评估集群随机试验的代表性:来自美国养老院的两项大型实用试验的证据
Nina R Joyce1,2, Sarah E Robertson3,4,5, Ellen McCreedy2,3
1Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
Clinical trials (London, England)
|July 26, 2023
概括
集群随机试验的结果可能不适用于一般人群. 设施特征,而不仅仅是居民特征,必须评估在养老院试验中的概括性.
科学领域:
- 老年学是一门学科.
- 临床试验 临床试验
- 医疗保健服务研究 医疗服务研究
背景情况:
- 集群随机试验 (CRT) 容易受到选择偏差的影响,当根据影响治疗有效性的因素选择集群时.
- 这可能会限制试验结果对更广泛的目标人群的概括性.
- 养老院试验特别脆弱,因为设施级别的差异.
研究的目的:
- 在两个实用CRT中,比较随机选择的养老院的特征与符合条件的非随机选择和不符合条件的设施.
- 评估CRT中包含的设施和居民的代表性.
- 为CRT结果的解释及其适用性提供信息.
主要方法:
- 利用来自两个大型养老院CRT的数据:高剂量流感疫苗试验和阿尔茨海默病养老院居民的音乐和记忆实用试验 (METRICaL).
- 将试验数据与养老院评估和医疗保险服务费索赔联系起来.
- 采用标准化平均差异和后勤回归来比较随机组,合格非随机组和不合格组的设施和居民特征.
主要成果:
- 在高剂量试验中,只有29%的养老院符合条件,其中18%是随机选择的. 随机选择的设施在规模,营利性地位,连锁加盟和特殊护理单位的存在方面存在显著差异.
- 在METRICaL试验中,59%的养老院符合条件,其中50%是随机的. 在规模,资源贫困状况和特殊护理单位的存在方面注意到了差异.
- 在这两项试验中,随机化,符合条件的非随机化和不符合条件的设施中,居民特征在很大程度上是相似的.
结论:
- 在CRT中的随机化养老院的设施级特征往往与符合条件的非随机化和不符合条件的设施有很大差异.
- 居民级别的特征在各设施组之间变化较小.
- 研究人员必须评估集群 (设施) 特性,而不仅仅是个人 (居民) 特性,以确定CRT发现的概括性.
更多相关视频
相关概念视频
01:20Cluster Sampling Method
12.0K
Appropriate sampling methods ensure that samples are drawn without bias and accurately represent the population. Because measuring the entire population in a study is not practical, researchers use samples to represent the population of interest.
To choose a cluster sample, divide the population into clusters (groups) and then randomly select some of the clusters. All the members from these clusters are in the cluster sample. For example, if you randomly sample four departments from your...
To choose a cluster sample, divide the population into clusters (groups) and then randomly select some of the clusters. All the members from these clusters are in the cluster sample. For example, if you randomly sample four departments from your...
12.0K
01:29Documentation in Long-Term and Home Healthcare Setting
926
Documentation in long-term care facilities and home healthcare settings is crucial for ensuring continuous, coordinated, and comprehensive care for patients. Each setting has its specific documentation processes and tools:
Long-Term Care Facilities
Long-Term Care Facilities
926
01:29Nursing Interventions II: Selecting and Classifying the Nursing Interventions
2.2K
Creating and executing a nursing diagnosis helps nurses plan care and guide patient, family, and community interventions. They are developed based on a patient's physical evaluation and support measuring the outcomes. It is not recommended to select random interventions throughout the planning process. Instead, consider the following six essential factors when choosing interventions:
2.2K
01:15Nursing Evaluation
3.4K
The evaluation stage signals the end of the nursing process. The nurse gathers evaluative data to assess whether or not the patient has attained the expected results. Whereas the nurse collects data in the nursing assessment to identify the patient's health concerns, the evaluation stage data determines if the indicated health issues are resolved. Evaluative data collection includes two sections: the data acquired to evaluate patient outcomes and the time criteria for data collection.
3.4K
01:30Specialized Care Centers and Settings-II
756
Rural Health Centers
Rural health centers are specialized care facilities in remote locations with very few medical personnel. The primary care providers who run the centers are mostly Registered Nurse Practitioners. Here, emergency treatment is provided to critically ill or injured patients before they are transferred to the closest hospital. Fortunately, due to advancement in technology, many rural healthcare facilities and professionals have easy access to diagnostic and treatment...
Rural health centers are specialized care facilities in remote locations with very few medical personnel. The primary care providers who run the centers are mostly Registered Nurse Practitioners. Here, emergency treatment is provided to critically ill or injured patients before they are transferred to the closest hospital. Fortunately, due to advancement in technology, many rural healthcare facilities and professionals have easy access to diagnostic and treatment...
756
01:13Randomized Experiments
7.0K
The randomization process involves assigning study participants randomly to experimental or control groups based on their probability of being equally assigned. Randomization is meant to eliminate selection bias and balance known and unknown confounding factors so that the control group is similar to the treatment group as much as possible. A computer program and a random number generator can be used to assign participants to groups in a way that minimizes bias.
Simple randomization
Simple...
Simple randomization
Simple...
7.0K