Articles: patients.
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Intensive care medicine · Jan 2010
Prospective meta-analysis using individual patient data in intensive care medicine.
Meta-analysis is a technique for combining evidence from multiple trials. However, meta-analyses of studies with substantial heterogeneity among patients within trials-common in intensive care-can lead to incorrect conclusions if performed using aggregate data. ⋯ We review the features of prospective IPD meta-analysis and identify those of relevance to intensive care research. We identify three clinical questions, which are the subject of recent or planned randomised controlled trials where IPD MA offers advantages over approaches using aggregate data.
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Swiss medical weekly · Jan 2010
General practitioner's adherence to the COPD GOLD guidelines: baseline data of the Swiss COPD Cohort Study.
As part of an ongoing investigation into the effect of GPs prescriptions on the clinical course of COPD, 139 GPs submitted a standardised questionnaire for each COPD patient recruited. Information requested included spirometric parameters, management and demographic data. Participating GPs were provided with and received instruction on a spirometer with automatic feedback on quality. Patients were grouped by the investigators into the GOLD COPD severity classifications, based on spirometric data provided. Data from the questionnaires were compared between the groups and management was compared with the recommendations of GOLD. ⋯ Adherence to GOLD (COPD) guidelines is low among GPs in Switzerland and COPD is often misdiagnosed or treated inappropriately. This is probably due to poor knowledge of disease definitions.
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Real patients are generally recruited to participate in assessment of medical students all over the world in their clinical examinations. In the past, such voluntary patients were taken for granted. However, this is no longer true nowadays. ⋯ Printed information given during recruitment, and briefing sessions conducted immediately prior to the examination are recommended to improve patients' satisfaction.
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Z Evid Fortbild Qual Gesundhwes · Jan 2010
[Patient-reported clinical trial endpoints--the current state of affairs in research and practice].
Patient-reported outcomes are increasingly considered as endpoints for clinical studies. Instruments for measuring patient-reported outcomes range from simple assessments of discrete symptoms or signs to complex measures addressing multidimensional constructs such as health-related quality of life. While generic measures are designed to be applicable across a wide range of clinical conditions, disease- or population-specific instruments address health problems which are relevant for a particular disease or target group. ⋯ As predictors and mediators of clinical outcomes they may contribute to the understanding of how patients benefit from treatment. They are included as primary endpoints when treatment effects comprise subjective phenomena such as pain, fatigue or psychological well-being. Current research activities in the field of patient-reported outcomes include the development of new (disease-specific) instruments, head-to-head comparisons of psychometric properties of measures, analysis of the context-dependence of results, and application of patient-reported outcomes in clinical practice.