UTILIZATION OF RESEARCH ON CARDIOVASCULAR TECHNOLOGIES

心血管技术研究的应用

• 批准号: 3371885
• 负责人: PAUL M WORTMAN
• 金额: $ 12.85万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 1989
• 资助国家: 美国
• 起止时间: 1989-01-01 至 1990-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/3371885
• 关键词: automated medical record system; computer assisted patient care; congestive heart failure; coronary bypass; endarterectomy; health care cost /financing; health care referral /consultation; health care service evaluation; heart disorder chemotherapy; human therapy evaluation; information systems; myocardial infarction; plasminogen activator; streptokinase; thrombosis

The proposed research seeks to use meta-analytic methods to exploit the rather considerable databases on coronary artery bypass graft surgery, lytic agents for myocardial infarction, carotid endarterectomy, and drug interventions for congestive heart myocardial infarction, carotid endarterectomy, and drug interventions for congestive heart failure created during the first two years of NIH support. We are particularly interested in the clinical and methodological issues related to the generalizability or "external validity" (Cook & Campbell, 1979) of the results of meta-analysis. The basic question addressed by external validity concerns the scope and limitations of an observed effect. Essentially, this involves demonstrating that the effects are consistent for subgroups or clusters resulting from variations of treatments within different time periods, populations, or settings. Fortunately, the quantitative methods provide tests for heterogeneity. When such tests fail (i.e., indicate statistically significant heterogeneity), these external validity issues should be considered in accounting for this variation (although in some cases, heterogeneity may reflect methodological artifacts). If significant non-artifactual variation is detected, then an explanation for the differences must be determined. There are three analysis strategies. The first two that we have followed involve forming subgroups of individual studies or subgroups within studies based on relevant variables and determining if these strata account for the observed heterogeneity. This is consistent with the traditional approach to meta-analysis as developed by Glass where the categories or strata were established a priori. Another methodological approach involves the use of multiple regression to relate background variables such as health status to outcomes (here effect sizes). We have taken two approaches to examining treatment variation. First (as noted in Section C) we have expanded our database to allow inclusion of a variety of new treatments. Second we will conduct a temporal synthesis to examine trends (by cumulating results over time). Such a strategy not only allows us to track changes between similar treatments but also to note major changes within a technology (as with t- PA in managing acute myocardial infarction). Our preliminary research (reported in Section C) clearly demonstrates that the above approaches can be easily accommodated using our current databases and should be fully investigated before resorting to other procedures.

拟议的研究试图使用元分析方法来开发 相当多的关于冠状动脉搭桥手术的数据库， 用于心肌梗死、颈动脉内膜切除术和药物的溶栓剂 介入治疗充血性心肌梗死，颈动脉 动脉内膜剥脱术和充血性心力衰竭的药物干预 是在NIH支持的头两年创建的。我们特别是 对临床和方法学相关的问题感兴趣 可概括性或“外部有效性”(Cook&Campbell，1979) Meta分析结果。外部解决的基本问题 有效性与观察到的效果的范围和局限性有关。 从本质上讲，这涉及到证明影响是一致的 对于因内部处理的变化而产生的子组或簇 不同的时间段、人口或环境。幸运的是， 定量方法提供了异质性测试。当这样的测试 不合格(即，表明统计上显著的异质性)， 在核算这一问题时应考虑外部有效性问题 差异(尽管在某些情况下，异质性可能会反映 方法论人工制品)。如果显著的非人工变化是 检测到，则必须确定对差异的解释。 分析策略有三种。我们关注的前两个问题 涉及形成个别研究的子组或在 基于相关变量的研究，并确定这些地层 解释了观察到的异质性。这与 由Glass开发的传统元分析方法，其中 类别或阶层是先天确定的。另一种方法 该方法涉及使用多元回归来关联背景 变量，如健康状况对结果的影响(这里是影响大小)。我们有 采取了两种方法来检查治疗变异。首先(如中所述 C)我们已经扩展了我们的数据库，以允许包括各种 新的治疗方法。第二，我们将进行时间综合来检验 趋势(通过随着时间积累结果)。这样的策略不仅允许 美国将跟踪类似治疗之间的变化，但也要注意主要 技术内的变化(如t-PA在管理急性心肌梗死中的作用 脑梗塞)。我们的初步研究(在C部分中报告)清楚地 演示了上述方法可以很容易地使用 我们目前的数据库，在诉诸之前应该进行充分的调查 到其他程序。