The Moral Reasoning of Nurse Practitioners

The purpose of this phenomenological study was to identify the moral dilemmas experienced by nurse practitioners in their clinical practice and to describe the essential features of moral reasoning utilized by the nurse practitioners to resolve the moral dilemma. The participants in the study were ten female volunteers who were currently employed as NPs in a variety of settings. Unstructured interviews were conducted with the participants and the qualitative data was analyzed using a nine step process. Five essential features of moral reasoning emerged through the process of data analysis: values, elements in the contextual framework for moral reasoning, influencing factors, recognizing the dilemma, and outcomes. The first essential feature, values were those ideals which motivated the participants in making decisions amid competing choices in any given situation. The next essential feature, elements in the contextual framework for moral reasoning described the environment in which the NP practiced, including other persons within that setting. Elements in the contextual framework for moral reasoning also described the nurse practitioner role and referred not only to the activities the NP performed, but also to the nurse-patient relationship. Influencing factors were those elements that changed the everyday, clinical practice of the NP into one which became a moral dilemma. Influencing factors impacted the setting, the participants within the setting, and were the factors taken under consideration in the decision making process. One or more of these influencing factors were catalytic in motivating the practitioner into making a decision about the dilemma. The catalysts emerged because of certain values which were held in high esteem by the participants. Two patterns of moral reasoning were identified: independent and lateral reasoning. The nurse practitioners who utilized the independent pattern of reasoning based their decision making on self-chosen values regardless of other influences present in the situation. Lateral reasoning was a mode of reasoning where the individual chose to defer the decision to others in the environment. The implications for nursing practice, education and research based on the findings in this study are discussed. Recommendations are proposed which include further research into the essential features of moral reasoning to determine whether the findings in this study can be generalized to other nurses. It is hoped that research studies such as this will advance the knowledge of nursing and other disciplines concerning moral reasoning and ethics

Applying a Precautionary Approach to Mobile Contact Tracing for COVID-19: The Value of Reversibility

The COVID-19 pandemic presents unprecedented challenges to public health decision-making. Specifically, the lack of evidence and the urgency with which a response is called for, raise the ethical challenge of assessing how much (and what kind of) evidence is required for the justification of interventions in response to the various threats we face. Here we discuss the intervention of introducing technology that aims to trace and alert contacts of infected persons-contact tracing (CT) technology. Determining whether such an intervention is proportional is complicated by complex trade-offs and feedback loops. We suggest that the resulting uncertainties necessitate a precautionary approach. On the one hand, precautionary reasons support CT technology as a means to contribute to the prevention of harms caused by alternative interventions, or COVID-19 itself. On the other hand, however, both the extent to which such technology itself present risks of serious harm, as well as its effectiveness, remain unclear. We therefore argue that a precautionary approach should put reversibility of CT technology at the forefront. We outline several practical implications

Studies on structural, electrical, and optical properties of Cu doped As-Se-Te chalcogenide glasses

Cu doped chalcogenide (ChG) glassy films in the As-Se-Te glass system have been prepared using thermal evaporation techniques. Single-source evaporation from bulk (1-x) As(0.40)Se(0.35)Te(0.25)+x Cu glasses with x=0.05, 0.075, 0.10, 0.125, and 0.15, as well as dual-source coevaporation from As-chalcogenide and Cu-chalcogenide binary glasses as source materials, has been explored. We have shown that it is not possible to deposit high concentration Cu doped ChG glassy films, from the Cu doped bulk samples using single-source evaporation. However, using the dual-source coevaporation technique, we have demonstrated that the films can be doped with high concentrations of Cu. Micro-Raman spectroscopy has been utilized to verify that Cu is introduced into the glass network without disrupting the basic As-chalcogen units. Optical measurements have shown that introduction of Cu decreases the band gap of As-Se-Te glasses. The electrical properties of the investigated films have been measured at different temperatures and it has been shown that Cu incorporation in the As-Se-Te glass system vastly improves electrical conductivity. Moreover, we have shown that the temperature dependence of electrical conductivity can be fitted assuming variable range hopping between states near the Fermi level

Immunohistochemical subtypes predict the clinical outcome in high-risk node-negative breast cancer patients treated with adjuvant FEC regimen: results of a single-center retrospective study

Prognostic factors for disease-free survival in patients treated before 2005 September: multivariate analysis. (DOCX 15 kb

Nectin-4: a new prognostic biomarker for efficient therapeutic targeting of primary and metastatic triple-negative breast cancer

International audienceBackground: Triple-negative breast cancers (TNBCs) are associated with a poor prognosis. In contrast to other molecular sub-types, they have no identified specific target and chemotherapy remains the only available systemic treatment. The adhesion molecule nectin-4 represents a new potential therapeutic target in different cancer models. Here, we have tested the prognos-tic value of nectin-4 expression and assessed the therapeutic efficiency of an anti-nectin 4 antibody drug conjugate (ADC) on localised and metastatic TNBC in vitro and in vivo. Materials and methods: We analysed nectin-4/PVRL4 mRNA expression in 5673 invasive breast cancers and searched for correlations with clinicopathological features including metastasis-free survival (MFS). Immunohistochemistry was carried out in 61 TNBCs and in samples of primary TNBC Patient-Derived Xenografts (PDXs). An anti-nectin-4 antibody eligible for ADC was produced and tested in vitro and in vivo in localised and metastatic TNBC PDXs. Results: High nectin-4/PVRL4 mRNA expression was associated with poor-prognosis features including the TN and basal sub-types. High PVRL4 mRNA expression showed independent negative prognostic value for MFS in multivariate analysis in TNBCs. Nectin-4 protein expression was not detected in adult healthy tissues including mammary tissue. Membranous protein expression was found in 62% of TNBCs, with strong correlation with mRNA expression. We developed an ADC (N41mab-vcMMAE) comprising a human anti-nectin-4 monoclonal antibody conjugated to monomethyl auristatin-E (MMAE). In vitro, this ADC bound to nectin-4 with high affinity and specificity and induced its internalisation as well as dose-dependent cytotoxicity on nectin-4-expressing breast cancer cell lines. In vivo, this ADC induced rapid, complete and durable responses on nectin-4-positive xenograft TNBC samples including primary tumours, metastatic lesions, and local relapses; efficiency was dependent on both the dose and the nectin-4 tumour expression level. Conclusion: Nectin-4 is both a new promising prognostic biomarker and specific therapeutic target for ADC in the very limited armamentarium against TNBC

Participants' uptake of clinical trial results: a randomised experiment

BJC OPENInternational audienceBACKGROUND: Participants are showing great interest these days in obtaining the results of clinical trials. The aim of this study was to assess patients' uptake and understanding of the results of the trial in which they have participated and the impact of a letter offering patients the possibility of consulting the trial results on a specific website. METHODS: Breast cancer patients participating in a trial on the efficacy of Trastuzumab were randomly subdivided into an Internet group (who received the letter of invitation) and a control group (who did not receive it). Among 115 HER2-positive women from 21 centres, 107 (93%) answered a self-administered questionnaire. RESULTS: Most of the patients in both groups had access to the Internet (72.0%). The majority (97.2%) stated that receiving information about the trial results would be useful, and the oncologist was the most frequently preferred information provider. The Internet group's declared uptake of the trial results was only slightly higher (47.1% vs 33.9%; P=0.166); however, they understood the results significantly more accurately (18.8% vs 5.6%; P=0.039). INTERPRETATION: Although Internet was not the respondents' preferred source of information, the possibility of using this source slightly increased the uptake and understanding of the results