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PubMed1994

Environmental influences on methods used to collect dietary data from children.

When collecting dietary data on children, confidence about responses is required. Children exist in multienvironments in their everyday lives, eg, the personal, school, home, peer, medical care, media, food industry, and fast-food facility environments. These macroenvironments influence the format and type of data-collection methods used to interview today's youth. Researchers should identify the influence of each environment on the child's eating pattern and nutrient intake, explore the pros and cons of various data-collection methods amid these environments, and determine unresolved methodological issues to stimulate future research. Standardized protocols for interviewing children, exclusion criteria for surrogate responses, and currency of nutrient data for new food products available to children are needed. Redefining our methods by understanding the macroenvironments of youth can create a dietary methodology for the 21st century--an evolutionary method that builds on past research and incorporates current technology and societal changes.

Aging↗
PubMed1990

Paperless Poison Center: an alternative to bubbling.

The Paperless Poison Center (PPC) is a computer software program which allows for direct entering of data collection, data submission to the American Association of Poison Control Centers (AAPCC) and on-site analysis of data using RBASE. A comparison of the computer collection system vs bubbling of AAPCC sheets is discussed as to speed and ease of use, accuracy and cost. A summary of our comparison concludes that the computerized system is cost effective, more efficient, and more accurate than the paper method. Poison Information Specialist (PIS) acceptance of the program has been overwhelmingly positive.

Data Collection↗
PubMed1988

An approach to forecast aminoglycoside-related nephrotoxicity from routinely collected clinical data.

Routinely collected clinical data on 104 critically ill patients who had received an aminoglycoside (gentamicin or tobramycin) were evaluated using a proposed approach to forecast aminoglycoside-related nephrotoxicity. Observed steady-state peak and trough concentrations were greater than the respective predicted values when one-compartment model was assumed. This difference was particularly eminent for trough concentrations. The bias (difference between predicted and observed values) for trough concentrations was analyzed assuming tissue accumulation by an extended least-squares method to estimate population pharmacokinetics. The mean values for terminal half-life of gentamicin and tobramycin in patients who did not develop nephrotoxicity were estimated to be approximately 50 and 116 h, respectively. By using these values, the bias of trough concentration was found to be greater in patients who developed nephrotoxicity during or within 60 days after the therapy than in those who did not. Our results suggest that assessing the bias of steady-state trough concentrations of aminoglycosides can provide a useful index to forecast an aminoglycoside-induced nephrotoxicity.

Adolescent↗
PubMed1989

A comparison of response rate, data quality, and cost in the collection of data on sexual history and personal behaviors. Mail survey approaches and in-person interview.

The authors examined differences in rate of response, data quality, and cost between mail approaches and in-person interview in the collection of data on sexual history and personal behaviors. A sample of women from a midwestern United States university (n = 342) was identified from health service medical records as having been seen for a sexually transmitted disease (cases) or a contraceptive visit (controls) during the latter half of 1985. The women were randomly assigned to one of three data collection strategies. A total of 268 subjects (78%) participated. Results indicated no differences in validity by method of data collection or by case-control status but there were significant differences in completeness, cost, and response rates. In-person interviews resulted in more complete data than mail approaches, although all instruments had low proportions of missing data (0.001-0.006). Response rate differences were not found when data collection methodologies were compared (75-82%) but were found in case-control analyses. Cases were consistently less likely to participate and significantly less likely to respond by mail (p less than 0.05). The cost of the in-person interview was approximately four times that of the mail survey for the data collection. Implications of the case-control response rate difference suggest that mail methodologies, although low in cost, may introduce sampling bias in studies of sexually transmitted diseases.

Adolescent↗
PubMed2001

Exploiting the nursing minimum data set for the Netherlands.

The purpose of this overview is to examine and illustrate the feasible options for the statistical analysis of the Nursing Minimum Data Set for the Netherlands. Distinct purposes for information use and for the presentation of information require different approaches for data collection and data analysis. Several explorative studies are discussed, illustrating their goals, data collection methods, data analysis and results. The overview ends with general recommendations for data collection and analysis of nursing minimum data sets.

Data Collection↗
PubMed2000

401(k) plan asset allocation, account balances, and loan activity in 1998.

The Employee Benefit Research Institute (EBRI) and the Investment Company Institute (ICI) have been collaborating for the past three years to collect data on participants in 401(k) plans. This effort, known as the EBRI/ICI Participant-Directed Retirement Plan Data Collection Project, has obtained data for 401(k) plan participants from certain of EBRI and ICI members serving as plan record keepers and administrators. The report includes 1998 information on 7.9 million active participants in 30,102 plans holding nearly $372 billion in assets. The data include demographic information, annual contributions, plan balances, asset allocation, and loans, and are broadly representative of the universe of 401(k) plans. The database also includes three years of longitudinal information on approximately 3.3 million participants. Key findings include: For all 401(k) participants in the 1998 EBRI/ICI database, almost three-quarters of plan balances are invested directly or indirectly in equity securities. Specifically, 49.8 percent of total plan balances are invested in equity funds, 17.7 percent in company stock, 11.4 percent in guaranteed investment contracts (GICs), 8.4 percent in balanced funds, 6.1 percent in bond funds, 4.7 percent in money funds, and 0.3 percent in other stable value funds. Participant asset allocation varies considerably with age. Younger participants tend to favor equity funds, while older participants are more disposed to invest in GICs and bond funds. On average, participants in their 20s have 62.1 percent of their account balances invested in equity funds, in contrast to 39.8 percent for those in their 60s. Participants in their 20s invest 4.7 percent of their assets in GICs, while those in their 60s invest 20.6 percent. Bond funds, which represent 4.7 percent of the assets of participants in their 20s, amount to 9.0 percent of the assets of participants in their 60s. Investment options offered by 401(k) plans appear to influence asset allocation. For example, the addition of company stock substantially reduces the allocation to equity funds and the addition of GICs lowers allocations to bond and money funds. The average account balance (net of plan loans) for all participants was $47,004 at year-end 1998, which is 26 percent higher than the average account balance at year-end 1996. The median account balance was $13,038 at year-end 1998. The balances, however, represent only amounts with current employers and do not include amounts remaining in the plans of prior employers. The average balances of older workers with long tenure indicate that a mature 401(k) plan program will produce substantial account balances. For example, individuals in their 60s with at least 30 years of tenure have average account balances in excess of $185,000. The ratio of account balance to 1998 salary varies with salary, increasing slightly as earnings rise from $20,001 to $80,000, and falling a bit for salaries greater than $80,000. The increase in ratio likely reflects a greater propensity of higher-income participants to save, whereas the decline after $80,000 results from contribution and nondiscrimination rule constraints.

Adult↗
PubMed2006

Using personal digital assistants (PDAs) for the collection of safety belt use data in the field.

From 1975 through 2003, because of the use of safety belts, an estimated 180,000 deaths from traffic crashes have been prevented. In order to assess the gains that have been made in safety belt use across the U.S., in individual states, and in communities, belt use surveys are conducted at regular intervals to determine use rates. The most valid method for surveying safety belt use is through direct observation. Direct observation surveys are conducted along roadways by trained researchers looking into passing vehicles and recording safety belt use. This method of data collection has been effective in the past through the use of paper-and-pencil data recording, yet it could be improved through the use of electronic and communication technology. Reported here is a study designed to compare electronic data collection, using personal digital assistants (PDAs), with collection using the traditional paper-and-pencil method during the annual statewide survey of safety belt use in Michigan that we have been conducting since 1984. The goals of the study were to develop a PDA database program for data entry in the field, to directly compare the PDA data collection process with the paper-and-pencil method on both accuracy and speed, and to assess mechanical and environmental factors, such as battery life, screen visibility, and reaction to adverse weather, that may act as limitations to the PDA method, in comparison with the paper-and-pencil method. In a direct comparison of methods, two observers collected data at the same roadway intersections, one using paper and a pencil and one using a PDA equipped with our custom software. The study showed that the PDA method was as fast and as accurate as the paper-and-pencil method. There were no adverse effects on the PDA caused by environmental conditions. The PDA was superior to the paper-and-pencil method in rainy weather and for data collector supervision. In addition, the use of the PDA obviated the need for entry of paper-recorded data into an electronic format. We conclude that the use of PDAs for safety belt field data collection is superior to the paper-and-pencil method. A Web address is given where the custom PDA safety belt data collection software can be obtained free of charge.

Adolescent↗
PubMed2003

Substance use disorder comorbidity among inpatient youths with psychiatric disorder.

OBJECTIVE: Substance abuse/dependence has been reported to show significant association with psychopathology, and is likely to influence the course and outcome of psychiatric illness. The aim of this study was to determine the rate of substance use disorders (other than alcohol) comorbidity among inpatient adolescents with severe Axis 1 psychiatric disorder. METHOD: A retrospective analysis of systematically collected data was carried out. The subjects were 16-18-year-old youths, admitted to an inpatient unit for severe psychiatric disorder. The data collection process utilized the DSM-IV criteria for diagnostic categorization of psychiatric disorder and substance use disorder. Demographic data, and data on suicide attempts were also collected. RESULTS: Over a period of one year (March 2001-March 2002), 62 patients were admitted to the Christchurch Youth Inpatient Unit; 40 (64.5%) had a comorbid Substance Abuse Disorder (SAD) according to DSM-IV criteria and none had a Substance Dependence Disorder. The vast majority involved cannabis and stimulants. Sixty per cent of those with mood disorder, 63% of those with anxiety disorder and 80% of those with schizophrenia spectrum disorder had a comorbid SAD. Internalizing problems, especially mood disorders, pre-dominated among those with SAD reflecting the Unit's admission criteria. There were no differences in attempted suicide rates between those with SAD and those without SAD, but those with SAD were more likely to have unstable accommodation/living arrangements than those without SAD. CONCLUSIONS: Our findings confirm previous reports suggestive of high rates of SAD comorbidity among youth with severe psychiatric illness. There are clinical and process implications for these findings particularly identification of substance use disorders and their treatment as well as resource availability and staff training.

Adolescent↗
PubMed2003

Remote detection of heated ethanol plumes by airborne passive Fourier transform infrared spectrometry.

Methodology is developed for the automated detection of heated plumes of ethanol vapor with airborne passive Fourier transform infrared spectrometry. Positioned in a fixed-wing aircraft in a downward-looking mode, the spectrometer is used to detect ground sources of ethanol vapor from an altitude of 2000-3000 ft. Challenges to the use of this approach for the routine detection of chemical plumes include (1) the presence of a constantly changing background radiance as the aircraft flies, (2) the cost and complexity of collecting the data needed to train the classification algorithms used in implementing the plume detection, and (3) the need for rapid interferogram scans to minimize the ground area viewed per scan. To address these challenges, this work couples a novel ground-based data collection and training protocol with the use of signal processing and pattern recognition methods based on short sections of the interferogram data collected by the spectrometer. In the data collection, heated plumes of ethanol vapor are released from a portable emission stack and viewed by the spectrometer from ground level against a synthetic background designed to simulate a terrestrial radiance source. Classifiers trained with these data are subsequently tested with airborne data collected over a period of 2.5 years. Two classifier architectures are compared in this work: support vector machines (SVM) and piecewise linear discriminant analysis (PLDA). When applied to the airborne test data, the SVM classifiers perform best, failing to detect ethanol in only 8% of the cases in which it is present. False detections occur at a rate of less than 0.5%. The classifier performs well in spite of differences between the backgrounds associated with the ground-based and airborne data collections and the instrumental drift arising from the long time span of the data collection. Further improvements in classification performance are judged to require increased sophistication in the ground-based data collection in order to provide a better match to the infrared backgrounds observed from the air.

Air Pollutants↗
PubMed2005

Involvement of nurses in caring for patients requesting euthanasia in Flanders (Belgium): a qualitative study.

BACKGROUND: Although nurses worldwide are confronted with euthanasia requests, how nurses experience their involvement in euthanasia remains unclear. OBJECTIVES: To explore nurses' involvement in the care for patients requesting euthanasia. DESIGN: A qualitative grounded theory strategy. SETTING: Two general hospitals (A, B) and a palliative care setting in Flanders (Belgium). PARTICIPANTS: Nurses who fulfilled the following inclusion criteria: (a) Dutch-speaking; (b) working for at least one year in hospital A or B; (c) working at least part-time (50%); and (d) ever received a euthanasia request. We collected data using purposeful sampling, superseded by theoretical sampling in a palliative care setting. The sample included one intensive care nurse, one oncology nurse, eight palliative care nurses, and five internal medicine nurses. All but five were women. Their age ranged from 24 to 49 years. METHODS: We conducted one-on-one semi-structured interviews between November 2001 and September 2002. Grounded theory was applied for guiding data collection and analysis. The trustworthiness of data was ensured by several strategies. RESULTS: Although euthanasia was still illegal, the nurses unanimously stated that they had an important role in caring for patients requesting euthanasia. Their personal and intense involvement caused them to experience a spectrum of emotions, chief among them being a sense of powerlessness. Several elements contributed to the nurses' conflicted involvement. Nurses became frustrated if the context (e.g., lack of time) hindered their efforts to provide compassionate care. The palliative care setting and its associated culture (group mentality, care philosophy) created the opportunity for nurses to take time to holistically support patients and their relatives. CONCLUSIONS: Hospital nurses are confronted with patients' euthanasia requests. Each stage of this process requires that the nurses possess specific competencies. Their willingness to personally care for these patients, in addition to their specific care expertise, allows them to be skilled companions.

Adult↗
PubMed2002

The nature, extent and effects of emotional abuse on primary school pupils by teachers in Zimbabwe.

OBJECTIVE: The study seeks to determine the nature, extent and effects of emotional abuse; and who the perpetrators are in Zimbabwean primary schools. METHOD: Data collection was twofold because this involved reported cases of emotional abuse and the use of two questionnaires to collect data on the forms of emotional abuse perpetrated on pupils by teachers. First, data of reported cases of emotional abuse were collected from six regional offices of the Ministry of Education, Sport and Culture in Zimbabwe. The rationale was to determine forms of emotional abuse perpetrated on pupils by teachers in Zimbabwean primary schools. Second, the Teacher Trainees Questionnaire and the Teacher Questionnaire were administered to randomly selected samples of 150 primary school teacher trainees and 300 primary school teachers. Random numbers were used in the selection of the teachers and teacher trainees. The rationale for using teachers and teacher trainees was to make an in-depth analysis of the forms of emotional abuse perpetrated on pupils by teachers and to determine who the perpetrators are in this form of child abuse. In this study, emotional abuse shall refer to constant belittling of a pupil, the absence of a positive emotional atmosphere, verbal abuse, shouting, scolding, use of vulgar language, humiliation and negative labeling of pupils, and terrorizing of pupils by teachers in schools. RESULTS: The study found that the majority of teacher trainees and teachers believe that shouting, scolding, use of vulgar language, humiliation and negatively labeling of pupils as stupid, ugly, foolish is mainly done by female teachers in schools. However, 52.7% of the teacher trainees indicated that it is the male teachers who "use vulgar language on pupils." This study found some of the forms of emotional abuse that are perpetrated on pupils by teachers in schools. The findings seem to be consistent with the literature available on the gender of perpetrators associated with this form of child abuse. CONCLUSION: It is clear that emotional abuse exists in Zimbabwean primary schools and female teachers appear to be the main perpetrators of this form of child abuse. This form of child abuse may involve one perpetrator and a series of victims.

Child↗
PubMed1996

Rules for collection of clinical data: the eight Rs.

Many reports in medical journals give advice on statistical analysis of data collected in clinical studies. The terms used are statistical, and clinicians often ponder how their data stand up to these analyses. Eight simple, easy to remember words are suggested that will help clinicians both to interpret their own data and to assess the accuracy of presented or published data.

Data Collection↗
PubMed1993

Colorectal cancer in patients under 30 years of age. Contributors to the Southwestern Surgical Congress Unusual Case Registry.

The Southwestern Surgical Congress (SWSC) recently initiated a registry of unusual cases. The registry was created to collect information on patients with uncommon conditions treated by members of the Congress. The registry is intended to be a source of clinical information for the members, as well as a tool for the conduct of retrospective and prospective clinical and epidemiologic studies. As the first project, we collected data on patients with colorectal cancer who were 30 years of age or less at the time of diagnosis. Letters were sent to all members of the SWSC soliciting information about such patients. Data collection sheets were subsequently mailed to those who responded to the letter. The data sheets asked for demographic data, as well as pertinent anamnestic, clinical, and staging information. Operative reports, pathology reports, and paraffin-embedded tissue blocks were also requested. Twenty-four members contributed a total of 55 patients to the registry. There were 23 males (age range: 14 to 30 years) and 32 females (age range: 16 to 30 years). In 37 patients, factors assumed to predispose to colorectal cancer were identified. The most common predisposing factor was smoking. There were 12 right colon tumors, 24 left colon tumors, and 11 rectal tumors. According to the TNM classification, 6 patients had stage I disease, 15 patients had stage II disease, 17 patients had stage III disease, and 17 patients had stage IV disease. Tissue blocks from tumor and adjacent bowel will be examined to address the issue of a possible genetic predisposition for cancer at the molecular level, in these young patients. We will also assess the independent influence of age on prognosis by comparing the actuarial survival and recurrence rates in patients from the registry with data from older patients who are matched for the presence of other known prognostic factors. The Unusual Case Registry will provide the members of the Congress with a valuable database of clinical information. Furthermore, this method of compilation will facilitate the collection of relatively large patient samples over a short period of time. This will greatly facilitate the conduct of original and relevant collaborative prospective studies of uncommon diseases within the framework of the SWSC.

Adolescent↗
PubMed2004

Liver transplantation in cirrhotic patients with small hepatocellular carcinoma: an analysis of pre-operative imaging, explant histology and prognostic histologic indicators.

BACKGROUND: In recent years, liver transplantation in patients with hepatocellular cancers and cirrhosis has been restricted to those with small cancers (<5 cm for solitary and <3 cm for multifocal HCC with <3 nodules). The selection of patients for liver transplantation is based on pre-operative imaging. The accuracy of imaging correlated with explant histology and the effect of tumour stage has not been evaluated in this selected population. METHODS: In this study, prospectively collected data for 30 patients who underwent orthotopic liver transplantation for cirrhosis complicated by small hepatocellular carcinoma (HCC) at a single centre have been reviewed with the aim of correlating radiological findings, explant histology and patient outcome. Patients who underwent orthotopic liver transplantation between 1995 and 1999 had plain and contrast-enhanced dual-phase spiral CT (DCT) scans of the liver. Patients suspected of having HCC on CT scan or due to elevated serum alpha-fetoprotein underwent iodized oil CT (IOCT). Following transplantation, the explanted liver was serially sectioned at 10-mm intervals and examined by a pathologist blinded to the results of imaging. Data collected prospectively on imaging and histology were compared with outcome data. The median period of follow-up was 1,139 days (range 690-1,955 days) after transplantation. All patients were followed up by clinical assessment, assessment of serum alpha-protein levels and imaging when indicated. RESULTS: All the patients transplanted fulfilled the selective criteria on the basis of imaging (solitary HCC <5 cm in diameter or multifocal HCC <3 cm in diameter with <3 nodules). Of the 30 patients transplanted, 46 HCCs were detected on explant histology with a median size of 24 mm (range 6-75 mm). Ten patients had multifocal disease (median number of lesions 2, range 2-4). No significant difference was observed between IOCT and DCT with regards to the sensitivity (67.4 vs. 68%) and specificity (78.97 vs. 88.6%) of detecting HCCs. IOCT had a positive predictive value of 78.9% as compared to 82.8% for DCT. IOCT had an overall sensitivity of 40% as compared to 30% for DCT in detecting multifocal disease (not significant). Histological assessment of the explanted livers showed that 8 patients had well-, 17 moderate and 5 poorly differentiated HCCs. Tumour size and the presence of multifocal disease did not influence survival in this study. Microvascular invasion was more common with larger tumours (from 38% with lesions less than 40 mm in diameter to 60% with lesions >40 mm in diameter; p < 0.01) and with moderately (29.4%) or poorly differentiated (60%) HCCs than well-differentiated HCC (12.5%) (p < 0.04 and 0.01 for well- vs. moderately and poorly differentiated HCC, respectively). Microvascular invasion on explant histology was associated with poor survival. Of the 17 transplant recipients without vascular invasion, 15 were alive at 1 and 2 years in comparison to 7 of 9 with microscopic vascular invasion (p < 0.01). Four patients died in the post-transplant period due to recurrent HCC. Overall survival [after excluding early post-transplant sepsis-induced deaths (n = 4)] at 1 year was 83.3%. CONCLUSIONS: Selective criteria for transplantation of HCC in cirrhosis are associated with a 1-year and 3-year survival rate of 73.3% (including early post-transplant sepsis-induced deaths). IOCT and DCT are similar in their ability to detect unifocal or multifocal HCC. Tumour size and number are not predictive of recurrence with these selective criteria, but microscopic vascular invasion is a bad prognostic factor.

Carcinoma, Hepatocellular↗
PubMedDate not supplied

[Collection of familial data in pharmacogenetics. Methodological problems].

The purpose of this paper is to show the problems with family data collection in a pharmacogenetic study, the aim of which was to study the genetic polymorphism of inducibility of cytochromes P4501A by polycyclic aromatic hydrocarbon (PAH). Data were collected from 76 smoker nuclear families (315 volunteers). A caffeine test, a blood sample and answers to a questionnaire were obtained from each healthy volunteer. It was a crucial problem to recruit nuclear families with healthy smoker father and/or mother and 2 smoker children. On 127 answers, 22 families were not eligible, 27 refused and 10 had a single child, that meant secondary refusals. Problems differed with origin of the recruitment. Included were 40 families obtained from 3 antismoking outpatient departments, 29 from general practitioners but 6 only from students. The family rates with 2 parents/2 children were significantly higher with general practitioners (p < 0.01). This emphasized their part in epidemiologic studies. Problems with the use of methodology were bound to acceptability of the tests which were better in females (p < 0.05), and a change in caffeine form could improve this acceptability. Lastly, difficulties with laboratories constraints required a very good coordination between families, nurses and laboratories.

Cytochrome P-450 Enzyme System↗
PubMed1995

Instrumentation for automated determination of protein stability.

A new instrument system has been developed that automatically carries out solvent and thermal denaturations of proteins using fluorescence as a probe of structure. This instrument also automatically performs pH titrations and can make kinetic measurements on the time scale of seconds. The design philosophy and implementation are described. The prototype instrument was subjected to extensive testing. The instrument can very reproducibly and accurately collect data that allow the calculation of the thermodynamics of protein denaturation. This data collection can proceed without human intervention after acquisition start until the data are saved.

Guanidine↗
PubMed1990

The efficiency of two-phase designs in prevalence surveys of mental disorders.

A two-phase survey of mental disorders uses a screening test to identify possible cases, thereby reducing the resources devoted to interviewing those not having the condition of interest. It is demonstrated using a mathematical model that in situations likely to be encountered in practice a two-phase design may lead to an increase in the efficiency of prevalence rate estimation, and also to an improvement in the efficiency of case detection. However, in certain applications the modest gain in efficiency may not warrant the additional complexity of a two-phase approach to data collection. Data from a survey of mental disorders in Edmonton, Canada, which collected information on 3258 community residents using the Diagnostic Interview Schedule and the General Health Questionnaire, are used to demonstrate how two-phase methods would have changed the efficiency of an actual survey.

Adult↗
PubMed1999

Application of mortality prediction systems to individual intensive care units.

OBJECTIVE: To evaluate the predictive accuracy of the severity of illness scoring systems in a single institution. DESIGN: A prospective study conducted by collecting data on consecutive patients admitted to the medical intensive care unit over 20 months. Surgical and coronary care admissions were excluded. SETTING: Veterans Affairs Medical Center at Buffalo, New York. PATIENTS AND PARTICIPANTS: Data collected on 302 unique, consecutive patients admitted to the medical intensive care unit. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Data required to calculate the patients' predicted mortality by the Mortality Probability Model (MPM) II, Acute Physiology and Chronic Health Evaluation (APACHE) II and Simplified Acute Physiology Score (SAPS) II scoring systems were collected. The probability of mortality for the cohort of patients was analyzed using confidence interval analyses, receiver operator characteristic (ROC) curves, two by two contingency tables and the Lemeshow-Hosmer chi-square statistic. Predicted mortality for all three scoring systems lay within the 95 % confidence interval for actual mortality. For the MPM II, SAPS II and APACHE II, the c-index (equivalent to the area under the ROC curve) was 0.695 +/- 0.0307 SE, 0.702 +/- 0.063 SE and 0.672 +/- 0.0306 SE, respectively, which were not statistically different from each other but were lower than values obtained in previous studies. CONCLUSION: Although the overall mortality was consistent with the predicted mortality, the poor fit of the data to the model impairs the validity of the result. The observed outcome could be due to erratic quality of care, or differences between the study population and the patient population in the original studies. The data cannot be used to distinguish between these possibilities. To increase predictive accuracy when studying individual intensive care units and enhance quality of care assessments it may be necessary to adapt the model to the patient population.

APACHE↗