Service of Neuroradiology, Department of Radiology, Notre-Dame Hospital, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada.
Division of Neurosurgery, Department of Surgery, Mackenzie Health Sciences Centre, University of Alberta Hospital, Edmonton, Alberta, Canada.
J Clin Epidemiol. 2019 Dec;116:155-160. doi: 10.1016/j.jclinepi.2019.05.025. Epub 2019 Jun 14.
A central question of medical care ethics is what is "good medical practice?" We will defend the argument that medical ethics must include care research not only to find out what "good" practice will turn out to be in the future once results are available but also to guide practice in the meantime, when no one knows what to do, optimizing patient outcomes in real time.
This work is a summary of our reflections on the barriers to progress we have encountered after many years of implementing small randomized controlled trials in our clinical field, but which are certainly present in other fields as well.
We review nine conceptions regarding care and research that need to be revised if we are to practice outcome-based medical care.
These revisions lead to a reconstruction of the care-research separation, where care research is reintegrated into care using trials specifically designed to offer optimal care in spite of uncertainty, in the best medical interest of participating patients.
医疗保健伦理学的一个核心问题是“什么是良好的医疗实践？”我们将捍卫这样一种论点，即医学伦理学必须包括护理研究，不仅是为了在未来一旦结果可用时找出“良好”实践将是什么，而且是为了在没有人知道该怎么做的时候指导实践，从而实时优化患者的结果。
这项工作是对我们在多年来在临床领域实施小型随机对照试验中遇到的障碍的反思总结，但这些障碍肯定也存在于其他领域。
我们回顾了关于护理和研究的九个概念，如果我们要实践基于结果的医疗保健，这些概念需要修改。
这些修订导致了护理-研究分离的重建，其中护理研究通过专门设计的试验重新融入护理，这些试验旨在提供最佳护理，尽管存在不确定性，但符合参与患者的最佳医疗利益。
