Stammers Alfred H
Geisinger Health Systems, Danville and Wilkes Barre, Pennsylvania, USA.
J Extra Corpor Technol. 2009 Dec;41(4):P59-64.
The methodological approach to decision making in optimizing medical care has focused on using the best available evidence with the primary endpoint being patient outcome. Through this emphasis, quality becomes relegated as the quintessential factor in determining application of medical intervention and in directing resource allocation. When evidence is inconclusive or absent, then clinical judgment becomes elevated in the decision analysis schema. The paucity of well designed controlled trials in perfusion technology has resulted in a greater reliance on clinical judgment than published information. This has created an environment where significant variability exists throughout the perfusion community. The following report will discuss several reasons for this variability, and describe techniques where the preponderance of evidence is available supporting inclusion in perfusion practice.
优化医疗护理决策的方法侧重于使用现有最佳证据，主要终点是患者结局。通过这种强调，质量在确定医疗干预的应用和指导资源分配时被降格为次要因素。当证据不确凿或不存在时，临床判断在决策分析模式中的地位就会提高。灌注技术方面精心设计的对照试验较少，这导致比已发表的信息更依赖临床判断。这就造成了整个灌注领域存在显著差异的环境。以下报告将讨论造成这种差异的几个原因，并描述有大量证据支持纳入灌注实践的技术。
