Gi respons på artikler gjennom artiklenes kommentarfelt på tidsskriftet.no. Innleggene publiseres fortløpende på Tidsskriftets nettside og et utvalg av innleggene publiseres også i papirutgaven i spalten «Brev til redaktøren». Redaksjonen forbeholder seg retten til å foreta redaksjonelle endringer. Forfattere av vitenskapelige artikler har tilsvarsrett, jf. Vancouver-gruppens regler. BREV TIL REDAKTØRENTidsskr Nor Legeforen nr. 4, 2015; 135 307Brev til redaktøren Stigmatiserande legemiddelannonse307I Tidsskriftet nr. 23 -24/2014 har Galderma Nordic AB ein annonse for eit middel mot akne. Bildet som følgjer reklamen, er av ein ung mann. Det er todelt -på den eine sida har han bustete hår, akne og ei jakke full av pins og sikringsnåler, på den andre har han kjemma hår, er fri for akne og ber ein streit genser.Kva prøver dei å fortelje oss med denne dikotomien? Har akne samanhang med livsstil, klesstil og kjemma hår? Dei gjev inntrykk av at for å nå målet om eit aknefritt liv, må ein endre livsstil, vere streit og kle seg «sømeleg». Under ligg meldinga om at gutar med akne kan skulde seg sjølv. I tillegg er det eit veldig normativt bodskap om kva ein reknar for «rett» livsstil. Mannen til venstre gjev inntrykk av å vere meir rebelsk i høve til gjeldande normer enn han til høgre. Han er kanskje ikkje like sporty og skuleflink, viss vi byggjer vidare på dei stereotypiane reklamen speler på.I bunn og grunn er dette ein misvisande og stereotyp reklame, og i tillegg synest eg han er stigmatiserande når det kjem til folks val av livsstil. For Galderma er det på tide å endre taktikk dersom dei vil nå alle. Mette Løkeland lokeland@gmail.comMette Løkeland er gynekolog og nettredaktør for Norsk Gynekologisk forening. Galderma svarer:307Tack för Mette Løkelands kommentar så att vi får möjlighet att förklara tanken med bilden i reklamen. Vi vill med bilden förmedla en historia. När man är ung finns bara «här och nu» och inget «sen». Många går till läkaren för sina aknebesvär och vill ha hjälp och behandling -gärna något som hjälper redan igår... Det ska den vänstra delen av bilden visa.Det är svårt, men viktigt, för behandlande läkare att lyfta fram vikten av ordentlig och kontinuerlig behandling av akne för att inte bara hjälpa problemen som finns just nu utan även för att motverka framtida akne och förebygga ärrbildning.Den högra delen av bilden ska symbolisera ca 10 år senare i personens liv då situationen kanske är en helt annan -man ska söka jobb, studera etc.Kontentan är: Ungdomar vill ha snabba resultat -Läkare vill ge en behandling som även hjälper över tid (för ungdomarnas bästa). Vi tar till oss att detta inte har framgått tydligt. Charlotta Lind charlotta.lind@galderma.comCharlotta Lind er Marketing Manager Prescription i Galderma Nordic. Interessekonflikter: Lind er ansatt i Galderma Nordic. Re: Paternalisme på fremmarsj?307Aslak Syse har i sin leder i Tidsskriftet nr. 1/2015 knyttet noen kommentarer til at det i Tidsskriftet er «publisert tre bidrag der det er problematisert at det ikke kan anvendes tvang i flere ...
Background: Clinical research in severely ill or injured patients is required to improve healthcare but may be challenging to perform in practice. The aim of this study was to analyse barriers and challenges in the process of including critically ill patients in clinical studies. Methods: Data from critically ill patients considered for inclusion in an observational study of venous thromboembolism in Norway were analysed. This included quantitative and qualitative information from the screening log, consent forms and research notes. Results: Among 279 eligible critically ill patients, 204 (73%) were omitted from the study due to challenges and barriers in the inclusion process. Reasons for omission were categorised as practical in 133 (65%), medical in 31 (15%), and legal or ethical in 40 (20%) of the patients. Among 70 included patients, 29 (41%) consents were from patients and 41 (59%) from their next of kin. Several challenges were described herein; these included whether patients were competent to give consent, and which next of kin that should represent the patient. Furthermore, some included patients were unable to recall what they have consented, and some appeared unable to separate research from treatment. Conclusions: Barriers and challenges in the inclusion process led to the omission of near three out of four eligible patients. This analysis provided information about where the problem resides and may be solved. The majority of challenges among included patients were related to issues of autonomy and validity of consent. Trial registration: ClinicalTrials.gov (NCT03405766).
Background Respect for patient autonomy and the requirement of informed consent is an essential basic patient right. It is constituted through international conventions and implemented in health law in Norway and most other countries. Healthcare without informed consent is only allowed under specific exceptions, which requires a record in the patient charts. In this study, we investigated how surgeons recorded decisions in situations where the elderly patient’s ability to provide a valid informed consent was questionable or clearly missing. Method We investigated all medical records of patients admitted to surgical departments in a Norwegian large academic emergency hospital over a period of 38 days (approximately 5000 patients). We selected records of patients above the age of 70 (570 patients) and searched through these 570 medical records for any noted clear indications of inability to consent such as “do not understand”, “confused” etc. (102 patients). We read through all the medical records on these 102 patients noting any recordings on lack of informed consent, any recordings on reasoning and process hereto. We also took note whether there were clear indications on the use of coercion. Results None of the 102 included patients´ charts contained legally valid recorded assessments (for example related to the patients´ competence to consent) when patients without the ability to consent were admitted and provided healthcare. Some charts contained records that the patient resisted treatment, thus indicating treatment with coercion. In these situations, we did not find any documentation related to legal requirements that regulate the use of coercion. Discussion and conclusion We found a substantial lack of compliance with the legal requirements that apply when obtaining valid informed consent. There are many possible reasons for this: Lack of knowledge of the legal requirements, disagreement about the rules, or that it is simply not possible to comply with the extensive formal and material legal requirements in clinical practice. The results do not point out whether the appropriate measures are amending the law, educating and requiring more compliance from surgeons, or both.
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