David Vandenberg

David Vandenberg

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David Vandenberg


Selective or inadequate discussion of results Regarding Critical Care

For comparative effectiveness studies to become useful they not only need to be relevant, well-designed, and executed. It is also essential that the evidence generated makes it to the clinical decision-maker and, ultimately, is implemented in his patients. You can aslo read demonstration speech ideas on critical care Research.

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It is estimated that 50% of the studies conducted are never published in a paper1 and the part that, ultimately, is published is an over-representation of the studies with positive results, and under-representation of the treatment adverse events (publication bias). For example, at one time or another, glutamine supplements were recommended by certain clinical practice guidelines in patients who suffered burns and traumatic injuries71; one Cochrane meta-analysis conducted in general critically ill patients found traces of publication bias,72 and one large, well-designed trial found increased mortality rates in critically ill patients with multiple organ failure. Writing an rhetorical analysis essay on critical care Research is an ideal thought.

The publication bias lies at the root of resistance from the sponsors who do not with to publish unfavorable results and hide themselves behind permissive regulations that entitle them to conceal the results of studies,74 and at the editors’ tendency to preferably publish studies with positive results. However, several studies indicate that researchers themselves implement some sort of self-censorship that leads to never publish negative results.74 The severity of this situation has given birth to initiatives such as the Alltrials campagin,75 or the James Lind initiative41 that promote the publication of all available evidence and encourage patients to never participate in trials if the publication of all the results is not guaranteed.The essay format of essays on critical care Research should be to the point.

On the other hand, not all outcomes studied are ultimately published which generates some sort of “intra-study publication bias”. Chan et al.76 said that in up to 62% of the studies whose protocol had already been registered, the paper had finally been published with, at least, one primary outcome changed, introduced, or omitted; also, the statistically significant outcomes had more chances of being communicated that the non-statistically significant ones. For example, in one comparative study of fluid therapy with saline solution vs hydroxyethyl starch (HES) in a group of traumatized patients,77 the conclusion was that “the HES causes less renal damage and a significantly lower lactate clearance compared to the saline solution”. In the previous registry of the trial, the authors had marked two (2) primary outcomes, and seven (7) secondary outcomes. However, Reinhart and Hartog,78 say that three (3) of the outcomes published were not part of the registry, among them, acute renal damage and lactate clearance, that happen to be the paper main results. This selective communication of the outcomes tends to favor false positives and contributes to over-estimating the benefits of the treatments published in the medical literature. In any case, do write a cause and effect essay on critical care Research.