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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">The Prevention of Hemorrhagic Stroke</title><author><name sortKey="Raymond, J" sort="Raymond, J" uniqKey="Raymond J" first="J." last="Raymond">J. Raymond</name><affiliation><nlm:aff id="FN1"></nlm:aff></affiliation></author><author><name sortKey="Mohr, Jp" sort="Mohr, Jp" uniqKey="Mohr J" first="Jp" last="Mohr">Jp Mohr</name><affiliation><nlm:aff id="FN2"></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">20557736</idno><idno type="pmc">3313804</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3313804</idno><idno type="RBID">PMC:3313804</idno><date when="2008">2008</date><idno type="wicri:Area/Pmc/Corpus">000094</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000094</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">The Prevention of Hemorrhagic Stroke</title><author><name sortKey="Raymond, J" sort="Raymond, J" uniqKey="Raymond J" first="J." last="Raymond">J. Raymond</name><affiliation><nlm:aff id="FN1"></nlm:aff></affiliation></author><author><name sortKey="Mohr, Jp" sort="Mohr, Jp" uniqKey="Mohr J" first="Jp" last="Mohr">Jp Mohr</name><affiliation><nlm:aff id="FN2"></nlm:aff></affiliation></author></analytic><series><title level="j">Interventional Neuroradiology</title><idno type="ISSN">1591-0199</idno><imprint><date when="2008">2008</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><title>Summary</title><p>There is currently no evidence that preventive treatment of unruptured aneurysms or AVMs is beneficial and randomized trials have been proposed to address this clinical uncertainty. Participation in a trial may necessitate a shift of point of view compared to a certain habitual clinical mentality. A review of the ethical and rational principles governing the design and realization of a trial may help integrate clinical research into expert clinical practices.</p><p>The treatment of unruptured aneurysms and AVMs remains controversial, and data from observational studies cannot provide a normative basis for clinical decisions. Prevention targets healthy individuals and hence has an obligation of results. There is no opposition between the search for objective facts using scientific methods and the ethics of medical practice since a good practice cannot forbid physicians the means to define what could be beneficial to patients. Perhaps the most difficult task is to recognize the uncertainty that is crucial to allow resorting to trial methodology. The reasoning that is used in research and analysis differs from the casuistic methods typical of clinical work, but clinical judgement remains the dominant factor that decides both who enters the trial and to whom the results of the trial will apply. Randomization is still perceived as a difficult and strange method to integrate into normal practice, but in the face of uncertainty it assures the best chances for the best outcome to each participant. Some tension exists between scientific methods and normal practice, but they need to coexist if we are to progress at the same time we care for patients.</p></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Interv Neuroradiol</journal-id><journal-id journal-id-type="iso-abbrev">Interv Neuroradiol</journal-id><journal-id journal-id-type="publisher-id">Interv Neuroradiol</journal-id><journal-title-group><journal-title>Interventional Neuroradiology</journal-title></journal-title-group><issn pub-type="ppub">1591-0199</issn><publisher><publisher-name>Centauro S.r.l.</publisher-name><publisher-loc>Bologna - Italy</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">20557736</article-id><article-id pub-id-type="pmc">3313804</article-id><article-id pub-id-type="other">IN.v14.i4.p365</article-id><article-categories><subj-group subj-group-type="heading"><subject>Special Article</subject></subj-group></article-categories><title-group><article-title>The Prevention of Hemorrhagic Stroke</article-title><subtitle>A Review of the Rational and Ethical Principles. of Clinical Trials on Unruptured Intracranial Aneurysms and Arteriovenous Malformations</subtitle></title-group><contrib-group><contrib contrib-type="author"><name><surname>Raymond</surname><given-names>J.</given-names></name><xref rid="FN10" ref-type="author-notes"></xref><xref ref-type="aff" rid="FN1">1</xref></contrib><contrib contrib-type="author"><name><surname>Mohr</surname><given-names>JP</given-names></name><xref ref-type="aff" rid="FN2">2</xref></contrib><contrib contrib-type="author"><name><surname>the TEAM-ARUBA collaborative groups</surname><given-names></given-names></name></contrib></contrib-group><aff id="FN1"><addr-line><sup>1</sup> Interventional Neuroradiology Research Unit, Department of Radiology, Centre Hospitalier de l’Université de Montréal, Notre-Dame Hospital, Montreal, Canada</addr-line></aff><aff id="FN2"><addr-line><sup>2</sup> Doris & Stanley Tananbaum Stroke Center, Columbia University College of Physicians & Surgeons, New York, NY, USA</addr-line></aff><author-notes><fn id="FN10"><p>Dr Jean Raymond, MD - CHUM – Notre-Dame Hospital - Interventional Neuroradiology (NRI) - 1560 Sherbrooke east, suite Z12909 - Montreal, Quebec, Canada H2L 4M1 - Email: <email>dr_jean_raymond@hotmail.com</email></p></fn></author-notes><pub-date pub-type="ppub"><day>29</day><month>12</month><year>2008</year></pub-date><pub-date pub-type="epub"><day>8</day><month>10</month><year>2008</year></pub-date><volume>14</volume><issue>4</issue><fpage>365</fpage><lpage>373</lpage><history><date date-type="received"><day>1</day><month>10</month><year>2008</year></date><date date-type="accepted"><day>30</day><month>10</month><year>2008</year></date></history><permissions><copyright-statement>Copyright © 2008, Centauro S.r.l.</copyright-statement><copyright-year>2008</copyright-year></permissions><abstract><title>Summary</title><p>There is currently no evidence that preventive treatment of unruptured aneurysms or AVMs is beneficial and randomized trials have been proposed to address this clinical uncertainty. Participation in a trial may necessitate a shift of point of view compared to a certain habitual clinical mentality. A review of the ethical and rational principles governing the design and realization of a trial may help integrate clinical research into expert clinical practices.</p><p>The treatment of unruptured aneurysms and AVMs remains controversial, and data from observational studies cannot provide a normative basis for clinical decisions. Prevention targets healthy individuals and hence has an obligation of results. There is no opposition between the search for objective facts using scientific methods and the ethics of medical practice since a good practice cannot forbid physicians the means to define what could be beneficial to patients. Perhaps the most difficult task is to recognize the uncertainty that is crucial to allow resorting to trial methodology. The reasoning that is used in research and analysis differs from the casuistic methods typical of clinical work, but clinical judgement remains the dominant factor that decides both who enters the trial and to whom the results of the trial will apply. Randomization is still perceived as a difficult and strange method to integrate into normal practice, but in the face of uncertainty it assures the best chances for the best outcome to each participant. Some tension exists between scientific methods and normal practice, but they need to coexist if we are to progress at the same time we care for patients.</p></abstract><kwd-group><title>Key words:</title><kwd>hemorrhagic stroke, brain vascular pathology, clinical trials</kwd></kwd-group><counts><ref-count count="19"></ref-count><page-count count="9"></page-count></counts></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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