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建模重症监护的现行实践比较有效性研究研究.

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许多重症监护的比较有效性研究研究都不能代表当前的医疗实践. 这种设计缺陷可能会导致临床试验中不适当的患者护理.

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科学领域:

  • 关键护理医学 关键护理医学
  • 临床试验的设计
  • 比较有效性研究比较有效性研究

背景情况:

  • 现代医学实践对于相关的临床试验结果至关重要.
  • 重症监护中的比较有效性研究 (CER) 旨在评估不同的治疗策略.
  • 确保试验设计反映现实世界的临床场景对于概括性至关重要.

研究的目的:

  • 评估近期的临床护理比较有效性研究在多大程度上充分代表了当代的临床实践.
  • 识别关键护理试验中的潜在设计缺陷,以纳入当前的治疗标准.

主要方法:

  • 2019年4月至2020年3月,在顶级医学期刊 (NEJM,JAMA,The Lancet) 上发表的随机临床试验 (RCT) 的系统审查.
  • 确定符合纳入标准的临床治疗比较有效性研究试验.
  • 审查引用的来源和医学文献,以定义当代重症监护实践.
  • 检查对照组和可比疗法在确定试验与既定的当代实践对比.

主要成果:

  • 在332个RCT中,有25个符合重症监护治疗比较有效性研究的纳入标准.
  • 17个试验成功地将当前的实践纳入了研究组.
  • 八个试验没有足够的"常规护理"组;四个使用固定方法导致潜在的不适当的小组护理,四个未能反映常见的做法,尽管先前的表征努力.

结论:

  • 大约三分之一的重症监护在主要期刊上的比较有效性研究试验没有充分代表当代实践在他们的控制臂或可比的疗法.
  • 这表明在重症监护研究中存在广泛的设计缺陷,可能会影响试验结果的有效性和适用性.
  • 如果未能将试验设计与当前的临床标准保持一致,可能会损害重症监护机构中比较有效性研究的相关性.