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(2)
ONE IN TEN HOSPITAL LIFT RIDES BREACH
PATIENT
PRIVACY
(3)
ADVANCE DIRECTIVES OPEN TO DIFFERENT
INTERPRETATIONS
(1) HOW CAN WE
SECURE THE FUTURE OF
MEDICAL RESEARCH?
(Descriptive survey of non-commercial
randomised
controlled trials in the United
Kingdom)
http://bmj.com/cgi/content/full/327/7422/1017
(Resuscitating clinical research
in the United Kingdom)
http://bmj.com/cgi/content/full/327/7422/1041
(Editorials)
http://bmj.com/cgi/content/full/327/7422/1001
Clinical research in Britain is in decline.
This week's BMJ
reveals that the number of non-commercial
trials has
fallen in recent years, while a summary
of a new report
from the Academy of Medical Sciences sets
out what is
needed to revitalise clinical research.
Researchers identified 1,464 randomised
controlled trials
supported by the main non-commercial sources
of
funding in the UK (Medical Research Council,
NHS,
and medical research charities) between
1980 and 2002.
They found that the number of trials declined
without any
associated increase in the sample sizes
of these studies.
Of 615 trials funded by the NHS or Department
of
Health during this time, 514 (83.6%) were
funded
through programmes that were discontinued.
Support also seems to be declining from
the Medical
Research Council and the medical research
charities, say
the authors, and they call for a coherent
strategy to
ensure support for trials that address
issues of no interest
to industry but are of great importance
to patients and
practitioners.
Failure to energise clinical research will
have serious
implications for the future of health
care, patients, and
those trying to develop new medicines,
warn the
Academy of Medical Sciences in a new report
"Strengthening clinical research."
They highlight the challenges facing research
in the NHS
and set out recommendations for overcoming
these
obstacles. These include establishing
a national network
for clinical research, better career and
reward structures
for researchers, and increased funding
from all sources.
Contact:
Emma Dickinson, BMA Press Office, London,
UK
Email: edickinson@bma.org.uk
(2) ONE IN TEN
HOSPITAL LIFT RIDES BREACH
PATIENT PRIVACY
(Privacy of patients' information
in hospital lifts:
observational study)
http://bmj.com/cgi/content/full/327/7422/1024
More than one in ten hospital lift rides
breach patient
privacy, according to a study in this
week's BMJ.
Medical students at St Michael's Hospital
in Toronto
recorded the date, time, duration, and
location of every
journey they took in a public lift at
the hospital during
regular hours for two weeks in November
2002.
They recorded all compromises of patients'
confidentiality by hospital staff and
any reactions by
witnesses to these comments.
Hospital staff made 18 comments deemed
to
compromise a patients' confidentiality
on 13 out of 113
lift journeys (observers overheard multiple
comments on
some journeys). Reactions attempting to
minimise
breaches by medical students not involved
in the study
happened on two occasions.
Breaches of a patient's confidentiality
compromise ethical
health care and undermine patients' confidence
in
caregivers, say the authors. Clarification
of what
constitutes a breach in patient confidentiality
is needed
and healthcare institutions must provide
effective training
to minimise these breaches, they conclude.
Contact:
John Bohnen, Associate Professor, Departments
of
Surgery and Health Policy, St Michael's
Hospital,
University of Toronto, Canada
Email: macisaact@smh.toronto.on.ca
(3) ADVANCE DIRECTIVES
OPEN TO DIFFERENT
INTERPRETATIONS
(Adherence to advance directives
in critical care decision
making: vignette study)
http://bmj.com/cgi/content/full/327/7422/1011
Health professionals come to different
conclusions about
the "right thing to do" when applying
the terms of an
advance directive to a clinical scenario,
finds a study in
this week's BMJ.
Advance directives are written statements
about future
treatment preferences made when a patient
is in sound
mind.
Researchers conducted interviews and focus
groups with
general practitioners, hospital specialists,
and nurses.
They were given a hypothetical advance
directive and
asked what they believed was the "right
thing to do" in a
particular critical care scenario involving
a mildly
demented woman with suspected pneumonia.
Health professionals came to different
conclusions about
the "right thing to do." Those who favoured
treatment
thought the directive did not apply, or
saw adherence to
the directive as not being in the patient's
best interests.
Those who opposed treatment centred on
respect for
autonomy as an ethical principle.
Some of this variability was related to
the ambiguity of
the directive's terminology whereas some
was related to
the willingness of health professionals
to make subjective
value judgements concerning quality of
life.
Advance directives will not lessen the
responsibility of
health professionals to weigh up a range
of conflicting
considerations, say the authors. Medical
education
should seek to develop students' empathetic
skills and
scenarios such as this could be used for
this purpose,
they conclude.
Contact:
Trevor Thompson, Clinical Lecturer, Division
of Primary
Health Care, University of Bristol, UK
Email: trevor.thompson@bristol.ac.uk
/
trevorthompson@btinternet.com
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(contact: pressoffice@bma.org.uk)
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Association for the
Advancement of Science
(http://www.eurekalert.org)