TY - JOUR
T1 - Worldwide Opinion on Multicenter Randomized Interventions Showing Mortality Reduction in Critically Ill Patients
T2 - A Democracy-Based Medicine Approach
AU - Pisano, Antonio
AU - Landoni, Giovanni
AU - Lomivorotov, Vladimir
AU - Comis, Marco
AU - Gazivoda, Gordana
AU - Conte, Massimiliano
AU - Hajjar, Ludhmila
AU - Finco, Gabriele
AU - Jovic, Miomir
AU - Mucchetti, Marta
AU - Kunstýř, Jan
AU - Paternoster, Gianluca
AU - Likhvantsev, Valery
AU - Ruggeri, Laura
AU - Ma, Jun
AU - Alvaro, Gabriele
AU - Bukamal, Nazar
AU - Borghi, Giovanni
AU - Pasyuga, Vadim
AU - Cabrini, Luca
AU - Greco, Massimiliano
AU - Guarracino, Fabio
AU - Lembo, Rosalba
AU - Lobreglio, Rosetta
AU - Monaco, Fabrizio
AU - Montisci, Andrea
AU - Pala, Giovanni
AU - Pasin, Laura
AU - Pieri, Marina
AU - Santini, Francesco
AU - Silvetti, Simona
AU - Zambon, Massimo
AU - Baiardo Redaelli, Martina
AU - Castella, Alberto
AU - De Vuono, Giovanni
AU - Lucchetta, Luca
AU - Zangrillo, Alberto
AU - Bellomo, Rinaldo
PY - 2016/10
Y1 - 2016/10
N2 - Objectives Democracy-based medicine is a combination of evidence-based medicine (systematic review), expert assessment, and worldwide voting by physicians to express their opinions and self-reported practice via the Internet. The authors applied democracy-based medicine to key trials in critical care medicine. Design and Setting A systematic review of literature followed by web-based voting on findings of a consensus conference. Participants A total of 555 clinicians from 61 countries. Interventions The authors performed a systematic literature review (via searching MEDLINE/PubMed, Scopus, and Embase) and selected all multicenter randomized clinical trials in critical care that reported a significant effect on survival and were endorsed by expert clinicians. Then they solicited voting and self-reported practice on such evidence via an interactive Internet questionnaire. Relationships among trial sample size, design, and respondents’ agreement were investigated. The gap between agreement and use/avoidance and the influence of country origin on physicians’ approach to interventions also were investigated. Measurements and Main Results According to 24 multicenter randomized controlled trials, 15 interventions affecting mortality were identified. Wide variabilities in both the level of agreement and reported practice among different interventions and countries were found. Moreover, agreement and reported practice often did not coincide. Finally, a positive correlation among agreement, trial sample size, and number of included centers was found. On the contrary, trial design did not influence clinicians’ agreement. Conclusions Physicians’ clinical practice and agreement with the literature vary among different interventions and countries. The role of these interventions in affecting survival should be further investigated to reduce both the gap between evidence and clinical practice and transnational differences.
AB - Objectives Democracy-based medicine is a combination of evidence-based medicine (systematic review), expert assessment, and worldwide voting by physicians to express their opinions and self-reported practice via the Internet. The authors applied democracy-based medicine to key trials in critical care medicine. Design and Setting A systematic review of literature followed by web-based voting on findings of a consensus conference. Participants A total of 555 clinicians from 61 countries. Interventions The authors performed a systematic literature review (via searching MEDLINE/PubMed, Scopus, and Embase) and selected all multicenter randomized clinical trials in critical care that reported a significant effect on survival and were endorsed by expert clinicians. Then they solicited voting and self-reported practice on such evidence via an interactive Internet questionnaire. Relationships among trial sample size, design, and respondents’ agreement were investigated. The gap between agreement and use/avoidance and the influence of country origin on physicians’ approach to interventions also were investigated. Measurements and Main Results According to 24 multicenter randomized controlled trials, 15 interventions affecting mortality were identified. Wide variabilities in both the level of agreement and reported practice among different interventions and countries were found. Moreover, agreement and reported practice often did not coincide. Finally, a positive correlation among agreement, trial sample size, and number of included centers was found. On the contrary, trial design did not influence clinicians’ agreement. Conclusions Physicians’ clinical practice and agreement with the literature vary among different interventions and countries. The role of these interventions in affecting survival should be further investigated to reduce both the gap between evidence and clinical practice and transnational differences.
KW - anesthesia
KW - consensus conference
KW - critically ill
KW - intensive care
KW - mortality
KW - survival
UR - http://www.scopus.com/inward/record.url?scp=84991098085&partnerID=8YFLogxK
U2 - 10.1053/j.jvca.2016.05.005
DO - 10.1053/j.jvca.2016.05.005
M3 - Review Article
AN - SCOPUS:84991098085
VL - 30
SP - 1386
EP - 1395
JO - Journal of Cardiothoracic and Vascular Anesthesia
JF - Journal of Cardiothoracic and Vascular Anesthesia
SN - 1053-0770
IS - 5
ER -