Competências gerenciais: conhecimento de enfermeiros / Managerial competencies: knowledge of nurses / Competencias de gestión: conocimiento de las enfermeras

Introdução: A enfermagem é considerada uma das ocupações mais versáteis dentro da força de trabalho de saúde. A gestão dos serviços de enfermagem é essencial para o sucesso da instituição de saúde e para a qualidade e segurança da assistência ao paciente. O enfermeiro gestor precisa ser apto a trabalhar e conduzir com cooperação e dinamismo a sua equipe, com respaldo em conhecimento técnico e valores éticos. Objetivo: Investigar o conhecimento dos enfermeiros quanto às competências gerenciais. Método: Estudo descritivo, exploratório, de abordagem qualitativa, realizado com enfermeiros, de um hospital universitário de pequeno porte, situado na região noroeste do estado do Paraná. As entrevistas foram pautadas na seguinte questão norteadora "Fale-me sobre as competências gerenciais executadas pelo enfermeiro?", após coleta dos dados, os mesmos foram transcritos e analisados segundo análise de conteúdo de Bardin. Resultados: Participaram do estudo sete enfermeiros, com idades entre 22 a 35 anos, a maioria desses profissionais terminaram a graduação em menos de três anos e atuavam naquela unidade de saúde, há menos de menos de um ano. A partir da análise das entrevistas emergiram três categorias, sendo elas: Habilidades para gestão; Dificuldades para gerenciar; e, Potencialidades/Facilidades para gerenciar. Principais resultados: por meio deste estudo foi possível notar que as percepções acerca das atribuições dos enfermeiros foram bem esclarecidas, demonstrando que a gerência está ligada às questões técnicas e burocráticas, e da sua relevância na condução eficiente da equipe sob sua liderança. Conclusão: Observa-se que há a necessidade de os profissionais de enfermagem compreenderem que a formação teórica e prática das atividades de educação continuada devem ser buscadas com afinco e não devem somente aguardar que os serviços de saúde as ofereçam.

Objective: To investigate nurses' knowledge of managerial skills. Method: Descriptive, exploratory study, with a qualitative approach, carried out with nurses from a small university hospital, located in the northwest region of the state of Paraná. The interviews were guided by the following guiding question "Tell me about the managerial competences performed by the nurse?", after collecting the data, they were transcribed and analyzed according to Bardin's content analysis. Results: Seven nurses participated in the study, aged between 22 and 35 years, most of these professionals finished their graduation in less than three years and worked in that health unit for less than less than a year. From the analysis of the interviews, three categories emerged, namely: Management skills; Difficulties to manage; and, Potential/Facilities to manage. Main results: through this study, it was possible to notice that the perceptions about the nurses' attributions were well clarified, demonstrating that the management is linked to technical and bureaucratic issues, and their relevance in the efficient management of the team under their leadership. Conclusion: It is observed that there is a need for nursing professionals to understand that the theoretical and practical training of continuing education activities should be pursued diligently and should not just wait for the health services to offer them.

Introducción: La enfermería se considera una de las ocupaciones más versátiles dentro del personal sanitario. La gestión de los servicios de enfermería es esencial para el éxito de la institución sanitaria y para la calidad y seguridad de la atención al paciente. El enfermero gestor debe ser capaz de trabajar y dirigir a su equipo con cooperación y dinamismo, apoyándose en conocimientos técnicos y valores éticos. Objetivo: Investigar los conocimientos de las enfermeras sobre las competencias de gestión. Método: Estudio descriptivo, exploratorio, de abordaje cualitativo, realizado con enfermeros, de un hospital universitario de pequeño porte, situado en la región noroeste del estado de Paraná. Las entrevistas se basaron en la siguiente pregunta orientadora: "Háblame de las competencias directivas que desempeñan las enfermeras". Tras la recogida de datos, se transcribieron y analizaron según el análisis de contenido de Bardin. Resultados: Participaron en el estudio siete enfermeros, con edades comprendidas entre los 22 y los 35 años, la mayoría de estos profesionales terminaron el grado en menos de tres años y permanecieron en la unidad de salud, por lo menos un año. Del análisis de las entrevistas surgieron tres categorías, a saber Habilidades para la gestión; Dificultades para la gestión; y, Potencialidades/Facilidades para la gestión. Principales resultados: a través de este estudio se ha podido constatar que las percepciones sobre las atribuciones de los enfermeros se han esclarecido, demostrando que la gerencia está ligada a las cuestiones técnicas y brocráticas, y a su relevancia en la conducción eficiente del equipo bajo su liderazgo. Conclusión: Se observa que existe la necesidad de que los profesionales de la enfermería comprendan que la formación teórica y práctica de las actividades de educación continuada debe ser buscada con afán y no debe aguantar que los servicios de salud los ofrezcan.

Gestión de la atención de salud bucal en tiempos de la COVID-19 / Management of oral health care in the time of COVID-19

Tema a presentar: En tiempos de COVID-19, debido al riesgo de transmisión derivado de varios procederes estomatológicos, se requiere reforzar la protección de los pacientes y de los trabajadores. Por tanto, se hace necesario actualizar a la comunidad científica y a los decisores de políticas en salud pública sobre aspectos esenciales para el perfeccionamiento de la gestión de la atención de salud bucal durante la pandemia. Comentarios principales: Con un enfoque actualizado según las experiencias internacionales, se trató el tema de la evaluación del riesgo laboral en estomatología y la gestión de la atención estomatológica durante la presente pandemia de COVID-19. Consideraciones globales: La profesión estomatológica tiene ante sí la responsabilidad de evitar la transmisión nosocomial de infecciones en los centros laborales, en las áreas de desempeño y que el personal en ejercicio de las acciones de salud esté protegido y no se convierta en trasmisor que ponga en riesgo a sus compañeros de trabajo, a la población que atiende, a su familia y a la población en general. El desempeño de los especialistas debe responder en todo momento a la ética médica y velar por ofrecer alternativas a las necesidades de salud bucal de la población en todas las situaciones de la vida social. La efectividad del accionar dependerá del perfeccionamiento de la gestión de la atención de salud bucal en tiempos de la COVID-19(AU)

Topic to be presented: In the time of COVID-19, and due to the risk of transmission derived from various dental procedures, it is necessary to enhance the protection of patients and workers. The scientific community and public health policy makers should therefore be updated on essential contents related to the improved management of oral health care during the pandemic. Main remarks: The topic of occupational risk assessment and dental care management during the current COVID-19 pandemic was addressed with an updated approach in keeping with international experiences. General considerations: The dental care profession has the responsibility of preventing nosocomial transmission of infections at work places and performance areas, as well as ensuring the protection of those involved in health actions, so that they do not become infected and transmit the disease to their colleagues, their patients, their family and the population at large. Specialists should always comply with medical ethics and offer alternatives to the oral health care needs of the population in all social life situations. The effectiveness of such actions will depend on improving the management of oral health care in the time of COVID-19(AU)

Sostenibilidad del sistema sanitario: compromiso ético de los médicos / No disponible

No disponible

Conflicting demands on a modern healthcare service: Can Rawlsian justice provide a guiding philosophy for the NHS and other socialized health services?

We explore whether a Rawlsian approach might provide a guiding philosophy for the development of a healthcare system, in particular with regard to resolving tensions between different groups within it. We argue that an approach developed from some of Rawls' principles - using his 'veil of ignorance' and both the 'difference' and 'just savings' principles which it generates - provides a compelling basis for policy making around certain areas of conflict. We ask what policies might be made if those making them did not know if one was patient, doctor, nurse or manager - in this generation or the next. We first offer a brief summary of Rawls' approach and how we intend to extrapolate from it. We examine how this adapted Rawlsian framework could be applied to specific examples of conflict within healthcare; we demonstrate how this framework can be used to develop a healthcare service which is both sustainable (in its training and treatment of staff, and in encouraging research and innovation) and open (to protect the powers and opportunities of those using the health service). We conclude that while Rawls' approach has previously been rejected as a means to address specific healthcare decisions, an adapted veil of ignorance can be a useful tool for the consideration of how a just health service should be constructed and sustained. Turning the theoretical into the practical (and combining Rawls' thought experiment with Scanlonian contractarianism), managers, doctors, patients, carers and nurses could come together and debate conflicting issues behind a hypothetical veil.

The interactions of Canadian ethics consultants with health care managers and governing boards during times of crisis.

BACKGROUND: Health care organizations can be very complex, and are often the setting for crisis situations. In recent years, Canadian health care organizations have faced large-scale systemic medical errors, a nation-wide generic injectable drug shortage, iatrogenic infectious disease outbreaks, and myriad other crises. These situations often have an ethical component that ethics consultants may be able to address. Organizational leaders such as health care managers and governing boards have responsibilities to oversee and direct the response to crisis situations. This study investigates the nature and degree of involvement of Canadian ethics consultants in such situations. METHODS: This qualitative study used semi-structured interviews with Canadian ethics consultants to investigate the nature of their interactions with upper-level managers and governing board members in health care organizations, particularly in times of organizational crisis. We used a purposive sampling technique to identify and recruit ethics consultants throughout Canada. RESULTS: We found variability in the interactions between ethics consultants and upper-level managers and governing boards. Some ethics consultants we interviewed did not participate in managing organizational crisis situations. Most ethics consultants reported that they had assisted in the management of some crises and that their participation was usually initiated by managers. Some ethics consultants reported the ability to bring issues to the attention of upper-level managers and indirectly to their governing boards. The interactions between managers and ethics consultants were characterized by varying degrees of collegiality. Ethics consultants reported participating in or chairing working groups, participating in incident management teams, and developing decision-making frameworks. CONCLUSIONS: Canadian ethics consultants tend to believe that they have valuable skills to offer in the management of organizational crisis situations. Most of the ethics consultants we interviewed believed that they play an important role in this regard.

Dificultades de las enfermeras de atención primaria en los procesos de planificación anticipada de las decisiones: un estudio cualitativo / Primary care nurses’ difficulties in advance care planning processes: a qualitative study

OBJETIVO: Conocer las dificultades que encuentran las enfermeras de atención primaria para promover procesos de planificación anticipada de las decisiones con personas en el final de la vida. DISEÑO: Estudio cualitativo fenomenológico. EMPLAZAMIENTO: Área de Gestión Sanitaria Norte de Jaén. PARTICIPANTES: Enfermeras de atención primaria. MÉTODO: Muestreo intencional. Realización de 14 entrevistas en profundidad hasta la saturación de los discursos. Análisis de contenido en 4 etapas: transcripción de datos, codificación, obtención de resultados y verificación de conclusiones. Uso de N-Vivo como apoyo al análisis. Triangulación de resultados entre investigadores. RESULTADOS: Dificultades referidas a los profesionales: falta de conocimiento sobre el tema, falta de habilidades de comunicación o de experiencia y presencia de emociones negativas. En la institución sanitaria, la falta de tiempo y las interferencias con otros profesionales suponen una barrera. También la actitud del propio paciente o su familia es vista como una traba ya que pocos hablan sobre el final de la vida. Finalmente, nuestra sociedad evita las conversaciones abiertas sobre temas relacionados con la muerte. CONCLUSIONES: Es necesario el aprendizaje de los profesionales sobre planificación anticipada de decisiones, su entrenamiento en habilidades comunicativas y su educación afectiva. Los gestores sanitarios han de tener en cuenta el hecho de que las intervenciones para planificar anticipadamente decisiones sanitarias precisan formación, tiempo y atención continuada. En tanto no acontezca un cambio cultural, persistirá un modelo evasivo para afrontar el final de la vida

OBJECTIVE: To know the primary care nurses' difficulties to promote advance care planning process with patients in the end of life. DESIGN: Phenomenological qualitative methodology. LOCATION: Health Management Area North of Jaén. PARTICIPANTS: Primary care nurses. METHOD: Purposive sampling. Fourteen in-depth interviews were conducted until the speeches saturation. Content analysis in four steps: transcription, coding, obtaining results and conclusions verification. Supported whit the software Nvivo 8. Triangulation of results between researchers. RESULTS: Professionals' difficulties: Lack of knowledge about the topic, lack of communication skills, lack of experience and presence of negative emotions. In the health institution lack of time and interference with other professionals is a barrier. Also the patient's attitude and the family are identified as an obstacle because few people speak about the end of life. Finally, our society prevents open discussion about issues related to death. CONCLUSIONS: Professional learning about advanced care planning, training in communication skills and emotional education are necessary. Health managers should consider the fact that early interventions for planning health decisions require training, time and continued attention. If a cultural change does not happen, an evasive way to face the end of life will persist

Bioética del día a día: más allá de los expertos / Day to day bioethics: beyond the experts

No disponible

Ethical priority setting for universal health coverage: challenges in deciding upon fair distribution of health services.

Priority setting is inevitable on the path towards universal health coverage. All countries experience a gap between their population's health needs and what is economically feasible for governments to provide. Can priority setting ever be fair and ethically acceptable? Fairness requires that unmet health needs be addressed, but in a fair order. Three criteria for priority setting are widely accepted among ethicists: cost-effectiveness, priority to the worse-off, and financial risk protection. Thus, a fair health system will expand coverage for cost-effective services and give extra priority to those benefiting the worse-off, whilst at the same time providing high financial risk protection. It is considered unacceptable to treat people differently according to their gender, race, ethnicity, religion, sexual orientation, social status, or place of residence. Inequalities in health outcomes associated with such personal characteristics are therefore unfair and should be minimized. This commentary also discusses a third group of contested criteria, including rare diseases, small health benefits, age, and personal responsibility for health, subsequently rejecting them. In conclusion, countries need to agree on criteria and establish transparent and fair priority setting processes.

La historia clínica compartida y el ejercicio de la autonomía de las personas en sanidad / Shared Electronic Health Record and the exercise of personal autonomy in Health

En este artículo se exponen los elementos principales que configuran la relación entre los usuarios de la sanidad y la gestión de sus datos personales de salud en el marco de la implementación de la historia clínica compartida, poniendo el énfasis en los riesgos que para la privacidad de las personas y para la debida confidencialidad pueden ocasionar la compartición de estos datos sensibles (AU)

This article set out the main elements that structure the relationship between Health Service users and the management of their personal health data, in the frame of implementation of Shared Electronic Health Record, emphasizing the risks that sharing this sensitive data can produce to personal privacy and confidentiality (AU)

[The prevention of corruption]. / La prevenzione della corruzione.

The escalation of the crisis between society and administration had a negative impact on public administration, as highlighted by criminal acts (bribery, extortion, abuse of power). Other consequences of this crisis have been the bad administration phenomena, such as delays in carrying out the practices, lack of attention to people's questions and failure to comply with working hours. These phenomena culminate in treating people without due respect and necessary kindness. In this context, the so-called applied ethics has developed, consisting of the construction of rules for moral behaviour, adapted to particular fields as well as to the public.

Inernational research in health care management: its need in the 21st century, methodological challenges, ethical issues, pitfalls, and practicalities.

PURPOSE: This commentary argues in favor of international research in the 21st century. Advances in technology, science, communication, transport, and infrastructure have transformed the world into a global village. Industries have increasingly adopted globalization strategies. Likewise, the health sector is more internationalized whereby comparisons between diverse health systems, international best practices, international benchmarking, cross-border health care, and cross-cultural issues have become important subjects in the health care literature. The focus has now turned to international, collaborative, cross-national, and cross-cultural research, which is by far more demanding than domestic studies. In this commentary, we explore the methodological challenges, ethical issues, pitfalls, and practicalities within international research and offer possible solutions to address them. DESIGN/METHODOLOGY/APPROACH: The commentary synthesizes contributions from four scholars in the field of health care management, who came together during the annual meeting of the Academy of Management to discuss with members of the Health Care Management Division the challenges of international research. FINDINGS: International research is worth pursuing; however, it calls for scholarly attention to key methodological and ethical issues for its success. ORIGINALITY/VALUE: This commentary addresses salient issues pertaining to international research in one comprehensive account.

Gestión del trabajo: implicaciones para el cuidado en la Atención Primaria de Salud / Gestão do trabalho: implicações para o cuidado na Atenção Primária à Saúde / Work management: implications for care in Primary Health Care

Objetivo: Describir las implicaciones de la gestión del trabajo en el cuidado en la Atención Primaria a la Salud. Método: Investigación cualitativa, un estudio de caso. La unidad de análisis fue una Unidad de Salud Familiar de un municipio de Rio Grande do Sul, Brasil. Se realizaron observaciones, entrevistas con los trabajadores y usuarios e ivestigaciones en documentos y en registros. El periodo de la colecta de datos fue de febrero a julio de 2012 y el análisis conforme orientación de estudio de caso. Resultados: La gestión de la unidad se caracterizó por la falta de escucha y singularidad con el equipo y autoritarismo; el equipo se sintió abandonado por la gestión y las Agentes Comunitarias de Salud por las enfermeras. Hubo discontinuidad en el cuidado. Discusión: La gestión en salud necesita pautar el tema de la autonomía y responsabilidad del trabajador. La no responsabilización es un efecto de la postmodernidad. La gestión del trabajo está relacionada con la continuidad del cuidado. Conclusiones: Los conceptos de pluralidad humana y de potencial de poder pueden ayudar en la construcción de ambientes de trabajo más humanos. Se apunta a la integración con la comunidad (AU)

Objetivo: descrever as implicações da gestão do trabalho no cuidado na Atenção Primária à Saúde. Método: pesquisa qualitativa, um estudo de caso. A unidade de análise foi uma Unidade de Saúde da Família de um município do Rio Grande do Sul, Brasil. Foram realizadas observações, entrevistas com os trabalhadores e usuários e pesquisas em documentos e em registros. O período de coleta de dados foi fevereiro a julho de 2012 e a análise conforme orientação de estudo de caso. Resultados: a gestão da unidade caracterizou-se pela falta de escuta e singularidade com a equipe e autoritarismo; a equipe sente-se abandonada pela gestão e as Agentes Comunitárias de Saúde pelas enfermeiras. Há descontinuidade no cuidado. Discussão: a gestão na saúde precisa pautar o tema da autonomia e responsabilidade do trabalhador. A não responsabilização é um efeito da pós-modernidade. A gestão do trabalho está relacionada com a continuidade do cuidado. Conclusões: os conceitos de pluralidade humana e de potencial de poder podem auxiliar na construção de ambientes de trabalhos mais humanos. Aponta-se para a integração com a comunidade como caminho para a transformação da realidade. A pesquisa pela temática deve responsabilizar-se pela produção de saúde e pelo outro, individual ou coletivamente

Objective: To describe the implications of the management of care work in Primary Health Care. Methods: Qualitative research, a case study. The unit of analysis was one of the Family Health Unit of a city in Rio Grande do Sul, Brazil. Observations, interviews with workers and users and research documents and records were made. The data collection period was from February to July 2012 and as directed analysis of a case study. Results: unit management was characterized by lack of listening and uniqueness with the staff and authoritarianism, the team feels abandoned by management and the Community Health Agents by nurses. There is discontinuity in care. Discussion: Managing health needs guided the theme of autonomy and responsibility of the employee. The accountability is not an effect of post modernity. The management of labor is related to continuity of care. Conclusions: The concepts of human plurality and potential power can assist in building a more humane work environment. It looks to the integration with the community as a way to transform reality. The search for the theme should be responsible for the production of health and the other, individually or collectively (AU)

Gestión clínica: Bases fundamentales y organización / Clinical Management: Basics and organization

En los últimos años se han planteado numerosas estrategias de gestión para asegurar la sostenibilidad del sistema sanitario, especialmente tras la reciente crisis económica global. Una de los planteamientos más atractivos es la gestión clínica, que es una forma de organizar las unidades asistenciales, basada en la participación activa de los profesionales y en la transferencia de responsabilidades, para la consecución de objetivos con la misión de asegurar una correcta atención centrada en los pacientes, teniendo en cuenta el uso racional de los recursos (eficiencia). Para la puesta en marcha de estructuras asistenciales basadas en la gestión clínica es necesaria una cultura de gestión previa en los servicios implicados y en el equipo directivo del centro. Además, para lograr los objetivos planteados se deben de utilizar diferentes herramientas como la medicina basada en la evidencia, el análisis de la variabilidad en la práctica clínica, la gestión por procesos, además de estrategias de calidad y seguridad. Las unidades implicadas deben de plantear un plan de gestión que se plasmará en un contrato de gestión con la dirección del centro. En este acuerdo se establecerán unos objetivos de actividad, gasto y calidad que serán cuantificables mediante diversos indicadores. La transferencia de riesgos hacia la unidad debe de incluir cierta capacidad de decisión presupuestaria y de incentivación. La gestión clínica no debe de ser empleada como una herramienta de ahorro por parte de los macro y mesogestores. No existe una estructura asistencial basada en la gestión clínica que tenga un carácter general para todas las organizaciones sanitarias, existiendo una gran variabilidad en la adopción de diferentes fórmulas organizativas y por tanto cada centro debe realizar su propio análisis y decidir el modelo más adecuado. En nuestro país existen numerosas experiencias en gestión clínica, aunque todavía queda mucho camino por recorrer

OBJECTIVES: Many strategies have been proposed over the last years to ensure the Health Care System sustainability, mainly after the recent global economic crisis. One of the most attractive approaches is clinical management, which is a way of organizing health care units based on active participation of professionals who receive the transference of responsibilities to achieve the objectives with the mission of ensuring a proper patient centered care, taking into consideration the rational use of resources (Efficiency) For the start up of Health Care structures based on clinical management, it is necessary a previous management culture within the departments involved and the center`s executive board. Furthermore, to achieve the objectivesproposed various tools must be used, such as evidence based medicine, clinical practice variability analysis, process management, in addition of quality and safety strategies. The units involved have to propose a management plan that will result in a management contract with the center`s executive board. This agreement will establish some activity, expense and quality objectives that will be quantifiable through various indicators. Risk transference to the unit must include certain budget allocation and incentive decision capacity. Clinical management must not be employed as a savings tool from the part of macro and meso management. There is not a health care structure based on clinical management that have a general character for all health care organizations, existing a great variability in the adoption of various organizational formulas, so that every center must perform its own analysis and decide the most adequate model. In our country there are many clinical management experiences, although there is a long way to go

Arquitectura y diseño de un mapa de procesos en un Servicio de Urología / Architecture and design of a processes map in a Urology Department

Una organización que pretenda orientarse a la gestión por procesos ha de saber qué es un sistema y cuáles son los factores que le caracterizan. Las instituciones sanitarias son sistemas abiertos y mixtos. Es en este sistema donde se produce la cadena de valor del proceso productivo, originando un sistema integrado de gestión muy complejo, dado que los destinatarios principales del sistema productivo son personas con necesidades de salud. El enfoque de la gestión por procesos en los centros, servicios y unidades clínicas supone que, una vez que se hayan identificado los procesos, hay que situarlos según su misión estableciéndose una arquitectura de cajas y conexiones que se conoce como mapas de procesos. Un mapa de proceso es, por lo tanto, la representación gráfica del sistema de gestión de la organización, el cual puede desplegarse aplicando técnicas de modelación en diversos niveles. En este artículo revisaremos el marco conceptual del sistema de producción y gestión sanitaria con enfoque de procesos, incorporando productos didácticos que están basados en experiencias llevadas a cabo en diferentes centros y servicios sanitarios

Every organization with the intention to be oriented to processes management must know it is a system and what are the factors that characterize it. Health care institutions are open and mixed systems. It is in this system where the chain of value of the productive process occurs, generating a very complex integrated management system, as the productive system main recipients are people with health needs. The process management approach in clinical centers, departments and units means that, once the processes have been identified, they have to be set depending on their mission, establishing a boxes and connections architecture known as process maps. Therefore, a map of processes is the graphical representation of the organizational management system, which may be deployed applying modeling techniques at various levels

O papel do gestor mediante as mudanças, conflitos e desafios nas organizações de saúde / The role of the manager by the changes, conflicts and challenges in health organizations

Muitas foram as mudanças que ocorreram neste século nas organizações de saúde, entre elas, na saúde pública, destacou-se a implantação do Sistema Único de Saúde (SUS), que afirma que a saúde é direito de todos e dever do Estado, garantido mediante políticas sociais e econômicas que visem à redução do risco de doença e de outros agravos e ao acesso igualitário às ações e serviços para sua promoção, proteção e recuperação. Com profissionais diversificados e de áreas afins, torna-se necessário, maior atuação por parte dos gestores para se adaptarem às mudanças e administrarem os conflitos, existentes entre os profissionais de saúde levando-os a enfrentarem os novos desafios, ocasionados pelas mudanças, de maneira profissional e harmoniosa (AU)

Comparing the burden: what can we learn by comparing regulatory frameworks in abortion and fertility services?

In the UK, regulation of clinical services is being restructured. We consider two clinical procedures, abortion and IVF treatment, which have similar ethical and political sensitivities. We consider factors including the law, licensing, inspection, amount of paperwork and reporting requirements, the reception by practitioners and costs, to establish which field has the greater 'regulatory burden'. We test them based on scientific, ethical, social, political factors that might explain differences. We find that regulatory burden borne by IVF services is greater than in abortion, but none of the explanatory theses can provide a justification of this phenomenon. We offer an alternative explanation based on regulatory 'overspill' from research regulation and policy making, conceptualisation of risk regulation and a high public profile that locks a regulator into self-preservation.

Can research and care be ethically integrated?

Medical ethics assumes a clear boundary between clinical research and clinical medicine: one produces knowledge for the benefit of future patients, while the other provides optimal care to individuals right now. It also assumes that the two cannot be integrated without sacrificing the needs of the current patient to those of future patients. But integration could allow us to provide better care to everyone, now and in the future.