Worldwide Opinion on Multicenter Randomized Interventions Showing Mortality Reduction in Critically Ill Patients: A Democracy-Based Medicine Approach.

Autor: Pisano A; Division of Cardiac Anesthesia and Intensive Care, AORN 'Dei Colli', Monaldi Hospital, Naples, Italy., Landoni G; Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy. Electronic address: landoni.giovanni@hsr.it., Lomivorotov V; Research Institute of Circulation Pathology, Novosibirsk, Russia., Comis M; Cardiac and Vascular Department, Mauriziano Hospital, Turin, Italy., Gazivoda G; Institute of Cardiovascular Diseases ׳Dedinje׳, Belgrade, Serbia., Conte M; Department of Anesthesia and Intensive Care, Mater Dei Hospital, Bari, Italy., Hajjar L; Intensive Care Unit, Universidade de Sao Paulo, Sao Paulo, Brazil., Finco G; Department of Medical Sciences 'M. Aresu', University of Cagliari, Cagliari, Italy., Jovic M; Institute of Cardiovascular Diseases ׳Dedinje׳, Belgrade, Serbia., Mucchetti M; Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy., Kunstýř J; Department of Anesthesiology and Intensive Care, First Faculty of Medicine, Charles University in Prague, and General University Hospital in Prague, Prague, Czech Republic., Paternoster G; Cardiovascular Anaesthesia and Intensive Care, San Carlo Hospital, Potenza, Italy., Likhvantsev V; Moscow Clinical Regional Research Institute-MONIKI, Moscow, Russia., Ruggeri L; Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy., Ma J; Center for Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China., Alvaro G; Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria 'Mater Domini', Catanzaro, Italy., Bukamal N; Mohammed Bin Khalifa Bin Sulman Al-Khalifa Cardiac Center, West Riffa, Bahrain., Borghi G; Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy., Pasyuga V; Cardiac Anesthesia and Intensive Care, Federal Centre for Cardiac Surgery, Astrakhan, Russia., Cabrini L; Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy., Greco M; Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy., Guarracino F; Cardiothoracic Department, University Hospital of Pisa, Pisa, Italy., Lembo R; Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy., Lobreglio R; Cardiac Anesthesia and Intensive Care, San Giovanni Battista Hospital, University of Turin, Turin, Italy., Monaco F; Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy., Montisci A; Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy., Pala G; Cardioanaesthesia and Intensive Care, Civil Hospital 'SS Annunziata', Sassari, Italy., Pasin L; Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy., Pieri M; Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy., Santini F; Division of Cardiac Surgery, IRCCS S Martino, University Hospital, Genova, Italy., Silvetti S; Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy., Zambon M; Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy., Baiardo Redaelli M; Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy., Castella A; Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy., De Vuono G; Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy., Lucchetta L; Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy., Zangrillo A; Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy., Bellomo R; Faculty of Medicine, University of Melbourne, Melbourne, Australia.
Jazyk: angličtina
Zdroj: Journal of cardiothoracic and vascular anesthesia [J Cardiothorac Vasc Anesth] 2016 Oct; Vol. 30 (5), pp. 1386-95. Date of Electronic Publication: 2016 May 06.
DOI: 10.1053/j.jvca.2016.05.005
Abstrakt: Objectives: Democracy-based medicine is a combination of evidence-based medicine (systematic review), expert assessment, and worldwide voting by physicians to express their opinions and self-reported practice via the Internet. The authors applied democracy-based medicine to key trials in critical care medicine.
Design and Setting: A systematic review of literature followed by web-based voting on findings of a consensus conference.
Participants: A total of 555 clinicians from 61 countries.
Interventions: The authors performed a systematic literature review (via searching MEDLINE/PubMed, Scopus, and Embase) and selected all multicenter randomized clinical trials in critical care that reported a significant effect on survival and were endorsed by expert clinicians. Then they solicited voting and self-reported practice on such evidence via an interactive Internet questionnaire. Relationships among trial sample size, design, and respondents' agreement were investigated. The gap between agreement and use/avoidance and the influence of country origin on physicians' approach to interventions also were investigated.
Measurements and Main Results: According to 24 multicenter randomized controlled trials, 15 interventions affecting mortality were identified. Wide variabilities in both the level of agreement and reported practice among different interventions and countries were found. Moreover, agreement and reported practice often did not coincide. Finally, a positive correlation among agreement, trial sample size, and number of included centers was found. On the contrary, trial design did not influence clinicians' agreement.
Conclusions: Physicians' clinical practice and agreement with the literature vary among different interventions and countries. The role of these interventions in affecting survival should be further investigated to reduce both the gap between evidence and clinical practice and transnational differences.
(Copyright © 2016 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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