Journal ArticleDOI
Practical clinical trials: increasing the value of clinical research for decision making in clinical and health policy.
TLDR
Increasing the supply of pragmatic or practical clinical trials will depend on the development of a mechanism to establish priorities for these studies, significant expansion of an infrastructure to conduct clinical research within the health care delivery system, more reliance on high-quality evidence by health care decision makers, and a substantial increase in public and private funding forThese studies.Abstract:
Decision makers in health care are increasingly interested in using highquality scientific evidence to support clinical and health policy choices; however, the quality of available scientific evidence is often found to be inadequate. Reliable evidence is essential to improve health care quality and to support efficient use of limited resources. The widespread gaps in evidencebased knowledge suggest that systematic flaws exist in the production of scientific evidence, in part because there is no consistent effort to conduct clinical trials designed to meet the needs of decision makers. Clinical trials for which the hypothesis and study design are developed specifically to answer the questions faced by decision makers are called pragmatic or practical clinical trials (PCTs). The characteristic features of PCTs are that they (1) select clinically relevant alternative interventions to compare, (2) include a diverse population of study participants, (3) recruit participants from heterogeneous practice settings, and (4) collect data on a broad range of health outcomes. The supply of PCTs is limited primarily because the major funders of clinical research, the National Institutes of Health and the medical products industry, do not focus on supporting such trials. Increasing the supply of PCTs will depend on the development of a mechanism to establish priorities for these studies, significant expansion of an infrastructure to conduct clinical research within the health care delivery system, more reliance on high-quality evidence by health care decision makers, and a substantial increase in public and private funding for these studies. For these changes to occur, clinical and health policy decision makers will need to become more involved in all aspects of clinical research, including priority setting, infrastructure development, and funding.read more
Citations
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Journal ArticleDOI
Purposeful Sampling for Qualitative Data Collection and Analysis in Mixed Method Implementation Research.
Lawrence A. Palinkas,Sarah M. Horwitz,Carla A. Green,Jennifer P. Wisdom,Naihua Duan,Kimberly Hoagwood +5 more
TL;DR: This paper reviews the principles and practice of purposeful sampling in implementation research, summarizes types and categories of purposefully sampling strategies and provides a set of recommendations for use of single strategy or multistage strategy designs, particularly for state implementation research.
Journal ArticleDOI
Effectiveness of Antipsychotic Drugs in Patients with Chronic Schizophrenia
Jeffrey A. Lieberman,T. Scott Stroup,Joseph P. McEvoy,Joseph P. McEvoy,Marvin S. Swartz,Robert A. Rosenheck,Diana O. Perkins,Richard S.E. Keefe,Sonia M. Davis,C.E. Davis,Barry D. Lebowitz,Joanne B. Severe,John K. Hsiao +12 more
TL;DR: Olanzapine was the most effective in terms of the rates of discontinuation, and the efficacy of the conventional antipsychotic agent perphenazine appeared similar to that of quetiapine, risperidone, and ziprasidone.
Journal ArticleDOI
Lifestyle, Diabetes, and Cardiovascular Risk Factors 10 Years after Bariatric Surgery
TL;DR: A prospective, controlled Swedish Obese Subjects Study involved obese subjects who underwent gastric surgery and contemporaneously matched, conventionally treated obese control subjects, which reported follow-up data for subjects who had been enrolled for at least 2 years or 10 years before the analysis.
Journal ArticleDOI
Effectiveness-implementation Hybrid Designs: Combining Elements of Clinical Effectiveness and Implementation Research to Enhance Public Health Impact
TL;DR: Although traditional clinical effectiveness and implementation trials are likely to remain the most common approach to moving a clinical intervention through from efficacy research to public health impact, judicious use of the proposed hybrid designs could speed the translation of research findings into routine practice.
Developing and Evaluating Complex Interventions: New Guidance
TL;DR: This research highlights the need to understand more fully the rationale behind the continued use of EMMARM, as well as the barriers to doing so, in patients and clinicians.
References
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Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the Women's Health Initiative randomized controlled trial
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The effectiveness of right heart catheterization in the initial care of critically ill patients
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Small Area Variations in Health Care Delivery
John E. Wennberg,Alan Gittelsohn +1 more
TL;DR: Numbers show prima facie inequalities in the input of resources that are associated with income transfer from areas of lower expenditure to areas of higher expenditure, which indicates that there is considerable uncertainty about the effectiveness of different levels of aggregate, as well as specific kinds of, health services.
Book
Clinical practice guidelines : directions for a new program
TL;DR: This clinical practice guidelines directions for a new program, it will really give you the good idea to be successful.