The growing prevalence of health care ethics consultation (HCEC) services in the U.S. has been accompanied by an increase in calls for accountability and quality assurance, and for the debates surrounding why and how HCEC is evaluated. The objective of this study was to evaluate the effectiveness of HCEC as indicated by several novel outcome measurements in East Asian medical encounters.

Extra-corporeal membrane oxygenation has been introduced to clinical practice for several decades. It is unclear how internet and newspapers portray the use of extra-corporeal membrane oxygenation. This study were: (1) to quantify the coverage of extra-corporeal membrane oxygenation use in newspapers and on the Internet; (2) to describe the characteristics of extra-corporeal membrane oxygenation users presented in newspaper articles and the Internet web pages in comparison with those shown in extra-corporeal membrane oxygenation studies in Taiwan; and (3) to examine the (...) survival rates of extra-corporeal membrane oxygenation users presented in newspaper articles and the Internet web pages in comparison with those in Taiwan and in the Extracorporeal Life Support Registry Report International Summary for January 2014. (shrink)

One of the interpretive devices that Ch'eng-kuan (澄 觀) is famous for having employed to distill the essence of the vast Mahāvaipulya Buddhāvataṃsaka Sūtra (Tafang-kuang fo-hua-yen ching 《大方廣佛華嚴經》 was a series of variations on the contemplative theme (kuan-men 觀門) of the complete interfusion (yüan-jung 圓融) of the scripture's three chief protagonists (san-sheng 三聖) ── the Buddha Vairocana (Pi-lu-che-na 毘盧遮那) and the bodhisattvas Mañjuśrī (Wen-shu-shih-li 文殊師利) and Samantabhadra (P'u-hsien 普賢). By aligning these three powerful sacred persons with a number of philosophical (...) categories that he believed to be central to the sūtra ── categories like "cause" (yin 因 ), "fruition" (kuo 果 ), "faith" (hsin 信 ), "understanding" (chieh 解), "insight" (chih 智), "practice" (hsing 行), "principle" (li 理), etc. ── he provided a focal point at which the rich and vivid meditative and liturgical lives of Hua-yen devotees could be made to converge with their philosophical reflections. -/- Although Ch'eng-kuan invoked this device in several of his writings, his most concerted development of it is a short essay entitled San-sheng yüan-jung kuan-men, which appears to have been written relatively late in his long career. Like many important Hua-yen texts, this essay seems to have been lost in China not long after its author's death. However, it was preserved in Korea and Japan and from the latter country was reintroduced to China in the last years of nineteenth century. Neither in China nor in the West has it yet been adequately studied. -/- The core of the present article is a critical edition of the Chinese text of the essay based on a careful comparison of all available versions and presented together with a copiously annotated English translation. The edition translation are preceded by a brief interpretive introduction and followed by an appendix in which are given: a detailed discussion of the work's textual history, detailed accounts of its various editions, and descriptions of its several surviving paraphrases and commentaries. (shrink)

We are of the opinion that there is also identity between erroneous thinking and existence. Our opinion is based on the following facts.

Ensuring adequate informed consent for surgery in a trauma setting is challenging. We developed and pilot tested an educational video containing information regarding the informed consent process for surgery in trauma patients and a knowledge measure instrument and evaluated whether the audiovisual presentation improved the patients’ knowledge regarding their procedure and aftercare and their satisfaction with the informed consent process. A modified Delphi technique in which a panel of experts participated in successive rounds of shared scoring of items to forecast (...) outcomes was applied to reach a consensus among the experts. The resulting consensus was used to develop the video content and questions for measuring the understanding of the informed consent for debridement surgery in limb trauma patients. The expert panel included experienced patients. The participants in this pilot study were enrolled as a convenience sample of adult trauma patients scheduled to receive surgery. The modified Delphi technique comprised three rounds over a 4-month period. The items given higher scores by the experts in several categories were chosen for the subsequent rounds until consensus was reached. The experts reached a consensus on each item after the three-round process. The final knowledge measure comprising 10 questions was developed and validated. Thirty eligible trauma patients presenting to the Emergency Department were approached and completed the questionnaires in this pilot study. The participants exhibited significantly higher mean knowledge and satisfaction scores after watching the educational video than before watching the video. Our process is promising for developing procedure-specific informed consent and audiovisual aids in medical and surgical specialties. The educational video was developed using a scientific method that integrated the opinions of different stakeholders, particularly patients. This video is a useful tool for improving the knowledge and satisfaction of trauma patients in the ED. The modified Delphi technique is an effective method for collecting experts’ opinions and reaching a consensus on the content of educational materials for informed consent. Institutions should prioritize patient-centered health care and develop a structured informed consent process to improve the quality of care. The ClinicalTrials.gov Identifier is NCT01338480. The date of registration was April 18, 2011. (shrink)

Background Ensuring adequate informed consent for surgery in a trauma setting is challenging. We developed and pilot tested an educational video containing information regarding the informed consent process for surgery in trauma patients and a knowledge measure instrument and evaluated whether the audiovisual presentation improved the patients’ knowledge regarding their procedure and aftercare and their satisfaction with the informed consent process. Methods A modified Delphi technique in which a panel of experts participated in successive rounds of shared scoring of items (...) to forecast outcomes was applied to reach a consensus among the experts. The resulting consensus was used to develop the video content and questions for measuring the understanding of the informed consent for debridement surgery in limb trauma patients. The expert panel included experienced patients. The participants in this pilot study were enrolled as a convenience sample of adult trauma patients scheduled to receive surgery. Results The modified Delphi technique comprised three rounds over a 4-month period. The items given higher scores by the experts in several categories were chosen for the subsequent rounds until consensus was reached. The experts reached a consensus on each item after the three-round process. The final knowledge measure comprising 10 questions was developed and validated. Thirty eligible trauma patients presenting to the Emergency Department were approached and completed the questionnaires in this pilot study. The participants exhibited significantly higher mean knowledge and satisfaction scores after watching the educational video than before watching the video. Conclusions Our process is promising for developing procedure-specific informed consent and audiovisual aids in medical and surgical specialties. The educational video was developed using a scientific method that integrated the opinions of different stakeholders, particularly patients. This video is a useful tool for improving the knowledge and satisfaction of trauma patients in the ED. The modified Delphi technique is an effective method for collecting experts’ opinions and reaching a consensus on the content of educational materials for informed consent. Institutions should prioritize patient-centered health care and develop a structured informed consent process to improve the quality of care. Trial registration The ClinicalTrials.gov Identifier is NCT01338480. The date of registration was April 18, 2011. (shrink)

Most studies have examined the outcomes of patients supported by extracorporeal membrane oxygenation as a life-sustaining treatment. It is unclear whether significant social events are associated with the use of life-sustaining treatment. This study aimed to compare the trend of extracorporeal membrane oxygenation use in Taiwan with that in the world, and to examine the influence of significant social events on the trend of extracorporeal membrane oxygenation use in Taiwan.

We investigated whether, in the emergency department, educational video-assisted informed consent is superior to the conventional consent process, to inform trauma patients undergoing surgery about the procedure, benefits, risks, alternatives, and postoperative care. We conducted a prospective randomized controlled trial, with superiority study design. All trauma patients scheduled to receive trauma-related debridement surgery in the ED of Kaohsiung Medical University Hospital were included. Patients were assigned to one of two education protocols. Participants in the intervention group watched an educational video (...) illustrating informed consent information, whereas those in the control group read an informed consent document. The primary outcome was knowledge scores and the secondary outcome was assessment of patient satisfaction. A multivariable regression model, with predefined covariates, was used to analyze differences in knowledge scores and patient satisfaction levels between the groups. A total of 142 patients were enrolled, with 70 and 72 assigned to the intervention and control groups, respectively. Mean knowledge scores were higher in the intervention ) than in the control group. By multivariate analysis, the intervention group had significantly greater differences in knowledge scores. Age, injury severity score, and baseline knowledge score significantly affected the differences in knowledge scores. Significant improvements were observed in patients’ perception of statements addressing comprehension of the information provided, helpfulness of the supplied information for decision making, and satisfaction with the informed consent process. Multivariate analysis showed significant correlations between video education and patient satisfaction. Both the educational approach and severity of injury may have an impact on patient understanding during the informed consent process in an emergency environment. Video-assisted informed consent may improve the understanding of surgery and satisfaction with the informed consent process for trauma patients in the ED. Institutions should develop structured methods and other strategies to better inform trauma patients, facilitate treatment decisions, and improve patient satisfaction. The ClinicalTrials.gov Identifier is NCT01338480. The date of registration was April 18, 2011. (shrink)

Obtaining adequate informed consent from trauma patients is challenging and time-consuming. Healthcare providers must communicate complicated medical information to enable patients to make informed decisions. This study aimed to explore the challenges of obtaining valid consent and methods of improving the quality of the informed consent process for surgical procedures in trauma patients. We conducted a systematic review of relevant English-language full-text original articles retrieved from PubMed that had experimental or observational study design and involved adult trauma patients. Studies involving (...) informed consent in clinical or research trials were excluded. Titles and abstracts of searched articles were reviewed and relevant data were extracted with a structured form. Results were synthesized with a narrative approach. A total of 2044 articles were identified in the initial search. Only eight studies were included in the review for narrative synthesis. Six studies involved orthopedic surgeries, one involved nasal bone surgeries, and one involved trauma-related limb debridement. Only one study was conducted in an emergency department. Information recall was poor for trauma patients. Risk recall and comprehension were greater when written or video information was provided than when information was provided only verbally. Patient satisfaction was also greater when both written and verbal information were provided than when verbal information alone was provided; patients who received video information were more satisfied than patients who received written or verbal information. Many articles have been published on the subject of informed consent, but very few of these have focused on trauma patients. More empirical evidence is needed to support the success of informed consent for trauma patients in the emergency department, especially within the necessarily very limited time frame. To improve the informed consent process for trauma patients, developing a structured and standardized informed consent process may be necessary and achievable; its effectiveness would require evaluation. Adequately educating and training healthcare providers to deliver structured, comprehensive information to trauma patients is crucial. Institutions should give top priority to ensuring patient-centered health care and improved quality of care for trauma patients. (shrink)

Background: To evaluate the effectiveness of a multifaceted intervention in improving emergency department (ED) patient privacy and satisfaction in the crowded ED setting. Methods: A pre- and post-intervention study was conducted. A multifaceted intervention was implemented in a university-affiliated hospital ED. The intervention developed strategies to improve ED patient privacy and satisfaction, including redesigning the ED environment, process management, access control, and staff education and training, and encouraging ethics consultation. The effectiveness of the intervention was evaluated using patient surveys. Eligibility (...) data were collected after the intervention and compared to data collected before the intervention. Differences in patient satisfaction and patient perception of privacy were adjusted for predefined covariates using multivariable ordinal logistic regression. Results: Structured questionnaires were collected with 313 ED patients before the intervention and 341 ED patients after the intervention. There were no important covariate differences, except for treatment area, between the two groups. Significant improvements were observed in patient perception of "personal information overheard by others", being "seen by irrelevant persons", having "unintentionally heard inappropriate conversations from healthcare providers", and experiencing "providers' respect for my privacy". There was significant improvement in patient overall perception of privacy and satisfaction. There were statistically significant correlations between the intervention and patient overall perception of privacy and satisfaction on multivariable analysis. Conclusions: Significant improvements were achieved with an intervention. Patients perceived significantly more privacy and satisfaction in ED care after the intervention. We believe that these improvements were the result of major philosophical, administrative, and operational changes aimed at respecting both patient privacy and satisfaction. (shrink)

The relationship between intuition and ethical decision-making has been researched extensively during the past two decades. This study aimed at exploring empirically observable associations between intuition and the moral intensity of ethical decision-making processes. A scenario-based quantitative approach was used to collect data from 157 practising professional spirit mediums. It was found that only collective universal intuition had a significant positive association with the moral intensity of ethical decision-making processes. Personal experience intuition and collective archetype intuition were not significantly associated (...) with moral intensity. This may explain why previous studies were unable to gauge the effects of intuition on ethical decision-making. The results suggest that a pure mind can improve one’s ability to make decisions. Thus, decision-makers would benefit by being more attuned to their sense of morality. (shrink)

The rapid development of digital technologies has transformed the world but can be a double-edged sword. We study the interaction of important variables that affect individual news reporters’ performance in which digital technology is the dominant feature. A multilevel model illustrates how transactive memory and job competence affect individual performance. The empirical study includes data from 19 teams of news reporters and 211 valid survey responses, applying hierarchical linear modeling to analyze the data. The results indicate that transactive memory and (...) technology competence help to improve a reporter’s job performance. More importantly, teamwork competence fully mediates the relationships. Our findings thus suggest that teamwork competence is the core skill. Neither technology competence nor transactive memory alone translates directly into enhanced individual performance. (shrink)

The recent rapid development of information technology, such as sensing technology, communications technology, and database, allows us to use simulation experiments for analyzing serious accidents caused by hazardous chemicals. Due to the toxicity and diffusion of hazardous chemicals, these accidents often lead to not only severe consequences and economic losses, but also traffic jams at the same time. Emergency evacuation after hazardous chemical accidents is an effective means to reduce the loss of life and property and to smoothly resume the (...) transport network as soon as possible. This paper considers the dynamic changes of the hazardous chemicals’ concentration after their leakage and simulates the diffusion process. Based on the characteristics of emergency evacuation of hazardous chemical accidents, we build a mixed-integer programming model and design a heuristic algorithm using network optimization and diffusion simulation. We then verify the validity and feasibility of the algorithm using Jinan, China, as a computational example. In the end, we compare the results from different scenarios to explore the key factors affecting the effectiveness of the evacuation process. (shrink)

Recent studies on the effects of mandatory online teaching, resulting from the COVID-19 pandemic, have widely reported low levels of satisfaction, unwillingness to continue online teaching, and negative impacts on the psychological well-being of teachers. Emerging research has highlighted the potential role of psychological need thwarting, in terms of autonomy, competence, and relatedness thwarting, resulting from online teaching. The aim of this study was to evaluate the immediate and delayed effects of PNT of online teaching on teachers’ well-being, intention to (...) continue online teaching, and job satisfaction. Moreover, data collected from both cross-sectional and longitudinal surveys allowed for a systematic validation of an important instrument in the field of teacher psychology, the Psychological Need Thwarting Scale of Online Teaching, in terms of longitudinal reliability and validity. The data reveal the usefulness of the construct of PNT in terms predicting and explaining teachers’ willingness to continue using online teaching as well as the degree of burnout after a period of 2 months, such that PNT is positively associated with burnout and negatively associated with willingness to continue online teaching. As such, the PNTSOT is recommended for future research evaluating the long-term psychological, affective, and intentional outcomes stemming from teachers’ PNT. Moreover, based on our findings that the impact from PNT of online teaching is persistent and long-term, we suggest that school leaders provide flexible and sustained professional development, model respectful and adaptive leadership, and create opportunities for mastery for the development of community of practice that can mitigate the thwarting of teachers’ autonomy, competence, and relatedness during times of uncertainty. Additionally, in terms of the psychometric properties of the PNTSOT instrument, our empirical findings demonstrate internal reliability, test–retest reliability, measurement invariance, and criterion validity based on cross-sectional and longitudinal data. (shrink)

The relationships between age and the life-supporting treatments use, and between gender and the life-supporting treatments use are still controversial. Using extracorporeal membrane oxygenation as an example of life-supporting treatments, the objectives of this study were: to examine the relationship between age and the extracorporeal membrane oxygenation use; to examine the relationship between age and the extracorporeal membrane oxygenation use; and to deliberate the ethical and societal implications of age and gender disparities in the initiation of extracorporeal membrane oxygenation. This (...) is a population-based, retrospective cohort study. Taiwan’s extracorporeal membrane oxygenation cases from 2000 to 2010 were collected. The annual incidence rate of extracorporeal membrane oxygenation use adjusting for both age and gender distribution for each year from 2000 to 2010 was derived using the population of 2000 as the reference population. The trend of extracorporeal membrane oxygenation use was examined using time-series linear regression analysis. We conducted joinpoint regression for estimating the trend change of extracorporeal membrane oxygenation use. The trends of extracorporeal membrane oxygenation use both for different gender groups, and for different age groups have been significantly increasing over time. Men were more likely to be supported by extracorporeal membrane oxygenation than women. Women’s perspectives toward life and death, and women’s perception of well-being may be associated with the phenomenon. In addition, the patients at the age of 65 or older were more likely to be supported by extracorporeal membrane oxygenation than those younger than 65. Family autonomy/family-determination, and the Confucian tradition of filial piety and respecting elders may account for this phenomenon. This study showed gender and age disparities in the initiation of extracorporeal membrane oxygenation use in Taiwan, which may be accounted for by the cultural and societal values in Taiwan. For a healthcare professional who deals with patients’/family members’ medical decision-making to initiate life-supporting treatments, he/she should be sensitive not only to the legality, but also the societal and ethical issues involved. (shrink)