Faculty of Health and Medical Sciences

White researcher, examines how health professionals working in remote Aboriginal communities engage with antiracism as instructed by national standards, whether strong emotions are elicited while reflecting on these concepts, and how these reactions impact on antiracist professional practice. Methods: Eleven non-Indigenous allied health professionals were interviewed in a semi-structured format. Interviews were transcribed, thematically analysed and compared to existing literature. Results and discussion: Every participant identified overwhelming emotions that they linked to reflecting on racism, White privilege and colonisation. Professionals reported grappling with denial, anger, guilt, shame, fear, anxiety and perfectionism, loss of belonging, disgust and care. They reported that these emotions caused overwhelm, exhaustion, tensions with colleagues and managers, and disengagement from antiracism efforts, and contributed to staff turmoil and turnover. Conclusion: Previously, these emotional reactions and their impact on antiracism have only been described in the context of universities and by antiracist activists. This research identifies for the first time that these reactions also occur in health services in Aboriginal communities. Wider research is needed to better understand how these reactions impact on health service delivery to Aboriginal communities, and to evaluate ways of supporting staff to constructively navigate these reactions and develop antiracist, decolonised professional practice.

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ABSTRACT
National standards require health professionals to address racism in health service delivery at individual and systemic levels. However, identifying racism elicits strong emotional reactions including denial, anger, guilt and shame, fear, loss of belonging and disgust. These emotional reactions shut down critical reflection on racism and thwart antiracist initiatives. These emotional reactions need to be better understood in order to successfully develop antiracist professional practice. This research examines how health professionals working in remote Aboriginal communities engage with antiracism in their professional practice, whether it elicits strong emotional reactions, and if so whether these emotional reactions impact on their health service delivery. Eleven non-Indigenous allied health professionals were
interviewed in a semi-structured format. Interviews were transcribed and thematically analysed. Themes were compared against existing literature. Every professional interviewed identified overwhelming and difficult emotions in their work that they linked to racism, white privilege and colonisation. Professionals reported grappling with denial, anger, guilt, shame, fear, anxiety and perfectionism, loss of belonging, disgust, and care. They reported the emotions cause exhaustion, poor performance, tensions with colleagues and managers, burnout, leaving remote jobs and changing professions. Previously these emotional reactions and their impact on antiracism have only been described in the context of universities and by antiracist activists. This research identifies for the first time that these reactions also occur in health services working with remote Aboriginal communities in Australia. This indicates the need for wider research to understand how these emotional reactions impact health service delivery to Aboriginal communities. It also demonstrates the need to trial and evaluate ways to support staff constructively navigate these reactions and develop antiracist, decolonised professional practice.

Objectives To assess the effectiveness of clinical decision support systems (CDSSs) at reducing unnecessary and suboptimal antibiotic prescribing within different healthcare settings. Methods A systematic review of published studies was undertaken with seven databases from database inception to November 2018. A protocol was developed using the PRISMA-P checklist and study selection criteria were determined prior to performing the search. Critical appraisal of studies was undertaken using relevant tools. Meta-analyses were performed using a random-effects model to determine whether CDSS use affected optimal antibiotic management. Results Fifty-seven studies were identified that reported on CDSS effectiveness. Most were non-randomized studies with low methodological quality. However, randomized controlled trials of moderate methodological quality were available and assessed separately. The meta-analyses indicated that appropriate antibiotic therapy was twice as likely to occur followi...

Background: Clinical decision support systems (CDSS) are designed to promote evidence-based patient care and shared-decision making in healthcare settings. Despite these benefits, adoption and long-term use of the systems remain limited. There is a need to identify different factors that influence CDSS adoption in healthcare settings.Objective: The Unified Theory of Acceptance and Use of Technology (UTAUT) model was applied to determine different factors that influence the adoption of CDSS in healthcare settings.Methods. A cross-sectional online survey examining clinicians’ perceptions about CDSS implementation in hospital and primary care settings in Australia was undertaken from June - October 2019. Multivariate logistic regression was used to examine the association of UTAUT moderators (age, gender and experience) and care settings (hospital and primary care) with perceived benefits, barriers and facilitators to CDSS adoption.Results: Access to information required for evidence-b...

The study evaluated individual and setting-specific factors that moderate clinicians’ perception regarding use of clinical decision support systems (CDSS) for antibiotic management. A cross-sectional online survey examined clinicians’ perceptions about CDSS implementation for antibiotic management in Australia. Multivariable logistic regression determined the association between drivers of CDSS adoption and different moderators. Clinical experience, CDSS use and care setting were important predictors of clinicians’ perception concerning CDSS adoption. Compared to nonusers, CDSS users were less likely to lack confidence in CDSS (OR = 0.63, 95%, CI = 0.32, 0.94) and consider it a threat to professional autonomy (OR = 0.47, 95%, CI = 0.08, 0.83). Conversely, there was higher likelihood in experienced clinicians (>20 years) to distrust CDSS (OR = 1.58, 95%, CI = 1.08, 2.23) due to fear of comprising their clinical judgement (OR = 1.68, 95%, CI = 1.27, 2.85). In primary care, clinicia...

To ignite, inspire, and include audiences who may not otherwise have engaged with this material is a wonderful gift given by Carter. More than just a "helpful aid," Carter's book succeeds in providing a window into the world behind the New Testament by offering a comprehensive exploration of the historical, religious, socio-cultural, and political contexts for a broad spectrum of communities.

Introduction
Electroconvulsive Therapy (ECT) is one of the most controversial and misunderstood treatments in modern psychiatry. Despite its contentious history, ECT has evolved into a safe and effective treatment for a variety of psychiatric disorders, particularly those resistant to pharmacotherapy. The practice of ECT involves the induction of controlled seizures through electrical stimulation of the brain, and its application has expanded over the years to address a wide array of conditions, including bipolar disorder, major depressive disorder, catatonia, and psychosis. This essay provides a comprehensive overview of ECT, tracing its historical development, examining its current clinical applications, exploring its physiological mechanisms, and evaluating its safety and future as a psychiatric treatment.

The community of inquiry methodology was developed by Professor Matthew Lipman to enable the teaching of philosophy in schools. Lipman felt that inquiry based learning was essential in schools because he felt that:

Education should empower children to be thoughtful about the lives they lead, and doing philosophy is important to that goal.

The community of inquiry is a powerful pedagogical tool to foster student engagement, critical thinking, collaborative and affective skills development. As such it can be useful in the bioethics classroom. This paper describes the community of inquiry methodology, and how it can be a useful arrow in quiver of someone teaching bioethics.

In this paper I discuss the often made claim that “bad science is bad ethics”. This claim is typically used by Research Ethics Committees to justify rejecting scientifically problematic research projects on ethical grounds. However I will show that while a piece of research being scientifically poor does make it ethically problematic, this is not always good grounds for an ethics committee to reject it. In particular I will draw a distinction
between morally bad and morally poor research and argue that the role of an ethics committee is to enforce morally satisfactory behaviour and encourage morally excellent behaviour. This being the case, I claim that ethics committees ought to reject morally bad research, but not reject morally poor research.

This paper is in part a response to the model of human subjects ethics review proposed by Bryn Williams-Jones & Soren Holm in Research Ethics Review (2005) and the current proposed ethical review process at the University of Ulster. In it I will suggest an alternative model of ethical review which removes some of the deficiencies that might come with devolved systems of ethical review, whilst maintaining some of their efficiency.

In this brief paper I intend to make some distinctions between the activities that research ethics committees are required to undertake as part of their role in protecting research
participants. These functions are, identifying ethical issues and risks within research projects, providing advice on how to resolve these issues and risks without compromising the validity of the research and finally, when this cannot be achieved, deciding whether the research should still be allowed to go ahead. Distinguishing these distinct functions allows us to determine what an appropriate membership of a Research Ethics Committee is. I will sketch out the implications of these functions for the appropriate membership of NHS and university based ethics committees in the UK.

It is an uncontested truth that many medical students and practising clinicians dread having to get their research proposal through a research ethics committee. In this paper, the author, a long-standing member of a research ethics committee, offers a practical guide on applying for research ethics approval, detailing common mistakes and flaws in applications, and giving specific guidance on getting through what can seem a daunting process.

It is now typical for human subjects research to be regulated by review by an independent research ethics committee in most jurisdictions. However it is common for countries to opt to only compulsorily regulate medical research while leaving some or all non-medical research either unregulated or only regulated on a voluntary basis. In this paper I will argue, using regulation in the UK as an example, that it is difficult to justify this sharp distinction in practices. While I won't come to any definitive conclusions in this paper as to whether research ought to be regulated compulsorily I will suggest that we would be better to regulate all research, albeit perhaps with a lighter touch than the present UK system if we want to prevent some highly risky research avoiding appropriate regulation. I will examine several arguments to defend making such a distinction; that medical professionals have special moral duties, that medical research has a higher magnitude/frequency of risks and that regulating non-medical research constitutes the inappropriate imposition of the medical model onto non-medical research. Having critiqued these objections I will then discuss the advantages of harmonizing the regulation of research and conclude that there is not a good reason to treat medical and non-medical research as fundamentally different in kind.

New genetic technologies can not only be used to ‘cure’ many significant health care conditions, but at least potentially they can be used in ways that either change the user’s identity significantly and/or cause a different person to come into existence. It might be argued that these technologies present a challenge for Luck Egalitarians - the essence of this challenge is the claim that, given a commitment towards luck neutralisation, a Luck Egalitarian ought to be committed to equalisation of talent using this technology, which appears repugnant. In this paper I will argue that this challenge is not as powerful as it appears, and that Luck Egalitarianism has sufficient resources to resist a commitment to equalisation of talent of a repugnant kind. Furthermore it provides us a useful framework to consider the introduction of technologies of this nature.

Any new technology faces several significant ethical challenges before we might think it ought to be developed, we might be concerned about the risks involved in the research, or the risks involved in the widespread availability of the technology. Alternatively we might be concerned by the impact of the technology on the pattern of distribution of resources available, or the opportunities available to people. In other words we might be concerned by the impact of the new technology on distributive justice. This is a recurring objection to the exploration and development of new technologies is the implications that they have in terms of justice. In this paper I will explore this line of objection and how we ought to think about justice in the context of the development and introduction of new technologies. I will argue that justice rarely provides a reason not to investigate, develop and introduce new technologies though it may have significant implications for how they ought to be introduced. In particular I will focus on the time dependency of justice objections and argue that often these function by only looking at the implications of the introduction of the technology at that point rather than the more important impact on patterns of distribution and opportunity in the long run.

In this Open peer commentary I respond to one of the arguments given by David Wendler in his forthcoming paper A New Justification for Pediatric Research Without Clinical Benefit. I suggest that he is too quick to reject parental authority as a justification for minimal risk research with children without clinical benefit. I argue that his argument holds researchers to an unreasonably high standard in regards to parental decision making, a much higher standard than we would hold parents to making similarly risky decisions. Hence for Wendler's argument to work we would need a justification for research exceptionalism – holding researchers to a much higher standard than others.

This paper argues that neither the Argument from Evil, nor responses to it can be genuinely ethically neutral since both rely on normative claims that not all moral theories endorse. I argue that this is particularly problematic for those proposing theodicies since to explain all evils they are required to endorse moral claims that most theists would reject.