To Each Technology Its Own Ethics: The Problem of Ethical Proliferation

Ethics plays a key role in the normative analysis of the impacts of technology. We know that computers in general and the processing of data, the use of artificial intelligence, and the combination of computers and/or artificial intelligence with robotics are all associated with ethically relevant implications for individuals, groups, and society. In this article, we argue that while all technologies are ethically relevant, there is no need to create a separate ‘ethics of X’ or ‘X ethics’ for each and every subtype of technology or technological property—e.g. computer ethics, AI ethics, data ethics, information ethics, robot ethics, and machine ethics. Specific technologies might have specific impacts, but we argue that they are often sufficiently covered and understood through already established higher-level domains of ethics. Furthermore, the proliferation of tech ethics is problematic because (a) the conceptual boundaries between the subfields are not well-defined, (b) it leads to a duplication of effort and constant reinventing the wheel, and (c) there is danger that participants overlook or ignore more fundamental ethical insights and truths. The key to avoiding such outcomes lies in a taking the discipline of ethics seriously, and we consequently begin with a brief description of what ethics is, before presenting the main forms of technology related ethics. Through this process, we develop a hierarchy of technology ethics, which can be used by developers and engineers, researchers, or regulators who seek an understanding of the ethical implications of technology. We close by deducing two principles for positioning ethical analysis which will, in combination with the hierarchy, promote the leveraging of existing knowledge and help us to avoid an exaggerated proliferation of tech ethics.publishedVersio

Surgical complications: a hospital-wide registering system and factors associated with surgical complications

ABSTRACT The primary aim of the present thesis was to study how surgical quality can be measured in a single hospital, by creating and describing a simple and usable tool for registering outcomes data based on severity of complications. First, a systematic review of the subject was conducted. The evaluation of the articles revealed wide methodological heterogeneity in the classification and categorization of complications and data collection methods. Subsequently, a pilot hospital-wide surgical complication register was created and implemented in Satasairaala, Pori, Finland. Perioperative data related to all adult general and orthopedic surgery procedures for 3 years (2016–2018) were included in the study. Complications were recorded according to a modified Clavien–Dindo classification, and the preoperative risk factors were compiled based on the literature and coded as numerical measures. The overall complication rate in 4529 patients was 17.2% (95% confidence interval (CI) 16.1–18.3), and 4.6% (95% CI 4.0–5.2) were graded as major complications. The results also showed that only a few patient-related risk factors were sufficient to account for the case mix. Further aims of this thesis were to study factors associated with patient education and patient perceptions on surgical quality, and their association with surgical complications. Adult patients undergoing surgical operations were studied by questionnaires in 2016–2017 in Satasairaala, Pori. The results indicate that the information needs of the patients vary individually. The level of received information by patient education and the patient perception on quality of care may have an association with reported surgical complications. KEYWORDS: surgery, quality improvement, health policy, health services management, performance measures, quality in healthcare, patient safety, human resource management, human factors, real-world effectivenessTIIVISTELMÄ Tämän tutkimuksen ensisijaisena kohteena on kirurgisten komplikaatioiden mittaaminen sairaalatasolla. Väitöskirjan tavoitteena oli luoda kaikki kirurgian alat kattava komplikaatioita mittaava rekisteri, joka hyödyntää olemassa olevaa sähköistä sairaskertomusjärjestelmää. Järjestelmällisen katsauksen avulla selvitettiin ensin tieteellisessä kirjallisuudessa julkaistut tutkimukset olemassa olevista vastaavista rekistereistä sekä ne potilaaseen ja kirurgiseen toimenpiteeseen liittyvät tekijät, joiden tiedetään olevan yhteydessä kirurgisiin komplikaatioihin. Järjestelmällinen kirjallisuuskatsaus osoitti, että tiedonkeruumenetelmissä ja komplikaatioiden luokittelussa on maailmalla suurta vaihtelua. Satasairaalaan luotiin pilottihankkeena koko kirurgian klinikan laajuinen komplikaatiorekisteri, ja tässä väitöskirjassa esitellään tulokset kolmen vuoden ajalta (2016–2018). Komplikaatioita todettiin 17.2 %:lla (95 %CI 16.1–18.3) 4529 leikatusta potilaasta. Näistä 4.6 % (95 %CI 4.0–5.2) luokiteltiin vakaviksi. Tulosten mukaan potilaskohtaisen riskin määrittämiseen saattaa riittää muutama kliininen mittari. Lisäksi tässä väitöskirjassa tutkittiin, missä määrin potilaan informointi ja ohjaus sekä potilaan kokemus hoidon laadusta ovat yhteydessä komplikaatioiden esiintyvyyteen kotiutuksen jälkeen. Tulosten mukaan potilaskohtaisen ohjauksen tarve vaihtelee yksilöllisesti, ja potilasohjauksella ja potilaan kokemalla laadulla saattaa olla yhteyttä leikkauksesta toipumiseen ja komplikaatioiden esiintymiseen. Tässä väitöskirjassa kuvataan koko aikuiskirurgian kattava komplikaatioita mittaava järjestelmä, sekä tuodaan esiin kirurgisen hoidon osa-alueita, joilla saattaa olla yhteyttä hoidon lopputulokseen, esimerkkeinä potilasohjaus ja potilaan kokema laatu. AVAINSANAT: kirurgia, laadun parantaminen, terveyspolitiikka, terveydenhuoltohallinto, dokumentointi, potilasturvallisuus, terveydenhuollon laatu, henkilöstöhallinto, inhimilliset tekijät, arkivaikuttavuu

Medical Education for the 21st Century

Medical education has undergone a substantial transformation from the traditional models of the basic classroom, laboratory, and bedside that existed up to the late 20th century. The focus of this text is to review the spectrum of topics that are essential to the training of 21st-century healthcare providers. Modern medical education goes beyond learning physiology, pathophysiology, anatomy, pharmacology, and how they apply to patient care. Contemporary medical education models incorporate multiple dimensions, including digital information management, social media platforms, effective teamwork, emotional and coping intelligence, simulation, as well as advanced tools for teaching both hard and soft skills. Furthermore, this book also evaluates the evolving paradigm of how teachers can teach and how students can learn – and how the system evaluates success

4. The Validity of ComputerBased Test Interpretations of the MMPI

With advances in computer technology, computer-based test interpretations (CBTI), first developed in the early 1960s (Fowler, 1985), have proliferated (Eyde & Kowal, 1987). CBTIs have been developed and marketed for a variety of tests used in clinical, counseling, educational, and employment settings. The largest number of commercial CBTI systems are available for the Minnesota Multiphasic Personality Inventory (MMPI; Krug, 1987), the most widely used inventory of its kind in the world, which has a continuously growing literature of more than 8,000 books and articles (Holden, 1986; Lanyon, 1984). According to Harris: CBTI refers to the automation of a set of pre-specified rules for use in analyzing, interpreting and assigning certain qualities to a response or response pattern (e .g., test score, profile pattern). The discrete rules are used to form an algorithm that guides the activity of the computer to interpret specific input data. (1987, p. 239) Consumers of CBTIs have very little information available on the development of the algorithm or the validity of the CBTI systems. Companies selling CBTIs often do not provide a user\u27s guide. The algorithms used in generating the computer interpretations are not available to CBTI users nor are they provided for scholarly review purposes. Notable exceptions to these business practices include Lachar\u27s (1974) presentation of all the rules and interpretive statements for the WPS Test Report, the MMPI CBTI sold by Western Psychological Services. National Computer Systems provided the algorithms for the Minnesota Report:Personnel Selection System, for scholarly review purposes, and gave an independent evaluation of the extent to which the interpretive statements were based on the MMPI\u27s research literature or on the clinical judgment of the CBTI\u27s author (Eyde, 1985). Numerous critics have pointed out serious problems arising from the growth of CBTIs. Mitchell (1984) observed that the advent of CBTIs presents the field of psychology with its most serious and consequential challenge of the next decade. Lanyon (1984) called attention to the exponential growth of available CBTI systems, noting that Meehl\u27s cookbook approach to MMPI interpretation (however carefully designed) has been used to justify and market many inadequate systems. Eyde and Kowal (1987) commented that the scientific basis for the C.B.T.I., namely the decision rules which codify the rationale and the evidence used to produce the computer interpretations, may wind up locked in a black box, inaccessible to test users (p. 402). Also, Matarazzo (1986) decried the lack of validity evidence for CBTIs. The problems associated with CBTIs have to do not only with the lack of validity data, but also with the problem of how to establish the validity of a computer interpretive report (Mitchell, 1984; Moreland, 1985, 1987; O\u27Dell, 1972). Mitchell (1984) notes that purists who want to do the job properly, are faced with the task of a conducting a statement-by-statement validation involving statements generated by decision rules and decision trees of almost incomprehensible complexity. Critics of prevailing practices in developing, marketing, and validating computerized applications of knowledge-based systems, may choose, as Eyde and Kowal (1985) have, to do some of the developmental work that should have been done before a computerized test product is sold. The intent of this chapter is to describe a methodology for studying the validity of the output of CBTI systems . The research focuses on a variety of CBTI systems developed as tools for interpreting the MMPI. The MMPI is the most widely used psychodiagnostic instrument with active-duty military populations (Parkison & Fishburne, 1984). Our methodology is designed so that it may be adapted to CBTIs for other tests or self-report inventories. The study involves a comparative analysis of the accuracy, relevancy, and usefulness of the output of seven CBTI systems for patients in a military hospital which draws its patients from a wide geographical area. The research design allows us to make some inferences about the relative accuracy of CBTI systems for different profile types. A secondary objective of the research was to identify racial differences, if any, in the accuracy of the CBTIs. This chapter will describe the study, provide basic data, and describe the results. Other chapters will cover (a) the Black/white differences in the accuracy of the CBTIs, which are minimal (Eyde, Kowal, & Fishburne, 1987); and (b) neuropsychological cases vs. non neuropsychological cases (Fishburne, Eyde, & Kowal, 1988)

Treatment of cholelithiasis and acute cholecystitis : surgical safety in gallstone surgery

INTRODUCTION: Laparoscopic cholecystectomy is one of the most frequently performed surgical procedures worldwide, with nearly 14,000 operations per year in Sweden alone. Recurrent biliary colic or acute cholecystitis are indications for surgery. Despite being a standardized procedure, complications occur in more than 10% of all operations. This thesis includes five research papers, all of which focus on different aspects of surgical safety in gallstone surgery. PAPER 1: The recommended treatment of acute cholecystitis is acute cholecystectomy during the first hospital admission, but the optimal timing is still under discussion. The aim of the first study was to analyse whether the timing of surgery for acute cholecystitis affects complication rates. A registry-based study, based on the Swedish National Registry for Gallstone Surgery and Endoscopic Retrograde Pancreatography (GallRiks) was performed. We included 87,108 patients undergoing cholecystectomy from 2006 to 2014. Of these operations, 15,760 (18.1%) were performed due to acute cholecystitis. We analysed differences in outcomes related to timing of surgery. The results showed that intra-and postoperative complications, bile duct injuries and 30-and 90-day mortality increased with longer delays. The conclusion is that the optimal timing of surgery seems to be within two days of hospital admission. PAPER 2: Increasing hospital and surgeon volumes have been associated with better outcomes for more complicated procedures. However, it is still unknown whether the annual volume of cholecystectomies affects surgical outcomes. The aim of this study was to investigate whether the surgeon’s and hospital’s annual volume of cholecystectomies has an impact on complication rates and operating time. A registry-based study was conducted based on all cholecystectomies registered in GallRiks between 2006 and 2019. A total of 154,934 patients were analysed: 101,221 (65.3%) elective procedures and 53,713 (34.7%) acute procedures. Low volume was defined as <211 operations per hospital per year and <20 operations per surgeon per year. The correlation between annual volumes and different outcomes was calculated. The conclusion is that high volume hospitals and surgeons have more favourable outcomes in both elective and acute cholecystectomy. PAPER 3: Female and male physicians practice medicine differently but it is still unknown whether female and male surgeons produce different outcomes. The aim of this study was to analyse whether female and male surgeons differ in complication rates and operating times in both elective and acute cholecystectomies. A registry-based study was performed based on all cholecystectomies registered in GallRiks between 2006 and 2019. In total, 150,509 patents were included: 97,755 (64.9%) were elective and 52,754 (35.1%) were acute operations. Procedures were performed by 2,553 surgeons: 849 (33.3%) female surgeons and 1,704 (67.7%) male surgeons. Differences in outcomes and operating times were analysed. The results showed that patients operated on by male surgeons had more surgical complications overall (Odds Ratio (OR) 1.29, 95% CI 1.19- 1.40) including more bile duct injures in elective surgery (OR 1.69, 95% CI 1.22-2.34). In addition, female surgeons had longer operating times; converted less frequently to open surgery in the acute setting and their patients had overall shorter hospital stays. The conclusion is that female surgeons have more favourable outcomes but operate more slowly than male surgeons, in elective and acute cholecystectomies. PAPER 4: An alternative to electrocautery dissection is ultrasonic dissection, which has proven favourable in elective cholecystectomies. The aim of this study was to evaluate the learning curve for ultrasonic fundus-first dissection, in elective laparoscopic cholecystectomy. Surgeons with no previous experience of the technique could participate. Patients were recruited between 2017 and 2019. Sixteen residents and specialists, from eight Swedish hospitals, performed 15 operations each and 240 patients were included. The primary endpoint was dissection time with secondary endpoints being complication rate and the surgeon’s self-assessed performance level. In addition, five of the operations were recorded and the videos were graded by two external surgeons. Associations between the procedural number and the different outcomes were analysed. The results showed that dissection time decreased as experience increased (p=0.001). The technique had a complication rate of 5.8%, comparable to the traditional technique. No correlation between the number of performed procedures and the video-assessment score could be demonstrated. The self-assessed performance level was rated lower in more complicated procedures (p=<0.001). The conclusion is that ultrasonic fundus-first dissection is easy to learn and safe during the learning curve, for both residents and specialists. PAPER 5: Ultrasonic dissection seems to be a safe alternative in elective cholecystectomy, but it is still unclear whether the technique is favourable in acute operations. The aim of this study was to compare electrocautery to ultrasonic dissection in patients with acute cholecystitis. A multicentre, randomized, controlled trial was conducted at eight Swedish hospitals. Eligible participants were patients ≥18 years old, with acute cholecystitis with a duration of ≤7 days. Patients were randomly assigned to either traditional electrocautery or ultrasonic dissection, with a 1:1 allocation. Patients, postoperative caregivers, and follow-up personnel were masked to group assignment. The primary endpoint was the total complication rate with analyses according to intention-to-treat. From September 30, 2019, until March 22, 2023, a total of 300 patients was randomized to electrocautery dissection (n=148) or ultrasonic dissection (n=152). No difference in complication rate was seen between the groups (risk difference (RD) 1.6%, 95% CI − 7.2% to 10.4%, p=0.72). Haemostatic agents were used in 40 (27.0%) of patients assigned to electrocautery and 27 (17.8%) of patients assigned to ultrasonic dissection, (RD 10.6%, 95% CI 1.3%-19.8%, p=0.025). In 13 (8.8%) operations in the electrocautery group the surgeon chose to use ultrasonic dissection mostly due to the perceived higher complexity of the operation. The conclusion is that ultrasonic and electrocautery dissection have comparable risks for total complications in patients with acute cholecystitis. Ultrasonic dissection can be used as an alternative to electrocautery dissection, or as a complement in complicated cases

Английский язык : учебно-методический комплекс для студентов специальности 1-03 04 04-01 «Практическая психология. Английский язык»

Построен по модульно-блочному принципу: весь курс разбит на модули, которые в свою очередь делятся на учебные блоки, материал которых объединен тематически. В каждом модуле предлагаются лексические упражнения, задания для развития речевых умений, тематический словарь, тексты для дополнительного чтения. Может быть использован как во время самостоятельной подготовки студентов, так и во время аудиторных занятий. Предназначен для студентов специальности «Практическая психология. Английский язык», а также для всех, изучающих английский язык

Spring 2015 Vol. 14 No. 1

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