Entry II.B: Observational Study, (1) Retrospective Study, and (2) Prospective Study

Objective.To quantify and characterize overall antimicrobial use, including appropriateness of indication, among patients receiving chronic hemodialysis.Design.Retrospective and prospective observational study.Setting.Two outpatient hemodialysis units.Patients.All patients receiving chronic hemodialysis.Methods.The rate of parenteral antimicrobial use (number of doses per 100 patient-months) was calculated retrospectively from September 2008 through July 2011. Indication and appropriateness of antimicrobial doses were characterized prospectively from August 2010 through July 2011. Inappropriate administration was defined as occasions when criteria for infection based on national guidelines were not met, failure to choose a more narrow-spectrum antimicrobial on the basis of culture data, or occasions when indications for surgical prophylaxis were not met.Results.Over the 35-month retrospective study period, the rate of parenteral antimicrobial use was 32.9 doses per 100 patient-months. Vancomycin was the most commonly prescribed antimicrobial, followed by cefazolin and third- or fourth-generation cephalosporins. Over the 12-month prospective study, 1,003 antimicrobial doses were prescribed. Among the 926 (92.3%) doses for which an indication for administration was available, 276 (29.8%) were classified as inappropriate. Of these, a total of 146 (52.9%) did not meet criteria for infection, 74 (26.8%) represented failure to choose a more narrow-spectrum antimicrobial, and 56 (20.3%) did not meet criteria for surgical prophylaxis. The most common inappropriately prescribed antimicrobials were vancomycin and third- or fourth- generation cephalosporins.Conclusions.Parenteral antimicrobial use was extensive, and as much as one-third was categorized as inappropriate. The findings of this study provide novel information toward minimizing inappropriate antimicrobial use.

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Development of the phenylketonuria screening programme in Estonia

Journal of Medical Screening ◽

10.1136/jms.5.1.22 ◽

1998 ◽

Vol 5 (1) ◽

pp. 22-23 ◽

Cited By ~ 7

Author(s):

K Õunap ◽

H Lilleväli ◽

A Metspalu ◽

M Lipping-Sitska

Keyword(s):

Retrospective Study ◽

Prospective Study ◽

Newborn Screening ◽

Filter Paper ◽

Screening Programme ◽

European Countries ◽

Diagnosis And Treatment ◽

Fluorometric Method ◽

Live Births ◽

Ninhydrin Reaction

Objective To develop the phenylketonuria (PKU) screening programme in Estonia. Method All data about patients with PKU, born during 1980–92, were documented to establish its prevalence at birth in Estonia. Newborn screening for the diagnosis and treatment of PKU was started in Estonia in 1993 and the prevalence at birth established by screening. Phenylalanine was determined from filter paper blood by a modified fluorometric method based on enhancement of the fluorescence of a phenylalanine-ninhydrin reaction product by L-leucyl-L-alanine. Results During three years (1993–5) 36 074 newborns (85% of the total) were screened for PKU. PKU was diagnosed in six cases during the first four to six weeks of life. All investigated cases could be classified as classical PKU. No cases of mild forms of hyperphenylalaninaemia were diagnosed. The retrospective study showed an average incidence of PKU of 1 in 8090, the prospective study identified a comparable incidence of 1 in 6010 live births. Conclusion The prevalence at birth of classic PKU in Estonia is higher than the average in Europe and similar to that of some eastern and middle European countries.

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Screening of epileptic seizures in children and adolescents with hydrocephalus and ventriculoperitoneal shunt

Journal of Epilepsy and Clinical Neurophysiology ◽

10.1590/s1676-26492009000300002 ◽

2009 ◽

Vol 15 (3) ◽

pp. 106-109 ◽

Cited By ~ 1

Author(s):

Raimundo Francisco de Amorim Júnior ◽

Suerda Emiliana Cavalcanti Dantas ◽

Rodrigo de Holanda Mendonça ◽

Abdiel de Lira Rolim ◽

Maria Luiza de Carvalho Jales ◽

...

Keyword(s):

Retrospective Study ◽

Data Analysis ◽

Prospective Study ◽

Children And Adolescents ◽

Ventriculoperitoneal Shunt ◽

Epileptic Seizures ◽

Significant Difference ◽

A Prospective Study ◽

Larger Sample ◽

Diagnosis Age

OBJECTIVES: To assess the occurrence of epileptic seizures (ES) in children and adolescents with hydrocephalus and their relationship with ventriculoperitoneal shunt (VPS) treatment. METHODS: Retrospective study of 45 patients from both genders, aged 0 to 18 years, with hydrocephalus and presenting with ES or not. The following variables were analyzed: gender, hydrocephalus etiology, age at diagnosis, age at initial VPS treatment, age at first ES and types of ES. RESULTS: Data analysis showed the following: 20 (44.4%) presented with ES, 13 (65%) of the girls and seven (35%) of the boys. There was a predominance of ES in the girls, but with no statistically significant difference. In total, 13 (65%) patients used VPS. Of the 13 patients with VPS and ES, it was observed that the onset of ES was after VPS in 10 (76.9%) individuals, whereas it occurred before VPS in two (15.4%). CONCLUSIONS: The results showed no association between VPS treatment and ES (ρ=0.832); however, most of the patients presented with their first ES episode after VPS, suggesting a possible relationship between this treatment and the occurrence of ES. A larger sample and a prospective study might answer this question.

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A Prospective Study of Dietary Calcium and Other Nutrients and the Risk of Symptomatic Kidney Stones

50 Studies Every Urologist Should Know ◽

10.1093/med/9780190655341.003.0033 ◽

2021 ◽

pp. 189-192

Author(s):

Michael S. Borofsky ◽

Vincent G. Bird

Keyword(s):

Observational Study ◽

Prospective Study ◽

Kidney Stones ◽

Calcium Intake ◽

Dietary Calcium ◽

Stone Disease ◽

Dietary Calcium Intake ◽

History Of ◽

The Mean ◽

A Prospective Study

This chapter reviews the results of an important observational study seeking to establish how, in individuals without a history of nephrolithiasis, dietary calcium intake is associated with the risk of symptomatic stone disease. The study found that the mean daily dietary calcium intake was lower in the group who formed stones compared to those who did not and that, after adjusting for covariates, high daily dietary calcium intake was strongly associated with decreased risk of stones.

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Evaluation of Suzor forceps training by studying obstetric anal sphincter injuries: a retrospective study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03358-0 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Perrine COSTE MAZEAU ◽

Nedjma BOUKEFFA ◽

Nathalie TICAUD BOILEAU ◽

Samantha HUET ◽

Maud TRAVERSE ◽

...

Keyword(s):

Risk Factors ◽

Body Mass Index ◽

Retrospective Study ◽

Observational Study ◽

Anal Sphincter ◽

University Hospital ◽

Obstetric Anal Sphincter Injuries ◽

Fourth Degree ◽

Perineal Tears ◽

Vacuum Extractor

Abstract Background Instrumental deliveries are an unavoidable part of obstetric practice. Dedicated training is needed for each instrument. To identify when a trainee resident can be entrusted with instrumental deliveries by Suzor forceps by studying obstetric anal sphincter injuries. Methods A French retrospective observational study of obstetric anal sphincter injuries due to Suzor forceps deliveries performed by trainee residents was conducted from November 2008 to November 2016 at Limoges University Hospital. Perineal lesion risk factors were studied. Sequential use of a vacuum extractor and then forceps was also analyzed. Results Twenty-one residents performed 1530 instrumental deliveries, which included 1164 (76.1%) using forceps and 89 (5.8%) with sequential use of a vacuum extractor and then forceps. Third and fourth degree perineal tears were diagnosed in 82 patients (6.5%). Residents caused fewer obstetric anal sphincter injuries after 23.82 (+/− 0.8) deliveries by forceps (p = 0.0041), or after 2.36 (+/− 0.7) semesters of obstetrical experience (p = 0.0007). No obese patient (body mass index> 30) presented obstetric anal sphincter injuries (p = 0.0013). There were significantly fewer obstetric anal sphincter injuries after performance of episiotomy (p < 0.0001), and more lesions in the case of the occipito-sacral position (p = 0.028). Analysis of sequential instrumentation did not find any additional associated risk. Conclusion Training in the use of Suzor forceps requires extended mentoring in order to reduce obstetric anal sphincter injuries. A stable level of competence was found after the execution of at least 24 forceps deliveries or after 3 semesters (18 months) of obstetrical experience.

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A New Therapeutic Application of Platelet-Rich Plasma to Chronic Breast Wounds: A Prospective Observational Study

Journal of Clinical Medicine ◽

10.3390/jcm9103063 ◽

2020 ◽

Vol 9 (10) ◽

pp. 3063

Author(s):

Juan de Dios Berná-Serna ◽

Florentina Guzmán-Aroca ◽

José A. García-Vidal ◽

Dolores Hernández-Gómez ◽

Ana Azahara García-Ortega ◽

...

Keyword(s):

Breast Cancer ◽

Observational Study ◽

Prospective Study ◽

Prospective Observational Study ◽

Wound Closure ◽

Chronic Wounds ◽

Platelet Rich Plasma ◽

Therapeutic Application ◽

History Of ◽

A Prospective Study

The aim of this study was to investigate the usefulness of platelet-rich plasma (PRP) treatment for chronic wounds (CWs) of the breast. A prospective study was performed in 23 patients with CW of the breast who were treated with PRP. The procedure was repeated until the wound was closed completely. The study included patients with a history of breast cancer (n = 8) and patients without cancer (n = 15). The treatment with PRP was successful in all cases and observed in ≤4 weeks in 82.6% (19/23) of patients. The patients without breast cancer showed significantly less time for wound closure than the patients with a history of breast cancer. Moreover, a greater number of PRP treatments were necessary to achieve wound closure in patients undergoing conservative breast treatment. No patients had complications associated with the application of PRP. Conclusions: To the best of our knowledge, this is the first study to reveal that PRP treatment for CWs of the breast is safe, simple, useful and well-tolerated by patients.

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Retrospective analysis underestimates neurological deficits in complex spinal deformity surgery: a Scoli-RISK-1 Study

Journal of Neurosurgery Spine ◽

10.3171/2016.12.spine161068 ◽

2017 ◽

Vol 27 (1) ◽

pp. 68-73 ◽

Cited By ~ 12

Author(s):

Michael P. Kelly ◽

Lawrence G. Lenke ◽

Jakub Godzik ◽

Ferran Pellise ◽

Christopher I. Shaffrey ◽

...

Keyword(s):

Retrospective Study ◽

Cohort Studies ◽

Prospective Study ◽

Spinal Deformity ◽

Neurological Deficit ◽

Prospective Studies ◽

Adult Spinal Deformity ◽

Statistical Significance ◽

Neurological Deficits ◽

Inclusion Criteria

OBJECTIVEThe authors conducted a study to compare neurological deficit rates associated with complex adult spinal deformity (ASD) surgery when recorded in retrospective and prospective studies. Retrospective studies may underreport neurological deficits due to selection, detection, and recall biases. Prospective studies are expensive and more difficult to perform, but they likely provide more accurate estimates of new neurological deficit rates.METHODSNew neurological deficits were recorded in a prospective study of complex ASD surgeries (pSR1) with a defined outcomes measure (decrement in American Spinal Injury Association lower-extremity motor score) for neurological deficits. Using identical inclusion criteria and a subset of participating surgeons, a retrospective study was created (rSR1) and neurological deficit rates were collected. Continuous variables were compared with the Student t-test, with correction for multiple comparisons. Neurological deficit rates were compared using the Mantel-Haenszel method for standardized risks. Statistical significance for the primary outcome measure was p < 0.05.RESULTSOverall, 272 patients were enrolled in pSR1 and 207 patients were enrolled in rSR1. Inclusion criteria, defining complex spinal deformities, and exclusion criteria were identical. Sagittal Cobb measurements were higher in pSR1, although sagittal alignment was similar. Preoperative neurological deficit rates were similar in the groups. Three-column osteotomies were more common in pSR1, particularly vertebral column resection. New neurological deficits were more common in pSR1 (pSR1 17.3% [95% CI 12.6–22.2] and rSR1 9.0% [95% CI 5.0–13.0]; p = 0.01). The majority of deficits in both studies were at the nerve root level, and the distribution of level of injury was similar.CONCLUSIONSNew neurological deficit rates were nearly twice as high in the prospective study than the retrospective study with identical inclusion criteria. These findings validate concerns regarding retrospective cohort studies and confirm the need for and value of carefully designed prospective, observational cohort studies in ASD.

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Use of the McIsaac Score to Predict Group A Streptococcal Pharyngitis in Outpatient Nurse Phone Triage and Electronic Visits Compared With In-Person Visits: Retrospective Observational Study (Preprint)

10.2196/preprints.25899 ◽

2020 ◽

Author(s):

Jennifer L Pecina ◽

Leah M Nigon ◽

Kristine S Penza ◽

Martha A Murray ◽

Beckie J Kronebusch ◽

...

Keyword(s):

Retrospective Study ◽

Observational Study ◽

Sore Throat ◽

Scoring System ◽

Group A Streptococcus ◽

Streptococcal Pharyngitis ◽

Future Studies ◽

Face To Face ◽

Geographic Barriers ◽

Group A

BACKGROUND The McIsaac criteria are a validated scoring system used to determine the likelihood of an acute sore throat being caused by group A streptococcus (GAS) to stratify patients who need strep testing. OBJECTIVE We aim to compare McIsaac criteria obtained during face-to-face (f2f) and non-f2f encounters. METHODS This retrospective study compared the percentage of positive GAS tests by McIsaac score for scores calculated during nurse protocol phone encounters, e-visits (electronic visits), and in person f2f clinic visits. RESULTS There was no difference in percentages of positive strep tests between encounter types for any of the McIsaac scores. There were significantly more phone and e-visit encounters with any missing score components compared with f2f visits. For individual score components, there were significantly fewer e-visits missing fever and cough information compared with phone encounters and f2f encounters. F2f encounters were significantly less likely to be missing descriptions of tonsils and lymphadenopathy compared with phone and e-visit encounters. McIsaac scores of 4 had positive GAS rates of 55% to 68% across encounter types. There were 4 encounters not missing any score components with a McIsaac score of 0. None of these 4 encounters had a positive GAS test. CONCLUSIONS McIsaac scores of 4 collected during non-f2f care could be used to consider empiric treatment for GAS without testing if significant barriers to testing exist such as the COVID-19 pandemic or geographic barriers. Future studies should evaluate further whether non-f2f encounters with McIsaac scores of 0 can be safely excluded from GAS testing.

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The Influence of Bias on the Outcome of Prospective versus Retrospective Cephalometric Twin-Block Trials

International Journal of Dentistry and Oral Health ◽

10.16966/2378-7090.352 ◽

2021 ◽

Vol 7 (3) ◽

Author(s):

Trenouth MJ

Keyword(s):

Retrospective Study ◽

Prospective Study ◽

Treatment Response ◽

Twin Block ◽

A Prospective Study

Objective: This was to investigate whether a retrospective study inflates or deflates the treatment response compared to a prospective study.

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Virologic Outcomes of Switching to Dolutegravir Functional Monotherapy, or Functional Dual Therapy With Dolutegravir Plus A Non-cytosine Nucleoside Analog: A Retrospective Study of Treatment-Experienced, HIV-1 Infected Patients

10.21203/rs.3.rs-74793/v1 ◽

2020 ◽

Author(s):

Charlotte-Paige Rolle ◽

Vu Nguyen ◽

Federico Hinestrosa ◽

Edwin DeJesus

Keyword(s):

Retrospective Study ◽

Observational Study ◽

Median Duration ◽

Primary Endpoint ◽

Real World ◽

Virologic Failure ◽

Dual Therapy ◽

Nucleoside Analog ◽

Hiv 1

Abstract Background Dolutegravir (DTG) monotherapy results in unacceptable virologic failure rates and the development of DTG resistance. Here, we evaluated virologic outcomes of patients switched to DTG functional monotherapy, or functional dual therapy with DTG plus a non-cytosine nucleoside analog (NA).Methods This observational study included treatment-experienced patients switched to regimens containing ≥ 3 antiretrovirals later found to be on DTG functional monotherapy, or functional dual therapy with DTG plus a non-cytosine NA based on historical genotypes. Eligible patients were either suppressed or viremic at baseline and had ≥2 HIV-1 RNA measurements at least four weeks apart following switch. The primary endpoint was the proportion with HIV-1 RNA<50 copies/mL following switch. Results Thirty-nine patients were included, 19 (49%) were found to be on DTG functional monotherapy and 20 (51%) were found to be on functional dual therapy with DTG plus a non-cytosine NA. The median duration of follow-up was 50 weeks (range 12-244). Following switch, 32/39 (82%) patients achieved or maintained an HIV-1 RNA<50 copies/mL. In 7 (18%) patients with persistent HIV-1 RNA ≥50 copies/mL, there was no evidence of treatment-emergent resistance among those with post-switch genotypes.Conclusions In this real-world cohort, the majority of whom had virus with the M184V/I and ≥ 1 additional NA mutation, switching to DTG functional monotherapy, or functional dual therapy with DTG plus a non-cytosine NA resulted in persistent HIV-1 RNA≥ 50 copies/mL in 18%. None with post-switch genotypes developed treatment-emergent resistance.

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