Development of Authorized Translation of “WHO Definition of Palliative Care”: Collaboration of 18 Academic Medical Societies in Japan Using Delphi Method

Objective: To create an authorized translation of the “definition of palliative care” according to WHO using the Delphi method. Methods: Through a palliative care association council (hereafter referred to as the “council”) composed of 18 academic organizations, this research aimed to create an authorized translation draft and develop a consensus for it using the Delphi method according to 54 experts, three from each organization. The main clause and nine subordinate clauses of the document were evaluated from “not at all appropriate” (1 point) to “completely appropriate” (9 points). The standard for consensus was if the median was 7 points or above, or if there was a difference of 5 points or less between the maximum and minimum. The council created an authorized translation in light of the consensus status. Results: Three rounds of the Delphi method were performed; the response rates were 100%, 93%, and 91% respectively. As 30% of the clauses reached the predetermined standard for consensus, the council discussed and considered, established an authorized translation draft, and made a decision upon public comment from each academic organization. Conclusion: Academic organizations associated with palliative care jointly created an authorized translation for the “definition of palliative care” according to WHO.

Survey on the contributions of hospice and palliative care staff to spiritual and life-and-death education at school

We surveyed the involvement of hospice and palliative care staff in spiritual and life-and-death education at school. We sent a questionnaire to a total of 138 hospice and palliative care institutions, receiving 67 responses (response rate 49%). A variety of staff at 15 institutions (22%) practiced life-and-death education. Most often, they realized the necessity of such education when they observed children grieving from the death or dying of a family member. 6 institutions targeted their life-and-death education to primary schools, 8 to junior high schools, and 6 to senior high schools. The number of teaching sessions ranged from once to 97 times per year, with hours of class contact less than one hour in 2 institutions, and 1-3 hours in the other 12 institutions. Even those institutions not conducting school education almost all responded that school education on life and death by healthcare workers would be meaningful. Respondents concurred that children would be moved by both "life-and-death education" and "spiritual education." Further comments almost all noted the importance of life-and-death education, not only for children but also for adults. In this sense, the expertise and experiences of hospice and palliative care institutions will become valuable educational resources.

Ethical Views of First-year Medical Students and Nursing Students in a Joint Bioethics Course / 医学教育

The ethical views of 85 first-year medical students and 53 first-year nursing students were studied during a joint bioethics course. Questions used to examine their views included: “Would you treat a mentally ill man condemned to death so that he could be executed?” ; “Should a doctor inform a patient of the risk of an extremely rare but possibly fatal drug reaction?” ; “Is criminal prosecution of a surgeon responsible for a patient's death reasonable?” ; and “Should a surgeon responsible for a patient's death be prosecuted for manslaughter?” Students were also asked two open-ended questions about the beginning of human life and what they considered the single most important ethical issue. Medical students favored treating a condemned, mentally ill man more frequently than did nursing students. More than 85% of all students endorsed full disclosure of medical information. Although most students considered reasonable the criminal prosecution of a responsible surgeon, significantly fewer medical students than nursing students thought that the surgeon should be prosecuted for manslaughter. Most students believed that human life begins at conception. The ethical issue named as most important by medical students was brain death/organ transplant and that named by nursing students was assisted reproductive technology. Thus, medical and nursing students at the beginning of their professional education agree on some, and differ on other, ethical issues. The author hopes that joint student courses on medical ethics will foster ethical sensitivity and stimulate and enhance future dialogue among healthcare professionals.

Educational Materials for Lectures in Bioethics Education / 医学教育

The type of educational material most suitable for lectures in ethics education has not been determined. This study specifically examined which type of informational materials is most useful for understanding bioethical issues: materials in which a correct answer is shown (complete information type) or materials in which a correct is not shown (question type). The author found that the self-assessed understanding of bioethical issues by nursing students was greater with question-type materials than with complete information-type materials. In contrast, medical students' understanding of bioethical issues was not affected by the type of informational material. These results indicate that the understanding of bioethics can be enhanced by exploratory materials but may also be dependent on existing knowledge.

Qat chewing and pesticides: a study of adverse health effects in people of the mountainous areas of Yemen

Chewing qat leaves, Cathula Edulis, is now a very common behavioul among the people of the mountainous areas of Yemen. For about the past 20 years, in tandem with national development. qat chewing hay been rapidly expanding, and the use of chemical pesticlde4 in qat production has been increasing. In this study the adverse effects on human health of qat chewing combined with pesticide use were investigated. Results of interviews and questionnaires showed that chewers of qat grown with Sew or no chemical pesticides and chewers of qat grown with chemical pesticides have considerably different subjective symptoms. Chewers of qat produced in fields where chemical pesticides are used regularly have more symptoms than chewers of qat produced in fields where chemical pesticides are rarely or never used. Chewers of qat produced with more chemical pesticides, in particular, experience acute adverse effects on the digestive system and chronic adverse effects such as body weakness and nasal problems. Farmers who chew homemade qat on which they spread chemical pesticides by themselves may have the highest health risks regarding the combination of qat and pesticides. It is concluded that chewing qat grown with chemical pesticides causes considerable adverse health effects in human beings

Significance of Instructors' Assessments in Medical Ethics Education / 医学教育

Our medical ethics course emphasizes problem-based-learning (PBL) via group discussion of clinical cases. The significanceof instructors' assessments of PBL in ethics education was studied with different assessment tools during thelast 2 years. In the first year, students' behavior and level of functioning in group discussion were assessed on a group basiswith an 8-item instrument. In the second year, students' level of functioning and flexibility in response to differentopinions in group discussion were assessed on an individual basis with a 2-item instrument. Instsments ofstudent's performance in group discussion were positively but weakly correlated with scores of their reports derivedfrom group discussions. Instructors could consistently assess student performance in PBL in terms of behavior and levelof functioning in group discussions. Furthermore, instructors rated flexibility in response to other opinions as an importantfactor in group dynamics, including interaction between students and instructors. These results suggest that instructors'assessments can be used to help evaluate students in a medical ethics course. Instructors' assessments of studentflexibility during PBL can be particularly useful in this regard.

Students' Evaluation of a Medical-ethics Course / 医学教育

A medical-ethics course was anonymously evaluated by first-year students over 2 years. The course emphasizes problem-based learning through group discussion of clinical cases and lectures on ethical issues. A tutorial system was added to the course in the second year. Students' evaluations indicated that most students had positive attitudes about the course and that both group discussion and lectures were helpful for achieving the general instructional objectives and specific behavioral objectives of the course. A comparison of the 2 years showed that a majority of evaluated items received higher evaluations from second-year students than from first-year students. We attribute the difference to the livelier discussion with the introduction of the tutorial system and the smaller discussion groups. These results indicate that students consider medical-ethics education to be useful.

The Effects on First-year Medical Students of Medical Ethics Education with Case Studies / 医学教育

We introduced a compulsory medical ethics course for first-year medical students so that they would understand the basis of bioethics thinking and acquire the basic capacity to solve patients' clinical problems. The course consists of 14 school hours, of which 11 were for group discussion of 2 clinical cases and 3 were for whole-class lectures on various ethical issues. Identical, short ethics tests were given on the first and last days of the course. The acceptance level was evaluated on the basis of the score of the second test, reports submitted after group discussions, and class attendance. The scores of the second test correlated with the results of reports of the second clinical case but not with those of the first clinical case. Logistic regression analysis indicated that factors contributing to the acceptance level were the scores of the second test and the attendance rate, which was an independent contributing factor. Furthermore, the scores of the second test, but not of the first test, correlated with the acceptance level. These results indicate that this ethics course is useful for increasing students' thinking about ethical issues.