Background Informed consent is an integral component of good medical practice. Many researchers have investigated measures to improve the quality of informed consent, but it is not clear which techniques work best and why. To address this problem, we propose developing a core outcome set to evaluate interventions designed to improve the consent process for surgery in adult patients with capacity. Part of this process involves reviewing existing research that has reported what is important to patients and doctors in the (...) informed consent process. Methods This qualitative synthesis comprises four phases: identification of published papers and determining their relevance; appraisal of the quality of the papers; identification and summary of the key findings from each paper while determining the definitiveness of each finding against the primary data; comparison of key themes between papers such that findings are linked across studies. Results Searches of bibliographic databases returned 11,073 titles. Of these, 16 studies met the inclusion criteria. Studies were published between 1996 and 2016 and included a total of 367 patients and 74 health care providers. Thirteen studies collected data using in-depth interviews and constant comparison was the most common means of qualitative analysis. A total of 94 findings were extracted from the primary papers and divided into 17 categories and ultimately 6 synthesised findings related to: patient characteristics, knowledge, communication, the model patient, trust and decision making. Conclusions This qualitative meta-aggregation is the first to examine the issue of informed consent for surgery. It has revealed several outcomes deemed important to capture by patients and clinicians when evaluating the quality of a consent process. Some of these outcomes have not been examined previously in research comparing methods for informed consent. This review is an important step in the development of a COS to evaluate interventions designed to improve the consent process for surgery. Registration The study protocol was registered on the international prospective register for systematic reviews. (shrink)

The cosmetics, detergents and food industries trial development products using healthy human volunteer studies. They also use human tissue for in vitro investigations. Hitherto, the ethics of such work has not been regulated. The UK Human Tissue Act will have legal implications on current arrangements for such studies within the industry, especially with regards to informed consent and seeking ethical review of research proposals. At present, however, it is unclear who will fund ethical review for use of ‘relevant material’ in (...) non-medical research, and on the required status of ethics committees to review such work. The principles behind the sampling, storage and processing of ‘relevant material’ are largely identical whether it be for medical or non-medical investigations. It is argued, therefore, that this is further justification for industry and professional bodies to adopt best practice of ethical review for all studies in ‘grey areas’ outside the scope of regulations. This would follow closely those standards applied to biomedical research. (shrink)

Patient consent has been formulated in terms of radical individualism rather than shared benefits. Medical education relies on the provision of patient consent to provide medical students with the training and experience to become competent doctors. Pelvic examination represents an extreme case in which patients may legitimately seek to avoid contact with inexperienced medical students particularly where these are male. However, using this extreme case, this paper will examine practices of framing and obtaining consent as perceived by medical students. This (...) paper reports findings of an exploratory qualitative study of medical students and junior doctors. Participants described a number of barriers to obtaining informed consent. These related to misunderstandings concerning student roles and experiences and insufficient information on the nature of the examination. Participants reported perceptions of the negative framing of decisions on consent by nursing staff where the student was male. Potentially coercive practices of framing of the decision by senior doctors were also reported. Participants outlined strategies they adopted to circumvent patients’ reasons for refusal. Practices of framing the information used by students, nurses and senior doctors to enable patients to decide about consent are discussed in the context of good ethical practice. In the absence of a clear ethical model, coercion appears likely. We argue for an expanded model of autonomy in which the potential tension between respecting patients’ autonomy and ensuring the societal benefit of well-trained doctors is recognised. Practical recommendations are made concerning information provision and clear delineations of student and patient roles and expectations. (shrink)

David Lewis's modal realism claims that nothing can exist in more than one world or time, and that statements about how something would have been are to be analysed in terms of its counterpart. I first explain why the counterpart relation depends on de re modal statements in an intensional language, so that intuitive properties of similarity relations cannot be used to show that the counterpart relation is not an equivalence relation. I then look at test sentences in (the intensional) (...) natural language, and show that none of them provide compelling evidence that a counterpart semantics is needed. (shrink)

Phillips & Silverstein emphasize the gain-control properties of NMDA synapses in cognitive coordination. We endorse their view and suggest that NMDA synapses play a crucial role in biased attentional competition and (visual) working memory. Our simulations show that NMDA synapses can control the storage rate of visual objects. We discuss specific predictions of our model about cognitive effects of NMDA-antagonists and schizophrenia.

Publication de deux poèmes byzantins du 12ème s. attribués à Théodore Prodomos, qui fournissent un certain nombre de renseignements sur les tentes des camps d'hiver des Comnène, et en particulier sur celle de la maison d'Irène la Sevastokratorissa. Cette étude mène l'auteur à un commentaire historico-artistique des éléments décrits: il compare d'abord ceux-ci avec l'art des 11ème et et 12ème s., et particulièrement avec l'art profane, puis il s'interroge sur l'authenticité des descriptions par rapport aux figures de rhétorique employées dans (...) ces textes. (shrink)

In list-method directed forgetting, reexposure to forgotten List 1 items has been shown to reduce directed forgetting. proposed that reexposure to a few List 1 items only during a direct test of memory reinstates the entire List 1 episode. In the present experiments, part-list reexposure in the context of indirect as well as direct memory tests reduced directed forgetting. Directed forgetting was reduced when 50% or more of the items were reexposed, and was intact when only 25% were reexposed. Furthermore, (...) part-list reexposure appeared to reinstate only reexposed items-not the entire List 1 episode. (shrink)

Africa’s current socio-economic predicament is often solely attributed to political and economic mismanagement. However, such an analysis is far from comprehensive, as it fails to account for the historical, sociological and psychological causes of the current unsatisfactory social conditions in the continent. Consequently, using the critical and prescriptive techniques of philosophic reflection, this paper examines four apparent mental impediments to desirable social transformation in contemporaryAfrica, namely, conservatism, feeble social consciousness, blind acceptance of the white-black dichotomy, and a fixation with foreign (...) paradigms of managing public affairs. The paper calls for an interdisciplinary approach to the verifying, mitigating and/or eliminating of these impediments. (shrink)

While H. Odera Oruka is best known for his views on sage philosophy, he spent a considerable portion of his philosophical career agonizing over the question of human rights. The present paper argues that there is need for further philosophical reflection on Oruka’s account of the foundation of human rights with a view to refining it.

Scientific tradition holds that it is essential to permit individual researchers almost complete freedom in their selection of research projects. As a result, structured research planning has not played a major role in determining the course of the sciences. By “structural research planning” we mean the methodical establishment of goals, and the identification of research routines which apparently accord priority to highest value goals, while minimizing the cost and time of their attainment. With increasing competition for limited fiscal and intellectual (...) resources this kind of planning may become more necessary. Let us cite three specific examples: First, the individual researcher is often faced with the question of how best to spend his time in pursuing a particular line of investigation. He must allocate his personal resources of time and talent to work which appears to hold the promise of highest pay-off. Second, on a larger scale, the competition for resources also raises the question of priority among alternative government-sponsored research projects. Individuals proposing equally alluring projects sometimes seek the same funds; government planners need some sort of objective criteria in order to judge the proposals. Furthermore, government planners face the problem of justifying their request for “big science” resources; a planning strategy which defines the use and expected output of the requested resources can help in the design and promotion of their concept. Finally, there is a growing sentiment that at least some research should be directed toward the solution of current and anticipated societal problems, to find means of circumventing or minimizing the impact of potentially dangerous problems of civilization. These needs : the choice of individual research, allocation of national resources among competing projects, and selecting research of societal importance, suggest that structured research planning might be valuable. (shrink)