On Sept. 17 an editorial entitled "Quebec's Bill 114" appeared in CMAJ addressing the appropriateness of physician staffing of a Quebec emergency department.1 The editorial considered implications ...for patient care and the resultant provincial legislation mandating certain physicians to report to the emergency department for periods of duty as specified by chief hospital administrators. In a response on Oct. 29 in CMAJ, Dana Hanson, President of the Canadian Medical Association, suggested that the editorial had "serious flaws," and went further to indicate that the editorial's conclusion was "repugnant" and called for a retraction.2 Other comments by members of the CMA board and provincial associations conveyed to the editor indicated that the editorial was unacceptable. C'est precisement afin de preserver et d'ameliorer la qualite du journal que le Conseil d'administration de l'AMC a recemment approuve la creation d'un Comite independant de surveillance du journal, charge de preciser le mandat de la publication et le role du redacteur en chef, et de contribuer a preserver l'independance redactionnelle du journal. Cette initiative s'inspire des experiences positives realisees ailleurs. Je suis persuade que cette mesure et d'autres prises par l'AMC en etroite collaboration avec le JAMC dissiperont toute confusion au sujet de la relation entre l'Association et le journal qui lui appartient.
When should an effective treatment be used? Sinclair, John C.; Cook, Richard J.; Guyatt, Gordon H. ...
Journal of clinical epidemiology,
3/2001, Volume:
54, Issue:
3
Journal Article
Care at for-profit hospitals Richman, Vincent V
Canadian Medical Association journal (CMAJ),
2004-Nov-09, 2004-11-09, 20041109, Volume:
171, Issue:
10
Journal Article
Mechanical ventilation incurs substantial morbidity, mortality, and costs. Both premature extubation and delayed extubation can cause harm. Therefore, weaning that is both expeditious and safe is ...highly desirable. The purpose of this review is to summarize the literature related to weaning modes, spontaneous breathing trials, weaning predictors, weaning with noninvasive positive pressure ventilation, and weaning protocols. We used 5 computerized databases and a duplicate independent review process to select articles for this review. We included randomized clinical trials evaluating any weaning interventions and nonrandomized trials of weaning predictors, with a focus on studies reporting clinically important outcomes. We abstracted quantitative data using several metrics and pooled results across studies only when our assessment of the patients, interventions, and outcomes indicated that pooling was legitimate. The available clinical research evidence suggests that, for progressive weaning of the level of mechanical support, it may be best to choose modes other than synchronized intermittent mandatory ventilation and it is unreasonable to be dogmatic about the use of other modes. There may also be substantial benefits to early extubation with back-up institution of noninvasive positive pressure ventilation, as needed, though this remains an experimental approach. For trials of spontaneous breathing, low levels of pressure support may hasten extubation. We did not uncover any consistently powerful weaning predictors, suggesting that formal use of predictors in patients being considered for reduction or discontinuation of mechanical support is unlikely to improve patient care. The likely explanation is that clinicians already fully consider information from weaning predictors in choosing patients for trials of reduction or discontinuation of mechanical ventilation. Finally, implementation of respiratory therapist- or nurse-driven protocols may be useful for all phases of weaning, and clinicians should adopt daily assessment for a trial of unassisted breathing as a safe method to reduce the duration of mechanical ventilation.
PDF
