scholarly journals The dangers of ignoring underlying trends in before-and-after studies – A cautionary tale using hip fracture mortality data

2020 ◽  
Vol 28 (2) ◽  
pp. 230949902093599
Author(s):  
Mohammad Cheik-Hussein ◽  
Ian A Harris ◽  
Adriane M Lewin
Keyword(s):  
Hip Fracture ◽  
Study Design ◽  
Secondary Analysis ◽  
Mortality Data ◽  
Control Group ◽  
Before And After ◽  
Hip Fracture Mortality ◽  
The Impact ◽  
Underlying Trend ◽  
Before And After Study

Background: Before-and-after studies are a valuable study design in situations where randomization is not feasible. These studies measure an outcome both before and after an intervention and compare the outcome rates in both time periods to determine the effectiveness of the intervention. Before-and-after studies do not involve a contemporaneous control group and must, therefore, take into account any underlying secular trends to separate the effect of the intervention from any pre-existing trend. Methods: To illustrate the importance of accounting for underlying trends, we performed a before-and-after study assessing 30-day mortality in hip fracture patients without any actual intervention, and instead designated an arbitrarily chosen time point as our ‘intervention’. We then analysed the data first disregarding and then incorporating the pre-existing underlying trend. We did this to show that even intervention of nothing may be spuriously interpreted to have an effect if the before-and-after study design is incorrectly analysed. Our study involved a secondary analysis of routinely collected data on 30-day mortality following hip fracture in our institution. Results: We found a secular trend in our data showing improving 30-day mortality in hip fracture patients in our institution. We then demonstrated that disregarding this underlying trend showed that our intervention of nothing ‘resulted’ in a significant 54% decrease in mortality, from 6.7% in the ‘before’ period to 3.1% in the ‘after’ period ( p < 0.0008). Though the 30-day mortality rate decreased during the ‘after’ period, the decrease was not significantly different from the underlying trend in the ‘before’ period, projected onto the ‘after’ period. When we accounted for the underlying trend in our analysis, the impact of the intervention (nothing) on 30-day mortality was no longer apparent (incidence rate ratio 0.75, 95% confidence interval 0.32–1.78; p = 0.5). Conclusion: Our study highlights the importance of appropriate measurement and consideration of underlying trends when analysing data from before-and-after studies and illustrates what can happen should researchers neglect this important step.

Reflection on research methods: The before and after study.

2019 ◽  
Author(s):  
Mohammad Cheik-Hussein ◽  
Ian Harris ◽  
Adriane Lewin
Keyword(s):  
Hip Fracture ◽  
Study Design ◽  
Secular Trend ◽  
Population Level ◽  
Control Group ◽  
Fracture Failure ◽  
Before And After ◽  
Underlying Trend ◽  
Before And After Study ◽  
Actual Intervention

Abstract Background Before and after studies allow for the investigation of population-level health interventions and are a valuable study design in situations where randomisation is not feasible. The before and after study design involves measuring an outcome both before and after an intervention and comparing the outcome rates in both time periods to determine the effectiveness of the intervention. These studies do not involve a contemporaneous control group and must therefore take into account any underlying secular trends in order to separate the effect of the intervention from any pre-existing trend. Neglecting this important step can lead to spurious results.Methods To illustrate the importance of accounting for underlying trends, we performed a before and after study assessing 30-day mortality in hip fracture patients without any actual intervention, and instead designated an arbitrarily-chosen time-point as our ‘intervention’. We did this to ensure that we were basing our results exclusively on the underlying trend throughout the studied period and also to enable us to show that even an intervention of nothing may be spuriously interpreted to have an effect if the before and after study is incorrectly analysed. Results We found a secular trend in our data showing improving 30-day mortality in hip fracture patients in our institution. We then demonstrated that disregarding this underlying trend showed that our intervention of nothing ‘resulted’ in a significant decrease in mortality, from 6.7% in the ‘before’ period to 3.1% in the ‘after’ period (p<0.0008). This apparent impact on mortality disappeared when we accounted for the underlying trend in our analysis (IRR of 0.75, 95% CI 0.32 – 1.78; p=0.5). In the context of declining 30-day mortality following hip fracture, failure to consider the existing underlying trend lead us to believe that it was our ‘intervention’ that ‘caused’ the decrease in mortality in the ’after’ period compared to the ‘before’ period when our results clearly show that mortality was decreasing irrespective of any intervention.Conclusion Our study highlights the importance of appropriate measurement and consideration of underlying trends when analysing data from before and after studies and illustrates what can happen should researchers neglect this important step.

INTERVENSI PELATIHAN PENILAIAN KINERJA PADA ATASAN UNTUK MENINGKATKAN PERCEIVED ORGANIZATIONAL SUPPORT & EMPLOYEE ENGAGEMENT

2017 ◽  
Vol 2 (2) ◽  
pp. 1-8
Author(s):  
Holy Greata
Keyword(s):  
Performance Appraisal ◽  
Employee Engagement ◽  
Study Design ◽  
Work Engagement ◽  
Organizational Support ◽  
Perceived Organizational Support ◽  
Paired Sample ◽  
Utrecht Work Engagement Scale ◽  
Before And After ◽  
Before And After Study

This study aims to look at the effectiveness of performance appraisal training programs to improve perceived organizational support and employee engagement among employees at YPTK educational institutions. This research uses a quantitative approach, with the before-and-after study design research design. The strength of this program is the ability to measure the impact of an intervention. Measuring devices perceived organizational support is an adaptation of the survey of perceived organizational support, while measuring instruments employee engagement is an adaptation of the Utrecht work engagement scale. The results of this study indicate the influence of perceived organizational support on employee engagement of 0.168 (p = 0.016 significant at l.o.s 0.05). Paired sample t-test results showed significant differences in perceived organizational support and employee engagement scores before and after the training and outreach of performance appraisal. Keywords: Perceived Organizational Suppor; Employee Engagement, Performance assessment   Penelitian ini bertujuan melihat efektifitas program pelatihan penilaian kinerja untuk meningkatkan perceived organizational support dan employee engagement pada karyawan di lembaga pendidikan YPTK. Penelitian ini menggunakan pendekatan kuantitatif, dengan design penelitian the before-and-after study design. Kelebihan dari program ini adalah kemampuan untuk mengukur dampak dari sebuah intervensi. Alat ukur perceived organizational support merupakan adaptasi dari survey of perceived organizational support, sedangkan alat ukur employee engagement merupakan adaptasi dari Utrecht work engagement scale. Hasil penelitian ini menunjukkan adanya pengaruh perceived organizational support terhadap employee engagement sebesar 0.168 (p=0.016 signifikan pada l.o.s 0.05). Hasil uji paired sample t-test menunjukkan adanya perbedaan skor perceived organizational support dan employee engagement yang signifikan sebelum dan sesudah dilakukan pelatihan dan sosialisasi penilaian kinerja.   Kata Kunci: Perceived Organizational Suppor; Employee Engagement, Penilaian Kinerja.

scholarly journals Robust Inferences from a Before-and-After Study with Multiple Unaffected Control Groups

2013 ◽  
Vol 1 (2) ◽  
pp. 209-234 ◽  
Author(s):  
Pengyuan Wang ◽  
Mikhail Traskin ◽  
Dylan S. Small
Keyword(s):  
Sensitivity Analysis ◽  
Control Groups ◽  
Two Stage ◽  
Time Effects ◽  
Unaffected Control ◽  
Group Time ◽  
Before And After ◽  
Group Variation ◽  
The Impact ◽  
Before And After Study

AbstractThe before-and-after study with multiple unaffected control groups is widely applied to study treatment effects. The current methods usually assume that the control groups’ differences between the before and after periods, i.e. the group time effects, follow a normal distribution. However, there is usually no strong a priori evidence for the normality assumption, and there are not enough control groups to check the assumption. We propose to use a flexible skew-t distribution family to model group time effects, and consider a range of plausible skew-t distributions. Based on the skew-t distribution assumption, we propose a robust-t method to guarantee nominal significance level under a wide range of skew-t distributions, and hence make the inference robust to misspecification of the distribution of group time effects. We also propose a two-stage approach, which has lower power compared to the robust-t method, but provides an opportunity to conduct sensitivity analysis. Hence, the overall method of analysis is to use the robust-t method to test for the overall hypothesized range of shapes of group variation; if the test fails to reject, use the two-stage method to conduct a sensitivity analysis to see if there is a subset of group variation parameters for which we can be confident that there is a treatment effect. We apply the proposed methods to two datasets. One dataset is from the Current Population Survey (CPS) to study the impact of the Mariel Boatlift on Miami unemployment rates between 1979 and 1982.The other dataset contains the student enrollment and grade repeating data in West Germany in the 1960s with which we study the impact of the short school year in 1966–1967 on grade repeating rates.

The impact of a music education program on meta-musical awareness, logical-mathematical, and notational skills in preschoolers

2021 ◽  
pp. 025576142110272
Author(s):  
Oriana Incognito ◽  
Laura Scaccioni ◽  
Giuliana Pinto
Keyword(s):  
Music Education ◽  
Education Program ◽  
Cognitive Abilities ◽  
Musical Training ◽  
Control Group ◽  
Transfer Of Knowledge ◽  
General Domain ◽  
Music Program ◽  
Before And After ◽  
The Impact

A number of studies suggest a link between musical training and both specific and general cognitive abilities, but despite some positive results, there is disagreement about which abilities are improved. This study aims to investigate the effects of a music education program both on a domain-specific competence (meta-musical awareness), and on general domain competences, that is, cognitive abilities (logical-mathematical) and symbolic-linguistic abilities (notational). Twenty 4- to 6-year-old children participated in the research, divided into two groups (experimental and control) and the measures were administered at two different times, before and after a 6-month music program (for the experimental group) and after a sports training program (for the control group). Children performed meta-musical awareness tasks, logical-mathematical tasks, and emergent-alphabetization tasks. Non-parametric statistics show that a music program significantly improves the development of notational skills and meta-musical awareness while not the development of logical-mathematical skills. These results show that a musical program increases children’s meta-musical awareness, and their ability to acquire the notational ability involved in the invented writing of words and numbers. On the contrary, it does not affect the development of logical skills. The results are discussed in terms of transfer of knowledge processes and of specific versus general domain effects of a musical program.

AIRA, an Artificial Intelligence Realistic Assistant that will save your time, a before-and-after study during Pandemic (Preprint)

2021 ◽  
Author(s):  
Kaio Bin ◽  
Adler Araújo Ribeiro Melo ◽  
José Guilherme Franco Da Rocha ◽  
Renata Pivi De Almeida ◽  
Vilson Cobello Junior ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Electronic Health Record ◽  
Medical Care ◽  
Health Screening ◽  
Urgent Care ◽  
Health Record ◽  
Before And After ◽  
Electronic Health ◽  
The Impact ◽  
Before And After Study

BACKGROUND AIRA is an AI designed to reduce the time that doctors dedicate filling out EHR, winner of the first edition of MIT Hacking Medicine held in Brazil in 2020. As a proof of concept, AIRA was implemented in administrative process before its application in a medical process. OBJECTIVE The aim of the study is to determinate the impact of AIRA by eliminating the Medical Care Registration (MCR) on Electronic Health Record (EHR) by Administrative Officer. METHODS This is a comparative before-and-after study following the guidance “Evaluating digital health products” from Public Health England. An Artificial Intelligence named AIRA was created and implemented at CEAC (Employee Attention Center) from HCFMUSP. A total of 25,507 attendances were evaluated along 2020 for determinate AIRA´s impact. Total of MCR, time of health screening and time between the end of the screening and the beginning of medical care, were compared in the pre and post AIRA periods. RESULTS AIRA eliminated the need for Medical Care Registration by Administrative Officer in 92% (p<0.0001). The nurse´s time of health screening increased 16% (p<0.0001) during the implementation, and 13% (p<0.0001) until three months after the implementation, but reduced in 4% three months after implementation (p<0.0001). The mean and median total time to Medical Care after the nurse’ Screening was decreased in 30% (p<0.0001) and 41% (p<0.0001) respectively. CONCLUSIONS The implementation of AIRA reduced the time to medical care in an urgent care after the nurse´ screening, by eliminating non-value-added activity the Medical Care Registration on Electronic Health Record (EHR) by Administrative Officer.

scholarly journals The Use of Procalcitonin as a Sepsis Marker in a Community Hospital

2019 ◽  
Vol 3 (4) ◽  
pp. 545-552
Author(s):  
Nathalia De Oro ◽  
Maria E Gauthreaux ◽  
Julie Lamoureux ◽  
Joseph Scott
Keyword(s):  
Lactic Acid ◽  
Length Of Stay ◽  
Community Hospital ◽  
Unit Length ◽  
Hospital Setting ◽  
Control Group ◽  
Before And After ◽  
Quasi Experimental ◽  
Current Cutoff ◽  
The Impact

Abstract Background Procalcitonin (PCT) is a biomarker that shows good sensitivity and specificity in identifying septic patients. Methods This study investigated the diagnostic accuracy of PCT in a community hospital setting and how it compared to that of lactic acid. It explored the impact on patient care before and after PCT implementation regarding costs and length of stay. Two comparative groups were analyzed using an exploratory descriptive case–control study with data from a 19-month period after PCT implementation and a retrospective quasi-experimental study using a control group of emergency department patients diagnosed with sepsis using data before PCT implementation. Results Post-procalcitonin implementation samples included 165 cases and pre-procalcitonin implementation sample included 69 cases. From the 165 sepsis cases who had positive blood cultures, PCT had a sensitivity of 89.7%. In comparison, lactic acid's sensitivity at the current cutoff of 18.02 mg/dL (2.0 mmol/L) was 64.9%. There was a 32% decrease in median cost before and after PCT implementation, even with the length of stay remaining at 5 days in both time periods. Conclusions There was a significant decrease after the implementation of PCT in cost of hospitalization compared to costs before implementation. This cost is highly correlated with length of stay; neither the hospital nor the intensive care unit length of stay showed a difference with before and after implementation. There was a positive correlation between lactic acid and PCT values. PCT values had a higher predictive usefulness than the lactic acid values.

scholarly journals 888. Improving outcomes with revised preoperative universal decolonization protocol

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S479-S479
Author(s):  
Silvia I Gnass
Keyword(s):  
Surgical Procedures ◽  
Baseline Period ◽  
Surgical Team ◽  
Team Members ◽  
Surgical Infection ◽  
Before And After ◽  
Trial Basis ◽  
The Impact ◽  
Before And After Study ◽  
Patient Infection

Abstract Background In order to improve outcomes, including reduced surgical infection rate and costs, a revised universal preoperative decolonization protocol was implemented on a trial basis. Methods In a 12 month before and after study at a public teaching hospital in southern California, an alcohol based nasal antiseptic was introduced in place of nasal povidone iodine (PVI) for all surgical patients pre-operatively, paired with chlorhexidine (CHG) bathing which was already in place. All surgical procedures were included, the most common being cholecystectomy, cesarean section and hip fracture. The alcohol nasal antiseptic was selected to replace the PVI nasal antiseptic based on efficacy, staff preference and cost. At the same time, surgical team members began self-application of the alcohol nasal antiseptic each day prior to surgical procedures. This was not mandatory and compliance was not tracked, though informal feedback and observation revealed most surgical team members were applying the nasal antiseptic prior to cases daily. Results In comparison to the 6 month baseline period where there were 27 SSI in 1188 procedures, during the 6 month study period there were 10 SSI in 1253 procedures, representing a 63% reduction (p=.0162) for all types of procedures. We have observed a reduction of 17 SSIs in 2019, compared to the previous year, during the 6 months period. That means a saving of $589,420 during the same period. Conclusion Preoperative universal decolonization with alcohol based nasal antiseptic in place of nasal PVI, paired with CHG bathing, was effective in reducing SSI rate and associated costs. Further study is needed to measure and assess the impact of surgical team member nasal decolonization on patient infection risk and rate. Disclosures All Authors: No reported disclosures

scholarly journals Controlled Study of the Impact of a Virtual Program to Reduce Stigma Among University Students Toward People With Mental Disorders

2021 ◽  
Vol 12 ◽  
Author(s):  
Matías E. Rodríguez-Rivas ◽  
Adolfo J. Cangas ◽  
Daniela Fuentes-Olavarría
Keyword(s):  
Mental Disorders ◽  
University Students ◽  
Intervention Group ◽  
Project Based Learning ◽  
Controlled Study ◽  
Control Group ◽  
Global Score ◽  
Stigma Reduction ◽  
Before And After ◽  
The Impact

Stigma toward mental disorders is one of today's most pressing global issues. The Covid-19 pandemic has exacerbated the barriers to social inclusion faced by individuals with mental disorders. Concurrently, stigma reduction interventions, especially those aimed at university students, have been more difficult to implement given social distancing and campus closures. As a result, alternative delivery for programs contributing to stigma reduction is required, such as online implementation. This paper reports the results of a controlled study focused on an online multi-component program on reducing stigma toward mental illness that included project-based learning, clinical simulations with standardized patients and E-Contact with real patients. A total of 40 undergraduate students from the Universidad del Desarrollo in Santiago, Chile, participated in the study. They were randomly divided between an intervention and control group. The intervention group participated in the online multi-component program, while the control group participated in an online educational program on cardiovascular health. We assessed the impact of the program by using the validated Spanish-language versions of the Attribution Questionnaire AQ-27 and the Questionnaire on Student Attitudes toward Schizophrenia with both groups, before and after the intervention. In addition, an ad hoc Likert scale ranging from 0 to 5 was used with the intervention group in order to assess the learning strategies implemented. Following the intervention, the participants belonging to the intervention group displayed significantly lower levels of stereotypes, perception of dangerousness, and global score toward people with schizophrenia (p &lt; 0.001). In addition, participants presented lower levels of dangerousness-fear, avoidance, coercion, lack of solidarity, and global score (p &lt; 0.001). The control group displayed no statistically significant differences in the level of stigma before and after the evaluation, for all of the items assessed. Finally, the overall assessment of each of the components of the program was highly positive. In conclusion, the study shows that online programs can contribute to reducing stigma toward mental disorders. The program assessed in this study had a positive impact on all the dimensions of stigma and all of the components of the program itself were positively evaluated by the participants.

scholarly journals Pneumococcal Conjugate Vaccine impact assessment in Bangladesh

2018 ◽  
Vol 2 ◽  
pp. 21 ◽  
Author(s):  
Abdullah H. Baqui ◽  
Eric D. McCollum ◽  
Samir K. Saha ◽  
Arun K. Roy ◽  
Nabidul H. Chowdhury ◽  
...  
Keyword(s):  
Conjugate Vaccine ◽  
Study Design ◽  
Pneumococcal Conjugate Vaccine ◽  
Case Control Study ◽  
Case Control ◽  
Incident Case ◽  
Vaccine Type ◽  
Before And After ◽  
The Impact ◽  
Control Study

The study examines the impact of the introduction of 10-valent Pneumococcal Conjugate Vaccine (PCV10) into Bangladesh’s national vaccine program. PCV10 is administered to children under 1 year-old; the scheduled ages of administration are at 6, 10, and 18 weeks. The study is conducted in ~770,000 population containing ~90,000 <5 children in Sylhet, Bangladesh and has five objectives: 1) To collect data on community-based pre-PCV incidence rates of invasive pneumococcal diseases (IPD) in 0-59 month-old children in Sylhet, Bangladesh; 2) To evaluate the effectiveness of PCV10 introduction on Vaccine Type (VT) IPD in 3-59 month-old children using an incident case-control study design. Secondary aims include measuring the effects of PCV10 introduction on all IPD in 3-59 month-old children using case-control study design, and quantifying the emergence of Non Vaccine Type IPD; 3) To evaluate the effectiveness of PCV10 introduction on chest radiograph-confirmed pneumonia in children 3-35 months old using incident case-control study design. We will estimate the incidence trend of clinical and radiologically-confirmed pneumonia in 3-35 month-old children in the study area before and after introduction of PCV10; 4) To determine the feasibility and utility of lung ultrasound for the diagnosis of pediatric pneumonia in a large sample of children in a resource-limited setting. We will also evaluate the effectiveness of PCV10 introduction on ultrasound-confirmed pneumonia in 3-35 month-old children using an incident case-control design and to examine the incidence trend of ultrasound-confirmed pneumonia in 3-35 month-old children in the study area before and after PCV10 introduction; and 5) To determine the direct and indirect effects of vaccination status on nasopharyngeal colonization on VT pneumococci among children with pneumonia.  This paper presents the methodology. The study will allow us to conduct a comprehensive and robust assessment of the impact of national introduction of PCV10 on pneumococcal disease in Bangladesh.

scholarly journals (A296) Psychosocial Disaster Preparedness Program Form School Children

2011 ◽  
Vol 26 (S1) ◽  
pp. s83-s83 ◽  
Author(s):  
E.A. Raj ◽  
K. Sekar
Keyword(s):  
School Children ◽  
Disaster Preparedness ◽  
Tamil Nadu ◽  
Control Group ◽  
Care Givers ◽  
Effective Manner ◽  
Before And After ◽  
Teachers And Students ◽  
The Individual ◽  
The Impact

The impact of natural disasters on individuals is substantial. Among the affected population in any disaster, children are identified as the most vulnerable group along with women, aged and disabled people. An estimated 77 million children under 15, on average, had their lives severely disrupted by a natural disaster or an armed conflict, each year, between 1991 and 2000 (Plan UK, 2003). Children are most affected since they loose the familiar environment, loss of parents, witness death of their loved ones, fear of reoccurrence of the disaster event. The impact of disaster on children of different age group is multiple times greater than that of the adults. This leads to various psychological problems in children (Dave et al., 2003). Disaster preparedness, through care givers, is one among the ways to reduce the distress of individuals followed by any disaster because it reduces the vulnerability factor that minimizes the impact of any disaster on the individual. A disaster preparedness program with special reference to psychosocial aspects was developed and implemented among the school children through teachers in Kanniyakumari District, Tamil Nadu, India, one of the severely affected areas in Tsunami. The current attempt was to standardize a disaster preparedness module focusing on preparing children to deal with their psychosocial issues before and after disaster in an effective manner. The outcome of disaster preparedness input through teachers and its reach out to the students was determined through an experimental research. The results reveal that the teachers and students from the experimental group gained significantly more knowledge on psychosocial disaster preparedness after implementation of the program in comparison to control group where the program was not implemented. The implications of the study points out the need to integrate psychosocial component of disaster preparedness in to the broader Community Based Disaster Preparedness (CBDP) programs.

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