Background: Moral case deliberation is a form of clinical ethics support to help healthcare professionals in dealing with ethically difficult situations. There is a lack of evidence about what outcomes healthcare professionals experience in daily practice after moral case deliberations. The Euro-MCD Instrument was developed to measure outcomes, based on the literature, a Delphi panel, and content validity testing. To examine relevance of items and adequateness of domains, a field study is needed. Aim: To describe experienced outcomes after participating in (...) a series of moral case deliberations, both during sessions and in daily practice, and to explore correlations between items to further validate the Euro-MCD Instrument. Methods: In Sweden, the Netherlands, and Norway, healthcare institutions that planned a series of moral case deliberations were invited. Closed responses were quantitatively analyzed. The factor structure of the instrument was tested using exploratory factor analyses. Ethical considerations: The study was approved in Sweden by a review board. In Norway and the Netherlands, data services and review boards were informed about the study. Results: The Euro-MCD Instrument was completed by 443 and 247 healthcare professionals after four and eight moral case deliberations, respectively. They experienced especially outcomes related to a better collaboration with co-workers and outcomes about individual moral reflexivity and attitude, both during sessions and in daily practice. Outcomes were experienced to a higher extent during sessions than in daily practice. The factor structure revealed four domains of outcomes, which did not confirm the six Euro-MCD domains. Conclusion: Field-testing the Euro-MCD Instrument showed the most frequently experienced outcomes and which outcomes correlated with each other. When revising the instrument, domains should be reconsidered, combined with theory about underlying concepts. In the future, a feasible and valid instrument will be presented to get insight into how moral case deliberation supports and improves healthcare. (shrink)

BackgroundThere is a lack of empirical research regarding the outcomes of such clinical ethics support methods as moral case deliberation (MCD). Empirical research in how healthcare professionals perceive potential outcomes is needed in order to evaluate the value and effectiveness of ethics support; and help to design future outcomes research. The aim was to use the European Moral Case Deliberation Outcome Instrument (Euro-MCD) instrument to examine the importance of various MCD outcomes, according to healthcare professionals, prior to participation.MethodsA North European (...) field survey among healthcare professionals drawn from 73 workplaces in a variety of healthcare settings in the Netherlands, Norway and Sweden. The Euro-MCD instrument was used.ResultsAll outcomes regarding the domains of moral reflexivity, moral attitude, emotional support, collaboration, impact at organisational level and concrete results, were perceived as very or quite important by 76%–97% of the 703 respondents. Outcomes regarding collaboration and concrete results were perceived as most important. Outcomes assessed as least important were mostly about moral attitude. ‘Better interactions with patient/family’ emerged as a new domain from the qualitative analysis. Dutch respondents perceived most of the outcomes as significantly less important than the Scandinavians, especially regarding emotional support. Furthermore, men, those who were younger, and physician-respondents scored most of the outcomes as statistically significantly less important compared with the other respondents.ConclusionsThe findings indicate a need for a broad instrument such as the Euro-MCD. Outcomes related to better interactions between professionals and patients must also be included in the future. The empirical findings raise the normative question of whether outcomes that were perceived as less important, such asmoralreflexivity andmoralattitude outcomes, should still be included. In the future, a combination of empirical findings (practice) and normative reflection (theories) will contribute to the revision of the instrument. (shrink)

To support healthcare professionals in dealing with ethically difficult situations, Clinical Ethics Support (CES) services like Moral Case Deliberation (MCD) are increasingly implemented. To assess the impact of CES, it is important to evaluate outcomes. Despite general claims about outcomes from MCD experts and some qualitative research, there exists no conceptual analysis of outcomes yet. Therefore, the aim of this study was to systematically define and categorize MCD outcomes. An additional aim was to compare these outcomes with the outcomes in (...) the Euro-MCD Instrument from 2014, to further validate this Instrument. The concept mapping method was used and involves qualitative and quantitative steps including brainstorming, individual structuring, computation of concept maps (by principal component analysis and cluster analysis), group interpretation and utilization. In total, 12 experienced MCD participants from a variety of professional backgrounds participated in two sessions. The focus group brainstorm resulted in a list of 85 possible MCD outcomes, of which a point map and concept maps were constructed. After a thorough discussion of each cluster, final consensus was reached on the names and position of 8 clusters of MCD outcomes: 1) Organisation and Policy; 2) Team development; 3) Personal development focused on the Other Person; 4) Personal development as Professional, focused on Skills; 5) Personal development as Professional, focused on Knowledge; 6) Personal development as an Individual; 7) Perception and Connection; and 8) Concrete action. This study explored and categorized MCD outcomes in a concept mapping focus group. When comparing the results with the Euro-MCD Instrument, our study confirms that outcomes of MCD can be categorized in clusters referring to the organisational level, team development, personal development (both as an individual and a professional) and the concrete case-level. In developing CES evaluation tools, it is important to be explicit if an outcome refers to the individual or the team, to knowledge or skills, to the organisation or the specific case. The findings will be used in the further validation of the Euro-MCD Instrument. The current study further contributes to the field of evaluating CES in general and defining outcomes of MCD in particular. (shrink)

BackgroundAlthough the number of reporting guidelines has grown rapidly, few have gone through an updating process. The STARD statement (Standards for Reporting Diagnostic Accuracy), published in 2003 to help improve the transparency and completeness of reporting of diagnostic accuracy studies, was recently updated in a systematic way. Here, we describe the steps taken and a justification for the changes made.ResultsA 4-member Project Team coordinated the updating process; a 14-member Steering Committee was regularly solicited by the Project Team when making critical (...) decisions. First, a review of the literature was performed to identify topics and items potentially relevant to the STARD updating process. After this, the 85 members of the STARD Group were invited to participate in two online surveys to identify items that needed to be modified, removed from, or added to the STARD checklist. Based on the results of the literature review process, 33 items were presented to the STARD Group in the online survey: 25 original items and 8 new items; 73 STARD Group members (86 %) completed the first survey, and 79 STARD Group members (93 %) completed the second survey.Then, an in-person consensus meeting was organized among the members of the Project Team and Steering Committee to develop a consensual draft version of STARD 2015. This version was piloted in three rounds among a total of 32 expert and non-expert users. Piloting mostly led to rewording of items. After this, the update was finalized. The updated STARD 2015 list now consists of 30 items. Compared to the previous version of STARD, three original items were each converted into two new items, four original items were incorporated into other items, and seven new items were added.ConclusionsAfter a systematic updating process, STARD 2015 provides an updated list of 30 essential items for reporting diagnostic accuracy studies. (shrink)

For the historian who aspires to the study of Scipio Aemilianus one of the happier features of his material is the considerable number of Scipio's dicta which have been preserved: sayings which are distinct from the extracts from formal speeches yet which in most cases were uttered in public. This paper is concerned with a small group of such dicta which belong to the last period of Scipio's life, between his return from Numantia in 132 and his death in 129. (...) The intention is not to provide an historical interpretation but simply to establish die content, context, and relationship of the sayings concerned. At the request of the editors I do not quote in full the passages which provide the evidence, most of which are reproduced, at least in part, on pages 131 f. of the second edition of Malcovati's Oratorum Romanorum Fragmenta. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:American Journal of Philology 121.4 (2000) 549-557 [Access article in PDF] Cato Orationes 66 and the Case Against M.' Acilius Glabrio In 189 B.C.E. J. Bradford Churchill THE RACE FOR THE CENSORSHIP of 189 became the setting for one of the most dramatic domestic political disputes of the early second century. 1 M. Porcius Cato (cos. 195) was seeking the censorship, and among his competitors was another homo novus, (...) M.' Acilius Glabrio (cos. 191). Now, Cato had served as tribunus militum under the consul Glabrio during the campaign of 191 against Antiochus III in Greece. Cato had led a flanking expedition to decide the battle at Thermopylae, at the conclusion of which the king's camp was invaded and plundered. 2 Cato said that after the battle, Glabrio had embraced him and cried out that neither he nor the Roman people could repay his good services. 3 Glabrio sent Cato home with news of the victory. 4Now, in the race for the censorship of 189, public opinion was inclining in favor of Glabrio because he had conducted a lavish distribution of congiaria--vessels, perhaps precious, filled with wine or oil. The nobles among the competitors took umbrage at his being preferred to them, and two tribunes, P. Sempronius Gracchus and C. Sempronius Rutilus, brought Glabrio to trial on the charge "that there was some amount of the royal money and booty taken in the camp of Antiochus which he had neither carried in the triumph nor deposited in the treasury." 5 Legates and military tribunes were called to testify, and most visible among them was Cato, who had a reputation for integrity, but [End Page 549] because he was testifying against an opponent in a political race, his influence was diminished. The substance of Cato's testimony, as Livy summarized it, was that he had seen some gold and silver vessels among the royal booty at the sack of the camp, and had not seen them in the triumph.Glabrio withdrew from the race after a fine had been proposed and twice argued, and the case lapsed. He vilified Cato as a perjurious hypocrite for attacking a fellow homo novus for something the nobles usually passed over in silence. 6We have a fragment of a speech Cato gave against Glabrio, and his trial is the only appropriate occasion which is known to us. The fragment itself is clearly designed to set up a contrast between Cato and Glabrio, but the text is corrupt. The codex Farnesianus of Festus has the following entry (Fest. p. 268L): Penatores: qui penus gestant. Cato adversus M.' Acilium quarta: "postquam nativitas ex navibus eduxi, non ex militibus atque nautis piscatores penatores fici, sed arum dedi." First there are several problems which are relatively minor and no longer yield much controversy. The word quarta indicates there were at least four speeches "against Acilius." More often than not, this is dismissed as a simple error. 7 The word nativitas is clearly foreign to the context, and was long ago emended to navitas, as a poetic and archaic variant on nautas. 8 The transmitted fici is regularly and reasonably emended to feci. 9 [End Page 550]The more difficult question centers on the phrase sed arum dedi. André Dacier, in an early modern edition of Festus (Amsterdam 1700), emended arum to aurum. 10 Much later, Theodor Mommsen offered the conjecture arma. 11 This is now the prevailing reading, accepted most significantly by Enrica Malcovati (1953, 39) in the authoritative edition of the Oratorum Romanorum Fragmenta. 12 Maria Teresa Sblendorio Cugusi (1982, 77), following Lindsay (1913, 268), printed and obelized arum, but in her commentary (1982, 215) considered Mommsen's emendation preferable to Dacier's because the latter "appears inconsistent with the context." I intend to show that this is rather the opposite of the case, and we ought to accept Dacier's emendation. 13With Mommsen's conjecture, the passage reads: "When I brought sailors off the ships, I didn't make fishers and provisioners out of soldiers... (shrink)