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At least 19 recordsLinked to original sources

[Research in emergency medicine. Ethical requirements].

Having pointed out some curriculum goals in medical ethics, a plea is made for extensive animal experimentation, especially in emergency medicine in order to minimize necessary investigations in human beings. Although certain groups of patients (persons in custody, minors) are protected nowadays against unjustified research activities by legal restraints, well-designed therapeutic (even nontherapeutic) investigative projects can be facilitated under certain conditions. The same attitude might be adopted for "special" populations (e.g., HIV patients), which are very often excluded for various reasons. Research protocols and statistical evaluation should not be permitted to differ in these groups in comparison to "normal" patients. The issue of "informed consent" in emergency research with the main emphasis on resuscitation cannot be considered as resolved since many patients are unconscious or at least incompetent. Irrespective of the number of legislative constructions proposed mainly in the USA ("proxy consent", "substitute decision making," "deferred consent"--the latter being already declared a misnomer by its "inventor", ethical standards might better be adapted to the respective situations guided by competent ethical committees. As for the particulars of research protocols, randomization combined with a blind or double-blind study design is now considered to be ethically desirable by a majority of authors, the same holding true for risk stratification and sequential test procedures in order to reduce the number of patients required. The "theory of intuitive thinking" is briefly touched upon as a futuristic investigative method and/or decision strategy.(ABSTRACT TRUNCATED AT 250 WORDS)

Emergency Medicine↗

The impact of women's family status on completion of substance abuse treatment.

This study examines the role of family status and demographic characteristics in explaining the nearly 60% dropout rate for women in substance abuse treatment. Data from the administrative record files of the Illinois Office of Alcoholism and Substance Abuse (OASA) for the fiscal year 1996-97 were analyzed for women age 12 or older who completed intake for publicly funded substance abuse treatment and whose outpatient treatment records were closed at year-end. Multivariate logistic regression models found that the likelihood of not completing treatment was greatest for women who were African American, pregnant, had custody of minor children, or were younger than age 21. However, African American women who had children in foster care were more likely to complete treatment. Implications for treatment and research are discussed.

Adolescent↗

Custody planning. a retrospective review of oncology patients who were single parents.

With rising numbers of single-parent families, a phenomenon becoming increasingly prevalent is the child orphaned by cancer. We sought to examine issues related to custody planning addressed prior to the patient's death. Ten deceased patients with minor children were identified. The contact person was administered a brief questionnaire regarding the minor children and custody issues. The study involved twenty children, ages ranging from 3-20, mean age 9.8. Only five of the ten families developed custody plans that were ultimately successful. One-half of the families reported the patient had suffered with this issue and almost one-half of the children were not aware of the custody plans that had been arranged for them. In 40% of the cases, the children ultimately went to people to whom the deceased parents were opposed. It is our belief that if we can improve these statistics, we might improve the quality of life of these families.

Child↗

Child custody evaluations and domestic violence: case comparisons.

The literature indicates that witnessing domestic violence is harmful to children, that them is a high overlap between domestic violence and child abuse, and that safety is an important issue for separating women because separation from abusive partners is a particularly dangerous time for victims of domestic violence. Further, child custody is often a contentious issue in domestic violence cases. Child custody evaluations are typically used to assist courts in deciding custody when custody is disputed and when the best interests of the child are unclear. The concept of "best interests of the child" does not specify evaluation techniques or approaches, however, and while custody evaluation standards generally address the best interests of the child, they offer little guidance in high-risk situations such as parental domestic violence. In addition, there has been limited research focused on understanding the custody evaluation process or the degree to which practitioners differ in their procedures and reporting for cases with and without parental domestic violence. This study is one of the first to examine characteristics of disputed custody cases and their custody evaluation reports differences between domestic violence and non-domestic violence cases. This study selected a 60% random sample of cases with custody evaluations in Fiscal Year 1998 and 1999 (n = 82 cases). Out of the 82 cases, 56% (n = 46) met criteria for classification into the domestic violence group and 44% (n = 36) did not. In general, results indicated that although there were some important differences in court records between cases with and without domestic violence, there were only minor differences between custody evaluation reported process and recommendations for the two groups. Implications for research and practice are discussed.

Adult↗

[Admission with freedom restriction of minors to child and adolescent psychiatrics clinics--medical decisions without regard for psychodynamic sequelae?].

The placement of minors who have been given a custodial sentence is barely mentioned in child psychiatric literature. The aim of this contribution is to present the statutory rules in civil law and public law regulating placement and to discuss the similarities and differences between them. The legislation on the placement of minors, which is concurrent in most of the German states, and the resulting problems for legal laypersons (such as doctors) are explained. Uncertainties among family and guardianship courts in regard to application of the law are examined. Case reports are presented to show the relevance to clinical practice. The conclusion can be drawn that the competing legislative regimes must be taken into account in each individual case when placing minors who have been given a custodial sentence. The application of legislation should take into account psychodynamic effects on the minor and his or her parents or guardians. Under certain circumstances, an insufficiently considered legal decision can have a counterproductive effect on the course of the disease. It is therefore recommended to proceed according to the principle of "priority to the better form of placement" when placing minors who have been given a custodial sentence.

Adolescent↗

[The evolution of child custody after the separation of the parents].

Following the separation of spouses, a family undergoes a reorganization process where the choice of a formula for child custody represents a major step, which child's living environment will depend on. Despite the importance of this form of custody, it seems, in the context of the crisis following separation, that decisions surrounding that choice are often taken haphazardly, without much consideration of various alternatives. On a different note, the family's profile at the time of the separation is bound to change following the pace of the child's and the parent's development. What may seem a relevant formula for a three year-old child may not necessarily be the case when the child turns eight. This article looks at the extent to which the child custody formula evolves to adjust itself to the changing needs of children and parents. Research focused on a sampling of 112 families separated for an average of four and a quarter years, with children aged 10 (N = 49) or adolescents of 15 years of age (N = 63). Data was compiled through a telephone questionnaire filled out by the parent who was the most committed to the child's custody. The description of the two categories of change (minor and major) was made according to the original child custody formula, the time lapse since the separation, the child's age and parental re-composition. Results point to three main trends: a) child custody arrangements do not evolve much over time; b) when there are changes, these are especially motivated by the needs of the parents; and c) the changes mainly result in reducing the frequency of contacts between the child and the parent without custody.

Adolescent↗