tailieunhanh - Báo cáo y học: "The dilemma of good clinical practice in the study of compromised standards of care"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: The dilemma of good clinical practice in the study of compromised standards of care. | Barilan Critical Care 2010 14 176 http content 14 4 176 CRITICAL CARE COMMENTARY L__ The dilemma of good clinical practice in the study of compromised standards of care Yechiel M Barilan See related research by Lieberman etal. http content 14 2 R48 Abstract Four ethical issues loom over the study by Lieberman and colleagues - the absence of informed consent the study being non-interventional in situations that typically call for life-saving interventions the bias involved in doctors that study their own problematic practice and monopoly over intensive care unit triage and ageism. We learn that the Israeli doctors in this study never make no-treatment decisions regarding patients in need of mechanical ventilation. They are complicit with botched standards of care for these patients however accepting without much doubt an ethos of scarce resources and poor managerial habits. The main two practical lessons to be taken from this study are that for patients in need of mechanical ventilation compromised care is better than a policy of intubation only when the intensive care unit is available and that vigorous efforts are needed in order to extirpate ageism. The biomedical community has established the standards of good clinical practice as the cornerstone of medical research on humans 1 . What are the standards for studying practices that overtly and intentionally fall short of good practice and are clearly discriminatory against the aged I find four ethical problems in the study on ventilated patients outside the intensive care unit ICU 2 . First the local Institutional Review Board waived the requirement for informed consent. Had this been an interventional study omission of informed consent would have been unthinkable. But unfortunately in that hospital and in many others these patients would have been sent anyway to a medical floor. In some other countries they Correspondence YMBarilan@ Department of Medical Education Sackler