英文医学ppt课件资料：J-club-Non-invasive-CV-Imaging-(MSIH)

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Influence of Non-invasive CV Imaging in Primary prevention,Arch Int Med 2011;171:977-982,Influence of Non-invasive CV I,J Club goals,Causality(or lack thereof),Prognosis,Hierarchy of evidence,J Club goalsCausality(or lack,Thomas Sydenham(1624-1689),“A man is as old as his arteries,.,Thomas Sydenham(1624-1689),Primary prevention,“Strategies intended to avoid the,development,of disease.”,Primary prevention,Research Question:,What influence does cardiac imaging,have on:,1)medication prescribing,2)lifestyle modification,3)use of angiography,4)revascularization,Research Question:What influen,Background,Some believe that noninvasive CV imaging may improve primary prevention,Explosive growth in imaging without much evidence as to efficacy,BackgroundSome believe that no,When in doubt.,DO A META-ANALYSIS,“a quantitative statistical analysis of several separate but similar experiments or studies in order to test the pooled data for,statistical significance”,When in doubt.,Hierarchy,Hierarchy,Is it REALLY the highest form of clinical evidence?,More below,Is it REALLY the highest form,Methodology,Methodology,Copyright restrictions may apply.,Hackam,D.G.et al.Arch Intern Med 2011;171:977-982.,Literature search and selection,Copyright restrictions may app,Copyright restrictions may apply.,Hackam,D.G.et al.Arch Intern Med 2011;171:977-982.,Characteristics of Included Studies,Copyright restrictions may app,Copyright restrictions may apply.,Hackam,D.G.et al.Arch Intern Med 2011;171:977-982.,Methodological Quality Parameters,Copyright restrictions may app,What is Forrest plot?,(Why not a Forest Plot?),What is Forrest plot?(Why n,Copyright restrictions may apply.,Hackam,D.G.et al.Arch Intern Med 2011;171:977-982.,Effect of imaging on measures of care,Copyright restrictions may app,Strengths of study,Meta-analysis of RCTs,Good people,Important study,Strengths of studyMeta-analysi,Limitations,Small studies(therefore low power;not representative?not true?),Reporting biases(eg of 7 trials,only 4 reported prescribing at baseline),Potential conflicts of interest(see below),Limitations,Are RCTs REALLY the highest form of clinical evidence?,Are RCTs REALLY the highest f,Two examples,Cigarette smoking and lung CA,Two examples,Second example,2.Parachutes,Second example,So what should we do?,As my late mom said,So what should we do?As my lat,and,and,Sponsorship,“This work was funded by a partnered knowledge,synthesis grant from the Canadian Institutes of Health Research,and Canadian Stroke Network.Dr Hackam was,supported by a Canadian Institutes of Health Research New Investigator Award in Clinical Research.Dr Shojania was supported by the Government of Canada Research Chairs Program,Drs Alter and Beanlands were supported by Career Investigator Awards from the Heart and Stroke Foundation of Ontario.”,Sounds good?,but.,Sponsorship“This work was fund,Sponsorshipbut,Financial Disclosure,“Dr Spence has received consulting fees from Boehringer-Ingelheim regarding 3-dimensional measurement of carotid plaque Dr Beanlands has received grant funding or in kind contribution from Medical Imaging,GE,and MDS NordionDr Badano is a member of the speakers bureau for or has received honoraria from GE Healthcare,Sorin Biomedica,Edwards LifeSciences,as well as research grants from GE Healthcare and Actelion.blah,blah,blah,SponsorshipbutFinancial Discl,Discussion,Discussion,