Magnetoencephalography is increasingly used for presurgical planning in people with medically refractory focal epilepsy. Localization of interictal epileptiform activity, a surrogate for the seizure onset zone whose removal may prevent seizures, is challenging and depends on the use of multiple complementary techniques. Accurate and reliable localization of epileptiform activity from spontaneous MEG data has been an elusive goal. One approach toward this goal is to use a novel Bayesian inference algorithm—the Champagne algorithm with noise learning—which has shown tremendous success in (...) source reconstruction, especially for focal brain sources. In this study, we localized sources of manually identified MEG spikes using the Champagne algorithm in a cohort of 16 patients with medically refractory epilepsy collected in two consecutive series. To evaluate the reliability of this approach, we compared the performance to equivalent current dipole modeling, a conventional source localization technique that is commonly used in clinical practice. Results suggest that Champagne may be a robust, automated, alternative to manual parametric dipole fitting methods for localization of interictal MEG spikes, in addition to its previously described clinical and research applications. (shrink)

The compulsive habit model proposed by Everitt and Robbins has accumulated important empirical evidence. One of their proposals is the existence of an axis, on which each a person with a particular addiction can be located depending on the evolutionary moment of his/her addictive process. The objective of the present study is to contribute in addressing the identification of such axis, as few studies related to it have been published to date. To do so, the use/abuse of Information and Communication (...) Technologies (ICT) was quantified on an initial sample of 807 subjects. Questionnaires were also delivered to measure impulsivity, compulsivity and symptoms of prefrontal dysfunction. Evidence of the existence of the proposed axis was obtained by means of Machine Learning techniques, thus allowing the classification of each subject along the continuum. The present study provides preliminary evidence of the existence of the Impulsivity-Compulsivity axis, as well as an IT tool so that each patient that starts getting treatment for an addiction can be statistically classified as “impulsive” or “compulsive.” This would allow the matching of each person with the most appropriate treatment depending on his/her moment in the addiction/abuse process, thus facilitating the individualized design of each therapeutic process and a possible improvement of the results of the treatment. (shrink)

Body awareness refers to the individual ability to process signals originating from within the body, which provide a mapping of the body’s internal landscape and its relation with space and movement. The present study aims to evaluate psychometric properties and validate in French two self-report measures of body awareness: the Postural Awareness Scale, and the last version of the Multidimensional Assessment of Interoceptive Awareness questionnaire. We collected data in a non-clinical, adult sample using online survey, and a subset of (...) the original sample also completed the retest control. Factor analyses and reliability analyses were conducted. Construct validity of the PAS and the MAIA-2 were examined by testing their association with each other, and with self-report measures of personality, alexithymia and dispositional trait mindfulness. Factor analyses of the PAS supported the same two-factor structure as previously published versions. For the MAIA-2, factor analyses suggested that a six-factor structure, excluding Not-Worrying and Not-Distracting factors, could successfully account for a common general factor of self-reported interoception. We found satisfactory internal consistency, construct validity, and reliability over time for both the PAS and the MAIA-2. Altogether, our findings suggest that the French version of the PAS and the MAIA-2 are reliable self-report tools to assess both components of body awareness. (shrink)

BackgroundThe high incidence of post-stroke depression during rehabilitation exerts a negative effect on the treatment and functional recovery of patients with stroke and increases the risk of mortality. It is necessary to screen PSD in the rehabilitation stage and thus provide effective intervention strategies. However, existing measurements used to assess PSD in the rehabilitation stage in patients with stroke lack specificity. This study aimed to develop a clinical measure to assess symptoms of PSD in the rehabilitation stage.MethodsThe research team (...) created the initial items through a literature review and semi-structured interviews of patients with stroke. Then, the symptom-related items were estimated by three panels: healthcare professionals, Delphi experts, and patients with stroke in the rehabilitation stage.ResultsThe literature review and semi-structured interview produced 51 symptom-related items including six domains, and the items were reduced to 47 by the healthcare professionals. The symptom-related items were further reduced to 33 items by a two-round Delphi consultation. The initiative coefficients of the two Delphi rounds were 71.4 and 100%, the expert authority coefficients were both 0.85, Kendall’s W were 0.152 and 0.408, and the coefficient of variation were 0.05–0.32 and 0.00–0.18, respectively. The item-level content validity index was 0.53–1.00, the scale-level CVI/universal agreement was 0.26, and the S-CVI/average was 0.85 for the first found Delphi consultation; the I-CVI was 0.67–1.00, the S-CVI/UA was 0.61, and the S-CVI/Ave was 0.97 for the second round Delphi consultation. All content validity indicators have been significantly improved compared with the first round. Using mean ≥ 4 and full score ≥ 0.5, combined with CV ≤ 0.16 as the item criteria, a clinical measure of PSD with 33 items and 6 dimensions was finally formed after two rounds. The patients with stroke made no further revisions after evaluation.ConclusionThe research team developed a specific tool with good content validity to assess the symptoms of PSD in the rehabilitation stage. (shrink)

Family carers of individual’s living with Huntington’s Disease (HD) manage a distinct and unique series of difficulties arising from the complex nature of HD. This paper presents the validation of the definitive measure of quality of life for this group. The Huntington’s Disease Quality of Life Battery for carers (HDQoL-C) was expanded and then administered to an international sample of 1716 partners and family carers from 13 countries. In terms of the psychometric properties of the tool, exploratory analysis of half (...) of the sample, demonstrated good internal consistency and reliability. Some items on the full version did not meet psychometric thresholds and a short version (HDQoL-Cs) was developed based on more stringent criteria. Confirmatory Factor Analysis of the model structure showed a good fit for all Factors and, indicated that the HDQoL-C and HDQoL-Cs are psychometrically robust measures of quality of life. We found that carers who lived with and looked after their spouse/partner had reduced sense of coping, hope for the future and overall quality of life. Carers with children who were at risk, carried the gene or were symptomatic also had poorer quality of life outcomes. Findings indicated the HDQoL-C and HDQoL-Cs are valid in multiple languages and across varied cultures as measures of self-reported quality of life in family carers of individual’s living with HD. These psychometrically validated tools can aid and guide the implementation of therapeutic interventions to improve life quality in this population. (shrink)

Background and rationale Clinicians often encounter a variety of ethical challenges in their routine clinical practice, and it varies across healthcare and cultural settings of their practice. Despite of this, there are no clear-cut available guidelines concerning the right course of action in a given ethically challenging situation. A validated instrument that could capture the health care providers’ viewpoints in this regard is lacking from Indian settings. Thus, the current study aimed at developing an instrument to assess the HCP’s (...) perspective regarding different ethically challenging situations encountered in the Indian settings. Methods The questionnaire was developed by involving 15 medical experts. A mixed-method approach, Delphi-technique, and online survey were used for item generation and validation. Results The questionnaire comprised of 11 items representing four factors: health-resource constraints, medical responsibility of the HCP, obtaining patients/family members’ consent for the treatment, and treatment beyond the standard protocol. The gender and clinical disciplines of the participants were related to their level of endorsement for various domains of the ECCS-Q. Conclusions Ethical challenges in the clinical practice fall in different clusters. The clinicians’ course of action in such situations have many socio-demographic and professional determinants. Future studies are warranted to investigate these phenomena. (shrink)

Clinical research has at least three problematic features: it tends to be redundant, secretive, and isolated.1 Research with these features not only wastes resources and causes harm, it also fails to meet a basic ethical requirement of research: scientific validity. As bioethicists, we should be asking why, if research with these three features is ethically unjustified, it has been so routinely approved by research ethics committees over the past half century. In what follows, I provide one answer to (...) this question. The first section of this paper outlines empirical evidence for the redundant, secretive, and isolated nature of much contemporary clinical research. Next, I argue that a lack of clarity .. (shrink)

For two decades Adolf Grünbaum’s publications have shaken the foundations of psychoanalysis and stimulated the thinking of philosophers of science, psychiatrists, psychoanalysts, and psychologists. It all started with Grünbaum’s critique of Popper’s famous critique of psychoanalysis as not falsifiable. Grünbaum succeeded in giving counter-examples to Popper’s claims. Within two years after his own systematic and detailed analysis of psychoanalysis, and especially of Freud’s writings in The Foundations of Psychoanalysis: A Philosophical Critique he responded to fortyone reviewers with his “Is Freud’s (...) theory well-founded?”. (shrink)

Distinct sources of stress have emerged during the COVID-19 pandemic. Particularly, fear is expected to generate significant psychological burden on individuals and influence on either unsafe behavior that may hinder recovery efforts or virus-mitigating behaviors. However, little is known about the properties of measures to capture them in research and clinical settings. To resolve this gap, we evaluated the psychometric properties of a novel measure of fear of illness and viruses and tested its predictive value for future development of (...) distress. We extracted a random sample of 450 Chilean adult participants from a large cross-sectional survey panel and invited to participate in this intensive longitudinal study for 35 days. Of these, 163 ended up enrolling in the study after the demanding nature of the measurement schedule was clearly explained to them. For this final sample, we calculated different Confirmatory Factor Analyses (CFA) to evaluate the preliminary proposed structure for the instrument. Complementarily, we conducted a content analysis of the items to qualitatively extract its latent structure, which was also subject to empirical test via CFA. Results indicated that the original structure did not fit the data well; however, the new proposed structure based on the content analysis did. Overall, the modified instrument showed good reliability through all subscales both by its internal consistency with Cronbach’s alphas ranging from 0.814 to 0.913, and with test–retest correlations ranging from 0.715 to 0.804. Regarding its convergent validity, individuals who scored higher in fears tended to also score higher in depressive and posttraumatic stress symptoms at baseline. Furthermore, higher fears at baseline predicted a higher score in posttraumatic stress symptomatology 7 days later. These results provide evidence for the validity, reliability, and predictive performance of the scale. As the scale is free and multidimensional potentially not circumscribed to COVID-19, it might work as a step toward understanding the psychological impact of current and future pandemics, or further life-threatening health situations of similar characteristics. Limitations, practical implications, and future directions for research are discussed. (shrink)

The integration of artificial intelligence into bioethics education represents a new pedagogical approach that addresses complex moral issues in healthcare. The use of AI-driven platforms like ChatGPT in bioethics education can enhance critical thinking and decision-making skills among students by providing a diverse range of perspectives and solutions. To assess the ability of ChatGPT-4 to understand and resolve ethical dilemmas using validated clinical case vignettes, thereby determining its suitability as a teaching aid in bioethics. Ten clinical scenarios, each (...) with inherent ethical issues, were presented to ChatGPT-4. These scenarios were expert-validated to ensure relevance and complexity. ChatGPT's responses were evaluated by two blinded external raters to eliminate bias. The assessment criteria included identification of bioethical principles, recognition of stakeholders and their outcomes, and comprehension of ethical and legal frameworks. Additionally, the quality of responses was scored on a scale of 1–10. ChatGPT showed proficiency in identifying the pertinent bioethical principles and stakeholders involved in the ethical dilemmas presented. It achieved an overall score of 84.5%, with high marks for its analytical capabilities in complex scenarios. However, the study identified areas for improvement, particularly in proposing comprehensive solutions and alternative actions. ChatGPT demonstrates potential as an effective tool for bioethics education, capable of guiding learners through the resolution of ethical issues in clinical practice. However, to fully integrate ChatGPT into bioethics education, it requires enhancements in delivering detailed, actionable guidance in ethical decision-making. Future development should focus on refining ChatGPT’s ability to offer nuanced solutions aligned with patient values and clinician needs. (shrink)

Rationale, aims and objectives Given the increasing prevalence of cataract and demand for cataract extraction surgery, patients must often wait to undergo this procedure. We validated a previously developed priority scoring system in terms of clinical variables, pre-intervention health status, appropriateness of surgery and gain in visual acuity (VA) and health-related quality of life (HRQoL).Methods Explicit prioritization criteria for cataract extraction created by a variation of the Research and Development (RAND) and University of California Los Angeles appropriateness methodology were (...) retrospectively applied to a prospective cohort of 5257 patients on waiting lists to undergo cataract by phacoemulsification at 17 hospitals in Spain. Demographic data, clinical data and data related to surgical technique were collected by trained ophthalmologists. Patients were evaluated by their ophthalmologist before the intervention and 6 weeks afterward. They also completed, by mail, the Visual Function Index (VF-14) before the intervention and 3 months afterward.Results High-priority patients experienced greater improvement in VA and HRQoL than those classified as intermediate or low-priority (P < 0.0001), even after adjusting by VA and the VF-14 score at baseline. The time to intervention was the same for high-priority patients as it was for intermediate and low-priority patients.Conclusions The priority score we developed identified patients most likely to experience the greatest improvements from cataract extraction. Use of this tool could provide a fairer and more rational way to prioritize patients for cataract extraction. (shrink)

This article addresses two areas of continuing controversy about consent in clinical research: the question of when consent to low risk research is necessary, and the question of when consent to research is valid. The article identifies a number of considerations relevant to determining whether consent is necessary, chief of which is whether the study would involve subjects in ways that would (otherwise) infringe their rights. When consent is necessary, there is a further question of under what conditions consent (...) is valid or successful in waiving a right. The most influential account of validity conditions is non-moralized, in the sense that the conditions make no essential reference to whether the researcher soliciting consent has obtained it in a way that wrongs the subject. The article examines the implications of this account, and compares it with recent accounts that moralize some of the validity conditions. -/- . (shrink)

As ethics committees and programs become integrated into the “usual business” of healthcare organizations, they are likely to face the predicament of responding to greater demands for service and higher expectations, without an influx of additional resources. This situation demands that ethics committees and programs allocate their scarce resources (including their time, skills and funds) strategically, rather than lurching from one ad hoc request to another; finding ways to maximize the effectiveness, efficiency, impact and quality of ethics services is essential (...) in today’s competitive environment. How can Hospital Ethics Committees (HECs) begin the process of strategic priority-setting to ensure they are delivering services where and how they are most needed? This paper describes the creation of the Clinical Ethics Needs Assessment Survey (CENAS) as a tool to understand interprofessional staff perceptions of the organization’s ethical climate, challenging ethical issues and educational priorities. The CENAS was designed to support informed resource allocation and advocacy by HECs. By sharing our process of developing and validating this ethics needs assessment survey we hope to enable strategic priority-setting in other resource-strapped ethics programs, and to empower HECs to shift their focus to more proactive, quality-focused initiatives. (shrink)

This dissertation explores conflicts between religion and medicine, cases in which cultural and religious beliefs motivate requests for inappropriate treatment or the cessation of treatment, requests that violate the standard of care. I call such requests M-requests (miracle or martyr requests). I argue that current approaches fail to accord proper respect to patients who make such requests. Sometimes they are too permissive, honoring M-requests when they should not; other times they are too strict. I propose a phronesis-based approach to decide (...) whether to honor an M-request or whether religious beliefs are medically valid. This approach is culturally sensitive, takes religious beliefs seriously, and holds them to a high ethical standard. This approach uses a principle of belief evaluation developed by Linda Zagzebski: The Principle of Rational Belief, which is founded upon Aristotelian virtue ethics. In addition to the Principle, I propose a concrete set of conditions to assist caregivers in clinical case evaluations. In the final chapters, I apply the phronesis-based approach to well-known adult cases such as the refusal of blood transfusions by Jehovah’s Witnesses and requests for continued (futile) care by Orthodox Jews at the end of life. Also, I consider cases involving children such as African female circumcision and cases of faith healing. I argue that The Principle of Rational Belief should define the threshold of the kinds of M-requests for children that can be honored, but I allow a lower threshold for M-requests made by competent adult patients. (shrink)

Background Non-adherence to medication is associated with increased risk of relapse in patients with bipolar disorder. Objectives To validate patient-evaluated adherence to medication measured via smartphones against validated adherence questionnaire; and investigate characteristics for adherence to medication measured via smartphones. Methods Patients with BD evaluated adherence to medication daily for 6–9 months via smartphones. The Medication Adherence Rating Scale and the Rogers’ Empowerment questionnaires were filled out. The 17-item Hamilton Depression Rating Scale, the Young Mania Rating Scale and the Functional (...) Assessment Short Test were clinically rated. Data were collected multiple times per patient. The present study represents exploratory pooled reanalyses of data collected as part of two randomised controlled trials. Findings During the study 90.50% of the days were evaluated as ‘medication taken’, 6.91% as ‘medication taken with changes’ and 2.59% as ‘medication not taken’. Adherence to medication measured via smartphones was valid compared with the MARS. Younger age and longer illness duration were significant predictors for non-adherence to medication. Decreased affective symptoms measured with smartphone-based patient-reported mood and clinical ratings as well as decreased empowerment were associated with non-adherence. Conclusions Smartphone-based monitoring of adherence to medication was valid compared with validated adherence questionnaire. Younger age and longer illness duration were predictors for non-adherence. Increased empowerment was associated with adherence. Clinical implications Using smartphones for empowerment of adherence using patient-reported measures may be helpful in everyday clinical settings. Trial registration number NCT01446406 and NCT02221336. (shrink)

This study examined the validity and reliability of a Turkish version of the Modified Moral Sensitivity Questionnaire for Student Nurses. After obtaining permission to adapt the MMSQSN into Turkish, the translation/back-translation method was used with expert opinions to determine content validity. Factor analysis was conducted to examine the construct validity and test–retest was performed on the questionnaire to determine reliability. Cronbach’s alpha coefficients were calculated to assess for internal consistency. Participants included 272 baccalaureate degree student nurses who (...) took ethics lessons prior to their clinical internship. The factor analysis revealed that even though the factor structure in the original scale was the same, relevant items were categorized with similar components, and factor loads were sufficient. The correlation coefficient in the analyses of test–retest scores was.66 for the total scale and the Cronbach’s alpha was.73 for the total scale. The translated MMSQSN is a valid and reliable measure of ethical sensitivity in student nurses in Turkey. (shrink)

Robust clinical decision-making depends on valid reasoning and sound judgment and is essential for delivering quality healthcare. It is often susceptible, however, to a clinician’s biases such as towards a patient’s age, gender, race, or socioeconomic status. Gender bias in particular has a deleterious impact, which frequently results in cognitive myopia so that a clinician is unable to make an accurate diagnosis because of a patient’s gender—especially for female patients. Virtue epistemology provides a means for confronting gender bias in (...) clinical decision-making and for correcting or even preventing its impact. The medical literature on cardiovascular and coronary heart disease is used to illustrate the role intellectual virtues can play in redressing the deleterious impact of gender bias on clinical decision-making and practice. Finally, questions are considered surrounding the pedagogy of intellectual virtues for medical students and practicing clinicians in order to provide quality care for patients, regardless of gender. (shrink)

Introduction:The concept of mentalizing is nowadays widely used in research as well as in clinical practice. Despite its popularity, the development of an economic assessment is still challenging. The Mentalization Scale appears to be a promising measurement with good psychometric properties but lacking convergent validity with the Reflective Functioning Scale.Objective:This study aims to test the construct validity of the Mentalization Scale through correlations with the gold standard, the Reflective Functioning Scale, within a clinical sample. Furthermore, it (...) was of interest to replicate its internal consistency.Methods:Twenty-six inpatients of an acute psychiatric ward in Vienna were given the Mentalization Scale (MentS). They were interviewed with the Brief Reflective Function Interview, which was coded with the Reflective Functioning Scale. Correlations and internal consistency were calculated.Results:Concerning the primary aim of this study, the validity was satisfactory for the MentS whole-scale mentalizing as well as for the subscales self- and other-oriented mentalizing. Internal consistency was lower to the findings of the developer and close to the 0.70 threshold.Conclusion:Our findings could foster the psychometric properties of the MentS. Furthermore, the MentS seems to be a promising measurement tool for detecting different dimensions of reflective functioning. Limitations and further research are discussed. (shrink)

This landmark volume brings together the work of the world's leading researchers in sublimated perception. This compilation marks a fundamental shift in the current study of subliminal effects: No longer in question is the notion that perception without awareness occurs. Now, the emphasis is on elucidating the parameters of subliminal effects and understanding the conditions under which stimuli perceived without awareness significantly influence affect, cognition, and behavior. PERCEPTION WITHOUT AWARENESS firmly establishes subliminal perception within the mainstream of psychological science. Well (...) represented here are the two main research branches that have emerged: One directly investigates the nature of subliminal effects; the other uses subliminal techniques as tools for investigating psychological phenomena such as hypnosis, dreaming, repression, social judgment and inference, psychopathology, and symptom formation. Broadly grouped into three main sections, the contributed chapters explore * The cognitive perspective--including implicit memory and implicit perception, the measurement of unconscious perceptual processes, and methods for revealing unconscious processes * The clinical perspective--exploring the cognitive and dynamic aspects of subliminal perception, memory, and consciousness; direct recovery of subliminal stimuli; and validation of subliminal psychodynamic activation * The social perspective--discussing subliminal mere-exposure effects, affect and social perception, and the role of subliminality in social psychology Timely and thought-provoking, PERCEPTION WITHOUT AWARENESS is sure to be of enormous interest to all psychoanalytic clinicians and scholars, as well as cognitive, clinical, and social psychologists whose work touches upon issues relating to psychopathology, perception, cognition, and memory. (shrink)

We argue that charging people to participate in research is likely to undermine the fundamental ethical bases of clinical research, especially the principles of social value, scientific validity, and fair subject selection.

Background Caring behaviour is critical for nursing quality, and the clinical internship environment is a crucial setting for preparing nursing students for caring behaviours. Evidence about how to develop nursing students’ caring behaviour in the clinical environment is still emerging. However, the mechanism between the clinical internship environment and caring behaviour remains unclear, especially the mediating role of moral sensitivity and the moderating effect of self-efficacy. Research objective This study aimed to examine the mediating effect of moral (...) sensitivity and the moderating function of self-efficacy on the association between the clinical internship environment and caring behaviours. Research design A cross-sectional design used acceptable validity scales. The hypothesised moderated mediation model was tested in the SPSS PROCESS macro. Participants and research context This survey collected data from 504 nursing students in an internship at a teaching hospital in Changsha, China. Ethical considerations This study was pre-approved by the ethics committee of the medical school (No. E2022210). Informed consent was obtained from all students. Results The clinical internship environment ( B = 0.450, 95% CI = [0.371, 0.530]) and moral sensitivity ( B = 1.352, 95% CI = [1.090, 1.615]) had positive direct effects on nursing students' caring behaviours. Clinical internship environment also indirectly influenced students’ caring behaviours via moral sensitivity ( B = 0.161, 95% CI = [0.115, 0.206]). In addition, self-efficacy played a moderating role between the clinical internship environment and caring behaviours ( B = 0.019, 95% CI = [0.007, 0.031]), as well as the relationship between the clinical internship environment and moral sensitivity ( B = 0.006, 95% CI = [0.003, 0.010]). Conclusion Moral sensitivity mediates the effect of the clinical internship environment on caring behaviour, and self-efficacy strengthens both direct and indirect effects. This study emphasises the importance of self-efficacy in developing moral sensitivity and caring behaviours in nursing students. (shrink)

A long-debated question in the philosophy of health, and contingent disciplines, is the extent to which wise clinical practice (“clinical wisdom”) is, or could be, compatible with empirically validated medicine (“evidence-based medicine”—EBM). Here we respond to Baum-Baicker and Sisti, who not only suggest that these two types of knowledge are divided due to their differing sources, but also that EBM can sometimes even hurt wise clinical practice. We argue that the distinction between EBM and clinical wisdom (...) is poorly defined, unsupported by the methodology employed, and ultimately incorrect; crucial differences exist, we argue, not in the source of a particular piece of clinical knowledge, but in its dependability. In light of this subtle but fundamental revision, we explain how clinical wisdom and EBM are—by necessity—complementary, rather than in conflict. We elaborate on how recognizing this relationship can have far-reaching implications for the domains of clinical practice, medical education, and health policy. (shrink)