ABSTRACT
Surveys are one of the most common study designs in healthcare research. They are easy to undertake, have minimal cost and aim to obtain reliable and unbiased information from a population of interest. Surveys in pediatric surgery/urology are an effective tool for gathering information on clinical practices for rare and complex conditions that highlight information on their behavior, institutional disparities, and healthcare paradigms. This education article consists of using a published survey by one of the authors as an example to demonstrate both positive and negative aspects, including limitations, of survey design studies with the purpose of helping pediatric urologists develop a framework to create and critically appraise survey methodology. Using this approach, readers should be able to reliably discern the methodological quality of published surveys.
Subject(s)
Urology , Child , Delivery of Health Care , Humans , Research Design , Surveys and Questionnaires , UrologistsABSTRACT
Inflammatory biomarkers may be associated with disease severity and increased mortality in COVID-19 patients but have not been studied in North American populations. We sought to determine whether a set of commonly ordered inflammatory biomarkers can predict 28-day mortality. We analyzed a multi-centered (four) COVID-19 registry cohort from March 4th to December 7th, 2020. This cohort included COVID-19-positive patients admitted to medical wards or intensive care units. Patients presenting to the emergency department for COVID-19 symptoms and then subsequently discharged were also included. We performed Cox-regression analysis to measure whether commonly used biomarkers were associated with an increased 28-day mortality. Of 336 COVID-19-positive patients, 267 required hospital admission, and 69 were seen in the emergency room and discharged. The median age was 63 years (IQR 80-50) and the female-to-male ratio was 49:51. Derivation of internally validated cut-offs suggested that C-reactive protein ≥ 78.4 mg/L, neutrophil-to-lymphocyte ratio ≥ 6.1, lymphocyte-to-white blood cell ratio < 0.127, and a modified Glasgow prognostic score equal to 2 vs. 1 or 0 were associated with the highest increased risk of 28-day mortality. We provide early estimates of cut-off values for inflammatory biomarkers and indices measured at the time of admission that may be useful to clinicians for predicting 28-day mortality in North American COVID-19 patients.
Subject(s)
C-Reactive Protein/metabolism , COVID-19/metabolism , COVID-19/mortality , Lymphocytes/metabolism , Neutrophils/metabolism , Aged , Biomarkers/metabolism , COVID-19 Testing , Critical Illness/mortality , Female , Hospital Mortality , Humans , Intensive Care Units , Male , Middle Aged , Prognosis , Retrospective Studies , Risk Factors , Severity of Illness IndexABSTRACT
BACKGROUND AND OBJECTIVES: The benefit of tissue plasminogen activator (tPA) in acute ischemic stroke is time dependent. A 15-minute decrease in door-to-needle (DTN) time has been associated with increased odds of ambulating independently, faster discharge, and decreased odds of death. We investigated common causes of delay in DTN times in a community hospital setting in order to identify areas for improvement. METHODS: A retrospective medical record review was conducted at a 574-bed community hospital. This included 100 patients who received tPA from 2016 to 2019. Time segments were classified a priori to reflect key work elements from the time between hospital arrival to tPA and recorded for each chart. Linear regression models were used to identify work elements associated with increased DTN time. RESULTS: Median DTN time was 54:29 minutes. Linear regression analyses determined that differences in NIHSS score (P = .030), triage to computed tomography (CT) start (P = .017), triage to stroke physician page (P = .016), and CT report to tPA administration (P < .001) were associated with increased DTN time. CT report to tPA administration was most strongly associated with a Pearson coefficient of 0.868 (P < .001) with increased DTN time. CONCLUSIONS: The DTN time at our institution was above the recommended target. Our findings suggest that reducing the CT report time interval may decrease DTN time.
