Violation of ethical principles in clinical research. Influences and possible solutions for Latin America.

BACKGROUND: Even though we are now well into the 21st century and notwithstanding all the abuse to individuals involved in clinical studies that has been documented throughout History, fundamental ethical principles continue to be violated in one way or another. DISCUSSION: Here are some of the main factors that contribute to the abuse of subjects participating in clinical trials: paternalism, improper use of informed consent, lack of strict ethical supervision, pressure exerted by health institutions to increase the production of scientific material, and the absence of legislation regarding ethics in terms of health care and research. Are researchers ready to respect fundamental ethical principles in light of the ample window of information provided by individual genomes, while defending the rights of the subjects participating in clinical studies as a major priority? SUMMARY: As one of the possible solutions to this problem, education regarding fundamental ethical principles is suggested for participants in research studies as an initial method of cognitive training in ethics, together with the promotion of ethical behavior in order to encourage the adoption of reasonable policies in the field of values, attitudes and behavior.

[Participatory education and the development of critical reading in teachers theoretical texts. Multicenter study]. / Educación participativa y el desarrollo de la lectura crítica de textos teóricos en profesores. Estudio multicéntrico.

AIM: Determine what the relationship between participation in classroom of students attending courses at the Educational Research and Teacher Education (CIEFD's) and the development of proficiency in critical reading of theoretical texts in education. MATERIAL AND METHODS: Intervention study, multicenter students (medical specialist) level Diploma in teaching methodology (DMDN) 1 and 2 (n=46 n=29) of the six CIEFD's (DF Siglo XXI, Mexico City La Raza, Nuevo Leon, Sonora, Puebla and Veracruz), period: March to August 2007 and a Masters in education (n=9, generation 2007-2008). Two instruments were constructed that evaluated the participation variables and critical reading of theoretical texts in education, conceptual validity; content and reliability were assessed by experts in education research. The educational intervention was in the form of seminars (three times a week in DMDN 1 and twice weekly in DMDN 2 and Masters). Participation was assessed halfway through the course and on completion, critical reading at the beginning as well as the end. RESULTS: Statistically significant associations were observed in DMDN 1 (four Centers) and the Masters, but not DMDN 2. DISCUSSION: In this investigation some of the theoretical proposals of the participatory education were recreated, starting from the analysis of our results. CONCLUSION: In some centers and in the masters, strengthening participation in this educational intervention is related to the development of critical reading of theoretical texts in education.

[Clinical competence of anesthesiology residents in patients requiring hospital care in the specialty hospital "Siglo XXI"]. / Competencia clínica de los residentes de anestesiología en pacientes que requieren atención médica en un hospital de especialidades.

INTRODUCTION: The study of clinical competence is essential because it summarizes the attributes that characterize a specialist capable of providing quality health care OBJECTIVE: Investigate the development of clinical competence among anesthesiology residents that care for patients in a tertiary level facility. MATERIAL AND METHODS: In February 2007 we conducted a cross-sectional study among 42 anesthesiology residents, 21 were in second and 21 in third year. In order to measure the degree of development of clinical competence we created an instrument with four case studies that summarized patients undergoing surgical anesthetic procedure. The instrument included 200 items that explored eight indicators and covered a range of time periods: pre-trans and post anesthesia. The instrument was validated by a group of experts with clinical, teaching and publication experience. We carried out a pilot test and estimated the instrument's internal reliability using the Kuder-Richardson test (KR-21). We obtained a coefficient of 0.95. We collected the study data and instrument rating technique using a blinded design. Statistical analysis was performed using nonparametric tests. RESULTS: In the overall ranking, third-year medical residents versus sophomores, achieved the highest scores, which resulted in statistically significant differences (p = 0.045). Regarding the degree of expertise we found that most participants had scores of "very low" and "low". In the study of ratings by indicator, we noted that when comparing second vs third year residents we only found statistically significant differences in default decisions that were also potentially iatropathogenic (p = 0.026). CONCLUSION: The clinical competence of anesthesiology residents who care for patients attending a tertiary level facility is low when compared with the maximum theoretical scores they should obtain.