BACKGROUND: Literature depicts differences in ethical decision-making (EDM) between countries and intensive care units (ICU). OBJECTIVES: To better conceptualise EDM climate in the ICU and to validate a tool to assess EDM climates. METHODS: Using a modified Delphi method, we built a theoretical framework and a self-assessment instrument consisting of 35 statements. This Ethical Decision-Making Climate Questionnaire (EDMCQ) was developed to capture three EDM domains in healthcare: interdisciplinary collaboration and communication; leadership by physicians; and ethical environment. This instrument was subsequently validated among clinicians working in 68 adult ICUs in 13 European countries and the USA. Exploratory and confirmatory factor analysis was used to determine the structure of the EDM climate as perceived by clinicians. Measurement invariance was tested to make sure that variables used in the analysis were comparable constructs across different groups. RESULTS: Of 3610 nurses and 1137 physicians providing ICU bedside care, 2275 (63.1%) and 717 (62.9%) participated respectively. Statistical analyses revealed that a shortened 32-item version of the EDMCQ scale provides a factorial valid measurement of seven facets of the extent to which clinicians perceive an EDM climate: self-reflective and empowering leadership by physicians; practice and culture of open interdisciplinary reflection; culture of not avoiding end-of-life decisions; culture of mutual respect within the interdisciplinary team; active involvement of nurses in end-of-life care and decision-making; active decision-making by physicians; and practice and culture of ethical awareness. Measurement invariance of the EDMCQ across occupational groups was shown, reflecting that nurses and physicians interpret the EDMCQ items in a similar manner. CONCLUSIONS: The 32-item version of the EDMCQ might enrich the EDM climate measurement, clinicians' behaviour and the performance of healthcare organisations. This instrument offers opportunities to develop tailored ICU team interventions.

• Klíčová slova
• communication, critical care, decision-making, teamwork,
• MeSH
• jednotky intenzivní péče * MeSH
• lékařský personál nemocniční MeSH
• lidé MeSH
• organizační kultura * MeSH
• rozhodování etika   MeSH
• sebezhodnocení (psychologie) * MeSH
• teoretické modely MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• validační studie MeSH

Assisted reproductive technologies (ARTs) can make a difference in biodiversity conservation. Their application, however, can create risks and raise ethical issues that need addressing. Unfortunately, there is a lack of attention to the topic in the scientific literature and, to our knowledge, there is no tool for the ethical assessment of ARTs in the context of conservation that has been described. This paper reports the first applications of the Ethical Assessment Tool (ETHAS) to trans-rectal ovum pick-up (OPU) and in vitro fertilization (IVF) procedures used in a northern white rhinoceros (Ceratotherium simum cottoni) conservation project. The ETHAS consists of two checklists, the Ethical Evaluation Sheet and the Ethical Risk Assessment, and is specifically customized for each ART procedure. It provides an integrated, multilevel and standardized self-assessment of the procedure under scrutiny, generating an ethical acceptability ranking (totally, partially, not acceptable) and a risk rank (low, medium, high), and, hence, allows for implementing measures to address or manage issues beforehand. The application of the ETHAS to the procedures performed on the northern white rhinoceros was effective in ensuring a high standard of procedures, contributing to the acceptability and improved communication among the project's partners. In turn, the tool itself was also refined through an iterative consultation process between experts and stakeholders.

• Klíčová slova
• animal welfare, assisted reproductive technologies, conservation ethics, ethical review process, ethical risk assessment, ethical self-assessment, northern white rhinoceros,
• Publikační typ
• časopisecké články MeSH

Genome Resources Banks (GRBs) represent vital repositories for the systematic collection, storage, and management of genetic material across various taxa, with a primary objective of safeguarding genetic diversity for research and practical applications. Alongside the development of assisted reproductive techniques (ART), GRBs have evolved into indispensable tools in conservation, offering opportunities for species preservation, mitigating inbreeding risks, and facilitating genetic management across fragmented populations. By preserving genetic information in a suspended state, GRBs serve as backups against population vulnerabilities, potentially aiding in the restoration of endangered species and extending their genetic lifespan. While evidence demonstrates the efficacy of GRBs, ethical considerations surrounding biobanking procedures for wildlife conservation remain largely unexplored. In this article, we will discuss possible ethical issues related to GRBs and the need to ethically monitor biobanking procedures in wildlife conservation. We will then propose a methodological tool, ETHAS, already in use for the ethical self-assessment of assisted reproduction techniques, to assess also biobanking procedures. ETHAS can make it possible to monitor a GRB from its design phase to its actual operation, helping to build biobanking procedures that meet high ethical standards.

• Klíčová slova
• Conservation ethics, Ethical self-assessment, Ethical tool, Ethics of biobanking, Genome resource bank, Research ethics,
• MeSH
• asistovaná reprodukce etika   MeSH
• banky biologického materiálu * etika   MeSH
• divoká zvířata * MeSH
• genom MeSH
• lidé MeSH
• ohrožené druhy * MeSH
• zachování přírodních zdrojů * metody   MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

PURPOSE: Apart from organizational issues, quality of inter-professional collaboration during ethical decision-making may affect the intention to leave one's job. To determine whether ethical climate is associated with the intention to leave after adjustment for country, ICU and clinicians characteristics. METHODS: Perceptions of the ethical climate among clinicians working in 68 adult ICUs in 12 European countries and the US were measured using a self-assessment questionnaire, together with job characteristics and intent to leave as a sub-analysis of the Dispropricus study. The validated ethical decision-making climate questionnaire included seven factors: not avoiding decision-making at end-of-life (EOL), mutual respect within the interdisciplinary team, open interdisciplinary reflection, ethical awareness, self-reflective physician leadership, active decision-making at end-of-life by physicians, and involvement of nurses in EOL. Hierarchical mixed effect models were used to assess associations between these factors, and the intent to leave in clinicians within ICUs, within the different countries. RESULTS: Of 3610 nurses and 1137 physicians providing ICU bedside care, 63.1% and 62.9% participated, respectively. Of 2992 participating clinicians, 782 (26.1%) had intent to leave, of which 27% nurses, 24% junior and 22.7% senior physicians. After adjustment for country, ICU and clinicians characteristics, mutual respect OR 0.77 (95% CI 0.66- 0.90), open interdisciplinary reflection (OR 0.73 [95% CI 0.62-0.86]) and not avoiding EOL decisions (OR 0.87 [95% CI 0.77-0.98]) were all associated with a lower intent to leave. CONCLUSION: This is the first large multicenter study showing an independent association between clinicians' intent to leave and the quality of the ethical climate in the ICU. Interventions to reduce intent to leave may be most effective when they focus on improving mutual respect, interdisciplinary reflection and active decision-making at EOL.

• Klíčová slova
• Decision-making, Ethical climate, Intent to leave, Interdisciplinary reflection, Respect,
• MeSH
• dospělí MeSH
• jednotky intenzivní péče etika   organizace a řízení   statistika a číselné údaje   MeSH
• lékařská etika MeSH
• lidé MeSH
• organizační kultura * MeSH
• péče o pacienty v kritickém stavu etika   psychologie   normy   MeSH
• postoj zdravotnického personálu MeSH
• průzkumy a dotazníky MeSH
• úmysl * MeSH
• zdravotnický personál psychologie   statistika a číselné údaje   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• Geografické názvy
• Evropa MeSH
• Spojené státy americké MeSH

BACKGROUND: Autonomy has become a key organizing principle in the official and expert discourses of the social services focused on strengthening of clients' independence and self-sufficiency. While "caring" has been seen as a threat to the autonomy of an individual, the care dependency and need for palliative care for people with dementia living in residential institutions are growing. METHODS: Participatory action research was realized in 9 homes providing services for people with dementia with the aim to improve the quality of care. Research teams from the homes were involved in assisted self-assessment which included observation, documentation analysis, workshops, interviews and interventions targeting the issues arising from practice. Ethnographic research was performed by the consultant/researcher to reflect on the experience. RESULTS: Over the last 15 years, the needs of clients in the residential care institutions in the Czech Republic have changed significantly and the pressure on people involved in direct care is growing. I suggest that relational approach to care, enhancing personal commitment of care workers and their appreciation of sociomateriality of caring relations, is well suited for enacting autonomy and dignity of people living and dying with dementia. The relational approach to care improvement is embedded in everyday practices and thus brings a wider scope of possibilities for providing good care than the controlling mode of improvement, measuring evidence against the national standards. CONCLUSIONS: If we are, as a collective, to build up appropriate structures and resources in dementia care, more attention must be paid to the needs of residents and care workers alike, as well as to realities of the daily practices.

• Klíčová slova
• Ethics of care, dementia, improvement, relational autonomy,
• MeSH
• demence ošetřování   MeSH
• lidé MeSH
• paliativní péče etika   normy   MeSH
• pečovatelské domovy * MeSH
• zdravotní služby pro seniory etika   normy   MeSH
• zlepšení kvality MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: Effective management of seasonal and pandemic influenza is a high priority internationally. Guidelines in many countries recommend antiviral treatment for older people and individuals with comorbidity at increased risk of complications. However, antivirals are not often prescribed in primary care in Europe, partly because its clinical and cost effectiveness has been insufficiently demonstrated by non-industry funded and pragmatic studies. METHODS AND ANALYSIS: Antivirals for influenza-Like Illness? An rCt of Clinical and Cost effectiveness in primary CarE is a European multinational, multicentre, open-labelled, non-industry funded, pragmatic, adaptive-platform, randomised controlled trial. Initial trial arms will be best usual primary care and best usual primary care plus treatment with oseltamivir for 5 days. We aim to recruit at least 2500 participants ≥1 year presenting with influenza-like illness (ILI), with symptom duration ≤72 hours in primary care over three consecutive periods of confirmed high influenza incidence. Participant outcomes will be followed up to 28 days by diary and telephone. The primary objective is to determine whether adding antiviral treatment to best usual primary care is effective in reducing time to return to usual daily activity with fever, headache and muscle ache reduced to minor severity or less. Secondary objectives include estimating cost-effectiveness, benefits in subgroups according to age (<12, 12-64 and >64 years), severity of symptoms at presentation (low, medium and high), comorbidity (yes/no), duration of symptoms (≤48 hours/>48-72 hours), complications (hospital admission and pneumonia), use of additional prescribed medication including antibiotics, use of over-the-counter medicines and self-management of ILI symptoms. ETHICS AND DISSEMINATION: Research ethics committee (REC) approval was granted by the NRES Committee South Central (Oxford B) and Clinical Trial Authority (CTA) approval by The Medicines and Healthcare products Regulatory Agency. All participating countries gained national REC and CTA approval as required. Dissemination of results will be through peer-reviewed scientific journals and conference presentations. TRIAL REGISTRATION NUMBER: ISRCTN27908921; Pre-results.

• Klíčová slova
• adaptive clinical trial, cost-benefit analysis, influenza, oseltamivir, primary healthcare,
• MeSH
• adaptivní klinické zkoušky jako téma MeSH
• analýza nákladů a výnosů MeSH
• antivirové látky ekonomika   terapeutické užití   MeSH
• bolesti hlavy virologie   MeSH
• časové faktory MeSH
• chřipka lidská komplikace   farmakoterapie   prevence a kontrola   MeSH
• činnosti denního života MeSH
• horečka virologie   MeSH
• hospitalizace MeSH
• léky bez předpisu terapeutické užití   MeSH
• léky na předpis terapeutické užití   MeSH
• lidé MeSH
• multicentrické studie jako téma MeSH
• myalgie virologie   MeSH
• oseltamivir ekonomika   terapeutické užití   MeSH
• péče o sebe MeSH
• pneumonie virologie   MeSH
• pragmatické klinické studie jako téma * MeSH
• určení symptomu MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• protokol klinické studie MeSH
• Názvy látek
• antivirové látky MeSH
• léky bez předpisu MeSH
• léky na předpis MeSH
• oseltamivir MeSH

Previously, scientists sometimes resorted to infecting themselves or colleagues with parasites, usually to assess the pathogenicity and obtain insight into the life cycles of the parasites, host specificity, and epidemiology. However, with recent research addressing the possible beneficial impact of intestinal helminths on a range of immune-mediated diseases in humans, these studies offer valuable information, although many are now considered unethical owing to a lack of experimental oversight and informed consent. Here, we critically review cases in which humans were deliberately infected with parasites. Moreover, we summarize the contribution of (self-) infections and propose protist and helminth candidates, chosen on the basis of several criteria, to test as possible therapy for selected human diseases.

• Klíčová slova
• autoimmune diseases, helminth therapy, helminths, protists, self-infection, volunteers,
• MeSH
• autoimunitní nemoci parazitologie   terapie   MeSH
• cizopasní červi imunologie   MeSH
• Eukaryota imunologie   MeSH
• imunitní systém - jevy MeSH
• interakce hostitele a parazita MeSH
• lékařská etika MeSH
• lidé MeSH
• parazitární nemoci imunologie   přenos   MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH

HYPOTHESIS: For cognitive behavioural therapy, acquisition and maintenance of psychotherapeutic and supervisory competencies is crucial. METHODS: The PubMed, Web of Science and Scopus databases were searched for articles containing the following keywords: cognitive-behavioural therapy, competencies, therapeutic relationship, intervention, technique, training, supervision, self-reflection, empirically supported, transference, countertransference, scheme of therapy, dialectical behaviour therapy. The search was performed by repeating the words in different combinations with no language or time limitations. The articles were sorted and key articles listed in reference lists were searched. In addition, original texts by A.T. Beck, J. Beck, C. Padesky, M. Linehan, R. Leahy, J. Young, W. Kuyken and others were used. The resources were confronted with our own psychotherapeutic and supervisory experiences and only most relevant information was included in the text. Thus, the article is a review with conclusions concerned with competencies in cognitive behavioural therapy. RESULTS: For cognitive behavioural therapy, four domains of competencies in psychotherapy are crucial - relationship, case assessment and conceptualization, self-reflection and intervention. These may be divided into foundational, specific and supervisory. The foundational competencies include recognition of empirical basis for a clinical approach, good interpersonal skills, ability to establish and maintain the therapeutic relationship, self-reflection, sensitivity to a difference and ethical behaviour. The specific competencies involve the skill of case conceptualization in terms of maladaptive beliefs and patterns of behaviour, ability to think scientifically and teach this to the patient, structure therapy and sessions, assign and check homework, etc. The supervisor's competencies include multiple responsibilities in supporting the supervisee, identification and processing of the therapist's problems with the patient, continuous development, increasing the supervisee's self-reflection, serving as an example and being as effective as possible in the role of a clinical instructor. CONCLUSION: Both the literature and our own experiences underline the importance of competencies in cognitive behavioural therapy and supervision.

• MeSH
• kognitivně behaviorální terapie výchova   metody   normy   MeSH
• lidé MeSH
• pracovní síly MeSH
• psychoterapie výchova   MeSH
• zdravotnický personál výchova   normy   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Spiritual health is a topic of emergent interest; however, lack of a clear distinction between spiritual health and religious involvement makes it difficult to understand the potential role of spiritual health as a determinant of health. Analyses of such relationships that cross countries and cultures are rare. We therefore assessed whether differences exist between spiritual health and religious involvement and their respective associations with general indicators adolescent health. The study was based on the 2013/2014 Health Behaviour in School-aged Children study conducted in Canada (n = 10 761) and the Czech Republic (n = 4411). In both countries, we failed to identify strong or statistically significant associations between self-reported religiosity and adolescent health. In contrast, adolescents with higher spiritual health scores consistently reported enhanced levels of general health status. Study findings point to the importance of a strong sense of spiritual health as a protective determinant of adolescent health, and raise questions about religious involvement as protective to adolescent health outcomes.

• Klíčová slova
• religiosity, spiritual health, youth,
• MeSH
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• náboženství MeSH
• spiritualita * MeSH
• zdraví dospívajících * MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH
• Kanada MeSH

The family environment is associated with religiosity and spirituality as well as many aspects of adolescent lives, including their health behaviour. Therefore, the aim of this study was to assess family environment associations with adolescent religious attendance (RA), i.e., weekly participation in religious services, and spirituality in a highly secular country. A nationally representative sample (n = 4182, 14.4 ± 1.1 years, 48.6% boys) of Czech adolescents participated in the 2014 Health Behaviour in School-aged Children cross-sectional study. RA, spirituality and the family environment, i.e., family communication, perceived emotional support, and parental monitoring, were measured. Higher adolescent RA was associated with lower self-reported easiness of communication with mother (odds ratio (OR) = 0.68; 99% confidence interval (99% CI) = 0.47-0.99; p < 0.01). In contrast, spiritual respondents were more likely to report both easier communication with their father (OR per standard deviation (SD) change = 1.12, 99% CI 1.02-1.23; p < 0.01) and mother (OR per SD change = 1.38 (1.23-1.55); p < 0.001) and higher perceived emotional support (OR per SD change = 1.73 (1.55-1.92); p < 0.001). Parents of respondents who attended religious services at least once a week, as well as parents of spiritual respondents, were generally more likely to monitor adolescent behaviour. Thus, this study provides information for parents, mental health workers, and pastoral carers. Further research should assess the association of a lower easiness of family communication with dissonances in adolescent-parent religiosity/spirituality and with higher parental monitoring.

• Klíčová slova
• adolescent, communication, emotional support, family, parental monitoring, religion, spirituality,
• MeSH
• charakteristiky rodiny * MeSH
• chování mladistvých * MeSH
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• náboženství * MeSH
• odds ratio MeSH
• průřezové studie MeSH
• rodinné vztahy * MeSH
• spiritualita * MeSH
• zpráva o sobě MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH