शैडोइंग अभ्यास: Sequential, Multiple Assignment, Randomized Trial Designs With Dr Kidwell - वीडियो के साथ अंग्रेजी बोलना सीखें
अभ्यास मोड चुनें
हर मोड पूरी स्क्रीन का अभ्यास कक्ष खोलता है।
154 वाक्य
यदि वाक्य बहुत छोटे या लंबे हों, तो समायोजित करने के लिए Edit पर क्लिक करें।
1
Hello, and welcome to JAMA Evidence, our podcast series based on core issues in evidence -based medicine.
2
Today, we will be discussing sequential, multiple assignment, randomized trial designs.
3
I'm your host, Dr. Roger Lewis, statistical editor for JAMA and co -editor of the JAMA Guide to Statistics and Methods series.
4
I'm here with Dr. Kelly Kidwell.
5
Dr. Kidwell, thank you so much for joining us.
6
Can you go ahead and tell our listeners a little bit about yourself?
7
Sure.
8
Thank you so much for having me, Roger.
9
I'm Kelly Kidwell.
10
I'm a professor of biostatistics at the University of Michigan School of Public Health, and my expertise is in clinical trial design and analysis,
11
and in particular, the sequential multiple assignment randomized trials or SMART design.
12
Well, again, thank you so much for joining us.
13
So the name of this approach to a trial design is a bit daunting, so let's try to break it up a little bit.
14
So for each of those terms, can you go ahead and tell us what it means and then how we put it together in designing a clinical trial?
15
I completely agree with you that the vocabulary around smart design is quite daunting.
16
So what an excellent first question to start with.
17
So sequential is about a few things.
18
One is that we're interested in sequences of treatments.
19
And in this clinical trial design, we're going to have sequential randomization.
20
So those terms aren't next to each other, but that's really what's happening and defines this trial,
21
such that at least some group of participants will be randomized twice in sequence.
22
So usually there's some upfront randomization
23
and then a subsequent randomization for some group of participants based on their response to the initial treatment.
24
And so that multiple assignment comes into the fact that we'll have this sequential treatment assignment.
25
So individuals could be assigned to multiple treatments.
26
And this is all wrapped up in a clinical trial.
27
So we're going to use this SMART clinical trial tool to give us robust evidence for sequences of treatments
28
that adapt to individual responses or patient status.
29
So in contrast, in a traditional or a simpler clinical trial design.
30
We just randomize once, and then the patient either does well
31
or perhaps doesn't do so well on the treatment to which they are assigned.
32
And if they don't do well, we often have some sort of rescue therapy or they have to leave the trial.
33
So how is the experience of a patient or a participant different in a SMART design?
34
Right.
35
So in a general, standard, traditional randomized clinical trial, we're really looking at one point in time,
36
sort of this trial in a vacuum.
37
The SMART is going to say, let's look at that patient over the course of care.
38
So in a standard trial where you might stop collecting their data and treating them off trial if they didn't respond, we actually want to use that data.
39
And in fact, we might want to randomize the treatment to
40
which rescue therapy they're getting so that we can collect unbiased evidence
41
and use causal inference to better understand what the effect of that treatment is.
42
And not just that treatment, but the entire treatment sequence.
43
And so really for the patient,
44
it might not be too different than a standard trial because we're going to treat you over the course of your care.
45
But to the investigators, we're going to make sure that
46
that data is collected for our trial and there might be randomization for the treatment assignment that follows for that patient.
47
So, let's think a little bit about how we analyze or what we can learn from those two different approaches.
48
So in the first, we randomize at a single point in time, and if the patient doesn't do well,
49
they either drop out of the trial or we assign a rescue therapy.
50
Whereas in the SMART design, if they require a change in therapy, we actually randomize what we do.
51
So what's different about what we can learn from those two different approaches?
52
That's right.
53
Often in our standard clinical trial, in that one stage where the patient drops out or receives clinician or patient choice therapy,
54
we no longer make inference or have any decisions or really robust results about that subsequent treatment or their outcome.
55
Whereas in the SMART, by randomizing that individual and continuing to collect that data,
56
we will be able to have really robust evidence over the course of care, over the sequence of treatments
57
that could have adapted based on their response to allow us
58
to give these sequential guidelines to clinicians to treat the patient not just up front at one point in time,
59
but over time, and really tailor it to how they're doing, if they responded, if they adhered, if they engaged with that treatment.
60
So in a sense, this more closely follows what happens in actual clinical care,
61
where we make a series of treatment decisions based on the patient's prior response, but in this case, you're setting it up
62
so we can rigorously learn about what is the best next
63
thing to do based on what's happened to the patient so far.
64
Is that a fair summary?
65
Absolutely.
66
We are looking at a type of clinical trial that more closely mimics the way in which treatment is practiced.
67
And so that we can provide evidence for these treatment strategies
68
that adapt to individual's response or patient status in the way that we would actually treat them in practice.
69
Let's suppose that a SMART design is run and there's two points at which patients are randomized,
70
maybe the initial therapy and then after some defined period of follow -up.
71
What does the result look like in the publication that results,
72
and how can clinicians utilize the results of the SMART in guiding their own clinical care?
73
One of the amazing advantages of a SMART design is
74
that it can answer many questions as opposed to just what is the best treatment at one time.
75
We can think about what is the best treatment to begin with?
76
What is the best subsequent treatment for those who respond?
77
What is the best subsequent treatment for those who don't respond?
78
And then we can think about that entire sequence of, okay, so what do we start with?
79
How do we change?
80
When do we change?
81
For whom do we change and what treatment do we give them?
82
And so we can really get from SMARTS this sequence of treatments adapted to patient response.
83
Not only that, we can collect baseline information, so information up front at the start of the trial, and information about the patient and how they're doing with the treatment,
84
how they're adhering, how they're engaging, if they're having side effects,
85
and use that information to better tailor the treatment assignment to that individual so that after the trial, right, we have all this information.
86
And we can look at what are the best sequences of treatments for which particular individuals.
87
The fact that the SMART design more closely matches actual clinical care,
88
which the sequences of therapies we offer patients is informed by their responses to prior therapies is an obvious advantage.
89
But what are some of the limitations or challenges in either the implementation or the interpretation of a SMART clinical trial?
90
I think there are a few limitations and also just lack of knowledge of this design and its opportunities that it offers.
91
Some of the limitations are that individuals think, oh, now that we have multiple randomizations or multiple assignments in sequence,
92
this is now logistically infeasible, or you're going to lose more people if you have to consent multiple times.
93
So one thing is that we often just consent once at the beginning of the smart design.
94
and we may randomize multiple times.
95
Alternatively, you could randomize up front to that sequence that they may follow, whether they respond or do not respond.
96
So logistically, this doesn't have to be very difficult.
97
We also have lots of technology that helps us with complex trials, if you want to say that it's complex, although it's not.
98
Number two is that individuals are worried about bias coming into play from a smart design
99
because of these multiple randomizations and the subsequent randomization depending upon patient response or status.
100
This is not a concern because we do not compare these treatment pathways or you first get A,
101
you respond and you continue versus you first get A, you do not respond and you switch to B.
102
We're not going to compare those people.
103
We know that they're different.
104
One responded and one didn't, and we can have some issues if we do those comparisons.
105
We're looking at what we call adaptive interventions or dynamic treatment regimens that include that entire treatment sequence that's adapted.
106
So start with A, and if you respond, continue.
107
And if you don't, receive B.
108
We're going to think about what are the effects of that entire sequence that's tailored to the response.
109
Another misconception is that a SMART is an adaptive design.
110
Usually a SMART is a fixed design, not an adaptive design, meaning
111
that we're not going to use information from patients who have
112
been through the trial to change the trial in some way for future patients.
113
So we're not going to change randomization probabilities or eligibility criteria based on the information we've gained from the trial thus far.
114
What does happen in a SMART is that patients' treatment might change based on their own response.
115
So there might be a within -person adaptation, but there's no between -person adaptation.
116
And so generally, these aren't adaptive designs.
117
Since we're trying to learn more from a clinical trial that's a smart design versus a traditional design
118
that just has a single point of randomization, it seems like we might need larger sample sizes to answer the additional questions.
119
What are the challenges, if any, with respect to sample size requirements for a smart design?
120
If you see pictures of smart designs, they look a little bit intimidating because there's a fair amount of branching that occurs due to these sequential randomizations.
121
And often investigators are quite worried that we're going to require thousands of patients.
122
The thing is that to size a SMART is just like sizing any other trial.
123
And so it's really dependent on the primary aim, which can be similar to a standard one -stage trial and compare,
124
for example, the initial treatments.
125
Alternatively, the aim can be based on those embedded tailored sequences of treatments or the adaptive interventions.
126
And for those perhaps more patients may be required than a standard trial.
127
However, this really isn't an apples -to -apples comparison of a SMART design to a standard or traditional one -stage trial.
128
As I mentioned before, the questions
129
that we can answer in a SMART are much different and many more than we could with a standard design.
130
And so perhaps we may need more depending on the primary aim, but we're going to get a lot more information,
131
data, robust results, and more practical information that we can use after a smart design.
132
In your article, you discuss a study that was performed by Fortney et al that used a smart approach.
133
Can you tell us a little bit about what they did, what they found, and how they analyzed their data?
134
Sure.
135
So in this study, they had a design where individuals were sequentially randomized to better understand some effects of direct
136
and indirect telecare.
137
And what they did is they answered questions that are sort of more similar to one stage design.
138
So they said, okay, so what's the best first thing to start with?
139
And then subsequently, what do we do if individuals aren't responding well to that initial treatment or intervention.
140
So they haven't yet pieced together that full sequence.
141
It seems like that's subsequent analyses for this group in terms of figuring out,
142
so what is the best overall sequences of treatment that can adapt to the individuals?
143
While they answered those individually, what they could find when they move forward with the analysis of the adaptive intervention is
144
that there might be interactions between the initial treatment
145
and the subsequent treatment for
146
which we can only really quantify in these types of SMART designs as opposed to individual randomized clinical trials.
147
And so what they likely will subsequently do is look at
148
that sequence of treatment over the course of the trial
149
or those adaptive interventions to see if there are any interactions between the first step and the second step.
150
I'm Roger Lewis, and I've been speaking with Professor Kelly Kidwell about sequential multiple assignment randomized trials.
151
You can find a link to her article in this episode's description.
152
This episode was produced by Daniel Musisi at the JAMA Network.
153
To follow this and other JAMA Network podcasts, please visit us online at jamanetworkaudio .com.
154
Thanks for listening.
ऐप डाउनलोड करें
धाराप्रवाह बोलने के लिए ज़रूरी सब कुछ
AI उच्चारण स्कोरहर वाक्य का स्कोर
IPA अभ्यासहर ध्वनि में महारत
शब्दावलीअपना शब्द भंडार बनाएँ
शब्द गेमखेलते हुए सीखें
📺 उसी चैनल से
✨ अनुशंसित वीडियो
C11
368 वाक्य
Essentials: Neuralink & Technologies to Enhance Human Brains | Dr. Matt MacDougall
Daily ConversationUniversity StudentsWorking Adults
C11
689 वाक्य
Database Sharding! Designing Data-Intensive Applications chapter 6
Daily ConversationUniversity StudentsWorking Adults
C12
442 वाक्य
Allergy Assessment for Nurses: True Allergy vs Sensitivity, and Safer Care with Dr. Sophia Thomas
Daily ConversationUniversity StudentsWorking Adults
C13
31 वाक्य
Usability Heuristic 2: Match Between the System and the Real World
Daily ConversationUniversity StudentsWorking Adults
C11
346 वाक्य
Trust the Process: How to Design Teams That Actually Work
Daily ConversationUniversity StudentsWorking Adults
C23
99 वाक्य
12. Parallel Stent Retriever Technique in Mechanical Thrombectomy for Acute Ischemic Stroke
Daily ConversationUniversity StudentsWorking Adults
C11
113 वाक्य
Architectural Design Process Explained
Daily ConversationUniversity StudentsWorking Adults
C11
60 वाक्य
Quick Study: How Venture Capitalists Make Decisions
Daily ConversationUniversity StudentsWorking Adults
C11
406 वाक्य
Scoliosis: How to medically classify scoliosis (the Lenke System for AIS)
Daily ConversationUniversity Students
B21
623 वाक्य
How evolution works, in 54 minutes | Sean B. Carroll: Full Interview
Daily ConversationUniversity StudentsWorking Adults
C11
710 वाक्य
The truth about peptides, NAD, & other longevity treatments | Rachele Pojednic, Ph.D.
Daily ConversationUniversity StudentsWorking Adults
B21
78 वाक्य
Day in the Life as a Doctor
Daily ConversationUniversity StudentsWorking Adults
इस पाठ की शब्दावली और बोलने के सुझाव
यह स्पीकिंग पाठ वीडियो “Sequential, Multiple Assignment, Randomized Trial Designs With Dr Kidwell” पर आधारित है। सबसे ज़्यादा दोहराए गए शब्द ये हैं: treatment, trial, design, smart, patient। इस वीडियो में शैडोइंग के लिए 103 वाक्य और 2153 शब्द हैं। बोला गया हिस्सा 13:26 लंबा है। वक्ता लगभग 160 शब्द प्रति मिनट की स्वाभाविक गति से बोलता है, जो रोज़मर्रा की बातचीत के करीब है। 84% शब्द अंग्रेज़ी के 3,000 सबसे आम शब्दों में से हैं; बाकी शब्द अभ्यास से पहले देख लेना अच्छा रहेगा। इसके 103 वाक्यों में से 18 प्रश्न हैं, इसलिए यह प्रश्नों के लहजे और छोटे जवाबों के अभ्यास के लिए अच्छा है।
इस वीडियो की मुख्य शब्दावली
वीडियो के 15 सीखने लायक शब्द, उच्चारण और अर्थ के साथ:
| शब्द | उच्चारण | अर्थ |
|---|---|---|
| assignment संज्ञा | /əˈsaɪn.mənt/ | नियुक्ति |
| collect क्रिया | /ˈkɑlɪkt/ | शामिल होने, इकट्ठा करना |
| intervention संज्ञा | /ɪntɚˈvɛnʃən/ | हस्तक्षेप, मुदाख़लत |
| tailor संज्ञा | /ˈteɪlɚ/ | दर्ज़ी |
| rescue क्रिया | /ˈɹɛs.kjuː/ | बचाना |
| compare क्रिया | /kəmˈpɛɚ/ | तौलना |
| participant संज्ञा | /pɑːɹˈtɪsəpənt/ | भागी, भागिनी |
| assign क्रिया | /əˈsaɪn/ | निर्दिष्ट, आवंटित करना |
| consent क्रिया | /kənˈsɛnt/ | सहमति |
| podcast संज्ञा | /ˈpɑdˌkæst/ | पॉडकास्ट, कोशसत्र |
| analyze क्रिया | /ˈæn.əˌlaɪz/ | विश्लेषण करना |
| investigator संज्ञा | /ɪnˈvɛs.tɪˌɡeɪ̯.təː/ | जाँचकर्ता, अन्वेषक |
| practical विशेषण | /ˈpɹæk.tɪ.kəl/ | प्रायोगिक |
| occur क्रिया | /əˈkɜː/ | बीतना |
| publication संज्ञा | /ˌpʌblɪˈkeɪʃ(ə)n/ | प्रकाशन |
वीडियो में आने वाली फ़्रेज़ल वर्ब
| शब्द | उच्चारण | अर्थ |
|---|---|---|
| go ahead क्रिया | /ˌɡoʊ əˈhɛd/ | आगे बढ़ना |
दोहराने लायक वाक्य
वीडियो के छोटे, पूरे वाक्य जिन्हें आप रोज़ की बातचीत में इस्तेमाल कर सकते हैं:
- Let's try to break it up a little bit.
- One is that we're interested in sequences of treatments.
- We can think about what is the best treatment to begin with?
- How do we change?
- When do we change?
इस वीडियो का व्याकरण
वक्ता जिन संरचनाओं का सबसे अधिक प्रयोग करता है, वीडियो के असली शब्दों के साथ:
| संरचना | वीडियो में |
|---|---|
| Passive voice be + past participle — ज़ोर इस पर कि क्या होता है, न कि कौन करता है | will be randomized · could be assigned · are assigned |
| Relative clauses who / which + उपवाक्य — व्यक्ति या वस्तु के बारे में अतिरिक्त जानकारी | those who respond · those who don · aim, which can |
ध्यान देने योग्य उच्चारण
वक्ता 44 बार संक्षिप्त रूपों का प्रयोग करता है, जैसे we're, they're, I'm। इन्हें वैसे ही छोटा बोलें जैसा आप सुनते हैं।
- “sh” और “zh” की ध्वनियाँ: intervention /ɪntɚˈvɛnʃən/, limitation /lɪmɪˈteɪʃən/, interaction /ˌɪn.təˈɹæk.ʃən/, adaptation /ˌæd.æpˈteɪ.ʃən/, contrast /kənˈt(ʃ)ɹæst/
- लंबे शब्द — बलाघात सही रखें: intervention /ɪntɚˈvɛnʃən/, participant /pɑːɹˈtɪsəpənt/, limitation /lɪmɪˈteɪʃən/, interaction /ˌɪn.təˈɹæk.ʃən/, subsequently /ˈsʌb.sɪ.kwənt.li/
हिंदी भाषियों के लिए मुश्किल ध्वनियाँ:
- /v/ और /w/ का फ़र्क़ — /v/ में ऊपर के दाँत निचले होंठ को छूते हैं, /w/ में होंठ गोल होते हैं: sequence /ˈsiː.kwəns/, subsequent /ˈsʌbsɪkwənt/, adaptive /əˈdæp.tɪv/, intervention /ɪntɚˈvɛnʃən/, whereas /(h)wɛɹˈæz/
- /z/ — इसे “ज” (/dʒ/) न बनाएँ: whereas /(h)wɛɹˈæz/, oppose /əˈpoʊz/, analyze /ˈæn.əˌlaɪz/, expertise /ˌɛkspɜːˈtiːz/, utilize /ˈjuː.tɪ.laɪz/
- /æ/ — “ऐ” से ज़्यादा खुला: adaptive /əˈdæp.tɪv/, adapt /əˈdæpt/, whereas /(h)wɛɹˈæz/, interaction /ˌɪn.təˈɹæk.ʃən/, podcast /ˈpɑdˌkæst/
इस वीडियो से अभ्यास कैसे करें
- पहले बिना बोले पूरा वीडियो एक बार सुनें और जो शब्द नहीं आते उन्हें लिख लें।
- 0.75× गति से शुरू करें, एक-एक वाक्य की शैडोइंग करें, और सहज लगने पर सामान्य गति पर लौटें।
- अपनी आवाज़ रिकॉर्ड करें और मूल से तुलना करें, ख़ासकर assignment, collect, intervention जैसे शब्दों पर ध्यान दें।
शैडोइंग तकनीक क्या है?
शैडोइंग (Shadowing) एक विज्ञान-समर्थित भाषा सीखने की तकनीक है जो मूल रूप से पेशेवर दुभाषिया प्रशिक्षण के लिए विकसित की गई थी। विधि सरल लेकिन शक्तिशाली है: आप मूल अंग्रेज़ी ऑडियो सुनते हैं और तुरंत इसे ज़ोर से दोहराते हैं — जैसे वक्ता की छाया 1-2 सेकंड की देरी से। शोध से पता चलता है कि यह उच्चारण सटीकता, स्वर, लय, जुड़ी हुई ध्वनियाँ, सुनने की समझ और बोलने की प्रवाहशीलता में काफ़ी सुधार करता है।