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Quantitative methods for health research
A practical introduction to epidemiology, biostatistics, and research methodology for the whole health care community
This comprehensive text, which has been extensively revised with new material and additional topics, utilizes a practical slant to introduce health professionals and students to epidemiology, biostatistics, and research methodology. It draws examples from a wide range of topics, covering all of the main contemporary health research methods, including survival analysis, Cox regression, and systematic reviews and meta-analysis—the explanation of which go beyond introductory concepts. This second edition of Quantitative Methods for Health Research: A Practical Interactive Guide to Epidemiology and Statistics also helps develop critical skills that will prepare students to move on to more advanced and specialized methods.
A clear distinction is made between knowledge and concepts that all students should ensure they understand, and those that can be pursued further by those who wish to do so. Self-assessment exercises throughout the text help students explore and reflect on their understanding. A program of practical exercises in SPSS (using a prepared data set) helps to consolidate the theory and develop skills and confidence in data handling, analysis, and interpretation. Highlights of the book include:
* Combining epidemiology and bio-statistics to demonstrate the relevance and strength of statistical methods
* Emphasis on the interpretation of statistics using examples from a variety of public health and health care situations to stress relevance and application
* Use of concepts related to examples of published research to show the application of methods and balance between ideals and the realities of research in practice
* Integration of practical data analysis exercises to develop skills and confidence
* Supplementation by a student companion website which provides guidance on data handling in SPSS and study data sets as referred to in the text
Quantitative Methods for Health Research, Second Edition is a practical learning resource for students, practitioners and researchers in public health, health care and related disciplines, providing both a course book and a useful introductory reference.
eBook
The Dose Response Multicentre Investigation on Fluid Assessment (DoReMIFA) in critically ill patients
Background
The previously published “Dose Response Multicentre International Collaborative Initiative (DoReMi)” study concluded that the high mortality of critically ill patients with acute kidney injury (AKI) was unlikely to be related to an inadequate dose of renal replacement therapy (RRT) and other factors were contributing. This follow-up study aimed to investigate the impact of daily fluid balance and fluid accumulation on mortality of critically ill patients without AKI (N-AKI), with AKI (AKI) and with AKI on RRT (AKI-RRT) receiving an adequate dose of RRT.
Methods
We prospectively enrolled all consecutive patients admitted to 21 intensive care units (ICUs) from nine countries and collected baseline characteristics, comorbidities, severity of illness, presence of sepsis, daily physiologic parameters and fluid intake-output, AKI stage, need for RRT and survival status. Daily fluid balance was computed and fluid overload (FO) was defined as percentage of admission body weight (BW). Maximum fluid overload (MFO) was the peak value of FO.
Results
We analysed 1734 patients. A total of 991 (57 %) had N-AKI, 560 (32 %) had AKI but did not have RRT and 183 (11 %) had AKI-RRT. ICU mortality was 22.3 % in AKI patients and 5.6 % in those without AKI (
p
< 0.0001). Progressive fluid accumulation was seen in all three groups. Maximum fluid accumulation occurred on day 2 in N-AKI patients (2.8 % of BW), on day 3 in AKI patients not receiving RRT (4.3 % of BW) and on day 5 in AKI-RRT patients (7.9 % of BW). The main findings were: (1) the odds ratio (OR) for hospital mortality increased by 1.075 (95 % confidence interval 1.055–1.095) with every 1 % increase of MFO. When adjusting for severity of illness and AKI status, the OR changed to 1.044. This phenomenon was a continuum and independent of thresholds as previously reported. (2) Multivariate analysis confirmed that the speed of fluid accumulation was independently associated with ICU mortality. (3) Fluid accumulation increased significantly in the 3-day period prior to the diagnosis of AKI and peaked 3 days later.
Conclusions
In critically ill patients, the severity and speed of fluid accumulation are independent risk factors for ICU mortality. Fluid balance abnormality precedes and follows the diagnosis of AKI.
Journal Article
Artery Wall Assessment Helps Predict Kidney Transplant Outcome
Kidney transplant recipients have high cardiovascular risk, and vascular inflammation may play an important role. We explored whether the inflammatory state in the vessel wall was related to carotid intima-media thickness (c-IMT) and patient survival following kidney transplantation.
In this prospective observational cohort study we measured c-IMT and expression of proinflammatory cytokines and adhesion molecules in the inferior epigastric artery in 115 kidney transplant candidates. Another c-IMT measurement was done 1-year post-transplantation in 107. By stepwise multiple regression analysis we explored factors associated with baseline c-IMT and their changes over time. Multivariate Cox regression analysis was constructed to identify risk factors for mortality.
A worse cardiovascular profile (older age, smoker, diabetic, carotid plaque, systolic blood pressure and vascular calcification) and higher VCAM-1 levels were found in patients in the highest baseline c-IMT tertile, who also had a worse survival. Factors independently related to baseline c-IMT were age (β=0.369, P<0.0001), fasting glucose (β=0.168, P=0.045), smoking (β=0.228, P=0.003) and VCAM-1 levels (β=0.244, P=0.002). Independent factors associated with c-IMT measurement 1-year post-transplantation were baseline c-IMT (β=-0.677, P<0.0001), post-transplant diabetes (β=0.225, P=0.003) and triglycerides (β=0.302, P=0.023). Vascular VCAM-1 levels were associated with increased risk of mortality in bivariate and multivariate Cox regression. Notably, nearly 50% of patients showed an increase or maintenance of high c-IMT 1 year post-transplantation and these patients experienced a higher mortality (13 versus 3.5%; P=0.021).
A worse cardiovascular profile and a higher vascular VCAM-1 protein levels at time of KT are related to subclinical atheromatosis. This could lead to a higher post-transplant mortality. Pre-transplant c IMT, post-transplant diabetes and triglycerides at 1-year post-transplantation may condition a high c-IMT measurement post-transplantation, which may decrease patient survival.
Journal Article
Monitoring the health of populations by tracking disease outbreaks : saving humanity from the next plague
\"Today the citizens of developed counties have never experienced a large-scale disease outbreak. One reason is the success of the public health community, including epidemiologists and biostatisticians, in tracking and identifying disease outbreaks. Monitoring the Health of Populations by Tracking Disease Outbreaks: Saving Humanity from the Next Plague is the story of the application of statistics for disease detection and tracking. The work of public health officials often critically depends on the use of statistical methods to help discern whether an outbreak may be occurring and, if there is sufficient evidence of an outbreak, then to locate and track it\"-- Provided by publisher.
Book
Foundations of evidence-based medicine: clinical epidemiology and beyond
This comprehensive text focuses on reasoning, critical thinking and pragmatic decision making in medicine. Based on the author's extensive experience and filled with definitions, formulae, flowcharts and checklists, this fully revised second edition continues to provide invaluable guidance to the crucial role that clinical epidemiology plays in the expanding field of evidence-based medicine. Key Features: * Considers evidence-based medicine as a universal initiative common to all health sciences and professions, and all specialties within those disciplines * Demonstrates how effective practice is reliant on proper foundations, such as clinical and fundamental epidemiology, and biostatistics * Introduces the reader to basic epidemiological methods, meta-analysis and decision analysis * Shows that structured, modern, argumentative reasoning is required to build the best possible evidence and use it in practice and research * Outlines how to make the most appropriate decisions in clinical care, disease prevention and health promotion Presenting a range of topics seldom seen in a single resource, the innovative blend of informal logic and structured evidence-based reasoning makes this book invaluable for anyone seeking broad, in-depth and readable coverage of this complex and sometimes controversial field.
eBook
Crisis averted : the hidden science of fighting outbreaks
\"A fascinating window into the secret life of epidemiology, weaving together stories of triumph and tragedy, with a boots-on-the-ground perspective on how we can avert the next public health crisis There are few visible markers of the accomplishments of public health. If epidemiologists do their jobs, nothing happens. An outbreak does not grow into an epidemic. A child does not go hungry. A would-be smoker never lights up. These achievements are rarely noticed or celebrated, but Caitlin Rivers lives for such victories. By making sure that things don't happen, she and legions of scientists, practitioners, and policymakers change the course of history. We have many of the tools and experiences needed to prevent the next crisis, but countless challenges remain, including constantly emerging pathogens, the rapid growth of biotechnology, and the inconsistent cycles of funding for government organizations like the CDC. Progress can be slow, even with the next pandemic potentially right around the corner, but the unsung heroes in public health remain focused on their missions. Crisis Averted is their story-from the eradication of smallpox in the 20th century to today's safeguards against extraterrestrial germs. By taking a candid look at how we solve problems in public health, Caitlin Rivers illuminates the role of epidemiology in all our lives and lays out the case for what can be accomplished, given sufficient vision, leadership, and resources. Crisis Averted is an inspiring and galvanizing clarion call for us to work together towards a healthier, more resilient future\"-- Provided by publisher.
BOOK
Measurement in Medicine
The success of the Apgar score demonstrates the astounding power of an appropriate clinical instrument. This down-to-earth book provides practical advice, underpinned by theoretical principles, on developing and evaluating measurement instruments in all fields of medicine. It equips you to choose the most appropriate instrument for specific purposes. The book covers measurement theories, methods and criteria for evaluating and selecting instruments. It provides methods to assess measurement properties, such as reliability, validity and responsiveness, and interpret the results. Worked examples and end-of-chapter assignments use real data and well-known instruments to build your skills at implementation and interpretation through hands-on analysis of real-life cases. All data and solutions are available online. This is a perfect course book for students and a perfect companion for professionals/researchers in the medical and health sciences who care about the quality and meaning of the measurements they perform.
eBook