By Ken Pope
Journal of Trauma & Dissociation
Volume 16, Issue 2, 2015
Abstract
Research shows that many organizations overlook needs and opportunities to strengthen ethics. Barriers can make it hard to see the need for stronger ethics and even harder to take effective action. These barriers include the organization’s misleading use of language, misuse of an ethics code, culture of silence, strategies of justification, institutional betrayal, and ethical fallacies. Ethics placebos tend to take the place of steps to see, solve, and prevent problems. This article reviews relevant research and specific steps that create change.
The entire article is here.
Monday, April 13, 2015
Antipsychotics, Other Psychotropics, and the Risk of Death in Patients With Dementia
Maust DT, Kim H, Seyfried LS, et al.
Antipsychotics, Other Psychotropics, and the Risk of Death in Patients With Dementia: Number Needed to Harm.
JAMA Psychiatry. Published online March 18, 2015.
doi:10.1001/jamapsychiatry.2014.3018.
Importance
Antipsychotic medications are associated with increased mortality in older adults with dementia, yet their absolute effect on risk relative to no treatment or an alternative psychotropic is unclear.
Objective
To determine the absolute mortality risk increase and number needed to harm (NNH) (ie, number of patients who receive treatment that would be associated with 1 death) of antipsychotic, valproic acid and its derivatives, and antidepressant use in patients with dementia relative to either no treatment or antidepressant treatment.
(cut)
Conclusions and Relevance
The absolute effect of antipsychotics on mortality in elderly patients with dementia may be higher than previously reported and increases with dose.
The research article is here.
Antipsychotics, Other Psychotropics, and the Risk of Death in Patients With Dementia: Number Needed to Harm.
JAMA Psychiatry. Published online March 18, 2015.
doi:10.1001/jamapsychiatry.2014.3018.
Importance
Antipsychotic medications are associated with increased mortality in older adults with dementia, yet their absolute effect on risk relative to no treatment or an alternative psychotropic is unclear.
Objective
To determine the absolute mortality risk increase and number needed to harm (NNH) (ie, number of patients who receive treatment that would be associated with 1 death) of antipsychotic, valproic acid and its derivatives, and antidepressant use in patients with dementia relative to either no treatment or antidepressant treatment.
(cut)
Conclusions and Relevance
The absolute effect of antipsychotics on mortality in elderly patients with dementia may be higher than previously reported and increases with dose.
The research article is here.
Sunday, April 12, 2015
Human, All Too Human: 3-Part Documentary Profiles Nietzsche, Heidegger & Sartre
From Open Culture
Originally published in April 8, 2014
Certainly three of the most radical thinkers of the last 150 years, Nietzsche, Heidegger, and Sartre were also three of the most controversial, and at times politically toxic, for their perceived links to totalitarian regimes. In Nietzsche’s case, the connection to Nazism was wholly spurious, concocted after his death by his anti-Semitic sister. Nevertheless, Nietzsche’s philosophy is far from sympathetic to equality, his politics, such as they are, highly undemocratic. The case of Heidegger is much more disturbing—a member of the Nazi party, the author of Being and Time notoriously held fascist views, made all the more clear by the recent publication of his infamous “black notebooks.” And Sartre, author of Being and Nothingness, has long been accused of supporting Stalinism—a charge that may be oversimplified, but is not without some merit.
The three 50 minute videos are here.
Originally published in April 8, 2014
Certainly three of the most radical thinkers of the last 150 years, Nietzsche, Heidegger, and Sartre were also three of the most controversial, and at times politically toxic, for their perceived links to totalitarian regimes. In Nietzsche’s case, the connection to Nazism was wholly spurious, concocted after his death by his anti-Semitic sister. Nevertheless, Nietzsche’s philosophy is far from sympathetic to equality, his politics, such as they are, highly undemocratic. The case of Heidegger is much more disturbing—a member of the Nazi party, the author of Being and Time notoriously held fascist views, made all the more clear by the recent publication of his infamous “black notebooks.” And Sartre, author of Being and Nothingness, has long been accused of supporting Stalinism—a charge that may be oversimplified, but is not without some merit.
The three 50 minute videos are here.
Saturday, April 11, 2015
Amid a Sea of False Findings, the NIH Tries Reform; Science needs to get its house in order, says Francis Collins, director of the NIH
By Paul Voosen
Chronicle of Higher Education
Originally published March 16, 2015
How do you change an entire scientific culture?
It may sound grandiose, but that is the loaded question now facing the National Institutes of Health, the federal agency that oversees and finances U.S. biomedical research.
While the public remains relatively unaware of the problem, it is now a truism in the scientific establishment that many preclinical biomedical studies, when subjected to additional scrutiny, turn out to be false.
Many researchers believe that if scientists set out to reproduce preclinical work published over the past decade, a majority would fail.
(cut)
The NIH, if it was at first reluctant to consider the problem, is now taking it seriously. Just over a year ago, the agency's director, Francis S. Collins, and his chief deputy, Lawrence A. Tabak, announced actions the agency would take to improve the research it finances.
Science needs to get its house in order, Dr. Collins said in a recent interview with The Chronicle.
The entire article is here.
Chronicle of Higher Education
Originally published March 16, 2015
How do you change an entire scientific culture?
It may sound grandiose, but that is the loaded question now facing the National Institutes of Health, the federal agency that oversees and finances U.S. biomedical research.
While the public remains relatively unaware of the problem, it is now a truism in the scientific establishment that many preclinical biomedical studies, when subjected to additional scrutiny, turn out to be false.
Many researchers believe that if scientists set out to reproduce preclinical work published over the past decade, a majority would fail.
(cut)
The NIH, if it was at first reluctant to consider the problem, is now taking it seriously. Just over a year ago, the agency's director, Francis S. Collins, and his chief deputy, Lawrence A. Tabak, announced actions the agency would take to improve the research it finances.
Science needs to get its house in order, Dr. Collins said in a recent interview with The Chronicle.
The entire article is here.
Telepsychology, Telehealth, & Internet-Based Therapy
From Ken Pope's site
I gathered the following resources to help therapists, counselors, and other clinicians to keep abreast of the rapidly evolving professional guidelines, research, treatments, innovations, and practices in the areas of telepsychology, telehealth, internet-based therapy.
I've divided the resources into 3 sections:
1) Links to 24 sets of professional guidelines that focus on telepsychology, online counseling, internet-based therapy, etc.
2) Citations for 51 recent (i.e., published in 2013-2015) articles
3) State Psychology Board Telepsychology Laws, Regulations, Policies, & Opinions--This third section was generously compiled by psychologist Kenneth R. Drude, and I am indebted to him for his kind offer to post it here.
The resource page is here.
I will link it in the Guides and Guidelines section of this site.
I gathered the following resources to help therapists, counselors, and other clinicians to keep abreast of the rapidly evolving professional guidelines, research, treatments, innovations, and practices in the areas of telepsychology, telehealth, internet-based therapy.
I've divided the resources into 3 sections:
1) Links to 24 sets of professional guidelines that focus on telepsychology, online counseling, internet-based therapy, etc.
2) Citations for 51 recent (i.e., published in 2013-2015) articles
3) State Psychology Board Telepsychology Laws, Regulations, Policies, & Opinions--This third section was generously compiled by psychologist Kenneth R. Drude, and I am indebted to him for his kind offer to post it here.
The resource page is here.
I will link it in the Guides and Guidelines section of this site.
Friday, April 10, 2015
Ethics of Money in Medicine
By Danielle Ofri
Physician, Writer, Editor
Here is an excerpt:
But this is just one example of unethical allocation of money in medicine. Much ado was rightly made last year when Medicare data showed a few doctors with unsavory and maybe illegal billing practices. But for all the complaints about doctors’ salaries driving up healthcare costs, hardly anyone made a peep when that same data revealed that it is the salaries of the administrators and executives that are tipping the scales.
Nor did anyone so much as hiccup when it was reported that $455 million dollars was spent on TV ads since the Affordable Care Act was enacted, more than 90% of which was devoted to trying to destroy the ACA. We are so jaded about CEO salaries and the money swamp of politics that we hardly are hardly bothered when we see these statistics.
When I read about the $400 million was spent on TV ads to prevent uninsured Americans from getting health insurance, I was frankly disgusted. If people with deep pockets are really interested in improving our healthcare system there are far better ways to use that money. That handsome sum could have put several thousand nurses in clinics or schools. It could have sponsored medical school for 2000 students from underserved communities. Heck, it could have purchase 6 million albuterol inhalers and handed them out. But no, the money was squandered on TV advertisements.
The entire article is here.
Physician, Writer, Editor
Here is an excerpt:
But this is just one example of unethical allocation of money in medicine. Much ado was rightly made last year when Medicare data showed a few doctors with unsavory and maybe illegal billing practices. But for all the complaints about doctors’ salaries driving up healthcare costs, hardly anyone made a peep when that same data revealed that it is the salaries of the administrators and executives that are tipping the scales.
Nor did anyone so much as hiccup when it was reported that $455 million dollars was spent on TV ads since the Affordable Care Act was enacted, more than 90% of which was devoted to trying to destroy the ACA. We are so jaded about CEO salaries and the money swamp of politics that we hardly are hardly bothered when we see these statistics.
When I read about the $400 million was spent on TV ads to prevent uninsured Americans from getting health insurance, I was frankly disgusted. If people with deep pockets are really interested in improving our healthcare system there are far better ways to use that money. That handsome sum could have put several thousand nurses in clinics or schools. It could have sponsored medical school for 2000 students from underserved communities. Heck, it could have purchase 6 million albuterol inhalers and handed them out. But no, the money was squandered on TV advertisements.
The entire article is here.
Informed Consent Procedures with Cognitively Impaired Patients: A Review of Ethics and Best Practices
By L. M. Field and J. D. Calvert
Psychiatry Clin Neurosci. 2015 Mar 10
doi: 10.1111/pcn.12289
Abstract
AIM:
The objectives of this paper are to discuss ethical issues of informed consent in cognitively impaired patients and review considerations for capacity determination. We will also discuss how to evaluate capacity, determine competence, and obtain informed consent when a patient is deemed incompetent. This review emphasizes how to carry out informed consent procedures when capacity is questionable and discusses measures supported for use when determining cognitively impaired patients' ability to consent.
METHODS:
Information was gathered from medical and psychological codes of ethics, peer-reviewed journals, published guidelines from healthcare organizations (e.g., American Medical Association), and scholarly books. Google Scholar and PsycINFO were searched for articles related to "informed consent" and "cognitive impairment" published in English between 1975 and 2014. Relevant sources referenced in retrieved publications were subsequently searched and reviewed.
RESULTS:
We selected 43 sources generated by our search. Sources were included in our review if they presented information related to at least one of our focus areas. These areas included: review of informed consent ethics and procedures, review of cognitive impairment evaluations, recommendations for measuring cognitive capacity, and alternative forms of informed consent.
CONCLUSIONS:
Patients' cognitive impairments can hinder the ability of patients to understand treatment options. Evaluating the capacity of patients with cognitive impairment to understand treatment options is vital for valid informed consent and should be guided by best practices. Thus, proper identification of patients with questionable capacity, capacity evaluation, and determination of competence, as well as reliance upon appropriate alternative consent procedures, are paramount.
The article is here.
Psychiatry Clin Neurosci. 2015 Mar 10
doi: 10.1111/pcn.12289
Abstract
AIM:
The objectives of this paper are to discuss ethical issues of informed consent in cognitively impaired patients and review considerations for capacity determination. We will also discuss how to evaluate capacity, determine competence, and obtain informed consent when a patient is deemed incompetent. This review emphasizes how to carry out informed consent procedures when capacity is questionable and discusses measures supported for use when determining cognitively impaired patients' ability to consent.
METHODS:
Information was gathered from medical and psychological codes of ethics, peer-reviewed journals, published guidelines from healthcare organizations (e.g., American Medical Association), and scholarly books. Google Scholar and PsycINFO were searched for articles related to "informed consent" and "cognitive impairment" published in English between 1975 and 2014. Relevant sources referenced in retrieved publications were subsequently searched and reviewed.
RESULTS:
We selected 43 sources generated by our search. Sources were included in our review if they presented information related to at least one of our focus areas. These areas included: review of informed consent ethics and procedures, review of cognitive impairment evaluations, recommendations for measuring cognitive capacity, and alternative forms of informed consent.
CONCLUSIONS:
Patients' cognitive impairments can hinder the ability of patients to understand treatment options. Evaluating the capacity of patients with cognitive impairment to understand treatment options is vital for valid informed consent and should be guided by best practices. Thus, proper identification of patients with questionable capacity, capacity evaluation, and determination of competence, as well as reliance upon appropriate alternative consent procedures, are paramount.
The article is here.
Thursday, April 9, 2015
Controversy Continues at University of Oregon Counseling Center
By Richard Read
The Oregonian
Originally published April 8, 2015
Here is an excerpt:
Bronet assured students in a March 20 memo that UO's counseling center would keep records confidential barring extraordinary circumstances. She urged them to use university mental-health services without fear.
Meanwhile, The Oregonian/OregonLive has learned, the head of the University Counseling and Testing Center significantly weakened confidentiality safeguards in a policy statement she wrote with UO's legal department.
Director Shelly Kerr wrote in an internal April 3 email obtained by the news organization that she worked with university attorneys to draft the new confidentiality policy. "I want to be sure that the information on our web and printed materials are as clear and accurate as possible," she wrote.
But the new policy, already in effect, contradicts promises Bronet made and greatly expands the number of exceptions that could be cited as justification to break confidentiality.
The entire article is here.
The Oregonian
Originally published April 8, 2015
Here is an excerpt:
Bronet assured students in a March 20 memo that UO's counseling center would keep records confidential barring extraordinary circumstances. She urged them to use university mental-health services without fear.
Meanwhile, The Oregonian/OregonLive has learned, the head of the University Counseling and Testing Center significantly weakened confidentiality safeguards in a policy statement she wrote with UO's legal department.
Director Shelly Kerr wrote in an internal April 3 email obtained by the news organization that she worked with university attorneys to draft the new confidentiality policy. "I want to be sure that the information on our web and printed materials are as clear and accurate as possible," she wrote.
But the new policy, already in effect, contradicts promises Bronet made and greatly expands the number of exceptions that could be cited as justification to break confidentiality.
The entire article is here.
Ethical Framework for the Use of Technology in Mental Health
Online Therapy Institute
Here is an excerpt from their resource page:
A competent practitioner working online will always adhere at least the following minimum standards and practices in order to be considered to be working in an ethical manner.
Practitioners have a sufficient understanding of technology.
Technology basics are required for practitioners who choose to deliver therapeutic services via technology. Practitioners will possess a basic understanding of technology as the technology relates to delivery of services
Here is an excerpt from their resource page:
A competent practitioner working online will always adhere at least the following minimum standards and practices in order to be considered to be working in an ethical manner.
Practitioners have a sufficient understanding of technology.
Technology basics are required for practitioners who choose to deliver therapeutic services via technology. Practitioners will possess a basic understanding of technology as the technology relates to delivery of services
- Encryption: Practitioners understand how to access encrypted services to store records and deliver communication. Records storage can be hosted on a secure server with a third-party, stored on the practitioner’s hard drive utilizing encrypted folders or stored on an external drive that is safely stored.
- Backup Systems: Records and data that are stored on the practitioner’s hard drive are backed up either to an external drive or remotely via the Internet.
- Password Protection: Practitioners take further steps to ensure confidentiality of therapeutic communication and other materials by password protecting the computer, drives and stored files or communication websites.
- Firewalls: Practitioners utilize firewall protection externally or through web-based programs.
- Virus Protection: Practitioners protect work computers from viruses that can be received from or transmitted to others, including clients.
- Hardware: Practitioners understand the basic running platform of the work computer and know whether or not a client’s hardware/platform is compatible with any communication programs the practitioner uses.
- Software: Practitioners know how to download and operate software and assist clients with the same when necessary to the delivery of services.
- Third-party services: Practitioners utilize third-party services that offer an address and phone number so that contact is possible via means other than email. This offers a modicum of trust in the third-party utilized for such services as backup, storage, virus protection and communication.
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