Research Methdology in Cardiovascular Surgery

Clinical Research and Paper in CVS

Robert Chen

Outlines

•Data Source(s)

•Journals and Paper Submission

•Examples of Submitted Papers

•Topics Welcome

Motivation

•How well are we doing? Benchmark.

•How is the operation risk from experience?

•Papers

4

Database Example

Data Variables(Computer)

•Text

•Number

•Date

•Administrative data

Data Variables(Epidemiology)

•X1, X2, ..., Xn -> Y

•Predictor: Xi

•Outcome: Y

Data Variables(Statistics)

•Scale: Continuous. eg. body weight

•Ordinal: Grading. eg. severity

•Nominal: Category. eg. location

Data Variables(Surgery)

•Demographics

•Baseline

•Preop

•Op

•Postop

•Outcome

Variable Content

•Yes / No

•Timing

•Category

•Measurement

Paperwork

•Question

•Grant (optional, if big research)

•Data collection

•Analysis

•Paper writing

•Submission and revision

Data Source

•FEMH CVS Database

•National Health Insurance Database

•FEMH Hospital Database

CVS Database•Basic data

•Risk factors

•Preop Intervention

•Symptoms/Signs

•Preop Cardiac Condition

•Hemodynamics

•Preop Meds

CVS Database

•Mechanical Circulatory Support

•Preop Assessment

•CPB (perfusionist)

•Operation Intro (OR)

•Op CABG

•Op Valve

CVS Database

•Op MICS

•Op Others Cardiac

•Op Others Non-cardiac

•Postop Conditions

•Complications

CVS Database

•Death

•Discharge

•Re-admission

Process

•13 F, Database specialist 林孟葦

•Time range

•Diagnosis or procedures

•Variables (from questions)

Process

•Excel data spreadsheet

•Statistics analysis

•Paper writing and submission

•Revision

http://w3.nhri.org.tw/nhird

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ICD-9 Codes and Diagnoses DM=250.* COPD=490-492.* or 496 PAOD=443.*-444.* CVA 434.91 or 434.11 or 997.02 Acute renal failure=584.* Chronic renal failure=586.*-588.* Critical=785.51 or “shock” or “IABP” or “ECMO” UA=413.* or “angina” LV dysfunction = 428.* or “critical” or “CHF” or “ICMP”

AMI=410.* or “AMI” or “infarction” PHT=416.* or “pulmonary hypertension” IE=424.*

Nat’l Health Insurance CodeOperations Postop Course

CABG*1= 68023 CABG+LIMA=

68023X1/2 CABG*2=68024 CABG*3=68025

MVA/TVA=68015 AVR/MVR/TVR=68016 DVR=68017 AVR+MVR+TVR=6801

8 Redo=68003

Ventilator=57001 IABP=33079 HD=58001 CVVH=58014

“Text data-mining”

Hospital Information

System (HIS)•Help from IT

•Variable definitions

•SQL (Structured Query Language)

•SELECT [X1], [X2] FROM [DB] WHERE [X3] ? [X4]

•Xi? DB?

Data Collection from HIS

•Diagnosis: ICD9

•Operation: NHI

•Procedures: NHI

•IABP, MV, HD,...

•Drugs: ?

Data Analysis: Statistics

•Descriptive (敘述性 ): Tables, Graphs

•Inferential (推論性 ): p-values

Inferential Statistics

•Different or not?

•Related or not?

•Predictor or not?

Different?

•Groups

•Variables to compare

Related?

•Correlation

•Variable-1

•Variable-2

Predictors?

•Predictor variables X1, X2,...Xn

•Outcome variable Y

•Scale

•Event (Y/N)

•Time-event

Journals•JCR 2011 Ranking

•Impact Factors

•Different journals, different rules

EndNote X5

Submitted•Pigtail delivery of cardioplegia for minimally

invasive mitral valve surgery

•Parasternal minimally invasive cardiac surgery

•Comparative Study of Serum Amyloid A and C-Reactive Protein in Patients undergoing Off-pump Coronary Artery Bypass Surgery

•Comparing the endothelial integrity of the saphenous vein grafts harvested by the endoscopic and open techniques

Potential Topics•MICS vs. conventional for outcomes

and complications

•Limiting factors of MICS

•NHID valve mechanical vs. bio for outcomes and complications

•Aortic bifurcation angle and cross-over tech success rate

Welcome Ideas•Interesting topics

•Questions

•Then we can go on to papers

DEMO