Social Work Practice for Social Development in Bangladesh: Issues and Challenges

Social work addresses social issues that constrain the betterment of a community. However, social work practice is struggling to deal effectively with the development challenges of Bangladesh. Based on a literature review and the experiences of the authors, this paper explores the emerging issues where social work practice is anticipated as a promising alternative for bringing sustainable social development in Bangladesh. Simultaneously, the paper discovers the limitation of social work practice in Bangladesh addressing these challenges.     

Clinical Trials of Drugs Used Off-Label in Neonates: Ethical Issues and Alternative Study Designs

The use of drugs for indications unapproved by the Food and Drug Administration (FDA), often called “off-label use,” is widespread in children, including neonates. The widespread off-label use of drugs in neonates presents ethical and safety challenges. Since the passage of the Best Pharmaceuticals for Children Act (BPCA) in 2002, both the FDA and National Institutes of Health (NIH) have taken initiatives to facilitate and encourage research to achieve the necessary labeling for drugs routinely used in infants and children. Federal regulations provide broad rules and guidance for the protection of human subjects in research. However, there are ethical issues that a physician may face when designing clinical trials of drugs in neonates that are routinely used off-label and widely believed to be beneficial. We attempt to describe these ethical challenges and provide recommendations, including alternative study designs, to resolve them in an ethical framework that takes into account the Belmont Report, the statement of the World Medical Association (WMA), and federal regulations.     

Anticipated Ethics and Regulatory Challenges in PCORnet: The National Patient-Centered Clinical Research Network

PCORnet, the National Patient-Centered Clinical Research Network, seeks to establish a robust national health data network for patient-centered comparative effectiveness research. This article reports the results of a PCORnet survey designed to identify the ethics and regulatory challenges anticipated in network implementation. A 12-item online survey was developed by leadership of the PCORnet Ethics and Regulatory Task Force; responses were collected from the 29 PCORnet networks. The most pressing ethics issues identified related to informed consent, patient engagement, privacy and confidentiality, and data sharing. High priority regulatory issues included IRB coordination, privacy and confidentiality, informed consent, and data sharing. Over 150 IRBs and five different approaches to managing multisite IRB review were identified within PCORnet. Further empirical and scholarly work, as well as practical and policy guidance, is essential if important initiatives that rely on comparative effectiveness research are to move forward.     

The Common Factors Model: Its Place in Clinical Practice and Research

The common factors model advances the view that client, relationship, and clinician factors account for a greater proportion of therapeutic change than do specific techniques or types of therapy. In this era of evidence-based practice, in which specific techniques are heavily emphasized, this updated review of the common factors model focuses attention on other components of therapeutic change, including the client's contribution, the therapeutic alliance, and clinician factors. The common factors model has recent and long-standing research support of several kinds. The model affirms many widely used therapeutic practices and has led to the development of several procedures to enhance therapeutic outcomes. This article explores the origins and development of the common factors model; its current research support; and its implications for practice, research, and education.     

The Inclusion of Minority Groups in Clinical Trials: Problems of Under Representation and Under Reporting of Data

Objective: To evaluate the representation of minority groups in randomized control trials (RCTs), and the frequency with which this information is reported.

Study Design: Reviewers collected data on the racial/ethnic composition of study samples from all RCTs published in six leading medical journals in 1999.

Results: Of the 280 RCTs, most (204, 71.3%) provided no information on the race/ethnicity of participants. Of the 89 U.S.-based RCTs, 50 (56.1%) reported their minority distribution. Relative to other trials, those funded by the National Institute of Health (NIH) (n = 52) were more likely to report race/ethnicity data (55.8% vs. 23.7%; χ² = 20.9, p ≤ 0.001) and to include nonwhite participants (13.5% vs. 12.5%; χ² = 22.7, p ≤ 0.001).

Conclusion: Minority groups are currently under-represented in clinical trials. Information on the race and ethnicity of clinical trial participants is currently underreported in six leading medical journals. Reporting of minority group information was significantly better only in NIH funded trials, which also were more likely to include nonwhite participants. This suggests that mandatory reporting policies may have a positive effect on both reporting and representation.     

Challenges in Rural Social Work Practice: When Support Groups Contain Your Neighbors,Church Members,and the PTA

Rural social work occurs in unique practice environments with challenges and rare opportunities. Strong social ties, commonly found in rural communities and often missing in urban areas, can serve as sources of resilience for group members facing adverse life circumstances. Therapeutic formal and informal support groups, bolstered by this support and led by social workers in rural communities, can face numerous challenges due to locale, lack of transportation, and potential worker burnout. This article highlights ethical considerations rooted in a theme of rural group work while providing helpful hints based on the IASWG Standards for Social Work Practice with Groups.     

国家控制与医生临床自主性的滥用:对公立医院医生执业行为的分析

如何对医生的执业行为实施有效的社会控制是职业社会学的一个重要问题。本文通过对我国城市医生的执业环境与执业行为的分析,指出医生仍然依附于占据医疗服务市场垄断地位的公立医院,丧失法团自主性的他们无法与国家就收入与服务补偿进行协商。但也正是由于垄断地位,公立医院及其医生获得了对患者和医药厂商的双向支配地位,可以便利地将处方权转换为经济利益。但与此同时,医生对临床自主性的这种滥用意味着卫生行政部门的监管、职业规范内化后的自律等社会控制方式的失败。本文认为,医生这一职业群体在医疗卫生政策制定过程中的参与、逐步开放医生的执业自由以及给予非公立医疗机构平等的地位与待遇等措施会使这些问题得到改观。