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Zhou XD, Zhang Y, Jiang LF, Zhang JJ, Zhou D, Wu LD, Huang Y, Xu NW. Efficacy and Safety of Tranexamic Acid in Intertrochanteric Fractures: A Single-Blind Randomized Controlled Trial. Orthop Surg 2019; 11:635-642. [PMID: 31419080 PMCID: PMC6712408 DOI: 10.1111/os.12511] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 07/04/2019] [Accepted: 07/10/2019] [Indexed: 12/31/2022] Open
Abstract
Objective To investigate the efficacy and safety of tranexamic acid (TXA) in the reduction of bleeding and the need for transfusion in elderly intertrochanteric fracture patients. Methods A total of 100 patients with intertrochanteric fractures undergoing surgery were enrolled and randomly allocated to the TXA group in which patients (75.10 ± 8.27 years old) were treated with 1 g of TXA, or the control group (77.82 ± 6.42 years old) treated with a placebo. Surgery was performed by two senior orthopaedic surgeons from two institutions. The proximal femoral nail antirotation (PFNA) was conducted using the standard procedure. Three outcome measures, including blood loss, transfusion, and complications, were recorded. Blood loss and transfusion were investigated to assess TXA's effectiveness, while complications were investigated to assess TXA's safety. Statistical indicators for blood loss included total, intraoperative, postoperative, and hidden blood loss volumes, calculated by hemoglobin levels, hematocrit levels, and drainage volume. The number and amount of blood transfusions were recorded. Complications associated with surgery, including deep vein thrombosis, pulmonary embolism, wound hematoma, wound infection, cardiovascular and cerebrovascular accidents, and respiratory infections, were also recorded. Results All patients were followed up for 1 month after surgery. There were no significant differences in demographic and clinical characteristics between the two groups. The TXA group suffered significantly less total blood loss (563.37 ± 197.51 vs 819.25 ± 273.96 mL, 95% CI: −349.49 to −162.27, P < 0.01), intraoperative blood loss (140.3 ± 80.64 vs 230.5 ± 130.56 mL, 95% CI −132.74 to −47.66, P < 0.01), and hidden blood loss (410.42 ± 178.23 vs 571.19 ± 218.13 mL, 95% CI: −238.85 to −82.69, P < 0.01) than the control group. However, postoperative total blood loss was not significantly different (97.5 ± 20.93 vs 94.7 ± 35.78 mL; P = 0.63). A total of 5 patients from the TXA group and 27 from the control group received packed RBC for postoperative transfusion, but the mean number of transfusion units was not significantly different between groups. Complications including deep vein thrombosis, pulmonary embolism, myocardial infarction, ischemic cerebral infarction, hematoma, and infection were observed in both groups, but no significant differences were found. Conclusions In intertrochanteric fracture surgery performed using PFNA, intravenous administration of TXA significantly reduced the risk of intraoperative, total and hidden blood loss, in addition to the need for allogeneic transfusion, without increasing the rate of complications.
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Affiliation(s)
- Xin-Die Zhou
- Department of Orthopaedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Yi Zhang
- Department of Orthopaedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Li-Feng Jiang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jun-Jie Zhang
- Department of Orthopaedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Dong Zhou
- Department of Orthopaedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Li-Dong Wu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yong Huang
- Department of Orthopaedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Nan-Wei Xu
- Department of Orthopaedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
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Browne JL, Rees CO, van Delden JJM, Agyepong I, Grobbee DE, Edwin A, Klipstein-Grobusch K, van der Graaf R. The willingness to participate in biomedical research involving human beings in low- and middle-income countries: a systematic review. Trop Med Int Health 2019; 24:264-279. [PMID: 30565381 PMCID: PMC6850431 DOI: 10.1111/tmi.13195] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objectives To systematically review reasons for the willingness to participate in biomedical human subjects research in low‐ and middle‐income countries (LMICs). Methods Five databases were systematically searched for articles published between 2000 and 2017 containing the domain of ‘human subjects research’ in ‘LMICs’ and determinant ‘reasons for (non)participation’. Reasons mentioned were extracted, ranked and results narratively described. Results Ninety‐four articles were included, 44 qualitative and 50 mixed‐methods studies. Altruism, personal health benefits, access to health care, monetary benefit, knowledge, social support and trust were the most important reasons for participation. Primary reasons for non‐participation were safety concerns, inconvenience, stigmatisation, lack of social support, confidentiality concerns, physical pain, efficacy concerns and distrust. Stigmatisation was a major concern in relation to HIV research. Reasons were similar across different regions, gender, non‐patient or patient participants and real or hypothetical study designs. Conclusions Addressing factors that affect (non‐)participation in the planning process and during the conduct of research may enhance voluntary consent to participation and reduce barriers for potential participants.
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Affiliation(s)
- Joyce L Browne
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Connie O Rees
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johannes J M van Delden
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Irene Agyepong
- Ghana Health Service, Research and Development Division, Accra, Ghana.,Public Health Faculty, Ghana College of Physicians and Surgeons, Accra, Ghana
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ama Edwin
- Department of Psychological Medicine and Mental Health, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rieke van der Graaf
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Tchuandom SB, Tchouangueu TF, Antonio-Nkondjio C, Lissom A, Djang JON, Atabonkeng EP, Kechia A, Nchinda G, Kuiate JR. Seroprevalence of dengue virus among children presenting with febrile illness in some public health facilities in Cameroon. Pan Afr Med J 2018; 31:177. [PMID: 31086629 PMCID: PMC6488248 DOI: 10.11604/pamj.2018.31.177.16390] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 08/21/2018] [Indexed: 01/05/2023] Open
Abstract
Introduction A routine diagnosis of Dengue virus (DENV) infection is not usually conducted in hospitals. Because symptoms overlap, many potential febrile illnesses due to DENV may be confused for malaria, typhoid or paratyphoid (enteric) fever. The absence of data on DENV exposure rates among children attending health facilities could undermine management of this disease. This study aimed to investigate the seroprevalence of dengue virus infection in children presenting febrile illness in some public health facilities in Cameroon. Methods A cross-sectional study was performed in children ≤ 15 years attending seven urban and three semi-urban public hospitals of Cameroon. From each volunteer, 2ml of whole blood was collected and tested for dengue virus IgM, malaria (Pf/Pan antigens) and enteric fever (Typhoid IgM) using rapid diagnostic tests (RDT); in order to allow the healthcare workers to quickly put the positive cases under appropriate treatment. Positive cases of dengue virus infection were confirmed by indirect ELISA. Data analysis were performed using the statistical package for social sciences software, version 22.1. Results A total of 961 children were enrolled in the study and 492 (51.2%) were infected with at least one of the three pathogens. Overall, DENV IgM seroprevalence among febrile children was 14.4% (138/961). About 390 (40.6%) and 22 (2.3%) had malaria (Pf/Pan Ag) and enteric fever (Typhoid IgM) respectively. Co-infection with dengue virus was found in 51 (5.3%) participants. The dengue virus IgM seroprevalence was higher in Bankim (19.3%), Ntui (18.3%) and Douala (18.2%). Conclusion Dengue virus infection seroprevalence appears to be low in children presenting with febrile illness in the studied health centres in Cameroon but call for more attention and research to further characterise the circulating strains of the dengue virus.
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Affiliation(s)
- Salomon Bonsi Tchuandom
- Department of Biochemistry, University of Dschang, Cameroon.,Public School of medical Laboratory Technicians, Yaoundé, Cameroon
| | - Thibau Flaurant Tchouangueu
- Department of Biochemistry, University of Dschang, Cameroon.,Laboratory of Microbiology and Immunology, Chantal Biya International Reference Centre for Research and Prevention on HIV/AIDS Yaoundé
| | - Christophe Antonio-Nkondjio
- Laboratoire de Recherche sur le Paludisme, Organisation de Coordination pour la lutte Contre les Endémies en Afrique Centrale (OCEAC), Yaoundé, Cameroun
| | - Abel Lissom
- Department of Animal Biology and Physiology, University of Yaoundé 1, Yaoundé
| | | | | | | | - Godwin Nchinda
- Laboratory of Microbiology and Immunology, Chantal Biya International Reference Centre for Research and Prevention on HIV/AIDS Yaoundé
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Geller SE, Patel A, Niak VA, Goudar SS, Edlavitch SA, Kodkany BS, Derman RJ. Conducting International Collaborative Research in Developing Nations. Int J Gynaecol Obstet 2017; 87:267-71. [PMID: 15548406 DOI: 10.1016/j.ijgo.2004.08.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2004] [Revised: 08/24/2004] [Accepted: 08/24/2004] [Indexed: 11/23/2022]
Abstract
International research partnerships bring together some of the best and the brightest in an effort to tackle global health problems. Such collaborations also pose complex challenges, such as maintaining ethical principles in the conduct of research in developing nations. In implementing a randomized clinical trial to reduce postpartum hemorrhage (PPH) during childbirth in rural India, U.S. and Indian collaborators addressed three such issues: the appropriateness of an ethical randomized controlled trial in the developing world, the inclusion of a placebo arm, and the relevance of informed consent in a semiliterate rural population.
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Affiliation(s)
- S E Geller
- Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, IL 60612, USA.
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5
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Kaddoura M, Van-Dyke O, Yang Q. Impact of a concept map teaching approach on nursing students' critical thinking skills. Nurs Health Sci 2016; 18:350-4. [PMID: 26891960 DOI: 10.1111/nhs.12277] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 12/24/2015] [Accepted: 01/06/2016] [Indexed: 12/31/2022]
Abstract
Nurses confront complex problems and decisions that require critical thinking in order to identify patient needs and implement best practices. An active strategy for teaching students the skills to think critically is the concept map. This study explores the development of critical thinking among nursing students in a required pathophysiology and pharmacology course during the first year of a Bachelor of Science in Nursing in response to concept mapping as an interventional strategy, using the Health Education Systems, Incorporated critical thinking test. A two-group experimental study with a pretest and posttest design was used. Participants were randomly divided into a control group (n = 42) taught by traditional didactic lecturing alone, and an intervention group (n = 41), taught by traditional didactic lecturing with concept mapping. Students in the concept mapping group performed much better on the Health Education Systems, Incorporated than students in the control group. It is recommended that deans, program directors, and nursing faculties evaluate their curricula to integrate concept map teaching strategies in courses in order to develop critical thinking abilities in their students.
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Affiliation(s)
| | - Olga Van-Dyke
- School of Nursing, Massachusetts College of Pharmacy and Health Sciences (MCPHS University), Boston, Massachusetts, USA
| | - Qing Yang
- School of Nursing, Duke University, Durham, North Carolina, USA
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6
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Five-year clinical outcome of posterior zirconia ceramic inlay-retained FDPs with a modified design. J Dent 2015; 43:1411-5. [DOI: 10.1016/j.jdent.2015.11.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 09/29/2015] [Accepted: 11/05/2015] [Indexed: 11/22/2022] Open
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7
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Chaar MS, Passia N, Kern M. Ten-year clinical outcome of three-unit posterior FDPs made from a glass-infiltrated zirconia reinforced alumina ceramic (In-Ceram Zirconia). J Dent 2015; 43:512-7. [PMID: 25765867 DOI: 10.1016/j.jdent.2015.02.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 02/15/2015] [Accepted: 02/26/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To evaluate the long-term survival and complication rates of posterior three-unit fixed dental prostheses (FDPs) fabricated from a glass-infiltrated zirconia reinforced alumina ceramic (In-Ceram Zirconia). METHODS Fifty-eight patients received 65 FDPs. Twelve FDPs replaced the second premolar (8 in the maxilla, 4 in the mandible), and 53 replaced the first molar (19 in the maxilla, 34 in the mandible). The In-Ceram Zirconia ceramic frameworks were designed and milled using the Cerec CAD/CAM system. The minimum dimension of the proximal connectors of the frameworks was 12 mm(2) and 16 mm(2) for premolars and molars, respectively. After milling and glass infiltration, the frameworks were veneered with a feldspathic ceramic. All FDPs were cemented with glass-ionomer cement. The patients were recalled 6-12 months after placement, and then annually. Kaplan-Meier analysis was used to calculate the survival and complication rates of the FDPs. RESULTS The mean observation time was 9.7 years. Six patients with 6 FDPs were regarded as dropouts. Using the Kaplan-Meier method the 10-year cumulative survival rate was 93.6%. In a worst-case scenario, in which the 6 missing FDPs are considered as failed, the 10-year survival rate would be 84.6%. CONCLUSION Three-unit posterior FDPs made from In-Ceram Zirconia presented a 10-year survival rate similar to that reported for conventional FDPs. However more technical and biological complications were reported. CLINICAL SIGNIFICANCE Three-unit posterior FDP made from In-Ceram Zirconia may be a viable treatment modality, taking the strict adherence to the manufacturer's recommendations into consideration.
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Affiliation(s)
- M Sad Chaar
- Department of Prosthodontics, Propaedeutics and Dental Materials, School of Dentistry, Christian-Albrechts University, Kiel, Germany.
| | - Nicole Passia
- Department of Prosthodontics, Propaedeutics and Dental Materials, School of Dentistry, Christian-Albrechts University, Kiel, Germany
| | - Matthias Kern
- Department of Prosthodontics, Propaedeutics and Dental Materials, School of Dentistry, Christian-Albrechts University, Kiel, Germany
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Goldenberg MJ. Placebo orthodoxy and the double standard of care in multinational clinical research. THEORETICAL MEDICINE AND BIOETHICS 2015; 36:7-23. [PMID: 25663050 DOI: 10.1007/s11017-015-9317-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
It has been almost 20 years since the field of bioethics was galvanized by a controversial series of multinational AZT trials employing placebo controls on pregnant HIV-positive women in the developing world even though a standard of care existed in the sponsor countries. The trove of ethical investigations that followed was thoughtful and challenging, yet an important and problematic methodological assumption was left unexplored. In this article, I revisit the famous "double standard of care" case study in order to offer novel consideration of the placebo orthodoxy that underlies much of the ethical debate. This majority view found in medical research is that placebo-controlled trials are methodologically superior to comparative trials that use active controls. I challenge this orthodoxy and argue that lives were unnecessarily lost in these trials as a result. Furthermore, current HIV research on vaccines and microbicides is now poised to repeat the error of subscribing to the placebo orthodoxy.
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Affiliation(s)
- Maya J Goldenberg
- Department of Philosophy, University of Guelph, Guelph, ON, N1G 2W1, Canada,
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9
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Kapiriri L, Lavery JV, Singer PA, Mshinda H, Babiuk L, Daar AS. The case for conducting first-in-human (phase 0 and phase 1) clinical trials in low and middle income countries. BMC Public Health 2011; 11:811. [PMID: 22008649 PMCID: PMC3339411 DOI: 10.1186/1471-2458-11-811] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Accepted: 10/18/2011] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Despite the increase in the number of clinical trials in low and middle income countries (LMICs), there has been little serious discussion of whether First in Human (FIH; phase 0 and phase 1) clinical trials should be conducted in LMICs, and if so, under what conditions. Based on our own experience, studies and consultations, this paper aims to stimulate debate on our contention that for products meant primarily for conditions most prevalent in LMICs, FIH trials should preferably be done first in those countries. DISCUSSION There are scientific and pragmatic arguments that support conducting FIH trials in LMIC. Furthermore, the changing product-development and regulatory landscape, and the likelihood of secondary benefits such as capacity building for innovation and for research ethics support our argument. These arguments take into account the critical importance of protecting human subjects of research while developing capacity to undertake FIH trials. SUMMARY While FIH trials have historically not been conducted in LMICs, the situation in some of these countries has changed. Hence, we have argued that FIH should be conducted in LMICs for products meant primarily for conditions that are most prevalent in those contexts; provided the necessary protections for human subjects are sufficient.
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Affiliation(s)
- Lydia Kapiriri
- Department of Health Aging and Society, McMaster University, 1280 Main St. W, Hamilton, Ontario, L8S 4M4, Canada
| | - James V Lavery
- Centre for Research on Inner City Health and Centre for Global Health Research, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital & University of Toronto 209 Victoria St, 3rd floor, Toronto, Ontario, M5B 1C6, Canada
| | - Peter A Singer
- Centre for Global Health MaRS Centre, South Tower, 101 College Street, Suite 406, Toronto, Ontario, M5G 1L7, Canada
| | - Hassan Mshinda
- Tanzania Commission for Science and Technology, P.O. BOX 4302, Dar es salaam, Tanzania
| | - Lorne Babiuk
- University of Alberta, University of Alberta, 1-20 University Hall, Edmonton, Alberta, T6G 2J9, Canada
| | - Abdallah S Daar
- Centre for Global Health MaRS Centre, South Tower, 101 College Street, Suite 406, Toronto, Ontario, M5G 1L7, Canada
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Abstract
Contemporary research ethics policies started with reflection on the atrocities perpetrated upon concentration camp inmates by Nazi doctors. Apparently, as a consequence of that experience, the policies that now guide human subject research focus on the protection of human subjects by making informed consent the centerpiece of regulatory attention. I take the choice of context for policy design, the initial prioritization of informed consent, and several associated conceptual missteps, to have set research ethics off in the wrong direction. The aim of this paper is to sort out these confusions and their implications and to offer instead a straightforward framework for considering the ethical conduct of human subject research. In the course of this discussion I clarify different senses of autonomy that have been confounded and present more intelligible justifications for informed consent. I also take issue with several of the now accepted dogmas that govern research ethics. These include: the primacy of informed consent, the protection of the vulnerable, the substitution of beneficence for research's social purpose, and the introduction of an untenable distinction between innovation and research.
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11
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Cáceres CF, Mendoza W. Globalized research and "national science": the case of Peru. Am J Public Health 2009; 99:1792-8. [PMID: 19696375 DOI: 10.2105/ajph.2008.159236] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Issues in the area of international health research are insufficiently discussed in Latin America. We examine the practices of stakeholders such as the state and the academic community regarding research policy processes and funding sources in Peru. Our findings showed that research policy development and evaluation processes are poor in Peru, most of the country's academic research is published in English only, and researchers' access to funding is limited. Given that the relationship between local academic institutions and foreign research centers is key in developing a "national science," there is a clear need to reinforce the state's capacities for management and research oversight and implementation and to encourage the academic community to improve their institutional policies and research frameworks.
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Affiliation(s)
- Carlos F Cáceres
- Institute of Studies in Health, Sexuality and Human Development, Cayetano Heredia University School of Public Health, Av. Armendáriz 445, Lima 18, Peru.
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12
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Klitzman R. Views of the process and content of ethical reviews of HIV vaccine trials among members of US institutional review boards and South African research ethics committees. Dev World Bioeth 2009; 8:207-18. [PMID: 19046258 DOI: 10.1111/j.1471-8847.2007.00189.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Given the ethical controversies concerning HIV vaccine trials (HVTs), we aimed to understand through an exploratory study how members of institutional review boards (IRBs) in the United States (US) and research ethics committees (RECs) in South Africa (SA) view issues concerning the process and content of reviews of these studies. We mailed packets of 20 questionnaires to 12 US IRB chairs and administrators and seven REC chairs to distribute to their members. We received 113 questionnaires (76 from the US and 37 from SA). In both countries, members tended to be white males with advanced academic degrees. Compared to the US, SA members called for 'major changes' in HVT protocols more frequently (p = 0.004), and were less likely to think that HVT participants understood risks and benefits (p = 0.033) or informed consent forms (p = 0.000). In both countries, members were divided on several critical issues (e.g. the minimum standard for treatment for HVT participants who became infected during the HVT), but agreed that they needed more training. Of the SA respondents, 40% reported that they were 'self-taught' in ethics. This study, the first we know of to offer quantitative data comparing US vs. non-US IRBs/RECs, thus suggests key similarities and differences (e.g. compared to SA respondents, US respondents appeared to overestimate participants' understanding of informed consent), along with needs for education. These initial exploratory data in this area have important implications for IRBs, RECs, policy-makers and scholars concerning future practice, training, policy, and investigations in research ethics, and prevention and treatment of HIV and other diseases in the developing world and elsewhere.
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Affiliation(s)
- Robert Klitzman
- Columbia University College of Physicians and Surgeons, New York, NY 10032USA.
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Levine RJ. Reflections on 'Rethinking research ethics'. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2005; 5:1-3; author reply W15-8. [PMID: 16036649 DOI: 10.1080/15265160590944076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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14
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Abstract
Contemporary research ethics policies started with reflection on the atrocities perpetrated upon concentration camp inmates by Nazi doctors. Apparently, as a consequence of that experience, the policies that now guide human subject research focus on the protection of human subjects by making informed consent the centerpiece of regulatory attention. I take the choice of context for policy design, the initial prioritization of informed consent, and several associated conceptual missteps, to have set research ethics off in the wrong direction. The aim of this paper is to sort out these confusions and their implications and to offer instead a straightforward framework for considering the ethical conduct of human subject research. In the course of this discussion I clarify different senses of autonomy that have been confounded and present more intelligible justifications for informed consent. I also take issue with several of the now accepted dogmas that govern research ethics. These include: the primacy of informed consent, the protection of the vulnerable, the substitution of beneficence for research's social purpose, and the introduction of an untenable distinction between innovation and research.
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15
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Abstract
The World Medical Association's Declaration of Helsinki was first adopted in 1964. In its 40-year lifetime the Declaration has been revised five times and has risen to a position of prominence as a guiding statement of ethical principles for doctors involved in medical research. The most recent revision, however, has resulted in considerable controversy, particularly in the area of the ethical requirements surrounding placebo-controlled trials and the question of responsibilities to research participants at the end of a study. This review considers the past versions of the Declaration of Helsinki and asks the question: How exactly has the text of the Declaration changed throughout its lifetime? Regarding the present form of the Declaration of Helsinki we ask: What are the major changes in the most recent revision and what are the controversies surrounding them? Finally, building on the detailed review of the past and present versions of the Declaration of Helsinki, we give consideration to some of the possible future trajectories for the Declaration in the light of its history and standing in the world of the ethics of medical research.
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Affiliation(s)
- Robert V Carlson
- Clinical Pharmacology Unit, University of Edinburgh, Western General Hospital, UK.
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Orentlicher D. Universality and its limits: when research ethics can reflect local circumstances. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2002; 30:403-410. [PMID: 12497700 DOI: 10.1111/j.1748-720x.2002.tb00409.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Studies in several developing countries for treatmen to prevent HIV-transmission from mother to child generated considerable controversy in 1997. Critics of the studies argued that basic principles of research ethics were violated. According to the critics, researchers subjected women in developing countries to studies that would have been unethical in the United States (and other developed countries) and that the researchers were therefore engaged in unethical exploitation ofcitizens of the developing countries in which the studies were conducted.While the critics agreed that unethical exploitation had occurred, they differed on the exact nature of the exploitation. Some observers condemned the researchers for employing a double standard — because the researchers were applying a standard of care that would have been unacceptable in their own country. In the view of these critics, researchers should have been comparing the experimental treatment to established therapy rather than to placebo, as would have been required in the United States or other developed countries.
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Affiliation(s)
- David Orentlicher
- Center for Law and Health, Indiana University School of Law-Indianapolis, USA
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