November 28, 2021
Clinical research is an area of medical research. It refers to research conducted in clinical practice based on awareness of problems in clinical medicine, and forms the same as "basic (medical) research" and "social medicine research."
If there is not enough evidence to practice evidence-based medicine (EBM), then the question is a clinically important subject, without ethical issues, and on a scale that can be done financially and personnel-wise. If it is research, it can be explored as clinical research. Evidence is not given from above, but rather the attitude of trying to create evidence from daily clinical practice is one of the important things in EBM practice.
A research design that observes the effects of treatments that have already been performed and their prognosis, rather than performing treatments for the purpose of research. Diseases that develop over a long period of time and diseases that are rarely seen can also be targeted.
The strength of the correlation between factors and results can be measured quantitatively, but when trying to prove a causal relationship, the temporality of the relationship between factors and results is measured, as in case-control studies and cohort studies. You need to take a study design.
We will report the details of those who did not follow the textbook course after experiencing the treatment of individual cases, or those who devised beyond the textbook treatment, for future reference. In the case of a disease that is rarely seen, it will be a direct reference for future treatment, and it will be an opportunity to report an unknown disease first.
Case series report (case series)
When patients with diseases in a single facility or in a small number of institutions are gathered, past treatment details and prognosis are aggregated and listed. It may be possible to suggest a hypothesis of the correlation between treatment and efficacy or adverse events, such as in rare cases.
Examine and compare the abundance of background factors such as dosing and exposure to toxic substances in each of the groups that developed the disease or event and those that did not. The strength of the association between exposure and outcome can be quantitatively evaluated as an odds ratio, and the odds ratio can be interpreted as an approximation of the relative risk if the probability of occurrence of the outcome can be assumed to be low.
Multiple populations who have experienced different lifestyles, diseases, treatments, etc. are followed for a certain period of time, and the rate of occurrence of events such as predetermined diseases is compared. The strength of the association between exposure and outcome can be quantitatively evaluated as relative risk. If you have access to large-scale data such as insurance medical data, you can list various factors that affect the onset and identify their interrelationships.
Cross sectional study
Investigate the abundance ratio of each factor and result for one group. It is often used to determine the prevalence of a disease. If the presence or absence of a factor and the presence or absence of a result are related, it can be a hint of a causal relationship, but since the temporality of the causal relationship has not been investigated, it is not possible to prove the causal relationship.
Prognosis prediction rule
Use the results of cohort studies, such as patient age and gender, underlying disease, and test data, to create a model for predicting disease prognosis. Many are published in the form of "severity scores".
Interventions such as treatment are conducted experimentally for the purpose of research. Since the intervention is performed, the results are not affected by individual differences and background factor differences.