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Katzenschlager S, Elshaer A, Metelmann B, Metelmann C, Thilakasiri K, Karageorgos V, Barry T, Alm-Kruse K, Karim H, Maurer H, Kramer-Johansen J, Orlob S. Top 5 barriers in cardiac arrest research as perceived by international early career researchers - A consensus study. Resusc Plus 2024; 18:100608. [PMID: 38524147 PMCID: PMC10957401 DOI: 10.1016/j.resplu.2024.100608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
Aim of the study Cardiac arrest research has not received as much scientific attention as research on other topics. Here, we aimed to identify cardiac arrest research barriers from the perspective of an international group of early career researchers. Methods Attendees of the 2022 international masterclass on cardiac arrest registry research accompanied the Global Out-of-Hospital Cardiac Arrest Registry collaborative meeting in Utstein, Norway, and used an adapted hybrid nominal group technique to obtain a diverse and comprehensive perspective. Barriers were identified using a web-based questionnaire and discussed and ranked during an in-person follow-up meeting. After each response was discussed and clarified, barriers were categorized and ranked over two rounds. Each participant scored these from 1 (least significant) to 5 (most significant). Results Nine participants generated 36 responses, forming seven overall categories of cardiac arrest research barriers. "Allocated research time" was ranked first in both rounds. "Scientific environment", including appropriate mentorship and support systems, ranked second in the final ranking. "Resources", including funding and infrastructure, ranked third. "Access to and availability of cardiac arrest research data" was the fourth-ranked barrier. This included data from the cardiac arrest registries, medical devices, and clinical studies. Finally, "uniqueness" was the fifth-ranked barrier. This included ethical issues, patient recruitment challenges, and unique characteristics of cardiac arrest. Conclusion By identifying cardiac arrest research barriers and suggesting solutions, this study may act as a tool for stakeholders to focus on helping early career researchers overcome these barriers, thus paving the road for future research.
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Affiliation(s)
- Stephan Katzenschlager
- Heidelberg University, Medical Faculty Heidelberg, Department of Anesthesiology, Heidelberg, Germany
| | - Ahmed Elshaer
- The Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Bibiana Metelmann
- Department of Anaesthesiology, Greifswald University Medicine, Greifswald, Germany
| | - Camilla Metelmann
- Department of Anaesthesiology, Greifswald University Medicine, Greifswald, Germany
| | - Kaushila Thilakasiri
- Oxford University Hospitals NHS Trust Oxford UK, Postgraduate Institute of Medicine, UK
- University of Colombo, Ministry of Health, Sri Lanka
| | - Vlasios Karageorgos
- Cardiopulmonary Resuscitation Lab, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | | | - Kristin Alm-Kruse
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hritul Karim
- Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Holger Maurer
- Department of Anesthesiology and Intensive Care Medicine, University of Luebeck, Luebeck, Germany
| | - Jo Kramer-Johansen
- Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS) , Norway
- Norwegian Cardiac Arrest Registry, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Simon Orlob
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
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Obermaier M, Zimmermann JB, Popp E, Weigand MA, Weiterer S, Dinse-Lambracht A, Muth CM, Nußbaum BL, Gräsner JT, Seewald S, Jensen K, Seide SE. Automated mechanical cardiopulmonary resuscitation devices versus manual chest compressions in the treatment of cardiac arrest: protocol of a systematic review and meta-analysis comparing machine to human. BMJ Open 2021; 11:e042062. [PMID: 33589455 PMCID: PMC7887349 DOI: 10.1136/bmjopen-2020-042062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Cardiac arrest is a leading cause of death in industrialised countries. Cardiopulmonary resuscitation (CPR) guidelines follow the principles of closed chest compression as described for the first time in 1960. Mechanical CPR devices are designed to improve chest compression quality, thus considering the improvement of resuscitation outcomes. This protocol outlines a systematic review and meta-analysis methodology to assess trials investigating the therapeutic effect of automated mechanical CPR devices at the rate of return of spontaneous circulation, neurological state and secondary endpoints (including short-term and long-term survival, injuries and surrogate parameters for CPR quality) in comparison with manual chest compressions in adults with cardiac arrest. METHODS AND ANALYSIS A sensitive search strategy will be employed in established bibliographic databases from inception until the date of search, followed by forward and backward reference searching. We will include randomised and quasi-randomised trials in qualitative analysis thus comparing mechanical to manual CPR. Studies reporting survival outcomes will be included in quantitative analysis. Two reviewers will assess independently publications using a predefined data collection form. Standardised tools will be used for data extraction, risks of bias and quality of evidence. If enough studies are identified for meta-analysis, the measures of association will be calculated by dint of bivariate random-effects models. Statistical heterogeneity will be evaluated by I2-statistics and explored through sensitivity analysis. By comprehensive subgroup analysis we intend to identify subpopulations who may benefit from mechanical or manual CPR techniques. The reporting follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. ETHICS AND DISSEMINATION No ethical approval will be needed because data from previous studies will be retrieved and analysed. Most resuscitation studies are conducted under an emergency exception for informed consent. This publication contains data deriving from a dissertation project. We will disseminate the results through publication in a peer-reviewed journal and at scientific conferences. PROSPERO REGISTRATION NUMBER CRD42017051633.
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Affiliation(s)
- Manuel Obermaier
- Department of Anaesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Erik Popp
- Department of Anaesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Markus A Weigand
- Department of Anaesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Sebastian Weiterer
- Department of Anaesthesiology, Heidelberg University Hospital, Heidelberg, Germany
- Rheinland Klinikum, Lukaskrankenhaus Neuss, Neuss, Germany
| | | | - Claus-Martin Muth
- Department of Anaesthesiology, Ulm University Hospital, Ulm, Germany
| | | | - Jan-Thorsten Gräsner
- Institute for Emergency Medicine, Schleswig-Holstein University Hospital, Kiel, Germany
| | - Stephan Seewald
- Institute for Emergency Medicine, Schleswig-Holstein University Hospital, Kiel, Germany
| | - Katrin Jensen
- Institute of Medical Biometry and Informatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Svenja E Seide
- Institute of Medical Biometry and Informatics, Heidelberg University Hospital, Heidelberg, Germany
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Gupta P, Naeem SS, Mohan P, Banerjee A. Is written informed consent 'cast in iron' even during a pandemic? Med J Armed Forces India 2020; 76:367-369. [PMID: 33162647 PMCID: PMC7598424 DOI: 10.1016/j.mjafi.2020.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/12/2020] [Indexed: 11/21/2022] Open
Affiliation(s)
- Pooja Gupta
- Associate Professor (Pharmacology) & Member Secretary, IEC Subcommittee, AIIMS, New Delhi, India
| | - Syed Shariq Naeem
- Assistant Professor (Pharmacology), Aligarh Muslim University, Aligarh, UP, India
| | - Prafull Mohan
- Professor, Department of Pharmacology, Armed Forces Medical College, Pune, India
| | - Amitav Banerjee
- Professor & Head (Community Medicine), Dr. DY Patil Medical College, Hospital & Research Centre, Pune & Chairperson, Institutional Ethics Committee, AFMC, Pune, India
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4
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Scott J, Langsrud K, Vethe D, Kjørstad K, Vestergaard CL, Faaland P, Lydersen S, Vaaler A, Morken G, Torgersen T, Kallestad H. A pragmatic effectiveness randomized controlled trial of the duration of psychiatric hospitalization in a trans-diagnostic sample of patients with acute mental illness admitted to a ward with either blue-depleted evening lighting or normal lighting conditions. Trials 2019; 20:472. [PMID: 31370871 PMCID: PMC6676579 DOI: 10.1186/s13063-019-3582-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 07/16/2019] [Indexed: 12/13/2022] Open
Abstract
Background There is increasing recognition of the need to stabilize sleep-wake cycles in individuals with major mental disorders. As such, clinicians and researchers advocate the use of interventions targeted at sleep and circadian dysrhythmias as an adjunct to the standard treatments offered for acute illness episodes of a broad range of diagnoses. To determine the trans-diagnostic generalizability of chronotherapy, we explore the benefits of admitting individuals with an acute illness episode to a psychiatric inpatient unit where changes in light exposure are integrated into the therapeutic environment. Methods/design A two-arm, pragmatic effectiveness, randomized controlled treatment trial, where individuals admitted for acute inpatient psychiatric care will be allocated to a ward with blue-depleted evening light or to a ward with the same layout and facilities but lacking the new lighting technology. The trial will test whether the experimental lighting conditions offer any additional benefits beyond those associated with usual treatment in an acute psychiatric inpatient unit. The main objectives are to examine any differences between groups in the mean duration of hospitalization in days. Additional analyses will compare group differences in symptoms, functioning, medication usage, and side effects and whether length of stay is associated with stability of sleep-wake cycles and circadian rhythms. Ancillary investigations should determine any benefits according to diagnostic subgroups and potential drawbacks such as any adverse effects on the well-being of professionals working across both wards. Discussion This unit offers a unique opportunity to explore how exposure to different lighting conditions may modify sleep-wake cycles and how any changes in sleep-wake cycle may impact on the clinical and functional outcomes of individuals experiencing an acute episode of a severe mental disorder that requires inpatient care. The findings could influence the future design of hospital units offering care to patients with mental or physical disorders. Trial registration ClinicalTrials.gov, ID: NCT03788993. Retrospectively registered on 28 December 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3582-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jan Scott
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Knut Langsrud
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Division of Mental Health Care, St. Olavs University Hospital, Trondheim, Norway
| | - Daniel Vethe
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Division of Mental Health Care, St. Olavs University Hospital, Trondheim, Norway
| | - Kaia Kjørstad
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Division of Mental Health Care, St. Olavs University Hospital, Trondheim, Norway
| | - Cecilie L Vestergaard
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Division of Mental Health Care, St. Olavs University Hospital, Trondheim, Norway
| | - Patrick Faaland
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Division of Mental Health Care, St. Olavs University Hospital, Trondheim, Norway
| | - Stian Lydersen
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arne Vaaler
- Division of Mental Health Care, St. Olavs University Hospital, Trondheim, Norway
| | - Gunnar Morken
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Division of Mental Health Care, St. Olavs University Hospital, Trondheim, Norway
| | - Terje Torgersen
- Division of Mental Health Care, St. Olavs University Hospital, Trondheim, Norway
| | - Håvard Kallestad
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway. .,Division of Mental Health Care, St. Olavs University Hospital, Trondheim, Norway. .,Department of Research and Development, St. Olavs University Hospital, PO Box 3250, Sluppen, 7006, Trondheim, Norway.
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Sweet L, Adamis D, Meagher DJ, Davis D, Currow DC, Bush SH, Barnes C, Hartwick M, Agar M, Simon J, Breitbart W, MacDonald N, Lawlor PG. Ethical challenges and solutions regarding delirium studies in palliative care. J Pain Symptom Manage 2014; 48:259-71. [PMID: 24388124 PMCID: PMC4082407 DOI: 10.1016/j.jpainsymman.2013.07.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 07/11/2013] [Accepted: 07/17/2013] [Indexed: 11/20/2022]
Abstract
CONTEXT Delirium occurs commonly in settings of palliative care (PC), in which patient vulnerability in the unique context of end-of-life care and delirium-associated impairment of decision-making capacity may together present many ethical challenges. OBJECTIVES Based on deliberations at the Studies to Understand Delirium in Palliative Care Settings (SUNDIPS) meeting and an associated literature review, this article discusses ethical issues central to the conduct of research on delirious PC patients. METHODS Together with an analysis of the ethical deliberations at the SUNDIPS meeting, we conducted a narrative literature review by key words searching of relevant databases and a subsequent hand search of initially identified articles. We also reviewed statements of relevance to delirium research in major national and international ethics guidelines. RESULTS Key issues identified include the inclusion of PC patients in delirium research, capacity determination, and the mandate to respect patient autonomy and ensure maintenance of patient dignity. Proposed solutions include designing informed consent statements that are clear, concise, and free of complex phraseology; use of concise, yet accurate, capacity assessment instruments with a minimally burdensome schedule; and use of PC friendly consent models, such as facilitated, deferred, experienced, advance, and proxy models. CONCLUSION Delirium research in PC patients must meet the common standards for such research in any setting. Certain features unique to PC establish a need for extra diligence in meeting these standards and the employment of assessments, consent procedures, and patient-family interactions that are clearly grounded on the tenets of PC.
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Affiliation(s)
- Lisa Sweet
- Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada
| | | | - David J Meagher
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada; Cognitive Impairment Research Group, Department of Psychiatry, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Daniel Davis
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - David C Currow
- Discipline of Palliative and Supportive Services, Bedford Park, South Australia, Australia; Flinders Centre for Clinical Change, Flinders University, Bedford Park, South Australia, Australia
| | - Shirley H Bush
- Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada; Palliative Care Unit, Bruyère Continuing Care, Ottawa, Ontario, Canada
| | - Christopher Barnes
- Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada; Palliative Care Unit, Bruyère Continuing Care, Ottawa, Ontario, Canada
| | - Michael Hartwick
- Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada; Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Critical Care Response Team, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Meera Agar
- Discipline of Palliative and Supportive Services, Bedford Park, South Australia, Australia; Department of Palliative Care, Braeside Hospital, HammondCare, Sydney, New South Wales, Australia; South West Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Jessica Simon
- Division of Palliative Medicine, Department of Oncology and Department of Internal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - William Breitbart
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York, USA; Department of Psychiatry, Weill Medical College of Cornell University, New York, New York, USA
| | - Neil MacDonald
- Department of Oncology, McGill University, Montreal, Quebec, Canada
| | - Peter G Lawlor
- Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada; Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Hutchison JS, Frndova H, Lo TYM, Guerguerian AM. Impact of hypotension and low cerebral perfusion pressure on outcomes in children treated with hypothermia therapy following severe traumatic brain injury: a post hoc analysis of the Hypothermia Pediatric Head Injury Trial. Dev Neurosci 2011; 32:406-12. [PMID: 21252486 DOI: 10.1159/000323260] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 11/24/2010] [Indexed: 11/19/2022] Open
Abstract
Hypotension and low cerebral perfusion pressure are known to be associated with unfavorable outcome in children and adults with traumatic brain injury. Using the database from a previously published, randomized controlled trial of 24 h of hypothermia therapy in children with severe traumatic brain injury, we compared the number of patients with hypotension or low cerebral perfusion pressure between the hypothermia therapy and normothermia groups. We also determined the association between these physiologic insults and unfavorable outcome using regression analysis. There were more patients with episodes of hypotension or low cerebral perfusion pressure in the hypothermia therapy group than in the normothermia group. These physiologic insults were associated with unfavorable outcome in both intervention groups. Hypotension and low cerebral perfusion pressure should be anticipated and prevented in future trials of hypothermia therapy in patients with traumatic brain injury.
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Affiliation(s)
- James S Hutchison
- Department of Critical Care, Hospital for Sick Children, Toronto, Ont., Canada.
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Hutchison JS, Ward RE, Lacroix J, Hébert PC, Barnes MA, Bohn DJ, Dirks PB, Doucette S, Fergusson D, Gottesman R, Joffe AR, Kirpalani HM, Meyer PG, Morris KP, Moher D, Singh RN, Skippen PW. Hypothermia therapy after traumatic brain injury in children. N Engl J Med 2008; 358:2447-56. [PMID: 18525042 DOI: 10.1056/nejmoa0706930] [Citation(s) in RCA: 388] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Hypothermia therapy improves survival and the neurologic outcome in animal models of traumatic brain injury. However, the effect of hypothermia therapy on the neurologic outcome and mortality among children who have severe traumatic brain injury is unknown. METHODS In a multicenter, international trial, we randomly assigned children with severe traumatic brain injury to either hypothermia therapy (32.5 degrees C for 24 hours) initiated within 8 hours after injury or to normothermia (37.0 degrees C). The primary outcome was the proportion of children who had an unfavorable outcome (i.e., severe disability, persistent vegetative state, or death), as assessed on the basis of the Pediatric Cerebral Performance Category score at 6 months. RESULTS A total of 225 children were randomly assigned to the hypothermia group or the normothermia group; the mean temperatures achieved in the two groups were 33.1+/-1.2 degrees C and 36.9+/-0.5 degrees C, respectively. At 6 months, 31% of the patients in the hypothermia group, as compared with 22% of the patients in the normothermia group, had an unfavorable outcome (relative risk, 1.41; 95% confidence interval [CI], 0.89 to 2.22; P=0.14). There were 23 deaths (21%) in the hypothermia group and 14 deaths (12%) in the normothermia group (relative risk, 1.40; 95% CI, 0.90 to 2.27; P=0.06). There was more hypotension (P=0.047) and more vasoactive agents were administered (P<0.001) in the hypothermia group during the rewarming period than in the normothermia group. Lengths of stay in the intensive care unit and in the hospital and other adverse events were similar in the two groups. CONCLUSIONS In children with severe traumatic brain injury, hypothermia therapy that is initiated within 8 hours after injury and continued for 24 hours does not improve the neurologic outcome and may increase mortality. (Current Controlled Trials number, ISRCTN77393684 [controlled-trials.com].).
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Affiliation(s)
- James S Hutchison
- Department of Critical Care Medicine, Hospital for Sick Children, 555 University Ave., Toronto, ON M5G 1X8, Canada.
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Chenaud C, Merlani P, Luyasu S, Ricou B. Informed consent for research obtained during the intensive care unit stay. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2007; 10:R170. [PMID: 17156444 PMCID: PMC1794486 DOI: 10.1186/cc5120] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2006] [Revised: 09/08/2006] [Accepted: 12/08/2006] [Indexed: 01/31/2023]
Abstract
Introduction Patients in the intensive care unit (ICU) may be in an inadequate condition to give their informed consent for research. The aim of this study was to analyse the ability to recall participation in a clinical trial for which ICU patients had given their consent. Methods The data presented are a two-step observational study: first, a protocolled informed consent procedure was conducted then the informed consent was given by the patient, and second, a patient interview was held 10 ± 2 days later by the same investigator. The primary endpoints were the ability to recall their participation in the clinical trial, as well as its purpose and related risks. As secondary endpoints, we investigated whether asking questions about the clinical trial or reading the informative leaflet was related to the recall. To be included in the study, the patient had to have a Glasgow Coma Scale score of 15, be fully oriented and free of mechanical ventilation, and be judged competent by both the investigator and the attending physician. Patients admitted to the ICU after major surgery or trauma were eligible. However, patients who refused to participate, or those whose next-of-kin gave consent, were excluded. Results Of the 44 patients, 35 (80%) recognized, 10 to 12 days after informed consent had been obtained, that they had participated in the clinical trial, but only 14 out of 44 (32%) could recall the clinical trial purpose and its related risks. More patients with complete recall had read the informative leaflet or asked at least one question before signing the informed consent. Asking at least one question was associated with complete recall. Conclusion Our results confirm that obtaining informed consent for research during an ICU stay is associated with poor patient recall of participation in a clinical trial and its components (purpose and risk). Whether encouraging reading the informative leaflet and asking questions about the clinical trial improves the informed consent procedure remains to be fully investigated.
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Affiliation(s)
- Catherine Chenaud
- Service of Intensive Care, Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, Rue Micheli-du-Crest 24, 1211 Geneva 14, Switzerland
| | - Paolo Merlani
- Service of Intensive Care, Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, Rue Micheli-du-Crest 24, 1211 Geneva 14, Switzerland
| | - Samuel Luyasu
- Service of Intensive Care, Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, Rue Micheli-du-Crest 24, 1211 Geneva 14, Switzerland
| | - Bara Ricou
- Service of Intensive Care, Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, Rue Micheli-du-Crest 24, 1211 Geneva 14, Switzerland
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Abstract
There are many controversial issues surrounding ethics in study design and conduct of human subjects research. In this review we briefly touch on the origin of ethics in clinical research and how the current regulations and standards came into practice. We then discuss current controversies regarding informed consent, conflicts of interest, institutional review boards, and other relevant issues such as innovative procedures and quality improvement projects. The question of whether we need more standards is a very important yet challenging one to which there is no simple answer. We address this question by reviewing and commenting on relevant literature. We conclude that what is needed are not more standards per se, but rather refinement and uniformity of current standards, and their interpretation and application both to protect human subjects and to advance medicine.
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Affiliation(s)
- David T Huang
- CRISMA Laboratory, Department of Critical Care Medicine, Department of Emergency Medicine, University of Pittsburgh, 641 Scaife Hall, Pittsburgh, PA 15261, USA
| | - Mehrnaz Hadian
- Department of Critical Care Medicine, University of Pittsburgh, 641 Scaife Hall, Pittsburgh, PA 15261, USA
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11
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McClure KB, DeIorio NM, Gunnels MD, Ochsner MJ, Biros MH, Schmidt TA. Attitudes of emergency department patients and visitors regarding emergency exception from informed consent in resuscitation research, community consultation, and public notification. Acad Emerg Med 2003; 10:352-9. [PMID: 12670849 DOI: 10.1111/j.1553-2712.2003.tb01348.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess public views on emergency exception to informed consent in resuscitation research, public awareness of such studies, and effective methods of community consultation and public notification. METHODS A face-to-face survey was conducted in two academic Level I trauma center emergency departments (EDs) in Oregon and Minnesota from June through August 2001. RESULTS Five hundred thirty people completed the survey, with an 82% response rate. The mean age of the respondents was 41 years (range 18-95) with a standard deviation of 14.5; 46% were female and 64% white. Most (88%) believed that research subjects should be informed prior to being enrolled, while 49% believed enrolling patients without prior consent in an emergency situation would be acceptable and 70% (369) would not object to be entered into such a study without providing prospective informed consent. Informing and consulting the community as a substitute for patient consent in emergency research was thought to be reasonable by 45% of the respondents. Most respondents would prefer to be informed about a study using emergency exception from informed consent by radio and television media (42%). Two hundred fifty-eight respondents (49%) stated they would attend a community meeting; the less educated were more likely to attend than those with college degrees (OR = 0.53; 95% CI = 0.33 to 0.85, p = 0.008). However, only 5% knew of ongoing studies in their community using emergency exception from informed consent. CONCLUSIONS Most respondents disagreed with foregoing prospective informed consent for research participation even in emergency situations; however, many would be willing to participate in studies using emergency exception from informed consent. Most respondents would not attend community meetings, and would prefer to rely upon the media for information. Very few were aware of emergency exception from informed consent studies in their community. This suggests that current methods of community notification may not be effective.
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Affiliation(s)
- Katie B McClure
- Department of Emergency Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Road, Mail Code UHN 53, Portland, OR 97201, USA.
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13
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Abstract
The CRASH Trial (Corticosteroid Randomisation After Significant Head injury), which started in April 1999 hopes to answer the question of whether or not there is any benefit to giving high dose corticosteroids after significant head injuries. To do this patients are randomised to receive either the standard care for head injuries, as defined by the receiving hospital, or standard care plus a 48 hour infusion of corticosteroids. This is to be started within eight hours of injury, preferably as soon as possible. As all eligible patients will have a reduced level of consciousness informed consent has been deemed unnecessary. In this review the issue of consent in human experimentation is presented with a special emphasis on the problems faced in emergency medicine research, and the way these have been tackled.
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Affiliation(s)
- B A Foëx
- Department of Accident and Emergency Medicine, Royal Bolton Hospital.
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Kennedy KA, Ipson MA, Birch DG, Tyson JE, Anderson JL, Nusinowitz S, West L, Spencer R, Birch EE. Light reduction and the electroretinogram of preterm infants. Arch Dis Child Fetal Neonatal Ed 1997; 76:F168-73. [PMID: 9175946 PMCID: PMC1720640 DOI: 10.1136/fn.76.3.f168] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIMS To examine the effects of light on retinal development and function in preterm infants as measured by the electroretinogram (ERG). Secondary outcomes included visual acuity testing, the incidence of retinopathy of prematurity, and general wellbeing, reflected in feeding tolerance, rate of weight gain, and length of hospital stay. METHODS Eligibility criteria for enrollment were birthweight < or = 1250 g and gestational age < or = 31 weeks. Sixty one infants were randomly allocated by 6 hours after birth to a control or treatment group which wore 97% light filtering goggles for a minimum of four weeks or until the infant reached 31 weeks postmenstrual age. RESULTS There were no significant differences between the two groups in the numbers of electroretinograms performed at 36 weeks of postmenstrual age. Although the sample size was not large enough to exclude clinically important differences in secondary outcomes, no significant differences were observed between the groups in visual acuity testing at 4-6 months corrected age, incidence of retinopathy of prematurity, weight gain, or length of stay. CONCLUSION These data support the safety and feasibility of this intervention. A much larger study will be needed to determine whether light reduction to the eyes of very low birthweight infants will reduce the incidence of retinopathy of prematurity or enhance general well-being.
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Affiliation(s)
- K A Kennedy
- Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas 75235, USA
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Olson CM, Jobe KA. Reporting approval by research ethics committees and subjects' consent in human resuscitation research. Resuscitation 1996; 31:255-63. [PMID: 8783411 DOI: 10.1016/0300-9572(95)00928-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine how frequently reports of research in human cardiopulmonary resuscitation mention approval by a research ethics committee and address subjects' consent. METHODS Retrospective review of published reports of interventional research in human cardiopulmonary resuscitation. Reports were retrieved from the MEDLINE database and selected according to pre-established criteria. Data were abstracted independently by the two authors with differences resolved by mutual agreement. Results were analyzed according to whether the research took place in the prehospital setting, the emergency department, or the hospital; whether it was conducted within or outside the United States; whether it received any funding from the US government; its randomization scheme; the year of publication; and whether the journal's instructions required mention of REC approval or subjects' consent. RESULTS Reports of 47 studies met our criteria for inclusion. Of these, 24 (51%) mentioned approval by a research ethics committee and 12 (26%) addressed subjects' consent. Significantly more studies reported ethics committee approval or addressed consent during more recent years. Authors were more likely to report consent, REC approval, or both when journal instructions required that REC approval be mentioned. CONCLUSION Reports of resuscitation research have not consistently mentioned approval from a research ethics committee or addressed subjects' consent for interventional studies using human subjects. However, they are doing so more frequently in recent years as journal requirements for reporting change. REC approval is now almost always being reported, but subjects' consent is often not addressed. Journal editors and reviewers should ensure that authors adhere to the journal's instructions about reporting ethical conduct of experiments.
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Affiliation(s)
- C M Olson
- University of Washington, Seattle 98195-6123, USA
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Tyson JE. Use of unproven therapies in clinical practice and research: how can we better serve our patients and their families? Semin Perinatol 1995; 19:98-111. [PMID: 7604307 DOI: 10.1016/s0146-0005(05)80030-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- J E Tyson
- Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas 75235, USA
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Abstract
The amount of financial and other resources used by physicians in the treatment of critically ill patients makes it incumbent upon physicians to ensure that sufficient benefit is obtained from these resources and that physicians are in fact doing good for their patients. Knowing that one is in fact doing good requires an understanding of what counts as benefit. Current medical practice suggests that patient benefit is typically understood in terms of physiological changes and responses, highlighting the role of medical subspecialties in patient care. An alternative view is suggested, which requires a broader understanding by physicians of patient needs and welfare. This broader understanding calls for an ambitious research agenda so that physicians will be able to learn how they can genuinely help critically ill patients and their families during times of illness. Carrying out such an agenda requires overcoming the ethical challenges of performing research on patients as vulnerable as critically ill patients. It also requires physicians to establish collaborative ties with other professionals so that truly interdisciplinary research can be performed on a routine basis.
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Affiliation(s)
- M Yarborough
- Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver 80262
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Halperin HR, Tsitlik JE, Gelfand M, Weisfeldt ML, Gruben KG, Levin HR, Rayburn BK, Chandra NC, Scott CJ, Kreps BJ. A preliminary study of cardiopulmonary resuscitation by circumferential compression of the chest with use of a pneumatic vest. N Engl J Med 1993; 329:762-8. [PMID: 8350885 DOI: 10.1056/nejm199309093291104] [Citation(s) in RCA: 129] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND More than 300,000 people die each year of cardiac arrest. Studies have shown that raising vascular pressures during cardiopulmonary resuscitation (CPR) can improve survival and that vascular pressures can be raised by increasing intrathoracic pressure. METHODS To produce periodic increases in intrathoracic pressure, we developed a pneumatically cycled circumferential thoracic vest system and compared the results of the use of this system in CPR (vest CPR) with those of manual CPR. In phase 1 of the study, aortic and right-atrial pressures were measured during both vest CPR (60 inflations per minute) and manual CPR in 15 patients in whom a mean (+/- SD) of 42 +/- 16 minutes of initial manual CPR had been unsuccessful. Vest CPR was also carried out on 14 other patients in whom pressure measurements were not made. In phase 2 of the study, short-term survival was assessed in 34 additional patients randomly assigned to undergo vest CPR (17 patients) or continued manual CPR (17 patients) after initial manual CPR (duration, 11 +/- 4 minutes) had been unsuccessful. RESULTS In phase 1 of the study, vest CPR increased the peak aortic pressure from 78 +/- 26 mm Hg to 138 +/- 28 mm Hg (P < 0.001) and the coronary perfusion pressure from 15 +/- 8 mm Hg to 23 +/- 11 mm Hg (P < 0.003). Despite prolonged unsuccessful manual CPR, spontaneous circulation returned with vest CPR in 4 of the 29 patients. In phase 2 of the study, spontaneous circulation returned in 8 of the 17 patients who underwent vest CPR as compared with only 3 of the 17 patients who received continued manual CPR (P = 0.14). More patients in the vest-CPR group than in the manual-CPR group were alive 6 hours after attempted resuscitation (6 of 17 vs. 1 of 17) and 24 hours after attempted resuscitation (3 of 17 vs. 1 of 17), but none survived to leave the hospital. CONCLUSIONS In this preliminary study, vest CPR, despite its late application, successfully increased aortic pressure and coronary perfusion pressure, and there was an insignificant trend toward a greater likelihood of the return of spontaneous circulation with vest CPR than with continued manual CPR. The effect of vest CPR on survival, however, is currently unknown and will require further study.
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Affiliation(s)
- H R Halperin
- Peter Belfer Cardiac Mechanics Laboratory, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD 21205
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A randomized clinical study of a calcium-entry blocker (lidoflazine) in the treatment of comatose survivors of cardiac arrest. N Engl J Med 1991; 324:1225-31. [PMID: 2014035 DOI: 10.1056/nejm199105023241801] [Citation(s) in RCA: 266] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Abnormalities of cellular calcium homeostasis have been implicated in the pathophysiology of postischemic encephalopathy. Calcium-entry-blocking drugs inhibit the influx of calcium into cells and have been shown to mitigate postischemic encephalopathy in animal models. METHODS Five hundred twenty patients with cardiac arrest who remained comatose after the restoration of spontaneous circulation were randomly assigned to receive three doses of lidoflazine, an experimental calcium-entry blocker, or a placebo and were followed for six months. Four patients were lost to follow-up. Treated patients received an intravenous loading dose (1 mg per kilogram of body weight) of lidoflazine and two subsequent doses (0.25 mg per kilogram) 8 and 16 hours after resuscitation. The investigators were blinded to treatment assignment. RESULTS There was no statistically significant difference between the lidoflazine group (n = 259) and the placebo group (n = 257) in the proportion of patients who died during the six-month follow-up (82 vs. 83 percent), who survived with good cerebral recovery (15 vs. 13 percent), or who survived with severe neurologic deficit (1.2 vs. 1.9 percent). Analysis of the best level of recovery achieved at any time during follow-up also did not show a difference between the treatment groups: 24 percent of those given lidoflazine and 23 percent of those given placebo recovered good cerebral function (normal or only moderately disabled cerebral performance) at some time. CONCLUSIONS The administration of lidoflazine after cardiac arrest was not found to be beneficial. Our data do not support the routine use of this calcium-entry-blocking drug in comatose survivors of cardiac arrest.
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