EDITORIALS Why the Structured Abstract? Readers of Annals will soon note another change - all abstracts for original contributions will have a formal structure with defined subsections. The subsections inelude the study objectives, design, setting, type of participants, interventions, measurements and main results, and conclusions. We will implement this change in June for two reasons. One is our desire to make Annals increasingly precise and scientifically sound; the structured abstract now ensures that vital information about a study will always appear in the abstract. The second reason is the information explosion in which we all live and the increasingly electronic nature of that information. Most readers scan an abstract to decide whether they should read the full article. The ever-increasing numbers of electronic database users often have easy access only to the abstract itself and not the text. Increasingly in the future readers will have neither time nor inclination to read the full article, and the essentials of the study will have to be conveyed in the abstract alone. Connoisseurs of the abstract know that there is little uniformity as to what information is or is not included in m o s t abstracts. Moreover, i m p o r t a n t l i m i t a t i o n s and
weaknesses of a study may be completely omitted from the traditional abstract. The structured abstract is an attempt to remedy both problems. It provides specific organized information about all key elements. It should leave the reader not only m u c h better informed about the soundness and applicability of the study, but help the reader make more informed judgments about whether the entire substance of the paper needs to be read. For example, having instant access to the information that the study concerned only 12 subjects examined by medical students in a university tertiary referral center, readers may well decide that no conclusions, no matter how fascinating, could safely be applied to their c o m m u n i t y emergency medicine practices and may choose to move on to the next article. The structured abstract, like many of the other changes we have instituted in the last few years, requires more work of authors, editors, and editorial staff. However, it should enhance the scientific quality of our journal, and we hope it makes the journal more useful for you, our readers.
The Editors
Ethics Emergent • An air medical patient with multiple trauma and unstable vital signs is diverted from the nearest trauma center because the patient has no insurance. 1 • A 37-year-old patient with blunt abdominal trauma states that he is a Jehovah's Witness and will accept all forms of medical treatment except blood products. He becomes critically hypotensive, his blood pressure unresponsive to colloid solutions. • A 94-year-old unresponsive man with Alzheimer's disease and generalized sepsis from pneumonia is brought in from a nursing home in respiratory failure. The patient's family is unavailable and there are no orders or directives concerning intubation and resuscitation. In these examples, the ethical issues at hand are as important as the emergency medical issues. However, ethical issues such as these have not typically been addressed in a formal way in the emergency medicine residency curriculum. Is the subject of emergency medicine ethics important and distinctive enough to deserve a formal place in the residency training curriculum? In this issue of Annals, Moskop, Mitchell, and Ray outline an ethics curriculum for teaching emergency medicine residents and propose that the subject of ethics be incorporated as a major category in the Emergency Medicine Core Content. The subject of medical ethics (or bioethics, comprising ethical issues in science, medicine, and health care) is, of course, not new. Physicians and the rest of society have 19:2 February 1990
been concerned with the ethical aspects of medical practice since early times. Ethical concerns have been expressed in codes of ethics from the Hippocratic Oath and Corpus to the World Medical Organization's Declaration of Geneva. Medical ethics has been the subject of religious thinkers from Maimonides to Pope Pius XII and legal scholars from Justice Benjamin Cardozo to Justice Harry Blackmun. What is new, however, is a practical resurgence of interest in ethics. The impetus for this resurgence of interest in medical ethics is technology. As our technological capabilities to treat disease and prolong life increase, so do the number and complexity of ethical questions concerning resuscitation and the discontinuation of life support. Ethical dilemmas arise involving informed consent for (and refusal of) technologically more complex procedures. Expensive technology has fueled the health care cost crisis and exacerbated the problems of resource allocation, access, and equity in health care. (Allocation questions are not just a question of the 1990s. Some trace the beginning of the modern era in medical ethics to the committees of the 1950s that determined who was to get the scarce resource of renal dialysis.) To examine these ethical dilemmas spawned by technological advances, biomedical researchers, physicians, theologians, philosophers, and lawyers have formed such centers devoted to bioethical analysis as the Hastings Center, established in 1969, and the Kennedy Center for Ethics at
Annals of Emergency Medicine
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