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Some studies of shared medical appointments have shown improvement surrogate end points of A1C and cardiovascular risk in patients with diabetes (36, 37).
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In another example, [ 37] improvements in care processes did not translate into improved surrogate outcomes, possibly because baseline levels were relatively good.
We hypothesised that systematic healthcare improvements would reduce the severity of harm resulting from tracheostomy-related safety incidents and improve surrogate markers of the quality of patient-centred outcomes such as time to first vocalisation.
However, when comparing two high-risk groups, improvement in surrogate markers (improved functionality and self-care, reduced diabetes-related stress) indicate potential for cost-benefits in a large population over a longer period of time.
Duration of assessment in these studies rarely exceeds few weeks, and endpoints relate to seizure deterioration rather than improvement; this surrogate measure of efficacy is not necessarily predictive of clinical usefulness and, in view of ethical concerns, the rationale for these studies should be questioned.
These studies also showed improvement of surrogate measures of β-cell function.
We found that the RAMP-DM group showed improvement in surrogate effectiveness measures including HbA1c level and predicted cardiovascular risks.
We have learned from other trials that improvement of surrogate markers does not necessarily translate into clinical benefit (18).
In small studies, ARB and ACE inhibitor combinations were shown to be beneficial in patients with CV or renal disease, with improvement in surrogate markers.
We found that these interventions were associated with some improvement in surrogate outcomes (trivial reduction in hemoglobin A1c and LDL cholesterol levels).
Results have shown rapid improvement of surrogate markers of inflammation, such as FENO and AMP PC20, but these effects were not always dose-dependent [ 26, 7, 6].
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