Abstract:
:Polls show increasing public interest in advance statements or directives about medical treatment ("living wills") but that few people, apart from Jehovah's Witnesses, carry such documents. Patients' firm, witnessed oral decisions are often sufficient to aid clinical decision making but should still be recorded in medical notes. Without documentation, dilemmas arise when others claim to know patients' views on the basis of past unrecorded conversations and demand withdrawal of treatment when patients are not terminally ill and cannot speak for themselves. Legal and ethical considerations oblige doctors to act in the best interests of an incapacitated patient; these considerations are now formally defined in draft legislation as including consideration of the patient's past wishes. The practicalities of ascertaining the strength and validity of such wishes from conversations reported second hand are complex. The paucity of legal and ethical guidance on reported oral advance statements makes debate imperative and renders the alternative of having designated surrogate decision makers increasingly attractive.
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
Sommerville Adoi
10.1136/bmj.310.6995.1663asubject
Has Abstractpub_date
1995-06-24 00:00:00pages
1663-5issue
6995eissn
0959-8138issn
1756-1833journal_volume
310pub_type
杂志文章abstract:OBJECTIVE:To determine the risk of chronic kidney disease in patients with psoriasis. DESIGN:Population based cohort study and nested cross sectional study. SETTING:Electronic medical records database based in United Kingdom. PARTICIPANTS:Cohort study: patients with psoriasis aged 18-90 each matched to up to five pa...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.f5961
更新日期:2013-10-15 00:00:00
abstract:OBJECTIVE:To determine the implications of variation in mortality associated with use of weapons in different contexts. DESIGN:Literature review. SETTINGS:Armed conflicts and civilian mass shootings, 1929-96. MAIN OUTCOME MEASURE:Mortality from wounds. RESULTS:During the fighting of war the number of people wounded...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.319.7207.407
更新日期:1999-08-14 00:00:00
abstract:OBJECTIVE:To assess the effectiveness of health checks by nurses in reducing risk factors for cardiovascular disease in patients from general practice. DESIGN:Randomised controlled trial. SETTING:Five urban general practices in Bedfordshire. SUBJECTS:2136 patients receiving an initial health check in 1989-91 and sch...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1994-01-29 00:00:00
abstract::For many years Tayside has benefited from a successful opportunistic cytology screening programme. In recent years, however, the decrease in mortality due to cervical cancer has levelled off, with most cases of severe disease arising in women who have not been screened. In view of this the health board developed a new...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.299.6692.163
更新日期:1989-07-15 00:00:00
abstract:OBJECTIVE:To determine whether poor reporting of methods in randomised controlled trials reflects on poor methods. DESIGN:Observational study. SETTING:Reports of randomised controlled trials conducted by the Radiation Therapy Oncology Group since its establishment in 1968. PARTICIPANTS:The Radiation Therapy Oncology...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.328.7430.22
更新日期:2004-01-03 00:00:00
abstract:OBJECTIVES:To assess whether and how investigators of placebo controlled randomised trials inform participants of their treatment allocation at trial closure and to assess barriers to feedback. DESIGN:Postal survey with a semistructured questionnaire. PARTICIPANTS:All investigators who published a placebo controlled ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.325.7376.1329
更新日期:2002-12-07 00:00:00
abstract:OBJECTIVES:To investigate the claim that 90% of episodes of low back pain that present to general practice have resolved within one month. DESIGN:Prospective study of all adults consulting in general practice because of low back pain over 12 months with follow up at 1 week, 3 months, and 12 months after consultation. ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.316.7141.1356
更新日期:1998-05-02 00:00:00
abstract:OBJECTIVE:To assess the waste of research related to inadequate methods in trials included in Cochrane reviews and to examine to what extent this waste could be avoided. A secondary objective was to perform a simulation study to re-estimate this avoidable waste if all trials were adequately reported. DESIGN:Methodolog...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.h809
更新日期:2015-03-24 00:00:00
abstract:OBJECTIVE:To compare neonatal mortality and morbidity in term infants presenting by the breech and delivered vaginally or by caesarean section. DESIGN:Population based comparison of outcomes. Data derived from the St Mary's maternity information system. SETTING:North West Thames Regional Health Authority, 1988-90. S...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.305.6856.746
更新日期:1992-09-26 00:00:00
abstract:OBJECTIVES:To relate cancer since entry into the Framingham Heart Study with the risk of incident Alzheimer's disease and to estimate the risk of incident cancer among participants with and without Alzheimer's disease. DESIGN:Community based prospective cohort study; nested age and sex matched case-control study. SET...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.e1442
更新日期:2012-03-12 00:00:00
abstract:OBJECTIVES:To assess the association of Apgar score 5 minutes after birth with cerebral palsy in both normal weight and low birthweight children, and also the association with the cerebral palsy subdiagnoses of quadriplegia, diplegia, and hemiplegia. DESIGN:Population based cohort study. SETTING:The Medical Birth Reg...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.c4990
更新日期:2010-10-06 00:00:00
abstract:OBJECTIVE:To investigate the risk of glioma in adults in relation to mobile phone use. DESIGN:Population based case-control study with collection of personal interview data. SETTING:Five areas of the United Kingdom. PARTICIPANTS:966 people aged 18 to 69 years diagnosed with a glioma from 1 December 2000 to 29 Februa...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.38720.687975.55
更新日期:2006-04-15 00:00:00
abstract:OBJECTIVE:To assess whether occupational exposure among commercial airline cabin attendants are associated with risk of cancer. DESIGN:Record linkage study. SETTING:Finland. SUBJECTS-1577 female and 187 male cabin attendants who had worked for the Finnish airline companies. MAIN OUTCOME MEASURE:Standardised incidenc...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.311.7006.649
更新日期:1995-09-09 00:00:00
abstract::According to a London physician, women with epilepsy taking antiepileptic drugs can take combined oral contraceptives (OCs). It is usual to recommend a combined OC preparation containing at least 50 mcg of estrogen (Ovran) from patients taking enzyme-inducing antiepileptic drugs; this can be increased to 60 mcg by ta...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.307.6902.492
更新日期:1993-08-21 00:00:00
abstract:OBJECTIVE:To find out whether enalapril or ramipril causes the sensitivity of the cough reflex to change or symptomatic cough to develop in patients with hypertension. DESIGN:Prospective, placebo controlled, double blind, randomised crossover study. SETTING:Academic units of clinical pharmacology and medicine. PATIE...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.299.6690.13
更新日期:1989-07-01 00:00:00
abstract:OBJECTIVE:To assess the impact of teaching general practitioners to carry out structured assessments of their long term mentally ill patients. DESIGN:Randomised controlled trial. SETTING:Sixteen group general practices in South Thames (west) region. SUBJECTS:440 adults disabled by long term mental illness. INTERVEN...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.311.6997.93
更新日期:1995-07-08 00:00:00
abstract:OBJECTIVE:To assess the association between genitourinary infections in the month before conception to the end of the first trimesterand gastroschisis. DESIGN:Case-control study with self reported infections from a computer assisted telephone interview. SETTING:National birth defects prevention study, a multisite, po...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.39567.509074.25
更新日期:2008-06-21 00:00:00
abstract:OBJECTIVE:To quantify the impact of citalopram and other selective serotonin reuptake inhibitors on corrected QT interval (QTc), a marker of risk for ventricular arrhythmia, in a large and diverse clinical population. DESIGN:A cross sectional study using electrocardiographic, prescribing, and clinical data from electr...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.f288
更新日期:2013-01-29 00:00:00
abstract:OBJECTIVE:To evaluate the effectiveness of an integrated care programme, combining a patient directed and a workplace directed intervention, for patients with chronic low back pain. DESIGN:Population based randomised controlled trial. SETTING:Primary care (10 physiotherapy practices, one occupational health service, ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.c1035
更新日期:2010-03-16 00:00:00
abstract:OBJECTIVES:To compare the clinical and cost effectiveness of total hip arthroplasty with resurfacing arthroplasty in patients with severe arthritis of the hip. DESIGN:Single centre, two arm, parallel group, assessor blinded, randomised controlled trial with 1:1 treatment allocation. SETTING:One large teaching hospita...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmj.e2147
更新日期:2012-04-19 00:00:00
abstract:OBJECTIVE:To estimate the costs of diagnosis and treatment of diabetes in Tanzania. DESIGN:Costs estimated from the reported and recorded experience of patients with newly presenting diabetes in 1989-90 and of diabetic patients first seen in 1981-2. SETTING:Muhimbili Medical Centre, Dar es Salaam. SUBJECTS:464 patie...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.304.6836.1215
更新日期:1992-05-09 00:00:00
abstract:OBJECTIVE:To assess the association of lichen planus with liver complaints and with known aetiological factors of liver diseases. DESIGN:Multicentre case-control study. Interviews were conducted by trained medical investigators on the basis of a structured questionnaire. At the interview patients and controls were ask...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1136/bmj.300.6719.227
更新日期:1990-01-27 00:00:00
abstract:OBJECTIVE:To examine period trends in the rate of suicide in the first 28 days after discharge from psychiatric hospital. DESIGN:Cohort study of patients discharged from psychiatric hospital. SETTING:Scotland. SUBJECTS:All patients aged 15-84 who were discharged from Scottish psychiatric hospitals during 1968 to 199...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.311.7001.357
更新日期:1995-08-05 00:00:00
abstract::Several forces have resulted in the creation in Tayside of the first formally integrated unit of undergraduate and postgraduate education in general practice in the United Kingdom. Forces that helped this integration included the desire for change, national developments in education, financial support through funds se...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.310.6994.1577
更新日期:1995-06-17 00:00:00
abstract:OBJECTIVE:To determine the long term effects of antibiotic treatment for acute otitis media in young children. DESIGN:Prospective three year follow-up study within the framework of a primary care based, double blind, randomised, placebo controlled trial. SETTING:53 general practices in the Netherlands. PARTICIPANTS:...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.b2525
更新日期:2009-06-30 00:00:00
abstract:OBJECTIVE:To determine whether total hip arthroplasty is associated with lower reoperation rates, mortality, and complications, and better function and quality of life than hemiarthroplasty for displaced fractures of the femoral neck in older patients. DESIGN:Systematic review and meta-analysis of randomised trials, q...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析,评审
doi:10.1136/bmj.c2332
更新日期:2010-06-11 00:00:00
abstract:OBJECTIVE:To evaluate the associations between personal use of permanent hair dyes and cancer risk and mortality. DESIGN:Prospective cohort study. SETTING AND PARTICIPANTS:117 200 women enrolled in the Nurses' Health Study, an ongoing prospective cohort study of female nurses in the United States. The women were free...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.m2942
更新日期:2020-09-02 00:00:00
abstract:OBJECTIVES:To estimate survival after a diagnosis of dementia in primary care, compared with people without dementia, and to determine incidence of dementia. DESIGN:Cohort study using data from The Health Improvement Network (THIN), a primary care database. SETTING:353 general practices in the United Kingdom providin...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.c3584
更新日期:2010-08-05 00:00:00
abstract:OBJECTIVES:To investigate the association between four sociodemographic measures (unemployment, overcrowding, low social class, and the proportion of migrants from areas of high prevalence of tuberculosis) and average level and rate of change of notification rates for tuberculosis. DESIGN:Ecological analysis of both t...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.310.6985.963
更新日期:1995-04-15 00:00:00
abstract:OBJECTIVE:To systematically review measures of data quality in electronic patient records (EPRs) in primary care. DESIGN:Systematic review of English language publications, 1980-2001. DATA SOURCES:Bibliographic searches of medical databases, specialist medical informatics databases, conference proceedings, and instit...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.326.7398.1070
更新日期:2003-05-17 00:00:00