An official multi-society statement: the role of clinical research results in the practice of critical care medicine. Am J Respir Crit Care Med 2012 May 15;185(10):1117-24
Date
05/17/2012Pubmed ID
22589312DOI
10.1164/rccm.201204-0638STScopus ID
2-s2.0-84861360822 (requires institutional sign-in at Scopus site) 51 CitationsAbstract
BACKGROUND: While the results of clinical research are clearly valuable in the care of critically ill patients, the limitations of such information and the role of other forms of medical knowledge for clinical decision making have not been carefully examined.
METHODS: The leadership of three large professional societies representing critical care practitioners convened a diverse group representing a wide variety of views regarding the role of clinical research results in clinical practice to develop a document to serve as a basis for agreement and a framework for ongoing discussion.
RESULTS: Consensus was reached on several issues. While the results of rigorous clinical research are important in arriving at the best course of action for an individual critically ill patient, other forms of medical knowledge, including clinical experience and pathophysiologic reasoning, remain essential. No single source of knowledge is sufficient to guide clinical decisions, nor does one kind of knowledge always take precedence over others. Clinicians will find clinical research compelling for a variety of reasons that go beyond study design. While clinical practice guidelines and protocols based upon clinical research may improve care and decrease variability in practice, clinicians must be able to understand and articulate the rationale as to why a particular protocol or guideline is used or why an alternative approach is taken. Making this clinical reasoning explicit is necessary to understand practice variability.
CONCLUSIONS: Understanding the strengths and weaknesses of different kinds of medical knowledge for clinical decision making and factors beyond study design that make clinical research compelling to clinicians can provide a framework for understanding the role of clinical research in practice.
Author List
Tonelli MR, Curtis JR, Guntupalli KK, Rubenfeld GD, Arroliga AC, Brochard L, Douglas IS, Gutterman DD, Hall JR, Kavanagh BP, Mancebo J, Misak CJ, Simpson SQ, Slutsky AS, Suffredini AF, Thompson BT, Ware LB, Wheeler AP, Levy MM, ACCP/ATS/SCCM Working GroupAuthor
David Gutterman MD Emeritus Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Biomedical ResearchClinical Protocols
Critical Care
Decision Support Techniques
Evidence-Based Medicine
Humans
Knowledge Bases
Practice Patterns, Physicians'
Precision Medicine
Research Design
