Combo with Nursing Research CHP 1 Key Terms and 2 others
the Cochrane Database of Systematic Reviews
"Gold Standard" for high quality systematic reviews. One of the most popular databases, which reviews and summarizes individual clinical trials and systematic reviews from more than 100 medical journals. Includes complete reviews and protocols.
National. Leauge of Nursing
focuses on nursing education reform and nursing education research
A ____________ is a special type of proposition that has a theoretical basis and can be tested empirically.
hypothesis
Probability is how likely it is that the effect of the dependent variable was caused by the ____________ variable.
independent
The degree to which one can conclude that the independent variable, rather than extraneous variables, produced the change in the dependent variable is known as
internal validity.
three areas of research competence
interpreting and using research evaluating practice conducting research
Manipulation is the ____________, or treatment, that is being tested in an experimental study.
intervention
Basic Research
scientific investigations intended to expand the knowledge base
In which situation does the use of key words provide better results than a controlled vocabulary search
searching full text or citation records
justice
the obligation to be fair to all people; includes fairness, just deserts, and entitlements; social equality and distributive justice
beneficence
the obligation to do good, not harm, to other people
Evidence based nursing practice
the process by which nurses make clinics (patient care) decisions based on the best avaliable research evidence, their clinical expertise, and patient preferences
scientific inquiry
the process of analyzing data critically that have been gathered systematically about a particular phenomenon. A process in which observable, verifiable data is systematically collected from our surroundingsthrough our senses to describ, explain, or predict events.
values clarification
the process of becoming more conscious of naming what one values or considers worthy
risk/benefit ratio
the relationship between potential harm to subjects and potential positive outcomes of participating in a research study
evidence-based practice
use of the best clinical evidence in making patient care decisions.
In research, a(n) ____________ is an observation that can be measured by assigning a number to each dimension.
variable
As a staff nurse, how can you further educate yourself about EBP?
Read evidence related to your area of practice on a regular basis.
Determinism
The belief that phenomena are not haphazard or random, but rather have antecedent causes: an assumption in the postivist paradigm
Inductive reasoning
The process of reasoning from specific observations to more general rule
Which type of bias occurs when the dependent variable is influenced by changes made in the way variables are measured?
Threat of instrumentation
A relationship between variables so that when one variable changes, the other variable changes is a(n)
associative relationship.
research program
tams of researchers engage in a series of related research on important topics, rather than discrete and unconnected studies.
What are the five EBP levels of collaboration
Individual, organizational, regional, national, and international
What type of research, usually based on qualitative methods, is used to develop theory
Inductive
Variables that confuse the effect of the independent variable on the dependent variable, so that the research results do not really reflect a true relationship between the independent and dependent variables are
extraneous variables
A nurse has agreed to assist in collecting data from clients in a long-term-care setting. The nurse becomes concerned upon realizing that many of the clients participating in the study have documented cognitive impairments. Which ethical responsibility is being violated?
Informed consent
Many nurses in clinical settings base nursing interventions on information obtained from
colleagues
Role of Baccalaureate Degree Nurses in Research
"intelligent consumers of research", read, interpret, critique, evaluate, and apply research; understand the basic elements of evidence-based nursing practice, identify nursing research problems that need to be investigated, collaborates on research terms, participates in implementation of scientific studies, shares research findings with colleagues, applies established findings of nursing and other health related research to nursing practice.
Assumption
A principle that is accepted as being true based on logic or reason, without proof.
Evidence hierarchy
A ranked arrangement of the validity and dependability of evidence of causality based on the rigor of the method that produced it
systematic review
A rigorous ans systematic synthesis of research findings on a research question
scientific method
A set of orderly, systematic controlled procedures for acquiring dependable, empirical and typically quantitative information; the meteorologic approach associated with te positivist paradigm.
Of the situations listed, which is the best example of collaboration between the levels described in the model of EBP collaboration?
A staff nurse uses findings from the Joanna Briggs Institute to support an EBP project, evaluates outcomes, and reports the findings at an international conference
Paradigm
A way of looking at natural phenomena that encompasses a set of philosophical assumptions and that guides one's approach to inquiry
Which section of a research article provides an overview of the study?
Abstract
What national organizations can nurses use to locate EBP resources and EBP-based clinical guidelines?
Agency for Healthcare Research and Quality, National Institute of Nursing Research, National Nursing Practice Network, and specialty nursing organizations.
Verify that all material has been subjected to the peer-review process.
Appraise the materials to ensure their integrity and applicability
A nurse conducting a keyword search of a literature database enters the search terms "anorexia NOT bulimia" to obtain what result?
Articles that discuss anorexia only
You are a new nurse working at XYZ hospital. Your preceptor tells you to dangle Ms. Jones' legs on the side of the bed before you attempt to assist her to a chair. You ask your preceptor why this is done and she answers, "Because I said so." This is an example of which type of evidence?
Authority
What compels nurses to continue learning throughout their careers to avoid becoming laggards
Changes over time regarding knowledge of effective practices
A major portion of a research article is the methods section, which includes a discussion of the study design, the sample, and the ____________ collected.
Data
Which international code for ethical conduct by physicians conducting biomedical research followed the Nuremberg Code and provides more specific guidelines
Declaration of Helsinki
the Belmont Report
Defined the principles and applications that have guided more detailed regulations and the American Psychological Association Ethics Code 3 Basic ethical principles are 1) beneficience, 2) respect for persons (autonomy), 3) Justice
Which section of a research article provides an interpretation of the study's results?
Discussion
In which type of designs do neither subjects nor individuals administering the treatments know if subjects are receiving experimental interventions or the standard of care?
Double-blind experimental
Empirical evidence
Evidence rooted in objective reality and gathered using one's senses as the basis for generating knowledge
After completing a database search, if you have any doubts or concerns regarding the validity of articles you've located, what options do you have to resolve the issue?
Exclude any materials for which you have doubts about their integrity. Verify questionable material elsewhere using a reputable source. Ask a nursing faculty member or a librarian for assistance.
Which design type allows researchers to manipulate more than one intervention during the same experiment?
Factorial
A nurse researcher wants to interview parents and their autistic children regarding the children's sleep patterns. This study would require which type of IRB review?
Full review
Which type of IRB review is required for research involving vulnerable populations or when there are substantial risks to participants?
Full review
What type of scholarly material can indicate upcoming "hot" topics and includes unpublished reports, conference papers, and grant proposals?
Grey literature
The ____________ occurs when changes noted in the dependent variable can be a result of subject reactivity and not a result of the independent variable.
Hawthorne effect
What is one step a staff nurse can take to advance EBP at the point of care
Identify clinical questions related to current nursing practice.
Which section of a research article identifies the problem being studied and includes a purpose statement and background information on the topic?
Introduction
Why would a researcher need to be concerned about the administration of a pretest and posttest in a research study?
It is a threat to internal validity.
Level VI
Level of evidence from a single descriptive or qualitative study. case study
Level V
Level of evidence from systematic reviews of descriptive and qualitative studies. individual case control study
Level IV
Level of evidence from well designed case control and cohort studies. outcomes research
Level II
Level of evidence obtained from at least one well designed randomized controlled trial. individual randomized clinical trials
Level III
Level of evidence obtained from well designed controlled trials without randomization. individual cohort study
A researcher interested in studying the effect of hearing loss on self-esteem in adolescents in grades 6 through 12 would need to be aware of what type of threat to internal validity?
Maturation
In conducting a keyword search of a literature database, including the Boolean operator "AND" to connect two words has what effect on the search results?
Narrows the search to include only articles that contain both words
Which of the following best describes a primary source
Original information Journal Article
A widely used EBP model consisting of four components for identifying clinical questions for specific patient problems is known as the ____________ model.
PICO
What is an effective way to control extraneous variables?
Randomization
As a staff nurse, what steps can you take to advance EBP as part of your team or unit
Participate in QI initiatives Participate in implementing practice changes based on evidence. Participate as a member of an EBP project team.
PICO
Patient population, intervention of interest, comparison of interest, outcome of interest.
Once an idea is generated for a research problem, what is the next step?
Perform a review of the literature
Which of the following is the best definition of research?
Planned and systematic activity that leads to new knowledge and/or the discovery of solutions to problems or questions.
Which design type is similar to experimental design but does not meet one of the other essential components of experimental design, lacking either randomization or a control group?
Quasi-experimental
Joanna Briggs Institute
Resources in evidence-based nursing and healthcare from South Australlia. Access to restricted/ subscription content such as systematic reviews, evidence summaries, and best practice guidelines
Which of the following is an example of secondary sources
Reviews Commentaries or interpretations Summaries of primary sources
False
Should all nurses conduct research? T or F
Nursing research
Systematic inquire designed to develop knowledge about issues of importance to the nursing profession
Which of the following summarize the results and implications of large quantities of research and include articles addressing the same clinical problem?
Systematic reviews
True
T or F. All nurses should be intelligent consumers of research?
Generalizability
The degree to which the research methods justify the inference that the findings are true for a broader group than study participants
utilitarianism
a theory of ethics that prescribes get quantitative maximization of good consequences for a population. It is best for the largest amount of people. is a form of consequentialism. This good to be maximized is usually happiness, pleasure, or preference satisfaction.
Quantitative Research
The investigation of phenomena that lend themselves to precise measurement and quantification, often involving a rigorous an controlled design.
Qualitative research
The investigation of phenomena, typically in an in depth and holistic fashion, through the collection or rich narrative materials using a flexible research design.
Which one of the following could form the basis for a potential research study?
The majority of patient falls occur on the evening shift.
research methods
The overall plan for addressing a research question, including strategies for enhancing the study's integrity
Deductive reasoning
The process of developing specific predictions from general principles
What provides an essential foundation for nursing practice
Theories and research
In what way can evidence from disciplines other than nursing be helpful?
Theory based non-nursing evidence can provide a basis on which to build new evidence.
What is the purpose of the peer-review process
To ensure confidence in the quality of published works
What is the purpose of formulating a hypothesis or hypotheses?
To provide direction for the research study by identifying possible outcomes
You are a new nurse working at XYZ hospital. Your preceptor tells you to dangle Ms. Jones' legs on the side of the bed before you attempt to assist her to a chair. You ask your preceptor why this is done and she answers, "This is what we have always done, so go do it." This is an example of which type of evidence?
Tradition
Which design type is considered to be the "classic" experimental design in which subjects are randomized into either the intervention group or the control group and measured before and after the intervention is implemented?
Two group pretest-posttest
Which of the following is the best definition of evidence-based practice (EBP)?
Use of theory-derived, research-based information in making decisions about health care delivery, with consideration of individual needs and preferences and the clinical expertise of the provider.
How can a nurse manager advance EBP as part of evaluating his or her staff
Use performance criteria related to EBP.
The advanced practice nurse can work to implement EBP by
Uses evidence to writes and modify practice standards. Locates relevant evidence and synthesizes evidence for practice. Serving as a coach and mentor in EBP.
research
Where do we get a specialized body of knowledge?
Which of the following is the best definition of research utilization
Which of the following is the best definition of research utilization
Which of the following statements should be cited if used in a research paper
Zithromax has shown statistically significant results in the treatment of URIs.
Ethics
a branch of philosophy that deals with/pertains to morals
Abstract
a brief, succinct summary of a research study; usually includes the purpose, methods, and findings of a study.
Patient Oriented Evidence that Matters) info POEMS
a database similar to the ACP journal Club and reviews and provides commentary on recent articles.
MD Consult
a database that provides full text access to textbooks, journal articles, practice guidelines, patient education, handouts, and drug awareness.
National Guideline Clearinghouse
a publicity available database of evidence based clinical practice guidelines and related documents. It provides internet users with online access to guidelines. It is produced by the Agency for Healthcare Research and Quality (AHRQ) and the American Association of Healthcare Pans (AAHP) Foundation
Systematic Review
a research oricess that uses a predefined process; identifying relevant studies, selecting them for inclusion, and collecting and combing their data
Systematic review
a research process used to develop the evidence on which healthcare practices can be based to help identify which forms of healthcare work, which do not, and which are even harmful. Asseses the quality of research studies/ clinical trials. Then the findings are combined to produce both a more statistically reliable result and one that can be more easily applied in other settings.
In searching a database, a controlled vocabulary is
a standardized, hierarchical list of terms that represent major subjects and conditions
meta-analysis
a statistical method that takes the result of many studies in a specific area and synthesizes their findings to draw conclusions regarding the state of the science in the area of focus.
scientific method
a systematic research process that involves the following steps; selecting and defining the problem, formulating research questions or hypotheses, collecting data, analyzing data, and reporting results.
deontology
a theory holding that decisions should be made solely or primarily by considering ones duties and the rights of others; a persons behavior can be wrong even if it results ins the best possible consequences; insists that how people accomplish their goal is usually more important than what people accomplish
values
abstract standards that give a person a sense of what is right and wrong and provides a framework for making decisions
Bixler & Bixler
an extensive university education, unique body of knowledge, and orientation of service to others, autonomy, self regulation, code of ethics, Professional society
evidence based practice
apractices problem solving approach to clinical practice that integrates a systematic search for and critical appraisal of the most relevant evidence to answer a burning clinical question and ones own clinical experience and patient preferences and values.
Researchers formulated hypotheses based on clear definitions of
concepts and variables
According to Florence Nightingale, health is defined as the absence of disease. This is an example of a(n
conceptual definition
The Belmont Report, issued in 1979, identified the following three ethical principles
beneficence, respect for persons, and justice
When extraneous variables influence and distort the relationship between the independent variable (IV) and the dependent variable (DV) so that the findings do not reflect a true relationship between the IV and the DV, the result is
bias
In health-related experimental designs, the group of subjects receiving the standard of care but not the intervention is the
control group.
Which type of design would be used by researchers interested in establishing relationships between two or more variables, for example, the type of coping used by caregivers of older adults having cognitive changes and the occurrence of elder abuse?
correlational
AACN American Association of Colleges of Nursing
culture of inquiry, broad-sharing, evidence based practice
deception
deliberately withholding information about the about the study or providing false information
Role of Associate Degree Nurses in Research
demonstrate awareness of the value or relevance of research in nursing, assist in identify problem areas in nursing practice, assists in collection of data within established structured format
There will be a change in nursing practice after completion of an EBP mentorship program as compared to before the mentorship program." In the preceding statement, "completion of an EBP mentorship program" represents the
dependent variable
In research studies using nonexperimental designs, the purpose is to
describe a phenomenon in detail. predict relationships and differences among variables. explain relationships and differences among variables
Simple Hypothesis
describes the associative or causal relationship between two variables
risk/benefit assessments
designed to determine whether the benefits of participating in a study are in line with the cost
Cause-probing research
designed to illuminate underlying causes of phenomena.
Nursing research
diligent, systematic inquiry, or study to develop knowledge about issues of importance to nursing practice. it encompasses systematic related to clinical practice, basic nursing knowledge and nursing education. Validates and refines existing knowledge related to nursing issues and establish a scientific knowledge base for nursing practice.
post graduate (masters)
evaluate research findings, develop and implement evidence based practice guidelines, design care based on new nursing knowledge, provide clinical expertise about problems, identify practice and systems problems requiring study, collaborate and assist others in initiating research
A theory has credence until
evidence comes forward to refute it.
Ethical research involves citation of previous researchers and their findings to assist in the
evolution of nursing knowledge and practice.
The researcher actively manipulates the independent (causal) variable to determine its effect on the dependent (outcome) variable when using a(n)
experimental design
The three major categories of quantitative research designs are
experimental, quasi-experimental, nonexperimental
In searching database subject headings, you would use the ____________ technique to broaden the search by locating all records indexed to your search term plus any that include the term in a related, narrower category
exploding
As an undergraduate student, which of the following should be the focus of your literature review?
gathering information
Agency for Healthcare Research & Quality (AHRQ)
has promoted evidence based practice through the establishment of 12 evidence based practice centers (EPC's). These EPC's are responsible for developing evidence guidelines and technology assessments on various clinical topics.
stakeholders
healthcare providers, educators, consumers, payers, industry, ect.
Researchers perform a literature review for the purpose of
highlighting areas of needed change. helping to sharpen and focus a research question. identifying gaps in current research.
naturalistic paradigm
holds that there are multiple interpretations of reality, and that the goal of research is to understand how individuals construct reality within there context; often associated with qualitative research
culture of broad sharing
investigators will value the need to share their work with a a variety if audiences- old and new, information will be framed, packaged, and communicated based upon the needs of stakeholders or audiences, will demonstrate a willingness to listen and make their messages meaningful to their varied audiences, sharing results of investigations or projects will be a professional norm.
Intervention research
involves research on interventions for both treating and preventing health problems and adverse outcomes. plays critical role in EBP.
Trial and error is not a preferred approach for delivering nursing care because
it is not based on systematic scientific approaches.
Nursing's Body of Knowledge focuses on
knowing, experiencing, and understanding individuals and their healthcare experiences
Level I
level of evidence from a systematic review or meta-analysis of all relevant randomized controlled trials, or evidence based clinical practice guidelines based on systematic reviews of randomized controlled trials . meta-analysis of randomized clinical trials
Level VII
level of evidence from the opinion of authorities and/or reports of expert committees. Expert opinion
Nuremburg Code (1949)
medical research experiments conducted by Nazi doctors; Numberg trials; internationally recognized set of ethical standards; designed to protect human subjects; based on basic principles of ethics
A type of quantitative study is the ____________, which examines outcomes across a number of studies.
meta-analysis
The concepts that are core to nursing are person, environment, health, and nurse; these are known as the nursing
metaparadigm
When outcomes have many causes, the situation is known as
multicausality
NGC Criteria
must contain systematically developed recommendations, strategies, or other information to assist healthcare decision making in specific clinical circumstances. Must have been produced under the the auspices of a relevant professional organization. Must have included a verifiable, systematic literature search and review of existing evidence published in peer reviewed journals And must be current and most recent version
The following statement: "There will be no difference in practice of nurses after completion of an EBP program as compared to before the mentorship program," is an example of a
null hypothesis.
culture of inquiry
nurses move away from rituals in practice, questioning their practice is expected, change is the norm, practice effects ongoing evaluations, nurses seek answers to their questions and articulate and teach the rationale and teach the rationale for their practices to others.
In the United States during the 1970s, nursing practice included the use of granulated sugar to pack stage III and IV wounds based on the rationale that bacteria would be less invasive of new tissue formation. Over time, this method did not result in statistically significant increase in wound healing time as compared to use of normal saline wet packing. Research was begun to determine what packing method led to best wound healing. The 1970s practices provides an example of
nursing practice based on untested theory
Explicit statements of how a variable will be measured, such as using a rating scale to collect quantitative data regarding pain, are called
operational definitions
post doctoral nurses
opportunity to establish programs or research with formal mentorship from senior researchers/sciences.
Creating an EBP culture is an example of contribution at the
organizational level.
There is a study being conducted of adults over the age of 65 to investigate the effect of caregiver education on calming communication techniques in comparison to sedative medications on the agitation level of clients experiencing stage 2 dementia. In this study, the clients' level of agitation would be the measured
outcome
culture of evidence based practice
practice reflects the current state of the science and is not ritualistic, no gap exists between research and practice, optimal patient outcomes are achieved.
An example of a ____________ is: "The use of alcohol by freshman at XYZ State University contributes to alcohol-related injuries and increasing numbers of visits to the local emergency room
problem statement
clinical nursing research
problems relating to clinical practice
nonmalficence
prohibiting intentional harm; nurses prevent this by reporting unethical/ immora nursing practice
A ____________ is a statement about the relationship between two or more concepts.
proposition
International Council of Nurses Guidelines
publishes guidelines on various topics of relevance to the nursing profession. as a service to nurses worldwide, they have posted guidelines here in PDF format.
An example of a ____________ is: "To determine if brief screening for alcohol use and nursing intervention during orientation reduces self-reported alcohol use, alcohol-related injuries, and visits to the emergency room by college students during their freshman year."
purpose statement
doctoral nurses (research focused)
pursue intellectual inquiry and conduct independent research for the purpose of extending nursing knowledge; plan and launch independent programs
In searching a literature database, you would use the ____________ technique to designate which fields (e.g., author, title, subject, publication date) are to be included in the search.
qualification
systematic inquiry
questioning what we do and why we do it
background questions
questions ask for general knowledge about a condition or thing, disease or disease process. it is usually asked for the need for basic informatio and not to make a clinical decision about a patient. Has 2 essentials components; a question root and a disorder, test, treatment, or another aspect of healthcare.
foreground questions
questions ask for specific knowledge about managing patients with a disease to inform clinical decisions or actions. Has 3 or 4 essential components; patient &/or problem, intervention, comparative intervention (optional), and clinical outcome.
A method of sampling in which all people in the population of interest have an equal chance of being selected to be included in the study is
random sampling.
Causality is the ____________ that exists between a cause and its effect.
relationship
scientific knowledge is
reliable because it is systematic, quantifiable, and undergoes scholarly review.
An area of concern due to a gap in knowledge that requires a solution that can be described, explained, or predicted to improve practice is a
research problem.
applied research
research used to gain knowledge that can be used in a practical setting and is conducted in an actual practice setting (most clinical nursing falls into this category)
The major difference between experimental and nonexperimental designs is the role of the
researchers
The ____________ section of a research article outlines the methods used to analyze the data and notes the findings
results
Federal regulations mandate the establishment of institutional review boards whose purpose is to
review and approve research studies
respect for human dignity
right to self determination and right to full disclosure
major features of NGC
structured, standardized abstracts (summaries) about each guideline and it's development, a utility for compairing attributes of two or more guidelines inns side by side comparison, synthesis of guidelines covering similar topics, highlighting areas of similarity and differences, links to full text guidelines, where available, and/or ordering information for print copies, and annotated bibliographies on guideline development, methodology, structure, implementation, and evaluation.
APC Journal Club
summarizes and interprets the best evidence of one recent study or review article from traditional journals, based on the criteria provided by the practitioner
Nationl Institute for Nursing Research NINR
supports clinical and basic research to establish a scientific basis for the care of individuals across the lifespan, encompass cross-cutting issues (ethnic, cultural, gender differences, biological and behavioral mechanisms, clinical settings in which care is provided, cost effectiveness of interventions)
Nursing Research
systematic inquiry to develop evidence on problems of importance to nurses
Nursing Best Practice Guidelines
the Royal Nurses Association of Ontario launched the Nursing Best Practice Guidelines Program in November 1999 with funding from the Government of Ontarion, Canada
Study validity refers to
the ability to accept that the research results are logical, reasonable, and justifiable based on the evidence presented.
morals
the basic standards for what we consider right and wrong; often based on religious beliefs and to some extent, social influence and group norms
rigorous research studies
the best source of "evidence" is from....
social equity
the concern for society should be directed towards the most disadvantaged because they are the ones least able to speak for themselves
Evidence-Based Medicine (EBM)
the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of this means integrating individual clinical expertise with the best available external clinical evidence from systemic research.
evidence based practice
the conscientious, explicit, and judicious use of current best evidence in making decisions about the delivery of care of individuals or groups of patients in consideration of individual needs and preferences
evidence based nursing
the conscientious, explicit, and judicious use of theory derived, research based information in making decisions about care to individuals or groups of patients and ion consideration of individual needs and preferences.
Evidence-Based Practice
the conscientious, explicit, and judicious use of theory-derived, research-based information in making decisions about care delivery to individuals or groups of patients and inconsideration of individual needs and preferences.
External validity refers to
the degree to which the findings can be generalized to other subjects, settings, and times
External validity refers to
the degree to which the findings can be generalized to other subjects, settings, and times.
The advantage of using a quasi-experimental design in nursing is
the design is more adaptable to real-world settings.
distributive justice
the fair distribution of burdens and benefits
A ____________ is a set of concepts linked through propositions to explain a phenomenon.
theory
Research proposals may be eligible for an expedited review by the IRB if they involve minimal risk to participants. This means that:
there is a very low risk of harm or discomfort to study participants, no more than that involved in daily life or routine physical or psychological exams.
Nursing's body of knowledge
this is marked by the growth of knowledge that is useful in solving problems encountered in practice and focuses on knowing and understanding individuals and their health experience
Researchers use nonexperimental, descriptive designs for a variety of purposes, including
to assess current practice for early stages of theory development.
Purpose of Nursing Research
to develop, refine, and expand nursing's knowledge base
Nursing Research Goal
to discover new knowledge and relationships and find solutions to problems or questions
Positivist paradigm
traditional scientific approach, which assumes that there is an orderly reality that can be objectively studied; often associated with quantitative research
doctoral nurses (practice focused)
translate specific knowledge into complex clinical interventions tailored meet individual, family, and community health and illness needs; used advanced leadership knowledge and skills to evaluate the transition of research into practice and collaborate with new researchers/scientist on new health policy research opportunities; focus is on evaluation and use of research rather than the conduct of research.
values conflict
when we must choose between two things, both of which are important to us
Decleration of Helsinki
world medical association; developed guidelines for physicians