Attitudes and other barriers to the utilization of clinical research findings by American physicians: A systematic review

Background: The Institute of Medicine estimates that only a maximum of 25% of clinical research findings are incorporated into practice by physicians. To improve clinical practice, efforts have been made to promote evidence-based medicine and the use of clinical guidelines. Despite these efforts, the gap between research and clinical practice remains wide.^ Objective: To systematically review the literature describing the factors which influence the use of clinical research recommendations by American physicians.^ Hypothesis: Barriers exist in the application of clinical research into clinical practice, and are multifactorial. The establishment of the Clinical and Translational Awards (CTSA; special federal grants awarded to selected institutions to support clinical and translational research) has reduced the effect of these barriers and improved the process of clinical research translation into practice among American physicians.^ Aims: Identify barriers and facilitators of the use of research findings in clinical practice by American physicians. Contrast studies published six years before and after the creation of the CTSA.^ Methods: The sources of data include published literature from Medline, PubMed and PsycINFO. Selected studies must be qualitative, a survey of American clinicians, based on evidence-based medicine practice, clinical guidelines or treatment pathways. Systematic reviews and reports were excluded, as well as studies with less than 100 respondents.^ Results: In total, 1036 abstracts were reviewed; 115 full text potential articles were identified and reviewed, and a total of 31 studies met all criteria for inclusion in the final review.^ Conclusions: The barriers against the application of clinical research findings, in the forms of clinical guidelines, evidence-based medicine guides and clinical pathways, can be divided broadly into physician barriers, practice/system barriers and patient barriers. Physician barriers are the most common barriers, especially the lack of familiarity with guidelines and the lack of time. Of the factors which improve the use of research based guidelines, physician factors such as younger age, lower duration of clinical practice, specialty training, and practice in large group Health Maintenance Organization (HMO) settings with fewer patients seen were the most commonly cited.^

Ethics and materials. Some Spanish Case Studies

In Navea, north of Spain, a medieval arch bridge shows a visible distortion (fig.1a). A stone falls down from the web of a gothic vault in a big parish church in Burgos (fig. 1b), and a voussoir falls down from the rib of another gothic vault in Oviedo (fig. 1c). An oval dome collapses in Zaragoza, though another four identical domes remain safe (fig. 1d). Sometimes the building has to support new, heavier loads. The ruin of the abandoned (since the 19th Century) monastery of Melón should be consolidated, some vaults are rebuilt and the visitors can walk over them. A Franciscan Convent is going to be turned into a Cultural Centre, the loads to be supported being multiplied by a factor of two. A little medieval bridge is asked to support the pass of heavy lorries. These are some of the cases I have studied in the last two decades, all of them referring to questions of structural safety. These are the kind of situations which often occurs in the field of Historic Structures. They require a study and an answer. This is no scholarly work (though in some cases new lines of future research will emerge). A judgement must be made by the expert and this judgement affects the safety and economy, in the last instance, of people. As there are rarely unique answers, the behaviour of the expert, then, can also be judged as "ethical", if he proposes an intervention that is necessary and adequate (or, recommends no intervention, judging the situation safe), or "non-ethical", if recommends an unnecessary or disproportionate intervention. In relation to the monument, also, the proposal can be judged ethically; any intervention damaging seriously the character of the monument may be labelled un-ethical.

Business ethics: a way to identify fraud from the basics

When we look to perform a work for developing a framework to create a business and take it correctly, there are always some persons looking as a challenge those bases and finding a mistake. The way to work in these situations is not a matter of law, is a matter of devoting time to identify these situations. It is always said that the evil goes a step ahead. The business ethics have been altered for quite time by some would-be entrepreneurs. These people have learned to play with business ethics to show your business as prosperous as something that is sought to highlight and adulterate their results quickly. Once the company reaches an international dimension, many companies take on global responsibility and, in these cases where you can see if the objective has been to obtain a rapid capital increase or growth is in line with its proportions. A business ethics is based on establishing a strong base so that interest is encouraged from an early time. Good staff, organizational level should be achieved and not only at the company but, out of the company too. Thus, you can create a secure base to convince potential investors and employees about the business. There are no freeways in business ethics and all fast track can be or a genius or leads to failure. We must find where these jumps are occurring, such errors or corrections to business ethics and their rules. Thus we can differentiate a company or an entrepreneur who is working correctly from the cloaking. Starting from the basics of business ethics and studying the different levels from the personal to the prospect that the company shows in the world. Lets see where these changes are occurring and how we can fight against them and anticipate the market to possible cases of fraud or strange movements seeking to attract the unwary

Ethics and access to teaching materials in the medical library: the case of the Pernkopf atlas*

Conflicts can occur between the principle of freedom of information treasured by librarians and ethical standards of scientific research involving the propriety of using data derived from immoral or dishonorable experimentation. A prime example of this conflict was brought to the attention of the medical and library communities in 1995 when articles claiming that the subjects of the illustrations in the classic anatomy atlas, Eduard Pernkopf's Topographische Anatomie des Menschen, were victims of the Nazi holocaust. While few have disputed the accuracy, artistic, or educational value of the Pernkopf atlas, some have argued that the use of such subjects violates standards of medical ethics involving inhuman and degrading treatment of subjects or disrespect of a human corpse. Efforts were made to remove the book from medical libraries. In this article, the history of the Pernkopf atlas and the controversy surrounding it are reviewed. The results of a survey of academic medical libraries concerning their treatment of the Pernkopf atlas are reported, and the ethical implications of these issues as they affect the responsibilities of librarians is discussed.

Clinical ethics revisited

A decade ago, we reviewed the field of clinical ethics; assessed its progress in research, education, and ethics committees and consultation; and made predictions about the future of the field. In this article, we revisit clinical ethics to examine our earlier observations, highlight key developments, and discuss remaining challenges for clinical ethics, including the need to develop a global perspective on clinical ethics problems.

Intervening in evolution: Ethics and actions

Biologists should help to guide a process of cultural evolution in which society determines how much effort, if any, is ethically required to preserve options in biological evolution. Evolutionists, conservation biologists, and ecologists should be doing more research to determine actions that would best help to avoid foreclosing evolutionary options.

Time's Social Metaphors: An empirical research

The article addresses the analysis of time images furnished by a qualitative research made in Spain on the relations of working time and family/personal time. The analysis focuses on three widespread time metaphors used in day-to-day speeches by social agents. The first one is the metaphor of time as resource for action. Its value is equally economical, moral and political. Used in different context of action, it may mean something that can be either invested, donated generously to others, appropriated for caring for oneself, or spent without purpose with others. The second metaphor represents time as an external environment to which action must adapt. This metaphor shows many variants that represent time as a dynamic/static, repetitive/innovative, ordered/chaotic environment. In this external environment, the agents must resolve the problems of temporal embeddedness, hierarchy and synchronization of their actions. The third metaphor shows time as a horizon of action intentionality where the agents try to construct the meaning of their action and identity. Within this horizon the construction of a significant narrative connecting past and present experiences with future expectations is possible.

Attitudes of the autism community to early autism research

Investigation into the earliest signs of autism in infants has become a significant sub-field of autism research. This work invokes specific ethical concerns such as use of 'at-risk' language, communicating study findings to parents and the future perspective of enrolled infants when they reach adulthood. This study aimed to ground this research field in an understanding of the perspectives of members of the autism community. Following focus groups to identify topics, an online survey was distributed to autistic adults, parents of children with autism and practitioners in health and education settings across 11 European countries. Survey respondents (n = 2317) were positively disposed towards early autism research, and there was significant overlap in their priorities for the field and preferred language to describe infant research participants. However, there were also differences including overall less favourable endorsement of early autism research by autistic adults relative to other groups and a dislike of the phrase 'at-risk' to describe infant participants, in all groups except healthcare practitioners. The findings overall indicate that the autism community in Europe is supportive of early autism research. Researchers should endeavour to maintain this by continuing to take community perspectives into account.

Bioethical perspectives for ageing: the documents produced by the Ethics Councils

Aging attracted keen interest in research, health, education as well as cross-sectors approaches. We researched what has been produced by the National Bioethics/Ethics Councils in the form of opinions or other documents, relating to aging and elderly people. In the websi-tes of the 28 EU councils and 12 other countries, we identified 4 documents relating to aging and 8 opinions, which we analyse. The Councils have proposed to draw the attention and reflection of public opinion to the elderly condition; all agree that the age has its own traits and that matters revert to a “culture of old age”, respect and promotion of a positive aging. Enhance the diversity of modes of aging and the importance of preparing all, promoting literacy for aging, creating social and legal protective elements (Elderly Statute, Observatory of the Elderly Conditions). From the analysis, a set of principles and bioethical elements: [1] respect for human dignity, regardless of the stage of life; [2] recognition of the person’s situation uniqueness to aging; [3] freedom of one’s own decision, which is materialized in respect for autonomy; [4] recognition of the vulnerabilities of the elderly, [5] ethical commitment and social responsibility in monitoring the elderly, [6] non-discrimination by age and [7] the guidance to the conditions of the integral good and quality of life. Aging is an existential step for which we can prepare, on the assumption that human life in its longevity, interweaves those who are older and those younger, on the crucial issue of human existence.

Social policy, social ethics, and the aging society : report /

Inserted Technical documentation page designates B.L. Neugarten ... [et al.] as "authors."

Extending the human life span : social policy and social ethics /

"NSF/RA 770123."

Investigating the dilemmas of ethical social research

The author’s work with a university ethics committee and field research in Pacific New Caledonia is used as a basis to problematise the biomedical research models used by universities in Australia for assessing social research as ethical. The article explores how culturally specific Western emotional bases for ethical decisions are often unexamined. It expresses concerns about gaps in biomedical models by linking the author’s description of field interactions with research participants to debates about the creation of knowledge.

The policy and ethical implications of genetic research on attention deficit hyperactivity disorder

Objective: To review the policy and ethical implications of recent research on the molecular genetics of attention deficit hyperactivity disorder (ADHD). Method: MEDLINE and psycINFO database searches were used to identify studies on the genetics of ADHD. The implications of replicated candidate genes are discussed. Results: The findings for most genes have been inconsistent but several studies have implicated the genes in the dopaminergic pathway in the aetiology of ADHD. Conclusions: The current evidence on the genetics of ADHD is insufficient to justify genetic screening tests but it will provide important clues as to the aetiology of ADHD. Genetic information on susceptibility to ADHD has the potential to be abused and to stigmatize individuals. Researchers and clinicians need to be mindful of these issues in interpreting and disseminating the results of genetic studies of ADHD.