ORCID Profile
0000-0002-5652-9451
Current Organisation
Flinders University
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Applied Ethics | Law And Society | Applied Ethics (Incl. Bioethics And Environmental Ethics) | Human Bioethics |
Justice and the law not elsewhere classified | Bioethics | Health policy evaluation
Publisher: Wiley
Date: 19-07-2016
DOI: 10.1111/JAN.13046
Abstract: The aim of this study was to examine factors impacting family presence during resuscitation practices in the acute care setting. Family presence during resuscitation was introduced in the 1980s, so family members/significant others could be with their loved ones during life-threatening events. Evidence demonstrates important benefits yet despite growing support from the public and endorsement from professional groups, family presence is practiced inconsistently and rationales for poor uptake are unclear. Constructivist grounded theory design. Twenty-five health professionals, family members and patients informed the study. In-depth interviews were undertaken between October 2013-November 2014 to interpret and explain their meanings and actions when deciding whether to practice or participate in FPDR. The Social Construction of Conditional Permission explains the social processes at work when deciding to adopt or reject family presence during resuscitation. These processes included claiming ownership, prioritizing preferences and rights, assessing suitability, setting boundaries and protecting others/self. In the absence of formal policies, decision-making was influenced primarily by peoples' values, preferences and pre-existing expectations around societal roles and associated status between health professionals and consumers. As a result, practices were sporadic, inconsistent and often paternalistic rather than collaborative. An increased awareness of the important benefits of family presence and the implementation of clinical protocols are recommended as an important starting point to address current variations and inconsistencies in practice. These measures would ensure future practice is guided by evidence and standards for health consumer safety and welfare rather than personal values and preferences of the in iduals 'in charge' of permissions.
Publisher: Mary Ann Liebert Inc
Date: 10-2011
Abstract: The study objectives were to examine the effectiveness of acupuncture for reducing infertility-related stress. The study design was a randomized controlled trial of acupuncture compared with a wait-list control. The study was conducted at The University of Western Sydney. Thirty-two (32) women aged 20-45 years, with a diagnosis of infertility, or a history of unsuccessfully trying to conceive for 12 months or more, were the subjects of the study. Women received six sessions of acupuncture over 8 weeks. The primary outcomes were infertility self-efficacy, anxiety, and infertility-related stress. The women's experience of infertility and acupuncture is also reported. At the end of the 8-week intervention, women in the acupuncture group reported significant changes on two domains on the Fertility Problem Inventory with less social concern (mean difference [MD] -3.75, 95% confidence interval [CI] -7.58 to 0.84, p=0.05), and less relationship concern (MD -3.66, 95% CI -6.80 to -0.052, p=0.02). There were also trends toward a reduction of infertility stress on other domains, and a trend toward improved self-efficacy (MD 11.9, 95% CI -2.20 to 26.0, p=0.09) and less anxiety (MD -2.54, 95% CI -5.95 to 0.86, p=0.08) in the acupuncture group compared with the wait-list control. Women described the experience and impact of acupuncture as positive relating to a sense of relaxation and time out, the engagement with the practitioner, and an intervention that had very few negative side-effects. Changes were also perceived after treatment with women describing a physical and psychologic sense of relaxation and calmness, and a changed perspective in relation to coping. Acupuncture may be a useful intervention to assist with the reduction of infertility-related stress. Further research is justified.
Publisher: Informa UK Limited
Date: 03-2013
DOI: 10.3109/14647273.2013.770173
Abstract: Frozen storage of supernumerary in vitro fertilisation (IVF) embryos benefits patients, but when a decision is required for their disposal this may be experienced as a difficult, emotionally loaded process for many patients. There is the potential at several points for patients to become "stuck" in their decision making and a need for clinics to consider information provision, and implications and decision support counselling to patients in the aftermath of infertility treatment. This paper presents a review of studies about decision making for supernumerary embryos and the implications for counselling within clinics.
Publisher: Wiley
Date: 20-01-2019
DOI: 10.1111/AOGS.13528
Abstract: Studies have shown in vitro fertilization (IVF) treatment to have a significant impact on women's quality of life. In addition, anxiety is experienced during IVF treatment and prior to knowing the outcome from a treatment cycle. Although support services are available at many IVF clinics, the uptake of these opportunities may not be high. Acupuncture is used by women undertaking IVF treatment in the belief that it improves their reproductive outcomes, and some studies suggest that it may reduce anxiety. The objective of this study was to examine the effects of acupuncture compared with sham acupuncture on quality of life and anxiety for women undergoing an IVF cycle. A multicenter randomized controlled trial was conducted in Australia and New Zealand. Women were eligible if they were aged 18-42 years, undergoing a fresh IVF cycle and not using acupuncture. Recruitment occurred between June 2011 and October 2015. Women were randomized to acupuncture or a sham acupuncture control group and three treatments were administered, the first treatment between day 6 and 8 of ovarian stimulation, and two treatments were given on the day of embryo transfer. The primary outcome was livebirth. Secondary outcomes included quality of life and anxiety, and were assessed at baseline, on the day of embryo transfer and 14 weeks from trial entry. In all, 848 women were randomized to the trial, 608 women underwent an embryo transfer, of which 526 (86%) received all three treatments. Adjusted analysis found that women receiving acupuncture reported reduced anxiety following embryo transfer (mean difference [MD] -1.1, 95% CI -2.2 to -0.1, P = 0.03). Unadjusted analysis of quality of life did not differ between groups following embryo transfer. Adjusted analyses by per protocol found a significant positive change for the acupuncture group for the general health MOS Short Form 36 (SF36) domain (MD 2.6, 95% CI 0.5-4.7, P = 0.01) following embryo transfer. The benefit was not sustained at 14 weeks (MD 0.1, 95% CI -2.7 to 2.9). Acupuncture may reduce anxiety at embryo transfer. Quality of life did not differ between the groups. Women experience reduced emotional well-being 3 months following the IVF cycle, highlighting ongoing unmet psycho-social needs.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2016
Publisher: Oxford University Press (OUP)
Date: 10-03-2005
Abstract: Many patients prefer to donate unused embryos when surveyed. However, it is a source of frustration and curiosity that clinical audits of embryo outcomes show the majority changed their minds. In many clinics, the number of recipients continues to outweigh the number of donors. To plan effective counselling practices, it is important to understand the dynamics of decision-making for patients when determining outcomes for unused embryos. Twelve couples and nine women (n = 33) who had discarded unused embryos were interviewed using a narrative structure and various interview techniques. Interview transcripts underwent qualitative analysis through which data were grouped thematically according to similarities. Differences were also examined. Participants described their initial choice to donate embryos as an idealistic plan rather than a purposeful decision. Their change of mind was due to two factors: (i) a change in their standpoint from a childless couple to parents and (ii) a change in the symbolism of the embryo from representing a chance to become pregnant to representing a 'virtual' child in cryo-storage. The meaning of embryo donation was likened to child relinquishment. Counselling and social policy need to take account of the symbolism of the embryo and reform current practices.
Publisher: Elsevier BV
Date: 07-2014
DOI: 10.1016/J.RBMO.2014.03.014
Abstract: The importance of providing evidence-based health care in reproduction medicine has resulted in a wealth of research which has largely focused on patient outcomes. Comparatively little is known about the knowledge and attitudes of health professionals who are often required to contribute to research. This study sought to examine the knowledge and attitudes to research of reproductive medicine health professionals and to explore the motivators and barriers to participating in research. A cross-sectional online survey was developed from previous research. The survey was distributed to members of the Fertility Society of Australia between November 2012 and February 2013. Ninety-six health professionals consented to participate and completed the questionnaire. The majority acknowledged the importance of research in informing practice and improving patient outcomes. While many clinicians expressed an interest in participating in research, time and resources were acknowledged as barriers that hindered their involvement. Collaborations with academics may offer a pathway to building the evidence to improve patient care. There is increasing focus on improving patient outcomes from reproductive treatment by using research to inform clinical practice. However little is known about the views of reproductive nurses, counsellors and doctors about the role of research in their day to day clinical work. This study examined the knowledge and attitudes to research of reproductive medicine health professionals, and explored factors that may motivate or create barriers to their involvement in research. We conducted a survey in Australia between November 2012 and February 2013. Ninety-six health professionals consented to participate and completed the questionnaire. The majority indicated the importance of research influencing their clinical practice, and the role research has with improving patient outcomes. Many clinicians indicated they would like to participate in research, however time and resources were acknowledged as barriers which stopped their involvement.
Publisher: Oxford University Press (OUP)
Date: 21-07-2005
Abstract: It has been argued that terminology in reproductive medicine related to reproductive success is ambiguous, confusing and misleading. A proposed solution is the conditional use of the term 'fertility' which is qualified according to statements concerning description, diagnosis and prognosis, and for which a grading system is proposed. We argue that there already exists (from 1989) a well-articulated conceptualization of fertility that does not appear to have been well disseminated within reproductive medicine. Within this conceptualization there is an important place for separate terms that clearly distinguish aetiology from outcome. We therefore see a central role for maintaining and articulating the terms fecundity and fertility. It is also suggested that one source of confusion within reproductive medicine stems from the conflation of interests for clinicians and patients when discussing infertility as both a cause and an outcome. Unpacking the meaning of the term 'infertility' reveals a complex of interdependent concepts that are both social and biological in origin.
Publisher: American Medical Association (AMA)
Date: 15-05-2018
Publisher: Springer Science and Business Media LLC
Date: 12-2009
Abstract: In Vitro Fertilisation (IVF) is now an accepted and effective treatment for infertility, however IVF is acknowledged as contributing to, rather than lessening, the overall psychosocial effects of infertility. Psychological and counselling interventions have previously been widely recommended in parallel with infertility treatments but whilst in many jurisdictions counselling is recommended or mandatory, it may not be widely used. Acupuncture is increasingly used as an adjunct to IVF, in this preliminary study we sought to investigate the experience of infertile women who had used acupuncture to improve their fertility. A s le of 20 women was drawn from a cohort of women who had attended for a minimum of four acupuncture sessions in the practices of two acupuncturists in South Australia. Eight women were interviewed using a semi-structured questionnaire. Six had sought acupuncture during IVF treatment and two had begun acupuncture to enhance their fertility and had later progressed to IVF. Descriptive content analysis was employed to analyse the data. Four major categories of perceptions about acupuncture in relation to reproductive health were identified: (a) Awareness of, and perceived benefits of acupuncture (b) perceptions of the body and the impact of acupuncture upon it (c) perceptions of stress and the impact of acupuncture on resilience and (d) perceptions of the intersection of medical treatment and acupuncture. This preliminary exploration, whilst confined to a small s le of women, confirms that acupuncture is indeed perceived by infertile women to have an impact to their health. All findings outlined here are reported cautiously because they are limited by the size of the s le. They suggest that further studies of acupuncture as an adjunct to IVF should systematically explore the issues of wellbeing, anxiety, personal and social resilience and women's identity in relation to sexuality and reproduction.
Publisher: SAGE Publications
Date: 19-11-2017
Abstract: Studies have established that negative perceptions of people living with HIV/AIDS exist among nursing students throughout the world, perceptions which can be detrimental to the delivery of high-quality nursing care. The purpose of this research was to explore socio-cultural influences on the perceptions of nursing students towards caring for people living with HIV/AIDS. The study was guided by stigma theory, a qualitative descriptive research approach was adopted. Data collected via semi-structured interviews were thematically analysed. Participants were 21 international and Australian undergraduate nursing students enrolled in a Bachelor of Nursing programme at an Australian university. Ethical approval was granted by the Social and Behavioural Research Ethics Committee at the study university. Participation was entirely voluntary informed consent was obtained before the study commenced confidentiality and anonymity were assured. Three major themes were found: blame, othering and values. Complex and interrelated factors constructed participant perceptions of people living with HIV/AIDS, perceptions underscored by the prevailing culturally construed blame and othering associated with HIV/AIDS. The study found discordance between the negative personal beliefs and perceptions some nursing students have towards people living with HIV/AIDS, and the professional values expected of them as Registered Nurses. There was considerable commonality between this and previous studies on how homosexuality and illicit drug use were perceived and stigmatised, correlating with the blame directed towards people living with HIV/AIDS. These perceptions indicated some nursing students potentially risked not fulfilling the ethical and professional obligations the Registered Nurse. Nursing curriculum should be strengthened in relation to comprehending the meaning of being stigmatised by society. Educational institutions need to work towards enhancing strategies that assist nursing students to reconcile any incongruity between their personal beliefs and requisite professional nursing values.
Publisher: Hindawi Limited
Date: 2014
DOI: 10.1155/2014/794380
Abstract: Objective . This research aimed to investigate the fertility management of women aged over 30 years prior to a termination of pregnancy (TOP) to inform primary health care service delivery providers and policy makers. Design . An ethically approved, two-phase sequential explanatory mixed methods design was used. This paper reports on part of that study. Setting . The study was conducted in five South Australian TOP clinics. Patients . Women aged over 30 years attending for a TOP in 2009 were invited to participate. Interventions . The Contraception Sexual Attitude Questionnaire (modified version) of women attending termination of pregnancy services was used. Main Outcomes Measures . Quantitative data analysis utilized SPSS V16 where simple descriptive statistics were described. Results . There were 101 questionnaire respondents where 70.5% were Australian women, predominantly married and with children. Women used contraception but experienced method failure, were beginning a new method, or were afraid of side effects. Risk-taking behaviours were reported such as putting the possibility of pregnancy out of their mind, getting carried away and not thinking of pregnancy risk, or frequently having unprotected intercourse. Conclusion . Service delivery needs to include age specific programs, and policy makers need to include policies which are adequately funded and evaluated. Further research is required to provide greater depth of knowledge in this area.
Publisher: Wiley
Date: 17-08-2017
DOI: 10.1111/JOG.13449
Abstract: To compare perinatal outcomes for neonates conceived with donated sperm with those for neonates conceived spontaneously in an Australian population cohort. Perinatal outcomes for all births in South Australia for the period January 1986-December 2002 were linked with assisted reproductive treatment records to determine those conceived from donated sperm. Birth outcome measures were analyzed using Student's t-test and logistic regression using generalized estimating equations to determine statistical significance. Donor sperm neonates were not significantly different from their spontaneously conceived counterparts in terms of mean birthweight, low birthweight, preterm delivery, small for gestational age, or large for gestational age. They were, however, significantly more likely to be born at lower mean gestational age (P = 0.012), and to have preterm delivery with low birthweight (P = 0.008), when controlling for maternal age, parity, ethnicity, socioeconomic quartile and baby's sex. These associations were not apparent when singletons and twins were considered separately. There was some evidence of compromised perinatal outcomes for donor sperm neonates compared with their spontaneously conceived counterparts, which appeared to be partly attributable to multiplicity.
Publisher: Wiley
Date: 11-08-2009
DOI: 10.1111/J.1440-1800.2009.00461.X
Abstract: In this paper we comment on the changes in the provision of fertility care in Australia, New Zealand and the UK to illustrate how different funding arrangements of assisted reproductive technologies (ART) shape the delivery of patient care and the position of fertility nursing. We suggest that the routinisation of in vitro fertilisation technology has introduced a new way of managing the fertility patient at a distance, the distal fertility patient. This has resulted in new forms of organisational routines in ART which challenge both traditional forms of nursing and advanced nursing roles. We discuss the consequences of this increasingly globalised approach to infertility through the lens of three national contexts, Australia, New Zealand and the UK to unpack the position of nursing within the new forms of organisational routines.
Publisher: Elsevier BV
Date: 03-2011
DOI: 10.1111/J.1600-6143.2010.03432.X
Abstract: Donation after cardiac death (DCD) offers an alternative pathway to donation for some donors. Successful recovery of organs for transplantation following DCD requires that organ recovery surgery commence as soon as possible after death has occurred. This limits the amount of time that family and friends can spend with the donor prior to surgery. The aim of this study was to identify community views about the timing of organ recovery in DCD. Data were collected from two sources in South Australia: 32 members of the public participated in four focus groups, and 2693 adults participated in a representative population survey. Respondents were asked their views about a decent interval to wait after death prior to organ recovery surgery. Focus group participants identified a tension between preserving organ viability and allowing families time with the deceased. Of the survey respondents, 45.2% selected a timeframe compatible with potentially viable donations 34.1% selected a timeframe incompatible with viable donations and 20.8% gave an indeterminate answer. These findings provide information about public perceptions of DCD, can be used to inform educational c aigns about DCD and serve as a baseline for evaluating such c aigns, and identify a number of areas for further investigation.
Publisher: Oxford University Press (OUP)
Date: 25-03-2004
Publisher: Cambridge University Press (CUP)
Date: 03-05-2018
Publisher: Springer Science and Business Media LLC
Date: 25-09-2017
Publisher: Wiley
Date: 08-02-2018
DOI: 10.1111/JOCN.14222
Abstract: To examine how clinicians practise the principles of beneficence when deciding to allow or deny family presence during resuscitation. Family presence during resuscitation has important benefits for family and is supported by professional bodies and the public. Yet, many clinicians restrict family access to patients during resuscitation, and rationales for decision-making are unclear. Secondary analysis of an existing qualitative data set using deductive category application of content analysis. We analysed 20 interview transcripts from 15 registered nurses, two doctors and three paramedics who had experienced family presence during resuscitation in an Australian hospital. The transcripts were analysed for incidents of beneficent decision-making when allowing or denying family presence during resuscitation. Decision-making around family presence during resuscitation occurred in time poor environments and in the absence of local institutional guidelines. Clinicians appeared to be motivated by doing "what's best" for patients and families when allowing or denying family presence during resuscitation. However, their in idual interpretations of "what's best" was subjective and did not always coincide with family preferences or with current evidence that promotes family presence during resuscitation as beneficial. The decision to allow or deny family presence during resuscitation is complex, and often impacted by personal preferences and beliefs, setting norms and tensions between clinicians and consumers. As a result, many families are missing the chance to be with their loved ones at the end of life. The introduction of institutional guidelines and policies would help to establish what safe and effective practice consists of, reduce value-laden decision-making and guide beneficent decision-making. These findings highlight current deficits in decision-making around FPDR and could prompt the introduction of clinical guidelines and policies and in turn promote the equitable provision of safe, effective family-centred care during resuscitation events.
Publisher: Wiley
Date: 03-2002
DOI: 10.1046/J.1440-1800.2002.00126.X
Abstract: This paper reports an aspect of a poststructural feminist study in which I explored the discursive formations within which women for whom in vitro fertilisation (IVF) was unsuccessful constitute themselves. In my exploration I draw on data from interviews with women who discontinued infertility treatment, print media material and infertility self-help books. Specifically, I highlight a metaphor of lottery in discourses of infertility, arguing that it is hegemonic and showing how when women are situated as gamblers, the metaphor is instrumental in polarising them into 'winners' or 'losers' in relation to the subjectivity of motherhood. I further deconstruct these subjectivities, showing how 'winners' are valorised and 'losers' are pathologised. But importantly, I show how infertile women who are not mothers resisted locating themselves as 'losers' in a metaphor of lottery and instead situated themselves in a contesting metaphor of investment as diligent 'workers' and as active agents in choosing the best employment of their bodily and monetary resources. This paper therefore lifies the marginalised perspective of infertile women who are not mothers.
Publisher: Springer Science and Business Media LLC
Date: 18-05-2012
Publisher: University of Toronto Press Inc. (UTPress)
Date: 2013
Publisher: Oxford University Press (OUP)
Date: 11-01-2016
Publisher: Elsevier BV
Date: 03-2006
Publisher: Oxford University Press (OUP)
Date: 06-01-2015
Abstract: How is the welfare principle interpreted and practised and what meaning does it hold for health professionals who must apply it in assisted reproductive technology (ART)? The welfare of a child is a meaningful concept to ART counsellors but it is also impractical when applied preconception. Policy which promotes the interests of a child to be born is inconsistent between and within countries, and has been widely criticized as meaningless, as an unfair imposition and for its lack of clarity and inconsistent translation to ART practice. We conducted a qualitative study of ART counsellors in Australia and New Zealand in 2012. This study took an inductive approach. Thirty-two counsellors (15 psychologists and 17 social workers) participated in 6 focus groups. Vignettes were used to focus and stimulate discussion of how the welfare of all participants but especially the interests of a non-existent child were interpreted and operationalized in practice. Qualitative descriptive content analysis was used to analyse the data into themes. Five themes emerged in the data: giving presence to the child that could be, balancing welfare interests, welfare concerns, balancing values and making a decision and screening and legal presumptions against treatment. Themes were validated according to qualitative research standards. The study showed that counsellors take the child welfare principle seriously but that the concept is indeed slippery and difficult to operationalize. Counsellors denied a role in screening patients for parenting fitness but were engaged in health care assessment of patients and these roles need further differentiation, clarity and research. Health care practitioners would benefit from a process that reviews decisions and clarifies professional values. Participants were drawn from only two of the six Australian states and two territories. The study provides insight and deeper understanding of how welfare principles play out in counselling practice, what gives them meaning and the difficulties of balancing various interests and values. Our findings have shown that the welfare of a child can be a meaningful concept to ART counsellors but that it can also be impractical and unclear. Despite differences in legislation among countries, our study contributes to the growing data and debate emerging from the USA and the UK. This study was funded by a Flinders University Faculty of Health Sciences Grant. There are no conflicts of interest. Not applicable.
Publisher: Elsevier BV
Date: 02-2016
Publisher: Elsevier BV
Date: 06-2012
DOI: 10.1016/J.RBMO.2012.01.014
Abstract: Increasingly, important areas of medical therapy and research rely on the donation and use of human embryos. Yet their use is commonly determined by community tolerance and ethico-legal regulation. The aim of this study was to explore the views of an Australian community about what an embryo is, how it should be used and who should make disposition decisions. The findings of a large representative population survey showed that most participants thought of an embryo as human or potentially human but that this did not affect a majority community view that embryos should be used rather than discarded. This study also found ergent views about what the community perceived to be acceptable uses of embryos. The majority perceived the couple as having the authority to make a disposition decision. Women held different views to men across all three questions. The way an embryo was perceived related significantly to how it should be used and who should decide its disposition. These differences and relationships should be considered when developing clinic practices and ethico-legal frameworks to regulate embryo use in science or treatment.
Publisher: Cambridge University Press (CUP)
Date: 30-08-2016
DOI: 10.1017/S2040174416000489
Abstract: Although the use of donor sperm as a treatment modality for male infertility has become common place, the health outcomes for those conceived has been poorly studied. A structured search of the literature using PubMed, EMBASE and Cochrane Reviews was performed to investigate the health outcomes of offspring conceived from donor sperm. Eight studies were eligible and included in the review, and of these, three were included in a meta-analysis. Meta-analysis of clinical outcomes showed that donor sperm neonates are not at increased risk of being born of low birth weight ( g), preterm ( weeks) or with increased incidences of birth defects, than spontaneously conceived neonates.
Publisher: Wiley
Date: 22-10-2016
Abstract: Perspectives on the status of human embryos and whether they should be discarded differ globally. Some countries protect embryos in law while in other countries embryos 'die' or 'succumb' in assisted reproductive technology clinics on a daily basis. This study analyses interview data drawn from a larger qualitative study conducted in South Australia from 2004-2007. 21 women and 12 of 21 partners were interviewed about the decision they made to discard their embryos. The analysis reported here sought to examine the ways in which women constructed and experienced the decision to discard embryos. The article highlights the ways in which embryo discard is a contested discursive space. Embryo death is sequestered through their confinement in the laboratory and their invisibility to the naked eye. The clinic treated embryo discard as disposal of biological waste and failed to acknowledge the meaning of the event. By contrast women experienced emotional bereavement described as similar to early pregnancy loss, and described experiences of attachment and grief. For sensitive and compassionate care these differences in perceptions of embryo discard need to be addressed.
Publisher: Oxford University Press (OUP)
Date: 07-04-2007
Abstract: In the final decision for the disposition of unused IVF embryos patients must choose between options involving either donation or destruction, and this decision must be made in a context where there is tension about the status of embryos (i.e. whether viewed as potential children or as a base for further development) and whether embryo donation is adoption or tissue donation. This study explored the emotive experience of making a decision for either the destruction or donation of unused embryos. Thirty-three patients (9 women and 12 couples) who discarded embryos and 15 (7 women and 4 couples) who donated embryos were interviewed. Interview data were analysed with particular attention to elements of moral deliberation and use of analogy. Adoption and tissue donation metaphors were both identified, and further, a metaphor of pregnancy termination was identified and found to be highly influential in the decision to donate embryos. Contrary to the majority of current evidence, this study found that participants who discarded embryos emphasized the adoption metaphor while embryo donors emphasized the metaphor of pregnancy termination. For each group the decision was driven by awareness of the option they did not want. The pregnancy termination metaphor emerged as morally relevant and this holds implications for defining and discussing embryo discard in counselling and consent processes.
Publisher: Oxford University Press (OUP)
Date: 29-03-2006
Abstract: This article critically reviews legislative and ethical frameworks that regulate embryo research. Australian legislation for embryo research is currently being reviewed. It is a legal mandate that scientists disclose to embryo donors any intent to pursue commercial gain from altruistic donation. But scientists are also required to inform donors that, as donors, they too must not benefit financially. In the same political context, public subsidy for IVF treatment is under review. There is contradiction in values and indication of inequity in the Australian social context. IVF is undervalued, yet products derived from IVF embryos are imbued with public hope. Rather than regulate to balance this inequity, assumptions of altruism and attention to autonomy in legislative framework give it further scope. This article proposes that justice be addressed by acknowledging reproductive effort, and thereby embryo research be considered in terms of reciprocity. It further proposes regulation of commercial profit and the imposition of a redirected tax levy.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2013
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1016/J.JVAL.2018.01.020
Abstract: In addition to theoretical justifications, many statistical methods have been used for selecting covariates to include in algorithms mapping nonutility measures onto utilities. However, it is not clear whether using exploratory factor analysis (EFA) as one such method improves the predictive ability of these algorithms. This question is addressed within the context of mapping a non-utility-based outcome, the core 23-item Women's Health Questionnaire (WHQ-23), onto two utility instruments: five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) and the six-dimensional health state short form (derived from short form 36 health survey) (SF-6D). Data on all three outcomes were collected from 455 women from the Australian general population participating in a study assessing attitudes toward in vitro fertilization. Statistical methods for selecting covariates included stepwise regression (SW), including all covariates (Include all), multivariable fractional polynomial (MFP), and EFA. The predictive accuracy of 108 regression models was assessed using five criteria: mean absolute error, root mean squared error, correlation, distribution of predicted utilities, and proportion of predictions with absolute errors of less than 0.0.5. Validation of "primary" models was carried out on random s les of the in vitro fertilization study. The best results for EQ-5D-5L and SF-6D predictions were obtained from models using SW, "Include all," and MFP covariate-selection approaches. Root mean squared error (0.0762-0.1434) and mean absolute error (0.0590-0.0924) estimates for these models were within the range of published estimates. EFA was outperformed by other covariate-selection methods. It is possible to predict valid utilities from the WHQ-23 using regression methods based on SW, "Include all," and MFP covariate-selection techniques.
Publisher: Cambridge University Press (CUP)
Date: 27-11-2015
DOI: 10.1017/S2040174415007898
Abstract: Donated oocytes are a treatment modality for female infertility which is also associated with increased risks of preecl sia. Subsequently it is important to evaluate if there is concomitant increased risks for adverse neonatal events in donated oocyte neonates. A structured search of the literature using PubMed, EMBASE and Cochrane Reviews was performed to investigate the perinatal health outcomes of offspring conceived from donor oocytes compared with autologous oocytes. Meta-analysis was performed on comparable outcomes data. Twenty-eight studies were eligible and included in the review, and of these, 23 were included in a meta-analysis. Donor oocyte neonates are at increased risk of being born with low birth weight ( g) [risk ratio (RR): 1.18, 95% confidence interval (CI): 1.14–1.22, P -value ( P ) .00001], very low birth weight ( g) (RR: 1.24, CI: 1.15–1.35, P .00001), preterm ( weeks) (RR: 1.26, CI: 1.23–1.30, P .00001), of lower gestational age (mean difference −0.3 weeks, CI: −0.35 weeks to −0.25 weeks, P .00001), and preterm with low birth weight (RR: 1.24, CI: 1.19–1.29, P .00001), when compared with autologous oocyte neonates. Conversely, low birth weight outcomes were improved in term donor oocyte neonates (RR: 0.86, CI: 0.8–0.93, P =0.0003). These negative outcomes remained significant when controlling for multiple deliveries. The donor oocyte risk rates are higher than those found in general ART outcomes, are important considerations for the counselling of infertile patients and may also influence the long term health of the offspring.
Publisher: Elsevier BV
Date: 02-2017
DOI: 10.1016/J.NEDT.2016.11.008
Abstract: Since HIV and AIDS were discovered, studies have demonstrated that negative perceptions and reluctance to provide care to affected people persist among nursing students throughout the world. This leads to poor quality care. To report on a study that explored socio-cultural influences on the perceptions of international nursing students toward caring for people living with HIV/AIDS. A qualitative descriptive research design, guided by stigma theory, was utilised. Participants were 21 international and Australian undergraduate nursing students enrolled in a Bachelor of Nursing program at an Australian university. Data were collected via semi-structured interviews in 2009 and 2011 manual thematic analysis was performed on interview data. Three major themes emerged: blame othering values. Perceptions were influenced by complex, interrelated factors and underscored by culturally construed blame and othering. People living with HIV/AIDS were perceived as alien and assumed as homosexuals, drug users, or promiscuous. They were labelled 'bad people'. Many participants were compassionate but others struggled with differences between their personal values and professional values expected of a Registered Nurse. There was considerable variation in the degree to which participants were willing to embrace different perspectives and values. Nursing curricula is vital to patient health and wellbeing and requires increased focus on the impact of HIV/AIDS. It is important for educators to recognise that simply providing information to students does not necessarily change their existing stigmatising perceptions. By addressing the effect of being stigmatised and marginalised by society nursing care to all patients will be enhanced. Students must also reflect on their perceptions and values so as to embrace ersity.
Publisher: Elsevier BV
Date: 02-2007
DOI: 10.1016/J.BPOBGYN.2006.08.003
Abstract: The clinical management of embryo storage and disposal is dynamic and subject to changes in the cultural context such as public debate and the implementation of public policy. Studies of the decisions made by patient couples for their embryos, and trends in decision-making over time and in relation to issues arising in the cultural context are rare. Studies of the attitudes that patient couples have towards their frozen embryos have largely focused on measuring patients' intentions in relation to publicly contentious outcomes. A small but expanding number of interview studies are illuminating the meaning that couples attribute to frozen embryos and how this influences decisions for their destiny. This chapter maps both quantitative and qualitative studies of patients' attitudes and decisions illuminating similarities and contradictions in study findings, and ultimately highlights the range of attitudes in patients, clinics and the community towards what is evidently a difficult and morally challenging decision to end the storage of frozen embryos.
Publisher: Oxford University Press (OUP)
Date: 2018
Publisher: Mary Ann Liebert Inc
Date: 06-2013
Publisher: Informa UK Limited
Date: 10-04-2017
Publisher: Springer Science and Business Media LLC
Date: 06-2017
Start Date: 2007
End Date: 12-2012
Amount: $105,000.00
Funder: Australian Research Council
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