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However anxiety symptoms vision order 20 mg escitalopram with visa, some clinicians intuitively come to anxiety symptoms checklist discount escitalopram 10mg without a prescription learn the value of the placebo effect as they learn that conventional medicine has substantial limitations in treating many chronic and self-limiting conditions anxiety attack symptoms yahoo discount 10mg escitalopram overnight delivery. One of the more interesting questions is whether there is a dose response to anxiety university california cheap escitalopram 5mg placebos. For example, in clinical trials of surgical procedures, the placebo response may be quite strong, while in the case of a medication there is only a small effect. Based on the little research available, patient-centered Figure 4 represents a posconfident, respectful touching by clinician/physical exam sible dose/intensity grading (Kaptchuk, Goldman, the patient’s expectation for recovery Stone, & Stason, 2000). Specifically, the placebo can be used to assist clinical outcomes using the symbolic meaning model (Moerman & Jonas, 2002). The patient feels listened to, and receives coherent explanations aligned with his or her world view. Based on that understanding, the following guidelines offer practitioners a way to boost the placebo response in dealing with patients. Enhance the promise of mastery over the problem and the expectation of improvement. In a 1964 study at a well regarded teaching hospital, anesthesiologists visited patients before surgery and, with half the patients, engaged in a five-minute, friendly, hand-holding explanation of the procedure and expectations of postoperative pain management. Those treated in the patient-centered fashion required 50 percent less post-op analgesia, and were discharged nearly three days sooner than the other group (Shapiro & Shapiro, 1997). When they were told they were inhaling an irritant, bronchial obstruction increased. But after being told they were inhaling a bronchodilator, pulmonary function improved substantially (Hahn, 1999). A third example is a recent systematic review of 19 randomized-controlled trials of the therapeutic effect of the doctor-patient relationship. The study generally confirmed its clinical value in improving outcomes of patient satisfaction, but was equivocal in terms of biological improvement (Di Blasi, Harkness, Ernst, Georgiou, & Kleijnen, 2001). He wants to get back to work, tive manifestation—the expectation of a but is worried about continued high fever and fatigue. Some possibiliplacebo/nocebo effect is exemplified when ties: someone lives or dies by sheer will, fear, Natural process:Natural process:Natural process: the natural history of an illness that ends in recovery:Natural process:Natural process: or belief. Jones gains un-iatrotherapy:iatrotherapy:iatrotherapy:iatrotherapy: the Declaration of Independence. Another derstanding and information about the natural history and prognosis of example of a major nocebo effect is voothe illness, reassurance and comfort, a form of healing symbolism. Jones positively in a physical sense or helps him cope from the death spell (Cannon, 1942; more effectively with the symptoms. Placebo Effect B—Placebo Effect B—Placebo Effect B—Placebo Effect B—Placebo Effect B— the psychic effect: Mr. Jones may have a certainthe psychic effectthe psychic effectthe psychic effectthe psychic effect Nocebo effects in medicine can attitude towards being sick— perhaps either a tendency to suffer and bearise from fears aroused in patients either come dependent, or maybe to fight it and get on with daily tasks. Conseby the lack of an adequate explanation of quently, his beliefs and actions while sick may well alter the course of the medical procedures or by raising possibiliillness. The doctor proceeds to list meningitis, stroke, aneurysm, and cancer—even Thus, the patient may experience a placebo response to reassurance that though most headaches are not life threathe will get better— especially if the nurse practitioner is very positive about ening. Upon hearing these serious options, the situation; or from being given a symbolic prescription for a cold the patient arranges an urgent office visit remedy or the anti-viral by a clinician who believes it to be scientifior goes to the emergency room where he cally shown as effective and that may or may not shorten the course of the waits for four hours to be seen, and then illness; or from the whole empathic interaction. The ultimate impact of the nocebo response—in the form of costs, tests, stress, and anxiety—may be considerable. Yes, and as far as we know it is no different than the response experienced in conventional medicine. However, the more leisurely and patient-centered approach of complementary practitioners, with aligned expectations, usually in a relaxing environment, fits the principles laid out by Benson (1997) for maximizing the non-specific placebo effect. In addition, the modality itself may have a specific or additional biological regulatory effect to enhance improvement over and above the placebo response. Given the biomedical model of care, one can understand why the effect of a complementary therapy such as ginseng—which is used to boost the immune system as an aid to self-healing—might be regarded by conventional medicine as a placebo, rather than an agent directly addressing the cause and treatment of a specific illness. These problems exist for conventional medicine, but may be particularly relevant for complementary and alternative therapies. For example, in 1970, it was theorized that acupuncture acted by enhancing endorphin activity in the body as the result of needle insertion. Subsequently, this explanation did not account for other discovered effects of acupuncture such as vasodilation, gastric changes, effects on the uterine blood flow, and contractility (Peters, 2001; Shapiro & Shapiro, 1997). The study of such complex interventions is more challenging than that of a pure intervention that can be isolated in a conventional randomized controlled study. Inappropriate or insufficient methods often are chosen to evaluate or measure an intervention. One example is the use of a global health functioning measure to assess improvement of only one symptom, such as nausea. Optimal dosage schedules and administration routes of herbals and supplements are not always known or established, and standard dose-related interventions may be difficult to set up. There is often great difficulty in developing control/placebo interventions for studies of complementary and alternative therapies. In a pharmaceutical study, it is a simple matter to prepare an inert pill to serve as a control. And is it possible to develop a control magnet that the patient cannot recognize? Unlikely—a control magnet would not stick to a refrigerator door, so the patient would soon discover it was a dud! For example, healing touch, currently used by thousands of nurses, was first proposed as a healing energy field, focused and manipulated by the therapist. A single negative study of this mechanism published in a prestigious medical journal proved to the scientific community that the human energy field does not exist and the therapy was dismissed as useless (Dossey, 2003). There is also evidence for a strong publishing bias in favor of conventional studies (odds ratio 3. Until recently, the medical press has often misrepresented or generalized from negative findings in complementary medicine. There are many published studies (mostly small) of just one part of a healing system. But because the research design isolates components of the system, the results from the studies do not reflect true clinical practice and thereby may not relate directly to outcomes in the normal clinical environment. In the United States, substantial funding has not been available to support research on complementary and alternative medicine, so the criticism that these therapies have not been validated must be tempered. Research and funding may be biased toward treatment of specific conditions because of medical/herbal/supplement industry market forces that promote certain products. John’s wort for depression and glucosamine sulfate for arthritis—popular remedies for two very common conditions—are examples of alternative therapy products that have been researched and marketed extensively. Developing large studies in any health care field usually requires considerable piloting to work out the kinks. Well trained researchers and funding for such projects in complementary and alternative medicine are in short supply (Nahin & Straus, 2001). At the same time, a growing trend toward integrated health care delivery systems demands the attention of researchers. Randomization: the best way to make intervention and control groupsAre the two (or three) groups similar in characteristics? Randomization:Randomization:Randomization:Randomization: similar— protects against the influence of unknown factors. Blinding: removing patient, observer, therapist and measurement biases from the study by hidingWere interventions/outcomes masked? Blinding:Blinding:Blinding:Blinding: what group they are in or what the intervention is. Statistical significance: the demonstration that the effect produced was more thanWhat statistical tests were used? Statistical significance:Statistical significance:Statistical significance:Statistical significance: a chance happening (better than 50/50). Although some leaders in conventional medicine propose a more integrated approach to health care services (Snyderman & Weil, 2002), there are, as yet, few data to support this concept.

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Informed consent should be obtained before enrolling a participant and its regulations should be maintained throughout the whole research process anxiety symptoms for months buy 20mg escitalopram with mastercard. Vulnerable groups Vulnerable groups should be given extra attention and precautions in terms of ethical considerations when to zantac anxiety symptoms generic escitalopram 5mg fast delivery be included in clinical research anxiety brain escitalopram 5 mg discount. Researchers refer to anxiety symptoms xanax cheap 20 mg escitalopram amex populations which have low autonomy as "vulnerable populations". These are groups which may not be able to fairly decide for themselves whether to participate in clinical research or those who are relatively (or absolutely) incapable of protecting their own interests. Examples of groups which are considered as vulnerable populations include: prisoners, children, pregnant women, human fetuses, neonates, racial minorities, as well as people who are very sick, physically handicapped, mentally disabled, economically or educationally disadvantaged, or institutionalized. They are as follows:[1,31]  Respect for Persons: the principle of respect requires that subjects participating in the research should be fully aware of the nature of such research and assured that such participation is voluntary, with no pressure or duress. They should also be aware of the physical, psychological, and socio-economic risks that such participation might bring to the subject immediately or in the future. This requirement is imperative, even if the risks were described as minimal or insubstantial. This proposal will be sent to reviewers who will provide detailed feedback pertaining to the ethical conduct of the study. Upon granting approval to the investigators, the research project could be initiated. It is important in this section that the reader should be acquainted with some of the most commonly used terms during the phase of data collection, which are explained below: 1. General terms the following is a brief explanation of some of the most commonly used terms that relate to this phase of research when data is collected. A variable in clinical research is any piece of information collected on a patient through the data collection process. The variability aspect of a variable is the potential of changing between different patients rather than within the same patient. For instance, gender is fixed for each patient, but it will be a variable when some patients are males and some patients are females. Types of variables There are 2 main types of variables:[34]  Categorical variables: They are those that have the responses falling into fixed categories. Different types of categorical variables exit, which depends on the potential responses. For instance, instead of entering „F‟ for females, and „M‟ for males, a code of „1‟ is given for males and a code of „2‟ for females. Data collection Data is defined as the raw facts that are not yet interpreted, organized or evaluated. Data collection is the systematic gathering of data to serve a particular purpose. There are different sources used for data collection, and these include questionnaires, interviews, observation, already existing records, or electronic means. Figure: is a snapshot of a data collection form for a study to assess characteristics of patients admitted with acute myocardial infarction to an emergency department in Saudi Arabia. Database structure A database is a collection of data that is organized so that it will be easily accessed, managed, and updated. Databases are used to manage and archive 28 Section 7: Data collection, entry, cleaning and management large amounts of data. Databases could be structured in different computer programs, such as Microsoft Excel, Microsoft Access, etc. Microsoft Excel does not allocate the first line for a patient‟s record; instead it is used to include the variable names. A database structure is a process where the variables included in the study are defined. Type: It specifies the format of the variable, such as numeric (anything that includes only numbers), dates (anything where date is involved), or string (where a combination of letters, numbers or symbols are included). Decimals: It is where the number of decimals needed for the variable is specified. Other options for each variable are available that allow the user to control the variables. Data entry Data entry is the process of entering text or numbers into a computer program either by typing the fields through the keyboard, or by scanning the documents. A single data entry means that the data is entered once into the computer while the double data entry is carried out when the data is entered twice into two different computers. The two databases will then be compared and any discrepancy will be resolved by the checking the original data collection forms. Note that although the entries have been entered as numbers, they appear as words, since the coding for these numbers were specified in the variable view earlier. Data cleaning Data cleaning is an important step that is usually overseen by a lot of researchers. Thus, data cleaning is a process where the data is checked for entry errors or extreme values in the dataset. Identifying the errors this is a step where an error is identified through different methods. The most obvious type of data cleaning is to check the two extreme sides of the distribution of the variable. For instance, in a specific study, age might be expected to be between 18 and 80, thus by sorting the data in an ascending or descending order, one can identify any outliers or data entry mistakes. Correcting the errors Once the error is identified, the next step is to correct it. This could be done through going back to the data collection form used in the data collection, going 31 Section 7: Data collection, entry, cleaning and management to the patient‟s record, calling the patient, or any other method to find the correct information. Leaving an empty space on the data collection sheet (missing data) means failure to correct the error. Data management Data management is a crucial step in the preparation of the data for analyses. There are three types of data management that researchers encounter in clinical research: a. Recoding As mentioned earlier, coding is assigning a number to a non-numeric variable; thus, recoding means to modify the coding of an already coded variable. For instance, smoking might be defined as: non-smoker (code = 0), ex-smoker (code = 1), and current smoker (code = 2). However, the researcher might be interested in having a variable that provides information on whether the patient is a smoker or a non-smoker. Thus, recoding could be done where the non-smokers and exsmokers are grouped together in a new variable (code = 0), and current smokers (code = 1). Categorization It is a process where a continuous variable is divided into groups, or categorized. More specifically, a continuous variable is transformed into a categorical variable through this step. Computation It is a step where a new variable is created using a specific mathematical equation. Statistics is the study of the collection, organization, analysis, interpretation and presentation of data. At this stage, a description of the sample collected, in terms of general characteristics, is done through some analyses. Descriptive statistics are the techniques used to summarize and describe the main features of a sample. The type of descriptive statistics that needs to be carried out depends on the type of variable under consideration. Descriptive statistics for categorical variables There are two types of descriptive statistics for categorical variables, either by providing frequency distribution or constructing a graph. Frequency distribution A frequency distribution lists, for each value (or small range of values) of a variable, the number and percent of times that observation occurs in the study sample. The second column Percent presents the percentage of each category out of the total, including the missing values. The third column Valid Percent is the percentage in each category among those who have known information, i. Finally, the fourth column Cumulative Percent presents the addition of the valid percent at each level. If this variable is to be summarized, providing the number alone will not be adequate since it will not be clear enough, as it is dependent on the total sample. Similarly, providing the percentage alone will not be clear as well, as it will have no reflection on the sample size.

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Basic research funding (currently 30 % of the fixed sum provided by the Ministry of Health and Care Services in Norway) is the same for all four health regions in Norway anxiety girl purchase 10mg escitalopram amex. Evaluation of research and reporting of results and resources has challenged many scientific communities to anxiety symptoms all day cheap 10 mg escitalopram overnight delivery generate new ideas anxiety 4th breeders generic escitalopram 5mg with amex. There are now greater opportunities to anxiety zap reviews purchase escitalopram 10 mg on line apply for research funding and many active researchers express increasing optimism about the future of research in health trusts. In addition, new strategies for research linked to health trusts and universities, have been developed both at a local and a regional level. The regional research strategies can be found on the websites of the relevant universities and the regional health authorities. Additional national research strategies may also affect the field of medical research. Nationally In line with the Norwegian legislation on health trusts ( Lov om helseforetak ) the health trusts in Norway are obliged to ensure management of patients, research, and education odin. The Ministry of Health and Care Services ("Helseog omsorgsdepartementet") is responsible for research at the health trusts, whereas the Ministry of Education and Research ( Kunnskapsdepartementet ) is responsible for research at the universities. This division of responsibility for medical research in Norway has led to considerable challenges at all levels. The Ministry of Education and Research has overall responsibility for university schools/ faculties. Reporting procedures for the utilization of research funds allocated to the regional health authorities have been established. The Ministry of Education and Research is responsible for the funding allocated to universities and university colleges ( høyskoler ). Research at health trusts is by nature often based within research groups at university hospitals where expertise and equipment required for translational and basic science research is available. In addition, national or regional research competency centers are located at the university hospitals. Regionally the regional health authorities receive instructions from the Ministry of Health and Care Services that outline the framework and principles for research activities and regulate collaboration between regional health authorities and universities in key areas. In 2002, after the healthcare reform on ownership, collaborative bodies ("Samarbeidsorganer") between the regional health authorities and the universities/university colleges have been established in each region. Within most specialties, senior hospital positions have been relatively easy to obtain without a PhD, even at university hospitals. Furthermore, it has been more financially rewarding to be a clinician rather than a researcher. In prior years, a PhD was often a prerequisite for permanent senior employment at a university hospital. As a result of the projected increase in newly qualified doctors over the next few years, the competition for physician positions at Norwegian hospitals is likely to increase significantly. This is likely to increase interest in research as a means by which doctors may qualify for hospital positions. In addition, a number of measures have been taken to increase interest in medical research. Since 2003 many hospitals have introduced an annual salary bonus for completion of a PhD, provided continued active research. Also, combined clinical/research posts at university hospitals allow physicians to spend a minimum of 50% of paid working hours on research (previously known as "D-stillinger", "fordypningsstillinger"). This type of position secures clinical salary levels, while allowing the individual designated time for research. The most substantial reason for embarking on a PhD program however, should be the personal motivation and the wish to enjoy the challenges involved. A PhD provides candidates the opportunity for in depth study of an exciting subject of their choice. Such study gives rise to a deeper understanding of a field and 119 enables a person to more effectively take in, comprehend and disseminate novel scientific ideas and knowledge in general. In addition to yielding many pleasures, research is a source of numerous challenges, not only scientific, but also personal, that one must be prepared to face. Although colleagues, supervisors and family can be a great source of support during PhD studies, a strong inner drive is essential to tackling the challenges that are likely to arise. How to "do a PhD" Common practice is to find a PhD supervisor, and then to apply for a PhD program at the university where he or she is employed. Since the fall of 2003, the term PhD (philosophiae doctor) has been used for all doctoral degrees completed at a Norwegian university, irrespective of the candidate’s academic background. For admission to a PhD program at a medical school, the applicant must have either a cand. Applicants that possess equivalent qualifications may also be accepted; this is evaluated on an individual basis. Approved completion of a PhD program, which includes the trial lecture and thesis defense, gives the individual the right to use the title PhD. For admission to a PhD program, universities often require documentation of research financing for at least 50% of ordinary work-hours. The track outlines the major steps on the road to the PhD disputation and can easily be adapted to other Norwegian universities as well as to other schools within the various universities. In addition, the Appendix presents a "Supervisor track" n the Appendix, with tips for supervision and distribution of tasks between the supervisor and the PhD student. Completion of research-related courses within the PhD program (equivalent to 30 credits) is mandatory. The number of publications required is reduced compared with previous years (usually 3-4 articles, see information from the relevant university for details). The standard timeline of Norwegian PhD programs encompasses three years of full-time research training. The timeline may be extended to allow for prescribed training, including teaching medical students. This is a limited period of time to complete a PhD, particularly for patient-based studies. Formally, supervisors are appointed by the medical school on the basis of suggestions made by the candidate and research groups at the institution (or the supervisor herself/himself). The most tangible result from completion of a PhD is the papers published in international, peer-reviewed journals. These are then collated with an overall introduction and summary of findings in the final thesis ("synopsis", "avhandling"). More information on research training programs at medical schools in Norway (including requirements for PhD degrees and applications for admission) are found on the following university websites: 121 University of Oslo (UiO): This website is a collaboration between several contributors, including the University Library of Oslo, the National Library ( Nasjonalbiblioteket ), the University of Bergen, Bergen University College ( Høyskolen i Bergen ) and the Norwegian School of Economics ( Norges Handelshøyskole ): This criterion implies that one and the same PhD cannot be reported by two or more institutions partaking in the pole. The criterion means that one PhD thesis normally only can be credited to one institution. The exception is when the PhD studies have involved equal cooperation between two institutions, 123 in which case, the PhD degree points may be shared. The intent of two collaborating institutions to share the credit for a PhD thesis should be included in the contract between the institutions. Postdoctoral grants (from 1-3 years) from the universities, the Research Council of Norway (see Chapter 11), from the regional health authorities or possibly from individual health trusts/hospitals. A 10-30% part-time clinical post at a health trust is not unusual, but this varies. Few positions are available at universities and university hospitals for researchers at the level between a postdoctoral level (fixed term of years) and a professor. One may possess the experience and skills required to be an excellent professor, but face the situation where there are no professorships to apply for. There are certainly challenges ahead for hospitals and universities in terms of securing a sufficient number of postdoctoral research positions for skilled researchers, not to mention the challenge of ensuring productive research amongst those currently employed as professors. Hopefully researchers at hospitals and biomedicalor healthcare research institutions in Norway experience research as a source of intellectual and personal fulfillment. Although this chapter focuses on some of the problems that can and do arise, the pursuit of ideas is undoubtedly exciting, challenging and rewarding. At times research will be challenging, fun and sometimes even euphoric, whilst at other times it can be tiring, frustrating and difficult. Attitude plays a significant role in determining quality of life as a researcher. Pessimists will maintain that there are endless possibilities for things to go wrong in any research project.

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A research participant consent does not however anxiety symptoms palpitations generic escitalopram 20mg online, protect participants against risk of damage anxiety symptoms questionnaire safe 20 mg escitalopram. An irresponsible research projects is anxiety nervousness purchase 5mg escitalopram mastercard, in other words anxiety journal template generic escitalopram 20mg visa, not justifiable even if potential participants consent to participating. The Act on Medical and Health Research was ratified in July 2009 lovdata. In addition to affecting the reputation of medical research, cheating can lead to risk of great harm to patient groups exposed to new treatments implemented based on false information. In practice, qualitatively poorly executed research and outright research fraud may be on the same sliding scale. This includes everything from unintentional mistakes and actions, such as incorrect observations, analytical errors, and missing credits, to plagiarism, false correction, or exclusion of "inappropriate" data, as well as fabrication of data. Some define the difference between fraud and error by stating that fraud entails a deliberate intention to cheat and deceive. In the Act on Research Ethics ("Lov om behandling av etikk og redelighet i forskningen"), academic fraud is defined as "falsification, fabrication, plagiarism and other serious breaches of academic practice carried out with intent or with gross negligence in the planning, carrying out, or reporting of research". The authors of the Research Handbook are of the opinion that "gross negligence" ( grovt uaksomt ) in this context includes breaches of standard internal or external scientific norms or regulations that researchers, by way of their skills and position, ought to be acquainted with and comply with. This is partly because the definition of fraud is somewhat unclear and partly because the legal definitions do not necessarily correspond exactly to research ethics definitions. By its very nature, research fraud is based on factors that are concealed and denied, as in other forms of fraud and breaches of trust. It is uncertain whether scientific fraud is more prevalent than before and whether variation exists between disciplines. There have been attempts to establish the extent of scientific fraud via questionnaires to researchers. Such questionnaires in Norway in the 1990s indicated that many researchers were aware of concrete cases of scientific fraud, but very few declared that they were involved in fraudulent research themselves. Personal motives as the reason for misconduct and fraud There is an increasing pressure to publish ("publish or perish"), particularly within biomedical disciplines in which it is crucial for researchers to be the first to publish important findings. Publications have also become the basis of a merit system, both in terms of personal career and with respect to allocation of research grants. However, the pressure to publish cannot fully explain why a few researchers deliberately choose to commit fraud in research, for example fabricating research data. It is likely that personal characteristics of the individual researcher also play a role. For example some researchers exposed of committing fraud have been found to repeat their fraudulent behavior (in research). The desire for "honor and glory" may also represent a motivational factor that can lead to research fraud. Existing measures A number of quality assurance systems are already in place to minimize research errors and improve the quality of research within research institutions. In reality, 147 the most important elements of the quality assurance system are the research groups and the researchers themselves. Systematic errors can be prevented through sound research design and random errors can be corrected for by statistical analyses. All research institutions are required to have internal control routines so that they can carry out their activities in a responsible manner (cf. Health Personnel Act, "Helsepersonelloven", § 16 and the Health Research Act, §6). In addition, a number of public agencies have auditing and supervisory functions with respect to research, see Chapter 6. Audits of ongoing research and of completed research projects are likely to be more fragmentary, both at the level of individual research institutions and at higher levels. Many research institutions also have their own bodies and routines for monitoring ethical and quality aspects of ongoing research projects. Once a research project has been completed, publishing mechanisms become an important factor in revealing errors or deficiencies. Often preliminary findings are presented as lectures or posters and manuscripts are revised according to the feedback received on these before submission to an academic journal. Methodological, ethical and presentational aspects of the study are evaluated through the peer review system of academic journals and, as a rule, articles have to be revised a number of times before they are published. The underlying assumption is that peer review improves the academic quality of published work, but there is general agreement that this system cannot guarantee exposure of fraudulent research. Peer reviewers are not close enough to the data sources to be able to check the validity of results, although they do sometimes discover irregularities, which may lead to suspicions of fraud. It is a matter of some debate among editors of leading medical journals, how the peer review process may be improved and also the degree of responsibility editors have for articles they publish. It has 148 become increasingly common for journals to require authors to declare the exact nature of the contribution they have made to the study and the publication. If a journal suspects there is something dubious about the research, they have the option of rejecting the article or sending out a "warning". By requiring the publication of the main results in publicly available databases (such as prsinfo. Citation and ethics Correct use of references shows academic integrity and avoids plagiarism. Presentation of results, thoughts, ideas or formulations made by others, as your own, is plagiarism. Plagiarism is intellectual theft, and is regulated by several Norwegian acts, including "åndsverkloven" lovdata. See Chapter 9 (on publishing), as well as an article on the use of references in the "Research Ethics Library" etikkom. Current sanction imposed on fraudulent researchers the regulation of scientific fraud and misconduct in the research process is inadequate in Norway. Sanctioning may have a general preventive effect and thereby reduce risk of fraud and misconduct in the research field. The sanction options include actions include censure by colleagues and exclusion from academic circles, as well as withdrawal of research funding. In addition, fraudulent researchers may face administrative, disciplinary, civil or criminal action, risking imprisonment and fines. They may be given notice by their employer and sentenced to pay compensation to parties who have been duped or injured. Fraudulent researchers who are also healthcare workers risk receiving a 149 warning from the Norwegian Board of Health Supervision ("Helsetilsynet"), and in extreme cases the authorization to practice clinically. The opinion of the authors of this Handbook is that more bureaucracy and control could easily lead to research being paralyzed by over-regulation and may result in many researchers giving up their careers. On the other hand, research culture must be based on a fundamental ethos of integrity, openness and honest work of high quality in all parts of the research process, as well as awareness on the part of research institutions of their responsibility for the system. In practice, the integrity of the researchers themselves and internal social research control are probably more important than external control, which is chiefly designed to expose the most serious cases of fraud. The opinion of the authors of this Handbook is that research institutions must continue to be the cornerstone of initiatives promoting sound research ethics and prevention of misconduct. This implies the need for clarification, simplification and streamlining of existing rules and development of internal and external control systems. Continued promotion of sound principles in research and ethical awareness in the research community and PhD education is essential, and includes emphasis on the moral, professional and legal responsibilities of the individual researchers. Open debate and communication in research groups 150 regarding ongoing research projects as well as discussions of what is sound research practice and research ethics, should contribute to the promotion of sound research and help prevent misconduct and fraud. Presentation of research data and methodology not only provides opportunities for improving the scientific quality of projects, but also ensures openness in the research environment, which, in turn, makes fraud more difficult. Any fraud would soon be discovered if large amounts of data appeared after only a brief period of time since other researchers in the group are fully aware that data collection can take several years. Sound research behavior and sound research culture require openness, honesty, trust and fruitful collaboration and are thus likely to contribute to reducing conflicts, misconduct and fraud. It is also important that a greater number of researchers in research groups have access to original data so that the data material, calculations and presentation of results may undergo a greater degree of quality control. Some of the possible avenues for research institutions to explore in this context include further development of research training with greater emphasis on research ethics and improved supervision procedures, as well as closer followup of PhD-candidates and researchers. The opinion of the authors of this Handbook is that supervisors should, as a rule, be well acquainted with all aspects of a research project, including quality control of data collection, electronic data processing, and statistical analyses, in addition to contributing to the publication process itself. The New Norwegian Health Research Act involves greater emphasis on research institutions’ formal responsibility for all aspects of the research project (see 151 Chapter 6).

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