822 resultados para Life and Medical Sciences
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ed. by L. Loewe
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Talk at the Symposium "Opportunities and Challenges of Longitudinal Perspectives"
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BACKGROUND Recent reports using administrative claims data suggest the incidence of community- and hospital-onset sepsis is increasing. Whether this reflects changing epidemiology, more effective diagnostic methods, or changes in physician documentation and medical coding practices is unclear. METHODS We performed a temporal-trend study from 2008 to 2012 using administrative claims data and patient-level clinical data of adult patients admitted to Barnes-Jewish Hospital in St. Louis, Missouri. Temporal-trend and annual percent change were estimated using regression models with autoregressive integrated moving average errors. RESULTS We analyzed 62,261 inpatient admissions during the 5-year study period. 'Any SIRS' (i.e., SIRS on a single calendar day during the hospitalization) and 'multi-day SIRS' (i.e., SIRS on 3 or more calendar days), which both use patient-level data, and medical coding for sepsis (i.e., ICD-9-CM discharge diagnosis codes 995.91, 995.92, or 785.52) were present in 35.3 %, 17.3 %, and 3.3 % of admissions, respectively. The incidence of admissions coded for sepsis increased 9.7 % (95 % CI: 6.1, 13.4) per year, while the patient data-defined events of 'any SIRS' decreased by 1.8 % (95 % CI: -3.2, -0.5) and 'multi-day SIRS' did not change significantly over the study period. Clinically-defined sepsis (defined as SIRS plus bacteremia) and severe sepsis (defined as SIRS plus hypotension and bacteremia) decreased at statistically significant rates of 5.7 % (95 % CI: -9.0, -2.4) and 8.6 % (95 % CI: -4.4, -12.6) annually. All-cause mortality, SIRS mortality, and SIRS and clinically-defined sepsis case fatality did not change significantly during the study period. Sepsis mortality, based on ICD-9-CM codes, however, increased by 8.8 % (95 % CI: 1.9, 16.2) annually. CONCLUSIONS The incidence of sepsis, defined by ICD-9-CM codes, and sepsis mortality increased steadily without a concomitant increase in SIRS or clinically-defined sepsis. Our results highlight the need to develop strategies to integrate clinical patient-level data with administrative data to draw more accurate conclusions about the epidemiology of sepsis.
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BACKGROUND Correlations between symptom documentation in medical records and patient self-report (SR) vary depending on the condition studied. Patient symptoms are particularly important in urinary tract infection (UTI) diagnosis, and this correlation for UTI symptoms is currently unknown. METHODS This is a cross-sectional survey study in hospitalized patients with Escherichia coli bacteriuria. Patients were interviewed within 24 hours of diagnosis for the SR of UTI symptoms. We reviewed medical records for UTI symptoms documented by admitting or treating inpatient physicians (IPs), nurses (RNs), and emergency physicians (EPs). The level of agreement between groups was assessed using Cohen κ coefficient. RESULTS Out of 43 patients, 34 (79%) self-reported at least 1 of 6 primary symptoms. The most common self-reported symptoms were urinary frequency (53.5%); retention (41.9%); flank pain, suprapubic pain, and fatigue (37.2% each); and dysuria (30.2%). Correlation between SR and medical record documentation was slight to fair (κ, 0.06-0.4 between SR and IPs and 0.09-0.5 between SR and EDs). Positive agreement was highest for dysuria and frequency. CONCLUSION Correlation between self-reported UTI symptoms and health care providers' documentation was low to fair. Because medical records are a vital source of information for clinicians and researchers and symptom assessment and documentation are vital in distinguishing UTI from asymptomatic bacteriuria, efforts must be made to improve documentation.
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by J. Aikin, M.D, Oliver Goldsmith
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by Johs. Pedersen. [Transl. by Aslaug Møller]
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by Max Schloessinger
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by Henry Malter
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Hierarchical linear growth model (HLGM), as a flexible and powerful analytic method, has played an increased important role in psychology, public health and medical sciences in recent decades. Mostly, researchers who conduct HLGM are interested in the treatment effect on individual trajectories, which can be indicated by the cross-level interaction effects. However, the statistical hypothesis test for the effect of cross-level interaction in HLGM only show us whether there is a significant group difference in the average rate of change, rate of acceleration or higher polynomial effect; it fails to convey information about the magnitude of the difference between the group trajectories at specific time point. Thus, reporting and interpreting effect sizes have been increased emphases in HLGM in recent years, due to the limitations and increased criticisms for statistical hypothesis testing. However, most researchers fail to report these model-implied effect sizes for group trajectories comparison and their corresponding confidence intervals in HLGM analysis, since lack of appropriate and standard functions to estimate effect sizes associated with the model-implied difference between grouping trajectories in HLGM, and also lack of computing packages in the popular statistical software to automatically calculate them. ^ The present project is the first to establish the appropriate computing functions to assess the standard difference between grouping trajectories in HLGM. We proposed the two functions to estimate effect sizes on model-based grouping trajectories difference at specific time, we also suggested the robust effect sizes to reduce the bias of estimated effect sizes. Then, we applied the proposed functions to estimate the population effect sizes (d ) and robust effect sizes (du) on the cross-level interaction in HLGM by using the three simulated datasets, and also we compared the three methods of constructing confidence intervals around d and du recommended the best one for application. At the end, we constructed 95% confidence intervals with the suitable method for the effect sizes what we obtained with the three simulated datasets. ^ The effect sizes between grouping trajectories for the three simulated longitudinal datasets indicated that even though the statistical hypothesis test shows no significant difference between grouping trajectories, effect sizes between these grouping trajectories can still be large at some time points. Therefore, effect sizes between grouping trajectories in HLGM analysis provide us additional and meaningful information to assess group effect on individual trajectories. In addition, we also compared the three methods to construct 95% confident intervals around corresponding effect sizes in this project, which handled with the uncertainty of effect sizes to population parameter. We suggested the noncentral t-distribution based method when the assumptions held, and the bootstrap bias-corrected and accelerated method when the assumptions are not met.^
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http://lib.dr.iastate.edu/carver_narratives/1025/thumbnail.jpg
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Fil: Peretó Rivas, Rubén.
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Fil: Costarelli Brandi, Hugo Emilio. Universidad Nacional de Cuyo
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This archive consists of the hydrographic data collected on Cruise 82-002 of C.S.S. Hudson, April 11 to May 2, 1982. 78 stations were occupied on a line running near 48°N from the mouth of the English Channel to the Grand Banks of Newfoundland. Pressure, temperature and salinity were measured by a Guildline digital CTP system. Salinity, dissolved oxygen, silicate, nitrate and phosphate were measured from water samples collected on the CTP upcasts. CTP and discrete bottle data and associated derived parameters are tabulated at standard levels. This is the digital version of the printed report (of 1989, see further details), published in 2006 with the information system Pangaea.
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Este trabajo tiene como objetivo describir la experiencia de implementación y desarrollo del Portal de revistas de la Facultad de Humanidades y Ciencias de Educación de la Universidad Nacional de La Plata a fin de que pueda ser aprovechada por todos aquellos que emprendan iniciativas de características similares. Para ello, se realiza en primer lugar un repaso por la trayectoria de la Facultad respecto a la edición de revistas científicas y la labor bibliotecaria para contribuir a su visualización. En segundo orden, se exponen las tareas llevadas adelante por la Prosecretaría de Gestión Editorial y Difusión (PGEyD) de la Facultad para concretar la puesta en marcha del portal. Se hace especial referencia a la personalización del software, a la metodología utilizada para la carga masiva de información en el sistema (usuarios y números retrospectivos) y a los procedimientos que permiten la inclusión en repositorio institucional y en el catálogo web de todos los contenidos del portal de manera semi-automática. Luego, se hace alusión al trabajo que se está realizando en relación al soporte y a la capacitación de los editores. Se exponen, después, los resultados conseguidos hasta el momento en un año de trabajo: creación de 10 revistas, migración de 4 títulos completos e inclusión del 25de las contribuciones publicadas en las revistas editadas por la FaHCE. A modo de cierre se enuncian una serie de desafíos que la Prosecretaría se ha propuesto para mejorar el Portal y optimizar los flujos de trabajo intra e interinstitucionales
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Fil: Amícola, José. Universidad Nacional de La Plata. Facultad de Humanidades y Ciencias de la Educación; Argentina.