A Preponderance of Evidence Is Sufficient

Parker, Thomas

doi:10.2215/cjn.09440911

Cited by 3 publications

(2 citation statements)

References 8 publications

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“…This enhanced understanding has been drawn largely from observational studies derived from registry data and not from controlled prospective interventional studies. As recently noted by Parker (5) there is a dearth of prospective interventional studies on dialysis prescription and so, in their absence, the sheer number and concurrence of these retrospective observational reports should be accepted as guiding. In the only formal study of this pragmatic approach that I am aware of, the half‐life of the “truth” derived from studies of “high methodological quality” (read prospective interventional trials) as contrasted with those of lower rigor (read retrospective observational data) showed no significant difference (6).…”

mentioning

confidence: 99%

Symptomatic Intradialytic Hypotension and Mortality: An Opinionated Review

Henderson¹

2012

Seminars in Dialysis

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mentioning

confidence: 99%

Symptomatic Intradialytic Hypotension and Mortality: An Opinionated Review

Henderson¹

2012

Seminars in Dialysis

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“…We answer this question unequivocally no. Complimenting and perhaps preceding the RCT should be a preponderance of evidence methodology from large observational trials driving the needed changes (14). We believe the changes can be achieved quickly through the comparative effectiveness research provision of the Affordable Care Act and implemented on a time-limited basis to assess validity.…”

Section: Gaps Between Current Clinical Metrics and Better Dialysis Carementioning

confidence: 99%

Dialysis at a Crossroads—Part II

Parker

Straube

Nissenson

et al. 2012

Clinical Journal of the American Society of Nephrology

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Summary A previous commentary pointed out that the renal community has led American healthcare in the development and continuous improvement of quality outcomes. However, survival, hospitalization, and quality of life for US dialysis patients is still not optimal. This follow-up commentary examines the obstacles, gaps, and metrics that characterize this unfortunate state of affairs. It posits that current paradigms are essential contributors to quality outcomes but are no longer sufficient to improve quality. New strategies are needed that arise from a preponderance of evidence, in addition to beyond a reasonable doubt standard. This work offers an action plan that consists of new pathways of care that will lead to improved survival, fewer hospitalizations and rehospitalizations, and better quality of life for patients undergoing dialysis therapy. Nephrologists in collaboration with large and small dialysis organizations and other stakeholders, including the Centers for Medicare and Medicaid Services, can implement these proposed new pathways of care and closely monitor their effectiveness. We suggest that our patients deserve nothing less and must receive even more.

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