It's easy to do a direct comparison between NPs and physicians. Give 100 NPs a 2,000 patient panel like physicians have, with similar characteristics- averaged out over 200,000 patients, you should have a very representative sample of the general population, or at least enough so that a few outliers aren't going to affect the data care of how statistics works. Compare them to 100 physicians with the same size panel. Look at the outcomes. It isn't that hard. A big health system like Kaiser could easily do this just by replacing some of their retiring or relocating physicians with NPs, giving the NP that physician's exact panel as they go out.
they can continue to stay as vague as they want...I can continue to point out that feigning objectivity and adherence to scientific method while exhibiting some gaps in the understanding of that scientific method, when coupled with pretending that their background isn't important, isn't productive.
I think my point was that if you put too many restrictions on this type of clinical study, you'll never be able to collect enough data to support any claim. The reason I used that phrasing is because there is variability in the drug trial process, but also a lot of regulations. Hence, this is why I used the term "formatting" as a blanket statement. When I made that point, it was in reference to studying cost of treatment, as well as ability to diagnose and resolve/mitigate patient medical conditions in comparing providers. My point was that it was important to explore the latter point before exploring both the former and the latter to establish some level of quality of care. This goes back to the idea of a balancing act between how specific and sensitive you want your clinical study to be. If you were to create limits for both cost and quality of care (not necessarily saying the two are separate), then you might limit locations, where only certain tests and treatments are available.
You're making this too complicated. The easiest way to control for variables is to get a big-ass sample size. If you actually do the math, 100,000 patients is big enough that you can ignore small differences in patient population. Its why European data is usually pretty robust. You also want patients from all walks of life and geographic areas. If you limit yourself to rural then all you're proving is that the results apply only to rural populations.
Luckily zebras are not as rare as you'd think. My practice is pretty small yet I find something unusual at least once/month that I'm pretty sure most NPs would miss.
which is to say a cat is no less a fish than a dog...
This is why I specifically want NPs to not be supervised in these studies, and to have equal patient loads to physicians. I'm tired of them using studies that are asymmetric to prove "equality." You want to say you've got equal outcomes? Do equal work, with no oversight, and put your skills where your ****ing mouth is.
That's the whole point of having complete panels. They won't see every disease, but over 200,000 patients, you have more than enough representation to average out general trends. In regard to ICUs, you'd have to structure things differently, but trust me, no health care organization would be comfortable with conducting an entirely nurse-led non-community intensive care unit with no intensivist support. We've proven that intensivists improve outcomes over non-intensivists in the ICU in multiple studies, I can't even imagine the bloodbath that would result in nurse-only units lol.
Stop the preaching about side discussions, it's wearisome
in a discussion about nurses trying to assume the role of a doctor, exactly what counts as a doctor in the medical setting is very relevant
I will repeat what has been said here enough to be boring by now....it is unethical to propose a study in which you are trying to prove something is bad for outcomes. The physicians know this is a bad idea and no IRB worth it's salt would let us run a study attempting to prove that nurses will harm patients. Asking for it over and over again doesn't change that
it is completely unethical to set-up a trial where you intentionally give patients a presumed inferior treatment just to prove that you were correct about it being inferior. You can only (in good conscience) propose studies in which you believe the alternative will be superior/equal to the control.
you aren't listening. physicians designing a study that assigned patients to unsupervised nurses with the assumption that it's inferior care would be unethical. If you were part of a krokodil lobby that was trying to get WIC to fund krokodil for kids as an option to formula we wouldn't go and setup a double blind study to kill a bunch of kids with krokodil just so we could prove krokodil is a bad idea....we just tell you it's a horrible idea and point out that you have not found any reasonable studies to show equivalency
Screw the researcher, the risk isn't in the patients favor. I wouldn't subject my grandmother to that trial because I'd know she was getting less than the best...I wouldn't put anyone else through it eitherI'm listening. I've been listening all along. I'm simply not agreeing.
The Belmont Report, found here http://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/, states:
"It is commonly said that benefits and risks must be "balanced" and shown to be "in a favorable ratio." The metaphorical character of these terms draws attention to the difficulty of making precise judgments. Only on rare occasions will quantitative techniques be available for the scrutiny of research protocols. However, the idea of systematic, nonarbitrary analysis of risks and benefits should be emulated insofar as possible. This ideal requires those making decisions about the justifiability of research to be thorough in the accumulation and assessment of information about all aspects of the research, and to consider alternatives systematically. This procedure renders the assessment of research more rigorous and precise, while making communication between review board members and investigators less subject to misinterpretation, misinformation and conflicting judgments. Thus, there should first be a determination of the validity of the presuppositions of the research; then the nature, probability and magnitude of risk should be distinguished with as much clarity as possible. The method of ascertaining risks should be explicit, especially where there is no alternative to the use of such vague categories as small or slight risk. It should also be determined whether an investigator's estimates of the probability of harm or benefits are reasonable, as judged by known facts or other available studies.
Finally, assessment of the justifiability of research should reflect at least the following considerationsi)Brutal or inhumane treatment of human subjects is never morally justified.(ii)Risks should be reduced to those necessary to achieve the research objective. It should be determined whether it is in fact necessary to use human subjects at all. Risk can perhaps never be entirely eliminated, but it can often be reduced by careful attention to alternative procedures.(iii)When research involves significant risk of serious impairment, review committees should be extraordinarily insistent on the justification of the risk (looking usually to the likelihood of benefit to the subject -- or, in some rare cases, to the manifest voluntariness of the participation).(iv)When vulnerable populations are involved in research, the appropriateness of involving them should itself be demonstrated. A number of variables go into such judgments, including the nature and degree of risk, the condition of the particular population involved, and the nature and level of the anticipated benefits.(v)Relevant risks and benefits must be thoroughly arrayed in documents and procedures used in the informed consent process."
Risk/Benefit ratio's are categorized into different classifications, from low to high. Patients are already being seen by unsupervised nurses, as a result this would be a low risk study; no previous studies have shown significant outcome disparities between NP/MD care. As I've stated many times, the risk benefit ratio would be in the researchers favor.
so we're done with the claim that you'll be a doctor then?
Incorrect. The full designation of an NP is an APRN which stands for Advanced Practice Registered Nurse. So calling an NP a nurse is completely accurate.
And here I thought MD vs. DO was superfluous.
In all seriousness, folks: There are a few dozen reasons why the "NP vs. MD/DO" studies aren't coming. PA's are irrelevant (love you all, though) because they require physician oversight.
It's been explained multiple times why the studies are flawed, how to create a reasonable comparison study, etc. Posters are just choosing not to listen to those criticisms. Besides, if you want a better study, and you're an aspiring Mundinger, why on earth are you soliciting doctors for your improvements? If NP's are equivalent, they can design their own bloody study that meets muster.
Seriously.... this is getting ridiculous. But thanks for making the first part of my vacation entertaining.
I already told you how to do it, it isn't that hard. Just let nurses practice to the "extent of their training" like they want, and see if that extent goes as far as they believe it does. This study is actually quickly becoming one of my goals in life.
