[Appreciating COVID-19 as a child and adolescent psychiatrist on the move]. / Appréhender le COVID-19 au fil de l'eau en tant que psychiatre d'enfant et d'adolescent.

COVID-19 is a multi-organ disease due to an infection with the SARS-CoV2 virus. It has become a pandemic in early 2020. The disease appears less devastating in children and adolescents. However, stress, quarantine and eventually mourning have major impacts on development. It is difficult to describe what this pandemic implies for a child psychiatrist, other than by giving a first-hand account. I propose to go through the main ethical questions that have arisen; to describe how my hospital team has reorganized itself to meet the new demands and questions, in particular by opening a unit dedicated to people with autism and challenging behaviors affected by COVID-19; and to address, in a context of national discussion, how the discipline has sought to understand the conditions of a certain well-being during quarantine. Finally, I will try to conclude with more speculative reflections on re-opening.

Evaluating the Strength of the Association Between Industry Payments and Prescribing Practices in Oncology.

BACKGROUND: Financial relationships between physicians and the pharmaceutical industry are common, but factors that may determine whether such relationships result in physician practice changes are unknown. MATERIALS AND METHODS: We evaluated physician use of orally administered cancer drugs for four cancers: prostate (abiraterone, enzalutamide), renal cell (axitinib, everolimus, pazopanib, sorafenib, sunitinib), lung (afatinib, erlotinib), and chronic myeloid leukemia (CML; dasatinib, imatinib, nilotinib). Separate physician cohorts were defined for each cancer type by prescribing history. The primary exposure was the number of calendar years during 2013-2015 in which a physician received payments from the manufacturer of one of the studied drugs; the outcome was relative prescribing of that drug in 2015, compared with the other drugs for that cancer. We evaluated whether practice setting at a National Cancer Institute (NCI)-designated Comprehensive Cancer Center, receipt of payments for purposes other than education or research (compensation payments), maximum annual dollar value received, and institutional conflict-of-interest policies were associated with the strength of the payment-prescribing association. We used modified Poisson regression to control confounding by other physician characteristics. RESULTS: Physicians who received payments for a drug in all 3 years had increased prescribing of that drug (compared with 0 years), for renal cell (relative risk [RR] 1.81, 95% confidence interval [CI] 1.58-2.07), CML (RR 1.22, 95% CI 1.08-1.39), and lung (RR 1.69, 95% CI 1.58-1.82), but not prostate (RR 0.97, 95% CI 0.93-1.02). Physicians who received compensation payments or >$100 annually had increased prescribing compared with those who did not, but NCI setting and institutional conflict-of-interest policies were not consistently associated with the direction of prescribing change. CONCLUSION: The association between industry payments and cancer drug prescribing was greatest among physicians who received payments consistently (within each calendar year). Receipt of payments for compensation purposes, such as for consulting or travel, and higher dollar value of payments were also associated with increased prescribing. IMPLICATIONS FOR PRACTICE: Financial payments from pharmaceutical companies are common among oncologists. It is known from prior work that oncologists tend to prescribe more of the drugs made by companies that have given them money. By combining records of industry gifts with prescribing records, this study identifies the consistency of payments over time, the dollar value of payments, and payments for compensation as factors that may strengthen the association between receiving payments and increased prescribing of that company's drug.

Atrofia muscular espinal y fracaso respiratorio. ¿Cómo actúan los pediatras de atención primaria en un escenario simulado? / Spinal muscular atrophy and respiratory failure. How do primary care pediatricians act in a simulated scenario?

Introducción: La atrofia muscular espinal tipo 1 (AME-1) suele ser mortal en el primer año de vida sin soporte ventilatorio. La decisión de iniciar dicho soporte o no supone un conflicto ético para los profesionales sanitarios. Material y métodos: Se incluyó un escenario de fracaso respiratorio agudo en un lactante con AME-1 en un programa de formación mediante simulación avanzada para pediatras de atención primaria (PAP). Se analizaron de forma sistemática las actuaciones de 34 grupos de 4 pediatras que participaron en 17 cursos. Se valoraron los aspectos clínicos, éticos y de comunicación con los padres. Resultados: La asistencia técnica inicial (administración de oxígeno y soporte ventilatorio inmediato) fue realizada correctamente por el 94% de los equipos. Sin embargo, los PAP tuvieron problemas al abordar los aspectos éticos del caso. Del 85% de los equipos que plantearon el conflicto ético a los padres, lo hizo por iniciativa propia el 29%, el 23% los excluyó de forma activa y solo el 6% los implicaron y tuvieron en cuenta su opinión en la toma de decisiones. Solo el 11,7% preguntó por la calidad de vida del niño y el 12% por su conocimiento del pronóstico de la enfermedad. Ninguno les explicó las alternativas de tratamiento ni trató de contactar con el pediatra de referencia. Conclusiones: Ante un caso simulado de AME-1, los PAP tienen dificultades para interactuar con la familia e implicarla en la toma de decisiones. La formación práctica de todos los pediatras debería incluir problemas de ética clínica (AU)

Introduction: Spinal muscular atrophy type 1 (SMA-1) tends to be fatal in the first year of life if there is no ventilatory support. The decision whether to start such support is an ethical conflict for healthcare professionals. Material and methods: A scenario of acute respiratory failure in an infant with SMA-1 has been included in a training program using advanced simulation for Primary Care pediatricians (PCP). The performances of 34 groups of 4 pediatricians, who participated in 17 courses, were systematically analyzed. Clinical, ethical and communication aspects with parents were evaluated. Results: The initial technical assistance (Administration of oxygen and immediate ventilatory support) was correctly performed by 94% of the teams. However, the PCP had problems in dealing with the ethical aspects of the case. Of the 85% of the teams that raised the ethical conflict with parents, 29% did so on their own initiative, 23% actively excluded them, and only 6% involved them and took their opinion into account in making decisions. Only 11.7% asked about the quality of life of children and 12% for their knowledge of the prognosis of the disease. None explained treatment alternatives, nor tried to contact the pediatrician responsible for the child. Conclusions: When faced with a simulated SMA-1 infant with respiratory failure, PCP have difficulties in interacting with the family, and to involve it in the decision making process. Practical training of all pediatricians should include case scenarios with an ethical clinical problema (AU)

An exploratory, descriptive study of consumer opinions and behaviors regarding health products sales at 4 chiropractic practices in a large, western Canadian urban center.

OBJECTIVE: This study describes the opinions and behaviors of chiropractic patients in a large, western Canadian urban center regarding the sale of health products by doctors of chiropractic. METHODS: A brief, descriptive survey consisting of both fixed-choice and open-ended questions was distributed by clinic reception staff at 4 chiropractic offices in Calgary, Alberta, Canada. Each practice sold a range of health products, including those relating to musculoskeletal care and nutrition, and served between 275 and 320 clients per week. RESULTS: After a 10-week recruitment interval between January and March 2013, a convenience sample of 103 chiropractic patients was obtained. Most patients supported the sale of health products by doctors of chiropractic (n = 101; 98.1%), and most had made health product purchases from a doctor of chiropractic at some point (n = 73; 70.9%). Products relating to muscular care, exercise/rehabilitation products, and pillows were purchased most often (>40%). Consumers were most supportive of doctors of chiropractic selling products they perceived to be directly related to musculoskeletal care. Some participants believed that there should be limits placed on the range of products sold including the products had to be consistent with the practitioner's area of expertise and had to have some demonstrated level of effectiveness. Primary reasons for health product purchase included the doctor's recommendations, convenience, and perception that the product would improve well-being (>50%). CONCLUSIONS: This study found that chiropractic patients were supportive of health product sales by doctors of chiropractic, assuming certain conditions were met. Consumers believed that product sales should be undertaken with integrity and should be consistent with the doctor's area of expertise. Consumer beliefs appeared to impact their purchasing behaviors.

Actuaciones profesionales realizadas en la farmacia comunitaria / Professional services carried out in the community pharmacy

Objetivo: Describir todas las actuaciones profesionales (AP) que se llevan a cabo como respuesta a las demandas realizadas por los usuarios en la farmacia comunitaria (FC). Material y métodos: Estudio observacional, descriptivo y transversal, realizado durante 6 meses en dos farmacias comunitarias de Denia (Alicante). La población de estudio fueron todas las demandas de servicio que realizaron los usuarios de ambas farmacias. La variable de estudio fue la AP, es decir, cada uno de los servicios demandados por el usuario en la FC: dispensación, indicación, automedicación, consultas y ventas, clasificándose cada uno en sus resoluciones e incidencias. Resultados: En el estudio se realizaron 30.617 AP, correspondiendo un 42% a la dispensación con receta, y se registró casi un 23% de incidencias. Las indicaciones farmacéuticas supusieron un 9% del total, resolviéndose en la mayoría de casos con la recomendación de un medicamento. Un 33% fueron demandas de automedicación, cursando con casi un 20% de incidencias. Un 7% fueron consultas y un 10% ventas de productos sanitarios. Conclusiones: Del total de AP realizadas, el 90% se consideran farmacéuticas. El 83% fueron dispensaciones de medicamentos, más de la mitad de éstas sin prescripción médica, lo que revela la importancia del asesoramiento farmacéutico en las dispensaciones sin receta. El hecho de que 9 de cada 10 incidencias que se producen en la dispensación con receta y en la automedica ción sean por la falta de información del paciente nos pone en alerta sobre la necesidad de implementar medidas que mejoren esta carencia(AU)

Objective: To describe all the professional actions (PA) carried out by the community pharmacy in response to the requests made by pharmacy users. Methods: Observational, cross-sectional, descriptive study in two pharmacies in Spain, over a 6 month-period. Population: all service requests made by pharmacy users. Study variable: Professional action, each of the services requested by pharmacy users: prescription-drug-dispensing, patient-counseling in minor ailments, self-medication, pharmacist-consultations, and sales-services. Classifying each of them in their decisions and incidents. Results: The study involved 30,617 PA, of which 42% were requests for prescription-drug-dispensing. Incidences were also recorded (23%). Nine percent of requests were for patient-counseling in minor ailments, and these were solved in 99% of cases with recommending of a drug, herbal or homeopathy product. Of the total PA, 33% were self-medication cases, with 20% of incidences. Seven percent were inquiries to the pharmacist and 10% of total requests were sales-services. In one out of four prescription-drug-dispensing event an incidence was detected, and in self-medication cases, in one out of every five. Conclusions: Of all the PA performed in the pharmacies under study, 90% were pharmaceutical activities. Most of these (83%) are directly associated with drug delivery (with/without prescription). The fact that more than a half of the total PA requested were without medical prescription should be further analyzed. The fact that nine out of ten incidents that occur in prescription-drug-dispensing and self-medication are the lack of patient information, it alerts us to implement measures to improve this shortcoming(AU)

Discipline, desire, and transgression in physiotherapy practice.

Therapeutic touch has played an important part in human civilization and continues to contribute to our social relations and individual identities. Therapeutic touch has been a vital component in the development and definition of physiotherapy practice and continues to be one of the profession's principal distinguishing competencies. It is surprising then that while so much has been written about how to perform therapeutic touch techniques, little has been written about the role that these techniques have played in defining physiotherapy's professional identity. Drawing on the work of three postmodern philosophers, we offer a critique of physio-therapeutic approaches to therapeutic touch, examining why certain modes of touch were adopted by the profession in the past and not others; how the innate sensuality of touch had to be managed; and how the disciplinary technologies that surrounded the practice of massage came to define physiotherapy's professional identity. Our thesis is that the disciplinary technologies adopted by the profession in the 1890s endure today and that the profession's heavily disciplined approach to touch is now constraining new therapeutic possibilities that may be necessary if the profession is to respond to the demands of twenty-first century health care.

Personal and professional values grading among midwifery students.

The purpose of this study was to determine the professional and personal values among midwifery students in Turkey and to identify whether the years of study affected these values. A total of 192 participants were asked to prioritize 16 professional and 36 personal values. The relationship between the year of study and value ranking was analyzed by Kruskal-Wallis test. The first three of the professional values were justice, equality, and human dignity. Equality ranked sixth among the personal terminal values, and it increased with the years of study. Of personal instrumental values, responsibility and cleanliness ranked second and fifth, which are of central importance for the profession of midwifery. However, the other two important values, privacy and preventing unnecessary suffering, ranked lower when the years of study increased, in other words when the students confront clinics. Since these values are important for midwifery, ethics courses should be given throughout the midwifery education to prepare students for the challenges they face in the clinical environment.

Thoughts on legal and ethical concepts on the professional development of Ayurveda in the U.S.

The following is a transcript of a talk given by Wynn Werner, who is a board member of the National Ayurvedic Medical Association (NAMA) and member of the NAMA standards committee, at the NAMA conference in April 2010. In this talk, Werner discusses the legal and licensing challenges facing Ayurvedic practitioners in the United States. IAYT finds the work of NAMA on the issue of professional development to be both educational and thought-provoking for our own field's parallel process. We present this transcript to contribute to the conversation within the yoga therapy community.

An audit of health products advertised for sale on chiropractic Web sites in Canada and consideration of these practices in the context of Canadian chiropractic codes of ethics and conduct.

OBJECTIVE: This study describes the extent to which chiropractors with Web sites practicing in Canada advertise health products for sale and considers this practice in the context of chiropractic codes of ethics and conduct. METHODS: Chiropractic Web sites in Canada were identified using a public online business directory (Canada 411). The Web sites were searched, and an inventory of the health products for sale was taken. The influences of type of practice and province of practice on the sale of health product were assessed. Textual comments about health product marketing were summarized. National and provincial codes of ethics were reviewed, and the content on health product advertising was summarized. RESULTS: Two hundred eighty-seven Web sites were reviewed. Just more than half of the Web sites contained information on health products for sale (n = 158, 54%). Orthotics were advertised most often (n = 136 practices, 47%), followed by vitamins/nutritional supplements (n = 53, 18%), pillows and supports (n = 40, 14%), and exercise/rehabilitation products (n = 20, 7%). Chiropractors in solo or group chiropractic practices were less likely to advertise health products than those in multidisciplinary practice (P < .001), whereas chiropractors in BC were less likely to advertise nutritional supplements (P < .01). Provincial codes of ethics and conduct varied in their guidelines regarding health product sales. CONCLUSIONS: Variations in codes of ethics and in the proportions of practitioners advertising health products for sales across the country suggest that opinions may be divided on the acceptability of health product sales. Such practices raise questions and considerations for the chiropractic profession.

Ethics of complementary medicine: practical issues.

Complementary medicine is popular, yet ethical issues are rarely discussed. Misleading information, informed consent, publishing, and confidentiality are discussed in the light of medical ethics. The message that emerges is that, in complementary medicine, ethical issues are neglected and violated on a daily basis.

Ejercicio clínico y espiritualidad / Clinical practice and spirituality

¿Quién debe hacerse cargo de las necesidades espirituales de un paciente, y cómo? Se ha reportado evidencia sobre la importante asocia-ción entre la vida espiritual y la salud física y mental de las personas (e.g. Meisenhelder y Chandler, 2002; Silberfarb, Anderson, y Rundle, 1991; Koenig, George y Siegler, 1988). Atender las necesidades espirituales de los pacientes bajo cuidado médico es una realidad clínica cotidiana (Mue-ller, Plevak, y Rummans, 2001) en las unidades de traumatología, oncolo-gía, y en general en aquellas áreas donde el paciente se ve confrontado con su propia muerte, o la de un ser querido, y la Organización Mundial de la Salud ha enfatizado su importancia (Dein y Stygall, 1997). Sin embargo, actualmente se realizan esfuerzos a fin de precisar cómo llevar a cabo esta función, haciéndose clara la necesidad de mejorar la identificación de los roles que en este sentido desempeña cada clínico (Kristeller, Zumbrun y Schilling et al.,1999; Daaleman y VandeCreek, 2000). El presente trabajo analiza esta problemática explorando la inserción de lo espiritual en los cuatro recursos psicoterapéuticos básicos que constituyen el arsenal clínico en psicología: el acompañamiento, la consejería, la psicoterapia y los siste-mas psicoterapéuticos

Who must be in charge of the spiritual necessities of patients, and how? The literature reports evidence about the importance of the association between the spiritual life and the physical and mental health in people (e.g. Meisenhelder y Chandler, 2002; Silberfarb, Anderson, y Rundle, 1991; Koenig, George y Siegler, 1988). Attend the spiritual neces-sities of the patients in medical care is a daily clinical reality (Mueller, Ple-vak, y Rummans, 2001), in traumatology, oncology, and all those areas where the patient is confronted with his own death, or the death of loved beings, and the World Health Organization had emphasized his impor-tance (Dein y Stygall, 1997). However, nowadays, there are efforts to determine how this function has to be done, and how must operate each clinic (Kristeller, Zumbrun y Schilling et al.,1999; Daaleman y VandeCreek, 2000). The present paper analyzes this problem, exploring how to insert the spiritual world inside the four basic resources in psychotherapy that constitutes the clinical arsenal in psychology: accompanying, counseling, psychotherapy, and psychotherapeutic systems