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
21
23
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