tailieunhanh - Báo cáo khoa học: "Evidence-based medicine: Classifying the evidence from clinical trials – the need to consider other dimension"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Evidence-based medicine: Classifying the evidence from clinical trials – the need to consider other dimensions. | Available online http content 10 5 232 Review Evidence-based medicine Classifying the evidence from clinical trials - the need to consider other dimensions Rinaldo Bellomo1 2 and Sean M Bagshaw1 1 Department of Intensive Care Austin Hospital Studley Rd Heidelberg Victoria 3084 Australia 2Faculty of Medicine University of Melbourne Royal Parade Parkville Victoria 3052 Australia Corresponding author Rinaldo Bellomo Published 4 October 2006 This article is online at http content 10 5 232 2006 BioMed Central Ltd Critical Care 2006 10 232 doi cc5045 Abstract The current approach to assessing the quality of evidence obtained from clinical trials focuses on three dimensions the quality of the design with double-blinded randomised controlled trials representing the highest level of such design the statistical power beta and the level of significance alpha . While these aspects are important we argue that other significant aspects of trial quality impinge upon the truthfulness of the findings biological plausibility reproducibility and generalisability. We present several recent studies in critical care medicine where the design beta and alpha components of the study are seemingly satisfactory but where the aspects of biological plausibility reproducibility and generalisability show serious limitations. Accordingly we argue for more reflection definition and consensus on these aspects of the evaluation of evidence. The extent to which beliefs are based on evidence is very much less than believers suppose. Bertrand Russell 1928 Sceptical Essays Introduction The evidence-based medicine EBM movement has brought about a paradigm shift not only in medical practice and education but also in study design and in the appraisal and classification of published research in the field of critical care medicine as well as medicine in general 1 2 . The principles created by pioneers in the field of EBM are now widely accepted as