Springer Online Journal Archives 1860-2000
Abstract Investigators establish connections among the underlying pathophysiological model of a particular disease, a clinician's perceptions of the clinical course of that disease, and the pharmacological properties and/or biologic effects related to individual components of an intervention protocol. To delineate various cause-and-effect relationships among events and a specific outcome, a causal model of the disease can be constructed by depicting longitudinally the connections between the pathophysiological model of the disease and events, occurring during the course of the disease. Connections between a causal model and a new treatment protocol can be formulated by superimposing each component of the protocol onto the specific pathway(s), affected by the treatment intervention. Flowcharting techniques are useful in producing a visual display of a causal model, with or without the superimposed protocol. It is especially important that, as emerging pathophysiological elements are identified through clinical or basic science investigations, a clinical investigator test and revise various elements and relationships of a previously accepted causal model. Moreover, if such new information is incompatible with a previously accepted causal model, a clinical investigator may need to abandon that model and formulate an alternative causal model. Finally, an example is presented that demonstrates the steps involved in formulating, testing, and revising a causal model of final outcome (i.e., survival or death) in patients with sepsis-induced acute respiratory distress syndrome and/or multiple organ dysfunction.
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