1
|
Vie KJ. Empowering the Research Community to Investigate Misconduct and Promote Research Integrity and Ethics: New Regulation in Scandinavia. SCIENCE AND ENGINEERING ETHICS 2022; 28:59. [PMID: 36396797 PMCID: PMC9671971 DOI: 10.1007/s11948-022-00400-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
Researchers sometimes engage in various forms of dishonesty and unethical behavior, which has led to regulatory efforts to ensure that they work according to acceptable standards. Such regulation is a difficult task, as research is a diverse and dynamic endeavor. Researchers can disagree about what counts as good and acceptable standards, and these standards are constantly developing. This paper presents and discusses recent changes in research integrity and ethics regulation in Norway, Denmark, and Sweden. Recognizing that research norms are developed through practice and are therefore unsuited for comprehensive national regulation, the Scandinavian countries focus on empowering the research community to regulate itself instead, except for the most severe cases of misconduct. This empowerment takes the form of giving research institutions tools and investigatory powers while also holding them responsible for ensuring that both the institution and individual researchers are up to date on relevant norms. In this way, the Scandinavian governments seek to avoid some of the challenges found in more legalistic approaches, which risk lagging behind the continuous development of research norms and can be insensitive to the fact that different disciplines have different norms. While the new approach in Scandinavian has several potential benefits, it also involves potential trade-offs and limitations. The new laws can create confusion about what researchers are allowed to do. Another issue is that it only addresses the fundamental drivers of misconduct to a limited extent.
Collapse
Affiliation(s)
- Knut Jørgen Vie
- TIK Centre for Technology, Innovation and Culture, University of Oslo, Sognsveien 77B, 3. Et., 0855, Oslo, Norway.
| |
Collapse
|
2
|
Nichol G, Zhuang R, Russell R, Holcomb JB, Kudenchuk PJ, Aufderheide TP, Morrison L, Sugarman J, Ornato JP, Callaway CW, Vaillancourt C, Bulger E, Christenson J, Daya MR, Schreiber M, Idris A, Podbielski JM, Sopko G, Wang H, Wade CE, Hoyt D, Weisfeldt ML, May S. Variation in time to notification of enrollment and rates of withdrawal in resuscitation trials conducted under exception from informed consent. Resuscitation 2021; 168:160-166. [PMID: 34384820 DOI: 10.1016/j.resuscitation.2021.07.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/19/2021] [Accepted: 07/27/2021] [Indexed: 12/30/2022]
Abstract
IMPORTANCE Emergency research is challenging to do well as it involves time sensitive interventions in unstable patients. There is limited time to obtain informed consent from the patient or their legally authorized representative (LAR). Such research is permitted under exception from informed consent (EFIC) if specific criteria are met, including notification after enrollment. Some question whether the risks of EFIC outweighs its benefits. To date, there is limited empiric information about time to notification (TTN) and rates of withdrawal in such trials. OBJECTIVE To describe variation in TTN and rates of withdrawal among that patients enrolled in EFIC trials over a twelve-year period. DESIGN We performed post hoc descriptive analyses of data from five trials conducted under EFIC. SETTING Emergency medical services and receiving hospitals participating in the Resuscitation Outcomes Consortium in the United States and Canada. PARTICIPANTS Patients with out-of-hospital cardiac arrest or life-threatening traumatic injury. EXPOSURES Notification strategies were specified at each site before initiation of enrollment by a local institutional review board. We monitored TTN within each site centrally throughout each study's enrollment period. OUTCOMES TTN was defined as time from randomization to first-reported notification of patient or LAR of enrollment. Withdrawal was defined as patient or LAR opt out of ongoing participation at the time of notification. RESULTS Of 35,442 patients enrolled in five trials, 33,805 had cardiac arrest; and 1636 had traumatic injury. TTN varied overall and by patient outcome. Among those with cardiac arrest, TTN ranged from median (5%ile, 95%ile) of 6 (1,27) days to 28 (2, 53) days across sites. 0.3% of notified patients with cardiac arrest withdrew. Among those with traumatic injury, TTN ranged from 0 (0, 5) days to 36 (5, 68) days across sites. 7.7% of notified patients with traumatic injury withdrew. CONCLUSIONS AND RELEVANCE There is large variation in TTN in trials conducted under EFIC for emergency research. This may be due to several factors. It may or may not be modifiable. Overall rates of withdrawal are low, which suggests current practices related to EFIC are acceptable to those who have participated in emergency research.
Collapse
Affiliation(s)
- Graham Nichol
- University of Washington-Harborview Center for Prehospital Emergency Care, Departments of Medicine and Emergency Medicine, University of Washington, Seattle, WA, United States.
| | - Rui Zhuang
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Renee Russell
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - John B Holcomb
- Center for Injury Science, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Peter J Kudenchuk
- King County EMS and Departments of Medicine, University of Washington, Seattle, WA, United States
| | - Tom P Aufderheide
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Laurie Morrison
- Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Division of Emergency Medicine, Department of Medicine, University of Toronto, Ottawa, ON and Vancouver, BC, Canada
| | - Jeremy Sugarman
- Berman Institute of Bioethics, Department of Medicine and Department of Health Policy and Management, Johns Hopkins University, Baltimore, MD, United States
| | - Joseph P Ornato
- Department of Emergency Medicine, Virginia Commonwealth University Health, Richmond, VA, United States
| | - Clifton W Callaway
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Christian Vaillancourt
- Ottawa Hospital Research Institute and Department of Emergency Medicine, University of Ottawa, Ottawa, ON, United States
| | - Eileen Bulger
- Department of Surgery, University of Washington, Seattle, WA, United States
| | - Jim Christenson
- Department of Emergency Medicine, University of British Columbia, Providence Health Care Research Institute, Vancouver, BC, United States
| | - Mohamud R Daya
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Marty Schreiber
- Department of Surgery, Oregon Health & Science University, Portland, OR, United States
| | - Ahamed Idris
- Department of Emergency Medicine, University of Texas Southwestern, Dallas, TX, United States
| | - Jeanette M Podbielski
- Department of Surgery, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - George Sopko
- National Heart Lung Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Henry Wang
- Department of Emergency Medicine, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Charles E Wade
- Department of Surgery, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - David Hoyt
- American College of Surgeons, Chicago, IL, United States
| | - Myron L Weisfeldt
- Department of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Susanne May
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| |
Collapse
|
3
|
Abstract
OBJECTIVE The objective of this project was to determine how investigators conduct clinical trials in the prehospital setting and to suggest how emergency medical services (EMS) systems can develop the capacity to conduct prehospital clinical research. METHODS A representative sample of U.S.-based study sites was selected from all studies registered on clinicaltrials.gov since the year 2000, where prehospital care providers conducted study-related activities in the prehospital setting. The site principal investigator and the research coordinator or EMS liaison were invited to participate in a structured discussion. A single interviewer conducted each discussion following a structured guide that generically asked for barriers and enablers to the sites' research success and then reviewed commonly identified prehospital research barriers. Notes were taken during each discussion and reviewed for common themes. Themes were reviewed by the project team and sent for comment to all participants. RESULTS Discussions were held with 25 principal investigators, 9 coordinators, and 7 EMS liaisons. A total of 27 communities were represented in the discussions from 22 different states. The communities had a range of research experience from one prehospital trial to multiple trials. Key barriers were funding, ethics approval, data collection, protocol training and compliance, randomizing and blinding interventions, obtaining patient outcomes, adequate study staffing, and partnering with EMS agencies. CONCLUSION This project identified many challenges to EMS research, but they were not insurmountable. Not every community can conduct every prehospital study. Communities should engage in studies that align with their values and resources. Investigators need to develop honest relationships where issues can be openly discussed and the community can collaborate on prehospital research. Learning from those who have overcome challenges may be a key to expanding the quality and quantity of EMS research.
Collapse
|
4
|
Einav S, Kaufman N, O'Connor M. Can anesthesiologists help? Analysis of the american heart association-emergency cardiac care recommendations for cardiopulmonary resuscitation, with a focus on management of airway and breathing. Anesth Analg 2015; 120:484-90. [PMID: 25602457 DOI: 10.1213/ane.0000000000000560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Sharon Einav
- From the *Shaare Zedek Medical Center, Surgical Intensive Care, Jerusalem, Israel; †Shaare Zedek Medical Center, Department of Emergency Medicine and Intensive Care Unit, Jerusalem, Israel; and ‡Department of Anesthesia and Critical Care, The University of Chicago, Chicago, Illinois
| | | | | |
Collapse
|
6
|
International resuscitation research, exception from informed consent, and the European Union Directive 2001/20/EC. Eur J Emerg Med 2009; 16:234-41. [PMID: 19433982 DOI: 10.1097/mej.0b013e32830fe959] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND United States regulations allow a narrow exception from informed consent for a subset of resuscitation research. Such an exception is also allowed under the Declaration of Helsinki. In 2001, a European Union (EU) Directive was passed, which, if enforced literally, could prohibit resuscitation research. The purpose of this study is to assess the knowledge and attitudes of healthcare workers, specifically emergency physicians, with regard to the EU Directive as it applies to resuscitation research and informed consent. METHODS A closed-response survey was distributed in six languages at the Third Mediterranean Emergency Medicine Congress in Nice, France, and to a sample of emergency physicians using a directed approach. Descriptive and bivariate statistics, with a weighting adjustment to account for a disproportionately large number of responses from one country, are reported. RESULTS Two hundred and thirty-two surveys (111 using a weighted analysis) were returned from 26 countries. Sixty-seven percent of EU respondents and 70% of non-EU respondents stated that their country adhered to the Declaration of Helsinki, but only 44% of EU and 43% of non-EU respondents, were aware the Declaration allowed a waiver for resuscitation research. Among EU respondents, 49% were unaware of the EU Directive and another 15%, although aware of the Directive, were unaware of its implications for resuscitation research. CONCLUSION The international regulatory status of consent in resuscitation research is in flux; yet, most emergency physicians are unaware of the potential implications of the EU Directive or the provisions in the Declaration of Helsinki allowing an exemption from informed consent for resuscitation research.
Collapse
|
7
|
Dickert NW, Kass NE. Patients' perceptions of research in emergency settings: a study of survivors of sudden cardiac death. Soc Sci Med 2008; 68:183-91. [PMID: 19004536 DOI: 10.1016/j.socscimed.2008.10.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2008] [Indexed: 11/18/2022]
Abstract
Conditions such as stroke, sudden cardiac death, and major traumatic injury are major causes of morbidity and mortality, and there is a need for clinical research to improve treatment for these conditions. However, because informed consent is often impossible, research in these situations poses ethical concerns. Despite growing literature on the ethics of emergency research, little is known about the views of relevant patient populations regarding research in emergency settings conducted under an exception from informed consent (EFIC). In this qualitative study, survivors of sudden cardiac death (SCD)--recruited from an outpatient cardiology clinic in late 2005--were asked their views on scenarios representing different types of EFIC research. Patients were generally accepting of such research, more than previous studies would have predicted. Their concerns focused primarily on study risks and benefits and less on waiving consent or randomization. EFIC research is of international importance and ethical controversy. This study represents the first attempt to assess views of SCD survivors on this type of research and one of the first to assess patients' views in-depth. Findings indicate broad acceptance of EFIC research among this population and re-focus discussion on what risks are reasonable for non-autonomous subjects. The study also demonstrates potential for valuable input from patients regarding complicated and ethically challenging issues using a method that allows them to develop opinions on unfamiliar issues.
Collapse
Affiliation(s)
- Neal W Dickert
- Division of Cardiology, Emory University, EPICORE, Bldg A, Suite 1N, Mailstop 1256/001/1AR, Atlanta, GA 30322, USA.
| | | |
Collapse
|
9
|
Silverman HJ, Lemaire F. Ethics and research in critical care. Intensive Care Med 2006; 32:1697-705. [PMID: 16896851 DOI: 10.1007/s00134-006-0305-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2006] [Accepted: 06/30/2006] [Indexed: 11/28/2022]
Abstract
BACKGROUND The past few years have witnessed several controversies regarding the ethics of conducting research involving critically ill patients, and such research is ethically challenging. DISCUSSION Research ethics is a changing field, one that is influenced by empirical data, contemporary events, and new ideas regarding aspects of clinical trial design and protection of human subjects. We describe recent thoughts regarding several aspects of research ethics in the critical care context. CONCLUSION The ability of the research community to conduct research ethically and to maintain public trust would benefit from heightened awareness to the principles and requirements that govern such research.
Collapse
Affiliation(s)
- Henry J Silverman
- Department of Medicine, School of Medicine, University of Maryland, Baltimore, MD 21201, USA.
| | | |
Collapse
|