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）结合了最佳可用实践与临床医生的经验和 患者价值观。在循证医学之前，护理质量是基于遵守当地标准的 医疗保健提供者提供的实践。该标准是基于什么历史实践，并且是 自然界通常是轶事。改进的统计分析手段，尤其是多变量分析， 系统的评论和荟萃分析有助于EBM的进步。 EBM原则的采用 一直很慢，对基于杰出的骨科的EBM接受了。为此， 教育外科医生有关高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 骨科患者。此外，实践中的临床解释需要了解合并的 报告试验的标准（配偶）和加强观察性研究的报告 流行病学（频闪）图。 EBM与以前接受的标准之间的冲突是 在EBM质疑价值的几种骨科程序中，很明显 椎体成形术和膝截肢切除术，用于退化半月板眼泪。 RCT和观察性研究在手术研究中都有重要地位。做得好的队列试验 与不适用于许多患者的RCT相比，可以为实践患者护理提供更大的见解。在 此外，观察性研究在解决与手术有关的问题时特别有用 无法执行RCT或实现足够的患者数量的程序 统计能力太多了，无法使试验实用。改善了外科医生阅读的教育和 审查研究对于推进骨科手术的实践和手术护理至关重要 患者。对最高证据的研究的益处和偏见有了改进的了解， 即RCT和前瞻性观察研究将使重要和急需的 我们患者护理的进步。该研讨会将解决 这些类型的肌肉骨骼护理中的分析。出于质量目的的注册表数据的最新流行 将探讨这是如何符合证据和医师/患者决定的层次结构的 制作。考虑到AAOS的重点和国家注册机构的发展，这一点尤其重要 主要的骨科程序。