Perceived Quality of Informed Refusal Process: A Cross‐Sectional Study from Iranian Patients' Perspectives

Patients have the right to refuse their treatment; however, this refusal should be informed. We evaluated the quality of the informed refusal process in Iranian hospitals from patients' viewpoints. To this end, we developed a questionnaire that covered four key aspects of the informed refusal process including; information disclosure, voluntariness, comprehension, and provider‐patient relationship. A total of 284 patients who refused their treatment from 12 teaching hospitals in the Isfahan Province, Iran, were recruited and surveyed to produce a convenience sample. Patients' perceptions about the informed refusal process were scored and the mean scores of the four components were calculated. The findings showed that the practice of information disclosure (9.6 ± 6.4 out of 22 points) was perceived to be moderate, however, comprehension (2.3 ± 1.4 out of 4 points), voluntariness (8.7 ± 1.5 out of 12 points) and provider–patient relationship (10.2 ± 5.2 out of 16 points) were perceived to be relatively good. We found that patients, who refused their care before any treatment had commenced, reported a lower quality of information disclosure and voluntariness. Patients informed by nurses and those who had not had a previous related admission, reported lower scores for comprehension and relationship. In conclusion, the process of obtaining informed refusal was relatively satisfactory except for levels of information disclosure. To improve current practices, Iranian patients need to be better informed about; different treatment options, consequences of treatment refusal, costs of not continuing treatment and follow‐ups after refusal. Developing more informative refusal forms is needed.     

No conscientious objection without normative justification: Against conscientious objection in medicine

Most proponents of conscientious objection accommodation in medicine acknowledge that not all conscientious beliefs can justify refusing service to a patient. Accordingly, they admit that constraints must be placed on the practice of conscientious objection. I argue that one such constraint must be an assessment of the reasonability of the conscientious claim in question, and that this requires normative justification of the claim. Some advocates of conscientious object protest that, since conscientious claims are a manifestation of personal beliefs, they cannot be subject to this kind of public justification. In order to preserve an element of constraint without requiring normative justification of conscientious beliefs, they shift the justificatory burden from the belief motivating the conscientious claim to the condition of the patient being refused service. This generally involves a claim along the lines that conscientious refusals should be permitted to the extent that they do not cause unwarranted harm to the patient. I argue that explaining what would constitute warranted harm requires an explanation of what it is about the conscientious claim that makes the harm warranted. ‘Warranted’ is a normative operator, and providing this explanation is the same as providing normative justification for the conscientious claim. This shows that resorting to facts about the patient’s condition does not avoid the problem of providing normative justification, and that the onus remains on advocates of conscientious objection to provide normative justification for the practice in the context of medical care.     

新医改背景下佛教团体举办医疗机构的可行性研究

从政策环境、经济环境、社会环境、行业环境、上海现代佛教事业的发展等五个方面对上海佛教团体出资举办医疗机构的可行性进行了全面分析，并对佛教团体举办的医疗机构的定位及运行模式提出设想。通过分析认为，成立上海佛教医疗机构不仅有政策扶持和经济基础，还有社会和行业环境培育的良好条件，更是上海佛教事业发展的必然产物。     

探究式课程设计在医学生临床决策能力培养中的探索

临床决策能力是一个医生的必备能力之一，是医学教育中必要且重要的培养目标之一。目前对医学生临床决策能力的培养没有形成完备的体系，一般安排在高年级阶段进行，为时较晚。如何把临床决策能力的培养融入低年级基础课中，以尽早开展能力训练值得探索研究。本研究以医学遗传学课程为例，结合探究式教学方式的特点，模拟临床决策思维过程的各细分模块，优化了课程设计，探索在低年级课程中融入临床决策能力的培养。结果提示：探究式课程设计能充分调动学生主动性，增加学生分析、思考的投入；在教师引导下，促使学生依循临床决策思维的过程得到有效地训练。最后，整理分析了探究式课程设计及实践的思路，总结了设计原则和要点，反思了教学中的经验得失。     

The price of an egg: oocyte donor compensation in the US fertility industry

Market-based health services have arisen out of major transformations in US healthcare in the last several decades. This study addresses pricing in the human egg donation market – an under-explored topic despite substantial scholarship on commodification and financial coercion of donors. Through analysis of primary data collected from 276 US fertility clinics and egg donation agencies, I assess what impacts average donor compensation and likelihood of compensation being more than $5000. Drawing on theories of organizational behavior, I test whether organizational characteristics, ecological factors, or regulatory pressure have the greatest impact on donor compensation amounts. I find that compensation is influenced primarily by ecological/market factors. Furthermore, industry self-regulation (measured by professional affiliation) did not deter clinics and agencies from having higher donor compensation levels, despite American Society for Reproduction Medicine recommendations. I conclude by addressing the broader implications of these findings for medical market dynamics and the problem of industry self-regulation.     

Assessing Health Risks from Sub-Standard Medical Waste Incineration: A Site Conceptual Model

Poor medical waste treatment is common practice in most developing countries where on-site sub-standard incineration is common. Potentially hazardous substances such as polychlorinated dioxins and dibenzofurans and polycyclic aromatic hydrocarbons have been detected in gaseous emissions as well as bottom ash generated by the said process. There is also evidence on the emission of potentially toxic trace metals such as lead and cadmium as well as speculations on the release of brominated dioxins and dibenzofurans. The presence of residential areas within the vicinity of these sites increases human susceptibility to various health risks. This eventually necessitates the development of efficient risk assessment tools such as a site conceptual model that can adequately facilitate data collection activities and the estimation of health risks.     

Psychoactive substance use among medical students in a Nigerian university

The study was aimed at determining the prevalence, pattern and factors associated with psychoactive substance use among medical students in the University of Ilorin, Nigeria. All consenting medical students were requested to compile a 22-item modified, pilot-tested semi- structured self-report questionnaire based on the World Health Organization''s guidelines for student substance use survey. It was found that the most currently used substances were mild stimulants (33.3%), alcohol (13.6%), sedatives (7.3%) and tobacco (3.2%). Except for tobacco, the use of these substances seemed to be only instrumental. Substance use was directly associated with male gender, living alone, self-reported study difficulty, being a clinical student, and being aged 25 years or more. There was an inverse relationship of substance use with religiosity and good mental health.