scholarly journals The Development of a Bayesian Network Framework with Model Validation for Maritime Accident Risk Factor Assessment

2021 ◽  
Vol 11 (22) ◽  
pp. 10866
Author(s):  
Lea Vojković ◽  
Ana Kuzmanić Skelin ◽  
Djani Mohovic ◽  
Damir Zec
Keyword(s):  
Risk Factor ◽  
Real World ◽  
Causal Factor ◽  
Integrative Approach ◽  
Accident Risk ◽  
Real World Data ◽  
Risk Factor Assessment ◽  
Formal Safety Assessment ◽  
Passenger Ships ◽  
Quantitative Validation

An integrative approach to maritime accident risk factor assessment in accordance with formal safety assessment is proposed, which exploits the multifaceted capabilities of Bayesian networks (BNs) by consolidation of modelling, verification, and validation. The methodology for probabilistic modelling with BNs is well known and its application to risk assessment is based on the model verified though sensitivity analysis only, while validation of the model is often omitted due to a lack of established evaluation measures applicable to scarce real-world data. For this reason, in this work, the modified Lyapunov divergence measure is proposed as a novel quantitative assessor that can be efficiently exploited on an individual accident scenario for contributing causal factor identification, and thus can serve as the measure for validation of the developed expert elicited BN. The proposed framework and its approach are showcased for maritime grounding of small passenger ships in the Adriatic, with the complete grounding model disclosed, quantitative validation performed, and its utilization for causal factor identification and risk factor ranking presented. The data from two real-world grounding cases demonstrate the explanatory capabilities of the developed approach.

scholarly journals 794. Healthcare-Associated Urinary Tract Infection (HA-UTI): A Risk Factor for Clostridioides difficile Infection (CDI)? Results of a Real-World Data Analysis

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S440-S441
Author(s):  
Timothy Kelly ◽  
Timothy Kelly ◽  
ChinEn Ai ◽  
ChinEn Ai ◽  
John Murray ◽  
...  
Keyword(s):  
Risk Factor ◽  
Data Analysis ◽  
Urinary Tract ◽  
Real World ◽  
Healthcare Associated Infection ◽  
Real World Data ◽  
World Data ◽  
Increased Risk ◽  
Tract Infections ◽  
Healthcare Associated

Abstract Background It is estimated that 223,900 cases of CDI occur annually in hospitalized patients resulting in 12,800 deaths and $1 billion in attributable costs. Antimicrobial use is a risk factor for CDI and the antimicrobials ordered to treat urinary tract infections have been identified as a factor in both recurrent CDI and community-acquired CDI. This real-world data analysis seeks to explore the relationship between HA-UTI and hospital-onset CDI (HO-CDI). Methods An electronic infection surveillance system was the source of de-identified real-world data from 290 hospitals. Algorithmically-derived measures of healthcare-associated infections (ADM-HAIs), and records of all-cause antimicrobial orders, for all inpatient admissions for the period 10/1/18–9/30/19 were analyzed. All patients who presented with a urine ADM-HAI – suggestive of HA-UTI – and no other healthcare-associated infection (Urine+ patients), were observed for subsequent HO-CDI. Urine+ patients were compared to patients with no HAI of any type, other than CDI (HAI-free patients), and relative risk (RR) was estimated. The analysis was repeated for the subgroup of patients who received an antimicrobial order for any reason during their stay. Results 3,050,525 inpatient admissions were analyzed. 26,634 were identified as Urine+ patients. 188 of those patients subsequently presented with HO-CDI. 2,978,507 were identified as HAI-free patients. 6,238 of those patients presented with HO-CDI. The incidence of HO-CDI was significantly higher in Urine+ patients compared to HAI-free patients (RR=3.37, 95% CL[2.92, 3.89], p< 0.0001). When the analysis was repeated to examine only patients who received antimicrobial orders, Urine+ patients continued to be at higher risk of subsequent HO-CDI compared to HAI-free patients (RR=3.28, 95% CL[2.74,3.92], p< 0.0001). Conclusion The presence of a urine ADM-HAI, suggestive of HA-UTI, was associated with an increased risk of subsequent HO-CDI. This held when only patients with antimicrobial orders were considered. These observations mirror findings from other published studies, however, other factors may have contributed to increased risk for both HA-UTI and HO-CDI. Disclosures Timothy Kelly, MS, MBA, BD (Employee) ChinEn Ai, MPH, BD (Employee) John Murray, MPH, BD (Employee) Yan Xiong, n/a, BD (Becton Dickinson) (Employee) Hanna Jokinen-Gordon, PhD, BD (Employee)

scholarly journals An integrative approach using real-world data to identify alternative therapeutic uses of existing drugs

PLoS ONE ◽  
2018 ◽  
Vol 13 (10) ◽  
pp. e0204648 ◽  
Author(s):  
Kouichi Hosomi ◽  
Mai Fujimoto ◽  
Kazutaka Ushio ◽  
Lili Mao ◽  
Juran Kato ◽  
...  
Keyword(s):  
Real World ◽  
Integrative Approach ◽  
Real World Data ◽  
World Data ◽  
Therapeutic Uses

Abstract #946: Assessment of Acromegaly Patients with and Without Diabetes Treated with Lanreotide Depot: 2-Year Real World Data

2016 ◽  
Vol 22 ◽  
pp. 219
Author(s):  
Roberto Salvatori ◽  
Olga Gambetti ◽  
Whitney Woodmansee ◽  
David Cox ◽  
Beloo Mirakhur ◽  
...  
Keyword(s):  
Real World ◽  
Real World Data ◽  
World Data

Safety and efficacy of direct acting oral anticoagulants and vitamin K antagonists in nonvalvular atrial fibrillation – a network meta-analysis of real-world data

VASA ◽  
2019 ◽  
Vol 48 (2) ◽  
pp. 134-147 ◽  
Author(s):  
Mirko Hirschl ◽  
Michael Kundi
Keyword(s):  
Real World ◽  
Meta Analysis ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Efficacy And Safety ◽  
Nonvalvular Atrial Fibrillation ◽  
Real World Data ◽  
Hazard Ratios ◽  
Direct Acting ◽  
Event Rates

Abstract. Background: In randomized controlled trials (RCTs) direct acting oral anticoagulants (DOACs) showed a superior risk-benefit profile in comparison to vitamin K antagonists (VKAs) for patients with nonvalvular atrial fibrillation. Patients enrolled in such studies do not necessarily reflect the whole target population treated in real-world practice. Materials and methods: By a systematic literature search, 88 studies including 3,351,628 patients providing over 2.9 million patient-years of follow-up were identified. Hazard ratios and event-rates for the main efficacy and safety outcomes were extracted and the results for DOACs and VKAs combined by network meta-analysis. In addition, meta-regression was performed to identify factors responsible for heterogeneity across studies. Results: For stroke and systemic embolism as well as for major bleeding and intracranial bleeding real-world studies gave virtually the same result as RCTs with higher efficacy and lower major bleeding risk (for dabigatran and apixaban) and lower risk of intracranial bleeding (all DOACs) compared to VKAs. Results for gastrointestinal bleeding were consistently better for DOACs and hazard ratios of myocardial infarction were significantly lower in real-world for dabigatran and apixaban compared to RCTs. By a ranking analysis we found that apixaban is the safest anticoagulant drug, while rivaroxaban closely followed by dabigatran are the most efficacious. Risk of bias and heterogeneity was assessed and had little impact on the overall results. Analysis of effect modification could guide the clinical decision as no single DOAC was superior/inferior to the others under all conditions. Conclusions: DOACs were at least as efficacious as VKAs. In terms of safety endpoints, DOACs performed better under real-world conditions than in RCTs. The current real-world data showed that differences in efficacy and safety, despite generally low event rates, exist between DOACs. Knowledge about these differences in performance can contribute to a more personalized medicine.

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