{"title":"接受环境如何影响 RCT 证据的意义。","authors":"Simon Carmel","doi":"10.1177/13634593221134011","DOIUrl":null,"url":null,"abstract":"<p><p>This article takes as a case study a set of disagreements in the early 2000s about randomised controlled trial (RCT) evidence for a newly developed drug in the field of intensive care medicine. The interpretation of RCT findings - and in particular, the application of these findings to clinical practice - were contested among research-active intensive care doctors, despite their shared professional and epistemic values. I examine the arguments about scientific interpretation and application to clinical practice advanced by two readily identifiable groups. The analysis documents how four particular aspects of scientific knowledge were perceived and portrayed differently by the two groups, and notes how each group was associated with different kinds of routine work practices and external networks. My argument is that these differences give rise to distinctive hermeneutic frames and orientations towards the scientific results and disparities in their consequential judgements regarding the legitimate use of the newly developed drug, and I extend Stones and Turner's concept <i>situationally specific habitus</i> to make the link between context and hermeneutic frames and orientations. The analysis has implications for furthering our understanding of how the clinical meaning attributed to scientific evidence is affected by the context of reception of results, even where epistemic and professional values are shared.</p>","PeriodicalId":12944,"journal":{"name":"Health","volume":" ","pages":"253-271"},"PeriodicalIF":1.9000,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10900864/pdf/","citationCount":"0","resultStr":"{\"title\":\"How the context of reception affects the meaning of RCT evidence.\",\"authors\":\"Simon Carmel\",\"doi\":\"10.1177/13634593221134011\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>This article takes as a case study a set of disagreements in the early 2000s about randomised controlled trial (RCT) evidence for a newly developed drug in the field of intensive care medicine. The interpretation of RCT findings - and in particular, the application of these findings to clinical practice - were contested among research-active intensive care doctors, despite their shared professional and epistemic values. I examine the arguments about scientific interpretation and application to clinical practice advanced by two readily identifiable groups. The analysis documents how four particular aspects of scientific knowledge were perceived and portrayed differently by the two groups, and notes how each group was associated with different kinds of routine work practices and external networks. My argument is that these differences give rise to distinctive hermeneutic frames and orientations towards the scientific results and disparities in their consequential judgements regarding the legitimate use of the newly developed drug, and I extend Stones and Turner's concept <i>situationally specific habitus</i> to make the link between context and hermeneutic frames and orientations. The analysis has implications for furthering our understanding of how the clinical meaning attributed to scientific evidence is affected by the context of reception of results, even where epistemic and professional values are shared.</p>\",\"PeriodicalId\":12944,\"journal\":{\"name\":\"Health\",\"volume\":\" \",\"pages\":\"253-271\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2024-03-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10900864/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Health\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/13634593221134011\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2022/11/5 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Health","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/13634593221134011","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2022/11/5 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}
引用次数: 0
摘要
本文以 2000 年代初重症监护医学领域一种新开发药物的随机对照试验(RCT)证据引发的一系列分歧为案例进行研究。尽管从事研究工作的重症监护医生们有着共同的专业价值观和认识论价值观,但他们对随机对照试验结果的解释,尤其是将这些结果应用于临床实践的问题却存在争议。我研究了两个容易识别的群体就科学解释和临床实践应用提出的争论。分析记录了两个群体对科学知识四个特定方面的不同看法和描述,并指出了每个群体与不同类型的常规工作实践和外部网络的关联。我的论点是,这些差异导致了对科学成果的不同诠释框架和取向,并导致了他们对新研发药物的合法使用的不同判断。我扩展了斯通斯(Stones)和特纳(Turner)的 "特定情境习惯"(situational specific habitus)概念,将情境与诠释框架和取向联系起来。这一分析有助于我们进一步理解,即使在认识论和专业价值观相同的情况下,科学证据的临床意义是如何受到接受结果的环境影响的。
How the context of reception affects the meaning of RCT evidence.
This article takes as a case study a set of disagreements in the early 2000s about randomised controlled trial (RCT) evidence for a newly developed drug in the field of intensive care medicine. The interpretation of RCT findings - and in particular, the application of these findings to clinical practice - were contested among research-active intensive care doctors, despite their shared professional and epistemic values. I examine the arguments about scientific interpretation and application to clinical practice advanced by two readily identifiable groups. The analysis documents how four particular aspects of scientific knowledge were perceived and portrayed differently by the two groups, and notes how each group was associated with different kinds of routine work practices and external networks. My argument is that these differences give rise to distinctive hermeneutic frames and orientations towards the scientific results and disparities in their consequential judgements regarding the legitimate use of the newly developed drug, and I extend Stones and Turner's concept situationally specific habitus to make the link between context and hermeneutic frames and orientations. The analysis has implications for furthering our understanding of how the clinical meaning attributed to scientific evidence is affected by the context of reception of results, even where epistemic and professional values are shared.
期刊介绍:
Health: is published four times per year and attempts in each number to offer a mix of articles that inform or that provoke debate. The readership of the journal is wide and drawn from different disciplines and from workers both inside and outside the health care professions. Widely abstracted, Health: ensures authors an extensive and informed readership for their work. It also seeks to offer authors as short a delay as possible between submission and publication. Most articles are reviewed within 4-6 weeks of submission and those accepted are published within a year of that decision.