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Etiological explanations
Published in Olaf Dammann, Etiological Explanations, 2020
First, observation of manipulated occurrence in humans may be considered epistemologically superior to the observation of natural or free-floating occurrence in natural experiments or in observational epidemiological studies, because it comes with the added benefit of providing evidence of efficacy, which suggests that the intervention would work (or not) in the real-life setting of medical or public health interventions. RCTs are conducted in humans; they involve the administration of real drugs, and they measure real outcomes. If a drug works in an RCT, it is likely that it will also work in a real-life setting. This added benefit is not provided by randomization or blinding alone, which are characteristics of RCTs that make them less like real-life interventions; the manipulation makes the observed phenomena in RCTs more like real-life medical or public health interventions.
Psychosocial Interventions
Published in Zaven S. Khachaturian, Teresa S. Radebaugh, Alzheimer’s Disease, 2019
Mary S. Mittelman, Steven H. Ferris
Occasionally, natural experiments provide evidence for changes in patient care. In recent years there has been a widespread implementation of laws that require nursing homes to stop using restraints unless they are demonstrably unavoidable. Reports from some nursing homes of the outcome of removal of restraints indicated a dramatic reduction both in the number of falls and in incontinence. A report from another nursing home concluded that, although the incidence of minor falls increased, the number of serious falls did not.
Epidemiology and its uses
Published in Liam J. Donaldson, Paul D. Rutter, Donaldsons' Essential Public Health, 2017
Liam J. Donaldson, Paul D. Rutter
Sometimes, fortuitously for the investigator but often to the great misfortune of the population concerned, natural experiments take place that allow conclusions to be drawn about causation. Examples of this are the observations on the incidence of cancer following the exposure to radiation from the Hiroshima bomb and the Chernobyl nuclear accident, as well as the observation of the incidence of vaginal tumours in the female offspring of women treated during pregnancy with diethylstilboestrol.
Defining and supporting high-quality telehealth for patients with opioid use disorder: The promise and potential pitfalls of telehealth expansion
Published in Substance Abuse, 2022
Christopher J. Frank, Lewei (Allison) Lin
Like initial physical exams, toxicology testing is widely accepted as an important component of evaluating and treating patients with SUDs.18 But the range of how point-of-care testing and confirmatory testing is used across clinics and clinicians varies widely from every visit, to only when diversion is suspected, or even once a year or less.19 There are no studies to date that examine impact of frequency and type of toxicology testing on patient outcomes.7 Early studies of telehealth delivery of OUD treatment identified concerns about access to accurate drug testing as a potential barrier to treatment.20 Drug testing is often more difficult when OUD care is delivered remotely, and during the early phase of the COVID-19 pandemic rates of urine drug testing decreased in some treatment environments.2 Like other aspects of treatment, these natural experiments provide an opportunity to examine if practices we perceive as important are associated with improved clinical outcomes.
Similar risk of complete revision for infection with single-dose versus multiple-dose antibiotic prophylaxis in primary arthroplasty of the hip and knee: results of an observational cohort study in the Dutch Arthroplasty Register in 242,179 patients
Published in Acta Orthopaedica, 2020
Ewout S Veltman, Erik Lenguerrand, Dirk Jan F Moojen, Michael R Whitehouse, Rob G H H Nelissen, Ashley W Blom, Rudolf W Poolman
Thus, this study resembles a natural experiment. Rather than controlling for observed confounders and expecting no unobserved confounders to be present (as in multiple regression, matching, and reweighting), natural experiments identify variation in the exposure, known to be independent of other confounders (Bor 2016). In our study quasi-random variation in the exposure (antibiotic prophylaxis regimen after total hip or knee arthroplasty) arises from naturally occurring random variation due to allocation of patients to the regional hospital near their residence. Natural experiments minimize the risk of confounding due to selective exposure to the intervention or residual confounding, and have internal validity and transparency of assumptions (Bor 2016). To establish true causality, a superiority or non-inferiority randomized controlled trial is still needed. However, as PJI is rare, the numbers needed for such a trial would be very large. Nonetheless, as the impact of PJI is so devastating (Moore et al. 2015) we recommend that such a trial is undertaken and suggest that embedding such a trial in a national arthroplasty registry may reduce costs and improve feasibility. Until such time, the data represented here are the best available evidence and it must be questioned whether there is any advantage to the use of prolonged antibiotic prophylaxis beyond a single dose.
Patterns of pre-crash behaviour in railway suicides and the effect of corridor fencing: a natural experiment in New South Wales
Published in International Journal of Injury Control and Safety Promotion, 2019
Shirley Gregor, Gary Beavan, Adrian Culbert, Priscilla Kan John, Nguyen Viet Ngo, Byron Keating, Ruonan Sun, Ibrahim Radwan
Apart from descriptive statistics, the data allowed for a natural experiment where cases from mostly fenced areas could be compared with geographic areas with less fencing. Natural experiments are observational studies and can be used in cases where controlled experiments are difficult to implement or unethical. An early well-known example was the attribution of an outbreak of cholera in Soho in 1854 to the nearest public water pump. Analysis of the incidence of cholera in this area compared with other geographic areas provided convincing evidence that the specific pump was responsible (see Freedman, 2009). Due to the nature of the data, non-parametric statistical tests were used (chi-square tests). A significance value of p < .05 was used unless otherwise noted.