Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_612_Библиотеки_им_академика_М_И_Перельмана
.pdf
colleagues but also with industry, policymakers, and patients. The
reason for emphasis on the so what is to underscore the “now
what?” Many projects end with “future research is required.” We
propose an actionable research plan so that a researcher can build a
body of work and expertise. These high-impact projects can inform
patient education material development and advocacy with
professional societies and policy makers and change surgical
practice.
QUESTIONS
1. A researcher is interested in investigating quality of free flap
reconstruction. When discussing available datasets, their
mentor asks what the focus on the project will be. The
Donabedian framework proposes three domains of quality:
a. Patient, Surgeon, Hospital
b. Structure, Process, Outcome
c. Diagnosis, Treatment, Morbidity
d. Intervention, Comparison, Outcome
2. A team of plastic surgery residents is interested in exploring
the impact of work-hour restrictions on reconstructive
outcomes. They propose an interrupted time series design.
Causal inference and randomized controlled trials are similar
in that they:
a. Blind researchers to intervention assignments.
b. Support causation rather than association.
c. Address unmeasured confounders.
d. Evaluate policy changes.
3. Systematic bias refers to:
a. Random error causing the measurement to differ from the
true measurement.
b. Variables in the analysis that relate the independent and
dependent variables.
https://t.me/med1917
c. A measurement error that over- or underestimates the
value repeatedly.
d. Unconscious preference for one approach.
4. A research team is considering a multi-institutional trial to
evaluate robotic-assisted DIEP flap harvest. Some of the
interested sites have structured robotic training, and others do
not. Several additional limitations of the proposed study are
identified during development of the analytic plan. The next
best step is:
a. Consider a different question given the presence of
limitations.
b. Ignore these limitations in the development process and
address them in the manuscript.
c. Only consider limitations specific to your area of expertise
(eg, robotic training).
d. Review the literature to see how other researchers have
addressed known limitations of multi-institutional trials.
5. A grand rounds speaker introduces the growing use of
patient-reported outcome measures. To incorporate WOUNDQ scores in your upcoming chronic wound research proposal,
you should:
a. Request NSQIP data
b. Request TOPS data
c. Consider a prospective design instead
d. Reach out to patients in your institutional dataset from
2010 to 2020 and administer the WOUND-Q.
ANSWERS AND EXPLANATIONS
1. Answer: b. The Donabedian framework has been applied to
surgical outcomes research to consider quality within three
domains: structure, process, and outcomes.7 Although
https://t.me/med1917
outcomes research often focuses on discrete measurement of
patient-reported and provider-documented outcomes, this
framework can help new and established researchers consider
alternative approaches to improving outcomes for patients within
their specialty and across their healthcare systems. Variables
can also be assessed and measured at the patient, surgeon,
and hospital levels. This is not a framework for quality
measurement, but surgeon and hospital outcomes can be
incorporated into an analysis using multilevel modeling.
Intervention, comparison, and outcome are components of the
PICOS criteria.
2. Answer: b. Causal inference and randomized controlled
trials can both support causation. They share that strength,
compared with other designs that support association. Patients,
surgeons, hospitals, or even neighborhoods can be randomized
to treatments with or without researcher blinding in randomized
controlled trials. Causal inference studies are retrospective
analyses in which researchers know which groups received the
intervention. Careful recognition of potential confounders is
important for study design of both. One of the key assumptions
of causal inference is that no unmeasured confounders exist.
3. Answer: c. Systematic bias differs from random error
(chance) in that it is consistent variation causing the measured
association to differ from the true association. This systematic
error results from information bias (as in a device or measure
that over- or underreports a value), confounding, and selection
bias. Mediators differ from confounders in that they are a part of
the causal pathway, connecting the independent and dependent
variables. Mediators do not contribute to systematic bias,
although they should be included in a carefully designed analytic
plan.
4. Answer: d. In addition to conducting a literature review to
clarifying knowledge gaps, it is important to know what has been
published with your data sources or outcomes. There may be
recognized limitations with prior attempts to tailor the analysis
accordingly. Every study design will have limitations, which is
why all manuscripts address them in the discussion. However, a
https://t.me/med1917
rigorous study considers these limitations early in the design
and analytic process. Waiting until the discussion allows for a
few sentences to discuss them but can result in those limitations
having more impact on the results than if addressed proactively.
Although it is important to apply the unique approach of a
surgeon to understanding the clinical implications of study
design and findings, a multidisciplinary research team must
consider all limitations.
5. Answer: c. Incorporating these domain scores will entail
prospective data collection. WOUND-Q domain scores are not
captured in TOPS or NSQIP. To date, neither are any of the
other Q portfolio scales (eg, BREAST-Q or LYMPH-Q). This is
one of the considerations when designing a study using existing
retrospective datasets. Although current research efforts
incorporating these scales may create datasets available for
future use, these PROM (patient-reported outcomes measures)
are not included in datasets created prior to their development.
As a result, if patient-reported outcomes are the priority for
understanding the clinical problem, it may be necessary to
design a prospective data collection approach.
REFERENCES
1. Greenberg CC, Dimick JB. Health services research. In: Chen H,
Kao LS , eds. Success in Academic Surgery: Part 1. Springer
London; 2012:91-109.
2. Ayanian JZ. Determinants of racial and ethnic disparities in
surgical care. World J Surg. 2008;32(4):509-515. doi:10.1007/s00268007-9344-4
3. Connors SK, Goodman MS, Myckatyn T, Margenthaler J, Gehlert
S. Racial disparities in breast reconstruction at a comprehensive
cancer center. J Racial Ethn Health Disparities. 2022;9(6):2323-2333.
doi:10.1007/s40615-021-01169-3
https://t.me/med1917
4. Kamali P, Zeervall SL, Wu W , et al. Differences in the reporting
of racial and socioeconomic disparities among three large national
databases for breast reconstruction. Plast Reconstr Surg.
2017;139(4):795-807. doi:10.1097/prs.0000000000003207
5. Berwick DM. The moral determinants of health. JAMA.
2020;324(3):225-226. doi:10.1001/jama.2020.11129
6. Le E, Adekunle D, McMurray P , et al. Health equity tourism:
ravaging the justice landscape. J Med Syst. 2022;46(3):17.
doi:10.1007/s10916-022-01803-5
7. Birkmeyer JD, Dimick JB, Birkmeyer NJ. Measuring the quality of
surgical care: structure, process, or outcomes? J Am Coll Surg.
2004;198(4):626-632. doi:10.1016/j.jamcollsurg.2003.11.017
8. Donabedian A. The quality of care. How can it be assessed?
JAMA. 1988;260(12):1743-1748. doi:10.1001/jama.260.12.1743
9. Ibrahim AM, Dimick JB. What metrics accurately reflect surgical
quality? Annu Rev Med. 2018;69:481-491. doi:10.1146/annurevmed-060116-022805
merit-based incentive payment system. J Hand Surg Am.
2022;47(9):890-893. doi:10.1016/j.jhsa.2022.04.009
payment system and surgeons caring for patients at high social
risk. JAMA Surg. 2021;156(11):1018-1024.
doi:10.1001/jamasurg.2021.3746
Johns Hopkins University Press; 2020:xi, 216.
distance on breast reconstruction in the United States. Plast
Reconstr Surg. 2016;137(1):12-18. doi:10.1097/prs.0000000000001847
https://t.me/med1917
between hospital financial distress and immediate breast
reconstruction surgery after mastectomy among women with
ductal carcinoma in situ. JAMA Surg. 2018;153(4):344-351.
doi:10.1001/jamasurg.2017.5018
state-specific medicaid expansion and receipt of autologous breast
reconstruction among patients undergoing mastectomy. JAMA
Netw Open. 2021;4(8):e2119141.
doi:10.1001/jamanetworkopen.2021.19141
of access to breast reconstruction: a systematic review. Plast
Reconstr Surg. 2019;143(3):465e-476e.
doi:10.1097/prs.0000000000005313
access: a systematic literature review, conceptual model, and
evidence map. J Am Coll Surg. 2019;228(3):276-298.
doi:10.1016/j.jamcollsurg.2018.12.028
state policy changes on racial/ethnic variation in immediate
postmastectomy breast reconstruction. Plast Reconstr Surg.
2015;135(5):1285-1294. doi:10.1097/prs.0000000000001149
Perspectives of women who forgo post-mastectomy breast
reconstruction: a mixed methods analysis. Plast Reconstr Surg
Glob Open. 2021;9(2):e3203. doi:10.1097/gox.0000000000003203
September 10, 2023. hps://decisionaid.ohri.ca/models.html
postmastectomy breast reconstruction and strategies for
https://t.me/med1917
mitigation. Ann Surg Oncol. 2021;28(11):6099-6108.
doi:10.1245/s10434-021-10487-z
racial and ethnic minorities and interventions to address inequities:
a narrative review. Ann Surg. 2023;278(2):184-
192.doi:10.1097/sla.0000000000005858
breast reconstruction: reducing the disparity through educational
outreach to the underserved. Support Care Cancer. 2021;29(2):1055-
1063. doi:10.1007/s00520-020-05589-5
improve delivery of oncologic reconstructive surgery. Ann Surg
Oncol. 2020;27(7):2117-2119. doi:10.1245/s10434-020-08465-y
study of the number and frequency of terms used to refer to
knowledge translation in a body of health literature in 2006: a
Tower of Babel? Implement Sci. 2010;5:16. doi:10.1186/1748-5908-516
implementation research: conceptual distinctions, measurement
challenges, and research agenda. Adm Policy Ment Health.
2011;38(2):65-76. doi:10.1007/s10488-010-0319-7
done. JAMA Surg. 2019;154(10):891-892.
doi:10.1001/jamasurg.2019.1515
Wilkins; 2007.
clinical research: insight from the M-CHOIR group. Plast Reconstr
https://t.me/med1917
Surg Glob Open. 2020;8(5):e2848.
doi:10.1097/gox.0000000000002848
Development of a new patient-reported outcome measure for
breast surgery: the BREAST-Q. Plast Reconstr Surg.
2009;124(2):345-353. doi:10.1097/PRS.0b013e3181aee807
mastectomy improves quality of life in transmasculine patients: a
single-center prospective study. Ann Surg. 2023;277(3):e725-e729.
doi:10.1097/sla.0000000000005158
claims. Surgery. 2018;164(6):1135-1136.
doi:10.1016/j.surg.2018.01.005
research in plastic surgery. Ann Plast Surg. 2016;76(4):453-458.
doi:10.1097/sap.0000000000000750
Learning from an unsuccessful study idea: reflection and
application of innovative techniques to prevent future failures.
Plast Reconstr Surg. 2018;141(4):1056-1062.
doi:10.1097/prs.0000000000004246
for more robust and reproducible presentation of the methodology
employed in a scientific study. World J Plast Surg. 2017;6(3):390-
392.
surgery. Plast Reconstr Surg. 2010;126(3):1089-1097.
doi:10.1097/PRS.0b013e3181e60624
https://t.me/med1917
study to develop the WOUND-Q patient-reported outcome
measure for all types of chronic wounds. Int Wound J.
2021;18(4):487-509. doi:10.1111/iwj.13549
American Society of Plastic Surgeons. Accessed September 9, 2021.
hps://www.plasticsurgery.org/for-medicalprofessionals/registries/tracking-operations-and-outcomes-forplastic-surgeons
plastic surgery operations using the NSQIP and TOPS databases.
Plast Reconstr Surg Glob Open. 2020;8(5):e2841.
doi:10.1097/gox.0000000000002841
registries in breast surgery: a comparison of the tracking
operations and outcomes for plastic surgeons and national surgical
quality improvement program data sets. Ann Plast Surg.
2015;74(2):157-162. doi:10.1097/sap.0000000000000383
incidence of the impostor phenomenon in academic plastic
surgery: a multi-institutional survey study. Plast Reconstr Surg.
2023.
relationship between breast reconstruction subtype and risk of
financial toxicity: a single-institution pilot study. Plast Reconstr
Surg. 2021;148(1):1e-11e.
reality of commercial payer-negotiated rates in cleft lip and palate
repair. Plast Reconstr Surg. 2023;152(3):476e-487e.
https://t.me/med1917
fixation for open retromuscular ventral hernia repairs: a
randomized clinical trial. JAMA Surg. 2023;158(8):789-795.
doi:10.1001/jamasurg.2023.1786
Injury Surgical Trial Group. The wrist and radius injury surgical
trial: 12-month outcomes from a multicenter international
randomized clinical trial. Plast Reconstr Surg. 2020;145(6):1054e1066e.
Effect of abandoned housing interventions on gun violence,
perceptions of safety, and substance use in black neighborhoods: a
citywide cluster randomized trial. JAMA Intern Med.
2023;183(1):31-39. doi:10.1001/jamainternmed.2022.5460
trials: best practices and statistical guidance. Health Serv Outcome
Res Methodol. 2019;19(1):23-35. doi:10.1007/s10742-018-0192-5
association through causal inference. Plast Reconstr Surg.
2023;152(4):899-907. doi:10.1097/prs.0000000000010305
Reconstr Surg. 2022;150(1):1-3.
Affordable care act state-specific medicaid expansion: impact on
health insurance coverage and breast cancer screening rate. J Am
Coll Surg. 2020;230(5):775-783.
doi:10.1016/j.jamcollsurg.2020.01.031
research. JAMA. 2016;316(17):1818-1819.
doi:10.1001/jama.2016.16435
https://t.me/med1917
Соседние файлы в папке Библиотека им академика М.И. Перельмана