Study design

研究设计
  • 文章类型: Journal Article
    电子健康记录(EHR)越来越被认为是临床研究中招募患者的一种具有成本效益的资源。然而,如何从数百万个体中最佳地选择一个队列来回答一个感兴趣的科学问题仍不清楚.考虑一项研究来估计昂贵结果的平均值或平均差。预测结果的廉价辅助协变量通常可以在患者的健康记录中获得,提供了一个有选择地招募病人的机会,这可能会提高下游分析的效率。在本文中,我们提出了一种两阶段采样设计,该设计利用了EHR数据中辅助协变量的可用信息。使用EHR数据进行多相采样的一个关键挑战是潜在的选择偏差,因为EHR数据不一定代表目标人群。扩展有关两阶段采样设计的现有文献,我们得出了一种最佳的两阶段抽样方法,该方法可以提高随机抽样的效率,同时考虑到EHR数据中潜在的选择偏差。我们通过模拟研究和利用密歇根基因组学计划的数据评估美国成年人高血压患病率的应用,证明了我们的采样设计的效率提高。密歇根医学的纵向生物储物库。
    Electronic health records (EHRs) are increasingly recognized as a cost-effective resource for patient recruitment in clinical research. However, how to optimally select a cohort from millions of individuals to answer a scientific question of interest remains unclear. Consider a study to estimate the mean or mean difference of an expensive outcome. Inexpensive auxiliary covariates predictive of the outcome may often be available in patients\' health records, presenting an opportunity to recruit patients selectively, which may improve efficiency in downstream analyses. In this paper we propose a two-phase sampling design that leverages available information on auxiliary covariates in EHR data. A key challenge in using EHR data for multiphase sampling is the potential selection bias, because EHR data are not necessarily representative of the target population. Extending existing literature on two-phase sampling design, we derive an optimal two-phase sampling method that improves efficiency over random sampling while accounting for the potential selection bias in EHR data. We demonstrate the efficiency gain from our sampling design via simulation studies and an application evaluating the prevalence of hypertension among U.S. adults leveraging data from the Michigan Genomics Initiative, a longitudinal biorepository in Michigan Medicine.
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  • 文章类型: Journal Article
    鼻咽癌(NPC)患者的生存率明显提高,但是对于它们是否可以被认为治愈没有共识。我们旨在确定在当代治疗领域中NPC患者是否可以实现统计治愈。
    这项回顾性多中心研究纳入了2007年至2020年来自中国非地方性和地方性地区的6315例非转移性鼻咽癌患者。我们应用混合和非混合治愈模型,通过纳入一般人群的背景死亡率来估计治愈概率和治愈时间,按性别匹配,年龄,诊断一年。
    将死亡视为未治愈的事件,NPC患者达到与一般人群相当的预期寿命的概率为78.1%.将进展视为未治愈的事件,患者达到与普通人群相同的无进展预期寿命的可能性为72.4%.对于个人来说,实现治愈的概率是有条件的和时间依赖性的,需要大约7.1和4.7年,95%的确定性,分别。未治愈患者的相应治愈时间为8.9年和6.8年,分别。治愈概率与年龄相关,东部肿瘤协作组评分,TNM分期,爱泼斯坦-巴尔病毒的DNA拷贝,和乳酸脱氢酶.5年总生存期/无进展生存期和治愈分数之间的相关性非常好。
    在接受现代治疗方式的NPC患者中,统计治愈是可能实现的。结果对临床实践和患者观点都具有重要的潜在意义。
    国家高级医院临床研究资助;北京喜思客临床肿瘤学研究基金会;北京希望跑基金。
    UNASSIGNED: The survival rates of patients with nasopharyngeal carcinoma (NPC) have improved significantly, but there is no consensus on whether they can be considered cured. We aimed to determine whether a statistical cure could be achieved for patients with NPC in the contemporary therapeutic landscape.
    UNASSIGNED: This retrospective multicenter study enrolled 6315 patients with nonmetastatic NPC from nonendemic and endemic regions of China from 2007 to 2020. We applied mixture and nonmixture cure models to estimate the cure probabilities and cure times by incorporating background mortality for the general population, matching by gender, age, and diagnosed year.
    UNASSIGNED: With death as the uncured event, the probability of patients with NPC achieving a life expectancy at par with the general population was 78.1%. Considering progression as the uncured event, the likelihood of patients attaining a life expectancy without progression equivalent to that of the general population was 72.4%. For individuals, the probabilities of achieving cure were conditional and time-dependent, requiring approximately 7.1 and 4.7 years with 95% certainty, respectively. The corresponding cure times for uncured patients were 8.9 and 6.8 years, respectively. The cure probability was correlated with age, Eastern Cooperative Oncology Group score, TNM staging, Epstein-Barr virus DNA copies, and lactate dehydrogenase. The correlation was excellent between 5-year overall survival/progression-free survival and cure fractions.
    UNASSIGNED: Statistical cure is potentially achievable among patients with NPC undergoing contemporary treatment modalities. The results hold significant potential implications for both clinical practice and patient perspectives.
    UNASSIGNED: National High Level Hospital Clinical Research Funding; Beijing Xisike Clinical Oncology Research Foundation; Beijing hope run fund.
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  • 文章类型: Journal Article
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  • 文章类型: Journal Article
    严重急性呼吸道综合症冠状病毒2(SARS-CoV-2)在2019年的几个月中席卷全球,并在2020年初成为冠状病毒病19(COVID-19)大流行的原因。在之前的呼吸道大流行中使用恢复期血浆(CP)为2020年初在没有经过验证的治疗或先前免疫的情况下快速部署COVID-19恢复期血浆(CCP)提供了强有力的生物学依据。CCP是一种抗病毒剂,其对SARS-CoV-2的活性源于病毒引起的特异性抗体。在针对COVID-19住院患者的随机临床试验(RCTs)中,早期调查CCP疗效的努力没有证明CCP的总体疗效,尽管在某些亚组中有获益的信号,比如那些在疾病早期接受治疗的人。相比之下,在研究设计中坚持抗体治疗原则的研究,患者人群的选择,和产品资格,即,那些在免疫功能低下或免疫功能低下的个体在疾病的病毒阶段或非常早期施用高水平特异性抗体的人,展示的好处。在这一章中,我们利用从CCP对COVID-19的临床研究中获得的知识,为未来CP对一种新的传染病的研究提出了一个框架。该框架包括获得高质量的CP和设计遵循抗体治疗原则的临床研究,以产生使用CP的强大证据基础。
    Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) swept across the world in the waning months of 2019 and emerged as the cause of the coronavirus disease 19 (COVID-19) pandemic in early 2020. The use of convalescent plasma (CP) for prior respiratory pandemics provided a strong biological rationale for the rapid deployment of COVID-19 convalescent plasma (CCP) in early 2020 when no validated treatments or prior immunity existed. CCP is an antiviral agent, with its activity against SARS-CoV-2 stemming from specific antibodies elicited by the virus. Early efforts to investigate the efficacy of CCP in randomized clinical trials (RCTs) that targeted hospitalized patients with COVID-19 did not demonstrate the overall efficacy of CCP despite signals of benefit in certain subgroups, such as those treated earlier in disease. In contrast, studies adhering to the principles of antibody therapy in their study design, choice of patient population, and product qualification, i.e., those that administered high levels of specific antibody during the viral phase of disease in immunocompromised or very early in immunocompetent individuals, demonstrated benefits. In this chapter, we leverage the knowledge gained from clinical studies of CCP for COVID-19 to propose a framework for future studies of CP for a new infectious disease. This framework includes obtaining high-quality CP and designing clinical studies that adhere to the principles of antibody therapy to generate a robust evidence base for using CP.
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  • 文章类型: Journal Article
    韩国家庭医学杂志(KJFM),这是韩国家庭医学研究院的官方期刊,是自2009年以来出版的英文医学杂志。尽管自该杂志发行以来已经过去了近15年,据我们所知,没有研究回顾了KJFM发表的文章.因此,我们首次分析了KJFM发表的文章。
    2018年1月至2023年11月在KJFM上发布的文章根据文章类型进行了分类。关于作者从属关系的信息,研究对象,研究方法,然后对数据收集模式进行了审查。此外,我们比较了受试者的频率,之前的研究方法和数据收集模式,during,在2019年冠状病毒病大流行之后。
    原始文章是最常见的文章类型。大约52%的文章是由家庭医学以外的其他部门的作者发表的,40%是由家庭医学出版的。大约60%和38%的文章是由韩国作者和国际会员作者发表的,分别。在整个大流行期间,专注于“疾病和症状”的研究主题已经减少,而“家庭医学原则”逐渐增多。此外,横断面研究方法的使用有所下降.在数据收集方面,“大数据”的使用,\"\"医疗记录,“和”问卷“已经减少,而“研究结果”的使用有所增加。
    KJFM是广泛和国际参与的期刊,涵盖各种研究主题和研究方法。我们相信我们的研究为KJFM的未来方向和发展提供了有价值的数据。
    UNASSIGNED: The Korean Journal of Family Medicine (KJFM), which is an official journal of the Korean Academy of Family Medicine, is an English-text medical journal published since 2009. Although nearly 15 years have passed since the journal was launched, to the best of our knowledge, no study has reviewed articles published in the KJFM. Accordingly, we analyzed articles published in the KJFM for the first time.
    UNASSIGNED: Articles published in the KJFM between January 2018 and November 2023 were categorized according to article type. Information about author affiliations, study subjects, research methods, and modes of data collection was then scrutinized. Moreover, we compared the frequencies of subjects, research methods and modes of data collection before, during, and after the coronavirus disease 2019 pandemic.
    UNASSIGNED: Original article was the most common article type. Approximately 52% of the articles were published by authors affiliated with departments other than family medicine, and 40% were published by family medicine. Approximately 60% and 38% of the articles were published by Korean authors and authors of international affiliations, respectively. Throughout the pandemic periods, research subjects focusing on \"diseases & symptoms\" have diminished, while \"principles of family medicine\" have progressively increased. Additionally, the use of cross-sectional study methods has declined. In terms of data collection, the use of \"big data,\" \"medical records,\" and \"questionnaires\" has decreased, whereas the use of \"study results\" has increased.
    UNASSIGNED: KJFM is journal with wide and international participation covering various research subjects and study methods. We believe that our study provides valuable data for the future direction and development of the KJFM.
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  • 文章类型: Journal Article
    成功的临床试验需要参与者,但是许多因素会阻碍有效的学习招募。为了更好地在客户拥有的动物中招募高质量的兽医临床试验,从而改善基于证据的患者护理和结果,集体需要分享和实施当前的招聘战略最佳做法。这些战略应利用招聘的整体观点,包括研究设计和后勤,代表参与,激励机制,人力资源,广告,和参与者保留。虽然人体临床试验数据和资源可以提供指导,还需要努力评估当前的实践和流程改进的机会,这是具体的兽医临床试验的进行。考虑到宠物作为自然发生的疾病模型和哨兵的力量,兽医临床研究的改进有可能告知人类健康结果。围绕兽医临床研究最佳实践和培训机会的持续合作发展将提高兽医临床试验团队的影响力,同时还促进了兽医专业人员的劳动力发展和替代职业道路。
    A successful clinical trial requires participants, but many factors can impede effective study recruitment. To better recruit for quality veterinary clinical trials in client-owned animals that lead to improved evidence-based patient care and outcomes, there is a collective need to share and implement current best practices for recruitment strategies. These strategies should utilize a holistic view of recruitment, encompassing study design and logistics, representative participation, incentives, personnel resources, advertising, and participant retention. Although human clinical trial data and resources can provide guidance, effort also needs to be put into evaluating current practices and opportunities for process improvement that are specific to the conduct of veterinary clinical trials. Considering the power of pets as naturally occurring models of disease and as sentinels, improved conduct of veterinary clinical research has the potential to inform human health outcomes. Continued development of collaborations surrounding best practices and training opportunities in veterinary clinical research will improve the impact of veterinary clinical trials teams, while also promoting workforce development and alternate career paths for veterinary professionals.
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  • 文章类型: Journal Article
    背景:研究已经确定了恋爱关系对个体发病率和死亡率的影响。然而,关系运作之间的相互作用,情感过程,健康行为研究相对不足。在COVID-19大流行期间,关系过程可能会影响新的健康行为,如社交距离和掩蔽。
    目的:我们描述了设计,招募,以及关系的方法,风险认知,以及COVID-19大流行研究期间与癌症相关的行为。这项研究旨在了解关系和情感过程如何影响浪漫伴侣参与癌症预防行为以及COVID-19大流行引入或加剧的健康行为。
    方法:关系,风险认知,在COVID-19大流行研究期间,癌症相关行为使用在线调查方法招募和招募2组参与同居浪漫关系的个体,包括1组成组(n=223)和1组癌症幸存者(n=443)。调查评估在平均间隔5.57(SD3.14)周的2个时间点完成。评估的健康行为包括COVID-19疫苗接种和社交距离,身体活动,饮食,睡眠,酒精使用,和吸烟行为。我们还检查了关系因素,心理困扰,家庭混乱。
    结果:数据收集发生在2021年10月至2022年8月之间。在此期间,共有926名参与者参加,其中约三分之二来自英国(n=622,67.8%),三分之一来自美国(n=296,32.2%);约三分之二已婚(n=608,66.2%),三分之一是未婚夫妇(n=294,32%).在队列1和2中,平均年龄分别约为34岁和50岁。在队列1的478名参与者中,有19名(4%)被确定为西班牙裔或拉丁裔/a,79(17%)为非西班牙裔亚洲人,40(9%)是非西班牙裔黑人或非裔美国人,和306(64%)为非西班牙裔白人;62(13%)参与者确定他们的性取向为双性恋或泛性,359(75.1%)为异性恋或异性恋,和53(11%)为同性恋。在队列2中,在440名参与者中,13(3%)被确定为西班牙裔或拉丁裔/a,8(2%)为非西班牙裔亚洲人,5(1%)是非西班牙裔黑人或非裔美国人,和398(90.5%)为非西班牙裔白人;41(9%)参与者确定他们的性取向为双性恋或泛性,384(87.3%)为异性恋或异性恋,13(3%)是同性恋。个人的总体入学率为66.14%,总体完成率为80.08%。
    结论:我们讨论了收集在线调查数据的最佳实践,用于研究人际关系和健康,与COVID-19大流行有关的挑战,招募代表性不足的人口,和二元组的注册。建议包括进行试点研究,为边缘化或服务不足的人群提供额外的数据收集时间,盈余筛选,以说明二元组合内的预期减员,以及计划dyad特定的数据质量检查。
    DERR1-10.2196/48516。
    BACKGROUND: Research has established the effects of romantic relationships on individuals\' morbidity and mortality. However, the interplay between relationship functioning, affective processes, and health behaviors has been relatively understudied. During the COVID-19 pandemic, relational processes may influence novel health behaviors such as social distancing and masking.
    OBJECTIVE: We describe the design, recruitment, and methods of the relationships, risk perceptions, and cancer-related behaviors during the COVID-19 pandemic study. This study was developed to understand how relational and affective processes influence romantic partners\' engagement in cancer prevention behaviors as well as health behaviors introduced or exacerbated by the COVID-19 pandemic.
    METHODS: The relationships, risk perceptions, and cancer-related behaviors during the COVID-19 pandemic study used online survey methods to recruit and enroll 2 cohorts of individuals involved in cohabiting romantic relationships, including 1 cohort of dyads (n=223) and 1 cohort of cancer survivors (n=443). Survey assessments were completed over 2 time points that were 5.57 (SD 3.14) weeks apart on average. Health behaviors assessed included COVID-19 vaccination and social distancing, physical activity, diet, sleep, alcohol use, and smoking behavior. We also examined relationship factors, psychological distress, and household chaos.
    RESULTS: Data collection occurred between October 2021 and August 2022. During that time, a total of 926 participants were enrolled, of which about two-thirds were from the United Kingdom (n=622, 67.8%) and one-third were from the United States (n=296, 32.2%); about two-thirds were married (n=608, 66.2%) and one-third were members of unmarried couples (n=294, 32%). In cohorts 1 and 2, the mean age was about 34 and 50, respectively. Out of 478 participants in cohort 1, 19 (4%) identified as Hispanic or Latino/a, 79 (17%) as non-Hispanic Asian, 40 (9%) as non-Hispanic Black or African American, and 306 (64%) as non-Hispanic White; 62 (13%) participants identified their sexual orientation as bisexual or pansexual, 359 (75.1%) as heterosexual or straight, and 53 (11%) as gay or lesbian. In cohort 2, out of 440 participants, 13 (3%) identified as Hispanic or Latino/a, 8 (2%) as non-Hispanic Asian, 5 (1%) as non-Hispanic Black or African American, and 398 (90.5%) as non-Hispanic White; 41 (9%) participants identified their sexual orientation as bisexual or pansexual, 384 (87.3%) as heterosexual or straight, and 13 (3%) as gay or lesbian. The overall enrollment rate for individuals was 66.14% and the overall completion rate was 80.08%.
    CONCLUSIONS: We discuss best practices for collecting online survey data for studies examining relationships and health, challenges related to the COVID-19 pandemic, recruitment of underrepresented populations, and enrollment of dyads. Recommendations include conducting pilot studies, allowing for extra time in the data collection timeline for marginalized or underserved populations, surplus screening to account for expected attrition within dyads, as well as planning dyad-specific data quality checks.
    UNASSIGNED: DERR1-10.2196/48516.
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  • 文章类型: Journal Article
    背景:设计有效的健康干预措施并评估其影响对于改善人群健康至关重要。为了确保干预措施的质量和有效性,基于证据的研究是必不可少的,特别是使用随机对照试验(RCT)或系统评价的研究。然而,RCT在某些情况下可能不可行或不符合道德标准,例如在重症监护病房。集群或阶梯式楔形RCT是评估干预措施的替代方法,也可以解决这些道德问题。
    目的:解释阶梯式楔形设计及其主要特征,以及如何使用它来评估护理干预措施。
    结论:了解阶梯式楔形设计使护士能够实施循证干预措施并改善患者预后。在过去的二十年中,阶梯式楔形设计的使用在护理研究中有所增加,表明人们越来越认识到其优势:对医疗保健干预措施的有效评估,确保所有集群随着时间的推移接受治疗;较小的样本量;道德考虑;和时间控制。然而,挑战依然存在:确保护士研究人员对它的理解和应用是一致的,延长的持续时间和后勤复杂性。方法的严谨性,合作和对长期趋势的理解至关重要,护士参与RCT增强了集群选择,数据收集和传播。
    结论:阶梯式楔形设计为研究干预措施提供了一种道德和适应性的方法,考虑医疗保健的复杂性和资源分配。它的多功能性有助于推进护理服务的提供和促进循证实践。
    结论:了解护理实践中的阶梯式楔形设计可增强循证护理,决策,合作和专业发展,有利于患者的结果。
    BACKGROUND: Designing effective health interventions and evaluating their impact is crucial to improving the health of the population. To ensure interventions are of high quality and effective, evidence-based research is essential, particularly studies that use randomised controlled trials (RCTs) or systematic reviews. However, RCTs may not be feasible or ethical in certain situations, such as in intensive care units. Cluster or stepped-wedge RCTs are alternative ways to assess interventions that also address these ethical concerns.
    OBJECTIVE: To explain the stepped-wedge design and its main features as well as how to use it to evaluate nursing interventions.
    CONCLUSIONS: Understanding stepped-wedge designs empowers nurses to implement evidence-based interventions and improve patient outcomes. The use of stepped-wedge designs has increased in nursing research over the past two decades, indicating growing recognition of its advantages: efficient evaluation of healthcare interventions, ensuring all clusters receive treatment over time; smaller sample sizes; ethical considerations; and time control. However, challenges remain: ensuring nurse researchers\' understanding and application of it is consistent, extended duration and logistical complexities. Methodological rigour, collaboration and understanding of secular trends are crucial, and nurses\' involvement in RCTs enhances cluster selection, data collection and dissemination.
    CONCLUSIONS: The stepped-wedge design offers an ethical and adaptable method for studying interventions, considering healthcare complexities and allocating resources. Its versatility assists the advancement of nursing care delivery and in promoting evidence-based practice.
    CONCLUSIONS: Understanding stepped-wedge designs in nursing practice enhances evidence-based care, decision-making, collaboration and professional development, benefiting patient outcomes.
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  • 文章类型: Journal Article
    虽然人们认识到身体活动和心理健康之间的联系可以追溯到近两千年前,体育活动的学术研究是一个相对年轻的学科新兴的过去50年。本章概述了身体活动中的关键术语和测量技术,锻炼,心理健康研究。体育活动研究中最常见的研究设计包括横截面,队列,随机对照试验,系统评价,和元分析研究。在心理健康研究的整个章节中,讨论了文献中的例子以及各种方法论方法的优缺点。
    While recognition of the link between physical activity and mental health dates back nearly two millennia, the academic study of physical activity is a relatively young discipline emerging over the last 50 years. This chapter provides an overview of key terms and measurement techniques in physical activity, exercise, and mental health research. The most common study designs in physical activity research include cross-sectional, cohort, randomized controlled trials, systematic reviews, and meta-analytic studies. Examples from the literature as well as the advantages and disadvantages of various methodological approaches are discussed throughout the chapter in the context of mental health research.
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