Medical Ethics

ISSN Print 2713-0894 ISSN Online 2713-0908

BIOMEDICAL JOURNAL OF ERMC EASTERN EUROPEAN

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Zyryanov SK, Baibulatova EA

Older adults consume a disproportionate amount of medicinal products. Polypharmacy may increase the risk of adverse effects, result in poor medication adherence and unfavorable outcomes. There is considerable evidence that older adults are prescribed unnecessary or excessive medications. Treatment outcomes can be improved owing to controlled discontinuation of medicinal products. The deprescribing principles include analysis of all current prescriptions, detecting the medications that must be discontinued, dosage replacement or reduction, discussing the deprescribing regimen together with a patient, patient’s control and support. Clear comprehension of indications and benefit of the conducted pharmacotherapy, objective risk assessment by prescribing physicians and by a patient, and a deliberate deprescribing plan can improve treatment outcomes of the elderly.

Received: 2023-02-02

Published online: 2023-03-13

DOI: 10.24075/medet.2023.008

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VIEWS 1188

Ziganshina LE, Ziganshin AU

A half a century ago Archibald Cochrane, British physician and researcher, emphasized the necessity for critical assessment and a more elaborated approach to biomedical research results. Evidence-based medicine, which is designed to protect a patient from using scientifically unjustified technologies in healthcare, was widely developed subsequently. However, it soon became evident that numerous essential scientific researches contain a substantial proportion of costly but less informative and unjustified trials. They do not add any significant knowledge (wastes or unnecessary spending in research). In 2014, like-minded investigators have joined together in the international community of Evidence-based research. They suggested a plan of actions and algorithm for evidence-based research denoting the liability of all subjects. It is essential that the processes were under supervision of the scientific and medical society.

Received: 2023-02-07

Published online: 2023-03-13

DOI: 10.24075/medet.2023.007

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VIEWS 1259

Fitilev SB, Vozzhaev AV, Shkrebniova II, Kliuev DA, Saakova LN

Early phase clinical research is an essential step in the development of novel medicinal products. Its main subjects are healthy volunteers. The research quality and outcomes directly depend on how and among whom healthy volunteers are selected and how well the volunteers follow the requirements. Selection of healthy volunteers for participation in early phase clinical research can be influenced by a number of various factors and ethical problems. Better comprehension of volunteer’s expectations, potential fears, limiting factors and motives will promote adherence to respective ethical standards and, as a rule, result in qualitative research practice. In this article, authors have tried to analyze the attitude of healthy volunteers towards various aspects of participation in clinical research using own research experience and available literature data. Surveys of healthy volunteers, individual observations and interviews of researchers with participants represented data to be analyzed. Basic variables of interest included the social and demographic portrait of a healthy volunteer, motivation and barriers to research participation, perception of risks by volunteers and their attitude to adverse events, and financial aspects.

Received: 2023-02-02

Published online: 2023-03-06

DOI: 10.24075/medet.2023.006

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VIEWS 1210

Butranova OI, Zyryanov SK

Considering patients of elderly and senile age, pronounced discrimination continues to be observed, expressed in their insufficient inclusion or non-inclusion in randomized clinical trials. As a result, the clinical recommendations based on the results of such studies cannot be fully applicable to this category of patients. The problems of inclusion/non-inclusion of older people in clinical trials are numerous. The reasons for their occurrence and solutions affect, among other things, the ethical sphere. Compliance with basic ethical principles such as respect for persons, beneficence and justice should underlie the decision to include a patient in a study. In general, when evaluating these ethical principles from the point of view of the well-being of the entire population of elderly and senile patients, it is necessary to rethink the principles according to which this category of patients was excluded from clinical trials.

Received: 2023-01-30

Published online: 2023-03-06

DOI: 10.24075/medet.2023.005

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VIEWS 1286

Butranova OI, Ushkalova EA, Zyryanov SK

Increased life expectancy along with an increasing share of elderly and senile patients in the structure of the population make the tasks of longer healthy life expectancy pressing. A set of activities aimed at optimization of management of patients within the framework of gerontological practice should include elimination and prevention of diagnostic and therapeutic errors. The basic risk factors of medical errors include high heterogeneity of elderly and senile patients, overburdened healthcare system, polypharmacy, including due to parallel prescription of drugs to the same patient by multiple medical professionals, concomitant diseases, and high comorbidity, measured by the Charlson Comorbidity Index. Mismanagement of elderly patients can result both from underestimated severity of the patient’s conditions, and from hyperdiagnostics. Typical errors of pharmacotherapy include use of potentially inappropriate medications, potential prescribing omissions, simultaneous prescription of drugs with high risk of clinically significant interactions, incorrect selection of dosage without taking into account the renal failure, which is associated with high risk of toxic effects. Affordability of medical aid for an elderly patient is another important social aspect influencing the patient’s quality of life. As far as basic ethical principles of management of elderly and senile patients go, it is necessary to respect independence, well-being and justice for the patients regarding possible obtaining of qualitative medical aid as compared with other age groups.

Received: 2023-01-30

Published online: 2023-02-28

DOI: 10.24075/medet.2023.004

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VIEWS 1425

Fokina DS, Zhukova OV, Grekhov AV, Khokholov AL

A lack of the single criterion for classifying rare diseases as a group of orphan diseases is the main current problem. First, it is associated with rare detection of symptoms among patients, especially children. Second, specialists have a limited number of methods of detecting orphan diseases. As the disease is considered rare, it is not profitable for pharmaceutical companies to produce the preparations which are purchased not in large numbers, but in single packages, because expenses on clinical trials and marketing advertising exceed return of investment. The market of orphan drugs in Russia is at the stage of development and formation. Medical organizations that carry out medicinal therapy of patients with orphan diseases require a clear set of regulatory documents ensuring provision of medical and pharmaceutical aid. Special attention should be paid to drawing up the lists of medicinal preparations to treat the patients. Personified accounting of patients with detected orphan diseases is an important stage for medical and pharmaceutical organizations. Modern diagnostics of orphan diseases at early stages, especially in children, exploration of specialized genetic methods of research and making them accessible for the population constitute an essential problem.

Received: 2023-01-10

Published online: 2023-02-27

DOI: 10.24075/medet.2023.003

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VIEWS 1269

Palyutin ShH, Zilber IE, Pozdnyakov NO, Sinitsina OA, Speshilova SA, Sirotkina AM

During the long history of antibiotics, resistance of causative agents of main infectious diseases was estimated as a very serious threat to effective treatment of patients and as a social and economic problem faced by the entire mankind. The activities performed by the medical society provided no significant effect resulting in growing antibiotic resistance. The pandemic of novel coronavirus infection only made things worse. It became a new challenge for the medical community regarding searching solutions which are clinical, organizational and methodological by nature in the global struggle with resistance to antibiotics. The reviews of several studies of coronaviral infections have shown that treatment with antibiotics failed to correlate with the decreased all-cause mortality. In this work, we have reviewed some aspects of therapy with antibiotics, including ethical ones. Ethical aspects of antibiotic therapy concern decisions of physicians about administration of commonly unnecessary antimicrobial agents.

Received: 2022-12-21

Published online: 2023-02-25

DOI: 10.24075/medet.2023.002

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VIEWS 1078

Strakhov VV, Korsakov MK, Fedorov VN, Vdovichenko VP, Shetnev AA, Popova AA, Volkhin NN

Glaucoma is the leading cause of irreversible blindness. Its leading symptom and the most important initial link of the disease pathogenesis is represented by an increase of intraocular pressure (IOP). Decrease of IOP is a basic notion in the therapy of glaucoma. Drug-induced therapy is currently the most widely spread initial intervention to decrease IOP. Prostaglandin analogues are referred to the basic group of pharmacotherapeutic agents, because they are the most effective and well tolerated. Beta-blocking agents are selected as an alternative. Other medicinal products to treat glaucoma include inhibitors of carbonic anhydrase for systemic (acetazolamide and methazolamide) and local (dorzolamide and brinzolamide) use. Systemic inhibitors of carbonic anhydrase are, on the one hand, more active than non-systemic medicinal preparations, and, on the other hand, have numerous side effects which are not safe for humans. Thus, medicinal preparations for local use are most frequently applied in the therapy of glaucoma. If necessary, they are combined with beta-blocking agents or alpha-adrenergic agonists.

Received: 2023-01-16

Published online: 2023-02-16

DOI: 10.24075/medet.2023.001

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VIEWS 1355