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It has been suggested that the percentage of responding patients is lower in everyday clinical practice than that observed in RCTs, possibly because of patient selection, the use of a washout period before inclusion (which may artificially increase disease activity), and differences in doses, co-morbidities and adherence to therapy.
Incomplete registration or coding mistakes, which can bias the survival estimates because of patient selection, is not a likely source of bias in this study.
Factors responsible may include the fact that the overall event rate was quite low, as is common in many clinical trials in part because of patient selection and the intensity of monitoring and care.
If high volume hospitals have better outcomes because of patient selection or factors other than hospital volume itself, the mortality benefit and number of lives saved reported by transferring patients from low volume hospitals may be overstated.
In our opinion, the results are hard to translate into daily practice because of patient selection and small sample size and should be viewed with a measure of caution.
Although the Tournigand trial (Tournigand et al, 2001) reported impressive median survival, this may have been because of patient selection as a first-line single-agent control arm was not included.
Similar(52)
Because of the heterogeneity of patient selection, type of prognostic factors and outcome measures, no statistical pooling was able to be performed.
Also, we cannot exclude the possibility of patient selection bias, because our hospital is a tertiary referral centre.
Flowchart of patient selection from database.
Flow chart of patient selection.
In the past 10 years, results of OLT have improved steadily because of careful patient selection pioneered by the introduction of the Conventional Milan Criteria (CMC) in 1996.
More suggestions(15)
because of patient request
because of patient body
because of patient withdrawal
because of patient respiratory
because of weapon selection
because of patient non-compliance
because of locomotor selection
because of patient discomfort
because of patient clustering
because of patient preselection
because of patient confidentiality
because of patient demand
because of patient allergy
because of patient refusal
because of patient death
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