Clinical review: moral assumptions and the process of organ donation in the intensive care unit.
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The objective of the present article is to review moral assumptions underlying organ donation in the intensive care unit. Data sources used include personal experience, and a Medline search and a non-Medline search of relevant English-language literature. The study selection included articles concerning organ donation. All data were extracted and analysed by the author. In terms of data synthesis, a rational, utilitarian moral perspective dominates, and has captured and circumscribed, the language and discourse of organ donation. Examples include "the problem is organ shortage", "moral or social duty or responsibility to donate", "moral responsibility to advocate for donation", "requesting organs" or "asking for organs", "trained requesters", "pro-donation support persons", "persuasion" and defining "maximising donor numbers" as the objective while impugning the moral validity of nonrational family objections to organ donation. Organ donation has recently been described by intensivists in a morally neutral way as an "option" that they should "offer", as "part of good end-of-life care", to families of appropriate patients. In conclusion, the review shows that a rational utilitarian framework does not adequately encompass interpersonal interactions during organ donation. A morally neutral position frees intensivists to ensure that clinical and interpersonal processes in organ donation are performed to exemplary standards, and should more robustly reflect societal acceptability of organ donation (although it may or may not "produce more donors"). (+info)
Active collaboration with primary care providers increases specialist referral in chronic renal disease.
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BACKGROUND: Late referral to specialist nephrological care is associated with increased morbidity, mortality, and cost. Consequently, nephrologists' associations recommend early referral. The recommendations' effectiveness remains questionable: 22-51% of referrals need renal replacement therapy (RRT) within 3-4 months. This may be due to these recommendations addressing the specialist, rather than the primary care providers (PCP). The potential of specialist intervention aiming at slowing progression of chronic renal failure was introduced individually to some 250 local PCPs, and referral strategies were discussed. To overcome the PCPs' most often expressed fears, every referred patient was asked to report back to his PCP immediately after the initial specialist examination, and new medications were prescribed directly, and thus allotted to the nephrologist's budget. METHODS: In retrospective analysis, the stage of renal disease in patients referred within three months before the introductory round (group A, n = 18), was compared to referrals two years later (group B, n = 50). RESULTS: Relative number of patients remained stable (28%) for mild/ moderate chronic kidney disease (MMCKD), while there was a noticeable shift from patients referred severe chronic kidney disease (SCKD) (group A: 44%, group B: 20%) to patients referred in moderate chronic kidney disease (MCKD) (group A: 28%, group B: 52%). CONCLUSION: Individually addressing PCPs' ignorance and concerns noticeably decreased late referral. This stresses the importance of enhancing the PCPs' problem awareness and knowledge of available resources in order to ensure timely specialist referral. (+info)
The eHealth Behavior Management Model: a stage-based approach to behavior change and management.
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Although the Internet has become an important avenue for disseminating health information, theory-driven strategies for aiding individuals in changing or managing health behaviors are lacking. The eHealth Behavior Management Model combines the Transtheoretical Model, the behavioral intent aspect of the Theory of Planned Behavior, and persuasive communication to assist individuals in negotiating the Web toward stage-specific information. It is here - at the point of stage-specific information - that behavioral intent in moving toward more active stages of change occurs. The eHealth Behavior Management Model is applied in three demonstration projects that focus on behavior management issues: parent-child nutrition education among participants in the U.S. Department of Agriculture Special Supplemental Nutrition Program for Women, Infants and Children; asthma management among university staff and students; and human immunodeficiency virus prevention among South African women. Preliminary results have found the eHealth Behavior Management Model to be promising as a model for Internet-based behavior change programming. Further application and evaluation among other behavior and disease management issues are needed. (+info)
Teaching appropriate interactions with pharmaceutical company representatives: the impact of an innovative workshop on student attitudes.
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BACKGROUND: Pharmaceutical company representatives (PCRs) influence the prescribing habits and professional behaviour of physicians. However, the skills for interacting with PCRs are not taught in the traditional medical school curriculum. We examined whether an innovative, mandatory workshop for third year medical students had immediate effects on knowledge and attitudes regarding interactions with PCRs. METHODS: Surveys issued before and after the workshop intervention solicited opinions (five point Likert scales) from third year students (n = 75) about the degree of bias in PCR information, the influence of PCRs on prescribing habits, the acceptability of specific gifts, and the educational value of PCR information for both practicing physicians and students. Two faculty members and one PCR led the workshop, which highlighted typical physician-PCR interactions, the use of samples and gifts, the validity and legal boundaries of PCR information, and associated ethical issues. Role plays with the PCR demonstrated appropriate and inappropriate strategies for interacting with PCRs. RESULTS: The majority of third year students (56%, 42/75) had experienced more than three personal conversations with a PCR about a drug product since starting medical school. Five percent (4/75) claimed no previous personal experience with PCRs. Most students (57.3%, 43/75) were not aware of available guidelines regarding PCR interactions. Twenty-eight percent of students (21/75) thought that none of the named activities/gifts (lunch access, free stethoscope, textbooks, educational CD-ROMS, sporting events) should be restricted, while 24.0% (8/75) thought that students should be restricted only from sporting events. The perceived educational value of PCR information to both practicing physicians and students increased after the workshop intervention from 17.7% to 43.2% (chi square, p = .0001), and 22.1% to 40.5% (p = .0007), respectively. Student perceptions of the degree of bias of PCR information decreased from 84.1% to 72.9% (p = .065), but the perceived degree of influence on prescribing increased (44.2% to 62.1% (p = .02)). CONCLUSIONS: Students have exposure to PCRs early in their medical training. A single workshop intervention may influence student attitudes toward interactions with PCRs. Students were more likely to acknowledge the educational value of PCR interactions and their impact on prescribing after the workshop intervention. (+info)
To what extent do mass media health messages trigger patients' contacts with their GPs?
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BACKGROUND: A recent Cochrane review concluded that mass media intervention may play an important role in influencing the use of health services, but little is known about the effects of unplanned untargeted information in the media. AIM: To investigate the influence of messages in mass media about health issues on patients' contacts with their GPs. DESIGN OF STUDY: A case crossover design study comparing the frequency of receiving mass media health messages in a period before contact with a GP versus the frequency in matching control time periods for the same individuals. The outcome measure was the odds of patients having received health messages in the period before they contacted their GP, compared to the odds in the control periods. SETTING: The practices of 21 single-handed Danish GPs. METHOD: Three hundred and twenty-two patients between 18 and 91 years of age were interviewed by telephone after an unscheduled contact with a GP, and 148 patients were interviewed again 3-6 months later. Health media messages were only recorded if patients could remember the topics. RESULT: More than a third (35%) of the patients remembered receiving health media messages in the week before contact. No significant relationship (odds ratio = 1.2, 95% confidence interval = 0.5 to 2.6) between health messages and contact with GPs could be observed. CONCLUSION: In the absence of health campaigns and drug advertisements, mass media health messages seldom directly trigger patients to consult their GPs. (+info)
How effective are tobacco industry bar and club marketing efforts in reaching young adults?
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OBJECTIVE: Recently, the tobacco industry has focused marketing efforts on young adults through bar and club promotions, such as advertising and distribution of free cigarettes in these settings. This study estimates the fraction of the California young adult population that might be exposed and potentially influenced by these efforts. DESIGN AND PARTICIPANTS: Data were from 9364 young adult (18-29 years) respondents to the cross sectional population based 2002 California Tobacco Survey. As background, we analysed social smoking (only smoke with other smokers), and enjoyment of smoking while drinking. Our main focus was on bar and club attendance, what was observed in bars and clubs, and how this might differ according to respondents' risk for future smoking. RESULTS: Social smokers comprised 30.0 (2.2)% of all current smokers, including experimenters. Nearly three quarters (74.5 (2.3)%) of current smokers/experimenters said they enjoyed smoking while drinking. About one third (33.8 (1.2)%) of all young adults said they attended bars and clubs at least sometimes; attendance was significantly higher among smokers and those at risk for future smoking. Close to 60% (57.9 (2.2)%) of bar and club attenders reported seeing cigarette advertising and promotions in these settings. Again, smokers and those at risk were more likely to report seeing such advertising and promotions in these settings. CONCLUSIONS: About 20% of all young adults and about 30% of those at risk for future smoking (including current smokers) were exposed to tobacco advertising and promotions in bars and clubs. These California results may be conservative, but nonetheless indicate that the group potentially influenced is sizable. (+info)
Promoting stair use: single versus multiple stair-riser messages.
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Message banners attached to stair risers produced a significant increase in pedestrian stair use, exceeding effects previously reported for conventional posters. Multiple instances of the same message banner, however, were as effective as banners featuring different messages. Therefore, greater visibility, rather than message variety, appears to account for the superiority of the banner format. Our findings indicate the feasibility of simple stair-use promotion campaigns based around the repetition of a single message. (+info)
Benefits and costs of Channel One in a middle school setting and the role of media-literacy training.
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OBJECTIVES: Channel One is a public-affairs program that includes 10 minutes of news and 2 minutes of paid product advertising or public service announcements. Advocates assert that it increases public-affairs knowledge, but critics charge that it garners a captive audience for teen-targeted advertising. This experiment analyzed the differential effects of Channel One depending on whether early-adolescent viewers received a media-literacy lesson in conjunction with viewing the program. Outcomes included perceptions of Channel One news programming, recall of program content and advertising, materialism, and political efficacy. METHODS: Researchers used a posttest-only field experiment (N = 240) of seventh- and eighth-grade students using random assignment to conditions. Conditions included a control group, a group that received a fact-based lesson, and a group that received the same lesson content using a more emotive teaching style. It was expected that the emotion-added lesson condition would be more effective than the logic-only lesson condition because of its motivational component. RESULTS: On average, students remembered more ads from Channel One than news stories. Participants in the control group remembered fewer news stories than did the groups that received the lessons. Students reported having purchased during the preceding 3 months an average of 2.5 items advertised on the program. Both fact-based and affect-added training increased student skepticism toward advertisers. As expected, student liking of the program enhanced their learning from it and was associated with higher levels of political efficacy. Students held misconceptions about the role of their school in the production of Channel One. CONCLUSIONS: The use of Channel One by schools can have benefits, but these come with risk that some may consider unacceptable. On the positive side, student liking of the program was associated with their political efficacy. Although those who responded positively to program content and presentation style learned more from it, they also tended to want things that they saw in the advertisements. The data therefore show that the program can provide some benefits to young adolescents, but the results also provide justification for concerns about the commercialization of the classroom. (+info)