scholarly journals 知情同意與語境

2002 ◽  
Vol 4 (2) ◽  
pp. 24-37
Author(s):  
Deyan WANG
Keyword(s):  
Informed Consent ◽  
Semantic Analysis ◽  
Medical Information ◽  
Local Population ◽  
Medical Knowledge ◽  
Reading Level ◽  
Effective Measure ◽  
Level Of Education ◽  
Everyday Language ◽  
The Right

LANGUAGE NOTE | Document text in Chinese; abstract also in English.理解是實現知情同意的基礎，而理解與知情同意的語境學問題有密切關係。醫生常常抱怨病人聽不懂，病人也認為醫生的解釋過科術語化。問題就在於醫患雙方語境的差異。20世紀80年代對知情同意的研究已經開始從告訴病人什麼資訊轉向了怎樣告訴病人的研究。因此醫生除了關心病人敘述的意義之外，還需要關注以各㮔語言為中介與事實之間所建立的聯繫，注意語句的規範性以及正確地把握雙方的語言意圖和目的。本文試圖對知情同意進行語義學、語形學和語用學的分析，以便從這三者統一上來透視和闡述知情同意的各種語境的規定性，以提高知情同意的可理解性。Understanding, being closely associated with the context, is the basis of realization of informed consent. Physician often complains that patients cannot well comprehend medical information, while patients are often unsatisfied with the explanatory statements and technical terms given by physicians. Since 1980s the emphasis in the studies of informed consent has shifted from what should be presented to patient to how to present the related information to patients. Besides being concerned with the meaning of the narratives of patients, physician should pay close attention to the connection of the medical facts or information and the everyday language, to maintain the norms of the syntax, and to understand the real goal and intention of the patients. This paper aims to approach the context of informed consent by semantic analysis, syntax and pragmatics.Informed consent involves much more than merely reading and signing a paper. It normally has two essential parts: a document and a process. The document of informed consent should be understandable to any ordinary patient in the local population. It should be written in such a way that anyone with an education level of the ninth grade or lower can read it. To make the document of informed consent easy-to-read, the following requirements should be met. First, the language is everyday language and familiar to the readers. Any scientific, medical, or legal terms should be defined clearly. Second, terms and key concepts should be consistent throughout the document. Third, sentences should be short, direct, and easy to comprehend. Fourth, the paragraph should be short too. Each paragraph coveys one major idea only. Fifth, every idea should be clear and logically sequenced. Last but not least important, readability analysis should be to determine the reading level of the document.The process of informed con sent process requires physicians to provide the patient with ongoing explanations so that patients can make his or her informed decisions. This is to say, before the patient makes his or her decisions, the physician should fully discuss related issues with the patient. Of course, the physician's communications kills are usually difficult to change. However, physicians can improve their communication skills through learning and practicing.Of course, in China, not only researchers and physicians, but patients and research participants, including the public who can be regarded as the potential subjects, lack the full understanding of the principle of informed consent. It is thus important to improve the nationwide level of education, for it is only by doing that the principle of informed consent can be carried out in reality. The current level of education of the nation is not high yet, and many people even cannot fully understand some basic terms in medical and life sciences. There is s till a still considerable amount of illiterates in China. In medical education, especially in the educating of medical ethics, we have not paid enough attention to on the principle of informed consent so that some medical students even never heard the term" informed consent." As a result, there is still a long way for us to go.Informed consent, serving as an effective measure to protect the subjects and patients, has enjoyed the wide recognition in the fields of medical and related laws. It has become the paradigm of consent in medical research and clinical practice internationally. Many international relative organization s have regarded informed consent a basic ethical requirement. Legally speaking, physicians and patients are equal. But in reality they are not equal. There is an imbalance of medical knowledge between doctors and patients. Although the patient has the right to make his or her own decision, he or she is often not capable of deciding and choosing. It is necessary to establish the law in order to guarantee the realization of the patient's rights such as informed consent.DOWNLOAD HISTORY | This article has been downloaded 13 times in Digital Commons before migrating into this platform.

scholarly journals Practice of informed consent in Guangdong, China: a qualitative study from the perspective of in-hospital patients

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e020658 ◽  
Author(s):  
Ni Gong ◽  
Yinhua Zhou ◽  
Yu Cheng ◽  
Xiaoqiong Chen ◽  
Xuting Li ◽  
...  
Keyword(s):  
Informed Consent ◽  
Qualitative Study ◽  
Medical Information ◽  
Medical Knowledge ◽  
Information Provision ◽  
Clinical Decision ◽  
Clinical Settings ◽  
Clinical Practices ◽  
Informed Consent Form ◽  
Hospital Patients

ObjectiveThis study aimed to investigate the practice of informed consent in China from the perspective of patients.DesignA qualitative study using in-depth interviews with in-hospital patients focusing on personal experience with informed consent.SettingGuangdong Province, China.Participants71 in-hospital patients in rehabilitation after surgical operations were included.ResultsMedical information is not actively conveyed by doctors nor effectively received by patients. Without complete and understandable information, patients are unable to make an autonomous clinical decision but must sign an informed consent form following the doctor’s medical arrangement. Three barriers to accessing medical information by patients were identified: (1) medical information received by patients was insufficient to support their decision-making, (2) patients lacked medical knowledge to understand the perceptions of doctors and (3) patient–doctor interactions were insufficient in clinical settings.ConclusionsInformed consent is implemented as an administrative procedure at the hospital level in China. However, it has not been embedded in doctors’ clinical practices because, from the perspective of patients, doctors do not fulfil the obligation of medical information provision. As a result, the informed part of informed consent was neglected by individual doctors in China. Reforming medical education, monitoring the process of informed consent in clinical settings and redesigning medical institutional arrangements are pathways to restoring the practice of informed consent and patient-centred models in China.

The Medically Examined Applicant for Private Insurance and his/her Right to Informed Consent: A Comparative Analysis

2011 ◽  
Vol 18 (3) ◽  
pp. 319-330
Author(s):  
Sarah Defloor
Keyword(s):  
Comparative Analysis ◽  
Informed Consent ◽  
Medical Information ◽  
Private Insurance ◽  
Insurance Contract ◽  
Medical Examination ◽  
Insurance Law ◽  
Private Insurer ◽  
Legal Coercion ◽  
The Right

AbstractWithin the context of health and insurance law, an important question that arises is “to what extent is an applicant for private insurance truly capable of giving his/her ‘free’ and informed consent for a medical examination?”. It should be borne in mind that it is the private insurer who requires a medical examination in order to gather medical information, and, moreover, that the insurer will not be inclined to conclude or carry out an insurance contract without this medical information. A distinction has to be made between not being free by legal coercion and not being (completely) free by factual circumstances. Exercising the right to informed consent involves exactly weighing up the consequences of the decision. Hence the applicant must be put in a position of being able to weigh up the consequences and take them into consideration.

scholarly journals P005 Rheumatology virtual clinics during COVID-19: are our patients satisfied?

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Fajer A Altamimi ◽  
Una Martin
Keyword(s):  
Medical Information ◽  
Worker Safety ◽  
University Hospital ◽  
Free Text ◽  
Risk Of Infection ◽  
Further Training ◽  
Return Envelope ◽  
The Right ◽  
Reduced Risk

Abstract Background/Aims  Telemedicine can be broadly defined as the use of telecommunication technologies to provide medical information and services. It can be audio, visual, or text. Its use has increased dramatically during the COVID-19 pandemic to ensure patient and healthcare worker safety. Any healthcare professional can engage with it. It carries benefits like reduced stress and expense of traveling, maintenance of social distancing, and reduced risk of infection. There are some potential drawbacks such as lack of physical examination, liability and technological issues. Methods  A questionnaire was sent to 200 patients, selected from different virtual clinics (new and review, doctor and ANP led) run between March and May 2020 in the rheumatology department of University Hospital Waterford. We formulated 14 questions to cover the following aspects: demography, the purpose of the consult, punctuality, feedback, medico-legal concerns, and free text for comments. A self-addressed return envelope was included. Results  83 responses were received. 2 were excluded. The ratio of females to male respondents was 59: 41, with the majority over 60 years old. The main appointment type was review 67 (83%). 80% of patients were called either before or at the time of their scheduled appointment. The vast majority (98.8%) of our patients had confidence in our data protection and trusted our system to maintain their confidentiality. 95% stated that they felt comfortable, were given enough time to explain their health problem and felt free from stress. The respondents who preferred attending the clinic in person (17 in total) compared to the virtual were mostly follow up patients- 12 vs. 5 new. Conclusion  Patient satisfaction among those surveyed was high, despite having to introduce the service abruptly during the COVID-19 pandemic. There are many improvements we can adopt to improve our service and even maintain after the pandemic as a way of communicating with our stable patients. As we are covering a large geographical catchment, we can continue to implement the virtual clinic for some appointments. We should prioritize our efforts on identifying the right patient and the type of service we can offer, further training of staff, and increasing awareness of the patients as to how to get the most out of a virtual appointment. Disclosure  F.A. Altamimi: None. U. Martin: None. C. Sheehy: None.

Informed Consent in the Military: Fighting a Losing Battle Against the Anthrax Vaccine

2002 ◽  
Vol 28 (2-3) ◽  
pp. 325-343
Author(s):  
Ruth K. Miller
Keyword(s):  
Informed Consent ◽  
Service Member ◽  
Individual Choice ◽  
Civilian Life ◽  
Medical Treatments ◽  
Employment History ◽  
Receive Treatment ◽  
The Right ◽  
The Military ◽  
To Receive

In civilian life, an individual has the right to refuse medical treatment in almost any circumstance. While a patient who refuses treatment may face adverse consequences such as prolonged illness, our society recognizes the importance of individual choice in health matters. Members of the military, however, enjoy no such right. Service members are required to submit to certain medical treatments as a part of their employment contract. Refusing such treatments is disobeying an order, and the service member then faces the prospect of a dishonorable or “other than honorable” discharge, and even imprisonment. Disobeying an order to receive treatment can thus result in the equivalent of a felony conviction on the individual's employment history forever.

P2426Validating the diagnostic value of a machine learning algorithm for STEMI detection

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Mehta ◽  
R Botelho ◽  
F Fernandez ◽  
C Villagran ◽  
A Frauenfelder ◽  
...  
Keyword(s):  
Medical Information ◽  
Learning Algorithm ◽  
Artery Bypass ◽  
Hospital Setting ◽  
Coronary Intervention ◽  
Diagnostic Value ◽  
Retrospective Case ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
The Right

Abstract Background We have previously reported the use of Artificial Intelligence (AI) guided EKG analysis for detection of ST-Elevation Myocardial Infarction (STEMI). To demonstrate the diagnostic value of our algorithm, we compared AI predictions with reports that were confirmed as STEMI. Purpose To demonstrate the absolute proficiency of AI for detecting STEMI in a standard12-lead EKG. Methods An observational, retrospective, case-control study. Sample: 5,087 EKG records, including 2,543 confirmed STEMI cases obtained via feedback from health centers following appropriate patient management (thrombolysis, primary Percutaneous Coronary Intervention (PCI), pharmacoinvasive therapy or coronary artery bypass surgery). Records excluded patient and medical information. The sample was derived from the International Telemedical Systems (ITMS) database. LUMENGT-AI Algorithm was employed. Preprocessing: detection of QRS complexes by wavelet system, segmentation of each EKG into individual heartbeats (53,667 total beats) with fixed window of 0.4s to the left and 0.9s to the right of main QRS; Classification: A 1-D convolutional neural network was implemented, “STEMI” and “Not-STEMI” classes were considered for each heartbeat, individual probabilities were aggregated to generate the final label for each record. Training & Testing: 90% and 10% of the sample were used, respectively. Experiments: Intel PC i7 8750H processor at 2.21GHz, 16GB RAM, Windows 10 OS with NVIDIA GTX 1070 GPU, 8GB RAM. Results The model yielded an accuracy of 97.2%, a sensitivity of 95.8%, and a specificity of 98.5%. Conclusion(s) Our AI-based algorithm can reliably diagnose STEMI and will preclude the role of a cardiologist for screening and diagnosis, especially in the pre-hospital setting.

Extracting Medical Information from Paper COVID-19 Assessment Forms

2021 ◽  
Vol 12 (01) ◽  
pp. 170-178
Author(s):  
Jacob D. Schultz ◽  
Colin G. White-Dzuro ◽  
Cheng Ye ◽  
Joseph R. Coco ◽  
Janet M. Myers ◽  
...  
Keyword(s):  
User Interface ◽  
Character Recognition ◽  
Optical Character Recognition ◽  
Medical Information ◽  
Medical Center ◽  
Data Validation ◽  
Average Accuracy ◽  
Medical Documents ◽  
Optical Mark Recognition ◽  
The Right

Abstract Objective This study examines the validity of optical mark recognition, a novel user interface, and crowdsourced data validation to rapidly digitize and extract data from paper COVID-19 assessment forms at a large medical center. Methods An optical mark recognition/optical character recognition (OMR/OCR) system was developed to identify fields that were selected on 2,814 paper assessment forms, each with 141 fields which were used to assess potential COVID-19 infections. A novel user interface (UI) displayed mirrored forms showing the scanned assessment forms with OMR results superimposed on the left and an editable web form on the right to improve ease of data validation. Crowdsourced participants validated the results of the OMR system. Overall error rate and time taken to validate were calculated. A subset of forms was validated by multiple participants to calculate agreement between participants. Results The OMR/OCR tools correctly extracted data from scanned forms fields with an average accuracy of 70% and median accuracy of 78% when the OMR/OCR results were compared with the results from crowd validation. Scanned forms were crowd-validated at a mean rate of 157 seconds per document and a volume of approximately 108 documents per day. A randomly selected subset of documents was reviewed by multiple participants, producing an interobserver agreement of 97% for documents when narrative-text fields were included and 98% when only Boolean and multiple-choice fields were considered. Conclusion Due to the COVID-19 pandemic, it may be challenging for health care workers wearing personal protective equipment to interact with electronic health records. The combination of OMR/OCR technology, a novel UI, and crowdsourcing data-validation processes allowed for the efficient extraction of a large volume of paper medical documents produced during the COVID-19 pandemic.

Analysis of Factors Affecting Technological Innovativeness in Engineering Enterprises in Tanzania

2010 ◽  
Vol 34 (1) ◽  
pp. 1-14
Author(s):  
Emmanuel A. Mjema
Keyword(s):  
Innovation Management ◽  
Positive Culture ◽  
Key Factors ◽  
Factors Affecting ◽  
Level Of Education ◽  
Fundamental Innovation ◽  
Local Material ◽  
The Right

This paper discusses the technological innovativeness in engineering enterprises in Tanzania and analyses the factors affecting the innovativeness. It starts by analyzing various concepts regarding innovation, then analyzed from documentary review factors affecting innovativeness and then analyzed the innovativeness in Tanzanian enterprises.From the documentary review it was learnt that the following key factors influence technological innovativeness: Existence of innovation management; Existence of market to absorb the products of innovation; Existence of partnership between the universities and the firms; Existence of positive culture and politics towards innovation; The governmentplaying its role to influence innovation; Existence of the right knowledge; and Ability of the enterprises to access to financing institutions that support innovation.The research shows that there is hardly any fundamental innovation in Tanzania, what is presented as innovation is the copying of technologies and manufacture them using local material. Theresearcher established the following factors affecting the innovativeness of engineering enterprises in Tanzania: Level of education among the entrepreneurs in engineering enterprises; financing for the enterprises in Tanzania; partnership with R&D institutions; innovativeness culture; and market for Tanzanian products.

Legal Pluralism, Human Rights and the Right to Vote: The Case of the Noken System in Papua

2021 ◽  
Vol 22 (2) ◽  
pp. 255-286
Author(s):  
Ignatius Yordan Nugraha
Keyword(s):  
Human Rights ◽  
Local Population ◽  
Constitutional Court ◽  
International Human Rights Law ◽  
Human Rights Law ◽  
International Human Rights ◽  
International Human ◽  
Right To Vote ◽  
The Right ◽  
Legal Pluralist

Abstract The goal of this article is to explore the clash between international human rights law and a legal pluralist framework in the case of the noken system and also to investigate potential solutions to the clash. Elections in Indonesia are generally founded on the principle of direct, universal, free, secret, honest and fair voting. There is a notable exception in the Province of Papua, where tribes in the Central Mountains area are following the noken system. Under this system, votes are allocated to the candidate(s) based on the decision of the big man or the consensus of the tribe. The Indonesian Constitutional Court has accepted this practice as reflecting the customs of the local population. However, this form of voting seems to be contrary to the right to vote under international human rights law, since article 25(b) of the International Covenant on Civil and Political Rights stipulates that elections shall be held genuinely by universal suffrage and secret ballot to guarantee the free will of the electors. Consequently, the case of the noken system in Papua reflects an uneasy clash between a legal pluralist approach and universal human rights.

HUBUNGAN SIKAP PASIEN TERHADAP HAK DAN KEWAJIBAN RAWAT INAP DI RUMAH SAKIT PEKANBARU MEDICAL CENTER (PMC)

2021 ◽  
Vol 13 (1) ◽  
pp. 17-25
Author(s):  
Nur Maimun ◽  
Arnawilis ◽  
Cindy Feby Fayza ◽  
Nur Asikin
Keyword(s):  
Patient Safety ◽  
Medical Information ◽  
Medical Center ◽  
Patient Treatment ◽  
Patient Attitudes ◽  
Chi Square ◽  
Cross Sectional ◽  
The Right ◽  
Relationship Of ◽  
The Relationship

Patient as service users have right and obligations to be hospitalized and patients also have the right to medical information in receiving medical practice services. This study aims to determine the relationship between patient attitudes towards the rights and obligations of being hospitalized in the hospital Pekanbaru Medical Center (PMC). This research method using observational analytic method with cross sectional design. The total sample used in this study 107 sample were taken as simpel random sampling. Chi square test is used to determine the relationship between variables. The data were processed using SPSS statistical software and analyzed using univariate and bivariate analyzes. Of the result obtained of the study namely the relationship between patient attitude to the rights and obligations of patient with chi-suare obtained pvalue 0.016 (<0,05), the relationship of attitude patients to the rights and obligations of choosing a doctor and class of patient care with chi-square obtained pvalue 0,070 (<0,05), the relationship of patient attitudes to the right and obligations of confidentiality of disease by inpatient medical staff with chi-square obtained pvalue 0,000 (<0,05), the relationship of patient attitudes to the rights and obligations of consent to the patient treatment with chi-square obtained pvalue 0,000 (<0,05), the relationship of patient attitudes to the right and obligation of patient safety with chi-square obtained pvalue 0,000 (<0,05), the relationship between patient attitudes towards the right and obligations of patient safety with chi-square obtained pvalue 0,000 (<0,05). Suggestions in order to protect what has been achieved in this case is his ability as effort of service is getting better in the future Keyword : Attitudes of patient, Rights and Obligations inpatient, Hospital

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