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November 27, 2019

Clinical Practice Settings vs Clinical Trials: Is Artificial Intelligence the Answer?

Author Affiliations
  • 1Feinberg School of Medicine, Department of Ophthalmology, Northwestern University, Chicago, Illinois
  • 2Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
JAMA Ophthalmol. 2020;138(1):5-6. doi:10.1001/jamaophthalmol.2019.4782

At clinical conferences and in publications, use of the term real world is widespread. It describes physicians’ accumulated experience in treating patients. It is contrasted with academic trials.

Randomized clinical trials differ from practice in that they have fixed prespecified inclusion and exclusion criteria, adherence to a prespecified protocol, and ideally good patient retention. Randomized clinical trials have an advantage against observational studies when comparing treatments because they largely control for confounders, bias, and chance. Patient and treatment selection bias, losses to follow-up, outcome measurement, and imaging variability as well as many other confounding and bias factors can have large effects on study results. Unfortunately, at times it has been suggested that randomized clinical trials may not be relevant to the care of patients because their regimens may be difficult to replicate.

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