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1.
Int J Behav Nutr Phys Act ; 18(1): 40, 2021 03 17.
Artigo em Inglês | MEDLINE | ID: mdl-33731132

RESUMO

BACKGROUND: COVID-19 lockdowns may lead to physical inactivity, a major risk factor for non-communicable diseases. This study aims to determine: 1) the trajectory in daily step counts before, during and after the lockdown in China, and 2) the characteristics associated with the trajectories. METHODS: From December 2019 to July 2020, smartphone-based step counts were continuously collected in 815 Chinese adults residing in Shanghai over 202 days across three phases: before, during, and after the lockdown. Participant characteristics were reported, and height, weight and body composition measured before the lockdown. A 'sharp' regression discontinuity design with cluster robust standard errors was used to test the effect of the lockdown and reopening on daily steps and a linear mixed model was used to examine the characteristics associated with trajectories during the observed period. RESULTS: Based on 164,630 person-days of data, we found a sharp decline in daily step counts upon the lockdown (24/01/2020) by an average of 3796 (SE = 88) steps, followed by a significant trend of increase by 34 steps/day (SE = 2.5; p < .001) until the end of the lockdown (22/03/2020). This increasing trend continued into the reopening phase at a slower rate of 5 steps per day (SE = 2.3; p = 0.029). Those who were older, married, university educated, insufficiently active, had an 'at risk' body composition, and those in the control group, were slower at recovering step counts during the lockdown, and those who were older, married, without university education and with an 'at risk' body composition recovered step counts at a slower pace after the reopening. CONCLUSIONS: Despite later increases in step counts, COVID-19 lockdown led to a sustained period of reduced physical activity, which may have adverse health implications. Governments and health professionals around the world should continue to encourage and facilitate physical activity during the pandemic.


Assuntos
/prevenção & controle , Coleta de Dados/estatística & dados numéricos , Exercício Físico , Monitores de Aptidão Física , Aplicativos Móveis , Comportamento Sedentário , Adulto , China/epidemiologia , Controle de Doenças Transmissíveis/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Smartphone
2.
Rev Paul Pediatr ; 39: e2020267, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33146295

RESUMO

OBJECTIVE: Social isolation is currently identified as the best way to prevent the infection by the new coronavirus. However, for some social groups, such as children and adolescents, this measure carries a contradiction: the home, which should be the safest place for them, is also a frequent environment of a sad aggravation: domestic violence. This study aims to evaluate the notifications of interpersonal/self-inflicted violence available in the Information System for Notifiable Diseases in the State of Santa Catarina (southern Brazil), for the juvenile age group, before and during the new coronavirus pandemics. METHODS: Cross-sectional, descriptive study of violence against children and adolescents (from 0 to 19 years) notified by health professionals by completing and entering the occurrence in the Information System for Notifiable Diseases of the State of Santa Catarina in 11 weeks in which the social isolation measure was instituted as mandatory, comparing with the same period before this measure. RESULTS: During the study period, 136 municipalities in Santa Catarina made 1,851 notifications. There was a decrease of 55.3% of them in the isolation period, and the difficulties encountered in seeking protection and assistance institutions were listed. CONCLUSIONS: The society needs to be aware of possible cases of violence in the children and adolescent population. It is important to provide accessible, effective, and safe ways for complaints and notifications, as well as a quick response to the cases, aiming at protecting victims and minimizing damages to prevent the perpetuation of the violence.


Assuntos
Maus-Tratos Infantis , Bem-Estar da Criança , Infecções por Coronavirus/epidemiologia , Violência Doméstica , Pneumonia Viral/epidemiologia , Adolescente , Saúde do Adolescente/tendências , Betacoronavirus , Brasil/epidemiologia , Criança , Maus-Tratos Infantis/prevenção & controle , Maus-Tratos Infantis/estatística & dados numéricos , Saúde da Criança/tendências , Estudos Transversais , Coleta de Dados/métodos , Coleta de Dados/estatística & dados numéricos , Violência Doméstica/prevenção & controle , Violência Doméstica/tendências , Feminino , Humanos , Masculino , Determinação de Necessidades de Cuidados de Saúde , Pandemias
3.
Biomedica ; 40(Supl. 2): 96-103, 2020 10 30.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33152193

RESUMO

Introduction: The COVID pandemic is a challenge for public health surveillance and an opportunity to assess its strengths and weaknesses to improve the response. Objective: To evaluate the performance of the Colombian public health surveillance system during the first 50 days of the COVID-19 pandemic in the country. Materials and methods: We analyzed the data published between March 6 and April 24, 2020, by the Instituto Nacional de Salud and the World Health Organization (WHO). We evaluated: i) the quality of the data according to the fulfillment of Benford's law, and ii) the timeliness of the information measured as the difference in dates between the data generated by the Instituto Nacional de Salud and WHO's situational reports. We assessed the fulfillment of Benford's law using the p values of the log-likelihood ratio, the chi square or Moreno's exact tests. Results: Until April 24 there were 4,881 cases of COVID-19 in Colombia. During most of the first 50 days of the pandemic, Benford's law was fulfilled except the first days of the epidemic. The difference between Instituto Nacional de Salud and WHO reports largely depends on the different reporting times. Conclusion: In general, the Colombian public health surveillance system fulfilled Benford's law suggesting that there was quality in the data. Future studies comparing the performance of the departments and districts will improve the diagnosis of the Colombian surveillance system.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Coleta de Dados/normas , Pandemias , Pneumonia Viral/epidemiologia , Vigilância da População , Saúde Pública , Colômbia/epidemiologia , Coleta de Dados/métodos , Coleta de Dados/estatística & dados numéricos , Surtos de Doenças , Humanos , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/epidemiologia , Internet , Vigilância da População/métodos , Controle de Qualidade , Distribuições Estatísticas , Infecção por Zika virus/epidemiologia
5.
Cien Saude Colet ; 25(suppl 2): 4211-4224, 2020 Oct.
Artigo em Português, Inglês | MEDLINE | ID: mdl-33027358

RESUMO

This study discusses to what extent the inclusion, or not, of the race/color variable in epidemiological analysis of the COVID-19 pandemic can work as an external manifestation of necropolitics and as a producer of health inequities. We conducted a literature review on 09 articles, and on Scientific Electronic Library, PubMed and Virtual Health Library databases. We also conducted a documental analysis on 27 epidemiological reports from all the federal states and the Federal District of Brazil. We did not see much information regarding race/color, which can be interpreted as an intentional omission in order to hide those who the epidemics affects the most. The denial of basic and fundamental rights is the element that characterizes the larger racist structure of Brazil's COVID-19 policies.


Assuntos
Grupo com Ancestrais do Continente Africano , Infecções por Coronavirus/epidemiologia , Coleta de Dados/estatística & dados numéricos , Equidade em Saúde , Pneumonia Viral/epidemiologia , Betacoronavirus , Brasil/epidemiologia , Monitoramento Epidemiológico , Disparidades nos Níveis de Saúde , Humanos , Pandemias , Racismo
6.
Nat Commun ; 11(1): 5446, 2020 10 28.
Artigo em Inglês | MEDLINE | ID: mdl-33116118

RESUMO

Continuous, battery-free operation of sensor nodes requires ultra-low-power sensing and data-logging techniques. Here we report that by directly coupling a sensor/transducer signal into globally asymptotically stable monotonic dynamical systems based on Fowler-Nordheim quantum tunneling, one can achieve self-powered sensing at an energy budget that is currently unachievable using conventional energy harvesting methods. The proposed device uses a differential architecture to compensate for environmental variations and the device can retain sensed information for durations ranging from hours to days. With a theoretical operating energy budget less than 10 attojoules, we demonstrate that when integrated with a miniature piezoelectric transducer the proposed sensor-data-logger can measure cumulative "action" due to ambient mechanical acceleration without any additional external power.


Assuntos
Engenharia Biomédica/instrumentação , Coleta de Dados/instrumentação , Fontes de Energia Elétrica , Transdutores , Aceleração , Fontes de Energia Bioelétrica , Engenharia Biomédica/estatística & dados numéricos , Coleta de Dados/estatística & dados numéricos , Eletrônica/instrumentação , Eletrônica/estatística & dados numéricos , Desenho de Equipamento , Fenômenos Mecânicos , Processamento de Sinais Assistido por Computador/instrumentação
7.
PLoS One ; 15(8): e0237656, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32866167

RESUMO

OBJECTIVE: Preterm birth is the primary driver of neonatal mortality worldwide, but it is defined by gestational age (GA) which is challenging to accurately assess in low-resource settings. In a commitment to reducing preterm birth while reinforcing and strengthening facility data sources, the East Africa Preterm Birth Initiative (PTBi-EA) chose eligibility criteria that combined GA and birth weight. This analysis evaluated the quality of the GA data as recorded in maternity registers in PTBi-EA study facilities and the strength of the PTBi-EA eligibility criteria. METHODS: We conducted a retrospective analysis of maternity register data from March-September 2016. GA data from 23 study facilities in Migori, Kenya and the Busoga Region of Uganda were evaluated for completeness (variable present), consistency (recorded versus calculated GA), and plausibility (falling within the 3rd and 97th birth weight percentiles for GA of the INTERGROWTH-21st Newborn Birth Weight Standards). Preterm birth rates were calculated using: 1) recorded GA <37 weeks, 2) recorded GA <37 weeks, excluding implausible GAs, 3) birth weight <2500g, and 4) PTBi-EA eligibility criteria of <2500g and between 2500g and 3000g if the recorded GA is <37 weeks. RESULTS: In both countries, GA was the least recorded variable in the maternity register (77.6%). Recorded and calculated GA (Kenya only) were consistent in 29.5% of births. Implausible GAs accounted for 11.7% of births. The four preterm birth rates were 1) 14.5%, 2) 10.6%, 3) 9.6%, 4) 13.4%. CONCLUSIONS: Maternity register GA data presented quality concerns in PTBi-EA study sites. The PTBi-EA eligibility criteria of <2500g and between 2500g and 3000g if the recorded GA is <37 weeks accommodated these concerns by using both birth weight and GA, balancing issues of accuracy and completeness with practical applicability.


Assuntos
Coleta de Dados/normas , Idade Gestacional , Serviços de Saúde Materna/organização & administração , Nascimento Prematuro/epidemiologia , Sistema de Registros/estatística & dados numéricos , Peso ao Nascer , Coleta de Dados/estatística & dados numéricos , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Lactente Extremamente Prematuro , Recém-Nascido , Quênia/epidemiologia , Serviços de Saúde Materna/estatística & dados numéricos , Gravidez , Nascimento Prematuro/prevenção & controle , Melhoria de Qualidade , Sistema de Registros/normas , Reprodutibilidade dos Testes , Estudos Retrospectivos , Uganda/epidemiologia
8.
PLoS One ; 15(7): e0234349, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32628678

RESUMO

BACKGROUND: The importance of randomization in clinical trials has long been acknowledged for avoiding selection bias. Yet, bias concerns re-emerge with selective attrition. This study takes a causal inference perspective in addressing distinct scenarios of missing outcome data (MCAR, MAR and MNAR). METHODS: This study adopts a causal inference perspective in providing an overview of empirical strategies to estimate the average treatment effect, improve precision of the estimator, and to test whether the underlying identifying assumptions hold. We propose to use Random Forest Lee Bounds (RFLB) to address selective attrition and to obtain more precise average treatment effect intervals. RESULTS: When assuming MCAR or MAR, the often untenable identifying assumptions with respect to causal inference can hardly be verified empirically. Instead, missing outcome data in clinical trials should be considered as potentially non-random unobserved events (i.e. MNAR). Using simulated attrition data, we show how average treatment effect intervals can be tightened considerably using RFLB, by exploiting both continuous and discrete attrition predictor variables. CONCLUSIONS: Bounding approaches should be used to acknowledge selective attrition in randomized clinical trials in acknowledging the resulting uncertainty with respect to causal inference. As such, Random Forest Lee Bounds estimates are more informative than point estimates obtained assuming MCAR or MAR.


Assuntos
Coleta de Dados/métodos , Interpretação Estatística de Dados , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Viés , Coleta de Dados/estatística & dados numéricos , Humanos , Estudos Longitudinais
10.
Epilepsia ; 61(7): 1319-1335, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32474909

RESUMO

Our objective was to undertake a systematic review ascertaining the accuracy of using administrative healthcare data to identify epilepsy cases. We searched MEDLINE and Embase from 01/01/1975 to 03/07/2018 for studies evaluating the diagnostic accuracy of routinely collected healthcare data in identifying epilepsy cases. Any disease coding system in use since the International Classification of Diseases, Ninth Revision (ICD-9) was permissible. Two authors independently screened studies, extracted data, and quality-assessed studies. We assessed positive predictive value (PPV), sensitivity, negative predictive value (NPV), and specificity. The primary analysis was a narrative synthesis of review findings. Thirty studies were included, published between 1989 and 2018. Risks of bias were low, high, and unclear in 4, 14, and 12 studies, respectively. Coding systems included ICD-9, ICD-10, and Read Codes, with or without antiepileptic drugs (AEDs). PPVs included ranges of 5.2%-100% (Canada), 32.7%-96.0% (USA), 47.0%-100% (UK), and 37.0%-88.0% (Norway). Sensitivities included ranges of 22.2%-99.7% (Canada), 12.2%-97.3% (USA), and 79.0%-94.0% (UK). Nineteen studies contained at least one algorithm with a PPV >80%. Sixteen studies contained at least one algorithm with a sensitivity >80%. PPV was highest in algorithms consisting of disease codes (ICD-10 G40-41, ICD-9 345) in combination with one or more AEDs. The addition of symptom codes to this (ICD-10 R56; ICD-9 780.3, 780.39) lowered PPV. Sensitivity was highest in algorithms consisting of symptom codes with one or more AEDs. Although using AEDs alone achieved high sensitivities, the associated PPVs were low. Most NPVs and specificities were >90%. We conclude that it is reasonable to use administrative data to identify people with epilepsy (PWE) in epidemiological research. Studies prioritizing high PPVs should focus on combining disease codes with AEDs. Studies prioritizing high sensitivities should focus on combining symptom codes with AEDs. We caution against the use of AEDs alone to identify PWE.


Assuntos
Coleta de Dados/estatística & dados numéricos , Bases de Dados Factuais/estatística & dados numéricos , Assistência à Saúde/estatística & dados numéricos , Epilepsia/epidemiologia , Estudos de Validação como Assunto , Coleta de Dados/normas , Bases de Dados Factuais/normas , Assistência à Saúde/normas , Epilepsia/diagnóstico , Humanos
11.
JAMA Netw Open ; 3(4): e202764, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32286657

RESUMO

Importance: The collection of patient-reported outcomes (PROs) has garnered intense interest, but dissemination of PRO programs has been limited, as have analyses of the factors associated with successful programs. Objective: To identify factors associated with improving PRO collection rates within a large health care system using a centralized PRO infrastructure. Design, Setting, and Participants: This cohort study included 205 medical and surgical clinics in the Partners Healthcare system in Massachusetts that implemented a PRO program between March 15, 2014, and December 31, 2018, using a standardized centralized infrastructure. Data were analyzed from March to April 2019. Exposures: Relevant clinical characteristics were recorded for each clinic launching a PRO program. Main Outcomes and Measures: The primary outcome was the mean PRO collection rate during each clinic's most recent 6 months of collection prior to January 2019. Data were analyzed using a linear regression model with the 6-month PRO collection rate as the dependent variable and clinic characteristics as independent variables. Secondary analysis used a logistic regression model to assess clinical factors associated with successful clinics, defined as those that collected PROs at a rate greater than 50%. Results: Between March 2014 and December 2018, 205 Partners Healthcare clinics were available for analysis, and 4 061 205 PRO measures from 745 028 encounters were collected. Among these, 103 clinics (50.2%) collected at a rate greater than 50%. Increased collection rates were associated with more than 50% of physicians in a clinic trained on PROs (change, 19.6% [95% CI, 9.9%-29.4%]; P < .001), routine administrative oversight of collection rates (change, 16.0% [95% CI, 6.6%-25.5%]; P = .001), previous collection of PROs on paper (change, 12.5% [95% CI, 4.7%-20.3%]; P = .002), presence of a clinical champion (change, 11.2% [95% CI, 2.5%-20.0%]; P = .01) and payer incentive (change, 10.5% [95% CI, 2.0%-18.9%]; P = .02). Conclusions and Relevance: These findings suggest that training physicians on the use of PROs, administrative surveillance of collection rates, and the presence of a local clinical champion may be promising interventions for increasing PRO collection. Clinics that have previously collected PROs may have greater success in increasing collections. Payer incentive for collection was associated with improved collections, but not associated with successful programs.


Assuntos
Coleta de Dados/estatística & dados numéricos , Assistência à Saúde/estatística & dados numéricos , Medidas de Resultados Relatados pelo Paciente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Massachusetts , Pessoa de Meia-Idade , Inquéritos e Questionários
13.
PLoS One ; 15(3): e0227330, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32218569

RESUMO

THIS ARTICLE USES WORDS OR LANGUAGE THAT IS CONSIDERED PROFANE, VULGAR, OR OFFENSIVE BY SOME READERS. The presence of a significant amount of harassment in user-generated content and its negative impact calls for robust automatic detection approaches. This requires the identification of different types of harassment. Earlier work has classified harassing language in terms of hurtfulness, abusiveness, sentiment, and profanity. However, to identify and understand harassment more accurately, it is essential to determine the contextual type that captures the interrelated conditions in which harassing language occurs. In this paper we introduce the notion of contextual type in harassment by distinguishing between five contextual types: (i) sexual, (ii) racial, (iii) appearance-related, (iv) intellectual and (v) political. We utilize an annotated corpus from Twitter distinguishing these types of harassment. We study the context of each kind to shed light on the linguistic meaning, interpretation, and distribution, with results from two lines of investigation: an extensive linguistic analysis, and the statistical distribution of uni-grams. We then build type- aware classifiers to automate the identification of type-specific harassment. Our experiments demonstrate that these classifiers provide competitive accuracy for identifying and analyzing harassment on social media. We present extensive discussion and significant observations about the effectiveness of type-aware classifiers using a detailed comparison setup, providing insight into the role of type-dependent features.


Assuntos
Coleta de Dados/métodos , Assédio não Sexual/estatística & dados numéricos , Linguística/métodos , Aprendizado de Máquina , Assédio Sexual/estatística & dados numéricos , Coleta de Dados/estatística & dados numéricos , Feminino , Assédio não Sexual/prevenção & controle , Humanos , Idioma , Masculino , Assédio Sexual/prevenção & controle , Mídias Sociais/estatística & dados numéricos
14.
Int J Public Health ; 65(1): 17-28, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31932856

RESUMO

OBJECTIVES: To assess the policy utility of national cause of death (COD) data of six high-income countries with highly developed health information systems. METHODS: National COD data sets from Australia, Canada, Denmark, Germany, Japan and Switzerland for 2015 or 2016 were assessed by applying the ANACONDA software tool. Levels, patterns and distributions of unusable and insufficiently specified "garbage" codes were analysed. RESULTS: The average proportion of unusable COD was 18% across the six countries, ranging from 14% in Australia and Canada to 25% in Japan. Insufficiently specified codes accounted for a further 8% of deaths, on average, varying from 6% in Switzerland to 11% in Japan. The most commonly used garbage codes were Other ill-defined and unspecified deaths (R99), Heart failure (I50.9) and Senility (R54). CONCLUSIONS: COD certification errors are common, even in countries with very advanced health information systems, greatly reducing the policy value of mortality data. All countries should routinely provide certification training for hospital interns and raise awareness among doctors of their public health responsibility to certify deaths correctly and usefully for public health policy.


Assuntos
Causas de Morte , Confiabilidade dos Dados , Coleta de Dados/estatística & dados numéricos , Países Desenvolvidos/estatística & dados numéricos , Mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália , Canadá , Dinamarca , Feminino , Alemanha , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Suíça
15.
Clin Pharmacol Ther ; 107(4): 858-870, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31955413

RESUMO

Application of contemporary molecular biology techniques to clinical samples in oncology resulted in the accumulation of unprecedented experimental data. These "omics" data are mined for discovery of therapeutic target combinations and diagnostic biomarkers. It is less appreciated that omics resources could also revolutionize development of the mechanistic models informing clinical pharmacology quantitative decisions about dose amount, timing, and sequence. We discuss the integration of omics data to inform mechanistic models supporting drug development in immuno-oncology. To illustrate our arguments, we present a minimal clinical model of the Cancer Immunity Cycle (CIC), calibrated for non-small cell lung carcinoma using tumor microenvironment composition inferred from transcriptomics of clinical samples. We review omics data resources, which can be integrated to parameterize mechanistic models of the CIC. We propose that virtual trial simulations with clinical Quantitative Systems Pharmacology platforms informed by omics data will be making increasing impact in the development of cancer immunotherapies.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/terapia , Coleta de Dados/métodos , Imunoterapia/métodos , Neoplasias Pulmonares/terapia , Oncologia/métodos , Farmacologia Clínica/métodos , Carcinoma Pulmonar de Células não Pequenas/imunologia , Coleta de Dados/estatística & dados numéricos , Desenvolvimento de Medicamentos/métodos , Desenvolvimento de Medicamentos/estatística & dados numéricos , Humanos , Imunidade Celular/efeitos dos fármacos , Imunidade Celular/imunologia , Imunoterapia/estatística & dados numéricos , Neoplasias Pulmonares/imunologia , Oncologia/estatística & dados numéricos , Farmacologia Clínica/estatística & dados numéricos
16.
Int J Public Health ; 65(1): 5-16, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31993674

RESUMO

OBJECTIVES: Using the European Health Interview Survey (EHIS) questionnaire, a web-based survey was organized alongside a face-to-face (F2F) survey including a paper-and-pencil (P&P) questionnaire for sensitive topics. Associated with these different modes, other design features varied too (e.g., recruitment, incentives, sampling). We assessed whether these whole data collection systems developed around the modes produced equivalent health estimates. METHODS: Data were obtained from two population-based surveys: the EHISWEB (web-administered, n = 1010) and the Belgian Health Interview Survey 2018 (BHIS2018) (interviewer-administered, n = 2748). Logistic regression analyses were used to assess mode system differences while adjusting for socio-demographic differences in the net samples. RESULTS: For the P&P mode of the BHIS, significant mode system differences were detected for 2 of the 9 health indicators. Among the indicators collected via the F2F mode, 9 of the 18 indicators showed significant differences. CONCLUSIONS: Indicators collected via the web-based and P&P self-administered modes were generally more comparable than indicators collected via the web-based and F2F mode. Furthermore, fewer differences were detected for indicators based on simple and factual questions compared to indicators based on subjective or complex questions.


Assuntos
Coleta de Dados/métodos , Coleta de Dados/estatística & dados numéricos , Inquéritos Epidemiológicos/métodos , Inquéritos Epidemiológicos/estatística & dados numéricos , Internet , Inquéritos e Questionários/estatística & dados numéricos , Redação , Adulto , Idoso , Idoso de 80 Anos ou mais , Bélgica , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade
17.
Handb Exp Pharmacol ; 257: 71-79, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31696348

RESUMO

Confirmation through competent replication is a founding principle of modern science. However, biomedical researchers are rewarded for innovation, and not for confirmation, and confirmatory research is often stigmatized as unoriginal and as a consequence faces barriers to publication. As a result, the current biomedical literature is dominated by exploration, which to complicate matters further is often disguised as confirmation. Only recently scientists and the public have begun to realize that high-profile research results in biomedicine can often not be replicated. Consequently, confirmation has become central stage in the quest to safeguard the robustness of research findings. Research which is pushing the boundaries of or challenges what is currently known must necessarily result in a plethora of false positive results. Thus, since discovery, the driving force of scientific progress, is unavoidably linked to high false positive rates and cannot support confirmatory inference, dedicated confirmatory investigation is needed for pivotal results. In this chapter I will argue that the tension between the two modes of research, exploration and confirmation, can be resolved if we conceptually and practically separate them. I will discuss the idiosyncrasies of exploratory and confirmatory studies, with a focus on the specific features of their design, analysis, and interpretation.


Assuntos
Pesquisa Biomédica , Coleta de Dados/estatística & dados numéricos , Recompensa
18.
Comput Inform Nurs ; 38(3): 157-164, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31498252

RESUMO

Inpatient falls are among the most common adverse events threatening patient safety. Although many studies have developed predictive models for fall risk, there are some drawbacks. First, most previous studies have relied on an incident-reporting system alone to identify fall events. Thus, it has been found that falls are more likely to be underreported. Second, there has been a controversy on how to select accurate representative values for patient status data across multiple times and various data sources in electronic health records. Given this background, this study used nurses' progress notes as a complementary data source to detect fall events. In addition, we developed criteria including coverage, currency, and granularity in order to integrate electronic health records data documented at multiple times in various data types and sources. Based on this methodology, we developed three models, logistic regression, Cox proportional hazard regression, and decision tree, to predict risk of patient falls and evaluate the predictive performance of these models by comparing the results to results from the Hendrich II Fall Risk Model. The findings of this study will be used in a clinical decision support system to predict risk of falling and provide evidence-based tailored recommendations in the future.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Coleta de Dados/instrumentação , Registros Eletrônicos de Saúde/estatística & dados numéricos , Medição de Risco/normas , Idoso , Coleta de Dados/estatística & dados numéricos , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , República da Coreia , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Estatísticas não Paramétricas , Centros de Atenção Terciária/organização & administração , Centros de Atenção Terciária/estatística & dados numéricos
19.
Healthc (Amst) ; 8(1): 100369, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31445878

RESUMO

Patient contextual data (PCD), defined as patient's values, environment, or behavior influencing health, are essential to the proper care of patients, yet often are missing in the electronic health record (EHR). The current EHR structures and practice demands produce barriers to document PCD systemically. We sought to understand clinicians' perceived facilitators and barriers to use PCD using a consumer informatics technology integrated into the EHR. The PCD components include patient perceived pressures; joys; preferred approach to care; perceived health; health-goals; and visit agenda. We conducted semi-structured interviews of twenty primary care clinicians from an academic health system implementing a PCD initiative. The analysis included an inductive approach and a deductive a priori framework, the Consolidated Framework for Implementation Research (CFIR). Clinicians identified the following facilitators of adoption: reinforcement of patient engagement; a focus on enhancing team-based care; and communication around how the tool can be incorporated for individualized care. Clinicians identified barriers as: challenges incorporating PCD into the time-compressed visit and reviewing the tool involved another click in the EHR. The deductive results spanned four domains and seven constructs of CFIR, principally finding intervention source, relative advantage, organizational needs, and relative priority as facilitators with a need for ongoing leadership for the culture change. Overall, clinicians supported the adoption of a consumer informatics technology, as they reflected on the perceived value of a new data source to enhance patient-centered care and involvement in the development process. User-focused optimization efforts aided in the improved functionality and adoption of the application.


Assuntos
Pessoal de Saúde/psicologia , Autorrelato/estatística & dados numéricos , Coleta de Dados/métodos , Coleta de Dados/normas , Coleta de Dados/estatística & dados numéricos , Assistência à Saúde/métodos , Gerenciamento Clínico , Pessoal de Saúde/estatística & dados numéricos , Humanos , Ciência da Implementação , Pesquisa Qualitativa
20.
J Nurs Care Qual ; 35(2): 182-188, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31290782

RESUMO

BACKGROUND: Previous research found that reliability estimates for chart-extracted quality of care data vary. PURPOSE: The purpose was to examine methods and processes used to gather data on the National Database of Nursing Quality Indicators (NDNQI) pressure injury (PI) risk and prevention measures to identify factors that may influence their reliability. METHODS: Study participants (N = 120) from 36 hospitals completed a 35-item online survey. Included were the NDNQI PI Survey Team member with the most experience and/or skill in patient record review from each hospital (n = 36) and 84 other NDNQI PI Survey Team members. RESULTS: In general, participants followed NDNQI PI data collection guidelines. However, deviations were noted such as 60 (50%) participants collected PI data on units where they work, and 92 (76.7%) determined whether moisture management was performed by direct observation of patients rather than chart documentation. CONCLUSIONS: Findings provide insight on how to improve the reliability of hospital-acquired PI risk and prevention measures that includes clarification of the data collection guidelines.


Assuntos
Coleta de Dados/estatística & dados numéricos , Bases de Dados Factuais , Recursos Humanos de Enfermagem no Hospital , Lesão por Pressão/prevenção & controle , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Medição de Risco/normas , Hospitais , Humanos , Internet , Reprodutibilidade dos Testes , Inquéritos e Questionários
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