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  1. 1. Translational Research at the UIB Closing the circle: Patients-Data-Models-Patients 2019-2022 Trajectory
  2. 2. Activities with Innovation/Translation Potential  Application of the Foster-Hartman method (SMR) from the HUT  Development of a contextual model that mathematically confirms the relevance of the Stroke Units.  Development of two predictive models:  Mortality in non-reperfused ischaemic stroke (GRD 14)  Mortality in interventional Colorectal Cancer (ICD 9MC 154-155)  Approaching convolutional neural networks
  3. 3. IDi value chain
  5. 5. Implantación del método de Foster en España
  6. 6. Empirical model (SEM) of Stroke Mortality in Spanish intra-hospital settings: the role of Individual and Contextual factors Juan Manuel García-Torrecillas. HU Torrecárdenas Jesús de la Fuente Arias. University of Almeria/Navarra Giulliana Solinas. University of Sassary Mar Iglesias Espinosa. HU Torrecárdenas Angélica Garzón-Umerenkova. Fundación Konrad Lorenz Javier Fiz Pérez. Universitá Europea di Roma
  7. 7. Stroke and Contextual Models
  8. 8. + - -
  9. 9. From data to information Robust Logistic Modeling and transference to an App in estimating the risk of mortality in the emergency department Juan Manuel García-Torrecillas. Hospital Torrecárdenas, Almería Jesús de la Fuente Arias. University of Almeria Giulliana Solinas. University of Sassary Gabrielle Giorgy. University of Roma Grupo de Investigación en CCR. #EpiCCR Hospital Universitario Torrecárdenas Proyecto FIS-ISCIII 16/01931 Cofinanciado Fondos FEDER
  10. 10. Third etiology of death in Occident USA: 1 event every 40 seconds Incidence (Europe): 95-290 ep/100.000 p-year High rate of complications and sequels Mortality Rate 36 episodes/100,000person-year First etiology of death in Spanish women Is an time-dependent disease Importance of individual and contextual factors Importance of specialted personal in the first atention What about benefits of knowing Stroke´s risk of mortality?
  11. 11. Third etiology of malignant neoplasm 15% tumoral incidence at Spain Second aetiology of death in Europe 25,000 new cases/year at Spain High mortality but with a forecast of continuous improvement Significant differences between observed and expected mortality (SMR) Importance of individual and contextual factors Importance of specialted personal in the first atention What about CCR mortality?
  12. 12. PRINCIPAL Detect associated factors to in hospital mortality in patients admited by isquémic Stroke/CCR surgery treated ESPECIFIC Evaluate the Discriminative ability (trough de AUC) and Callibration (trough visual risk centiles of Hosmer Lemeshow Test)
  13. 13. All the episodes of DRG 14//CCR admited in Spanish hospitals during the period 2008-2012-14 Source Information CMBDH years 2008-14 -Heath and Social Politics Ministery -Statistical Web of Health Ministery - National Health Statistics Diagnosis Codification CIE 9- MC AP-GRD versión 21.0 Criterios de Urrea et al Specific GRD 186,245 episodes (Stroke) 258,927 episodes (CCR) Observational anality study. Historic Cohort, DRG (Ischemic Stroke and CCR) Design and Episodes in the study
  14. 14. Explanatory Variables In Hospital Mortality Dependent Variable Variables in the study Age (years) Year (2008-2012) Sex (male-female) AACC (Méth. Foster/SMR) Brain topography Clinical Comorbidities Financials Dates: Born-Admission-Discharge Type of Admission: (UI-PI)/ Type of discharge CIE Diagnostic (14 places) CIE Procedures (20 places) Clinical Complications
  15. 15. Descriptive and Inference Inferential Study Descriptive Exploratory Cuantitative Variables Means (SD), CI 95% normal method Categórical Variables Frecuency Tables; % & CI 95% Cualitative Variables t de Student (con Levene) Categorical Variables Pearson χ2 CI Examination Bivariant Studies OR (CI 95%) Robust Logistic Regression OR adjusted (CI 95%) Discrimination: ROC. C-Statistic Calibration: Hosmer-Lemeshow Predictive Model Constant observation of the non- differential classification bias
  16. 16. Introducing Data Science with Classic Models Clasification Trees
  17. 17. Permutation Test Random Forest Anothe point of view Selecting Variables
  18. 18. Descriptive and Evolution of Admissions (Stroke example) 186,245 patients admitted (episodes) Length of stay: 7,54 (4,54) days Age: 73,92(12,54) years NDA: 6,91 (2.96) diag. NPA: 3,27 (2,45) proc. Readmissions: 4,8% Exitus: 6,9% 36900 37000 37100 37200 37300 37400 37500 2008_ 2009_ 2010_ 2011_ 2012_ Año 37084 37114 37399 37228 37420 Admissions/Year
  19. 19. Robust Logistic Regression Method of logistic: Forced Enter Resampling (Bootstraping) -Apparent paradoxical effect of HTA -Effect of probable under-reporting of Dyslipidemia C=0,7746
  20. 20. Calibration with Risk Decils H-L STROKE. GRD 15 H-L CRC. CIE 9 154-155
  21. 21. FX1 = e EXP (-7,852 + 0,067*edad + 0,189*Sexoa + 0,679*Reingreso + 0,287*Cardiopatía isquémica - 0,336*HTA + 0,090*Diabetes + 0,428*Fibrilación Auricular - 0,441*Dislipemia + 0,397*Insuf Cardíaca + 1,039*Estenosis arteria basilar.
  22. 22. APPs for Ictus - Quick stimation of risk - Agile - Easy
  23. 23. Neurotics (
  24. 24. Modelo y Score de CCR Score de Riesgo
  25. 25. Inter-Model Comparison Internal Validation CRC
  26. 26. Model and Score of Subdural H Conservative Treatment
  27. 27. Colaboration UPM-HUT
  28. 28. AI-Conv
  29. 29. Conclusions  The use of CADB such as the CMBD allows quality benchmarking in Spain using the Foster methodology.  Hierarchical structural equation methodology confirms pre-existing evidence of the undeniable benefit of stroke units.  The predictive mortality model for non-lysed ischaemic stroke can be used to further optimise the high standards of stroke care already in place (Patent, PCT and PRI).
  30. 30.  External validation with Neurology will allow us to refine the stroke prediction model and assess whether imaging tests are essential for risk prediction or whether clinical tests can be equivalent.  The first entirely Spanish risk score for estimating the risk of death after surgery for CRC, entirely from Almeria, has been achieved (Registered).  The development of mobile applications in conjunction with the TICs Service will allow the estimation of complex risks in the shortest possible time.