While reasons for this difference are not entirely clear, one possibility may be that lower perceived physical functioning is a primary reason why severely obese individuals opt for bariatric surgery, a more aggressive treatment modality, over lifestyle intervention, a more conservative treatment modality.
For example, PCPs' involvement in episodes of knee degeneration and benign prostatic neoplasm may lead to more conservative treatment that emphasizes non-surgical interventions before concluding that surgery is needed.
More conservative surgical interventions, such as pancreatic head resection and suprapapillary segmental resection of the duodenum, have been reported [ 27, 60] as case reports.
We therefore reasoned that when BTS guidance was followed, the subsequent requirement for ICD within 1 month of initial presentation was likely to reflect clinical compromise or failure of more conservative management (no intervention or aspiration alone) and was therefore a valid end-point for testing the definition of large or "severe" pneumothorax.
Furthermore, and owing to own experiences, these endpoints are highly variable with the experience and knowledge of the neonatal team caring for the newborn in that regard, that neonatologists knowing the substance and its unique pharmacokinetic profile tend to be more conservative regarding early airway interventions.
In contrast, studies showing a higher risk of complications and of revisions of arthroplasty in diabetic subjects could translate into a more conservative indication for surgical interventions resulting in an underestimation rather than overestimation of the effect size of diabetes in our study (29).
Mean differences (and standard deviations) of this magnitude, and this potential attrition rate are more conservative than a prior intervention trial using these same outcome measures (but evaluating a clinic only based intervention) and our own pilot investigations [ 15, 28].
In patients who underwent surgery but are missing a postoperative serum creatinine value (expected in <2% of patients), we will carry the prerandomisation serum creatinine value forward which should provide a more conservative estimate of the intervention effect than the alternative of removing such patients.
14 In patients who underwent surgery but have a missing post-operative peak serum creatinine value (<4% patients), we will carry the pre-randomisation serum creatinine forward as the post-operative value (which should provide a more conservative estimate of the intervention effect than the alternative of removing such patients).
In patients who underwent surgery but are missing a postoperative serum creatinine value (expected <10% of patients), we will impute in its place the prerandomisation serum creatinine value which should provide a more conservative estimate of the intervention effect than the alternative of removing such patients.
Conversely, the goal of lifestyle intervention, a more conservative approach, is to promote voluntary modification of eating and physical activity behaviors to lose weight [ 2].
