Lee Grace, Byram Adrian C, Owen Adrian M, Ribary Urs, Stoessl A Jon, Townson Andrea, Stables Christine, Illes Judy
1National Core for Neuroethics,Division of Neurology,Department of Medicine,University of British Columbia,Vancouver,Canada.
2The Brain and Mind Institute,University of Western Ontario,London,Canada.
Can J Neurol Sci. 2015 Mar;42(2):96-105. doi: 10.1017/cjn.2015.8.
Acquired brain injury is a critical public health and socioeconomic problem in Canada, leaving many patients in vegetative, minimally conscious, or locked-in states, unresponsive and unable to communicate. Recent advances in neuroimaging research have demonstrated residual consciousness in a few exemplary patients with acquired brain injury, suggesting potential misdiagnosis and changes in prognosis. Such progress, in parallel with research using multimodal brain imaging technologies in recent years, has promising implications for clinical translation, notwithstanding the many challenges that impact health care and policy development. This study explored the perspectives of Canadian professionals with expertise either in neuroimaging research, disorders of consciousness, or both, on the potential clinical applications and implications of imaging technology.
Twenty-two professionals from designated communities of neuroimaging researchers, ethicists, lawyers, and practitioners participated in semistructured interviews. Data were analyzed for emergent themes.
The five most dominant themes were: (1) validation and calibration of the methods; (2) informed consent; (3) burdens on the health care system; (4) implications for the Canadian health care system; and (5) possibilities for improved prognosis.
Movement of neuroimaging from research into clinical care for acquired brain injury will require careful consideration of legal and ethical issues alongside research reliability, responsible distribution of health care resources, and the interaction of technological capabilities with patient outcome.
后天性脑损伤是加拿大一个严重的公共卫生和社会经济问题，导致许多患者处于植物人、微意识或闭锁状态，无反应且无法交流。神经影像学研究的最新进展表明，一些后天性脑损伤的典型患者存在残余意识，这提示可能存在误诊及预后变化。尽管影响医疗保健和政策制定的挑战众多，但近年来使用多模态脑成像技术的研究进展，对临床转化具有潜在意义。本研究探讨了加拿大在神经影像学研究、意识障碍或两者都有专业知识的专业人员对成像技术潜在临床应用及意义的看法。
来自神经影像学研究人员、伦理学家、律师和从业者等特定群体的22名专业人员参与了半结构化访谈。对数据进行分析以找出新出现的主题。
五个最主要的主题是：（1）方法的验证和校准；（2）知情同意；（3）医疗保健系统的负担；（4）对加拿大医疗保健系统的影响；（5）改善预后的可能性。
将神经影像学从研究应用于后天性脑损伤的临床护理，需要在考虑研究可靠性、合理分配医疗保健资源以及技术能力与患者预后相互作用的同时，仔细权衡法律和伦理问题。
