The Need for Large Clinical Studies in Perioperative Medicine

* Departments of Clinical Epidemiology and Biostatistics and Medicine, McMaster University, Hamilton, Ontario, Canada, and Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada. † Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China. ‡ Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina. § Department of Anesthesia, McGill University, Montreal, Quebec, Canada. ‖ Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, and Population Health Research Institute, Hamilton Health Sciences and McMaster University.
Anesthesiology (Impact Factor: 5.88). 03/2012; 116(6):1169-75. DOI: 10.1097/ALN.0b013e31825037bc
Source: PubMed
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    • "Widespread acceptance of this concept in other countries will probably take longer due to the relative infrequency of large clinical studies. Such evaluations are strongly needed in the perioperative period [11,114]. This is exemplified by Devereaux and colleagues in an editorial recently published in Anesthesiology [114]: 'Unlike cardiology, large clinical studies remain uncommon in perioperative medicine [115,116]. "
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    ABSTRACT: Hemodynamic monitoring and management has greatly improved during the past decade. Technologies have evolved from very invasive to non-invasive, and the philosophy has shifted from a static approach to a functional approach. However, despite these major changes, the critical care community still has potential to improve its ability to adopt the most modern standards of research methodology in order to more effectively evaluate new monitoring systems and their impact on patient outcome. Today, despite the huge enthusiasm raised by new hemodynamic monitoring systems, there is still a big gap between clinical research studies evaluating these monitors and clinical practice. A few studies, especially in the perioperative period, have shown that hemodynamic monitoring systems coupled with treatment protocols can improve patient outcome. These trials are small and, overall, the corpus of science related to this topic does not yet fit the standard of clinical research methodology encountered in other specialties such as cardiology and oncology. Larger randomized trials or quality improvement processes will probably answer questions related to the real impact of these systems.
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