英文醫(yī)學(xué)課件資料：J club Non-invasive CV Imaging (MSIH)

1、Influence of Non-invasive CV Imaging in Primary prevention Arch Int Med 2011;171:977-982 J Club goals 1. Causality (or lack thereof) 2. Prognosis 3. Hierarchy of evidence Thomas Sydenham (1624-1689) “A man is as old as his arteries. Primary prevention “Strategies intended to avoid the development of

2、 disease.” Research Question: What influence does cardiac imaging have on: 1) medication prescribing 2) lifestyle modification 3) use of angiography 4) revascularization Background Some believe that noninvasive CV imaging may improve primary prevention Explosive growth in imaging without much eviden

3、ce as to efficacy 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” Hierarchy Is it REALLY the highest form of clinical evidence ? More below Methodology Copyri

4、ght restrictions may apply. Hackam, D. G. et al. Arch Intern Med 2011;171:977-982. Literature search and selection Copyright restrictions may apply. Hackam, D. G. et al. Arch Intern Med 2011;171:977-982. Characteristics of Included Studies Copyright restrictions may apply. Hackam, D. G. et al. Arch

5、Intern Med 2011;171:977-982. Methodological Quality Parameters What is Forrest plot ? (Why not a Forest Plot ?) Copyright restrictions may apply. Hackam, D. G. et al. Arch Intern Med 2011;171:977-982. Effect of imaging on measures of care Strengths of study 1. Meta-analysis of RCTs 2. Good people 3.

6、 Important study Limitations 1. Small studies (therefore low power; not representative? not true?) 2. Reporting biases (eg of 7 trials, only 4 reported prescribing at baseline) 3. Potential conflicts of interest (see below) Are RCTs REALLY the highest form of clinical evidence ? Two examples 1. Ciga

7、rette smoking and lung CA Second example So what should we do? As my late mom said 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 Re

8、search 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. Sponsorshipbut Financial Disclo

9、sure “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 fro