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Five Types of Clinical Difference to Monitor in Practice

机译：五种类型的临床差异在实践中监测

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摘要

A fundamental part of professional practice is to monitor case progress to inform basic clinical decisions about when to discontinue interventions, when to adjust interventions, and when to proceed as planned. When interpreting observed change, there are at least five distinct types of clinical difference that can occur independently, and mistaking one for another can lead to misinformed clinical decisions. We introduce a distinction between obsemed difference, detected difference, predicted difference, attainment difference, and induced difference, and use these to analyze current systems for routine outcome monitoring (ROM) in clinical practice. Contrary to what supporting evidence of current ROM systems suggests, we find that-by design-these systems fail to detect and predict potentially harmful treatment and fail to detect and predict likely treatment responders. We discuss implications of the presented classification for professional practice and further development of ROM systems. We argue that clinical practice would benefit from monitoring difference instead of change, as these are not equivalent. We further argue that future research and development efforts should focus on the development of a working approach to monitoring induced difference, improving how to monitor predicted difference, exploring statistical models that better discriminate between various types of clinical cases, and better communicate what can and cannot be interpreted from the clinical differences that are actually monitored, as guided by the presented classification of clinical differences to monitor in practice.
机译：专业练习的基本部分是监测案件进展，以告知基本临床决定何时停止干预措施，何时调整干预措施，以及何时按计划进行。在解释观察到的变化时，至少有五种不同类型的临床差异，可以独立发生，另一个用于另一个可能导致错误信息的临床决策。我们介绍了差异，检测差异，预测差异，达到差异和诱导差异之间的区别，并利用这些分析临床实践中常规结果监测（ROM）的当前系统。违背当前ROM系统的支持证据表明，我们发现由设计 - 这些系统未能检测和预测潜在的有害治疗，并且无法检测和预测可能的治疗响应者。我们讨论了对专业实践和进一步发展的rom系统的分类的影响。我们认为，临床实践将受益于监测差异而不是变化，因为这些不等同。我们进一步讨论了未来的研发努力应侧重于开发监测致病差异的工作方法，改善如何监测预测的差异，探索统计模型更好地区分各种类型的临床病例，更好地传达可以和不能沟通从实际监测的临床差异中解释，如临床差异的分类在实践中监测的临床差异的指导。

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