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PubMed1997

[Investigation methods in clinical cardiology. IV. Clinical measurements in cardiology: validity and errors of measurements].

Measurements represent an essential part of clinical activity. Very often, however, relevant disagreement in clinical measurements becomes apparent. The sources of this variability are the subjects (patients) that are measured, the measurement instrument itself, and the observer. The assessment of the quality of measurement usually relies on the evaluation of its reproducibility and its validity. The reproducibility is basically measured as the inter-observer concordance, the intra-observer concordance, and the test-retest concordance. The specific parameter used to its quantification (intra-class correlation coefficient, kappa index, graphic methods, etc.) depend on the kind of variable to be measured. The validity of the measurement is the degree to which the measurement is really measuring what we think it should. If an acceptable standard is available, then so called criterion validity is usually assessed. Otherwise the validity should be assessed by other ways that use subjective criteria (content validity and face validity) or empirical criteria (construct validity).

Cardiology↗
PubMed1997

[Investigation methods in clinical cardiology. VI. Evaluation of results (outcomes) and its clinical relevance in cardiology: with a special reference to the quality of life].

Over the last decade, changes in health care delivery and concern with costs and with dramatic variations in practice between regions, institutions and even physicians at the same institution have led the administrators and health politicians to focus on the outcomes of medical care. The Agency for Health Care Policy and Research was established with the objective of fostering research on the outcomes of medical interventions and on the development of guidelines. The Agency supports studies based not only on standard outcomes such as mortality and morbidity, but also on quality of life and patient satisfaction. The Patient Outcome Research Teams (PORTs) projects are the showcase displays of the Agency, and their goals are to identify and analyze the outcomes and costs of alternative interventions for a given clinical condition, in order to determine the most effective and cost-effective means to prevent, diagnose, treat, or manage it and develop and test methods for reducing inappropriate or unnecessary variations. Three PORTs are focused on the following cardiovascular conditions: acute myocardial infarction, chronic ischemic heart disease and stroke. There are many situations in which randomized clinical trials are not feasible and large-scale observational studies are necessary to generate information about what happens in the real practice. This information deepens the understanding of practical effectiveness as opposed to theoretical efficacy since trials do not always measure all the outcomes of interest to patients and physicians. One way to solve the problem of inaccurate data of observational studies is by establishing a specific registry to measure in an efficient way key patient characteristics, process of care elements and relevant outcomes. The Cardiac Surgery Reporting System is a registry that collects clinical data on all patients undergoing cardiac surgery in New York State. This registry has produced reliable and valid measures of quality and hospitals and cardiac surgery programs throughout New York use this information to improve outcomes for their patients. Health related quality of life can be a useful outcome measure in the assessment of clinical effectiveness. However, there are still many methodological questions regarding the validity and sensitivity of quality of life measurement an optimal study design calls for caution in the interpretation of current results and makes refinement of methodological issues a desirable goal. Nevertheless, apparently valid studies of cardiovascular diseases and interventions using health related quality of life as an outcome measures have been reported where such measures have provided information about undesirable side effects of medications and the impact of the intervention on the health related quality of life. Moreover, some of these studies have identified different patterns of health care as leading to different quality of life outcomes. Thus, quality of life measurement appears as a technology which holds promise for the future assessment of clinical effectiveness.

Cardiology↗
PubMed2001

ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: executive summary. A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation): developed in Collaboration With the North American Society of Pacing and Electrophysiology.

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