245 research outputs found
Bibliometric analysis of surgical papers that use Bayes' theorem in the past two decades (2000 to 2024)
No full textBayesian inference is a type of statistical analysis that seeks to answer research questions through probability statements about uncertain outcomes. The use of Bayesian inference in biomedical research is under utilized but has the potential to offer advantages over conventional frequentist methods. The aim of the study is to evaluate the use of Bayes' theorem in surgical papers in top journals based on impact factors in the past two decades.
Project team:
Zhenyu Li, University of Ottawa, Ottawa, ON, Canada; Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
Aliya Izumi, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
Dr. Dominique Vervoort, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
Dr. Stephen Fremes, Division of Cardiac Surgery, Schulich Heart Institute, Sunnybrook Health Sciences Centre, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canad
Supplemental material - Supplemental material for A Systematic Review and Meta-Analysis of del Nido Versus Conventional Cardioplegia in Adult Cardiac Surgery
No full textSupplemental material, Supplemental material for A Systematic Review and Meta-Analysis of del Nido Versus Conventional Cardioplegia in Adult Cardiac Surgery by Kevin R. An, Ishtiaq A. Rahman, Derrick Y. Tam, Niv Ad, Subodh Verma, Stephen E. Fremes, David A. Latter, and Bobby Yanagawa in Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery</p
Bibliometric analysis of medical papers that use win ratio in the past decade (2012 to 2024)
No full textIn this bibliometrics analysis, the focus is on medical sciences papers that have employed the win ratio methodology over the past decade. The win ratio is a relatively novel analytical approach for clinical trials, which uses a composite outcome that emphasizes the relative importance of the different endpoints. It is often used as an alternative to traditional time-to-first-event analysis but is flexible in that multiple types of outcomes can be considered.
Project team:
Zhenyu Li, University of Ottawa, Ottawa, ON, Canada; Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
Aliya Izumi, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
Anika Ranadive, McMaster University, Hamilton, ON, Canada; Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
Dr. Dominique Vervoort, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
Dr. Stephen Fremes, Division of Cardiac Surgery, Schulich Heart Institute, Sunnybrook Health Sciences Centre, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canad
Reduced order methods for parametric optimal flow control in coronary bypass grafts, toward patient-specific data assimilation
No full textCoronary artery bypass grafts (CABG) surgery is an invasive procedure performed to circumvent partial or complete blood flow blockage in coronary artery disease. In this work, we apply a numerical optimal flow control model to patient‐specific geometries of CABG, reconstructed from clinical images of real‐life surgical cases, in parameterized settings. The aim of these applications is to match known physiological data with numerical hemodynamics corresponding to different scenarios, arisen by tuning some parameters. Such applications are an initial step toward matching patient‐specific physiological data in patient‐specific vascular geometries as best as possible. Two critical challenges that reportedly arise in such problems are: (a) lack of robust quantification of meaningful boundary conditions required to match known data as best as possible and (b) high computational cost. In this work, we utilize unknown control variables in the optimal flow control problems to take care of the first challenge. Moreover, to address the second challenge, we propose a time‐efficient and reliable computational environment for such parameterized problems by projecting them onto a low‐dimensional solution manifold through proper orthogonal decomposition‐Galerkin
Systematic reviews and meta-analyses in cardiac surgery: rules of the road - 2
No full textIn the era of evidence-based medicine, systematic reviews and meta-analyses are considered at the top of evidence hierarchy. Despite the almost exponential increase in the number of published meta-analyses over the course of the last decades, only a small minority of them is of high quality, with major flaws involving every aspect of the meta-analytic process. The strength of a meta-analysis is closely linked to the quality of the included studies. Once preliminary phases are completed, it is vital that selected papers undergo a thorough quality assessment, using the most appropriate tools among those available. Analytical approaches must be tailored to the nature of the extracted data and the specific purpose of the meta-analysis. Appraisal of heterogeneity is a key step to inform subgroup or meta-regression analyses. The solidity of the results of the main analysis (especially in meta-analyses of observational studies or studies with high heterogeneity) should be tested by means of pertinent sensitivity analyses. Finally, the investigators should be aware of the possibility of publication bias and make efforts to assess it using qualitative and quantitative methods. The aim of the second part of this expert review is to provide guidance on how to appropriately perform trial level meta-analyses, with particular focus on the quality assessment of the included studies, the choice of the appropriate statistical approach, the methods to deal with heterogeneity (including subgroup, meta-regression and sensitivity analyses), and the appraisal of publication bias
The Relationship between Cardiac Rehabilitation and Long-term Outcomes in a Post CABG Population – A Clinical and Administrative Database Study
No full textThis is a single center retrospective study of 5,000 patients evaluating the effect of cardiac rehabilitation on long-term outcomes following coronary artery bypass surgery. A multivariable Cox proportional hazard model showed that cardiac rehabilitation was associated with a reduction in the composite of all-cause mortality, acute myocardial infarction, stroke or repeat revascularization, hazard ratio (HR) 0.83, 95% confidence interval (CI) 0.75-0.91, pM.Sc
The ROMA trial: 7 years of trial activities and the development of the ROMA trial network
No full textAssessment of Operative Strategies to Improve Coronary Bypass Graft Patency
No full textThe ultimate success of bypass surgery depends on the construction of a technically perfect bypass graft to an appropriate coronary vessel using a conduit which will remain durable for the lifetime of the patient. This thesis explores methods to improve coronary surgery by enhancing intraoperative imaging and conduit selection in the operating room.
It is known that technical errors in graft construction cause failure of up to 12% of coronary bypass grafts in the operating room. We performed investigations of a new technique of intraoperative fluorescence angiography using indocyanine green dye to determine graft patency. We developed optimal methods of obtaining images and preliminary investigations revealed the technique was highly reproducible. In a follow-up trial, we demonstrated that over 80% of technical errors which would otherwise have been missed were identifiable with indocyanine green angiography, while only 25% of these errors were identified by transit-time ultrasonic flow measurement, the current clinical standard. We also determine that coronary surgery with indocyanine green angiographic graft patency verification was associated with less perioperative myocardial injury than bypass surgery without graft patency assessment.
The long term graft patency of saphenous vein grafts is sub-optimal, with over 40% of such grafts totally occluded and a further 30% significantly diseased at ten years. We attempted to improve these outcomes by increasing the use of arterial grafts, which are less prone to intimal hyperplasia. In a multicentre clinical trial, we demonstrated a 40% relative risk reduction in graft occlusion at one year when radial arteries were used as bypass conduits versus saphenous veins. We identified that women and patients with small coronary vessels maximally benefited from radial artery bypass grafts. Conversely, in settings of less severe target vessel stenosis or concomitant peripheral vascular disease, saphenous veins performed as well as radial arteries.
We have demonstrated that high quality imaging to identify technical errors during the operation, increased use of radial artery grafts and careful consideration of individual patient and target vessel characteristics can all improve graft patency. Future studies will be aimed at identifying the role of intraoperative imaging and arterial grafting in improving long-term clinical outcomes.Ph
Assessment of Operative Strategies to Improve Coronary Bypass Graft Patency
No full textThe ultimate success of bypass surgery depends on the construction of a technically perfect bypass graft to an appropriate coronary vessel using a conduit which will remain durable for the lifetime of the patient. This thesis explores methods to improve coronary surgery by enhancing intraoperative imaging and conduit selection in the operating room.
It is known that technical errors in graft construction cause failure of up to 12% of coronary bypass grafts in the operating room. We performed investigations of a new technique of intraoperative fluorescence angiography using indocyanine green dye to determine graft patency. We developed optimal methods of obtaining images and preliminary investigations revealed the technique was highly reproducible. In a follow-up trial, we demonstrated that over 80% of technical errors which would otherwise have been missed were identifiable with indocyanine green angiography, while only 25% of these errors were identified by transit-time ultrasonic flow measurement, the current clinical standard. We also determine that coronary surgery with indocyanine green angiographic graft patency verification was associated with less perioperative myocardial injury than bypass surgery without graft patency assessment.
The long term graft patency of saphenous vein grafts is sub-optimal, with over 40% of such grafts totally occluded and a further 30% significantly diseased at ten years. We attempted to improve these outcomes by increasing the use of arterial grafts, which are less prone to intimal hyperplasia. In a multicentre clinical trial, we demonstrated a 40% relative risk reduction in graft occlusion at one year when radial arteries were used as bypass conduits versus saphenous veins. We identified that women and patients with small coronary vessels maximally benefited from radial artery bypass grafts. Conversely, in settings of less severe target vessel stenosis or concomitant peripheral vascular disease, saphenous veins performed as well as radial arteries.
We have demonstrated that high quality imaging to identify technical errors during the operation, increased use of radial artery grafts and careful consideration of individual patient and target vessel characteristics can all improve graft patency. Future studies will be aimed at identifying the role of intraoperative imaging and arterial grafting in improving long-term clinical outcomes.Ph
Continuing Conundrum of Multiple Arterial Conduits for Coronary Artery Bypass Grafting
No full textN/
- …
