Applying Evidence Based Principles to Personalized Medicine

将循证原则应用于个性化医疗

• 批准号: 9913253
• 负责人: Kurt Paul Spindler
• 金额: $ 2万
• 依托单位: AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-01-02 至 2020-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9913253
• 关键词: Address; Adherence; Adoption; Benefits and Risks; Big Data; Caring; Clinical; Communities; Conflict (Psychology); Consensus; Data; Decision Making; Development; Education; Epidemiology; Evidence Based Medicine; Health Personnel; Knee; Level of Evidence; Literature; Meniscus structure of joint; Meta-Analysis; Musculoskeletal; Nature; Observational Study; Operative Surgical Procedures; Orthopedic Procedures; Orthopedic Surgery procedures; Orthopedics; Outcome; Patient Care; Patients; Physicians; Practical trial; Quality of Care; Randomized; Reading; Registries; Reporting; Research Design; Role; Statistical Data Interpretation; Surgeon; base; clinical care; cohort; control trial; data registry; evidence base; experience; improved; insight; personalized medicine; prospective; surgical research; symposium; systematic review

Project Summary/Abstract: Evidence-based medicine (EBM) combines the best available practices with clinician experience and patient values. Prior to evidence-based medicine, quality of care was based on adherence to local standard practices given by healthcare providers. This standard was based on what historical practices, and was often anecdotal in nature. Improved means of statistical analysis, especially multivariable analysis, systematic reviews and meta-analysis has helped the advancement EBM. The adoption of EBM tenets has been slow, and acceptance of EBM over eminence-based orthopaedics has suffered. To this end, educating surgeons about the benefits and biases of high level of evidence studies, including randomized control trials (RCTs) and prospective observational studies, will help improve the clinical care of orthopaedic patients. Further, clinical interpretation in practice requires understanding of the Consolidated Standards of Reporting Trials (CONSORT) and Strengthening the Reporting of Observational studies in Epidemiology (STROBE) diagrams. The conflict between EBM and previously accepted standards is evident in several orthopaedic procedures in which EBM has questioned value: viscosupplementation, vertebroplasty, and knee meniscectomy for degenerative meniscal tears. Both RCTs and observational studies have important places in surgical research. A well-done cohort trial may provide greater insight to practical patient care than a RCT that is not applicable to many patients. In addition, observational studies can be particularly useful in addressing questions related to surgical procedures where RCTs cannot be performed or the number of patients necessary to achieve adequate statistical power is too numerous to make the trial practical. Improved education for surgeons reading and reviewing studies is critical to advancing the practice of orthopaedic surgery and the care of surgical patients. Improved understanding of the benefits and biases of studies at the highest levels of evidence, namely RCTs and prospective observational studies, will enable important and much needed advancements in the care of our patients. This symposium will address the strengths and weaknesses of these types of analyses in musculoskeletal care. The recent popularity of registry data for quality purposes will be explored as to how this fits within the hierarchy of evidence and physician/patient decision making. This is especially important given the AAOS emphasis and development of national registries for major orthopaedic procedures.

项目摘要/摘要： 循证医学 (EBM) 将最佳可行实践与临床医生经验相结合， 患者价值观。在循证医学出现之前，护理质量基于遵守当地标准 医疗保健提供者提供的做法。该标准基于历史实践， 本质上常常是轶事。改进统计分析手段，特别是多变量分析， 系统评价和荟萃分析有助于EBM的进步。 EBM 原则的采用 进展缓慢，EBM 相对于基于隆起的骨科的接受度也受到了影响。为此， 教育外科医生关于高水平证据研究的好处和偏见，包括随机 对照试验（RCT）和前瞻性观察研究，将有助于改善临床护理 骨科患者。此外，实践中的临床解释需要了解综合 报告试验标准（CONSORT）和加强观察性研究的报告 流行病学 (STROBE) 图。 EBM 与先前接受的标准之间的冲突是 在一些骨科手术中，EBM 的价值受到质疑：粘弹性补充、 椎体成形术和膝关节半月板切除术治疗退行性半月板撕裂。 随机对照试验和观察性研究在外科研究中都具有重要地位。一项出色的队列试验 与不适用于许多患者的随机对照试验相比，它可以为实际患者护理提供更深入的见解。在 此外，观察性研究对于解决与外科手术相关的问题特别有用。 无法进行随机对照试验的程序或达到足够的患者数量所需的 统计功效太多，无法使试验具有实际意义。改善外科医生的阅读和教育 回顾研究对于推进骨科手术实践和手术护理至关重要 患者。提高对最高水平证据研究的好处和偏见的理解， 即随机对照试验和前瞻性观察研究，将使重要且急需的研究成为可能 患者护理方面的进步。本次研讨会将探讨以下领域的优势和劣势 肌肉骨骼护理中的这些类型的分析。最近出于质量目的而流行的注册数据 将探讨这如何适应证据层次和医生/患者决策 制作。鉴于 AAOS 的重视和国家登记册的发展，这一点尤其重要 主要骨科手术。