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Báo cáo y học: "Interpreting the odd"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học General Psychiatry cung cấp cho các bạn kiến thức về ngành y đề tài: Interpreting the odds. | Fisher Critical Care 1998 2 41 http ccforum.com c CRITICAL CARE COMMENTARY Interpreting the odds Malcolm Fisher 42cc-2-2-041 What Chance does she have doctor This is a common question in intensive care units when discussion is begun with families as to the appropriateness of continuing therapy with a goal of cure or instituting or withdrawing therapy to provide a peaceful appropriate death. Limiting therapy is primarily instituted to reduce the likelihood of patient s inappropriate suffering but it has important resource implications in addition to this. Futile care wastes money and denies resources to others. Callahan 1 suggests that instituting therapy when an appropriate life has been completed increases the risk of a wild death as opposed to a peaceful death. Notwithstanding that a peaceful death is not necessarily the same as a painless death this is not always true. Despite documentation of a high frequency of badly managed deaths in the US Support studies 2 our ability to provide pharmacological oblivion in ventilated patients should allow death to be paint-free albeit undignified. Few outside the specialty understand the complexity of the practical aspects of determining chances of survival in intensive care units. Only in extreme cases can the intensivit categorically say there is no chance of survival. The intensivist s solicitude is compromised by the number of patients in whom unprecedented survival has occurred emphasising the fallibility of their knowledge. When the intensivist uses their mandate from society to work with families to determine whether the treatment is what the patient would wish odds and uncertainty are serious dilemmas. This is because 1. Intensive care unit predictive indices are unreliable in individuals 3 . 2. Physician determinants of risk are biased 4 . 3. Surrogate decision makers often have little idea of the risks to the patient 5 . 4. Fifteen percent of patients with advance declarations will change their minds 6 . 5. .