scholarly journals Ethical care requires pragmatic care research to guide medical practice under uncertainty

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Tim E. Darsaut ◽  
Jean Raymond
Keyword(s):  
Medical Practice ◽  
Care Ethics ◽  
Random Allocation ◽  
Pragmatic Trials ◽  
Optimal Care ◽  
Care Research ◽  
Ethical Care ◽  
Potential Benefits ◽  
Medical Interest ◽  
Practice Care

Abstract Background The current research-care separation was introduced to protect patients from explanatory studies designed to gain knowledge for future patients. Care trials are all-inclusive pragmatic trials integrated into medical practice, with no extra tests, risks, or cost, and have been designed to guide practice under uncertainty in the best medical interest of the patient. Proposed revision Patients need a distinction between validated care, previously verified to provide better outcomes, and promising but unvalidated care, which may include unnecessary or even harmful interventions. While validated care can be practiced normally, unvalidated care should only be offered within declared pragmatic care research, designed to protect patients from harm. The validated/unvalidated care distinction is normative, necessary to the ethics of medical practice. Care trials, which mark the distinction and allow the tentative use of promising interventions necessarily involve patients, and thus the design and conduct of pragmatic care research must respect the overarching rule of care ethics “to always act in the best medical interest of the patient.” Yet, unvalidated interventions offered in contexts of medical uncertainty cannot be prescribed or practiced as if they were validated care. The medical interests of current patients are best protected when unvalidated practices are restricted to a care trial protocol, with 1:1 random allocation (or “hemi-prescription”) versus previously validated care, to optimize potential benefits and minimize risks for each patient. Conclusion Pragmatic trials can regulate medical practice by providing (i) a transparent demarcation between unvalidated and validated care; (ii) norms of medical conduct when using tests and interventions of yet unknown benefits in practice; and eventually (iii) a verdict regarding optimal care.

scholarly journals A pragmatic view on pragmatic trials

2011 ◽  
Vol 13 (2) ◽  
pp. 217-224 ◽  
Keyword(s):  
Clinical Trials ◽  
Medical Practice ◽  
Real Life ◽  
Main Tool ◽  
Health Sciences ◽  
Routine Practice ◽  
Special Focus ◽  
Pragmatic Trials ◽  
Explanatory Trials

Clinical trials have been the main tool used by the health sciences community to test and evaluate interventions, Trials can fall into two broad categories: pragmatic and explanatory. Pragmatic trials are designed to evaluate the effectiveness of interventions in real-life routine practice conditions, whereas explanatory trials aim to test whether an intervention works under optimal situations. Pragmatic trials produce results that can be generalized and applied in routine practice settings. Since most results from exploratory trials fail to be broadly generalizable, the "pragmatic design" has gained momentum. This review describes the concept of pragmatism, and explains in particular that there is a continuum between pragmatic and explanatory trials, rather than a dichotomy. Special focus is put on the limitations of the pragmatic trials, while recognizing the importance for and impact of this design on medical practice.

scholarly journals The Parisinus Graecus 2293 as a Document of Scientific Activity in Swabian Sicily

2003 ◽  
Vol 13 (1) ◽  
pp. 137-161 ◽  
Author(s):  
Peter E. Pormann
Keyword(s):  
Medical Practice ◽  
Southern Italy ◽  
Cultural Exchange ◽  
Scientific Activity ◽  
The West ◽  
Medical Interest

The production of manuscripts can be an indication for the scientific, linguistic or medical interests of a community. In this paper the author argues that Parisinus Graecus 2293, a bilingual Greek-Arabic manuscript, containing parts of the first three books of Paul of Aegina's medical encyclopaedia, was produced in Sicily or Southern Italy, probably in Palermo during the reign of the Hohenstaufen. It is thus a testimony to the fervent scientific and medical interest of the Swabian court which promoted cultural exchange between the East and the West. The purpose of the manuscript was not so much to help medical practice but rather to further bilingualism by giving the reader a tool with which he could improve his knowledge of either language.

Ethical issues in palliative care research

2015 ◽  
Author(s):  
David Casarett
Keyword(s):  
Palliative Care ◽  
Ethical Issues ◽  
Research Participation ◽  
Ethical Aspects ◽  
Interventional Study ◽  
Care Research ◽  
Qualitative And Quantitative ◽  
Decision Making Capacity ◽  
Potential Benefits ◽  
Study Designs

Recent growth in palliative care research has created a heterogeneous field that encompasses both qualitative and quantitative techniques, and descriptive as well as interventional study designs. Despite the valuable knowledge that has been produced by this research, and the promise of future important advances, its progress has been impeded by a persistent uncertainty about the ethics of these studies. For instance, there have been concerns raised about whether patients near the end of life should ever be asked to participate in research, although others have objected to this extreme position. Nevertheless, the combination of ethical and practical issues can create substantial barriers to palliative care research. This chapter discusses five ethical aspects of palliative care research that investigators and clinicians should consider in designing and conducting palliative care research. These include (1) the study’s potential benefits to future patients, (2) the study’s potential benefits to subjects, (3) the study’s risks to subjects, (4) subjects’ decision-making capacity, and (5) the voluntariness of subjects’ choices about research participation.

scholarly journals Potential Benefits of Jujube (Zizyphus Lotus L.) Bioactive Compounds for Nutrition and Health

2016 ◽  
Vol 2016 ◽  
pp. 1-13 ◽  
Author(s):  
Souleymane Abdoul-Azize
Keyword(s):  
Bioactive Compounds ◽  
Biological Effects ◽  
Health Benefit ◽  
Immunomodulatory Effects ◽  
Nutrition And Health ◽  
Biologically Relevant ◽  
Cyclopeptide Alkaloids ◽  
Potential Benefits ◽  
Deciduous Shrub ◽  
Medical Interest

Zizyphus lotus, belonging to the Rhamnaceae family, is a deciduous shrub which generally grows in arid and semiarid regions of the globe. In traditional medicine, Z. lotus is used as antidiabetes, sedative, bronchitis, and antidiarrhea by local populations. Recently, several scientific reports for health benefit and nutritional potential of bioactive compounds from this jujube have been reported. This plant is rich in polyphenols, cyclopeptide alkaloids, dammarane saponins, vitamins, minerals, amino acids, and polyunsaturated fatty acids. These identified compounds were supposed to be responsible for most of Z. lotus biologically relevant activities including antimicrobial, anti-inflammatory, hypoglycemic, antioxidant, and immunomodulatory effects. The aim of the present review was to give particular emphasis on the most recent findings on biological effects of the major groups of Zizyphus lotus components and their medical interest, notably for human nutrition, health benefit, and therapeutic impacts.

scholarly journals Teaching surgery – a review

2019 ◽  
Vol 65 (4) ◽  
Author(s):  
Andrzej Żyluk
Keyword(s):  
Medical Practice ◽  
Medical Knowledge ◽  
Current Medical ◽  
Ward Round ◽  
Specific Task ◽  
Medical Studies ◽  
Education Curriculum ◽  
Potential Benefits ◽  
Manual Skills ◽  
Skills Learning

Introduction: Teaching medicine is a specific task consisting of transferring current medical knowledge and rules of medical practice to students. Teaching surgery traditionally includes acquiring manual skills. This article touches several issues concerning surgical education (curriculum) in the course of medical studies. Attention was paid to the specificity of operative room experience, risk of intimidation, anxiety provocation, and potential benefits. The factors which motivate surgeons to engage in teaching students were discussed.Conclusions: It was noticed that the range and methods of transferring medical knowledge during medical studies (the curriculum) frequently does not comply with the requirements of future medical practice. The usefulness of frequent everyday testing of acquired knowledge was emphasised. Unreasonable hopes relevant to the introduction of novel techniques of teaching medicine in training centres with skills learning on dummies and simulators were questioned. The importance of ward-round sand simple manual skills teaching was emphasised.

The Relevance of the Ethics of Understanding of Life in Nursing

2005 ◽  
Vol 9 (4) ◽  
pp. 39-44 ◽  
Author(s):  
Arne Rehnsfeldt,
Keyword(s):  
Nursing Care ◽  
Care Ethics ◽  
Ethical Decisions ◽  
Ethical Care

The ultimate, universal goal of caring is described by the ethics of understanding of life. The ultimate goal of alleviating suffering is the progression of suffering as an existential sign of development of the understanding of life. The progression of suffering means to create meaning in suffering together with a caregiver. The aim of this study was to elaborate on the ethics of understanding of life in relation to phenomenological aspects of nursing care ethics. Inward and outward ethical decisions affect the patient’s understanding of life through practical ethical care. When the patient and caregiver encounter one another with different understandings of life, there is no development in the understanding of life and the patient may even be abused.

scholarly journals Practicing outcome-based medical care using pragmatic care trials

Trials ◽  
2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Tim E. Darsaut ◽  
Jean Raymond
Keyword(s):  
Medical Care ◽  
Patient Outcomes ◽  
Medical Practice ◽  
Trial Methodology ◽  
Management Options ◽  
Scientific Methods ◽  
Good Medical Practice ◽  
Reliable Knowledge ◽  
Medical Interest

Abstract The current separation between medical research and care is an obstacle to essential aspects of good medical practice: the verification that care interventions actually deliver the good outcomes they promise, and the use of scientific methods to optimize care under uncertainty. Pragmatic care trials have been designed to address these problems. Care trials are all-inclusive randomized trials integrated into care. Every item of trial design is selected in the best medical interest of participating patients. Care trials can eventually show what constitutes good medical practice based on patient outcomes. In the meantime, care trials give clinicians and patients the scientific methods necessary for optimization of medical care when no one really knows what to do. We report the progress of 9 randomized care trials that were used to guide the endovascular or surgical management of 1212 patients with acute stroke, intracranial aneurysms, and arteriovenous malformations in a single center in an elective or acute care context. Care trials were used to address long-standing dilemmas regarding rival medical, surgical, or endovascular management options or to offer innovative instead of standard treatments. The trial methodology, by replacing unrepeatable treatment decisions by 1:1 randomized allocation whenever reliable knowledge was not available, had an immediate impact, transforming unverifiable dogmatic medical practice into verifiable outcome-based medical care. We believe the approach is applicable to all medical or surgical domains, but widespread adoption may require the revision of many currently prevalent views regarding the role of research in clinical practice.

Ethical issues in palliative care research

2021 ◽  
pp. 1312-1317
Author(s):  
Tyler Tate ◽  
David Casarett
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
End Of Life ◽  
Ethical Issues ◽  
Research Participation ◽  
Ethical Aspects ◽  
Care Research ◽  
Qualitative And Quantitative ◽  
Decision Making Capacity ◽  
Potential Benefits

Recent growth in palliative care research has created a heterogeneous field that encompasses both qualitative and quantitative techniques, and descriptive as well as interventional studies. Despite the valuable knowledge that has been produced by this research, and the promise of future important advances, its progress has been impeded by a persistent uncertainty about the ethics of these studies. For instance, there have been concerns raised about whether patients near the end of life should ever be asked to participate in research, although others have objected to this extreme position. Nevertheless, the combination of ethical and practical issues can create substantial barriers to palliative care research. This chapter discusses five ethical aspects of palliative care research that investigators and clinicians should consider in designing and conducting palliative care research. These include (1) the study’s potential benefits to future patients, (2) the study’s potential benefits to subjects, (3) the study’s risks to subjects, (4) subjects’ decision-making capacity, and (5) the voluntariness of subjects’ choices about research participation.

Structural Studies on Mitotic Spindle Fibres

1978 ◽  
Vol 36 (3) ◽  
pp. 615-626
Author(s):  
J.R. Mcintosh
Keyword(s):  
Chemical Composition ◽  
Mitotic Spindle ◽  
Structural Studies ◽  
Mitotic Apparatus ◽  
Chemical Studies ◽  
Medical Interest ◽  
Spindle Fibres

The mitotic apparatus is a structure of obvious biological and medical interest, but it has proved to be a difficult cellular machine to understand. The chemical composition of the spindle is only slightly elucidated, largely because of the difficulties in preparing useful isolates of the structure. Chemical studies of the mitotic spindle have been reviewed elsewhere (Mcintosh, 1977), and will not be discussed further here. One would think that structural studies on the mitotic apparatus (MA) in situ would be straightforward, but even with this approach there is some disagreement in the results obtained with various methods and by different investigators. In this paper I will review briefly the approaches which have been used in structural studies of the MA, pointing out the strengths and problems of each approach. I will summarize the principal findings of the different methods, and identify what seem to be fruitful avenues for further work.

Sign in / Sign up

Export Citation Format

Share Document