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Bench-to-bedside review: The MET syndrome – the challenges of researching and adopting medical emergency teams

机译:逐岗位审查:MET综合症–研究和采用医疗急救小组的挑战

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摘要

Studies of hospital performance highlight the problem of 'failure to rescue' in acutely ill patients. This is a deficiency strongly associated with serious adverse events, cardiac arrest, or death. Rapid response systems (RRSs) and their efferent arm, the medical emergency team (MET), provide early specialist critical care to patients affected by the 'MET syndrome': unequivocal physiological instability or significant hospital staff concern for patients in a non-critical care environment. This intervention aims to prevent serious adverse events, cardiac arrests, and unexpected deaths. Though clinically logical and relatively simple, its adoption poses major challenges. Furthermore, research about the effectiveness of RRS is difficult to conduct. Sceptics argue that inadequate evidence exists to support its widespread application. Indeed, supportive evidence is based on before-and-after studies, observational investigations, and inductive reasoning. However, implementing a complex intervention like RRS poses enormous logistic, political, cultural, and financial challenges. In addition, double-blinded randomised controlled trials of RRS are simply not possible. Instead, as in the case of cardiac arrest and trauma teams, change in practice may be slow and progressive, even in the absence of level I evidence. It appears likely that the accumulation of evidence from different settings and situations, though methodologically imperfect, will increase the rationale and logic of RRS. A conclusive randomised controlled trial is unlikely to occur.All truth passes through three stages.First, it is ridiculed.Second, it is violently opposed.Third, it is accepted as being self-evident.Arthur Schopenhauer (1788–1860), German philosopher
机译:医院绩效研究突出了急性病患者的“抢救失败”问题。这是与严重不良事件,心脏骤停或死亡密切相关的缺陷。快速响应系统(RRS)及其传出部门医疗急诊小组(MET)为受“ MET综合征”影响的患者提供早期专业重症监护:明确的生理不稳定或医院工作人员对非重症监护患者的关注环境。该干预旨在防止严重的不良事件,心脏骤停和意外死亡。尽管从临床上讲逻辑且相对简单,但其采用却带来了重大挑战。此外,关于RRS有效性的研究很难进行。怀疑论者认为,证据不足以支持其广泛应用。确实,支持性证据是基于前后研究,观察性研究和归纳推理。但是,实施像RRS这样的复杂干预措施会带来巨大的后勤,政治,文化和财务挑战。另外,根本不可能进行RRS的双盲随机对照试验。相反,就像在心脏骤停和创伤小组中一样,即使没有I级证据,实践中的改变也可能是缓慢而渐进的。尽管在方法上不完善,但从不同背景和情况收集的证据似乎将增加RRS的原理和逻辑。不可能进行结论性的随机对照试验。所有真相都经历三个阶段。首先,它是可笑的;其次,它是遭到强烈反对的。第三,它是不言而喻的。亚瑟·叔本华(Arthur Schopenhauer,1788–1860年),德国人哲学家

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