Risk Prediction in Clinical Practice: A Practical Guide for Cardiothoracic Surgeons.
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ABSTRACT:
SUBMITTER: Maiga A
PROVIDER: S-EPMC8859994 | biostudies-literature | 2019 Nov
REPOSITORIES: biostudies-literature
Publications
Risk Prediction in Clinical Practice: A Practical Guide for Cardiothoracic Surgeons.
Maiga Amelia A Farjah Farhood F Blume Jeffrey J Deppen Stephen S Welty Valerie F VF D'Agostino Richard S RS Colditz Graham A GA Kozower Benjamin D BD Grogan Eric L EL
The Annals of thoracic surgery 20190627 5
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Project description:BackgroundCardiothoracic surgeons are frequently confronted with complex ethical issues. Educational efforts to help surgeons navigate such issues have been undertaken in recent years, but their effectiveness is uncertain.MethodsA survey instrument exploring the effects of ethics educational sessions at annual meetings and publications in cardiothoracic surgery journals was sent electronically to cardiothoracic surgeons who belong to The Society of Thoracic Surgeons and the American Association for Thoracic Surgery.ResultsOf 3,705 surgeons, 578 responded (15.6%). The majority of respondents practice in an academic setting (55%), attended at least two of the last five Society annual meetings (66%), and at least one of the last five Association annual meetings (68%). A majority of respondents agreed that their own practices would be improved (69%) and that cardiothoracic surgeons in general would benefit (83%) from better understanding of ethical issues. Respondents also believed that demonstration of an adequate understanding of ethical issues should be part of both American Board of Thoracic Surgery certification and maintenance of certification processes (61% and 60%, respectively). Among respondents who attended ethics presentations at annual meetings, only 4% believed that the sessions did not improve their understanding of complex ethical issues, and only 10% believed that the sessions did not affect their surgical practices.ConclusionsThe survey suggested that efforts toward ethics education for cardiothoracic surgeons might be both relevant and important; the results encourage continuation and further improvement of such efforts.
| S-EPMC4481736 | biostudies-literature
Project description:BackgroundThe Physician Payment Sunshine Act was implemented to provide transparency to financial transactions between industry and physicians. Under this law, the Open Payments Program (OPP) was created to publicly disclose all transactions and inform patients of potential conflicts of interest. Collaboration between industry and cardiothoracic surgeon-scientists is essential in developing new approaches to treating patients with cardiac disease. The objective of this study is to characterize industry payments to cardiothoracic surgeons as reported by the OPP.MethodsWe used the first wave of Physician Payment Sunshine Act data (August 2013 to December 2013) to assess industry payments made to cardiothoracic surgeons.ResultsCardiothoracic surgeons (n = 2,495) received a total of $4,417,545 during a 5-month period. Cardiothoracic surgeons comprised 0.5% of all persons in the OPP and received 0.9% of total disclosed industry funding. Among cardiothoracic surgeons receiving funding, 34% received payments less than $100, 43% received payments of $100 to $999, 19% received payments of $1,000 to $9,999, 4% received payments of $10,000 to $99,999, and 0.2% received payments of more than $100,000. The median was $181 (interquartile range [IQR]: $60 to $843) and the mean ± SD was $1,771 ± $7,664. The largest payment to an individual surgeon was $159,444. The three largest median payments made to cardiothoracic surgeons by expense category were royalty fees $8,398 (IQR: $536 to $12,316), speaker fees $3,600 (IQR: $1,500 to $8,000), and honoraria $3,344 (IQR: $1,563 to $7,350).ConclusionsAmong cardiothoracic surgeons who are listed as recipients of nonresearch industry payments, 50% of cardiothoracic surgeons received less than $181. Awareness of the OPP data is critical for cardiothoracic surgeons, as it provides a means to prevent potential public misconceptions about industry payments within the specialty that may affect patient trust.
| S-EPMC5183564 | biostudies-literature
Project description: Not available
| S-EPMC6938646 | biostudies-literature
Project description:It is a fact that, despite the worldwide increasing intake of women in medical schools, women are still grossly underrepresented in all medical and surgical specialities, and definitely in cardiothoracic surgery in both developed and developing countries. This is counter-productive towards meeting the escalating need for cardiac surgical care in Africa. However, the natural evolution over time of increasing numbers of females entering medical school and specializing in the field of surgery, is expected to continue despite multiple challenges encountered on their way. The inequities of healthcare provision in Africa in particular needs the continual support of all professionals that are able to contribute to the wellbeing of those innocent individuals that need medical care particularly children born with congenital cardiac defects. In addition to factors on the African continent, realities and challenges for future female cardiothoracic surgeons include gender bias and gender-based discrimination by some male counterparts. The question must be asked: "Is it mere gender-based discrimination, or how much does deliberate 'bullying behaviour' mimic signs of superiority, arrogance and entitlement, bordering on psychological personality disorders?" Thorough investigation of the possible role of such behaviour disorders in gender bias and discrimination is long overdue. These disparities and challenges should be actively addressed on all levels by all role players by placing more emphasis on merit, competence and surgical outcomes than on the gender of the surgeon. Despite all these challenges, the benefits of a career in cardiothoracic surgery and tremendous job satisfaction far exceed the disadvantages.
| S-EPMC7867814 | biostudies-literature
Project description:Background: One of the main fields of lung cancer research is identifying patients who are at high risk of post-resection recurrence. Individual recurrence risk evaluation by accurate but simple and reproducible method is needed for the clinical practice. Results: The log-rank test and further selection by our criteria of assayability generated 87 genes from microarray data with significant level 5%. Of these, by PTQ-PCR, the expression of most significant 18 genes was obtained. Using these gene expression information and clinical parameters, by stepwise variable selection method, the recurrence prediction model, which composed of 6 genes (CALB1, MMP7, SLC1A7, GSTA1, CCL19, IFI44) and pStage and cell differentiation, were developed. Validation into the two independent cohorts showed good results of the proposed model (p=0.0314, 0.0305, respectively). The predicted median recurrence-free survival times for each patient were reflected real ones well. Conclusions: Our method of individualized recurrence risk prediction is accurate, technically simple and reproducible to be used in clinical practice. Therefore, it would be useful in customizing the lung cancer management strategies. Keywords: Recurrence Free Survival Analysis
2007-11-20 | GSE8894 | GEO
Project description:BACKGROUND:Acne in women is often associated with anxiety and depression, and may persist from adolescence as well as manifest for the first time in adulthood. Genetic and hormonal factors contribute to its etiopathogenesis, and maintenance treatment is required, usually for years, due to its clinical evolution. OBJECTIVE:To develop a guide for the clinical practice of adult female acne. METHODS:A team of five experts with extensive experience in acne conducted a literature review of the main scientific evidence and met to discuss the best practices and personal experiences to develop a guide containing recommendations for the clinical practice of adult female acne. RESULTS:The group of specialists reached consensus on the main guidelines for clinical practice, providing detailed recommendations on clinical picture, etiopathogenesis, laboratory investigation and treatment of adult female acne. CONCLUSION:Different from teenage acne, adult female acne presents some characteristics and multiple etiopathogenic factors that make its management more complex. This guide provides recommendations for best clinical practices and therapeutic decisions. However, the authors consider that additional studies are needed in order to provide more evidence for adult female acne to be better understood.
| S-EPMC6360964 | biostudies-other
Project description:BackgroundBayesian statistical approaches are extensively used in new statistical methods but have not been adopted at the same rate in clinical and translational (C&T) research. The goal of this paper is to accelerate the transition of new methods into practice by improving the C&T researcher's ability to gain confidence in interpreting and implementing Bayesian analyses.MethodsWe developed a Bayesian data analysis plan and implemented that plan for a two-arm clinical trial comparing the effectiveness of a new opioid in reducing time to discharge from the post-operative anesthesia unit and nerve block usage in surgery. Through this application, we offer a brief tutorial on Bayesian methods and exhibit how to apply four Bayesian statistical packages from STATA, SAS, and RStan to conduct linear and logistic regression analyses in clinical research.ResultsThe analysis results in our application were robust to statistical package and consistent across a wide range of prior distributions. STATA was the most approachable package for linear regression but was more limited in the models that could be fitted and easily summarized. SAS and R offered more straightforward documentation and data management for the posteriors. They also offered direct programming of the likelihood making them more easily extendable to complex problems.ConclusionBayesian analysis is now accessible to a broad range of data analysts and should be considered in more C&T research analyses. This will allow C&T research teams the ability to adopt and interpret Bayesian methodology in more complex problems where Bayesian approaches are often needed.
| S-EPMC10877520 | biostudies-literature
Project description:Selecting among competing statistical models is a core challenge in science. However, the many possible approaches and techniques for model selection, and the conflicting recommendations for their use, can be confusing. We contend that much confusion surrounding statistical model selection results from failing to first clearly specify the purpose of the analysis. We argue that there are three distinct goals for statistical modeling in ecology: data exploration, inference, and prediction. Once the modeling goal is clearly articulated, an appropriate model selection procedure is easier to identify. We review model selection approaches and highlight their strengths and weaknesses relative to each of the three modeling goals. We then present examples of modeling for exploration, inference, and prediction using a time series of butterfly population counts. These show how a model selection approach flows naturally from the modeling goal, leading to different models selected for different purposes, even with exactly the same data set. This review illustrates best practices for ecologists and should serve as a reminder that statistical recipes cannot substitute for critical thinking or for the use of independent data to test hypotheses and validate predictions.
| S-EPMC8187274 | biostudies-literature
Project description:Today, skills laboratories or "skills labs", i.e. specific practical skill training facilities, are a firmly established part of medical education offering the possibility of training clinical procedures in a safe and fault-forging environment prior to real life application at bedside or in the operating room. Skills lab training follows a structured teaching concept, takes place under supervision and in consideration of methodological-didactic concepts, ideally creating an atmosphere that allows the repeated, anxiety- and risk-free practice of targeted skills. In this selective literature review, the first section is devoted to (I) the development and dissemination of the skills lab concept. There follows (II) an outline of the underlying idea and (III) an analysis of key efficacy factors. Thereafter, (IV) the training method's effectiveness and transference are illuminated, before (V) the use of student tutors, in the sense of peer-assisted-learning, in skills labs is discussed separately. Finally, (VI) the efficiency of the skills lab concept is analyzed, followed by an outlook on future developments and trends in the field of skills lab training.
| S-EPMC5003146 | biostudies-other
Project description:BackgroundSpasticity is a known complication to the hemiplegic shoulder following acquired brain injury. However, there is a current discrepancy between the diagnosis of arm spasticity and the subsequent assessment and treatment of spasticity in people with shoulder involvement.ObjectiveAn expert panel aimed to establish a consensus and provide a simple structured approach to identifying and assessing people with spasticity of the hemiplegic shoulder.MethodsA consensus group of six spasticity experts were interviewed individually via 1-h video calls to ascertain how they assess people with arm spasticity for shoulder involvement. During an in-person meeting in March 2023, a consensus-building process was used to discuss four topics: a checklist/tool to identify shoulder involvement in upper limb spasticity, measurements/scales for assessing shoulder spasticity, 'red flags' for other conditions affecting the shoulder, and assessment limitations and practicalities.ResultsWhere there was full agreement on a topic, recommendations to overcome challenges for initial and ongoing assessment of shoulder spasticity and goal-setting were developed, and categorized as Posture, Purposeful activity and Pain ('the three Ps'). Posture should be observed when sitting and walking, as appropriate for the person, and compared to published shoulder spasticity patterns. Purposeful activity should be assessed using a systematic approach. The presence and nature of shoulder pain should be ascertained. Recommendations on impairment- and function-related measures are given.ConclusionThis consensus guidance provides practical recommendations on identifying shoulder spasticity to support clinicians in their management of people with neurological shoulder dysfunction.
| S-EPMC11800359 | biostudies-literature