The Ethical Issues in the Clinical Practice - Essay Example

Overall evaluation and general comments What do you consider to be the key messages in this paper? Did you learn anything from reading it that you would consider important for the field to know given existing understanding? Is the paper original? Is it suitable for this nominated journal? (250 words) This is a qualitative study designed as a focus group research, exploring the ethical issues in the clinical practice of the audiologists responsible for screening of infants less than 3 months of age for eventual herring loss. From this paper it is obvious that the screening itself is only the first step in the fighting against hearing loss in infants because the implementation of medical procedures and rehabilitation of the infant depends on many factors. This study is showing that the focus should not be only to cover all of the infant population with the screening procedure, but protocols should be implemented that can monitor and assure that infants best interest are met. Authors point that this is also very sensitive subject because hearing loss is not perceived as significant disability and the parents may actually chose not to treat the condition. Medical aspects of complications of cochlear implant are also important factor. Summary this stydy very clearly and interestingly grabs my attention to one really important problem. This is an original paper that focuses on research of a focus group of audiologists involved in the screening process and tries to recognize their view of the ethical issues regarding screening. It is interesting that this focus group mostly reported that implementation of medical and rehabilitative treatments in the infants with hearing loss are the most important ethical problem. This paper is suitable for this journal because is concise, the topic is clearly defined and provides usable information. 2. Title and abstract These are arguably the most important pieces of a paper as they will determine whether or not a potential reader chooses to read the full text. Were you able to get a clear picture of what the paper is about from the title—did the title match the content of the paper? (50-100 words) The title of the paper is very concise and informative. A future researcher can easily identify that the paper is analyzing the ethical implications that arise from the process of screening for health loss in infants. But the title is only the initial step of the research and should grab the attention of the researcher. The abstract is the second step in the process of identifying a potentially usable paper, unfortunately there is no abstract associated with this paper. 3. Introduction and conceptual framework Does the paper establish a clear conceptual framework, laying out what is already known on the topic, and identifying the gaps in the literature that this paper is an attempt to fill? Is it made clear that the work is original and relevant to a broad, international readership? Is the purpose of the study made clear by the inclusion of a research question or hypotheses? (200 words) Introduction part of the paper is informative and clearly presents the previous data and knowledge regarding the topic of interest. Hearing loss in infants is a condition that can have serious impact on the development of the children and early recognition and treatment can prevent this from happening. However in the introduction par authors state the ethical issues that arise from this treatment. The screening itself is “system driven” or the infants are screened as part of national program. However the further treatment of the infants is “parents driven” or the parents are responsible for the initiation of further investigation and treatment. Ethical problems arise if the parents do not understand the implications of hearing loss in the infant, or they simply deny the presence of the condition. This is the essence of the problem and can be clearly understood from the introduction of the paper. The area of research of the paper is original because it tries to explore the views of the medical professionals that are implementing the screening process. They are uniquely involved in the screening process and have insight of the problematic that is unique and of great interest. This purpose of the study if clearly of interest to the international readership because publically presents the views of the doctors directly implementing the screening process. 4. Methodological Rigour Has the development and design of the data collection methods (whether quantitative or qualitative) been outlined in a manner that would allow another researcher to replicate the study if one desired to do so? Are the methods appropriate for the stated research question? Is the data analysis appropriate given the problem the authors are trying to address and given the data available? (100 words) This is qualitative study that uses focus group as mean of obtaining qualitative data about a particular subject. Authors used single small focus group of 6 audiologists which is a small group of participants and cannot be accepted as representative sample, however since this is qualitative research valuable data can still be obtained. Also authors used only single sessions and there were no repeated discussion which may provide further insight on the subject. Also they did not use dual-moderator focus group, which is important because while the first moderator is conducting the discussion the other can monitor the character of the conversation and prevent any unrelated conversation (Marshall and Gretchen 1999). 5.Results Are the results clearly presented? Are they consistent with both the methods used and the problem the authors are trying to address? Do they yield a clear answer to the research question? (100 words) Authors used medical coding to recognize the medical issues presented in the discussion and were able to clearly identify the key aspects of the ethical problems identified by the audiologists. Based on their analysis they concisely present 3 main ethical problems which are consistent with the research question of the authors and they provide partial answer to the research question. This is mainly because of the fact that all of the 3 questions are related to the personal involvement of the audiologists and their role in the process and none of the questions is related to the infant itself or the parents. 6.Discussion and Conclusion Are the conclusions clearly stated? Do they relate back to the conceptual framework presented in the introduction? Are they appropriate given the methods adopted and results found? Does the study add to the existing body of knowledge in a meaningful and important way? Are limitations in the study design acknowledged and discussed? (200 words) Authors identify 3 aspects of the communication with the parents, aspects that are closely related to their work as medical professionals. These questions are mainly aspects of their individual feeling of anxiety regarding to the compliance of the parents with their advices for the treatment of the infants. The questions that authors defined are in relation to the research question and appropriate but strictly connected to the personal ethical involvement of the audiologists and not the general ethical problems that may arise with this medical practice. However authors made additional literature review of other ethical points that are of importance in relation to the research question. Therefore they define several categories of responses of the parents. Authors also define that there are ethical implications regarding the medical treatment also: is it appropriate for infant under 6 months of age, should the parents wish for lack of treatment be granted etc. Authors also define simple protocols for managing different types or categories of parets and their reaction to the diagnosis of hearing loss to the infant. This is providing some new ideas and is a good basis for further research and investigation. However the limitation of this study is that it uses a single, small focus group which was unable to cover wider range of professionals that would be able to point other ethical issues. 7. Improvements to be made Summarise the main argument the student has made or is trying to make, highlight the strengths of the argument in the paper and provide the student with information about how the paper could be improved for publication (500 words) The students presented a good and concise paper with well defined research question and excellent literature review regarding the field of interest. Authors were able to identify the key ethical aspects regarding the screening of infants under the age of 3 months and were able to provide consistent literature references that support their claim. The main arguments in this paper are that the most important ethical aspects in the process of medical practice regarding implementation of screening for hearing loss is the communication with the parents, providing accurate information’s to the parents and making shore that they understand those information’s and finally assurance that the parents will proceed with further investigations and treatment of the condition. Interestingly students also designed a very elaborative and well designed protocol for every audiologist in order to meet and help them improve these ethical issues. All of the parents were divided in 3 separate categories and appropriate and elaborative protocol is presented for every type of parent reaction. However these protocols can only be used as a starting point for further research and not as established protocols for the management of these ethical issues. This is because further research is needed, in consultation with the legal aspects of the problem in order to correctly design these protocols. There are several issues that should be addressed in this paper. First using a single, small focus group cannot give reliable information’s. The fact that all of the participants were from the same hospital is another negative aspect because all of the participants work in the same environment and therefore have the same issues. Secondly all of the identified ethical problems by the participants are from personal and individual aspects in regards to their personal view of their role in the process of screening. However some other ethical questions may arise that are not closely related to their personal involvement in the process, for example what is the best technology for screening and there are several types (Automated auditory brainstem response, Transient evoked otoacoustic emissions, Distortion product otoacoustic emissions etc.). There is a higher rate of false positive screening results in youngest infants and what ethical implication this may have when presenting the results to the parents, what is the implication if the audiologist inform the parents that the results maybe are not accurate etc. One very important aspect that should also be corrected is that this paper does not have abstract. Abstract is very important part of every paper or study because enables fast and informative insight into the key aspects of the paper. Often a researcher will not look at the paper simply because he doesn’t have the time to review the whole text, but he is only reading the abstract in order to assess the content of the article. Finally it can be stated that this is very informative paper and deserves to be a part of the found of articles presented in the online journal. This paper presents some new insights into the ethical but also medical problems that arise during the practical implementation of the process of screening of infants (Jennifer and Martyn 2002). References: Marshall, Catherine and Gretchen B. Rossman. (1999), Designing Qualitative Research. 3rd Ed. London: Sage Publications, p. 115 Jennifer Sokol and Martyn Hyde (2002), Hearing screening, Article Neonatology, Pediatrics in Review Vol.23 No.5 May 2002, Available from: http://www.ohsu.edu Read More