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Experience using pragmatic care trials to guide neurovascular practice under uncertainty
1University of Alberta Hospital, Mackenzie Health Sciences Centre, Department of Surgery, Division of Neurosurgery,8440 112 street, T6G 2B7, Alberta, Canada.
Neuro-Chirurgie
|October 13, 2020
Summary
Pragmatic care trials integrate randomized treatment decisions into routine neurovascular practice. This approach transforms uncertain medical decisions into evidence-based care, offering patients optimal management for conditions like stroke and aneurysms.
Area of Science:
- Neurovascular Medicine
- Clinical Trial Design
- Evidence-Based Practice
Background:
- Pragmatic care trials aim to optimize neurovascular care amidst clinical uncertainty.
- The feasibility, benefits, and drawbacks of this novel approach require thorough investigation.
Purpose of the Study:
- To evaluate the integration and impact of pragmatic care trials in routine neurovascular practice.
- To address uncertainties in the management of intracranial aneurysms, arteriovenous malformations, and acute stroke.
Main Methods:
- Conducted 9 randomized trials integrated into routine clinical practice.
- Included 1212 neurovascular patients undergoing elective or acute care.
- Reviewed criticisms and ethical/scientific concepts related to outcome-based neurovascular care.
Main Results:
- Pragmatic care trials guided treatment for diverse neurovascular conditions.
- Randomized allocation replaced unverified treatment decisions, establishing outcome-based care.
- Criticisms focused on pragmatic trial design, patient/clinician selection, protocol flexibility, funding, and feasibility.
Conclusions:
- Care trials can be successfully integrated into neurovascular practice.
- This approach reduces unverifiable medical practices and enhances patient care.
- Ongoing development is necessary for the full realization of pragmatic care trials.
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