Announcing the Lancet Commission on Medicine and the Holocaust: Historical Evidence, Implications for Today, Teaching for Tomorrow

Recruitment, retention and reporting of variables related to ethnic diversity in randomised controlled trials: an umbrella review

OBJECTIVE

This umbrella review synthesises evidence on the methods used to recruit and retain ethnically diverse participants and report and analyse variables related to ethnic diversity in randomised controlled trials.

DESIGN

Umbrella review.

DATA SOURCES

Ovid MEDLINE, Ovid Embase, CINAHL, PsycINFO and Cochrane and Campbell Libraries for review papers published between 1 January 2010 and 13 May 2024.

ELIGIBILITY CRITERIA

English language systematic reviews focusing on inclusion and reporting of ethnicity variables. Methodological quality was assessed using the AMSTAR 2 tool.

RESULTS

Sixty-two systematic reviews were included. Findings point to limited representation and reporting of ethnic diversity in trials. Recruitment strategies commonly reported by the reviews were community engagement, advertisement, face-to-face recruitment, cultural targeting, clinical referral, community presentation, use of technology, incentives and research partnership with communities. Retention strategies highlighted by the reviews included frequent follow-ups on participants to check how they are doing in the study, provision of incentives, use of tailored approaches and culturally appropriate interventions. The findings point to a limited focus on the analysis of variables relevant to ethnic diversity in trials even when they are reported in trials.

CONCLUSION

Significant improvements are required in enhancing the recruitment and retention of ethnically diverse participants in trials as well as analysis and reporting of variables relating to diversity in clinical trials.

PROSPERO REGISTRATION NUMBER

CRD42022325241.

Legacy of the Role of Medicine and Nursing in the Holocaust: An Educational Intervention to Support Nursing Student Professional Identity Formation and Ethical Conduct

ABSTRACT

Reflecting on history of medicine and nursing in the Holocaust scaffolds professional identity formation. Students grapple with 1) nurses' active participation in identifying/killing patients with mental and physical disabilities, camouflaged as "euthanasia" or "mercy killing" of German citizens and others, preceding mass murder of Jews and others at death camps; 2) involvement in unethical, cruel experiments; 3) resistance narratives; and 4) relevance for contemporary nursing. Impact of a seminar/colloquium on historical knowledge and personal/professional relevance included reported increased historical awareness/knowledge and themes of nurse as patient advocate/judicious obedience, importance of ethics/values adherence, and value of art/reflective writing for processing experience.

"Where my responsibility lies": Reflecting on medicine during the Holocaust to support personal and professional identity formation in health professions education

Objectives

Physicians and the medical/scientific establishment during Nazism and the Holocaust committed egregious ethical violations including complicity with genocide. Critical reflection on this history serves as a powerful platform for scaffolding morally resilient professional identity formation (PIF) with striking relevance for contemporary health professions education and practice. Study aim was to explore the impact of an Auschwitz Memorial study trip within the context of a medicine during Nazism and the Holocaust curriculum on students' personal and PIF.

Methods

The authors analyzed 44 medical and psychology students' reflective writings from a 2019 Auschwitz Memorial study trip using immersion-crystallization qualitative thematic analysis.

Results

Six distinct themes and 22 subthemes were identified and mapped to a reflective learning process model: 1. "What am I bringing?" 2. "What am I experiencing through the curriculum?" 3. "What am I initially becoming aware of as a first response?" 4./5. "How and what am I processing?" 6. "What am I taking with me?" Particularly compelling subthemes of power of the place, emotional experience, reflection on myself as a moral person, and contemporary relevance referred to impactful course elements.

Conclusions

This curriculum catalyzed a critically reflective learning/meaning-making process supporting personal and PIF including critical consciousness, ethical awareness, and professional values. Formative curriculum elements include narrative, supporting emotional aspects of learning, and guided reflection on moral implications. The authors propose Medicine during Nazism and the Holocaust curriculum as a fundamental health professions education component cultivating attitudes, values, and behaviors for empathic, moral leadership within inevitable healthcare challenges.

Anatomy From Nazi Germany to Today

This viewpoint reviews the anatomical body procurement used in Nazi Germany, notes the continued use of those images, and calls for disclosure of the biographical history of the people whose bodies and tissues are now studied.

Medicine during the Nazi period and the Holocaust: what are the implications? An interview with Volker Roelcke

In this interview, Volker Roelcke explains and analyzes historical evidence refuting erroneous assumptions about medical atrocities committed by physicians during the Nazi era, provides insight into the implications of medicine during the Nazi period and the Holocaust for medicine and bioethics today, analyzes the history of the term "genocide," and suggests formats for future teaching, among other topics.

The evolution of hypothermia for neuroprotection after cardiac arrest: a history in the making

While much has been observed regarding hypothermia by way of environmental exposure, it is modern day medicine that deployed hypothermia as a therapeutic. From the early 1930s, when Temple Fay deployed "refrigeration" to treat pain, to the work of Wilfred Bigelow and Charles Drew, who utilized hypothermia in open heart surgery-the opportunities seemed endless. However, questions arose surrounding appropriate temperatures to achieve best outcomes and how to minimize adverse events, such as coagulopathy and infection. In the 1980s, hypothermia underwent a resurgence through Peter Safar's critical studies in large animals, which quickly translated into feasibility studies and the landmark trials of 2002 that paved the way for postcardiac arrest care as we currently know it. Through clinical and observational trials, modern-day targeted temperature management continues to adapt, striving to improve patient outcomes. While hypothermia has come a long way from the writings of Hippocrates, the ideal therapy has not yet been defined, and more work is needed. While the history is long, there is more to be written and advances to be achieved as we optimize the neuroprotective effects of hypothermia for comatose survivors of cardiac arrest.

Towards Informed Use of the Pernkopf Atlas

Knowledge of the dark history and inherent ethical dilemmas of Pernkopf's atlas is essential to individual decisions on use. Seventy-five years after the Holocaust, the legacy of Pernkopf's Atlas of Topographical and Applied Human Anatomy continues to unfold. Informed use of the atlas needs to be integrated in academia and in practice. This paper advocates for the adoption of The Vienna Protocol and improving informed use of the atlas by: (1) updating and inserting an information letter in as many volumes as possible, so that the history can be known before use; (2) conducting and publishing a research study within the medical art community, to examine knowledge of the history of the atlas and elevate awareness; and (3) creating a museum archive and permanent exhibition of the original anatomical illustrations, to document historical facts, disseminate visual evidence, and illuminate embedded controversies. Moving towards informed use, in these ways, provides opportunities for continued ethical discourse, personal reflection and future Holocaust education. Through informed use we memorialize and pay tribute to the Nazi victims portrayed in the atlas.

Guest Editor's Remarks: Journal of Biocommunication Special Issue on Legacies of Medicine in the Holocaust and the Pernkopf Atlas

The 2019 Toronto Symposium, THE VIENNA PROTOCOL: Medicine's Confrontation with Continuing Legacies of its Nazi Past, was sponsored by Biomedical Communications, Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto and the Neuberger Centre for Holocaust Education. https://www.holocaustcentre.com/hew-2019/the-vienna-protocol   Prof. Leila Lax, coordinated the Symposium and was inspired by its presenters to create an online collection of Holocaust education resources. She is grateful to the Editor-in-Chief, Gary Schnitz and the Journal of Biocommunication Management Board for their dedication to scholarship, ethics, and the advancement of knowledge, in support of this Special Issue, that deals with contemporary controversies from a dark time in history, that is part of our professional legacy - and memory. This Special Issue is dedicated to the memory of the victims portrayed in the Pernkopf atlas. Image credit: Table of Contents image provided by the Medical University of Vienna, MUW-AD-003250-5-ABB-151.  

Books, bones and bodies: The relevance of the history of anatomy in Nazi Germany for medical education today

The history of anatomy in Nazi Germany highlights the consequences to humanity when the destructive potentials immanent to all science and medicine are enabled by an anti-democratic, totalitarian regime. Anatomy presents an example of ethical transgressions by scientists and health care professionals that were amplified in the criminal political climate of the Nazi regime. This can happen anywhere, as science is never apolitical. This article gives a short account of anatomy in Nazi Germany, which is followed by an outline of the tangible and intangible legacies from this history, to then discuss implications for anatomy education today. While Jewish and politically dissident anatomists were forced out of their positions and country by the Nazi regime, the majority of the remaining anatomists joined the Nazi party and used bodies of Nazi victims for education and research. Some anatomists even performed deadly human experiments. Patterns and legacies that emerge from this history can be traced into the present and concern research ethics in general and anatomical body procurement specifically. They shed light on current practices and controversies in the anatomical sciences, including anthropology. It will be argued here that the history of anatomy in Nazi Germany can inform current anatomy education in a concept of anatomy as the first "clinical discipline." By integrating insights from the history of anatomy into the learning process, anatomy education can model an approach to medicine that includes a full appreciation of the shared humanity of medical practitioners and patients.