Pascal's Wager, infective endocarditis and the "no-lose" philosophy in medicine

Big Data and Digitalization in Dentistry: A Systematic Review of the Ethical Issues

Big Data and Internet and Communication Technologies (ICT) are being increasingly implemented in the healthcare sector. Similarly, research in the field of dental medicine is exploring the potential beneficial uses of digital data both for dental practice and in research. As digitalization is raising numerous novel and unpredictable ethical challenges in the biomedical context, our purpose in this study is to map the debate on the currently discussed ethical issues in digital dentistry through a systematic review of the literature. Four databases (Web of Science, Pub Med, Scopus, and Cinahl) were systematically searched. The study results highlight how most of the issues discussed by the retrieved literature are in line with the ethical challenges that digital technologies are introducing in healthcare such as privacy, anonymity, security, and informed consent. In addition, image forgery aimed at scientific misconduct and insurance fraud was frequently reported, together with issues of online professionalism and commercial interests sought through digital means.

NICE guidance on antibiotic prophylaxis to prevent infective endocarditis: a survey of clinicians' attitudes

BACKGROUND

Since the introduction of the National Institute for Health and Clinical Excellence (NICE) guideline (CG064) in 2008 recommending cessation of antibiotic prophylaxis (AP) against infective endocarditis (IE), low level prescribing persists in the UK and is a potential reason why there has been no significant change in the general upward trend in cases of IE.

AIM

To undertake a survey of dentists (Ds), cardiologists and cardiothoracic surgeons (C/CTSs) and infection specialists (ISs) to determine why this might be the case.

DESIGN

Internet questionnaire-based survey.

METHODS

A questionnaire was distributed by email to specialists via UK national societies.

RESULTS

A total of 1168 responses were received. All the specialist groups are aware of the guideline (99%). Ds are broadly satisfied, whereas C/CTSs are not. Most Ds follow the NICE guidance (87%), whereas many C/CTSs (39%) do not; ISs adopt a middle course (56%). Even amongst Ds, a significant proportion believe that patients with a prosthetic heart valve (25%) or previous history of IE (38%) should receive AP. A total of 36% of Ds have prescribed AP since March 2008 and many have undertaken procedures where AP has been prescribed by someone else. The majority of respondents (65%) feel that more evidence is required, preferably in the form of a randomized controlled trial.

CONCLUSION

Many patients perceived to be at high risk of IE are still receiving AP in conflict with current NICE guidance.