Bench-to-bedside review: the evaluation of complex interventions in critical care

Delaney, Anthony, Angus, Derek C., Bellomo, Rinaldo, Cameron, Peter, Cooper, D. James, Finfer, Simon, Harrison, David A., Huang, David T., Myburgh, John A., Peake, Sandra L., Reade, Michael C., Webb, Steve A. R. and Yealy, Donald M. (2008) Bench-to-bedside review: the evaluation of complex interventions in critical care. Critical Care, 12 2: . doi:10.1186/cc6849


Author Delaney, Anthony
Angus, Derek C.
Bellomo, Rinaldo
Cameron, Peter
Cooper, D. James
Finfer, Simon
Harrison, David A.
Huang, David T.
Myburgh, John A.
Peake, Sandra L.
Reade, Michael C.
Webb, Steve A. R.
Yealy, Donald M.
Title Bench-to-bedside review: the evaluation of complex interventions in critical care
Journal name Critical Care   Check publisher's open access policy
ISSN 1364-8535
1466-609X
Publication date 2008-04-14
Year available 2008
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1186/cc6849
Open Access Status DOI
Volume 12
Issue 2
Total pages 9
Place of publication Philadelphia, PA, United States
Publisher Current Science
Language eng
Abstract Complex interventions, such as the introduction of medical emergency teams or an early goal-directed therapy protocol, are developed from a number of components that may act both independently and inter-dependently. There is an emerging body of literature advocating the use of integrated complex interventions to optimise the treatment of critically ill patients. As with any other treatment, complex interventions should undergo careful evaluation prior to widespread introduction into clinical practice. During the development of an international collaboration of researchers investigating protocol-based approaches to the resuscitation of patients with severe sepsis, we examined the specific issues related to the evaluation of complex interventions. This review outlines some of these issues. The issues specific to trials of complex interventions that require particular attention include determining an appropriate study population and defining current treatments and outcomes in that population, defining the study intervention and the treatment to be used in the control group, and deploying the intervention in a standardised manner. The context in which the research takes place, including existing staffing levels and existing protocols and procedures, is crucial. We also discuss specific details of trial execution, in particular randomization, blinded outcome adjudication and analysis of the results, which are key to avoiding bias in the design and interpretation of such trials. These aspects of study design impact upon the evaluation of complex interventions in critical care. Clinicians should also consider these specific issues when implementing new complex interventions into their practice.
Keyword Critical Care Medicine
General & Internal Medicine
CRITICAL CARE MEDICINE
Q-Index Code C1
Q-Index Status Provisional Code
Grant ID 1P50 GM076659
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collection: School of Medicine Publications
 
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