Ethics, Evidence Based Sports Medicine, and the Use of Platelet Rich Plasma in the English Premier League.

The use of platelet rich plasma (PRP) as a novel treatment is discussed in the context of a qualitative research study comprising 38 interviews with sports medicine practitioners and other stakeholders working within the English Premier League during the 2013-16 seasons. Analysis of the data produced several overarching themes: conservatism versus experimentalism in medical attitudes; therapy perspectives divergence; conflicting versions of appropriate evidence; subcultures; community beliefs/practices; and negotiation of medical decision-making. The contested evidence base for the efficacy of PRP is presented in the context of a broader professional shift towards evidence based medicine within sports medicine. Many of the participants while accepting this shift are still committed to casuistic practices where clinical judgment is flexible and does not recognize a context-free hierarchy of evidentiary standards to ethically justifiable practice. We also discuss a tendency in the data collected to consider the use of deceptive, placebo-like, practices among the clinician participants that challenge dominant understandings of informed consent in medical ethics. We conclude that the complex relation between evidence and ethics requires greater critical scrutiny for this emerging specialism within the medical community.

Paralympism, Paralympic values and disability sport: a conceptual and ethical critique.

PURPOSE: This paper explores the conceptual content of Paralympism. It exists by exploring the nascent normative framework that the International Paralympic Committee (IPC) has begun to construct around its constituent sports. The IPC sets out four values: Courage, Determination, Inspiration and Equality. METHOD: Drawing on philosophical ethical methods it offers a critical evaluation of the four values that comprise the IPC position. CONCLUSION: While courage is undoubtedly a moral virtue, there is more than one conception that might inform Paralympism with either/both active and passive content. It is argued that Determination is an instrumental character trait that is not necessarily ethically praiseworthy. While potentially inspiring, the efforts and abilities of Paralympic athletes need not depend on the reception of spectators whom they have no control over. Finally, being an important ethical idea, it is neither clear what kind of equality is aimed for nor how it would be operationalized within sports with respect to access to expensive technology that is often the precondition of Paralympic sporting success. It is concluded that the Paralympic movement has not yet invested sufficient intellectual effort to articulate its ethical basis, and while these four values may have something to do with Paralympism, they are insufficient to articulate the concept. Implications for Rehabilitation Athletes with disabilities are governed by a range of normative frameworks that affect their preparation for and participation in the Paralympic games and associated events. Medical models often espouse a conception of biostatistical normality that derogates persons with disabilities, yet in elite sports abnormalities in structure and function can be highly valued. There is a lack of clarity about the ethical goals for those assisting Paralympic athletes. Governing bodies in disability sports, such as the International Paralympic Committee need to more critically and coherently spell out their ethical vision for Paralympic sports, which should guide athletes and rehabilitation professionals to behave in ways that would command the general public's admiration. Paralympism, Paralympic values and disability sport: a conceptual and ethical critique.

Doping and supplementation: the attitudes of talented young athletes.

There is evidence of a small but significant proportion of adolescents engaging in doping practices. Young athletes face very specific pressures to achieve results as they strive for a career at an elite level. This study used an anonymized questionnaire to survey 403 (12-21 years old) talented young athletes' attitudes toward performance-enhancing substances and supplements. Two-thirds of the sample comprised males. Athletes were generally against the use of doping substances to enhance sporting performance. Within this generally unfavorable view, males tended to express a more permissive attitude toward performance-enhancing methods than females. Those convinced of the necessity of supplementation for sporting success were also more likely to express permissive attitudes. When asked whether they would take a "magic" drug that, while undetectable, would significantly enhance performance, the overwhelming majority of athletes said "no," but many thought others would take the substance. Interestingly, there was a significant association between the projected use of the hypothetical drug by competitors and the individual respondent's willingness to take the hypothetically "magic" substance. The study offers an insight into young athletes' attitudes toward specific forms of performance enhancement, and the strength of their beliefs in the face of a tempting hypothetical scenario.

Transhumanism, medical technology and slippery slopes.

In this article, transhumanism is considered to be a quasi-medical ideology that seeks to promote a variety of therapeutic and human-enhancing aims. Moderate conceptions are distinguished from strong conceptions of transhumanism and the strong conceptions were found to be more problematic than the moderate ones. A particular critique of Boström's defence of transhumanism is presented. Various forms of slippery slope arguments that may be used for and against transhumanism are discussed and one particular criticism, moral arbitrariness, that undermines both weak and strong transhumanism is highlighted.

Ethical concerns regarding guidelines for the conduct of clinical research on children.

In this article we examine ethical aspects of the involvement of children in clinical research, specifically those who are incapable of giving informed consent to participate. The topic is, of course, not a new one in medical ethics but there are some tensions in current guidelines that, in our view, need to be made explicit and which need to be responded to by the relevant official bodies. In particular, we focus on tensions between the World Medical Association Declaration of Helsinki, and the guidance offered by the British Medical Association, the Royal College of Paediatrics and Child Health (formerly the British Paediatric Association), and the Council for International Organizations of Medical Sciences. We conclude with a call for these organisations to make their guidance explicit in relation to the World Medical Association Declaration.

Health problems of sheltered homeless men using a mobile health van: a 4-year study.

The number of homeless persons in the United States is increasing on an annual basis, with men accounting for the greatest number. Accessing health care for this group is difficult for many reasons, particularly those related to finances, transportation, lack of insurance, and transiency of lifestyle. Consequently, data regarding homeless men's health problems/concerns are difficult to obtain, and often the information reported is only for acute care services provided by emergency rooms and clinics. The purpose of this study was to determine the demographic characteristics and health problems/concerns of sheltered homeless men using the services of a mobile van for health care over a 4-year period. A total of 2,086 records, representing 1,171 men aged 19 and over, were retrospectively reviewed to determine demographic and health characteristics (age, sex, self-reported medical and addiction histories, and self-reported medication use). Data on presenting concerns, diagnoses, visit patterns, treatments, medications and teaching provided were also collected and analyzed. Recommendations to improve the quality, continuity, and follow-up of care for homeless men are included.

The community health nursing implications of the self-reported health status of a local homeless population.

This study explored the personal characteristics and the health and health-related concerns reported by members of the local homeless population in order to design population-specific health programming. The study also examined whether there were significant differences between homeless who are shelter residents and those who are not. An exploratory descriptive design was used to analyze retrospective data collected by a local County Health Department in interviews of 132 homeless adults. The demographic characteristics found reflect many common patterns: marked over-representation of males, mean age in the mid-thirties, education levels comparable to similar socio-economic groups, high unemployment rates, and low health insurance rates. One third of the sample reported self-assessed health statuses of fair or poor. The most frequently identified physical health issue was joint problems, followed by cardiovascular disease. Depression was mentioned most frequently as a self-identified mental health problem. Loneliness was the number one fear identified. Chi Square analysis showed that homeless who did not stay in shelters were significantly longer term residents (p < 0.0001) of the community and reported fear of loneliness significantly more frequently (p < 0.01). This study identifies health concerns that local homeless people themselves find important and provides direction for development of sound population-specific health programming.

Severe hypothermia in the elderly.

Hypothermia is not an uncommon clinical problem in the geriatric population. Several factors place elderly individuals at risk, including their reduced ability to sense and react to cold and their underlying medical conditions and medications. Successful detection and treatment of these patients involve an awareness of these risk factors and the characteristic physiology of the elderly, as well as an appreciation of the often controversial aspects of hypothermia management. Elderly victims of severe hypothermia have a particularly grave prognosis. We present one of the oldest reported survivors of severe hypothermia, and discuss some unique aspects of his presentation.

Use of a mobile health van by a vulnerable population: homeless sheltered women.

Little is known about the health status of homeless women. In this study, we examined the health problems of and services provided to sheltered, homeless, Midwestern women who used a mobile health van. Our objectives were to document these women's ages, self-reported past medical histories, self-reported histories of addictions and hospitalizations, presenting concerns, diagnoses, and visit patterns. To this end, we performed a retrospective review of the 689 records of 408 women who had sought care during a 3-year period. The data were divided into three groups, representing women ages 15-25 (n = 111), 26-40 (n = 211), and 41-70 (n = 86). In all three age groups, respiratory disorders were most frequently treated. Preventive health maintenance concerns were also major concerns of all age groups. Recommendations for improving the quality, continuity, and follow-up of care are offered.

Health problems of sheltered homeless children using mobile health services.

Homeless families are an increasing problem in the United States, with children representing 34% of the total homeless population. This retrospective study describes the demographic characteristics and health care problems and concerns of sheltered homeless children who used the services of a mobile health van over a 1-year period in a midwestern metropolitan area. The patterns of utilization, medications prescribed, and referrals are also described. Medical records of 175 sheltered homeless children who sought care from a mobile health van were reviewed. Forty-eight percent of the children were female; 52% were male. The majority were under 6 years of age (15% infants, 22% toddlers, 22% preschoolers, 23% school-age children, and 18% adolescents). The major reasons for seeking health care, the primary diagnoses, and treatments are presented. Recommendations for using a mobile van to provide efficient, quality health care for this population are discussed.

Management of the severely anemic patient who refuses transfusion: lessons learned during the care of a Jehovah's Witness.

OBJECTIVE: To present the case of a Jehovah's Witness with severe anemia and to review the religious philosophy of such patients, the ethical and medicolegal aspects of their care, and the therapeutic options available to clinicians. DATA SOURCES: A MEDLINE literature search (1980 to 1992) identified most studies. Other studies were selected from the bibliographies of identified articles. STUDY SELECTION: Selection of articles was limited to the history, philosophy, medicolegal and ethical issues, and clinical management of anemic Jehovah's Witnesses; a recent article on recommendations for red cell transfusion was also reviewed. CONCLUSIONS: A clear understanding of the philosophy of the Jehovah's Witnesses regarding blood transfusion and of the medicolegal and ethical aspects of their care is essential to clinicians who care for such patients. One must also be aware of the many alternative therapeutic options that can maximize oxygen delivery and minimize oxygen consumption. The insights gained from this review are applicable to any severely anemic patient who refuses blood transfusion.

The Adolescent Life Change Event Scale: its development and use.

A variety of instruments have been used by researchers from several disciplines to assess life change events in adolescents. Most instruments have not been tested for validity and reliability, and have been used in one-time studies, with limited effort to synthesize all studies using the particular instrument. Because of the number of requests, over more than a decade, to use the Adolescent Life Change Event Questionnaire, the authors have attempted to review all known studies using this instrument as a preliminary step toward further testing of the questionnaire for validity and reliability. Twenty-five studies, involving a total of 4,024 adolescent subjects from nine states, were reviewed. Findings included gender and age differences in number of events experienced and the perceived stressfulness, and a relationship between events experienced and suicidal ideation. Recommendations are made regarding future development and use of the instrument.