An informatics consult approach for generating clinical evidence for treatment decisions.
An informatics consult approach for generating clinical evidence for treatment decisions.
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信息学咨询方法，用于为治疗决策生成临床证据。
DOI：
10.1186/s12911-021-01638-z
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发表时间：
2021-10-12
影响因子：
3.5
通讯作者：
Hemingway H
中科院分区：
文献类型：
--
作者：
Lai AG;Chang WH;Parisinos CA;Katsoulis M;Blackburn RM;Shah AD;Nguyen V;Denaxas S;Davey Smith G;Gaunt TR;Nirantharakumar K;Cox MP;Forde D;Asselbergs FW;Harris S;Richardson S;Sofat R;Dobson RJB;Hingorani A;Patel R;Sterne J;Banerjee A;Denniston AK;Ball S;Sebire NJ;Shah NH;Foster GR;Williams B;Hemingway H
信息学咨询已经被提出，其中临床医生从大规模健康数据资源中请求新的证据，针对特定患者的治疗进行定制。然而，缺乏这种协商。我们寻求为同一患者的治疗适应症和禁忌症共存的情况提供信息咨询，即，在患有心房纤颤（AF）和肝硬化的患者中用于预防中风的抗凝用途。我们检查了华法林对卒中风险或全因死亡率影响的四个证据来源：（1）随机对照试验（RCT），（2）既往观察性研究的荟萃分析，（3）试验模拟（使用人群电子健康记录（N = 3，854，710）和（4）遗传证据（孟德尔随机化）。我们开发了原型形式，要求信息咨询和电子健康记录系统的结果返回。我们发现0份RCT报告和0项试验招募了AF和肝硬化患者。我们发现我们产生的三个新证据来源之间存在广泛的一致性。既往观察性研究的荟萃分析显示，华法林使用与卒中风险降低相关（风险比[HR] = 0.71，CI 0.39-1.29）。在一项目标试验模拟中，华法林与较低的全因死亡率（HR = 0.61，CI 0.49-0.76）和缺血性卒中（HR = 0.27，CI 0.08-0.91）相关。孟德尔随机化作为药物靶点验证，我们发现较低水平的维生素K1（华法林是一种维生素K1拮抗剂）与较低的中风风险相关。对34名临床医生进行的一项独立样本的试点调查显示，85%的临床医生认为预后信息有用，79%的临床医生认为他们应该在其医疗保健系统中获得信息咨询服务。我们确定了自动化的候选步骤，以扩展证据生成并加速结果的返回。我们进行了概念验证信息学咨询以生成证据，这可能会在缺乏随机试验的情况下为治疗决策提供信息。患者惊讶地发现，他们的临床医生目前无法从“像我这样的患者”的数据中学习。我们确定了提供这种信息咨询服务的关键挑战。在线版本包含补充材料，可通过10.1186/s12911-021-01638-z获得。
An Informatics Consult has been proposed in which clinicians request novel evidence from large scale health data resources, tailored to the treatment of a specific patient. However, the availability of such consultations is lacking. We seek to provide an Informatics Consult for a situation where a treatment indication and contraindication coexist in the same patient, i.e., anti-coagulation use for stroke prevention in a patient with both atrial fibrillation (AF) and liver cirrhosis. We examined four sources of evidence for the effect of warfarin on stroke risk or all-cause mortality from: (1) randomised controlled trials (RCTs), (2) meta-analysis of prior observational studies, (3) trial emulation (using population electronic health records (N = 3,854,710) and (4) genetic evidence (Mendelian randomisation). We developed prototype forms to request an Informatics Consult and return of results in electronic health record systems. We found 0 RCT reports and 0 trials recruiting for patients with AF and cirrhosis. We found broad concordance across the three new sources of evidence we generated. Meta-analysis of prior observational studies showed that warfarin use was associated with lower stroke risk (hazard ratio [HR] = 0.71, CI 0.39–1.29). In a target trial emulation, warfarin was associated with lower all-cause mortality (HR = 0.61, CI 0.49–0.76) and ischaemic stroke (HR = 0.27, CI 0.08–0.91). Mendelian randomisation served as a drug target validation where we found that lower levels of vitamin K1 (warfarin is a vitamin K1 antagonist) are associated with lower stroke risk. A pilot survey with an independent sample of 34 clinicians revealed that 85% of clinicians found information on prognosis useful and that 79% thought that they should have access to the Informatics Consult as a service within their healthcare systems. We identified candidate steps for automation to scale evidence generation and to accelerate the return of results. We performed a proof-of-concept Informatics Consult for evidence generation, which may inform treatment decisions in situations where there is dearth of randomised trials. Patients are surprised to know that their clinicians are currently not able to learn in clinic from data on ‘patients like me’. We identify the key challenges in offering such an Informatics Consult as a service. The online version contains supplementary material available at 10.1186/s12911-021-01638-z.
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AASLD临床实践指南：对科学证据和不断发展的建议的批判性综述。
DOI：
10.1002/hep.26578
发表时间：
2013-12
期刊：
Hepatology (Baltimore, Md.)
影响因子：
--
作者：
Koh C;Zhao X;Samala N;Sakiani S;Liang TJ;Talwalkar JA
通讯作者：
Talwalkar JA
影响因子：
13.6
作者：
Gokhale KM;Chandan JS;Toulis K;Gkoutos G;Tino P;Nirantharakumar K
通讯作者：
Nirantharakumar K
影响因子：
30.8
作者：
Malik R;Chauhan G;Traylor M;Sargurupremraj M;Okada Y;Mishra A;Rutten-Jacobs L;Giese AK;van der Laan SW;Gretarsdottir S;Anderson CD;Chong M;Adams HHH;Ago T;Almgren P;Amouyel P;Ay H;Bartz TM;Benavente OR;Bevan S;Boncoraglio GB;Brown RD Jr;Butterworth AS;Carrera C;Carty CL;Chasman DI;Chen WM;Cole JW;Correa A;Cotlarciuc I;Cruchaga C;Danesh J;de Bakker PIW;DeStefano AL;den Hoed M;Duan Q;Engelter ST;Falcone GJ;Gottesman RF;Grewal RP;Gudnason V;Gustafsson S;Haessler J;Harris TB;Hassan A;Havulinna AS;Heckbert SR;Holliday EG;Howard G;Hsu FC;Hyacinth HI;Ikram MA;Ingelsson E;Irvin MR;Jian X;Jiménez-Conde J;Johnson JA;Jukema JW;Kanai M;Keene KL;Kissela BM;Kleindorfer DO;Kooperberg C;Kubo M;Lange LA;Langefeld CD;Langenberg C;Launer LJ;Lee JM;Lemmens R;Leys D;Lewis CM;Lin WY;Lindgren AG;Lorentzen E;Magnusson PK;Maguire J;Manichaikul A;McArdle PF;Meschia JF;Mitchell BD;Mosley TH;Nalls MA;Ninomiya T;O'Donnell MJ;Psaty BM;Pulit SL;Rannikmäe K;Reiner AP;Rexrode KM;Rice K;Rich SS;Ridker PM;Rost NS;Rothwell PM;Rotter JI;Rundek T;Sacco RL;Sakaue S;Sale MM;Salomaa V;Sapkota BR;Schmidt R;Schmidt CO;Schminke U;Sharma P;Slowik A;Sudlow CLM;Tanislav C;Tatlisumak T;Taylor KD;Thijs VNS;Thorleifsson G;Thorsteinsdottir U;Tiedt S;Trompet S;Tzourio C;van Duijn CM;Walters M;Wareham NJ;Wassertheil-Smoller S;Wilson JG;Wiggins KL;Yang Q;Yusuf S;AFGen Consortium;Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) Consortium;International Genomics of Blood Pressure (iGEN-BP) Consortium;INVENT Consortium;STARNET;Bis JC;Pastinen T;Ruusalepp A;Schadt EE;Koplev S;Björkegren JLM;Codoni V;Civelek M;Smith NL;Trégouët DA;Christophersen IE;Roselli C;Lubitz SA;Ellinor PT;Tai ES;Kooner JS;Kato N;He J;van der Harst P;Elliott P;Chambers JC;Takeuchi F;Johnson AD;BioBank Japan Cooperative Hospital Group;COMPASS Consortium;EPIC-CVD Consortium;EPIC-InterAct Consortium;International Stroke Genetics Consortium (ISGC);METASTROKE Consortium;Neurology Working Group of the CHARGE Consortium;NINDS Stroke Genetics Network (SiGN);UK Young Lacunar DNA Study;MEGASTROKE Consortium;Sanghera DK;Melander O;Jern C;Strbian D;Fernandez-Cadenas I;Longstreth WT Jr;Rolfs A;Hata J;Woo D;Rosand J;Pare G;Hopewell JC;Saleheen D;Stefansson K;Worrall BB;Kittner SJ;Seshadri S;Fornage M;Markus HS;Howson JMM;Kamatani Y;Debette S;Dichgans M
通讯作者：
Dichgans M
影响因子：
3.7
作者：
Meyer, Chase;Bowers, Aaron;Vassar, Matt
通讯作者：
Vassar, Matt
影响因子：
5
作者：
Hernan, Miguel A.;Robins, James M.
通讯作者：
Robins, James M.