10 research outputs found
Perceptions de néphrologues transplanteurs et référents face à la quantification du risque immunologique global en transplantation rénale
ProblĂ©matique : La pĂ©nurie dâorganes qui sĂ©vit actuellement en transplantation rĂ©nale incite les chercheurs et les Ă©quipes de transplantation Ă trouver de nouveaux moyens afin dâen amĂ©liorer lâefficacitĂ©. Le Groupe de recherche transdisciplinaire sur les prĂ©dicteurs du risque immunologique du FRSQ travaille actuellement Ă mettre en place de nouveaux outils facilitant la quantification du risque immunologique global (RIG) de rejet de chaque receveur en attente dâune transplantation rĂ©nale. Le calcul du RIG sâeffectuerait en fonction de facteurs scientifiques et quantifiables, soit le biologique, lâimmunologique, le clinique et le psychosocial. La dĂ©termination prĂ©cise du RIG pourrait faciliter la personnalisation du traitement immunosuppresseur, mais risquerait aussi dâentraĂźner des changements Ă lâactuelle mĂ©thode de sĂ©lection des patients en vue dâune transplantation. Cette sĂ©lection se baserait alors sur des critĂšres quantifiables et scientifiques. Lâutilisation de cette mĂ©thode de sĂ©lection possĂšde plusieurs avantages, dont celui dâamĂ©liorer lâefficacitĂ© de la transplantation et de personnaliser la thĂ©rapie immunosuppressive. MalgrĂ© tout, cette approche soulĂšve plusieurs questionnements Ă©thiques Ă explorer chez les diffĂ©rents intervenants Ćuvrant en transplantation rĂ©nale quant Ă sa bonne utilisation.
Buts de lâĂ©tude : Cette recherche vise Ă Ă©tudier les perceptions de nĂ©phrologues transplanteurs et rĂ©fĂ©rents de la province de QuĂ©bec face Ă lâutilisation dâune mĂ©thode de sĂ©lection des patients basĂ©e sur des critĂšres scientifiques et quantifiables issus de la mĂ©decine personnalisĂ©e. Les rĂ©sultats pourront contribuer Ă dĂ©terminer la bonne utilisation de cette mĂ©thode et Ă Ă©tudier le lien de plus en plus fort entre science et mĂ©decine.
MĂ©thodes : Des entretiens semi-dirigĂ©s combinant lâemploi de courtes vignettes cliniques ont Ă©tĂ© effectuĂ©s auprĂšs de 22 nĂ©phrologues quĂ©bĂ©cois (transplanteurs et rĂ©fĂ©rents) entre juin 2007 Ă juillet 2008. Le contenu des entretiens fut analysĂ© qualitativement selon la mĂ©thode dâanalyse de Miles et Huberman.
RĂ©sultats : Les rĂ©sultats dĂ©montrent une acceptation gĂ©nĂ©ralisĂ©e de cette approche. La connaissance du RIG pour chaque patient peut amĂ©liorer le traitement et la prise en charge post-greffe. Son efficacitĂ© serait supĂ©rieure Ă la mĂ©thode actuelle. Par contre, la possible exclusion de patients pose un important problĂšme Ă©thique. Cette nouvelle approche doit toutefois ĂȘtre validĂ©e scientifiquement et accorder une place au jugement clinique.
Conclusions : La mĂ©decine personnalisĂ©e en transplantation devrait viser le meilleur intĂ©rĂȘt du patient. MalgrĂ© lâutilisation de donnĂ©es scientifiques et quantifiables dans le calcul du RIG, le jugement clinique doit demeurer en place afin dâaider le mĂ©decin Ă prendre une dĂ©cision fondĂ©e sur les donnĂ©es mĂ©dicales, son expertise et sa connaissance du patient. Une rĂ©flexion Ă©thique approfondie sâavĂšre nĂ©cessaire quant Ă lâexclusion possible de patients et Ă la rĂ©solution de la tension entre lâĂ©quitĂ© et lâefficacitĂ© en transplantation rĂ©nale.Background: The overwhelming scarcity of organs within renal transplantation forces researchers and transplantation teams to seek new ways to increase efficacy. The Groupe de recherche transdisciplinaire sur les prĂ©dicteurs du risque immunologique is attempting to put in place a scientifically precise method for determining the global immunological risk (GIR) of rejection for each patient waiting for a renal transplant. The quantification of the GIR is based on scientific factors, such as biological, immunological, clinical and psychosocial. The precise and global determination of the GIR could change the way patients are selected for renal transplantation. This selection will be based thus on scientific and quantifiable criteria. The advantages of the use of this method for selecting potential allograft recipients could be improvement in the efficacy of the process and the individualization of immunosuppressive therapy. In spite of these numerous advantages, this approach raises several ethical questions to explore with nephrologists working in kidney transplantation.
Aims of the study: The aims of this study is to explore the views of transplant and referring nephrologists on the use of personalized medicine tools to develop a new method for selection potential recipients of a renal allograft. The results of this research could contribute to determine the acceptable use of this method in renal transplantation and to study the link between science and medicine.
Methods: Twenty-two semi-directed interviews, using short clinical vignettes, were conducted with nephrologists in the province of Quebec between June 2007 and July 2008. The semi-directed interviews were analyzed qualitatively using the content and thematic analysis method described by Miles and Huberman.
Results: The results demonstrate a general acceptance of this approach amongst the participants. Knowledge of each patientâs immunological risk could improve treatment and the post-graft follow-up. On the other hand, the possibility that patients might be excluded from transplantation poses a significant ethical issue. It could be more effective than the method presently used. The method must be validated scientifically, and must leave a role for clinical judgment.
Conclusions: The use of personalized medicine within transplantation must be in the best interests of the patient. However, in spite of the use of such scientific data, a place must be retained for the clinical judgment that allows a physician to make decisions based on medical data, professional expertise and knowledge of the patient. An ethical reflection is necessary in order to focus on the possibility of patients being excluded, as well as on the resolution of the equity/efficacy dilemma
La médiation comme méthode de consultation en éthique clinique : une démarche de soin
Les conflits que vivent les soignants et les patients mettent Ă mal la qualitĂ© du prendre soin. La consultation dâĂ©thique clinique vise Ă rĂ©soudre ces situations. La rĂ©ussite du prendre soin est liĂ©e Ă la capacitĂ© de dĂ©libĂ©ration des divers acteurs. Le premier point prĂ©sente diffĂ©rents modĂšles de consultation. Par la suite, lâanalyse porte sur la mĂ©diation comme mĂ©thode de consultation en Ă©thique clinique : exigences de son fonctionnement et dĂ©fis. De lĂ , lâexamen de la mĂ©thode fait voir en quoi celle-ci exprime le prendre soin de la maniĂšre la plus authentique. La dĂ©marche constitue un instrument pĂ©dagogique majeur en contexte contemporain oĂč se multiplient les intervenants aux compĂ©tences et aux valeurs diverses. Pour reprendre le langage de Max Weber, elle privilĂ©gie une Ă©thique de la responsabilitĂ© plutĂŽt que de la conviction.Conflicts between caregivers and patients undermine the quality of care. Clinical ethics consultation aims to resolve these situations. The success of caregiving is linked to the deliberative capacity of the various actors implied in the situation. The first point of the article presents different consultation models. Then, the analysis focuses on mediation as a method of consultation in clinical ethics: requirements of its functioning and challenges. From there, the examination of the method shows how it expresses care in the most authentic way. The approach constitutes a major pedagogical tool in a contemporary context where the number of stakeholders with different skills and values is increasing. To use Max Weberâs language, it favours an ethics of responsibility rather than conviction
The use of personalized medicine for patient selection for renal transplantation: Physicians' views on the clinical and ethical implications
<p>Abstract</p> <p>Background</p> <p>The overwhelming scarcity of organs within renal transplantation forces researchers and transplantation teams to seek new ways to increase efficacy. One of the possibilities is the use of personalized medicine, an approach based on quantifiable and scientific factors that determine the global immunological risk of rejection for each patient. Although this approach can improve the efficacy of transplantations, it also poses a number of ethical questions.</p> <p>Methods</p> <p>The qualitative research involved 22 semi-structured interviews with nephrologists involved in renal transplantation, with the goal of determining the professionals' views about calculating the global immunological risk and the attendant ethical issues.</p> <p>Results</p> <p>The results demonstrate a general acceptance of this approach amongst the participants in the study. Knowledge of each patient's immunological risk could improve treatment and the post-graft follow-up. On the other hand, the possibility that patients might be excluded from transplantation poses a significant ethical issue. This approach is not seen as something entirely new, given the fact that medicine is increasingly scientific and evidence-based. Although renal transplantation incorporates scientific data, these physicians believe that there should always be a place for clinical judgment and the physician-patient relationship.</p> <p>Conclusions</p> <p>The participants see the benefits of including the calculation of the global immunological risk within transplantation. Such data, being more precise and rigorous, could be of help in their clinical work. However, in spite of the use of such scientific data, a place must be retained for the clinical judgment that allows a physician to make decisions based on medical data, professional expertise and knowledge of the patient. To act in the best interests of the patient is key to whether the calculation of the global immunological risk is employed.</p
Public participation in national preparedness and response plans for pandemic influenza: toward an ethical contribution of public health policies
Faced with the threat of pandemic influenza, several countries have made the decision to put a number of measures in place which have been incorporated into national plans. In view of the magnitude of the powers and responsibilities that States assume in the event of a pandemic, a review of the various national preparedness and response plans for pandemic influenza brought to light a series of extremely important ethical concerns. Nevertheless, in spite of the recent emergence of literature focusing specifically on the ethical aspects of pandemics, too few studies explicitly examine public participation as one means of ethical contribution to public health policies. Thus this article seeks, in the first place, to present an analysis of the various national preparedness and response plans for pandemic influenza, and secondly, to outline the role that the plans envisage for ethics and more importantly for public participation
The enigmatic nature of altruism in organ transplantation: a cross-cultural study of transplant physicians' views on altruism
Use of personalized medicine in the selection of patients for renal transplantation: views of Quebec transplant physicians and referring nephrologists
Aux sciences, citoyens !
Ce livre décrit plus de 25 expériences de consultation et de participation, réalisées au Québec et ailleurs dans le monde, touchant les enjeux scientifiques les plus divers. Couronnées de succÚs ou pas, ces expériences sont toujours instructives. C'est pourquoi les auteurs proposent aussi un répertoire des méthodes et des moyens utilisés pour en évaluer la pertinence et l'efficacité