Translating Research Into Practice

2016 ◽  
pp. 163-188
Author(s):  
John C. Norcross ◽  
Thomas P. Hogan ◽  
Gerald P. Koocher ◽  
Lauren A. Maggio
Keyword(s):  
Clinical Trials ◽  
Decision Analysis ◽  
Translational Research ◽  
Decision Trees ◽  
Research Evidence ◽  
Randomized Clinical Trials ◽  
Clinical Decision ◽  
Reflective Practitioner ◽  
Critical Junctures ◽  
The Face

This chapter assists practitioners in translating the research evidence into direct applications to their patients. It reviews the imperative of translational research and the stance of the reflective practitioner. The chapter helps practitioners translate the results of randomized clinical trials into practice by applying the CONSORT checklist. It considers potential harms that might accrue to patients in applying the research. The chapter also examines the process of identifying discredited practices—interventions that do not work—and reflects on how to proceed in the face of inconsistent evidence. The chapter concludes by applying clinical decision analysis, using decision trees to explore choices at critical junctures.

scholarly journals How should the ticagrelor be used? The point after the TWILIGHT and THEMIS-PCI studies

2020 ◽  
Vol 22 (Supplement_L) ◽  
pp. L72-L76
Author(s):  
Laura Gatto ◽  
Francesco Prati
Keyword(s):  
Clinical Trials ◽  
Heart Attack ◽  
Randomized Clinical Trials ◽  
Stable Coronary Artery Disease ◽  
Diabetic Patients ◽  
Increased Risk ◽  
The Face ◽  
Risk Patients ◽  
History Of ◽  
Artery Disease

Abstract The ticagrelor represents a cornerstone of antiplatelet therapy and its use has been supported, over the years, by several clinical trials that have enrolled thousands of patients; while the PLATO study initially demonstrated its effectiveness in the immediate treatment of acute coronary syndromes, the PEGASUS study documented the benefit of prolonging this treatment beyond 12 months from the heart attack. Over the past few months, two new randomized clinical trials have been published that have seen the use of ticagrelor in different clinical settings. The TWILIGHT study showed that in high-risk patients who completed 3 months of double antiplatelet drugs after coronary angioplasty, ticagrelor monotherapy is associated with a 44% reduction in the risk of clinically relevant bleeding in the absence of an increase in the ischaemic risk. The THEMIS study instead concluded that in the population of diabetics with stable coronary artery disease, but without a history of heart attack or stroke, a strategy that involves the addition of ticagrelor to the acetylsalicylic acid is not advisable as in the face of a benefit in the prevention of events ischaemic an increased risk of bleeding has been observed. Only in the subgroup of diabetic patients with a history of previous angioplasty would a more powerful antithrombotic therapy seem to be advantageous.

scholarly journals Cancer-associated thrombosis: updates and controversies

Hematology ◽  
2012 ◽  
Vol 2012 (1) ◽  
pp. 626-630 ◽  
Author(s):  
Alok A. Khorana
Keyword(s):  
Molecular Weight ◽  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Clinical Decision ◽  
Low Molecular Weight ◽  
Clinical Settings ◽  
Level Of Evidence ◽  
Patients With Cancer ◽  
Multiple Biomarkers ◽  
Cancer Associated Thrombosis

Abstract Emerging data have enhanced our understanding of cancer-associated thrombosis, a major cause of morbidity and mortality in patients with cancer. This update will focus on recent findings, including the phenomenon of incidental venous thromboembolism (VTE), novel approaches to risk assessment, and the results of randomized clinical trials focusing on prophylaxis of cancer outpatients. Incidental VTE is an important contributor to rates of cancer-associated VTE and, in terms of outcomes, appears to be as consequential for patients as symptomatic VTE. Multiple biomarkers have been studied, with the highest level of evidence for prechemotherapy elevated platelet counts, elevated leukocyte counts, and low hemoglobin. Other candidate biomarkers, including D-dimer and tissue factor, are currently being evaluated. A recently validated risk score for chemotherapy-associated VTE has now been evaluated in more than 10 000 cancer patients in a variety of clinical settings and trials and is ready for clinical use (Level 1 clinical decision rule). Several randomized clinical trials in solid-tumor patients with low-molecular-weight heparins and semuloparin, an ultra-low-molecular-weight heparin, demonstrate clearly that outpatient thromboprophylaxis is feasible, safe, and effective. Selecting the appropriate patients for prophylaxis, however, continues to be a matter of controversy.

scholarly journals Comparison of published guidelines for management of coagulopathy and thrombosis in critically ill patients with COVID 19: implications for clinical practice and future investigations

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Adam Flaczyk ◽  
Rachel P. Rosovsky ◽  
Clay T. Reed ◽  
Brittany K. Bankhead-Kendall ◽  
Edward A. Bittner ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Randomized Clinical Trials ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Anticoagulation Management ◽  
Randomized Controlled Clinical Trials ◽  
Increased Risk ◽  
Individualized Approach

Abstract Critically ill patients with COVID-19 are at increased risk for thrombotic complications which has led to an intense debate surrounding their anticoagulation management. In the absence of data from randomized controlled clinical trials, a number of consensus guidelines and recommendations have been published to facilitate clinical decision-making on this issue. However, substantive differences exist between these guidelines which can be difficult for clinicians. This review briefly summarizes the major societal guidelines and compares their similarities and differences. A common theme in all of the recommendations is to take an individualized approach to patient management and a call for prospective randomized clinical trials to address important anticoagulation issues in this population.

scholarly journals Use of Bayesian Decision Analysis to Minimize Harm in Patient-Centered Randomized Clinical Trials in Oncology

JAMA Oncology ◽  
2017 ◽  
Vol 3 (9) ◽  
pp. e170123 ◽  
Author(s):  
Vahid Montazerhodjat ◽  
Shomesh E. Chaudhuri ◽  
Daniel J. Sargent ◽  
Andrew W. Lo
Keyword(s):  
Clinical Trials ◽  
Decision Analysis ◽  
Randomized Clinical Trials ◽  
Bayesian Decision ◽  
Patient Centered

Developing translational research infrastructure and capabilities associated with cancer clinical trials

2013 ◽  
Vol 15 ◽  
Author(s):  
Jacqueline A Hall ◽  
Robert Brown
Keyword(s):  
Clinical Trials ◽  
Clinical Research ◽  
Translational Research ◽  
Cancer Biology ◽  
Clinical Decision Making ◽  
Treatment Strategies ◽  
Scientific Progress ◽  
Clinical Decision ◽  
Research Infrastructure ◽  
High Quality

The integration of molecular information in clinical decision making is becoming a reality. These changes are shaping the way clinical research is conducted, and as reality sets in, the challenges in conducting, managing and organising multi-disciplinary research become apparent. Clinical trials provide a platform to conduct translational research (TR) within the context of high quality clinical data accrual. Integrating TR objectives in trials allows the execution of pivotal studies that provide clinical evidence for biomarker-driven treatment strategies, targeting early drug development trials to a homogeneous and well defined patient population, supports the development of companion diagnostics and provides an opportunity for deepening our understanding of cancer biology and mechanisms of drug action. To achieve these goals within a clinical trial, developing translational research infrastructure and capabilities (TRIC) plays a critical catalytic role for translating preclinical data into successful clinical research and development. TRIC represents a technical platform, dedicated resources and access to expertise promoting high quality standards, logistical and operational support and unified streamlined procedures under an appropriate governance framework. TRIC promotes integration of multiple disciplines including biobanking, laboratory analysis, molecular data, informatics, statistical analysis and dissemination of results which are all required for successful TR projects and scientific progress. Such a supporting infrastructure is absolutely essential in order to promote high quality robust research, avoid duplication and coordinate resources. Lack of such infrastructure, we would argue, is one reason for the limited effect of TR in clinical practice beyond clinical trials.

scholarly journals Hygiene protocols for the treatment of denture-related stomatitis: local and systemic parameters analysis - a randomized, double-blind trial protocol

Trials ◽  
2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Adriana B. Ribeiro ◽  
Camila B. de Araújo ◽  
Luiz Eduardo V. Silva ◽  
Rubens Fazan-Junior ◽  
Helio C. Salgado ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Clinical Decision Making ◽  
Complex Structure ◽  
Material Design ◽  
Clinical Decision ◽  
Sodium Hypochlorite Solution ◽  
Oral Diseases ◽  
Double Blind ◽  
Lactose Monohydrate

Abstract Background Denture-related stomatitis (DS) is chronic multifactorial inflammation, strongly related to the presence of the biofilm that is the complex structure formed by microorganisms held together by a mucus-like matrix of carbohydrate that adheres to different surfaces, including the denture surface. DS has recently been correlated with deleterious cardiovascular alterations. The potential effect of hygiene protocols in the control of DS and randomized clinical trials that address this oral condition with cardiovascular complications are important in clinical decision-making. Material/design A clinical trial, randomized, double-blind, and with parallel groups, will be conducted in Brazil The sample will consist of 100 patients without teeth in both arches, users of at least maxillary complete dentures, and diagnosed with DS, who will be allocated to groups (n = 25 per group) according to the different hygiene protocols: (1) brushing of the palate and immersion of the prosthesis in 0.25% sodium hypochlorite solution (positive control); (2) brushing of the palate and immersion of the prosthesis in 0.15% triclosan solution; (3) brushing of the palate and immersion of the prosthesis in lactose monohydrate; or (4) brushing the palate with citric acid and immersing the prosthesis in lactose monohydrate. The response variables will be heart rate variability and alteration of blood pressure (systemic level), remission of DS, removal of biofilm, reduction of microbial load (colony-forming units (CFU)), mouth and prosthesis odor level, expression of MUC1, proinflammatory cytokines, C-reactive protein (CRP), viscosity, pH and salivary flow (locally); patient-centred qualitative analysis will also be undertaken. Measurements will be performed at baseline and 10 days after the interventions. The results obtained will be statistically analyzed as pertinent, with a level of significance of 0.05. Discussion This study will provide a guideline for clinical practice regarding the use of hygiene protocols in the treatment of oral diseases (DS) mediated by biofilm. Also, it may provide evidence of correlation of oral manifestation with cardiac risk. Trial registration Brazilian Registry of Clinical Trials, RBR-4hhwjb. Registered on 9 November 2018.

scholarly journals The comparative efficacy and safety of acupuncture for mild and moderate Alzheimer's disease: A systematic review and network meta-analysis

2021 ◽  
Author(s):  
Nana Han ◽  
◽  
Yang Fang ◽  
Guozhen Zhao ◽  
Bo Ji
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Decision Making ◽  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Clinical Decision Making ◽  
Acupuncture Treatment ◽  
Clinical Decision ◽  
Quality Of Evidence

Review question / Objective: According to the current randomized clinical trials (RCT) of acupuncture therapy for Alzheimer's disease (AD), to evaluate their methodology, the quality of evidence and the report are evaluated and summarize evidence of important outcomes of randomized clinical trials. We aim to provide accurate clinical decision-making for acupuncture treatment of Alzheimer's disease. Condition being studied: According to the current randomized clinical trials (RCT) of acupuncture therapy for Alzheimer's disease (AD), to evaluate their methodology, the quality of evidence and the report are evaluated and summarize evidence of important outcomes of randomized clinical trials. We aim to provide accurate clinical decision-making for acupuncture treatment of Alzheimer's disease.

scholarly journals Acupuntura no tratamento da paralisia facial periférica: uma revisão sistemática

2020 ◽  
Vol 10 (29) ◽  
pp. 155-165
Author(s):  
Lícia Regina Siqueira Garcia ◽  
José Jailson de Almeida Junior ◽  
Henrique Affonso Oliveira Souza Neto ◽  
Lígia Rejane Siqueira Garcia
Keyword(s):  
Clinical Trials ◽  
Facial Paralysis ◽  
Randomized Clinical Trials ◽  
Sudden Onset ◽  
Peripheral Facial Paralysis ◽  
Scientific Publications ◽  
Serious Adverse Events ◽  
Calidad De Vida ◽  
The Face ◽  
Nerve Recovery

A paralisia facial periférica é um distúrbio de instalação repentina, marcado pelo enfraquecimento dos músculos de um dos lados do rosto. Objetivo: revisar publicações científicas que demonstrem os efeitos e os resultados da utilização da acupuntura no tratamento da paralisia facial periférica. Realizou-se busca nas bases de dados Pubmed, Medline, Scielo, Biblioteca Virtual em Saúde, resultando na seleção de cinco ensaios clínicos randomizados. A acupuntura demonstrou eficácia no alívio dos sintomas da doença: cefaléia, neuralgia do trigemio e dor retro-aurícular, além de melhorar a recuperação muscular e a qualidade de vida dos pacientes. Os ensaios clínicos não demostraram a eficácia da acupuntura em relação a outros tratamentos. A acupuntura é uma possibilidade de tratamento seguro em pacientes com Paralisia Facial Periférica, visto que não houve relato de eventos adversos graves nos estudos, e contribuiu satisfatoriamente para recuperação do nervo facial tanto na fase aguda quanto na fase tardia da doença.Descritores: Terapia por Acupuntura, Paralisia Facial, Terapias Complementares. Acupuncture in the treatment of peripheral facial paralysis: a systematic reviewAbstract: Peripheral facial paralysis is a sudden onset disturbance, marked by weakening of the muscles on one side of the face. Objective: to review scientific publications those demonstrate the effects and results of the use of acupuncture in the treatment of peripheral facial paralysis. The search was done in the database websites: Pubmed, Medline, Scielo, Virtual Health Library, resulting in five randomized clinical trials. Acupuncture has demonstrated efficacy in relieving the symptoms of the disease: headache, trigeminal neuralgia and retro-auricular pain, as well as improving muscle recovery and quality of life of patients. The clinical trials did not demonstrate the efficacy of acupuncture in relation to other treatments. Acupuncture is a safe treatment option in patients with Peripheral Facial Paralysis, since there were no reports of serious adverse events in the studies and contributed satisfactorily to facial nerve recovery in both the acute and late phases of the disease.Descriptors: Acupuncture Therapy, Facial Paralysis, Complementary Therapies. Acupuntura en el tratamiento de la parálisis facial periférica: una revisión sistemáticaResumen: La parálisis facial periférica es una alteración repentina de inicio, marcada por el debilitamiento de los músculos de un lado de la cara. Objetivo: revisar las publicaciones científicas que demuestren los efectos y resultados del uso de la acupuntura en el tratamiento de la parálisis facial periférica. La búsqueda se realizó en los sitios web de la base de datos: Pubmed, Medline, Scielo, Virtual Health Library, resultando en cinco ensayos clínicos aleatorizados. La acupuntura ha demostrado eficacia para aliviar los síntomas de la enfermedad: dolor de cabeza, neuralgia del trigémino y dolor retro-auricular, así como mejorar la recuperación muscular y la calidad de vida de los pacientes. Los ensayos clínicos no demostraron la eficacia de la acupuntura en relación con otros tratamientos. La acupuntura es una opción de tratamiento seguro en pacientes con parálisis facial periférica, ya que no hubo informes de acontecimientos adversos graves en los estudios y contribuyó satisfactoriamente a la recuperación del nervio facial tanto en las fases aguda como tardía de la enfermedad.Descriptores: Terapia por Acupuntura, Parálisis Facial, Terapias Complementarias. 

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