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JAC-antimicrobial Resistance Feb 2024Comparisons between antimicrobial usage (AMU) in humans and food-producing animals are regularly made. The accuracy of such comparisons depends on the indicators used to... (Review)
Review
Comparisons between antimicrobial usage (AMU) in humans and food-producing animals are regularly made. The accuracy of such comparisons depends on the indicators used to quantify AMU. Indicators for AMU quantitatively relate use data (the numerator) to population data (the denominator). The denominator should be a proxy for the population at risk in a certain period when comparing the exposure of different populations to antimicrobials. Denominators based on numbers of animals slaughtered, such as the commonly used population correction unit, do not consider the time at risk of antimicrobial treatment. Production-based indicators underestimate animal AMU. Additionally, production-based indicators are fundamentally different from indicators used to quantify human AMU. Using such indicators to compare human and animal AMU therefore leads to biased results. More caution should be taken in selecting the indicator to quantify AMU when comparing AMU in food-producing animals and humans.
PubMed: 38268966
DOI: 10.1093/jacamr/dlae005 -
Pediatrics Aug 2015Available data on survival rates and outcomes of extremely low gestational age (GA) infants (22-25 weeks' gestation) display wide variation by country. Whether similar... (Review)
Review
BACKGROUND AND OBJECTIVES
Available data on survival rates and outcomes of extremely low gestational age (GA) infants (22-25 weeks' gestation) display wide variation by country. Whether similar variation is found in statements by national professional bodies is unknown. The objectives were to perform a systematic review of management from scientific and professional organizations for delivery room care of extremely low GA infants.
METHODS
We searched Embase, PubMed, and Google Scholar for management guidelines on perinatal care. Countries were included if rated by the United Nations Development Programme's Human Development Index as "very highly developed." The primary outcome was rating of recommendations from "comfort care" to "active care." Secondary outcomes were specifying country-specific survival and considering potential for 3 biases: limitations of GA assessment; bias from different definitions of stillbirths and live births; and bias from the use of different denominators to calculate survival.
RESULTS
Of 47 highly developed countries, 34 guidelines from 23 countries and 4 international groups were identified. Of these, 3 did not state management recommendations. Of the remaining 31 guidelines, 21 (68%) supported comfort care at 22 weeks' gestation, and 20 (65%) supported active care at 25 weeks' gestation. Between 23 and 24 weeks' gestation, much greater variation was seen. Seventeen guidelines cited national survival rates. Few guidelines discussed potential biases: limitations in GA (n = 17); definition bias (n = 3); and denominator bias (n = 7).
CONCLUSIONS
Although there is a wide variation in recommendations (especially between 23 and 24 weeks' GA), there is general agreement for comfort care at 22 weeks' GA and active care at 25 weeks' GA.
Topics: Delivery, Obstetric; Female; Humans; Infant, Extremely Premature; Infant, Newborn; Practice Guidelines as Topic; Pregnancy; Premature Birth
PubMed: 26169424
DOI: 10.1542/peds.2015-0542 -
New Directions For Child and Adolescent... 2013There are important lessons to be learned from taking a comparative perspective in considering migration. Comparative examination of immigration experiences provides a... (Review)
Review
There are important lessons to be learned from taking a comparative perspective in considering migration. Comparative examination of immigration experiences provides a way to glean common denominators of adaptation while considering the specificity of sending and receiving contexts and cultures. Equally important is a historical perspective that provides a way for us to consider how we may have gone through similar travails in the past while recognizing that we face particular challenges in this moment.
Topics: Culture; Emigrants and Immigrants; Emigration and Immigration; History, 20th Century; History, 21st Century; Humans
PubMed: 24038804
DOI: 10.1002/cad.20040 -
Biometrical Journal. Biometrische... Dec 2023We give a simulation-based method for computing the multiplicity adjusted p-values and critical constants for the Dunnett procedure for comparing treatments with a...
We give a simulation-based method for computing the multiplicity adjusted p-values and critical constants for the Dunnett procedure for comparing treatments with a control under heteroskedasticity. The Welch-Satterthwaite test statistics used in this procedure do not have a simple multivariate t-distribution because their denominators are mixtures of chi-squares and are correlated because of the common control treatment sample variance present in all denominators. The joint distribution of the denominators of the test statistics is approximated by correlated chi-square variables and is generated using a novel algorithm proposed in this paper. This approximation is used to derive critical constants or adjusted p-values. The familywise error rate (FWER) of the proposed method is compared with some existing methods via simulation under different heteroskedastic scenarios. The results show that our proposed method controls the FWER most accurately, whereas other methods are either too conservative or liberal or control the FWER less accurately. The different methods considered are illustrated on a real data set.
Topics: Models, Statistical; Computer Simulation; Algorithms
PubMed: 37789586
DOI: 10.1002/bimj.202200300 -
The International Journal of... May 2007Current international tuberculosis (TB) guidelines recommend the microscopic examination of three sputum specimens for acid-fast bacilli in the evaluation of persons... (Review)
Review
Current international tuberculosis (TB) guidelines recommend the microscopic examination of three sputum specimens for acid-fast bacilli in the evaluation of persons suspected of having pulmonary TB. We conducted a systematic review of studies that quantified the diagnostic yield of each of three sputum specimens. By searching multiple databases and sources, we identified a total of 37 eligible studies. The incremental yield in smear-positive results (in studies using all smear-positive cases as the denominator) and the increase in sensitivity (in studies that used all culture-positive cases as the denominator) of the third specimen were the main outcomes of interest. Although heterogeneity in study methods and results presented challenges for data synthesis, subgroup analyses suggest that the average incremental yield and/or the increase in sensitivity of examining a third specimen ranged between 2% and 5%. Reducing the recommended number of specimens examined from three to two (particularly to two specimens collected on the same day) could benefit TB control programs, and potentially increase case detection for several reasons. A number of operational research issues need to be addressed. Studies examining the most effective and efficient means to utilize current technologies for microscopic examination of sputum would be most useful if they followed an internationally coordinated and standardized approach, both to strengthen the country-specific evidence base and to permit comparison among studies.
Topics: Humans; Sensitivity and Specificity; Specimen Handling; Sputum; Tuberculosis, Pulmonary
PubMed: 17439669
DOI: No ID Found -
American Journal of Perinatology Jan 2012Measurement of patient safety serves to identify opportunities to improve safety within a neonatal intensive care unit (NICU), compare the safety of care provided by... (Review)
Review
Measurement of patient safety serves to identify opportunities to improve safety within a neonatal intensive care unit (NICU), compare the safety of care provided by different NICUs, determine changes in response to safety interventions or programs, follow safety trends over time, and potentially deny payment for specific events. The ideal patient safety measures are rates of events derived from surveillance with valid and reliable detection of numerators (errors or adverse events) and denominators (the opportunities for errors or adverse events to occur). Methods used to identify these numerators and denominators include reporting, direct observation, videotaping, chart review, trigger tools, and automated methods. However, there are significant methodological and practical (feasibility) challenges to the accurate and reliable determination of rates of errors and adverse events. These include failure to detect and document such events, surveillance bias, lack of consistent definitions, frequent requirement for judgment in identifying and classifying challenges (which introduces interrater inconsistency), and need for significant additional resources.
Topics: Bias; Humans; Intensive Care, Neonatal; Medical Errors; Organizational Culture; Patient Safety; Population Surveillance
PubMed: 21879457
DOI: 10.1055/s-0031-1286183 -
Statistical Methods in Medical Research Feb 2021Cancer incidence and mortality are typically presented as age-standardized rates. Inference about these rates becomes complicated when denominators involve sampling...
Cancer incidence and mortality are typically presented as age-standardized rates. Inference about these rates becomes complicated when denominators involve sampling errors. We propose a bias-corrected rate estimator as well as its corresponding variance estimator that take into account sampling errors in the denominators. Confidence intervals are derived based on the proposed estimators as well. Performance of the proposed methods is evaluated empirically based on simulation studies. More importantly, advantage of the proposed method is demonstrated and verified in a real-life study of cancer mortality disparity. A web-based, user-friendly computational tool is also being developed at the National Cancer Institute to accompany the new methods with the first application being calculating cancer mortality rates by US-born and foreign-born status. Finally, promise of proposed estimators to account for errors introduced by differential privacy procedures to the 2020 decennial census products is discussed.
Topics: Bias; Computer Simulation; Incidence; Research Design; Selection Bias
PubMed: 33059531
DOI: 10.1177/0962280220962516 -
Biometrics Sep 1965
Topics: Agriculture; Animals; Biometry; Body Weight; Growth; Nutritional Physiological Phenomena
PubMed: 5858102
DOI: No ID Found -
American Journal of Infection Control Aug 2015Large-scale, prospective, evaluation of sampling for central line-associated bloodstream infection (CLABSI) denominator data was necessary prior to National Healthcare...
BACKGROUND
Large-scale, prospective, evaluation of sampling for central line-associated bloodstream infection (CLABSI) denominator data was necessary prior to National Healthcare Safety Network (NHSN) implementation.
METHODS
In a sample of volunteer hospitals from states in the Emerging Infections Program, prospective collection of CLABSI denominators (patient days, central line days [CLDs]) was performed in eligible locations for ≥6 and ≤12 consecutive months using the current NHSN method (daily collection) and also by a second data collector who sampled the denominator data 1 d/wk. The quality of the sampled data was evaluated and used to calculate estimated CLDs and CLABSI rates, which were compared with actual CLDs and CLABSI rates (daily counts).
RESULTS
In total, 89 locations in 66 acute care hospitals participated. Sampled data were collected as intended 88% of the time; the quality of the data was comparable with the data collected daily. In locations with higher CLDs per month (≥75), estimated CLDs and CLABSI rates were similar to actual CLDs and CLABSI rates; however, there were significant differences in actual and estimated values among locations with lower (≤74) CLDs per month.Sampling was successfully implemented, but significant differences in the accuracy of estimated CLDs and CLABSI rates, based on the actual number of CLDs per month, were noted.
CONCLUSION
For locations with a higher number of CLDs per month, sampling 1 d/wk is a valid and accurate alternative to daily collection of CLABSI denominator data.
Topics: Catheter-Related Infections; Catheterization, Central Venous; Epidemiologic Methods; Hospitals; Humans; Incidence; Prospective Studies; Sepsis
PubMed: 26004907
DOI: 10.1016/j.ajic.2015.03.031 -
Tropical Medicine & International... Jul 2015Dengue fever is globally considered underestimated. This study provides expansion factors (EFs) for dengue endemic selected countries and highlights critical issues in... (Review)
Review
OBJECTIVE
Dengue fever is globally considered underestimated. This study provides expansion factors (EFs) for dengue endemic selected countries and highlights critical issues in the use of EFs.
METHODS
We identified dengue epidemiological cohort studies from 2000 to July 2013 through a literature search using PubMed, Web of Science and Lilacs (Latin American and Caribbean Health Sciences Database), pre-defined keywords and inclusion/exclusion criteria, and included Brazil, Colombia, Nicaragua, Peru, Puerto Rico, Venezuela, Bangladesh, Cambodia, India, Indonesia, Philippines, Singapore, Sri Lanka, Thailand and Vietnam. Dengue national and local passive surveillance data were derived from WHO regional websites, PAHO, SEARO and WPRO. EFs were calculated as CI cohort studies/CI passive data for both national and local levels.
RESULTS
Cohort studies differed in case definition, laboratory test used and surveillance methods. The information on SEARO, PAHO and WPRO websites differed in terms of dengue epidemiological variables, population denominators and completeness. The highest incidence was reported by PAHO countries followed by WPRO and SEARO countries. EFs may vary for the different variables and denominators used for calculation. EFs were the highest in SEARO countries and lowest in PAHO countries. A trend for lower local EFs was observed.
CONCLUSIONS
The use of EFs for quantifying dengue underreporting may be problematic due to lack of uniformity in reporting dengue both active and passive surveillance data. Quality dengue surveillance data are urgently needed for a better estimate of dengue disease burden and to measure the impact of preventive intervention.
Topics: Americas; Asia; Dengue; Disease Outbreaks; Endemic Diseases; Humans; Incidence; Population Surveillance
PubMed: 25753454
DOI: 10.1111/tmi.12498