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INTRODUCTION: Poor communication about serious injury in older adults can lead to treatment that is inconsistent with patient preferences, create conflict and strain healthcare resources. We developed a communication intervention called Best Case/Worst Case-intensive care unit (ICU) that uses daily scenario planning, that is, a narrative description of plausible futures, to support prognostication and facilitate dialogue among patients, their families and the trauma ICU team. This article describes a protocol for a multisite, randomised, stepped-wedge study to test the effectiveness of the intervention on the quality of communication (QOC) in the ICU. METHODS AND ANALYSIS: We will follow all patients aged 50 and older admitted to the trauma ICU for 3 or more days after a serious injury at eight high-volume level 1 trauma centres. We aim to survey one family or like family member per eligible patient 5-7 days following their loved ones admission and clinicians providing care in the trauma ICU. Using a stepped-wedge design, we will use permuted block randomisation to assign the timing for each site to begin implementation of the intervention and routine use of the Best Case/Worst Case-ICU tool. We will use a linear mixed-effects model to test the effect of the tool on family-reported QOC (using the QOC scale) as compared with usual care. Secondary outcomes include the effect of the tool on reducing clinician moral distress (using the Measure of Moral Distress for Healthcare Professionals scale) and patients length of stay in the ICU. ETHICS AND DISSEMINATION: Institutional review board (IRB) approval was granted at the University of Wisconsin, and all study sites ceded review to the primary IRB. We plan to report results in peer-reviewed publications and national meetings. TRIAL REGISTRATION NUMBER: NCT05780918.

Chatbots are "computer agents that can interact with the user" in a way that feels like human-to-human conversation.1 While the use of chatbots for reference service in academic libraries is a topic of interest for both library professionals and researchers, little is known about how they are used in library reference service, especially in academic libraries in Canada. This article aims to fill this gap by conducting a web-based survey of 106 academic library websites in Canada and analyzing the prevalence and characteristics of chatbot and live chat services offered by these libraries. The authors found that only two libraries were using chatbots for reference service. For live chat services, the authors found that 78 libraries provided this service. The article discusses possible reasons for the low adoption of chatbots in academic libraries, such as accessibility, privacy, cost, and professional identity issues. The article also provides a case study of the authors' institution, the University of Calgary, which integrated a chatbot service in 2021. The article concludes with suggestions for future research on chatbot use in libraries. [ABSTRACT FROM AUTHOR]

In terms of utility and technical quality, open-source software solutions have become a common option for many libraries. As barriers to adoption have been reduced and systems such as FOLIO appear poised to change the landscape of LIS technology, it is worth examining how the use of open source can support the normative core values of librarianship and to outline a strategy for critical engagement with the technology that is beneficial to patrons and libraries. Such a strategy will require further codification, institutionalization, and investigation of open source at many levels. [ABSTRACT FROM AUTHOR]

Background: Medical malpractice presents a significant challenge to the healthcare system in Egypt and other countries, inflicting both physical and psychological harm on patients. Furthermore, it imposes a financial burden on both patients and physicians. This study aimed to analyze the medicolegal aspects of malpractice claims associated with aesthetic interventions. The study also aims to establish explicit criteria for identifying and differentiating positive cases from negative ones. This study is a retrospective descriptive observational analysis of medical malpractice claims related to aesthetic interventions. The data was obtained from the records of the Cairo Medicolegal Area between 2016 and 2020, encompassing a total of 98 cases in the study. Results: The majority of cases were females (89.8%). The age group most significantly affected was between 26 to 35 years old. Plastic surgery accounted for the highest percentage (51%) of alleged cases among medical specialties. Consultants were the most frequently accused physicians (32.7%). Liposuction was the most frequent procedure (31.6%). Most of the malpractices occurred in private hospitals (45.9%). The outcome indicated that permanent infirmity accounted for 10.2%, while mortality constituted 3.1%. Conclusions: The current study demonstrated that women constitute the predominant demographic in the examined malpractice cases, with plastic surgery being the most common area for alleged claims. The main complaints include disfigurement, dissatisfaction with results, and burn injuries. Aesthetic malpractice is more frequent in private hospitals than in general hospitals, frequently necessitating further treatment due to complications. [ABSTRACT FROM AUTHOR]

Background: With artificial intelligence (AI) increasingly revolutionising medicine, this study critically evaluates the integration of large language models (LLMs), known for advanced text processing and generation capabilities, in medical ethics education, focusing on promoting virtue. Positing LLMs as central to mimicking nuanced human communication, it examines their use in medical education and the ethicality of embedding AI in such contexts. Method: Using a hybrid approach that combines principlist and non-principlist methodologies, we position LLMs as exemplars and advisors. Results: We discuss the imperative for including AI ethics in medical curricula and its utility as an educational tool, identify the lack of educational resources in medical ethics education, and advocate for future LLMs to mitigate this problem as a "second-best" tool. We also emphasise the critical importance of instilling virtue in medical ethics education and illustrate how LLMs can effectively impart moral knowledge and model virtue cultivation. We address expected counter-arguments to using LLMs in this area and explain their profound potential to enrich medical ethics education, including facilitating the acquisition of moral knowledge and developing ethically grounded practitioners. Conclusions: The study involved a comprehensive exploration of the function of LLMs in medical ethics education, positing that tools such as ChatGPT can profoundly enhance the learning experience in the future. This is achieved through tailored, interactive educational encounters while addressing the ethical nuances of their use in educational settings. [ABSTRACT FROM AUTHOR]

Background: Metabolic Bariatric Surgery (MBS) has gained significant popularity over the past decade. Legally and ethically, physicians should obtain the patient's voluntary and informed consent before proceeding with the surgery. However, the decision to undergo MBS is often influenced by external factors, prompting questions about their impact on the patient's ability to choose voluntarily. In addressing this issue, the study focuses on two key questions: first, which factors influence MBS candidates during the decision-making process, and second, whether these influences undermine the candidates' ability to make decisions voluntarily, according to theories of autonomy. Methods: The study employed a qualitative methodology, conducting 21 in-depth semi-structured interviews with adults who had undergone bariatric surgery. The conclusions were drawn from an inductive analysis of the interview data conducted using a grounded theory approach, and by applying theories of autonomy to the empirical findings. Results: Our study indicates that interviewees were exposed to different external influences, which had diverse effects on the interviewees' decision to undergo MBS. Category 1 influences included intentional attempts to induce people, through arguments and reason, to accept the attitudes advocated by the persuader in support of the surgery. Applying theoretical accounts of autonomy to these influences suggests that they did not compromise the interviewees' autonomy. Category 2 influences included threats made by a physician or a family member. These influences were found to undermine autonomy. Category 3 influences included emotional manipulation, informational manipulation, and the construction of medical and social norms. Manipulations and norms were experienced differently by different interviewees, and their impact on autonomy varies depending on the theoretical framework applied. Conclusions: Acknowledging that the influences exerted on MBS candidates may undermine their ability to make autonomous decisions regarding surgery, we suggest reformulating the duties that apply to medical practitioners with respect to informed consent to MBS. Medical practitioners who discuss the option of MBS with candidates should be aware of the various factors that influence this choice, and actively promote the candidates' ability to make autonomous decisions. [ABSTRACT FROM AUTHOR]

The article focuses on the ethical implications of discontinuing antipsychotic medication for individuals with schizophrenia, examining the challenges clinicians face in balancing risks and benefits. Topics include the concept of epistemic injustice in psychiatric care, the trend of patients choosing to discontinue medication, and the shift from expert recommendations to shared decision-making in mental health care.

Based on open-ended survey data of 400 women who self-identify as either Black or Latinx, this study examines women's digital media sharing practices in romantic relationships amid a growing trend towards the personalization of digital technologies. Communication Privacy Management (CPM) theory as well as scholarship on privacy and trust in romantic relationships frame our work. Approximately 56% of participants said romantic partners should not have access to each other's social media accounts, 24% said they should, and 20%, said that access needed to be negotiated based on situational and personal factors (e.g., seriousness of the relationship, special circumstances). Justifications for sharing included having nothing to hide, trust, and a desire for open communication in the relationship. Explanatory themes for keeping social media and smartphone access private focused on trust, privacy, risk of conflict, and the need to respect a person's individuality and personal boundaries. Interestingly, trust was a major motivator for both granting and denying access. We make sense of this duality of trust through the introduction of a trust/privacy dialectic relationship that extends current scholarship on CPM in romantic relationships. [ABSTRACT FROM AUTHOR]

In the year 2025, artificial intelligence (AI) has firmly established itself as a transformative force in critical care medicine, influencing patient care, diagnostics, decision-making, and resource management. The integration of AI into critical care settings has shown substantial promise, particularly in optimizing patient outcomes, streamlining healthcare workflows, and reducing the burden on healthcare professionals. This article . explores the multifaceted applications of AI in critical care medicine, focusing on its role in patient monitoring, clinical decision support, predictive analytics, personalized treatment, and telemedicine. We analyzed current trends, technological advancements, global disparities, challenges, and ethical considerations associated with AI in critical care. We present an optimistic yet cautious outlook for its future trajectory in diverse healthcare systems worldwide. [ABSTRACT FROM AUTHOR]

Objectives: Ethical considerations are central to deciding on resuscitation in a prehospital setting. A systematic study of ethical views can enlighten the area and potentially reveal variations in decision-making. We aimed to explore the ethical views on resuscitation and their impact on the reasoning of prehospital healthcare professionals using a qualitative approach and a structured questionnaire. This study describes the validation of a structured questionnaire designed to explore the ethical views on resuscitation and its impact on the reasoning of prehospital healthcare professionals. Methods: This observational cross-sectional study used a mixed-methods approach. The questionnaire included qualitative free-text fields and quantitative scales. Its first version was developed based on data from a systematic review and an ethnographic study. Validation involved face-to-face interviews and a two-round Delphi process with experts in qualitative research, philosophy, epidemiology, and prehospital medicine. The final questionnaire was field-tested among Danish prehospital physicians. Exploratory factor analysis assessed underlying relationships, and Cronbach's alpha measured internal consistency. Results: 216 out of 380 invited Danish prehospital physicians completed the questionnaire. The ethical aspects addressed in the cases included "do-not-attempt cardiopulmonary resuscitation," "socioeconomic status," "quality of life," "the patient and family's cultural background," and "relatives' emotional reaction." The questionnaire demonstrated satisfactory internal consistency, with a Cronbach's alpha of 0.71. Conclusions: The questionnaire was validated as a tool for assessing moral reasoning and variations in perspectives in prehospital decision-making. The survey can be used to assess the moral reasoning and variations therein in prehospital resuscitation decision-making. [ABSTRACT FROM AUTHOR]

When diagnosing psychological disorders, doctors are expected to take the mental anguish of patients and offer fast and accurate explanations. The pressure that comes with this often leaves doctors in need of epistemic shortcuts for faster diagnoses. One such epistemic shortcut is to lean on statistical data when offering a diagnosis. When used justly, doctors consider a patient’s testimony, exhibited symptoms and statistical data relating to the general features of the patient such as age, weight and sex to determine if a patient has a given disorder or illness. Practices such as this have the capacity to yield good results at a quick pace, however, such practices may also be abused. With a focus on gender statistics and psychological diagnoses, I argue that systematic practices of epistemic injustice may occur when the statistical data becomes over-valued and the epistemic privilege of patients to be able to assert their own bodily and mental experiences is ignored. This places patients at risk of misdiagnosis, long-term damage and pain, or even death. It also produces patient mistrust both of themselves and of the medical community, which can carry further repercussions for public health. [ABSTRACT FROM AUTHOR]

Background: Artificial Intelligence (AI) is increasingly applied in healthcare to boost productivity, reduce administrative workloads, and improve patient outcomes. In nursing, AI offers both opportunities and challenges. This study explores nurses' perspectives on implementing AI in nursing practice within the context of Jordan, focusing on the perceived benefits and concerns related to its integration. Method: A qualitative research approach was employed, involving semi-structured interviews with 25 nurses and 3 focus group discussions, each consisting of 7–8 participants. The data collected was coded and analyzed using thematic analysis to identify recurring patterns and key themes in the nurses' views on AI. Results: Three major themes emerged from the analysis: (1) AI as an efficiency tool – Nurses recognized AI's ability to reduce administrative burdens and improve patient monitoring in real-time. (2) Ethical and practical concerns – Nurses raised issues regarding patient privacy, data security, and the fear that AI might replace human decision-making in care. (3) Lack of preparedness and training – There was a consensus on nurses' inadequate training in AI tools, limiting their ability to integrate AI into their practice fully. Conclusion: While AI is seen as a valuable tool to enhance nursing productivity, several challenges still need to be addressed, particularly regarding ethical concerns and insufficient training. To ensure AI complements nursing without compromising the human element, healthcare institutions must address these issues by implementing comprehensive training programs and establishing clear ethical guidelines. [ABSTRACT FROM AUTHOR]

Introduction: Despite the existing reports on mistreatment and disrespectful maternal care, few studies have investigated interventions to mitigate this issue. The present study aims to assess the impact of consulting midwives on maternal rights charter on perception of respectful maternity care and postpartum blues among postpartum women in two hospitals in southern Iran. Methodology: This quasi-experimental study was conducted on 437 postpartum women (217 mothers before the intervention and 220 mothers after the intervention) and 44 midwives working in the maternity ward of two hospitals affiliated to Bushehr University of Medical Sciences in 2023–2024. The hospitals were randomly divided into control and intervention groups. The mothers and midwives were selected using convenience and census sampling methods, respectively. Initially, the first sampling phase of postpartum women was conducted. Then, midwives in the intervention group received consultation on patient rights charter in groups of 3–4 individuals over three sessions. After the intervention, the second phase of sampling of postpartum women was conducted. Data collection tools included questionnaires assessing women's perception of respectful maternity care and postpartum blues. The data were analyzed using descriptive and analytical statistical tests in SPSS 20.0. Results: After performing the intervention on midwives, the mean score of postpartum respectful maternity care from the perspectives of the mothers in the intervention and control hospitals were 91.08 ± 5.51 and 68.34 ± 10.81 respectively (P < 0.001). Also, the mean scores of postpartum blues in the intervention and control hospitals were 12.88 ± 4.66 and 14.85 ± 5.94 respectively (P = 0.007). Multivariable linear regression analysis revealed that consulting with midwives regarding the Maternal Rights Charter, led to an increase in respectful maternity care (β coefficient = 0.780, 95% C.I. = 19.796). ~ 24.541) and decreased postpartum blues (β coefficient = -0.172, 95% C.I. = -3.318 ~ -0.390) from the perspectives of the mothers. Conclusion: Consulting midwives on patient rights charter was positively correlated with mothers' perception of respectful maternity care and negatively correlated with postpartum blues, indicating the positive effect of intervention on increasing women's satisfaction and reducing postpartum blues. It is recommended that this consultation be included in midwives' continuing education programs. Clinical trial number: Not applicable. [ABSTRACT FROM AUTHOR]

Aim: To carry out a detailed study of existing positions in the French public of the acceptability of refusing treatment because of alleged futility, and to try to link these to people's age, gender, and religious practice. Method: 248 lay participants living in southern France were presented with 16 brief vignettes depicting a cancer patient at the end of life who asks his doctor to administer a new cancer treatment he has heard about. Considering that this treatment is futile in the patient's case, the doctor refuses to prescribe it. The vignettes were composed by systematically varying the level of four factors: likelihood of a positive effect, painfulness to the patient of the treatment, cost of the treatment, and attitude of the family. Results: Five main positions were identified. For 10%, refusing treatment was almost never acceptable. 35% judged acceptability in line with the level of painfulness. 19% judged acceptability consistent with an interaction between the painfulness of treatment and likelihood of positive effect. For 30% it was either almost always acceptable or always acceptable. 5% did not take a position. Conclusion: A range of positions regarding the acceptability of refusing to provide treatment on the basis of perceived futility was observed. These positions have been analyzed in terms of what physicians and medical ethicists would see as the four principles of medical ethics. This description of lay people's positions in terms of the principles of medical ethics present clinicians with a conceptual tool to improve communication and shared decision making. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has led governments worldwide to make ethically controversial decisions. As a result, healthcare professionals are facing several ethical dilemmas, especially in terms of healthcare services provided to senior citizens. Thus, the aim of this review is to identify and categorize ethical dilemmas as well as propose solutions regarding health care services for elderly individuals. Methods: A qualitative systematic review of the literature was undertaken in the first tier of the pandemic. All identified scientific and editorial articles published in English or French between December 2019 and October 2021 were included. An article was excluded if it was commercial, did not address an issue in the care of the elderly or present any qualitative data. Article eligibility was determined through a process of triangulation among three independent reviewers. Results: Initially, 69 articles met our inclusion criteria and were selected for this review. These studies can be divided into 2 distinct categories: scientific articles (17 studies) and expert opinion articles (52 articles). However, due to the large quantity of qualitative data that was extracted, only the results from the scientific literature are presented here. The analysis of the data of 17 studies has allowed the emergence of 2 main themes of ethical dilemmas: 1) access to care (3 subthemes: A) triage decisions for admission, B) access to the intensive care unit and C) vaccine allocation) and 2) infection control decisions (2 subthemes: (D) isolation and E) autonomy). Our results also revealed 4 categories of potential solutions to the encountered ethical dilemmas, namely, optimal protocols, enhanced communication, caregiver support and technological assistance (virtual team-based, AI). Conclusions: The ethical dilemmas that emerged from our results highlight the interest of a serious international discussion around the phenomena of ageism and its potential ethical implications for health care workers (be it under normal circumstances or exceptional circumstances such as those of a pandemic). We highly recommend that future research be undertaken to test the efficacy of the proposed solutions in providing age-friendly, dilemma-free health care and environments. [ABSTRACT FROM AUTHOR]

Introduction: The ubiquity of Bring Your Own Device (BYOD) personal smartphones, Instant Messaging (IM), and third-party apps, has made these technologies compelling for efficient communications between clinicians regarding patient care. However, the sensitivity of patient-related information necessitates secure, GDPR compliant modalities that prevent unauthorised access and ensure confidentiality. This scoping review explores existing guidelines, policies, and regulations that advise clinicians in the UK and Ireland on the secure use of these digital communication tools. Methods: Following the Joanna Briggs Institute (JBI) updated Framework for Scoping Reviews and the PRISMA ScR guidelines, this review examines the literature to identify relevant guidelines, policies, and regulations informing current clinical practice on the use of this technology. Academic databases including OneSearch, Embase, EBSCO, PubMed, Medline, and CINAHL were searched, in addition to hand searches of professional entities' websites, including trade unions, regulators, two national health systems, and several employers. Direct inquiries were made to 69 professional entities via telephone, email, websites, and X (formerly known as Twitter). Results: The review identified 18 papers that broadly recognise the importance of secure communication however, a lack of information on the appropriate selection or configuration of these popular technologies was evident. Most guidelines emphasise general security and data protection standards rather than providing clear actionable recommendations for technology use, thereby leaving a significant gap in technical guidance for clinicians. Discussion: There is a distinct lack of detailed, specific, consistent technical guidance available to clinicians. This review evidences an urgent requirement for enhanced guidelines that specify the most secure platforms, appropriate features, and configuration to maximise the security and confidentiality of clinical communications. Further research is recommended to develop comprehensive, actionable advice for clinicians. [ABSTRACT FROM AUTHOR]

Generating synthetic data from medical records is a complex task intensified by patient privacy concerns. In recent years, multiple approaches have been reported for the generation of synthetic data, however, limited attention was given to jointly evaluate the quality and the privacy of the generated data. The quality and privacy of synthetic data stem from multivariate associations across variables, which cannot be assessed by comparing univariate distributions with the original data. Here, we introduce a novel algorithm (MIIC-SDG) for generating synthetic data from electronic records based on a multivariate information framework and Bayesian network theory. We also propose a new metric to quantitatively assess the trade-off between the Quality and Privacy Scores (QPS) of synthetic data generation methods. The performance of MIIC-SDG is demonstrated on different clinical datasets and favorably compares with state-of-the-art synthetic data generation methods, based on the QPS trade-off between several quality and privacy metrics. [ABSTRACT FROM AUTHOR]

Background: Kidney transplantation is the preferred treatment for patients with end-stage renal disease, significantly preserving kidney function and patient quality of life. However, post-transplant diabetes mellitus (PTDM) is a common complication, occurring in approximately one-third of renal transplant recipients. This study aims to evaluate the role of pulse wave parameters in predicting PTDM and to identify other pre-transplant risk factors. Methods: This prospective cohort study included 105 patients on the kidney transplant waiting list from 2017 to 2022. Exclusion criteria included any pre-existing diabetes mellitus. Patients underwent physical examinations, laboratory analyses, and pulse wave analysis before transplantation and one year post-transplant. PTDM diagnosis followed International Consensus Guidelines. Data were analyzed using Wilcox test, Bonferroni correction, May-Whitney U-test, and Fisher's exact test, with p < 0.05 considered statistically significant. Results: Post-transplant, 21% of patients were diagnosed with PTDM, increasing to 35% 3months post-transplant and 43% at one year post-transplant. Significant findings included: Pre-transplat risk factors for developing PTDM: Proteinuria (p = 0.037, OR = 3.942) and perioperative hyperglycemia (p = 0.003, OR = 4.219 at 3 months; p = 0.001, OR = 4.571 at 1 year). Pulse wave parameters for developing PTDM: Pre-transplant Aortic PP > 45 mmHg (AUC = 0.757) and PWV > 8.5 m/s (AUC = 0.730) were strong predictors of the development of PTDM after 3 months (p < 0.0001). Moreover, we found significant improvements in aortic pulse pressure (Aortic PP) and pulse wave velocity (PWV) post-transplant (p < 0.0001). Conclusion: Our study confirms that pulse wave parameters, such as Aortic PP and PWV, are significant predictors of PTDM in kidney transplant recipients (KTR). These findings support incorporating pulse wave analysis into routine pre-transplant evaluations to identify high-risk patients. Additionally, monitoring these parameters post-transplant may aid in early intervention and prevention of PTDM, ultimately improving patient outcomes. Trial registration: Ethical approval was obtained from the Ethics Committee of Medical faculty and University Hospital Olomouc (approval no. 94/15). [ABSTRACT FROM AUTHOR]

Background: The World Professional Association for Transgender Health guidelines Standards of Care 8 draw on ethical arguments based on individual autonomy, to argue that healthcare and other professionals should be advocates for trans people. Such guidelines presume the presence of medical services for trans people and a degree of consensus on medical ethics. Very little is known, however, about the ethical challenges associated with both providing and accessing trans healthcare, including gender affirmation, in the Global South. In light of the challenges associated with medical and legal gender affirmation in Indonesia, we conducted a qualitative study to understand the views of trans people, healthcare providers, and legal practitioners. Methods: In this qualitative study, we drew on a participatory methodology to conduct 46 semi-structured interviews between October and December 2023, with trans people (10 trans feminine people and 10 trans masculine people, each interviewed twice) and key informants (three healthcare providers and three lawyers and paralegals). Trans people were a central part of the research team from inception through to analysis and writing. Participants were recruited via community-led sampling. Data analysis of interview data took place through an immersion/crystallisation technique and preliminary inductive coding which highlighted key quotes. We focused on an inductive analysis using participant narratives to identify key concepts in the ethics of gender affirmation in Indonesia. Results: We characterize the ethics of supportive healthcare workers, community members, and family members, as that akin to "accomplices," a concept of ethics used in theories of racial justice which evaluate a willingness to support people to navigate laws and regulations which perpetuate injustices and violence. Overall, both trans people and key informants shared an understanding that the legal status of gender-affirming medical care was particularly ambiguous in Indonesia due to a lack of clarity in both laws and regulations. For trans participants, ethical arguments for the validity of legal and medical gender affirmation was premised on evidence that their gender identity and expression was already recognized within society, even if limited to immediate friends and family. Given that all participants expressed a desire for gender affirmation, but such services were widely unavailable, accomplices played a crucial role in supporting trans people to access healthcare. Conclusions: An empirical study based on an "ethics from below" helps to show that arguments grounded in autonomy, or based on biomedical evidence, are unlikely to alter unjust laws or facilitate a change to pathologizing guidelines governing understanding of trans people's healthcare and legal needs in Indonesia. We provide an analysis that is sensitive to the ethics of facilitating gender affirmation in a context where that process is inherently social, and often articulated in relation to a prevailing religious morality. [ABSTRACT FROM AUTHOR]

Over the past decade, there has been an increase in the number of clinical trials for psychedelic therapies as treatments for a wide range of psychiatric conditions. We are concerned that research organizations overseeing these trials have neglected the inclusion of individuals with physical and sensory disabilities. We suggest that psychedelic research organizations should prioritize and plan for the inclusion of individuals with physical and sensory disabilities to address the mental health burdens they confront. Not doing so risks reinforcing structural ableism in healthcare: the discriminatory manifestation of lowered expectations toward people with disabilities on the part of medical providers. Drawing on scholarship from disability studies and medical ethics, we offer four recommendations for disability inclusion in research. We recognize particular populations shoulder significant mental health burdens; these populations deserve priority and should be given a range of accommodations. We emphasize the need for extensive disability awareness training for those facilitating psychedelic therapies and encourage psychedelic researchers and therapists to exercise cultural humility toward individuals with physical and sensory disabilities. This article should be the impetus for further scholarship and debate about how psychedelic research and therapies can be made accessible to members of disability communities who might benefit. [ABSTRACT FROM AUTHOR]

Introduction: The elderly population is increasing worldwide, and our region is no the exception. Elderly patients frequently present surgical emergencies, which can lead to unfavorable outcomes. The implementation of a program for the comprehensive management of elderly patients who will undergo a surgical procedure could bring multiple benefits. Methods: Narrative review and reflective analysis of available information on surgical programs for the comprehensive care of elderly patients and their importance. Results: Among the benefits of establishing a surgical program for the care of elderly patients are offering better surgical and, in certain cases, precisely non-surgical outcomes. It is highly possible that the morbidity and mortality of the procedures undertaken will be reduced, or at least the patient's baseline functionality will be preserved. An organized co-management service between surgery and geriatrics, which adopts management protocols and identifies the particular risk of patients through validated scales adopted by consensus, would favor informed decision-making by the patient, their family, and the surgeon. Conclusions: The previous considerations lead us to suggest the need to implement specialized programs to comprehensively address the needs of the growing elderly population, who frequently require surgical procedures to solve complex pathologies. [ABSTRACT FROM AUTHOR]

A significant and important ethical tension in resource allocation and public health ethics is between utility and equity. We explore this tension between utility and equity in the context of health AI through an examination of a diagnostic AI screening tool for diabetic retinopathy developed by a team of researchers at Duke-NUS in Singapore. While this tool was found to be effective, it was not equally effective across every ethnic group in Singapore, being less effective for the minority Malay population than for the Chinese majority. We discuss the problematic normative nature of bias in health AI and explore the ways in which bias can interact with various forms of social inequalities. From there, we examine the specifics of the diabetic retinopathy case and weigh up specific trade-offs between utility and equity. Ultimately, we conclude that it is ethically permissible to prioritise utility over equity where certain criteria hold. Given that any medical AI is more likely than not to have lingering bias due to bias in the training data that may reflect other social inequalities, we argue that it is permissible to implement an AI tool with residual bias where: (1) its introduction reduces the influence of biases (even if overall inequality is worsened), and/or (2) where the utility gained is significant enough and shared across groups (even if unevenly). [ABSTRACT FROM AUTHOR]

An increasing number of women are undergoing female genital cosmetic surgery (FGCS). Labiaplasty, the most commonly performed FGCS, consists of a surgical procedure to decrease the inner labia size so that no or less tissue protrudes beyond the outer labia. Anatomically, it is similar to female genital mutilation/cutting (FGM/C) Type 2a. Thus, what are the differences and similarities between FGCS and FGM/C? Even though FGCS is not recommended by most scientific societies, it is considered legal, contrary to FGM/C. Most women seeking FGCS have physiologic (neither diseased nor anatomically atypical) genitalia and are reassured by counseling. We recommend counseling, history taking, screening for relevant conditions, and, if surgery is pursued, medical care by a specialist. We present the cases of three patients who reported feeling genitally mutilated after having willingly undergone FGCS. This feeling led these women to seek care at an outpatient clinic that receives migrants, refugees, second-generation, or naturalized patients originating mainly from African countries having experienced FGM/C. We discuss clinical implications, health insurance coverage, legal, ethical, and social implications. Multiple unresolved issues must be carefully addressed by scientific societies, legislators, and anti-FGM/C advocates to ensure equal treatment of all individuals in relation to genital cutting or surgery. Genital modifications experienced as harmful, or that are performed without informed consent, should be studied in relationship to one another and evaluated with consistent principles, regardless of the skin color of the individuals concerned, their cultural, ethnic, or religious background, or the name given to the genital modification they underwent. [ABSTRACT FROM AUTHOR]

Rarely any study investigates how information gatekeeping through the solutions and services enabled by algorithms, hereafter referred to as algorithmic technologies (AT), creates negative consequences for the users. To fill this gap, this state‐of‐the‐art review analyzes 229 relevant articles from diverse academic disciplines. We employed thematic analysis to identify, analyze, classify, and reveal the chain reactions among the negative consequences. We found that the gatekeeping of information (text, audio, video, and graphics) through AT like artificial intelligence (e.g., chatbots, large language models, machine learning, robots), decision support systems (used by banks, grocery stores, police, etc.), hashtags, online gaming platforms, search technologies (e.g., voice assistants, ChatGPT), and Web 3.0 (e.g., Internet of Things, non‐fungible tokens) creates or reinforces cognitive vulnerability, economic divide and financial vulnerability, information divide, physical vulnerability, psychological vulnerability, and social divide virtually and in the offline world. Theoretical implications include the hierarchical depiction of the chain reactions among the primary, secondary, and tertiary divides and vulnerabilities. To mitigate these negative consequences, we call for concerted efforts using top‐down strategies for governments, organizations, and technology experts to attain more transparency, accountability, ethical behavior, and moral practices, and bottom‐up strategies for users to be more alert, discerning, critical, and proactive. [ABSTRACT FROM AUTHOR]

Since the introduction of OpenAI's ChatGPT‐3 in late 2022, conversational chatbots have gained significant popularity. These chatbots are designed to offer a user‐friendly interface for individuals to engage with technology using natural language in their daily interactions. However, these interactions raise user privacy concerns due to the data shared and the potential for misuse in these conversational information exchanges. Furthermore, there are no overarching laws and regulations governing such conversational interfaces in the United States. Thus, there is a need to investigate the user privacy concerns. To understand these concerns in the existing literature, this paper presents a literature review and analysis of 38 papers out of 894 retrieved papers that focus on user privacy concerns arising from interactions with text‐based conversational chatbots through the lens of social informatics. The review indicates that the primary user privacy concern that has consistently been addressed is self‐disclosure. This review contributes to the broader understanding of privacy concerns regarding chatbots the need for further exploration in this domain. As these chatbots continue to evolve, this paper acts as a foundation for future research endeavors and informs potential regulatory frameworks to safeguard user privacy in an increasingly digitized world. [ABSTRACT FROM AUTHOR]

In the article "The Past 110 Years: Historical Data on the Underrepresentation of Women in Philosophy Journals," Hassoun et al. claim that there is a connection between triple anonymous review and the proportion of women authors in interdisciplinary journals. However, the sample size of interdisciplinary journals using triple-blind review practice in the analysis is 1. In addition, the sole interdisciplinary journal claimed to be triple-blind, the Journal of Medical Ethics , is not and has not been triple-blind. The finding that interdisciplinary journals publish the greatest proportion of women authorship when practicing triple anonymous review is thus unwarranted. [ABSTRACT FROM AUTHOR]

Background: This study examines the perspectives of individuals with coronary heart disease (CHD) on a nurse‐led eHealth cardiac rehabilitation (NeCR) program, which included a website, tele‐monitoring device, and social media chatroom. Methods: Using a descriptive qualitative approach, semi‐structured interviews were conducted with 18 participants to capture their feedback and experiences with the NeCR program. Results: Participants found the NeCR program valuable in addressing gaps in cardiac rehabilitation services in China, empowering them to make behavioral changes and enhancing their social motivation. However, they also highlighted the need for a more user‐friendly website, better symptom management during exercise, and stronger privacy protections in the peer networking chatroom. The study concludes that the NeCR program is feasible in providing accessible rehabilitative services at home post‐discharge. Recommendations include improving the self‐monitoring platform for ease of use, incorporating immediate symptom management guidance during exercise, and ensuring a secure environment for online peer support. Conclusions: These findings offer crucial insights for developing patient‐centered eHealth cardiac rehabilitation services, emphasizing the importance of user‐friendly design, effective symptom management features, and privacy protection in promoting participant engagement with e‐platforms. Trial Registration: ChiCTR1800020411 (http://www.chictr.org.cn/showprojen.aspx?proj=33906) [ABSTRACT FROM AUTHOR]

Young people of Pacific heritage living in Aotearoa New Zealand experience poor sexual and reproductive health outcomes. Current understandings of Pacific youth sexual and reproductive experiences are limited and efforts to deliver culturally appropriate sexuality education are made difficult by lack of resources and cultural sensitivities and taboos. This study aimed to understand Pacific youth experiences of sexuality education within the school setting to ascertain culturally responsive approaches to sexuality education for Pacific youth. The study used the Pacific talanoa methodology to conduct group discussions with young people aged 16–18 years old. A total of six group discussions were carried out over a three-month period. Data were analysed using thematic analysis. The study found a lack of information provided at school. Discussion of abstinence, sex before marriage and asking questions at home was aligned to Pacific values of family, taboo, and gender. Perspectives on trust, privacy and confidentiality within the school setting were important to young people, many of whom were not familiar with being able to speak freely about sexual health topics. Pornography and social media were easily accessible to youth and influenced their ability to explore and understand sexual and reproductive health issues and needs. [ABSTRACT FROM AUTHOR]

In Kenya, persons insufficiently engaged in HIV Testing Services (HTS) are often treated in emergency departments (ED). There are limited data from healthcare workers on ED-HTS. A qualitative study was completed to understand challenges and facilitators for ED-HTS and HIV self-testing (HIVST). Data were collected via six focus groups of healthcare workers. Data were inductively analyzed and mapped to the Capability–Opportunity–Motivation Behavioral Model. Focus groups were completed with 49 healthcare workers: 18 nurses, 15 HIV counselors, 10 physicians and 6 administrators. HTS challenges included staff burdens, resources access, deficiencies in systems integration and illness severity. HTS facilitators included education of healthcare workers and patients, services coordination, and specific follow-up processes. HIVST challenges included accuracy concerns, follow-up barriers and psychosocial risks. HIVST facilitators were patient autonomy and confidentiality, resource utilization and ability to reach higher-risk persons. Mapping to the Capability–Opportunity–Motivation Behavioral Model interventions within the domains of knowledge, decision processes, environmental aspects, social influences and professional identities could support enhanced ED-HTS with integrated HIVST delivery. This study provided insights into challenges and facilitators on ED-HTS and identifies pragmatic approaches to improve healthcare workers' behaviors and abilities to provide services to persons already in contact with healthcare. [ABSTRACT FROM AUTHOR]

Latino men, especially Latino men who have sex with men (LMSM), experience disparities in HIV prevention. Lack of attention to key barriers to care, such as stigma, result in inequitable access to HIV prevention and care for LMSM. This paper describes how intersectional stigma and related factors act as barriers to HIV prevention among Latino men and proposes strategies to overcome these barriers. Qualitative data were collected via in-depth interviews (n = 15) with Latino men about HIV prevention services, mobile outreach, peer navigation and care coordination, and analyzed using rapid qualitative methods. Three key themes emerged: (1) HIV stigma as a barrier to HIV testing, (2) sexual minority stigma as a barrier to accessing HIV prevention services and (3) strategies for stigma reduction, such as confidentiality, comprehensive education about HIV and prevention, and empathy and warmth from staff/care providers. Identified stigmas were intersectional. Addressing and reducing stigma is critical to engaging Latino men in HIV prevention and care, and requires strategies sensitive to the Latino cultural context and community. [ABSTRACT FROM AUTHOR]

Background: Health data sharing is important for monitoring diseases, policy and practice, and planning health services. If health data are used for secondary purposes, information needs to be provided to assist in reuse. Objectives: To review government health information asset websites to ascertain the extent of readily available, explanatory documentation for researcher sharing and reuse of these data. Method: Documentary analysis was undertaken on selected Victorian Government health information assets' websites in Australia. Data were obtained on nine information-categories: data custodian; data context; data dictionary; quality controls; data quality; limitations; access process; privacy/confidentiality/security and research requests/outputs. Information-categories were compared by dataset type (administrative or population-health) and by curating organisation (government or other agency). Descriptive statistics were used. Results: The majority of the 25 websites examined provided information on data custodian (96%) and data context (92%). Two-thirds reported access process (68%) and privacy/confidentiality/security information (64%). Compared with population-health websites, administrative dataset websites were more likely to provide access to a data dictionary (67% vs 50%) and information on quality controls (56% vs 44%), but less likely to provide information on the access process (56% vs 75%) and on research requests/outputs (0% vs 56%, p = 0.024). Compared with government-curated websites, other agency websites were more likely to provide information on research requests/outputs (80% vs 7%, p < 0.001). Conclusion: There is inconsistent explanatory documentation available for researchers for reuse of Victorian Government health datasets. Importantly, there is insufficient information on data quality or dataset limitations. Research-curated dataset websites are significantly more transparent in displaying research requests or outputs. [ABSTRACT FROM AUTHOR]

The 2022 Dobbs v Jackson Women's Health Organization US Supreme Court decision drastically altered the landscape of reproductive health care in the United States. By overturning legal precedent, the Supreme Court decision catalyzed significant changes in the provision of guideline-based obstetric and gynecologic care, creating a series of ethical, legal, and practical dilemmas for healthcare providers and trainees. This article provides an overview of the decision's implications and explores how medical students' legal concerns regarding abortion care provision has evolved in response, assessing across race, sex, and geography. Objectives: The 2022 Dobbs v Jackson Women's Health Organization US Supreme Court decision dramatically shifted the legal landscape in health care, leaving state legislatures to redefine the ethics of medical practice. As gold-standard medical procedures become banned and criminalized, physicians are facing heightened legal uncertainty and grappling with moral dilemmas of where and how to practice. This study aimed to quantitatively assess trends in legal concern among medical students and identify correlations with decision making regarding future medical training. Methods: To assess the impact of the Dobbs decision on trainees, a 24-item RedCAP survey was distributed to 72 medical schools assessing both geographic residency preferences and level of legal concern surrounding 10 abortion provision scenarios. Level of concern was assessed on a 3-point Likert scale from "not at all concerned" to "very concerned." To observe overall trends, an average level of concern score was computed by assigning numeric values to responses and averaging the scores for each respondent. Results: In total, 2298 medical students completed the survey and were included in the analysis. Students identifying with she/her pronouns and as Asian or studying in abortion-protected states had significantly higher levels of concern. Moreover, respondents located in abortion-restricted states with high levels of legal concern were more likely than their peers to indicate wanting to move to abortion-protected states for residency. Conclusions: Individuals with heightened proximity to reproductive healthcare may face greater ethical and moral dilemmas as they seek future career opportunities in a post– Roe v Wade world. These data suggest that they seem highly responsive to moving out of abortion-restricted states, indicating that the Dobbs decision, and the legal landscape it has created, may further exacerbate disparities in reproductive health care. [ABSTRACT FROM AUTHOR]

The article discusses the results of a study on the long-term effects of intermittent fasting on individuals with insulin-treated type 2 diabetes. The study found that a 12-week intermittent fasting intervention led to sustained weight loss over two years compared to a control group. While there was a slight increase in HbA1c levels in the intermittent fasting group from 12 weeks to 2 years, it remained lower than baseline levels. The study suggests that intermittent fasting could be an effective strategy for managing type 2 diabetes, but further research is needed to evaluate long-term efficacy and safety. [Extracted from the article]

Phishing is a common cybersecurity threat to email users. An automated phishing decision-support aid can help users identify suspicious emails. The aid's success depends on both the aid's capability and the user's trust in and usage of the aid. In this study, 465 participants were asked to judge phishing emails with an automated decision aid. We measured how users' trust and decision making were affected by the type of aid (human, AI, text, no aid), gender (male, female), decision transparency (reasoning for aid's decision present, absent), as well as feedback (present, absent). We found that an aid was helpful regardless of its anthropomorphic appearance (human vs. AI) and gender. Transparency was helpful with the human aid, but not the AI aid. Feedback effectively improved trust in all the aids, although it helped aid retention only for the text aid. Participants had overall positive comments about the aid and found it helpful. The findings can be applied to automated aid design to understand potential avenues for improving users' trust, performance, and aid use. [ABSTRACT FROM AUTHOR]

Purpose: The current study performed a post-occupancy evaluation on a new cancer infusion center with pod-like layout and compared results to a pre-occupancy evaluation to investigate the impact of different cancer infusion center designs on staff efficiency and patient and staff satisfaction. Background: The new cancer infusion center opened in October 2020 and replaced two previously existing infusion centers, in the same healthcare system. Methods: The study used a similar mixed-method approach as the pre-occupancy research, which included staff shadowing, medication delivery shadowing, and staff and patient questionnaires. Results: The new infusion center improved staff efficiencies by reducing nurse travel time compared to pre-occupancy infusion centers. Results also showed an increase in satisfaction with different aspects of the new infusion center including patient privacy, by both patients and nurses. The pod design allowed for better audio and visual privacy for patients, provided a higher amount of worksurface and availability of workstations, reduced noise levels, and enhanced nurse concentration at workstations. Findings indicated that nurses who had prior experience working in the pre-occupancy infusion centers expressed significantly lower levels of satisfaction in the new infusion center, especially in the ability to connect with nurses in other pods. Conclusions: Although the new pod design had limitations in terms of collaborative opportunities across pods, it showed to provide a more efficient work environment for the staff and increase staff and patient satisfactions. The results also highlight the importance of effective change management strategies when nurses transition to a new work environment. [ABSTRACT FROM AUTHOR]

The challenges faced by caregivers of people living with serious mental illness in Canada are well documented in the literature including emotional distress, financial strain, social isolation, and concerns about their physical health following the impact of caregiving. Peer support programs (including peer support groups) emerged as a promising method to attempt to address these challenges. While there is evidence on the positive impacts of peer support groups in providing support for caregivers, the mechanisms by which peer support groups operate and influence support for caregivers of people living with serious mental illness are less understood. This qualitative study took on a co-designed participatory research approach. Fifteen adult caregivers of people living with serious mental illness across Canada were engaged through key informant interviews that lasted for 45 – 60 min each. A thematic analysis was carried out to help understand the operational mechanisms of peer support groups in influencing support for caregivers. The key informant interviews allowed for the identification and description of the following operational mechanisms that influenced the support caregivers received from peer support groups: (1) Group dynamics; (2) Messaging/content; (3) Equity and inclusion, (4) Group philosophy; and (5) Privacy concerns. Findings from this study showed that caregivers identified a number of operational mechanisms of peer support groups that explained how they felt supported when they participated in peer support groups. Among other operational mechanisms, group dynamics in terms of the gathering of caregivers of different age brackets and varying caregiving experience negatively influenced the peer support experience of caregivers. This pointed to the need for group dynamics that consider close age ranges and similar caregiving experience during group meetings to enhance support for caregivers. Caregivers also identified a gap in equity and inclusion in peer support groups that could have otherwise enriched their experience and enhanced the support they looked to receive from the group. Practical examples to enhance equity and inclusion include promoting active listening, using inclusive language, encouraging diverse representation and asking for feedback from peer support group members. While peer support groups in Canada exist independently of one another, it may help to consolidate evidence-based recommendations in the operational mechanisms of these groups, for the benefit of caregivers who turn to these groups for support, having been left on their own by an otherwise fractured mental health system. [ABSTRACT FROM AUTHOR]