Talavera Juan O, Rivas-Ruiz Rodolfo
Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Distrito Federal, México.
Rev Med Inst Mex Seguro Soc. 2012 May-Jun;50(3):267-72.
Two strategies to understand and document causality are: 1) clinical reasoning (CR) and 2) clinical trial (CT). CR identifies: basal state, maneuver and outcome. These components show us the complex of causality, its identification and control allows us to avoid systematic errors, such as: at baseline-improper assembly and susceptibility bias, during the application of the maneuver-performance bias, and at measurement of outcome-detection and transfer bias. In the CT tactics attempt to separate the effect of the main maneuver from the effect of other components that participate in causality previously described in CR. CT takes advantage of its characteristics: the opportunity to manipulate the maneuver and the temporality into the causal relationship. Some features to highlight are: the allocation of the maneuver, blinding of the maneuver, the feasibility of early interruption of the maneuver, the analysis according to maneuver adherence, the groups to compare, the timing of comparative maneuver, and the informed consent. Each occasion the clinician applies all this knowledge and skills, in a conscious way and structured, he improves his efficiency and align medical practice with clinical research.
1）临床推理（CR）和2）临床试验（CT）。临床推理确定：基础状态、操作和结果。这些要素向我们展示了因果关系的复合体，对其进行识别和控制能使我们避免系统性错误，例如：在基线时——组装不当和易感性偏倚，在操作应用过程中——执行偏倚，以及在结果测量时——检测和转移偏倚。在临床试验中，策略是试图将主要操作的效果与先前在临床推理中描述的参与因果关系的其他要素的效果区分开来。临床试验利用其特点：有机会操控操作以及因果关系中的时间性。一些需要强调的特征包括：操作的分配、操作的盲法、操作早期中断的可行性、根据操作依从性进行分析、要比较的组、比较操作的时间以及知情同意。每当临床医生有意识且有条理地运用所有这些知识和技能时，他就能提高效率，并使医疗实践与临床研究保持一致。
