Interstate Nursing Practice and Regulation: Ethical Issues for the 21st Century.
Open in a separate window Note: Provocative and convincing arguments have been made for both initiating randomized clinical trials in the at-risk sample and withholding treatment until a more definitive diagnosis is made.
One of the primary aims of the CARE program is to improve early identification of psychosis and decrease the false positive rate by also assessing brain-based vulnerability markers for schizophrenia.
At-risk subjects in the CARE program receive treatment as usual both pharmacological and psychosocial according to presenting symptoms and are not participating in a clinical trial. The current report assesses the clinical and demographic data of 50 subjects enrolled in the CARE program at the end of 1 year.
Comparisons are made between those individuals who had converted to psychosis and those who had not. Given the high false positive rate of Ethical implications in practice population in published reports, another objective was to further assess those individuals who did not convert to psychosis.
The plan was to develop hypotheses as to why this population initially fit the prodromal criteria and did not convert to psychosis and to determine whether it is possible to identify factors that protected them or delayed conversion.
Additionally, by examining the rate of conversion and nonconversion in this sample of individuals, we hope to contribute to the discussion of implications for clinical practice and the direction of future research in the schizophrenia prodrome.
Finally, our data can serve to strengthen the evidence base available to inform the discussion of empirical ethics regarding this important area of research. The mean age of the sample was Clinical and demographic information from a larger sample of 62 individuals, some of whom have not been followed for 1 year, is reported in the review article.
All subjects signed informed consent or assent with parental consent if under age 18 IRB At-risk subjects were not told that they were specifically at risk for schizophrenia or psychosis but were presented with a broad differential diagnosis with a focus on presenting symptoms.
It was made clear that they had been referred to the study because they had had changes in their thoughts, behavior, or emotions and that the research program was specifically interested in problems experienced by young people.
They were told that the study was designed to understand more about the difficulties they were having and to provide support and education to them and their families. Past medical and school records were requested with consent. Subjects were also asked to identify a family informant to provide family history information, also with appropriate consent.
Subjects were re-consented on a biannual basis after yearly institutional review board IRB reviews. At intake all potential at-risk subjects received a comprehensive clinical assessment and were reassessed at monthly intervals for 1 year.
Any subject who needed psychiatric care during the course of the study was provided treatment regardless of their funding status.
Some subjects were referred to outpatient clinics, and others already had a treating psychiatrist. Recruitment and Assessment We have a referral network in place in the city of San Diego that involves regular outreach and education.
All potential participants were screened for possible exclusions neurological illness, psychotic diagnosis then interviewed using the Structured Interview for Prodromal Syndromes SIPS 9 to determine whether they met entry criteria for a putative prodromal state since this diagnosis can only truly be made retrospectivelyaccording to the Criteria of Prodrome Syndromes COPS from the SIPS, as well as the CARE, prodromal criteria.
Comparisons were made between those individuals who had converted to psychosis and those who had not at 1 year. A Kaplan-Meier Survival Analysis was performed to assess rate of conversion.Clinical and research implications of this field of research intersect in several ways with ethical considerations.
First, the research has not reached a point where it can optimally inform clinicians faced with these complex patients.
To be an ethical implication, it would be a consequence touching on ethical decision-making and/or attitudes. Let's say that increasing numbers of people decided to stop tipping waitstaff.
There would be material implications for . Ethical issues that can arise in distinguishing public health research from practice are highlighted in 2 case studies—an investigation of a tuberculosis outbreak in a prison and an evaluation of a program for improving HIV prevention services.
Patient confidentiality is a fundamental practice in healthcare and it is integral part of healthcare ethical standards (Purtilo & Dougherty, ). Special Education Professional Ethical Principles (PDF version) Professional special educators are guided by the CEC professional ethical principles, practice standards, and professional policies in ways that respect the diverse characteristics and needs of individuals with exceptionalities and their families.
The practice of law naturally presents pitfalls and quandaries that lawyers must unravel on a daily basis. When that practice includes representing medical marijuana organizations, or those affiliated with them, then those pitfalls become even more alarming.