Program Description
ICU clinicians rely on bedside physiological measurements to inform many routine clinical decisions. Because deranged physiology is usually associated with poor clinical outcomes, it is tempting to hypothesize that manipulating and intervening on physiological parameters might improve outcomes for patients. However, testing these hypotheses through mathematical models of the relationship between physiology and outcomes presents a number of important methodological challenges.
These models reflect the theories of the researcher and can therefore be heavily influenced by one’s assumptions and background beliefs. Model building must therefore be approached with great care and forethought, because failure to consider relevant sources of measurement error, confounding, coupling, and time dependency or failure to assess the direction of causality for associations of interest before modeling may give rise to spurious results. This paper outlines the main challenges in analyzing and interpreting these models and offers potential solutions to address these challenges.
Target Audience
Pulmonologists, critical care specialists, translational researchers, and clinicians
Learning Objectives
At the conclusion of this activity, learners should be able to:
- Define measurement accuracy and measurement precision, and explain how to quantify these parameters
- Identify different sources of confounding and bias in models that include physiological variables
- Discuss the importance of prespecifying hypotheses about causal relationships for optimal model design
Course summary
1.00 Participation
1.00 AMA PRA Category 1 Credit
Credit Expires: June 01, 2025
Format: Journal
ACCREDITATION STATEMENT
The American Thoracic Society is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
| Credit Type | Credit/Points | Credit Designation Statement |
| AMA PRA Category 1 Credit™ | 1.00 | The American Thoracic Society designates this Journal for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. |
DISCLOSURE DECLARATIONS
The current practice of the American Journal of Respiratory and Critical Care Medicine (AJRCCM) is to publish high quality, peer-reviewed and evidence-based original research, Concise Clinical Reviews, Guidelines and Consensus Statements. Articles published in AJRCCM include evidence-based summaries of optimal practice (Concise Clinical Reviews), evidence-based guidelines, workshop summaries and original contributions that will influence clinical practice. The publication of these articles by itself is only one piece of a multi-step process for the translation of evidence-based improvements in care to clinical practice. Articles selected for CME credit are designed to be the next step in the process of translating clinically relevant, evidence-based recommendations into clinical practice. This will be accomplished through a series of questions specifically designed by the author(s) to test that readers have the tools needed to translate recommendations for diagnostic and therapeutic clinical care into clinical practice. Members of the AJRCCM editorial board will review these questions and assess the quality of the questions based on:
- Clarity,
- Educational content, and
- The quality of the evidence supporting the response to the question. Posttest questions will assess if practitioners have understood the most important recommendations available for the diagnosis and treatment of pulmonary diseases, critical illness, and sleep disorders and are able to implement them into clinical practice.
Article Authorship Disclosures (as submitted to the ATS prior to article publication date)
Jose Dianti, M.D. (University of Toronto, Toronto, Canada) reported no relevant financial relationships with ineligible companies.
Idunn S. Morris, M.B.Ch.B.(Hons), F.R.C.A., F.C.I.C.M. (University of Toronto, Toronto, Canada; Nepean Hospital, Sydney, Australia) reported no relevant financial relationships with ineligible companies.
Martin Urner, M.D. (University of Toronto, Toronto, Canada) reported no relevant financial relationships with ineligible companies.
Marcello Schmidt, M.D., M.Sc. (University of Toronto, Toronto, Canada) reported no relevant financial relationships with ineligible companies.
George Tomlinson, M.Sc., Ph.D. (University Health Network and Sinai Health System, Toronto, Canada) reported receiving personal fees from ACCP Critical Care Board Review Course.
Marcelo B.P. Amato, M.D. (Universidade de São Paulo, Brazil) reported that, in the last five years, his laboratory has received research grants to investigate mechanical ventilation from Covidien/Medtronics, Orange Med/Nihon Koden, and MagnaMed S.A. He also received research grants from Timpel S.A, to investigate electrical impedance tomography. Dr. Amato is a minority shareholder in Timpel S.A.
Lluis Blanch, M.D., Ph.D. (Critical Care Center, Institut d’Investigació i Innovació Parc Taulí I3PT-CERCA, Parc Taulí Hospital Universitari, Barcelona, Spain) reported that he is a founder and stockholder of Bettercare, S.L. He has received US Patent No. 12/538,940 for a method and system for managed related patient parameters provided by a monitoring device.
Gordon Rubenfeld, M.D., M.Sc. (Sunnybrook Health Sciences Centre, Toronto, Canada) reported receipt of consulting fees related to study design from Cellenkos and Endpoint Health.
Ewan C. Goligher, M.D., Ph.D. (University of Toronto, Toronto, Canada; Toronto General Hospital Research Institute, Toronto, Canada) reported receipt of grants or contracts from CIHR; consulting fees from LungPacer, BioAge, and Zoll; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Vyaire and Getinge; and equipment, materials, drugs, medical writing, gifts or other services from LungPacer and Timpel.
Disclosures of AJRCCM CME Planners
The current practice of the American Journal of Respiratory and Critical Care Medicine (AJRCCM) is to publish high quality, peer-reviewed and evidence-based original research, Concise Clinical Reviews, Guidelines and Consensus Statements. Articles published in AJRCCM include evidence-based summaries of optimal practice (Concise Clinical Reviews), evidence-based guidelines, workshop summaries and original contributions that will influence clinical practice. The publication of these articles by itself is only one piece of a multi-step process for the translation of evidence-based improvements in care to clinical practice. Articles selected for CME credit are designed to be the next step in the process of translating clinically relevant, evidence-based recommendations into clinical practice. This will be accomplished through a series of questions specifically designed by the author(s) to test that readers have the tools needed to translate recommendations for diagnostic and therapeutic clinical care into clinical practice. Members of the AJRCCM editorial board will review these questions and assess the quality of the questions based on (1) clarity, (2) educational content, and (3) the quality of the evidence supporting the response to the question. Posttest questions will assess if practitioners have understood the most important recommendations available for the diagnosis and treatment of pulmonary diseases, critical illness, and sleep disorders and are able to implement them into clinical practice.
Off-Label Usage Disclosure
None
AJRCCM CME Planners
Edward Schenck, M.D.
Associate Editor, AJRCCM
Dr. Schenck reported that he is a consultant for Axle Informatics.
INSTRUCTIONS TO RECEIVE CREDIT
To receive credit for this journal article:
- Read the journal article. Keep track of how long it takes you to read it.
- Once you open the article, the Post-Test becomes available. After reading the article, answer the post-test questions. You must answer all questions correctly to earn credit. You may take the test as many times as you like.
- Once you pass the Post-Test, the Evaluation becomes available. Answer all the evaluation questions.
- Once you complete the evaluation, select the amount of credit to receive based on the time it took you to read the article.
- You can view, save and print your Certificate by pressing the Certificate button.
- To review the credits you've earned in this system and reprint certificates, go to the My Learning drop-down list. Then select Transcript.