Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Dec 2011
ReviewBest practice & research in anaesthesiology issue on new approaches in clinical research ethics in clinical research.
The history of ethics in clinical research parallels the history of abuse of human beings. The Nuremberg Code, Declaration of Helsinki, and the Belmont Report laid the foundations for modern research ethics. In the United States, the OHRP and the FDA provide guidelines for the ethical conduct of research. Investigators should be familiar with regulations concerning informed consent, doing research in vulnerable populations, and protection of privacy.
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Best Pract Res Clin Anaesthesiol · Dec 2011
ReviewA novel approach to implementation of quality and safety programmes in anaesthesiology.
Far too many patients suffer preventable harm from medical errors that add to needless suffering and cost of care. Underdeveloped residency training programmes in patient safety are a major contributor to preventable harm. ⋯ Additionally, the Accreditation Council for Graduate Medical Education (ACGME) now requires education in 'systems-based practice' and 'practice-based learning and improvement' as core competencies of residency training programmes. The specific aim of this article is to describe the implementation of a novel programme designed to enhance residency education, meet ACGME core competencies and improve quality and safety education in one residency programme at an academic medical institution.
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Best Pract Res Clin Anaesthesiol · Dec 2011
ReviewPerioperative comparative effectiveness research.
The goal of comparative effectiveness research (CER) is to improve effectiveness, efficacy and efficiency in health care. While CER seems to present a major opportunity to introduce accountability into health care by identifying and promoting best practices in medicine, many issues surrounding CER remain poorly understood by clinicians and researchers, including what study designs are most appropriate for such research and what analytic tools are most helpful. ⋯ We provide a brief outline of the types of analytic methods particularly useful for CER and connect the reader to references for their practice. Finally, we assess the role of CER in perioperative research and provide some thoughts on future paths.
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Meta-analysis uses numerical tools to pool data and to estimate a summary effect size for the comparison of two interventions from a set of randomised controlled trials identified in a systematic review. An effect size is a single number that expresses the difference in outcome from the interventions. ⋯ Sensitivity analyses are performed to clarify the effect of the experimental design bias on the effect size. Clinical and statistical heterogeneity of the included studies are explored by the additional tools of fixed effect versus random effects models and subgroup analyses.
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Best Pract Res Clin Anaesthesiol · Dec 2011
ReviewPerioperative effectiveness research using large databases.
While the delivery of anaesthesia care is largely a safe process and adverse events are infrequent, they can have devastating consequences for patients and providers when they occur. Given concerns about the role of anaesthesia care in shaping long-term outcomes traditionally considered outside the scope of anaesthesiology, new avenues for perioperative research are being explored at a rapid rate by anaesthesia researchers. ⋯ We highlight many sources of data, both clinical and non-clinical, and evaluate their utility in perioperative research. We then discuss how to design a successful effectiveness study, focussing particularly on which questions in anaesthesiology would be most amenable to exploration with this method, thereby providing a guide for future research endeavours.