Carl L. Tishler

The Recruitment of Normal Healthy Volunteers: A Review of The Literature on the Use of Financial Incentives

Unresolved issues of ethical, methodological, and legal concerns in the use of normal healthy volunteers persist. Financial incentives in their recruitment offer a unique ethical dilemma because of questions surrounding payment. A review of literature was conducted to obtain research systematically examining volunteer motivation and the role of financial incentives. The primary selection criterion was motivation and payment to volunteers; seven studies met the criterion for re view. Studies that have systematically investigated volunteer motivation have found financial rewards to be an important motivator among normal healthy volunteers in their decision to participate in clinical trials. Also evident is that differences based on demographic characteristics exist in the motivation and rates of volunteerism. Ethical issues surrounding the use of normal healthy volunteers are discussed, with attention to the issue of financial incentives (e.g., economically vulnerable volunteers, undue inducements). Regulations, guidelines, and recommendations are discussed with regard to volunteers and financial incentives.

Inpatient suicide: preventing a common sentinel event.

OBJECTIVE Suicide in the hospital is one of the most common types of sentinel events, and hospitals can (and should) take steps to decrease the likelihood of experiencing this type of crisis. METHOD MEDLINE, Cochrane Library, National Electronic Library for Mental Health, and PSYCHINFO searches were conducted. In addition, manual and phone queries were used to identify relevant empirical and clinical publications. Reference sections of published articles were also searched. RESULTS The current article discusses the rates of suicide in hospitals, related risk factors, methods of suicidal behavior, and factors which contribute to this tragic event. Environmental, patient care, staff training, and hospital policy recommendations for decreasing the number of inpatient suicides are presented. CONCLUSION Inpatient suicide is a traumatic event. Although it is a relatively rare occurrence that is often difficult to predict and prevent, continuing to refine our efforts to assist the population at risk is imperative.

Adolescent Suicide A Comparison of Attempters and Nonattempters in an Emergency Room Population

Forty-six adolescent suicide attempters and their parents were compared with 46 adolescent nonattempters and their parents using various measures of family conflict, family cohesion, and parental maladaptive behavior. Data analysis in dicated several significant differences between these two family groups in these dependent measures of family functioning, suggesting that the family milieu plays an important role in the etiology of adolescent suicidal behavior.

Repeat Participation Among Normal Healthy Research Volunteers: Professional Guinea Pigs in Clinical Trials?

The recent death of a normal healthy volunteer, as well as the increased use of normal volunteers as research subjects, has heightened the attention given to the participation of normal volunteers in clinical research. An overlooked sub-population of normal healthy volunteers are repeat, veteran volunteers. This essay discusses ethical and methodological issues associated with the use of repeat volunteers in research, along with existing guidelines regarding the use of repeat healthy volunteers, and concludes with recommendations for safeguarding repeat volunteers and ideas supporting centralized recruiting.

Parental negative self and adolescent suicide attempts

The parents of 46 adolescent suicide attempters were compared with parents of 46 adolescent nonattempters to determine differences in factors descriptive of self image. Results indicated that the fathers of the attempters were significantly more depressed, had significantly lower self-esteem, and consumed significantly more alcohol than did fathers of nonattempters. Mothers of the adolescent attempters were significantly more anxious, experienced significantly greater suicidal ideation, and consumed significantly more alcohol than mothers of nonattempters.

Is Domestic Violence Relevant? An Exploratory Analysis of Couples Referred for Mediation in Family Court

Mediation is an essential component of custody evaluation and reconciliation services in domestic courts. Data from 306 couples with and without a reported history of domestic violence (DV) who were ordered to attend an assessment for mediation were analyzed to determine differences in the mediation process. More than one third reported a history of DV. Chi-square analysis showed that differences in the mediation process exist between couples reporting DV and couples reporting no DV. A greater proportion of couples with reported DV (a) actually attended the court-mandated assessment session, (b) were deemed unsuitable to participate in the mediation process, (c) were in default of child-support payments, and (d) reported drug and alcohol abuse. No significant differences were found between the two groups in the measured mediation outcomes. Implications for the use of mediation with couples who reported DV and recommendations for future research are discussed.

Pediatric Drug-Trial Recruitment: Enticement Without Coercion

Despite federal initiatives to increase research and expand data about the effectiveness and safety of medications in children, data are still limited for this population. One of the most salient barriers to conducting pediatric clinical trials involves participant recruitment. In this article, we summarize recruitment challenges including a lack of research infrastructure, the need to properly define appropriate use of incentives and payments, and inconsistencies in the current use of payments and incentives. We also searched the Centerwatch.com and ClinicalTrials.gov databases for updated data on current practices in pediatric participant compensation/payment. We provide recommendations for tackling current barriers to recruiting and retaining children and families in clinical trials.

Ethical Parameters of Challenge Studies Inducing Psychosis With Ketamine

Researchers routinely induce psychosis in healthy volunteers via ketamine infusion to expand their knowledge of schizophrenia. We question the ethics of the nature and procedures of such studies. We also address safeguards for ethically conducting and reporting such pursuits, including recruitment, screening, available treatment, and follow-up.

Managing the Violent Patient: A Guide for Psychologists and Other Mental Health Professionals

Being threatened, harassed, attacked, or confronted by a patient with a weapon is becoming more common and is likely to occur at some point in a mental health professionals career. Effective violence management programs can reduce the incidence of violence. Yet, few resources have been provided to assist psychologists and other mental health professionals to deal with aggressive patients. The authors offer strategies for the management of aggressive behavior that can be implemented to empower practitioners to take precautions when necessary in a quick and efficient manner when dealing with violent and potentially violent patients. What would you do if your next patient were violent? Are you prepared to handle a violent patient? Assume your next patient arrives for a scheduled session and you notice a gun in the patients briefcase. What would you do? Or what if your next patient discloses a plan to injure a coworker and threatens harm to you and your loved ones if the plan is disclosed to anyone, including authorities? How would you handle these situations on a short- or long-term basis? Rapid and efficient management of violent and potentially violent patients is a critical skill. Violence management is needed by inpatient and outpatient mental health professionals in this era of managed care (i.e., minimal inpatient stays, limited and inexperienced staffing). The pervasiveness of aggression in acute psychiatric and other mental health settings has been documented. Employees staffing one urban psychiatric emergency service identified 99 Of 1,806 consecutive patients as violent or potentially violent (Beck, White, & Gage, 1991). A survey of 300 independent practitioners revealed that 81% experienced at least one incident of patient physical attack, verbal abuse, or other harassment (Tryron, 1986). Armed police in acute psychiatric facilities and pharmacies, panic buttons, and metal detector searches of patients have become the norm (McCulloch, McNiel, Binder, & Hatcher, 1986). Psychologists and other staff often have little or no training regarding the management of potentially violent patients. We

The assessment and management of the violent patient in critical hospital settings

OBJECTIVE Patient violence and aggression is prevalent in critical care settings, yet clinicians are often inadequately trained to assess and respond to these types of behaviors. Targeted toward trainees as well as seasoned clinicians, this articles provides an updated review of the literature regarding the management of violence in the emergency department. METHODS This narrative review is largely derived from research articles and reviews published since 2000. We conducted a systematic search of electronic databases for review articles or studies examining patient violence and aggression in critical care settings. Electronic searches were supplemented by manual searches of reference lists. RESULTS Current statistics, risk factors and imminent signs of violent patient behavior are presented. We conclude with recommendations for pharmacological and psychological interventions that can help manage aggressive behavior in the emergency department. CONCLUSIONS The relatively high frequency of aggressive and violent behavior in critical care settings increases the likelihood that clinicians working in this environment will encounter this situation. It is our hope that providing additional information about the factors associated with and techniques for managing violent patient behavior will reduce the occurrence of injuries in health care professionals in emergency departments.