| An ethical hierarchy for decision making during medical emergencies. | |
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MedLine Citation:
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PMID: 20437578 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Evidence from well-designed clinical trials may guide clinicians, reduce regional variation, and lead to improved outcomes. Many physicians choose to ignore evidence-based practice guidelines. Using unproven therapies outside of a randomized trial slows recruitment in clinical trials that could yield information on clinical and economic efficacy. Using acute stroke therapy as an illustration, we present an ethical hierarchy for therapeutic decision making during medical emergencies. First, physicians should offer standard care. If no standard care option exists, the physician should consider enrollment in a randomized clinical trial. If no trial is appropriate, the physician should consider a nonrandomized registry, or consensus-based guidelines. Finally, only after considering the first 3 options, the physician should use best judgment based on previous personal experience and any published case series or anecdotes. Given the paucity of quality randomized clinical trial data for most medical decisions, the "best judgment" option will be used most frequently. Nevertheless, such a hierarchy is needed because of the limited time during medical emergencies for consideration of general principles of clinical decision making. There should be general agreement in advance as to the hierarchy to follow in selecting treatment for critically ill patients. Were more clinicians to follow this hierarchy, and choose to participate in clinical trials, the generation of new knowledge would accelerate, yielding rigorous data supporting or refuting the efficacy and safety of new interventions more quickly, thus benefiting far more patients over time. |
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Authors:
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Patrick D Lyden; Brett C Meyer; Thomas M Hemmen; Karen S Rapp |
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Publication Detail:
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Type: Case Reports; Journal Article |
Journal Detail:
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Title: Annals of neurology Volume: 67 ISSN: 1531-8249 ISO Abbreviation: Ann. Neurol. Publication Date: 2010 Apr |
Date Detail:
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Created Date: 2010-05-03 Completed Date: 2010-05-14 Revised Date: 2011-07-27 |
Medline Journal Info:
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Nlm Unique ID: 7707449 Medline TA: Ann Neurol Country: United States |
Other Details:
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Languages: eng Pagination: 434-40 Citation Subset: IM |
Affiliation:
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Department of Neurosciences, University of California, San Diego School of Medicine, La Jolla, CA, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Clinical Trials as Topic / ethics* Decision Making / ethics* Diffusion Magnetic Resonance Imaging / methods Emergencies / psychology* Humans Male Paresis / diagnosis, therapy Patient Participation Physicians / psychology* |
| Grant Support | |
ID/Acronym/Agency:
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P50 NS044148-05/NS/NINDS NIH HHS |
| Comments/Corrections | |
Comment In:
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Ann Neurol. 2010 Apr;67(4):419-21
[PMID:
20437575
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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