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The article discusses a study on trends in sedative prescription among older adults after critical illness. Topics include the prescription of sedatives in intensive care units (ICUs), reduction in the proportion of sedative-naive older adults surviving an ICU admission filing a new outpatient sedative prescription, and incident rate ratio and estimated annual percentage change in sedative prescriptions.

Despite a growing need for mental health services for adolescents, treatment access among adolescents remains poor. Psychologists practicing in the United States are subject to highly variable legal standards for consent and confidentiality of minor clients, which can further suppress treatment accessibility. States permit independent consent for minors according to a wide range of criteria, but whether these criteria are empirically derived remains unknown. Inconsistencies between the law and ethical obligations for psychologists can expose minor clients to harm and force psychologists to make disclosures that violate patients' rights and ethical standards. These harms may be particularly severe for clients from vulnerable populations such as sexuality and gender diverse youth (SGDY). To prevent ethical dilemmas, psychologists and professional organizations should work toward an empirical understanding of the adolescent capacity to consent to mental health care and use that understanding to promote uniform consent and confidentiality standards. [ABSTRACT FROM AUTHOR]

The quality of cancer care delivery varies across different regions of Ghana, highlighting the need for improved access to quality healthcare services. Telemedicine has emerged as a promising solution to address this disparity, as it can reduce costs and improve access to healthcare services for cancer patients in remote areas. Despite the widely reported benefits of telemedicine, its adoption in low-resource settings has been slow due to several challenges. This study explores strategies for incorporating telemedicine into the current healthcare system in Ghana for the benefit of all patients especially those diagnosed with cancer. The study also highlights the current challenges and opportunities associated with the implementation and utilisation of telemedicine in Ghana. This research was a cross-sectional study conducted in Accra, Ghana that adopted a mixed-methods approach. Participants were selected through multi-stage probability sampling. Quantitative data were collected via a survey whereas qualitative data were obtained by means of in-depth interviews and focus group discussions among healthcare professionals, patients and key stakeholders in the telemedicine industry. The Statistical Program for the Social Sciences (version 21) was used to assemble, analyse and display the research data. The major challenges discussed centered on high initial investment costs, privacy and security concerns, poor internet connectivity, insufficient infrastructure and training of healthcare providers as well as the resistance to change among healthcare professionals. The study contributes to the understanding of telemedicine adoption in Ghana with findings underscoring the potential to address healthcare challenges while highlighting the need to overcome implementation obstacles. The study findings also provide valuable insights for policymakers, healthcare institutions and stakeholders to enhance telemedicine adoption in Ghana. [ABSTRACT FROM AUTHOR]

AbstractHigh profile data breaches and the proliferation of self-tracking technologies generating bio-feedback data have raised concerns about data privacy and data sharing practices among users of these devices. However, our understanding of how self-trackers in sexual health populations, where the data may be sensitive, personal, and stigmatising, perceive data privacy and sharing is limited. This study combined industry consultation with a survey of users of the world’s first biofeedback smart vibrator, the Lioness, that enables users to monitor and analyse their sexual response intensity and orgasm duration over time. We found users of the Lioness are motivated to self-track by both individual and altruistic goals: to learn more about their bodies, and to contribute to research that leads to better sexual health outcomes. Perceptions of data privacy and data sharing were shaped by an eagerness to collaborate with sexual health researchers to challenge traditional male-centric perspectives in biomedical research on women’s sexual health, where gender plays a crucial role in defining healthcare systems and outcomes. This study extends our understanding of the non-digital aspects of self-tracking by emphasising the role of gender and inclusive healthcare advocacy in shaping perceptions of data privacy and sharing within sexual health populations. [ABSTRACT FROM AUTHOR]

AbstractThis review explores the transformative potential of Artificial Intelligence (AI) in the light of evolving threats to planetary health, particularly the dangers posed by the climate crisis and its emerging mental health impacts, in the context of a climate-vulnerable country such as the Philippines. This paper describes the country’s mental health system, outlines the chronic systemic challenges that it faces, and discusses the intensifying and widening impacts of climate change on mental health. Integrated mental healthcare must be part of the climate adaptation response, particularly for vulnerable populations. AI holds promise for mental healthcare in the Philippines, and be a tool that can potentially aid in addressing the shortage of mental health professionals, improve service accessibility, and provide direct services in climate-affected communities. However, the incorporation of AI into mental healthcare also presents significant challenges, such as potentially worsening the existing mental health inequities due to unequal access to resources and technologies, data privacy concerns, and potential AI algorithm biases. It is crucial to approach AI integration with ethical consideration and responsible implementation to harness its benefits, mitigate potential risks, and ensure inclusivity in mental healthcare delivery, especially in the era of a warming planet. [ABSTRACT FROM AUTHOR]

Patients leave ED for a variety of reasons and at all stages of care. In Australian law, clinicians and health services owe a duty of care to people presenting to the ED for care, even if they have not yet entered a treatment space. There is also a positive duty to warn patients of material risks associated with their condition, proposed treatment(s), reasonable alternative treatment options and the likely effect of their healthcare decisions, including refusing treatment. This extends to a decision to leave the ED before care is completed. The form of that warning may vary based on what is known about the patient's condition and the associated risks at the time. Specific documentation of warnings given is essential. [ABSTRACT FROM AUTHOR]

Introduction: The disclosure of information that identifies deceased organ donors and/or organ transplant recipients by organ donation agencies and transplant centres is regulated in Australia by state and territory legislation, yet a significant number of donor family members and transplant recipients independently establish contact with each other. Aim: To describe and synthesize Australian laws and guidelines on the disclosure of identifying information. Method: Legislation and guidelines relevant to organ donation and transplantation were obtained following a search of government and DonateLife network websites. Information about the regulation of identity disclosure was extracted and synthesised using a process guided by Walt and Gilson's (1994) policy analysis framework. Findings: Nineteen documents were examined. Six guidelines refer to and were consistent with current legislation. Four documents did not address identity disclosure. All jurisdictions prohibit healthcare professionals from disclosing identifying information. In three states, the prohibition extends to all members of the public including donor family members and transplant recipients. Conclusion: Restrictions on identity disclosure have implications for public promotion of donation and transplantation where sharing of stories and images of organ donors and transplant recipients is common. Further research is required to understand the perspective of donor family members, transplant recipients, and healthcare professionals impacted by the current laws. [ABSTRACT FROM AUTHOR]

This perspective paper provides a comprehensive examination of artificial intelligence (AI) in healthcare, focusing on its transformative impact on clinical practices, decision-making, and physician-patient relationships. By integrating insights from evidence, research, and real-world examples, it offers a balanced analysis of AI's capabilities and limitations, emphasizing its role in streamlining administrative processes, enhancing patient care, and reducing physician burnout while maintaining a human-centric approach in medicine. The research underscores AI's capacity to augment clinical decision-making and improve patient interactions, but it also highlights the variable impact of AI in different healthcare settings. The need for context-specific adaptations and careful integration of AI technologies into existing healthcare workflows is emphasized to maximize benefits and minimize unintended consequences. Significant attention is given to the implications of AI on the roles and competencies of healthcare professionals. The emergence of AI necessitates new skills in data literacy and technology use, prompting a shift in educational curricula towards digital health and AI training. Ethical considerations are a pivotal aspect of the discussion. The paper explores the challenges posed by data privacy concerns, algorithmic biases, and ensuring equitable access to AI-driven healthcare. It advocates for the development of comprehensive ethical frameworks and ongoing research to guide the responsible use of AI in healthcare. Conclusively, the paper advocates for a balanced approach to AI adoption in healthcare, highlighting the importance of ongoing research, strategic implementation, and the synergistic combination of human expertise with AI technologies for optimal patient care. [ABSTRACT FROM AUTHOR]

Background Speculum examination is an intrusive practice in the clinical care of women. It requires privacy and patients may experience discomfort or anxiety related to the procedure, which can result in delays or avoidance of necessary healthcare. Speculum self-insertion originated in the United States in the 1970s as part of the self-help movement. However, this clinical practice is largely unknown among healthcare providers and has rarely been assessed. Aim This study investigates the women's views and healthcare providers' experiences of the self-insertion method. Method A qualitative study was conducted between December 2021 and October 2022, including fieldwork combining semi-structured interviews (10 women) and focus groups associated with individual interviews of 13 healthcare providers. The data collected were independently coded by 2 authors and analysed using an inductive approach and grounded theory method. Results Speculum self-insertion was described as a way to decrease discomfort and facilitate speculum insertion. Self-insertion was proposed as a means of allowing women to participate in the examination, reducing their vulnerability against power imbalances in the doctor–patient relationship. Both patients and healthcare providers have reported that speculum self-insertion is a method that can contribute to improving trust and communication during the examination. Conclusion The practice of speculum self-insertion during the consultation is an alternative to traditional practitioner insertion and may be offered to all women by any practitioner who wishes to use this technique. [ABSTRACT FROM AUTHOR]

Background Obstetricians often times find themselves in a conflict of right and duty with their patients, when these patients refuse recommended treatment. On the one hand, the obstetrician, aiming to fulfil the duty of care, recommends a treatment in the best interest of the woman. The woman, on the other hand, exercising her right of self-determination and autonomy, declines the recommended treatment. Materials and Methods A search was conducted for literature, articles and case reports on the subject on PubMed/MEDLINE and Google Scholar using the keywords: medical ethics, medical law, obstetric mortality, maternal medicine, foetal medicine, patient autonomy, informed consent, right to life and right to liberty. Results Opinions have historically differed on whether maternal or foetal rights should be deferred to in situations where pregnant women refuse obstetric interventions. So also have legal decisions on the issue. The general consensus is, however, to respect a woman's refusal of recommended medical treatment, in deference to her right of self-determination and autonomy. The obstetric outcomes in such instances are however, often times, unfavourable. Conclusion The ethics of patient care in the face of conflicting rights deserves renewed examination and discourse. [ABSTRACT FROM AUTHOR]

Background: In Morocco, medical research ethics training was integrated into the medical curriculum during the 2015 reform. In the same year, a law on medical research ethics was enacted to protect individuals participating in medical research. These improvements, whether in the reform or in the enactment of the law, could positively impact the knowledge of these researchers and, consequently, their attitudes and practices regarding medical research ethics. The main objective of this work is to assess Moroccan physicians' knowledge, attitudes, and practices at the beginning of their careers (interns and residents) in medical research ethics. Patients and methods: This is a multicenter cross-sectional study conducted in 2021 among Moroccan physicians. Three scores were created and validated to assess physicians' level of knowledge, attitudes, and practices regarding research ethics. A descriptive analysis was carried out, followed by a univariate analysis and a multivariate analysis using multivariate binary logistic regression to study the factors associated with the different calculated scores. Results: A total of 924 physicians were included in the study, with an average age of 27.8 ± 2.2 years. 40.7% had a high medical research ethics knowledge score, and 68.8% had good attitudes. These two scores were positively associated with age and were statistically higher in residents and in physicians who had received training in medical research ethics during their medical curriculum. Only 29,9% of physicians who had participated in research studies had adequate practices with medical research ethics. This score was statistically higher in residents and in physicians who had heard about research ethics. Conclusion: A genuine introduction to ethics in the medical curriculum is essential to enhance researchers' knowledge, attitudes, and practices. This, in turn, can lead to an increase in both the quantity and quality of research conducted in Morocco. [ABSTRACT FROM AUTHOR]

Here, we analyze the public health implications of recent legal developments — including privacy legislation, intergovernmental data exchange, and artificial intelligence governance — with a view toward the future of public health informatics and the potential of diverse data to inform public health actions and drive population health outcomes. [ABSTRACT FROM AUTHOR]

Background and Aims: ChatGPT represents the most popular and widely used generative artificial intelligence (AI) model that received significant attention in healthcare research. The aim of the current study was to assess the future trajectory of the needed research in this domain based on the recommendations of the top influential published records. Materials and Methods: A systematic search was conducted on Scopus, Web of Science, and Google Scholar (27–30 November 2023) to identify the top ten ChatGPT-related published records in healthcare across the three databases. Classification of the records as “top” denoting high influence in the field was based on citation counts. Results: A total of 22 unique records from 17 different journals representing 14 different publishers were identified as the top ChatGPT-related publications in healthcare subject. Based on the identified records’ recommendations, the following themes appeared as important areas to consider in future ChatGPT research in healthcare: improving healthcare education, improved efficiency of clinical processes (e.g., documentation), addressing ethical concerns (e.g., patient privacy and consent), supporting research tasks (e.g., data analysis, manuscript preparation), mitigating ChatGPT output biases, improving patient education and engagement, and developing standardized assessment protocols for ChatGPT utility in healthcare. Conclusions: The current review highlighted key areas to be prioritized in assessment of ChatGPT utility in healthcare. Interdisciplinary collaborations and standardizing methodologies are needed to synthesize robust evidence in these studies. Based on these recommendations and the promising potential of ChatGPT on healthcare, JMJ launched a call for papers for a special issue entitled “Evaluating Generative AI-Based Models in Healthcare”. [ABSTRACT FROM AUTHOR]

The evolution of Patient-Generated Health Data (PGHD) represents a major shift in healthcare, fueled by technological progress. The advent of PGHD, with technologies such as wearable devices and home monitoring systems, extends data collection beyond clinical environments, enabling continuous monitoring and patient engagement in their health management. Despite the growing prevalence of PGHD, there is a lack of clear understanding among stakeholders about its meaning, along with concerns about data security, privacy, and accuracy. This article aims to thoroughly review and clarify PGHD by examining its origins, types, technological foundations, and the challenges it faces, especially in terms of privacy and security regulations. The review emphasizes the role of PGHD in transforming healthcare through patient-centric approaches, their understanding, and personalized care, while also exploring emerging technologies and addressing data privacy and security issues, offering a comprehensive perspective on the current state and future directions of PGHD. The methodology employed for this review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Rayyan, AI-Powered Tool for Systematic Literature Reviews. This approach ensures a systematic and comprehensive coverage of the available literature on PGHD, focusing on the various aspects outlined in the objective. The review encompassed 36 peer-reviewed articles from various esteemed publishers and databases, reflecting a diverse range of methodologies, including interviews, regular articles, review articles, and empirical studies to address three RQs exploratory, impact assessment, and solution-oriented questions related to PGHD. Additionally, to address the future-oriented fourth RQ for PGHD not covered in the above review, we have incorporated existing domain knowledge articles. This inclusion aims to provide answers encompassing both basic and advanced security measures for PGHD, thereby enhancing the depth and scope of our analysis. [ABSTRACT FROM AUTHOR]

The digitisation of healthcare systems has brought numerous benefits, including improved accessibility, enhanced efficiency and the potential for personalised medicine, ushering in a new era of medical advancements and streamlined patient care. However, alongside these advantages, it has also introduced a host of security and privacy challenges. The widespread adoption of digital technologies in healthcare raises concerns regarding security and privacy. This article explores critical issues surrounding the security and privacy of healthcare data in the digital age, aiming to highlight potential risks and vulnerabilities that arise with the adoption of technology in healthcare. Key security and privacy issues associated with digitisation efforts in healthcare are examined, and potential strategies to mitigate these concerns are discussed. The findings emphasise the importance of implementing robust security measures, ensuring patient privacy and fostering trust in digital healthcare systems. Furthermore, the article delves into the various challenges faced by healthcare organisations, policymakers and stakeholders in safeguarding sensitive medical information. These challenges encompass data breaches, unauthorised access, ransomware attacks and the potential misuse of patient data. Understanding these threats is essential for developing effective strategies to protect patient privacy and maintain data integrity. To address these challenges, the article presents a range of strategies and best practices, including implementing robust encryption measures, adopting multi-factor authentication, establishing secure communication channels and training healthcare professionals to be vigilant against cyber threats. Moreover, the significance of complying with regulatory frameworks, such as the Health Insurance Portability and Accountability Act and the General Data Protection Regulation, is explored to ensure the legal and ethical handling of patient data. By exploring these challenges and presenting practical strategies, this article aims to raise awareness among healthcare professionals and policymakers about the importance of prioritising security and privacy in the digitisation of healthcare systems. Acknowledging and proactively addressing these concerns will enable the healthcare industry to fully harness the potential of digitisation while ensuring the trust and confidence of patients and stakeholders. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to identify the reasons why cases of leakage of patient personal data often occur in the health sector. This paper also analyzes personal data protection regulations in the health sector from a comparative legal perspective between Indonesia, Singapore and the European Union (EU). Design/methodology/approach: This type of research is legal research. The research approach used is the statute approach and conceptual approach. The focus of this study in this research is Indonesia with a comparative study in Singapore and the EU. Findings: Cases of leakage of patient personal data in Indonesia often occur. In 2021, the data for 230,000 COVID-19 patients was leaked and sold on the Rapid Forums dark web forum. A patient's personal data is a human right that must be protected. Compared to Singapore and the EU, Indonesia is a country that does not yet have a law on the protection of personal data. This condition causes cases of leakage of patients' personal data to occur frequently. Research limitations/implications: This study analyzes the regulation and protection of patients' personal data in Indonesia, Singapore and the EU to construct a regulatory design for the protection of patients' personal data. Practical implications: The results of this study are useful for constructing regulations governing the protection of patients' personal data. The regulation is to protect the patient's personal data like a patient's human right. Social implications: The ideal regulatory design can prevent data breaches. Based on the results of comparative studies, in Singapore and the EU, cases of personal data leakage are rare because they have a regulatory framework regarding the protection of patients' personal data. Originality/value: Legal strategies that can be taken to prevent and overcome patient data breaches include the establishment of an Act on Personal Data Protection; the Personal Data Protection Commission; and management of patients' personal data. [ABSTRACT FROM AUTHOR]

The article focuses on the emergence of direct-to-consumer platforms for new antiobesity medications, highlighting both concerns and potential opportunities associated with this approach. Topics discussed include the rise in demand for antiobesity medications like semaglutide, the challenges of traditional healthcare systems in meeting this demand, and the potential risks and benefits of direct-to-consumer prescribing models for such medications.

Social workers are bound to maintaining confidentiality of information provided by service users. The client provides information on the assumption that the social worker will maintain his privacy even in legal proceedings. However, sometimes social workers are forced to break the boundaries of confidentiality in accordance with legislation, such as in reporting harm or injury to a minor by his/her guardian, even if the latter is the social worker's client. This study examined the attitude of Israeli courts toward the limits of maintaining confidentiality in social work, using a quantitative-descriptive research of documents - judgments selected for this study. In the social work cases presented, the court outlined the boundaries of confidentiality and its perception of social workers' professional work. The findings revealed that social workers' clients rarely filed personal claims against them. The main legal issue raised in the judgments was the removal of confidentiality; most of the judgments found that the breach of confidentiality claim between social worker and client was unjustified. The study concludes by offering several courses of action to help educate social workers in dealing with the desire to maintain confidentiality in daily practice. [ABSTRACT FROM AUTHOR]

Edge computing has emerged as a potential solution to some of the challenges in healthcare. It involves processing data closer to the source, such as medical devices and sensors, rather than relying solely on centralized data centers or cloud computing. This approach offers advantages like reduced latency, real-time decision-making, and enhanced privacy protection. Efficient privacy-preserving medical diagnosis on edge computing platforms is a concept deeply rooted in the intersection of healthcare and technology. Over the years, medical diagnosis has increasingly relied on machine learning algorithms to analyze vast amounts of patient data. These algorithms can predict diseases, identify anomalies in medical images, and offer personalized treatment recommendations. However, a significant challenge in this domain is the protection of patient data privacy. Healthcare data is incredibly sensitive, and data breaches or unauthorized access can result in severe consequences, including identity theft and discrimination. Therefore, this research work tackles several key issues. First and foremost, it aims to ensure the privacy of medical data throughout the diagnosis process. This means developing machine learning models and algorithms that can make accurate predictions while safeguarding the sensitive information contained in patient records. Additionally, these models must be highly efficient to operate effectively within the resource-constrained environment of edge computing platforms. Further, real-time processing is a critical requirement in healthcare, especially for conditions that demand immediate attention. Hence, this work strives to provide timely results to healthcare providers. Furthermore, the models must maintain a high level of accuracy and reliability to instill trust in the medical community and ensure that patients receive the best possible care. Ultimately, this research aligns with the goal of patient-centric care. It empowers patients to have more control over their data, share it securely with healthcare providers, and receive real-time decision support, all while preserving their privacy and the integrity of their medical information. [ABSTRACT FROM AUTHOR]

Bangladesh received the United Nations Award for DigitalHealth Development in 2011. Inspired by the recognition, the country has launched several digital health initiatives over the last decade. However, despite achievements in expanding information and communication technologies, recent studies show that current digital health services are difficult to use, fail to meet user needs, are subject to threats in data privacy and security, lack a robust digital infrastructure, and do not benefit from a cohesive policy and regulatory environment. As the country currently deals with the post‐COVID‐19 consequences, it is high time for its healthcare policymakers to address these challenges and take the necessary actions to establish a people‐centered framework for digital health service design and operations. In this commentary, we proposed a design framework for digital health services that address these ongoing challenges in the digital health services of Bangladesh. We believe the proposed framework stands to help Bangladesh and other coutnries attain sustainability. Key Points: Most digital health services in Bangladesh lack usability, user‐centricity, data privacy and security, digital infrastructure, technical and resource expertise, digital literacy, motivation, and trust of all healthcare stakeholders.It is time for Bangladesh's health policymakers to address the ongoing challenges that demand a people‐centred digital health service design and operations framework.This policy perspective proposes a design framework for digital health services that addresses the ongoing challenges in the digital health services of Bangladesh. [ABSTRACT FROM AUTHOR]

The World Health Organization (WHO) has released a publication outlining key considerations for regulating artificial intelligence (AI) in healthcare. The WHO recognizes the potential benefits of AI in improving clinical trials, diagnoses, and treatment, but also highlights the risks associated with its use. These risks include privacy and security concerns, unethical data collection, cybersecurity risks, and the amplification of biases and misinformation. The WHO has identified six areas for regulation, including transparency, risk management, data validation, data quality, privacy, and collaboration. The goal is to protect healthcare professionals and patients while harnessing the full potential of AI in healthcare. [Extracted from the article]

Data Privacy has increasingly become a matter of concern in the era of large public digital respositories of data. This is particularly true in healthcare where data can be misused if traced back to patients, and brings with itself a myriad of possibilities. Bring custodians of data, as well as being at the helm of disigning studies and products that can potentially benefit products, healthcare professionals often find themselves unsure about ethical and legal constraints that undelie data sharing. In this review we touch upon the concerns, leal frameworks as well as some common practices in these respects. [ABSTRACT FROM AUTHOR]

BACKGROUND: Protection of wireless technology-enabled e-healthcare data transfer over constrained devices of body sensor networks using lightweight security mechanisms is the demand of health sector nowadays. OBJECTIVE: A new secure wireless body sensor network architecture (S-WBSN) with reduced CPU cycles and computational cost is proposed. S-WBSN uses OTP-Q (One-Time Pad-Quasi) and Diffie-Hellman key exchange algorithms for encryption and mutual authentication, respectively. METHODS: To ensure mutual authentication among < WBSN, Local Processing Center (LPC) > and < WBSN, Data Server > components, the Diffie-Hellman key exchange algorithm is used. Using the S-WBSN architecture, security requirements such as mutual authentication, and privacy preservation thwarting security attacks are perfectly met comparing other security-based research works on healthcare data monitoring. RESULTS: The one-time pad-based quasi-group algorithm is a stream block cipher that operates on the data observed from the sensors of the WBSN. Before transmitting encrypted data, authentication is to be established. CONCLUSION: The proposed system methodology proves to be efficient and consumes fewer CPU cycles. The encryption and decryption processing times are comparatively less than the state-of-the-art approaches. [ABSTRACT FROM AUTHOR]

In this article I argue that non-disclosure agreements represent the latest in a continuum of tools used to silence women who seek justice in response to the misconduct of those in authority. I draw a connection between the use of these apparently objective, non-corporeal organizational processes and the historic use of the scold's bridle, a corporeal instrument of control applied to physically silence. Specifically, I argue that both are on a continuum of violence from the antiquated, overt and embodied, to the present day, covert and epistemic with embodied effects. This article offers a critical phenomenological analysis of the effects on women who submitted evidence of their experiences to the UK Parliament Women and Equalities Committee Inquiry into the use of non-disclosure agreements in Discrimination Cases. By critically analysing these accounts I offer a contribution toward a continued understanding of the ways in which oppressive organizational practices according to gender continue to function and reproduce through practices of embodied epistemic injustice. [ABSTRACT FROM AUTHOR]

Background: Electronic medical record software is common in healthcare settings. However, data privacy and security challenges persist and may impede patients' willingness to disclose health information to their clinicians. Positive patient-provider communication may foster patient trust and subsequently reduce information nondisclosure. This study sought to characterize information-withholding behaviors among women and evaluate the association between positive patient-provider communication and women's health information-withholding behavior in the United States. Methods: Data were pooled from the 2011 to 2018 Health Information National Trends Survey. We used descriptive statistics, bivariate, and logistic regression analyses to investigate whether positive patient-provider communication significantly impacted health information-withholding behaviors. Data from 7,738 women were analyzed. Results: About 10.8% or 1 in 10 women endorsed withholding health information from their providers because of privacy or security concerns about their medical records. After adjusting for the covariates, higher positive patient-provider communication scores were associated with lower odds of withholding information from the provider because of privacy and security concerns (aOR 0.93; 95% CI = 0.90–0.95). Additionally, we found that age, race/ethnicity, educational status, psychological distress, and smoking status significantly predicted women's willingness to disclose health information. Conclusions: Findings suggest that improving positive patient-provider communication quality may reduce women's privacy and security concerns and encourage them to disclose sensitive medical information. [ABSTRACT FROM AUTHOR]

The use and disclosure of patient information is subject to multiple legal and ethical obligations. Within European human rights law the differences relating to consent are reflected in the separate requirements of data protection law, the common law, and professional ethics. The GDPR requires explicit consent. This contrasts with the ethical and common law availability of reliance on implied consent for the use of patient information for that patient's care and treatment. For any proposed use of patient information for healthcare purposes other than direct care, even where GDPR may be satisfied if the patient refuses to consent to disclosure, the information should not normally be disclosed. For any proposed use or disclosure outside healthcare the justification should normally be consent. However, consent is often not possible or appropriate and an overriding public interest can be relied upon to justify the use or disclosure, both legally and ethically. [ABSTRACT FROM AUTHOR]

Introduction: Healthcare systems are complex and challenging for all stakeholders, but artificial intelligence (AI) has transformed various fields, including healthcare, with the potential to improve patient care and quality of life. Rapid AI advancements can revolutionize healthcare by integrating it into clinical practice. Reporting AI's role in clinical practice is crucial for successful implementation by equipping healthcare providers with essential knowledge and tools. Research Significance: This review article provides a comprehensive and up-to-date overview of the current state of AI in clinical practice, including its potential applications in disease diagnosis, treatment recommendations, and patient engagement. It also discusses the associated challenges, covering ethical and legal considerations and the need for human expertise. By doing so, it enhances understanding of AI's significance in healthcare and supports healthcare organizations in effectively adopting AI technologies. Materials and Methods: The current investigation analyzed the use of AI in the healthcare system with a comprehensive review of relevant indexed literature, such as PubMed/Medline, Scopus, and EMBASE, with no time constraints but limited to articles published in English. The focused question explores the impact of applying AI in healthcare settings and the potential outcomes of this application. Results: Integrating AI into healthcare holds excellent potential for improving disease diagnosis, treatment selection, and clinical laboratory testing. AI tools can leverage large datasets and identify patterns to surpass human performance in several healthcare aspects. AI offers increased accuracy, reduced costs, and time savings while minimizing human errors. It can revolutionize personalized medicine, optimize medication dosages, enhance population health management, establish guidelines, provide virtual health assistants, support mental health care, improve patient education, and influence patient-physician trust. Conclusion: AI can be used to diagnose diseases, develop personalized treatment plans, and assist clinicians with decision-making. Rather than simply automating tasks, AI is about developing technologies that can enhance patient care across healthcare settings. However, challenges related to data privacy, bias, and the need for human expertise must be addressed for the responsible and effective implementation of AI in healthcare. [ABSTRACT FROM AUTHOR]

The recent emergence of publically facing artificial intelligence (AI) chatbots has generated vigorous discussion in the lay public around the possibilities, liabilities, and uncertainties of the integration of such technology into everyday life. As primary care clinicians continue to struggle against ever-increasing loads of asynchronous, electronic work, the potential for AI to improve the quality and efficiency of this work looms large. In this essay, we discuss the basic premise of open-access AI chatbots such as CHATGPT, review prior applications of AI in healthcare, and preview some possible AI chatbot–assisted in-basket assistance including scenarios of communicating test results with patients, providing patient education, and clinical decision support in history taking, review of prior diagnostic test characteristics, and common management scenarios. We discuss important concerns related to the future adoption of this technology including the transparency of the training data used in developing these models, the level of oversight and trustworthiness of the information generated, and possible impacts on equity, bias, and patient privacy. A stepwise and balanced approach to simultaneously understand the capabilities and address the concerns associated with these tools will be needed before these tools can improve patient care. [ABSTRACT FROM AUTHOR]

Background: In Australia, national policy prioritises the integration of clinical genetic data with networked electronic medical records (EMRs) for enhanced coordination of care and clinical decision-making. Objective: To examine the needs, privacy expectations and concerns of patients, family members, patient advocates and clinicians in relation to the use of networked EMRs for clinical genetic information. Method: Purposive sampling was used to recruit 27 participants for a semi-structured qualitative interview, primarily over Zoom. The interviews were audio and video-recorded and externally transcribed. Interview transcripts were then coded and analysed in NVivo, using an inductive thematic approach. Results: Thematic analysis revealed diverse preferences regarding genetic information access and handling across participants, with five core themes being identified: degree of access and control; central role of genetic professionals as information gatekeepers; complexities of familial implications; external risks; and law, governance and policy; all strong themes that emerged across numerous participants. Conclusion: This project yielded unprecedented and significant insights into the views, needs and concerns of key stakeholders in Australia regarding the inclusion of health-related genetic test results in networked EMRs. Implications: These findings provide a critical reference point for much-needed law reform and policy-making around genetic test results in Australia. [ABSTRACT FROM AUTHOR]

Digital health is a broad term that includes telecommunication technologies to collect, share and manipulate health information to improve patient health and health care services. With the growing use of wearables, artificial intelligence, machine learning, and other novel technologies, digital health is particularly relevant to the field of cardiac arrhythmias, with roles pertinent to education, prevention, diagnosis, management, prognosis, and surveillance. This review summarizes information on the clinical use of digital health technology in arrhythmia care and discusses its opportunities and challenges. Digital health has begun to play an essential role in arrhythmia care regarding diagnostics, long-term monitoring, patient education and shared decision making, management, medication adherence, and research. Despite remarkable advances, integrating digital health technologies into healthcare faces challenges, including patient usability, privacy, system interoperability, physician liability, analysis and incorporation of the huge amount of real-time information from wearables, and reimbursement. Successful implementation of digital health technologies requires clear objectives and deep changes to existing workflows and responsibilities. [ABSTRACT FROM AUTHOR]

This Viewpoint describes the newly finalized Reproductive Privacy Rule, a HIPAA regulatory update intended to prevent law enforcement in abortion-restrictive states from obtaining reproductive care medical records to prosecute patients and physicians. [ABSTRACT FROM AUTHOR]

This article discusses the disparities and challenges faced by LGBTQ+ individuals in accessing healthcare and achieving health equity. It highlights the discrimination and inequity experienced by sexual and gender minority populations, as well as the impact of anti-LGBT+ legislation. The article presents three studies that examine the health disparities faced by sexual minority adults, transgender and gender diverse individuals within the Veterans Health Administration, and intersex populations. The findings of these studies provide recommendations for future research and policy, emphasizing the need for longitudinal studies, the inclusion of measures of sexual orientation and gender identity in research, and the implementation of trauma-informed care practices. The article also emphasizes the importance of privacy and data security policies, comprehensive training of healthcare staff, and systematic reviews to consolidate knowledge on LGBTQ+ health. Finally, it calls for policy evaluation research and the effectiveness of training and educational programs for healthcare providers to ensure culturally competent and inclusive care for LGBTQ+ individuals. [Extracted from the article]

The recently passed Privacy Legislation Amendment (Enforcement and Other Measures) Act 2022 (Cth) introduced important changes to the Australian Privacy Act 1988 (Cth) which increase penalties for serious and repeated interferences with privacy and strengthen the investigative and enforcement powers of the Information Commissioner. The amendments were made subsequent to a number of high profile data breaches and represent the first set of changes to the Privacy Act following the review of the Act commenced by the Attorney-General in October 2020. The submissions made to the review emphasized the need for more effective enforcement mechanisms to increase individuals' control over their personal information and as a form of deterrence. This article reviews the recent amendments to the Privacy Act and explains their effect. It comments upon the relevance of the amendments for health and medical data and other data collected in the context of healthcare, and refers to the Attorney-General's Department's review of the Privacy Act regarding other proposals relating to enforcement which have not as yet been put into effect in legislation. [ABSTRACT FROM AUTHOR]

Purpose: Community pharmacists' role is shifting from product-oriented function towards patient-centered care. The patient-centered role of pharmacists is undervalued, as the public is unaware of pharmacists' role. This study aims to identify patients' perceptions and satisfaction with pharmaceutical care services and factors affecting their preferences for community pharmacy services. Patients and Methods: A quantitative cross-sectional study was conducted for three months on patients visiting registered community pharmacies in Kathmandu metropolitan ward number 10. Results: Out of 406 participants, 30.5% perceive pharmacists to have a balance between business and health aspects of pharmacy practices; 29.1% view them as drug experts; and 11.8% consider pharmacists to be more concerned with business. 43.8% of participants were found to discuss their drug-related queries with pharmacists, possibly due to low treatment costs. Approximately 77% of respondents had no hesitancy when contacting pharmacists for health-related information because they believed pharmacists were sufficiently qualified to address drug-related questions. Around 88% of respondents agreed that the role of pharmacists is to counsel the patient about the directions for the use of medications. The level of satisfaction indicated that 72.4% are highly satisfied with pharmacy services. In addition, patients feel comfortable discussing their health with pharmacists due to their ability to protect the privacy of their medical records. In contrast, more trust in doctors seems to be the most common barrier for patients visiting pharmacists. Conclusion: Overall, pharmacists were regarded as the most trusted health care personnel to contact. However, to facilitate the expansion of pharmaceutical care services, the public should be aware of their distinctive professional talents. It is recommended for future researchers to understand the subjective perspective of pharmacy staff, managers, and pharmaceutical policy makers. [ABSTRACT FROM AUTHOR]

Truly personalized precision medicine combines pharmacogenomics (PGx), a person's lived medication experiences and ethics; person-centeredness lies at the confluence of these considerations. A person-centered perspective can help inform PGx-related treatment guidelines, shared decision-making for PGx-related therapeutics and PGx-related healthcare policy. This article examines the interplay between these components of person-centered PGx-related care. Ethics concepts addressed include privacy, confidentiality, autonomy, informed consent, fiduciary responsibility, respect, the burden of pharmacogenomics knowledge for both the patient and healthcare provider and the pharmacist's ethical role in PGx-testing. Incorporating the patient's lived medication experience and ethics principles into PGx-based discussions of treatment can optimize the ethical, person-centered application of PGx testing to patient care. [ABSTRACT FROM AUTHOR]

In the United States, religious exemptions to health-driven mandates enjoy, and should enjoy, protected status in medical ethics and healthcare law. Religious exemptions are defined as seriously professed exceptions to state or federal laws, which appeal to Title VII of the Civil Rights Act of 1964, allowing workers to request an exception to a job requirement, including a health-protective mandate, if it "conflicts with their sincerely held religious beliefs, practices, or observances". In medical ethics, such religious exceptions are usually justified on the basis of the principle of autonomy, where personally held convictions, reflected in scripture or established religious norms, are safeguarded on the basis of the first amendment, thereby constituting an important area in which societal good must yield to individual liberty. Acknowledging the longstanding category of "religious exemptions", and referencing some examples that adhere to its parameters in good faith (e.g., objections made by some institutions to HPV vaccines), I argue that, to date, no coherent basis for religious exemptions to COVID-19 vaccines has been offered through appeal to the principle of autonomy, or, in a healthcare context, to "medical freedom". Indeed, proponents of characterizing these exemptions as legitimate misconstrue autonomy and abuse the reputation of the religious traditions they invoke in defense of their endeavors to opt out. The upshot is not only an error in interpreting the principle of autonomy, whereby it is issued a "blank check", but also a dishonesty in itself whereby a contested political position becomes deliberately disguised as a protected religious value. "Sincerely held beliefs", I conclude, appear no longer to constitute the standard for religious accommodation in the era of COVID-19. Individual declaration, seemingly free of any reasonable constraint, does. This is a shift that has serious consequences for public health and, more broadly, the public good. [ABSTRACT FROM AUTHOR]

Ensuring the confidentiality and protection of health information is the standard of care for adolescents. In 2023 and beyond, the protection of personal health information is more critical than ever. The 21st Century Cures Act Office of the National Coordinator for Health Information Technology Rule, with its requirements for the broad sharing of electronic health information and ban on "information blocking," poses serious concerns for confidentiality in adolescent health care delivery. The coronavirus disease 2019 pandemic has rapidly increased the use of telehealth and, thereby, patient portal use for adolescent health records, increasing risks for disclosure. Understanding the legal and clinical underpinnings for confidential adolescent health services and the clinical challenges and health information technology limitations presented by the Office of the National Coordinator for Health Information Technology Rule is key to providing quality adolescent health services while implementing the Rule. A framework is presented to facilitate decision-making in individual cases by clinicians. [ABSTRACT FROM AUTHOR]

Introduction: Client-accessible interdisciplinary health records potentially contribute to integrated care by facilitating collaboration and enhancing clients’ involvement in care. To achieve this, three Dutch organizations providing ‘care for youth’ developed a fully client-accessible electronic patient record (EPR-Youth). Objective: To evaluate the implementation of EPR-Youth and to determine barriers and facilitators. Methods: A mixed methods design combined system data, process observations, questionnaires and focus group interviews. Target groups were parents, adolescents, professionals using EPR-Youth, and implementation stakeholders. Findings: Client-portal acceptability was high among all clients. Client-portal adoption rate was high and differed between age groups and educational levels. Professionals’ doubts about acceptability, appropriateness and fidelity were partly due to lack of system knowledge. Implementation barriers were the complexity of co-creation, lack of clear leadership, and concerns about legal issues. Facilitators were clarifying vision and legal context, setting deadlines, and a pioneering spirit. Conclusion: The early implementation of EPR-Youth, the first Dutch client-accessible interdisciplinary electronic health record in ‘care for youth’ was successful. To enhance adoption among clients, group-specific barriers for portal-use should be determined. Professionals need additional training. Further research is needed to gain insight into client-portal access barriers. To benefit more from co-creation, an organizational change towards situational leadership is necessary. [ABSTRACT FROM AUTHOR]

Medical ethics and law are essential topics that should be included in medical residency programs. However, surgery training programs in Iran lack a specific course in medical ethics and law, which can lead to patient dissatisfaction with surgical outcomes. This study aimed to assess surgery residents' knowledge of medical ethics and law and suggest improvements for future residency programs. This descriptive cross-sectional study involved 112 surgery residents from six teaching hospitals. A valid and reliable questionnaire comprising 15 items on medical ethics and 12 items on medical law was used to assess participants' knowledge. Most participants were female (31-40 years old), and their mean knowledge score for medical ethics was 3.26±0.53 out of 5, with the lowest score in "futile treatment and DNR orders." The mean knowledge score for medical law was 3.69±0.69, with the lowest score in "surrogate decision-maker." Age did not affect residents' knowledge, but gender did, with female residents demonstrating significantly better knowledge of medical ethics (3.344/5 vs. 3.112/5) and law (3.789/5 vs. 3.519/5). Surgery residents had a relatively favorable knowledge of medical ethics and law, but they require further training in some areas to improve their knowledge. Training should include journal clubs, role-play programs, standardized patient programs, and debates to achieve better results, as purely didactic lectures appear inadequate. [ABSTRACT FROM AUTHOR]

The current legal status and medical ethics of routine or religious penile circumcision of minors is a matter of ongoing controversy in many countries. We focus on the United Kingdom as an illustrative example, giving a detailed analysis of the most recent British Medical Association guidance from 2019. We argue that the guidance paints a confused and conflicting portrait of the law and ethics of the procedure in the UK context, reflecting deeper, unresolved moral and legal tensions surrounding child genital cutting practices more generally. Of particular note is a lack of clarity around how to apply the "best interests" standard—ordinarily associated with time-sensitive proxy decision making regarding therapeutic options for a medically unwell patient—to a parental request for a medically unnecessary surgery to be carried out on the genitalia of a healthy child. Challenges arise in measuring and assigning weights to intended sociocultural or religious/spiritual benefits, and even to health-related prophylactic benefits, and in balancing these against potential physical, functional, and psychosexual risks or harms. Also of concern are apparently inconsistent safeguarding standards being applied to children based on their birth sex categorization or gender of rearing. We identify and discuss recent trends in British and international medical ethics and law, finding gradual movement toward a more unified standard for evaluating the permissibility of surgically modifying healthy children's genitals before they can meaningfully participate in the decision. [ABSTRACT FROM AUTHOR]

The United States Supreme Court's decision in Dobbs v. Jackson Women's Health Organization, eliminating the national right to abortion, poses challenges to psychiatrists and patients. Abortion laws now vary widely from state to state and are constantly changing and being challenged. The laws affect both patients and health care professionals; some prohibit not only the performance of abortion but efforts to inform and assist patients seeking abortion. Patients may become pregnant during and/or because of episodes of clinical depression, mania, or psychosis, and recognize that their current circumstances will not allow them to become adequate parents. Some laws allowing abortion to protect a woman's life or health explicitly exclude mental health risks; many prohibit transfer of a patient to a permissive venue. Psychiatrists working with patients contemplating abortion can convey the scientific evidence that abortion does not cause mental illness and help them identify and work through their own beliefs, values, and likely responses to the decision. Psychiatrists will also have to decide whether medical ethics or state laws will govern their own professional behavior. [ABSTRACT FROM AUTHOR]

Healthcare started as a one-man business where only the doctor received, reviewed, diagnosed, prescribed, dispensed the treatment, and nursed the patient. There was no regulation, and hence society relied solely on the doctor's morals for appropriate treatment, professional handling of patients, and confidentiality. The doctor was highly regarded in society and was close to royalty. The perceived benefits and lack of external regulation bred charlatans and eroded society's confidence stimulating the development of the Hippocratic Oath. The Hippocratic Oath has progressively evolved in tandem with developments in society to what it is today. From the Hippocratic Oath, medical ethics sprung and evolved. We review several oaths that abound in medical practice and their evolution over the years to what we have today as the Physician's Pledge. We reviewed several articles published in English within ten years based on specified search terms for conformity. The selected articles were screened for relevance to the research topic, and necessary data were extracted. The Oath, though controversial in origin, evolved from a one-liner "primus non nocere" to what it is today, having started as a document heavily influenced by religion to become completely secular. It also transitioned from relying on the physician's morality for compliance to becoming externally enforceable. The transformations of the Oath and Ethics, which could be seen as the compartmentalization of the Oath based on this study, resulted from landmark events in society and changes in religious ideologies and societal morals. The existence of many forms of the Oath was also established. Some of the Oaths were also adapted to suit the morals and beliefs of the areas used. In conclusion, concluded that the "One Oath for All" era is over. We propose an Oath or Pledge that will suit our society to avoid going counter to our laws. [ABSTRACT FROM AUTHOR]

Late last year, the Department of Health and Humans Services (HHS) published a 260‐page Notice of Proposed Rulemaking (NPRM) on changes to 42 CFR Part 2, a regulation which protects the confidentiality of treatment records for alcohol and drug use disorders. [ABSTRACT FROM AUTHOR]