On shrinkage and model extrapolation in the evaluation of clinical center performance

Abstract We consider statistical methods for benchmarking clinical centers based on a dichotomous outcome indicator. Borrowing ideas from the causal inference literature, we aim to reveal how the entire study population would have fared under the current care level of each center. To this end, we evaluate direct standardization based on fixed versus random center effects outcome models that incorporate patient-specific baseline covariates to adjust for differential case-mix. We explore fixed effects (FE) regression with Firth correction and normal mixed effects (ME) regression to maintain convergence in the presence of very small centers. Moreover, we study doubly robust FE regression to avoid outcome model extrapolation. Simulation studies show that shrinkage following standard ME modeling can result in substantial power loss relative to the considered alternatives, especially for small centers. Results are consistent with findings in the analysis of 30-day mortality risk following acute stroke across 90 centers in the Swedish Stroke Register.

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Implementation of a Constipation Action Plan for Patients Discharged From a Pediatric Hospitalist Service

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-26.7.718 ◽

2021 ◽

Vol 26 (7) ◽

pp. 718-722

Author(s):

Andrew Allison ◽

Courtney Sweet ◽

Melissa Knopp

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Action Plan ◽

Patient Specific ◽

Care Utilization ◽

Entire Study ◽

Phone Calls ◽

Bowel Movements ◽

Study Population

OBJECTIVE The objective of this study was to determine the effect of a pharmacist-led constipation action plan on the rate of health care utilization. METHODS We conducted a prospective research study of patients 2 to 18 years of age admitted to a pediatric hospitalist service for constipation. A study pharmacist developed a patient-specific constipation action plan for each enrolled patient. Data were collected from the electronic medical record, patient/caregiver interview, and follow-up phone calls completed by a pharmacist. The primary outcome was to determine the effect of a pharmacist-led constipation action plan on the rate of health care utilization. RESULTS Twenty-seven patients were enrolled in the study. Median (range) age was 9 (2–18) years. Health care utilization of the entire study population decreased from approximately 8.7 encounters per month prior to implementation to approximately 3 encounters per month after implementation. Patients also reported an increase in daily bowel movements from approximately 1 per day prior to implementation to 2 per day post implementation. CONCLUSIONS Health care utilization appeared to decrease after implementation of a patient-specific, pharmacist-led constipation action plan.

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Pengaruh Kepuasan Kerja terhadap Organizational Citizenship Behavior (OCB) Alumni Diklat Kepemimpinan Tingkat IV di Provinsi Banten

Jurnal Good Governance ◽

10.32834/gg.v16i1.155 ◽

2020 ◽

Vol 16 (1) ◽

Author(s):

Enong Rostiawati

Keyword(s):

Job Satisfaction ◽

Organizational Citizenship ◽

Organizational Citizenship Behavior ◽

Leadership Training ◽

Survey Methods ◽

Citizenship Behavior ◽

Entire Study ◽

Analysis Technique ◽

Study Population

Abstract: Organizational Citizenship Behavior (OCB) is a variable that can be influenced by job satisfaction. This study aims to determine the effect of job satisfaction variables on Organizational Citizenship Behavior OCB alumni level IV leadership training in Banten Province. This research uses a quantitative approach through survey methods. Data analysis technique used is simple linear regression. The population in this study were 40 respondents and the sample used was 40 respondents. Determination of the sample using total sampling techniques or samples taken from the entire study population. The results of the analysis and interpretation of research data show that the value of the regulatory coefficient of influence on job satisfaction on Organizational Citizenship Behavior (OCB) alumni of leadership training level IV is 0.740 thus it can be concluded that job satisfaction has a direct positive effect on Organizational Citizenship Behavior alumni training, meaning that improvement of satisfaction in IV level leadership training is 0.740. work has an impact on improving Organizational Citizenship Behavior for training alumni, So Organizational Citizenship Behavior for training alumni can be achieved through job satisfaction.Keywords: Job satisfaction, Organizational Citizenship Behavior, Leadership Training Alumni Level IV

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The Impact of Internal Work Environment on the Retention of Healthcare Providers at Turaif General Hospital

Journal of Business and Economics ◽

10.15341/jbe(2155-7950)/12.10.2019/006 ◽

2019 ◽

Vol 10 (12) ◽

pp. 1183-1199

Author(s):

Mohammed Alrouili ◽

Keyword(s):

Work Environment ◽

General Hospital ◽

Professional Growth ◽

Healthcare Providers ◽

Entire Study ◽

Internal Work ◽

Research Findings ◽

Study Population ◽

The Right ◽

The Impact

This study attempted to identify the impact of internal work environment on the retention of healthcare providers at Turaif General Hospital in the Kingdom of Saudi Arabia. In particular, the study aimed to identify the dimensions of work circumstances, compensation, and relationship with colleagues, professional growth, and the level of healthcare providers’ retention. In order to achieve the study goals, the researcher used the descriptive analytical approach. The researcher used the questionnaire as the study tool. The study population comprised all the healthcare providers at Turaif General Hospital. Questionnaires were distributed to the entire study sample that consisted of 220 individuals. The number of questionnaires valid for study was 183 questionnaires. The research findings were as follows: the participants’ estimate of the work circumstances dimension was high (3.64), the participants’ estimate of the compensation dimension was moderate (3.32), the participants’ estimate of the relationship with colleagues dimension was high (3.62), the participants’ estimate of the professional growth dimension was weak (2.39), and the participants’ estimate of healthcare providers’ retention level was intermediate (2.75). Accordingly, the researcher’s major recommendations are: the need to create the right atmosphere for personnel in hospitals, the interest of the hospital to provide the appropriate conditions for the staff in terms of the physical and moral aspects for building the work adjustment in the staff, and conducting training courses and educational lectures for personnel in hospitals on how to cope with the work pressures.

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Multicentre Study of Endo-Ectoparasite Infection in Italian Cats

10.21203/rs.3.rs-558064/v1 ◽

2021 ◽

Author(s):

Marco Genchi ◽

ALICE VISMARRA ◽

STEFANIA ZANET ◽

SIMONE MORELLI ◽

ROBERTA GALUPPI ◽

...

Keyword(s):

Risk Factors ◽

Geographic Area ◽

Human Infection ◽

Diagnostic Methods ◽

Effective Control ◽

Entire Study ◽

Private Households ◽

Health Concept ◽

Study Population ◽

The One

Abstract BackgroundParasites infecting cats include protozoa, helminths and arthropods. Many are also transmissible to humans. Effective control relies on knowledge of parasite distribution and risk factors for infection. The present study was aimed at evaluating prevalence of major feline parasites in Italy and risk factors associated with their occurrence.MethodsOver a 12-month study period, thirteen study centers across Italy analyzed feces, hair and ectoparasites from naturally infected cats coming from feral colonies, shelters and private households. Samples from cats (n=987) were analyzed by all centers using the same diagnostic methods. Prevalence values and risk factors were evaluated statistically for identification of predictors of risk. ResultsThe overall prevalence of gastro-intestinal (GI) and bronco-pulmonary (BP) nematodes was 35.9% (354/987). T. cati was the most prevalent species (253/987; 25.6%), followed by hookworms (98/987; 9.9%). Among BP nematodes, A. abstrusus was the most common (76/987; 7.7%). Approximately 35.7% (352/987) of the study population was infested by ectoparasites. The most common were fleas 29.4% (290/987), followed by ear mites O. cynotis 9.8% (97/987).Predictors of risk for parasite infection included age, a predominantly or exclusively outdoor lifestyle, geographic area and lack of anti-parasitic treatment.ConclusionBoth ecto- and endoparasites are still common in cats throughout Italy, many of them being of zoonotic concern and vectors of pathogens to humans. Given the presence of parasites throughout the entire study period, year-round treatment should be considered. Furthermore, data confirm the need to protect the human-animal bond using proper endo- and ecto-parasiticides to reduce the risk of human infection, in application of the One-Health concept.

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A school-based oral health educational program: the experience of Maringa- PR, Brazil

Journal of Applied Oral Science ◽

10.1590/s1678-77572004000100006 ◽

2004 ◽

Vol 12 (1) ◽

pp. 27-33 ◽

Cited By ~ 10

Author(s):

Carlos Alberto Conrado ◽

Sandra Mara Maciel ◽

Márcia Regina Oliveira

Keyword(s):

Health Care ◽

Oral Health ◽

Oral Hygiene ◽

Primary Schools ◽

Oral Health Care ◽

School Level ◽

Educational Approach ◽

Entire Study ◽

School Based ◽

Study Population

The main purpose of this study was to evaluate the preliminary results of a school-based oral health educational strategy adopted in public primary schools from the city of Maringa, State of Parana, Brazil. The study sample was composed by 556 children and adolescents aged 6 to 17 years old, 124 schoolteachers and a group of 55 mothers. The educational approach was implemented for 18 months and consisted of reinforcements of interventions addressed to students and schoolteachers at school level and few activities targeted at the mothers, performed by means of home visits. Baseline and follow-up interviews focused on oral health care were undertaken for the entire study population. As a stimulus for the students to achieve proper oral hygiene habits, the simplified oral hygiene index was assessed at three different moments. A statistically significant improvement in their oral hygiene index (p<0.001) was recorded. The results achieved suggest an encouraging tendency towards the improvement in the levels of oral health care among the school-age youths studied. They also point out the need of intensifying the preparation of schoolteachers in oral health topics, as well the instructions to the mothers for their oral health care. Moreover, they highlight the importance of the continuous implementation of school-based programs to promote the oral health.

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The importance of kindergarten institutions in achieving integrated education for pre-school children: أهمية مؤسسات رياض الأطفال في تحقيق التربية المتكاملة لأطفال ما قبل المدرسة

المجلة العربية للعلوم ونشر الأبحاث مجلة العلوم التربوية والنفسية ◽

10.26389/ajsrp.n230317 ◽

2017 ◽

Vol 1 (4) ◽

Author(s):

Nafez Ayoub "Ali Ahmed"

Keyword(s):

Social Sciences ◽

Preschool Child ◽

School Children ◽

Emotional Development ◽

Point Of View ◽

Integrated Education ◽

Entire Study ◽

Statistical Program ◽

Study Population ◽

Descriptive Approach

The aim of this study is to understand the importance of kindergarten institutions in achieving integrated education for pre-school children. The researcher used the descriptive approach. The study population consisted of all the principals and educators of kindergartens in Salfit Governorate. The study sample included the entire study population of (120) director and educator. The researcher used the statistical program for social sciences (SPSS) to process the data statistically. The results showed that the percentage of achievement of kindergarten institutions in Salfit governorate for integrated education reached (68%) in terms of specifications of buildings, sites and facilities to help achieve the integrated education of the preschool child. The study also showed that 98% of the activities carried out within kindergartens help pre-school children to grow properly in various aspects of physical, mental and emotional development, thus achieving integrated education. The results showed that there were no statistically significant differences at the level of (α 0.05 0.05) for the importance of kindergartens in achieving the integrated education of pre-school children from the point of view of the principals and educators of the kindergartens in Salfit governorate for the fields (building, location, facilities, activities) Paragraphs attributed to the variables of nature of work and scientific qualification.

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Reduced Growth in Non-Small for Gestational Age Fetuses from 35 Weeks of Gestation to Birth and Perinatal Outcomes

Fetal Diagnosis and Therapy ◽

10.1159/000519639 ◽

2021 ◽

pp. 1-10

Author(s):

Peña Dieste Pérez ◽

Luis M. Esteban ◽

Ricardo Savirón-Cornudella ◽

Faustino R. Pérez-López ◽

Sergio Castán-Mateo ◽

...

Keyword(s):

Gestational Age ◽

Small For Gestational Age ◽

Perinatal Outcomes ◽

Entire Study ◽

Birth Weight Percentile ◽

Gestational Age At Delivery ◽

Study Population ◽

The Difference ◽

Relationship Of ◽

The Relationship

Objective: This study aimed to assess reduced fetal growth between 35 weeks of gestation and birth in non-small for gestational age fetuses associated with adverse perinatal outcomes (APOs). Material and Method: It is a retrospective cohort study of 9,164 non-small for gestational age fetuses estimated by ultrasound at 35 weeks. The difference between the birth weight percentile and the estimated percentile weight (EPW) at 35 weeks of gestation was calculated, and we studied the relationship of this difference with the appearance of APO. APOs were defined as cesarean or instrumental delivery rates for nonreassuring fetal status, 5-min Apgar score <7, arterial cord blood pH <7.10, and stillbirth. Fetuses that exhibited a percentile decrease between both moments were classified into 6 categories according to the amount of percentile decrease (0.01–10.0, 10.01–20.0, 20.01–30.0, 30.01–40.0, 40.01–50.0, and >50.0 percentiles). It was evaluated whether the appearance of APO was related to the amount of this percentile decrease. Relative risk (RR) was calculated in these subgroups to predict APOs in general and for each APO in particular. Receiver operating characteristic and area under curves (AUC) for the difference in the percentile was calculated, used as a continuous parameter in the entire study population. Results: The median gestational age at delivery in uncomplicated pregnancies was 40.0 (39.1–40.7) and in pregnancies with APOs 40.3 (49.4–41.0), p < 0.001. The prevalence of APOs was greater in the group of fetuses with a decrease in percentile (7.6%) compared to those with increased percentile (4.8%) (p < 0.001). The RR was 1.63 (95% CI: 1.365–1.944, p < 0.001). Although the differences were significant in all decreased percentile groups, RRs were significantly higher when decreased growth values were >40 points (RR: 2.036, 95% CI: 1.581–2.623, p < 0.001). The estimated value of the AUC for percentile decrease was 0.58 (0.56–0.61, p < 0.001). Conclusion: Fetuses with a decrease in the EPW between the ultrasound at 35 weeks of gestation and birth have a higher risk of APOs, being double in fetuses with a decrease of >40 percentile points.

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Efficacy of Intra-Articular Injection of 10 mg and 20 mg Triamcinolone for Rheumatoid Arthritis of the Wrist: A Prospective, Randomized, Pilot Study

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835521200046 ◽

2021 ◽

Vol 26 (03) ◽

pp. 490-493

Author(s):

Takeshi Mochizuki ◽

Koichiro Yano ◽

Katsunori Ikari ◽

Ken Okazaki

Keyword(s):

Rheumatoid Arthritis ◽

Pilot Study ◽

Scale Score ◽

Rating Scale ◽

Numerical Rating Scale ◽

Wrist Joint ◽

Power Doppler ◽

Total Study Population ◽

Entire Study ◽

Study Population

Background: To compare the efficacy of intra-articular injection (IA) with 10 mg and 20 mg triamcinolone for treatment of rheumatoid arthritis (RA) of the wrist joint. Methods: We enrolled 20 patients with swelling and pain in wrist due to RA in the present prospective, randomized, pilot study. Patients were randomly assigned in a 1:1 ratio to either the 20 mg or 10 mg group, and received IA of the appropriate dose of triamcinolone. Efficacy was assessed by recording Numerical Rating Scale (NRS) for pain and improvement in power doppler (PD) scale score at weeks 1, 4, and 12 of treatment compared with baseline. The shortened Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) was recorded at baseline and week 12. Results: The NRS was found to be significantly improved at weeks 4 (p = 0.006) and 12 (p = 0.036) among the total study population. Neither the change in NRS nor the improvement PD scale score from baseline were significantly different between the two groups at any week (NRS: week 1, p = 0.617; week 4, p = 0.727; and week 12, p = 0.878; PD scale score: week 1, p = 0.370; week 4, p = 1.000; and week 12, p = 0.179). Among the entire study population, the QuickDASH was not significantly improved at week 12 nor was the change from baseline significantly different between the two groups at week 12 (p = 0.592). Conclusions: IA of triamcinolone was effective for pain relief in context of RA in the wrist joint. However, in terms of NRS, improvement of PD scale score, and QuickDASH score, the efficacies of 10 mg and 20 mg triamcinolone were not significantly different. Thus, IA of 10 mg triamcinolone may be sufficient for the treatment of RA in the wrist joint.

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Abstract 2381: Aneurysmal Subarachnoid Hemorrhage: Metabolic and Blood Flow Patterns

Circulation ◽

10.1161/circ.116.suppl_16.ii_522 ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

parham moftakhar ◽

Thomas C Glenn ◽

John Boscardin ◽

Neil A Martin

Keyword(s):

Blood Flow ◽

Phase Ii ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Phase Iii ◽

Entire Study ◽

Cerebral Metabolic Rate ◽

Study Population ◽

Blood Flow Patterns ◽

The Brain ◽

Oxygen Difference

Objective: The purpose of this study is to classify and describe the clinically distinct metabolic and hemodynamic phases post-ASAH. Methods: 224 patients who suffered an ASAH (mean age 55±14; 74% female, 26% male) were examined. Patients underwent daily transcranial Doppler (TCD) and cerebral blood flow (CBF) studies (using 133 Xe clearance). Due to the paucity of data on post-hemorrhage day (PHD) 0, the internal carotid artery end-diastolic (ICA ED ) velocity, a surrogate for CBF, was used for the first 24 hours. The brain arteriovenous oxygen difference (AVDO 2 ) was recorded for each patient and the cerebral metabolic rate of oxygen (CMRO 2 ) was calculated. Clinical outcome was evaluated based on the Glasgow Outcome Scale (GOS) 6 months after rupture. Results: Following ASAH, 3 distinct hemodynamic phases arose for the entire study population. Phase I (hypoperfusion phase), occurs on the day of rupture (PHD 0) and is defined by a low ICA ED velocity (mean 17.8±1.1 cm/s), normal middle cerebral artery (MCA) velocity (mean V MCA 58.0±23.4 cm/s), and normal Lindegaard Ratio ([LR], mean 1.66±0.50). Phase II (relative hyperemia), (PHD 1–3), is characterized by an increasing ICA ED (mean 35.4±1.0 cm/s, p<0.0001), a relative hyperemia (mean CBF 15 40.1±1.5 ml/100g/minute, CMRO 2 1.17±0.41 ml/100g/min), a rising V MCA (mean 71.5±5.8 cm/sec, p<0.0001), and a rising but normal LR (mean 2.21±0.19, p<0.0001). During phase III (vasospasm phase, PHD 4–21), both the ICA ED and CBF decrease (mean ICA ED 19.9±0.9 cm/s, p<0.0001; mean CBF 15 36.8±0.7 ml/100g/minute, p=0.04), V MCA continues to rise (mean 107.6±2.9cm/sec, p<0.0001), and the LR is further increased (mean 3.25±0.08, p<0.0001). The CMRO 2 remains low (mean 1.17±0.40 ml/100g/min, p=1). Based on the GOS up to 90% of patients who experienced either a relative or absolute hyperemia had good outcomes. Conclusions: After an ASAH, 3 discrete metabolic and hemodynamic phases arise each with the potential for its own unique phase-specific management and therapy. Relative hyperemia, or “luxury perfusion,” during Phase II in the setting of non-elevated ICPs may provide some type of benefit for patients.

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An unresolved issue: The relationship between spot urine protein-to-creatinine ratio and 24-hour proteinuria

Journal of International Medical Research ◽

10.1177/0300060518819602 ◽

2019 ◽

Vol 47 (3) ◽

pp. 1179-1184 ◽

Cited By ~ 3

Author(s):

Davut Akin ◽

Sehmus Ozmen

Keyword(s):

Medical Records ◽

Urine Protein ◽

Entire Study ◽

Spot Urine ◽

Protein Excretion ◽

Ratio Data ◽

Study Population ◽

The Mean ◽

The Relationship ◽

H Protein

Objective To investigate the relationship between spot urine protein-to-creatinine (sP/Cr) ratio and 24-h protein excretion in patients with different diagnoses. Methods This retrospective study analysed data from the medical records of patients admitted for24-h proteinuria determination who also had sP/Cr ratio data for the same day. Results A total of 1222 urine samples obtained from 694 adult outpatients were analysed. The mean ± SD age of the patients was 53.6 ± 15.9 years. The mean ± SD 24-h proteinuria and sP/Cr were 1.7 ± 2.4 g/day and 1.8 ± 2.4, respectively. The correlation between the sP/Cr and 24-h protein excretion was high (R2 = 0.89). The sP/Cr ratio accounted for 72% of the variability in 24-h proteinuria in the entire study population. Areas under the curve for 24-h proteinuria at 0.3 g/day, 1.0 g/day and 3.0 g/day were 0.940, 0.966, and 0.949, respectively. The mean + 2SD limits of agreement were between +2.99 and –2.73 g/day according to the Bland Altman analysis. Conclusion This current study found a clinically unacceptable deviation between 24-h proteinuria and sP/Cr ratio. Therefore, the sP/Cr ratio cannot replace 24-h proteinuria. A new method using spot urine protein and creatinine values that is able to minimize under or over estimation is still warranted.

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