@article{Modi:2014:10.1159/000360650,
author = {Modi, N},
doi = {10.1159/000360650},
journal = {Neonatology},
pages = {350--351},
title = {Ethical pitfalls in neonatal comparative effectiveness trials.},
url = {http://dx.doi.org/10.1159/000360650},
volume = {105},
year = {2014}
}

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TY  - JOUR
AB  - Evidence-based medicine has been embraced wholeheartedly, and rightly so, as the best approach for reducing clinical uncertainty and ensuring that patients receive treatment and care that are efficacious (i.e. they work) and effective (i.e. they work in real life). High-quality evidence comes from high-quality clinical research. It would hence be reasonable to assume that these two would form a closely integrated partnership. Alas, this is not yet the case. So many uncertainties in medical care relate to treatments and practices already widely in use. In neonatal medicine, for example, some of us use protein-carbohydrate fortification of human milk and some of us do not, some of us stop enteral feeds during blood transfusions whereas some of us do not, some of us reach for dopamine when blood pressure falls while some of us use dobutamine. For our patients, these uncertainties represent a lottery, the throw of the dice that determines whether they receive the treatment advocated by Dr. A or Dr. B. They deserve better than this. Randomization is considered the gold standard approach to eliminating the clinician bias that very often dominates the choice of treatments. Randomization reduces the influence on outcomes of confounding by unknown factors, and ensures that every patient has a fair and equal chance of receiving the best possible treatment when this is, in fact, not known. In an ideal world, every medical uncertainty would be addressed in this way. The evaluation of treatments that are in accepted use has been termed 'comparative effectiveness research', i.e. the comparison of existing healthcare interventions to determine which works best, for whom and under which circumstances. Recently a long-standing uncertainty, the optimum saturation target for preterm babies receiving oxygen was put to the test of randomization. The accepted standard-of-care saturation range of 85-95% has been used for a considerable time and its use is intended to avoid both levels of
AU  - Modi,N
DO  - 10.1159/000360650
EP  - 351
PY  - 2014///
SP  - 350
TI  - Ethical pitfalls in neonatal comparative effectiveness trials.
T2  - Neonatology
UR  - http://dx.doi.org/10.1159/000360650
UR  - https://www.ncbi.nlm.nih.gov/pubmed/24931328
VL  - 105
ER  - 

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