Search

Background: Since January 2003, all clinical scientific articles published in the American volume of The Journal of Bone and Joint Surgery (JBJS-A) have included a level-of-evidence rating. The aim of the current study was to evaluate the interobserver agreement among reviewers, with varying levels of epidemiology training, in categorizing the levels of evidence of these clinical studies. Methods: Fifty-one consecutive clinical papers published in the American volume of JBJS were identified by a computerized search of the table of contents from January 2003 through June 2003. Each paper was blinded so that only the title, abstract (without the level of evidence designated), and methods section were provided to the reviewers. The papers were coded and were randomly organized in a binder. Six surgeons graded each blinded paper for (1) the type of study (therapeutic, prognostic, diagnostic test, or economic or decision analysis), (2) the level of evidence (on a scale of I through V), and (3) the subcategory within the particular level of evidence. Three surgeons were members of JBJS American Editorial Board, two surgeons were reviewers for JBJS-A, and one surgeon was an active researcher not formally associated with JBJS-A. The reviewers did not receive any formal training in the application of the classification system, but each was provided with a detailed description of the classification system used by JBJS-A. Intra-class correlation coefficients with 95% confidence intervals were determined for the reviewers' agreement regarding the type of study, level of evidence, and subcategory within the level of evidence. Results: The majority (69%) of the fifty-one included articles were studies of therapy, and 57% of the studies constituted Level-IV evidence. The intraclass correlation coefficients for the agreement among all reviewers with regard to the study type, level of evidence, and subcategory within the level of evidence ranged from 0.61 to 0.75. Reviewers trained in epidemiology demonstrated greater agreement (range in intraclass correlation coefficients, 0.99 to 1.0), across all aspects of the classification system, than did reviewers who were not trained in epidemiology (range in intraclass correlation coefficients, 0.60 to 0.75). Conclusions: These findings suggest that epidemiology and non-epidemiology-trained reviewers can apply the levels- of-evidence guide to published studies with acceptable interobserver agreement. The validity of this system remains a question for future research. [ABSTRACT FROM AUTHOR]

Two important measurements for the evaluation of a public health surveillance system are sensitivity and predictive value positive (PVP). The computation of sensitivity and PVP for a public health surveillance system, however, can be complicated by the absence of an appropriate gold standard. In addition, there are few references for the computation of sensitivity and PVP for a surveillance system. To determine how these attributes of evaluation have been reported in epidemiologic literature, I review papers that report sensitivity and PVP for public health surveillance systems. Of the 31 papers that met selection criteria, 21 (68%) included either a reference for the computation or a definition of the attributes, whereas 18 (58%) reported both attributes. All 31 papers reported sensitivity, and among the 31 papers, 24 (77%) reported more than one sensitivity measurement. Among the 18 papers that reported at least PVP, 13 (72%) reported more than one PVP measurement. This review provides guidance in computing sensitivity and PVP for a public health surveillance system.

Several abstracts of research papers on epidemiology including acuity scoring systems, respiratory failure and measuring patients' health-related quality of life are presented.

Several abstracts of research papers on epidemiology including the 2010 Nationwide Emergency Department Sample (NEDS), improving mortality outcomes by managing increased risk of venous thromboembolism and the pediatric early warning system (PEWS) score are presented.

Several abstracts of research papers on epidemiology including patients undergoing major surgical procedures, asthma and an increased body mass index (BMI) are presented.

Several abstracts of research papers on epidemiology including pediatric intensive care units, improved survival outcomes of pediatric critical illness and mortality of children are presented.

Several abstracts of research papers on epidemiology including percutaneous endoscopic gastrostomy (PEG), interest in the significance of chloride plasma levels and Subarachnoid Hemorrhage are presented.

Several abstracts of research papers on epidemiology including perfusion and outflow dysfunction, Child Maltreatment Syndrome and depression are presented.

Several abstracts of research papers on epidemiology including the Modified Early Warning Score (MEWS) tool, a large academic Pediatric Intensive Care Unit and patient blood management are presented.

Several abstracts of research papers on epidemiology including Tracheal Intubation (TI), preoperative markers of poor graft evolution after liver transplantation and ICU readmissions after cardiac and transplant surgery are presented.

Several abstracts of research papers on epidemiology including surgical operations, surgeon-related outcomes and feasibility testing of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) tool are presented.

Several abstracts of research papers on epidemiology including the outcome of severe sepsis in Catalonia, Spain, the evolution of telemedicine in the last decade and predictors of mortality are presented.

Several abstracts of research papers on epidemiology including the diagnosis of pulmonary embolism, the Pediatric Early Warning Score (PEWS) and causes of patient admission are presented.

Several abstracts of research papers on epidemiology including the impact of aneurysmal sub-arachnoid hemorrhage, dysthermia and patients with cancer are presented.

Several abstracts of research papers on epidemiology including trauma activations, severity of illness scores and Extracorporeal Membrane Oxygenation (ECMO) are presented.

Several abstracts of research papers on epidemiology including pediatric in-hospital cardiac arrest (IHCA) events, intensive care and mesenteric ischemia (MI) are presented.

Several abstracts of research papers on epidemiology including characterizing H1N1 clinical findings, device related pressure ulcers and extreme obesity are presented.

Several abstracts of research papers on epidemiology including the outcomes after cardiac arrest or cardiogenic shock, comorbidity measures and increased utilization of advanced imaging services in medicine are presented.

Several abstracts of research papers on epidemiology including the incidence of adverse drug reactions in hospitalized patients, Acute respiratory distress syndrome (ARDS) and pediatric severe sepsis are presented.

Several abstracts of research papers on epidemiology including the impact of ethnicity on the development of pregnancy-associated severe sepsis, patients with necrotizing fasciitis (NF) requiring ICU care and patients with unplanned transfers to the ICU are presented.

The article presents abstracts of papers related to occupational radio epidemiology, which are to be presented at the Fiftieth Annual Meeting of the Health Physics Society in Spokane, Washington on July 13, 2005. In almost any workplace in which one might stud the effects of low-level ionizing radiation, there are chemical exposures that are integral to the process and which many workers can be simultaneously exposed. This can lead to the problem, well-recognized epidemiology, known as confounding. In order confound the radiation dose-response relationship; the exposure must be associated both with exposure radiation and with the health effect being studied. It is important to account for this confounding since it ca: influence or bias the conclusions of the study. Not doing this can lead to spurious findings of associations of: health effect with the agent under study, or worse, result in not finding an association where in truth there is one HERB scientists have conducted, and currently an conducting, studies in which a number of chemical exposures are present and are being assessed along with the radiation dose. For example, in a study of the relationship between external ionizing radiation and lung cancer at a nuclear naval shipyard, historical work-exposures to asbestos and welding fumes are being reconstructed.

This paper explores some factors that may explain why the possibility of hormesis has not been embraced by the radiation protection community. If shown to be sustainable, hormesis might ameliorate several serious issues plaguing radiation protection including the high economic cost of environmental regulatory compliance and public fear of radiation exposure. Some but not all analyses of data from various sources, including the Japanese survivors of the atomic bombs and residential radon studies, suggest that low levels of ionizing radiation may be beneficial to human health. The evidence, however, has not been viewed as compelling for the following reasons: (1) Data in support of radiation hormesis in human populations is limited and much of it is based on re-evaluation of selected epidemiological data that has beenused to test a different hypothesis; (2) Hormetic effects are weak and inconsistent, and are subject to large statistical uncertainties as is the case for carcinogenic effects at small doses; (3) A consensus is lacking on how hormesis should be defined and quantified; and (4) It is unclear how hormesis can be incorporated into the regulatory framework when beneficial health effects exceed the requirement for protection of health. [ABSTRACT FROM AUTHOR]

In a 1997 paper, Stabin et al. published estimates of the fetal radiation doses for women who received oral administrations of 59Fe at Vanderbilt University in the 1940's. These authors concludedthat there was "considerable uncertainty... in the amount of radioactive material administered to these subjects:" In an effort to quantify this uncertainty, the underlying factors in the input data used inthe Stabin et al. dose estimates have been examined in detail. Such factors include (a) an absence of detailed information on, and discrepancies in, the amounts of 59Fe reported to have been administered; (b) the probability that the radioactive iron included 55Fe as well as 59Fe; (c) uncertainties as to the period of time that elapsed between the administration of the radioiron and the taking of the maternal blood samples, and the accompanying impacts of radioactive decay; (d) possible losses of 59Fe in the procedures used in preparing the blood samples; and (e) questions as to the reported efficiency of the counting equipment. Our principal conclusion is that, due to the significant uncertainties and the lack of key information, it is not possible to estimate the doses accurately. An ancillary conclusion, however, is that the doses were probably significantly higher than previously estimated. This latter possibility should be carefully considered by any investigators who subsequently seek to use these estimates to quantify the relationship between the doses to the fetus and the resulting health effects. [ABSTRACT FROM AUTHOR]