Health Care Analysis最新文献

Industry 4.0 represents the latest phase of industrial evolution, characterized by the seamless integration of cyber-physical systems, the Internet of Things, big data analytics, artificial intelligence, advanced robotics, and cloud computing, enabling smart, adaptive, and interconnected processes where physical, digital, and biological realms converge. In parallel, healthcare has progressed from the traditional, physician-centered model of Healthcare 1.0 by introducing medical devices and digitized records to Healthcare 4.0, which leverages Industry 4.0 technologies to create personalized, data-driven, and patient-centric systems. In this context, we hereby introduce Pediatrics 4.0 as a new paradigm that adapts these innovations to children's unique developmental, physiological, and ethical considerations and aims to improve diagnostic precision, treatment personalization, and continuous monitoring in pediatric populations. Key applications include AI-driven diagnostic and predictive analytics, IoT-enabled remote monitoring, big data-powered epidemiological insights, robotic assistance in surgery and rehabilitation, and 3D printing for patient-specific devices and pharmaceuticals. However, realizing Pediatrics 4.0 requires addressing significant challenges-data privacy and security, algorithmic bias, interoperability and standardization, equitable access, regulatory alignment, the ethical complexities of consent, and long-term technology exposure. Future research should focus on explainable AI, pediatric-specific device design, robust data governance frameworks, dynamic ethical and legal guidelines, interdisciplinary collaboration, and workforce training to ensure these transformative technologies translate into safer, more effective, and more equitable child healthcare.

Third-party consent, while common in medical practice, presents complex ethical dimensions and intricate legal connotations. In Malaysia, the absence of comprehensive legislation governing third-party consent for adults lacking decision-making capacity due to temporary conditions creates profound dilemmas for healthcare professionals. This article critically examines these challenges through a compelling case study of an 18-year-old female with respiratory failure who required immediate invasive intervention but did not receive consent from her mother. Despite medical urgings and a favourable prognosis, the mother's refusal highlights the difficulties healthcare providers face when navigating between their ethical obligations to act in the patient's best interests and the patient's family's wishes. Employing a dual analysis from ethical and Malaysian legal perspectives, the study explores the tensions between universal medical ethics-particularly the principles of autonomy, beneficence, and non-maleficence-and the existing Malaysian legal framework. It reveals contradictions between the Malaysian Medical Council's guidelines, which appear to grant decision-making authority to family members, and English common law principles that emphasise acting in the patient's best interests, especially in emergency situations. This inconsistency generates significant uncertainty for healthcare professionals, potentially compromising patient care and exposing physicians to litigation when acting without explicit consent. Through systematic examination of both emergency and non-emergency scenarios, the article underscores the urgent need for comprehensive legislation in Malaysia to address third-party consent, particularly for patients not covered by the Mental Health Act 2001. It advocates for laws that clearly differentiate between emergency and non-emergency situations, delineate the authority of relatives and legal guardians, and align with international practices and fundamental medical ethics principles. By harmonising legal statutes with ethical imperatives, Malaysia can resolve the contradictions that currently jeopardise patient welfare and physician security. These findings have important implications for healthcare policy development and clinical practice, emphasising the necessity for ethical and legal coherence in medical care in Malaysia.

Hospital-based research plays a crucial role in advancing medical knowledge, but it also presents significant ethical challenges, particularly when involving hospitalized patients. Ethical concerns such as informed consent, patient autonomy, and the power dynamics between healthcare providers and patients are critical to maintaining the integrity of such research. The aim of this research was to explore and analyze the ethical considerations in conducting research involving hospitalized patients. A qualitative phenomenological approach was used to investigate the experiences and perceptions of healthcare professionals involved in clinical or public health research in hospital settings. Semi-structured interviews were conducted with 33 participants from both public and private hospitals in Dhaka, Bangladesh. The data were analyzed using thematic analysis to identify recurring ethical themes. This study identified five key themes: (1) Ethical challenges in hospital-based research, (2) Informed consent and patient vulnerability, (3) Patient autonomy and decision-making in research, (4) Institutional Review Boards (IRBs) and ethical oversight, and (5) Strategies to improve ethical research practices in hospitals. Participants reported concerns about coercion, difficulties in obtaining consent from critically ill patients, conflicts in surrogate decision-making, and delays in IRB approval. The findings also emphasized the importance of ethical training, continuous consent practices, and patient-centered approaches. Ethical research practices in hospital settings require a balance between scientific progress and patient protection. The study emphasizes the need for improved ethical guidelines, better informed consent processes, and ongoing training for healthcare professionals to ensure patient autonomy is respected. The findings also call for streamlined Institutional Review Board (IRB) processes to support timely and ethical research execution.

Culturally diverse societies often struggle with providing appropriate dementia care. Cultural sensitivity is considered an important prerequisite for meeting the needs of persons with dementia. This article discusses culture specific aspects of dementia care by referring to the Turkish community in Germany as an example. Factors are discussed that specifically infringe on the quality of dementia care for migrants. The article defends the claim that good dementia care for migrants can be provided through a person-centered approach which is again based on culturally sensitive approach. We show how culture shapes health phenomena but also argue that a focus on culture may stereotype individuals as belonging to a particular culture, grouping people together irrespective of their heterogeneity. Person-centered care is ideal for recognizing diverse needs and values. It is often seen as being at odds with culturally sensitive care, but this paper suggests a way of reconciling them. We argue that culture does indeed provide a framework to create the necessary foundation for person-centered care. Finally, some criticisms and plausible replies are discussed and practical implications arising from the analysis are presented.

The opioid epidemic continues to be a prevalent crisis in North America. How best to address this challenge has long been debated. Abstinence is currently the preferred policy within the inpatient hospital setting, however, this is fraught with difficulties such as withdrawal and using substances in secrecy. It can also result in stigma and a lack of knowledge on substance use among health care providers. The concept of harm reduction could provide an ethical approach to supporting people with substance use disorder. Through Principlism and the principles of Autonomy, Beneficence, Justice and Non-Maleficence, this paper suggests that harm reduction practices represent a viable and more ethically sound approach to health care compared to abstinence-based approaches. Harm reduction practices could result in a more equitable health care system that reduces stigma and increases help-seeking behaviour. More empirical research in other jurisdictions or other settings such as long-term care is needed. Future research should address additional theoretical frameworks such as dialogical bioethics, care ethics and the capabilities approach.

Singapore is a small, affluent and technologically advanced city-state located in Southeast Asia. Due to its lack of natural resources, this country relies heavily on its highly educated and skilled workforce to drive its economic engine. However, in recent years, Singapore has been facing a demographic crunch due to its ultra-low fertility rate and rapidly aging population, which poses an existential threat to its survival as a nation-state. The advent of new reproductive technologies such as In Vitro Gametogenesis (IVG) and Stem Cell-Based Embryo Models (SCBEMs) may thus provide novel fertility treatment options for local patients, which may possibly alleviate Singapore's ultra-low birthrate. Nevertheless, these new technology platforms also raise various controversial ethical, legal and social issues. It is anticipated that the application of SCBEMs (also known as synthetic embryos) in human reproduction will likely be banned because these entities are viewed as human clones. Conversely, IVG technology is expected to receive approval in Singapore for a narrow range of applications in human clinical assisted reproduction, as it seeks to recapitulate the natural process of human sexual reproduction and is more aligned with Singapore's family laws and sociocultural values. It is anticipated that IVG will be permitted for the treatments of primary infertility and age-related female infertility, facilitating transgender and intersex parenthood and preventing the transmission of genetic diseases. However, the applications of IVG in posthumous reproduction, mass production of donor gametes, genetic enhancement of offspring, same-sex, solo- and multiplex-parenthood, will likely be banned.

The coronavirus disease (COVID-19) pandemic has significantly affected mental health worldwide, highlighting the need for reliable tools to assess emotional impact (cognitive-psysiological repercusiones) and coping strategies. To validate the psychometric properties of an evaluation instrument with an ad hoc design, called the Evaluation Inventory of Cognitive-Physiological Repercussions and Coping Strategies in a Pandemic Situation (EICPCP), which has two scales: "Cognitive and Physiological repercussions arising from the pandemic due to COVID-19" (RCFPC19-13) and "Coping strategies during the pandemic due to COVID-19" (EAPC19-15). A total of 1,629 participants (students, teachers, and healthcare professionals) from Spain and Colombia completed the instrument. Exploratory and confirmatory factor analyses were conducted to assess their structure and reliability. Both exploratory and confirmatory factor analyses supported the five proposed dimensions: cognitive and physiological impacts on the RCFPC19-13 scale, and adaptation, support, and organization on the EAPC19-15 scale. In addition, satisfactory internal consistency, reliability indices, and temporal stability were obtained for both scales. The EICPCP is a valid and reliable tool for evaluating the cognitive-physiological impact of the pandemic and coping strategies employed. This instrument provides valuable insights for clinical research and psychological interventions in pandemic-related mental-health studies..

One in five people worldwide is expected to develop cancer during their lifetime. This study aimed to examine the effect of women's E-health literacy levels on their healthy lifestyle behaviors about their cancer screening status, within the scope of preventive cancer healthcare services in Türkiye. This cross-sectional analytical study involved 392 women, and a structural equation model (SEM) was used to identify the causal relationships between variables. Data were collected using the "E-health literacy scale" and the "healthy lifestyle behavior scale". A structural equation model (SEM) was developed to examine the causal relationships among the variables, and the model's fit indices and test values were analyzed and interpreted. Results showed that both E-health literacy and healthy lifestyle behavior scores were significantly higher among women who had undergone cancer screening. Additionally, women who had been screened for breast and cervical cancer demonstrated higher healthy lifestyle behavior scores. The SEM analysis indicated that E-health literacy had a positive effect on healthy lifestyle behaviors. Based on these findings, enhancing women's E-health literacy may promote healthier lifestyle behaviors and encourage more consistent participation in preventive screenings such as cancer screenings.

Decentralized clinical trials (DCTs) have the potential to advance the conduct of clinical trials, but raise several ethical issues, including obtaining valid informed consent. The debate on the ethical issues resulting from digitalization is predominantly focused on direct risks relating to for example data protection, safety, and data quality. We submit however, that a broader view on ethical aspects of DCTs is needed to touch upon the new challenges that come with the DCT practice. Digitalization has impacts that go beyond its direct purposes, by shaping behaviors, experiences, social relations, and values. We examine four elements of the informed consent procedure that are affected by DCTs, while taking these soft impacts of technologies into account: (i) informing participants and testing understanding, (ii) freedoms in relation to responsibilities and burdens, (iii) trust in participant-researcher relations, and (iv) impacts on the concept of privacy. Our analysis reveals that a broad view is key for optimal conduct of DCTs. In addition, it provides insight into the ethical impacts of DCTs on informed consent. Technologies such as DCTs potentially have profound impacts which are not immediately addressed by the existing regulatory frameworks, but nonetheless important to recognize. These findings can guide future practices of DCTs to foster the important values of clinical research in this novel approach for conducting clinical trials.