Ethical Challenges in Clinical Research During the COVID-19 Pandemic.

The sudden emergence of the COVID-19 pandemic brought global disruption to every aspect of society including healthcare, supply chain, the economy, and social interaction. Among the many emergent considerations were the safety and public health of the public, patients, essential workers, and healthcare professionals. In certain locations, clinical research was halted-or terminated-in deference to the immediate needs of patient care, and clinical trials focusing on the treatment and prevention of coronavirus infection were prioritized over studies focusing on other diseases. Difficult decisions were made rapidly; flexibility and reconsideration were necessary not only because the intensity and severity of infection varied over time and by locale but also because knowledge of the disease and understanding of its treatment (and prevention) grew. Here we discuss the ethical challenges in decision-making and competing ethical tensions during the pandemic in an effort to advance future preparedness.

Association of common single-nucleotide polymorphisms in innate immune genes with differences in TLR-induced cytokine production in neonates.

Significant variability in cytokine and chemokine expression after Toll-like receptor (TLR) stimulation has been observed between individuals. In this study, we determined the immunophenotypic variation in a cohort of 152 neonates associated with specific single-nucleotide polymorphisms (SNPs). We identified 23 SNPs in 12 genes of the innate immune system to be significantly associated with differential cytokine and chemokine production. SNPs in three gene families, namely STAT, IRF and SYK, accounted for most associations. These gene families are important signaling components of the innate anti-viral response. A potentially damaging non-synonymous SNP in the TLR3 gene (rs3775291) associated with significant differences in expression of interferon-γ after stimulation with the synthetic TLR3 ligand, poly (I:C). Additionally, a general increase in cytokine production was observed in subjects of Asian descent. This observation could be associated with differences in SNP genotype distribution between racial groups in our cohort. Taken together, our data suggest that particular aspects of the newborn innate response to TLR stimulation are closely associated with genetic variation. These findings provide the basis for detailed molecular dissection of cause-effect relationships between genotype and immune responses, and may account for inter-individual differences in response to vaccination and risk for infection and autoimmune disease.

The effect of imaging guidelines on the number and quality of outpatient radiographic examinations.

OBJECTIVE: A significant percentage of outpatient diagnostic radiology is performed by nonradiologists. Studies have shown nonradiologists have higher utilization and cost, as well as quality problems. We sought to determine if, in a managed care environment, a set of guidelines limiting imaging privileges of nonradiologist physicians could decrease imaging costs while ensuring that equipment and personnel providing imaging were of the highest quality. MATERIALS AND METHODS: We determined the number and type of radiographic imaging studies performed the year after these guidelines were set in place (1997) and compared these findings with those of the year before the guidelines were established (1995) and with preguideline trends. We established quality criteria and, based thereon, inspected imaging offices. RESULTS: The number of radiographic examinations per 1000 enrollees decreased 20-25% from the previous trend. Nonradiologists' share of the total fell from 39% to 15%. No deficiencies were found in the inspection of five radiologists' offices, whereas significant deficiencies of equipment, equipment maintenance, or documentation of the examinations performed were found in 78% of nonradiologists' offices. None of the quality indicators monitored by the health plan showed significant change. CONCLUSION: Specific guidelines can effect change in the location and number of radiologic examinations performed, with an improvement in the quality of the studies and a decrease in radiation dose and cost. No decline in quality of care appears to result, despite claims by opponents to such changes that widespread serious quality impairment would occur.

The impact of organizational redesign on nurse executive leadership.

How have nursing leadership roles been affected by organizational redesign? The authors discuss the results of a survey of more than 5000 nurse executives and managers. They highlight reasons and core features of redesign processes, changing roles, expanded responsibilities, learning needs, and impact on quality.

[The rehabilitation of the psychiatric hospital. A question of audacity and synergy]. / La réhabilitation de l'hôpital psychiatrique. Une question d'audace et de synergie.

Using a mode of psychodynamic analysis, this article exposes some similarities between the factors that hinder the social reintegration of the "patient" and the social and political forces opposing the "rehabilitation" of the social institution represented by the psychiatric hospital. In support to this analogy, the article outlines the transformations realized over the last few years at the Centre hospitalier psychiatrique Sainte-Thérèse of Shawinigan and suggests that, in order to make such changes, the development of rehabilitation services can serve as a catalyst. The authors also propose a perceptual analysis of human, political and social reactions created by the metamorphosis of the traditional role attributed to the psychiatric hospital.

Improving patient outcomes through system change: a focus on the changing roles of healthcare organization executives.

In this article, the authors report on a project that studied the impact of work redesign on the roles of hospital executives. Thirty-six in-depth interviews were conducted with executives from 13 VHA healthcare organizations that were considered excellent practice models in the area of work redesign. This report represents a broad, multidisciplinary perspective reflecting the ideas of various members of the healthcare management team. VHA hired Marie Manthey and Creative Nursing Management, Inc., to conduct the interviews in an objective manner and to assist with results interpretation.