1,721,082 research outputs found
Emerg Infect Dis
No full textIn June 1999, the dioxin crisis, caused by dioxin-contaminated feed components, exploded in Belgium, resulting in withdrawal of chicken and eggs from the market. Through the sentinel surveillance system, a decrease in Campylobacter infections during June 1999 was noticed. A model was generated with the reports from preceding years (1994 to 1998), and a prediction of the number of infections in 1999 was calculated. The model shows a significant decline (40%) in the number of infections, mainly because of the withdrawal of poultry. The use of a disaster as an epidemiologic tool offers a unique opportunity to observe exceptional changes in the occurrence of infections or other diseases
Statistical and geographic analysis of out-of-hospital cardiac arrest using registry data
No full textBackground: Out-of-hospital cardiac arrest (OHCA) is the most critical health event that occurs in the community. When the heart stops pumping blood, if resuscitation is not started, biological death will occur within minutes. It is known that patient-level factors significantly affect OHCA incidence and outcome however, area-level variation is often observed. The aim of this thesis was to investigate if area-level grouping or area-level characteristics could be identified that influence OHCA incidence and outcome, and their impact quantified.
Methods: Using data from the Irish OHCA registry, descriptive and geographical analysis of OHCA incidence was performed. Cases were geocoded to Electoral Division (ED) level and combined with national census data, and area-level deprivation data, and classified by urban-rural category. The impact of urban-rural grouping was quantified using multilevel linear regression. To adjust for the impact of a small number of cases at ED-level, and the spatial properties of EDs, Bayesian conditional autoregression (CAR) was used to estimate the relative risk of OHCA. Swedish and Irish registry data was compared using logistic regression to identify the predictors of outcome, and to quantify variation measured. Finally, multilevel logistic regression analyses of outcomes in international airports was performed to allow for a differing effect of predictor variables between countries.
Results: The incidence of OHCA where resuscitation was performed was higher in City and Town EDs (51/100,000 population per year; 95% confidence interval [CI], 46 to 55) than in Rural EDs (35/100,000 population per year; 95% CI, 28 to 42). However, urban-rural grouping accounted for only 2% of variation. Bayesian CAR modelling showed that a one-point increase in relative deprivation was associated with an 11% increased risk of OHCA that occurred at home. Logistic regression analysis of the Utstein comparator group (adults, bystander-witnessed, initial shockable rhythm, presumed medical cause) explained only 17% of outcome variation between Sweden and Ireland, with a 4-fold ‘country effect’ in favour of Sweden. Country-level differences in survival in international airports were also evident, particularly when adjusted for age, gender, and attempted bystander defibrillation (median odds ratio 3.0; 95% credible interval, 1.6 to 14.3]).
Conclusions: Findings did not support changes in provision of resuscitation services based on area-level differences, and only a small proportion of between-country variation was explained by routinely collected variables. As patient-level factors are likely to explain the greater proportion of variation in OHCA outcome, it is recommended that there is international collaboration to ensure comparability of data collection and data interpretation, and to promote comprehensive case capture and maximise data quality. It is also recommended that more explanatory variables are incorporated into OHCA registry data collection. Finally, improvements in survival cannot be achieved without cooperation from local communities, but community preparedness should include: discussion on the inevitability of cardiac arrest as part of life; the prospect of patient survival; and, the need for innovative thinking to make sure that pre-hospital resuscitation is initiated efficiently and effectively
Statistical and geographic analysis of out-of-hospital cardiac arrest using registry data
No full textBackground: Out-of-hospital cardiac arrest (OHCA) is the most critical health event that occurs in the community. When the heart stops pumping blood, if resuscitation is not started, biological death will occur within minutes. It is known that patient-level factors significantly affect OHCA incidence and outcome however, area-level variation is often observed. The aim of this thesis was to investigate if area-level grouping or area-level characteristics could be identified that influence OHCA incidence and outcome, and their impact quantified. Methods: Using data from the Irish OHCA registry, descriptive and geographical analysis of OHCA incidence was performed. Cases were geocoded to Electoral Division (ED) level and combined with national census data, and area-level deprivation data, and classified by urban-rural category. The impact of urban-rural grouping was quantified using multilevel linear regression. To adjust for the impact of a small number of cases at ED-level, and the spatial properties of EDs, Bayesian conditional autoregression (CAR) was used to estimate the relative risk of OHCA. Swedish and Irish registry data was compared using logistic regression to identify the predictors of outcome, and to quantify variation measured. Finally, multilevel logistic regression analyses of outcomes in international airports was performed to allow for a differing effect of predictor variables between countries. Results: The incidence of OHCA where resuscitation was performed was higher in City and Town EDs (51/100,000 population per year; 95% confidence interval [CI], 46 to 55) than in Rural EDs (35/100,000 population per year; 95% CI, 28 to 42). However, urban-rural grouping accounted for only 2% of variation. Bayesian CAR modelling showed that a one-point increase in relative deprivation was associated with an 11% increased risk of OHCA that occurred at home. Logistic regression analysis of the Utstein comparator group (adults, bystander-witnessed, initial shockable rhythm, presumed medical cause) explained only 17% of outcome variation between Sweden and Ireland, with a 4-fold ‘country effect’ in favour of Sweden. Country-level differences in survival in international airports were also evident, particularly when adjusted for age, gender, and attempted bystander defibrillation (median odds ratio 3.0; 95% credible interval, 1.6 to 14.3]). Conclusions: Findings did not support changes in provision of resuscitation services based on area-level differences, and only a small proportion of between-country variation was explained by routinely collected variables. As patient-level factors are likely to explain the greater proportion of variation in OHCA outcome, it is recommended that there is international collaboration to ensure comparability of data collection and data interpretation, and to promote comprehensive case capture and maximise data quality. It is also recommended that more explanatory variables are incorporated into OHCA registry data collection. Finally, improvements in survival cannot be achieved without cooperation from local communities, but community preparedness should include: discussion on the inevitability of cardiac arrest as part of life; the prospect of patient survival; and, the need for innovative thinking to make sure that pre-hospital resuscitation is initiated efficiently and effectively
COSUTI: a protocol for the development of a core outcome set (COS) for interventions for the treatment of uncomplicated urinary tract infection (UTI) in adults
No full textBackground: Urinary tract infections (UTIs) are the second most common infection presenting in the community. Clinical guidelines and decision aids assist health practitioners to treat a UTI; however, treatment practices vary due to patient needs and context of presentation. Numerous trials have evaluated the effectiveness of treatment interventions for UTI; however, it is difficult to compare the results between trials due to inconsistencies between reported outcomes. Poor choice of outcome measures can lead to impairment of evidence synthesis due to the inability to compare outcomes between trials with similar aims. Transparency in selecting and reporting outcomes can be mitigated through the development of an agreed minimum set of outcomes that should be reported in clinical trials, referred to as a core outcome set (COS). This paper presents the protocol for the development of a COS for interventions in the treatment of uncomplicated UTI in adults. Methods: This COS development consists of three phases. Phase 1 is a systematic review, which aims to identify the core outcomes that have been reported in trials and systematic reviews of interventions treating uncomplicated UTI in adults. Phase 2 consists of a three-round online Delphi survey with stakeholders in the area of treatment interventions for UTI. The aim of this online Delphi survey is to achieve consensus on the importance of the outcomes emerging from Phase 1 of this research. Phase 3 is a consensus meeting to finalise the COS that should be reported in trials evaluating the effectiveness of interventions for the treatment of UTI. Discussion: It is hoped that the development of a COS for interventions for the treatment of uncomplicated UTI in adults will be adopted as a minimum set of outcomes that should be reported and measured within this context. If the findings from clinical trials related to treatment interventions for UTI are to impact on policy and practice, it is important that the findings from different treatment interventions are comparable across trials.</p
The very first requirement of treatment is that it should do no harm†, so why are antibiotics still overprescribed?
No full text[No abstract available
Antimicrobial prescribing and resistance in Irish general practice
No full textThe emerging problem of antimicrobial resistance in bacterial pathogens is complex and the result of individual and population factors. Antimicrobial agents are unique therapeutics in that their impact goes beyond the individual; antimicrobials also affect the microbial population of the host (including the pathogen population) and thereby society. The practical application of quantifying direct, individual level antimicrobial effects is to assess the short-term risk of infection with a resistant organism to an individual about to initiate antimicrobial treatment. The long-term population effect, also known as the collateral effect, involves a chain of low probability events which result in a population risk of an infection with a resistant organism which affects the individual in turn. Standard statistical analytic approaches make the assumption that outcomes in different subjects are independent, but for antimicrobial prescribing and resistance this assumption of independence is violated as the group level prevalence of antimicrobial resistance is likely to affect the individual's risk. For this reason, studies into antimicrobial resistance need to combine information from individual and group level antimicrobial use and resistance and analyse intra as well as inter level variation. Urinary tract infections (UTIs) are common infections and treatment of UTI in daily practice is largely empirically based. The easy availability of urine samples from patients with a suspected UTI, the established empiric treatment with antimicrobials, standard methods for diagnosis, and high antimicrobial use, make urinary tract infections an ideal subject to study antimicrobial resistance in the community. The thesis is set up in two distinct parts, each divided into chapters representing discrete research areas (published/submitted papers) within each part. The first part used retrospective data to address the multilevel structure in the analysis of antimicrobial resistance of uropathogenic E.coli in the individual and prescribing at the general practice level. Data on practice antimicrobial prescribing were obtained from the prescriptions of medical card patients (patients with free medical care and free medication) and aggregated at the practice level. Data on antimicrobial resistance of uropathogenic E.coli from individuals were obtained from the laboratory and consisted of more than 14,000 positive urine culture results from general practices in the West of Ireland. The results from this analysis confirmed a significant association between practice level prescribing and individual risk of a resistant E.coli for trimethoprim and ciprofloxacin. The odds ratio for trimethoprim was 1.02 (95% CI 1.01-1.04) and for ciprofloxacin 1.08 (95% CI 1.04-1.11) for every additional prescription of trimethoprim or ciprofloxacin respectively per 1000 patients per month. Additionally, a theoretical risk for the practice was quantified as a median odds ratio (mOR); 1.10 (95% Credible Interval (CrI) 1.03-1.16) for trimethoprim and 1.37 (95% CrI 1.22-2.59) for ciprofloxacin. The mOR can be interpreted as the increase in risk of being diagnosed with a resistant E.coli in the imaginary event of a patient moving from a practice with low to a practice with high resistance. Another detailed retrospective analysis which studied patients with repeated urinary tract infection, of whom only details on the resistance pattern of the E.coli were available, showed the persistence of resistance against trimethoprim as well as ciprofloxacin in repeated E.coli UTIs. The probability that an E.coli isolated from urine from a patient was still resistant up to three months after the previous isolate was found to be resistant, was 78% for trimethoprim and 84% for ciprofloxacin. For nitrofurantoin, the probability that a subsequent E.coli infection was resistant after resistance against this antimicrobial was detected in the E.coli from a previous infection, was 20%. Knowing the antimicrobial test results from previous episodes of UTI may help general practitioners in their choice of empiric antimicrobial treatment for the current episode. The second part of the study was a prospective study in which 22 practices co-operated. All patients with a suspected UTI were requested to submit a urine sample. Patients were informed of the study and included in the study by means of an opt-out methodology. Participation of 86% was achieved. Patient data were obtained from the practice records and merged with the (antimicrobial susceptibility) results from their urine sample. The analysis from this study resulted in two papers. Firstly, management of UTI in general practice showed important differences between practices. Overall, of the 866 patients, an organism was identified in the urine sample of 21%, while 56% received an antimicrobial. Comparing the laboratory report on the urine sample with the treatment received, treatment was interpreted as appropriate for 55% of the patients. National guidelines on antimicrobial prescribing were not always implemented, which raises concern when general practices showed preferences for antimicrobials which should be used prudently. In the second paper analysis of previous individual antimicrobial prescribing and practice resistance levels showed both have an important impact on the risk of a UTI with a resistant E.coli. The odds of a trimethoprim resistant E.coli UTI increased by 1.4 (95% CI 0.8-2.2) for one, 4.7 (95% CI 1.9-12.4) for two and 6.4 (95% CI 2.0-25.4) for three or more prescriptions of trimethoprim in the previous year, and for ciprofloxacin resistance by 2.7 (95% CI 1.2-5.6) for one and 6.5 (95% CI 2.9-14.8) for two or more prescriptions of ciprofloxacin in the previous year. Similar to the retrospective study, a mOR was calculated as 1.17 (95% CrI 1.03-1.46) for trimethoprim and 1.33 (95% CrI 1.03-1.9) for ciprofloxacin. The thesis' discussion links the papers together, resulting in some practical suggestions for setting up interventions to curtail antimicrobial resistance
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
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