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Medicina Fluminensis : Medicina Fluminensis, Vol.53 No.4 Prosinac 2017.

Pregledni rad
https://doi.org/10.21860/medflum2017_187362

Klinička praksa temeljena na dokazima: pregled prijetnji valjanosti dokaza i kako ih spriječiti

Silvio Garattini ; IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
Janus C Jakobsen ; The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Holbæk Hospital, Holbæk, Denmark
Jørn Wetterslev ; The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
Vittorio Bertele’ ; IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
Rita Banzi ; IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
Ana Rath ; Orphanet, Institut National de la Santé et de la Recherche Médicale US14, Paris, France
Edmund A.M. Neugebauer ; Faculty of Health, School of Medicine, Witten/Herdecke University, Campus Cologne, Germany
Martine Laville ; Centre de Recherche en Nutrition Humaine, Rhône-Alpes, Univ de Lyon, Lyon, France
Yvonne Masson ; Centre de Recherche en Nutrition Humaine, Rhône-Alpes, Univ de Lyon, Lyon, France
Virginie Hivert ; Centre de Recherche en Nutrition Humaine, Rhône-Alpes, Univ de Lyon, Lyon, France
Michaela Eikermann ; Institute for Research in Operative Medicine, Faculty of Health, School of Medicine, Witten/Herdecke University, Cologne, Germany
Burc Aydin ; Department of Medical Pharmacology, School of Medicine, Dokuz Eylul University, Izmir, Turkey
Sandra Ngwabyt ; Orphanet, Institut National de la Santé et de la Recherche Médicale US14, Paris, France
Cecilia Martinho ; Palliative Care Service, Portuguese Institute of Oncology, Porto, Portugal
Chiara Gerardi ; IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
Cezary A Szmigielski ; Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
Jacques Demotes-Maynard ; European Clinical Research Infrastructure Network, Ministry of Higher Education and Research, Paris, France
Christian Gluud   ORCID icon orcid.org/0000-0002-8861-0799 ; The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

Puni tekst: engleski, pdf (1 MB) str. 424-438 preuzimanja: 131* citiraj
APA 6th Edition
Garattini, S., Jakobsen, J.C., Wetterslev, J., Bertele’, V., Banzi, R., Rath, A., ... Gluud, C. (2017). Evidence-based clinical practice: overview of threats to the validity of evidence and how to minimise them. Medicina Fluminensis, 53 (4), 424-438. https://doi.org/10.21860/medflum2017_187362
MLA 8th Edition
Garattini, Silvio, et al. "Evidence-based clinical practice: overview of threats to the validity of evidence and how to minimise them." Medicina Fluminensis, vol. 53, br. 4, 2017, str. 424-438. https://doi.org/10.21860/medflum2017_187362. Citirano 19.07.2018.
Chicago 17th Edition
Garattini, Silvio, Janus C Jakobsen, Jørn Wetterslev, Vittorio Bertele’, Rita Banzi, Ana Rath, Edmund A.M. Neugebauer, et al. "Evidence-based clinical practice: overview of threats to the validity of evidence and how to minimise them." Medicina Fluminensis 53, br. 4 (2017): 424-438. https://doi.org/10.21860/medflum2017_187362
Harvard
Garattini, S., et al. (2017). 'Evidence-based clinical practice: overview of threats to the validity of evidence and how to minimise them', Medicina Fluminensis, 53(4), str. 424-438. doi: https://doi.org/10.21860/medflum2017_187362
Vancouver
Garattini S, Jakobsen JC, Wetterslev J, Bertele’ V, Banzi R, Rath A i sur. Evidence-based clinical practice: overview of threats to the validity of evidence and how to minimise them. Medicina Fluminensis [Internet]. 01.12.2017. [pristupljeno 19.07.2018.];53(4):424-438. doi: https://doi.org/10.21860/medflum2017_187362
IEEE
S. Garattini, et al., "Evidence-based clinical practice: overview of threats to the validity of evidence and how to minimise them", Medicina Fluminensis, vol.53, br. 4, str. 424-438, Srpanj 2018. [Online]. doi: https://doi.org/10.21860/medflum2017_187362

Sažetak
Primjena najkvalitetnijih dokaza kliničkih istraživanja ključna je u odabiru ispravnog liječenja pacijenata. No, način na koji će se odabrati najbolji dokazi predstavlja često poteškoću. Ovim preglednim člankom prikazujemo opasnosti navedenog odabira, kao i načine kako ih umanjiti. Relevantni izvori razmatrani su pretragom literature u kombinaciji s osobnim datotekama. Izbor liječenja uglavnom se ne bi smio temeljiti isključivo na opservacijskim ili pojedinačnim randomiziranim kliničkim studijama. Sustavni pregledi s metaanalizom svih identificiranih randomiziranih kliničkih studija procijenjenih sustavom stupnjevanja procjene, razvoja i evaluacije preporuka (engl. Grading of Recommendations Assessment, Development and Evaluation; GRADE) predstavljaju najvišu razinu dokaza. Iako su sustavni pregledi pouzdaniji od drugih vrsta dokaza, sve razine hijerarhije dokaza ugrožene su sustavnim pogreškama (engl. bias); pogreškama dizajna studije (zloupotreba surogatnih ishoda, složenih ishoda itd.) i slučajnim pogreškama (igra slučaja). Kliničke istraživačke infrastrukture mogu pomoći u pružanju većih i adekvatnije provedenih ispitivanja. Sekvencijska analiza studija može pomoći pri odlučivanju kada postoji dovoljna razina dokaza u metaanalizama. Ako se prijetnje valjanosti kliničkih istraživanja pažljivo razmatraju i minimiziraju, rezultati istraživanja bit će vrjedniji i korisniji pacientima i zdravstvenim sustavima.

Ključne riječi
klinička praksa temeljena na dokazima; medicina temeljena na dokazima; meta-analiza; randomizirana klinička studija; sekvencijska analiza studija; sustavni pregled

Hrčak ID: 187362

URI
https://hrcak.srce.hr/187362

[engleski]

Posjeta: 239 *