocabulary and cross-disciplinary nature of the bioethics literature. As a scholar and student of bioethics, and as a trained and former reference librarian, I feel it is important to examine these changes and their consequences. There are good reasons to integrate BIOETHICSLINE into these other databases on the NLM Gateway, but I argue that, in addition this integration, BIOETHICSLINE should be continued as a distinct database.

Abstracting and Indexing↗
PubMed1997

BIOETHICSLINE use by medical students: curriculum-integrated instruction and collection development implications.

BIOETHICSLINE uselogs were analyzed during months when second-year medical students were engaged in ethics coursework that included curriculum-integrated bibliographic instruction. Uselog data showed that peak activity occurred while students were preparing a required paper. Further uselog analysis indicated that students applied database features such as controlled vocabulary, the "explode" command, and a combination of multiple search concepts. In addition, the study examined journal use and interlibrary loan activity for a correlation with online search activity. Higher bioethics journal use and interlibrary loan statistics coincided with peak BIOETHICSLINE activity periods. Citation analysis of student bibliographies reflected the interdisciplinary nature of BIOETHICSLINE and the need for ethics, legal, and clinical information sources in a bioethics collection. This study suggests that the integration of bibliographic instruction and the coordination of collection development with students' curricular needs lead to increased and more competent use of information resources.

Bioethics↗
PubMed2002

In focus. Life after BioethicsLine: a reply to Joyce Plaza.

The recent closure and removal of BioethicsLine led many researchers to wonder where to turn for their research needs. Joyce Plaza wrote that the closure is a mistake. In this essay I maintain, contra Plaza, that due to its cross-disciplinary nature researchers can find bioethics literature in other databases. In developing the search strategy the researcher needs to consider what the problem is about. If the researcher has a philosophical approach in mind, a wise choice would be to use Philosopher's Index; a legal approach suggests using Academic Universe, Westlaw, Lexis or legal databases freely available through state and federal websites. Further, in so far as the National Library of Medicine is integrating citations in BioethicsLine into the NLM Gateway databases (PubMed and LOCATORplus) I point out suggestions on using the latter databases effectively. There is a wealth of information readily available and researchers have much to learn by trying the alternatives.

Abstracting and Indexing↗
PubMed1984

BIOETHICSLINE: an overview for searchers.

The BIOETHICSLINE File (BIOETHICS) is a bibliographic database produced at the Kennedy Institute of Ethics, Georgetown University, and made available online through the the National Library of Medicine's MEDLARS system. BIOETHICS provides multidisciplinary coverage of the ethical, legal, and public policy aspects of medicine, health care, and biomedical and behavioral research. This article describes the content and development of the database, suggests effective strategies for searching, and presents illustrative searches. An appendix lists selected major indexing terms (Keywords) from the controlled vocabulary of the Bioethics Thesaurus.

Bioethical Issues↗
PubMed2001

Confidentiality of health information postmortem.

CONTEXT: Recent discussions of health care privacy have prompted new concerns over the control of private health information after a patient's death. The importance of confidentiality protections postmortem is compounded as genetic technologies and research capabilities advance and public interest in this information increases. OBJECTIVE: The Council on Ethical and Judicial Affairs of the American Medical Association developed this report to guide physicians in the management of patients' health information postmortem. PARTICIPANTS: This report was developed by the 9 physician members of the Council on Ethical and Judicial Affairs with the assistance of staff from the Ethics Standards Group at the American Medical Association. EVIDENCE: Literature searches in the MEDLINE and BIOETHICSLINE databases using the search terms postmortem and health information qualified with confidentiality or privacy yielded a combined total of 129 references. Additional references were culled from policies of a number of health care organizations. CONSENSUS PROCESS: The Council on Ethical and Judicial Affairs solicited suggestions from the federation of state medical and specialty societies before drafting this report. A copy of the report was sent to the College of American Pathologists for comment. It was then adopted by a majority vote of the House of Delegates of the American Medical Association. CONCLUSIONS: The report emphasizes the importance of maintaining confidentiality for information held within a deceased patient's medical record. However, these protections are subject to certain exceptions. Confidentiality can be upheld when such information is used for educational or research purposes by removing individual identifiers. For disclosures in which the identity of the deceased patient is known, a number of considerations are provided to assess when disclosure would be ethically permissible.

American Medical Association↗
PubMed2001

A controlled vocabulary for nursing and allied health in Norway.

Nursing and allied health libraries at educational institutions in Norway have generally indexed their book collections with uncontrolled terms. With the reorganization of higher education in 1994, the majority of these libraries joined BIBSYS, which is a joint library system for higher education and research in Norway. This has led to chaos when searching the joint catalogue for literature on nursing and related fields. A term such as 'behaviour problems' may have up to five synonyms. In an attempt to improve the quality of searching the health literature, BIBSYS appointed a working group in the Spring of 1999 to find a suitable controlled vocabulary for this subject area, and to see how this vocabulary could be integrated into BIBSYS. The group presented its recommendations in October 1999. The report has been well received by the BIBSYS Board and by user groups. There are no Norwegian vocabularies that are suitable for use in nursing and allied health, therefore it will be necessary to translate and combine existing thesauri. The group has looked at the Nordic Multilingual Thesaurus on Health Promotion, the Swedish Spriline Thesaurus, MeSH (Medical Subject Headings) and CINAHL Subject Heading List. Other relevant thesauri are AMED/CATS Thesaurus, Bioethics Thesaurus (Bioethicsline) and the RCN thesaurus. The group recommends the development of a Norwegian thesaurus based on a translation of parts of MeSH and CINAHL Subject Heading List.

Abstracting and Indexing↗
PubMed2002

Reviewing intuitive decision-making and uncertainty: the implications for medical education.

CONTEXT: Intuition and uncertainty are inescapable conditions of many instances of clinical decision- making. Under such conditions biases and heuristics may operate, distorting the decision-making process. Physicians and students are generally unaware of these influences. PURPOSE: To review the extant literature regarding the role of uncertainty and intuition and associated biases on medical decision-making, to highlight the implications this holds for medical education. CONTENT: Using literature identified via Medline and Bioethicsline searches of the past 3 decades, this paper reviews the sources of uncertainty in clinical practice and the role of intuitive decision-making. A detailed description of associated heuristics and biases is provided, and linked with demonstrable examples from medical decision-making. CONCLUSIONS: It is argued that although uncertainty can be reduced, it can never be completely eliminated from decision-making. Therefore most decision-making performed in medicine contains an irreducible intuitive element and is thus vulnerable to these biases and heuristics. Given that few medical curricula overtly address the process of medical decision-making, both medical students and physicians remain vulnerable to these effects on their own (and their patients') decision-making. Insight via education appears the major means in which to avoid distorting decision-making processes.

Clinical Competence↗
PubMed2003

Patient perspectives of medical confidentiality: a review of the literature.

OBJECTIVE: To lay the groundwork for a better understanding of patient views on medical confidentiality. DESIGN: Studies were found by searching medline, bioethicsline, and selected bibliographies. Articles concerning physician perspectives or implications of legal and administrative regulations were excluded. Only peer-reviewed journal articles reporting original research on patients' confidentiality views and conduct were included. MAIN RESULTS: Many patients are unaware of or misunderstand their legal or ethical right to medical confidentiality protections, which leads them to both over- and underestimate confidentiality protections. The possibility that medical information might be revealed, intentionally or not, to acquaintances in a clinic or other social community troubles patients as much as information release to insurers or employers. A significant minority of patients distrust confidentiality protections, leading some to report that they delay or forgo medical care. If doubtful that confidentiality will be upheld, patients will act independently to protect information. CONCLUSIONS: Our review found a wider variety of understandings and beliefs about medical confidentiality among patients than are often indicated in the writings of practitioners or legal experts. As medical confidentiality regulations evolve, these differences need to be recognized and accounted for in interactions between practitioners and patients.

Awareness↗
PubMed2001

Sexualization of the doctor-patient relationship: is it ever ethically permissible?

Whilst having sexual relationships with current patients is clearly unethical, the ethics of such a relationship between a doctor and former patient is more debatable. In this review of the current evidence, based on major articles listed in Medline and Bioethicsline in the past 15 years, the argument is made here that such relationships are almost always unethical due to the persistence of transference, the unequal power distribution in the original doctor-patient relationship and the ethical implications that arise from both these factors especially with respect to the patient's autonomy and ability to consent, even when a former patient. Only in very particular circumstances could such relationships be ethically permissible.

Ethics, Clinical↗
PubMed1998

Getting meaningful informed consent from older adults: a structured literature review of empirical research.

OBJECTIVES: To perform a structured literature review of the published empirical research on informed consent with older adults in order to make recommendations to improve the informed consent process and to highlight areas needing further examination. DESIGN: Relevant literature was identified by searching electronic databases (AGELINE, BIOETHICSLINE, CancerLit, Ethics Index, Health, LegalTrac, MEDLINE, PAIS International, PsycInfo, and Sociofile). Studies were included if they were reports of primary research data about informed consent and, if patients or other subjects were used, older subjects were included in the sample. Data related to the aspect of informed consent under study (recruitment, decision-making capacity, voluntariness, disclosure of information, understanding of information, consent forms, authorization, and policies and procedures) were abstracted and entered into a specially designed database. MEASUREMENTS: Characterization of the population, age of subjects, setting, whether informed consent was being studied in the context of research or treatment, study design, the nature of outcome or dependent variables, independent variables (e.g., experimental conditions in a randomized controlled trial or patient/subject characteristics in a nonrandomized comparison), and results according to the aspect of informed consent under study. RESULTS: A total of 99 articles met all the inclusion criteria and posed 289 unique research questions covering a wide range of aspects of informed consent: recruitment (60); decision making capacity (21); voluntariness (6); disclosure (30); understanding (139); consent forms (7); authorization (11); policies (13); and other (2). In the secondary analyses of numerous studies, diminished understanding of informed consent information was associated with older age and fewer years of education. Older age was also sometimes associated with decreased participation in research. Studies of disclosure of informed consent information suggest strategies to improve understanding and include a variety of novel formats (e.g., simplified, storybook, video) and procedures (e.g., use of health educators, quizzing subjects, multiple disclosure sessions). CONCLUSIONS: A systematic review of the published literature on informed consent reveals evidence for impaired understanding of informed consent information in older subjects and those with less formal education. Effective strategies to improve the understanding of informed consent information should be considered when designing materials, forms, policies, and procedures for obtaining informed consent. Other than empirical research that has investigated disclosure and understanding of informed consent information, little systematic research has examined other aspects of the informed consent process. This deficit should be rectified to ensure that the rights and interests of patients and of human subjects who participate in research are adequately protected.

Adult↗
PubMed2000

Ineffectiveness of the SUPPORT intervention: review of explanations.

BACKGROUND: The aim of the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments -- SUPPORT -- was to improve the care of seriously ill patients by improving decision-making for patients with life-threatening illnesses. Several theories have been proposed to explain why the SUPPORT intervention was unsuccessful at improving outcomes. OBJECTIVE: To review and discuss explanations offered by others regarding why the SUPPORT intervention failed to have a discernible impact on its prespecified outcome measures. DESIGN: A descriptive review of published articles and book chapters, with synthesis of data-based and conceptual insights. METHODS: The Medline, Bioethicsline, and Ethx databases were searched for citations to SUPPORT articles between 1994 and the end of 1998. This search was supplemented by other published materials that had come to the authors' attention. RESULTS: The critiques and explanations regarding the reasons the SUPPORT intervention did not improve outcomes were catalogued and organized into 11 major categories, the first 10 of which are explored in the present study: (1) the inception cohort was biased against an effect of the intervention, (2) the intervention was not implemented as designed, (3) the intervention failed because nurses were too readily ignored, (4) the intervention was too polite, (5) the intervention presented information ineffectively, (6) the intervention did not focus on primary care physicians, (7) the intervention falsely dichotomized do not resuscitate (DNR) decisions, (8) the intervention needed more years on site or an earlier start with each patient, (9) the intervention required more appropriate outcome measures, (10) the intervention was irrelevant because usual care is not seriously flawed, (11) the conceptual model behind SUPPORT was fundamentally flawed in aiming to improve individual, patient-level decision-making as the way to improve seriously ill, hospitalized patients' experiences. CONCLUSIONS: Although some of the critiques were found to raise important concerns, we conclude in each case that the explanation offered is inadequate to explain the failure of the intervention. We urge further reflection on the fundamental assumptions that informed the design of that intervention and refer the reader to a more comprehensive treatment of that issue in the companion paper in this volume.

Communication↗
PubMed1995

Principles and theory in bioethics.

The following citations were selected from BIOETHICSLINE, the online database prepared at the Kennedy Institute of Ethics for the National Library of Medicine's MEDLARS system. Searching the keywords autonomy, beneficence, casuistry, justice, and virtues, as well as the text word principlism produced more than 400 citations. Only the citations concerned with theory and principle in the practice of bioethics are included here -- e.g., works about justice in resource allocation have been deleted.

Bioethics↗
PubMed1999

Advance directives: the emerging body of research.

BACKGROUND: With the passage of the Patient Self-Determination Act in 1990, new procedures and documents became available for planning end-of-life care. These new procedures and documents are now being examined scientifically. OBJECTIVE: To review existing research on the use of advance directives. DATA SOURCES: Computer search using Grateful Med software from the National Library of Medicine with MEDLINE and BIOETHICSLINE databases. STUDY SELECTION: Studies that showed an emerging consensus or reported vastly differing results were selected. Selected studies examined these specific areas: demographic data on patients with advance directives, completion rates, capacity to complete, patients' preferences, stability of patients' decisions over time, treatment choices, proxy decision makers, treatment provided, and cost. RESULTS: The body of important research about advance directives is growing. A profile of their clinical utility is emerging. CONCLUSIONS: The research done so far can stimulate future research and can begin to suggest possible changes in practice. However, the body of research is not yet large enough or well controlled enough to answer conclusively many of the questions about planning of end-of-life care.

Advance Directives↗