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BACKGROUND: Despite the growing necessity for government-led policy changes on clinical research ethics during pandemic, the scope of previous literature is limited to Korean government's pandemic response strategies or reflections of research ethics at the level of institutions and academic societies. This paper examines the proactive policy changes and responses by the South Korean government in addressing the challenges and issues of research ethics against the backdrop of the urgency of rapid development and emergency supply of medical products during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: We conducted searches of various government documents, using predetermined keywords related to research ethics and integrity during the COVID-19 pandemic. Only documents issued by governments or public institutions were included. A total of 24 documents were selected for analysis. They were divided into two phases: the first phase for urgent response (January 2020-February 2021) and the second phase (March 2021-February 2023) for long-term preparedness. RESULTS: The Korean government recommended several measures of research governance to accelerate the ethical review of COVID-related research to be shortened less than one week: the joint operation of Institutional Review Boards (IRBs), exempted or expedited review by a special review committee, guidelines for urgent reviews, and designation of the Korean Academy of Medical Sciences as the supervising agency for the Clinical Trial Safety Support Institution as well as the Central IRB. It allowed temporary non-face-to-face methods for informed consent process (telephone explanations and a photo of the original signed consent) and clinical trials (telephone counselling and prescription, proxy prescription, and drug delivery and supply to clinical trial participants, and online ethics training). CONCLUSION: As a result of South Korea's commitment to ethical principles in their pandemic response, the medical system did not experience collapses due to the pandemic, and pandemic research was conducted with careful ethical considerations. The pandemic ethics immunization during the Middle East respiratory syndrome epidemic in 2015 laid the foundation for prompt government initiatives that ensured both pandemic research ethics and pandemic response ethics.
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COVID-19 , Humanos , COVID-19/epidemiologia , Pandemias/prevenção & controle , SARS-CoV-2 , República da Coreia/epidemiologia , Ética em Pesquisa , GovernoRESUMO
The Korea Association of Health Promotion and Japanese Organization for International Cooperation in Family Planning (JOICFP), and Taiwan's Chinese Foundation of Health all originated from parasite control organizations. Currently these organizations hold no apparent relations to parasite control activities. However, many of the senior leaderships of these organizations including presidents, have parasitology as their background. Kunii Chojiro (the founder of Japan Association of Parasite Control (JAPC) and JOICFP) explained it as "it all started from worms." In 1949, Kunii Chojiro established JAPC after personally experienced intestinal parasite infection. The JAPC people conducted mass examination and mass chemotherapy focusing on school children, which allowed them to have sustainable income. In 1965, the Korea Association of Parasite Eradication (KAPE) requested JAPC to assist Korea's parasite control activity. In 1968, when Korea-Japan cooperation for parasite control activity established, Japan's operating procedures were directly absorbed by KAPE. With support from JAPC and official development aid through Overseas Technical Cooperation Agency in Japan (now Japan International Cooperation Agency), Korea successfully controlled parasite infection. Post-war and cold-war geopolitics had a significant impact on Korea-Japan cooperation. In 1960s the president of KAPE, Chong-Chin Lee and Kunii Chojiro were well known figures in population control network. They did understand the importance of population control, but did not agree with the approaches taken by western population control experts. From their point of view, it had to be self-initiated, economically self sustainable grass-root activities rather than top-down activities, as experienced in their parasite control in Japan and Korea. This lead to a new Asian model named "Integrated Program". Together with their influence in population control network, Kunii and Lee manage to secure the fund from IPPF. Emergence of Integrated Program showed how collective experience of Asia, as well as overlap of networking formed 'Asian Model' of public health activities. Kunii and Lee shared the same agenda to enable people to have better life through public health measures. While they funneled money from global population control network, they were more interested in securing sustainability of the parasite control activities. This paper focuses on activities and experiences of Kunii Chojiro and Chong-Chin Lee to show interplay of Cold War geopolitics in Asia led to emergence of Asian network.
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Controle de Doenças Transmissíveis/história , Cooperação Internacional/história , Parasitos , Doenças Parasitárias/história , Animais , Controle de Doenças Transmissíveis/economia , Controle de Doenças Transmissíveis/métodos , História do Século XX , Japão , Doenças Parasitárias/prevenção & controle , Saúde Pública , República da CoreiaRESUMO
Until the 1950s, Ascaris was regarded as an essential part of life which controls every aspect of human physiology among Koreans. Therefore, Ascaris should not be removed from human body. Efforts from medical professionals and the Korean government officials who wished to push forward the parasite control program, had to constantly contest with this perception of Ascaris among ordinary Koreans. In 1966, the 'Parasitic Disease Prevention Act' was promulgated and 'the Korean Association for Parasite Eradication (KAPE)' established in Korea. From the 1970s, Korea mobilized 15 million people each year to achieve the eradication goal. Such mass mobilization could not be possible without public awareness on necessity of parasite eradication. Until the early 1960s, however, Korean people were not sympathetic to the needs of eradication of parasites, especially that of Ascaris. Then, what changed the social perception towards Ascaris during the 1960s? What contributing factors allowed the mass mobilization and public involvement for that campaign? Employing newspaper articles and periodicals, this paper analyzes how social perception on Ascariasis changed during the 1960s, when the 'Parasitic Disease Prevention Act' was established. During the 1960s, Ascariasis became a shameful disease for Koreans. A series of events made Ascariasis more visible and shameful to Koreans. First event happened with Korean miners who were dispatched to Germany in 1963. When the miners turned out to have been infected with intestinal parasites, they were prohibited from work at the mines by the authorities in Germany and quarantined for several weeks. This humiliating experience of Korean expatriate people having bodies swarmed with parasites became a national shame to Koreans. The parasite infected bodies of Korean workers were revealed to the World through German newspapers. Second event happened when a child died of intestinal obstruction due to Ascariasis. The doctor retrieved 1,063 Ascaris from the bowel of the 9 year-old girl, and the photo of the 1,063 worms was published in several newspapers. It was a shocking visualization of Ascariasis in Korean society. Through these visualizations of Ascariasis, the Korean society began to perceive Ascariasis as a shame of the nation as well as that of an individual.
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Ascaríase/epidemiologia , Animais , Ascaris , Feminino , Alemanha , Humanos , Enteropatias Parasitárias , República da Coreia/epidemiologiaRESUMO
This research aimed to investigate the changes in ethical issues in everyday clinical practice recognized by critical care nurses during two observation periods. We conducted a retrospective analysis of data obtained by prospective questionnaire surveys of nurses in the intensive care units (ICU) of a tertiary university-affiliated hospital in Seoul, Korea. Data were collected prospectively during two different periods, February 2002-January 2003 (Period 1) and August 2011-July 2012 (Period 2). Significantly fewer cases with ethical issues were reported in Period 2 than in Period 1 (89 cases [2.1%] of 4,291 ICU admissions vs. 51 [0.5%] of 9,302 ICU admissions, respectively; P < 0.001). The highest incidence of cases with identified ethical issues in both Periods occurred in MICU. The major source of ethical issues in Periods 1 and 2 was behavior-related. Among behaviorrelated issues, inappropriate healthcare professional behavior was predominant in both periods and mainly involved resident physicians. Ethical issue numbers regarding end-oflife (EOL) care significantly decreased in the proportion with respect to ethical issues during Period 2 (P = 0.044). In conclusion, the decreased incidence of cases with identified ethical issues in Period 2 might be associated with ethical enhancement related with EOL and improvements in the ICU care environment of the studied hospital. However, behaviorrelated issues involving resident physicians represent a considerable proportion of ethical issues encountered by critical care nurses. A systemic approach to solve behavior-related issues of resident physicians seems to be required to enhance an ethical environment in the studied ICU.
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Enfermagem de Cuidados Críticos/ética , Unidades de Terapia Intensiva , Humanos , Enfermeiras e Enfermeiros , Estudos Retrospectivos , Assistência Terminal , Centros de Atenção TerciáriaRESUMO
This study is about the Sisters of Charity of St. Joseph in New Orleans' Charity Hospital during the years between 1834 and 1860. The Sisters of Charity of St. Joseph was founded in 1809 by Saint Elizabeth Ann Bailey Seton (first native-born North American canonized in 1975) in Emmitsburg, Maryland. Seton's Sisters of Charity was the first community for religious women to be established in the United States and was later incorporated with the French Daughters of Charity of St. Vincent de Paul in 1850. A call to work in New Orleans' Charity Hospital in the 1830s meant a significant achievement for the Sisters of Charity, since it was the second oldest continuously operating public hospitals in the United States until 2005, bearing the same name over the decades. In 1834, Sister Regina Smith and other sisters were officially called to Charity Hospital, in order to supersede the existing "nurses, attendants, and servants," and take a complete charge of the internal management of Charity Hospital. The existing scholarship on the history of hospitals and Catholic nursing has not integrated the concrete stories of the Sisters of Charity into the broader histories of institutionalized medicine, gender, and religion. Along with a variety of primary sources, this study primarily relies on the Charity Hospital History Folder stored at the Daughters of Charity West Center Province Archives. Located in the "Queen city of the South," Charity Hospital was the center of the southern medical profession and the world's fair of people and diseases. Charity Hospital provided the sisters with a unique situation that religion and medicine became intertwined. The Sisters, as nurses, constructed a new atmosphere of caring for patients and even their families inside and outside the hospital, and built their own separate space within the hospital walls. As hospital managers, the Sisters of Charity were put in complete charge of the hospital, which was never seen in other hospitals. By wearing a distinctive religious garment, they eschewed female dependence and sexuality. As medical and religious attendants at the sick wards, the sisters played a vital role in preparing the patients for a "good death" as well as spiritual wellness. By waging their own war on the Protestant influences, the sisters did their best to build their own sacred place in caring for sick bodies and saving souls. Through the research on the Sisters of Charity at Charity Hospital, this study ultimately sheds light on the ways in which a nineteenth-century southern hospital functioned as a unique environment for the recovery of wellness of the body and soul, shaped and envisioned by the Catholic sister-nurses' gender and religious identities.
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Catolicismo , Instituições de Caridade/história , Hospitais Religiosos/história , Hospitais Urbanos/história , História do Século XIX , Nova OrleansRESUMO
BACKGROUND: International clinical trials are now rapidly expanding into Asia. However, the proportion of global trials is higher in South Korea compared to Japan despite implementation of similar governmental support in both countries. The difference in clinical trial environment might influence the respective physicians' attitudes and experience towards clinical trials. Therefore, we designed a questionnaire to explore how physicians conceive the issues surrounding clinical trials in both countries. METHODS: A questionnaire survey was conducted at Kyoto University Hospital (KUHP) and Seoul National University Hospital (SNUH) in 2008. The questionnaire consisted of 15 questions and 2 open-ended questions on broad key issues relating to clinical trials. RESULTS: The number of responders was 301 at KUHP and 398 at SNUH. Doctors with trial experience were 196 at KUHP and 150 at SNUH. Among them, 12% (24/196) at KUHP and 41% (61/150) at SUNH had global trial experience. Most respondents at both institutions viewed clinical trials favorably and thought that conducting clinical trials contributed to medical advances, which would ultimately lead to new and better treatments. The main reason raised as a hindrance to conducting clinical trials was the lack of personnel support and time. Doctors at both university hospitals thought that more clinical research coordinators were required to conduct clinical trials more efficiently. KUHP doctors were driven mainly by pure academic interest or for their desire to find new treatments, while obtaining credits for board certification and co-authorship on manuscripts also served as motivation factors for doctors at SNUH. CONCLUSIONS: Our results revealed that there might be two different approaches to increase clinical trial activity. One is a social level approach to establish clinical trial infrastructure providing sufficient clinical research professionals. The other is an individual level approach that would provide incentives to encourage doctors to participate in and conduct clinical trials.
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Atitude do Pessoal de Saúde , Ensaios Clínicos como Assunto , Médicos , Adulto , Feminino , Hospitais Universitários , Humanos , Consentimento Livre e Esclarecido , Japão , Masculino , Pessoa de Meia-Idade , República da Coreia , Inquéritos e QuestionáriosRESUMO
The oral history helps researchers to fill the gap in historical documents in research on the contemporary history of medicine in Korea. More and more studies in history of contemporary medicine in Korea have come out using oral history of doctors and patients. Based upon the author's research on development of neurosurgery in late 20th century Korea, this paper discusses how to apply oral history to contemporary history of medicine, focusing on oral history of doctors in Korea. In this paper the author describes how to do and use oral history of key doctors and medical scientists in the contemporary history of medicine in Korea. The oral history can be a powerful tool to complement the written documents as following. First, from their interview, doctors and medical scientists often provide valuable information which historians cannot get from documents and written sources. As intelligent interviewees, they not only understand the purpose of research but also help actively the historianresearcher- interviewer. Second, the oral history facilitates further searches and often it leads to more findings of informants, and written and image material. More often than not, doctors and medical scientists do their own research on the topic and provide the historian with valuable historical source material from their laboratories, bedsides, family and friends. Third, interviews with medical scientists and oral material produced by doctors and medical scientists helped the researcher to understand and interpret the papers and written documents. Fourth, the subjective stories told by the medical scientists provide perspectives and historical source as narrative truth. Before a historian attempts to use the oral material as complementary historial evidence, he or she needs to cross-check the validity and of objectivity of the oral material. Oral material is produced through bidirectional intersubjective interaction between the interviewer and interviewee, and critical reflection over the relationship between the two is crucial. Especially the researcher should keep an eye on the possible bias and strive for the objectivity of the oral material with discernment and reflection, when she or he found the interviewees of doctors and medical scientists closely connected together and tied together in a web of relationship with a common interest or agenda.
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This paper deals with Pavlov theory in North Korea in the late 1950s, focusing on its role in ideological struggle in medicine and in reinterpretation of traditional medicine. In North Korean Ministry of Health found Pavlov theory to have rich resources which could be used in the construction of the North Korea's socialist medicine. First of all, Pavlov theory provided the North Korean Communist Party with a powerful ideological weapon against capitalist medical thoughts, representing superior socialist medicine based upon Marx-Leninism and dialectical materialism. This paper examines the contents of Pavlov theory introduced in the North Korea from the Soviet Union in the late 1950s. Pavlov theory in the North Korea was not merely a political slogan but a unified medical system of thought, ranging from biological theory on the organism and pathogenesis to clinical theory. Nonetheless, Pavlov theory became Pavlov doctrine in the ideological struggle in healthcare field initiated by Kim Il Sung and the Communist Party. In the process of the ideological struggle, the abducted surgeon Kim Si-Chang was accused and purged of counter-revolutionary and refusal to conform to Pavlov doctrines by the Communist Party in 1959. Interestingly, Pavlov theory was used in reinterpretation of Traditional Medicine in North Korea from unscientific practice to a rich and scientific complementary medicine by connecting the two with common theoretical components such as Pavlov's typology. By the enthusiastic Communist Party members, Pavlov doctrine was introduced, transformed and exploited to build monolithic ideology system in medicine in North Korea in the late 1950s.
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This paper deals with social history of carbon monoxide poisoning in Korea in 1960s. From the mid 1950s, Korean society began to use coal briquettes (Yeontan) for fuel for cooking and heating in the winter, especially in urban area. As the use of coal briquettes replaced fire woods which had been used as fuel in traditional Korean society for centuries, incidence and deaths from carbon monoxide poisoning increased dramatically during the 1960s. The coal briquettes were used to heat the living rooms through "Ondol" arrangement. The coal briquettes at the kitchen place make the heated air and smoke, which pass through the horizontal space under a stone floor of the room and escape through chimney at the opposite site of the kitchen. This Ondol system could make leakage of carbon monoxide easily and thereby kill people who sleep in the room. In the 1960s, carbon monoxide poisoning by briquettes gas was a serious health problem to kill more people than all of the infectious diseases. It was a unique and very serious health hazard in 1960s Korea. No other place in the world has experienced such a high mortality and incidence from the briquettes gas as in Korea. Employing newspaper articles and epidemiological papers, this paper analyzes how the Korean society experienced and perceived carbon monoxide poisoning (CO poisoning) in 1960s. It also follows how the perception changed over time and how the changes affected social responses to CO poisoning. In the early 1960s, the CO poisoning was perceived as an accident due to carelessness of the people who did not fix the leakages of the Ondol system or that of the people who built the Ondol improperly. Mostly CO poisoning was the casualty caused by carelessness and ignorance of the poor class. The prevention measure was mainly education which would enlighten the ignorant so that they care about CO poisoning and their lives. It was the victims who were to be blamed, for they caused the their poisoning with their own carelessness. Since CO poisoning was perceived as preventable with a good care, people were optimistic about the prevention of the CO poisoning. In the late 1960s, however, the perception of CO poisoning changed as the epidemiological studies demonstrated meteorological, social, economical, and cultural factors were related to the poisoning. As CO poisoning was regarded not as an accident due to carelessness but as a social disease, the Korean government began to take various measures for its control including surveillance and punishment, education and certification of those who made Ondol, and funding research for detoxification of the poisoning. In spite of the state's intervention, the number of CO poisoning cases drastically increased every year. At the end of 1960s, in contrast to the optimism of the early 1960s, the outlook of CO poisoning control was grim. It was merely a beginning of huge epidemic of CO poisoning in 1970s and 1980s in Korea.
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The phase I trial is the first step in administering a drug to humans, but it has no therapeutic purpose. Under the absence of therapeutic purpose, healthy volunteers demonstrated different motivations, unlike the actual patients participating in trials. There were many reported motivations, such as financial motivation, contributing to the health science, accessing ancillary health care benefits, scientific interest or interest in the goals of the study, meeting people, and general curiosity. The aim of this study was to identify the motivation and characteristics of healthy volunteers participating in phase I trials in the Republic of Korea. We gave surveys to 121 healthy volunteers to study their demographic characteristics and the reasons of participation. We identified whether the decision to participate in the research was influenced by demographic factors and whether the perception and attitudes toward the research were influenced by the characteristics of the healthy volunteers. After completion of the first survey, 12 healthy volunteers who had participated in a phase I clinical trial were selected to answer the second interview. According to our survey, most healthy volunteers were unmarried men and economically dependent. Most of them participated in the study because of financial reward. The most important factor to measure financial reward was the research period. Also, 43% of the volunteers were university students, 42% answered "university graduation" and 55% were residing in family-owned houses. Many healthy volunteers were found to be living in family homes and to have a student status or lack of economic independence. Results of the survey showed that 64% of respondents indicated having more than one clinical trial participation. In-depth interviews showed that healthy volunteers had diverse motivation to participate in research and that healthy volunteer perceive the clinical trial positively. The main motivation for healthy volunteers' participation in research was "financial reward." Healthy volunteers also considered research schedules, processes, and safety, and had a positive perception of clinical trials, but they thought that the public has a negative perception.
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Ensaios Clínicos Fase I como Assunto , Motivação , Recompensa , Voluntários Saudáveis , Humanos , Masculino , República da Coreia , Inquéritos e Questionários , VoluntáriosRESUMO
Studies on the history of Western medicine in Korea began to be actively conducted and published since the restart of the Korean Society for the History of Medicine in 1991, which had been originally inaugurated in 1947, and the publication of its official journal, the Korean Journal of Medical History in 1992. In 1970s and 1980s, even before the start of the Journal, articles on a history of Western medicine were published mainly written by physicians in medical journals. This paper aims to provide an overview of the publications on the history of Western medicine in Korea, comparing papers published in the Journal with those published in other journals. Authors of the papers in the Journal are those who majored in history of medicine or history science whose initial educational backgrounds were medicine or science, whereas authors of the papers in other journals majored in Western history, economic history, social history, religious history, or women's history. While a large portion of papers in the Journal deal with medicine in ancient Greek or in modern America with no paper on medieval medicine, the papers in other journals deal with more various periods including ancient, medieval and modern periods and with diverse areas including France, Britain, Germany, Europe etc. Recent trends in 2000s show an increase in the number of researchers who published the history of Western medicine in other journals, total number of their publications, and the topics that they dealt with in their papers. In contrast, however, the number of researchers published in the Journal, the number of the papers and its topics - all decreased in recent years. Only three papers on the history of diseases have been published in the Journal, while eleven published in other journals. In order to stimulate research on the history of Western medicine in Korea, concerted efforts are necessary including academic communication among various disciplines, formulation of a long term plan to enlarge the pool of researchers and readers of the history of Western medicine, and development of strategic educational programs for both graduates and undergraduates including students of medicine and of humanities in Korea.
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Publicações Periódicas como Assunto/história , Pesquisa/história , Educação Médica/história , Europa (Continente) , História do Século XX , História do Século XXI , História Antiga , História Medieval , Humanos , Coreia (Geográfico) , Editoração/história , Pesquisa/tendências , Estudantes de MedicinaRESUMO
Medical research during the Japanese Colonial Period became systematic and active after the Keijo Imperial University Medical School was established in 1926. Various kinds of research were conducted there including pharmacological, physiological, pathological and parasitological research. The Keijo Imperial University was give a mission to study about Korea. Urgent topics for medical research included control of infectious diseases, hygiene and environmental health that might have affected colonizing bodies of the Japanese as well as the colonized. The bodies of Koreans had been studied by Japanese even before the establishment of the University. The Keijo Imperial University research team, however, organized several field studies for physical anthropology and blood typing research at the national scale to get representative sampling of the people from its north to its south of the Korean peninsula. In the filed, they relied upon the local police and administrative power to gather reluctant women and men to measure them in a great detail. The physical anthropology and blood typing research by the Japanese researchers was related to their eagerness to place Korean people in the geography of the races in the world. Using racial index R.I.(= (A%+AB%)/(B%+AB%)), the Japanese researchers put Koreans as a race between the Mongolian and the Japanese. The preoccupation with constitution and race also pervasively affected the medical practice: race (Japanese, Korean, or Japanese living in Korea) must be written in every kind of medical chart as a default. After the breakout of Chinese-Japanese War in 1937, the Keijo Imperial University researchers extended its physical anthropology field study to Manchuria and China to get data on physics of the people in 1940. The Japanese government and research foundations financially well supported the Keijo Imperial University researchers and the field studies for physical anthropology in Korea, Manchuria and China. The physical anthropology research was actively conducted hand in hand with imperialistic expansion, and driven by zeal for measuring the body.
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Antropologia Física/história , Grupos Raciais/história , Tipagem e Reações Cruzadas Sanguíneas/história , Colonialismo/história , Feminino , História do Século XX , Humanos , Coreia (Geográfico) , Masculino , Grupos Raciais/classificação , Faculdades de Medicina/históriaRESUMO
Ethical considerations are essential in planning for and responding to outbreaks of infectious diseases. During the outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) in the Republic of Korea in 2015, serious challenges emerged regarding important ethical issues, such as transparency and the protection of privacy. The development of bioethics in Korea has been influenced by individualistic perspectives applied in clinical contexts, leading to a paucity of ethical perspectives relevant to population-level phenomena such as outbreaks. Alternative theories of public health ethics include the perspectives of relational autonomy and the patient as victim and vector. Public health actions need to incorporate clear and systematic procedures founded upon ethical principles. The MERS-CoV epidemic in Korea created significant public support for more aggressive early interventions in future outbreaks. This trend makes it all the more imperative for ethical principles and procedures to be implemented in future planning and responses to outbreaks in order to promote perceptions of legitimacy and civic participation.
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Infecções por Coronavirus/epidemiologia , Saúde Pública/ética , Infecções por Coronavirus/prevenção & controle , Surtos de Doenças , Humanos , Pandemias/ética , República da Coreia/epidemiologiaRESUMO
Studies on medicine in North Korea have suffered from the lack of material and from the lack of reliability of information. So far, studies on North Korean medicine have centered on the health care system, and medical education system based upon the official data and interviews on refugees from North Korea. The author had a travel grant for archive research to National Archive Center II and Library of Congress from Association of Asian Studies in U.S.A. and photocopied volumes of a North Korean medical journal called In-Min-Bo-Gun(People's Health) published in 1949-1950, and 1957-1960. Captured by the U.S. Army during the Korean War and declassified in 1977, the journal volumes are rare and valuable resources for historical study. This study aims to analyze the form and contents of the available volumes of the journal. As an official journal of the Ministry of Health, North Korea, the primary purpose of the journal was to mobilize all the people who worked in medicine and public health, and to make them implement the public health policies of North Korean government. Accordingly, various categories of people wrote and read the journal from high officials to local public health workers. The genre of the articles published in the journal was also various including papers, declarations, speeches, reports, scientific papers, case reports, news, criticism, conte, poem, essays, and many more. This study showed that In-Min-Bo-Gun(People's Health) was at the center of the Hygiene Reform Movement during the Cultural Revolution from 1958-1959 as an important media that connected health workers and the North Korean government.
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Educação em Saúde/história , Publicações Periódicas como Assunto/história , Saúde Pública/história , História do Século XX , Coreia (Geográfico)RESUMO
Many approaches are being used for exposure of the anterior cranial base regions, ranging from extracranial to intracranial, such as transsphenoidal approach. This intracranial approach, developed in the beginning of the twentieth century, has recently become one of the most commonly used approaches after many incremental improvements. This thesis aims at examining the development of the approach and those who contributed to this procedure. The author also contemplate problems which may occur in the historical analysis. From the nineteenth century, advances have been made in anesthesiology, sterilization, cerebral localization and knowledge of anatomical and physiologic aspects of the skull base. The development of new knowledge and technique has helped to overcome obstacles, making surgery of the skull base through extracranial approach both technically feasible and therapeutically effective. To avoid serious postoperative complications after the extracranial approach, transsphenoidal approach had been developed in the beginning of the twentieth century. Transsphenoidal approach had been widely used right after its introduction. But it had not been used popularly since late 1920s in the United States. In early 1960s, this technique, spread from Europe, has regained popularity and become one of the most widely-used approaches. In the history of the transsphenoidal approach, it has been though that the effort of Harvey Cushing and Oskar Hirsch, the endeavor of Cushing's scholars, several new attempts of otolaryngologists played an important role. However, comparing to great appreciation of neurosurgeons, especially Harvey Cushing on their significant contribution to the further development of this technique, the role of other pioneering doctors have been underestimated in previous historical studies on the transsphenoidal approach. It was because dynamical relationships among several specialties had influence on the historical analysis. This cases shows that historical analysis is influenced not only by past figures bu also by current situations.
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Cirurgia Geral/história , Neurocirurgia/história , Base do Crânio/cirurgia , História do Século XIX , História do Século XX , História do Século XXIRESUMO
Prompted by an increased interest of both research participants and the patient advocacy community in obtaining information about research outcomes and on the use of their biological samples; the international community has begun to debate the emergence of an ethical 'duty' to return research results to participants. Furthermore, the use of new technologies (e.g., whole-genome and -exome sequencing) has revealed both genetic data and incidental findings with possible clinical significance. These technologies together with the proliferation of biorepositories, provide a compelling rationale for governments and scientific institutions to adopt prospective policies. Given the scarcity of policies in the context of stem cell research, a discussion on the scientific, ethical and legal implications of disclosing research results for research participants is needed. We present the International Stem Forum Ethics Working Party's Policy Statement and trust that it will stimulate debate and meet the concerns of researchers and research participants alike.
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Revelação/ética , Políticas , Pesquisa com Células-Tronco/ética , Bancos de Tecidos/ética , Diretrizes para o Planejamento em Saúde , HumanosRESUMO
Novel methods and associated tools permitting individual identification in publicly accessible SNP databases have become a debatable issue. There is growing concern that current technical and ethical safeguards to protect the identities of donors could be insufficient. In the context of human embryonic stem cell research, there are no studies focusing on the probability that an hESC line donor could be identified by analyzing published SNP profiles and associated genotypic and phenotypic information. We present the International Stem Cell Forum (ISCF) Ethics Working Party's Policy Statement on "Publishing SNP Genotypes of Human Embryonic Stem Cell Lines (hESC)". The Statement prospectively addresses issues surrounding the publication of genotypic data and associated annotations of hESC lines in open access databases. It proposes a balanced approach between the goals of open science and data sharing with the respect for fundamental bioethical principles (autonomy, privacy, beneficence, justice and research merit and integrity).
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Linhagem Celular , Células-Tronco Embrionárias/fisiologia , Genótipo , Políticas , Polimorfismo de Nucleotídeo Único , Pesquisa com Células-Tronco , Humanos , Cooperação Internacional , Pesquisa com Células-Tronco/ética , Pesquisa com Células-Tronco/legislação & jurisprudênciaRESUMO
PURPOSE: The aims of this study were to define the necessity and effectiveness of patient safety education during surgical clerkship to develop competency for managing and preventing medical errors. METHODS: Fifty 3rd-year students participated in the patient safety education program during a 4-week surgical clerkship. The students were divided into 4 groups: control group, pretest-only group, education-only group, and pretest and education group. Students were assessed using short essays and an oral exam for reasoning skills, clinical performance exams for patient education and communication skills, and multisource feedback and direct observation of error reporting for real-world problem-solving skills. The results were analyzed with SPSS 14.0K. The reliability (Cronbach alpha) of the entire assessment was 0.893. RESULTS: There was no difference in scores between early and late clerkship groups. Reasoning skills were improved by the pretest. Reasoning, patient education, and error reporting skills were much more developed by patient safety education. Real-world error identification, reporting, and communication did not change after the 4-week course. CONCLUSIONS: Patient safety education during surgical clerkship is necessary and effective. Error prevention and competency management in the real world should developed.