1,721,538 research outputs found
Prediction of first coronary events with the Framingham score: a systematic review
No full textBACKGROUND: Uncertainty exists about the performance of the Framingham risk score when applied in different populations. OBJECTIVE: We assessed calibration of the Framingham risk score (ie, relationship between predicted and observed coronary event rates) in US and non-US populations free of cardiovascular disease. METHODS: We reviewed studies that evaluated the performance of the Framingham risk score to predict first coronary events in a validation cohort, as identified by Medline, EMBASE, BIOSIS, and Cochrane library searches (through August 2005). Two reviewers independently assessed 1496 studies for eligibility, extracted data, and performed quality assessment using predefined forms. RESULTS: We included 25 validation cohorts of different population groups (n = 128,000) in our main analysis. Calibration varied over a wide range from under- to overprediction of absolute risk by factors of 0.57 to 2.7. Risk prediction for 7 cohorts (n = 18658) from the United States, Australia, and New Zealand was well calibrated (corresponding figures: 0.87-1.08; for the 5 biggest cohorts). The estimated population risks for first coronary events were strongly associated (goodness of fit: R2 = 0.84) and in good agreement with observed risks (coefficient for predicted risk: beta = 0.84; 95% CI 0.41-1.26). In 18 European cohorts (n = 109499), the corresponding figures indicated close association (R2 = 0.72) but substantial overprediction (beta = 0.58, 95% CI 0.39-0.77). The risk score was well calibrated on the intercept for both population clusters. CONCLUSION: The Framingham score is well calibrated to predict first coronary events in populations from the United States, Australia, and New Zealand. Overestimation of absolute risk in European cohorts requires recalibration procedures
The role of causal inference in health services research I: tasks in health services research.
Full text linkIn a recent issue of the American Journal of Public Health, Herna´n and other colleagues strongly plea for causal thinking in scientific research where the research question investigates consequences of decisions and interventions (Ahern 2018; Begg and March 2018; Chiolero 2018; Glymour and Hamad 2018; Herna´n 2018a, b; Jones and Schooling 2018). Herna´n argues that causal reasoning improves quality of observational research; however, the causal terminology is often loomed by the ‘association is not causation’ argument and is viewed with skepticism (Herna´n 2018b). Health services research (HSR) supports decision making by investigating the effect of complex ‘interventions’ or ‘policies’ on different healthcare system outcomes (Glass et al. 2013). Thus, some of the research questions in HSR are inherently causal. Surprisingly, there is no consensus on how to integrate causal inference into tasks of HSR (Dowd 2011; O’Malley 2011; Pearl 2011; Herna´n et al. 2019). Typically, tasks in data science are classified into ‘description’, ‘modeling’ and ‘causal inference’ (Herna´n et al. 2019). In the present Hints and Kinks, we explain why a solidly principled causal inference framework should be integrated into the tasks of HSR
The role of causal inference in health services research II: a framework for causal inference.
Full text linkIn a previous Hints and Kinks, we discussed the role of causal inference in tasks of health services research (HSR) using examples from health system interventions (Moser et al. 2020). In the present Hints and Kinks, we more formally introduce a principled framework for causal inference. Specifically, we discuss in more detail the role of counterfactuals for the definition of a causal effect and the ‘association is not causation’ adage. We continue on the example of a hospital merger (HM) as a health system intervention
Lungenkarzinom-Screening mit Niederdosis-Computertomographie: Zusammenbringen von Evidenz und Kontext - PRO
No full textPatient Participation.
No full textThe Synthesis Working Paper "Patient participation" provides scientifically based recommendations for decision-makers, designed to make the Swiss health care system more efficient. Efficiency in this context means that with the given resources more health for all is achieved.
The recommendations are mainly based on the scientific findings delivered by nine projects of the Swiss National Science Foundation’s National Research Programme "Smarter Health Care" (NRP 74). These projects represent the part of the NRP 74 that specifically dealt various aspects of pa-tient involvement.
The process leading to this working paper was largely driven by doctoral students engaged NRP 74 projects who are members of the NRP 74's Emerging Health Care Leaders (EHCL) programme. They interviewed researchers, consulted the current literature on the topic and interacted with stake-holders from practice, administration and politics. This Synthesis Working Paper thus bridges edu-cation, research and practice, contributing at multiple levels to proactively address some of the ma-jor challenges facing Swiss health care
Physical activity as a crucial patient-reported outcome in Chronic Obstructive Pulmonary Disease
No full textPhysical inactivity is a hallmark of Chronic Obstructive Pulmonary Disease (COPD), which relates to outcomes relevant for patients and healthcare providers. Despite its importance, no patient reported outcome (PRO) instrument exists that captures physical activity that maximally reflects the experience of patients with COPD. The aim of the PROactive project is to develop, validate and use two PRO instruments (one for daily assessment, while the second as a clinical measure) to measure physical activity in COPD, researching and incorporating all dimensions of physical activity reported by patients. These tools are developed in accordance with the guidelines from the Food and Drug Administration (FDA) and European Medicines Agency (EMA). At the end of the first phase of the project, it has an initial version of the two PROs instruments validated. In the second phase, the PROs instruments are used and validated in several clinical trials that will determine, among other things, the utility, viability and sensitivity to change in different samples from patients with COPDLa inactivitat física és un aspecte clau en la MPOC que es relaciona amb esdeveniments de salut rellevants tant per als pacients com per als proveïdors de salut. Malgrat la importància de l’activitat física, no existeix cap instrument de resultats percebuts pels pacients (patient-reported outcomes – PRO) que capturi l'activitat física reflectint al màxim l'experiència dels pacients amb MPOC. L'objectiu del projecte PROactive és desenvolupar, validar i utilitzar dos instruments PRO (un per a l'avaluació diària, i un com a mesura clínica) per mesurar l'activitat física en la MPOC, investigant i incorporant totes les dimensions de l'activitat física reportades pels pacients. Aquestes eines es desenvolupen d'acord amb les directrius de l'Administració d'Aliments i Medicaments (FDA) i l'Agència Europea de Medicaments (EMA). Al final de la primera fase del projecte, que compta amb una versió inicial dels instruments PRO validats. A la segona fase, els qüestionaris PROs són utilitzats i validats en diversos assajos clínics que determinaran, entre altres coses, la utilitat, la viabilitat i sensibilitat al canvi en diferents mostres de pacients amb MPOC.Programa de doctorat en Biomedicin
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Consensus recommendations on how to assess the quality of surgical interventions
No full textPostoperative complications represent a major public health burden worldwide. Without standardized, clinically relevant and universally applied endpoints, the evaluation of surgical interventions remains ill-defined and inconsistent, opening the door for biased interpretations and hampering patient-centered health care delivery. We conducted a Jury-based consensus conference incorporating the perspectives of different stakeholders, who based their recommendations on the work of nine panels of experts. The recommendations cover the selection of postoperative outcomes from the perspective of patients and other stakeholders, comparison and interpretation of outcomes, consideration of cultural and demographic factors, and strategies to deal with unwarranted outcomes. With the recommendations developed exclusively by the Jury, we provide a framework for surgical outcome assessment and quality improvement after medical interventions, that integrates the main stakeholders' perspectives
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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