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Lead-Time Bias

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181. Do variations in hospital admission rates bias comparisons of standardized hospital mortality rates? A population-based cohort study. (PubMed)

is reduced by two-thirds to a 0.068 percentage point increase in the risk of death.Comparisons of standardized hospital mortality rates following unplanned admissions can be biased by variations in emergency department admission rates, leading to incorrect conclusions about quality. The use of mortality as a performance measure could therefore lead to misleading comparisons if admission rates vary and illness severity is not fully controlled for. Accounting for sample selection bias and dependence (...) Do variations in hospital admission rates bias comparisons of standardized hospital mortality rates? A population-based cohort study. Standardized mortality rates are routinely used as measures of hospital performance and quality. Such metrics may, however, be biased if hospital admission thresholds differ and patient severity is not fully measured.To examine whether comparisons of hospital mortality rates suffer from selection bias due to variations in hospital admission rates, using

2019 Social Science & Medicine

182. A systematic review finds that spin or interpretation bias is abundant in evaluations of ovarian cancer biomarkers. (PubMed)

A systematic review finds that spin or interpretation bias is abundant in evaluations of ovarian cancer biomarkers. In the scientific literature, "spin" refers to reporting practices that make the study findings appear more favorable than results justify. The practice of "spin" or misrepresentation and overinterpretation may lead to an imbalanced and unjustified optimism in the interpretation of study results about performance of putative biomarkers. We aimed to classify spin (i.e

2019 Journal of Clinical Epidemiology

183. Gender Bias Experiences of Female Surgical Trainees. (PubMed)

)."Female surgical trainees continue to experience gender bias. A culture of sexism leads to physical and social adaptations to fit into the role of surgeon. Participants expressed significant effort to sustain this level of adaptation, leading to fatigue and creation of resilience mechanisms. The environment in which a trainee operates (male-dominant vs female-dominant) significantly impacts their experience. Those experiencing more bias were less likely to recommend their specialty and reported plans (...) Gender Bias Experiences of Female Surgical Trainees. Medical schools now average approximately 50% female students, yet a disproportionate number of women continue to choose nonsurgical over surgical specialties. Once in training, studies indicate that pervasive gender stereotypes, sexism and harassment negatively affect female surgeons. The aim of this study is to describe female surgeons' experiences with gender bias and microaggressions in the workplace during residency and fellowship

2019 Journal of Surgical Education

184. HIV infection drives IgM and IgG3 subclass bias in Plasmodium falciparum-specific and total immunoglobulin concentration in Western Kenya. (PubMed)

participants, HIV-1 VL and CRP were weakly correlated with AMA1 and GLURP-R0 specific IgM and IgG1 concentrations and total (not antigen specific) IgM, IgG, IgG1, and IgG3 concentrations (all p < 0.05), suggesting that these changes are related in part to viral load and inflammation.Overall, HIV infection leads to a total and malaria antigen-specific immunoglobulin production bias towards higher levels of IgM, IgG1, and IgG3, and HIV-1 viraemia and systemic inflammation are weakly correlated (...) HIV infection drives IgM and IgG3 subclass bias in Plasmodium falciparum-specific and total immunoglobulin concentration in Western Kenya. HIV infection is associated with more frequent and severe episodes of malaria and may be the result of altered malaria-specific B cell responses. However, it is poorly understood how HIV and the associated lymphopenia and immune activation affect malaria-specific antibody responses.HIV infected and uninfected adults were recruited from Bondo subcounty

2019 Malaria journal

185. Orbitofrontal cortex is selectively activated in a primate model of attentional bias to cocaine cues. (PubMed)

into the orbitofrontal cortex, anterior cingulate cortex, dorsal anterior striatum, and ventral striatum. As in clinical studies, attentional bias was indicated by elongated response times on trials with cocaine-associated distractors compared with trials with water-associated, or control unconditioned distractors. In both animals studied, across an unbiased sample of neurons, the orbitofrontal cortex differentiated distractor condition by the proportion of single-units activated, as well as by population response (...) Orbitofrontal cortex is selectively activated in a primate model of attentional bias to cocaine cues. Attentional bias to drug-associated cues correlates with extent of current use, and risk of relapse among those attempting abstinence. Electroencephalogram (EEG) and functional imaging measures in clinical studies have previously investigated the neural basis of attentional bias, but the lack of animal models precluded investigation at the single-unit level. To complement results obtained from

2019 Neuropsychopharmacology

186. Publication Bias Among Conference Abstracts Reporting on Pediatric Quality Improvement Projects. (PubMed)

Publication Bias Among Conference Abstracts Reporting on Pediatric Quality Improvement Projects. This study evaluated progress to publication of pediatric quality improvement (QI) projects initially presented as national conference abstracts, according to project findings and other characteristics. QI abstracts were identified among presentations at the 2010-2015 American Academy of Pediatrics National Conference & Exhibition, and publications were tracked through June 2018. Positive findings (...) (improvement on at least 1 quantitative project outcome), interventions, and analyses were correlated with journal publication. Of 142 abstracts, 128 (90%) reported positive findings. Forty-nine positive abstracts and 3 abstracts reporting negative results resulted in publication (38% vs 21%, respectively; P = .256). Median time to publication was 1.2 years for projects with positive findings, compared to >3 years for abstracts with negative findings (P = .029). Ninety percent of abstracts reported

2019 American Journal of Medical Quality

187. Diversity and inclusion: the role of unconscious bias on patient care, health outcomes and the workforce in obstetrics and gynaecology. (PubMed)

Diversity and inclusion: the role of unconscious bias on patient care, health outcomes and the workforce in obstetrics and gynaecology. Although the business world has long recognized the benefits of diversity and inclusion and the effects of unconscious bias, the discourse is just now gaining traction in the medical field. In addition, many businesses have developed key initiatives to address unconscious bias in the workplace.In the medical field, diversity leads to improved health outcomes (...) , increased access to healthcare by the underserved and more innovation. However, unconscious bias may inadvertently propagate health disparities, affect trainee evaluations, hinder faculty satisfaction and exclude populations from meaningful research.In this review, we discuss diversity, inclusion and unconscious bias in obstetrics and gynaecology, as it relates to patient care, health outcomes, medical faculty and trainees. We also discuss potential interventions that mitigate these issues.

2019 Current Opinion in Obstetrics and Gynecology

188. Time-lapse systems for embryo incubation and assessment in assisted reproduction. (PubMed)

Time-lapse systems for embryo incubation and assessment in assisted reproduction. Embryo incubation and assessment is a vital step in assisted reproductive technology (ART). Traditionally, embryo assessment has been achieved by removing embryos from a conventional incubator daily for quality assessment by an embryologist, under a light microscope. Over recent years time-lapse systems have been developed which can take digital images of embryos at frequent time intervals. This allows (...) embryologists, with or without the assistance of embryo selection software, to assess the quality of the embryos without physically removing them from the incubator.The potential advantages of a time-lapse system (TLS) include the ability to maintain a stable culture environment, therefore limiting the exposure of embryos to changes in gas composition, temperature and movement. A TLS has the potential advantage of improving embryo selection for ART treatment by utilising additional information gained

2018 Cochrane

189. Antibiotics at the time of removal of central venous catheter to reduce morbidity and mortality in newborn infants. (PubMed)

sepsis rates and led to no significant differences in any of the prespecified outcomes. Review authors judged the study to be of low quality because of high risk of bias and imprecision.Randomised controlled trials have provided inadequate evidence for assessment of the efficacy or safety of antibiotics given at the time of CVC removal. The single identified trial was underpowered to address this question. Future research should be directed towards targeting use of antibiotics upon removal of CVC (...) Antibiotics at the time of removal of central venous catheter to reduce morbidity and mortality in newborn infants. Late-onset sepsis is associated with increased rates of mortality and morbidity in newborn infants, in addition to poorer long-term developmental outcomes and increased length of stay and hospital costs. Central line-associated blood stream infection (CLABSI) is the most common cause of late-onset sepsis in hospitalised infants, and prevention of CLABSI is a key objective

2018 Cochrane

190. Timing of dornase alfa inhalation for cystic fibrosis. (PubMed)

Timing of dornase alfa inhalation for cystic fibrosis. Inhalation of the enzyme dornase alfa reduces sputum viscosity and improves clinical outcomes of people with cystic fibrosis. This is an update of a previously published Cochrane Review.To determine whether the timing of dornase alfa inhalation (in relation to airway clearance techniques or morning versus evening inhalation) has an impact on objective and subjective measures of clinical efficacy in people with cystic fibrosis.Relevant (...) randomised and quasi-randomised controlled trials were identified from the Cochrane Cystic Fibrosis Trials Register, Physiotherapy Evidence Database (PEDro), clinical trial registries and international cystic fibrosis conference proceedings.Date of the most recent search: 06 June 2018.Any trial of dornase alfa in people with cystic fibrosis where timing of inhalation was the randomised element in the trial with either: inhalation before compared to after airway clearance techniques; or morning compared

2018 Cochrane

191. Timing of renal replacement therapy initiation for acute kidney injury. (PubMed)

Timing of renal replacement therapy initiation for acute kidney injury. Acute kidney injury (AKI) is a common condition among patients in intensive care units (ICUs), and is associated with high death. Renal replacement therapy (RRT) is a blood purification technique used to treat the most severe forms of AKI. The optimal time to initiate RRT so as to improve clinical outcomes remains uncertain.This review complements another Cochrane review by the same authors: Intensity of continuous renal (...) replacement therapy for acute kidney injury.To assess the effects of different timing (early and standard) of RRT initiation on death and recovery of kidney function in critically ill patients with AKI.We searched the Cochrane Kidney and Transplant's Specialised Register to 23 August 2018 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings

2018 Cochrane

192. Methodological issues in current practice may lead to bias in the development of biomarker combinations for predicting acute kidney injury. (PubMed)

Methodological issues in current practice may lead to bias in the development of biomarker combinations for predicting acute kidney injury. Individual biomarkers of renal injury are only modestly predictive of acute kidney injury (AKI). Using multiple biomarkers has the potential to improve predictive capacity. In this systematic review, statistical methods of articles developing biomarker combinations to predict AKI were assessed. We identified and described three potential sources of bias (...) (resubstitution bias, model selection bias, and bias due to center differences) that may compromise the development of biomarker combinations. Fifteen studies reported developing kidney injury biomarker combinations for the prediction of AKI after cardiac surgery (8 articles), in the intensive care unit (4 articles), or other settings (3 articles). All studies were susceptible to at least one source of bias and did not account for or acknowledge the bias. Inadequate reporting often hindered our assessment

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2015 Kidney International

193. Social disparities in hazardous alcohol use: self-report bias may lead to incorrect estimates (PubMed)

Social disparities in hazardous alcohol use: self-report bias may lead to incorrect estimates Self-report bias in surveys of alcohol consumption is widely documented; however, less is known about the distribution of such bias by socioeconomic status (SES) and about the possible impact on social disparities. This study aims to assess social disparities in hazardous drinking (HD) and to analyze how correcting alcohol consumption data for self-report bias may affect estimates (...) -educated women are more likely than less-educated women to engage in HD, while the opposite is observed in men in most countries. Large discrepancies in alcohol consumption between survey-based and aggregate estimates were found. Correcting for self-report bias increased estimates of social disparities in women, and decreased them in men, to the point that gradients were reversed in several countries (from higher rates in low education/SES men to an opposite pattern).This study provides evidence

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2015 The European Journal of Public Health

194. Stopping biological drugs for rheumatoid arthritis can lead to twice the relapse rate

Stopping biological drugs for rheumatoid arthritis can lead to twice the relapse rate Stopping biological drugs for rheumatoid arthritis can lead to twice the relapse rate Discover Portal Discover Portal Stopping biological drugs for rheumatoid arthritis can lead to twice the relapse rate Published on 24 January 2018 doi: It seems safer to reduce the dose of biological drugs, rather than to stop them if people with rheumatoid arthritis and their doctors want to avoid relapse. Stopping (...) activity and often lead to remission. However, it is important not to remain on them at high doses due to infection risk and side effects. This review aimed to address the actual risk of relapse if stopping or reducing the dose of biological drugs. What did this study do? This systematic review and meta-analysis pooled the results of 15 randomised controlled trials and two non-randomised trials. It included 2,855 adults who had rheumatoid arthritis for less than a year to 13.6 years. Four trials were

2018 NIHR Dissemination Centre

195. Transfusing blood at less severe levels of anaemia may lead to fewer heart problems

Transfusing blood at less severe levels of anaemia may lead to fewer heart problems Transfusing blood at less severe levels of anaemia may lead to fewer heart problems Discover Portal Discover Portal Transfusing blood at less severe levels of anaemia may lead to fewer heart problems Published on 2 August 2016 doi: For people with existing heart disease or stroke, a strategy of transfusing blood if anaemia is less severe, haemoglobin above 80g/L, led to fewer coronary syndromes. The strategy (...) syndrome (heart attack or unstable angina). Six of the trials were judged to be at high risk of bias due to the lack of blinding of participants and staff, though this would have been hard to do. The pooling of overlapping cut-off values made comparison of the restrictive and liberal groups challenging. Also definitions of cardiovascular disease differed between trials. However, heterogeneity across trials was found to be low, increasing our confidence that the meta-analysis was valid. What did it find

2018 NIHR Dissemination Centre

196. Diabetes self-management education leads to better blood sugar control

Diabetes self-management education leads to better blood sugar control Diabetes self-management education leads to better blood sugar control Discover Portal Discover Portal Diabetes self-management education leads to better blood sugar control Published on 23 March 2016 doi: Diabetes self-management education can lead to greater, and clinically important, reductions in blood sugar levels than usual care or other control treatments. Self-management programmes were most effective in people (...) with higher blood sugar levels to start with, and when they involved ten or more hours of contact time, although there was no indication that programmes running over a longer overall period of time were more effective. The interventions were very diverse so the optimal intervention duration, provider, or contact hours is not clear. This review did not study cost-effectiveness either, so it is not possible to give advice on how interventions compared to each other or which might deliver value for money

2018 NIHR Dissemination Centre

197. Reducing street lighting doesn’t lead to more road traffic accidents or crime

Reducing street lighting doesn’t lead to more road traffic accidents or crime Reducing street lighting doesn’t lead to more road traffic accidents or crime Discover Portal Discover Portal Reducing street lighting doesn’t lead to more road traffic accidents or crime Published on 12 October 2015 doi: This NIHR study found that reducing or adapting street lighting was not linked to more road traffic accidents or crime in the UK. Many local authorities have changed their street lighting in recent (...) authorities on the type of street lighting changes made, the location of affected lighting and the date changes were introduced. Traffic collision data came from the UK’s official Department for Transport dataset (STATS19) and included dates, times, locations and details of casualties. Crime data came from the national Police website, including the type of crime, date (year/month) and geographical location. This publicly-available police crime data does not give precise locations or times of crimes, so

2018 NIHR Dissemination Centre

198. Reducing street lighting doesn’t lead to more road traffic accidents or crime

Reducing street lighting doesn’t lead to more road traffic accidents or crime Reducing street lighting doesn’t lead to more road traffic accidents or crime Discover Portal Discover Portal Reducing street lighting doesn’t lead to more road traffic accidents or crime Published on 12 October 2015 doi: This NIHR study found that reducing or adapting street lighting was not linked to more road traffic accidents or crime in the UK. Many local authorities have changed their street lighting in recent (...) authorities on the type of street lighting changes made, the location of affected lighting and the date changes were introduced. Traffic collision data came from the UK’s official Department for Transport dataset (STATS19) and included dates, times, locations and details of casualties. Crime data came from the national Police website, including the type of crime, date (year/month) and geographical location. This publicly-available police crime data does not give precise locations or times of crimes, so

2018 NIHR Dissemination Centre

199. Problem-Based Learning May Lead to Better Student Performance Results

Problem-Based Learning May Lead to Better Student Performance Results UTCAT3040, Found CAT view, CRITICALLY APPRAISED TOPICs University: | | ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM View the CAT / Title Problem-Based Learning May Lead to Better Student Performance Results Clinical Question In dental pre-doctoral courses, does Problem-Based Learning (PBL) lead to better student performance on written exams and in clinical assessments in comparison to traditional lecture-based courses (...) ? Clinical Bottom Line Problem-Based Learning (PBL) was found to lead to equal or better student performance on written exams and may aid in applying learned knowledge in clinical situations. This is supported by systematic reviews of student performance and a case control study that evaluated the satisfaction of dentists trained with PBL. Studies with higher-level validity should be conducted in the future to develop higher quality evidence on the outcomes of PBL in dental education. Best Evidence (you

2016 UTHSCSA Dental School CAT Library

200. Estimating the effect of cumulative occupational asbestos exposure on time to lung cancer mortality: Using structural nested failure-time models to account for healthy-worker survivor bias (PubMed)

Estimating the effect of cumulative occupational asbestos exposure on time to lung cancer mortality: Using structural nested failure-time models to account for healthy-worker survivor bias Previous estimates of the effect of occupational asbestos on lung cancer mortality have been obtained by using methods that are subject to the healthy-worker survivor bias. G-estimation of a structural nested model provides consistent exposure effect estimates under this bias.We estimated the effect (...) exposure, and age at study entry yielded a survival time ratio of 0.88 (95% confidence interval = 0.83 to 0.93). Further adjustment for work status yielded no practical change. The corresponding survival time ratio obtained using g-estimation of a structural nested model was 0.57 (0.33 to 0.96).Accounting for the healthy-worker survivor bias resulted in a 35% stronger effect estimate. However, this estimate was considerably less precise. When healthy-worker survivor bias is suspected, methods

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2014 Epidemiology (Cambridge, Mass.)

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