Appraisal of Evidence and Control of Bias in the Kidney Disease Outcomes Quality Initiative Guideline Development Process

[摘要] It is not evidence alone but a combination of evidence and judgment that drives most medical decision making. Limitations afflict even high-quality evidence; subjectivity influences even the most objective experts. Therefore, in the absence of successful clinical practice guidelines, prevalent practice suffers from an overreliance on flawed information and a susceptibility to uncontrolled bias. Ascribing causality to observational results (1), assuming the equivalence of surrogate and direct patient outcomes (2), and pursuing practices or interventions despite a dearth of evidence for safety (3) are signs that clinical practice may be operating without critical appraisal of the evidence or sufficient restraint of subjectivity. Practice under such conditions provides fertile ground for the seeds of influence, whatever their source.

[学科分类] 泌尿医学

[关键词] Bone marrow necrosis;Sickle cell disease;Hyperhemolysis syndrome