Question 1. This question is based on a journal article that appeared in the New England...

 

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Question 1. This question is based on a journal article that appeared in the New England Journal of Medicine: Gawande AA et al., "Risk factors for retained instruments and sponges after surgery." NEJM 2003;348:229-235. Excerpt from the Background section of the paper: "One persistent but poorly understood error [in surgical practice] is leaving sponges or instruments inside patients who undergo surgery. Such incidents may result in major injury... and are considered by many to be avoidable... The standards of the Association of Operating Room Nurses require that only sponges detectable on radiography be used and that they be counted once at the start and twice at the conclusion of all surgical procedures; that instruments be counted in all cases involving an open cavity; that if a count is incorrect then radiography or manual re-exploration is to be performed. We performed a case-control study to identify risk factors for retention of foreign bodies during surgery. Because these [errors] are avoidable and frequently injurious, many lead to malpractice claims and... most insurers encourage clinicians and hospitals to report them. Therefore, we used malpractice-insurance files from several institutions to identify cases." Modified Table 2 from the paper: Characteristics of patients with a retained foreign body Characteristic Female sex Counts of sponges and instruments performed Operation performed on an emergency basis Unexpected change in operation >1 surgical team involved Cases with a retained foreign body (n=54) n % 34 36 18 18 8 63.0 163 66.7 33.3 34.0 14.8 Control patients (n=235) n 161 181 16 21 17 161 235 181 235 16. 235 21 235 17 235 % 68.5 ==77.0 6,8 8.9 = 7.2 a. Write a hypothesis to describe what is being investigated in this study. (5 pts) b. What is the exposure (independent variable) in your hypothesis? (4 pts) c. What is the outcome (dependent variable) in your hypothesis? (4 pts) d. Fill in the table cells for the proportion (%) of control patients with each characteristic. (5 pts) Problem Set 1 Page 1 HCA 5483 e. What is the main advantage of comparing the proportions, rather than the number of cases and controls, for a particular characteristic? (4 pts) IF f. Using number and words describe the results from the table (e.g. for each characteristic, compare the proportions of cases and controls to describe the associations between the characteristics and risk of having a retained surgical sponge or instrument). (4 pts) Question 2, Streptococcus pneumoniae is a common cause of community-acquired pneumonia, meningitis, and bacteremia. Effective vaccines have now been developed against the most common disease-causing strains of S. pneumoniae. To quantify the burden of this disease prior to widespread vaccination, the Centers for Disease Control and Prevention (CDC) used data from one of their national surveillance programs to estimate the number of cases and deaths from invasive S. pneumoniae infection in the US in 1998. The figure below shows the distribution of these events by age group. n *Active Bacterial Core Surveillance (ABCs): http://www.cdc.gov/abcs/index.html Incidence (cases/100,000 pop) 180 160 140 120 100 80 60 40 20 5-17 18-34 Problem Set 1 Incidence 35-49 50-64 Age group, years 65-79 80+ 30 25 20 15 10 Case fatality rate (%) a. Use the figure to describe using numbers and words the trends in the distribution of invasive 5. pneumoniae disease incidence and case fatality rate by age group. (The case fatality rate is the proportion of deaths among diseased cases over a period of time.) (4 pts) b. Do the data in the figure suggest that there is an outbreak of S. pneumoniae cases? Explain the rationale for your answer. (4 pts) Page 2 Question 3. Please use PubMed to access the scientific abstract for each study listed below. Read the abstract (you do not need to copy/paste it into your homework assignment) and identify whether each study is a (1) descriptive or (2) scientific/analytic study. For the scientific/analytic studies, also list the exposure(s) and outcome(s) being evaluated. You can access PubMed on the Texas Woman's University Library Website, https://pubmed.ncbi.nlm.nih.gov/?holding-txuwxtlib_fft_ndi&otool-txuwxtlib; and then enter your TWU username and password. You can also access PubMed via http://www.ncbi.nlm.nih.gov/pubmed. Enter the author name and year in the PubMed search field and you will access the abstract. a. Biino G, Casula L, de Terlizzi F, Adamo M, Vaccargiu S, Francavilla M, Loi D, Casti A, Atzori M, Pirastu M. Epidemiology of osteoporosis in an isolated Sardinian population by using quantitative ultrasound. Am J Epidemiol. 2011 Aug 15;174(4):432-9. Epub 2011 Jun 27. (4 pts) b. Lu BB, Li KH. Association between ABO Blood Groups and Osteoporosis Severity in Chinese Adults Aged 50 Years and Over. J Int Med Res. 2011;39(3):929-33. (4 pts) c. Oyen J, Brudvik C, Gjesdal CG, Tell GS, Lie SA, Hove LM. J Bone Joint Surg Am. 2011 Feb 16:93(4):348-56.Osteoporosis as a risk factor for distal radial fra ARPA cantoral d http://www.ncbi.nlm.nih.gov/pubmed (4 pts) d. Looker AC, Melton LJ 3rd, Harris TB, Borrud LG, Shepherd JA. Prevalence and trends in low femur bone density among older US adults: NHANES 2005-2006 compared with NHANES III. J Bone Miner Res. 2010 Jan;25(1):64-71. (4 pts) Question 1. This question is based on a journal article that appeared in the New England Journal of Medicine: Gawande AA et al., "Risk factors for retained instruments and sponges after surgery." NEJM 2003;348:229-235. Excerpt from the Background section of the paper: "One persistent but poorly understood error [in surgical practice] is leaving sponges or instruments inside patients who undergo surgery. Such incidents may result in major injury... and are considered by many to be avoidable... The standards of the Association of Operating Room Nurses require that only sponges detectable on radiography be used and that they be counted once at the start and twice at the conclusion of all surgical procedures; that instruments be counted in all cases involving an open cavity; that if a count is incorrect then radiography or manual re-exploration is to be performed. We performed a case-control study to identify risk factors for retention of foreign bodies during surgery. Because these [errors] are avoidable and frequently injurious, many lead to malpractice claims and... most insurers encourage clinicians and hospitals to report them. Therefore, we used malpractice-insurance files from several institutions to identify cases." Modified Table 2 from the paper: Characteristics of patients with a retained foreign body Characteristic Female sex Counts of sponges and instruments performed Operation performed on an emergency basis Unexpected change in operation >1 surgical team involved Cases with a retained foreign body (n=54) n % 34 36 18 18 8 63.0 163 66.7 33.3 34.0 14.8 Control patients (n=235) n 161 181 16 21 17 161 235 181 235 16. 235 21 235 17 235 % 68.5 ==77.0 6,8 8.9 = 7.2 a. Write a hypothesis to describe what is being investigated in this study. (5 pts) b. What is the exposure (independent variable) in your hypothesis? (4 pts) c. What is the outcome (dependent variable) in your hypothesis? (4 pts) d. Fill in the table cells for the proportion (%) of control patients with each characteristic. (5 pts) Problem Set 1 Page 1 HCA 5483 e. What is the main advantage of comparing the proportions, rather than the number of cases and controls, for a particular characteristic? (4 pts) IF f. Using number and words describe the results from the table (e.g. for each characteristic, compare the proportions of cases and controls to describe the associations between the characteristics and risk of having a retained surgical sponge or instrument). (4 pts) Question 2, Streptococcus pneumoniae is a common cause of community-acquired pneumonia, meningitis, and bacteremia. Effective vaccines have now been developed against the most common disease-causing strains of S. pneumoniae. To quantify the burden of this disease prior to widespread vaccination, the Centers for Disease Control and Prevention (CDC) used data from one of their national surveillance programs to estimate the number of cases and deaths from invasive S. pneumoniae infection in the US in 1998. The figure below shows the distribution of these events by age group. n *Active Bacterial Core Surveillance (ABCs): http://www.cdc.gov/abcs/index.html Incidence (cases/100,000 pop) 180 160 140 120 100 80 60 40 20 5-17 18-34 Problem Set 1 Incidence 35-49 50-64 Age group, years 65-79 80+ 30 25 20 15 10 Case fatality rate (%) a. Use the figure to describe using numbers and words the trends in the distribution of invasive 5. pneumoniae disease incidence and case fatality rate by age group. (The case fatality rate is the proportion of deaths among diseased cases over a period of time.) (4 pts) b. Do the data in the figure suggest that there is an outbreak of S. pneumoniae cases? Explain the rationale for your answer. (4 pts) Page 2 Question 3. Please use PubMed to access the scientific abstract for each study listed below. Read the abstract (you do not need to copy/paste it into your homework assignment) and identify whether each study is a (1) descriptive or (2) scientific/analytic study. For the scientific/analytic studies, also list the exposure(s) and outcome(s) being evaluated. You can access PubMed on the Texas Woman's University Library Website, https://pubmed.ncbi.nlm.nih.gov/?holding-txuwxtlib_fft_ndi&otool-txuwxtlib; and then enter your TWU username and password. You can also access PubMed via http://www.ncbi.nlm.nih.gov/pubmed. Enter the author name and year in the PubMed search field and you will access the abstract. a. Biino G, Casula L, de Terlizzi F, Adamo M, Vaccargiu S, Francavilla M, Loi D, Casti A, Atzori M, Pirastu M. Epidemiology of osteoporosis in an isolated Sardinian population by using quantitative ultrasound. Am J Epidemiol. 2011 Aug 15;174(4):432-9. Epub 2011 Jun 27. (4 pts) b. Lu BB, Li KH. Association between ABO Blood Groups and Osteoporosis Severity in Chinese Adults Aged 50 Years and Over. J Int Med Res. 2011;39(3):929-33. (4 pts) c. Oyen J, Brudvik C, Gjesdal CG, Tell GS, Lie SA, Hove LM. J Bone Joint Surg Am. 2011 Feb 16:93(4):348-56.Osteoporosis as a risk factor for distal radial fra ARPA cantoral d http://www.ncbi.nlm.nih.gov/pubmed (4 pts) d. Looker AC, Melton LJ 3rd, Harris TB, Borrud LG, Shepherd JA. Prevalence and trends in low femur bone density among older US adults: NHANES 2005-2006 compared with NHANES III. J Bone Miner Res. 2010 Jan;25(1):64-71. (4 pts) Question 1. This question is based on a journal article that appeared in the New England Journal of Medicine: Gawande AA et al., "Risk factors for retained instruments and sponges after surgery." NEJM 2003;348:229-235. Excerpt from the Background section of the paper: "One persistent but poorly understood error [in surgical practice] is leaving sponges or instruments inside patients who undergo surgery. Such incidents may result in major injury... and are considered by many to be avoidable... The standards of the Association of Operating Room Nurses require that only sponges detectable on radiography be used and that they be counted once at the start and twice at the conclusion of all surgical procedures; that instruments be counted in all cases involving an open cavity; that if a count is incorrect then radiography or manual re-exploration is to be performed. We performed a case-control study to identify risk factors for retention of foreign bodies during surgery. Because these [errors] are avoidable and frequently injurious, many lead to malpractice claims and... most insurers encourage clinicians and hospitals to report them. Therefore, we used malpractice-insurance files from several institutions to identify cases." Modified Table 2 from the paper: Characteristics of patients with a retained foreign body Characteristic Female sex Counts of sponges and instruments performed Operation performed on an emergency basis Unexpected change in operation >1 surgical team involved Cases with a retained foreign body (n=54) n % 34 36 18 18 8 63.0 163 66.7 33.3 34.0 14.8 Control patients (n=235) n 161 181 16 21 17 161 235 181 235 16. 235 21 235 17 235 % 68.5 ==77.0 6,8 8.9 = 7.2 a. Write a hypothesis to describe what is being investigated in this study. (5 pts) b. What is the exposure (independent variable) in your hypothesis? (4 pts) c. What is the outcome (dependent variable) in your hypothesis? (4 pts) d. Fill in the table cells for the proportion (%) of control patients with each characteristic. (5 pts) Problem Set 1 Page 1 HCA 5483 e. What is the main advantage of comparing the proportions, rather than the number of cases and controls, for a particular characteristic? (4 pts) IF f. Using number and words describe the results from the table (e.g. for each characteristic, compare the proportions of cases and controls to describe the associations between the characteristics and risk of having a retained surgical sponge or instrument). (4 pts) Question 2, Streptococcus pneumoniae is a common cause of community-acquired pneumonia, meningitis, and bacteremia. Effective vaccines have now been developed against the most common disease-causing strains of S. pneumoniae. To quantify the burden of this disease prior to widespread vaccination, the Centers for Disease Control and Prevention (CDC) used data from one of their national surveillance programs to estimate the number of cases and deaths from invasive S. pneumoniae infection in the US in 1998. The figure below shows the distribution of these events by age group. n *Active Bacterial Core Surveillance (ABCs): http://www.cdc.gov/abcs/index.html Incidence (cases/100,000 pop) 180 160 140 120 100 80 60 40 20 5-17 18-34 Problem Set 1 Incidence 35-49 50-64 Age group, years 65-79 80+ 30 25 20 15 10 Case fatality rate (%) a. Use the figure to describe using numbers and words the trends in the distribution of invasive 5. pneumoniae disease incidence and case fatality rate by age group. (The case fatality rate is the proportion of deaths among diseased cases over a period of time.) (4 pts) b. Do the data in the figure suggest that there is an outbreak of S. pneumoniae cases? Explain the rationale for your answer. (4 pts) Page 2 Question 3. Please use PubMed to access the scientific abstract for each study listed below. Read the abstract (you do not need to copy/paste it into your homework assignment) and identify whether each study is a (1) descriptive or (2) scientific/analytic study. For the scientific/analytic studies, also list the exposure(s) and outcome(s) being evaluated. You can access PubMed on the Texas Woman's University Library Website, https://pubmed.ncbi.nlm.nih.gov/?holding-txuwxtlib_fft_ndi&otool-txuwxtlib; and then enter your TWU username and password. You can also access PubMed via http://www.ncbi.nlm.nih.gov/pubmed. Enter the author name and year in the PubMed search field and you will access the abstract. a. Biino G, Casula L, de Terlizzi F, Adamo M, Vaccargiu S, Francavilla M, Loi D, Casti A, Atzori M, Pirastu M. Epidemiology of osteoporosis in an isolated Sardinian population by using quantitative ultrasound. Am J Epidemiol. 2011 Aug 15;174(4):432-9. Epub 2011 Jun 27. (4 pts) b. Lu BB, Li KH. Association between ABO Blood Groups and Osteoporosis Severity in Chinese Adults Aged 50 Years and Over. J Int Med Res. 2011;39(3):929-33. (4 pts) c. Oyen J, Brudvik C, Gjesdal CG, Tell GS, Lie SA, Hove LM. J Bone Joint Surg Am. 2011 Feb 16:93(4):348-56.Osteoporosis as a risk factor for distal radial fra ARPA cantoral d http://www.ncbi.nlm.nih.gov/pubmed (4 pts) d. Looker AC, Melton LJ 3rd, Harris TB, Borrud LG, Shepherd JA. Prevalence and trends in low femur bone density among older US adults: NHANES 2005-2006 compared with NHANES III. J Bone Miner Res. 2010 Jan;25(1):64-71. (4 pts) Question 1. This question is based on a journal article that appeared in the New England Journal of Medicine: Gawande AA et al., "Risk factors for retained instruments and sponges after surgery." NEJM 2003;348:229-235. Excerpt from the Background section of the paper: "One persistent but poorly understood error [in surgical practice] is leaving sponges or instruments inside patients who undergo surgery. Such incidents may result in major injury... and are considered by many to be avoidable... The standards of the Association of Operating Room Nurses require that only sponges detectable on radiography be used and that they be counted once at the start and twice at the conclusion of all surgical procedures; that instruments be counted in all cases involving an open cavity; that if a count is incorrect then radiography or manual re-exploration is to be performed. We performed a case-control study to identify risk factors for retention of foreign bodies during surgery. Because these [errors] are avoidable and frequently injurious, many lead to malpractice claims and... most insurers encourage clinicians and hospitals to report them. Therefore, we used malpractice-insurance files from several institutions to identify cases." Modified Table 2 from the paper: Characteristics of patients with a retained foreign body Characteristic Female sex Counts of sponges and instruments performed Operation performed on an emergency basis Unexpected change in operation >1 surgical team involved Cases with a retained foreign body (n=54) n % 34 36 18 18 8 63.0 163 66.7 33.3 34.0 14.8 Control patients (n=235) n 161 181 16 21 17 161 235 181 235 16. 235 21 235 17 235 % 68.5 ==77.0 6,8 8.9 = 7.2 a. Write a hypothesis to describe what is being investigated in this study. (5 pts) b. What is the exposure (independent variable) in your hypothesis? (4 pts) c. What is the outcome (dependent variable) in your hypothesis? (4 pts) d. Fill in the table cells for the proportion (%) of control patients with each characteristic. (5 pts) Problem Set 1 Page 1 HCA 5483 e. What is the main advantage of comparing the proportions, rather than the number of cases and controls, for a particular characteristic? (4 pts) IF f. Using number and words describe the results from the table (e.g. for each characteristic, compare the proportions of cases and controls to describe the associations between the characteristics and risk of having a retained surgical sponge or instrument). (4 pts) Question 2, Streptococcus pneumoniae is a common cause of community-acquired pneumonia, meningitis, and bacteremia. Effective vaccines have now been developed against the most common disease-causing strains of S. pneumoniae. To quantify the burden of this disease prior to widespread vaccination, the Centers for Disease Control and Prevention (CDC) used data from one of their national surveillance programs to estimate the number of cases and deaths from invasive S. pneumoniae infection in the US in 1998. The figure below shows the distribution of these events by age group. n *Active Bacterial Core Surveillance (ABCs): http://www.cdc.gov/abcs/index.html Incidence (cases/100,000 pop) 180 160 140 120 100 80 60 40 20 5-17 18-34 Problem Set 1 Incidence 35-49 50-64 Age group, years 65-79 80+ 30 25 20 15 10 Case fatality rate (%) a. Use the figure to describe using numbers and words the trends in the distribution of invasive 5. pneumoniae disease incidence and case fatality rate by age group. (The case fatality rate is the proportion of deaths among diseased cases over a period of time.) (4 pts) b. Do the data in the figure suggest that there is an outbreak of S. pneumoniae cases? Explain the rationale for your answer. (4 pts) Page 2 Question 3. Please use PubMed to access the scientific abstract for each study listed below. Read the abstract (you do not need to copy/paste it into your homework assignment) and identify whether each study is a (1) descriptive or (2) scientific/analytic study. For the scientific/analytic studies, also list the exposure(s) and outcome(s) being evaluated. You can access PubMed on the Texas Woman's University Library Website, https://pubmed.ncbi.nlm.nih.gov/?holding-txuwxtlib_fft_ndi&otool-txuwxtlib; and then enter your TWU username and password. You can also access PubMed via http://www.ncbi.nlm.nih.gov/pubmed. Enter the author name and year in the PubMed search field and you will access the abstract. a. Biino G, Casula L, de Terlizzi F, Adamo M, Vaccargiu S, Francavilla M, Loi D, Casti A, Atzori M, Pirastu M. Epidemiology of osteoporosis in an isolated Sardinian population by using quantitative ultrasound. Am J Epidemiol. 2011 Aug 15;174(4):432-9. Epub 2011 Jun 27. (4 pts) b. Lu BB, Li KH. Association between ABO Blood Groups and Osteoporosis Severity in Chinese Adults Aged 50 Years and Over. J Int Med Res. 2011;39(3):929-33. (4 pts) c. Oyen J, Brudvik C, Gjesdal CG, Tell GS, Lie SA, Hove LM. J Bone Joint Surg Am. 2011 Feb 16:93(4):348-56.Osteoporosis as a risk factor for distal radial fra ARPA cantoral d http://www.ncbi.nlm.nih.gov/pubmed (4 pts) d. Looker AC, Melton LJ 3rd, Harris TB, Borrud LG, Shepherd JA. Prevalence and trends in low femur bone density among older US adults: NHANES 2005-2006 compared with NHANES III. J Bone Miner Res. 2010 Jan;25(1):64-71. (4 pts)