The evolving landscape of scientific publishing has brought renewed attention to the concepts of authorship, contributorship, and acknowledgments. While authorship is a marker of intellectual contribution and accountability, the role of professional medical writers in the development of scientific and biomedical publications has evolved significantly, particularly in the context of industry-supported research. Drawing upon established guidance such as the International Committee of Medical Journal Editors (ICMJE), Good Publication Practice (GPP) 2022, the Contributor Roles Taxonomy (CRediT), and other international standards, this review highlights credible authorship criteria, clarifies the role of medical writers in the publication process, and underscores the necessity of transparent and appropriate acknowledgment of their contribution to a publication. The current frameworks and perspectives are synthesized to support informed decision-making for authors and foster responsible recognition of medical writers as contributors in scientific publishing.
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Academic integrity conversations are often emotionally charged for nurse practitioner educators, particularly when learners respond with defensiveness, denial, or distress. These encounters require educators to balance empathy with accountability while upholding institutional standards. A needs assessment identified educator discomfort when navigating academic integrity discussions, including fear of conflict escalation, learner denial/defensiveness, and uncertainty about language that is both supportive and appropriately corrective. An interactive educator development session introduced trauma-informed communication principles and restorative language tools applicable to academic integrity conversations. Group-level improvements were most pronounced in knowledge and awareness ( P < .001) and institutional support and application domains ( P < .001). Modest gains were observed in confidence and comfort. Participants continued to report difficulty balancing empathy with accountability. An educational intervention may enhance nurse practitioner educators' perceived preparedness for academic integrity conversations. Practice-based strategies (eg, role-play, scripting, coached rehearsal) may be needed to address persistent empathy-accountability tensions.
Purpose: Core values influence health care professionals' behaviours and decision-making. Research has yet to examine Canadian physiotherapists' views about core professional values (CPVs). We explore physiotherapists' views about CPVs and associated behaviours (ABs). Method: A qualitative descriptive approach was undertaken. Narrative text data collected from members of the Canadian Physiotherapy Association (CPA), including physiotherapists, physiotherapist assistants, retired and student members, regulators, and executives and members in leadership roles during three rounds of e-Delphi surveys, conducted as part of the CPA Core Professional Values and Associated Behaviours document development process, were analyzed using descriptive content analysis by teams of two researchers. Results: Three categories (Integral … It's a given; Perhaps, it's debatable; Conflicting, competing and differing tensions and perspectives) and two sub-categories (In part, maybe, but … I'm not sure I completely agree with what you are proposing; I beg to differ … I'm not on board with what you are proposing) emerged. Accountability, integrity, and respect were perceived most positively. Wavering views regarding advocacy, client/patient-centredness, compassion/caring, and excellence were evident. Altruism, equity, and social accountability had the most contentious and divergent perspectives. Conclusion: Views about CPVs varied on a continuum from wholly positive/agreement to more neutral to ambivalent to wholly negative/disagreement. Future research, utilizing different theoretical approaches, can further our understanding about the role CPVs play in the practice of Canadian physiotherapists. Objectif: les valeurs fondamentales influent sur les comportements et les décisions des professionnels de la santé. Aucune recherche n'a encore analysé les points de vue des physiothérapeutes canadiens à l’égard des valeurs professionnelles fondamentales (VPF). Nous explorons les points de vue des physiothérapeutes sur le VPF et les comportements associés (CA). Méthodologie: les chercheurs ont adopté une approche descriptive qualitative. Des équipes de deux chercheurs ont procédé à l'analyse descriptive de contenu des données extraites des textes narratifs obtenus auprès des membres de l'Association canadienne de physiothérapie (ACP), ce qui inclut des physiothérapeutes, des assistants-physiothérapeutes, des membres retraités et étudiants, des régulateurs, des cadres et des membres dans des rôles de direction pendant les trois cycles d'un sondage Delphi en ligne, réalisé dans le cadre du processus d’élaboration du document sur les VPF et les CA. Résultats: trois catégories (intégrale… c’était une évidence; peut-être, c'est discutable; conflictuelle, concurrentielle et tensions et points de vue différents) et deux sous-catégories (en partie, peut-être, mais… Je ne sais pas trop, je suis tout à fait d'accord avec votre proposition) ont émergé. La responsabilité, l'intégrité et le respect étaient perçues de la manière la plus positive. L'hésitation était évidente à l’égard de la représentation, du fait d’être centré sur le client, de la compassion/des soins et de l'excellence. L'altruisme, l’équité et la responsabilité sociale étaient les points de vue les plus litigieux et divergents. Conclusion: les points de vue sur les VPF variaient sur un continuum allant de pleinement positif/en accord à neutre, puis ambivalent et pleinement négatif/en désaccord. De futures recherches, effectuées à l'aide d'approches théoriques différentes, peuvent faire progresser notre compréhension du rôle des VPF dans la pratique des physiothérapeutes canadiens.
Multi-agent AI systems are believed to bring significant improvements in digital health, but it also brings new and more serious ethical issues. Such systems distribute the decision-making process among multiple interacting agents, and this decentralized decision-making system has raised ethical concerns in the medical field. On the one hand, it continues the ethical issues of traditional AI tools; on the other hand, the interaction processes within complex systems have also brought about new dilemmas. This narrative review aims to synthesize the ethical issues related to multi-agent AI systems in healthcare presented and explore the corresponding mitigation strategies. The study outcomes were synthesized using a narrative approach. Relevant records were gathered through Boolean searches in databases such as PubMed, Scopus, and Web of Science. A total of 21 articles related to multi-agent AI, healthcare, and ethical issues are included in this review. Seven key ethical challenges were identified: (1) compound opacity, where interacting AI agents create layers of inscrutable decision-making; (2) error propagation and attribution difficulties, complicating accountability for clinical harm; (3) increased clinician dependence and automation bias, leading to potential deskilling and overreliance; (4) erosion of human oversight, as multi-agent AI systems operate beyond effective human control; (5) privacy and data security risks, stemming from complex data flows among agents; (6) threats to patient autonomy and informed consent, due to opaque or paternalistic AI recommendations; and (7) contextual blindness, reflecting a loss of individualized patient understanding in modular AI workflows. Furthermore, this review also summarized solutions proposed in the existing literature for these ethical issues. Multi-agent AI systems intensify existing ethical concerns in healthcare by distributing decision-making and blurring responsibility. To mitigate these issues, recent research advocates for the development of adaptive governance models, clear accountability frameworks, human-AI collaboration structures that preserve clinician authority, enhanced systems for explainability, and privacy-centered designs. In order to successfully incorporate agentic AI into healthcare, it is essential to maintain transparency, protect patient rights, and ensure that human-centered values continue to guide clinical decision-making in an era dominated by autonomous, interacting AI systems.
Artificial intelligence (AI) is increasingly applied in pediatric healthcare, with the potential to improve diagnostic and treatment accuracy and efficiency. However, parental acceptance and trust are critical for successful implementation. The aim of this study is to assess parents' knowledge, attitudes, and concerns regarding the use of AI in pediatric medicine. A cross-sectional, questionnaire-based study was conducted at Johns Hopkins Aramco Healthcare (JHAH, Southern Area) from 7 to 13 July 2024. Parents of children attending the paediatric outpatient clinics completed a 12-item questionnaire. Data were collected via Google Forms, exported to Excel, and analysed using SPSS. A total of 254 parents participated. The majority were mothers (58%), with nearly half aged 31-40 years (48%). Most respondents had at least a secondary education (36.2%) or a university-level education (56%). Over half reported some knowledge of AI. While 44% supported its use in paediatrics (14% strongly), 50% were unsure. Parents expected AI to assist in diagnosis (57%), reduce clinic visits (43%), and lower costs (22%). Regarding consent, 47% would agree to its use. Concerns included errors due to incorrect data (58%), lack of transparency (18%), and privacy concerns (17%). Informed consent, autonomy, and accountability were rated as highly important by most participants. Parents in this study demonstrated moderate knowledge and cautious acceptance of AI in pediatric medicine. While expectations of AI are generally positive, concerns about accuracy, transparency, privacy, and accountability underscore the need for education, clear communication, legislation, and continued physician involvement to build trust and facilitate adoption. The research is registered with the IRB of Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia, in accordance with the Declaration of Helsinki.
To meet growing demands for accountability in medical education, continuous and objective assessment of trainees is essential. The European Society of Pathology (ESP) offers the ESP Pathology Progress Test (ESP-PPT) to objectively assess trainees and meet growing demands for accountability in medical education. The goal of this report is to address the importance of the ESP-PPT as a potential self-assessment tool. Data from 2018-2024 were analyzed for assessing participation, discrimination capacity and educational value. Participation in the ESP-PPT has grown. Clear distinctions are observed between resident groups and specialist groups, demonstrating the ESP-PPT ability to differentiate levels of experience. Most questions incorporate images and clinical vignettes and cover all cognitive levels according to Bloom's taxonomy, supported by pre-and post-test psychometric analysis. Higher-order questions are more difficult but more discriminative, confirming validity and robustness. The ESP-PPT has proven valuable for self-assessment and benchmarking in pathology training. It provides a standardized and reliable measure of progress. Growing participation and institutional adoption highlight its potential as a Europe-wide tool for external quality assurance in pathology education even in the absence of harmonized curricula across Europe.
Despite several initiatives to benchmark national action in responding to antimicrobial resistance (AMR), no comprehensive inventory exists of indicators used across these efforts. We present a scoping review that maps and synthesises existing indicators used to assess national performance in addressing AMR. We conducted a review of academic and grey literature to identify quantitative and qualitative indicators used to assess national AMR performance across animal, environmental, and human health sectors. The academic search was conducted across MEDLINE, EMBASE, and Global Health. The grey literature search was conducted across multilateral organisations (e.g., WHO, FAO, WOAH, UNEP, OECD) and think-tanks. We categorised indicators into a thematic framework spanning 19 subdomains within three overarching domains: Governance & Leadership, Action Areas, and Monitoring & Evaluation. From 184 academic studies, we identified 2311 indicators, and 1406 from 48 grey literature sources. In total, 2101 were in human health, 675 in animal health, 232 in environmental health, and 709 were multisectoral. Within the three overarching domains, 281 were Governance & Leadership, 1907 were Action Areas, and 1671 were Monitoring & Evaluation indicators. When grouping indicators by subdomain, Surveillance & Laboratory (1427), Stewardship (765), and Prevention & Control (365) accounted for the largest volumes, followed by Social Determinants (232), Reporting (141), and Workforce (140), in contrast to Accountability (22), Transparency (22), and Equity (29). This comprehensive scoping review provides a One Health inventory of 3717 indicators used to assess national performance in responding to AMR. While revealing robust Surveillance & Laboratory, Prevention & Control, and Stewardship metrics, we identify critical gaps in Accountability, Transparency, and Equity. These measures comprise the Governance & Leadership domain, which is essential for policy implementation.
Psychological safety, defined as a shared belief that a team is safe for interpersonal risk-taking, has emerged as a foundational determinant of learning, innovation, and performance across industries. In surgery, where hierarchy, time pressure, and irreversible consequences converge, the interpersonal risk of speaking up is amplified. In this environment, silence is not benign; it shapes outcomes. This article reframes psychological safety not as a cultural accessory but as infrastructure-an enabling condition for excellence in surgical teams and health-care systems. We examine psychological safety at three levels: first, within the operating room and surgical services, where it determines whether uncertainty, error, and dissent are surfaced or suppressed; second, across integrated health-care systems, where inclusive leadership and relational architecture allow voice to scale beyond individual teams; and third, through theoretical integration-drawing on social exchange theory, conservation of resources theory, and trait activation theory-to explain how psychological safety reallocates cognitive and emotional resources from self-protection to contribution. We argue that psychological safety enhances both innovation and reliability-aims often perceived as competing-by promoting early problem detection, learning behaviors, and engagement. Importantly, psychological safety does not reduce accountability; the optimal performance state combines high standards with high psychological safety, enabling rigorous improvement without humiliation or concealment. For surgical and executive leaders, psychological safety functions as a leading indicator of a system's capacity to learn, adapt, and sustain workforce well-being. In high-reliability health-care environments, excellence is achieved not by eliminating imperfection but by creating conditions in which it can be voiced, examined, and improved.
Pediatric clinicians are increasingly asked to participate in alternative payment models (APMs) that hold clinicians financially accountable for population-level spending. Drawing heavily on evidence from Medicare, policymakers promote accountable care organizations and other risk-sharing arrangements as pathways to lower costs and higher quality. Yet the pediatric context differs in fundamental ways that limit the direct applicability of adult models. Child health care has fewer short-term opportunities for cost savings, and small numbers of children with medical complexity drive much spending, with substantial year-to-year volatility in spending. Coverage churn across Medicaid, Children's Health Insurance Program, and commercial plans, and the relative lack of pediatric-specific data, infrastructure, and capital further complicate efforts to manage the total cost of care. In this special article, we summarize the evidence base for APMs; highlight how selection, benchmarking, and coding practices can overstate apparent savings in adult programs; and explain why these dynamics may not translate to pediatrics. We then outline key design features needed for pediatric-appropriate APMs, including multi-year pediatric baselines, exclusion of birth hospital and neonatal intensive care unit costs, robust stop-loss and reinsurance protections, pediatric-validated clinical and social risk adjustment, attribution methods that reflect medical home, and quality "gates" focused on actionable, child-relevant measures. We conclude that pediatric clinicians should approach downside risk arrangements cautiously and only under conditions that align financial accountability with clinical influence and available infrastructure. Poorly designed pediatric APMs risk destabilizing already fragile pediatric systems and access to them, whereas carefully tailored models could enable innovation in prevention-oriented, team-based child health care.
Mortality surveys in conflict-affected settings are essential for documenting the human cost of armed conflict, guiding the humanitarian response, and promoting accountability. The success of such studies relies on the participation of the affected populations. Yet, we know little about how the public in conflict-affected countries perceives such studies, their willingness to participate, or the barriers they face to participate. This study aimed to explore public perceptions, willingness and barriers to participate in mortality surveys in six conflict-affected countries of the Eastern Mediterranean Region. An exploratory, cross-sectional mixed-methods study was conducted in Sudan, Somalia, Syria, Lebanon, Iraq, and Yemen between March and June 2025. An online self-administered questionnaire captured both quantitative and qualitative data. Quantitative data were analyzed using descriptive statistics and bivariate tests, while qualitative responses underwent inductive content analysis. Among 3455 participants (median age 29 years; 56.5% female), 94% (n = 3254) considered mortality surveys during armed conflicts important. Two-thirds (66.7%, n = 2306) expressed willingness to participate in mortality surveys, with a preference for electronic surveys. Willingness to participate was positively associated with older age, male sex, nationality, presence in the country during conflict, comfort with data sharing in social media, and absence of perceived cultural and religious barriers (p < 0.05). More than 40% of respondents reported trusting to provide death data to the government (44.3%, n = 1529) and international organizations (43.8%, n = 1515). Respondents reporting no trust to provide this data mentioned lack of credibility and political bias were the main reasons for distrust. Only 13.1% (n = 453) of the respondents perceived mortality surveys as harmful; key concerns included retaliation, political manipulation, and psychological distress. 19% (n = 658) cited cultural or religious barriers, most linked to sectarianism, honor, and the sanctity of death, as an obstacle to participation. Perceptions captured across the six conflict-affected EMR countries among the digitally-active adult respondents reflect both recognition of the importance of mortality surveys and concerns about safety, trust, and cultural sensitivities. Enhancing confidentiality, engaging trusted institutions in data collection, and adopting culturally sensitive approaches are critical to strengthening participation and ensuring the ethical implementation of mortality surveys in conflict zones.
The Central Drugs Standard Control Organization (CDSCO), the national regulatory authority for drugs and clinical trials in India, recently issued a comprehensive inspection checklist for ethics committees (ECs), dated 29 May 2025. This checklist aligns with the New Drugs and Clinical Trial Rules, 2019, and Indian Good Clinical Practice guidelines. Its release marks a significant step toward the standardization and accountability of ECs involved in clinical research. This review article critically examines the checklist and outlines strategies by which ECs in India can strengthen their structure, function, and preparedness in anticipation of CDSCO inspections.
This study examines how Shiite Muslims in Pakistan construct resistance and solidarity in response to collective violence. Using discursive psychology within a constructionist social-psychological frame, it analyses 14 semi-structured interviews and 255 social media posts collected between November 2024 and January 2025. The analysis identifies discursive practices such as category entitlement, footing shifts, corroboration and extreme case formulation through which participants perform moral accountability, communal identity and defiance. Resistance emerges through ordinary discourse that reclaims voice, while solidarity is enacted through shared religious and moral language. The findings demonstrate how language operates as social practice, transforming grief into collective agency. The study advances discursive psychology by showing how discourse functions as a medium for moral repair and social reconstruction in contexts of sectarian violence.
Contaminants of emerging concern (CECs) represent a growing yet inadequately governed threat to drinking water safety in the USA. Advances in analytical technologies have detected widespread, low-level contamination from substances like per- and polyfluoroalkyl substances (PFAS), pharmaceuticals, agrochemicals, and personal care products. This raises concerns about the long-term health of humans and ecosystems. Despite growing scientific knowledge, regulatory and policy frameworks have lagged, leading to uneven protections across public water systems. Here, we assess the policy and regulatory infrastructure related to CECs nationwide across all 50 states. Only four states (8%), California, Maine, Wisconsin, and Vermont, had strong, multi-CEC policy infrastructure with enforceable standards, systematic monitoring, and investments in advanced treatment. Many states (36; 72%), distributed across regions, exhibited moderate capacity, typically focusing on PFAS rather than on comprehensive CEC management. In contrast, ten states (20%), mainly in the South and rural West, exhibited poor policy infrastructure with limited regulation, technology, and weak enforcement. These disparities reveal substantial geographic and institutional gaps in drinking water governance. By comparing US and international policies, we propose phased, practical recommendations that combine precautionary regulation, polluter accountability, innovation incentives, and transparency. These steps aim to update drinking water governance to match current chemical challenges, safeguard vulnerable communities, and prepare US water systems for an expanding list of emerging contaminants.
SUMMARYInfection prevention and control (IPC) programs are essential for safe healthcare; yet, implementation across sub-Saharan Africa remains constrained by chronic underfunding, weak water, sanitation, and hygiene (WASH) systems, limited laboratory capacity, and shortages of trained staff. Healthcare-associated infections (HCAIs) are presumed common, underreported, and often severe, with a disproportionate burden among hospitalized neonates and postpartum women, and they pose substantial risks to healthcare workers during outbreaks. Gram-negative pathogens such as Klebsiella, Escherichia coli, Pseudomonas, and Acinetobacter predominate, alongside methicillin-resistant Staphylococcus aureus, with widespread resistance to third-generation cephalosporins and other key antibiotics linking HCAIs directly to the region's antimicrobial resistance crisis. National and regional IPC policy frameworks have expanded, but facility-level implementation lags, reflected in patchy surveillance, weak accountability, and unreliable supplies of alcohol-based hand rub (ABHR), personal protective equipment, environmental cleaning materials, and core WASH and ventilation infrastructure. Evidence from sub-Saharan Africa shows that pragmatic multimodal strategies, locally produced ABHR, infrastructure designed to facilitate hand hygiene, role-specific training for clinical and non-clinical staff, and inclusive approaches involving families can improve practices and outcomes when supplies and supervision are sustained. A whole-system approach is required, prioritizing fit-for-purpose surveillance, stronger WASH and waste management services, development of an IPC workforce, and support for African-led innovation, including local manufacturing and context-specific decision-support tools. Implementing these actions through community engagement, empowered leadership at all levels, and sustainable financing is critical to reducing HCAIs, slowing antimicrobial resistance, and strengthening healthcare quality and resilience in sub-Saharan Africa.
The principle of dignity of risk (DoR) has become a cornerstone of contemporary aged care reform. DoR is ethically framed as an extension of autonomy and person-centred care. While widely considered in policy and professional discourse, DoR is often treated as a self-evident ethical good, with limited critical attention to how it is operationalised within regulated care systems. This paper offers a critical ethical analysis of DoR as enacted in contemporary aged care, arguing that it functions not merely as a moral principle but as a moral technology that redistributes responsibility, liability and ethical burden across residents, nurses, families, organisations and regulatory structures. Drawing on nursing ethics, relational autonomy and regulatory theory, the paper examines how documentation practices, audit cultures and family involvement reconstitute nurses as ethical risk brokers who must legitimise resident choice while remaining accountable for adverse outcomes. Rather than rejecting DoR, the paper reframes it as a form of collective ethical responsibility which requires organisational, regulatory and moral support for nurses beyond individualised accountability. This analysis highlights the need to move from symbolic invocations of autonomy toward ethically sustainable practices that recognise the relational and institutional labour underpinning DoR in everyday nursing practice.
This study explored student experiences with team-based learning (TBL), a highly structured teaching-learning method. Participants were first-semester students enrolled in a prelicensure nursing course in the entry-level master's program at a private university. Student engagement, accountability, preference for lecture or TBL, and satisfaction with TBL were measured. Results showed that students were highly engaged with TBL, and their perceptions toward this method were favorable. TBL is an effective learning method that allows for more active learning.
Learning health systems (LHSs) aim to integrate continuous learning into routine care, yet their development raises persistent ethical challenges. Questions remain about when and how informed consent should be obtained, how ethical oversight should be organized for learning activities that blur the boundary between care and research, and what system-level conditions are necessary to support ethically sound learning. This integrative review synthesizes ethical recommendations for the design, implementation and evaluation of LHSs, and aims to provide practical guidance and identify gaps in the current literature. A systematic search of PubMed, Web of Science and a search on LinkedIn on 22 October 2025 identified studies offering explicit ethical recommendations related to LHSs. Eligible studies were situated within an existing LHS and provided at least one actionable ethical recommendation. Data were extracted and analysed using Friedman's LHS functioning cycle of three knowledge-to-action steps: data to knowledge, knowledge to practice and practice to data. In total, 44 studies met the inclusion criteria. Ethical guidance was unevenly distributed across Friedman's cycle. Most studies (n = 32) focused on transforming data into knowledge, addressing data governance, patient autonomy, consent models and ethical prerequisites for artificial intelligence (AI). Far fewer studies (n = 6) examined translating knowledge into practice, where attention centred on the ethical implementation of AI, workflow integration and risk mitigation. The final step, feeding performance back into new data, was represented (n = 6), with limited guidance on accountability, continuous monitoring and equitable interpretation of performance outcomes. Across all stages, informed consent and ethical oversight emerged as dominant themes, though considerable variation existed in how institutions operationalized these concepts. Current ethical discourse in LHSs remains focused mainly on transforming data to knowledge. Relatively limited recommendations for ethical implementation of other action steps were identified. In addition, some of the recommendations contradicted each other or offered differing advice on aspects of the ethical implementation of LHS (for instance, on informed consent and ethical review). This imbalance highlights the need for context-sensitive governance models, empirical evaluation of ethical practices in real-world LHSs and regulatory frameworks that reflect the dynamic nature of continuous learning.
Open Science (OS) promises to democratise knowledge and reduce epistemic inequalities. However, a critical analysis reveals the potential of OS to amplify structural vulnerabilities, especially for people and communities already at the margins. With a particular focus on health data, this interdisciplinary essay examines how OS infrastructures perpetuate epistemic harms through the dominance of Eurocentric knowledge norms, legal regimes and corporate capture. Amidst the rapidly evolving health and data landscape, realising the social justice potential of OS, especially in healthcare, demands moving beyond techno-optimism to approaches that centre plural epistemologies, relational accountability and community empowerment.