Background: Discussions about medical errors facilitate professional learning for physicians and may provide emotional support after an error, but little is known about physicians’ attitudes and practices regarding error discussions with colleagues.Methods: Survey of faculty and resident physicians in generalist specialties in Midwest, Mid-Atlantic and Northeast regions of the US to investigate attitudes and practices regarding error discussions, likelihood of discussing hypothetical errors, experience role-modelling error discussions and demographic variables.Results: Responses were received from 338 participants . In all, 73% of (...) respondents indicated they usually discuss their mistakes with colleagues, 70% believed discussing mistakes strengthens professional relationships and 89% knew at least one colleague who would be a supportive listener. Motivations for error discussions included wanting to learn whether a colleague would have made the same decision , wanting colleagues to learn from the mistake and wanting to receive support . Given hypothetical scenarios, most respondents indicated they would likely discuss an error resulting in no harm , minor harm or major harm . Fifty-seven percent of physicians had tried to serve as a role model by discussing an error and role-modelling was more likely among those who had previously observed an error discussion .Conclusions: Most generalist physicians in teaching hospitals report that they usually discuss their errors with colleagues, and more than half have tried to role-model discussions. However, a significant number of these physicians report that they do not usually discuss their errors and some do not know colleagues who would be supportive listeners. (shrink)

Background and objective: Code status discussions may fail to address patients’ treatment-related goals and their knowledge of cardiopulmonary resuscitation (CPR). This study aimed to investigate patients’ resuscitation preferences, knowledge of CPR and goals of care. Design, setting, patients and measurements: 135 adults were interviewed within 48 h of admission to a general medical service in an academic medical centre, querying code status preferences, knowledge about CPR and its outcome probabilities and goals of care. Medical records were reviewed for clinical information (...) and code status documentation. Results: 41 (30.4%) patients had discussed CPR with their doctor, 116 (85.9%) patients preferred full code status and 11 (8.1%) patients expressed code status preferences different from the code status documented in their medical record. When queried about seven possible goals of care, patients affirmed an average of 4.9 goals; their single most important goals were broadly distributed, ranging from being cured (n = 36; 26.7%) to being comfortable (n = 8; 5.9%). Patients’ mean estimate of survival to discharge after CPR was 60.4%. Most patients believed it was helpful to discuss goals of care (n = 95; 70.4%) and the chances of surviving inhospital CPR (n = 112; 83.0%). Some patients expressed a desire to change their code status after receiving information about survival following inhospital CPR (n = 11; 8.1%) or after discussing goals of care (n = 2; 1.5%). Conclusions: Doctors need to address patients’ knowledge about CPR and take steps to avoid discrepancies between treatment orders and patients’ preferences. Addressing CPR outcome probabilities and goals of care during code status discussions may improve patients’ knowledge and influence their preferences. (shrink)

"Effective Weight Loss presents 25 detailed sessions of an empirically supported, cognitive-behavioral treatment package called Acceptance-Based Behavioral Treatment. The Clinician Guide is geared towards helping administer treatment, and the companion Workbook provides summaries of session content, exercises, worksheets, handouts, and assignments for patients and clients receiving the treatment"--.

The obesity epidemic is one of the most serious public health threats confronting the nation and the world. The majority of overweight individuals want to lose weight, but the overall success of self-administered diets and commercial weight loss programs is very poor. Scientific findings suggest that the problem boils down to adherence. The dietary and physical activity recommendations that weight loss programs promote are effective; however, people have difficulty initiating and maintaining changes. Effective Weight Loss presents 25 detailed sessions of (...) an empirically supported, cognitive-behavioral treatment package called Acceptance-Based Behavioral Treatment. The foundation of this approach is comprised of the nutritional, physical activity, and behavioral components of the most successful, gold-standard behavioral weight loss programs. These components are synthesized with acceptance, willingness, behavioral commitment, motivation, and relapse prevention strategies drawn from a range of therapies. ABT is based on the idea that specialized self-control skills are necessary for weight control, given our innate desire to consume delicious foods and to conserve energy by avoiding physical activity. These self-control skills revolve around a willingness to choose behaviors that may be perceived as uncomfortable, for the sake of a more valuable objective. The Clinician Guide is geared towards helping administer treatment, and the companion Workbook provides summaries of session content, exercises, worksheets, handouts, and assignments for patients and clients receiving the treatment. The books will appeal to psychologists, primary care physicians, nutritionists, dieticians, and other clinicians who counsel the overweight. (shrink)

Backround Education in ethics and professionalism should reflect the realities medical students encounter in the hospital and clinic. Method We performed content analyses on Case Observation and Assessments (COAs) written by third-year medical students about ethical and professional issues encountered during their internal medicine and paediatrics clinical clerkships. Results A cohort of 141 third-year medical students wrote 272 COAs. Content analyses identified 35 subcategories of ethical and professional issues within 7 major domains: decisions regarding treatment (31.4%), communication (21.4%), professional duties (...) (18.4%), justice (9.8%), student-specific issues (5.4%), quality of care (3.8%), and miscellaneous (9.8%). Conclusions Students encountered a wide variety of ethical and professional issues that can be used to guide pre-clinical and clinical education. Comparison of our findings with results from similar studies suggests that the wording of an assignment (specifying “ethical” issues, “professional” issues, or both) may influence the kinds of issues students identify in their experience-based clinical narratives. (shrink)

The authors discuss some of the conceptual issues that must be considered in using and understanding psychiatric classification. DSM-IV is a practical and common sense nosology of psychiatric disorders that is intended to improve communication in clinical practice and in research studies. DSM-IV has no philosophic pretensions but does raise many philosphical questions. This paper describes the development of DSM-IV and the way in which it addresses a number of philosophic issues: nominalism vs. realism, epistemology in science, the mind/body dichotomy, (...) the definition of mental disorders, and dimensional vs. categorical classification. (shrink)

El presente volumen recoge seis ensayos publicados originalmente en inglés en revistas especializadas y volúmenes colectivos a lo largo de la última década. Tratan de las consecuencias de desarrollos recientes en el análisis del conocimiento para la evaluación de los argumentos escépticos tradicionales. Los argumentos escépticos pretenden mostrar que es imposible conocer el mundo. Forman parte de la tradición filosófica occidental desde la antigüedad, y han tenido una influencia importantísima en el desarrollo de la filosofía desde entonces hasta nuestros (...) días. Sin embargo, los principales argumentos escépticos parecen descansar sobre premisas acerca de la naturaleza del conocimiento que han sido puestas en tela de juicio en la epistemología actual. Esto se debe sobre todo a los análisis externistas del conocimiento, que conciben la formación de creencias como un fenómeno natural y el conocimiento como una característica objetiva de este fenómeno. Muchos epistemólogos contemporáneos piensan que si el externismo es verdadero los argumentos escépticos carecen de valor. Los trabajos recogidos aquí consideran diversos aspectos de esta situación, estudiando en detalle la interacción entre principios externistas específicos y las líneas argumentativas principales del escepticismo. (shrink)

Posverdad y populismo forman parte de una nueva intolerancia que se extiende por todo el planeta. Ambos se apoyan en la usurpación de los hechos, ahora frecuentemente difundida en las redes sociodigitales. Posverdad es la creencia masiva en versiones y falsedades que se ajustan a los prejuicios de quienes las consideran ciertas. Populismo es el ejercicio autoritario del poder a cargo de personajes que, al considerar que encarnan la voluntad del pueblo, avasallan reglas, instituciones y derechos de la democracia. (...) Los líderes populistas reaccionaron con impericia ante la pandemia y trataron de aprovecharla para ampliar su popularidad y/o para legitimar medidas autoritarias. Posverdad, populismo y pandemia son procesos con múltiples aristas. Al describir los rasgos de cada uno, este libro quiere contribuir a su discusión. --back cover. (shrink)

Are mystical experiences primarily formed by the mystic's cultural background and concepts, as modern day "constructivists" maintain, or do mystics in some way transcend language, belief, and culturally conditioned expectations? Do mystical experiences differ in the different religious traditions, as "pluralists" contend, or are they identical across cultures? Twelve contributors here attempt to answer these questions through close examination of a particular form of mystical experience, "Pure Consciousness"--the experience of being awake but devoid of intentional content for consciousness. The contributors (...) analyze pure consciousness and other mystical experiences from historical Hindu, Buddhist, Christian, and Jewish sources, as well as from modern mystics. They demonstrate that pure consciousness poses serious conceptual problems for a contructivist understanding of mysticism. Revealing the inconsistencies and inadequacies of current models, they make significant strides towards developing new models for the phenomenon of mysticism, breaking new ground for our understanding of mysticism and of human experience in general. (shrink)

The norm of assertion, to be in force, is a social norm. What is the content of our social norm of assertion? Various linguistic arguments purport to show that to assert is to represent oneself as knowing. But to represent oneself as knowing does not entail that assertion is governed by a knowledge norm. At best these linguistic arguments provide indirect support for a knowledge norm. Furthermore, there are alternative, non-normative explanations for the linguistic data (as in recent work from (...) Van Elswyk). Direct arguments would rely on normative judgments about the permissibility or impermissibility of assertions with and without the speaker knowing the content asserted. John Turri's work experimental results purport to show that our norm of assertion is factive, and probably knowledge. But as a number of recent experimentalists (Kneer, Reuter and Broessel, Marsili and Wiegmann) have shown, Turri's results rely on the problemmatic use of 'should' as in 'Maria should assert that she owns a 1990 watch.' Correcting for this, these experimentalists provide strong evidence that our norm of assertion is not factive. The standard reply to evidence like this from the assertion of unlucky falsehoods is the excuse maneuver. But Marsili and Wiegmann, following Turri's protocol for testing for excuse validation, show that participants who judge that assertions unlucky falsehoods are permissible are not guilty of excuse validation. Given our current understanding of the experimental evidence, knowledge is not our norm of assertion. (shrink)

Background Residual dried blood spots (rDBS) from newborn screening programmes represent a valuable resource for medical research, from basic sciences, through clinical to public health. In Hong Kong, there is no legislation for biobanking. Parents’ view on the retention and use of residual newborn blood samples could be cultural-specific and is important to consider for biobanking of rDBS. Objective To study the views and concerns on long-term storage and secondary use of rDBS from newborn screening programmes among Hong Kong Chinese (...) parents. Methods A mixed-method approach was used to study the views and concerns on long-term storage and secondary use of rDBS from newborn screening programmes among Hong Kong Chinese parents of children 0–3 years or expecting parents through focus groups (8 groups; 33 participants) and a survey (n = 1012, 85% mothers) designed with insights obtained from the focus groups. We used framework analysis to summarise the themes as supportive factors, concerns and critical arguments for retention and secondary use of rDBS from focus group discussion. We used multiple logistic regression to assess factors associated with support for retention and secondary use of rDBS in the survey. Results Both in focus groups and survey, majority of parents were not aware of the potential secondary use of rDBS. Overall secondary use of rDBS in medical research was well accepted by a large proportion of Hong Kong parents, even if all potential future research could not be specified in a broad consent. However parents were concerned about potential risks of biobanking rDBS including leaking of data and mis-use of genetic information. Parents wanted to be asked for permission before rDBS are stored and mainly did not accept an “opt-out” approach. The survey showed that parents born in mainland China, compared to Hong Kong born parents, had lower awareness of newborn screening but higher support in biobanking rDBS. Higher education was associated with support in rDBS biobanking only among fathers. Conclusion Long-term storage and secondary use of rDBS from newborn screening for biomedical research and a broad consent for biobanking of rDBS are generally acceptable to Hong Kong parents given their autonomy is respected and their privacy is protected, highlighting the importance of an accountable governance and a transparent access policy for rDBS biobanks. (shrink)

This article examines what happens when local gender rights activism is taken up by international allies and appropriators, using case studies of activism in Saudi Arabia and India. The relationship between local and transnational activists is shaped by histories of Euro-Americans writing about the gendered organisation of Eastern societies. In an economic system where nongovernmental activist groups compete for donor support, political causes are commodities with value, and value is generated through representations (e.g. of patriarchal oppression). These representations of the (...) sexuality and gender organisation of other societies are fetishes in the Marxian sense, essential to the commodity-cause that generates value in circulation. These representations gain value through the accretion of cultural images and texts that adhere to the cause, e.g. the stereotype of the violent brown man and oppressed woman. Such images in the cultural repository allow transnational consumers to make sense of issues they are called to support. But such images also reify stereotypes that activists seek to undermine, even at the same time that these representations generate an international audience. We analyse this process and identify strategies for how transnational allies can show solidarity without overshadowing or devaluing the voices of local activists, with primary focus on the case of activism against male guardianship laws in Saudi Arabia. (shrink)

This paper provides a series of reflections on making the case to senior leaders for the introduction of clinical ethics support services within a UK hospital Trust at a time when clinical ethics committees are dwindling in the UK. The paper provides key considerations for those building a case for clinical ethics support within hospitals by drawing upon published academic literature, and key reports from governmental and professional bodies. We also include extracts from documents relating to, and annual reports of, (...) existing clinical ethics support within UK hospitals, as well as extracts from our own proposal submitted to the Trust Board. We aim for this paper to support other ethicists and/or health care staff contemplating introducing clinical ethics support into hospitals, to facilitate the process of making the case for clinical ethics support, and to contribute to the key debates in the literature around clinical ethics support. We conclude that there is a real need for investment in clinical ethics in the UK in order to build the evidence base required to support the wider introduction of clinical ethics support into UK hospitals. Furthermore, our perceptions of the purpose of, and perceived needs met through, clinical ethics support needs to shift to one of hospitals investing in their staff. Finally, we raise concerns over the optional nature of clinical ethics support available to practitioners within UK hospitals. (shrink)